Summary:

Because this lucid, rich, and incisive book has not, as yet, been published in the United States, it has not acquired the readership it deserves. For those teaching Medical Humanities or those interested in broader or more global stories and perspectives about physician training, practice, and experiences, Helman’s most recent publication should be considered.

Part One (“Setting Out”) begins in South Africa where Helman’s family, comprised of a dozen doctors, has lived for generations and where his own medical studies occurred. As a child, he accompanied his father on rounds while other children spent holidays at the beach. Before long he discovered how hospitals, during the madness of Apartheid, were to “some extent a distorted mirror-image of the world outside” (3). Appalled by the differences in care and treatment, the keenly aware young man kept notes. His vivid observations of the harsh context of social injustices provide an unequivocal, eloquent, and disturbing critique of medicine then and there. His acute observations of physician behaviors and indigent populations in the city and in the bush contribute, as readers discover in later chapters, to the author’s expanded and compelling interests in cultural anthropology.

Part Two (“The Family Doctor”) leads to London. “After all the heat and light and space of Africa, London—with its low leaden sky and constant drizzle—was like living inside a Tupperware box, one stored deep inside a refrigerator” (47). In the 60s Helman’s migration required an adjustment to a world of technology and order, where as a family practitioner, he had become, in fact, a suburban shaman. In any society, patients wanted “relief from discomfort, relief from anxiety, a relationship of compassion and care, some explanation of what has gone wrong, and why, and a sense of order or meaning imposed on the apparent chaos of their personal suffering to help them make sense of it and to cope with it” (xvi).

Gradually Helman saw connections between the role of family physician and traditional healer: both involved an understanding of “not only a body’s internal equilibrium but also the equilibrium of the patient’s relationships with the world he or she lives in and how treatment should aim not only to treat the diseased organ but also to restore the patient’s life that equilibrium of relationships” (xvii). His encounters with patients and the stories they reveal suggest how important these often overlooked connections are and why they ought to be included in medical training and practice.

By the time readers reach Part Three ("States of the Art”), the author has moved into broader realms of thinking, in which medicine and illnesses are examined anthropologically. After 27 years of clinical practice Helman’s white coat and stethoscope are placed on a hook. Now, as a credentialed anthropologist at University College London, his larger lens allows for sustained scrutiny of the complexities, ambiguities, and nuances in such chapters as “Grand Rounds,” “Hospitals,” “Placebos,” “Third Worlds.” Helman’s range of experiences, multi-disciplinary training, intellectual conclusions, and abundant common sense argues for techno-doctors to learn from holistic practitioners. Whether devastating or humorous, the critiques reflect not just care provision but shared human capacities: the insights are thoughtful and fresh and very worthwhile.

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This story details several months in the life of a thirteen-year-old with incurable kidney disease and of her extended family--the policeman father who has cared for her since her mother ran off, the mother who reappears in time to learn she is the most likely donor, two sets of grandparents and several of the father's close friends. Two women in the father's life find their romantic attachments to him complicated by his role as his daughter's caretaker.

As Mary Grace's health deteriorates, her maturing accelerates. Each of the principal characters has to come to terms not only with impending loss, but with how this crisis reconfigures old patterns of family conflict and dependency. The story continues after her death as focus shifts to the father's grief, mourning, and new empathy with victims of accident and loss.

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This play in eight scenes presents the fictionalized character of Alice James, sister of Henry and William James, who after a sickly childhood, succumbed at 19 to a variety of vague and recurrent illnesses that made her a lifetime invalid. She died at 43 of breast cancer.

In a series of encounters (with her nurse; her father; her brother, Henry; several Victorian female figures: Margaret Fuller, Emily Dickinson, and mythological figures from Victorian fantasy fiction and from Parsifal; and a burglar), as well as a long dramatic monologue, her various forms of internal conflict are hilariously and poignantly articulated. They converge on the implications of her recurrently deciding whether or not to get out of bed and do something, and her confusion, often discussed by biographers and critics, about her place in her brilliant family, her vocation as a woman, and her own desires.

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At the age of 72, Lily Maynard finds herself suddenly famous for a memoir she has published about the disintegration of her marriage years before at the height of the civil rights movement, the women's movements, and the religious shifts of the 1960's. The book brings two young women into her life: one a journalist who wants to do a story on her, the other an African-American historian who takes an interest in the connections between her personal history and the pressures of the civil rights conflicts.

Simultaneous with her cresting notoriety is an exacerbation of the Parkinson's disease which makes it necessary for Lily to move in temporarily with her son and his wife while awaiting a place in a retirement home. Half her face is paralyzed; she has difficulty feeding herself; and her extreme fatigue makes it hard to conduct interviews without dissolving into a fog of incommunicable feeling.

Each of the younger people involved in her life is driven to come to terms with his or her own life in new ways, especially her son, who finds complex feelings surfacing after years of emotional estrangement. Ultimately, her story told, Lily quietly exits the family before relocation to a home by committing suicide with an overdose of medication. In the aftermath Alan's grief gives him a new understanding of his mother's life and his own.

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Dominic Birdsey's identical twin, Thomas, is paranoid schizophrenic. With proper medication he can work at a coffee stand, but occasionally he has severe outbreaks. Thinking he is making a sacrificial protest that will stop the war in the Middle East, Thomas cuts off his own hand in a public library. Dominic sees him through the ensuing decision not to attempt to reattach the hand, and makes efforts on his behalf to free him from what he knows to be an inadequate and depressing hospital for the dangerous mentally ill.

In the process, Dominic reviews his own difficult life as Thomas's normal brother, his marriage to his ex-wife which ended after their only child died of SIDS (Sudden Infant Death Syndrome), and his ongoing hostility to his stepfather. First in Thomas's interests, and then for his own sake, he sees a gifted Indian woman employed by the hospital as therapist. She helps Dominic come to understand Thomas's illness and the family's accommodations or reactions to it in terms of the whole family system.

In the course of treatment, Dominic discovers sexual abuses taking place in the hospital and helps to expose the perpetrators. He succeeds in getting Thomas released, but Thomas soon commits suicide. After Thomas's death Dominic finds out about their birth father--a secret their mother had shared with Thomas, but not with him.

He also learns that the woman he has been seeing is HIV-positive. She asks him to keep her baby if she dies. At first he resists, but later, having found his way back into relationship with his wife, he takes the baby. The book ends with several healing events that leave Dominic able to cope with the considerable loss, failure, and sadness in his personal and family history.

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Eleven-year-old Amy has been hiding cookies beneath her bed, drinking gallons of liquid to slake her thirst, getting headaches, feeling irritable, and failing to grow though she's been eating huge meals for months by the time she faints and is taken to the hospital. There she is diagnosed with Type 1 diabetes. Though she feels disoriented and angry, she is immediately put into a training group with other kids around her age who have been recently diagnosed.

She has to learn how to maintain a carefully balanced diet and how to give herself insulin injections. The male nurse who teaches them is himself a diabetic as well as a competent, cheerful young man who takes the edge off the experience. He makes it clear to Amy and the others that the primary responsibility for their health maintenance routines lies with them personally.

After release from the hospital, Amy begins to deal with the social adjustments her disease demands. Her brother and parents are helpful, but uncertain about how much to change their own eating habits to accommodate her. Her younger sister finds the accommodations trying and unfair. Amy's friends also have learning to do.

It helps her that she knows a few other diabetic kids, including Coby, a boy who has struggled with his own resentment and the consequences of sloppy monitoring of his condition, but has learned how to control his diet for the sake of staying on the baseball team where he's a star player. Their friendship helps Amy transition into "normal" life hopefully.

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The narrator, who has been a counselor at a summer camp, brings a friend home to meet her computer-wizard older brother, Eric, but finds him acting very strange--overprotective, defensive, and aggressive. Later his inexplicable behavior shows up at the dinner table. He is unreceptive to parents' inquiries. Readers learn some of the delusional thoughts from italicized passages interspersed with the narrative of a family recognizing mental illness and making treatment decisions.

Eric is hospitalized after an episode in which he threatens the family with a kitchen knife. He is released on medication in a matter of weeks, but continues to behave strangely if not dangerously--he asks his sister at one point if she knows any "secret numbers"--and she realizes his new condition is not simply going to go away, but has opened a whole new chapter in family life and requires new and careful adaptations.

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Geneva Jordan, a successful stage actress in New York, reluctantly agrees to stay for a month with her thirteen-year-old nephew who has Down syndrome so that his parents can take a long-postponed and much-needed vacation. She is unmarried and has no children herself, has always found herself a little intimidated about close interaction with the boy, and leads a complicated personal and professional life in New York which the requisite month in Minnesota will interrupt.

Nevertheless, she takes on the job and gradually finds herself adapting to rural life, substitute parenthood, and the special needs of her nephew. She makes friends with the mother of Rich's best (and only real) friend, Conrad, who has cerebral palsy. After the month is over, she returns to New York, only to realize that her life lacks a dimension that caregiving gave it.

She also realizes she left a good man behind in Minnesota--a local divorced father who has become an unsought love interest. Nevertheless, she remains on stage and in the city until the death of her nephew's friend calls her back to Minnesota, and to the man with whom she can finally imagine taking on a family life of her own.

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Keely, whose three "best friends" are a dominant clique in their class, notices that a classmate, Anya, appears to be wearing a wig. The girls confer about it at lunchtime, wonder whether to ask about it, and theorize that she may have cancer and be undergoing chemotherapy. Stef, long the most aggressive among the four friends, suggests that Keely talk with Anya and find a way to determine whether it is a wig, but Keely refuses, recognizing in Anya, whom she rarely notices, a quality of loneliness she hadn’t seen before.

Their curiosity is satisfied when Anya’s wig comes off during a gym exercise and she runs out and remains absent for several days. Keely decides to visit Anya and learns that she has a rare disease, alopecia areata, which is painless and otherwise harmless, but causes hair to fall out, sometimes all over the body. When she asks if she can help, Anya replies, "Not unless you want to give me your hair."

Keely researches the disease for class and finds that there is a foundation that collects long hair for wigs for patients suffering from Anya’s condition, so she cuts off her own long hair and encourages classmates to do the same in a gesture of solidarity with Anya, in the process defining a new independence from the clique of friends who have too long shaped and confined her judgments of others.

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Twelve-year-old Jake moves from Boston to the rural port town of Wicasset, Maine, with his mother, father, and six-year-old brother, who has "fits" as a result of what we now know to be cerebral palsy. The family keeps Frankie hidden, because neighbors in Boston regarded his disease as evidence of some wrongdoing on the parents' part and shunned them. It is 1838, and the father has lost his job in a bank because of the "Panic of 1837," and takes a job at a lumber mill for which he is ill suited. As the job keeps him away except for weekends, Jake has to learn how to gather food, fuel, and local information to care for his mother and brother in a small, drafty house.

He gets to know neighbor children whose mother remains hidden because, as he later learns, she is a hopeless alcoholic. Eventually he gets a job with the schoolmaster/jailer, befriends a mentally handicapped young man with no home, and gets to know the local doctor who persuades him that the community will accept his brother and family, and that their secret need not remain hidden. After weeks upstate on a logging trip, the father comes home with an arm crushed in an accident. The doctor helps him find work as a clerk in the custom house.

In the father's absence, in addition to his other accomplishments, Jake helped prison inmates and the schoolmaster/jailer's family escape a burning building, winning the gratitude and respect of the townspeople. On his father's return and promise of new work, he has renewed hope of private tutoring that might prepare him for college despite the family's poverty.

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