Summary:

The poems in physician Rafael Campo's latest collection examine familiar themes: lost homelands, the agonies of patients and providers, local and global abuses, love and betrayal, of both the heart and the body.  In this book, Campo expands these themes, writing of child abuse, war, and the certainties and uncertainties of maturing love.  As in his earlier collections, Campo investigates these themes in poems that are expertly crafted and often in form, as if form might contain this poet's empathic and deeply felt connection to the world.  While Campo has always been a reliable witness, especially to the world of healthcare, in this volume his vision becomes even more incantatory, paradoxical and mature.  The narrator's personal losses and responsibilities expand into the universal, into a world that cries out to us to care, to act, to heal, to notice, to tell, to "realize the human" (92).

Divided into four sections, the first section begins with a poem, "Dialogue with Sun and Poet," dedicated to June Jordan, a deceased activist and poet whose poems once made Campo uncomfortable but now mobilize him to "arise."  Following poems tell of local abuses--an abused woman ("Addressed to Her"), the displacement of memory ("Elsa, Varadero, 1934" and "Night Has Fallen"), the crushing of the spirit ("Personal Mythology") and the reality of evil, evil that calls poets to "refuse nostalgia's reassurance that the way was clear" ("Brief Treatise on the New Millennial Poetics").  This section ends with a translation from Neruda's "Book of Questions," a poem that asks if we are in control and if we are indeed capable of change (22).

In the second section, Campo takes us, in sonnets, through "Eighteen Days in France," another country and yet one in which he is still haunted by melancholy, by both sadness and joy--when one sees clearly one cannot leave behind suffering or the potential for suffering.  These sonnets speak of loss, fear, doubt and death grounded in moments of pure happiness.  

The book's third section, "Toward a Theory of Memory," opens with another masterful Neruda translation, one that speaks of love's convolutions, "just as life is of two minds" (47).  Following are exceptionally beautiful poems that speak of the misuse of love and power ("Granymede, to Zeus") and of the deep joy and deep complications of long-married love (see especially "The Story of Us").

Section Four, "Dawn, New Age," is a collection of laments for human selfishness, for war, for the inevitable passage of time, for the emotional depressions we might lose ourselves in, for the patients we cannot cure.  In "Tuesday Morning," the poet says, "No poet cares / for such deceptions anymore, and words / don't cure" (93).  Perhaps words alone cannot cure, but these poems, intelligent and very often incredibly beautiful, can sustain us and remind us that only human connection, human love might help us survive.

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In the Emergency Room at 2 AM, a doctor tries to suture a laceration on the forehead of "a huge black man," brought in by the police. The man groans and strains; he won't hold still. Finally, the doctor becomes so angry that he sutures the patient's earlobes to the mattress. Not only that, he leans over the man's face and grins: "It is the cruelest grin of my life." Then he sutures the man's wound.

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This is a gripping and poignant account of newsman Bob Woodruff’s brain injury and recovery. He was injured in Iraq by a roadside bomb on January 29, 2006, shortly after being named co-anchor for ABC’s World News Tonight. A public figure—even a celebrity—his injury and recovery were well publicized, bringing to light the injuries of many kinds suffered by soldiers (not to mention civilians) in war-torn Iraq. Woodruff received every benefit American military medicine could offer and had impressive support of ABC and various luminaries. He made a spectacular recovery against all odds.

The book is mostly told by Lee Woodruff, Bob’s wife, who flew to Germany on a moment’s notice to see him at the Landstuhl Military Hospital, who waited 36 days for him to wake up, who saw the CT scan with rocks embedded in his head, who managed their four children and household during the long recovery time, and who writes vividly and personably. There are also flashbacks about the lives of Lee and Bob, truly a remarkable couple: their courtship, their time in China and London, their decision to use a surrogate mother to have their second two children.

Bob himself contributes pages, before and long after the accident. Thirty-one photos, both black and white and in color, enliven the text. One photo shows the interior of a critical Care Air Transport Team, a C-17 cargo plane outfitted like an ICU to transport wounded soldiers.  Throughout, the costs of warfare on people, society, materials, and land (not to mention dollars) is dramatically evident.

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In How Doctors Think, Jerome Groopman explores clinical decision making with a particular emphasis on the poor communication skills and cognitive errors that often lead to misdiagnosis and inappropriate treatment. He uses a narrative approach, filling the book with compelling stories that illustrate the world of patient-physician interactions. Why did a second doctor quickly conclude that Blanche Begaye suffered from aspirin toxicity, while her first doctor mistakenly diagnosed viral pneumonia? Why did several physicians fail to diagnose Maxine Carlson's ectopic pregnancy until the day it ruptured? Groopman's storytelling skill permits him to convey complex concepts (e.g. availability bias, anchoring, and Ockham's razor) through conversation and narrative.

Three major themes run throughout the book, and each is presented with several variations. The first theme is that doctors who don't listen to their patients are likely to make serious mistakes in diagnosis and treatment. The second is that doctors frequently don't have the self-awareness to understand their own errors, especially those that involve dealing with ambiguity and understanding the importance of emotions. The final theme is that that patients ought to be active participants in their own care. This is not a new message, but Groopman frames it in a new way. Given the complexity of clinical decision making, and the many cognitive errors physicians may fall prey to, patients can improve their own care by helping their doctors minimize or avoid such errors. Among other things this means asking thought-provoking questions like "What else could it be?", "What is the worst thing it could be?," or "Is it possible I have more than one problem?"

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The famed surgeon Douglas Stone flaunts his notorious affair with Lady Sannox, although his professional reputation begins to suffer. One night a mysterious Turk asks him to attend his wife, who has cut her lip on a poisoned dagger. The Turk insists that amputation offers the only hope of recovery. Anxious to pocket the proffered gold, and impatient to get to his mistress, Stone dismisses his professional misgivings. He excises the lower lip of the veiled, drugged woman--only to find that he was tricked into disfiguring Lady Sannox herself. Lord Sannox (disguised as the "Turk") thus gains his revenge, with his wife morally chastised (and forever after in seclusion), and Stone’s "great brain [thenceforth] about as valuable as a cap full of porridge."

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This collection of essays by surgeon-writer Atul Gawande (author of Complications: A Surgeon's Notes on an Imperfect Science --see annotation) is organized into three parts (Diligence, Doing Right, and Ingenuity) and includes an introduction, an afterword entitled "Suggestions for becoming a positive deviant," and reference notes. Each part is comprised of three to five essays, which illustrate, as Gawande explains in the introduction, facets of improving medical care - hence the title of the collection: Better: A Surgeon's Notes on Performance. In typical Gawande style, even the introduction contains tales of patients - a woman with pneumonia who would have fared far worse had the senior resident not paid close and particular attention to her well-being, and a surgical case delayed by an overcrowded operating room schedule. Such tales are interwoven with the exposition of themes and the detailing of the medical and historical contexts of the topic at hand.

The essays, though loosely grouped around the improvement theme, can easily be read as individual, isolated works. The concerns range widely both geographically (we travel to India and Iraq as well as roam across the United States) and topically. For instance, we learn about efforts to eradicate polio in rural south India and the dedicated people who devise and implement the program. Another essay, far flung from the plight of paralyzed children, is "The doctors of the death chamber," which explores the ethical, moral and practical aspects of potential physician involvement in the American system of capital punishment (from formulating an intravenous cocktail ‘guaranteed' to induce death to the actual administration of such drugs and pronouncement of death).

In sum, the topics of the eleven essays are: hand washing, eradicating polio, war casualty treatments, chaperones during physical examinations, medical malpractice, physician income, physicians and capital punishment, aggressive versus overly-aggressive medical treatment, the medicalization of birth, centers of excellence for cystic fibrosis treatment, and medical care in India. The afterword comprises five suggestions Gawande offers to medical students to transform themselves into physicians who make a difference, and by including this lecture in the book, what the reader can do to lead a worthy life.

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A Princeton professor has less than one night to live. His physician visits him in the hospital late in the evening. Dr. Dean is uncomfortable interacting with the dying man. He feigns optimism about the clinical situation and offers false hope but avoids eye contact with the professor and urgently exits the room. A compassionate nurse, Mrs. Roszel, is on duty. Before bedtime, she gves the professor a blue pill that dampens the constant pain in his stomach and also provides a pleasant sensation of weightlessness.

Out of nowhere, he hears a beautiful melody played on a violin. It is barely audible and imperceptible to the nurse. The professor has been a violinist since his youth, and the music triggers a flashback. Sixty years earlier, as a 15-year-old boy, he visited a small town in Italy. The silence of the village was punctured by heavenly violin music. Time slowed and then stopped. Light surrounded and permeated him before giving way to absolute darkness. Was it enlightenment or heatstroke? He awoke and saw a priest hovering over him.

Like that day long ago, the violin music now playing in his hospital room is still a revelation. The harmony reveals the mystery of the universe - the connection between time and space and light. Suddenly it is imperative that the professor shares this new knowledge before he dies. Calling fo Nurse Roszel, he attempts to impart to her what he has just discovered. She is baffled by the language but listens intently anyway.

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This Japanese horror story is set in a hospital in financial crisis, short of supplies and staff. We see various nurses and doctors struggling with their working conditions. A patient is injured falling out of bed, a nurse practices her IV technique on an unconscious burn patient, a demented woman wanders the hallways talking to apparitions she sees in mirrors. Two events set the central plot in motion: the burn patient dies because of a medication error and those present—Dr Akiba (Koichi Sato) who was responsible and Dr Uozumi (Masanobu Takashima) who was supervising, as well as the nurse who gave the lethal dose and her supervisor—decide to cover up the mistake, and a patient is brought to the ER suffering from a mysterious infection that is liquefying his internal organs.

Dr Akai (Shirô Sano), a senior physician, demands that Drs Akiba and Uozumi begin a study of the infected patient, despite their terror. The patient is never shown directly, but we see green ooze running from his bed. Akai argues that that discovering the pathogen causing this illness will raise money for the hospital, but the real incentive he offers is blackmail: he knows about the mistake and the cover-up.

As the night proceeds, all those involved in the error are infected, taking on zombie-like characteristics, behaving abnormally (a nurse attempts to transfuse her own blood into a corpse; a doctor tries to strangle a patient who has asked to have his pain relieved) and oozing green fluid before dying. With Dr Akiba, however, we begin to realize that the pathogen is not purely somatic. Dr Akai may in fact be the dead burn patient, the “green” ooze is red blood seen through the distorted perception of those haunted by guilt, and the title’s infection is the contagious fear felt by health care professionals who, for various reasons, are incapable of the infallible work of healing that is expected of them.

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Jay Baruch offers readers a series of multi-layered stories focusing on caregivers, both professionals (doctors and nurses primarily) and family members, and those they are trying to care for. The setting for a number of the stories (and therefore a number of the characters) is from the working class or underclass. Another group of stories is written from the perspective of medical students, residents or physicians early in their training. In all the stories, the characters' lives are close and full of conflict. The language they use to express themselves is raw and direct. There are no simple solutions to their problems. Yet struggle on do these characters, testing the limits of their compassion and abilities to deliver care at least competently.

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Serving as a summer hospital volunteer, fifteen-year-old Teri d'Angelo meets Valerie Ross, a girl her age who has damaged a nerve in a fall, and lost the use of one leg. Valerie's anguish over her partial paralysis takes the form of anger; she manages to keep most of those who try to help her at a distance. But Teri finds her intriguing, and Valerie's condition evokes a kind of sympathy and interest in her that overcomes even the patient's most strenuous rebuffs. Gradually, and with much caution on Valerie's part, they become friends. Valerie finds herself welcomed into Teri's large, warm Italian-American family. Teri's compassion for Valerie grows as she recognizes her loneliness; Valerie's parents are divorced, her father rarely visits, and her mother keeps up a hectic work schedule.
      
Teri also benefits in ways she didn't expect from the friendship; Valerie's bravery, even when masked with anger, inspires her to speak up more clearly on her own behalf, to ask for what she needs, and even to circulate a petition at school when she feels she has been discriminated against in the judging of a science project.
     
When Valerie is taken to a "sanitarium"-a mental health facility-for depression and apparently psychosomatic involvement of her good leg in the paralysis, Teri visits her patiently, despite Valerie's apparent lack of interest. But finally, when she watches Valerie rejecting the grandmother who traveled from England to see her, she acts in uncharacteristic anger, and in the shock of the moment, Valerie stands up, proving to herself and others that her good leg does, infact, function.  It is a turning point in her healing.

In an interesting twist, the book ends with the girls drifting apart.  They are, indeed, very different. Valerie is planning to attend City College in engineering. Valerie is going to live with her grandmother in England and attend Oxford University, hoping later to become a writer. In a final phone call, two years after Valerie's accident, the girls part with some affection and gratitude on both sides, but also with an acceptance of the fact that their friendship may have been for a season. They gave each other important gifts, and now life is taking them in very different directions. 

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