Summary:

An aging plastic surgeon afflicted with diabetes examines his life and is forced to confront death and the failures of his past. Dr. Moses Galen is a 69 year old California physician with a penchant for sex, Jaguars, and boxing but a fear of making commitments and experiencing a slow death. He spends a weekend with his girlfriend Linda, a trauma surgeon in her forties. After they have sex, he experiences chest pain that he mistakenly attributes to heartburn. Dr. Galen had coronary artery bypass surgery only three years ago and figures it should last at least ten.

He wakes up early in the morning to work out on his punching bag. His chest pain returns and is now accompanied by ventricular fibrillation. He realizes he is having a myocardial infarction and will die. Despite the pain and his fear, Dr. Galen continues to throw punches. He only hopes he can remain quiet enough not to awaken Linda. If she realizes what is happening, she might try to save his life.

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John Ames narrates this story in the form of a lengthy letter to his young son. Ames is a 76-year-old minister suffering from angina pectoris and heart failure. He has spent almost all of his life in Gilead, a small town in Iowa. His first wife died during childbirth along with a baby girl. Ames remarried a younger woman who is now 41. They have a son almost 7 years old.

Because Ames believes his death is close at hand, he pens a missive to the boy. Its purpose is to teach his son about all the important things in life Ames may not be around to share with him. During the course of composing the letter, Ames reflects upon his own existence. He recalls the experiences of his father and grandfather who were also ministers.

Reverend Ames likes to think, read, and pray. Born in 1880, he has lived through three wars, the Great Depression, a pandemic of influenza, and droughts. His hope is that his young son will grow into a brave and useful man.

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Five women find fellowship and comfort in the swimming pool at a community center managed by Ursuline nuns. Each woman suffers from a chronic disease--lupus, multiple sclerosis, Crohn's disease, and rheumatoid arthritis. One is also being treated for ovarian cancer. The diverse group includes a pregnant woman, an elderly nun, and a retired nurse who currently peddles Avon products. On Tuesdays and Thursdays, they participate in aquatic therapy. The one-hour sessions temporarily soothe the body and boost morale. It is a welcome reprieve from the burden of disease and the complications of life.

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A teenager with a learner's permit drives his father to the emergency room. The father is hemorrhaging from the nose--the result of blood that is too thin and a punch thrown by his son. The father is abusive, especially when he drinks. Feeling endangered when his father shoves him, the boy retaliates by hitting the man in the face.

The father has valvular heart disease caused by a bout of rheumatic fever. He also has a cardiac arrhythmia requiring treatment with anticoagulation, but the dose of blood thinning medication must frequently be adjusted. After a frenetic ride, they arrive at the hospital and the father immediately enters the emergency room. The boy remains in the car listening to the radio and hoping the noise will somehow expunge the ugly words and perilous sentiment in his head. He discovers too late that a bloody nose can kill a man.

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Cortney Davis follows her 30 year career in nursing, from her experience as a student nurse washing a patient's feet, to dealing as a nurse practitioner with life and death issues in an inner city OB/GYN clinic. Her essays present epiphanies where she realizes what is important in a confusing and ambiguous situation, why she writes poetry even though she is exhausted from her daily work in the clinic, why she is a nurse when the job  sometimes seems overpowering and depressing.  The positive connections with patients--through kindness, caring, truth-telling, touch-outweigh the difficulties.  Tedious routines are often transformed by spiritual insights and empathy. And sometimes what seems like a miracle inserts itself in a time of grief. Whether she is talking to a man in a coma or treating a sexually-abused teenager, her focus is on the care of the patient.

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Professor of performance studies at New York University, Peggy Phelan narrates the story of a vision disorder that began when she was 23 years old, caused by "open-angle glaucoma," a difficult-to-treat condition in which the vessels draining ocular fluid periodically constrict. The episodes are excruciatingly painful and disorienting: "I feel a staggering push behind my right eye. The right upper half of my face is on fire: I am certain that my eye has fallen out of its socket . . . " (508).

Phelan resists patienthood, beginning with her first visit to the doctor, in which she underplays what has happened to her. Rejecting surgery, coping with side effects of the drugs she must take, and concerned about her ability to continue as a visual arts scholar, she muddles through for several years. Then she experiences a frightening, vividly described episode of temporary blindness, which is followed by a migraine headache. Six months later she agrees to have surgery.

During the surgery, under local anesthesia, "my eye, which is frozen, can still see things as they pass over it . . . colors I have never seen before . . . I am seeing the roof of my own eye from the interior side. It is utterly breath stopping. I cannot speak" (521-522). Enabled to see her eye from a perspective that was not available to the physician, and grateful for this "visionary experience," Phelan finally accepts her situation. She is not cured, although her condition improves. "My story is finally the same as those of all the other patients . . . The only difference between me and them comes from the words I’ve suffered to find and the words I’ve suffered to flee" (525).

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Before Jamie Weisman went to medical school and became a physician she wanted to be a writer. As she struggled to make a career out of writing, she was forced to acknowledge that the obscure, life-threatening condition that had plagued her since adolescence could not be factored out of her plans. Writers don't have easy access to affordable health insurance and her monthly intravenous infusions of antibodies and interferon were very expensive. Yet they were essential to fend off infection, for she had an immune system malfunction.

Of course, finances were not the only reason that Weisman decided to go into medicine. As is often the case, her own experience of illness was an important motivating factor, as was the fact that her father, of whom she is very fond, was a physician. This memoir describes significant stages of Weisman's illness, her interaction with the physicians she consulted, and the issues she grapples with as she pursues her life as a physician, wife, and mother (she graduated from Emory University's school of medicine in 1998 and practices dermatology).

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Spoiler alert: for educational purposes, this annotation reveals plot lines and may interfere with some viewers' enjoyment of the film. In the opening scene, Juliette (Kristin Scott Thomas), looking ashen, drawn, and nervous, sits in an airport as her much younger and radiant sister Léa (Elsa Zylberstein) rushes to meet her.  Léa brings an eager, if somewhat forced cheer to their halting conversations during this meeting and in their car ride to the home Léa shares with her husband, their two small adopted Vietnamese daughters, and her mute father-in-law.  From this awkward beginning, the sisters try to cross the chasm of a fifteen-year separation.  The cause and nature of the separation gradually unfold in small, slowly paced scenes of ordinary life at home, at work, in a café, during dinners with friends.  These scenes form the visible surface under which secrets and plangent, unacknowledged emotions lie, sometimes erupting into view, sometimes gently suggested.
    
The cause of the separation is the prison term Juliette has served in England.  We eventually learn that the sentence has to do with the death of her child, with her being a physician, with her child's suffering from cancer, and with the application of her medical knowledge to end his pain.  Following the court sentence, Juliette's parents refuse to acknowledge her, her husband divorces her, her sister buries memories of their childhood and chooses not to give birth, family and friends never visit her in prison.  We also learn that Juliette remained inexplicably silent throughout her trial.  She continues to say very little as she settles in with Lea's family and circle of friends, who are baffled by her sudden appearance in Lea's life.  But as Juliette's participation in her sister's circle increases in fitful starts, she becomes cautiously more communicative and brighter.

During a confrontation with Léa at the end of the film, Juliette reveals that, more than avoiding a shameful appraisal from others, she remains silent because there are no words to express her pain.  Being in prison made literal the isolating psychological state she inhabited.  "The worst prison is the death of one's child," she says.  "You never get out of it."  With these words, the film places the wound and the pain at the core of its main character in the inescapable vulnerability of motherhood.    

    

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The poet considers pain as a place she inhabits, from which she could (hope to) escape, " . . . returned magically to life . . . ." But it is inescapable, "like your softest skin . . . a room no one else can come into . . . . " Finally, it is "only feeling" that defines this place, a place of silence, suffering, and separateness.

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Editor Helman is a physician and anthropologist as well as a published author of short stories, essays, and a medical anthropology textbook. For this anthology he has selected short stories, case studies, memoir and novel excerpts whose purpose is "to illustrate different aspects of [the] singular but universal relationship" between doctors and patients (1). In the introduction he discusses how these selections illustrate storytelling in medicine; the unique experience of individual illness; differences between fast-paced contemporary technological specialized medicine, and an older more leisurely medicine where the physician employed all his/her senses to diagnose illness, doctors made house calls, and patients recovered over time, or died.

The anthology is subdivided into three parts: "Doctors," represented by the work of Mikhail Bulgakov, Franz Kafka, Sir Arthur Conan Doyle, and Rachel Naomi Remen; "Patients," represented by authors Renate Rubenstein, Ruth Picardie, Rachel Clark, Clive Sinclair, W. (William) Somerset Maugham, and O. Henry; and "Clinical Encounters," with work by Oliver Sacks, Cecil Helman, William Carlos Williams, A. J. (Archibald Joseph) Cronin, Anton P.Chekhov, and Moacyr Scliar. (In total there are 16 selections.) Each piece is preceded by a paragraph of biographical information about its author and an introduction to the text.

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