Summary:

In this rich opening chapter of his work on the Nazi doctors, Lifton lays out the groundwork for answering the question of how German doctors became the agents of Hitler’s vision of the purified Aryan race, sterilizing involuntarily several hundred thousand citizens with a variety of mental and physical deficiencies. His answer, in brief: a romanticized genetics coupled with total political control.

Amazingly, the Nazi medical atrocities were carried out not against the opposition of Germany’s medical establishment, but with its approval. (Of course, there were individual dissenters, the more vocal of whom were removed from positions of authority or put to death). Nazi leaders worked hard to convert medical people to the official position. This was accomplished partly by force, but also partly by metaphor, as the normal language of medicine was used to hide the unethical nature of what doctors were being asked to do.

Individual patients were replaced by the racial term "Volk," meaning the (Aryan) people, and their rights were superceded by their doctors’ new duty to assure the health of this collective political idea. According to Nazi publicity, the Aryan race was in grave danger of "Volkstod," of dying out, because its genetic pool had been contaminated both by the transmission of inherited genetic defects and by the "foreign invasion" of Jews and their intermingling with members of the "superior" Aryan race.

To save their new patient, German doctors were expected to carry out the sterilizations, medical experiments, and, later, the euthanasia required by Nazi doctrine, which, in the words of one Nazi writer, declared that "misery can only be removed from the world by painless extermination of the miserable." Doctors were urged not to worry about ethical issues, because Nazi medicine was "nothing but applied biology."

In these ways, says Lifton, Hitler’s racial policies were ’medicalized’ and their evil made less obvious. Those who went along were billed as the "saviors of mankind," the "alert biological soldiers" whose actions would restore the purity of the Aryan race. Jewish doctors were not invited, of course, their research having been officially discredited in the mid-1930s, Lifton tells us, and their medical licenses revoked in 1939--in spite of the fact that they made up half the doctors in some large cities.

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Described as an autobiographical novel, this book is narrated in the first person and reads like a memoir. But it is a "memoir" charged with atmosphere, imagery, and longing. The narrator is an American woman, a mother of three children, and the wife of an academic. After an absence of 17 years she has returned to Niger--the country in northwestern Africa where she had lived with her three small children and husband, while the latter was completing his doctoral dissertation. Now she is visiting her oldest child, Zara, who has been living for the past two years in Niger, and working in a medical clinic.

As the narrator reacquaints herself with the culture and climate of the country, she re-visits--in memory--young motherhood, her relationship with the six-year-old Zara, and her interactions with the people and surroundings. The novel shifts back and forth between the past and the present Niger while the narrator attempts to integrate her experiences: she sees the country and her daughter through new eyes.

She is overwhelmed with guilt about what she calls her "inattention" (17 years ago) to the lives of the Nigerans around her; guilt about her failure to learn the native language; guilt toward her children, for her own self absorption. "After all, what was I doing the year we lived in Zinder [the city where they had lived]? That is the question that looms between Zara and me . . . Of what was I thinking? It is not enough to say that instead of working in a clinic [as Zara now does] I was spending my days with Lizzie and Tulu and herself. That doesn't answer it. All of Zinder waited beyond the gate." (71)

The narrator watches with admiration and envy as Zara interacts comfortably, even intimately, with the native women and their children, speaks the language fluently, and negotiates her way with self assurance in this foreign land. Not only does the narrator feel inept, she feels that she has "lost Zara to a world in which I am entirely a stranger." (73) Thus cultural dislocation becomes the trigger for intense reflections on the nature of parenthood, and the female experience of marriage, pregnancy, motherhood, and aging. These reflections are magnified by the narrator's loss of her own mother, who has recently died.

The native women that she meets through Zara help her to understand that some of these experiences transcend cultures, even though their surface manifestations may differ. For example, the often hyper-critical attitude toward first born children, and the refusal of native parents to even utter the name of the first born child relates to the shame associated with this evidence that the mother has lost her virginity. "Shame is the right word, exactly," thinks the narrator, "and I wonder now that I have not stumbled on this knowledge before." (77) But more than the "thorough and irrevocable . . . violation of the space around one's skin" it is the associated separation from the mother that the narrator recognizes as being at the core of sexual awakening; it is this inevitable separation from her own daughter that she is now trying to absorb.

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Peter Selwyn spent the first ten years out of medical school at Montefiore Medical Center in the Bronx, caring for HIV-positive patients--mostly intravenous drug users and their families--in the early years of the AIDS crisis. As he worked with dying young men and women and their families, Selwyn returned to his own unexplored pain surrounding the loss of his father, who fell or (more likely) jumped from a 23-story building when Selwyn was a toddler. Mirroring their function in Selwyn’s life, the stories of the five patients who most affected him serve in this book as the threshold to the narrative of how Selwyn investigated, mourned, and commemorated his father’s death, finally revaluing it as central to the person and doctor he became.

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Cosima Nolinas (Codi) trained as a physician, but decided during her residency to give up medicine. As the novel opens, she is returning to her hometown, Grace, Arizona, to teach high school biology and care for her physician father, Doc Homero, who is suffering from Alzheimer's disease. Her younger sister, Hallie, has just left for Nicaragua to help with agricultural development. Codi's journey back to where she grew up reinforces a sense of aimlessness which she attributes to the death of her mother when she was three years old, to the miscarriage of an unwanted pregnancy when she was fifteen, and to her father's remoteness. She intends her stay to be temporary.

But gradually she is drawn into the community. She restarts a relationship with Loyd [sic] Peregrina, the Native-American father--though she never told him--of the child she lost in high school. She joins the town's struggle against a mining company that has polluted the town's water supply and now plans to dam the river. As her father's condition deteriorates, she learns more about the history of his connection with the town and, by examining the results of a life-long study he has done on a genetic anomaly affecting children born to second-generation inhabitants of Grace, she learns that her own hereditary background is far more deeply rooted in the town than she had known.

Codi's narrative is interspersed with her father's confused but illuminating memories of her childhood, and with the letters she receives from Hallie, who has always been the motivated and determined sister. When Hallie is kidnapped and then murdered by the contras, Codi's first response is to run away once more, but in laying her sister to rest and telling Loyd about their lost child, she realizes that she has found her home and--in her fierce and practical education of the new generation of Grace adolescents--her purpose.

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Yesterday (Leleti Khumalo) is a young woman living in a tiny rural town in Kwazulu province in South Africa with her six-year-old daughter, Beauty (Lihle Mvelase). Yesterday becomes ill and, after several failed attempts to be seen by the lone doctor at a clinic several hours' walk away, is diagnosed as HIV positive. At the doctor's urging, she travels to Johannesburg to find her husband (Kenneth Kambule), who works on the mines there, to tell him of her diagnosis and that he needs to be tested. He beats her viciously and sends her away.

Months later, he returns to the village, dying of AIDS. He has lost his job. She takes care of him. Rumors spread in the village that Yesterday's husband has "the virus." The people begin to avoid them both, and the (true) story is told of a young woman in a nearby village who, after moving to the city and then returning home with AIDS, was stoned to death by her people. There is no room for her husband at the hospital, so Yesterday builds a scrap metal hut outside the village and cares for him there until he dies.

At one point the doctor observes that Yesterday's body is resisting the disease well; she replies that it is not her body, but that "I have made up my mind: until my child goes to school I will not die."

When the new school year begins, Yesterday gives a delighted Beauty her school uniform, and the schoolteacher promises Yesterday that she will take care of Beauty. Yesterday watches as Beauty begins her first day at school and then walks home alone.

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This novel is based on the facts of an actual hantavirus outbreak that took place in the southwestern US in 1993, retelling the events as medical mystery, as ghost story, and as meditation on the relationship between rationalist western medicine and the beliefs of local indigenous cultures.

Dr. Push Foster is part Choctaw and part white, raised in Oklahoma. He returns to Arizona as an Indian Health Services physician at the time an outbreak begins of what is later identified as Hantavirus Pulmonary Syndrome. Western medicine and traditional health beliefs and practices overlap in the investigation and response to the illness as it infects and kills Navajo people.

Querry presents us with a convincing epidemiological investigation into the virus, but also suggests an alternative, or complementary, etiology for the outbreak: an archaeologist has stolen a sacred stone from the Hopi people with the help of a Navajo witch, or shape-shifter, the title's "bad medicine" practitioner. This theft, the novel suggests, is the reason that only Navajo, and one white person (the archaeologist's partner) become ill.

The climax of the story is a showdown between the shape-shifter, a Hopi village headman, and the ghost of a woman killed trying to save her people from the 1805 massacre of Navajo by Spanish troops at Muerto Canyon. (The virus, when first identified, was named Muerto Canyon Virus.) This woman becomes a figure of both vengeance and reconciliation, an uneasy meeting of cultures that echoes and informs the work of Push Foster and his colleague, Sonny Brokeshoulder: both are men of Indian blood with a "white" upbringing and who return to their culture bearing Western medical training, but do not deny the traditional knowledge either.

Unlike most medical thrillers, this book does not offer reductive explanations and answers; instead, we are left with the certainty that traditional and western thinkers must collaborate, not only to care for patients, but to take care of the natural environment on which all our health depends.

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Tessa Quayle, the young wife of a British civil servant in Kenya, is mysteriously murdered. Tessa, a lawyer, had been an outspoken human rights activist, and something of an embarrassment to her husband. But shaken from his marital and political complacency by her death and the rumors that quickly surround it, Justin Quayle sets out to solve the mystery and in doing so inherits her cause.

Tessa had discovered, as Justin now learns, that a new tuberculosis drug was being prematurely tested on Kenyan patients: clinical trials were effectively being carried out on the African population by the drug's giant pharmaceutical producer without the patients' knowledge or consent, but with the support and cover of a global corporation with African interests and of the British High Commission in Kenya. Lethal side effects and deaths were being concealed, the drug retitrated and retested in preparation for its safer and more lucrative release in the west in time for a predicted rise in incidence of multi-resistant strains of TB.

Justin, now a kind of rogue agent, uncovers the layers of sinister plotting to be expected in one of Le Carré's intelligence thrillers, but in the process we are led to consider, vividly, the interlocking roles of international biomedical research, postcolonial political interests, and global capital in determining the fates of impoverished, uneducated, and deeply vulnerable patients in developing countries--as well as the fates of those who try, often against all odds, to offer them the best available care. The novel also gives us, in Justin Quayle's odyssey, a moving study of desire, loss, regret, and, finally, outraged action.

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This book sketches the development of Schweitzer's ideas and accomplishments in theology, philosophy, musicology, and medicine. The author tends to pick up a theme at one time and then follow further developments on that theme at later points in Schweitzer's life. Thus, the book is not a comprehensive biography and it often departs from a strict chronological approach.

While there is some discussion of Schweitzer's "tortured" childhood and his later world-renown as the "jungle doctor," of Gabon, Bentley focuses on four intellectual and spiritual developments in Schweitzer's life. The first is his theological career, which led to the groundbreaking Quest for the Historical Jesus (1906) and subsequent theological books such as The Mysticism of Paul the Apostle (1930).

The second is his philosophy of "reverence for life, "which was first fully articulated in Civilization and Ethics (1923). The third is Schweitzer's career as a musician, musicologist, and organ designer. Finally, Bentley traces the development of Schweitzer's ministry as a medical missionary in Central Africa.

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The journal, Emerging Infectious Diseases, published by The Centers for Disease Control and Prevention (CDC) in Atlanta, features artwork on its cover. Under the guidance of managing editor, Polyxeni Potter, these images are selected to enhance the journal's communication of its scientific public health content. Among the goals that govern the choice of its cover art are the editors' intention to illustrate ideas, stimulate the intellect, and fire the emotions (personal communication).

Acompanying each image is a one-page commentary on the artist, the topic depicted, and its relevance to infectious disease. Cover art (and commentary) from past issues can be accessed from the title page of each current issue.

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This fine collection of writings by women involved in health care stems largely from a writing group cosponsored by the Nebraska Humanities Council and the Creighton University Center for Health Policy and Ethics. However, other writings also appear in this volume: in all there are 40 pieces by 16 authors. Writing genres include essay, short story, and poetry. The works are divided into three sections: Power and Powerlessness, Vulnerability and Voice, Connection and Disconnection. As noted in the introduction, these are "major themes in feminist perspectives in ethics" and the works are offered as reflections on modern ethical dilemmas in health care.

Some of the most powerful pieces are stories about being the newcomer--the student or junior trainee. For instance, "Washing Cora's Hair" by co-editor Amy Haddad is a poignant look at the struggle of two young nursing students to wash the long braids of a bed-bound elderly woman in her cramped home, and "The Story of David" by Ruth Purtilo, written as a memoir looking back to when she was a newly graduated physical therapist, concerns her interactions with a young, angry, depressed quadriplegic patient and with her superiors.

Another memorable piece is "The Things You Do" by Kelly Jennings Olsen. This story about being a new volunteer emergency medical technician masterfully controls the tensions of emergency medical care, the anguish of the father whose little girl slipped under his tractor, and the nuances of living in a small town. Several poems also deal with issues of the newcomer and witness to suffering (e.g., "As Ordered" by Ruth Ann Vogel--a poem about shaving the head of a neurosurgical patient on the pediatric ward)

As noted by the multiple keywords listed above, these pieces touch on many topics. Power relations play a key role, both between professionals and between patient and the health care team. For instance, in the polished story, "Procedures" the author Kim Dayton writes from the perspective of a young single mother with a critically ill neonate. This mother is repeatedly prevented from visiting her child because of "important" events like rounds and procedures, and she ironically only gets to hold her baby after the baby dies.

Throughout the collection the patients are described with honesty and vividness. Their suffering can haunt the health care worker ("Maggie Jones" by Veneta Masson) as well as teach ("Back to Square One" by Barbara Jessing). Many of the pieces remind us of our good fortune and the privilege we have in our lives and in providing health care services (e.g., "Spring Semester" by Amy Haddad). Ultimately in this volume our common humanity is emphasized--the connections between people and the remarkable grace that can be exhibited in the face of suffering.

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