Summary:

Nan Shin was an American woman living as a Zen Buddhist nun in France. She is diagnosed with advanced uterine cancer, undergoes surgery and chemotherapy and, by the end of the book, it appears, is dying. Her account does not, however, take the conventional form of the illness narrative; in fact its form might be called anti-narrative, for its focus is not on the story of Shin's illness and dying, but rather on the "every day living" that is at the center of her Zen beliefs.

The book consists of several strands that recur in alternating sections. One strand describes, in minute detail, the course of a single day's devotions and activities in the life of a Zen nun. Another traces the author's travels in the United States with her sensei, an astonishing man whose perspective on American culture is both detached and hilariously insightful.

A third tells of the author's frequent horseback rides through the French countryside, with beautifully focused and precise descriptions of the natural surroundings. Finally, there is the illness, presented matter-of-factly but conveying powerfully the author's (not always wholly successful) efforts to put into practice, in such trying circumstances, all she has learnt as a practitioner of Zen.

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As the narrator, an "outcast among outcasts," begins to recount his story, he cautions the reader that "William Wilson" is not his real name; he doesn't want the page to "be sullied with my real appellation." The miserable man tells of his childhood and his life at school, where he encountered another boy who looked exactly like himself and had the same name and birthday.

All the children at school recognized the narrator's preeminence among them, except for this strange double. While the first William Wilson was aggressive, witty, and imperious, the double presented himself as quiet, gentle and wise--but unthreatened. In the end their feelings towards each other "partook very much of positive hatred."

Many years later, as the narrator was busily engaged in cheating at a game of cards, the second William Wilson suddenly appeared out of nowhere and revealed Wilson's scam to everyone present. Subsequently, time after time, just as Wilson was about to achieve some nefarious end, this anti-Wilson unerringly stepped in and destroyed Wilson's chances.

The last straw occurred in Rome during Carnival; just as Wilson was about to seduce a married woman, his double arrived to squelch the affair. Wilson flew into a rage and killed his nemesis, only to discover he had stabbed a mirror--but the dying image in the mirror whispered, " . . . How utterly thou hast murdered thyself."

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The editor, herself a writer and one who has suffered depressive episodes, collects a series of personal essays or illness narratives about experiences with depression. Her contributors are all artists, primarily writers, who generally but not exclusively speak to the relationship between their art and their mood disorders. Some of the essays included have been previously published, but most are original contributions to this collection. The collection is introduced by Kay Redfield Jamison whose academic work has examined the relationship between creativity and depression, including manic-depressive disease.

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The first poem in this chapbook ("Sonogram") contains two images of a small, mysterious life (the fetus imagined as a "white boat on whiter water" and as a "tiny orca") in the midst of the coldly technical medical world. This juxtaposition is characteristic of B. A. St. Andrews's poems in this small collection. In most of them, she uses disciplined and sparkling language to explore the interface between modern medicine with its impersonal machinery and the irreducible mystery of life.

Some of the images are simply breathtaking. For example, in "A Dying Art: Room 309," a terminally ill artist lies in bed, surrounded by "plastic bags that hang / like udders dripping pigment / into her." In a love poem called "The Body of Science," the poet confesses, "Each time your voluntary / muscles make contact / my involuntary ones / contract." And at the end of "Alzheimer's," she observes, "She stood at the big bay / window screaming but he never / heard what it was she never said."

The four poems entitled "Your Breast a Unicorn" consider the fate of breasts attacked "at consolation's center" by "one aberrant cell metastasized." These learned, wise, and witty poems are, in my opinion, among the very best of the breast cancer genre.

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Malcolm Vaughan, an architect, his wife, Sarah, a biochemist, and their five-year-old son, Harry, are driving home one evening. The driver of the car in front of them is acting strangely. Malcolm goes to investigate and the driver shoots him dead. The novel traces the effects of Malcolm's death from the alternating points of view of his wife and his best friend, Deckard Jones, a black Vietnam vet. Following different and often conflicting trajectories but linked by their love for Harry, both Sarah and Deck begin to move from traumatized shock to the beginnings of recovery.

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Charlie Babbitt (Tom Cruise), a young businessman aggressively pursuing his fortune in collector automobiles, hears that the wealthy father from whom he has been estranged for years, has died. He attends the funeral planning to remain only long enough to hear the will and receive the fortune he believes is coming to him. He is shocked to learn that most of the fortune has been left in trust to someone whose name is not disclosed. Investigations lead him to a home for the mentally handicapped where he discovers he has a brother, Raymond (Dustin Hoffman), an autistic savant, who has been housed there since Charlie's early childhood.

Charlie kidnaps him, planning to keep him "hostage" until the institution delivers the half of Raymond's inheritance he believes rightly to be his. On the road, two things happen: 1) he is baffled, angered, and confused by the paradoxical behavior of this genius with no emotional vocabulary and no social skills and 2) he uncovers early memories of Raymond as the "Rain man" who comforted him when he was very small. He takes Raymond to Las Vegas to exploit his card-counting skills, wins enough at blackjack to get kicked out of the casino, and ends up calling Raymond's guardian out to California, hoping to be entrusted with his guardianship.

He is finally convinced, however, that Raymond is indeed incapable of progressing in relationship much beyond where he is, and that he, Charlie, is not sufficiently equipped to care for him. He sends him back to the institution, committed to maintaining relationship not for the money, but for its own sake. Mystified as he is by the brother whose humanity he can't quite fathom, something like love has been awakened in him in the course of his painful journey in caregiving.

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Mrs. Wilson is a woman diagnosed with an advanced malignancy of the genital tract. Her husband had died from cancer ten years earlier. She is treated with a hysterectomy and oophorectomy along with aggressive chemotherapy by a good doctor who has no bedside manner.

Throughout the story her best friends are always medications to relieve pain: Dilaudid, morphine, Tylenol #3, and methadone. Only her son-in-law really understands her needs and comprehends how to care for her. He is genuine and vital and appears to know as much or more than the doctors in the story.

Mrs. Wilson acknowledges that "to maybe get well you first had to poison yourself within a whisker of death" but discovers that "if you had something to live for, if you loved life, you lived." She dies in a hospital room receiving an IV morphine drip. Before fading into oblivion, she recalls her youth and makes one last attempt at fathoming the meaning of life.

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Kirklin, a physician and Lecturer in Medical Humanities at the Royal Free and University College Medical School, and Richardson, a historian and associate at the Wellcome Trust Centre for the History of Medicine, are both educators in medical humanities in London. This well-written and concise volume focuses on "the role of the humanities in medical education" and is aimed at "those wishing to integrate medical humanities into their own teaching, and learning." (p. xv) The chapters are written by a variety of educators with a wide range of backgrounds, including artist, medical student, writer, nurse, surgeon and philosopher.

At least two stimuli are cited as reasons for the development of this book: (1) the 1993 publication by the General Medical Council of Tomorrow's Doctors which recommends the inclusion of medical humanities in the required curriculum for undergraduate medical education in the UK and (2) a national conference, "The healing arts: The role of the humanities in medical education" in London, March, 2000. The rationale for such a book is delineated in several prefatory statements including remarks by Professors Sir David Weatherall and Sir K. George M. M. Alberti (Alberti is the president of the Royal College of Physicians). The book concludes with recommendations for further reading, schemata for undergraduate and graduate degrees in medical humanities at University of Wales, Swansea, and an index.

The nine chapters in this volume combine pedagogic philosophy, citations for literature and art and how to encourage reflection about these selections, tools for encouraging student creativity, reproductions of art and literature generated by students or patients or used by teachers for discussion, and some practical advice about teaching medical humanities and its, at times, uneasy connection to the rest of the curriculum. Each chapter reflects the individual contributor's area of expertise and experience. For example, in "Fostering the creativity of medical students", the authors Heather Allan, Michele Petrone (who painted the striking cover art), and Deborah Kirklin provide useful guides for teaching creative writing and art production by students studying cancer and genetic disease.

In a particularly insightful chapter, "Medical humanities for postgraduates: an integrated approach and its implications for teaching," Martyn Evans describes the challenges of developing a full-fledged interdisciplinary program for graduate as well as undergraduate studies in Wales. He addresses concerns about "bolt-on" versus integration of medical humanities in the curriculum, risks of superficiality, and how such studies may transform the culture of modern medicine. Several chapters address a theme (such as "clinical detachment" or understanding the patient's perspective) and include topic-specific sources and guidelines.

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Art Myers is not only an art photographer but also a physician who specializes in preventive medicine and public health. Having experienced breast cancer in members of his own family, including his wife, he began to see the disease in a new light and undertook this photographic project to show that for a woman, the loss of part or all of her breast need not be a threat to her being.

In addition to the artistic nude photographs of thirteen different women from a variety of backgrounds there are meaningful personal vignettes and beautiful poetry by Maria Marrocchino. Some of the photographs show women with significant others. The women present their bodies and themselves with humor, sadness, vulnerability and honesty.

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At the age of 37, artist/photographer (and former model), Matuschka, was diagnosed with breast cancer. While her most famous response to the disease was her startling photograph on the cover of The New York Times Magazine revealing the results of mastectomy, her political activism surrounding breast cancer took many forms. (The photograph can be viewed at a Web site, Matuschka Archives )

Not only did she have a disease to confront, she felt she had the responsibility to "take on the establishment." She wrote, "My extensive research and understanding of how cancer works and how breast cancer therapies don’t--in addition to my medical nightmare with my doctor (I was first underdiagnosed, then overtreated)--I felt I had other messages to convey."

Thus, her essay describes her ongoing project: not hiding or concealing the condition, but becoming sexy and strong as a result; and reaching middle America with her images to promote breast cancer awareness, education, treatment, and prevention. Artistically and politically, she was determined to project images of women after surgery as whole people with a scar, not the decapitated torsos of medical illustration and other media that give "too much weight to the ’deformity’ that accompanies breast cancer surgery."

The essay chronicles the difficulties she had in finding sites for publication of her work, including her photo/biography, Beauty Out of Damage, and the continuing harsh criticism that she receives, much of it from "mastectomy women." In turn, she continues her harsh criticism against what she calls "backlash in the breast cancer movement," such as mixing political action with consumerism (e.g. Ralph Lauren’s "Target Breast Cancer" t-shirts that put targets on women), or mixing modeling with breast cancer activism (Cindy Crawford modeling the t-shirt rather than women who have had breast cancer modeling the shirt), among many other examples.

Her closing lines summarize the intent of her activism: "to inspire others to become involved in revolutionizing the medical profession, particularly in regard to women’s cancers. After seeing the film of my mastectomy operation, my only reply was, ’No one should ever have to go through this.’"

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