Summary:

A physician recounts an experience he had assisting an American plastic surgeon as he performed charity surgery in Honduras. One young woman, Imelda, dies of malignant hyperthermia prior to surgical repair of her cleft lip. After her death, the surgeon returns to the patient to finish the surgery. The narrator tries to imagine the surgeon's motivation for this act, as well as the family's reaction to it.

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Ruth Picardie was a journalist working in London. Shortly after her marriage in 1994 to Matt Seaton, also a journalist, she found a breast lump. After testing, she was told it was benign. Two years later, and a year after giving birth to twins, the lump enlarged and this time she was diagnosed with advanced, inoperable breast cancer. She rapidly developed bone, liver, and brain metastases and died in September 1997, aged 33.

This book consists of a selection of Picardie's e-mail correspondence during the last year of her life, the columns she wrote for the Observer newspaper (a series about dying she called "Before I say goodbye"), readers' letters responding to her column, and an introduction and epilogue by her husband. While not, then, strictly a memoir, this collection of texts constitutes an intimate view of a witty, angry young woman undergoing an intolerable illness.

The expected elements are there: diagnosis, chemotherapy, radiation, hope, the loss of hope. What is unexpected is the way these are presented, and the vividness with which we share the prospect of saying good bye to her children, her gradual detachment from her husband, and, as the brain metastases spread, the loss of coherence and the appalling silencing of her powerful voice.

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The Physician in Literature is an anthology edited and introduced by Norman Cousins that aims to illustrate the multiple ways in which doctors are portrayed in world literature. Literary selections are organized into 12 categories including Research and Serendipity, The Role of the Physician, Gods and Demons, Quacks and Clowns, Clinical Descriptions in Literature, Doctors and Students, The Practice, Women and Healing, Madness, Dying, The Patient, and An Enduring Tradition.

Some of the notable authors represented in this collection include Leo Tolstoy, Herman Melville, Albert Camus, William Shakespeare, Charles Dickens, George Bernard Shaw, Anton P. Chekhov, Orwell, Fyodor Mikhailovich Dostoevski, Ernest Hemingway, Thomas Mann, Gustave Flaubert, and Sir Arthur Conan Doyle. A healthy dose of William Carlos Williams makes for some of the most enjoyable reading ("The Use of Force" and excerpts from his Autobiography).

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The story begins in London as Lilia, the young widow of Charles Herriton departs for an extended tour of Italy, taking with her a companion (Caroline Abbott), who is supposed to keep her our of trouble. Lilia leaves her 8-year-old daughter Irma home with the Herritons. The Herritons are a snobbish upper middle class family ruled by an iron-willed matriarch, who has never approved of her daughter-in-law's unassuming and spontaneous nature.

The trouble begins when word arrives from the small town of Monteriano that Lilia has gotten engaged to an Italian man. Mrs. Herriton sends her son Philip to buy off the "wretched Italian" and bring Lilia home. But he arrives too late. The 32-year-old Lilia has already married Gino Carella, who is the unemployed son of a dentist and a decade younger than she is. Gino is charming and seems guileless, although he has no intention of adopting an English attitude toward marriage. Indeed, he has married Lilia for her money and expects her to become a proper Italian wife.

Later, Lilia dies in childbirth, but the baby survives. At first the Herritons intend to sever contact and not acknowledge the child. However, nudged by Miss Abbott, the unsuccessful chaperone, they decide to "save" the child from becoming an Italian. Once again, Philip goes to Italy to buy off Gino and bring the boy to England. Once again, he fails.

But this time, his aggressive sister Harriet intervenes; when all else fails, she steals the baby. Unfortunately, a mishap occurs, and the baby dies. Meanwhile, Philip has fallen in love with Miss Abbott who, in turn, has fallen for the recently remarried Gino. In the end it looks like Phillip and Miss Abbott will become "just good friends."

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Dr. Sacks was growing up in London during World War II and had a very traumatic experience when he was sent away from his home for protection from the bombing. He and his brother were sent to a boarding school, where they were beaten and underfed. Sack's home had been filled with a wonderful extended family of physicists, mathematicians, teachers, and chemists, in addition to his parents who were both practicing physicians. Being unusually bright and talented, Sacks responded to a wide variety of stimuli when he returned to this environment.

He became fascinated with the chemistry of metals and with the periodic table of elements. An uncle, for whom the book is named, was a manufacturer of light bulbs with tungsten filaments and encouraged him in setting up his own chemistry laboratory in the family laundry room, to do experiments. The family allowed him a great deal of freedom, which encouraged his creativity.

In writing about these experiences Sacks includes the history of the development of chemistry concepts that fascinated him. It was only much later that his interests moved on to the natural sciences and medicine. He says that his parents had been tolerant and even pleased with his early interests in chemistry but by the time he was fourteen they felt that the time for play was over. He kept a journal from the age of fourteen and took advantage of every opportunity to read broadly and experience nature, music and art.

In retrospect, however, Sacks felt that life was shallower after he left behind his passion for chemistry. He says that he dreams of chemistry at night. This description of such intense interest in the world around him and the people he read about or knew explains a great deal about his great success as a neurologist and as a remarkable story teller.

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In this collection, twenty-two authors take up the subject of wanting a baby and what happens to one's self-image and marriage/relationship when difficulties arise. All the contributors are accomplished writers--e.g. Amy Hempel, Michael Bérubé, Tama Janowitz--who tell stories of the miracles, disapppointments and sometimes horrors of the various reproductive technologies; the experience of childlessness when one/a couple desperately wants one; the joys of "success" via technology or adoption; what happens when every method fails.

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Sir Luke Fildes's eldest son Phillip died Christmas morning, 1877. He was attended by Dr. Murray, who directed all of his attention and care to the patient during the child's fatal illness. This unswerving dedication impressed Fildes.

Ten years later, when Sir Henry Tate commissioned Fildes for a painting to exhibit in what was to become the Tate Gallery, Fildes was given freedom to choose the subject matter. Fildes immediately decided to depict this scene of a family physician holding a bedside vigil by a seriously ill child. However, the painting was not begun for four years, and then only at the urging of Tate.

The shade of a lamp is tilted so as to bestow light on the two central figures: the physician, and especially, the recumbent child. The physician faces away from the bottled medicine and cup on the table and directs his gaze fully on the child. He is dressed neatly and sits calmly, patiently, resting his bearded chin on his hand.

The small child is central in the picture, in a white nightshirt on a large white pillow and covered with pale blankets. The makeshift bed consists of two unmatched dining room-type chairs. The child's hair is tousled and the left arm flung out, with hand supinated and beyond the edge of the pillow. Nonetheless, the child rests quite peacefully, as the pose appears quite natural.

To the right and rear of the painting are the parents. They are placed in such deep shadows that it is frequently difficult to make out these figures in reproductions. The mother sits at a table and hides her face in her clasped hands. The father stands beside her, with a comforting hand on her shoulder, as he gazes at the physician.

The painting is set in the interior of a small cottage. Rafters are low, furniture simple. Colors are muted; earth tones predominate. Although the majority of the light comes from the lamp, a bit of light also enters from the recessed window near the mother.

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The narrator stands working at her ironing board, responding mentally to a request someone (a teacher? a social worker?) makes of her regarding her daughter Emily, "I wish you could manage the time to come in and talk with me . . . She's a youngster who needs help." The woman's thoughts go back to Emily's birth during the Depression when she was only 19, and her thoughts range forward, haltingly, in piecemeal fashion, through her daughter's difficult childhood.

Due to the wages of loss, poverty and dislocation, a wall has grown up between mother and daughter--she has always wanted to love the sickly, awkward, stiff, and isolated girl, but has not been able to penetrate the wall. And then, she recalls, out of nowhere Emily won first prize in her school amateur show. The girl is a natural performer, a wonderful comedienne, who now is in demand throughout the city and state.

Suddenly, Emily appears on the scene. "Aren't you ever going to finish the ironing, mother?" She says that she wants to sleep in the morning, even though this will make her late for mid-term exams. Near the end of the story the narrator imagines telling her interlocutor, "Why were you so concerned? She will find her way." But then she implores, "Only help her to know--help make it so there is cause for her to know--that she is more than this dress on the ironing board, helpless before the iron."

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Malcolm Vaughan, an architect, his wife, Sarah, a biochemist, and their five-year-old son, Harry, are driving home one evening. The driver of the car in front of them is acting strangely. Malcolm goes to investigate and the driver shoots him dead. The novel traces the effects of Malcolm's death from the alternating points of view of his wife and his best friend, Deckard Jones, a black Vietnam vet. Following different and often conflicting trajectories but linked by their love for Harry, both Sarah and Deck begin to move from traumatized shock to the beginnings of recovery.

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This is a cluster of seven short poems focusing on the response of husband to the diagnosis, treatment, and prognosis for the future of his beloved wife who has breast cancer. For example, "The Cloud" speaks of the passage of the uncertain weeks and years: "And into this idyllic time breast cancer crept. . . Wonder if it’s coming back. It’s life writ small / You don’t know what’s around that curve. . . ."

"For Rosemarie" is a plea for strength, while "Mommy’s Getting Chemo" contemplates the stance of the couple’s very young son. "Lymphedema Hand" is a loving tribute to the power and competence of the altered body of the woman. In all, the collection is forthright, painfully frank, while sustained by the gentle love that propels it.

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