Summary:

Written by a medical historian who is also a physician, The Breast Cancer Wars narrates how breast cancer diagnostic methods and treatments have developed from the early twentieth century. More significantly, the book describes the debates and controversies that permeated this evolution and the ways in which not only clinicians and researchers, but, increasingly, women patients/activists shaped how we view, diagnose, and treat breast cancer today.

Individual chapters explore the influential (and ultimately contested) radical mastectomy procedure of William Halsted, the development of the "war" against breast cancer as a full-blown campaign developed and conducted within the public media and consciousness of the United States as well as within medical practice and research, the intertwined development of feminism and breast cancer activism, the "fall" of the radical mastectomy, and the continuing controversies surrounding mammography and genetic testing as modes of early detection and risk assessment. Lerner draws on a range of primary sources including texts from the archives of the American Cancer Society, the papers of doctors and patients, and advertisements from popular and professional magazines throughout the century.

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In a mountainous village in Spain, a man in the prime of his life has labored fifteen years constructing a museum of miniatures that no one has yet seen. Just before completing his project, the artist Gregorio has an accident and both his hands are terribly crushed by a piece of marble. There is little hope that he will ever regain complete use of his hands.

Gregorio is treated by the town's elderly physician, Dr. Xavia. The doctor narrates the story and also dreams about the contents of the mysterious museum. One day Dr. Xavia finds that the door to the museum is unlocked and has been open all along for anyone wanting to enter it. The doctor discovers that the three story building housing the museum contains a complete and perfect recreation of the village that he finds both familiar and strange.

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A traveler falls ill and is treated by the local physician, Doctor Trifon Ivanitch, who unexpectedly shares a personal and potentially embarrassing story with the stranger. Once the doctor was asked to make a house call by a woman who believed her daughter might be dying. On his arrival, the physician finds a beautiful 20 year old woman named Alexandra who is feverish and initially unconscious. Although fully aware how ill she is, he nonetheless promises everyone that she will survive.

He is immediately infatuated with the woman and spends days and nights at her home caring for this single patient. As Alexandra's condition worsens and she becomes convinced her death is imminent, she professes love for the doctor satisfying a basic need to experience love before she dies. Just before her death, the doctor lies about their relationship to Alexandra's mother. Later the doctor marries an "ill-tempered woman" who sleeps all day. Did he marry for love, convenience, money, or penance?

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The Heavenly Ladder is physician-poet Jack Coulehan's most recent chapbook, bringing together 48 poems, many of which have been published individually in various medical journals and literary magazines. The collection is divided into four sections.

Poems in the first section, "Medicine Stone," are written in the voice of patients or in the voice of the physician who treats them. The second section, "So Many Remedies," consists of five poems inspired by physician-author Chekhov. The poems of "The Illuminated Text" section reflect a wide-ranging interest in people who lived in distant times or in distant places. The final section, "Don't Be Afraid, Gringo," stays, for the most part, closer to home and includes a number of poems addressed to, or about, family members.

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To relieve her insomnia, Claire Vornoff seeks help from Dr. Declan Farrell, a well-known holistic physician, who begins to see her professionally at his country home. Farrell's methods focus on massage and bodywork, along with some acupuncture. Claire finds him an attractive paradox--sensitive and "tuned in" to her, yet also blunt and emotionally unsettling.

The client-therapist relationship becomes deeper and more complex. After Claire has a brief sexual escapade with a married man, she admits to herself that she actually loves Declan and confesses her love to him. Indirectly, he reveals that he also has strong feelings for her, but is desperately resisting those feelings and attempting to maintain his professionalism.

Claire finally breaks off their relationship and attempts to go on with her life. Over the next couple of years, Declan closes his practice, moves elsewhere, divorces his wife, and ultimately commits suicide. Claire learns of these events gradually, at second hand, as she, too, moves on, but in much a different direction. Eventually she begins a new life in Toronto.

Although the relationship between Claire and Declan occupies center stage, Claire's quest for improved health leads her to consider, and sometimes consult with, other alternative medicine practitioners as well. (I say "improved health" rather than "relief of insomnia" because, although never stated, it seems clear that Claire seeks a sense of completeness and meaning in life that goes far beyond solving her sleep problem.)

One of these healers, for example, is Mr. Spaulding, who reviews Claire's blood work and concludes, "You're in rough shape, girl." (p. 231) He explains that her "body salts are so high I can't measure them" and that her "body is throwing off one hundred times more dead cells than it should . . . "

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In this collection Richard Selzer brings together 25 stories from his previous books, along with two new stories, Avalanche (see this database) and "Angel, Tuning a Lute." The unifying theme is the world of medicine and healing, which Selzer explores with a keen eye and compassionate heart. These stories are firmly grounded in the foibles, suffering, and exultation of the human body.

In the Introduction Selzer sketches the path by which he became a surgeon-writer and he indicates the origin of some of the stories. Particularly interesting are the stories that do homage to literary and historical figures; for example, "Poe's Light-house," which grew out of a fragment Edgar Allan Poe wrote in his last delirium, and "The Black Swan," a re-writing of a Thomas Mann novella (Mann's The Black Swan is annotated in this database).

Likewise, the story of how "Avalanche" was written is an interesting tale in itself. Selzer's description of pruning the story from his journal reminds me of Michelangelo's comment that the sculpture already exists in the block of marble. The sculptor merely removes the unnecessary stone. The Doctor Stories contains many of Selzer's tales that have become part of the Literature and Medicine canon; these include, for example, "Tube Feeding," "Sarcophagus," Imelda, Mercy, Brute, and Four Appointments with the Discus Thrower. (See this database for annotations of the latter four.)

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The story begins with the doctor-narrator unobtrusively observing an older man lying in a hospital bed. The patient is blind and has amputations of both legs. (We are given no medical details that cannot be observed in the room.) The narrator tends to the man's amputation wounds and answers a few simple questions. The man requests a pair of shoes.

Back in the corridor, a nurse tells the doctor that the patient refuses his food, throwing his china plate against the wall of his room. The narrator hears the man and a nurse argue briefly about food and then, by himself, watches as the patient carefully and powerfully throws another dish against the wall. The next day the doctor discovers that the patient has died.

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Dr. Constance Petersen (Ingrid Bergman) is a beautiful, unattached psychiatrist whose business-like facade fails to conceal a natural empathy that draws men. For her, however, love is a mere epi-phenomenon, easy to explain and resist, until she meets Dr. Edwardes (Gregory Peck). The famous expert on the guilt complex has arrived to replace the retiring chief (Leo Carroll). Constance is smitten, and so, it seems, is he.

But soon, she realizes that Edwardes is "not well," that he is terrified of dark lines on white: fork marks on a tablecloth; threads in her robe. Worse, she discovers that Edwardes is not, in fact, Edwardes, but an amnesic physician of initials "J. B." who is convinced that he has murdered his analyst. Constance does the right thing by having him removed from work, but she refuses to believe he is a murderer. Wanting to protect her, he leaves. But she, intent on curing her lover, follows him on a journey to retrace his last movements. The task is to recover both a memory and a missing person.

They go skiing (dark lines on white) at a resort where the real Dr. Edwardes had sojourned with his patient-colleague. On a dangerous slope, J. B. suddenly remembers that Edwardes went over the cliff. The body is found, but it has a bullet in the back.

Now hiding from the police, the couple pose as newlyweds and flee to her old mentor in Rochester. Complete with accent and beard, Dr. Brulov (Michael Chekhov) is a delightful double of the recently deceased Sigmund Freud (1858-1939). It emerges that John Ballantine (Peck) never lost his childhood feelings of guilt over the accidental death of his little brother.

In a gruesome ten-second flashback, the tyke is abruptly impaled on a iron-spike fence. This ancient guilt was reactivated by his doctor’s demise and it was sublimated by the defense mechanism of an assumed identity to keep the dead man alive. An idle slip of the tongue reveals the murderer to be the jealous retiree. The killer threatens Constance and then makes a quick end by dispatching himself instead.

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In the "free love" context of the nineteen-sixties, Harriet and David Lovatt are throwbacks to a more conservative, traditional, and family-oriented decade. Their life dream is to have a big house in the country filled with children, and it seems that they will succeed. After bearing four young children, however, Harriet is feeling the strain of years of childbearing, sleeplessness, money trouble, and her parents' and in-laws' disapproval of her fecundity.

Her fifth pregnancy is not only unplanned, but also unusually painful and disruptive. Harriet's doctor prescribes sedatives but finds nothing abnormal in her situation. When Ben is born, Harriet jokes that he is like "a troll or a goblin," but no one responds well to this unusually hairy and physically vigorous baby, who in turn does not respond to anything but his own desires and fears.

As he grows older, family pets and other children seem to be in physical danger. Health care professionals do not confirm the couple's conviction that Ben is not normal, but neither do they obstruct the decision to send Ben to a private institution, a removal that leaves the family temporarily happy until Harriet visits Ben and recognizes the institution for what it is, a place where all manner of "different" children are sent to live heavily medicated, physically restrained, and foreshortened lives away from families who do not want them.

Harriet brings Ben home, where he grows up amid what remains of the Lovatts' domestic fantasy, and finds community in a gang of thuggish older boys whom Harriet suspects are involved in various criminal acts. As the story closes, Ben has left home and Harriet imagines him in another country, "searching the faces in the crowd for another of his own kind" (133).

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Words rushing forth in a punctuationless stream, a patient describes how his doctor gives him the bad news of advanced lung cancer, and his reaction to it. There is an almost comical aspect as the doctor struggles to be both factual and sympathetic, and the patient struggles to absorb what he is being told. The doctor asks if the patient is able to find comfort and "understanding" from religion (since, apparently, he is unable to provide them). This triggers a brief poetic flight of fancy in the patient, but then he departs in a state of dazed politeness.

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