Summary:

In 1877, the widowed Sarah Bell writes to the New York Children’s Aid Society to explain that poverty has driven her to leave her daughter Lily May in its care. Mr Bassett writes to the same office that he and his wife would like to adopt a little girl. They are given Lily May and change the baby’s name to Mabel.

Over the years, Sarah keeps writing to ask for news of her child; when she remarries she begs to have her daughter back. With evident alarm, the Bassetts tell of the good care they have given the girl; they love her and will not relinquish her. Lily/Mabel has no idea that she is adopted and will never be told.

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This book describes San Francisco’s Laguna Honda Hospital, where Victoria Sweet worked as a doctor for 20 years. In the tradition of the Hôtel-Dieu in Paris (literally “God’s Hotel”), Laguna Honda cares for the sickest and poorest patients, many staying there indefinitely because there is no alternative for them. Sweet learns from her long experience at Laguna Honda that “Slow Medicine” has benefits, that a holistic or unified view of patients works best, and that the reductionism and specialization of modern medicine has limitations and costs. During these years Sweet becomes fascinated by the medieval abbess Hildegard of Bingen and earns a Ph.D. focusing on medieval medicine. At the same time (and increasingly) various forces—economic, legal, political, bureaucratic—cause many changes at Laguna Honda, mostly contrary to Sweet’s vision of medicine.

            Part history, part memoir, part social criticism, the book is informative, entertaining, and important for its discussion of the care of our least-well-off citizens and for its perspectives on modern, Western medicine.         

            There are three intertwining strands to this engaging book: Sweet’s medical evolution as a physician, the changes in Laguna Honda, and her investigations of Hildegard of Bingen and other spiritual matters.

            Sweet joins up with Laguna Honda initially for only two months, but she finds the hospital and her work there so fascinating that she stays for 20 years. As an almshouse, Laguna Honda takes care of indigent patients, most with complicated medical conditions, including mental illness and dependencies on alcohol and/or drugs. Many of these cases come from the County Hospital with continuing (but not carefully reviewed) drug treatments. Every 15 or 20 pages, Sweet describes the dilemmas of a particular patient, and her medical (and personal) attention to that patient. The cases are vivid and instructive.

   Clearly Laguna Honda is a major figure on the book; we can even consider it (or “her”) a beloved character and a teacher to the young Dr. Sweet, who learns three principles from her work there: hospitality, community, and charity. 

Because Laguna Honda is old-fashioned in many ways, Sweet reads her own X-rays, goes the to lab to see results, and spends large amounts of time with each patient. Laguna Honda has an aviary, a farm with barnyard, and a solarium; such features help to heal the whole person. While respectful of modern medicine, Sweet slowly learns that a careful review of a patient through Slow Medicine is more accurate and more cost-efficient than standard, reductionist, high-tech medicine. She comes to respect approaches from “premodern” medicine, including that of Hippocrates and Hildegard.

  The second strand is the evolution of Laguna Honda itself. Sweet describes a variety of pressures: the recommendations of consulting firms, rulings from the Department of Justice, a lawsuit, financial difficulties (including fiscal mismanagement), administrators focused on a narrow concept of efficiency, a utilization review board, forms and more forms, and a pervasive sense that modern (including Evidence Based Medicine) is always good. All these and more create a “relentless pressure squeezing the hospital’s Old Medicine into the New Health Care” (p. 322). Sweet demonstrates that her Slow Medicine can actually save money in the long run. Confident that her way is better, she proposes an “ecomedicine unit” that she would match against the modern, “efficient” units in a two-year experiment. (For more information on her concept of ecomedicine proposal, see http://www.victoriasweet.com/.)

            As the hospital is “modernized,” many important features of the old place are gone and many “new and improved” aspects don’t work. Somehow there are no rooms for physicians in the new building while there is plenty of space for administrators and managers. A sophisticated computer system doesn’t work. Sweet doesn’t say “I told you so” directly, but we get the picture.

            The third strand is Sweet’s investigations of spirituality and pilgrimage. She is fascinated by Hildegard’s notions of the healing power of nature, the ability of the body to heal itself, and wholeness as an aim for a person and for a community. Sweet attends a Swiss conference on Hildegard. She hikes the pilgrimage route from France to Santiago de Compostela in four installments and considers notions of pilgrimage. She feels called to pursue her ecomedicine project and to write this book.           

            By the end of the book, both Sweet and Laguna Honda have changed and are now headed in different directions. 

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When Lia Lee's sister slammed the front door to their Merced, California, apartment, Lia experienced her first in several years of increasingly severe seizures. The Lee family knew that the noise had awakened a dab, an evil spirit who stole Lia's soul. They also knew, in the midst of their grief for their infant daughter, that people suffering from "the spirit catches you and you fall down" often grew up to be healers in their Hmong culture.

Not surprisingly, the physicians and other health professionals who worked with Lia and her parents over the next seven-plus years did not share this diagnosis--most of them did not even know about it. Fadiman melds her story of Lia, the Lees, the family's physicians and social workers, and countless other people who enter the Lees' life (usually uninvited and unwelcome) with the long history of the Hmong people, their religion and culture, and their more recent lives as refugees from war in Laos and Cambodia (and the troubled history of their relationship to the U.S. military system).

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Tora lived happily on a mountain farm in Norway until her beloved mother's death  and her own subsequent diagnosis with leprosy, an illness common in early 19^th-century Norway and one that drove her mother to suicide.  Upon diagnosis (at the age of 13) she is taken to the leprosarium in Bergen, from which very few emerge.  Most are left there by families whose fear of the disease leads them to abandon even much-loved children, parents, and spouses.  There, despite the misery of living among many who consider themselves the living dead, she finds a friend in Marthe, the chief cook and general caregiver, a woman of almost boundless kindness; and the "Benefactor," a pastor who is remarkably unafraid of the disease from which most flee, and who befriends Tora as she grows into an unpromising early adulthood.  Another unlikely friend is a noblewoman who has languished, embittered, behind a closed door with a trunk full of her old gowns and several cherished books, including the Bible, The Divine Comedy, Gulliver's Travels, and a popular Norwegian epic about the adventures of Niels Klim at the center of the earth.  She gradually softens toward Tora, who cares for her tenderly as the older woman teaches her to read.  Reading becomes not only Tora's consolation, but that of many of her fellow inmates.  Near the end of her own short, but surprisingly rich life, Tora's father shows up after years of neglect.  Forgiving him, almost against her will, she reaches a new level of acceptance of her own mysterious fate.  The book includes a short afterword about the actual leprosarium in which the story is situated and about Gerhard Armauer Hansen who in 1873 discovered the bacillus responsible for leprosy, the first bacterium proved to be the cause of a chronic human disease.

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In this collection of "clinical tales," to use Oliver Sacks' term, Sue Hall, an experienced neonatologist who spent some years as a social worker before medical school, tells a remarkable range of stories about newborns in the NICU and their parents.  As memoir, the stories record moments in a life full of other people's traumas, disappointments, anxieties, and hard-won triumphs where her job has been to hold steady, find a balance point between professionalism and empathy as young parents go through one of the hardest kinds of loss.  Each story is told with clarity and grace, sketching the characters deftly and offering useful medical information along the way on the assumption that many who read the book will do so because they are facing similar challenges and decisions.  Each story is followed by a two- to three-page "Note" giving more precise medical background and offering further resources for those who have particular interest in the kind of case it was. 

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This powerful collection by nurse-poet Jeanne Bryner addresses several themes.  She tells very difficult child abuse stories in the voices of children and health care professionals.  Nursing stories emerge from experiences on the surgical floor, in the ICU, labor and delivery, ER, etc.  In one poem nurses take a political stand for healthcare reform; in another the nurse helps a patient die; in another she listens to a patient describe how he endured the colonoscopy prep in his bathroom, then took his shotgun and blasted the plastic jug "to Kingdom Come.  That, he said, felt like justice." A whole section of the collection is devoted to writing workshops the nurse-poet led with cancer survivors, assisted living residents, former patients.

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Open Wound is a novel crafted from the extensive documents of an unsettling, little-known, yet remarkable episode in the history of medicine.

In the summer of 1822, Dr. William Beaumont was practicing medicine at a rugged military outpost on Mackinac Island in Lake Huron, part of the Michigan territory.  His assignment as Assistant Surgeon, US Army represented about the best circumstances he could expect from his training as a medical apprentice without a university education.  In addition to soldiers and officers, Beaumont sometimes attended patients from the American Fur Company, whose warehouses shared the island's harbor.  On June 6, an accidentally discharged gunshot cratered the abdomen of an indentured, French-speaking Canadian trapper.  Fortunately for him, Beaumont served during the War of 1812 and knew how to care for devastating wounds.   With the surgeon's medical attention and willingness to house and feed the hapless trapper, Alexis St. Martin's body unexpectedly survived the assault.  But his wound didn't fully heal.  As a result, it left an opening in his flesh and ribs that allowed access to his damaged stomach.  Through the fistula, Beaumont dangled bits of food, collected "gastric liquor," and made unprecedented observations about the process of digestion.  

His clever and meticulously documented experiments, conducted on the captive St. Martin over several years, corrected prevailing assumptions about digestion.  Once thought to depend on grinding and putrification, normal digestion, Beaumont observed, was a healthy chemical process.  Any signs of putrification or fermentation indicated pathology.  In 1833 Beaumont published his thesis on the chemistry of digestion in Experiments and Observations of the Gastric Juice and the Physiology of Digestion.  Shortly before completing the book, he received a temporary leave from his military service to restart his research in Washington.  But to carry on his project, Beaumont had to persuade St. Martin-who entered and exited his physician-researcher's life several times before-to leave his growing family in Canada and once again become a research subject.  St. Martin does return, with pay, and briefly accepts his role.  But he also confronts Beaumont about whether the long confinement on Mackinac Island was more necessary for the patient's survival or the doctor's research agenda.  Or for the doctor's subsequently improved station in life. 

Although some of Beaumont's academically trained colleagues found fault with his methodologies, the farmer's son and frontier doctor did achieve a gratifying level of professional accomplishment and wealth.  To enjoy them, he had to set aside humiliations he experienced along the way, accept his lot after military service as an ordinary practitioner in St. Louis,  and weather an unforeseen turn near the end of life.    

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Painted while Neel was enrolled in the Works Progress Administration--a New Deal program to help the unemployed-- the work depicts a scene with which the artist was probably familiar, being herself impoverished at the time. The setting is a room at The Russell Sage Foundation, established by Margaret Olivia Sage in 1907 for "'the improvement of social and living conditions in the United States.' In its early years the Foundation undertook major projects in low-income housing, urban planning, social work, and labor reform" (quote from http://www.russellsage.org/about) .

At the painting's rear center sits an elderly (gray haired) woman facing sideways, dressed all in black, head buried in her hands. From her clothing and affect, she is probably a widow. She is seated in front of a small table around which, in a semicircle, sit her interrogators - nine men and two women. They all face her. One of the women seems to be interviewing her while the other people listen with varying expressions on their faces, ranging from thoughtful to impassive. The men are all wearing suits and ties except for one (possibly two), with clerical collar. The women, including the elderly lady under investigation, all wear hats. All are white, with the possible exception of a clergyman, who may be a light skinned black. To the right foreground of the painting sit two men, facing sideways, who appear to be waiting to be questioned. The man closest to the viewer is elderly, with a white mustache, apparently Latino since his skin color is light brown; he is wearing a suit and tie and holds two bananas in his hand. The expression on his face is one of worry and fatigue. To the left foreground, with his back to the viewer, a man sits leaning forward, apparently one of the questioners.

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This documentary is a film biography of American artist, Alice Neel (1900-1984), directed by her grandson, Andrew Neel. The film utilizes interviews with art historians; comments and interviews by Alice Neel herself; comments by her two sons and other family members; interviews with some of those that the artist painted; still photographs and other archival materials; and most spectacularly, displays of many Neel paintings. There are annotations of several important Neel paintings in this database. This film or sections of it would make a good accompaniment to discussions of those works.

Neel was a complex person and the film pays attention to this complexity. She lived what was considered to be a "bohemian" life, not following social conventions of the times and determined to pursue her art. There was early tragedy: marriage to a Cuban artist eventually disintegrated but produced two girl children, one of whom died as a baby and another who was kept in Cuba by the father and his family. These events were catastrophic for Neel and resulted in psychiatric hospitalization. For many years her life was one of poverty. In the 1930s she was funded to paint by the Works Progress Administration and later survived on welfare in Spanish Harlem while raising two sons born "out of wedlock". There she painted neighbors, and others who lived in that community. During the McCarthy era in the 1950s she was under investigation by the FBI for her occasional association with the Communist Party. She struggled to have her work recognized: although her paintings date back to the 1920s, it was not until 1974 that a retrospective exhibit of her art was presented by an important museum, the Whitney Museum of American Art. By that time she was painting portraits of well known individuals like Andy Warhol.

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A nurse clothed in white and holding a baby stands in the center of a hospital ward. Surrounding her sit adults colored brown and grey. Naked babies lie mostly unattended on white beds. Most of the newborns share the same posture--their arms are splayed and their legs are raised towards the ceiling. A handful of adults in the room attend to the children. Their blurred faces and pallid coloring assign them a baleful monstrousness.

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