Summary:

The editor, herself a writer and one who has suffered depressive episodes, collects a series of personal essays or illness narratives about experiences with depression. Her contributors are all artists, primarily writers, who generally but not exclusively speak to the relationship between their art and their mood disorders. Some of the essays included have been previously published, but most are original contributions to this collection. The collection is introduced by Kay Redfield Jamison whose academic work has examined the relationship between creativity and depression, including manic-depressive disease.

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The first poem in this chapbook ("Sonogram") contains two images of a small, mysterious life (the fetus imagined as a "white boat on whiter water" and as a "tiny orca") in the midst of the coldly technical medical world. This juxtaposition is characteristic of B. A. St. Andrews's poems in this small collection. In most of them, she uses disciplined and sparkling language to explore the interface between modern medicine with its impersonal machinery and the irreducible mystery of life.

Some of the images are simply breathtaking. For example, in "A Dying Art: Room 309," a terminally ill artist lies in bed, surrounded by "plastic bags that hang / like udders dripping pigment / into her." In a love poem called "The Body of Science," the poet confesses, "Each time your voluntary / muscles make contact / my involuntary ones / contract." And at the end of "Alzheimer's," she observes, "She stood at the big bay / window screaming but he never / heard what it was she never said."

The four poems entitled "Your Breast a Unicorn" consider the fate of breasts attacked "at consolation's center" by "one aberrant cell metastasized." These learned, wise, and witty poems are, in my opinion, among the very best of the breast cancer genre.

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Mrs. Wilson is a woman diagnosed with an advanced malignancy of the genital tract. Her husband had died from cancer ten years earlier. She is treated with a hysterectomy and oophorectomy along with aggressive chemotherapy by a good doctor who has no bedside manner.

Throughout the story her best friends are always medications to relieve pain: Dilaudid, morphine, Tylenol #3, and methadone. Only her son-in-law really understands her needs and comprehends how to care for her. He is genuine and vital and appears to know as much or more than the doctors in the story.

Mrs. Wilson acknowledges that "to maybe get well you first had to poison yourself within a whisker of death" but discovers that "if you had something to live for, if you loved life, you lived." She dies in a hospital room receiving an IV morphine drip. Before fading into oblivion, she recalls her youth and makes one last attempt at fathoming the meaning of life.

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Kirklin, a physician and Lecturer in Medical Humanities at the Royal Free and University College Medical School, and Richardson, a historian and associate at the Wellcome Trust Centre for the History of Medicine, are both educators in medical humanities in London. This well-written and concise volume focuses on "the role of the humanities in medical education" and is aimed at "those wishing to integrate medical humanities into their own teaching, and learning." (p. xv) The chapters are written by a variety of educators with a wide range of backgrounds, including artist, medical student, writer, nurse, surgeon and philosopher.

At least two stimuli are cited as reasons for the development of this book: (1) the 1993 publication by the General Medical Council of Tomorrow's Doctors which recommends the inclusion of medical humanities in the required curriculum for undergraduate medical education in the UK and (2) a national conference, "The healing arts: The role of the humanities in medical education" in London, March, 2000. The rationale for such a book is delineated in several prefatory statements including remarks by Professors Sir David Weatherall and Sir K. George M. M. Alberti (Alberti is the president of the Royal College of Physicians). The book concludes with recommendations for further reading, schemata for undergraduate and graduate degrees in medical humanities at University of Wales, Swansea, and an index.

The nine chapters in this volume combine pedagogic philosophy, citations for literature and art and how to encourage reflection about these selections, tools for encouraging student creativity, reproductions of art and literature generated by students or patients or used by teachers for discussion, and some practical advice about teaching medical humanities and its, at times, uneasy connection to the rest of the curriculum. Each chapter reflects the individual contributor's area of expertise and experience. For example, in "Fostering the creativity of medical students", the authors Heather Allan, Michele Petrone (who painted the striking cover art), and Deborah Kirklin provide useful guides for teaching creative writing and art production by students studying cancer and genetic disease.

In a particularly insightful chapter, "Medical humanities for postgraduates: an integrated approach and its implications for teaching," Martyn Evans describes the challenges of developing a full-fledged interdisciplinary program for graduate as well as undergraduate studies in Wales. He addresses concerns about "bolt-on" versus integration of medical humanities in the curriculum, risks of superficiality, and how such studies may transform the culture of modern medicine. Several chapters address a theme (such as "clinical detachment" or understanding the patient's perspective) and include topic-specific sources and guidelines.

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Through a compilation of journal entries, prose, and poetry, poet and activist Audre Lorde considers her breast cancer and mastectomy. Lorde emphasizes the importance of having a support network of other women. As a lesbian and feminist, she also offers a different perspective on this surgery. Her concern is not attracting or pleasing men despite the loss of a breast.

In one chapter, "Breast Cancer: Power vs. Prosthesis," Lorde considers the political implications of prosthetic breasts, arguing that hiding women’s pain and suffering disguises the widespread nature of the disease and places too much emphasis on "normal" femininity. She also writes about plastic surgeons who perform dangerous reconstructive surgery in the name of "quality of life."

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These fourteen sonnets interweave themselves to form a unified work, just as lines are repeated or echoed to interweave in the individual poems, providing an account of the author’s experience of breast cancer, radical mastectomy, and recovery. The medical details appear more prominently in the early sonnets, but gradually, other themes take precedence: suffering and how to compare relative degrees of suffering among individuals and groups; the reaction of oneself and one’s lovers to a disfigured body; and the search for affirmation, for a reason to want to live and be rid of the horror of disease and death.

Note: A relevant Web site about and by artist-model Matuschka, http://www.songster.net/projects/matuschka/, has been annotated in the art section of this database (Matuschka: Matuschka Archive).

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The author, an internist and medical educator with a long-term interest in literature (she recently was awarded a Ph.D. in English literature), describes the literary exercise she uses to develop empathy in students taking her required course in medical interviewing. Charon has her students choose a difficult medical encounter from their own recent training and then write, using the first person, the story of that patient’s life in the day before the difficulty--including being treated by the medical student who is doing the writing. Because much of the story must be imagined, the writer’s intuition is automatically brought into play.

Because it is told from the patient’s point of view, the medical student is forced to see the patient whole and without reference to medical terms. Charon argues that this exercise of the imagination yields a combination of objectivity and empathy that forms the basis for good medical care. She also finds that the exercise helps medical students see themselves as their patients see them--and thus to understand, for instance, the effect on their patients of their youth and nervousness.

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Crossing Over presents "extended, richly detailed, multiperspectival case narratives" of 20 dying patients served by the Hospice of Lancaster County in Pennsylvania and the Palliative Care Service of Royal Victoria Hospital in Montreal. These complex narratives (each written by a single author) reveal the patient’s story from many points of view, including those of family members and professional caregivers.

The authors explain how this project differs from recent books of clinical narratives by Timothy Quill (A Midwife Through the Dying Process, 1996), Ira Byock (Dying Well: The Prospect of Growth at the End of Life, 1997), and Michael Kearney (Mortally Wounded. Stories of Soul Pain, Death and Healing, 1996 [see entry in this database]). Barnard et al. point out that Quill, Byock, and Kearney are "passionate advocates for their own styles of care . . . Yet these very characteristics--advocacy and close personal involvement--limit their books in important respects." (p. 5) Basically, these authors select cases that illustrate the efficacy of their models and present the patients’ stories from their own point of view.

Crossing Over draws on a standard qualitative methodology that includes tape-recorded interviews of patients, families, and health care professionals; chart reviews; and participant observation. After the introduction, the narratives occupy 374 pages of text (almost 19 pages per patient). Part II of the book, entitled "Working with the Narratives," includes a short chapter on research methods and 29 pages of "Authors’ Comments and Questions for Discussion." The latter is designed to be used as a teaching guide.

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In July 1998 the poet Maxine Kumin was thrown from her carriage when her horse bolted during a competition. The type of cervical (C1-C2) fracture that she sustained is fatal before reaching the hospital in 95% of cases, and if survived, usually results in quadriplegia. This book is a memoir written in the form of a journal that begins on the day of the accident. In fact, it was nearly a month after the accident that the poet's daughter brought writing materials to the rehab hospital, and Maxine began to dictate the journal, and the two of them filled in the temporal gaps.

The journal covers her experience in the acute care hospital, the rehab facility, and the following months of convalescence at home. It ends on April 23, 1999, when Maxine climbs a hill (unassisted) near her Vermont home, looks out over the early spring vista, and concludes, "I am letting myself believe I will heal."

The journal describes the poet's physical, emotional, and spiritual experiences as she struggles, first to survive, and then to live with the "halo vest" that for months she had to wear to stabilize her fractured neck bones, and finally to regain her function and equilibrium. Much of the story is about her family--husband, son, and daughters--who mobilize from various points around the world to support her. Comments about her doctors and the medical care she received constitute only a small, at times almost incidental, part of this narrative.

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This varied collection of short stories and poems is unified not so much by theme as by their appropriateness to the intended listening audience--the bedridden or homebound elderly. In a brief but moving preface editor Carolyn Banks recalls her work in an adult day care center where she was expected to entertain those who were recovering from strokes or suffering from Alzheimer's disease.

Reading aloud provided sometimes startling moments of contact with patients who were incapable of sustained conversation. Banks realized that while there are many story collections for children and general adult audiences, no one had done a collection for a group with these specific needs.

The collection includes 52 stories--one a week for a year--that cover a range of life situations. Not all focus on age or illness, though some do. In several a grandparent plays a crucial role in a grandchild's life. Some are set in the 1930's, 40's and 50's--periods likely to trigger memories for those now in their 70's and 80's.

Several stories focus on situations of widowhood and other losses, and some on death: Banks insists that death "is not a taboo topic." Many of the stories are comic, since, she comments, laughter is "an important response to court." All are short enough to read in a half hour or less, and "not insultingly simple."

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