Summary:

This is the most detailed and comprehensive biography of Anton P. Chekhov written to date. Rayfield is a Chekhov scholar who published an earlier biography of the writer in 1975. There are numerous biographies of Chekhov available. In the Preface to this book, Rayfield explains why he wrote it. Chekhov's life is documented by a vast amount of archival material, much of which was unavailable to Western scholars in the past. Russian scholars have studied these sources extensively, but the studies they have published use only a small part of the material. Rayfield's own study convinced him that by drawing liberally from these archives he could write a new biography that would increase our understanding of Chekhov's life and character.

Rayfield's approach is strictly chronological. The book consists of 84 short chapters, each one named and subtitled with the period covered (e.g. July - August 1894). Rayfield sticks closely to the texts, developing a rather staccato style that is heavy on factual statements and light on his own interpretations. He also chooses not to discuss Chekhov's writings as such, except to present brief summaries of the plays and some of the more important stories, and to indicate relationships between Chekhov's life and his art.

The new material gives us a much better view of the day-to-day texture of Chekhov's life, his interactions with family and friends, and his interesting and enigmatic relationships with women. The book also includes a helpful diagram of the Chekhov family tree, two maps of Chekhov's country, and many photographs.

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In this remarkable book of essays, Rafael Campo explores his coming-of-age as a gay Cuban-American physician. He presents us with a series of stories illuminating his childhood and college experience, skillfully interweaving them with narratives from his life as a young physician, especially his interactions with patients dying of AIDS. We follow the author from Amherst College, through Harvard Medical School, to his medical residency in San Francisco. At each step Campo is a close observer of human character and motivation--his own and others. At each step he asks, "Who am I? Who am I becoming?"

He discovers his identity as a gay man, an Hispanic man, a poet, and, finally, as a healer--not four identities, but one. He discovers, too, the healing power of connecting with patients, the "poetry of healing," something far different from the orthodox image of the physician-as-detached-or-distanced from his patients. Though Campo rejects the concept that physicians are agents for social change ("naive," he calls it), he brings sensitivity and poetry to bear on his continued search for "some way to give."

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Matthew Modine plays Joe Slovak, son of a West Coast fisherman, who goes to medical school and has a hard time adjusting. The film focuses on Joe and the members of his dissection group in Gross Anatomy. Joe, perhaps because of the proud independence of fishermen, goes through most of the film with a big chip on his shoulder, refusing to take things seriously, showing up late for dissection carrying a basketball, refusing to consider the feelings of hypothetical patients, etc., while everyone else is trying their hardest to become good doctors. He falls in love with dissection partner Laurie Rohrbach (Daphne Zuniga), but he has a hard time there, too.

When Joe's roommate David is kicked out, Joe goes home to think things over. He visits Dr. Rachel Woodruff (Christine Lahti), head of Anatomy who all along has been critical of his attitude but is now at home, incapacitated with lupus. She tells him of her disappointment in her own career ("I made doctors--people need healers.") and in him, because he has never wanted to be as good as she knew he could be. She pleads with him to commit to being a good doctor.

Switch to the group's all-nighter before finals and the sudden labor pains of the very pregnant member. They all rush off to the hospital, but don't make it, and Joe winds up delivering the baby on a table in a roadside diner (soft trumpet fanfare from the soundtrack). Between Dr. Woodruff, who dies at the end, and the delivery, Joe gets the message about commitment, and he winds up with both good grades and the girl.

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In 1877, Richard Maurice Bucke (1837-1902) (Colm Feore) becomes the superintendent of the asylum in London Ontario, where physical restraints are used. His lovely but tense wife (Wendel Meldrum) is grudgingly deferential to his professional needs. They are parents of a happy little girl. Bucke travels to a Philadelphia conference to read a paper on his liberal ideas about care of the mentally ill, but he senses the intolerance of the audience and storms out.

An odd "free thinker" in the audience--who turns out to be the great American poet Walt Whitman (Rip Torn)--admired the paper. Whitman invites the doctor to meet his mentally disturbed brother kept at home rather than in an asylum. Smitten with Whitman and his philosophy, Bucke brings him to Canada.

At first, his wife and the town are suspicious of the famous stranger, but they gradually change their minds. The asylum replaces its coercive methods of care with exercise, music, and talk. The film closes with a lively summer cricket match between the asylum (patients and workers) and the town.

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A woman medical student finds herself in a hierarchical dilemma while rotating through her internal medicine clerkship. She is helping to take care of a middle-aged man who has been hospitalized for a diagnostic work-up. As a consequence of invasive procedures ordered by his physicians to determine the cause of his symptoms, the patient has suffered serious complications and is moribund. The doctors are evasive with the patient and his family, who beseech the medical student for an explanation. Even though she has been instructed by the physicians to refer all issues back to them, she follows her own convictions and tells the truth: "Your father is dying."

As a result of this "insubordination," she is called in to see the head of the department, a man of "legendary diagnostic skill" with a long tenure at the hospital. He says that he will have her dismissed, and launches into a long diatribe, making the case for a paternalistic medicine in which the patient needs to believe that the physician is omniscient and possesses quasi-magical healing powers. "Miracle, mystery, and authority," he says, are at the heart of what physicians can do for their patients and to undermine these is to do harm to the vast majority of the sick. Having made his point, he terminates the interview but reinstates the student, who, it is suggested, is so grateful (for his advice or for not being dismissed?) that she kisses him.

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This is a collection of stories and sketches by a practicing neurologist. Most of the material is clinical and autobiographical. In "Mrs. Bachman" a new patient enters the doctor's office, carrying a thick stack of medical records. It all started in 1946 and no doctor has ever found the explanation of her condition. Meanwhile, the doctor is wearing contact lenses for the first time. His eyes begin to tear. Mrs. Bachman thinks that he is crying over her misfortune. She consoles him, "I want you to know that you are the kindest, most sympathetic man I have ever met."

In "Intensive Care" an elderly woman is agitated after a seizure. The staff try unsuccessfully to calm her. Finally, her husband approaches and kisses her. She settles peacefully and they hold hands.

The doctor in "Continuing Medical Education" finally discovers metastatic breast cancer as the cause of a psychotherapist's neck pain, long after he and other physicians had told her again and again that the "driving mechanism" of her chronic pain was "unresolved anger and frustration." In a longer essay, "The Narrow Bridge," the author reflects on the meaning of healing, "Healing helps us find a place in this world for ourselves and for each other."

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William Morton first introduced ether anesthesia in 1846. This was followed shortly by nitrous oxide and chloroform. Within a few years, surgical anesthesia was being used throughout the United States. However, widespread acceptance did not mean universal usage. Physicians and surgeons debated the risks and benefits of anesthesia. Anesthesia was thought to be dangerous. Some argued that pain was a necessary part of life, that it made people stronger, and/or that it was a punishment from God. Others argued that anesthesia constituted an abuse of medical power.

Surgeons took care to select appropriate patients for anesthesia, while performing surgery without anesthetics on others. Women, people of higher social and economic classes, and people of the white race were thought to be more sensitive to pain than men, the poor, and Negroes and American Indians. Likewise, the young experienced pain more than the elderly. Certain procedures (e.g. major limb amputations and prolonged tissue dissection) were also thought to require more anesthetic than others (e.g. natural childbirth or ENT surgery). These beliefs carried over into practice, as evidenced by records from the Massachusetts General Hospital and other hospitals in the mid-19th century.

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This study explores the history of physician-patient relationships, especially as it relates to the ascendancy of science in medicine. The book begins by describing traditional physician-patient relationships in the 18th century. The focus, however, is on the "modern" doctor (beginning in the 1880's) and the "postmodern" doctor (beginning in the 1950's).

The author describes the transition from modern to postmodern doctor and a corresponding transition from modern to postmodern patient. A "sympathetic alliance" between physician and patient was essentially a development of the modern period (1880's - 1950's).

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Dr. Hertzler leads the reader, topically and generally chronologically, through the nature of the practice of medicine in rural America from the 1880's through the 1930's. His early narratives are those of a child observing the ravages of epidemic diseases in the face of medical futility.

The remainder of the work, divided into subject headings, is devoted to anecdotes and observations on such things as horse and buggy home visits, kitchen surgery, the proprietary hospital and physician education. Having served not only as a rural practitioner, but as a professor of pathology at academic centers and a consulting surgeon, Hertzler draws on a wide experience over a period of time known for rapid advances in basic biological science which would, near the end of the narrator's life, open the way for technological medicine as we know it today.

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This collection of vignettes follows the growth and development of one internist as he reflects on some of the critical experiences that shaped him as physician. The common thread of the work is the celebration of the relationship that can, and perhaps should, be built between the physician and his or her patient in the course of caring: this relationship is the sacred space of the title.

The author accomplishes his self-imposed task of describing this space by presenting situations in his practice life that illustrate the concept. The chronological structure of the collection enables the reader to study the maturation of the author as a self-reflective practitioner over the many decades of his professional life. Many of the stories are very funny; others are wrenching; all are gently told.

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