Summary:

Max, who has lost his wife after a long life and career together as circus acrobats, reluctantly retires to an assisted living home. There he finds unexpected friendship first in his neighbor, Lettie, a widow who has a gift for uncomplicated kindness, and Alison, a thirteen-year-old he meets when he gives juggling and stunt lessons at the local junior high. The unhealed ache of his wife's slow death from cancer makes Max skittish about opening his heart to either of them, though Lettie offers him patient companionship and Alison, full of adolescent restlessness, unfocused intelligence, and need, desperately wants something of the grandfatherly good humor and wit she finds in Max.

Alison's mother is pregnant with a long-delayed second child and the distance she feels from her parents drive her to lengthy novel-writing and to rather pushy efforts to make Max her special friend. For him, she learns to juggle. She cuts class to visit him, and to go out for sodas with Lettie. Alienated from peers she finds silly, the old people touch a place in her that needs love. After a heart attack, Max comes home with newly raised defenses, and retreats from the budding friendship with both women.

But when Alison runs away to a circus he refused to attend with her, and then to Penn Station, Max goes with her parents and finds her on a hunch. Found, she clings to him like a small child, and he finds himself full of a long-resisted love. On the way home, however, he succumbs to a heart attack. In the final chapter, Lettie helps Alison begin the long, difficult process of accepting mortality, grief, and the possibility of eventual healing from a loss of a kind she finds herself still unable fully to articulate to anyone she believes will understand.

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A woman with breast cancer describes dealing with doctors and medical procedures, from facing "embarrassing questions" to the finality of the mastectomy itself. She copes passively with the procedures by escaping into a fantasy world; but when it is time for the doctors to remove her breast, she assumes an active role and "[gives] it to them."

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Written with controlled elegance, this is an absorbing autobiographical account of psychiatric hospitalization. Twenty-five years after the fact, the author describes the two years during her late adolescence in which she "slip[ped] into a parallel universe." The surreal nature of the experience is reflected in darkly comedic recollections of her inner life, the other patients, their families, the staff, and of forays into the outside world.

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This story takes place on a drive home to the country from a medical appointment in town. Jinny has cancer and is on chemotherapy; she feels unwell and wears an uncomfortable hat because she has lost her hair. Her visit to the doctor ends with disconcerting news, but her husband, Neal, seems uninterested. In a supposed effort to be cheerful, he plays up to Helen, the young woman whom they are taking home to help while Jinny is ill. She senses that Neal will have a life and loves beyond her existence.

In the van, Neal becomes obsessed with teasing Helen about a forgotten pair of shoes; over her objections, he insists on picking them up from friends. Neither the girl nor Jinny are eager to visit this place, which turns out to be a bleak trailer-home surrounded by unfriendly dogs and occupied by a garrulous, obese couple that invite them to visit. Jinny just wants to go home and stays in the van, but Neal ignores her wishes and goes inside for a beer, which extends into a meal.

The teenage son, Ricky, returns to find Jinny waiting. More sympathetic than anyone else has been that day, he offers to drive her home. She surprises herself by leaving with Ricky at the wheel of Neal's van and by not caring what the others might think. He chooses a back-road that passes over a floating bridge. They stop. The dusk turns to dark and the stars emerge over dark water; exquisite beauty in a simple spot.

Jinny suddenly realizes that she has been without her hat all the while. The lad then kisses the much older woman. He admits it is the first time he has kissed a married woman; she tells him it will not likely be the last, and, soberly, he agrees. The tiny adventure of betrayal--an innocent form of sexual retaliation against her husband--brings a sense of hilarity, self-worth, and well being "for the time given."

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A Woman Dead In Her Forties is divided into eight sections, each consisting of between 5 and 10 stanzas, which vary in length from 1 to 4 lines. The poem explores bereavement due to breast cancer (perhaps of one woman, perhaps of many--and perhaps there is no difference); it also interrogates the privacies of loss. One of the tensions in the poem is between what is said and what cannot be said, both for those who are ill and those who are not, those who have died and those left behind. This is expressed in the half-conversations and snippets of memory in the narrative, as well as in the form of the poem itself with its pauses, staccato jumps, and prolonged caesuras.

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The novel is set in a small, Southern town. Velma Henry, a long-time civil rights activist and feminist, sits in a hospital gown on a stool listening to the musical voice of Minnie Ransom. Old Minnie is a healer; she heals people by contacting the points of physical or psychical pain in her patients and relieving them. She is helped by her spirit guide, Old Wife. Scars heal and wounds close in minutes under her touch.

Velma needs her help because she has just tried to kill herself, sick of the painful fight for change that never comes. Her healing takes a long time, for Minnie must first convince her that she wants to be cured. The two are surrounded by tourists, doctors, and passers-by. They are in a clinic that focuses on traditional medicines of all kinds. The novel describes the inner-healing process of Velma, the efforts of Minnie and the thoughts of people looking on or associated with the scene.

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George, a strong introverted African-American man and Guilio, a delicate and flighty Italian man, have been lovers for many decades. Guilio's deteriorating heart condition strains their relationship. Guilio is haunted by childhood death fantasies and George becomes frustrated trying to help him to deal with his illness and his fears. In the end, however, George is comforted by Guilio, who has sensed his pain and grief over being the surviving partner.

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This AIDS play removes "the fourth wall" of a waiting room at an HIV clinic. Using numerous scenes the audience is able to sense how over a period of time a group of strangers thrown together by circumstance "travel the way to friendship, and, finally to family." (from author's note) Juxtaposed through the characters in this play are boundary issues dealing with differences and similarities among gay/straight, rich/poor, black/white, sick/healthy responses to HIV/AIDS.

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This documentary, narrated alternately by the daughter-filmmaker and mother whose stories it tells, focuses on how two women move apart and together while experiencing, respectively, adolescence and mid-life. The mother has cancer, a mastectomy, and then rheumatoid arthritis, and these experiences intertwine thematically and structurally with the narrative of the mother-daughter relationship.

Another provocative juxtaposition cross-cuts scenes from the daughter's modeling career (and the social and erotic body that context constructs for her) with scenes of the mother's illness, stigmatization, and erotic daydreams. Both women come to a new awareness of the social meaning of mastectomy within heterosexual and same-sex contexts by the documentary's end; they also come to a place of recognition of the mother's personal and social value and the nature of their relationship.

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This is an ambitious and far-ranging book, the result of years of thinking, teaching, and working with patients. An internist at the College of Physicians and Surgeons at Columbia University, Charon sees a wide range of patients in an urban setting. Also a Ph.D. in English literature, Charon has devised a "Parallel Chart" and other means for caregivers to write personally about the dynamics between healer and patient, to read texts--narratives in particular--and, as a result, to listen better to patients, thus improving the delivery of medical care.

Charon defines narrative medicine as "medicine practiced with these skills of recognizing, absorbing, interpreting, and being moved by the stories of illness" (4). She calls this a "new frame" for medicine, believing that it can improve many of the defects of our current means of providing (or not) medical care. Caregivers who possess "narrative competence" are able to bridge the "divides" of their relation to mortality, the contexts of illness, beliefs about disease causality, and emotions of shame, blame, and fear.

Charon finds that medical care and literature share five narrative features; she argues that careful reading of narratives builds skills that improve medical care, including intersubjectivity between caregiver and patient, and ethicality. Beyond the theory, there are powerful and persuasive examples of interactions between caregiver and patient, many from Charon's own practice. A mother of a sick daughter experiences stress that makes her ill; when she sees a narrative connection, she begins to heal.

Charon sees wider applications. As caregivers understand better concepts of attention, representation, and affiliation, they become more ethical, more community minded, and better healers to their patients. Patient interviews will be different: instead of following a grid of questions, physicians will converse with patients in an open-ended way. What is most important will emerge and emerge in ways that are most beneficial to the patient. Yes, this method will take more time but it will be more efficient in the long run. Bioethics, Charon argues, has been limited by legal approaches and philosophical principles. For her, narrative bioethics offers more human values in how people feel, experience reality, and relate to each other. Finally, there are implications for social justice: why are the poor underserved in this country and in many others?

One of the most exciting and radical formulations comes late in the book: ". . . practitioners, be they health care professionals to begin with or not, must be prepared to offer the self as a therapeutic instrument" (p. 215). This notion links up fruitfully with concepts of energy medicine (v1377v), therapeutic touch (Tiffany Field), and intentionality (Wayne W. Dyer).

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