Summary:

Raina is 17, living alternately on the streets with a boyfriend addicted to hard drugs and at home with an abusive mother, also an addict. She has been victimized by a succession of her mother's live-in boyfriends and lost a young brother to an accidental overdose: he swallowed some of his mother's pills while the mother slept and seven-year-old Raina was watching him.

Margaret Johnson is 45, Raina's teacher at an underfunded, overcrowded public school where Raina's life of squalor is more typical than not. Her own story is told in chapters that alternate with Raina's story and with the texts of autobiographical compositions Raina gives her but refuses to discuss. Only when Raina finds herself pregnant, shortly after her boyfriend has been killed in a drug-related accident, does she take Ms. Johnson up on her repeated offers of help.

She lives at the teacher's home for awhile, runs away to her own home, unused to kind treatment and afraid she'll disappoint the teacher and be thrown out, goes to a shelter, has her baby, and finally returns, having nowhere to go. Ms. Johnson, with some hesitation, takes her and the baby in and the three begin to work out a life together, knowing it will involve difficult change, but willing to bet on love against the odds.

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The author, a Canadian physician-historian-educator, blows the dust off the shelves of medical history with this fascinating text designed for medical students, educators, and those with an interest in history of medicine. Duffin begins this survey of the history of Western medicine with a glimpse at a pedagogical tool designed to spark the interest of even the most tunnel visioned medical students: a game of heroes and villains. In the game, students choose a figure from a cast of characters selected from a gallery of names in the history of medicine.

Using primary and secondary sources, the students decide whether the figures were villains or heroes. The winner of the game is the student who first recognizes that whether a person is a villain or hero depends on how you look at it. This philosophy imbues the entire book, as this treatise is not a tired litany of dates, names and discoveries, but rather a cultural history of the various times in which medical events occurred.

The book is organized by topics which roughly follow a medical school curriculum: anatomy, physiology, pathology, pharmacology, health care delivery systems, epidemiology, hematology, physical diagnosis and technology, surgery, obstetrics and gynecology, psychiatry, pediatrics, and family medicine. The last chapter, entitled "Sleuthing and Science: How to Research a Question in Medical History," gives guidance to formulating a research question and searching for source material. Fifty-five black and white illustrations are sprinkled throughout the book, as well as 16 tables.

Direct quotes from historical figures, such as Galen and Laennec, as well as excerpts from writings of eyewitnesses of events, anecdotes and suggestions for discussion, appear in boxes within the chapters. Many of the chapters contain discussion about the formation of professional societies. Each chapter ends with several pages of suggested readings and the third appendix delineates educational objectives for the book and individual chapters. The other two appendices list the recipients of the Nobel Prize in Physiology or Medicine, and tools for further study, including titles of library catalogues, and resources in print and on-line.

Although the book is a survey covering multiple eras and topics, each chapter contains choice tidbits of detail. For instance, the chapter on obstetrics and gynecology includes the story and photograph of Dr. James Miranda Barry, the mid-nineteenth century physician, surgeon and British military officer, who was discovered to be a woman at the time of her death. The impact of the stethoscope on the practice of medicine is explored in depth in the chapter, "Technology and Disease: The Stethoscope and Physical Diagnosis."

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This posthumously published collection of essays by Dr. Klawans, an eminent neurologist and writer, explores the interactions between patient, family and neurologist and the implications of specific neurologic diseases. Klawans's special interest in neurology is movement disorders, such as Huntington's chorea and Parkinson's disease, but his outside interests range from evolutionary biology to classical music. His essays, therefore, focus on single patients or families, but the author weaves thoughts about his other interests into each "case."

The book is divided into two sections, "The Ascent of Cognitive Function" and "The Brain's Soft Spots: Programmed Cell Death, Prions, and Pain." In a brief preface, Klawans declares that this book is "more than just a set of clinical tales about interesting and at times downright peculiar patients" from his 35 years of practice, but rather it "humbly grapples with the 'whys' of our brain, not the 'hows.'" (pp. 9-10) In the preface, as well as in one essay, Klawans acknowledges the work and impact of fellow neurologist-writer Oliver Sacks ("Oliver is truly the father of us all." p 12).

The title essay concerns a six-year-old girl who was found, locked and completely speech-deprived, in a closet. Because she is still within the window of opportunity for language acquisition, "Lacey" quickly learns to speak, unlike Victor, the Wild Boy of Aveyron, whose story was immortalized in the François Truffaut film, L'enfant Sauvage. Klawans uses these stories as a launch pad to discuss the evolution of language, including a proposal that the cavewoman, not the man, was responsible for development of the human species as she taught her offspring language.

Other chapters focus on patients with epilepsy, Parkinson's disease, localized and hemispheric stroke, "painful-foot-and-toe syndrome, " and Creutzfeldt-Jakob disease. Two particularly memorable chapters concern Huntington's chorea and Refsum's disease. The chapter, "Anticipation," explores the profound ethical concerns of genetic testing for Huntington's chorea as applied to three generations of one particular family. In the chapter, "The Hermit of Thief River Falls," Klawans recollects his first year as a neurology resident, and his care of a reclusive patient with a rare eponymous illness, Refsum's disease--just in time for a visit by Refsum himself, a famous Norwegian neurologist.

The book concludes with a speculative "afterthought" about genetics, evolution, and the importance of extended "juvenilization" --the protracted post-natal development of Homo sapiens. This essay intertwines some of the threads regarding speech development and evolutionary biology, particularly brain development, that were introduced earlier in the text.

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Consider the possibility of a man whose sense of hearing is so enhanced that he can discern the noise of the entire world and also mimic all the sounds made by men and beasts. Imagine a human being who can SEE sounds as well as hear them. It is little wonder that he would have an affinity and talent for music.

Johannes Elias Alder is such a musical genius born in 1803 with a preternatural gift of hearing. The illegitimate son of the village curate, Elias experiences a physical metamorphosis as a child and by the age of ten is already a man. He effortlessly composes magnificent music that he plays on the organ.

Although Elias falls in love with his cousin, Elsbeth, she marries another man. After this loss, he becomes tired of life. Elias commits suicide at the age of 22 by refusing to sleep and succumbing to starvation and an overdose of belladonna.

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The story is a letter written by a 24-year-old woman to her niece who was given up for adoption. Bitte Liten, from a close Norwegian family, remembers the summer she was 12 when she was sent away during the last months of her sister's pregnancy to stay with her uncle. Her sister, 15, unwed and pregnant, had found adoptive parents for the child, but Bitte, imagining the pleasures of being an aunt and helping care for a baby, wanted her to keep it.

While at her uncle's, she visits her aging favorite aunt in a nursing home. Her aunt, sinking into dementia, doesn't remember her. This leaves her reflecting on how much of life is memory of the past and dreams of the future. Her period comes that summer for the first time, and with it, a new understanding of adult responsibilities and her sister's predicament.

She writes her sister to tell her she understands her decision and will support her. In return, her sister invites her to be at the hospital the day the baby is born. There Bitte meets the adoptive parents as well as the baby, says hello and goodbye to her little niece, and comes to understand something new and harder about what love looks like. Twelve years later, she records all these memories for the niece who has grown up as someone else's child.

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This story takes place late at night in the quiet wards of a hospital. Some of the staff are kidding around about Night Sister Bean, who is supposedly a witch, but is now off-duty because she had an operation. Hilda from Housekeeping is pregnant again.

Since Hilda is unmarried, some of her co-workers come up with the idea of giving her a proper wedding. The Casualty Porter volunteers to be the groom. They just manage to complete the fanciful night wedding when Hilda goes into labor. Her baby is born in an elevator on the way to the maternity ward.

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This is a collection of partly fictional, partly autobiographical stories about a young Russian doctor sent to practice at a rural hospital immediately after graduating from medical school. Muryovo hospital serves the peasantry in a remote region lacking decent roads and amenities like electricity. The doctor works day and night, aided by a feldsher and two midwives. Sometimes he sees over 100 patients a day in his clinic while attending to another 40 in the hospital.

The stories reveal in a clear, engaging style the doctor's anxiety as daily he encounters new problems (his first amputation, his first breech presentation, his first dental extraction) and-- for the most part--overcomes them. They also reveal a constant tension between the peasants' ignorance and the doctor's instructions. Full of blizzards and isolation, the stories are also warm and companionable, with vignettes of friendship, gratitude, and nobility.

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The 18 poems in this chapbook (26 pages) focus on caring relationships, especially between nurse and patient. In "Standing There" the poet admits that "our history isn't an album of healers." There is little to be triumphant about in the world of nursing and medicine: "Our story is how we did not break / and run--no matter how close / the lightning gouged." In "Blue Lace Socks" she evokes a nurse beside the bed of a dying child, "listening for the whisper of her blood pressure."

"Butterfly," a poem about caring for young men with AIDS, is characterized by honesty and sensitivity: "They cough as I enter their room, / and something in me stiffens." Yet, the nurse is able to close the gap between herself and the patients and demonstrate her care: "they are migrating back to the cocoon, / the place where brown masks / protect the unbeautiful." Some of the other poems deal just as sensitively with the explosive topics of childhood sexual abuse ("Taste of Tin") and rape ("This Red Oozing"). Blue Lace Socks", Butterfly, and This Red Oozing have been annotated in this database.

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This excerpt from Tim O'Brien's autobiographical fiction about the war in Vietnam is a reverie of memory, dream, and story that resurrects the dead. The dead are fellow soldiers, the enemy dead, and a first love who died in childhood.

Tim, the narrator and writer, was only four days into his tour of duty when his platoon commander ordered an air strike against a village that is the source of sniper fire. When the platoon walked through the destroyed village, they found one old, dead, mutilated villager. Tim's fellow soldiers had developed a ritual of "greeting the dead" in which they pretended the dead person was still alive, was someone to be greeted, spoken to, both in mockery and in respect. They applied this ritual to the enemy dead as well as to their own dead.

Both repelled and fascinated by the ritual, Tim remembered his own method for animating the dead-in childhood-friend, Linda, whom he mourned and continues to mourn. After she died of brain cancer, he intentionally dreamed her alive and held conversations with her, just as his compatriots held conversations with their dead colleagues. Now, years later, he is telling the story of these experiences, these dead, these rituals, "keeping the dead alive," and "trying to save Timmy's [his younger self's] life with a story."

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Most of the thirteen stories in this collection portray interactions among pension guests in a German spa town; a few represent the lives of the town's permanent residents. The minor health problems (mostly digestive ailments, or unspecified "internal complaints") of the guests are not the crux of the plot but rather what gives it its texture. Talk about eating, "internal complaints," sexuality, body image, and pregnancy is the vehicle through which people try to relate.

Most of the stories are about failed communications: between men and women, for example, or between German and English people. Several stories are narrated in the first person by a young Englishwoman whose bodily and marital status (ill? pregnant? married or not?) are pointedly ambiguous.

Two stories represent childbirth from "outsider" perspectives. In "At Lehman's," a virginal serving girl sees her mistress's pregnancy as an "ugly, ugly, ugly" state; later, her sexual explorations with a young man are interrupted by her mistress's screams in labor. In "A Birthday," a man waiting for his wife to give birth focuses on his own suffering rather than hers. "The Child-Who-Was-Tired" follows a child-servant through a day of repeated abuses to body and spirit that culminates in infanticide.

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