Summary:

This anthology culls 1,500 excerpts from approximately 600 works of literature primarily written in the past two centuries and representing all major genres--the novel, drama, poetry, and essay. These brief selections highlight how literature portrays the medical profession and also provide ample evidence of many recurrent themes about the doctor-patient relationship and the personal lives of physicians present in the pages of fiction.

The book is organized into eleven chapters devoted to the following subjects: the doctor's fee, time, bedside manner, the medical history and physical examination, communication and truth, treatment, detachment, resentment of the medical profession, hospital rounds, social status, and the doctor in court. Many well-known authors including Anton P. Chekhov, Sir Arthur Conan Doyle, Ernest Hemingway, Thomas Mann, W. (William) Somerset Maugham, Leo Tolstoy, Tennessee Williams, and William Carlos Williams are featured in this anthology but less notable writers are also introduced. A twenty-three-page bibliography of primary and secondary sources is a useful element of the book.

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This outstanding anthology of poems, stories, excerpts and essays by African-American writers is prefaced by a poem ("Aunt Sue’s Stories" by Langston Hughes), a foreword, two essays and an introduction. The book is then divided into three sections: Section I, Illness and Health-Seeking Behavior; Section II, Aging; and Section III, Loss and Grief.

Each section begins with an introduction which clarifies the choice of the section’s theme and briefly describes each piece. At the conclusion of each section is a list of ten to fifteen questions which "are intended for personal reflection and group discussion." Brief autobiographical information for each of the thirty-one authors is presented in Appendix 1.

As Secundy notes in the introduction, a divide exists between the health care worker and patient, which is particularly prominent when color and economic status are different between them. Secundy, as an educator in the medical humanities, selected pieces that reveal "the significance of color and social distinctions" when African-Americans face illness or enter the health care system.

The selections chronicle struggle and survival, illness and loss, humiliation and pride, triumph and sorrow. These pieces speak to all of us, as Edmund Pellegrino states in his essay, "Ethnicity and Healing": "[p]aradoxically, as we learn more about the uniqueness of African-American culture, we are drawn closer to the common humanity we share with the subjects of these stories and poems."

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Banishing Verona concerns a 22-year-old house painter living in London. One soon realizes that Zeke Cafarelli is not normal. He has had a nervous breakdown a few years earlier; collects clocks--he has nine at the beginning of the novel and adds two more by novel's end--which he takes apart and restores; he has basic questions about interpersonal relations that, were it not for his illness, mentioned once, briefly and vaguely (24), one would describe as childlike naiveté.

For example, he wonders why people lie. Or, why is it so easy to identify vegetables (his parents are greengrocers) but not people each time one encounters them in even slightly different settings? Several times the author describes Zeke's mother or father (whom Zeke calls Gwen and Don, respectively) while their son is trying to confirm their identity as his parents.

Quite early in the narrative, like a dea ex machina, Verona MacIntyre enters Zeke's life. Or perhaps Venus on the half shell would be a more specific identification of the dea, since Verona is pregnant, and soon becomes as naked as Venus in the famous painting by Botticelli, to whose paintings Zeke is likened with his angelic appearance and lustrous hair. The two become oceanic--if not star-crossed--lovers-at-first-sight since Verona has to traipse off to Boston to help bail her sociopathic brother out of yet another financial and amorous mess of his own making. Despite the appearances of Jigger (Verona and Henry's grandfather in the persona of a long letter to Verona), and Toby (a mutual lover-friend of Verona and Henry), and Maurice (Gwen's lover), the plot does not seem unwieldy.

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At fourteen, after marginally consensual sex with a boyfriend, Jane has a baby.  She managed to keep her pregnancy a well-camouflaged secret until late in the process; both family and friends are still reeling from her late-breaking news.  Her mother has died; her grandmother has moved from the tribal reservation to live with Jane, her father (a white Canadian), and Jane's two brothers.  Though the school she attends has daycare for students' babies, Jane finds little emotional support, even among former friends, until a new girl, Dawna, takes an active, unpretentious interest in both Jane and the baby.

With Dawna's and her grandmother's help Jane decides to make the rather complicated arrangements required to allow her to audition for the school play and pursue a longstanding dream of singing and dancing on stage.  She meets with fierce and aggressive competition from a much more privileged girl who does her best to discredit Jane's efforts on account of her unfitness as both a Native American who doesn't look the part, and as an unwed mother who, as one faculty member puts it, shouldn't "parade herself" in public.  Nevertheless, Jane's skill and determination and soul-searching pay off; despite the steep learning curve required to care for a baby and the psychological cost of teen motherhood, she succeeds in making the accommodations and compromises necessary to retrieve old dreams on new terms.

            

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This collection of stories offers a sidelong view of medicine from the perspective of a thoughtful, experienced doctor of internal medicine at a teaching institution (UCSF) in an urban setting that brings a wide variety of types of patients to his door.  In a context of evident respect and admiration for even the quirkiest of them, Watts admits to the kinds of personal responses most have been trained to hide-laughter, anger, bewilderment, frustration, empathetic sorrow.  The cases he recounts include several whose inexplicabilities ultimately require action based as much on intuition as on science.  He includes several stories of illness among his own family and friends, and makes it clear in others how his professional decisions affect his home life and his own state of mind.  

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The unusual title is borrowed from Nathaniel Hawthorne's story, "The Custom House," to suggest a shift in fortune when immigrants "strike their roots into unaccustomed earth."  Set almost entirely in the United States (the unaccustomed earth), eight separate stories are connected most obviously by cultural dissonances affecting characters who are Indian or have Indian parents.  Three of the stories, however, are linked by a strong narrative connection that is unexpected, profound, and unforgettable.

For Indian readers, the narratives describe complexities about migration patterns, cultural issues, alienation, and generational differences. The stories deal with well-educated children of immigrants who become offspring their parents barely recognize.  For other readers, the stories reveal situations about families and customs that are strangely familiar, especially those stories dealing with relationships between parents and children.
 
The forces of globalization have created and accelerated shifts that can seem staggering to all parents intent on preserving cultural patterns and traditions. Whether Indian or not, most parents experience a sense of alienation while watching their children flourish in a world that increasingly appears unfamiliar and foreign.

Not surprisingly, the stories concern strains and challenges affecting mixed relationships and/or mixed marriages and stresses on disapproving and disappointed parents, while others focus on children succumbing to drugs and alcohol(for the latter, see annotation of "Only Goodness").  All deal with some kind of emotional loss, but provide connections to feelings experienced by children and their parents in life's quiet and more kinetic negotiations.
 
The first story is about Ruma, a well-educated woman who lives in Seattle with her work-alcoholic American husband, and child, Akash.  Generational and cultural contrasts are revealed in overt and more subtle ways when her recently widowed father arrives for a short visit. Even though Ruma's complete assimilation into her non-Indian home as well as her on-going worries about her father's loneliness are major considerations, another story thread is spun, one that quietly reveals the father's thoughts about himself and a new relationship made recently during a vacation in Europe. Ruma's assumptions about her father, his loneliness, his possible dependency on her, and the Seattle vacation as a possible signal for relocating to her household turn out to be entirely wrong. 
 
The last three stories follow a boy, Kaushik, and girl, Hema, into adulthood.  In the first story, "Once in a Lifetime," Hema recalls her first memory of Kaushik when he was 9 and she was 6. The occasion was a farewell party for Kaushik's parents who were returning from the United States to live in Calcutta. The mothers, who grew up in Calcutta, but met in Cambridge, Massachusetts had become very close and were saddened by this separation.

Seven years pass before Kaushik‘s parents return to the Boston area and stay with Hema's family. Hema found the now 16-year old young man appealing, but brooding and totally uninterested in her. Even though Hema expected Kaushik to be Indian-like in behavior, he was more Americanized than she was. That the family had flown first-class shocked Hema's conservative family as did their new smoking and moderate drinking habits.

After a long search, and to the relief of Hema's parents, Kaushik's family found a  modern house on the North Shore.  Before they moved to their new home, Kaushik surprised Hema with confidential information-- his family had left India to seek treatment in Boston for his mother's breast cancer.  All medical efforts had been unsuccessful and his mother had only a short time to live.  Hema promised to keep this disclosure secret and grieved for the woman she had come to admire and love.
 
The second story in the link, "Year's End," is narrated by Kaushik.  With the opening line, "I did not attend my father's wedding," readers know that Kaushik‘s mother has died.  His father, in Calcutta for a visit, had married Chitra, a woman with two young daughters, and all would be returning to the North Shore house to live. Most of the chapter recounts the ordeal of the mother‘s dying, Kaushik‘s tremendous sense of loss, and the loneliness experienced by him at Swarthmore College.  No mention is made of Hema by the desolate narrator except to remember he had hated every day spent under her parents' roof, but later had come to think of that time with nostalgia.  

"Going Ashore" brings Hema and Kaushik together in Rome where she has a study grant and a visiting lectureship and he is on vacation from his work as an award-winning photo journalist.  Hema's parents have arranged for her to marry Navin in Calcutta.  Navin has accepted a teaching position at MIT. Until her unexpected reunion with Kaushik and the intense love affair that follows, neither had experienced any real connection with another person.  The story about them in Rome seems to represent an independence from the cultural forces that have shaped their lives, but this independence is short lived.  Ultimately, she is unable to set aside the expectations imposed by her parents.  The consequences of their final separation are more than any reader might imagine.

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In this disturbing work Kahlo paints herself lying on her back in a hospital bed after a miscarriage. The figure in the painting is unclothed, the sheets beneath her are bloody, and a large tear falls from her left eye. The bed frame bears the inscription "Henry Ford Hospital Detroit," but the bed and its sad inhabitant float in an abstract space circled by six images relating to the miscarriage, all tied to blood-red filaments the figure holds in her left hand. The main image is a perfectly-formed male fetus. The others refer to aspects of childbearing.

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A woman is pregnant. She is a nurse married to a physician, Jeff, and they have a young son, Willie. The couple is pregnant with their second child. Long before her due date, the woman--author Susan LaScala--begins experiencing signs of premature labor. Because she is a nurse, because she is married to a doctor who takes call, she doesn't want to over-react or bother her obstetrician unnecessarily. But when vague aches turn into cramps, the author enters, as a patient, the world she had known, until then, only as a caregiver.

It is impossible, in a brief annotation, to describe fully the richness of this memoir. Because the author is a nurse, she brings to the story of the premature birth and survival of her daughter, Sarah, a wonderful double vision: LaScala tells this tale not only as a mother and a patient but also as a clinician able to explain, in simple language, the complex technologies used to sustain the life of her one pound nine ounce baby. The author's rendering of the bells and whistles of neonatal medicine, whether describing the process of intubating a preemie (p. 23) or ultrasounding a baby determined to survive (p. 182-3) are precise and haunting.

Equally compelling (and instructive for caregivers) are the author's candid revelations of how it feels to be a patient. She takes to "grading" the doctors and nurses--an "A" for the staff that lets her see her newborn girl (p. 3), and a "C" for a nurse with "No kind words. No warmth" (p.11). She describes her own bodily sensations in language both lovely and informing: the pushing and tugging she feels during her C-Section is a "quiet violence" (p.21); standing beside her daughter during the ventilator weaning process she feels "a witch's brew of fear and panic mixing and growing inside" (p. 225).

In an introduction, physician Barbara Wolk Stechenberg, describes the "gift" that the author has given by writing this memoir. The author has allowed Dr. Stechenberg, who was part of the team that saved Sarah, "a rare glimpse into two worlds" (p. xii). One was the world of intensive care nurses and how "they truly are the primary caregivers" (p. xii). The other world was that of physicians, who "may feel we are empathic and caring, but we really have no idea of the emotional roller coaster many of our parents are riding" (p. xii).

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This novel begins as it ends - as an interior monologue, a soliloquy only the reader hears. Paula Hook, married 25 years to her husband Mike, who is asleep beside her throughout the entire novel, is reflecting on the discussion she and her husband have decided to have with their fraternal twins on their sixteenth birthday (June 10, 1995), which is the "Tomorrow" of the title. Although the book begins with "tomorrow" yet to come, it ends on "today" around dawn. The twins, Nick and Kate, have no idea that this revelation--that they are the products of artifical insemination (AI), i.e., that Mike is not their biological father--is forthcoming.

Paula Campbell and Mike Hook met casually but experienced love at first sight, despite Mike's making the sexual rounds of Paula's friends and roommates. Mike was initially a biologist but becomes a publisher of popular biological publications. Paula is a director in an art gallery in London. Both gradually become more successful and prosperous, have infertility problems and undergo AI. The discussion with the twins never takes place in the novel, which ends at dawn.

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Dora Rare, the only girl child born in multiple generations of her family is encouraged by her mother to establish a bond with Miss Babineau, an odd isolated midwife, whose wisdom on health matters is much sought after by the local women in their small Nova Scotia community. Gripping and intimate encounters with her neighbours as birthing mothers and as women seeking control over their fertility lead Dora to accept a role as Marie’s successor. When arrogant, young Dr Gilbert Thomas comes to town with his strong ideas about science and birth, he is appalled at the practices of the local women; he also resents the competition. Dora embarks on a difficult marriage herself and seeks temporary refuge in the United States where she witnesses a new kind of independence.

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