Summary:

As Audrey Young describes her process of becoming a compassionate internist in a besieged public hospital, she simultaneously argues for turning the hospital's patient care and financial practices into a model for improving health care in America.  Young, a compelling storyteller, first entered Seattle's Harborview Medical Center in 1996 as a third-year medical student on trauma surgery service.  She completed a residency there in general internal medicine and stayed on as an attending for six more years.  She stayed, she tells us, because she met physicians "committed to a vision of equality" who were "the sort of people I hoped to become" (xiii).   She also "fell in love" with "the story of a unique place" (xiii).  Young's stories of that often chaotic place, where ambulances regularly transport homeless, indigent, addicted, and mentally ill refugees from neighboring private hospitals, emphasizes the ways the Harborview staff manages to treat patients with dignity and to choose an ethic of hope in the face of dire circumstances.           

We quickly learn that at Harborview compassion is expressed concretely as actions toward patients.  Michael Copass, known as "the mostly benign dictator of emergency operations," pronounced the core of these actions in what came to be known as his commandments:  "1. Work hard.  2. Be polite.  3. Treat the patient graciously, even if he is not the president of the United States" (9).  Politeness always meant asking "'How may I help you, sir?'" regardless of the patient's social status or addiction history.  Politeness sometimes meant finding a way to reach the patient who regularly threatened the staff.  Young finds ways and creates a therapeutic bond.  But working hard and treating patients considerately also took measurable forms, such as not allowing emergency patients to wait.  Facing a flurry of admissions, the Emergency Department (ED) staff interpreted a young Ethiopian's complaints about pain as a drug addict's ploy.  Because Young glanced at the admissions board and noticed that he remained unattended for three hours--far longer than Copass could tolerate--she jumped into action.  He suffered, she discovered, from a collapsed lung. 

However, Young moves her narrative beyond individual doctor and patient encounters and into the larger, interrelated social and financial structures in which medicine is practiced.  For instance, she links meager funding for drug and alcohol rehabilitation programs with expensive ED admissions and rising healthcare costs.  In the chapter "Bunks for Drunks," Young visits an experimental residence that houses homeless addicts in furnished studios with private baths and cooking appliances.  Although residents can keep alcohol in their rooms and elect not to participate in the home's social services, including counseling, alcohol consumption and ED admissions decrease.  While the chapter points out the cost savings of such arrangements, Young further urges readers to value the dignity residents experience there.

In "Black Friday," Young details the hospital's tense, but ingenious responses to a Mass Casualty Incident, the result of carbon monoxide poisoning, which almost depleted the resources of all of Seattle's medical centers.  The final chapter, "A Vision," outlines how Harborview has tried to succeed as both a charitable institution and a business, as a provider of both indigent and luxury care, with the hope that others will follow the medical center's example.  However, in presenting her recommendations for "health justice," Audrey Young also makes the case that "seemingly ordinary citizens" are implicated in healthcare reform (231).  To enable their informed participation in making changes, Young includes an appendix with further readings and another that lists strategies for effecting reform.  

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Edited by psychiatrist and poet Mark Bauer, this anthology collects poems about mental illness, broadly defined to include such topics as alcoholism and drug abuse, depression and melancholia, and post-traumatic experiences (with World War I's shell-shock and the Vietnam war's PTSD represented by Siegfried Sassoon, Ivor Gurney, and Wilfred Owen, and Yusuf Komunyakaa, respectively).  Bauer provides an introductory essay, arranges the selections chronologically rather than thematically, and, in a welcome touch at the end, offers brief biographical sketches of the authors.  A Mind Apart would form a nice companion piece to Poets on Prozac, edited by Richard Berlin

The represented poets are: Thomas Hoccleve, Charles d'Orleans, William Dunbar, Alexander Barclay, Fulke Greville, Thomas Lodge, William Shakespeare, Sir Henry Wotton, Sir John Davies, Robert Burton, John Fletcher and/or Thomas Middleton, Lady Mary Wroth, Robert Herrick, George Herbert, John Milton, Anne Bradstreet, Margaret Cavendish, Thomas Traherne, James Carkesse, Anne Finch, Edward Ward, Isaac Watts, Edward Young, William Harrison, Mary Barber, Matthew Green, William Collins, Thomas Mozeen, Christopher Smart, Thomas Warton, William Cowper, Robert Fergusson, Thomas Chatterton, John Codrington Bampfylde, William Blake, Robert Bloomfield, Samuel Taylor Coleridge, George Gordon (Lord Byron), Percy Bysshe Shelley, John Clare, John Keats, Thomas Haynes Bayly, Elizabeth Barrett Browning, Alfred Tennyson, Matthew Arnold, Sydney Dobell, Emily Dickinson, Henry Kendall, Thomas Hardy, Robert Bridges, Gerard Manley Hopkins, A. Mary F. Robinson, Ernest Dowson, Edward Thomas, Siegfried Sassoon, Ivor Gurney, Wilfred Owen, Edna St. Vincent Millay, Dorothy Parker, Louise Bogan, Hart Crane, (John Orley) Allen Tate, Richard David Comstock, Stanley Kunitz, Theodore Roethke, Elizabeth Bishop, J. V. Cunningham, Delmore Schwartz, John Berryman, Randall Jarrell, Weldon Kees, Dylan Thomas, Robert Lowell, Robert Edward Duncan, Howard Nemerov, Hayden Carruth, Philip Larkin, Anthony Hecht, Richard Hugo, James Schuyler, Donald Justice, Allen Ginsberg, Robert Bly, Wiley Clemens, Anne Sexton, Carl Wolfe Solomon, Ned O'Gorman, Stuart Z. Perkoff, Sylvia Plath, Lucille Clifton, Jim Harrison, Les Murray, Sharon Olds, Timothy Dekin, Quincy Troupe, Thomas P. Beresford, R. L. Barth, Jane Kenyon, Yusef Komunyakaa, Joseph Salemi, Aimee Grunberger, Jimmy Santiago Baca, Mark Jarman, Franz Wright, David Baker, Michael Lauchlan, Joe Bolton, Kelly Ann Malone, Brian Turner, Kevin Young, Jeff Holt, Ricky Cantor, Anne Stevenson, and several contributions that are anonymous, including some from nineteenth century popular songs and selections from two collections of poetry by people with mental illness.

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Prozac Nation is Wurtzel's memoir of her depression, which she traces from the age of 11 to her senior year in college in chapters marking different phases or manifestations of her illness. The book situates her illness squarely within her family dynamics where she found herself the "battlefield on which [her] parents' differences were fought," and describes in excruciating detail her inner life that at any given time was marked with a "free-flowing messy id" to nihilism, numbness, rage, and fear, ultimately leading to a suicide attempt. The last few chapters chronicle her slow "recovery," due to her conflicted relationship with psychopharmacology and an extraordinary psychiatrist.

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Four doomed characters illustrate the downward course of drug initiation and addiction. Aronofsky's innovative portrayal is arrestingly brutal and compelling; many viewers will be disturbed by penetrating and darkly lucid visual effects guiding the descending spiral--from spring to winter, from life and hope to destruction and death.

One character, Sara Goldfarb, played courageously and brilliantly by Ellen Burstyn, becomes addicted to diet pills prescribed by a despicably careless physician. The other characters--her son, Harry (Jared Leto) and his two friends (played by Marlon Wayon and Jennifer Connelly)--are heroin addicts and dealers. In separate ways all move toward the same abyss.

Although graphic and, at times, extremely difficult to watch, the frightening nightmare of addiction should be required viewing for those who might yet succumb and those who think that just saying "no" works. The grisly and unbearably sad storyline and its explicit horror recalls the 1989 film and novel on which it was based, Last Exit to Brooklyn, also written by Hubert Selby, Jr.

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Cortney Davis follows her 30 year career in nursing, from her experience as a student nurse washing a patient's feet, to dealing as a nurse practitioner with life and death issues in an inner city OB/GYN clinic. Her essays present epiphanies where she realizes what is important in a confusing and ambiguous situation, why she writes poetry even though she is exhausted from her daily work in the clinic, why she is a nurse when the job  sometimes seems overpowering and depressing.  The positive connections with patients--through kindness, caring, truth-telling, touch-outweigh the difficulties.  Tedious routines are often transformed by spiritual insights and empathy. And sometimes what seems like a miracle inserts itself in a time of grief. Whether she is talking to a man in a coma or treating a sexually-abused teenager, her focus is on the care of the patient.

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A Doctor's Story of Friendship and Loss, this book is, in a sense, a sequel to Verghese's earlier memoir, My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS (see this database). The Tennis Partner tells the parallel stories of Verghese's disintegrating marriage as he establishes new roots in El Paso, Texas and of his new deep friendship with a (male) medical student who shares his passion for tennis. Both men are struggling to re-establish order in their personal lives: Verghese, in easing himself out of a dying marriage while trying to maintain a close relationship with his two sons; David (the tennis partner), in remaining drug-free and successfully completing medical training, which had been interrupted by his addiction.

Verghese, an experienced physician trained in infectious disease and an expert on AIDS treatment, relishes his role as David's mentor; David, a former tennis "pro," enjoys teaching Verghese how to play better. Playing tennis together for the sheer joy of it, each finds release. Tennis becomes the route through which each can unburden himself to the other, seeking solace in a difficult time. Through it "we found a third arena outside of the defined boundaries of hospital and tennis court . . . at a time in both our lives when friendship was an important way to reclaim that which had been lost." (339)

While the reader suspects that David must have a drug problem because the Prologue to the book, narrated in the third person, describes a "young doctor from El Paso" in drug treatment, Verghese the biographer has no inkling of the problem until one-third into his first person narrative. He is shocked, but in some ways the bonds of their friendship are strengthened. Each has only the other as a confidant.

David, however, has another addiction: women. The friendship becomes increasingly complicated as Verghese tries to remain both supportive and objective. Eventually David resumes "using" and Verghese must decide how to respond, both professionally and on a personal level. The turmoil in both lives ends tragically for David and causes profound grief in Verghese.

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In short, episodic chapters that move unpredictably and unchronologically through the years between 1956 and 2003, Nick Flynn tells us about his father, Jonathan Flynn--a man of many trades, a writer, an alcoholic with a prison record, a homeless person--and of his own life, which sporadically interweaves with Jonathan's. When Nick was six months old, his 20-year-old mother left Nick's father and made a meager life for herself and her two young sons. A string of her live-in boyfriends and one more failed marriage wound their way through Nick's young life, which was in the seaside town of Scituate, Massachusetts, "the second most alcohol-consuming town . . . in the United States" (77).

At 12, Nick is drinking beer; at 17 he is drinking to get drunk, sometimes with his mother, and smoking marijuana (and later doing other drugs). For years Nick's father "had been manifest as an absence, a nonpresence, a name without a body" yet, "some part of me knew he would show up, that if I stood in one place long enough he would find me, like you're taught to do when you're lost. But they never taught us what to do if both of you are lost, and you both end up in the same place, waiting" (24).

The place where Nick and his father "end up" is the Pine Street homeless shelter in Boston where 27-year-old Nick is a caseworker and Jonathan Flynn appears, a few months after being evicted from his rooming house. Reluctantly, Nick gradually acknowledges his father's presence in the shelter, and gradually, during the next 15 years, reconstructs the lost years through conversations with his father and his father's acquaintances, letters, and manuscript excerpts. The title of the memoir is what Jonathan Flynn mutters at night, when he is looking for a place to sleep (205).

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Knapp describes how she gradually became an alcoholic, drinking more and more, until she couldn't live without alcohol. She found drinking to be the most important relationship in her life; she loved how it made her feel, how it coped with her fears and worries. When family and friends spoke to her about her drinking, she made promises to them she couldn't keep. Finally one time while drunk she was carrying two children accross the street when she fell. She could have killed them. Three months later she checked into rehab and gave up drinking. She used the support of Alcoholics Anonymous to help her stay sober and to gradually learn how to love people, instead of alcohol. Her need for protection and for escape, which alcohol gave her, had to be replaced with an honest facing of problems and with social skills. This memoir also describes her struggling with anorexia.

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Summary:

This anthology culls 1,500 excerpts from approximately 600 works of literature primarily written in the past two centuries and representing all major genres--the novel, drama, poetry, and essay. These brief selections highlight how literature portrays the medical profession and also provide ample evidence of many recurrent themes about the doctor-patient relationship and the personal lives of physicians present in the pages of fiction.

The book is organized into eleven chapters devoted to the following subjects: the doctor's fee, time, bedside manner, the medical history and physical examination, communication and truth, treatment, detachment, resentment of the medical profession, hospital rounds, social status, and the doctor in court. Many well-known authors including Anton P. Chekhov, Sir Arthur Conan Doyle, Ernest Hemingway, Thomas Mann, W. (William) Somerset Maugham, Leo Tolstoy, Tennessee Williams, and William Carlos Williams are featured in this anthology but less notable writers are also introduced. A twenty-three-page bibliography of primary and secondary sources is a useful element of the book.

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Bomgard, a young doctor recently transferred from a rural area to a small town hospital, receives an urgent message from Polyakov, the doctor who replaced him. Polyakov has become ill; he needs medical help. Before Bomgard can respond, however, Polyakov arrives at the hospital, dying of a self-inflicted wound. In his last moments, he gives Bomgard a notebook, on which is recorded the story of Polyakov's addiction to morphine.

Polyakov first took morphine to relieve an abdominal pain. He found that it also relieved his despair over the loss of his lover, an opera singer in Moscow. Morphine relieved his loneliness and improved his work. He gradually increased the dose until he became hopelessly dependent on the substance. He failed in his attempts to break the habit at a clinic in Moscow. Eventually there is nothing in life but the drug and Polyakov suicides.

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