Summary:

This book, "a humanistically oriented sociocultural history of medicine" (p. x), focuses on the interactions between patient and doctor in western medicine from the nineteenth century through contemporary times. Furst, a Professor of Comparative Literature at the University of North Carolina at Chapel Hill, uses literary works to chronicle the changing patterns of medical practice, the social positions of doctors, and effects of medical education as they relate to "the doctor-patient alliance." (p. x) By "mapping cultural history in and through literature" (p. x), Furst enriches our understanding of the development of various roles and expectations of doctors and patients since approximately 1830.

The first chapter details the concept of the book and clarifies its purpose. Most histories of medicine concern famous discoveries, introductions of new technologies, and lives of renowned physicians and researchers, yet they neglect to examine patients' perspectives. Furst's mission is to reinstate patients into medical history and contemporary analysis. She chooses to focus on everyday-type of medicine, and more specifically, "to chart the evolution of the changing balance of power in the wake of the advances made in medicine in the nineteenth and twentieth centuries, drawing on literary texts as sources." (p. 17)

The other seven chapters are topic oriented and placed in general chronological order. The chapters vary in the number of sources examined. For example, Chapter 2, "Missionary to the Bedside" is a comparative analysis of Anthony Trollope's Doctor Thorne (see this database) and Elizabeth Gaskell's Wives and Daughters, and Chapter 3, "Seeing-and Hearing-is Believing" almost exclusively concerns Middlemarch by George Eliot (see this database).

Other chapters, however, include commentary on more sources. A chapter on twentieth century hospital-based practice and medical education, "Eyeing the Institution," begins with a review of various films, television shows, and novels and follows with an in-depth comparative analysis of three autobiographical accounts of medical education and training: A Year-Long Night by Robert Klitzman, A Not Entirely Benign Procedure: Four Years as a Medical Student by Perri Klass (see this database), and Becoming a Doctor by Melvin Konner.

Furst examines the effect of gender on patient and physician experiences and expectations. In Chapter 4, "A Woman's Hand," five novels about "doctresses" (a term used for women doctors in the late nineteenth century) are compared. How and why the protagonists became doctors, what sacrifices they made, how patients viewed having a woman doctor, the range of solutions to career and/or marriage choices, and the personalities of the protagonists are some of the comparisons made. These novels are placed in historical context with information about the lives and attitudes of physicians such as Elizabeth Blackwell and Mary Putnam Jacobi.

Other topics include evaluations of the nineteenth century hospital, the role of research and the laboratory (Sinclair Lewis's Arrowsmith annotated by Felice Aull, also annotated by Pamela Moore and Jack Coulehan --see this database--and A. J. Cronin's The Citadel), and the impact of contemporary changes in reimbursement and management on the power relations in medicine. A sensitivity to the effects of language on power relations is a theme throughout the book, and is more fully examined in the final chapter, "Balancing the Power." After an analysis of several books by Oliver Sacks , and his attempts to truly understand his patients' perspectives, Furst concludes, "The balance of power cannot be even, but it must at least strive to be fair." (p. 251)

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The strange cast of characters in this satirical detective thriller includes most prominently, Dr. Rudy Graveline, a hack plastic surgeon trying to cover up the "accidental" death of a patient during a rhinoplasty procedure four years prior to the start of action. "One of the wondrous things about Florida, Rudy Graveline thought as he chewed on a jumbo shrimp, was the climate of unabashed corruption: There was absolutely no trouble from which money could not extricate you . . . Since the medical board was made up mostly of other doctors, Rudy Graveline had fully expected exoneration-- physicians stick together like shit on a shoe." (p.95)

Doctors, however, are not the only profession slammed by the author. Also receiving their comeuppance are corrupt lawyers, politicians, police officers, and judges. Searing satire is also directed at "reality journalists" through the character Reynaldo Flemm (i.e. Geraldo Rivera). Not surprisingly the "good guys" win and the "bad guys," including Dr. Graveline, lose. But the hideous way in which Dr. Graveline meets his demise is too gruesome to reveal here.

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This biography, written by a second party in conjunction with the person whose story is portrayed, is the tale of a black lay-midwife working in the southern United States during the mid to latter part of the 20th century. Gladys Milton, mother of seven children herself, is called to midwifery training by the Health Department in a rural county in Florida.

After an introductory chapter that sets the stage for the ultimate challenge to Gladys, the following few chapters follow her through some of the high points of her childhood and early years of motherhood. The remainder of the work describes broadly the career--with its ups and downs--of Gladys as midwife, doing home deliveries and working in the birthing center she has established in her own home. The final chapters deal with the legal efforts and ultimately the hearing in which the Health Department attempts to revoke Gladys's license to deliver babies.

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The sculptor Ken Harrison (Richard Dreyfuss) is badly injured in a car accident and finds himself in the middle of life permanently paralyzed below the neck and dependent on others for his care and survival. Ken is a strong-minded, passionate man totally dedicated to his art, and he decides he does not want to go on with the compromised, highly dependent life that his doctors, his girlfriend Pat (Janet Eilber), and others urge on him. He breaks up with Pat and fights to be released from the hospital, to gain control of his life in order to stop the care that keeps him alive and unhappy.

His antagonist is the hospital's medical director Dr. Emerson (John Cassavetes), who believes in preserving life no matter what, and so tries to get Ken committed as clinically depressed. Ken's attending physician, Dr. Scott (Christine Lahti), begins with the establishment but gradually moves toward Ken's position.

The film ends with the judge at a legal hearing deciding that Ken is not clinically depressed and that he thus has the right to refuse treatment and be discharged. In the last scene, Ken lies in a hospital bed framed by his own sculptural realization of the forearm and hand of God from Michelangelo's Creation of Man.

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A year in the life of a group of interns in a big city hospital guided by the wise internist (Buddy Ebsen) and the irascible, woman-hating surgeon (Telly Savalas). Contortionist posturing designed to lead to desired residencies is the major theme. The only female intern, and the most brilliant of the lot, wants to be a surgeon, but she is repeatedly belittled by the surgical chief until he realizes--not that she is good--but that she is the sole support of a daughter.

Another intern falls in love with a young Asian patient and at her death resolves to work in her country. A crisis emerges around the overdose of a suicidal patient with syringomyelia; all the interns are held responsible until they rather brutally force a confession from the man's wife. Friends throughout medical school, Lou Worship (James MacArthur) and Sean Otis (Cliff Robertson) plan to become surgeons and open a clinic for the poor. Otis falls for a glamorous model, while Worship is smitten with obstetrics and a student nurse (Stephanie Powers).

Forsaking the original plan, Worship applies to obstetrics, pressures his fiancee to sacrifice her dream of an international career, and tells on Otis when he discovers that he is helping his girlfriend abort her unwanted child. His career ruined, Otis marries the irretrievably pregnant woman and expresses his admiration to Worship for doing the right thing.

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In this documentary film about euthanasia in the Netherlands, a man--Kees van Wendel de Joode--with amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease) requests death in his home, to be performed by his doctor, Wilfred Sidney van Oijen. The film mostly consists of what appear to be unscripted discussions between Kees, his wife Antoinette, and the doctor; however, there are also interviews with the doctor and views of the doctor seeing other patients. The film shows the doctor performing euthanasia: we watch him inject a barbiturate and then a muscle relaxant and we see him supporting Antoinette during the bedside deathwatch.

Kees has had a rapid deterioration of his ability to function: he is unable to move his legs and right arm, he can no longer speak coherently, and he is having difficulty swallowing. His wife cares for him in their Amsterdam apartment. The film documents the legal requirements for euthanasia in the Netherlands: Kees's repeated requests for euthanasia, confirmation that he has an incurable disease, the second opinion doctor's visit, and reporting the death to the municipal coroner and public prosecutor.

The film's strength lies in the sensitive treatment of the impact of this request on the patient, his wife, and especially on his doctor. Dr. van Oijen is an introspective man who cares for his patients--he makes house calls, explains medical terms to his patients, touches his patients, and asks what they are concerned about. He allows his patients (Antoinette is, in many ways, his patient too) to weep and be emotional.

The religious and moral dimensions of euthanasia are explored mostly with the doctor, who does not view himself as a wanton killer, but rather a doctor whose duty includes the alleviation of suffering. The film concludes with a voice-over stating the doctor will not sleep this night, but still has a clinic full of patients awaiting him in the morning.

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In Rethinking Life and Death: The Collapse of Our Traditional Values, Peter Singer argues that "the traditional western ethic has collapsed" as we enter "a period of transition in our attitude to the sanctity of life" (pp. 1). The book begins with the tale of Trisha Marshall, a twenty-eight year old woman, who in 1993 was seventeen weeks pregnant when a gunshot to her head left her in an intensive care unit, her body warm, her heart beating, a respirator supporting her breathing. However, she was brain dead.

Her boyfriend and her parents wanted the hospital to do everything possible so that the baby would be born. The ethics committee of the hospital supported the decision. For the next 100 days, Trisha Marshall continued to be supported in the ICU until her baby was delivered by cesarean birth. After a blood test showed that the boyfriend was not the father, and after three weeks in the intensive care unit, the baby went to live with Marshall's parents.

Singer uses this introduction to pose the many ethical questions that are raised because of medicine's ability to keep a "brain dead" body warm for an extended period of time. "How should we treat someone whose brain is dead, but whose body is still warm and breathing? Is a fetus the kind of being whose life we should make great efforts to preserve? If so, should these efforts be made irrespective of their cost? Shall we just ignore the other lives that might be saved with the medical resources required?

Should efforts to preserve the fetus be made only when it is clear that the mother would have wanted this? Or when the (presumed?) father or other close relatives ask for the fetus to be saved? Or do we make these efforts because the fetus has a right to life which could only be overridden by the right of the pregnant woman to control her own body--and in this case there is no living pregnant woman whose rights override those of the fetus?" (pp. 17-18).

In the chapters that follow, Singer argues that whether western society will acknowledge it or not, we have, in our actions and decisions, moved to an ethic where "quality of life" distinctions trump "sanctity of life" positions. Yet, many continue to raise the "sanctity of life" position when it is clear that our legal and ethical positions in western society have embraced the "quality of life" stance. For Singer, this paradox results in an incoherent and illogical approach to the ethical challenges presented by modern medicine.

Throughout his book, Singer presents evidence for his argument through ethical and historical analysis of brain death, abortion, physician assisted suicide and euthanasia, organ donation, and the nature of persons. For those uncomfortable with Singer's position on "infanticide," this book allows one to follow Singer's argument and his recommendations in the last chapter for a coherent approach to these "quality of life" decisions.

He closes his book with the recommendation that a new ethic should embrace five new commandments to replace the old "sanctity of life" commandments. His commandments are: 1) Recognize that the worth of human life varies; 2) Take responsibility for the consequences of our decisions (in end of life care); 3) Respect a person's desire to live or die; 4) Bring children into the world only if they are wanted; and 5) Do not discriminate on the basis of species.

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A nurse enters an elderly woman's bedroom. "Wake up! It's nearly five," she cries. Does she mean five AM, or is it afternoon teatime? The nurse lets the window blinds unroll and puts some coal on the fire in the fireplace.

In fact, the patient is dead. She had died the previous evening, "by the light of the ev'ning star." Setting aside her "chintzy cheeriness," the nurse begins to pay attention. She looks "at the gray, decaying face," realizing what has happened. Her response is simply to straighten up a bit and leave the room. [28 lines]

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The film opens with a bird's-eye sweep over the frieze of a post-engagement battlefield--mud, strewn with bodies and shards of machinery, all iron grey and relieved only by rare patches of crimson blood. Psychiatrist William Rivers (Jonathan Pryce) treats shell-shocked soldiers in the converted Craiglockhart Manor. He is obliged to admit the poet and decorated war hero, Siegfried Sassoon (James Wilby), because his military superiors prefer to label the much-loved Sassoon's public criticism of the war as insanity rather than treason. Rivers is supposed to "cure" the very sane poet of his anti-war sentiments.

At the hospital, Sassoon meets another poet, Wilfred Owen (Stuart Bunce), equally horrified by the war although he, like Sassoon, believes himself not to be a pacifist. A secondary plot is devoted to the mute officer Billy Pryor (Jonny Lee Miller) who recovers his speech, his memories, and a small portion of his self-respect through the patience of his doctor and his lover, Sarah (Tanya Allen). Vignettes of other personal horrors and the brutal psychological wounds they have caused are presented with riveting flashbacks to the ugly trenches. Sassoon, Owen, and Pryor return to active service. The film closes with a dismal scene of Owen's dead body lying in a trench.

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This is the true story of Christy Brown (Daniel Day-Lewis), who was born with cerebral palsy (CP) into a poor Irish family in 1932 and overcame severe physical disability to become a famous artist and writer. In his early years Christy is severely disabled and disfigured--spastic, unable to speak, and close to quadriplegic, able to control only his left foot. His father (Ray McAnally) initially regards him as both retarded and sinful, but his mother (Brenda Fricker) faithfully and heroically cares for him.

Gradually, as he begins to speak, Christy's intelligence becomes apparent, his father accepts him into the family, and he trains himself to paint with his left foot. In his Dublin neighborhood, Christy is widely accepted, playing football goalie (by lying across the goal) and being made King of the Bonfire on All Hallows Eve, and he at least passively participates in an adolescent game of spin-the-bottle.

CP specialist Dr. Eileen Cole (Fiona Shaw) recognizes Christy's artistic talent and offers to train him. She brings him Shakespeare's "To be or not to be" soliloquy, gives him training in speech and movement control, and arranges for a one-man show of his artistic work. Christy falls in love with Dr. Cole and is crushed when she reveals that she is already engaged, and he tries unsuccessfully to slit his wrists.

Recovering emotionally from that disappointment, Christy in the years that follow sees more success as an artist and writes the autobiography on which this film is based--and, we are told in a closing title, he marries his nurse when he is about 40. (Christy Brown died in 1981 in his late forties.)

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