Summary:

Spencer Nadler, a surgical pathologist for over 25 years in southern California, offers 8 essays, as well as an introduction, epilogue and 9 full color histopathology plates in this collection. As he explains in the introduction, Nadler began his training in surgery, but, during a required year of surgical pathology, he finds his true vocation: "I realized a flair for surgical pathology that I had never demonstrated in surgery." (p. xix) However, over the years, he realizes he misses patient contact--these essays, written over 10 years, are forays into an unusual relationship: the pathologist-patient relationship.

Each essay is about a different patient (or other contact) and tissue. One of the most compelling is the first, "Working Through the Images," in which a woman (Hanna Baylan) with metastatic breast cancer seeks Nadler out so that she may view her cancer cells. She arrives in his office unannounced at 6 p.m. and he proceeds to not only show her the slides, but to listen to her. He becomes a witness to her pain, loneliness, sorrow and hope.

"For years I have processed thousands of such cases, determined the manifold forms of disease, but I've never been an intimate part of anyone's illness, never felt the connections of cells to a larger self." (p. 12) During later visits, Baylan cries in his arms and even brings her youngest son in to meet Nadler and view her cells. By this time, Nadler is completely connected to her: "This is heartrending to me, for I have come to love her . . . I can no longer think of Hanna in terms of the cells I see on her slides." (p. 21)

Other chapters highlight fat and bariatric surgery; neurologic disorders such as brain tumor, Parkinson's, Alzheimer's and paraplegia; heart disease; sickle cell disease; and palliative care. Each chapter conveys Nadler's visual sophistication and ability to graphically describe cells. For instance, within a fat cell "a large fat globule steamrolls other cell contents flat against the outer membrane until it bulges like a mozzarella." (p. 32) More importantly, Nadler ably extends his cellular acuity to the larger human dimension.

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Sir Luke Fildes's eldest son Phillip died Christmas morning, 1877. He was attended by Dr. Murray, who directed all of his attention and care to the patient during the child's fatal illness. This unswerving dedication impressed Fildes.

Ten years later, when Sir Henry Tate commissioned Fildes for a painting to exhibit in what was to become the Tate Gallery, Fildes was given freedom to choose the subject matter. Fildes immediately decided to depict this scene of a family physician holding a bedside vigil by a seriously ill child. However, the painting was not begun for four years, and then only at the urging of Tate.

The shade of a lamp is tilted so as to bestow light on the two central figures: the physician, and especially, the recumbent child. The physician faces away from the bottled medicine and cup on the table and directs his gaze fully on the child. He is dressed neatly and sits calmly, patiently, resting his bearded chin on his hand.

The small child is central in the picture, in a white nightshirt on a large white pillow and covered with pale blankets. The makeshift bed consists of two unmatched dining room-type chairs. The child's hair is tousled and the left arm flung out, with hand supinated and beyond the edge of the pillow. Nonetheless, the child rests quite peacefully, as the pose appears quite natural.

To the right and rear of the painting are the parents. They are placed in such deep shadows that it is frequently difficult to make out these figures in reproductions. The mother sits at a table and hides her face in her clasped hands. The father stands beside her, with a comforting hand on her shoulder, as he gazes at the physician.

The painting is set in the interior of a small cottage. Rafters are low, furniture simple. Colors are muted; earth tones predominate. Although the majority of the light comes from the lamp, a bit of light also enters from the recessed window near the mother.

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Kirklin, a physician and Lecturer in Medical Humanities at the Royal Free and University College Medical School, and Richardson, a historian and associate at the Wellcome Trust Centre for the History of Medicine, are both educators in medical humanities in London. This well-written and concise volume focuses on "the role of the humanities in medical education" and is aimed at "those wishing to integrate medical humanities into their own teaching, and learning." (p. xv) The chapters are written by a variety of educators with a wide range of backgrounds, including artist, medical student, writer, nurse, surgeon and philosopher.

At least two stimuli are cited as reasons for the development of this book: (1) the 1993 publication by the General Medical Council of Tomorrow's Doctors which recommends the inclusion of medical humanities in the required curriculum for undergraduate medical education in the UK and (2) a national conference, "The healing arts: The role of the humanities in medical education" in London, March, 2000. The rationale for such a book is delineated in several prefatory statements including remarks by Professors Sir David Weatherall and Sir K. George M. M. Alberti (Alberti is the president of the Royal College of Physicians). The book concludes with recommendations for further reading, schemata for undergraduate and graduate degrees in medical humanities at University of Wales, Swansea, and an index.

The nine chapters in this volume combine pedagogic philosophy, citations for literature and art and how to encourage reflection about these selections, tools for encouraging student creativity, reproductions of art and literature generated by students or patients or used by teachers for discussion, and some practical advice about teaching medical humanities and its, at times, uneasy connection to the rest of the curriculum. Each chapter reflects the individual contributor's area of expertise and experience. For example, in "Fostering the creativity of medical students", the authors Heather Allan, Michele Petrone (who painted the striking cover art), and Deborah Kirklin provide useful guides for teaching creative writing and art production by students studying cancer and genetic disease.

In a particularly insightful chapter, "Medical humanities for postgraduates: an integrated approach and its implications for teaching," Martyn Evans describes the challenges of developing a full-fledged interdisciplinary program for graduate as well as undergraduate studies in Wales. He addresses concerns about "bolt-on" versus integration of medical humanities in the curriculum, risks of superficiality, and how such studies may transform the culture of modern medicine. Several chapters address a theme (such as "clinical detachment" or understanding the patient's perspective) and include topic-specific sources and guidelines.

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Levin, a social documentary photographer, immersed herself with the Class of 2001 in the anatomy course at Weill Medical College of Cornell University. Her photographs of cadavers, students and instructors are prefaced by a foreword by physician-writer Abraham Verghese. He describes the rite of passage of anatomical dissection: "The living studying the dead. The dead instructing the living." (p. 9)

Interspersed with the full-color images are journal entries by 11 medical students and several artistic anatomic illustrations by 3 of the students. The journal entries and photographs are organized temporally, from the introduction to the dissection lab to the final exam and student-organized memorial service. The end of the book includes the interests and brief biographies of the 11 students and a final dedication by Levin of the book to those who donated their bodies: "I have never before witnessed a gift that is honored, respected, and consumed so completely."

The photographs are not for the squeamish. For example, the double amputee pelvis prosection on page 102, or the multiple images of flayed skin, bits and pieces, or limbs tied to supports provide an insider's view of an anatomy course. Many of the images show the living in motion: translucent images of students in time-lapse swirl near the static cadavers. Other images conjure the once-upon-a-time personhood of the dead: pink fingernail polish on a female cadaver or a heart palmed by a student. The intensity of the student experience is well documented, as is the relaxed atmosphere that inevitably develops as students become accustomed to the experience of dissection.

The student journal entries are sensitive and thoughtful. Students comment on the intersections of daily living, home life, and their own bodies and bodily functions with what they are learning in the classroom. Particular discomfort regarding certain dissections, such as the pelvic region, are acknowledged. Even though students note growing immunity to the dissection experience, such comments reflect insight into professionalism and defense systems. Gallows humor and uneasiness with such humor is explored by Rebecca (p 62) after she sings "New York, New York" to the roomful of cadavers. Forensic clues about the cause of death for a particular cadaver renew the sense for students that this was once a living, feeling person.

The intense, long hours required for understanding and memorizing the material are clearly evident, but ultimately, these students realize they are given a truly special opportunity: "I began to love learning the material just for the sake of learning. Anatomy no longer felt like a burden, but rather a gift." (David, p. 119) Relationships explored include those of student with cadaver (particularly respect/disrespect, ownership and protection), life with death, and those who have had the experience of dissection with those who never will.

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Summary:

Levin, a social documentary photographer, immersed herself with the Class of 2001 in the anatomy course at Weill Medical College of Cornell University. Her photographs of cadavers, students and instructors are prefaced by a foreword by physician-writer Abraham Verghese. He describes the rite of passage of anatomical dissection: "The living studying the dead. The dead instructing the living." (p. 9)

Interspersed with the full-color images are journal entries by 11 medical students and several artistic anatomic illustrations by 3 of the students. The journal entries and photographs are organized temporally, from the introduction to the dissection lab to the final exam and student-organized memorial service. The end of the book includes the interests and brief biographies of the 11 students and a final dedication by Levin of the book to those who donated their bodies: "I have never before witnessed a gift that is honored, respected, and consumed so completely."

The photographs are not for the squeamish. For example, the double amputee pelvis prosection on page 102, or the multiple images of flayed skin, bits and pieces, or limbs tied to supports provide an insider’s view of an anatomy course. Many of the images show the living in motion: translucent images of students in time-lapse swirl near the static cadavers. Other images conjure the once-upon-a-time personhood of the dead: pink fingernail polish on a female cadaver or a heart palmed by a student. The intensity of the student experience is well documented, as is the relaxed atmosphere that inevitably develops as students become accustomed to the experience of dissection.

The student journal entries are sensitive and thoughtful. Students comment on the intersections of daily living, home life, and their own bodies and bodily functions with what they are learning in the classroom. Particular discomfort regarding certain dissections, such as the pelvic region, are acknowledged. Even though students note growing immunity to the dissection experience, such comments reflect insight into professionalism and defense systems. Gallows humor and uneasiness with such humor is explored by Rebecca (p 62) after she sings "New York, New York" to the roomful of cadavers. Forensic clues about the cause of death for a particular cadaver renew the sense for students that this was once a living, feeling person.

The intense, long hours required for understanding and memorizing the material are clearly evident, but ultimately, these students realize they are given a truly special opportunity: "I began to love learning the material just for the sake of learning. Anatomy no longer felt like a burden, but rather a gift." (David, p. 119) Relationships explored include those of student with cadaver (particularly respect/disrespect, ownership and protection), life with death, and those who have had the experience of dissection with those who never will.

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Two metaphors permeate this poem about drinking a barium containing liquid prior to fluoroscopy to determine cancer growth and staging. The first metaphor involves the liquid as alcohol and the radiology suite as a rather perverse bar. Hence the patient drinks the proffered liquid which "froths and hisses like volcanic vodka / or martinis by Dr. Hyde." The second metaphor is 'cancer is war.' The body is seen as a battleground in which the "army of metastasizing cells / advances, armed and dangerous." The patient realizes that medical interventions are allies in this fight, but drinks the barium "as Socrates / must have: one eye on the door."

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This monumental portrait of the 17th century knight, Sir Richard Saltonstall, and his family was commissioned for the Saltonstall family home. The wealth of the family is indicated by intricate tapestries, a woven rug, jewels, and the rich fabrics of clothing and curtains. Absent from the picture is any religious iconography.

Saltonstall stands left of center and draws back the rich red curtain on the deathbed of his first wife. With his ungloved right hand he holds the hand of his eldest child, a son. This son is still young enough to wear a dress, but his coloring and the dress style indicate a boy. He in turn holds the arm of his younger sister, so that a diagonal line is formed from the father's hat, down his arm and through the two children.

The pale dead mother lies all in white, her eyes open, and her upturned hand reaching towards her children. On the right side of the picture sits Saltonstall's second wife, and she holds her baby on her lap. She also is dressed in white and is separated from her husband by the first wife. In addition, the diagonal line between Saltonstall's left hand and his baby is interrupted by his dead wife. However, he does gaze in the direction of his second wife, although no one in the portrait looks directly at another person.

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August is divided into two sections: "On the Corner of Fourth & Irving" and "To Marie Curie." The narrator, on a street corner in San Francisco near the teaching hospitals and medical school of University of California, San Francisco, meditates on the recurrence of lymphoma in a patient. Evening is approaching, fog blows in from the ocean, and the city pigeons are unsettled--landing and taking flight.

The meditation includes a tribute to Madame Curie and her discovery of the effects of radium. The patient had had a good chance of cure by radiation treatment--unfortunately, this patient is in the twenty percent who are not cured. The narrator, probably a physician-in-training due to the load of textbooks, had read the patient's chest x-ray as negative (normal) previously.

By the end of the poem, we learn that the physician had felt enlarged lymph nodes in this patient's neck today and he bluntly states: "I have failed. He has not been cured." The poem closes with the sound of the wind and the "beating and beating of wings."

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This poem concerns the poet's painful loss of his infant son: "a brown berry gone / to rot just two days on the branch . . . . " The anguish is raw and fierce. Throughout the poem emotion and music are intertwined. The poet reaches for a way to deal with his grief and finds a "music great enough" to offer solace and understanding: jazz.

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The narrator's mother becomes the child in her illness which has emaciated her body to look like a "childish skeleton." The son cares for the mother in every way: bathing her, carrying her, feeding her with a spoon. But this is caregiving with a twist--the mother is likened to a weakened enemy and the luck of caring for her is the luck of having finally gained power over an ancient enemy.

So although the physical acts of caring are done well--lowering her gently into a warm bath and soaping her withered body, sitting by her bed, feeding her ice cream--the thoughts behind such acts are less than pure. At one point, the son holds his wet mother in midair between bath and wheelchair until she begs him to put her down, an act which he recognizes as cruel and also an "ancient irresistible rejoicing / of power over weakness." The poem concludes on a more positive note--affirming the bond between mother and son and realizing that enemy or no, to feed someone ice cream is still an act of nurturing: "sweet is sweet in any language."

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