Summary:

The narrator is an ICU (intensive care unit) resident. He describes his encounters with three patients: a 23-year-old woman, Kimberley, shot in the head by her fiancé before he killed himself; Mr. Wilson, the alcoholic into whom Kimberley’s liver is transplanted after she has been declared brain dead; and Mr. Griego who, in a failed suicide attempt, has shot off his lower jaw.

In the call room there is a poster that reminds the doctor of a lake in Vermont where his family had vacationed when he was a child. The lake, alive with fishes, had filled the boy and his brother with expectation: "We wanted something to happen, we wanted it to come gliding out to us, miraculous, powerful, full of wonder." (p. 56)

When the resident’s thoughts are interrupted by Mr. Griego, who has leeches attached to the wound where his chin is being constructed, his recollections shift to another lake. Overgrown with algae, it had insufficient oxygen, no fish, and when he and his brother swam in it, they emerged covered with leeches. He recalls the violence with which his brother tried to kill one of the creatures, pounding it with a rock. The lake had become "repugnant" but also "exciting."

These memories are juxtaposed with Mr. Wilson, who has Kimberley’s young liver in its new, "damaged bed." The resident finds himself withdrawing from Mr. Wilson, whom he imagines as a ghost that has haunted Kimberley’s life, drinking it away, or as a kind of monster rising up from beneath the surface of a lake.

The resident is called out a third time, to transfer Mr. Griego to the floor. The leeches have been removed and killed and his chin is healing well, looking both "clean and terrible." His new face will scare his little daughter, the resident thinks.

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Summary:

In 28 autobiographical stories, the narrator writes of his patient encounters (and self encounters) as a medical student, resident, and finally Emergency Room attending physician. "The Unknown Assailant" opens the collection, a tale of a criminal and his victim who are both brought into the doctor-narrator's emergency room. The young doctor chooses "the young one" (p. 1), not knowing he is the assailant, and works frantically to save his life. This criminal allegedly killed two men a year before, but his current victim lives and the doctor learns the story of the attack from this victim's point of view. The assailant, who slowly recovers, has "an aura about him" (p. 5) and the doctor is strangely drawn to him, thankful that this man means him no harm. Perhaps aware of the irony of healing a man who, in another environment, might kill him, the doctor helps the assailant get better.

This underlying theme--that nothing is black and white in medicine or life--shapes every story. "Prelude," is the revealing, three-page tale of a medical student's life outside the hospital juxtaposed with his first encounter with death in the anatomy lab.

Every story deals with significant issues: the physician's inner emptiness when a patient dies ("Through the Dark, Softly"), how a greater power might suddenly intervene ("Faith"), how narrow the margin is between a successful and a missed diagnosis ("Sugar"), how both patients and residents survive because of, or in spite of, their medical attendings ("A Difference of Opinion"), and how things that seem final or sinister--like death and leeches--become instruments of hope and cure ("The Dead Lake"). [Sugar and The Dead Lake have been annotated in this database.)

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Summary:

A child dies in the hospital shortly after the infectious disease consultant, Dr. Michael Grant, evaluates her. The 35-year-old physician has cause to be troubled by the patient's death. He failed to perform a careful examination, did not check the results of her most recent lab tests, and held off on ordering antibiotics. Although an autopsy was not performed, it is believed she died of sepsis.

Divorced and recently relocated to North Carolina, Dr. Grant is already depressed. Now he must worry about the possibility of a malpractice lawsuit. Jonas Williams, the father of the dead child, is also ill. He complains of fatigue, visual disturbances, confusion, night sweats, and fever. Jonas has developed unusual lesions in his throat and retina--white threads in a serpentine pattern. A biopsy of his oral lesion demonstrates the presence of osteoblasts and new bone formation. Dr. Grant becomes convinced he has stumbled onto a completely new infectious illness even though he cannot identify the causative organism.

Jonas experiences gastrointestinal bleeding as a result of a low platelet count. He dies in a trailer that has caught on fire. Dr. Grant soon develops the same symptoms as his patient. He remembers coming into contact with some of Jonas's blood. He is admitted to the hospital with massive gastrointestinal bleeding. His physician attributes the bleeding to ulcers, gastritis, and thrombocytopenia. Dr. Grant, however, believes the bleeding is due to the same mysterious disease that Jonas had.

The body of Jonas's daughter is exhumed, and there is anatomic evidence of the same bizarre changes that occurred in her father. Dr. Grant visits a cabin in the woods where Jonas had lived. He is looking for clues to the puzzling new illness. What he finds, however, is not an answer. Instead, it is a renewed appreciation for his life as well as the world around him.

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Summary:

A two-year-old girl is brought to the Emergency Room. Her father believes there's nothing wrong with her, but the mother says that earlier the child had looked "blank," and is sure there's a problem. The physician tries to work out what might be wrong.

The child seems fine, but he automatically looks for signs of abuse, and the triage nurse suggests the parents, who are African-American and on Medicaid, are there because they want "something for free" (127). There are other patients waiting, the child's vital signs are fine, the father wants to leave.

As the doctor is leaving the examining room, he asks whether she might have taken someone's medication, and the mother mentions that the child's grandmother takes "sugar pills," hypoglycemics. They test the child's blood sugar and it is dangerously low. She is admitted to the hospital.

The physician tells the mother she has saved her child's life, and then considers how lucky they had all been--"I felt sick, cold, and damp, terrified by what I had almost missed" (131). He says that since then, he often thinks of the child, "alive in the world, going out into it, . . . decade after decade ahead."

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