Summary:

Twelve contemporary stories set in Rhode Island and New York City. Major themes include the pain of cultural dislocation and cross-cultural experience ("Theng," "Shambalileh," "My German Problem"); human frailty and self-deception ("Sleep," "Juilliard"); and the personal and moral dimensions of medical practice. See the separate annotations for Laundry, The Good Doctor and Ambulance--three stories which are particularly relevant to Literature and Medicine.

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Dr. Cassell examines the social and cultural forces that encourage the practice and teaching of a medicine that is governed by the disease theory. This theory discounts the impact of illness on the patient and ignores the suffering that the patient is experiencing. Cassell does not debunk science and technology, rather he encompasses them within the moral enterprise of medicine as tools for helping patients.

The ability to provide compassionate attention to the patient as individual (i.e., with unique values, life experiences, family interactions, etc.), trustworthiness and self-discipline are required characteristics of a "good physician." Cassell illustrates and personalizes the philosophical shift towards focusing on the sick person with stories and anecdotes.

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This autobiographical account of Dr. Lown's five decades of practice and research in cardiovascular medicine is both a history of the field and a history of a man passionately interested in people and healing. The book is divided into six sections: Hearing the Patient: The Art of Diagnosis; Healing the Patient: The Art of Doctoring; Healing the Patient: Science; Incurable Problems; The Rewards of Doctoring; and The Art of Being a Patient.

The first three sections comprise the bulk of the book: Lown chronicles his early medical training and career through stories of memorable patients, anecdotes about key role models (particularly Dr. Samuel A. Levine), and histories of medical mistakes, diagnostic acumen, and his remarkable research innovations. These achievements include the introduction of intravenous lidocaine, cardioversion and defibrillation, and development of the coronary care unit.

The core of the book, however, is about how deeply Lown cares for his patients. He states, “This book is a small recompense to my patients, ultimately my greatest teachers, who helped me to become a doctor.” The book contains many reflections on medical practice, such as this definition of medical wisdom: “It is the capacity to comprehend a clinical problem at its mooring, not in an organ, but in a human being.”

In a thoughtful chapter on death and dying, Lown muses on his emotional and spiritual responses to encounters with death, and bemoans the medical profession's increasing tendency to “put technology between us and our patients, to spare us the grief of failing to confront our own mortality.” In the final chapter, Lown takes an unusual twist, and writes a treatise to patients on how to get the doctor to truly pay attention to them and what are reasonable expectations to have of one's doctor.

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Reade was known for writing "novels with a cause." Here, as in several other of his novels, his cause is the deplorable condition of mental hospitals in the early to mid-nineteenth century. Until late in the century, many considered the mentally ill untreatable. Hospitals were more like prisons than places for treatment. Admission policies were also fairly lax. Reade records a common fear that healthy people would be incarcerated.

In Hard Cash, a father incarcerates his son in order to cover up a crime. The doctors who admit him have a kickback scheme worked out with the hospital--they get money for each patient admitted. Once in the hospital, the hero tries to prove his sanity but finds it impossible to battle against doctors who refuse to look past the diagnosis that caused his admission to his actual mental condition. He also must negotiate with the head of the hospital, a woman who is madly in love with him and refuses to allow him out of her sight.

He cannot prove his sanity and only escapes when there is a fire in the asylum. There is one "good" doctor in the story who refuses to bleed patients, deny them food, or admit the sane to mental hospitals. The other doctors think him a quack, but he saves several lives.

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This book offers an insightful, well-reasoned interpretation of the nature of medicine. Hunter, an English professor who teaches and coordinates humanities programs at a medical school, observed first-hand how an academic medical center functions--she joined various teams during their multiple rounds and conferences for two years. In sum, she "behaved rather like an ethnographer among a white-coated tribe." The resultant book details the profound importance of narrative in medicine.

Narrative is integral to the medical encounter, to communications by and about the patient, and to the structure and transmission of medical knowledge. For example, the patient's story is told to and interpreted by the physician, who then tells another story of the patient, in case format to other physicians, and records that story in a formulaic chart entry. Hunter observes that most of the rituals and traditions of medicine and medical training are narrative in structure, and explains why narratives such as cautionary tales, anecdotes, case reports and clinical-pathological conferences are central, not peripheral, to medicine. The thesis is further developed to maintain that, if the narrative structure of medicine is fully recognized by physicians, they will attend to their patients better and acknowledge the details and importance of their patients' individual life stories.

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This is a collection of short stories by a young physician, Stewart Massad, who completed a residency in obstetrics and gynecology and a fellowship in gynecologic cancer. The stories are all written in the first person, all physicians. The subjects include the physical/emotional demands of residency ("Fatigue"), especially as they strain a marriage; the motivations of a doctor who runs an abortion clinic ("Healers"); and a young doctor facing his own fatal illness and his experience as a patient ("Casualties"). While the stories do portray the difficulties (and often angst) of training, they do so without the despair/cynicism often found in other accounts of the same experience.

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The doctor-narrator is working in a hospital during the Great Depression. The pediatric ward cares for many children left there by families unable to feed or care for them. The doctor sometimes thinks the children should just be allowed to die. One particular child captures his interest. She has a high fever and he cannot figure out why. Her condition becomes progressively worse and she dies. It turns out that she had meningitis. Perhaps he could have saved her if he had made the correct diagnosis. Yet, he doesn't feel guilty.

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This is a light-hearted short story about an attractive, middle-aged female hypnotist who has a minor respiratory infection and visits the doctor. At first she hypnotizes the nurses so that they will put her in the examining room without a wait, and convinces them that her vital signs are different from what they had originally measured.

After this initial, good-natured experiment, the narrator waits a full 45 minutes for the doctor. He is abrupt and impersonal. Out of frustration, she hypnotizes him, and learns that he is afraid to be warm with patients, and is afraid to take time with them, because he needs to maintain control. She has him undress, put on a gown, and then leaves him to shiver in the exam room. She tells him that he will never forget what this humiliating experience feels like.

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This is the story of a successful use of play therapy with an emotionally disturbed five-year-old boy named Dibs. In nursery school Dibs is very withdrawn and resists his teachers' attempts to engage him. Dibs' parents and teachers had all but given him up as mentally retarded. Axline is brought in as a last resort, and in a series of play therapy sessions over a period of several months, cures him. (Dibs turns out to have an IQ of 168.) Axline takes an emotionally neutral approach to her patient, in spite of his obvious need for emotional support, in order not to interfere with his discovering of the self that had been severely repressed at home.

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The initial chapter in this novel, Of Mist, and Grass, and Sand (annotated separately), sets the stage for the quest of the young healer/heroine, "Snake," to find a replacement for the snake she had carelessly allowed to come to harm, in the course of caring for a seriously ill child. The remainder of this coming-of-age novel chronicles Snake's journey during her "proving year" (aka/residency training).

Over the course of this year, Snake continues to minister to the sick and encounters, among others, a patient who demands assistance in suicide, a patient who refuses treatment for a gangrenous leg, and a young girl who has been sexually abused (whom Snake eventually adopts and begins to apprentice). There are, as well, myriad lessons in humility, rigidity of thought, and ethnocentrism.

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