Summary:

While on an airplane, Carson experiences abdominal pain. He is a divorced man in his fifties and a sales representative for a computer and information technology firm. He spends much of his time traveling and fancies himself "a connoisseur of cities." The increasingly severe stomach pain forces Carson to reschedule his business meeting and retreat to his hotel room.

His suffering mounts and he decides to visit the emergency department of the city hospital. Carson is evaluated by two young male doctors and later a middle-aged female physician. Despite blood tests and X-rays, his diagnosis remains murky and a surgical consultation is obtained. The surgeon suspects appendicitis. He postulates that Carson may have a retrocecal appendix and explains that in such cases the anatomical location of the organ often confounds the diagnosis.

Carson undergoes surgery. His appendix is indeed retrocecal and rupturing. He spends five days convalescing from the operation. During that time he acquires an intimate knowledge of the city from his stay at the hospital. The experience revitalizes him. Carson reasons that the world is miraculous in part because it is so simple yet still spectacular.

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The title The Body in the Library suggests medicine (the body) as seen through literary eyes. True enough, this collection of stories, poems, essays, and excerpts from longer works is subtitled "A Literary Anthology of Modern Medicine." However, as Iain Bamforth points out in his introduction, nowadays we are more concerned with "the library in the body" (p. xxiv); that is, we believe the truth of human illness can be found by biochemical tests and positron scans, rather than by storytelling. In this anthology Bamforth uses literature itself to document this change in perspective. Beginning with "The Black Veil" (1836), an early sketch by Charles Dickens, Bamforth recounts the recent history of medicine as seen by poets and writers, many of whom were (and are) physicians themselves.

Part of the anthology consists of material already annotated in this database. This includes stories (e.g. Conan Doyle’s "The Curse of Eve" from Round the Red Lamp, Kafka’s A Country Doctor, and Williams’s Jean Beicke); excerpts from novels (e.g. "The Operation" from Flaubert’s Madame Bovary, "The Fever Ward" from Camus’ The Plague, and "Doctor Glas" from Hjalmar Soderberg’s novel, Doctor Glas); and essays (e.g. Virginia Woolf’s On Being Ill and John Berger’s "Clerk of Their Records" from A Fortunate Man).

However, most of the selections have not previously been noted in this database, nor do they appear in other recent anthologies. Iain Bamforth has discovered some wonderful "new" material on the medical experience. This includes several poems by the German physician-poet Gottfried Benn (pp. 151-153); and a brief piece by neurologist-writer Alfred Döblin ("My Double," pp. 177-179), in which the physician Döblin and the writer Döblin describe their respective "doubles" in rather detached and negative terms.

Another delight is the series of selections from Miguel Torga’s diary (pp. 256-278); Torga (1907-1995) was a provincial Portuguese medical practitioner for 60 years. Among the other pieces are short excerpts from plays by Georg Buchner, Jules Romains, and Karl Valentin; and poems by Weldon Kees, W. H. Auden, Philip Larkin, Dannie Abse, Robert Pinsky, Miroslav Holub , and Thom Gunn.

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This long poem in 20 sections seeks to explore, dissect, and create a language for the experience of hemophilia. "Blood pools in a joint / The limb locks . . . " The poet first dissects words like "trans / fusion" and "hema / toma," and showers the reader with images (like splatters of blood?).

In section 5 he states his purpose in the familiar jargon of educational objectives and later, in section 10, he utilizes spacing and line breaks to convert standard admonitions into poetry; for example, "These child- / ren should / not / be / punished, and / their / play with / other / children / should / be super- / vised . . . " Isolated phrases and sentences appear--some from the hospital and some from the "outside" world.

In some phrases the worlds of outside and inside mix, as in "Arterial sunrise, capillary dusk." Section 13 consists of laboratory reports. The poem breathes in and out, between syllables and long lines, between prosaic statements and poetic images. Finally, the poet finds words for the endless rhythm of hemophilia, "Gratitude and / fear--Your relentless / rhythm--I move to / it still . . . "

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This is the story of the life, loves, wounds, grit, artistic genius, and death of the well-known Mexican artist Frida Kahlo, played by Salma Hayek. At the age of eighteen Kahlo was in a near-fatal bus accident that left her with lifelong injuries to her pelvis, spine, and uterus. (The film does not include the fact that Kahlo had suffered some physical disability since a case of polio at the age of six.)

The life Kahlo survived to live was artistically enormously productive and successful, but it also had more than the usual share of physical suffering, medical procedures, attempts to self-medicate, and accompanying emotional distress. The film covers these things, as well as what Kahlo called the second disaster in her life, her marriage to the famous Mexican muralist Diego Rivera, played by Alfred Molina.

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This thorough and fascinating treatment of the politics of anatomy studies in 19th-century America provides a variety of perspectives on the vexed question of how appropriately to study human anatomy while also maintaining respect for the human body and honoring the various, deeply held community beliefs, and attitudes toward treatment of the dead. Sappol seeks, as he puts it, to "complicate the cultural history of medicine in late-eighteenth- and nineteenth-century America. . . by telling it from an anatomical perspective."

That statement of his objectives hardly suggests the startling range of approaches to the topic he takes in the book's nine chapters. These cover such issues as the legacies of belief about the "personhood" of the dead human body; the status of anatomy as both a legitimate and valuable study and also as an "icon of science"; the relationship of dissection and anatomy study to medical status and professionalization; the political tensions engendered by the "traffic in dead bodies" that most often expropriated corpses from marginalized communities; and the relationship of anatomy studies to sexual commerce and sensationalist fiction.

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In 1991 the artist and model Matuschka was diagnosed with breast cancer and had a mastectomy. Following her surgery, which she discovered had not been necessary, Matuschka became an activist on breast cancer issues. Hoping to increase awareness of the prevalence of breast cancer and also to suggest a more positive self image for women who had had mastectomies, she continued producing artistic portraits of herself, many of them revealing the results of her mastectomy.

Her career took a very public turn with the appearance of her photographic self-portrait on the cover of the New York Times Magazine on August 15, 1993.(She appears in a tailored white dress cut away from her right shoulder and torso to give a full view of her mastectomy scar.)This photo (titled "Beauty out of Damage" and accompanied by Susan Ferraro’s article, "The Anguished Politics of Breast Cancer") and a dozen other photos and paintings were exhibited on the Web by the Pincushion Forum web site and later put into an archive. The archive also contains several texts that help orient viewers to the visual works.

Viewer-readers may be interested in numerous poems, stories, and longer works about breast cancer that have been annotated in this database. Especially recommended are: Audre Lorde’s The Cancer Journals; Betty Rollin’s First, You Cry, excerpt from; Joyce Wadler’s autobiography, My Breast; Marilyn Hacker’s poem sequence, Cancer Winter; Linda Pastan’s poem, Routine Mammogram; Henry Schneiderman’s poem sequence, Breast Cancer in the Family; and a story by Helen Yglesias, Semi-Private. Other titles may be found here by searching for "breast And cancer."

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This masterful collection of essays was written by Gawande while he was a general surgery resident. The book consists of fourteen essays divided into three sections: Fallibility, Mystery, and Uncertainty. Although some of the essays fall clearly within the boundaries of the section title (such as "When Doctors Make Mistakes" and "When Good Doctors Go Bad" in the Fallibility section), others cross boundaries or don’t fall as squarely in these general themes ("Nine Thousand Surgeons," an anthropological essay on the cult and culture of a major surgical convention, is also located in the Fallibility section). Nevertheless, the many pleasures of the individual essays, the range of topics explored in depth, and the accuracy of the medicine portrayed are the true strengths of this work.

The book begins Dragnet-style with an Author’s Note: "The stories here are true." (p. 1) And it is this attention to fidelity that makes the essays so compelling. Because even when the truths are hard--the terrible acknowledgment by the medical neophyte about lack of skill and knowledge, the mistakes in judgment at all levels of doctoring, the nature of power relations and their effects on medical pedagogy and on the doctor-patient relationship, the gnawing uncertainties about so many medical decisions--the author confronts the issues head on with refreshing rigor, grace and honesty.

Many of the essays reference scientific and medical research (historical and current) as part of the exploration of the topic. This information is imbedded within the essay, hence avoiding a dry recitation of statistical evidence. Typically, the reader’s interest in an essay is immediately piqued by a story about a particular patient. For example, the story of an airway emergency in a trauma patient, her oxygen saturation decreasing by the second as Gawande and the emergency room attending struggle to secure an airway, surgical or otherwise, sets the scene for "When Doctors Make Mistakes."

This leads to a meditation on not only the culture of the Morbidity and Mortality Conference, with its strange mix of third-person case narrative and personal acceptance of responsibility by the attending physician (see Bosk, Charles, Forgive and Remember: Managing Medical Failure, U. Chicago Press, 1981 for an in depth analysis of this culture), but also a positive examination of the leadership role that anesthesiologists have played in improving patient safety via research, simulator training and systems improvement.

Gawande’s journalistic verve takes him beyond the confines of his own hospital and training to interview patients and physicians on topics as diverse as incapacitating blushing ("Crimson Tide"), chronic pain ("The Pain Perplex"), malpractice and incompetence ("When Good Doctors Go Bad") and herniorraphy ("The Computer and the Hernia Factory"). In addition, he visits his own post-operative patients at home ("The Man Who Couldn’t Stop Eating" and "The Case of the Red Leg") which gives a longer view of postoperative recovery and a broader exposure to patients’ perspectives.

Some of the most telling moments come with the introduction of his children’s medical problems into the text. These range from the relatively straightforward (a broken arm, but a chance to comment on detection of child abuse in the emergency room) to the downright parental nightmare scary (severe congenital cardiac defect in their oldest child and a life-threatening respiratory infection in their prematurely born youngest).

These last two experiences are introduced to provide an angle on issues of choice. Choice of a fully trained, attending physician rather than a fellow to provide follow-up cardiac care for their oldest, and the choice to opt out of the decision-making process for whether to intubate the trachea of the youngest and hence leave the medical decisions up to the care team.

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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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Tim Metcalfe is an Australian general practitioner who gave up medical practice to become a full-time poet and writer. A statement on the back cover summarizes the process in relation to this collection of 38 poems: " ’Cut to the Word’ is a moving account of one man’s transition from doctor to poet." He begins with the customary initiation: "We were introduced, respectfully, / to the volunteer dead . . . " (p. 13) He discovers the limitations and uncertainties of his new profession: "In tense moments / I wish my stethoscope / was all they want it to be." (p. 18) And the omnivorous demands of medicine: "I come home from work / and there it is: the family / the oldest crying / at the youngest crying / at her mother’s anger / at her crying . . . " (p. 21)

Metcalfe carries the reader through a series of short, incisive poems describing the doctor’s day-to-day work ("Morning Session, " pp. 47-50), as well as through a number of disturbing poems about the world of mental illness, but the book’s climax--so to speak--arrives with "The Doctor’s Complaint, " in which the physician heals herself "by laying down her stethoscope / and walking right out / of that in-patient clinic." At the end the poet writes, "Like a patient I have learned silence . . . Fine steel scissors in hand, / I cut to the word." (p. 63)

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This historical novel is set in 16th century Venice, where the great anatomist and physician Mateo Colombo has just been charged with heresy and placed under house arrest. The book proceeds in a series of short frames or fragments, presenting Colombo’s story from a wide variety of perspectives, ranging from the perspective of Mona Sofia, the most prestigious whore in Venice, to that of Leonardino, the crow who waits each morning to scavenge an eyeball or piece of flesh from one of the anatomist’s cadavers.

What is Colombo’s heresy? True, he has consistently violated the Papal Bull of Pope Boniface VIII that forbid obtaining cadavers for dissection, but his scholarly eminence and friendship with Pope Paul III have protected him from recrimination. His heresy is far worse than simply ignoring a Papal Bull; in fact, Mateo Colombo has discovered a dangerous new anatomical structure, the clitoris!

Mateo was called to the bedside of an unconscious holy woman named Inés de Torremolinos. In the process of examining her, the physician was amazed to discover "between his patient’s legs a perfectly formed, erect and diminutive penis." (p. 105) He took hold of the strange organ and began massaging it. As he did so, there was an amazing response in his patient: "(Her) breathing became hoarser and then broke into a loud panting . . . Her lifeless features changed into a lascivious grimace . . . " (p. 107) Subsequent research undertaken with Mona Sofia, the resplendent whore, as well as with cadavers, confirmed the significance of Colombo’s discovery.

At his hearing before the High Tribunal, Colombo explains his findings, which are far too complex and subtle to summarize (pp. 138-165). The finding of greatest interest, however, is that "there is no reason to believe that there exists in women such a thing as a soul." (p. 151) In fact, Colombo contends he has proven that the "amor veneris" or clitoris performs in women "similar functions to those of the soul in men, " although its nature "is utterly different since it depends entirely on the body." (p. 153)

You’ll have to read the book to discover what the verdict of the High Tribunal of the Holy Office was and Mateo Colombo’s fate.

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