Summary:

Body of Work is a cleverly crafted memoir - or, rather, the first chapter of a memoir - of the author's medical school experience at Brown University School of Medicine in Providence, Rhode Island. Ms Montross relates the chronological course of her team's dissection of a female cadaver with no discernible umbilicus and whom they therefore name Eve. (She neglects to comment on Eve's ribs and whether she has the normal complement or a supernumerary, more masculine, rib.) As she and her team of four (later three as one student drops out of school) proceed with the orderly dismantling of Eve, bone by bone, nerve by nerve and blood vessel by blood vessel, she uses this experience as a springboard to analyze her and her team's emotional reactions to the often unnatural process of deconstructing, literally (at times with a saw), a former person now cadaver, as well as the gradual, almost imperceptible acculturation that transmogrifies medical students into doctors. In fact, she devotes the final pages to this metamorphosis and what it means to the person undergoing the transition from caring student to detached physician, and whether one can retain enough caring, while remaining sufficiently detached to function as one must as a clinician, to become both a whole person and competent physician: "How much of becoming a doctor demands releasing the well-known and well-loved parts of my self?" (page 209)

Although it primarily revolves about the axis of her gross anatomy (cadaver dissection) course, the author's narrative includes tangents that have variably relevant relationships to this course, e.g., a trip to Italy to inspect first hand the anatomy theater of Vesalius in Padua and the Basilica of St. Anthony; another trip to the anatomical wax sculptures museum in Bologna, where the author also observes the "incorrupt corpse of Santa Caterina" in a "small church called Corpus Domini" (pages 223-224); interspersed histories of the traffic of corpses for dissection, including the infamous Burke and Hare story; some flash-forwards to her second and third years; and a prolonged narration of the final illnesses of her grandmother and grandfather. This last bit of family history is worth the price of the book alone. Despite the apparently incongruous collection of such asides, the author makes it work smoothly, if not seamlessly.

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In A Step from Death a profusion of memories radiate from a near-fatal accident on Larry Woiwoide's farm in western North Dakota. Woiwode, a novelist and poet of America's heartland, had just finished baling hay when his denim jacket got caught in the tractor's power take-off, "a geared stub at the rear of the tractor that spins at 500 rpm." (p. 9) Caught in the powerful machine with no one around to hear his cries for help, Woiwode could easily have died, but survived by using his pocket knife to free himself from the jacket.

In a sense A Step from Death takes up where the author's previous memoir, What I Think I Did, leaves off. The earlier book focuses on surviving North Dakota's outrageously bitter winter of 1996-97. The current memoir ranges far and wide over nearly 40 years of Woiwode's life as a writer who chooses a difficult but fulfilling life for himself and his family on the land. The memoir is addressed to Woiwode's only son Joseph (the second of four children), with whom he shares his fatherly failures, as well as the strengths of their relationship. The reader soon learns that accidents were no strangers to their life on the northern plains. Woiwode and his wife and older daughter had survived a serious car accident on an icy road in one of their early Dakota winters. Joseph, too, sustained severe injuries as a child when he fell off a horse and again later in a tractor accident. On another occasion, Joseph and his sisters are responsible for accidentally causing a fire that burned down the family barn.

Now, however, Joseph is a married man, a helicopter pilot, with two children of his own. The recollections and wisdom that his father shares with him (and us) flow freely, creating a free associational, rather than linear, narrative. Woiwode explores the deep network of connections that bind him to the land and his family, as well as to the community of creative writers and especially William Maxwell, his long-time editor at The New Yorker, mentor, and father figure. Woiwode explores as well the strong pull of loss in his life-his parents' deaths and eventually that of Maxwell-but A Step from Death is ultimately a celebration of survival.

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The Glass Castle, a gripping memoir about growing up devastatingly poor in America, opens with this first line: "I was sitting in a taxi, wondering if I had overdressed for the evening, when I looked out the window and saw Mom rooting through a Dumpster." (p. 3) Jeanette Walls slinks down in the taxi's back seat and returns to her Park Avenue apartment. A few days later, she manages to contact her homeless mother and take her out for dinner, offering her help, yet again. But her mother refuses, and when asked what Jeannette is supposed to say about her parents, her mother replies "Just tell the truth...[t]hat's simple enough." (p.5) And with these words, Walls launches into the history of her upbringing, with all the deprivations, suffering, joys, shame, exasperations, tribulations and sorrows - the story of the Rex and Rose Mary Walls' family.

Rex Walls is an alcoholic and dreamer, his wife an artist and egoist; both are psychotically blind to the basic needs of their four children. Yet the parents do feed the children with love and intellectual stimulation, managing to keep the family unit intact while the children figure out how to survive. The reader first meets the child Jeannette at age three when she is on fire, cooking hot dogs on the stove in a trailer park, completely unsupervised. She requires multiple skin grafts but enjoys the regularity of hospital food, until six weeks later her father abducts her from the hospital in the first of a series of "skedaddles" that the reader learns is the way Rex Walls stays ahead of bill collectors and other authorities.

At each miserable turn, the reader wonders if things can get any worse. They do. The family winds up living in a rotting hut without plumbing in the coal mining town of Welch, West Virginia. Rex steals money from his children, Rose Mary buys herself art books instead of food for the family. The kids eat garbage they secretly remove from trash bins at school.

But finally, one by one, the kids do escape, although, like everyone, they carry the past within them. To varying degrees, each is scarred. Nonetheless, Jeannette works her way through Barnard in New York City and becomes a contributor to MSNBC. Ultimately the book is a tribute to the gutsy resilience of some remarkable individuals.

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Cancer Vixen is the graphic narrative of Marisa Acocella Marchetto’s eleven-month cancer experience in 2004. Marchetto, a successful forty-something cartoonist for Glamour magazine and the New Yorker, serialized Cancer Vixen in Glamour while undergoing treatment. As well as the narrative of Marchetto’s diagnosis, treatment, and remission, Cancer Vixen recounts the story of Marchetto’s romance and engagement to restaurateur Silvano Marchetto, a narrative embedded in the graphic novel despite preceding it in actual chronology. The narrative explores fears about the cancer's effect on the relationship and about the loss of the chance to be a biological mother, as well as developing the relationship between the engaged couple and between Marisa and her mother (or "(s)mother," as she calls her).

The culture of cancer is another focus, including the social dynamics of having hair during cancer treatment and thus leaving oneself open to critique for not undertaking a strong enough chemotherapy. While this New York story, full of cuisine, couture (including images of the specific shoes Marchetto wore to each chemo), and cappuccino may recall the episodes of the television show Sex in the City featuring cancer, the brightly colored frames of this “Cancer in the City” tale also engage political issues like environmental causes of cancer and the reduced survival rates of women with cancer and no insurance.

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This book chronicles a tortured parenthood during the birth and brief life of a severely brain-damaged female infant, Silvie. Doctors predict that the child will live only a few days but instead she survives for seven months. The story is told in first person by the mother, beginning with her arduous labor during a home delivery in the presence of an experienced midwife and the family physician. The baby does not cry when she is born and turns blue even with oxygen that the doctor administers. An ambulance is summoned; "a bigger, better oxygen machine" restores the baby's color and she is brought to a hospital neonatal intensive care unit where she is artificially ventilated and fed.

In the hospital Silvie "fails" all the tests of normalcy. The doctors recommend removing artificial ventilation. "I feared, even more than I feared her death I think (and harder to admit), that they would remove the oxygen pump and the baby would live on and on and never be able to do anything at all" (14). Yet when the child does in fact breathe independently, "I took the fact that she could sustain her own breathing to mean that the baby wanted to live. It was all right to love her" (15). A few days later, however, the medical team concludes that there is nothing further they can do for the baby, that the parents should take the child home, where she will likely die within a couple of days. Upon being prodded, one physician suggests the parents give her an overdose of phenobarbital, which she is receiving for continual epileptic seizures.

At home, the parents feed Silvie by tube, medicate her, change her diapers, hold her, and learn from a friend how to swaddle her. The child never cries, does not focus her eyes on anything, rarely responds to sound or touch, and gains no weight. Whatever random responsiveness there seems to be gives the author a sense of motherhood: "I was able to survive because of my faith in these intermittent chance meetings, believing that Silvie did know when I was here and that I was holding her close in a way that meant love" (37). The parents brace themselves for Silvie's death. The husband's sister visits and councils them to actively put an end to Silvie's life, which they refuse to do. But they do not plan to take extra measures (CPR) if Silvie seems to be dying at home and when they articulate this to a social worker whom they consult to obtain respite care, it becomes clear that she would report them to Child Protective Services.

The husband quits his job as a residential counselor of emotionally disturbed teenagers to do part-time carpentry work -- he is too preoccupied to care about other people's problems. When a friend accidentally breaks the phenobarbital bottle, the parents together with the family physician decide to see how Silvie will get along without the drug. To their amazement, the baby appears slightly more alert and is able to suck from a bottle -- no more feeding tube required. But the husband reminds his wife, "The doctors warned us she might do this. This is the one and only thing she can ever learn. They said when this happened to other parents they started to believe that the baby was getting better" (59).

The parents live in limbo, attempt to live a "normal" life. When Silvie starts to lose weight at age 4 months, the doctor advises to resume tube feeding; they don't see the point, but when hospital physicians use the word, "murder," and threaten to "take over" Silvie's care, the parents relent. The baby lives but "it was the sameness of Silvie that drove you crazy . . . She slept and woke, but was awake that much different? She did not change, she did not change. Her sameness was a stone I wore, an emblem of failure, failed life" (96).

The final act for Silvie begins when the author's mother-in-law is dying of cancer in New York and a decision is made to leave the baby at home in California for several days in the care of a retired nurse. The nurse has been shown how to do the tube feeding, but while the parents are in New York she experiments with spoon feeding, then discontinues tube feeding for three days before the parents return. The parents see that Silvie has deteriorated in their absence and resume tube feeding. For the remaining couple of months the parents wait, investigate institutionalizing Silvie, and finally determine that "the way we loved Silvie meant we loved her enough to let her die" at home, with "a certain amount of fluid and nourishment for comfort, but a gradual withdrawal of excessive food. Replaced with a lot of touching and holding, stroking and whispering" (122). Silvie dies and the author is four months pregnant with the baby she and her husband have decided not to abort.

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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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A brooding book that sounds the death knell for optimistic views on humanity's progress through civilization, Civilization and its Discontents begins with a recapitulation of Freud's disdainful views on religion as a psychological salve and then goes on to challenge enduring platitudes about human society: that civilization has emerged as a simple marker of progress of mankind over nature, protects us against suffering, and guards our liberties and happinesses. Comparing the development of civilization to the development of individual psychologies, he sees in both an essential conflict between eros and thanatos, between the desire to be with other people and the violence committed (or wished upon) other people.

Given that civilization is a process of negotiating and structuring communities, it must also be a way of controlling and repressing both violent and libidinous instincts; it does so not only through its laws but by infiltrating our own psychologies, which Freud discusses through the filter of his structural theory (where the instinctual, unconscious drives of the id are reined in by the ego under the fierce supervision of the inwardly aggressive superego). Freud's psychological perspective is to try to make sense of individual guilt, conscience, and remorse in the broadest social context as the products of this compromise between eros and thanatos, between the individual and the group, and between satisfying one's own instinctual drives and a broader community's needs. While some of his views are redolent of turn-of-the-century anthropology, his focus on guilt, aggression, and the murderous instincts towards extermination are very much prescient, charting the next decade and a half's fall into civilization's darkest hour.

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This book chronicles four meals, tracked from the production of the food through to the preparation and consumption of the meals themselves. The first is a fast food meal eaten in the car, the quintessential American meal consisting entirely of industrially farmed produce. Pollan then goes on to have an industrial-organic meal, an organic pasture-grown meal, and finally a meal containing only products that he foraged, hunted, and cultivated himself. Throughout, he looks closely at how economic and commercial values have supplanted ecological ones in the cultivation and production of the food we ingest. In addition to attending to the social and political dimensions of the American diet, Pollan also notes the effects of this diet on public health, from rising levels of obesity through to the antibiotic resistances developing in herds of cattle living in pens in their own manure.

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The book is split into three parts, the Analytic Part, the Synthetic Part and the Theoretical Part. The Analytic Part begins with an excellent synopsis of earlier theories of comedy, joking and wit, followed by a meticulous psychological taxonomy of jokes based on such features as wordplay, brevity, and double meanings, richly illustrated with examples. This section ends with Freud's famous distinction about the "tendencies" of a joke, in which he attempts to separate those jokes that have tendencies towards hidden meanings or with a specific hidden or partly hidden purpose, from the "abstract" or "non-tendentious" jokes, which are completely innocuous. He struggles to provide any examples of the latter. In the midst of his first example, he suddenly admits that he begins "to doubt whether I am right in claiming that this is an un-tendentious joke"(89) and his next example is a joke that he claims is non-tendentious, but which he elsewhere studies quite intensely for its tendencies. Freud uses this to springboard into an exploration of how a joke involves an arrangement of people - a joketeller, an audience/listener, and a butt, often involving two (the jokester and the listener) against one, who is often a scapegoat. He describes how jokes may be sexual, "stripping" that person, and then turns towards how jokes package hostility or cynicism.

The synthetic part is an attempt to bring together the structure of the joke and the pleasurable tendencies of the joke. Why is it that jokes are pleasurable? Freud's answer is that there is a pleasure to be obtained from the saving of psychic energy: dangerous feelings of hostility, aggression, cynicism or sexuality are expressed, bypassing the internal and external censors, and thus enjoyed. He considers other possible sources of pleasure, including recognition, remembering, appreciating topicality, relief from tension, and the pleasures of nonsense and of play. Then, in a move that would either baffle his critics or is ignored by them, Freud turns to jokes as a "social process", recognizing that jokes may say more about social life at a particular time than about particular people; he turns this into an investigation of why people joke together, expanding on his economical psychic perspectives with discussions of social cohesion and social aggression.

In the third part, Freud connects his theories of joking with his dream theories in order to explain some of the more baffling aspects of joking (including how jokes seem to come from nowhere; how we usually get the joke so very quickly, even when it expresses very complicated social phenomena; and why we get a particular type of pleasure from an act of communication). He ends with an examination of some of these themes in other varieties of the comic, such as physical comedy and caricature.

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Sandeep Jauhar, M.D., Ph.D. is currently director of the Heart Failure Program at Long Island Jewish Medical Center in New York. Thus, one can assume that he is an accomplished cardiologist and administrator. It was not always so. This memoir flashes back to 10-15 years earlier when the author was casting about for a career, finally settling on medicine almost by default; it follows him to medical school (at Washington University in St. Louis) and then centers on his first year of residency training at Cornell's New York Hospital in Manhattan -- the internship year.

We learn in the introduction to the book that the author will speak freely of self-doubt about career choice, constant anxiety and feelings of inadequacy, exhaustion, and disillusionment. Which indeed he does. But Jauhar first discusses his family background: born in India and emigrating with his family to the USA at age 8; father holding a Ph.D. in plant genetics, now writing academic textbooks and still regretting that he had not been able to afford his dream of becoming a doctor; mother helping to support the family as a lab technician; older brother, Rajiv, a mentor and competitor, charming, self-assured, and unquestioningly headed for a medical career; sister, Suneeta. Sandeep (the author) undertakes graduate work in theoretical physics but as he nears completion of his doctoral degree, realizes that he probably does not have what it takes to be successful in the field. When his girlfriend, Lisa, becomes seriously ill, he begins to (re)consider medicine as a career. Against the advice of his parents who are now convinced he is a dilettante, he applies to medical school and is accepted.

Disillusionment began during the first two years of medical school: "In graduate school I had never learned to memorize . . . But now I couldn't rely on logic and reasoning; I had to commit huge swaths of material to memory" (32). He considered quitting to become a journalist, a profession that had always intrigued him, but which had been discouraged: "my father made it clear that journalism and writing were never to be considered career options because they offered no security" (33). Yet, amazingly, he was awarded a summer fellowship just before starting medical school that placed him in the Washington, DC office of Time magazine; the contacts he made then allowed him to work as a student reporter for the St. Louis Post-Dispatch during medical school and led ultimately to his ongoing and current position as a contributing medical essayist for the New York Times.

Internship for Jauhar unfolds as a series of anxiety-provoking encounters with patients and humiliating encounters with his physician superiors. Feeling inept and inadequate, he stumbles along and worries that he is harming patients. There is too much to keep track of, too many "little things that I find burdensome" (91). "Having so much to do was bad enough, but not knowing why you were doing what you were doing was terrifying . . . Patients were needy, their demands overwhelming . . . Everyone seemed to know how the place worked except me . . . The ecology on the wards was hostile; interactions were hard-bitten, fast paced" (112-113). He is in constant doubt and conflict about his career choice. Even his private life is affected -- his girlfriend Sonia, still a medical student, comes from a medical family, is strongly motivated and secure in her career choice, which aggravates his own sense of insecurity. (Reader, he married her.)

Midway through internship Jauhar suffers a herniated disk. He tries to tough it out without taking time off but his stint as "night float" at Memorial Sloan-Kettering hospital, which specializes in treating cancer patients, proves too difficult-- up all night trying to tend to the severely ill and "taking care of patients about whom you knew next to nothing" (154). He takes a brief leave followed by a reduced schedule. He recognizes that his problems are emotional as well as physical -- he is depressed. But gradually, as his neck problem improves, as he recognizes that medical professionals are actually able to help patients feel better -- his neurologist and physical therapist had "provided hope and comfort to me at a vulnerable time" (181)--, as he makes a house call to a dying patient, as his essays are published in the New York Times, and as the season moves to Spring, his depression lifts and he looks forward to his work.

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