Summary:

After living with various foster families, nine-year-old Gabe is taken to live with his aging Uncle Vernon in West Virginia. The relationship with his mother's gruff and distant older brother, a Vietnam vet, is distant at first, but warms up over time. But after his first day in 6th grade, Gabe comes home to find his uncle dead on the floor.

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This is a collection of 91 poems on medical topics by medical students, physicians in training, and attending physicians; two are Canadian and the rest American. The poems are organized by six traditional groups of medical training and advancement in the profession: Medical Student, First Year; Medical Student, Second Year, Medical Student, Clinical Years; Intern; Resident; and Attending. There are no sections for pre-meds, retired doctors, or other programs (naturopath, chiropractor).

The editors have done a good job of picking well crafted and evocative poems. A dozen have been previously published. For the most part, the poems are short, easily fitting on one page. Almost all are in free verse, although there is one group of haiku, one prose poem, and an impressive sequence of ten Shakespearean sonnets “Breughel at Bellevue” by Anna Reisman.

Many poems treat dramatic moments in training: the anatomy lab, first gynecological exams, physician-patient relationships, especially when a patient is gravely ill or dying. Several poems in the first three sections comment on the differences between the normal social world and the intense medical world of the hospital. Throughout there are references to the pressures of high-tech, unfeeling medicine. Indeed Jack Coulehan sounds this theme in his introduction; he writes that "steadiness and tenderness" are both needed in medical practice.

 

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Dr. Pauline Chen is a transplant surgeon and hence highly trained in the surgical care of desperately ill patients. She found, however, that although she had intensive and first rate training, time and again the message she received from her mentors and peers encouraged a distance from frank discussions about dying with patients who were clearly dying. Dr. Chen successfully suppressed her urges to reflect on the meaning of illness and death. Years into her training, she finally witnessed an attending surgeon stay with a patient and the patient's wife until the patient passed away. The widow sent a thank you note to Dr. Chen for allowing a "dignified and peaceful death." (p. 101) Chen notes that observing her attending stand with the patient during death changed her profoundly: "...from that moment on, I would believe that I could do something more than cure. This narrative, then, is my acknowledgment to him." (p. 101)

Final Exam chronicles Chen's journey from medical student to attending surgeon and examines her experiences with death and serious illness - of patients, family members, friends. The memoir contains three parts: Principles, Practice, and Reappraisal - each with three chapters. The book is chronologically arranged, beginning with anatomy dissection at the start of medical school and ending with Chen as an attending arranging for hospice, thus honoring a patient's desire to die at home rather than in hospital. Chen skillfully weaves her stories around commentary on the social, cultural and philosophical issues surrounding death and the medical response to death. An introduction and epilogue bookend the text and 46 pages of extensive notes and bibliography complete the book.

Although Chen claims to have slowly and painfully awakened to the fact that patient needs extend well beyond good technical care, in fact one sees Chen emerge as a caring physician even from her initial patient contacts in medical school. Chen speaks more to her role as an Asian-American than to being a woman in a male-dominated field, but she clearly has what it takes to succeed in this extremely competitive field, including a good dose of compulsiveness and an incredible work ethic.

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A bleak landscape of death and destruction confronts the viewer. An army of skeletons massacres masses of people of every age and gender. At the top of the painting, the sky is black with smoke from fires that have destroyed the landscape, as if the land had been decimated by war. Ships lie half sunken in the bay. The middle of the painting features skeletons herding masses into a spike rimmed tunnel; the door of the tunnel is marked with the holy cross of Christ. There is no suggestion of salvation however, for piles of bones, skulls, and intact skeletons fill pens and wagons, and litter the ground. In the painting’s foreground, people of high social status are sprawled dead or dying near more ordinary individuals -- king, cardinal, wanderer, lovers -- all, regardless of their social status, meet Death.

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The Cuban-American physician-poet Rafael Campo tells a story in this poem. His speaker is both a curandero, or folk healer, and a modern-day American physician. Returning home after a trauma-filled day at the Emergency Ward, the speaker immerses himself in a soothing bath with "Twenty different herbs at first (dill, spices / From the Caribbean, aloe vera)." He weeps and prays to his patron saint and curandero St. Rafael, who has the same name as the poet himself. Rafael announces his arrival: "Rafael, / He says, I am your saint." The speaker tells his healer about two female patients he has seen that day, one, an abused wife, and the second a little girl killed on her tricycle. St. Rafael listens, touches the speaker, and carries him to bed. Sleep "takes the world away."

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Sultana, a doctor who escaped her illiterate nomadic background to study and work in France, returns to her native Algeria when she hears of the death of her former lover and fellow physician, Yacine. She is treated with hostility, but defiantly stays in Yacine’s place at the clinic. Vincent, a Frenchman who is the baffled recipient of a perfectly matched kidney from a young Algerian woman, travels to the desert to explore the culture of this unknown person whose death has brought him back to life.

Sultana and Vincent meet through their common friendship with the furtive, questioning children, Dalila and Alilou. Vincent and Salah, Yasmine’s best friend, both fall in love with Sultana, but she seems indifferent to them. The violence and suspicion of the town leaders causes her to regress into anorexia and mutism, during which she is tormented by the horrible memory of the loss of her parents. Her three male friends and the village women help her to recover a sense of self worth, but she must flee when the leaders set fire to their dwellings. A glimmer of optimism can be found in the aspirations of the children and the solidarity of the women.

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Canadian surgeon Norman Bethune, 1890-1939, (Donald Sutherland) journeys 1500 miles into China to reach Mao Zedong's eighth route army in the Wu Tai mountains where he will build hospitals, provide care, and train medics. Flashbacks narrate the earlier events of his life: a bout with tuberculosis at the Trudeau sanatorium; the self-administration of an experimental pneumothorax; the invention of operative instruments; his fascination with socialism; a journey into medical Russia; and the founding of a mobile plasma transfusion unit in war-torn Spain.

Bethune twice married and twice divorced his wife, Frances (Helen Mirren) who chooses abortion over child-rearing in her unstable marriage. By 1939, Bethune had been dismissed from his Montreal Hospital for taking unconventional risks and from his volunteer position in Spain for his chronic problems of drinking and womanizing. As his friend states: "China was all that was left." Even there, Bethune confidently ignores the advice of Chinese officials, until heavy casualties make him realize his mistake and lead him to a spectacular apology. The film ends with his much-lamented death from an infected scalpel wound.

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In the year 2000, Nafas (Niloufar Pazira) a 29-year old Afghan-born Canadian journalist travels back to her homeland in search of her sister. The sister was maimed by the long war, and her life under oppressive Taliban rule is no longer worth living; she has resolved to commit suicide on the last solar eclipse of the century.

Dependent for her travels on the uncertain help of men, Nafas encounters many other charismatic women hiding under the seclusion of the burqas. The inquiries she makes to find her sister raise the veil just enough to reveal the torment of Afghan women, deprived of rights, education, and basic health care. A doctor must question his women patients, who are hidden from him by a canvas wall, through a child intermediary; he does not touch them. The ending is inconclusive.

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In a fascinating and wide-ranging series of chapters organized by categories of disease or disability that have afflicted known artists, writers, and musicians, Sandblom examines the multifaceted relationship between creative work and illness. He begins his discussions of particular artists usually with basic information about the nature of the affliction and its manifestations; where available, introduces the artist’s own comments upon his or her condition; and then analyzes how particular works represent or implicitly allude to the illness. In some cases the disease is a context; in others a theme; in others a vehicle or tenor of metaphor.

The book is richly illustrated with reproductions of paintings, parts of musical scores, and poems or prose excerpts. Artists and writers under discussion include Bacon, Beethoven, Jorge Luis Borges, the Brontes, George Gordon Byron, Cezanne, Anton P.Chekhov, Chopin, Emily Dickinson, F. (Francis) Scott Fitzgerald, Johann Wolfgang von Goethe, Nathaniel Hawthorne, Franz Kafka, John Keats, Mahler, Thomas Mann, Herman Melville, John Milton, Flannery O’Connor, Proust, Rainer Maria Rilke, William Shakespeare, Robert Louis Stevenson, Titian, John Updike, William Wordsworth, and Yeats, to name a few.

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Although doctors have told her that things will get better, Jyl’s odds of surviving cancer are only five percent. She lives alone in a mountain cabin and receives cancer treatments at the hospital in town. She sleeps much of the day. “Her intestines had been scalded, cauterized as if by volcanic flow” [p 67], and Jyl continues to experience problem with digestion. She feels fatigued and is easily short of breath.

Her closest neighbors are the Workman’s, a Christian fundamentalist family of seven. They live miles away in a mountain valley near the creek. Without telephone, electricity, or indoor plumbing, they live off the land and toil day and night. Jyl starts carving small boats toting messages to send down the creek for the Workman children to find. Soon 15-year-old Stephan and 7-year-old Shayna visit Jyl. The two children bring her food that the Workman’s have hunted and gathered. They cut and stack firewood for the recluse. Jyl teaches them about geology and gives them small gemstones that her father had collected. The children’s visits revitalize the ill woman.

When Stephan and Shayna do not return to see her, Jyl is overcome by loneliness. She acknowledges that being alone is far worse than any aspect of her disease and treatment. Jyl makes the difficult trek to the Workman’s property to call on the children but finds that the place is deserted. Nothing remains in their boarded-up cabin except a stack of the small boats that she had crafted. Jyl sits outside their cabin and cries. The falling snow and silence envelop everything.          

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