Summary:

A child dies in the hospital shortly after the infectious disease consultant, Dr. Michael Grant, evaluates her. The 35-year-old physician has cause to be troubled by the patient's death. He failed to perform a careful examination, did not check the results of her most recent lab tests, and held off on ordering antibiotics. Although an autopsy was not performed, it is believed she died of sepsis.

Divorced and recently relocated to North Carolina, Dr. Grant is already depressed. Now he must worry about the possibility of a malpractice lawsuit. Jonas Williams, the father of the dead child, is also ill. He complains of fatigue, visual disturbances, confusion, night sweats, and fever. Jonas has developed unusual lesions in his throat and retina--white threads in a serpentine pattern. A biopsy of his oral lesion demonstrates the presence of osteoblasts and new bone formation. Dr. Grant becomes convinced he has stumbled onto a completely new infectious illness even though he cannot identify the causative organism.

Jonas experiences gastrointestinal bleeding as a result of a low platelet count. He dies in a trailer that has caught on fire. Dr. Grant soon develops the same symptoms as his patient. He remembers coming into contact with some of Jonas's blood. He is admitted to the hospital with massive gastrointestinal bleeding. His physician attributes the bleeding to ulcers, gastritis, and thrombocytopenia. Dr. Grant, however, believes the bleeding is due to the same mysterious disease that Jonas had.

The body of Jonas's daughter is exhumed, and there is anatomic evidence of the same bizarre changes that occurred in her father. Dr. Grant visits a cabin in the woods where Jonas had lived. He is looking for clues to the puzzling new illness. What he finds, however, is not an answer. Instead, it is a renewed appreciation for his life as well as the world around him.

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This is a collection of 23 stories, five of which take the form of "letters" in which an older physician (not surprisingly, a surgeon) gives advice to an imaginary young surgeon. However, every one of the stories "fits" as a tale that might be told in such a letter--assuming the author was a wise and gifted writer, in addition to being a surgeon.

The book begins with the gift of a physical diagnosis textbook on the occasion of the young doctor's graduation ("Textbook") and ends with a reflection on "your first autopsy" ("Remains"). Among the other stories are Imelda (see annotation), Brute (see annotation), Toenails (see annotation), Mercy (see annotation), "A Pint of Blood," "Witness," "The Virgin and the Petri Dish," and "Impostor."

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The new interns, Roy Basch (Tim Matheson), Chuck (Howard Rollins, Jr.) and Wayne Potts (Michael Sacks), begin their year of internal medicine training in a busy city hospital under construction. After initial introductions led by the vague staff man and vapid chief resident, they become the specific charges of the cynical resident doctor "Fats" (Charles Haid). Fats teaches them attitude and language: how to "buff" (improve) and "turf" (transfer) "gomers" (Get Out of My Emergency Room)--the words used to describe management of incurable, hateful patients who "never die," regardless of the abuse the clumsy housestaff might inflict. But Fats has heart.

Soon, they fall under the command of the militaristic and lonely woman resident, Jo Miller (Lisa Pelikan), who cannot bring herself to withhold treatment, even at a patient's request. She blames underlings for the failings of medicine and nature, as well as herself.

Wayne throws himself from the hospital roof because of a misplaced sense of guilt over a patient's demise. Roy falls in love with the nurse, Molly (Kathryn Dowling), but nearly loses her as he begins to emulate Jo's cold, calculating style. He is "rescued" in the nick of time by his friends, Fats, and the death of a physician patient (Ossie Davis) whom he admires. With recovered equanimity and renewed anger over the suicide of his fellow intern, Roy refuses to go on with his residency.

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This book, a sequel to It's Not About the Bike: My Journey Back to Life, chronicles five-time Tour de France winner Lance Armstrong's personal and professional triumphs and agonies from late 1999 (after he won his first Tour and after the birth of his son Luke) to mid-2003, the 100th anniversary of the Tour. Armstrong defines himself by his cancer experience and survival; he devotes himself to both one-on-one connections with fellow cancer patients as well as his public persona to raise awareness and funds for cancer programs and survivors' needs.

There are many medically related themes in the book. Descriptions of cycling sports injuries and illnesses include a severe concussion, a broken cervical vertebra, dehydration, road rash, tendonitis and exhaustion. Armstrong experiences the loss of friends and acquaintances to cancer and trauma. He is the subject of an intense investigation into the possible use of recombinant erythropoietin and finally cleared of suspicion after nearly two years. As a world class athlete, he is subject to frequent, random drug testing.

His wife experiences a failed in vitro fertilization cycle, though a subsequent successful treatment leads to the birth of healthy twin girls. The Red Cross invites Armstrong to visit NYC firefighters soon after the devastation of September 11, 2001 in a successful effort to boost morale. Armstrong, though, describes encounters with some cancer patients in which he felt he did not succeed in providing the desired inspiration.

Despite reaching his five-year cancer-free milestone, Armstrong, like many other cancer survivors, wonders if the cancer will return. He is hyper-vigilant of his body not only because of his elite athlete status, but also because of his cancer history. Nonetheless, he is reckless and jumps from a steep cliff to sense the rush of fear and freedom.

Armstrong trusts and believes in modern medicine and technology, as well as the physicians, nurses and other health care practitioners dedicated to cancer treatments and health care. He also lauds complementary practices, particularly the team chiropractor who uses a variety of techniques to support the riders during the grueling Tour.

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The author comments initially that most physicians become involved in the stories of their patients' lives--as witnesses, chroniclers, and players. He uses as an example the story of a physician's role in the death of Anton P. Chekhov. Another interesting example is the book, A Fortunate Man (see this database), the story of an English country doctor who matures in the profession and comes to recognize the task of the doctor as one to help his patients feel recognized.

Dr. Verghese believes that all patients seen by physicians are in the midst of a story that begins the moment they walk through the portals of a hospital or a clinic. He sees the challenge as engaging the patient and the family in finding an "epiphany," even if that epiphany is simply the understanding that there is nothing more that can be done medically. In his conclusion he says that as physicians we should be ministers of healing, storytellers, storymakers, and players in the stories of our patients and ourselves.

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The author, Samuel Shem, opens these reflections by saying that he was a writer before he was a doctor. His early answers to questions about healing came from stories he read. "Life as it should be in addition to life as it is" became the "motor" of his writing. He loved stories that he heard from patients and the "few humane doctors" he met and decided he would be able to understand people better by writing about experiences with them.

Shem's experience as an intern spawned The House of God (see this database) and he sees writing about his training as an example of the use of resistance when he saw "something unjust, cruel, militaristic or simply not right." He recommends the following to resist the inhumanities in medicine: (1) Learn our trade in the world, (2) Beware of isolation, (3) Speak up, (4) Resist self-centeredness. He says that the healing essence of narrative is in "we," meaning the patient and the physician.

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Winter investigates the process by which Freudian psychoanalysis became legitimized within modern Western culture and internalized as a kind of "psychological common sense" (4). She argues that Freud's adoption of the Oedipus myth allowed him to draw on the cultural status of classical scholarship and claim the universality of the tragic theme for his own project. She traces how Freud worked to establish an institutional infrastructure for psychoanalysis, to establish it as a profession. His analysis of culture and society represents another strategy in establishing and extending the importance of psychoanalysis: the claim that psychoanalysis powerfully illuminates not only the workings of the human brain (the domain of psychiatry, psychology, and neurology) but also the functions of society (the analytic domain of anthropology and sociology).

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The title The Body in the Library suggests medicine (the body) as seen through literary eyes. True enough, this collection of stories, poems, essays, and excerpts from longer works is subtitled "A Literary Anthology of Modern Medicine." However, as Iain Bamforth points out in his introduction, nowadays we are more concerned with "the library in the body" (p. xxiv); that is, we believe the truth of human illness can be found by biochemical tests and positron scans, rather than by storytelling. In this anthology Bamforth uses literature itself to document this change in perspective. Beginning with "The Black Veil" (1836), an early sketch by Charles Dickens, Bamforth recounts the recent history of medicine as seen by poets and writers, many of whom were (and are) physicians themselves.

Part of the anthology consists of material already annotated in this database. This includes stories (e.g. Conan Doyle’s "The Curse of Eve" from Round the Red Lamp, Kafka’s A Country Doctor, and Williams’s Jean Beicke); excerpts from novels (e.g. "The Operation" from Flaubert’s Madame Bovary, "The Fever Ward" from Camus’ The Plague, and "Doctor Glas" from Hjalmar Soderberg’s novel, Doctor Glas); and essays (e.g. Virginia Woolf’s On Being Ill and John Berger’s "Clerk of Their Records" from A Fortunate Man).

However, most of the selections have not previously been noted in this database, nor do they appear in other recent anthologies. Iain Bamforth has discovered some wonderful "new" material on the medical experience. This includes several poems by the German physician-poet Gottfried Benn (pp. 151-153); and a brief piece by neurologist-writer Alfred Döblin ("My Double," pp. 177-179), in which the physician Döblin and the writer Döblin describe their respective "doubles" in rather detached and negative terms.

Another delight is the series of selections from Miguel Torga’s diary (pp. 256-278); Torga (1907-1995) was a provincial Portuguese medical practitioner for 60 years. Among the other pieces are short excerpts from plays by Georg Buchner, Jules Romains, and Karl Valentin; and poems by Weldon Kees, W. H. Auden, Philip Larkin, Dannie Abse, Robert Pinsky, Miroslav Holub , and Thom Gunn.

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Auden wrote this poem in memory of his own physician, Dr. David Protetch. He begins, "Most people believe / dying is something they do, / not their physician . . . " Auden, whose father was a physician, knows better. His father had warned him about doctors who are too aggressive or too concerned with money. Fortunately, he found a consultant who thought as his father did, perhaps because he (Dr. Protetch) had himself "been a victim / of medical engineers / and their arrogance, / when they atom-bombed / your sick pituitary / and over-killed it."

While prescribing for Auden’s minor complaints, Protetch himself was "mortally sick." Because of this, Auden felt that he could trust his doctor to tell him the truth about his medical condition: "if I were dying, / to say so, not insult me / with soothing fictions." Thus, Auden praises Protetch for having been, "what all / doctors should be, but few are . . . " [78 lines]

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How JFK Killed My Father is a collection of 52 poems by psychiatrist Richard Berlin. The book is divided into five sections--"Learning the Shapes," "Role Models," "Code Blue," "What a Psychiatrist Remembers," and "What I Love"--and these subtitles guide the reader through this physician's poignant journey from medical student to accomplished, and humbled, "healer, priest, turner of textbook pages, searcher, listener, arrogant crow consumed in white" ("If You Ask Me My Name").

Berlin's poems succeed because of strong imagery and the kind of internal "knowing" that only comes when one pays attention to the sights, sounds, and emotional nuances that occur in training, in practice, and in life. A musician as well as a doctor, Berlin sometimes uses jazz as a metaphor: in "Uncle Joe" he writes about "suffering's music" and in "Learning the Shapes" medical students practice examining patients until their fingers are as sensitive as a "blind bluesman" whose fingers can sense the right note "an instant before / touching a tight steel string."

Berlin "gets" the stress of med school and residency just right in "Sunday Parade" and "January Thaw"; as his poems retrace his path from student to practicing psychiatrist, he transmits the deepening of both experience and empathy in the same right-on way: "What I Revealed," "Places We Have Met," "What a Dying Woman Saw," "Transference," "What a Psychiatrist Remembers," "What Makes a Psychiatrist Cry," "Our Medical Marriage," and "What I Love" stand out as examples. The poems in this collection are personal, eloquent, straightforward and well crafted; they move effortlessly between body, mind, and spirit.

A reader could open this collection to any poem and be captivated, but for full impact this collection is best read from beginning to end. Medical students, especially, might welcome this volume as a guide along their way.

(Some of the poems here also appear in Berlin's chapbook, Code Blue, which is annotated in this database.)

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