Summary:

This short story begins with a summary of the tale of Guillermo Blake, who believed that "the five senses obstruct or deform the apprehension of reality." The narrator then relates the tale to his own experience: upon visiting his gerontologist for a check-up, he is informed of a procedure that confers immortality. The "immortals" are reduced to living brains within wooden cubes, their bodies having been replaced by "formica, steel, plastics." The narrator tries not to show his horror, but moves immediately to a different part of the country under an alias.

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In "Fortitude" Dr. Elbert Little, a Vermont family physician, visits the laboratory of Dr. Frankenstein and his trusty assistant, Dr. Tom Swift. Frankenstein has only one patient, Sylvia Lovejoy. His life work has been to keep Lovejoy alive. In 78 operations over the last 36 years, Frankenstein has replaced every one of her organs with prosthetic devices, so that now she consists of a head on a tripod, attached by tubes to various machines.

Frankenstein controls her mood, as he controls all her functions, from a "fantastically complicated" master console. Usually he makes sure that she feels joyful and loving, but last month a transistor went bad in one of the machines and she felt depressed for a while; so depressed, in fact, that she wrote to Dr. Little and asked him to bring her some cyanide.

Lovejoy's only friend is Gloria, the beautician who comes every day to care for her hair. Gloria is horrified over what Sylvia Lovejoy has become; she sees only a "spark" of the real person remaining, but she knows that the "spark" wants to die. After Frankenstein fires Gloria for speaking about death in Sylvia's presence, she sneaks back into the room when Sylvia is sleeping and puts a loaded revolver in her knitting bag.

Later, Sylvia finds the gun and tries to kill herself, but her prosthetic arms have been designed not to allow her to do that. Instead, she shoots Frankenstein, who promptly becomes the second head attached to the machines. (It seems he has designed all the prosthetic organs to be able to serve two "persons," so that he and Sylvia will be able to "live in such perfect harmony . . . that the gods themselves will tear out their hair in envy!")

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Spencer Nadler, a surgical pathologist for over 25 years in southern California, offers 8 essays, as well as an introduction, epilogue and 9 full color histopathology plates in this collection. As he explains in the introduction, Nadler began his training in surgery, but, during a required year of surgical pathology, he finds his true vocation: "I realized a flair for surgical pathology that I had never demonstrated in surgery." (p. xix) However, over the years, he realizes he misses patient contact--these essays, written over 10 years, are forays into an unusual relationship: the pathologist-patient relationship.

Each essay is about a different patient (or other contact) and tissue. One of the most compelling is the first, "Working Through the Images," in which a woman (Hanna Baylan) with metastatic breast cancer seeks Nadler out so that she may view her cancer cells. She arrives in his office unannounced at 6 p.m. and he proceeds to not only show her the slides, but to listen to her. He becomes a witness to her pain, loneliness, sorrow and hope.

"For years I have processed thousands of such cases, determined the manifold forms of disease, but I've never been an intimate part of anyone's illness, never felt the connections of cells to a larger self." (p. 12) During later visits, Baylan cries in his arms and even brings her youngest son in to meet Nadler and view her cells. By this time, Nadler is completely connected to her: "This is heartrending to me, for I have come to love her . . . I can no longer think of Hanna in terms of the cells I see on her slides." (p. 21)

Other chapters highlight fat and bariatric surgery; neurologic disorders such as brain tumor, Parkinson's, Alzheimer's and paraplegia; heart disease; sickle cell disease; and palliative care. Each chapter conveys Nadler's visual sophistication and ability to graphically describe cells. For instance, within a fat cell "a large fat globule steamrolls other cell contents flat against the outer membrane until it bulges like a mozzarella." (p. 32) More importantly, Nadler ably extends his cellular acuity to the larger human dimension.

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Paula Henning (Franka Potente) is a brilliant medical student from Munich, who comes second in the Robert Koch competition winning a place at the prestigious Heidelberg medical school. Medicine is a family tradition, but Paula has little respect for her father's boring suburban practice. Instead, she takes inspiration from her dying grandfather, an academic doctor, who celebrates her decision.

En route to Heidelberg she meets the stunningly beautiful and highly sexed Gretchen (who stood first in the competition) and David, a 22 year-old lad with cardiomyopathy and multiple piercings. Gretchen is interested in partying; Paula is serious, studies all the time, and ignores fellow student Caspar (Sebastian Blumberg) who strives for her attention. When David appears on the dissecting table with no obvious cause of death and "rubbery blood," Paula begins investigating. She determines his death is due to Promidal--a drug developed by The Anti-Hippocratic Society (or "AAA!").

This clandestine group engages in unethical anatomical research on living subjects to "better" the human race. Her classmates scorn her conspiracy theory, but she is drawn deeper into the mystery when Gretchen disappears only to reappear as a perfectly dissected, plasticized cadaver. Paula nearly succumbs to the same fate with her lover, Caspar (who turns out to be an incognito history student writing his thesis on the AAA! ). The ending is happy, although Paula must reckon with the discovery that her venerated grandfather was a member of the "AAA!".

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The first poem in this chapbook ("Sonogram") contains two images of a small, mysterious life (the fetus imagined as a "white boat on whiter water" and as a "tiny orca") in the midst of the coldly technical medical world. This juxtaposition is characteristic of B. A. St. Andrews's poems in this small collection. In most of them, she uses disciplined and sparkling language to explore the interface between modern medicine with its impersonal machinery and the irreducible mystery of life.

Some of the images are simply breathtaking. For example, in "A Dying Art: Room 309," a terminally ill artist lies in bed, surrounded by "plastic bags that hang / like udders dripping pigment / into her." In a love poem called "The Body of Science," the poet confesses, "Each time your voluntary / muscles make contact / my involuntary ones / contract." And at the end of "Alzheimer's," she observes, "She stood at the big bay / window screaming but he never / heard what it was she never said."

The four poems entitled "Your Breast a Unicorn" consider the fate of breasts attacked "at consolation's center" by "one aberrant cell metastasized." These learned, wise, and witty poems are, in my opinion, among the very best of the breast cancer genre.

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Two metaphors permeate this poem about drinking a barium containing liquid prior to fluoroscopy to determine cancer growth and staging. The first metaphor involves the liquid as alcohol and the radiology suite as a rather perverse bar. Hence the patient drinks the proffered liquid which "froths and hisses like volcanic vodka / or martinis by Dr. Hyde." The second metaphor is 'cancer is war.' The body is seen as a battleground in which the "army of metastasizing cells / advances, armed and dangerous." The patient realizes that medical interventions are allies in this fight, but drinks the barium "as Socrates / must have: one eye on the door."

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Summary:

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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The first full-length collection of poetry by a Canadian medical social worker who cares for cancer patients and their families. The "longing" of the title expresses the human yearning for love, knowledge, completeness, and healing.

Many of these poems deal with the process of revealing the inner workings of the world (and the inner truth of persons) through photography; see "Darkroom: 1," in which, "I watched you emerge / take on form / and intensity." X-ray photography, of course, takes this one step further, allowing us to see the insides of bodies.

The long last section of the book includes 24 poems that deal explicitly with illness and health care. Among the best of these are "Worker Classification: Material Handler," "Hand to Mouth," "Wishbone," and a sequence of short poems called "Post-Mortem Report."

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The narrator is visiting a sick loved one in University Hospital, Boston and reflects on the many patients who have stayed in this hospital, most especially the young men from the battlefields of the American Civil War.

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This is a two-verse, ten-line poem about the narrator's father, who is obviously being kept alive against his own will (he "stormed against equivocation, / Heaving against tubes and wires"). He wants no part of these life-sustaining gadgets; in fact, "they" have to "bind him down." Finally, the doctors ask him why he's acting this way and, unable to speak, the old man asks for a pencil and paper and angrily scribbles in his "clearest, / Most commanding hand, 'I am dead.'"

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