2013 L&H DISCUSSION SCHEDULE - Facilitator Notes

Book: The Marriage Plot by Jeffrey Eugenides

Facilitator: Rachel Borup, PhD

In many ways Jeffrey Eugenides’ novel, The Marriage Plot, tells an old-fashioned story about the love triangle between three bright, idealistic college grads in the 1980s: Madeleine, Mitchell, and Leonard.  However through its nuanced character development, the novel examines the forces that propel and thwart young people in their journeys to adulthood, the role of free-will, the institution of modern marriage, and the challenges that mental illness, specifically manic depression, bring to romantic relationships.  Some readers will be interested in Leonard’s aspiration to be a geneticist, his work at a lab based on the real one at Cold Spring Harbor, and an eccentric side-character modeled on Nobel Prize winner Barbara McClintock.  Eugenides’ earlier novel, Middlesex, won the Pulitzer Prize. 

LDSH Amicus Boardroom

Book: God's Hotel A Doctor; a Hospital, and a Pilgrimage to the Heart of Medicine by Victoria Sweet

Facilitator: Susan Sample, MFA

The subtitle of God’s Hotel aptly reflects the three narratives that make up this captivating book:  it is a memoir by physician Victoria Sweet about how her practice and philosophy of medicine were (re)shaped by an historical hospital, Laguna Honda in San Francisco, in tandem with the writings of a medieval medical practitioner, Hildegard of Bingen.  Sweet agreed initially to a two-month stint at Laguna Honda, one of the last remaining almshouses in the United States dedicated to caring for chronically ill and indigent patients.  It was distinctly “low-tech” medicine.  But the physician found herself energized by the personal attention and time given to patients--which seemed strikingly similar to healing practices advocated by Hildegard, a twelfth-century German abbess whom Sweet was focusing on in her doctoral studies in medical history.  She ended up staying at Laguna Honda for 20 years.  God’s Hotel chronicles the parallel journeys of Sweet who advocates for “slow medicine,” a re-envisioning of modern health care that incorporates humanizing aspects of “premodern” medicine; her patients, many who gain a new sense of life through seemingly inefficient care; and Laguna Honda, a character as much as a hospital that is forced to undergo modernization.  Sweet’s vivid stories are interspersed with historical notes, which make for an informative yet personally inspiring inquiry into “the heart of medicine.”         

Book: State of Wonder by Ann Patchett

Facilitator: Rachel Borup, Ph.D

In her novel, State of Wonder, Ann Patchett takes protagonist Marina Singh from her staid life as a researcher at a large Minnesota pharmaceutical company and plunges her into the jungles of the Amazon where she is sent to investigate the reported death of one of her colleagues and to track down a rogue scientist who has quit playing by the pharmaceutical company’s rules. The brilliant but mercurial Dr. Annick Swenson was given open-ended funding several years ago to pursue a top secret, potentially lucrative female fountain of youth rumored to derive from jungle plants. Finding the secretive Dr. Swenson is only the first problem Marina must face on her journey. Ann Patchett won the Orange Prize for her novel Bel Canto. State of Wonder has been likened to a female re-visioning of Joseph Conrad’s Heart of Darkness.

Book: Pulse: Voices From the Heart of Medicine by Paul Gross and Dane Guernsey

Facilitator:  Susan Sample, MFA

The inclusion of narrative in the practice of medicine has been advocated for the empathy it can engender and the professional isolation it can help ease.  Narrative has proven to be a safe space allowing physicians, nurses, and others to give voice to a sense of vulnerability and conflict often not addressed in medical journals, as physician-editor Paul Gross points out in the introduction to Pulse:  Voices from the Heart of Medicine.  What makes this collection of stories, personal reflections, and poems different from other narrative publications is that it spans genres.  It began in 2008--and continues--as a weekly on-line magazine, but also now includes two printed collections.  

In her review of Pulse—The First Year in JAMA, physician Perri Klass lauds the honesty and “high quality” of the narratives that “are told with a kind or urgency; these encounters change lives and mark memories.”  They also are short, ranging from one to three pages.  Although arranged chronologically, the entries can be read in any order.  As you read, mark your favorites, as well as those that may not have “worked” for you.  Both categories will provide springboards into a broader inquiry into narrative medicine:  what makes a narrative effective and what value can it bring to clinicians and lay readers alike.  We’ll begin our discussion with the following selections:  “Aunt Helen Sees a Ghost,” “Losing Tyrek,” “Jeannie,” “Antibodies,” “little black boy,” “First Night Call,” and “Chemo?  No Thanks.”

Book: The Constant Gardener by John LeCarre

Facilitator: Gretchen Case, PhD

John LeCarre's 2000 novel The Constant Gardener is written as a mass-market thriller, but takes on a deeply serious topic of interest to medical folk: pharmaceutical research conducted among arguably vulnerable populations.  The international intrigue begins as Justin Quayle, a British diplomat posted to Kenya, tries to uncover what happened to his murdered wife, an attorney known to be investigating pharmaceutical companies conducting drug trials in Africa.  The ethical questions begin as soon as the intrigue does: What is consent? Who can consent? Who is vulnerable? What is the role of "the greater good"? Which countries' culture and traditions (let alone laws) are most important in any international research? LeCarre's work is fiction, but the story eerily mimics several real-life drug trials that took place outside of what is considered the "developed" world.  

Book:  A Farewell to Arms by Ernest Hemingway

Facilitator: Gretchen Case, PhD

Ernest Hemingway's classic novel Farewell to Arms plunges us into the human stories of World War I. Injuries sustained in combat--as well as other events, notably childbirth--lead to interactions with nurses, physicians, and other medical personnel.  Hemingway's characters express love and other strong opinions toward those medical providers; this will be the focus of our discussion of a book you might not have read since high school.

LDSH Amicus Boardroom

In his 1925 Pulitzer Prize winning novel Arrowsmith, Sinclair Lewis examines the personal, ethical, and social challenges facing its protagonist, Martin Arrowsmith, as he moves from a youth spent at the feet of an affable, alcoholic country physician through the politics and hierarchies of medical education and finally to a showdown between the exigencies of being a family physician and public health officer and the value of pure scientific exploration.  Inflected with the themes of “pep”
 and self-improvement, the novel puts Martin at the center of key medical dilemmas.  Should he train as  the “medic school” dictates or start with the basics of physical and biological science?  Should he give his country patients what they want or what they need?  Is public health about educating the populace or protecting them from themselves with catchy slogans?  How many lives is it conscionable to lose in the pursuit of truth and the greater good? Written at a time of great reform in medical education, Arrowsmith eschews easy polemics about ethics and the politics of medicine and presents a fallible, familiarly human character faced with choices about life, death, and science. 

Book: Turn of Mind by Alice LaPlante

Facilitator:  Gretchen Case, PhD

 Turn of Mind by Alice LaPlante features an extremely unreliable narrator: Jennifer White, a surgeon forced to retire as she deals with early-onset dementia.  Mysteries slowly unfold and and then twist closed again as Jennifer tells what she knows and the reader is left to fill in the blanks and guess at the veracity of her knowledge. Jennifer is suspected of her best friend's murder, although she remembers nothing.  Jennifer's children are either looking after her welfare or plotting against her.  Everyone and everything in her life is complicated and unstable; time passes in an erratic pattern.  This novel allows the reader to imagine the experience of a brilliant mind slowly fading, but never allows for the easy explanation that Jennifer has lost her mind.  Indeed, she is often painfully aware of her circumstances, her own shortcomings, and the deeply flawed people who surround her.  The tension inherent to any murder mystery allows this story to emphasize the terrifying progression of dementia and the desperation at the loss of professional identity.  

Facilitator: Susan Sample, MFA
  

Since its publication in 1996, Kitchen Table Wisdom has become a classic in the field of mind/body health.  The collection of “stories that heal” is included in introductory courses in clinical medicine at eighteen medical schools.  A reviewer in the Journal of Psychiatry recommends physicians read it to “reclaim their full humanity” by reconnecting to the ideals they entered medical school with:  “hopes for providing healing and comfort for others, establishing a good and satisfying life for ourselves, and making discoveries and breakthroughs to benefit future generations.”  Each of the essays tells a story about health care; the emphasis is always on care, or the lack of, and how that influences the health of patients as well as the professionals caring for them.  All of the stories feature individuals who have changed the way the author practices medicine.  Rachel Naomi Remen trained as a pediatrician, but then transitioned into psychiatry, treating oncology patients.  She is a clinical professor of family and community medicine at the University of California, San Francisco, and co-founded of the Commonweal Cancer Help Program.  She also has lived with Crohn’s disease for nearly fifty years, so she knows medicine from both sides of the bed.

Remen’s stories, all short and masterfully told, are arranged by themes into sections.  I suggest reading the preface to each section, as well as the Introduction, and then choosing stories that are most meaningful to you. For our discussion, we’ll begin with “The Will to Live” and “Silence” in section I; “How It Was” and “The Gift of Healing” in section II; “The Emperor’s New Clothes” in III; “Another Kind of Silence” in IV; “Surprised by Meaning” in V; and “Embracing Life” in section VI.

Book: A Sand County Almanac by Aldo Leopold

Facilitator: Mark Matheson, D.Phil

Aldo Leopold's A Sand County Almanac is one of the classics of the conservation movement. Leopold wrote it just before his death in 1948, and it was first published in 1949. He had a remarkable career, which included working as a National Forest ranger in Arizona and New Mexico from 1909 to 1924. He went on to become the first professor of Wildlife Management at the University of Wisconsin in 1933. Leopold's experience in Western National Forests led him to a new concept of the kind of preservation he believed necessary in our region. His term for this was "wilderness." In 1935 he helped found theWilderness Society, which he described as "one of the focal points of a new attitude"—an "intelligent humility" with respect to the place of human beings in the natural order. He suggested that human society should no longer believe it holds sovereignty over the land with a right to exploit the earth for self-interested ends. Instead human beings need to recognize and achieve a deeper understanding of our relationships in the community of life and the ecosystems we inhabit. Leopold's prose is remarkably fresh and direct, and his writing is informed by his exceptional powers of observation and his profound understanding of natural systems. 

Book: Middlesex by Jeffrey Eugenides

Facilitator: Gretchen Case, PhD

The novel Middlesex is narrated by the fictional Cal, who began life identified as a girl but later identified himself as a man.  Cal was born with ambiguous genitalia, and through his journey to understand the complexities of living in an intersex body, the reader is invited to ponder the meaning of sexuality and gender.  Middlesex addresses biological and cultural contributors to Cal's state of being and shows us how he is treated by his family--recent immigrants from Greece to US--and by physicians eager to normalize his body.  Cal's story is set against a backdrop of changing norms regarding race and class in 1960-70s Detroit and its suburbs.  Jeffrey Eugenides won the Pulitzer Prize for Fiction in 2003 for this sharp and poignant story. 

Book:  Tiger's Wife by Tea Obreht

Facilitator: Rachel Borup, PhD

Tea Obreht’s novel, The Tiger’s Wife, follows the story of a young doctor, Natalia Stefanovi, who is trying to both care for children orphaned by the recent war in her unnamed Balkan homeland and solve the mystery of her grandfather’s recent death. Along the way, she is forced to reflect on the effects of war and the enchantment offered by her culture’s ancient folklore, most powerfully the tales of “the tiger’s wife” and “the deathless man.”  Obreht was named one of The New Yorker’s prestigious 40-under-20 in 2010.