Summary:

This is a gripping and poignant account of newsman Bob Woodruff’s brain injury and recovery. He was injured in Iraq by a roadside bomb on January 29, 2006, shortly after being named co-anchor for ABC’s World News Tonight. A public figure—even a celebrity—his injury and recovery were well publicized, bringing to light the injuries of many kinds suffered by soldiers (not to mention civilians) in war-torn Iraq. Woodruff received every benefit American military medicine could offer and had impressive support of ABC and various luminaries. He made a spectacular recovery against all odds.

The book is mostly told by Lee Woodruff, Bob’s wife, who flew to Germany on a moment’s notice to see him at the Landstuhl Military Hospital, who waited 36 days for him to wake up, who saw the CT scan with rocks embedded in his head, who managed their four children and household during the long recovery time, and who writes vividly and personably. There are also flashbacks about the lives of Lee and Bob, truly a remarkable couple: their courtship, their time in China and London, their decision to use a surrogate mother to have their second two children.

Bob himself contributes pages, before and long after the accident. Thirty-one photos, both black and white and in color, enliven the text. One photo shows the interior of a critical Care Air Transport Team, a C-17 cargo plane outfitted like an ICU to transport wounded soldiers.  Throughout, the costs of warfare on people, society, materials, and land (not to mention dollars) is dramatically evident.

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Author Diedrich investigates ("treats") mid-late 20th century memoirs about illness (illness narratives) from an interdisciplinary perspective drawing on the disciplines of literature, social sciences, and philosophy. Her analysis uses the theoretical frameworks of poststructuralism, phenomenology, and psychoanalysis to consider "what sort of subject is formed in the practice of writing . . . illness narratives," the kind of knowledges articulated by such writing, whether and how such writing can transform "expert medical knowledges," how language operates in these memoirs, and "what sort of ethics emerges out of such scenes of loss and the attempts to capture them in writing" (viii).

The book is divided into Introduction, five chapters on specific memoirs, and Conclusion. Chapter 1, "Patients and Biopower: Disciplined Bodies, Regularized Populations, and Subjugated Knowledges," draws on Foucault's theory of power to discuss two mid-20th-century memoirs of institutionalization for tuberculosis. Betty McDonald's the Plague and I is compared with Madonna Swan: A Lakota Woman's Story. Dividing practices and regularization are shown to serve different functions in these two incarcerations, figurative in the case of Betty McDonald, and literal in the case of Madonna Swan.

Chapter 2, "Politicizing Patienthood: Ideas, Experience and Affect," draws on Foucault's approach to the subject and on his discussion of "practices of the self" in contrasting Audre Lorde's The Cancer Journals with Susan Sontag's Illness as Metaphor and AIDS and Its Metaphors (see annotations). Diedrich also brings into her analysis Eve Sedgwick's theory of queer performativity and Sedgwick's own illness narrative, White Glasses. Diedrich views all of these as counter narratives to the clinical medical narrative of illness but she shows how they differ in stance.

Chapter 3, "Stories For and against the Self: Breast Cancer Narratives from the United States and Britain" looks at "the arts of being ill" as they are represented in two cultures, two "conceptions of the self in these countries at a particular historical moment" (61). The narratives discussed are Sandra Butler and Barbara Rosenblum's narrative, Cancer in Two Voices and Ruth Picardie's Before I Say Goodbye (see annotations). Diedrich associates Cancer in Two Voices with an American notion of self-improvement and Before I Say Goodbye with a British "emphasis on the cultivation of an ironic self" (55). The author works in this chapter with Freud's idea of the uncanny, Benedict Anderson's concept of "imagined political communities" and Elaine Scarry's discussion of pain, language, and the unmaking of the self.

Chapter 4, "Becoming-Patient: Negotiating Healing, Desire, and Belonging in Doctors' Narratives," treats Oliver Sacks's illness narrative, A Leg to Stand On, Abraham Verghese's autobiographical My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS, and Rafael Campo's book of essays, The Poetry of Healing (see annotations). Here Diedrich considers "the possibility that doctors, especially AIDS doctors, might become patients through desiring-and writing-productions" (83) and she utilizes the rhizome model of Deleuze and Guattari to make her case. She discusses how Verghese and Campo are each both cultural insiders and outsiders and how they each "bring the body into language through their writing" (88).

Chapter 5, "Between Two Deaths: Practices of Witnessing," focuses primarily on Paul Monette's writing about the loss of his partner to AIDS, and on John Oliver Bayley's books about the loss of his wife, Iris Murdoch, to Alzheimer's, and her ultimate death (see annotations in this database). In this chapter Diedrich invokes Lacan's concept of the real and his formulation of "the ethical possibility of being between two deaths" (117). She draws also on trauma theory and the work of Kelly Oliver, a contemporary feminist philosopher who has written on witnessing.

Finally, in her "Conclusion: Toward an Ethics of Failure," Diedrich returns to Elaine Scarry's "phenomenological discussion of the experience of pain" and brings in Jean-François Lyotard's concept of incommensurability and his suggestion between the two poles of what is seemingly incommensurable one might search, in Diedrich's words, for "new rules for forming and linking phrases between . . . subject positions" (150). In that context she analyzes physician Atul Gawande's discussion of medical uncertainty and error in his book, Complications (see annotation) and philosopher Gillian Rose's book, Love' s Work. Diedrich concludes that the basic incommensurability between doctor and patient can be a starting point for a new ethics, an ethics of failure and risk "because by taking such risks [of failure, of relations], we open up the possibility of new routes, new treatments: in and between art, medicine, philosophy, and politics" (166).

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Summary:

In How Doctors Think, Jerome Groopman explores clinical decision making with a particular emphasis on the poor communication skills and cognitive errors that often lead to misdiagnosis and inappropriate treatment. He uses a narrative approach, filling the book with compelling stories that illustrate the world of patient-physician interactions. Why did a second doctor quickly conclude that Blanche Begaye suffered from aspirin toxicity, while her first doctor mistakenly diagnosed viral pneumonia? Why did several physicians fail to diagnose Maxine Carlson's ectopic pregnancy until the day it ruptured? Groopman's storytelling skill permits him to convey complex concepts (e.g. availability bias, anchoring, and Ockham's razor) through conversation and narrative.

Three major themes run throughout the book, and each is presented with several variations. The first theme is that doctors who don't listen to their patients are likely to make serious mistakes in diagnosis and treatment. The second is that doctors frequently don't have the self-awareness to understand their own errors, especially those that involve dealing with ambiguity and understanding the importance of emotions. The final theme is that that patients ought to be active participants in their own care. This is not a new message, but Groopman frames it in a new way. Given the complexity of clinical decision making, and the many cognitive errors physicians may fall prey to, patients can improve their own care by helping their doctors minimize or avoid such errors. Among other things this means asking thought-provoking questions like "What else could it be?", "What is the worst thing it could be?," or "Is it possible I have more than one problem?"

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Thin, a documentary film produced, aired and distributed by HBO, is the centerpiece of a multi-faceted project that explores the complex issues of body images and eating disorders in young women. Photographer and journalist Lauren Greenfield began documenting eating disorders in 1997, eventually publishing an article for Time Magazine and a book entitled Girl Culture, as well as producing a traveling photographic exhibit. Returning to one of the facilities featured in the exhibit, Greenfield took up residence at the Renfrew Center, an in-patient facility for eating disorders in Florida, to film the day-to-day suffering of four young women struggling with anorexia over the course of six months.

The youngest is Brittany, a sad and troubled fifteen-year old, whose bulimia and anorexia began when she was only eight (her weight bounced from 185 to 95 pounds in one year) and whose mother has her own very unhealthy relationship to food. Brittany is eventually returned to her weight-obsessed mother because of the loss of insurance. Shelly, a twenty-five year-old, psychiatric nurse, has been anorexic for six years and enters Renfrew at 84 pounds with a surgically-implanted feeding tube. Her identical twin visits to plead with Shelly to refrain from slowly killing herself and ultimately destroying their family. Polly is a twenty-nine year old, charming troublemaker whose health is returning but whose defiance of rules eventually gets her kicked out of the facility. The oldest patient is Alisa, a thirty-year old, divorced mother of two whose eating disorder ostensibly developed at age seven when a pediatrician persuaded her mother to put her plump daughter on a severe diet. Alisa's graphic account of a single day of binging and purging is shocking, and her forced release from Renfrew because of problems with health insurance precipitates a return to this pattern after she tucks her children into bed.

 

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Serving as a summer hospital volunteer, fifteen-year-old Teri d'Angelo meets Valerie Ross, a girl her age who has damaged a nerve in a fall, and lost the use of one leg. Valerie's anguish over her partial paralysis takes the form of anger; she manages to keep most of those who try to help her at a distance. But Teri finds her intriguing, and Valerie's condition evokes a kind of sympathy and interest in her that overcomes even the patient's most strenuous rebuffs. Gradually, and with much caution on Valerie's part, they become friends. Valerie finds herself welcomed into Teri's large, warm Italian-American family. Teri's compassion for Valerie grows as she recognizes her loneliness; Valerie's parents are divorced, her father rarely visits, and her mother keeps up a hectic work schedule.
      
Teri also benefits in ways she didn't expect from the friendship; Valerie's bravery, even when masked with anger, inspires her to speak up more clearly on her own behalf, to ask for what she needs, and even to circulate a petition at school when she feels she has been discriminated against in the judging of a science project.
     
When Valerie is taken to a "sanitarium"-a mental health facility-for depression and apparently psychosomatic involvement of her good leg in the paralysis, Teri visits her patiently, despite Valerie's apparent lack of interest. But finally, when she watches Valerie rejecting the grandmother who traveled from England to see her, she acts in uncharacteristic anger, and in the shock of the moment, Valerie stands up, proving to herself and others that her good leg does, infact, function.  It is a turning point in her healing.

In an interesting twist, the book ends with the girls drifting apart.  They are, indeed, very different. Valerie is planning to attend City College in engineering. Valerie is going to live with her grandmother in England and attend Oxford University, hoping later to become a writer. In a final phone call, two years after Valerie's accident, the girls part with some affection and gratitude on both sides, but also with an acceptance of the fact that their friendship may have been for a season. They gave each other important gifts, and now life is taking them in very different directions. 

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Born in Vienna, Alma Rosé (1906-1944) was a gifted violinist with an illustrious concert career. Her mother was the sister of composer, Gustav Mahler, and her famous father, Arnold, conducted orchestras. All the family members were non-observant Jews. Alma was talented, beautiful, audacious, and arrogant. After an unhappy early marriage to Czech violinist Vása Príhoda, she established a remarkable orchestra for women that toured Europe.

As the German Third Reich consolidated its power, her only brother, Alfred, fled to the USA. She managed to bring their widowed father to England, but displaced musicians crowded London making work difficult to find. Alma left her father and returned to the continent, living quietly as a boarder in Holland and giving house concerts when and where she could. She took lovers.

Despite the urging of her family and friends, she kept deferring a return to safety in England. In early 1943, she was arrested and transported to Drancy near Paris, thence to Auschwitz six months later. Initially sent to a barrack for sterilization research, she revealed her musical brilliance and was removed to marginally better accommodations and allowed to assemble an orchestra of women players.

The hungry musicians were granted precarious privileges, but Alma became obsessed with their progress and insisted on a grueling schedule of rehearsal and perfection. Some said that she believed that survival depended on the quality of their playing; others recognized that the music, like a drug, took her out of the horror of her surroundings.

In April 1944, she died suddenly of an acute illness thought to have been caused by accidental food poisoning. In a bizarre and possibly unique act of veneration for Auschwitz, her body was laid "in state" before it was burned. Most members of her camp orchestra survived the war.

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Memoirs of Hadrian is a historical novel in the form of a long letter written by the Roman Emperor Hadrian to his young friend and eventual successor, Marcus Aurelius. Alas, Hadrian is "growing old, and is about to die of a dropsical heart." The Emperor begins by describing his recent visit with his physician Hermogenes, who "was alarmed, in spite of himself, at the rapid progress of the disease" (3). In light of his physical deterioration, Hadrian begins to reflect on his life and work, and to share his wisdom with his young correspondent.

Hadrian tells of his early life as the protégé of the Emperor Trajan, his military and political victories, and his eventual adoption by Trajan, a move that guaranteed the succession when his adoptive father died. While Trajan, whose victories brought the Roman Empire to its greatest size, was a military man to the core, Hadrian considers himself essentially peace loving--his personal life devoted to simplicity and harmony; and his public life to prosperity and justice. Nonetheless, he has always recognized that, in order to govern effectively, ruthless action is sometimes required.

Hadrian's marriage to the Empress Sabina was simply a matter of convenience. The love of his life was a beautiful young man named Antinous. The two men were deeply committed to one another, but at the same time the middle-aged emperor had "a certain dread of bondage" ( 177) that kept him from fully giving himself to Antinous with the abandon of youth. They were visiting Alexandria when the despondent Antinous committed suicide in a way that mimicked a religious ritual, essentially sacrificing himself to the deified Emperor.

Hadrian was crushed with grief and descended into a long period of depression. However, he eventually overcame his depression through his love of literature and ideas, as well as his sense of duty to the Empire (no SSRIs being available at the time), although not before attempting to enlist his physician in assisted suicide. Unable to refuse his emperor's request, the physician himself commits suicide rather than violating his Hippocratic Oath.

Hadrian's final military engagements involve crushing Jewish insurgents in Palestine, completing the destruction of Jerusalem, and founding a new Roman city on its site. The aged Emperor reflects frequently on his tolerance for all religions, except for politically disruptive fanatics like the followers of a Jewish prophet called Christ. As to the Jews in Palestine, he cannot understand why they continue to engage in self-destructive rebellion, most recently with Bar Kokhba and Rabbi Akiva as their leaders.

In his final years Hadrian adopts Lucius, one of his former lovers (in this account), as his son and heir, but Lucius soon dies, presumably from tuberculosis. Eventually, the Emperor adopts Antinous Pius as his heir and further arranges for Marcus Aurelius to succeed Antinous Pius. At the end of his letter, Hadrian writes, "I could now return to Tibur, going back to that retreat which is called illness, to experiment with my suffering, to taste fully what delights are left to me, and to resume in peace my interrupted dialogue with a shade." [i.e. Antinous, his lost love (271)].

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This remarkable collection of short writings, introduced by renowned poet Naomi Shihab Nye, who visited the Sutterwriters (of Sutter Hospital in Sacramento, California) to offer a workshop, provides a broad, compassionate, imaginative window into the life inside and around an urban hospital. Patients, staff, and all interested in healing through writing are invited to come and participate-with an accent on the latter: no one is invited who isn't willing to write.

Chip Spann, the editor, came to Sutter Hospital with a Ph.D. in English, and has the privilege of coordinating this fluid community of writers as part of his work as a staffmember. His conviction, voiced in an engaging introduction, is that literature is a powerful instrument of healing--both the literature we read and the literature we create--and that the experience of literature belongs in community. The individual pieces are accompanied by photographs and short bios of contributors.

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A group of eight women gather for a joint consultation with Dr. Kailey Madrona who is a devotée and colleague of the research endocrinologist, Dr. Jerilynn Prior, a professor at University of British Columbia in Vancouver. Madrona explains that she has arranged for the unorthodox group encounter because she will be leaving practice to pursue graduate studies in medical history.

Dr. Madrona leads an open-ended discussion on the physiological changes associated with perimenopause. Following the controversial research of Prior, she emphasizes that the symptoms are owing to the unbalanced rise in estrogen levels during perimenopause—a period leading up to the cessation of menstruation and continuing for twelve months after the last flow.

Some women patients are skeptical, because they have been placed on estrogen ‘replacement” medication, or they have read that their symptoms are owing to the waning of estrogen. The doctor describes the results of various trials about supplmentary estrogen, including the 2002 Journal of the American Medical Association report. She invites them to keep detailed diaries of their cycles and symptoms.

One by one the women return for private consultation, physical examination, discussion and another follow up visit. Although they have reached roughly the same physiological moment in life, they are a diverse group with different symptoms and needs. Darlene, an angry nurse, is suspicious and non-compliant. Beverley, an Asian immigrant is still hoping to become pregnant. A lesbian wishes to control her moods and hot flashes. A very hard-working waitress needs to understand her strange lack of energy. A wiry, lean athelete wants to improve her performance and is irritated by the inexplicable alterations in her abilities. Others are plagued by sweats, nausea, or migraines. They all are confused about sex.

Dr. Madrona listens to them carefully, examines them with special attention to their breasts, not their genitalia, and recommends treatment with progesterone for everyone. She also urges weight gain for most and readily volunteers personal information about her own perimenopause. All but the nurse eventually comply and are relieved of their symptoms. At the end of a year they meet for a pot-luck dinner to celebrate their recovered health and thank their doctor. Beverley is pregrant.

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Tracy Kidder met Paul Farmer in 1994 when the former was writing an article about Haiti. They next met again in 1999 but it was only when Kidder expressed an interest in Farmer and his oeuvre that Farmer emailed him back, writing "To see my oeuvre you have to come to Haiti" (17). Kidder did just that, following the peripatetic workaholic Farmer to Peru, Russia, Boston, and wherever Farmer flew, which is anywhere there is poverty and disease, especially infectious disease.

In Mountains Beyond Mountains (MBM), Kidder chronicles Farmer’s childhood, medical school years (almost a correspondence course with Farmer’s frequent trips to Haiti), his founding of Partners in Health (PIH) and the construction of the medical center in Cange, Haiti, where "Partners in Health" becomes Zanmi Lasante in Creole.

The story of Farmer’s crusade for a more rational anti-tuberculosis regimen for resistant TB; his political struggles to wrestle with drug manufacturers to lower the price of these and medicines for HIV; his charismatic establishment of a larger and larger cadre, then foundation of co-workers; the story of Jim Kim, a fellow Harvard infectious disease specialist; Farmer’s marathon house calls on foot in Haiti; endless global trips punctuated by massive email consultations from all over the world; and gift-buying in airports for family, friends and patients--these are fascinating reading. In the end one is as amazed and puzzled by the whirlwind that is Paul Farmer--surely a future Nobel Peace Prize laureate like Mother Teresa--as Tracy Kidder was and grateful to have the opportunity to read about it by such an intelligent writer.

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