Summary:

One of two sons of a broken U.S.-Dutch family, Kiddo chooses to live off the Dutch welfare system spending his state alms on drugs. Although he realizes it is but the bleakest of efforts not to come to grips with a difficult relationship with his older brother, Morton, Kiddo perseveres, forming an uneasy alliance with Pietje, a woman who also knows Morton.

The novel is told by Kiddo with contributions to the multi-faceted story in the form of letters from Morton, who gives up a brilliant future as a genius in physics to travel around the world, and diary entries by Pietje, who has some unpleasant truths to tell about Kiddo's world. Morton, known as Mort, writes Kiddo that he has cancer and not long to live, returning home to die. Honoring the dying request of his brother, Kiddo attends Mort's autopsy (yes, the play on Morte/Mort proves irresistible to Morley, or is it Mor(te)ley), a fairly gruesome scene. This proves not to be the death of Mort/Morte/Death for Kiddo and he requires help from Pietje and more introspection before Kiddo can lay his brother's bones to rest.

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This book describes San Francisco’s Laguna Honda Hospital, where Victoria Sweet worked as a doctor for 20 years. In the tradition of the Hôtel-Dieu in Paris (literally “God’s Hotel”), Laguna Honda cares for the sickest and poorest patients, many staying there indefinitely because there is no alternative for them. Sweet learns from her long experience at Laguna Honda that “Slow Medicine” has benefits, that a holistic or unified view of patients works best, and that the reductionism and specialization of modern medicine has limitations and costs. During these years Sweet becomes fascinated by the medieval abbess Hildegard of Bingen and earns a Ph.D. focusing on medieval medicine. At the same time (and increasingly) various forces—economic, legal, political, bureaucratic—cause many changes at Laguna Honda, mostly contrary to Sweet’s vision of medicine.

            Part history, part memoir, part social criticism, the book is informative, entertaining, and important for its discussion of the care of our least-well-off citizens and for its perspectives on modern, Western medicine.         

            There are three intertwining strands to this engaging book: Sweet’s medical evolution as a physician, the changes in Laguna Honda, and her investigations of Hildegard of Bingen and other spiritual matters.

            Sweet joins up with Laguna Honda initially for only two months, but she finds the hospital and her work there so fascinating that she stays for 20 years. As an almshouse, Laguna Honda takes care of indigent patients, most with complicated medical conditions, including mental illness and dependencies on alcohol and/or drugs. Many of these cases come from the County Hospital with continuing (but not carefully reviewed) drug treatments. Every 15 or 20 pages, Sweet describes the dilemmas of a particular patient, and her medical (and personal) attention to that patient. The cases are vivid and instructive.

   Clearly Laguna Honda is a major figure on the book; we can even consider it (or “her”) a beloved character and a teacher to the young Dr. Sweet, who learns three principles from her work there: hospitality, community, and charity. 

Because Laguna Honda is old-fashioned in many ways, Sweet reads her own X-rays, goes the to lab to see results, and spends large amounts of time with each patient. Laguna Honda has an aviary, a farm with barnyard, and a solarium; such features help to heal the whole person. While respectful of modern medicine, Sweet slowly learns that a careful review of a patient through Slow Medicine is more accurate and more cost-efficient than standard, reductionist, high-tech medicine. She comes to respect approaches from “premodern” medicine, including that of Hippocrates and Hildegard.

  The second strand is the evolution of Laguna Honda itself. Sweet describes a variety of pressures: the recommendations of consulting firms, rulings from the Department of Justice, a lawsuit, financial difficulties (including fiscal mismanagement), administrators focused on a narrow concept of efficiency, a utilization review board, forms and more forms, and a pervasive sense that modern (including Evidence Based Medicine) is always good. All these and more create a “relentless pressure squeezing the hospital’s Old Medicine into the New Health Care” (p. 322). Sweet demonstrates that her Slow Medicine can actually save money in the long run. Confident that her way is better, she proposes an “ecomedicine unit” that she would match against the modern, “efficient” units in a two-year experiment. (For more information on her concept of ecomedicine proposal, see http://www.victoriasweet.com/.)

            As the hospital is “modernized,” many important features of the old place are gone and many “new and improved” aspects don’t work. Somehow there are no rooms for physicians in the new building while there is plenty of space for administrators and managers. A sophisticated computer system doesn’t work. Sweet doesn’t say “I told you so” directly, but we get the picture.

            The third strand is Sweet’s investigations of spirituality and pilgrimage. She is fascinated by Hildegard’s notions of the healing power of nature, the ability of the body to heal itself, and wholeness as an aim for a person and for a community. Sweet attends a Swiss conference on Hildegard. She hikes the pilgrimage route from France to Santiago de Compostela in four installments and considers notions of pilgrimage. She feels called to pursue her ecomedicine project and to write this book.           

            By the end of the book, both Sweet and Laguna Honda have changed and are now headed in different directions. 

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Emily Bauer, mother of two small children, psychotherapist and teacher, social, smart, athletic, and strong-willed, finds, after a curious series of falls and other accidents, that she has ALS, "Lou Gehrig's Disease," a disease that involves slow atrophy of all muscular control, leading to complete paralysis and then death.  The disease is relentless, and treatments palliative at best. 

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Jerome Lowenstein is a nephrologist, author, and founder of the Bellevue Literary Press and the Humanistic Aspects of Medicine Education seminar program at the NYU School of Medicine.  In this thoughtful and illuminating book of essays he explores the patient/physician relationship in a world where medicine has embraced technology and scientific advances in the laboratory at the risk of neglecting the humanistic underpinnings of the field.

Dr. Lowenstein graduated from medical school at NYU in the late 1950s and spent nearly his entire professional career at NYU Medical Center and Bellevue Hospital. When he was a resident, long before work hour limits were instituted, the house staff gathered in the cafeteria at midnight to dine on the days’ leftovers.  This communal meal “provided a fine opportunity to communicate with colleagues directly, rather than by beeper and phone, about many of the days ‘medical leftovers,’ ” (1) sharing information as well as the frustrations and rewards of caring for patients.  “The Midnight Meal” poses the challenge of retaining the core of relationships, both between patient and physician and among colleagues in the rapidly changing world of medicine today.

In the essay, “Can You Teach Compassion,” Dr. Lowenstein tells his readers about the student who responded to the question with “I don’t know if you can teach compassion, but you surely can teach the opposite.” (13) The student was referring to how students become “desensitized” during their clinical years to the suffering of their patients, sometimes to the point of using derogatory terms to describe them. Dr. Lowenstein argues that teaching attendings can and should encourage students to learn about their patients. He writes how he once interrupted an intern who began to present a case by stating: “This is the first hospital admission of this thirty-five year old IVDA.”  Dr. Lowenstein asks: “Would our thinking or care be different if you began your history by telling us that this is a thirty-five-year-old Marine veteran who has been addicted to drugs since he served with valor, in Vietnam?” (17) Learning about the lives of their patients, Lowenstein emphasizes, does not detract from the clinical picture, but rather enhances it.  

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In this collection of "clinical tales," to use Oliver Sacks' term, Sue Hall, an experienced neonatologist who spent some years as a social worker before medical school, tells a remarkable range of stories about newborns in the NICU and their parents.  As memoir, the stories record moments in a life full of other people's traumas, disappointments, anxieties, and hard-won triumphs where her job has been to hold steady, find a balance point between professionalism and empathy as young parents go through one of the hardest kinds of loss.  Each story is told with clarity and grace, sketching the characters deftly and offering useful medical information along the way on the assumption that many who read the book will do so because they are facing similar challenges and decisions.  Each story is followed by a two- to three-page "Note" giving more precise medical background and offering further resources for those who have particular interest in the kind of case it was. 

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Where many writers about illness have raised questions about the widespread and often unexamined appropriation of military metaphors to describe how doctors and patients have "struggled with," "combatted," "fought," or "defeated" illness, Dreuilhe embraces it and plays it out to the far reaches of its logic.  Part of the brilliance of this AIDS narrative lies in the way it brings new dimensions of meaning to a metaphor that has become so conventional as to be cliché or so imbedded in the language of illness and treatment, it simply fails to be recognized as metaphor.  Beginning with the "simple skirmishes at the frontier garrisons," Dreuilhe chronicles the progression of his own illness with the sharp eye of a good war reporter who sees through the chaos of the battlefield to the strategies being played out.  "Whenever I take an experimental drug," Dreulhe writes, "—and people fight desperately to be among those privileged to risk their lives—I feel as though I belong to a unit of shock troops parachuted behind enemy lines: already written off as a casualty, I'm entrusted with the task of spearheading the advance."

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Parts of medical history read like detective novels.  The discovery of the source of cholera by Dr. John Snow in London in 1854 is one of those episodes.  The Ghost Map tells the story of Snow's pioneering work in what have now become standard epidemiological methods.  Tracing a cholera outbreak to a local pump in a poor section of London involved many door-to-door visits working with people who weren't always cooperative, incurring the suspicion and/or ridicule of both them and the medical professionals with whom he worked.  In the course of the story the author offers reflections on the organization of cities and on public hygiene.  Snow, an out-of-the-box thinker, also helped develop surgical anesthesia. 

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Simon Bear is a hard-charging physician; his wife Emily is a successful public relations executive, now a senior partner in her firm. Although they have a lavish house, a teen-aged daughter, and much wealth, their marriage is troubled, in large part because they have never fully mourned the death of their baby Caleb.

The title “Remedies” fits well with the long struggle for how to heal their grief. The remedies that clearly have not worked are obsessions with career, professionalism, rationalism, and the trappings of American materialism.

Simon has two obsessions about his practice. The first is that he is a rescuer, the perfect doctor who listens to his patients and gives them what they want. As a self-appointed expert on pain, he is free and easy about prescribing opiates. When his father-in-law feels no pain after a car accident, Simon is sure that a drug that the man is taking is, in fact, the Holy Grail of pain medications. Simon becomes obsessed with this “discovery,” promoting it to his patients, without a scientific study or consideration of ethical implications. When he flies to a national medical meeting to trumpet the news of this remedy, no one will listen to him.

While Simon is the point of view for Parts One, Three, and Five, Emily—structurally separated—is the voice and focus of Parts Two and Four. She is troubled by her distance from Simon and, increasingly, her 13-year-old daughter, who is sullen and rebellious. When she meets Will, a former lover, she seeks another kind of remedy in an affair with him, even prospects of marriage. Contrasting with her strategic, rational approach to life, Will is an open, easy-going man, conveniently separated from his wife.

A series of crises rock Emily, then Simon. Emily begins to understand her anger; she has a breakthrough with her daughter. Simon has several setbacks, including humiliations, but he is not crushed. Although ordinarily a secular Jew, Simon attends the Kol Nidre service the evening service before Yom Kippur, the Day of Atonement. In a powerful and moving passage, he finds healing, relief, and a new direction for his life—a true remedy.   

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In this satirical etching, a recumbent, slack-limbed man is attended by two shadow background figures (one of whom may be his wife) and his physician--a fashionably attired ass! The ass/physician is searching for the pulse of his patient, a pose that accentuates the ostentatiously large gem encircling his hoof.

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The foreground of this painting is dominated by a "pieta" type grouping. One woman hovers closely over what appears to be a dying man, while another comforts a small child. This part of the canvas is underlighted. The colors are rich earth tones. The figures are non-Caucasian.

In the background, in harsh light, is a group of identical looking starkly white men. In fact, their faces are almost skeletal. All are in suits, three are seated, with four others standing behind the seated figures. They look very much like a "tribunal."

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