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Miriam Himmelfarb is the middle of three daughters of holocaust survivors Rachael and Daniel, who are secular Jews born in Europe.  Safe in the house on Lippincott in an immigrant neighborhood of Toronto, Sondra, Miriam and Esther grow up hearing their parents’ nightmare screams every night. They bask in genuine affection and learn to respect the horrific history of their elders whose needs come to dominate their own. Their father angers at the slightest provocation, and every tiny domestic issue is a reminder of Auschwitz. 

These conditions become their own form of trauma. Daniel allows his child-abusing younger brother into the home where he secretly molests Sondra. The girl flees to live on the street in prostitution and addiction. Esther turns to religion and marries within the faith, finding comfort in traditions. Following in the footsteps of her professor mother, Miriam becomes a philosopher. She briefly moves out during her studies to live in the avant-garde Rochdale College, but she is unable to build a life outside the parental home and returns, denying herself independence and love. The loss of her mother by carefully planned suicide is terrifying.

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This is a gripping, informative, and well-researched book about human blood. An accomplished journalist, Rose George, covers a variety of topics, largely in the U.S., Britain, and Canada but also in Nepal, India, and South Africa. She describes many current issues, provides historical background, and speculates on future technologies, such as replacement of blood by other fluids. There are nine sections:

 “My Pint”  While the book’s title refers to the author's volume of blood, this chapter’s title refers to a single pint she is donating. We read about blood supply (donated and stored blood) in the U.S. and—by contrast—in India.

“The Most Singular and Valuable Reptile” refers to the leech. This arresting chapter describes both historical and  modern uses of leeches to gather blood from humans. She visits a company called Biopharm in Wales where leeches are raised and prepared for shipment to medical clinics and hospitals.  

 “Janet and Percy” is a historical chapter focusing on Dame Janet Maria Vaughan, a central figure in creating the Blood Transfusion Service in England during WWII and Percy Oliver, who guided its predecessor, the London Blood Transfusion Service.  

“Blood Borne.”  This chapter describes Khayelitsha, South Africa, “the ugly backside of Cape Town” (p. 100): a place of poverty, crime, rape, sexual predation, and HIV. While rich nations provide assessment and treatment for people with HIV, poor nations have many citizens infected with the virus and, over time, rising rates of infection. 

 “The Yellow Stuff” describes the plasma portion of blood; it can be frozen (as FFP) and used as a filler for bleeding or trauma patients. Unlike blood—which can only be given without payment—plasma can be collected from paid donors. It is a largely traded commodity, part of a multi-billion dollar industry worldwide. Plasma carries Factor VIII, a crucial protein for clotting blood; hemophiliacs lack this and are at risk for death by bleeding externally or internally. Some plasma has been tainted, for example by HIV.

“Rotting Pickles.”  In Western Nepal (and other places), menstruation is taboo. George writes, “We are in a minority among species, and among mammals, to bleed every month.” She reviews historical views of women’s periods, mostly negative. Worldwide, there are many taboos, but also some educational efforts for public health that are helpful in impoverished areas.  

 “Nasty Cloths.” This tells the unusual story of an Indian man named Muruga, “a poorly educated workshop helper” who became a leader in creating sanitary protection for menstruating women. Worldwide, the feminine hygiene industry is some $23 billion. George also reviews related history, including Toxic Shock Syndrome from tampons.  

 “Code Red.” Bleeding is often a fatal factor in trauma, even with the best efforts to transfuse blood into the patient, unit after unit. George observes open chest techniques at a resuscitation. She reviews breakthroughs in blood typing, component therapy, and “buddy transfusions.”  

“Blood like Guinness: The Future.” George starts with images from the past: vampires, human drinkers of blood, past and, even, present. She interviews a purveyor of the concept that “young blood” is healthier than older blood. Can there be, discovered or created, blood substitutes that also save lives? 

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We would all like to live longer and healthier lives; the question is how much of our lives should be devoted to this project, when we all, or at least most of us, have other, often more consequential things to do (p. xv)  

Ehrenreich doesn’t reject the project of getting longer and healthier lives per se, but she believes that what this project requires isn’t always worth the results it produces. The time and energy needed could be put towards better ends.  

Like many other critics, Ehrenreich details how Biomedicine often comes up short on outcomes for all the time, effort, and money it requires from the people it serves. She covers the familiar territories of over diagnosis and over utilization of health care products and services, and goes further to suggest that many common medical practices are more ritualistic and humiliating than evidence-based and effective.

Unlike other critics, Ehrenreich takes on other activities directed at health outside of Biomedicine. She questions whether the physical fitness industry delivers on its promises to produce healthier lives and especially whether there is a net benefit based on the time and energy required from people who take it on. She crosses to the other side of the mind-body continuum when she next aims at the “madness of mindfulness” (p. 71).  She finds the mindfulness movement offers more hubris than solutions.  

Ehrenreich worries that the combined effects of the authority of Biomedicine, the physical fitness frenzy, and the madness of mindfulness have created a social context that treats death as something that can be avoided or at least delayed. This social context thereby implies that not actively engaging in efforts to fight off death “can now be understood as a suicide” (p. 97).

Ehrenreich offers some reasons for why these efforts to improve health and prolong life do not always produce benefits that in her view are worth pursuing to the exclusion of other activities resulting in a better life (or death). Drawing on examples from cell biology and immunology, she suggests that what is at work are disease processes too complex for the human mind to apprehend completely combined with the human impulse to  simplify, which lead to practices, procedures, and prescriptions that in the best case are ineffective and in the worst case harmful.   

At the end of the book, Ehrenreich laments the efforts health care professionals, nonprofit organizations, government agencies, and commercial entities make to push older people into commitments for “successful aging.” Those making these efforts argue “aging itself is abnormal and unacceptable” (p. 164).  This commitment requires older people to spend a lot of time in clinics, gyms, and wellness classes—“The price of survival is endless toil,” is how Ehrenreich formulates it (p. 163).  She doesn’t think this price is worth what is required of people who are supposed to benefit, and advises her friends to insist “on a nonmedical death, without the torment of heroic interventions to prolong life by a few hours or days” (p. 208).

I continue to elude unnecessary medical attention and still doggedly push myself in the gym, where, if I am no longer a star, I am at least a fixture. In addition, I retain a daily regimen of stretching, some of which might qualify as yoga. Other than that, I pretty much eat what I want and indulge my vices, from butter to wine. Life is too short to forgo these pleasures, and would be far too long without them (p. 207).

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In this remarkable anthology, 51 women and men describe their nursing school experiences, from initial fears and anxieties to increasing confidence and appreciation of the profession.  Jeanne Bryner, in her Introduction, explains how she and Cortney Davis deliberately sought a diverse group of nurse-writers, from recent nursing graduates in their twenties to seasoned veterans in their nineties.  Their collection includes different races, nationalities, social and economic classes, and education levels.  What the contributors have in common besides being nurses is that they are gifted writers able to capture in poetry or prose the transforming moments of their lives. Nursing students reading this anthology will recognize many kindred souls, struggling with the same uncertainties and apprehensions, wondering how they will ever accomplish all this, but also gaining command of the profession, relishing its special rewards, valuing patients as their ultimate teachers. All readers will understand what is so special about nursing .

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Victorians Undone is no ordinary history book.  If you have ever felt dissatisfied by a sterile biography, wondering if its subject actually possessed bodily functions, look no further.  Here, British historian Kathryn Hughes undoes centuries of sheltering the reader from the unseemly by putting it on full display.  While the very term “Victorian” evokes an image of propriety, it was also a time of population displacement from the country to cities where “other people’s sneezes, bums, elbows, smells, snores, farts and breathy whistles were, quite literally, in your face”  (p. xi). The author seeks to rectify the imbalance by creating a history that puts “mouths, bellies and beards back into the nineteenth century“ (p. xiv), which she hopes will “add something to our understanding of what it meant to be a human animal“ (p. xv) during the Victorian Era.  

The book consists of five essays, each following a part of the body of an historical figure. In the first, entitled “Lady Flora’s Belly,” we learn about the tragic saga of Queen Victoria’s lady-in-waiting.  Did Flora’s protuberant abdomen conceal a tumor or a baby?  It was harder to find out than one might think.  Most women went through their lives without ever exposing their private parts to anyone but their husband.   Medical consultation when unavoidable might be conducted discretely, by post.   

Other essays focus on George Eliot’s hands, Fanny Cornforth’s (the lover of Dante Gabriel Rossetti, the Pre-Raphaelite painter) sensual mouth, and the beard that Charles Darwin’s grew to hide his eczema.  The book concludes with the gruesome tale of the dismemberment of Fanny Adams, an early case study in forensic pathology. The term "Fanny Adams" soon came, in navy slang, to mean unpleasant meat rations.

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From the late 18th to mid-19th centuries a peculiar trend swept through European fashion. Through couture and cosmetics, this vogue emulated the physical ravages of a much-feared disease, tuberculosis, aestheticizing its symptoms as enviable qualities of physical beauty. Pale skin, stooped posture, white teeth, an emaciated figure, and a white complexion that evinced delicate blue veins were lauded by the era’s posh fashion journals. Carolyn A. Day aptly terms this craze a “tubercular moment,” a cultural phenomenon that elevated the grim realities of physical illness to a plane of desirable beauty. Medical discourses promoting the fragility and refinement of the “sensible” body were inspired by romanticized notions of morbidity, suffering, and illness. These discourses coincided with the the ideologies of Romanticism, a philosophical movement that was popularly understood to be a counter-discourse to the Enlightenment through its emphasis on emotion and imagination. Day cites the English poet, John Keats, whose legacy emphatically contributed to the cult of sensibility, as he embodied a living example of the refined tubercular body endowed with artistic genius but doomed to illness. The male artist was an example of a body too sensitive, too delicate to endure earthly life, but one whose intellect left an indelible imprint on culture.  

The romanticized construction of tuberculosis, however, waned in the 1830s and 1840s due to dominant Victorian views that emphasized the inherent biological weakness of the female body. This shift in rationalizing consumption was the direct result of understanding women as burdened with a surfeit of sensibility. By contrast, consumption was understood differently to be an emasculating illness that denoted male weakness and was therefore no longer popularly considered to be a portent of gifted creativity. During this period, a number of women’s fashions dictated the tastes of the middle and upper classes. Corsets, cosmetics, and the gossamer neoclassical style of dress were used to emulate the frail frames, drooping postures, narrow torsos, and pale complexions of the consumptive body. Thin fabrics, sandals, and hair pieces also contributed to styling the ‘gorgeously’ spectral image of the tubercular body. Dresses were contrived to feature the bony wing-like shoulder blades of the consumptive back, emphasizing an emaciated frame. Physicians and cultural pundits condemned the trappings of this fashionable dress because they were thought to impose health risks. Tight corsets, for example, were considered to harmfully compress the lungs, while diaphanous dresses and sandals exposed women to cold weather. Despite the stentorian warnings of physicians, the tubercular wardrobe continued to house articles that were thought to excite tuberculosis.  

By the 1850s, public health and sanitary reforms reshaped cultural discourses that associated tuberculosis with beauty. Tuberculosis was gradually viewed as a pernicious biological force that needed to be controlled. As a result, the Victorian model of womanhood—the weak and susceptible female body—gave way to a model of health and strength. Literature, as Day points out, contributed significantly to altering the consumptive chic discourse and the link between tuberculosis and ideal femininity. She references Alexandre Dumas fils, whose influential novel, La Dame aux Camélias, presents redemption for moral transgressions through tubercular suffering. Through popular literature, tuberculosis was gradually supplanted from the sphere of upper-class women and placed in association with ‘fallen’ women, an unsavory association that led the genteel public to change perspective. Literary influence was important, but the increased visibility of consumption in the lower classes was likely the most visceral reality that forced upper classes to distance themselves from fashions that beautified the illness.

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In 1869 in the remote northern Scottish village of Culduie, teenager Roderick (Roddy) Macrae brutally murders his neighbor, Lachlan “Broad’ Mackenzie, and two others. He readily admits to his crime, motivated, he says, by a desire to end the dreadful vendetta that Broad waged against his widowed father. The sympathetic defence lawyer, Andrew Simpson, urges him to write an account of the events leading up to the tragedy.  

Roddy agrees. In a surprisingly articulate essay, the young crofter describes his motive, originating with his birth and escalating through the lad’s mercy killing of an injured sheep belonging to Broad (interpreted as wanton), Broad’s sexual torment of his sister and mother, and his abuse of power as a constable that strips the family of land, crops, and finally their home.  

Given Roddy’s passivity, intelligence, and previously clean record, Simpson prepares a defence of temporary insanity and brings two physicians to assess his client, one a purported expert in the new field of medical criminology.    

The jury trial proceeds with an almost verbatim transcript derived from newspaper sources. The reader is able to juxtapose Roderick’s account with that presented in court. To report the outcome here would reveal too much.

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The play has two characters: Ruth and Friend (who is a male doctor).Ruth is an engaging, straight-talking quadriplegic who can zip and dance with her chin-operated wheelchair and takes delight in terrorizing medical staff both physically and verbally. She wants to write poetry and is waiting for a device to make it possible for her to use a computer. She keeps developing bedsores that threaten her life and require long admissions to the hospital before they will heal. She desperately wants to live no matter what happens, as she feels that having no mind would be worse than having no body.Friend is a male doctor with children who is ashamed of having examined her while she was unaware. Burdened with his guilt, he asks to be her “friend.” Ruth is skeptical and runs circles around him, but eventually comes to trust him and believe in his sincerity.She makes him a witness to her advance directive to instigate all heroic measures, as she is afraid of the kindly "ethical" and cost-effective arguments not to treat the disabled. But Ruth dies horribly from sepsis, and Friend is helpless to prevent it. She never obtains the device that would have allowed her to put her poems into printed words.

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An artist, Ruth, lives with quadriplegia and manages to drive (and dance) with a special wheelchair that she controls with her chin. She also enjoys terrorizing doctors in the hospital corridors, where she is seen on a regular basis because of frequent bouts of infected bedsores. She has a new computer and is “patiently waiting for” a biomedical engineer to set it up to manage, like her chair, with her chin. She wants to write, to draw, to create. But the wait list is long, technicians scarce, and every candidate deserving.

On one of her admissions, Ruth meets the physician-narrator who is appalled by a medical resident’s lack of empathy in relating her case as if she were not present. Distressed by the encounter, the doctor is all the more disturbed when he notices that Ruth’s birth date is the same as his own.

He tries to make it up to her by withdrawing from her care in order to be her “friend,” one who tries to understand and will defend her strong desire to live despite her disability. Driven by curiosity about her past, her sharp wit, and how she faces each day, the doctor never quite achieves his goal and constantly feels guilty for letting her down as an advocate and a friend, and possibly also for being able-bodied himself.  He never visited her in her group home, and when she comes to hospital in florid sepsis, he is unable to prevent his colleagues from letting nature take its course. His own bout with severe illness, possibly MS—more likely a stroke--resonates with Ruth’s plight. Long after her death, he can imagine the acid remarks that she would make about his foibles.

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