The Story of a Heart

 

The Story of a Heart by Dr. Rachel Clarke

Nonfiction

2024

Finished on January 20, 2026

Rating: 3.5/5 (Good)

Publisher's Blurb:

A riveting and inspiring true story of two families linked by one heart—written by a bestselling author and palliative care doctor. 

The first of our organs to form and the last to die, the heart is both a simple pump and the symbol of what makes us human; as long as it continues to beat, there is hope. In The Story of a Heart, Dr. Rachel Clarke interweaves the history of medical innovations behind transplant surgery with the story of two children—one of whom desperately needs a new heart.

One summer day, nine-year-old Keira Ball was in a terrible car accident and suffered catastrophic brain injuries. As the rest of her body began to shut down, her heart continued to beat. In an act of extraordinary generosity, Keira’s parents and siblings immediately agreed that she would have wanted to be an organ donor.

Meanwhile nine-year-old Max Johnson had been in a hospital for nearly a year, valiantly fighting the virus that was causing his young heart to fail. When Max’s parents received the call they had been hoping for, they knew it came at a terrible cost to another family—in what Clarke calls “the brutal arithmetic of transplant surgery.”

The act of Keira’s heart resuming its rhythm inside Max’s body was a medical miracle. But this was only part of the story. While waiting on the transplant list, Max had become the hopeful face of a campaign to change the UK’s laws around organ donation. Following his successful surgery, Keira’s mother saw the little boy beaming on the front page of the newspaper and knew it was the same boy whose parents had recently sent her an anonymous letter overflowing with gratitude for her daughter’s heart. The two mothers began to exchange messages and eventually decided to meet. This is the unforgettable story of how one family’s grief transformed into a lifesaving gift. Clarke relates the urgent journey of Keira’s heart and explores the history of the remarkable surgery that made it possible, stretching back over a century and involving the knowledge and dedication not just of surgeons but of countless nurses and technicians, immunologists and paramedics. The Story of a Heart is a testament to compassion for the dying, the many ways we honor our loved ones, and the tenacity of love.

Last year a couple of my friends read The Story of a Heart, giving it such high praise that last week I decided to borrow a copy from the library. I find that if I don't already own a book, it's too easy to forget about those that are on my friends' year-end favorites' lists. Unless it's a auto-buy author, I try not to buy every book that lands on my radar.

The Story of a Heart is a short book (220 pages, excluding the notes), but it wasn't one I could zip through quickly. The author doesn't simply tell the story of the two families and how their lives intersect, but provides extensive background on the history of new technologies in medicine. Ventilators, skin grafts, artificial heart-lung machines, LVADs (a titanium and gold HeartWare left ventricular assist device), are just a few that Dr. Clarke incorporates in her book. While not dry or too technical, these clinical details pulled me out of the story at hand, ultimately holding me back from what could have been a real tear-jerker. My heart went out to both families, reminding me of the importance of organ donation.

"In the back of my mind, I know nothing I say can make their day any worse because they've already lost their loved one. This is the worst day of their life. But if I can give them a slight bit of hope and comfort by offering organ donation as part of end-of-life care, then that's what I need to do. It's not a taboo topic. It's a normal part of critical care. If someone meets the criteria to be an organ donor and we're not offering it to them, then I'm not doing my patient justice, I'm not being their advocate. The foundation of who I am as a nurse is trying to support the family however I can. Organ donation can help a family feel as though something good has come out of an awful situation, so it can be incredibly positive." (Sarah Crosby, specialist nurse)

 

Looking Back - The Spirit Catches You and You Fall Down

Looking Back... In an effort to transfer my book journal entries over to this blog, I'm going to attempt to post (in chronological order) an entry every Friday. I may or may not add extra commentary to what I jotted down in these journals.

The Spirit Catches You and You Fall Down by Anne Fadiman

Nonfiction - Medicine

1997 Noonday Press

Finished on April 4, 2001

Rating: 3/5 (Good)

Publisher's Blurb:

Winner of the National Book Critics Circle Award for Nonfiction

When three-month-old Lia Lee Arrived at the county hospital emergency room in Merced, California, a chain of events was set in motion from which neither she nor her parents nor her doctors would ever recover. Lia's parents, Foua and Nao Kao, were part of a large Hmong community in Merced, refugees from the CIA-run "Quiet War" in Laos. The Hmong, traditionally a close-knit and fiercely people, have been less amenable to assimilation than most immigrants, adhering steadfastly to the rituals and beliefs of their ancestors. Lia's pediatricians, Neil Ernst and his wife, Peggy Philip, cleaved just as strongly to another tradition: that of Western medicine. When Lia Lee Entered the American medical system, diagnosed as an epileptic, her story became a tragic case history of cultural miscommunication.

Parents and doctors both wanted the best for Lia, but their ideas about the causes of her illness and its treatment could hardly have been more different. The Hmong see illness and healing as spiritual matters linked to virtually everything in the universe, while medical community marks a division between body and soul, and concerns itself almost exclusively with the former. Lia's doctors ascribed her seizures to the misfiring of her cerebral neurons; her parents called her illness, "qaug dab peg"--the spirit catches you and you fall down--and ascribed it to the wandering of her soul. The doctors prescribed anticonvulsants; her parents preferred animal sacrifices.

My Original Thoughts (2001):

I thought this was a fascinating book. I feel like it should be a supplemental book in an anthropology class. I highlighted several passages and learned a great deal about Hmong culture. The chapters devoted to Lia Lee and her family were very readable. The others, dealing with the Hmong culture and history, were interesting, but required dedication and patience. I was easily distracted and sometime bored with these chapters. I'm glad I read the book, in spite of not being a gripping story.

My Current Thoughts:

I chose to read this book based on the recommendation of a fellow online book group member (Books on the Fence) over twenty years ago. It was educational and thought-provoking, although at times, somewhat dry. I no longer own my copy, so it's not one that I ever intended to read a second time.

When My Time Comes

 

When My Time Comes: Conversations About Whether Those Who Are Dying Should Have the Right to Determine When Life Should End by Diane Rehm

Nonfiction

2020 Random House Audio

Read by the author and contributing guests

Finished on September 19, 2020

Rating: 4/5 (Very Good)

Publisher's Blurb:

From Diane Rehm, renowned radio host - one of the most trusted voices in the nation - and best-selling author: an audiobook of candor and compassion, addressing the urgent, hotly contested cause of the Right-to-Die movement, of which she is one of our most inspiring champions. 

Soon to be a public television documentary of the same name, featuring the author.

Through interviews with terminally ill patients, and with physicians, ethicists, spouses, relatives, and representatives of those who vigorously oppose the movement, Rehm gives voice to a broad range of people who are personally linked to the realities of medical aid in dying. The audiobook presents the fervent arguments - both for and against - that are propelling the current debates across the nation about whether to adopt laws allowing those who are dying to put an end to their suffering. With characteristic even-handedness, Rehm skillfully shows both sides of the argument, providing the full context for this highly divisive issue.

With a highly personal foreword by John Grisham, When My Time Comes is a response to many misconceptions and misrepresentations of end-of-life care; it is a call to action - and to conscience - and it is an attempt to heal and soothe our hearts, reminding us that death, too, is an integral part of life.

I've been listening to NPR for almost 30 years and it was there that I first heard The Diane Rehm Show and quickly became a fan of this intelligent and charming woman. I've had my eye on a couple of her earlier books (Finding My Voice and On My Own), but it wasn't until I spotted her latest release of When My Time Comes that I decided it was time to finally read one of her books. I downloaded the audiobook and was quickly engrossed in the interviews. Rehm discusses the subject of death with dignity (also known as medical aid in dying) with two dozen individuals, handling the interviews with compassion and empathy, even with those with whom she disagrees. Her emotions are true and her kindness authentic as she speaks with family members who describe the intimate details of their loved ones' final days. She asks personal questions, yet doesn't probe gratuitously. She is one class act.

Five years ago, I read Being Mortal, Atul Gawande's eye-opening book on the elderly, nursing homes and death. His exploration of how we treat our aging parents was a valuable lesson and one that shaped not only my mother's future, but also mine and my husband's. We moved from Lincoln, Nebraska to the Oregon Coast in 2017 after my husband retired. With her blessing, we decided to move in with my mom (who was 84 at the time), thus allowing her to remain in her beautiful home, near her friends and community. Like Gawande's bestseller, Diane Rehm's book has given me a lot to think about with regard to aging and end of life choices. Rehm asks each interviewee what they believe is a good death and I would like to think that my father and stepfather (both of whom died of cancer) died the way they wished, surrounded by family, in their own homes, under the care of Hospice. That is my wish, as well.

As I listened to the book, I kept wanting to highlight specific passages to discuss with my husband, so a print copy is on order. However, I'm glad I listened to the audiobook, which reminded me of Rehm's radio show. I'm anxious to tune in to her podcast, On My Mind, as well as view the documentary based on this new book, which will be available for viewing in January 2021. When My Time Comes and Being Mortal would be great companion reads, leading to deep discussions on how we feel about the final chapters of our lives. Highly recommend!

Note to self: When asked which celebrity or famous person in history I would choose to have at a dinner party, don't forget to include Diane Rehm!

Being Mortal

Being Mortal: Medicine and What Matters in the End by Atul Gawande
Nonfiction – Medicine
2014 Metropolitan Books
Finished on February 24, 2015
Rating: 4.5/5 (Terrific!)



Being Mortal is an AARP, Amazon, Apple iBooks, Astoria Bookshop, Book Riot, Business Standard, Chicago Tribune, The Daily Beast, The Economist, Financial Times, The Globe and Mail, The Guardian, Houston Chronicle, Huffington Post, LA Times, Maclean’s Magazine, Mother Jones, New Hampshire Public Radio, The New Statesman, The New York Times, NPR, NPR’s Science Friday, Oprah, Politics & Prose, Shelf Awareness, Wall Street Journal, Washington Post, and Wired Magazine Bestseller. [It was also a Barnes & Noble Best Book of 2014.]

Publisher’s Blurb:

Medicine has triumphed in modern times, transforming the dangers of childbirth, injury, and disease from harrowing to manageable. But when it comes to the inescapable realities of aging and death, what medicine can do often runs counter to what it should.

Through eye-opening research and gripping stories of his own patients and family, Gawande reveals the suffering this dynamic has produced. Nursing homes, devoted above all to safety, battle with residents over the food they are allowed to eat and the choices they are allowed to make. Doctors, uncomfortable discussing patients’ anxieties about death, fall back on false hopes and treatments that are actually shortening lives instead of improving them. And families go along with all of it.

In his bestselling books, Atul Gawande, a practicing surgeon, has fearlessly revealed the struggles of his profession. Now he examines its ultimate limitations and failures – in his own practices as well as others’ – as life draws to a close. And he discovers how we can do better. He follows a hospice nurse on her rounds, a geriatrician in his clinic, and reformers turning nursing homes upside down. He finds people who show us how to have the hard conversations and how to ensure we never sacrifice what people really care about.
Riveting, honest, and humane, Being Mortal shows that the ultimate goal is not a good death but a good life – all the way to the very end.

“You’re as young as you feel!”

Right??

Or, maybe it’s more like, “You’re not getting any younger!”

Whatever.

I’ve always felt much younger than the date on my driver’s license, but last week, while writing about a book in which a 53-year-old woman is referred to as middle-aged, I stopped dead in my tracks. Really? Middle-aged? But, 53 is middle-aged. So why is that so difficult for me to accept? Isn’t 50 the new 30? (Someone really should mention this to my back and knees.)

I had my first experience of extreme back pain a couple of years ago (who knew lifting one large duffel bag into the back of an SUV could cause such pain!) and now I need to be extra careful when lifting heavy boxes of books at work. Gone are the days of running 3-5 miles, thanks to over 30 years of pounding the pavement, so walking and biking have replaced that passion for a runner’s high. I now own a half dozen pairs of readers, as well as my first pair of bifocals (which I never got used to and have stashed in my purse for emergencies), and while I hate to admit it, I think my hearing is not what it used to be. If there’s too much background noise and I have my back to the room (washing dishes, for instance), I really can’t hear what my husband is saying if he’s in an adjacent room. And, those extra pounds that used to be so easy to drop with just a few simple modifications to my diet, combined with an increase in my exercise routine? Ha! I’m falling apart. Thankfully, more slowly than my husband, but then, he has a decade on me.

So what does all this whining have to do with Atul Gawande’s latest book? Well, it’s pretty obvious that one day we’re all going to die, but this book really got me thinking about how we are treating our elders and how I hope to enjoy my final years of life. Never too early to start worrying, right?

I started listening to Being Mortal on audio, but found my mind wandering, so I decided to switch over to the print edition. This turned out to be a good thing, since I wound up with over a dozen passages marked for future reference. This book is filled with many anecdotes and much information about aging, nursing homes, hospice, etc., and it’s one you’ll want to share with your spouse, hopefully inspiring some heartfelt discussions about planning for “the golden years.” It’s also a great book to share and discuss with your parents, although that might prove to be a bit more uncomfortable than with your spouse. We are a society that loathes to talk about grief, let alone dying. But if we don’t learn our loved-ones' wishes while they can still share them with us, we might not know what their desires are when it’s too late to discuss.

On scientific advances in medicine:

Modern scientific capability has profoundly altered the course of human life. People live longer and better than at any other time in history. But scientific advances have turned the processes of aging and dying into medical experiences, matters to be managed by health care professionals. And we in the medical world have proved alarmingly unprepared for it.

This reality has been largely hidden, as the final phases of life become less familiar to people. As recently as 1945, most deaths occurred in the home. By the 1980s, just 17 percent did. Those who somehow did die at home likely died too suddenly to make it to the hospital—say, from a massive heart attack, stroke, or violent injury—or were too isolated to get somewhere that could provide help. Across not just the United States but also the entire industrialized world, the experience of advanced aging and death has shifted to hospitals and nursing homes.

and

There’s no escaping the tragedy of life, which is that we are all aging from the day we are born. One may even come to understand and accept this fact. My dead and dying patients don’t haunt my dreams anymore. But that’s not the same as saying one knows how to cope with what cannot be mended. I am in a profession that has succeeded because of its ability to fix. If your problem is fixable, we know just what to do. But if it’s not? The fact that we have had no adequate answers to this question is troubling and has caused callousness, inhumanity, and extraordinary suffering.

This experiment of making mortality a medical experience is just decades old. It is young. And the evidence is it is failing.

On nursing homes:

It is a near-universal reality. Nursing home priorities are matters like avoiding bedsores and maintaining residents’ weight—important medical goals, to be sure, but they are means, not ends. The woman had left an airy apartment she furnished herself for a small beige hospital-like room with a stranger for a roommate. Her belongings were stripped down to what she could fit into the one cupboard and shelf they gave her. Basic matters, like when she went to bed, woke up, dressed, and ate, were subject to the rigid schedule of institutional life. She couldn’t have her own furniture or a cocktail before dinner, because it wasn’t safe.

There was so much more she felt she could do in her life. “I want to be helpful, play a role,” she said. She used to make her own jewelry, volunteer at the library. Now, her main activities were bingo, DVD movies, and other forms of passive group entertainment. The things she missed most, she told me, were her friendships, privacy, and a purpose to her days. Nursing homes have come a long way from the firetrap warehouses of neglect they used to be. But it seems we’ve succumbed to a belief that, once you lose your physical independence, a life of worth and freedom is simply not possible.

On simple pleasures:

As our time winds down, we all seek comfort in simple pleasures—companionship, everyday routines, the taste of good food, the warmth of sunlight on our faces. We become less interested in the rewards of achieving and accumulating, and more interested in the rewards of simply being. Yet while we may feel less ambitious, we also become concerned for our legacy. And we have a deep need to identify purposes outside ourselves that make living feel meaningful and worthwhile.

On the dying role:

Technological society has forgotten what scholars call the “dying role” and its importance to people as life approaches its end. People want to share memories, pass on wisdoms and keepsakes, settle relationships, establish their legacies, make peace with God, and ensure that those who are left behind will be okay. They want to end their stories on their own terms. This role is, observers argue, among life’s most important, for both the dying and those left behind. And if it is, the way we deny people this role, out of obtuseness and neglect, is cause for everlasting shame. Over and over, we in medicine inflict deep gouges at the end of people’s lives and then stand oblivious to the harm done.

As I finished the final chapter of Atul Gawande’s thought-provoking work, I felt a sense of deep sadness, perhaps because his father’s final days reminded me of the last days I spent with my stepfather, who died on December 15, 2013. Both men died of cancer, in their homes, surrounded by their families, under the care of hospice. It may sound strange to those who have never experienced the passing of a loved one in hospice, but as my stepdad took his final breath, with only candles burning to illuminate the bedroom, his wife and adult children holding his hands and gently touching his arms and back, I couldn’t help but think that it was one of the most beautiful and peaceful moments I’d ever experienced. Of course it was extremely sad, but I can’t think of a better place to say our goodbyes. Certainly not a noisy, sterile hospital room, that’s for certain.

Final Thoughts:

If you only read one book in 2015, Being Mortal is my #1 recommendation for a nonfiction title. I can’t recommend it highly enough. Couples will find plenty of information to use in discussions about their futures as senior citizens, as will adult children with their aging parents. And, of course, members of book groups will have plenty to share about their individual hopes (and fears) to live out their final years not simply with good health and comfort, but also with pleasure and dignity.

Middle-aged? I guess it’s really just a state of mind. While I’m not quite ready to order off the senior menu at Las Margaritas, I do have lots to look forward to in the coming years.

Joie de vivre!

Atul Gawande is the author of The Checklist Manifesto, Better, and Complications. He is also a MacArthur Fellow, a general surgeon at Brigham and Women's Hospital, a staff writer at The New Yorker, and an assistant professor at Harvard Medical School and the Harvard School of Public Health. He lives with his wife and three children in Newton, Massachusetts.

Go here to listen to Atul Gawande’s interview with Diane Rehm on NPR.

Oxygen

Oxygen by Carol Cassella
Fiction
2008 Simon & Schuster
Finished on 12/7/13
Rating: 4.5/5 (Terrific!)



 
Publisher’s Blurb:

Jodi Picoult meets Atul Gawande.

In this riveting new novel by a real-life anesthesiologist, an intimate story of relationships and family collides with a high-stakes medical drama.

Dr. Marie Heaton is an anesthesiologist at the height of her profession. She has worked, lived and breathed her career since medical school, and she now practices at a top Seattle hospital. Marie has carefully constructed and constricted her life according to empirical truths, to the science and art of medicine. But when her tried-and-true formula suddenly deserts her during a routine surgery, she must explain the nightmarish operating room disaster and face the resulting malpractice suit. Marie’s best friend, colleague and former love, Dr. Joe Hillary, becomes her closest confidant as she twists through depositions, accusations and a remorseful preoccupation with the mother of the patient in question. As she struggles to salvage her career and reputation, Marie must face hard truths about the path she’s chosen, the bridges she’s burned and the colleagues and superiors she may have mistaken for friends.

A quieter crisis is simultaneously unfolding within Marie’s family. Her aging father is losing his sight and approaching an awkward dependency on Marie and her sister, Lori. But Lori has taken a more traditional path than Marie and is busy raising a family. Although Marie has been estranged from her Texas roots for decades, the ultimate responsibility for their father’s care is falling on her.

As her carefully structured life begins to collapse, Marie confronts questions of love and betrayal, family bonds and the price of her own choices. Set against the natural splendor of Seattle, and inside the closed vaults of hospital operating rooms, Oxygen climaxes in a final twist that is as heartrending as it is redeeming.

I’ve always been fascinated by medical dramas. Over the past four decades, I’ve watched countless episodes of Emergency!, Chicago Hope, E.R., Grey’s Anatomy, and House. I’m intrigued by the specific details of medical care, whether I’m watching a TV show, reading a novel, or hearing about someone’s recent surgery. I’m probably one of those annoying patients (or the spouse of a patient) who asks far too many questions about a specific procedure. ;)

Anesthesia has always been somewhat of a mystery to me. I can never quite shake that strange feeling upon awakening from surgery. One minute you’re awake, waiting to drift off to sleep, and in the blink of an eye a nurse is gently waking you and you feel like you just missed out on a big chunk of your life.

Anesthesia was the antithesis of the complete, personally involved physician I had idealized to myself and my parents for all the years I studied chemistry and physics and biology alongside music and literature. It came as an unexpected, almost uncomfortable surprise to me when I discovered the immediate gratification of my specialty—injecting a local anesthetic at the precise nerve plexus to relieve the unrelenting pain of strained backs or injured limbs; calming a terrified obstetrical patient rushed into an emergency cesarean section, keeping her pain-free and hopeful, so her infant could make the miraculous transition from fetus to newborn uninjured; pulling the sleeping heart bypass patient back to consciousness and the inexpressible relief that they are still among the living. All of this, I discovered, was in contrast to general medicine, which could often do little more than shift the incessant, declining slope of mortality that begins the day we are born.

I understood the general concept of anesthesia (well, as much as a layman can understand something so complex), but until I read Carol Cassella’s compelling drama, Oxygen, I failed to appreciate the incredible talent of an anesthesiologist. It is not simply the job of an anesthesiologist to keep a patient sedated, but it is also his or her responsibility to anticipate the patient’s pain in response to the various stages of the surgery, adjusting or adding the various drugs to maintain the patient’s comfort. Of course, now that makes sense, but it’s not something to which I’d ever given any thought until reading this novel.

People feel so strong, so durable. I anesthetize airline pilots, corporate executives, high school principals, mothers of well-brought-up children, judges and janitors, psychiatrists and salespeople, mountain climbers and musicians. People who have strutted and struggled and breathed on this planet for twenty, thirty, seventy years defying the inexorable, entropic decay of all living things. All of them clinging to existence by one molecule: oxygen.

There is a moment during the induction of general anesthesia when I am intimately bonded to my patient. A moment of transferred power. I squeeze the drug out of the syringe, into the IV line, and watch the face slacken, watch the last organized thoughts slip from consciousness, see breathing shallow, slow, stop. 

I received an ARC of Cassella’s debut novel way back in early 2008. It sat on my desk for a few months and eventually found its way to one of my stacks of ARCs, where I promptly forgot about it. Over the course of that year, I started seeing great reviews for Oxygen and yet it remained in my stacks, soon to be completely buried. I’m not sure what finally prompted me to dig it out after more than five years, but I’m so very glad I did. Cassella’s narrative drew me in from the opening scene and I became completely engrossed, particularly with those sections involving a specific operation.

On the fear of flying: 

Joe squeezes my hand as he pulls out into the runway and waits for clearance. He sounds different talking into his headset, a clipped song in the shorthand lingo of flight. My breath jumps high into my throat when we leave the ground. He banks out over the sound—the city looks like it's cupped inside the protective palms of encircling peaks: the eastern Cascades and western Olympics, the northern and southern volcanoes of Mount Baker and Mount Rainer. From this height the geometry of bridged lakes and islanded ocean sprawls like a rumpled quilt in greens and blues. It's worth the price of fear.

On Texas heat:

Lori lives in the plains just west of Fort Worth, where cattle drives used to camp on their way to the transcontinental railroads and settlers laid claim to Indian lands with barbed wire. Now, a grid of pavement allots quarter-acre swatches of azaleas and scrappy live oaks to homeowners who coax green growth out of the dust. The lushly watered lawns invite barefoot play, until the Texas sun slaps you back inside. 

Carol Cassella is a consummate storyteller and when it comes to medicine, specifically anesthesia, she knows her stuff. She majored in English Literature at Duke University and graduated from medical school in 1986. She is a practicing physician, board certified in both internal medicine and anesthesiology, and has recently published her third novel, Gemini. As luck would have it, I came upon an ARC of Gemini a couple of months ago and I am very anxious to give it a read. And I can assure you that I won’t be waiting five years!

Have you read any books by Carol Cassella? If so, which is your favorite? Healer sounds quite intriguing, too!

The Midwife

The Midwife: A Memoir of Birth, Joy, and Hard Times by Jennifer Worth
Medical History/Memoir
2009 Penguin
Finished on 4/28/09
Rating: 4/5 (Very Good)




Product Description

An unforgettable story of the joy of motherhood, the bravery of a community, and the hope of one extraordinary woman

At the age of twenty-two, Jennifer Worth leaves her comfortable home to move into a convent and become a midwife in post war London’s East End slums. The colorful characters she meets while delivering babies all over London—from the plucky, warm-hearted nuns with whom she lives to the woman with twenty-four children who can’t speak English to the prostitutes and dockers of the city’s seedier side—illuminate a fascinating time in history. Beautifully written and utterly moving, The Midwife will touch the hearts of anyone who is, and everyone who has, a mother.

About the author

Jennifer Worth trained as a nurse at the Royal Berkshire Hospital in Reading, England. She then moved to London to train as a midwife. She later became a staff nurse at the Royal London Hospital, Whitechapel, and then ward sister at the Elizabeth Garrett Anderson Hospital in Euston. Music had always been her passion and in 1973 Jennifer left nursing in order to study music intensively. She gained the Licentiate of the London College of Music in 1974 and was awarded a fellowship ten years later. Mother of two daughters and grandmother of two; Jennifer lives in Hertfordshire with her husband Philip Worth.

I generally don't read a lot of nonfiction, but I sure do love memoirs, so I was happy to accept a review copy of The Midwife. I had a little bit of difficulty getting started, stumbling a bit through the introduction, but after that it was smooth sailing. The author has an engaging style and I was quickly transported to the streets of East London.

This is one of those books that must cause a bit of confusion for bookstore buyers and merchandisers. The subtitle indicates that it's a memoir. However, Barnes & Noble has it shelved in the medical history section. I'm not sure it's either. I think it falls more into the area of British history, as many of the anecdotes have more to do with life in London after World War II than with the art and science of delivering babies. Regardless of its classification, it's a lovely story of a young woman living amongst a group of kind-hearted nuns, learning the ropes of midwifery.

On the joy of a delivery:

I am about ready to leave. It has been a long day and night, but a profound sense of fulfilment and satisfaction lighten my step and lift my heart. Muriel and baby are both asleep as I creep out of the room. The good people downstairs offer me more tea, which again I decline as gracefully as I can, saying that breakfast will be waiting for me at Nonnatus House. I give instructions to call us if there seems to be any cause for worry, but say that I will be back again around lunch time, and again in the evening.

I entered the house in the rain and the dark. There had been a fever of excitement and anticipation, and the anxiety of a woman in labour, on the brink of bringing forth new life. I leave a calm, sleeping household, with the new soul in the midst, and step out into the morning sunlight.

I cycled through the dark deserted streets, the silent docks, past the locked gates, the empty ports. Now I cycle through bright early morning, the sun just rising over the river, the gates open or opening, men streaming through the streets, calling to each other; engines beginning to sound, the cranes to move; lorries turning in through the huge gates; the sounds of a ship as it moved. A dockyard is not really a glamorous places, but to a young girl with only three hours sleep on twenty-four hours work, after the quiet thrill of a safe delivery of a healthy baby, it is intoxicating. I don't even feel tired.

From large families (one delivery is of a woman's 25th child!) to rickets to interracial births to the horrors of the "workhouse," Worth entertains and enlightens her readers with anecdotes that help balance the story's grim poverty and hardships with stories imbued with her keen sense of humor:

A convent is essentially a female establishment. However, of necessity, the male of the species cannot be excluded entirely. Fred was the boiler-man and odd-jobber of Nonnatus House. He was typical of the Cockney of his day and age. Stunted growth, short bowed legs, powerful hairy arms, pugnacious, obstinate, resourceful; all these attributes were combined with endless chat and irrepressible good humour. His most striking characteristic was a spectacular squint. One eye was permanently directed north-east, whilst the other roved in a south-westerly direction. If you added to this the single yellow tooth jutting from his upper jaw, which he generally held over his lower lip and sucked, you would not say he was a beautiful specimen of manhood.

I noticed an occasional repetition to some of the stories, making me wonder if each chapter originated as an essay or column, later to be woven together in the form of a book. This is very minor quibble, as it really didn't distract from my enjoyment of the narrative.

The Midwife is much more than simply a memoir about a young woman's experiences in her new role as a midwife. It's a warm, engaging examination of life in a convent, life in London's post-war slums, and the friendships that grow between the nuns, midwives and mothers-to-be. If you enjoy any sort of medical narrative or historical memoirs (such as Frank McCourt's Angela's Ashes), you'll fall in love with Worth's richly evocative story. I certainly did.

Be sure to watch this wonderful video (from BookVideos.tv) of Jennifer Worth discussing her memoir. There are some marvelous black and white photographs included throughout the clip.