Summary:

Subtitled, "Essays from a Cancer Limbo Time," this collection of essays constitutes a memoir of living while dying. It was written during the time following the author’s acute treatment for Stage IV lung cancer, when she felt well enough to write--a period of approximately one year during which she was still taking oral anticancer medication. Based on journal entries and memory, Cumming reflects on what it is like to be in a state of "recovery" while at the same time, and variably, anticipating death. "I knew that my kind of cancer was not curable, and yet, for a spell, it seemed to have vanished" (xvi). How does one go about living in the face of "a very good partial response" to treatment?

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The poet C. K. Williams enters the room where his father has just died and exclaims to the corpse, "What a war we had!" (p. 1) Soon thereafter, his mother comes into the room and quietly lies down beside her dead husband, their bodies close but not touching. Thus begins Williams's memoir about his parents' deaths and his grieving. In the process of working through his grief, the poet finally comes to "see" his parents and to understand the nature of his feelings toward them and their feelings toward each other.

"You used to be such a nice man," he remembers his mother once telling his father. Indeed, when Williams was a child (and the family poor), his father was engaged and attentive. But as he evolved into a very successful businessman, he emotionally withdrew from the family. Throughout Williams's adult life, he and his father were alienated, their interactions consisting of verbal warfare, made much worse by the young man's choice of profession (writing poetry). It was only after the father had his first "stroke" (indicating brain metastases) that he was able to declare a truce. At one point he said, bemusedly, to his son, "We were kids together, you and I" (p. 37). However, during this truce, Williams's father, unable to bear his suffering, repeatedly pleaded with his son to help him end his life, an act that Williams was unable to perform.

Williams remembers whispering "I love you," when he first viewed his mother's corpse. Yet during life he saw her as a "completely and unquestioningly self-centered" woman (p. 58) whose life was filled with constant anxiety that she wouldn't get enough out of life, or that she'd lose what she had. She was a careless mother and a fretful and vain person. Yet there was more than that. Williams connects with his mother as a suffering person during her final illness: "Someday I'll thank her for how much of herself she risked to have divided herself when she was so young, so unprepared, so vulnerable, into the double creature she and I were...and the linked beings we always would be." (p. 166)

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Written with controlled elegance, this is an absorbing autobiographical account of psychiatric hospitalization. Twenty-five years after the fact, the author describes the two years during her late adolescence in which she "slip[ped] into a parallel universe." The surreal nature of the experience is reflected in darkly comedic recollections of her inner life, the other patients, their families, the staff, and of forays into the outside world.

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The author came to Houston in 1962 as a visiting professor. While there, he and his wife decided to become volunteers at "J.D." (Jefferson Davis), the county hospital. They found that the hospital was overcrowded, understaffed, over-bureaucratized, and very poorly supported by the county. In particular, they found that the volunteer corps (Women-in-Yellow) was primarily involved in clerical work, rather than providing service to patients.

Marjorie de Hartog wished to form a group that would feed and nurture infants in the nursery, but the hospital authorities thought that was out of the question. This book is an account of how the de Hartogs, their Quaker community, and other Houston citizens developed a significant volunteer presence at "J.D." and, in the process, became aware of the frightful state of patient care. They became activists supporting the opening (and better funding) of a new public hospital.

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A holocaust memoir, this is the painfully honest and unsentimental account of one physician's experience in the Warsaw Ghetto. The author, who was a Jewish medical student of 22 when Germany invaded Poland, remained from 1940 through most of 1943, serving as caretaker of sick or orphaned children in a ghetto hospital. During this time, she tells the reader, she made some decisions she has never been able to fully reconcile-- such as to perform multiple acts of euthanasia involving adults as well as children when the waves of slaughter and deportation increased in brutality and frequency.

Eventually, the writer joined the active resistance and was a part of the movement which ended with the complete razing of the Warsaw Ghetto in 1944. After the liberation of Poland, Blady Szwajger resumed her interrupted career in pediatric chest diseases. Only after 45 years did she choose to write of her experiences and, in her introduction, she articulates her reasons for remaining silent and for her ultimate decision to speak out.

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Williams's autobiography recounts his life from his first memory ("being put outdoors after the blizzard of '88") to the composition of "Patterson" and a trip to the American West in 1950. The book's 58 short chapters epitomize the writer's episodic and impressionistic style, presenting a series of scenes and meditations, rather than a narrative life story.

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Nathaniel Lachenmeyer’s memoir is a reconstructed account of his father Charles’s battle with paranoid schizophrenia and Nathaniel’s inability or unwillingness to recognize his father’s need for help. After his father’s death, Nathaniel contacted many of the people who had known his father, both when he was a student and college professor and later when his illness forced him into mental hospitals, squalid apartments, and homeless living on the streets. Nathaniel’s search to understand his father after his death led him to interview the many health care workers, police, street people, restaurant staff, and others who knew Charles when he was very ill.

Charles was delusional, often hearing voices and talking to his mother, who had been dead for years. Typical of people suffering from paranoid schizophrenia, Charles did not see himself as mentally ill. Therefore he did not like to take medications and would refuse treatments when he could, although his health care workers could see substantial changes for the better when he was on medication. He believed he was the victim of a mind control experiment, forced on him by his persecutors. He died out of touch with his family, having suffered almost twenty years on his own with his illness.

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This is an ambitious and far-ranging book, the result of years of thinking, teaching, and working with patients. An internist at the College of Physicians and Surgeons at Columbia University, Charon sees a wide range of patients in an urban setting. Also a Ph.D. in English literature, Charon has devised a "Parallel Chart" and other means for caregivers to write personally about the dynamics between healer and patient, to read texts--narratives in particular--and, as a result, to listen better to patients, thus improving the delivery of medical care.

Charon defines narrative medicine as "medicine practiced with these skills of recognizing, absorbing, interpreting, and being moved by the stories of illness" (4). She calls this a "new frame" for medicine, believing that it can improve many of the defects of our current means of providing (or not) medical care. Caregivers who possess "narrative competence" are able to bridge the "divides" of their relation to mortality, the contexts of illness, beliefs about disease causality, and emotions of shame, blame, and fear.

Charon finds that medical care and literature share five narrative features; she argues that careful reading of narratives builds skills that improve medical care, including intersubjectivity between caregiver and patient, and ethicality. Beyond the theory, there are powerful and persuasive examples of interactions between caregiver and patient, many from Charon's own practice. A mother of a sick daughter experiences stress that makes her ill; when she sees a narrative connection, she begins to heal.

Charon sees wider applications. As caregivers understand better concepts of attention, representation, and affiliation, they become more ethical, more community minded, and better healers to their patients. Patient interviews will be different: instead of following a grid of questions, physicians will converse with patients in an open-ended way. What is most important will emerge and emerge in ways that are most beneficial to the patient. Yes, this method will take more time but it will be more efficient in the long run. Bioethics, Charon argues, has been limited by legal approaches and philosophical principles. For her, narrative bioethics offers more human values in how people feel, experience reality, and relate to each other. Finally, there are implications for social justice: why are the poor underserved in this country and in many others?

One of the most exciting and radical formulations comes late in the book: ". . . practitioners, be they health care professionals to begin with or not, must be prepared to offer the self as a therapeutic instrument" (p. 215). This notion links up fruitfully with concepts of energy medicine (v1377v), therapeutic touch (Tiffany Field), and intentionality (Wayne W. Dyer).

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Born in 1728 the tenth child in a struggling Scottish farm family, John Hunter was a wayward and unteachable child who spent most of his time outdoors. At the age of 20, with no prospects and having lost his father and 6 siblings, he wrote for help to his older brother William, who was practicing midwifery in London and had just opened England's first anatomy school, one featuring the revolutionary opportunity for students to dissect their own cadavers.

John rode the 400 miles to London on horseback, apprenticed with great success under William, learned dissection, then surgery, and went on to become a supremely gifted anatomist and surgeon, one whose brilliant and tireless experimentation broke with ancient and outmoded medical traditions and established the foundation for modern science-based surgery. (When John arrived in London, the city's Company of Barber-Surgeons had only just dissolved to allow surgeons to organize themselves independently of barbers.)

One of his most important activities in working for his brother--and which continued when he made his own way--was the procuring of cadavers, which because of the customs of the time involved him intimately in the grisly business of grave-robbing.

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Shannon Moffett, a medical student at Stanford University School of Medicine, became fascinated with the brain during her anatomy and neurobiology courses. She set off across the country to interview people--scientists, doctors, patients, ethicists, and religious leaders--who devote their careers trying to understand the brain and cognition. With infectious enthusiasm and energy, Moffett brings the reader to meet these dedicated people, their work, their theories and their lives.

The book contains eight chapters and hence eight mini-biographies: 1) neurosurgeon Roberta Glick, 2) cognitive neuroscientist and brain imagist John Gabrieli, 3) Francis Crick (of DNA double helix fame) and Christof Koch--scientists studying consciousness, 4) sleep researcher Robert Stickgold, 5) Judy Castelli who has dissociative identity disorder (multiple personality disorder), 6) philosopher Daniel Dennett, 7) neuroethicist Judy Illes, and 8) Zen monk Norman Fischer.

Separating the chapters are "interludes" that map neural and brain development from conception to death. The book has a reference list for each chapter and a complete index, as well as a web resource (www.shannonmoffett.com) to which the reader is directed for graphics.

The writing is compelling, direct, fresh and insightful. For example, in "Touching the Brain," we follow the exhausting lifestyle of an academic neurosurgeon who works at Cook County Hospital in Chicago as she performs surgery, teaches, attends services at a temple, drives her car, takes care of her family including two young children, rounds on patients, hosts a potluck dinner, and simultaneously discusses her reading, travel and spirituality.

Moffett aptly describes Glick with her "waist-length red hair, ... beaten-metal earrings dangling almost to her shoulders and a saffron batik dress" as someone you'd "expect to find reading storybooks to kindergartners in a public library" (8). In fact, it is Moffett's eye for accessible detail that makes not only the people, but also neuroscience come alive. Artfully woven into the text are lessons on the history of brain research and current understanding (and questions) about the brain, its meaning and function.

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