Summary:

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 collection of poems chronicles moments of felt experience in the writer's life before and after her diagnosis of ovarian cancer. Starting with a memory of a carefree childhood lived in an era when streets were sanitized with DDT, and a poem entitled "The Body is the Repository of Memory," the poems move freely from close-ups of moments in the hospital or grieving at the waterside to wide-angle views of a life that has been and still is normal, worth living, pulsing, albeit a bit more irregularly, with creative energies.

Cumulatively the poems explore the paradox that illness (and a terminal prognosis) changes everything and also, but for the shadow it casts, changes very little. "Still," she writes in a final line, "my wild heart beats." The poems are interspersed with prose-poems that shift the focus toward the writer's reflections upon the project and circumstances of creating this "memory board"--a term borrowed from the Luba people of Africa, who bead boards that represent memories to pass on as visible legacies of lives they believe worthy of being remembered.

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A woman lies in her bed, dying of cancer. Several family members have gathered in the room around her, including her son Bruno. From the age of 11 Bruno had wanted to be an artist, but had become a doctor instead because it was easier to make a living. "And medicine at one point--when he was nineteen or twenty--had seemed more humane than the humanities, more artful than art." Yet four years earlier, Bruno gave up his medical practice in Rome to devote his life to painting. But now he is back to medicine, helping to coordinate the efforts of his mother's physicians.

The dying woman sips an opium solution to ease her pain. She teases Bruno about the many times she had embarrassed him as a child, by acting funny or assertive or eccentric, behaving very differently from the other children's mothers. She would always make people laugh. Likewise, she was never confused about what she wanted. Even now, tipsy with opium, she remains in charge, a rock among the gathered family members, deflecting their sadness with her good humor.

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The poem depicts the vulnerability a woman may feel during this procedure, one that feels anything but routine. Even though the mammogram turns out predictably normal, the patient knows that she is changed. She has seen the fragile faults deep in her body, and she knows that no one, not even her doctor with his reassuring diagnosis, can "give innocence back."

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The narrator's mother, having received "all the benefits of modern medicine," was still alive after 14 months. The son, himself a doctor, finally told her that she had cancer, after which she requested that she receive no treatment, other than pain control. Thus, her son provided her with a bottle of opium solution to use as needed. However, the other doctors continued their pretense that, if only she would take the "cure," she would get better.

She died six days later, "not slowly, like a train arriving at a station, but swiftly and convulsively, like a train derailing." She was buried without the priest's blessing because she hadn't been a practicing Catholic. However, the "ceremonies" of the craftsmen creating a masonry border around her grave, and of the stonecutter carving her headstone, were "last rites" more to her liking than the priest's prayers anyway, because she had never been fond of religion.

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In this collection Richard Selzer brings together 25 stories from his previous books, along with two new stories, Avalanche (see this database) and "Angel, Tuning a Lute." The unifying theme is the world of medicine and healing, which Selzer explores with a keen eye and compassionate heart. These stories are firmly grounded in the foibles, suffering, and exultation of the human body.

In the Introduction Selzer sketches the path by which he became a surgeon-writer and he indicates the origin of some of the stories. Particularly interesting are the stories that do homage to literary and historical figures; for example, "Poe's Light-house," which grew out of a fragment Edgar Allan Poe wrote in his last delirium, and "The Black Swan," a re-writing of a Thomas Mann novella (Mann's The Black Swan is annotated in this database).

Likewise, the story of how "Avalanche" was written is an interesting tale in itself. Selzer's description of pruning the story from his journal reminds me of Michelangelo's comment that the sculpture already exists in the block of marble. The sculptor merely removes the unnecessary stone. The Doctor Stories contains many of Selzer's tales that have become part of the Literature and Medicine canon; these include, for example, "Tube Feeding," "Sarcophagus," Imelda, Mercy, Brute, and Four Appointments with the Discus Thrower. (See this database for annotations of the latter four.)

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The poem begins, "I'm mighty glad to see you, Mrs. Curtis." The speaker is a woman who is dying of leukemia and Mrs. Curtis is the lady who comes around periodically with the book-cart, offering patients something to read. While the other patients are celebrating the holiday with family or friends, the speaker, who has no visitors, feels conspicuous and lonely. Thus, she is grateful for Mrs. Curtis' regular visit, especially since the book-cart lady appears willing to sit down and listen.

The patient's father is afraid to visit, since he knows "that I will predecease him / which is hard enough." Chemotherapy hasn't helped. The leukemia makes her so fatigued that she doesn't even feel like reading. So instead, she sits by the window and looks at the trees. Since the leaves have fallen, the trees look like "magnificent enlargements / Of the vascular system of the human brain."

The patient has given names to these "discarnate minds." For example, "there, near the path, / Is the great brain of Beethoven, and Kepler / Haunts the wide spaces of that mountain ash." These trees remind her of "The Transparent Man," a toy one of her friends had when they were girls. "It was made of plastic, with different colored organs, / And the circulatory system all mapped out / In rivers of red and blue." At the time she and her friend giggled, but now she remembers the intricacy with amazement, and stares at the riddle of the trees.

The dying patient decides not to take one of the books, but thanks Mrs. Curtis again for coming. [120 lines]

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Words rushing forth in a punctuationless stream, a patient describes how his doctor gives him the bad news of advanced lung cancer, and his reaction to it. There is an almost comical aspect as the doctor struggles to be both factual and sympathetic, and the patient struggles to absorb what he is being told. The doctor asks if the patient is able to find comfort and "understanding" from religion (since, apparently, he is unable to provide them). This triggers a brief poetic flight of fancy in the patient, but then he departs in a state of dazed politeness.

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The narrator is a patient with advanced cancer who has come home from the hospital after being told that "medicine has no hope." Yet, for one night, he strives to overcome his cancer with drink, his "Basic Life Force," and hope.

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The narrator recounts the interview with his physician during which he learned the bad news about his lung cancer--although the word "cancer" is never mentioned. But the interview is marked throughout by signs of imperfect communication. At several points, the physician's grave remarks are matched by diffident, sometimes humorous responses.

For example, when asked if he is a religious man or a communer with nature, the narrator responds "I said not yet but I intend to start today." The culminating account of miscommunication is near the end: "he said something else / I didn't catch and not knowing what else to do / and not wanting him to have to repeat it / and me to have to fully digest it / I just looked at him." The final line clinches the oddly blurred nature of the whole exchange: "I may even have thanked him habit being so strong."

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