Summary:

Aurelio Escovar is introduced as a poor dentist without a degree. He is busy polishing false teeth early one morning when the mayor arrives to see him. At first he refuses to see this would-be patient, until the mayor, who has been suffering severe toothache for five days and is desperate, threatens to shoot him. Eventually the dentist lets him in, examines him, and then removes the infected wisdom tooth, without anesthesia.

We realize that the dentist has deliberately made the mayor suffer all this time, and he gives the reason as he pulls out the tooth, saying "Now you’ll pay for our twenty dead men." When the mayor has recovered and wiped his tears, he leaves, telling the dentist to send the bill. When Escovar asks whether to send the bill "To you or the town?," the mayor replies, "It’s the same damn thing."

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This little novel is the retrospective tale of a childhood event told by the protagonist 40 years later. Family relationships and bonds in conflict with professional and community obligations vie with the shadow of racism and sexual abuse in the doctor/patient relationship for the core tensions in the book. The setting is a small rural community where the pioneer family about which the tale evolves controls the law and the medicine. The boy narrator relates his view of the breakdown of family as its secret--a physician uncle who is suspected of sexually abusing his native-American women patients--becomes a force that demands action from the doctor’s brother who serves as the sheriff.

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In this sequel to his earlier seem-autobiographical novel, House of God, Shem (this time using both his pseudonym and his real name) describes the experience of a physician in the first year of a psychiatry residency in a prestigious private psychiatric hospital. In this first hand account it is assumed that the author is the resident, Dr. Roy Basch; he describes not only his experiences with a variety of patients but also with the other doctors and the staff members of the institution. It is not a happy place and in the telling of the story there is a biting irony and a sense of the absurd.

It is obvious from the first that Dr. Basch is very serious about becoming a psychiatrist but that he is also searching for meaning and connections. He finds that colleagues may often hurt you more than your patients. Another issue addressed is that of competing psychiatric theories, particularly the competition between pharmacologic treatment and psychoanalysis. Issues about drug treatment trials and the questionable way in which they are conducted also receive attention, as does the problem of insurance coverage for hospitalization.

The fact that psychiatrists often specialize in their own defects becomes a reality to Dr. Basch. There are not many exemplary people in this book--hopefully it exaggerates the real situation. There is, surprisingly, a sort of poignant positive ending.

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This is a story about Bea, a single woman professor who has just had a caeserian section for an 11 pound boy, and her hospital roommate, Corinne. Bea describes her own discomfort with Corinne’s race, while admiring Corinne’s pride and nurturance toward her newborn son. As the story progresses, Corinne is betrayed by the medical world in a multitude of ways: misdiagnosis, racist treatment, denial of medical treatment, and incompetent care, resulting in Corinne’s sepsis and her son’s eventual death.

At the end of the story, after Corinne and Bea are discharged from the hospital, Bea tries to visit Corinne and deliver the pictures of her child that Corinne hadn’t been able to afford. But at the last minute, Bea turns away. Although she wants to help, she feels wholly inadequate, and believes she will only cause Corinne pain. Ironically, Bea remembers her last night in the hospital, how she covered her ears as Corinne’s baby whimpered, and as her own breasts surged with milk for the crying child. Even though her instincts and body tell her what to do for Corinne, she is not able to listen.

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Nathan was born with a strawberry birthmark on his chest, which both repels and comforts him. Sometimes it is an intricate and unique part of himself that sets him apart from other people and has the power to make him feel special. On the other hand, its very strangeness makes it repulsive to others, especially to women. At his girlfriend’s urging he decides to have the birthmark removed. Despite his doubts, he goes through with the surgery only to realize he has made a big mistake. He blames his girlfriend for his decision.

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Miss Armistead is a nurse in the surgical division of a hospital. She is being courted by two men, Dr. Joe Trask, the chief resident, and Dr. Mort Baker, an established and very successful surgeon. Everyone in the division is taking bets on her choice. Most assume she will choose Baker, the wealthier, more powerful doctor.

Then Miss Armistead develops appendicitis and requires emergency surgery. Joe Trask is on duty and has to begin the operation before Baker arrives, but experiences a terrible crisis of confidence, becoming helpless with fear. Baker arrives and completes the operation.

Everyone assumes that this will clinch Baker’s victory, but when Joe tells her how he was unable to operate on her, Miss Armistead takes this inability to see her as just another patient to be proof of the depth of his love for her, and agrees to marry him.

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A lieutenant named Alexander Grigoryvitch Sokolsky arrives at the home of Susanna Moiseyevna Rothstein, a Jewess and owner of a vodka distillery. Sokolsky has come to collect the 2300 rubles that Rothstein owes his married cousin. In fact, his cousin doesn’t actually need the money, but Sokolsky is helping his cousin get his debts paid so that he can then borrow the 5000 rubles that he needs to marry his fiancée.

Susanna, a luscious, free-spirited young woman, receives the lieutenant and offers him supper. She entices the IOUs from him, but then refuses to pay up. The next morning Sokolsky returns to his cousin’s house without the money, but presumably sexually satisfied. Kryukov, the cousin, rants and raves. What an outrage! He determines to visit the Jewess himself and demand payment. He does so and, likewise, only returns the next morning, penniless.

After a week, Sokolsky borrows the money from his cousin and leaves. After another week, Kryukov gets an uncontrollable itch to visit the Jewess again. When he arrives at her mansion, there are many men around, including Sokolsky, who evidently has hung around Susanna’s house for a week, having completely forgotten about his fiancée. Krykov’s final words are: "How can I judge him since I’m here myself?"

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In their introduction to this anthology, the editors write that their goal is "to illustrate and to illuminate the many ways in which medicine and culture combine to shape our values and traditions." Using selections from important literary, philosophical, religious, and medical texts, as well as illustrations, they explore, from a historical perspective, the interactions between medicine and culture. The book is arranged in nine major topical areas: the human form divine, the body secularized, anatomy and destiny, psyche and soma, characteristics of healers, the contaminated and the pure, medical research, the social role of hospitals, and the cultural construction of pain, suffering, and death.

Within each section, a cluster of well-chosen (and often provocative) texts and drawings illuminate the topic. Specifically, literary selections include poems by W. D. Snodgrass ("An Envoi, Post-TURP"), William Wordsworth ("Goody Blake and Harry Gill: A True Story"), and Philip Larkin ("Aubade"); and prose or prose excerpts by Robert Burton ("The Anatomy of Melancholy"), Zora Neale Hurston (My Most Humiliating Jim Crow Experience), Sara Lawrence Lightfoot ("Balm in Gilead: Journey of a Healer"), William Styron (Darkness Visible: A Memoir of Madness), George Orwell ("How the Poor Die"), Ernest Hemingway (Indian Camp), and Paul Monette (Borrowed Time: An AIDS Memoir). (The full texts of the pieces by Hurston, Styron, Hemingway, and Monette have been annotated in this database.)

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Summary:

A doctor is riding through the desolate steppe at twilight and loses his way. He comes to a hut along the new railroad where two men, an engineer and his young assistant, are spending the night. After they all have a few drinks, the engineer marvels over the beauty of lights in the distance, while the young man says the lights remind him "of something long dead, that lived thousands of years ago." (p. 607) He sees no point in human love or accomplishment because, after all, we all have the same fate--death. This encourages the old engineer to tell a tale of his youth.

Once, when visiting his hometown on business, he had come across a childhood friend, a woman who was unhappily married. He looked forward to having a brief affair with her, but she considered him her savior. She desperately wanted him to take her away. The engineer agreed, but then callously abandoned her.

Later, he realized that "I had committed a crime as bad as murder." (p. 635) He went back and "besought Kisotchka’s forgiveness like a naughty boy and wept with her . . . " (p. 639) At the end of "Lights," the doctor rides off at sunrise toward home. All around him nature seems to be saying, "Yes, there’s no understanding anything in the world!"

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Summary:

Ten months after being burned over 68% of his body, Dax Cowart was interviewed on videotape at the University of Texas Medical Branch in Galveston by Dr. Robert B. White. Blind, disfigured and helpless, Dax had consistently asserted his right to refuse medical treatment, including further corrective surgery on his hands (useless, unsightly stumps) as well as the daily, excruciatingly painful baths in the Hubbard tank.

At the time of his admission to UTMB, he had become adamant that he be allowed to leave the hospital and return home to die--a certain outcome since only daily tankings would prevent overwhelming infection. Dr. White had been called in as a psychiatric consultant, and much of the twenty-nine minute documentary is a conversation between patient and psychiatrist.

Calm and coherent, Dax states his wishes clearly and presents his case compellingly. He does not "want to go through the pain"; he does not "want to go on as a blind and a crippled person"; and he does not understand or accept any physician’s "right to keep alive a patient who wants to die."

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