Summary:

It is 1915. Sasha, only daughter of a renowned English doctor, longs to be a nurse, as her brother, Thomas, longs to be a doctor. Their father is opposed to both objectives: he thinks Thomas should sign up to "do his bit" in the war effort like his older brother, Edgar, rather than go to medical school, and he doesn't think Sasha could handle the gore of wartime medicine. He is also concerned because on a few occasions, Sasha has let slip that she has accurate premonitions of people's deaths. The first of these came when she was five. She has learned since then not to speak of this "gift" to anyone in her family, for fear of losing credibility, but keeps with her a book of Greek myths, in which the story of Cassandra helps her to validate her sense of her own gift/curse.

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Katie Takeshima, the narrator of this coming-of-age novel, moved with her immigrant family from Iowa to Georgia when she was in kindergarten. As her parents work long hours in a poultry processing plant with other exploited non-union immigrant workers, she and her older sister Lynn, and her little brother, Sammy, enjoy a loving and fairly free childhood. Lynn is Katie's primary teacher. Among her most important lessons is to see everything around her as "kira kira"--a Japanese word meaning something like "glittering"--moving and alive. When Lynn sickens and then dies of lymphoma, Katie has to do some fast growing up, and in her mourning develops a sharper sense of the glittering, mysterious presence of spirit and life in a world full of prejudice, poverty, and loss.

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Thin, a documentary film produced, aired and distributed by HBO, is the centerpiece of a multi-faceted project that explores the complex issues of body images and eating disorders in young women. Photographer and journalist Lauren Greenfield began documenting eating disorders in 1997, eventually publishing an article for Time Magazine and a book entitled Girl Culture, as well as producing a traveling photographic exhibit. Returning to one of the facilities featured in the exhibit, Greenfield took up residence at the Renfrew Center, an in-patient facility for eating disorders in Florida, to film the day-to-day suffering of four young women struggling with anorexia over the course of six months.

The youngest is Brittany, a sad and troubled fifteen-year old, whose bulimia and anorexia began when she was only eight (her weight bounced from 185 to 95 pounds in one year) and whose mother has her own very unhealthy relationship to food. Brittany is eventually returned to her weight-obsessed mother because of the loss of insurance. Shelly, a twenty-five year-old, psychiatric nurse, has been anorexic for six years and enters Renfrew at 84 pounds with a surgically-implanted feeding tube. Her identical twin visits to plead with Shelly to refrain from slowly killing herself and ultimately destroying their family. Polly is a twenty-nine year old, charming troublemaker whose health is returning but whose defiance of rules eventually gets her kicked out of the facility. The oldest patient is Alisa, a thirty-year old, divorced mother of two whose eating disorder ostensibly developed at age seven when a pediatrician persuaded her mother to put her plump daughter on a severe diet. Alisa's graphic account of a single day of binging and purging is shocking, and her forced release from Renfrew because of problems with health insurance precipitates a return to this pattern after she tucks her children into bed.

 

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In her senior year of high school, having uncharacteristically drunk too much at a party, Angel Hansen consents to be taken home by a boy she normally doesn’t care much about, and ends up having sex with him. Two months later, with the help of her best friend, Karin, she takes a pregnancy test, finds it is positive, and visits an abortion clinic. Karin, who has had an abortion, is ready to support her in complete secrecy. Tim, the father, is horrified, but consents to pay for the procedure. At the last minute, however, and without being able to explain her reasoning to either of them, Angel decides not to go through with the abortion.

In the ensuing months, she endures her parents’ disappointment, her friends’ distancing, and the loss of a number of hopes, including the Yale education she was expecting. In the course of those months, however, she also finds new levels of relationship evolving with parents, grandparents, and the few friends who decide to engage with her on new terms, including Danny Stanton, a friend she’d grown up with, and had recently come to love in new (but, she thought, hopeless) ways. To her great surprise, Danny asks to accompany her to Lamaze classes, and, after taking her to the prom in her ninth month, sees her through the baby’s birth. The story, told in the first person in the form of journal entries, chronicles a young woman’s process of maturing through the consequences of a mistake into acceptance of responsibility for choices, even one she can’t fully account for.

One interesting scene records a conversation between Angel and Karin where Karin admits that her weeks-long estrangement comes from a feeling that Angel’s choice to keep the baby implies a judgment of her for terminating her own earlier pregnancy. Angel makes it clear that she respects their differences, fosters no judgment, and can’t even fully articulate why she felt strongly about needing to make a different choice, but feels clear and sure about her own.

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Serving as a summer hospital volunteer, fifteen-year-old Teri d'Angelo meets Valerie Ross, a girl her age who has damaged a nerve in a fall, and lost the use of one leg. Valerie's anguish over her partial paralysis takes the form of anger; she manages to keep most of those who try to help her at a distance. But Teri finds her intriguing, and Valerie's condition evokes a kind of sympathy and interest in her that overcomes even the patient's most strenuous rebuffs. Gradually, and with much caution on Valerie's part, they become friends. Valerie finds herself welcomed into Teri's large, warm Italian-American family. Teri's compassion for Valerie grows as she recognizes her loneliness; Valerie's parents are divorced, her father rarely visits, and her mother keeps up a hectic work schedule.
      
Teri also benefits in ways she didn't expect from the friendship; Valerie's bravery, even when masked with anger, inspires her to speak up more clearly on her own behalf, to ask for what she needs, and even to circulate a petition at school when she feels she has been discriminated against in the judging of a science project.
     
When Valerie is taken to a "sanitarium"-a mental health facility-for depression and apparently psychosomatic involvement of her good leg in the paralysis, Teri visits her patiently, despite Valerie's apparent lack of interest. But finally, when she watches Valerie rejecting the grandmother who traveled from England to see her, she acts in uncharacteristic anger, and in the shock of the moment, Valerie stands up, proving to herself and others that her good leg does, infact, function.  It is a turning point in her healing.

In an interesting twist, the book ends with the girls drifting apart.  They are, indeed, very different. Valerie is planning to attend City College in engineering. Valerie is going to live with her grandmother in England and attend Oxford University, hoping later to become a writer. In a final phone call, two years after Valerie's accident, the girls part with some affection and gratitude on both sides, but also with an acceptance of the fact that their friendship may have been for a season. They gave each other important gifts, and now life is taking them in very different directions. 

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In this collection, twenty-two medical students and young physicians across the United States eloquently recount the process of medical education for those who do not believe they fit standard measures of student demographics. The editors, Takakuwa, an emergency medicine resident physician; Rubashkin, a medical student; and Herzig, who holds a doctorate in health psychology, group the essays into three sections: Life and Family Histories, Shifting Identities, and Confronted.

Each section is prefaced by an essay explicating the essay selection process, the history of medical school admissions policies and requirements, the basic progression of medical education and the reasons for this collection, such as "putting a human face" (p. xx) on the changing characteristics of admitted medical students: "With their diversity and through their self-reflections, we hope that these students will bring new gifts and insights to the practice of medicine and that they might one day play an important role in transforming American medical education into a fairer and more responsive system." (p. 141)

Additionally, a foreword by former Surgeon General Joycelyn Elders outlines her experience as a black woman entering medical school in 1956, including eating in the segregated cafeteria. The book concludes with recommendations for further reading and improvements to the medical education process as well as with brief biographies of the contributors and editors.

The range of essays is impressive: diversity itself is given a new meaning by the variety of narrative voices in this volume. Contributors include people from impoverished backgrounds, both immigrant (Vietnamese, Mexican) and not. One student, marginalized by his academic difficulties, began a homeless existence during his first clinical year. Others were made to feel different because of being African or Native American.

In two essays, mothers defy labels placed on them (pregnant black teen; lesbian) and describe the trials and triumphs of their situations. Students write of being subjected to ridicule, ignorance and prejudice due to their gender, interest in complementary medicine, political and advocacy views, or religious beliefs. Due to pressures to conform, even students from what might be considered more mainstream in American culture (e.g., growing up in a small town, or being Christian) can experience the effects of being "different" when in medical school.

A number of essays communicate the difficulties of illness, disability and bodily differences. Issues include recovered alcoholism (rather tellingly, this is the only essay that is anonymous), obsessive compulsive disorder, sickle cell anemia, Tourette Disorder, attention deficit hyperactivity disorder, chronic pain, and obesity. The authors balance their narratives of hardship with insights into how their struggles improve their opportunities for empathy, perspective and fulfillment as physicians.

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The subtitle to this collection of insightful and compassionate essays by gastroenterologist David Watts is: "One Doctor's Reflections on the Oddly Intimate Encounters Between Patient and Healer." Watts provides 48 narratives, most of which concern his patients and are written in the first person. In the preface Watts states "The stories in this book are true" (xv), that he has received permission from his patients, and that he has "disguise[d]" his patients to respect their right to privacy.

The stories cover a range of settings, from Watts's home and locations in the San Francisco Bay area, to the clinic and hospital. They also cover a range of his experience from medical school ("Sylvester" and "Love is Just a Four-letter Word") to his current position as a practitioner and an attending physician at a teaching hospital.

Stories in which Watts clearly situates himself with the patient and details the encounter are most compelling. For example, in the opening essay, "White Rabbits" and later, in "Flu Shot," Watts allows the reader to discover that patience and listening are required to in order for the patient to expose why he or she is truly there. In that space, Watts becomes present for his patient, and one learns that what may initially appear tangential is central to the patient's concern.

Watts writes of some very difficult patients and families, such as a woman who stalks him ("The Stalker's Bridegroom"), a woman who obsesses over caring for her elderly mother ("Home Remedy"), and a woman who demands narcotics ("The Third Satisfaction"). In one of the longer pieces, "Codger," Watts describes an irascible, elderly Jewish patient who skewers just about anyone with his critiques, including Watts's young son, and yet who later exposes his vulnerability by unfolding the tale of his World War II service and discovery of a Nazi death camp. It is because Watts spends time with the Codger and recognizes that the doctor-patient relationship is above all a human relationship that the doctor receives the gift of the story: this terrible experience which informed the rest of the Codger's life.

A few of the vignettes explore the therapeutic potential of poetry. For instance, in "Annie's Antidote" a piano teacher, fearful of endoscopy, asks Watts to recite one of his poems. The poem concerns the tender relationship between Watts and his son and is a metaphor for Watts's patient encounters as well: "for this is one of those moments / that turns suddenly towards you, opening / as it turns, as if we paused / on the edge of a heartbeat. . . " The poem works, the moment opens, and the woman has her endoscopy.

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Memoirs of Hadrian is a historical novel in the form of a long letter written by the Roman Emperor Hadrian to his young friend and eventual successor, Marcus Aurelius. Alas, Hadrian is "growing old, and is about to die of a dropsical heart." The Emperor begins by describing his recent visit with his physician Hermogenes, who "was alarmed, in spite of himself, at the rapid progress of the disease" (3). In light of his physical deterioration, Hadrian begins to reflect on his life and work, and to share his wisdom with his young correspondent.

Hadrian tells of his early life as the protégé of the Emperor Trajan, his military and political victories, and his eventual adoption by Trajan, a move that guaranteed the succession when his adoptive father died. While Trajan, whose victories brought the Roman Empire to its greatest size, was a military man to the core, Hadrian considers himself essentially peace loving--his personal life devoted to simplicity and harmony; and his public life to prosperity and justice. Nonetheless, he has always recognized that, in order to govern effectively, ruthless action is sometimes required.

Hadrian's marriage to the Empress Sabina was simply a matter of convenience. The love of his life was a beautiful young man named Antinous. The two men were deeply committed to one another, but at the same time the middle-aged emperor had "a certain dread of bondage" ( 177) that kept him from fully giving himself to Antinous with the abandon of youth. They were visiting Alexandria when the despondent Antinous committed suicide in a way that mimicked a religious ritual, essentially sacrificing himself to the deified Emperor.

Hadrian was crushed with grief and descended into a long period of depression. However, he eventually overcame his depression through his love of literature and ideas, as well as his sense of duty to the Empire (no SSRIs being available at the time), although not before attempting to enlist his physician in assisted suicide. Unable to refuse his emperor's request, the physician himself commits suicide rather than violating his Hippocratic Oath.

Hadrian's final military engagements involve crushing Jewish insurgents in Palestine, completing the destruction of Jerusalem, and founding a new Roman city on its site. The aged Emperor reflects frequently on his tolerance for all religions, except for politically disruptive fanatics like the followers of a Jewish prophet called Christ. As to the Jews in Palestine, he cannot understand why they continue to engage in self-destructive rebellion, most recently with Bar Kokhba and Rabbi Akiva as their leaders.

In his final years Hadrian adopts Lucius, one of his former lovers (in this account), as his son and heir, but Lucius soon dies, presumably from tuberculosis. Eventually, the Emperor adopts Antinous Pius as his heir and further arranges for Marcus Aurelius to succeed Antinous Pius. At the end of his letter, Hadrian writes, "I could now return to Tibur, going back to that retreat which is called illness, to experiment with my suffering, to taste fully what delights are left to me, and to resume in peace my interrupted dialogue with a shade." [i.e. Antinous, his lost love (271)].

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This remarkable collection of short writings, introduced by renowned poet Naomi Shihab Nye, who visited the Sutterwriters (of Sutter Hospital in Sacramento, California) to offer a workshop, provides a broad, compassionate, imaginative window into the life inside and around an urban hospital. Patients, staff, and all interested in healing through writing are invited to come and participate-with an accent on the latter: no one is invited who isn't willing to write.

Chip Spann, the editor, came to Sutter Hospital with a Ph.D. in English, and has the privilege of coordinating this fluid community of writers as part of his work as a staffmember. His conviction, voiced in an engaging introduction, is that literature is a powerful instrument of healing--both the literature we read and the literature we create--and that the experience of literature belongs in community. The individual pieces are accompanied by photographs and short bios of contributors.

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Sixteen-year-old Angelina Rossini tells the story of the year her father died. A lively, opinionated, attractive sixty-nine-year-old Italian happily married to a forty-two-year-old English woman, he has hardly been an inconspicuous presence in the small town of Blodgett, Vermont with a population of 854. Angelina, the only child of this second marriage, loves her father dearly, though she rolls her eyes at his eccentricities, and knows herself to be fortunate in both parents, though they're older, and her mother somewhat less expressive, than she would choose. Her best friend, Jax, belongs to a very different family, large, blue-collar, partly French Canadian. Though she and Jax have been friends since kindergarten, and though she has known for some time that he is gay, her love for him sometimes spills over into desire. They talk about this, as they do about everything else, though this subject is a little tenderer than most. When a girl who has been aggressive and unfriendly suddenly reveals her own same-sex desires, Angelina is able to handle her awkward revelation with compassion.

When Angelina's father has a stroke, all the rhythms of family life are disrupted. Her half sister, whom she's never liked much, comes for an extended visit. Her mother is preoccupied, first at the hospital, then with home care. And she herself has to learn aspects of caregiving for a partly paralyzed father who has lost his speech. The process is, of course, emotionally complex, sometimes comical, often heartbreaking. But when she speaks at his funeral, after a heart attack takes his life, it is with a widened appreciation of the kind of man he was, and of what value his life had even in the months he was severely incapacitated. After his death, she explores, in a few final chapters, the ambiguities of grief, and the process of forging a new relationship with her mother, who has lost her own best friend and companion.

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