Summary:

This collection of stories describes "a medical student's journey" (the subtitle) through the difficult terrain of clinical education. In Audrey Young's case, this is also a geographical odyssey from Seattle to Swaziland to Pocatello, Idaho, as she completes her University of Washington clinical rotations and electives. In one sense the main characters of these narratives are the patients the author encounters in clinics and hospitals. As she writes in the Preface, "Patients teach things that the wisest and most revered physicians cannot, and their lessons are in this book."

In another sense, of course, Dr. Young herself is the central character of these stories; this is an account of her journey into doctoring. The author first takes us to Bethel, a Yupik Eskimo town on the Bering seacoast of Alaska, where she had her initiation into clinical experiences in the form of a summer preceptorship. There she learns that patients are far different from textbook examples, as she confronts the social and cultural factors that influence illness and its amenability to treatment. We follow the author to assignments throughout the WWAMI network. WWAMI is the University of Washington's decentralized clinical training program (Wyoming, Washington, Alaska, Montana, and Idaho).

In Spokane she delivers a baby for the first time, supervised by an opera-loving attending physician. In Pocatello she takes care of her first critically ill neonate. In Missoula her life becomes "one of resigned solitude" in her internal medicine clerkship, where she experiences sleep deprivation and experiences sunlight only "through dusty windows."

During her fourth year, the author finds herself treating desperately ill AIDS patients without a supervising physician (he had gone to Zaire for a funeral and might be back the following week) and also without anti-retroviral drugs. However, it is in Swaziland that she learns the deep power and dignity of medicine, as exemplified by a patient who invites her to a dinner in her honor that requires killing one of his precious chickens.

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People can’t say goodbye / any more. They say last hellos. In this poem the narrator says his last hellos to his father, who is dying from a brain tumor. Cecil (the father) seems wise and cantankerous, reflective yet humorous.

His son asks, "Sorry, Dad, but like / have you forgiven your enemies?" Cecil replies that he must have because he doesn’t think about them anymore. Later, near the end in the hospital, he tells his son, "You’re bustin to talk / but I’m too busy dyin." The son concludes, "Snobs mind us off religion / nowadays, if they can. / Fuck them. I wish you God." [76 lines]

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This collection of 20 poems is inspired by the human body. In anatomical detail these poems depict the body's beauty of structure, its rhythm of movement, its versatility of metaphor. This is not surprising, perhaps, for the work of a poet who is also a physical therapist.

In "What I Know" (p. 11) the poet helps his patient across a hospital lobby into the "breezy, sun-dotted day." She struggles with her walker, as the poet visualizes her impairment in himself, in a spiritual sense "unable to move or feel my right side." And the world's more global impairment, where each day violence is visited upon the "brave peacemakers and blessedly meek." "Tongue" (pp. 16-17) builds upon the earthy glossals, glottals and trills made by the muscles of speech to celebrate the expressive beauty of song, while remembering that the tongue is "flesh . . . first and last."

Kelly sticks closely to flesh in "Surface Anatomy" (pp. 21-22), in which he draws word-portraits of bones, including the greater trochanter of the femur, vertebral spinous processes, and patella, and in "Voluptuosity" (pp. 27-28), where he thanks God for the body's curves: "The body's curving comes / to the hand like the dry fields / rise to rain. . . "

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This is a comprehensive social history of European (or "Western") attitudes toward death and dying over the last thousand years. Ariès organizes his history into five sequential cultural constructs, each of which conveys the meaning of death to the individual and community, as well as the social institutions around death and dying, during a different period of Western history, beginning in the Middle Ages.

Cultural responses to death must begin by acknowledging that death is mysterious and overwhelming; a wild beast; a meaningless monster. Death lurks at the edge of our consciousness, ready to destroy us and demolish whatever meaning we attribute to our lives. In medieval Europe Christianity had domesticated this monster by establishing a comprehensive set of beliefs and practices that Ariès calls the "tame death." Death was merely a transition to eternal life. The individual was understood as an integral part of the community and not as autonomous and isolated. Therefore, death and dying were communal events, supported by specific prayers and practices (i.e. ars moriendi) that "tamed" the unknown.

In the centuries that followed, Ariès's "tame death" evolved through five stages into the radically different cultural conception of death that characterizes Western society--especially in its American form--today. These changes result largely from the gradual replacement of community-oriented personal identity with today's radical individualism; and the gradual sequestration of death to a position behind the scenes, so that dying and death become remote from ordinary experience.

In today's world we encounter "invisible death," a somewhat paradoxical name because its invisibility allows the savage beast free rein. Death is no longer "tame" because we deny its existence so effectively we no longer develop personal and communal resources to give it meaning. Death's invisibility enhances its terror; our culture's loss of spirituality enhances death's meaninglessness.

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Martin Arrowsmith is from a tiny mid-western town. He goes to college and then to medical school in the largest town in the state. He begins to worship Gottlieb, Professor of Bacteriology, one of the few professors who is devoted to pure science instead of lucrative practice. Martin becomes Gottlieb’s assistant and annoys his professors and friends by constantly talking about methodology. He is engaged to Madeline, a rather dull graduate student in English. When he meets Leora, a nurse, he breaks his engagement to Madeline. Martin grows disenchanted with his career, leaves school, and wanders around the midwest. Finally, he marries Leora and returns to school. Now, however, he becomes a disciple of the Dean, Silva, whose science is much less precise and who is devoted to making people comfortable at all costs.

Martin sets up practice after graduation in Leora’s home town. The Swedish and German farmers find him invasive and unwilling to cater to their small-town expectations. When Martin misdiagnoses a case of smallpox, he is forced to leave town. He has by then found a new hero, Gustave Sondelius, who fights plagues abroad and returns to America to lecture. Sondelius finds him a job in a larger town as an assistant to Dr. Almus Pickerbaugh, Director of Public Health. Pickerbaugh writes popular poems against sidewalk spitting and alcohol but does little else. The town loves him. He becomes a senator and Martin takes over the department. He quickly makes enemies of the very people Sondelius pleased. He also returns to research. Between annoying the upper crust with his brusqueness and annoying the farmers by closing their diseased dairies, he is soon drummed out of town.

He is then hired as a pathologist at the Rouncefield Clinic, where he does meaningless, repetitive work. His old mentor, Gottlieb, saves him by getting him a position at the McGurk Institute in New York. The Institute is very rich and gives scientists a chance to work without the interruption of patients or a need for practical application. Martin returns to Gottlieb’s principles and discovers a cure for bubonic plague. The Institute, which is not free from economic interests, sends him off to the tropical island of St. Hubert to test his material and save the population.

Martin is determined to conduct a controlled trial. When his wife and Sondelius both die of the plague, however, he injects everyone, saves the island, and returns to New York. Gottlieb has dementia and can neither blame nor forgive Martin for his lack of scientific aplomb. Martin marries an heiress and briefly lives the rich life he always dreamed of, but finds that his new wife will not let him work. Finally, he joins a friend who has built a laboratory in Vermont and happily returns to research.

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This anthology of "healing poems" is designed, according to the editors, "to find readers who might not usually read poetry." They say it should also be read "by those sitting in waiting rooms in surgeries and outpatients' clinics." These are definitely large tasks to expect this small collection of poems to accomplish, but in a different world (for example, a world in which people believed in the power of poetry to heal), this particular anthology would have a good shot at becoming a standard waiting room fixture.

The therapeutic intervention is well thought out. The editors have arranged the book into eight sections, each containing poems that exemplify a different theme, or situation, or style of treatment. The sections include: Admissions, Poems to Make You Feel Better, What It Feels Like, For Those We Love, The Language of Pain, Healing Rhythms, Body Parts, and Talking to the Dead. There is considerable overlap among these categories, because good poems speak several languages and can't be pinned down to a single feature. However, the classification does serve a heuristic purpose. It is another way to hook the reader, by choosing a topic he or she likes; once inside the covers, the reader may explore at will without regard to categories.

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J.J.’s parents are both deaf, so he grew up with Auslan (Australian sign language) as his native "tongue," although he is not deaf and speaks English perfectly. After a disastrous marriage, J.J. returns to live with his parents and to teach sign language at the Deaf Institute. Two students in his beginners’ class befriend him. They are Clive, an elderly man world renowned as a leader of the animal rights movement, and his much younger wife Stella, who is a poet. They soon present J.J. with a mysterious proposition: would he be willing to provide private lessons for their "step-daughter" at their home? We soon learn that their "step-daughter," Wish, is actually a young female gorilla, which they "rescued" from a research laboratory.

At first J.J. is reluctant because he is aware that the purported mastery of signing by non-human primates is not only controversial, but very limited, even if true. However, he discovers that Wish has remarkable cognitive abilities. She learns Auslan quickly and even begins to converse using metaphor and expressing complex topics.

Eventually her story is revealed. She had undergone fetal surgery to remove her adrenal glands, which evidently limit cortical growth in gorillas. Unconstrained by her adrenals (although receiving daily cortisone injections), Wish has developed intelligence far beyond that of other gorillas.

Nonetheless, she is still a sexually mature female gorilla. She falls in "love" with J.J. who, after initially rebuffing her, mates with her. J.J., by the way is quite obese, and so he is much more attractive to Wish than the other human males she encounters, who are all so un-gorilla-like. J.J. and Wish live in connubial bliss for a brief period, until Clive decides to prosecute J.J. for sexually abusing his gorilla, since presumably gorillas cannot give informed consent to sexual activity with humans. (Of course, Wish can and does, because of her super brain, but this concept is a bit too subtle for the frenzied media and the legal system.) After J.J. is arrested and she is removed to a local zoo, Wish becomes depressed and commits suicide. Clive drops the charges, after which the story lumbers to a generally unhappy ending.

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This is the house of Bedlam. So begins the strong poem by Elizabeth Bishop, the woman who wrote of that wretched old man who lived in the house of Bedlam. "This is the man / that lies in the house of Bedlam." So go the two lines of the following stanza of the 1950 poem about the cranky old man who was kept for his crimes in the house of Bedlam. "This is the time / of the tragic man" begins the three lines of the following stanza of the nursery rhyme poem by the consummate poet who wrote of "the Jew in a newspaper hat / that dances joyfully down the ward" and the brilliantly cruel and crazy man who lived in the house of Bedlam.

"This is the soldier home from the war. These are the years and the walls and the door." So starts the 12th and last stanza of the metrical rhyming repetitive poem by one of the finest American poets about Ezra Pound, an American poet, who found himself at the end of the war "walking the plank of a coffin board" and because of his treason becoming the man--the tragic, talkative, wretched and tedious man--who lived in the house of Bedlam. [79 lines]

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According to the Soviet version, in 1921 Russian scholars discovered the manuscript of a "lost" play by Chekhov among his papers in a safety deposit box in a bank in Moscow. In reality, the play wasn’t lost at all. During the turmoil of the Revolution in 1918, Maria Chekhov, Anton’s sister, had placed in the safety deposit box papers and manuscripts that she considered particularly valuable.

Subsequently, she was unable to travel to Moscow from her home in Yalta until 1921, because of the continuing Civil War in southern Russia. By the time she did return to Moscow, the Communists had "liberated" her brother’s safety deposit box and made their amazing discovery. The title page of the manuscript was missing, so scholars named the play "Platonov" after its major protagonist.

"Platonov" is a huge wreck of a play with numerous characters and subplots that would require about six hours to perform. It is obviously Chekhov’s earliest known play. The majority belief is that it was written between 1880 and 1882, during his first or second year of medical school. Most critics stress its many dramatic faults. However, as Michael Frayn points out in his introduction to "Wild Honey," the play is more remarkable for its strengths than its weaknesses, especially considering that a 21 or 22-year-old medical student wrote it. By carefully pruning the underbrush, Frayn has created a clearly Chekhovian comedy that takes perhaps two and a half hours to perform.

The story takes place in a provincial country estate (so what else is new?), where the widowed landowner returns for the summer after spending the winter months in Moscow. All the local friends and hangers-on gather to greet her, including among others two elderly suitors, the district doctor, and Platonov (the schoolteacher) and his wife. The widow wants to have an affair with Platonov--in fact, three women, one of them married, vie for Platonov’s attention; while Platonov, for the most part, tries to remain faithful to his wife.

The first scene of the second act is a classic comedy of errors. It takes place at night in the forest, just outside Platonov’s house where his wife is sleeping. Anna Petrovna, the landowner, appears out of the darkness and wants to spirit Platonov off to the summerhouse to make hay. But various other characters, some of them drunk and some sober, keep interrupting this rendezvous. One of them is Sofya, married to Platonov’s best friend, who wants to run away with him. The comings and goings in this scene are hilarious--reminiscent of one of Shakespeare’s comedies in which each character misinterprets what every other character says or does.

The play ends, though, on a dark note, or at least a sobering note. Platonov’s wife has left him due to these misunderstandings, and each of the three other women is closing in for the (metaphorical) kill. He decides to run away, and the play ends as he is running down the tracks distractedly, not paying any attention to the train that overtakes him from behind and kills him. This is not a tragic death; it’s funny, but also very sad. Platonov is, after all, a good man, even though weakness and indecision led to his downfall and meaningless death.

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This biography, first published in French in 1971, was written by a Soviet émigré living in Paris. She begins her introduction with a quotation from Chekhov, "Happiness and the joy of life do not lie in money, nor in love, but in truth" (1). She follows this statement with an observation of her own, "Chekhov makes no prognoses, never raises his voice, does not explain, insist, and above all, does not instruct. . .

He is the least Russian of the great Russian writers." To a large extent, her short biography is devoted to presenting a particular vision of Chekhov that might be called "compassionate objectivity." Although her subject may not have insisted or instructed his readers, Ms. Laffitte does. In fact, there is a hagiographic quality about this book that leads the reader to conclude that if Chekhov had been a believer, by now he would have been canonized as Blessed Anton of Moscow.

Ms. Laffitte proceeds in multiple short chapters. While they are generally in chronological sequence, each one also takes up an issue or theme in Chekhov’s life. She makes copious and skillful use of her subject’s letters and notebooks. She also devotes considerable attention to Chekhov’s medical career, unlike V. S. Pritchett, whose short biography entitled, Chekhov. A Spirit Set Free (1988, see annotation in this database) portrays medicine as more of a hobby than a serious enterprise for Chekhov.

Ms. Laffitte also has a habit of tying up loose ends without presenting much evidence for her point of view, or acknowledging that uncertainty exists. For example, when dealing with what she calls Chekhov’s "moral depression" of the mid-1890s, she concludes, "By a logical exertion of willpower, Chekhov was gradually to emerge from this moral depression" (168). It seems here that she considers depression--assuming this is the correct term to use in the first place--a weakness or failure of will, rather than a clinical disorder.

Nonetheless, this short literary biography (not out-of-print) provides much easier reading than most of the major Chekhov biographies that have appeared since it was published.

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