Showing 21 - 30 of 45 annotations contributed by Carter, III, Albert Howard

A Little Something

Haddaway, Richard

Last Updated: May-13-2014

Primary Category: Literature / Fiction

Genre: Novel


A Little Something is a story of a medical catastrophe for a family: at a baseball game, 10-year-old Justin is struck in the face by a foul ball. He seems OK initially, but he has a loose tooth. His father takes him to a dentist, where, left unattended, he has a drug reaction and loses consciousness. Paramedics take him to a hospital, but he does not wake up. He becomes the still center of the book; three circles form around him.  The closest circle includes the attending neurologist Dr. Goldstein and, of course, his parents. His mother Kath is a pediatric physician; she follows closely the medicine involved and knows well the hospital where Justin is being treated. His father Sam is an introverted financial man; he measures everything in numbers. Their marriage is stressed even before the accident. Kath’s nurse at her clinic, Jonesie, is a steady support. Granny, a Licensed Vocational Nurse, comes to watch over Justin. In a moving scene, she bathes the unconscious boy.

A second circle includes other family and friends, the clientele of Kath’s pediatric clinic, the children, and their parents. These are largely Latino, underserved in Fort Worth, Texas, of 2001. (Kath has chosen a medical specialty that earns less money than other fields—in contrast to her money-grubbing mother, who is satirically portrayed.) Next door to the clinic is a firehouse, where Justin has visited and made friends. The blue-collar firemen are public servants who help make a community work.

A third circle is less defined but contextual for the novel: country folks, like Granny, who are not intellectual but practical. They believe in keeping going no matter what, a folk wisdom of realistic, durable hope.

For three-quarters of the novel there’s suspense about Justin’s recovery. At one brief moment, Sam is sure of a turnaround when he sees (or thinks he sees) a smile on Justin’s face. For nine days Sam and Kath experience hope, anger, exhaustion, expressed rage, confusion, and continuous uncertainty.

Finally there is “the meeting,” a gathering of the doctor, the family, Kath’s faithful clinic nurse Jonesie, and Father Red, a Catholic priest from Justin’s school.  Dr. Goldstein says there is no hope for recovery and gives the medical details of Justin’s brain death, which has both anatomical and legal certainty.

Kath and Sam decide to disconnect Justin from life support and allow organ donation. When Justin must be transferred from the children’s hospital to the neighboring one, Sam carries him in his arms. A surprise ritual is an honor guard of firemen who line the path of the procession.

We read the specifics of disconnecting the vent tube, watching the heart race on the monitor, then the flat line of the still heart. Father Red reads from the Book of Common Prayer. An hour later, a helicopter takes off from the hospital with Justin’s donated heart.

An Epilogue six months later describes a Thanksgiving dinner at the firehouse. Sam and Kath are closer now, and he plans for them a trip to Hawaii. There’s has been, however, no easy “closure,” and the couple combines memories with mourning. 


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Primary Category: Literature / Fiction

Genre: Collection (Short Stories)


This collection of 16 short stories focuses on doctors and patients in San Francisco, where a wide variety of wealth and culture impact the delivery of medical care.  Further, there are many restrictions—financial, bureaucratic, ethical, and legal —that limit what doctors can do, especially in cases of patients near death.

The author, Louise Aronson, is a geriatrician who knows this terrain very well, having trained in San Francisco and worked as a physician there. A skilled writer and close observer, she has created dramatic and often funny stories that reveal social and bioethical complexity. About half the stories describe end-of-life issues for the aged and the dilemmas for their physicians and families.

In ‘The Promise,” Dr. Westphall orders comfort care only for an elderly patient who has suffered a massive stroke, but a hospital gives full treatment because there was no advance directive and the daughter told the attending to do “what he thought best.”

When Dr. Westphall sees this barely functioning patient in a skilled nursing facility seven months later, he tenderly washes her face and hair—although the text teases us that he might have been prepared to kill her.

In “Giving Good Death,” a doctor is in jail charged with murder; he has fulfilled the request of Consuela, a Parkinson’s patient, to help her die. When it appears that she may have died for other reasons, he is released, his life “ruined.” He leaves San Francisco, and, we surmise, medicine. In three other stories, doctors also leave the profession: the cumulative stresses of work and family and/or a sense that it’s not the right path bring them to that choice.

On the other hand, one of the longer pieces “Becoming a Doctor” celebrates the profession, despite all the rigors of training including sexism against women. 

The stories bring multicultural insights; we read of people from China, Cambodia, Latin America, India, Russia, and the Philippines. Some are African-American; some Jewish, some gay. These different backgrounds color notions of health, death, and medical care. There are also pervasive issues of poverty and, at another extreme, professionalism that is hyper-rational and heartless.

Indeed, a recurring theme is care and love for people, no matter their background or current health status. A surgeon realizes (regrettably too late) that the secret of medical care is “caring for the patient—for anyone—just a little. Enough, but not too much” (p. 135). 

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Primary Category: Literature / Nonfiction

Genre: Treatise


F. González-Crussi, professor emeritus of Pathology at the Feinberg School of Medicine at Northwestern University, has written several books on medicine and the human body. Carrying the Heart deals with five basic organ systems; he styles them as Digestive, Scatology, Respiratory, Reproductive, and Cardiovascular.

In his Foreword, he rejects a mechanical view of the body and medicine that treats patients as passive protoplasm. He seeks to engage the imagination of his readers so that they can become active participants in health care.

For each system, González-Crussi assembles an eclectic wealth of materials: views of authors from classical times onwards, scientists who changed perceptions of the body, his own hands-on view as a pathologist, parallel organs in other mammals, and, usually, an extended narrative of a person with an unusual anatomical history. These are highly personal essays, “rhapsodies,” we might say, which stitch together unusual and interesting facts, observations, and interpretations. It’s impossible to guess what will be on the next page, and the discoveries are many. A gifted stylist, González-Crussi writes with both erudition and wit. 

For “Digestive,” he cites Livy, Paracelsus, Joan Baptista van Helmont, and others before turning to Thomas Bartholin, who questioned the notion that the stomach was somehow the “king” of the body and the seat of the soul. González-Crussi writes, “the gastric cardia admits and stores impure food, without this having any discernible effect on the soul. Nor is the soul damaged by performers at circuses and country fairs who lower swords and knives into the stomach” (p.7). The text marches on through Réamur, Spallanzani and others, before turning to the well-known story of Dr. William Beaumont and his patient Alexis St. Martin, who had a hole in his side (from a gunshot). Beaumont experimented with materials placed directly into the stomach.

Next in the digestive process are the bowels, discussed on “Scatology,” literally the study of scat or excrement. González-Crussi is fascinated by cultural values of “death, putrescence, and dissolution” that attach to our scat. He draws on Rabelais, Luther, the Gnostics, Chuang-tzu, and the Aztecs for the views on the contents and process of the bowels—more than the nature of the actual bowels themselves. The next 30 pages deal with enemas, including the modern (and discredited) notion of “auto-intoxication” a justification bruited about even today for colonics.

Oddly enough, the enema theme continues in the “Respiratory” essay, because there were “smoke enemas” for some 200 years. Page 104 shows a French illustration of interlocked tubes for this purpose; indeed the same illustration graces the slipcover for the book. González-Crussi draws on Anaximenes, Pirandello, Plutarch, Hawthorne, and others. Some 15 pages describe a famous tuberculosis patient, Frederic Chopin, although perhaps he was actually a cardiac patient.

Part I of “Reproductive” is “Female.” We quickly learn that “The uterus is placed between the bladder and the rectum. As a piece of real estate, the uterus would be much devalued by the condition of the neighborhood” (p. 152). Nonetheless, the uterus is “immunologically privileged,” fending off germs that might infect a fetus (which in itself is “half foreign” because of the father’s genes). Drawing on many commentators, González-Crussi discusses menstruation, and pregnancy, although not genital pleasure or orgasm. Some insightful pages explore the normal death of cells within our body.

Part II, “Male” discusses erections, side-curving penises, and the famous penises of Napoleon, Rasputin, and Jesus.

The last essay, “Cardiology” briefly explores two types of knowing (from the heart, from the brain) before a lengthy retelling of the Lay of Ignauer; this strange story ends with women whom he has seduced eating his cooked heart. The last section discusses Harvey’s discovery of the heart as a pump. The final two pages see a new consideration of the heart as a second brain.

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Open Heart

Wiesel, Elie

Last Updated: Feb-01-2013

Primary Category: Literature / Nonfiction

Genre: Memoir


Elie Wiesel, 82-years-old, has pain that he thinks is in his stomach or esophagus, perhaps caused by his chronic acid reflux.  After tests, however, doctors diagnose cardiac illness and insist on immediate surgery. Reluctant to go to the hospital, Wiesel dawdles in his office. When he does go, doctors believe a stent will do the job. Instead, the intervention becomes a quintuple bypass.

This brief memoir—a scant 8,000 words—presents the “open heart” of a gifted writer as he contemplates his open-heart surgery, his past life, and the future. He asks himself basic, even primal questions about life, death, and the nature of God.            

Although a man with an extraordinary career—prizes, fame, honorary doctorates, friends in high places, professorships—Wiesel experiences and describes ordinary feelings of anxiety, pain, and doubts about his cardiac emergency and possible death. His stylistic gifts describe frankly and vividly a patient’s fears. As many have observed, patients with a serious disease have two difficulties, the disease itself and their emotional responses to that disease.  As Wiesel is wheeled into the OR, he looks back on his wife and son; he wonders whether he will ever see them again.            

He writes that his “thoughts jump wildly; I am disoriented.” He recalls a friend undergoing similar surgery; she died on the table. He says he can’t follow the jargon of physicians. The texture of the prose is rhapsodic, jumping from the present to memories, many of them about war, his past surgeries, or important family events. This short book has 26 “chapters,” some just half a page; they are like journal entries.

As he slowly recovers, he feels pain and has visions of hell, including the concept of ultimate judgment. “Evidently, I have prayed poorly…; otherwise why would the Lord, by definition just and merciful, punish me in this way?” (p. 38).  Because he has a “condemned body,” he feels he must search his soul. In the longest chapter of the book, he reviews several of his writings.

Wiesel asks some of the questions from his famous novel Night (La nuit, 1958).  If there is a God, why is there evil? Auschwitz, he says, is both a human tragedy and “a theological scandal” (p. 67). Nonetheless, he affirms, “Since God is, He is to be found in the questions as well as in the answers” (p. 69).

At the end, he still has some pain but feels much gratitude for his continuing active life and for his grandchildren.

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This book describes San Francisco’s Laguna Honda Hospital, where Victoria Sweet worked as a doctor for 20 years. In the tradition of the Hôtel-Dieu in Paris (literally “God’s Hotel”), Laguna Honda cares for the sickest and poorest patients, many staying there indefinitely because there is no alternative for them. Sweet learns from her long experience at Laguna Honda that “Slow Medicine” has benefits, that a holistic or unified view of patients works best, and that the reductionism and specialization of modern medicine has limitations and costs. During these years Sweet becomes fascinated by the medieval abbess Hildegard of Bingen and earns a Ph.D. focusing on medieval medicine. At the same time (and increasingly) various forces—economic, legal, political, bureaucratic—cause many changes at Laguna Honda, mostly contrary to Sweet’s vision of medicine.

            Part history, part memoir, part social criticism, the book is informative, entertaining, and important for its discussion of the care of our least-well-off citizens and for its perspectives on modern, Western medicine.         

            There are three intertwining strands to this engaging book: Sweet’s medical evolution as a physician, the changes in Laguna Honda, and her investigations of Hildegard of Bingen and other spiritual matters.

            Sweet joins up with Laguna Honda initially for only two months, but she finds the hospital and her work there so fascinating that she stays for 20 years. As an almshouse, Laguna Honda takes care of indigent patients, most with complicated medical conditions, including mental illness and dependencies on alcohol and/or drugs. Many of these cases come from the County Hospital with continuing (but not carefully reviewed) drug treatments. Every 15 or 20 pages, Sweet describes the dilemmas of a particular patient, and her medical (and personal) attention to that patient. The cases are vivid and instructive.

   Clearly Laguna Honda is a major figure on the book; we can even consider it (or “her”) a beloved character and a teacher to the young Dr. Sweet, who learns three principles from her work there: hospitality, community, and charity. 

Because Laguna Honda is old-fashioned in many ways, Sweet reads her own X-rays, goes the to lab to see results, and spends large amounts of time with each patient. Laguna Honda has an aviary, a farm with barnyard, and a solarium; such features help to heal the whole person. While respectful of modern medicine, Sweet slowly learns that a careful review of a patient through Slow Medicine is more accurate and more cost-efficient than standard, reductionist, high-tech medicine. She comes to respect approaches from “premodern” medicine, including that of Hippocrates and Hildegard.

  The second strand is the evolution of Laguna Honda itself. Sweet describes a variety of pressures: the recommendations of consulting firms, rulings from the Department of Justice, a lawsuit, financial difficulties (including fiscal mismanagement), administrators focused on a narrow concept of efficiency, a utilization review board, forms and more forms, and a pervasive sense that modern (including Evidence Based Medicine) is always good. All these and more create a “relentless pressure squeezing the hospital’s Old Medicine into the New Health Care” (p. 322). Sweet demonstrates that her Slow Medicine can actually save money in the long run. Confident that her way is better, she proposes an “ecomedicine unit” that she would match against the modern, “efficient” units in a two-year experiment. (For more information on her concept of ecomedicine proposal, see

            As the hospital is “modernized,” many important features of the old place are gone and many “new and improved” aspects don’t work. Somehow there are no rooms for physicians in the new building while there is plenty of space for administrators and managers. A sophisticated computer system doesn’t work. Sweet doesn’t say “I told you so” directly, but we get the picture.

            The third strand is Sweet’s investigations of spirituality and pilgrimage. She is fascinated by Hildegard’s notions of the healing power of nature, the ability of the body to heal itself, and wholeness as an aim for a person and for a community. Sweet attends a Swiss conference on Hildegard. She hikes the pilgrimage route from France to Santiago de Compostela in four installments and considers notions of pilgrimage. She feels called to pursue her ecomedicine project and to write this book.           

            By the end of the book, both Sweet and Laguna Honda have changed and are now headed in different directions. 

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Ledger, Kate

Last Updated: Apr-30-2012

Primary Category: Literature / Fiction

Genre: Novel


Simon Bear is a hard-charging physician; his wife Emily is a successful public relations executive, now a senior partner in her firm. Although they have a lavish house, a teen-aged daughter, and much wealth, their marriage is troubled, in large part because they have never fully mourned the death of their baby Caleb.

The title “Remedies” fits well with the long struggle for how to heal their grief. The remedies that clearly have not worked are obsessions with career, professionalism, rationalism, and the trappings of American materialism.

Simon has two obsessions about his practice. The first is that he is a rescuer, the perfect doctor who listens to his patients and gives them what they want. As a self-appointed expert on pain, he is free and easy about prescribing opiates. When his father-in-law feels no pain after a car accident, Simon is sure that a drug that the man is taking is, in fact, the Holy Grail of pain medications. Simon becomes obsessed with this “discovery,” promoting it to his patients, without a scientific study or consideration of ethical implications. When he flies to a national medical meeting to trumpet the news of this remedy, no one will listen to him.

While Simon is the point of view for Parts One, Three, and Five, Emily—structurally separated—is the voice and focus of Parts Two and Four. She is troubled by her distance from Simon and, increasingly, her 13-year-old daughter, who is sullen and rebellious. When she meets Will, a former lover, she seeks another kind of remedy in an affair with him, even prospects of marriage. Contrasting with her strategic, rational approach to life, Will is an open, easy-going man, conveniently separated from his wife.

A series of crises rock Emily, then Simon. Emily begins to understand her anger; she has a breakthrough with her daughter. Simon has several setbacks, including humiliations, but he is not crushed. Although ordinarily a secular Jew, Simon attends the Kol Nidre service the evening service before Yom Kippur, the Day of Atonement. In a powerful and moving passage, he finds healing, relief, and a new direction for his life—a true remedy.   

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Primary Category: Literature / Nonfiction

Genre: Treatise


This is a huge and wonderful book about cancer, the collection of diseases that sickens people all over the globe and kills many of them. An epigraph to the book states, “A quarter of all American deaths, and about 15 percent of all deaths worldwide, will be attributed to cancer,” but the book also describes medical advances that now heal, prevent, or palliate most forms of cancer.

Mukherjee, a cancer physician and researcher, has several strong themes. He sees cancer as an affliction with a long history, a story worthy of a biography; indeed recent discoveries show it to be rooted in our genes (although external factors such as viruses, asbestos, and tobacco smoke can cause genetic disruption). The story of cancer implies a surrounding triangle, the stories of sick people, treating physicians, and biological researchers, all of which Mukherjee artfully weaves across 472 pages. Cancer has Rohrschach blot qualities: depending on time, place, and role in life, humans have perceived different attributes of cancer. As the book ends, however, there is a coalescence of scientific understanding that is satisfying—although there is certainly more to be learned and we are all still vulnerable to genetic errors and, of course, we are intractably mortal.

Another strand is the nature of stories themselves, their twists and turns, presumed early solutions, and personal and social values embedded in them. Mukherjee threads throughout the book the case of a contemporary kindergarten teacher, Carla Reed, who has a leukemia. He bookends his text with ancient Persian Queen Atossa with (presumably) breast cancer. Reed, healed by the end of the book, was Mukherjee’s patient; Atossa was described by Herodotus: both suffered emotional turmoil because of their disease.  Mukherjee understands the affective dimensions of disease for patients and caregivers alike; literature represents these in various ways, and he quotes in his chapter epigraphs and in his prose many writers who describe human experience deeply: Aleksandr Solzhenitsyn, Susan Sontag, Charles Dickens, Thomas Mann, William Carlos Williams, Carlo Levi, and Italo Calvino, to name a few.

The primary story, however, is the interplay of cancer and a large cast of observers, investigators, doctors, scientists, activists, and government officials. Sidney Farber and Mary Lasker dominate the first 100 pages with their two-decade war against cancer. While surgery—historically dramatic and disfiguring—had been a mainstay for treatment of cancer, Farber pursued a biochemical route, which elaborated into chemotherapy, the second major approach of the late 20th century.

Mukherjee also explains ancient views, Hippocrates’, Galen’s humors, Vasealius’ anatomy, Hunter’s stages, Lister’s antisepsis, and Röntgen’s X-rays, which became the third major approach. By 1980, however, the American “War on Cancer” had not been won.

Further advances in cellular biology and genetics would be needed to make targeted molecular therapy possible.  Mukherjee tells this complicated story clearly and engagingly, showing the human investigators to be personable and dogged in their pursuits.  

Another important approach is prevention. The biostatistical work of Doll and Hill, for example, showed the links between tobacco and lung cancer. Screening, such as Pap smears and mammograms, also saved lives, but the basic cellular understanding still eluded investigators.

The final 150 pages explain the search for and discovery of genetic factors, specifically oncogenes. Harold Varmus and J. Michael Bishop were the leaders, winning a Nobel Prize in 1989. Bert Vogelstein, Judah Folkman, Robert Weinberg and Douglas Hanahan took the work further, opening the doors for such drugs as Herceptin, Gleevec, and Avastin. 

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Primary Category: Literature / Nonfiction

Genre: Treatise


This short, gripping book describes Taylor's massive stroke, a burst blood vessel in the left side of her brain. Ironically, she was at 37, a neuroanatomist at Harvard, well versed in the anatomy and function of the brain. Her knowledge allowed her to understand from the inside her rapid loss of mental function and, with treatment, her very long (some eight years) recovery to health and, once again, professional activity.

Taylor presents an overview of brain structure and function, emphasizing the different roles of the left and right hemispheres. Since her left hemisphere was damaged and needed to be "rebuilt," in her term (learning to read, to dress herself, to drive a car, to think), she had plenty of time to explore her right brain and understand its wisdom and peace. This is her insight: our culture prizes the admirable but often frantic work of the left brain, putting us in stressed, competitive modes of thinking and acting, often aggressive and argumentative. "My stroke of insight," she writes, "is that at the core of my right hemisphere consciousness is a character that is directly connected to my feeling of deep inner peace" (page 133). Both sides of the brain have their strengths and uses, but she especially enjoys the spiritual and humane aspects of the right brain and, by extension, invites her readers to consider these resources for themselves and for the larger society.

Taylor credits her mother's care for much of the recovery, although it is clear between the lines that Taylor herself worked hard with various therapists (speech, massage, acupuncture). Despite the severity of her injury and the surgery, she appears to have returned to professional work at a high level, fully recovered and very grateful.

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This is a collection of four stories and a novella with pervasive themes of death, loss, grieving, mourning, and anger; the characters live in rural parts of the upper midwest, and there is much unhappiness in their lives.

In "Catch and Release," we accompany Danny, a talented fishing guide "not quite thirty," as he floats down a stream he knows well. He and his siblings have divided his father's ashes, his portion now in a thermos. His father died suddenly, absurdly on a bathroom floor. Although Danny knows nature well (and loves it), he is angry and heartsick. Nor is religion a comfort. Bit by bit he scatters the ashes, but there is no healing ritual.

In "Bloodsport" a young man murders is wife and then kills himself. The town funeral director feels this is "utterly incomprehensible" but provides his professional services to the family and all who  come to the service and burial. He knew the young woman, Elena, and found her attractive; now he embalms her. Twenty years later he feels a "sense of shame" that men "let her down badly."

"Hunter's Moon" presents Harold, a casket salesman. Retired, he goes on long walks, trying to make sense of is life and loves. He likes naming things. His first wife left him for another woman. His daughter (pregnant and drunk) was killed by a train. His second wife left him. His third wife died of cancer. He abuses antidepressants and liquor. Sitting on his front porch, he slumps over. All night a dog keeps watch over, we assume, his dead body.

In "Matineé de Septembre" we find a reworking of Thomas Mann's "Death in Venice." In both stories, a literary figure escapes ordinary time, falling in love with a young person of the opposite sex, and falling into decadent gestures in the hope of recapturing youth. Both efforts end in failure and death. In Mann's story, the person is an older man of much literary accomplishment. In Lynch's retelling, the person is a professor and "poet of note," although not really of international fame. Actually she's a woman of inherited wealth, a wealthy snob, a narcissist, a survivor of a "perfectly bargained marriage." Her one child was stillborn. A dozen hints at her headaches suggest that she is doomed, and she dies in the last paragraph, without (as in the Mann story) the notice of the literary world.

After these grim tales comes the satiric (and also grim) novella, "Apparition." We follow one Adrian Littlefield (the last name is symbolic) who was a strait-laced pastor, then (after his wife left him) a self-help author who urged post-divorce people to live it up. The satire is trenchant. Adrian's big book is "Good Riddance." A church fundraiser with gambling allows "otherwise devout people to wallow in sin for a worthy cause." Adrian has girlfriends and one-nighters. He's an expensive speaker. Fortunately one Mary De Dona provides him with gratuitous sex, and he is saved. Now 50+, he visits the empty house where his wife once lived, learning little; his tour guide, one "Gloria" is in her 70s, married for 58 years, with grandchildren and great-grandchildren. He wishes he could have had such a life and feels "a wave of sadness." 

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Echoes of War

Brown, S., H., ed.

Last Updated: Feb-23-2010

Primary Category: Literature / Literature

Genre: Anthology (Mixed Genres)


This is an anthology of 32 pieces, many directly relating to war and its aftermath, or, in general, kinds of violence humans inflict upon each other and the ensuing suffering: hence the title, "echoes of war." The pieces include short fiction, essay, a dozen poems, and a photo collection. Since none are lengthy, this is a good reader to supplement other longer texts or to serve as an anthology for a reading group. A short essay, "Suggested Longer Readers," mentions some three dozen pivotal topics, including "homecoming" and "sense of identity." 

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