Summary:

The narrator suffers from depression and a pain in the right side beneath his ribs. Surgery will be performed at his home by Dr. Haddon and Dr. Mowbray, but the narrator worries that he might die during the operation. During an afternoon nap on the day before surgery, he dreams of death and resurrection. Chloroform is administered prior to the operation, but the narrator continues to be aware of everything taking place.

He can see into the minds of the surgeons and learns that Dr. Haddon is afraid of inadvertently cutting a vein. Almost on cue, the vein is slashed and hemorrhaging occurs. The narrator has a near-death experience associated with an extraordinary clarity of perception. He senses movement upward - beyond his body, beyond the town, and beyond the world. He believes his soul is streaming through space past the solar system and nearby constellations.

His impression of absolute serenity is eventually replaced by a sensation of loneliness. All matter becomes condensed into a single point of light, then a fuzzy glow, and finally the image of a colossal hand clenching a rod. A faint sound punctures the silence followed by a voice proclaiming, "There will be no more pain" (63). He awakens and sees the surgeon standing next to the rail of the bed. The narrator has not only survived the operation, but his pain and melancholy are vanquished.

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This slim volume dips into "quotable quotes" drawn from literature and historical writings dating back several centuries. The quotes are put forth by physicians, patients, observers of medical issues, and writers of fiction as well as essayists. Each quote is but a few lines. The author, the source, and the date (when known) are provided for each quotation.

Many of these quotations will be familiar to persons who are widely read or who study the literature by and about medicine. Some of the quotes are scatological in the sense that they address issues of bodily parts and functions; others are simply amusing, while many are profound observations. The range is wide and the selections eclectic.

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A down-and-out attorney, who has become somewhat obsessed with the case of a severely impaired woman who had suffered brain damage during the course of a surgical procedure, presses forward to prove medical malpractice. In the course of developing the case he is opposed by the Bishop of the diocese which owns the hospital in question; one of the most powerful law firms in the city; and, acting as "spy" for the defense team, a beautiful woman lawyer.

Galvin, the protagonist, is encouraged to continue his pursuit of justice by an honest former partner and his own belief in the patient's childrens' right to a settlement. Galvin wins his case by proving that the medical records have been altered.

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The aim of this collage of anecdotes from medical history is largely to entertain, though it is pointedly instructive in its focus on reasons for and results of medical mistakes, misapprehensions, and serendipitous breakthroughs. Gordon's dryly humorous skepticism and general irreverence is balanced by an obvious delight in the intellectual play that characterizes the history of science.

The stories he tells range from Hippocrates to the present with a heavy focus on the 18th and 19th centuries. The book includes a good representative collection of visual art and photography documenting moments in medical history upon which Gordon casts a cold but twinkling eye. Chapter titles such as "Discoveries in the Dark," "Sex and its Snags," "Odd Practices," and "Freud, the English Governess and the Smell of Burnt Pudding" give a bit of the book's flavor.

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This anthology of "healing poems" is designed, according to the editors, "to find readers who might not usually read poetry." They say it should also be read "by those sitting in waiting rooms in surgeries and outpatients' clinics." These are definitely large tasks to expect this small collection of poems to accomplish, but in a different world (for example, a world in which people believed in the power of poetry to heal), this particular anthology would have a good shot at becoming a standard waiting room fixture.

The therapeutic intervention is well thought out. The editors have arranged the book into eight sections, each containing poems that exemplify a different theme, or situation, or style of treatment. The sections include: Admissions, Poems to Make You Feel Better, What It Feels Like, For Those We Love, The Language of Pain, Healing Rhythms, Body Parts, and Talking to the Dead. There is considerable overlap among these categories, because good poems speak several languages and can't be pinned down to a single feature. However, the classification does serve a heuristic purpose. It is another way to hook the reader, by choosing a topic he or she likes; once inside the covers, the reader may explore at will without regard to categories.

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Doctors Everett and Mimi Menlo are psychiatrists living in Toronto. The married couple sleeps in separate beds. They vow never to work as a team or in the same medical facility. Each doctor is deeply troubled by a patient who refuses to communicate. For Mimi, it is Brian Bassett, an eight-year-old boy with autism who eventually dies under her care. For Everett, it is Kenneth Albright, a hospitalized patient with severe paranoid schizophrenia who has attempted suicide four times.

Kenneth's dreams were once complex and intriguing but lately they lack detail and variety. One morning, he is found covered with blood but has no signs of injury. Despite a thorough investigation, it remains a mystery as to whose blood it really is. Following that strange occurrence, Everett experiences insomnia, but he is reluctant to admit the cause to Mimi. She worries that he might be having a nervous breakdown.

In truth, he fears dreaming. He has recurrent nightmares of a bloody Kenneth kneeling next to the bodies of strangers. Everett suspects that Kenneth has placed these corpses in his dreams. Everett finally tells Mimi about his nightmares. He shocks her with the revelation that Kenneth Albright has genuine bloodstains on his clothing and hands every day even though he is still confined to the psychiatric ward. There is only one spot Kenneth can escape to--dreams. After their conversation, Mimi falls asleep and dreams of Brian Bassett. She wakes up and finds Everett in the bathtub. His pajamas are saturated with blood. Mimi promises Everett, "I'm waiting here . . . until we both wake up" (596).

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One of Campo's projects has been to interrogate the methods used by physicians to understand patients. These methods can be expertly employed to hone in on certain diseases and pathologies, but can also come with a price, most notably a blindness to that patient's experience and personhood. Campo's message might be, It's hard to see the big picture through a microscope.

In this sonnet, he turns to the mental status exam. The inadequacy of a dualist perspective of mind and brain and the reductionism of simple interpretations are the starting point. Campo then turns to several questions from the Feinstein mental status exam (remembering three objects, interpreting a phrase, etc.). Ever attuned to the life of being a physician, Campo has captured the embarrassed way in which many of the (very simple) questions are asked ("Just two more silly questions").

He does grant the divergence of mental experience, with the reminder that the mind is "timeless, dizzy, unscrupulous" as well as "sometimes only dimly lit," and acknowledges the limits of the mental status exam, one in which a certain type of memory is tested (three objects) but not another (that the patient might sing).

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The physician-narrator recounts two unsettling house calls made three decades earlier when he began his medical practice in a remote part of Virginia. The doctor is asked to see Alan Jordan at the request of his wife, Judith. They live with their son and three elderly female relatives in a deteriorating house on a secluded estate known as Jordan's End. The Jordan clan is notorious for marrying their own relatives, but Alan wedded someone outside the family.

Judith is beautiful, and in the doctor's eyes, ethereal. Alan's infirmity began 3 years ago with brooding and melancholy but has now progressed to episodes of withdrawal alternating with agitation. A renowned psychiatrist from Baltimore evaluates Alan, deems his condition incurable, and recommends institutionalization.

Mental illness and insanity--the result of heredity and inbreeding--seem to affect all the Jordan men. Alan's grandfather and two uncles are in an asylum. His father died in one. After the narrator examines Alan, he gives Judith a bottle of opiate medication to help ease her husband's restlessness.

The doctor is soon called back to Jordan's End. He finds Alan's dead body in bed covered by a linen sheet and notices that the full bottle of medicine he left only two nights previously is now empty. The doctor cannot decide whether or not Judith has killed her husband nor does he really want to know.

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Joseph takes a lengthy journey on a strange train to visit his father who resides in the Sanatorium. On the way, he meets a fellow with a swollen face who wears a tattered railwayman's uniform. That man eventually vanishes from the train. When Joseph arrives at his destination, he is informed, "Here everybody is asleep all the time" (115). The Sanatorium's physician, Dr. Gotard, provides a confusing explanation about the condition of Joseph's father. From the perspective of the natural world, Joseph's father is already dead. As a patient in the Sanatorium, however, time is manipulated for him. The past is reactivated allowing for the remote chance of recovery (or at least existence in a type of limbo).

During his stay, Joseph sleeps with his father since no other bed is available at the Sanatorium even though he suspects they may be the only two guests there. He discovers that his father--pale, emaciated, and nicely dressed in a black suit--has two different lives. In the Sanatorium, the man is moribund. Outside the facility, he is vibrant and runs a small cloth shop in a peculiar nearby town. Joseph finds himself "mortally tired" [p 125] and often overpowered by sleep.

A ferocious watchdog guards the Sanatorium, but up close Joseph notices that it is not a canine but rather a man (or perhaps a dog in human guise) so he unchains the creature. Feeling an urgent need to escape his situation, Joseph races to the railroad station where he boards a departing train. He is convinced he will never see the place again. Joseph makes the train his home. Nonstop travel becomes his future. Joseph now has a swollen cheek that is bandaged. He is attired in a worn out railwayman's outfit. When he is not wandering on the train or dozing, Joseph sings and people lob money into his hat.

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Set sometime in the near future, Cast of Shadows has as its protagonist Davis Moore, a successful private practice physician specializing in cloning human babies for infertile couples. Early in the book, Anna Kat, his high school senior daughter, is murdered and raped. (For a while a likely suspect is Mickey the Gerund, a right wing extremist member of the Hands of God with a fascinating grammatical moniker never explained, who shoots cloning physicians, including Dr. Moore, in the abdomen, a short time before his daughter, Anna Kat, is brutally killed. However, Mickey is only a shadow of a suspect and quickly becomes supplanted by another much more likely villain. Mickey goes on to kill, by various methods, dozens of cloning physicians and staff by book's end.)

After a year of unsuccessful detective work, the local police return Anna Kat's belongings, including a plastic vial with the suspected murderer-rapist's semen. In an act never fully explored by Dr. Moore or the author, an otherwise rational and ethical physician surreptitiously uses the suspect's semen to fertilize a married woman patient.

The offspring, a clone of the suspected killer-rapist, is Justin, who becomes a formidable presence in the book. He is very intelligent--at his psychologist's advice, his parents provide him at an early age with advanced reading materials like Plato (hence one of the allusions to shadows, i.e., Plato's cave, in the book's title and referenced directly on page 118 and indirectly on page 208) and other philosophers. By the time he is a senior in high school, Justin has become a dominant player in the affairs of Dr. Moore; Sally Barwick, a private investigator-turned journalist; and the suspected killer-rapist--his origin of the species as it were.

This book has a number of subplots all of which radiate from the initial cloning and the various members of the extended family and professional staff involved in it, some knowingly, most not. There are narrative threads involving the suspected murderer rapist-now-prominent attorney, Sam Coyne; the triangle of Dr. Moore and Jackie, his alcoholic wife, and Joan, his attractive pediatrician associate; Mickey the Gerund's various murderous and obsessional religious activities and reflections; Justin's life in school and involvement with Sally Barwick's investigation of a serial killer called The Wicker Man; and, most especially, the development of Shadow World, a computer game and a virtual replica of the real world--the world as Justin, Sally, Sam Coyne, and Dr. Davis Moore know it.

Since this is a thriller, it would be inappropriate to divulge more of the plot, which is intricate, often a little far-fetched but always engaging, highly readable and more labyrinthine than most medical thrillers.

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