Summary:

This memoir focuses on the various ways in which his being an African American affected Tweedy’s medical education and early practice as a medical resident and later in psychiatry. Raised in the relative safety and privilege of an intact family, he found himself underprepared for some of the blatant forms of personal prejudice and institutional racism he encountered in his first years of medical education at Duke Medical School.  One shocking moment he recounts in some detail occurred when a professor, seeing him seated in the lecture hall, assumed he’d come to fix the lights.  Other distressing learning moments occur in his work at a clinic serving the rural poor, mostly black patients, where he comes to a new, heightened awareness of the socioeconomic forces that entrap them and how their lives and health are circumscribed and often shortened by those forces.  Well into his early years of practice he notices, with more and more awareness of social contexts and political forces, how the color line continues to make a difference in professional life, though in subtler ways.  The narrative recounts clearly and judiciously the moments of recognition and decision that have shaped his subsequent medical career.    

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Blow’s account of growing up in rural Louisiana, exposed to negligence, sexual molestation, violence, and loss focuses on a child’s strategies of survival first, and then on sexual confusion, social ambition, and discovery of the gifts that led him to his life as a writer for the New York Times.  A major theme in the memoir is his learning to claim his bisexuality after years of secrecy and shame.  That emergent fact about his identity, along with moving to New York after a life in the rural South required an unusual level of self-reflection and hard, costly choices that challenged norms at every level.  His account of learning to assume a leadership role in a college fraternity and deciding to finally leave it behind offers a particularly vivid example of what it takes to resist perpetuating rites of humiliation and conformity designed to curb individuation.     

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The poet, an anesthesiologlist and mother, describes her early morning departure from home as she prepares to begin her professional day, leaving behind her little son and the physical and emotional warmth of their relationship. After arriving at work, she readies the operating suite for her first patient, taking pleasure in "the rote motions," noting that "all is bright pristine ordered."Having made the transition from home to work she tries to remember her son’s "just-awakened warmth." The poem ends with the arrival of her patient, who is naked and ready to be put to sleep (anesthetized), inverting the opening image of her sleepy, naked child and their leave-taking.

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This poem describes the life of a man who lives alone with 122 pet finches. Although he loves them, he imagines a quiet life without them, without the nuisance and esponsibility. He ponders what it would be like to set them free and thus, to free himself.

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The poet considers the philosophy of Marcus Aurelius, who recommended "wipe out imagination, check desire, extinguish appetite" in order to achieve contentment. The author sees living examples of the contrary in these tough motorbikers in leather, who are "fifty if they’re a day." There is a note of envy in his voice as he observes their rebelliousness, spirit, and sheer freedom.

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Since Joy Davidman is known to most readers as the woman C.S. Lewis married late in life and lost to cancer four years after that marriage, it is likely that many readers will pick up Joy Davidman’s letters out of fondness for her husband’s Narnia stories or popular theology.  They will quickly find that the letters chronicle a life of considerable interest in itself.  Davidman was an award-winning writer herself, a secular Jew and atheist who turned hopefully to communism and then wholeheartedly to Christianity in her later years, though remaining skeptical—and acerbic—about church people.  The fact that she remained friends with her first husband after their difficult marriage broke up resulted in many of the letters in the collection, which include material Lewis fans will be glad to see, though it offers little intimate information about their lives except that they were devoted to one another through her painful final years with breast cancer.  Her account of that last illness is often matter-of-fact; she writes as though it is one of the less interesting parts of her life, which was full of intellectual pursuits, including editing some of Lewis’s later works, and of practical concerns that included caring for her two boys with whom she emigrated to England from New York.  

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The Bad Doctor is a graphic novel describing the daily life of Dr. Iwan James, a general practitioner in a small Welsh town. At the time of the story, Dr. James is an established, middle-aged physician, with a wife and two grown sons. Initially it appears that despite his outward success, Dr. James is simply dissatisfied with his life and career – with his early marriage, with his overbearing colleague, and with his patients, who come to him with all sorts of ailments, from silly to tragic to creepy. However, the readers learn that Dr. James is also struggling mentally with himself. Through flashbacks to his childhood and his medical school years, and through his clinical interactions with a patient suffering from obsessive compulsive disorder, it is revealed that Dr. James has also wrestled with this disorder since childhood. In between composedly caring for all of his patients, releasing his frustrations on long bike rides through the Welsh hills, and sharing his concerns with friends, he learns to understand his compulsions and confront his own sense of inadequacy.

The author, Dr. Ian Williams, has in fact worked in a rural general practice in Wales. Although this novel is a work of fiction, and “any resemblance to actual persons, living or dead, or actual events is purely coincidental” (pg. 2), the story is naturally and richly informed by his personal experiences.

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Lament is a twenty-two line dirge in free verse with one rhyme, at the end of the poem, which is almost certainly intentional. The poem represents a mother’s terse lament over the death of the father of the two children whom she is addressing. More of a soliloquy than a dialogue, one receives the distinct impression that the children may not even be present as the mother announces matter-of-factly that their father is dead, that they must soldier on, and describes the manner in which she will distribute the coins and keys in his pocket to them. The final couplet succinctly sums up the poem’s sentiment:


Life must go on,
And the dead be forgotten;
Life must go on,
Though good men die;
Anne, eat your breakfast;
Dan, take your medicine;
Life must go on;
I forget just why.

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Carol Levine began a roiling odyssey as a caregiver when a car accident left her husband paralyzed and in need of 24-hour care. She regards her husband’s survival as “a testament to one of American medicine's major successes — saving the lives of trauma patients.” But once he returned to their home, Levine encountered a healthcare system that was fragmented, chaotic, and inequitable. Unprepared to address chronic care, it remained oblivious to her needs as her husband’s primary medical “provider,” as they would say. Written nine years after the accident and eight years into her care giving, Levine’s essay recounts the stress and isolation she experienced attempting to navigate that system, to perform unrelenting chores, and to sustain her employment. Her job was, after all, the source of her husband’s managed care insurance, which regularly managed to leave Levine with unpaid bills. Even her work in medical ethics and healthcare policy could not help her locate the assistance she needed to assure the well being of her husband or herself.  Or of other care-giving families.

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Carol Levine's anthology of stories and poems about the intimate caregiving that takes place within families and among friends and lovers reminds us that the experience of illness reaches beyond clinicians and patients. It can also touch, enrich, and exasperate the lives of those who travel with patients into what Levine calls the land of limbo. This land oddly resembles the place where some Christian theologians believe lost souls wander indefinitely between heaven and hell. For Levine the limbo of familial caregiving is an unmapped territory. In it caregivers perform seemingly endless medical, social, and psychological labors without professional training and with feelings of isolation and uncertainty. Caregiving in this modern limbo, created by contemporary medicine's capacity to extend the lives of those with chronic conditions and terminal illnesses, has become, according to Levine, "a normative experience" (1).

By compiling this useful selection of well known and less familiar stories and poems, Levine increases the visibility of the experience of familial caregiving among works of literature about medicine. While illness literature is typically classified by disease or disability, Levine focuses instead on the relationships between caregivers and those being cared for. Her collection organizes the literature into five parts: Children of Aging Parents; Husbands and Wives; Parents and Sick Children; Relatives, Lovers, and Friends; and Paid Caregivers who assist families. The literature in each section tends nonetheless to represent particular conditions: dementias, including Alzheimer's disease, cancer, and frailty in the first two sections; childhood cancer, hyperactivity, and mental illness in the third; AIDS in the fourth. 

Probably the most familiar and powerful works include Rick Moody's "Whosoever: The Language of Mothers and Sons," Ethan Canin's "We Are Nighttime Travelers," Alice Munro's "The Bear Came over the Mountain" (the source for the film "Away from Her"), Lorrie Moore's "People Like That Are the Only People Here," and several poems: Mark Doty's "Atlantis" and selections by Donald Hall, Jane Kenyon, James Dickey, and Raymond Carver.

These and the less familiar works offer disparate responses from both caregivers and those they care for. The narrator of Tereze Gluck's "Oceanic Hotel, Nice" thinks "what a bad person I was to not even want to touch his feet. . . it made me shudder" (220). The wife in Ann Harleman's "Thoreau's Laundry" cannot place her husband with Multiple Sclerosis in a nursing home because "his presence, however diminished, was as necessary to her as breathing" (116). The caregiver in "Starter" by Amy Hanridge "didn't want to be the person people feel bad about" (180).  Several stories explore the limits of obligation. As is often the case, the son in Eugenia Collier's "The Caregiver" is sick himself, failing to schedule his own doctor's appointments and dying before his mother. Marjorie Kemper's witty, exuberant "God's Goodness" plays out an unexpected relationship between a dying teenage boy and his Chinese immigrant aide, while his parents remain in the background.

Carol Levine's brief introduction to the collection explains that she excluded excerpts from memoirs and selected only very recent literature, almost all from the past three decades. A Resources section at the end includes some introductory medical humanities resources and practical resources for caregivers.

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