Summary:

Looking back on his first year of medical practice in an out-of-the-way section of Russia, a 25 year old physician reflects on how much he has changed both personally and professionally. He lists the year's accomplishments: performing a tracheostomy, successful intubations, amputations, many obstetrical deliveries, and setting several fractures and dislocations. With pride, the doctor calculates he has seen 15,613 patients in his first twelve months of practice.

He recalls some poignant moments. A pregnant woman has a baby while lying in the grass near a stream. The doctor pulls a soldier's carious tooth but is horrified when a piece of bone is attached to it. During a delivery, he inadvertently fractures a baby's arm and the infant is born dead.

Basking in his year's worth of experience and newfound clinical confidence, the physician quickly comprehends the limits of his knowledge on the first day of his second year in practice when a mother brings her baby to the doctor. The infant's left eye appears to be missing. In its place sits an egg-like nodule. Unsure of the diagnosis and worried about the possibility of a tumor, the physician recommends cutting the nodule out. The mother refuses. One week later she returns with her child whose left eye is now normal in appearance. The doctor deduces that the boy had an abscess of the eyelid that had spontaneously ruptured.

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This series of 28 poems plus an envoy describe, from the patient's point of view, a 20-month stay in an Edinburgh hospital in the 1870s. The narrator delineates--from the cold and dread of Enter Patient through the giddiness of "Discharged"--his reactions to hospital personnel (from doctors and nurses to scrub lady); to his fellow patients (from children to the elderly, during bad days and holidays), to visitors, and to death.

Because he stays for 20 months, we also witness his seesawing emotions about his own state of health. The epigraph from Balzac suggests that a person in bed and ill might become self-centered, so the narrator purposefully maintains a dispassionate tone. It is a tone so distinct yet distanced that Jerome H. Buckley (William Ernest Henley: A Study in the "Counter-Decadence" of the 'Nineties, New York: Octagon Books, 1971, c. 1945) compares the poems to steel engravings.

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Selzer tells four stories of surgical loss: a surprise loss on the operating table, the drowning of a sick child in a flood in wartime Korea, the sudden death of a professor due to a perforated ulcer, and the loss of some facial mobility in a young woman following the removal of a tumor in her cheek. As we move from one vignette to the next, the narrator's mood goes from despair to accepting to redeemed, with various forms of love the agent.

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Selzer begins by describing an anonymous painting of Vesalius at the dissecting table, about to cut into the cadaver in front of him, yet glancing over his shoulder at a crucifix on the wall behind him. He then tells two medical stories in which spirituality has played a crucial role.

In the first, a man who has repeatedly refused to have a brain cancer operated on turns up one day healed, attributing it to the holy water a family member brought back from Lourdes. In the second, the Dalai Lama's personal physician does rounds in an American hospital and, using ancient techniques, diagnoses correctly, and in some detail, a case of congenital heart disease.

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The unnamed narrator, a physician, notices a surgeon in a "seedy cafe on the edge of town." (73) He learns from the waiter that the shabby man with the "aristocratic demeanor" is "a doctor: Surgeon once" (73). The surgeon hears the narrator call for medical papers and makes his acquaintance. One night soon thereafter the narrator notices that the surgeon, sitting and drinking alone, drains the green syrup of his absinthe "so slowly and pleasurably" (74) that he must be, in fact is, an alcoholic.

The latter approaches the narrator and begins elaborating a complicated theory of time and how it is an internalized, organically controlled, locus in the brain, no different "from an ordinary brain cell" (77). As such, he, the surgeon, proposes to cut it out, imagining, grandiloquently, vast seas of gratitude washing up on his shore as he frees humanity of the "silent madness of mortality" (78). The surgeon ends with a toast to absinthe, "a drug to be taken orally, and which is useful against time, temporarily. . . . We won’t be needing it much longer, since the surgical method’s both radical and excellent. Cheers, my dear colleague!" (78-79)

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It is 1905, and a young doctor just out of internship in Chicago has decided to head for the southwest to seek his fortune. He finds himself on a slow train in southern New Mexico, sitting across from a Sister of Mercy "in her black robes, skirts and sleeves, and heavy starch." When the train stops, the doctor inquires about a group of men huddled on the platform. They surround a severely ill Mexican worker, who turns out to have appendicitis. The doctor insists that only an immediate operation will save his life, but the Mexicans are violently opposed to surgery. Eventually, the doctor enlists the nun’s help to persuade them.

In the blistering heat, they carry the man to a shed where the doctor performs an appendectomy with instruments in his black bag, including morphine and chloroform. For the next 24 hours, he and the nun watch over the man, and then carry him to the nearest town on the next train. He survives, which is good because otherwise the Mexicans have threatened to kill the doctor. The nun, who throughout has been cool toward the doctor because of his use of "rough" language, proceeds on her way to Texas.

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This selection of Miroslav Holub's poems is organized around five major topics--genealogy, anthropology, semiology, pathology, and tautology--rather than chronologically. The poems, some of which date back to his first collection in 1958, were translated into English by a number of different persons, but mostly by David Young, who has had a long-term collaboration with Holub.

Holub states his major preoccupation in "Bones," the very first poem in this collection: "We seek / a backbone / that will stay / straight." (p. 13) The search reaches its fullest expression in "Interferon," a long poem about messages, messengers, and interference: "Cells infected by a virus / send signals out . . .

And when a poet dies, deep in the night / a long black bird wakes up in the thicket / and sings for all it's worth." (p.159) The first step in the search is to learn to interpret the signals, and to understand the black bird's song. To do that, one has to ask questions. Yet, in the face of enormous "Suffering," we are drawn to passivity: "But I ask no questions, / no one asks any questions, / because it's all quite useless." (p. 147) How to overcome the inertia and proceed, even in the face of likely failure?

Holub reminds us that even "In the Microscope" we find "cells, fighters / who lay down their lives / for a song." (p. 149) In fact, there may be something worth fighting for, although perhaps we can only see it under extreme circumstances, as in "Crush Syndrome," where a concrete mixer snaps up the hand of a man cleaning it: "The finger bones / said a few things you don't hear very often...In that moment / I realized I had a soul." (p. 174). But perhaps what we call the soul is really just our deep yearning to survive, as in "Heart Transplant": "It's like a model of a battlefield / where Life and Spirit / have been fighting / and both have won." (p. 179)

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Fifteen selections--short stories, essays, and memoir--make up this collection. Two stories are notable: The Whistlers' Room and Atrium: October 2001 (see annotations). The title story is a translation and retelling of an obscure German tale published 75 years ago. Set in a military hospital in Germany during World War I, four soldiers share a common wound--throat injuries and laryngeal damage necessitating a tracheostomy for each man. This remarkable quartet of patients forges a fellowship of the maimed.

"Atrium: October 2001" describes the random meeting between a physician and a terminally ill teenager in the hospital atrium. The subject of death dominates their discussion. "Parable" chronicles an elderly doctor's efforts to comfort a dying man, and in the process, ease both their suffering.

Excerpts from Selzer's diary reveal much about the character of the author as well as the characters in his life. He also reminisces about growing up in Troy, New York. Approximately one-quarter of the book is devoted to Selzer's musings on works of art (sculpture and painting). Lighter fare includes a discussion of life behind the podium, a description of his home, and a new ending for A Tale of Two Cities by Charles Dickens.

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Boyle drives out to the cottage to visit Joady, who is dying of cancer. Dinny and Joady are two elderly brothers who live together. "In all his years Joady had never slept away from the cottage," until recently when he went to the hospital and had an operation. Boyle and Dinny speak about how, a week earlier, they had been stopped by police in a helicopter as they were driving to the hospital to visit Joady--this was the day after an IRA bombing in which five people lost their lives. When they reached the hospital, they spoke to the surgeon who told them that Joady was terminal. By this time (back at the cottage), Joady knows that he is dying. However, he follows his normal routine, apparently unchanged, while Dinny is sullen, distracted, and complaining.

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Birth Sounds includes 45 short tales of labor and delivery, ranging through a wide swath of the human comedy, but always maintaining focus on the very first scene. In most of these stories, it isn't the delivery that provides the drama, but rather the people. Take the first story, for example. In "Faceless" a Vietnamese husband cautions the obstetrician-narrator, "In our country no man will examine a woman in such an intimate way." The obstetrician never sees the patient's face, which she has covered with a towel. After the delivery, he examines her and speaks carefully, not sure that she understands English. However, from beneath the towel, she thanks him in a perfect American Southern accent. A neat surprise!

In "The Little Devil" (p. 6) a 38-year-old member of a satanic cult announces that she intends to kill the baby if it is a boy. She has been directed to do so by her satanic mentor. When, amid a panoply of lit candles and inverted crucifixes she delivers a boy, the resident contacts the sheriff's office, where the mother's intentions are already known. Sure enough, the SWAT team storms the delivery room and takes the baby.

In "Red Bag" (p. 31) the narrator is serving as a medical expert in a murder trial. The defendant had arrived at the hospital hemorrhaging after delivering a baby at home, evidently into the toilet bowl. The baby had died of head injury. The obstetrician-narrator turns out to be more supportive of the woman and less compliant than the prosecutor had expected; but afterward the doctor receives his financial reward--a check from the state for a full $7.00!

In "Resilience" (p. 259) a woman with a near-term pregnancy asks the obstetrician to examine her breast, which has suddenly developed a red lump. He takes one look and immediately experiences a flashback to another young woman he cared for who had developed breast cancer during pregnancy and died of metastatic disease about a year later. Sure enough, the current patient also has cancer. But in this case the patient delivers, receives treatment, and recovers, apparently cured of her cancer.

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