Summary:

Steinbeck begins Tortilla Flat with a tidy summary of what is to follow: "This is the story of Danny and of Danny's friends and of Danny's house." Returning from service in World War I (for which he had drunkenly signed up, subsequently spending the duration of the war driving mules in Texas), Danny discovers that he has inherited two houses from his deceased viejo. He reunites with his friends, who gradually accumulate in his houses, bringing with them parties, disasters, and holy visions.

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Looking back on his first year of medical practice in an out-of-the-way section of Russia, a 25 year old physician reflects on how much he has changed both personally and professionally. He lists the year's accomplishments: performing a tracheostomy, successful intubations, amputations, many obstetrical deliveries, and setting several fractures and dislocations. With pride, the doctor calculates he has seen 15,613 patients in his first twelve months of practice.

He recalls some poignant moments. A pregnant woman has a baby while lying in the grass near a stream. The doctor pulls a soldier's carious tooth but is horrified when a piece of bone is attached to it. During a delivery, he inadvertently fractures a baby's arm and the infant is born dead.

Basking in his year's worth of experience and newfound clinical confidence, the physician quickly comprehends the limits of his knowledge on the first day of his second year in practice when a mother brings her baby to the doctor. The infant's left eye appears to be missing. In its place sits an egg-like nodule. Unsure of the diagnosis and worried about the possibility of a tumor, the physician recommends cutting the nodule out. The mother refuses. One week later she returns with her child whose left eye is now normal in appearance. The doctor deduces that the boy had an abscess of the eyelid that had spontaneously ruptured.

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Kirk, a man in his 50s with highly metastasized kidney cancer, presents himself to Dr. Groopman after having been turned away as a helpless case by several respected cancer clinics. He tells Groopman that he is a risk-taking venture capitalist and is willing to take any medical risk on the chance that it will save him. After pondering the ethics of the situation and the nature of informed consent under such conditions, Groopman agrees to treat Kirk. He proceeds to devise a highly risky (and untried) combination of chemotherapeutic agents. The course of treatment is excruciatingly difficult, but the experiment succeeds, and Kirk's cancer goes into complete remission.

Kirk calls it magic, a miracle, and the hospital interns call it a "fascinoma," a case defying normal expectations. Groopman releases Kirk to home and weekly checkups with a local internist, but in doing so he notices that Kirk's mood has mysteriously changed. He has lost the "piss and vinegar" of their earlier contact. Kirk continues to improve physically, traveling and playing golf and even tennis, but Kirk's wife soon reports that Kirk has stopped reading the newspapers he used to devour, which now collect in their driveway.

Several months later some physical symptoms return, and Kirk's cancer is back. A month later he is dead. In talks with Kirk near the end, Groopman discovers that Kirk's brush with death had brought with it a new and sharply negative view of himself as selfish and disconnected from the world and other people. Suddenly all his financial success seemed to him "pointless," and, since his life contained nothing else, it seemed to him a waste, and he felt it was too late to live it over. What Kirk ironically calls "my great epiphany" seems to have undone his doctor's "magic."

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When faced with breast cancer and chemotherapy, Catherine Lord chronicles her illness in a literary performance piece by adopting the online persona of Her Baldness--a testy, witty, passionate presence who speaks forthrightly about her fears to a highly selective listserv audience of friends, family, and colleagues. The fragmented, multifaceted format of this autobiographical text includes photos, lists, e-mail narrations of her illness, responses from friends, plus the quick-tempered, no-holds-barred ruminations of Her Baldness on what cancer, chemotherapy, and baldness have meant in her life.

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A husband and wife in Ireland struggle to make ends meet. Corry and Nuala, each 31 years old, have 3 children. Corry works at the joinery. He also carves religious statues on the side. A wealthy English woman is impressed by his artwork and encourages Corry to pursue his craft fulltime. His talent is undeniable, but there is no market for his wooden statues.

Now Nuala is pregnant and Corry is without a job. The English woman's wealth has vanished, and she can no longer help the couple financially. Nuala offers to sell her unborn baby to an infertile couple, Mr. and Mrs. Rynne, who long for a child of their own. Mrs. Rynne is shocked by Nuala's proposition and rejects it. Corry turns down work as an apprentice tombstone engraver but accepts a job working on the roads.

Nuala is angry about the way events have unfolded. She finds solace, however, in the concrete shed that functions as her husband's workshop. As she views the wooden figures of saints, Madonnas, and the Stations of the Cross created by her husband, Nuala concludes, "The world, not she, had failed" (152).

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The physician-narrator celebrates his 24th birthday in the company of two midwives and a feldsher (physician’s assistant). They toil in a remote area of Russia where conditions are harsh. The doctor tells the group about a peasant woman who requested a refill of belladonna (an atropine-like drug) that was prescribed for stomach pain the day before. Although the instructions were to take five drops as needed, the bottle was completely empty already. Since the woman had no signs of belladonna poisoning, the feldsher concludes she shared it or maybe even sold it to other villagers.

The group shares other stories about patient mistakes and misguided beliefs. That same night a man comes to the doctor’s house. He is a miller suffering from recurrent fevers. The physician diagnoses malaria and remarks how sensible and literate the patient is. Powdered quinine is prescribed to be taken once a day before the onset of fever. Soon the doctor receives word the miller is dying. The patient has defied the instructions and taken all 10 doses of quinine at one time to expedite his recovery. His stomach is pumped, and he survives the overdose.

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The narrator is an inexperienced and overworked doctor in a remote region of Russia. Although accustomed to seeing as many as a hundred or more patients in a day, a blizzard brings him unexpected relief. Only two patients show up in the clinic. He welcomes the prospect of a leisurely day but soon receives a summons for help from a physician in a nearby district.

A bride-to-be has fallen out of a sleigh and is unconscious. The narrator travels more than 2 hours to lend his help, but she is already dying. He later realizes the young woman had a fracture at the base of the skull. Ignoring advice to stay the night, the doctor insists on returning home. Four hours after departing in a sleigh, the doctor and driver are lost and trapped in the snow. With great effort, the two men free the sleigh and horses from the drifts.

As their journey resumes, wolves chase the sleigh until the doctor fires his pistol. Finally, he sees the lights of his hospital in the distance. Once safe in his house, the doctor picks up a manual containing information about skull fractures but decides instead to go to sleep.

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In the Foreword to this collection, poet John Graham-Pole writes, "Children have uncovered for me the last and greatest lesson: souls thriving on failing at bigger and bigger things" (xvii). The heroes of these poems are just such children, transformed by serious illness. For example, Dominic in "Waiting" who "rests on his airbubble cot / awaiting life’s flight from its earthly beat" (10); Ruby in "Ruby Red": "And so poor Ruby meets her final test, in gentle hemolysis rolled to res" (35); the lovely young woman in "Elegy": "You’re newly dead, sans wig, / seventeen year old virgin whom / I’d loved." (57).

"I try through writing poems to lay a finger on the purpose of illness, on its pulse .  . Poems turn denial and withdrawal into compassion--feeling with. They turn fear into mercy--thank you" (xvii). The poet’s eye remains dispassionate, even though his heart may be breaking, as in "Last Rites" (32), in which a dead toddler’s father and his companion "sluice down the flooring with their hoses. After the vomit and blood the water runs clear." He understands the limits of communication about loss, but recognizes, too, that we must make the attempt; and the attempt has meaning in itself: "Afterward the circles of our talk / snap . . . - Within, we write our / separate texts of it. Between, the tension / stands: this no talk could break." ("Circles," p. 87)

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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 novel takes place in the eponymous Cannery Row, a place made up of 'junk heaps, sardine canneries of corrugated iron, honky tonks, restaurants and whore houses, and little crowded groceries, and laboratories and flophouses' (1). Although there is a narrative trajectory--the desire of Mack and the other boys living at the Palace Flophouse to throw a party for their friend and benefactor, Doc--the plot of this novel is really that plot of land Steinbeck describes so well.

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