Summary:

Frears presents a stark portrayal of London’s underbelly, a place where everything is for sale--at a price. It is a world in which most people tend to ignore or overlook: prostitution, illegal immigrants struggling to survive, illegal activities, humiliating circumstances, and most centrally, black market organ transplantation. "We are the people you don’t see." Information age technologies mix with greed and desperation to depict an engrossing and sordid narrative about real-life events occurring in places beyond the ordinary purview. This modern day thriller brings audiences to the edge of their seats as they witness harrowing and very believable accounts of marginalized members of society deprived of basic human dignities.

The story is complex but two characters dominate, a doctor from Nigeria (Chiwetel Ejiofor) now reduced by harsh circumstances to several menial jobs including taxi driving and hotel clerking, and an illegal chambermaid from Turkey (Audrey Tautou) whom he befriends and assists. She lives in constant danger of humiliation, exposure, deportation. Their paths cross in a hotel where both work, where "johns" are served by prostitutes, and where illegal and sloppy surgical procedures are employed to harvest kidneys from desperate donors.

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The dentist, William Thomas Green Morton, gave the first successful public demonstration of anesthesia on October 16, 1846 at the Massachusetts General Hospital. This painting depicts the patient, Gilbert Abbot, sitting in a chair in the surgical amphitheater, eyes closed and neck exposed for the excision of a small vascular tumor of the jaw.

The surgeon, John Collins Warren, a distinguished Professor of Surgery at Harvard Medical School is leaning slightly forward, delicately holding a surgical tool vertically at the hidden point of incision. Morton holds his specially designed glass apparatus used to contain the anesthetic agent, ether.

Eleven other men watch the proceedings from the floor of the amphitheater, with varying levels of surprise and concentration. One is rising, as if in amazement, from a chair, and another steps up on a chair to see better. Two attend the patient: one holds his head and the other holds the right hand and checks the pulse at the wrist. Numerous men are seated in the gallery, and are painted with less and less detail, the higher the row.

The men are all dressed formally in dark suits, some with fur lapels, except for the patient, who is in white shirt with tan pants and dark shoes. This operation occurred before antisepsis and germ theory were discovered.

Hinckley used light and line to focus attention on the surgery. A strong diagonal line from the side wall of the gallery ends at Warren’s head. Light reflects off Morton’s ether inhaler, such that one can even see the sponge inside. The white of the patient’s shirt and the cloth and bowl on the instrument table in the foreground also serve to direct attention to the operation. Light glints off the surgeon’s head, although not as dramatically as in Thomas Eakins’s The Gross Clinic (see this database). Warren’s pronouncement at the end of the surgery, "Gentlemen, this is no humbug," paved the way for the rapid acceptance of anesthesia for surgery.

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Harry Pope is afraid to move even a muscle. While lying in bed and reading a book, he notices a krait--Bungarus caeruleus, a deadly Asian snake--slithering on top of his pajamas. When his companion, Timber, arrives at the bungalow around midnight, Harry is still petrified with fright. Convinced the snake is asleep on his stomach beneath the bed sheet, Harry has been lying motionless for hours.

Timber telephones Dr. Ganderbai for help and despite the late hour, the Indian physician promptly makes a house call. He administers an injection of anti-venom just in case the snake bites Harry. Next, Dr. Ganderbai carefully infuses chloroform underneath the bed sheet in an attempt to anesthetize the krait. Timber and the doctor then remove the sheet but no snake is found. Dr. Ganderbai questions the validity of Harry's account and wonders if the man was merely dreaming. Harry becomes enraged and spews insults including racial slurs. The doctor remains composed and exits quietly, remarking only that Harry could use a vacation.

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Half-waking from surgical anesthesia, a woman named Mary realizes that she has had a breast removed. She immediately begins to imagine how this will affect her already troubled marriage. When she is fully awake, other women on the ward try to comfort her, each with a strategy for bearing up under suffering which Mary finds unacceptable because these strategies represent values about marriage, submissive gender roles, or religion which Mary cannot quite swallow.

Later, talking with her brusque surgeon and her family doctor, Mary learns that the mastectomy may not have been necessary, that the tumor was benign. At the end of the story, husband Matt hustles in to ask: "Well, baby, are you still going to divorce me?"

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A neurosurgeon looks forward to having a day off from work, but a promising Saturday brings only trouble. Henry Perowne is 48 years old and practices in London. Lately, he's concerned about the impending invasion of Iraq. Perowne's views on the situation have changed considerably after conversations with a patient who was tortured and imprisoned in Iraq for no apparent reason. A protest march against the looming war is held on Saturday.

On his way to play a game of squash that morning, Perowne is involved in a car accident on an otherwise deserted street. No one is injured and the two vehicles sustain only minor damage. The owner of the other car is a man in his twenties named Baxter. He is accompanied by two buddies. Perowne refuses Baxter's demand for cash to repair the car so Baxter punches the doctor. Perowne is moments away from a pummeling.

He notices that Baxter has a tremor and an inability to perform saccades. Perowne deduces that Baxter has Huntington's disease. The doctor capitalizes on the fortuitous diagnosis. He speculates that Baxter has kept the neurodegenerative disorder a secret from his sidekicks. When Perowne initiates a discussion about the illness, Baxter orders the cronies away so that he can speak privately to the doctor. The two men desert Baxter, and Perowne escapes in his car, hopeful he can still make the squash game.

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The narrator suffers from depression and a pain in the right side beneath his ribs. Surgery will be performed at his home by Dr. Haddon and Dr. Mowbray, but the narrator worries that he might die during the operation. During an afternoon nap on the day before surgery, he dreams of death and resurrection. Chloroform is administered prior to the operation, but the narrator continues to be aware of everything taking place.

He can see into the minds of the surgeons and learns that Dr. Haddon is afraid of inadvertently cutting a vein. Almost on cue, the vein is slashed and hemorrhaging occurs. The narrator has a near-death experience associated with an extraordinary clarity of perception. He senses movement upward - beyond his body, beyond the town, and beyond the world. He believes his soul is streaming through space past the solar system and nearby constellations.

His impression of absolute serenity is eventually replaced by a sensation of loneliness. All matter becomes condensed into a single point of light, then a fuzzy glow, and finally the image of a colossal hand clenching a rod. A faint sound punctures the silence followed by a voice proclaiming, "There will be no more pain" (63). He awakens and sees the surgeon standing next to the rail of the bed. The narrator has not only survived the operation, but his pain and melancholy are vanquished.

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A down-and-out attorney, who has become somewhat obsessed with the case of a severely impaired woman who had suffered brain damage during the course of a surgical procedure, presses forward to prove medical malpractice. In the course of developing the case he is opposed by the Bishop of the diocese which owns the hospital in question; one of the most powerful law firms in the city; and, acting as "spy" for the defense team, a beautiful woman lawyer.

Galvin, the protagonist, is encouraged to continue his pursuit of justice by an honest former partner and his own belief in the patient's childrens' right to a settlement. Galvin wins his case by proving that the medical records have been altered.

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This poem explores the act of inserting an intravenous line (I.V.) into a patient just prior to induction of anesthesia or sedation. The physician-narrator is initially full of bravado, stating "I am good at this" and "I'm the best". The physicality of the act is detailed: the vein "lies stretched and succulent" and the needle "waits / like a mosquito attached / by its sucker." By the end of the second stanza, however, when the I.V. has been successfully inserted, the significance of this seemingly simple medical intervention is stated: "I am suddenly aware / I am connected to his brain."

It is this power, the fear of this power felt by both the doctor and the patient, and, by extension, the fear of anesthesia or sedation, that form the heart of the poem. The narrator states that he cannot let his own fears about anesthesia and "loss of control get in the way." Instead he accepts the power and control that the patient gives him and "bring[s] him down."

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The surgeon-narrator and his team of assistants (the anesthesiologist, scrub nurse, circulating nurse, surgical resident, and medical student) perform a difficult operation during the night. The patient has an infiltrating cancer of the stomach (linitis plastica) that has eroded his aorta. Because of uncontrollable bleeding, the operation (an exploratory laparotomy with attempted repair of a malignant aorto-gastric fistula) is as doomed as the patient himself.

The surgeon soon comprehends the hopelessness of the procedure as well as the patient's terminal condition. He turns off the oxygen from the gas tank and stops the patient's blood transfusion. Minutes later, the man dies. Blood is all over everything. The doctor must now deliver the bad news to the man's family. He has the medical student tag along.

Members of the patient's family are upset and some are even out of control so he dispenses tranquilizers to them. The surgeon returns to the operating room (OR) and even now finds blood everywhere. The OR team is still working. The doctor showers and then goes back to the OR once more. The room is now dark and empty but clean. The surgeon imagines the dead man's body with a row of abdominal stitches that he likens to hieroglyphics. The unsuccessful operation and the surgeon's actions are thus both concealed and unforgettable.

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The author of this bold collection is a registered nurse who relates, through her poems, patient and caregiver experiences culled from her own years of working in Intensive Care-Coronary Care. There are 24 poems here, most running two to three pages and most written in short lines, a point of craft that adds to their power. There is not one moment of easy sentimentality in these poems. Instead, the author plunges into the grittier side of nursing and illness--and yet, in aggregate, these poems celebrate the embodied and holy work of healing.

In the opening poem, "The-Trickle-Down-Theory-Of-Health," Adam, in the Garden of Eden, is surprised by "The knife" that "separates his ribs." By poem's end, we see health slip "like a ring / from earth's finger" (2), and with this simile we are introduced to the book's underlying metaphor and also to the poet's technique: dense and sometimes near-extreme imagery that ranges, in this poem alone, from encyclopedias to acid rain to barefoot children to librarians to a patient in the dark, "her arteries and shelves / of bone in a ruby gloom" (2). This accumulation of unrelenting, unusual images recreates the world of a patient's pain and suffering and the fierce determination and occasional despair of a caregiver.

"Coma" is written from a comatose woman's point of view, and yet we also see her from the nurse's vantage. In a lovely and surprising twist, the coma becomes, for the patient, a sort of liberation as "Slowly she sloughs, / cell by cell, / the old thorn" (15). This patient is not Sleeping Beauty, who in some fairy tale might be wakened by a kiss. "On the Fireline" becomes a wonderful metaphor for the daily confrontation of illness, for the way the nurse, returning daily to tend her patients, also "coalesces into fire" (16).

The 5-page poem "Intensive Care" perfectly renders the physical sense of being alternately caregiver, patient, and family member within the rarified atmosphere of the ICU (24-28). A patient's blood "pulls against/ the moon, his breath / this tide going out" (26) and, as she comforts a waiting family member, a nurse's eyes "beyond clarity, / unfold a silken language / all their own" (28).

Other not-to-be-missed poems are "The Holy O" (36), "Prayer to a Purple God" (38), "Pieta" (44), "A Riot of Flowers" (52), "What the Body Remembers" (57), and one of my very favorites, "Anesthesia" (59). In "Anesthesia" the caregiver lets an anesthetized patient float like "an embryo / tethered on the end of IV tubing, / floated like an astronaut / in cold stratosphere, / a naked thing / alone / in the universe" (60). But since these poems are finally loving, involved, experienced and hopeful, the patient is told to hush; he is watched over; he is protected. When danger is past, he is reclaimed: "She will hold you / within white-curved wings. / She will reel you back in / when you are healed" (60).

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