Summary:

Gabriel Noone, a late-night radio personality ("Noone at Night" on PBS) who reads his semi-autobiographical stories to millions of Americans, has just separated from his lover Jess when a publisher sends him the proofs of a memoir written by a 13-year-old boy with AIDS. Peter, the young author, has suffered heinous sexual abuse from his parents and hoards of strangers; he lives with his adoptive mother Donna, who was his therapist. Gabriel, shaken by the memoir, calls Peter, a conversation (all via phone, almost all at night) that begins a relationship that quickly becomes an intense, father-son-like relationship that grows deeper as it grows more unsettling as Jess and others begin to cast suspicion on the actual existence of Peter.

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Second Opinions, Jerome Groopman's second collection of clinical stories, illuminates the mysteries, fears, and uncertainties that serious illness evokes in both patients and doctors. The book is divided into 8 chapters, each a clinical story involving a patient with a life-threatening illness, plus a prologue and epilogue written by Groopman. The stories focus on people who face myelofibrosis, acute leukemia, hairy cell leukemia, breast cancer, and marrow failure of unknown cause. Two chapters are Groopman's personal accounts of his firstborn son's near fatal misdiagnosis, and of his grandfather's Alzheimer's dementia.

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Sister John of the Cross is a Carmelite nun who has lived in a California monastery for 28 years. She writes poetry and essays. In some ways, writing is nearly equivalent to prayer for her. Sister John is revered for her spirituality and visions. What she has long assumed to be special blessings from God turn out to be manifestations of temporal lobe epilepsy due to a small meningioma.

The nun is forced to confront the scientific explanation that her headaches, altered perception, and hypergraphia are secondary to a seizure disorder and not a gift of divine favor and spiritual ecstasy. Sister John agrees to undergo surgery to remove the tumor aware of the likelihood that a surgical cure will also eliminate her unique visions and insight. Postoperatively, she admits that life without epilepsy seems dull but realizes that "only in complete darkness do we learn that faith gives off light." [p. 178]

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In this journal, Murray traces a month-long rotation he spends as attending physician in the ICU (Intensive Care Unit) of San Francisco General Hospital. For each of the 28 days, Murray presents the patients he sees, both new and ongoing, along with commentary on the care of each patient and on broader issues raised by their cases.

In the course of the month, we encounter sixty patients, fifteen of whom die in the ICU. The patients are apparently quite typical for the hospital: cases are dominated by HIV, pneumonia, tuberculosis, and drug abuse, or all four. The ICU is not a very safe place: there are twelve cases of iatrogenic pulmonary edema, and several of hospital-acquired infections.

Murray candidly presents both the triumphs and the limitations of contemporary intensive care while giving us vivid glimpses into the lives of both patients and staff. In his epilogue, Murray asks some tough questions about the value of intensive care units, and discusses palliative care, patients' rights to the withholding and withdrawing of life-sustaining therapy, and even physician-assisted suicide, as "more humane"--and economically responsible--alternatives to intensive care in cases of advanced terminal illness (270).

He describes the ICU as a "battleground" where people who are "clinging to life" can "fight for it" (275). This is its value. But the battles need to be better understood and winning must be carefully evaluated. Murray concludes that the last few decades' medical and technical advances in critical care now need to be matched by ethical ones.

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Mr. Lucas, an Englishman, is growing old. He has always wanted to visit Greece and has finally achieved this, accompanied by his unmarried daughter, Ethel, who will, it has been assumed, dedicate her life to taking care of him in his old age. In Greece, Mr. Lucas becomes restless and resistant to the idea of an expected passive, peaceful death from old age. He wants to "die fighting." Something mysterious happens: he finds a great old hollow tree from which a spring of water flows. He climbs into the tree and experiences an epiphany: he suddenly sees all things as "intelligible and good."

But when the rest of his party find him, he is oddly repelled by them. He does not feel that anyone can share the revelation he has experienced, and he becomes afraid that if he leaves the place he will lose the feeling himself. He decides not to leave, and says he plans to stay at an inn near the old tree, but the others are horrified, and force him to leave with them.

Back in England, some time later, Ethel is now about to be married. Mr. Lucas has become a perpetually disgruntled old man, complaining about everything (especially the sound of water in the plumbing--the mystical Greek spring has been reduced to this annoyance--he says, "there’s nothing I dislike more than running water"). His sister, Julia, whom he hates, is going to take care of him once Ethel is married.

Then a gift arrives from a friend in Greece, wrapped in a Greek newspaper. In it Ethel reads the news that on the night they left, the old tree was blown down, and fell on the family who kept the inn nearby, killing them all. Ethel is upset, and says how lucky it was that they hadn’t stayed there that night, calling it a "marvellous deliverance," but Mr. Lucas dismisses the story without interest. He no longer cares.

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England in the 18th century. The wealthy Lady Neville finds that she has become sad and bored with life. So she arranges an elaborate ball and decides to invite Death as the guest of honor. To be invited, Death must first be found. After discussion about whether Death lives among the rich or the poor, Lady Neville remembers that her hairdresser’s child is dying, so she gives him the invitation to pass on when death arrives.

Two days later the heartbroken hairdresser arrives with a note of acceptance. All agree that Death’s handwriting looks feminine, but when the hairdresser will not describe the source of the note, Lady Neville has him whipped and thrown out.

At the ball, the guests become increasingly fearful until Death arrives, late, in the form of a beautiful young woman. Everyone falls in love with her. When she says she has to leave, they beg her to stay, and she says she will, if they’re sure. They are, so she says that she must now choose someone to take her place as immortal Death.

After a careful (and revealing) process of selection, Death chooses Lady Neville herself, concluding that one who could treat her hairdresser so heartlessly would take on the role well, since it is clear that only she knows "how meaningless it is to be alive." The story ends as Death kisses Lady Neville--and they, presumably, change roles.

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Much to the disapproval of her children, a newly-widowed seventy-two year old woman decides to continue living independently and spends her time in disreputable behavior like going to the cinema alone, visiting insalubrious parts of town, eating at inns, and going to the races. She befriends a middle-aged cobbler (who is also, scandalously, a Social Democrat) and a young "feeble-minded" kitchen maid, and she stops visiting her husband's grave. One of her sons assumes she must be sick and wants to call the doctor. Without consulting her children, she mortgages her large house and apparently gives the money to her cobbler.

The narrator (her grandchild) observes that she has lived two lives: the first as dutiful daughter, wife, and mother, and the second "as Mrs. B, an unattached person without responsibilities." She dies suddenly, without illness, and the grandchild describes a photograph taken of her corpse after death: she has the face of one who "had savoured to the full the long years of servitude and the short years of freedom and consumed the bread of life to the last crumb."

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Summary:

This collection of 20 essays continues and expands upon the theme--how we living care for our dead and incorporate them into memory--that Thomas Lynch, a poet and undertaker, introduced in his first book, The Undertaking: Life Studies from the Dismal Trade (see this database).

In this new book, Lynch writes rambling pieces that begin with some observation about his funereal trade then blaze off into musings about religion ("The Dead Priest"), love and divorce ("The Blindness of Love," "Y2Cat"), poetry ("Reno," "Notes on 'A Note on the Rapture to His True Love'"), and the interplay of mortality and morality ("Wombs," "The Bang & Whimper and the Boom"). In his first book, Lynch wrote scathingly of abortion and mercy killing, and here he continues his thought provoking considerations of both.

In what might be the most interesting and radical essay in this collection, "Wombs," Lynch walks a precarious line between pro-life and pro-choice rhetoric; ultimately, he asserts a woman's right to abhor decisions about her body that "leave her out." At the same time, he asks if the reproductive choices available to women, "when considered for men," might not seem "irresponsible, overly indulgent, and selfish." What if, he writes, men could declare (without stating their reasons) their interest in their unborn children "null and void, ceased and aborted?" Lynch, who spends most of his time in the contemplation of the deceased, seems to find in death a spark of life; then he fans it into flame with language.

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This memoir of a clinical psychologist (also a professor of psychology) chronicles her own depression over a period of a year and a half, from early symptoms, through near despair, electroconvulsive therapy, and hospitalization to recovery. The journey is detailed, not only in its treatment of her emotional states, but of her struggle to maintain family and professional life, keep her house and office organized, and attend to a dying friend.

As her bouts of panic and disorientation grow more apparent, first to herself and finally to others, she seeks refuge in spiritual retreats and in conversation with colleagues, ultimately submitting to treatment. She names the emotional "undercurrents" suggested in the book's title with moving precision: panic over sudden disorientation, anxiety about what to keep secret, frustration with her own unreliability, dread of small duties and ordinary appointments, heartache over her faltering efforts to be a good and present mother.

The consent to hospitalization costs a great deal in humility, in risking a controversial treatment, and in letting go of a professional persona she doesn't know whether she'll be able to retrieve. But clearly the book is written by a woman whose clarity is a testimony to regained mental health and exceptional intellectual clarity. It is not a professional record, but an intensely personal memoir of what was both an encounter with serious mental illness and a spiritual journey.

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Marina, a fourteen-year-old recently transferred from a mental hospital to a boarding school, can't speak. Her muteness is a reaction to trauma; in a moment of fury at her mother, her father threw photographic acid in the car window and, instead of hitting his wife, hit his daughter's face. Severely scarred, both inside and outside, resentful of her mother and bewildered by her father's pain, anger, and now imprisonment for assault, she records her daily life tentatively in a journal assigned, but not read by, a favorite English teacher at her new school.

The girls in her dorm have been apprised of her problem and treat her mostly with respect, but only one of them is fully able to keep making the moves that open a door to friendship. Despite Marina's silence, even in sessions with the school counselor, she begins to heal as she makes her journal (the text of the story) a safe place, allows herself to be included in the family lives of her teacher and friend, and finally summons the courage to visit her father, with whom she retrieves the language she needs, finding, as the title suggests, she has "so much to tell him."

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