Summary:

Kaplan Publishing has recently released several anthologies aimed at a nursing audience or perhaps at a reading audience that wants to know more about what nurses think and feel about their professions.  This anthology, a collection of poetry and essays, looks at the various reasons these authors went into nursing in the first place, how nursing changed them, and why they either stayed the course or went on to other pursuits.  As the editors say in the Introduction, "nursing abounds with experiences that can either reinforce our vocational commitment or cause us to reconsider it" (p. xi).

In the first section, "The Calling," poems and essays examine "the idealistic reflections of those aglow with nursing's promise of intimacy and connection" (xii).  Here we meet student nurses with a true calling who are "living, breathing and sleeping nursing" (p.5), and students who are sure they are going "to murder someone" (p. 6).  Like most professionals, nurses often have mentors, and those mentors--"brisk, frank, fast, sometimes sharp" (p. 30)---are honored in this section as well.  Readers, upon completing this section, will be moved and cheered by the poems and essays that reflect the romance of nursing and the intense drive that many nurses have to give of themselves to others. 

The editors, however, are no Polyannas.  They know that a student's illusions and dreams will run right smack into reality.  While the rewards will certainly be many, the discouragements will be present as well.  The fact that both experiences---the highs and the lows---can occur within a single day is reflected in the collection's second section, "The Reckoning."  Here the realities of death, exhaustion, burnout and doubt are faced full on.  Some of the works in this section are by nurses who have chosen to leave the profession:  "Brazil, the new hospital.  We have no water.  Doctors protest poor facilities by refusing to see patients and sitting in their cars outside in the parking lot" (p. 81), writes Veneta Masson as she traces her career from 1958 to 1998 when she decides to leave nursing and "use my hands to write and to bless" (p. 84).  While some have chosen to leave, other nurses have found ways to survive: "Nursing allowed me to help my mother die; my music has helped me live" (p. 88) writes Colleen O'Brien, and Fr. Robert J. Kus writes about his dual roles, priest and nurse, how they balance and enhance one another (pp. 102-110).  The works in this section remind readers of the sacrifices caregivers must make every day.  As Jo Ann Papich writes, "Please appreciate your nurse while you still have one" (p. 99).

Section Three, "Reincarnation," tells of the "informed commitment that arises after sustained trial" (p. 165).  Here nurse-writers talk about survival and the oddly comfortable balance between stress and transcendence that comes, at last, after many years in nursing.  In "Why I Like Dead People," Sallie Tisdale takes a wry look at death, nursing homes and their "cockeyed logic" (p. 175).  Anne Webster, in "Slow Night in the E.R." talks about doing what you must do to help others even when you "can't do it," when you "stand outside the curtain, shaking" until the patient asks, "Are you there?" (p. 186-7).  Kathryn Gahl, in "The Reason Nurses Write Mostly Poetry" says it's because nurses "convert heart sounds // and hard words into art before the next patient / arrives, hemorrhaging, counting on that nurse / to flow like a pen, bleed for both of them" (p. 195).  And in the book's final essay, "I'm Staying," Shirley Stephenson offers a series of lovely statements about why she, and others, might continue in the frustrating, tiring, challenging and miraculous profession of nursing.  "Because I have been in the bed, and beside the bed. Because I have waited. Because I believe any one of us could face the circumstances of those for whom we provide care, and we're much more similar than different. Because this is where the rhythm is loudest---yes this yes this yes this yes this" (p. 246).

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In his debut novel, Dr. Khaled Hosseini tells a tale that begins in his homeland, Afghanistan, and ends in his adopted country, the United States. Amir, son of a wealthy Pashtun merchant, narrates the story. Amir and his father, Baba, are attended by two Hazara servants, Ali and his hare-lipped son, Hassan. Amir and Hassan are friends, but Amir is troubled by a guilty conscience over multiple slights and sly insults aimed at Hassan. The burden of guilt intensifies over an incident at a kite-flying contest when Amir is twelve years old.

Kite flying in Afghanistan is an intricate affair involving glass-embedded string that contestants use to slice the strings of other kites. The winner is not only the one with the last kite flying, but also the one who catches the last cut kite--the kite runner. At the close of the contest, Amir witnesses the traumatization of his friend Hassan, the finest kite runner, at the hands of an evil youth, Assef. Too shamed to help Hassan, Amir is nearly swallowed by his cowardice: the rest of the story follows the consequences of his guilt.

Amir and Baba emigrate to the United States during the Soviet invasion of Afghanistan, but Amir, as a young adult, returns during the Taliban regime in order to redeem himself and help Hassan's son. The story is filled with plot twists and revelations of secrets and hidden relationships, which enable Amir to confront some of his shortcomings. The oppression, torture, and murder of Afghanis by the Taliban are graphically depicted.

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Author Jennifer Culkin has been involved, for all of her nursing career, in high stakes, heart stopping, instant-decision-making areas of critical care.  After years working in Neonatal Intensive Care, she became a flight nurse--and giving intensive care to trauma victims while trying to maintain balance and sterile technique in a wind-buffeted helicopter has to be one of the most difficult tasks a nurse might undertake.  Her memoir, A Final Arc of Sky, opens with such a scene.  The patient, Doug, is soon crashing, and the nursing team, Jennifer and her partner, have to make a series of tough decisions (pp. 8-12).  From this scene on, the action rarely wavers.  And although Culkin keeps the pace moving, she is not always, or even most often, telling us about similar traumas.  She deftly weaves her personal narrative--husband and sons and dying parents--in and out of scenes from her nursing career, braiding the plot lines of her life in chapters both moving and compelling. 

In those chapters that deal with the often dangerous helicopter transports Culkin has flown, we learn (and we feel) just what it's like to be a flight nurse crammed in-between patient and helicopter door, juggling instruments that too often slip to the floor and trying to save patients that too often want to die.  In those pages that deal with family, we are privy to Culkin's internal debate about how to separate family from nursing (what she calls "the great neuronal divide between my work and my life" (p.136), and we see that she sometimes doesn't have much energy left at the end of the day to draw close to those she loves.  Part of what makes this memoir difficult to put down is the persona of the narrator herself: Culkin comes across as an honest, often irreverent risk taker, a woman who likes to ride her bike down dangerous hills at breakneck speed and allows her son to do the same (see chapter six, p. 57); a woman who loves the dangerous drama of flight nursing and doesn't worry about crashing (p. 80)--in fact she enjoys strapping herself "into the eye of a maelstrom" (p. 80). 

This memoir entertains, and it provides a glimpse into how some caregivers not only risk their lives to save the lives of others but also shoulder the responsibility of making split second decisions upon which a patient's life might depend.  And there is a surprise in this memoir, one that I can't too fully divulge because to do so would be to rob potential readers of their own discovery.  Suffice it to say that near the end, Culkin reveals something about her own health, an illness she has fought against in every chapter.  When we learn the details of her own illness narrative, we look again, with new understanding, at her fascinating career and her interactions with her loved ones.   

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In this candid chronicle of what many would call a prolonged depression occasioned in part by her husband's illness and death, Norris, a popular memoirist and essayist, seeks carefully to distinguish the psychological or psycho-medical category of "depression" from the spiritual state of "acedia" or, more bluntly, "sloth," in its oldest and most precise sense.  In doing so she raises important questions about widespread and often imprecise use of categories derived from clinical psychology, an imprecision that may muddy the distinction between spiritual and psychopathological experience.

"Acedia" she defines as a failure of will, signifying a need for spiritual guidance and prayer, whereas "depression" requires medical treatment.  Going beyond the confessional, Norris suggests that acedia may be an endemic condition among middle-class Americans, over-busy but spiritually slothful.  The book is loosely organized, often characteristically lyrical, and more invitational than diagnostic.  Her purpose, finally, seems to be to inspire readers to embrace simple life-giving spiritual disciplines like reading the Psalms as a stay against excessive self-preoccupation and actual depression as well as spiritual depletion.  

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Testifying to its author's "fascination with death" (324), this scholarly and abundantly illustrated work focuses on the history of the American idea of the Good Death as this concept took shape during the Civil War. Frederic Law Olmstead used the phrase "republic of suffering" to describe the many wounded and dying soldiers being treated at Union hospital ships on the Virginia Peninsula. Faust argues that the task of dealing with more than half a million dead during the War motivated Americans in the North and South to discover cultural and physical measures of interpreting and coping with the suffering and loss that occurred in thousands of families.

The scale of this War was unprecedented due to rifles and railroads; however, Gilpin Faust reminds us that twice as many soldiers died of disease as died of wounds suffered in the conflict. The illnesses were epidemics of measles, mumps and smallpox, then diarrhea and dysentery, typhoid and malaria. Medical care was inadequate; consequently, soldiers and their families turned to spiritual consolation. The Good Death was identified as sacrificing your life for the cause; many  believed in the Christian idea of resurrection and the afterlife. Killing became work,  as African American soldiers fought for "God, race and country" (53), where  Southerners fought to preserve the status quo, including slavery.

Because of the War, public cemeteries and ceremonies, and government's identifying and counting the dead are now taken for granted. Because of the Civil War, bodies of the dead military are today brought back from foreign lands and honored with decent burial: "We still seek to use our deaths to create meaning where we are not sure any exists" (271).

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Filmed at Shands (teaching) Hospital in Florida, this documentary validates the importance of the arts and expressive therapies in all aspects of health care, including medical education. Pediatric oncologist John Graham-Pole and poetry therapist John Fox -often as a team- work with patients of all ages in groups and at the bedside.   Other physicians including a neuroscientist provide rational explanations of the release of endorphins and brain changes resulting from creative activities.  Though the healing process initiated by the reflective act of writing poetry is ostensibly the focus of the film, the documentary is permeated with the transforming effects of dance and art therapies in their ability to lessen physical and emotional pain; the importance of healing environments, not just paintings in lobbies, but in patient created ceiling tiles and wall installations; and especially the warmth, intimacy and humanity generated by exemplary physician communication skills.

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Body Language, a beautifully crafted and expansive memoir by retired nurse Constance Studer, spans a range of issues within the narrative of the author's life: a childhood marred by a medical procedure--a hasty frontal lobotomy that left her father incarcerated in a mental institute-- and, in later years, by her own illness, one caused by the Hepatitis B vaccine.  These two events are the bookends that frame Body Language, a memoir that examines family life, nursing, medicine, medical ethics, personal survival and illness in language that is poetic and compelling.  Studer, a writer as well as a nurse, intersperses her own story--which is novel-like in its intensity--with literary allusions, research material and knowledge culled from her years as a nurse in Intensive Care.  In her memoir, she writes not only with the authority of one who has been on both sides of the bed, as professional caregiver and as suffering patient, but also as a family member who has witnessed how unwise and unchallenged medical decisions might affect generations. 

What I especially admire about this memoir is that it is not simply a "telling about."  Instead Studer brings us into the action of the narrative, for example giving us imagery and dialogue as her father prepares for the surgery that he doesn't know will deprive him of memory and sense ("Holy Socks" p. 21).  She also intertwines many narrative strands, giving us the fullness of her family history and her professional adventures, so that when we reach the narrative of her own illness we have a sense of a life, a full life, that has been forever altered.

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Ethiopia, 1954. Twin boys conjoined at the head survive a surgical separation and a gruesome C-section delivery. Their mother, Sister Mary Joseph Praise, does not. The Carmelite nun, a native of India, dies in the same place where she worked as a nurse - the operating room of a small hospital in Addis Ababa. The facility is dubbed Missing Hospital, and it is staffed by some remarkable people.

Thomas Stone is a British general surgeon. The only thing that he loves more than medicine is Sister Praise. When she dies during childbirth, he has a meltdown - abruptly fleeing the hospital and leaving Africa. Although Thomas Stone is the father of the twins, he blames the babies for the nun's death. Decades later, he is working at a prestigious medical center in Boston where he specializes in hepatic surgery and research on liver transplantation. The twins are raised by two physicians at Missing Hospital - Dr. Ghosh and Dr. Hemlatha (Hema) - who get married. Hema is an obstetrician-gynecologist. Ghosh is an internist who becomes the hospital's surgeon by necessity after Thomas Stone departs.

The fate of the twin boys, Marion Stone and Shiva Stone, is sculpted by their experiences at Missing Hospital and the growing pains of Ethiopia. The African nation is full of possibilities and mayhem. Both boys are highly intelligent and unusually bonded. Shiva is eccentric and empathic. Although he never attends medical school, Ghosh and Hema train him. Shiva becomes a world authority on treating vaginal fistulas. Marion narrates the story. He is repeatedly hurt by love. The girl of his dreams, Genet, opts to have her first sexual encounter with Shiva. Genet plays a role in hijacking an airplane and rebels against the Ethiopian government. Although innocent, Marion comes under suspicion because of her actions. He escapes the country for his own safety.

Like his father, Marion lands in America. He completes his residency training as a trauma surgeon in New York. He locates his biological father but reconciliation is difficult for both men. Genet has also come to America. She shows up at Marion's apartment, and they have sexual intercourse. Genet exposes him to tuberculosis and Hepatitis B. Marion delevelops liver failure due to hepatitis. He is going to die. Shiva and Hema travel to New York to be with Marion. Shiva proposes an experimental treatment for his brother - a living donor liver transplantation. After all, there is no better organ donor than an identical twin. Thomas Stone performs the operation along with one of Marion's coleagues. The surgery is successful. Then Shiva has bleeding in his brain and dies. Marion returns to Ethiopia and Missing Hospital. Half a century removed from his birth, Marion is back at home and still conected to his twin brother. The lobe of liver donated by Shiva is functioning perfectly.

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Intended to "spark a philosophical dialogue among readers and in classrooms, clarifying, refining, and challenging the ethical positions people hold on a great many bioethical topics"(1), Bioethics at the Movies contains 21 essays discussing bioethical issues, from abortion and cloning to disability narratives and end-of-life care, in relation to various films. The two dozen authors come from the United States, Spain, Australia, Israel and the United Kingdom, and the majority have their academic homes in Departments of Philosophy. For the most part, the essays use one particular film as a springboard to discuss a bioethical topic, such as terminating pregnancies (The Cider House Rules), marketing organs (Dirty Pretty Things), and memory deletion (Eternal Sunshine of the Spotless Mind). Two films get a pair of essays (Gattaca and Million Dollar Baby), and several authors cover more than one film. In addition to the aforementioned films, Wit, Citizen Ruth, Bicentennial Man, I, Robot, Babe, Multiplicity, Star Trek: Nemesis, Ghost in the Shell, Dad, Critical Care, Big Fish, Soylent Green, Extreme Measures, Talk to Her, and Ikiru are closely covered.

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When diagnosed with Amyotrophic Lateral Sclerosis (ALS) at age 36, filmmaker Ben Byer began recording a video diary.  Episodes from his diary create the engaging, coherent narrative of "Indestructible," a documentary that intimately, but unsentimentally invites viewers to witness Byer's and his family's responses to his diagnosis.  Their first impulse is to search for a cure for this degenerative disease, "the grim reaper of neurological diseases," a physician tells him.  They also find themselves seeking ways to understand living with loss, most centrally losing the illusion of control over their lives. 

Over the course of three years Byer and family travel to six countries, including Greece, China, Tibet, and Israel.  During his journey, Byer, an irrepressible extrovert, also seeks the companionship and insights of other ALS patients and families, wishing to create a world-wide bond among people who struggle daily.   A montage of clips from family videos prefaces the film, revealing Byer in the decades before his diagnosis.  The images show a luminous child, who grows into a playful, photogenically handsome teen ager and young man, husband, father, son, and brother.  His exceptional force of personality, incandescent smile, and spontaneous sense of humor fill the screen.  These robust images contrast touchingly with the thinner, clumsier Byer who later struggles to remove a t-shirt.  But they also reveal continuities between Byer's capacity to enjoy his life during seemingly carefree days and his strength of spirit as he becomes increasingly more disabled, disappointed, and introspective.  Although even such strength can't alter his condition, it nonetheless sees him through to the next day and fresh adventure.

The family in the montage and the film emerge as Byer's source of support as well as conflict.  One of the most devastating conflicts arises from his father Steve's restless determination to find treatments to reverse or retard ALS.  After searching the Internet for remedies, Steve turns his garage into an ad hoc distribution center for an herbal concoction he encourages his son to drink.  To advance his son's place on the waiting list of a Chinese neurosurgeon who performs olfactory cell transplantation, he recruits other ALS patients for the procedure.  The results are dubious, in some cases perhaps fatal.  After these strategies fail to reverse Byer's physical decline, and place others at risk, the camera rolls during a family showdown that exposes their fears and desperation as it acknowledges their love.  This memorable scene does so in a way that's consistent with the rest of the film: by letting the camera show, not tell. 

Even the many moments when Byer's family help him with daily activities and his most reflective moments at the end of his film resist sentimentality and easy didacticism.  Byer's equally irrepressible young son John raises a fork wound thick with pasta to his father's mouth and loops his belt through his pants, setting off giggles all around.  The ordinariness and extraordinariness of these acts, the learning of selflessness, the uneasy acceptance of dependency, the inevitability of loss are told through such images or captured in fragments lifted from daily conversations.  Bathing Byer, his brother Josh matter-of-factly says, "You don't have all the time in the world":  a searing acknowledgment of Byer's decline that reminds us of all human fragility.  The closing scenes of the film unobtrusively place Byer's solitary experience in the long history of the search for meaning in human struggle.  They record his wobbly, yet victorious ascent of Masada, supported by Josh, right after we hear a rabbi recount Camus's version of the myth of Sisyphus. 

 

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