Summary:

In this series of six linked stories the narrator, Sara Boyd, weaves together stories of loss: her father's death when she was twelve, her husband's diagnosis of terminal kidney cancer, her mother's recurrent descent into mental illness, and even the death of a beloved dog. The stories merge in ways that reinforce the notion that new griefs bring up old ones, and that the trajectories of mourning are unpredictable and sometimes surprising in the conflicting currents of emotion they evoke. Sara doesn't present her life only in terms of losses, but the losses frame the story in such a way as to suggest that while key losses may not trump all other life-shaping events, they do organize and color them. The mother's mental illness is, in its way, a crueler loss than the death of Sara's beloved father, since hope of recovery keeps being dashed. Her siblings and children are marginal characters, but enter the stories enough to develop complex family contexts of caregiving.

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In 1543—the time of Henry VIII-Matthew Shardlake a hunchback lawyer, and his Jewish assistant, Barak, strive to solve a string of murders that, they quickly realize, are based on the seven vials in the Book of Revelation (chapter 16). They can almost predict when the next death will happen.

Barak is having trouble with his wife owing to a recent stillbirth that has deeply affected them both and driven them apart. Shardlake’s friend, Guy Malton, a Spanish-moorish physician acts as a medical consultant to their investigation. They encounter a boy and a woman both confined in Bethelham Hospital, the asylum known as Bedlam. A diagnostic dilemma arises over a problem of religious melancholy versus demonic possession.

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Zol Szabo, is public health doctor for the Hamilton Ontario region. He is also a single parent to nine year-old, Max, because his wife could not deal with Max’s mild physical disability. He is dating Colleen an attractive woman detective whom he met in the previous novel. The story opens with Zol’s angst over his son’s expensive misuse of a cell phone that he’d been given for safety reasons.

Soon he and his team are investigating cases of diarrhea in a seniors’ residence.  The diagnosis is difficult—but the doctors are confident they know what it is; however, the recommended treatments prove ineffective. Gradually they begin to suspect that the drugs are not working because they might be fake. Even worse, they notice that the people infected are all taking the same arthritis medicine—could that drug be the source of the infection?

In the background an unbending hospital administration and a hostile boss make the situation even worse.

A team of elderly friends who reside in the senior’s home collaborate to help solve the mystery. And of course the son’s cell phone is crucial to the dramatic conclusion.

 

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During World War II, a man is found beaten and unconscious in the streets of Trieste and brought to a German hospital ship. The Finnish-born doctor serving the German naval forces recognizes the name on his uniform as that of a vessal originating in Helsinki, the “Sampo Karjalainen." When the man wakes up, he has total amnesia; his memory loss has extended to language. In a crazy gesture of compassion, the doctor arranges for the man to be conveyed across war-torn Europe and home to Helsinki to be tended by a specialist. The doctor hopes that exposure to his homeland, its culture, and especially its language, will help the recovery of the man now called Sampo. They never see each other again.

Isolated and confused, Sampo, is given a bed in an empty visitors' ward of the hospital. The much awaited specialist never appears and Sampo never understands why. His closest friend is a tippling priest who teaches him Finnish through a reading of the Kalevala legends, libated with shots of Kosenkorva. He befriends some Russians who are housed briefly in his ward and he contemplates the hostilities between the nations. He wanders the city of Helsinki looking for triggers that may hand him back his identity – his past, a narrative. One of the nurses takes an interest in his case, shows him a special memory tree in a Helsinki park – and accepts his rejection of her affection with good grace. She is transferred to another place, but writes to him. He is unable to respond. She is angry.

In desperation Sampo joins the Finnish army and leaves for the eastern front. An epilogue tracks his demise and the doctor’s later discovery of his massive error. 

 

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Joan Didion's memoir, The Year of Magical Thinking, chronicled the overlap of two catastrophes: the critical illness of her adopted daughter Quintana Roo and the sudden death of her husband of forty years, John Dunne. Between the writing of that memoir and its publication in 2005, Quintana died at age 39. She had suffered a 20 month illness which started as a flu, advanced to pneumonia and sepsis, with intracranial hemorrhage and other complications necessitating 5 surgeries and extended intensive care unit stays. Blue Nights is a meditation on Quintana, and her mother's consuming sense of loss over the tragedy of her only child.

Blue nights refer to the quality of the light during evenings around summer solstice, a time of year which the author feels starts the whole cycle of diminishment and death. The memoir begins with a reminiscence of Quintana's wedding in July 2003 (the same year she falls ill and Dunne dies), as seen 7 years on by Didion. Throughout the description of the wedding are particulars of dress, flowers, design choices and locale which are not only precise, but also hold tremendous meaning to Didion. The branding of clothing, furniture, dishware, hotels etc, is dominant in many parts of the book - the Didion-Dunnes' family life was filled with movie stars, glamorous restaurants, and the hard work of writing. We see Didion on book tours and backstage during the Vanessa Redgrave one woman show of A Year of Magical Thinking.

Although Quintana's death and dying are prominent in the book, her whole life is explored. Issues of her adoption, her mental illness(es), her precociousness and talents, and above all, her relationship with her mother are intimately explored. The reader is given her childhood poems and descriptions of her nightmares and toys.

Another prominent theme is aging. The author was born in 1934, the same year, she notes, as Sophia Loren. Didion experiences neuromuscular problems and describes a particularly frightening episode of loss of consciousness and bleeding. She fears the deterioration of her cognitive abilities and laments she is unable to gain weight. She has a supportive and loving family and network of friends, but ultimately she ponders her aloneness, the lack of someone's name to write down on hospital forms as her emergency contact.  

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In this autobiographical novel, written while the author was under severe mental strain and as she recovered from psychotic breakdown, Head tracks the protagonist Elizabeth’s struggle to emerge from the oppressive social situation in which she finds herself, and from the nightmares and hallucinations that torment her. Elizabeth, like Bessie Head, was conceived in an out-of-wedlock union between a white woman of social standing, and a black man--a union outlawed by her country of birth, South Africa.

Like the author, Elizabeth leaves South Africa with her young son--but without her husband, from whom she is fleeing--to live in neighboring Botswana, a country that has escaped some of the worst evils of colonial domination. But in rural Botswana she is once again faced with a constricting social system as the African villagers are suspicious of her urban ways and frown upon her individualistic behavior. Further, they bear her ill will on racial grounds because she is light skinned like the "bushmen" who are a despised tribe there.

Elizabeth suffers not only social isolation but intellectual deprivation as well. One of the few people with whom she can converse as an intellectual equal is the American peace corps volunteer, Tom, who acknowledges that "men don’t really discuss the deep metaphysical profundities with women" (24). During the four years in which Elizabeth is plagued by tribal suspiciousness, terrifying dreams, economic hardships, and two hospitalizations for mental breakdown, it is Tom, and her own love for and obligation to her young son that help her to survive this ordeal.

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In the well-written preface, Arthur Kopit describes how he came to write Wings, a play about stroke and language disorder. And he explains there how his fictional account of strokes and their aftermath, "is a work of speculation informed by fact." One fact important to Kopit was that his father suffered a major stroke seven months before Kopit was commissioned by National Public Radio to write an original radio play.

Wings, (which has been sucessfully staged as well) however, is not based on Kopit's father, but on the life of a character, Emily Stilson, who is an amalgam of people, both stroke victims and their stroke-recovered caregivers, from the rehab center caring for Kopit's father. The title of the play refers to an early career of Emily Stilson--she was an airplane wingwalker. Kopit deftly employs the sounds of an airplane in the scenes in which Emily is experiencing a stroke. In fact, the sounds and sights inside and outside of Emily as well as her private dialogue are combined masterfully by Kopit to bring about a high degree of verisimilitude to the chaos produced by stroke.

The play is divided into four sections: "Prelude," the moments before her first stroke; "Catastrophe," her trip to and stay in an institution; "Awakening," a longer section dealing primarily with her struggle to reorient and regain language skills; and "Explorations," where further therapy, including group therapy, and her eventual demise are portrayed.

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Johanna Shapiro, Director of the Medical Humanities Program at University of California Irvine School of Medicine, brings her considerable skills and experience as medical educator, writer and literary critic to this unique volume of medical student poetry. Shapiro collected over 500 poems by medical students not only from her home institution but also from other US medical schools and performed a content and hermeneutic analysis. As Shapiro carefully details in her methodology section, she treats "poetry as a form of qualitative data, and [therefore] techniques of analysis developed for other sources of qualitative data (such as interviews, focus groups, and textual narratives) can be applied to an understanding of poetry." (p. 42)

Relying on the work of Arthur W. Frank (see The Wounded Storyteller), Shapiro devises a typology of student poems: chaos, restitution (and anti-restitution), journey, witnessing, and transcendence (this last category was not Frankian in origin). These categories are developed and explicated in Chapter 2: Functions of Writing for Medical Students. As the author notes, poems traverse the boundaries between types; nonetheless, the framework of the analysis rests with this typology. Further, Shapiro explores the metaphors of topography (illness as a foreign land) and quest (student on a heroic, however tentative or confused, journey) throughout her study.

The book contains many fully reproduced medical student poems, contextualized with academic theory on medical education. Hundreds of references, particularly in the fields of narratology and medical education, are cited. After three chapters of theory and methods, eight topics are explored using the outlined analytic tools: anatomy class, becoming a physician, patient experience, doctor-patient relationship, student-patient relationship, social and cultural issues, death and dying, love and life. Prefacing each of these topics is a scholarly essay providing historical and research foundations; every chapter concludes with a summation.

Within the chapters are examples of poems, not only organized by typology, but also by content. For instance in the patient experience chapter, the topics are: "patient pleas for empathy and compassion," "patient fears and suffering," "stigmatized voices," "vulnerability/courage of child patients," and "personal experiences of illness." Within each topic/subtopic, different poems are highlighted and fully analyzed. Additionally, other poems, not reproduced, are quoted as illustrative examples. Summary arguments are provided at the conclusion of each chapter as well as in the final chapter: "Strangers in a Strange Land: What Matters to Medical Students on Their Journey and How They Tell About It."

Although Shapiro states that her purpose "is not to address the literary and aesthetic attributes and value of the poems", she also notes "when students write authentically about their own experience, the results are uniformly moving, compelling and impossible to ignore." (pp 44-5) Indeed many of the poems are rewarding to read not only for content but also for word choice, word play, imagery and narrative line. For instance, in "Ode to the Peach" Brian McMichael explores the senses Neruda or Pollitt-like: "you invite me with / your voluptuous curves / your feminine little cleft". (p 236) Another example is the humorous, self-deprecating "Piriformis" by Curtis Nordstrom relating an early clinical experience by a medical student who hopes against hope that the patient's presenting complaint will require the student to demonstrate his acumen. Unfortunately the sum total of the student's knowledge base is limited to the location of the piriformis muscle; both the student and patient are "so screwed" when, "Alas, the patient presents with / an upper respiratory infection." (p. 16)

Shapiro's sensitivity and generosity of spirit vis-à-vis the medical student experience are evident throughout the volume. She concludes that "what may be most noteworthy about the analysis of these poems is that, amidst their own difficulties and fears, time and again these students reported engaging deeply with their patients." (p 259) She hopes that medical educators will be encouraged to support "in solidarity" the "idealism and high aspirations" expressed in these student poems. (p. 260)

In a postscript, Shapiro reveals her own experiences as a poet-patient. After noting that "[m]edical students are mostly annoyingly healthy, energetic, smart, and capable young adults who like order, structure, and control", (p 261) she also acknowledges how frequently students grapple with the topic of death and dying in their poems. That her poems emerged from advising a student creative writing group demonstrates how poetry can be renewing and vital not just to the student, but to the educator as well.

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On July 5, 1998, physics Professor Alan Cromer suffered a heart attack on a plane, and survived after almost an hour of resuscitation efforts, but sustained brain injury from lack of oxygen.  In this chronicle of caregiving, his wife, a psychiatric nurse by training, gives a very personal, detailed account of the radical adaptations his disability required of both of them.  Her story includes reflection on his and her own emotional adjustments to loss of parity in communication and awareness, practical adjustments to physical limitations, and social adjustments to family, friends and professional colleagues.

Arduously, over time, Alan regained some ability to read and speak--indeed, he spoke to groups with Janet about their life together during the peak of his rehabilitation.  But the road to even partial recovery was bumpy, and the writer fully acknowledges the pain, grief, irritation, and deep frustrations that intersected moments of authentic pleasure, discovery, and mutual kindness.  Professor Cromer died September 3, 2005.

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As explained in the succinct yet thorough introduction by co-editor Kimberly Myers, an international conference on the topic of "The Patient" was convened at Bucknell University in Pennsylvania in 2006. This collection of essays, which range from personal experience to scholarly literary critique, results from the conference presentations.
 
Of the ten essays, four concern personal or familial experience of illness. These four cover a vast range: literature and disability specialist Kristin Lindgren describes her story of the elusive diagnosis of chronic fatigue syndrome and her coping skills; medical humanities and medical ethics expert Carol Schilling offers a poignant narrative of her experience as a mother of a previously healthy, athletic son who suffers a cervical spine injury from a skiing accident; Gayle Whittier places the story of her daughter's disability amongst a trio of nonfictional and fictional narratives of disability and illness; and renowned poet Tess Gallagher explores her relationship with and caring of her mother who has Alzheimer's disease. These essays, written as they are by women steeped in literature and writing, are not merely chronicles; rather they are infused with commentary on story and the meaning of life as story, journey and relationship.
 
The other six essays are likewise diverse and range from cultural/political studies from the Navajo to the Irish (which includes literary analysis of works by poets Eavan Boland and Nuala Ní Dhomhnaill), to insightful critiques of literary works such as  Hjalmar Soderberg 's Doctor Glas, Lauren Slater's Lying: A Metaphorical Memoir, Brian Clark's Whose Life Is It Anyway?, Alejandros Amenabar's film The Sea Inside (Mar Adentro), and George (Marian Evans) Eliot's Janet's Repentance.

Consistent with the nature of medical humanities, the essays cross boundaries. For example, Whittier weaves her experiences as a mother of a disabled child with reflections on embodiment and literary critique. Gallagher compares the notions of time in poem-making with the necessity to live in the moment when caring for a loved one with Alzheimer's. She notes: "Of the written arts, poetry is most responsive to the moment and so coincides with the condensed time frame of those with Alzheimer's - which oscillates between the distant past and the present moment." (p. 71) Schilling tenderly writes of her family (for an illness strikes not just the patient): "We live the best lives we can, folding each of our stories into one another's." (p. 40) Diedrich explores not just the (at times infuriating) play with deceit in Lying, but also examines the ways in which patients lie and medical language obfuscates illness. She further explores, with great insight, expectations: of literary reviewers, patients and physicians.

 

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