Summary:

A surgeon attending a medical meeting becomes bored and hires a prostitute. When he awakens next to her in bed the following morning, he first observes, then palpates a suspicious lump in the right breast of the sleeping woman. Although he informs her of the abnormality and the need for further evaluation and treatment, the surgeon cannot bring himself to divulge the possibility (or even likelihood) that the breast lump is malignant.

It is the prostitute who acknowledges (and eventually proclaims) that the lump might be cancer. She realizes that breast cancer might prove fatal to her livelihood as well as her life. The surgeon appears less upset by the diagnosis and potential suffering associated with it than the realization that both he and the tumor were rivals, "each feeding on her flesh" in a competition to consume the woman.

He pays the prostitute one hundred dollars for her services and cannot wait to exit the room. She offers him ten dollars for his consultation, but the surgeon refuses the fee with the excuse that he doesn't make house calls.

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Tenderly Lift Me is the latest publication from Kent State University Press in the Literature and Medicine series edited by Martin Kohn and Carol Donley. Not all the 39 caregivers Bryner honors through poetry, biographical sketches and photos are nurses, but all have discharged their caregiving duties as the title indicates: tenderly. The book opens with a preface by Bryner who wants "people to care about nurses the way nurses care about people who are total strangers" (p.xii). A literate and insightful introduction by Suzanne Poirier and Rosemary Field follows.

The book, divided into eight parts, contains biographical sketches and interviews with nurses or tender caregivers, their photographs, and poems by Bryner in which she speaks in the voices of the individual nurses, celebrating but never sentimentalizing their stories.

Some of the nurses are daughters of blue-collar workers: Carol Johnson (p. 77) went on to become a cardiothoracic nurse practitioner, harvesting veins for open heart surgeries. Helen Albert (p. 52), the granddaughter of a slave, became "the first black registered nurse hired in Warren, Ohio." The nurses celebrated are both living and dead; some are aged, this book the only vessel that might hold their histories. All the caregivers, like Father Damien, born in 1840, caretaker to a colony of lepers in Molokai, come alive in Bryner's prose and poems, speaking to us in image and metaphor as well as fact and biography.

There are journal entries from Kate Cumming, who cared for confederate soldiers during the Civil War (p. 151), and comments from contemporary nurses, like Sylvia Engelhardt, one of the first nurses to graduate from an associate degree program and feel the "sting of labels" (p. 69), or Theresa Marcotte Kokrak (p. 46) who remembers traveling though Canada's seventy-below wind-chill to report to duty. Bryner celebrates the nurses' accomplishments as well as the daily events, the doubts and frustrations, the dark moments that these nurses have overcome in order to care for others, nurses who are "human, and sometimes a little heroic, but not from heaven" (P. xii).

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While on an airplane, Carson experiences abdominal pain. He is a divorced man in his fifties and a sales representative for a computer and information technology firm. He spends much of his time traveling and fancies himself "a connoisseur of cities." The increasingly severe stomach pain forces Carson to reschedule his business meeting and retreat to his hotel room.

His suffering mounts and he decides to visit the emergency department of the city hospital. Carson is evaluated by two young male doctors and later a middle-aged female physician. Despite blood tests and X-rays, his diagnosis remains murky and a surgical consultation is obtained. The surgeon suspects appendicitis. He postulates that Carson may have a retrocecal appendix and explains that in such cases the anatomical location of the organ often confounds the diagnosis.

Carson undergoes surgery. His appendix is indeed retrocecal and rupturing. He spends five days convalescing from the operation. During that time he acquires an intimate knowledge of the city from his stay at the hospital. The experience revitalizes him. Carson reasons that the world is miraculous in part because it is so simple yet still spectacular.

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For three weeks the narrator has been working as a clerk in the emergency department. His good friend, Georgie, is a hospital orderly. Both men abuse drugs, and Georgie steals them from the hospital. The ER staff includes Nurse (an overweight woman who shakes) and the Family Service doctor (a physician with limited competence who is not well-liked).

At 3:30 A.M., a man named Terrence Weber arrives at the ER. He has a hunting knife stuck deep in his eye. Ironically, his other eye is artificial. Weber's wife apparently tried to blind him because he ogled the woman next door. The doctor immediately decides the situation is beyond his expertise and calls for an ophthalmologist, neurosurgeon, and anesthesiologist.

Meanwhile Georgie is prepping Weber for surgery. The drugged-up orderly, who cannot even tie his shoe at this point, somehow removes the knife by himself. Weber's vision is fine. Later on, the narrator and Georgie get lost while driving around in a pick-up truck without headlights. The truck runs over a jackrabbit on the road. Intent on making rabbit stew, Georgie cuts the animal open with the hunting knife he had earlier removed from Weber's eye. The rabbit is pregnant with eight miniature bunnies inside her.

Georgie decides to save the babies. Unfortunately the narrator forgets about the rabbits and accidentally squashes them to death. At the end of the story the two men encounter a hitchhiker who has gone AWOL from military service. Georgie promises to take him to Canada.

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Manlius is a 5th C Roman patrician living in Provence who has studied with the wise, reclusive Sophia. He writes his understanding of her teaching in his essay, 'Dream of Scipio,' which trades on an essay by the great Roman orator, Cicero. Sensing that the Empire is gravely threatened, he makes a pact with barbarians, sells out his neighbors, slays his adopted son, and becomes a bishop of the Christian religion, which he has long despised. Late in this ruthless and doomed attempt to salvage what he values most in his world, Sophia makes it clear that he has misunderstood her teaching.

Olivier is an astonishingly gifted 14th century Provencal poet whose intolerant father tries to stifle his love of letters, among which is Manlius's 'Dream'; his father destroys the manuscript, but Olivier recopies it from memory. As plague advances on their region, Olivier finds a mentor in the high churchman, Ceccani, who is bent on keeping the papacy in Avignon. He plans to destroy Jews as symbolic expiation for plague, widely construed to be a form of divine punishment. Olivier befriends a Jewish scholar and falls in love with his beautiful heretic servant.

The 'Dream' and the imprisonment of his friends lead Olivier to question and then betray his mentor. Either because of his efforts to save them, or for his role in a murder, he is mutilated--his tongue and hands cut off to rob him of speech and writing. The brutal mutilation appears early in the book--it is not fully explained until the end.

Julien is a French historian who has studied the poet, Olivier, and the rendition of Manlius' manuscript. He finds solace in his erudition as his county falls to the Nazi occupation. An old school friend who is a collaborator, gives him work as a censor and tolerates Julien's Jewish lover, the artist Julia. In the end, Julien is forced to choose between saving either another school friend in the Resistance or Julia. He chooses Julia, looses her anyway, and commits suicide in a vain attempt to warn his friend.

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The physician Tsvyetkov visits a child who is dying of a brain tumor, and the boy's mother. There is no hope, nothing to be done. Tsvyetkov has had one romantic fling in his life; when he was younger, he had an affair with the boy's mother. She has always told him that Misha was his son. Yet she also had affairs with other men around the same time; one of them might be the father. Tsvyetkov suspects that she insists that he is the father just so he will continue to make payments to support them, which he has always done. As he leaves, he asks the boy's mother one last time, "It can make no difference now. Is the boy mine?" She hesitates for a moment, but answers, "Yes. he is your son."

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This is a collection of 23 stories, five of which take the form of "letters" in which an older physician (not surprisingly, a surgeon) gives advice to an imaginary young surgeon. However, every one of the stories "fits" as a tale that might be told in such a letter--assuming the author was a wise and gifted writer, in addition to being a surgeon.

The book begins with the gift of a physical diagnosis textbook on the occasion of the young doctor's graduation ("Textbook") and ends with a reflection on "your first autopsy" ("Remains"). Among the other stories are Imelda (see annotation), Brute (see annotation), Toenails (see annotation), Mercy (see annotation), "A Pint of Blood," "Witness," "The Virgin and the Petri Dish," and "Impostor."

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When we view photographs of war-torn bodies, piled-up corpses, or starving children, are we changed? How about the photographer, whether a professional or an amateur, who takes such pictures? Do these photographs teach us about suffering--or do they numb us over time and simply cause us to turn away? In this slim book Sontag re-visits her ideas in "On Photography," published 25 years ago.

Her aim, it seems, is not so much to answer the above questions but to provoke us by her statements, urging us at least to THINK about what happens when suffering is viewed third hand; because after all, she reminds us, we see only what the photographer wanted us to see. When scenes of violence are as close as our morning papers or our TV screens, Sontag's is an important debate.

She also gives a brief history of photo-journalism, from the Crimean and Civil Wars to the almost instantaneous transmission of images from Operation Iraqi Freedom. In chapters that sometimes seem to disagree with one another, she plays the devil's advocate and views the IDEA of photographs of suffering from all directions. Can gruesome photos be artistic? Should they be? And if a war photo is posed--a corpse moved for a better shot or a battle scene restaged to make it more dramatic--is the effect enhanced or decreased? She considers the impact of candid photos versus those technologically manipulated; she discusses how photos, and their impact on us, change when the names of the victims are revealed.

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The new interns, Roy Basch (Tim Matheson), Chuck (Howard Rollins, Jr.) and Wayne Potts (Michael Sacks), begin their year of internal medicine training in a busy city hospital under construction. After initial introductions led by the vague staff man and vapid chief resident, they become the specific charges of the cynical resident doctor "Fats" (Charles Haid). Fats teaches them attitude and language: how to "buff" (improve) and "turf" (transfer) "gomers" (Get Out of My Emergency Room)--the words used to describe management of incurable, hateful patients who "never die," regardless of the abuse the clumsy housestaff might inflict. But Fats has heart.

Soon, they fall under the command of the militaristic and lonely woman resident, Jo Miller (Lisa Pelikan), who cannot bring herself to withhold treatment, even at a patient's request. She blames underlings for the failings of medicine and nature, as well as herself.

Wayne throws himself from the hospital roof because of a misplaced sense of guilt over a patient's demise. Roy falls in love with the nurse, Molly (Kathryn Dowling), but nearly loses her as he begins to emulate Jo's cold, calculating style. He is "rescued" in the nick of time by his friends, Fats, and the death of a physician patient (Ossie Davis) whom he admires. With recovered equanimity and renewed anger over the suicide of his fellow intern, Roy refuses to go on with his residency.

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The author comments initially that most physicians become involved in the stories of their patients' lives--as witnesses, chroniclers, and players. He uses as an example the story of a physician's role in the death of Anton P. Chekhov. Another interesting example is the book, A Fortunate Man (see this database), the story of an English country doctor who matures in the profession and comes to recognize the task of the doctor as one to help his patients feel recognized.

Dr. Verghese believes that all patients seen by physicians are in the midst of a story that begins the moment they walk through the portals of a hospital or a clinic. He sees the challenge as engaging the patient and the family in finding an "epiphany," even if that epiphany is simply the understanding that there is nothing more that can be done medically. In his conclusion he says that as physicians we should be ministers of healing, storytellers, storymakers, and players in the stories of our patients and ourselves.

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