Summary:

Sandeep Jauhar, M.D., Ph.D. is currently director of the Heart Failure Program at Long Island Jewish Medical Center in New York. Thus, one can assume that he is an accomplished cardiologist and administrator. It was not always so. This memoir flashes back to 10-15 years earlier when the author was casting about for a career, finally settling on medicine almost by default; it follows him to medical school (at Washington University in St. Louis) and then centers on his first year of residency training at Cornell's New York Hospital in Manhattan -- the internship year.

We learn in the introduction to the book that the author will speak freely of self-doubt about career choice, constant anxiety and feelings of inadequacy, exhaustion, and disillusionment. Which indeed he does. But Jauhar first discusses his family background: born in India and emigrating with his family to the USA at age 8; father holding a Ph.D. in plant genetics, now writing academic textbooks and still regretting that he had not been able to afford his dream of becoming a doctor; mother helping to support the family as a lab technician; older brother, Rajiv, a mentor and competitor, charming, self-assured, and unquestioningly headed for a medical career; sister, Suneeta. Sandeep (the author) undertakes graduate work in theoretical physics but as he nears completion of his doctoral degree, realizes that he probably does not have what it takes to be successful in the field. When his girlfriend, Lisa, becomes seriously ill, he begins to (re)consider medicine as a career. Against the advice of his parents who are now convinced he is a dilettante, he applies to medical school and is accepted.

Disillusionment began during the first two years of medical school: "In graduate school I had never learned to memorize . . . But now I couldn't rely on logic and reasoning; I had to commit huge swaths of material to memory" (32). He considered quitting to become a journalist, a profession that had always intrigued him, but which had been discouraged: "my father made it clear that journalism and writing were never to be considered career options because they offered no security" (33). Yet, amazingly, he was awarded a summer fellowship just before starting medical school that placed him in the Washington, DC office of Time magazine; the contacts he made then allowed him to work as a student reporter for the St. Louis Post-Dispatch during medical school and led ultimately to his ongoing and current position as a contributing medical essayist for the New York Times.

Internship for Jauhar unfolds as a series of anxiety-provoking encounters with patients and humiliating encounters with his physician superiors. Feeling inept and inadequate, he stumbles along and worries that he is harming patients. There is too much to keep track of, too many "little things that I find burdensome" (91). "Having so much to do was bad enough, but not knowing why you were doing what you were doing was terrifying . . . Patients were needy, their demands overwhelming . . . Everyone seemed to know how the place worked except me . . . The ecology on the wards was hostile; interactions were hard-bitten, fast paced" (112-113). He is in constant doubt and conflict about his career choice. Even his private life is affected -- his girlfriend Sonia, still a medical student, comes from a medical family, is strongly motivated and secure in her career choice, which aggravates his own sense of insecurity. (Reader, he married her.)

Midway through internship Jauhar suffers a herniated disk. He tries to tough it out without taking time off but his stint as "night float" at Memorial Sloan-Kettering hospital, which specializes in treating cancer patients, proves too difficult-- up all night trying to tend to the severely ill and "taking care of patients about whom you knew next to nothing" (154). He takes a brief leave followed by a reduced schedule. He recognizes that his problems are emotional as well as physical -- he is depressed. But gradually, as his neck problem improves, as he recognizes that medical professionals are actually able to help patients feel better -- his neurologist and physical therapist had "provided hope and comfort to me at a vulnerable time" (181)--, as he makes a house call to a dying patient, as his essays are published in the New York Times, and as the season moves to Spring, his depression lifts and he looks forward to his work.

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Dora Rare, the only girl child born in multiple generations of her family is encouraged by her mother to establish a bond with Miss Babineau, an odd isolated midwife, whose wisdom on health matters is much sought after by the local women in their small Nova Scotia community. Gripping and intimate encounters with her neighbours as birthing mothers and as women seeking control over their fertility lead Dora to accept a role as Marie’s successor. When arrogant, young Dr Gilbert Thomas comes to town with his strong ideas about science and birth, he is appalled at the practices of the local women; he also resents the competition. Dora embarks on a difficult marriage herself and seeks temporary refuge in the United States where she witnesses a new kind of independence.

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The basis for this autobiographical essay on the experience of having a malignancy are 92 illustrations, all the work of the author; they include 32 ink or woodcut sketches, 24 charcoal drawings, and many acrylic paintings (16 in full colour). Pope's images evoke the dependence, fear, loneliness, pain, and even the mutilation surrounding cancer illness and therapy.

He describes in plain language the course of his own illness, diagnosis, and treatment; he also relates the experiences of a few fellow patients. Most intriguing is his ready description of the stories behind his pictures: who posed, how he painted them, and what exactly he was trying to convey. When the book was published, Pope was in a hard-won remission from Hodgkin's Disease, but he died the following year of treatment-induced bone marrow failure.

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Summary:

The basis for this autobiographical essay on the experience of having a malignancy are 92 illustrations, all the work of the author; they include 32 ink or woodcut sketches, 24 charcoal drawings, and many acrylic paintings (16 in full colour). Pope's images evoke the dependence, fear, loneliness, pain, and even the mutilation surrounding cancer illness and therapy.

He describes in plain language the course of his own illness, diagnosis, and treatment; he also relates the experiences of a few fellow patients. Most intriguing is his ready description of the stories behind his pictures: who posed, how he painted them, and what exactly he was trying to convey. When the book was published, Pope was in a hard-won remission from Hodgkin's Disease, but he died the following year of treatment-induced bone marrow failure.

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Janis Caldwell, who practiced emergency medicine for five years before getting her Ph.D. in English, examines the philosophy and practice of nineteenth-century British literature and medicine in this book. In an erudite introduction, she explains what she means by the "double vision" of "Romantic materialism," "Romantic because [physicians and authors] were concerned with consciousness and self-expression, and materialist because they placed a particularly high value on what natural philosophy was telling them about the material world" (1). These writers' intellectual context, influenced by natural theology, was dualist, including both the Book of Scripture and the Book of Nature. Their methodology "tacked back and forth between physical evidence and inner, imaginative understanding" (1), giving rise to the two-part "history and physical exam" familiar to physicians today.

The book examines this dual hermeneutic in six influential sites over the course of the century. In Chapter Two, Caldwell reads early-nineteenth-century debates over vitalism in the context of Mary Shelley's Frankenstein, arguing against the materialist-spiritualist divide so often cited in that period. She also brings readings of the novel into line with contemporary theories of physiologic sympathy. Next, she turns to the enormously influential sage Thomas Carlyle, arguing that he broadens the body/soul model to include both natural and supernatural aspects of the world. Again rejecting the notion of a philosophical dualism that prohibits mixing differing approaches, she argues, both Carlyle and the anatomist Richard Owen enthusiastically endorse a more heterodox vision of the world, in which we learn from both natural and spiritual enquiry.

The fourth chapter reads Emily Brontë's Wuthering Heights in the context of contemporary popular treatises on children's health and child-rearing. Caldwell argues that Brontë's image of the Romantic child, as emblematized in Cathy and Heathcliff, and characterized as "a more social, empirical, physical, literal version of childhood," derives in part from the "domestic medical texts which function as a sort of secular scripture in the Brontë household" (74). She suggests that the dualist language of natural theology, which combined spiritual and natural interpretation, and which was well-known in the Bronte household, influenced Emily's mixture of religious and medical concepts in her portrait of Romantic childhood.

Chapter Five contrasts Emily Brontë's version of childhood to that of her sister, Charlotte Bronte, in Jane Eyre and Villette. Charlotte Brontë, argues Caldwell, inclines more to the professional version of medicine, less suspicious of physician authority and more likely to experiment (in her fiction) with alternative medical theories such as phrenology. In an extended discussion of theories of literalization and metaphor, using Ricoeur to argue that the literalization of a metaphor returns us to the fact but also reinvigorates the metaphor through its dissonance with the fact. Caldwell proposes that the supposed "coarseness" of Brontë's novels is linked to her use of literalization.

A chapter on Darwin posits that "Darwin's thought arises directly out of ... Romantic materialism" (117). Although by the end of his life Darwin had renounced literary reading, the "dialectic of Romantic materialism" (shaped by Romantic literature as well as science) appears in "Darwin's preferred scientific method," in his rhetoric, and in the narrative structure of his scientific autobiography (123-24).

Caldwell's final chapter provides a significant new reading of the genre of the medical case history, by studying George Eliot's Middlemarch in the light of the bipartite structure of "the patient's narrative and the physical exam" (143). Emphasizing the negotiations between doctors and patients in the mid-nineteenth century, and calling for similar negotiations today, Caldwell navigates the differing critical positions on George Eliot's novel, weighing whether the narrator "participates in the systematic, totalizing knowledge of the pathologist" or undercuts that knowledge (156). Caldwell concludes that the narrator of Middlemarch practices a "hermeneutic circling" that shuttles back and forth between incommensurate perspectives, part and whole, nature and spirit, seeking "a partial and provisional, rather than absolute or positive, knowledge" (160). The book ends with a call to return the term "clinical" to its full meaning, not just of detachment, but of engaged practice.

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Veneta Masson's latest poetry collection is a clinician's guide not to illness and disease but to the souls touched by illness, both the patient's and the caregiver's. In 45 poems, she reviews her life in caregiving, from her early days in nursing to her work as a nurse practitioner in a community clinic and finally to her decision to use her hands "to write and to bless" (p. 93). Her poems are enhanced by the artwork of Rachel Dickerson, whose woodcuts and etchings are paired with poems to provide another voice, another way of looking into the soul of caregiving. For an example of this wonderful pairing, see the print that accompanies "The Screamer in Room 4" (p. 24). The print allows us to see the frustration of the screaming child, the child's mother, and the caregiver.

As always, Masson's poems center on the patient-caregiver experience; in this volume, as we follow her through her various adventures in nursing we also travel with her through the changes she has witnessed in healthcare and the politics that continue to affect its delivery. "Rx" (p. 22) examines Medicare and Medicaid and the political decisions that often deny medications to the elderly who need them most. "Gold Standard" (p.34) looks again at medicine and money, juxtaposing the medical pill against the placebo of the caring healer. One of my favorite poems, "The Doctor's Laptop" (p. 40) laments how technology might deprive patients of the doctor's time, attention and touch.

Other themes that are central to this collection are the unexpected presence of humor in caregiving (see "Conga! at the Rio," page 50), of spirituality (see especially "Rescue," page 36, "Refuge," page 45, and "Prevention," page 82), and of the personal. In several moving poems Masson looks at her own sister's death and her reaction to it, writing about her conflicting roles as sister and nurse (see, among others, "Matinee," "Hilda and Snow White," and "The Nurse's Job," pages 70, 72 and 74). In an excellent final poem, "Winter Count," Masson takes us through her own nursing history, a chronicle of work, joy, disappointment and survival that any caregiver will recognize.

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Doctor and Doll is part of the collection of the Norman Rockwell Museum in Stockbridge, Massachusetts. The triangular composition depicts an elderly general practitioner seated in a Windsor chair. A little girl is holding her doll out to him, watching intently as the doctor pretends to listen to her doll's heart through his stethoscope. The fact that the little girl comes to his office and stands up before her doctor suggests that she is coming in for a check-up.

The doctor's large black bag on top of the rug by his feet indicates he makes house calls. Behind the two figures is an old-fashioned desk. On top of the desk are several thick volumes, two brass candlesticks, and two pictures. The image on the left may represent a group of doctors in the style of Rembrandt. On the wall we see a large, framed document which has the word "Registration" on it.

The doctor is wearing a dark suit, cravat, and highly polished, black shoes. He turns his head to the right and upwards as he concentrates on his task. His patient, the little girl, is dressed in heavy shoes, stockings, wool skirt, jacket, scarf, and red beret and mittens. She has removed her doll's dress and holds the dress close to her left side with her elbow. The colors of the painting are dark, but the doctor's head with its gray hair, the doll, and the child's serious face are illuminated.

The girl's red beret, mittens, and the doctor's ruddy cheeks and nose give warmth to the picture. Clearly, the doctor is empathetic and kind, and the little girl trusting. Rockwell paints the ideal country doctor taking time to reassure his young patient that he will do her no harm. His gray hairs make him look fatherly.

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Part of a series, "Letters to a Young . . . [fill in the career]," this collection of essays by pediatrician-author Perri Klass is addressed to her son Orlando during the recent period when he was applying to medical school. The essays follow a chronological sequence, beginning with the decision to apply to medical school, the first two years of medical school, learning how to examine and talk to patients, residency training, physicians as patients, making mistakes, grappling with the most fundamental human issues in medicine, and the mingling of professional work and life.

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Summary: All thirteen short stories in this collection draw readers into the quietly compelling lives of disparate and very ordinary characters who function and suffer in unsettling ways. We are like them and not like them, but their circumstances, while sometimes disturbing, are familiar--and strangely magnetic. The opening lines of "The Lapse" illustrate this power of attraction:

I married Joanne during a lapse. A religious lapse. I don't display my beliefs like a gold medallion, though, as many whom I know do. I prefer to observe in private. After all, any intimate relationship belongs only to the entities or people involved. (p. 35)

Who can bypass an invitation to enter into announced intimacies, however private, that must be revealed in a matter of pages. What lapse and who is Joanne?!

"Bad News," centers around Sheila Powers, a psychologist, whose disruptive marital break-up is compounded by her mother's recent diagnosis of cancer and a subsequent flow of memories about her mother, her father, and herself. She is "between worlds...between life zones." (p. 113) Aspects of the future, at least her mother's, may be somewhat predictable, but the complex depths of the past mix with the present to generate sticky threads that belong to the story and to the readers as well who will recognize bits and pieces of their own family lives.

In a fourteen page story with a decidedly off-putting title, "The Encyclopedia," Wineberg zeroes in on Doris who, after a dissolved relationship, decides to sell the thirty volumes of the Encyclopedia Britannica-"the macro-edition, the micro-edition and the year books" purchased by the former couple. Not about remote bits of history or dinosaurs, we discover, but a story about separation, a series of lovers, benign conversation with a fellow worker who claims to be similarly tired of men, a possible buyer for the unwanted encyclopedia, a relationship with the married buyer, an end to the relationship, and a decision to keep the books after all. Her life, we might decide, is encyclopedic, a litany of minutiae that does, indeed, provide information about conditions of existence.

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The most famous European visitation of plague was the fourteenth-century epidemic often called the Black Death. But plague recurred in waves for many centuries. In the seventeenth century, Italy suffered several devastating outbreaks. Fairly accurate estimates of the losses during that period are available through extant records. For example, in 1656, over 100,000 people died of plague in Naples. Strange to imagine, this carnage coincided with the religious Counter Reformation and the extraordinary artistic output of the Baroque.

This intriguing collection of essays analyzes the effect of plague on painting, and assesses the utility of artwork as a source for the religious and social history. The essays concentrate on the cities that suffered major epidemics, such as Milan, Naples, Palermo, Rome, and Venice, and on portrayals of particular "plague saints," such St Roch, St Sebastien, St Carlo Borromeo, St Rosalie of Palermo and St Luigi Gonzaga. The artists include Tiepolo, Tintoretto, Crespi, Sweets, Canaletto, and Van Dyck.

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