Summary:

Two men who are not very fond of one another and opposites in almost every way are brought together by their affection for the same woman. Isabel is the 30-year-old wife of Maurice Pervin and the longtime friend of Bertie Reid. While fighting in Flanders during World War I, Maurice is blinded and sustains a disfiguring facial scar. He also has episodes of major depression. Maurice and Isabel have become socially isolated since his injury. Although their first child died in infancy, Isabel is pregnant again and due to deliver soon.

Bertie, a bachelor and barrister, pays a visit. The three of them enjoy dinner together. Afterwards, Maurice becomes restless and leaves the house. When Bertie goes out to check on him, he finds Maurice in the barn. The blind man asks Bertie for permission to touch him. With one hand, Maurice examines Bertie's skull, face, and arm.

He then asks Bertie to touch his useless eyes and awful scar. Without warning, Maurice places his hand on top of Bertie's fingers, which still rest upon the maimed face. The experience is a revelation for both men. Maurice suddenly understands the splendor of friendship while Bertie realizes how much he fears intimacy.

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Fifty-two year old Pete, the hospital mailman, suddenly experiences severe abdominal pain. He is evaluated and treated in the emergency room. His diagnosis is acute surgical abdomen, but the exact cause of his pain is still unknown. The surgeon-narrator determines that the severity of Pete's condition mandates exploratory surgery. During the operation, "an old enemy" (18) is encountered--pancreatitis.

Afterwards, the surgeon assures Pete that he will get better. One week later though, the mailman dies. His death has been painful. An autopsy is scheduled, but the surgeon deliberately arrives 20 minutes late. He does not want to view the intact body of his deceased patient. No matter, the pathologist has waited for him to arrive before beginning the post-mortem examination. The pathologist closes Pete's eyelids before starting the autopsy, mindful of how the mailman's "blue eyes used to twinkle" (21) when he delivered the mail everyday.

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A trader from the north arrives by boat in Miriam's village carrying bright and beautiful bolts of fabric--the juliana cloth of the story's title. The trader chooses to trade fabric for sex with some of the village women and girls; for others, perhaps the less appealing, he will take only money. Miriam wants a piece of the cloth, but hasn't the coins to buy and is not offered a trade. Over time, the village watches the more adventurous and attractive women and some of their male partners sicken and die from a strange new malady.

Miriam's mother, a widowed government employee, warns Miriam of the relationship between the deadly sickness and sexual behavior. The officials have promised condoms, but even had they arrived, the programs for education and understanding were not in place. The last we see of the 16-year-old Miriam, she is succumbing to her own adolescent sexual desires with a local boy.

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Looking back on his first year of medical practice in an out-of-the-way section of Russia, a 25 year old physician reflects on how much he has changed both personally and professionally. He lists the year's accomplishments: performing a tracheostomy, successful intubations, amputations, many obstetrical deliveries, and setting several fractures and dislocations. With pride, the doctor calculates he has seen 15,613 patients in his first twelve months of practice.

He recalls some poignant moments. A pregnant woman has a baby while lying in the grass near a stream. The doctor pulls a soldier's carious tooth but is horrified when a piece of bone is attached to it. During a delivery, he inadvertently fractures a baby's arm and the infant is born dead.

Basking in his year's worth of experience and newfound clinical confidence, the physician quickly comprehends the limits of his knowledge on the first day of his second year in practice when a mother brings her baby to the doctor. The infant's left eye appears to be missing. In its place sits an egg-like nodule. Unsure of the diagnosis and worried about the possibility of a tumor, the physician recommends cutting the nodule out. The mother refuses. One week later she returns with her child whose left eye is now normal in appearance. The doctor deduces that the boy had an abscess of the eyelid that had spontaneously ruptured.

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Kirk, a man in his 50s with highly metastasized kidney cancer, presents himself to Dr. Groopman after having been turned away as a helpless case by several respected cancer clinics. He tells Groopman that he is a risk-taking venture capitalist and is willing to take any medical risk on the chance that it will save him. After pondering the ethics of the situation and the nature of informed consent under such conditions, Groopman agrees to treat Kirk. He proceeds to devise a highly risky (and untried) combination of chemotherapeutic agents. The course of treatment is excruciatingly difficult, but the experiment succeeds, and Kirk's cancer goes into complete remission.

Kirk calls it magic, a miracle, and the hospital interns call it a "fascinoma," a case defying normal expectations. Groopman releases Kirk to home and weekly checkups with a local internist, but in doing so he notices that Kirk's mood has mysteriously changed. He has lost the "piss and vinegar" of their earlier contact. Kirk continues to improve physically, traveling and playing golf and even tennis, but Kirk's wife soon reports that Kirk has stopped reading the newspapers he used to devour, which now collect in their driveway.

Several months later some physical symptoms return, and Kirk's cancer is back. A month later he is dead. In talks with Kirk near the end, Groopman discovers that Kirk's brush with death had brought with it a new and sharply negative view of himself as selfish and disconnected from the world and other people. Suddenly all his financial success seemed to him "pointless," and, since his life contained nothing else, it seemed to him a waste, and he felt it was too late to live it over. What Kirk ironically calls "my great epiphany" seems to have undone his doctor's "magic."

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The narrator is an inexperienced and overworked doctor in a remote region of Russia. Although accustomed to seeing as many as a hundred or more patients in a day, a blizzard brings him unexpected relief. Only two patients show up in the clinic. He welcomes the prospect of a leisurely day but soon receives a summons for help from a physician in a nearby district.

A bride-to-be has fallen out of a sleigh and is unconscious. The narrator travels more than 2 hours to lend his help, but she is already dying. He later realizes the young woman had a fracture at the base of the skull. Ignoring advice to stay the night, the doctor insists on returning home. Four hours after departing in a sleigh, the doctor and driver are lost and trapped in the snow. With great effort, the two men free the sleigh and horses from the drifts.

As their journey resumes, wolves chase the sleigh until the doctor fires his pistol. Finally, he sees the lights of his hospital in the distance. Once safe in his house, the doctor picks up a manual containing information about skull fractures but decides instead to go to sleep.

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In the Foreword to this collection, poet John Graham-Pole writes, "Children have uncovered for me the last and greatest lesson: souls thriving on failing at bigger and bigger things" (xvii). The heroes of these poems are just such children, transformed by serious illness. For example, Dominic in "Waiting" who "rests on his airbubble cot / awaiting life’s flight from its earthly beat" (10); Ruby in "Ruby Red": "And so poor Ruby meets her final test, in gentle hemolysis rolled to res" (35); the lovely young woman in "Elegy": "You’re newly dead, sans wig, / seventeen year old virgin whom / I’d loved." (57).

"I try through writing poems to lay a finger on the purpose of illness, on its pulse .  . Poems turn denial and withdrawal into compassion--feeling with. They turn fear into mercy--thank you" (xvii). The poet’s eye remains dispassionate, even though his heart may be breaking, as in "Last Rites" (32), in which a dead toddler’s father and his companion "sluice down the flooring with their hoses. After the vomit and blood the water runs clear." He understands the limits of communication about loss, but recognizes, too, that we must make the attempt; and the attempt has meaning in itself: "Afterward the circles of our talk / snap . . . - Within, we write our / separate texts of it. Between, the tension / stands: this no talk could break." ("Circles," p. 87)

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This book contains 29 short essays by physician-scientist Lewis Thomas, originally published in the early 1970s in The New England Journal of Medicine. The essays center on science, and range in focus from the molecular (e.g., DNA) to the subcellular to the organism to social interactions and all the way up to the search for extra-terrestrial life. Some themes reappear in several essays: science as a grand, engaging enterprise worthy of the brightest minds; communication between organisms creating the intricate dance of the social organism; the relationship of man to both nature and the grand scheme of the universe.

Lewis is fascinated by communication not only at the cellular level, but also at the pheremonal and cerebral level: "Language, once it comes alive, behaves like an active, motile organism" (90). The ant and its colony, as an example of a simultaneous individual and integrated social organism, form a link for Thomas between the enclosed unit of a cell and the complex interactions of a society. Indeed, macro-micro comparisons continue throughout the essays, and even conclude the final essay, "The World's Biggest Membrane," which lauds the atmosphere as protector, filter, and provider: "Taken all in all, the sky is a miraculous achievement. It works, and for what it is designed to accomplish it is as infallible as anything in nature. . . it is far and away the grandest product of collaboration in all of nature" (48).

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Anna's grandfather, who used to take her for walks in the cornfields and "listen to the corn" with her, dies. Before his death he gave Anna her own kernels to plant when spring came. Anna, mourning her grandfather when spring comes, doesn't want to plant the seeds; she wants to save them. But her mother points out that if she doesn't plant them, she'll never hear the music from them that her grandfather taught her to hear. She tends the corn and listens. It isn't until fall that she hears the song and crackle of the corn she shared with her grandfather. After the harvest she gathers her own seeds to plant in the coming year.

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Summary:

Selzer tells four stories of surgical loss: a surprise loss on the operating table, the drowning of a sick child in a flood in wartime Korea, the sudden death of a professor due to a perforated ulcer, and the loss of some facial mobility in a young woman following the removal of a tumor in her cheek. As we move from one vignette to the next, the narrator's mood goes from despair to accepting to redeemed, with various forms of love the agent.

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