Summary:

This haunting memoir by a South African surgeon who has witnessed tremendous suffering across the globe is best read as his story, and not a war chronicle as the subtitle would suggest, since large chunks of the book are not about war in the dressing station sense of the term. That said, however, the war that rages inside the author continues throughout the book and gives the reader glimpses of wisdom gained during Kaplan's remarkable journey of life amidst death. The book is culled from journals of writing and sketches that he kept throughout his travels.

Kaplan's first crisis occurs when he joins fellow medical students in an anti-apartheid demonstration in Cape Town and, following the lead of a more senior student, Stefan, tends to the wounded and frightened after riot police attacked the demonstrators. Kaplan then gets the call of not only medicine as service, but surgery as service, when, as a neophyte doctor, he saves the life of a youth shot in the liver by the police.

This feat should not be underestimated, though the author writes with humility. Indeed, in recounting later incidents in which patients die, the odds tremendously stacked against the patients surviving anyway (a woman with disseminated intravascular coagulopathy and multiple organ failure, or the Kurdish boy in a refugee camp with a great hemorrhaging, septic wound), the author's self-chastisement is a painful reminder of how the physician suffers with each loss.

After a beautifully written prologue which begins, "I am a surgeon, some of the time" (p. 1), the book proceeds chronologically, each chapter named for the location of the action. Kaplan leaves South Africa to avoid military service and the fate that befell Stefan, who becomes an opioid addict after euthanizing a torture victim in a horrible scene of police brutality and violence. Kaplan's post-graduate training in England and BTA (Been to America) research stint heighten his sense of cynicism about hierarchy in English society and capitalistic forces in American medical research.

Ever the outsider, Kaplan first returns to Africa (treating victims of poverty, deprivation and violence), then sets off to war zones in Kurdistan, Mozambique, Burma (Myanmar), and Eritrea. In between, he works not only as a surgeon, but also a documentary filmmaker and a cruise ship and flight doctor. He avoids the more established medical humanitarian relief efforts, such as Médecins Sans Frontières, and instead prefers to work where no other ex-pat physician will go--enemy territory, front lines, and poorly equipped dressing stations.

Along the way he decides the number of people he has helped as a surgeon, particularly in Kurdistan, has been small compared to the potential to intervene in broader public health measures (he meets a Swiss water treatment engineer) and occupational health exposés to help abused victims (e.g., of mercury poisoning in South Africa and Brazil). The book ends with Kaplan studying to become an expert in occupational medicine, though, incongruously, in the heart of London's financial district where he treats stress-related illness.

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David Rosen and Joel Weishaus are long-time friends, the former a psychiatrist, the latter a poet, teacher, and literary critic. Both authors have lived and traveled in Japan, and both are enamored of the haiku form. In this book, Rosen and Weishaus carry on the "renga" tradition of writing haiku as part of an on-going conversation, a call and response of commentary and haiku. Grouped into 53 two-page chapters, such as "Feeling Death," "Learning to Bow," "Eating," "Mother Ill, Mother Dead," "Tuscany," and "Turtle Wisdom," this conversation is enriched by the black and white illustrations of Arthur Okamura.

The comments and haiku range widely and deeply, reflecting the authors’ recognition of the possibility and need for healing, not only in human relationships but also with Nature. In part, this conversation is the authors’ quest to understand the "psychology, meaning, and healing value" of haiku (1), and to explore how poems might lead not necessarily to cure but to "becoming whole" (5).

The commentaries are open and transparent, interwoven as one poet picks up a word or image in his friend’s haiku and extends it, turning it over both in commentary and verse-for example, see the chapter "In the Flow" where the last line of Rosen’s haiku, "A river streaming back toward the sun," is used as the first line of Weishaus’s responsive commentary, one that transports the discussion from Japan to Africa (82-83). Often movingly honest, the poets discuss loneliness and death, their insights reflected in artist Okamura’s stark ink swirls (8-15). They examine their relationships with their fathers ("making Peace with One’s Father," 44-45), and they don’t shrink from humor ("Learning to bow," 34-35) or from sensuality ("Anima," 86-87). Their spiritual references range widely, from the Hebrew God to the Buddhist’s tribute to Nature (70-71).

The haiku are lovely, both strong and delicate, our appreciation of them enhanced by a review of haiku’s traditions in the Preface (1-5). Rather than try to describe the haiku (because, like all good haiku, these cannot be captured or retold and remain the same), I’ll present one haiku from each poet and hope readers will be compelled to seek out the book and read further.

David Rosen, on walking near his apartment in Mukaijima (40): Shimmering paddy-- / The slap of small feet nearing / Where dragonflies hover. Joel Weishaus, on September 11, 2002 (103): Sluggish creek-- / A shadow dips / And drinks.

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Gilbert begins her narrative with the event that inspired her to write: her husband's death in 1991 after a routine prostatectomy. "Though he was in robust health apart from the tumor for which he was being treated, Elliot died some six hours after my children and I were told that his surgeon had successfully removed the malignancy. And for the first six months after he died, death suddenly seemed plausible ... "(1).

But whereas her book Wrongful Death (annotated in this database) deals with Elliot Gilbert's death, the present work takes the author through death's door into personal reflection and research across a vast area, including personal, cultural, and literary aspects of death. Larger than a memoir, her work universalizes her personal experience with dying and death. And writing is what she does and what she has to do: "THIS is the curse. Write" (92).

Gilbert divides her material into three main sections, each containing several subsections: 1. Arranging my mourning: five meditations on the psychology of grief; 2. History makes death: how the twentieth century reshaped dying and mourning; and 3. The handbook of heartbreak: contemporary elegy and lamentation. The 27 illustrations she has selected range from the Isenheim Altarpiece by Matthias Grünewald to recent photographs by Dan Jury, to Maya Lin's Vietnam War Memorial. In these symbolic representations, Gilbert finds our universal fear of the process of dying, "If this is what it is, GrŸnewald seems to be telling the viewer, for Our Lord to die the death, what must it be for those of us less staunch, less noble - in short, less divine?" (115).

Traditional elegy, by John Milton and Percy Bysshe Shelley, on the other hand, seeks to comfort the poet and reader with the hope of a life hereafter, but modern secular poets like William Carlos Williams and Samuel Beckett offer no solace at all. The older term "expiration" gives hope that our spirit may survive our death. But "termination," the twentieth-century word for death, describes how humans and animals die, in our post-Darwinian world. Her word for this is nada. The holocaust stands as the ultimate ex-termination, or death by technology.

Seeking to understand Sylvia Plath's disease- and death-filled poetry, Gilbert travels literally to Berck-Plage, France, and figuratively, through the notorious "Daddy," "Lady Lazarus," and "Getting There." As a woman and a writer, Gilbert is fascinated by Plath: "For perhaps more than anyone else - more even than her much-admired Wallace Stevens himself - she really did articulate not just the vision but the 'mythology of modern death' that Stevens tentatively proposed" (310). The author contrasts Plath with nineteenth-century Walt Whitman who said, "... to die is different from what anyone supposed, and luckier" (332). Whitman seems to be ambivalent or even positive towards death; Emily Dickinson, of his same century, finds death terrifying.

Ultimately, modern death is embarrassing; death avoidance prevails, notably among doctors. This despite the fact that the first patient a medical student sees is a cadaver. Death is a doctor's failure and it is easier to blame the patient than to accept the death. Death in an American hospital is a "humanectomy", or physical removal of the individual's humanity as she/he is attached to IVs, monitors, feedings tubes, and other mechanical devices.

Modern hospital death is demeaning, because patients are granted little privacy, their TV sets are set to blaring; all personnel, including doctors, enter their rooms unannounced: "Whereas the patient is emotional - fearful, angry, needy - the doctor is detached, abstract, 'objective' " (189). Clearly, the author still lovingly mourns her dead husband bleeding to death alone in a hospital room. Energized by lost love, she writes and documents and works her way toward death.

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This film tells the remarkable story of Vivien Thomas (played by Mos Def), an African-American fine carpenter, who found his way into medicine through the back door and changed medical history. Hired when jobs were in short supply to work as a custodian and sometime lab assistant to Dr. Alfred Blalock (Alan Rickman), a research cardiologist, Thomas quickly becomes an irreplaceable research assistant. His keen observations, his skill with the most delicate machinery and, eventually, in performing experimental surgery on animals, make clear that he has both a genius and a calling.

Though the relationship has its tensions (Blalock, as a Southern white man and a doctor, has some blind spots in the matter of mutual human respect, though he highly values Thomas’s skills) it lasts for decades. The two move their families to Baltimore, where Blalock becomes Head of Surgery at Johns Hopkins and, much to his colleagues surprise and to some of their dismay, brings Thomas in to perform groundbreaking open heart surgery on a blue baby. It is not until after Blalock’s death that Thomas is granted an honorary doctorate from Johns Hopkins, where he continues to work in research until his own retirement.

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The world as everyone knew it ended years earlier when "the clocks stopped at 1:17" [p 45] and power was lost. Not many people are still alive. The landscape is charred and hostile with "cauterized terrain" [p 12], "ashen scabland" [p 13], and "the mummied dead everywhere" [p 20]. A father and his young son travel south towards the coast. The boy's mother has committed suicide. Papa and the child wear masks and tote knapsacks. The father pushes a shopping cart filled with potentially useful items that he has collected during the journey. The man keeps his pistol close. It only contains two bullets - one reserved for him and one for the boy.

The father and son follow a road towards the ocean, but they scurry and hide like two animals. Papa's biggest worries are marauders, food, and shoes. The world is cold. Rape and cannibalism are common occurrences. Although their goal is to remain alive and reach the coast, father and son wonder if the destination is any more hospitable than the rest of the dying world. Often hungry and freezing, both of them become sick. The boy contracts a febrile illness. The man frequently coughs blood and is wounded in the leg by an arrow.

Father and child ultimately reach the ocean, but it too is cold and dead. Not long after arriving at the coast, Papa dies. A stranger finds the grieving boy and invites the child to join his family - wife, son, and daughter. He assures the boy that he is a good man. He tells the child that his family does not eat other people. He advises the boy to hold onto his father's pistol.

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Having remarried after a long and partly happy life with a woman who bore him three sons, novelist Campbell Armstrong lives in rural Ireland with his second wife. He learns that his first wife, who works in Phoenix, has advanced lung cancer and, with his second wife’s blessing, goes to spend time with her and their grown sons. In the course of that trip, he reflects on their life together, their romance, his alcoholism and its effect on their family, their move to the U.S., their losses, and the remarkably enduring affection between them and, surprisingly, between the first wife and the second.

Completely surprising all of them, a daughter his first wife gave up for adoption, who has searched for years for her birth mother, shows up in the months before Eileen’s death and makes the trip to Phoenix to meet her birth mother. Her appearance turns out to be a gift to the whole family. She assuages decades of sorrow and longing in both her and her mother’s hearts. She herself has cancer, not as advanced as her mothers. Both she and her mother work in health care professions. Much psychological and spiritual healing is accomplished between them in the short time they have before Eileen’s death several months later.

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The novel is set in Washington, DC in April, 1865. At fourteen, Emily is sole caretaker of her mother who is dying of tuberculosis. Her neighbor, Annie Surratt, is her best friend, though their mothers have been estranged for some time. Both families have deep roots in the South. Annie’s brother, Johnny, an object of Emily’s romantic fantasies, has recently left on a secret mission. The war is nearly over. Emily’s uncle Valentine, a physician, wants to take custody of her after her mother dies, but because her mother has also felt estranged from him, Emily resists. Still, after her mother’s death, she does go to live with her uncle, and learns that he (with his two assistants, one of whom is a woman who is 1/8 African American) has a lively practice among the poor and the African Americans who have flooded the streets of Washington since the emancipation.

Valentine is called to Lincoln’s bedside the night of his assassination, and participates in efforts to track down John Wilkes Booth and his accomplices, one of whom appears to have been Johnny Surratt, who has escaped to Canada. In the course of her time there Emily discovers that her uncle and his assistant are involved in elaborate, marginally legal, schemes to obtain bodies for study at the medical college. Emily, at first horrified by this discovery, comes to recognize the good that comes of anatomical studies and to sympathize with her uncle’s efforts to bring about legislation making the acquisition of bodies for medical research easier. Annie’s mother is hanged as an accomplice in the Booth conspiracy, Annie leaves town, and Emily comes to understand a great deal more about the harsh terms on which life must be lived in times of national crisis and ideological warfare. The story ends with her growing interest in medicine as a possible career path.

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In Especially Then David Moolten discovers his poetry in the ordinary, often painful, texture of childhood, adolescence, love, and marriage. Each memory becomes a small story-like poem that looks simple and straightforward at first, until suddenly the poem reveals its hidden truth.  A sense of existential loss pervades these poems, as in “One morning as a man’s wife offers to fill / His empty bowl he feels suddenly desolate / For how plain he has become…” (“Cornflakes,” p. 31)  But Moolten’s melancholy is sweet, rather than bitter; energized, rather than depleted; and cumulatively powerful, as “The tractor / Of memory drags on, churning its femurs, / Its numbers and dates.” (“Verdun,” p. 64)

Especially Then is ripe with traumatic events: A father’s abandonment, “During that proud, petulant year my father left / And I became a punk, nothing could touch me.” (“Achilles,” p. 17). A brother’s death: “in the shallow dark of years since / I buried my brother…” (“Pulled Over on I-95,” p. 23) Divorce, “despite the years between you / And a hard divorce, the unshrived recriminations…” (“Seen and So Believed,” p. 51) And a wife’s death, “As if his wife had always gone / By the name of death he thinks of her / Whenever he sees or hears the word.” (“In Name Only,” p. 49)

These ordinary tragedies play out against a panorama of tragedy, as evidenced in “Photograph of a Liberated Prisoner, Dachau (1945)” and “The War Criminal Gives His Testimony.” Most often, though, the world’s suffering has little impact on the way we live our lives, “Someone at the next table sighs / Over Guatemala, the tragedy / Of having read an article or watched / A TV special…” (“Who You Are,” p. 53) We go on as we always do.

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Daniel has plenty of problems. He is already divorced. He loses his job. He is stalked by a mysterious group of well-dressed men (maybe federal agents) for an unknown reason. They follow him around in a blue Toyota SUV and show up at his ex-wife's house asking questions. On his way to an interview for an assistant manager's job at Dunkin' Donuts, Daniel drives through a medical district containing six hospitals. His mother died in one of these buildings. When he spots the blue SUV trailing him, he takes evasive action. After parking his car in a hospital lot, he wanders into the hallway outside the intensive care unit.

Eventually he settles into the ICU waiting room where he meets many family members of critically ill patients. Michael, a former Russian KGB agent whose elderly mother is a patient in the ICU, befriends him. Daniel remains in the medical complex for one month visiting the intensive care area of a different hospital each day. He sits with the relatives of ICU patients, and even though they are strangers, he listens to their tales of woe and empathizes with them.

Daniel becomes addicted to the humanity of the waiting room. Even when his car is finally towed from the parking lot, the threatening men in suits still wait for him outside the hospital. Daniel never learns the nature of his offense. Although he has nowhere to safely go, Daniel finds himself strangely comforted and at home in the ICU waiting room.

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This video depicts Robert Coles, noted author, psychiatrist, documentator and humanist, teaching his popular undergraduate course, "The Literature of Social Reflection," at Harvard University in 1990. The film begins with a bell tolling in a steeple and students entering the lecture hall. Excerpts from his lectures are presented in 4 parts: I: Ruby; II: Seeing--The Paintings of Edward Hopper and The Stories of Raymond Carver; III: Praying; and IV: Potato Chips and Tolstoy.

Some additional documentary clips are shown, such as footage of six-year-old Ruby Bridges being escorted into a previously all-white New Orleans school amidst a screaming mob during forced integration of schools. In between segments, brief interviews of Coles’ students let the viewer know that his message is getting through: it matters how you live your life--it matters a great deal.

Coles teaches with stories and these stories are riveting. In 1960, while in the Air Force and assigned to a psychiatric detail, he befriends young Ruby after he witnesses her courage in entering the school building. He comes to know her family and teacher.

Several months later, during the morning escort, Ruby stops in front of the school and says something which makes the mob even more frenzied. Coles is asked by the teacher to tell Ruby not to do that again. Upon gentle questioning, it turns out that Ruby was not talking to the mob, but to God: "Please God, try to forgive those people because they don’t know what they’re doing."

It was a prayer she said every morning, usually a couple of blocks away from the school, but that morning she had forgotten to do it earlier. Coles discusses the remarkable gift of forgiveness instilled in this brave child by her parents, who despite poverty and lack of opportunity to advance in life, were able to love and teach their children values and grace.

In Part II, Coles uses paintings by Edward Hopper, a poem by Raymond Carver ("What the Doctor Said" (annotated by Felice Aull and Irene Chen, also annotated by James Terry) and Carver short story (Cathedral) to illustrate how difficult it can be to truly communicate with and know another person. And how magical the moments are when we do.

In Part III, Coles shows some of the children’s drawings that he has collected during his documentary work. Coles delights in describing what the children said about their drawings at the time they created them. He clearly respects them and their ideas.

The last part ends with the story of the death of Coles’s mother at Massachusetts General Hospital. In her dying days she befriended an African-American woman, whose job was at the bottom of the hierarchy of the hospital: an orderly. After Coles’s mother died, it was this woman--not any doctor or nurse--who taught Coles how to take the time and be with his mother, rather than rush off as he was preparing to do. Coles asks, "Who was the doctor, the healer, the wise person?"

He notes that these twists are characteristic of many stories, such as those by Flannery O’Connor. He then concludes before a standing ovation: "Let us be good to one another, live on behalf of one another . . . . We are lucky to have these writers . . . and to have the lives that can include them."

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