Summary:

In the title story of this collection, "Survival Rates," a husband's thyroid cancer appears to be a greater threat to his marriage than it does to his health. The young girl who survives an accident in "Jumping" ends up a casualty anyway. In "Howard Johnson's House," a plastic surgeon repairs a nine year old girl's nose after it is severely damaged by a dog bite. Even before the injury, however, the child's nose was hideous. When the surgeon gives her a cosmetically perfect nose, the girl's mother is not merely disappointed but outraged. Two girls must adapt to life after colon surgery in "Krista Had a Treble Clef Rose."

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The title story, "In the Gloaming," recounts a mother's final weeks with her 33 year old son who is dying from AIDS. Janet realizes that "the enemy was part of Laird, and neither he nor she nor any of the doctors or experts or ministers could separate the two." (p. 29) He dies at home with his mother next to him.

"Home" depicts the struggle of an elderly woman in the early stages of Alzheimer's dementia who is being coerced by her family to live in a nursing home. She immediately understands that living there would essentially kill her.

In "Watch the Animals," Diana Frick is a wealthy animal lover who has no interest in human relationships. After being diagnosed with lung cancer, she refuses conventional treatment and continues to smoke cigarettes. Surrounded by her pets, she commits suicide by drug overdose but not before she has arranged new homes for all her animals.

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In 1929, a Danish physician identifies a new strain of smallpox that is capable of infecting and killing even those individuals who have previously been vaccinated against the disease. Before this incurable plague reaches them, the citizens of Vaden, a prosperous town renowned for their fanatical love of children, unanimously agree to barricade the city from the rest of the world.

Only once during this time when Vaden has quarantined all of Denmark does the town make an exception. A traveling European circus is allowed into the city because the mayor cannot bring himself to refuse its sick children. Unbeknownst to the villagers, a dwarf clown who is the featured performer of the circus has just died from the virulent strain of smallpox, but not before introducing it to Vaden. A 12 year old member of the circus successfully impersonates the dead clown. One night, the imposter with his wooden flute leads the children out of Vaden through a gate in the wall.

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Denny and Susan McCready are a young couple whose newborn son has cystic fibrosis. They take him home to the farm, where they live with Denny's father. For several months Denny can barely bring himself to touch the baby, because he is afraid to develop too close a relationship with a child condemned to an early death.

After the boy dies, the grief-stricken Susan drifts away from her husband, finally leaving the farm and moving into town. Denny, too, is lost. He buys a small boat--something his father always objected to--and cruises on the river. One day Susan returns. "I want to come home," she says. (p. 196) "I sometimes think that all of us out here just gave up a little early." (p. 204) They endure.

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This fine collection of nine stories--the author's first--offers the reader a variety of experiences that are both familiar and foreign. All concern Southeast Asian Indian (often Bengali) protagonists living either in India, or after transplantation, in the United States. All provide rich descriptions of the details of Indian life, and of cultural values and customs. While the domestic routines (for example, Indian food and cooking provide an important backdrop in several stories) may be unfamiliar to American readers, the style and themes of Lahiri's writing are highly accessible, absorbing, and moving.

Most of the stories are written from a perspective that is between cultures. The characters are not traumatized refugees but are negotiating a path in a country (America) that seems to provide opportunities ("A Temporary Matter," "The Third and Final Continent," "Mrs. Sen's," "When Mr. Pirzada Came to Dine"); or they are the Americanized children of such Indian families ("Interpreter of Maladies," "This Blessed House"). Ties to the Asian sub-continent may be strong or weak, primary text or subtext, but they are ever-present. Living between cultures lends an extra layer of complexity to situations and relationships that are difficult in and of themselves.

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Raina is 17, living alternately on the streets with a boyfriend addicted to hard drugs and at home with an abusive mother, also an addict. She has been victimized by a succession of her mother's live-in boyfriends and lost a young brother to an accidental overdose: he swallowed some of his mother's pills while the mother slept and seven-year-old Raina was watching him.

Margaret Johnson is 45, Raina's teacher at an underfunded, overcrowded public school where Raina's life of squalor is more typical than not. Her own story is told in chapters that alternate with Raina's story and with the texts of autobiographical compositions Raina gives her but refuses to discuss. Only when Raina finds herself pregnant, shortly after her boyfriend has been killed in a drug-related accident, does she take Ms. Johnson up on her repeated offers of help.

She lives at the teacher's home for awhile, runs away to her own home, unused to kind treatment and afraid she'll disappoint the teacher and be thrown out, goes to a shelter, has her baby, and finally returns, having nowhere to go. Ms. Johnson, with some hesitation, takes her and the baby in and the three begin to work out a life together, knowing it will involve difficult change, but willing to bet on love against the odds.

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Gottlieb, nearing thirty years old, discovered her childhood diaries in a closet in her parents' home as she searched for some chemistry notes to aid in her quest to attend medical school. This book is "based on diaries" she wrote when she was diagnosed with and underwent treatment for anorexia nervosa. It is the writing of a precocious, strong-willed preteen who enjoys chess, being unique, writing, and getting straight A's in school, yet who is lonely and desperate to fit in and be popular.

Lori is eleven years old, lives in Beverly Hills, California with her fashion-conscious, loves-to-shop mother, her somewhat distant stockbroker father, her older brother David who now is into music and friends and not-Lori, and her best friend Chrissy, a pet parakeet. Lori's diary entries are filled with astute observations of adults (teachers, parents, relatives, medical personnel, even a television star she meets, Jaclyn Smith) and classmates.

She is wry and witty. An early entry gives an English essay she rewrote to get an "A". These "power paragraphs" are generously and hilariously sprinkled with "proper transitions" such as "to begin with", "moreover", and "on the other hand" that her teacher insists are necessary for readability. This essay provides telling insights about Lori's perceptions of her family, particularly (note transition word) her mother's superficiality.

Lori is surrounded by messages of the glories of thinness for women. Every female she encounters, from peer to adult, is on a diet, counts calories, avoids desserts and gossips about how other women and girls look. The culture is not only anti-obesity, but pro-superthinness. Hence it is logical that Lori, angry about being taken from school to go on a family trip to Washington, D.C., begins her rebellion and search for control by skipping meals and dieting.

She gets the attention she craves from her parents. Her schoolmates ask her for diet advice and admire her weight loss. Self-denial, obsession with calories (that she believes can even be gained by breathing), and secret exercising lead to an alarming weight loss in this already skinny kid.

Her mother takes her to the pediatrician, who prescribes whole milk which Lori refuses. He refers her to a psychiatrist, who eventually hospitalizes her for behavior modification, observation, and a possible feeding tube. At the hospital, Lori meets medical students, nurses and fellow patients, but becomes progressively more depressed, dehydrated and lonely. She attempts to run away and makes a suicide gesture. Finally, she sees herself for what she has become--an emaciated stick figure.

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The author, a Canadian physician-historian-educator, blows the dust off the shelves of medical history with this fascinating text designed for medical students, educators, and those with an interest in history of medicine. Duffin begins this survey of the history of Western medicine with a glimpse at a pedagogical tool designed to spark the interest of even the most tunnel visioned medical students: a game of heroes and villains. In the game, students choose a figure from a cast of characters selected from a gallery of names in the history of medicine.

Using primary and secondary sources, the students decide whether the figures were villains or heroes. The winner of the game is the student who first recognizes that whether a person is a villain or hero depends on how you look at it. This philosophy imbues the entire book, as this treatise is not a tired litany of dates, names and discoveries, but rather a cultural history of the various times in which medical events occurred.

The book is organized by topics which roughly follow a medical school curriculum: anatomy, physiology, pathology, pharmacology, health care delivery systems, epidemiology, hematology, physical diagnosis and technology, surgery, obstetrics and gynecology, psychiatry, pediatrics, and family medicine. The last chapter, entitled "Sleuthing and Science: How to Research a Question in Medical History," gives guidance to formulating a research question and searching for source material. Fifty-five black and white illustrations are sprinkled throughout the book, as well as 16 tables.

Direct quotes from historical figures, such as Galen and Laennec, as well as excerpts from writings of eyewitnesses of events, anecdotes and suggestions for discussion, appear in boxes within the chapters. Many of the chapters contain discussion about the formation of professional societies. Each chapter ends with several pages of suggested readings and the third appendix delineates educational objectives for the book and individual chapters. The other two appendices list the recipients of the Nobel Prize in Physiology or Medicine, and tools for further study, including titles of library catalogues, and resources in print and on-line.

Although the book is a survey covering multiple eras and topics, each chapter contains choice tidbits of detail. For instance, the chapter on obstetrics and gynecology includes the story and photograph of Dr. James Miranda Barry, the mid-nineteenth century physician, surgeon and British military officer, who was discovered to be a woman at the time of her death. The impact of the stethoscope on the practice of medicine is explored in depth in the chapter, "Technology and Disease: The Stethoscope and Physical Diagnosis."

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This posthumously published collection of essays by Dr. Klawans, an eminent neurologist and writer, explores the interactions between patient, family and neurologist and the implications of specific neurologic diseases. Klawans's special interest in neurology is movement disorders, such as Huntington's chorea and Parkinson's disease, but his outside interests range from evolutionary biology to classical music. His essays, therefore, focus on single patients or families, but the author weaves thoughts about his other interests into each "case."

The book is divided into two sections, "The Ascent of Cognitive Function" and "The Brain's Soft Spots: Programmed Cell Death, Prions, and Pain." In a brief preface, Klawans declares that this book is "more than just a set of clinical tales about interesting and at times downright peculiar patients" from his 35 years of practice, but rather it "humbly grapples with the 'whys' of our brain, not the 'hows.'" (pp. 9-10) In the preface, as well as in one essay, Klawans acknowledges the work and impact of fellow neurologist-writer Oliver Sacks ("Oliver is truly the father of us all." p 12).

The title essay concerns a six-year-old girl who was found, locked and completely speech-deprived, in a closet. Because she is still within the window of opportunity for language acquisition, "Lacey" quickly learns to speak, unlike Victor, the Wild Boy of Aveyron, whose story was immortalized in the François Truffaut film, L'enfant Sauvage. Klawans uses these stories as a launch pad to discuss the evolution of language, including a proposal that the cavewoman, not the man, was responsible for development of the human species as she taught her offspring language.

Other chapters focus on patients with epilepsy, Parkinson's disease, localized and hemispheric stroke, "painful-foot-and-toe syndrome, " and Creutzfeldt-Jakob disease. Two particularly memorable chapters concern Huntington's chorea and Refsum's disease. The chapter, "Anticipation," explores the profound ethical concerns of genetic testing for Huntington's chorea as applied to three generations of one particular family. In the chapter, "The Hermit of Thief River Falls," Klawans recollects his first year as a neurology resident, and his care of a reclusive patient with a rare eponymous illness, Refsum's disease--just in time for a visit by Refsum himself, a famous Norwegian neurologist.

The book concludes with a speculative "afterthought" about genetics, evolution, and the importance of extended "juvenilization" --the protracted post-natal development of Homo sapiens. This essay intertwines some of the threads regarding speech development and evolutionary biology, particularly brain development, that were introduced earlier in the text.

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The poem takes place in a respiratory ward of a children's hospital, where the narrator hears "a children's wind ensemble / hooting through the weary nocturne." One mother is massaging her child's back, "working calm's liniment between shoulder blades / scarcely bigger than chicken wings."

The narrator appears to be a friend or relative, who silently tries to breathe for the breathless child, whose panic is held in check by "his mother's dulcet voice." It seems like everything will be all right "as long as the hand strokes, and while the voice croons . . . " [30 lines]

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