Summary:

This is a selection from "The Call of Stories" in which Robert Coles argues for a medical ethics rooted in particular lives and particular situations, rather than (or to supplement) the ethics of abstract rules and principles. He tells the tale of an "uppidy nigger" in Clarksdale, Mississippi, in 1967 who took issue with her clinic doctor because he was insulting and condescending toward his patients: "I told him I expected more of him. Isn’t he a doctor? If he can lord it over people, being a doctor, then he ought to remember how our Lord, Jesus Christ behaved . . . did He go around showing how big and important He was . . . ?"

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Daniel Raeburn tells the story of watching the birth of his infant daughter Irene who had died in utero three days before and the weeks and months following the event, spent at the intersection of immense grieving, trying to understand why, and attempting to live in a world without his daughter.

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Fowles, and many other well-known Anglo-American writers in this collection, provide marvelous personal rationales for reading: what it has meant in their lives, and most important for our discussion, how reading can work against the "atrophy of the imagination" brought on by this century’s fervor for electronic media.

This essay can be used early in Literature and Medicine courses to discuss the very different experiences of reading fiction and nonfiction, to show how their aims are opposed in many ways. According to Fowles, this includes: "learning to dream awake, against learning to absorb hard facts; almost, to be subjective, to learn to feel, to be oneself--or to be objective, become what society expects . . . . Talking about reading [fiction] is like talking about flight in a world rapidly becoming flightless; like raving about music to the deaf, or about painting to the color-blind."

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The subtitle of this photographic essay is "The Story of a Country Doctor." Berger and Mohr give the reader an imaginative portrait of Dr. John Sassall, an English general practitioner who lives and practices in a remote rural community. The book begins with several stories of Sassall’s work with patients, gradually introducing the man himself and revealing his thoughts about his profession, his life, and the nature of healing.

Berger explores what people in the community think about this unusual doctor who has given up his chance to "get ahead" in the world in order to remain with them. They are sure he is a "good doctor," but what does that mean? How does one judge "goodness" in a physician? Berger comments in an impressionistic way on the nature of Sassall’s relationships with patients--a complex mixture of authority, fraternity, and intimacy.

The latter part of the essay expands its focus to the community as a whole and the nature of contemporary medicine. Throughout the book, Jean Mohr’s photographs serve as indispensable features of the story.

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Shortly after the American Civil War, neurologist S. (Silas) Weir Mitchell became interested in a certain group of women, whom he describes as "of a class well known to every physician,--nervous women, who, as a rule, are thin and lack blood." Mitchell’s basic premise was that these women, largely between the ages of 20 and 30, have lost their vitality as a result of some form of prolonged strain--which has caused them to become thin, of insufficient blood, and unable to perform their regular duties.

In his long essay, essentially a compilation of case studies, he further characterizes these patients and outlines the treatment which he found to be unfailingly successful in returning them to normal activity. The treatment he utilized had the following essentials: seclusion and rest; massage; electric stimulation, a high-fat and high-calorie diet. His patients were not allowed to see their families, nor to read, write or otherwise strain themselves. The average duration of therapy was six weeks, usually carried out in an institution or private retreat.

Of interest is the single male who Mitchell felt met the criteria for his treatment plan. This patient, who had some (to the modern reader) lung findings suggestive of tuberculosis, allegedly was cured after three months of bed rest and frequent feedings.

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Atul Gawande, a surgical resident at Harvard Medical School, asks in his well written essay, "when you see your patient making a grave mistake, should you simply do what the patient wants?" (p. 86) He answers this question by sharing a number of cases from his training that suggest that the orthodoxy of 'absolute respect for patient autonomy' may interfere with good patient care.

Gawande also gives the reader insight into the difficulties that young residents especially have in developing an artful approach to medical practice. He suggests that part of respecting autonomy is (at appropriate times) allowing patients to cede that autonomy to an authority figure. He argues further that, "patients frequently don't want the freedom that we've given them." (p. 89)

He also shares in his essay a personal experience with his youngest child. She was a premature baby who at eleven days old ended up in the intensive care unit. He was glad to put the ultimate decision(s) of how to care for his daughter in the hands of physicians--"they could live with the consequences, good or bad." (p. 90)

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The italicized sentence under the title of this New Yorker essay summarizes it well: "Wanted: Highly accomplished young women willing to undergo risky, painful medical procedure for very large sums." Mead traces the phenomenon of women selling their eggs through the experience of Cindy Schiller, a 26-year-old law student who was "donating" her eggs for the third time.

In addition to Schiller's observations, the article is full of information about the clinical dimensions of egg donation--the donor shuts down her ovaries so that none of her eggs ripen and none of her follicles develop, followed by injections of follicle-stimulating hormones, followed by eggs that are "sucked out, one by one," and whisked away to be fertilized in a petri dish. Most of the article addresses the legal and ethical dimensions of egg donation, the hopes and expectations of those seeking donors, and the new-found marketing strategies of the American fertility industry.

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Subtitled "What happens when patients find out how good their doctors really are," this article starts with an important statement: "Every illness is a story, and Annie Page's began with the kinds of small unexceptional details that mean nothing until seen in hindsight."

This is the introduction to a look at a child with cystic fibrosis and how her family sought the best care for her.

The author, Dr. Atul Gawande, goes on not only to tell their story but also the story of the way in which the understanding of this disorder has increased and the unusual rigor with which centers that specialize in the disease are evaluated.

He also includes stories of other sufferers to emphasize the importance of surveillance of their care.

These stories allow him to generalize about the way physicians' care is evaluated in general by the public and our medical organizations and how difficult it is to be at the high end of the Bell Curve. The author concludes, "When the stakes are our lives and the lives of our children, we expect averageness to be resisted."

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Fifty-two year old Pete, the hospital mailman, suddenly experiences severe abdominal pain. He is evaluated and treated in the emergency room. His diagnosis is acute surgical abdomen, but the exact cause of his pain is still unknown. The surgeon-narrator determines that the severity of Pete's condition mandates exploratory surgery. During the operation, "an old enemy" (18) is encountered--pancreatitis.

Afterwards, the surgeon assures Pete that he will get better. One week later though, the mailman dies. His death has been painful. An autopsy is scheduled, but the surgeon deliberately arrives 20 minutes late. He does not want to view the intact body of his deceased patient. No matter, the pathologist has waited for him to arrive before beginning the post-mortem examination. The pathologist closes Pete's eyelids before starting the autopsy, mindful of how the mailman's "blue eyes used to twinkle" (21) when he delivered the mail everyday.

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Summary:

Selzer tells four stories of surgical loss: a surprise loss on the operating table, the drowning of a sick child in a flood in wartime Korea, the sudden death of a professor due to a perforated ulcer, and the loss of some facial mobility in a young woman following the removal of a tumor in her cheek. As we move from one vignette to the next, the narrator's mood goes from despair to accepting to redeemed, with various forms of love the agent.

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