Summary:

Perri Klass, who had already written of her medical school education (A Not Entirely Benign Procedure: Four Years as a Medical Student, see this database), took notes, made dashed journal entries, and saved sign-out sheets and other written memorabilia during her internship and residency in pediatrics at The Children’s Hospital in Boston, Massachusetts. Because she is a writer, she looked at her experiences in medical training with an eye towards what stories were happening. This book then is a compendium of stories and essays (some previously published) about Klass’s pediatrics training.

Klass reflects on the difficulties of being a writer and physician: "I have been a double parasite, not only learning off patients, but also writing about them, turning the agonies of sick children into articles, using them to point little morals either about my own development as a doctor or about the dilemmas of modern medicine." (p. 297) But she also notes the benefits of writing during training: "between life at the hospital and with my family, it seemed that all my time was spoken for, and spoken for again. I needed some corner of my life which was all my own, and that corner was writing . . . I could describe the astonishing contacts with life and death which make up everyday routine in the hospital." (p. xvii)

Part of the book concerns issues of women in medicine; Klass debunks the mystique of the "superwoman"--the professional, wife and mother rolled up into one incredible ball of efficiency and perfection--with a month of laundry spilling over the floor. Klass, as a successful writer, struggles with this label and includes an essay on her experiences with a "crazy person" who anonymously and publicly accuses her of plagiarism in the midst of the stress and responsibilities of residency.

However, most of the book is about being a new doctor--the terror, the patients, the procedures, the other doctors and staff. She writes of first nights in the Neonatal Intensive Care Unit, delivery room crises, adolescents with chronic illnesses, and her struggles as a sleep and time deprived mother.

She addresses difficult issues: moral dilemmas, suffering, loss, the rape and abuse of children, children with AIDS. Throughout the book is a concern for the patient’s experience, as well as the doctor-in-training’s experience. After her first night on call caring for very premature infants she notes: "Maybe my first patient and I have more in common than I realized: we are both too immature to be out in the world, but with a lot of help, we may just make it." (p. 15)

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This is a tight, short poem that takes its central metaphor from the uncredited quote, ". . . a madman attacked Michelangelo's Pietà with a hammer." The speaker is presumably a physician who, with a pathology report on his desk, contemplates the task before him. He likens himself, as bearer of grim news, to an avenging creature about to assault his patient, the Pietà, with a catalogue of cutting and pounding tools as images for the effect of such news on the recipient. The speaker also reflects on his own anger, the anger he feels about his patient's bad fortune, yet ". . . not wanting to judge / the cracked face of God."

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The austere and homesick Breton doctor, René T.H. Laennec (1781-1826) (Pierre Blanchar) and his religious friend, G.L. Bayle (1774-1816) are caring for the hundreds of patients dying of epidemic tuberculosis in the Necker Hospital of Paris. They conduct autopsies on the dead, but cannot predict the findings before the patients' demise, nor can they offer any treatment.

Laennec's sister, Marie-Anne, arrives from Brittany with news of their brother's death from tuberculosis. He confesses his despair over this devastating scourge to his friend, but quickly realizes that Bayle too is doomed. A distant cousin, the widow Jacquemine Guichard Argou, becomes Laennec's housekeeper and companion in philanthropic work for the sick after he is able to reassure her about her health; she engages the widow of Bayle in the same enterprise.

One day in 1816, Laennec is invited by urchins to hear to the scratching of a pin transmitted through the length of a wooden beam. He is thereby inspired to fashion a paper tube to listen to the chests of his patients. With Jacquemine at his side, he joyously announces that he can hear sounds from inside the chest. Feverish research ensues as he links the chests sounds of the dying to the findings at autopsy.

He turns his wooden, cylindrical stethoscopes on a lathe in his apartment, publishes his findings, and marries Argou. Fame and notoriety follow, as Laennec is able to distinguish fatal disease from minor illness and to predict the need for operations; however, he is ridiculed by jealous colleagues. Suffering now himself, Laennec consults his friend Pierre Louis, who tells him that he has tuberculosis. In the final scene, he returns to his native Brittany only to collapse on the stairs of his beloved home and die.

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The young English doctor, Mary Percy Jackson (M.D. Birmingham 1928), went to practice in northern Alberta for a year. She had been recruited by a philanthropic movement that targeted women doctors: they could be paid lower wages and would also cook and keep house. But she fell in love with the subarctic community, its native peoples, and a certain widowed farmer with two young sons, and stayed for the next seven decades.

Dr. Jackson became the only physician responsible for the well being of aboriginals and settlers in a wide radius of remote territory where winters last more than six months and the only effective mode of transportation was the horse. Married and in relative prosperity, she did not seek payment for her medical work, although she appreciated gifts in kind.

Despite the isolation, Jackson was vigilant about nutrition, vaccination, and tuberculosis control and she kept up with the latest advances in health promotion. She and her husband were active in improving opportunities for education. The film closes with a simple party for Jackson, at the local school named in her honour.

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Coulehan speaks to the cadaver (Ernest), beginning with factual observations about his damp face and beard. He then becomes confessional--in fact, by directly paraphrasing the traditional Catholic formula of confession ("Bless me, father, for I have sinned . . . "). He implores the cadaver to reveal himself, to yield the truth of his condition.

In the last stanza, the tears of conjunctival irritation (formaldehyde) become tears of sorrow "for all offenses / to the heart . . . " and "for the violence / of abomination . . . . " Cutting up a corpse is an "abomination," but one that must be accepted and transcended in order to gain the power to heal. In the end, the tears become life-giving rain on the canyon wall.

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This is the third volume of poetry by Bamforth, a physician and scientific translator who practices in Strasbourg, France. Open Workings is precisely that--the poet opens various ideas, places, and events and shows us their inner workings. But we find that the workings are not what we expect.

Some of these poems (e.g. "Between the Rhins and the Machars," pp. 20-23) evoke Scottish folk tales and traditions. "The Fever Hospital" (p. 33) alludes to William Carlos Williams's famous poem "Spring and All," which begins, "By the road to the contagious hospital . . . " Several are set in a mining town in the Australian outback. In "A Clear Thought" (p. 39) Bamforth recalls the "scorched mesas / and camel-track droppings / of overland Australia" where he and his wife, "two transients, / (we) were crossing a language / bigger than its markers." The long sequence (30 poems) called "Doing Calls on the Old Portpatrick Road" provides a richly textured view of the life and interactions of a country doctor, one of whose patients asks, "Why do you call it failure now my heart breaks?" (p. 64)

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This essay is told from the perspective of an ophthalmologist who was consulted about a patient who had blurry vision. She is told by his internist that he has cancer but the family does not want him to know it. She plays along with the deception and does not inform the patient that his vision problems are from brain metastases. By serendipity she later learns that the patient knows his diagnosis but is playing along with the deception so as not to hurt his family. She is relieved to finally talk with him openly about his disease and his prognosis.

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A physician recounts the experience of caring for a small child with an incurable disease. The father brings in a bright stuffed dinosaur for the child and despite all expectations, the child opens one eye and reaches for the toy, then lapses back into a coma. The family and physicians cry together. A week later the child dies. The narrator uses this example to argue that it is the intensity of a physician's experiences and the privilege of being a part of them, rather than whether or not the experience is happy, that gives medicine its meaning and satisfaction.

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A pediatric intern encounters her first dying child. Her initial response is to care for the child, hold him, and try to comfort him. She is told by her attending physician that this behavior is unprofessional. When she cries in response to her stress and grief, she is told she will never be an effective physician. The narrator then describes how she ultimately came to terms with her impulse to cry at stressful times, and how she interacts with patients in her current practice.

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This is the 17th of Patrick O'Brian's novels about the adventures of Captain Jack Aubrey of the British Navy, and his friend, Stephen Maturin, the ship's surgeon and secret intelligence agent. Aubrey is a large, hearty, cheerful man who loves music and astronomy, and whose fortunes wax and wane as O'Brian follows him through numerous engagements and exploits around the world, roughly from 1800 to 1815. (While the early books in this series place Aubrey in some of the actual sea battles of the British war against Napoleon, "real time" gets suspended in the later novels.)

Maturin is small, dark, and secretive; of Irish and Basque descent; and a Roman Catholic. Nonetheless, he hates Napoleon so much that he becomes an agent for the British, working under the intelligence chief, Sir Joseph Blaine. Maturin is also a famous physician and naturalist, and he plays the cello to Aubrey's violin. The two men are the closest of friends, despite their many differences; in fact, this series of novels is the story of two complex and engaging characters and their years of friendship, as much as it is a series of sea yarns and adventures.

In The Commodore, Aubrey and Maturin have returned to England after a protracted trip around the world that occupied the previous four novels. Aubrey happily spends time with his wife and children, but Maturin discovers that his wife, Diana, has disappeared and his young daughter appears to be autistic.

Shortly, Aubrey receives orders to lead a squadron of ships to the west African coast, where he is to harass the slavers and, on the return voyage, to engage a French squadron being sent (secretly) to attack Ireland. Maturin joins the squadron after carrying his daughter to safety in Spain. They successfully knock off some slaving ships and terrorize the Coast of Guinea, before hurrying back to the southwestern coast of Ireland where they catch up with the French ships and defeat them.

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