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Dr. Pauline Chen is a transplant surgeon and hence highly trained in the surgical care of desperately ill patients. She found, however, that although she had intensive and first rate training, time and again the message she received from her mentors and peers encouraged a distance from frank discussions about dying with patients who were clearly dying. Dr. Chen successfully suppressed her urges to reflect on the meaning of illness and death. Years into her training, she finally witnessed an attending surgeon stay with a patient and the patient's wife until the patient passed away. The widow sent a thank you note to Dr. Chen for allowing a "dignified and peaceful death." (p. 101) Chen notes that observing her attending stand with the patient during death changed her profoundly: "...from that moment on, I would believe that I could do something more than cure. This narrative, then, is my acknowledgment to him." (p. 101)

Final Exam chronicles Chen's journey from medical student to attending surgeon and examines her experiences with death and serious illness - of patients, family members, friends. The memoir contains three parts: Principles, Practice, and Reappraisal - each with three chapters. The book is chronologically arranged, beginning with anatomy dissection at the start of medical school and ending with Chen as an attending arranging for hospice, thus honoring a patient's desire to die at home rather than in hospital. Chen skillfully weaves her stories around commentary on the social, cultural and philosophical issues surrounding death and the medical response to death. An introduction and epilogue bookend the text and 46 pages of extensive notes and bibliography complete the book.

Although Chen claims to have slowly and painfully awakened to the fact that patient needs extend well beyond good technical care, in fact one sees Chen emerge as a caring physician even from her initial patient contacts in medical school. Chen speaks more to her role as an Asian-American than to being a woman in a male-dominated field, but she clearly has what it takes to succeed in this extremely competitive field, including a good dose of compulsiveness and an incredible work ethic.

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In 1921, the twenty-four year-old Scottish medical graduate, Andrew Manson, takes up an assistant’s position in a small Welsh mining town. He is idealistic, but he quickly learns that his training is inadequate and that his hemiplegic employer will never return to practice. Manson must do all the work for a pittance and bad food. He befriends another assistant, the surgeon Phillip Denny, whose fatal flaw is devotion to drink. Together they solve the town’s problem with typhoid by blowing up the sewer.

Manson’s escape comes in a new job in a larger town and marriage to the equally idealistic Christine. She encourages him to continue his studies and to conduct research on the relationship between dust inhalation and tuberculosis. The results include higher degrees and international recognition, but they also bring about the wrath of the town’s antivivisectionists. To add to the gloom, Christine looses a much wanted pregnancy and the ability to have children.

The Mansons leave Wales for London, where Manson hopes to extend his research within a government agency. Quickly disillusioned by bureaucracy, he is lured into society practice and slowly abandons his ideals in exchange for prestige and wealth. Christine is increasingly unhappy, but his response is annoyance with her and an affair with a married woman. When one of his new associates botches an elective operation on a trusting patient, he realizes the colleague is nothing more than a society abortionist and that he and his new friends are little better.

He decides to sell his practice and renews contact with Denny to establish a group consulting practice "on scientific principles" in a carefully chosen Midland town. He also helps the tubercular daughter of an old friend to an unorthodox (but effective) pneumothorax in a clinic run by Stillman, an American who does not have an MD. Just as he and Christine have rediscovered joy in each other and their future together, she is killed in a freak accident. Only days later in the depths of grief, he is brought before the General Medical Council on charges of unprofessional conduct laid by his former associates. He acquits himself brilliantly and leaves with his old friend Denny for work in the Midlands.

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This documentary film is narrated by Dustin Hoffman; all other characters play themselves. Five stories (pathographies) introduced as panels from the 14-acre AIDS quilt are interwoven with each other, together with personal photos, newsreels and radio reports to recount the history of the first decade of AIDS in the United States.

Tom was a highly educated and athletic, gay man whose story is told by his lesbian friend and co-parent of his adored little daughter. Rob was a married Afro-American, I.V.-drug-user whose loving wife recounts his battle with drugs as well as his disease and who views her own HIV seropositivity as "God’s will." Jeff’s story is told by his grieving male lover over images of his once golden health.

The parents of twelve-year-old hemophiliac, David, tell the story of his entire life as a rush to consume, from his babyhood forward until the sadness of his last Christmas. The shy, handsome architect, David, is mourned by his bisexual lover, a naval officer at the Pentagon, who now lies dying with the lesions of Kaposi’s sarcoma quite visible on his face.

The narrators describe solace they derived from quilting memorial panels for their loved ones. In the final scene, the AIDS quilt lies on the Mall in Washington as names of hundreds of loved ones are read by grieving families and friends.

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Living in Bombay, India, Sera (Souad Faress) and Sam (Khodas Wadia), a beautiful Parsee couple who adore dancing, have a son (Firdaus Kanga) who will never grow and never walk because he has osteogenesis imperfecta (brittle bone disease). They name him Brit, for his bones. As narrator, Brit says that Sera suffers from the "Parsee disease of anglophilia." But she accepts Brit’s disability.

His father, however, does not; and he continuously appeals to magic, folklore, and religious healers, hoping to find a cure. He professes love for his son, but is never able to forge a confident bond. Brit does not fail to criticize. Sam’s quest leads to a woman scholar who nurtures the boy’s intelligence and encourages him to write a diary and short stories.

Brit’s older sister is his staunchest ally and best friend, but she eventually must leave for a marriage in America. Sam escorts his daughter to America, where he commits suicide on Fifth Avenue. Brit and his mother come to rely heavily on a widow friend and her deaf daughter, "promised" to Brit in childhood.

But the girl is soon spirited away on a wave of romanticism into a life of prostitution. They take a boarder, Cyrus, a gifted and handsome law student who offers Brit a new world of night life, action, dancing, and physical affection; his love leads Brit to like and accept his own body. When his mother dies, Brit becomes a writer and finds a new life and a new lover.

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Idealistic, nervous, and rigid, Andrew Manson (Robert Donat) takes his first medical job as an assistant to a doctor in a Welsh mining community. The greedy wife of his invalid employer obliges Manson to hand over most of his earnings. But he finds a local kindred spirit in the outspoken Dr. Denny (Ralph Richardson). In a drunken prank, they blow up the town sewer forcing the unwilling government to repair a notorious source of typhoid.

Manson marries a beautiful school teacher (Rosalind Russell) who leaves her beloved classroom to follow him to an even larger mining town. There he is employed by a group practice run on a capitation basis by the miners. In their evenings, the Mansons investigate the problem of chronic cough in miners, linking it to tuberculosis and coal dust--a discovery that they publish. But suspicious miners destroy their laboratory and force them to London and poverty.

A chance encounter with a wealthy hysteric and an old mate (Rex Harrison) raises Manson’s social standing. He opens a Harley Street practice and makes a fortune. His wife regrets the loss of his ideals and the death of his research. She begs him to remember how happy they were in poverty when each day was a noble challenge to take "the citadel" of life. Denny returns to entice Manson into a new group practice funded by community insurance, but Manson flatly refuses. Denny’s accidental death and a blunder by an elite, unethical Harley Street surgeon bring Andrew back to his idealistic senses.

The film closes with his eloquent self defense against charges of irregular practice for having intervened (successfully) in the case of a little girl with tuberculosis. Manson assists as the child is treated gratis with the controversial new pneumothorax operation administered by an American who does not hold a medical degree. Whether or not Manson keeps his license, the audience is confident that his sense of purpose has been restored and that his wife loves him more than ever. He will return both to the comfortably compatible pursuits of research and serving the sick poor.

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As the two physician-authors suggest, this book is kind of a primer for medical educators who plan to integrate medial humanities materials and approaches into curricula for healthcare providers and trainees. It is a "how-to" manual for teaching medical humanities content to clinicians.

The book's Introduction asks "why use the arts In medical education?" and identifies their utility in understanding the patient's unique and personal experience of illness, and the effects of  patients' social locations and psychological responses to their disease and to the healthcare professionals who care for them. And further, the arts offer a way for healthcare professionals to explore and reflect emotionally on their personal interactions with patients, to think creatively and practice empathetically.

The next chapter provides a model of "how to teach the arts" using a non-didactic, interactive approach as a series of questions around the work of art. Illustrative examples are included at each step. In the subsequent chapters, each focuses on an individual art forms-- literature, visual art, sculpture, photographs, music and drama-- with specific examples, exercises and activities for learners that have been piloted by the authors. For the music chapter, a CD with examples is included.

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In a fascinating and wide-ranging series of chapters organized by categories of disease or disability that have afflicted known artists, writers, and musicians, Sandblom examines the multifaceted relationship between creative work and illness. He begins his discussions of particular artists usually with basic information about the nature of the affliction and its manifestations; where available, introduces the artist’s own comments upon his or her condition; and then analyzes how particular works represent or implicitly allude to the illness. In some cases the disease is a context; in others a theme; in others a vehicle or tenor of metaphor.

The book is richly illustrated with reproductions of paintings, parts of musical scores, and poems or prose excerpts. Artists and writers under discussion include Bacon, Beethoven, Jorge Luis Borges, the Brontes, George Gordon Byron, Cezanne, Anton P.Chekhov, Chopin, Emily Dickinson, F. (Francis) Scott Fitzgerald, Johann Wolfgang von Goethe, Nathaniel Hawthorne, Franz Kafka, John Keats, Mahler, Thomas Mann, Herman Melville, John Milton, Flannery O’Connor, Proust, Rainer Maria Rilke, William Shakespeare, Robert Louis Stevenson, Titian, John Updike, William Wordsworth, and Yeats, to name a few.

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Although doctors have told her that things will get better, Jyl’s odds of surviving cancer are only five percent. She lives alone in a mountain cabin and receives cancer treatments at the hospital in town. She sleeps much of the day. “Her intestines had been scalded, cauterized as if by volcanic flow” [p 67], and Jyl continues to experience problem with digestion. She feels fatigued and is easily short of breath.

Her closest neighbors are the Workman’s, a Christian fundamentalist family of seven. They live miles away in a mountain valley near the creek. Without telephone, electricity, or indoor plumbing, they live off the land and toil day and night. Jyl starts carving small boats toting messages to send down the creek for the Workman children to find. Soon 15-year-old Stephan and 7-year-old Shayna visit Jyl. The two children bring her food that the Workman’s have hunted and gathered. They cut and stack firewood for the recluse. Jyl teaches them about geology and gives them small gemstones that her father had collected. The children’s visits revitalize the ill woman.

When Stephan and Shayna do not return to see her, Jyl is overcome by loneliness. She acknowledges that being alone is far worse than any aspect of her disease and treatment. Jyl makes the difficult trek to the Workman’s property to call on the children but finds that the place is deserted. Nothing remains in their boarded-up cabin except a stack of the small boats that she had crafted. Jyl sits outside their cabin and cries. The falling snow and silence envelop everything.          

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In the poem, persimmons are a symbol of several elements that have figured importantly in this Chinese narrator's life: they stand for painful memories of cultural barriers imposed by language and custom, and for a present-day loving connection to an elderly, blind father. The poet begins with a schoolboy incident in which he was punished for not knowing the difference between "persimmon" and "precision" and makes a play on other words which sound similar and "that got [him] into trouble." He takes revenge later, when the teacher brings to class a persimmon that only the narrator knows is unripe, as he "watched the . . . faces" without participating. Persimmons remind him of an adult sensual relationship with Donna, a Caucasian woman, and of his attempts to teach her Chinese words which he himself can no longer remember.

The second part of the poem describes the role persimmons have played in his father's life and in their relationship. To comfort his father, gone blind, the narrator gives him a sweet, ripe persimmon, so full and redolent with flavor that it will surely stimulate the senses remaining. Later yet again, the father and he "feel" a silk painting of persimmons, "painted blind / Some things never leave a person."

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This short poem is about work--all kinds of work--and what it takes out of us--physically, emotionally, spiritually: "All the work / that makes love difficult . . . that reaches the intestines and sprawls."

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