Summary:

The play has two characters: Ruth and Friend (who is a male doctor).Ruth is an engaging, straight-talking quadriplegic who can zip and dance with her chin-operated wheelchair and takes delight in terrorizing medical staff both physically and verbally. She wants to write poetry and is waiting for a device to make it possible for her to use a computer. She keeps developing bedsores that threaten her life and require long admissions to the hospital before they will heal. She desperately wants to live no matter what happens, as she feels that having no mind would be worse than having no body.Friend is a male doctor with children who is ashamed of having examined her while she was unaware. Burdened with his guilt, he asks to be her “friend.” Ruth is skeptical and runs circles around him, but eventually comes to trust him and believe in his sincerity.She makes him a witness to her advance directive to instigate all heroic measures, as she is afraid of the kindly "ethical" and cost-effective arguments not to treat the disabled. But Ruth dies horribly from sepsis, and Friend is helpless to prevent it. She never obtains the device that would have allowed her to put her poems into printed words.

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An artist, Ruth, lives with quadriplegia and manages to drive (and dance) with a special wheelchair that she controls with her chin. She also enjoys terrorizing doctors in the hospital corridors, where she is seen on a regular basis because of frequent bouts of infected bedsores. She has a new computer and is “patiently waiting for” a biomedical engineer to set it up to manage, like her chair, with her chin. She wants to write, to draw, to create. But the wait list is long, technicians scarce, and every candidate deserving.

On one of her admissions, Ruth meets the physician-narrator who is appalled by a medical resident’s lack of empathy in relating her case as if she were not present. Distressed by the encounter, the doctor is all the more disturbed when he notices that Ruth’s birth date is the same as his own.

He tries to make it up to her by withdrawing from her care in order to be her “friend,” one who tries to understand and will defend her strong desire to live despite her disability. Driven by curiosity about her past, her sharp wit, and how she faces each day, the doctor never quite achieves his goal and constantly feels guilty for letting her down as an advocate and a friend, and possibly also for being able-bodied himself.  He never visited her in her group home, and when she comes to hospital in florid sepsis, he is unable to prevent his colleagues from letting nature take its course. His own bout with severe illness, possibly MS—more likely a stroke--resonates with Ruth’s plight. Long after her death, he can imagine the acid remarks that she would make about his foibles.

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Hillel D. Braude, a physician and a philosopher, has written an important, albeit dense and narrowly circumscribed, study. While “Intuition in Medicine” is the main title, the subtitle, “A Philosophical Defense of Clinical Reasoning” is a more accurate description of the book, which originated as a doctoral dissertation.  While some of the prose will appeal only to specialists, there are important and thoughtful analyses of such topics as Evidence-Based Medicine, modern dehumanized medicine, the relation of beneficence and automony, and principalist ethics in general. Throughout, intuition is narrowly conceived and in the service of clinical reasoning, as it applies to standard, Western physicians and not to other healers (or nurses), and the emphasis is on interventive medicine to cure illness and relieve suffering more than on health promotion.
 
Braude writes in the introduction that intuition has long been understood to be “a direct perception of things,” but he resists a more precise definition: “Rather than defining and using a single concept of intuition—philosophical, practical, or neuroscientific—this study examines intuition as it occurs at different levels and in different contexts of clinical reasoning” (xviii).  Eight chapters explore these different levels in such topics as moral intuitionism, Aristotle’s phronesis (or practical reason), the rise of statistics (a basis for Evidence-Based Medicine), and C. S. Peirce’s notion of abduction. Braude’s careful analysis traces historical and theoretical developments in analytic philosophy and how these may be applied to clinical reasoning.  He uses an impressive range of thinkers: Achenwall, Albert, Allan, Andre, Ashcroft, Aristotle, Bacon, Barrow, Barton, Beauchamp, Bergson, Bernard, Bichat, Black, Bottero, Bourdieu, Brody, Browne—just to take names headed by A or B.  Throughout, Braude puts in dialectic two poles of a spectrum arguing that they both have contributions to make. He believes that between them is an “ethical space,” where discoveries and applications can be made.  One pole, which he clearly favors, includes the following qualities:  Aristotelian practical reasoning, naturalist approaches, primacy of beneficence, fact and value joined, case-based, individual patients, narrative experience, anthropocentric focus, and tacit/organic knowledge (Polanyi). The other pole, less desirable, includes Kantian abstraction, nonnaturalist approaches, primacy of autonomy, fact and value separated, Evidence-Based Medicine, large groups of patients, statistical correlations, mechanist/positivist foci, and Dualism (Descartes).

Braude believes intuition is a cognitive process but has other dimension, the corporeal and the social. While these provide a grounding, intuition for him is generally rational. He also argues for medical care at the personal, face-to-face level, not through applications of algorithms.   A brief conclusion, “Medical Ethics beyond Ontology” clarifies some of the arguments and sketches some valuable notions from Husserl and Levinas. He writes “intuition . . . does appear to be fundamental for human judgment” because “an intuition faculty” can “extract universals from the particular” (p. 170).  Drawing on Husserl, he defines phenomenological intuition as “the primary means through which objects are presented to consciousness.” This affirmation includes the basic human, which is also the focus for medicine. For Levinas (and my summary is much too brief), “interhuman solidarity” is a source for medical care, a form of responsibility that is different from Foucaultian power relationships, ethical rules and priniciples, or “an uncritical acceptance of medical authority” (p. 177).

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Leonardo da Vinci – the name alone evokes images of an artistic virtuoso, the Renaissance man, the mind behind the Mona Lisa. Though known best as an artist, his work extended beyond paintings into a myriad of disciplines, with notebook entries documenting his studies of optics, bird flight, comparative anatomy, hydraulics, and countless others. And yet what has been obscured by the shadow cast by his prolific career are the details of how a young man from a town called Vinci became Leonardo da Vinci. What did he do every day? What did he eat? Who were his friends? Did he even have any? We tend to immortalize Leonardo as a god, and yet he was human after all, not unlike the rest of us. This realization should encourage us to study one of history’s most celebrated humans, and see if we ourselves might be able unlock our own inner genius.

Walter Isaacson aids us in this study with his thoroughly researched biography of Leonardo da Vinci. He adds this to his growing portfolio of biographies of history’s great minds, including Benjamin Franklin, Albert Einstein, and Steve Jobs. In this most recent biography, Isaacson takes us through the life and times of Leonardo, highlighting milestones of his career, while also underscoring some of the seemingly trivial habits that were signatures of Leonardo’s personality and worldview.

Born of illegitimacy and openly gay, Leonardo was no stranger to defying convention. In fact, many of his grandest discoveries were a result of his willingness to challenge commonly accepted wisdom. Yet his greatest asset was his relentless curiosity and unquenchable thirst for knowledge, a recurring theme of Isaacson’s biography and of Leonardo’s life. Intertwined with this curiosity was his tendency to draw connections across disciplines, blurring the lines between art and science. Everything that Leonardo produced – whether his sketches of war machines, his treatises on anatomy, or his timeless portraits – was a manifestation of his desire for unifying knowledge.

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A civil war rages inexorably in J. M. Coetzee’s novel, Life & Times of Michael K. Details of the war are vague, but the fighting will determine whether “minorities will have a say in their destinies” (Coetzee 157). Riots splinter communities, peoples are displaced, the military patrols and slaughters, and prison camps are erected. The novel’s first half introduces an unlikely protagonist at the center of the bloody tumult: Michael K, a municipal gardener—a gentle “simpleton” with a harelip “curled like a snail’s foot”—who cares for his ailing mother in Cape Town (3). Sick and unable to work, K’s mother resolves to return to her birthplace and girlhood home, Prince Albert, a far-flung cluster of homesteads in the Karoo, where she hopes to convalesce peacefully. Their migration permits, however, never arrive, likely lost in the abyss of State bureaucracy. Gathering his mother and their few possessions in a makeshift wheelbarrow, K attempts the arduous journey anyway but the passage is thwarted by a government checkpoint. As his mother’s condition deteriorates, she is hospitalized and dies, her body cremated before K gives hospital officials consent.  

The novel’s lulling elliptical cycle pushes K along the currents of departure and circumvention, to capture and escape. Pressing on to Prince Albert where he will deliver his mother’s remains, K is arrested and incarcerated in a railcar where he and other prisoners remove landslide rubble from a remote part of the rail line. Released after finishing the labor, K arrives to Prince Albert where he settles on the property of the ramshackle homestead and begins contentedly scavenging. Far from the tremors of war, he hunts birds, nibbles roots and bulbs, turns over rocks for grubs, drinks from streams, and, in a fit of wild hunger, drowns and slaughters a wild goat. All the while he finds a package of pumpkin and melon seeds that for the rest of his time on the property he will sedulously plant and water— “[t]his was the beginning of his life as a cultivator” (59). Immersed in this blanched world, at the center of its arid winds and mineral expanses, K devotedly coaxes his mean crop to life. But the war encroaches on K’s hiding place and he absconds to a mountain cave where he hides, and nearly starves.  

The stillness, silence, and sunlight of the Karoo seep into K’s bones: “If I were cut, he thought, holding his wrists out, looking at his wrists, the blood would no longer gush from me but seep, and after a little seeping dry and heal. I am becoming smaller and harder and drier every day” (67). Imperceptibly, K becomes the ephemeral ‘stuff’ of this harsh land: “He thought of himself not as something heavy that left tracks behind it, but if anything as a speck upon the surface on an earth too deeply asleep to notice the scratch of ant-feet, the rasp of butterfly teeth, the tumbling of dust” (97). K is shortly captured by the military and forced into a resettlement camp. Through the elliptical current of the novel, he escapes and returns to the Prince Albert homestead, where he finds his crop trampled. He nourishes the vines back to life and, in a moment of lonely exaltation, grills pumpkin flesh: “All that remains is to be a tender of the soil. […] He chewed with tears of joy in his eyes” (113). What K seeks, or what is seeking him, is a life of solitude, remote from peril and unrest, living in quiet reciprocity with the earth, exercising simple cultivation—a skill conspicuously anachronistic (but universally essential) in an age marked by the depravities of war.  

Wringing nourishment from veld-grown pumpkins, however, leaves K famished, and winds and squalls gut his makeshift shanty. Soon K is picked up, again, by a military patrol (he is suspected of abetting rebels camping in the mountains) that consigns him to a government hospital. The novel’s latter half is narrated by the hospital’s medical officer, a caring man who, doubtful of the war’s objectives, takes special interest in K’s recovery. By now, severely malnourished, K resembles “someone out of Dachau” (146). The medical officer is baffled by K, not for his uncooperative responses nor refusal to eat hospital food, but because of his status as a kind of ahistorical oddity in a time of modern warfare: “a human soul above and beneath classification, a soul blessedly untouched by doctrine, untouched by history, a soul stirring its wings within that stiff sarcophagus […] a creature left over from an earlier age, like a coelacanth or the last man to speak Yaqui” (151). The medical officer realizes K’s condition lies beyond simple diagnosis; rather, K’s body craves “a different kind of food, food that no camp could supply” (163). Sometime in the night, K vanishes from the hospital with his packet of pumpkin seeds, moving toward another remote patch of earth to cultivate.

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Intern, Maggie Altman, begins her postgraduate training in a large Texas hospital where a new computerized system has been implemented to improve service. She pours heart and soul into her work, but her admissions always seem to be the sickest patients who keep dying, sometimes inexplicably. Maggie becomes suspicious of her colleagues and of Dr. Milton Silber, an irrascible, retired clinician with no fondness for the new technology. Silber also happens to be a financial genius. Overhearing conversations and finding puzzling papers, Maggie imagines a scam, in which her supervisors may be eliminating dying patients to reduce costs, improve statistics, and siphon funds to their own pockets.

The bad outcomes for Maggie's patients are noticed and criticized, and she is pressured to drop out, switch hospitals, or go back into research. She senses that the perpetrators are aware of her suspicions and send her the worst patients in an effort to eliminate her. She trusts no one. These worries are compounded by her own illness and her accidental discovery in the morgue of a traffic in unclaimed bodies. With the help of excellent clinical skills, true friends, Dr. Silber, and a new love interest who is a budding financial genius, she survives physical and emotional violence and solves the mystery of patient homicides, poisonings, and fraud.

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Approaching age 60 and childless, Fiona Maye is a family court judge who must decide if 17 year-old Adam has the right to refuse blood transfusions for his leukemia. He and his parents are Jehovah’s Witnesses.  The Children Act does not allow a child to make this decision until age 18. Fiona is an atheist and her 35-year marriage to an academic is falling apart.  She takes the extraordinary step of visiting Adam to know him and understand his conviction. He is beautiful and gifted, he writes poetry and plays violin. Why would he not want to try to live? She makes her decision having no idea if it will be morally, legally or medically right. To say more would spoil it.

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In 1780, Thomas Silkstone, a young American surgeon and anatomist, is invited by Lydia to establish the cause of death of her brother, Lord Crick, a dissolute who held the Oxfordshire estate that she will inherit. Her goal is to absolve her husband of the suspicion of murder; however, as the investigation proceeds, it increasingly seems that her husband is guilty after all.

 The earnest young doctor methodically examines each new lead—performing experiments on tissues and with various poisons in his effort to determine the cause of death – and in so doing solve a murder. Before long, another person is dead and Thomas is in love with Lydia, a scarcely concealed complication that calls his testimony into question.

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This collection of poems is a memoir in verse: it is a lyric and epistolary exploration of what it is to live in the limbo of an emotional and psychological ambiguity whose genesis lies in maternal loss, mourning, depression, and despair.  The poems are arranged in three sections:  “Crossing,” “Asylum Song,” and “Holding.” 

The “Crossing section generally conveys to readers the nature of life in this limbo, even as it discloses some of the familial anguish that has brought about a repressive silence in the poet’s mother, as well as a depression that wreaked its havoc on the poet’s growing up.  The family mysteries and the suffering of the poet prompt her to research the death of her maternal grandmother, and we learn many details of that loss in the poems of the “Asylum Song” section. 

A Czech immigrant, the woman had, in the old country, lost her parents and sister, and she’d apparently abandoned—for reasons unknown—her illegitimate child.  She’d married an older man and moved to the States.  After giving birth to another child, she suffered a postpartum depression, for which she was placed in an asylum, and was heavily and inappropriately medicated.  She died within three weeks, at age 34.  Her daughter, the poet’s mother, grew up in her absence and, in turn, lost her own child—the poet’s sister—in infancy, prior to Baptism. 

According to widely held beliefs of Catholics at the time, the infant would thus be relegated to Limbo for eternity: she would be barred from union with God, this is to say, though kept free from any punishment or any suffering, other than the longing for a bliss she could never attain.  Such a belief would clearly exacerbate the feelings of failure and guilt that a mother might feel in losing her infant.  The poet’s mother’s depression resulted, unsurprisingly, in a bewildering absence of maternal care in the poet’s life: she is stuck in her own “asylum” or Limbo—a state of emotional confinement where she maintains some vision of “beatific” maternal love, but feels it forever beyond her reach to experience.  The poems of the final section, “Holding,” convey the struggle and surprising joy of inhabiting this Limbo.

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In "Mandatory Evacuation Zone," Felice Aull has gathered 63 beautifully crafted poems in which she examines the intricacies of language and loss, of grief and healing.  Each of the book's five sections considers these themes in slightly different ways, always in language that is understated, vivid, and exact.  In Section I, we read poems that focus on the author's complicated family history and her early loss of homeland.  In "Tracings" (page 15), an unknown relative (thanks to online genealogy searches) reaches the narrator and wants to meet her.  She, however, only wishes to learn ". . . how my parents / and my infant self / made our tortuous way out . . . . " Brought in infancy from Germany to America, the author suffers the loss of both native homeland and native language ("Notes from an Alpine Vacation" page 16).  She searches photos of her mother and ponders museum note cards illustrated by Holocaust survivors ("Museum Notecards" page 18), imagining what she can't quite know and yet can't quite forget.  

Section II finds the narrator as a young woman in American, awakening to sexuality ("Gay Blades," "Camp Counselors Make Out,"  "On the Staircase" pages 29-31), becoming a wife and mother, and then a grandmother.  A grandchild's birth is both joyful and yet another "slipping toward / the edge of separation" ("Daughter in her Eighth Month" page 37). 

In Section III, the author turns her gaze to observations of the world around her, around us, aware of how many come to loss and death.  "Be prepare to mourn," she tells us in "Disaster in October" (page 49), and in the moving poem, "I Saw the Smoke," re-visions September 11th in words stripped of sentimentality and therefore made more powerful. 

Sections IV and V confront bodily loss through aging and illness, noting how, in so many ways, we try both to capture and to let go: "You snap photo upon photo / hoping to grasp and preserve / what cannot be grasped" (Capturing Alaska" page 66).  We learn of the most personal losses in poems of biopsies, surgeries, and chemotherapy.  When facing the unknown, every event might seem to hold a prediction.  In "Stunning Blows," a doorman stuns a mouse, claims that it's dead.  But the narrator, aware of the wages of time, writes, "But I still see it, like death, / moving toward me" (page 81).  At the book's end, we return to language, how it too can leave us ("Forget That" page 90).  Yet in the collection's final, gentle poems, the poet is "able, finally / to walk past the park's redbud tree / without weeping" ("Immunity" page 96).

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