Summary:

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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Couser, long interested in autobiography, explores the ethics of representation in biographical writing, and in particular, the ethics of representing vulnerable subjects--for example, the aged or very young, the sick or impaired, or those who are "socially or culturally disadvantaged." He is concerned with representation of people who are intimately connected to the biographer, either as family members, or in some other "trust-based relationship." Couser argues that the relationship between vulnerable subjects and their biographers is analogous to that between patients and their physicians and that therefore principles of bioethics should be applied to such life writing, especially the principles of autonomy, nonmaleficence, and beneficence.

Couser explores life writing and betrayal (Chapter 1), outlines how he will apply the principles of biomedical ethics and ethnographical ethics to life writing (Chapter 2), and applies these principles to examples of collaborative autobiography (Chapter 3). He then critiques in detail Michael Dorris’s memoir about his adopted son, The Broken Cord (Chapter 4); the work of Oliver Sacks (Chapter 6); memoirs of euthanasia (Couser calls these "euthanographies"), Saying Goodbye to Daniel: When Death Is the Best Choice, by Julia Cassutto Rothman; Rescuing Jeffrey, by Richard Galli, and But What If She Wants to Die, by George DeLury (Chapter 7). Finally, in the last chapter, Couser considers how investigation of the human genome might influence the "scripts" of our lives and hence life writing, and also how life writing might be a counter discursive force against genomic essentialism.

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In this book Sacks takes the reader into the world of the prelingually deaf, a world in which spoken language is incomprehensible. He describes the visual language, Sign, and considers the development and culture of American Sign Language. Sacks evokes the conflict between those who seek to teach the deaf to communicate via voice and lip-reading and those who affirm Sign, the native culture of the deaf.

In the latter part of the book, Sacks re-creates the student rebellion at Gallaudet University in 1988 when a "hearing" president was chosen from among three finalists, two of whom were deaf. The back cover summarizes this book as "a provocative meditation on communication, biology, and culture."

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The story takes place in Jakarta during the last year of Sukarno's presidency. Despite the near collapse of the Indonesian economy, President Sukarno continues to spend money on massive projects and mobilize the nation against foreign imperialists, especially the United States and Britain. The Great Leader has pronounced this "the Year of Living Dangerously."

The main protagonists of the novel are several foreign newsmen, in particular, Hamilton, a newly arrived representative of the Australian Broadcasting Service, and Billy Kwan, a free-lance cameraman, also from Australia. Billy is an achondroplastic dwarf, an intense man whose secret fantasy life includes a belief that dwarfs form a separate race.

Billy's onetime hero, Sukarno, has now led Indonesia to the brink of revolution. Billy befriends Hamilton, to whom he also attributes heroic qualities, and the two become inseparable for a while. However, both Hamilton and Sukarno prove that they have clay feet. Hamilton does this by co-opting Billy's fantasy girlfriend. In the climactic last weeks before the Indonesian coup d'etat, Billy is radicalized and decides to take direct action. Realizing that his course of action may be fatal, Billy tries to publicize Sukarno's misuse of power by unfurling an anti-Sukarno banner from a government building in Jakarta. He is killed in the attempt.

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The novel begins in Hobart, Tasmania, in the 1950's. Richard Miller, a student at the Christian Brothers' school, spends his adolescence recovering from the effects of polio. His one friend is Brian Brady, who is expelled from the school after a tiff with a sadistic Brother. Brian finds work and studies the guitar with Clive Broderick, the "doubleman" of the novel's title, an enigmatic occultist who believes in separate worlds of good (invisible) and evil (visible) reality.

Years later, in the freewheeling '60's, Richard has become a television producer in Sydney. He once again encounters Brian and his friend Darcy Burr, who have been eking out a living as a folk singing duo. Darcy, who has inherited Broderick's Gnosticism, is convinced that his group, the Rymers (which soon grows to include Richard's wife Katrin as lead singer), will achieve fame and fortune.

Richard produces a series of television shows, which, in fact, turn the Rymers into a very hot commodity. They are on the verge of a triumphant tour to England when the threads of their complex story begin to unravel.

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Sapphira was a fashionable young woman in Winchester when she married Henry Colbert, a man beneath her station, and moved to a rugged backwoods village, where they have lived for more than 30 years. Twenty of Sapphira's slaves came with them. This caused somewhat of a sensation among the poor, non-slave owning population of the region, where even to this day the Colberts are admired but not well-liked. Henry successfully took over the village grinding mill, while Sapphira assumed the role of local granddame. They had three daughters, all of whom married and moved away. However, Rachel's husband died, and she returned to Back Creek with her two young children.

Sapphira and Rachel are lay nurses who often visit and comfort the sick. Sapphira appears to do this work out of a sense of noblesse oblige, but Rachel feels empathy for the sick and less fortunate. She sets herself above nobody. Rachel is also an abolitionist at heart (as, to some extent, is her father), but Sapphira is firmly convinced that slavery is not only necessary, but also moral. Henry, a rather ineffectual male presence in this story, has responded to Sapphira's haughty regime by gradually withdrawing. In fact, he has largely abandoned the Big House to live at the mill, which he justifies by claiming the lack of a reliable foreman.

Sapphira suffers from severe dropsy. Her swelling is so bad she can no longer walk. She is jealous of a young slave named Nancy, with whom she believes Henry is having an affair. Much of the novel describes Sapphira's attempts to get rid of Nancy, first by selling the girl in Winchester, and later (when Henry refuses to sell) by importing her ne'r-do-well nephew to rape and destroy Nancy. This doesn't work either, primarily because Rachel takes Nancy under her wing and arranges her escape to Canada via the Underground Railroad.

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The author, a renowned monologist, gives a hilarious account of his adventures as he attempts to cure a disturbing change in vision, diagnosed as macula pucker. His encounter with conventional medicine, including a physician who coldly recommends "a little macula scraping" leads the author on a worldwide search for the perfect, alternative cure.

He winds up naked and panting in a "Native American sweat lodge," following a rigid raw vegetable diet, trying the Christian Science prayers of his youth, and participating in a wild and gory psychic healing session in the Philippines with the "Elvis Presley of psychic surgeons." He finally controls his multiple anxieties about entering middle age, listens to his sensible fiancee, and undergoes conventional surgery.

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This fine collection of writings by women involved in health care stems largely from a writing group cosponsored by the Nebraska Humanities Council and the Creighton University Center for Health Policy and Ethics. However, other writings also appear in this volume: in all there are 40 pieces by 16 authors. Writing genres include essay, short story, and poetry. The works are divided into three sections: Power and Powerlessness, Vulnerability and Voice, Connection and Disconnection. As noted in the introduction, these are "major themes in feminist perspectives in ethics" and the works are offered as reflections on modern ethical dilemmas in health care.

Some of the most powerful pieces are stories about being the newcomer--the student or junior trainee. For instance, "Washing Cora's Hair" by co-editor Amy Haddad is a poignant look at the struggle of two young nursing students to wash the long braids of a bed-bound elderly woman in her cramped home, and "The Story of David" by Ruth Purtilo, written as a memoir looking back to when she was a newly graduated physical therapist, concerns her interactions with a young, angry, depressed quadriplegic patient and with her superiors.

Another memorable piece is "The Things You Do" by Kelly Jennings Olsen. This story about being a new volunteer emergency medical technician masterfully controls the tensions of emergency medical care, the anguish of the father whose little girl slipped under his tractor, and the nuances of living in a small town. Several poems also deal with issues of the newcomer and witness to suffering (e.g., "As Ordered" by Ruth Ann Vogel--a poem about shaving the head of a neurosurgical patient on the pediatric ward)

As noted by the multiple keywords listed above, these pieces touch on many topics. Power relations play a key role, both between professionals and between patient and the health care team. For instance, in the polished story, "Procedures" the author Kim Dayton writes from the perspective of a young single mother with a critically ill neonate. This mother is repeatedly prevented from visiting her child because of "important" events like rounds and procedures, and she ironically only gets to hold her baby after the baby dies.

Throughout the collection the patients are described with honesty and vividness. Their suffering can haunt the health care worker ("Maggie Jones" by Veneta Masson) as well as teach ("Back to Square One" by Barbara Jessing). Many of the pieces remind us of our good fortune and the privilege we have in our lives and in providing health care services (e.g., "Spring Semester" by Amy Haddad). Ultimately in this volume our common humanity is emphasized--the connections between people and the remarkable grace that can be exhibited in the face of suffering.

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Walt Koontz (Robert De Niro) is a retired security officer, cited for his heroism, and now living alone in an unsavory apartment building on Manhattan's Lower East Side. He regards his neighbors with contempt, especially the "faggot" upstairs, Busty Rusty, (Philip Seymour Hoffman), a transvestite and singer/piano player at a popular drag club. During a drug-related shoot-out with an upstairs neighbor, Walt attempts to help, but suffers a stroke that leaves him with paralysis of his right side and significant speech impairment. Walt's status as hero is radically changed. His friends become awkward around him.

Walt refuses to leave the apartment building for treatment. His doctor (Mahdur Jaffrey) recommends singing lessons to improve his speech. Walt reluctantly seeks help from Rusty. The relationship between a bigot and a drag queen is an unlikely one that begins with mutual loathing and considerable stereotyping on both sides. Eventually each is forced to renegotiate his own prejudices.

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This haunting memoir by a South African surgeon who has witnessed tremendous suffering across the globe is best read as his story, and not a war chronicle as the subtitle would suggest, since large chunks of the book are not about war in the dressing station sense of the term. That said, however, the war that rages inside the author continues throughout the book and gives the reader glimpses of wisdom gained during Kaplan's remarkable journey of life amidst death. The book is culled from journals of writing and sketches that he kept throughout his travels.

Kaplan's first crisis occurs when he joins fellow medical students in an anti-apartheid demonstration in Cape Town and, following the lead of a more senior student, Stefan, tends to the wounded and frightened after riot police attacked the demonstrators. Kaplan then gets the call of not only medicine as service, but surgery as service, when, as a neophyte doctor, he saves the life of a youth shot in the liver by the police.

This feat should not be underestimated, though the author writes with humility. Indeed, in recounting later incidents in which patients die, the odds tremendously stacked against the patients surviving anyway (a woman with disseminated intravascular coagulopathy and multiple organ failure, or the Kurdish boy in a refugee camp with a great hemorrhaging, septic wound), the author's self-chastisement is a painful reminder of how the physician suffers with each loss.

After a beautifully written prologue which begins, "I am a surgeon, some of the time" (p. 1), the book proceeds chronologically, each chapter named for the location of the action. Kaplan leaves South Africa to avoid military service and the fate that befell Stefan, who becomes an opioid addict after euthanizing a torture victim in a horrible scene of police brutality and violence. Kaplan's post-graduate training in England and BTA (Been to America) research stint heighten his sense of cynicism about hierarchy in English society and capitalistic forces in American medical research.

Ever the outsider, Kaplan first returns to Africa (treating victims of poverty, deprivation and violence), then sets off to war zones in Kurdistan, Mozambique, Burma (Myanmar), and Eritrea. In between, he works not only as a surgeon, but also a documentary filmmaker and a cruise ship and flight doctor. He avoids the more established medical humanitarian relief efforts, such as Médecins Sans Frontières, and instead prefers to work where no other ex-pat physician will go--enemy territory, front lines, and poorly equipped dressing stations.

Along the way he decides the number of people he has helped as a surgeon, particularly in Kurdistan, has been small compared to the potential to intervene in broader public health measures (he meets a Swiss water treatment engineer) and occupational health exposés to help abused victims (e.g., of mercury poisoning in South Africa and Brazil). The book ends with Kaplan studying to become an expert in occupational medicine, though, incongruously, in the heart of London's financial district where he treats stress-related illness.

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