Summary:

Written as an interior monologue, Destiny begins as Chris Burton receives a phone call informing him of his schizophrenic son's suicide. Burton, a British ex-pat journalist in the final stages of writing his chef d'oeuvre--a cultural history on national character--is married to Mara, a provocative, capricious, flamboyant Italian. The vitriolic arguments and hurtful stratagems that characterize their discordant marriage intensify with the crisis of death and its aftermath--the identification, transport and entombment of Marco's body. Family relationships are further complicated by Mara's distrust and estrangement of her adopted daughter, Paola.

Burton reveals the chaos that schizophrenia imposes not only on the patient, but also on the entire family. In order to avoid prison following an attack on his family and home, Marco had been placed in a psychiatric institute, Villa Serena, and it was at this facility that Marco stabbed himself to death with a screwdriver. The onset of disordered thinking and erratic behavior, the search for therapies, the various repercussions of guilt and blame (including recriminations about the intense, border-blurring maternal love lavished on Marco), are re-examined by Burton as he travels from London to Rome, sits vigil by his son's body in the camera ardente, and confronts his wife at her family's tomb.

Burton's physical distress mirrors his mental anguish. Burton has heart disease and obsesses about lacking his anti-coagulant medication. In addition to the worry of clot formation, urinary retention prevents Burton from emptying his bladder. These physical ailments of containment, confinement, obstruction and blockage form resonances throughout the book: the tomb, the strictures of marriage and the leakage of adultery, the oppressive family 'house of ghosts,' the separateness of interior thought from observable behavior, the barriers of language, the herky-jerky redirections of emergency travel.

Furthermore, the will to create permanence, to make one's destiny more than a transient destination, informs Burton's moves. In the midst of his exploding marriage and tormented trek home, Burton agitates over his work, and in particular, his book, which "must serve to transform a respectable career into a monument" (p. 1).

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Manlius is a 5th C Roman patrician living in Provence who has studied with the wise, reclusive Sophia. He writes his understanding of her teaching in his essay, 'Dream of Scipio,' which trades on an essay by the great Roman orator, Cicero. Sensing that the Empire is gravely threatened, he makes a pact with barbarians, sells out his neighbors, slays his adopted son, and becomes a bishop of the Christian religion, which he has long despised. Late in this ruthless and doomed attempt to salvage what he values most in his world, Sophia makes it clear that he has misunderstood her teaching.

Olivier is an astonishingly gifted 14th century Provencal poet whose intolerant father tries to stifle his love of letters, among which is Manlius's 'Dream'; his father destroys the manuscript, but Olivier recopies it from memory. As plague advances on their region, Olivier finds a mentor in the high churchman, Ceccani, who is bent on keeping the papacy in Avignon. He plans to destroy Jews as symbolic expiation for plague, widely construed to be a form of divine punishment. Olivier befriends a Jewish scholar and falls in love with his beautiful heretic servant.

The 'Dream' and the imprisonment of his friends lead Olivier to question and then betray his mentor. Either because of his efforts to save them, or for his role in a murder, he is mutilated--his tongue and hands cut off to rob him of speech and writing. The brutal mutilation appears early in the book--it is not fully explained until the end.

Julien is a French historian who has studied the poet, Olivier, and the rendition of Manlius' manuscript. He finds solace in his erudition as his county falls to the Nazi occupation. An old school friend who is a collaborator, gives him work as a censor and tolerates Julien's Jewish lover, the artist Julia. In the end, Julien is forced to choose between saving either another school friend in the Resistance or Julia. He chooses Julia, looses her anyway, and commits suicide in a vain attempt to warn his friend.

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The author comments initially that most physicians become involved in the stories of their patients' lives--as witnesses, chroniclers, and players. He uses as an example the story of a physician's role in the death of Anton P. Chekhov. Another interesting example is the book, A Fortunate Man (see this database), the story of an English country doctor who matures in the profession and comes to recognize the task of the doctor as one to help his patients feel recognized.

Dr. Verghese believes that all patients seen by physicians are in the midst of a story that begins the moment they walk through the portals of a hospital or a clinic. He sees the challenge as engaging the patient and the family in finding an "epiphany," even if that epiphany is simply the understanding that there is nothing more that can be done medically. In his conclusion he says that as physicians we should be ministers of healing, storytellers, storymakers, and players in the stories of our patients and ourselves.

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The author, Samuel Shem, opens these reflections by saying that he was a writer before he was a doctor. His early answers to questions about healing came from stories he read. "Life as it should be in addition to life as it is" became the "motor" of his writing. He loved stories that he heard from patients and the "few humane doctors" he met and decided he would be able to understand people better by writing about experiences with them.

Shem's experience as an intern spawned The House of God (see this database) and he sees writing about his training as an example of the use of resistance when he saw "something unjust, cruel, militaristic or simply not right." He recommends the following to resist the inhumanities in medicine: (1) Learn our trade in the world, (2) Beware of isolation, (3) Speak up, (4) Resist self-centeredness. He says that the healing essence of narrative is in "we," meaning the patient and the physician.

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This is a new collection of poetry and short prose by nurses, edited by Cortney Davis and Judy Schaefer, whose remarkable first anthology, Between the Heartbeats: Poetry and Prose by Nurses [see annotation in this database], may be the founding document of "nurse writing" as a recognizable genre. In the Foreword, Cortney Davis comments on the process of selection and sketches the similarities and differences between this and the previous volume.

One of the interesting similarities is that nurses write more often about birth than death; one of the differences is the wider range of topics, including nurses who reveal their own experiences as patients (see Amy Haddad, "Conversations with Wendy," pp. 100-102) and others whose fatigue and frustration cause them to step away from nursing (see Pamela Mitchell, "A Nurse's Farewell," pp., 149-151)

As in Between the Heartbeats, the authors of Intensive Care appear in alphabetical order, which favors variety and surprise over categorization. In "Medical Ward," the first poem (pp. 1-2), Krys Ahlman captures many of the themes of the anthology. "I was wearing a thousand tiny failures," Ahlman writes, and concludes: "I held out my hand, I said / I am not afraid to cry."

Intensive Care is full of delights. As advertised, there is much about bringing children into the world and caring for them; for example, Lynn Bernardini's reminiscence, "Does This Day Mean Anything to You?" about having given up her own baby for adoption (pp. 11-16); Celia Brown's poem "Forget-Me-Nots" (pp. 35-36); and the powerful but ambiguous hope of "Neonatal ICU" (Leigh Wilkerson, p.247). There are the painful memories of dying children and adolescents, especially Jeanne Bryner's amazing, "Breathless" (p. 42) and "Car Spotting, " (pp. 173-184), a story by Christine Rahn about a terminally ill adolescent. In "Car Spotting" the head nurse criticizes the young narrator because, "You become too personally involved with the patients . . . Nurses must make decisions based on objective data. Becoming too attached can cloud professional judgment." (p. 175) I found this an interesting statement coming from a nursing instructor--it could well have been made by a professor of medicine to a third year medical student.

Other major themes include the humor of nursing (see "RX for Nurses: Brag!" by Kathleen Walsh Spencer, p. 203; and "What Nurses Do on Their Day Off," Judy Schaefer, p. 188); women's health (see "Every Day, the Pregnant Teenagers," Cortney Davis, p 69; and "Redemption at the Women's Center," Jeanne Lavasseur, pp. 132-133); nursing the elderly (see "Home Visits," Paula Sergi, pp. 195-196); and the wonderful narratives of patient care (see "Sarah's Pumpkin Bread," Terry Evans, pp. 87-90; "Edna's Star," Chris Grant," pp. 95-99; and "That Mystique," Madeline Mysko, pp. 158-167). Finally, Intensive Care looks back thoughtfully in a number of pieces to nursing in military settings.

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Winter investigates the process by which Freudian psychoanalysis became legitimized within modern Western culture and internalized as a kind of "psychological common sense" (4). She argues that Freud's adoption of the Oedipus myth allowed him to draw on the cultural status of classical scholarship and claim the universality of the tragic theme for his own project. She traces how Freud worked to establish an institutional infrastructure for psychoanalysis, to establish it as a profession. His analysis of culture and society represents another strategy in establishing and extending the importance of psychoanalysis: the claim that psychoanalysis powerfully illuminates not only the workings of the human brain (the domain of psychiatry, psychology, and neurology) but also the functions of society (the analytic domain of anthropology and sociology).

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Subtitled "The Story of a Gifted Young Obstetrician's Mistake and the Psychologist Who Helped Her," this is an absorbing account of a young female physician's torment following the difficult delivery of a baby who was soon thereafter diagnosed with cerebral palsy. "Doctor Amelia" seeks counseling after she has taken an indefinite leave of absence from her practice and faculty position. The book intertwines reconstructed counseling sessions in the voice of the doctor-patient, with the therapeutic strategy and personal reflections of her therapist, author Dan Shapiro.

The obstetrician enters therapy because she has lost confidence in her professional abilities. Once deeply engaged in her chosen profession, she has lost her enthusiasm for it and feels "numb." Her marriage is under strain. When asked if she is suicidal, she hesitates and then denies she is. Shapiro thinks there may be trouble ahead, and so does the reader. Gradually, Doctor Amelia reveals the incident that triggered her changed emotional state. She had delayed performing a cesarean section on a patient who was in extended labor and whose baby was showing deceleration of its heartbeat rate. A few weeks later, the baby's pediatrician informed Doctor Amelia that the baby had cerebral palsy and now the baby's parents are filing a lawsuit.

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This is a collection of related stories, sketches, poems, and a one-act play by Jean Toomer, a little-known writer of the Harlem Renaissance. The book is divided into three sections. The first part of the book is a series of stories that portray the lives of poor black women in rural Georgia. They deal with such subjects as infanticide ("Karintha"), miscegenation ("Becky"), hysteria ("Carma"), lynching ("Blood-Burning Moon"), and religious mysticism ("Fern" and "Esther"). Taken together, these stories portray an intuitive, violent, spontaneous, and pre-rational culture.

The second part of Cane takes place in Washington, DC, where Toomer depicts the life of urban black Americans in the early 1920's. Here we encounter the conflict between rationalism, as represented by the well-educated "intellectuals," and traditional lifestyle and morality. The best stories in this section include, "Avey," "Theater," and "Box Seat."

The last section is a one-act play ("Kabnis") about two urban black writers attempting to establish a contemporary "Negro identity" in light of the repression and suffering of their people. One is overwhelmed by negativity and a sense of victimization, while the other man believes that the past can be transcended, especially through the power of art.

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When Dan Shapiro was 20 years old and a junior in college, he was diagnosed with "nodular sclerosing Hodgkin's disease." Thus began a five-year ordeal of chemotherapy, radiation treatments, and a bone marrow transplant that failed. But this memoir, which recounts diagnosis, treatment, and two relapses, is more than a narrative of illness. Woven in and out of the subjective experience of physical and emotional trauma is the author's life as an adolescent, a family member, a young man who falls in love with the woman who eventually becomes his wife, a graduate student learning to be a clinical psychologist.

Sequences of ordinary life are carefully juxtaposed with sections on illness and treatment, emphasizing the author's determination to incorporate his illness into his life, all part of one continuous fabric. Even though disease was enormously disruptive, "[l]ife doesn't stop when something horrible happens" (158). Part of that life was a mother who decided to grow marijuana plants in her backyard ("Mom's Marijuana") so that her son would have an antidote for the terrible nausea that accompanied his chemotherapy. It is Mom who learns in a waiting room conversation that it might be advisable for Dan to bank his sperm for the future-- and who then proceeds to make the arrangements. As the memoir ends, Dan's mother finally disposes of the dry marijuana leaves that have been hanging in her attic for several years.

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This long poem in 20 sections seeks to explore, dissect, and create a language for the experience of hemophilia. "Blood pools in a joint / The limb locks . . . " The poet first dissects words like "trans / fusion" and "hema / toma," and showers the reader with images (like splatters of blood?).

In section 5 he states his purpose in the familiar jargon of educational objectives and later, in section 10, he utilizes spacing and line breaks to convert standard admonitions into poetry; for example, "These child- / ren should / not / be / punished, and / their / play with / other / children / should / be super- / vised . . . " Isolated phrases and sentences appear--some from the hospital and some from the "outside" world.

In some phrases the worlds of outside and inside mix, as in "Arterial sunrise, capillary dusk." Section 13 consists of laboratory reports. The poem breathes in and out, between syllables and long lines, between prosaic statements and poetic images. Finally, the poet finds words for the endless rhythm of hemophilia, "Gratitude and / fear--Your relentless / rhythm--I move to / it still . . . "

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