Summary:

The practice of medicine in equatorial Africa is both a challenge and an escape for Dr. Koestler. The physician from New Zealand works at a Global Aid mission in Zaire. He has toiled there a long time but is still a loner. His best friend appears to be a pet baboon named George Babbitt. The monkey drinks whiskey and smokes cigarettes. It is a clever creature with a mean streak and is generally despised by everyone except Koestler.

Two young American doctors arrive at the mission to assist Koestler. While the three physicians and the bush pilot drink whiskey and smoke marijuana, Koestler instructs the new doctors on some of the laws of jungle medicine: Use only disposable needles and then destroy them. Never transfuse a patient unless they require at least 3 units of blood (since all blood will likely be contaminated by Hepatitis B or HIV). Safe sex means no sex. Speed matters. Avoid getting involved because feelings will inevitably obstruct your work.

Although a leopard is roaming outside the confines of the mission, Koestler ventures into the darkness of the jungle to search for George Babbitt who has run off with a bottle of whiskey. In a locale teeming with life, the physician remains essentially alone--by choice.

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A young art student falls off a ladder and literally lands into the arms of a middle-aged doctor. Daisy Whimple is a poor, homeless woman with multiple body piercings. She has volunteered to decorate the Gynae Ward of the hospital where she had once been a patient undergoing surgery for a complicated abortion.

Dr. Damian Becket is an obstetrician and gynecologist. He is a lapsed Catholic who is separated from his wife. Becket is interested in modern art and attracted to an art historian, Martha Sharpin. The hospital has a collection of medical antiquities in need of cataloging. Some of the pieces are treasures but others are horrible relics. Martha is in charge of organizing the collection, and Daisy is paid to assist her.

Because she has nowhere to live, Becket invites Daisy to stay at his apartment. They make love every night for one week until she leaves. While attending an art exhibit, Becket and Martha spot a sculpture of the goddess Kali. The figure is comprised of artifacts "borrowed" from the hospital's collection including prosthetic arms, antiquated instruments, and body parts. It is designed by Daisy.

The sculpture is not the only unexpected thing created by Daisy. She is pregnant by Becket. Daisy requests an abortion but he insists that she have the baby. The pregnancy is almost miraculous given the damage done to Daisy's fallopian tubes from her previous abortion. It turns out to be a difficult delivery and Becket must perform it since he is the most qualified obstetrician at the hospital. The baby is a healthy girl. The newborn child radically changes the lives of Daisy, Becket, and Martha, yet the three of them have no clue what to do next.

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Megan is deaf, but has managed to make a comfortable niche for herself in her neighborhood as well as being a force to be reckoned with in a family where she wants no pity and insists on as much independence as possible. The summer Cindy moves in down the street is full of changes for her. Their friendship teaches both girls new skills in giving and receiving help, understanding, and loyalty.

Cindy needs to learn when and how to offer help. She also learns sign language. Megan needs to learn how to receive the concessions and help others offer without defensiveness. When the girls go to camp together they are taken under the wing of a counselor with a deaf sister who knows how to sign and who integrates them into camp life gracefully and protectively. Their friendship is challenged when Megan meets Lizzy who is also deaf, and who therefore shares common ground with Megan in ways Cindy can't.

The three girls form a bond, but not without rivalry and misunderstanding. After a period of estrangement during which both Megan and Cindy have to reevaluate their strategies of giving and receiving help and leadership, they reaffirm a friendship that involves a new maturity in understanding the demands of real inclusiveness.

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Francis (aka "Jed") tells how he went off into the Sierra mountains for a few weeks of peace in order to write a novel and accidentally left his world behind. Fragmented radio reports hint that a catastrophe is brewing; appeals to avoid panic splutter to a silent stop. A trip to the nearest gas station confirms his impression that an Ebola-like epidemic must have wiped out most of the people of America. He worries about friends and family, but he worries too about himself and decides to stay put with his large cache of food.

Soon, wiry Sarai storms out of the wilderness demanding help. She has lost her hiking companion and refuses to believe in the full extent of the horror. They return to a city trying to build a life, but they dislike each other too much. They and other scattered survivors dwell in whatever house and drive whatever vehicle they choose; they avoid rotting corpses and each other, furtively taking what they need from shops and leaving the aisles undisturbed. Francis finds a compatible companion in Felicia and they engage in a polite, easy courtship. Their peace is disturbed by the rantings of Sarai, until they are saved by a survivor ex machina.

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Deserted by her husband, who teaches in a bucolic, private school for the visually impaired, Candida is a 50-ish, unemployed woman, estranged from her three daughters, at least two of whom blame her for the failure of her marriage. To the astonishment of everyone in her sphere, she embarks on a completely new, though modest life in a tiny, walkup flat in one of London's immigrant communities. Her consciously passive efforts to find new friends and discard old ones leads her to keep a diary, to take a night course on Virgil, and improbably--when the night school closes--to join the Health club that replaces it.

Eventually, she assembles six new friends--the seven sisters--for an Aeneas-like journey from Carthage to Rome, with plans to consult the Cumean Sybil en route. Illness draws her closer to her middle daughter, Ellen, whose own perspectives on her parents' marriage contrast with those of her mother. Illness also forces an abrupt end to the travels. Candida wrestles with the issues of survival, suicide, and the meaning of life for an aging woman in an aging body whose entire purpose had once been helpmeet and mother. Can any other purpose be found?

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Harry is a writer on safari in Africa with his wife, Helen. They are temporarily stranded when their truck breaks down from a burned-out bearing. While photographing a herd of waterbuck, Harry's knee is scratched by a thorn. Gangrene develops in his right leg. Harry attributes the problem to his failure to apply iodine to the wound.

The rotting leg has an awful stench but Harry denies any pain or horror. He is just angry and extremely fatigued. He resents his wife (and maybe even her wealth) and is verbally cruel to her. While he rests, she shoots a ram. Harry reminisces about the people and places in his past. He has multiple flashbacks and contemplates all the writing he had one day hoped to do about the many experiences he has accumulated in his life but realizes nothing more will be accomplished. He senses the heavy presence of death.

When a rescue plane finally arrives, Harry is transported over the summit of Mt. Kilimanjaro, the highest mountain in Africa. But wait. It seems Harry was only dreaming. There is no rescue plane yet. Helen discovers that her husband has died in his sleep. Outside their tent, a hyena makes a strange noise that resembles the sound of a human being crying.

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While on an airplane, Carson experiences abdominal pain. He is a divorced man in his fifties and a sales representative for a computer and information technology firm. He spends much of his time traveling and fancies himself "a connoisseur of cities." The increasingly severe stomach pain forces Carson to reschedule his business meeting and retreat to his hotel room.

His suffering mounts and he decides to visit the emergency department of the city hospital. Carson is evaluated by two young male doctors and later a middle-aged female physician. Despite blood tests and X-rays, his diagnosis remains murky and a surgical consultation is obtained. The surgeon suspects appendicitis. He postulates that Carson may have a retrocecal appendix and explains that in such cases the anatomical location of the organ often confounds the diagnosis.

Carson undergoes surgery. His appendix is indeed retrocecal and rupturing. He spends five days convalescing from the operation. During that time he acquires an intimate knowledge of the city from his stay at the hospital. The experience revitalizes him. Carson reasons that the world is miraculous in part because it is so simple yet still spectacular.

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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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