Summary:

Five Days at Memorial is the book length expansion  of the New York Times Sunday Magazine article that the author, a Pulitzer Prize-winning physician-journalist, published in 2009. The book, the result of years of research and literally hundreds of interviews, chronicles the five days (August 28 to September 1, 2005) during which the medical staff remaining at Memorial Hospital in New Orleans tried to care for the patients -- over a hundred of them stranded, like the staff, in a hospital without water or electricity --following the flooding wrought by Hurricane Katrina.

After an 8 page prologue, the book is divided into two sections, "Deadly Choices" (228pp, the narrative of those five days) and "Reckoning" (256pp, the legal battles over the injections of midazolam (a sedative) and morphine by some of those staff and prosecuted as homicide -- what others called "euthanasia.") "Deadly Choices" relates almost hourly the five days inside Memorial from the viewpoint of patients, patients' relatives, physicians, nurses, administrators of Memorial, Tenet (the holding company owning and running Memorial) and LifeCare -- the long-term care area within Memorial devoted to the care of terminally ill and debilitated patients -- owned by a separate company. Ethical and legal questions of triage, DNR, record-keeping, accountability, communication (primarily the failure thereof) and leadership are on almost every page. At the heart of this book, however, is the mystery of the unexplained deaths of so many patients during those five days. (On September 11, 2005, a disaster mortuary team recovered 45 bodies from many different places in Memorial, page 234). The crux of the mystery of these deaths is the manner in which nine in particular died in the beleaguered hospital on the fifth and last day when, paradoxically, relief had become real and effective and inclusive, seemingly obviating such injections.

The final pages of "Reckoning" deal with the fallout - historical, ethical, political and medical -- and current events relevant to these five days and the almost two years following. (The final verdict of not guilty -- the actual wording was "Not a true bill" since it was a grand jury declining to indict the one physician, Anna Pou, and the two nurses, Cheri Landry and Lori Budo -- was rendered on July 24, 2007). There are a map of Memorial Hospital and a cast of characters at the front of the book and extensive notes, bibliography and index at the end.

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Summary:

The third novel in the series of Zol Szabo, who is a public-health doctor for the Hamilton Ontario region. He is also a single parent to ten year-old, Max, because his unstable wife, Francine, could not deal with Max’s mild physical disability. His partner in life and work is now Colleen, an attractive woman detective whom he met in the first novel and who looks "like Cameron Diaz in a ponytail” (p. 140).

Teenagers at a private religious school begin to sicken and some die of a mysterious liver ailment. School authorities categorically deny any use of drugs, tobacco, or alcohol—but Szabo’s team quickly discovers that not only do the kids smoke, they prefer a cheaper form of cigarette that is manufactured and sold at cut rates by the local native community.

In the background of this stressful situation, Zol’s mother is dying of cancer, his ex-wife is threatening to visit, and Zol is caught up in a violent break-in at a Toronto museum that resulted in the theft of a precious native artifact.

The team unravels a series of epidemiological clues that point to the interaction of pesticide-tainted tobacco reacting with liver cells to produce the dangerous disease. He must then convince the unscrupulous cigarette manufacturer to stop production before the problem spreads widely. Their methods are unorthodox because they lack support from the bosses who are afraid of public and political opinion. Using clandestine photography they prove that the owner has been lying about his distribution methods.

The investigation helps to solve the older murder of a native woman scientist who had uncovered the problem and been brutally silenced.

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Summary:

This memoir spins out in detail the despair and violence that emerges from a childhood of poverty and parental absence. When Dubus was preadolescent, his writer father of the same name (see Andre Dubus), took up with a student of his, and the parents divorced. Andre's mother became a social worker, working full-time with no support system, exhausted. Although Andre's father lived nearby and paid child support, it was never enough to keep the four children and their mother out of poverty. They moved frequently, always to the rough sections of depressed Massachusetts towns on or near the Merrimack River. The memoir describes vividly the smells of the polluted river; garbage strewn lawns; smoky, raucous bars; afternoons and evenings spent aimlessly watching television and, in adolescence, neighborhood kids and punks doing drugs and sex in Andre's home - before his mother arrived back from work each evening  .

At school, in bars, and around the neighborhood, kids and adults beat each other up - violence was a constant. Andre was slight and fearful but also drawn to watch the frequent fights. He avoided direct involvement when he could, was beaten up when he couldn't, and loathed himself in either case. He felt like a non-person: "There was the non-feeling that I had no body, that I had no name, no past and no future, that I simply was not. I was not here" (78). Finally, after being unable to help his brother during a fight, Andre resolved to build himself up physically--lifting barbells, bench pressing, and eventually taking boxing lessons.

Now when there was the threat of a fight, he plunged in quickly, inflicting damage. He could defend himself and those he cared about. But always there was the need for vigilance and the need - frequently actualized - to explode in rage. Later, he came to realize that being quick to jump into fights was a way "to get out what was inside him. Like pus from a wound, it was how [I] expressed what had to be expressed" (191). Gradually Andre came to think there might be other ways "to express a wound."

In the second part of the memoir, Dubus writes of how that other way evolved into creative writing. Training for physical prowess had imposed some discipline in his life, which meant being able to concentrate in school, do homework, and read. There were stints in and out of college (eventually he graduated from the University of Texas in Austin), making ends meet as a gas station attendant, construction worker, fast food manager, bartender, and later-- halfway house counselor. At the local Massachusetts college he attended for a while, he overheard himself being called a "townie." He navigated at the interface of the old neighborhood where he still lived and the life of the more privileged. He became more self-aware, more interior, and at the same time, more interested in the larger world. Threaded throughout this period is a developing relationship with his father, whose writing he admired and whose approval he craved.

In spite of the author's ambivalence toward his father - "where were you when I needed you?" (333)--one probably cannot overestimate the role that the senior Dubus played as a writer model for his son. Dubus read and admired his father's stories. He saw the discipline required to write, even though Dubus senior's weekends were often spent unwinding in bars (sometimes with the younger Dubus). Andre met his father's academic colleagues, met other writers, met writers who had stable relationships with a spouse.

He even learned that a writer can be a sports fan (Boston Red Sox), and avid sports participant (jogger). One of the most moving chapters in the book describes the first baseball game Dubus ever attended or watched - at age 13 - (with two tickets from his father), to see the Red Sox play the Yankees in Boston. Dubus went with a friend who explained the game to him as it unfolded. Dubus was stunned: "Every time one of them walked up to home plate with his bat, hundreds of men and boys would yell insults at him I couldn't quite make out, just the tone, which I knew well, but it wasn't directed at me or anyone I would have to try to protect, and I felt relieved of everything, part of something far larger than I was, just one of thousands and thousands of people united in wanting the same thing, for those men from our team to beat the men from the other team, and how strange that they did this by playing, that one beat the other by playing a game" (161-162).

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Summary:

Ape House is the fourth novel of Sara Gruen. It relates the story of a group of bonobos living in the Great Ape Language Lab in Kansas City under the immediate direction of scientist Isabel Duncan. These six apes are quite adept in using American Sign Language to express their thoughts, wishes and interactive relations with humans. When the Laboratory is the target of a violent explosion, apparently by animal rights activists, Isabel Duncan is severely injured. The six bonobos escape, soon resurfacing in New Mexico as the prime time stars of Ape House, a reality TV show produced by Ken Foulks, a stereotypically evil TV mogul. The bonobos and the show become a controversial hit and the immediate bane of a still recuperating Isabel.

Covering the Great Ape Language Lab pre-explosion as a feature story, print reporter John Thigpen follows them from their first home in the language lab to their TV residence. Meanwhile he is undergoing his own domestic turmoil with his wife Amanda, a frustrated novelist who is also less than happy with their marriage. The novel follows these twin threads - the trajectory of the bonobos from protected apes in a nourishing research environment to exploited animals, and the sturm und drang, both marital and career, of John and Amanda Thigpen. While millions of TV viewers watch the bonobos playing house and enjoying the "generous amounts of sex"? (as described by the book jacket), Isabel tries to regain ownership and protector status of her bonobos, whom she considers family.

Without divulging the denouement of the novel, suffice it to say that Isabel is successful in renewing her mater familias status of the apes, and John Thigpen gets a huge journalistic scoop as well. In the process, he and Isabel find true love and happiness, but not with each other, as coyly but falsely suggested earlier in the book. For everyone except Isabel's first love interest, Dr. Peter Benton, and Ken Foulks, the book ends on a very happy note.

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Summary:

In 1889, young doctor Ephraim Carroll is in Philadelphia working with the team of the famous physician and pathologist, William Osler. In their zeal to learn more, they conduct careful autopsies, but the body of a young woman upsets Osler and teammate Dr. George Turk, and they defer the examination. Baffled when her body vanishes, Carroll becomes preoccupied with identifying the woman and the cause of her death.

A darling of Philadelphia society, Osler arranges for Carroll to attend a dinner where Carroll meets and falls head over heels in love with the unconventional Abigail Benedict. Abigail is a painter and free thinker, friendly with the great artist Thomas Eakins. Both are worried about their missing friend, Rebecca Lachtmann, and they engage Carroll to help find her. Through a series of adventures he is able to locate and identify the missing corpse as hers. He discovers the cause of death by exhuming the body.

In the meantime, Turk is found dead of what appears to be cholera; however, Carroll’s suspicions lead him to conclude that the young doctor was murdered by a dose of arsenic cleverly calculated to mimic symptoms of the infection. Drug addiction and an abortion ring lie at the heart of this crime.

Osler is being courted for a position at the new Johns Hopkins Medical School and he invites Carroll to consider joining him there.  But Carroll decides not to go to Baltimore.

To write more would give too much away. The surprise ending implicates famous doctors for unethical behavior, if not murder.

 

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Summary:

As Audrey Young describes her process of becoming a compassionate internist in a besieged public hospital, she simultaneously argues for turning the hospital's patient care and financial practices into a model for improving health care in America.  Young, a compelling storyteller, first entered Seattle's Harborview Medical Center in 1996 as a third-year medical student on trauma surgery service.  She completed a residency there in general internal medicine and stayed on as an attending for six more years.  She stayed, she tells us, because she met physicians "committed to a vision of equality" who were "the sort of people I hoped to become" (xiii).   She also "fell in love" with "the story of a unique place" (xiii).  Young's stories of that often chaotic place, where ambulances regularly transport homeless, indigent, addicted, and mentally ill refugees from neighboring private hospitals, emphasizes the ways the Harborview staff manages to treat patients with dignity and to choose an ethic of hope in the face of dire circumstances.           

We quickly learn that at Harborview compassion is expressed concretely as actions toward patients.  Michael Copass, known as "the mostly benign dictator of emergency operations," pronounced the core of these actions in what came to be known as his commandments:  "1. Work hard.  2. Be polite.  3. Treat the patient graciously, even if he is not the president of the United States" (9).  Politeness always meant asking "'How may I help you, sir?'" regardless of the patient's social status or addiction history.  Politeness sometimes meant finding a way to reach the patient who regularly threatened the staff.  Young finds ways and creates a therapeutic bond.  But working hard and treating patients considerately also took measurable forms, such as not allowing emergency patients to wait.  Facing a flurry of admissions, the Emergency Department (ED) staff interpreted a young Ethiopian's complaints about pain as a drug addict's ploy.  Because Young glanced at the admissions board and noticed that he remained unattended for three hours--far longer than Copass could tolerate--she jumped into action.  He suffered, she discovered, from a collapsed lung. 

However, Young moves her narrative beyond individual doctor and patient encounters and into the larger, interrelated social and financial structures in which medicine is practiced.  For instance, she links meager funding for drug and alcohol rehabilitation programs with expensive ED admissions and rising healthcare costs.  In the chapter "Bunks for Drunks," Young visits an experimental residence that houses homeless addicts in furnished studios with private baths and cooking appliances.  Although residents can keep alcohol in their rooms and elect not to participate in the home's social services, including counseling, alcohol consumption and ED admissions decrease.  While the chapter points out the cost savings of such arrangements, Young further urges readers to value the dignity residents experience there.

In "Black Friday," Young details the hospital's tense, but ingenious responses to a Mass Casualty Incident, the result of carbon monoxide poisoning, which almost depleted the resources of all of Seattle's medical centers.  The final chapter, "A Vision," outlines how Harborview has tried to succeed as both a charitable institution and a business, as a provider of both indigent and luxury care, with the hope that others will follow the medical center's example.  However, in presenting her recommendations for "health justice," Audrey Young also makes the case that "seemingly ordinary citizens" are implicated in healthcare reform (231).  To enable their informed participation in making changes, Young includes an appendix with further readings and another that lists strategies for effecting reform.  

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Summary:

Some 40 years after a ceasefire that ended the Cylon wars, the 12 human colonies across the galaxy have been lulled into a state of calm complacence.  This is abruptly interrupted by a Cylon attack that annihilates billions of humans, leaving only 50,000 survivors in a small fleet of ships, led by the one remaining ship from the Colonial Fleet, the Battlestar Galactica.  Fleeing the Cylons, they set out to find the legendary 13th Colony: Earth.

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Summary:

This is an anthology of 32 pieces, many directly relating to war and its aftermath, or, in general, kinds of violence humans inflict upon each other and the ensuing suffering: hence the title, "echoes of war." The pieces include short fiction, essay, a dozen poems, and a photo collection. Since none are lengthy, this is a good reader to supplement other longer texts or to serve as an anthology for a reading group. A short essay, "Suggested Longer Readers," mentions some three dozen pivotal topics, including "homecoming" and "sense of identity." 

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Summary:

Because this lucid, rich, and incisive book has not, as yet, been published in the United States, it has not acquired the readership it deserves. For those teaching Medical Humanities or those interested in broader or more global stories and perspectives about physician training, practice, and experiences, Helman’s most recent publication should be considered.

Part One (“Setting Out”) begins in South Africa where Helman’s family, comprised of a dozen doctors, has lived for generations and where his own medical studies occurred. As a child, he accompanied his father on rounds while other children spent holidays at the beach. Before long he discovered how hospitals, during the madness of Apartheid, were to “some extent a distorted mirror-image of the world outside” (3). Appalled by the differences in care and treatment, the keenly aware young man kept notes. His vivid observations of the harsh context of social injustices provide an unequivocal, eloquent, and disturbing critique of medicine then and there. His acute observations of physician behaviors and indigent populations in the city and in the bush contribute, as readers discover in later chapters, to the author’s expanded and compelling interests in cultural anthropology.

Part Two (“The Family Doctor”) leads to London. “After all the heat and light and space of Africa, London—with its low leaden sky and constant drizzle—was like living inside a Tupperware box, one stored deep inside a refrigerator” (47). In the 60s Helman’s migration required an adjustment to a world of technology and order, where as a family practitioner, he had become, in fact, a suburban shaman. In any society, patients wanted “relief from discomfort, relief from anxiety, a relationship of compassion and care, some explanation of what has gone wrong, and why, and a sense of order or meaning imposed on the apparent chaos of their personal suffering to help them make sense of it and to cope with it” (xvi).

Gradually Helman saw connections between the role of family physician and traditional healer: both involved an understanding of “not only a body’s internal equilibrium but also the equilibrium of the patient’s relationships with the world he or she lives in and how treatment should aim not only to treat the diseased organ but also to restore the patient’s life that equilibrium of relationships” (xvii). His encounters with patients and the stories they reveal suggest how important these often overlooked connections are and why they ought to be included in medical training and practice.

By the time readers reach Part Three ("States of the Art”), the author has moved into broader realms of thinking, in which medicine and illnesses are examined anthropologically. After 27 years of clinical practice Helman’s white coat and stethoscope are placed on a hook. Now, as a credentialed anthropologist at University College London, his larger lens allows for sustained scrutiny of the complexities, ambiguities, and nuances in such chapters as “Grand Rounds,” “Hospitals,” “Placebos,” “Third Worlds.” Helman’s range of experiences, multi-disciplinary training, intellectual conclusions, and abundant common sense argues for techno-doctors to learn from holistic practitioners. Whether devastating or humorous, the critiques reflect not just care provision but shared human capacities: the insights are thoughtful and fresh and very worthwhile.

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Summary:

A stranger knocks on the door of the apartment occupied by the R. family. He warns them that an epidemic is spreading in town. Death usually ensues in 3 days and is preceded by swelling, blisters, and redness of the skin. Mice are suspected to carry the disease. The young man appears ill but claims to be a survivor and now immune to the epidemic. He advises the family to remain indoors, avoid mice, and practice strict hygiene. He offers to bring food. The family is skeptical and declines his offer of assistance.

Soon the city is ravaged by the disease. TV and phone stop working. Violence and looting are rampant. Nikolai, the father, regularly goes out at night to rob food and supplies for his family. Sometimes he kills. When he returns home, he always cleans himself thoroughly. He lives with his wife, Elena, their daughter, and Elena's parents.

The family's cat is outside on the balcony and hungry so they bring it inside. The animal eats a mouse, and afterwards the little girl kisses the cat on its mouth. The adults are horrified. They quarantine the child in her bedroom along with the cat. After 3 days, there is no sound or activity in the bedroom. The girl is presumed dead. The cat is alive and escapes. The child's parents and grandparents manifest signs of the infection and die.

Six days after his initial visit, the young man who warned the R. family returns to the apartment building. The place is silent except for the meowing of a cat. The stranger breaks into the apartment and sees 4 dead bodies. Inside the barricaded bedroom, he finds the little girl alive and recovering from the infection. Next to her in bed is the pet cat.

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