In her second collection, “I Watched You Disappear” Silver’s poems invited us to accompany her on her journey through treatment, anger, despair, determination, and faith. This third collection (her penultimate) continues the author’s beautifully written illness narrative, again presenting moments of joy and of despair, and always of hope. 

Silver places her title poem, “From Nothing” (pg. 1), before Section I as an epigraph to the entire collection. “Each death I witness makes me more my own,” she writes, and although the poem sees “muscle shredded” and “bone sheared,” the poem’s last lines lift, as do many of Silver’s poems, into hope and faith: “and my molecules will vault, emerging. / From darkening days, the light will surge and flee.” Section I begins with poems of memory–“Summers in Vermont” with her family (pg. 5)–and “Coincidence,” when her sister’s child is born on the same day that Silver holds her breath and presses her “shorn chest” to an X-ray machine (pg. 7). The memories here are of family moments, both the joyful and those tinged with such “darkening days.” In “Luzerne,” she recalls when time was “consigning” her to such darkness, but two things saved her: her son, the poet’s hand touching his “damp blond hair,” and poetry, “offering itself like a pair of velvet shoes” (pg.13). Silver develops the idea of poetry as a special entity, a gift that enables her to walk forward in her journey, in “Raven” (pg. 15). She imagines a raven lifting her, holding her, and then setting her down in her home, where, she says, “dawn drove a pen into my hand.” This sense of urgency and necessity pervades all of Silver’s poems, as if she has been commanded to write her story.  

Section II begins in “Anguish” (pg. 19) a stunning poem about the loss of her first child, a daughter, but the section ends in joy with “After a Favorable PET Scan” (pg. 38). It might be difficult to find another poem by any author that offers such resounding relief and happiness. This poem, especially, speaks to how terrible every test is for those who are suffering, for those whose test results might mean more medication, more surgery, or less time to live. The celebratory release felt by patients when results bring good news must be a special kind of joy: “Oh world, I will give you all my love. / I will race like a child through the fields, / I will chase off the unkindness of ravens. / My words will grow thick as marshes, / sheltering nests in salty steams.” The poems in Section II are some of the most beautiful and moving poems in this collection. See especially “Tenebrae” (pg. 21), a plea for life; “Poise” (pg. 26), a rant against giving in to cancer; “Snow White” (pg. 30), a poem of mourning for self and others; and “Four Prayers for Forgiveness” (pg. 34-35), a poem that turns illness into beauty: “–the scattered lumps in my lungs / become church domes roofed in green mosaics, / my bones’ fissures fill in with grass-green yarn. / . . . I open my eyes and all is golden.” 

Section III seems to present a corrective reaction to the joy expressed in the final poem in Section II. The poems in this last section are short, mostly one stanza, a catalog of things that are broken, cracked, ripped, or chipped. The warning that nothing lasts forever is implied in poems such as “Partings” (pg. 44) and “Woman with a Hole in Her Stocking” (pg. 45), in “Red Never Lasts” (pg. 47) and “Autumn” (pg. 57). Yet, as always in Silver’s poems, the warning is tempered by the beauty of her words and the depth of her insight into what it is to suffer over the course of an illness that has remissions and recurrences, that sees the body changed and relationships altered. In “Ideal Speech” (pg. 58), she writes “Listen to the Holy Ghost. She blows through you, / she blows her poems right through you.” Even when days seem darkest, the ideal speech for Silver is poetry, and she is the “you” through which the Holy Ghost speaks these auricles. In the book’s final poem, “Three Roses” (pg. 59), the author once again works her spell, turning illness into beauty and despair into hope. “Where only my scar line remains, a red rose blooms. / Luscious, full, so open that if it dropped a single petal, / it would not be as lovely as it is this very moment.” And in the poem’s final lines, “Lay her hands on my chest–here, I give it to you. / Feel your palm on my skin heat and spark,” What is the “it” she gives us? I believe that Silver invites us, as Whitman did, to merge with her and to live within her words, which are her flesh, the poems she writes and then gives us to read and ponder.  

Miscellaneous 

In my annotation of Silver’s second collection, “I Watched You Disappear,” I wrote that her poems might be difficult for some to read: “These poems are beautifully crafted, often primal, and they touch the deepest reaches of personal illness and the shadow of mortality. Readers who have breast cancer or who have family or friends living with breast cancer, might find these poems difficult to read–others under the same circumstances might find them difficult and yet, at the same time, essential.” The poems in this collection can be as raw as they are hauntingly beautiful. But, as do her other books, this one again opens to us a world apart, one we cannot enter unless we share this author’s diagnosis and illness trajectory. If we are caregivers or care receivers, if we suffer or we watch loved ones suffer, these poems plunge us into emotions that we ignore at our peril.  

Publisher Louisiana State University Press 
Place Published Baton Rouge 
Edition 2016 
Page Count 65 

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database. 
Web image created by Medhum.org

Modern medicine’s emphasis on extending the human lifespan has, in some cases, transformed dying, once a communal and spiritual event, into a cascade of arduous procedures. Deftly synthesizing the wisdom of many experts with his own insights and experiences, Palmer offers compelling, accessible, and refreshingly honest advice on how to shape our lives and legacies so that we are better prepared to die as we see fit—highlighting agency in aging in the face of ageist norms. 

Just last week, New York Governor Kathy Hochul announced that the state will join 11 others and Washington, D.C., in legalizing medical aid in dying (MAID), or when physicians prescribe a lethal dose of medications to patients with fewer than six months to live. 

“New York has long been a beacon of freedom,” Hochul said, “and now it is time we extend that freedom to terminally ill New Yorkers who want the right to die comfortably and on their own terms.” 

The governor’s rhetoric emphasizes a collective cognitive dissonance: As physician (and fellow politician) Dan Morhaim observes, “our culture celebrates personal autonomy,” but when it comes to death and dying, “we collectively abdicate” that value. 

Citing Morhaim and others, Palmer provides valuable context for our relationship with mortality (along with additional information about MAID). During the nineteenth and early twentieth centuries, the average death was relatively quick and happened at home, with little involvement from healthcare providers and medical technology. Today, dying is protracted and tends to take place in hospitals or nursing homes; healthcare providers and medical technology are highly involved; and life can be prolonged with organ transplants, chemotherapy, and more. 

“There is a significant difference between dying peacefully in your bed at home and dying yoked to tubes and machines in an ICU,” Palmer writes, “receiving futile care that only prolongs the dying process for perhaps a few days while providing a horrendous quality of life.” 

Drawing on surgeon Atul Gawande’s [1] work, Palmer argues that, at best, physicians are uneducated about aging and dying and what might matter to patients approaching the end of their lives. At worst, they are financially motivated to perform aggressive interventions that may do more harm than good.  

According to numerous studies, frail patients do poorly in hospitals, and Palmer points out that doctors nearing death tend to eschew the very treatments they give to their older patients, such as surgeries and radiation. 

“I don’t want my last conscious thought to be of doctors stabbing needles into my veins, my ribs breaking from chest compressions, and a large-bore tube thrust into my throat and lungs,” the end-of-life activist writes. “When a patient is young and robust, such curative measures may make good sense despite their violence, but not for an old, debilitated, frail patient.” 

But we have choices: “where to die, how much treatment to have, and how to spend the limited time we have left.” 

“While, in a real sense, no death is ever ‘good,’” Palmer underscores, “planning and preparation can make death less awful and painful.” 

Legislation to make MAID available to the terminally ill is one step in that direction. However, critics argue that MAID may endanger the elderly and disabled, who might feel pressured to end their lives out of fear of causing hardship to their families. Opponents also contend that such policies reinforce the toxic notion that a life with a disability or chronic illness is not worth living. Also, some individuals may seek MAID due to high treatment costs, but MAID should not substitute for accessible care and support. 

Racial inequities in healthcare are also relevant; Black people might opt for MAID because they are more likely to receive inadequate pain management due to stereotypes that they are drug-seeking or pain-tolerant.[2] Palmer could have engaged more fully with these valid concerns. Fortunately, the Medical Aid in Dying Act in New York has a number of guardrails meant to ensure the patient’s decision is informed and voluntary, including a conflict-of-interest prohibition and a mandatory mental health evaluation. 

Well before we are terminally ill, we need to be having routine conversations about dying with our loved ones and physicians. To that end, Palmer endorses The Conversation Project. He also suggests creating an advance directive, or a legal document outlining your healthcare wishes, and choosing a healthcare proxy—not necessarily your closest relative—when you’re young or in good health. One way to think about your healthcare wishes is to complete the sentence “I would want to live as long as I could still…”, as recommended by physician Eleanor Tanno. Another is to consider an “exit strategy,” or an illness for which you would decline treatment.[3] 

Some other tips from Palmer for a “good” death: 

• Write a personal mission statement; letters of gratitude to loved ones; and legacy letters, also known as ethical wills, that capture your essence, beliefs, and stories to pass on to future generations. 

• Make a folder containing everything your children must handle when you die. 

• Join a “village,” or “virtual retirement community.” 

The author also illuminates the benefits and limitations of palliative and hospice care, delineates various eco-friendly alternatives to embalming (reader: as of writing this, I’d like to be affordably composted), and presents ideas for making funeral and memorial services more substantive—and even fun. 

Achieving a Good Death is a touch dogmatic, but Palmer demonstrates in the book’s rich appendices that he practices what he preaches. In a letter to his family about his own end-of-life wishes, he shares the pain of witnessing his mother’s final years in a nursing home: “I want to prevent what happened to her from happening to me.” 

“If my mental function is seriously compromised with little chance for full recovery, please seek opportunities to encourage death’s approach… Are my kidneys faltering? Let them,” he writes, giving new meaning to author Mel Robbins’ self-help concept. 

The book’s main flaw—one the author himself acknowledges—is that it is primarily aimed at those with friends and families. Readers without such connections may feel less comforted than grimly recognized by Palmer’s planned memorial service playlist featuring the Beatles’ “Eleanor Rigby.” 

Ultimately, Achieving a Good Death is a stimulating must-read for mortals that will leave you equipped for a more peaceful, dignified, and meaningful end. 

Achieving a Good Death: A Practical Guide to the End of Life
Chris Palmer
Rowman & Littlefield, 2024

[1] Gawande, Atul. Being Mortal: Medicine and What Matters in the End. Metropolitan Books, 2014. 
[2] Substance Abuse and Mental Health Services Administration. The Opioid Crisis and the Black/African American Population: An Urgent Issue. Publication No. PEP20-05-02-001, Department of Health and Human Services, Office of Behavioral Health Equity, 17 Mar. 2020, samhsa.gov/sites/default/files/meeting/documents/csap-nac-presentation-03172020.pdf.  
[3] Harrington, Samuel. At Peace: Choosing a Good Death After a Long Life. Hatchette, 2018. 

Web image by Medhum.org.

Egon devotedly cares for his sick wife despite her warning, “You will get it from me” (p111). Soon she is unresponsive. As Egon listens for a heartbeat with his ear against Edi’s motionless chest, he can only auscultate the distant, faint beat of his unborn child’s heart that is quickly silent. He tragically describes Edi’s corpse: “Her body being both cradle and coffin, within a minute” (p128). Egon feels compelled to make multiple sketches of his dead wife. 

Before long, Egon experiences harsh bouts of coughing, fever, and chills. He becomes remorseful about the drawings he made of Edi and burns them in the kitchen stove. Egon gazes at the fire, knowing he too will die shortly but aware that he will be survived by all his other artwork. 

This short story imagines the final days of Austrian painter Egon Schiele and his pregnant wife Edith. He died at age 28, just three days after she passed away, both victims of the 1918 influenza pandemic. 

A stunning and sorrowful re-creation of what the end of life might have felt like for a young husband and his expectant wife during the 1918 pandemic. The tale highlights the risk of love, the inescapable weight of dread, and the connection between creativity and illness. 

Primary Source 
Blank Pages and Other Stories (pp105-138) 

Publisher 
W.W. Norton & Company, New York, 2022: 34 pages 
A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.
Web image by Medhum.org

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For more than twenty years, Dr. K worked in a hot town in the Middle East yet never got to know or understand its people. His only friend was a troubled hospital anesthetist, Biju. Dr. K was employed by the local hospital and assigned to the Accident and Emergency department. The hospital administrator, Sir Farhad (a man Dr. K feared and revered) was an enigmatic figure of authority. Dr. K was obsessed with accumulating wealth. When Farhad offered him an opportunity to earn extra money, Dr. K had no qualms accepting the new part-time position: punishment-surgeon. He would supervise criminal sentences requiring physical mutilation that were imposed by a judge. 

Biju sarcastically told his friend, “You are at the cutting edge of your profession, Dr. K” (111). Yet there was no humor or humanity at presiding over the amputation of the hands of a father-son team of thieves or a maid convicted of stealing jewelry who underwent a similar clinical maiming. The hospital routinely accepted these “punishment cases” referred from the Corrections department and constructed a special operating theatre on the top floor for these “special ops.” Over a decade, Dr. K figured his involvement in this injurious punishment amounted to at least twenty cases.  

Raucous Biju gets accused and convicted of stealing drugs from the hospital. His penalty was removal of a hand. Dr. K pleaded on behalf of Biju with the hospital administrator but to no avail. Dr. K was not convinced of Biju’s guilt and would not participate in the amputation of his friend’s hand. Dr. K resigned his post as punishment-surgeon and eventually settled in England with plenty of money for a comfortable albeit lonely life.  

This disturbing and at times dastardly story displays more than a slight hint of Franz Kafka’s influence including the brutal application of “justice” and a byzantine bureaucracy. Even the physician-narrator’s nickname, Dr. K, appears to be a nod to Kafka.  

The novel illustrates the personal and professional downward spiral that can occur when empathy and morality are subjugated to the pursuit of wealth and status. The story raises troubling questions about the participation of doctors in the legal system’s punishment of criminals.  

The reliability of the narrator is tenuous. He may be in denial or perhaps his memory has grown fragile and corrupted. Remorse seems mostly absent. The story warns of the preponderance of lies we tell – to oneself and to others. Dr. K will not be mistaken for a model doctor or a good man. He has participated in hideous acts of cruelty, been an absent father, and placed the acquisition of money as his main priority. The opening line of the novel is a blunt confession and a succinct conclusion: “I did it for money” (3).

Tell Her Everything
Mirza Waheed
Melville House, Brooklyn, NY, 2022: 234 pages 
A previous version of this review was published in the NYU Literature, Arts, and Medicine Database. 
Web image by Medhum.org

Book Launch at the Lahore Literary Festival: 

This thought-provoking poem is best read with a representation of the painting to which it refers in view (the painting, Landscape with the Fall of Icarus by Pieter Bruegel, is reproduced in On Doctoring). Auden considers the nature of human suffering: “how it takes place / While someone else is eating or opening a window or just walking / dully along . . . . ” For each individual life affected by personal catastrophe (in the painting, Icarus falling from the sky into the ocean), there is the rest of humankind which must go about its daily business, either oblivious or unable to assist (in the painting, Icarus might almost be overlooked, flailing in the lower corner of the picture while the ploughman in the foreground has his back turned). Life, and death go on although the sufferer, and sometimes those who are paying attention, find this inconceivable. And what about the ship “that must have seen / Something amazing” but “had somewhere to get to”? What is the context in which suffering is noticed, what obligations exist, what can and cannot be remedied?

Source Collected Poems
Publisher Random House
Edition 1976
Editors Edward Mendelson
Place Published New York
Alternate Source On Doctoring
Alternate Publisher Simon & Schuster
Alternate Edition 1995, 2001
Alternate Editors Richard Reynolds & John Stone
Place Published New York
First published 1938

Image of Landscape of the Fall of Icarus from wikicommons
A previous version of this review was published in the NYU Literature, Arts, and Medicine Database (Litmed).

As The Ghost Road begins, Prior has been cured of shell shock and is preparing to return to the front in France. Rivers takes care of his patients and his invalid sister, amid memories of his experience ten years earlier on an anthropological expedition to Melanesia (Eddystone Island). He befriended Nijiru, the local priest-healer who took Rivers on his rounds to see sick villagers and also to the island’s sacred Place of the Skulls.

Rivers entertains very un-British thoughts about the morality of these headhunting people, and about the power of symbolic healing. As these thoughts intrude upon his consciousness, Rivers is himself in the process of curing by suggestion a soldier with hysterical paralysis. Meanwhile, Billy Prior returns to the front. It is the autumn of 1918 and the last inhuman spasms of the war are in progress. In a futile battle that takes place a few days before the Armistice, Billy and his friend Wilfred Owen are killed.

To me The Ghost Road, which won the Booker Prize in 1995, is the most gripping and fastest paced of Pat Barker’s trilogy. The first two novels are Regeneration (1991) and The Eye in the Door (1993). As W. H. R. Rivers reflects on the culture of death on Eddystone Island, World War I, a culmination of the culture of death in Europe, grinds to a close, taking with it the poet Wilfred Owen. Of course, the characters in The Ghost Road are unaware of the new heights (or depths) that the culture of death will attain later in the 20th Century.

The Ghost Road
Pat Barker
Dutton, 1995
New York, 256 pages

Web image by  Claudio Carrozzo 

Mental Cases by Wilfred Owen

Carol Donley Aug 11, 2025

Owen’s stark poem portrays shell-shocked soldiers haunted by war, exposing both their torment and society’s complicity in their suffering.

In my four years of Canadian medical school, I can only remember being taught four clinical pearls specific to Chinese patients. The first two were epidemiological facts: Hepatitis B is endemic in China and Chinese people have a higher incidence of nasopharyngeal carcinoma than non-Chinese. The third was an observation, that Chinese babies are often born with a large, purple discolouration on their buttocks that fades with time. These discolourations were pejoratively called Mongolian blue spots. 

The fourth clinical pearl was the strange one. I don’t remember much about the classroom content of first-year medical school, but this moment sticks with me even now, two decades on. In ethics class, we were learning about the concept of patient autonomy, the concept that patients have the right to make choices about their own health care. At this point, the ethicist mentioned to us that in many Asian cultures, especially Chinese and Japanese, people chose to forego autonomy and informed consent when it came to elderly family members and end of life care. What she meant was that Asian families often withheld information about the nature of their parents’ terminal illnesses from them for fear that by telling them parents the truth, their parents would feel irrevocably sad or upset, and that this might even hasten the progression of their illnesses. Until that day, I had never heard of this issue of withholding information from elderly family members before. As a Chinese Canadian, I had taken it for granted everyone would want to know the truth about their health when the time came. 

A few months after that talk, I was at home and broached the topic with my father. 

“Dad, they taught us that Chinese don’t like to tell elderly people that they are dying in order to protect them. Have you ever heard of this?” 

“Of course. You didn’t know about this?” He raised an eyebrow and gave me a look, as if surprised at how little I understood the world. “For Chinese people, we don’t talk about these things. If you know you are sick and dying, then your sickness will be worse.” 

My father was a learned man. He was a PhD in economics and had lived in North America for more than half his life. I expected more from him. “So you’re telling me that if it was you, you wouldn’t want to know?” 

“Of course I wouldn’t want to know.” 

His answer startled me. I had known that we had some different conceptions rooted in our different backgrounds, but for some reason, this caught me by surprise. I had expected him to share in my discovery of something that I presumed was backwards, old-fashioned Chinese thinking. But now it turned out that he was exactly the person being described in the ethics handbook. How little did I know of the world? How little did I know of my father? 

I dug out my first-year ethics textbook the other day and found the specific passage in question. On the subject of autonomy and Asian patients, the author Philip C. Hébert explains: 

When I read the passage over now, I can’t help but find it jarring. For an ethics textbook, the passage does seem to make the assumption that the western way of autonomy is the only right way. I wonder why I didn’t feel that way when I read the passage the first time so many years ago. 

This specific issue, that of telling an elderly family member about their diagnosis, became the basis of The Farewell, a 2019 film directed by Lulu Wang starring Awkwafina and Tzi Ma. The movie was loosely based on events from Wang’s own family life, in which an elderly grandmother is unaware that she’s been diagnosed with lung cancer. In the movie, the grandmother’s extended family decides that they want to have one last big family get-together but they can’t tell her about her diagnosis. They plot an elaborate fake wedding for one of the grandchildren and use it as an excuse to get everyone together. The movie is told from the vantage point of Billy Wang (played by Awkwafina,) the Americanized granddaughter who loves her grandmother and doesn’t really understand why they can’t tell her the truth. 

By the end, the movie settles on making the point that although the Chinese way of not telling the elderly about the diagnosis is different from what Billy is used to in the West, it isn’t necessarily worse, and it might even have its own merits. 

The movie wraps up with a postscript that Wang’s grandmother in real life is still living happily a good six years following her diagnosis. The movie implies that by not burdening her with the truth, the family has managed to improve the grandmother’s quality of life for at least these last few years, and hints that they might even have possibly affected the outcome of her illness and helped send the cancer into remission by not burdening her with the truth about cancer. 

In my own medical career working with Chinese immigrant patients, I have witnessed versions of this issue arise on several occasions. Several times, I have been asked by well-meaning children that “should anything serious ever happen to my mother or father, please do not inform them of the situation.” 

Sometimes, the request is gentler. “If any really important bad news needs to be broken to the parents, please let me know first and then we can discuss what to do about it.” 

As I’ve come to understand it, the reason for the request is a combination of things. There’s the obvious, overarching cultural basis to it. Confucius may not have ever specifically addressed the issue of whether people should withhold life-threatening medical diagnoses from their parents, but he did repeatedly underscore the value of filial piety and how one’s loyalty to one’s own parents should in some ways exceed their loyalty to themselves. So, in a way, not telling our parents the truth about their own mortality is just a little white lie to ease help ease a loved one through one of life’s inevitable travails. At least they’ll feel better not having to worry. 

This leads to the second reason, the belief that knowledge of one’s own mortality will almost certainly worsen any medical condition and hasten one’s demise. Given our own modern understanding that stress can make health worse, it does make sense to presume that fear about one’s own demise, very likely the greatest stress of all, could have deleterious health effects on a person who is already ill. 

Finally, sometimes the reason for requesting us to forego patient autonomy is simple pragmatism. Maybe mom or dad are unable to handle stress even at the best of times and we already know they won’t take the news well. In this case, shielding them from the truth might make a lot of things go more smoothly. 

In any case, when I’ve been presented with this scenario, as a Westerner, it’s difficult to dial down the urge to sit the patient’s family down and start channeling American police and cowboy movies. I can just imagine myself putting my hand on my holster and informing them that, “Ma’am, this isn’t the way we do things around here.” 

In my early years in practice, this is pretty much how I approached the problem, by understanding it as a purely cultural difference, and assuming that the ethics underpinning autonomy and informed consent should have universal application to all patients, regardless of cultural background. My understanding was that if you were living in Canada, then you had better accept that you had to do things the Canadian way. In short: when it comes to medical care, this is how we do it here. 

With that in mind, I’d sit down with the family member and explain to them that while we respected that other cultures could feel differently about this issue, this wasn’t really the way it’s done in the West. Then I’d present a compromise. “How about I ask your parent a hypothetical question along the lines of ‘if something were to happen to you, would you want to know about it?’” 

I’ve done this on several occasions in my career, and without fail, each time the elderly patient would contemplate the question for a moment before shaking their head and deciding that that no, they were better off not knowing the truth. 

What’s the big deal about all this? What happens if Grandmother or Grandfather doesn’t know the truth about their own illness? Is it really such a big problem if their child makes all the major medical decisions for them while they exist in a state of unknowing bliss? Isn’t that not that different than how parents often approach major medical decisions for an infant or a small child? 

And what about patients who explicitly abdicate responsibility for their own health at the eleventh hour? If the parent specifically says that they don’t want to know about their illness, then what? What are the implications of them ceding responsibility for this portion of their life to their loved ones? 

On a very basic pragmatic level, the parent not knowing about their own medical illness throws a monkey wrench into the basic efficiency of the health care encounter. In the West, certain aspects of health care depend on the patient being able to make informed choices, or at least depend on them having the knowledge of their illness. 

Imagine attempting to go for surgery or chemotherapy but not actually knowing that you have cancer. Imagine furthermore, that all the nurses and doctors who talk to you, who know full well that you are dying, cannot slip up even once and tell you the truth about what you are facing because once they spill the beans, there’s no putting anything back into Pandora’s box. 

Treatment decisions that might normally just be a quick conversation with a patient, now need to be run by an intermediary. Doctor visits that take ten minutes now take twenty minutes as a result.  

Furthermore, the practical effect of withholding information doesn’t end with health care. It applies even beyond the medical aspects of end-of-life care. Estate planning, inheritances, all the things that give grieving families around the world even more grief, are much more easily dealt with if the person who is dying is able to say what they actually want done. Except they can’t, if nobody actually is allowed to tell them that they are dying. 

There’s also this aspect from the family member’s standpoint: when a person agrees to make all medical decisions for their parent, they are agreeing to take responsibility for some decisions that are essentially impossible to make, especially when it pertains to end-of-life care. Should we perform heroic, but most likely futile measures on your parent? How hard is it for someone, even if they’ve had a full discussion with their parent, to be willing to make these life and death choices on behalf of their parent? 

Perhaps I’m giving away my Western upbringing, but I still can’t help but feel that there is something inauthentic about withholding the truth. Imagine living your days in an imagined reality where you believe you aren’t actually very sick, but you are. Without this end-of-life discussion experience, the person who is sick, and very likely their children, are not able to emotionally share life’s final journey together. Since it’s a journey that we all have to take, and it’s well-accepted that a serious illness or death in the family is one of the most difficult and stressful things that anyone has to go through, it only makes sense that if we can talk about it as a collective, surely we could deal with it better together than going through it alone. 

In the West, we are proud to have come up with these ethical principles that define our medical care. We laud the principles of autonomy and informed consent and look down at cultures that do things a different way. But as I’ve gotten older, I’ve noticed that in fact, Eastern and Western ideas about this aspect of medicine are not as dissimilar as we might presume. Yes, it’s true that in the West, as doctors we make a point to talk to the patient about death. We’re not afraid to tell a patient they have cancer, and we’re not afraid to try to tell them that the end is near. But at the same time, we usually stop right there and don’t say much beyond that. 

What does it actually mean to be dying? How does that make you feel? Is it scary? Do you have any regrets? Is there anything else you would like to do before you go? How does it make your children feel? Is there anything we can do to help with any of this? These are not conversations doctors typically have, but they seem to be at the heart of facing death honestly and authentically. 

The fact is we’re mostly not trained as doctors to have these conversations. Quite frankly, I’m not sure that most of us even have these conversations at home with our own families. It’s too easy, most times, when faced with these end-of-life crises, for doctors to leap into problem-solving mode. That is, after all, what we’re best at. End of life care sometimes becomes a series of day-to-day crises to manage. You’re having difficulty getting up? We’ll bring in a wheelchair. Constipated? There are so many pills for that. In pain? Good thing narcotics have been invented. As doctors, we’re trained to reflexively problem-solve. But sometimes, maybe what people need as they face death, is just someone to be present, to listen, and to talk to. Death may be inevitable, but it can still come with catharsis. 

Fortunately, the culture of Western medicine is changing. Conversations around death have become more normalized. The development of palliative care, a relatively new field of medicine that has appeared in the last several decades, has certainly helped this process. When it comes to death and dying, medicine in both the East and West still has much to learn, but at least we are trying. Maybe we will get where we need to be someday. 

My father was diagnosed with Alzheimer’s dementia in 2013. Shortly after he was diagnosed, we were faced with the issue of establishing power of attorney and determining what to do in the event of end-of-life care decisions. At the time, his illness wasn’t that severe, and he was a pleasant, if mildly confused, sixty-eight-year-old. He’d even been driving up to a few months prior. 

So one night, at dinner at my mother’s house with my sister and me present, we took out the power of attorney paperwork and gathered around the dinner table with him. I remembered how he’d told me so many years ago that he wouldn’t want to know if he was suffering from a terminal illness, so I tried to explain to him that we weren’t asking him these questions because anything was imminent, but just as a precaution for the distant, distant future; we wanted to know his wishes in advance. We asked him that in the event he became incapacitated, what would he want us to do? Did he want heroic measures like CPR and being put on a ventilator? 

I still remember him looking back at us, sheepishly, like a small child. It’s impossible to know just how much he understood in that moment. 

He smiled and said, “I guess if it’s already that bad, you don’t need to do anything.” 

Then he got up and shuffled off to the living room. 

I breathed a sigh of relief. It was obvious that, demented or not, it was a conversation that my father had not wanted to have. And the same went for me. 

I never talked to him about his diagnosis again. 

Web photo by Alexander Grey

Additional Chapters from A Chinese City Doctor’s Notebook

When Your Body Isn’t Yours 

01.12.26 817

From Tigers to Otaku

09.16.25 1700

The Happiest Couple

07.28.25 1434

The Things We Don’t Talk About When We Talk About Dying 

05.13.25 2013

One Patient, Two Systems 

02.24.25 2701

Ingrid (played by Julianne Moore) finds out that her good friend from long ago has terminal cancer. Martha (played by Tilda Swinton) still lives near enough that Ingrid can visit her in short order, and she does. For Martha, Ingrid’s visit is welcome and well-timed; she is looking for someone to accompany her on her journey to her last breath. The plan is set. On the day that seems right to her, Martha will ingest a drug that will release her from a cancerous life promising more suffering. She asks Ingrid to be the one accompanying her, and only asks that she be in the room next door. Ingrid agrees. 

They decamp to a place in the hills Martha rents. Ingrid takes a room downstairs instead of the room next to Martha’s, perhaps as the first visible sign of some pressure on the relationship and the idea. While many days pass when Martha is not ready, Ingrid does what she can to put Martha and herself at ease by maintaining some activities of daily living. They respond to each other as close friends do. Nevertheless, tensions threaten the facade of normality. Ingrid seeks activities away from the house, further yet from the room next door, and a friend warns about dangers she could encounter from her involvement in Martha’s death. The way they talk and respond to each other gets more stilted and wary up to the day Martha finally takes the pill, a day Ingrid is not in the room next door, or in the room downstairs, or in the house.  

That’s not the end, though. Ingrid returns not long after Martha dies, spends time with and offers succor to her daughter, and then defends Martha and herself to the police at great risk. The answer to Almodóvar’s question could be that these reconstituted relationships can endure, however bumpy and sad they may become along the way.  

The Room Next Door
Director: Pedro Almodóvar 
Cast: Julianne Moore, Tilda Swinton 
Sony Pictures Classics: 2024
RT: 1hr 47minutes 
Web image from Sony Picture Classics

“Prof. William Osler, of the University of Pennsylvania, was summoned by telegraph this afternoon to go to Walt Whitman’s bedside. The aged poet had a relapse, and it was feared that he was dying. When the doctor came away from the little frame house at 328 Mickle Street, Camden, at 8 o’clock tonight, he said the poet was resting easily and about holding his own.” 

Osler first visited Whitman in 1884, shortly after moving to Philadelphia to take up his position as Professor of Medicine at the University of Pennsylvania. Dr. Maurice Bucke, a Canadian psychiatrist and mutual friend, had asked Osler to look in on Whitman, who was complaining of dizzy spells and fatigue. The professor obligingly ferried across the Delaware River to Camden and made a house call. Osler reported that the poet had no residual neurological deficits from his earlier stroke. He was unimpressed with Whitman’s current symptoms and, in fact, later described him as “a fine figure of a man who had aged beautifully, or more properly speaking, majestically with a large frame and a well-shaped, well-poised head…“ ^{1, p. 21} 

However, four years later the situation was more serious. On June 14, 1888, Whitman developed slurred speech, prostration, and confusion “such as we know are not uncommon with sclerosis of the arteries of the brain.”^{1, p. 178} When Osler was called in, he recommended general supportive care and issued a cautiously optimistic prognosis (as the Times reported), but evidently did not present his patient with a specific diagnosis or discuss pathophysiology. Whitman recovered over the following weeks, but his health gradually deteriorated over the next several years until his death in 1892. 

During the years Osler served as the poet’s primary care physician, their relationship was respectful, but not ideal. Whitman frequently complained about the great clinician’s rosy bedside manner. “Osler made light of my condition,” the poet wrote. “I don’t like his pooh-poohs. The professional air of the doctor grates on me.” ^{1, p. 50} On another occasion he told his friend Horace Traubel, “I confess I do not wholly like or credit what he (Osler) says. I do not fancy the jaunty way in which he seems inclined to dismiss my troubles.” ^{2, July 3, 1888} Evidently, Osler continued to speak in generalities, rather than addressing specific concerns that Whitman raised as he became progressively feebler.  

This situation contrasts with some of the poet’s earlier medical experience. For example, shortly after his stroke in 1873, Whitman consulted Dr. Mathew Grier who must have explained the etiology of the problem. Whitman later wrote to his friend Peter Doyle, “Did I tell you that Dr. Grier here says that my real disease is the brain not being properly furnished and nourished with blood…” ³ The poet’s other physicians included Drs. Silas Weir Mitchell and his son John Kearsley Mitchell. The famous neurologist and champion of neurasthenia made house calls on Whitman twice in 1878 when the poet reported symptoms of rheumatism and prostration, which he had self-diagnosed as a recurrence of his previous stroke. Mitchell assured him that the stroke, which had resulted from a ruptured blood vessel in the brain, was not responsible for the current symptoms. These, Mitchell claimed, were caused by chronic stress, perhaps exacerbated by anxiety over a public lecture that the poet was just then preparing to give.³ In other words Mitchell considered the illness a manifestation of neurasthenia. He prescribed travel, mountain air, and vigorous outdoor activity, which was Mitchell’s generic regimen for neurasthenia in males, quite the opposite of his more famous regimen of complete bed rest for female neurasthenics. ³ The poet took Mitchell’s advice seriously and embarked on a trip to Colorado, after which he professed himself cured.  

While Osler’s optimistic persona must have pleased many patients, it irritated Whitman. He judged his doctor’s cheerfulness to be insincere, or at least questionable. The elderly poet was an eccentric who fiercely valued his independence. While at times he showed a sweet and gentle side, he could also be touchy, irascible, and assertive. As the poet grew progressively frailer during 1888 and 1889, Traubel recorded a series of house calls during which Osler assured him that he would soon recover. “Do not take a gloomy view of Whitman’s case,” Osler told Traubel, “he will come around.” ^{2, July 3, 1888} In this short poem, I try to resurrect the poet’s attitude toward his famous doctor: 

Walt Whitman Reflects on His Doctor’s Bedside Manner 

As an old rat that must be allowed to die 
in his own way, I start with a prejudice 
against doctors. Never mind worrying 

about your sickness, he scolds me,  
I’m seeing to all that. The man tinkers  
with platitudes and conceals his thoughts.  

In his gospel of encouragement 
I’m supposed to be agreeable and dumb 
while he puts the best construction  

on what’s happening. What does he know 
about Whitman, the old rat? A shoemaker  
tells his customer the shoe fits just right 
but the shoe pinches the fellow wearing it.  

Whitman was a master of self-promotion. He appeared to encourage members of his inner circle who viewed him as a prophet, as well as a poet. Dr. Maurice Bucke even wrote a book claiming that his friend was one of the few humans who had achieved “cosmic consciousness.” The others included Jesus, Mohamed, and the Buddha. Did Osler fail to understand that his one- size- fits- all approach to physician-patient communication might not be appropriate for a patient with Whitman’s complex and eccentric personality?  

Although dissatisfied with Osler’s bedside manner, the poet respected his doctor’s clinical abilities. Several months after the medical crisis in 1888, Whitman wrote, “As for Osler: he is a great man—one of the rare men. I should be much surprised if he didn’t soar way, way up—get very famous at his trade—someday. He has the air of something about him—of achievement.”^{2, December 26, 1888} Indeed, by that time, Osler had already accepted the position of Professor of Medicine at the new Johns Hopkins medical school in Baltimore.  

Osler was a sensitive, cultivated man, but also a rationalist, who initially looked askance both at Whitman’s exuberant poetry and the cult that had grown up around its author. Although he admired the man, he had no wish to become a disciple. He loved poetry and enjoyed quoting passages from Shakespeare and the Romantic and Victorian poets. Regarding his first impressions of Leaves of Grass, Osler later wrote, “Whether the meat was too strong, or whether it was the style of cooking—‘twas not for my pampered palate.” ^{1, p. 22} He found his new patient’s long, unruly poems and earthy subject matter self-indulgent and lacking in discipline. The boisterous persona reflected in Whitman’s poems jarred Osler’s methodical mind. In the following poem, I imagine the clinician’s response to his early encounters with the Good Grey Poet: 

Dr. William Osler Remembers His Call on Walt Whitman 

I took the ferry that day and found him 
in the front room of a small house 
on Mickle Street, buried to his chest 
in papers, magazines, and musty  
brown bundles. Push yourself a path, 
he said. I reckon you’re a friend of Bucke’s. 

His famous head had aged majestically— 
unkempt white beard; smooth, clear cheeks; 
a fissured, geographic forehead. 
His voice was pitched a shade too high,  
but strong like the rest of him. Of symptoms 
he said but little–remarkable 

for a man of 65. For a moment 
I felt that sweet aromatic presence 
his disciples spoke of–for me, though, 
the edge of chaos. I sometimes wish 
the man had made a difference in my life, 
opened me up, but how could I forego 

my restraint? Or professional kindness? 
For a man like me, a man of substance, 
what could be worse than falling in love 
with Whitman? I listened to the music 
of his tongue, but could never cross the line 
that reads, Who enters here, abandons discipline. 

Yet, in his later years, Osler grew to respect his one-time patient’s poetry, as well as his charismatic personality. In fact, at the time of his death from pneumonia in 1919, he was in the process of writing an appreciative reminiscence of his encounters with Whitman. 

The uneasy, but respectful, relationship between these giants in their respective fields provides interesting material for reflection. If the poet was so dissatisfied with Osler, why didn’t he go back to Weir Mitchell or his son, who were more easy-going and communicative? Mitchell’s reputation as a clinician easily equaled Osler’s, and he was a poet as well. Could it be that Whitman benefited in some way from Osler’s staunch optimism, or had developed deep trust in Osler’s judgment, despite the constant complaints he issued to Traubel and others? Alternatively, why didn’t Osler modify his paternalistic approach, since it seemed clear that Whitman preferred to play a more active role in the relationship? And those time-consuming house calls that required taking a ferry across the river! Why not recommend a more pliable colleague?  

References 

1. Philip Leon, Walt Whitman & Sir William Osler, ECW Press, Toronto, 1995. 

2. Horace Traubel, With Walt Whitman in Camden, vol. 2, at http://whitmanarchive.org/criticism/disciples/traubel (accessed December 30, 2024) 

3. Feinberg CE. Walt Whitman and his doctors. Arch Intern Med 1964; 114: 834-842. 

Photo of Sir William Osler and Walt Whitman from WikiCommons.

Cyrus aspires to be a poet but is drowning in self-pity and drug use. He wants more than anything to achieve renown and martyrdom and to die after having made a lasting mark in the world. Interwoven with these tragic human circumstances are antic elements that collide with this depressing narrative. The novel opens abruptly with a humorous but disconcerting encounter between Cyrus, who is working as a surrogate patient in an introduction to medicine class, and a student, who is clearly in the early stages of her education. Cyrus is having a bad day and cynically takes on the role of the difficult patient, nearly driving the student to tears. There is a zany episode when Cyrus and a friend take on a home maintenance and wood chopping job for a man who lives alone and who monitors their work wearing only his underwear.  

Dream sequences in which Cyrus receives guidance from figures ranging from Kareem Abdul Jabbar to a thinly disguised, now President Trump materialize without warning. An uncle, his mother’s older brother, passes through the story several times appearing as a figure draped in a black hooded cape and riding on horseback across the blood-drenched Iran-Iraq war battlefields. His mission is to reassure the dying soldiers that they will ascend to paradise. Yet, despite these disparate elements, the book has a powerful coherence and momentum. One of the most striking features of the book is its extraordinarily imaginative similes– “he was skinny in a scrawny way, not like a runner but like a mathematician who forgets to eat,” “the middle school teacher… offered him a racial slur, like a juicy orange they might peel together and share.” These phrases demand that you slow down the pace of your reading and take note of the author’s creativity.  

Engagement with language and its communicative limitations emerges as a key theme of Martyr!. Cyrus comments frequently on the arbitrariness of language and the terrifying consequences that can arise from the words we use. Akbar embeds this idea in his writing by implying that plain words alone are inadequate to capture the essence of things, and the only reliable way to convey meaning to readers is by creating vivid and arresting comparisons. The plot of the book takes off when Cyrus is encouraged by a friend to go to the Brooklyn Museum and visit a featured exhibit, DEATH-SPEAK. It consists of an artist who is dying of cancer sitting on a chair and talking with the visitors about death during the final weeks of her life. An unanticipated bond is quickly established between the artist named Orkideh and Cyrus. He feels compelled to return and speak with her over the next four days. Their conversation is genuine and moving. There is more to the artist and her art than meets Cyrus’ eye, and those unexpected twists drive the story to its blazing finish.  

What is one to make of this wholly original and emotionally charged novel? I will restrict myself to three thoughts that have had staying power after finishing the book a month ago. First, as mentioned above, Martyr! raises provocative questions about the limitations of language and our ability to communicate with one another. Cyrus (and Akbar) questions the capacity of words alone to express meaning, as if each of us has our own private language. If we can firmly ground our language with references to concrete, real life experiences, which is precisely what Akbar does with the beautiful and jarring similes that are interwoven into the entire book, then we may be able to convey meaning. That Akbar can introduce such a recondite idea, a variant of playing language games, into a best-selling novel is a feat worth noting.  

Second, there is a yearning to be healed that drives Cyrus’ quest. Martyrdom is the outer expression, but it is a quest for meaning that is the true driving force that motivates Cyrus to take healthy action in the novel. He attends a group therapy program and has a tough-minded supervisor to help him detox from his drug use. Ultimately, it is the new awareness that Cyrus gains about his parents that enables him to achieve psychological equanimity and peace of mind.  

Finally, what is the martyrdom that Cyrus longs for? He is not looking to wrap himself with explosives, kill the infidels, and gain entry to paradise. One could say that what he so desperately wants is lasting fame and renown for an act or artistic creation that will be seen as unique and cherished, that will survive after him, and that will keep his name eternally alive. The Book of Martyrs, a fictional collection of poems written by Cyrus that are interspersed in the text, could conceivably represent this hoped-for act of martyrdom. However, the ending of the novel suggests that Akbar may have a less explosive and more intimate notion of what martyrdom means. The knowledge that Cyrus gains over the course of the novel and his interactions with Orkideh spur him to finally achieve the martyrdom he seeks. His ultimate fate on the final page is actually a bit murky. But the vision that one is left with is that Cyrus has indeed achieved a life of meaning because it is a life of meaningful interpersonal connections.  

Martyr! 
Kaveh Akbar 
Alfred A. Knopf, 2024, pp 332 
Web image by Levi Meir Clancy