Summary:

A small stone island sits in the middle of a body of water. No other land is visible. Within the apparently naturally formed stonewalls that constitute the island’s perimeter, vestiges of man-made dwellings are apparent. On the left-hand embankment, the front of what appears to be a white house is visible albeit only slightly. On the other side of the island, doorways or windows have been carved out of the rock itself. Below the front most door some white paint has been added, as though to signify the fading presence of man’s creations on this island.

The center of the island opens up as a bay of sorts. In the middle of the bay and island, large vertical trees similar in appearance to Cyprus trees stretch all the way up past the stone and to the very top of the painting. Nothing of the island is visible through the dense trees. One solitary boat with two passengers makes its way into the middle of the bay. One passenger controls the oars while the other stands erect, as though a statue, and is completely white. At the front of the boat sits a box that looks like a coffin.

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A female figure stands facing us, unclothed, her left side darker than her right, occupying the middle of the frame. She is surrounded with images from the process of human reproduction. The largest of the former is the well-formed male fetus in the frame’s lower left, which is connected by a thin umbilical cord wrapped around the figure’s right leg to a fetus in an early stage of development in the figure’s abdomen, which we see as if by x-ray.

Tear-shaped droplets of blood drip down the figure’s left leg and soak into a dark mass in the earth, where they nourish the roots of several plants. A tear rolls down each of the figure’s cheeks. Just above her to her left is a weeping crescent moon. Below it is an artist’s palette that the figure holds up with a second left arm.

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Summary:

Creation tells the story of Charles Darwin (Paul Bettany) at home with his family in Down House during the last decade he researched and wrote, but hesitated to publish, The Origin of Species (1859).  The film represents the sorrow of those intellectually ripe years when he worked out his insights into the process of natural selection as his "radiant," beloved daughter Annie-Anne Elizabeth-(Martha West) became fatally ill.  These events were compounded by Darwin's own mysterious chronic illness, which he attempted to relieve through laudanum and trips to Great Malvern for Gulley's cold water cures.

In 1851 he took a very sick ten-year-old Annie with him to the waters and, inconsolable, left her to be buried in the local churchyard.  Through his physical and emotional suffering, he continued to dissect barnacles, breed and skeletonize pigeons, engage the village parson and local farmers alike, consult with supporters Thomas Hooker and Thomas Huxley, exchange hundreds of letters, and remain an affectionate father and husband. 

The loss of "the joy of the Household" strengthened his wife Emma's (Jennifer Connelly) religious beliefs, as it exhausted whatever might have existed of his. The story, artfully told in beautifully sequenced flashbacks, keeps the tensions and accommodations between Charles and Emma on the subject of religious faith in balance, emphasizing their loving partnership as spouses and parents.  Emma supported his work, read his manuscript, and understood its importance, even as she disagreed with its implications for her spiritual life.  Darwin contributed to the local parish church Emma attended.    

Some of the most compelling moments in the film occur during Darwin's joyous outings with his children when they suddenly witness the demise of woodland creatures.  In these scenes, the ineluctable struggles between life and death that Darwin's theory of natural selection eloquently describes resonate with his personal experience.  We see a fledgling fall from its nest near a sheep's skull and decay before our eyes.  We hear Annie explain to her horrified siblings that if the fox they encounter didn't kill the screeching rabbit in its jaws, its pups would die.

These scenes, along with the earlier view of the captive Fuegian child Boat Memory dying of small pox in an English hospital, suggest the fragility of the young that Annie's death makes devastatingly personal for Darwin.  The film simultaneously acknowledges Darwin's empirically derived logic of such deaths in his scientific treatise and his suffering from the brutal manifestations of that logic in the life of his family.  While scientific explanation fails to console him for the loss of Annie, the film suggests human affection as the best, though still potentially painful response.     

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A series of interrelated stories that include a novella (Sukkwan Island), the book is a semi-autobiographical tale of the impact of a father's suicide on his teenage son.  The author, David Vann, represents his fictional self as Roy Fenn, and his father as Jim.  In the first story, "Ichthyology," Roy is born on an island "at the edge of the Bering Sea" of Alaska and then he and his family move to Ketchikan, on an island in southeastern Alaska.  Roy's father is ever restless and that includes an interest in women other than his wife.  When Roy is about five years old the marriage breaks up and Roy moves to California with his mother.  At the end of this chapter, Roy's father kills himself with one of his own guns.

"Rhoda" is the story of Jim's second marriage to Rhoda who becomes Roy's stepmother, until that marriage also ends in divorce.  "A Legend of Good Men" relates how Roy's mother was courted by various suitors following her divorce.  These narratives are told from Roy's perspective.  The next and largest section of the book is "Sukkwan Island."  It is on this Alaskan island that Roy spends an extended visit with his father, in a simple, isolated cabin where their only other human contact is with a supply plane that comes periodically.  Life is primitive and difficult and reflects the relationship of father and son, which is uneasy and foreign to Roy.  Jim is depressed, obsessed with his former wife Rhoda and often cries at night, which Roy finds sad, scary, and eventually despicable.  Life on the island takes a bizarre turn, which I will not reveal here.

In "Ketchikan" Roy at age 30 returns to the town of his early childhood "the place where my dead father had first gone astray [with Gloria, his dental receptionist], the place where this father and his suicide and his cheating and his lies and my pity for him, also, might finally be put to rest" (209).  The last story, "The Higher Blue," is a mixture of fantasy and narrative reality; comments about Jim made by Roy's mother serve to bookend the novel.

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Perillo's essays offer a lively, variegated view from the wheelchair of a woman with multiple sclerosis who is also a naturalist, an outdoorswoman, a wife, and an award-winning writer.  Not all of them focus on her condition, though observations about living with the disease occur in most, and are thematic to some.  Most are also laced with wry humor.  One comes to see in these sketches from the Pacific Northwest how full and rich a life it is possible to live while also fully acknowledging and even lamenting the loss of mobility.  She invokes Thoreau several times, and her work may be easily situated in his tradition of personal, reflective essays on the natural world.  For her, the natural world extends to the world of the body, linked as it is with the bodies of all living things.

            

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George Washington Crosby is dying from kidney failure. The eighty-year-old man has a crumbling body - Parkinson's disease, cancer, diabetes, and previous heart attacks - and a murky mind. He is hallucinating and his memories are disordered. George occupies a hospital bed in the living room of a house that he constructed himself. His family keeps him company as they await his imminent demise.

Some of George's thoughts revolve around his passion for clocks and his skill in repairing them. Most of his memories center on his father, Howard Aaron Crosby. About seventy years earlier, Howard owned a wooden wagon and a horse and scratched out a living as a tinker and a peddler of household goods. Howard's father had been a Methodist minister who exhibited worsening signs of mental illness. The man was eventually escorted out of his home. Only a young boy at the time, Howard would never see his father again.

Howard suffered from frequent and violent epileptic seizures. His wife and the family doctor thought Howard should be admitted to the Eastern Maine State Hospital, an institution housing feebleminded and insane individuals. Howard had a different opinion. One evening, he left his wife and four children and headed to Philadelphia. He took a new name and a new wife. He found work in a grocery store. The frequency of his seizures decreased dramatically.

George's final memory before death is a vivid one. He recalls a Christmas dinner in 1953. Someone is at the door. It is a surprise (and brief) visit by Howard to George's house. It is the first time that he has seen his father since George was twelve.

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This is a collection of four stories and a novella with pervasive themes of death, loss, grieving, mourning, and anger; the characters live in rural parts of the upper midwest, and there is much unhappiness in their lives.

In "Catch and Release," we accompany Danny, a talented fishing guide "not quite thirty," as he floats down a stream he knows well. He and his siblings have divided his father's ashes, his portion now in a thermos. His father died suddenly, absurdly on a bathroom floor. Although Danny knows nature well (and loves it), he is angry and heartsick. Nor is religion a comfort. Bit by bit he scatters the ashes, but there is no healing ritual.

In "Bloodsport" a young man murders is wife and then kills himself. The town funeral director feels this is "utterly incomprehensible" but provides his professional services to the family and all who  come to the service and burial. He knew the young woman, Elena, and found her attractive; now he embalms her. Twenty years later he feels a "sense of shame" that men "let her down badly."

"Hunter's Moon" presents Harold, a casket salesman. Retired, he goes on long walks, trying to make sense of is life and loves. He likes naming things. His first wife left him for another woman. His daughter (pregnant and drunk) was killed by a train. His second wife left him. His third wife died of cancer. He abuses antidepressants and liquor. Sitting on his front porch, he slumps over. All night a dog keeps watch over, we assume, his dead body.

In "Matineé de Septembre" we find a reworking of Thomas Mann's "Death in Venice." In both stories, a literary figure escapes ordinary time, falling in love with a young person of the opposite sex, and falling into decadent gestures in the hope of recapturing youth. Both efforts end in failure and death. In Mann's story, the person is an older man of much literary accomplishment. In Lynch's retelling, the person is a professor and "poet of note," although not really of international fame. Actually she's a woman of inherited wealth, a wealthy snob, a narcissist, a survivor of a "perfectly bargained marriage." Her one child was stillborn. A dozen hints at her headaches suggest that she is doomed, and she dies in the last paragraph, without (as in the Mann story) the notice of the literary world.

After these grim tales comes the satiric (and also grim) novella, "Apparition." We follow one Adrian Littlefield (the last name is symbolic) who was a strait-laced pastor, then (after his wife left him) a self-help author who urged post-divorce people to live it up. The satire is trenchant. Adrian's big book is "Good Riddance." A church fundraiser with gambling allows "otherwise devout people to wallow in sin for a worthy cause." Adrian has girlfriends and one-nighters. He's an expensive speaker. Fortunately one Mary De Dona provides him with gratuitous sex, and he is saved. Now 50+, he visits the empty house where his wife once lived, learning little; his tour guide, one "Gloria" is in her 70s, married for 58 years, with grandchildren and great-grandchildren. He wishes he could have had such a life and feels "a wave of sadness." 

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This unusual story, beautiful and overwhelmingly sad, is set in Sicily on the craggy and barren island of Lampadusa surrounded by the bluest of seas. Everyone in the small fishing and canning village may be related; certainly, this is a place where secrets are not possible. Grazia (Varria Golino) appears to be the loveliest and most loving mother and wife, although her carefree, even childlike behavior is foreboding. The camera loves her and so do viewers who are ravished by her beauty and innocence.

With children positioned on the back of her Vespa, she and they escape to a deserted beach where she swims topless with her children; later, she releases hundreds of howling stray dogs from their inhumane confinement. Not surprisingly, spied-upon actions such as these produce critical response from more conservative neighbors whose norms are less capricious.

When signs of instability and manic depression become apparent, the community joins together to suggest hospitalization to her very supportive and heart-broken husband (Vincenzo Amato). She, like the caged-up dogs, seems to deserve the kind of freedom epitomized by her trips to the beach and will not, we sense, survive medical "imprisonment."

At this juncture, just as her wings are to be clipped, the story’s unexpected turn forces the mourning village to wonder about human frailty and reality. The ending, ultimately unclear and haunting, is a celebration of imaginative madness and ephemeral beauty. Visually stunning.

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Because this lucid, rich, and incisive book has not, as yet, been published in the United States, it has not acquired the readership it deserves. For those teaching Medical Humanities or those interested in broader or more global stories and perspectives about physician training, practice, and experiences, Helman’s most recent publication should be considered.

Part One (“Setting Out”) begins in South Africa where Helman’s family, comprised of a dozen doctors, has lived for generations and where his own medical studies occurred. As a child, he accompanied his father on rounds while other children spent holidays at the beach. Before long he discovered how hospitals, during the madness of Apartheid, were to “some extent a distorted mirror-image of the world outside” (3). Appalled by the differences in care and treatment, the keenly aware young man kept notes. His vivid observations of the harsh context of social injustices provide an unequivocal, eloquent, and disturbing critique of medicine then and there. His acute observations of physician behaviors and indigent populations in the city and in the bush contribute, as readers discover in later chapters, to the author’s expanded and compelling interests in cultural anthropology.

Part Two (“The Family Doctor”) leads to London. “After all the heat and light and space of Africa, London—with its low leaden sky and constant drizzle—was like living inside a Tupperware box, one stored deep inside a refrigerator” (47). In the 60s Helman’s migration required an adjustment to a world of technology and order, where as a family practitioner, he had become, in fact, a suburban shaman. In any society, patients wanted “relief from discomfort, relief from anxiety, a relationship of compassion and care, some explanation of what has gone wrong, and why, and a sense of order or meaning imposed on the apparent chaos of their personal suffering to help them make sense of it and to cope with it” (xvi).

Gradually Helman saw connections between the role of family physician and traditional healer: both involved an understanding of “not only a body’s internal equilibrium but also the equilibrium of the patient’s relationships with the world he or she lives in and how treatment should aim not only to treat the diseased organ but also to restore the patient’s life that equilibrium of relationships” (xvii). His encounters with patients and the stories they reveal suggest how important these often overlooked connections are and why they ought to be included in medical training and practice.

By the time readers reach Part Three ("States of the Art”), the author has moved into broader realms of thinking, in which medicine and illnesses are examined anthropologically. After 27 years of clinical practice Helman’s white coat and stethoscope are placed on a hook. Now, as a credentialed anthropologist at University College London, his larger lens allows for sustained scrutiny of the complexities, ambiguities, and nuances in such chapters as “Grand Rounds,” “Hospitals,” “Placebos,” “Third Worlds.” Helman’s range of experiences, multi-disciplinary training, intellectual conclusions, and abundant common sense argues for techno-doctors to learn from holistic practitioners. Whether devastating or humorous, the critiques reflect not just care provision but shared human capacities: the insights are thoughtful and fresh and very worthwhile.

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Twelve-year-old Jake moves from Boston to the rural port town of Wicasset, Maine, with his mother, father, and six-year-old brother, who has "fits" as a result of what we now know to be cerebral palsy. The family keeps Frankie hidden, because neighbors in Boston regarded his disease as evidence of some wrongdoing on the parents' part and shunned them. It is 1838, and the father has lost his job in a bank because of the "Panic of 1837," and takes a job at a lumber mill for which he is ill suited. As the job keeps him away except for weekends, Jake has to learn how to gather food, fuel, and local information to care for his mother and brother in a small, drafty house.

He gets to know neighbor children whose mother remains hidden because, as he later learns, she is a hopeless alcoholic. Eventually he gets a job with the schoolmaster/jailer, befriends a mentally handicapped young man with no home, and gets to know the local doctor who persuades him that the community will accept his brother and family, and that their secret need not remain hidden. After weeks upstate on a logging trip, the father comes home with an arm crushed in an accident. The doctor helps him find work as a clerk in the custom house.

In the father's absence, in addition to his other accomplishments, Jake helped prison inmates and the schoolmaster/jailer's family escape a burning building, winning the gratitude and respect of the townspeople. On his father's return and promise of new work, he has renewed hope of private tutoring that might prepare him for college despite the family's poverty.

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