Summary:

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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This novel recounts the fictional life of Syms Covington, an historical character who was Charles Darwin's servant during the voyage of the Beagle (1831-1836) and for two years thereafter in England. Covington then moved to New South Wales, but remained in correspondence with Darwin for the rest of his life. (He died in February 1861.)

MacDonald expands on these facts to create the engrossing story of an "elderly" Covington--he would have been in his mid-40's at the time--who befriends a young American physician in New South Wales. Covington develops appendicitis and MacCracken, the young doctor, saves his life. They become friends and during the next two years Covington gradually reveals his story.

The book flashes back to the voyage of the Beagle and reveals the development of Covington's prickly but worshipful relationship with Darwin. In 1860 Covington, who has become a wealthy landowner in New South Wales, anxiously awaits his copy of The Origin of Species. After enduring the agony and adventure, after studying thousands and thousands of specimens, how will Darwin bring it all together? The theory of evolution rocks Covington to the core. Has his work played a part in helping Darwin to develop this godless theory?

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In 1848 a member of the Irish gentry named Robert Devereaux is convicted of treason and sentenced to 14 years imprisonment for publishing articles that advocate the violent overthrow of English rule in Ireland. This novel is purportedly based on the journal that Devereaux kept during his years as a prisoner (1848 through 1851).

It begins when he is transported from Ireland to Bermuda, where he spends many months in a prison "hulk." The authorities have to handle him carefully, though, because he is both a gentleman and a symbol of Irish resistance. They do not want to have a martyr on their hands. Thus, when Devereaux develops severe asthma in Bermuda, they send him to Van Diemen's Land (Tasmania), where he is given a "Ticket-of-Leave"; i. e. he is allowed to live as he wishes in the colony, provided he adheres to certain restrictions and agrees not to attempt escape.

Once in Van Diemen's Land, Devereaux is reunited with other prominent political prisoners. He also meets and falls in loves with Katherine, an Irish Catholic woman, far lower in social class. (Devereaux is a member of the land owning Protestant Ascendancy.)

To be close to Katherine, Devereaux buys a hop farm with an English prisoner named Thomas Langford. The lovers intend to escape to New York together, but Katherine is pregnant. She dies shortly after delivering a healthy son. The despondent Devereaux eventually escapes as the journal ends.

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The title of this collection of poems recalls the formulaic statement by which a physician introduces a patient's medical problem or chief complaint. For example, "The patient presents with a history of fever, abdominal cramps and diarrhea for the last 24 hours." Or, "The patient presents with a long history of hypertension and diabetes." In this case, though, Dr. White's patients' presentations are poems, rather than chunks of sanitized medical jargon; and, while the patient remains a key character in most of these works, they also present the doctor's story.

Domestic violence, child abuse, and sexual abuse figure prominently in these poems. In "365" (p. 1) a five year old girl presents with "a foul smelling vaginal discharge"; she was a victim of rape. Baby "John Brown" (p. 9) has 47 fractured bones and was "dipped in boiling water" for soiling himself. In "Ironing" (p. 18) a first grade girl has the impression of an iron burned into her thigh. And the two-year-old girl in "Peek" (p. 49) is admitted to the Intensive Care Unit (ICU) with cigarette burns and a liver fracture.

Dr. White also writes of babies left behind by their mothers ("Autumn Angels," p. 3), homeless mothers and children ("Numbers," p. 42), and complex multigenerational family pathology ("Riddle," p. 50). All in all, these stories carry the reader very close to "Looking at the Gates of Hell" (p. 32).

Yet, a still, small voice of calm, maybe even of salvation, can appear in the most unlikely places. In "Belly" (p. 4) the physician lays her face against a baby's belly and "the warm brown skin calms my forehead. / All stiffness melts." In "Maplewood & Greene" (p. 36) she revels in seeing "three little girls on roller skates." And in the Whitmanesque poem called "Oh" (p. 45), she gloriously affirms, "Oh to laughter, oh to sorrow / Oh to a better day, oh tomorrow."

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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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From a fishing trip the local doctor is summoned to an Indian village to assist a woman in labor. With him are his young son and an older male relative. The physician assesses the situation in the closed, pungent hut and determines that his only option is section--with a pen knife and fishing leader as his instruments, and no anesthesia for the Indian woman. The doctor arrogantly, but only briefly, celebrates his success as a surgeon only to discover that the woman's husband, apparently unable to tolerate his wife's pain and the racism of the white visitors, has silently slit his own throat. The child, who has observed the entire proceedings asks, "Is dying hard, Daddy?"

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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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Dr. Alvord was born to a Navajo father and a Caucasian mother--bilagaana--and felt from the beginning that she was walking the path between two worlds. Her childhood was spent on an Indian reservation and she was very close to her Indian grandmother.

She was fortunate to be able to attend Dartmouth College where there is strong support for American Indians. Actually there were 50 other Indian students there when she enrolled. From there she went to Stanford University for medical school and a surgical residency. This was a very unusual path for an Indian woman.

While in medical school and residency she felt very much separated from her Indian heritage and was glad to start her practice of surgery in the Indian Health Service and eventually to return to the Indian Hospital at Gallup, New Mexico, just fifty miles from the reservation where she grew up. This gave her the opportunity to learn more about Indian medicine and how to care for Indian patients.

While there she met her husband, a considerably younger Caucasian, and had her first child after a problem pregnancy. She sought the help of an Indian Medicine Man during this experience and felt much help from him. This is described very vividly.

Just eighteen years after she left Dartmouth she returned to be the Associate Dean for Minority and Student Affairs and to practice surgery and teach part time. There she hopes to share the Navajo philosophy of a balanced and harmonious life called "Walking in Beauty."

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In his third collection, Campo presents visceral poems that grow organically from the body: his own body and the bodies of patients, lovers, family, and friends. He doesn't write about being a gay physician of Cuban background--rather he crafts poems that address pain, love, and memory within a metrical framework so seamlessly that readers might feel they are healing, seeking, and singing alongside him.

Outstanding poems include "Sonnet in the Cuban Way," "The Return," "The Dream of Loving Cuba," "Madonna and Child," "Baby Pictures" (a prose-poem sequence), "A Poet's Education," "The Changing Face of Aids," and "Recognition." Section V, "Lorca," gives us Campo's translations of Federico Garcia Lorca's Sonnets of Dark Love.

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Dr. Robert Weiss passes through the town of Sankt Vero in the Tirol and rents a room from the Lukasser family. During the night, the Lukasser's son, Niki, develops acute appendicitis; the visiting doctor operates right there on the kitchen table, saving the boy's life. Years later, when war rages in Europe, the Jewish doctor returns to Sankt Vero and knocks on the Lukasser's door. He tells of soldiers forcing men, women, and children into railroad cars, and how he himself--he who had saved Niki years before--needs asylum.

To hide Dr. Weiss, Mr. Lukasser boards him up in a small room in the back of the hayloft, a space one meter wide and three meters high. For two years, the doctor exists in this box. Niki and his friend, a blind girl named Sigi, bring Dr. Weiss food once a day and, for ten minutes or so, they stay and talk. Sustained by Niki and Sigi's lives--the stories of their discoveries of sexuality, cruelty, and love--the doctor survives.

Although Sigi is blind, she has the insight to recognize and try to alleviate the doctor's growing depression by encouraging him to tell his own stories. It is through these stories and through the doctor's observation of Sigi and Niki's blossoming adolescence and struggles with morality that we experience both the doctor's confinement and the powerful conflicts and transformations that rage behind the doors of Sankt Vero.

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