Summary:

Under the aegis of the Association of American Medical Colleges and its journal, Academic Medicine, the editor of the Medicine and the Arts column has collected 100 selections for publication in this volume. Each selection is made up of a piece of literature or art relevant to the medical humanities, followed by a commentary that elucidates or elaborates upon the contribution of the primary piece to the practice of medicine.

Given the wide-ranging nature of the art and literature in this collection, essentially every keyword listed in this database could come into play; those denoted above identify broad categories under which fall the works discussed. The artists represented vary from poets of the classical period, to ancient and modern painters, to writers who study the human condition in their fiction or essays. The scope is enormous; the adventure daunting.

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Dr. Constance Petersen (Ingrid Bergman) is a beautiful, unattached psychiatrist whose business-like facade fails to conceal a natural empathy that draws men. For her, however, love is a mere epi-phenomenon, easy to explain and resist, until she meets Dr. Edwardes (Gregory Peck). The famous expert on the guilt complex has arrived to replace the retiring chief (Leo Carroll). Constance is smitten, and so, it seems, is he.

But soon, she realizes that Edwardes is "not well," that he is terrified of dark lines on white: fork marks on a tablecloth; threads in her robe. Worse, she discovers that Edwardes is not, in fact, Edwardes, but an amnesic physician of initials "J. B." who is convinced that he has murdered his analyst. Constance does the right thing by having him removed from work, but she refuses to believe he is a murderer. Wanting to protect her, he leaves. But she, intent on curing her lover, follows him on a journey to retrace his last movements. The task is to recover both a memory and a missing person.

They go skiing (dark lines on white) at a resort where the real Dr. Edwardes had sojourned with his patient-colleague. On a dangerous slope, J. B. suddenly remembers that Edwardes went over the cliff. The body is found, but it has a bullet in the back.

Now hiding from the police, the couple pose as newlyweds and flee to her old mentor in Rochester. Complete with accent and beard, Dr. Brulov (Michael Chekhov) is a delightful double of the recently deceased Sigmund Freud (1858-1939). It emerges that John Ballantine (Peck) never lost his childhood feelings of guilt over the accidental death of his little brother.

In a gruesome ten-second flashback, the tyke is abruptly impaled on a iron-spike fence. This ancient guilt was reactivated by his doctor’s demise and it was sublimated by the defense mechanism of an assumed identity to keep the dead man alive. An idle slip of the tongue reveals the murderer to be the jealous retiree. The killer threatens Constance and then makes a quick end by dispatching himself instead.

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In this collection of 11 short stories, pediatrician-author Perri Klass primarily explores the world of women and their multiple and complex roles as mother, mother-to-be, friend, spouse, lover and professional. Parenthood--its glories, heartaches, tensions and mysteries--plays a prominent role in many of the stories. There is also a close look at woman-woman friendship--at what women say to their best friends and the nuances of the emotional responses to what is said or left unsaid.

Several stories feature single mothers: "For Women Everywhere" (a woman is helped through labor by her best friend), "Rainbow Mama" (a woman cares for her son during his diagnosis and initial treatment of leukemia), and "City Sidewalks" (a woman finds a baby on the sidewalk on Christmas Eve as she rushes to pick up her child from day care).

"In Necessary Risks," an anesthesiologist deals with work and her high energy preschool daughter while husband and easy-to-raise son head out to a dude ranch. In "The Trouble with Sophie," another high energy, dominant daughter wreaks havoc in kindergarten as well as with her concerned parents. In addition to the anesthesiologist, two other physician-mothers are featured in "Freedom Fighter" and "Love and Modern Medicine."

Parenting a newborn whilst handling other tasks is a theme featured in "Intimacy" (a high school biology teacher celebrates her first night of uninterrupted sleep as she both enjoys and envies her single friend's sex life) and in "Dedication" (a writer takes his stepson to a chess tournament while his biologist wife and newborn enjoy breastfeeding at home). Woman friendships are prominent in "For Women Everywhere," "Freedom Fighter," and "The Province of the Bearded Fathers." Grief and sudden infant death syndrome are themes of "Love and Modern Medicine."

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Hilfiker describes a number of his own medical errors. He is concerned with the physical, emotional, social, and economic consequences of medical mistakes, all of which have grown as medicine's ability to cure disease has grown. Hilfiker contends that physicians are poorly equipped to cope with their own mistakes. The nature and practice of medicine are such that it is often possible to conceal mistakes from patients. Should they be concealed? Hilfiker says not. He implies that there are few (if any) circumstances which warrant deception.

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This short autobiographical account gives a flavor of American medical practice in the early part of the 20th century. It also sketches the medical "persona" and the human character of the author's father.

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A physician is summoned to make a housecall on a family with whom he has had no prior contact. He quickly sizes up the situation: the household is poor but clean; the patient is a female child whose parents are nervously concerned, dependent on, yet distrustful of the doctor. The child's beauty and penetrating stare make an immediate impression on him.

Concerned that diphtheria may be the cause of illness, he uses his customary professional manner to determine whether or not the child has a sore throat. But the child will have none of it and "clawed instinctively for my eyes." The attempt at an examination rapidly escalates into a physical "battle" as the physician, convinced that it is crucial to see the child's throat "and feeling that I must get a diagnosis now or never," becomes ever more enraged and forceful while the girl continues to resist with all her strength, and the parents are in an agony of fear for her health and embarrassment over her behavior.

This is no longer a professional encounter. The doctor admits at the beginning of the struggle to having "fallen in love with the savage brat" and recognizes that he is behaving irrationally. The closing sequence could as easily be depicting a rape as a forced throat examination.

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A physician recounts an experience he had assisting an American plastic surgeon as he performed charity surgery in Honduras. One young woman, Imelda, dies of malignant hyperthermia prior to surgical repair of her cleft lip. After her death, the surgeon returns to the patient to finish the surgery. The narrator tries to imagine the surgeon's motivation for this act, as well as the family's reaction to it.

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A third year medical student rotates through a gynecology clinic at the university. The attending Dr. Snarr, is supposed to treat his patients' chronic pelvic pain, but only seems to inflict pain himself. The student/narrator wants to comfort the patients, but lacks the knowledge, skills, and authority. The student also feels uncomfortable with issues of sexuality and intimacy with these female patients.

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The narrator recounts the interview with his physician during which he learned the bad news about his lung cancer--although the word "cancer" is never mentioned. But the interview is marked throughout by signs of imperfect communication. At several points, the physician's grave remarks are matched by diffident, sometimes humorous responses.

For example, when asked if he is a religious man or a communer with nature, the narrator responds "I said not yet but I intend to start today." The culminating account of miscommunication is near the end: "he said something else / I didn't catch and not knowing what else to do / and not wanting him to have to repeat it / and me to have to fully digest it / I just looked at him." The final line clinches the oddly blurred nature of the whole exchange: "I may even have thanked him habit being so strong."

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In this chapter from late in his autobiography Williams focuses on his subjective experience in caring for patients. The unusual truthfulness of patients in need, their "coming to grips with the intimate conditions of their lives," inspires him both personally and artistically, as a poet. The things that patients reveal about themselves and about the human condition not only keep him going as a physician; they are the stuff of poetry, the human truths that lie beneath the "dialectical clouds" we construct to protect ourselves from contact in everyday life.

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