Showing 81 - 90 of 142 annotations contributed by Miksanek, Tony
When a wealthy man falls victim to incapacitating attacks of vertigo, a young doctor decides that the problem and solution both reside in the patient's head. Gierke is an eccentric widower in his forties who remarries. While honeymooning in Italy with his 17-year-old bride, he collapses after looking down from the heights of a bell tower. Gierke becomes paralyzed by a fear of future attacks of vertigo and eventually stops walking.
Multiple physicians evaluate him without success. Finally a neurologist, Dr. Hugo Spitz, is consulted. He wants to try psychoanalysis but the patient has become extremely introverted. Spitz interviews all Gierke's relatives and even hires private investigators. The doctor devises a theory that Gierke murdered his first wife by pushing her off a mountain and then inherited her fortune.
Spitz reasons that Gierke's vertigo is the result of repressed feelings of fear and guilt. After confronting Gierke with the explanation, Spitz orders his patient to stand. Gierke walks without experiencing any dizziness. Immediately after the doctor exits the house, there is a loud sound and Gierke's dead body, fractured in multiple places from a fall, is found at the bottom of the staircase. Spitz deduces it was suicide.
Middle-aged Clyde Behn has been bothered by a twitching eyelid for two months. His doctor in Massachusetts diagnoses the disorder as minor and transient. While visiting his mother in the town in Pennsylvania where he grew up, Clyde seeks advice from his former eye, ear, nose, and throat specialist. Dr. Pennypacker examines Clyde but is less concerned with the twitch than a possible fungus problem of Clyde's eyelashes. The ENT specialist eventually decides the tic is the result of muscle fatigue.
While at Pennypacker's office, Clyde encounters a former girlfriend, Janet. Although both are now married, Clyde is still attracted to her and asks to see her again. Janet slips a handwritten note into Clyde's shirt pocket and then leaves. Because his eyes have been dilated by Pennypacker, Clyde is unable to read the note. Even so, he exits the doctor's office buoyed by the familiarity of his hometown and the promise of recapturing a bit of his youth.
While driving away from a dangerous city in an area of north Afghanistan ravaged by war, three men must journey by foot when their car is damaged in an accident. Donk is an American combat photographer. Hassan is a young Afghan translator. Graves is a British journalist suffering from a severe case of malaria and in desperate need of medication.
They arrive at a remote village ruled by a warlord, General Ismail Mohammed. Medication is unavailable there and transportation to a larger city is not possible for at least another day. The local doctor recommends an herbal remedy for the treatment of malaria, and General Mohammed attests to its effectiveness. The medicinal grass grows only in a nearby mountain valley. Two soldiers escort Donk and Hassan to the vale. They encounter a convoy of transport vehicles that have been incinerated by a bomb blast.
When the grass is finally in sight, Donk and Hassan race towards it even as the two soldiers shout at them. Too late! Donk steps on a bomblet and the device detonates. Badly injured (and maybe even mortally wounded), Donk and Hassan lie on their backs and gaze at the sky. They are surrounded by the thick grass they hoped might save the life of their companion, Graves.
The surgeon-narrator and his team of assistants (the anesthesiologist, scrub nurse, circulating nurse, surgical resident, and medical student) perform a difficult operation during the night. The patient has an infiltrating cancer of the stomach (linitis plastica) that has eroded his aorta. Because of uncontrollable bleeding, the operation (an exploratory laparotomy with attempted repair of a malignant aorto-gastric fistula) is as doomed as the patient himself.
The surgeon soon comprehends the hopelessness of the procedure as well as the patient's terminal condition. He turns off the oxygen from the gas tank and stops the patient's blood transfusion. Minutes later, the man dies. Blood is all over everything. The doctor must now deliver the bad news to the man's family. He has the medical student tag along.
Members of the patient's family are upset and some are even out of control so he dispenses tranquilizers to them. The surgeon returns to the operating room (OR) and even now finds blood everywhere. The OR team is still working. The doctor showers and then goes back to the OR once more. The room is now dark and empty but clean. The surgeon imagines the dead man's body with a row of abdominal stitches that he likens to hieroglyphics. The unsuccessful operation and the surgeon's actions are thus both concealed and unforgettable.
Two men who are not very fond of one another and opposites in almost every way are brought together by their affection for the same woman. Isabel is the 30-year-old wife of Maurice Pervin and the longtime friend of Bertie Reid. While fighting in Flanders during World War I, Maurice is blinded and sustains a disfiguring facial scar. He also has episodes of major depression. Maurice and Isabel have become socially isolated since his injury. Although their first child died in infancy, Isabel is pregnant again and due to deliver soon.
Bertie, a bachelor and barrister, pays a visit. The three of them enjoy dinner together. Afterwards, Maurice becomes restless and leaves the house. When Bertie goes out to check on him, he finds Maurice in the barn. The blind man asks Bertie for permission to touch him. With one hand, Maurice examines Bertie's skull, face, and arm.
He then asks Bertie to touch his useless eyes and awful scar. Without warning, Maurice places his hand on top of Bertie's fingers, which still rest upon the maimed face. The experience is a revelation for both men. Maurice suddenly understands the splendor of friendship while Bertie realizes how much he fears intimacy.
The narrator of the story, a former district doctor in Russia, reminisces about his frequent encounters with patients suffering from secondary syphilis ("the speckled rash"). The first case he diagnoses is a 40-year-old man seeking treatment for a sore throat. The doctor recommends the application of a bagful of mercury ointment once a day and a follow-up visit after 6 days, but the man never returns. The physician advises him that his wife needs to be examined also, but she is never seen in the clinic.
The doctor remembers many other cases of secondary syphilis in the community. Except for one young woman, patients seem to have little fear of the disease. Children and even entire families are infected. The physician decides to tackle the widespread venereal disease and to confront the rampant patient apathy in the district.
His weapons include mercury ointment, potassium iodide, Salvarsan (an arsenic compound) injections, harsh words, and warnings about the horrible effects of the disease if left untreated. He opens an inpatient unit to treat patients with syphilis. Now long-removed from that remote medical outpost, the narrator still wonders about the people living there.
Fifty-two year old Pete, the hospital mailman, suddenly experiences severe abdominal pain. He is evaluated and treated in the emergency room. His diagnosis is acute surgical abdomen, but the exact cause of his pain is still unknown. The surgeon-narrator determines that the severity of Pete's condition mandates exploratory surgery. During the operation, "an old enemy" (18) is encountered--pancreatitis.
Afterwards, the surgeon assures Pete that he will get better. One week later though, the mailman dies. His death has been painful. An autopsy is scheduled, but the surgeon deliberately arrives 20 minutes late. He does not want to view the intact body of his deceased patient. No matter, the pathologist has waited for him to arrive before beginning the post-mortem examination. The pathologist closes Pete's eyelids before starting the autopsy, mindful of how the mailman's "blue eyes used to twinkle" (21) when he delivered the mail everyday.
Looking back on his first year of medical practice in an out-of-the-way section of Russia, a 25 year old physician reflects on how much he has changed both personally and professionally. He lists the year's accomplishments: performing a tracheostomy, successful intubations, amputations, many obstetrical deliveries, and setting several fractures and dislocations. With pride, the doctor calculates he has seen 15,613 patients in his first twelve months of practice.
He recalls some poignant moments. A pregnant woman has a baby while lying in the grass near a stream. The doctor pulls a soldier's carious tooth but is horrified when a piece of bone is attached to it. During a delivery, he inadvertently fractures a baby's arm and the infant is born dead.
Basking in his year's worth of experience and newfound clinical confidence, the physician quickly comprehends the limits of his knowledge on the first day of his second year in practice when a mother brings her baby to the doctor. The infant's left eye appears to be missing. In its place sits an egg-like nodule. Unsure of the diagnosis and worried about the possibility of a tumor, the physician recommends cutting the nodule out. The mother refuses. One week later she returns with her child whose left eye is now normal in appearance. The doctor deduces that the boy had an abscess of the eyelid that had spontaneously ruptured.
A husband and wife in Ireland struggle to make ends meet. Corry and Nuala, each 31 years old, have 3 children. Corry works at the joinery. He also carves religious statues on the side. A wealthy English woman is impressed by his artwork and encourages Corry to pursue his craft fulltime. His talent is undeniable, but there is no market for his wooden statues.
Now Nuala is pregnant and Corry is without a job. The English woman's wealth has vanished, and she can no longer help the couple financially. Nuala offers to sell her unborn baby to an infertile couple, Mr. and Mrs. Rynne, who long for a child of their own. Mrs. Rynne is shocked by Nuala's proposition and rejects it. Corry turns down work as an apprentice tombstone engraver but accepts a job working on the roads.
Nuala is angry about the way events have unfolded. She finds solace, however, in the concrete shed that functions as her husband's workshop. As she views the wooden figures of saints, Madonnas, and the Stations of the Cross created by her husband, Nuala concludes, "The world, not she, had failed" (152).
The physician-narrator celebrates his 24th birthday in the company of two midwives and a feldsher (physician’s assistant). They toil in a remote area of Russia where conditions are harsh. The doctor tells the group about a peasant woman who requested a refill of belladonna (an atropine-like drug) that was prescribed for stomach pain the day before. Although the instructions were to take five drops as needed, the bottle was completely empty already. Since the woman had no signs of belladonna poisoning, the feldsher concludes she shared it or maybe even sold it to other villagers.
The group shares other stories about patient mistakes and misguided beliefs. That same night a man comes to the doctor’s house. He is a miller suffering from recurrent fevers. The physician diagnoses malaria and remarks how sensible and literate the patient is. Powdered quinine is prescribed to be taken once a day before the onset of fever. Soon the doctor receives word the miller is dying. The patient has defied the instructions and taken all 10 doses of quinine at one time to expedite his recovery. His stomach is pumped, and he survives the overdose.