THE NIB FORUM is a place to share current calls for stories and to discuss intriguing stories, narrative symposia, and articles. Occasionally, we publish commentaries from guest writers. The Forum also publishes stories that complement narrative symposia.

Comments are welcome. Approved comments will ordinarily be posted within 1 business day.




Wednesday, April 2, 2014

Journey with WeCan


NIB 4.1 with a narrative symposium focused on Parenting Children with Pediatric Brain Tumors is coming out soon. Here is a story we couldn't include in the journal but wanted to share with our readers.


Story By Gary Painter

 

                  Our daughter was diagnosed with a brain tumor (glioblastoma multiforme) while we were on vacation in August 2005.  As with all parents facing this horrible situation, we felt like were thrust into the front lines of battle for which we had no training.  We relied on the doctors in that hospital to tell us what was the best course of action through initial brain surgery and recovery.  When our daughter had recovered well enough to go home, we were recommended a protocol of treatment that may not have been in the best interest of her or our family, but at that time, we did not know what other options were available.  Fortunately, our insurance company did not want to pay out of network and brought us to Children’s Hospital Los Angeles and the best neuro oncologist in the country.
                  Shortly after arriving back home, our daughter required a shunt surgery to alleviate fluid build-up in the brain.  While in ICU, we met Kathy Riley from WeCan.  It hard to put into words what it meant to speak to someone that knew what we were going through, and then could provide us with information to help us judge what were our options both within the medical world and outside the hospital environment (school options, etc.).  We then were able to connect to other families in our same situation.  We spent time getting to know them at a wonderful family camp, and then walked with them in the hospital and clinic visits for the next 15 months.
                  Unfortunately, our journey ended with the tragic death of our daughter.  Fortunately, our support did not evaporate at that point.  WeCan continued to provide a lifeline.  Over the next two years, WeCan developed a bereavement program to help families like ours.  Nothing can take away the pain of losing a child, but having a community with people provides an environment where healing can begin.


Wednesday, February 5, 2014

Volume 3 issue 3 is on Project MUSE

Please see table of contents for issue here.


This issue of Narrative Inquiry in Bioethics explores a series of bioethical topics through a narrative symposium, a case study, and two qualitative research articles.

What is the experience of living with the label of “disability”? The narrative symposium, edited by Naomi Sunderland and Jeffery Bishop, presents a collection of stories from authors with both visible and invisible “disabilities.” These authors share deeply personal accounts of how their lives are affected by their disabilities and the way society views their disabilities. This collection of stories is fairly unique insofar as it explores a wide range of conditions, often labeled as amputation, autism, blindness, brain injury, deafness, spastic cerebral palsy and other conditions. The collection of stories not only allows us to read about diverse experiences, but to identify some common themes, which are explored in commentary articles by: Elizabeth R. Schiltz; Lorna Hallahan; Nicole Matthews, Kathleen Ellem, and Lesley Chenoweth; and Jeffery Bishop, Rachelle Barina, and Devan Stahl.

How Do Deployed Health Care Providers Experience Moral Injury? Susanne W. Gibbons, Michaela Shafer, and Edward J. Hickling, and Gloria Ramsey address this question in their research article. The authors gathered narrative responses from a sample of recently deployed nurses and physicians that were analyzed help better understand individual perceptions of moral dilemmas that arise in combat. In the discussion section the authors draw out areas where healing efforts should be focused.

What are the perspectives of healthcare providers caring for patients with disorders of consciousness? The research article by Catherine Rodrigue, Richard Riopelle, James L. Bernat, and Eric Racine is based on their qualitative study involving healthcare providers with different backgrounds. They conclude that there is a need for greater awareness of contextual, institutional and social aspects and focus on these issues in training programs.

What does a families’ request to “do everything” mean when the patient has no chance of survival? In his case study H. Rex Greene discusses this common request and how to help both patients and families in such cases. He draws on Buckman’s SPIKES format to help unearth the real needs of the family and resolve the dilemma in a way that respects all parties concerned.

For a list of current Calls for Stories and Author Guidelines, please visit www.nibjournal.org.

Thursday, November 7, 2013

Volume 3 Issue 2 is Now Available on Project MUSE



Please see the table of contents for Narrative Inquiry in Bioethics 


This issue contains a narrative symposium: The Many Faces of Moral Distress Among Clinicians, edited by Cynda Hylton Rushton and Renee Boss. This symposium highlights stories from Clinicians about moral distress faced in their work and work environments and how they handled it.These stories are the focus of four comentary articles by

The issue also contains two research articles. The Content of Hope in Ambulatory Patients with Colon Cancer by Emily S. Beckman, Paul R. Helft, Alexia M. Torke.
Analyzing Reflective Narratives to Assess the Ethical Reasoning of Pediatric Residents by Margaret Moon, Holly A. Taylor, Erin L. McDonald, Mark T. Hughes, Mary Catherine Beach, Joseph A. Carrese

There is also a Case Study called, A Case of Deceptive Mastectomy, by Rebecca Volpe, Maria Baker, George F. Blackall, Gordon Kauffman, Michael J. Green

Don't forget:

Narrative Inquiry in Bioethics has a new website.

 http://www.nibjournal.org/index.html


50% off all new journal subscriptions!

http://www.nibjournal.org/subscribe/index.html

End of the Tunnel



A story about living with the label of "disability". The symposium on that topic (in NIB 3.3) will be out in Dec. of 2013. 

By M. Sophia Newman

Sleeping during a Norwegian summer can be nearly impossible. The country lies on the far northern edge of our tilted, rotating planet. In summer, nightfall is meaningless: pink twilight can fade to pale gray night and reverse to peachy dawn within two hours. Inside the Arctic Circle, even that brief twilight is absent – the sun is out continuously for nearly three months. Without sunset, the brain, which normally reacts to darkness like a bird with a blanket over its cage, cannot figure out when to sleep. It becomes easy to lie awake on the sofa, gazing at the sky.
Back home, on a dark night months before, I had been on another sofa with a handsome friend. Three days before, he’d asked me out. I’d been flattered. He was an advanced student in the martial arts school where we’d met, and I liked his bold, generous laugh.
            Three days later, we were hanging out on his sofa, laughing together. But I could feel my friend hesitating, too. I asked if he was concerned about my past. He was.
I had expected that. I had started training in martial arts after surviving a violent attack, which had given me post-traumatic stress disorder (PTSD). I had shared my story to explain how victim-blaming can be as harmful as abuse, convincing the school to improve information on stigma in its self-defense curriculum. But I’d noticed my friend had been unsettled by my personal disclosures. Here on his sofa, I realized his fears weren’t fully resolved.
 To answer them felt easy. The traumatic violence was eight years in the past. My friend was a doctor, so there was no need to explain the symptoms: irritability, expectations of harm, inability to focus, sleeplessness. I merely said they were all past-tense. I had gone from victim to survivor to quiet advocate, trading personal pain for social insights.
“It’s not that I’ve seen the light at the end of the tunnel,” I told him. “It’s that I’ve reached the end of the tunnel and set off running through fields of flowers in the sunshine.”
            "Hmm," he said, perhaps critiquing the metaphor’s schmaltzy quality. He paused, and then – as if working to believe me – said, “You are more jovial than most people with this problem.”
            “I’ve turned back into the person I was supposed to have been all along,” I said.
            “Hmm,” he murmured, disbelieving. I could feel our date crash-landing.
I considered this my main disability: not my illness, but his disbelief. I felt my statements about my own well-being were as credible as anyone’s. But my friend seemed to regard my trauma as a permanent fragility, despite my statements to the contrary. Perhaps he mislabeled my hard-won happiness as misguided, willful naïveté. It didn’t matter much – rather than the condition itself, it was his stigma that bound me.
I worried over him until I went to Norway months later. The vacation, though, wasn’t about fleeing him. I had come to see friends, and to run a half-marathon in the Midnight Sun Marathon festival.
The race was in a beautiful town called Tromsø. The town sits on a small island surrounded a winding freshwater estuary, sheltered from the Arctic sea by a peninsula of lichen-covered mountains. The town is the largest this far north, but it is tiny. The island has room for stands of birch and open fields of thistle and Queen Anne's lace. Overhead, the polar summer sun flitted through a tight circular path, rather than its usual arc between horizons.
On race day, we ran under a sunny late-night sky. Long-distance running demands almost nothing but persistence. Runners, no matter how nimble, can feel overwhelmed by raw exertion. A few miles into the first race of my life, I felt deep fatigue.
But it lifted when I remembered that this race proved how well I was. Earlier in my life, physical exertion had been a reliable way to elicit flashbacks, the ultra-vivid memories that characterize PTSD. This was a quirk of how my damaged brain reacted to biochemicals released during exercise. No clinician had ever been able to advise me, but I had used the fluke to heal – running until memories overwhelmed me, and then soothing myself, rewriting my perceptions of the past. It had worked. Now I could run until I was fatigued, not until I was frightened. My brain had healed.
Eight miles into the 13.1-mile race, I ran through a low underpass. Then, what I had said to my friend on his sofa suddenly became literal: I was running out the end of a tunnel and through a field of flowers in the clear sunshine. It wasn't a schmaltzy metaphor, but a reality so clear and profound – and silly – I began to laugh out loud. I smiled until I crossed the finish line just after midnight.
Later, I reconsidered my friend. The midnight sun is a phenomenon hard to believe. The idea that the sky could be constantly dark and then relentlessly light was rationally true but strange-feeling. To my friend, I was the same way: I had been all dark in illness, but all bright and sunny now. To him, it was unbelievable.
He was a doctor, and I found his incapacity strange. But he had just passed through a terrible relationship with someone for whom mental illness was deeply disabling. Perhaps he, too, was in his own endless darkness, where steady sunlight was a bewildering thought.
Irrespective of my friend’s errors, it is wrong to impose stigma on disabled people. It’s even more wrong to insist a person remain stigmatized when the disability has already been resolved. The problem, in the end, was his inability to see my human qualities beyond my PTSD: me as I really was.
Running in Tromsø, I realized the misbelief was his problem, not mine. In my head, I wished him well. And far and away, across fields of wildflowers under that astonishing sun, I ran off towards my own life.

Monday, August 12, 2013

New Call for Stories

Narrative Symposium: Religion in Medical and Nursing Practice

Narrative Inquiry in Bioethics will publish an issue focused on stories about how healthcare providers integrate their faith into their practice. We are interested in the perspective of healthcare providers from diverse religious backgrounds. We want a broad range of stories that extend beyond traditional settings for integrating religion and clinical healthcare. 

In writing your story, you may want to consider these questions:

·       Have you ever prayed with or offered spiritual support to a patient? Why? How did it go?
·       How have your religious convictions affected your practice of medicine or nursing?
·       How has your clinical practice affected your religious development?
·       Have you faced any problems involving peers, the law, chaplains, patients, or others, based on your integration of religion into clinical care? How does your institutional setting affect your integration of religion and medicine?
·       How would you recommend that healthcare providers integrate their religious conviction into their practice?

You do not need to address each of these questions—write on the issues that you think are most important to share with others. If you are not a writer, tell your story in your own words and our editorial staff will help you.
If you are interested in submitting a story, we ask you first to submit a 300-word proposal—a short description of the story you want to tell. Inquiries or proposals should be sent to the editorial office via email: narrativebioethics@gmail.com. We will give preference to story proposals received by September 16th of 2013.
We plan to publish 12 stories (4 – 10 double-spaced pages or 800 – 2000 words) on this topic. Some additional stories may be published as online-only supplemental material. We also publish 2 – 4 commentary articles that discuss the stories that are published in the journal. To see a finished symposium you may access Narrative Inquiry in Bioethics, volume 2, issue 1, on living organ donation for free on Project MUSE.
For more information about the journal Narrative Inquiry in Bioethics, the guidelines for authors, and
privacy policies, visit our webpage with Johns Hopkins University Press at:
http://www.press.jhu.edu/journals/narrative_inquiry_in_bioethics/guidelines.html




Friday, July 5, 2013

Volume 3 Issue 1 of Narrative Inquiry in Bioethics is now available


Please see the table of contents for Narrative Inquiry in Bioethics 


This issue contains a narrative symposium: Taking Bioethics Personally, edited by Tod Chambers. This symposium highlights stories from bioethicists about their own illnesses or the illnesses of family or friends.

The issue also contains two research articles;  The Protectors and the Protected: What Regulators and Researchers Can Learn from IRB Members and Subjects by Ann Freeman Cook, Helena Hoas, and Jane Clare Joyner and Reason for Hospital Admission: A Pilot Study Caomparing Patient Statements with Chart Reports by Zackary Berger, Anne Dembitzer, and Mary Catherine Beach.

There is also a case study by Erica K. Salter called, Should We Tell Annie? Preparing for Death at the Intersection of Parental Authority and Adolescent Autonomy.

Don't forget:

Narrative Inquiry in Bioethics has a new website.

 http://www.nibjournal.org/index.html


50% off all new journal subscriptions!

http://www.nibjournal.org/subscribe/index.html

My Son is Not a "Write-off"


Barbara MacArthur shares her story about parenting her ASD child in the 1970's. 

When he was a child, Howard, was diagnosed as profoundly autistic and asthmatic. “Just one of those things,” the doctors said. One told me he was “a write-off.” and “Stop sacrificing yourself, put him in an institution and forget him.”
Howard was a noisy, awkward child. Everything was slow — and fractious. I had to chop up a wooden playpen and nail the bars against the bedroom window because he would climb on to the sill and push hard against the glass. Once when I picked him up quickly to save him from danger he head butted me and chipped my two front teeth. I would lock us in the bedroom, having awoken once to find him downstairs in his pajamas, turning on the gas taps. At 3 a.m. one morning Howard hit me in the eye with a metal bus to wake me up. I had to go to work with a black eye and a cracked nose.
I always had to work. My husband never supported us and I did not know where he was. He left unexpectedly when I was five months pregnant. In 1973 we received an official letter to say he had died in Manchester. He had never remarried, but nothing was left except just enough to pay the burial expenses. I had managed to buy an old house with a dodgy roof, no bathroom and an outside toilet. It was all I could afford and it took me ages to get rid of the cockroaches, beetles and mice. I managed to carry out repairs myself until I saved enough to pay for proper repairs.
The stigma of being a divorcee with a child with learning difficulties was very strong, and we were regarded as less than second–class citizens. Because of his hyperactivity, screams and tantrums, people thought he was a naughty child with a bad mother. In supermarkets he would go behind the counters and switch any switches on or off, or pull trays of goods to the floor. Could you blame the staff for threatening to ban us? If the bus home ever deviated from the usual route he would try to jump off while the conductor and passengers would remark: “Why don’t you control that effing boy! Women like you shouldn’t be allowed to have children. You should be sterilized.” Even doctors did not seem to understand autism and no support was available. I came to believe that what people said must be true; sometimes I used to feel that people were stepping all over me with heavy boots, and that I was beaten down into the pavement.
I am proud of my son for what he has achieved. He will always be autistic and be considered by many as being ‘eccentric’ or a ‘bit odd’, but he is popular and has a tremendous sense of humor. Some years ago we signed on for computer courses. My son became so proficient that the tutors nicknamed him ‘cyber–junkie.’ We both lost education in our youth—me at 14 because my school was gutted by explosive incendiaries during WW2—my son because he was refused admission to any school until he was 10 because he could not speak until then. The Education Department wrote “the medical officer and the educational psychologist have decided that Howard has such a disability of mind as to make him incapable of receiving education.”
For 17 years I was a full-time carer for three people—my elderly parents and my son. My parents gave up their Council flat and lived with us. They died within a month of each other—both in their 90’s, in our home, leaving just enough money to cover cremation expenses.
My son and I gained Computer Science qualifications. Howard graduated from University in 2003—Computer Science. Now I am nearly 87 and still Howard’s only carer. I enjoy time on my own. Go to bed late and watch a late–night film. Tonight as I write, he is in bed and I have just put out the rubbish. He helped earlier by emptying waste–paper baskets around the house, so it is teamwork. But he is often in his own world in his mind. I worry what will happen to Howard when I die. We have our own home and Howard would want to remain here. Howard loves his home and is happy here; it would break his heart to be moved.
We survived despite the system—not because of it.

Friday, May 31, 2013

New Website and 50% off subscriptions to NIB!

Narrative Inquiry in Bioethics has a new website.

 http://www.nibjournal.org/index.html

50% off all new journal subscriptions!


We are so excited about our new website and all the great information and resources it makes available. We are also very pleased to be able to offer the journal at an extraordinary low price. Our goal is to make Narrative Inquiry in Bioethics accessible to everyone.

Please share this offer with anyone you think might be interested.

Tuesday, April 23, 2013

Narrative Inquiry in Bioethics News

We would like to welcome John T. Chibnall, PhD, Department of Neurology & Psychiatry, and Health Disparities Research at Saint Louis University to our Foundation's Board of Directors.

We would also like to welcome Arthur W. Frank, PhD, Department of Sociology, University of Calgary and Eric Racine, PhD, Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Université de Montréal, and McGill University to our Editorial Board. 

We are very fortunate to work with some wonderful people on both our Foundation's board of directors and the journals editorial board. Many thanks to all of you for your support and encouragement! 

Thursday, April 18, 2013

In Other Words: Narrative Inquiry in Bioethics

Johns Hopkins University Press just finished a video highlighting Narrative Inquiry in Bioethics. Thanks to Janet Gilbert and her team - great work! http://www.youtube.com/watch?v=E9jK_m6a5wk&feature=youtu.be

This is a great way to share with people just what NIB is trying to do!

Friday, March 15, 2013

Confronting Pediatric Brain Tumors: Parent Stories


Confronting Pediatric Brain Tumors: Parent Stories

Edited by Christy A. Rentmeester and Gigi McMillan

Narrative Inquiry in Bioethics will publish an issue devoted to personal stories about the experiences of parents caring for children with brain tumors. Please include diagnosis and treatment; other important phases of the journey, which track the child’s acute and long term recovery from treatment, long term quality of life issues, possible recurrences of tumors, and possible end-of-life issues. We would like stories from mothers, fathers, and other guardian caregivers. We are looking for true, personal stories in a form that is interesting and easy to read.

In writing your story, you might want to think about:

1.     Sharing a description the circumstances, your feelings and the skills you had
(or wished you had) as you faced the following situations: A) Diagnosis,
 
B) Treatment, C) Acute Recovery, D) Long-term Quality of Life,
E) Recurrence, F) End-of-Life.
2.     If you were enrolled in a research study, what was that like for you and
your child?
3.     How did you communicate the diagnosis, treatment and outcome
scenarios to your child and family?
4.     What support systems did you find that met your needs?
5.     Looking back on your experiences, what do you wish had been different?
How might these aspects be addressed?
6.     What advice would you offer to other families who might face similar
circumstances?
7.    What suggestions would you offer to medical caregivers or researchers?
8.    How has this experience influenced you, your child and your family?

You do not need to address each of these questions—write on the issues that you think are most important to share with others. If you are not a writer, just tell your story in your own words and our editorial staff will help you.

We plan to publish 12 brief stories (800 – 2000 words) on this topic in the print edition of the journal. An additional 6 stories will be published as online-only supplemental material and other stories may be posted on our online Forum. We also publish 2-4 commentary articles that discuss the stories in the journal. To see a finished symposium you may access Narrative Inquiry in Bioethics Vol. 2 issue 1 for free on Project MUSE.

If you are interested in submitting a story, we ask you first to submit a 300-word proposal—a short description of the story you want to tell. Inquiries or proposals should be sent to the editorial office via email: narrativebioethics@gmail.com. We will give preference to story proposals received by April 30, 2013.


For more information about the journal Narrative Inquiry in Bioethics, the guidelines for authors, and
privacy policies, visit our webpage with Johns Hopkins University Press at:
http://www.press.jhu.edu/journals/narrative_inquiry_in_bioethics/guidelines.html

Thursday, February 21, 2013

Award Winning Journal

Exciting News!

Narrative Inquiry in Bioethics: A Journal of Qualitative Research received the Honorable Mention (2nd place) for Best New Journal of 2012 in Science, Technology, and Medicine from the PROSE Awards. 


The journal is edited by James M DuBois and Ana Iltis and published by Johns Hopkins University Press. 
We are very grateful to all the people who have helped us make this journal a reality. Our editors, board of directors, board of advisors, JHUP, The Bander Family Foundation, symposium editors, and all our wonderful authors, Thanks! 
Please let everyone know that all six issues (Volumes 1 and 2) are now available on Project MUSE. Vol 2, issue 1 (with stories from living organ donors) is now free. 



Thursday, January 3, 2013

News for a New Year!

We have finished another volume of Narrative Inquiry in Bioethics.

The issue edited by Paul Farmer and Sadath Sayeed on Delivering Health Care to Resource Constrained Areas (NIB 2.1) and the issue edited by Kelly Dineen and Margaret Bultas on Parenting ASD Children Through the Transition to Adulthood (NIB 2.3) are now in print and have been posted on Project MUSE http://muse.jhu.edu/journals/narrative_inquiry_in_bioethics/

The first issue of Volume 2 on Living Organ Donors is now free on Project MUSE http://muse.jhu.edu/journals/narrative_inquiry_in_bioethics/toc/nib.2.1.html Please share this link with anyone who might be interested in this topic.

Please watch for more news. We have some very exciting projects in the works.


Wednesday, September 12, 2012

Calling All Clinicians! New call for stories: The Many Faces of Moral Distress Among Clinicians


Narrative Symposium: The Many Faces of Moral Distress Among Clinicians
Edited by Cynda Hylton Rushton, PhD, RN, F.A.A.N. and Renee Boss, MD, MHS

Narrative Inquiry in Bioethics will publish an issue devoted to personal stories from clinicians regarding situations that cause moral distress and how they have responded to them. Moral distress arises when professionals find that they are unable to act in accordance with their moral convictions. The focus of this inquiry is on the personal and professional short- and long-term impact of moral distress and the ways that clinicians respond to and make meaning from that distress. Appropriate contributors might include nurses, physicians, social workers, nursing assistants, clinical ethicists, occupational and physical therapists, and professionals in training. We want true, personal stories in a form that is easy to read.

In writing your story, you might want to think about:
  •     Which specific clinical situations give rise to moral distress? Why?
  •      How do you experience moral distress—physically, psychologically,  socially or spiritually?     
  •       How do you deal with moral distress? In past distressing situations …
  •       Did you take actions that allowed you to uphold your deepest values?
  •    What conditions within yourself, the people involved, and the external   environment allowed you to do this?
  •    How did you made sense of the situation? 
  •      What have been the short or long term consequences?
  •    Have you ever been professionally disciplined for acting upon your moral conviction?
  •    How has moral distress affected your job performance or your commitment to your job?
  •    What has been left undone or been the residual impact?
  •    How have your own values evolved as a result of moral distress?
  •       How would you change the system (e.g., policies, hierarchies, processes) to alleviate moral distress within your position? Do you think it can be alleviated, or is it inevitable?

You do not need to address all of these questions—write on the issues that you think are most important to share with others. You do not need to be a writer, just tell your story in your own words. We plan to publish 12 stories (800 – 2000 words) on this topic. Additional stories may be published as online-only supplemental material. We also publish two to four commentary articles that discuss the stories in the journal.

If you are interested in submitting a story, we ask you first to submit a 300-word proposal—a short
description of the story you want to tell. Please
include a statement about what type of clinician you are and what kind of environment you work in (no institutional names are needed). Inquiries or proposals should be sent to the editorial office via email: narrativebioethics@gmail.com. We will give preference to story proposals received by Oct 31st. For more information about the journal Narrative Inquiry in Bioethics, the guidelines for authors, and privacy policies, visit our webpage with Johns Hopkins University Press at: http://www.press.jhu.edu/journals/narrative_inquiry_in_bioethics/guidelines.html

Saturday, July 28, 2012

Book Review: The Brewsters


Book Review: The Brewsters written by Jeffrey P. Spike, Thomas R. Cole, and Richard Buday 
Reviewed by: E. Ann Jeschke M.T.S

A real challenge for those studying to become health care professionals or ethicists is engaging real people in situations that do not easily fit into textbook answers and defy the limits of sound argumentation.  In their book The Brewesters, Jeffrey P. Spike, Thomas R. Cole, and Richard Buday expose their readers to the nitty-gritty of health care professionalism, clinical ethics, and research ethics through a choose your adventure format.  The novelty of The Brewsters lies not so much in the format, as in the way the book introduces theoretical concepts by encouraging readers to enter the complexity of the ethical decision making process and experience the consequences.  The Brewsters requires its readers to clothe themselves in the daily challenges of six different characters in order to embody the complexity of health care ethics.  Readers of The Brewsters must be ready to roll up their proverbial sleeves and get their hands dirty by trying to figure out how to navigate common ethical dilemmas of health care. The pedagogical brilliance of this book lies in the fact that it engages the reader by making ethics real and deeply personal. 
            The Brewsters is organized into three main acts.  The first half of each act is a narrative that relates various perspectives on the Brewster’s family drama.  The second half of each act highlights the most pressing theoretical elements pertaining to health care professionalism, clinical ethics, and research ethics that were uncovered in the events of the narrative section.  The structure works well because it allows the reader to wade through the events of the narrative unbiased by prior information.  After the readers make their choices and come to the conclusion of each act, the second half functions as a pseudo answer key.  This format allows the readers’ decisions, whether right or wrong, to be reinforced by a high-level explanation of the theories underpinning the evolving dilemmas from the previous act.
The first act begins with the reader entering the narrative as a third year medical students, either Cheryl or John.  Both of these characters are relaxing amidst the festivities at a pool party hosted by Dr. Enrique Hernandez. The host of seemingly prosaic choices that emerge from interactions at the party could have major ramifications for their careers even in the formative stages of medical school. When individuals are unable to stave off all the temptations posed by the combination of alcohol and a pool, Dr. Hernandez is ready to reprimand, but does not seem to take any responsibility for the context.  I think this section would have been even more potent if the setting had been an innocuous backyard barbeque allowing Dr. Hernandez to seem above reproach on every level. 
The second act introduces the reader to two new character options, Wayne, the father of Walter Brewster from the previous act, or Julie, a registered nurse working part time in Dr. Hernandez’s office while completely a master’s degree. In the second act I was impressed with Dr. Hernandez’s concern for the whole patient, not just a diagnosis and treatment plan. Psycho-social concerns that emerge in the clinical setting are not easy to delimit and do not come with prescriptive answers.
 While I really appreciated the authors’ emphasis on whole person treatment, this section could have left more room for learning from mistakes.  One of the challenges of ethics in context is that individuals trying to weigh all the information may, and likely will, make erroneous decisions that are prompted by meticulous thought and the best of intentions. The tone of this section, as in the previous section, was slightly paternalistic.  While this comment does not detract from the overall pedagogical value of the book, illustrating Dr. Hernandez to be a wise Socratic mentor would have made the book even more powerful.  Ultimately, I must concede that the structure of an adventure novel somewhat limits robust discussion of nuances because this style is set up in binary mode that keeps the plot moving forward.    
             The final act continues a scene from act two where Gloria has been referred by Dr. Hernandez to a colleague’s dental clinic providing the reader with two final character choices.  Neither Gloria Brewster, Wayne’s bombastic mother, nor Parvesh, a first year dental student, are new characters in the overall plot progression.  However, the reader switches to focus on the medical concerns of Gloria Brewster in order to engage the issues of medical research ethics as either participant or research coordinator.
                     Of the three sections, act three was definitely my favorite.  I felt like I was the protagonist in a mystery novel and was never sure where to look for new the clues to solve the puzzle.  It was completely enthralling and I felt tense just waiting to make the next decision.  Sometimes I even got mad at certain characters for their attitude, dismissiveness, or arrogance.  When I chose to read forward as Gloria I felt the distinct stress of uncertainty enter my body.  When I chose Parvesh I was completely convinced I was going to get in trouble no matter what decision I made.  The immediacy of the experience was wonderful and somewhat unexpected.  While I definitely felt a kinship throughout the book with all the characters I chose, act three took my emotional participation to the next level. The reader who is unfamiliar with issues and theories in research ethics will particularly enjoy this section.
Ultimately, the book ends on a particularly positive note, but is not hyper-idealized, which allows the reader to buy into the story throughout the entire book.  More importantly, the concluding scene convinces the reader that being ethical in health care is definitely possible, but never simple. 
In the introduction to The Brewsters, the authors comment on the importance of character development through moral virtue, compassion, integrity, and respect.  There can be no doubt that when readers finish charting a course through The Brewsters they will be feel a sense of connection to every character whether good or bad. Kinship with the characters is the real meat and potatoes of this book.
The Brewsters is a superb book for the novice or experienced individual interested in the world of health care ethics.  Jeffrey P. Spike, Thomas R. Cole, and Richard Buday have crafted an exciting adventure novel that successfully takes the reader into the heart of ethical deliberations in the daily lives of health care practitioners and patients.  I would recommend this book to anyone who needs an excellent resource for an undergraduate medical humanities class or a medical school ethics course.  It is also a delightful refresher tool for the advanced student in or practitioner of health care ethics.  While The Brewsters will serve each level of reader differently, it will definitely serve every reader well.