Summary:

The site of the multiple stories interwoven in this novel is a teaching hospital in San Francisco. One of the featured characters is a young single mother who comes in with a swollen arm and finds herself in more medical trouble than she anticipated. She suffers a mild stroke after debatable treatment. Two doctors attend her, but differ markedly in their ideas of how to treat her and their human responses to her. One ends up having a brief affair with her that changes his life.

In addition to these there are stories of a comatose young man and the family that refuses to believe he will not awaken (he does); a volunteer coordinator who observes the politics of hospital life from a privileged margin, and sundry staff people who represent alternative points of view. The single mother recovers, but only after a stay in the hospital has convinced her she may not yet be too old to go to medical school to find a life not in marrying a doctor, but in being one.

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This documentary video follows the making of an opera, based on the illness experiences of four Australians who have been diagnosed and treated for cancer. Their feelings about these experiences are translated into music (with lyrics) as they work closely with music therapist/composer, Emma O'Brien. As the three women and one man tell their stories of physical debility and emotional pain, the music therapist asks them to think in terms of color (they choose purple, black) and tones and rhythms that she plays for them on the piano.

When the narratives and their musical representations have evolved sufficiently, trained singers take on the roles "written" for them by the four former patients; the latter continue to be intimately involved in the opera's production, directed by David Kram. At the end of the project, which is also the conclusion of the film, the opera is performed in front of an audience (with musicians playing instruments, singing, and dramatic enactment) and the four people whose illness experience is performed take their bows together with the singers.

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The devoted, and antagonistic, bond between a dramatic, charismatic widow (Shirley MacLaine) and her quietly rebellious daughter (Debra Winger) is the focal point of this film's exploration of a range of human relationships and their changes over time and under various pressures, including that of serious illness. The major focus of the last part of the film is the illness and death of the daughter from cancer and its impact on her mother, her husband and children, and their immediate circle of friends and lovers.

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When their young son dies from kidney failure, Stewart and Sharon Mackaney funnel their grief into a business--transporting donated organs for transplant patients. Sharon has put on weight and not cut her long hair since the death of her child, Matthew. The fortyish woman likes to read about vertebrate organs in a worn copy of Gray's Anatomy. She totes a red cooler on her trips crisscrossing the country. Inside of it is a precious organ--a kidney, liver, or pancreas.

Sharon spends lots of time in airplanes, hotels, and bars. Although they continue to share a house, she and her husband have been estranged since Matthew's death three years earlier. Stew suffers from irritable bowel syndrome and chronic flatulence that began at his son's funeral and has not improved a bit despite psychiatric treatment.

Stew and Sharon receive an award for their work as organ transporters. During a speech at the fundraising event, Sharon criticizes the audience for hoarding their kidneys. On returning home, she spends time in Matthew's bedroom and later has a variation of the recurrent nightmare that has plagued her since her son's death. Sharon dreams that her hair is gone, and she rises, unencumbered, until reaching the ozone layer where she is incinerated.

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Half-waking from surgical anesthesia, a woman named Mary realizes that she has had a breast removed. She immediately begins to imagine how this will affect her already troubled marriage. When she is fully awake, other women on the ward try to comfort her, each with a strategy for bearing up under suffering which Mary finds unacceptable because these strategies represent values about marriage, submissive gender roles, or religion which Mary cannot quite swallow.

Later, talking with her brusque surgeon and her family doctor, Mary learns that the mastectomy may not have been necessary, that the tumor was benign. At the end of the story, husband Matt hustles in to ask: "Well, baby, are you still going to divorce me?"

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A chronicle of the author's perceptions, thoughts, memories, and personal relationships during the months after he was diagnosed as having AIDS. Brodkey's mind and prose are as sharp as a knife's edge. Beginning with the desperate struggle for breath that signaled pneumonia and, retrospectively, "how my life ended. And my dying began," continuing with the reactions and decisions of himself and his wife, the first half of the essay spins out an observant, introspective, cerebral, even amusing account of his particular experience.

But AIDS is often a disease associated with more emotional baggage than other fatal illnesses, and in Brodkey's case we learn that he traces both his dying and his homosexual experiences to "the major drama of [his] adolescence", daily sexual abuse by his adoptive father, with the implied knowledge and acquiescence of his mother. Writes Brodkey, "I experimented with homosexuality to break my pride, to open myself to the story." "Now I will die disfigured and in pain."

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The middle-aged narrator is caught in the maelstrom of tending to her father, who is dying of cancer; coping with her demented mother; mediating between her parents, for whom "[S]ixty years of marriage had only heated the furious war between them"; and dealing with her own grief. This glimpse of an increasingly common family dilemma is superbly rendered.

Although it is narrated in the first-person, the narrator is never intrusive as she allows the situation to unfold through dialog and unadorned description. The mother's dementia lends the story its bizarrely humorous moments, as well as its poignancy. This little "memoir" of a complex family dynamic is written with skill, insight, and a light touch.

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Celia Gilchrist is an editor in London who is in her thirties waiting for the right man. She meets Lewis, clearly (at least clearly to everyone else in the novel and the reader but not, typically, to Celia) a cad and a womanizer. About the time she realizes this, she receives and accepts a job offer in Edinburgh where she promptly meets Stephen, who is separated from his wife, Helen--a Helen as elusive and mysterious as the Helen of Troy, and also as powerful to affect the lives of others, especially men--and their nine-year-old child, Jenny. Despite Celia's valiant effort to get to know and accept Jenny, Celia and Jenny do not get along. From the very first chapter, which is a flash-forward, to the last page, Celia encounters accidents, lies, damage to her personal property, from dresses to sweaters to jewelry--all when Jenny is in the vicinity. The ending is cataclysmic.

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A woman who has had extensive bowel surgery and a colostomy now must deal with her changed appearance. She feels unattractive, and the strong odors and liquid stool that come from her colostomy are repulsive to her and to her husband. She is angry about her loss of identity, and takes the anger out on her husband. He feels guilty about her illness and surgery, and tries to overcompensate by trying extra hard to please his wife. He finally begins reading "Moby Dick" to his wife as a way to say that he will stay with her through the long haul.

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Set sometime in the near future, Cast of Shadows has as its protagonist Davis Moore, a successful private practice physician specializing in cloning human babies for infertile couples. Early in the book, Anna Kat, his high school senior daughter, is murdered and raped. (For a while a likely suspect is Mickey the Gerund, a right wing extremist member of the Hands of God with a fascinating grammatical moniker never explained, who shoots cloning physicians, including Dr. Moore, in the abdomen, a short time before his daughter, Anna Kat, is brutally killed. However, Mickey is only a shadow of a suspect and quickly becomes supplanted by another much more likely villain. Mickey goes on to kill, by various methods, dozens of cloning physicians and staff by book's end.)

After a year of unsuccessful detective work, the local police return Anna Kat's belongings, including a plastic vial with the suspected murderer-rapist's semen. In an act never fully explored by Dr. Moore or the author, an otherwise rational and ethical physician surreptitiously uses the suspect's semen to fertilize a married woman patient.

The offspring, a clone of the suspected killer-rapist, is Justin, who becomes a formidable presence in the book. He is very intelligent--at his psychologist's advice, his parents provide him at an early age with advanced reading materials like Plato (hence one of the allusions to shadows, i.e., Plato's cave, in the book's title and referenced directly on page 118 and indirectly on page 208) and other philosophers. By the time he is a senior in high school, Justin has become a dominant player in the affairs of Dr. Moore; Sally Barwick, a private investigator-turned journalist; and the suspected killer-rapist--his origin of the species as it were.

This book has a number of subplots all of which radiate from the initial cloning and the various members of the extended family and professional staff involved in it, some knowingly, most not. There are narrative threads involving the suspected murderer rapist-now-prominent attorney, Sam Coyne; the triangle of Dr. Moore and Jackie, his alcoholic wife, and Joan, his attractive pediatrician associate; Mickey the Gerund's various murderous and obsessional religious activities and reflections; Justin's life in school and involvement with Sally Barwick's investigation of a serial killer called The Wicker Man; and, most especially, the development of Shadow World, a computer game and a virtual replica of the real world--the world as Justin, Sally, Sam Coyne, and Dr. Davis Moore know it.

Since this is a thriller, it would be inappropriate to divulge more of the plot, which is intricate, often a little far-fetched but always engaging, highly readable and more labyrinthine than most medical thrillers.

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