Summary:

Note: I try not to reveal too much here. Nevertheless, I urge you to read the book first. I would not want the magic of reading this book to be diminished by too much foreknowledge--no matter when the book is initially opened.

Harry Potter and the Order of the Phoenix is the fifth book in a planned series of seven (see Harry Potter and the Sorcerer's Stone for an introductory summary). Harry is now fifteen years old. The opening chapter, "Dudley Demented," features a return of the Dementors (see Harry Potter and the Prisoner of Azkaban), who had been sent to Harry's neighborhood in Little Whinging to deliver their soul-sucking kiss. In order to repel the Dementors and save himself and his bullying cousin Dudley Dursley from the kiss's death-in-life, Harry uses magic. This transgression from rules on underage wizardry leads to Harry's near expulsion from his school, Hogwarts, and a trial by the full court, the Wizengamot, led by Cornelius Fudge, in the Department of Mysteries of the Ministry of Magic.

Headmaster Albus Dumbledore, concerned with Harry's safety as well as with leading the resistance efforts (The Order of the Phoenix) against the resurgent evil Lord Voldemort, not only prevents Harry's expulsion, but also organizes the guard for Harry's transfer from the Dursley home to the ancient house of Harry's godfather, the wonderfully moody and complex Sirius Black. Sirius, like Harry's parents, would risk anything for his godson, but the relationship is charged by Sirius' goading of Harry to be more cavalier like James Potter--Harry's father and Sirius' best friend--and by Sirius' antipathy towards being imprisoned in his ancestral home, filled with reminders of his pureblood wizard family.

These include a portrait of his raging, hate-filled, deceased mother and a malevolent house elf, Kreacher. Communication between Harry and Sirius is a key theme in the book, as Harry looks to Sirius for guidance on the tribulations of adolescence and to satiate Harry's continued craving for information about his father. Harry's emotional tether is short in this novel, and runs the gamut from frustration and envy that his two best friends, Ron and Hermione, were made prefects of Gryffindor House, to despising two teachers (potions teacher Snape, of course, and the new venomous, officious Defense of the Dark Arts teacher, Dolores Umbridge) and finally to absolute fear and hatred of Voldemort, his mortal, yet intimate, enemy.

Harry's scar pains him almost continuously now that Voldemort has returned in the flesh, and also now that Harry has dreams and visions of Voldemort's actions. With this ability, Harry envisions himself as a snake and witnesses the wounding of Ron's father, Arthur Weasley. This episode leads to two visits to the wizard hospital: St. Mungo's Hospital for Magical Maladies and Injuries. The reader is deliciously informed that the personnel in green robes are not doctors ("those Muggle nutters that cut people up" p. 484), but rather Healers: wizards and witches who passed a large battery of tests in a range of subjects to qualify for such training.

The hospital is a mix of the mundane (the irritable receptionist) and the arcane (patients suffering from bizarre spell damage). Mr. Weasley's recovery from the nearly lethal snake bite suffers a minor setback when Trainee Healer Pye (not the Healer-in-Charge, Hippocrates Smethwyck) tries some "complementary medicine . . .

[an] old Muggle remed[y] . . .

called stitches . . . " (pp. 306-7). The loving Mrs. Weasley, whose temper is notorious and hence humorous, shouts at her husband that even he "wouldn't be that stupid" as to allow his skin to be sewn together. (p. 307)

While in the hospital, Harry and his friends encounter schoolmate Neville Longbottom visiting his parents, who suffer dementia caused by dark magic performed by one of Voldemort's Death Eater followers. Mental illnesses prove far more difficult to remedy than bodily injuries and maladies. Indeed, late in the book, Madam Pomfrey, the Healer at Hogwarts, wisely advises that "thoughts could leave deeper scarring than almost anything else." (p. 847) As Dumbledore, the embodiment of sagacity, states, memories of old hurts, slights and abuses, make "some wounds run too deep for . . .

healing." (p. 833)

Other medically related items include the Skivving Snackboxes--an assortment of magical treats and their antidotes concocted to fake various illnesses in order to skip classes, and Umbridge's detention punishment which results in the painful etching of the required written phrases on the back of the hand of the miscreant student.

Professor Snape is charged with teaching Harry the subtleties of mind-reading (Legilimency) and its prevention (Occlumency), in an effort to prevent Voldemort's use of Harry's mind. "The mind is a complex and many-layered thing," says Snape, and hence the mind cannot be read like a book. (p. 530) Harry's failure at these lessons leads to the denouement of the book and ultimately to the loss of someone very dear to him. After the inevitable confrontation between Voldemort and Harry, Dumbledore gently coaches Harry through his guilt and anger to teach him about destiny, love and death.

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Emiko a child survivor of Hiroshima, is now a documentary filmmaker. She has horrific memories of August 1945 when she lost her parents and little brother, and of the years of painful operations and homesickness in America where she was sent to restore her mutilated face. She is hoping to interview Anton Böll, a scientist who had fled Germany to work on the Manhattan project.

Böll contends that he had been unaware of human rights abuses; he left Europe because the Nazi regime had cramped his scientific style. As a consequence, his mother was imprisoned and killed. During the war, he met his Austrian-born Jewish wife, Sophie, at a displaced persons camp in Canada. Sophie had lost her whole family, but she does not speak of them and he does not ask.

Briefly they knew happiness, but soon Böll left for work on the bomb and on to Hiroshima in its aftermath. Their marriage would never be the same. For the rest of his life, Böll justified his involvement as a "dream" turned "nightmare" emerging from the imperative demands of a virtuous science. When Emiko approaches him, he hesitates. He does not want to risk blame. But his dying wife knows that absolution for unacknowledged guilt is what he craves.

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When I had Annina, the narrator says, her first-born child was eight years old, frost covered the geraniums, and something "warm and wet" ran down her legs. She lost her second pregnancy at only nine weeks from a spontaneous abortion. Secretly, she names the tiny girl "Annina" and tucks her inside her heart and mind, where for years she nurtures her, protects her, dresses her, listens to her language, and watches her grow to a daring adventuress, though she is Thumbelina small, and carries a needle for a sword. Annina eventually moves on and the narrator will not dare to ask her to come home.

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In this documentary film about euthanasia in the Netherlands, a man--Kees van Wendel de Joode--with amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease) requests death in his home, to be performed by his doctor, Wilfred Sidney van Oijen. The film mostly consists of what appear to be unscripted discussions between Kees, his wife Antoinette, and the doctor; however, there are also interviews with the doctor and views of the doctor seeing other patients. The film shows the doctor performing euthanasia: we watch him inject a barbiturate and then a muscle relaxant and we see him supporting Antoinette during the bedside deathwatch.

Kees has had a rapid deterioration of his ability to function: he is unable to move his legs and right arm, he can no longer speak coherently, and he is having difficulty swallowing. His wife cares for him in their Amsterdam apartment. The film documents the legal requirements for euthanasia in the Netherlands: Kees's repeated requests for euthanasia, confirmation that he has an incurable disease, the second opinion doctor's visit, and reporting the death to the municipal coroner and public prosecutor.

The film's strength lies in the sensitive treatment of the impact of this request on the patient, his wife, and especially on his doctor. Dr. van Oijen is an introspective man who cares for his patients--he makes house calls, explains medical terms to his patients, touches his patients, and asks what they are concerned about. He allows his patients (Antoinette is, in many ways, his patient too) to weep and be emotional.

The religious and moral dimensions of euthanasia are explored mostly with the doctor, who does not view himself as a wanton killer, but rather a doctor whose duty includes the alleviation of suffering. The film concludes with a voice-over stating the doctor will not sleep this night, but still has a clinic full of patients awaiting him in the morning.

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In Rethinking Life and Death: The Collapse of Our Traditional Values, Peter Singer argues that "the traditional western ethic has collapsed" as we enter "a period of transition in our attitude to the sanctity of life" (pp. 1). The book begins with the tale of Trisha Marshall, a twenty-eight year old woman, who in 1993 was seventeen weeks pregnant when a gunshot to her head left her in an intensive care unit, her body warm, her heart beating, a respirator supporting her breathing. However, she was brain dead.

Her boyfriend and her parents wanted the hospital to do everything possible so that the baby would be born. The ethics committee of the hospital supported the decision. For the next 100 days, Trisha Marshall continued to be supported in the ICU until her baby was delivered by cesarean birth. After a blood test showed that the boyfriend was not the father, and after three weeks in the intensive care unit, the baby went to live with Marshall's parents.

Singer uses this introduction to pose the many ethical questions that are raised because of medicine's ability to keep a "brain dead" body warm for an extended period of time. "How should we treat someone whose brain is dead, but whose body is still warm and breathing? Is a fetus the kind of being whose life we should make great efforts to preserve? If so, should these efforts be made irrespective of their cost? Shall we just ignore the other lives that might be saved with the medical resources required?

Should efforts to preserve the fetus be made only when it is clear that the mother would have wanted this? Or when the (presumed?) father or other close relatives ask for the fetus to be saved? Or do we make these efforts because the fetus has a right to life which could only be overridden by the right of the pregnant woman to control her own body--and in this case there is no living pregnant woman whose rights override those of the fetus?" (pp. 17-18).

In the chapters that follow, Singer argues that whether western society will acknowledge it or not, we have, in our actions and decisions, moved to an ethic where "quality of life" distinctions trump "sanctity of life" positions. Yet, many continue to raise the "sanctity of life" position when it is clear that our legal and ethical positions in western society have embraced the "quality of life" stance. For Singer, this paradox results in an incoherent and illogical approach to the ethical challenges presented by modern medicine.

Throughout his book, Singer presents evidence for his argument through ethical and historical analysis of brain death, abortion, physician assisted suicide and euthanasia, organ donation, and the nature of persons. For those uncomfortable with Singer's position on "infanticide," this book allows one to follow Singer's argument and his recommendations in the last chapter for a coherent approach to these "quality of life" decisions.

He closes his book with the recommendation that a new ethic should embrace five new commandments to replace the old "sanctity of life" commandments. His commandments are: 1) Recognize that the worth of human life varies; 2) Take responsibility for the consequences of our decisions (in end of life care); 3) Respect a person's desire to live or die; 4) Bring children into the world only if they are wanted; and 5) Do not discriminate on the basis of species.

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The film opens with a bird's-eye sweep over the frieze of a post-engagement battlefield--mud, strewn with bodies and shards of machinery, all iron grey and relieved only by rare patches of crimson blood. Psychiatrist William Rivers (Jonathan Pryce) treats shell-shocked soldiers in the converted Craiglockhart Manor. He is obliged to admit the poet and decorated war hero, Siegfried Sassoon (James Wilby), because his military superiors prefer to label the much-loved Sassoon's public criticism of the war as insanity rather than treason. Rivers is supposed to "cure" the very sane poet of his anti-war sentiments.

At the hospital, Sassoon meets another poet, Wilfred Owen (Stuart Bunce), equally horrified by the war although he, like Sassoon, believes himself not to be a pacifist. A secondary plot is devoted to the mute officer Billy Pryor (Jonny Lee Miller) who recovers his speech, his memories, and a small portion of his self-respect through the patience of his doctor and his lover, Sarah (Tanya Allen). Vignettes of other personal horrors and the brutal psychological wounds they have caused are presented with riveting flashbacks to the ugly trenches. Sassoon, Owen, and Pryor return to active service. The film closes with a dismal scene of Owen's dead body lying in a trench.

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May-Alice Culhane (Mary McDonnell) is a daytime soap opera star who is struck by a taxi in New York and wakes up in a hospital paralyzed from the waist down. Upset and bitter, and unable to continue acting, which she says is the only thing she was ever good at, she returns to her Louisiana bayou family home to begin the rest of her life in isolation.

An employment agency sends out a string of helpers. Some are better than others, but all are quickly defeated by May-Alice’s deep bitterness and negativity and her incipient alcoholism. Then comes Chantelle (Alfre Woodard), who needs the job so badly, as part of digging herself out from a cocaine addiction, that her determination makes her a match for May-Alice.

It is decidedly bumpy going, but Chantelle persists and May-Alice finally strops drinking and begins to make some progress in physical therapy. She takes up black-and-white photography, developing her own prints from her wheelchair, and she gratefully receives the gentlemanly attentions of her high school idol Rennie, played by David Strathairn. (The film takes its title from a practice that locals believe can make love-wishes come true.)

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This is the story of the life, loves, wounds, grit, artistic genius, and death of the well-known Mexican artist Frida Kahlo, played by Salma Hayek. At the age of eighteen Kahlo was in a near-fatal bus accident that left her with lifelong injuries to her pelvis, spine, and uterus. (The film does not include the fact that Kahlo had suffered some physical disability since a case of polio at the age of six.)

The life Kahlo survived to live was artistically enormously productive and successful, but it also had more than the usual share of physical suffering, medical procedures, attempts to self-medicate, and accompanying emotional distress. The film covers these things, as well as what Kahlo called the second disaster in her life, her marriage to the famous Mexican muralist Diego Rivera, played by Alfred Molina.

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The poem tells the story of one who travels to the hot springs seeking a cure for his chronic illness/disability. For 25 years the subject faithfully visits what remains of the opulent dream of spa-builders--a bubble that burst for both the entrepreneurs and their visitants. In the nearly deserted town, the poet's character continues to seek relief without success, yet he remains. The writer seems to be asking if it has become the search itself that keeps the sufferer alive; if he were to suddenly be made well perhaps he would lose everything in losing his familiar identity.

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This masterful collection of essays was written by Gawande while he was a general surgery resident. The book consists of fourteen essays divided into three sections: Fallibility, Mystery, and Uncertainty. Although some of the essays fall clearly within the boundaries of the section title (such as "When Doctors Make Mistakes" and "When Good Doctors Go Bad" in the Fallibility section), others cross boundaries or don’t fall as squarely in these general themes ("Nine Thousand Surgeons," an anthropological essay on the cult and culture of a major surgical convention, is also located in the Fallibility section). Nevertheless, the many pleasures of the individual essays, the range of topics explored in depth, and the accuracy of the medicine portrayed are the true strengths of this work.

The book begins Dragnet-style with an Author’s Note: "The stories here are true." (p. 1) And it is this attention to fidelity that makes the essays so compelling. Because even when the truths are hard--the terrible acknowledgment by the medical neophyte about lack of skill and knowledge, the mistakes in judgment at all levels of doctoring, the nature of power relations and their effects on medical pedagogy and on the doctor-patient relationship, the gnawing uncertainties about so many medical decisions--the author confronts the issues head on with refreshing rigor, grace and honesty.

Many of the essays reference scientific and medical research (historical and current) as part of the exploration of the topic. This information is imbedded within the essay, hence avoiding a dry recitation of statistical evidence. Typically, the reader’s interest in an essay is immediately piqued by a story about a particular patient. For example, the story of an airway emergency in a trauma patient, her oxygen saturation decreasing by the second as Gawande and the emergency room attending struggle to secure an airway, surgical or otherwise, sets the scene for "When Doctors Make Mistakes."

This leads to a meditation on not only the culture of the Morbidity and Mortality Conference, with its strange mix of third-person case narrative and personal acceptance of responsibility by the attending physician (see Bosk, Charles, Forgive and Remember: Managing Medical Failure, U. Chicago Press, 1981 for an in depth analysis of this culture), but also a positive examination of the leadership role that anesthesiologists have played in improving patient safety via research, simulator training and systems improvement.

Gawande’s journalistic verve takes him beyond the confines of his own hospital and training to interview patients and physicians on topics as diverse as incapacitating blushing ("Crimson Tide"), chronic pain ("The Pain Perplex"), malpractice and incompetence ("When Good Doctors Go Bad") and herniorraphy ("The Computer and the Hernia Factory"). In addition, he visits his own post-operative patients at home ("The Man Who Couldn’t Stop Eating" and "The Case of the Red Leg") which gives a longer view of postoperative recovery and a broader exposure to patients’ perspectives.

Some of the most telling moments come with the introduction of his children’s medical problems into the text. These range from the relatively straightforward (a broken arm, but a chance to comment on detection of child abuse in the emergency room) to the downright parental nightmare scary (severe congenital cardiac defect in their oldest child and a life-threatening respiratory infection in their prematurely born youngest).

These last two experiences are introduced to provide an angle on issues of choice. Choice of a fully trained, attending physician rather than a fellow to provide follow-up cardiac care for their oldest, and the choice to opt out of the decision-making process for whether to intubate the trachea of the youngest and hence leave the medical decisions up to the care team.

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