Summary:

After several years as a firefighter, Paul Austin decided to return to school and become a doctor.  Both his training as firefighter and a somewhat late start at medical school gave him an unusual perspective on his selected specialty-emergency medicine.  The book chronicles a wide variety of surprises, learning moments, and challenges from his years in the emergency room.  These are interspersed with vignettes about the interrupted home life of an emergency physician rotating into night duty three to four times a month.  The pace is lively and the stories confessional in the best sense-rich with reflection on what he has learned, often at great cost to his resilient wife and three children, one with Down syndrome.  A strong theme in the book is the importance of developing strategies for sustaining humanity and compassion even under intense pressure to be quick, clinical, and detached. 

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Great Deeds Against the Dead is a mixed media rendering of Plate 39 of Goya's Disaster of War series. In Goya's original etching, three figures are strung up on a tree trunk, murdered and mutilated; the Chapmans use mannequins, wigs, and fake blood to create a lifesize sculpture.

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"Every year I bury a couple hundred of my townspeople. Another two or three dozen I take to the crematory to be burned.... I sell caskets, burial vaults, and urns for the ashes.... I am the only undertaker in this town." The speaker is Thomas Lynch, a poet, writer and funeral director in Milford, a small town in central Michigan, where he and his family have cared for the dead and the living for three generations. The words are the introduction to a documentary film which was written, produced and directed by Miri Navansky and Karen O'Connor for PBS Frontline and which is a visual, aural and dramatic companion to Lynch's award-winning collection of essays, The Undertaking: Life Studies from the Dismal Trade (see this database).

Although Lynch's poetic sentiments and philosophical observations about our own cultural estrangement from death ("We're among the first generations for whom the presence of the dead at their own funeral has become optional....") and about the crucial importance of our accompanying the dead ("In getting them where they need to be, we get where we need to be....") are a significant feature of the film, he himself is not the focus of the film. Rather, he serves as both guide and chorus through the stories of four individuals and families: Robert Kelly, eighty-five, who is planning his own funeral in meticulous detail; Anne Beardsley whose beloved Aunt Mary, eighty-four, is now facing death as boldly as she lived life; David King who is skeptical about the meaningfulness of bearing witness at his father's cremation; Nevada and Anthony Verrino who are the parents of a two-year old son born with and dying from a rare genetic condition.

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Lenny Savage (Philip Bosco) lives in the Sun City retirement community in Arizona with Doris, his companion of 20 years. When Doris dies, her children sell their home and Lenny's son and daughter, both in their late 30's, become responsible for his care. Wendy (Laura Linney) is a playwright in New York City. Jon (Philip Seymour Hoffman) is a theater professor in Buffalo. Niether has seen Lenny for many years. He had been an abusive and violent father. The mother is absent, apparently having abandoned the family when the children were young. Both Wendy and Jon seem lost. Wendy is having an unsatisfying affair with a married man and Jon's partner, Kasia, is about to return to Poland because her visa has expired and he is not ready to marry her. Reaquainting themselves with their father forces them to confront the danger of letting unhappy childhood haunt them, and makes them recognize their difficulties being adult (they have Peter Pan names).

Lenny has dementia, probably Parkinson's. Wendy and Jon find him in restraints in a hospital bed. He is hostile from the outset. They take him from the bright light in Arizona to dark sleet in upstate New York, and they put him in a nursing home. Wendy stays with Jon as their father "settles in." She feels guilty but does all the wrong things in trying to make up, while Jon is pragmatic and resentful. Brother and sister get to know each other better. As they bicker, their father seems to watch from a distance with an opacity that is also a kind of dignity. His condition deteriorates and he dies in the nursing home. Wendy returns to New York.

Six months later, Wendy's play about their childhood ("Wake Me up when it's Over") is being produced in New York, and Jon is on his way to give a conference paper ("No Laughing Matter: Dark Comedy in the Plays of Brecht") in Poland where he plans to be reunited with Kasia.

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Body of Work is a cleverly crafted memoir - or, rather, the first chapter of a memoir - of the author's medical school experience at Brown University School of Medicine in Providence, Rhode Island. Ms Montross relates the chronological course of her team's dissection of a female cadaver with no discernible umbilicus and whom they therefore name Eve. (She neglects to comment on Eve's ribs and whether she has the normal complement or a supernumerary, more masculine, rib.) As she and her team of four (later three as one student drops out of school) proceed with the orderly dismantling of Eve, bone by bone, nerve by nerve and blood vessel by blood vessel, she uses this experience as a springboard to analyze her and her team's emotional reactions to the often unnatural process of deconstructing, literally (at times with a saw), a former person now cadaver, as well as the gradual, almost imperceptible acculturation that transmogrifies medical students into doctors. In fact, she devotes the final pages to this metamorphosis and what it means to the person undergoing the transition from caring student to detached physician, and whether one can retain enough caring, while remaining sufficiently detached to function as one must as a clinician, to become both a whole person and competent physician: "How much of becoming a doctor demands releasing the well-known and well-loved parts of my self?" (page 209)

Although it primarily revolves about the axis of her gross anatomy (cadaver dissection) course, the author's narrative includes tangents that have variably relevant relationships to this course, e.g., a trip to Italy to inspect first hand the anatomy theater of Vesalius in Padua and the Basilica of St. Anthony; another trip to the anatomical wax sculptures museum in Bologna, where the author also observes the "incorrupt corpse of Santa Caterina" in a "small church called Corpus Domini" (pages 223-224); interspersed histories of the traffic of corpses for dissection, including the infamous Burke and Hare story; some flash-forwards to her second and third years; and a prolonged narration of the final illnesses of her grandmother and grandfather. This last bit of family history is worth the price of the book alone. Despite the apparently incongruous collection of such asides, the author makes it work smoothly, if not seamlessly.

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In A Step from Death a profusion of memories radiate from a near-fatal accident on Larry Woiwoide's farm in western North Dakota. Woiwode, a novelist and poet of America's heartland, had just finished baling hay when his denim jacket got caught in the tractor's power take-off, "a geared stub at the rear of the tractor that spins at 500 rpm." (p. 9) Caught in the powerful machine with no one around to hear his cries for help, Woiwode could easily have died, but survived by using his pocket knife to free himself from the jacket.

In a sense A Step from Death takes up where the author's previous memoir, What I Think I Did, leaves off. The earlier book focuses on surviving North Dakota's outrageously bitter winter of 1996-97. The current memoir ranges far and wide over nearly 40 years of Woiwode's life as a writer who chooses a difficult but fulfilling life for himself and his family on the land. The memoir is addressed to Woiwode's only son Joseph (the second of four children), with whom he shares his fatherly failures, as well as the strengths of their relationship. The reader soon learns that accidents were no strangers to their life on the northern plains. Woiwode and his wife and older daughter had survived a serious car accident on an icy road in one of their early Dakota winters. Joseph, too, sustained severe injuries as a child when he fell off a horse and again later in a tractor accident. On another occasion, Joseph and his sisters are responsible for accidentally causing a fire that burned down the family barn.

Now, however, Joseph is a married man, a helicopter pilot, with two children of his own. The recollections and wisdom that his father shares with him (and us) flow freely, creating a free associational, rather than linear, narrative. Woiwode explores the deep network of connections that bind him to the land and his family, as well as to the community of creative writers and especially William Maxwell, his long-time editor at The New Yorker, mentor, and father figure. Woiwode explores as well the strong pull of loss in his life-his parents' deaths and eventually that of Maxwell-but A Step from Death is ultimately a celebration of survival.

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This book consists of a series of "found poems" abstracted from transcripts of interviews that Loreen Herwaldt conducted with 24 writers who had previously published accounts of their illnesses. Dr. Herwaldt, an infectious disease specialist at the University of Iowa, began her investigation into the personal experience of illness after having read Mary Swander's Out of this World: A Journey of Healing and Reynolds Price's A Whole New Life, both of which revealed a negative dimension of medical care. These books initiated an "unexpected turn" (p. 1) in Dr. Herwaldt's life, culminating in a sabbatical year during which she interviewed a wide array of writers, intending to investigate the texture and dynamics of their experience of medical care by textual analysis of interview transcripts.

However, as a result of a further (and fortunate) insight, the author decided to abstract and arrange these texts into "found poems" that have "a concentrated emotional power that the unedited stories did not." (p. 5) Among the authors whose stories of illness appear in these poems are Arthur Frank (see The Wounded Storyteller ), Nancy Mairs (A Troubled Guest: Life and Death Stories), Richard Selzer (Raising the Dead), Oliver Sacks (A Leg to Stand On), Mary Swandler (The Desert Pilgrim: En Route to Mysticism and Miracles), and Christina Middlebrook (Seeing the Crab: A Memoir of Dying). In most cases Dr. Herwaldt has crafted two or more poems giving voice to different aspects of the subject's experience. For example, Richard McCann (pp. 82-90) speaks about loving his primary care physician, why patients can't talk to doctors, what he needs from a doctor, and being labeled as a patient with hepatitis C (cf. "The Resurrectionist").

The author includes a section on "How to Use This Book" (pp.9-20) that summarizes her experience utilizing these poems in medical education settings and provides helpful hints for teaching them.

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This book chronicles a tortured parenthood during the birth and brief life of a severely brain-damaged female infant, Silvie. Doctors predict that the child will live only a few days but instead she survives for seven months. The story is told in first person by the mother, beginning with her arduous labor during a home delivery in the presence of an experienced midwife and the family physician. The baby does not cry when she is born and turns blue even with oxygen that the doctor administers. An ambulance is summoned; "a bigger, better oxygen machine" restores the baby's color and she is brought to a hospital neonatal intensive care unit where she is artificially ventilated and fed.

In the hospital Silvie "fails" all the tests of normalcy. The doctors recommend removing artificial ventilation. "I feared, even more than I feared her death I think (and harder to admit), that they would remove the oxygen pump and the baby would live on and on and never be able to do anything at all" (14). Yet when the child does in fact breathe independently, "I took the fact that she could sustain her own breathing to mean that the baby wanted to live. It was all right to love her" (15). A few days later, however, the medical team concludes that there is nothing further they can do for the baby, that the parents should take the child home, where she will likely die within a couple of days. Upon being prodded, one physician suggests the parents give her an overdose of phenobarbital, which she is receiving for continual epileptic seizures.

At home, the parents feed Silvie by tube, medicate her, change her diapers, hold her, and learn from a friend how to swaddle her. The child never cries, does not focus her eyes on anything, rarely responds to sound or touch, and gains no weight. Whatever random responsiveness there seems to be gives the author a sense of motherhood: "I was able to survive because of my faith in these intermittent chance meetings, believing that Silvie did know when I was here and that I was holding her close in a way that meant love" (37). The parents brace themselves for Silvie's death. The husband's sister visits and councils them to actively put an end to Silvie's life, which they refuse to do. But they do not plan to take extra measures (CPR) if Silvie seems to be dying at home and when they articulate this to a social worker whom they consult to obtain respite care, it becomes clear that she would report them to Child Protective Services.

The husband quits his job as a residential counselor of emotionally disturbed teenagers to do part-time carpentry work -- he is too preoccupied to care about other people's problems. When a friend accidentally breaks the phenobarbital bottle, the parents together with the family physician decide to see how Silvie will get along without the drug. To their amazement, the baby appears slightly more alert and is able to suck from a bottle -- no more feeding tube required. But the husband reminds his wife, "The doctors warned us she might do this. This is the one and only thing she can ever learn. They said when this happened to other parents they started to believe that the baby was getting better" (59).

The parents live in limbo, attempt to live a "normal" life. When Silvie starts to lose weight at age 4 months, the doctor advises to resume tube feeding; they don't see the point, but when hospital physicians use the word, "murder," and threaten to "take over" Silvie's care, the parents relent. The baby lives but "it was the sameness of Silvie that drove you crazy . . . She slept and woke, but was awake that much different? She did not change, she did not change. Her sameness was a stone I wore, an emblem of failure, failed life" (96).

The final act for Silvie begins when the author's mother-in-law is dying of cancer in New York and a decision is made to leave the baby at home in California for several days in the care of a retired nurse. The nurse has been shown how to do the tube feeding, but while the parents are in New York she experiments with spoon feeding, then discontinues tube feeding for three days before the parents return. The parents see that Silvie has deteriorated in their absence and resume tube feeding. For the remaining couple of months the parents wait, investigate institutionalizing Silvie, and finally determine that "the way we loved Silvie meant we loved her enough to let her die" at home, with "a certain amount of fluid and nourishment for comfort, but a gradual withdrawal of excessive food. Replaced with a lot of touching and holding, stroking and whispering" (122). Silvie dies and the author is four months pregnant with the baby she and her husband have decided not to abort.

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A woman is pregnant. She is a nurse married to a physician, Jeff, and they have a young son, Willie. The couple is pregnant with their second child. Long before her due date, the woman--author Susan LaScala--begins experiencing signs of premature labor. Because she is a nurse, because she is married to a doctor who takes call, she doesn't want to over-react or bother her obstetrician unnecessarily. But when vague aches turn into cramps, the author enters, as a patient, the world she had known, until then, only as a caregiver.

It is impossible, in a brief annotation, to describe fully the richness of this memoir. Because the author is a nurse, she brings to the story of the premature birth and survival of her daughter, Sarah, a wonderful double vision: LaScala tells this tale not only as a mother and a patient but also as a clinician able to explain, in simple language, the complex technologies used to sustain the life of her one pound nine ounce baby. The author's rendering of the bells and whistles of neonatal medicine, whether describing the process of intubating a preemie (p. 23) or ultrasounding a baby determined to survive (p. 182-3) are precise and haunting.

Equally compelling (and instructive for caregivers) are the author's candid revelations of how it feels to be a patient. She takes to "grading" the doctors and nurses--an "A" for the staff that lets her see her newborn girl (p. 3), and a "C" for a nurse with "No kind words. No warmth" (p.11). She describes her own bodily sensations in language both lovely and informing: the pushing and tugging she feels during her C-Section is a "quiet violence" (p.21); standing beside her daughter during the ventilator weaning process she feels "a witch's brew of fear and panic mixing and growing inside" (p. 225).

In an introduction, physician Barbara Wolk Stechenberg, describes the "gift" that the author has given by writing this memoir. The author has allowed Dr. Stechenberg, who was part of the team that saved Sarah, "a rare glimpse into two worlds" (p. xii). One was the world of intensive care nurses and how "they truly are the primary caregivers" (p. xii). The other world was that of physicians, who "may feel we are empathic and caring, but we really have no idea of the emotional roller coaster many of our parents are riding" (p. xii).

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Because he can't reach the hospital in a winter snowstorm, Dr. David Henry ends up assisting his own wife in the birth of their twin children at his clinic with the help of his nurse, Caroline. The boy is fine; the girl has Down symdrome. While his wife is as yet unaware, he gives the girl baby to Caroline to take to an institution. Norah, his wife, remains unaware that she give birth to two children, yet is haunted by some sense of loss she can't name. Caroline, unable to leave the baby in an unappealing institutional setting, makes a snap decision to keep her. She leaves town, renewing communication later with the baby's father, and raises her as a single mother until she meets a man who is willing to marry her and love Phoebe as a daughter.

Only after Dr. Henry dies suddenly does his wife discover the existence of her daughter, through photographs sent to him over the years by Caroline, and then a visit from Caroline and Phoebe. Sadly, but with a will to choose life on strange and demanding terms, Norah and her son, Phoebe's brother, choose to enlarge their circle of family to include a loving relationship with Phoebe, clearly her own person, and the woman and man who have cared for her.

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