Summary:

Leap into the world imagined by Kurt Vonnegut, WNYC's reporter on the afterlife, and land with him at the Pearly Gates, or more precisely, "the hundred yards or so of vacant lot between the far end of the blue tunnel and the Pearly Gates" (8). There, Vonnegut, forever the humanist, has his interviewees talk about that which is of ultimate importance--how they lived (or should have lived) their lives.

Vonnegut begins his journeys from the state-of-the-art lethal injection facility in Huntsville, Texas, and reaches his destination though the able assistance of Jack Kevorkian. Who does he meet at the mid-point of his round trip journeys? Dead folks--many famous ones, some not so famous--21 in all (including his fictional creation, Kilgore Trout). Also on the list of interviewees are John Brown, Clarence Darrow, William Shakespeare, Mary Wallstonecraft Shelley, Karla Faye Tucker (actually put to death in the Huntsville facility), and Isaac Asimov.

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In this book Robert Coles elucidates the nature of moral leadership by presenting a series of narratives about moral leaders. These are individuals who have made significant contributions to the author's moral development, mostly through personal interaction, but in some cases through their writings or their influence on other people.

The subjects include public personages like Robert Kennedy, Dorothy Day (of the Catholic Worker), Danilo Dolci (a Sicilian community organizer), Dietrich Bonhoeffer, and Erik Erikson; writers who have influenced Coles, such as Joseph Conrad and Ralph Waldo Emerson; and "ordinary" persons whom he encountered over the years in his studies of the moral lives of children.

The "ordinary" person category is most extraordinary. Coles draws heavily on personal interviews that reconstruct the courageous narratives of people like Andrew Thomas, a young Mississippian who worked on the voter registration project during the summer of 1964; Donita Gaines, one of the first black teenagers to "integrate" an all-white high school in Atlanta in 1961; and Albert Jones, a parent who volunteered to drive the school bus that carried black children in 1967 from Roxbury to a previously all-white school in South Boston.

However, the clearest and most powerful narrative that emerges from this book is that of the author himself, as he develops from young, socially conscious child psychiatrist to a middle-aged man seeking to understand what it means to be a moral leader in today's world.

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The author first presents an introduction and rationale for the concept of using creative writing as therapy, either self-prescribed or as part of professional treatment. She then provides practical guidelines for starting a journal (Chapter 3), and for beginning to write poetry, fiction, and autobiography (Chapter 7).

The text includes an accessible introduction to images and metaphors--aspects of the craft--as well as to methods of capturing dream material (Chapter 6) for use in one's creative writing. The later chapters present therapeutic writing in various contexts--as group work (Chapter 9), or in various institutional settings (hospital, nursing home, hospice, and prison). There are examples of therapeutic writing, especially poetry, throughout the book.

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Anna, the "I" of this journal, suffered the pain of emotional abuse in her childhood. As an adult, she works in a hospice and cares for patients consumed by physical pain. She begins to "hunger for storylessness," wishing to find a way to separate pain from the experience of pain; yet without a narrative frame she cannot recognize pain in its original and pure state--the pain that occurs before language or thought. And so she enters into a meditation practice in order to see pain "uncompounded."

The book is divided into three sections, each reflecting a part of Anna's meditation practice and each containing sections of dreams, meditation notes, and musings on three friends who have died. As her meditations deepen, Anna begins to see pain in more detail, and in so doing begins to understand the difference between pain and suffering. Pain, she concludes, is inevitable. But suffering can be dismantled, carefully, like a house might be. The goal is to keep the house "whole enough" so it doesn't collapse and crush the individual living within.

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This is a brilliant reconstruction of a most improbable event: the major contributions made to the great Oxford English Dictionary by a deeply delusional, incarcerated 'madman,' and the development of a true friendship between him and the editor of the dictionary. One sees here the redemptive potential of work and love in even the most deeply psychotic patient.

Incongruously the patient is an American physician who was discharged because of service-related mental instability from the U.S. Army after the Civil War and received a pension for life. He went to Europe to seek relief of his delusional symptoms and ended up killing a man. Judged to be criminally insane, he was institutionalized at the newly built showpiece of the British penal system, the Asylum for the Criminally Insane, Broadmoor. While there he read an advertisement requesting volunteer help in reading specific books and making word lists and describing how the words were used in the books for the preparation of the new Oxford English Dictionary.

Over the next twenty years Dr. Minor, who was a voracious reader and had accumulated a large library, became the greatest contributor and maintained a lively correspondence with the famous editor, Dr. James Murray. For these many years they never met and Dr. Murray did not suspect that Dr. Minor was insane and institutionalized. After their meeting they became friends. The institutional care appeared to be very humane and Dr. Minor was a special patient in many ways, yet never regained his normal demeanor.

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By the author's own admission, this memoir is a collection of fragments taken from her memory of bits and pieces of her four year experience as a nurse in an evacuation hospital unit following the front lines up and down the European theatre during World War I. The work is fragmented because this experience was fragmented.

The first few chapters are dream-like descriptions of the men marching into battle and crawling back, or being carried back. The second collection of short vignettes dips--just a wee bit--into some of the individual soldiers' immediate stories. The latter segment of the book deals in more detail with the operations of the field hospital, some of its personnel, and some of the patients. Finally, the author treats the reader to a handful of poems, perhaps unnecessary, since the entire memoir is like one giant poem.

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In 1988, having suffered for years from major depression and borderline personality disorder, and now also showing symptoms of obsessive-compulsive disorder, the twenty-six-year-old Lauren Slater is prescribed a new drug: Prozac. In this "diary," a series of meditations and progress reports on her experience, Slater traces ten years on Prozac, providing a remarkable before-and-after picture of the drug's effects.

She is "hobbled" by her illness: has dropped out of college, has been fired from most jobs, has been hospitalized five times. By the end of the book, she has received a doctorate from Harvard, has a successful career as writer, teacher, and psychologist, and is in a happy marriage.

Despite these unquestionable positives, Slater is ambivalent about the drug, describing the shock of becoming "normal," of being assaulted by health. She describes the sexual dysfunction, her anxiety about losing the need and ability to write the kind of poetry she had written before, and the terrifying moment when the drug suddenly stops working, and she must confront the possibility that it may not be a reliable and permanent solution.

She comes to fear that, healthy, she is no longer herself but something the drug has created. At the same time, though, it is only because of the drug that she is even able to ask these questions. Finally, she thanks her doctor for his ambiguous gift: she has become like a beautiful fish, her "skin all silver," her "mouth pierced" on Prozac, "this precious hook."

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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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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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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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