Summary:

In early 1847, the young Quebec city doctor, Lauchlin Grant, struggles to extract a living from his boring practice and pines over his childhood sweetheart, Susannah. She is now the wife of a prominent journalist, Arthur Adam Rowley, who has charged Lauchlin with her care, while he travels in Europe to report on the ghastly potato famine in Ireland and his predictions for its effects on immigration.

Even as Rowley's letters are read at home, waves of starving Irish land at Grosse Ile in the St. Lawrence River where thousands are ill or will sicken of ship fever (typhus), and die. Lauchlin is called to help at the quarantine station. Of the hundreds in his care, he rescues only Nora. Having lost her family, Nora decides to remain as a nurse, because she is now immune.

Lauchlin sees Susannah only once more, learning that she too cares for victims of typhus, which is also ravaging the mainland, despite the quarantine. He senses her unspoken love for him and, filled with an inner peace, returns to Grosse Ile, only to contract typhus and die. Nora takes the doctor's belongings to Susannah's home, hoping to meet the woman whose name he had mumbled in his delirium. Instead, she finds Susannah's newly returned husband dreading the loss of his now dying wife.

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A journalistic account of the CIA-funded experiments in "psychic-driving" of Dr. Ewen Cameron at Montreal's Allan Memorial Institute in the 1950's and early 1960's. Cameron investigated "treatment" for various forms of depression, consisting of high-dose electroshock (Page-Russell variant), heavy sedation, and the repetetive playing of patient's or the doctor's recorded voice.

Many patients did not respond; some were destroyed by the technique. Particularly moving is the story of Mary Morrow (Chapter 9), a physician-patient whose career was damaged by her experiences. Cameron held the most prominent positions in professional psychiatry; he died unscathed by his questionable research and in pursuit of yet another goal, a mountain peak.

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During an art class on anatomy, an art instructor in an undergraduate curriculum addresses the students on the dedication and vision an artist needs to become a true artist.

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Scarlett writes about the tradition of medicine in a recognizably British (Canadian) voice. He presents a definition of a profession that features social responsibility and duty to serve others, and notes that "an organized profession does not seek to advance the money-making feature of professional activity." Scarlett identifies seven "pillars" (principal qualities) of the physician, or any other professional: technical skill, social responsibility, knowledge of history, knowledge of literature and the arts, personal integrity, faith that there is some meaning and value in life, and "the grace of humility."

Scarlett critiques the medical profession in two ways. First, physicians are not skeptical enough and willing enough to correct their errors. Secondly, professional qualities have declined "at the hands of the scarcely literate pushing public . . . . " As a result of this, some physicians now believe that "all this rhetoric about the essential nobility of the medical profession is a load of old rubbish" (p. 129).

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A young doctor, just graduated, arrives at the country hospital to which he is assigned. He is fraught with anxiety because of his inexperience, especially when he meets the seasoned feldsher and midwives, who sing the praises of his predecessor. During the night his first patient arrives: a girl who was caught in a brake (a machine for threshing flax) and is now mangled and near death. No one expects her to live. The feldsher whispers, “She'll die now.” Yet the doctor feels compelled to try to save her, despite his ignorance. He amputates a leg, he continues treatment, the girl hangs on. Eventually she recovers. The new doctor has established his reputation in the district.

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This novel was inspirational for several generations of pre-medical and medical students. It follows the hero, Martin Arrowsmith, from his days as a medical student through the vicissitudes of his medical/scientific career. There is much agonizing along the way concerning career and life decisions. While detailing Martin’s pursuit of the noble ideals of medical research for the benefit of mankind and of selfless devotion to the care of patients, Lewis throws many less noble temptations and self-deceptions in Martin’s path. The attractions of financial security, recognition, even wealth and power distract Arrowsmith from his original plan to follow in the footsteps of his first mentor, Max Gottlieb, a brilliant but abrasive bacteriologist.

In the course of the novel Lewis describes many aspects of medical training, medical practice, scientific research, scientific fraud, medical ethics, public health, and of personal/professional conflicts that are still relevant today. Professional jealousy, institutional pressures, greed, stupidity, and negligence are all satirically depicted, and Martin himself is exasperatingly self-involved. But there is also tireless dedication, and respect for the scientific method and intellectual honesty.

Martin’s wife, Leora, is the steadying, sensible, self-abnegating anchor of his life. In today’s Western culture it is difficult to imagine such a marital relationship between two professionals (she is a nurse). When Leora dies in the tropics, of the plague that Martin is there to study, he seems to lose all sense of himself and of his principles. The novel comes full circle at the end as Arrowsmith gives up his wealthy second wife and the high-powered, high-paying directorship of a research institute to go back to hands-on laboratory research.

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This story concerns the death of a child and failures of communication. Scotty, an eight year old, is hit by a car on his birthday. His mother had ordered a birthday cake but "there were no pleasantries between" her and the baker. Scotty is hospitalized, unconscious, and the cake is forgotten. Dr. Francis reassures the anxious parents that all will be well when the boy wakes up.

The baker phones the parents’ home in the dead of night (when he does his baking) because the cake hasn’t been picked up, but they can’t figure out who he is or what he wants. At the same time the doctors and staff can’t and won’t answer their questions about why Scotty isn’t waking up. Dr. Francis comes to the hospital to check the child, looking tanned, meticulously dressed, as if he has just been out for the evening- he has a life outside of the hospital, but the parents have none. When they do run home, separately, to take a break, the baker torments them with his mysterious late-night calls. Their confusion and isolation deepen. The child dies-"a one-in-a-million circumstance."

The mother finally realizes that it is the baker who has been calling and tracks him down, enraged. She unleashes all of the anger which she had been unable to express to the doctors. The baker is stunned to learn about the child’s death; he begs forgiveness and offers them warm delicious cinnamon rolls. "Eating is a small, good thing in a time like this" and they are comforted.

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Helen van Horne, the good doctor, has left her solitary practice as a physician in rural East Africa to become chief of the Department of Medicine at City Hospital. She is a tough, hard-as-nails woman who has given up the comforts of marriage, family, and human indiscretion for her profession. While the folks in South Bronx initially "hate" her because of her skin color, they soon learn that van Horne is a model of rectitude, dedication, and compassion. The Hispanic chief resident becomes her disciple.

Van Horne's yearning for human comfort and sexual gratification brings her into intimate contact with a lazy, irresponsible, but charming male student. Out of weakness, she tells the failing student that he will pass the rotation, but is later challenged by the chief resident, who has left her own lazy husband and dedicated herself to be "just like you." Van Horne realizes her own weakness, allows the failing grade to be recorded, then contemplates (but rejects) suicide.

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A physician stands in the laundry, folding her baby’s diapers, and thinks about Mr. Dantio, who died of wildly metastatic cancer. She reflects on the development of her relationship with Mr. Dantio during the time that she was pregnant. Toward the end, he developed a lung infiltrate, maybe a type of pneumonia. There was a chance that a biopsy might have helped--perhaps he had a treatable infection--but she recommended against it. Now she wonders about this decision. She wonders also about what the other physicians think of her: "you don’t really want to be a doctor anyway, you must be conflicted to have a child . . . . " She remembers seeing Mrs. Dantio in the supermarket shortly after her husband died, and crying with her. She asks herself: Will I ever be a REAL doctor, "because in moments of great stress I revert to my native tongue."

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A medical student at Lincoln Hospital in the south Bronx is called to the Emergency Room, where a gang war is going on. She plunges through fighting bodies in the waiting room to reach the treatment area, where she is enlisted to ride an ambulance with a critically injured and intubated patient. During the trip, the ambulance jerks, the tube comes out, and the student tries but fails to ventilate him with mouth-to-mouth respiration. At the other hospital, she is turned away from the cafeteria because her clothes are blood-soaked. The patient dies. Although she feels terrible, her friend Marie, a practical nurse, comforts her with a touch of ordinary love, a photo of her new grandchild.

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