Summary:

Dr. Aloysius Lana, a "Black Doctor" of Spanish ancestry, settled in a Lancashire town and courted Miss Frances Morton, a young woman of the local gentry. After he unexpectedly broke off their engagement, he was found dead, and Frances's brother was arrested. At the trial, Dr. Lana himself appeared: the corpse was instead his dissipated twin brother Ernest, dead of a heart attack. Ernest's secret arrival had forced Aloysius to dissolve his engagement, not wishing scandal; Ernest's death allowed Aloysius to create a new identity abroad, his future shattered. But, hearing that the death had been misdiagnosed as murder, Aloysius explained the situation, and he and the Mortons were reunited.

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This fine collection of short memoirs and stories by doctors offers a variety of narratives about memorable moments in medical education and practice that raise and explore practical and ethical issues in medicine. An explicit aim of the editors was to focus on some of the rewards in medical life as well as the struggles it entails--those often being inseparable.

Starting with a section on medicine and poetry which includes memories of William Carlos Williams by two of his well-known students, Robert Coles and John Stone, and a reflection on illness in poetry by Rafael Campo, the collection is then divided into two major sections: "Grand Perspectives" and "Intimate Experiences." The former includes narratives that show the development of practices, conflicts, or learning over time spent in hospitals and clinics, observing the careers of elders in the profession or the parade of patients whose expectations and needs stretch the physician's creative resources. Several, including Perri Klass and David Hilfiker write about particular patients whose cases became personal landmarks.

In the latter section, stories focus on single cases or incidents in the lives of doctors, some humorous, some tragic, some bemusing, all attesting to the chronic ambiguities of the work of healing and to the very human tensions that arise in institutions that both enable and inhibit the compassion all good doctors want to exercise.

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The setting is the children's ward of a hospital in Paterson, N.J. during the Great Depression. Alternating between a cynicism born of desperation, and empathetic concern, the physician-narrator describes the sorry condition of his young patients, virtually abandoned by their parents. He muses that they would be better off left untreated so that they would not have to live the inevitably wretched lives ahead of them.

One child in particular has captured his attention. She is Jean Beicke, an eleven month old, malnourished, deformed girl suffering acutely from broncho-pneumonia. The nurses and he look after her, and she responds to their care by taking nourishment and gaining weight. This is tremendously rewarding and reinforces their interest in her, but to their consternation she continues to be very ill. "We did everything we knew how to do except the right thing." "Anyhow she died." The benumbed mother is persuaded to allow an autopsy; the physician wants to understand what went wrong although he "never can quite get used to an autopsy."

The postmortem uncovers an infection of the mastoid process which has spread to the brain. The narrator and the "ear man" berate themselves for having failed to take proper steps to identify and treat the infection. In the end, however, the physician is still unable to resolve the dilemma of wanting passionately to have saved his patient's life, and knowing that the life saved would have been one of misery.

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In this tale, Selzer juxtaposes the wealthy chair of the Department of Radiation Therapy, Dr. Arnoldo Cherubini, with Luis Figueira, a scavenger of refuse in the teeming Brazilian city they both call home. Cherubini lives in splendor in the wealthy hillside district, while Luis lives in a ramshackle hut by the sprawling municipal dump. What brings the two together is the discovery by Luis of discarded cesium, which had been inadvertently left in an "outmoded" x-ray machine taken to the dump.

Luis believes his discovery to be miraculous--a piece of a star. He buries his treasure each night, only to uncover and behold it the next evening. Fearing that the guards at the dump will steal his prize, Luis takes it to the home he shares with his sister and her family.

Soon, his avaricious brother-in-law finds the treasure and greedily sells pieces of it to the local slum-dwellers. Luis, with hands rotting, eventually seeks, but then refuses medical attention from Dr. Cherubini. The doctor makes a few half-hearted efforts to aid his patient, but returns to his insular world. Luis returns to the dump and dies shortly after in the arms of his lover.

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Sarah (Whoopi Goldberg) is an African-American woman who runs a bookstore, the "African Queen," in San Francisco. She has an adolescent daughter, Zora (Nia Long), conceived with donor sperm after the death of Sarah's husband, Charlie. Zora believes she is Charlie's daughter until she discovers a discrepancy while learning about blood types in biology class. Sarah tells Zora about her conception and Zora, determined to find out the identity of her "real father," breaks into the computer records of the California Cryobank.

She discovers the name of the sperm donor, Halbert Jackson, and tracks him down, discovering that he is a white truck salesman (Ted Danson). She and Sarah are both horrified (Sarah had requested the sperm of a black man), as is Hal, but after some comic conflict, Sarah and Hal fall in love and Zora begins to think of Hal as her father. They then learn that there was a mix up in the records and Hal is NOT after all Zora's genetic father, but by this point they have nonetheless become a family.

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Doebin is an island reserve for Aborigines off the coast of north Queensland. In 1930 the superintendent goes insane after his wife dies. He sets fire to his house, kills his children, and wounds others in a bloody rampage that ends in his being shot by an Aboriginal man. Interestingly, this superintendent was a benevolent dictator who actually appeared to care for the Aborigines, whom he considered childlike and treated in a strict paternalistic manner. In return, his charges respected him and called him "Uncle Boss."

The book tells this story from the perspectives of several different characters and reveals how the events of 1930 influenced their lives and bound them together in mysterious ways. We learn of the influence these events had on the subsequent lives of the island's little community: doctor, matron, schoolteacher, boarding house operator, priest, and Manny Cooktown, the man who shot and killed the madman, Captain Brodie.

Time moves on, things change. World War II comes and goes. On Doebin Island, however, Aboriginal people continue to be treated like prisoners. Benign paternalism is replaced by out-and-out hatred during the reigns of a succession of superintendents, who treat their Aboriginal charges as if they were animals.

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Ian Young spent the summer of 1970 as a medical student working at a hospital in the province of Kabylia in Algeria. He was assigned to the Maternity department, where he worked primarily with two Bulgarian doctors. Most foreign medical personnel in Algeria at the time came from Eastern bloc countries, as "Islamic Socialism" was the official political system in the newly independent (1962) North African country. According to Young, obstetrical care for the mostly Berber women of the area was brutal, disorganized, antiquated, and dangerous.

Dr. Vasilev, the head of the department, is a passive and indecisive man, who spends most of his day reading the newspaper. Once roused from his lethargy, which doesn't happen very often, he demonstrates competence and concern for his patients. His colleague, Dr. Kostov, is an aggressively brutal man who introduces himself to pregnant patients by shoving his fist into their vaginas.

Both doctors excuse their behavior by saying, "We just can't do it here they way we do it in Bulgaria." For the most part, they do not use sterile technique, and although anesthetics are available, neither Kostov nor Vasilev typically use them. The Algerian nursing staff provides at least a modicum of organization and care in this dreadful environment.

At first Young approaches the situation with disbelief and anger. He then attempts to improve the quality of care, first by introducing a flow sheet for obstetrical care, and later by submitting a report on the poor conditions to the hospital director.

Mild-mannered Dr. Vasilev supports him, but no one uses the new flow sheets, and the Director considers the report a personal (and political) affront. Meanwhile, Ian Young presents the reader with a seemingly endless series of fascinating patient cases and interesting stories about hospital personnel, as well as about his excursions to various parts of Kabylia.

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A foreign correspondent accustomed to global calamities now finds himself entangled in a personal disaster. Tom is a middle-aged man with a weakness for cigarettes and women but not much interest in his wife, Barbara, and their young daughter. Tom develops a nagging cough. Night sweats, bloody sputum, and weight loss soon follow. He visits multiple physicians. A chest X-ray demonstrates a suspicious "shadow." Even before further testing is performed, a distinguished pulmonary specialist tells Tom that the diagnosis is lung cancer.

Tom and his wife search the Internet and worry even more when they learn about the harsh side effects of treatment and the dismal prognosis of the disease. Although he has smoked cigarettes since he was a teenager, Tom suddenly has little trouble quitting. He develops a greater appreciation of his wife and fondness for his daughter. If only he could have another chance at life, he would mend his ways and become a new man. The results of Tom's additional tests reveal a different diagnosis - tuberculosis. Tom and Barbara are ecstatic that he can be cured with a combination of five different medications. With the threat of cancer eliminated, Tom resumes all his old habits: smoking cigarettes, ignoring his wife, and flirting with women.

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The young pathologist David Coleman (Ben Gazzara) arrives to join a hospital pathology lab. He encounters disorganization and a hostile, cigar-smoking chief, Joe Pearson (Frederic March), who declares his intention to keep working until he dies. Coleman tries to implement a few changes, but his suggestions are overruled.

The film revolves around two cases: possible erythroblastosis in the child of an intern and his wife whose first child died; possible bone cancer in Coleman's girlfriend, student nurse Kathy Hunt (Ina Balin). The infant's problem is misdiagnosed due to Pearson's refusal to order the new Coombs' test recommended by Coleman; the baby nearly dies, alienating the obstetrician (Eddie Albert), a long time friend who now presses for Pearson's dismissal.

Coleman disagrees with Pearson, who thinks that Kathy's bone tumor is malignant, but he opts for professional discretion, defers to the chief, and urges her to have her leg amputated anyway. He discovers that Pearson had been right: the surgery, which he thought unnecessary, has provided her with her only chance of survival. Just as Coleman realizes the enormity of his error, he learns that Pearson has resigned and that he will take over the lab.

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A small-town doctor’s son is saved by a black man from a burning house. In gratitude, the doctor takes it upon himself to salvage the life of the badly burned and disfigured hero. Others warn him that he is doing no service to the patient, but the physician cannot let go of one whom he owes such a profound debt. The town begins to fear the newly created "monster." The burned man’s life becomes a nightmare of rejection; the physician and his family are progressively rejected by the community.

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