Summary:

Although Dr. Helman’s untimely death did not permit a final editing by this prodigious writer, the published edition is not a book-in-progress. An Amazing Murmur of the Heart: Feeling the Patient’s Beat represents a powerful and persistent continuation of observations and themes that grew out of medical education, close observations of physicians and patients, and his studies in anthropology. All of these forge an approach to patient care that is out of the ordinary.  

As his previous writings suggest, Helman is passionate about medicine but concerned, equally about the emergence of those who fail to listen and to those who might be called techno-doctors.  While professing his appreciation of and attraction to the magic machine or computer, he is mindful of its absence of emotion and ambiguity.  “For this post-human body is one that exists mainly in abstract, immaterial form.  It is a body that has become pure information.” (p. 11)

Chapters are comprised of stories about patients and their care providers, each representing complex facets that defy precise measurement, answers and conclusions.  As Helman steadily notes, the physician must be an archeologist:

Most patients present their doctors with only the broken shards of human life—the one labeled infection, disease, suffering and pain each of these shards is only a small part of a much larger picture….the doctor will have to try and reconstruct the rest. (p.66)

In general, the chapters illustrate first an initial review of medical history, and then specific patient stories.  Of the two, the story is most important.  “Mask of Skin,” for example, begins with an overview of skin from Vesalius to the present: largest organ, stripped bare by anatomists, penetrated by disease, later scanned and X-Rayed, tattooed, re-fitted by surgeons, etc.   That said, Helman the physician-anthropologist, moves from science to specific stories about patients whose skin may cover profound experiences, psychic and otherwise, that might be overlooked by a dermatologist.   Although skin is involved in each of that chapter’s stories, the willing physician must dig deeper in his observations and caring manner to make more profound discoveries.      

In a chapter entitle “Healing and Curing” the author describes an old friend, a practitioner who provides advice about patient care that ”was not included in his medical texts”.  Patients are more than a diagnosis dressed in clothes.  Doctors must make patients “feel seen, listened to, alive”.  Always patients should be regarded as people who happen to be sick.  From his admired colleague Helman learned to be an attentive listener  to the "tiny, trivial, almost invisible things" in patient encounters and stories. To truly heal as well as cure requires the doctor to empathise with what the patient is feeling thereby requiring both an act of imagination and of the heart.  The chapter, of course, continues with with stories that illustrate the points enunciated by his colleague and accepted by his disciple. 

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This is a compendium of original critical essays on a wide range of topics written by a diverse group of scholars of what has traditionally been called "medical humanities." The editors argue for a change of name to "health humanities," pointing out that "medical" has a narrow frame of reference - evoking primarily the point of view of physicians and their interaction with patients, as well as the institution of biomedicine. Such a focus may exclude the myriad allied individuals and communities who work with patients and their families. The editors quote Daniel Goldberg, who notes that the health humanities should have the primary goal of "health and human flourishing rather than  . .  the delivery of medical care" (quoted on page 7).

The three editors are innovative contemporary scholar-educators in the field of medical/health humanities. They advocate Megan Boler's "pedagogy of discomfort" (quoted on page 8) and wish to provide students and educators "an opportunity to examine critically the origins and nature of their personal beliefs and values, beliefs and values embedded in the curriculum and the learning environment, as well as institutional policies - all of which intersect" . . and influence quality of care (8). In their own work and in this Reader the editors favor an approach to health humanities education and research that "challenge[s] the hegemony of a biomedicine that contributes to disparities and the discrimination of persons who don't quite fit the codified and naturalized norms of health."

The book is divided into 12 parts, each comprising three or four chapters: Disease and Illness, Disability, Death and Dying, Patient-Professional Relationships, The Body, Gender and Sexuality, Race and Class, Aging, Mental Illness, Spirituality and Religion, Science and Technology, and Health Professions Education. At the end of each section there is "an imaginative or reflective piece" on the topic. A wide range of disciplines is represented, including disability studies, history, bioethics, philosophy, literature, media studies, law, and medicine. Some of the authors are well-known and have been practicing their profession for many years (for example, Arthur Frank, Sander Gilman, Anne Hudson Jones, Martha Montello, John Lantos) while others have entered the field more recently and are gaining increasing attention (for example, Rebecca Garden, Daniel Goldberg, Allan Peterkin, Sayantani DasGupta).

The Reader is well documented: there are footnotes at the end of most chapters, a references section of 50 pages, notes on contributors, and a 72-page index.

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Soldier Girls is an exhaustively researched, intimate report by a journalist of the lives and deployments of three women in the Indiana National Guard, who, through serving together in Afghanistan, become friends. Each of the women joined the Guard prior to 9/11/2001, mostly for economic reasons. Thorpe selected women who were vastly different in age and background.  Debbie Helton becomes a grandmother during deployment and has served in the guard for decades - she is eager to be deployed. Michelle Fischer (a pseudonym) is newly out of high school, has liberal political views and sees the Guard as a way to pay college tuition. Desma Brooks is a single mother of three with a fractured and unreliable support system. All three have alcohol and or drug dependency issues. Brooks and Helton are deployed a second time - to Iraq.

 As one of the women, Fischer, notes, the Bush wars were an ‘economic draft' (p. 374) The struggles to find adequate housing, reliable partners, good schools, decent jobs, and to avoid the morass of drug dealing, which particularly surround Fischer and Brooks, are paramount in their lives.   

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In the photograph, the camera frames the window of a rundown motel room on a snowy evening. Inside, a young mother in a pale green nightgown sits on the side of a bed gazing sadly at her sleeping baby curled up on the far side of the mattress.  This is one of the hauntingly beautiful images in “Brief Encounters,” a documentary about the photographer Gregory Crewdson and his project “Beneath the Roses.“

The son of a Brooklyn psychoanalyst, Crewdson and his family spent summers at a lakeside cottage near Pittsfield in western Massachusetts.  It is to this area, with its abandoned shops and dilapidated buildings, that Crewdson returns over and over again to search for settings for his intricately composed photographs.  These towns, he says in the film’s narration, “were really backdrops for a more submerged psychological drama,” one that blurs the line between reality and fiction. Crewdson approaches his photographs as if making a film, with a crew of as many as 60 people and a cast composed of the townspeople he encounters in his travels.  But unlike a film, the photographs capture a single moment in time.  For Crewdson, what happens before and after is of no interest to him. Rather, he is concerned with just that one frame, “a perfect moment.”

Crewdson creates his worlds as a way to explore his own anxieties, fears and desires.  The images he constructs are exquisitely detailed and psychologically complex, inviting multiple interpretations by viewers. An engaging narrator, he directly addresses his own fear of failure, how he struggles to overcome it and to continue working despite periods of self-doubt.

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This book combines social history with personal memoir. It serves as a reflection on how the various challenges of living with chronic illness have shifted over time, and how they are still real and present for the increasing portion of the population who suffer from ills invisible to others and often hard to account for.  The book's brief treatments of cultural and medical approaches to chronic illness, from ancient practices to "patients in the digital age," provide a broad perspective against which to consider current legislative, political, medical, and personal concerns for those coping with chronic illness or disability. 

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In this collection of essays on writers' end-of-life memoirs Berman combines a fine-tuned appreciation of literary strategies with reflections on how writers, who have defined themselves, their philosophies, their voices, and their values publicly, bring their life work to characteristic and fitting conclusions in writing about their own dying.  The writers he considers cover a broad spectrum that ranges from Roland Barthes and Edward Said to Elisabeth Kübler-Ross and Tony Judt to Art Buchwald and Randy Pausch.  Each essay offers insights into the writer's approaches to death and dying against the background of his or her earlier work. 

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The conventional, young, corporate executive, Ross Gardiner, is sentenced by a judge to pay weekly visits to the recently widowed and childless Mr. Green. Ross had knocked the elderly gentleman down when he stepped out into the road without looking. No real damage was done, but the judge decided that Ross had been driving too fast.

Neither man wants to be anywhere near the other. Mr Green sends Ross packing, and the younger man appeals to the judge for a different punishment, without success. He therefore returns bringing the peace offering of soup from a kosher deli that the passive-aggressive senior grudgingly devours. “Would I waste good food?” Their common Jewish identity makes everything better for Mr Green, although Ross does not care. For Mr Green the Jews are a people who suffered intolerance and murder and must stick together now. 

They begin to tell stories of their lives. Mr Green grievously misses his wife who did all the cooking and cleaning; “we never argued once in sixty years.”

Things slip back again when Mr Green learns that Ross is gay. Negotiating that shock is facilitated by the older man’s bafflement over how Ross’s father has abandoned and derided him; they slowly grow closer. Mr Green wants Ross to find a nice girl and be happy as he was. Ross patiently explains how that cannot work for him.

Then another crisis erupts when Ross learns that the Green’s had a daughter who married a Gentile for which crime she was shunned by her parents as if she had died.  It is compounded by the shocking discovery that Green’s wife had been writing to her daughter for thirty years without telling her husband. 

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A chorus of lab techs making symmetrical repetitive motions with microscopes, pipettes, and petri dishes opens the play. They persist in the background of the set, which is the waiting and consulting rooms of a clinic for reproductive technology.  The chief, Dr. Staiman, is not only an expert in this field of human biology — he also enjoys an international reputation (and many patents) for his genetic manipulation of orchids in a quest for perfect blooms.

Heather and Rose are both clients of the facility. Heather wants a baby and needs help to be able to conceive. Rose could actually conceive on her own; however, she is investing in expensive and painful genetic selection to avoid having a child with the same trait as her brother. His Tourette’s syndrome, she contends, ruined life for her parents and herself as well as for him.

It emerges that Heather too has Tourette’s syndrome, but she does not believe it ruined life for her family and is unafraid of having an affected child. The women must wrestle with the notion that Rose does not think someone like Heather should exist; and Heather wonders if she should be testing her own embryos.

The two clinic doctors, Blume and Staiman, offer similar services, but as an ethicist, Blume worries about the moral implications of the new technology. Heather challenges Staiman over his willingness to destroy an embryo that might become a person like herself. He seems baffled by her concern, claiming that science makes perfection possible and that the decision should belong to the parent.

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Five Days at Memorial is the book length expansion  of the New York Times Sunday Magazine article that the author, a Pulitzer Prize-winning physician-journalist, published in 2009. The book, the result of years of research and literally hundreds of interviews, chronicles the five days (August 28 to September 1, 2005) during which the medical staff remaining at Memorial Hospital in New Orleans tried to care for the patients -- over a hundred of them stranded, like the staff, in a hospital without water or electricity --following the flooding wrought by Hurricane Katrina.

After an 8 page prologue, the book is divided into two sections, "Deadly Choices" (228pp, the narrative of those five days) and "Reckoning" (256pp, the legal battles over the injections of midazolam (a sedative) and morphine by some of those staff and prosecuted as homicide -- what others called "euthanasia.") "Deadly Choices" relates almost hourly the five days inside Memorial from the viewpoint of patients, patients' relatives, physicians, nurses, administrators of Memorial, Tenet (the holding company owning and running Memorial) and LifeCare -- the long-term care area within Memorial devoted to the care of terminally ill and debilitated patients -- owned by a separate company. Ethical and legal questions of triage, DNR, record-keeping, accountability, communication (primarily the failure thereof) and leadership are on almost every page. At the heart of this book, however, is the mystery of the unexplained deaths of so many patients during those five days. (On September 11, 2005, a disaster mortuary team recovered 45 bodies from many different places in Memorial, page 234). The crux of the mystery of these deaths is the manner in which nine in particular died in the beleaguered hospital on the fifth and last day when, paradoxically, relief had become real and effective and inclusive, seemingly obviating such injections.

The final pages of "Reckoning" deal with the fallout - historical, ethical, political and medical -- and current events relevant to these five days and the almost two years following. (The final verdict of not guilty -- the actual wording was "Not a true bill" since it was a grand jury declining to indict the one physician, Anna Pou, and the two nurses, Cheri Landry and Lori Budo -- was rendered on July 24, 2007). There are a map of Memorial Hospital and a cast of characters at the front of the book and extensive notes, bibliography and index at the end.

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Nurse Moira is caring for three different women in labour: two have female birth partners; one is alone. 

Teenage Stacey with her school friend Jeannine adopts a punk, devil-may-care attitude to the whole process, but shrieks in agony with her pains; she plans to keep the baby in defiance of all her family members and advisors. Unknown to Stacey, Jeannine once had a baby and gave it away for adoption; it is a secret that Jeannine wants to believe was for the best.

The solitary Jane had once adopted a baby like Jeannine’s only to lose it again within the requisite month-long waiting period. Heartbroken Jane and her husband paid for a woman to have IVF so that Jane could become pregnant. She is thrilled that she will finally become a mother, but her earlier experiences make her sympathize with mothers who cannot conceive or who have lost babies through adoption or death.

Eva an immigrant from Kosovo had been brought to Canada as a housekeeper by the driven businesswoman Carol, who is "coaching" her. Because Carol is no longer fertile, she deliberately goaded Eva into becoming a surrogate mother, inseminated artificially through her husband’s sperm. Should Eva refuse or break the contract, she will be returned to Kosovo. For fear of the slightest damage to the child that she intends to claim, Carol will not let Eva speak or have any analgesia. Eva is miserable; the audience hears her thoughts, but Carol and the nurse cannot.

Moira copes with the three radically different scenarios, succeeding in giving egalitarian care. Moira and Jane inform Eva of her rights, and she takes her baby and returns to Kosovo. 

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