Summary:

This novel is based on the facts of an actual hantavirus outbreak that took place in the southwestern US in 1993, retelling the events as medical mystery, as ghost story, and as meditation on the relationship between rationalist western medicine and the beliefs of local indigenous cultures.

Dr. Push Foster is part Choctaw and part white, raised in Oklahoma. He returns to Arizona as an Indian Health Services physician at the time an outbreak begins of what is later identified as Hantavirus Pulmonary Syndrome. Western medicine and traditional health beliefs and practices overlap in the investigation and response to the illness as it infects and kills Navajo people.

Querry presents us with a convincing epidemiological investigation into the virus, but also suggests an alternative, or complementary, etiology for the outbreak: an archaeologist has stolen a sacred stone from the Hopi people with the help of a Navajo witch, or shape-shifter, the title's "bad medicine" practitioner. This theft, the novel suggests, is the reason that only Navajo, and one white person (the archaeologist's partner) become ill.

The climax of the story is a showdown between the shape-shifter, a Hopi village headman, and the ghost of a woman killed trying to save her people from the 1805 massacre of Navajo by Spanish troops at Muerto Canyon. (The virus, when first identified, was named Muerto Canyon Virus.) This woman becomes a figure of both vengeance and reconciliation, an uneasy meeting of cultures that echoes and informs the work of Push Foster and his colleague, Sonny Brokeshoulder: both are men of Indian blood with a "white" upbringing and who return to their culture bearing Western medical training, but do not deny the traditional knowledge either.

Unlike most medical thrillers, this book does not offer reductive explanations and answers; instead, we are left with the certainty that traditional and western thinkers must collaborate, not only to care for patients, but to take care of the natural environment on which all our health depends.

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Tessa Quayle, the young wife of a British civil servant in Kenya, is mysteriously murdered. Tessa, a lawyer, had been an outspoken human rights activist, and something of an embarrassment to her husband. But shaken from his marital and political complacency by her death and the rumors that quickly surround it, Justin Quayle sets out to solve the mystery and in doing so inherits her cause.

Tessa had discovered, as Justin now learns, that a new tuberculosis drug was being prematurely tested on Kenyan patients: clinical trials were effectively being carried out on the African population by the drug's giant pharmaceutical producer without the patients' knowledge or consent, but with the support and cover of a global corporation with African interests and of the British High Commission in Kenya. Lethal side effects and deaths were being concealed, the drug retitrated and retested in preparation for its safer and more lucrative release in the west in time for a predicted rise in incidence of multi-resistant strains of TB.

Justin, now a kind of rogue agent, uncovers the layers of sinister plotting to be expected in one of Le Carré's intelligence thrillers, but in the process we are led to consider, vividly, the interlocking roles of international biomedical research, postcolonial political interests, and global capital in determining the fates of impoverished, uneducated, and deeply vulnerable patients in developing countries--as well as the fates of those who try, often against all odds, to offer them the best available care. The novel also gives us, in Justin Quayle's odyssey, a moving study of desire, loss, regret, and, finally, outraged action.

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Vanya and Uncle Nicolai, two orderlies in a morgue, are preparing for funeral the body of Trepov ("Known everywhere simply as Trepov" (63), a hated officer because of whom "more [Russian] people were murdered than absolutely necessary." Trepov is the pawn of "the Little Father" (64); both very well may be cruel administrators of an invading force, not necessarily Russians themselves, although this is not clear.

What is clear is that Vanya, the younger orderly, despises Trepov. After finishing the dressing of the cadaver in military finery, replete with "all those gilt-enameled medals" (64). Vanya suddenly closes the door, to Uncle Nicolai’s bewilderment. Even more surprising is Vanya’s determined slapping of Trepov’s face three times. With tacit approval from Uncle Nicolai, Vanya then kicks Trepov. Finally, Vanya slaps, with all his strength "the corpse’s face again. Now we can go, he stammered, his face flushed with the thrill of it." (65)

Vanya goes to bed thinking about the son his wife is expecting (since there was no ultrasound between 1908 and 1912 when Csáth most likely wrote this story, this detail remains mysterious) and how he will boast to him about "that day’s doings." And then he falls fast asleep, "breathing evenly, deeply, like all healthy people" (65).

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According to the U.S. Department of Health and Human Services, nearly thirty-one percent of the American public is obese; obesity accounts for 300,000 deaths a year, making it the second-most common preventable cause of death after cigarette smoking; individuals who are obese have a fifty to one-hundred percent increased risk of premature death from all causes.  On the opposite end of the scale, so to speak, is anorexia, which, as one of the deadliest of psychiatric diseases, claims up to fifteen percent of its sufferers who either die of suicide or complications related to starvation; about one-third spend their lives dominated by their obsession with food, and almost half never marry. 

How can we ever understand the psychological, physical, emotional, cultural and spiritual complexity of eating disorders, whether they result in morbid obesity or in a starving body digesting itself?  Ann Pai's memoir opens a window to reveal the inner world of a food obsession, her own, and holds up a mirror to reflect the outer experience of a dying, five hundred fifty pound woman, her sister.

The narrative weaves together three strands:  the sweet but unsentimental history of two sisters growing up in the midwest--Joyce, the elder of the two, and Ann, younger by almost five years; the detailed and horrific account of Joyce's sudden hospitalization on September 11, 2001, and her inexorable decline through multiple, undiagnosable and fatal illnesses as the result of her obesity; and the stream-of-conscious and raw monologue of Ann's own struggle to manage a compulsive eating disorder.

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A young woman observes the slow decline of her grandmother into dementia and her grandfather’s reaction to the situation. Issues of denial, anger, autonomy, and intimacy rise to the surface—and expose the formerly private dimensions of their marriage. The illness also stresses her own relationship and invites the idea that someday she and her partner could be projected into a future with the same vulnerability.

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This absorbing, sad, humorous evocation of an impoverished Irish Catholic childhood describes the first nineteen years of Frank McCourt’s life--from his birth in Brooklyn, New York; through the family’s emigration four years later to his mother’s roots in the slums of Limerick, Ireland--and ends with McCourt’s return migration to America, a young man on his own. McCourt sets the scene in his first lines: "When I look back on my childhood I wonder how I survived at all. It was, of course, a miserable childhood: the happy childhood is hardly worth your while. . . the poverty; the shiftless loquacious alcoholic father; the pious defeated mother moaning by the fire; pompous priests; bullying schoolmasters . . . . "

Born during the Great Depression, the author leads us in lilting present-tense narrative through the struggle and occasional small joys of daily life with siblings, school friends, and the adults who circumscribe his life. He is an alien in his parental homeland, the oldest child of a father whose background in "the North" engenders continual suspicion, and a mother (Angela of the book’s title) who had never known her father and whose own mother is as miserly with her affections as with offers of economic assistance.

The hardships in Limerick are so profound that starvation is a way of life. "Consumption," pneumonia, and typhoid are rampant; children go to school barefoot or in pieces of flopping rubber; stealing is a necessity. Frank’s tiny sister and twin brothers die. Above all, there is "the drink"--the endemic disease of Irish fathers who spend their weeks’ wages in the pub on Friday night.

Frank leaves school to earn money for the family (his father had joined the war-time wave of work in England, but continued to drink his earnings away), and to save for a return to America. Blessed with verbal skills and stamina, through stealth, charm and struggle he manages to save what is needed to book ship’s passage to America. As the Hudson River flows by en route to Albany, the ship’s Wireless Officer says to Frank, "My God, . . . isn’t this a great country altogether?" Answers Frank in the single phrase comprising the last chapter, " ’T. is."

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This poem by physician, Rafael Campo, is No. 5 in the sequence, "Canción de las Mujeres" ("Song of the Women"). A drag queen is dying of AIDS, as she and the physician try to maintain her dignity and her identity. "Her shade of eye shadow was emerald green; / She clutched her favorite stones."

The patient is resigned, "almost at peace" while she remembers the strength that she drew from the community of drag queens who were her friends, now dead. The physician turns up the morphine drip, and straightens her wig, "[b]efore pronouncing her to no applause."

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As much about the abusive treatment of women, and the clash of traditional and contemporary mores as it is about the HIV/AIDS pandemic, this beautifully crafted novel tells the story of a nineteen-year-old Mosa (for mosadi--woman) who has already lost two brothers to AIDS. The reader is caught up in the mega-deaths and non-mention of the dreaded acronym, AIDS, as the story unfolds. At their brother’s gravesite Mosa’s one remaining living brother is halted as he shovels in the final loads of earth: "All around him were fresh graves . . . He looked at the not fresh, fresh graves, and noted the dates of birth. Young people who had died prematurely . . . He had known about their long illnesses, their deaths and their funerals." (p. 20)

The author is the first (and only) female judge of the High Court of Botswana and a human rights activist. She is internationally renowned for bringing about the Dow Case, which challenged Botswana nationality laws; she argued successfully for revisions allowing women to pass their nationality on to their children.

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A Mexican-American woman has an appointment for her son Jorge to be seen at the Anglo clinic. She insists on keeping the appointment, even though her relatives think she is crazy. She reflects on events in her life--Jorge's congenital heart disease, the fact that she had a tubal ligation after his birth, and that the heart disease might have been a punishment from God. She reflects upon the fact that often people go for clinic appointments, only to find that the Anglo doctors aren't there and another appointment must be made. She carefully selects Jorge's clothes. She takes the crowded bus.

Finally, at the clinic two doctors enter after a long wait. One is a psychiatrist. In this last scene it becomes evident that Jorge has already died. His mother has brought a bundle of Jorge's clothes to the clinic for "his" appointment, still hoping for a miracle. Referring to the psychiatrist, the woman doctor tells the mother, "He will make you better."

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Tama, a young Maori man who works as a clerk in Wellington, receives word that his father has died. He flies home to northern New Zealand, participates with his mother and siblings in his father's wake and funeral, then returns to Wellington to collect his belongings. As the eldest son, he is now responsible for the family and must return to the family farm. The story begins on the morning that Tama catches the train to Wellington; the events of the preceding week flash back and forward through his consciousness during the long, lonely railroad trip.

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