Summary:

A screening chest X-ray reveals the presence of a cardiac myxoma in a 72-year-old dictator. His personal physician (fearing for his own life) timidly informs Mr. President about the tumor and the likelihood that it will claim the dictator's life in a matter of months. The physician lacks the training and ability to remove the tumor but recommends Dr. Gala Sampras as the surgeon most qualified to perform the procedure.

Slight problem: Sampras was one of 14 surgeons who "disappeared" in 1992 after criticizing the dictator and his regime. She was imprisoned and abused in a labor camp. Her husband and three children were also removed from society. A bargain is struck. Sampras will do the operation. After the surgery is done, she will be reunited with her family.

The dictator shows Sampras pictures of her family. Although the photos of her children appear to be recent, the picture of her husband seems to have been taken years ago. On the day of surgery, the dictator directs the doctor's attention to the courtyard where soldiers surround her daughter. Sampras realizes the dictator might not survive the operation given the complexity of the procedure and the patient's age. Before succumbing to his anesthesia-induced sleep, the dictator is told by Sampras not to worry, but her every move is closely monitored by his soldiers. The night is likely to be long and hard for the doctor and the dictator.

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While riding his bicycle, Paul Rayment, a 60-year-old Australian photographer, is struck by a car. He winds up in the hospital, has a leg amputated, and returns to his quarters to contemplate his future and deal with a series of nurses sent by the hospital social worker. Paul is divorced and has no living family.

His future looks bleak, and none of the nurses is satisfactory until the appearance of Marijana, a middle-aged Croatian woman with a young daughter, a teenage son, and a husband. The narrator gradually falls in love with Marijana, but by degrees his lust sublimates into an intense devotion to helping her son Drago survive his motorcycle phase and achieve his educational and professional objectives.

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Atul Gawande, a surgical resident at Harvard Medical School, asks in his well written essay, "when you see your patient making a grave mistake, should you simply do what the patient wants?" (p. 86) He answers this question by sharing a number of cases from his training that suggest that the orthodoxy of 'absolute respect for patient autonomy' may interfere with good patient care.

Gawande also gives the reader insight into the difficulties that young residents especially have in developing an artful approach to medical practice. He suggests that part of respecting autonomy is (at appropriate times) allowing patients to cede that autonomy to an authority figure. He argues further that, "patients frequently don't want the freedom that we've given them." (p. 89)

He also shares in his essay a personal experience with his youngest child. She was a premature baby who at eleven days old ended up in the intensive care unit. He was glad to put the ultimate decision(s) of how to care for his daughter in the hands of physicians--"they could live with the consequences, good or bad." (p. 90)

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A neurosurgeon looks forward to having a day off from work, but a promising Saturday brings only trouble. Henry Perowne is 48 years old and practices in London. Lately, he's concerned about the impending invasion of Iraq. Perowne's views on the situation have changed considerably after conversations with a patient who was tortured and imprisoned in Iraq for no apparent reason. A protest march against the looming war is held on Saturday.

On his way to play a game of squash that morning, Perowne is involved in a car accident on an otherwise deserted street. No one is injured and the two vehicles sustain only minor damage. The owner of the other car is a man in his twenties named Baxter. He is accompanied by two buddies. Perowne refuses Baxter's demand for cash to repair the car so Baxter punches the doctor. Perowne is moments away from a pummeling.

He notices that Baxter has a tremor and an inability to perform saccades. Perowne deduces that Baxter has Huntington's disease. The doctor capitalizes on the fortuitous diagnosis. He speculates that Baxter has kept the neurodegenerative disorder a secret from his sidekicks. When Perowne initiates a discussion about the illness, Baxter orders the cronies away so that he can speak privately to the doctor. The two men desert Baxter, and Perowne escapes in his car, hopeful he can still make the squash game.

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Subtitled "What happens when patients find out how good their doctors really are," this article starts with an important statement: "Every illness is a story, and Annie Page's began with the kinds of small unexceptional details that mean nothing until seen in hindsight."

This is the introduction to a look at a child with cystic fibrosis and how her family sought the best care for her.

The author, Dr. Atul Gawande, goes on not only to tell their story but also the story of the way in which the understanding of this disorder has increased and the unusual rigor with which centers that specialize in the disease are evaluated.

He also includes stories of other sufferers to emphasize the importance of surveillance of their care.

These stories allow him to generalize about the way physicians' care is evaluated in general by the public and our medical organizations and how difficult it is to be at the high end of the Bell Curve. The author concludes, "When the stakes are our lives and the lives of our children, we expect averageness to be resisted."

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The middle-aged narrator is caught in the maelstrom of tending to her father, who is dying of cancer; coping with her demented mother; mediating between her parents, for whom "[S]ixty years of marriage had only heated the furious war between them"; and dealing with her own grief. This glimpse of an increasingly common family dilemma is superbly rendered.

Although it is narrated in the first-person, the narrator is never intrusive as she allows the situation to unfold through dialog and unadorned description. The mother's dementia lends the story its bizarrely humorous moments, as well as its poignancy. This little "memoir" of a complex family dynamic is written with skill, insight, and a light touch.

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This is the last published entry in the journal kept by author Harold Brodkey, before he died of AIDS on January 26, 1996. Brodkey, ever the flamboyant writer, began a record of his diagnosis with AIDS and "my passage into nonexistence" in the pages of The New Yorker (see also earlier journal entry, Dying: An Update, annotated in this database).

In this last entry he focuses intensely on the end of consciousness that looms ahead. In spare poetic phrases he describes what he is attempting to grasp-- " . . . this wild darkness, which is not only unknown but which one cannot enter as oneself." He reflects also on memory, medication, creature comforts, family history, the legacy he leaves, and describes with amazement that he feels happy.

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This two-page story is a tour de force. A jaded book critic, known to us only as Anders, is standing on a long line at the bank. He engages in sarcastic, belittling repartee with the women on line ahead of him. Suddenly two ski-masked bank robbers--one with a sawed-off shotgun--appear and threaten everyone.

Anders can't keep his acid tongue quiet. He seems incapable of recognizing the real danger and instead keeps up a commentary, like a cynical uninvolved reviewer. He explodes with laughter--and is shot in the head. "Once in the brain . . . the bullet came under the mediation of brain time . . . ." "It is worth noting what Anders did not remember, given what he did remember."

The remainder of the story is a list of incidents that the victim does NOT remember, during the seconds while he is dying, followed by what he does recall. The bullet, "in the end . . . will do its work and leave the troubled skull behind, dragging its comet's tail of memory and hope and talent and love . . . . "

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Half-waking from surgical anesthesia, a woman named Mary realizes that she has had a breast removed. She immediately begins to imagine how this will affect her already troubled marriage. When she is fully awake, other women on the ward try to comfort her, each with a strategy for bearing up under suffering which Mary finds unacceptable because these strategies represent values about marriage, submissive gender roles, or religion which Mary cannot quite swallow.

Later, talking with her brusque surgeon and her family doctor, Mary learns that the mastectomy may not have been necessary, that the tumor was benign. At the end of the story, husband Matt hustles in to ask: "Well, baby, are you still going to divorce me?"

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A chance meeting with her former and most compassionate fertility doctor brought Wendy Wasserstein (at age 48, and after 8 years of effort) back to his fertility clinic. Two weeks later she got the news that she was pregnant, and six months after that, just as she was getting ready to tell her friends "that the twenty pounds I had gained were not the result of bad habits and anxiety," she developed preeclampsia and was hospitalized.

What follows in this ’Annals of Motherhood’ memoir is an account of her hospitalization; her subsequent delivery 16 days later of 1lb., 12oz. daughter, Lucy Jane (Lucy’s waving hand sonogram picture reminded Wasserstein of "Lucy in the Sky With Diamonds"); and her separation from Lucy, who spent two months in the neonatal intensive care unit.

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