Summary:

This book could perhaps have been called "Pathology and Identity in the Medical Case History and the British Novel." Tougaw here examines the mutual fascination of both nineteenth-century medicine and the British novel with pathology: that both "novels and case histories require a suffering body at narrative's center" (8), and that both "put into circulation a model of identity whereby the subject is always caught in a double bind... between health and pathology" (9). He examines developments in the medical case history, as a narrative, and argues that both this and the novel permitted an escape from "the nineteenth-century zeal for classification" (2). He reads the doctor-patient relationship as analogous to the reader-novel relationship, and argues that both genres must balance competing modes of approach: diagnosis and sympathy.

The book focuses on "controversial or marginalized maladies" (18), with each chapter acting as, itself, a case study. The first chapter, however, sets up Tougaw's critical terms of diagnostic and sympathetic reading, alternatives that help readers negotiate their discomfort with controversial conditions. The second chapter examines how the rhetoric of disability helps provide cover for "scientific scrutiny" (19) in cases of breast cancer, which bring to the foreground concerns over the limits and gendering of privacy and the body. Chapter Three builds on Peter Logan's work on the nervous narrator, examining Jane Austen's use of indirect discourse to finesse questions of hypochondria, compulsive storytelling, and early-nineteenth-century medical knowledge.

The fourth chapter focuses on the mid-century debate over mesmerism and anesthesia, reading cases alongside relevant novels by Wilkie Collins, Sheridan Le Fanu, Robert Louis Stevenson, and Mary Elizabeth Braddon. It traces Victorians' interest in altered consciousness and the effects of drugs on agency, and it argues for an analogy between the intersubjective relations of mesmerist/subject, doctor/patient, and narrator/reader. The final chapter reads Freud's "Rat Man" and "Wolf Man" against three novels by William James. Tougaw sees both these authors as putting forward a complex epistemology based on interpretation and intersubjectivity rather than assertion or individuality. The Afterword reframes Tougaw's arguments in the context of contemporary debates over the doctor-patient relation and the patient narrative; that "the real work of autobiography is the establishment of an intersubjective rapport between writer and reader" (21).

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A beautiful elderly couple are forced to confront Fiona’s (Julie Christie) problems with memory. Always stylish and active, she begins to neglect her appearance and do odd things. She loses her way while cross-country skiing in a familiar terrain; at nightfall, Grant (Gordon Pinsent) finds her frightened and frozen. She decides that she must go into a nursing home, but Grant is horrified to learn that, in order for her to adapt, he may not visit for an entire month. When he finally returns, bearing a bouquet of flowers and hoping for her warm affection, he is stunned to find Fiona pleasant but indifferent to his presence. Instead, she is preoccupied, even infatuated with Aubrey (Michael Murphy), who silently occupies a wheelchair. Fiona is able to interpret Aubrey’s moods and desires.

At first, Grant is hurt and jealous, but gradually he accepts Fiona’s need to be important for someone. Haunted by guilt over an affair with a student years ago, Grant wonders if Fiona is somehow retaliating. When Aubrey’s wife Marian (Olympia Dukakis) brings Aubrey home because she cannot afford the care, Fiona is despondent. He approaches Marian about returning Aubrey to the center. Thrown together by their absent yet present spouses, Marian and Grant indulge in a half-hearted affair. By the time, Aubrey returns, Fiona may have forgotten him, but she still knows Grant and appears to recall his distant infidelity though so much else is lost. But he still loves her and together they can find reasons to laugh.

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The movie opens with a shot of a young man stitching up a laceration in his own knee. Another describes how he had to select which of two severed fingers would be re-attached because he could not afford both operations. They are among the millions of Americans without health insurance. But, the narrator says, the movie is not for them; rather it is for the majority of U.S. citizens who do have medical insurance and believe themselves protected.

Through a series of riveting vignettes, for-profit health care is shown to tyrannize the well, ruin the ill, and destroy families. It also erodes the psychological and moral fiber of the people working in the industry. Excursions to England, Canada, France and Cuba are presented in a series of encounters with physicians and patients, none of whom believe that they would be better off in the United States. A French doctor opines that he earns an adequate salary for a good quality of life. Even those seated in a Canadian waiting room profess satisfaction with the care given and understanding about delays. When asked why anyone would accept to pay the expenses of others, an elderly golfer explains patiently that it is what we do for each other in a caring society. Ex-pat Americans gather at a bar to describe their positive experiences with foreign health and maternity care.

Interviews with emotionally distraught people who have worked in the insurance industry reveal the relentless pressure to deny coverage and its reward system that favors those who generate the biggest savings. Special attention is given to Dr. Linda Peeno who testified before Congress in 1996, confessing that she had harmed people for the economic benefit of the insurance industry.

Moore gathers up a group of people whose sorry dilemmas within the U.S. system have left them with serious health problems. He escorts them to Cuba where physicians and nurses are only too pleased to diagnose and treat their illnesses– for free. The movie ends with an exposé of the superior health care given prisoners at Guantanamo and Moore’s stunt at trying to bring the unhappy Americans there for treatment.

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Ann, the primary protagonist, is diagnosed with and operated on for breast cancer. Her family history leads her to suspect that she may have passed the breast cancer gene on to her daughters-this assertion without having been tested. She retreats from society. Her husband leaves her and she raises two daughters, ever plagued with guilt. The two daughters, as technology advances, choose to have themselves tested. One daughter, tests positive for BRCA-2; the second daughter is not tested, but is diagnosed with breast cancer.

The mystery becomes: from which parent did the women inherit the gene? While the younger daughter struggles with her progressive cancer, the older daughter goes in search of the genetic contributor. Since this becomes a search for an answer, the answer remains up to the reader to pursue. The angst created by the unanswered questions makes up the bulk of the intrigue, and may emulate real life struggles with this particular disease.

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In 1999, eighteen years after Project HOPE began publishing the journal "Health Affairs," the founding editor, John Iglehart, began a new column: Narrative Matters. This book contains 46 of the 80 essays published to date, and an inspiring foreword by Abraham Verghese. The essays are contained in eight chapters-- "Writing to Change Things: Essays on the Policy Narrative," "Dollars and Sense: Hard Financial Realities," "Bearing Witness: Patient's Stories," "The Maddening System: Frustrations and Solutions," "Trouble in the Ranks: Professional Problems," "Drug Resistance: Battling Undue Influences," "Disparity Dilemmas: Stories on Race and Ethnicity," and "Values and Choice: Stories of Practical Ethics." Familiar voices include those of Fitzhugh Mullan (one of the editors), Abigail Zuger, Howard Brody, Richard Lamm, John Lantos, Danielle Ofri, and Carol Levine. The essays in the first section strike an important cautionary tone, reminding readers that the plural of anecdote too often is taken for policy and that the repetition of anecdote should not be seen as evidence.

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John Grogan's best selling memoir of his and his family's life with an exuberant, loving Labrador retriever pup that grew into an overly boisterous ninety-seven pound member of the family chronicles the joys and tribulations of dog ownership. Particularly, of Marley ownership. Marley flunked obedience school, required tranquilizers to tolerate thunder storms, destroyed possessions and jumped on people, to name a few traits.

The young married couple adopted Marley before they had children. The reader learns of the pregnancies and births of the Grogan's three children, including a miscarriage, ‘performance failure' during sex timed to ovulation, and an episode of post-partum depression, with an eye to what Marley was up to during that phase of family life, and especially how he responded to his owners' emotional states. Marley's protective stance towards not only the children, but also to a knifing victim in the neighborhood and to Grogan himself when he was struck by lightning, proved the dog's loyalty and devotion.

Marley lived a full life; as he aged, his hearing, sight and mobility worsened. He required emergency abdominal surgery at an old age, recuperated, but then suffered the same stomach bloat and twist problem again.

Grogan, a newspaper columnist, decided, after a period of intense grief, to write an article about Marley. "‘No one ever called him a great dog - or even a good dog. He was as wild as a banshee and as strong as a bull. He crashed joyously through life with a gusto most often associated with natural disasters...' There was more to him than that, however... ‘He taught me to appreciate the simple things...And as he grew old and achy, he taught me about optimism in the face of adversity. Mostly, he taught me about friendship and selflessness and, above all else, unwavering loyalty.'" (p. 279)

The column generated an avalanche of responses; fellow owners of bad yet lovable dogs wrote to the newspaper of their own experiences. These responses were cathartic to Grogan as he and his family learned to live without Marley, the dog who had taught them all so much: "the art of unqualified love." (p. 287)

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Veneta Masson's latest poetry collection is a clinician's guide not to illness and disease but to the souls touched by illness, both the patient's and the caregiver's. In 45 poems, she reviews her life in caregiving, from her early days in nursing to her work as a nurse practitioner in a community clinic and finally to her decision to use her hands "to write and to bless" (p. 93). Her poems are enhanced by the artwork of Rachel Dickerson, whose woodcuts and etchings are paired with poems to provide another voice, another way of looking into the soul of caregiving. For an example of this wonderful pairing, see the print that accompanies "The Screamer in Room 4" (p. 24). The print allows us to see the frustration of the screaming child, the child's mother, and the caregiver.

As always, Masson's poems center on the patient-caregiver experience; in this volume, as we follow her through her various adventures in nursing we also travel with her through the changes she has witnessed in healthcare and the politics that continue to affect its delivery. "Rx" (p. 22) examines Medicare and Medicaid and the political decisions that often deny medications to the elderly who need them most. "Gold Standard" (p.34) looks again at medicine and money, juxtaposing the medical pill against the placebo of the caring healer. One of my favorite poems, "The Doctor's Laptop" (p. 40) laments how technology might deprive patients of the doctor's time, attention and touch.

Other themes that are central to this collection are the unexpected presence of humor in caregiving (see "Conga! at the Rio," page 50), of spirituality (see especially "Rescue," page 36, "Refuge," page 45, and "Prevention," page 82), and of the personal. In several moving poems Masson looks at her own sister's death and her reaction to it, writing about her conflicting roles as sister and nurse (see, among others, "Matinee," "Hilda and Snow White," and "The Nurse's Job," pages 70, 72 and 74). In an excellent final poem, "Winter Count," Masson takes us through her own nursing history, a chronicle of work, joy, disappointment and survival that any caregiver will recognize.

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In this compelling memoir, Grace, a writer, artist and teacher, unexpectedly finds herself attracted to a carpenter, Howard Staab, whom she meets when looking at a new home. Shortly after their relationship begins, Staab is told in a routine physical examination that he has severe mitral valve regurgitation and will require surgery. Staab, an active, otherwise healthy fifty-three year-old man, has no health insurance. The cardiac surgery will cost over $200,000. Thus Staab and Grace embark on a quest to find an affordable, but excellent surgeon and hospital. Grace details her efforts to find the best care possible, including correspondence with her son, Bryan, a Stanford medical student with interests in international health. These inquiries lead to the possibility of surgery in India.

After a useful, explanatory preface the book begins when Staab and Grace land in New Delhi and enter the Escorts Heart Institute. Staab undergoes a series of tests confirming the need for surgery, which is subsequently performed by Dr. Naresh Trehan. Through Grace's eyes, we also meet nurses, aides, other physicians, administrators and friends. The narrative follows the hospitalization, including dramatic complications and eventual recovery, and also backtracks to better detail the search for care and the predicament of un- and underinsured Americans. Grace also describes the post-hospital phase, including venturing out beyond hospital and hotel walls.

The book, highlighting the fact that Grace and Staab face more than one cultural challenge in this journey, contains both a medical terms glossary and a short list of Hindi terms. Ultimately, Grace concludes she would consider returning to Escorts or a similar hospital should she or a loved-one require surgery, even without the insurance issue. She states: "India, the land of contradictions. Organized chaos. A third-world country with first-world state-of-the-art medical care available for a fraction of the cost of the same procedures here in the U.S." (p. 259)

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Summary: All thirteen short stories in this collection draw readers into the quietly compelling lives of disparate and very ordinary characters who function and suffer in unsettling ways. We are like them and not like them, but their circumstances, while sometimes disturbing, are familiar--and strangely magnetic. The opening lines of "The Lapse" illustrate this power of attraction:

I married Joanne during a lapse. A religious lapse. I don't display my beliefs like a gold medallion, though, as many whom I know do. I prefer to observe in private. After all, any intimate relationship belongs only to the entities or people involved. (p. 35)

Who can bypass an invitation to enter into announced intimacies, however private, that must be revealed in a matter of pages. What lapse and who is Joanne?!

"Bad News," centers around Sheila Powers, a psychologist, whose disruptive marital break-up is compounded by her mother's recent diagnosis of cancer and a subsequent flow of memories about her mother, her father, and herself. She is "between worlds...between life zones." (p. 113) Aspects of the future, at least her mother's, may be somewhat predictable, but the complex depths of the past mix with the present to generate sticky threads that belong to the story and to the readers as well who will recognize bits and pieces of their own family lives.

In a fourteen page story with a decidedly off-putting title, "The Encyclopedia," Wineberg zeroes in on Doris who, after a dissolved relationship, decides to sell the thirty volumes of the Encyclopedia Britannica-"the macro-edition, the micro-edition and the year books" purchased by the former couple. Not about remote bits of history or dinosaurs, we discover, but a story about separation, a series of lovers, benign conversation with a fellow worker who claims to be similarly tired of men, a possible buyer for the unwanted encyclopedia, a relationship with the married buyer, an end to the relationship, and a decision to keep the books after all. Her life, we might decide, is encyclopedic, a litany of minutiae that does, indeed, provide information about conditions of existence.

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The most famous European visitation of plague was the fourteenth-century epidemic often called the Black Death. But plague recurred in waves for many centuries. In the seventeenth century, Italy suffered several devastating outbreaks. Fairly accurate estimates of the losses during that period are available through extant records. For example, in 1656, over 100,000 people died of plague in Naples. Strange to imagine, this carnage coincided with the religious Counter Reformation and the extraordinary artistic output of the Baroque.

This intriguing collection of essays analyzes the effect of plague on painting, and assesses the utility of artwork as a source for the religious and social history. The essays concentrate on the cities that suffered major epidemics, such as Milan, Naples, Palermo, Rome, and Venice, and on portrayals of particular "plague saints," such St Roch, St Sebastien, St Carlo Borromeo, St Rosalie of Palermo and St Luigi Gonzaga. The artists include Tiepolo, Tintoretto, Crespi, Sweets, Canaletto, and Van Dyck.

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