Summary:

The story takes place in the men's cancer ward of a hospital in a city in Soviet Central Asia. The patients in Ward 13 all suffer from cancer, but differ in age, personality, nationality, and social class (as if such a thing could be possible in the Soviet "classless" society!). We are first introduced to Pavel Rusanov, a Communist Party functionary, who enters the hospital because of a rapidly-growing neck tumor.

We soon learn, however, that the book's central character is Oleg Kostoglotov, a young man who has recently been discharged from a penal camp and is now "eternally" exiled to this particular province. Only two weeks earlier, he was admitted to the ward in grave condition from an unspecified tumor, but he has responded rapidly to radiation therapy. Among the doctors are Zoya, a medical student; Vera Gangart, a young radiologist; and Lyudmila Dontsova, the chief of radiation therapy.

Rusanov and Kostoglotov respond to therapy and are eventually discharged; other patients remain in the ward, get worse, or are sent home to die. In the end Kostoglotov boards a train to the site of his "eternal" exile: "The long awaited happy life had come, it had come! But Oleg somehow did not recognize it."

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This short narrative is told in the first person, the person of the quack. The tale opens with the narrator in the public hospital ward, suffering from what his doctors say is Addison's disease, composing the tale of his adventures which makes up the bulk of the work. The narrator tells us about his training as a physician and his first practice, which was sufficiently non-lucrative that he determines to alter his career direction.

He moves through a series of increasingly seamy scams in search of quick and easy money--including claiming to be a homeopathic physician, then an expert in vegetable remedies and "electromagnetic" treatment, falling through a multitude of suspect activities culminating in his setting up shop as a spiritualist. His shady career is cut short by his illness, from which he abruptly dies, thus ending the narrative.

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This study explores the history of physician-patient relationships, especially as it relates to the ascendancy of science in medicine. The book begins by describing traditional physician-patient relationships in the 18th century. The focus, however, is on the "modern" doctor (beginning in the 1880's) and the "postmodern" doctor (beginning in the 1950's).

The author describes the transition from modern to postmodern doctor and a corresponding transition from modern to postmodern patient. A "sympathetic alliance" between physician and patient was essentially a development of the modern period (1880's - 1950's).

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Summary:

Dr. Hertzler leads the reader, topically and generally chronologically, through the nature of the practice of medicine in rural America from the 1880's through the 1930's. His early narratives are those of a child observing the ravages of epidemic diseases in the face of medical futility.

The remainder of the work, divided into subject headings, is devoted to anecdotes and observations on such things as horse and buggy home visits, kitchen surgery, the proprietary hospital and physician education. Having served not only as a rural practitioner, but as a professor of pathology at academic centers and a consulting surgeon, Hertzler draws on a wide experience over a period of time known for rapid advances in basic biological science which would, near the end of the narrator's life, open the way for technological medicine as we know it today.

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This collection of vignettes follows the growth and development of one internist as he reflects on some of the critical experiences that shaped him as physician. The common thread of the work is the celebration of the relationship that can, and perhaps should, be built between the physician and his or her patient in the course of caring: this relationship is the sacred space of the title.

The author accomplishes his self-imposed task of describing this space by presenting situations in his practice life that illustrate the concept. The chronological structure of the collection enables the reader to study the maturation of the author as a self-reflective practitioner over the many decades of his professional life. Many of the stories are very funny; others are wrenching; all are gently told.

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Summary:

Canadian artist, Robert Pope (d.1992), devoted the last years of his short life to documenting his decade-long experience as a patient with Hodgkin's Disease. Shortly after his diagnosis he was influenced by the 1945 autobiographical novel of Elizabeth Smart, By Grand Central Station I Sat Down and Wept. Pope's early work explored the interconnectedness and pain of individuals bound by an imperfect love, in Smart's case for a married man. After his disease went into remission, he began to paint the patient's perspective on illness, hospitals, visitors, family, and health-care providers in a series of images that suggest the lighting of de la Tour, the photographic immediacy of Doisneau, and the menacing surrealism of de Chirico. His book, Illness and Healing: Images of Cancer (1991), became a bestseller.

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Summary:

An intern in internal medicine is frustrated by his weekly clinics; he seems unable to understand why most of his patients come to see him, why they seem happy when they leave, and wonders when he is going to have the chance to do "real" medicine, such as ordering tests and making sophisticated diagnoses. One day, he sees an elderly woman who had been worked up over the years for "heart pain" without finding a diagnosis. In the past she had seen other residents for no discernible reasons.

At this visit, the author recognizes that she seems upset, encourages her to talk, realizes that she reminds him of his grandmother. The woman reluctantly admits she has fallen in love with a younger man. The resident is respectful towards her, and recognizes the beautiful woman she had once been. He begins to realize that she has experienced much that he hasn't, and that she has much to teach him about life and about being human.

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The author is a fourth year medical student dealing simultaneously with the rigors of medical training and the difficulties of living with diabetes. She has discovered that when she tries to interact with patients she over-identifies with them. When she reads about diabetes in medical textbooks, which present a rigid equation for balancing diet, exercise, and insulin need, she tries to adopt this approach to her personal diabetes management, convincing herself that emotions, fatigue, stress and other factors have no effect on her diabetes control. When this biomedical approach fails, she feels deep shame and frustration.

Only over time does she develop the confidence to realize that it is not shameful to admit one's personal needs even in medical training, that disease is a part of all humans and is not an enemy, that she need not be defined solely by her disease (or her profession), and that blurred boundaries between doctors and patients are not as dangerous as she was first led to believe.

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A surgical intern has participated in 86 year old Mrs. Byrnes's abdominal surgery, where extensive metastases from ovarian cancer are found. The surgeons take biopsies, confirm the diagnosis, and close her abdomen, knowing that her case is not treatable. Later that day, it falls to the intern to inform Mrs. Byrne of what they found.

The author describes how he avoided the task, finding other chores to do, appealing to the attending physician to not make him talk to the patient. The attending insists, and the author finally finds the nerve to talk with his patient. Much to his surprise, she has already suspected that she has cancer, tells him not to be upset, and assures him he did his best. The author discovered that learning to be a doctor meant being open to learning from his patients.

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Summary:

The physician author is puzzled about what he can do to help a young woman who comes to him for treatment of her chronic abdominal pain. She has had every test, seen every specialist, and has no clear diagnosis. Only on the third visit, which she has initiated, does he discover that she was sexually assaulted at age 14. He is the only person she has told.

He immediately feels out of his element, and asks her to see a psychiatrist. She refuses, and insists he handle her care. He sets up open-ended visits to allow her time to talk, and looks for help in the medical literature and from a psychiatrist colleague.

Over time, as they explore her feelings and experiences, his patient gains self esteem and transforms herself into a confident, beautiful woman, planning on travel, school, and career. After her last visit with him, he realizes, "I had been chosen to receive a gift of trust, and of all the gifts I had ever received, none seemed as precious."

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