Summary:

The surgeon-narrator and his team of assistants (the anesthesiologist, scrub nurse, circulating nurse, surgical resident, and medical student) perform a difficult operation during the night. The patient has an infiltrating cancer of the stomach (linitis plastica) that has eroded his aorta. Because of uncontrollable bleeding, the operation (an exploratory laparotomy with attempted repair of a malignant aorto-gastric fistula) is as doomed as the patient himself.

The surgeon soon comprehends the hopelessness of the procedure as well as the patient's terminal condition. He turns off the oxygen from the gas tank and stops the patient's blood transfusion. Minutes later, the man dies. Blood is all over everything. The doctor must now deliver the bad news to the man's family. He has the medical student tag along.

Members of the patient's family are upset and some are even out of control so he dispenses tranquilizers to them. The surgeon returns to the operating room (OR) and even now finds blood everywhere. The OR team is still working. The doctor showers and then goes back to the OR once more. The room is now dark and empty but clean. The surgeon imagines the dead man's body with a row of abdominal stitches that he likens to hieroglyphics. The unsuccessful operation and the surgeon's actions are thus both concealed and unforgettable.

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Kirk, a man in his 50s with highly metastasized kidney cancer, presents himself to Dr. Groopman after having been turned away as a helpless case by several respected cancer clinics. He tells Groopman that he is a risk-taking venture capitalist and is willing to take any medical risk on the chance that it will save him. After pondering the ethics of the situation and the nature of informed consent under such conditions, Groopman agrees to treat Kirk. He proceeds to devise a highly risky (and untried) combination of chemotherapeutic agents. The course of treatment is excruciatingly difficult, but the experiment succeeds, and Kirk's cancer goes into complete remission.

Kirk calls it magic, a miracle, and the hospital interns call it a "fascinoma," a case defying normal expectations. Groopman releases Kirk to home and weekly checkups with a local internist, but in doing so he notices that Kirk's mood has mysteriously changed. He has lost the "piss and vinegar" of their earlier contact. Kirk continues to improve physically, traveling and playing golf and even tennis, but Kirk's wife soon reports that Kirk has stopped reading the newspapers he used to devour, which now collect in their driveway.

Several months later some physical symptoms return, and Kirk's cancer is back. A month later he is dead. In talks with Kirk near the end, Groopman discovers that Kirk's brush with death had brought with it a new and sharply negative view of himself as selfish and disconnected from the world and other people. Suddenly all his financial success seemed to him "pointless," and, since his life contained nothing else, it seemed to him a waste, and he felt it was too late to live it over. What Kirk ironically calls "my great epiphany" seems to have undone his doctor's "magic."

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It is 1905, and a young doctor just out of internship in Chicago has decided to head for the southwest to seek his fortune. He finds himself on a slow train in southern New Mexico, sitting across from a Sister of Mercy "in her black robes, skirts and sleeves, and heavy starch." When the train stops, the doctor inquires about a group of men huddled on the platform. They surround a severely ill Mexican worker, who turns out to have appendicitis. The doctor insists that only an immediate operation will save his life, but the Mexicans are violently opposed to surgery. Eventually, the doctor enlists the nun’s help to persuade them.

In the blistering heat, they carry the man to a shed where the doctor performs an appendectomy with instruments in his black bag, including morphine and chloroform. For the next 24 hours, he and the nun watch over the man, and then carry him to the nearest town on the next train. He survives, which is good because otherwise the Mexicans have threatened to kill the doctor. The nun, who throughout has been cool toward the doctor because of his use of "rough" language, proceeds on her way to Texas.

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Birth Sounds includes 45 short tales of labor and delivery, ranging through a wide swath of the human comedy, but always maintaining focus on the very first scene. In most of these stories, it isn't the delivery that provides the drama, but rather the people. Take the first story, for example. In "Faceless" a Vietnamese husband cautions the obstetrician-narrator, "In our country no man will examine a woman in such an intimate way." The obstetrician never sees the patient's face, which she has covered with a towel. After the delivery, he examines her and speaks carefully, not sure that she understands English. However, from beneath the towel, she thanks him in a perfect American Southern accent. A neat surprise!

In "The Little Devil" (p. 6) a 38-year-old member of a satanic cult announces that she intends to kill the baby if it is a boy. She has been directed to do so by her satanic mentor. When, amid a panoply of lit candles and inverted crucifixes she delivers a boy, the resident contacts the sheriff's office, where the mother's intentions are already known. Sure enough, the SWAT team storms the delivery room and takes the baby.

In "Red Bag" (p. 31) the narrator is serving as a medical expert in a murder trial. The defendant had arrived at the hospital hemorrhaging after delivering a baby at home, evidently into the toilet bowl. The baby had died of head injury. The obstetrician-narrator turns out to be more supportive of the woman and less compliant than the prosecutor had expected; but afterward the doctor receives his financial reward--a check from the state for a full $7.00!

In "Resilience" (p. 259) a woman with a near-term pregnancy asks the obstetrician to examine her breast, which has suddenly developed a red lump. He takes one look and immediately experiences a flashback to another young woman he cared for who had developed breast cancer during pregnancy and died of metastatic disease about a year later. Sure enough, the current patient also has cancer. But in this case the patient delivers, receives treatment, and recovers, apparently cured of her cancer.

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The House of God is a chronicle of Roy Basch's internship year at a prestigious Boston teaching hospital, also known as The House of God but clearly modeled after the Harvard-affiliated Beth Israel Hospital. Cycling through various medical disciplines, Roy and his peers learn medicine from the eccentric, irreverent, yet oddly compassionate Fat Man, whose 13 Laws of the House of God cynically summarize the harrowing and often demeaning hospital practices and rituals reflected in both the doctor-patient relationship and in the residency experience itself.

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A young art student falls off a ladder and literally lands into the arms of a middle-aged doctor. Daisy Whimple is a poor, homeless woman with multiple body piercings. She has volunteered to decorate the Gynae Ward of the hospital where she had once been a patient undergoing surgery for a complicated abortion.

Dr. Damian Becket is an obstetrician and gynecologist. He is a lapsed Catholic who is separated from his wife. Becket is interested in modern art and attracted to an art historian, Martha Sharpin. The hospital has a collection of medical antiquities in need of cataloging. Some of the pieces are treasures but others are horrible relics. Martha is in charge of organizing the collection, and Daisy is paid to assist her.

Because she has nowhere to live, Becket invites Daisy to stay at his apartment. They make love every night for one week until she leaves. While attending an art exhibit, Becket and Martha spot a sculpture of the goddess Kali. The figure is comprised of artifacts "borrowed" from the hospital's collection including prosthetic arms, antiquated instruments, and body parts. It is designed by Daisy.

The sculpture is not the only unexpected thing created by Daisy. She is pregnant by Becket. Daisy requests an abortion but he insists that she have the baby. The pregnancy is almost miraculous given the damage done to Daisy's fallopian tubes from her previous abortion. It turns out to be a difficult delivery and Becket must perform it since he is the most qualified obstetrician at the hospital. The baby is a healthy girl. The newborn child radically changes the lives of Daisy, Becket, and Martha, yet the three of them have no clue what to do next.

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Martin Nanther is a member of the British House of Lords, having inherited his title from his great-grandfather, Henry. Physician to Queen Victoria, Henry specialized in hemophilia, the disease that Her Majesty was known to have passed to her son, Leopold, and other descendants. While the House of Lords considers a Bill to abolish hereditary peerage and Martin's much younger, second wife is obsessed with becoming pregnant, he escapes into his slow research for a biography of Henry

His patient genealogical investigations uncover deaths in infancy of several young boys in his own family, and Martin soon realizes that hemophilia (rather than the family's legendary tuberculosis) is the cause. Was that irony merely a coincidence? Or was hemophilia in his own lineage the impetus for his grandfather's research and position in life? And why was the disease hushed? Was it possible that his grandfather deliberately sought a bride with the trait in order to investigate it in his own progeny?

Martin soon finds himself wondering if this well-respected, medical man actually committed murder, or was he merely waylaid by unexpected love? Without giving too much away, suffice it to say that the answers prove so surprising and so disturbing, that Martin decides to abandon the biography of his ancestor, even as he learns that his inherited peerage has been revoked and that his next child will soon be born.

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This story of one exceptionally accomplished family's discovery of their past and future relationships with Huntington's Disease (HD) is also the story of how the Wexler family changed the cultural narrative of HD for other families at risk for this genetically-transmitted and currently incurable disease. The HD diagnosis of Leonore Wexler (the author's mother) inspires Milton Wexler, a psychologist, to create a major foundation for HD research, which develops critical mass and influence as Leonore Wexler's condition deteriorates, and after her death. The book interweaves the story of the Wexlers' emotional and other negotiations with HD and the story of their efforts to create an HD community comprised of those with active symptoms of HD, family members, advocates, and researchers.

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The narrator, Rick, is let out of rehab to live with his older brother, Philip, who is a doctor in Detroit. He will work at a mundane job in Philip's lab. The awkwardness of their encounter slowly evaporates and Rick begins to enjoy life with his family, especially his two young nephews. But he is concerned about Philip's weary appearance, so reminiscent of their father.

It emerges, quickly and to Rick's surprise, that Philip runs an abortion clinic. The clinic is subject to constant harassment by a persistent group of religious, "right-to-lifers," who taunt the doctors, the workers, the patients, and their families at home. Rick struggles to control--even avoid--his feelings; and he tries (unsuccessfully) to suppress the desire to befriend patients.

Eventually, he is reconciled to his new task through an unwelcome fixation on one patient. But angry urges to protect her and his brother well up. After weeks of pent-up rage and fear, he hides a gun, loses control, and begins shooting aggressive protestors. The murder is "nothing"; it's "just like killing babies."

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Summary:

This is a collection of 23 stories, five of which take the form of "letters" in which an older physician (not surprisingly, a surgeon) gives advice to an imaginary young surgeon. However, every one of the stories "fits" as a tale that might be told in such a letter--assuming the author was a wise and gifted writer, in addition to being a surgeon.

The book begins with the gift of a physical diagnosis textbook on the occasion of the young doctor's graduation ("Textbook") and ends with a reflection on "your first autopsy" ("Remains"). Among the other stories are Imelda (see annotation), Brute (see annotation), Toenails (see annotation), Mercy (see annotation), "A Pint of Blood," "Witness," "The Virgin and the Petri Dish," and "Impostor."

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