Summary:

On July 5, 1998, physics Professor Alan Cromer suffered a heart attack on a plane, and survived after almost an hour of resuscitation efforts, but sustained brain injury from lack of oxygen.  In this chronicle of caregiving, his wife, a psychiatric nurse by training, gives a very personal, detailed account of the radical adaptations his disability required of both of them.  Her story includes reflection on his and her own emotional adjustments to loss of parity in communication and awareness, practical adjustments to physical limitations, and social adjustments to family, friends and professional colleagues.

Arduously, over time, Alan regained some ability to read and speak--indeed, he spoke to groups with Janet about their life together during the peak of his rehabilitation.  But the road to even partial recovery was bumpy, and the writer fully acknowledges the pain, grief, irritation, and deep frustrations that intersected moments of authentic pleasure, discovery, and mutual kindness.  Professor Cromer died September 3, 2005.

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Wit takes place in a University Hospital Comprehensive Cancer Center. The main character, Vivian Bearing, Ph.D., is a John Donne scholar who has stage IV ovarian cancer. Much of the action takes place in the last few days/hours of her life, although flashback scenes to weeks, months, even years before are interspersed effectively throughout the performance.

Bearing has lived an isolated life. Her love is her teaching and research. She is a stern taskmaster, perhaps "non-humanistic" in her approach. Similarly, she faces doctors and a medical system that emphasize technique over caring. She does find, in the end, compassion from a nurse who prevents the medical team from carrying out a CPR (cardiopulmonary resuscitation) attempt that she did not want.

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The story follows the final twelve or so hours in the life of a 62 year old widow, emblematically named Dante Remus Lazarescu, (Ioan Fiscuteanu). Suffering with stomach distress and a terrible headache (eventually diagnosed as a subdural hematoma and late stage liver cancer), he spends his last night being shuttled by ambulance, or rather by an ill-equipped van serving as ambulance, from hospital to hospital, unable to secure the emergency surgery that would save him. The hand-held camera and long uncut takes -some are six or more minutes- give the movie the feel of unfolding in real time. In places, it has the look of a documentary, and it has been compared to Frederick Wiseman's Hospital (1970).

Before the odyssey begins, we meet Mr. Lazarescu in the cramped, unkempt Bucharest apartment he shares with his three cats. Of his circumstances we learn that he is a retired engineer whose only daughter has emigrated to Toronto, and that despite having had ulcer surgery years earlier, Mr. Lazarescu drinks heavily. In his every encounter -with neighbors and with a string of doctors- he is reprimanded for his drinking, implicitly or explicitly blamed for his ill-health. From the television blaring in his apartment we hear news of a truck gone out of control that has rammed a tourist bus. Casualties from the accident are taxing hospital resources, which accounts in part for why this ill-smelling elderly man who appears to be drunk (but turns out to be having a cerebral bleed) is a low priority, although this doesn't account for the callousness with which he is treated by much of the medical staff.

The most significant relationship in the film is between Mr. Lazarescu and the ambulance nurse, Mioara (Luminita Gheorghiu) who shepherds him throughout the night. Almost everything we know about her is what one knows from watching someone at her job; in Puiu's hands, this vantage turns out to be richly informative. (Ms. Gheorghiu's body language speaks volumes.) Mioara and Mr. Lazarescu hardly speak to one another; they don't "open up" to one another or have a "meaningful moment," nothing to compare, for example, to the Popsicle scene between the nurse, Susie, and patient, Vivian Bearing, in Wit (see annotation). The power of the relationship in this film is in what is not overt, but what is palpable nonetheless -that Mioara's presence means very much to Mr. Lazarescu, and that doing her job includes letting him know that she is standing by him, that he is the priority, the only priority. Mioara staunchly meets the irascibility and chastisement of various physicians in her efforts to advocate for her patient as he is passed off from one hospital to the next.

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McMurphy (Jack Nicholson) escapes work on a prison farm by feigning mental illness, but he finds himself in a far more coercive institution than the one he left behind. The other men, both sane and insane, are just like him: they hide in the locked ward from the law, their families, or the despair of their own lives.

McMurphy animates the dull monotony with fractious games, pranks, and excursions, but he encounters stiff opposition from the head nurse, Mildred Ratched (Louise Fletcher), whose system provides her with pills and electroshock to maintain control. When the nurse discovers that McMurphy has smuggled two women into the ward, she threatens to tell the mother of young Billy (Brad Dourif). Billy commits suicide and an enraged McMurphy tries to strangle Ratched. McMurphy is lobotomized and returned to the ward only to be smothered by his friend Bromden, who then escapes.

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In 2008, editor and physician Paul Gross launched a new online publication, "Pulse--voices from the heart of medicine" (published by the Department of Family and Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center). This anthology contains every poem and first-person narrative published during Pulse's first year, arranged in five sections corresponding to publication date and not to theme: Spring, Summer, Autumn, Winter, and Spring.  Paul Gross, in his introduction, states "After more than a decade of practice as a family doctor, I came to appreciate that the science I'd learned in medical school, though powerful and useful, was also incomplete . . . . it contained much truth about illness and healing, but not the whole truth" (xvii).  Like many other caregivers, Gross discovered "that writing and sharing my healthcare stories with others was therapeutic" (xviii).  He looked to "Sun Magazine" as an example of how first person narratives, both prose and poems, could turn "hurts and triumphs into something potentially beautiful, funny or moving" (xviii). 

The poems and prose that arrive every Friday online to Pulse's thousands of subscribers (and the selections in this anthology) are carefully screened by the editors according to these guidelines: the stories have to be first-person, and they have to be true, recounting the writer's own experience.  Submissions are accepted from any person involved in healthcare.  The language used must be "clear, simple language.  No medical jargon. No arcane literary devices" (xx).  Gross and his editors decided that Pulse would not be a medical journal nor a literary magazine--its purpose fell outside the perimeters of both genres--and so Pulse, and this anthology, offers work that is, in a refreshing and honest way, different from the slick or more polished poetry and prose that might be found elsewhere.

In reading this anthology from cover to cover, and so from season to season, I found that the poems and prose seemed to fall into several categories: Personal musings, in which authors relate healthcare experiences that engender intimate and revealing narratives about their own lives--among the best of these are "Well Baby Check," p.3; "Finding Innisfree," p. 31; "First Patient," p. 39; "Losing Tyrek," p. 45; "Carmen's Story," p. 62; and "Chemo? No Thanks," p. 106.  Other pieces are commentaries on the other side of healthcare, the one that cries out for reform and affects both patients and caregivers.  Among the best of these are "Redesigning the Practice of Medicine," p. 9; "A Brush with the Beast," p. 22; "Rx," p. 60; "Halloween Horrors," p. 69; and "Brain Cutting," p. 136.

Other pieces are humorous ("Aunt Helen Sees a Ghost," p. 6) or political ("My War Story," p. 11), and many poems and prose pieces speak of patient encounters or about being a patient, some more anecdotal, relating a specific incident that affected the author ("Once," p. 41) and others multi-layered, some relating medical student or intern experiences ("Jeannie," p. 48; "A View from Nepal," p. 87; "Ripped from the Headlights," p. 90; "Snowscape," p. 97; "First Night Call," p. 100; and "Wounded Messenger," p. 114.)  The "category" I found most interesting and most unique are the selections I will call "confessions."  These writings--demonstrating openess and bravery on the part of the authors--tell of regrets, mistakes, sorrows, wrong calls and other mishaps that occur, daily, in the practice of healthcare.  In these, the most human face of caregiving is revealed.  Although most of the pieces in this anthology contain elements of "confession," the most specifically revealing include "Mothers and Meaning," p. 14; "Physician's Exasperation," p. 44; "Confidential," p. 53; "My Patient, My Friend," p. 73; and "Apologies," p. 104.

Editor's note: Coincidentally, a recent relevant paper on confessional writing by physicians expounds further on this topic:"Bless Me Reader for I Have Sinned: physicians and confessional writing" by Delese Wear and Therese Jones (Perspectives in Biology and Medicine, Vo. 53, No.2, Spring 2010, pp. 215-30).

 

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The Crimean War (1853-1856) holds a place in the history of medicine, specifically, the history of nursing. For as the British public read the 1850s Times reports about the total lack of care suffered by their wounded in this conflict, a British nurse, Florence Nightingale, volunteered to recruit a team of nurses to aid the suffering men. The Times created a relief fund for the sick and wounded, and Queen Victoria, an enthusiastic supporter of this war against Russia, sponsored an even larger fund. Female nurses had a reputation for drunkenness and promiscuity. Nightingale made it a point to recruit nuns and women from the lower classes who would be more manageable than educated, upper class women. Three black nurses applied, including Mary Seacole, but they were rejected.

The Turks, British allies, allowed Florence Nightingale the use of their army barracks at Scutari, across from Constantinople: "'I have been well acquainted with the dwellings of the worst parts of most of the great cities of Europe,' Nightingale wrote,' but have never been in any atmosphere which I could compare with that of the Barrack Hospital at night'" (111). Open sewers ran beneath these vermin-infested structures  which were crammed with sick soldiers lying on the filthy floor. There were no supplies and few doctors. Typhus, typhoid, cholera or dysentery killed many patients. Nightingale's meticulous statistics showed alarming escalation of mortality rates; she believed in cleanliness and fresh air but not in the germ theory of disease. When comparing her numbers with those of other military hospitals, Nightingale understood that soap alone would not save the men.

Rappaport describes the nursing offered by army wives, widows and other volunteers, including French nuns. The women's living conditions, especially during pregnancy and childbirth, often resulted in sickness and death. Others volunteered as cooks, including Elizabeth Davis who alleged that while "...she and the other nurses dined on the stewed-up, tough old meat used to make soup for the patients, Nightingale ‘had a French cook, and three courses of the best of every kind of food ... served up everyday at her table'" (168-169).

Nightingale became famous as the heroine of the Crimean War. She is known now as the founder of professional nursing. Recent research has questioned whether Nightingale was the real angel of the Crimea. Rappaport investigates the work of the Jamaican nurse, healer, and entrepreneur Mary Seacole, one of the 3 black nurses rejected for service in the Crimean War. She financed her journey to and stay in the Crimea herself. She built a British Hospital in the Crimea, and treated the wounded at Balaklava there and in the field. The soldiers called her Mother Seacole because she cared for their material and spiritual needs. She sold gin and raki and home-cooked meals, and went bankrupt because too generous with credit. Seacole recouped her losses and achieved bestseller status with her memoir, Mrs. Seacole's Wonderful Adventures in Many Lands (1857), the first memoir by a black woman from Britain.

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The title refers to a Veteran’s Administration hospital regulation concerning the withholding of full medical benefits if an ailment is not specifically related to military service. In an oftentimes comic battle between the forces of good--physicians and vulnerable patients--and those of evil--the administrators and their minions--the story has currency and direct appeal to viewers.

The Darth-Vader-like administrators are self-serving, inhumane bureaucrats with emotions that run the gamut "from A to B" (Dorothy Parker). Physicians, especially the character played by Ray Liotta, but also his dedicated colleagues, are imaginative and non-rule abiding in their central concerns: the patients. They listen to stories and sympathize; in addition, they turf, lie, steal, and do whatever is necessary to protect, serve, and treat their patients. When the government denies a heart bypass, for example, the docs schedule prostate surgery for the official record and do, instead, the needed heart surgery.

At times, it’s as if the Marx Brothers or the Keystone Cops have donned white coats to sneak around the hospital with patient-centered antics. In the absurd bureaucracy, viewers, perforce, must cheer enthusiastically for the merry band of renegade docs.

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Eleven-year-old Amy has been hiding cookies beneath her bed, drinking gallons of liquid to slake her thirst, getting headaches, feeling irritable, and failing to grow though she's been eating huge meals for months by the time she faints and is taken to the hospital. There she is diagnosed with Type 1 diabetes. Though she feels disoriented and angry, she is immediately put into a training group with other kids around her age who have been recently diagnosed.

She has to learn how to maintain a carefully balanced diet and how to give herself insulin injections. The male nurse who teaches them is himself a diabetic as well as a competent, cheerful young man who takes the edge off the experience. He makes it clear to Amy and the others that the primary responsibility for their health maintenance routines lies with them personally.

After release from the hospital, Amy begins to deal with the social adjustments her disease demands. Her brother and parents are helpful, but uncertain about how much to change their own eating habits to accommodate her. Her younger sister finds the accommodations trying and unfair. Amy's friends also have learning to do.

It helps her that she knows a few other diabetic kids, including Coby, a boy who has struggled with his own resentment and the consequences of sloppy monitoring of his condition, but has learned how to control his diet for the sake of staying on the baseball team where he's a star player. Their friendship helps Amy transition into "normal" life hopefully.

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The meeting of John and Florence Dowell and Edward and Leonora Ashburnham in a German health spa is the center of a train of lies, deceptions, adulterous love triangles, and deaths. John Dowell, a memorably "unreliable" narrator, calls it "the saddest story I have ever heard" (7). His narrative distance stems partly from the pastness of the events, partly from his absence for some of them, but mostly from his ignorance or denial of realities as intimate as his wife's serial deceptions of him.

Heart disease is the central narrative trope, a literary device easily unpacked as a site of irony: Each of the two major characters who have a "heart" (i.e. heart condition) is faking it, in service of his/her serial "affairs du coeur." Florence fabricates her heart trouble before her marriage is ever consummated, using it to turn Dowell into a cardiac nurse and keep him out of her bedroom. Edward Ashburnham fakes his illness to escape his military post and take his latest love object (and his stoically Catholic wife) to Germany.

The extramarital romps occasioned by Dowell's solicitude for Florence's "heart" comprise the main gag of this novel's comic beginning. When the focus shifts to Edward, Leonora, and their ward Nancy Rufford, The Good Soldier becomes a tragedy of emotional sadism, sentimental martyrdom, madness, and moral exhaustion that leaves us unsure about who in this novel has a literal or figurative heart.

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Robert and Jinnie Salesby are an English couple staying at a French resort to restore Jinnie’s health. Rather than a dramatically delineated plot, the story is comprised of a series of moments in daily life, drawn with psychological precision and depth. Robert, whose point of view the narrator explores most of the time, is characterized through his frequent shifts in perspective--from the present, shaped by his wife’s illness, to their past experiences of health and joy. As the story traces the Salesbys’ daily regimen of meals, walks, and rest, Robert’s grief and hostility regarding his wife’s illness becomes ever clearer.

The hotel’s other inhabitants, who are mostly drawn as caricatures--the American woman who talks to her dog, for example, and the Honeymoon Couple, whose vigor and sexuality provide a foil to the Salesbys’ subdued relationship--call Robert an "ox" and observe his solitariness and lack of apparent emotion. The local children react to him as if he is a figure of sexualized threat. Jinnie’s perspective is revealed only through her self-effacing cheerfulness, her appreciation of her husband, and her plenitude of that "temperament" her husband seems without.

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