Summary:

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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A physician stands in the laundry, folding her baby’s diapers, and thinks about Mr. Dantio, who died of wildly metastatic cancer. She reflects on the development of her relationship with Mr. Dantio during the time that she was pregnant. Toward the end, he developed a lung infiltrate, maybe a type of pneumonia. There was a chance that a biopsy might have helped--perhaps he had a treatable infection--but she recommended against it. Now she wonders about this decision. She wonders also about what the other physicians think of her: "you don’t really want to be a doctor anyway, you must be conflicted to have a child . . . . " She remembers seeing Mrs. Dantio in the supermarket shortly after her husband died, and crying with her. She asks herself: Will I ever be a REAL doctor, "because in moments of great stress I revert to my native tongue."

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A medical student at Lincoln Hospital in the south Bronx is called to the Emergency Room, where a gang war is going on. She plunges through fighting bodies in the waiting room to reach the treatment area, where she is enlisted to ride an ambulance with a critically injured and intubated patient. During the trip, the ambulance jerks, the tube comes out, and the student tries but fails to ventilate him with mouth-to-mouth respiration. At the other hospital, she is turned away from the cafeteria because her clothes are blood-soaked. The patient dies. Although she feels terrible, her friend Marie, a practical nurse, comforts her with a touch of ordinary love, a photo of her new grandchild.

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Twelve contemporary stories set in Rhode Island and New York City. Major themes include the pain of cultural dislocation and cross-cultural experience ("Theng," "Shambalileh," "My German Problem"); human frailty and self-deception ("Sleep," "Juilliard"); and the personal and moral dimensions of medical practice. See the separate annotations for Laundry, The Good Doctor and Ambulance--three stories which are particularly relevant to Literature and Medicine.

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Dr. Cassell examines the social and cultural forces that encourage the practice and teaching of a medicine that is governed by the disease theory. This theory discounts the impact of illness on the patient and ignores the suffering that the patient is experiencing. Cassell does not debunk science and technology, rather he encompasses them within the moral enterprise of medicine as tools for helping patients.

The ability to provide compassionate attention to the patient as individual (i.e., with unique values, life experiences, family interactions, etc.), trustworthiness and self-discipline are required characteristics of a "good physician." Cassell illustrates and personalizes the philosophical shift towards focusing on the sick person with stories and anecdotes.

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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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The poem depicts a fiercely wild and free woman who meets an untimely death in a motorcycle accident. The anatomy student views the cadaver as more than just "thirty-one-year-old female flesh," and fantasizes about what her life (and death) must have been like.

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This story is told by Tillie's grandfather. Tillie's parents were killed in a plane crash and she now lives with her paternal grandfather, a man who (in a sense) has never really grown up. "Retirement" has always been his natural lifestyle. He says that he never "amounted to anything." The grandfather enjoys story-telling and fantasy. In his stories for Tillie, he invents the character Joey Moxey, a clown whose life-events just happen to mirror the daily events in Tillie's life.

Joey Moxey always overcomes adversity. His story is full of hairbrained schemes, breathtaking escapes, and the loving support of friends, like Tina the cat, Oogak the jungle boy, and Sadie Donut the policewoman. These stories provide a way for Tillie to understand her own world.

Finally, the grandfather discovers that he has inoperable cancer. Shortly thereafter, Joey Moxey develops a terrible runny nose and "to everyone's disappointment" dies. However, his friends, led by Sadie Donut, gather and agree to continue their friendship and their adventures together.

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As you are now, so once was I; Prepare for death and follow me. The novel's advisory epigram prepares readers for the realities of aging and death which affect both narrator and reader. Following surgery, Caro Spencer is delivered to Twin Elms, a nursing home in a rural New England setting. While this intelligent woman requires only short-term care, she is deposited, permanently, in an understaffed, sub-standard care facility by relatives unwilling to add her minor but time-consuming difficulties to their own.

It is not a pretty setting. The staff is overworked and demeaning, especially to the new resident who is well-educated and accustomed to better circumstances. The nursing home routine is careless of individual differences and needs, and set up to strip away autonomy and dignity through petty and cruel indignations.

Caro is able to survive by keeping a secret diary for observations, reflections, and interpretations; ultimately, this alone sustains her. While the voice is that of an elderly woman (as we are now), the journal is for us, those still able to manage their lives, but unable to predict or control end-of-life events.

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Summary:

Shelley compares man's ability to stay alive to the flickering light of a passing meteor. Our light of life is wavering and brief. He urges man to strive on and live life fully nevertheless.

In the third stanza, he compares earth to a mother and a nurse; it is that which comforts and sustains us and we are afraid to leave it. Again, however, Shelley argues that life must be lived anyway. Indeed, he argues that life (and poetry) is enhanced by its close relationship with death. The hopes of what will be after death must be united with the love for the here and now.

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