Nervous System

Meruane, Lina

Last Updated: Dec-13-2021

Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Ella needs time for finishing her doctoral dissertation on black holes she has been writing for years and thinks an illness could provide the time: “Just enough to take one semester off, to not have to teach all those planetary sciences classes to so many distracted students whom she had to instruct evaluate forget immediately (p. 6). Before she can decide which illness would best suit her purposes, a mysterious illness finds her.

A sudden cramp shoots down the spine and then, stillness... (p. 9)

An unbearable stinging had settled into her shoulder neck ember... (p. 10)

She felt an invisible wound wrapping her up and suffocating her... (p.10)

A slight numbness that starts in the shoulder and extends along the arm to the elbow until it reaches the back of her right hand, the fingers where it all started. (p. 12)

Inflammatio. In flames. En llamas. Ardor without romance. (p. 10)

Quickly, then, the story shifts from Ella’s dissertation odyssey to her diagnostic odyssey. As she makes her way along this journey during the first chapter, other characters come into the picture: El, Ella’s long-term boyfriend and forensic scientist, is one. The others in her family history are “the Father,” “the Mother,” “the Brother,” and “the Twins”—none are ever named (neither, really, is Ella or El because they are “she” and “he,” respectively in Spanish). Except for the Twins, each of the subsequent four chapters center on one of these characters and how they figure into the family history. Just as in the first chapter, the stories are told through and around the health challenges each character faced; all harrowing, many life-threatening, and some metaphorical.

Ever present in these histories is the story of Ella’s birth mother,“genetic Mother”. She died giving birth to Ella. Ella’s stepmother, “the Mother,” is called at different times, “the volunteer Mother,” “the replacement Mother,” and “the living Mother.” The Brother, alternatively known as “the Firstborn,” shares with Ella her birth mother and was born nine years before her. The Twins, known separately as “the Boy Twin” and “the Girl Twin,” came after the Father remarried. Another dimension shaping the stories is both the Father and the replacement Mother work as practicing physicians.

Ella’s prominence in each chapter makes her our witness to El’s recovery after an explosion rips through his mass grave excavation site, and his many surgeries for separate gastrointestinal troubles; the Mother’s aggressive and brutal breast cancer treatment; the Firstborn’s recurring bone fractures (an “osseous enigma”); and the Father’s bleeding ulcers and life-threatening hemorrhagic complications from prostate surgery.

The author, Lina Meruane, structured the book in a somewhat unconventional form. She delineates sections within each chapter with asterisks centered on the page (“***”), and these sections rarely comprise more than two paragraphs. Dialog is neither separated from other text nor signaled with quotation marks. The text moves back in forth in time, from here to there in place (presumably somewhere in South America), and sometimes takes the form of pensées rather than plot narrative. But, overall, the book moves towards resolving some mysteries surrounding family history.

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The Problem of Alzheimer’s

Karlawish, Jason

Last Updated: Nov-29-2021

Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: History

Summary:

In a 1976 Archives of Neurology essay, the neurologist Robert Katzman successfully argued for relabeling “senility” as “Alzheimer’s disease.” He urged rejecting various forms of dementia and senility as common consequences of aging, and accepting them as a disease requiring all the attention any other important disease deserves. Now medicine and society had a problem—"The Problem of Dementia,” the famed physician Lewis Thomas called it in a 1981 essay published by the popular magazine Discover, and he noted that, suddenly, “a disease of the century” had arisen (p. 3).

Forty years on, Jason Karlawish thinks there is still a problem, but in keeping with Katzman’s call, he refers to “The Problem with Alzheimer’s.” Based on the history he covers and the experiences he shares in this book, nothing of much significance has occurred since “The Problem of Dementia” became the “The Problem of Alzheimer’s.”

Karlawish is a physician who cares for people with Alzheimer’s and a researcher delving into “issues at the intersections of care, ethics, and policy” (p. 5). He draws on his experiences in this book, which he describes as “the story of how once upon a time, Alzheimer’s disease was a rare disease, and then it became common, and then it turned into a crisis.” Karlawish wants to answer why during the time between Thomas’ essay and the year 2010, “nothing really changed,” and how that could be the case in “the richest and most powerful nation.” (p. 6) He tells this story in four parts.

The first part concentrates on efforts clinicians and researchers were making following Thomas’ call to distinguish Alzheimer’s disease from normal aging, other dementia types (e.g., frontotemporal, Lewy body), and precursor syndromes (e.g., minimal cognitive impairment). They were looking for definitive clinical patterns, imaging studies, diagnostic tests, and pathologic markers for the disease.

In the second part, Karlawish goes back in time to when Alois Alzheimer first found what are known today as “plaques” in the brain of a patient who had an early onset of severe, progressive dementia. He traces the attention this finding drew to eventual advances in imaging and biochemistry aimed at diagnosis. Karlawish also covers how a cascade of events over the decades following Alois Alzheimer’s finding disrupted the pursuit of a pathophysiological basis for dementia. These events included the rise and dominance of Freudian psychology; followed by two world wars; the cold war; the overshadowing of AIDS; Medicare political and funding constraints; tussles among patient advocacy groups; loss of asylums where care and research had coexisted; clinical failure of the first drug; and the continued debate over whether dementia is a consequence of aging or is a disease.

Karlawish moves on in the third and fourth parts to cover what “we will have to learn to live with the disease so as to improve the lives of persons...to provide the care they need to live well at home...and repair the broken system” (p. 171). Success in his view requires integrated biological, psychological, and social components. He reports the progress on each of these three fronts: some failed approaches continue to fail (such as drugs targeting amyloid); some psychological interventions show promise (though at times causing moral tension); some of the social configurations engineered for Alzheimer’s patients, families, caregivers, and society have produced triumphs and some disasters. He has much to say about why and how this search must go on, but with some much-needed course corrections.

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Secret Wounds

Berlin, Richard

Last Updated: Aug-06-2021

Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

In Secret Wounds, his second full length collection of poetry, psychiatrist Richard Berlin continues his exploration of the inner world of medicine with a sequence of 73 poems that flow seamlessly, uninterrupted by grouping into topics or sections. In the first poem, “Lay Down Sally,” the author attends a man dying on dialysis, and concludes with “A nurse hangs the morphine. / I write my blue notes.” In the last, “The Last Concert of Summer,” he reflects on his long experience with the sick and suffering, ending the poem with, “I place a stethoscope in my ears and listen / to the heart when I’ve run out of things to say.” In between, the poems reflect varied incidents, topics, conflicts, and wounds, as they occur from medical education (“Teaching Rounds,” “Touch,” “On Call, 3 AM”) through a life in medical practice (“Rage,” “The Scientists,” “How a Psychiatrist Parties”) to something like enlightenment (“Note to Pablo Neruda,” “A Psychiatrist’s Guitar,” “End of Summer”).

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The Ministry of Bodies

O'Mahony, Seamus

Last Updated: Jul-26-2021

Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Starting eight months before his retirement, a gastroenterologist chronicles a myriad of encounters between himself and others - patients and their family members, colleagues, administrators, hospital staff, and even drug reps. He has worked for many years at a large Irish hospital dubbed the "ministry." His professional work there is divided between the endoscopy unit (where he performs colonoscopies and EGDs), medical wards, an outpatient clinic, and the ER.

Given his specialty, the roster of patients tilts heavily towards gastrointestinal problems: alcoholic cirrhosis, GI bleeding, chronic diarrhea, and abdominal pain. But additionally, his days are filled with patients presenting with a variety of medical problems including pneumonia, mental health issues, heart failure, serious fractures, dementia, seizures, anemia, and cancer. He attends to many frail elderly folks in the emergency department. His interactions with patients range from intense to jovial, from unexpected to heart-wrenching. For example, a woman with chronic abdominal pain asks the doctor if she might be suffering from PTSD. When asked why she thinks that might be possible, her reply is "My son hung himself. I found him" (p191).

The doctor is beleaguered by frequent, and at times wacky, emails generated by the hospital bureaucracy as well as unproductive meetings. He must cope with his own health problems too (a vitreous detachment, arthritic hands, and unexplained nosebleeds). He decries the "foolishness" of excessive medical testing and overtreatment and cites the case of a young woman with irritable bowel syndrome who already had over 1,200 test results logged in the hospital lab. He describes the ministry as "an oasis of kindness and comfort" but "also a place of chaos and conflict, of institutional cruelty" (p8).

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The Arrow Tree: Healing from Long COVID

Weliver, Phyllis

Last Updated: May-18-2021

Clark, Mark

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The title of this memoir derives from the Native American custom of bending a tree’s growth in order to indicate a direction of safe passage. The custom represents a reverent cooperation with nature through which a compassionate communication is accomplished: a message to other journeying souls as to how they might find a way to their flourishing. The title is exquisitely apt for this memoir, which echoes the gesture of the arrow tree, testifying to a safe passage through the wilderness of COVID. The author, a first-rate, published Victorian scholar, contracted COVID-19 in March 2020 upon her return from a sabbatical at the University of Cambridge, which was cut short as a result of the pandemic.

Weliver has suffered from symptoms ever since: hers is the experience of living with long COVID. The condition warrants her taking a leave from her university, and she returns to her childhood home of Interlochen, in northern Michigan. Her living in and engaging with the natural world there encourages her to undertake meditations about that world and her place in it as she lives with her illness. The writing—the foundational means of her healing—inclines her, crucially, to think with the stories of the Odawa (Ottawa) and the Ojibwe (Chippewa), Anishinaabek ("Original Man") of the region, which she researches as a means of deepening her understanding of her home, her origins, and the nature of her identity. Her quest for understanding turns not only to these stories, but to an integration of them with the wisdom of other guides in her life: authors of the Romantic and Victorian periods, poets and thinkers of Taoism and other ancient Eastern philosophies, mentors in her rich journey of studying both literature and music (she attended Interlochen Center for the Arts, Oberlin, where she double-degreed in English Literature and Voice (Music), Cambridge, and the University of Sussex), and her own family, particularly her mother. Her prose is accessible and welcoming, not at all the erudite sort one might anticipate from a reputable scholar: it invites curiosity and encourages insight that is, at times, breathtaking and joyous. This “arrow tree” memoir points its readers in the direction of a safe passage to the home of our natural world, where, in finding union with that world, we may experience healing not only from COVID but from habits of the heart that have left us more broken than we know.

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The Father

Zeller, Florian

Last Updated: Apr-26-2021

Teagarden, J. Russell

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

The basic plot of The Father mirrors the all-too-common trajectory people with dementia follow: first they deny any problems; then they progressively need more in-home assistance; and then they require institutionalization. This scenario, however, gets obscured when watching the film’s main character—the father—wrestle with quotidian activities and familiar faces. The viewers wrestle with him, and become just as confused and rattled. Florian Zeller, the screenwriter and director, admits he wants viewers feeling what people with dementia feel. He succeeds in the movie as he succeeded in the Broadway play version preceding it.

The father, Anthony, lived in his London flat with help from hired caregivers and his daughter, Anne, who lived nearby. After Anthony banished several caregivers on grounds they were unnecessary, Anne moves him into her flat, and when he’s too much for her there, she moves him to a nursing home. We’re never quite sure, though. Zeller makes the two flats and the nursing home look almost identical. He changes Anne’s story at different times: she’s still married after ten years; she’s been divorced for five years; she’s relocating to Paris with a lover; she was never relocating to Paris; she relocated to Paris. Anne appears as a different person on occasion and the husband she may or may never had appears as different people. Zeller overlays these confusing surroundings and events by jumping forward and backward in time, and repeating some scenes with slight variations. Eventually, Anthony says, “strange things are going on around us.” Viewers will feel the same, and that’s the point.

The movie ends as Anthony awakes in his nursing home room. Just as we are lured into thinking we have returned to the common dementia trajectory at its end, we see his nurse is the person who had appeared as Anne before, and his room looks like the bedrooms in both his own and Anne’s flats. We wonder.

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Parenthesis

Durand, Élodie

Last Updated: Apr-23-2021

Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Graphic Memoir

Summary:

Judith, a French woman in her early twenties, experiences "spells" - episodes of shaking, staring, and sudden memory loss. These spells occur daily and her behavior becomes erratic. She visits a neurologist. He diagnoses epileptic seizures and prescribes medication. Yet the convulsions continue so Judith's drug dose is upped and an MRI of the brain is done.

The MRI scan finds a small tumor that appears inoperable. A brain biopsy reveals an astrocytoma. Judith's life now revolves around her illness and the medical monitoring of it. Time feels distorted, and she likens her seizures to "a little death." Everyday life becomes blurred. She is advised to see a neuropsychiatrist. Her parents worry about her constantly.

Eventually Judith is referred for Gamma Knife radiosurgery. Eighteen months after the procedure is completed, only a tiny scar at the site of the tumor remains. Three years following the treatment, the seizures are gone. She rediscovers the joy of life and embraces a hopeful future.

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Letter to a Young Female Physician: Notes from a Medical Life

Koven, Suzanne

Last Updated: Feb-26-2021

Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

In this collection of autobiographical essays, Koven contemplates some unique challenges confronting female physicians: discrimination, sexism, lower annual salary on average than male counterparts, possible pregnancy and motherhood. She recalls her medical school and residency experience, describes her internal medicine practice, and highlights her role as a daughter, spouse, and mother.

Worry is a theme that works its way into many phases of Koven's life and chapters of this book. The opening one, "Letter to a Young Female Physician," introduces self-doubt and concerns of inadequacy regarding her clinical competence. "Imposter syndrome" is the term she assigns to this fear of fraudulence (that she is pretending to be a genuine, qualified doctor). She worries about her elderly parents, her children, patients, and herself. Over time, she learns to cope with the insecurity that plagues both her professional and personal life.

Some of these essays are especially emotional. "We Have a Body" dwells on the difficult subject of dying, spotlighting a 27-year-old woman who is 27 weeks pregnant and diagnosed with adenocarcinoma of the lung. "Mom at Bedside, Appears Calm" chronicles the author's terror when her young son experiences grand mal seizures and undergoes multiple brain surgeries for the tumor causing them.

Listening emerges as the most important part of a doctor's job. Koven encourages all doctors to utilize their "own personal armamentarium" which might include gentleness, exemplary communication skills, a light sense of humor, or unwavering patience. She fully endorses a concept articulated by another physician-writer, Gavin Francis: "Medicine is an alliance of science and kindness" (p228).

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Elizabeth is Missing

Walsh, Aisling

Last Updated: Feb-16-2021

Teagarden, J. Russell

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Maud’s dear friend Elizabeth is missing, suddenly. Maud’s dear older sister Sukey is long missing. And, Maud’s mind is missing more and more. These three facts and how they relate to one another form the matrix of this movie. Maud Horsham is an elderly widow living alone with help from a home health aide’s daily visits, and from an attentive, if occasionally resentful daughter and a loving teenage granddaughter. She is well into the inexorable decline dementia brings, but at a stage where the support in place and reminder notes she leaves around are enough to keep her functioning.

On a routine visit to her friend Elizabeth, and while they dig in Elizabeth’s garden, Maud comes across the top of a compact that immediately takes her mind to a scene seventy years before when her sister Sukey was applying makeup with what looks to Maud as the same compact Sukey had in her hand. This flashback starts the story of Sukey’s unsolved disappearance as a young adult. A couple of days later, Maud and Elizabeth are to meet outside the Salvation Army store where they both once worked. Elizabeth never shows.

Elizabeth is Maud’s only remaining friend, and Maud sets off to find her. Her search triggers many flashbacks and hallucinations from the time of Sukey’s earlier disappearance, which she then becomes determined to solve. Maud’s worsening dementia often frustrates her own efforts in these parallel missions and also causes family, friends, and officials to doubt her findings and assertions. The parallel stories each have twists, turns, and surprises all the while Maud’s dementia is progressing to where she can no longer live on her own. Nevertheless, Elizabeth is found, Sukey’s grave is found, but Maud’s mind is never to be found again.

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Seven and a Half Lessons about the Brain

Barrett, Lisa Feldman

Last Updated: Jan-24-2021

Carter, III, Albert Howard

Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

This engaging and informative book describes the latest scientific understanding of the brain, primarily in humans, but also in other animals. The author, a leading brain researcher, writes clearly and often with humor.

As Barrett explores the deep history of brains, she emphasizes that as much as some humans may prize thinking, the brain’s central task is not thinking but monitoring and guiding—day and night—the many systems of the body. Brains of all creatures manage a “budget” for various factors such as water, salt, glucose, blood gases, etc., to create an on-going fitness against any future threats.

Our brains and bodies are interlinked, interactive, and unified, not the “triune” brain Carl Sagan popularized in 1977. All animal brains have similar neurons, and all mammals share a “single manufacturing plan” for brain development after birth. Babies’ brains develop according to their genes and in response to their environment, especially to their caregivers. Human brains have flexible networks much like the global air-travel system and can vary from person to person and, individually, over time because of brain plasticity.

Our individual brains influence—even create—our perceptions and relate to brains of other people through family, language, gesture, culture, and more. Barrett concludes, “Social reality is a superpower that emerges from an ensemble of human brains. It gives us the possibility to chart our own destiny and even influence the evolution of our species” (p. 123).

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