Summary:

Second Opinions, Jerome Groopman's second collection of clinical stories, illuminates the mysteries, fears, and uncertainties that serious illness evokes in both patients and doctors. The book is divided into 8 chapters, each a clinical story involving a patient with a life-threatening illness, plus a prologue and epilogue written by Groopman. The stories focus on people who face myelofibrosis, acute leukemia, hairy cell leukemia, breast cancer, and marrow failure of unknown cause. Two chapters are Groopman's personal accounts of his firstborn son's near fatal misdiagnosis, and of his grandfather's Alzheimer's dementia.

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This memoir of a clinical psychologist (also a professor of psychology) chronicles her own depression over a period of a year and a half, from early symptoms, through near despair, electroconvulsive therapy, and hospitalization to recovery. The journey is detailed, not only in its treatment of her emotional states, but of her struggle to maintain family and professional life, keep her house and office organized, and attend to a dying friend.

As her bouts of panic and disorientation grow more apparent, first to herself and finally to others, she seeks refuge in spiritual retreats and in conversation with colleagues, ultimately submitting to treatment. She names the emotional "undercurrents" suggested in the book's title with moving precision: panic over sudden disorientation, anxiety about what to keep secret, frustration with her own unreliability, dread of small duties and ordinary appointments, heartache over her faltering efforts to be a good and present mother.

The consent to hospitalization costs a great deal in humility, in risking a controversial treatment, and in letting go of a professional persona she doesn't know whether she'll be able to retrieve. But clearly the book is written by a woman whose clarity is a testimony to regained mental health and exceptional intellectual clarity. It is not a professional record, but an intensely personal memoir of what was both an encounter with serious mental illness and a spiritual journey.

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Peppered with a plethora of black and white stills, this book is a compilation of a physician's film reviews and reflections on how movies have mirrored the changes in medical care and in society's attitudes towards doctors and medicine over the last sixty years. Ten chapters blend a chronological approach with a thematic perspective: Hollywood Goes to Medical School; The Kindly Savior:

From Doctor Bull to Doc Hollywood; Benevolent Institutions; The Temple of Science; "Where are All the Women Doctors?"; Blacks, the Invisible Doctors; The Dark Side of Doctors; The Institutions Turn Evil; The Temple of Healing; More Good Movie Doctors and Other Personal Favorites.

The appendices (my favorite) briefly note recurring medical themes and stereotypes ("You have two months to live," "Boil the Water!"). Formatted as a filmography, the appendices reference the chapter number in which the film is discussed, the sources of the photographs, and a limited index.

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Alan Shapiro, poet and professor of English at the University of North Carolina, Chapel Hill, chronicles the life and death of his sister, Beth, who died of breast cancer at the age of 49. Beth lived the last four weeks of her life at a hospice in Texas--this memoir traces those weeks in particular and refracts them against decades of family dynamics, turmoil and triumph. The memoir is composed of 14 tersely named chapters ("The Death," "The Joke") followed by "Afterwords": six poems about Beth.

Alan is the youngest of 3 siblings; Beth was the oldest and David, an actor is the middle child. Despite, or perhaps because of their age difference, Beth and Alan were very close. It was he whom she asked to write her eulogy and it was he who stayed the entire 4 weeks of hospice, save for a brief trip home. From Alan's love and devotion grows an admiration for Beth's integrity in life and death.

Beth married an African-American man, fought for liberal causes, and suffered complete estrangement from her parents due to her choices. Her husband, Russ, must deal not only with the loss of his wife and their daughter's loss of her mother, but also with the prejudice of the Shapiro parents and the medical establishment. At one point Shapiro describes how, whenever he accompanied his sister and her husband to the doctor's office, Alan, not Russ, was treated as the spouse and decision-maker.

Shapiro vividly depicts the poignancy of parent-child relationships. Gabbi, the seven-year-old daughter who loves horses, gallops through the house with grace and abandon not possible at the hospice. Alan's anger at his father's actions and his forgiveness of his mother's accomplice role are also strongly demonstrated. A great strength of this book is the choice of detail: the mother completes a book of crossword puzzles during the vigil; the brother becomes infatuated with a particular joke he wants to memorize; nurses leave a solitary rose on the bed of the newly dead at the hospice.

Shapiro is keenly interested in being with his sister right at the moment of her death. He describes the end: "one long, deep, and profoundly eerie moan . . . That moan, I'm certain, marked the end of Beth, the end of life, though the body went on breathing for another minute or so, each breath a little fainter, weaker, the body's electricity guttering down, dissolving, till there was no breath at all." (pp. 111-2)

He also analyzes whether this was "a good death." There had been many gifts: Beth's recognition of her importance, her reconciliation with her father, and her acceptance of her mother's devotion. However, Shapiro also keeps the reader cognizant of Beth's suffering and the now motherless child, the spouseless husband and the myriad other ways that Beth's death marked a void.

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Sally Wang, the 27-year-old daughter of highly educated (her widowed mother is a Yale professor) immigrant parents, quits her job as an art director in New York City. Her depression leads her to a suicide attempt and admission into a mental hospital, where she begins to come to terms with her memories of sexual abuse by her father (the "Monkey King"). Continuing to struggle with the need to cut herself as a way of feeling alive, Sally begins to re-explore her relationship to the world through her painting and begins shattering well-kept family secrets on her way towards healing.

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Kate, a doctoral student, has chosen to move far away from the small town in which she grew up and in which her widowed mother (a school superintendent) and brother (an insurance man) still live. Kate's life is solitary, punctuated by unsatisfactory and transitory sexual relationships with men; she has headaches and wonders if "there were an agent in her body, a secret in her blood making ready to work against her" (p. 180).

While her mother disagrees with Kate's life choices, their long-distance relationship is sisterly, playful, and intimate. Kate sends her mother Valentine's Day cards, "a gesture of compensatory remembrance" since her father's death six years earlier (177). One year Kate forgets to send the card; soon after, her mother is suddenly hospitalized for tests that reveal a brain tumor.

Kate's brother insists that if she wants to come home, she must keep quiet about the likelihood of the tumor's malignance and the risk that the upcoming surgery will result in paralysis. He argues that their mother is terrified and that there is no point in making her more afraid. Kate objects to the concealment of the truth but complies unwillingly with her brother's request.

She gains permission to take her mother for a ten-minute walk outside, just time enough to take a ferris wheel ride. As their car reaches the top of the wheel, Kate is clearly upset. Her mother comforts her, saying, "I know all about it . . . I know what you haven't told me" (196).

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Sometime in the 1970s, the historian Lou is sent by her Institute to research the life of a nineteenth-century colonel on the island he once owned in the middle of a wide river in northern Ontario. A magnificent house remains with a shack behind where a huge male bear is chained.

At first Lou is afraid of the bear, but gradually she feels sorry for it, allows it into the house, and eventually into her bed. The experience leads her to reevaluate her life, her friendships, and her loves. The summer passes and a wistful Lou returns to the city, and the indifferent bear, to his captivity.

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This is a scholarly book and the author, who is an exceptionally good writer, has gone to great lengths to search out original source material, much of which has not been examined by previous authors. Instead of retelling Elizabeth Blackwell's story she relates in some detail that of Sarah Adamson Dolley, another important pioneer woman physician who was the third woman medical graduate in America. She also was one of the eight founding members of the earliest society of women physicians in the United States.

The book also details the period in the late eighteen hundreds and early nineteen hundreds which was referred to as "maternalist medicine," when women began to pursue their careers in public health. After being "sidelined" in the first half of this century, the numbers of women physicians began to slowly increase, greatly aided by the new women's movement and the equal opportunity era.

Dr. More does an excellent job of bringing together the history of women physicians with the history of medicine from 1850 until the present. Her descriptions of women physicians' lives and problems are evenly presented and make interesting reading. The evolution of medical education in general is also well described. Her conclusion is not unexpected--that the greatest obstacle facing women practitioners today is the need to accommodate the demands of childbearing and child rearing with their professional lives.

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Written by surgeon and renowned author Sherwin B. Nuland, this book offers both a detailed look into the workings of the human body and a glimpse into the heart and work of the author. Furthermore, it is also a philosophical treatise on the wonder of human life and the beauty of "animal economy." As a human biology text for the layman, the book explicates the major organ systems of the human body, such as the nervous system (including the sympathetic nervous system), the cardiovascular system, the gastrointestinal tract, the immunologic and hematologic systems (including coagulation, cell lines, lymphatics), and the urogenital system (including reproduction and childbirth).

Nuland intertwines dramatic stories of his surgical patients with the systems review. For instance, the book begins with the near death of a woman by hemorrhage from a ruptured splenic artery aneurysm. Another dramatic story involves the near death of a young diabetic woman from bacterial overgrowth in the gut. The reader also hears the patients' versions of their illness experiences--Nuland gives direct quotes from what they have said or written about their experiences. Through it all, Nuland expresses his awe and wonder at the workings and capabilities of the human body.

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When Ruth's unfaithful and unappreciative husband Bobbo calls her a she-devil, she decides to appropriate that identity with a vengeance and take a different spot in the power relations of the world. She wants revenge, power, money, and "to be loved and not love in return"(49). Specifically, Ruth wants to bring about the downfall of her husband's lover, Mary Fisher, a pretty, blonde romance novelist who lives in a tower by the sea and lacks for neither love nor money nor power.

Ruth commences her elaborate revenge by burning down her own home and dumping her surly children with Mary and Bobbo. She continues on a literally shape-shifting quest in which she changes identities; gains skill, power, and money; and explores and critiques key sites of power and powerlessness in contemporary society, including the church, the law, the geriatric institution, the family home, and (above all) the bedroom.

By the end of the novel, Ruth achieves all four of her goals in abundance. Her success, however, raises complex ethical questions, not only because she uses the same strategies of manipulation and cruelty of which she was a victim, but also because of the painful physical reconstruction of her body that is the tool of her victory.

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