Summary:

Helen van Horne, the good doctor, has left her solitary practice as a physician in rural East Africa to become chief of the Department of Medicine at City Hospital. She is a tough, hard-as-nails woman who has given up the comforts of marriage, family, and human indiscretion for her profession. While the folks in South Bronx initially "hate" her because of her skin color, they soon learn that van Horne is a model of rectitude, dedication, and compassion. The Hispanic chief resident becomes her disciple.

Van Horne's yearning for human comfort and sexual gratification brings her into intimate contact with a lazy, irresponsible, but charming male student. Out of weakness, she tells the failing student that he will pass the rotation, but is later challenged by the chief resident, who has left her own lazy husband and dedicated herself to be "just like you." Van Horne realizes her own weakness, allows the failing grade to be recorded, then contemplates (but rejects) suicide.

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A physician stands in the laundry, folding her baby’s diapers, and thinks about Mr. Dantio, who died of wildly metastatic cancer. She reflects on the development of her relationship with Mr. Dantio during the time that she was pregnant. Toward the end, he developed a lung infiltrate, maybe a type of pneumonia. There was a chance that a biopsy might have helped--perhaps he had a treatable infection--but she recommended against it. Now she wonders about this decision. She wonders also about what the other physicians think of her: "you don’t really want to be a doctor anyway, you must be conflicted to have a child . . . . " She remembers seeing Mrs. Dantio in the supermarket shortly after her husband died, and crying with her. She asks herself: Will I ever be a REAL doctor, "because in moments of great stress I revert to my native tongue."

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A medical student at Lincoln Hospital in the south Bronx is called to the Emergency Room, where a gang war is going on. She plunges through fighting bodies in the waiting room to reach the treatment area, where she is enlisted to ride an ambulance with a critically injured and intubated patient. During the trip, the ambulance jerks, the tube comes out, and the student tries but fails to ventilate him with mouth-to-mouth respiration. At the other hospital, she is turned away from the cafeteria because her clothes are blood-soaked. The patient dies. Although she feels terrible, her friend Marie, a practical nurse, comforts her with a touch of ordinary love, a photo of her new grandchild.

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Twelve contemporary stories set in Rhode Island and New York City. Major themes include the pain of cultural dislocation and cross-cultural experience ("Theng," "Shambalileh," "My German Problem"); human frailty and self-deception ("Sleep," "Juilliard"); and the personal and moral dimensions of medical practice. See the separate annotations for Laundry, The Good Doctor and Ambulance--three stories which are particularly relevant to Literature and Medicine.

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Dr. Cassell examines the social and cultural forces that encourage the practice and teaching of a medicine that is governed by the disease theory. This theory discounts the impact of illness on the patient and ignores the suffering that the patient is experiencing. Cassell does not debunk science and technology, rather he encompasses them within the moral enterprise of medicine as tools for helping patients.

The ability to provide compassionate attention to the patient as individual (i.e., with unique values, life experiences, family interactions, etc.), trustworthiness and self-discipline are required characteristics of a "good physician." Cassell illustrates and personalizes the philosophical shift towards focusing on the sick person with stories and anecdotes.

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This novel is set on San Pedro Island off the coast of Washington in 1954. Kabuo Miyamoto, a member of the island's Japanese-American community, is on trial for the murder of Carl Heine, a fellow fisherman. Heine's boat was found drifting one morning, with his body entangled in a net. While the death initially appeared accidental, bits of circumstantial evidence accumulate that seem to implicate Miyamoto.

Miyamoto's family was unjustly cheated out of some land by Heine's mother during the time the island's Japanese community was incarcerated in a "relocation camp" in California during the War. The dead man's traumatic head wound appeared suggestive of a Japanese "kendo" blow. Carl Heine's blood type was found on a wooden gaff on Kabuo Miyamoto's boat.

As the trial proceeds, the story of Carl, Kabuo, and what happened that night gradually evolves, as does the tale of Ishmael Chambers, the local newspaper reporter, who had a "charmed love affair" with Kabuo's wife when they were both adolescents, just before the Japanese families were sent away in 1942. It is clear, however, that this is more than a story of one man's guilt or innocence; it is a story of a community's fear and prejudice against the Japanese-Americans in its midst.

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This autobiographical account of Dr. Lown's five decades of practice and research in cardiovascular medicine is both a history of the field and a history of a man passionately interested in people and healing. The book is divided into six sections: Hearing the Patient: The Art of Diagnosis; Healing the Patient: The Art of Doctoring; Healing the Patient: Science; Incurable Problems; The Rewards of Doctoring; and The Art of Being a Patient.

The first three sections comprise the bulk of the book: Lown chronicles his early medical training and career through stories of memorable patients, anecdotes about key role models (particularly Dr. Samuel A. Levine), and histories of medical mistakes, diagnostic acumen, and his remarkable research innovations. These achievements include the introduction of intravenous lidocaine, cardioversion and defibrillation, and development of the coronary care unit.

The core of the book, however, is about how deeply Lown cares for his patients. He states, “This book is a small recompense to my patients, ultimately my greatest teachers, who helped me to become a doctor.” The book contains many reflections on medical practice, such as this definition of medical wisdom: “It is the capacity to comprehend a clinical problem at its mooring, not in an organ, but in a human being.”

In a thoughtful chapter on death and dying, Lown muses on his emotional and spiritual responses to encounters with death, and bemoans the medical profession's increasing tendency to “put technology between us and our patients, to spare us the grief of failing to confront our own mortality.” In the final chapter, Lown takes an unusual twist, and writes a treatise to patients on how to get the doctor to truly pay attention to them and what are reasonable expectations to have of one's doctor.

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As you are now, so once was I; Prepare for death and follow me. The novel's advisory epigram prepares readers for the realities of aging and death which affect both narrator and reader. Following surgery, Caro Spencer is delivered to Twin Elms, a nursing home in a rural New England setting. While this intelligent woman requires only short-term care, she is deposited, permanently, in an understaffed, sub-standard care facility by relatives unwilling to add her minor but time-consuming difficulties to their own.

It is not a pretty setting. The staff is overworked and demeaning, especially to the new resident who is well-educated and accustomed to better circumstances. The nursing home routine is careless of individual differences and needs, and set up to strip away autonomy and dignity through petty and cruel indignations.

Caro is able to survive by keeping a secret diary for observations, reflections, and interpretations; ultimately, this alone sustains her. While the voice is that of an elderly woman (as we are now), the journal is for us, those still able to manage their lives, but unable to predict or control end-of-life events.

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The 22 short stories in this volume are lively, economically written accounts of medical and epidemiological investigations over a thirty year time span from the mid-1940's to the late 1970's. Similar to the "clinical tales" Oliver Sacks (see this database) and others have more recently popularized, these stories are full of medical detail interspersed with dialogue, and are narrated in the manner of popular mysteries.

Even technical medical problems are made comprehensible to a lay audience without oversimplification. "Eleven Blue Men," the opening story details an investigation of eleven simultaneous cases of cyanosis traced to a particular salt shaker. "The Orange Man" traces the investigation of a rare case of carotenemia-lycopenemia. "The Dead Mosquitoes" recounts a strange outbreak of reactions to organic-phosphate poisoning traced to a batch of blue jeans. All the stories are notable for the relative rarity of the cases on record.

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The Stone Diaries recount the life of Daisy Goodwill (1905-199? [sic]). "[W]ife, mother, citizen of our century," her son closes the benediction of her memorial service. Yet Daisy is also the orphaned daughter of an orphan--her dramatic birth a turning point for her father, the neighbours--and a social outcast. Daisy becomes a happy child, a lifelong friend, a college graduate, a consummate gardener, a cultivator of stories, a pragmatist, a romantic, a widow twice (once scandalously, once more ordinarily) . . . . In short, the diaries of "Day's Eye" bear witness to the extraordinary lives of seemingly ordinary "citizens."

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