Summary:

Eric Calhoune is known to his classmates as "Moby" because of the extra weight he has carried since grade school.  Though his mother is young and athletic, he has inherited the body type of the father he's never known.  Now, in high school, the fat is turning to muscle under the discipline of hard swim team workouts.  But that transformation has been slow in coming, since for some time Eric has taken on a private commitment to "stay fat for Sarah Byrnes."  Sarah, whose name is a painful pun, was severely burned as a small child not, as we are given to believe early on, because of an accident, but because of a cruel and crazy father who stuck her face and hands into a woodstove in a moment of rage.  She has lived with him and his threats for some time; that and her disfiguring scars have made her tough, smart, and self-protective.  Eric and she became friends as social outcasts.  Well-matched intellectually and in their subversive wit, they write an underground newspaper together.  Sarah, however, lands suddenly in the hospital, speaking to no one, making eye contact with no one.  Eric faithfully visits her and, per nurses' instructions, keeps up a running one-sided conversation as if she could hear him.  As it turns out, she can.  She is faking catatonia because the hospital is a safe place, and she has chosen this as an escape route from her father.  Eric and a sympathetic coach/teacher go to great lengths to find Sarah's mother-who, it turns out, can't bring herself to be involved in her daughter's life because of her own overwhelming shame.  Ultimately the father is apprehended, and Sarah, nearly eighteen, is taken into the coach's home and adopted for what remains of the childhood she bypassed long before.  In the course of this main plot, other kids enter the story and in various ways come to terms with serious issues in their own lives, some of which are aired in a "Contemporary American Thought" course where no controversy is taboo.

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Jerome Lowenstein is a nephrologist, author, and founder of the Bellevue Literary Press and the Humanistic Aspects of Medicine Education seminar program at the NYU School of Medicine.  In this thoughtful and illuminating book of essays he explores the patient/physician relationship in a world where medicine has embraced technology and scientific advances in the laboratory at the risk of neglecting the humanistic underpinnings of the field.

Dr. Lowenstein graduated from medical school at NYU in the late 1950s and spent nearly his entire professional career at NYU Medical Center and Bellevue Hospital. When he was a resident, long before work hour limits were instituted, the house staff gathered in the cafeteria at midnight to dine on the days’ leftovers.  This communal meal “provided a fine opportunity to communicate with colleagues directly, rather than by beeper and phone, about many of the days ‘medical leftovers,’ ” (1) sharing information as well as the frustrations and rewards of caring for patients.  “The Midnight Meal” poses the challenge of retaining the core of relationships, both between patient and physician and among colleagues in the rapidly changing world of medicine today.

In the essay, “Can You Teach Compassion,” Dr. Lowenstein tells his readers about the student who responded to the question with “I don’t know if you can teach compassion, but you surely can teach the opposite.” (13) The student was referring to how students become “desensitized” during their clinical years to the suffering of their patients, sometimes to the point of using derogatory terms to describe them. Dr. Lowenstein argues that teaching attendings can and should encourage students to learn about their patients. He writes how he once interrupted an intern who began to present a case by stating: “This is the first hospital admission of this thirty-five year old IVDA.”  Dr. Lowenstein asks: “Would our thinking or care be different if you began your history by telling us that this is a thirty-five-year-old Marine veteran who has been addicted to drugs since he served with valor, in Vietnam?” (17) Learning about the lives of their patients, Lowenstein emphasizes, does not detract from the clinical picture, but rather enhances it.  

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In this collection of "clinical tales," to use Oliver Sacks' term, Sue Hall, an experienced neonatologist who spent some years as a social worker before medical school, tells a remarkable range of stories about newborns in the NICU and their parents.  As memoir, the stories record moments in a life full of other people's traumas, disappointments, anxieties, and hard-won triumphs where her job has been to hold steady, find a balance point between professionalism and empathy as young parents go through one of the hardest kinds of loss.  Each story is told with clarity and grace, sketching the characters deftly and offering useful medical information along the way on the assumption that many who read the book will do so because they are facing similar challenges and decisions.  Each story is followed by a two- to three-page "Note" giving more precise medical background and offering further resources for those who have particular interest in the kind of case it was. 

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It started with a faint. Javier Miranda, a generally healthy 69-year-old man living in Venezuela, attributes his episode of dizziness to the summer heat and humidity. His only child, Andres Miranda, is a physician whose intuition tells him something is seriously wrong with his father. The doctor obtains blood work and schedules a CT scan and MRI of the brain for Javier. The medical work-up reveals rapidly progressing lung cancer with metastases to the brain. Violating his credo of complete honesty with patients, Dr. Miranda lies to his father and reassures him instead. Dr. Miranda's mother died when he was just 10 years old. Now his father's remaining lifespan has dwindled to a couple of months. The doctor must find a way to break the bad news to his dad.

Meanwhile, Dr. Miranda receives multiple messages - phone calls, e-mails, and letters - from a difficult and persistent patient. Ernesto Duran suffers from dizzy spells and multiple other symptoms. It could be panic disorder or maybe Ernesto is a hypochondriac. Dr. Miranda instructs his office secretary, Karina, to deal with these communications and remind the patient that there is nothing more that can be done for him. When Ernesto admits he is stalking the doctor, Karina worries. Pretending to be Dr. Miranda, she begins corresponding with Ernesto via e-mail. Before long, Karina develops symptoms similar to Ernesto's and experiences empathy for him.

When his physician-son finally summons the courage to announce the terminal diagnosis, everything changes for Javier - his mood, personal relationships, and awareness of his body's metamorphosis. He perceives the smell of rot associated with his physical deterioration. Dr. Miranda's frame of mind also changes as he copes with his father's impending death. Javier's deathbed request is simply for his son to shatter the terrible silence by talking about the two of them.

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Parts of medical history read like detective novels.  The discovery of the source of cholera by Dr. John Snow in London in 1854 is one of those episodes.  The Ghost Map tells the story of Snow's pioneering work in what have now become standard epidemiological methods.  Tracing a cholera outbreak to a local pump in a poor section of London involved many door-to-door visits working with people who weren't always cooperative, incurring the suspicion and/or ridicule of both them and the medical professionals with whom he worked.  In the course of the story the author offers reflections on the organization of cities and on public hygiene.  Snow, an out-of-the-box thinker, also helped develop surgical anesthesia. 

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In 1974, a student befriends Pärssinen, the gardener of his apartment complex in the town of Turku, Finland. Pärssinen invites him to drink and watch pornographic movies from his extensive collection. One night when both are full of alcohol, the gardener stops a girl on a bicycle, rapes and strangles her, and tosses the body in a lake. The drunken student is a baffled witness. The body resurfaces several months later, but the case is never solved. Her name was Pia.

More than thirty years later, in 2007, another girl, Sinikka, goes missing. Her bicycle is found with traces of her blood right beside the memorial shrine to Pia at the place of her murder. The retired cop, Ketola, is convinced that solving this new crime will also solve the old one.

At the same time, far away in Helsinki, Timo Korvensuo and his wife are entertaining friends. He is a successful real estate agent with a lovely, kind wife and two children, a boy and a girl. News of the missing girl greatly disturbs Timo and he leaves home headed to Turku telling his family it is for business. The reader realizes that Timo must be the unnamed student who witnessed the first murder.  

In parallel with the police investigation, Timo’s abject wanderings in Turku seem to be centered on (re-)finding and perhaps outing the original killer. Police discover that Sinikka’s parents are consumed with guilt for the difficulties they have had with their adolescent daughter; they fear she has been snatched, perhaps killed, before they could patch things up.  The father is a suspect.

Timo finds Pärssinen again and learns that he is unaware of the copycat crime. The police also also visit Pärssinen as a person of interest, but nothing comes of it. Timo goes to Pia’s mother, still living in the same home, to express his sorrow for her loss.

SPOILER ALERT!  Primed by Ketola, Pia’s mother contacts the police. They raid Timo’s home in Helsinki and find child pornography on his computer. They know he cannot have committed the recent crime, but they are convinced that he killed Pia. As the noose tightens, Sinikka reappears alive and well from a hiding place in the forest. She staged the second crime as bait to lure the true killer in a plan she had cooked up for Ketola. Timo commits suicide and the police close both cases, but they are wrong.

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Open Wound is a novel crafted from the extensive documents of an unsettling, little-known, yet remarkable episode in the history of medicine.

In the summer of 1822, Dr. William Beaumont was practicing medicine at a rugged military outpost on Mackinac Island in Lake Huron, part of the Michigan territory.  His assignment as Assistant Surgeon, US Army represented about the best circumstances he could expect from his training as a medical apprentice without a university education.  In addition to soldiers and officers, Beaumont sometimes attended patients from the American Fur Company, whose warehouses shared the island's harbor.  On June 6, an accidentally discharged gunshot cratered the abdomen of an indentured, French-speaking Canadian trapper.  Fortunately for him, Beaumont served during the War of 1812 and knew how to care for devastating wounds.   With the surgeon's medical attention and willingness to house and feed the hapless trapper, Alexis St. Martin's body unexpectedly survived the assault.  But his wound didn't fully heal.  As a result, it left an opening in his flesh and ribs that allowed access to his damaged stomach.  Through the fistula, Beaumont dangled bits of food, collected "gastric liquor," and made unprecedented observations about the process of digestion.  

His clever and meticulously documented experiments, conducted on the captive St. Martin over several years, corrected prevailing assumptions about digestion.  Once thought to depend on grinding and putrification, normal digestion, Beaumont observed, was a healthy chemical process.  Any signs of putrification or fermentation indicated pathology.  In 1833 Beaumont published his thesis on the chemistry of digestion in Experiments and Observations of the Gastric Juice and the Physiology of Digestion.  Shortly before completing the book, he received a temporary leave from his military service to restart his research in Washington.  But to carry on his project, Beaumont had to persuade St. Martin-who entered and exited his physician-researcher's life several times before-to leave his growing family in Canada and once again become a research subject.  St. Martin does return, with pay, and briefly accepts his role.  But he also confronts Beaumont about whether the long confinement on Mackinac Island was more necessary for the patient's survival or the doctor's research agenda.  Or for the doctor's subsequently improved station in life. 

Although some of Beaumont's academically trained colleagues found fault with his methodologies, the farmer's son and frontier doctor did achieve a gratifying level of professional accomplishment and wealth.  To enjoy them, he had to set aside humiliations he experienced along the way, accept his lot after military service as an ordinary practitioner in St. Louis,  and weather an unforeseen turn near the end of life.    

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The foreground of this painting is dominated by a "pieta" type grouping. One woman hovers closely over what appears to be a dying man, while another comforts a small child. This part of the canvas is underlighted. The colors are rich earth tones. The figures are non-Caucasian.

In the background, in harsh light, is a group of identical looking starkly white men. In fact, their faces are almost skeletal. All are in suits, three are seated, with four others standing behind the seated figures. They look very much like a "tribunal."

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In 1953 Alice Neel created a series of ink and gouache drawings depicting the last weeks of her mother's life, which were spent in a New York city hospital. One of these is at the Robert Miller website linked to this annotation. In the drawing, a black nurse comforts a prone elderly lady. The pale hues of the painting--blue, black, white--evoke a somber mood and imply sickness. This sense of despair is augmented by a harsh cityscape background beyond a dark river, which the viewer sees through a window.

Compassion counters these desolate surroundings, however, for a bond is apparent between the nurse and elderly patient. The nurse's hands rest on the patient in a partial cradling gesture, and the trajectory of the lines made by the nurse's arms and hands and the elderly patient's flowing hair establishes a visual and emotional link. The connection between the two figures is supplemented by the thin smiles on both women's faces.

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