Summary:

 In his introduction, the author summarizes the history of polio’s first appearance as an epidemic in the United States, the ensuing research, subsequent applications of new information, attempts at abatement and ultimate success in the development of preventative measures.

Embedded in the successes and failures of the research applications are the details of human interactions.  Their impact on the goal of achieving near extinction of polio in America constitutes a dramatic subplot, which the historian adroitly weaves into the work.

For the reader who has only a sketchy knowledge of this important period in medical research, this history provides details of human exchanges, conflicts and resolutions necessary to bring the scientific developments to fruition.  Central among the multiple struggles rests the basic disagreement between Jonas Salk and Albert Sabin, two of the most prominent scientists working against the clock to develop the most effective and safest form of immunization.  Each new surge of the disease added to the urgency of the problem as well as to the question of the best solution.  Salk felt strongly that the immune system should be stimulated by a killed virus preparation, while Sabin was equally convinced that only the living virus could provide this need.  Each view had its own cadre of supporters and of opponents.

Funding issues also troubled those fighting the polio epidemics.  The March of Dimes is credited with raising a record $55 million in the fight against polio in early 1954, becoming the first major infectious disease battle to benefit from a concerted public awareness campaign and demonstrating the power of such volunteer driven efforts to supplement public and other private funding efforts.

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This book combines social history with personal memoir. It serves as a reflection on how the various challenges of living with chronic illness have shifted over time, and how they are still real and present for the increasing portion of the population who suffer from ills invisible to others and often hard to account for.  The book's brief treatments of cultural and medical approaches to chronic illness, from ancient practices to "patients in the digital age," provide a broad perspective against which to consider current legislative, political, medical, and personal concerns for those coping with chronic illness or disability. 

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In a dramatic monologue, Joanne traces the devastation of a familial proclivity to breast cancer through four generations of women: her grandmother Sarah; her mother; Joanne herself and her two daughters, one of whom is also Sarah.

Joanne’s mother and grandmother both died very young of breast cancer; however, many other family members vanished in the Holocaust and the number of familial cancer deaths is insufficient for her to qualify for genetic testing. Her friend Linda, also a mother of two daughters, learns too late that she carries the BRCA gene; she urges Joanne to be tested.

Tormented by not knowing and equally tormented by what should be done if the test is positive—both for herself and her daughters, she convinces a doctor to lie so that the test can be performed. It is positive; Joanne opts for bilateral preventative mastectomies. During a visit to the gravesite of her mother and grandmother, she begins to explain the genetic risk to her daughters. 

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Five Days at Memorial is the book length expansion  of the New York Times Sunday Magazine article that the author, a Pulitzer Prize-winning physician-journalist, published in 2009. The book, the result of years of research and literally hundreds of interviews, chronicles the five days (August 28 to September 1, 2005) during which the medical staff remaining at Memorial Hospital in New Orleans tried to care for the patients -- over a hundred of them stranded, like the staff, in a hospital without water or electricity --following the flooding wrought by Hurricane Katrina.

After an 8 page prologue, the book is divided into two sections, "Deadly Choices" (228pp, the narrative of those five days) and "Reckoning" (256pp, the legal battles over the injections of midazolam (a sedative) and morphine by some of those staff and prosecuted as homicide -- what others called "euthanasia.") "Deadly Choices" relates almost hourly the five days inside Memorial from the viewpoint of patients, patients' relatives, physicians, nurses, administrators of Memorial, Tenet (the holding company owning and running Memorial) and LifeCare -- the long-term care area within Memorial devoted to the care of terminally ill and debilitated patients -- owned by a separate company. Ethical and legal questions of triage, DNR, record-keeping, accountability, communication (primarily the failure thereof) and leadership are on almost every page. At the heart of this book, however, is the mystery of the unexplained deaths of so many patients during those five days. (On September 11, 2005, a disaster mortuary team recovered 45 bodies from many different places in Memorial, page 234). The crux of the mystery of these deaths is the manner in which nine in particular died in the beleaguered hospital on the fifth and last day when, paradoxically, relief had become real and effective and inclusive, seemingly obviating such injections.

The final pages of "Reckoning" deal with the fallout - historical, ethical, political and medical -- and current events relevant to these five days and the almost two years following. (The final verdict of not guilty -- the actual wording was "Not a true bill" since it was a grand jury declining to indict the one physician, Anna Pou, and the two nurses, Cheri Landry and Lori Budo -- was rendered on July 24, 2007). There are a map of Memorial Hospital and a cast of characters at the front of the book and extensive notes, bibliography and index at the end.

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The first-person, nameless narrator is in mid-1970s San Francisco on a "sabbatical" that is more like an exile from his academic post in the east. He takes an office in a downtown building to force himself to leave his dull accommodations. Occasionally he can hear everything that transpires from the space on the other side of the wall, which is the office of psychiatrist, Dr. Schüssler. Normally, the woman doctor runs a white-noise machine to ensure privacy, but one patient — who becomes “my patient” — hates the noise and insists it be turned off.

Adopted in infancy, “my patient” is in a fraught lesbian relationship. Her doctor has been encouraging her to find her birth mother, but she keeps resisting. Finally she embarks on a long exploration that is told through her accounts to the doctor, through conversations repeated and letters read out loud. As an academic scholar, the eavesdropping narrator is able to trace records that could not be found by the patient; he takes the liberty of meddling, falsifying an agency letter and setting her on the correct path. He also realizes that the psychiatrist’s father was a Nazi officer by listening to telephone conversations with her own mentor.

“My patient” learns that her mother was Jewish and escaped death by being in a special facility as a comfort woman. Chameleon-like the mother’s identity changes over and over. In contrast to the nameless patient, her name moves from Maria to Miriam to Michal; she lives in Israel where the patient goes to find her. The biological father’s identity is a mystery—perhaps someone whom Michal loved, perhaps a Nazi officer. The sacrifice of her child to a Catholic adoption agency moves from inexplicable selfishness to desperate selflessness. Surprises continue to the end when "my patient" finds an Israeli sister who has been in contact with the mother but is no less confused over her identity.

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Augustine, a fifteen-year old maid in a wealthy home, collapses with a seizure while she is serving an elegant dinner. When she recovers, she is unable to open one eye. She is transported to Salpetriere hospital in Paris under the care of the famous J. M. Charcot, neurologist and psychiatrist who is fascinated by the condition of hysteria. He uses hypnosis to suggest cures to his patients and to trigger attacks which he demonstrates to his colleagues. Augustine is particularly susceptible to fits under hypnosis and obliges her doctor with lewd, convulsive performances virtually on command.

After one such episode the paralysis moves from her eye to her hand. She says that she wishes to be cured, but life in the asylum is not terrible: she has a warm room and food; she no longer needs to work in a kitchen or serve demanding masters.  The doctor is clearly taken with her as a scientific subject. “Augustine est une patient magnifique,” he assures a colleague. He is personally intrigued by her too.

Finally, one day she announces that she is cured. When Charcot tries to hypnotize her for another demonstration, she does not succumb; however, a look passes between them. Taking pity on her doctor, she stages a seizure that satisfies the audience. Immediately after, she and the doctor have a single passionate encounter against a clinic wall, and then she runs away.

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This painting depicts what in some respects mimics an anatomy amphitheater, but the title, "Arena," tells us that what is going on here is more spectacle than instruction. Painted in 1992, early in the AIDS epidemic, when rapid decline and death from the disease was almost unavoidable, this complex artwork catalogs some of what was taking place in society at the time. A shaft of window light illuminates the center where a masked doctor is examining a Caucasian patient while a nurse, similarly masked, stands nearby. A large white plume of smoke or steam is emanating from the patient's head. The examination is being filmed and narrated.
 
In the lower right-hand corner a dark skinned patient attached to an IV is lying on a gurney. An attendant has his back toward the patient, whom he seems to be ignoring as he speaks with another white clad hospital worker. If one follows a diagonal from the ignored patient through to the central figures, toward the upper left, another patient, covered completely by a sheet and apparently dead, is being wheeled out of the arena. Adjacent to this scene are people seated cross-legged on the floor, listening to a speaker reading from a book while a Buddha floats above him. [According to art critic Klaus Kertess, the reader is poet John Giorno, "who instructed Moore in Buddhist practice" (Toxic Beauty, p. 11)]. In the lower left, a vendor wheels his cart, selling soda and sausages, adding to the carnival atmosphere. Just ahead of him an elderly woman holds a flattened out body in her arms.
 
To the upper right, police barricades and struggling policeman attempt to hold back a group of protesters carrying a sign saying "Who's in Charge?". In the upper center, two skeletons stand in front of a screen and hold banners bearing Latin inscriptions. An instructor is pointing to drawings on the screen - molecules and cell membranes. Other skeletons are positioned at the edges of the painting, also bearing banners, and in the lower center two skeletons stand in front of a fruit tree. One of these skeletons holds what seems to be a heart dripping blood. Several figures dressed in costume are posing or dancing. The curved rows of the arena are sparsely populated and include skeletons of various animals as well as two men who are injecting themselves in the arm. Robotic figures appear here and there in the painting.

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Young, beautiful Caroline Mathilde (Vikander) writes a letter to her children explaining why they have been separated. A few years earlier in 1766, she was sent from her native England to Denmark to become consort to King Christian VII (Følsgaard).

Her hopes are dashed when she discovers that her regal husband is deeply disturbed and little interested in her. They manage to conceive a baby boy – and all further relations between them discontinue.

Dr. Johann Struensee (Mikkelsen) is a progressive, German physician, interested in helping the poor. His friends wish to curry favour with the monarch and sway politics. They believe that Struensee might be good for the King and good for them. He is recruited to the royal entourage.

The plan works well. Struensee is able to calm the king, who grows fond of and dependent on his physician. Under his influence, the king asserts his own authority and begins making progressive laws – banning torture, improving sanitation, outlawing biased financial practices for artistocrats. These changes displease some of the very people who had brought Struensee to court.

Worse, the doctor understands Caroline Mathilde and her loneliness. He is instrumental in a partial reconciliation between the queen and the king, but inevitably he and she fall in love. Their affair is an open secret at court. When she bears a daughter, the King recognizes the child, but everyone knows that the infant is not his.

Eventually the affair is used to bring down both Struensee and the Queen. She is sent into exile without her children. He is lied to, and brutally decapitated in 1772. Three years later, she writes to her children and dies of fever.

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Jacob Needleman, a philosopher concerned with "applying philosophy to the questions of everyday life," taught medical ethics at San Francisco State University (SFSU). In this highly personal book he addresses what it means to be a "good doctor" and the role of physicians in contemporary society. The book is structured as a series of imaginary letters addressed to his childhood idol, the physician who treated him when he was 12 years old.

The aged Dr. Kaufman responds to these letters, although we see only the philosopher’s side of the correspondence. Toward the end of the book, Needleman makes a pilgrimage to Philadelphia to visit his ailing mentor. They talk for a while, then when the old man takes a nap, Needleman spends the rest of the day conversing with Dr. Kaufman’s daughter, a pediatrician who in some sense represents the "good" medicine of the future, just as her father represented the "good" medicine of the past.

In these letters the author addresses the deep questions of character and motivation in the form of a personal narrative. He recalls his experiences as a boy, his ambition to become a doctor, and several incidents from his life as an autopsy assistant and hospital orderly. For example, there is the bizarre story of the young man transporting an amputated leg by elevator; he accidentally drops the leg to the floor and the wrappings flip open, much to the astonishment of others on the elevator.

"People don’t trust science; people trust people." (p. 15) Similarly, Jacob Needleman writes, people don’t trust or distrust medicine as an institution; they trust or distrust doctors. "To be a good doctor, one must first of all be a good (person). And to be a good (person) one has to begin by discovering in oneself the desire for truth . . . truth is the only effective force." (p. 68)

To facilitate this quest for truth, Needleman describes in these letters a four-seminar sequence he teaches at SFSU: "To whom is the physician responsible?," "The art of living and the art of medicine," "Care," and "The financial disease of modern medicine." (pp. 71-72) Through these seminars the author hopes to re-awaken in prospective physicians the quest for truth, and the possibility of care, that he believes have been submerged by technology and infected by the financial disease. Dr. Kaufman’s daughter serves as a real-life example of the possibility of cultivating the contemporary version of the "good doctor."

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Nora Kynd (born in 1825) was a central character in Barrett’s Ship Fever (in this database). She survived illness and quarantine at Grosse Ile, but lost contact with both her younger brothers, Ned and Denis. She reaches Detroit by 1848 where she learns about herbal remedies from a kindly landlady. She marries late and has a son, Michael, but never stops searching for her brothers. Her husband dies. One day in 1868, Nora sees Ned’s name as the proprietor of a hunting and fishing lodge in the Adirondacks. She packs up everything and moves there with her young son.

Ned takes Nora and Michael into his home. He carries on with the hunting business and taxidermy, but they increasingly cater to people with tuberculosis who come for “The Cure” of good food, fresh air, and lots of rest—as a reflection of the famous nearby sanatorium (unnamed but likely the Trudeau Sanatorium at Saranac Lake). In this capacity, they meet lodgers Clara and her two daughters Gillian and Elizabeth—the almost abandoned family of the naturalist Max from Barrett’s story “Servants of the Map” (also this database).

Young Elizabeth has a cough and an eye for Michael, but he has eyes only for Gillian whom he eventually marries. Together they take over Ned’s Inn. For her cough, Elizabeth becomes a resident of the sanatorium and finds her own husband in fellow invalid, Andrew. Together they open a nearby boarding house for other invalids and Nora joins them in the endeavor as the nurse, serving until her death. But Nora was difficult to replace and Elizabeth is now searching for a new nurse to help with the care of her ailing clients.

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