Summary:

Fran, a fourteen-year-old from New York, is finally allowed to spend a month of her summer vacation with her aunt of Cape Cod. As yet she is unaware that her parents have put off such a visit because her aunt, a lively, empathetic teacher, has a long-term lesbian partner. Among Fran’s new acquaintances is a girl her age, Wilma, who is confined to a wheelchair and, apparently because of the way her disability sets her apart, as well as her famous father’s divorce and remarriage, is extremely demanding and difficult.

Wilma’s stepmother hires Fran to be Wilma’s "companion" a few hours a day while she rests, being in the final stages of her first pregnancy. With the help of some pivotal conversations with her aunt and a new friend, Jack, Fran finds her way through her own anger and bewilderment at Wilma’s behavior to the beginning of an authentic friendship with her, as well as an understanding of the imagination caregiving demands. Along the way she becomes aware of her aunt’s lesbianism and finds that her other experience has helped open her to acceptance of this difference as well.

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This story concerns the death of a child and failures of communication. Scotty, an eight year old, is hit by a car on his birthday. His mother had ordered a birthday cake but "there were no pleasantries between" her and the baker. Scotty is hospitalized, unconscious, and the cake is forgotten. Dr. Francis reassures the anxious parents that all will be well when the boy wakes up.

The baker phones the parents’ home in the dead of night (when he does his baking) because the cake hasn’t been picked up, but they can’t figure out who he is or what he wants. At the same time the doctors and staff can’t and won’t answer their questions about why Scotty isn’t waking up. Dr. Francis comes to the hospital to check the child, looking tanned, meticulously dressed, as if he has just been out for the evening- he has a life outside of the hospital, but the parents have none. When they do run home, separately, to take a break, the baker torments them with his mysterious late-night calls. Their confusion and isolation deepen. The child dies-"a one-in-a-million circumstance."

The mother finally realizes that it is the baker who has been calling and tracks him down, enraged. She unleashes all of the anger which she had been unable to express to the doctors. The baker is stunned to learn about the child’s death; he begs forgiveness and offers them warm delicious cinnamon rolls. "Eating is a small, good thing in a time like this" and they are comforted.

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This is the first person narrative of Maarten, a seventy-one year old man who is experiencing a rapidly progressive loss of intellectual function. It is a harrowing yet poetic account of mental deterioration, revealed in an on-going chronicle of daily life and disjointed memories. The reader experiences what Maarten experiences, not only through descriptions of what life is like, but through the sequencing of thoughts and actions.

At first Maarten is just aware of being uneasy and anxious, "this feeling of being absent while being fully conscious" and he knows, from the comments of his wife, that he must be behaving absent-mindedly. His hold on familiar certainties becomes shaky--he’s not sure of how the rooms in his house are arranged. His wife, Vera, is his anchor and he realizes that his behavior has become deeply disturbing to her, as well as incomprehensible to himself. As Maarten becomes increasingly forgetful and unable to function, Vera is alternately worried, exasperated, and profoundly understanding.

Finally, Maarten is institutionalized--his thoughts disintegrate--yet we know from his observations of "the utterly moronic community" that he still has some awareness of what is happening. Although he no longer recognizes his wife, he listens to "a woman" whisper that "the spring is almost beginning . . . ."

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Dr. Cassell examines the social and cultural forces that encourage the practice and teaching of a medicine that is governed by the disease theory. This theory discounts the impact of illness on the patient and ignores the suffering that the patient is experiencing. Cassell does not debunk science and technology, rather he encompasses them within the moral enterprise of medicine as tools for helping patients.

The ability to provide compassionate attention to the patient as individual (i.e., with unique values, life experiences, family interactions, etc.), trustworthiness and self-discipline are required characteristics of a "good physician." Cassell illustrates and personalizes the philosophical shift towards focusing on the sick person with stories and anecdotes.

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As you are now, so once was I; Prepare for death and follow me. The novel's advisory epigram prepares readers for the realities of aging and death which affect both narrator and reader. Following surgery, Caro Spencer is delivered to Twin Elms, a nursing home in a rural New England setting. While this intelligent woman requires only short-term care, she is deposited, permanently, in an understaffed, sub-standard care facility by relatives unwilling to add her minor but time-consuming difficulties to their own.

It is not a pretty setting. The staff is overworked and demeaning, especially to the new resident who is well-educated and accustomed to better circumstances. The nursing home routine is careless of individual differences and needs, and set up to strip away autonomy and dignity through petty and cruel indignations.

Caro is able to survive by keeping a secret diary for observations, reflections, and interpretations; ultimately, this alone sustains her. While the voice is that of an elderly woman (as we are now), the journal is for us, those still able to manage their lives, but unable to predict or control end-of-life events.

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In a short 28 lines, Jarman captures the hothouse images of a bout of fever and the dreariness of an urban apartment where he recuperates under the care of his spouse. He can feel the way that, as he gets better, his wife's emotions unravel. She has suppressed her hatred of the apartment and the city--and perhaps, of his requirements of her as a nurse, despite the title's reference to marriage vows. As she cries, Jarman addresses himself in conclusion: "You have married the patient wait for exhaustion."

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This is a lovely poem about an elderly married couple who share a room at a nursing home. The woman is confined to bed because her backbone is "so thin / the doctor jokes that X-rays can't find it." Her husband's mind is gone. The woman reflects on the morning activities, especially those of the "night girl" who brings the breakfast trays and, later, bends down to take her husband's tray, "the perfume / still lingering from whatever went on / before last night's shift." The woman asks herself: How would this young girl of 20 know that the two elderly people she is caring for once "made love / in the sweetfern high on an island."

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In this reflective memoir, a son in his mid-forties recalls the final years of his mother's life, the mystery of her changed being as she succumbed to Alzheimer's disease, and the long weeks and months he spent as caretaker, confronting the mystery of his own life and the role of memory in it by witnessing at close range the closing down of both life and memory in her. The book is candid about the whole range of feelings--including the most unexpected and unwelcome--associated with the difficult decision to bring an aging and infirm parent into one's household, care for her, reconfigure family life, and consent to the disconcerting inversion of parent-child roles.

Each of its forty short chapters is a lyrical moment. Daniel weaves memories of his mother's life--musing about those parts he can only know second hand--and exquisite portraiture, with ongoing reflection about his purposes in writing; what gifts there may have been in the difficult process of seeing her through a difficult passage into death; and how some of those gifts unfold only in the aftermath. His speculations about the inner life of an Alzheimer's patient add nothing to medical understanding, but model a deeply edifying kind of compassion and will to imagine beyond the failures of mind and body to a silent, inarticulate self that still deserves to be honored.

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The initial chapter in this novel, Of Mist, and Grass, and Sand (annotated separately), sets the stage for the quest of the young healer/heroine, "Snake," to find a replacement for the snake she had carelessly allowed to come to harm, in the course of caring for a seriously ill child. The remainder of this coming-of-age novel chronicles Snake's journey during her "proving year" (aka/residency training).

Over the course of this year, Snake continues to minister to the sick and encounters, among others, a patient who demands assistance in suicide, a patient who refuses treatment for a gangrenous leg, and a young girl who has been sexually abused (whom Snake eventually adopts and begins to apprentice). There are, as well, myriad lessons in humility, rigidity of thought, and ethnocentrism.

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A frantic phone call from an elderly mother to her middle-aged daughter opens this somewhat surreal and menacing short story. What follows is the daughter’s search for her father who has been missing for one and one-half days. Is he lost because of the stroke he had suffered or merely being wickedly mischievous as his wife suggests? Or is he hiding in anger or seeking revenge? Or, is he dead?

The menacing tone to this story is a result of the author’s skillful use of the second person voice: "Dad? Daddy? you whisper. You imagine you hear low, throaty laughter--unless it’s the wind . . . the door to the closet is open, your mother preceded you here, desperate in her search; you know no one is hiding inside but you can’t stop yourself from peering in, holding your breath. Then you switch off the closet light, you switch off the lights in the room, shut the door and walk away."

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