Summary:

Lenny's development from childhood to adolescence concurs with India's independence from Britain and the partitioning of India into India and Pakistan. The interwoven plots give each other substantial meaning. Partly because Lenny's family are Parsees, a religious and ethnic minority that remained relatively neutral in post-Partition religious conflicts, she has access to people of all ethnicities and religions, both within Lahore and in other locales. More significantly, she has access to a wide variety of viewpoints both pre-and post-Partition through her Ayah, a beautiful woman whose suitors are ethnically and religiously diverse.

Lenny's passionate love of Ayah and the loss of innocence that accompanies their changing relationship through the Partition is an energetic center to the plot. Lenny's relationships with her mother, her powerful godmother, and her sexually invasive cousin are also important to the novel. Lenny's polio forms a significant early narrative thread. Other minor but compelling subplots include Lenny's parents' changing relationship, the murder of a British official, and the child marriage of the much-abused daughter of one of Lenny's family's servants.

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According to the U.S. Department of Health and Human Services, nearly thirty-one percent of the American public is obese; obesity accounts for 300,000 deaths a year, making it the second-most common preventable cause of death after cigarette smoking; individuals who are obese have a fifty to one-hundred percent increased risk of premature death from all causes.  On the opposite end of the scale, so to speak, is anorexia, which, as one of the deadliest of psychiatric diseases, claims up to fifteen percent of its sufferers who either die of suicide or complications related to starvation; about one-third spend their lives dominated by their obsession with food, and almost half never marry. 

How can we ever understand the psychological, physical, emotional, cultural and spiritual complexity of eating disorders, whether they result in morbid obesity or in a starving body digesting itself?  Ann Pai's memoir opens a window to reveal the inner world of a food obsession, her own, and holds up a mirror to reflect the outer experience of a dying, five hundred fifty pound woman, her sister.

The narrative weaves together three strands:  the sweet but unsentimental history of two sisters growing up in the midwest--Joyce, the elder of the two, and Ann, younger by almost five years; the detailed and horrific account of Joyce's sudden hospitalization on September 11, 2001, and her inexorable decline through multiple, undiagnosable and fatal illnesses as the result of her obesity; and the stream-of-conscious and raw monologue of Ann's own struggle to manage a compulsive eating disorder.

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A night on the town with two friends turns into "an attack of nerves" for Vasilyev, a law student. The three students spend the night drinking and visiting houses of prostitution; Vasilyev is horrified and repulsed by the women, who he thinks are "more like animals than human beings." The social problem of prostitution becomes an obsession; he is so fixated on finding a solution that he is in moral agony. His friends, among whom is a medical student, are concerned only with his health; they take him to a psychiatrist who "cures" Vasilyev with bromide and morphine.

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This collection of 116 poems by 76 poets includes a wide range of perspectives, although most are written about a friend or loved one with AIDS or by a poet with AIDS. The poems are about love, loss, grief, pain, fear, beauty, illness, death, and transcendence.

Some well-known poets, such as Adrienne Rich, Paul Monette, James Merrill, Philip Booth, Robert Creeley, and Marvin Bell have contributed to the anthology. Brief introductory essays by The Rt. Reverend Paul Moore, Jr., Joseph Papp, Carol Muske, and the editor comment on the power of the voices, the politics of AIDS, and the elegiac quality of many of the poems. Michael Klein likens the book to the patchwork quilt of the NAMES Project, and hopes that the book, like a "well-made" quilt, will "last awhile, keep you warm."

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This fine collection of writings by women involved in health care stems largely from a writing group cosponsored by the Nebraska Humanities Council and the Creighton University Center for Health Policy and Ethics. However, other writings also appear in this volume: in all there are 40 pieces by 16 authors. Writing genres include essay, short story, and poetry. The works are divided into three sections: Power and Powerlessness, Vulnerability and Voice, Connection and Disconnection. As noted in the introduction, these are "major themes in feminist perspectives in ethics" and the works are offered as reflections on modern ethical dilemmas in health care.

Some of the most powerful pieces are stories about being the newcomer--the student or junior trainee. For instance, "Washing Cora's Hair" by co-editor Amy Haddad is a poignant look at the struggle of two young nursing students to wash the long braids of a bed-bound elderly woman in her cramped home, and "The Story of David" by Ruth Purtilo, written as a memoir looking back to when she was a newly graduated physical therapist, concerns her interactions with a young, angry, depressed quadriplegic patient and with her superiors.

Another memorable piece is "The Things You Do" by Kelly Jennings Olsen. This story about being a new volunteer emergency medical technician masterfully controls the tensions of emergency medical care, the anguish of the father whose little girl slipped under his tractor, and the nuances of living in a small town. Several poems also deal with issues of the newcomer and witness to suffering (e.g., "As Ordered" by Ruth Ann Vogel--a poem about shaving the head of a neurosurgical patient on the pediatric ward)

As noted by the multiple keywords listed above, these pieces touch on many topics. Power relations play a key role, both between professionals and between patient and the health care team. For instance, in the polished story, "Procedures" the author Kim Dayton writes from the perspective of a young single mother with a critically ill neonate. This mother is repeatedly prevented from visiting her child because of "important" events like rounds and procedures, and she ironically only gets to hold her baby after the baby dies.

Throughout the collection the patients are described with honesty and vividness. Their suffering can haunt the health care worker ("Maggie Jones" by Veneta Masson) as well as teach ("Back to Square One" by Barbara Jessing). Many of the pieces remind us of our good fortune and the privilege we have in our lives and in providing health care services (e.g., "Spring Semester" by Amy Haddad). Ultimately in this volume our common humanity is emphasized--the connections between people and the remarkable grace that can be exhibited in the face of suffering.

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This haunting memoir by a South African surgeon who has witnessed tremendous suffering across the globe is best read as his story, and not a war chronicle as the subtitle would suggest, since large chunks of the book are not about war in the dressing station sense of the term. That said, however, the war that rages inside the author continues throughout the book and gives the reader glimpses of wisdom gained during Kaplan's remarkable journey of life amidst death. The book is culled from journals of writing and sketches that he kept throughout his travels.

Kaplan's first crisis occurs when he joins fellow medical students in an anti-apartheid demonstration in Cape Town and, following the lead of a more senior student, Stefan, tends to the wounded and frightened after riot police attacked the demonstrators. Kaplan then gets the call of not only medicine as service, but surgery as service, when, as a neophyte doctor, he saves the life of a youth shot in the liver by the police.

This feat should not be underestimated, though the author writes with humility. Indeed, in recounting later incidents in which patients die, the odds tremendously stacked against the patients surviving anyway (a woman with disseminated intravascular coagulopathy and multiple organ failure, or the Kurdish boy in a refugee camp with a great hemorrhaging, septic wound), the author's self-chastisement is a painful reminder of how the physician suffers with each loss.

After a beautifully written prologue which begins, "I am a surgeon, some of the time" (p. 1), the book proceeds chronologically, each chapter named for the location of the action. Kaplan leaves South Africa to avoid military service and the fate that befell Stefan, who becomes an opioid addict after euthanizing a torture victim in a horrible scene of police brutality and violence. Kaplan's post-graduate training in England and BTA (Been to America) research stint heighten his sense of cynicism about hierarchy in English society and capitalistic forces in American medical research.

Ever the outsider, Kaplan first returns to Africa (treating victims of poverty, deprivation and violence), then sets off to war zones in Kurdistan, Mozambique, Burma (Myanmar), and Eritrea. In between, he works not only as a surgeon, but also a documentary filmmaker and a cruise ship and flight doctor. He avoids the more established medical humanitarian relief efforts, such as Médecins Sans Frontières, and instead prefers to work where no other ex-pat physician will go--enemy territory, front lines, and poorly equipped dressing stations.

Along the way he decides the number of people he has helped as a surgeon, particularly in Kurdistan, has been small compared to the potential to intervene in broader public health measures (he meets a Swiss water treatment engineer) and occupational health exposés to help abused victims (e.g., of mercury poisoning in South Africa and Brazil). The book ends with Kaplan studying to become an expert in occupational medicine, though, incongruously, in the heart of London's financial district where he treats stress-related illness.

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The first sentence of the introduction indicates the author's intention to talk about "how we do it--and how we could do it". Ending life, she says, is an issue under sustained debate in the United States and in much of the developed world. The argument over physician-assisted suicide is the central framework. The described debates on euthanasia and suicide include two pro and three con arguments in American and international contexts. This collection includes essays, practical notes, historical explorations, policy analyses, fiction, and creative non-fiction written by the author.

The author describes the role of fiction and creative non-fiction as offering a recognition of narrative as a respected form of investigation of social issues. Included are two selections that are in this genre and they are very powerful. The essay on the ethics of self-sacrifice is timely and well written. The author's final conclusion is that Stoic and Christian thinking are still in active collision in much of our consideration of these issues and that this means that advance personal policy making remains in the fullest sense an exercise for each individual.

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The world as everyone knew it ended years earlier when "the clocks stopped at 1:17" [p 45] and power was lost. Not many people are still alive. The landscape is charred and hostile with "cauterized terrain" [p 12], "ashen scabland" [p 13], and "the mummied dead everywhere" [p 20]. A father and his young son travel south towards the coast. The boy's mother has committed suicide. Papa and the child wear masks and tote knapsacks. The father pushes a shopping cart filled with potentially useful items that he has collected during the journey. The man keeps his pistol close. It only contains two bullets - one reserved for him and one for the boy.

The father and son follow a road towards the ocean, but they scurry and hide like two animals. Papa's biggest worries are marauders, food, and shoes. The world is cold. Rape and cannibalism are common occurrences. Although their goal is to remain alive and reach the coast, father and son wonder if the destination is any more hospitable than the rest of the dying world. Often hungry and freezing, both of them become sick. The boy contracts a febrile illness. The man frequently coughs blood and is wounded in the leg by an arrow.

Father and child ultimately reach the ocean, but it too is cold and dead. Not long after arriving at the coast, Papa dies. A stranger finds the grieving boy and invites the child to join his family - wife, son, and daughter. He assures the boy that he is a good man. He tells the child that his family does not eat other people. He advises the boy to hold onto his father's pistol.

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Having remarried after a long and partly happy life with a woman who bore him three sons, novelist Campbell Armstrong lives in rural Ireland with his second wife. He learns that his first wife, who works in Phoenix, has advanced lung cancer and, with his second wife’s blessing, goes to spend time with her and their grown sons. In the course of that trip, he reflects on their life together, their romance, his alcoholism and its effect on their family, their move to the U.S., their losses, and the remarkably enduring affection between them and, surprisingly, between the first wife and the second.

Completely surprising all of them, a daughter his first wife gave up for adoption, who has searched for years for her birth mother, shows up in the months before Eileen’s death and makes the trip to Phoenix to meet her birth mother. Her appearance turns out to be a gift to the whole family. She assuages decades of sorrow and longing in both her and her mother’s hearts. She herself has cancer, not as advanced as her mothers. Both she and her mother work in health care professions. Much psychological and spiritual healing is accomplished between them in the short time they have before Eileen’s death several months later.

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The poet stands before an ancient Lycian tomb, upon which is carved the sorrowful face of a woman: "One woman garbed in sorrow’s every mood." He reflects on the constancy of loss in human life. He asks the woman to weep for him, also, because [I] "Share thy stilled sadness, which must ever be / Too changeless, and unending like my own . . . . "

Though the Lycian woman’s grief is old, the poet’s is young. He has lost a child: "With that too human wail in pain expressed, / The parent cry above the empty nest." He is skeptical about dreams of a better life. He rejects "The first confusing, mad bewilderment, / Life’s unbelief in death . . . . " Death is real and final. He concludes with full understanding that "life is but a tender instrument / Whereon the master hand of grief doth fall."

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