Summary:

The devoted, and antagonistic, bond between a dramatic, charismatic widow (Shirley MacLaine) and her quietly rebellious daughter (Debra Winger) is the focal point of this film's exploration of a range of human relationships and their changes over time and under various pressures, including that of serious illness. The major focus of the last part of the film is the illness and death of the daughter from cancer and its impact on her mother, her husband and children, and their immediate circle of friends and lovers.

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When their young son dies from kidney failure, Stewart and Sharon Mackaney funnel their grief into a business--transporting donated organs for transplant patients. Sharon has put on weight and not cut her long hair since the death of her child, Matthew. The fortyish woman likes to read about vertebrate organs in a worn copy of Gray's Anatomy. She totes a red cooler on her trips crisscrossing the country. Inside of it is a precious organ--a kidney, liver, or pancreas.

Sharon spends lots of time in airplanes, hotels, and bars. Although they continue to share a house, she and her husband have been estranged since Matthew's death three years earlier. Stew suffers from irritable bowel syndrome and chronic flatulence that began at his son's funeral and has not improved a bit despite psychiatric treatment.

Stew and Sharon receive an award for their work as organ transporters. During a speech at the fundraising event, Sharon criticizes the audience for hoarding their kidneys. On returning home, she spends time in Matthew's bedroom and later has a variation of the recurrent nightmare that has plagued her since her son's death. Sharon dreams that her hair is gone, and she rises, unencumbered, until reaching the ozone layer where she is incinerated.

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Thirteen-year-old Charles has been sick with a fever for days. The family doctor makes house calls and diagnoses the problem as scarlet fever and a cold. The boy is unconvinced and questions the physician's certainty since no diagnostic tests have been done. Charles is terrified when first his hands and then his legs change. He senses that his extremities become swollen, warm, throbbing, and twitching. Although the limbs appear normal, Charles is sure that he no longer has control of them. Recalling how the wood of petrified trees transforms into stone, he now fears that his entire body has been irrevocably replaced by a propagating mass of microbes.

The doctor dismisses the boy's fright as the result of fever and imagination. He placates Charles by giving him pills. When Charles begins choking himself, his parents restrain him in bed. Fortunately, the teenager improves dramatically. His fever disappears, and he is suddenly robust. Yet there is something odd (and a bit creepy) about Charles following his recovery.

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A screening chest X-ray reveals the presence of a cardiac myxoma in a 72-year-old dictator. His personal physician (fearing for his own life) timidly informs Mr. President about the tumor and the likelihood that it will claim the dictator's life in a matter of months. The physician lacks the training and ability to remove the tumor but recommends Dr. Gala Sampras as the surgeon most qualified to perform the procedure.

Slight problem: Sampras was one of 14 surgeons who "disappeared" in 1992 after criticizing the dictator and his regime. She was imprisoned and abused in a labor camp. Her husband and three children were also removed from society. A bargain is struck. Sampras will do the operation. After the surgery is done, she will be reunited with her family.

The dictator shows Sampras pictures of her family. Although the photos of her children appear to be recent, the picture of her husband seems to have been taken years ago. On the day of surgery, the dictator directs the doctor's attention to the courtyard where soldiers surround her daughter. Sampras realizes the dictator might not survive the operation given the complexity of the procedure and the patient's age. Before succumbing to his anesthesia-induced sleep, the dictator is told by Sampras not to worry, but her every move is closely monitored by his soldiers. The night is likely to be long and hard for the doctor and the dictator.

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The italicized sentence under the title of this New Yorker essay summarizes it well: "Wanted: Highly accomplished young women willing to undergo risky, painful medical procedure for very large sums." Mead traces the phenomenon of women selling their eggs through the experience of Cindy Schiller, a 26-year-old law student who was "donating" her eggs for the third time.

In addition to Schiller's observations, the article is full of information about the clinical dimensions of egg donation--the donor shuts down her ovaries so that none of her eggs ripen and none of her follicles develop, followed by injections of follicle-stimulating hormones, followed by eggs that are "sucked out, one by one," and whisked away to be fertilized in a petri dish. Most of the article addresses the legal and ethical dimensions of egg donation, the hopes and expectations of those seeking donors, and the new-found marketing strategies of the American fertility industry.

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A neurosurgeon looks forward to having a day off from work, but a promising Saturday brings only trouble. Henry Perowne is 48 years old and practices in London. Lately, he's concerned about the impending invasion of Iraq. Perowne's views on the situation have changed considerably after conversations with a patient who was tortured and imprisoned in Iraq for no apparent reason. A protest march against the looming war is held on Saturday.

On his way to play a game of squash that morning, Perowne is involved in a car accident on an otherwise deserted street. No one is injured and the two vehicles sustain only minor damage. The owner of the other car is a man in his twenties named Baxter. He is accompanied by two buddies. Perowne refuses Baxter's demand for cash to repair the car so Baxter punches the doctor. Perowne is moments away from a pummeling.

He notices that Baxter has a tremor and an inability to perform saccades. Perowne deduces that Baxter has Huntington's disease. The doctor capitalizes on the fortuitous diagnosis. He speculates that Baxter has kept the neurodegenerative disorder a secret from his sidekicks. When Perowne initiates a discussion about the illness, Baxter orders the cronies away so that he can speak privately to the doctor. The two men desert Baxter, and Perowne escapes in his car, hopeful he can still make the squash game.

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Subtitled "What happens when patients find out how good their doctors really are," this article starts with an important statement: "Every illness is a story, and Annie Page's began with the kinds of small unexceptional details that mean nothing until seen in hindsight."

This is the introduction to a look at a child with cystic fibrosis and how her family sought the best care for her.

The author, Dr. Atul Gawande, goes on not only to tell their story but also the story of the way in which the understanding of this disorder has increased and the unusual rigor with which centers that specialize in the disease are evaluated.

He also includes stories of other sufferers to emphasize the importance of surveillance of their care.

These stories allow him to generalize about the way physicians' care is evaluated in general by the public and our medical organizations and how difficult it is to be at the high end of the Bell Curve. The author concludes, "When the stakes are our lives and the lives of our children, we expect averageness to be resisted."

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Celia Gilchrist is an editor in London who is in her thirties waiting for the right man. She meets Lewis, clearly (at least clearly to everyone else in the novel and the reader but not, typically, to Celia) a cad and a womanizer. About the time she realizes this, she receives and accepts a job offer in Edinburgh where she promptly meets Stephen, who is separated from his wife, Helen--a Helen as elusive and mysterious as the Helen of Troy, and also as powerful to affect the lives of others, especially men--and their nine-year-old child, Jenny. Despite Celia's valiant effort to get to know and accept Jenny, Celia and Jenny do not get along. From the very first chapter, which is a flash-forward, to the last page, Celia encounters accidents, lies, damage to her personal property, from dresses to sweaters to jewelry--all when Jenny is in the vicinity. The ending is cataclysmic.

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This novel spans one day in the life of a London neurosurgeon, Henry Perowne. It is set on a specific day, Saturday, February 15, 2003, when mass demonstrations were held in London protesting the coming war on Iraq. This actual historical and geographical context colors the fictional narrative, told entirely from the point of view of Perowne, who wakes in the early hours of the morning to see a burning aircraft descending towards Heathrow. Although this turns out not to be a terrorist attack, as Perowne at first fears, it sets up the book's atmosphere of foreboding and the powerful contrast between dangerous world events and Perowne's essentially happy family.

The Perownes are all talented and successful and fond of each other. Henry's wife, Rosalind, is a media lawyer; their son, Theo, a blues guitarist; and their daughter, Daisy, a published poet. This Saturday's highlight is to be a family dinner, where it is expected that Daisy and her grandfather, John Grammaticus, a famous poet, will reconcile after an argument.

Henry is on the way to his morning squash game when he is involved in a minor car accident with a dubious character named Baxter. He escapes theft and a beating by realizing that Baxter suffers from Huntington's Disease. He tells Baxter the diagnosis and offers hope of a non-existent treatment, shifting the power base of the encounter from brawn to brain and humiliating Baxter in front of his cronies. (This part of the novel was published in the New Yorker as a short story, The Diagnosis. See the annotation in this database for a more detailed account.)

Henry then plays an aggressive game of squash with Jay Strauss, his American colleague, and they discuss the Middle East and the impending war. He buys seafood at the market for the evening's dinner, and he goes to the nursing home to visit his mother, Lily, who has multiple-infarct dementia. He listens to his son's band, goes home and cooks dinner. He argues with Daisy, his daughter, just come from the protest march, about the coming war.

When the family is gathered for dinner, Rosalind returns from work and Baxter and his henchmen force their way into the house. They threaten Rosalind with a knife, break Grammaticus's nose, and force Daisy to strip, at which point Perowne realizes his daughter is pregnant. Then Daisy recites poetry--Matthew Arnold's "Dover Beach"--and, unlikely as it is, the effect of the poem is to distract Baxter enough that Perowne is able to lure him upstairs with the promise of more information on treating Huntington's, and he and Theo then throw Baxter down the stairs. Baxter is taken away in an ambulance, and later Perowne is called in to operate on his brain. The novel ends with Perowne back in bed with his wife.

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Set sometime in the near future, Cast of Shadows has as its protagonist Davis Moore, a successful private practice physician specializing in cloning human babies for infertile couples. Early in the book, Anna Kat, his high school senior daughter, is murdered and raped. (For a while a likely suspect is Mickey the Gerund, a right wing extremist member of the Hands of God with a fascinating grammatical moniker never explained, who shoots cloning physicians, including Dr. Moore, in the abdomen, a short time before his daughter, Anna Kat, is brutally killed. However, Mickey is only a shadow of a suspect and quickly becomes supplanted by another much more likely villain. Mickey goes on to kill, by various methods, dozens of cloning physicians and staff by book's end.)

After a year of unsuccessful detective work, the local police return Anna Kat's belongings, including a plastic vial with the suspected murderer-rapist's semen. In an act never fully explored by Dr. Moore or the author, an otherwise rational and ethical physician surreptitiously uses the suspect's semen to fertilize a married woman patient.

The offspring, a clone of the suspected killer-rapist, is Justin, who becomes a formidable presence in the book. He is very intelligent--at his psychologist's advice, his parents provide him at an early age with advanced reading materials like Plato (hence one of the allusions to shadows, i.e., Plato's cave, in the book's title and referenced directly on page 118 and indirectly on page 208) and other philosophers. By the time he is a senior in high school, Justin has become a dominant player in the affairs of Dr. Moore; Sally Barwick, a private investigator-turned journalist; and the suspected killer-rapist--his origin of the species as it were.

This book has a number of subplots all of which radiate from the initial cloning and the various members of the extended family and professional staff involved in it, some knowingly, most not. There are narrative threads involving the suspected murderer rapist-now-prominent attorney, Sam Coyne; the triangle of Dr. Moore and Jackie, his alcoholic wife, and Joan, his attractive pediatrician associate; Mickey the Gerund's various murderous and obsessional religious activities and reflections; Justin's life in school and involvement with Sally Barwick's investigation of a serial killer called The Wicker Man; and, most especially, the development of Shadow World, a computer game and a virtual replica of the real world--the world as Justin, Sally, Sam Coyne, and Dr. Davis Moore know it.

Since this is a thriller, it would be inappropriate to divulge more of the plot, which is intricate, often a little far-fetched but always engaging, highly readable and more labyrinthine than most medical thrillers.

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