Summary:

Originally a three-part series in the New Yorker, this is an account of McPhee's six months of observing rural family doctors in Maine. It is both an engaging portrait of a kind of family practice increasingly rare in America, and implicitly an argument that those involved in professional medicine consider the tradeoffs in choosing between urban, high-tech, specialization and rural family practice where they know whole families in the context of community over time.

The narrative, based on interviews with physicians, some patients, and observations of clinical encounters, follows the daily routines and decision-making of several rural practitioners who consciously chose against the more lucrative, prestigious option of urban private practice, specialization, or academic medicine.

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The story begins with Dr. Frank Rapallo's son recalling his father's funeral and then progresses with a series of vignettes that show us who Dr. Rapallo was and how he died. Rapallo was an old time doctor who loved his work and whose patients told him "everything."

The boy was only seven when his father had radiation treatment for a cancer of his shoulder; subsequently, he had surgery to try to save the arm, but this left a hole "big enough to fit my hand." The hole never healed. He lost the arm anyway, but continued to perform operations with the assistance of Matthew, his young Japanese partner. The son reflects on his father's experiences in World War II--he was profoundly moved by the destruction in Japan and by the courage of Japanese physicians.

A strong, dedicated doctor, Rapallo was painstakingly honest, both with his patients and himself. In the end, he developed an incurable infection in his incurable wound. With characteristic dignity, Dr. Rapallo set about doing his last things--seeing patients for a few hours, visiting with his old friend Finch--and then in the evening took the contents of the vial he had prepared, and died.

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Uncle Jimmie is slowly dying of cancer, "the rat that gnawed away behind his ears." Jimmie believes that cancer is part of nature and must, at some level, be accepted. At first he permits surgery--they removed his ear and cheek and upper lip--but he eventually concludes, "Stop cutting . . . let / me go to earth and snow and silver trees." However, Aunt Flo will not let him go; she reads St. Paul and prays for his recovery.

Next the surgeons remove Uncle Jimmie’s tongue (without his consent?), but his eyes "kept pleading: Stop the cutting, let me go . . . ." So then they removed his eyes. Finally, "a specialist / trimmed away one quarter of his brain ... " Jimmie is left with no memory, lying in bed among his tubes, while Auntie Flo "comes every day / to read to bandages the Word Made Flesh, / and pray, and pay the bills . . . . "

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This poem is in the voice of a faith healer who calls upon the reader to witness the marvels of God's healing power, a holy power that shows the terrible evil embodied in the theory of evolution: "Darwin's demon apes of hell / howl the name of blasphemy." The narrative centers on a young boy with diabetes, whose father brings him to be healed. He and his father prayed and their faith grew strong; "he threw away the pills, those ugly / relics of his doubt-- / and the boy cried out, rejoicing!"

Later, though, during the night, the boy became ill again and begged his father for the pills. But the congregation prayed and the father's faith held . . . and the boy died. The healer rejoices, though, because "he is not dead--the boy / only sleeps in the Lord." The healer believes the child died because " Darwin's great beast" rose that night and "passed his hand over the boy's / sick faith."

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This long poem tells a story within a story. The framing story is Charles Darwin falling asleep and thinking, "as he always does, of animals . . . . " His dream turns into the story of the Deluge and Noah and his ark. Poor Noah is a bumbling 600 year old man, who much against his own inclinations, is told by God to build the ark and, later, to stuff it with a pair of every kind of animal. Well, Noah's sons think this whole project is stupid, but they eventually go along with it.

The most difficult part was finding and capturing the animals, two of every species, including in the end, "sixteen thousand hungry birds / lusting for the eighteen hundred thousand insects, / and the twelve thousand snakes and lizards / nipping at the seven thousand mammals, / and everyone slipping and sliding around / on the sixty-four thousand worms / and the one hundred thousand spiders--." When the deluge began and the waters rose, the ark floated past all the desperate, dying people, until the last woman "holding her baby over her head" went under "and God was well pleased."

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Miss Gee wants to be a good girl and keep "her clothes buttoned up to her neck." Time goes by. Finally, she gets on her bicycle and goes to the doctor about "a pain inside me." The doctor diagnoses cancer. Later, over dinner, he comments to his wife that "cancer's a funny thing" that attacks "childless women" and "men when they retire."

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The narrator of this poem is the father who is dying. He takes all kinds of pills in different colors which he identifies, perhaps correctly, as poisons. He knows he is dying and so does his son, who brings him his medicine and "sees poison in my eyes." The last few lines are especially touching: "He wants to take my hand, but he's / afraid. That's two of us. / For heart I take a white one once."

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A woman named Kitty calls the doctor and reports that her husband has died. "Can you come over?" she asks. At the house he finds that the husband has been shot in the head. It is evident that the wife has killed him. The doctor reflects that Kitty "held the record for most abused woman in Taylor County." He remembers how many times he has seen her badly beaten by her husband. In the end he decides to "play God." He calls the police chief and reports the death as a "clear" suicide.

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This remarkable poem notes the contrast between the mechanical, technologically manipulated heart today (without faith or spirit) and the mysterious, spirit-creating heart of Riverius. In the days of Riverius, the heart created spirit which "descended like dew" into the body and "ascended like steam" into the head--"how souls and bodies blended!" But now all mystery and spirit are gone. Cadaver-cutting scientists made an ox of the heart which pumps "the blood in dispirited circles" (note the wonderful use of "dispirited").

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This short (10 line) poem presents a simple scene. A man leaves the hospital, carrying a woman's coat. "Clearly she would not need it." The weather is mild for December, but the man has zipped his coat, "preparing / for irremediable cold."

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