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This early Greek painting depicts an episode from Homer's Iliad where Sarpedon, a hero of the Trojan War, is killed by the spear of Patroklos, an enemy warrior. Zeus watches as his son "dies raging" (Iliad, transl. Richmond Lattimore, book 16, line 491). Two winged figures who represent Sleep and Death gently lift the still-bleeding Sarpedon off the battlefield. Standing stoically behind Sleep and Death, are Laodamas and Hippolochos, two Trojan warriors who were killed in battle prior to Sarpedon.

Euphronios, one of the first to work in the red-figure method, uses his simple but skillful technique to draw the hero's body at the moment it succumbs to death. Especially vivid are the three open wounds on Sarpedon's body from which blood spills to the ground. Sarpedon's eyes are closed, his limp hands drag along the ground. Zeus, powerless to prevent his son's suffering and death, sends the god Hermes to attend to his son's burial. Hermes, in turn, summons the caretakers Sleep and Death to transport Sarpedon to his grave.

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Five Days at Memorial is the book length expansion  of the New York Times Sunday Magazine article that the author, a Pulitzer Prize-winning physician-journalist, published in 2009. The book, the result of years of research and literally hundreds of interviews, chronicles the five days (August 28 to September 1, 2005) during which the medical staff remaining at Memorial Hospital in New Orleans tried to care for the patients -- over a hundred of them stranded, like the staff, in a hospital without water or electricity --following the flooding wrought by Hurricane Katrina.

After an 8 page prologue, the book is divided into two sections, "Deadly Choices" (228pp, the narrative of those five days) and "Reckoning" (256pp, the legal battles over the injections of midazolam (a sedative) and morphine by some of those staff and prosecuted as homicide -- what others called "euthanasia.") "Deadly Choices" relates almost hourly the five days inside Memorial from the viewpoint of patients, patients' relatives, physicians, nurses, administrators of Memorial, Tenet (the holding company owning and running Memorial) and LifeCare -- the long-term care area within Memorial devoted to the care of terminally ill and debilitated patients -- owned by a separate company. Ethical and legal questions of triage, DNR, record-keeping, accountability, communication (primarily the failure thereof) and leadership are on almost every page. At the heart of this book, however, is the mystery of the unexplained deaths of so many patients during those five days. (On September 11, 2005, a disaster mortuary team recovered 45 bodies from many different places in Memorial, page 234). The crux of the mystery of these deaths is the manner in which nine in particular died in the beleaguered hospital on the fifth and last day when, paradoxically, relief had become real and effective and inclusive, seemingly obviating such injections.

The final pages of "Reckoning" deal with the fallout - historical, ethical, political and medical -- and current events relevant to these five days and the almost two years following. (The final verdict of not guilty -- the actual wording was "Not a true bill" since it was a grand jury declining to indict the one physician, Anna Pou, and the two nurses, Cheri Landry and Lori Budo -- was rendered on July 24, 2007). There are a map of Memorial Hospital and a cast of characters at the front of the book and extensive notes, bibliography and index at the end.

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This collection of 16 short stories focuses on doctors and patients in San Francisco, where a wide variety of wealth and culture impact the delivery of medical care.  Further, there are many restrictions—financial, bureaucratic, ethical, and legal —that limit what doctors can do, especially in cases of patients near death.

The author, Louise Aronson, is a geriatrician who knows this terrain very well, having trained in San Francisco and worked as a physician there. A skilled writer and close observer, she has created dramatic and often funny stories that reveal social and bioethical complexity. About half the stories describe end-of-life issues for the aged and the dilemmas for their physicians and families.

In ‘The Promise,” Dr. Westphall orders comfort care only for an elderly patient who has suffered a massive stroke, but a hospital gives full treatment because there was no advance directive and the daughter told the attending to do “what he thought best.”

When Dr. Westphall sees this barely functioning patient in a skilled nursing facility seven months later, he tenderly washes her face and hair—although the text teases us that he might have been prepared to kill her.

In “Giving Good Death,” a doctor is in jail charged with murder; he has fulfilled the request of Consuela, a Parkinson’s patient, to help her die. When it appears that she may have died for other reasons, he is released, his life “ruined.” He leaves San Francisco, and, we surmise, medicine. In three other stories, doctors also leave the profession: the cumulative stresses of work and family and/or a sense that it’s not the right path bring them to that choice.

On the other hand, one of the longer pieces “Becoming a Doctor” celebrates the profession, despite all the rigors of training including sexism against women. 

The stories bring multicultural insights; we read of people from China, Cambodia, Latin America, India, Russia, and the Philippines. Some are African-American; some Jewish, some gay. These different backgrounds color notions of health, death, and medical care. There are also pervasive issues of poverty and, at another extreme, professionalism that is hyper-rational and heartless.

Indeed, a recurring theme is care and love for people, no matter their background or current health status. A surgeon realizes (regrettably too late) that the secret of medical care is “caring for the patient—for anyone—just a little. Enough, but not too much” (p. 135). 

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One of two sons of a broken U.S.-Dutch family, Kiddo chooses to live off the Dutch welfare system spending his state alms on drugs. Although he realizes it is but the bleakest of efforts not to come to grips with a difficult relationship with his older brother, Morton, Kiddo perseveres, forming an uneasy alliance with Pietje, a woman who also knows Morton.

The novel is told by Kiddo with contributions to the multi-faceted story in the form of letters from Morton, who gives up a brilliant future as a genius in physics to travel around the world, and diary entries by Pietje, who has some unpleasant truths to tell about Kiddo's world. Morton, known as Mort, writes Kiddo that he has cancer and not long to live, returning home to die. Honoring the dying request of his brother, Kiddo attends Mort's autopsy (yes, the play on Morte/Mort proves irresistible to Morley, or is it Mor(te)ley), a fairly gruesome scene. This proves not to be the death of Mort/Morte/Death for Kiddo and he requires help from Pietje and more introspection before Kiddo can lay his brother's bones to rest.

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This is an aerial view of a comatose patient being force-fed by a funnel leading directly into her stomach. Surrounding the consultation table are six (identifiable) black-robed supreme judges gleefully pouring nutritious foods (grapes, fish, Quaker Oats, peanut butter, water and 7-Up) into her. Two tiny symbols, the scales of justice and a red-white-and-blue eagle contribute to the otherwise empty courtroom decor.

In the upper right corner, barely visible, is an open door with a "Keep Out" sign dangling from its knob, through which a doctor and nurse peer in. Four tiny red paper-doll figures holding hands, symbolizing the family, are also by this door. Hanging precariously over the patient and consultation table is an ugly, large, bare 25-watt light bulb.

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McMurphy (Jack Nicholson) escapes work on a prison farm by feigning mental illness, but he finds himself in a far more coercive institution than the one he left behind. The other men, both sane and insane, are just like him: they hide in the locked ward from the law, their families, or the despair of their own lives.

McMurphy animates the dull monotony with fractious games, pranks, and excursions, but he encounters stiff opposition from the head nurse, Mildred Ratched (Louise Fletcher), whose system provides her with pills and electroshock to maintain control. When the nurse discovers that McMurphy has smuggled two women into the ward, she threatens to tell the mother of young Billy (Brad Dourif). Billy commits suicide and an enraged McMurphy tries to strangle Ratched. McMurphy is lobotomized and returned to the ward only to be smothered by his friend Bromden, who then escapes.

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The speaker in this short poem is a physician whose father's "castrated body" is "crooked in prostatic pain." From the family home in Tennessee, the dying man's wife provides daily phone reports to the son about her husband's deteriorating condition. The speaker's mind swirls with conflicting feelings: he thinks about "Dr. Death," whose efforts he has just come to understand; he thinks about the suffering experienced by his father and his mother's "terminal voice"; and he considers "how many of those little pain killers it might take."

Similarly, recollection of the Hippocratic vows intrudes to counsel against the kind of assistance his filial nature wants to provide. The internal debate about choices directs readers back to the title's imperative, "let's talk about it," suggesting, I believe, the need for social and professional discourse about quality of life, futility, and physician-assisted-suicide.

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The title refers to a Veteran’s Administration hospital regulation concerning the withholding of full medical benefits if an ailment is not specifically related to military service. In an oftentimes comic battle between the forces of good--physicians and vulnerable patients--and those of evil--the administrators and their minions--the story has currency and direct appeal to viewers.

The Darth-Vader-like administrators are self-serving, inhumane bureaucrats with emotions that run the gamut "from A to B" (Dorothy Parker). Physicians, especially the character played by Ray Liotta, but also his dedicated colleagues, are imaginative and non-rule abiding in their central concerns: the patients. They listen to stories and sympathize; in addition, they turf, lie, steal, and do whatever is necessary to protect, serve, and treat their patients. When the government denies a heart bypass, for example, the docs schedule prostate surgery for the official record and do, instead, the needed heart surgery.

At times, it’s as if the Marx Brothers or the Keystone Cops have donned white coats to sneak around the hospital with patient-centered antics. In the absurd bureaucracy, viewers, perforce, must cheer enthusiastically for the merry band of renegade docs.

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Spoiler alert: for educational purposes, this annotation reveals plot lines and may interfere with some viewers' enjoyment of the film. In the opening scene, Juliette (Kristin Scott Thomas), looking ashen, drawn, and nervous, sits in an airport as her much younger and radiant sister Léa (Elsa Zylberstein) rushes to meet her.  Léa brings an eager, if somewhat forced cheer to their halting conversations during this meeting and in their car ride to the home Léa shares with her husband, their two small adopted Vietnamese daughters, and her mute father-in-law.  From this awkward beginning, the sisters try to cross the chasm of a fifteen-year separation.  The cause and nature of the separation gradually unfold in small, slowly paced scenes of ordinary life at home, at work, in a café, during dinners with friends.  These scenes form the visible surface under which secrets and plangent, unacknowledged emotions lie, sometimes erupting into view, sometimes gently suggested.
    
The cause of the separation is the prison term Juliette has served in England.  We eventually learn that the sentence has to do with the death of her child, with her being a physician, with her child's suffering from cancer, and with the application of her medical knowledge to end his pain.  Following the court sentence, Juliette's parents refuse to acknowledge her, her husband divorces her, her sister buries memories of their childhood and chooses not to give birth, family and friends never visit her in prison.  We also learn that Juliette remained inexplicably silent throughout her trial.  She continues to say very little as she settles in with Lea's family and circle of friends, who are baffled by her sudden appearance in Lea's life.  But as Juliette's participation in her sister's circle increases in fitful starts, she becomes cautiously more communicative and brighter.

During a confrontation with Léa at the end of the film, Juliette reveals that, more than avoiding a shameful appraisal from others, she remains silent because there are no words to express her pain.  Being in prison made literal the isolating psychological state she inhabited.  "The worst prison is the death of one's child," she says.  "You never get out of it."  With these words, the film places the wound and the pain at the core of its main character in the inescapable vulnerability of motherhood.    

    

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