Summary:

Suzanne Poirier has studied over 40 book-length memoirs describing medical training in the United States. These texts vary in format from published books to internet blogs, in time (ranging from 1965 to 2005), and in immediacy, some reporting during medical school or residency while others were written later--sometimes many years later.

A literary scholar and cultural critic, Poirier analyzes these texts thematically and stylistically, finding pervasive and regrettable (even tragic) weaknesses in medical education. Her three major points are these: such training (1) ignores the embodiment of future doctors, (2) is insensitive to the power relationships that oppress them, and (3) makes it difficult to create a nurturing relationship--especially by tacitly promoting the image of the lone, heroic physician.

While some of these repressive features have improved in the last decade or so--in contrast to the momentous scientific progress--there is a general failure to deal with the emotional needs of persons in training as they confront difficult patients, brutal work schedules, and mortality, both in others and in themselves.

In her conclusion, Poirier describes some contemporary efforts to help medical students write about their feelings, but she also sees the negative consequences of "an educational environrment that is inherently hostile to such exercises" (169).  Her challenge is this: " "Emotional honesty is a project for all health professionals, administrators, and professional leaders" (170).

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The overworked doctor-narrator finds himself extremely irritated by the requests of a poor immigrant couple in their twenties to examine their infant. He spouts an alarming number of cultural and economic prejudices and tries to avoid seeing them. They persist, however, and the doctor examines the child, whom he finds healthy. The husband then asks if the doctor can examine his wife. The doctor flashes his anger again but agrees.

He finds her legs extremely bowed, probably from severe childhood rickets, and asks the husband about her history. It turns out that she had grown up in Poland during World War I and had lost all her family. As he hears of the woman's suffering, the doctor becomes empathetic, suddenly understanding the couples' fearful tenacity which had so annoyed him before. The woman responds in kind, and the doctor-patient relationship changes significantly for the better.

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Medicine and religion cross paths in the examination of miracles and the canonization process of Roman Catholic saints. The author of this book, a medical historian and hematologist, compiles an impressive amount of data procured largely from four trips to the Vatican Secret Archives. She reviews 1,400 miracles from the time period 1588 to 1999 and discovers that 95% of these phenomena involve the healing of a physical illness. The author scrutinizes the nature of these miracles and investigates the dynamics and beneficiaries of them.

Medical expertise plays a central role in the substantiation of miracles. After all, miracles that involve healing imply a failure of medical treatment. Over the centuries, any physician providing testimony about the occurrence of a possible miracle must address two issues. The doctor must confirm the hopelessness of a patient's prognosis. The doctor must admit that the positive outcome of the case is nothing short of astonishing. The text is adorned by some splendid and strange paintings that illustrate people requesting or receiving miracles. It profiles celebrities in the history of the canonization process such as Prospero Lambertini (Pope Benedict XIV) and Paolo Zacchia.

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This study sets forth the mystery of scurvy  which devastated the British Navy during the eighteenth century. Among several diseases common on board, including yellow fever, typhus, or typhoid fever, syphilis, tuberculosis, and dysentery, scurvy was the most devastating. Caused by a lack of vitamin C, scurvy’s symptoms appear as swollen and bleeding gums, livid spots on the skin, and prostration. Untreated, the illness results in agonizing death. When Commodore George Anson’s flagship, Centurion, sailed from Plymouth in 1741, rounded Cap Horn and returned to Britain, his ship carried home only two hundred of the two thousand men he set out with. A deadly combination of voyages lasting a year or more, unhealthy conditions on board, including malnutrition, filth, crowding, ignorance about basic facts of biology, as well as inexperienced sailors pressed into crewing on ships managed by violent officers using harsh physical punishment resulted in millions of deaths at sea from the age of Columbus to the nineteenth century, when scurvy remedies were finally found.

Bown credits three men with discovering a solution to the mystery of scurvy: a surgeon, James Lind (1716-1794), sea captain James Cook (1728-1779), and a  physician, Gilbert Blane (1749-1843). Lemon juice had been known to prevent and cure scurvy since the 17^th century, but 18^th century medical men disregarded empirical knowledge in favor of the theory of humours.

James Lind entered the Royal Navy as a surgeon’s mate in 1739 under appalling conditions similar to those described by Tobias Smollett in Roderick Random (1748). He initiated a two-week controlled experiment where he separated the afflicted sailors into 6 groups who each received a different diet: cider, vitriol, vinegar, sea water, oranges and lemons, and nutmeg paste. The group receiving the oranges and lemons obtained the best results. Lind published his treatise on scurvy in 1753. However, he was unable to explain the causes of scurvy and why oranges and lemons led to its cure.

James Cook circumnavigated the world 3 times. On his lengthy voyages, he stopped for fresh fruits and antiscorbutics wherever he could, as he noticed these kept the seamen free of scurvy. Cook showed that scurvy was curable, but not why.

During the War of American Independence, Gilbert Blane served as a physician on board several warships in the British Navy. He instituted a diet of fresh fruits and better hygiene on board ship. He published Observations on the Diseases Incident to Seamen, in which he advocated using oranges and lemons to cure scurvy. He advised that lemon juice be mixed into the sailors’ grog.

The British Navy encountered an historic ordeal in 1805 with the Battle of Trafalgar. Admiral Nelson, commander of the British Navy, had nearly died from scurvy in 1780. Now he faced Napoleon Bonaparte and the French fleet. Bown argues that the near- elimination of scurvy on board their ships contributed mightily to the British victory.

A timeline, from 1492 to 1933, concludes the volume. Recommended readings, a bibliography and an index are provided.

 

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This collection of stories offers a sidelong view of medicine from the perspective of a thoughtful, experienced doctor of internal medicine at a teaching institution (UCSF) in an urban setting that brings a wide variety of types of patients to his door.  In a context of evident respect and admiration for even the quirkiest of them, Watts admits to the kinds of personal responses most have been trained to hide-laughter, anger, bewilderment, frustration, empathetic sorrow.  The cases he recounts include several whose inexplicabilities ultimately require action based as much on intuition as on science.  He includes several stories of illness among his own family and friends, and makes it clear in others how his professional decisions affect his home life and his own state of mind.  

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Triggered in part by a trip to the Galápagos Islands, the author interweaves two parallel narratives: Darwin's "journey toward evolution" along with the related work of Alfred Russel Wallace; and the author's own journey through life, partially disabled and dependent on the specially fitted shoes that help him to walk.  Together these two narratives develop "all I have come to understand about chance and change, fear and transformation, variation and cultural context, ideas about the body that question the definition and existence of difference in all of our lives" (xvii).

Born with an unnamed congenital condition in which his fibulae are absent along with other lower limb "abnormalities," Fries underwent five major reconstructive surgeries as a child, but after those, what helped him most were special shoes that were fitted to his special body, assisting him to walk.  As an adult, however, he begins to experience back pain and knee problems.  The memoir relates, both in flashback, and in the present day, Fries's quest for a proper pair of shoes that will help him avoid yet another surgery -- the shoes he has been wearing are 20 years old and no longer do the job.  We meet Dr. Mendotti, who treated him like a peculiar specimen and offered a pharmacologic way out of his pain; shoemaker Eneslow, in a dingy Union Square office, whose shoes not only fit Fries well, but were festive in appearance -- "I felt both normal and special" (17); other practitioners of orthotics who try but fail to construct shoes that relieve Fries's pain, and finally, the gifted, patient orthoticist, Tom Coburn, who persists until he is able to provide shoes that work.  The shoes have been adapted for Fries's body, just as man has constructed adaptations that allow him to live in a variety of climates and circumstances.  Conversely, Fries, convinced he "can adapt to the circumstances in which my body places me (169)," draws from Darwin, whom he quotes: "individual differences are highly important for us, as they afford materials for natural selection to accumulate" (169).
 
Darwinian connections are invoked throughout the narrative.  The peculiar configuration of Fries's feet and shoes help him to ascend a series of mountain ladders while his partner, Ian -- who usually has to assist Fries with such physical maneuvers -- suddenly becomes fearful of the height and exposure;  back problems might have developed even without his congenital abnormalities because evolution of the capacity to walk upright included the tendency toward back pain; the role of chance in natural selection and the role of chance in the physical fact of congenital conditions; the positive role that his partner Ian's attention deficit disorder (ADD) could have played in the days of hunter-gatherers and the cultural context in which ADD is now considered to be "abnormal."
 
Fries discusses his fears -- both rational and irrational -- as well as his awareness of stigma, difference, and sameness.  The context of these discussions is usually a reminiscence about vacations in far-flung countries (Thailand, the Galápagos, Bali, Alaska, the Canadian Rockies) and physically challenging domestic locales (a Colorado River raft trip, the Beehive Mountain in Acadia National Park).  He  occasionally brings into the discussion his homosexuality, especially as his physical deformity affected sexual encounters.  The relationship between Fries and Ian is woven throughout the memoir as one of understanding, mutual need and benefit.  As the memoir ends, Fries worries about the likelihood he will need a wheelchair, but is at the same time gathering confidence in his ability to ride the Easy Flyer bicycle that Ian has discovered at the local bike shop.

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In his debut novel, Dr. Khaled Hosseini tells a tale that begins in his homeland, Afghanistan, and ends in his adopted country, the United States. Amir, son of a wealthy Pashtun merchant, narrates the story. Amir and his father, Baba, are attended by two Hazara servants, Ali and his hare-lipped son, Hassan. Amir and Hassan are friends, but Amir is troubled by a guilty conscience over multiple slights and sly insults aimed at Hassan. The burden of guilt intensifies over an incident at a kite-flying contest when Amir is twelve years old.

Kite flying in Afghanistan is an intricate affair involving glass-embedded string that contestants use to slice the strings of other kites. The winner is not only the one with the last kite flying, but also the one who catches the last cut kite--the kite runner. At the close of the contest, Amir witnesses the traumatization of his friend Hassan, the finest kite runner, at the hands of an evil youth, Assef. Too shamed to help Hassan, Amir is nearly swallowed by his cowardice: the rest of the story follows the consequences of his guilt.

Amir and Baba emigrate to the United States during the Soviet invasion of Afghanistan, but Amir, as a young adult, returns during the Taliban regime in order to redeem himself and help Hassan's son. The story is filled with plot twists and revelations of secrets and hidden relationships, which enable Amir to confront some of his shortcomings. The oppression, torture, and murder of Afghanis by the Taliban are graphically depicted.

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Mabry Kincaid, a New York art conservator is flying home on September 11, 2001, when news comes to him on the plane of the attacks on the World Trade Center.  Unable to return to his apartment in the city, he decides to visit his aging father, an Episcopal priest, in his boyhood home in North Carolina. There he meets Audrey, an African-American seminary student in her forties, who has moved in to care for his disabled father.  In the ensuing weeks Mabry is led to reflect deeply not only on the fate of the country and of his career, but on how his father's apparently final illness compels him to come to new terms with their constrained relationship. The death of the brother Mabry always believed to be the favorite has left a painful chasm between father and son, made more so by his father's own admission of favoritism.

At the same time Mabry is coming to terms with his own diagnosis of multiple sclerosis and with the grief he continues to process since his wife's death from cancer.  Audrey and her son bring a new dimension to the life of the household and a widened sense of family to the two men as they struggle to lay the past to rest and to accept the radical uncertainties of the personal and national future. One interesting subplot involves Mabry's discovery of what is reputed to be a minor, uncatalogued Van Gogh painting, covered by the work of another artist, that he has brought home for his employer, now dead, and his musings about what to do with this undocumented treasure.  The question remains open for symbolic reflection as he leaves it behind in North Carolina and returns to New York for a very different kind of life than the one he left. 

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In this candid chronicle of what many would call a prolonged depression occasioned in part by her husband's illness and death, Norris, a popular memoirist and essayist, seeks carefully to distinguish the psychological or psycho-medical category of "depression" from the spiritual state of "acedia" or, more bluntly, "sloth," in its oldest and most precise sense.  In doing so she raises important questions about widespread and often imprecise use of categories derived from clinical psychology, an imprecision that may muddy the distinction between spiritual and psychopathological experience.

"Acedia" she defines as a failure of will, signifying a need for spiritual guidance and prayer, whereas "depression" requires medical treatment.  Going beyond the confessional, Norris suggests that acedia may be an endemic condition among middle-class Americans, over-busy but spiritually slothful.  The book is loosely organized, often characteristically lyrical, and more invitational than diagnostic.  Her purpose, finally, seems to be to inspire readers to embrace simple life-giving spiritual disciplines like reading the Psalms as a stay against excessive self-preoccupation and actual depression as well as spiritual depletion.  

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Testifying to its author's "fascination with death" (324), this scholarly and abundantly illustrated work focuses on the history of the American idea of the Good Death as this concept took shape during the Civil War. Frederic Law Olmstead used the phrase "republic of suffering" to describe the many wounded and dying soldiers being treated at Union hospital ships on the Virginia Peninsula. Faust argues that the task of dealing with more than half a million dead during the War motivated Americans in the North and South to discover cultural and physical measures of interpreting and coping with the suffering and loss that occurred in thousands of families.

The scale of this War was unprecedented due to rifles and railroads; however, Gilpin Faust reminds us that twice as many soldiers died of disease as died of wounds suffered in the conflict. The illnesses were epidemics of measles, mumps and smallpox, then diarrhea and dysentery, typhoid and malaria. Medical care was inadequate; consequently, soldiers and their families turned to spiritual consolation. The Good Death was identified as sacrificing your life for the cause; many  believed in the Christian idea of resurrection and the afterlife. Killing became work,  as African American soldiers fought for "God, race and country" (53), where  Southerners fought to preserve the status quo, including slavery.

Because of the War, public cemeteries and ceremonies, and government's identifying and counting the dead are now taken for granted. Because of the Civil War, bodies of the dead military are today brought back from foreign lands and honored with decent burial: "We still seek to use our deaths to create meaning where we are not sure any exists" (271).

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