Summary:

Another Dimension is an occasional feature of the journal, Emerging Infectious Diseases, published by The Centers for Disease Control and Prevention (CDC). These essays (and occasionally poems or stories) focus on human and philosophical issues related to medical practice, scientific research, and public health. The intention of this feature is to bring a new perspective to the journal’s coverage of medical science and public health. Some of the essays include a painting or other image that draws attention to the subject matter of the essay.

Managing editor, Polyxeni Potter, with the encouragement of Joseph E. McDade, founding editor of the journal, initiated and is guiding this feature (see also the annotation of Potter: Emerging Infectious Diseases cover art). Since this is a government site, its material is freely available on-line.

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One 1970s summer, Madeleine L'Engle brings her mother to Crosswicks, the rambling country house where the extended family has spent extended vacations for many years. At ninety, the elder Madeleine is suffering from the ravages of the now vanished diagnosis, 'hardening of the arteries.' By times she is frightened, angry, or difficult; at night she cries out or tries to wander. Round-the-clock caregivers help with the strain, while the writer's own children and grandchildren figure in her journal with concern, affection, and wonder.

The presence of the dwindling old lady provokes detailed recollections--direct and indirect memories--of the lives of her mother, grandmother, and great-grandmother, all named Madeleine--bringing the span of this narrative to six generations. Despite the grandmother's slow mental decline, death comes suddenly, while L'Engle is away and her son is left to help.

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In this short volume, Janet Malcolm frames a series of reflections on Chekhov's life and work with her pilgrimage to Chekhov-related sites in Russia and the Ukraine. The book begins with Malcolm's visit to Oreanda, a village on the Crimean coast near Yalta, which is the site where the fictional lovers in Chekhov's story The Lady with the Dog (1899, see annotation) sit quietly and look out at the sea on the morning after their first sexual encounter. While these lovers are fictional, their creator actually spent the last several years of his life as a respiratory cripple living amid the seascapes around Yalta.

The visit to Oreanda occurred near the end of Janet Malcolm's literary journey, but it provides a fulcrum or center of gravity for the book. From there, she constructs a narrative with three interweaving plots. One consists of her reminiscences of the last 10 days or so in St. Petersburg and Moscow, and her visit to Chekhov's estate (now a state museum) in the village of Melikhovo, south of Moscow. A second presents biographical material about Chekhov. Malcolm triangulates and interweaves these two with critical observations about the writer's stories and plays.

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Lance Armstrong, (currently) four time Tour de France cycling champion, is a survivor of metastatic testicular cancer. This book is largely the story of how his life changed from the moment of his diagnosis (October 2, 1996) onwards. He had been a world class cyclist prior to cancer, but his experience with cancer gave him profound insight not only into his life as a cyclist and competitor, but into life itself.

It is this latter insight which he recognizes as ultimately the most important aspect of his cancer experience. Armstrong notes: "Odd as it sounds, I would rather have the title of cancer survivor than winner of the Tour, because of what it has done for me as a human being, a man, a husband, a son, and a father." (p. 259)

Written in a conversational, straightforward tone, the book chronicles Armstrong's childhood in Texas as the son of a strong, loving, supportive, financially struggling, young mother; his beatings at the hands of a step-father; and his early excellence at endurance athletics. Armstrong became a brash powerhouse cyclist and began to enjoy the material rewards of winning while ignoring the onset of symptoms. At the time of diagnosis, the cancer had spread to his abdomen, lungs and brain.

He documents his search for optimal care, sperm banking, lack of health insurance, surgeries, chemotherapy, self-education and interactions with doctors and nurses. Through it all he acknowledges the tremendous support of his mother and friends, as well as sponsors who stuck with him with no assurance that he would survive, let alone race.

Before he was even through the first year, he decided to start a charitable organization, The Lance Armstrong Foundation, dedicated to cancer research and support of cancer survivors. Through this effort he met his future wife, Kristin Richard (Kik), and her love and support helped him through the dark days of emotional soul-searching post-treatment. The book also details her struggles with successful in vitro fertilization (They currently have a son and twin daughters).

Chapter Nine, The Tour, is an in depth look at the 1999 Tour de France which Armstrong won with the help of his US Postal Service teammates, expert coaching, and his will. This race is brutal, dangerous, and as Armstrong notes, both "a contest of purposeless suffering" and "the most gallant athletic endeavor in the world." (p. 215) He details the maneuvering in the peloton, the strategies, the stages and personalities.

The book concludes with reflections on the birth of his son, the anniversary of his cancer diagnosis, the love of his wife, and his need to ride.

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In this chapter (no. 43) from his autobiography, Williams seeks to describe the poetry of medicine, the almost indescribable quality (Williams frequently refers to it as "it" and "the thing") that draws him to his practice. Clearly it is not anything medical-technical. He particularly disparages surgery and the idea that you can cure by merely cutting. Rather, it involves seeing each patient as "material for a work of art"(287), by which he seems to mean a natural showing of strong character or selfhood under pressure of difficulty. In a strong central passage Williams calls medicine "the thing which gained me entrance to these secret gardens of the self"(288).

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This is a memoir of the author's troubled teen years. It begins in 1955 with Toby and his divorced mother driving west from Florida, running from her abusive boyfriend and with the cockeyed scheme of striking it rich in the Utah uranium fields. When that doesn't work out, they go on to the West Coast, where the mother moves around in search of work and fends off that boyfriend and a number of other undesirable suitors. Tragically, she finally marries Dwight, a controlling and abusive man who makes both her and Toby miserable.

Much of the memoir deals with Toby's desperate and often destructive attempts to survive under Dwight's reign of terror. Toby neglects his schoolwork and runs with some bad characters, and toward the end of the book he carries off an astonishing series of falsifications that leads to his being accepted for admission at a prestigious prep school. He doesn't last, and he winds up enlisting in the army, where he strangely feels "a sense of relief and homecoming."

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This memoir is DeBaggio's first-person account of his early experience of Alzheimer's disease and its effect on his life and the life of his family. The book is a collection, in loosely narrative form, of the author's diagnosis of early-onset Alzheimer's; brief excerpts from his journal; excerpts from the medical literature on the disease; and memories from his past that he wants to commit to paper before he can no longer recall them. He documents his struggle simply to write the book, as it becomes more and more difficult to sustain thoughts or find the words to express what he wants to say.

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Christ stopped at Eboli, say the southern Italians, meaning that they are "not Christian," uncivilized, forgotten, and deprived. Physician, writer, and painter, Levi was arrested and 'exiled' from his home in Turin for opposing Fascism during the Abyssinian war (1935). This is the memoir of his life as a political prisoner under house arrest in a malaria-ridden village in Lucania (Basilicata).

The peasants immediately seek his advice for their ailments, but the two local doctors are jealous, as well as incompetent, and they have him stopped. Grinding poverty, illness, superstition, and despair work on each individual in different ways; but the peasants move with the cycle of seasons and religious festivals. The feast of the black Madonna (Chapter 12) and an unforgettable pig castration (Chapter 19) are vividly described. In the 'atmosphere permeated by divinities' (p. 151), the animal, human, and spiritual spheres combine (Chapters 8, 13, 15).

The closing chapters are a political meditation. Deprivation and isolation make the south an irrelevant and different country to the powerful middle class that runs the Fascist party. In return, Fascism finds no supporters here other than corrupt, petty officials. Levi contends that "the State" of any political stripe will never solve the problems of southern Italy until peasants are involved.

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Written by a medical historian who is also a physician, The Breast Cancer Wars narrates how breast cancer diagnostic methods and treatments have developed from the early twentieth century. More significantly, the book describes the debates and controversies that permeated this evolution and the ways in which not only clinicians and researchers, but, increasingly, women patients/activists shaped how we view, diagnose, and treat breast cancer today.

Individual chapters explore the influential (and ultimately contested) radical mastectomy procedure of William Halsted, the development of the "war" against breast cancer as a full-blown campaign developed and conducted within the public media and consciousness of the United States as well as within medical practice and research, the intertwined development of feminism and breast cancer activism, the "fall" of the radical mastectomy, and the continuing controversies surrounding mammography and genetic testing as modes of early detection and risk assessment. Lerner draws on a range of primary sources including texts from the archives of the American Cancer Society, the papers of doctors and patients, and advertisements from popular and professional magazines throughout the century.

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This is an excellent review of the authors' choices of the ten greatest medical discoveries. They arrived at the ten selected after narrowing five thousand or more possibilities down to one hundred and then finally down to ten based on these three components in the field of medicine: 1) structure and function of the human body, 2) diagnosis of medical conditions and 3) treatment of such maladies. Finally the ten selected were approved by four avid and informed physician collectors of rare and important medical publications.

Chronologically, the anatomical observations of Vesalius come first with his publication of the Fabrica in 1543. Harvey's discovery of the circulation of the blood is considered the single most important discovery. Leeuwenhoek gets credit as the founder of bacteriology, but Koch and Pasteur are included in a discussion of this discovery. Jenner gets his just recognition for introducing vaccination and Roentgen for discovering the X-ray beam.

Crawford Long is recognized for the initial use of surgical anesthesia and Fleming for the discovery of penicillin. More unlikely choices are Ross Harrison for tissue culture, Anichkov for the relation of cholesterol to atherosclerosis and Wilkins, rather than Watson and Crick, for the DNA story.

Each chapter describes not only the discovery but also tells the life stories of the chosen "discoverers" and others who contributed to extension and usefulness of the discoveries. The authors conclude that it is not genius so much as curiosity and the ability to conduct methodological investigations that distinguish these men.

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