Summary:

Claire, Rachel, and Allison Barber share the trauma of having lost both parents in a strange and sudden accident. The youngest, Claire, and the oldest, Rachel, also share their late mother's migraine headaches. The novel's focus is Rachel's disappearance and Claire's search for her through North America, Europe, and Mexico. By herself and eventually with the help of Rachel's friend and sometime lover, a massage therapist named Brad Arnarson, Claire traces the steps of Rachel's professional (as a freelance science journalist) and personal meetings with researchers and health practitioners who work on migraines.

Initially, Claire's search is motivated by concern for Rachel and intensified by fears that Rachel's worsening migraines may have caused her to take desperate action. Her need to find Rachel is inevitably intertwined, however, with her own migraine experiences and with her drive to individuate within her family and her longterm relationship with her partner Stefan.

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Protagonist Mary Lennox, "as tyrannical and selfish a little pig as ever lived," is nine years old when she wakes one morning in India to an empty house, forgotten by all in the chaos of a cholera epidemic that has killed her pretty young mother, British army captain father, and most of their servants. The novel charts Mary’s removal to England and her physical, psychological, and moral development on the Yorkshire estate of her widowed uncle Archibald Craven, a reputed "hunchback." As part of her own maturation, Mary catalyzes growth and healing in (and between) her mildly spinally disfigured uncle and his "invalid" son Colin.

The secret garden of the title is Mary’s aunt Lilias’s creation. It has been virtually abandoned since the accident that resulted in Colin’s premature birth and Lilias’s death. Colin himself, while overprotected by the servants, is ignored by his depressed father and hidden in the estate. Mary discovers and rehabilitates both the secret garden and her secret cousin with the help of the working-class Sowerby family, including the servant Martha, her brother Dickon (a boy in tune with nature), and their mother Susan. Archibald, travelling across Europe to escape his sadness, is called back to the garden by a dream of his dead wife and returns to find Colin healthy and walking.

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When Mary Lennox (Margaret O’Brien)’s parents die in a cholera epidemic, she is sent from India to live with her uncle, Archibald Craven (Herbert Marshall) at Misslethwaite Manor, his large and lonely estate on the Yorkshire moors. A neglected, lonely, and disagreeable child, Mary changes through encounters with the gregarious maid Martha (Elsa Lanchester), an elderly gardener as irritable as she is, and Martha’s brother Dickon, a boy at home with nature who helps her rejuvenate the walled, neglected garden she finds on the estate.

Mary also unravels the mysteries associated with Misselthwaite Manor and her uncle’s family. A dramatically unhappy man, Lord Craven is a widower with a spinal deformity who fears he is losing his mind. He has locked the garden after his wife’s death, and similarly hidden away their son Colin, whom he thinks has inherited his bodily and psychiatric illnesses. When Mary discovers her cousin by following the sound of crying in the middle of the night, the two become friends. Whereas the domestic staff indulge Colin for fear of his temper, his reputed invalidism, and his father’s displeasure, Mary rebukes Colin, seeing her own former imperiousness in his bad behavior. She and Dickon bring Colin into the garden, where he grows strong and healthy, defying doctors’ orders and surprising his father—who has come home to sell the estate--by walking into his arms.

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When Mary Lennox (Kate Maberly)’s parents die in an earthquake, she is sent from India to live with her uncle, Lord Archibald Craven (John Lynch) at Misslethwaite Manor, his large and lonely estate on the Yorkshire moors. A neglected, lonely, and disagreeable child, Mary changes through encounters with the gregarious maid Martha, an elderly gardener as irritable as she is, and Martha’s brother Dickon (Andrew Knott), a boy at home with nature who helps her rejuvenate a walled, neglected garden she finds on the estate.

Mary also unravels the mysteries associated with Misselthwaite Manor and her aunt and uncle’s family. A depressed widower with a spinal deformity, Lord Craven has locked the garden after his wife’s accidental death. Mary discovers the key to the garden in her aunt’s closed-up boudoir. She also finds her cousin Colin (Heydon Prowse), who has been hidden away because his father thinks he has inherited his bodily and psychiatric illnesses. Mary provokes Colin to leave his bedroom, join her and Dickon in caring for the garden, and finally to summon his father, via a quasi-pagan ritual around a bonfire in the garden, to return from Europe. Lord Craven returns to find his sickly son walking and healthy, and a new family consisting of Colin, Mary, and Lord Craven is formed.

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This DVD, a documentary of a medical student retreat to a museum, illustrates an approach to cultivating empathic understanding in medical students and residents by using the visual arts.  Florence Gelo, D.Min, created the arts program and the video. She is Behavioral Science Coordinator, Family Medicine Residency, Drexyl University College of Medicine. Students observe closely four paintings and are encouraged to experience their feelings about what they are seeing, and to express those feelings. The paintings are Prometheus Bound (Peter Paul Rubens 1618), Massacre of the Innocents (Pacecco de Rosa 1640), Rachel Weeping (Charles Wilson Peale 1618), and The Agnew Clinic (Thomas Eakins 1889; see annotation in this database).

Prometheus Bound is a disturbing scene of an eagle ripping the liver out of Prometheus. Students comment on the nakedness. the vulnerable position and the helpless expression on the face of this strong man, and on the eye contact between the eagle and Prometheus. In Massacre of the Innocents Dr. Gelo calls our attention to the faces of the mothers, helpless to save their children from the swords. In Rachel Weeping Gelo asks the students if they noticed the vials of medicine before the days of allopathic medicine.  Did they notice the one tear dropping from Rachel's face? (Peale added the medicine vials and his wife weeping to the original portrait of his infant daughter Margaret who died of smallpox.)

Two physician speakers, Horace DeLisser, and Rhonda Soricelli provide additional commentary about how engagement with a painting is similar to engaging with a patient, and how learning technology-focusing on the scientific and the medical- detracts students from learning to look at the big picture and the humanistic side of medicine.  Traditional medical education does not teach doctors to be present to patients, to sit by their sides, to listen and invite dialogue of suffering and to not deny those aspects of what it means to be ill.  Dr. DeLisser further acknowledged his personal struggles with feelings of frustration, anger and grief when patients died in the ICU.  The importance of talking about the vulnerability of physicians, the concerns about what else they might have done, propelled him to develop Grieving Rounds.

A cancer survivor contrasts a "callous" physician's response to her care with  another physician who exemplified someone who has the expertise not only around the disease, but  has the ability to acknowledge the whole person and offer his companionship to be there to the very end: "...what we're going to do is....We'll take this step by step."

 

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A stranger knocks on the door of the apartment occupied by the R. family. He warns them that an epidemic is spreading in town. Death usually ensues in 3 days and is preceded by swelling, blisters, and redness of the skin. Mice are suspected to carry the disease. The young man appears ill but claims to be a survivor and now immune to the epidemic. He advises the family to remain indoors, avoid mice, and practice strict hygiene. He offers to bring food. The family is skeptical and declines his offer of assistance.

Soon the city is ravaged by the disease. TV and phone stop working. Violence and looting are rampant. Nikolai, the father, regularly goes out at night to rob food and supplies for his family. Sometimes he kills. When he returns home, he always cleans himself thoroughly. He lives with his wife, Elena, their daughter, and Elena's parents.

The family's cat is outside on the balcony and hungry so they bring it inside. The animal eats a mouse, and afterwards the little girl kisses the cat on its mouth. The adults are horrified. They quarantine the child in her bedroom along with the cat. After 3 days, there is no sound or activity in the bedroom. The girl is presumed dead. The cat is alive and escapes. The child's parents and grandparents manifest signs of the infection and die.

Six days after his initial visit, the young man who warned the R. family returns to the apartment building. The place is silent except for the meowing of a cat. The stranger breaks into the apartment and sees 4 dead bodies. Inside the barricaded bedroom, he finds the little girl alive and recovering from the infection. Next to her in bed is the pet cat.

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While riding on a commuter train, Bill Chalmers suddenly forgets who he is and where he is headed. His amnesia is accompanied first by a numbness of his hands and then later his legs. Eventually he is confined to a wheelchair and dependent on his family and a home nurse to care for him. Despite extensive testing and consultations with a variety of doctors, no one can make a definitive diagnosis of his illness.

Chalmers is subjected to many empirical treatments including antidepressants, steroids, plasmaphoresis, and psychotherapy, but his health continues to deteriorate and he loses his job. His wife and son become victims of his predicament. By the end of the story, Chalmers gains insight into his life and discovers that only his dignity still remains in his control.

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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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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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Subtitled "Tuberculosis and the Social Experience of Illness in American History," the book chronicles the medical and societal treatment of tuberculosis in the United States from the perspective of individuals who suffered from the disease. The author includes illness narratives derived from letters and diaries of the afflicted; her analysis spans the period in American history from the nineteenth through the first half of the twentieth century.

The book is divided into four sections. Part I, "The Invalid Experience: New England Men, 1810-60" and Part II, "The Female Invalid: The Narrative of Deborah Vinal Fiske, 1806-44" reveal an interesting contrast in the medical/societal treatment of tubercular men and women, and the resulting differences in their lives as "consumptives." Whereas men were expected to seek a cure by embarking on sea voyages and other travel, women remained at home and sought to control the disease by adjustments in domestic life. For men this meant major disruption and even change of career along with a sometimes exhilarating change of scene; for women it meant relentless anxiety and elaborate coping strategies.

Part III, "Health Seekers in the West, 1840-90" describes the role of cure-seekers in the westward migration and demonstrates how the culture of the time, an optimistic faith in nature and in the economic promise of the newly settled western territories, was reflected in the treatment regimen for tuberculosis. Interestingly, much of the promotional effort to bring "consumptives" west was initiated by physicians who were themselves tubercular.

The final section, "Becoming a Patient, 1882-1940," moves into the modern era with the discovery of the tubercle bacillus, public health measures, and the illness narratives of people who were confined in sanatoriums. Rothman points out that this period marked a transition away from the patient’s ability to understand and determine his/her treatment to one more like the current one in which the medical establishment is the authoritarian "expert."

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