Summary:

Hilfiker describes a number of his own medical errors. He is concerned with the physical, emotional, social, and economic consequences of medical mistakes, all of which have grown as medicine's ability to cure disease has grown. Hilfiker contends that physicians are poorly equipped to cope with their own mistakes. The nature and practice of medicine are such that it is often possible to conceal mistakes from patients. Should they be concealed? Hilfiker says not. He implies that there are few (if any) circumstances which warrant deception.

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This short autobiographical account gives a flavor of American medical practice in the early part of the 20th century. It also sketches the medical "persona" and the human character of the author's father.

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In this chapter from late in his autobiography Williams focuses on his subjective experience in caring for patients. The unusual truthfulness of patients in need, their "coming to grips with the intimate conditions of their lives," inspires him both personally and artistically, as a poet. The things that patients reveal about themselves and about the human condition not only keep him going as a physician; they are the stuff of poetry, the human truths that lie beneath the "dialectical clouds" we construct to protect ourselves from contact in everyday life.

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The author provides a historical review of physicians who became famous practicing a profession other than medicine. Most of the article focuses on physician-writers, beginning with Francois Rabelais, and including both well-known and obscure figures. There are extensive comments on Louis-Ferdinand Celine, Gottfried Benn, Friedrich Wolf, Mikhail Bulgakov, Oliver Goldsmith, Anton P. Chekhov, Arthur Schnitzler, W. (William) Somerset Maugham, Sir Arthur Conan Doyle, Oliver Wendell Holmes, William Carlos Williams, among others. The most complete discussion (5 pages) is devoted to Sir Arthur Conan Doyle.

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At the age of 37, artist/photographer (and former model), Matuschka, was diagnosed with breast cancer. While her most famous response to the disease was her startling photograph on the cover of The New York Times Magazine revealing the results of mastectomy, her political activism surrounding breast cancer took many forms. (The photograph can be viewed at a Web site, Matuschka Archives )

Not only did she have a disease to confront, she felt she had the responsibility to "take on the establishment." She wrote, "My extensive research and understanding of how cancer works and how breast cancer therapies don’t--in addition to my medical nightmare with my doctor (I was first underdiagnosed, then overtreated)--I felt I had other messages to convey."

Thus, her essay describes her ongoing project: not hiding or concealing the condition, but becoming sexy and strong as a result; and reaching middle America with her images to promote breast cancer awareness, education, treatment, and prevention. Artistically and politically, she was determined to project images of women after surgery as whole people with a scar, not the decapitated torsos of medical illustration and other media that give "too much weight to the ’deformity’ that accompanies breast cancer surgery."

The essay chronicles the difficulties she had in finding sites for publication of her work, including her photo/biography, Beauty Out of Damage, and the continuing harsh criticism that she receives, much of it from "mastectomy women." In turn, she continues her harsh criticism against what she calls "backlash in the breast cancer movement," such as mixing political action with consumerism (e.g. Ralph Lauren’s "Target Breast Cancer" t-shirts that put targets on women), or mixing modeling with breast cancer activism (Cindy Crawford modeling the t-shirt rather than women who have had breast cancer modeling the shirt), among many other examples.

Her closing lines summarize the intent of her activism: "to inspire others to become involved in revolutionizing the medical profession, particularly in regard to women’s cancers. After seeing the film of my mastectomy operation, my only reply was, ’No one should ever have to go through this.’"

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The author, an internist and medical educator with a long-term interest in literature (she recently was awarded a Ph.D. in English literature), describes the literary exercise she uses to develop empathy in students taking her required course in medical interviewing. Charon has her students choose a difficult medical encounter from their own recent training and then write, using the first person, the story of that patient’s life in the day before the difficulty--including being treated by the medical student who is doing the writing. Because much of the story must be imagined, the writer’s intuition is automatically brought into play.

Because it is told from the patient’s point of view, the medical student is forced to see the patient whole and without reference to medical terms. Charon argues that this exercise of the imagination yields a combination of objectivity and empathy that forms the basis for good medical care. She also finds that the exercise helps medical students see themselves as their patients see them--and thus to understand, for instance, the effect on their patients of their youth and nervousness.

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Referring to Francis Bacon's 17th-century definition of modern science as the conquest of nature "for the relief of man's estate," Kass looks with concern at the ironic possibility that future advances in medical science and technology may lead to the significant diminishing of humankind. Thus he asks, what price will we wind up paying for medical progress? Kass is concerned about the disconnect between modern medicine, with its powers to extend our controls over life and death and over many human potentials, and, on the other hand, traditional social and individual values.

He argues particularly for serious consideration of values in three areas: (1) distributive justice (which for Kass is, finally, the question as to who shall do the distributing), (2) the "use and abuse of power" (in which he focuses on the process by which power over nature becomes turned into power of some humans over others), and (3) "voluntary self-degradation and dehumanization" (two major concerns being the concept of the optimum baby and the development of technologies of pleasure).

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Seeking redemption in the bloody business of surgery, Selzer's narrator tells several medical stories that humbled his surgeon's pride and refers approvingly to an atheist priest in a story by Unamuno who carried on for the sake of his congregation because "their need is greater than his sacrifice." Selzer finally tells us that it is in writing, if anywhere, that the elusive soul can be represented.

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The Exact Location of the Soul is a collection of 26 essays along with an introduction titled "The Making of a Doctor/Writer." Most of these essays are reprinted from Selzer's earlier books (especially Mortal Lessons and Letters to a Young Doctor). Six pieces are new and include a commentary on the problem of AIDS in Haiti ("A Mask on the Face of Death"), musings on organ donation ("Brain Death: A Hesitation"), a conversation between a mother and son ("Of Nazareth and New Haven"), and the suicide of a college student ("Phantom Vision").

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This essay provides a rich and detailed critique of the medical view of women in 19th-century America. As the keywords suggest, the authors cover many topics. To mention a few: the coming of male dominance in medicine; the patronizing and disabling characterization of women as "weak, dependent, diseased," and naturally patients; S. (Silas) Weir Mitchell and his treatment of Charlotte Perkins Gilman; the social role of female invalidism in upper middle class culture; the "scientific" view of woman as evolutionarily devolved; and what the authors call "the expert-woman relationship."

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