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Through ten short chapters, family doctor Susan Boron explains the origin of her neologism, “tokothanatology,” the study of common practices that surround both birth and death, events that “bookend” our existence. Daughter of an obstetrician who pioneered family-centered birth and spouse of a man who worked in palliative care, Boron noticed the tremendous similarities in the gestures, rituals, and obligations of dealing with both the beginning and the end of life. The obligations extend to the loved ones in the sphere of patients in care--a practice, she writes, “from pre-cradle to post-grave.” 

One chapter reviews the rituals emerging from many different cultures and religions; another examines portrayals of birthing and dying in image and word; yet another addresses the impact of sudden and unanticipated outcomes. Ethical and legal dilemmas and the contingencies imposed by time and place are discussed frankly.  

Recognizing the advantages of medical technologies, she is nevertheless skeptical of their utility in every case and includes practical advice for dealing with pain, showing that midwifery techniques could enhance palliation. Throughout, she acknowledges that things have changed, are changing, and will change again. Sources are referenced in footnotes. 

In the end, the repeated message is one we’ve heard many times before, offered in a refreshing way: the importance of empathy and of listening to the patient's wishes in birthing and in dying. 

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In Medical Bondage: Race, Gender, and the Origins of American Gynecology, Owens argues that the emergence, practice, and professionalization of American gynecology in the 19th century were inextricably enmeshed with the institution of slavery and discourses of biological racism. “Modern American gynecology,” writes Owens, “could certainly exist without slavery, but slavery’s existence allowed for the rapid development of this branch of medicine, and especially of gynecological surgery” (6). As she shows, gynecology developed as quickly as it did only because white American physicians had access to women’s bodies marked as racially inferior. That gynecology’s maturation accelerated in the American South is no indication that its practitioners had a humane interest in enslaved women’s health (66). On the contrary. Owens argues that slave owners were invested in maintaining the reproductive health of enslaved women in the interest of increasing the size of their population: “Thus the repair of any medical condition that could render an otherwise healthy slave woman incapable of bearing children further strengthened the institution of slavery” (39). Additionally, there were broader implications, as medical research using enslaved women’s bodies produced knowledge about how to treat, in turn, white women: “Black lives mattered medically because they made white lives healthier and better” (107).

This leads Owens to argue why enslaved women should be esteemed as the maternal counterparts to the oft-celebrated white ‘fathers’ of American gynecology: “. . . black women, especially those who were enslaved, can arguably be called the ‘mothers’ of this branch of medicine because of the medical roles they played as patients, plantation nurses, and midwives. Their bodies enabled the research that yielded the data for white doctors to write medical articles about gynecological illnesses, pharmacology, treatments, and cures” (25). This is especially true, as she points out, when examining the medical research of the lauded gynecologist, James Marion Sims, who opened and operated a “sick house” for enslaved women suffering from gynecological ailments (36). Sims operated this clinic to devise a surgical solution to a serious and commonplace gynecological issue among enslaved women, vesico-vaginal fistulae. As an enterprising young physician, Sims took advantage of enslaved women’s bodies to conduct his surgical trials. Eventually, he triumphed and cured an enslaved woman, and published the results in a respected medical journal, thus enshrining his reputation (39). The point, Owen emphasizes, is that “[t]hanks in large part to his experimentation on enslaved black women, Sims had established himself as one of the country’s preeminent gynecological surgeons less than a decade after he began his gynecological career” (39). Medical Bondage thus strives, in part, to restore the lives and contributions of these enslaved women to the story of American gynecology’s genesis.

Owens’ study takes a surprising turn, arguing that “. . . the later development of modern American gynecology can no more be disentangled from Irish immigration than it can be separated from its roots in slavery” (90). This shift in racial and geographic focus parallels the similar roles of enslaved black women of the South and poor, immigrant Irish women of the urban North in the development of gynecology. Owens shows how racial alterity was “mapped onto” poor Irish immigrant women living in major urban centers, such as New York City (20). As many Irish immigrant women suffered poverty, inadequate (if any) medical care, sexual assault, and were drawn into prostitution (and the attendant onslaught of venereal diseases), they became ideal medical subjects for gynecologists. Physicians eventually published their Irish patient case studies, which “. . . helped to create the foundation for the racist laws that colored the Irish as not quite white and sometimes placed them alongside black people as biological models for racial inferiority” (90). Just as Southern gynecologists had access to enslaved women’s bodies, their Northern counterparts treated and experimented on racially othered immigrant women. In this way, Owens argues, “[t]he scientific and medical beliefs that doctors held about Irish women were nearly indistinguishable to [sic] those they held about African women” (115). Overall, Medical Bondage articulates a well-researched and sobering retelling of the dominant accounts of American gynecology.

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The titular "severance" surgical procedure is the ultimate answer to the work-life balance conundrum - separating work consciousness from personal consciousness. The person's work-self has no memory or knowledge of their personal-self, and vice versa. Lumon Industries and its employees do this for seemingly good reasons (e.g. to assuage grief) but unanticipated and darker motives are in tension throughout the series as its nine episodes follow a core team of four office workers navigating the realities of having had this procedure done.

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“Can you take your mother home? There’s no point our keeping her here,” the doctor says to Phillipe about his mother, Monique. Her breast cancer has spread to her spine and probably her brain. Monique had been staying with Phillipe and his wife, Nathalie, in their cramped apartment in Paris during her treatment. They took her to her home in Auvergne, and there she remained, confined to her bed, until she died. 

Monique’s husband, Roger, cared for her while also managing the family retail clothing store beneath their apartment. He spoon-fed her, cleaned her, and tried to make her comfortable with the aid of visiting nurses. Phillipe and Nathalie came from Paris to help care for Monique and provide some relief for Roger. As Monique deteriorated, she required more and more of their attention, which was made all the more difficult when she lost her ability to speak. Fatigue set in and nerves frayed. Nevertheless, when Monique died, tears were shed, hugs were shared, and memories were recounted. 

Through it all, though, not one of three family members exhibited a bit of grace. As they had before Monique became ill, they lied to each other, cheated on each other, and stole from each other while caring for her. None were above physical abuse—“you slapped me for no reason,” Nathalie reminds Phillipe, Roger paws his female customers just below where Monique lies ill in her bed. Monique, no angel herself, had behaved similarly before cancer crimped her style. After the funeral, Roger returned to his store, and Phillipe and Nathalie to Paris, where they ostensibly would pick up where they left off with their lives of banal wantonness.  

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In the not-too-distant future, Arthur Leander, a famous actor, suddenly collapses and dies on a Toronto stage in the final act of King Lear.. That same night the deadly and highly contagious Georgian Flu reaches North America from Russia. Within days, civilization, as we know it, collapses: no electricity, no gasoline, no water, no travel, no Internet, no information, no medicine, and no escape. A handful of survivors hide in their separate lairs, until their resources are depleted and then they flee on foot, at first alone, stealing and foraging for food, trusting no one, and learning to kill. Surviving. The story takes place in Year 20 after the collapse with frequent visits to the past. 

Without realizing it, the protagonists are all connected to Arthur– his ex-wives, young son, best friend, a child actor, the paramedic who tried to resuscitate him at the theatre. Older people remember and mourn the “before time” and its marvels that are lost, perhaps forever. In oppressive heat, a troupe of musicians and actors, called the Traveling Symphony, moves from place-to-place around the Great Lakes, performing music and Shakespeare’s plays because “survival is insufficient.” Usually, they bring pleasure and diversion. But they must take care, as some villages are led by cult-like prophets, intent on control by theft, rape, and murder. Only at the end do they reach Severn City, where a fledging community has created a semblance of peace and respect in an abandoned airport with a museum devoted to all that is lost.

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Brother Diggery, formerly called Jack Fox, tells us that he was given to the monastic order of St Odo at the age of seven in 1341. For another seven years, he is raised in innocence within the strict rules of the community, serving the brother healer, learning herbal remedies, and playing the hurdy gurdy.  

As plague arrives in 1349, he is assigned to help care for the anticipated sick – and immediately falls ill. The brothers seal him inside his cell, where he suffers greatly, narrowly escaping death; however, when he recovers and forces himself out of confinement, he discovers that everyone else has died or fled. After filling a mass grave with the remains of his brothers, he sets out on a picaresque series of adventures, blithely unaware that he and his fleas spread illness wherever they go.  

Like a fourteenth-century Candide, Brother Diggery’s gullibility and curiosity lead him to discover the wonders of good food, sex, and marriage, the cruelty of lies, theft, and wrongful imprisonment, and the corruption of the church (p. 164). He closes his account in 1352, age 18, already twice widowed, but set for life as a lay physician and father of a young boy whom he plans to give to the monastery of St Odo when he reaches age seven.

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In The Unseen Shore: Memories of a Christian Science Childhood, Thomas Simmons narrates the physical, emotional, and spiritual anguish of growing up in, and later leaving, the Christian Science Church. “Have I escaped now? Enormous question—who knows?” writes Simmons, “The obvious answer is Yes, of course I’ve escaped. I now go to doctors; I no longer lie for helpless hours in bed, writhing and trying to pray” (5). Christian Science teaches that illness and pain are illusions of an unreal material world, and that human suffering can be healed through prayer. As the founder of Christian Science, Mary Baker Eddy, wrote in Science and Health with Key to the Scriptures, "Sin, disease, whatever seems real to material sense, is unreal in divine Science" (353). Simmons explains how this theological indoctrination distorted his view of the material world, morality, and the human body: “I remember very clearly several occasions when Sunday school teachers would warn us that medical doctors were not to be trusted because the world they believed in was not our world—it was the world of mortal mind, of disease and distress” (4). Simmons wavers uneasily between apostasy and piety, questioning if he should trust his physical, bodily senses (“mortal mind”) or the numinous promises of Divine care. As he grows up practicing Christian Science, suffering untreated ear infections and other illnesses, he struggles to maintain a posture of devotion while coping with spiritual misgivings.

These “tremors of doubt”, however, haunt Simmons beyond childhood into his adult years (106). Yet two powerful experiences draw him away from Christian Science: the study and composition of poetry and “the love of bodies” (67). In need of a different kind of spiritual direction, Simmons turns to poets whose works celebrate the beauty of the concrete world, realizing that “. . . I want the world, want its physical hardness and qualities of light and sound, the depths of its touch and soul. In the words of poets and teachers I see my own path back into that world” (129). Another key incident occurs following a bout of spiritual renewal when Simmons interviews to become a Christian Science practitioner (a kind of minister who prays for ailing Church members). Stopping to savor the beauty of the California coastline, he hopes the gorgeous expanse will reveal a divine sign affirming his spiritual ambition. He receives an altogether different omen, however, one he considers mockingly lewd, in the form of a naked man exercising on the beach below where he sits: “And yet I could not quite leave. For a few seconds I watched this man run. Far from admiring the precision of his muscles or the stillness of his torso as he moved his legs, I rejected them: they could hold no sway over me, for they were not real. But they remained interesting in their unreality” (156). (Readers might imagine this nude interloper as Vesalius’s anatomical man from De humani corporis fabrica [1555], who stretches and moves with certainty, exhibiting the magnificent brawn and sinews of the human form.) In this moment, Simmons's spiritual optimism almost vanishes, unnerved by the physically real, naked human materiality in which he will ultimately find solace and beauty.

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