Summary:

This book concerns the care of dying persons. Hospice care provides a multidisciplinary approach to caring for the whole person, including his or her physical, emotional, social, and spiritual needs. Often, however, discussion about hospice or palliative care tends to focus almost exclusively on relieving physical symptoms. Kearney tells us a number of dying patients' stories. Some die at peace, in seeming fulfillment. Others die in great distress, with what Kearney calls "soul pain," a deep existential anguish that is not relieved by symptom control or social support.

Kearney proposes two complimentary models to describe what occurs in dying persons whose "soul pain" is relieved. For the first, he recounts the Greek myth of Chiron. The wise centaur Chiron suffered from an incurable arrow wound inflicted by Hercules. Chiron learned that if he would be willing to sacrifice his immortality on behalf of Prometheus, he would be freed from his suffering. After he did this and descended into the underworld, Zeus raised him to the heavens, where he became a constellation.

Thus, the mythological model has a hero who is wounded, struggles, makes a choice, then descends into the depths, and finally returns transformed. The second, psychological model portrays the mind as having a surface rational part (where the ego resides) and a deep symbolic and intuitive part (where the "deep center" resides). The relief of "soul pain" lies in choosing to reject the ego's resistance and "letting go" to get in touch with the deep center.

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This is the third novel in Pat Barker's trilogy about a group of shell shocked soldiers in World War I who are treated by Dr. William Rivers at Craiglockhart War Hospital. The protagonists include historical characters like Dr. Rivers (1864-1922), an eminent psychiatrist and anthropologist, and the poets, Siegfried Sassoon (1886-1967) and Wilfred Owen (1893-1918), as well as fictional creations, like Lieutenant Billy Prior, a working class man elevated to the position of British officer.

As The Ghost Road begins, Prior has been cured of shell shock and is preparing to return to the front in France. Rivers takes care of his patients and his invalid sister, amid memories of his experience ten years earlier on an anthropological expedition to Melanesia (Eddystone Island). He befriended Nijiru, the local priest-healer who took Rivers on his rounds to see sick villagers and also to the island's sacred Place of the Skulls.

Rivers entertains very un-British thoughts about the morality of these headhunting people, and about the power of symbolic healing. As these thoughts intrude upon his consciousness, Rivers is himself in the process of curing by suggestion a soldier with hysterical paralysis. Meanwhile, Billy Prior returns to the front. It is the autumn of 1918 and the last inhuman spasms of the war are in progress. In a futile battle that takes place a few days before the Armistice, Billy and his friend Wilfred Owen are killed.

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This is a personal narrative by one of America's most accomplished authors. For the past thirty years Reynolds Price has written novels, stories, poems, essays. In this memoir Price describes his battle with a spinal tumor detected in 1984 which left him with some neurological impairment. He struggled with his own rehabilitation and eventually recovered with the aid of biofeedback and hypnosis.

The most compelling part of the book is near the end. The author muses about the meaning of his illness, "advice I'd risk conveying to a friend confronted with grave illness or other physical or psychic trauma" (p.182). He puts the travails of life into a philosophical perspective that is almost Zen-like.

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Dr. Jonathan Hullah writes a memoir of his life in response to a young reporter who questions him about the death, years ago, of an old Anglican priest during Good Friday services. The tale unfolds of three schoolboy friends in Toronto before the Second World War: Brocky Gilmartin, who becomes a noted professor of literature; Charlie Iredale, who enters the Anglican priesthood; and Hullah himself, who begins as a police surgeon and later becomes a practitioner of his own unusual brand of psychosomatic medicine.

The central image of this story is the sudden death of Father Hobbes, the saintly vicar of St. Aidan's Church. Soon after Hobbes' death, the curate Charlie Iredale leads a movement to declare the elderly priest a saint. This movement is aborted by the bishop and Iredale, his vision crushed, goes on to become an itinerant (and alcoholic) clergyman in rural Ontario.

The central story though is that of Dr. Hullah, the "cunning man" who learns that healing is not just a matter of the body, but also the mind and spirit. He practices a type of "holistic" health care that the Canadian medical authorities find very suspicious. Yet, he is quite successful in his work, serving as physician-of-last-resort for many patients who have not been helped by other doctors.

The "cunning man" is a listener; he seems to stay on the outside, observing carefully, but revealing little of himself. In these memoirs he gradually reveals his rich experience and complex character. Only at the very end, however, does he reveal the true story of Father Hobbes's death.

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An engaging anthology of writings about illness, from over 330 sources, literary and medical, men and women, ranging from Deuteronomy and Hippocrates to Virginia Woolf and Oliver Sacks. Readable explication introduces the chapters devoted to various themes, a list of which will serve best to illustrate the scope.

1. Generalities; 2. Illnesses (greater and lesser); 3. Eyes, Ears and Teeth; 4. Doctors and Cures; 5. Hospitals and Patients; 6. Philosophers and Kings; 7. Intellectual and Spiritual Frets; 8. Strange Complaints, Mishaps, Embarrassments; 9. Imaginary, Feigned, Psychological; 10. Melancholy and Love Sickness; 11. Manias, Phobias, Fantasies, Fears; 12. Breakdown and Madness; 13. Young and Old; 14. Animals; 15. Invalids and Convalescents; 16. Short and Sharp (a collection of pithy aphorisms about illness).

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To escape accusations of plagiarism, Swedish neurosurgeon Stig Helmer (Ernst Hugo Jaregard) has come to work at The Kingdom, a large Copenhagen hospital. He is a surgical butcher with lamentable bedside manners and utter contempt for Denmark, but he resembles his colleagues in his medical positivism and abhorrence of spiritualism. His inadequacies are easily perceived by the hospital staff and resident Dr. Hook (Soren Pilmark), but his fellow consultants celebrate his arrival and make him a member of their lodge.

The malingering spiritualist Mrs. Drusse (Kirsten Rolffes), admitted for a variety of fictitious ailments, discovers The Kingdom is haunted by a little girl murdered there a century ago by her scientist stepfather. Drusse engages the help of her son, who is an orderly, to trace the child's secret.

Tangents to the main plot involve a pathologist, who is so obsessed with obtaining research tissue that he has a cancerous liver transplanted into himself, and the psychopathic medical student son of the hospital director, whose sick sense of humor leads him to mutilate corpses in the hospital morgue. The ending is pure horror.

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Ingenious Pain tells the life story of James Dyer, a surgeon in eighteenth-century England who is gifted--and cursed--with the inability to feel physical or emotional pain. Beginning with his postmortem, the novel traces the thirty-three years of his life, from his illegitimate conception on a frozen river, through the rise of his career from itinerant quack's assistant to ship's surgeon, and then to the court of Empress Catherine of Russia where he meets Mary, a mysterious woman who performs magical surgery on him with her hands, enabling him for the first time to feel and, as a result, to love.

At first this new ability drives him mad, and he is submitted to the infamous torments of Bethlehem Hospital. He gradually recovers, but his new sensitivity has disrupted his identity as a surgeon. He performs one last operation, saving the life of a Negro wrestler by opening his chest and massaging his heart. His own death, not long after, seems to signify that he has at last become a normal man, and this is a form of redemption.

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Today, Friday June 5th, I am going to meet the man who killed my father. So begins the narrator of this novel, who is about to drive to New Jersey to visit the physician (now retired) who took care of his father during his final illness 20 years previously. The narrator (Peter Cave), who was an adolescent at the time, is now a physician himself.

Most of the novel is a flashback in which the narrator describes his life during the several days prior to June 5th, "the white life," which is the term he uses for the practice of medicine. We learn, in particular, about his patient George Dittus, a difficult man who definitely doesn't want to play the hospital game. "I need to get home" is the first thing Dittus says. Dr. Cave wants to save the life of this gruff, eccentric man who may well have had a serious heart attack, but at the same time, he tries--sometimes painfully--to respect the patient's desire to be in charge.

Cave's encounter with the retired Dr. Gresser, who remembers the elder Cave as a difficult patient, is surprising--"You know he refused to take the medicines I suggested." Cave is disappointed; he wanted a confrontation with the man who "killed" his father, but, instead, is confronted with the realities of human nature. Back at the hospital, he discharges George Dittus, who disappears into the inscrutable future.

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Dr. Ernest Lash, single and around 40, discovers his enthusiasm and love for psychoanalysis, the talking therapy, after several years of practice as a psychopharmacologist. As the novel opens, we meet a smart, somewhat smug and self-absorbed Dr. Lash who practices from his office located in the privileged community surrounding Sacramento Street in San Francisco. He has an active psychoanalytic practice, ambition for respect and notice by the seniors of his professional community, and some aspiration to greater success as a theoretician and writer on the subject of psychoanalysis. Central to his character is a love for his work, where it appears that pride in technique and outcome shadows genuine concern for his patients and their unhappiness.

Early in the novel, a male patient, Justin, who has been working with Ernest for several years, announces that he is leaving his wife, Carol, for another woman. Ernest is pleased since he views the marriage between Justin and Carol as unhealthy, while a bit dismayed that Justin fails to acknowledge Ernest's contribution in helping Justin develop the confidence to take this step. Justin ends his relationship with Ernest Lash--feeling that he no longer needs his help--as the beginning of the novel takes an intriguing direction.

Justin's now abandoned wife, Carol, in a state of betrayal and desire for vengeance--she has a hateful attitude toward all psychiatrists after her psychotherapist of many years ago had an affair with her--decides to enter therapy with Dr. Ernest Lash in the hope of seducing him. She disguises herself with a name change and enough distortion of her past and present so that Dr. Lash will not be able to connect her to Justin. She wishes to expose him as a charlatan, and destroy his career.

Carol is an attorney, and smart. Dr. Ernest Lash is lonely and drawn to Carol. The therapy sessions and the progression of their relationship are central to Yalom's exploration of the intersubjective experience, where strangers struggle with the ambiguity of their own motives and intentions in the intimate world of psychoanalysis. Who is giving, who is receiving? Who is being helped, and who is helping?

Yalom weaves this central element of the plot with many other relationships. Dr. Marshal Streider is a senior psychoanalyst with ambitions for national recognition and a preoccupation with money. He is Dr. Ernest Lash's supervisor. He takes great pride in the fact that he treats many wealthy patients, and is engaged in his own boundary dilemmas when he invests, using insider information from one of his patients.

Dr. Seymour Trotter is a senior psychoanalyst who is condemned and removed from psychoanalytic practice after entering a sexual relationship with one of his patients. We learn that Seymour Trotter was once president of the American Psychiatric Association, and a mentor to Marshal Streider. His maxim, "My technique is to abandon all technique" (p. 7), both haunts and guides Ernest Lash throughout the novel as Ernest grapples with his own passions and temptations, while striving in his goal to achieve humane and healing therapy for his patients.

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This etching illustrated a book criticizing (male) physician birth attendants--"man midwives"--today’s obstetricians. The etching shows a figure that is male on one side, female on the other. The male half stands on a plain wood floor next to a large mortar and pestle, holding an instrument labeled a "lever" in his hand, which is pressed against his thigh. The background seems to be a shop, with shelves lined with vials, bottles, and frightening looking instruments labeled "forceps," "boring scissors," and "blunt book."

In contrast, the female half of the figure stands in a homey room on a decoratively carpeted floor; in her outstretched hand she holds a small cup. Behind her, a fire burns in a grate.

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