Summary:

Written by a medical historian who is also a physician, The Breast Cancer Wars narrates how breast cancer diagnostic methods and treatments have developed from the early twentieth century. More significantly, the book describes the debates and controversies that permeated this evolution and the ways in which not only clinicians and researchers, but, increasingly, women patients/activists shaped how we view, diagnose, and treat breast cancer today.

Individual chapters explore the influential (and ultimately contested) radical mastectomy procedure of William Halsted, the development of the "war" against breast cancer as a full-blown campaign developed and conducted within the public media and consciousness of the United States as well as within medical practice and research, the intertwined development of feminism and breast cancer activism, the "fall" of the radical mastectomy, and the continuing controversies surrounding mammography and genetic testing as modes of early detection and risk assessment. Lerner draws on a range of primary sources including texts from the archives of the American Cancer Society, the papers of doctors and patients, and advertisements from popular and professional magazines throughout the century.

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Please note that in order to provide a useful analysis of this novel, it is necessary to reveal the novel's ending in the discussion below. It is England, 1935. Briony Tallis, 12 years old, decides to become a writer. Her first experiment in novelistic technique involves narrating from three different points of view an odd incident she witnesses from her bedroom window: her sister Cecilia undresses and steps into a fountain in the presence of Robbie Turner, the son of a family servant. Robbie has been educated at Cambridge under Mr. Tallis's patronage, and intends to become a physician. He and Cecilia are in love.

Briony's reconstruction of the incident is inaccurate, but she fails to recognize the lesson of her exercise in multiple perspectives: her version is sufficiently coherent for her to mistake it for reality. She jumps to further conclusions and causes Robbie's wrongful conviction and imprisonment for rape and Cecilia's permanent estrangement from her family.

The rest of the novel both elucidates and unravels the opening sequence. It is 1940 and Briony is becoming both a nurse and a novelist. Both roles represent her efforts to atone for her disastrous narrative misconstrual. As a nurse, she learns a new humility and cares for the appalling injuries of soldiers who, like Robbie, are suffering the war in France.

A more metaphysical atonement lies in her work as a novelist: we realize that we have been reading Briony's own rewriting of the initial events and her careful imaginative reconstruction of Robbie's experiences in the Dunkirk evacuation. She tells of her discovery of the actual rapist (if a rape it was), her decision to retract her accusations and her efforts to make amends with Robbie and Cecilia.

In a final section, set in 1999, the aging Briony, now a successful novelist, learns that she is developing progressive vascular dementia. Soon, her ability to remember and grasp reality will desert her. But she has finished writing her latest version of Robbie and Cecilia's story, the novel we have just read, and can rest.

Her atonement seems complete until we learn that Robbie died in France and Cecilia in the Blitz, and that the (relatively) happy ending we read was simply made up by Briony. Devastatingly, we learn that atonement for an error of fiction has been limited to fictional reparation. The lethal damage it has caused in the actual world is beyond mending . . . unless, of course, we accept the vertiginous truth that the damage described in this novel is itself also no more (or less) than a fiction.

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The family in this story seems perfect: well-to-do, situated in a lovely home at the edge of Lake Tahoe, three children in the home, a retired military grandfather, and a caring, competent mother (Tilda Swinton). The absentee father, a military officer, is at sea. All appears as calm and still as the deep lake in their physical midst and at the story's center.

The story primarily concerns the mother and Beau, the oldest son (Jonathan Tucker), an extremely sensitive and gifted musician currently being considered for a scholarship at a major university. What viewers come to know is that the young man is exploring his sexuality with an inappropriate male opportunist in the nearby city.

When the mother suspects that her son is meeting someone, she confronts the amused man, asks him to back off, and returns home. The man finds their home that same night, meets with the son, and demands money. When the spurned man leaves, he slips on the dock and hits his head on a rock. The son had already returned to the house.

The surface world of lunches, carpools, and school activities is shattered by the mother's discovery of the familiar body in the lake at the edge of the family dock. Unbeknownst to the mother, the death of the man/her son's initial partner, is accidental. She assumes the worst and automatically moves to protect her son. While managing the ordinary routine for her family, she struggles to get the body into a skiff and sink it with weights in a different location.

Of course the body is discovered within a short time and unfortunately for the mother, associates of the deceased are able to figure out the scenario, or at least the connections with the son. She is approached by blackmailers with impossible financial demands.

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Born breech and deprived of oxygen for two hours, Irish poet and writer Christopher Nolan was diagnosed with cerebral palsy and is unable to speak and virtually unable to move voluntarily. His book, subtitled "The Life Story of Christopher Nolan," is narrated as a third person account of the life of "Joseph Meehan." The memoir opens with Meehan's winning the British Spastics' Society Literary Award for his first book of poetry, Dam-Burst of Dreams (1988) and ends with his last day at Trinity College, having turned down the invitation to continue his studies there towards a degree.

In the mixture of linear, traditional life narrative and lyrical, neologistic description that falls in between, the memoir addresses Meehan's birth, early life, education, and growing acclaim as a poet and writer. It recounts how his family and teachers helped develop a combination of medication, tools (a "unicorn-stick" attached to his forehead), and assistance that allowed him to type.

It details, above all, how various family, friends, and health and education professionals advocated Meehan's special-school and mainstream education and made available to him such normative life experiences as riding a pony, boating, fishing, skipping school with his mates, and going on school trips without his parents--and such unusual life experiences as becoming an award-winning writer.

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A woman lies in her bed, dying of cancer. Several family members have gathered in the room around her, including her son Bruno. From the age of 11 Bruno had wanted to be an artist, but had become a doctor instead because it was easier to make a living. "And medicine at one point--when he was nineteen or twenty--had seemed more humane than the humanities, more artful than art." Yet four years earlier, Bruno gave up his medical practice in Rome to devote his life to painting. But now he is back to medicine, helping to coordinate the efforts of his mother's physicians.

The dying woman sips an opium solution to ease her pain. She teases Bruno about the many times she had embarrassed him as a child, by acting funny or assertive or eccentric, behaving very differently from the other children's mothers. She would always make people laugh. Likewise, she was never confused about what she wanted. Even now, tipsy with opium, she remains in charge, a rock among the gathered family members, deflecting their sadness with her good humor.

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The narrator's mother, having received "all the benefits of modern medicine," was still alive after 14 months. The son, himself a doctor, finally told her that she had cancer, after which she requested that she receive no treatment, other than pain control. Thus, her son provided her with a bottle of opium solution to use as needed. However, the other doctors continued their pretense that, if only she would take the "cure," she would get better.

She died six days later, "not slowly, like a train arriving at a station, but swiftly and convulsively, like a train derailing." She was buried without the priest's blessing because she hadn't been a practicing Catholic. However, the "ceremonies" of the craftsmen creating a masonry border around her grave, and of the stonecutter carving her headstone, were "last rites" more to her liking than the priest's prayers anyway, because she had never been fond of religion.

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One April morning in the 1940's in Oran, Algeria, Dr. Rieux, preoccupied with his ill wife's imminent departure to a sanatorium, discovers a dead rat. This unusual event marks the beginning of an epidemic of bubonic plague that will besiege the city until the following February. Over the long ten months Rieux, his acquaintances, friends, colleagues and fellow citizens labor, each in his own way, with the individual and social transformations caused by the all-consuming illness. Separation, isolation, and penury become the common lot of distinct characters whose actions, thoughts and feelings constitute a dynamic tableau of man imprisoned.

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The Heavenly Ladder is physician-poet Jack Coulehan's most recent chapbook, bringing together 48 poems, many of which have been published individually in various medical journals and literary magazines. The collection is divided into four sections.

Poems in the first section, "Medicine Stone," are written in the voice of patients or in the voice of the physician who treats them. The second section, "So Many Remedies," consists of five poems inspired by physician-author Chekhov. The poems of "The Illuminated Text" section reflect a wide-ranging interest in people who lived in distant times or in distant places. The final section, "Don't Be Afraid, Gringo," stays, for the most part, closer to home and includes a number of poems addressed to, or about, family members.

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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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Salvadorian writer and activist Claribel Alegria has composed a sequence of poems, 47 sparse love letters to her late husband Darwin "Bud" Flakoll who died in 1995. Neither sentimental nor confessional, the poems draw on the struggles of Circe, Prometheus, and Orpheus as well as themes of unfinished rites, sadness, and symbolic immortality. The translator's preface is a reminiscence of her time with the couple then living in self-imposed exile, in addition to a critical introduction to the poetry.

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