Summary:

This little novel is the retrospective tale of a childhood event told by the protagonist 40 years later. Family relationships and bonds in conflict with professional and community obligations vie with the shadow of racism and sexual abuse in the doctor/patient relationship for the core tensions in the book. The setting is a small rural community where the pioneer family about which the tale evolves controls the law and the medicine. The boy narrator relates his view of the breakdown of family as its secret--a physician uncle who is suspected of sexually abusing his native-American women patients--becomes a force that demands action from the doctor’s brother who serves as the sheriff.

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It is difficult to characterize this book, which consists of a series of roughly chronological chapters, each of which deals with a person or an event important in shaping (or representative of) "the American grain." Williams begins with Red Eric (Eric the Red), whose son Leif Ericsson "discovered" the North American continent, and continues with chapters on Columbus, Cortez, Ponce de Leon, De Soto, Walter Raleigh, the Pilgrims, Champlain, Cotton Mather, Daniel Boone, George Washington, and so forth.

In each case the focus is on character and impact--not so much "impact" on the historical panorama, but "impact" on the emerging and evolving American character (or grain). In that sense the book might be considered an impressionistic biography of the childhood and adolescence of the American spirit.

About halfway through the book in a chapter entitled "Père Sebastian Rasles" (p. 105), Williams steps into the narrative as a first person narrator describing events that occurred during "my six weeks in Paris." Here he connects the development of American literature, as exemplified by Gertrude Stein, Ezra Pound, H. D. and other expatriates, to American cultural history, in this case the evolving conflict between the New England puritan culture and a Catholic influence that filtered down from Quebec (personalized in the form of the Jesuit priest for whom the chapter is named).

The clearest statement of the American grain occurs in a chapter called "Jacataqua." Consider this: "The United States without self-seeking has given more of material help to Europe and to the world . . . than have all other nations of the world put together in the entire history of mankind." (p. 175) "It is this which makes us the flaming terror of the world . . . with hatred barking at us from every sea." (p. 176) "America adores violence, yes. It thrills at big fires and explosions." (p. 177) And so forth. Williams’s observations remain pretty much on target in 2003, nearly 80 years after he wrote them.

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These poems stem from Coles's studies of the lives of poor black children in the South, and Native-American children in the Southwest and Alaska. In his Introduction to the first section of the book, Coles writes, "The words in this section tend to be soldiers." These tough, sad, hopeful, and militant poems give voice to children and adults on the firing-line during the civil rights movement of the 1960's. The poems in the second section, which arise from Coles's work among Native-Americans, are quieter in tone, more radiant, lyrical, and even transcendent.

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This is the story of Shed, a boy growing up in Idaho at the turn of the century. Shed, who believes he has a Native-American mother, is berdache, the Native-American third sex. Though physically male, he has feminine attributes and is bisexual. For the first half of the novel, Shed is trying to figure out who he is. He lives in a whore house run by Ida Richilieu, a bossy but deeply caring woman who acts as his mother. His own mother disappeared, hunting down a man who raped Shed. Shed later finds her body in the mountains.

One day he leaves Ida's place to visit his mother's people. On the way, he meets Dellwood Barker, a white man, who talks to the moon. Shed discovers a photograph of his mother in Dellwood's things and assumes that Dellwood is his father. Nevertheless, they fall in love and begin a sexual relationship. Dellwood believes in Moves Moves, the substance in sperm that gives life. The two separate so that Shed can go to the Indian reservation. He gets shot while there, but an old Indian man saves his life by breathing his soul into him.

Shed returns to Ida's where Ida, Shed, Dellwood (who stumbles back into Shed's life), and a whore named Alma Hatch, form a new family. Together they fight the racism and bigotry of the Mormons who take over the town. Ida and Alma get lost in a snow storm. Alma dies and Shed and Dellwood have to amputate Ida's legs which are badly frostbitten. They help her to heal by giving her the energy of their Moves Moves. By the end of the novel, Shed is content with his identity.

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This collection of stories describes "a medical student's journey" (the subtitle) through the difficult terrain of clinical education. In Audrey Young's case, this is also a geographical odyssey from Seattle to Swaziland to Pocatello, Idaho, as she completes her University of Washington clinical rotations and electives. In one sense the main characters of these narratives are the patients the author encounters in clinics and hospitals. As she writes in the Preface, "Patients teach things that the wisest and most revered physicians cannot, and their lessons are in this book."

In another sense, of course, Dr. Young herself is the central character of these stories; this is an account of her journey into doctoring. The author first takes us to Bethel, a Yupik Eskimo town on the Bering seacoast of Alaska, where she had her initiation into clinical experiences in the form of a summer preceptorship. There she learns that patients are far different from textbook examples, as she confronts the social and cultural factors that influence illness and its amenability to treatment. We follow the author to assignments throughout the WWAMI network. WWAMI is the University of Washington's decentralized clinical training program (Wyoming, Washington, Alaska, Montana, and Idaho).

In Spokane she delivers a baby for the first time, supervised by an opera-loving attending physician. In Pocatello she takes care of her first critically ill neonate. In Missoula her life becomes "one of resigned solitude" in her internal medicine clerkship, where she experiences sleep deprivation and experiences sunlight only "through dusty windows."

During her fourth year, the author finds herself treating desperately ill AIDS patients without a supervising physician (he had gone to Zaire for a funeral and might be back the following week) and also without anti-retroviral drugs. However, it is in Swaziland that she learns the deep power and dignity of medicine, as exemplified by a patient who invites her to a dinner in her honor that requires killing one of his precious chickens.

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Dr. McKechnie begins his overview of the history of the practice of medicine in British Columbia with records of Coastal Native practices encountered by the first explorers of the Northwest Territory in the 18th century. This opening section of the work contains interesting folklore regarding some of the methodologies and medicinals utilized, and terminates in descriptions of the rites surrounding the initiation of a new Shaman.

Moving forward in time, the author explores the early naval medicine of the seamen and their captains, including the early intermingling of the explorers with the Coastal Indians. The plagues of smallpox, measles, syphilis, and tuberculosis attributed to the arrival on the western continent of organisms to which the natives were not immune are covered briefly.

The third portion of the book is devoted to the changes in medical practice on this particular frontier as the emerging science of the 19th century moved gradually westward. The final chapters cover the century of the great world wars and the progressive advances in medical science as they affected the residents and physicians of British Columbia.

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A very old Navajo grandmother believes it is time her 10-year-old granddaughter, Annie, learns to weave. Gathering her family in the hogan, she asks each of them to choose a gift they wish to have (Annie’s eyes choose the weaving stick) as she announces to her family that when the weaving of the new rug is completed, she will go to Mother Earth.

Determined to delay her mother from finishing the rug, Annie plans her distractions. She acts out in school, letting the sheep out of their pen, and, most significantly, unravels at night what her mother had woven during the day. The adults catch on.

The Old One’s gentle explanations of nature’s ways--the inevitability of death and the ultimate connectedness of the whole universe--eventually comfort and inspire Annie: "The sun rose but it also set. The cactus did not bloom forever. Petals dried and fell to earth . . . She would always be a part of the earth, just as her grandmother had always been, just as her grandmother would always be, always and forever." Annie picks up her grandmother’s weaving stick, kneels at the loom and begins to weave "as her mother had done, as her grandmother had done."

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This multimedia online documentary is an essay on the ecstasies and agonies of longevity, researched and composed by photojournalist, Ed Kashi and reporter, Julie Winokur. The site consists of written and audio commentaries and a number of short slide shows. The documentary is divided into six segments, each of which is a complete "essay" in itself: Introduction: Julie Winokur on aging; Part 1, Youth in age: The spirited side of longevity; Part 2, Sentenced to life: Growing old behind bars; Part 3, Helping hands: New solutions for elder care; Part 4, Vanishing heritage: Tribal elders face modern times; and Part 5, Surviving death: Losing a mate with dignity.

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The Heavenly Ladder is physician-poet Jack Coulehan's most recent chapbook, bringing together 48 poems, many of which have been published individually in various medical journals and literary magazines. The collection is divided into four sections.

Poems in the first section, "Medicine Stone," are written in the voice of patients or in the voice of the physician who treats them. The second section, "So Many Remedies," consists of five poems inspired by physician-author Chekhov. The poems of "The Illuminated Text" section reflect a wide-ranging interest in people who lived in distant times or in distant places. The final section, "Don't Be Afraid, Gringo," stays, for the most part, closer to home and includes a number of poems addressed to, or about, family members.

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A young husband has died suddenly (has abandoned his wife "to the grace we pursue as wild horses in the wind") and his widow prepares his body for a dawn burial. The widow's friend tells the story in this prose poem, figuring life as a "gradual return to the maker of butterflies." The two women share a joke about burying the husband in "the shirt you always wanted him to wear, a shirt he hated." The speaker affirms that "we are all dying together, though there is nothing like the loneliness of being the first or the last."

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