Book Review by Jeffrey M. Brown

Stern, Joseph D. Grief Connects Us: A Neurosurgeon’s Lessons on Love, Loss, and Compassion. Central Recovery Press, 2021.

Joseph Stern’s recent book, Grief Connects Us, opens with a study in contrasts. “My younger sister was an actress,” Stern writes.

She was creative, trusting, warm, an engaged wife and mother, full of life…. Victoria loved an audience and could keep them spellbound.

I am a neurosurgeon, more comfortable with a single patient in the quiet of an examining room where I can apply logic and science to solve the problems and mysteries of the human body and disease. (1)

Over the course of the ensuing pages, Stern unfolds the story of his relationship with Victoria as it approached a devastating end: Victoria’s leukemia diagnosis in 2014 at the age of 51, the rapid progress of her illness, the vertiginous experience of her treatment, and the sudden shock of her death less than one year later. Along the way, he offers a series of poignant vignettes about Victoria’s life that seem to erupt from his own measured account. A brief precis on the delicacy of managing graft-versus-host reactions is followed immediately by a story of how the child Victoria earned the nickname of “the Imp” at home. A broad summary of the probability of locating a genetic match in relatively narrow Jewish bone marrow donor registries is punctuated by an outraged assertion from Victoria’s journal: “I am mad at Hitler all over again” (73). Through a trompe l’oeil effect of contoured shadowing, the snapshots Stern includes of Victoria and her family seem to float off the pages. It is often as though Victoria cannot be bound within Stern’s book: the impressions he offers of her luminous personality strain against his own careful prose, held in place by only the most tenuous of forces.

The net effect of these touches is, of course, an ironic counterpoint to the title’s central theme. Grief Connects Us is an entry into the popular genre of hybrid medical memoir: works that synthesize personal accounts of extraordinary medical challenges with efforts to draw conclusions that speak to generalizable forms of treatment or cultural understanding. Over the past decade or so, this particular literary structure has been leveraged to an impressive array of effects in books like Siddhartha Mukherjee’s The Emperor of All Maladies or Atul Gawande’s Being Mortal. For these most prominent examples—both monumental bestsellers, both directly cited in Stern’s book—personal writing provides not an end in itself but rather a frame to engage a non-specialist audience and a springboard for the work’s wider historical or cultural ambitions.

At first glance, Stern’s book seems to adopt the same agenda-based approach, which is implied within the book’s full title. Grief Connects Us: A Neurosurgeon’s Lessons on Love, Loss, and Compassion is divided roughly in two. In the first half, Stern offers an account of Victoria’s illness, documenting with painful honesty the sequence of discoveries and choices, tests and treatments, and opportunities to reassess personal relationships and life’s meaning that defined their family’s journey, often in defiance of medical certainty. In the second half, Stern zooms out, presenting those “lessons” by indicating how his experience led to new epiphanies. He accomplishes this first by surveying other patients and physicians, providing a wider assessment of communication failures and the forms of vulnerability that each had experienced. Finally, he details the advantages of prioritizing the emotional experience of medical treatment, and he patiently outlines how those advantages are felt both by those who give and those who receive care, including impressive accounts of the way that institutions and spaces might be modified to achieve these goals: from the creation of “healing gardens” to the adoption of better policies for the management of sound, light, and diurnal rhythms of activity in the ICU.

Throughout this section, Stern’s integration of others’ voices produces kaleidoscopic effects, in spite of his general thematic focus on “emotional agility,” compassion, and palliation. One fellow doctor meditates on religious values; a page later, another reflects on the regional distribution of medical expertise and what it means to sever a patient from a local community in pursuit of “better” care. The number of issues and perspectives they address can be dizzying, and Stern adopts a light touch in editing and collating their comments. These acts of ventriloquism are not, therefore, the incidental effect of a neurosurgeon’s preference for grounded research. Rather, they are the very substance of his work: an effort to establish “connection” on a direct and intimate level, where even the appropriation of others’ voices is not simple or obvious but rather a matter of the sincere personal effort and deep ambivalence that is threaded throughout the entire work.

Indeed, while Stern presents himself always as gently supportive of Victoria’s choices, another image of him appears briefly in an interpellated section of her personal journal: “Jody [a family nickname for Stern] said I need the radiation, no discussion. He had also said way back in the beginning that if I didn’t do what they told me and tried some Eastern approach, as is so much more my orientation, he would come to Santa Monica and drag me there himself” (73). The disconnection between Stern’s own reserved prose and the frantic image Victoria draws of him is never directly addressed; instead, such gaps proliferate across the book, as Stern recognizes that even the most essential connections may transform as time moves forward and contexts shift. In tantalizing and heartbreaking passages, we are reminded that the book that we are reading is not the one originally intended. Confident in her survival, Victoria had hoped to publish her journal herself as a record of victory; Stern’s original draft was scrapped, rewritten, and supplemented after the sudden death of Victoria’s husband in 2017; even the published book appends a short epilogue written after the emergence of COVID-19, which bristles at the limits of compassionate “connection” right in its final sentences: “What good is a yard sign celebrating ‘COVID warriors’ if you are unwilling to wear a mask to protect others (including healthcare workers) more vulnerable than yourself?” (257).

It is in these moments that the true import of Stern’s title reveals itself. The “lessons” that Stern’s book presents are not programmatic or prescriptive. Instead, Stern teaches through example, allowing us to emulate the lessons he himself has struggled to learn in assembling this work. Beginning with the gulf that separates Stern’s own sensibility from that of his sister, Grief Connects Us recognizes that the bridges spanning such divides are always ad hoc, delicate, and unique: threads suspended above an abyss, maintained by good will, generosity, a respect for enduring difference, and an awareness of their inherent instability. Tracing Stern’s “connections” is a highwire act that requires and engenders its own form of “emotional agility.” As a beautiful memorial to Victoria’s virtuosity, reading Stern’s book is moving: its call to action is sustained our own effort to navigate the distances it creates.