Summary:

Spencer Nadler, a surgical pathologist for over 25 years in southern California, offers 8 essays, as well as an introduction, epilogue and 9 full color histopathology plates in this collection. As he explains in the introduction, Nadler began his training in surgery, but, during a required year of surgical pathology, he finds his true vocation: "I realized a flair for surgical pathology that I had never demonstrated in surgery." (p. xix) However, over the years, he realizes he misses patient contact--these essays, written over 10 years, are forays into an unusual relationship: the pathologist-patient relationship.

Each essay is about a different patient (or other contact) and tissue. One of the most compelling is the first, "Working Through the Images," in which a woman (Hanna Baylan) with metastatic breast cancer seeks Nadler out so that she may view her cancer cells. She arrives in his office unannounced at 6 p.m. and he proceeds to not only show her the slides, but to listen to her. He becomes a witness to her pain, loneliness, sorrow and hope.

"For years I have processed thousands of such cases, determined the manifold forms of disease, but I've never been an intimate part of anyone's illness, never felt the connections of cells to a larger self." (p. 12) During later visits, Baylan cries in his arms and even brings her youngest son in to meet Nadler and view her cells. By this time, Nadler is completely connected to her: "This is heartrending to me, for I have come to love her . . . I can no longer think of Hanna in terms of the cells I see on her slides." (p. 21)

Other chapters highlight fat and bariatric surgery; neurologic disorders such as brain tumor, Parkinson's, Alzheimer's and paraplegia; heart disease; sickle cell disease; and palliative care. Each chapter conveys Nadler's visual sophistication and ability to graphically describe cells. For instance, within a fat cell "a large fat globule steamrolls other cell contents flat against the outer membrane until it bulges like a mozzarella." (p. 32) More importantly, Nadler ably extends his cellular acuity to the larger human dimension.

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P., a music teacher, whose associates have questioned his perception, is referred by his ophthalmologist to the neurologist Oliver Sacks. During the first office visit, Sacks notices that P. faces him with his ears, not his eyes. His gaze seems unnatural, darting and fixating on the doctor's features one at a time. At the end of the interview, at which his wife is present, P. appears to grasp his wife's head and try to lift it off and put it on his own head. "He had . . . mistaken his wife for a hat!" She gave no sign that anything odd had happened.

During the second interview, at P.'s home, P. is unable to recognize the rose in Sacks' lapel, describing it as "a convoluted red form with a linear green attachment." He is encouraged to speculate on what it might be, and guesses it could be a flower. When he smells it, he comes to life and knows it. The wife explains that P. functions by making little songs about what he is doing--dressing, washing or eating. If the song is interrupted he simply stops, till he finds in his sensorium a clue on how to proceed.

This cantatory method of compensating allows P. to function undetected in his professional and personal life. He remains unaware that he has a problem. Sacks chooses not to disturb his ignorant bliss with a diagnosis. Though his disease (never diagnosed but hypothesized as a tumor or degeneration of the visual cortex) advances, P. lives and works in apparent normalcy to the end of his days.

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In this collection, twenty-two authors take up the subject of wanting a baby and what happens to one's self-image and marriage/relationship when difficulties arise. All the contributors are accomplished writers--e.g. Amy Hempel, Michael Bérubé, Tama Janowitz--who tell stories of the miracles, disapppointments and sometimes horrors of the various reproductive technologies; the experience of childlessness when one/a couple desperately wants one; the joys of "success" via technology or adoption; what happens when every method fails.

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Sir Luke Fildes's eldest son Phillip died Christmas morning, 1877. He was attended by Dr. Murray, who directed all of his attention and care to the patient during the child's fatal illness. This unswerving dedication impressed Fildes.

Ten years later, when Sir Henry Tate commissioned Fildes for a painting to exhibit in what was to become the Tate Gallery, Fildes was given freedom to choose the subject matter. Fildes immediately decided to depict this scene of a family physician holding a bedside vigil by a seriously ill child. However, the painting was not begun for four years, and then only at the urging of Tate.

The shade of a lamp is tilted so as to bestow light on the two central figures: the physician, and especially, the recumbent child. The physician faces away from the bottled medicine and cup on the table and directs his gaze fully on the child. He is dressed neatly and sits calmly, patiently, resting his bearded chin on his hand.

The small child is central in the picture, in a white nightshirt on a large white pillow and covered with pale blankets. The makeshift bed consists of two unmatched dining room-type chairs. The child's hair is tousled and the left arm flung out, with hand supinated and beyond the edge of the pillow. Nonetheless, the child rests quite peacefully, as the pose appears quite natural.

To the right and rear of the painting are the parents. They are placed in such deep shadows that it is frequently difficult to make out these figures in reproductions. The mother sits at a table and hides her face in her clasped hands. The father stands beside her, with a comforting hand on her shoulder, as he gazes at the physician.

The painting is set in the interior of a small cottage. Rafters are low, furniture simple. Colors are muted; earth tones predominate. Although the majority of the light comes from the lamp, a bit of light also enters from the recessed window near the mother.

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This is one of the two dozen studies of patients with right-brain disorders that make up Sacks's volume The Man Who Mistook His Wife for a Hat. The nineteen-year-old Rebecca has significant physical and mental defects (her IQ is 60 at best), and by conventional neurological standards she is severely impaired, but Sacks discovers that she has moments of being quite in touch and "together" (her word).

The essay tells of Sacks's discovery of Rebecca's poetic expression and spiritual qualities, and of her self-awareness, in planes unknown to standard neurological and psychiatric categories. Sacks is broadly critical of psychological and neurological testing as constituting a "defectology" that is blind to important human qualities. He warmly recommends music and story-telling, both as modes of understanding and also as narrative therapies that work by ignoring the defects and speaking to the soul.

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This is an anthology of poems written by physicians from ancient times through the early part of the 20th century. It includes a great variety of work: poems by well-known physician-writers like Oliver Goldsmith, John Keats, Oliver Wendell Holmes, Sir Arthur Conan Doyle, and William Carlos Williams; poems by distinguished physicians who are not usually remembered as creative writers, such as Edward Jenner, Erasmus Darwin, S. (Silas) Weir Mitchell, and Sir Charles Sherrington; and others by currently little-known physicians.

In the Preface, the editor admits that the genre of "medical poetry" may not have very high standards. For example, she quotes one author as saying that it is generally "poetry in quotation marks and much of it is feeble stuff." However, poetic expression that arises from clinical experience has dignity and value insofar as it reflects "the spirit of helpfulness which gives to the medical profession its value to humanity." The last quotation is attributed by the editor to William Osler, although she cites no reference. Interestingly, the medical professor as reflected in this anthology is entirely male; of 110 poets represented, not one is a woman.

In an "Afterthought" the physician-poet Merrill Moore comments further on the theme of mixing medicine and poetry, presenting the literary equivalent of some insipid "pearls"; for example, "The way he writes is possibly a little different" and "the physician-poet does not quite reach the peaks of spiritual elation and emotional release . . . that a Byron or a Shelley achieves." Profound, huh?

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Mr. Galyadkin, minor clerk in Russian business, is introduced by the author as he begins an outrageous journey which takes him madly about St. Petersburg visiting his physician, who sends him away, and old friends who won't admit him to their homes. It is apparent that this man has either done something extremely objectionable to offend everyone, or he is not recognized by those whom he visits.

As he wanders along the streets, trying to decide why he is being so badly treated, he encounters a man who looks very like himself, in fact, who calls himself Mr. Galyadkin and was born in the same village as our hero. Mr. Galyadkin (now designated as "senior") welcomes the new Mr. G. into his life, sharing everything, including a position at his workplace.

The pleasures are short-lived, as the newcomer begins to act outrageously with the consequences being assigned to Mr. G, Sr. Life becomes unbearable for Mr. G; the worse things seem the more badly he and his double behave. And eventually, Dr. Krestyan Ivanovich is called to trick Mr. G into entering the carriage bound for the insane asylum.

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Many years later, a plastic surgeon is still haunted by memories of the war atrocities he committed as an infantryman in the Vietnam War. He returns to Vietnam searching for atonement. He spends two weeks there as a medical volunteer, repairing the cleft lips and palates of 30 children. He meets the director of the hospital, Dr. Lieh Viet Dinh, who once was a member of the North Vietnamese Army.

During the war, Dr. Dinh was tortured and both his thumbs were cut off. He asks the plastic surgeon to perform a toe transplant to replace one of his missing thumbs. Despite the initial optimism of both men, the operation ultimately fails as the digit becomes gangrenous and then dead. Once again, Vietnam has proven to be a dangerous place seeping hardship and disappointment. Only now the surgeon is capable of accepting the land and its risks as he makes peace with the country and himself.

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The editor, herself a writer and one who has suffered depressive episodes, collects a series of personal essays or illness narratives about experiences with depression. Her contributors are all artists, primarily writers, who generally but not exclusively speak to the relationship between their art and their mood disorders. Some of the essays included have been previously published, but most are original contributions to this collection. The collection is introduced by Kay Redfield Jamison whose academic work has examined the relationship between creativity and depression, including manic-depressive disease.

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Mrs. Wilson is a woman diagnosed with an advanced malignancy of the genital tract. Her husband had died from cancer ten years earlier. She is treated with a hysterectomy and oophorectomy along with aggressive chemotherapy by a good doctor who has no bedside manner.

Throughout the story her best friends are always medications to relieve pain: Dilaudid, morphine, Tylenol #3, and methadone. Only her son-in-law really understands her needs and comprehends how to care for her. He is genuine and vital and appears to know as much or more than the doctors in the story.

Mrs. Wilson acknowledges that "to maybe get well you first had to poison yourself within a whisker of death" but discovers that "if you had something to live for, if you loved life, you lived." She dies in a hospital room receiving an IV morphine drip. Before fading into oblivion, she recalls her youth and makes one last attempt at fathoming the meaning of life.

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