Summary:

Bomgard, a young doctor recently transferred from a rural area to a small town hospital, receives an urgent message from Polyakov, the doctor who replaced him. Polyakov has become ill; he needs medical help. Before Bomgard can respond, however, Polyakov arrives at the hospital, dying of a self-inflicted wound. In his last moments, he gives Bomgard a notebook, on which is recorded the story of Polyakov's addiction to morphine.

Polyakov first took morphine to relieve an abdominal pain. He found that it also relieved his despair over the loss of his lover, an opera singer in Moscow. Morphine relieved his loneliness and improved his work. He gradually increased the dose until he became hopelessly dependent on the substance. He failed in his attempts to break the habit at a clinic in Moscow. Eventually there is nothing in life but the drug and Polyakov suicides.

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Dr. Thomas Graboys is an eminent Boston cardiologist who developed Parkinson's disease in his late 50s. Shortly after his wife died in 1998, Graboys noticed unusual fatigue and mental sluggishness. He attributed these symptoms to grief, but they continued and he later experienced episodes of stumbling, falling, and syncope. During 2003 Graboys confided to his diary that it was "increasingly difficult to express concepts." ( p. 30) He also noticed tremor, problems with dictation, and frequent loss of his train of thought, symptoms "typical of Parkinson's." (p. 24)

While Graboys recorded these concerns in his diary, outwardly he denied that anything was wrong, even to family and close friends.  In fact, his denial continued until the day in 2003 when a neurologist friend accosted him in the parking lot and pointedly asked, "Tom, who is taking care of your Parkinson's?" (p. 27) Dr. Graboys faced an even more difficult challenge in 2004 when he developed the vivid, violent dreams and memory lapses that led to a diagnosis of Lewy body dementia, a form of progressive dementia sometimes associated with Parkinson's disease. With the cat out of the bag at last, the author finally began to confront the issue of professional impairment. In mid-2005 Graboys's colleagues seized the initiative and told him that "it was the unanimous opinion of my colleagues that I was no longer fit to practice medicine." (p. 36)

Writing now with the assistance of journalist Peter Zheutlin, Graboys reviews these events with unblinking honesty. He confronts his anger and denial, but also reveals the thoughtful, generous and passionate side of his character. "What will become of me?' This is the question that now lies at the center of Dr. Graboys' personal world. He knows that his loss of mental and physical control will worsen. With almost superhuman effort and his family's strong support, the author has been able to adapt to his limitations and maintain a sense of meaning in his life. Will that continue? In a chapter entitled "End Game," he addresses the question of suicide. Reflecting on his condition, especially the dementia, Graboys asks, "Will I lose myself, my very essence, to this disease?" (p. 161)

In the last chapter, Graboys acknowledges that he has no "simple prescription that will help you or someone you love live a life beyond illness, or tell you how to tap the hope that lives within." (p. 181)  However, he then goes on to make several suggestions of the advice-manual variety: "Use your family and friends as motivation to live life with as much grace as you can muster." "Find a safe place... to unburden yourself of anger." "Acceptance is key to defusing anger, stress, and self-pity."  "Use your faith in God, if you believe in God."  (pp. 181-182)

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Baiev’s chronicle of medical life in wartime is full of incident—tragic, touching, and repeatedly traumatic:  his own life was threatened repeatedly by Russians who suspected him and Chechens who resented him for treating Russians.  Members of his extended family were killed and his father’s home was destroyed.  He straddled other boundaries:  trained in Russia, he fully appreciated how modern medicine may bring relief not available even in the hands of the most respected traditional healers, but he mentions traditional ways with the reverence of a good son of devout Muslims.  His perspective is both thoughtfully nationalistic and international.

Finally coming to the States where he couldn’t at first practice the medicine he had honed to exceptional versatility under fire, he lives with a mix of gratitude for the privilege of safety and a longing for the people he served, whose suffering was his daily work for years that might for most of us have seemed nearly unlivable.  Before writing the book, he struggled with his own post-traumatic stress, and continues to testify to the futility of force as a way of settling disputes.  Medicine is his diplomacy as well as his gift to his own people, and the Hippocratic Oath a commitment that sustained him in the midst of ethical complexities unlike any one would be likely to face in peacetime practice.

 

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Pietro Brnwa, nicknamed "The Bearclaw," has embraced change - a new name, a different occupation, and a regenerated outlook. Thanks to the Federal Witness Protection Program, Pietro, who was formerly employed as a hitman by a mafia-connected lawyer, is now Dr. Peter Brown, an intern in the Department of Internal Medicine at Manhattan Catholic Hospital. His career as an assassin was motivated by the desire to avenge the murder of the grandparents who raised him. As a physician, Dr. Brown is paying off a moral debt - doing good deeds to atone for previous acts of violence including killing people.

Unfortunately, life doesn't get any easier for the hit man-turned-physician. Trouble stalks him and finds him. Everyone he loves is lost. In addition to the death of his grandparents, Dr. Brown's girlfriend, Magdalene, is gunned down in a car. His former best friend, "Skinflick" is thrown out of a window of a six-story building, survives, and is later stabbed to death by Dr. Brown.

Life might have been easier if Dr. Brown had not been recognized by a mafia acquaintance named Nicholas LoBrutto who is a patient in Manhattan Catholic Hospital. LoBrutto has stomach cancer and threatens to squeal to Dr. Brown's former crime boss. If Dr. Brown cannot keep LoBrutto alive, the mafia will be notified where to find the physician and he will be eliminated. Dr. Brown assists during LoBrutto's surgery but the mobster experiences ventricular fibrillation postoperatively. Dr. Brown's two medical students mistakenly administer intravenous potassium and LoBrutto dies.

A group of thugs quickly infiltrate the hospital and it appears likely that Dr. Brown will be exterminated. He risks his life to prevent a young woman from having her leg amputated for an erroneous diagnosis. The thugs capture Dr. Brown and detain him in the blood bank freezer. He removes a piece of bone from his own lower leg (an autofibulectomy) to use as a weapon and proceeds to kill the entire gang of murderers. Dr. Brown is sure to be dismissed from Manhattan Catholic Hospital but realizes there is still much he hopes to accomplish as a physician. With some help from friends in the Witness Protection Program (and a likely sequel to this novel on the horizon), it's a good bet that Dr. Brown is not likely to retire his stethoscope (or firearms) anytime soon.

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A drug-addicted doctor, a dying father, and a cantankerous angel constitute a less than holy trinity. Carl is an impaired physician who is hooked on drugs. He happens to have a guiding angel following him around, but she is no guardian. Instead, she is moody and provides no protection. She offers warnings and advice. Carl met his angel when he was six years old. After being stung by wasps and experiencing an allergic reaction, she didn't lift a finger (or wing) to help him.

The angel is prescient. She can foretell who will grow up naughty or beneficent. She knows when a person will die. She tells Carl that not everyone has an angel. Only those individuals destined for greatness get an angel, but some people choose not to heed the suggestions of their spiritual attendants.

Carl is a pediatrician. He cheated in medical school and on his certifying examination but is pleased with his choice of careers: "I make my living praising the beauty of well children. I love babies and I love ketamine" (p121). His father is dying from metastatic lung cancer. Their relationship is terrible. To make matters worse, Carl cannot stomach sick adults.

His three pregnant sisters implore Carl to care for their father after discharge from the hospital. Carl reluctantly leaves San Francisco and heads to Florida. He takes his father to chemotherapy sessions, but the oncologist thinks it's time to stop further treatment. Carl administers painkillers to his dad and frequently consumes some of the prescribed morphine and Percocet for his own pleasure. The two men hardly speak to each other.

Carl's angel repeatedly implores him to reach out to the dying man. She knows that emotional and physical connection will heal both men. Carl's father longs for a storm but the weather won't deliver his wish. One night, Carl stages rainfall with the aid of the garden hose. He rests his head against his dad's chest, and they fall asleep. When morning arrives, Carl awakens and discovers that his father died during the night. The angel is weeping in the room.

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Sandeep Jauhar, M.D., Ph.D. is currently director of the Heart Failure Program at Long Island Jewish Medical Center in New York. Thus, one can assume that he is an accomplished cardiologist and administrator. It was not always so. This memoir flashes back to 10-15 years earlier when the author was casting about for a career, finally settling on medicine almost by default; it follows him to medical school (at Washington University in St. Louis) and then centers on his first year of residency training at Cornell's New York Hospital in Manhattan -- the internship year.

We learn in the introduction to the book that the author will speak freely of self-doubt about career choice, constant anxiety and feelings of inadequacy, exhaustion, and disillusionment. Which indeed he does. But Jauhar first discusses his family background: born in India and emigrating with his family to the USA at age 8; father holding a Ph.D. in plant genetics, now writing academic textbooks and still regretting that he had not been able to afford his dream of becoming a doctor; mother helping to support the family as a lab technician; older brother, Rajiv, a mentor and competitor, charming, self-assured, and unquestioningly headed for a medical career; sister, Suneeta. Sandeep (the author) undertakes graduate work in theoretical physics but as he nears completion of his doctoral degree, realizes that he probably does not have what it takes to be successful in the field. When his girlfriend, Lisa, becomes seriously ill, he begins to (re)consider medicine as a career. Against the advice of his parents who are now convinced he is a dilettante, he applies to medical school and is accepted.

Disillusionment began during the first two years of medical school: "In graduate school I had never learned to memorize . . . But now I couldn't rely on logic and reasoning; I had to commit huge swaths of material to memory" (32). He considered quitting to become a journalist, a profession that had always intrigued him, but which had been discouraged: "my father made it clear that journalism and writing were never to be considered career options because they offered no security" (33). Yet, amazingly, he was awarded a summer fellowship just before starting medical school that placed him in the Washington, DC office of Time magazine; the contacts he made then allowed him to work as a student reporter for the St. Louis Post-Dispatch during medical school and led ultimately to his ongoing and current position as a contributing medical essayist for the New York Times.

Internship for Jauhar unfolds as a series of anxiety-provoking encounters with patients and humiliating encounters with his physician superiors. Feeling inept and inadequate, he stumbles along and worries that he is harming patients. There is too much to keep track of, too many "little things that I find burdensome" (91). "Having so much to do was bad enough, but not knowing why you were doing what you were doing was terrifying . . . Patients were needy, their demands overwhelming . . . Everyone seemed to know how the place worked except me . . . The ecology on the wards was hostile; interactions were hard-bitten, fast paced" (112-113). He is in constant doubt and conflict about his career choice. Even his private life is affected -- his girlfriend Sonia, still a medical student, comes from a medical family, is strongly motivated and secure in her career choice, which aggravates his own sense of insecurity. (Reader, he married her.)

Midway through internship Jauhar suffers a herniated disk. He tries to tough it out without taking time off but his stint as "night float" at Memorial Sloan-Kettering hospital, which specializes in treating cancer patients, proves too difficult-- up all night trying to tend to the severely ill and "taking care of patients about whom you knew next to nothing" (154). He takes a brief leave followed by a reduced schedule. He recognizes that his problems are emotional as well as physical -- he is depressed. But gradually, as his neck problem improves, as he recognizes that medical professionals are actually able to help patients feel better -- his neurologist and physical therapist had "provided hope and comfort to me at a vulnerable time" (181)--, as he makes a house call to a dying patient, as his essays are published in the New York Times, and as the season moves to Spring, his depression lifts and he looks forward to his work.

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In the Arctic, winter goes on for ten months every year. The cold temperatures penetrate every aspect of human life. Existence is a struggle. In the Canadian community of Rankin Inlet, an Inuit woman finds personal tragedy as abundant as the snow. Victoria is diagnosed with tuberculosis (puvaluq) as a child and sent to a sanatorium far south of home. Following treatment with medication and a thoracoplasty, she returns to her town years later. Victoria's experience has changed her view of the world but she quickly discovers that in her absence, the people and locale have transformed too.

She marries an outsider, John Robertson, who is a British businessman. His success and local influence allow him to arrange for a foreign-owned diamond mine to open in the area, and with it, a new hospital for the territory. The couple have three children - a son, Pauloosie, along with two daughters, Justine and Marie.

Victoria seems a magnet for misfortune. At age 16, she has a miscarriage. A fourth child dies during a complicated delivery. Her marriage is increasingly strained beyond repair. Victoria's father suffers a stroke and becomes demented. Her mother dies of lung cancer. Husband John is murdered - someone slits his throat. Marie commits suicide. Pauloosie leaves home and sails to the South Pacific.

The Robertson family frequently interacts with the American primary care physician stationed in the isolated region. Dr. Keith Balthazar is a middle-aged atheist who has toiled in the Arctic for more than 20 years and abuses morphine. He keeps a journal of his experiences and meditations and commiserates with the local priest, Father Bernard.

Escape appears to be the best chance at happiness. For Victoria and most everyone else living in this harsh and beautiful land, survival - both physical and emotional - is hard. Personal choices are confusing. Nature doesn't seem to care one way or another.

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The novel opens with a young surgical nurse, Justine Brent, nursing a mill worker whose arm has been mangled by a carding machine. She soon meets John Amherst, the mill’s assistant manager who works passionately to reform the dangerous conditions at the mill and to improve the living conditions of the workers. Amherst recognizes Justine’s intelligence and sympathy, but he quickly forgets about her when he meets and falls in love with the new mill owner, Bessy Langhope.

The narrative skips ahead three years. John Amherst has learned that his now-wife Bessy has no real interest in his plan to reform the mill, although she initially appeared to be moved by the workers’ misery. In fact, her insistence on luxury, which is funded by the profit from the mills, thwarts his desire to use her controlling interest to make significant changes. The couple encounters Justine, who knew Bessy in school. When the somewhat sickly Bessy invites her to be a private nurse to herself and her stepdaughter, Justine, who is exhausted from “difficult cases,” accepts. Justine attempts to shore up John and Bessy’s increasingly troubled marriage without success. When John is abroad, Bessy has an accident while riding her horse. Paralyzed, in constant pain, and slowly dying, Bessy is attended by a physician who advances his career with the technological feat of keeping Bessy alive, ostensibly until her husband and her father arrive to say their goodbyes. When Bessy begs Justine to let her die, Justine secretly gives her a fatal dose of morphine, an act that the physician suspects.

The narrative skips ahead again to over a year later when Amherst, who has inherited the mills from Bessy, invites her family to celebrate the opening of an emergency hospital he has built in the mill town. Justine, who had stayed on after Bessy’s death as her stepdaughter’s nurse, and Amherst become reacquainted. Their shared social and intellectual interests develop into love, and they marry. The physician who had cared for Bessy and who had, earlier, asked Justine to marry him, had developed an addiction, one that had begun while he was treating Bessy. Beginning to sink into financial ruin, he blackmails Justine. Eventually, Amherst finds out that Justine killed Bessie with morphine and, horrified, rejects her.

Justine confesses her act to Bessy’s father and negotiates a deal: She will remove herself from their lives if he allows Amherst to continue his work at the mills. Bessy’s father accepts the deal, and Justine disappears for many months until Bessy’s daughter becomes ill and begs to be reunited with Justine. A family friend explains to Amherst Justine’s arrangement to protect him and convinces him that she has suffered suitable penance. Justine is reunited with Amherst when he celebrates the opening of a gymnasium for the mill workers, a project he credits Bessy with having designed. Justine, who knows that Bessy had in fact designed the gymnasium for her private estate, a project that would have drained the funds for improving the mills, keeps silent and subverts her knowledge to her husband’s perception of the facts.

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Summary: All thirteen short stories in this collection draw readers into the quietly compelling lives of disparate and very ordinary characters who function and suffer in unsettling ways. We are like them and not like them, but their circumstances, while sometimes disturbing, are familiar--and strangely magnetic. The opening lines of "The Lapse" illustrate this power of attraction:

I married Joanne during a lapse. A religious lapse. I don't display my beliefs like a gold medallion, though, as many whom I know do. I prefer to observe in private. After all, any intimate relationship belongs only to the entities or people involved. (p. 35)

Who can bypass an invitation to enter into announced intimacies, however private, that must be revealed in a matter of pages. What lapse and who is Joanne?!

"Bad News," centers around Sheila Powers, a psychologist, whose disruptive marital break-up is compounded by her mother's recent diagnosis of cancer and a subsequent flow of memories about her mother, her father, and herself. She is "between worlds...between life zones." (p. 113) Aspects of the future, at least her mother's, may be somewhat predictable, but the complex depths of the past mix with the present to generate sticky threads that belong to the story and to the readers as well who will recognize bits and pieces of their own family lives.

In a fourteen page story with a decidedly off-putting title, "The Encyclopedia," Wineberg zeroes in on Doris who, after a dissolved relationship, decides to sell the thirty volumes of the Encyclopedia Britannica-"the macro-edition, the micro-edition and the year books" purchased by the former couple. Not about remote bits of history or dinosaurs, we discover, but a story about separation, a series of lovers, benign conversation with a fellow worker who claims to be similarly tired of men, a possible buyer for the unwanted encyclopedia, a relationship with the married buyer, an end to the relationship, and a decision to keep the books after all. Her life, we might decide, is encyclopedic, a litany of minutiae that does, indeed, provide information about conditions of existence.

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