Summary:

In 1988, having suffered for years from major depression and borderline personality disorder, and now also showing symptoms of obsessive-compulsive disorder, the twenty-six-year-old Lauren Slater is prescribed a new drug: Prozac. In this "diary," a series of meditations and progress reports on her experience, Slater traces ten years on Prozac, providing a remarkable before-and-after picture of the drug's effects.

She is "hobbled" by her illness: has dropped out of college, has been fired from most jobs, has been hospitalized five times. By the end of the book, she has received a doctorate from Harvard, has a successful career as writer, teacher, and psychologist, and is in a happy marriage.

Despite these unquestionable positives, Slater is ambivalent about the drug, describing the shock of becoming "normal," of being assaulted by health. She describes the sexual dysfunction, her anxiety about losing the need and ability to write the kind of poetry she had written before, and the terrifying moment when the drug suddenly stops working, and she must confront the possibility that it may not be a reliable and permanent solution.

She comes to fear that, healthy, she is no longer herself but something the drug has created. At the same time, though, it is only because of the drug that she is even able to ask these questions. Finally, she thanks her doctor for his ambiguous gift: she has become like a beautiful fish, her "skin all silver," her "mouth pierced" on Prozac, "this precious hook."

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In this journal, Murray traces a month-long rotation he spends as attending physician in the ICU (Intensive Care Unit) of San Francisco General Hospital. For each of the 28 days, Murray presents the patients he sees, both new and ongoing, along with commentary on the care of each patient and on broader issues raised by their cases.

In the course of the month, we encounter sixty patients, fifteen of whom die in the ICU. The patients are apparently quite typical for the hospital: cases are dominated by HIV, pneumonia, tuberculosis, and drug abuse, or all four. The ICU is not a very safe place: there are twelve cases of iatrogenic pulmonary edema, and several of hospital-acquired infections.

Murray candidly presents both the triumphs and the limitations of contemporary intensive care while giving us vivid glimpses into the lives of both patients and staff. In his epilogue, Murray asks some tough questions about the value of intensive care units, and discusses palliative care, patients' rights to the withholding and withdrawing of life-sustaining therapy, and even physician-assisted suicide, as "more humane"--and economically responsible--alternatives to intensive care in cases of advanced terminal illness (270).

He describes the ICU as a "battleground" where people who are "clinging to life" can "fight for it" (275). This is its value. But the battles need to be better understood and winning must be carefully evaluated. Murray concludes that the last few decades' medical and technical advances in critical care now need to be matched by ethical ones.

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Mr. Lucas, an Englishman, is growing old. He has always wanted to visit Greece and has finally achieved this, accompanied by his unmarried daughter, Ethel, who will, it has been assumed, dedicate her life to taking care of him in his old age. In Greece, Mr. Lucas becomes restless and resistant to the idea of an expected passive, peaceful death from old age. He wants to "die fighting." Something mysterious happens: he finds a great old hollow tree from which a spring of water flows. He climbs into the tree and experiences an epiphany: he suddenly sees all things as "intelligible and good."

But when the rest of his party find him, he is oddly repelled by them. He does not feel that anyone can share the revelation he has experienced, and he becomes afraid that if he leaves the place he will lose the feeling himself. He decides not to leave, and says he plans to stay at an inn near the old tree, but the others are horrified, and force him to leave with them.

Back in England, some time later, Ethel is now about to be married. Mr. Lucas has become a perpetually disgruntled old man, complaining about everything (especially the sound of water in the plumbing--the mystical Greek spring has been reduced to this annoyance--he says, "there’s nothing I dislike more than running water"). His sister, Julia, whom he hates, is going to take care of him once Ethel is married.

Then a gift arrives from a friend in Greece, wrapped in a Greek newspaper. In it Ethel reads the news that on the night they left, the old tree was blown down, and fell on the family who kept the inn nearby, killing them all. Ethel is upset, and says how lucky it was that they hadn’t stayed there that night, calling it a "marvellous deliverance," but Mr. Lucas dismisses the story without interest. He no longer cares.

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England in the 18th century. The wealthy Lady Neville finds that she has become sad and bored with life. So she arranges an elaborate ball and decides to invite Death as the guest of honor. To be invited, Death must first be found. After discussion about whether Death lives among the rich or the poor, Lady Neville remembers that her hairdresser’s child is dying, so she gives him the invitation to pass on when death arrives.

Two days later the heartbroken hairdresser arrives with a note of acceptance. All agree that Death’s handwriting looks feminine, but when the hairdresser will not describe the source of the note, Lady Neville has him whipped and thrown out.

At the ball, the guests become increasingly fearful until Death arrives, late, in the form of a beautiful young woman. Everyone falls in love with her. When she says she has to leave, they beg her to stay, and she says she will, if they’re sure. They are, so she says that she must now choose someone to take her place as immortal Death.

After a careful (and revealing) process of selection, Death chooses Lady Neville herself, concluding that one who could treat her hairdresser so heartlessly would take on the role well, since it is clear that only she knows "how meaningless it is to be alive." The story ends as Death kisses Lady Neville--and they, presumably, change roles.

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Much to the disapproval of her children, a newly-widowed seventy-two year old woman decides to continue living independently and spends her time in disreputable behavior like going to the cinema alone, visiting insalubrious parts of town, eating at inns, and going to the races. She befriends a middle-aged cobbler (who is also, scandalously, a Social Democrat) and a young "feeble-minded" kitchen maid, and she stops visiting her husband's grave. One of her sons assumes she must be sick and wants to call the doctor. Without consulting her children, she mortgages her large house and apparently gives the money to her cobbler.

The narrator (her grandchild) observes that she has lived two lives: the first as dutiful daughter, wife, and mother, and the second "as Mrs. B, an unattached person without responsibilities." She dies suddenly, without illness, and the grandchild describes a photograph taken of her corpse after death: she has the face of one who "had savoured to the full the long years of servitude and the short years of freedom and consumed the bread of life to the last crumb."

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The narrator, an author, is accosted by his friend, Sam Nolan, who has just had his appendix taken out and thinks his experience would provide useful information for one who writes stories: Sam says he has discovered how and why male patients fall in love with their nurses. Sam's experience of being hospitalized is at first like being caught in a machine, he says. This changes after the surgery, when the nurse becomes his caregiver and rescuer.

He feels a great tenderness for what he calls the "beauty of her efficiency." He denies being in love, blaming the morphine and fever for his attachment, but he tells how he did not want to see his wife when she visited, and when he describes giving the nurse a parting gift, a pair of gloves, the narrator sees tears in his eyes. According to the narrator, Sam's story is in fact about his "terrible wife," and she is the reason "it [falling in love] has happened."

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Millie is a "baby nurse," hired as a domestic helper and live-in night nurse who cares for other women's infants up to the age of two years. She is "condemned by life to love many babies and lose them all" (1). Millie is described as old, but we are not told how old, or of what else her life has consisted; probably little, since she appears to have cared for one child after another, and has no home apart from where she is employed.

The story begins as she starts a new job, caring for Mrs. Jones's baby daughter. She adores the baby, but is tense and possessive, strongly dislikes the Jones's noisy six-year-old boy, and complains to Mrs. Jones about the other servants. Reluctant to let the baby grow up, she does not encourage her development, and she is overly defensive and protective of the child.

As the baby gets older, Millie becomes more and more anxious until, after a fight with one of the other servants, Mrs. Jones fires her. The story ends where it began, in the waiting room of the employment agency as Millie seeks a new position, a new baby to love and lose.

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Corky Nixon is a patient in a ward of amputees in a military hospital for casualties of the Korean War. He has lost both legs. The head nurse on the ward has been given the nickname "Old Ironpuss" because she is so fierce and strict and unattractive, showing, as Corky says, "no warmth, no sympathy, no concern" (131). By implication, she is unfeminine. All the patients fear and hate her.

On Christmas Eve, a severely injured patient, Hancock, is brought in. He is conscious but catatonic. Corky is outraged that "Old Ironpuss" should be taking care of Hancock (he says that so sick a patient should get "the best damn-looking nurse in Christendom"!). Corky tries to get Hancock to talk, but is interrupted when the nurse comes in and berates Hancock for being such a difficult patient. Corky is outraged and complains to the colonel, who then points out that Hancock, reacting to the nurse's diatribe, has roused himself, talked back, and begun to recover.

He tells Corky that in cases like this, kindness and sympathy don't work and that the best treatment is the provocation of anger. Corky accepts this, and decides to collaborate with the nurse by having all the men in the ward stage the loud singing of Christmas carols with bawdy new lyrics, ostensibly to irritate her. In the midst of this chaotic display of good spirits, we see "Old Ironpuss" listening to their spirited defiance, and then turn away, alone, weeping.

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Summary:

Fred McCann is an energetic man in his thirties, something of a playboy, when the Second World War breaks out. He becomes a soldier, and in an Italian village one day he goes to a pump for a drink of water. The pump is booby-trapped and explodes. He is blinded and loses all four limbs. The story traces the development of a relationship between Fred and Alice, his nurse in the military hospital.

As he learns to submit to being entirely helpless, reliant on Alice for all his needs, he gradually begins to adapt to his new condition. Then Alice changes everything by having sex with him. At first their new and obsessive relationship makes him happy, restoring some of his old sense of himself as a man. When Alice is moved to another duty and replaced by a sadistic male nurse, Fred is so devastated and makes such a scene that he gets Alice back.

To celebrate her return, Alice sneaks some whiskey into his room and they get drunk. She then says something that appalls him: she calls him her "thing" and confides that she has always hated men, who look at her and touch her and have power. Fred is nauseated, seeing himself reduced to nothing more than a "a phallus on its small pedestal of flesh." He realizes now that he is no longer a man, and later that night he manages to drag himself out into the garden, where there is a small pool in which he drowns himself.

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Summary:

Alice Goodwin is the wife of Howard, a midwestern dairy farmer, the mother of two daughters aged five and three, and the nurse at a local elementary school. She and her friend, Theresa Collins, a family therapist who lives in the nearby suburbs, take turns watching each other's children. One morning, while Alice is momentarily distracted, Theresa's two-year-old daughter, Lizzy, falls into the pond on the Goodwin farm. Despite Alice's attempts to resuscitate her, she dies after three days in the hospital.

Not long after, while she is severely depressed, Alice is arrested on (false) charges of sexually abusing some of the schoolchildren in her care. Confused, and thinking only of Lizzy's drowning, Alice says to the police, "I hurt everybody." They take this to be a confession.

She spends three months in prison awaiting trial, until Howard sells the farm to pay her bond. The novel gives us both Alice's experiences in prison--in a world she had hardly imagined--and Howard's struggle to take care of their children. Theresa, who seems never to have blamed Alice for her child's death, helps him and they develop a powerful bond. The novel ends with the trial, in which Alice is exonerated, and their family's tentative beginning of a new, urban life.

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