Summary:

Dr. Conley became, in 1991, the center of media attention when she publicly declared her reasons for resigning her position as Professor of Neurosurgery at Stanford University: a hostile work environment due to the sexism of the male professor promoted first to acting chair, then chair of her department. This book is her story, but as she notes in the introduction, it is "one of many that could be told by women doctors across the country, about this institution [Stanford University] and many others like it."

Dr. Conley has been a remarkable pioneer in academic medicine: in 1975, she became the first female faculty member at Stanford in any surgical department. She was immediately elected the first female chair of the faculty Senate. She has led an active, innovative research team investigating the immunology of brain tumors. She is the first female tenured professor of neurosurgery in the country.

The book offers behind-the-scenes views of the anatomy lab and medical school, residency and sleep deprivation, the operating room and hospital medicine, and, above all, the political parrying and power struggles in academic medicine, particularly in the dean's office. In a bold move, Conley uses the real names of top administrators and those who had previously been identified in the media--not only concerning her issues, but also those involved with scandals that were unfolding concurrently in other departments.

Because of the circumstances surrounding her resignation and subsequent rescindment of the resignation, she became aware of many instances of sexism, gender discrimination and harassment, not only in academia, but throughout hospital and research environments. Her current position within the University and Veterans Affairs hospital enables her to be a strong voice for women's issues. This book chronicles her personal journey and acknowledges the support of her husband, parents, mentors, and friends along the way.

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This haunting memoir by a South African surgeon who has witnessed tremendous suffering across the globe is best read as his story, and not a war chronicle as the subtitle would suggest, since large chunks of the book are not about war in the dressing station sense of the term. That said, however, the war that rages inside the author continues throughout the book and gives the reader glimpses of wisdom gained during Kaplan's remarkable journey of life amidst death. The book is culled from journals of writing and sketches that he kept throughout his travels.

Kaplan's first crisis occurs when he joins fellow medical students in an anti-apartheid demonstration in Cape Town and, following the lead of a more senior student, Stefan, tends to the wounded and frightened after riot police attacked the demonstrators. Kaplan then gets the call of not only medicine as service, but surgery as service, when, as a neophyte doctor, he saves the life of a youth shot in the liver by the police.

This feat should not be underestimated, though the author writes with humility. Indeed, in recounting later incidents in which patients die, the odds tremendously stacked against the patients surviving anyway (a woman with disseminated intravascular coagulopathy and multiple organ failure, or the Kurdish boy in a refugee camp with a great hemorrhaging, septic wound), the author's self-chastisement is a painful reminder of how the physician suffers with each loss.

After a beautifully written prologue which begins, "I am a surgeon, some of the time" (p. 1), the book proceeds chronologically, each chapter named for the location of the action. Kaplan leaves South Africa to avoid military service and the fate that befell Stefan, who becomes an opioid addict after euthanizing a torture victim in a horrible scene of police brutality and violence. Kaplan's post-graduate training in England and BTA (Been to America) research stint heighten his sense of cynicism about hierarchy in English society and capitalistic forces in American medical research.

Ever the outsider, Kaplan first returns to Africa (treating victims of poverty, deprivation and violence), then sets off to war zones in Kurdistan, Mozambique, Burma (Myanmar), and Eritrea. In between, he works not only as a surgeon, but also a documentary filmmaker and a cruise ship and flight doctor. He avoids the more established medical humanitarian relief efforts, such as Médecins Sans Frontières, and instead prefers to work where no other ex-pat physician will go--enemy territory, front lines, and poorly equipped dressing stations.

Along the way he decides the number of people he has helped as a surgeon, particularly in Kurdistan, has been small compared to the potential to intervene in broader public health measures (he meets a Swiss water treatment engineer) and occupational health exposés to help abused victims (e.g., of mercury poisoning in South Africa and Brazil). The book ends with Kaplan studying to become an expert in occupational medicine, though, incongruously, in the heart of London's financial district where he treats stress-related illness.

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The speaker of this poem undergoes surgery for some kind of abdominal cancer--the important detail being that her mother had recently gone through the same experience and died several months later. A number of images convey the strangeness and alienation of serious illness. The mother’s cancer is an "embryo of evil" that curiously grew inside her like her own daughter (the speaker). The hospital room is the place "where the snoring mouth gapes / and is not dear."

And at her mother’s bedside the speaker finds that she must "lie / as all who love have lied." Her body hair shaved for her own operation, the speaker finds important values have been stripped away: "All that was special, all that was rare / is common here. /. . . Fact: the body is dumb, the body is meat." Coming out from under anesthesia, the speaker calls for her mother.

Later she realizes that, unlike her mother, she will probably survive. The last lines are comic in a self-deflating way, as the speaker gives herself get-back-to-life marching orders partly in the voice of her mother, concluding: "and run along, Anne, run along now / my stomach laced up like a football / for the game." (About 120 lines, in 6- and 9-line stanzas)

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The author selected 48 works of art, famous and obscure, which are presented in chronological order as full-page color plates. On the facing page of each piece is a brief essay which includes information such as artist, date and current location of the work. The essays, as well as the introduction by the author, are insightful, well-written, and demonstrate the author’s vast knowledge as a medical historian. Selections include the "Oath of Hippocrates", Studies of the Fetus by da Vinci, The Anatomy Lesson of Nicolaes Tulp by Rembrandt, The Dwarf Sebastian de Morra by Velazquez, "Muscle-Man from Vesalius" by van Calcar, and First Operation Under Ether by Hinckley (see art annotation in this database).

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This anthology frames a rich selection of fiction and nonfiction with astute and helpful introductions to issues in nineteenth-century medicine and the larger culture in which it participated. The fiction is comprised of Mikhail Bulgakov’s The Steel Windpipe in its entirety; Sir Arthur Conan Doyle’s story, "The Doctors of Hoyland" from Round the Red Lamp; and selections from George Eliot’s Middlemarch, Gustave Flaubert’s Madame Bovary, Sarah Orne Jewett’s A Country Doctor, Sinclair Lewis’s Arrowsmith, Thomas Mann’s Buddenbrooks, W. Somserset Maugham’s Of Human Bondage, George Moore’s Esther Waters, Robert Louis Stevenson’s Strange Case of Dr. Jekyll and Mr. Hyde, Eugène Sue’s Les Mystères de Paris, and Anthony Trollope’s Doctor Thorne [the full-length versions of many of the above have been annotated in this database]. The nonfiction consists of two versions of the Hippocratic Oath, two American Medical Association statements of ethics, and selections from Daniel W. Cathell’s The Physician Himself (1905).

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In "Life Support," a mother must make a difficult decision: whether or not to consent to heart surgery without anesthesia for her critically ill newborn who is on a ventilator. Her instincts and reason contradict each other, and she isn’t sure which to believe. She wants to let the child die naturally in her arms, but this will not be allowed in this particular institution. She feels distant from her husband and from the doctors, and believes that her sudden transformation into the guardian of this child presumes far more knowledge and ability than she possesses.

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This is a story of injury in the midst of exuberant good health, followed by a progressively darkening journey. The writer experiences a period of isolation from normal life by his hospitalization, isolation from a part of his body by neurosensory damage to the injured leg, isolation from the security of medical colleagues by their insensitivity to his anguish. Sacks reaches a psychological nadir before beginning his return. He chronicles, retrospectively, the stages of this trip. As in the classical journey myths, the traveler returns with new insight and an altered vision of the meaning of disease.

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An epigraph preceding this 28-line poem, apparently from notes by the physician-writer’s physician-father, sets the action of the poem in Wales in 1938. In the operating room, the surgeon attempts to locate the brain tumor of a patient who was under only local anesthesia because of his blood pressure. In those days in that place, finding the tumor was a "somewhat hit and miss" procedure that seems to have involved looking for it with one’s fingers.

A grotesque image, but all goes well until the patient, in a "gramophone" or "ventriloquist" voice not his own, cries out, "Leave my soul alone, leave my soul alone!" The doctor withdraws from the brain, but the patient then dies, after which the mood in the operating room is shocked and speechless, as "silence matched the silence under snow."

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A doctor has become fascinated by mesmerism. He is curious to see what would happen to an individual put under hypnosis while dying. Would it stave off death? Would dying make hypnosis impossible? A friend agrees to be the subject of this experiment.

Seven months later, the doctor is called to the dying man’s bedside. As the patient’s breath and heartbeat slow, the doctor successfully hypnotizes him. The dying man feels no pain and responds to questions without rising from his trance. He asks the doctor not to wake him, but to let him die without pain. The next day, the patient’s eyes roll upward, his cheeks lose their color, and his mouth falls open. The man is apparently dead.

As they prepare him for burial, however, the tongue begins to vibrate and a minute later, answers the question the doctor put to the patient just before his death. "Yes; - no; - I have been sleeping - and now - now - I am dead," says the corpse. The amazed doctors leave the patient in exactly the same state for seven months. Finally, they resolve to wake him. As he begins to wake, the doctor asks what the patient’s wishes are. The dead man cries out that he is dead and must be awakened. The doctor wakes him and the corpse immediately falls apart into "a nearly liquid mass of loathsome - of detestable putridity."

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The story is based on the life of Hanaoka Seishu, Japanese physician, who lived from 1760-1835. The author, using Hanaoka’s personal papers, has created a fictional representation of the jealous hatred that grows between his mother and his wife living in their feudal Japanese household. The physician is involved in trying to develop an anesthetic which would enable surgeons to remove diseased breasts. The beautiful, widowed mother of the young surgeon begins to compete with his wife for the "privilege" of being his first human subject to take the toxic substances. The remainder of the story revolves around the complex relationship among the family members, with predictably unhappy outcomes, and the results of the experiment.

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