Summary:

The protagonist of this story is Yakov Ivanov, an ill-tempered old coffin-maker, who hates Jews. Yakov is also a fiddler, but rarely gets to play in the village orchestra because of his antagonism with Rothschild, the flautist. Rothschild is certainly no beauty, a "gaunt, red-haired Jew" with "a perfect network of red and blue veins all over his face."

When Marfa, Yakov's wife of 52 years, becomes ill, Yakov fatalistically builds her coffin in preparation for her death. After she dies, he is "overcome by acute depression." When Rothschild visits him on a friendly errand, Yakov beats up the poor man, yelling, "Get out of my sight!" Afterward, Yakov goes and sits by the river and tries to figure out why he has become the scolding, ill-tempered old man that he is.

Unfortunately, he develops a chill from the exposure. The next day he falls mortally ill with pneumonia. When Rothschild appears at the house again, he is surprised to find Yakov playing the fiddle with tears gushing from his eyes. Later, Yakov tells the priest who has come to confess him, "Give the fiddle to Rothschild."

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This thorough and fascinating treatment of the politics of anatomy studies in 19th-century America provides a variety of perspectives on the vexed question of how appropriately to study human anatomy while also maintaining respect for the human body and honoring the various, deeply held community beliefs, and attitudes toward treatment of the dead. Sappol seeks, as he puts it, to "complicate the cultural history of medicine in late-eighteenth- and nineteenth-century America. . . by telling it from an anatomical perspective."

That statement of his objectives hardly suggests the startling range of approaches to the topic he takes in the book's nine chapters. These cover such issues as the legacies of belief about the "personhood" of the dead human body; the status of anatomy as both a legitimate and valuable study and also as an "icon of science"; the relationship of dissection and anatomy study to medical status and professionalization; the political tensions engendered by the "traffic in dead bodies" that most often expropriated corpses from marginalized communities; and the relationship of anatomy studies to sexual commerce and sensationalist fiction.

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This gripping narrative traces the history of the efforts to eradicate smallpox in the 1970s, the top-level decisions to keep a few vials of it for emergency purposes in American and Soviet freezers, and the reemergence of smallpox not only as a health threat, but as a potential bioweapon of unequaled destructive power. Preston details maverick natural cases that surfaced after worldwide eradication efforts, how it was discovered that undocumented reserves of smallpox were not only being kept, but researched and possibly "weaponized," and how hotly, in the US, teams of scientists and military intelligence personnel debated funding new smallpox research in the US with a view to developing a new vaccine as a defense.

The ethical issues in those debates are unprecedented in the scope of the possible public health threat and the variables that might make traditional vaccination ineffective against the weaponized virus. As in his previous books on biological threats, The Hot Zone and The Cobra Event (see annotation), Preston follows the work and lives of several key scientists and includes scenes from interviews with a variety of persons involved in confronting the political, ethical, and medical dilemmas posed by smallpox research and efforts to track and control it.

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The subtitle of this memoir is "Meditations upon Returning." Richard John Neuhaus is a Catholic priest and scholar, director of the Institute on Religion in Contemporary Life in New York City and described on the book cover as "one of the foremost authorities on religion in the contemporary world." The book is a meditation on his near-brush with death as a result of colon cancer.

As Fr. Neuhaus describes it, he underwent two colonoscopies to ascertain the cause of persistent abdominal symptoms, but in both cases his colon was pronounced completely normal. However, shortly thereafter, he developed extreme abdominal pain and was taken to the hospital, where emergency surgery was performed and a colon cancer the size of a "big apple" was removed. During the first procedure, the surgeon nicked his patient’s spleen, so a second emergent procedure was required to control hemorrhaging.

The two procedures left Fr. Neuhaus very near death, but he gradually recovered over a period of several months. When introducing the story of his illness, the author comments, "several lawyers have told me my case would make a terrific malpractice suit." (p. 79) But he says he won’t sue, because it would "somehow sully my gratitude for being returned from the jaws of death." (p. 80) In fact, he has considerable praise for his surgeon.

The narrative of Fr. Neuhaus’s illness occupies a relatively small proportion of this memoir. The first three of seven chapters consist of the author’s reflections on the meaning of suffering and death, and especially the existential question of "Why me, now?" (His answer is "Why not?) In chapter five Fr. Neuhaus describes a near-death experience that changed his life, a scene in which he heard two "presences" tell him, "Everything is ready now." In much of the rest of the book, the author examines and rejects the possibility that the experience was a dream or an hallucination. He is convinced that he witnessed the "door" to a more glorious life after death, and this has, in some sense, profoundly changed his present life.

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This poem, told in the voice of a troubled, angry teenager, describes her determination to control her eating and her body. The eight, eight-line stanzas each repeat the same words at the end of the lines, in a modified sestina form, so that emphasis falls on the same eight words: "disappear," "smile," bones," "fat," "mother," "touch," "person," "guts." By the end of the poem, the girl is clearly suicidal and unable to control her anorexia.

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The narrator's father is in the hospital awaiting surgery that might be his last. She and her sister have been coming to the hospital regularly during his prolonged stay, and have become familiar with the cast of characters there, including an old man in a state of dementia who wanders the halls asking directions. The narrator reflects on her family, what can be spoken of and what can't, the different reactions they have to hospital regulations, crisis, impending loss.

She longs to tell her father she loves him, but is constrained by family reserve. As the family gathers at his bed before the surgery, she comes to realize some things will never be fully expressed, but must remain implicit. The unspoken is part of the loss she recognizes as she faces her father's death.

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When literature and cultural studies professor Michael Bérubé's son James was born in 1991, he was diagnosed with Down Syndrome. Negotiating various medical, social, and educational environments and the identities each assigns their son, Bérubé and Janet Lyon (his wife, a literature professor and former cardiac-ICU nurse), become effective advocates for Jamie and embark on a course of questions about the social systems that produce disabled identities and administer to those human differences termed significant ones. Bérubé engages these questions with a mixture of family experience (his own, and that of other families with disabilities), historical research, critical theory, and sophisticated critical analysis.

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This masterful collection of essays was written by Gawande while he was a general surgery resident. The book consists of fourteen essays divided into three sections: Fallibility, Mystery, and Uncertainty. Although some of the essays fall clearly within the boundaries of the section title (such as "When Doctors Make Mistakes" and "When Good Doctors Go Bad" in the Fallibility section), others cross boundaries or don’t fall as squarely in these general themes ("Nine Thousand Surgeons," an anthropological essay on the cult and culture of a major surgical convention, is also located in the Fallibility section). Nevertheless, the many pleasures of the individual essays, the range of topics explored in depth, and the accuracy of the medicine portrayed are the true strengths of this work.

The book begins Dragnet-style with an Author’s Note: "The stories here are true." (p. 1) And it is this attention to fidelity that makes the essays so compelling. Because even when the truths are hard--the terrible acknowledgment by the medical neophyte about lack of skill and knowledge, the mistakes in judgment at all levels of doctoring, the nature of power relations and their effects on medical pedagogy and on the doctor-patient relationship, the gnawing uncertainties about so many medical decisions--the author confronts the issues head on with refreshing rigor, grace and honesty.

Many of the essays reference scientific and medical research (historical and current) as part of the exploration of the topic. This information is imbedded within the essay, hence avoiding a dry recitation of statistical evidence. Typically, the reader’s interest in an essay is immediately piqued by a story about a particular patient. For example, the story of an airway emergency in a trauma patient, her oxygen saturation decreasing by the second as Gawande and the emergency room attending struggle to secure an airway, surgical or otherwise, sets the scene for "When Doctors Make Mistakes."

This leads to a meditation on not only the culture of the Morbidity and Mortality Conference, with its strange mix of third-person case narrative and personal acceptance of responsibility by the attending physician (see Bosk, Charles, Forgive and Remember: Managing Medical Failure, U. Chicago Press, 1981 for an in depth analysis of this culture), but also a positive examination of the leadership role that anesthesiologists have played in improving patient safety via research, simulator training and systems improvement.

Gawande’s journalistic verve takes him beyond the confines of his own hospital and training to interview patients and physicians on topics as diverse as incapacitating blushing ("Crimson Tide"), chronic pain ("The Pain Perplex"), malpractice and incompetence ("When Good Doctors Go Bad") and herniorraphy ("The Computer and the Hernia Factory"). In addition, he visits his own post-operative patients at home ("The Man Who Couldn’t Stop Eating" and "The Case of the Red Leg") which gives a longer view of postoperative recovery and a broader exposure to patients’ perspectives.

Some of the most telling moments come with the introduction of his children’s medical problems into the text. These range from the relatively straightforward (a broken arm, but a chance to comment on detection of child abuse in the emergency room) to the downright parental nightmare scary (severe congenital cardiac defect in their oldest child and a life-threatening respiratory infection in their prematurely born youngest).

These last two experiences are introduced to provide an angle on issues of choice. Choice of a fully trained, attending physician rather than a fellow to provide follow-up cardiac care for their oldest, and the choice to opt out of the decision-making process for whether to intubate the trachea of the youngest and hence leave the medical decisions up to the care team.

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This history play narrates the rise to power through treachery and murder of Richard Plantaganet, Duke of Gloucester and last king of the House of York. Set in England during the Wars of the Roses (1455-1485), the play opens after the Lancastrian King Henry VI and his son Edward have been killed and Richard’s brother has been crowned Edward IV.

In the course of the play, Richard woos and wins Prince Edward’s widow Anne Neville and engineers the murders of his other brother (George, Duke of Clarence), his nephews, his closest advisor, possibly his wife, and other members of the court. He is crowned king but later dies a violent death in the Battle of Bosworth, defeated by Henry Tudor, Duke of Richmond, who will become the first Tudor King Henry VII.

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When Gerald is three, his mother, a drug addict, leaves him alone one time too often and he accidentally sets the apartment on fire. His mother is imprisoned for negligence, he goes to the hospital, and thereafter lives with "Aunt Queen," a great-aunt who exercises considerable authority from her wheelchair, and gives him all the love his mother hasn't.

When he is 9, however, his mother returns with a new sister and a man who claims to be the sister's father. They want to take him "home"; Gerald wants to stay with Aunt Queen. The matter is settled unhappily when Aunt Queen dies of a heart attack.

Gerald soon learns to despise his stepfather for his violence and, eventually, for the abuse of his half sister, which she hides out of fear until she's driven to confess it to Gerald in hope of his protection. Their mother remains in denial about that problem as well as her own and her husband's addictions to alcohol and drugs.

Caring for his sister, however, keeps love in Gerald's life. In defending her one last time, the apartment catches fire and his stepfather is killed. As he, his sister, and his mother ride away in the ambulance, a flicker of hope survives in the darkness for another new chapter in family life, this time without violence.

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