Summary:

Perri Klass, who had already written of her medical school education (A Not Entirely Benign Procedure: Four Years as a Medical Student, see this database), took notes, made dashed journal entries, and saved sign-out sheets and other written memorabilia during her internship and residency in pediatrics at The Children’s Hospital in Boston, Massachusetts. Because she is a writer, she looked at her experiences in medical training with an eye towards what stories were happening. This book then is a compendium of stories and essays (some previously published) about Klass’s pediatrics training.

Klass reflects on the difficulties of being a writer and physician: "I have been a double parasite, not only learning off patients, but also writing about them, turning the agonies of sick children into articles, using them to point little morals either about my own development as a doctor or about the dilemmas of modern medicine." (p. 297) But she also notes the benefits of writing during training: "between life at the hospital and with my family, it seemed that all my time was spoken for, and spoken for again. I needed some corner of my life which was all my own, and that corner was writing . . . I could describe the astonishing contacts with life and death which make up everyday routine in the hospital." (p. xvii)

Part of the book concerns issues of women in medicine; Klass debunks the mystique of the "superwoman"--the professional, wife and mother rolled up into one incredible ball of efficiency and perfection--with a month of laundry spilling over the floor. Klass, as a successful writer, struggles with this label and includes an essay on her experiences with a "crazy person" who anonymously and publicly accuses her of plagiarism in the midst of the stress and responsibilities of residency.

However, most of the book is about being a new doctor--the terror, the patients, the procedures, the other doctors and staff. She writes of first nights in the Neonatal Intensive Care Unit, delivery room crises, adolescents with chronic illnesses, and her struggles as a sleep and time deprived mother.

She addresses difficult issues: moral dilemmas, suffering, loss, the rape and abuse of children, children with AIDS. Throughout the book is a concern for the patient’s experience, as well as the doctor-in-training’s experience. After her first night on call caring for very premature infants she notes: "Maybe my first patient and I have more in common than I realized: we are both too immature to be out in the world, but with a lot of help, we may just make it." (p. 15)

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The young English doctor, Mary Percy Jackson (M.D. Birmingham 1928), went to practice in northern Alberta for a year. She had been recruited by a philanthropic movement that targeted women doctors: they could be paid lower wages and would also cook and keep house. But she fell in love with the subarctic community, its native peoples, and a certain widowed farmer with two young sons, and stayed for the next seven decades.

Dr. Jackson became the only physician responsible for the well being of aboriginals and settlers in a wide radius of remote territory where winters last more than six months and the only effective mode of transportation was the horse. Married and in relative prosperity, she did not seek payment for her medical work, although she appreciated gifts in kind.

Despite the isolation, Jackson was vigilant about nutrition, vaccination, and tuberculosis control and she kept up with the latest advances in health promotion. She and her husband were active in improving opportunities for education. The film closes with a simple party for Jackson, at the local school named in her honour.

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A pediatric intern encounters her first dying child. Her initial response is to care for the child, hold him, and try to comfort him. She is told by her attending physician that this behavior is unprofessional. When she cries in response to her stress and grief, she is told she will never be an effective physician. The narrator then describes how she ultimately came to terms with her impulse to cry at stressful times, and how she interacts with patients in her current practice.

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The thirty-four autobiographical essays were written while Klass was a medical student in the Harvard class of 1986. Many of her short chapters were previously published as columns in magazines, journals and newspapers. The insightful but often funny stories cover a variety of scientific and clinical subjects, lifestyle, eating habits, and relationships with other professionals, including nurses.

Pregnancy and the birth of her son half-way though training makes her experience somewhat unusual. In several other essays, including "Macho" and "Learning the Language," Klass reveals her particular sensitivity to language and the advantages and disadvantages of professional discourse.

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Alice Jones divides The Knot into three sections. The first is a series of poems evoking the poet's painful and tender relationship with Peter, a former lover who is dying of AIDS. We encounter him first on a rainy day in his hospital bed at St. Vincent's ("The Umbrella"), and then through flash-backs to their earlier lives ("In the Pine Woods," "Painting," "Communal Living"). In the long poem "Blood Clot" the author creates and sustains a dynamism between detachment and engagement, objectivity and subjectivity, medical and personal knowledge: from "This time it's his heart. He has / a tumor" to "The glacier that / freezes us in place for centuries, / the same old separateness, only / this time it's called death. / How dare you do it to me / one more time."

The second, and most intensely personal, section imagines the poet's relationship with her mother. The title poem is the centerpiece here. In it, the knot has two faces: the tie that binds us together and an obstacle to be overcome. While loss is real, she writes, "I refuse to be alone. // There is only one / of us. Loss does not / exist in our vocabulary." ("The Lie") The last section consists of poems on a variety of topics, including a long poem about gross anatomy as an initiatory experience ("The Cadaver").

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The narrator of this long, lyrical musing is a psychiatrist who works with autistic children. Though much of the narrative is a reflection on her mid-life relationship with a journalist lover who risks death to report on places in political turmoil, her observations about her patients provide a recurrent motif and reference point.

Several long passages detail the fascination and frustration involved in working with her young patients, what she has learned from them about limits, patience, and the semiotics of autism. She also reflects on how that learning has allowed her to understand "normal" people differently. One of the subtle but strong themes of the story is the question of what "normal" means.

A secondary focus is her close attachment to her two grown sons. This is developed through memories of particular scenes of their childhood that she identifies as bonding moments. Another focus is her relationship with her mother, now dwindling into mental incompetence and squalor in her old age. Thinking about these relationships, with lover, sons, mother and patients, is a way of taking stock of how the strands of her life have brought her to a place of qualified peace in mid-life.

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Rossetti writes about Lilith, Adam's evil first wife according to Hebraic oral tradition. She is described as a beautiful temptress. Her beauty hides a deep evil that nearly snares Adam and dooms mankind.

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A Boston attorney is injured on the road while traveling by buggy in Maine. His rescuer, who stabilizes his fractures and transports him to town for continued care, turns out, much to the patient's dismay, to be not only an attractive woman, but a very competent physician. As the attorney becomes increasingly aware of the quality of medical care he is receiving, he also finds himself falling in love with his doctor.

The work is replete with demonstrations of Dr. Zay's skill as physician, her humanity, and her professional commitment. Eventually her resistance to her suitor's offers of marriage is worn down, but she demands a contract which guarantees she will be able to continue the practice of medicine after the wedding. Set in the latter part of the nineteenth century, the novel romanticizes the practice of rural medicine and the contemporaneous view of late Victorian women pursuing this "masculine" profession.

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This is Krysl's fifth book of poetry, and the second to be published by the National League for Nursing Press. The collection is divided into seven sections: Self Healer; Self and Nature; All My Relations; Healers; Calcutta; Sanctuary; and Death, Life. The sections, and, in fact, many of the poems, are preceded by brief introductory explanatory remarks.

Krysl states that "this book records many moments of healing in widely varying circumstances." These moments, for her, include a summer volunteering in the Kalighat Home for the Destitute and Dying, administered by Mother Teresa's Sisters of Charity, and time spent with curanderas, Navajo healers, and "western" alternative healers. A sampling of poems from a number of the sections included in this collection are "Cancer Floor," "Curandera," "Innanna," and "Interpreter."

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The opening chapters of this sensational novel focus on "Mercy Merrick," a nurse in the Franco-Prussian War. Mercy's post is taken over by the Germans. Mercy meets the emergency with great skill and aplomb, comforting the wounded soldiers and ensuring their safe passage. Her bravery is set in opposition to the cowardly surgeon and a timid English gentlewoman on her way to England to claim an inheritance from relatives who have never before met her.

In the midst of the battle, the English woman is killed. Mercy determines to take over the dead woman's identity and claim her inheritance. She successfully does so. However, it miraculously turns out that the Englishwoman was not dead at all, merely stunned, and she arrives in England looking for revenge. It is impossible for her to prove her identity until Mercy confesses. Even then, the reader has sympathy for the desperation that caused her to take on the impersonation and her story ends happily as she goes off to a happy marriage and to nurse orphans.

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