Summary:

A bicycling, bee-keeping, British neurosurgeon approaching the end of his professional career recalls some distinctive patients, surgical triumphs as well as notable failures, difficult decisions, and mistakes. Nearly thirty years of a busy neurosurgical practice are distilled into a collection of linked stories throbbing with drama - both the flamboyant kind and the softly simmering type.

Most chapters are titled after a medical condition (exceptions are "Hubris" and "Melodrama"). Some of the headings are familiar - Trauma, Infarct, Aneurysm, Meningioma. Other chapter titles flaunt delicious medical terminology that mingles the mysterious and the poetic with nomenclature such as Angor animi, Neurotmesis, Photopsia, and Anaesthesia dolorosa.

Included are riveting accounts of both mundane and seemingly miraculous patient outcomes. One success story involves a pregnant woman losing her sight due to a brain tumor that compresses the optic nerves. Her vision is restored with an operation performed by the author. Her baby is born healthy too. But tales of failure and loss - malignant glioblastomas that are invulnerable to any treatment, operative calamities including bleeding of the brain, paralysis, and stroke - are tragically common. The author describes his humanitarian work in the Ukraine. He admits his aggravation with hospital bureaucracy and is frequently frustrated by England's National Health Service.

Sometimes the shoe falls on the other foot, and the doctor learns what it is to be a patient. He suffers a retinal detachment. He falls down some stairs and fractures his leg. His mother succumbs to metastatic breast cancer. His three month old son requires surgery for a benign brain tumor.

As his career winds down, the author grows increasingly philosophical. He acknowledges his diminishing professional detachment, his fading fear of failure, and his less-hardened self. He becomes a sort of vessel for patients to empty their misery into. He is cognizant of the painful privilege it is to be a doctor.

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In 1847, one of every six women whose babies were delivered by the medical students and supervising doctors at Allgemeine Krankenhaus (General Hospital) in Vienna died of puerperal fever (also known as childbed fever). In contrast, the incidence of this disease in women delivered by hospital midwives was dramatically lower and puerperal fever was quite rare when mothers had their babies born at home.While a few physicians (most notably Alexander Gordon and Oliver Wendell Holmes) realized that childbed fever was a contagious process, it was Semmelweis who identified the nature of the problem as stemming from the failure of obstetricians and medical students to wash their hands and change their clothing, especially after performing autopsies or doing surgery. He mandated that doctors and students wash with a disinfectant (chloride of lime) before examining any woman in labor.Despite the dramatic reduction of maternal mortality on his obstetrical unit, his ideas and methods were not well received. Semmelweis was reluctant to conduct experiments on animals to prove his theory and resisted publishing his findings in any medical journal. When he finally did write a book, The Etiology, the Concept, and the Prophylaxis of Childbed Fever, it was difficult to read and failed to impress many obstetrical experts.With his health failing and his behavior increasingly erratic and inappropriate, Semmelweis was committed to a state-run mental hospital. He died two weeks later. The official cause of death was sepsis secondary to an infection of his finger. The author is convinced, however, based on the autopsy report and findings upon exhumation of the body in 1963, that Semmelweis was beaten to death by the staff at the asylum. He may well have been suffering from Alzheimer's presenile dementia at the time.

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Originally intended as a frontispiece, El sueño de la razon produce monstruos is number 43 in the series Los Caprichos (1799) by Francisco José de Goya y Lucientes. Also one of his roughly 40 self-portraits, this ambiguous picture shows a seated male figure with his ankles crossed leaning over to his right as he rests his elbows and head on a desk. The male figure wears an ankle-length coat, breeches, stockings, and shoes. His hair is long, his face invisible. On top of the desk, under his right elbow, we see a paintbrush or writing instrument. The side of the desk, in the lower left corner, bears the title of the work. On the floor to the man's right crouches a lynx. Owls with huge wings and expressive eyes surround him. The owl on his right holds out a paintbrush. A cat with watchful eyes perches behind his back. Above the human figure large bats are flying; the largest one at the top right has a goat-like head.

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A chorus of lab techs making symmetrical repetitive motions with microscopes, pipettes, and petri dishes opens the play. They persist in the background of the set, which is the waiting and consulting rooms of a clinic for reproductive technology.  The chief, Dr. Staiman, is not only an expert in this field of human biology — he also enjoys an international reputation (and many patents) for his genetic manipulation of orchids in a quest for perfect blooms.

Heather and Rose are both clients of the facility. Heather wants a baby and needs help to be able to conceive. Rose could actually conceive on her own; however, she is investing in expensive and painful genetic selection to avoid having a child with the same trait as her brother. His Tourette’s syndrome, she contends, ruined life for her parents and herself as well as for him.

It emerges that Heather too has Tourette’s syndrome, but she does not believe it ruined life for her family and is unafraid of having an affected child. The women must wrestle with the notion that Rose does not think someone like Heather should exist; and Heather wonders if she should be testing her own embryos.

The two clinic doctors, Blume and Staiman, offer similar services, but as an ethicist, Blume worries about the moral implications of the new technology. Heather challenges Staiman over his willingness to destroy an embryo that might become a person like herself. He seems baffled by her concern, claiming that science makes perfection possible and that the decision should belong to the parent.

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The first-person, nameless narrator is in mid-1970s San Francisco on a "sabbatical" that is more like an exile from his academic post in the east. He takes an office in a downtown building to force himself to leave his dull accommodations. Occasionally he can hear everything that transpires from the space on the other side of the wall, which is the office of psychiatrist, Dr. Schüssler. Normally, the woman doctor runs a white-noise machine to ensure privacy, but one patient — who becomes “my patient” — hates the noise and insists it be turned off.

Adopted in infancy, “my patient” is in a fraught lesbian relationship. Her doctor has been encouraging her to find her birth mother, but she keeps resisting. Finally she embarks on a long exploration that is told through her accounts to the doctor, through conversations repeated and letters read out loud. As an academic scholar, the eavesdropping narrator is able to trace records that could not be found by the patient; he takes the liberty of meddling, falsifying an agency letter and setting her on the correct path. He also realizes that the psychiatrist’s father was a Nazi officer by listening to telephone conversations with her own mentor.

“My patient” learns that her mother was Jewish and escaped death by being in a special facility as a comfort woman. Chameleon-like the mother’s identity changes over and over. In contrast to the nameless patient, her name moves from Maria to Miriam to Michal; she lives in Israel where the patient goes to find her. The biological father’s identity is a mystery—perhaps someone whom Michal loved, perhaps a Nazi officer. The sacrifice of her child to a Catholic adoption agency moves from inexplicable selfishness to desperate selflessness. Surprises continue to the end when "my patient" finds an Israeli sister who has been in contact with the mother but is no less confused over her identity.

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Isserley is an alien whose assignment on earth is to abduct male (preferably muscular and burly) hitchikers for their processing, in a subterranean area under a barn in Scotland where she and her fellow aliens are based, as farmed animals that are castrated, made mute by tongue-amputation and fattened up in pens like calves for their veal. After a few months, they are eventually slaughtered and butchered for meat and then transported back to Isserley's native land, which is portrayed as a dark, arid, unpleasant place where meat is a rare and expensive delicacy.

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Benjamin Rubin is completing his surgical residency in a Tel Aviv hospital when the director of the hospital asks him to accompany him and his wife to India to rescue their daughter who is critically ill.  This invitation distresses him, as he recognizes in it a way of removing him from competition for a position in surgery at the hospital.  He makes the trip, however, and is entranced by Indian culture and mysticism, and, eventually, not by the daughter but by the mother he accompanied.  Back in Tel Aviv, he has a brief affair with the mother, moves into an apartment she owns, leaving his mother's home, and, to allay his obsession with an unavailable woman, marries an independent-minded woman who has also traveled in India and absorbed Buddhist spirituality and Eastern philosophy she discovered there.  Working as an anesthesiologist, Benjy continues in that setting, conflicted about both work and life, unable to connect deeply with any of those whose love he has received or sought.  Eventually his wife leaves with their baby daughter to return to India, where she has found a spiritual home, and Benjy remains in a divided state of mind in a divided country where his own spiritual heritage remains to be plumbed.

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A big believer in evidence-based science, Australian Professor Don Tillman is 39 years old, “tall fit and intelligent with a relatively high status and an above average income.” He should be attractive to women and succeed in reproducing. Yet he is alone. Dating is a disappointing waste of time.

After he is asked to give a lecture on Asperger’s syndrome, Don decides to solve his problem scientifically. He develops his Wife Project – a massive questionnaire designed to weed out incompatibles and identify women most likely to be a match. Intelligence, punctuality, shared tastes, and no use of tobacco or alcohol are high on the list of desirables. His only friends, geneticist Gene and psychologist Claudia, humor and support him. Gene and Claudia have an open marriage, which means that Gene’s “research” involves his bedding many women of different nationalities.

Into his life comes Rosie—a wild, disorganized bartender who smokes. She is totally incompatible. Curious about her biological father, Rosie inspires Don to develop the "father project" as a way of identifying all possible candidates and then eliminating them one by one using DNA. Circumstances force them to work together at various other schemes—running a one-off bar for which Don, the non-drinker, becomes a walking encyclopedia of cocktail recipes. A trip to New York City results in more hilarity, further destabilizing Don’s equanimity. His stereotypical assumptions are challenged when he discovers that she is completing a PhD on the side. They have fun. But Rosie cannot be the right one because she would fail the questionnaire.

Eventually and predictably Don realizes that it is Rosie whom he wants and needs. He develops the Rosie project to win her back. He also shows Gene that the wonderful Claudia is about to leave him and that open marriage is for the birds—or is it the bees? Happy endings all round.

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Police inspector Irene Huss, married to an inspired chef and mother of twin teenaged girls, is summoned to investigate the murder by strangulation of a nurse who had been working the night shift in a private hospital. A power failure that same night provokes the death of a patient when his respirator failed. The nurse’s body is found tossed over a generator in the basement electrical room—one of the first places inspected. The lines had been deliberately cut.

Another nurse is missing. The only other nurse on duty that night is convinced that she has seen the hospital’s old ghost, Nurse Tekla, who hanged herself in the hospital attic because of a broken heart a half century earlier.

The hospital director, handsome but administratively challenged Dr. Löwander, is devastated. He worries about the possible failure of the hospital, which he inherited from his father and he seems genuinely concerned for his staff. His ex-wife remains bitter about her divorce years ago, but his present wife – an obsessive body builder and trainer—seems unconcerned by the events. She has long been planning to turn the hospital into a spa and gym. The dead patient’s beautiful, youngish widow has just come into a lot of money with her husband’s death by power failure.

The investigation leads to the history of the hospital, old affairs, and the origins of the ghost-nurse story, which attaches itself to popular opinions about the case to the immense irritation of the police chief. 

Meanwhile, one of Huss's daughters has become a militant vegan, resulting in more stressors in her double life as a wife and a cop.  

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