Summary:

This powerful book of black and white photographs contains four sections labeled: I. The End of Manual Labor, 1986-, II. Diverse Images 1974-87, III. Famine in the Sahel, 1984-85, and IV. Latin America, 1977-84. In addition, photographs accompany the prose-poetry opening essay, "Salgado, 17 Times," by Uruguayan writer Eduardo Galeano and the concluding essay, "The Lyric Documentarian," by former New York Times picture editor Fred Ritchin. This oversize book concludes with a list of captions for the photographs and a detailed two-page biography of Salgado. Essentially the photographs cover Salgado’s impressive work from 1974-89.

Every image is of a person or people. Many are suffering, many are starving, grieving, keening, dying, displaced. Many are children. Many are laboring under impossibly harsh conditions such as the teeming, mud-coated manual laborers of the Brazilian Serra Pelada gold mine. An Ethiopian father anoints the corpse of his famine starved, skin and bone child with oil. An old man, squinting in the sun, leans over to touch the arm of an equally thin and weak man in a Sudanese refugee camp. Rarely, the people are smiling or celebrating.

The photographs are global: Angola, Bangladesh, Bolivia, Brazil, Chad, Cuba, Ecuador, Eritrea, Ethiopia, Mali, Mexico, Portugal, Sudan, Thailand, and more. As Galeano notes, "This much is certain: it would be difficult to look at these figures and remain unaffected. I cannot imagine anyone shrugging his shoulder, turning away unseeing, and sauntering off, whistling." (p. 7) [156 pp.]

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Among the "scenes from everyday life" which constitute so-called "genre" painting in 17th Century Dutch art, the profession of medicine was often lampooned. In Gerritt Dou’s painting, the doctor is depicted as a deceiving charlatan, marketing his products with impressive but unsubstantiated claims about their effectiveness. In Dou’s hometown of Leiden, with the Blauwpoort (Blue Gatehouse) in the background left, the quack has set up shop outside the studio of a painter. [At the Web Gallery of Art on-line site, select "D" from the Artist Index, scroll down for Dou, select "Page 2".)

The artist gazes out of his window, holding the tools of his trade, a pallet and brushes. Directly beside him the quack stands under a Chinese umbrella, with stopper in his hand, and presents the patent medicine in a large glass vial to his audience. On his table is a document with a large and authoritative red seal, indicating his credentials and bolstering his credibility. On one side is a barber- surgeon’s basin, on the other is a monkey.

A crowd has gathered around, including a huntsman with a dead rabbit suspended on his rifle, a man with vegetables in a cart, and a woman with a pancake griddle and batter in a large bowl in the right foreground; she is cleaning and diapering a child. In the right foreground a woman gapes at the doctor and his medicine, unaware that her pocket is being picked. In front of her sprawls a child who holds a bread crust to bait and capture a small bird. In the left foreground is a tall, twisted and dead tree; across from it at the corner of the artist’s studio is a living tree lush with foliage.

While Nicolas Tulp (see Rembrandt’s "The Anatomy Lesson of Nicolaes Tulp") enjoyed a reputation as the "Vesalius of the North," this painting is more typical of the prevailing popular depictions of the doctor, not just in the Netherlands but elsewhere in Europe and equally subject to mockery and suspicion. At this time medical care was provided by local physicians, but also by traveling barber-surgeons whose skills and knowledge were dubious.

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Sarah and Peter Bedford are sailing with their parents off the coast of Indonesia when the tsunami strikes. As they attempt to escape, their father breaks his leg. Their mother insists the children run ahead, so they do, up the hills into the jungle. Sarah later finds her mother, dead, on the beach, but not her father. Peter is soon running a fever and Sarah embarks on an arduous overland journey to try to get him help. At the same time Ruslan, an Indonesian boy, has taken his own escape route out of his village, and is looking for his father, along with many who are searching for missing relatives. Ruslan and Sarah recognize one another when their paths cross, as he had waited on her family on an earlier stop in his village. Together, with a few other refugees, they make their way to another village where Peter may be able to receive help in a makeshift hospital. Ruslan is threatened by an additional danger, since his family are partisans in a local conflict, and he is suspected of activity on behalf of the rebels.

At the hospital, lack of personnel and supplies throws Peter's survival into doubt, as well as the prospect of finding the children's father. Eventually Ruslan finds his own father, and Sarah and Peter are rescued by the military and taken to a base where more adequate care may be provided. Once there, Sarah finds herself swarmed by journalists, but realizes that the international attention their own case has incited is lopsided, given the many locals whose stories of loss and suffering are not being told. The story ends with the fates of Peter and their father unresolved; clearly part of the story is that no "end" is in sight, and that it will be a long, long time before anything that looks like "normality" will be restored.

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Aaron Raz Link was born a girl, named Sarah, and loved as a daughter. Twenty-nine years later, after inner turmoil, deep thought and relentless examination of how society views gender, Sarah became Aaron, a gay man. This starkly open and moving book describes, in Aaron's words and then in his mother's words, both the costs and the rewards of this journey.

The book is divided into two sections: the longer, beginning section is Aaron's, an intense rendering of what might be called an inner dialogue: Aaron talking to himself about his place in a gendered world; Aaron talking to society about the role of men and women; and Aaron talking to us, the readers, as if we were his close friends, gathered around him as he revealed his life.

The second section belongs to his mother, Hilda Raz. In musing, episodic scenes, she writes about herself as Sarah and then Aaron's mother, about her own work as a poet and editor, and most poignantly about losing her breast to cancer.

On page 86 Aaron says, "A stereotype is a kind of camouflage; the eye finds what it expects to find, and passes over details." Throughout this book we are asked to look at, directly but never sensationally, our bodies' organs, our gender "details," not only as functional anatomy but as symbols of identification.

In both sections, I felt pulled along on this journey, both as someone invited and as someone looking on, an emotional voyeur, and in both sections I observed the unflinching honesty of the authors' revelations. But it in was this final section, the mother's story, that I felt most keenly the love between the two authors. It is this love that becomes the strength of the narrative, the ground on which this incredible story unfolds.

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David Lynch’s The Elephant Man is based on the life of Joseph Merrick (1862-1890), a man who we first encounter in the film as “The Elephant Man” of a freak show, whose physical differences are so frightening to the authorities that the exhibit is closed. An ambitious young surgeon, Frederick Treves (Anthony Hopkins), seeks out Merrick (John Hurt) as a subject for a presentation to the Pathological Society and, taken by Merrick’s intelligence and amiability, arranges for Merrick to have a permanent home on the premises of London Hospital. The film portrays Treves as rescuing Merrick from a wretched existence in the squalid wharf district, where he is beaten savagely and otherwise abused by his sideshow manager, Bytes.

Treves provides Merrick with modest bourgeois comfort in the form of private rooms on the hospital premises. When the London Times publishes a letter from the hospital director describing Merrick’s disfigurement as terrifying and requiring isolation, first a famous actress, then most of London high society seek out Merrick, some to befriend him, others to indulge in spectatorship or the fashion of the day. A hospital porter who has access to Merrick’s room brings drunken revelers to view Merrick for a fee, giving the villainous Bytes the opportunity to kidnap Merrick and spirit him off to Belgium and a desperate existence as an abused and degraded sideshow freak.

Eventually, the other members of the freak show free Merrick and send him back to London, where, in a dramatic chase scene, he is pursued by an angry mob until the police arrive. Treves is summoned and reinstalls Merrick in his rooms at the hospital. Merrick is then celebrated by society when he attends his first theater performance. That night, he arranges himself to be able to sleep lying down, like a “normal person,” a position he knows will lead to his asphyxiation due to the size of his head, and he dies.

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The narrator is a woman who lives alone in a rural area of Puget Sound. She is a writer, an observer, a spiritual thinker. "Each day is a god, each day is a god, and holiness holds forth in time" begins her musings about the first of three days. But on day two, a catastrophe occurs: a small plane crashes and a seven-year-old girl’s face is "burned off" as she is carried away from the explosion in her father’s arms.

The narrator had met the girl once before, at a neighbor’s farm, and had formed a connection--they looked alike and the girl playfully tormented the narrator’s cat with a dress-up game. The narrator imagines the girl in the hospital, imagines her future life as a nun with no face, and ultimately imagines a gentler future in which the girl’s face is restored, she is married and the narrator has assumed the function of the nun for her.

Throughout, the narrator wrestles with the hard questions of life: why are we here; why do horrible things happen; what is the relationship of God and the world; where is God and what is he doing? She is angry: "Do we need blind men stumbling about, and little flamefaced children, to remind us what God can--and will--do?"

A Christian, she seeks answers in her wide-ranging theology, and seems to find an inroad in the idea of "Holy the Firm"--a substance lower than salts and minerals, below the earth’s crust, in touch with "the Absolute." The narrator hence posits that "Holy the Firm" allows for an unbroken circle between God, Christ, and the created world.

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After living with various foster families, nine-year-old Gabe is taken to live with his aging Uncle Vernon in West Virginia. The relationship with his mother's gruff and distant older brother, a Vietnam vet, is distant at first, but warms up over time. But after his first day in 6th grade, Gabe comes home to find his uncle dead on the floor.

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This is a collection of 91 poems on medical topics by medical students, physicians in training, and attending physicians; two are Canadian and the rest American. The poems are organized by six traditional groups of medical training and advancement in the profession: Medical Student, First Year; Medical Student, Second Year, Medical Student, Clinical Years; Intern; Resident; and Attending. There are no sections for pre-meds, retired doctors, or other programs (naturopath, chiropractor).

The editors have done a good job of picking well crafted and evocative poems. A dozen have been previously published. For the most part, the poems are short, easily fitting on one page. Almost all are in free verse, although there is one group of haiku, one prose poem, and an impressive sequence of ten Shakespearean sonnets “Breughel at Bellevue” by Anna Reisman.

Many poems treat dramatic moments in training: the anatomy lab, first gynecological exams, physician-patient relationships, especially when a patient is gravely ill or dying. Several poems in the first three sections comment on the differences between the normal social world and the intense medical world of the hospital. Throughout there are references to the pressures of high-tech, unfeeling medicine. Indeed Jack Coulehan sounds this theme in his introduction; he writes that "steadiness and tenderness" are both needed in medical practice.

 

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Dr. Pauline Chen is a transplant surgeon and hence highly trained in the surgical care of desperately ill patients. She found, however, that although she had intensive and first rate training, time and again the message she received from her mentors and peers encouraged a distance from frank discussions about dying with patients who were clearly dying. Dr. Chen successfully suppressed her urges to reflect on the meaning of illness and death. Years into her training, she finally witnessed an attending surgeon stay with a patient and the patient's wife until the patient passed away. The widow sent a thank you note to Dr. Chen for allowing a "dignified and peaceful death." (p. 101) Chen notes that observing her attending stand with the patient during death changed her profoundly: "...from that moment on, I would believe that I could do something more than cure. This narrative, then, is my acknowledgment to him." (p. 101)

Final Exam chronicles Chen's journey from medical student to attending surgeon and examines her experiences with death and serious illness - of patients, family members, friends. The memoir contains three parts: Principles, Practice, and Reappraisal - each with three chapters. The book is chronologically arranged, beginning with anatomy dissection at the start of medical school and ending with Chen as an attending arranging for hospice, thus honoring a patient's desire to die at home rather than in hospital. Chen skillfully weaves her stories around commentary on the social, cultural and philosophical issues surrounding death and the medical response to death. An introduction and epilogue bookend the text and 46 pages of extensive notes and bibliography complete the book.

Although Chen claims to have slowly and painfully awakened to the fact that patient needs extend well beyond good technical care, in fact one sees Chen emerge as a caring physician even from her initial patient contacts in medical school. Chen speaks more to her role as an Asian-American than to being a woman in a male-dominated field, but she clearly has what it takes to succeed in this extremely competitive field, including a good dose of compulsiveness and an incredible work ethic.

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The Cuban-American physician-poet Rafael Campo tells a story in this poem. His speaker is both a curandero, or folk healer, and a modern-day American physician. Returning home after a trauma-filled day at the Emergency Ward, the speaker immerses himself in a soothing bath with "Twenty different herbs at first (dill, spices / From the Caribbean, aloe vera)." He weeps and prays to his patron saint and curandero St. Rafael, who has the same name as the poet himself. Rafael announces his arrival: "Rafael, / He says, I am your saint." The speaker tells his healer about two female patients he has seen that day, one, an abused wife, and the second a little girl killed on her tricycle. St. Rafael listens, touches the speaker, and carries him to bed. Sleep "takes the world away."

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