A Matter of Death and Life

Yalom, Irvin; Yalom, Marilyn

Last Updated: Jun-02-2022

Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

After 65 years of marriage, two life-partners face the prospect of final separation, as one of them develops multiple myeloma. This is the crisis that led Irvin Yalom, eminent psychiatrist, novelist, and pioneer of existential psychotherapy, and his wife Marilyn, acclaimed feminist author and historian, to collaborate in writing the story of their journey through Marilyn’s final months of life. In the resulting book, Irvin and Marilyn write alternating chapters until Marilyn becomes unable to write. After her death, Irvin continues with the story of his bereavement.

Marilyn’s chapters include reflections on love and illness, ranging from Emily Dickinson and Henry James to Paul the Apostle. She frequently expresses her gratitude: “I can still talk, read, and answer my emails. I am surrounded by loving people in a comfortable and attractive home.” (p. 20) Most of all, she is thankful for her husband, “the most loving of caretakers.” (p. 15) Yet, as her disease progresses, she comes “to the understanding that I would never be the same again—that I would pass through days of unspeakable misery while my body would decline and weaken.” (p. 76) She decides to pursue the option of physician-assisted suicide, which is legal in California, when her suffering becomes overwhelming.

In his chapters, Irvin resists this decision, maintaining hope for additional “good” life, despite all evidence to the contrary. Near the end, Marilyn’s pain and other symptoms become so severe that she cries out, “It’s time, Irv. It’s time. No more, please. No more.” (p. 139) Her physician arrives, confirms her intention, and surrounded by her whole family, Marilyn sucks the liquid through a straw and quietly passes away.

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The Dropout

Meriwether, Elizabeth

Last Updated: May-19-2022

Sood, Shefali

Primary Category: Performing Arts / Film, TV, Video

Genre: TV Program

Summary:

Based on the 2021 podcast of the same title produced by Rebecca Jarvis, The Dropout is an 8-episode miniseries starring Amanda Seyfried as the infamous biotechnology fraudster Elizabeth Holmes and Naveen Andrews as her much older boyfriend-turned-accomplice, Ramesh “Sunny” Balwani. The miniseries documents the real-life story of Elizabeth Holmes and her evolution from an ambitious, dedicated and somewhat awkward teenager into a ruthless, immoral and still quite awkward CEO of Theranos, a company she founded after dropping out of Stanford her sophomore year. She claimed to develop technology to run hundreds of diagnostic medical tests on a single drop of a patient’s blood. She defrauded hundreds of doctors, investors, pharmaceutical companies and even Walgreens along the way and put hundreds of patients who received faulty Theranos blood test results at risk. This year, Holmes was found guilty on four counts of fraud by a federal grand jury.

The miniseries begins in Holmes’ childhood and utilizes footage from her federal deposition and media interviews to document her evolution from having an innocent desire to invent something to help people to a grifter who put others in danger without a second thought. In her teenage years, Holmes idolizes Steve Jobs. Instead of boyband posters in her room, she has photos of him with Apple products. She spends a summer in China in a language immersion program, where she meets a man 30 years her senior, Sunny Balwani, and strikes up an uncomfortable friendship after learning of his success in business. She is shown to be somewhat of an outcast in school, practicing being excited for a party in a mirror and speaking almost every day with Balwani instead of her peers. Her conversations with Balwani mostly are about her ideas to help people and her desire to be a billionaire. This goal of helping others pushes her to study biomedical engineering at Stanford. She proudly proclaims to family friend Dr. Richard Fuisz, a physician-turned-inventor, that she is in the top 10% of applicants. At Stanford, she is incredibly focused on her goal to invent, and with an unrelenting fervor, she enrolls in graduate level classes and pitches ideas to professors. She is a teacher’s pet; however, when she pitches her idea for a medical drug delivery patch to Dr. Phyliss Gardner, a highly accomplished physician and researcher, her world crashes. Dr. Gardner immediately shoots down her idea and tells her to focus on her schoolwork before trying to invent the next big thing. Holmes can’t take no for an answer and quotes Yoda from Star Wars: “Do or do not. There is no try.” Dr. Gardner responds that in medicine and science, some things are impossible and recognizing that is also part of the scientific process.

This all changes soon after pitching an idea for a blood test using a single drop of blood to Dr. Channing Robertson, an influential chemical engineer at Stanford. He backs her idea and gives her capital for a company. She encourages her parents to let her drop out of Stanford, citing Steve Jobs, Michael Dell and other influential tech leaders as examples, and uses her tuition money to establish Theranos.

Theranos, a combination of the words therapy and diagnosis, takes off, with significant roadblocks, fueled only by Holmes' dreams. Holmes neither has the scientific background nor the leadership skills to lead the company. She does little in the chemistry labs and her lack of engineering, chemistry and medical knowledge prevents her from being able to pitch the idea successfully to healthcare venture capitalists. The blood testing device requires technology that would take years to build and require significant scientific collaboration that does not exist at Theranos. She needs data for investors that the devices are complete and work, so enrolls the faulty, not yet completed devices in a trial testing the blood of cancer patients. This leads to a tense encounter between lead engineer Edmond Ku and Holmes outside a cancer clinic. Ku states that he is an engineer, not a healthcare provider, and he is uncomfortable looking these patients in the eye and testing their blood on a machine he knows does not work. He is clearly very upset; but Holmes forces him to go inside and collect the samples. The clinical trial goes nowhere.

After almost running the company into the ground, she convinces the Board to let her stay CEO if she brings on Balwani, with whom she is in a romantic relationship, as chief operating officer. Balwani offers advice on how to be a CEO of a tech company and encourages her to change her management style. The departments at Theranos become siloed to a point that scientists have no idea what is happening in the executive, marketing and media departments and vice versa. All information comes from Holmes. She spends no more time in the lab and has no meetings with lab personnel, but her name is on every patent. She markets herself as a young female tech CEO in a landscape dominated by men in sweatshirts. Her charisma and newfound business acumen allows her to secure a deal with Walgreens in which Theranos’ devices will be in Walgreens Wellness Centers for use by patients. She does not tell any of the scientists working on the device and does not consult any physicians. She shares no data with Walgreens about the design of the device, its accuracy or validity, citing trade secrets. When her lead chemist, the celebrated Dr. Ian Gibbons, catches wind of this plan, he confronts Holmes, who fires him on the spot for not having the same vision. Amidst pressure from the scientists, she rehires him the next day, but prevents him from working in the lab ever again. The toxic environment created by Holmes eventually causes Dr. Gibbons to commit suicide.

The Theranos devices for the Walgreens agreement fail quality control checks and cannot be used. Holmes and Balwani create a plan in which they use Siemens devices with Theranos logos to run the single drop blood patient samples which have been diluted to provide enough sample to be read by the Siemens machine. This leads to wildly inaccurate results being sent to patients. Examples include a high estrogen reading in a woman with a history of ovarian cancer, suggesting remission; a high thyroid hormone level in a pregnant woman already on thyroid medication, almost prompting her doctor to alter her dosage, which would be fatal for the fetus; and a high troponin level in a man with cardiovascular disease indicating he may be having a myocardial infarction. The lab technicians are aware of these inaccurate results. Eventually two techs, Erika Cheung and Tyler Schultz, the grandson of former Secretary of State George Schultz a and a Board member at Theranos, leak what is happening to a journalist, John Carreyrou at the Wall Street Journal, despite immense legal and physical threats from Holmes and Balwani. Eventually, using evidence from Cheung, Schultz, former scientists at Theranos, and physician-advocates among others, Carreyrou writes an article in the Journal exposing Theranos and Holmes for what they are --frauds. This spirals into the Centers for Medicare and Medicaid Services shutting down Theranos labs indefinitely and leads to thousands of lawsuits regarding Theranos products. Holmes loses all credibility and is arrested on federal charges of fraud and conspiracy to commit fraud.

In the last scene, Holmes visits the office with her new dog to speak with a former Theranos lawyer, who can no longer find a job as a result of the scandal. She boasts about her new boyfriend. The lawyer confronts her, “you hurt people.” Holmes denies this vehemently saying she just ‘failed to deliver’ as CEO and runs frantically out of the office where she breaks down while waiting for her Uber.

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The Urge: Our History of Addiction

Fisher, Carl Erik

Last Updated: May-02-2022

Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The Urge: Our History of Addiction, by Carl Erik Fisher, a psychiatrist, is really two books in one. It is a comprehensive history of addiction from ancient times to the present day. It is also a memoir of the author’s own struggle with addiction and an attempt “to understand how I went from being a newly minted physician in a psychiatry residency program…to a psychiatric patient” (p.ix).

Fisher has grown up with two alcoholic parents. Even as his mother’s drinking “suppresses her blood counts and causes her to miss the chemo sessions I have worked so hard to arrange” (p. 294), she does not stop. Fisher’s own first drink, in high school, is a revelation. He blows his interview for his first-choice college when he shows up late and hung over. His intelligence enables him to get by, but eventually the problem catches up with him as he begins to use Adderall and marijuana to counteract the effects of alcohol. After sleeping through and missing his residency orientation, he is under scrutiny. Finally, he has a drug-induced manic episode that results in his being tasered by the police, and he is forced into treatment.

In the historical sequences of the book, we discover that one of the oldest known examples of addiction is found as far back as the Rig Veda (1000 BC). From there we move through time, learning how Native American populations were devastated by alcohol, how Alcoholics Anonymous achieved prominence, and about the multiple challenges that persist to the present day.

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Should We Stay or Should We Go

Shriver, Lionel

Last Updated: Aug-11-2021

Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Cyril Wilkinson and his wife Kay make a pact. On Kay’s eightieth birthday, when Cyril is already eighty-one, they will commit suicide together. Cyril, a physician in the British National Health Service (NHS) secured a supply of secobarbital as the means to their end. It was 1991. They have planned well ahead; another twenty-nine years will pass before Kay’s eightieth in 2020.

Motivating the pact was the death of Kay’s father after “a good four years of steady deterioration, followed by a solid ten of nothing but degradation” from dementia (p. 7). They had just arrived home from his funeral service, and were reflecting on what they had been through. At one point, Cyril says, “Your father frankly made me suicidal—or homicidal—or both. Half an hour in his presence passed like a mini ice age,” and then promises Kay, “I will do almost anything to keep the two of us from acceding to such a fate” (p. 12). But Kay is dubious.

That’s what everyone says...Everyone looks at what happens to old people and vows that it will never happen to them...Somehow they’ll do something so their aging will proceed with dignity...Everyone thinks they have too much self-respect to allow a stranger to wash their private parts...Then it turns out that, lo and behold, they’re exactly like everyone else! And they fall apart like everyone else, and finish out their miserable end of their lives like everyone else. (pp. 12-13)

And so Kay dithers over the next few months whether to agree to the pact, but once her mother begins showing signs of dementia; “I’m all in,” she tells Cyril (p. 17).

Cyril and Kay proceed through the subsequent twenty-nine years, with Kay raising their three children, retiring, finding new work and passions; Cyril going on and on about politics, the NHS, old people; and both watching their remaining parents pass on, traveling to far-flung locations, becoming grandparents, aging. Then the day arrives; happy birthday, Kay?

The novel structure is simple or complex depending on how a reader approaches it. The first chapter sets up the pact. The second chapter leads up to the day of reckoning and becomes the first story telling what became of the Wilkinsons’ plan. The next eleven chapters envision alternative scenarios unfolding from choices Cyril and Kay make before and on their pre-determined end date. Some scenarios stem from one or both of them not going through with their pact. Some scenarios involve recognizable and available options today, and some are wholly futuristic and unattainable. Some scenarios are happy, some are sad, all are unsettling. These chapters can read as independent stories offering different choices and endings. But they can also be read as interdependent and collectively building toward a point of view on the question: Should we stay or should we go?

The interdependence and complexity of the chapters arise from the through lines among them. From the third chapter on, for example, the first few sentences of each chapter are taken verbatim or slightly modified from some part of a preceding chapter. Other blocks of text appear in one or more chapters. One through line even extends beyond the book to another of Shriver’s novels (So Much For That). Kay and Cyril exhibit the same personalities and preferences, and express the same general hopes and desires through all the chapters. Other through lines are shared events or recurring arguments and debates; however, not always with the same outcomes.

The four years preceding Kay’s eightieth birthday overlap both the decision of the United Kingdom (UK) to leave the European Union (“Brexit”) and the Coivd-19 pandemic. Thus, during the time Cyril and Kay are deciding whether they will actually leave or remain on Earth, the UK is deciding whether to leave or remain in the European Union, and while Cyril and Kay are seemingly willing to die rather than fight the ravages of old age, millions of people are willing to fight the ravages of Covid-19 rather than die. These juxtapositions pop up often giving the Wilkinsons’ decision added poignancy.

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The Ministry of Bodies

O'Mahony, Seamus

Last Updated: Jul-26-2021

Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Starting eight months before his retirement, a gastroenterologist chronicles a myriad of encounters between himself and others - patients and their family members, colleagues, administrators, hospital staff, and even drug reps. He has worked for many years at a large Irish hospital dubbed the "ministry." His professional work there is divided between the endoscopy unit (where he performs colonoscopies and EGDs), medical wards, an outpatient clinic, and the ER.

Given his specialty, the roster of patients tilts heavily towards gastrointestinal problems: alcoholic cirrhosis, GI bleeding, chronic diarrhea, and abdominal pain. But additionally, his days are filled with patients presenting with a variety of medical problems including pneumonia, mental health issues, heart failure, serious fractures, dementia, seizures, anemia, and cancer. He attends to many frail elderly folks in the emergency department. His interactions with patients range from intense to jovial, from unexpected to heart-wrenching. For example, a woman with chronic abdominal pain asks the doctor if she might be suffering from PTSD. When asked why she thinks that might be possible, her reply is "My son hung himself. I found him" (p191).

The doctor is beleaguered by frequent, and at times wacky, emails generated by the hospital bureaucracy as well as unproductive meetings. He must cope with his own health problems too (a vitreous detachment, arthritic hands, and unexplained nosebleeds). He decries the "foolishness" of excessive medical testing and overtreatment and cites the case of a young woman with irritable bowel syndrome who already had over 1,200 test results logged in the hospital lab. He describes the ministry as "an oasis of kindness and comfort" but "also a place of chaos and conflict, of institutional cruelty" (p8).

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Camouflage

Nisker, Jeffrey

Last Updated: Mar-19-2021

Duffin, Jacalyn

Primary Category: Literature / Plays

Genre: Play

The Beauty in Breaking

Harper, Michele

Last Updated: Sep-18-2020

Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The Beauty in Breaking is the memoir of an African American physician who, in her own words, has “been broken many times” (p. xiii).

Despite maintaining a veneer of affluence, the author, her mother and siblings live in constant fear of being battered by her father. Following one particularly vicious attack, she accompanies her injured brother to the local emergency room. That day she serendipitously discovers her calling: “As my brother and I left the ER, I marveled at the place, one of bright lights and dark hallways, a place so quiet and yet so throbbing with life. I marveled at how a little girl could be carried in cut and crying and then skip out laughing” (p. 18).

Much later, the author (Michele Harper) undergoes a shattering breakup and divorce. She endures disappointments at work, some of which, regrettably, can only be explained by the color of her skin.

As she picks herself up time and time again, Harper discovers her inner resilience: “The previously broken object is considered more beautiful for its imperfections” (p. xiii). She learns from the experience of her own suffering to develop compassion in her clinical work. The bulk of the Beauty in Breaking is devoted to case studies of the author’s clinical encounters with patients in the emergency room.

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The Winter Soldier

Mason, Daniel

Last Updated: Jun-20-2020

Field, Steven

Primary Category: Literature / Fiction

Genre: Novel

Summary:

When The Winter Soldier opens, Lucius Kszelewski, youngest son of a patrician Polish family living in Vienna, is on a train bound in the dead of winter for a field hospital in the Carpathian Mountains. It is 1915, and Austria-Hungary is at war with Russia. Lucius, a medical student, has completed only six semesters of medical school, but World War I has intervened, and due to a shortage of physicians in the army the government has decreed that students may graduate early, become doctors, and immediately be commissioned. Lucius has done so and is on his way to Lemnowice, a Galician village, where he believes he will work with other physicians and finally learn to be “a real doctor.”

When he arrives, he finds that the hospital is an expropriated village church overrun by rats and ravaged by typhus, and he is the only physician. The hospital is run by a nun, Sister Margarete, assisted only by orderlies, and the patient load runs the gamut from fractures and gunshot wounds to gangrenous legs and massive head trauma. The front is only a few kilometers away, and the wounded arrive continuously; the quiet and formal Sister Margarete confidently and surreptitiously guides him through rounds, surgeries, and battlefield medicine. Lucius is initially wary of her, perhaps a bit awed by her, and ultimately falls in love with her.

The transforming event is the arrival of the winter soldier, Jozsef Horvath, brought in from the snow mute and shell-shocked, but with no visible wounds. Lucius is fascinated by diseases of the brain and mind, and this patient presents a tremendous challenge. Lucius is sure that Horvath has “war neurosis,” what the British physicians of the time were calling shell shock and what we today would call PTSD, and he is determined to understand and heal him. Lucius and Margarete make slow progress with their patient, but his attempts to care for Horvath have unintended effects, and Lucius must then deal with the consequences of his actions.

The war, and the hospital routine, go on. One day, while Lucius and Margarete are relaxing in the woods, Lucius asks her to marry him. Margarete runs off, and Lucius returns to the village, but Margarete is not there. While Lucius and the staff search for her, Lucius gets lost; he stumbles onto a battlefield and is dragooned into service with a regiment of the Austrian infantry. He escapes and tries to make his way back to the field hospital, and to Margarete, but Lemnowice has fallen to the Russians. The hospital has been evacuated—and Margarete has disappeared. Lucius’ search for her will take him across the war-torn remnant of the Empire.

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5B

Haggis, Paul; Krauss, Dan

Last Updated: Apr-17-2020

Teagarden, J. Russell

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

5B is a documentary about the special unit created at San Francisco General Hospital (Ward 5B) in 1983 to take care of people with AIDS. Three years later, it moved to the larger Ward 5A, where it remained in operation until 2003 after the introduction of treatments effective enough to drastically reduce the demand for hospitalization and standards of care for AIDS patients were in place throughout the hospital. The documentary covers the medical, social, and political considerations surrounding the opening of Ward 5B, and the AIDS epidemic during that time.

The story is told from various perspectives through interviews with key figures in its development and operation, and archival footage of the ward and AIDS activism in the community. The most prominent among the key figures is Cliff Morrison, a clinical nurse specialist who spearheaded the idea for the unit and then managed it. Several other nurses who served in staff and supervisory positions are featured. Participating physicians include Paul Volberding, an oncologist at the time who became pivotal in the development of effective HIV treatments, and Julie Gerberding, a physician treating patients on the unit who later became the Director of the Centers for Disease Control (CDC). Lorraine Day, the chief of orthopedic surgery at the hospital when the unit opened is heard often as an opposing voice. Hank Plante, a local television news reporter also appears frequently to offer his perspectives on many of the social and political issues swirling around the unit. Among other participants are AIDS activists, volunteers, and family members of patients on the unit.

Several storylines frame the documentary including how nurses drove the unit’s inception and then were instrumental in running it. “Nurses were in charge,” said Volberding, admiringly. Interwoven throughout the film are the experiences of the patients and individual nurses, including one nurse who was infected with HIV from a needle stick. “Those nurses were the real heroes,” said one activist.

The unit and those who worked there also encountered opposition from inside the hospital. The nurses of this unit practiced in ways they considered safe but not in such a manner that would preclude them from touching patients or require that they don so much protective gear they become unseeable. Nurses and other clinicians from other parts of the hospital objected and did not want to be compelled to adopt practices they thought endangered them on the occasions they took care of AIDS patients. The film follows this story through union grievances and public debates to their conclusion, which sided with the unit nurses and their advocates.

The story is told against a backdrop of gay rights activism in the 1970s that led to AIDS activism with its influence on how the unit operated. Also getting attention is the fear AIDS struck in society and the resulting social backlash at a time of federal government insouciance. This fear continued up to the time the federal government recognized the epidemic and began taking action, relieving some of the tension but never eliminating it. The documentary ends with key participants reflecting on their experiences with the unit; most were proud, some bitter, and a few a little of both.

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One Child Nation

Wang, Nanfu; Zhang, Jialing

Last Updated: Apr-10-2020

Jiang, Joshua

Primary Category: Performing Arts / Film, TV, Video

Genre: Film