Summary:

This haunting memoir by a South African surgeon who has witnessed tremendous suffering across the globe is best read as his story, and not a war chronicle as the subtitle would suggest, since large chunks of the book are not about war in the dressing station sense of the term. That said, however, the war that rages inside the author continues throughout the book and gives the reader glimpses of wisdom gained during Kaplan's remarkable journey of life amidst death. The book is culled from journals of writing and sketches that he kept throughout his travels.

Kaplan's first crisis occurs when he joins fellow medical students in an anti-apartheid demonstration in Cape Town and, following the lead of a more senior student, Stefan, tends to the wounded and frightened after riot police attacked the demonstrators. Kaplan then gets the call of not only medicine as service, but surgery as service, when, as a neophyte doctor, he saves the life of a youth shot in the liver by the police.

This feat should not be underestimated, though the author writes with humility. Indeed, in recounting later incidents in which patients die, the odds tremendously stacked against the patients surviving anyway (a woman with disseminated intravascular coagulopathy and multiple organ failure, or the Kurdish boy in a refugee camp with a great hemorrhaging, septic wound), the author's self-chastisement is a painful reminder of how the physician suffers with each loss.

After a beautifully written prologue which begins, "I am a surgeon, some of the time" (p. 1), the book proceeds chronologically, each chapter named for the location of the action. Kaplan leaves South Africa to avoid military service and the fate that befell Stefan, who becomes an opioid addict after euthanizing a torture victim in a horrible scene of police brutality and violence. Kaplan's post-graduate training in England and BTA (Been to America) research stint heighten his sense of cynicism about hierarchy in English society and capitalistic forces in American medical research.

Ever the outsider, Kaplan first returns to Africa (treating victims of poverty, deprivation and violence), then sets off to war zones in Kurdistan, Mozambique, Burma (Myanmar), and Eritrea. In between, he works not only as a surgeon, but also a documentary filmmaker and a cruise ship and flight doctor. He avoids the more established medical humanitarian relief efforts, such as Médecins Sans Frontières, and instead prefers to work where no other ex-pat physician will go--enemy territory, front lines, and poorly equipped dressing stations.

Along the way he decides the number of people he has helped as a surgeon, particularly in Kurdistan, has been small compared to the potential to intervene in broader public health measures (he meets a Swiss water treatment engineer) and occupational health exposés to help abused victims (e.g., of mercury poisoning in South Africa and Brazil). The book ends with Kaplan studying to become an expert in occupational medicine, though, incongruously, in the heart of London's financial district where he treats stress-related illness.

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Veneta Masson’s wonderful collection contains 56 "entries," essays, poems, fragments, and articles about her work as a nurse in an inner-city clinic. Her story is offered not as a neat beginning to end narrative, but as a pastiche of observations that range from commentary on how doctors and nurses approach caregiving, to a poem about Maggie Jones, a patient who changed Masson’s life.

As she follows the growth of the clinic and muses about the professionals and patients who give it life, Masson also talks about nursing: how it was, how it is, and why it’s such an important, and sometimes difficult to define, vocation. Some entries were contributed by Masson’s colleagues, Jim Hall, Teresa Acquaviva, Sharon Baskerville and Katrina Gibbons, but the best are Masson’s own.

This book should be required reading for nursing students, especially entries, "Nurses and Doctors as Healers," A Case for Doctoring Nursing," "Pushing the Outside of the Envelope," "If New Graduates Went to the Community First," "A Good Nurse," "Nursing the Charts," "Tools of the Trade," "Bring Back Big Nurse," "A Ready Answer," "Mindset," "Seven Keys to Nursing," and "Prescriptive Ambivalence." This book, especially for the essays "Nurses and Doctors as Healers," "A Case for Doctoring Nursing," "Prescriptive Ambivalence," and "If New Graduates Went to the Community First," should also be slipped into every medical student’s pocket.

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According to the author's introduction, the most "beautiful and informative images of nursing are found on picture postcards" (xi). He has gathered over 580 full--color postcard images of nursing from 65 nations, documenting nurses' work in peace and war time and documenting, often in breathtakingly lovely images, an important part of nursing's history. Postcards from the years 1893 to 2002 (many of these from the "golden age of postcards," 1907 through World War I) follow nurses from factories to flu wards, from battlefields to mission welfare clinics.

The author has divided his book into seven chapters: "Symbols of Care," "Twentieth--Century Postcard Art," "As Advertised: The Nurse on the Advertising Postcard," "Portraits," "War!" "An American Photo Postcard Album," and "Parade of Nations." Each chapter begins with an intelligent, fascinating explanatory essay by the author, and each chapter ends with copious notes revealing the origins and stories behind the postcards. The book has an extensive bibliography and is well indexed.

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Nisbett, a professor of psychology at the University of Michigan, argues that thinking is not universally the same, in time or around the globe. Specifically, Asians and Westerners vary in what they perceive, how they process it, and what action they might take. Nisbett has studied seminal figures such as Aristotle and Confucius, the geographical and social origins of Greece and China, and clues from the languages involved.

He explains a series of polarities, which can be quickly sketched (Eastern first/then Western): relationships/action, choice; feelings/logic; interdependence/independence; circularity, cycles/linearity; field dependence/divisible categories; harmony/debate; ground/figure; context/focal object; setting/outcome; and multiple causes/single cause and effect. Nisbett has also conducted experiments with students of Eastern and Western backgrounds to demonstrate that such differences are still real.

Finally, he argues that, with globalization, the two traditions will merge.

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A severe synopsis of Foucault's first major work might show how Foucault charts the journey of the mad from liberty and discourse to confinement and silence and how this is signposted by the exercise of power. He starts in the epoch when madness was an "undifferentiated experience" (ix), a time when the mad roamed the countryside in "an easy wandering existence" (8); Foucault shows the historical and cultural developments that lead to "that other form of madness, by which men, in an act of sovereign reason, confine their neighbors" (ix), challenging the optimism of William Tuke and Phillipe Pinel's "liberation" of the mad and problematizing the genesis of psychiatry, a "monologue of reason about madness" (xi).

Central to this is the notion of confinement as a meaningful exercise. Foucault's history explains how the mad came first to be confined; how they became identified as confined due to moral and economic factors that determined those who ought to be confined; how they became perceived as dangerous through their confinement, partly by way of atavistic identification with the lepers whose place they had come to occupy; how they were "liberated" by Pinel and Tuke, but in their liberation remained confined, both physically in asylums and in the designation of being mad; and how this confinement subsequently became enacted in the figure of the psychiatrist, whose practice is "a certain moral tactic contemporary with the end of the eighteenth century, preserved in the rites of the asylum life, and overlaid by the myths of positivism." Science and medicine, notably, come in at the later stages, as practices "elaborated once this division" between the mad and the sane has been made (ix).

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The story itself commences after the vituperative dedication to Robert Southey and several stanzas mocking contemporary heroes, with Don Juan's birth in Seville to Donna Inez and Don José. The adventures begin with his affair with Donna Julia, his mother's best friend. Donna Julia's husband, Don Alfonso discovers the secret romance, and Don Juan is sent to Cadiz. A shipwreck along the way sees him stranded, the lone survivor; there he meets a pirate's daughter, Haidée. Expelled from this paradise by Haidée's father, the pirate Lambro, he is captured, and sold into slavery.

Gulbayaz, one of the Sultan's harem, has him purchased and smuggled into her company dressed as a girl; after he spends the night in the bed of one of her courtesans, Gulbayaz threatens both with death. When next we see Don Juan, he has escaped. He joins in the Russian attack on Ismail, where he fights valiantly and rescues Leila, a Muslim child. They are taken to St Petersburg, where he impresses Catherine The Great and joins her entourage. Due to illness, he is sent to London, where, as an ambassador for Russia, he joins the Court and finds for Leila a suitable governess; the final cantos see him amongst the Lords and Ladies of British aristocracy, in particular Lady Adeline and the mysterious Aurora Raby.

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Gulliver's Travels consists of four voyages, each of which involves Gulliver ending up on a distant shore where he encounters its strange and wonderful inhabitants. The first voyage finds Gulliver stranded on Lilliput after a shipwreck. Here, he is neatly captured by the famous Lilliputians, "human Creature[s] not six inches high" (5). Gulliver is a source of fear and awe to them, and participates somewhat helpfully in the Lilliputian war against Blefuscu, a lengthy conflict that has arisen between the big-enders and little-enders (depending upon which side of a boiled egg one must crack in order to eat it). Court intrigue and resentments, including the accusation of adultery with a Lilliputian, soon require of him that he escape an assassination attempt.

He returns to England, only to set off again on another voyage. A storm, a longboat journey to fetch water, and abandonment by a terrified crew, leaves him in Brobdingnag where he is captured by giants "as Tall as an ordinary Spire-steeple." (65). Gulliver becomes something of a pet, amusing and entertaining the Brobdingnagians with his exploits and size, competing with the royal dwarf and endearing himself to these massive people. While in transit to the Frontiers, a giant eagle captures him in his travel-box (imagine a carrier with holes punctured in the top to transport a small pet) and drops him into the ocean, where he is rescued by more familiarly-sized humans.

The third voyage finds Gulliver captaining a ship until conquered by pirates, who set him off on a longboat, where he makes his way to Laputa, Balnibari, Glubbdubdrib, Luggnagg and Japan. He encounters the flying island of Laputa, the never-dying Struldbrugs (who nevertheless age and become decrepit), and the Academy of Lagado, with its - to use modern vernacular - "fringe scientists". After returning to England by way of Japan, and somehow still restless, he commences a fourth voyage, again as a captain but this time a mutinous crew abandons him in the Land of the Houyhnhnms, populated by the rational race of horses and the putrid yahoos.

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Gilbert begins her narrative with the event that inspired her to write: her husband's death in 1991 after a routine prostatectomy. "Though he was in robust health apart from the tumor for which he was being treated, Elliot died some six hours after my children and I were told that his surgeon had successfully removed the malignancy. And for the first six months after he died, death suddenly seemed plausible ... "(1).

But whereas her book Wrongful Death (annotated in this database) deals with Elliot Gilbert's death, the present work takes the author through death's door into personal reflection and research across a vast area, including personal, cultural, and literary aspects of death. Larger than a memoir, her work universalizes her personal experience with dying and death. And writing is what she does and what she has to do: "THIS is the curse. Write" (92).

Gilbert divides her material into three main sections, each containing several subsections: 1. Arranging my mourning: five meditations on the psychology of grief; 2. History makes death: how the twentieth century reshaped dying and mourning; and 3. The handbook of heartbreak: contemporary elegy and lamentation. The 27 illustrations she has selected range from the Isenheim Altarpiece by Matthias Grünewald to recent photographs by Dan Jury, to Maya Lin's Vietnam War Memorial. In these symbolic representations, Gilbert finds our universal fear of the process of dying, "If this is what it is, GrŸnewald seems to be telling the viewer, for Our Lord to die the death, what must it be for those of us less staunch, less noble - in short, less divine?" (115).

Traditional elegy, by John Milton and Percy Bysshe Shelley, on the other hand, seeks to comfort the poet and reader with the hope of a life hereafter, but modern secular poets like William Carlos Williams and Samuel Beckett offer no solace at all. The older term "expiration" gives hope that our spirit may survive our death. But "termination," the twentieth-century word for death, describes how humans and animals die, in our post-Darwinian world. Her word for this is nada. The holocaust stands as the ultimate ex-termination, or death by technology.

Seeking to understand Sylvia Plath's disease- and death-filled poetry, Gilbert travels literally to Berck-Plage, France, and figuratively, through the notorious "Daddy," "Lady Lazarus," and "Getting There." As a woman and a writer, Gilbert is fascinated by Plath: "For perhaps more than anyone else - more even than her much-admired Wallace Stevens himself - she really did articulate not just the vision but the 'mythology of modern death' that Stevens tentatively proposed" (310). The author contrasts Plath with nineteenth-century Walt Whitman who said, "... to die is different from what anyone supposed, and luckier" (332). Whitman seems to be ambivalent or even positive towards death; Emily Dickinson, of his same century, finds death terrifying.

Ultimately, modern death is embarrassing; death avoidance prevails, notably among doctors. This despite the fact that the first patient a medical student sees is a cadaver. Death is a doctor's failure and it is easier to blame the patient than to accept the death. Death in an American hospital is a "humanectomy", or physical removal of the individual's humanity as she/he is attached to IVs, monitors, feedings tubes, and other mechanical devices.

Modern hospital death is demeaning, because patients are granted little privacy, their TV sets are set to blaring; all personnel, including doctors, enter their rooms unannounced: "Whereas the patient is emotional - fearful, angry, needy - the doctor is detached, abstract, 'objective' " (189). Clearly, the author still lovingly mourns her dead husband bleeding to death alone in a hospital room. Energized by lost love, she writes and documents and works her way toward death.

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The description on the cover of this collection of essays states that it is "candid firsthand accounts of the profound experiences that transform medical students into doctors". It is edited by a woman breast surgeon (Susan Pories) who teaches students in the Harvard Medical School Patient-Doctor Course; a MD/MBA candidate (Sachin Jain) who anticipates a career as a clinician , scholar and activist; and a psychiatrist (Gordon Harper) who is director of the Patient-Doctor III course at Harvard. The short forward is by physician-writer Jerome Groopman. The 44 essays are divided into sections by theme: Communication, Empathy, Easing Suffering and Loss, and Finding a Better Way. I found it helpful to read the short biographies of each student in the back of the book, before reading that student's essay.

The diversity of the essayists is very wide which makes for a broad look at many important issues. There are several subjects that we tend to avoid (student response to the nude body, the presence of students when end of life decisions are being made, the tensions between caring for a patient and having to do something which causes pain, trying to think of patients a people as well as complex biomedical problems). One of the editors wishes that the book will help people understand the working of the hospital and the many ways in which new doctors learn. The book is certainly a personal look at the teaching hospital from the students' view.

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Pym’s novels depict ordinary life among middle class Englishmen and women with compassion, humor, and irony. The quartet denoted in this title consists of two men and two women in their sixties, the autumn of their lives. These characters hold menial jobs at the same office in London during the nineteen-seventies; two live in rented rooms, and two own their own small houses. Pym’s opening chapter catches them going to the library, because it is free. She clues us in to their personalities by describing their hair: Edwin’s hair is “thin, graying and bald on top”; Norman’s hair is “difficult”, as he is; Letty wears her faded brown hair too long and soft and wispy. Marcia’s hair is “short, stiff, lifeless” and home dyed. (1-2)

Only Letty visits the library because she likes to read; the others take advantage of the shelter it offers. Edwin frequents the local churches when there are masses or holiday celebrations with sherry and perhaps free food. Pym depicts their office routines, conversations, and uneventful lives. When Letty and Marcia retire, the (acting) deputy assistant director wonders what they have done during their working life: ”The activities of their department seemed to be shrouded in mystery – something to do with records or filing, it was thought, nobody knew for certain, but it was evidently ‘women’s work’, the kind of thing that could easily be replaced by a computer.” (101)

Letty moves in with another woman, and Marcia, alone in her house, wears her old clothes and forgets to eat. She resists the well-meaning social worker knocking on her door. Letty begins thinking of her failures: she did not marry, and she has no children or grandchildren. After some time, Edwin arranges a reunion at a restaurant; Letty tries to be upbeat: ”She must never give the slightest hint of loneliness or boredom, the sense of time hanging heavy.” (134) Marcia complains about the social worker and brags about her “major operation”, a mastectomy. She takes the bus to her surgeon’s, Mr. Strong’s, house to spy on him, and her encounters with him are her happiest moments. After Marcia’s decline into dementia and lonely death, the three office mates meet at her house, which Marcia has willed to Norman. Here they divide up the contents of her cupboards: the tins of sardines, butter beans, and macaroni cheese. They find an unopened bottle of sherry and toast each other as they remember their deceased friend.

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