Summary:

Author Diedrich investigates ("treats") mid-late 20th century memoirs about illness (illness narratives) from an interdisciplinary perspective drawing on the disciplines of literature, social sciences, and philosophy. Her analysis uses the theoretical frameworks of poststructuralism, phenomenology, and psychoanalysis to consider "what sort of subject is formed in the practice of writing . . . illness narratives," the kind of knowledges articulated by such writing, whether and how such writing can transform "expert medical knowledges," how language operates in these memoirs, and "what sort of ethics emerges out of such scenes of loss and the attempts to capture them in writing" (viii).

The book is divided into Introduction, five chapters on specific memoirs, and Conclusion. Chapter 1, "Patients and Biopower: Disciplined Bodies, Regularized Populations, and Subjugated Knowledges," draws on Foucault's theory of power to discuss two mid-20th-century memoirs of institutionalization for tuberculosis. Betty McDonald's the Plague and I is compared with Madonna Swan: A Lakota Woman's Story. Dividing practices and regularization are shown to serve different functions in these two incarcerations, figurative in the case of Betty McDonald, and literal in the case of Madonna Swan.

Chapter 2, "Politicizing Patienthood: Ideas, Experience and Affect," draws on Foucault's approach to the subject and on his discussion of "practices of the self" in contrasting Audre Lorde's The Cancer Journals with Susan Sontag's Illness as Metaphor and AIDS and Its Metaphors (see annotations). Diedrich also brings into her analysis Eve Sedgwick's theory of queer performativity and Sedgwick's own illness narrative, White Glasses. Diedrich views all of these as counter narratives to the clinical medical narrative of illness but she shows how they differ in stance.

Chapter 3, "Stories For and against the Self: Breast Cancer Narratives from the United States and Britain" looks at "the arts of being ill" as they are represented in two cultures, two "conceptions of the self in these countries at a particular historical moment" (61). The narratives discussed are Sandra Butler and Barbara Rosenblum's narrative, Cancer in Two Voices and Ruth Picardie's Before I Say Goodbye (see annotations). Diedrich associates Cancer in Two Voices with an American notion of self-improvement and Before I Say Goodbye with a British "emphasis on the cultivation of an ironic self" (55). The author works in this chapter with Freud's idea of the uncanny, Benedict Anderson's concept of "imagined political communities" and Elaine Scarry's discussion of pain, language, and the unmaking of the self.

Chapter 4, "Becoming-Patient: Negotiating Healing, Desire, and Belonging in Doctors' Narratives," treats Oliver Sacks's illness narrative, A Leg to Stand On, Abraham Verghese's autobiographical My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS, and Rafael Campo's book of essays, The Poetry of Healing (see annotations). Here Diedrich considers "the possibility that doctors, especially AIDS doctors, might become patients through desiring-and writing-productions" (83) and she utilizes the rhizome model of Deleuze and Guattari to make her case. She discusses how Verghese and Campo are each both cultural insiders and outsiders and how they each "bring the body into language through their writing" (88).

Chapter 5, "Between Two Deaths: Practices of Witnessing," focuses primarily on Paul Monette's writing about the loss of his partner to AIDS, and on John Oliver Bayley's books about the loss of his wife, Iris Murdoch, to Alzheimer's, and her ultimate death (see annotations in this database). In this chapter Diedrich invokes Lacan's concept of the real and his formulation of "the ethical possibility of being between two deaths" (117). She draws also on trauma theory and the work of Kelly Oliver, a contemporary feminist philosopher who has written on witnessing.

Finally, in her "Conclusion: Toward an Ethics of Failure," Diedrich returns to Elaine Scarry's "phenomenological discussion of the experience of pain" and brings in Jean-François Lyotard's concept of incommensurability and his suggestion between the two poles of what is seemingly incommensurable one might search, in Diedrich's words, for "new rules for forming and linking phrases between . . . subject positions" (150). In that context she analyzes physician Atul Gawande's discussion of medical uncertainty and error in his book, Complications (see annotation) and philosopher Gillian Rose's book, Love' s Work. Diedrich concludes that the basic incommensurability between doctor and patient can be a starting point for a new ethics, an ethics of failure and risk "because by taking such risks [of failure, of relations], we open up the possibility of new routes, new treatments: in and between art, medicine, philosophy, and politics" (166).

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It is 1915. Sasha, only daughter of a renowned English doctor, longs to be a nurse, as her brother, Thomas, longs to be a doctor. Their father is opposed to both objectives: he thinks Thomas should sign up to "do his bit" in the war effort like his older brother, Edgar, rather than go to medical school, and he doesn't think Sasha could handle the gore of wartime medicine. He is also concerned because on a few occasions, Sasha has let slip that she has accurate premonitions of people's deaths. The first of these came when she was five. She has learned since then not to speak of this "gift" to anyone in her family, for fear of losing credibility, but keeps with her a book of Greek myths, in which the story of Cassandra helps her to validate her sense of her own gift/curse.

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Katie Takeshima, the narrator of this coming-of-age novel, moved with her immigrant family from Iowa to Georgia when she was in kindergarten. As her parents work long hours in a poultry processing plant with other exploited non-union immigrant workers, she and her older sister Lynn, and her little brother, Sammy, enjoy a loving and fairly free childhood. Lynn is Katie's primary teacher. Among her most important lessons is to see everything around her as "kira kira"--a Japanese word meaning something like "glittering"--moving and alive. When Lynn sickens and then dies of lymphoma, Katie has to do some fast growing up, and in her mourning develops a sharper sense of the glittering, mysterious presence of spirit and life in a world full of prejudice, poverty, and loss.

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In her senior year of high school, having uncharacteristically drunk too much at a party, Angel Hansen consents to be taken home by a boy she normally doesn’t care much about, and ends up having sex with him. Two months later, with the help of her best friend, Karin, she takes a pregnancy test, finds it is positive, and visits an abortion clinic. Karin, who has had an abortion, is ready to support her in complete secrecy. Tim, the father, is horrified, but consents to pay for the procedure. At the last minute, however, and without being able to explain her reasoning to either of them, Angel decides not to go through with the abortion.

In the ensuing months, she endures her parents’ disappointment, her friends’ distancing, and the loss of a number of hopes, including the Yale education she was expecting. In the course of those months, however, she also finds new levels of relationship evolving with parents, grandparents, and the few friends who decide to engage with her on new terms, including Danny Stanton, a friend she’d grown up with, and had recently come to love in new (but, she thought, hopeless) ways. To her great surprise, Danny asks to accompany her to Lamaze classes, and, after taking her to the prom in her ninth month, sees her through the baby’s birth. The story, told in the first person in the form of journal entries, chronicles a young woman’s process of maturing through the consequences of a mistake into acceptance of responsibility for choices, even one she can’t fully account for.

One interesting scene records a conversation between Angel and Karin where Karin admits that her weeks-long estrangement comes from a feeling that Angel’s choice to keep the baby implies a judgment of her for terminating her own earlier pregnancy. Angel makes it clear that she respects their differences, fosters no judgment, and can’t even fully articulate why she felt strongly about needing to make a different choice, but feels clear and sure about her own.

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Serving as a summer hospital volunteer, fifteen-year-old Teri d'Angelo meets Valerie Ross, a girl her age who has damaged a nerve in a fall, and lost the use of one leg. Valerie's anguish over her partial paralysis takes the form of anger; she manages to keep most of those who try to help her at a distance. But Teri finds her intriguing, and Valerie's condition evokes a kind of sympathy and interest in her that overcomes even the patient's most strenuous rebuffs. Gradually, and with much caution on Valerie's part, they become friends. Valerie finds herself welcomed into Teri's large, warm Italian-American family. Teri's compassion for Valerie grows as she recognizes her loneliness; Valerie's parents are divorced, her father rarely visits, and her mother keeps up a hectic work schedule.
      
Teri also benefits in ways she didn't expect from the friendship; Valerie's bravery, even when masked with anger, inspires her to speak up more clearly on her own behalf, to ask for what she needs, and even to circulate a petition at school when she feels she has been discriminated against in the judging of a science project.
     
When Valerie is taken to a "sanitarium"-a mental health facility-for depression and apparently psychosomatic involvement of her good leg in the paralysis, Teri visits her patiently, despite Valerie's apparent lack of interest. But finally, when she watches Valerie rejecting the grandmother who traveled from England to see her, she acts in uncharacteristic anger, and in the shock of the moment, Valerie stands up, proving to herself and others that her good leg does, infact, function.  It is a turning point in her healing.

In an interesting twist, the book ends with the girls drifting apart.  They are, indeed, very different. Valerie is planning to attend City College in engineering. Valerie is going to live with her grandmother in England and attend Oxford University, hoping later to become a writer. In a final phone call, two years after Valerie's accident, the girls part with some affection and gratitude on both sides, but also with an acceptance of the fact that their friendship may have been for a season. They gave each other important gifts, and now life is taking them in very different directions. 

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In this collection, twenty-two medical students and young physicians across the United States eloquently recount the process of medical education for those who do not believe they fit standard measures of student demographics. The editors, Takakuwa, an emergency medicine resident physician; Rubashkin, a medical student; and Herzig, who holds a doctorate in health psychology, group the essays into three sections: Life and Family Histories, Shifting Identities, and Confronted.

Each section is prefaced by an essay explicating the essay selection process, the history of medical school admissions policies and requirements, the basic progression of medical education and the reasons for this collection, such as "putting a human face" (p. xx) on the changing characteristics of admitted medical students: "With their diversity and through their self-reflections, we hope that these students will bring new gifts and insights to the practice of medicine and that they might one day play an important role in transforming American medical education into a fairer and more responsive system." (p. 141)

Additionally, a foreword by former Surgeon General Joycelyn Elders outlines her experience as a black woman entering medical school in 1956, including eating in the segregated cafeteria. The book concludes with recommendations for further reading and improvements to the medical education process as well as with brief biographies of the contributors and editors.

The range of essays is impressive: diversity itself is given a new meaning by the variety of narrative voices in this volume. Contributors include people from impoverished backgrounds, both immigrant (Vietnamese, Mexican) and not. One student, marginalized by his academic difficulties, began a homeless existence during his first clinical year. Others were made to feel different because of being African or Native American.

In two essays, mothers defy labels placed on them (pregnant black teen; lesbian) and describe the trials and triumphs of their situations. Students write of being subjected to ridicule, ignorance and prejudice due to their gender, interest in complementary medicine, political and advocacy views, or religious beliefs. Due to pressures to conform, even students from what might be considered more mainstream in American culture (e.g., growing up in a small town, or being Christian) can experience the effects of being "different" when in medical school.

A number of essays communicate the difficulties of illness, disability and bodily differences. Issues include recovered alcoholism (rather tellingly, this is the only essay that is anonymous), obsessive compulsive disorder, sickle cell anemia, Tourette Disorder, attention deficit hyperactivity disorder, chronic pain, and obesity. The authors balance their narratives of hardship with insights into how their struggles improve their opportunities for empathy, perspective and fulfillment as physicians.

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Born in Vienna, Alma Rosé (1906-1944) was a gifted violinist with an illustrious concert career. Her mother was the sister of composer, Gustav Mahler, and her famous father, Arnold, conducted orchestras. All the family members were non-observant Jews. Alma was talented, beautiful, audacious, and arrogant. After an unhappy early marriage to Czech violinist Vása Príhoda, she established a remarkable orchestra for women that toured Europe.

As the German Third Reich consolidated its power, her only brother, Alfred, fled to the USA. She managed to bring their widowed father to England, but displaced musicians crowded London making work difficult to find. Alma left her father and returned to the continent, living quietly as a boarder in Holland and giving house concerts when and where she could. She took lovers.

Despite the urging of her family and friends, she kept deferring a return to safety in England. In early 1943, she was arrested and transported to Drancy near Paris, thence to Auschwitz six months later. Initially sent to a barrack for sterilization research, she revealed her musical brilliance and was removed to marginally better accommodations and allowed to assemble an orchestra of women players.

The hungry musicians were granted precarious privileges, but Alma became obsessed with their progress and insisted on a grueling schedule of rehearsal and perfection. Some said that she believed that survival depended on the quality of their playing; others recognized that the music, like a drug, took her out of the horror of her surroundings.

In April 1944, she died suddenly of an acute illness thought to have been caused by accidental food poisoning. In a bizarre and possibly unique act of veneration for Auschwitz, her body was laid "in state" before it was burned. Most members of her camp orchestra survived the war.

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This remarkable collection of short writings, introduced by renowned poet Naomi Shihab Nye, who visited the Sutterwriters (of Sutter Hospital in Sacramento, California) to offer a workshop, provides a broad, compassionate, imaginative window into the life inside and around an urban hospital. Patients, staff, and all interested in healing through writing are invited to come and participate-with an accent on the latter: no one is invited who isn't willing to write.

Chip Spann, the editor, came to Sutter Hospital with a Ph.D. in English, and has the privilege of coordinating this fluid community of writers as part of his work as a staffmember. His conviction, voiced in an engaging introduction, is that literature is a powerful instrument of healing--both the literature we read and the literature we create--and that the experience of literature belongs in community. The individual pieces are accompanied by photographs and short bios of contributors.

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Sixteen-year-old Angelina Rossini tells the story of the year her father died. A lively, opinionated, attractive sixty-nine-year-old Italian happily married to a forty-two-year-old English woman, he has hardly been an inconspicuous presence in the small town of Blodgett, Vermont with a population of 854. Angelina, the only child of this second marriage, loves her father dearly, though she rolls her eyes at his eccentricities, and knows herself to be fortunate in both parents, though they're older, and her mother somewhat less expressive, than she would choose. Her best friend, Jax, belongs to a very different family, large, blue-collar, partly French Canadian. Though she and Jax have been friends since kindergarten, and though she has known for some time that he is gay, her love for him sometimes spills over into desire. They talk about this, as they do about everything else, though this subject is a little tenderer than most. When a girl who has been aggressive and unfriendly suddenly reveals her own same-sex desires, Angelina is able to handle her awkward revelation with compassion.

When Angelina's father has a stroke, all the rhythms of family life are disrupted. Her half sister, whom she's never liked much, comes for an extended visit. Her mother is preoccupied, first at the hospital, then with home care. And she herself has to learn aspects of caregiving for a partly paralyzed father who has lost his speech. The process is, of course, emotionally complex, sometimes comical, often heartbreaking. But when she speaks at his funeral, after a heart attack takes his life, it is with a widened appreciation of the kind of man he was, and of what value his life had even in the months he was severely incapacitated. After his death, she explores, in a few final chapters, the ambiguities of grief, and the process of forging a new relationship with her mother, who has lost her own best friend and companion.

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Thyme Gilcrest, an honor student in an upscale suburban high school, begins her short career as drug dealer by taking a friend's Ritalin and finding it useful as a "study drug." Though she has suspected she might have ADHD (attention deficit hyperactivity disorder), her parents don't think so; what she does know is that the drug helps her focus and perform with reassuring reliability. Gradually, experimenting with the effects of other drugs--Adderall, Xanax, Zoloft, Valium, and others easily found in medicine cabinets or in the purses of parents' party guests--she finds herself able not only to "manage" her own mood swings and compensate for the effects of the Ritalin, but also to supply a growing number of friends who trade in prescription drugs.

For some time, since she hardly fits the profile of a drug dealer, she is able to remain in denial about her growing preoccupation with obtaining and distributing drugs. Only when one friend gets caught, another commits suicide, and a boyfriend confronts her does she decide she needs to be done with personal use and disengage from the network of codependent "friends" who have come to rely on her for their drugs of choice. In the final chapter, in her college dorm, she once again faces the temptation to deal when she overhears new acquaintances asking where they might get Adderall or Ritalin or Stratera. They're willing to pay.

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