Summary:

Author Horace Davenport is a retired professor of physiology who had a distinguished career in medical science. This book reflects his more recent interest in the history of medicine and physiology in the 19th and 20th centuries. The best summary of this transcription with commentary resides in the author's own introductory paragraph, paraphrased here: From 1899 to 1900 fourth year medical students at the University of Michigan doing their medicine and surgery rotations attended a diagnostic clinic twice a week with George Dock, A.M., M.D., professor of theory and practice of clinical medicine. Dr. Dock had a secretary make a shorthand record of everything that was said at these clinics by Dock himself, the patients, and the students.

The clinics and recording of the interactions continued until the summer of 1908 when Dr. Dock left Michigan for a position at Tulane. The typed transcripts of these sessions fill 6,800 pages. This book is Davenport's distillation and, on occasion, clarification of these documents. In these transcriptions resides not only a view of the practice of academic medicine at the turn of the 20th century, but also a glimpse at one clinician's interpretation of clinical material in his own time.

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The time is 1954 and the place Boston. Dan Lassiter is a first year medical student back from Inchon and the Korean War, taking--and in danger of failing--anatomy when he becomes obsessed with his cadaver, a young and very well proportioned man he thinks must have been a boxer. As he tries to pass anatomy under the withering and authoritarian attention of Dr. Nathan Snider, a stern anatomist who worships at the altar of Vesalius, Dan discovers that his cadaver is a very physically fit young man, whose death fascinates him and about whom his professor will not yield any information. Using his newspaper connections with one of several women he's dating, Dan discovers that the cadaver Dr. Snider refused to identify was Rick Ferrar, a fearless boxer who was fast friends with Lemuel Harper, an African-American and also, like Dan, a veteran of the Korean War.

The remainder of the book resolves the familial baggage Dan is carrying from his parents' death and then his brother's; his quest for the character and mode of death of Rick Ferrar; the intertwining of his and Rick's personalities, girlfriend, and destinies; and his medical school career, which at times seems more a hobby than a serious pursuit. By novel's end all the subplots are resolved and Dan, attending a funeral for the class's cadavers, volunteers to work with Dr. Snider in the anatomy lab to improve his mediocre knowledge of anatomy.

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As a medical student Stone moves ("in our own tense tendons") into a new understanding of the body, in which knowledge of names ("the word") gives power over the mysteries that lie under the skin. "Ribs spring like gates." Within the gates they [students] find the secret cause of death: an aortic aneurysm. But the aneurysm isn't just a fact; it tells a human story, a story of an "old sin-- / the silent lust / that had buried itself . . . ." Thus, the cadaver speaks.

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Dr. Flaherty, a practicing neurologist, sets out to explore the act of writing and, more broadly, creativity, in the context of both neuroscience and emotion. She begins by describing several brain conditions that seem to enhance the need to write, even to the extent of obsessive hypergraphia. Next she turns to the opposite state, writer's block, looking at both psychological and neuroscientific perspectives.

Using some of the recent studies of the relationships between certain brain centers and language related phenomena, Flaherty further clarifies some of the cognitive bases for creating literature. Finally, the study turns specifically to the temporal lobe as the possible organic site of the perceived voice of the muse in religious and creative inspiration.

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Summary:

This is a collection of 23 stories, five of which take the form of "letters" in which an older physician (not surprisingly, a surgeon) gives advice to an imaginary young surgeon. However, every one of the stories "fits" as a tale that might be told in such a letter--assuming the author was a wise and gifted writer, in addition to being a surgeon.

The book begins with the gift of a physical diagnosis textbook on the occasion of the young doctor's graduation ("Textbook") and ends with a reflection on "your first autopsy" ("Remains"). Among the other stories are Imelda (see annotation), Brute (see annotation), Toenails (see annotation), Mercy (see annotation), "A Pint of Blood," "Witness," "The Virgin and the Petri Dish," and "Impostor."

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The new interns, Roy Basch (Tim Matheson), Chuck (Howard Rollins, Jr.) and Wayne Potts (Michael Sacks), begin their year of internal medicine training in a busy city hospital under construction. After initial introductions led by the vague staff man and vapid chief resident, they become the specific charges of the cynical resident doctor "Fats" (Charles Haid). Fats teaches them attitude and language: how to "buff" (improve) and "turf" (transfer) "gomers" (Get Out of My Emergency Room)--the words used to describe management of incurable, hateful patients who "never die," regardless of the abuse the clumsy housestaff might inflict. But Fats has heart.

Soon, they fall under the command of the militaristic and lonely woman resident, Jo Miller (Lisa Pelikan), who cannot bring herself to withhold treatment, even at a patient's request. She blames underlings for the failings of medicine and nature, as well as herself.

Wayne throws himself from the hospital roof because of a misplaced sense of guilt over a patient's demise. Roy falls in love with the nurse, Molly (Kathryn Dowling), but nearly loses her as he begins to emulate Jo's cold, calculating style. He is "rescued" in the nick of time by his friends, Fats, and the death of a physician patient (Ossie Davis) whom he admires. With recovered equanimity and renewed anger over the suicide of his fellow intern, Roy refuses to go on with his residency.

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The author, Samuel Shem, opens these reflections by saying that he was a writer before he was a doctor. His early answers to questions about healing came from stories he read. "Life as it should be in addition to life as it is" became the "motor" of his writing. He loved stories that he heard from patients and the "few humane doctors" he met and decided he would be able to understand people better by writing about experiences with them.

Shem's experience as an intern spawned The House of God (see this database) and he sees writing about his training as an example of the use of resistance when he saw "something unjust, cruel, militaristic or simply not right." He recommends the following to resist the inhumanities in medicine: (1) Learn our trade in the world, (2) Beware of isolation, (3) Speak up, (4) Resist self-centeredness. He says that the healing essence of narrative is in "we," meaning the patient and the physician.

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Rosenberg, a surgeon and bench research scientist, has an epiphany fairly early in his clinical career: a patient with widespread cancer determined to be terminal, returns to the clinic sometime later, apparently disease-free without medical treatment. The scientist wonders if this patient's body could have tapped into some immunological or genetic healing pool. After having formulated the question, the author takes the reader through the trials and tribulations of framing, trying, failing, retrying and failing again to determine a way to test and prove how this phenomenon could have happened.

Over the many years of experimental work in the laboratory and on the wards of the National Cancer Institute, Dr. Rosenberg presents in a fashion largely accessible to the lay public a glimpse into this process. The work covers nearly three decades of the author's struggle to better understand and to develop new treatments for malignancies.

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Subtitled "The Story of a Gifted Young Obstetrician's Mistake and the Psychologist Who Helped Her," this is an absorbing account of a young female physician's torment following the difficult delivery of a baby who was soon thereafter diagnosed with cerebral palsy. "Doctor Amelia" seeks counseling after she has taken an indefinite leave of absence from her practice and faculty position. The book intertwines reconstructed counseling sessions in the voice of the doctor-patient, with the therapeutic strategy and personal reflections of her therapist, author Dan Shapiro.

The obstetrician enters therapy because she has lost confidence in her professional abilities. Once deeply engaged in her chosen profession, she has lost her enthusiasm for it and feels "numb." Her marriage is under strain. When asked if she is suicidal, she hesitates and then denies she is. Shapiro thinks there may be trouble ahead, and so does the reader. Gradually, Doctor Amelia reveals the incident that triggered her changed emotional state. She had delayed performing a cesarean section on a patient who was in extended labor and whose baby was showing deceleration of its heartbeat rate. A few weeks later, the baby's pediatrician informed Doctor Amelia that the baby had cerebral palsy and now the baby's parents are filing a lawsuit.

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St. Luke’s Hospital was founded in 1750 to provide free care to the impoverished mentally ill. It mixed benevolence with "unconscious cruelty" in the treatments used by the "practitioners of old," from restraints and drugs to swings and a key to force-feed recalcitrant patients. Dickens describes this gloomy edifice as he saw it on December 26, 1851, although he notes a "seasonable garniture" of holly.

The inhabitants of St. Luke’s largely sit in solitude. Dickens decries the absence of "domestic articles to occupy . . . the mind" in one gallery holding several silent, melancholy women, and praises the comfortable furnishings--and the relative "earnestness and diligence" of the inmates--in another. He uses statistics to show the prevalence of female patients, "the general efficacy of the treatment" at St. Luke’s, and the unhealthy weight gain of the inhabitants due to inactivity. Dickens describes the behavior of various distinctive inhabitants during the usual fortnightly dance, the viewing of a Christmas tree, and the distribution of presents.

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