Summary:

Set in contemporary Boston, this medical thriller not only gets the reader's blood moving, but also raises some important ethical questions: How do corporate interests influence the judgment and character of physician researchers? To what length should older persons go to slow down the aging process? How does one's lifework of health care fit in with obligations to one's family?

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One 1970s summer, Madeleine L'Engle brings her mother to Crosswicks, the rambling country house where the extended family has spent extended vacations for many years. At ninety, the elder Madeleine is suffering from the ravages of the now vanished diagnosis, 'hardening of the arteries.' By times she is frightened, angry, or difficult; at night she cries out or tries to wander. Round-the-clock caregivers help with the strain, while the writer's own children and grandchildren figure in her journal with concern, affection, and wonder.

The presence of the dwindling old lady provokes detailed recollections--direct and indirect memories--of the lives of her mother, grandmother, and great-grandmother, all named Madeleine--bringing the span of this narrative to six generations. Despite the grandmother's slow mental decline, death comes suddenly, while L'Engle is away and her son is left to help.

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At the heart of this novel is a simple love story. Dr. Bruno Sachs, a slight, stooped, and somewhat unkempt general practitioner in a French village is dedicated to his work and loved by his patients. Sachs is a solitary, self-effacing man who takes his Hippocratic duties seriously and is especially sensitive to the needs of his patients.

In addition to his private practice, Sachs works part-time at an abortion clinic, where he performs an abortion on a distraught young woman named Pauline Kasser. Soon the doctor and his patient fall in love. She moves in with him and becomes pregnant. An editor by profession, Pauline also encourages and assists Dr. Sachs in completing the book he is writing.

The story has many additional layers and dimensions. The reader views Sachs through the eyes of multiple narrators--his patients, colleagues, friends and acquaintances, all of whom write in the first person and present Bruno Sachs as "you" or "he." Thus, the reader gradually builds up a "connection" (empathy) with Sachs by synthesizing multiple glimpses of his behavior and facets of his character. At the same time, Sachs is trying to find his own voice, his own connection, by becoming a writer. At first he jots down random thoughts, then he keeps a notebook, and eventually he produces a complete manuscript.

The book has innovative structural elements that introduce other layers of meaning. For example, the 112 short chapters are organized into seven sections, corresponding with the components of a complete clinical case history: presentation (as in "chief complaint"), history, clinical examination, further investigations, diagnosis, treatment, and prognosis. Similarly, the narratives delve progressively into Sachs' "illness" and follow the "patient" through his course of "treatment."

Another structural element is the cycle of fertility and gestation. The story takes place from September through June, precisely 40 weeks, a pregnancy of nine months, during which Sachs is re-born.

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The setting is a room in a home. Stretched out--half lying, half sitting--an elderly man ("the paralytic") gazes passively at a plate of food that is being held out to him by a gentleman who stands, bending toward him. In contrast to the paralytic, who wears a brown house coat, the standing men is properly dressed, but has a cloth draped over his left arm and holds a utensil in his right hand. The paralytic's arms, slightly bent, extend limply over his body; one foot rests on a stool and his lower limbs are covered with a blanket.

Hovering around the invalid with all eyes turned in his direction are several women, children, and a dog. The only figure who is not looking at the patient is a boy who kneels at his side, with an arm placed gently on the man's leg. In his stretched out position, the paralyzed man occupies a large space at the center of the picture and dominates it. The viewer's attention is further drawn to this central figure by the lighting--the background is dark while the cushion against which the man rests is light and glistens, and the man's face is bathed in light. Hence the viewer participates with the family in focusing attention on the invalid.

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This multimedia online documentary is an essay on the ecstasies and agonies of longevity, researched and composed by photojournalist, Ed Kashi and reporter, Julie Winokur. The site consists of written and audio commentaries and a number of short slide shows. The documentary is divided into six segments, each of which is a complete "essay" in itself: Introduction: Julie Winokur on aging; Part 1, Youth in age: The spirited side of longevity; Part 2, Sentenced to life: Growing old behind bars; Part 3, Helping hands: New solutions for elder care; Part 4, Vanishing heritage: Tribal elders face modern times; and Part 5, Surviving death: Losing a mate with dignity.

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The poems in this collection, written by a dermatologist, are not specifically about medicine or medical issues. Threading through them, however, is a sensibility that sees both the natural world and human relationships in terms of the great cycle of awakenings, rising passions, complex relationships, change, aging, and death. Many, though few run more than a page, have a narrative thrust; they offer windows on ordinary life that tie the particulars of events and encounters to large, seasonal, mythic rhythms and stories.

History is present in many poems, in the character of Persephone, for instance, in lacings of Gaelic language, in allusions to old stones and fires and (in the final long poem) to the historical Macbeth, immortalized inaccurately. Natural objects--bird songs, dolphins, nettles, an old pear tree--feature largely as anchoring images of poems that move gracefully from memories to metaphors, linking life observed with interior life lived alertly by a poet who plumbs small experiences for cosmic connections.

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This collection continues the work of mourning that characterized Hall's collection, Without (see this database). Hall's wife, poet Jane Kenyon, died of leukemia in 1995, at age 47. Hall, considerably older than Kenyon, was married to her for more than 20 years; they wrote their poetry at home, in the farm house that he inherited from his family. The painted bed of the book's title is their marriage bed, as well as the sick bed where Hall nursed Kenyon, and the bed in which she died.

The book is divided into four sections. The first is a six-page poem, "Kill the Day," a detailed rendering of the huge absence so present in Hall's daily activities during the month and even years following his wife's death. The poem is rich with expressions of loss and the daily effort to continue living, and, as time passes, the need to remember a fading presence. "When she died, at first the outline of absence defined / a presence that disappeared." "There was nothing to do, and nothing required doing." " . . . her pheromones diminished. / The negative space of her body dwindled as she receded . . . ."

The second section, "Deathwork," is a series of short poems about the final period before Kenyon died--during which Hall and Kenyon both knew that she was dying--the period after her death, Hall's recollections of earlier times together, the painful process of disposing of Kenyon's belongings ("Throwing the Things Away"), of letting her garden go untended, of "letting go" ("Her Garden," "The Wish"). There are many striking lines: "You think that their / dying is the worst / thing that could happen. / Then they stay dead." ("Distressed Haiku") "Now I no longer . . . call her 'you' / in a poem" ("Ardor"), and, indeed, Hall in this book refers to his dead wife as "she," and "Jane," in contrast to the direct address he used in Without.

Section 3, "Daylilies," is a long (13 page) chronicle of life in the family farm house, reflecting back to Hall's childhood and moving forward to his adult ownership of the house. This poem evokes the life cycles of nature, the march of generations, the repetition of birth and death, the farm house in New Hampshire as a microcosm of the universe, and seems to mark the beginning, in Hall, of some renewed joy in life. In the final section, "Ardor," Hall writes of re-awakened sexuality.

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Please note that in order to provide a useful analysis of this novel, it is necessary to reveal the novel's ending in the discussion below. It is England, 1935. Briony Tallis, 12 years old, decides to become a writer. Her first experiment in novelistic technique involves narrating from three different points of view an odd incident she witnesses from her bedroom window: her sister Cecilia undresses and steps into a fountain in the presence of Robbie Turner, the son of a family servant. Robbie has been educated at Cambridge under Mr. Tallis's patronage, and intends to become a physician. He and Cecilia are in love.

Briony's reconstruction of the incident is inaccurate, but she fails to recognize the lesson of her exercise in multiple perspectives: her version is sufficiently coherent for her to mistake it for reality. She jumps to further conclusions and causes Robbie's wrongful conviction and imprisonment for rape and Cecilia's permanent estrangement from her family.

The rest of the novel both elucidates and unravels the opening sequence. It is 1940 and Briony is becoming both a nurse and a novelist. Both roles represent her efforts to atone for her disastrous narrative misconstrual. As a nurse, she learns a new humility and cares for the appalling injuries of soldiers who, like Robbie, are suffering the war in France.

A more metaphysical atonement lies in her work as a novelist: we realize that we have been reading Briony's own rewriting of the initial events and her careful imaginative reconstruction of Robbie's experiences in the Dunkirk evacuation. She tells of her discovery of the actual rapist (if a rape it was), her decision to retract her accusations and her efforts to make amends with Robbie and Cecilia.

In a final section, set in 1999, the aging Briony, now a successful novelist, learns that she is developing progressive vascular dementia. Soon, her ability to remember and grasp reality will desert her. But she has finished writing her latest version of Robbie and Cecilia's story, the novel we have just read, and can rest.

Her atonement seems complete until we learn that Robbie died in France and Cecilia in the Blitz, and that the (relatively) happy ending we read was simply made up by Briony. Devastatingly, we learn that atonement for an error of fiction has been limited to fictional reparation. The lethal damage it has caused in the actual world is beyond mending . . . unless, of course, we accept the vertiginous truth that the damage described in this novel is itself also no more (or less) than a fiction.

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In this poem, dedicated to his brother, Stephen Dunn reflects back on childhood (and childish) parent-child relationships. The first stanza concerns the dead and the stories that keep them alive: parents who "died at least twice, / the second time when we forgot their stories . . . " The transitional second stanza asks, "what is the past if not unfinished work," prefacing the last stanza, in which the adult poet recognizes how self centered children are--"the only needy people on earth"--and wonders what his parents "must have wanted . . . back from us." But, he concludes, "We know what it is, don't we? / We've been alive long enough."

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Grandma's life was fully spent. Sensing her time was ending, she climbed up three flights of stairs, took to her bed, and began to die. The other inhabitants of the great house, her children and grandchildren, cried out for her. How could her great vibrancy end? What would become of them--of the house--without her? Grandma reassures those surrounding her that "no person ever died that had a family . . . other parts of me called Uncle Bert and Leo and Tom and Douglas, and all the other names, will have to take over, each to his own" (427-428).

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