Summary:

This book contains 29 short essays by physician-scientist Lewis Thomas, originally published in the early 1970s in The New England Journal of Medicine. The essays center on science, and range in focus from the molecular (e.g., DNA) to the subcellular to the organism to social interactions and all the way up to the search for extra-terrestrial life. Some themes reappear in several essays: science as a grand, engaging enterprise worthy of the brightest minds; communication between organisms creating the intricate dance of the social organism; the relationship of man to both nature and the grand scheme of the universe.

Lewis is fascinated by communication not only at the cellular level, but also at the pheremonal and cerebral level: "Language, once it comes alive, behaves like an active, motile organism" (90). The ant and its colony, as an example of a simultaneous individual and integrated social organism, form a link for Thomas between the enclosed unit of a cell and the complex interactions of a society. Indeed, macro-micro comparisons continue throughout the essays, and even conclude the final essay, "The World's Biggest Membrane," which lauds the atmosphere as protector, filter, and provider: "Taken all in all, the sky is a miraculous achievement. It works, and for what it is designed to accomplish it is as infallible as anything in nature. . . it is far and away the grandest product of collaboration in all of nature" (48).

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This selection of Miroslav Holub's poems is organized around five major topics--genealogy, anthropology, semiology, pathology, and tautology--rather than chronologically. The poems, some of which date back to his first collection in 1958, were translated into English by a number of different persons, but mostly by David Young, who has had a long-term collaboration with Holub.

Holub states his major preoccupation in "Bones," the very first poem in this collection: "We seek / a backbone / that will stay / straight." (p. 13) The search reaches its fullest expression in "Interferon," a long poem about messages, messengers, and interference: "Cells infected by a virus / send signals out . . .

And when a poet dies, deep in the night / a long black bird wakes up in the thicket / and sings for all it's worth." (p.159) The first step in the search is to learn to interpret the signals, and to understand the black bird's song. To do that, one has to ask questions. Yet, in the face of enormous "Suffering," we are drawn to passivity: "But I ask no questions, / no one asks any questions, / because it's all quite useless." (p. 147) How to overcome the inertia and proceed, even in the face of likely failure?

Holub reminds us that even "In the Microscope" we find "cells, fighters / who lay down their lives / for a song." (p. 149) In fact, there may be something worth fighting for, although perhaps we can only see it under extreme circumstances, as in "Crush Syndrome," where a concrete mixer snaps up the hand of a man cleaning it: "The finger bones / said a few things you don't hear very often...In that moment / I realized I had a soul." (p. 174). But perhaps what we call the soul is really just our deep yearning to survive, as in "Heart Transplant": "It's like a model of a battlefield / where Life and Spirit / have been fighting / and both have won." (p. 179)

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The young and upwardly mobile engineer, Joshua Jeavons, is obsessed with finding a solution to the water problems of 19th-century London. He spends almost every spare moment drawing and re-drawing maps of his precious drainage plans destined to save the city from the stench of effluent, which everyone believes is the source of cholera. His boss, Augustus Moynahan, is unimpressed with Joshua's plans, but allows him to continue analyzing sewers and drains. They work in conjunction with a master plan of coercive bureaucrats, led by Edwin Sleak Cunningham and manipulated by private interest.

Joshua has married the boss's daughter, Isobella, who had seemed more than eager to have him over her father's objections; however, she rebuffs all his physical attentions and the marriage is unconsummated. Brimming with sexual need and self-pity, Joshua continues a sporadic liaison with a friendly prostitute, all the while resenting what he decides must be his wife's infidelity.

When Isobella vanishes on the night of a disastrous dinner party, Joshua's fortunes plummet. He is reduced to poverty and shame, as he replaces his first obsession with the quest for his lost spouse--to reclaim her or kill her, he knows not. But his contact with urchins and beggars brings him to discover the real causes of pollution and disease--both environmental and moral.

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Just as the new plague that will eventually become known as AIDS begins to exact its toll on the gay community, William and Terry slide somewhat unintentionally into a committed relationship, complete with a dog. Terry has issues with the modest size of his penis; being "married" absolves him from performance anxiety.

Almost equally furtive, William has inherited polycystic kidney disease from his mother and is on dialysis, with the severe dietary restrictions and merciless thirst that it entails. William professes to Terry that size doesn't matter, but he indulges in elaborate fantasies about Peter Hunter, a well-endowed star of porn magazines; he becomes an obsessive collector of Hunter's work.

Terry and William are insulated by their singular bond from the havoc of AIDS, but William finds himself compelled to hunt the stigmata of that disease in photos of the exposed and hidden portions of Hunter's anatomy. When he realizes that motorbike riders are prone to becoming organ donors, he cultivates a fascination with their behavior and their machines, following them in his car and tracking statistics. Finally, a matched biker kidney is found for William, but the immunosuppressive drugs, which are given to help him tolerate the transplant, make him very ill. He is admitted with opportunistic pneumonia, ironically, to an AIDS ward.

More than once William says, "I went to sleep next to someone I knew and I woke side by side with a stranger," The book closes with a surreal dream-like sequence, as William takes leave of his lover. It could be continued life, readjusted by this brush with mortality toward a bold new freedom. On the other hand, it could be death itself, and the story suddenly becomes the memoir of a ghost.

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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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Martin Nanther is a member of the British House of Lords, having inherited his title from his great-grandfather, Henry. Physician to Queen Victoria, Henry specialized in hemophilia, the disease that Her Majesty was known to have passed to her son, Leopold, and other descendants. While the House of Lords considers a Bill to abolish hereditary peerage and Martin's much younger, second wife is obsessed with becoming pregnant, he escapes into his slow research for a biography of Henry

His patient genealogical investigations uncover deaths in infancy of several young boys in his own family, and Martin soon realizes that hemophilia (rather than the family's legendary tuberculosis) is the cause. Was that irony merely a coincidence? Or was hemophilia in his own lineage the impetus for his grandfather's research and position in life? And why was the disease hushed? Was it possible that his grandfather deliberately sought a bride with the trait in order to investigate it in his own progeny?

Martin soon finds himself wondering if this well-respected, medical man actually committed murder, or was he merely waylaid by unexpected love? Without giving too much away, suffice it to say that the answers prove so surprising and so disturbing, that Martin decides to abandon the biography of his ancestor, even as he learns that his inherited peerage has been revoked and that his next child will soon be born.

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This story of one exceptionally accomplished family's discovery of their past and future relationships with Huntington's Disease (HD) is also the story of how the Wexler family changed the cultural narrative of HD for other families at risk for this genetically-transmitted and currently incurable disease. The HD diagnosis of Leonore Wexler (the author's mother) inspires Milton Wexler, a psychologist, to create a major foundation for HD research, which develops critical mass and influence as Leonore Wexler's condition deteriorates, and after her death. The book interweaves the story of the Wexlers' emotional and other negotiations with HD and the story of their efforts to create an HD community comprised of those with active symptoms of HD, family members, advocates, and researchers.

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Dr. Dymov is an earnest and rather boring young physician, who is preoccupied with his patients and his research. Olga, his wife, craves the excitement and gaiety of the artistic life. She discovers a new lease on romance with Ryabovsky, a colorful landscape artist, who takes her on a cruise on the Volga River. As they spoon under the stars, Olga and her lover make light of her bumptious stay-at-home husband.

After she returns from the cruise, Dymov forgives her infidelity, but in Olga's mind, his forgiveness proves to be another strike against the poor slob, since she just can't stand his complaisant devotion. She runs back to Ryabovsky for a while, until he makes it clear that he is bored with her.

Then one day Dymov develops diphtheria, evidently contracted by "sucking up the mucus through a pipette from a boy with diphtheria. And what for? It was stupid . . . just from folly." Dymov soon becomes delirious, and then dies. Suddenly, Olga is overcome with guilt and grief. Too late, Olga realizes that her husband was a hero.

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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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Henry Moss is a medical geneticist specializing in Hickman syndrome, a fictitious disease resembling progeria. Children with Hickman syndrome experience premature aging and invariably die before the age of twenty. The physician meets Thomas Benhamouda, a teenager who genetically has Hickman syndrome but astonishingly has no physical manifestations of the disease. Dr. Moss identifies a protein that "corrects" Hickman syndrome in the blood of Thomas and proceeds to synthesize it.

Dr. Moss violates medical ethics by administering the experimental enzyme to his favorite Hickman patient, William Durbin, a dying 14-year-old boy. It is a last-ditch effort to save William's life even though the substance has not been tested for safety or efficacy in human beings. Dr. Moss also injects himself with the enzyme. He realizes the tremendous potential the drug has not only in curing Hickman syndrome but also in extending longevity in normal individuals. He is well aware of the great financial rewards he might reap from his discovery.

After a series of injections, William's deteriorating health stabilizes and even improves but he dies in his home. Dr. Moss has failed to save the doomed boy but in the process of breaking the rules and risking his career has learned how to understand and appreciate his own life as well as reconnect with his family.

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