Summary:

The narrator of this story, a wounded American soldier, is recuperating from his injury in Milan, Italy. He receives treatments delivered by machines each afternoon at the hospital. His doctor seems overly optimistic. "You are a fortunate young man," he tells the narrator, promising the soldier that his injured knee and leg will recover well enough for him to play football again.

The physician's prognosis for another patient, an Italian major receiving treatment for a shriveled hand, is also dubious. The officer was once a renowned fencer and is now angry and bitter. His invalid condition and the recent death of his young wife from pneumonia have sapped his will. He professes no faith in the machines treating his hand injury and does not believe in bravery.

Injury fosters camaraderie and the narrator socializes with four other young men undergoing treatment at the hospital. The narrator admits his injury was not the result of heroic action but merely an accident. The medals he received were undeserved. Life may be a series of random events but some people have it worse than others. The only certainty in the lives of these characters is the fact that "the war was always there."

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The diagnosis is delivered in the opening sentence: "a bad heart." Anton Rosicky is an immigrant to the United States from Czechoslovakia. The 65 year old man and his wife, Mary, own a farm in Nebraska. They have five sons and a daughter. Rosicky is an ordinary fellow with one remarkable quality--a genuine love for people. He is attached to his family, the land, and hard work. His physician, Doctor Ed Burleigh, writes a prescription for Rosicky and instructs him to avoid strenuous activities.

The young doctor is quite fond of Mr. and Mrs. Rosicky and speculates that tender and generous people like this couple are more interested in relishing life than getting ahead in it. Although he knows better, one day Rosicky overexerts himself raking thistles and bringing some horses into the barn. He experiences chest pain accompanied by shortness of breath. His daughter-in-law, Polly, helps him into bed and applies moist hot towels to his chest.

Unfortunately, Dr. Ed is out of town--his first vacation in seven years. Rosicky appears to recover from the episode but the following day after enjoying breakfast with his family, the chest pain recurs and he dies at home. When Dr. Ed returns from his trip, he stops at the graveyard near the farm. He realizes that the natural beauty and serenity of the landscape make a fitting final resting place for a farmer like Rosicky and a man whose life was not only rich with love but deeply fulfilling.

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While on an airplane, Carson experiences abdominal pain. He is a divorced man in his fifties and a sales representative for a computer and information technology firm. He spends much of his time traveling and fancies himself "a connoisseur of cities." The increasingly severe stomach pain forces Carson to reschedule his business meeting and retreat to his hotel room.

His suffering mounts and he decides to visit the emergency department of the city hospital. Carson is evaluated by two young male doctors and later a middle-aged female physician. Despite blood tests and X-rays, his diagnosis remains murky and a surgical consultation is obtained. The surgeon suspects appendicitis. He postulates that Carson may have a retrocecal appendix and explains that in such cases the anatomical location of the organ often confounds the diagnosis.

Carson undergoes surgery. His appendix is indeed retrocecal and rupturing. He spends five days convalescing from the operation. During that time he acquires an intimate knowledge of the city from his stay at the hospital. The experience revitalizes him. Carson reasons that the world is miraculous in part because it is so simple yet still spectacular.

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Manlius is a 5th C Roman patrician living in Provence who has studied with the wise, reclusive Sophia. He writes his understanding of her teaching in his essay, 'Dream of Scipio,' which trades on an essay by the great Roman orator, Cicero. Sensing that the Empire is gravely threatened, he makes a pact with barbarians, sells out his neighbors, slays his adopted son, and becomes a bishop of the Christian religion, which he has long despised. Late in this ruthless and doomed attempt to salvage what he values most in his world, Sophia makes it clear that he has misunderstood her teaching.

Olivier is an astonishingly gifted 14th century Provencal poet whose intolerant father tries to stifle his love of letters, among which is Manlius's 'Dream'; his father destroys the manuscript, but Olivier recopies it from memory. As plague advances on their region, Olivier finds a mentor in the high churchman, Ceccani, who is bent on keeping the papacy in Avignon. He plans to destroy Jews as symbolic expiation for plague, widely construed to be a form of divine punishment. Olivier befriends a Jewish scholar and falls in love with his beautiful heretic servant.

The 'Dream' and the imprisonment of his friends lead Olivier to question and then betray his mentor. Either because of his efforts to save them, or for his role in a murder, he is mutilated--his tongue and hands cut off to rob him of speech and writing. The brutal mutilation appears early in the book--it is not fully explained until the end.

Julien is a French historian who has studied the poet, Olivier, and the rendition of Manlius' manuscript. He finds solace in his erudition as his county falls to the Nazi occupation. An old school friend who is a collaborator, gives him work as a censor and tolerates Julien's Jewish lover, the artist Julia. In the end, Julien is forced to choose between saving either another school friend in the Resistance or Julia. He chooses Julia, looses her anyway, and commits suicide in a vain attempt to warn his friend.

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A child dies in the hospital shortly after the infectious disease consultant, Dr. Michael Grant, evaluates her. The 35-year-old physician has cause to be troubled by the patient's death. He failed to perform a careful examination, did not check the results of her most recent lab tests, and held off on ordering antibiotics. Although an autopsy was not performed, it is believed she died of sepsis.

Divorced and recently relocated to North Carolina, Dr. Grant is already depressed. Now he must worry about the possibility of a malpractice lawsuit. Jonas Williams, the father of the dead child, is also ill. He complains of fatigue, visual disturbances, confusion, night sweats, and fever. Jonas has developed unusual lesions in his throat and retina--white threads in a serpentine pattern. A biopsy of his oral lesion demonstrates the presence of osteoblasts and new bone formation. Dr. Grant becomes convinced he has stumbled onto a completely new infectious illness even though he cannot identify the causative organism.

Jonas experiences gastrointestinal bleeding as a result of a low platelet count. He dies in a trailer that has caught on fire. Dr. Grant soon develops the same symptoms as his patient. He remembers coming into contact with some of Jonas's blood. He is admitted to the hospital with massive gastrointestinal bleeding. His physician attributes the bleeding to ulcers, gastritis, and thrombocytopenia. Dr. Grant, however, believes the bleeding is due to the same mysterious disease that Jonas had.

The body of Jonas's daughter is exhumed, and there is anatomic evidence of the same bizarre changes that occurred in her father. Dr. Grant visits a cabin in the woods where Jonas had lived. He is looking for clues to the puzzling new illness. What he finds, however, is not an answer. Instead, it is a renewed appreciation for his life as well as the world around him.

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This book, a sequel to It's Not About the Bike: My Journey Back to Life, chronicles five-time Tour de France winner Lance Armstrong's personal and professional triumphs and agonies from late 1999 (after he won his first Tour and after the birth of his son Luke) to mid-2003, the 100th anniversary of the Tour. Armstrong defines himself by his cancer experience and survival; he devotes himself to both one-on-one connections with fellow cancer patients as well as his public persona to raise awareness and funds for cancer programs and survivors' needs.

There are many medically related themes in the book. Descriptions of cycling sports injuries and illnesses include a severe concussion, a broken cervical vertebra, dehydration, road rash, tendonitis and exhaustion. Armstrong experiences the loss of friends and acquaintances to cancer and trauma. He is the subject of an intense investigation into the possible use of recombinant erythropoietin and finally cleared of suspicion after nearly two years. As a world class athlete, he is subject to frequent, random drug testing.

His wife experiences a failed in vitro fertilization cycle, though a subsequent successful treatment leads to the birth of healthy twin girls. The Red Cross invites Armstrong to visit NYC firefighters soon after the devastation of September 11, 2001 in a successful effort to boost morale. Armstrong, though, describes encounters with some cancer patients in which he felt he did not succeed in providing the desired inspiration.

Despite reaching his five-year cancer-free milestone, Armstrong, like many other cancer survivors, wonders if the cancer will return. He is hyper-vigilant of his body not only because of his elite athlete status, but also because of his cancer history. Nonetheless, he is reckless and jumps from a steep cliff to sense the rush of fear and freedom.

Armstrong trusts and believes in modern medicine and technology, as well as the physicians, nurses and other health care practitioners dedicated to cancer treatments and health care. He also lauds complementary practices, particularly the team chiropractor who uses a variety of techniques to support the riders during the grueling Tour.

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Henry Moss is a medical geneticist specializing in Hickman syndrome, a fictitious disease resembling progeria. Children with Hickman syndrome experience premature aging and invariably die before the age of twenty. The physician meets Thomas Benhamouda, a teenager who genetically has Hickman syndrome but astonishingly has no physical manifestations of the disease. Dr. Moss identifies a protein that "corrects" Hickman syndrome in the blood of Thomas and proceeds to synthesize it.

Dr. Moss violates medical ethics by administering the experimental enzyme to his favorite Hickman patient, William Durbin, a dying 14-year-old boy. It is a last-ditch effort to save William's life even though the substance has not been tested for safety or efficacy in human beings. Dr. Moss also injects himself with the enzyme. He realizes the tremendous potential the drug has not only in curing Hickman syndrome but also in extending longevity in normal individuals. He is well aware of the great financial rewards he might reap from his discovery.

After a series of injections, William's deteriorating health stabilizes and even improves but he dies in his home. Dr. Moss has failed to save the doomed boy but in the process of breaking the rules and risking his career has learned how to understand and appreciate his own life as well as reconnect with his family.

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In a bleak setting, at an ocean's edge, a family grouping of three poor people, barefoot, huddled and shivering, are lost in contemplation. The figures' proportions are elongated. Imposing in their size, they take up the entire canvas. Rendered entirely in shades of blue, all other details are eliminated from the composition adding to the mood of blue empty coldness of sand, sky, and sea.

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In 1822, a young Canadian paddler named Guillaume Roleau is near death after suffering a gunshot wound to the stomach. His recovery is dramatic and scientifically important. The injury has resulted in a traumatic fistula--a porthole between the outside world and Guillaume's abdominal cavity and organs. The treating physician, Dr. William Barber, immediately recognizes the incredible opportunity for medical research and conducts a lengthy series of experiments on the process of human digestion.

Guillaume--patient, research subject, and guest in the doctor's cabin--is rowdy and frequently uncooperative. He continues to participate in the grisly experiments at least partially out of affection for the physician's wife, Julia, who helps nurse him back to health as well as providing emotional sustenance.

Julia ultimately makes a large, uncredited contribution to Dr. Barber's research. At her husband's request, she has sexual relations with Guillaume so that the unreliable man will remain with the doctor until the experiments are all completed. The efforts of this tragic trio result in a landmark textbook on gastrointestinal physiology authored by Dr. Barber and Julia's illegitimate son, Jacob, sired by Guillaume Roleau.

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Liv is pregnant. She is an artist, and married to Erland. She names the fetus, a boy, Ersatz (a replacement, a copy, a person not yet real?). This book-long poem, divided into short segments making up nine (month-like) chapters, reconstructs her pregnancy in words, often literally, using words-within-words (for instance in a section called "Proximity of Posed to Exposed"), echoing people-within-(pregnant)-people, ideas emerging from words, and life (and death) emerging from bodies.

The poem does not offer a simple coherent narrative, although it does follow the biological narrative form of gestation. Instead it circles around the experience of containing another person, and the dissonance Liv seems to find between biological and verbal or cultural creating. Liv's ambivalence about this tension is captured throughout the work, perhaps most notably in her exploration of a painting of the dead Virginia Woolf, the drowned body of a childless woman writer, now become "beached debris." The final part of the poem captures powerfully the experience of childbirth, and the afterword is in a new voice, that of Liv's son.

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