Summary:

This posthumously published collection of essays by Dr. Klawans, an eminent neurologist and writer, explores the interactions between patient, family and neurologist and the implications of specific neurologic diseases. Klawans's special interest in neurology is movement disorders, such as Huntington's chorea and Parkinson's disease, but his outside interests range from evolutionary biology to classical music. His essays, therefore, focus on single patients or families, but the author weaves thoughts about his other interests into each "case."

The book is divided into two sections, "The Ascent of Cognitive Function" and "The Brain's Soft Spots: Programmed Cell Death, Prions, and Pain." In a brief preface, Klawans declares that this book is "more than just a set of clinical tales about interesting and at times downright peculiar patients" from his 35 years of practice, but rather it "humbly grapples with the 'whys' of our brain, not the 'hows.'" (pp. 9-10) In the preface, as well as in one essay, Klawans acknowledges the work and impact of fellow neurologist-writer Oliver Sacks ("Oliver is truly the father of us all." p 12).

The title essay concerns a six-year-old girl who was found, locked and completely speech-deprived, in a closet. Because she is still within the window of opportunity for language acquisition, "Lacey" quickly learns to speak, unlike Victor, the Wild Boy of Aveyron, whose story was immortalized in the François Truffaut film, L'enfant Sauvage. Klawans uses these stories as a launch pad to discuss the evolution of language, including a proposal that the cavewoman, not the man, was responsible for development of the human species as she taught her offspring language.

Other chapters focus on patients with epilepsy, Parkinson's disease, localized and hemispheric stroke, "painful-foot-and-toe syndrome, " and Creutzfeldt-Jakob disease. Two particularly memorable chapters concern Huntington's chorea and Refsum's disease. The chapter, "Anticipation," explores the profound ethical concerns of genetic testing for Huntington's chorea as applied to three generations of one particular family. In the chapter, "The Hermit of Thief River Falls," Klawans recollects his first year as a neurology resident, and his care of a reclusive patient with a rare eponymous illness, Refsum's disease--just in time for a visit by Refsum himself, a famous Norwegian neurologist.

The book concludes with a speculative "afterthought" about genetics, evolution, and the importance of extended "juvenilization" --the protracted post-natal development of Homo sapiens. This essay intertwines some of the threads regarding speech development and evolutionary biology, particularly brain development, that were introduced earlier in the text.

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A young boy tells us, "My cat Barney died last Friday. I was very sad." Barney's mother suggests he think of ten good things to tell about Barney at his funeral. The story details his feelings and, from his perspective, the way his parents and friend Annie deal with the loss, ritual of burial and questions of afterlife (heaven, Barney's whereabouts now).

After the funeral, and after helping his father in the garden, comes a new and comforting understanding--the tenth good thing is that Barney's body becomes part of the cyclical process of nature. Fertilizing trees, grass and "helping grow flowers," the boy tells his mother as she tucks him into bed, is "a pretty nice job for a cat."

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Consider the possibility of a man whose sense of hearing is so enhanced that he can discern the noise of the entire world and also mimic all the sounds made by men and beasts. Imagine a human being who can SEE sounds as well as hear them. It is little wonder that he would have an affinity and talent for music.

Johannes Elias Alder is such a musical genius born in 1803 with a preternatural gift of hearing. The illegitimate son of the village curate, Elias experiences a physical metamorphosis as a child and by the age of ten is already a man. He effortlessly composes magnificent music that he plays on the organ.

Although Elias falls in love with his cousin, Elsbeth, she marries another man. After this loss, he becomes tired of life. Elias commits suicide at the age of 22 by refusing to sleep and succumbing to starvation and an overdose of belladonna.

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Summary:

This stark and sensual poetry collection is divided into three sections. The first, "Graveyard Shift," introduces the narrator's themes: the keen observation of suffering; the questioning of God's role in such suffering; the way caregivers and patients meld in shared moments of trauma; the struggle to integrate the reality of death and grief into a life outside the healthcare arena.

A longer second section, "Lessons," contains a chronology of poems that broaden the poet's themes. Suffering becomes personal through sexual abuse ("The Burning"), death of a baby ("To the Woman in the Next Bed," "Waiting Room," "Last Lullaby for the Dead Child"), and breast cancer ("Keeping Watch"); the mystery of God's role becomes the narrator's religious quest.

The final section, "The Ones Who Come," opens these themes to the universal: children and adults lost to "the holocausts" of war, poverty, and illness ("Lizard Whiskey: A Parting Gift from Viet Nam," "After the Siege," "The Ones Who Come," "The Man Who Stays Sane"), and how history repeats these cycles of birth, suffering, and death.

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Alice Goodwin is the wife of Howard, a midwestern dairy farmer, the mother of two daughters aged five and three, and the nurse at a local elementary school. She and her friend, Theresa Collins, a family therapist who lives in the nearby suburbs, take turns watching each other's children. One morning, while Alice is momentarily distracted, Theresa's two-year-old daughter, Lizzy, falls into the pond on the Goodwin farm. Despite Alice's attempts to resuscitate her, she dies after three days in the hospital.

Not long after, while she is severely depressed, Alice is arrested on (false) charges of sexually abusing some of the schoolchildren in her care. Confused, and thinking only of Lizzy's drowning, Alice says to the police, "I hurt everybody." They take this to be a confession.

She spends three months in prison awaiting trial, until Howard sells the farm to pay her bond. The novel gives us both Alice's experiences in prison--in a world she had hardly imagined--and Howard's struggle to take care of their children. Theresa, who seems never to have blamed Alice for her child's death, helps him and they develop a powerful bond. The novel ends with the trial, in which Alice is exonerated, and their family's tentative beginning of a new, urban life.

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Traumatized from a small plane accident that killed his parents and sister and injured him, Finn has returned to his grandmother's farm in Vermont where he's always spent happy summers, to regroup and continue his life. His trauma has left him unable to speak.

At the farm he is surrounded by the healing presences of his grandmother, an old summer friend, Julia, and the animals. Between painful flashback memories of the accident, Finn begins to allow himself to enjoy moments, especially in the tolerant and undemanding presence of the girl and the woman who are also grieving, but who find ways to help him reclaim life and the present.

Visiting an old childhood hideaway in nearby pine woods, Finn and Julia run into drug dealers who use the isolated spot for their transactions. Finn finally finds his voice when he is forced to rescue Julia in the midst of a spreading fire from an abandoned well into which she was dropped by a panicked drug dealer who feared exposure.

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Erin Bennett, a high school senior, faces the possibility of missing out on the senior play because of the violent headaches that have afflicted her since her sister's death a year before in a car accident. No physical cause has been found for the headaches, and her parents have insisted that she see a psychotherapist. Erin goes, resentfully at first, and after a few weeks begins to accept the possibility that her continuing pain may have something to do with the stress of unresolved grief which is exacerbated by various trigger events.

She is cast in West Side Story opposite David, to whom she takes an instant dislike, though she has the haunting feeling she has seen him before. Attracted to her, he pursues her despite fairly direct rejection, until Erin figures out where she's seen him: she took her sister's place once in clown costume and makeup at a party where he was also a clown.

David, whose little sister is hearing impaired, helps bring Erin to a place of acknowledging the ways in which she is hanging on both to her grief and to unresolved anger at her sister's boyfriend. She also blames herself for the accident, since she asked her sister to take the car on an errand in her place.

At a final counseling session, the therapist helps Erin and her parents understand how, in focusing attention on Erin's headaches instead of their own unattended grief, they have become "stuck" in a loop of stress and alienation. Going through a trunk of her sister's things, Erin finds a way ritually to say good-bye and joins David at a party with a renewed willingness to choose life and a hope that she can free herself from both blame and pain.

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Jacob Hansen is sheriff, undertaker, and pastor in the little Wisconsin town of friendship. A Civil War veteran like many of the men in his town, he has seen many faces of death and knows how to balance compassion, prayer, and practicality in the presence of grief. When he recognizes a diphtheria epidemic as one after another the people of Friendship fall ill and die, he has to shoulder responsibility for protecting public health.

This means imposing and enforcing quarantine, extending even to the encampment of religious revivalists at the edge of town who mostly keep their distance and their own ways. Jacob's equanimity falters when his wife and baby daughter succumb; he keeps them alive in his mind and unburied for days, unable to acknowledge his own loss, though he helps others through theirs.

Finally he forces a passing railroad engineer to transport the survivors across the quarantine border into a neighboring town for safety, but the train is sabotaged, wrecked, and the fugitives killed. Jacob survives almost alone to return to what is now a ghost town and cope with the grim fate of survival.

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Leandra lives alone in the backwoods of North Carolina where she makes a small but sufficient living repairing antique dolls for a dealer who sells them to collectors. The broken and ragged dolls occupy an old "mourner's bench" in her one-room cabin. For ten years she has lived in relative contentment, though she carries the pain of a trip to Boston when her sister bore a defective child who died.

The sister committed suicide soon thereafter. During that visit, as Leandra's sister withdrew into late-pregnancy depression and hostility, Leandra and Wim took comfort in one another's presence and finally fell in love. But after the suicide, Leandra returns to North Carolina with no intention of ever seeing Wim again.

Now, ten years later, he shows up on her doorstep, wanting to spend the final months of his life with her; he has inoperable brain cancer. He knows what course it is likely to take. He wants only to see her, but she insists that if he is to reenter her life, she wants to see him through all of it, even the worst parts.

They weather and cherish the days with gentle humor, frankness, careful sharing of memory, and the deepest love either has ever experienced. Leandra's neighbor, a friend from childhood, helps Wim build an extension onto Leandra's little cabin, one of several ways he finds to "provide for her" as he wishes he could have earlier.

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The story begins when Pearl comes home from school one day and learns from her mother that her grandfather has died. The following pages take us first through Pearl's feelings, how friends and family help her, her questions about the ritual of sitting shiva at her grandmother's house, her ways of remembering her grandfather. Her father helps her plant a garden, something she had shared with her grandfather, and when her grandmother sees the garden in the spring, she tells Pearl that her grandpa is still alive through her.

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