Summary:

In The Mysteries Within, Sherwin Nuland takes the reader on a guided tour of selected organs inside the human body. Beginning with the stomach, he progresses along to visit the liver, spleen, heart, uterus, and ovaries. At each point he addresses various historical and contemporary beliefs, as promised in the book's subtitle, "A Surgeon Reflects on Medical Myths." Nuland brings to this endeavor the patented mixture of personal story, elucidation of medical history, and plain old good writing that characterizes all of his books.

For example, he devotes the first three chapters to the stomach. The first consists mostly of a brilliant clinical tale in which a six-week-old baby is found to have a wax bezoar in his stomach. The second and third provide a cogent survey of beliefs about the stomach's function, beginning with Greek humoral theory, continuing through van Helmont and the iatrochemists, and ending with Ivan Petrovich Pavlov and his seminal monograph, The Work of the Digestive Glands.

Van Helmont and his mentor, Paracelsus, appear again and again in later chapters as the earliest champions of the idea that the body runs by means of chemical processes (iatrochemistry). However, as Nuland points out, Paracelsus has left us two different legacies. One is his devotion to chemistry and experimentation, which eventually led to modern biological science. The other is his devotion to alchemy and mysticism, which makes him as well a forerunner of contemporary irrational systems of healing.

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Fridolin, a doctor, and his wife, Albertine, have been married for a few years and are the parents of a much adored little girl. In a moment of unusual frankness, they decide to confess all their temptations and adventures to one another. Albertine admits that she deeply desired a blond Dane encountered in the previous summer. Fridolin professes to welcome this news and tells of similar attractions. They promise to confide the sexual adventures of their waking and dreaming states.

But Fridolin is not at ease. The idea that his wife desired another-even in a dream-inspires a jealous energy that sends him in search of adventures that will reassure him of his own desirability and hurt if not repudiate Albertine. On the pretext of a house call, he wanders, masked and unmasked, through the decadent private clubs and cafés of night-time Vienna. He toys with the dismal daughter of a patient, an "unspoiled" prostitute, and a sophisticated matron--none of whom he actually claims, all of whom remind him of his wife, one of whom dies, he believes, in protecting him.

Uncertain if his adventure was reality or dream, he returns with tenderness to Albertine, although he has repeatedly vowed to leave her. He tells his entire story; she listens with better grace than he would have done. Then he asks what they should do. She replies that they should be grateful to have "emerged safely from these adventures" . . . "neither the reality of a single night nor even of a person's entire life can be equated with the full truth about his innermost being." "And no dream," he responds "is altogether a dream." (p. 98-9). They begin another day.

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The Physician in Literature is an anthology edited and introduced by Norman Cousins that aims to illustrate the multiple ways in which doctors are portrayed in world literature. Literary selections are organized into 12 categories including Research and Serendipity, The Role of the Physician, Gods and Demons, Quacks and Clowns, Clinical Descriptions in Literature, Doctors and Students, The Practice, Women and Healing, Madness, Dying, The Patient, and An Enduring Tradition.

Some of the notable authors represented in this collection include Leo Tolstoy, Herman Melville, Albert Camus, William Shakespeare, Charles Dickens, George Bernard Shaw, Anton P. Chekhov, Orwell, Fyodor Mikhailovich Dostoevski, Ernest Hemingway, Thomas Mann, Gustave Flaubert, and Sir Arthur Conan Doyle. A healthy dose of William Carlos Williams makes for some of the most enjoyable reading ("The Use of Force" and excerpts from his Autobiography).

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Andy Safian (Bill Pullman), an English professor, and his wife Tracy (Nicole Kidman), recently married, have bought a new house. Short of money, they take in a lodger, Dr. Jed Hill (Alec Baldwin), a surgeon who went to high school with Andy. Tracy suffers from mysterious abdominal pains and then has to have emergency surgery when an ovarian cyst ruptures. Jed Hill performs the surgery. He finds that her other ovary appears necrotic and removes it. It later turns out to have been healthy.

Tracy sues for malpractice and receives a huge settlement. She then leaves her husband, who gradually realizes that she and the surgeon had been lovers and that he has been the victim of their complex con game: she has sacrificed her fertility and Dr. Hill his career in exchange for the millions of dollars paid out by the hospital's insurance company. Andy sets about seeking revenge.

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Spencer Nadler, a surgical pathologist for over 25 years in southern California, offers 8 essays, as well as an introduction, epilogue and 9 full color histopathology plates in this collection. As he explains in the introduction, Nadler began his training in surgery, but, during a required year of surgical pathology, he finds his true vocation: "I realized a flair for surgical pathology that I had never demonstrated in surgery." (p. xix) However, over the years, he realizes he misses patient contact--these essays, written over 10 years, are forays into an unusual relationship: the pathologist-patient relationship.

Each essay is about a different patient (or other contact) and tissue. One of the most compelling is the first, "Working Through the Images," in which a woman (Hanna Baylan) with metastatic breast cancer seeks Nadler out so that she may view her cancer cells. She arrives in his office unannounced at 6 p.m. and he proceeds to not only show her the slides, but to listen to her. He becomes a witness to her pain, loneliness, sorrow and hope.

"For years I have processed thousands of such cases, determined the manifold forms of disease, but I've never been an intimate part of anyone's illness, never felt the connections of cells to a larger self." (p. 12) During later visits, Baylan cries in his arms and even brings her youngest son in to meet Nadler and view her cells. By this time, Nadler is completely connected to her: "This is heartrending to me, for I have come to love her . . . I can no longer think of Hanna in terms of the cells I see on her slides." (p. 21)

Other chapters highlight fat and bariatric surgery; neurologic disorders such as brain tumor, Parkinson's, Alzheimer's and paraplegia; heart disease; sickle cell disease; and palliative care. Each chapter conveys Nadler's visual sophistication and ability to graphically describe cells. For instance, within a fat cell "a large fat globule steamrolls other cell contents flat against the outer membrane until it bulges like a mozzarella." (p. 32) More importantly, Nadler ably extends his cellular acuity to the larger human dimension.

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Sir Luke Fildes's eldest son Phillip died Christmas morning, 1877. He was attended by Dr. Murray, who directed all of his attention and care to the patient during the child's fatal illness. This unswerving dedication impressed Fildes.

Ten years later, when Sir Henry Tate commissioned Fildes for a painting to exhibit in what was to become the Tate Gallery, Fildes was given freedom to choose the subject matter. Fildes immediately decided to depict this scene of a family physician holding a bedside vigil by a seriously ill child. However, the painting was not begun for four years, and then only at the urging of Tate.

The shade of a lamp is tilted so as to bestow light on the two central figures: the physician, and especially, the recumbent child. The physician faces away from the bottled medicine and cup on the table and directs his gaze fully on the child. He is dressed neatly and sits calmly, patiently, resting his bearded chin on his hand.

The small child is central in the picture, in a white nightshirt on a large white pillow and covered with pale blankets. The makeshift bed consists of two unmatched dining room-type chairs. The child's hair is tousled and the left arm flung out, with hand supinated and beyond the edge of the pillow. Nonetheless, the child rests quite peacefully, as the pose appears quite natural.

To the right and rear of the painting are the parents. They are placed in such deep shadows that it is frequently difficult to make out these figures in reproductions. The mother sits at a table and hides her face in her clasped hands. The father stands beside her, with a comforting hand on her shoulder, as he gazes at the physician.

The painting is set in the interior of a small cottage. Rafters are low, furniture simple. Colors are muted; earth tones predominate. Although the majority of the light comes from the lamp, a bit of light also enters from the recessed window near the mother.

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This is an anthology of poems written by physicians from ancient times through the early part of the 20th century. It includes a great variety of work: poems by well-known physician-writers like Oliver Goldsmith, John Keats, Oliver Wendell Holmes, Sir Arthur Conan Doyle, and William Carlos Williams; poems by distinguished physicians who are not usually remembered as creative writers, such as Edward Jenner, Erasmus Darwin, S. (Silas) Weir Mitchell, and Sir Charles Sherrington; and others by currently little-known physicians.

In the Preface, the editor admits that the genre of "medical poetry" may not have very high standards. For example, she quotes one author as saying that it is generally "poetry in quotation marks and much of it is feeble stuff." However, poetic expression that arises from clinical experience has dignity and value insofar as it reflects "the spirit of helpfulness which gives to the medical profession its value to humanity." The last quotation is attributed by the editor to William Osler, although she cites no reference. Interestingly, the medical professor as reflected in this anthology is entirely male; of 110 poets represented, not one is a woman.

In an "Afterthought" the physician-poet Merrill Moore comments further on the theme of mixing medicine and poetry, presenting the literary equivalent of some insipid "pearls"; for example, "The way he writes is possibly a little different" and "the physician-poet does not quite reach the peaks of spiritual elation and emotional release . . . that a Byron or a Shelley achieves." Profound, huh?

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The author provides a historical review of physicians who became famous practicing a profession other than medicine. Most of the article focuses on physician-writers, beginning with Francois Rabelais, and including both well-known and obscure figures. There are extensive comments on Louis-Ferdinand Celine, Gottfried Benn, Friedrich Wolf, Mikhail Bulgakov, Oliver Goldsmith, Anton P. Chekhov, Arthur Schnitzler, W. (William) Somerset Maugham, Sir Arthur Conan Doyle, Oliver Wendell Holmes, William Carlos Williams, among others. The most complete discussion (5 pages) is devoted to Sir Arthur Conan Doyle.

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Many years later, a plastic surgeon is still haunted by memories of the war atrocities he committed as an infantryman in the Vietnam War. He returns to Vietnam searching for atonement. He spends two weeks there as a medical volunteer, repairing the cleft lips and palates of 30 children. He meets the director of the hospital, Dr. Lieh Viet Dinh, who once was a member of the North Vietnamese Army.

During the war, Dr. Dinh was tortured and both his thumbs were cut off. He asks the plastic surgeon to perform a toe transplant to replace one of his missing thumbs. Despite the initial optimism of both men, the operation ultimately fails as the digit becomes gangrenous and then dead. Once again, Vietnam has proven to be a dangerous place seeping hardship and disappointment. Only now the surgeon is capable of accepting the land and its risks as he makes peace with the country and himself.

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Kirklin, a physician and Lecturer in Medical Humanities at the Royal Free and University College Medical School, and Richardson, a historian and associate at the Wellcome Trust Centre for the History of Medicine, are both educators in medical humanities in London. This well-written and concise volume focuses on "the role of the humanities in medical education" and is aimed at "those wishing to integrate medical humanities into their own teaching, and learning." (p. xv) The chapters are written by a variety of educators with a wide range of backgrounds, including artist, medical student, writer, nurse, surgeon and philosopher.

At least two stimuli are cited as reasons for the development of this book: (1) the 1993 publication by the General Medical Council of Tomorrow's Doctors which recommends the inclusion of medical humanities in the required curriculum for undergraduate medical education in the UK and (2) a national conference, "The healing arts: The role of the humanities in medical education" in London, March, 2000. The rationale for such a book is delineated in several prefatory statements including remarks by Professors Sir David Weatherall and Sir K. George M. M. Alberti (Alberti is the president of the Royal College of Physicians). The book concludes with recommendations for further reading, schemata for undergraduate and graduate degrees in medical humanities at University of Wales, Swansea, and an index.

The nine chapters in this volume combine pedagogic philosophy, citations for literature and art and how to encourage reflection about these selections, tools for encouraging student creativity, reproductions of art and literature generated by students or patients or used by teachers for discussion, and some practical advice about teaching medical humanities and its, at times, uneasy connection to the rest of the curriculum. Each chapter reflects the individual contributor's area of expertise and experience. For example, in "Fostering the creativity of medical students", the authors Heather Allan, Michele Petrone (who painted the striking cover art), and Deborah Kirklin provide useful guides for teaching creative writing and art production by students studying cancer and genetic disease.

In a particularly insightful chapter, "Medical humanities for postgraduates: an integrated approach and its implications for teaching," Martyn Evans describes the challenges of developing a full-fledged interdisciplinary program for graduate as well as undergraduate studies in Wales. He addresses concerns about "bolt-on" versus integration of medical humanities in the curriculum, risks of superficiality, and how such studies may transform the culture of modern medicine. Several chapters address a theme (such as "clinical detachment" or understanding the patient's perspective) and include topic-specific sources and guidelines.

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