Summary:

Spencer Nadler, a surgical pathologist for over 25 years in southern California, offers 8 essays, as well as an introduction, epilogue and 9 full color histopathology plates in this collection. As he explains in the introduction, Nadler began his training in surgery, but, during a required year of surgical pathology, he finds his true vocation: "I realized a flair for surgical pathology that I had never demonstrated in surgery." (p. xix) However, over the years, he realizes he misses patient contact--these essays, written over 10 years, are forays into an unusual relationship: the pathologist-patient relationship.

Each essay is about a different patient (or other contact) and tissue. One of the most compelling is the first, "Working Through the Images," in which a woman (Hanna Baylan) with metastatic breast cancer seeks Nadler out so that she may view her cancer cells. She arrives in his office unannounced at 6 p.m. and he proceeds to not only show her the slides, but to listen to her. He becomes a witness to her pain, loneliness, sorrow and hope.

"For years I have processed thousands of such cases, determined the manifold forms of disease, but I've never been an intimate part of anyone's illness, never felt the connections of cells to a larger self." (p. 12) During later visits, Baylan cries in his arms and even brings her youngest son in to meet Nadler and view her cells. By this time, Nadler is completely connected to her: "This is heartrending to me, for I have come to love her . . . I can no longer think of Hanna in terms of the cells I see on her slides." (p. 21)

Other chapters highlight fat and bariatric surgery; neurologic disorders such as brain tumor, Parkinson's, Alzheimer's and paraplegia; heart disease; sickle cell disease; and palliative care. Each chapter conveys Nadler's visual sophistication and ability to graphically describe cells. For instance, within a fat cell "a large fat globule steamrolls other cell contents flat against the outer membrane until it bulges like a mozzarella." (p. 32) More importantly, Nadler ably extends his cellular acuity to the larger human dimension.

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This is one of the two dozen studies of patients with right-brain disorders that make up Sacks's volume The Man Who Mistook His Wife for a Hat. The nineteen-year-old Rebecca has significant physical and mental defects (her IQ is 60 at best), and by conventional neurological standards she is severely impaired, but Sacks discovers that she has moments of being quite in touch and "together" (her word).

The essay tells of Sacks's discovery of Rebecca's poetic expression and spiritual qualities, and of her self-awareness, in planes unknown to standard neurological and psychiatric categories. Sacks is broadly critical of psychological and neurological testing as constituting a "defectology" that is blind to important human qualities. He warmly recommends music and story-telling, both as modes of understanding and also as narrative therapies that work by ignoring the defects and speaking to the soul.

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Nan Shin was an American woman living as a Zen Buddhist nun in France. She is diagnosed with advanced uterine cancer, undergoes surgery and chemotherapy and, by the end of the book, it appears, is dying. Her account does not, however, take the conventional form of the illness narrative; in fact its form might be called anti-narrative, for its focus is not on the story of Shin's illness and dying, but rather on the "every day living" that is at the center of her Zen beliefs.

The book consists of several strands that recur in alternating sections. One strand describes, in minute detail, the course of a single day's devotions and activities in the life of a Zen nun. Another traces the author's travels in the United States with her sensei, an astonishing man whose perspective on American culture is both detached and hilariously insightful.

A third tells of the author's frequent horseback rides through the French countryside, with beautifully focused and precise descriptions of the natural surroundings. Finally, there is the illness, presented matter-of-factly but conveying powerfully the author's (not always wholly successful) efforts to put into practice, in such trying circumstances, all she has learnt as a practitioner of Zen.

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The editor, herself a writer and one who has suffered depressive episodes, collects a series of personal essays or illness narratives about experiences with depression. Her contributors are all artists, primarily writers, who generally but not exclusively speak to the relationship between their art and their mood disorders. Some of the essays included have been previously published, but most are original contributions to this collection. The collection is introduced by Kay Redfield Jamison whose academic work has examined the relationship between creativity and depression, including manic-depressive disease.

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Kirklin, a physician and Lecturer in Medical Humanities at the Royal Free and University College Medical School, and Richardson, a historian and associate at the Wellcome Trust Centre for the History of Medicine, are both educators in medical humanities in London. This well-written and concise volume focuses on "the role of the humanities in medical education" and is aimed at "those wishing to integrate medical humanities into their own teaching, and learning." (p. xv) The chapters are written by a variety of educators with a wide range of backgrounds, including artist, medical student, writer, nurse, surgeon and philosopher.

At least two stimuli are cited as reasons for the development of this book: (1) the 1993 publication by the General Medical Council of Tomorrow's Doctors which recommends the inclusion of medical humanities in the required curriculum for undergraduate medical education in the UK and (2) a national conference, "The healing arts: The role of the humanities in medical education" in London, March, 2000. The rationale for such a book is delineated in several prefatory statements including remarks by Professors Sir David Weatherall and Sir K. George M. M. Alberti (Alberti is the president of the Royal College of Physicians). The book concludes with recommendations for further reading, schemata for undergraduate and graduate degrees in medical humanities at University of Wales, Swansea, and an index.

The nine chapters in this volume combine pedagogic philosophy, citations for literature and art and how to encourage reflection about these selections, tools for encouraging student creativity, reproductions of art and literature generated by students or patients or used by teachers for discussion, and some practical advice about teaching medical humanities and its, at times, uneasy connection to the rest of the curriculum. Each chapter reflects the individual contributor's area of expertise and experience. For example, in "Fostering the creativity of medical students", the authors Heather Allan, Michele Petrone (who painted the striking cover art), and Deborah Kirklin provide useful guides for teaching creative writing and art production by students studying cancer and genetic disease.

In a particularly insightful chapter, "Medical humanities for postgraduates: an integrated approach and its implications for teaching," Martyn Evans describes the challenges of developing a full-fledged interdisciplinary program for graduate as well as undergraduate studies in Wales. He addresses concerns about "bolt-on" versus integration of medical humanities in the curriculum, risks of superficiality, and how such studies may transform the culture of modern medicine. Several chapters address a theme (such as "clinical detachment" or understanding the patient's perspective) and include topic-specific sources and guidelines.

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Through a compilation of journal entries, prose, and poetry, poet and activist Audre Lorde considers her breast cancer and mastectomy. Lorde emphasizes the importance of having a support network of other women. As a lesbian and feminist, she also offers a different perspective on this surgery. Her concern is not attracting or pleasing men despite the loss of a breast.

In one chapter, "Breast Cancer: Power vs. Prosthesis," Lorde considers the political implications of prosthetic breasts, arguing that hiding women’s pain and suffering disguises the widespread nature of the disease and places too much emphasis on "normal" femininity. She also writes about plastic surgeons who perform dangerous reconstructive surgery in the name of "quality of life."

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This is the first "selected poems" by Claes Andersson to appear in English. Drawn from his 18 collections published in Finland, they are generally short (less than one page) poems without titles. As the Introduction notes, Andersson's early poetry features blunt language, while his later work strives for more musicality. Drawing on his psychiatric experience, Anderson uses "private life as a foundation for an investigation of all that shapes our identity."

Friendship is a frequent theme in these poems, as in "Philemon and Baukis": "If you become a fir / I'll be a birch/ Thus you protect and warm me / through the cold seasons / In return I'll dance for you / in the summer nights . . . " (p. 75) One of the most striking poems in the collection is "the new theology," which begins: "Disease is the conscience of the body / What would we be without our ailments . . . " (p. 112)

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At the age of 42, Barbara Rosenblum learns, after several misdiagnoses, that she has advanced breast cancer. This book, co-written by Rosenblum, a sociologist, and her lesbian partner, Sandra Butler, a feminist writer and activist, is a record of their lives together from the diagnosis until Rosenblum's death three years later. Early on, Rosenblum decides that her dying will be exemplary and self-conscious, and she and Butler use their writing as a way to create an illuminating examination of their lives over those three years.

The book's title is accurate; the writing takes the form of alternating meditations by two women, on the effects of cancer on their relationship, their work, their families, and their social, political, and spiritual beliefs. Especially significant are the differences between their voices, and the differences between the experience of the person who is dying and that of the person who is going to have to survive and grieve. The writers bravely explore the conflicts between them as well as their profound bonds.

After a mastectomy and eighteen months of chemotherapy, Rosenblum has a very brief respite, followed by liver and lung metastases, and prolonged further chemotherapy. A few months after ending treatment, she dies at home.

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The narrator is visiting a sick loved one in University Hospital, Boston and reflects on the many patients who have stayed in this hospital, most especially the young men from the battlefields of the American Civil War.

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The speaker enumerates the pleasurable activities of daily life: getting out of bed "on two strong legs," walking the dog, lying down "with my mate," planning another day "just like this day." Counterpoised to these enumerations, however, is the recognition that "it might have been otherwise." Finally, the speaker acknowledges, "it will be otherwise."

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