Summary:

This fine collection of short memoirs and stories by doctors offers a variety of narratives about memorable moments in medical education and practice that raise and explore practical and ethical issues in medicine. An explicit aim of the editors was to focus on some of the rewards in medical life as well as the struggles it entails--those often being inseparable.

Starting with a section on medicine and poetry which includes memories of William Carlos Williams by two of his well-known students, Robert Coles and John Stone, and a reflection on illness in poetry by Rafael Campo, the collection is then divided into two major sections: "Grand Perspectives" and "Intimate Experiences." The former includes narratives that show the development of practices, conflicts, or learning over time spent in hospitals and clinics, observing the careers of elders in the profession or the parade of patients whose expectations and needs stretch the physician's creative resources. Several, including Perri Klass and David Hilfiker write about particular patients whose cases became personal landmarks.

In the latter section, stories focus on single cases or incidents in the lives of doctors, some humorous, some tragic, some bemusing, all attesting to the chronic ambiguities of the work of healing and to the very human tensions that arise in institutions that both enable and inhibit the compassion all good doctors want to exercise.

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Neely Tucker, a white journalist from Mississippi on assignment to Zimbabwe, and his wife, Vita, an African American from Detroit, volunteer to spend time with orphaned and abandoned children, many victims of the desperation caused by AIDS. In the orphanage, where a distressing number of children die due to lack of medicines or basic materials, or lack of adequate staff training, they come upon and find themselves deeply drawn to a particularly tiny, sick, vulnerable baby, abandoned in the desert. The director of the orphanage picks a name for her as she does for the other orphans: Chipo.

The Tuckers arrange to take her home, first for weekend care visits, hoping thereafter to do a more permanent foster care arrangement and then adopt her. A long story of struggle with Zimbabwean bureaucracy ensues, through which one learns much about suspicion of white Americans who want children, the ways in which child care becomes one more issue in partisan politics, and how abandoned children are caught in adults’ power struggles. Interspersed with this moving story are brief accounts of sometimes harrowing trips to other parts of Africa, including sites of major warfare in Rwanda and Uganda.

Tucker also intersperses memories of encounters with families in Bosnia during his work there. Ultimately, and only after much persistence, empathetic individuals in the system, and some newly learned under-the-table skills, the adoption papers come through and the family makes its way back to American where Tucker begins his ongoing assignment at the Washington Post.

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The narrator of these short stories is a social worker who works for an agency for the blind, many of whose clients are diabetic, alcoholic, or mentally disabled as well. Over the course of the stories, the narrator leaves this work to go back to school in the arts, a personal ambivalence that may play some role in her continual, often dry critique of her clients, her work, and herself. Mostly, though, she casts a gruffly compassionate eye on the hard yet often rich and triumphant lives her clients lead, faced with financial and physical hardship as well as social ostracism.

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Set in 19th-century Japan, the film’s action centers on the experience of the young doctor Yasumoto (Yuzo Kayama) in his work as an intern at a hospital-clinic for the poor run by the experienced and wise Dr. Kyojo Niide (Toshiro Mifune), nicknamed "Red Beard." Coming from a wealthy and influential family, and fresh from a Western-influenced medical education at Nagasaki, Yasumoto had believed he was on the path to become physician to the shogun (equivalent to a king).

He is initially insulted and deeply unhappy with conditions at the distinctly inglorious clinic. The poverty and suffering (and smell) of the clinic’s patients disgust him, and he tries his hardest to get fired. The mysterious Red Beard, however, is extremely patient, and simply waits. While he waits, we see Dr. Yasumoto slowly being converted as he is brought into close contact with the suffering in the lives of several patients.

Initially rebellious and emotionally unable to watch patients die or assist in surgery, Yasumoto gradually becomes a seasoned and enthusiastic member of the clinic’s medical team and announces that Red Beard is his idol. At the end, when Yasumoto is actually offered the position of physician to the shogun, he refuses, in order to continue his work at the clinic.

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In this rich opening chapter of his work on the Nazi doctors, Lifton lays out the groundwork for answering the question of how German doctors became the agents of Hitler’s vision of the purified Aryan race, sterilizing involuntarily several hundred thousand citizens with a variety of mental and physical deficiencies. His answer, in brief: a romanticized genetics coupled with total political control.

Amazingly, the Nazi medical atrocities were carried out not against the opposition of Germany’s medical establishment, but with its approval. (Of course, there were individual dissenters, the more vocal of whom were removed from positions of authority or put to death). Nazi leaders worked hard to convert medical people to the official position. This was accomplished partly by force, but also partly by metaphor, as the normal language of medicine was used to hide the unethical nature of what doctors were being asked to do.

Individual patients were replaced by the racial term "Volk," meaning the (Aryan) people, and their rights were superceded by their doctors’ new duty to assure the health of this collective political idea. According to Nazi publicity, the Aryan race was in grave danger of "Volkstod," of dying out, because its genetic pool had been contaminated both by the transmission of inherited genetic defects and by the "foreign invasion" of Jews and their intermingling with members of the "superior" Aryan race.

To save their new patient, German doctors were expected to carry out the sterilizations, medical experiments, and, later, the euthanasia required by Nazi doctrine, which, in the words of one Nazi writer, declared that "misery can only be removed from the world by painless extermination of the miserable." Doctors were urged not to worry about ethical issues, because Nazi medicine was "nothing but applied biology."

In these ways, says Lifton, Hitler’s racial policies were ’medicalized’ and their evil made less obvious. Those who went along were billed as the "saviors of mankind," the "alert biological soldiers" whose actions would restore the purity of the Aryan race. Jewish doctors were not invited, of course, their research having been officially discredited in the mid-1930s, Lifton tells us, and their medical licenses revoked in 1939--in spite of the fact that they made up half the doctors in some large cities.

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Peter Selwyn spent the first ten years out of medical school at Montefiore Medical Center in the Bronx, caring for HIV-positive patients--mostly intravenous drug users and their families--in the early years of the AIDS crisis. As he worked with dying young men and women and their families, Selwyn returned to his own unexplored pain surrounding the loss of his father, who fell or (more likely) jumped from a 23-story building when Selwyn was a toddler. Mirroring their function in Selwyn’s life, the stories of the five patients who most affected him serve in this book as the threshold to the narrative of how Selwyn investigated, mourned, and commemorated his father’s death, finally revaluing it as central to the person and doctor he became.

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Frank Eloff, the novel’s narrator, is a white doctor working at a hospital in the former capital of one of South Africa’s now-defunct independent homelands (rural areas set aside by the apartheid government for black "separate development"). The hospital, in its deserted and decaying city, is understaffed and understocked, and there are hardly any patients. Those who do arrive usually need to be taken elsewhere if they need any significant treatment. The homeland’s former leader, the Brigadier, has returned as a criminal gang leader to loot the place, and a white former army commander, now in the employ of the present government, is trying to capture him.

Frank moved to this place when promised directorship of the hospital (and in flight after his wife left him for his best friend), but the previous director has not left yet, and Frank is in a kind of personal and professional bureaucratic limbo. He has a sexual relationship with a black woman who runs a roadside souvenir stall. It is not quite prostitution, not quite a love affair: she is married, speaks little English, and Frank regularly gives her money.

A new doctor, Laurence Waters, arrives. He is fresh from medical school, sent to the hospital in order to complete the rural community service year required by the government of all new physicians. He and Frank become roommates and begin an uneasy friendship. Laurence is an idealist, planning to make heroic changes, but he misunderstands the complex balance of tolerance, cynicism and patience that characterize survival at the hospital, and his well-intentioned efforts, such as trying to end theft from the hospital and to establish a clinic in a local tribal village, lead to disaster. The novel ends with Frank appointed hospital director at last, and things returning to their depressingly ineffective "normality."

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Couser, long interested in autobiography, explores the ethics of representation in biographical writing, and in particular, the ethics of representing vulnerable subjects--for example, the aged or very young, the sick or impaired, or those who are "socially or culturally disadvantaged." He is concerned with representation of people who are intimately connected to the biographer, either as family members, or in some other "trust-based relationship." Couser argues that the relationship between vulnerable subjects and their biographers is analogous to that between patients and their physicians and that therefore principles of bioethics should be applied to such life writing, especially the principles of autonomy, nonmaleficence, and beneficence.

Couser explores life writing and betrayal (Chapter 1), outlines how he will apply the principles of biomedical ethics and ethnographical ethics to life writing (Chapter 2), and applies these principles to examples of collaborative autobiography (Chapter 3). He then critiques in detail Michael Dorris’s memoir about his adopted son, The Broken Cord (Chapter 4); the work of Oliver Sacks (Chapter 6); memoirs of euthanasia (Couser calls these "euthanographies"), Saying Goodbye to Daniel: When Death Is the Best Choice, by Julia Cassutto Rothman; Rescuing Jeffrey, by Richard Galli, and But What If She Wants to Die, by George DeLury (Chapter 7). Finally, in the last chapter, Couser considers how investigation of the human genome might influence the "scripts" of our lives and hence life writing, and also how life writing might be a counter discursive force against genomic essentialism.

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In 1848 a member of the Irish gentry named Robert Devereaux is convicted of treason and sentenced to 14 years imprisonment for publishing articles that advocate the violent overthrow of English rule in Ireland. This novel is purportedly based on the journal that Devereaux kept during his years as a prisoner (1848 through 1851).

It begins when he is transported from Ireland to Bermuda, where he spends many months in a prison "hulk." The authorities have to handle him carefully, though, because he is both a gentleman and a symbol of Irish resistance. They do not want to have a martyr on their hands. Thus, when Devereaux develops severe asthma in Bermuda, they send him to Van Diemen's Land (Tasmania), where he is given a "Ticket-of-Leave"; i. e. he is allowed to live as he wishes in the colony, provided he adheres to certain restrictions and agrees not to attempt escape.

Once in Van Diemen's Land, Devereaux is reunited with other prominent political prisoners. He also meets and falls in loves with Katherine, an Irish Catholic woman, far lower in social class. (Devereaux is a member of the land owning Protestant Ascendancy.)

To be close to Katherine, Devereaux buys a hop farm with an English prisoner named Thomas Langford. The lovers intend to escape to New York together, but Katherine is pregnant. She dies shortly after delivering a healthy son. The despondent Devereaux eventually escapes as the journal ends.

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The title of this collection of poems recalls the formulaic statement by which a physician introduces a patient's medical problem or chief complaint. For example, "The patient presents with a history of fever, abdominal cramps and diarrhea for the last 24 hours." Or, "The patient presents with a long history of hypertension and diabetes." In this case, though, Dr. White's patients' presentations are poems, rather than chunks of sanitized medical jargon; and, while the patient remains a key character in most of these works, they also present the doctor's story.

Domestic violence, child abuse, and sexual abuse figure prominently in these poems. In "365" (p. 1) a five year old girl presents with "a foul smelling vaginal discharge"; she was a victim of rape. Baby "John Brown" (p. 9) has 47 fractured bones and was "dipped in boiling water" for soiling himself. In "Ironing" (p. 18) a first grade girl has the impression of an iron burned into her thigh. And the two-year-old girl in "Peek" (p. 49) is admitted to the Intensive Care Unit (ICU) with cigarette burns and a liver fracture.

Dr. White also writes of babies left behind by their mothers ("Autumn Angels," p. 3), homeless mothers and children ("Numbers," p. 42), and complex multigenerational family pathology ("Riddle," p. 50). All in all, these stories carry the reader very close to "Looking at the Gates of Hell" (p. 32).

Yet, a still, small voice of calm, maybe even of salvation, can appear in the most unlikely places. In "Belly" (p. 4) the physician lays her face against a baby's belly and "the warm brown skin calms my forehead. / All stiffness melts." In "Maplewood & Greene" (p. 36) she revels in seeing "three little girls on roller skates." And in the Whitmanesque poem called "Oh" (p. 45), she gloriously affirms, "Oh to laughter, oh to sorrow / Oh to a better day, oh tomorrow."

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