Summary:

An aging plastic surgeon afflicted with diabetes examines his life and is forced to confront death and the failures of his past. Dr. Moses Galen is a 69 year old California physician with a penchant for sex, Jaguars, and boxing but a fear of making commitments and experiencing a slow death. He spends a weekend with his girlfriend Linda, a trauma surgeon in her forties. After they have sex, he experiences chest pain that he mistakenly attributes to heartburn. Dr. Galen had coronary artery bypass surgery only three years ago and figures it should last at least ten.

He wakes up early in the morning to work out on his punching bag. His chest pain returns and is now accompanied by ventricular fibrillation. He realizes he is having a myocardial infarction and will die. Despite the pain and his fear, Dr. Galen continues to throw punches. He only hopes he can remain quiet enough not to awaken Linda. If she realizes what is happening, she might try to save his life.

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Worlds Apart is a set of four documentary videos designed to stimulate thought and discussion about the effects of culture on communication and medical decision-making. Each video encapsulates the story of a real patient and his or her interactions with physicians and family.

The four videos are: (1) Kochi Story--an Afghan man, diagnosed with stomach cancer, decides about chemotherapy amidst miscommunication due to translation issues and religious convictions; (2) Chitsena Story--the mother of a four-year-old girl from Laos is caught between physicians who tell her that her daughter needs surgery to correct an atrial septal defect, and her mother who upholds the traditional Khmu beliefs that scars, including surgical scars, are injurious to a person in future lives; (3) Phillips Story--an African-American man on dialysis discusses the prejudices against black people in the health care system, particularly the decreased chances for receiving a renal transplant; (4) Mercado Story--a 60-year-old Puerto Rican woman who lives in Hell's Kitchen, New York City, explains the complex social situation which affects her ability to take care of her chronic health problems, such as diabetes and hypertension.

The films depict the patients and families in various settings--in doctors' offices, at other health care facilities, at home or work, during religious ceremonies. Phillips Story is different in that only the patient speaks during the film--in the other three stories we hear family members, translators, and physicians. The pitfalls of translation by a family member or friend are discussed, as well as the need for the physician to elicit information from patients about the social contexts that may affect their health and decisions.

For example, Mr. Kochi's religious beliefs contravene the use of continuous infusion chemotherapy, but not other regimens--this distinction is not elucidated for many months. Hence cultural competency in health care requires that the provider not assume reasons for patients' behaviors and decisions but rather emphasizes communication to understand the particulars of the situation.

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An overweight, older man is referred by his family doctor to a hospital-based Diabetic Clinic. The patient may have "borderline" diabetes and requires a glucose tolerance test to confirm the diagnosis. He remembers to bring two important items to his appointment - an early morning sample of his urine and something to read. He chooses a volume of short stories by Anton Chekhov.

At the clinic, three things vie for the man's attention: the environment of the waiting room, the requirement of providing a sample of blood and urine every thirty minutes, and one of Chekhov's stories titled "The Beauties." As the patient reads the short story, the clinic surroundings fade away. The existing reality is temporarily doused.

After the testing is completed, he meets with the doctor. Their encounter is brief. The diagnosis is not diabetes but rather impaired glucose tolerance (a condition that might progress to diabetes). The doctor recommends a healthier diet and extra exercise. The man telephones his worried wife with the news that he is alright. Like Chekhov, the patient also understands and savors the drama that is present in ordinary life.

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A Place Called Canterbury by social historian Dudley Clendinen, former New York Times national correspondent and editorial writer, provides readers with an intimate and revealing account of aging in a particular place at a particular time--Canterbury Tower in Tampa, Florida. The story about the author's mother, Bobbie--and so many others--begins in 1994, a few years after the death of James Clendinen, Bobbie's husband of 48 years, and known to the community as the progressive editor of the Tampa Tribune. Although she had been "falling apart, a piece here, a piece there...collapsing vertebrae...bent, frail, and crooked...subject to spells and little strokes...." (p. xii),

Bobbie Clendinen was in reasonably good health. Nevertheless, her grown son and daughter did what most children their age do--they worried. When she finally agreed to move from the home where she had lived for twenty-nine years to Canterbury Towers, room 502, two bedrooms, two baths ($88,000 in cash, $1505 each month), Clendinen and his sister were relieved. She would be cared for and safe in "the small, cream colored, obsessively well-run geriatric apartment tower and nursing wing...across a broad boulevard from an arm of Tampa Bay" (see book cover).  And, so many of her old friends were already established residents!

Clendinen was fascinated by his mother's new circumstance and by what he came to regard as the new old age. As a writer, he could not resist the opportunity before him. Although he lived in Baltimore, he could come and go, but over the twelve-year period of his mother's residence--three in the Towers and nine years in the hospital wing--he spent more than 400 days as a live-in visitor, observer, listener, interpreter. This unusual arrangement provided Clendinen with a close-up view of a 21st Century phenomenon, the comings and goings of aging people in the final setting of their lives.

Canterbury is a well-run camp and life there is a soap opera. Between his exchanges with the witty rabbi and the former jitterbug champs, the enthusiasm generated by a nudity calendar proposal (declined) and the geriatric bib enterprise (thriving), the inhabitants provided Clendinen with an abundance of riches. Whether at lunch in the dining room overlooking the Bay, over daily drinks at 5pm, or in bed in the health center, everyone of this Greatest Generation had a story to tell. This ethnographic page-turner, with its cohort of named characters--the Southern Belle, the Rabbi who escaped the Holocaust, Emyfish, the ageless New Yorker, Lucile, the warm-hearted Fundamentalist, the raunchy Atheist, the crusty Yankee, the horny widower, and the maddeningly muddled Wilber--reads like fiction. Whether rich or poor, married or widowed, Clendinen listened as they spoke and in doing so became a trusted friend and chronicler of small and great events in their collective lives: childhood, Depression, World War II, medical advancements, healthcare costs, 9/11. Because Bobbie Clendinen spent so many years in the hospital wing, much of the story describes the kind of care and staff standards that we would hope for all--including ourselves. Mrs. Clendinen died at age 91.

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In the Arctic, winter goes on for ten months every year. The cold temperatures penetrate every aspect of human life. Existence is a struggle. In the Canadian community of Rankin Inlet, an Inuit woman finds personal tragedy as abundant as the snow. Victoria is diagnosed with tuberculosis (puvaluq) as a child and sent to a sanatorium far south of home. Following treatment with medication and a thoracoplasty, she returns to her town years later. Victoria's experience has changed her view of the world but she quickly discovers that in her absence, the people and locale have transformed too.

She marries an outsider, John Robertson, who is a British businessman. His success and local influence allow him to arrange for a foreign-owned diamond mine to open in the area, and with it, a new hospital for the territory. The couple have three children - a son, Pauloosie, along with two daughters, Justine and Marie.

Victoria seems a magnet for misfortune. At age 16, she has a miscarriage. A fourth child dies during a complicated delivery. Her marriage is increasingly strained beyond repair. Victoria's father suffers a stroke and becomes demented. Her mother dies of lung cancer. Husband John is murdered - someone slits his throat. Marie commits suicide. Pauloosie leaves home and sails to the South Pacific.

The Robertson family frequently interacts with the American primary care physician stationed in the isolated region. Dr. Keith Balthazar is a middle-aged atheist who has toiled in the Arctic for more than 20 years and abuses morphine. He keeps a journal of his experiences and meditations and commiserates with the local priest, Father Bernard.

Escape appears to be the best chance at happiness. For Victoria and most everyone else living in this harsh and beautiful land, survival - both physical and emotional - is hard. Personal choices are confusing. Nature doesn't seem to care one way or another.

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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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The narrator of these short stories is a social worker who works for an agency for the blind, many of whose clients are diabetic, alcoholic, or mentally disabled as well. Over the course of the stories, the narrator leaves this work to go back to school in the arts, a personal ambivalence that may play some role in her continual, often dry critique of her clients, her work, and herself. Mostly, though, she casts a gruffly compassionate eye on the hard yet often rich and triumphant lives her clients lead, faced with financial and physical hardship as well as social ostracism.

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In the book’s Introduction, Dr. Cleaveland explains his personal need for real and fictional heroes. Seeing himself often as a victim of cruel childhood peers, he sought protectors and savored particularly the exploits of World War II heroes. His heroes, he notes, delivered him safely through childhood and adolescence.

Cleaveland describes seeing a documentary movie about Dr. Croydon Wassel in 1944; Dr. Wassel became his first personal hero. A book about Dr. Wassel was read by Cleaveland many times; later, as an adult, Cleaveland looked for the book again and set out to ascertain its authenticity. From extensive research he found Dr. Wassel to be far more courageous than he had anticipated--"studied, found not wanting."

The author was introduced to the story of Dr. Billie Dyer in 1992 through a collection of short stories. Dyer was a black physician who kept a diary during his eighteen months in service in the U.S. Medical Corp during the First World War. Cleaveland found a copy of the diary in the public library in Lincoln, Illinois and learned more about a new hero.

Other heroes he writes about were Dr. Woodrow Dodson, who served sixty years as a "domestic medical missionary"; and Dr. Lonnie Boaz, a black physician, the son of a victim of a hate crime, who became a well known ophthalmologist, husband, father, civic leader, and reformer after starting out as a painter, janitor, and army medic.

Cleaveland considers some of his patients to be heroes: Vera Gustafson, a World War II nurse whom he interviewed extensively, later adding historical information to her story; Paulette McGill, a childhood diabetic cared for by Dr. Cleaveland for twenty years; and an obese diabetic who became a "universal friend," teaching others about devotion and courage. Other patients were also deemed heroic, each for some special reason.

The longest story, saved till the last, is about Dr. Janusz Korczak, described by Dr. Cleaveland as the most heroic figure he knows of. Korczak was a Polish, Jewish pediatrician who devoted his life to improving the welfare of children in the Warsaw ghetto; he was deported to the Treblinka concentration camp with the children. (A movie that came out in 1990 dramatically tells this story.)

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Leonard Shelby (Guy Pearce) is trying to avenge the rape and murder of his wife. She was, as far as he can recall, killed by the same intruder who injured Leonard’s head, leaving him with "anterograde amnesia": he remembers everything up until the injury but no longer has short term memory. "I can’t make new memories. Everything fades."

Leonard’s single purpose now is to find and kill the person responsible for his wife’s death and his own disability. He remembers this purpose, and the steps in his progress towards it, by keeping annotated Polaroid photographs and tattooing important facts onto his body. At the end of the story--which is the beginning of the film--Leonard kills a man he believes to be the murderer, but who is probably not.

The story is narrated in reverse chronology, beginning with Leonard shooting the suspected killer, in short segments corresponding more or less to the length of Leonard’s ability to remember. These scenes are interspersed with parts of a longer scene that follows regular chronology, shot in black and white, in which Leonard sits in his motel room, talking on the telephone and telling the story of Sammy Jankis, a man he seems to remember from his earlier life as an insurance investigator.

Sammy suffered from anterograde amnesia after a car crash and Leonard dismissed his condition as psychological rather than physical, resulting in the refusal of Sammy’s insurance claim (the company doesn’t cover mental illness). Sammy’s diabetic wife, thinking that if the condition is mental it must also be voluntary, tries to get him to "snap out of it" by testing him in various ways: finally she tricks him into administering her insulin shot over and over until she dies. Sammy ends up institutionalized.

As we piece the story together, we realize that Leonard’s method for keeping track of his revenge plot is inadequate. Because the bits of information that substitute for memory can be manipulated, others are able to use him as an unwitting assassin. We also deduce that the story of Sammy Jankis may in fact be the story of Leonard Shelby, and that perhaps Leonard’s own wife was killed not by a murderer but by Leonard himself, the revenge motivation possibly planted by Teddy (possibly a cop) in order to make of Leonard a very efficient killer.

The story ends (where it begins) with Teddy’s plot turned against him by Natalie (Carrie-Anne Moss), a mysterious woman who has revenge motives of her own. Leonard takes Teddy (Joe Pantoliano) for the killer and shoots him. Our chilling realization is that Leonard will soon forget he has achieved his objective and again begin looking for someone to kill.

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I used to be able to think. My brain’s circuits were all connected . . . I had a memory and an intuition that I could trust. So begins Floyd Skloot’s memoir of living his life with "a scatter of white spots like bubbles" in his brain, as a result of a viral illness in 1988 that led to chronic fatigue syndrome and persistent brain damage. The first section ("Gray Area") consists of essays that re-create a texture of mistaken words and memory lapses, as well as the author’s creativity in discovering ways to minimize or bypass disability in his daily life. The temporal vector of this section begins with the onset of illness; continues through his marriage to Beverly and their settling on a hilltop in Oregon; and ends with an idyllic stay on Achill Island off the western coast of Ireland.

The second section draws us back in time to "The Family Story," a series of stories about childhood. In "Kismet," which begins section 3, the author returns to a description of his post-illness experience, in this case to his fateful final visit with an older brother, who is dying of diabetes and kidney failure. Later, in "A Measure of Acceptance," he tells of his encounter with a Social Security psychiatrist, whose task is to determine whether Floyd Skloot is "really" sick. The Social Security Administration provides one measure of acceptance; but the author creates a more important measure of acceptance for himself: "I can say that I’ve become adept at being brain damaged. It’s not that my symptoms have gone away: I still try to dice a stalk of celery with a carrot instead of a knife . . . Along the way, though, I’ve learned to manage my encounters with the world." (p. 196)

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