Summary:

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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From a fishing trip the local doctor is summoned to an Indian village to assist a woman in labor. With him are his young son and an older male relative. The physician assesses the situation in the closed, pungent hut and determines that his only option is section--with a pen knife and fishing leader as his instruments, and no anesthesia for the Indian woman. The doctor arrogantly, but only briefly, celebrates his success as a surgeon only to discover that the woman's husband, apparently unable to tolerate his wife's pain and the racism of the white visitors, has silently slit his own throat. The child, who has observed the entire proceedings asks, "Is dying hard, Daddy?"

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Karen Newman traces the visual depictions of the pregnant female body, the fetus, and obstetrical illustrations from the 9th century to the present in western culture. These images, in which the fetus looks baby-like or even adult and in which the female body is truncated or mythologized, have supported the anti-feminist rhetoric where the fetus or embryo is privileged with full human rights. Even in the fetal studies by Leonardo da Vinci (Studies of the Fetus), which were far more accurate than any prior or concurrent renditions, the roles of the uterus and placenta are de-emphasized and the uterus is simply a vessel, "almost a Fabergé egg."

Analysis and critique of medical art history is of relevance for today's society: "Early obstetrical illustration, Bologna's Museo ostetrico, and eighteenth-century anatomical sculpture and engraving are not merely antiquarian esoterica; rather, they constitute crucial political knowledge for the present." In fact, the book begins and ends in the 20th century.

In the first section, a close analysis of the Lennart Nilsson fetal photographs in Life Magazine "Drama of Life Before Birth" (1965) reveals that not only the photo captions, but also the manipulations of the specimens during and prior to photography (all the pictures but one were ex utero), were designed to proclaim and reinforce "fetal personhood." A similar conclusion is reached at the end of the book, when images from the current, widely used obstetrical text and from new imaging procedures are examined.

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This fine collection of writings by women involved in health care stems largely from a writing group cosponsored by the Nebraska Humanities Council and the Creighton University Center for Health Policy and Ethics. However, other writings also appear in this volume: in all there are 40 pieces by 16 authors. Writing genres include essay, short story, and poetry. The works are divided into three sections: Power and Powerlessness, Vulnerability and Voice, Connection and Disconnection. As noted in the introduction, these are "major themes in feminist perspectives in ethics" and the works are offered as reflections on modern ethical dilemmas in health care.

Some of the most powerful pieces are stories about being the newcomer--the student or junior trainee. For instance, "Washing Cora's Hair" by co-editor Amy Haddad is a poignant look at the struggle of two young nursing students to wash the long braids of a bed-bound elderly woman in her cramped home, and "The Story of David" by Ruth Purtilo, written as a memoir looking back to when she was a newly graduated physical therapist, concerns her interactions with a young, angry, depressed quadriplegic patient and with her superiors.

Another memorable piece is "The Things You Do" by Kelly Jennings Olsen. This story about being a new volunteer emergency medical technician masterfully controls the tensions of emergency medical care, the anguish of the father whose little girl slipped under his tractor, and the nuances of living in a small town. Several poems also deal with issues of the newcomer and witness to suffering (e.g., "As Ordered" by Ruth Ann Vogel--a poem about shaving the head of a neurosurgical patient on the pediatric ward)

As noted by the multiple keywords listed above, these pieces touch on many topics. Power relations play a key role, both between professionals and between patient and the health care team. For instance, in the polished story, "Procedures" the author Kim Dayton writes from the perspective of a young single mother with a critically ill neonate. This mother is repeatedly prevented from visiting her child because of "important" events like rounds and procedures, and she ironically only gets to hold her baby after the baby dies.

Throughout the collection the patients are described with honesty and vividness. Their suffering can haunt the health care worker ("Maggie Jones" by Veneta Masson) as well as teach ("Back to Square One" by Barbara Jessing). Many of the pieces remind us of our good fortune and the privilege we have in our lives and in providing health care services (e.g., "Spring Semester" by Amy Haddad). Ultimately in this volume our common humanity is emphasized--the connections between people and the remarkable grace that can be exhibited in the face of suffering.

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This is an exhibition catalogue for a show of 16 photographers who documented major topics in health over the last century. Carol Squiers, curator of the show, provides ten essays, amply illustrated by photos, on critical topics such as child labor, domestic violence, environmental pollution, AIDS, veterans of war, and aging. Some 80 per cent of the images treat American subjects.

Lewis Wickes Hine's photographs of child labor are dramatic and disturbing; these document children in coal mines, cotton mills, glass works, etc. in the first part of the 20th century. The Farm Security Administration sponsored photographers (including Dorothea Lange) to represent the New Deal Health Initiatives. Topics include farm labor, poverty in the South and Southwest, and inoculations. W. Eugene Smith created a photographic essay for Life magazine about Maude Callen, an African-American nurse-midwife in 1950s rural South Carolina.

Donna Ferrato documented domestic violence in the U.S. in powerful, personal shots, including a series of an actual attack. David T. Hanson created triptychs about environmental pollution: one panel shows a map of the area, a middle panel gives descriptive text, the last panel is an aerial shot in color. Eugene Richards spent time in the 1980s in Denver General's Emergency Room. Eleven black and white photos show the turmoil and drama.

Gideon Mendal documented HIV/AIDS in several African countries. Lori Grinker took photos of army veterans (some without hands) but also noncombatants harmed by war, including children. Ed Kashi presents images of aging Americans, rich and poor, urban and rural. Sebastião Salgado provides photos of vaccination in Africa and Asia.

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Anne Lamott, a writer, recovered alcoholic, former addict and impassioned Republican-hater, finds herself pregnant in her mid-thirties, and decides to have the baby. This journal is a chronicle of her son Sam’s first year. She is fiercely self-deprecatory and funny and unafraid to talk about the dark side of parenting an infant: the fear, exhaustion, anger, emotional swings; that 4 a.m. inability to cope with the crying neediness of the baby.

She is a single parent barely able to pay the bills, but she has a tremendous support network of family, friends, and the people of her church--all of whom clearly love Sam and love her. And then, when Sam is 7 months old, crawling "like a Komodo dragon," the author’s best friend Pammy is diagnosed with metastatic breast cancer. The author, who discovers the depth and resonance of love because of the gift of Sam, must now learn loss. She questions her faith, which she cannot justify on a cerebral level, but still hopes that God loves and guides her the way a parent loves and guides a child.

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This is a story about Bea, a single woman professor who has just had a caeserian section for an 11 pound boy, and her hospital roommate, Corinne. Bea describes her own discomfort with Corinne’s race, while admiring Corinne’s pride and nurturance toward her newborn son. As the story progresses, Corinne is betrayed by the medical world in a multitude of ways: misdiagnosis, racist treatment, denial of medical treatment, and incompetent care, resulting in Corinne’s sepsis and her son’s eventual death.

At the end of the story, after Corinne and Bea are discharged from the hospital, Bea tries to visit Corinne and deliver the pictures of her child that Corinne hadn’t been able to afford. But at the last minute, Bea turns away. Although she wants to help, she feels wholly inadequate, and believes she will only cause Corinne pain. Ironically, Bea remembers her last night in the hospital, how she covered her ears as Corinne’s baby whimpered, and as her own breasts surged with milk for the crying child. Even though her instincts and body tell her what to do for Corinne, she is not able to listen.

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In March, 1981, in Vermont, Charlotte Bedford goes into labor. She has decided to give birth at home with the help of a midwife, Sybil Danforth, but complications develop. Charlotte has a seizure, her heart stops, and she does not respond to CPR. The fetus is still alive, so Sybil delivers him successfully by Cesarean section, with a kitchen knife. But the bleeding when Sybil makes the incision convinces her assistant that the patient’s heart was still beating. She reports this to the police and Sybil is put on trial for involuntary manslaughter.

The story of the trial is told by Sybil’s daughter, Connie, fourteen years old at the time and now an obstetrician-gynecologist. The acquittal comes at a price: the midwife finds herself no longer capable of delivering babies, and both she and her daughter are given a new insight into the uncertainty which underlies so many of medical decisions. At the end of the novel we are left uncertain whether or not Charlotte was still alive when her baby was delivered.

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This anthology frames a rich selection of fiction and nonfiction with astute and helpful introductions to issues in nineteenth-century medicine and the larger culture in which it participated. The fiction is comprised of Mikhail Bulgakov’s The Steel Windpipe in its entirety; Sir Arthur Conan Doyle’s story, "The Doctors of Hoyland" from Round the Red Lamp; and selections from George Eliot’s Middlemarch, Gustave Flaubert’s Madame Bovary, Sarah Orne Jewett’s A Country Doctor, Sinclair Lewis’s Arrowsmith, Thomas Mann’s Buddenbrooks, W. Somserset Maugham’s Of Human Bondage, George Moore’s Esther Waters, Robert Louis Stevenson’s Strange Case of Dr. Jekyll and Mr. Hyde, Eugène Sue’s Les Mystères de Paris, and Anthony Trollope’s Doctor Thorne [the full-length versions of many of the above have been annotated in this database]. The nonfiction consists of two versions of the Hippocratic Oath, two American Medical Association statements of ethics, and selections from Daniel W. Cathell’s The Physician Himself (1905).

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Life on the Line relates the experience of 228 writers who express in their work the deep connection between healing and words. Walker and Roffman have organized their anthology into eight topical chapters: Abuse, Death and Dying, Illness, Relationships, Memory, Rituals and Remedies, White Flags From Silent Camps, and a chapter of poems about the nuclear accident at Chernobyl. This hefty volume contains a very broad selection of contemporary poems, stories, and essays by both well-known and relatively unknown writers on the experience of illness and healing.

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