Summary:

The adolescent Estrella labors with her farmworker family in the fields of California. Her mother, abandoned by Estrella's father years before, has married an older man who cares for the family but yearns for his home in Mexico. Enduring backbreaking work, the family lives the peripatetic lifestyle of migrant workers, including substandard housing, low wages and significant health risks.

The family extends itself to Alejo, whose only local family is a cousin close to his own age. Alejo and Estrella fall in love. Alejo is sprayed by a crop duster one day in the field, sickens, and is cared for by Estrella and her family. Eventually he becomes so sick they must take him to the community clinic and, later, to the hospital, presumably to die.

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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 narrator’s friend Douglas reads a memoir entrusted to him by his young sister’s governess when he was in college: to oblige a handsome bachelor, she agrees to care for his orphaned niece and nephew in a lonely country house. She becomes convinced that Flora and Miles (ages 8 and 10) are haunted by the evil spirits of their former governess, Miss Jessel, and a former valet, Quint.

The housekeeper, Mrs. Grose, tells the governess of the servants’ "corruption" and "contamination" of the children, Miss Jessel’s suspected pregnancy and mysterious death, and Quint’s fatal, drunken fall. The governess’s obsessive struggle with the ghosts over the children culminates in Flora’s descent into a fever and a climactic battle with Quint over the soul of Miles, who dies of heart failure even as the governess asserts her triumph.

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Nicholas Baran, a one-time student activist, is now in his 40s, teaching at a community college in rural Connecticut after having been denied tenure at an Ivy League school. The tenure denial, despite consistent teaching awards and high performance was clearly politically motivated and instigated by a right-wing professor protecting his turf and the school from a labor-oriented, media-challenging progressive. Nicholas has leukemia, and, upon noticing that he appears to be living in a cancer cluster, begins a private investigation of the large chemical company located just upstream on the river that runs through the town near his neighborhood.

The investigation becomes more intense after he comes upon a local rescue squad retrieving the body of a small boy who has drowned in the river, but whose body reveals effects of considerable acid in the water. Though his wife fears for him and resists his efforts, even to the point of temporarily allying herself (and engaging in a dailliance with) a powerful local real estate broker, Nick finds an ally in his son's teacher, hesitant, but committed to finding out the truth.

Though Nick's disease is progressing rapidly, he and Sandy, the teacher, manage to break into the company's files and retrieve enough damaging evidence to expose deliberate deception of the public as well as documenting the high incidence of cancers in the immediate neighborhood. Before his death Nick manages to supply enough material to the major media to expose the scandal, and leaves a hard-won legacy of truthtelling to his children.

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These poems offer a rich series of impressions of the speaker's present life, surrounded by family, a garden, and pockets of natural life that evoke memory after memory of a childhood lived in relative poverty with a father whose years as a coal miner damaged his lungs and finally killed him. Allusions to his chronic and worsening illness and his death thread through the poems like a long shadow.

Recurrent images of his blood-stained handkerchief, his coal-smeared face and hands, are echoed in images of the death of an uncle, the deaths of animals, and of a mother strained by poverty and taking frugal measures to preserve small things. The final poem in the collection recalls her in old age, barely able to see, but still "stitching it all together."

The title poem, one of the best, pauses over the famous idea that the flutter of a butterfly's wings might be the source of large effects continents away. Together the collection invites us, without sentimentality, to consider how things are connected over time and come together in memory in compositions one couldn't have anticipated.

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In this first person narrative, Dr. Edward Haggard addresses his story to James, the son of his former lover Fanny Vaughn. Haggard, once a surgical registrar at a major hospital in London, has isolated himself in a coastal town, where he serves as a general practitioner. The "present" of Dr. Haggard’s story is the early stages of World War II, when James Vaughn, a Royal Air Force pilot, lies dying in Edward Haggard’s arms.

The story’s "past" has multiple dimensions. The outermost, framing story recounts the relationship between James and Edward that began several months before the war and a year or so following Fanny Vaughn’s death from kidney disease. James sought out the reclusive Dr. Haggard to discover the "truth" about Haggard’s relationship with his mother.

The inner story consists of Haggard’s description of his reckless and passionate love affair with Fanny, an ultimately hopeless liaison between a young registrar and the wife of the hospital’s senior pathologist. Their few brief months of happiness ended when Dr. Vaughn learned of the affair, and Fanny made the realistic choice to remain with her husband and adolescent son. In a confrontation between the two men, Vaughn knocked Haggard to the floor, causing a leg injury that resulted in chronic pain and permanent disability.

Haggard resigned from the hospital and withdrew to a solitary life, in which "Spike" (the name he gives to his deformed and painful leg) is his only companion. He must constantly "feed" Spike with intravenous morphine to quell the emotional, as well as physical, pain. The situation only worsens when Haggard learns of Fanny’s death from kidney failure.

The obsession worsens further still after James Vaughn shows up at his door. As Haggard treats the young pilot for a minor wound (he has become the local RAF surgeon), he notices that James has a feminized body habitus--gynecomastia, lack of body hair, broad hips, narrow shoulders, and pre-pubertal penis. He interprets this as "a pituitary disorder" and attempts to convince James that he needs treatment. James is repulsed by these advances, which eventually escalate.

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Set in 1894 and based on a history of the logging projects among the California sequoias, this is a story of Francie, whose sister died in an accident six years earlier. She chafes under her parents' excessive protectiveness since Carrie's death. She loves the woods, and longs to do something to keep the loggers from cutting down the ancient sequoias, especially the oldest and largest, a tree over 2500 years old. Through a little sleuthing based on her sister's diary, she finds out that the property on which the ancient tree sits actually belongs to an old hermit, not to the logging company.

In an effort to get the company to stop before cutting the oldest tree, she rides the dangerous log flume into town to alert the one journalist she knows will support her cause. They arrive in time to save that tree and some of the others, and, perhaps as importantly to Francie, her mother and father begin to see her not only in terms of their loss of Carrie, but as a young woman independently interesting, daring, and very much alive.

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This book interweaves an American love story with the development and repercussions of x-ray technology and atomic energy. It is an intriguing and beautifully written story. The setting is the southeastern United States, where the male protagonist, Fos, meets and marries Opal. Fos is a returning World War I veteran when the story begins; the story ends some years after the atomic bomb is dropped in World War II.

Fos is stationed in France during World War I. His assignment is to produce chemical flares. He shares a trench bunker with "Flash," the regiment photographer. After the war is over, Fos and Flash open up a photography shop in Flash's hometown of Knoxville, Tennessee. Fos is fascinated by natural phenomena such as phosphorescence, radiation, and the application of scientific discoveries for practical use. Flash is a good businessman and has a way with the ladies.

After Fos marries Opal, the three are in business together--Opal has accounting experience and handles the shop's "books." On the side, Fos and Opal have a traveling show that features an "x-ray box" where people can view the skeleton of their own feet. Opal is part of the show, on exhibit to demonstrate how this works as Fos x-rays her feet. A baby comes into their lives--they name him Lightfoot. The novel takes these characters and a few other connected figures through the 1920s into the Depression of the 1930s and formation of the Tennessee Valley Authority, to the work on the atomic bomb at Oak Ridge National Laboratory. Fos is recruited by the government to work at Oak Ridge--to take photographs. To say any more about the plot would spoil the pleasure of reading this absorbing book.

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Dr. Dymov is an earnest and rather boring young physician, who is preoccupied with his patients and his research. Olga, his wife, craves the excitement and gaiety of the artistic life. She discovers a new lease on romance with Ryabovsky, a colorful landscape artist, who takes her on a cruise on the Volga River. As they spoon under the stars, Olga and her lover make light of her bumptious stay-at-home husband.

After she returns from the cruise, Dymov forgives her infidelity, but in Olga's mind, his forgiveness proves to be another strike against the poor slob, since she just can't stand his complaisant devotion. She runs back to Ryabovsky for a while, until he makes it clear that he is bored with her.

Then one day Dymov develops diphtheria, evidently contracted by "sucking up the mucus through a pipette from a boy with diphtheria. And what for? It was stupid . . . just from folly." Dymov soon becomes delirious, and then dies. Suddenly, Olga is overcome with guilt and grief. Too late, Olga realizes that her husband was a hero.

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The headstrong beauty Marcella Boyce, who has acquired radical political views while at school, returns home and becomes engaged to Aldous Raeburn, the son of her father's neighbor Lord Maxwell and a moderately conservative politician and landowner. Marcella champions Jim Hurd, a local poacher accused of murder (who is prosecuted by Raeburn): she nurses his grieving wife and dying, consumptive son and arranges his legal representation by Edward Wharton, a Socialist politician and Raeburn's romantic rival.

After Hurd's execution, Marcella breaks off her engagement, trains as a nurse, and turns her reformist efforts toward the London poor instead of the rural poor in rural villages. She refuses Wharton's offer of marriage and finally accepts Raeburn's hand.

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