Summary:

This strange little tale, set in western Europe, revolves around the shifting relationships among an Irish doctor, a would-be Austrian baron, a circus performer, and the American woman, Robin, who is to become the nemesis of them all. The plot is unfolded in a long series of conversations, many convoluted by their stream-of-consciousness style, rather than in observed action.

The physician (it is never clearly stated that he is a fully trained physician but the point is probably moot, since he assumes the role), the most consistently present and verbal character, is a study in contradictions. He is essentially never portrayed in a classic physician role, but much is made of his profession. This may be explained by the fact that it is his profession that justifies his central position--he knows and is in the confidence of all other characters. The reader follows, by means of the long and complex dialogues, Robin’s systematic destruction of a chain of male and female lovers in what appears to be an obsessive desire for self-destruction.

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An extraordinary phenomenon began to emerge a century or so ago, which, as it proceeded, allowed us a glimpse into what a society would look like when most of its members, rather than a select few, lived to, or more precisely, near, the limit of the human lifespan. Now we are facing the possibility of extending the upper limit of the human lifespan. How we live within this new world will be the result of numerous individual as well as corporate (in its fullest sense--business, professional societies, religious organizations, political bodies) decisions.

Stephen Hall, through compelling and clear writing takes us behind the scenes and into the lives and labs of the researchers and entrepreneurs who are seeking to slow down, stop, or reverse the aging process--those who intend to bring about, if not actual, then practical immortality. Figuring prominently throughout the book are Leonard Hayflick, early pioneering researcher on aging cells, and the charismatic (and former creationist) researcher-entrepreneur, Michael West. Rounding out the narrative are commentaries by noted ethicists and the chronicling of the political responses to these scientific and business developments, especially in regard to stem cell research.

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This poem, written in five sections of free verse, begins with the speaker remembering the old steel bridge he used to drive over on his way to work. He describes how the gaps between the steel beams had given him access to the world beyond the bridge: he had been able to see the river bank and railroad tracks and, most importantly, the people down there, "wild dangerous men" living near the edge of the river.

The poet next describes the new bridge, with its smooth speedy surface and solid concrete sides concealing the view. He then steps back and reflects: "what now?" He compares the engineer making the bridge with his own writing, "diminish[ing] the homeless to a poetic abstraction," and asks where this leaves him. Both bridge and abstraction, he implies, take the life, untidy and dangerous but valuable, out of his experience of crossing the Missouri.

He cannot view the material for his poetry now, unless he were to stop, back up the traffic, and risk his life climbing the walls of the bridge, and even then he does not know what he would say, because the new bridge has made him realize something about himself: "I am partly the leech come to feed, / yet I cannot waver from my groove." As a poet, he needs access to the lives of others, an access he likens to parasitism. But his career, the work to which he is going, requires him to speed on across the bridge without pausing.

He now elaborates on his distance from the world of the homeless people (and, by implication, all the other material for his poetry), saying that he has "safely bled away the guilt, / and pity and compassion," from his involvement or complicity in the meaning of his material, and "channeled it" into the poem. The leech image is now applied to the poem which, once filled with those ambivalent emotions, becomes separate from the poet and attaches itself instead to the reader, who now becomes the one feeding on the "dark spurt of old blood," the horrifying riches of which the speaker has rid himself.

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Miss Armistead is a nurse in the surgical division of a hospital. She is being courted by two men, Dr. Joe Trask, the chief resident, and Dr. Mort Baker, an established and very successful surgeon. Everyone in the division is taking bets on her choice. Most assume she will choose Baker, the wealthier, more powerful doctor.

Then Miss Armistead develops appendicitis and requires emergency surgery. Joe Trask is on duty and has to begin the operation before Baker arrives, but experiences a terrible crisis of confidence, becoming helpless with fear. Baker arrives and completes the operation.

Everyone assumes that this will clinch Baker’s victory, but when Joe tells her how he was unable to operate on her, Miss Armistead takes this inability to see her as just another patient to be proof of the depth of his love for her, and agrees to marry him.

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Nathan was born with a strawberry birthmark on his chest, which both repels and comforts him. Sometimes it is an intricate and unique part of himself that sets him apart from other people and has the power to make him feel special. On the other hand, its very strangeness makes it repulsive to others, especially to women. At his girlfriend’s urging he decides to have the birthmark removed. Despite his doubts, he goes through with the surgery only to realize he has made a big mistake. He blames his girlfriend for his decision.

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The nurse in this O. Henry Prize-winning story is Mary McDonald. She’s been a nurse for over 40 years and understands fully that the new pain she feels is a signal of her cancer’s spread, and for her, the beginning of the end. The remainder of this story is a retrospective of her life as a nurse and most significantly her role in forming a union, thirty years previously, at the local hospital.

Deftly placed between her reminiscences are scenes of her children’s visits to their dying mother, and perhaps as a final legacy to her nursing colleagues, Mary’s attempt to convince Eunice, her caretaker at the nursing home, to unionize the facility.

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The New Medicine and the Old Ethics, in Albert Jonsen’s own words, is a "secular aggadah." Jonsen explains that one Talmud reviewer defined aggadah as "a magical rabbinic mode of thought in which myth, theology, poetry and superstition robustly mingle" (4). The book begins with a personal essay entitled "Watching the Doctor." Jonsen establishes his premise that the moral history of Western medicine is best understood as a paradox between altruism and self-interest, a paradox alive and well entering the 21st Century.

He then takes the reader on his "secular aggadah," blending history, myths, and stories that trace important moral developments in the practice of Western medicine. In "Askelepios as Intensivist," we learn of the early Greek values of competence in shaping medical practice. Through the influence of the Church in the medieval period, Western medicine incorporates the value of compassion through the Biblical Good Samaritan, struggles with problems of justice in the care of the poor, and further elaborates the meaning of benefit.

In "The Nobility of Medicine," Jonsen describes the contribution of Sir William Osler and other knighted medical men of the 19th Century who established the ethics of noblesse oblige in the medical profession. He traces this noble tradition to the medieval Knights Hopitallers of Saint John of Jerusalem, a group of religious who provided hostels for pilgrims to the Holy Land and cared for the sick. With essays on John Locke and Jeremy Bentham, Jonsen brings us to the 20th Century and the play of individual rights and utilitarian values in the moral life of Western medicine.

In the final essays, Jonsen describes the mingling of these traditions as a means to establish a moral frame for Western medicine in our current times where technology and science have achieved and threatened so much. Ethics, he argues, "is disciplined reflection on ambiguity" (130). In the last essay, "Humanities Are the Hormones," Jonsen brings his "secular aggadah" full circle.

He argues that the paradox of altruism and self-interest that runs through the moral history of Western medicine must continually be vitalized and examined through the Humanities. The Humanities are "the chemical messengers that course through the complicated institution of medicine and enable it to respond to the constantly changing scientific, technological, social, and economic environment" (147).

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One morning in the shower Joyce Wadler, "a journalist, forty-four, Jewish, never married," discovers a lump in her left breast. In this brief, bright, and very readable account, Wadler describes what happened next, taking us through medical examination, diagnosis, and successful lumpectomy and chemotherapy.

But this is much more than a simple patient’s story. For one thing, Wadler is an intrepid researcher, and we learn a good deal about breast cancer and the often agonizing therapeutic choices its victims face. For another, she does not separate her medical adventure from the rest of her life, which includes a day job as a writer for People magazine, a book project, a semi-functional relationship, and a Jewish mother.

Finally, Wadler uses her ironic-sardonic sense of humor to great advantage--remarking, for instance, that through her post-diagnosis impulse to live in the present and not worry about her lover’s monogamy, cancer had made her "the dream girl of every uncommitted man in Manhattan"!

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This troubling narrative opens with, "They say you see your whole life pass in review the instant before you die. How would they know? If you die after the instant replay, you aren’t around to tell anyone anything" (120). The narrator, a newborn girl on her way down the garbage chute from the 10th floor of an apartment building, reflects on what might have been had she lived long enough to have experienced life.

The structure of the piece moves the reader from floors ten, nine, into the game of chance played with dice, to "The Floor of Facts." At this juncture, the newspaper account of the newborn dead in the trash is iterated in its cold truths. The narrator laments, "As grateful as I am to have my story made public you should be able to understand why I feel cheated, why the newspaper account is not enough, why I want my voice to be part of the record" (123). The narrator shifts gears and begins to explore what her life might have been had she lived beyond these few hours.

She enters a "Floor of Opinions," where her own beliefs must be voiced and for which there must be room on the "Floor of Facts." She speculates, based on the experiences of her socioeconomic--and possibly racial--situation, whether her death will serve any purpose. On the "Floor Of Wishes" she imagines things she would have likely loved, such as Christmas. From this point, the narrative, in quick and painful anecdotes, draws the reality of the powerlessness, the limitations of love, and the brutality suffered by those in the clutches of urban poverty. Then the narrator enters the garbage compactor at the bottom of the chute, inviting us all to join her "where the heart stops."

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A poem in a patient’s voice. He brings "a minor issue" to the doctor’s attention, something so trivial he ought not mention it. The doctor sees so many more important problems, like John Butler who "had a terrible / case of prostate cancer." He went downhill so quickly, unlike the patient’s mother who "died of old age / the way it should be, just pooped out . . . . " She didn’t have "the big C." In any case, the patient’s problem "probably / isn’t much of anything. Don’t you agree?"

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