Summary:

The Strand Magazine is a source for “unpublished works by literary masters.” The October-February (2017-2018) issue includes a Raymond Chandler short story that has never before been published. Chandler wrote crime fiction for the most part, and the stories usually involved the fictional detective Phillip Marlowe. This story, however, written between 1956 and 1958, centered on how American health care fails people who need it when they can’t pay for it or look like they can’t pay for it. 

In this story, a man who has been hit by a truck is brought into the emergency department at “General Hospital.” He arrives just before shift change and so the admitting clerk is already annoyed. The clerk checks the patient’s pockets for the required $50 deposit and finds nothing, so she could now send the patient to the county hospital, and that would be that. But, before she initiates the transfer, she asks a passing private attending physician to look at the patient. He sees that the patient is dirty, smells of alcohol, and would cost a lot to work up. Mindful of an admonition from a major donor that the “hospital is not run for charity,” the physician surmises the patient is “just drunk,” and agrees the patient should be moved to the county hospital. So off the patient goes.  

The next day, the same admitting clerk at General Hospital gets a call from the county hospital. She’s informed that the patient they transferred had a head injury requiring surgery, and that the patient had $4,000 in a money belt inside his undershirt. The patient couldn’t be saved, however, because of the delay involved in the transfer to the county hospital. It’s all right—he only died.

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This collection of 150 sonnets takes us through the journey from the writer’s wife’s diagnosis with Parkinson’s, eventually complicated by dementia and overmedication, to her death and his early days of grieving.  Married for over 40 years and close companions, their successive separations deal new blows as they happen: She goes into skilled nursing care, gets lost in delusions, and becomes more frail and erratic, finally succumbs after a fall and a short period in a coma.  The writer draws on biblical metaphors and threads memories of their earlier life together in fleeting images so that the reader is left to infer from glimpses a rich and happy marriage that, he reflects, prepared them—but not enough—for this going.  

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This is a dramatic and moving story about a concert pianist who, at 45 years of age, suddenly and inexplicably, has ALS, and also equally about his ex-wife Karina, who takes on his care throughout his slow, inevitable, and lethal decline. As many readers know, ALS (Amyotrophic Lateral Sclerosis). or “Lou Gherig’s disease,” hardens the motor nerves so that, progressively, there is no more control of muscles throughout the body. Not many readers know, however, the difficult path such patients and their families must pursue. This sensitive and detailed novel takes readers powerfully into the world of ALS, a disease for which there is today no cure.                                                                                      

Obsessed with his musical career and international travel, Richard has paid little attention to Karina and their daughter, Grace, and he has had affairs with other women. Karina has deceived him about her inability to bear more children. Because of their move from New York City to Boston, Karina, also a gifted pianist, has lost a possible career in jazz and now gives piano lessons to unpromising students. 

The first several chapters alternate between Richard and Karina. Although divorced from him, she brings him, now an ALS patient, back into the home they once shared. Various nurses, doctors, and other specialists try to explain the difficult future that includes certain loss of body functions, but Richard and Karina are slow to comprehend these. Despite their denial, they are forced to come to terms with Richard’s progressive decline and, finally, death.     
          
Richard loses the ability to use his hands, then his arms. He needs a special machine to breathe at night. Soon he has paid caregivers for parts of the day; these include a cheery and admirable man named Bill. No longer able to eat, Richard has a feeding tube. Later he needs a hospital bed. Also a Head Mouse to work his computer. Also an elaborate wheelchair. With unresolved issues in the past, Richard and Karina are emotionally apart—even with feelings of hate and rage—even while she cares for him.  

Karina’s walking partner Elise, a teacher, helps her stay sane. Karina travels to New Orleans with Elise and her class and finds her interest in jazz reawakened. No longer able to breathe even with assistance, should Richard go on to mechanical ventilation that will require 24-hour care at enormous expense? A choice is made. Richard dies, with various resolutions before and after his death.  

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Fran, an aging but energetic expert on elder housing, drives around the English countryside visiting facilities and also friends and family.  She, herself, is not at all ready to go gentle into the good night so many others are facing.  But everywhere she encounters reminders of mortality--her son's fiancee suddenly dies; an old friend is dying a lingering death of cancer; others in her circle of family and friends are facing their own or others' mortality in various ways, including natural disasters like earthquake and flood.  The episodic story takes place in England and in the Canary Islands; the large cast of characters are linked by intersecting stories and by their mortality, of which they, and the reader, are recurrently reminded.    

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The narrator tracks a hypothetical week in the life and work of a psychiatrist in a major Canadian hospital through the stories of individual patients, some of whom were willing to be identified by name.   

The book opens with “they are us” and the shocking discovery that a patient whose life has been ruined by mental illness is a medical school classmate.  

Other patients have been followed for many years—a woman with eating disorder, a man with bipolar disease, another with schizophrenia. A new patient with intractable depression finally agrees to electroshock therapy, and the first treatment is described. The painful duty of making an involuntary admission pales in contrast to the devastation of losing a patient to suicide.  

Goldbloom’s personal life, opinions, and worries are woven throughout with frank honesty. His mother’s metastatic brain tumor sparks the associated intimations of his own advancing age and mortality.  His genuine fascination with and appreciation of the effective modalities now available are matched by his frustration over how they are beyond reach of far too many because of the stigma that is still attached to mental illness and the lack of resources and political will to make them available.

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The 55 poems in Human Voices Wake Us fall primarily into 3 categories: biographical poems, poems about the natural world, and poems about the worldly travels and travails of a man learning and practicing medicine. As I began to read this book, I started checking off all the poems that I thought might merit comment, but stopped early on since almost all called to me--each in their own voice. Thankfully—and skillfully--the poems were often placed in ways that, although drawing from the different aspects of the author’s life, they complemented each other. For example, “The Tyranny of Aging,” a poem about caring for a half paralyzed 95 year old whose last living child has died, is followed by “Redbud,” where the speaker of the poem walks “the ravines, the treed/windbreaks, the creek bottom/all the wooded places//searching for redbuds” (p.49). Another example is the poem “Shock and Awe in Comfort, Texas,” where a solitary walker confronts dive-bombing dragonflies and birds of prey doing what they need to do to stay alive followed by “What I Remember in Embryology,” a poem about being created and born: “Tethered/we are all waiting/fetuses suckling/our way//to heart and hair/teeth and bone/reaching grasping/limb buds into fingers” (p.25).  Winakur came to poetry after realizing that "coming and going in the rooms on daily rounds was not enough to sustain a life"(xiv). What the reader experiences in this book is Winakur’s inspired attempt of seeking—and then delivering through poetry-- more. 

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Haunted by grief over the loss of his young daughter, Felix is a gifted director at a theatre festival. He plans an inspired interpretation of The Tempest, but is unfairly ousted from his beloved position by a jealous and inadequate rival.

As his fortunes dwindle, he accepts a position to promote literacy in a local prison—and hits upon the idea of using his newfound but incarcerated protégés to mount his long-planned Tempest. The project encounters financial difficulties that begin to seem insurmountable as his hostile rival assumes an influential government position.  

The result exceeds all expectations, helps to heal his grief, and with its unorthodox staging, provides a delicious revenge.

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Summary:

The play has two characters: Ruth and Friend (who is a male doctor).Ruth is an engaging, straight-talking quadriplegic who can zip and dance with her chin-operated wheelchair and takes delight in terrorizing medical staff both physically and verbally. She wants to write poetry and is waiting for a device to make it possible for her to use a computer. She keeps developing bedsores that threaten her life and require long admissions to the hospital before they will heal. She desperately wants to live no matter what happens, as she feels that having no mind would be worse than having no body.Friend is a male doctor with children who is ashamed of having examined her while she was unaware. Burdened with his guilt, he asks to be her “friend.” Ruth is skeptical and runs circles around him, but eventually comes to trust him and believe in his sincerity.She makes him a witness to her advance directive to instigate all heroic measures, as she is afraid of the kindly "ethical" and cost-effective arguments not to treat the disabled. But Ruth dies horribly from sepsis, and Friend is helpless to prevent it. She never obtains the device that would have allowed her to put her poems into printed words.

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Summary:

An artist, Ruth, lives with quadriplegia and manages to drive (and dance) with a special wheelchair that she controls with her chin. She also enjoys terrorizing doctors in the hospital corridors, where she is seen on a regular basis because of frequent bouts of infected bedsores. She has a new computer and is “patiently waiting for” a biomedical engineer to set it up to manage, like her chair, with her chin. She wants to write, to draw, to create. But the wait list is long, technicians scarce, and every candidate deserving.

On one of her admissions, Ruth meets the physician-narrator who is appalled by a medical resident’s lack of empathy in relating her case as if she were not present. Distressed by the encounter, the doctor is all the more disturbed when he notices that Ruth’s birth date is the same as his own.

He tries to make it up to her by withdrawing from her care in order to be her “friend,” one who tries to understand and will defend her strong desire to live despite her disability. Driven by curiosity about her past, her sharp wit, and how she faces each day, the doctor never quite achieves his goal and constantly feels guilty for letting her down as an advocate and a friend, and possibly also for being able-bodied himself.  He never visited her in her group home, and when she comes to hospital in florid sepsis, he is unable to prevent his colleagues from letting nature take its course. His own bout with severe illness, possibly MS—more likely a stroke--resonates with Ruth’s plight. Long after her death, he can imagine the acid remarks that she would make about his foibles.

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Intern, Maggie Altman, begins her postgraduate training in a large Texas hospital where a new computerized system has been implemented to improve service. She pours heart and soul into her work, but her admissions always seem to be the sickest patients who keep dying, sometimes inexplicably. Maggie becomes suspicious of her colleagues and of Dr. Milton Silber, an irrascible, retired clinician with no fondness for the new technology. Silber also happens to be a financial genius. Overhearing conversations and finding puzzling papers, Maggie imagines a scam, in which her supervisors may be eliminating dying patients to reduce costs, improve statistics, and siphon funds to their own pockets.

The bad outcomes for Maggie's patients are noticed and criticized, and she is pressured to drop out, switch hospitals, or go back into research. She senses that the perpetrators are aware of her suspicions and send her the worst patients in an effort to eliminate her. She trusts no one. These worries are compounded by her own illness and her accidental discovery in the morgue of a traffic in unclaimed bodies. With the help of excellent clinical skills, true friends, Dr. Silber, and a new love interest who is a budding financial genius, she survives physical and emotional violence and solves the mystery of patient homicides, poisonings, and fraud.

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