Summary:

An older woman is diagnosed as having cancer. The story is of the progression of her symptoms and the effects of her illness and eventual death on her husband and grown children. The years of silent compliance with the expectations of children and spouse begin to erode as the woman becomes sicker. The relationship between the aging couple, and the place of the ill mother in the priorities of her children clarify. The tale ends with the death, and a tiny glimpse of resolution of decades of strife and unexpressed rage between man and wife.

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The summer before her senior year of high school Julie Weiczynkowski qualifies for the Olympic developmental program's regional soccer team. She has every reason to believe she will be recruited by coaches from the best college teams in the country. But her elation is short-lived; the very day she returns home from soccer camp, she learns that her father has untreatable pancreatic cancer.

The story of that summer, told in Julie's journal entries, gives us a close-up look at her own stages of accommodation, and at the skills and strategies she develops to cope with her own grief, to support her mother, and to help care for her father. Each person in the family--mother, grandmother, siblings, and uncles--has a different perspective on and reaction to the crisis. Julie finds herself looking at the rest of her life as if through the wrong end of a telescope, and finds herself alienated from the boy who has been her best friend and support in high school.

The hospice workers who come to help her parents, though she finds their presence invasive, teach her a good deal about what dying looks like and how to bear with the one who is suffering. She travels a painful learning curve to arrive at a place of acceptance, claiming her life after her father's death, and reclaiming a friendship that matters to her on new terms.

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Martin Nanther is a member of the British House of Lords, having inherited his title from his great-grandfather, Henry. Physician to Queen Victoria, Henry specialized in hemophilia, the disease that Her Majesty was known to have passed to her son, Leopold, and other descendants. While the House of Lords considers a Bill to abolish hereditary peerage and Martin's much younger, second wife is obsessed with becoming pregnant, he escapes into his slow research for a biography of Henry

His patient genealogical investigations uncover deaths in infancy of several young boys in his own family, and Martin soon realizes that hemophilia (rather than the family's legendary tuberculosis) is the cause. Was that irony merely a coincidence? Or was hemophilia in his own lineage the impetus for his grandfather's research and position in life? And why was the disease hushed? Was it possible that his grandfather deliberately sought a bride with the trait in order to investigate it in his own progeny?

Martin soon finds himself wondering if this well-respected, medical man actually committed murder, or was he merely waylaid by unexpected love? Without giving too much away, suffice it to say that the answers prove so surprising and so disturbing, that Martin decides to abandon the biography of his ancestor, even as he learns that his inherited peerage has been revoked and that his next child will soon be born.

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While on an airplane, Carson experiences abdominal pain. He is a divorced man in his fifties and a sales representative for a computer and information technology firm. He spends much of his time traveling and fancies himself "a connoisseur of cities." The increasingly severe stomach pain forces Carson to reschedule his business meeting and retreat to his hotel room.

His suffering mounts and he decides to visit the emergency department of the city hospital. Carson is evaluated by two young male doctors and later a middle-aged female physician. Despite blood tests and X-rays, his diagnosis remains murky and a surgical consultation is obtained. The surgeon suspects appendicitis. He postulates that Carson may have a retrocecal appendix and explains that in such cases the anatomical location of the organ often confounds the diagnosis.

Carson undergoes surgery. His appendix is indeed retrocecal and rupturing. He spends five days convalescing from the operation. During that time he acquires an intimate knowledge of the city from his stay at the hospital. The experience revitalizes him. Carson reasons that the world is miraculous in part because it is so simple yet still spectacular.

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Written as an interior monologue, Destiny begins as Chris Burton receives a phone call informing him of his schizophrenic son's suicide. Burton, a British ex-pat journalist in the final stages of writing his chef d'oeuvre--a cultural history on national character--is married to Mara, a provocative, capricious, flamboyant Italian. The vitriolic arguments and hurtful stratagems that characterize their discordant marriage intensify with the crisis of death and its aftermath--the identification, transport and entombment of Marco's body. Family relationships are further complicated by Mara's distrust and estrangement of her adopted daughter, Paola.

Burton reveals the chaos that schizophrenia imposes not only on the patient, but also on the entire family. In order to avoid prison following an attack on his family and home, Marco had been placed in a psychiatric institute, Villa Serena, and it was at this facility that Marco stabbed himself to death with a screwdriver. The onset of disordered thinking and erratic behavior, the search for therapies, the various repercussions of guilt and blame (including recriminations about the intense, border-blurring maternal love lavished on Marco), are re-examined by Burton as he travels from London to Rome, sits vigil by his son's body in the camera ardente, and confronts his wife at her family's tomb.

Burton's physical distress mirrors his mental anguish. Burton has heart disease and obsesses about lacking his anti-coagulant medication. In addition to the worry of clot formation, urinary retention prevents Burton from emptying his bladder. These physical ailments of containment, confinement, obstruction and blockage form resonances throughout the book: the tomb, the strictures of marriage and the leakage of adultery, the oppressive family 'house of ghosts,' the separateness of interior thought from observable behavior, the barriers of language, the herky-jerky redirections of emergency travel.

Furthermore, the will to create permanence, to make one's destiny more than a transient destination, informs Burton's moves. In the midst of his exploding marriage and tormented trek home, Burton agitates over his work, and in particular, his book, which "must serve to transform a respectable career into a monument" (p. 1).

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This story of one exceptionally accomplished family's discovery of their past and future relationships with Huntington's Disease (HD) is also the story of how the Wexler family changed the cultural narrative of HD for other families at risk for this genetically-transmitted and currently incurable disease. The HD diagnosis of Leonore Wexler (the author's mother) inspires Milton Wexler, a psychologist, to create a major foundation for HD research, which develops critical mass and influence as Leonore Wexler's condition deteriorates, and after her death. The book interweaves the story of the Wexlers' emotional and other negotiations with HD and the story of their efforts to create an HD community comprised of those with active symptoms of HD, family members, advocates, and researchers.

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A child dies in the hospital shortly after the infectious disease consultant, Dr. Michael Grant, evaluates her. The 35-year-old physician has cause to be troubled by the patient's death. He failed to perform a careful examination, did not check the results of her most recent lab tests, and held off on ordering antibiotics. Although an autopsy was not performed, it is believed she died of sepsis.

Divorced and recently relocated to North Carolina, Dr. Grant is already depressed. Now he must worry about the possibility of a malpractice lawsuit. Jonas Williams, the father of the dead child, is also ill. He complains of fatigue, visual disturbances, confusion, night sweats, and fever. Jonas has developed unusual lesions in his throat and retina--white threads in a serpentine pattern. A biopsy of his oral lesion demonstrates the presence of osteoblasts and new bone formation. Dr. Grant becomes convinced he has stumbled onto a completely new infectious illness even though he cannot identify the causative organism.

Jonas experiences gastrointestinal bleeding as a result of a low platelet count. He dies in a trailer that has caught on fire. Dr. Grant soon develops the same symptoms as his patient. He remembers coming into contact with some of Jonas's blood. He is admitted to the hospital with massive gastrointestinal bleeding. His physician attributes the bleeding to ulcers, gastritis, and thrombocytopenia. Dr. Grant, however, believes the bleeding is due to the same mysterious disease that Jonas had.

The body of Jonas's daughter is exhumed, and there is anatomic evidence of the same bizarre changes that occurred in her father. Dr. Grant visits a cabin in the woods where Jonas had lived. He is looking for clues to the puzzling new illness. What he finds, however, is not an answer. Instead, it is a renewed appreciation for his life as well as the world around him.

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Dr. Andrey Yefimych Ragin has for many years been the superintendent of a town hospital. A solitary man who pursued a medical career to please his father, he feels superior to the people who live in the provincial town, none of whom engage in intellectual or aesthetic pursuits. Initially, Ragin was conscientious about his duties at the hospital, but after a while he withdrew his interest and energy. Now he sees only a minimal number of patients and leaves the rest to his assistant, Sergey Sergeyich.

Ragin has developed the philosophy that, since "dying is the normal and legitimate end of us all," there is no point in trying to cure patients or alleviate suffering. The endeavor is futile. While Ragin accurately observes deficiencies in the hospital and in the surrounding society, he does nothing to try to remedy them. Instead, he withdraws to his apartment and spends his time reading.

At one point, Ragin accidentally finds himself in Ward 6, where the lunatics are kept. One of them, Ivan Dmitrich Gromov is a well-educated paranoid man who engages Ragin in conversation. Ragin is so taken with this stimulating interchange that he begins to visit Ward 6 daily to debate with Gromov. Since the doctors never visit Ward 6, this is considered very peculiar behavior. Based on this new evidence of incompetence, the town council decides to fire Ragin from his position.

Ragin then goes on an extended tour with his one friend, Mikhail Averyanych, the postmaster. But when he returns, he behaves more strangely than ever. Finally, the new superintendent, Dr. Khobotov, tricks Ragin into visiting Ward 6, whereupon they incarcerate him as a lunatic. Shortly thereafter, Ragin has a stroke and dies.

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This is a collection of 23 stories, five of which take the form of "letters" in which an older physician (not surprisingly, a surgeon) gives advice to an imaginary young surgeon. However, every one of the stories "fits" as a tale that might be told in such a letter--assuming the author was a wise and gifted writer, in addition to being a surgeon.

The book begins with the gift of a physical diagnosis textbook on the occasion of the young doctor's graduation ("Textbook") and ends with a reflection on "your first autopsy" ("Remains"). Among the other stories are Imelda (see annotation), Brute (see annotation), Toenails (see annotation), Mercy (see annotation), "A Pint of Blood," "Witness," "The Virgin and the Petri Dish," and "Impostor."

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The haunting eyes of a beautiful young woman stare directly at us as we witness the final moment of her plummet from a New York skyscraper to the sidewalk, a stage-like platform in the lower foreground. Her barefoot body and its shadow protrude into the inscription panel where blood-red lettering records the facts: "In the city of New York on the 21st day of the month of October, 1938, at six o'clock in the morning, Mrs. Dorothy Hale committed suicide by throwing herself out of a very high window of the Hampshire House building. In her memory [words apparently painted out] this 'retablo,' executed by Frida Kahlo." Though her blood flows from her morbidly erotic body and seeps through the canvas into the painted wood frame, the bright yellow corsage of tiny roses pinned to the black velvet dress on her intact, virtually undamaged body and face eerily insinuate vitality and sensuality.

Two stages of her fall from the window of her apartment building, as in a multiple-exposure freeze-frame photograph, are surrealistically softened by swirling blue, white and gray cloud-like sky coloring which covers the entire background and the rest of the wooden frame. Barely visible, in the top of the frame is the suggestion of an angel holding a banner on which [now erased or whited-over] was proclaimed "The suicide of Dorothy Hale, painted at the request of Clare Boothe Luce, for the mother of Dorothy."

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