Summary:

The events in Dry follow those in Burroughs's memoir of his bizarre childhood, Running with Scissors (see this database). Burroughs, at 24 years old and with no formal education beyond grade school, works in the high pressure advertising world of Manhattan. He's also an alcoholic, and his addiction definitely interferes with his work. Fortunately for Burroughs, he is not fired, but rather, his boss and co-workers set up an intervention. Burroughs--after telling his best friend, Pighead, who is HIV positive; his drinking buddy, the undertaker Jim; and his abusive, alcoholic father, of the plan--leaves for an inpatient rehabilitation program in Minnesota designed for gay people.

Thus begins Burroughs journey to sobriety. A journey that is replete with temptation, relapse (not only with alcohol, but also crack cocaine), love, success, loss, and grief. Burroughs experiences hallucinations, coma and life-threatening withdrawal. But ultimately, Burroughs achieves the title of his memoir. What he reveals is that, for an addict, remaining clean and dry is hard work. This daily, moment-by-moment work forces the addict to examine what is truly precious in life.

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Written as an interior monologue, Destiny begins as Chris Burton receives a phone call informing him of his schizophrenic son's suicide. Burton, a British ex-pat journalist in the final stages of writing his chef d'oeuvre--a cultural history on national character--is married to Mara, a provocative, capricious, flamboyant Italian. The vitriolic arguments and hurtful stratagems that characterize their discordant marriage intensify with the crisis of death and its aftermath--the identification, transport and entombment of Marco's body. Family relationships are further complicated by Mara's distrust and estrangement of her adopted daughter, Paola.

Burton reveals the chaos that schizophrenia imposes not only on the patient, but also on the entire family. In order to avoid prison following an attack on his family and home, Marco had been placed in a psychiatric institute, Villa Serena, and it was at this facility that Marco stabbed himself to death with a screwdriver. The onset of disordered thinking and erratic behavior, the search for therapies, the various repercussions of guilt and blame (including recriminations about the intense, border-blurring maternal love lavished on Marco), are re-examined by Burton as he travels from London to Rome, sits vigil by his son's body in the camera ardente, and confronts his wife at her family's tomb.

Burton's physical distress mirrors his mental anguish. Burton has heart disease and obsesses about lacking his anti-coagulant medication. In addition to the worry of clot formation, urinary retention prevents Burton from emptying his bladder. These physical ailments of containment, confinement, obstruction and blockage form resonances throughout the book: the tomb, the strictures of marriage and the leakage of adultery, the oppressive family 'house of ghosts,' the separateness of interior thought from observable behavior, the barriers of language, the herky-jerky redirections of emergency travel.

Furthermore, the will to create permanence, to make one's destiny more than a transient destination, informs Burton's moves. In the midst of his exploding marriage and tormented trek home, Burton agitates over his work, and in particular, his book, which "must serve to transform a respectable career into a monument" (p. 1).

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This book, a sequel to It's Not About the Bike: My Journey Back to Life, chronicles five-time Tour de France winner Lance Armstrong's personal and professional triumphs and agonies from late 1999 (after he won his first Tour and after the birth of his son Luke) to mid-2003, the 100th anniversary of the Tour. Armstrong defines himself by his cancer experience and survival; he devotes himself to both one-on-one connections with fellow cancer patients as well as his public persona to raise awareness and funds for cancer programs and survivors' needs.

There are many medically related themes in the book. Descriptions of cycling sports injuries and illnesses include a severe concussion, a broken cervical vertebra, dehydration, road rash, tendonitis and exhaustion. Armstrong experiences the loss of friends and acquaintances to cancer and trauma. He is the subject of an intense investigation into the possible use of recombinant erythropoietin and finally cleared of suspicion after nearly two years. As a world class athlete, he is subject to frequent, random drug testing.

His wife experiences a failed in vitro fertilization cycle, though a subsequent successful treatment leads to the birth of healthy twin girls. The Red Cross invites Armstrong to visit NYC firefighters soon after the devastation of September 11, 2001 in a successful effort to boost morale. Armstrong, though, describes encounters with some cancer patients in which he felt he did not succeed in providing the desired inspiration.

Despite reaching his five-year cancer-free milestone, Armstrong, like many other cancer survivors, wonders if the cancer will return. He is hyper-vigilant of his body not only because of his elite athlete status, but also because of his cancer history. Nonetheless, he is reckless and jumps from a steep cliff to sense the rush of fear and freedom.

Armstrong trusts and believes in modern medicine and technology, as well as the physicians, nurses and other health care practitioners dedicated to cancer treatments and health care. He also lauds complementary practices, particularly the team chiropractor who uses a variety of techniques to support the riders during the grueling Tour.

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Note: I try not to reveal too much here. Nevertheless, I urge you to read the book first. I would not want the magic of reading this book to be diminished by too much foreknowledge--no matter when the book is initially opened.

Harry Potter and the Order of the Phoenix is the fifth book in a planned series of seven (see Harry Potter and the Sorcerer's Stone for an introductory summary). Harry is now fifteen years old. The opening chapter, "Dudley Demented," features a return of the Dementors (see Harry Potter and the Prisoner of Azkaban), who had been sent to Harry's neighborhood in Little Whinging to deliver their soul-sucking kiss. In order to repel the Dementors and save himself and his bullying cousin Dudley Dursley from the kiss's death-in-life, Harry uses magic. This transgression from rules on underage wizardry leads to Harry's near expulsion from his school, Hogwarts, and a trial by the full court, the Wizengamot, led by Cornelius Fudge, in the Department of Mysteries of the Ministry of Magic.

Headmaster Albus Dumbledore, concerned with Harry's safety as well as with leading the resistance efforts (The Order of the Phoenix) against the resurgent evil Lord Voldemort, not only prevents Harry's expulsion, but also organizes the guard for Harry's transfer from the Dursley home to the ancient house of Harry's godfather, the wonderfully moody and complex Sirius Black. Sirius, like Harry's parents, would risk anything for his godson, but the relationship is charged by Sirius' goading of Harry to be more cavalier like James Potter--Harry's father and Sirius' best friend--and by Sirius' antipathy towards being imprisoned in his ancestral home, filled with reminders of his pureblood wizard family.

These include a portrait of his raging, hate-filled, deceased mother and a malevolent house elf, Kreacher. Communication between Harry and Sirius is a key theme in the book, as Harry looks to Sirius for guidance on the tribulations of adolescence and to satiate Harry's continued craving for information about his father. Harry's emotional tether is short in this novel, and runs the gamut from frustration and envy that his two best friends, Ron and Hermione, were made prefects of Gryffindor House, to despising two teachers (potions teacher Snape, of course, and the new venomous, officious Defense of the Dark Arts teacher, Dolores Umbridge) and finally to absolute fear and hatred of Voldemort, his mortal, yet intimate, enemy.

Harry's scar pains him almost continuously now that Voldemort has returned in the flesh, and also now that Harry has dreams and visions of Voldemort's actions. With this ability, Harry envisions himself as a snake and witnesses the wounding of Ron's father, Arthur Weasley. This episode leads to two visits to the wizard hospital: St. Mungo's Hospital for Magical Maladies and Injuries. The reader is deliciously informed that the personnel in green robes are not doctors ("those Muggle nutters that cut people up" p. 484), but rather Healers: wizards and witches who passed a large battery of tests in a range of subjects to qualify for such training.

The hospital is a mix of the mundane (the irritable receptionist) and the arcane (patients suffering from bizarre spell damage). Mr. Weasley's recovery from the nearly lethal snake bite suffers a minor setback when Trainee Healer Pye (not the Healer-in-Charge, Hippocrates Smethwyck) tries some "complementary medicine . . .

[an] old Muggle remed[y] . . .

called stitches . . . " (pp. 306-7). The loving Mrs. Weasley, whose temper is notorious and hence humorous, shouts at her husband that even he "wouldn't be that stupid" as to allow his skin to be sewn together. (p. 307)

While in the hospital, Harry and his friends encounter schoolmate Neville Longbottom visiting his parents, who suffer dementia caused by dark magic performed by one of Voldemort's Death Eater followers. Mental illnesses prove far more difficult to remedy than bodily injuries and maladies. Indeed, late in the book, Madam Pomfrey, the Healer at Hogwarts, wisely advises that "thoughts could leave deeper scarring than almost anything else." (p. 847) As Dumbledore, the embodiment of sagacity, states, memories of old hurts, slights and abuses, make "some wounds run too deep for . . .

healing." (p. 833)

Other medically related items include the Skivving Snackboxes--an assortment of magical treats and their antidotes concocted to fake various illnesses in order to skip classes, and Umbridge's detention punishment which results in the painful etching of the required written phrases on the back of the hand of the miscreant student.

Professor Snape is charged with teaching Harry the subtleties of mind-reading (Legilimency) and its prevention (Occlumency), in an effort to prevent Voldemort's use of Harry's mind. "The mind is a complex and many-layered thing," says Snape, and hence the mind cannot be read like a book. (p. 530) Harry's failure at these lessons leads to the denouement of the book and ultimately to the loss of someone very dear to him. After the inevitable confrontation between Voldemort and Harry, Dumbledore gently coaches Harry through his guilt and anger to teach him about destiny, love and death.

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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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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 this verse for children, Silverstein plays with the idea of malingering: the protagonist, "little Peggy Ann McKay" invokes all kinds of alarming ailments from the common to the bizarre ("My hip hurts when I move my chin") in order to stay home from school. The poem swings with a couplet rhyme scheme until the dramatic turn, when little Peggy discovers it's Saturday. She is miraculously freed of all symptoms and one can imagine her puckishly skipping out the door to play.

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This masterful collection of essays was written by Gawande while he was a general surgery resident. The book consists of fourteen essays divided into three sections: Fallibility, Mystery, and Uncertainty. Although some of the essays fall clearly within the boundaries of the section title (such as "When Doctors Make Mistakes" and "When Good Doctors Go Bad" in the Fallibility section), others cross boundaries or don’t fall as squarely in these general themes ("Nine Thousand Surgeons," an anthropological essay on the cult and culture of a major surgical convention, is also located in the Fallibility section). Nevertheless, the many pleasures of the individual essays, the range of topics explored in depth, and the accuracy of the medicine portrayed are the true strengths of this work.

The book begins Dragnet-style with an Author’s Note: "The stories here are true." (p. 1) And it is this attention to fidelity that makes the essays so compelling. Because even when the truths are hard--the terrible acknowledgment by the medical neophyte about lack of skill and knowledge, the mistakes in judgment at all levels of doctoring, the nature of power relations and their effects on medical pedagogy and on the doctor-patient relationship, the gnawing uncertainties about so many medical decisions--the author confronts the issues head on with refreshing rigor, grace and honesty.

Many of the essays reference scientific and medical research (historical and current) as part of the exploration of the topic. This information is imbedded within the essay, hence avoiding a dry recitation of statistical evidence. Typically, the reader’s interest in an essay is immediately piqued by a story about a particular patient. For example, the story of an airway emergency in a trauma patient, her oxygen saturation decreasing by the second as Gawande and the emergency room attending struggle to secure an airway, surgical or otherwise, sets the scene for "When Doctors Make Mistakes."

This leads to a meditation on not only the culture of the Morbidity and Mortality Conference, with its strange mix of third-person case narrative and personal acceptance of responsibility by the attending physician (see Bosk, Charles, Forgive and Remember: Managing Medical Failure, U. Chicago Press, 1981 for an in depth analysis of this culture), but also a positive examination of the leadership role that anesthesiologists have played in improving patient safety via research, simulator training and systems improvement.

Gawande’s journalistic verve takes him beyond the confines of his own hospital and training to interview patients and physicians on topics as diverse as incapacitating blushing ("Crimson Tide"), chronic pain ("The Pain Perplex"), malpractice and incompetence ("When Good Doctors Go Bad") and herniorraphy ("The Computer and the Hernia Factory"). In addition, he visits his own post-operative patients at home ("The Man Who Couldn’t Stop Eating" and "The Case of the Red Leg") which gives a longer view of postoperative recovery and a broader exposure to patients’ perspectives.

Some of the most telling moments come with the introduction of his children’s medical problems into the text. These range from the relatively straightforward (a broken arm, but a chance to comment on detection of child abuse in the emergency room) to the downright parental nightmare scary (severe congenital cardiac defect in their oldest child and a life-threatening respiratory infection in their prematurely born youngest).

These last two experiences are introduced to provide an angle on issues of choice. Choice of a fully trained, attending physician rather than a fellow to provide follow-up cardiac care for their oldest, and the choice to opt out of the decision-making process for whether to intubate the trachea of the youngest and hence leave the medical decisions up to the care team.

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Lance Armstrong, (currently) four time Tour de France cycling champion, is a survivor of metastatic testicular cancer. This book is largely the story of how his life changed from the moment of his diagnosis (October 2, 1996) onwards. He had been a world class cyclist prior to cancer, but his experience with cancer gave him profound insight not only into his life as a cyclist and competitor, but into life itself.

It is this latter insight which he recognizes as ultimately the most important aspect of his cancer experience. Armstrong notes: "Odd as it sounds, I would rather have the title of cancer survivor than winner of the Tour, because of what it has done for me as a human being, a man, a husband, a son, and a father." (p. 259)

Written in a conversational, straightforward tone, the book chronicles Armstrong's childhood in Texas as the son of a strong, loving, supportive, financially struggling, young mother; his beatings at the hands of a step-father; and his early excellence at endurance athletics. Armstrong became a brash powerhouse cyclist and began to enjoy the material rewards of winning while ignoring the onset of symptoms. At the time of diagnosis, the cancer had spread to his abdomen, lungs and brain.

He documents his search for optimal care, sperm banking, lack of health insurance, surgeries, chemotherapy, self-education and interactions with doctors and nurses. Through it all he acknowledges the tremendous support of his mother and friends, as well as sponsors who stuck with him with no assurance that he would survive, let alone race.

Before he was even through the first year, he decided to start a charitable organization, The Lance Armstrong Foundation, dedicated to cancer research and support of cancer survivors. Through this effort he met his future wife, Kristin Richard (Kik), and her love and support helped him through the dark days of emotional soul-searching post-treatment. The book also details her struggles with successful in vitro fertilization (They currently have a son and twin daughters).

Chapter Nine, The Tour, is an in depth look at the 1999 Tour de France which Armstrong won with the help of his US Postal Service teammates, expert coaching, and his will. This race is brutal, dangerous, and as Armstrong notes, both "a contest of purposeless suffering" and "the most gallant athletic endeavor in the world." (p. 215) He details the maneuvering in the peloton, the strategies, the stages and personalities.

The book concludes with reflections on the birth of his son, the anniversary of his cancer diagnosis, the love of his wife, and his need to ride.

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In this collection of 11 short stories, pediatrician-author Perri Klass primarily explores the world of women and their multiple and complex roles as mother, mother-to-be, friend, spouse, lover and professional. Parenthood--its glories, heartaches, tensions and mysteries--plays a prominent role in many of the stories. There is also a close look at woman-woman friendship--at what women say to their best friends and the nuances of the emotional responses to what is said or left unsaid.

Several stories feature single mothers: "For Women Everywhere" (a woman is helped through labor by her best friend), "Rainbow Mama" (a woman cares for her son during his diagnosis and initial treatment of leukemia), and "City Sidewalks" (a woman finds a baby on the sidewalk on Christmas Eve as she rushes to pick up her child from day care).

"In Necessary Risks," an anesthesiologist deals with work and her high energy preschool daughter while husband and easy-to-raise son head out to a dude ranch. In "The Trouble with Sophie," another high energy, dominant daughter wreaks havoc in kindergarten as well as with her concerned parents. In addition to the anesthesiologist, two other physician-mothers are featured in "Freedom Fighter" and "Love and Modern Medicine."

Parenting a newborn whilst handling other tasks is a theme featured in "Intimacy" (a high school biology teacher celebrates her first night of uninterrupted sleep as she both enjoys and envies her single friend's sex life) and in "Dedication" (a writer takes his stepson to a chess tournament while his biologist wife and newborn enjoy breastfeeding at home). Woman friendships are prominent in "For Women Everywhere," "Freedom Fighter," and "The Province of the Bearded Fathers." Grief and sudden infant death syndrome are themes of "Love and Modern Medicine."

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