Summary:

Mary Sutter has been trained as a midwife by her widowed mother, and has demonstrated an unusual aptitude.  She is an eager learner, but her deepest desire is to be a surgeon.  No medical school will take her, however.  As reports reach her home town of Albany of the escalation toward civil war around Washington DC, and in the wake of a disappointment in love,  she decides to board a train and offer her services to Dorothea Dix as a nurse.  Though Miss Dix refuses her on the grounds of her youth, Mary finds her way into apprenticeship with a surgeon who, as the numbers of injured climb, needs all the hands he can get.  Slowly and grudgingly, he comes to accept her as a competent assistant and, eventually, to teach her as a respected apprentice, and the remarkable companion she has become to him.  She learns surgery in the most grueling circumstances possible, amputating shattered limbs of young men, many of whom die anyway of infection or water-borne diseases.  In the course of her sojourn in Washington she meets John Hay and, through him, President Lincoln, whose compassionate attention she manages to direct to the dire need for medical supplies.  Two men love her not only for her intelligence and courage, but for the passion she brings to the hard-won skill that, though it cannot save her brother from the respiratory illness that is rampant in the camps, or her sister from a disastrous childbirth, saves many lives and makes a wider way for women of her generation who find themselves called to medicine. 

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In 1176, King Henry the II of England persuades the physician Adelia Aguilar to accompany his daughter, Princess Joanna, on her long journey from England to marry the King of Sicily. Adelia studied medicine in Salerno, but in the disbelieving, intolerant world of Northern Europe, she must hide her skills. She masquerades as the assistant of her own eunuch assistant, the Arab Mansur.  Her task is to protect and preserve the health of the princess. The King convinces her to make the journey by holding Adelia’s own infant daughter as a hostage.

The procession is troubled by a murderer, who could be trying to attack the princess or her doctor. Joanna falls ill, and Adelia diagnoses appendicitis, and then performs an operation to save her life. The question then arises whether or not her future husband will accept a bride with a surgical scar.

As in the other three novels, Adelia also uses her medical skills to solve the murders—a forensic pathologist avant la lettre. 

 

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Johanna Shapiro, Director of the Medical Humanities Program at University of California Irvine School of Medicine, brings her considerable skills and experience as medical educator, writer and literary critic to this unique volume of medical student poetry. Shapiro collected over 500 poems by medical students not only from her home institution but also from other US medical schools and performed a content and hermeneutic analysis. As Shapiro carefully details in her methodology section, she treats "poetry as a form of qualitative data, and [therefore] techniques of analysis developed for other sources of qualitative data (such as interviews, focus groups, and textual narratives) can be applied to an understanding of poetry." (p. 42)

Relying on the work of Arthur W. Frank (see The Wounded Storyteller), Shapiro devises a typology of student poems: chaos, restitution (and anti-restitution), journey, witnessing, and transcendence (this last category was not Frankian in origin). These categories are developed and explicated in Chapter 2: Functions of Writing for Medical Students. As the author notes, poems traverse the boundaries between types; nonetheless, the framework of the analysis rests with this typology. Further, Shapiro explores the metaphors of topography (illness as a foreign land) and quest (student on a heroic, however tentative or confused, journey) throughout her study.

The book contains many fully reproduced medical student poems, contextualized with academic theory on medical education. Hundreds of references, particularly in the fields of narratology and medical education, are cited. After three chapters of theory and methods, eight topics are explored using the outlined analytic tools: anatomy class, becoming a physician, patient experience, doctor-patient relationship, student-patient relationship, social and cultural issues, death and dying, love and life. Prefacing each of these topics is a scholarly essay providing historical and research foundations; every chapter concludes with a summation.

Within the chapters are examples of poems, not only organized by typology, but also by content. For instance in the patient experience chapter, the topics are: "patient pleas for empathy and compassion," "patient fears and suffering," "stigmatized voices," "vulnerability/courage of child patients," and "personal experiences of illness." Within each topic/subtopic, different poems are highlighted and fully analyzed. Additionally, other poems, not reproduced, are quoted as illustrative examples. Summary arguments are provided at the conclusion of each chapter as well as in the final chapter: "Strangers in a Strange Land: What Matters to Medical Students on Their Journey and How They Tell About It."

Although Shapiro states that her purpose "is not to address the literary and aesthetic attributes and value of the poems", she also notes "when students write authentically about their own experience, the results are uniformly moving, compelling and impossible to ignore." (pp 44-5) Indeed many of the poems are rewarding to read not only for content but also for word choice, word play, imagery and narrative line. For instance, in "Ode to the Peach" Brian McMichael explores the senses Neruda or Pollitt-like: "you invite me with / your voluptuous curves / your feminine little cleft". (p 236) Another example is the humorous, self-deprecating "Piriformis" by Curtis Nordstrom relating an early clinical experience by a medical student who hopes against hope that the patient's presenting complaint will require the student to demonstrate his acumen. Unfortunately the sum total of the student's knowledge base is limited to the location of the piriformis muscle; both the student and patient are "so screwed" when, "Alas, the patient presents with / an upper respiratory infection." (p. 16)

Shapiro's sensitivity and generosity of spirit vis-à-vis the medical student experience are evident throughout the volume. She concludes that "what may be most noteworthy about the analysis of these poems is that, amidst their own difficulties and fears, time and again these students reported engaging deeply with their patients." (p 259) She hopes that medical educators will be encouraged to support "in solidarity" the "idealism and high aspirations" expressed in these student poems. (p. 260)

In a postscript, Shapiro reveals her own experiences as a poet-patient. After noting that "[m]edical students are mostly annoyingly healthy, energetic, smart, and capable young adults who like order, structure, and control", (p 261) she also acknowledges how frequently students grapple with the topic of death and dying in their poems. That her poems emerged from advising a student creative writing group demonstrates how poetry can be renewing and vital not just to the student, but to the educator as well.

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This suggestively titled collection of poems provides a lyric record of a physician’s way of seeing.  The situations to which the poems bear witness are not only medical, though many are.  Some are cityscapes into which are woven surprisingly astute observations of homeless people or hitchhikers or ducks in the park.  Some explore the geography of a body where memories are held in “neuron chains.”  Some articulate bits of personal history from the point of view of a woman who has spent years in medicine, caring for the elderly, seeing bodies with the double vision of a clinician and a person whose spirituality clearly informs all she sees.

Titles like “ER Alphabet of Hurt” or “Looking for God On the Radio” or “Hippocrates Voyeur” or simply “Scars” may give some sense of the range of focus.  Her vision and voice are strongly local; those who know Marin County, north of San Francisco, will recognize the places that become the poet’s personal geography.  Those who don’t will still see in these poems a sensibility shaped and refined by the knowledge that comes from deep habitation.  

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In 1889, young doctor Ephraim Carroll is in Philadelphia working with the team of the famous physician and pathologist, William Osler. In their zeal to learn more, they conduct careful autopsies, but the body of a young woman upsets Osler and teammate Dr. George Turk, and they defer the examination. Baffled when her body vanishes, Carroll becomes preoccupied with identifying the woman and the cause of her death.

A darling of Philadelphia society, Osler arranges for Carroll to attend a dinner where Carroll meets and falls head over heels in love with the unconventional Abigail Benedict. Abigail is a painter and free thinker, friendly with the great artist Thomas Eakins. Both are worried about their missing friend, Rebecca Lachtmann, and they engage Carroll to help find her. Through a series of adventures he is able to locate and identify the missing corpse as hers. He discovers the cause of death by exhuming the body.

In the meantime, Turk is found dead of what appears to be cholera; however, Carroll’s suspicions lead him to conclude that the young doctor was murdered by a dose of arsenic cleverly calculated to mimic symptoms of the infection. Drug addiction and an abortion ring lie at the heart of this crime.

Osler is being courted for a position at the new Johns Hopkins Medical School and he invites Carroll to consider joining him there.  But Carroll decides not to go to Baltimore.

To write more would give too much away. The surprise ending implicates famous doctors for unethical behavior, if not murder.

 

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As Audrey Young describes her process of becoming a compassionate internist in a besieged public hospital, she simultaneously argues for turning the hospital's patient care and financial practices into a model for improving health care in America.  Young, a compelling storyteller, first entered Seattle's Harborview Medical Center in 1996 as a third-year medical student on trauma surgery service.  She completed a residency there in general internal medicine and stayed on as an attending for six more years.  She stayed, she tells us, because she met physicians "committed to a vision of equality" who were "the sort of people I hoped to become" (xiii).   She also "fell in love" with "the story of a unique place" (xiii).  Young's stories of that often chaotic place, where ambulances regularly transport homeless, indigent, addicted, and mentally ill refugees from neighboring private hospitals, emphasizes the ways the Harborview staff manages to treat patients with dignity and to choose an ethic of hope in the face of dire circumstances.           

We quickly learn that at Harborview compassion is expressed concretely as actions toward patients.  Michael Copass, known as "the mostly benign dictator of emergency operations," pronounced the core of these actions in what came to be known as his commandments:  "1. Work hard.  2. Be polite.  3. Treat the patient graciously, even if he is not the president of the United States" (9).  Politeness always meant asking "'How may I help you, sir?'" regardless of the patient's social status or addiction history.  Politeness sometimes meant finding a way to reach the patient who regularly threatened the staff.  Young finds ways and creates a therapeutic bond.  But working hard and treating patients considerately also took measurable forms, such as not allowing emergency patients to wait.  Facing a flurry of admissions, the Emergency Department (ED) staff interpreted a young Ethiopian's complaints about pain as a drug addict's ploy.  Because Young glanced at the admissions board and noticed that he remained unattended for three hours--far longer than Copass could tolerate--she jumped into action.  He suffered, she discovered, from a collapsed lung. 

However, Young moves her narrative beyond individual doctor and patient encounters and into the larger, interrelated social and financial structures in which medicine is practiced.  For instance, she links meager funding for drug and alcohol rehabilitation programs with expensive ED admissions and rising healthcare costs.  In the chapter "Bunks for Drunks," Young visits an experimental residence that houses homeless addicts in furnished studios with private baths and cooking appliances.  Although residents can keep alcohol in their rooms and elect not to participate in the home's social services, including counseling, alcohol consumption and ED admissions decrease.  While the chapter points out the cost savings of such arrangements, Young further urges readers to value the dignity residents experience there.

In "Black Friday," Young details the hospital's tense, but ingenious responses to a Mass Casualty Incident, the result of carbon monoxide poisoning, which almost depleted the resources of all of Seattle's medical centers.  The final chapter, "A Vision," outlines how Harborview has tried to succeed as both a charitable institution and a business, as a provider of both indigent and luxury care, with the hope that others will follow the medical center's example.  However, in presenting her recommendations for "health justice," Audrey Young also makes the case that "seemingly ordinary citizens" are implicated in healthcare reform (231).  To enable their informed participation in making changes, Young includes an appendix with further readings and another that lists strategies for effecting reform.  

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The author, a young physician, guides the reader in temporal sequence through her years as a medical student, medical resident at several levels, and into the final days of her formal training. The format of the work is anecdotal, that is, a series of memorable patient encounters that seem to shape the writer's developing attitude toward her chosen profession. The precise time frame of the experiences is not clear, but this is an acknowledged story of growing into the practice of medicine as a trainee at Bellevue Hospital.

In describing her interactions with her patients, Dr. Ofri reveals her own doubts about her ability to accomplish some of the things expected of her as "healer." As she grows more confident with experience, she begins to challenge some of the rituals in which medical education seems mired. Each of the chapters is a self-contained story focused on a particular patient, some of which have been published previously as free standing essays. The composite is the physician-writer's personal narrative of her own growth and change.

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The Crimean War (1853-1856) holds a place in the history of medicine, specifically, the history of nursing. For as the British public read the 1850s Times reports about the total lack of care suffered by their wounded in this conflict, a British nurse, Florence Nightingale, volunteered to recruit a team of nurses to aid the suffering men. The Times created a relief fund for the sick and wounded, and Queen Victoria, an enthusiastic supporter of this war against Russia, sponsored an even larger fund. Female nurses had a reputation for drunkenness and promiscuity. Nightingale made it a point to recruit nuns and women from the lower classes who would be more manageable than educated, upper class women. Three black nurses applied, including Mary Seacole, but they were rejected.

The Turks, British allies, allowed Florence Nightingale the use of their army barracks at Scutari, across from Constantinople: "'I have been well acquainted with the dwellings of the worst parts of most of the great cities of Europe,' Nightingale wrote,' but have never been in any atmosphere which I could compare with that of the Barrack Hospital at night'" (111). Open sewers ran beneath these vermin-infested structures  which were crammed with sick soldiers lying on the filthy floor. There were no supplies and few doctors. Typhus, typhoid, cholera or dysentery killed many patients. Nightingale's meticulous statistics showed alarming escalation of mortality rates; she believed in cleanliness and fresh air but not in the germ theory of disease. When comparing her numbers with those of other military hospitals, Nightingale understood that soap alone would not save the men.

Rappaport describes the nursing offered by army wives, widows and other volunteers, including French nuns. The women's living conditions, especially during pregnancy and childbirth, often resulted in sickness and death. Others volunteered as cooks, including Elizabeth Davis who alleged that while "...she and the other nurses dined on the stewed-up, tough old meat used to make soup for the patients, Nightingale ‘had a French cook, and three courses of the best of every kind of food ... served up everyday at her table'" (168-169).

Nightingale became famous as the heroine of the Crimean War. She is known now as the founder of professional nursing. Recent research has questioned whether Nightingale was the real angel of the Crimea. Rappaport investigates the work of the Jamaican nurse, healer, and entrepreneur Mary Seacole, one of the 3 black nurses rejected for service in the Crimean War. She financed her journey to and stay in the Crimea herself. She built a British Hospital in the Crimea, and treated the wounded at Balaklava there and in the field. The soldiers called her Mother Seacole because she cared for their material and spiritual needs. She sold gin and raki and home-cooked meals, and went bankrupt because too generous with credit. Seacole recouped her losses and achieved bestseller status with her memoir, Mrs. Seacole's Wonderful Adventures in Many Lands (1857), the first memoir by a black woman from Britain.

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This edited anthology, which includes poems, essays, short stories, and other creative forms (e.g., a radio diary, a letter to a social service agency), is organized into sections that include Body and Self, Diagnosis and Treatment, Womanhood, Family Life and Caregiving, Professional Life and Illness, and Advocacy. Most works found their way into this collection through a call for submissions, although a few selections are well known, such as Lynne Sharon Schwartz's "So You're Going to Have a New Body !," or an excerpt from Rachel Naomi Remen's Kitchen Table Wisdom (see annotations). In addition, the anthology also includes essays by scholars such as Arthur W. Frank and Rita Charon, who theorize gendered illness narratives.

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Richard Timmerman doesn't see eye-to-eye with his sister, Ellen. After their parents die, the siblings inherit the house. Richard wants to sell his share of it, but Ellen won't budge. She and her son continue to live in the home. As an elementary school principal in upstate New York, Richard already has a lot on his mind.

He notices a swelling under his chin. Three weeks later, the lump is still there. He visits Dr. Taubman, but the family physician is uncertain of the diagnosis. It might be a benign enlarged lymph node but a lymphoma cannot be ruled out. Richard focuses only on the possibility of cancer. A CAT scan is scheduled along with a referral to an ENT specialist for a biopsy.

Richard questions the radiologist supervising the scan about the results. She will not tell him. He suspects that she is holding back the truth. He next sees Dr. Jameson, the ENT specialist. The young physician examines Richard and then reviews Richard's CAT scan. The doctor's verdict is a salivary gland stone (sialolithiasis) that will likely pass on its own.

At first, Richard is angry with his family physician for not making the correct diagnosis. Soon his irritation gives way to relief. Richard has received a medical reprieve. There is no lymphoma. No treatment is necessary. Life is suddenly glorious. Richard's joy is transient. He telephones his sister to announce the good news and to patch things up with her. Ellen is unimpressed by Richard's recent scare and his magnanimity. The phone call leaves Richard uncertain and fearful about his future.

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