Summary:

This documentary, narrated alternately by the daughter-filmmaker and mother whose stories it tells, focuses on how two women move apart and together while experiencing, respectively, adolescence and mid-life. The mother has cancer, a mastectomy, and then rheumatoid arthritis, and these experiences intertwine thematically and structurally with the narrative of the mother-daughter relationship.

Another provocative juxtaposition cross-cuts scenes from the daughter's modeling career (and the social and erotic body that context constructs for her) with scenes of the mother's illness, stigmatization, and erotic daydreams. Both women come to a new awareness of the social meaning of mastectomy within heterosexual and same-sex contexts by the documentary's end; they also come to a place of recognition of the mother's personal and social value and the nature of their relationship.

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Three novellas by a master storyteller. For the title story, see the separate entry in this database (Epiphany). "Harmony Ain't Easy" is a tale in which Dr. and Mrs. Sams (he retains his own name here) get stranded when their car is disabled on a country road, thanks to Dr. Sams's bull-headedness. After a warmly humorous series of reverses, they are finally saved.

In the last story, "Relative and Absolute," aged Mr. McEachern is approached by three high school students who want to interview him for their oral history project. They ask him questions about living conditions and race relations in their county when he was young. During the series of interviews, as he tells them anecdote after anecdote heavy with homey wisdom, the old man and the adolescents learn to like and respect each other.

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The story consists of a series of Dr. Mark Goddard's dictated office notes regarding the care of his patient Gregry McHune, interspersed with the narrator's description of these physician-patient interactions. McHune first presents as a standard case of high blood pressure; however, in subsequent visits the man tells his harrowing story.

Goddard learns that his patient was unjustly jailed for killing a black man in self-defense. McHune tells him about racism in the penitentiary and his fight for survival, both in prison and later. Eventually McHune and his family are hounded out of town by the son of the man he killed.

Through all these losses, McHune maintains his sense of humor and easy-going integrity. Meanwhile, the elderly Dr. Goddard is repeatedly harrangued by the clinic administrator (a vacuous young man) for including extraneous details and poetic language in his dictations. As time goes on, and he is transformed by his relationship with McHune, Goddard includes more and more poetry in his office notes.

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This is an ambitious and far-ranging book, the result of years of thinking, teaching, and working with patients. An internist at the College of Physicians and Surgeons at Columbia University, Charon sees a wide range of patients in an urban setting. Also a Ph.D. in English literature, Charon has devised a "Parallel Chart" and other means for caregivers to write personally about the dynamics between healer and patient, to read texts--narratives in particular--and, as a result, to listen better to patients, thus improving the delivery of medical care.

Charon defines narrative medicine as "medicine practiced with these skills of recognizing, absorbing, interpreting, and being moved by the stories of illness" (4). She calls this a "new frame" for medicine, believing that it can improve many of the defects of our current means of providing (or not) medical care. Caregivers who possess "narrative competence" are able to bridge the "divides" of their relation to mortality, the contexts of illness, beliefs about disease causality, and emotions of shame, blame, and fear.

Charon finds that medical care and literature share five narrative features; she argues that careful reading of narratives builds skills that improve medical care, including intersubjectivity between caregiver and patient, and ethicality. Beyond the theory, there are powerful and persuasive examples of interactions between caregiver and patient, many from Charon's own practice. A mother of a sick daughter experiences stress that makes her ill; when she sees a narrative connection, she begins to heal.

Charon sees wider applications. As caregivers understand better concepts of attention, representation, and affiliation, they become more ethical, more community minded, and better healers to their patients. Patient interviews will be different: instead of following a grid of questions, physicians will converse with patients in an open-ended way. What is most important will emerge and emerge in ways that are most beneficial to the patient. Yes, this method will take more time but it will be more efficient in the long run. Bioethics, Charon argues, has been limited by legal approaches and philosophical principles. For her, narrative bioethics offers more human values in how people feel, experience reality, and relate to each other. Finally, there are implications for social justice: why are the poor underserved in this country and in many others?

One of the most exciting and radical formulations comes late in the book: ". . . practitioners, be they health care professionals to begin with or not, must be prepared to offer the self as a therapeutic instrument" (p. 215). This notion links up fruitfully with concepts of energy medicine (v1377v), therapeutic touch (Tiffany Field), and intentionality (Wayne W. Dyer).

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The artist faces the viewer at a slight angle. He wears a bandage across his ear and under his chin, a purple and black winter cap upon his head, and a green overcoat with only the top button fastened. His sallow skin, in combination with the bandage, makes clear that the artist is unwell. In the background, upon a yellow wall, hangs one completed painting, vibrant and colorful, depicting a landscape and three women. Another painting that is only a sketch sits on a wooden easel to Van Gogh's right. A small section of a large window is visible on the right side of the painting.

Every color used to paint Van Gogh's person and clothing finds its pair in his surroundings: the purple of his hat couples with the window, his yellow skin couples with the wall, his overcoat and eyes pair with the landscape in the painting on the wall, and the white of his bandage complements the sketch behind him.

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The site of the multiple stories interwoven in this novel is a teaching hospital in San Francisco. One of the featured characters is a young single mother who comes in with a swollen arm and finds herself in more medical trouble than she anticipated. She suffers a mild stroke after debatable treatment. Two doctors attend her, but differ markedly in their ideas of how to treat her and their human responses to her. One ends up having a brief affair with her that changes his life.

In addition to these there are stories of a comatose young man and the family that refuses to believe he will not awaken (he does); a volunteer coordinator who observes the politics of hospital life from a privileged margin, and sundry staff people who represent alternative points of view. The single mother recovers, but only after a stay in the hospital has convinced her she may not yet be too old to go to medical school to find a life not in marrying a doctor, but in being one.

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Subtitled "New and Selected Medical Poems," this volume includes poems on illness and healing from Downie's three previous collections, along with several new poems. A longer piece called "Learning Curve Journal" serves as a framework for the book.

Beginning with the desperate voice he hears on his first night as a "suicide line" volunteer, the poet reveals the shape of his own medical learning curve, moving poem by poem from "Orientation" through the realm of "Patient Teaching" and "Teaching Rounds" to "Pronouncing Death." Among the many strong poems in this collection are "Diagnosis: Heart Failure," "Louise," "Sudden Infant Death," "Wishbone," "Living with Cancer," and "Ron and Don."

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Monsieur Daron, an eighty-six-year-old-man, comes to live at the new spa in Rondelis. He believes himself to be in excellent health, as a result of "careful living." He has always had "an obsessive fear of death," and he avoids all pleasure because it may be dangerous.

In order to measure and monitor his own condition, M. Daron arranges for the doctor in charge of the springs to visit him once a week with information on the health of everyone else in the surrounding area who is over the age of eighty. When he hears that someone has died, he quickly identifies a cause that might have been avoided; the man who died of pleurisy should not have gone out in the cold, and the one who died of dysentery must have eaten the wrong food.

Eventually, though, one old man dies for no apparent reason. The doctor can report no lesion, no disease: "He died because he died, that's all." M. Daron is horrified and asks the man's age. Eighty-nine. He laughs in relief, saying, "whatever it was, it wasn't old age . . . ."

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A one-person performance of thirteen characters during a single night on a hospice unit. Portrayed are patients, family members and professional caregivers. With minimal lighting and few props the actor/writer, who has been a hospice volunteer for many years, is able to capture in words and action the poignancy and humor of caring for the dying.

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Howard Carter very skillfully weaves together the various meanings that the heart holds for us--biological, medical, psychological, cultural, and spiritual. He does so through four patients that he interviewed when he was appointed to a distinguished professorship in medical humanities in a joint program of St. Patrick Hospital and the University of Montana, in Missoula.

Each of the sections of the book focuses on one of the patients who suffers, respectively, from a prototypical heart problem: a young man with congenital defects who undergoes successful surgery; a middle-aged woman with a viral illness who learns how to live with her chronic heart condition; a middle-aged man whose blocked coronary arteries are cleared, as is the stress in his life; and an old man who turns to spiritual matters as he faces heart failure.

What contribute significantly to the uniqueness of this book are the essays that Carter provides at the end of each Patient Section. They are the vehicles for the synthesis of the patient stories, the scholarly look at how "we have largely lost the anchoring image of the heart" in American society, and his very poignant personal reflections about life in (or at least near) the wilderness of Montana. (See Solid Footing, Higher Ground -Third Essay as an excellent example of his skillful and moving writing.)

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