Spring

Smith, Ali

Last Updated: Dec-02-2019

Trachtman, Howard

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Ali Smith is a Scottish writer. If she lived in the U.S., hopefully (a word I will come back to at the end) she would be a household name. She is 75% through a quartet of novels that are named for the seasons. Each captures the beauty and lightness of Vivaldi’s famous concerto and the heft of T.S. Eliot’s poetic quartets. Spring seamlessly blends brutal reality and a dream-like state. Anchored in the current world, it unfolds in a Brexit obsessed United Kingdom, and yet it incorporates artists, live and dead, ranging from Katherine Mansfield to Rainer Maria Rilke to Tacita Dean. The scope and inventiveness of the writing are staggering.

The plot will sound very odd in a brief summary. Like many modern novels, it incorporates two separate narrative strands that come together somewhat unexpectedly but satisfactorily in the climactic scenes. In the opening pages, we are introduced to Richard Lease, a modestly famous filmmaker who produced some well-regarded highbrow TV shows in the 1970s and 80s. He is considering an offer for a new film project about an imaginary crossing of paths by Rilke and Mansfield in Switzerland in 1922. But Richard is unable to rouse his enthusiasm partly because of misgivings about who he would have to work with. More importantly, he is still not over the recent death of his screenwriter, Patricia Neal or Paddy, who was more than just his artistic partner for four decades. Richard mulls over memories of their work and life together, reliving conversations and episodes that invoke Charlie Chaplin, Beethoven and Shakespeare. He aimlessly boards a train to Scotland. There, in an act of despair, he lowers himself onto the train track in an attempted suicide .

Richard is saved by a magical 12-year old girl, Florence. Although the description is scant, she is preternaturally bright, articulate, and endowed with an inexplicable power to move people to do what she wants. She supposedly was able to enter a restricted Immigrant Retention Center unaccompanied and persuade the supervisor to order a cleanup of the bathrooms for all the detainees. One morning, Florence encounters Brittany Hall, who is on her way to work as a security guard in one of the notorious British detention centers. Her dehumanizing work with the inmates is grinding her down, the degrading surroundings are destroying her soul. Florence and Brittany end up at a train station and in an impulsive act, Brittany follows Florence onto a departing that is heading off to Scotland. The warm interaction with Florence on the ride awakens Brittany’s submerged feelings of humanity. They end up at the same destination as Richard, and there Florence persuades him to climb back on to the platform and saves his life. A reinvigorated Richard, Florence and Brittany meet up with another mysterious character, a woman operating a mobile refreshment stand. The four travel in her crowded truck to Culloden, the site of the disastrous clash during the Jacobite Rebellion in 1746 when the Scots were annihilated by the English army. There the story reaches its climax which I will not divulge in full. But simply said, in full sight of all the tourists attracted to the Culloden battlefield site, it does not end up well for Florence or her mother who suddenly appears on the scene.

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Breaking & Mending: A Junior Doctor's Stories of Compassion and Burnout

Cannon, Joanna

Last Updated: Oct-21-2019

Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

A British physician-writer reflects on her topsy-turvy medical training emphasizing the mental and emotional burden of becoming a doctor. In 22 brief chapters with titles including "The Darkest Hour," "Buried," and "The Wrong Kind of Kindness," a struggle between hope and despair furiously plays out - in patients, hospital staff, and the narrator.

Dr. Jo (as one patient calls her) remembers interviewing for medical school admission, the difficulty dissecting a cadaver, starting lots of IV's, dutifully toting an almost always buzzing pager, and breaking bad news. She shares with readers her own serious car accident with resulting facial injuries. She comments on the underfunded UK National Health Service (NHS) that is "held together by the goodwill of those who work within it, but even then it will fracture" (p104).

Anecdotes of memorable encounters are scattered throughout the narrative: a fortyish woman in the emergency department who describes a fast pulse and sense of impending doom diagnosed as having an anxiety attack who ten minutes later suffers a cardiac arrest, a man with severe schizophrenia, a suicide, an elderly blind person, a young woman with metastatic breast cancer.

But the lessons that have stuck with her are primarily dark and somber ones. "Sacrifice and the surrender of the self are woven into the job" (p77). She realizes that "perhaps not all good doctors are good people" (p125) and that as wonderful and essential as the virtue of compassion is, "compassion will eat away at your sanity" (p16). She chooses psychiatry as a specialty where kindness, empathy, creating trust with patients, and careful listening work wonders for people. "I learned that saving a life often has nothing to do with a scalpel or a defibrillator" (pp13-14).

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Strange Relation—A memoir of marriage, dementia, and poetry

Hadas, Rachel

Last Updated: Aug-18-2019

Ratzan, Richard M.

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Strange Relation is a memoir of the terminal illness of George Edwards, a composer and professor of music at Columbia University, written by Rachel Hadas, his wife, a well- known poet and herself a professor of English at Rutgers University. Hadas begins with the insidious onset of Edwards's dementia, which is eventually diagnosed as frontotemporal dementia, a slow neurodegenerative disease characterized by a progressive paucity - and then absence - of communication, especially speech. She then continues with their meetings with physicians, especially neurologists, social workers, support groups and eventually nursing home personnel, recording, often in the form of her poems, her thoughts and reactions at the time.

The book consists of short chapters, more or less chronological, with occasional flashbacks to earlier periods in her life or their marriage. In addition to her poems, there are ubiquitous references to literature, many of them familiar, as well as not so familiar illness narratives by patients and relatives, especially those involving dementia and bereavement. George died in 2011, the year of the publication of this book, after 33 years of marriage to Ms. Hadas.

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Salt in My Soul: An Unfinished Life

Smith, Mallory

Last Updated: Aug-16-2019

Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Mallory Smith died of complications following a double-lung transplant for cystic fibrosis (CF). She was twenty-five years old and kept an extensive journal on her computer for 10 years. Salt in My Soul: An Unfinished Life is her memoir, edited by her mother, Diane Shader Smith, from the 2,500 pages of notes, observations and reflections which Mallory Smith wrote. The title refers to the intimate relationship of salt imbalance in cystic fibrosis, and the fact that Mallory felt her most well while swimming in the sea. Diagnosed at age three, she spent much of her days and nights treating the disease with medication, nutrition, chest percussive treatments, breathing treatments, adequate sleep, and aggressive treatment of infections. Unfortunately, while still a child her lungs were colonized with B. cepacia, a resistant bacteria ‘superbug’ which makes transplantation highly risky and hence leads to most centers to not accept CF patients onto their wait lists. Ultimately, University of Pittsburgh does accept Mallory as a transplant candidate, although her health insurance puts up every road block possible to her receiving care.

Mallory Smith was extraordinarily accomplished – she graduated from Stanford University Phi Beta Kappa, and became an editor and freelance writer. She was also deeply engaged with life and others; she was grateful for her loving, devoted family, and she developed close, fierce friendships within the CF community, among classmates, and eventually, she fell in love.

She resists being called ‘an inspiration.’ She writes: “I’m not an inspiration. I’m just a person, grounded in compassion, striving to achieve empathy and wanting to make my way with goodness and grace.” (p. 171) She marvels at the miracle of life: “Our existence is the result of stars exploding, solar systems forming. Our Earth having an environment hospitable to life, and then, finally, millions of highly improvable events accumulating over millions of years to bring us, a capable and conscious bag of stardust, to the here and now.” (p 111) Her memoir is a story of living and dying from CF, but it is also an inside look at the brief life of young gifted writer.

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That Good Night: Life and Medicine in the Eleventh Hour

Puri, Sunita

Last Updated: Aug-13-2019

Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Sunita Puri, a palliative care attending physician, educates and illuminates the reader about how conversations about end of life goals can improve quality of life, not just quality of dying, in her memoir, That Good Night: Life and Medicine in the Eleventh Hour. Thirteen chapters are grouped in three parts: Between Two Dark Skies, The Unlearning and Infinity in a Seashell. The arc of the book follows Puri as she is raised by her anesthesiologist mother and engineer father – both immigrants from India – Puri’s decision to enter medical school, her choice of internal medicine residency followed by a palliative care fellowship in northern California and her return to practice in southern California where her parents and brother live. Besides learning about the process of becoming a palliative care physician, the reader also learns of Puri’s family’s deep ties to spirituality and faith, the importance of family and extended family, and her family’s cultural practices.

Puri writes extensively about patients and their families, as well as her mentors and colleagues. She plans and rehearses the difficult conversations she will have with patients in the same way a proceduralist plans and prepares for an intervention. She provides extensive quotes from conversations and analyzes where conversations go awry and how she decides whether to proceed down a planned path or improvise based on the language and body language of her patients and their family members. We visit patients in clinic, in hospital, and at home, and at all stages of Puri’s training and initial practice. Some of the most charged conversations are with colleagues, who, for example, ask for a palliative care consultation but want to limit that conversation to a single focus, such as pain management. We also learn of the differences between palliative care and hospice, and the particularly fraught associations many have with the latter term. She feels insulted when patients or families vent by calling her names such as “Grim Reaper” or “human killer” (p. 232), but understands that such words mean that more education is needed to help people understand what a palliative care physician can do.

As a mediator of extremely difficult conversations, where emotions such as shame, guilt, fear, helplessness and anger can swirl with love and gratitude, Puri finds the grace to acknowledge that all such emotions are part of the feelings of loss and impending grief, and to beautifully render her reflections on these intimacies: “Yet although I am seeing a patient because I have agreed that they are approaching death, if I do my job well, what I actually encounter is the full force of their lives.” (p. 206) Having met many dying people she notes: “Dying hasn’t bestowed upon them the meaning of life or turned them into embodiments of enlightenment; dying is simply a continuation of living this messy, temporary life, humanly and imperfectly.” (pp 221-2)

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The Faraway Nearby

Solnit, Rebecca

Last Updated: Aug-09-2019

Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: Collection (Short Stories)

Summary:

Solnit dares the reader to categorize her book. Autobiography, memoir, travelogue, story collection, history, meditations, and pathography could fit. Common to all the categories and subjects covered is storytelling. “It’s all in the telling… and to be without a story is to be lost in the vastness of the world,” Solnit says in book’s opening. Storytelling can bring what is geographically faraway emotionally nearby.

Solnit’s first and last stories lay the foundation for the others in between. Both center on the hundred pounds of apricots she received from one of her brothers who was getting their mother’s house ready for sale when dementia made it impossible for her to live alone. Solnit saw “the apricots as an exhortation to tell of the time that began with their arrival, and so the stories concern the time from when they arrived onward” (p. 240). Solnit considers this time when her mother’s dementia is worsening, an “emergency,” but in this instance, she conceives emergency as “an accelerated phase of life, a point at which change is begotten, a little like a crisis” (p. 250). The book to her, she says, is “a history of an emergency and the stories that kept me company then” (p. 249).

The topics covered during this emergency are many and varied, related and unrelated. Just some of them are: her mother’s dementia, her cancer, her friend’s cancer, leprosy, Che Guevara as physician and revolutionary, Iceland, the Arctic, Mary Shelley’s Frankenstein, Buddhism, and cannibalism. In general terms, illness, pain, empathy, fairytales, and reading and writing are considered. Some of these topics are intertwined and some stand alone.

The book is organized into thirteen numbered “stories.” Each has a one-word title. The titles of the first five stories are the same as the last five in reverse order, i.e., the first and last stories are both called “Apricots.” They are arranged on the table of contents page to form the shape of a bell curve that has been rotated 90 degrees with the apex of the rotated curve comprising the stories, “Wound,” Knot,” and “Unwound.” Threads run through the stories, and perhaps Solnit is telling us the story threads running through the first six stories are wound into a knot and then unwound in stories running through the last six of them. This structure may be more grist for people interested in how literature can be structured than for people interested in the insights into illness experiences literary nonfiction can provide.

Not among the list of stories is one that is printed as a single line running along the bottom of each page in the book. It’s a story is about stories running along side the other stories. In an interview printed in the 8 August 2013 issue of Harper’s Magazine, Solnit said she used this form in part to invite“readers to decide how to read a book that has two narratives running parallel to each other; the thread can be read before, during, or after.”

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Bodies of Truth: Personal Narratives on Illness, Disability, and Medicine

Moore, Dinty; Murphy, Erin; Nicholson, Renee

Last Updated: Jul-19-2019

Schilling, Carol

Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

Bodies of Truth gathers twenty-five essays about experiencing illnesses and disabilities from the perspectives of patients, healthcare professionals, and families. These personal stories join the growing company of narratives that reflect on the inner experience of illness or caring for the ill and on the social circumstances that influence those experiences. In addition to the diversity of perspectives, the editors have selected pieces about an exceptionally wide range of health conditions: multiple sclerosis, brain damage, deafness, drug addiction, Down syndrome, pain, cancer, infertility, depression, trauma, HIV, diabetes, food allergies, asthma. They also include essays on the death of a child and an attempted suicide.

The essays resist easy categorization. In their Preface, the editors explain that they took “a more nuanced approach” to organizing the contributions loosely by themes so that they would “speak to each other as much as they speak to readers.” For example, Teresa Blankmeyer Burke’s spirited “Rendered Mute” calls out the OB-GYN who refused to remove his mask during delivery to allow this deaf mother-in-the-making to read his lips to exchange vital communications. Her essay is followed by Michael Bérubé’s “Jamie’s Place.” In it the father recounts the emotionally and logistically complicated path he and his son with Down syndrome navigate as they seek a place for him to live as independently as possible as an adult. This sequence invites readers to listen to two stories about disability from differing parental perspectives and circumstances. But perhaps readers can also to find commonalities in ways social attitudes toward disability fold themselves into the most intimate moments of the families’ lives.

Several of the essays take readers into a professional caregiver’s medical and moral struggles. In “Confession” nurse Diane Kraynak writes sensitively about a newborn in intensive care who distressed her conscience. She was troubled by both the extensive medical interventions he was given “because we can” and their failure to save him. When Matthew S. Smith was an exhausted neurology resident, he ignored a stroke patient who inexplicably handed him a crumpled paper. Scribbled on it was a ragged, ungrammatical, and urgently expressive poem, which he read only years later, admonishing himself “to cherish the moments of practice” that could “change your life forever (“One Little Mind, Our Lie, Dr. Lie”). Madaline Harrison’s “Days of the Giants” recounts “the sometimes brutal initiation” of her early medical training decades ago. Narrating those struggles has led her to “compassion: for my patients, for myself as a young doctor, and for the students and residents coming behind me.”

Overall, the essays range widely across medical encounters. After attending her husband’s death, Meredith Davies Hadaway (“Overtones”) became a Certified Music Practitioner who plays the harp to calm hospice patients. Dr. Taison Bell graciously thanks a pharmacist that he regards as a full partner in his treatment of patients (“A Tribute to the Pharmacist”). Tenley Lozano (“Submerged”), a Coast Guard veteran, was traumatized first by the various abuses of male supervisors, once nearly drowning, and then by her struggle to receive psychiatric care.

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I AM

Clare, John

Last Updated: Jun-24-2019

Ratzan, Richard M.

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

"I AM" is a poem by John Clare with three sestets in iambic pentameter with an ABABAB rhyming pattern unique to each sestet. In it the poet affirms his identity, his sorrows to date and ends with the expressed longing for a happier life in the presence of God and the solitude of Nature. Due to his disorderly life, unconcern for conventional spelling, and transcriptions of his poems by others, there are often multiple versions extant for an individual poem. This is true for "I AM", which Jonathan Bate, the author of a magisterial biography of the poet, states was written in a psychiatric institution about 1846. (1, page 505) For this annotation I have used what many consider to be the most authoritative edition of his poems. The poem also exists in several reliable sites on the internet.

The poet was a troubled man born near Peterborough, Cambridgeshire, England, in 1793, in meager circumstances and remaining so throughout his entire life. Save for a five month period in 1841, Clare spent the last 27 of his 71 years in psychiatric institutions. He wrote his poetry, which primarily celebrates the natural world he spent so much time in alone, before and during his hospitalizations. His reputation as a poet has burgeoned significantly in the last 100 years.

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The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science

Jain, Shaili

Last Updated: Jun-19-2019

Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

A psychiatrist and PTSD (post-traumatic stress disorder) specialist, Dr. Shaili Jain has written a book on PTSD and its many angles, from diagnosis to treatment to a larger perspective on cultural and historic influences on the development of traumatic stress. She weaves the story of her own family’s experience with the Partition of India and Pakistan in 1947, particularly its effect on her father and grandparents, as a way to consider the effect of trauma on family, but also how those traumas become ‘unspeakable.’

A brief but effective introduction outlines the seven parts of the book:
1. Discovering Traumatic Stress: historical perspective and the changing language to describe the effects of trauma.
2. The Brain: the physiologic and psychological underpinnings of PTSD, including effects on memory formation and retrieval.
3. The Body: such as addiction, cardiac effects and concerns at different stages of life.
4. Quality of Life: domestic and sexual violence, socioeconomic factors.
5. Treating Traumatic Stress: programs, treatment strategies and psychopharmacology.
6. Our World on Trauma: global health, large scale tragedy, terror and war.
7. A New Era: An Ounce of Prevention: resilience, accessibility of care including early and preventative care.

Additionally, almost 100 pages of notes, glossary, resources and an index provide an easy way to further explore, to use the book to look up specific topics, and underscore the heavily researched nature of the text. The book is eminently readable, with numerous, well-placed stories of patient encounters and particular experiences and manifestations of PTSD. These stories are illustrative of the concepts Jain ably explains. However, they also provide an insider’s view of what happens in the consulting room. In the prologue, Jain describes a young Afghanistan War veteran, who has been hospitalized after a violent outbreak at a birthday party: “Josh’s PTSD was fresh, florid, and untreated…. His earlier poise caves in to reality, and his face falls to anguish.” (p. xvi) We are in the room, listening to the patient, witnessing the tears of the medical student, glimpsing the attending psychiatrist’s response, and relating to Jain, as a psychiatry chief resident, as she understands that the individual before her, even as he shows classic signs of traumatic stress, remains an individual, a person in need of care.

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From Reading to Healing: Teaching Medical Professionalism through Literature

Stagno, Susan; Blackie, Michael

Last Updated: May-30-2019

Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Anthology (Mixed Genres)

Summary:

The subtitle of this collection explicitly states its purpose and implies its audience. The content includes essays on teaching, as well as a number of canonical stories taught in medical humanities courses. The first section consists of key texts that present a rationale for teaching narrative literature to medical and other health professions students. This is followed by five sections, each of which covers an aspect of that rationale, i.e. narrative exploration of professional boundaries, empathy and respect, authority and duty, stigma, and truth-telling and communication.

Within each section, several essays describe teaching considerations or techniques, often focusing on a specific story or novel. For example, in “A Novel Approach to Narrative Based Professionalism: The Literature Classroom in Medical Education” by Pamela Schaff and Erika Wright (p. 72), the authors describe how Pat Barker’s novel Regeneration stimulates discussion of doctor-patient antipathy, doctor-patient intimacy, and interprofessional communication. From Reading to Healing also includes the full text of many stories relevant to the essays; for example, “Toenails” (Richard Selzer),“The Most Beautiful Woman in Town” (Charles Bukowski), “The Speckled Rash” (Mikhail Bulgakov), “The Death of Ivan Ilyich” (Leo Tolstoy), “The Use of Force” (William Carlos Williams) and “The Birthmark” (Nathaniel Hawthorne).

In addition to stories and novels, From Reading to Healing presents essays on teaching with film, religious literature, and even comics, cf. “Assisting Students in the Creation of a Class Oath Using Comics,” by Michael Redinger, Cheryl Dickson, and Elizabeth Lorbeer (p. 217)

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