Summary:

One morning in the shower Joyce Wadler, "a journalist, forty-four, Jewish, never married," discovers a lump in her left breast. In this brief, bright, and very readable account, Wadler describes what happened next, taking us through medical examination, diagnosis, and successful lumpectomy and chemotherapy.

But this is much more than a simple patient’s story. For one thing, Wadler is an intrepid researcher, and we learn a good deal about breast cancer and the often agonizing therapeutic choices its victims face. For another, she does not separate her medical adventure from the rest of her life, which includes a day job as a writer for People magazine, a book project, a semi-functional relationship, and a Jewish mother.

Finally, Wadler uses her ironic-sardonic sense of humor to great advantage--remarking, for instance, that through her post-diagnosis impulse to live in the present and not worry about her lover’s monogamy, cancer had made her "the dream girl of every uncommitted man in Manhattan"!

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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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In March, 1981, in Vermont, Charlotte Bedford goes into labor. She has decided to give birth at home with the help of a midwife, Sybil Danforth, but complications develop. Charlotte has a seizure, her heart stops, and she does not respond to CPR. The fetus is still alive, so Sybil delivers him successfully by Cesarean section, with a kitchen knife. But the bleeding when Sybil makes the incision convinces her assistant that the patient’s heart was still beating. She reports this to the police and Sybil is put on trial for involuntary manslaughter.

The story of the trial is told by Sybil’s daughter, Connie, fourteen years old at the time and now an obstetrician-gynecologist. The acquittal comes at a price: the midwife finds herself no longer capable of delivering babies, and both she and her daughter are given a new insight into the uncertainty which underlies so many of medical decisions. At the end of the novel we are left uncertain whether or not Charlotte was still alive when her baby was delivered.

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This anthology frames a rich selection of fiction and nonfiction with astute and helpful introductions to issues in nineteenth-century medicine and the larger culture in which it participated. The fiction is comprised of Mikhail Bulgakov’s The Steel Windpipe in its entirety; Sir Arthur Conan Doyle’s story, "The Doctors of Hoyland" from Round the Red Lamp; and selections from George Eliot’s Middlemarch, Gustave Flaubert’s Madame Bovary, Sarah Orne Jewett’s A Country Doctor, Sinclair Lewis’s Arrowsmith, Thomas Mann’s Buddenbrooks, W. Somserset Maugham’s Of Human Bondage, George Moore’s Esther Waters, Robert Louis Stevenson’s Strange Case of Dr. Jekyll and Mr. Hyde, Eugène Sue’s Les Mystères de Paris, and Anthony Trollope’s Doctor Thorne [the full-length versions of many of the above have been annotated in this database]. The nonfiction consists of two versions of the Hippocratic Oath, two American Medical Association statements of ethics, and selections from Daniel W. Cathell’s The Physician Himself (1905).

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Villagers gather together in the central square for the annual lottery. There is much excitement and interest as the rituals of the event proceed. The familiar discussion of current and everyday happenings in village life is intermingled with commentary on the traditional and modern ways of holding the lottery, as well as observation of the particularities of this year’s proceedings. Finally a winning family is chosen by ballot, and from that family a winning member--Mrs. Hutchinson. Mrs. Hutchinson is then stoned by the villagers, including her family members.

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An epigraph preceding this 28-line poem, apparently from notes by the physician-writer’s physician-father, sets the action of the poem in Wales in 1938. In the operating room, the surgeon attempts to locate the brain tumor of a patient who was under only local anesthesia because of his blood pressure. In those days in that place, finding the tumor was a "somewhat hit and miss" procedure that seems to have involved looking for it with one’s fingers.

A grotesque image, but all goes well until the patient, in a "gramophone" or "ventriloquist" voice not his own, cries out, "Leave my soul alone, leave my soul alone!" The doctor withdraws from the brain, but the patient then dies, after which the mood in the operating room is shocked and speechless, as "silence matched the silence under snow."

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An even-handed consideration of the essence of doctoring, this poem packs into a few short lines the paradoxes, frustrations, rewards, and dangers inherent in the profession. It depicts the doctor’s power, skill, humanity, dedication, and sometime arrogance, and the arena in which the work is done--"they are only a human / trying to fix up a human." Sexton warns that arrogance has profound consequences: "If they [doctors] are too proud, . . . then they leave home on horseback / but God returns them on foot."

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The site of the multiple stories interwoven in this novel is a teaching hospital in San Francisco. One of the featured characters is a young single mother who comes in with a swollen arm and finds herself in more medical trouble than she anticipated. She suffers a mild stroke after debatable treatment. Two doctors attend her, but differ markedly in their ideas of how to treat her and their human responses to her. One ends up having a brief affair with her that changes his life.

In addition to these there are stories of a comatose young man and the family that refuses to believe he will not awaken (he does); a volunteer coordinator who observes the politics of hospital life from a privileged margin, and sundry staff people who represent alternative points of view. The single mother recovers, but only after a stay in the hospital has convinced her she may not yet be too old to go to medical school to find a life not in marrying a doctor, but in being one.

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The narrator suffers from depression and a pain in the right side beneath his ribs. Surgery will be performed at his home by Dr. Haddon and Dr. Mowbray, but the narrator worries that he might die during the operation. During an afternoon nap on the day before surgery, he dreams of death and resurrection. Chloroform is administered prior to the operation, but the narrator continues to be aware of everything taking place.

He can see into the minds of the surgeons and learns that Dr. Haddon is afraid of inadvertently cutting a vein. Almost on cue, the vein is slashed and hemorrhaging occurs. The narrator has a near-death experience associated with an extraordinary clarity of perception. He senses movement upward - beyond his body, beyond the town, and beyond the world. He believes his soul is streaming through space past the solar system and nearby constellations.

His impression of absolute serenity is eventually replaced by a sensation of loneliness. All matter becomes condensed into a single point of light, then a fuzzy glow, and finally the image of a colossal hand clenching a rod. A faint sound punctures the silence followed by a voice proclaiming, "There will be no more pain" (63). He awakens and sees the surgeon standing next to the rail of the bed. The narrator has not only survived the operation, but his pain and melancholy are vanquished.

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Summary:

This slim volume dips into "quotable quotes" drawn from literature and historical writings dating back several centuries. The quotes are put forth by physicians, patients, observers of medical issues, and writers of fiction as well as essayists. Each quote is but a few lines. The author, the source, and the date (when known) are provided for each quotation.

Many of these quotations will be familiar to persons who are widely read or who study the literature by and about medicine. Some of the quotes are scatological in the sense that they address issues of bodily parts and functions; others are simply amusing, while many are profound observations. The range is wide and the selections eclectic.

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