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When literature and cultural studies professor Michael Bérubé's son James was born in 1991, he was diagnosed with Down Syndrome. Negotiating various medical, social, and educational environments and the identities each assigns their son, Bérubé and Janet Lyon (his wife, a literature professor and former cardiac-ICU nurse), become effective advocates for Jamie and embark on a course of questions about the social systems that produce disabled identities and administer to those human differences termed significant ones. Bérubé engages these questions with a mixture of family experience (his own, and that of other families with disabilities), historical research, critical theory, and sophisticated critical analysis.

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An anthology of poetry and prose by doctors, nurses, patients, and other authors, A Life in Medicine is divided into four sections: "Physicians Must Be Altruistic"; "Physicians Must Be Knowledgeable"; "Physicians Must Be Skillful"; and "Physicians Must Be Dutiful." Each section begins with the Association of American Medical Colleges' (AAMC) definition of the physician trait examined in that section, and short "explications" precede each individual poem and prose piece, linking them to the section's overall theme.

The anthology has a preface outlining the editors' goals and Robert Coles's introduction, "The Moral Education of Medical Students." These organizational touches make the anthology a classroom-ready text for medical students. The anthology's poems and prose--many of which are stunning--were taken from previously published works and exclude many well-known and often-used pieces. But those selections are readily available elsewhere, and the editors do readers a greater service by introducing many lesser-known, but equally important, poems and essays.

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Abba Kovner wrote these poems during and after his hospitalization at Sloan Kettering for throat cancer. His exile into the world of illness begins as he enters the hospital. "He fell asleep under strange skies" (p. 7) and in the hospital "the silence astounds on all / its many floors."(p. 11) [Throughout the book, Kovner refers to himself in the 3rd person.] He tries to pray: "Is there a prayer for one who prays like him / seething . . . " (p. 15) He decries "the infuriating confidence of the doctors." (p. 21) He celebrates the beauty and magnificence of New York. But then the bad news arrives: "When they told him they were going to cut away his vocal cords / entirely it was merely / a confirmation of what he already knew."(p. 31)

To the brisk, young hospital staff, he is just another patient, nothing but an "ancient shard”: "They could not imagine that this was a man / who had fought the world."(p. 36) Only Norma, the Puerto Rican night nurse, connects with him at a different, more human level. "He blushes / when Norma says: What a lovely / head of hair you have, sir!" (p. 88) As he prepares for the laryngectomy, images from the past invade his consciousness--Christmas Eve, 1941; the Vilna ghetto, where "the lice / got under your skin" (p. 68); and "a shoemaker, his name forgotten" (p. 74). The Holy Guests--the souls of Abraham, Isaac, Jacob, Joseph, Moses, Aaron, and David--also visit the sick room.

After the surgery, the conspiracy of optimism brings him along, carries him forward: "What a healthy recovery, / they said. And patted him on the shoulder / with admiration: You’re doing fine. Wow!" (p. 85) But this is at best a voiceless recovery: "From the wreckage of his voice / there arose a bubble / a tiny bubble . . . " (p. 101) Eventually, the patient leaves the hospital, leaves New York, and arrives home: "Fearful from the moment of arrival: he / watches the landing that cannot / be avoided, into / the arms / of people who love him . . . " (p. 111) He settles into a routine, lives his life as if there is nothing new, but ends at "An Ending, Unfinished" (p. 126), back at Sloan Kettering. "Where now? He asked himself . . . " What next?

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One 1970s summer, Madeleine L'Engle brings her mother to Crosswicks, the rambling country house where the extended family has spent extended vacations for many years. At ninety, the elder Madeleine is suffering from the ravages of the now vanished diagnosis, 'hardening of the arteries.' By times she is frightened, angry, or difficult; at night she cries out or tries to wander. Round-the-clock caregivers help with the strain, while the writer's own children and grandchildren figure in her journal with concern, affection, and wonder.

The presence of the dwindling old lady provokes detailed recollections--direct and indirect memories--of the lives of her mother, grandmother, and great-grandmother, all named Madeleine--bringing the span of this narrative to six generations. Despite the grandmother's slow mental decline, death comes suddenly, while L'Engle is away and her son is left to help.

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The narrator of this historical novel, Anna Frith, works as a servant in the household of the local minister. The story recounts the horrific events in a plague-ridden village of 17th-century England. Anna, having lost her young husband in a mining accident, loses both her sons to the plague, as well as a boarder in her household who seems to have been the first case in the village.

After these losses, she stays her grief by tending the sick in many families. Particularly after the village works out terms of quarantine with the earl, no help but food and supplies comes in from outside. She learns much from the local herbalists, two midwives whose work she carries on after their violent deaths. In this work she develops a close partnership with the pastor's wife.

The story takes us through the whole trajectory of loss, accusations, spiritual struggle, shared grief, creative adaptations, and eventually emergence from sickness and quarantine. Anna's own journey takes some surprising turns as her confidence and clarity about her own mission grow and deepen.

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Please note that in order to provide a useful analysis of this novel, it is necessary to reveal the novel's ending in the discussion below. It is England, 1935. Briony Tallis, 12 years old, decides to become a writer. Her first experiment in novelistic technique involves narrating from three different points of view an odd incident she witnesses from her bedroom window: her sister Cecilia undresses and steps into a fountain in the presence of Robbie Turner, the son of a family servant. Robbie has been educated at Cambridge under Mr. Tallis's patronage, and intends to become a physician. He and Cecilia are in love.

Briony's reconstruction of the incident is inaccurate, but she fails to recognize the lesson of her exercise in multiple perspectives: her version is sufficiently coherent for her to mistake it for reality. She jumps to further conclusions and causes Robbie's wrongful conviction and imprisonment for rape and Cecilia's permanent estrangement from her family.

The rest of the novel both elucidates and unravels the opening sequence. It is 1940 and Briony is becoming both a nurse and a novelist. Both roles represent her efforts to atone for her disastrous narrative misconstrual. As a nurse, she learns a new humility and cares for the appalling injuries of soldiers who, like Robbie, are suffering the war in France.

A more metaphysical atonement lies in her work as a novelist: we realize that we have been reading Briony's own rewriting of the initial events and her careful imaginative reconstruction of Robbie's experiences in the Dunkirk evacuation. She tells of her discovery of the actual rapist (if a rape it was), her decision to retract her accusations and her efforts to make amends with Robbie and Cecilia.

In a final section, set in 1999, the aging Briony, now a successful novelist, learns that she is developing progressive vascular dementia. Soon, her ability to remember and grasp reality will desert her. But she has finished writing her latest version of Robbie and Cecilia's story, the novel we have just read, and can rest.

Her atonement seems complete until we learn that Robbie died in France and Cecilia in the Blitz, and that the (relatively) happy ending we read was simply made up by Briony. Devastatingly, we learn that atonement for an error of fiction has been limited to fictional reparation. The lethal damage it has caused in the actual world is beyond mending . . . unless, of course, we accept the vertiginous truth that the damage described in this novel is itself also no more (or less) than a fiction.

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The novel begins with a prologue in which the author reports that, while repairing an old chateau he had purchased in the north of France, he discovered a manuscript ("La Tendresse") hidden in one of the chateau's chimneys. Dr. Alain Hamilton, the manuscript's author, had hidden it there, as the German army approached the chateau in 1940. "La Tendresse" was a collection of writings that described Hamilton's early life, especially his experience as a battlefield surgeon in the British army during the First World War. The 80 short chapters that follow, Strauss explains, are an edited and annotated version of Dr. Hamilton's story.

We first meet Alain Hamilton as an adolescent, during an episode of sexual awakening with a girl his own age. Later, we see him as a medical student in Vienna and then as a young married surgeon in London, who has a tender affair with a married nurse. But most of the story takes place at a British Army field hospital, where Dr. Hamilton encounters the senselessness, devastation, and absolute terror of war.

His colleague in this tragedy is Elizabeth, a nurse whose brother and fiancé have died in the fighting. Alain and Elizabeth develop an exquisitely tender, yet unconsummated, intimacy, which ends tragically. After the war, Alain searches healing and consolation, eventually finding a measure of peace in the chateau where he and Elizabeth had once worked together.

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To relieve her insomnia, Claire Vornoff seeks help from Dr. Declan Farrell, a well-known holistic physician, who begins to see her professionally at his country home. Farrell's methods focus on massage and bodywork, along with some acupuncture. Claire finds him an attractive paradox--sensitive and "tuned in" to her, yet also blunt and emotionally unsettling.

The client-therapist relationship becomes deeper and more complex. After Claire has a brief sexual escapade with a married man, she admits to herself that she actually loves Declan and confesses her love to him. Indirectly, he reveals that he also has strong feelings for her, but is desperately resisting those feelings and attempting to maintain his professionalism.

Claire finally breaks off their relationship and attempts to go on with her life. Over the next couple of years, Declan closes his practice, moves elsewhere, divorces his wife, and ultimately commits suicide. Claire learns of these events gradually, at second hand, as she, too, moves on, but in much a different direction. Eventually she begins a new life in Toronto.

Although the relationship between Claire and Declan occupies center stage, Claire's quest for improved health leads her to consider, and sometimes consult with, other alternative medicine practitioners as well. (I say "improved health" rather than "relief of insomnia" because, although never stated, it seems clear that Claire seeks a sense of completeness and meaning in life that goes far beyond solving her sleep problem.)

One of these healers, for example, is Mr. Spaulding, who reviews Claire's blood work and concludes, "You're in rough shape, girl." (p. 231) He explains that her "body salts are so high I can't measure them" and that her "body is throwing off one hundred times more dead cells than it should . . . "

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The story begins with the doctor-narrator unobtrusively observing an older man lying in a hospital bed. The patient is blind and has amputations of both legs. (We are given no medical details that cannot be observed in the room.) The narrator tends to the man's amputation wounds and answers a few simple questions. The man requests a pair of shoes.

Back in the corridor, a nurse tells the doctor that the patient refuses his food, throwing his china plate against the wall of his room. The narrator hears the man and a nurse argue briefly about food and then, by himself, watches as the patient carefully and powerfully throws another dish against the wall. The next day the doctor discovers that the patient has died.

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The Physician in Literature is an anthology edited and introduced by Norman Cousins that aims to illustrate the multiple ways in which doctors are portrayed in world literature. Literary selections are organized into 12 categories including Research and Serendipity, The Role of the Physician, Gods and Demons, Quacks and Clowns, Clinical Descriptions in Literature, Doctors and Students, The Practice, Women and Healing, Madness, Dying, The Patient, and An Enduring Tradition.

Some of the notable authors represented in this collection include Leo Tolstoy, Herman Melville, Albert Camus, William Shakespeare, Charles Dickens, George Bernard Shaw, Anton P. Chekhov, Orwell, Fyodor Mikhailovich Dostoevski, Ernest Hemingway, Thomas Mann, Gustave Flaubert, and Sir Arthur Conan Doyle. A healthy dose of William Carlos Williams makes for some of the most enjoyable reading ("The Use of Force" and excerpts from his Autobiography).

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