Summary:

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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Half-waking from surgical anesthesia, a woman named Mary realizes that she has had a breast removed. She immediately begins to imagine how this will affect her already troubled marriage. When she is fully awake, other women on the ward try to comfort her, each with a strategy for bearing up under suffering which Mary finds unacceptable because these strategies represent values about marriage, submissive gender roles, or religion which Mary cannot quite swallow.

Later, talking with her brusque surgeon and her family doctor, Mary learns that the mastectomy may not have been necessary, that the tumor was benign. At the end of the story, husband Matt hustles in to ask: "Well, baby, are you still going to divorce me?"

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A chronicle of the author's perceptions, thoughts, memories, and personal relationships during the months after he was diagnosed as having AIDS. Brodkey's mind and prose are as sharp as a knife's edge. Beginning with the desperate struggle for breath that signaled pneumonia and, retrospectively, "how my life ended. And my dying began," continuing with the reactions and decisions of himself and his wife, the first half of the essay spins out an observant, introspective, cerebral, even amusing account of his particular experience.

But AIDS is often a disease associated with more emotional baggage than other fatal illnesses, and in Brodkey's case we learn that he traces both his dying and his homosexual experiences to "the major drama of [his] adolescence", daily sexual abuse by his adoptive father, with the implied knowledge and acquiescence of his mother. Writes Brodkey, "I experimented with homosexuality to break my pride, to open myself to the story." "Now I will die disfigured and in pain."

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A desperate patient visits a renowned oncologist with hope for a miraculous cure of his kidney cancer. The patient, a venture capitalist, doesn't want to die--can't face his death. He is willing to take whatever risk is necessary to survive. After a grueling course of experimental treatment and an expected period of remission, the cancer returns, leaving the patient (according to the physician-author) with an awful ending to his life--a death filled with regret.

What is revealed as Groopman deliberately walks "along the milestones" of his patient's life is more than the patient's story, however. For in addition to a chronicle of the disease's effect on his patient, the physician himself, and his concerns about the proper use of his knowledge and powerful tools also are revealed.

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Atul Gawande, a surgical resident at Harvard Medical School, asks in his well written essay, "when you see your patient making a grave mistake, should you simply do what the patient wants?" (p. 86) He answers this question by sharing a number of cases from his training that suggest that the orthodoxy of 'absolute respect for patient autonomy' may interfere with good patient care.

Gawande also gives the reader insight into the difficulties that young residents especially have in developing an artful approach to medical practice. He suggests that part of respecting autonomy is (at appropriate times) allowing patients to cede that autonomy to an authority figure. He argues further that, "patients frequently don't want the freedom that we've given them." (p. 89)

He also shares in his essay a personal experience with his youngest child. She was a premature baby who at eleven days old ended up in the intensive care unit. He was glad to put the ultimate decision(s) of how to care for his daughter in the hands of physicians--"they could live with the consequences, good or bad." (p. 90)

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A chance meeting with her former and most compassionate fertility doctor brought Wendy Wasserstein (at age 48, and after 8 years of effort) back to his fertility clinic. Two weeks later she got the news that she was pregnant, and six months after that, just as she was getting ready to tell her friends "that the twenty pounds I had gained were not the result of bad habits and anxiety," she developed preeclampsia and was hospitalized.

What follows in this ’Annals of Motherhood’ memoir is an account of her hospitalization; her subsequent delivery 16 days later of 1lb., 12oz. daughter, Lucy Jane (Lucy’s waving hand sonogram picture reminded Wasserstein of "Lucy in the Sky With Diamonds"); and her separation from Lucy, who spent two months in the neonatal intensive care unit.

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Gerald Wilcox is an otolaryngologist who lives with his wife and daughter in a small town in Montana in 1959. Dr. Wilcox has a weakness for women, alcohol, and, lately, morphine (with which he injects himself about once every six weeks). He enjoys writing in his journal almost every evening yet rarely reviews what he has previously written.

Although high on morphine, Dr. Wilcox repays a debt by making a house call late one night to treat a young boy with mastoiditis. On returning home, the doctor decides to bake a coffee cake for his wife at 5 o'clock in the morning while musing on what will happen to his journals after he dies.

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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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