Summary:

This work, originally entitled "Three Women," is a semi-autobiographical story of Willa Cather, her mother and grandmother, four younger children--all boys--the father, and a servant girl, who all lived together in a small midwestern town. The roles of the three women are beautifully described: the gentle grandmother who cared for and taught the children, her daughter, a displaced "southern belle" who was spoiled in many ways but wise and loving with her children, and her granddaughter, a teenager set upon her own needs and ambitions but dutiful toward her family.

Another part of the story is the relationship of this family to a well educated neighbor couple who "kept a tender watch over the comings and goings of the household." It was in their home that the granddaughter found a library she could use and encouragement for her studies. Eventually it was this couple who made it possible for her to attend college.

The gradual, unnoticed deterioration of the grandmother ended with her death. The response of the family to this event is well described. Also the empathic relationship between the grandmother and the servant girl is very poignant. Even the death of a family cat adds to the depth of the story in a metaphorical way.

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On the night before Easter, a traveler waits to cross the river to a monastery. Finally, a lay brother named Jerome brings the ferry across. As the ferry moves slowly to the other bank, Jerome reveals his sadness over the death of Nicholas, a fellow monk who wrote beautiful prayers for saints’ days. "Can you tell me, kind master," Jerome asks, "why it is that even in the presence of great happiness a man cannot forget his grief?"

Jerome loved Nicholas who was very quiet, kind and tender, not at all like the other monks, who are loud and harsh. At the monastery the traveler participates in services throughout the night, then returns to the ferry after sunrise on Easter morning. Jerome is still working the ferry. His promised relief has not arrived.

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In 1996, at the age of 31, David Biro is preparing for his specialty examinations in dermatology and is set to share a practice with his father. But he develops a visual disturbance. After repeated testing, he is found to have the rare blood disorder of paroxysmal nocturnal hemoglobinuria. The diagnosis was problematic, but the treatment choices are overwhelming. His youngest sister is a suitable donor, and he opts for a bone marrow transplant. He realizes that his decision was influenced not only by the diagnosis, but also by his personality and his reaction to the physicians.

Advance preparations are hectic and sometimes comic, especially his deposits at a local sperm bank. The pain of the transplant and the six weeks imprisonment in a small hospital room are told in graphic detail. The athletically inclined doctor suffers many complications: exquisitely painful ulcers of the scrotum, mouth, and esophagus; inflammation of the liver; unexplained fever; drug-induced delirium; weakness and weight loss.

His parents, sisters and friends leap into action to provide round-the-clock presence, but his independent wife, Daniella, resents the invasion. While David’s body is wracked with drugs and radiation, his family and his marriage are subjected to destructive forces too. Yet all--body, family, and marriage--emerge intact, though changed, by their experience.

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Miss Rosie is homeless, a street person surrounded by her foul-smelling possessions. She is not a stranger to the narrator, who has thought long and hard about her present circumstances and how she might have been long ago before she became a familiar sight in the neighborhood. Now reduced to rags, this "wet brown bag of a woman," says the narrator, once was "the best looking gal in Georgia." The narrator "stand[s] up" for her through her "destruction."

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One morning in the shower Joyce Wadler, "a journalist, forty-four, Jewish, never married," discovers a lump in her left breast. In this brief, bright, and very readable account, Wadler describes what happened next, taking us through medical examination, diagnosis, and successful lumpectomy and chemotherapy.

But this is much more than a simple patient’s story. For one thing, Wadler is an intrepid researcher, and we learn a good deal about breast cancer and the often agonizing therapeutic choices its victims face. For another, she does not separate her medical adventure from the rest of her life, which includes a day job as a writer for People magazine, a book project, a semi-functional relationship, and a Jewish mother.

Finally, Wadler uses her ironic-sardonic sense of humor to great advantage--remarking, for instance, that through her post-diagnosis impulse to live in the present and not worry about her lover’s monogamy, cancer had made her "the dream girl of every uncommitted man in Manhattan"!

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In this sequel to his earlier seem-autobiographical novel, House of God, Shem (this time using both his pseudonym and his real name) describes the experience of a physician in the first year of a psychiatry residency in a prestigious private psychiatric hospital. In this first hand account it is assumed that the author is the resident, Dr. Roy Basch; he describes not only his experiences with a variety of patients but also with the other doctors and the staff members of the institution. It is not a happy place and in the telling of the story there is a biting irony and a sense of the absurd.

It is obvious from the first that Dr. Basch is very serious about becoming a psychiatrist but that he is also searching for meaning and connections. He finds that colleagues may often hurt you more than your patients. Another issue addressed is that of competing psychiatric theories, particularly the competition between pharmacologic treatment and psychoanalysis. Issues about drug treatment trials and the questionable way in which they are conducted also receive attention, as does the problem of insurance coverage for hospitalization.

The fact that psychiatrists often specialize in their own defects becomes a reality to Dr. Basch. There are not many exemplary people in this book--hopefully it exaggerates the real situation. There is, surprisingly, a sort of poignant positive ending.

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The New Medicine and the Old Ethics, in Albert Jonsen’s own words, is a "secular aggadah." Jonsen explains that one Talmud reviewer defined aggadah as "a magical rabbinic mode of thought in which myth, theology, poetry and superstition robustly mingle" (4). The book begins with a personal essay entitled "Watching the Doctor." Jonsen establishes his premise that the moral history of Western medicine is best understood as a paradox between altruism and self-interest, a paradox alive and well entering the 21st Century.

He then takes the reader on his "secular aggadah," blending history, myths, and stories that trace important moral developments in the practice of Western medicine. In "Askelepios as Intensivist," we learn of the early Greek values of competence in shaping medical practice. Through the influence of the Church in the medieval period, Western medicine incorporates the value of compassion through the Biblical Good Samaritan, struggles with problems of justice in the care of the poor, and further elaborates the meaning of benefit.

In "The Nobility of Medicine," Jonsen describes the contribution of Sir William Osler and other knighted medical men of the 19th Century who established the ethics of noblesse oblige in the medical profession. He traces this noble tradition to the medieval Knights Hopitallers of Saint John of Jerusalem, a group of religious who provided hostels for pilgrims to the Holy Land and cared for the sick. With essays on John Locke and Jeremy Bentham, Jonsen brings us to the 20th Century and the play of individual rights and utilitarian values in the moral life of Western medicine.

In the final essays, Jonsen describes the mingling of these traditions as a means to establish a moral frame for Western medicine in our current times where technology and science have achieved and threatened so much. Ethics, he argues, "is disciplined reflection on ambiguity" (130). In the last essay, "Humanities Are the Hormones," Jonsen brings his "secular aggadah" full circle.

He argues that the paradox of altruism and self-interest that runs through the moral history of Western medicine must continually be vitalized and examined through the Humanities. The Humanities are "the chemical messengers that course through the complicated institution of medicine and enable it to respond to the constantly changing scientific, technological, social, and economic environment" (147).

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The spirit of St. Francis of Assisi presides over the garden in spring. Hyacinths bloom, and abandoned bird nests are tucked away in the nooks and crannies. Young couples embrace: "St. Francis forgive them / and all lovers / whoever they may be." The scene then fast forwards to summer, when the lovers find themselves bewildered and "incredulous / of their own cure / and half minded / to escape . . . "

The idyllic garden has turned menacing, yet St. Francis continues to have compassion for the lovers who "resemble children / roused from a long sleep." One lover stands up unafraid in the sunlight "as her heart / beats wildly / and her mind / drinks up / the full meaning / of it." [139 lines]

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A lieutenant named Alexander Grigoryvitch Sokolsky arrives at the home of Susanna Moiseyevna Rothstein, a Jewess and owner of a vodka distillery. Sokolsky has come to collect the 2300 rubles that Rothstein owes his married cousin. In fact, his cousin doesn’t actually need the money, but Sokolsky is helping his cousin get his debts paid so that he can then borrow the 5000 rubles that he needs to marry his fiancée.

Susanna, a luscious, free-spirited young woman, receives the lieutenant and offers him supper. She entices the IOUs from him, but then refuses to pay up. The next morning Sokolsky returns to his cousin’s house without the money, but presumably sexually satisfied. Kryukov, the cousin, rants and raves. What an outrage! He determines to visit the Jewess himself and demand payment. He does so and, likewise, only returns the next morning, penniless.

After a week, Sokolsky borrows the money from his cousin and leaves. After another week, Kryukov gets an uncontrollable itch to visit the Jewess again. When he arrives at her mansion, there are many men around, including Sokolsky, who evidently has hung around Susanna’s house for a week, having completely forgotten about his fiancée. Krykov’s final words are: "How can I judge him since I’m here myself?"

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The poem describes, satirically and in graphic detail, the sorry state of a man who, during an "emancipated evening" has fallen into a drunken stupor, been robbed, and left by the roadside, ignored by all who pass. Only at the end does the tone change as the narrator becomes the sole rescuer, "stagger[ing] . . . with terror through a million billion trillion stars."

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