Reading Guide: Medical Humanities Part 2, Conflict

Medical Humanities Curriculum

The experience of illness is both universal and specific. Each of us will at some time become a patient—experience an illness or disability that may be acute or chronic, mild or life-threatening.  All of us will experience sickness and death of a loved one. Some of us—doctors, nurses and other medical professionals—interact with illness from “both sides of the stethoscope.” The impact of illness on us as individuals, in our relationships to one another and in the broader socio-political context cannot be underestimated. 

Illness narratives, stories and poems that bring these issues to light provide a useful teaching tool. This reading guide is based on The Best of the Bellevue Literary Review, published by the Bellevue Literary Press. These readings provide a framework for considering the illness experience from a variety of perspectives.  This reading guide will be useful for teachers of literature, ethics, medical/nursing students, social workers, as well as for health care professionals, adult continuing education courses, general reading groups, and anyone interested in thinking more deeply about literature of the human body.

Part 1–Initiation–includes sections on Patients, Doctors, Coming of Age.
Part 2–Conflict: Grappling with Illness–includes sections on Disability, Coping, Madness, Connections, Family.
Part 3–Denouement–includes sections on Mortality, Death, Loss, Aftermath

Written by: Danielle Ofri , Ruth Oratz , Harold Horowitz,  Jerome Lowenstein , Suzanne McConnell , Frances Richey, Kathryn Coffman , Marylu Ekiert , Meghan Holeman

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PART II: Conflict: Grappling With Illness

DISABILITY

The Facts by Mark Rigney

1. What are the unspoken meanings of the line “I’m a big boy now…”?
2. What does the “walk” around the lake mean for each of the characters?
3. Were Maurice and/or Kaylie responsible for Lewis’ death?
4. Did Lewis commit suicide?
5. Discuss the author’s comments about the “newspaper reporting” point of view about Lewis, Maurice, Kaylie. 
6. How does the author reveal information about the characters and events?
7. Is there foreshadowing in this story?

Forgettery by Rachel Hadas

1. What happened to the poet? To her voice – spoken, written?
2. The language “lands on its feet” — did the poet? 
3. Has her quality of life been diminished, enhanced or left unchanged?
4. Comment on the last line “I could have been in search of nothing and found just what I was looking for.”
5. Discuss these words: “forgettery” and “obliviousness”

The Absolute Worst Thing by Seth Carey

1. “Laughter and denial are the tools that make living with this nightmare possible.” Is laughter denial?
2. Is denial a bad thing?
3. What is your absolute worst thing?
4. What tone does the author adopt in telling his story? Does this make you empathize more or less with him?
5. Discuss these 3 things: cats, mosquitoes, hugging your wife
6. What is the lesson of this story? Do you agree with author’s point of view? Would you have the same reaction to The Absolute Worst Thing you could think of?
7. Has the writer come to peace with his situation?

Sentence by Barbara Lefkowitz

1. Discuss the meaning of the title.
2. What is the “round black lacuna that will replace forever the middle of this page”? Do you know the poet’s diagnosis?
3. Is there really certainty about prognosis?
4. Has the poet come to peace with her situation?
5. How do we prepare for future disability?

Pain by Stephen Dixon

1. Who is disabled?
2. Who is sick and who is well?
3. What happens when the caretaker becomes ill? 
4. Does it make a difference if your caretaker is a family member or a health care professional?
5. Did you think the wife was sick at the beginning of the story ? the middle? the end? How did her illness change in relation to her husband’s health/illness?
6. How did you feel at the end of the story?

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COPING

Revelations by David Shine

1. When a person becomes a patient, describe some of the levels of fear that he/she may experience.
2. How do health care givers’ fears affect their relationship and communication with patients?
3. In your experience, are fears regarding medicines and surgery adequately handled by the health care system?
4. Describe how the “resolve of the device” contrasts with our more human foibles and how this may affect a person psychologically.

The Little Things by Joan Malerba-Foran

1. Does the protagonist sound her stated age? Why or why not and are you surprised?
2. Do you feel that the “counselors, therapists, and psychologists” have missed the protagonist’s underlying problem with alcohol while focusing on more ancillary ones?
3. Do you believe that the protagonist has a handle on her problem or, is she in a state of denial?
4. Does the author sympathize with the protagonist? Students? Who do you sympathize with, and why?
5. What does the author mean when she writes, “Tonight I’m going to do a planned drunk, the second hardest thing any professional drinker can attempt.” (pg 124)? What is the hardest thing?

Writing Poems on Antidepressants by Nikki Moustaki

1. Do you believe that “love is a type of madness”?
2. How does the author view the creative process and how is it impacted by the therapy for depression? Do you think that the author believes that the trade-off is worth the treatment?
3. How does an individual try to determine which treatments should be considered in the face of adverse reactions due to treatment, the severity of illness, the chance of cure?
4. Describe the major elements of irony in this poem.

The Bald and the Beautiful by William Bradley

1. Why does the narrator like soap operas?  
2. How does the narrator present his views of soap operas, to his fiancé and to the reader?  Are the methods humorous? Serious? Critical?
3. Is the narrator’s emotional investment in soap operas a form of escapism? Denial?  Does this investment ultimately help him or harm him?  
4. What differentiates “highbrow” and “lowbrow” art? How do the merits or flaws each relate to life in general and to the narrator’s situation in particular? 
5. What is the relationship between the narrator and his fiancé?  Do they deal with it differently?  
6. How does the narrator’s fiancé view soap operas? 
7. What is the author saying about the line between fiction and reality, between art and life?   
8. Are patients hesitant to be optimistic? Are physicians hesitant to use humor?

In the Hospital by David Lehman

1. What type of hospital is the author referring to? Is it relevant to this poem?
2. What does the author mean when he writes “Denmark wasn’t a prison or brothel, it was a hospital”?
3. How is the perception of time changed when a person is hospitalized?
4. What is the reference to Freud about in this poem?

How Suffering Goes by Melisa Cahnmann

1. What is the title of the poem referring to?
2. How do you think the girl perceives her mother? What does she feel about her and how does she cope with the problem?
3. Do you feel that the monkey metaphor is a successful device in this poem?
4. Is the mother’s sickness real or imagined?

Postoperative Care by Arlene Eager

1. Transformation through illness is a common theme in literature. Describe the ways in which this poem explores transformation.
2. Does detachment serve a positive role in dealing with illness for the patient?
3. Discuss the metaphor in the poem.  How does it reflect the speaker’s feelings about herself, her body, her treatment, and those who “cared” for and operated on her? 
4. What is the tone and the meaning of the first line “Glad to be alive”?
5. What is the interplay between the speaker’s physical confrontation with herself in the mirror and the way in which she regards herself psychologically/emotionally?  Is there a disjunction of sorts?  How so?   

Midnight in the Alzheimer’s Suite by Floyd Skloot

1. How does the poem illustrate the difficulty of converting intention into action?
2. Are there positive aspects to dementia?
3. Is the struggle to “maintain her poise” a metaphor?
4. Do we infantilize older, demented patients?
5. What is the most powerful image in the poem?
6. Is there any part that makes you “choke up”? Why?
7. The poet uses very simple language; there are no fancy or flowery phrases. Why is the poem so powerful?

Flu Shot by David Watts

1. Did the wife forgive the physician?
2. Is resolution without apology believable?
3. Was closure attained by either husband or wife?
4. Discuss the irony of the title and the medical lapse described in the poem?
5. Do you believe that the wife should sue the doctor?

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MADNESS

The City of Light by Sandy Suminski

1. The author writes, “It is the most real I have ever felt. Only in this intense light can I truly now live. Yet I realize the price of this—a certain isolation from the merely earthbound…” (137) Does this justify rejection of medical treatment by some writers and artists?
2. Was Ann negligent in leaving the protagonist alone? 
3. How does mental illness affect relationships of friends and family members?
4. Do you feel that the protagonist was taken advantage of by Nikolai? In your opinion, is this a prevalent problem in the lives of the mentally ill?
5. Why do you think that delusions and hallucinations related to religion are so prevalent among the mentally ill?
6. Does a physician need to “understand” in order to treat?

Bellevue by Julia Alvarez

1. Is the threat of “I’m going to Bellevue” an empty one?
2. Is the mother really ill or simply looking to control her children and perhaps express her desire for a break?
3. How do the threats of abandonment affect the lives of children?
4. Does our society provide enough support for single parents with little money?

Shaking the Dead Geranium by Harriet Rzetelny

1. What are some of the “survival” mechanisms noted in this story that families of the mentally ill employ?
2. Describe the role of guilt in this story (mother’s and daughter’s) and how the feeling of guilt plays out in the families of the mentally ill.
3. What does the author mean when she writes, “His mind is like an old suit of once-excellent quality, that has been patched and re-patched with odd pieces of material that don’t quite go together, kind of like a crazy quilt” (144)?
4. What does the protagonist feel when she states that “my love is inadequate to protect him” (146)?  Do you believe that this is a common theme for family and friends of the mentally ill? What about for family and friends of people with other illnesses?
5. Does the protagonist make the right choice at the end?  Will this lead to a change in lifestyle?

Thanksgiving: Visiting My Brother on the Ward by Peter Schmitt

1. Discuss the theme of betrayal that patients with psychiatric illness often feel, as noted in this poem and in the story “Shaking the Dead Geranium.”  How does this play out on the family?
2. Describe the “relationship” that patients with mental illness have with their medications. Are the medications perceived as friend or foe and why?
3. What is meant in the poem by “Have you gotten what you came for?”?

Overblown by Hal Sirowitz

1. Who is speaking in this poem and to whom?  What kind of tone is used?
2. What message does the therapist impart to the patient?  
3. What message does the representation of the therapist’s voice impart to the reader of the poem?  Is there a critique involved?  What is being criticized and how?    
4. Is there an implicit message directed at the therapist?  
5. How does the patient feel about the therapist?  How does the therapist make the patient feel?    
6. What effect does the monological nature of the therapist’s speech produce?    
7. In reference to the title, what is meant by “Overblown”?  What is overblown and by whom?  

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CONNECTIONS

Songs from the Black Chair by Charles Barber

1. Have you had the experience of being given “official terminology” for patients which don’t fit?
2. What do you think of the line “they may be mentally ill but they’re not crazy?”
3. What can be learned from the narratives of men like Leif and Richie?
4. The author speculates that Leif’s wildness might have served him well a few thousand years ago. Are there aspects of mental illness that are only “illnesses” in particular contexts?
5. Leif says, “I gotta keep moving. Death is being static.”  Why is “traveling” such an ingrained reflex? Is it a metaphor for anything? 
6. Comment on the contrast of Richie’s attitude and the author’s “official duties.”  
7. Why does the author describe his work as “strangely and cruelly exhilarating?”

Psychotherapist at the Landfill by Lou Lipsitz

1. What does the author mean by “detective of dreams”?
2. Does the author reach closure at the end of the poem?
3. Can one read this as a coming of age poem? If so, how and in which lines is this theme prominent?
4. What is the “long initiation through the comradely, lonely stinging sweat lodge of the years” referring to?
5. Overall, would you say that the author is contented with his life?

The Caves of Lascaux by Miriam Karmel

1. Is it ethical to leave patients in the dark as is written in the first paragraph?
2. Does the portrayal of the doctor’s anxieties regarding telling Nora the news of her breast cancer paint him in a favorable light? Do you think that such anxieties are commonplace for physicians or are most doctors too detached for such emotional attachment?
3. Is Lawr really in love with Nora or in love with the idea of her? Is it common for physicians to feel love for their patients? If so, how might this play out on the doctor-patient relationship?
4. Do you think that it is possible for physicians to keep their work in the workplace? What effects does the introduction of their work life into the home have on the family life of physicians?

Surgeon by Sharon Pretti

1. How does the speaker represent the surgery?  Does it seem like something invasive or something healing?  What language, what tone and metaphors would support your interpretation?  
2. The narrator projects into the mind of the surgeon near the end of the poem. What kinds of sentiments are revealed (with respect to the surgery itself, the patient, the patient’s family)?
3. How does the speaker feel towards the surgeon and the surgeon’s skill/methods/role?  How does she react to the surgery?  Does she react at all, or is she only observing?   
4. How has the surgery affected the narrator’s father and the way she feels about him?  (Think specifically of the language of exchange in the line “After she returns him.”)
5. The poem is silent about the outcome of the surgery, emphasizing instead the surgeon (note the title), as well as the process of the surgery itself.  Why do you think the poet made this choice in terms of content?  What kind of message does it send?  What kind of atmosphere does it create? 
6. The poem is framed or presented in terms of a journey, particularly in the last lines.  Whose journey?  What kind of journey?  Where has s/he gone (metaphorically speaking)?   
7. What are the power relationships in the poem?   Do the power distributions shift?  What does it mean to represent a surgery in terms of a play of power?  

The Levitron by Robert Oldshue

1. Do you feel that the description of the nurses’ job at the nursing home is an honest and real one? Do you feel more sympathy for them having read this?
2. This story is packed with satire. Name several aspects of the health care system that are satirized. Is the use of satire successful here?
3. Do you believe that the author is misguided in his lack of conviction that technology is the way out of some of our most difficult medical-social problems?
4. What do you think is the major point of this story?

Miss Erma, Private Duty by Madeleine Mysko

1. What is the relationship between the nurse and her patient?  Does she care for her?  How?  
2. What is the interplay of sight and blindness?  How are they conveyed (beyond merely physical blindness)?  What does the speaker see?  What does she not see?  Do we ever get a glimpse inside the mind of Mrs. Carlisle?  If so, then how?  If not, then why?
3. Discuss the metaphor describing the trashcans in the rain.  
4. What’s the effect of time and setting in this poem?  

Biofeedback by David Milofsky

1. What do you feel is the theme of this story?
2. Is the protagonist Sylvia a likeable character? Why or why not?
3. Why do you think that Sylvia connects with Dr. Nygaard?
4. How does a patient’s preconceptions of what a physician is supposed to be color their view in any particular patient-doctor relationship? Does “Biofeedback” make any judgments regarding this? If so, explain.
5. What does the divorce theme and Sylvia’s realization that she needs to be away from her husband add to the story?
6. Do you think that the author is asking the reader to generalize the beneficial effects of alternative therapy other than biofeedback?

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FAMILY

Peeled Grapes by Sharon Olds

1. At the beginning of the poem, Olds lists those things for which she feels grateful to her mother.  How do these “gifts” differ in nature from the peeled grapes her mother hopes she hasn’t forgotten?
2. What kind of person emerges in the few lines Olds uses to depict her mother?
3. Do one of the following: draw her; describe her. 
4. Write an imaginary conversation Olds’ mother might have with a close woman friend, revealing the mother’s personality as gleaned from the poem.
5. Would you like her as your mother? Explain in a paragraph or two, including the pros and cons.  
6. Evaluate how you would feel about her being your own mother, including the pros and cons.
7. Olds uses the terms “said” and “mean” at the end of the poem.  How has she transposed their usual arrangement?  What does that convey to you?
8. How does Olds draw the conclusion that her mother conveyed “Be yourself?”  Can you draw the same conclusion from the evidence she provides in this poem?

Lily of The Valley by Emma Wunsch

1. The father, Henry, took care of his wife when she became ill, and after his wife died, had to learn how to cook for himself and his daughter, and raise her alone.  What do you learn about the father, from how he’s handled this? 
2. Locate the several instances in which the father tries to bring up his concern to his daughter about her lack of eating, but fails to do so.
3. There are several minor threads that weave through the story: the boy with the hole in his cheek, the father’s work on the physics textbook, the unusual Seattle heat.  How do these resonate and add girth to the central story? 
4. This story appears at first to be about Lily’s possible anorexia.  But the turning point is not in solving that problem: it is an internal realization that occurs in the father. Henry travels common emotional responses to a problem: denial, recognition, struggle, breakthrough.  This journey is similar to the plot outline of a story:  exposition, intensifying conflict, crisis or turning point, resolution.  What epiphany does the father have?  Were you surprised at this ending?
5. Although the title and use of Lily’s name is about “the valley” as in Los Angeles, consider her name and the story in light of the following Biblical verses (Matthew 6:29-34): “Consider the lilies of the field, how they grow; they toil not, neither do they spin. Even Solomon in all his glory was not arrayed like one of these. Take therefore no thought for the morrow: for the morrow shall take thought for the things of itself.” 
6. In the midst of their exchange, there are lines about perception: when Lily was little, her father showed her how perception can change by closing one eye, then the other, and she is doing it as they speak.  This is a detail, and may be overlooked.  But it is in the planting of such details that the writer’s work accumulates to work its magic on the reader.  How does this foreshadow Henry’s epiphany?  Can you find other such details?

Above the Angels by Phillip Levine

1. “It’s their life.”  What kind of life is the poet describing? 
2. There is a description of a painting of the angel Gabriel, in the poem.  What are the differences between that represented angel and the child who is described as an angel?
3. “In this world the actual occurs.”  What is ‘actual’ here?  List words that leap out as showing what’s actual.  What does the ‘actual’ exclude?
4. The poet asks:

 “…how can the life of an angel abide
 a Ford plant where the treasures
of the earth are blasted and beaten into items?”

          Levine is alluding to these New Testament verses (Matthew 6:19-20):  

“Lay not up for yourselves treasures upon earth, where rust and dust doth corrupt, and where thieves break through and steal:  But lay up for yourselves treasures in heaven…For where your treasure is, there will your heart be also.”

How would you answer Levine’s question?

The Liver Nephew by Susan Ito

1. Trace the conflicting pulls vying for Parker’s choice to donate, or not to donate, his liver.
2. Consider Parker’s character.  What kind of a person does he seem to be? Aside from his circumstances, is he convincing as someone who would consider organ donation? What kind of person would do such a thing, and what kind would not?
3. What has become more solid in his character by the end of the story?  What has come undone?
4. “Blood is thicker than water.”  Consider the validity of this folk saying from the point of view of Parker, his uncle, and his cousin George. 
5. What motivates George to tell his cousin the truth?  How might that be more believable?
6. Write about a time in your life when you felt especially vulnerable.  What decisions have you made out of that sense of desperation?
7. What are the risks of donating a liver? In this story, the doctors offer limited counsel to the nephew.  Should the medical team take more responsibility for who donates an organ?  

The Golden Hour by Sue Ellen Thompson

1. What is similar in the poet’s caretaking of her dying parents and her memory of caretaking her infant daughter? 
2. What advice does this poem offer caretakers about their own self-care?  What advice do you have, or wish you had gotten?
3. Notice images of space and freedom.  Notice images of enclosure, confinement.  What does the poem say about the terrible pull of love, its obligation and snare?  Does it conjure up any such pull for you?  Write about such an instance in your life.
4. Find rhymes, slant-rhymes (words ending in the same consonants), and alliteration.  Then locate words and line ends that are declarative, abrupt.  How do these two kinds of sounds conspire to assist the poems’ themes?
5. Locate—or imagine—a golden hour in your own life. Describe it in a paragraph.

So Much in the World is Waiting to be Found Out by Sariah Dorbin

1. Discuss the interplay between the narrator’s career life and her personal life.  How does each change as the story progresses?  How does the narrator feel about these changes?
2. The mother never speaks in this piece. Her personality, remains on the periphery, in the realm of the narrator’s memory.  How does this form of presenting character affect the reader’s vision of the mother?  What does it tell us about the mother and the narrator, and their relationship? 
3. Locate the moments when black humor appears in the story.  Why is it used and to what effect?   
4. The moments when the narrator must choose between saying “yes” or “no” reveal an interior dialogue that highlights a disconnect between what is being said and what is truly meant  How does this echo the mother’s condition?  What does the narrator say “yes” to, and what does she say “no” to?  What effect does it have on the narrator and her mother?  
5. Silence is just as powerful as speech in this piece.  Who is silenced and how?  
6. How does the narrator wrestle with issues of blame and responsibility?  
7. How is the world of advertising similar to, or different from, the world of medicine?

“Socks” and “Stubborn” by Meg Kearney

1. In “Stubborn,” how does humor serve the father and daughter?  How does it ease their mutual self-consciousness?
2. In these poems, the relationship of parent to child is reversed: the daughters minister to the father. How does the labor and intimacy of caring for the father in a physical way serve as a ritual of love as well as preparation for mourning? 
3. The poet uses two comparisons in each poem.  Find each.  Read each poem again without these.  How do these similes and metaphors contribute to the impact of the poems?  To their vividness? 
4. The daughter says she later steals the Gold Toe socks. Why would she steal them?  Why would the poet use “steal” rather than “take”?  Have you ever stolen anything for similar reasons?
5. In many countries families are encouraged to, or must, participate in a patient’s hospital stay: supplying blankets, food, being present in the examination room.  Please comment.