Julia Leigh’s Avalanche, a story of the writer’s devastating desire and struggle to conceive a child, is a slender memoir. However, the pages are richly packed with the details of her private hell as she spirals through cycle after cycle of in vitro fertilization. The challenge of reading this book, though, is a worthwhile one.  It is difficult to witness someone’s pain so intensely, but it is also an honor.

What Leigh exposes in her writing isn’t just the inner workings of our infertility zeitgeist, with all of its statistics, though the numbers are bleaker than the media would generally have us believe.  She makes tangible the emotional and psychological turmoil that those numbers create in patients who will cling to any sign of hope.  “In the last year, what percentage of women my age at the clinic had taken home a baby using their own eggs?” she asks.  “[The doctor’s] answer: 2.8 percent for 44-year-olds, 6.6 percent for 43-year-olds…What to do?  What to do?  Where does this stop?” 

 The heart of this book beats with raw honesty. Leigh’s acknowledgement, for instance, of putting her career before her desire to start a family: “I also said—it pains me now—that I needed to safeguard ‘my hard-won creative life.’  Why was I so quick to add any sort of caveat? Why did I set the two ways of being—motherhood, writing—at odds?” And of course, the sad, perhaps humiliating reckoning with the biological reality of her age: “When I reported back to my sister she frowned and said… ‘I hate to say it but the main thing is the age of your eggs so any extra hope is marginal.’”

 Avalanche is not a traditional a memoir filled with scenes and stories.   Leigh isn’t concerned with writing workshop rhetoric here, which means less time spent on the areas where most writers are told to focus: developing characters and settings and showing not telling.  She’s concerned with telling her truth. Her story is internal, psychological.  Of course there are external factors—her marriage and divorce, her career—but ultimately, the story moves away from these forces and becomes an all-consuming individual quest.  Less a book, more an extended essay of sorts, Avalanche isn’t divided into chapters.  It reads like a wistful film, perhaps a result of Leigh’s experience in script-writing, and it feels intentionally written to be read and digested in one sitting. 

The prevalence of fertility treatments in our world deems this book timely, but at its core, this is not a story of fad medical treatments or the contemporary female plight.  “What I try to hold onto,” she writes at the end of her journey, “is a commitment to love widely and intensely.  Tenderly.  In ways I would not have previously expected…After the avalanche, the bare face of the mountain.  Under the sun and the moon.”  Leigh’s story, while deeply personal and specific, strikes a far more universal chord: the desire to love, and to be loved, unconditionally; to find beauty and satisfaction in unexpected places; and to gracefully accept our individual narratives, even if they don’t play out the way we hoped or imagined them. —Holly Schechter

HOLLY SCHECHTER teaches English and Writing at Stuyvesant High School in Manhattan. She graduated from McGill University with a degree in English Literature, and holds an MA from Teachers College, Columbia University. She is active at Mount Sinai Hospital in New York City, where she received excellent care as a patient, and in turn serves on the Friends of Mount Sinai Board and fundraises for spine research. Her piece "Genealogy" appeared in the Fall 2014 Intima.




The Heart

The Heart by French writer Maylis De Kerangal is exactly what it says it is: a dive into the multitude of lives that surround an organ donation. Unflinching and stark, this novel takes its readers into every crevice of the process of donation. We travel down each vein, into the inner depths of the many lives that will be changed by this experience.

the heart.jpg

De Kerangal’s novel is clear in its support of organ donation, but simultaneously opposes our culture’s narrative of this procedure. Rather than showing the miracle of a donation, the readers are first shown the torturous decision-making process. We see the protagonist, Simon, in his brutal accident. We are shown another character, Thomas Remige, as he confronts his role as a clinician—he must be compassionate, yet objective, and convince the family without any form of persuasion. Time bends as we follow Thomas’s storyline. We are shown the exacting time limitations for the immediate needs of others, but also the necessary, deliberate slowing of time for the grieving family. While the benefits and decisions about the organ’s next move are instantaneous, the family’s time almost stops completely. Thomas is acutely aware of the memories that will be associated with the decision and the months and years that will impact the family’s choices, and he has no intention of making the family feel coerced into donating Simon’s organs through a rushed conversation.

In this way, De Kerangal’s depiction of the family perspective is brutally honest and open in every form. However, the family’s journey to making this crucial decision about donation respectfully encompasses their grief and their need for a simultaneous closure and continuation of life. We see the way their family is sewn together through the wreckage of tragedy. Not only does De Kerangal describe the emotional effects of organ donation, but she also brings a level of clarity to the physical act of harvesting organs.

Maylis De Kerangal

Maylis De Kerangal

That kind of examination allows the reader to shift from one space to another almost seamlessly, from the slow, muddled process of a family grieving and Thomas’s instantaneous and urgent messaging to the factual, the sterile, and the professional removal process. Combining these opposing attitudes and realities about organ donation immerses the reader into this messy and irreverent space. She has captured the essence of humanity and of the continuation of life within the death of this young man.

 In the end, the author moves the reader poetically and seamlessly into a new space—one of sacred mourning that once again underscores the sacrifice. The author completely turns the ancient practice of heart-burial on its head, revealing a modernized perspective that simultaneously saves lives and gives the highest respect to the dead. Rather than keeping the heart separately interred in a place of worship, the heart is now "interred" in the most sacred space it can be given: another person's body. The heart’s consciousness and soul are symbolically kept safe and "live on" and in this way, De Kerangal takes a practice that may seem unnatural to some and puts it in line with revered practices, reserved only for kings and poets.

The Heart is a perspective-changing experience. De Kerangal transports us to the depths of grief, situating us elbow deep in the bloody body of a teenager, and then brings us up to the stars, to the heavens, and ultimately to the frailty and beauty of life and death--Katelyn Connor

Katelyn Connor is a National Sales Associate at Penguin Random House. She completed her degree in Narrative Medicine in May, 2016.

Catching Homelessness


When I read Josephine Ensign’s piece in this spring’s Intima and saw she had a novel coming out soon, I immediately wanted to read it.  The book, Catching Homelessness: A Nurse's Story of Falling Through the Safety Net, published this year by She Writes Press, doesn’t disappoint.  Ms. Ensign brings her masterful crisp prose and extensive experience as a family nurse practitioner, writer and teacher to the issue of homelessness, and offers an engaging, informative and moving memoir.

Catching Homelessness begins with Ms. Ensign’s childhood growing up at a camp near a Civil War battlefield, “a landscape of ghosts and half-buried violence, covered in violets, punctuated by deep, abandoned wells.”  But the memoir’s main focus is Richmond, Virginia in the 1980’s, when Ms. Ensign was a newly minted nurse practitioner running a health clinic out of a homeless shelter.  Her perspective of the homeless changes from her initial view of them as “exotic, impoverished, foreign-to-us people,” to real people with real problems:  Lee, “dressed in several layers of hospital gowns, with the vulnerable air that clings to them,” who when dying of AIDS names Ms. Ensign as his next of kin; schizophrenic Louie, covered in head lice; pregnant Sallie with an IQ of 45.  Ms. Ensign changes our view too, reaching us on an emotional level with these and other precisely drawn characters.  We pick up a lot of knowledge along the way, not just about homelessness but also about the origin of the nurse practitioner role, the geography of Richmond and the lingering effects of its history.  We learn to empathize with the people drawn to serving the homeless.  

Josephine Ensign

Josephine Ensign

    As a young new nurse at the Richmond clinic, Ms. Ensign recalls, “I still wasn’t sure how far I’d go, what I’d risk catching in the name of compassion or health care duty.”  Run-ins with Richmond’s male-dominated medical establishment, disillusionment with her Evangelical Christian upbringing, and a failing marriage lead to Ms. Ensign’s own homeless crisis, an experience which enables her to bring a unique perspective to the issue.  By the end of the book, you feel you’ve read a good story and learned a lot too.  And you’re sure to take the advice she offers in the book’s comprehensive appendix, and respond to the next homeless person you meet with a smile and a kind word. -- Priscilla Mainardi

PRISCILLA MAINARDI, a registered nurse, attended the University of Pennsylvania and earned her MFA degree in creative writing from Rutgers University.  Her work appears in numerous journals, most recently Blue Moon Literary and Art Review and The Examined Life Journal.  She teaches English Composition at Rutgers in Newark, New Jersey.  Her short story “Pretending Not to Know” appeared in the Spring 2014 Intima.



Poetry In Medicine: An Anthology of Poems About Doctors, Patients, Illness and Healing. Edited by Michael Salcman

For more information about Poetry in Medicine by Michael Salcman, go to http://www.perseabooks.com/detail.php?bookID=115

For more information about Poetry in Medicine by Michael Salcman, go to http://www.perseabooks.com/detail.php?bookID=115

If the doctors cure

then the sun sees it.

If the doctors kill,

then the earth hides it.

—from "Doctors" by Anne Sexton


Most of us would not be surprised to learn Anne Sexton had written a poem entitled "Doctors." The confessional poet, who was raised in Weston, MA., was institutionalized throughout her life and often under medical care for depression. But many of us in the medical humanities might be stunned at just how many poets have addressed issues in medicine, as we discover in Poetry In Medicine, an in-depth, beautifully-conceived collection edited by poet and neurosurgeon Michael Salcman.

What makes this collection a pleasure to read—either from the inspiring foreward by poet Michael Collier to the index of poets at the end, or by dipping in and out of its treasures in a random fashion—is that Dr. Salcman has organized it in the most ingenious ways: There are chapters entitled, "The Wisdom of the Body: Anatomy & Physiology," "Contagions, Infections & Fevers," "From The Children's Ward," and "Looking Inside: Procedures, Surgical & Diagnostic." There are also simpler categories, like "Patients" and "Doctors and Other Healers." Work by Shakespeare, Ovid, Rainer Maria Rilke, Ogden Nash, W.B. Yeats, William Wordsworth, e.e. cummings, Elizabeth Bishop and dozens more populate the pages. Each of these writers have written poems that celebrate, anoint, critique, embrace, love or hate doctors, illness, suffering, medicine and healthcare.

Michael Salcman, photo graphed here at a reading in November 2015 at the Columbia University Medical Center to celebrate the literary & fine arts journal, Reflexions, is a poet, neurosurgeon, and art historian, formerly chair of neurosurgery at the University of Maryland and president of the Contemporary Museum in Baltimore. He is the author of six medical textbooks and six collections of verse, including The Clock Made of Confetti and The Enemy of Good Is Better.  Dr. Salcman reads the poem, "The Clock Made of Confetti" below.

Michael Salcman, photo graphed here at a reading in November 2015 at the Columbia University Medical Center to celebrate the literary & fine arts journal, Reflexions, is a poet, neurosurgeon, and art historian, formerly chair of neurosurgery at the University of Maryland and president of the Contemporary Museum in Baltimore. He is the author of six medical textbooks and six collections of verse, including The Clock Made of Confetti and The Enemy of Good Is Better.  Dr. Salcman reads the poem, "The Clock Made of Confetti" below.

There is Thomas Hardy's "A Wasted Illness," Walt Whitman's "The Wound Dresser" and C. P. Cavafy's "The Bandaged Shoulder" alongside Kate Kimball's "Transfusion" and my particular favorite, "Night Thoughts Over A Sick Child," by Philip Levine, which brought back memories of caring for my feverish son on a long, lonely midnight vigil. We are given topics as specific as "Colonoscopy Sonnet" by Sandra M. Gilbert about a medical procedure being done on the leader of the free world ("On the news tonight, a presidential/colonoscopy...") to more philosophical musings about death from Yeats in "A Friend's Illness":

Sickness brought me this

Thought, in that scale of his:

Why should I be dismayed

Though flame had burned the whole

World, as it were a coal,

Now I have seen it weighed

Against a soul?

Poetry in Medicine achieves many things, the primary one being a pleasurable read for anyone interested in literature. What seems additionally relevant for those involved in healthcare or teaching Narrative Medicine is the tremendous cache of writing Dr. Salcman has amassed that provides us with rich material— for study, for inspiration and for reflection and response.—Donna Bulseco

Scars: An Anthology. Edited by Erin Wood

For more on this book, go to www.etaliapress.com

For more on this book, go to www.etaliapress.com

For some two years, Erin Wood spent her time examining scars. As careful and probing as a surgeon, the writer and editor of Scars: An Anthology examined a wealth of poems, photographs, and prose about the subject and handled each person's revealing narrative with the emerging understanding that "there is a great deal about our scars that extends far beyond the individual body and the self."

Wood, whose essay "We Scar, We Heal, We Rise" was a Notable Essay in The Best American Essays 2013 (it appears in this volume) reflects on the ways scars may "belong to different versions of ourselves: our past selves...or new selves, selves in transition, or even selves we wish to regard more fully."

Stories that address these issues make the collection a rich reading experience that at times can be intense and painful, but also enlightening and entertaining. There is a lot of humor alongside the humanity that's revealed, as well as insight into the clinical encounter, most notably in Sayantani DasGupta's "'Tell Me About Your Scar': Narrative Medicine and The Scars of Intelligibility." One of the most moving and insightful pieces in the collection is "The Women's Table," an interview with Andrea Zekis, who speaks frankly about her "gender confirmation surgery" and the scars, emotional and physical, created but also taken away during her transition. A photo essay by New York photographer David Jay, who began The SCAR Project, is a stunning look at those who show their scars frankly and with pride. And while many of the pieces in this book are personal essays and memoirs, it is the poetry— like Samantha Plakun's "Written In Stitches" and Philip Martin's "The Pry Bar"—that draws the reader in close to examine the beauty and personal history revealed in the body's terrain.—Donna Bulseco

On December 10,2015, Columbia University's Seminar on Narrative, Health and Social Justice presented "Scars as Art, Text and Experience" at the Faculty House, featuring Editor Erin Wood and contributors Kelli Dunham, Lorrie Fredette, Samantha Plakun, and Heidi Andrea Restrepo Rhodes. Marsha Hurst, who is a lecturer in Narrative Medicine at Columbia University and co-chairs the University Seminar on "Narrative, Health, and Social Justice" introduced the panel. Hurst is co-editor with Sayantani DasGupta of Stories of Illness and Healing: Women Write Their Bodies. Listen to the event in its entirety below:

Last Night in the OR: A Transplant Surgeon's Odyssey by Bud Shaw, M.D.


There’s a revelation that comes about halfway through Last Night in the OR: A Transplant Surgeon’s Odyssey by Bud Shaw, M.D. The title leads you to believe you’ll be reading a medical memoir, a genre that has drawn a lot of attention recently with fine books by Henry Marsh (Do No Harm) and Atul Gawande (Being Mortal). Dr. Shaw’s new book traces his evolution from an impressionable 31-year-old surgical resident in Utah through his years of training in what was then the relatively new field of liver transplantation, as well as other significant life events—marrying, divorcing, being fired, undergoing treatment for lymphoma, and getting older and shifting into a new life as a writer. Along the way, we meet the kind of characters you might encounter in a novel: Renowned transplant surgeon Dr. Thomas E. Starzl, one of the most ornery, foul-mouthed, caustic human beings you’d never want to entrust your life to—except for the fact that he was brilliant, fearless and demanded the best out of his team: the taciturn and efficient Dr. Shun Iwatsuki, Dr. Hong from Shanghai (dubbed the Human Retractor for his skill at retracting a patient’s rib cage out of Dr. Starzl’s way), Dr. Carlos Fernandez-Bueno, and Shaw. We meet many patients, in chapters with titles like “Janie and the Giant Abscess,” “Death 5, Mrs. Rothstein l” and “Burned Yolanda.” Shaw’s father, also a doctor, is a major presence, and the emotional thru-line of a father-son relationship complicated by a shared vocation is finely drawn.

Author Bud Shaw, M.D. The father of three adult children, Shaw lives with his wife, novelist Rebecca Rotert (Shaw), in the wooded hills north of Omaha, Nebraska. Check back in January for an interview with Dr. Shaw on Intima.

Author Bud Shaw, M.D. The father of three adult children, Shaw lives with his wife, novelist Rebecca Rotert (Shaw), in the wooded hills north of Omaha, Nebraska.

Check back in January for an interview with Dr. Shaw on Intima.

So here is the revelation: Medical humanities has found its Raymond Carver. Dr. Shaw’s writing is a true departure from the other brilliant books in this genre because of the distinctive way he tells his stories. His writing is taut, spare and direct, but also gracefully nuanced. We feel we’re getting a factual accounting of events, but also the bigger, more symbolic picture of a time and place and the lives within it. There is a visceral recognition of the physical and psychological toll exacted on physicians and the real fears associated with a job that deals with life and death on a daily basis. Yet, thankfully, the writing never succumbs to sentimentality or philosophizing. Like Carver, Dr. Shaw lays out the Big Issues by making the little worlds we live in alive and real on the page.

Here’s how the chapter “Good Opera” begins:

On the table lay a man from Kansas. He had a wife, two daughters under five, and a bad liver. He had a belly full of fluid, skin glowing like a pumpkin, and a nest of veins like snakes between my knife and his liver.

I looked into the eyes of four surgeons scrubbed and waiting to help me. Shun was in the lounge smoking. He’d helped me do dozens of transplants by then and he figured I’d call for him if I got into trouble. Hong, the Human Retractor, grinned at me. I asked for the knife and we began.

As with any medical memoir, expect a few squeamish moments (that is, if you’re not a clinician used to talk about fluids, blood, diseases, etc.). Expect, also, to be moved by a doctor’s tales, expressed succinctly and with great depth and feeling.—Donna Bulseco

DONNA BULSECO, M.A., M.S., is a graduate of the Narrative Medicine program at Columbia University and Managing Editor of Intima: A Journal of Narrative Medicine. After doing undergraduate work at UCLA in creative writing and American poetry, the L.A. native studied American Gothic and English at Brown University, then moved to New York City in the late seventies. She has been an editor and journalist for the past 25 years at publications such as Women's Wear Daily, W, Self, and InStyle, and has written articles for Health, More, Redbook, and the New York Times.