Summary:

This suggestively titled collection of poems provides a lyric record of a physician’s way of seeing.  The situations to which the poems bear witness are not only medical, though many are.  Some are cityscapes into which are woven surprisingly astute observations of homeless people or hitchhikers or ducks in the park.  Some explore the geography of a body where memories are held in “neuron chains.”  Some articulate bits of personal history from the point of view of a woman who has spent years in medicine, caring for the elderly, seeing bodies with the double vision of a clinician and a person whose spirituality clearly informs all she sees.

Titles like “ER Alphabet of Hurt” or “Looking for God On the Radio” or “Hippocrates Voyeur” or simply “Scars” may give some sense of the range of focus.  Her vision and voice are strongly local; those who know Marin County, north of San Francisco, will recognize the places that become the poet’s personal geography.  Those who don’t will still see in these poems a sensibility shaped and refined by the knowledge that comes from deep habitation.  

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This is an imaginative documentary film by director-producer Su Friedrich, of her experiences with health problems, physicians, the health-care system, and how these affected her relationship with her female partner over a period of more than two decades. The narrator-subject takes us through her numerous surgeries, hormonal (prolactin) imbalance, and her growing disenchantment with the traditional health-care system.

She films herself: getting dressed into the "humiliating" paper garb prior to being examined by her physician; in exchanges with her various physicians; reading from medical texts and self-help books as she tries to understand her condition(s); taking t'ai chi classes and preparing herbal potions; gardening and doing needle work. As the film ends, she is grappling with the prospect of menopause, but she feels that she has taken charge of her body and of her own care, that she tends herself as she tends her garden.

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This edited anthology, which includes poems, essays, short stories, and other creative forms (e.g., a radio diary, a letter to a social service agency), is organized into sections that include Body and Self, Diagnosis and Treatment, Womanhood, Family Life and Caregiving, Professional Life and Illness, and Advocacy. Most works found their way into this collection through a call for submissions, although a few selections are well known, such as Lynne Sharon Schwartz's "So You're Going to Have a New Body !," or an excerpt from Rachel Naomi Remen's Kitchen Table Wisdom (see annotations). In addition, the anthology also includes essays by scholars such as Arthur W. Frank and Rita Charon, who theorize gendered illness narratives.

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Sissman, whose chronic illness inspired him to incorporate illness experiences into his writings, muses about where he is likely to die. Like an archaeologist he begins with a vivid description of factors and events contributing to various wings and pavilions. He knows this hospital well: its external facades with "Aeolian embrasures" and "marble piping" associated with certain patrons or patronesses such as "the Maud Wiggin Building . . . commemorat[ing] a dog-jawed Boston bitch".

Slowly the narrator moves from the hospital's exterior layerings to imagine himself, a patient on a gurney, wearing the "skimpy chiton" while being subjected to syringes, "buttered catheter[s]," and IV "lisps and drips." Just before death his blood will "go thin, go white" and finally, there will be a journey through the hallways to the morgue and then to the undertaker. "That's all." The account is prosaic, an inventory or catalogue of steps familiar to anyone who has worked in a hospital setting. As a poet, however, Sissman transforms the ordinary into vividly fresh portrayals.

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The story is based on an actual 1950's trip by two university friends, Ernesto 'Che' Guevara (Gael Garcia Bernal) and Alberto Granado (Rodrigo De la Serna). Guevara is studying medicine, Granado biochemistry. They plan to travel from Buenos Aires across the Andes Mountains to Chile, Peru, and, then, to Venezuela. Before too many miles their derelict 1939 motorcycle fails, and the two young men continue by whatever means is available. The journey intent is one of adventure--drinking, meeting women, seeing the world.

The young men do discover South America's impressive natural beauty but more strikingly, their eyes and sensibilities are directed to abject poverty and shocking injustices. These blatant inequities, as well as an extended period of time in a leper colony, contribute to the reframing of their original happy-go-lucky adventure and explain, in part, the impulses that eventually would shape Guevara's role in the Cuban Revolution.

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Because this lucid, rich, and incisive book has not, as yet, been published in the United States, it has not acquired the readership it deserves. For those teaching Medical Humanities or those interested in broader or more global stories and perspectives about physician training, practice, and experiences, Helman’s most recent publication should be considered.

Part One (“Setting Out”) begins in South Africa where Helman’s family, comprised of a dozen doctors, has lived for generations and where his own medical studies occurred. As a child, he accompanied his father on rounds while other children spent holidays at the beach. Before long he discovered how hospitals, during the madness of Apartheid, were to “some extent a distorted mirror-image of the world outside” (3). Appalled by the differences in care and treatment, the keenly aware young man kept notes. His vivid observations of the harsh context of social injustices provide an unequivocal, eloquent, and disturbing critique of medicine then and there. His acute observations of physician behaviors and indigent populations in the city and in the bush contribute, as readers discover in later chapters, to the author’s expanded and compelling interests in cultural anthropology.

Part Two (“The Family Doctor”) leads to London. “After all the heat and light and space of Africa, London—with its low leaden sky and constant drizzle—was like living inside a Tupperware box, one stored deep inside a refrigerator” (47). In the 60s Helman’s migration required an adjustment to a world of technology and order, where as a family practitioner, he had become, in fact, a suburban shaman. In any society, patients wanted “relief from discomfort, relief from anxiety, a relationship of compassion and care, some explanation of what has gone wrong, and why, and a sense of order or meaning imposed on the apparent chaos of their personal suffering to help them make sense of it and to cope with it” (xvi).

Gradually Helman saw connections between the role of family physician and traditional healer: both involved an understanding of “not only a body’s internal equilibrium but also the equilibrium of the patient’s relationships with the world he or she lives in and how treatment should aim not only to treat the diseased organ but also to restore the patient’s life that equilibrium of relationships” (xvii). His encounters with patients and the stories they reveal suggest how important these often overlooked connections are and why they ought to be included in medical training and practice.

By the time readers reach Part Three ("States of the Art”), the author has moved into broader realms of thinking, in which medicine and illnesses are examined anthropologically. After 27 years of clinical practice Helman’s white coat and stethoscope are placed on a hook. Now, as a credentialed anthropologist at University College London, his larger lens allows for sustained scrutiny of the complexities, ambiguities, and nuances in such chapters as “Grand Rounds,” “Hospitals,” “Placebos,” “Third Worlds.” Helman’s range of experiences, multi-disciplinary training, intellectual conclusions, and abundant common sense argues for techno-doctors to learn from holistic practitioners. Whether devastating or humorous, the critiques reflect not just care provision but shared human capacities: the insights are thoughtful and fresh and very worthwhile.

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James Lang was diagnosed with Crohn's disease in 1996, when he was twenty-six years old. Five years later, however, a particularly severe bout with Crohn's, including a hospital stay, dramatically changed his relationship to the disease. Lang's memoir explores his ongoing relationship to Crohn's disease, both in the context of medical reassessments and diagnostic adjustments and in relation to his personal and professional development in his first year as a tenure-track professor of college English.

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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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This great literate novel is the tale of Hans Castorp, the "delicate child of life" whom we first meet at age 23, ambivalently embarking on a career as a ship-building engineer in his home city of Hamburg, Germany. Before beginning his professional work, however, he journeys on what is intended to be a vacation and a pro forma visit to see his tubercular cousin, Joachim Ziemssen, at a sanatorium in the mountain town of Davos, Switzerland. Yet as the train pursues its course through the alpine scenery, Hans and the reader become aware that this is no ordinary journey. The impressionable Hans is transported away from the life and obligations he has known, to the rarefied mountain environment and insular community of the sanatorium.

At first uneasy, he soon becomes fascinated with and drawn to the routine established for the "consumptives" and to the social scene which flourishes there. Ordinary life seems increasingly unreal to him; his perceptions are heightened and he becomes aware of his physical, spiritual, and emotional vulnerability, as well as of his own sexuality. He is greatly attracted to one of the patients, a married woman of Slavic background, Madame Clavdia Chauchat. She reminds him of a schoolboy to whom he had been strangely drawn as a child. The turmoil brought on by this romantic obsession seems even to be reflected in his physical state, which is unstable and feverish.

As his intended stay of three weeks nears its close, the director of the sanatorium advises Hans to stay on to recuperate from a heavy cold, which appears to reveal an underlying case of tuberculosis. Hans is almost relieved at this news, for it provides him with a reason for remaining near Madame Chauchat as well as the opportunity to continue intriguing, profound discussions and cogitation about illness, life, time, death, religion and world view initiated by another patient, Herr Settembrini.

Settembrini is an Italian man of letters and humanist who believes that reason and the intellect must and will prevail, in daily life as well as in world affairs. He is contemptuous of the foolish flirtations and empty talk in which most of the sanatorium inhabitants indulge, and warns Hans repeatedly of the dangers inherent in cutting off all ties to real life and responsibility.

Nevertheless, Hans remains at the sanatorium for seven years, freeing himself from the constraints and conventions of life "in the flatlands" and instead engaging in a prolonged "questioning of the universe." This questioning includes a critical flirtation with death, stunningly described in the chapter, "Snow." Hans does not return home until the outbreak of World War I, in which he fights and survives.

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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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