Summary:

Amelia Stern is an academic pediatrician in a large city hospital and mother of a bright, young son. She is deeply involved with her patients, including Darren, born with AIDS, and Sara, the malnourished child of anxious parents, both lawyers. As she struggles to answer to the demands of her work for "other women’s children," she neglects her own child and her marriage begins to fall apart. Her husband’s resentment and her own feelings of guilt come to a crisis when her son falls seriously ill while she is at the hospital.

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Middlemarch is a middle-sized country town typical of rural British life in the early nineteenth century. George Eliot (born Mary Ann Evans) was part of the realist school that dominated Victorian literature. She tried to create a true representation of the real, historical lives of ordinary people.

The novel has a vast number of characters and events but most of the plot centers on two couples: Dorothea and Casaubon (later Will Ladislaw) and Rosamond and Lydgate. Dorothea is an intelligent, vigorous woman, eager to improve the lives of her friends and the poor. She is determined not to marry any of the local, mindless squires but to devote herself to godly work.

Soon, however, she is introduced to Casaubon. Casaubon is an aging, ugly scholar, but Dorothea is attracted by his learning and agrees to marry him in hopes of helping him in his work. Their marriage is unhappy and cold. It is contrasted to Dorothea’s growing relationship with Will Ladislaw, a distant relative of Casaubon. Where Casaubon is cold, Will is passionate. Casaubon senses the kinship between his wife and Will and adds a codicil to his will insisting that if Dorothea and Will marry after his death than Dorothea must give up Casaubon’s house and money.

Shortly thereafter, Casaubon does die, and Dorothea is outraged upon hearing of the codicil. She does not recognize her feelings towards Will as feelings of love. By the end of the novel, however, the two confess their feelings and Dorothea gives up her earthly possesssions to live happily.

The plot developed around Lydgate and Rosamond is of particular medical interest. Lydgate is a new kind of medical practitioner. At the beginning of the nineteenth century, the traditional medical order, consisting of physicians (like modern consultants), surgeons, and apothecaries, was being replaced. New well-schooled general practitioners could perform all these functions.

When Lydgate arrives in Middlemarch with his modern techniques and visions of building a modern hospital for the poor, the medical establishment greet him with jealousy and suspicion. Lydgate’s practice therefore develops very slowly. His marriage to Rosamond, a woman used to a rich lifestyle, quickly depletes his savings.

Facing bankruptcy and the loss of his disappointed wife, Lydgate receives an unexpected loan from Bulstrode, a wealthy landowner. Soon after, Bulstrode is charged with murder and Lydgate is accused of having a hand in it; Middlemarch sees the loan as a payoff. Disgraced, Lydgate cannot fight back. He becomes a doctor who toadies to the wealthy and abandons his revolutionary dreams. He dies at 50.

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This little novel is the retrospective tale of a childhood event told by the protagonist 40 years later. Family relationships and bonds in conflict with professional and community obligations vie with the shadow of racism and sexual abuse in the doctor/patient relationship for the core tensions in the book. The setting is a small rural community where the pioneer family about which the tale evolves controls the law and the medicine. The boy narrator relates his view of the breakdown of family as its secret--a physician uncle who is suspected of sexually abusing his native-American women patients--becomes a force that demands action from the doctor’s brother who serves as the sheriff.

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Summary:

This strange little tale, set in western Europe, revolves around the shifting relationships among an Irish doctor, a would-be Austrian baron, a circus performer, and the American woman, Robin, who is to become the nemesis of them all. The plot is unfolded in a long series of conversations, many convoluted by their stream-of-consciousness style, rather than in observed action.

The physician (it is never clearly stated that he is a fully trained physician but the point is probably moot, since he assumes the role), the most consistently present and verbal character, is a study in contradictions. He is essentially never portrayed in a classic physician role, but much is made of his profession. This may be explained by the fact that it is his profession that justifies his central position--he knows and is in the confidence of all other characters. The reader follows, by means of the long and complex dialogues, Robin’s systematic destruction of a chain of male and female lovers in what appears to be an obsessive desire for self-destruction.

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In this sequel to his earlier seem-autobiographical novel, House of God, Shem (this time using both his pseudonym and his real name) describes the experience of a physician in the first year of a psychiatry residency in a prestigious private psychiatric hospital. In this first hand account it is assumed that the author is the resident, Dr. Roy Basch; he describes not only his experiences with a variety of patients but also with the other doctors and the staff members of the institution. It is not a happy place and in the telling of the story there is a biting irony and a sense of the absurd.

It is obvious from the first that Dr. Basch is very serious about becoming a psychiatrist but that he is also searching for meaning and connections. He finds that colleagues may often hurt you more than your patients. Another issue addressed is that of competing psychiatric theories, particularly the competition between pharmacologic treatment and psychoanalysis. Issues about drug treatment trials and the questionable way in which they are conducted also receive attention, as does the problem of insurance coverage for hospitalization.

The fact that psychiatrists often specialize in their own defects becomes a reality to Dr. Basch. There are not many exemplary people in this book--hopefully it exaggerates the real situation. There is, surprisingly, a sort of poignant positive ending.

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In March, 1981, in Vermont, Charlotte Bedford goes into labor. She has decided to give birth at home with the help of a midwife, Sybil Danforth, but complications develop. Charlotte has a seizure, her heart stops, and she does not respond to CPR. The fetus is still alive, so Sybil delivers him successfully by Cesarean section, with a kitchen knife. But the bleeding when Sybil makes the incision convinces her assistant that the patient’s heart was still beating. She reports this to the police and Sybil is put on trial for involuntary manslaughter.

The story of the trial is told by Sybil’s daughter, Connie, fourteen years old at the time and now an obstetrician-gynecologist. The acquittal comes at a price: the midwife finds herself no longer capable of delivering babies, and both she and her daughter are given a new insight into the uncertainty which underlies so many of medical decisions. At the end of the novel we are left uncertain whether or not Charlotte was still alive when her baby was delivered.

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An Australian man has recently been diagnosed as having a fatal disease. He decides to take a quixotic trip to Europe, an open-ended adventure to unplanned destinations. This novel takes the form of 20 long and extraordinarily articulate letters written from Venice to an anonymous correspondent in Melbourne.

The letters work on three levels. First, they describe the writer’s travels from Locarno to Vicenza to Padua, stages of his journey prior to arriving in Venice. In fact, the book is divided into groups of letters, each of them dealing with one of the three cities and followed by a set of notes that illuminate some of the writer’s literary and historical allusions.

Second, the letters describe the writer’s current activities in Venice and especially his reflections on human nature and mortality. Finally, he refers back to events that occurred in Melbourne immediately preceding his journey. The most important of these events are the consultations with his doctor and, to a lesser extent, the reaction of Peter, his lover, to the lethal diagnosis.

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After working with the Parisian physiologist, François Magendie, Dr. John Leggate returns to England to practice in the town of Middlethorpe in the late 1840s. He is obsessed with making a research discovery that will help humanity and establish his name. He falls in love with the intelligent and gifted Marian Brooks who aspires to a career as a concert pianist after study in Leipzig with Felix Mendelsohn. They marry and find happiness at first, but she is troubled by discovery of his past affair in France, and he is troubled by her abandoning music simply to be the type of wife he never wanted.

Leggate has a theory about the origins of cholera, but his painstaking work shows him two things: 1. his original idea is mistaken, and 2. the disease is spread by water. He does not publish, though he announces his intentions to do so. Intimidated by skeptical colleagues, he is unable to write, and the problem is exacerbated by a newspapermen who makes unwarranted accusations because he holds a grudge against Leggate’s wife.

Marian wants to help him, but he rejects her offers and retreats into himself. Their marriage is threatened. Just as cholera returns and the town learns from Leggate’s insights, John Snow publishes his famous observations on cholera. Leggate is scooped. He and Marian migrate to Canada where he is accepted for his skills and desire to be of service and she establishes a conservatory of music. Their marriage is restored.

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Hans Castorp makes a visit to the International Sanitarium Berghof in the Swiss Alps to rest and visit his cousin, Joachim Ziemssen. There he meets other patients from around Europe, all with different opinions about life and its meaning. Before his three week visit is up, Hans develops tuberculosis and ends up staying seven years. He leaves only when the Sanitarium gets news of the assassination of the Archduke that will begin World War One.

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This is a harrowing story, told in the first person, of an obsession with food and body image. "One day I will be thin enough", says Josie, the 25 year old anorectic woman who has been hospitalized for life-threatening self-starvation. "Just the bones, . . . the pure, clear shape of me." "One day I will be pure consciousness." The narration spins out in painful detail the pattern of compulsive behavior which pervades Josie’s existence. Her pitifully barren emotional life is revealed as well.

How did it all begin? Flashbacks of significant events invade Josie’s attempts to stop thinking. A shy, awkward adolescent, overly sensitive to casual comments about excess flesh, decides to diet. Josie stumbles non-communicatively through a teen-age sexual initiation to a later affair with her married professor, retreating ever further from her bewildered family.

But why do events take such an extreme turn? The mystery of anorexia nervosa remains. In the hospital, a nurse who has seen everything seems to strike some responsive cord, and Josie begins eating to gain weight. At the end of the novel she’ll soon be released , under supervision, but the outcome is in doubt. "Can I learn to be so present? Can I learn to be so full?" ". . . if I were a body, what would I be?"

 

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