Summary:

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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Through a compilation of journal entries, prose, and poetry, poet and activist Audre Lorde considers her breast cancer and mastectomy. Lorde emphasizes the importance of having a support network of other women. As a lesbian and feminist, she also offers a different perspective on this surgery. Her concern is not attracting or pleasing men despite the loss of a breast.

In one chapter, "Breast Cancer: Power vs. Prosthesis," Lorde considers the political implications of prosthetic breasts, arguing that hiding women’s pain and suffering disguises the widespread nature of the disease and places too much emphasis on "normal" femininity. She also writes about plastic surgeons who perform dangerous reconstructive surgery in the name of "quality of life."

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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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The author, an internist and medical educator with a long-term interest in literature (she recently was awarded a Ph.D. in English literature), describes the literary exercise she uses to develop empathy in students taking her required course in medical interviewing. Charon has her students choose a difficult medical encounter from their own recent training and then write, using the first person, the story of that patient’s life in the day before the difficulty--including being treated by the medical student who is doing the writing. Because much of the story must be imagined, the writer’s intuition is automatically brought into play.

Because it is told from the patient’s point of view, the medical student is forced to see the patient whole and without reference to medical terms. Charon argues that this exercise of the imagination yields a combination of objectivity and empathy that forms the basis for good medical care. She also finds that the exercise helps medical students see themselves as their patients see them--and thus to understand, for instance, the effect on their patients of their youth and nervousness.

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Crossing Over presents "extended, richly detailed, multiperspectival case narratives" of 20 dying patients served by the Hospice of Lancaster County in Pennsylvania and the Palliative Care Service of Royal Victoria Hospital in Montreal. These complex narratives (each written by a single author) reveal the patient’s story from many points of view, including those of family members and professional caregivers.

The authors explain how this project differs from recent books of clinical narratives by Timothy Quill (A Midwife Through the Dying Process, 1996), Ira Byock (Dying Well: The Prospect of Growth at the End of Life, 1997), and Michael Kearney (Mortally Wounded. Stories of Soul Pain, Death and Healing, 1996 [see entry in this database]). Barnard et al. point out that Quill, Byock, and Kearney are "passionate advocates for their own styles of care . . . Yet these very characteristics--advocacy and close personal involvement--limit their books in important respects." (p. 5) Basically, these authors select cases that illustrate the efficacy of their models and present the patients’ stories from their own point of view.

Crossing Over draws on a standard qualitative methodology that includes tape-recorded interviews of patients, families, and health care professionals; chart reviews; and participant observation. After the introduction, the narratives occupy 374 pages of text (almost 19 pages per patient). Part II of the book, entitled "Working with the Narratives," includes a short chapter on research methods and 29 pages of "Authors’ Comments and Questions for Discussion." The latter is designed to be used as a teaching guide.

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This book is composed of a series of essays written by Dr. Percy over a period of twenty years from 1954 to 1975. All have been published in journals except the last one, "A Theory of Language." The first one was written before his first novel, The Moviegoer, was published. These all reflect his recurring interest in the nature of human communication.

The first essay, "The Delta Factor," is perhaps the easiest to understand. It has a long subtitle: "How I Discovered the Delta Factor Sitting at my Desk One Summer Day in Louisiana in the 1950's Thinking About an Event in the Life of Helen Keller on Another Summer Day in Alabama in 1887." Percy asks why man feels so sad in the twentieth century; he goes on to state that this book is about two things: man's strange behavior, and man's strange gift of language and how understanding the latter might help understanding of the former.

Percy's view is that man's singular asset, which differentiates him from animals, is language. His interest in language and how children acquire language is almost certainly related to the fact that one of his daughters is deaf, hence also his interest in Helen Keller. Subsequent essays are further approaches to these questions, including the importance of symbolization as an essential act of the mind and a basic human need.

The essay, "The Message in the Bottle" is built around the supposition that a man who is a castaway on an island and has no memory of his past life finds on the shore a series of bottles which contain messages. The man, who has become a useful member of the island community, must decide which messages appear to state empirical facts and which seem to refer to the nature of reality. Dr. Percy sees that the messages can be in some ways like the news of the Christian faith. This fits with his own personal way of dealing with a feeling of alienation by turning to religion. He sees belief in one of the theistic historical religions as a way to redeem man from the catastrophe which has overtaken him. He describes not only himself but also man as a castaway who can recognize his need and have hope that some message might relieve his predicament.

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This autobiography by Janet Frame, a preeminent New Zealand writer, was originally published in three volumes in 1982, 1984, and 1985. The first volume is titled To the Is-land. In it the author tells the story of her early life "with its mixture of fact and truths and memories of truths." She describes her mother as a rememberer and a talker, partly exiled from her family through a marriage outside the family's faith and her father as having a strong sense of formal behavior that did not allow him the luxury of reminiscence. Her siblings (4 sisters and 1 brother) are described in equally perceptive language. The brother suffered from epilepsy which was poorly controlled and this had a strong influence on family dynamics.

Frame's writing is so descriptive and personal that it is easy to envision oneself as a family member. She was very early attracted to words and became a voracious reader. The family was poor and moved often but there was a firm family kinship. One older and one younger sister drowned when swimming which had a large impact and drew Janet much closer to the remaining younger sister. Janet was a good student and won many prizes; she writes that she "identified most easily with the stoical, solitary heroine suffering in silence."

The second volume, An Angel at My Table, concerns itself with Janet's experience as a student at Dunedin (Teacher)Training College and her subsequent breakdown and commitment to mental institutions. She was very lonely in college and retreated more and more into her own world of literature. At the end of her year of probationary teaching she walked out of the room during the visit of the school's inspector and disappeared.

After a suicide attempt she was eventually committed to Seacliff, a mental hospital. Her stay there, she writes, and later in another facility which eventually lasted most of seven years, was in a world she'd never known among people whose existences she never thought possible. She describes it as an intensive course in the horrors of insanity. She received multiple electric shock treatments and was scheduled for a lobotomy when it was learned that she had won a prestigious award for a book she had written.

Frame was discharged on probation and lived for a while in a small cottage owned by a well known writer who befriended her. After her book of prose and poems was accepted for publication she was awarded a grant that allowed her to travel abroad.

The third volume, The Envoy from Mirror City, is quite mystical and concerns itself with her life as a writer in England, Spain, and New Zealand after her return. She describes Mirror City as the saving world which sustains writers. She has continued writing and eventually learned that the diagnosis of schizophrenia, with which she had been burdened, was incorrect. With some life experience and wise psychotherapy she was able to write about her life in the mental institutions, among other things.

In all she has published eleven novels, four collections of short stories, a volume of poetry and a children's book.

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In July 1998 the poet Maxine Kumin was thrown from her carriage when her horse bolted during a competition. The type of cervical (C1-C2) fracture that she sustained is fatal before reaching the hospital in 95% of cases, and if survived, usually results in quadriplegia. This book is a memoir written in the form of a journal that begins on the day of the accident. In fact, it was nearly a month after the accident that the poet's daughter brought writing materials to the rehab hospital, and Maxine began to dictate the journal, and the two of them filled in the temporal gaps.

The journal covers her experience in the acute care hospital, the rehab facility, and the following months of convalescence at home. It ends on April 23, 1999, when Maxine climbs a hill (unassisted) near her Vermont home, looks out over the early spring vista, and concludes, "I am letting myself believe I will heal."

The journal describes the poet's physical, emotional, and spiritual experiences as she struggles, first to survive, and then to live with the "halo vest" that for months she had to wear to stabilize her fractured neck bones, and finally to regain her function and equilibrium. Much of the story is about her family--husband, son, and daughters--who mobilize from various points around the world to support her. Comments about her doctors and the medical care she received constitute only a small, at times almost incidental, part of this narrative.

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Referring to Francis Bacon's 17th-century definition of modern science as the conquest of nature "for the relief of man's estate," Kass looks with concern at the ironic possibility that future advances in medical science and technology may lead to the significant diminishing of humankind. Thus he asks, what price will we wind up paying for medical progress? Kass is concerned about the disconnect between modern medicine, with its powers to extend our controls over life and death and over many human potentials, and, on the other hand, traditional social and individual values.

He argues particularly for serious consideration of values in three areas: (1) distributive justice (which for Kass is, finally, the question as to who shall do the distributing), (2) the "use and abuse of power" (in which he focuses on the process by which power over nature becomes turned into power of some humans over others), and (3) "voluntary self-degradation and dehumanization" (two major concerns being the concept of the optimum baby and the development of technologies of pleasure).

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Seeking redemption in the bloody business of surgery, Selzer's narrator tells several medical stories that humbled his surgeon's pride and refers approvingly to an atheist priest in a story by Unamuno who carried on for the sake of his congregation because "their need is greater than his sacrifice." Selzer finally tells us that it is in writing, if anywhere, that the elusive soul can be represented.

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