Summary:

As Audrey Young describes her process of becoming a compassionate internist in a besieged public hospital, she simultaneously argues for turning the hospital's patient care and financial practices into a model for improving health care in America.  Young, a compelling storyteller, first entered Seattle's Harborview Medical Center in 1996 as a third-year medical student on trauma surgery service.  She completed a residency there in general internal medicine and stayed on as an attending for six more years.  She stayed, she tells us, because she met physicians "committed to a vision of equality" who were "the sort of people I hoped to become" (xiii).   She also "fell in love" with "the story of a unique place" (xiii).  Young's stories of that often chaotic place, where ambulances regularly transport homeless, indigent, addicted, and mentally ill refugees from neighboring private hospitals, emphasizes the ways the Harborview staff manages to treat patients with dignity and to choose an ethic of hope in the face of dire circumstances.           

We quickly learn that at Harborview compassion is expressed concretely as actions toward patients.  Michael Copass, known as "the mostly benign dictator of emergency operations," pronounced the core of these actions in what came to be known as his commandments:  "1. Work hard.  2. Be polite.  3. Treat the patient graciously, even if he is not the president of the United States" (9).  Politeness always meant asking "'How may I help you, sir?'" regardless of the patient's social status or addiction history.  Politeness sometimes meant finding a way to reach the patient who regularly threatened the staff.  Young finds ways and creates a therapeutic bond.  But working hard and treating patients considerately also took measurable forms, such as not allowing emergency patients to wait.  Facing a flurry of admissions, the Emergency Department (ED) staff interpreted a young Ethiopian's complaints about pain as a drug addict's ploy.  Because Young glanced at the admissions board and noticed that he remained unattended for three hours--far longer than Copass could tolerate--she jumped into action.  He suffered, she discovered, from a collapsed lung. 

However, Young moves her narrative beyond individual doctor and patient encounters and into the larger, interrelated social and financial structures in which medicine is practiced.  For instance, she links meager funding for drug and alcohol rehabilitation programs with expensive ED admissions and rising healthcare costs.  In the chapter "Bunks for Drunks," Young visits an experimental residence that houses homeless addicts in furnished studios with private baths and cooking appliances.  Although residents can keep alcohol in their rooms and elect not to participate in the home's social services, including counseling, alcohol consumption and ED admissions decrease.  While the chapter points out the cost savings of such arrangements, Young further urges readers to value the dignity residents experience there.

In "Black Friday," Young details the hospital's tense, but ingenious responses to a Mass Casualty Incident, the result of carbon monoxide poisoning, which almost depleted the resources of all of Seattle's medical centers.  The final chapter, "A Vision," outlines how Harborview has tried to succeed as both a charitable institution and a business, as a provider of both indigent and luxury care, with the hope that others will follow the medical center's example.  However, in presenting her recommendations for "health justice," Audrey Young also makes the case that "seemingly ordinary citizens" are implicated in healthcare reform (231).  To enable their informed participation in making changes, Young includes an appendix with further readings and another that lists strategies for effecting reform.  

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The book's chapters derive from a conference entitled "Representing Autism: Writing, Cognition, Disability" held in 2005. Contributors are scholars of English, communication studies, psychology, and other disciplines; some are on the autism spectrum themselves or are parents of autistic people. The book attempts to address what editor Mark Osteen in his introduction cites as a deficit in the field of disability studies, namely that the field has ignored cognitive disabilities. Osteen notes that autism is a spectrum not only among people but within individuals: "any given autistic person's abilities will occupy different locations on [the spectrum] at different times" (7) but a severely autistic person is not merely "different." The editor also addresses the question of self- representation, arguing that "we must strive to speak not for but with those unable or unwilling to communicate through orthodox modes" (7).

The book is divided into four sections: Clinical Constructions, Autistry, Autist Biography, and Popular Representations. Clinical Constructions includes a chapter on Virginia Axline's work with the boy, Dibs (see Dibs: In Search of Self in this database), a child who is now thought to have been autistic; and a chapter on how Bruno Bettelheim convinced the world of science and the public that autism was caused by parental behavior, especially that of mothers ("refrigerator mothers") and that he knew how to cure it. The essayists show how these two psychologists constructed a persona of omnipotence that enabled them to appear to "save" autistic children. Chapter 3 reviews the history of autism as a named condition and contextualizes it.

Chapters in the section on Autistry discuss the mental world of people with autism. Patrick McDonagh (chapter 4) postulates that "the capacity to perceive autism in the 1940s may be connected to the proliferation of modern, and modernist, notions of the self" (102) -- for example, isolation and alienation, and "the removal of referential and conventionally communicative functions from language" (111) that appear in the works of Gertrude Stein, Virginia Woolf, James Joyce. Subsequent chapters apply theories of information processing (chapter 5), metaphor and metonymy (chapter 6), and narrative (chapter 8) to an understanding of the mental world of autistic individuals, and chapter 7 discusses poetry written by autistics.

The section on Autist Biography concerns memoirs written by parents of autistic children. Deborah Cumberland contrasts the memoirs of several mothers with one written by a father (chapter 9) and Sheryl Stevenson (chapter 10) writes about the rhetorical strategies that mothers use "to negotiate contradictions of motherhood that are exacerbated by autism and their own privileged abilities" (199).

The essays in the section, Popular Representations, concern several films and Mark Haddon's novel, The Curious Incident of the Dog in the Night-Time (see annotation). Anthony Baker presents an "autistic formula" used in films and notes that the plots hinge on the way a central character who is not autistic uses the "special powers" of the autistic character, thereby robbing the latter of agency (Chapter 12). Stuart Murray is also critical of how films portray autistic people (Chapter 13). Phil Schwarz, father of a child with Asperger's and an Asperger's adult himself writes about four films ( Thirty-Two Short Films About Glenn Gould,  Smoke Signals, Breaking the Code, The Secret of Roan Inish) he uses to raise the consciousness of autistic peers and to promote self-esteem in the face of society's attitudes toward autistic individuals (Chapter 14).

The authors of chapters 15 and 16 come to different conclusions about the novel, The Curious Incident of the Dog in the Nighttime. Gyasi Burks-Abbott, "a 34 year-old African-American male on the autism spectrum" (303), criticizes the novel for perpetuating stereotypes and for "relegat[ing] the autistic to otherworldliness while establishing a non-autistic author like himself as the necessary medium between autistic and non-autistic reality" (295). James Berger, on the other hand, argues that Haddon uses the protagonist Christopher to "explore questions about language and social relations" (fn1, 286) and observes that Haddon understands human neurological features as a continuum.

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In 2008, editor and physician Paul Gross launched a new online publication, "Pulse--voices from the heart of medicine" (published by the Department of Family and Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center). This anthology contains every poem and first-person narrative published during Pulse's first year, arranged in five sections corresponding to publication date and not to theme: Spring, Summer, Autumn, Winter, and Spring.  Paul Gross, in his introduction, states "After more than a decade of practice as a family doctor, I came to appreciate that the science I'd learned in medical school, though powerful and useful, was also incomplete . . . . it contained much truth about illness and healing, but not the whole truth" (xvii).  Like many other caregivers, Gross discovered "that writing and sharing my healthcare stories with others was therapeutic" (xviii).  He looked to "Sun Magazine" as an example of how first person narratives, both prose and poems, could turn "hurts and triumphs into something potentially beautiful, funny or moving" (xviii). 

The poems and prose that arrive every Friday online to Pulse's thousands of subscribers (and the selections in this anthology) are carefully screened by the editors according to these guidelines: the stories have to be first-person, and they have to be true, recounting the writer's own experience.  Submissions are accepted from any person involved in healthcare.  The language used must be "clear, simple language.  No medical jargon. No arcane literary devices" (xx).  Gross and his editors decided that Pulse would not be a medical journal nor a literary magazine--its purpose fell outside the perimeters of both genres--and so Pulse, and this anthology, offers work that is, in a refreshing and honest way, different from the slick or more polished poetry and prose that might be found elsewhere.

In reading this anthology from cover to cover, and so from season to season, I found that the poems and prose seemed to fall into several categories: Personal musings, in which authors relate healthcare experiences that engender intimate and revealing narratives about their own lives--among the best of these are "Well Baby Check," p.3; "Finding Innisfree," p. 31; "First Patient," p. 39; "Losing Tyrek," p. 45; "Carmen's Story," p. 62; and "Chemo? No Thanks," p. 106.  Other pieces are commentaries on the other side of healthcare, the one that cries out for reform and affects both patients and caregivers.  Among the best of these are "Redesigning the Practice of Medicine," p. 9; "A Brush with the Beast," p. 22; "Rx," p. 60; "Halloween Horrors," p. 69; and "Brain Cutting," p. 136.

Other pieces are humorous ("Aunt Helen Sees a Ghost," p. 6) or political ("My War Story," p. 11), and many poems and prose pieces speak of patient encounters or about being a patient, some more anecdotal, relating a specific incident that affected the author ("Once," p. 41) and others multi-layered, some relating medical student or intern experiences ("Jeannie," p. 48; "A View from Nepal," p. 87; "Ripped from the Headlights," p. 90; "Snowscape," p. 97; "First Night Call," p. 100; and "Wounded Messenger," p. 114.)  The "category" I found most interesting and most unique are the selections I will call "confessions."  These writings--demonstrating openess and bravery on the part of the authors--tell of regrets, mistakes, sorrows, wrong calls and other mishaps that occur, daily, in the practice of healthcare.  In these, the most human face of caregiving is revealed.  Although most of the pieces in this anthology contain elements of "confession," the most specifically revealing include "Mothers and Meaning," p. 14; "Physician's Exasperation," p. 44; "Confidential," p. 53; "My Patient, My Friend," p. 73; and "Apologies," p. 104.

Editor's note: Coincidentally, a recent relevant paper on confessional writing by physicians expounds further on this topic:"Bless Me Reader for I Have Sinned: physicians and confessional writing" by Delese Wear and Therese Jones (Perspectives in Biology and Medicine, Vo. 53, No.2, Spring 2010, pp. 215-30).

 

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In 1818, the newly trained physician, John Keats (1795-1821) (Ben Wishaw) is living with his well-off friend, Charles Brown (Paul Schneider), and they are trying to devote themselves to the art of writing. Keats cannot abide the idea of having to practice medicine. 

The uneducated, fashion-conscious Fanny Brawne (Abbie Cornish), notices Keats, moved by the care that he bestows on his dying brother. She offers a gift of a beautifully embroidered pillow, which soon finds it way into the lad’s coffin.

Affected by the young man’s death and the mystery of poetry, Fanny flings herself at Keats, undeterred by Brown’s open disapproval of her lack of class, education and bearing. Flattering his work, she asks Keats for lessons in literature and then reveals herself to a reasonable judge of poetry. In spite of himself Keats is drawn to her and declares his love.

But the poet’s health is fragile. Funds are raised to send him to Italy, and Keats announces that he must go, because his friends have decided. He seems to know that he will die. Fanny is brave and hopeful. Chastened, Charles Brown comes to Fanny’s home to announce the death of Keats in Rome.

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Séraphine (Yolande Moreau) is a housekeeper, ill-treated by her employers, but she finds solace in painting naïve images of flowers, fruit, and birds, using vivid colours that she makes herself from plants and animals. Her mistress rejects the art as junk.

Séraphine sympathizes with the apparent loneliness of the German tenant Uhde (Ulrich Tukur) who is a connaisseur of art. He admires one of her tableaux and is astonished to discover that the artist is his housekeeper. He encourages her and buys some paintings.  But war in 1914 forces him to return to Germany.

Spiralling downward deeper into poverty and mental alienation, Séraphine continues to paint works that grow larger, bolder, and more colorful. Finally her bizarre behavior leads to her arrest and commital in an insane asylum, and her painting ceases.

Uhde eventually returns to France and organizes the first Naïve Art exhibition featuring work by Henri Rousseau and Séraphine. But only years later does he bother to look for her. She is miserable. He arranges for her to be given a more comfortable room, but he doesn’t speak to her and she never paints again.

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Some 40 years after a ceasefire that ended the Cylon wars, the 12 human colonies across the galaxy have been lulled into a state of calm complacence.  This is abruptly interrupted by a Cylon attack that annihilates billions of humans, leaving only 50,000 survivors in a small fleet of ships, led by the one remaining ship from the Colonial Fleet, the Battlestar Galactica.  Fleeing the Cylons, they set out to find the legendary 13th Colony: Earth.

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This book is exactly what it claims to be in the title. Dr. Ofri gives us fifteen clinical tales, each of which describes a lesson she has learned from a patient or from her own experience as a patient. It is an extension of her first book, Singular Intimacies: On Becoming a Doctor at Bellevue (see this database) and relates to her experiences after she completes residency training at Bellevue Hospital in New York City, to which she eventually returns as a staff physician. Three of the stories are examples of how a physician experiences the patient role, including one in which she relates an early personal experience to that of a patient she cares for ("Common Ground").

Since Ofri served as several locum-tenens, some of the stories take her to rural communities and small towns but most concern experiences with patients at Bellevue in clinics or in the hospital. She also discusses the challenges and limitations of teaching the next generation of doctors at Bellevue ("Terminal Thoughts").

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An animated documentary is the unlikely category assigned by producer/director/writer Ari Folman to this distinguished film.  In broad strokes the film is a memory-recovery narrative, the director’s pursuit to fill in the "black holes" in his recollection of the days, during the 1982 Lebanon War, surrounding the massacres at the Palestinian Refugee Camps of Sabra and Shatila by Christian supporters of the assassinated Phalangist leader Bashir Gemayal.  While the film finds its climax in the Palestinian genocide, along the way it examines the experience of ordinary Israeli soldiers in richly provocative storytelling –as these accounts are textured by a twenty-year time lapse, which offers perspective, insight, telling gaps, and small revelations, as, for example, when we learn that one character abandoned his ambitions to be a scientist after the war, left Israel to grow wealthy selling falafel in The Netherlands.

Folman recounts the soldiers’ narratives of disorientation, terror and loss by representing not only their experiences, but their dreams, hallucinations, distorted memories –all of which are rendered with exquisite power, mostly in vividly nightmarish cut-out animation. Added to these narratives are interviews with a psychologist, a trauma expert, a reporter who was on the scene at the refugee camps and others –adding texture and commentary to an already multi-layered story.

This films provides a fresh engagement with issues of memory and trauma, and explores the dynamics between the trauma of a nation –not only a war but the deep unexamined scar of “indirect responsibility” for a genocide— and the trauma of an individual soldier.  Representing the soldier’s war as a lonely, companionless and even passive experience, the film works to undermine a host of cinematic conventions. The viewer becomes alert to the paradox that the animation has the estranging effect of making what it recounts more “real” through its access to characters’ interior states.

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The story centers on Tsotsi (meaning thug), an adolescent in Soweto, the shantytown slum of modern Johannesburg, South Africa.  There Tsotsi (Presley Chweneyagai) leads a loose-knit gang of menacing thugs.  When gang members are first encountered, Butcher reveals his disturbing and sinister nature; Boston (Mothusi Magano), except for his alcoholism, represents a potentially thoughtful but ineffective source of goodness and decency; Aap (Kenneth Nkosi), a simpleton, is devoted to Tsotsi; and Tsotsi seethes with, as yet, inexplicable rage. 

As the story unfolds, a petty crime leads to senseless murder and an old wheelchair-bound man is threatened and cruelly abused.  Finally, Tsotsi, without gang participation, shoots a woman during an auto theft.  When he drives recklessly away, he discovers an infant in the stolen car's backseat.  Rather than killing the baby, his first inclination, he puts it into a paper bag and takes the baby home.  This new relationship--and responsibility becomes the harrowing twist in the story.   

Throughout, short and disturbing flash backs of Tsotsi's childhood reveal unimagined beginnings that have led to the boy's simmering rage and the string of unforgiving actions.  While concerns about vulnerable children within a context of social injustices are foremost in the minds of film viewers, the overwhelming circumstances and complexities frustrate thoughts about realistic interventions. 

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The film opens on the Coeur d'Alene Indian Reservation -- called "the rez" by its inhabitants -- in 1998. Immediately there is a flashback to July 4, 1976 when the community was celebrating "white man's Independence Day" in drunken abandon. Accidentally Arnold Joseph (Gary Farmer) sets an uncontrollable fire to his neighbor's house, killing the couple who live there. But Joseph catches the baby, Thomas, when he is thrown out of a second story window from the burning house. The rescued Thomas (Evan Adams) is brought up by his grandmother and along side of Victor (Adam Beach), Arnold Joseph's son of about the same age. Joseph keeps on drinking but is in despair about the conflagration and its consequences.

12-year-old Victor watches sullenly while his parents drink until one night he smashes all their beer bottles. This action is a wake-up call for Victor's mother, Arlene (Tantoo Cardinal), who insists that she and Arnold both stop drinking. She chases Arnold out of the house; he leaves, never to return, while Victor watches, sobbing. These elements of the story occur in flashbacks while the 20-year-old Victor and Thomas travel by bus to retrieve whatever they can of Arnold Joseph, who has died outside of Phoenix. The remaining story unfolds in that forsaken spot where Joseph lived in a trailer and befriended Suzy Song, a young Indian woman originally from New York.

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