Summary:

The site of the multiple stories interwoven in this novel is a teaching hospital in San Francisco. One of the featured characters is a young single mother who comes in with a swollen arm and finds herself in more medical trouble than she anticipated. She suffers a mild stroke after debatable treatment. Two doctors attend her, but differ markedly in their ideas of how to treat her and their human responses to her. One ends up having a brief affair with her that changes his life.

In addition to these there are stories of a comatose young man and the family that refuses to believe he will not awaken (he does); a volunteer coordinator who observes the politics of hospital life from a privileged margin, and sundry staff people who represent alternative points of view. The single mother recovers, but only after a stay in the hospital has convinced her she may not yet be too old to go to medical school to find a life not in marrying a doctor, but in being one.

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Subtitled "New and Selected Medical Poems," this volume includes poems on illness and healing from Downie's three previous collections, along with several new poems. A longer piece called "Learning Curve Journal" serves as a framework for the book.

Beginning with the desperate voice he hears on his first night as a "suicide line" volunteer, the poet reveals the shape of his own medical learning curve, moving poem by poem from "Orientation" through the realm of "Patient Teaching" and "Teaching Rounds" to "Pronouncing Death." Among the many strong poems in this collection are "Diagnosis: Heart Failure," "Louise," "Sudden Infant Death," "Wishbone," "Living with Cancer," and "Ron and Don."

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A one-person performance of thirteen characters during a single night on a hospice unit. Portrayed are patients, family members and professional caregivers. With minimal lighting and few props the actor/writer, who has been a hospice volunteer for many years, is able to capture in words and action the poignancy and humor of caring for the dying.

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Elisabeth Kubler-Ross was born in Switzerland in 1926. She was part of a package deal--a triplet (and a two-pounder at that). That she survived the birth (as did her two sisters, another two pounder and a more robust six pounder) is something of a miracle. As she explains, her early childhood was filled with other more memorable experiences around death as well, including a long battle with pneumonia and deathbed scenes of neighbors in her small town.

In the aftermath of World War II, she was a volunteer in IVSP, International Voluntary Service for Peace. She spent time in Poland and then Germany, aiding survivors of the concentration camps, as well as the defeated Germans, to rebuild their lives. She returned to Switzerland and went to medical school, eventually marrying an American student studying there.

After practicing as a small town family doctor, she came to the U.S. in the 1950s. Her plans to serve a residency in pediatrics were changed to psychiatry (because they didn’t want someone who was pregnant). In Denver, after residency, she was asked to lecture to medical students. She chose a topic that was out of the ordinary, but something she felt at home with--death and dying.

In 1965, in Chicago, she continued her work in this area. At the urging of some theology students she began a weekly seminar with dying patients, health professions students, (and eventually ) their more skeptical teachers. This experience led to the publication, in 1969, of her book, On Death and Dying. It is in this book that the "stages" of dying are discussed. The remainder of The Wheel of Life deals with more controversial aspects of Kubler-Ross’s life.

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Richard Koslowski, a 32-year-old computer systems supervisor and musician, breaks a tooth when he bites an olive pit. Although the remnant of the damaged tooth is removed during his initial visit to the dentist, Koslowski embarks on a peculiar quest. He longs to find a perfect-fitting dental bridge, to eliminate a mysterious oral pain, and to measure up to the suffering his parents have endured as survivors of concentration camps.

He eventually elicits opinions or treatment from ten different dentists and specialists. Koslowski realizes that he has sustained more than just a cracked tooth. His entire life is now fractured. Koslowski becomes obsessed with his teeth. His girlfriend, Lisa, is a law student who is passionate about women's rights. She travels to Bosnia to interview and assist rape victims. When Lisa returns, she breaks up with Koslowski. His suffering seems so small and his life so insignificant that she can no longer tolerate him.

Koslowski's father is dying of a brain tumor but remains stoic until the end. Koslowski, on the other hand, has a poor pain tolerance. After undergoing multiple dental procedures--tooth extraction, root canals, a series of gum cleanings every week, and finally dental implants--Koslowski ultimately resigns himself to living with the discomfort in his mouth. His "reward" is marriage to a disabled woman, three children, and an ordinary life filled with minor ailments and nuisances.

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The documentary film opens with the filmmaker, Susan Smiley, in search of her mother, Millie, who suffers from paranoid schizophrenia and who, once again, has disappeared into the woefully inadequate public health care system of middle America. Through old photographs and home movies, interviews with family members and health care professionals, and voice-over and direct narration by Smiley herself, the film chronicles the descent of a young, beautiful woman in her twenties into severe and chronic mental illness.

When Millie’s marriage to their father fails, Susan and her younger sister, Tina, are essentially abandoned to endure severe physical and emotional abuse by their mother. As the years unfold, Millie eventually loses her home and embarks on a journey of evictions, arrests, hospitalizations, and homelessness. At what seems to be Millie’s lowest point, warehoused in a nursing home where she is angrily refusing to take any medication, her daughters intervene, petition for guardianship, and navigate the system on behalf of their mother.

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After being struck by a speeding car while riding his bicycle, Paul Rayment suffers extensive damage to his right leg. An above-knee amputation is performed by a young surgeon, Dr. Hansen. Paul is a 60-year-old former photographer who lives in Australia. Divorced and childless, he has no one to assist him with the activities of daily living after he is discharged from the hospital. He refuses a prosthesis. Paul's accident and loss of a limb have triggered a reexamination of his life. He now regrets never having fathered a child. Paul's life is further complicated by three unusual women.

He hires a Croatian lady, Marijana Jokic, as his day nurse and aid. He is attracted to and dependent on the much younger Marijana. Although she is married and has three children, he lusts for her. He offers to act as a godfather for Marijana's children and provide funds for their education. Drago, Marijana's oldest child, lives with Paul for a while. Drago and his father build a customized cycle to convey Paul, but the crippled man doubts he will ever ride it.

Paul has a single sexual encounter with a woman blinded by a tumor. Her name is Marianna. He is blindfolded during the affair and pays her afterwards. A novelist with a weak heart, Elizabeth Costello, intrudes on Paul. The elderly woman is mysterious. She pesters him, occupies his apartment without an invitation, and peppers him with questions. In time, all three females fade from his world, leaving Paul still struggling to adapt to loss and a new life.

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In three sections of remarkable narrative poems, Fraser reviews how his own and his family's lives are utterly changed by the birth of his youngest brother, Jonathan, who is profoundly disabled by spina bifida and has survived into adulthood--long beyond what doctors predicted. An introduction provides the context: the poems chronicle a hard journey from denial, shame, and anger to acceptance. As Fraser writes toward the end of the final, title poem: "We must learn to cherish chance to have one." But chance has dealt his brother, and so his family, a particularly hard blow.

The first section focuses primarily on his own remembered reactions and reflections--his guilt, his cluelessness--as a child and adolescent; the second on relationships with family and friends as an adult, all of them partly shaped and shaded by the ongoing suffering of his disabled brother; the third and longest, an exercise in empathy-with his mother and with Jonathan, neither of whose suffering, he realizes, is entirely imaginable to him. The poems are regular free verse, rich with allusion, emotional precision, and narrative detail.

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This collection traces the writer/speaker's journey through her husband's diagnosis to his death of cancer and through the first year after loss, ending with an eight-part poem entitled "The First Yahrzeit," (69) that commemorates the one-year anniversary of her husband's death. The poems vary richly in tone, structure, and focus, some vividly descriptive of the experience, some obliquely figurative, some simple pauses over a moment or an object that has become evocative or sacralized in the course of mourning. Every one offers a surprise line or image that is worth returning to. The whole chronicles a journey of a kind many have had to take, and offers a testimony of hard-won, ambiguous healing.

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Joan Didion has written a very personal, powerful, and clear-eyed account of her husband's sudden and unexpected death as it occurred during the time their unconscious, hospitalized daughter was suffering from septic shock and pneumonia.

Quintana, the couple's 24-year-old adopted child, has been the object of their mutual care and worry. That John Gregory Dunne, husband and father, writer and sometime collaborator, should collapse from a massive, fatal coronary on the night before New Year's Eve at the small dinner table in their New York City apartment just after their visit with Quintana can be regarded as an unspeakable event, beyond ordinary understanding and expression. "Life changes fast . . . in the instant. You sit down to dinner and life as you know it ends" (3).

As overwhelming as these two separate catastrophes are, the account provided by Didion evokes extraordinary descriptions of the emotional and physical disorientations experienced by this very lucid, but simultaneously stunned and confused wife, mother, writer dealing with the shock of change. Her writing conveys universal grief and loss; she spins a sticky filament around the reader who cannot separate him or herself from the yearlong story of difficult, ongoing adjustment.

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