Summary:

Martin Nanther is a member of the British House of Lords, having inherited his title from his great-grandfather, Henry. Physician to Queen Victoria, Henry specialized in hemophilia, the disease that Her Majesty was known to have passed to her son, Leopold, and other descendants. While the House of Lords considers a Bill to abolish hereditary peerage and Martin's much younger, second wife is obsessed with becoming pregnant, he escapes into his slow research for a biography of Henry

His patient genealogical investigations uncover deaths in infancy of several young boys in his own family, and Martin soon realizes that hemophilia (rather than the family's legendary tuberculosis) is the cause. Was that irony merely a coincidence? Or was hemophilia in his own lineage the impetus for his grandfather's research and position in life? And why was the disease hushed? Was it possible that his grandfather deliberately sought a bride with the trait in order to investigate it in his own progeny?

Martin soon finds himself wondering if this well-respected, medical man actually committed murder, or was he merely waylaid by unexpected love? Without giving too much away, suffice it to say that the answers prove so surprising and so disturbing, that Martin decides to abandon the biography of his ancestor, even as he learns that his inherited peerage has been revoked and that his next child will soon be born.

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The narrator of this story, a wounded American soldier, is recuperating from his injury in Milan, Italy. He receives treatments delivered by machines each afternoon at the hospital. His doctor seems overly optimistic. "You are a fortunate young man," he tells the narrator, promising the soldier that his injured knee and leg will recover well enough for him to play football again.

The physician's prognosis for another patient, an Italian major receiving treatment for a shriveled hand, is also dubious. The officer was once a renowned fencer and is now angry and bitter. His invalid condition and the recent death of his young wife from pneumonia have sapped his will. He professes no faith in the machines treating his hand injury and does not believe in bravery.

Injury fosters camaraderie and the narrator socializes with four other young men undergoing treatment at the hospital. The narrator admits his injury was not the result of heroic action but merely an accident. The medals he received were undeserved. Life may be a series of random events but some people have it worse than others. The only certainty in the lives of these characters is the fact that "the war was always there."

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Written as an interior monologue, Destiny begins as Chris Burton receives a phone call informing him of his schizophrenic son's suicide. Burton, a British ex-pat journalist in the final stages of writing his chef d'oeuvre--a cultural history on national character--is married to Mara, a provocative, capricious, flamboyant Italian. The vitriolic arguments and hurtful stratagems that characterize their discordant marriage intensify with the crisis of death and its aftermath--the identification, transport and entombment of Marco's body. Family relationships are further complicated by Mara's distrust and estrangement of her adopted daughter, Paola.

Burton reveals the chaos that schizophrenia imposes not only on the patient, but also on the entire family. In order to avoid prison following an attack on his family and home, Marco had been placed in a psychiatric institute, Villa Serena, and it was at this facility that Marco stabbed himself to death with a screwdriver. The onset of disordered thinking and erratic behavior, the search for therapies, the various repercussions of guilt and blame (including recriminations about the intense, border-blurring maternal love lavished on Marco), are re-examined by Burton as he travels from London to Rome, sits vigil by his son's body in the camera ardente, and confronts his wife at her family's tomb.

Burton's physical distress mirrors his mental anguish. Burton has heart disease and obsesses about lacking his anti-coagulant medication. In addition to the worry of clot formation, urinary retention prevents Burton from emptying his bladder. These physical ailments of containment, confinement, obstruction and blockage form resonances throughout the book: the tomb, the strictures of marriage and the leakage of adultery, the oppressive family 'house of ghosts,' the separateness of interior thought from observable behavior, the barriers of language, the herky-jerky redirections of emergency travel.

Furthermore, the will to create permanence, to make one's destiny more than a transient destination, informs Burton's moves. In the midst of his exploding marriage and tormented trek home, Burton agitates over his work, and in particular, his book, which "must serve to transform a respectable career into a monument" (p. 1).

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Manlius is a 5th C Roman patrician living in Provence who has studied with the wise, reclusive Sophia. He writes his understanding of her teaching in his essay, 'Dream of Scipio,' which trades on an essay by the great Roman orator, Cicero. Sensing that the Empire is gravely threatened, he makes a pact with barbarians, sells out his neighbors, slays his adopted son, and becomes a bishop of the Christian religion, which he has long despised. Late in this ruthless and doomed attempt to salvage what he values most in his world, Sophia makes it clear that he has misunderstood her teaching.

Olivier is an astonishingly gifted 14th century Provencal poet whose intolerant father tries to stifle his love of letters, among which is Manlius's 'Dream'; his father destroys the manuscript, but Olivier recopies it from memory. As plague advances on their region, Olivier finds a mentor in the high churchman, Ceccani, who is bent on keeping the papacy in Avignon. He plans to destroy Jews as symbolic expiation for plague, widely construed to be a form of divine punishment. Olivier befriends a Jewish scholar and falls in love with his beautiful heretic servant.

The 'Dream' and the imprisonment of his friends lead Olivier to question and then betray his mentor. Either because of his efforts to save them, or for his role in a murder, he is mutilated--his tongue and hands cut off to rob him of speech and writing. The brutal mutilation appears early in the book--it is not fully explained until the end.

Julien is a French historian who has studied the poet, Olivier, and the rendition of Manlius' manuscript. He finds solace in his erudition as his county falls to the Nazi occupation. An old school friend who is a collaborator, gives him work as a censor and tolerates Julien's Jewish lover, the artist Julia. In the end, Julien is forced to choose between saving either another school friend in the Resistance or Julia. He chooses Julia, looses her anyway, and commits suicide in a vain attempt to warn his friend.

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This story of one exceptionally accomplished family's discovery of their past and future relationships with Huntington's Disease (HD) is also the story of how the Wexler family changed the cultural narrative of HD for other families at risk for this genetically-transmitted and currently incurable disease. The HD diagnosis of Leonore Wexler (the author's mother) inspires Milton Wexler, a psychologist, to create a major foundation for HD research, which develops critical mass and influence as Leonore Wexler's condition deteriorates, and after her death. The book interweaves the story of the Wexlers' emotional and other negotiations with HD and the story of their efforts to create an HD community comprised of those with active symptoms of HD, family members, advocates, and researchers.

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A child dies in the hospital shortly after the infectious disease consultant, Dr. Michael Grant, evaluates her. The 35-year-old physician has cause to be troubled by the patient's death. He failed to perform a careful examination, did not check the results of her most recent lab tests, and held off on ordering antibiotics. Although an autopsy was not performed, it is believed she died of sepsis.

Divorced and recently relocated to North Carolina, Dr. Grant is already depressed. Now he must worry about the possibility of a malpractice lawsuit. Jonas Williams, the father of the dead child, is also ill. He complains of fatigue, visual disturbances, confusion, night sweats, and fever. Jonas has developed unusual lesions in his throat and retina--white threads in a serpentine pattern. A biopsy of his oral lesion demonstrates the presence of osteoblasts and new bone formation. Dr. Grant becomes convinced he has stumbled onto a completely new infectious illness even though he cannot identify the causative organism.

Jonas experiences gastrointestinal bleeding as a result of a low platelet count. He dies in a trailer that has caught on fire. Dr. Grant soon develops the same symptoms as his patient. He remembers coming into contact with some of Jonas's blood. He is admitted to the hospital with massive gastrointestinal bleeding. His physician attributes the bleeding to ulcers, gastritis, and thrombocytopenia. Dr. Grant, however, believes the bleeding is due to the same mysterious disease that Jonas had.

The body of Jonas's daughter is exhumed, and there is anatomic evidence of the same bizarre changes that occurred in her father. Dr. Grant visits a cabin in the woods where Jonas had lived. He is looking for clues to the puzzling new illness. What he finds, however, is not an answer. Instead, it is a renewed appreciation for his life as well as the world around him.

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Dr. Dymov is an earnest and rather boring young physician, who is preoccupied with his patients and his research. Olga, his wife, craves the excitement and gaiety of the artistic life. She discovers a new lease on romance with Ryabovsky, a colorful landscape artist, who takes her on a cruise on the Volga River. As they spoon under the stars, Olga and her lover make light of her bumptious stay-at-home husband.

After she returns from the cruise, Dymov forgives her infidelity, but in Olga's mind, his forgiveness proves to be another strike against the poor slob, since she just can't stand his complaisant devotion. She runs back to Ryabovsky for a while, until he makes it clear that he is bored with her.

Then one day Dymov develops diphtheria, evidently contracted by "sucking up the mucus through a pipette from a boy with diphtheria. And what for? It was stupid . . . just from folly." Dymov soon becomes delirious, and then dies. Suddenly, Olga is overcome with guilt and grief. Too late, Olga realizes that her husband was a hero.

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The haunting eyes of a beautiful young woman stare directly at us as we witness the final moment of her plummet from a New York skyscraper to the sidewalk, a stage-like platform in the lower foreground. Her barefoot body and its shadow protrude into the inscription panel where blood-red lettering records the facts: "In the city of New York on the 21st day of the month of October, 1938, at six o'clock in the morning, Mrs. Dorothy Hale committed suicide by throwing herself out of a very high window of the Hampshire House building. In her memory [words apparently painted out] this 'retablo,' executed by Frida Kahlo." Though her blood flows from her morbidly erotic body and seeps through the canvas into the painted wood frame, the bright yellow corsage of tiny roses pinned to the black velvet dress on her intact, virtually undamaged body and face eerily insinuate vitality and sensuality.

Two stages of her fall from the window of her apartment building, as in a multiple-exposure freeze-frame photograph, are surrealistically softened by swirling blue, white and gray cloud-like sky coloring which covers the entire background and the rest of the wooden frame. Barely visible, in the top of the frame is the suggestion of an angel holding a banner on which [now erased or whited-over] was proclaimed "The suicide of Dorothy Hale, painted at the request of Clare Boothe Luce, for the mother of Dorothy."

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Patrimony relates the final illness and death of Philip Roth's father, Herman Roth. It begins as a misdiagnosis of Bell's palsy, which is eventually diagnosed as a brain tumor. Further tests reveal that it is cancer, operable only with great effort and little promise of cure or even significant palliation. The family (including Herman) decides against surgery and remains in close contact with him until his death.

Roth recounts his father's increasing weakness and helplessness, his own emergency quintuple bypass surgery, and his dreams of his father speaking to him from beyond the grave. Writing this book, he concludes, is the natural and necessary process in bearing witness to his father's life and death.

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The new interns, Roy Basch (Tim Matheson), Chuck (Howard Rollins, Jr.) and Wayne Potts (Michael Sacks), begin their year of internal medicine training in a busy city hospital under construction. After initial introductions led by the vague staff man and vapid chief resident, they become the specific charges of the cynical resident doctor "Fats" (Charles Haid). Fats teaches them attitude and language: how to "buff" (improve) and "turf" (transfer) "gomers" (Get Out of My Emergency Room)--the words used to describe management of incurable, hateful patients who "never die," regardless of the abuse the clumsy housestaff might inflict. But Fats has heart.

Soon, they fall under the command of the militaristic and lonely woman resident, Jo Miller (Lisa Pelikan), who cannot bring herself to withhold treatment, even at a patient's request. She blames underlings for the failings of medicine and nature, as well as herself.

Wayne throws himself from the hospital roof because of a misplaced sense of guilt over a patient's demise. Roy falls in love with the nurse, Molly (Kathryn Dowling), but nearly loses her as he begins to emulate Jo's cold, calculating style. He is "rescued" in the nick of time by his friends, Fats, and the death of a physician patient (Ossie Davis) whom he admires. With recovered equanimity and renewed anger over the suicide of his fellow intern, Roy refuses to go on with his residency.

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