Summary:

The unusual title is borrowed from Nathaniel Hawthorne's story, "The Custom House," to suggest a shift in fortune when immigrants "strike their roots into unaccustomed earth."  Set almost entirely in the United States (the unaccustomed earth), eight separate stories are connected most obviously by cultural dissonances affecting characters who are Indian or have Indian parents.  Three of the stories, however, are linked by a strong narrative connection that is unexpected, profound, and unforgettable.

For Indian readers, the narratives describe complexities about migration patterns, cultural issues, alienation, and generational differences. The stories deal with well-educated children of immigrants who become offspring their parents barely recognize.  For other readers, the stories reveal situations about families and customs that are strangely familiar, especially those stories dealing with relationships between parents and children.
 
The forces of globalization have created and accelerated shifts that can seem staggering to all parents intent on preserving cultural patterns and traditions. Whether Indian or not, most parents experience a sense of alienation while watching their children flourish in a world that increasingly appears unfamiliar and foreign.

Not surprisingly, the stories concern strains and challenges affecting mixed relationships and/or mixed marriages and stresses on disapproving and disappointed parents, while others focus on children succumbing to drugs and alcohol(for the latter, see annotation of "Only Goodness").  All deal with some kind of emotional loss, but provide connections to feelings experienced by children and their parents in life's quiet and more kinetic negotiations.
 
The first story is about Ruma, a well-educated woman who lives in Seattle with her work-alcoholic American husband, and child, Akash.  Generational and cultural contrasts are revealed in overt and more subtle ways when her recently widowed father arrives for a short visit. Even though Ruma's complete assimilation into her non-Indian home as well as her on-going worries about her father's loneliness are major considerations, another story thread is spun, one that quietly reveals the father's thoughts about himself and a new relationship made recently during a vacation in Europe. Ruma's assumptions about her father, his loneliness, his possible dependency on her, and the Seattle vacation as a possible signal for relocating to her household turn out to be entirely wrong. 
 
The last three stories follow a boy, Kaushik, and girl, Hema, into adulthood.  In the first story, "Once in a Lifetime," Hema recalls her first memory of Kaushik when he was 9 and she was 6. The occasion was a farewell party for Kaushik's parents who were returning from the United States to live in Calcutta. The mothers, who grew up in Calcutta, but met in Cambridge, Massachusetts had become very close and were saddened by this separation.

Seven years pass before Kaushik‘s parents return to the Boston area and stay with Hema's family. Hema found the now 16-year old young man appealing, but brooding and totally uninterested in her. Even though Hema expected Kaushik to be Indian-like in behavior, he was more Americanized than she was. That the family had flown first-class shocked Hema's conservative family as did their new smoking and moderate drinking habits.

After a long search, and to the relief of Hema's parents, Kaushik's family found a  modern house on the North Shore.  Before they moved to their new home, Kaushik surprised Hema with confidential information-- his family had left India to seek treatment in Boston for his mother's breast cancer.  All medical efforts had been unsuccessful and his mother had only a short time to live.  Hema promised to keep this disclosure secret and grieved for the woman she had come to admire and love.
 
The second story in the link, "Year's End," is narrated by Kaushik.  With the opening line, "I did not attend my father's wedding," readers know that Kaushik‘s mother has died.  His father, in Calcutta for a visit, had married Chitra, a woman with two young daughters, and all would be returning to the North Shore house to live. Most of the chapter recounts the ordeal of the mother‘s dying, Kaushik‘s tremendous sense of loss, and the loneliness experienced by him at Swarthmore College.  No mention is made of Hema by the desolate narrator except to remember he had hated every day spent under her parents' roof, but later had come to think of that time with nostalgia.  

"Going Ashore" brings Hema and Kaushik together in Rome where she has a study grant and a visiting lectureship and he is on vacation from his work as an award-winning photo journalist.  Hema's parents have arranged for her to marry Navin in Calcutta.  Navin has accepted a teaching position at MIT. Until her unexpected reunion with Kaushik and the intense love affair that follows, neither had experienced any real connection with another person.  The story about them in Rome seems to represent an independence from the cultural forces that have shaped their lives, but this independence is short lived.  Ultimately, she is unable to set aside the expectations imposed by her parents.  The consequences of their final separation are more than any reader might imagine.

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Summary:

New York is the setting for thirteen linked stories that profile a long line of curious and sometimes loony doctors who are passionate about medical science but often lack common sense and good judgment. Beginning with Dr. Olaf van Schuler in the seventeenth century and continuing over more than 300 years with generations of his descendants (the Steenwycks), missteps and madness loom large in this inquisitive and peculiar medical family.

Most of these doctors share common goals: They strive to eliminate pain. They attempt to expand the scope of medical knowledge. They seek the soul. In their quest for cures and enlightenment, many of these physician-scientists, their relatives, and patients embrace off-beat diagnostic techniques or unproven remedies: phrenology, magnetism, bloodletting, hypnosis, radium-emitting apparatus, electrical shocks, and lobotomy.

In "The Siblings," a doctor performs a lobotomy on his sister. She dies a few months after the operation. In "The Story of Her Breasts," a woman develops rheumatoid arthritis that may or may not be caused by her silicone breast implants. She also experiences guilt and worry after encouraging her 18-year-old daughter to undergo breast augmentation. In "The Baquet," hope is undeniable and a miracle cure is mesmerizing. In the book's final story, "The Doctors," two physicians - a father and his daughter - grapple with their strained relationship and the man's progressive deterioration that might be due to Creutzfeldt-Jakob disease.

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When Jamie Heywood, the eldest of three brothers in a tight New England family of engineers, learns that his middle brother Stephen (they all are in their 20’s at the outset of this drama which begins, for them, in early 1998) has amyotrophic lateral sclerosis (ALS), he has just assumed the position of entrepreneur in technology transfer at Gerald Edelman’s Neurosciences Institute, the prestigious think tank of the 1972 Nobel Laureate in Physiology and Medicine, in La Jolla, California.

Jamie quickly announces his resignation and simultaneously his decision to devote his life to helping his brother in the only way he can--as manager, CEO, COO and staff of, initially, a loosely organized team effort to develop a cure for ALS, an insidious wasting disease of the nervous system that progressively leaves the person with the merest remnants of voluntary motor function.

Jamie’s resignation and his move from the West to East coast is but the mildest of changes in the weather for what becomes a perfect storm of technology recruiting, fund-raising, career-rebuilding and the emotional equivalents of El Niño, profoundly affecting at least four families, three of them Heywoods: Stephen Heywood, the strapping carpenter/house-restorer with ALS, and his wife, Wendy; Jamie, and Melinda, his belly-dancing wife with a PhD in medieval French literature; the brothers’ mother, Peggy, and father, John; and, lastly, the author and his father, Jerome, and mother, Ponnie (a Polish diminutive).

Concomitant with Stephen’s development of ALS, Ponnie begins to evidence the dementia of Steele-Richardson-Olszewski syndrome, also known as progressive supranuclear palsy, a form of brain decay uncannily similar to ALS. (Fortunately for the Heywoods, ALS involves only the motor nerves, not the cognitive apparatus.)

The author’s decision to include his family’s ordeal is wise, generous and instructive. The Heywoods and Weiners are both engineering families with an academic engineer as the pater familias and both are trying their best to cope with a deteriorating illness that dismantles the center of all cerebral engineering activity, the brain. The comparison of the diseases and the responses of all the players involved are culturally and psychologically dissected with the author’s trademark precision and kindness. But this book, as the title indicates, is more about the keeper than the brother.

Within minutes of his learning of Stephen’s diagnosis, Jamie becomes a man possessed. He moves quickly, as though by intuition and almost a fated skill, from technology transfer to technology-bricolage; genetic therapy on the fly; and people-, funding- and support-transfer. In fact, when there is no transfer involved, Jamie creates in order to transfer.

Like Gregor Samsa, in the short story by Franz Kafk, from whom Weiner also deftly borrows another parable, "An Imperial Message," (to illustrate, metaphorically, the pathophysiology of ALS as a disease in which neural messages, like the Imperial Message, go awry), Jamie undergoes a metamorphosis, albeit admittedly much less drastic than Gregor’s. He molts his undergraduate degree in engineering at MIT to emerge as a self-appointed manager of any and all ALS research and gene therapy in the U.S. that might help retard the progress of his brother’s illness.

Recruiting, petitioning, nourishing, cajoling, funding, and courting researchers and clinicians alike, Jamie meets, entertains, enlists and co-ordinates the efforts of gene therapy researchers and other medical scientists. He becomes a fund-raiser with the help of Melinda and her family of belly dancers, raising $240,000 as a result of the First Annual Belly Dance Extravaganza. His efforts involve the Heywood and Weiner family members, as epicentric waves of activity inevitably affect them all.

We watch, through Weiner’s eyes (and the diaries of Wendy and Melinda, whom he cites with permission), as the four families experience the predictable mood shifts that accompany a devastating illness and the great adventure of a risky attempt to work a miracle (a miracle that Jerome E. Groopman grumpily and stuffily bemoans in a cited Wall Street Journal editorial): excitement when a genetically engineered ALS mouse outlives its cohorts and money starts to flow; and disillusionment, when Stephen’s disease relentlessly progresses, Jamie’s marriage dissolves for a lack of boundaries, as Melinda, Jamie’s wife, records in her diary, and the author’s mother slips deeper into a dementia that Lucretius, Weiner’s authorial inspiration of the book, would easily recognize as part of the world explored in his famous treatise De Rerum Natura.

By the end of the book, there is an air of exhaustion yet surprising calm--perhaps the calm after the storm--as we witness the normalcy of Stephen, in his motorized wheelchair, playing with his son. As Stephen repeatedly affirms to Weiner, now a family friend and no longer merely a reporter, "I’m fine."

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Job, a prosperous but god-fearing man, is stricken with a series of misfortunes, losing his goods, his sons, and his health all as a result of a wager between God and Satan about whether or not a "perfect and upright" man will remain thus under relentless misfortune (1:1). As he sits in ashes, covered with boils, a group of friends come to mourn with and comfort him, sitting beside him for seven days and nights in complete silence "for they saw that his grief was great" (3:13).

Job proves a good bet by never following his wife's advice to "curse God and die," but he does deliver a series of lamentations and questions about his condition, countering his friends' theories about the possible causes (unacknowledged sin, primarily) for his troubles and finally asserting his desire to speak directly to God and ask Him the reason that a good man has been burdened with a host of sorrows (2:9). Job's friends, including a fourth speaker, Elihu, who was probably added into the text by a later writer, reprove him angrily.

God appears suddenly and speaks to Job from within a whirlwind, ending Job's complaints with his chastening response. Rather than offering a rationale for Job's suffering, God reminds him of the limitations of a human perspective. Ultimately God rewards Job and reprimands Job's friends.

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Based on the memoir by British writer Blake Morrison, who is played in the film by Colin Firth, the story unfolds through Blake's eyes.  Blake's father Arthur (Jim Broadbent) is rapidly dying of cancer, cared for at home by Blake's mother, Kim (Juliet Stevenson).  Blake's parents are both physicians.  Blake is extremely ambivalent toward his father and reluctantly goes back to his childhood home to visit the dying man.  As his father lies dying Blake hashes out within himself his conflicted feelings toward his father -- long-standing anger, contempt, guilt, occasional grudging admiration.  The film flashes back and forth between the present and Blake's memories of the past.

As seen through Blake's eyes, his father is bombastic, overbearing, a deceiving and self-deceiving individual.  Blake recalls numerous instances where his father called him "fathead," barged unannounced into his room, humiliated him in front of others, competed with him for the attention of young women, and disparaged his choice of career as a writer.  Blake is deeply wounded by the knowledge that his father has been carrying on a romance with Aunt Beaty (Sarah Lancashire ) behind his mother's back -- although his mother is painfully aware of the infidelity.  In addition to recalling various humiliating and annoying situations with his father, Blake is enveloped in memories of his first sexual relationship with the family's maid and even makes a brief pass at her in the present, after his father's funeral.  He is so fixated on his obsessions -- with his first love and with his father -- that when his wife speaks with him on the telephone, he is distant and hostile toward her.
 
Blake's mother nurses her dying husband while Blake hovers in the background, hoping for an opportunity to talk to his father while he is still lucid, in what is bound to be a futile attempt at having a revelatory discussion about their fraught relationship -- such a discussion is bound to be futile because Arthur does not admit to his faults and even as he is on his deathbed, seeks reassurance from his wife that they had a happy life together.

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A drug-addicted doctor, a dying father, and a cantankerous angel constitute a less than holy trinity. Carl is an impaired physician who is hooked on drugs. He happens to have a guiding angel following him around, but she is no guardian. Instead, she is moody and provides no protection. She offers warnings and advice. Carl met his angel when he was six years old. After being stung by wasps and experiencing an allergic reaction, she didn't lift a finger (or wing) to help him.

The angel is prescient. She can foretell who will grow up naughty or beneficent. She knows when a person will die. She tells Carl that not everyone has an angel. Only those individuals destined for greatness get an angel, but some people choose not to heed the suggestions of their spiritual attendants.

Carl is a pediatrician. He cheated in medical school and on his certifying examination but is pleased with his choice of careers: "I make my living praising the beauty of well children. I love babies and I love ketamine" (p121). His father is dying from metastatic lung cancer. Their relationship is terrible. To make matters worse, Carl cannot stomach sick adults.

His three pregnant sisters implore Carl to care for their father after discharge from the hospital. Carl reluctantly leaves San Francisco and heads to Florida. He takes his father to chemotherapy sessions, but the oncologist thinks it's time to stop further treatment. Carl administers painkillers to his dad and frequently consumes some of the prescribed morphine and Percocet for his own pleasure. The two men hardly speak to each other.

Carl's angel repeatedly implores him to reach out to the dying man. She knows that emotional and physical connection will heal both men. Carl's father longs for a storm but the weather won't deliver his wish. One night, Carl stages rainfall with the aid of the garden hose. He rests his head against his dad's chest, and they fall asleep. When morning arrives, Carl awakens and discovers that his father died during the night. The angel is weeping in the room.

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The voice of a young girl leads us through this spare and tautly told story of a closely-knit family upon whom tragedy falls like a plague.  Before death and mental illness take up residence there, we meet the Bronstein’s, two parents and four children, in their comfortable, well-run home outside of Boston.  Hermann delicately renders the portents of change and pain that haunt all loving families. The novel opens with the nine year-old Ruby Bronstein’s discovering, while walking along the beach with her three older brothers on a winter afternoon, an old rusty pistol poking out of the sand. 

The family story deepens as the teenage Ruby recounts a sojourn with her parents to Terezin, the Nazi concentration camp where her father was interned as a child. Hermann’s restraint and precision in this sequence make this potentially familiar journey entirely new.  With her young eye trained on her father’s every muscle-twinge of reaction to what he sees, she crisply conveys the unknowability of even an adored father –let alone the events that took place within these walls. Her father’s inaccessible childhood memories are not miraculously jarred by this return to the scene of trauma – but he learns shortly thereafter of a brain tumor that soon will end his life.

One tragedy follows another, the emergence of mental illness in one brother, the death of another.  The narrative traces Ruby’s efforts to carry on in the face of these devastating losses.  Here is where the novel explodes in cold fire, in its quiet accounting of a young person’s grief as it is lived in its ordinary, daily course.  Loss begins to deform her social life, giving her the feeling that she is a freak.  The scale of things is too disproportionate; she dresses for the prom while her brother lies dying in the intensive care unit.  Carrying the stigma of disaster, she hides news of family developments for which she has no vocabulary.  What good would talking do anyhow, she asks –until she finds the listener she needs.  

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A Place Called Canterbury by social historian Dudley Clendinen, former New York Times national correspondent and editorial writer, provides readers with an intimate and revealing account of aging in a particular place at a particular time--Canterbury Tower in Tampa, Florida. The story about the author's mother, Bobbie--and so many others--begins in 1994, a few years after the death of James Clendinen, Bobbie's husband of 48 years, and known to the community as the progressive editor of the Tampa Tribune. Although she had been "falling apart, a piece here, a piece there...collapsing vertebrae...bent, frail, and crooked...subject to spells and little strokes...." (p. xii),

Bobbie Clendinen was in reasonably good health. Nevertheless, her grown son and daughter did what most children their age do--they worried. When she finally agreed to move from the home where she had lived for twenty-nine years to Canterbury Towers, room 502, two bedrooms, two baths ($88,000 in cash, $1505 each month), Clendinen and his sister were relieved. She would be cared for and safe in "the small, cream colored, obsessively well-run geriatric apartment tower and nursing wing...across a broad boulevard from an arm of Tampa Bay" (see book cover).  And, so many of her old friends were already established residents!

Clendinen was fascinated by his mother's new circumstance and by what he came to regard as the new old age. As a writer, he could not resist the opportunity before him. Although he lived in Baltimore, he could come and go, but over the twelve-year period of his mother's residence--three in the Towers and nine years in the hospital wing--he spent more than 400 days as a live-in visitor, observer, listener, interpreter. This unusual arrangement provided Clendinen with a close-up view of a 21st Century phenomenon, the comings and goings of aging people in the final setting of their lives.

Canterbury is a well-run camp and life there is a soap opera. Between his exchanges with the witty rabbi and the former jitterbug champs, the enthusiasm generated by a nudity calendar proposal (declined) and the geriatric bib enterprise (thriving), the inhabitants provided Clendinen with an abundance of riches. Whether at lunch in the dining room overlooking the Bay, over daily drinks at 5pm, or in bed in the health center, everyone of this Greatest Generation had a story to tell. This ethnographic page-turner, with its cohort of named characters--the Southern Belle, the Rabbi who escaped the Holocaust, Emyfish, the ageless New Yorker, Lucile, the warm-hearted Fundamentalist, the raunchy Atheist, the crusty Yankee, the horny widower, and the maddeningly muddled Wilber--reads like fiction. Whether rich or poor, married or widowed, Clendinen listened as they spoke and in doing so became a trusted friend and chronicler of small and great events in their collective lives: childhood, Depression, World War II, medical advancements, healthcare costs, 9/11. Because Bobbie Clendinen spent so many years in the hospital wing, much of the story describes the kind of care and staff standards that we would hope for all--including ourselves. Mrs. Clendinen died at age 91.

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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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George Hall has recently retired when he discovers a lesion on his hip which he takes to be skin cancer. Even though his doctor tells him that it is simply eczema, George is not reassured for long. His worry gradually becomes panic. He learns that his wife, Jean, is having an affair with an old friend of his, that his daughter, divorced single mother Katie, is going to marry a man he disapproves of, and that his son, Jamie, intends to bring his gay lover to the wedding. At this point his hypochondria becomes distinctly pathological. He attempts to excise the lesion himself with kitchen scissors and ends up in hospital.

With the help of antidepressants and psychotherapy, he begins to recover, and then, finding other marks on his skin, relapses. Things come to a climax at Katie's chaotic and (for the reader) very funny wedding, where George, on a risky mixture of valium and alcohol, makes an overly confessional speech and then physically attacks his wife's lover. Order is restored with the help of Jamie and Ray, the groom, who turns out to be heroically kind and efficient (and whose working-class status is then forgiven by George and Jean), and the novel ends with happy reconcilations. George's health anxiety has not, though, entirely disappeared and the novel ends with a clear sense of the mental effort required, especially as we age, not to give in to our fears of disease and death.

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