Summary:

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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Fifteen-year-old Webber hits a young girl, seriously injuring her, while taking a little illegal driving practice with his indulgent grandfather. Webber, himself, is injured, and unlikely to return to the track team he has loved. He has trouble remembering the accident during the first weeks of his recovery, especially since his grandfather has determined to take the blame for the accident. But as memory returns, aided by the bitter insinuations of a classmate who babysits the injured girl, Webber is torn between accepting his grandfather's cover for the sake of a clean record and an unencumbered high school career, and confessing. The technical fact that his grandfather was legally responsible for letting him drive complicates the ambiguity of his dilemma. Ultimately, he makes the decision to confess. The book concludes with his telling his grandfather of his intention--a decision that is sure to be relationally as well as legally consequential.

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In the title poem, Jimmy Santiago Baca says: "To write the story of my soul / I trace the silence and stone / of Black Mesa." This collection of poems carries the reader into the mountains and valleys of northern New Mexico, and to the barrio where the poet and his family live. They are poems full of incident and experience, of the "twenty-eight shotgun pellets" that remain in "my thighs, belly, and groin" from an incident with Felipe in 1988 ("From Violence to Peace"), and the slaughter of a sheep to the tattoo of wild drums ("Matanza to Welcome Spring"), and the tragic story of "El Sapo," the Frog King.

Baca’s characters live close to the land, close to the mountains, and sometimes outside the law ("Tomas Lucero"). These poems witness to the violence and despair of barrio life, but also to its energy and joy. Baca’s hope continues "to evolve with the universe / side by side with its creative catastrophe."

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The movie opens with a shot of a young man stitching up a laceration in his own knee. Another describes how he had to select which of two severed fingers would be re-attached because he could not afford both operations. They are among the millions of Americans without health insurance. But, the narrator says, the movie is not for them; rather it is for the majority of U.S. citizens who do have medical insurance and believe themselves protected.

Through a series of riveting vignettes, for-profit health care is shown to tyrannize the well, ruin the ill, and destroy families. It also erodes the psychological and moral fiber of the people working in the industry. Excursions to England, Canada, France and Cuba are presented in a series of encounters with physicians and patients, none of whom believe that they would be better off in the United States. A French doctor opines that he earns an adequate salary for a good quality of life. Even those seated in a Canadian waiting room profess satisfaction with the care given and understanding about delays. When asked why anyone would accept to pay the expenses of others, an elderly golfer explains patiently that it is what we do for each other in a caring society. Ex-pat Americans gather at a bar to describe their positive experiences with foreign health and maternity care.

Interviews with emotionally distraught people who have worked in the insurance industry reveal the relentless pressure to deny coverage and its reward system that favors those who generate the biggest savings. Special attention is given to Dr. Linda Peeno who testified before Congress in 1996, confessing that she had harmed people for the economic benefit of the insurance industry.

Moore gathers up a group of people whose sorry dilemmas within the U.S. system have left them with serious health problems. He escorts them to Cuba where physicians and nurses are only too pleased to diagnose and treat their illnesses– for free. The movie ends with an exposé of the superior health care given prisoners at Guantanamo and Moore’s stunt at trying to bring the unhappy Americans there for treatment.

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In a future society in which biological reproduction is restricted and humanoid robots ("Mechas") are routinely manufactured to supplement the economic and social needs of humans ("Orgas"), Dr. Hobby (William Hurt) creates a prototype child Mecha, David (Haley Joel Osment), who has "neuronal feedback," the ability to love, and "an inner world of metaphor, self-motivated reasoning," imagination, and dreams. David is given to Henry and Monica, a couple whose biological child Martin is incurably ill and cryopreserved, awaiting a future cure.

More specifically, David is created out of Hobby's own loss and given to aid Monica's mourning for Martin, whom she has been unable to "let go" of as dead. It is thus Monica (Frances O'Connor) who must make the decision to perform the "imprint protocol" that will make David love her. After she stops resisting the desire to love a child (of any kind) again and implements the protocol, Martin is unexpectedly cured and comes home.

The ensuing turmoil sends David, accompanied by a robot Teddy bear, out into a nightmare world of adult Mechas, comprised of both Rouge City, where functioning Mechas like Gigolo Joe (Jude Law) do their sex worker jobs and also the fugitive realm where unregistered, discarded Mechas try to find the spare parts they need to rebuild themselves and elude trappers who take them to reactionary "Flesh Fairs" where they are publicly destroyed as an expression of rage against artificial technologies.

Joe and David, both set up and betrayed by humans jealous of their superiority at performing human functions, join together on a quest to make David "real" and return him to Monica. The quest takes them to a partly submerged Manhattan and sends David and Teddy two thousand years into the future to resolve the dystopic narrative.

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Sophie, who has lived with her aunt in Haiti for the 12 years since her birth is being sent to live with her mother in New York. She leaves her aunt and grandmother amid a riot at the airport, and arrives in New York to meet her mother and her mother's long-term lover. Her mother has frequent nightmares, related, as it turns out, to the rape that eventuated in the birth of Sophie. Sophie's mother insists that the only road out of poverty is to study hard; she wants Sophie to become a doctor, and jealously oversees her work and protects her virginity, frequently testing her to make sure she has not been sexually active.

Eventually Sophie elopes with a kind musician, Joseph, but finds herself unable to enjoy sex. She returns to Haiti with their baby while he is on tour, and finds refuge among the women who raised her, though they themselves suffer various effects of poverty, alcohol, and violence. Sophie's mother flies to Haiti to be reconciled with her and takes her back to New York where the two women and their partners briefly share peace and kindness. But when Sophie's mother finds she is pregnant, she begins to have the nightmares about rape again, and kills herself. Sophie and the mother's lover fly to Haiti for the burial. Sophie runs away from the gravesite into the fields where her mother was raped, and attacks the cane stalks in fury, frustration, and a final cathartic gesture of self-liberation from a painful past.

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Summary: All thirteen short stories in this collection draw readers into the quietly compelling lives of disparate and very ordinary characters who function and suffer in unsettling ways. We are like them and not like them, but their circumstances, while sometimes disturbing, are familiar--and strangely magnetic. The opening lines of "The Lapse" illustrate this power of attraction:

I married Joanne during a lapse. A religious lapse. I don't display my beliefs like a gold medallion, though, as many whom I know do. I prefer to observe in private. After all, any intimate relationship belongs only to the entities or people involved. (p. 35)

Who can bypass an invitation to enter into announced intimacies, however private, that must be revealed in a matter of pages. What lapse and who is Joanne?!

"Bad News," centers around Sheila Powers, a psychologist, whose disruptive marital break-up is compounded by her mother's recent diagnosis of cancer and a subsequent flow of memories about her mother, her father, and herself. She is "between worlds...between life zones." (p. 113) Aspects of the future, at least her mother's, may be somewhat predictable, but the complex depths of the past mix with the present to generate sticky threads that belong to the story and to the readers as well who will recognize bits and pieces of their own family lives.

In a fourteen page story with a decidedly off-putting title, "The Encyclopedia," Wineberg zeroes in on Doris who, after a dissolved relationship, decides to sell the thirty volumes of the Encyclopedia Britannica-"the macro-edition, the micro-edition and the year books" purchased by the former couple. Not about remote bits of history or dinosaurs, we discover, but a story about separation, a series of lovers, benign conversation with a fellow worker who claims to be similarly tired of men, a possible buyer for the unwanted encyclopedia, a relationship with the married buyer, an end to the relationship, and a decision to keep the books after all. Her life, we might decide, is encyclopedic, a litany of minutiae that does, indeed, provide information about conditions of existence.

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This video is the film of the staged one-woman play written and acted by white South African Pamela Gien. The play begins in 1963, in a white suburb of Johannesburg, in the fenced yard of the Grace family and their black servants. Gien starts as six-year-old Lizzie Grace. Gien then fluidly shifts roles to enact twenty-eight different characters from newborn to age eighty-two, black and white, male and female--who talk, gesture, sing and dance in this tour-de-force performance.

The set contains only a large, plain swing; even the berry-bearing syringa tree to which the swing is attached is left to the imagination. Gien’s costume is similarly muted--she is barefoot and wears a beige jumper over a simple tee shirt. A sound system provides music of ethnically diverse origins at appropriate moments.

The play opens with Gien swinging and talking in a girlish voice and using exaggerated childlike gestures. Lizzie exclaims that she is "a very lucky fish": she proceeds to explain to the audience the meaning of her favorable white nailbed spots. Lizzie is, by self-definition, a "hyperactive," outspoken child with great imagination and energy. She is cared for by Salamina, a loving nanny and servant.

Lizzie’s father is Dr. Isaac Grace, who delivers Salamina’s baby in the home. The child, Moliseng, "has no papers" and is harbored illegally by the Grace family--a constant source of worry for all, including Lizzie. Isaac is a Jewish atheist, and Lizzie’s mother, Eugenie, is Catholic and of English descent. Their neighbors, however, are bigoted Afrikaners and create great tension for the Grace household. "Don’t ever make this place your home," advises Dr. Gien to his daughter after dealing with racist clients who do not want to be in the same examining room after a black patient.

Lizzie’s liberal, generous grandfather is brutally murdered by a Rhodesian freedom fighter shortly after the resolution of another crisis: Moliseng, suffering from malnutrition, is missing from the overcrowded hospital. The play then fast forwards through Lizzie’s college years, when Moliseng, at age fourteen, is murdered in youth riots. Lizzie leaves for America, land of the (she pounds her chest) "free and brave." She returns years later, with her infant son named for her grandfather, to visit her father, her demented mother, and, above all, her beloved Salamina.

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Author Diedrich investigates ("treats") mid-late 20th century memoirs about illness (illness narratives) from an interdisciplinary perspective drawing on the disciplines of literature, social sciences, and philosophy. Her analysis uses the theoretical frameworks of poststructuralism, phenomenology, and psychoanalysis to consider "what sort of subject is formed in the practice of writing . . . illness narratives," the kind of knowledges articulated by such writing, whether and how such writing can transform "expert medical knowledges," how language operates in these memoirs, and "what sort of ethics emerges out of such scenes of loss and the attempts to capture them in writing" (viii).

The book is divided into Introduction, five chapters on specific memoirs, and Conclusion. Chapter 1, "Patients and Biopower: Disciplined Bodies, Regularized Populations, and Subjugated Knowledges," draws on Foucault's theory of power to discuss two mid-20th-century memoirs of institutionalization for tuberculosis. Betty McDonald's the Plague and I is compared with Madonna Swan: A Lakota Woman's Story. Dividing practices and regularization are shown to serve different functions in these two incarcerations, figurative in the case of Betty McDonald, and literal in the case of Madonna Swan.

Chapter 2, "Politicizing Patienthood: Ideas, Experience and Affect," draws on Foucault's approach to the subject and on his discussion of "practices of the self" in contrasting Audre Lorde's The Cancer Journals with Susan Sontag's Illness as Metaphor and AIDS and Its Metaphors (see annotations). Diedrich also brings into her analysis Eve Sedgwick's theory of queer performativity and Sedgwick's own illness narrative, White Glasses. Diedrich views all of these as counter narratives to the clinical medical narrative of illness but she shows how they differ in stance.

Chapter 3, "Stories For and against the Self: Breast Cancer Narratives from the United States and Britain" looks at "the arts of being ill" as they are represented in two cultures, two "conceptions of the self in these countries at a particular historical moment" (61). The narratives discussed are Sandra Butler and Barbara Rosenblum's narrative, Cancer in Two Voices and Ruth Picardie's Before I Say Goodbye (see annotations). Diedrich associates Cancer in Two Voices with an American notion of self-improvement and Before I Say Goodbye with a British "emphasis on the cultivation of an ironic self" (55). The author works in this chapter with Freud's idea of the uncanny, Benedict Anderson's concept of "imagined political communities" and Elaine Scarry's discussion of pain, language, and the unmaking of the self.

Chapter 4, "Becoming-Patient: Negotiating Healing, Desire, and Belonging in Doctors' Narratives," treats Oliver Sacks's illness narrative, A Leg to Stand On, Abraham Verghese's autobiographical My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS, and Rafael Campo's book of essays, The Poetry of Healing (see annotations). Here Diedrich considers "the possibility that doctors, especially AIDS doctors, might become patients through desiring-and writing-productions" (83) and she utilizes the rhizome model of Deleuze and Guattari to make her case. She discusses how Verghese and Campo are each both cultural insiders and outsiders and how they each "bring the body into language through their writing" (88).

Chapter 5, "Between Two Deaths: Practices of Witnessing," focuses primarily on Paul Monette's writing about the loss of his partner to AIDS, and on John Oliver Bayley's books about the loss of his wife, Iris Murdoch, to Alzheimer's, and her ultimate death (see annotations in this database). In this chapter Diedrich invokes Lacan's concept of the real and his formulation of "the ethical possibility of being between two deaths" (117). She draws also on trauma theory and the work of Kelly Oliver, a contemporary feminist philosopher who has written on witnessing.

Finally, in her "Conclusion: Toward an Ethics of Failure," Diedrich returns to Elaine Scarry's "phenomenological discussion of the experience of pain" and brings in Jean-François Lyotard's concept of incommensurability and his suggestion between the two poles of what is seemingly incommensurable one might search, in Diedrich's words, for "new rules for forming and linking phrases between . . . subject positions" (150). In that context she analyzes physician Atul Gawande's discussion of medical uncertainty and error in his book, Complications (see annotation) and philosopher Gillian Rose's book, Love' s Work. Diedrich concludes that the basic incommensurability between doctor and patient can be a starting point for a new ethics, an ethics of failure and risk "because by taking such risks [of failure, of relations], we open up the possibility of new routes, new treatments: in and between art, medicine, philosophy, and politics" (166).

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It is 1915. Sasha, only daughter of a renowned English doctor, longs to be a nurse, as her brother, Thomas, longs to be a doctor. Their father is opposed to both objectives: he thinks Thomas should sign up to "do his bit" in the war effort like his older brother, Edgar, rather than go to medical school, and he doesn't think Sasha could handle the gore of wartime medicine. He is also concerned because on a few occasions, Sasha has let slip that she has accurate premonitions of people's deaths. The first of these came when she was five. She has learned since then not to speak of this "gift" to anyone in her family, for fear of losing credibility, but keeps with her a book of Greek myths, in which the story of Cassandra helps her to validate her sense of her own gift/curse.

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