That Good Night: Life and Medicine in the Eleventh Hour

Puri, Sunita

Last Updated: Aug-13-2019

Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Sunita Puri, a palliative care attending physician, educates and illuminates the reader about how conversations about end of life goals can improve quality of life, not just quality of dying, in her memoir, That Good Night: Life and Medicine in the Eleventh Hour. Thirteen chapters are grouped in three parts: Between Two Dark Skies, The Unlearning and Infinity in a Seashell. The arc of the book follows Puri as she is raised by her anesthesiologist mother and engineer father – both immigrants from India – Puri’s decision to enter medical school, her choice of internal medicine residency followed by a palliative care fellowship in northern California and her return to practice in southern California where her parents and brother live. Besides learning about the process of becoming a palliative care physician, the reader also learns of Puri’s family’s deep ties to spirituality and faith, the importance of family and extended family, and her family’s cultural practices.

Puri writes extensively about patients and their families, as well as her mentors and colleagues. She plans and rehearses the difficult conversations she will have with patients in the same way a proceduralist plans and prepares for an intervention. She provides extensive quotes from conversations and analyzes where conversations go awry and how she decides whether to proceed down a planned path or improvise based on the language and body language of her patients and their family members. We visit patients in clinic, in hospital, and at home, and at all stages of Puri’s training and initial practice. Some of the most charged conversations are with colleagues, who, for example, ask for a palliative care consultation but want to limit that conversation to a single focus, such as pain management. We also learn of the differences between palliative care and hospice, and the particularly fraught associations many have with the latter term. She feels insulted when patients or families vent by calling her names such as “Grim Reaper” or “human killer” (p. 232), but understands that such words mean that more education is needed to help people understand what a palliative care physician can do.

As a mediator of extremely difficult conversations, where emotions such as shame, guilt, fear, helplessness and anger can swirl with love and gratitude, Puri finds the grace to acknowledge that all such emotions are part of the feelings of loss and impending grief, and to beautifully render her reflections on these intimacies: “Yet although I am seeing a patient because I have agreed that they are approaching death, if I do my job well, what I actually encounter is the full force of their lives.” (p. 206) Having met many dying people she notes: “Dying hasn’t bestowed upon them the meaning of life or turned them into embodiments of enlightenment; dying is simply a continuation of living this messy, temporary life, humanly and imperfectly.” (pp 221-2)

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Sapiens: A Brief History of Humankind

Harari, Yuval

Last Updated: Dec-17-2018

Field, Steven

Primary Category: Literature / Nonfiction

Genre: History

Summary:

Yuval Noah Harari’s best-selling book “Sapiens” is subtitled “A Brief History of Humankind.” While this may seem to bespeak a bit of hubris—it would seem that 414 pages might be, despite the modifying adjective of the subtitle, a little too condensed to cover 2.5 million years (albeit only the last 70,000 or so in any kind of detail)—the impression after finishing is that he may have done it, or at least, done the effort proud. Mustering a combination of data and insights from the domains of history, archeology, genetics, biology, paleobiology, economics, and sociology, among others, Harari weaves an organized narrative that attempts to answer the questions of who we are and how we got here.

He divides the story into four assigned landmark periods in human history: The Cognitive Revolution (the earliest organization of humans into groups which evidence the use of tools and the beginnings of culture), The Agricultural Revolution (the impact of the learned ability to cultivate the land, with its shift from hunters and gatherers to farmers, and by necessity, from nomadic to settled tribes, and the beginnings of towns), The Unification of Humankind (the aggregation of people into larger groups and the emergence of money (and the earliest capitalism), religion, social expansion and conquest), and The Scientific Revolution (the development of science and the incredibly rapid acceleration of knowledge in the last five or six hundred years). The titles of the periods are, however, only guideposts, for the sections are broader in scope than simply farming or science. The section on the scientific revolution, for example, interweaves scientific progress with economics and imperialism (which are themselves interwoven, after all), religion, and philosophy. And that same section leads Harari to speculate, at the end, as to where the digital revolution and the development of artificial intelligence might be leading us and what we might say about our future as a species.

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joy: 100 poems

Wiman, Christian

Last Updated: Jun-12-2018

Davis, Cortney

Primary Category: Literature / Poetry

Genre: Anthology (Mixed Genres)

Summary:

"joy: 100 poems," edited by poet and editor Christian Wiman, is a collection of 100 poems that examine, in various ways, the state of consciousness we call "joy." The poets represented here are for the most part well known, as are many of their poems. But, happily, there are poems here that seem new, especially when viewed through the lens of "joy."

A brief list of the poets, chosen at random, includes Galway Kinnell, Donald Hall, Lucille Clifton, Josephine Miles, Sylvia Plath, Richard Wilbur, Sharon Olds, Wallace Stevens, Yehuda Amichai, W.B. Yeats, Stanley Kunitz, and Thom Gunn. Poems, again chosen at random, include "Plumbing" (Ruth Stone), "Tractor" (Ted Hughes), Laundromat" (Lorine Niedecker), and "Unrelenting Flood" (William Matthews)--titles that at first glance might not suggest "joy."

The book begins with an excellent twenty-eight page introduction by Wiman in which he discusses the various shades of joy we might encounter in our lives, examines closely some of the poems represented, and briefly comments on his selection process.

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The Children Act

McEwan, Ian

Last Updated: Jan-05-2018

Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Approaching age 60 and childless, Fiona Maye is a family court judge who must decide if 17 year-old Adam has the right to refuse blood transfusions for his leukemia. He and his parents are Jehovah’s Witnesses. The Children Act does not allow a child to make this decision until age 18. Fiona is an atheist and her 35-year marriage to an academic is falling apart. She takes the extraordinary step of visiting Adam to know him and understand his conviction. He is beautiful and gifted, he writes poetry and plays violin. Why would he not want to try to live? She makes her decision having no idea if it will be morally, legally or medically right. To say more would spoil it.

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Letters from Limbo

Beaumont, Jeanne Marie

Last Updated: Jan-02-2018

Clark, Mark

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

This collection of poems is a memoir in verse: it is a lyric and epistolary exploration of what it is to live in the limbo of an emotional and psychological ambiguity whose genesis lies in maternal loss, mourning, depression, and despair. The poems are arranged in three sections: “Crossing,” “Asylum Song,” and “Holding.”

The “Crossing section generally conveys to readers the nature of life in this limbo, even as it discloses some of the familial anguish that has brought about a repressive silence in the poet’s mother, as well as a depression that wreaked its havoc on the poet’s growing up. The family mysteries and the suffering of the poet prompt her to research the death of her maternal grandmother, and we learn many details of that loss in the poems of the “Asylum Song” section.

A Czech immigrant, the woman had, in the old country, lost her parents and sister, and she’d apparently abandoned—for reasons unknown—her illegitimate child. She’d married an older man and moved to the States. After giving birth to another child, she suffered a postpartum depression, for which she was placed in an asylum, and was heavily and inappropriately medicated. She died within three weeks, at age 34. Her daughter, the poet’s mother, grew up in her absence and, in turn, lost her own child—the poet’s sister—in infancy, prior to Baptism.

According to widely held beliefs of Catholics at the time, the infant would thus be relegated to Limbo for eternity: she would be barred from union with God, this is to say, though kept free from any punishment or any suffering, other than the longing for a bliss she could never attain. Such a belief would clearly exacerbate the feelings of failure and guilt that a mother might feel in losing her infant. The poet’s mother’s depression resulted, unsurprisingly, in a bewildering absence of maternal care in the poet’s life: she is stuck in her own “asylum” or Limbo—a state of emotional confinement where she maintains some vision of “beatific” maternal love, but feels it forever beyond her reach to experience. The poems of the final section, “Holding,” convey the struggle and surprising joy of inhabiting this Limbo.

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Hope and Grace: Spiritual Experiences in Severe Distress, Illness, and Dying

Renz, Monika

Last Updated: Dec-14-2017

McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

Dr. Monika Renz’s work with dying patients is unusual if not unique in the way she appropriates and applies insights from Jungian depth psychology, practices available in patients’ faith traditions, and musically guided meditation to invite and support the spiritual experiences that so often come, bidden or unbidden, near the end of life. An experienced oncologist, Dr. Renz offers carefully amassed data to support her advocacy of focused practices of spiritual care as a dimension of palliative care, but is also quite comfortable with the fact that “neither the frequency nor the visible effects of experiences of the transcendent prove that such experience is an expression of grace” because “unverifiability is intrinsic to grace.” Still, her long experience leads her to assert not only that “grace” can be a useful, practical, operative word for what professional caregivers may witness and mediate but also that affirmation and support of patients’ spiritual, religious, or transcendent experiences in the course of dying can amplify and multiply moments of grace, which manifest as sudden, deep peace in the very midst of pain, profound acceptance, openness to reconciliations, or significant awakenings from torpor that allow needed moments of closure with loved ones. Describing herself as “an open-minded religious person and a practicing Christian,” she reminds readers that God is a loanword, whose basic form in Germanic was gaudam, a neutral participle. Depending on the Indo-Germanic root, the word means “the called upon” or “the one sacrificed to . . . .” Openness to the divine in both patients and caregivers, Dr. Renz argues, can and does make end-of-life care a shared journey of discovery and offer everyone involved a valuable reminder that medicine is practiced, always, at the threshold of mystery.

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Second Bloom

Krugovoy Silver, Anya

Last Updated: Dec-05-2017

McEntyre, Marilyn

Primary Category: Literature / Poetry

Genre: Poetry

Another Country

Schoeman, Karel

Last Updated: Oct-24-2017

Galbo, MA, MILS, Sebastian

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In Karel Schoeman’s novel, Another Country, Versluis, an affluent and educated Dutchman diagnosed with tuberculosis, immigrates to Bloemfontein, South Africa, to convalesce. Bloemfontein in the 1870s, located within the remote interior of the Free State, is little more than a dusty outpost populated by first- and second-generation German, Dutch, and English inhabitants. As the novel quietly unfolds, Versluis’s tenuous recovery, and subsequent regression, are punctuated by his observations of the community’s struggle to both preserve and break from European culture to form a distinct South African identity. Whereas Versluis cherishes his familiar Dutch customs and courtesies, here, in Bloemfontein, he must adapt to the community’s irregularities and gaucheries. Nevertheless, he is regularly astonished by the town’s culture of insouciance—a lack of punctuality, etiquette, and municipal orderliness; its sometimes frowzy fashions; disregard for conservatism; and ease among poverty, violence, and isolation. His observations, however, are not the mordancies of a snobbish European, but a wrestling with his sense of profound alienation as a precariously ill man living abroad in a strange country. Informed that his case is terminal, Versluis resigns himself to the inescapable state of his life. With fresh sensibility, he embraces life in Bloemfontein, becoming more receptive to its people and daily life. Particularly, for Versluis, the veld—with its rocks, dust, succulents, and solitude—takes on a potent and portentous symbolism, as an immutable and implacable presence (and emptiness), much akin to the illness that is killing him. Within this ponderous flux of change, of a gradually evolving Africa, Versluis peacefully comes to terms with his imminent death.

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Augustown

Miller, Kei

Last Updated: Oct-03-2017

McClelland, Spencer

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Set in the loosely fictionalized Jamaican town of Augustown (“loosely,” as it bears a strong resemblance to August Town, which was absorbed over time into the expansion of Kingston), the novel spans three generations of a single family. The novel moves back and forth easily through different moments in time, from the birth of Rastafariansim in 1920 under British colonional rule, through the post-colonial division of the island and its citizens into turbulent threads, to the present day of 1982, where the same tensions run strong as ever.

Ostensibly a family novel, the story centers on Ma Taffy, her niece Gina, and Gina’s son Kaia, and it boils down to several key moments in their lives. But these moments are brief in the overall bulk of the novel, the majority of which is devoted to the fleshing out of the world that permits – and, as we ultimately realize, requires – that such moments come to pass. There is the miracle of the preacher Alexander Bedward, who, as seen through the eyes of Ma Taffy, could have literally floated up to the Heavens; the comically doomed marriage and foiled aspirations of schoolteacher Emanuel Saint-Josephs; the errand run by Soft-Paw, a young gang member; the second chance that comes before the well-to-do Claudia Garrick; the friendship of Clarky and Bongo Moody, and their run-ins with the police. As Miller moves between these characters, the forces pushing Ma Taffy, Gina, and Kaia to their conclusion become clearer and harder to resist.

Despite the complexity of the novel’s structure, Miller easily weaves all of the component parts together. The result is absorbing and affecting, a novel that is as much a family drama as it is an exploration of the legacy of colonialism, religion, class conflict, and violence.

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Nine Parts of Desire: The Hidden World of Islamic Women

Brooks, Geraldine

Last Updated: May-15-2017

Saleh, Mona

Primary Category: Literature / Nonfiction

Genre: Ethnography

Summary:

Written by successful Australian journalist Geraldine Brooks, Nine Parts of Desire recounts her experiences living among and working with Muslim women throughout her time as a correspondent in the Middle East. Brooks delves into topics as varied as non-marital sex, female genital mutilation, the different types of veiling (and the reasoning behind veiling at all), women’s participation in the Iranian military, the Qur’an, and the life and teachings of the Muslim Prophet, Muhammad. Brooks presents various perspectives and interpretations of certain Muslim practices, such as the wearing of the veil (hijab). She looks at the specific Qur’anic passage that prescribes the veil: “And when you [men] ask his [the Prophet’s] wives for anything, ask it of them from behind a curtain (hijab).” (p. 84) Brooks intelligently analyzes, “What is so puzzling is why the revelation of seclusion [veiling], so clearly packaged here with instructions that apply only to the prophet, should ever have come to be seen as a rule that should apply to all Muslim women.” (p. 84) It is often difficult to find alternative interpretations of Islamic requirements, but Brooks presents them here without filter and speculates why an apparently individually prescribed veil would become so widespread that it now practically symbolizes Islam.

Brooks recalls several encounters that she had with fellow Westerners living in the Middle East for various reasons, from work to having married a Middle Easterner and re-located there. Some of the most sympathy-inducing moments are in these situations where Westerners are forced to live under the rules of strict, conservative, Muslim societies. In one anecdote, Brooks relays the case of her friend, Margaret, an American woman who married an Iranian man. When Brooks asks Margaret why she does not go home to America to visit her family, Margaret replies, “My husband doesn’t want me to,” and Brooks then clarifies, “It was up to him to sign the papers that would allow her to leave the country.”
(p. 106) This situation shows that being an American woman or an educated woman does not prevent one from being held to the same standards as local women in certain Muslim societies.

The final chapter is entitled, “Conclusion: Beware the Dogma” and serves to share Brooks’s personal opinions on the lives and faith that she had so objectively presented in journalist fashion until this point. Her opinion is summarized:

“Today, the much more urgent and relevant task is to examine the way the faith [Islam] has proved such fertile ground for almost every antiwomen custom it encountered...When it found veils and seclusion in Persia, it absorbed them; when it found [female] genital mutilations in Egypt, it absorbed them; when it found societies in which women had never had a voice in public affairs, its own traditions of lively women’s participation withered.”
(p. 232)

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