Summary:

Eloy’s grandmother—his abuela—is dying of cancer.  She has been his faithful companion, teacher and refuge in a home where his parents often fight and his older brother seems to have lost interest in him.  He believes the only thing that will save her now is for him to make the annual pilgrimage on foot to the chapel at Chimayo, 17 miles from their New Mexico home, but his parents, both of who work full time, can’t go with him and won’t hear of his going alone.  Desperate for a miracle, and believing she can be saved by the blessed soil distributed at the chapel where many seem to have experienced miracles of healing, he sets out in secret early in the morning.  On the way a friendly dog begins to follow him and, despite Eloy’s efforts to get rid of him, travels the entire 17 miles with him, sharing the water Eloy reluctantly offers him from the canteen that once belonged to his grandfather.  Much of the story follows Eloy’s thoughts as he travels, and the small difficulties and surprises along the way.  As he finally sees the chapel in the distance, he hears his brother driving by slowly in his low-rider with tinted windows.  Angry at the brother who has given him no support so far and seems to be mocking him, Eloy flips him the finger.  Later, as he stands in line for the sacred soil, his brother enters the chapel with their abuela on his arm.  She explains to Eloy that she is indeed going to die, and that God has other ways of answering prayers.  She sees that Eloy has been sent a companion, and encourages him to bring the dog, whom he has now named, home with him.  His parents, who have steadily refused to let him have a dog, accept him, and Eloy comes to new terms with his grandmother’s approaching death.

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Each chapter in this book explores the forms and effects of humor in healthcare, mostly in hospital settings, beginning with a touching account of a person who worked as a hospital clown, visiting patients, enlivening staff, haunting the halls of a hospital where she became a beloved and important reminder that the disruptions of illness can be reframed in ways that make them more tolerable and bring patients back into communities from which they often feel exiled.  In subsequent chapters Carter, who himself went through cancer treatment, and writes from that experience as well as from his experience as a volunteer in an ER, draws from his compendious collection of medical jokes and stories to provide examples of the kinds of humor that help nurses and doctors, as well as patients and their families, get through the days.  Some of it is edgy and ironic, some broad and slapstick, some wordplay that helps to domesticate the often alienating discourse of clinical medicine.  His point is to provide some analytical categories and ways of understanding the kinds of humor that can be helpful-not simply to share a collection of jokes and stories, but the book does, especially in the final chapters, provide a sizeable collection of those, ranging from puns (including what he calls "groaners") to patient stories that in various ways turn medicine on its head.

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In 1907, Mary Mallon, an Irish-born cook, is identified as the source of typhoid fever outbreaks in several of the households where she has been employed. Deemed a healthy carrier, she nevertheless cannot comprehend her role in the tragedies and rejects her responsibility. How could she harbor the germ that causes the disease and not be ill herself?

Led by Dr. George Soper, the authorities ensure that she is incarcerated on North Brother Island in the Hudson River – until a lawyer takes an interest in her case. An important part of her defence comes from the growing knowledge that many other people are also healthy carriers of the germ and they have not been incarcerated. Finally in 1910, she regains her freedom on condition that she never cook for others again.

But Mary loves cooking, and it is a far more lucrative occupation than her work as a laundress. In addition, she needs to support her common-law partner, Alfred, who has a serious drinking problem and is chronically unable to find work. Alfred had left her for another woman during her incarceration and succeeds in giving up alcohol. But he still loves Mary and abandons the other woman; he vanishes out west and is injured in a horrible fire that leaves him deformed and in chronic pain. Mary finds him and tries to help him, but Alfred now slowly slips into drug addiction.

The temptation to start cooking again is too great. The inevitable happens and Mary is caught. This time, however, she does not protest and ends her days as a captive of New York City.

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A big believer in evidence-based science, Australian Professor Don Tillman is 39 years old, “tall fit and intelligent with a relatively high status and an above average income.” He should be attractive to women and succeed in reproducing. Yet he is alone. Dating is a disappointing waste of time.

After he is asked to give a lecture on Asperger’s syndrome, Don decides to solve his problem scientifically. He develops his Wife Project – a massive questionnaire designed to weed out incompatibles and identify women most likely to be a match. Intelligence, punctuality, shared tastes, and no use of tobacco or alcohol are high on the list of desirables. His only friends, geneticist Gene and psychologist Claudia, humor and support him. Gene and Claudia have an open marriage, which means that Gene’s “research” involves his bedding many women of different nationalities.

Into his life comes Rosie—a wild, disorganized bartender who smokes. She is totally incompatible. Curious about her biological father, Rosie inspires Don to develop the "father project" as a way of identifying all possible candidates and then eliminating them one by one using DNA. Circumstances force them to work together at various other schemes—running a one-off bar for which Don, the non-drinker, becomes a walking encyclopedia of cocktail recipes. A trip to New York City results in more hilarity, further destabilizing Don’s equanimity. His stereotypical assumptions are challenged when he discovers that she is completing a PhD on the side. They have fun. But Rosie cannot be the right one because she would fail the questionnaire.

Eventually and predictably Don realizes that it is Rosie whom he wants and needs. He develops the Rosie project to win her back. He also shows Gene that the wonderful Claudia is about to leave him and that open marriage is for the birds—or is it the bees? Happy endings all round.

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The author was the first blind physician to be licensed in Canada. Her autobiography is also an autopathography.

From her anger over developing severe diabetes as a teenager, through her relentless pursuit of a scientific degree and medical school, through a brief failed marriage – followed by the tragedy of completely losing her sight while still in training, to a rewarding and responsible career as a palliative care physician and educator.

Sustained by her religious faith and by loyal family members and friends, Poulson explains choices, compromises and supports that allowed her to continue studying and working in Montreal and later in Toronto.

Her complications from diabetes were numerous, and included heart disease for which she required surgery. Then she developed breast cancer, which eventually metastasized. In closing her narrative, she knows it will likely take her life.

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A 50-year-old man is showering when he experiences pressure in his chest and throat associated with profound fatigue. An ambulance is called, and the emergency medical personnel inform him that he is having a heart attack. As he lays bare on his bed, his emotions switch from shock to indifference to a sense of calm with acceptance of impending death.

The narrator is a poet and a foreigner. In the hospital, his complicated name gets truncated to "Me'med" for convenience. He emigrated with his family from Zagreb to America in 1996, but still wakes from sleep haunted by memories of Kalashnikovs firing in Sarajevo.

He has stents placed in two obstructed coronary arteries and is immediately asymptomatic. At the Washington, D.C. hospital where he is treated, the narrator encounters a collection of fellow-foreigners: an elderly Slovak roommate suffering from Alzheimer's disease, a young Somali nurse, an African echocardiographer, and an Indian physician. A few days later, when he is discharged from the hospital, he feels fear and insecurity even though his medical problem has been fixed.

The narrator's world is now different. He is no longer who he was. When he returns to his apartment, hints (cigarettes and ashtrays) of his prior life are missing. He has a chance to change, another opportunity to restart his life.

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Black Bag Moon is a collection (one is tempted to say a "mixed black bag") of short stories (but not clearly "short fictions" - clarified below) about medical patients. The reputed authors are identified as these patients' physicians, who recount these stories in first person. By my math, there are nine authors who narrate stories about 37 patients in 29 chapters. Most chapters have two patients in unrelated stories that sometimes share a theme. Several of the authors know each other as colleagues and two are a married medical couple. Most of the stories occur in Australia or New Zealand but some are in places are as far flung as England, Scotland and unidentified, possibly fictional, islands in the South Pacific. The practitioners are, for the most part, family physicians and care for people of all ages, providing care for everything from breast masses to congestive heart failure to trauma to occupational health to - almost overwhelmingly - mental illness threatening severe violence. The last - serious mental illness -  is, as are all the patients and their illnesses in this volume, almost exotically different from anything most readers of this database are likely to encounter as health care providers or readers. Think Crocodile Dundee or perhaps television's Dr. Quinn or ‘Doc' Adams of Gunsmoke. Or all the above but in the late 20th Century Outback.

Since most of the stories involve working men and women - mainly men - there is a decided flavor of  A. J. (Archibald Joseph) Cronin's The Citadel to the stories; but the peculiar aspect of Australia's frontier pervades each encounter with the patients in this book, whether they are being treated over the radio for breast lumps, being airlifted to the hospital for a badly broken elbow, or becoming demented from environmental toxins in a land and time wherein OSHA and DEP (and the principles underlying them) might as well be acronyms from Mars.

Curiously, for fiction, there are intermittent footnotes to literary (Honore de Balzac, Soubiran) sources, historical figures (Hippocrates) and relevant texts on subjects covered in the stories, e.g., petrol-sniffing, tropical diseases, and physical diagnosis. 

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At five years old, Willow O’Keefe has lived a life rich in love and exceptional learning; she reads beyond her years and has memorized a startling compendium of unusual facts.  She has also sustained over 50 broken bones, two of them in utero.  She has osteogenesis imperfecta, a congenital defect in the body’s production of type 1 collagen that leaves bones very brittle.  People with the disease generally suffer many fractures and often other conditions—exceptionally small stature, hearing loss, and bowed limbs.  Willow’s parents and older sister have organized their lives for five years around protecting her from damage and helping her heal from her many broken bones.  Though Amelia, her older sister, loves Willow, her parents’, Charlotte and Sean’s, intense focus on Willow’s condition often leaves her jealous and disgruntled.  Things go from bad to worse when their mother learns that a lawsuit for “wrongful birth” is legal in New Hampshire, and could bring them the money they need to cover Willow’s many medical expenses.  Such a step, however, means losing a best friend, since the obstetrician who oversaw Charlotte’s pregnancy and Willow’s birth, and who ostensibly overlooked signs of the disease and failed to warn the parents, has been Charlotte’s best friend for years.  A “wrongful birth” suit is based on the claim that medical information about a congenital defect was withheld that might have been grounds for a decision to abort the pregnancy.  Though Charlotte insists this drastic step is the best thing they can do to insure a secure future for Willow, Sean finds it repugnant enough finally to leave home.  It is clear that even a win will be a pyrrhic victory, and indeed, the outcome is ambiguous, costly, and life-changing for everyone concerned.

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This collection of 16 short stories focuses on doctors and patients in San Francisco, where a wide variety of wealth and culture impact the delivery of medical care.  Further, there are many restrictions—financial, bureaucratic, ethical, and legal —that limit what doctors can do, especially in cases of patients near death.

The author, Louise Aronson, is a geriatrician who knows this terrain very well, having trained in San Francisco and worked as a physician there. A skilled writer and close observer, she has created dramatic and often funny stories that reveal social and bioethical complexity. About half the stories describe end-of-life issues for the aged and the dilemmas for their physicians and families.

In ‘The Promise,” Dr. Westphall orders comfort care only for an elderly patient who has suffered a massive stroke, but a hospital gives full treatment because there was no advance directive and the daughter told the attending to do “what he thought best.”

When Dr. Westphall sees this barely functioning patient in a skilled nursing facility seven months later, he tenderly washes her face and hair—although the text teases us that he might have been prepared to kill her.

In “Giving Good Death,” a doctor is in jail charged with murder; he has fulfilled the request of Consuela, a Parkinson’s patient, to help her die. When it appears that she may have died for other reasons, he is released, his life “ruined.” He leaves San Francisco, and, we surmise, medicine. In three other stories, doctors also leave the profession: the cumulative stresses of work and family and/or a sense that it’s not the right path bring them to that choice.

On the other hand, one of the longer pieces “Becoming a Doctor” celebrates the profession, despite all the rigors of training including sexism against women. 

The stories bring multicultural insights; we read of people from China, Cambodia, Latin America, India, Russia, and the Philippines. Some are African-American; some Jewish, some gay. These different backgrounds color notions of health, death, and medical care. There are also pervasive issues of poverty and, at another extreme, professionalism that is hyper-rational and heartless.

Indeed, a recurring theme is care and love for people, no matter their background or current health status. A surgeon realizes (regrettably too late) that the secret of medical care is “caring for the patient—for anyone—just a little. Enough, but not too much” (p. 135). 

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Elie Wiesel, 82-years-old, has pain that he thinks is in his stomach or esophagus, perhaps caused by his chronic acid reflux.  After tests, however, doctors diagnose cardiac illness and insist on immediate surgery. Reluctant to go to the hospital, Wiesel dawdles in his office. When he does go, doctors believe a stent will do the job. Instead, the intervention becomes a quintuple bypass.

This brief memoir—a scant 8,000 words—presents the “open heart” of a gifted writer as he contemplates his open-heart surgery, his past life, and the future. He asks himself basic, even primal questions about life, death, and the nature of God.            

Although a man with an extraordinary career—prizes, fame, honorary doctorates, friends in high places, professorships—Wiesel experiences and describes ordinary feelings of anxiety, pain, and doubts about his cardiac emergency and possible death. His stylistic gifts describe frankly and vividly a patient’s fears. As many have observed, patients with a serious disease have two difficulties, the disease itself and their emotional responses to that disease.  As Wiesel is wheeled into the OR, he looks back on his wife and son; he wonders whether he will ever see them again.            

He writes that his “thoughts jump wildly; I am disoriented.” He recalls a friend undergoing similar surgery; she died on the table. He says he can’t follow the jargon of physicians. The texture of the prose is rhapsodic, jumping from the present to memories, many of them about war, his past surgeries, or important family events. This short book has 26 “chapters,” some just half a page; they are like journal entries.

As he slowly recovers, he feels pain and has visions of hell, including the concept of ultimate judgment. “Evidently, I have prayed poorly…; otherwise why would the Lord, by definition just and merciful, punish me in this way?” (p. 38).  Because he has a “condemned body,” he feels he must search his soul. In the longest chapter of the book, he reviews several of his writings.

Wiesel asks some of the questions from his famous novel Night (La nuit, 1958).  If there is a God, why is there evil? Auschwitz, he says, is both a human tragedy and “a theological scandal” (p. 67). Nonetheless, he affirms, “Since God is, He is to be found in the questions as well as in the answers” (p. 69).

At the end, he still has some pain but feels much gratitude for his continuing active life and for his grandchildren.

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