Summary:

This erudite collection of twelve essays by a physician-scientist weaves allegory, myth, clinical experience, science, and western history and religion (particularly Catholicism) with ruminations on the meaning of medicine and health. The author is the chair of the Department of Medicine at Jagiellonian University School of Medicine in Cracow, Poland – a university founded in 1364 and which counts Copernicus and Pope John Paul II as alumni. Hence it is with this sense of history that the author addresses such topics as cardiology, pain and its relief, genomics, critical care, infectious disease, health care financing. For instance, in Chapter VII “A Purifying Power” Szczeklik traces the word “katharsis” (the title of the book in the original Polish) to the Greek chorus, Pythagoras and Aristotle, then explores the interplay between music and medicine.

Some of the memorable clinical tales are of the reanimation of a frozen man and the resuscitation of a man who drags himself to the newly opened critical care unit and then very cooperatively codes. The narratives about research, such as the self-experimentation with prostacyclin just after its discovery in the 1970s, are also riveting.

The scope includes the realms of science and religion. For instance, Szczeklik mentions both the Papal Academy of Sciences session on evolution (Pope John Paul II: “The scientific theory of evolution is not at odds with any truth of the Christian faith.” p. 128) as well as religious overtones to metaphoric declarations about the power of the genome (“the language of God” p. 125).

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This film tells the remarkable story of Vivien Thomas (played by Mos Def), an African-American fine carpenter, who found his way into medicine through the back door and changed medical history. Hired when jobs were in short supply to work as a custodian and sometime lab assistant to Dr. Alfred Blalock (Alan Rickman), a research cardiologist, Thomas quickly becomes an irreplaceable research assistant. His keen observations, his skill with the most delicate machinery and, eventually, in performing experimental surgery on animals, make clear that he has both a genius and a calling.

Though the relationship has its tensions (Blalock, as a Southern white man and a doctor, has some blind spots in the matter of mutual human respect, though he highly values Thomas’s skills) it lasts for decades. The two move their families to Baltimore, where Blalock becomes Head of Surgery at Johns Hopkins and, much to his colleagues surprise and to some of their dismay, brings Thomas in to perform groundbreaking open heart surgery on a blue baby. It is not until after Blalock’s death that Thomas is granted an honorary doctorate from Johns Hopkins, where he continues to work in research until his own retirement.

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The novel is set in Washington, DC in April, 1865. At fourteen, Emily is sole caretaker of her mother who is dying of tuberculosis. Her neighbor, Annie Surratt, is her best friend, though their mothers have been estranged for some time. Both families have deep roots in the South. Annie’s brother, Johnny, an object of Emily’s romantic fantasies, has recently left on a secret mission. The war is nearly over. Emily’s uncle Valentine, a physician, wants to take custody of her after her mother dies, but because her mother has also felt estranged from him, Emily resists. Still, after her mother’s death, she does go to live with her uncle, and learns that he (with his two assistants, one of whom is a woman who is 1/8 African American) has a lively practice among the poor and the African Americans who have flooded the streets of Washington since the emancipation.

Valentine is called to Lincoln’s bedside the night of his assassination, and participates in efforts to track down John Wilkes Booth and his accomplices, one of whom appears to have been Johnny Surratt, who has escaped to Canada. In the course of her time there Emily discovers that her uncle and his assistant are involved in elaborate, marginally legal, schemes to obtain bodies for study at the medical college. Emily, at first horrified by this discovery, comes to recognize the good that comes of anatomical studies and to sympathize with her uncle’s efforts to bring about legislation making the acquisition of bodies for medical research easier. Annie’s mother is hanged as an accomplice in the Booth conspiracy, Annie leaves town, and Emily comes to understand a great deal more about the harsh terms on which life must be lived in times of national crisis and ideological warfare. The story ends with her growing interest in medicine as a possible career path.

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This is the first full-length collection by pediatrician and international health physician Roy Jacobstein. These 40 poems engage a wide range of topics, settings, and tones, but all demonstrate the same fine craftsmanship and strong voice.

Among the most engaging of Jacobstein’s poems are those dealing with memories of childhood and adolescence. Consider, for example: “Mr. Gardner in 10th grade told us there was no purpose / to mitochondria, only function.” (“Atomic Numbers,” p. 5). Or, “What transgression made fat Mr. Handler / drop his towel, his gloves, everything… to chase you from one end / of Fullerton to the other?” (“The Lesson,” p. 30) The poet displays a delightful sense of humor in pieces like “Bypass” (p. 36) and “Squid’s Sex Life Revealed in USA Today” (p. 59). Poems with explicit medical themes include “Pre-Med” (p. 6), “Admissions” (p. 8), and “What It Was” (p.11).

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The young pathologist David Coleman (Ben Gazzara) arrives to join a hospital pathology lab. He encounters disorganization and a hostile, cigar-smoking chief, Joe Pearson (Frederic March), who declares his intention to keep working until he dies. Coleman tries to implement a few changes, but his suggestions are overruled.

The film revolves around two cases: possible erythroblastosis in the child of an intern and his wife whose first child died; possible bone cancer in Coleman's girlfriend, student nurse Kathy Hunt (Ina Balin). The infant's problem is misdiagnosed due to Pearson's refusal to order the new Coombs' test recommended by Coleman; the baby nearly dies, alienating the obstetrician (Eddie Albert), a long time friend who now presses for Pearson's dismissal.

Coleman disagrees with Pearson, who thinks that Kathy's bone tumor is malignant, but he opts for professional discretion, defers to the chief, and urges her to have her leg amputated anyway. He discovers that Pearson had been right: the surgery, which he thought unnecessary, has provided her with her only chance of survival. Just as Coleman realizes the enormity of his error, he learns that Pearson has resigned and that he will take over the lab.

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This lively volume of medical history chronicles the forms of suffering, illness, injury, and treatment endured by the members of the Lewis and Clark expedition of 1805. Beginning with three chapters of political and medical history to set the context, the story follows the adventures of the extraordinarily fortunate "Corps of Discovery" among whom Lewis was the most trained in the medicine of the time (having studied in preparation for the trip under Dr. Benjamin Rush of Philadelphia), and he only an amateur. Even professional medicine of the time was approximate and largely ineffectual, limited mostly to purgatives, opiates and laudanum for pain relief, bleeding, and topical applications of various compounds or herbal substances.

The story chronicles the main events of the trip based on the extensive journals of Lewis and Clark as well as other historical account, maintaining focus in each chapter on the medical incidents including gastrointestinal distress from parasites and contaminated water; effects of overexposure like hypothermia and exhaustion; infections from wounds and scratches; syphilis; dislocations; muscular spasms; mosquitoes and other insect bites; snakebites and other animal attacks.

Along the way Peck pauses to explain the rather rudimentary medical theories upon which treatments were based, the effects of particular known treatments, and what Lewis and others likely knew, guessed at, or didn’t understand about lead, mercury, opium, and certain herbal substances they used. He speculates about the contexts of their medical decisions and offers occasional contemporary analogies to help readers imagine the circumstances and tradeoffs the explorers faced.

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Middlemarch is a middle-sized country town typical of rural British life in the early nineteenth century. George Eliot (born Mary Ann Evans) was part of the realist school that dominated Victorian literature. She tried to create a true representation of the real, historical lives of ordinary people.

The novel has a vast number of characters and events but most of the plot centers on two couples: Dorothea and Casaubon (later Will Ladislaw) and Rosamond and Lydgate. Dorothea is an intelligent, vigorous woman, eager to improve the lives of her friends and the poor. She is determined not to marry any of the local, mindless squires but to devote herself to godly work.

Soon, however, she is introduced to Casaubon. Casaubon is an aging, ugly scholar, but Dorothea is attracted by his learning and agrees to marry him in hopes of helping him in his work. Their marriage is unhappy and cold. It is contrasted to Dorothea’s growing relationship with Will Ladislaw, a distant relative of Casaubon. Where Casaubon is cold, Will is passionate. Casaubon senses the kinship between his wife and Will and adds a codicil to his will insisting that if Dorothea and Will marry after his death than Dorothea must give up Casaubon’s house and money.

Shortly thereafter, Casaubon does die, and Dorothea is outraged upon hearing of the codicil. She does not recognize her feelings towards Will as feelings of love. By the end of the novel, however, the two confess their feelings and Dorothea gives up her earthly possesssions to live happily.

The plot developed around Lydgate and Rosamond is of particular medical interest. Lydgate is a new kind of medical practitioner. At the beginning of the nineteenth century, the traditional medical order, consisting of physicians (like modern consultants), surgeons, and apothecaries, was being replaced. New well-schooled general practitioners could perform all these functions.

When Lydgate arrives in Middlemarch with his modern techniques and visions of building a modern hospital for the poor, the medical establishment greet him with jealousy and suspicion. Lydgate’s practice therefore develops very slowly. His marriage to Rosamond, a woman used to a rich lifestyle, quickly depletes his savings.

Facing bankruptcy and the loss of his disappointed wife, Lydgate receives an unexpected loan from Bulstrode, a wealthy landowner. Soon after, Bulstrode is charged with murder and Lydgate is accused of having a hand in it; Middlemarch sees the loan as a payoff. Disgraced, Lydgate cannot fight back. He becomes a doctor who toadies to the wealthy and abandons his revolutionary dreams. He dies at 50.

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This poem, written in five sections of free verse, begins with the speaker remembering the old steel bridge he used to drive over on his way to work. He describes how the gaps between the steel beams had given him access to the world beyond the bridge: he had been able to see the river bank and railroad tracks and, most importantly, the people down there, "wild dangerous men" living near the edge of the river.

The poet next describes the new bridge, with its smooth speedy surface and solid concrete sides concealing the view. He then steps back and reflects: "what now?" He compares the engineer making the bridge with his own writing, "diminish[ing] the homeless to a poetic abstraction," and asks where this leaves him. Both bridge and abstraction, he implies, take the life, untidy and dangerous but valuable, out of his experience of crossing the Missouri.

He cannot view the material for his poetry now, unless he were to stop, back up the traffic, and risk his life climbing the walls of the bridge, and even then he does not know what he would say, because the new bridge has made him realize something about himself: "I am partly the leech come to feed, / yet I cannot waver from my groove." As a poet, he needs access to the lives of others, an access he likens to parasitism. But his career, the work to which he is going, requires him to speed on across the bridge without pausing.

He now elaborates on his distance from the world of the homeless people (and, by implication, all the other material for his poetry), saying that he has "safely bled away the guilt, / and pity and compassion," from his involvement or complicity in the meaning of his material, and "channeled it" into the poem. The leech image is now applied to the poem which, once filled with those ambivalent emotions, becomes separate from the poet and attaches itself instead to the reader, who now becomes the one feeding on the "dark spurt of old blood," the horrifying riches of which the speaker has rid himself.

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The New Medicine and the Old Ethics, in Albert Jonsen’s own words, is a "secular aggadah." Jonsen explains that one Talmud reviewer defined aggadah as "a magical rabbinic mode of thought in which myth, theology, poetry and superstition robustly mingle" (4). The book begins with a personal essay entitled "Watching the Doctor." Jonsen establishes his premise that the moral history of Western medicine is best understood as a paradox between altruism and self-interest, a paradox alive and well entering the 21st Century.

He then takes the reader on his "secular aggadah," blending history, myths, and stories that trace important moral developments in the practice of Western medicine. In "Askelepios as Intensivist," we learn of the early Greek values of competence in shaping medical practice. Through the influence of the Church in the medieval period, Western medicine incorporates the value of compassion through the Biblical Good Samaritan, struggles with problems of justice in the care of the poor, and further elaborates the meaning of benefit.

In "The Nobility of Medicine," Jonsen describes the contribution of Sir William Osler and other knighted medical men of the 19th Century who established the ethics of noblesse oblige in the medical profession. He traces this noble tradition to the medieval Knights Hopitallers of Saint John of Jerusalem, a group of religious who provided hostels for pilgrims to the Holy Land and cared for the sick. With essays on John Locke and Jeremy Bentham, Jonsen brings us to the 20th Century and the play of individual rights and utilitarian values in the moral life of Western medicine.

In the final essays, Jonsen describes the mingling of these traditions as a means to establish a moral frame for Western medicine in our current times where technology and science have achieved and threatened so much. Ethics, he argues, "is disciplined reflection on ambiguity" (130). In the last essay, "Humanities Are the Hormones," Jonsen brings his "secular aggadah" full circle.

He argues that the paradox of altruism and self-interest that runs through the moral history of Western medicine must continually be vitalized and examined through the Humanities. The Humanities are "the chemical messengers that course through the complicated institution of medicine and enable it to respond to the constantly changing scientific, technological, social, and economic environment" (147).

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An extraordinary phenomenon began to emerge a century or so ago, which, as it proceeded, allowed us a glimpse into what a society would look like when most of its members, rather than a select few, lived to, or more precisely, near, the limit of the human lifespan. Now we are facing the possibility of extending the upper limit of the human lifespan. How we live within this new world will be the result of numerous individual as well as corporate (in its fullest sense--business, professional societies, religious organizations, political bodies) decisions.

Stephen Hall, through compelling and clear writing takes us behind the scenes and into the lives and labs of the researchers and entrepreneurs who are seeking to slow down, stop, or reverse the aging process--those who intend to bring about, if not actual, then practical immortality. Figuring prominently throughout the book are Leonard Hayflick, early pioneering researcher on aging cells, and the charismatic (and former creationist) researcher-entrepreneur, Michael West. Rounding out the narrative are commentaries by noted ethicists and the chronicling of the political responses to these scientific and business developments, especially in regard to stem cell research.

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