Summary:

Eva McEwen is born in Scotland in 1920. Her mother dies shortly after giving birth to her. At the age of six, Eva is "visited" by two strangers (an older woman and a teenage girl) that only she can see and hear. These mysterious companions steer the course of her life. During World War II, Eva serves as a nurse in a burn unit.

She falls in love with a plastic surgeon but her supernatural attendants have other plans for Eva. She secures a job as a school nurse, marries a teacher, and has a daughter. Sadly, Eva dies at a young age from cancer of the liver and pancreas. Thus the novel ends much like it began, with the tragic death of a young mother who leaves behind a devoted husband and daughter while ghostly visitors are poised to both share and meddle in the youngster's life.

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The narrator is visiting a sick loved one in University Hospital, Boston and reflects on the many patients who have stayed in this hospital, most especially the young men from the battlefields of the American Civil War.

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This memoir begins in Africa, where Dr. Grim is with Médecins sans Frontières managing a meningitis outbreak in Nigeria. Conditions are appalling, but she has come here because of burnout: "so I won't be back home and in the ER" (11). Later in the book, she describes her other "escapes" from the Emergency Room, caring for war refugees in the Balkans.

The book centers, however, on life in an American emergency department, as Grim remembers it from the vantage point of Africa (where she does eventually become nostalgic for well-stocked supply cupboards and a more comprehensible chaos). She organizes her stories into a series of "Lessons in Emergency Medicine," in which she addresses the reader directly. After going through a step-by-step account of death in the ER, illustrated with several moving and alarming cases, she concludes: "Congratulations: you have successfully declared someone dead. Now, as an encore . . . you'll get to do it all over again" (28).

The ironic, even bitter, tone warns us of the difficulty of working in such perpetually crisis-ridden circumstances, but it does not conceal a vulnerability that seems necessary to doing the job well, such as when Grim has to tell a family that the father has died of the heart attack he had at his daughter's wedding: "you just stood there," she says, "looking at the corsage, the tuxedo and the pearls . . . You had no idea what to say and you don't really remember what you finally came out with" (26).

The stories are organized around several lessons: "How to deliver a baby," "How to crack a chest," "How to write a prescription" (which includes a discussion of addiction to prescription medication and a withering account of the doctor who overprescribes), and, as if it's as inevitable as the rest, "How to burn out."

By the book's final chapter, emergency medicine has merged, along with the vaccination of refugee children and the impossibility of treating tetanus in Nigeria, into the story of almost unreasonable determination in the face of endless frustration--but this, Grim shows in her final chapter, "Why I do what I do," is the point. Against this backdrop her final story, about the rescue of a child, makes its point: the feeling of saving a life explains all the rest.

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Summary:

Warren here supposedly presents the papers of a late friend, detailing the interesting cases he had encountered as a physician. In fact, the "cases" are sensational short stories, presented as a novel due to the framing chapter introducing the narrator's "Early Struggles" to make a living as a physician. Other stories investigate typically Gothic themes like ghosts, duels, graverobbing, elopements, and broken hearts, with other scandalous problems like gambling, dissipation, murder, domestic abuse, and suicide. Medical topics include mental illness, epilepsy, hysterical paralysis ("catalepsy"), cancer, toothache, consumption, syphilis, heart disease, alcoholism, disease of the spine, gout, amaurosis (blindness), puerperal hemorrhage, measles, and stroke ("apoplexy").

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It is 1832. Europe is in turmoil of revolution and soon to be ravaged by cholera. Italians who resist the Austrian occupation of their country have fled to southern France where they are ruthlessly pursued and killed by special agents. Handsome, young, Angelo Pardi (Olivier Martinez), is an Italian fugitive whose wealthy but revolutionary-minded mother has purchased his rank of colonel. Upon learning that a friend has betrayed his cell of resistors, he determines to return to Italy carrying the funds raised for a defense.

But cholera has struck southern France. Roads and rivers are barricaded, quarantine is enforced, and he encounters death, decay, fear, and angry crowds who accuse every stranger of having caused the epidemic. Pardi meets an anxious doctor who teaches him a treatment for cholera, but moments later the doctor defies his own treatment to die of the illness caught from his patients.

As Pardi runs from both Austrian and French pursuers, he falls through a tiled roof into the life of the abandoned Pauline de Théus (Juliette Binoche). With almost comic formality, he becomes her chivalrous guide--her "angel(o)"--and leads her safely to her elderly husband through an improbable series of narrow escapes, including cholera itself. The doctor's dubious treatment comes in handy not only for saving her life but also as a pretext for nudity in their chaste relationship. A few years later, peace and health returned, Madame de Théus receives a letter from Italy. Her husband knows that he ought to let her go, but the credits roll as she gazes at the Alps and contemplates her decision.

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The aging and isolated Austin Fraser paints vividly realistic images inspired by his past; he then covers them with a filmy top coat that obfuscates the clarity. His housekeeper thinks he spoils his work with this "style."

Son of a privileged mining magnate, he spent his summers on the northern shores of the Great Lakes, and his winters in upstate New York. His model, Sara, opened her life to him, and waited. He took without giving in return. His good friend George, destined to inherit his father's China Hall, is satisfied, it seems, with a meager life in porcelain painting and selling--trite, cozy images that Austin scorns. They both remember Vivian, a beautiful sophisticate who floated through their lives one summer long ago. Austin has been away in the big city for many years, but he has a hankering to see George again. Vivian reappears and goads Austin to make the journey back in time.

Wounded in the war, George has found a partner in Augusta--a fragile nurse, haunted by her horrifying war experience and addicted to morphine. But when George is confronted with Vivian again, the peaceful stability vanishes. To his amazement, Austin discovers that George had actually married Vivian that summer, but she left him at the urging of his mother. Her return opens painful wounds. After a night of recollection with Austin, Augusta slips away. Austin waits downstairs while she overdoses on morphia. George finds her dead and takes his own life too. Austin has the bodies removed.

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In the first section of the book ("Rejected Prayers"), Liveson proves that the prayers were not rejected; rather, they resulted in a group of thoughtful and moving poems. These poems speak eloquently of suffering patients, especially the elderly and neurologically compromised; for example, "Jenna," wearing her "diapered dress" (p. 16), "Sonnet to Sarah," who "lets her fingers trace the pattern on the wall," (p. 20), and the patient in "Praxis," whose "smile was rare but even" (p. 21).

These poems also speak passionately of social and historical pain, and of injustice writ large. Some of the most powerful are in the section called "Before the Plaster Sets," with which the book ends: "My First Death" (p. 63), "Holocaust Torah" (p. 66), and "Yom Kippur, 5760--Musaf" (p. 68).

The latter poem is a kind of contemporary re-envisioning of Allen Ginsburg’s 1956 poem "America." Jay Liveson writes, "Yom Kippur, this is serious. We sit here / hoping to somehow tune the engine / or at least check the map." Is tuning the engine enough? Perhaps we are fooling ourselves; much more needs to be done. How can we be content to sit and tune the engine in this unjust world? Perhaps the poem that speaks this theme most eloquently is "Statistical Causes of Traumatic Shock Syndrome in Gaza--Chart VII" (p. 72).

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The author describes war from the soldier's perspective--"we cursed through sludge . . . Men marched asleep. Many had lost their boots, but limped on, blood shod." The author remembers a soldier dying in poison gas. He challenges the reader: If you only knew the horrors of war, you would not repeat "the old Lie: Dulce et decorum est / Pro patria mori."

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An old man bending I come upon new faces . . . . The old poet is asked by the young to tell of his experience during the war. In silence and in dreams, he returns to the battlefield: "Bearing the bandages, water and sponge, / Straight and swift to my wounded I go, / Where they lie on the ground after the battle brought in, / Where their priceless blood reddens the grass . . . . "

He describes the rows of the hospital tent, where one man has a bullet through his neck, another an amputated arm. The poet cleans and dresses each wound. Even though he never knew these soldiers before, "Yet I think I could not refuse this moment to die for you, if that would save you." At the end of the poem, he remarks, "Many a soldier’s kiss dwells on these bearded lips."

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Macbeth, Thane of Glamis, is told by a trio of witches that he will soon be promoted to Thane of Cawdor, and later will be King of Scotland. When the first of their prophesies comes true, he tells his wife, who is filled with ambition and determines to ensure that the second is realized as well. She persuades her husband to murder King Duncan, and so Macbeth becomes King.

The rest of the play traces the couple's downfall as a result not only of the murder and hence the political injustice of Macbeth's reign, which leads to war in Scotland, but also because of the terrible psychological effects of guilt. Neither of them sleeps soundly again; Macbeth sees ghosts and appears to go mad; Lady Macbeth sleepwalks, endlessly washing her hands of the metaphysical blood that stains her, and eventually commits suicide. Macbeth dies when Macduff, rightful heir to the throne, besieges his castle and beheads him in battle.

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