Summary:

Spencer Nadler, a surgical pathologist for over 25 years in southern California, offers 8 essays, as well as an introduction, epilogue and 9 full color histopathology plates in this collection. As he explains in the introduction, Nadler began his training in surgery, but, during a required year of surgical pathology, he finds his true vocation: "I realized a flair for surgical pathology that I had never demonstrated in surgery." (p. xix) However, over the years, he realizes he misses patient contact--these essays, written over 10 years, are forays into an unusual relationship: the pathologist-patient relationship.

Each essay is about a different patient (or other contact) and tissue. One of the most compelling is the first, "Working Through the Images," in which a woman (Hanna Baylan) with metastatic breast cancer seeks Nadler out so that she may view her cancer cells. She arrives in his office unannounced at 6 p.m. and he proceeds to not only show her the slides, but to listen to her. He becomes a witness to her pain, loneliness, sorrow and hope.

"For years I have processed thousands of such cases, determined the manifold forms of disease, but I've never been an intimate part of anyone's illness, never felt the connections of cells to a larger self." (p. 12) During later visits, Baylan cries in his arms and even brings her youngest son in to meet Nadler and view her cells. By this time, Nadler is completely connected to her: "This is heartrending to me, for I have come to love her . . . I can no longer think of Hanna in terms of the cells I see on her slides." (p. 21)

Other chapters highlight fat and bariatric surgery; neurologic disorders such as brain tumor, Parkinson's, Alzheimer's and paraplegia; heart disease; sickle cell disease; and palliative care. Each chapter conveys Nadler's visual sophistication and ability to graphically describe cells. For instance, within a fat cell "a large fat globule steamrolls other cell contents flat against the outer membrane until it bulges like a mozzarella." (p. 32) More importantly, Nadler ably extends his cellular acuity to the larger human dimension.

View full annotation

Summary:

This is one of the two dozen studies of patients with right-brain disorders that make up Sacks's volume The Man Who Mistook His Wife for a Hat. The nineteen-year-old Rebecca has significant physical and mental defects (her IQ is 60 at best), and by conventional neurological standards she is severely impaired, but Sacks discovers that she has moments of being quite in touch and "together" (her word).

The essay tells of Sacks's discovery of Rebecca's poetic expression and spiritual qualities, and of her self-awareness, in planes unknown to standard neurological and psychiatric categories. Sacks is broadly critical of psychological and neurological testing as constituting a "defectology" that is blind to important human qualities. He warmly recommends music and story-telling, both as modes of understanding and also as narrative therapies that work by ignoring the defects and speaking to the soul.

View full annotation

Summary:

The first poem in this chapbook ("Sonogram") contains two images of a small, mysterious life (the fetus imagined as a "white boat on whiter water" and as a "tiny orca") in the midst of the coldly technical medical world. This juxtaposition is characteristic of B. A. St. Andrews's poems in this small collection. In most of them, she uses disciplined and sparkling language to explore the interface between modern medicine with its impersonal machinery and the irreducible mystery of life.

Some of the images are simply breathtaking. For example, in "A Dying Art: Room 309," a terminally ill artist lies in bed, surrounded by "plastic bags that hang / like udders dripping pigment / into her." In a love poem called "The Body of Science," the poet confesses, "Each time your voluntary / muscles make contact / my involuntary ones / contract." And at the end of "Alzheimer's," she observes, "She stood at the big bay / window screaming but he never / heard what it was she never said."

The four poems entitled "Your Breast a Unicorn" consider the fate of breasts attacked "at consolation's center" by "one aberrant cell metastasized." These learned, wise, and witty poems are, in my opinion, among the very best of the breast cancer genre.

View full annotation

Summary:

Mrs. Wilson is a woman diagnosed with an advanced malignancy of the genital tract. Her husband had died from cancer ten years earlier. She is treated with a hysterectomy and oophorectomy along with aggressive chemotherapy by a good doctor who has no bedside manner.

Throughout the story her best friends are always medications to relieve pain: Dilaudid, morphine, Tylenol #3, and methadone. Only her son-in-law really understands her needs and comprehends how to care for her. He is genuine and vital and appears to know as much or more than the doctors in the story.

Mrs. Wilson acknowledges that "to maybe get well you first had to poison yourself within a whisker of death" but discovers that "if you had something to live for, if you loved life, you lived." She dies in a hospital room receiving an IV morphine drip. Before fading into oblivion, she recalls her youth and makes one last attempt at fathoming the meaning of life.

View full annotation

Summary:

The story begins as an MRI technician assures Baily that "Contrary to popular opinion, . . . this is not a torture device." The test was ordered because her arm suddenly went numb and she suddenly lost most of her vision during algebra class. With no idea what's wrong, Baily speculates about the possibility of a brain tumor, about how disease will change her life, about early death. She is uncomfortable with her mother's cheery reassurances, which consist mostly of simple theories like the possibility that Baily was reacting to missing lunch, but wants them, nonetheless.

Since the pediatric wing is full, she is put in a room with an old woman for observation overnight. The nurse runs her through a series of highly irrelevant questions about her physical health from drug use to dentures. Then her mother is required to leave for the night. In the morning they take her for an EKG before her mother can get there; Baily returns to her room in a state of morbid conviction that she's dying, which is finally overturned when the doctor comes in to explain to her that she had a classic case of severe migraine.

View full annotation

Summary:

Alison, 39 years old, is twice-divorced, with three children, on the verge of moving in with a man called Bobby. Her breast is sore and she is afraid it's cancer. Her mother tells her it's more likely she's pregnant. She says she uses contraceptives; her mother tells Alison that she was conceived when a condom broke.

Alison considers abortion, recalling her last pregnancy. Having given birth to a child with Down's Syndrome who died at three months, she had had amniocentesis and was told that she was carrying twin boys, both normal. When the twins were born, though, one turned out to be a girl. One twin, it seemed, had been tested twice. Although the female twin did not have Down's Syndrome, Alison began at that point to worry about luck and the uncertainty of medicine (and of life).

So now, pregnant again, she asks her mother what she should do, and is told to "trust to luck." But she is afraid that her luck has run out and she must take control for herself. A scan shows that she is carrying twins again. Only now does her mother tell her that she is in fact a twin, that her sister had Down's Syndrome and died shortly after birth--in fact, her mother admits, the midwife "did away with" her. (The euphemism carries the senses both of euthanasia and of murder.)

Hearing this, Alison decides she wants to have an abortion right away. Her doctor, thinking the problem is that she wants only one child, gives her the option of selectively terminating one fetus and carrying the other one, but tells her she wouldn't be able to choose which to keep and which to abort. She rejects the idea, imagining how she'd tell the surviving twin about her decision later on, and decides instead to "have them both and trust to luck."

As she leaves the clinic, she begins to bleed and miscarries. Later her mother tells her that she, too, once miscarried twins, and tells Alison she'll have better luck next time, because of the bleeding: "Blood, " her mother says, "is the libation the God of Chance requires."

View full annotation

Summary:

The scene is a medical office where "a white sleeved woman wraps a rubber / sleeve around your arm, steps back, listens, / whistles." Wow! The pressure must be amazingly high. The author imagines the blood pressure's power--"a tide of electrons," a "lightning snake, a "black rain." The patient sits on the cold table. How vibrant his interior chaos is compared to his quiet external appearance! He says the ordinary things--he'll lose weight, he won't complain--but behind his eyes is a flash of turbulence. [30 lines]

View full annotation

Summary:

The narrator has entered a hospital lavatory, prepared to obtain his sperm sample. He can hear voices at the nursing station, the everyday comings and goings of patient care. He tries to focus on erotic images, but deadening thoughts of "four hundred million perfect / spermatozoa" keep invading his sanctuary. Waves of guilt lap listlessly around the room, as he tries with eventual success to produce the needed specimen. At this point he emerges triumphant, having convinced himself that "Like John Wayne, your gun is legend." [58 lines]

View full annotation

Summary:

Sam Daniels (Dustin Hoffman) and his wife (Rene Russo) are both working for a federal infectious disease laboratory, but their marriage is on the rocks. A mysterious lethal illness, remarkably like Ebola fever, breaks out at various sites in America, all eventually connected to a pet shop that received a monkey from an illegal smuggling operation. Most cases are immediately isolated and contained, but a town in California develops an epidemic of the new disease.

The lab is called in and the military enforces a strict quarantine that divides families and prevents anyone from leaving the area. One worker dies quickly and Sam's wife falls ill. The crass General Donald McClintock (Donald Sutherland) is convinced that the nation can be saved only by the annihilation of the town by a gigantic bomb.

A plane sets out on the gruesome mission. Meanwhile, Hoffman leaps from a helicopter onto the cargo ship where the sailor-smuggler has just died leaving a photo of the monkey carrier. Sam makes a televised appeal for help locating the cute but dangerous, little monkey; a terrified mother responds and the creature is snatched from the arms of her child.

With military snipers in hot pursuit, Sam returns to the town, radioing the baffled bomber pilots with a barrage of reasons why they should ditch their mission of destruction. He puts the tiny monkey to work producing anti-sera and vaccines, which--in only a matter of minutes!--rescue the town, his wife, and his marriage. The pilots disobey orders and dump their bomb in the sea.

View full annotation

Summary:

Second Opinions, Jerome Groopman's second collection of clinical stories, illuminates the mysteries, fears, and uncertainties that serious illness evokes in both patients and doctors. The book is divided into 8 chapters, each a clinical story involving a patient with a life-threatening illness, plus a prologue and epilogue written by Groopman. The stories focus on people who face myelofibrosis, acute leukemia, hairy cell leukemia, breast cancer, and marrow failure of unknown cause. Two chapters are Groopman's personal accounts of his firstborn son's near fatal misdiagnosis, and of his grandfather's Alzheimer's dementia.

View full annotation