Summary:

Thirteen-year-old Charles has been sick with a fever for days. The family doctor makes house calls and diagnoses the problem as scarlet fever and a cold. The boy is unconvinced and questions the physician's certainty since no diagnostic tests have been done. Charles is terrified when first his hands and then his legs change. He senses that his extremities become swollen, warm, throbbing, and twitching. Although the limbs appear normal, Charles is sure that he no longer has control of them. Recalling how the wood of petrified trees transforms into stone, he now fears that his entire body has been irrevocably replaced by a propagating mass of microbes.

The doctor dismisses the boy's fright as the result of fever and imagination. He placates Charles by giving him pills. When Charles begins choking himself, his parents restrain him in bed. Fortunately, the teenager improves dramatically. His fever disappears, and he is suddenly robust. Yet there is something odd (and a bit creepy) about Charles following his recovery.

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A screening chest X-ray reveals the presence of a cardiac myxoma in a 72-year-old dictator. His personal physician (fearing for his own life) timidly informs Mr. President about the tumor and the likelihood that it will claim the dictator's life in a matter of months. The physician lacks the training and ability to remove the tumor but recommends Dr. Gala Sampras as the surgeon most qualified to perform the procedure.

Slight problem: Sampras was one of 14 surgeons who "disappeared" in 1992 after criticizing the dictator and his regime. She was imprisoned and abused in a labor camp. Her husband and three children were also removed from society. A bargain is struck. Sampras will do the operation. After the surgery is done, she will be reunited with her family.

The dictator shows Sampras pictures of her family. Although the photos of her children appear to be recent, the picture of her husband seems to have been taken years ago. On the day of surgery, the dictator directs the doctor's attention to the courtyard where soldiers surround her daughter. Sampras realizes the dictator might not survive the operation given the complexity of the procedure and the patient's age. Before succumbing to his anesthesia-induced sleep, the dictator is told by Sampras not to worry, but her every move is closely monitored by his soldiers. The night is likely to be long and hard for the doctor and the dictator.

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Atul Gawande, a surgical resident at Harvard Medical School, asks in his well written essay, "when you see your patient making a grave mistake, should you simply do what the patient wants?" (p. 86) He answers this question by sharing a number of cases from his training that suggest that the orthodoxy of 'absolute respect for patient autonomy' may interfere with good patient care.

Gawande also gives the reader insight into the difficulties that young residents especially have in developing an artful approach to medical practice. He suggests that part of respecting autonomy is (at appropriate times) allowing patients to cede that autonomy to an authority figure. He argues further that, "patients frequently don't want the freedom that we've given them." (p. 89)

He also shares in his essay a personal experience with his youngest child. She was a premature baby who at eleven days old ended up in the intensive care unit. He was glad to put the ultimate decision(s) of how to care for his daughter in the hands of physicians--"they could live with the consequences, good or bad." (p. 90)

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Gerald Wilcox is an otolaryngologist who lives with his wife and daughter in a small town in Montana in 1959. Dr. Wilcox has a weakness for women, alcohol, and, lately, morphine (with which he injects himself about once every six weeks). He enjoys writing in his journal almost every evening yet rarely reviews what he has previously written.

Although high on morphine, Dr. Wilcox repays a debt by making a house call late one night to treat a young boy with mastoiditis. On returning home, the doctor decides to bake a coffee cake for his wife at 5 o'clock in the morning while musing on what will happen to his journals after he dies.

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Summary:

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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Subtitled "What happens when patients find out how good their doctors really are," this article starts with an important statement: "Every illness is a story, and Annie Page's began with the kinds of small unexceptional details that mean nothing until seen in hindsight."

This is the introduction to a look at a child with cystic fibrosis and how her family sought the best care for her.

The author, Dr. Atul Gawande, goes on not only to tell their story but also the story of the way in which the understanding of this disorder has increased and the unusual rigor with which centers that specialize in the disease are evaluated.

He also includes stories of other sufferers to emphasize the importance of surveillance of their care.

These stories allow him to generalize about the way physicians' care is evaluated in general by the public and our medical organizations and how difficult it is to be at the high end of the Bell Curve. The author concludes, "When the stakes are our lives and the lives of our children, we expect averageness to be resisted."

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This memoir of Bayley's life with novelist Iris Murdoch who, in 1994, began exhibiting signs of Alzheimer's disease, is divided into "Then" and "Now," with emphasis on the "Then." Bayley admits that their independent lifestyles, which had both bound them and allowed them freedom, kept him from knowing the "real" Murdoch; sadly, the novelist is almost as much an unknown to him as to us. He speaks of Murdoch's lack of any sense of superiority and her disinterest in social or artistic success; she simply did her work.

In the brief section titled "Now," Bayley presents seven episodes of their life together between January and December 1997. These pictures of Murdoch lost and at sea, following him around, uttering "mouse cries," collecting pebbles, moss, sticks, dead worms, and asking over and over "When are we going?"--these will be familiar to Alzheimer's families, as will his sometimes rage and his constant sense of frustration and loss.

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Summary:

J.J.’s parents are both deaf, so he grew up with Auslan (Australian sign language) as his native "tongue," although he is not deaf and speaks English perfectly. After a disastrous marriage, J.J. returns to live with his parents and to teach sign language at the Deaf Institute. Two students in his beginners’ class befriend him. They are Clive, an elderly man world renowned as a leader of the animal rights movement, and his much younger wife Stella, who is a poet. They soon present J.J. with a mysterious proposition: would he be willing to provide private lessons for their "step-daughter" at their home? We soon learn that their "step-daughter," Wish, is actually a young female gorilla, which they "rescued" from a research laboratory.

At first J.J. is reluctant because he is aware that the purported mastery of signing by non-human primates is not only controversial, but very limited, even if true. However, he discovers that Wish has remarkable cognitive abilities. She learns Auslan quickly and even begins to converse using metaphor and expressing complex topics.

Eventually her story is revealed. She had undergone fetal surgery to remove her adrenal glands, which evidently limit cortical growth in gorillas. Unconstrained by her adrenals (although receiving daily cortisone injections), Wish has developed intelligence far beyond that of other gorillas.

Nonetheless, she is still a sexually mature female gorilla. She falls in "love" with J.J. who, after initially rebuffing her, mates with her. J.J., by the way is quite obese, and so he is much more attractive to Wish than the other human males she encounters, who are all so un-gorilla-like. J.J. and Wish live in connubial bliss for a brief period, until Clive decides to prosecute J.J. for sexually abusing his gorilla, since presumably gorillas cannot give informed consent to sexual activity with humans. (Of course, Wish can and does, because of her super brain, but this concept is a bit too subtle for the frenzied media and the legal system.) After J.J. is arrested and she is removed to a local zoo, Wish becomes depressed and commits suicide. Clive drops the charges, after which the story lumbers to a generally unhappy ending.

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Doctors Everett and Mimi Menlo are psychiatrists living in Toronto. The married couple sleeps in separate beds. They vow never to work as a team or in the same medical facility. Each doctor is deeply troubled by a patient who refuses to communicate. For Mimi, it is Brian Bassett, an eight-year-old boy with autism who eventually dies under her care. For Everett, it is Kenneth Albright, a hospitalized patient with severe paranoid schizophrenia who has attempted suicide four times.

Kenneth's dreams were once complex and intriguing but lately they lack detail and variety. One morning, he is found covered with blood but has no signs of injury. Despite a thorough investigation, it remains a mystery as to whose blood it really is. Following that strange occurrence, Everett experiences insomnia, but he is reluctant to admit the cause to Mimi. She worries that he might be having a nervous breakdown.

In truth, he fears dreaming. He has recurrent nightmares of a bloody Kenneth kneeling next to the bodies of strangers. Everett suspects that Kenneth has placed these corpses in his dreams. Everett finally tells Mimi about his nightmares. He shocks her with the revelation that Kenneth Albright has genuine bloodstains on his clothing and hands every day even though he is still confined to the psychiatric ward. There is only one spot Kenneth can escape to--dreams. After their conversation, Mimi falls asleep and dreams of Brian Bassett. She wakes up and finds Everett in the bathtub. His pajamas are saturated with blood. Mimi promises Everett, "I'm waiting here . . . until we both wake up" (596).

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Summary:

In poetry and prose the writer chronicles her father's final months as Alzheimer's disease progressively seals him into a world where those who love him can't follow. Each short segment details a moment on the writer's journey as witness to his losses: moments of confusion--his and her own, uncertainty about appropriate diplomacy, invention of new activities and rituals to keep him linked to love and alive.

With sure, spare language, she sketches in her own memories, bits of family stories, irrational feelings, the different way she comes to look at home, at family relationships, even at familiar objects. More a song than a story, the collection of vignettes offers both comfort and realism to those on similar journeys of slow loss.

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