Summary:

Three novellas by a master storyteller. For the title story, see the separate entry in this database (Epiphany). "Harmony Ain't Easy" is a tale in which Dr. and Mrs. Sams (he retains his own name here) get stranded when their car is disabled on a country road, thanks to Dr. Sams's bull-headedness. After a warmly humorous series of reverses, they are finally saved.

In the last story, "Relative and Absolute," aged Mr. McEachern is approached by three high school students who want to interview him for their oral history project. They ask him questions about living conditions and race relations in their county when he was young. During the series of interviews, as he tells them anecdote after anecdote heavy with homey wisdom, the old man and the adolescents learn to like and respect each other.

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The story consists of a series of Dr. Mark Goddard's dictated office notes regarding the care of his patient Gregry McHune, interspersed with the narrator's description of these physician-patient interactions. McHune first presents as a standard case of high blood pressure; however, in subsequent visits the man tells his harrowing story.

Goddard learns that his patient was unjustly jailed for killing a black man in self-defense. McHune tells him about racism in the penitentiary and his fight for survival, both in prison and later. Eventually McHune and his family are hounded out of town by the son of the man he killed.

Through all these losses, McHune maintains his sense of humor and easy-going integrity. Meanwhile, the elderly Dr. Goddard is repeatedly harrangued by the clinic administrator (a vacuous young man) for including extraneous details and poetic language in his dictations. As time goes on, and he is transformed by his relationship with McHune, Goddard includes more and more poetry in his office notes.

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A holocaust memoir, this is the painfully honest and unsentimental account of one physician's experience in the Warsaw Ghetto. The author, who was a Jewish medical student of 22 when Germany invaded Poland, remained from 1940 through most of 1943, serving as caretaker of sick or orphaned children in a ghetto hospital. During this time, she tells the reader, she made some decisions she has never been able to fully reconcile-- such as to perform multiple acts of euthanasia involving adults as well as children when the waves of slaughter and deportation increased in brutality and frequency.

Eventually, the writer joined the active resistance and was a part of the movement which ended with the complete razing of the Warsaw Ghetto in 1944. After the liberation of Poland, Blady Szwajger resumed her interrupted career in pediatric chest diseases. Only after 45 years did she choose to write of her experiences and, in her introduction, she articulates her reasons for remaining silent and for her ultimate decision to speak out.

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Williams's autobiography recounts his life from his first memory ("being put outdoors after the blizzard of '88") to the composition of "Patterson" and a trip to the American West in 1950. The book's 58 short chapters epitomize the writer's episodic and impressionistic style, presenting a series of scenes and meditations, rather than a narrative life story.

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This is an ambitious and far-ranging book, the result of years of thinking, teaching, and working with patients. An internist at the College of Physicians and Surgeons at Columbia University, Charon sees a wide range of patients in an urban setting. Also a Ph.D. in English literature, Charon has devised a "Parallel Chart" and other means for caregivers to write personally about the dynamics between healer and patient, to read texts--narratives in particular--and, as a result, to listen better to patients, thus improving the delivery of medical care.

Charon defines narrative medicine as "medicine practiced with these skills of recognizing, absorbing, interpreting, and being moved by the stories of illness" (4). She calls this a "new frame" for medicine, believing that it can improve many of the defects of our current means of providing (or not) medical care. Caregivers who possess "narrative competence" are able to bridge the "divides" of their relation to mortality, the contexts of illness, beliefs about disease causality, and emotions of shame, blame, and fear.

Charon finds that medical care and literature share five narrative features; she argues that careful reading of narratives builds skills that improve medical care, including intersubjectivity between caregiver and patient, and ethicality. Beyond the theory, there are powerful and persuasive examples of interactions between caregiver and patient, many from Charon's own practice. A mother of a sick daughter experiences stress that makes her ill; when she sees a narrative connection, she begins to heal.

Charon sees wider applications. As caregivers understand better concepts of attention, representation, and affiliation, they become more ethical, more community minded, and better healers to their patients. Patient interviews will be different: instead of following a grid of questions, physicians will converse with patients in an open-ended way. What is most important will emerge and emerge in ways that are most beneficial to the patient. Yes, this method will take more time but it will be more efficient in the long run. Bioethics, Charon argues, has been limited by legal approaches and philosophical principles. For her, narrative bioethics offers more human values in how people feel, experience reality, and relate to each other. Finally, there are implications for social justice: why are the poor underserved in this country and in many others?

One of the most exciting and radical formulations comes late in the book: ". . . practitioners, be they health care professionals to begin with or not, must be prepared to offer the self as a therapeutic instrument" (p. 215). This notion links up fruitfully with concepts of energy medicine (v1377v), therapeutic touch (Tiffany Field), and intentionality (Wayne W. Dyer).

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Henry Earlforward runs a crowded, dusty bookstore. He meets his neighbor, Mrs. Violet Arb, when they haggle over the price of a cookbook. She refuses to buy the book as she finds every price too high. Henry is a miser and admires her steadfastness. They eventually marry.

Henry is outraged at the cost of the wedding breakfast and grows increasingly annoyed as his new wife insists on spending even more money to celebrate. Sensing a threat to his savings, Henry grows more miserly than ever, refusing to light the stove and eating almost nothing. Violet insists that the maid, Elsie, cook steaks and omelets for them. When her husband refuses to eat them, Violet refuses too.

Henry finally becomes ill. Dr. Raste urges him to go into the hospital, but Henry fears losing his autonomy and his life. He only consents after much arguing. When the doctor arrives to pick him up, however, Violet is much more ill than her husband. She is taken to the hospital, while Henry resolutely refuses to go.

To Dr. Raste, the family is ridiculous and annoying. They are business he must put up with. Henry still holds his purse-strings tight and Elsie is forced to steal money from him to send for news of Violet. Violet dies after an operation for the removal of fibroids from her uterus. She was too undernourished to handle the intervention.

Henry still refuses to change his ways and even leaves his bed to check on his books. He discovers Elsie’s theft. Neighbors find his body on the floor of his office. Elsie and her lover Joe go to work for Dr. Raste.

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This concise and well-written biography is meant to be, as Sherwin Nuland tells us, "a guide for the perplexed," for those who may recognize the name of Maimonides and his historical importance to Jewish religion and culture, or who may even have read some of his works, but have no knowledge of the man behind the name. The story begins, as it should, in Medieval Spain with its vibrant Judaeo-Islamic culture, in which the historical relationship between Judaism and medicine developed and later expanded throughout the European and Islamic worlds. Though they were outsiders in both civilizations, Jewish physicians became the most sought after healers in the Christian and Muslim worlds.

Moses son of Maimon (also known as Maimonides and the Rambam, 1138-1204) was born in Cordoba, the cultural and political center of Muslim Spain. He and his family had to flee Cordoba to avoid persecution in 1148. They wandered through Spain until 1160, when they settled in Fez, Morocco. Again fleeing from persecution, Maimonides moved to Fustat, Egypt, when he was 30 years old and remained there for the rest of his life. During these early years, the young rabbi wrote numerous biblical commentaries, culminating in the Mishneh Torah, his great code of Jewish law. Later, he attempted to reconcile faith with reason in another great work, The Guide for the Perplexed, completed in 1190.

Maimonides's specifically medical work is difficult to characterize and evaluate. The traditional historical assessment is that he was "unique in his time in the theory and practice of medicine." Essentially, he practiced Galenic medicine, as transmitted and developed in the flourishing Islamic tradition. We don't know how he acquired his medical knowledge, but by the time he reached Fustat, Maimonides was acknowledged to be a leading physician and in 1190 he was appointed personal physician to the vizier of Egypt. Late in life, Maimonides wrote a number of medical treatises, most importantly his Medical Aphorisms, which presents a coherent, well-organized, and practical medical system based on Galen and Aristotle.

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Elisabeth Kubler-Ross was born in Switzerland in 1926. She was part of a package deal--a triplet (and a two-pounder at that). That she survived the birth (as did her two sisters, another two pounder and a more robust six pounder) is something of a miracle. As she explains, her early childhood was filled with other more memorable experiences around death as well, including a long battle with pneumonia and deathbed scenes of neighbors in her small town.

In the aftermath of World War II, she was a volunteer in IVSP, International Voluntary Service for Peace. She spent time in Poland and then Germany, aiding survivors of the concentration camps, as well as the defeated Germans, to rebuild their lives. She returned to Switzerland and went to medical school, eventually marrying an American student studying there.

After practicing as a small town family doctor, she came to the U.S. in the 1950s. Her plans to serve a residency in pediatrics were changed to psychiatry (because they didn’t want someone who was pregnant). In Denver, after residency, she was asked to lecture to medical students. She chose a topic that was out of the ordinary, but something she felt at home with--death and dying.

In 1965, in Chicago, she continued her work in this area. At the urging of some theology students she began a weekly seminar with dying patients, health professions students, (and eventually ) their more skeptical teachers. This experience led to the publication, in 1969, of her book, On Death and Dying. It is in this book that the "stages" of dying are discussed. The remainder of The Wheel of Life deals with more controversial aspects of Kubler-Ross’s life.

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This collection contains all the stories in Arthur Conan Doyle's Round the Red Lamp, six additional medical tales (three of which are from the Sherlock Holmes oeuvre), and the published version of "The Romance of Medicine" (1910), an awards ceremony address to the medical students at St. Mary's Hospital Medical School.

Round the Red Lamp (see annotation in this database) received almost universally negative reviews when it was published in 1894. They deplored the fact that Conan Doyle wrote about such "nauseating" and "ghastly" topics. All but one of the stories deal with doctors, disease, or medical practice. (The exception is a gothic tale that has a medical student as its hero.)

For example, "Behind the Times" contrasts the behavior of old fashioned humanistic physicians with that of modern scientifically-oriented physicians; "The Doctors of Hoyland" conveys a very positive image of women physicians; "His First Operation" depicts a first-year medical student fainting in the operating room; and "A False Start" presents a humorous account of Conan Doyle's difficulties in starting his own medical practice.

The three Sherlock Holmes stories are "The Dying Detective" (1913), "The Creeping Man," (1923) and "The Blanched Soldier" (1926). "The Romance of Medicine" is an inspirational essay on professionalism and medical history, somewhat similar in tone to, and contemporaneous with, the essays of William Osler.

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This collection of stories describes "a medical student's journey" (the subtitle) through the difficult terrain of clinical education. In Audrey Young's case, this is also a geographical odyssey from Seattle to Swaziland to Pocatello, Idaho, as she completes her University of Washington clinical rotations and electives. In one sense the main characters of these narratives are the patients the author encounters in clinics and hospitals. As she writes in the Preface, "Patients teach things that the wisest and most revered physicians cannot, and their lessons are in this book."

In another sense, of course, Dr. Young herself is the central character of these stories; this is an account of her journey into doctoring. The author first takes us to Bethel, a Yupik Eskimo town on the Bering seacoast of Alaska, where she had her initiation into clinical experiences in the form of a summer preceptorship. There she learns that patients are far different from textbook examples, as she confronts the social and cultural factors that influence illness and its amenability to treatment. We follow the author to assignments throughout the WWAMI network. WWAMI is the University of Washington's decentralized clinical training program (Wyoming, Washington, Alaska, Montana, and Idaho).

In Spokane she delivers a baby for the first time, supervised by an opera-loving attending physician. In Pocatello she takes care of her first critically ill neonate. In Missoula her life becomes "one of resigned solitude" in her internal medicine clerkship, where she experiences sleep deprivation and experiences sunlight only "through dusty windows."

During her fourth year, the author finds herself treating desperately ill AIDS patients without a supervising physician (he had gone to Zaire for a funeral and might be back the following week) and also without anti-retroviral drugs. However, it is in Swaziland that she learns the deep power and dignity of medicine, as exemplified by a patient who invites her to a dinner in her honor that requires killing one of his precious chickens.

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