Summary:

Professor Sandra Bertman founded the Medical Humanities Program at the University of Massachusetts Medical Center and holds certificates in grief counseling and death education. This handbook outlines how she uses the visual and literary arts to "improve our professional abilities to deal with death and dying." Her premise is that the arts provide a valuable vehicle for exploring and making bearable the prospect and fact of death.

Bertman illustrates her presentation technique (Chapter 2) of juxtaposing dual images around six central themes, here abbreviated: the chosen death; death and afterlife; existential aloneness; loss of control, unmentionable feelings, grief; the land of the sick vs. the land of the well; the moment of death. The book offers dozens of paintings, sketches, and photographs (reproduced in black and white), as well as many literary excerpts. Classic works are represented (David's painting, The Death of Socrates; Michelangelo's sculpture, "Pieta"; Tolstoy's novel, The Death of Ivan Ilyich) but there are many unusual representations as well--greeting card messages, epitaphs, cartoons.

In addition, some groups with whom she works (for example, medical students studying Gross Anatomy) have submitted their own drawings and commentary. These are shown in Chapter 3, along with written responses to a follow-up Death Attitude Questionnaire. Responses are from junior and senior high school students; college students; medical students; graduate nurses; hospice volunteers.

Chapter 4 gives suggestions for how to use images and texts and for how to approach discussions of loss and grief. The course syllabus for "Dissection, Dying, and Death," taught with Gross Anatomy, is appended, and there is an extensive bibliography.

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Simon Dykes is a successful artist about to open another big show of his work in London. A week before the opening, he goes out to a bar with his colleagues, indulges in drugs, has sex with his girlfriend, and falls into an uncomfortable sleep with bizarre dreams. He wakes up in a world where every person is a chimpanzee and where humans are kept in zoos or are experimented on in labs, and the few humans surviving in the wild are close to extinction.

Terrified and dismayed, he is taken to a psychiatric ward where the chimpanzee doctors try to help him overcome his "delusions" that he is actually a human. They eventually turn to Dr. Zack Busner, an alpha male, theoretical renegade and media star, as well as a maverick drug researcher, "anti-psychiatrist," psychoanalyst, and clinical psychologist. Together they try to understand the root of Simon's delusion and return Simon to his sanity and "chimpunity."

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This film by Danish filmmakers focuses on two Scots, Wilbur (Jamie Sives) and his older, considerate brother Harbour (Adrian Rawlins), who own a family buy-and-sell bookshop, North Books, in Glasgow. The opening movie credits intersperse with Wilbur's suicide attempt by pills and gassing himself. Wilbur's attempt is thwarted first by the fact that he has to put more coins into the apartment gas meter, and then by his brother, whom Wilbur had telephoned just before losing consciousness. Wilbur continues suicide attempts throughout much of the movie, with methods that range from the absurd to the disturbingly tragic.

The brothers' father had recently died and several scenes occur at a hillside cemetery. Surrounded by imposing stone monuments, the brothers' parents are buried without markers, but with a view, if you cock your head and imagine, of the bookshop. The tragedy of the mother's death when Wilbur was only 5 years old, is invoked to explain much of Wilbur's disturbance.

Early in the movie, Alice (Shirley Henderson), a waif-like single mother who cleans the operating and trauma theatres and sells books she finds at the hospital to the bookshop, is introduced, along with her soon to be 9 year old daughter, Mary (Lisa McKinlay). Alice and Harbour wed, and Mary presciently plunks a penguin eraser she has just received atop the wedding cake next to the bride and groom: "That's Wilbur," she says.

Two hospital workers feature prominently in the film. Horst (Mads Mikkelsen) is a Danish ex-pat physician and "senior psychologist." He chain smokes, distances himself from the group therapy he supposedly supervises, and yet deftly discusses bad news with Harbour in several scenes. The psychiatric nurse, Moira (Julia Davis), however, who, with ever-changing hairstyles and inappropriate nurse-patient interactions, acts primarily as comic relief, delivers the same bad news with unthinking, devastating directness.

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The narrator of the story, a former district doctor in Russia, reminisces about his frequent encounters with patients suffering from secondary syphilis ("the speckled rash"). The first case he diagnoses is a 40-year-old man seeking treatment for a sore throat. The doctor recommends the application of a bagful of mercury ointment once a day and a follow-up visit after 6 days, but the man never returns. The physician advises him that his wife needs to be examined also, but she is never seen in the clinic.

The doctor remembers many other cases of secondary syphilis in the community. Except for one young woman, patients seem to have little fear of the disease. Children and even entire families are infected. The physician decides to tackle the widespread venereal disease and to confront the rampant patient apathy in the district.

His weapons include mercury ointment, potassium iodide, Salvarsan (an arsenic compound) injections, harsh words, and warnings about the horrible effects of the disease if left untreated. He opens an inpatient unit to treat patients with syphilis. Now long-removed from that remote medical outpost, the narrator still wonders about the people living there.

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Fifty-two year old Pete, the hospital mailman, suddenly experiences severe abdominal pain. He is evaluated and treated in the emergency room. His diagnosis is acute surgical abdomen, but the exact cause of his pain is still unknown. The surgeon-narrator determines that the severity of Pete's condition mandates exploratory surgery. During the operation, "an old enemy" (18) is encountered--pancreatitis.

Afterwards, the surgeon assures Pete that he will get better. One week later though, the mailman dies. His death has been painful. An autopsy is scheduled, but the surgeon deliberately arrives 20 minutes late. He does not want to view the intact body of his deceased patient. No matter, the pathologist has waited for him to arrive before beginning the post-mortem examination. The pathologist closes Pete's eyelids before starting the autopsy, mindful of how the mailman's "blue eyes used to twinkle" (21) when he delivered the mail everyday.

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Looking back on his first year of medical practice in an out-of-the-way section of Russia, a 25 year old physician reflects on how much he has changed both personally and professionally. He lists the year's accomplishments: performing a tracheostomy, successful intubations, amputations, many obstetrical deliveries, and setting several fractures and dislocations. With pride, the doctor calculates he has seen 15,613 patients in his first twelve months of practice.

He recalls some poignant moments. A pregnant woman has a baby while lying in the grass near a stream. The doctor pulls a soldier's carious tooth but is horrified when a piece of bone is attached to it. During a delivery, he inadvertently fractures a baby's arm and the infant is born dead.

Basking in his year's worth of experience and newfound clinical confidence, the physician quickly comprehends the limits of his knowledge on the first day of his second year in practice when a mother brings her baby to the doctor. The infant's left eye appears to be missing. In its place sits an egg-like nodule. Unsure of the diagnosis and worried about the possibility of a tumor, the physician recommends cutting the nodule out. The mother refuses. One week later she returns with her child whose left eye is now normal in appearance. The doctor deduces that the boy had an abscess of the eyelid that had spontaneously ruptured.

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The physician-narrator celebrates his 24th birthday in the company of two midwives and a feldsher (physician’s assistant). They toil in a remote area of Russia where conditions are harsh. The doctor tells the group about a peasant woman who requested a refill of belladonna (an atropine-like drug) that was prescribed for stomach pain the day before. Although the instructions were to take five drops as needed, the bottle was completely empty already. Since the woman had no signs of belladonna poisoning, the feldsher concludes she shared it or maybe even sold it to other villagers.

The group shares other stories about patient mistakes and misguided beliefs. That same night a man comes to the doctor’s house. He is a miller suffering from recurrent fevers. The physician diagnoses malaria and remarks how sensible and literate the patient is. Powdered quinine is prescribed to be taken once a day before the onset of fever. Soon the doctor receives word the miller is dying. The patient has defied the instructions and taken all 10 doses of quinine at one time to expedite his recovery. His stomach is pumped, and he survives the overdose.

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In the Foreword to this collection, poet John Graham-Pole writes, "Children have uncovered for me the last and greatest lesson: souls thriving on failing at bigger and bigger things" (xvii). The heroes of these poems are just such children, transformed by serious illness. For example, Dominic in "Waiting" who "rests on his airbubble cot / awaiting life’s flight from its earthly beat" (10); Ruby in "Ruby Red": "And so poor Ruby meets her final test, in gentle hemolysis rolled to res" (35); the lovely young woman in "Elegy": "You’re newly dead, sans wig, / seventeen year old virgin whom / I’d loved." (57).

"I try through writing poems to lay a finger on the purpose of illness, on its pulse .  . Poems turn denial and withdrawal into compassion--feeling with. They turn fear into mercy--thank you" (xvii). The poet’s eye remains dispassionate, even though his heart may be breaking, as in "Last Rites" (32), in which a dead toddler’s father and his companion "sluice down the flooring with their hoses. After the vomit and blood the water runs clear." He understands the limits of communication about loss, but recognizes, too, that we must make the attempt; and the attempt has meaning in itself: "Afterward the circles of our talk / snap . . . - Within, we write our / separate texts of it. Between, the tension / stands: this no talk could break." ("Circles," p. 87)

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This series of 28 poems plus an envoy describe, from the patient's point of view, a 20-month stay in an Edinburgh hospital in the 1870s. The narrator delineates--from the cold and dread of Enter Patient through the giddiness of "Discharged"--his reactions to hospital personnel (from doctors and nurses to scrub lady); to his fellow patients (from children to the elderly, during bad days and holidays), to visitors, and to death.

Because he stays for 20 months, we also witness his seesawing emotions about his own state of health. The epigraph from Balzac suggests that a person in bed and ill might become self-centered, so the narrator purposefully maintains a dispassionate tone. It is a tone so distinct yet distanced that Jerome H. Buckley (William Ernest Henley: A Study in the "Counter-Decadence" of the 'Nineties, New York: Octagon Books, 1971, c. 1945) compares the poems to steel engravings.

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A sick woman (dying mother) in a comfortably made-up bed serenely occupies the center of the canvas's diagonal composition. She lies between a seated doctor focused on his hand-held watch while he takes her pulse, and a nun who holds the woman's child and extends her a drink (tea, medicine). The simple, calm, orderliness of the sparse setting is echoed in the postures and countenances of the four figures.

In his biographical study, Robert Maillard documents that Picasso's father--art teacher and model who posed as the doctor--worked out both the composition and the title of the painting for his 16-year-old son (Picasso. New York: Tudor, 1972, p. 180).

An earlier watercolor draft of this work sketches the child with arms outstretched reaching forward to the sick mother. In the draft, the physician and nun, too, are more concerned with the mother's condition. Though strengthening the allegorical significance of this academic composition, the dramatic intensity is lessened if not lost in the final version (1897), which was awarded an honorable mention in Madrid and a gold medal at the Exposición de Bellas Artes in Málaga.

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