Summary:

In this autobiographical novelization of a seven-year psychoanalysis the protagonist recounts the life story that led to her psychosomatic symptoms, and the medical and psychiatric story that led to her analysis. Her early relationships, particularly with her mother, her life in French Algeria in the 1930's to 1950's, and her adult relationships as wife and mother, are told through the associative processes of psychoanalysis as the protagonist grows into a healthy, fulfilled woman and writer. Cardinal beautifully illustrates the joy and rebirth in finding the words to say it.

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This story concerns the death of a child and failures of communication. Scotty, an eight year old, is hit by a car on his birthday. His mother had ordered a birthday cake but "there were no pleasantries between" her and the baker. Scotty is hospitalized, unconscious, and the cake is forgotten. Dr. Francis reassures the anxious parents that all will be well when the boy wakes up.

The baker phones the parents’ home in the dead of night (when he does his baking) because the cake hasn’t been picked up, but they can’t figure out who he is or what he wants. At the same time the doctors and staff can’t and won’t answer their questions about why Scotty isn’t waking up. Dr. Francis comes to the hospital to check the child, looking tanned, meticulously dressed, as if he has just been out for the evening- he has a life outside of the hospital, but the parents have none. When they do run home, separately, to take a break, the baker torments them with his mysterious late-night calls. Their confusion and isolation deepen. The child dies-"a one-in-a-million circumstance."

The mother finally realizes that it is the baker who has been calling and tracks him down, enraged. She unleashes all of the anger which she had been unable to express to the doctors. The baker is stunned to learn about the child’s death; he begs forgiveness and offers them warm delicious cinnamon rolls. "Eating is a small, good thing in a time like this" and they are comforted.

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This short story opens with an irritated and sometimes hostile narrator whose wife has invited a blind friend to spend the night. The narrator tells us immediately that his visitor's blindness bothers him and that he is not looking forward to having a blind man in his house. The vehemence of his prejudice is surprising. His initial anger and anxiety seem way out of proportion to the situation, as if this blind man were threatening him somehow.

Gradually, as the evening wears on, the narrator begins to relax with the blind man, though he still challenges him in all sorts of ways, such as drinking, smoking cigarettes and dope, and turning on the TV (which, of course, the blind man cannot see). A documentary about cathedrals is showing. The narrator tries to describe a cathedral in words. When that doesn't succeed, the blind man holds the narrator's hand as he draws a cathedral on a paper bag. The experience of this successful communication transforms the narrator.

As the blind man says, "Terrific. You're doing fine. Never thought anything like this could happen in your lifetime?" The narrator closes his eyes and draws blind, saying, "So we kept on with it. His fingers rode my fingers as my hand went over the paper. It was like nothing in my life up to now." The ending leaves us pondering about how much more the narrator is learning about himself and about human communication than the blind man is learning about cathedrals.

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This autobiographical account of Dr. Lown's five decades of practice and research in cardiovascular medicine is both a history of the field and a history of a man passionately interested in people and healing. The book is divided into six sections: Hearing the Patient: The Art of Diagnosis; Healing the Patient: The Art of Doctoring; Healing the Patient: Science; Incurable Problems; The Rewards of Doctoring; and The Art of Being a Patient.

The first three sections comprise the bulk of the book: Lown chronicles his early medical training and career through stories of memorable patients, anecdotes about key role models (particularly Dr. Samuel A. Levine), and histories of medical mistakes, diagnostic acumen, and his remarkable research innovations. These achievements include the introduction of intravenous lidocaine, cardioversion and defibrillation, and development of the coronary care unit.

The core of the book, however, is about how deeply Lown cares for his patients. He states, “This book is a small recompense to my patients, ultimately my greatest teachers, who helped me to become a doctor.” The book contains many reflections on medical practice, such as this definition of medical wisdom: “It is the capacity to comprehend a clinical problem at its mooring, not in an organ, but in a human being.”

In a thoughtful chapter on death and dying, Lown muses on his emotional and spiritual responses to encounters with death, and bemoans the medical profession's increasing tendency to “put technology between us and our patients, to spare us the grief of failing to confront our own mortality.” In the final chapter, Lown takes an unusual twist, and writes a treatise to patients on how to get the doctor to truly pay attention to them and what are reasonable expectations to have of one's doctor.

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This book offers an insightful, well-reasoned interpretation of the nature of medicine. Hunter, an English professor who teaches and coordinates humanities programs at a medical school, observed first-hand how an academic medical center functions--she joined various teams during their multiple rounds and conferences for two years. In sum, she "behaved rather like an ethnographer among a white-coated tribe." The resultant book details the profound importance of narrative in medicine.

Narrative is integral to the medical encounter, to communications by and about the patient, and to the structure and transmission of medical knowledge. For example, the patient's story is told to and interpreted by the physician, who then tells another story of the patient, in case format to other physicians, and records that story in a formulaic chart entry. Hunter observes that most of the rituals and traditions of medicine and medical training are narrative in structure, and explains why narratives such as cautionary tales, anecdotes, case reports and clinical-pathological conferences are central, not peripheral, to medicine. The thesis is further developed to maintain that, if the narrative structure of medicine is fully recognized by physicians, they will attend to their patients better and acknowledge the details and importance of their patients' individual life stories.

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In this poem a patient speaks to "Dr. Green," commenting on how much she likes him compared to her earlier doctor, "Dr. Gold," who wore a long face and would never smile. "Dr. Gold has track shoes on" but to Dr. Green she says: "You never seem / to be in a hurry even // though you're so busy . . . . " The patient would like "a little rest / before the next treatment, at least till / I'm stronger."

In the companion poem, "Dr. Gold & Dr. Green, II" (also found in One Word), the physician responds to his patient, Eleanor, who presumably wrote the first poem. He realizes that he himself is actually Dr. Green and Dr. Gold. Even though he tries to spend time with his patients, he now realizes that sometimes he must have appeared hurried and distant: "You tried / to say that each of us has two sides. / I wish I understood this before you died."

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Dunn's poem describes the choreography of married couples after an argument. The narrative voice considers how silence is imposed, then broken and how two people eventually come together after an unpleasant exchange of words. There are, according to the speaker, unspoken rules and rituals. First, a long silence permeates: after all, "whoever spoke first would lose something." In this household drama there is meaning to the clanging of dishes, sleeping arrangements, and accidental touching.

Eventually, one or the other is careless, spontaneously and shamelessly breaking the Yalta-like stalemate with an observation about something ordinary such as a "cardinal on the bird seeder." An accidental comment secures a truce, bringing the couple together in sex, a "knot untying itself."

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Sometimes communication is best served when it doesn't communicate baldly and precisely. In this 12 line poem "a daughter comes in late / and you don't say exactly what you feel . . . ." You tell a patient "the x-ray showed / little change, knowing they won't ask / if the lesion's a little smaller or larger."

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The patient lies in the hospital after having a stroke. The "word" is the patient's best friend, but suddenly it's become what "you can't say." "You lie flat / in the white yards of the clinic" unable to find the word. Like a dog, it "drags its chain over the emptied / bowl, barks," but the patient is unable to call it or command it. The stroke victim must simply wait and listen.

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