Summary:

The description on the cover of this collection of essays states that it is "candid firsthand accounts of the profound experiences that transform medical students into doctors". It is edited by a woman breast surgeon (Susan Pories) who teaches students in the Harvard Medical School Patient-Doctor Course; a MD/MBA candidate (Sachin Jain) who anticipates a career as a clinician , scholar and activist; and a psychiatrist (Gordon Harper) who is director of the Patient-Doctor III course at Harvard. The short forward is by physician-writer Jerome Groopman. The 44 essays are divided into sections by theme: Communication, Empathy, Easing Suffering and Loss, and Finding a Better Way. I found it helpful to read the short biographies of each student in the back of the book, before reading that student's essay.

The diversity of the essayists is very wide which makes for a broad look at many important issues. There are several subjects that we tend to avoid (student response to the nude body, the presence of students when end of life decisions are being made, the tensions between caring for a patient and having to do something which causes pain, trying to think of patients a people as well as complex biomedical problems). One of the editors wishes that the book will help people understand the working of the hospital and the many ways in which new doctors learn. The book is certainly a personal look at the teaching hospital from the students' view.

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The world as everyone knew it ended years earlier when "the clocks stopped at 1:17" [p 45] and power was lost. Not many people are still alive. The landscape is charred and hostile with "cauterized terrain" [p 12], "ashen scabland" [p 13], and "the mummied dead everywhere" [p 20]. A father and his young son travel south towards the coast. The boy's mother has committed suicide. Papa and the child wear masks and tote knapsacks. The father pushes a shopping cart filled with potentially useful items that he has collected during the journey. The man keeps his pistol close. It only contains two bullets - one reserved for him and one for the boy.

The father and son follow a road towards the ocean, but they scurry and hide like two animals. Papa's biggest worries are marauders, food, and shoes. The world is cold. Rape and cannibalism are common occurrences. Although their goal is to remain alive and reach the coast, father and son wonder if the destination is any more hospitable than the rest of the dying world. Often hungry and freezing, both of them become sick. The boy contracts a febrile illness. The man frequently coughs blood and is wounded in the leg by an arrow.

Father and child ultimately reach the ocean, but it too is cold and dead. Not long after arriving at the coast, Papa dies. A stranger finds the grieving boy and invites the child to join his family - wife, son, and daughter. He assures the boy that he is a good man. He tells the child that his family does not eat other people. He advises the boy to hold onto his father's pistol.

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Having remarried after a long and partly happy life with a woman who bore him three sons, novelist Campbell Armstrong lives in rural Ireland with his second wife. He learns that his first wife, who works in Phoenix, has advanced lung cancer and, with his second wife’s blessing, goes to spend time with her and their grown sons. In the course of that trip, he reflects on their life together, their romance, his alcoholism and its effect on their family, their move to the U.S., their losses, and the remarkably enduring affection between them and, surprisingly, between the first wife and the second.

Completely surprising all of them, a daughter his first wife gave up for adoption, who has searched for years for her birth mother, shows up in the months before Eileen’s death and makes the trip to Phoenix to meet her birth mother. Her appearance turns out to be a gift to the whole family. She assuages decades of sorrow and longing in both her and her mother’s hearts. She herself has cancer, not as advanced as her mothers. Both she and her mother work in health care professions. Much psychological and spiritual healing is accomplished between them in the short time they have before Eileen’s death several months later.

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At seven months, Remy, daughter and second child of Heather and Lon Davis, is hospitalized with a seizure that, after several days of agonizing uncertainty, is traced to a brain tumor. This narrative of her diagnosis and treatment, told by her mother and very much from her mother’s perspective, is not only a chronicle of a medical event, but, perhaps more centrally, of a spiritual awakening in the mother’s life. From a person uncertain about and largely indifferent to prayer, faith, and spirituality, Ms. Davis becomes, over the course of her daughter’s treatment, convinced of the presence of God, the power of prayer, and the availability of grace in precisely those circumstances that threaten life and lifestyle and bring individuals face to face with their deepest fears and deepest needs.

A series of “coincidences” makes her more and more aware of how little she controls in the grueling process, and how much of comfort, relief, and unexpected aid comes as unsolicited gift from un expected places. The child recovers, unlike several others the mother encounters during her weeks of witnessing hospital life. The mother emerges profoundly different for the experience, and clearer in her purposes as a writer and, eventually, a teacher.

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This is the first full-length collection by pediatrician and international health physician Roy Jacobstein. These 40 poems engage a wide range of topics, settings, and tones, but all demonstrate the same fine craftsmanship and strong voice.

Among the most engaging of Jacobstein’s poems are those dealing with memories of childhood and adolescence. Consider, for example: “Mr. Gardner in 10th grade told us there was no purpose / to mitochondria, only function.” (“Atomic Numbers,” p. 5). Or, “What transgression made fat Mr. Handler / drop his towel, his gloves, everything… to chase you from one end / of Fullerton to the other?” (“The Lesson,” p. 30) The poet displays a delightful sense of humor in pieces like “Bypass” (p. 36) and “Squid’s Sex Life Revealed in USA Today” (p. 59). Poems with explicit medical themes include “Pre-Med” (p. 6), “Admissions” (p. 8), and “What It Was” (p.11).

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In Especially Then David Moolten discovers his poetry in the ordinary, often painful, texture of childhood, adolescence, love, and marriage. Each memory becomes a small story-like poem that looks simple and straightforward at first, until suddenly the poem reveals its hidden truth.  A sense of existential loss pervades these poems, as in “One morning as a man’s wife offers to fill / His empty bowl he feels suddenly desolate / For how plain he has become…” (“Cornflakes,” p. 31)  But Moolten’s melancholy is sweet, rather than bitter; energized, rather than depleted; and cumulatively powerful, as “The tractor / Of memory drags on, churning its femurs, / Its numbers and dates.” (“Verdun,” p. 64)

Especially Then is ripe with traumatic events: A father’s abandonment, “During that proud, petulant year my father left / And I became a punk, nothing could touch me.” (“Achilles,” p. 17). A brother’s death: “in the shallow dark of years since / I buried my brother…” (“Pulled Over on I-95,” p. 23) Divorce, “despite the years between you / And a hard divorce, the unshrived recriminations…” (“Seen and So Believed,” p. 51) And a wife’s death, “As if his wife had always gone / By the name of death he thinks of her / Whenever he sees or hears the word.” (“In Name Only,” p. 49)

These ordinary tragedies play out against a panorama of tragedy, as evidenced in “Photograph of a Liberated Prisoner, Dachau (1945)” and “The War Criminal Gives His Testimony.” Most often, though, the world’s suffering has little impact on the way we live our lives, “Someone at the next table sighs / Over Guatemala, the tragedy / Of having read an article or watched / A TV special…” (“Who You Are,” p. 53) We go on as we always do.

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Toward the end of the Spanish Civil War, Manuel’s biological father, Jorge de Son Major, dies, finally recognizing him in his will. His social father, Jose Taronji, had been killed only two years before. Manuel, newly rich but philosophically impoverished, seeks a secular spiritual father in "Jeza", an imprisoned rebel leader, and Jose’s comrade. When Jeza is killed, Manuel informs his wife, Marta, and together they plan a final revolt. They use Jorge de Son Major’s boat, Antinea, to deliver rebel documents, then make one final, "crazy," fatal stand, to honor and mourn Jeza, to remember and create themselves.

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This video depicts Robert Coles, noted author, psychiatrist, documentator and humanist, teaching his popular undergraduate course, "The Literature of Social Reflection," at Harvard University in 1990. The film begins with a bell tolling in a steeple and students entering the lecture hall. Excerpts from his lectures are presented in 4 parts: I: Ruby; II: Seeing--The Paintings of Edward Hopper and The Stories of Raymond Carver; III: Praying; and IV: Potato Chips and Tolstoy.

Some additional documentary clips are shown, such as footage of six-year-old Ruby Bridges being escorted into a previously all-white New Orleans school amidst a screaming mob during forced integration of schools. In between segments, brief interviews of Coles’ students let the viewer know that his message is getting through: it matters how you live your life--it matters a great deal.

Coles teaches with stories and these stories are riveting. In 1960, while in the Air Force and assigned to a psychiatric detail, he befriends young Ruby after he witnesses her courage in entering the school building. He comes to know her family and teacher.

Several months later, during the morning escort, Ruby stops in front of the school and says something which makes the mob even more frenzied. Coles is asked by the teacher to tell Ruby not to do that again. Upon gentle questioning, it turns out that Ruby was not talking to the mob, but to God: "Please God, try to forgive those people because they don’t know what they’re doing."

It was a prayer she said every morning, usually a couple of blocks away from the school, but that morning she had forgotten to do it earlier. Coles discusses the remarkable gift of forgiveness instilled in this brave child by her parents, who despite poverty and lack of opportunity to advance in life, were able to love and teach their children values and grace.

In Part II, Coles uses paintings by Edward Hopper, a poem by Raymond Carver ("What the Doctor Said" (annotated by Felice Aull and Irene Chen, also annotated by James Terry) and Carver short story (Cathedral) to illustrate how difficult it can be to truly communicate with and know another person. And how magical the moments are when we do.

In Part III, Coles shows some of the children’s drawings that he has collected during his documentary work. Coles delights in describing what the children said about their drawings at the time they created them. He clearly respects them and their ideas.

The last part ends with the story of the death of Coles’s mother at Massachusetts General Hospital. In her dying days she befriended an African-American woman, whose job was at the bottom of the hierarchy of the hospital: an orderly. After Coles’s mother died, it was this woman--not any doctor or nurse--who taught Coles how to take the time and be with his mother, rather than rush off as he was preparing to do. Coles asks, "Who was the doctor, the healer, the wise person?"

He notes that these twists are characteristic of many stories, such as those by Flannery O’Connor. He then concludes before a standing ovation: "Let us be good to one another, live on behalf of one another . . . . We are lucky to have these writers . . . and to have the lives that can include them."

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This is a long (110 lines) narrative poem about the poet’s wife’s cancer, "large, rare and so anomalous / in its behavior that at first they mis- / diagnosed it." At first the poet personifies the cancer, then he demonizes the chemotherapy. He describes Tumor Hell and Tumor Hell Clinic, which "is, it turns out, a teaching hospital. / Every century or so, the way / we’d measure it, a chief doc brings a pack / of students round." Back on earth, his wife’s cancer is gone.

"This must be hell for you," some of his friends said. He reflects on the meaning of Sartre’s hell (created in Sartre’s own image) and Dante’s hell (created in his city’s image), and he considers the tumor’s name. He concludes that his wife should "think of its name and never / say it, as if it were the name of God."

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The poet stands before an ancient Lycian tomb, upon which is carved the sorrowful face of a woman: "One woman garbed in sorrow’s every mood." He reflects on the constancy of loss in human life. He asks the woman to weep for him, also, because [I] "Share thy stilled sadness, which must ever be / Too changeless, and unending like my own . . . . "

Though the Lycian woman’s grief is old, the poet’s is young. He has lost a child: "With that too human wail in pain expressed, / The parent cry above the empty nest." He is skeptical about dreams of a better life. He rejects "The first confusing, mad bewilderment, / Life’s unbelief in death . . . . " Death is real and final. He concludes with full understanding that "life is but a tender instrument / Whereon the master hand of grief doth fall."

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