Summary:

This little novel is the retrospective tale of a childhood event told by the protagonist 40 years later. Family relationships and bonds in conflict with professional and community obligations vie with the shadow of racism and sexual abuse in the doctor/patient relationship for the core tensions in the book. The setting is a small rural community where the pioneer family about which the tale evolves controls the law and the medicine. The boy narrator relates his view of the breakdown of family as its secret--a physician uncle who is suspected of sexually abusing his native-American women patients--becomes a force that demands action from the doctor’s brother who serves as the sheriff.

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The author selected 48 works of art, famous and obscure, which are presented in chronological order as full-page color plates. On the facing page of each piece is a brief essay which includes information such as artist, date and current location of the work. The essays, as well as the introduction by the author, are insightful, well-written, and demonstrate the author’s vast knowledge as a medical historian. Selections include the "Oath of Hippocrates", Studies of the Fetus by da Vinci, The Anatomy Lesson of Nicolaes Tulp by Rembrandt, The Dwarf Sebastian de Morra by Velazquez, "Muscle-Man from Vesalius" by van Calcar, and First Operation Under Ether by Hinckley (see art annotation in this database).

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This strange little tale, set in western Europe, revolves around the shifting relationships among an Irish doctor, a would-be Austrian baron, a circus performer, and the American woman, Robin, who is to become the nemesis of them all. The plot is unfolded in a long series of conversations, many convoluted by their stream-of-consciousness style, rather than in observed action.

The physician (it is never clearly stated that he is a fully trained physician but the point is probably moot, since he assumes the role), the most consistently present and verbal character, is a study in contradictions. He is essentially never portrayed in a classic physician role, but much is made of his profession. This may be explained by the fact that it is his profession that justifies his central position--he knows and is in the confidence of all other characters. The reader follows, by means of the long and complex dialogues, Robin’s systematic destruction of a chain of male and female lovers in what appears to be an obsessive desire for self-destruction.

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This poem, written in five sections of free verse, begins with the speaker remembering the old steel bridge he used to drive over on his way to work. He describes how the gaps between the steel beams had given him access to the world beyond the bridge: he had been able to see the river bank and railroad tracks and, most importantly, the people down there, "wild dangerous men" living near the edge of the river.

The poet next describes the new bridge, with its smooth speedy surface and solid concrete sides concealing the view. He then steps back and reflects: "what now?" He compares the engineer making the bridge with his own writing, "diminish[ing] the homeless to a poetic abstraction," and asks where this leaves him. Both bridge and abstraction, he implies, take the life, untidy and dangerous but valuable, out of his experience of crossing the Missouri.

He cannot view the material for his poetry now, unless he were to stop, back up the traffic, and risk his life climbing the walls of the bridge, and even then he does not know what he would say, because the new bridge has made him realize something about himself: "I am partly the leech come to feed, / yet I cannot waver from my groove." As a poet, he needs access to the lives of others, an access he likens to parasitism. But his career, the work to which he is going, requires him to speed on across the bridge without pausing.

He now elaborates on his distance from the world of the homeless people (and, by implication, all the other material for his poetry), saying that he has "safely bled away the guilt, / and pity and compassion," from his involvement or complicity in the meaning of his material, and "channeled it" into the poem. The leech image is now applied to the poem which, once filled with those ambivalent emotions, becomes separate from the poet and attaches itself instead to the reader, who now becomes the one feeding on the "dark spurt of old blood," the horrifying riches of which the speaker has rid himself.

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In this sequel to his earlier seem-autobiographical novel, House of God, Shem (this time using both his pseudonym and his real name) describes the experience of a physician in the first year of a psychiatry residency in a prestigious private psychiatric hospital. In this first hand account it is assumed that the author is the resident, Dr. Roy Basch; he describes not only his experiences with a variety of patients but also with the other doctors and the staff members of the institution. It is not a happy place and in the telling of the story there is a biting irony and a sense of the absurd.

It is obvious from the first that Dr. Basch is very serious about becoming a psychiatrist but that he is also searching for meaning and connections. He finds that colleagues may often hurt you more than your patients. Another issue addressed is that of competing psychiatric theories, particularly the competition between pharmacologic treatment and psychoanalysis. Issues about drug treatment trials and the questionable way in which they are conducted also receive attention, as does the problem of insurance coverage for hospitalization.

The fact that psychiatrists often specialize in their own defects becomes a reality to Dr. Basch. There are not many exemplary people in this book--hopefully it exaggerates the real situation. There is, surprisingly, a sort of poignant positive ending.

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This is a story about Bea, a single woman professor who has just had a caeserian section for an 11 pound boy, and her hospital roommate, Corinne. Bea describes her own discomfort with Corinne’s race, while admiring Corinne’s pride and nurturance toward her newborn son. As the story progresses, Corinne is betrayed by the medical world in a multitude of ways: misdiagnosis, racist treatment, denial of medical treatment, and incompetent care, resulting in Corinne’s sepsis and her son’s eventual death.

At the end of the story, after Corinne and Bea are discharged from the hospital, Bea tries to visit Corinne and deliver the pictures of her child that Corinne hadn’t been able to afford. But at the last minute, Bea turns away. Although she wants to help, she feels wholly inadequate, and believes she will only cause Corinne pain. Ironically, Bea remembers her last night in the hospital, how she covered her ears as Corinne’s baby whimpered, and as her own breasts surged with milk for the crying child. Even though her instincts and body tell her what to do for Corinne, she is not able to listen.

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In March, 1981, in Vermont, Charlotte Bedford goes into labor. She has decided to give birth at home with the help of a midwife, Sybil Danforth, but complications develop. Charlotte has a seizure, her heart stops, and she does not respond to CPR. The fetus is still alive, so Sybil delivers him successfully by Cesarean section, with a kitchen knife. But the bleeding when Sybil makes the incision convinces her assistant that the patient’s heart was still beating. She reports this to the police and Sybil is put on trial for involuntary manslaughter.

The story of the trial is told by Sybil’s daughter, Connie, fourteen years old at the time and now an obstetrician-gynecologist. The acquittal comes at a price: the midwife finds herself no longer capable of delivering babies, and both she and her daughter are given a new insight into the uncertainty which underlies so many of medical decisions. At the end of the novel we are left uncertain whether or not Charlotte was still alive when her baby was delivered.

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Miss Armistead is a nurse in the surgical division of a hospital. She is being courted by two men, Dr. Joe Trask, the chief resident, and Dr. Mort Baker, an established and very successful surgeon. Everyone in the division is taking bets on her choice. Most assume she will choose Baker, the wealthier, more powerful doctor.

Then Miss Armistead develops appendicitis and requires emergency surgery. Joe Trask is on duty and has to begin the operation before Baker arrives, but experiences a terrible crisis of confidence, becoming helpless with fear. Baker arrives and completes the operation.

Everyone assumes that this will clinch Baker’s victory, but when Joe tells her how he was unable to operate on her, Miss Armistead takes this inability to see her as just another patient to be proof of the depth of his love for her, and agrees to marry him.

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Summary:

The nurse in this O. Henry Prize-winning story is Mary McDonald. She’s been a nurse for over 40 years and understands fully that the new pain she feels is a signal of her cancer’s spread, and for her, the beginning of the end. The remainder of this story is a retrospective of her life as a nurse and most significantly her role in forming a union, thirty years previously, at the local hospital.

Deftly placed between her reminiscences are scenes of her children’s visits to their dying mother, and perhaps as a final legacy to her nursing colleagues, Mary’s attempt to convince Eunice, her caretaker at the nursing home, to unionize the facility.

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The New Medicine and the Old Ethics, in Albert Jonsen’s own words, is a "secular aggadah." Jonsen explains that one Talmud reviewer defined aggadah as "a magical rabbinic mode of thought in which myth, theology, poetry and superstition robustly mingle" (4). The book begins with a personal essay entitled "Watching the Doctor." Jonsen establishes his premise that the moral history of Western medicine is best understood as a paradox between altruism and self-interest, a paradox alive and well entering the 21st Century.

He then takes the reader on his "secular aggadah," blending history, myths, and stories that trace important moral developments in the practice of Western medicine. In "Askelepios as Intensivist," we learn of the early Greek values of competence in shaping medical practice. Through the influence of the Church in the medieval period, Western medicine incorporates the value of compassion through the Biblical Good Samaritan, struggles with problems of justice in the care of the poor, and further elaborates the meaning of benefit.

In "The Nobility of Medicine," Jonsen describes the contribution of Sir William Osler and other knighted medical men of the 19th Century who established the ethics of noblesse oblige in the medical profession. He traces this noble tradition to the medieval Knights Hopitallers of Saint John of Jerusalem, a group of religious who provided hostels for pilgrims to the Holy Land and cared for the sick. With essays on John Locke and Jeremy Bentham, Jonsen brings us to the 20th Century and the play of individual rights and utilitarian values in the moral life of Western medicine.

In the final essays, Jonsen describes the mingling of these traditions as a means to establish a moral frame for Western medicine in our current times where technology and science have achieved and threatened so much. Ethics, he argues, "is disciplined reflection on ambiguity" (130). In the last essay, "Humanities Are the Hormones," Jonsen brings his "secular aggadah" full circle.

He argues that the paradox of altruism and self-interest that runs through the moral history of Western medicine must continually be vitalized and examined through the Humanities. The Humanities are "the chemical messengers that course through the complicated institution of medicine and enable it to respond to the constantly changing scientific, technological, social, and economic environment" (147).

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