Summary:

This is a collection of 61 poems by physician-poet Richard Bronson. The first and largest section contains many poems related to the poet's medical life and experience, including several that arose from his formative and bittersweet years at New York's Bellevue Hospital ("A Bellevue Story," "I Shall Be Your Vasari," and "Pain"). Others re-imagine events in the history of medicine ("The Knowledge," "Plague Doctor," and "The Man Who Dissected His Wife's Brain")

The second section, "Ten Portents of the Future," contains poems that examine the symptoms and signs of contemporary malaise, but find the diagnosis uncertain and the prognosis . . . who knows? It appears grim, though: "I am a lame man / gone to seed / at the terminus of an age." ("After the Big Bang," p. 94) In his last suite of poems, "Six Aspects of Love," written to his wife, Bronson reveals his strong, but purely personal, antidote for the cruelty of our "barbarous times."

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The dentist, William Thomas Green Morton, gave the first successful public demonstration of anesthesia on October 16, 1846 at the Massachusetts General Hospital. This painting depicts the patient, Gilbert Abbot, sitting in a chair in the surgical amphitheater, eyes closed and neck exposed for the excision of a small vascular tumor of the jaw.

The surgeon, John Collins Warren, a distinguished Professor of Surgery at Harvard Medical School is leaning slightly forward, delicately holding a surgical tool vertically at the hidden point of incision. Morton holds his specially designed glass apparatus used to contain the anesthetic agent, ether.

Eleven other men watch the proceedings from the floor of the amphitheater, with varying levels of surprise and concentration. One is rising, as if in amazement, from a chair, and another steps up on a chair to see better. Two attend the patient: one holds his head and the other holds the right hand and checks the pulse at the wrist. Numerous men are seated in the gallery, and are painted with less and less detail, the higher the row.

The men are all dressed formally in dark suits, some with fur lapels, except for the patient, who is in white shirt with tan pants and dark shoes. This operation occurred before antisepsis and germ theory were discovered.

Hinckley used light and line to focus attention on the surgery. A strong diagonal line from the side wall of the gallery ends at Warren’s head. Light reflects off Morton’s ether inhaler, such that one can even see the sponge inside. The white of the patient’s shirt and the cloth and bowl on the instrument table in the foreground also serve to direct attention to the operation. Light glints off the surgeon’s head, although not as dramatically as in Thomas Eakins’s The Gross Clinic (see this database). Warren’s pronouncement at the end of the surgery, "Gentlemen, this is no humbug," paved the way for the rapid acceptance of anesthesia for surgery.

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In 28 autobiographical stories, the narrator writes of his patient encounters (and self encounters) as a medical student, resident, and finally Emergency Room attending physician. "The Unknown Assailant" opens the collection, a tale of a criminal and his victim who are both brought into the doctor-narrator's emergency room. The young doctor chooses "the young one" (p. 1), not knowing he is the assailant, and works frantically to save his life. This criminal allegedly killed two men a year before, but his current victim lives and the doctor learns the story of the attack from this victim's point of view. The assailant, who slowly recovers, has "an aura about him" (p. 5) and the doctor is strangely drawn to him, thankful that this man means him no harm. Perhaps aware of the irony of healing a man who, in another environment, might kill him, the doctor helps the assailant get better.

This underlying theme--that nothing is black and white in medicine or life--shapes every story. "Prelude," is the revealing, three-page tale of a medical student's life outside the hospital juxtaposed with his first encounter with death in the anatomy lab.

Every story deals with significant issues: the physician's inner emptiness when a patient dies ("Through the Dark, Softly"), how a greater power might suddenly intervene ("Faith"), how narrow the margin is between a successful and a missed diagnosis ("Sugar"), how both patients and residents survive because of, or in spite of, their medical attendings ("A Difference of Opinion"), and how things that seem final or sinister--like death and leeches--become instruments of hope and cure ("The Dead Lake"). [Sugar and The Dead Lake have been annotated in this database.)

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Nan Prince is an orphan who becomes the ward of the local general practitioner, Dr. Leslie, upon the death of her elderly aunt. Nan and Dr. Leslie develop a close emotional bond. She is a bright young woman who enjoys accompanying him during his long day's work as a country doctor in Oldfields. They often discuss medicine and healing. Dr. Leslie encourages Nan to read medical books, while instilling in her an understanding of the intimacies of his patients' lives and a love of caring for them. He would like to see her become a physician, an ambition she soon begins to pursue despite many obstacles. She goes away to medical school in the city.

After her first year at medical school, she spends part of the summer in the town of Dunport where she is introduced to her closest relative, Miss Prince (her father's sister), and the "smart" society she has never experienced in the country. Miss Prince and Nan's new friends are all amazed and scandalized by the thought of a woman becoming a physician. They think the whole idea is utterly outrageous, especially for a young, attractive woman like Nan.

She meets and falls in love with a young lawyer, George Gerry, who asks her to marry him. With great emotional pain (but no hesitation), Nan chooses medicine over marriage. She returns to medical school and, after graduation, to spend a year in Oldfields practicing with Dr. Leslie. In the end she stands by the river on a beautiful summer day, raises her hands to the sky, and exclaims, "O God . . . I thank thee for my future!"

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Set in the 1950s Eisenhower era, this film creates an enlarged snapshot of a model suburban household in Connecticut as well as a companion negative of two suppressed social issues lurking beneath the painfully smooth surface. In his effort to portray dominant values, as well as the melodramatic look and feel of the period, Director Hayes appropriates visual effects and music associated with fifties films by Douglas Sirk such as "All That Heaven Allows" with Rock Hudson and Jane Wyman. Colors are too vivid; music heavily underlines emotional elements; and stylistically designed sets reflect superficial ideals. Too perfect.

Moving from the margins and into the center two disruptive shadows gradually emerge, one dealing with race, the other with homosexuality. In the years preceding racial protests and riots and in a time when few could imagine public conversation about sexual orientations, use of condoms, or AIDS, the story reveals unspeakable abuses, intolerances, and injustices that have subsequently been addressed but not resolved.

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Three novellas by a master storyteller. For the title story, see the separate entry in this database (Epiphany). "Harmony Ain't Easy" is a tale in which Dr. and Mrs. Sams (he retains his own name here) get stranded when their car is disabled on a country road, thanks to Dr. Sams's bull-headedness. After a warmly humorous series of reverses, they are finally saved.

In the last story, "Relative and Absolute," aged Mr. McEachern is approached by three high school students who want to interview him for their oral history project. They ask him questions about living conditions and race relations in their county when he was young. During the series of interviews, as he tells them anecdote after anecdote heavy with homey wisdom, the old man and the adolescents learn to like and respect each other.

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The story consists of a series of Dr. Mark Goddard's dictated office notes regarding the care of his patient Gregry McHune, interspersed with the narrator's description of these physician-patient interactions. McHune first presents as a standard case of high blood pressure; however, in subsequent visits the man tells his harrowing story.

Goddard learns that his patient was unjustly jailed for killing a black man in self-defense. McHune tells him about racism in the penitentiary and his fight for survival, both in prison and later. Eventually McHune and his family are hounded out of town by the son of the man he killed.

Through all these losses, McHune maintains his sense of humor and easy-going integrity. Meanwhile, the elderly Dr. Goddard is repeatedly harrangued by the clinic administrator (a vacuous young man) for including extraneous details and poetic language in his dictations. As time goes on, and he is transformed by his relationship with McHune, Goddard includes more and more poetry in his office notes.

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Williams's autobiography recounts his life from his first memory ("being put outdoors after the blizzard of '88") to the composition of "Patterson" and a trip to the American West in 1950. The book's 58 short chapters epitomize the writer's episodic and impressionistic style, presenting a series of scenes and meditations, rather than a narrative life story.

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This is an ambitious and far-ranging book, the result of years of thinking, teaching, and working with patients. An internist at the College of Physicians and Surgeons at Columbia University, Charon sees a wide range of patients in an urban setting. Also a Ph.D. in English literature, Charon has devised a "Parallel Chart" and other means for caregivers to write personally about the dynamics between healer and patient, to read texts--narratives in particular--and, as a result, to listen better to patients, thus improving the delivery of medical care.

Charon defines narrative medicine as "medicine practiced with these skills of recognizing, absorbing, interpreting, and being moved by the stories of illness" (4). She calls this a "new frame" for medicine, believing that it can improve many of the defects of our current means of providing (or not) medical care. Caregivers who possess "narrative competence" are able to bridge the "divides" of their relation to mortality, the contexts of illness, beliefs about disease causality, and emotions of shame, blame, and fear.

Charon finds that medical care and literature share five narrative features; she argues that careful reading of narratives builds skills that improve medical care, including intersubjectivity between caregiver and patient, and ethicality. Beyond the theory, there are powerful and persuasive examples of interactions between caregiver and patient, many from Charon's own practice. A mother of a sick daughter experiences stress that makes her ill; when she sees a narrative connection, she begins to heal.

Charon sees wider applications. As caregivers understand better concepts of attention, representation, and affiliation, they become more ethical, more community minded, and better healers to their patients. Patient interviews will be different: instead of following a grid of questions, physicians will converse with patients in an open-ended way. What is most important will emerge and emerge in ways that are most beneficial to the patient. Yes, this method will take more time but it will be more efficient in the long run. Bioethics, Charon argues, has been limited by legal approaches and philosophical principles. For her, narrative bioethics offers more human values in how people feel, experience reality, and relate to each other. Finally, there are implications for social justice: why are the poor underserved in this country and in many others?

One of the most exciting and radical formulations comes late in the book: ". . . practitioners, be they health care professionals to begin with or not, must be prepared to offer the self as a therapeutic instrument" (p. 215). This notion links up fruitfully with concepts of energy medicine (v1377v), therapeutic touch (Tiffany Field), and intentionality (Wayne W. Dyer).

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This concise and well-written biography is meant to be, as Sherwin Nuland tells us, "a guide for the perplexed," for those who may recognize the name of Maimonides and his historical importance to Jewish religion and culture, or who may even have read some of his works, but have no knowledge of the man behind the name. The story begins, as it should, in Medieval Spain with its vibrant Judaeo-Islamic culture, in which the historical relationship between Judaism and medicine developed and later expanded throughout the European and Islamic worlds. Though they were outsiders in both civilizations, Jewish physicians became the most sought after healers in the Christian and Muslim worlds.

Moses son of Maimon (also known as Maimonides and the Rambam, 1138-1204) was born in Cordoba, the cultural and political center of Muslim Spain. He and his family had to flee Cordoba to avoid persecution in 1148. They wandered through Spain until 1160, when they settled in Fez, Morocco. Again fleeing from persecution, Maimonides moved to Fustat, Egypt, when he was 30 years old and remained there for the rest of his life. During these early years, the young rabbi wrote numerous biblical commentaries, culminating in the Mishneh Torah, his great code of Jewish law. Later, he attempted to reconcile faith with reason in another great work, The Guide for the Perplexed, completed in 1190.

Maimonides's specifically medical work is difficult to characterize and evaluate. The traditional historical assessment is that he was "unique in his time in the theory and practice of medicine." Essentially, he practiced Galenic medicine, as transmitted and developed in the flourishing Islamic tradition. We don't know how he acquired his medical knowledge, but by the time he reached Fustat, Maimonides was acknowledged to be a leading physician and in 1190 he was appointed personal physician to the vizier of Egypt. Late in life, Maimonides wrote a number of medical treatises, most importantly his Medical Aphorisms, which presents a coherent, well-organized, and practical medical system based on Galen and Aristotle.

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