Summary:

Molly Lane, restaurant critic and photographer, has died of a progressive neurological disease. She is survived by George, her husband, as well as by several past lovers, including Clive Linley, a famous composer, his old friend Vernon Halliday, editor of a London newspaper, and Julian Garmony, the British foreign secretary, rumored to be headed for Downing Street. After Molly's funeral, both Clive and Vernon experience odd neurological symptoms and make a mutual pact to help each other commit suicide in order to end suffering. The symptoms appear in both cases to have been psychosomatic, but the pact remains.

George has found career-destroying photographs of Julian Garmony (in drag) among Molly's things, and he gives them to Vernon for the newspaper. Vernon and Clive quarrel over the ethics of a decision each has made: Vernon's decision to publish the pictures, and over Clive's decision not to intervene when, while working on a crucial melody for his symphony during a walk in the country, he sees a woman being attacked by a man who turns out to be a serial rapist. When Vernon is fired and Clive's symphony is a failure, each blames the other and the suicide pact becomes a means of mutual revenge.

A subtext has been a running storyline in Vernon's paper about rumored abuse of the Netherlands's liberal euthanasia laws; the novel ends in Amsterdam, each man involuntarily euthanized by a physician paid by his friend. (Meantime, Garmony's career is in ruins. George has successfully destroyed all three of his wife's lovers.)

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In the "free love" context of the nineteen-sixties, Harriet and David Lovatt are throwbacks to a more conservative, traditional, and family-oriented decade. Their life dream is to have a big house in the country filled with children, and it seems that they will succeed. After bearing four young children, however, Harriet is feeling the strain of years of childbearing, sleeplessness, money trouble, and her parents' and in-laws' disapproval of her fecundity.

Her fifth pregnancy is not only unplanned, but also unusually painful and disruptive. Harriet's doctor prescribes sedatives but finds nothing abnormal in her situation. When Ben is born, Harriet jokes that he is like "a troll or a goblin," but no one responds well to this unusually hairy and physically vigorous baby, who in turn does not respond to anything but his own desires and fears.

As he grows older, family pets and other children seem to be in physical danger. Health care professionals do not confirm the couple's conviction that Ben is not normal, but neither do they obstruct the decision to send Ben to a private institution, a removal that leaves the family temporarily happy until Harriet visits Ben and recognizes the institution for what it is, a place where all manner of "different" children are sent to live heavily medicated, physically restrained, and foreshortened lives away from families who do not want them.

Harriet brings Ben home, where he grows up amid what remains of the Lovatts' domestic fantasy, and finds community in a gang of thuggish older boys whom Harriet suspects are involved in various criminal acts. As the story closes, Ben has left home and Harriet imagines him in another country, "searching the faces in the crowd for another of his own kind" (133).

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In "Fortitude" Dr. Elbert Little, a Vermont family physician, visits the laboratory of Dr. Frankenstein and his trusty assistant, Dr. Tom Swift. Frankenstein has only one patient, Sylvia Lovejoy. His life work has been to keep Lovejoy alive. In 78 operations over the last 36 years, Frankenstein has replaced every one of her organs with prosthetic devices, so that now she consists of a head on a tripod, attached by tubes to various machines.

Frankenstein controls her mood, as he controls all her functions, from a "fantastically complicated" master console. Usually he makes sure that she feels joyful and loving, but last month a transistor went bad in one of the machines and she felt depressed for a while; so depressed, in fact, that she wrote to Dr. Little and asked him to bring her some cyanide.

Lovejoy's only friend is Gloria, the beautician who comes every day to care for her hair. Gloria is horrified over what Sylvia Lovejoy has become; she sees only a "spark" of the real person remaining, but she knows that the "spark" wants to die. After Frankenstein fires Gloria for speaking about death in Sylvia's presence, she sneaks back into the room when Sylvia is sleeping and puts a loaded revolver in her knitting bag.

Later, Sylvia finds the gun and tries to kill herself, but her prosthetic arms have been designed not to allow her to do that. Instead, she shoots Frankenstein, who promptly becomes the second head attached to the machines. (It seems he has designed all the prosthetic organs to be able to serve two "persons," so that he and Sylvia will be able to "live in such perfect harmony . . . that the gods themselves will tear out their hair in envy!")

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George tries to take care of his mentally retarded friend, Lennie, whose mental disability makes it impossible for him to judge his powerful strength. Lennie means well and tried hard; he likes soft, furry things, like a mouse and a puppy, both of which he squeezes to death accidentally. Though his great strength is useful on the ranch where he works, his inability to govern his behavior leads him into an accidental homicide. George, not wanting Lennie to live the rest of his life in prison, shoots him in the head as an act of mercy.

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In the late 20th century, Britannula, an island near New Zealand, has achieved its independence from Great Britain. Settled by a group of young men some 30 years before the action of this novel, Britannula has developed into a prosperous land governed by a President and a single-house legislative body, the Assembly. They have adopted a great social experiment called the "Fixed Period," by which the society and its citizens will avoid the suffering, decrepitude, and expense of old age. At age 67 each person will be "deposited" into a lovely, carefree "college" (Necropolis) where he or she will spend one delightful year before being euthanized.

The story takes place just as the time approaches for Gabriel Crasweller, a wealthy landowner and good friend of President Neverbend, to be deposited. Crasweller is the first citizen to have lived out his Fixed Period, and the President, whose brainchild the Fixed Period is, experiences a conflict between his love for Crasweller--who inexplicably does not want to die--and his determination to carry out the law. Mounting resistance to the Fixed Period among the older citizens (including his wife) also surprises Neverbend, although the Assembly, composed mostly of young people, reaffirms the law. Just as Crasweller is led off to Necropolis, a British gunship arrives in port to relieve Neverbend of his duties as President and re-establish direct control of Britannula.

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The Exact Location of the Soul is a collection of 26 essays along with an introduction titled "The Making of a Doctor/Writer." Most of these essays are reprinted from Selzer's earlier books (especially Mortal Lessons and Letters to a Young Doctor). Six pieces are new and include a commentary on the problem of AIDS in Haiti ("A Mask on the Face of Death"), musings on organ donation ("Brain Death: A Hesitation"), a conversation between a mother and son ("Of Nazareth and New Haven"), and the suicide of a college student ("Phantom Vision").

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Alison, 39 years old, is twice-divorced, with three children, on the verge of moving in with a man called Bobby. Her breast is sore and she is afraid it's cancer. Her mother tells her it's more likely she's pregnant. She says she uses contraceptives; her mother tells Alison that she was conceived when a condom broke.

Alison considers abortion, recalling her last pregnancy. Having given birth to a child with Down's Syndrome who died at three months, she had had amniocentesis and was told that she was carrying twin boys, both normal. When the twins were born, though, one turned out to be a girl. One twin, it seemed, had been tested twice. Although the female twin did not have Down's Syndrome, Alison began at that point to worry about luck and the uncertainty of medicine (and of life).

So now, pregnant again, she asks her mother what she should do, and is told to "trust to luck." But she is afraid that her luck has run out and she must take control for herself. A scan shows that she is carrying twins again. Only now does her mother tell her that she is in fact a twin, that her sister had Down's Syndrome and died shortly after birth--in fact, her mother admits, the midwife "did away with" her. (The euphemism carries the senses both of euthanasia and of murder.)

Hearing this, Alison decides she wants to have an abortion right away. Her doctor, thinking the problem is that she wants only one child, gives her the option of selectively terminating one fetus and carrying the other one, but tells her she wouldn't be able to choose which to keep and which to abort. She rejects the idea, imagining how she'd tell the surviving twin about her decision later on, and decides instead to "have them both and trust to luck."

As she leaves the clinic, she begins to bleed and miscarries. Later her mother tells her that she, too, once miscarried twins, and tells Alison she'll have better luck next time, because of the bleeding: "Blood, " her mother says, "is the libation the God of Chance requires."

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Death is compared to an "insect / Menacing the tree" in its insidious, covert actions. Although the reader is urged to fight death with whatever means are available, the poet recognizes that some circumstances are beyond hope.

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The narrator delineates the needs of a human heart and soul: "pleasure," relief of pain, and finally, "the liberty to die."

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In this journal, Murray traces a month-long rotation he spends as attending physician in the ICU (Intensive Care Unit) of San Francisco General Hospital. For each of the 28 days, Murray presents the patients he sees, both new and ongoing, along with commentary on the care of each patient and on broader issues raised by their cases.

In the course of the month, we encounter sixty patients, fifteen of whom die in the ICU. The patients are apparently quite typical for the hospital: cases are dominated by HIV, pneumonia, tuberculosis, and drug abuse, or all four. The ICU is not a very safe place: there are twelve cases of iatrogenic pulmonary edema, and several of hospital-acquired infections.

Murray candidly presents both the triumphs and the limitations of contemporary intensive care while giving us vivid glimpses into the lives of both patients and staff. In his epilogue, Murray asks some tough questions about the value of intensive care units, and discusses palliative care, patients' rights to the withholding and withdrawing of life-sustaining therapy, and even physician-assisted suicide, as "more humane"--and economically responsible--alternatives to intensive care in cases of advanced terminal illness (270).

He describes the ICU as a "battleground" where people who are "clinging to life" can "fight for it" (275). This is its value. But the battles need to be better understood and winning must be carefully evaluated. Murray concludes that the last few decades' medical and technical advances in critical care now need to be matched by ethical ones.

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