Summary:

Alois Burda loves money. He is a wealthy owner of a car dealership who has many acquaintances but no true friends. He has been married twice and has three children but is uninterested in his family. Prior to his sixtieth birthday, he experiences weight loss, abdominal pain, and night sweats. Burda is diagnosed with inoperable metastatic cancer of the pancreas.

He seems worried most about what to do with his property and money. Before entering the hospital, he hides his money in some old slippers until he can decide what to do with it. He is comforted by a young nurse, Vera, whose voice reminds him of his mother's. After he dies, Burda's wife discards her husband's belongings into a heap of rubbish, unaware of the fortune hidden in his slippers.

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The author, a Canadian physician-historian-educator, blows the dust off the shelves of medical history with this fascinating text designed for medical students, educators, and those with an interest in history of medicine. Duffin begins this survey of the history of Western medicine with a glimpse at a pedagogical tool designed to spark the interest of even the most tunnel visioned medical students: a game of heroes and villains. In the game, students choose a figure from a cast of characters selected from a gallery of names in the history of medicine.

Using primary and secondary sources, the students decide whether the figures were villains or heroes. The winner of the game is the student who first recognizes that whether a person is a villain or hero depends on how you look at it. This philosophy imbues the entire book, as this treatise is not a tired litany of dates, names and discoveries, but rather a cultural history of the various times in which medical events occurred.

The book is organized by topics which roughly follow a medical school curriculum: anatomy, physiology, pathology, pharmacology, health care delivery systems, epidemiology, hematology, physical diagnosis and technology, surgery, obstetrics and gynecology, psychiatry, pediatrics, and family medicine. The last chapter, entitled "Sleuthing and Science: How to Research a Question in Medical History," gives guidance to formulating a research question and searching for source material. Fifty-five black and white illustrations are sprinkled throughout the book, as well as 16 tables.

Direct quotes from historical figures, such as Galen and Laennec, as well as excerpts from writings of eyewitnesses of events, anecdotes and suggestions for discussion, appear in boxes within the chapters. Many of the chapters contain discussion about the formation of professional societies. Each chapter ends with several pages of suggested readings and the third appendix delineates educational objectives for the book and individual chapters. The other two appendices list the recipients of the Nobel Prize in Physiology or Medicine, and tools for further study, including titles of library catalogues, and resources in print and on-line.

Although the book is a survey covering multiple eras and topics, each chapter contains choice tidbits of detail. For instance, the chapter on obstetrics and gynecology includes the story and photograph of Dr. James Miranda Barry, the mid-nineteenth century physician, surgeon and British military officer, who was discovered to be a woman at the time of her death. The impact of the stethoscope on the practice of medicine is explored in depth in the chapter, "Technology and Disease: The Stethoscope and Physical Diagnosis."

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This posthumously published collection of essays by Dr. Klawans, an eminent neurologist and writer, explores the interactions between patient, family and neurologist and the implications of specific neurologic diseases. Klawans's special interest in neurology is movement disorders, such as Huntington's chorea and Parkinson's disease, but his outside interests range from evolutionary biology to classical music. His essays, therefore, focus on single patients or families, but the author weaves thoughts about his other interests into each "case."

The book is divided into two sections, "The Ascent of Cognitive Function" and "The Brain's Soft Spots: Programmed Cell Death, Prions, and Pain." In a brief preface, Klawans declares that this book is "more than just a set of clinical tales about interesting and at times downright peculiar patients" from his 35 years of practice, but rather it "humbly grapples with the 'whys' of our brain, not the 'hows.'" (pp. 9-10) In the preface, as well as in one essay, Klawans acknowledges the work and impact of fellow neurologist-writer Oliver Sacks ("Oliver is truly the father of us all." p 12).

The title essay concerns a six-year-old girl who was found, locked and completely speech-deprived, in a closet. Because she is still within the window of opportunity for language acquisition, "Lacey" quickly learns to speak, unlike Victor, the Wild Boy of Aveyron, whose story was immortalized in the François Truffaut film, L'enfant Sauvage. Klawans uses these stories as a launch pad to discuss the evolution of language, including a proposal that the cavewoman, not the man, was responsible for development of the human species as she taught her offspring language.

Other chapters focus on patients with epilepsy, Parkinson's disease, localized and hemispheric stroke, "painful-foot-and-toe syndrome, " and Creutzfeldt-Jakob disease. Two particularly memorable chapters concern Huntington's chorea and Refsum's disease. The chapter, "Anticipation," explores the profound ethical concerns of genetic testing for Huntington's chorea as applied to three generations of one particular family. In the chapter, "The Hermit of Thief River Falls," Klawans recollects his first year as a neurology resident, and his care of a reclusive patient with a rare eponymous illness, Refsum's disease--just in time for a visit by Refsum himself, a famous Norwegian neurologist.

The book concludes with a speculative "afterthought" about genetics, evolution, and the importance of extended "juvenilization" --the protracted post-natal development of Homo sapiens. This essay intertwines some of the threads regarding speech development and evolutionary biology, particularly brain development, that were introduced earlier in the text.

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This stark and sensual poetry collection is divided into three sections. The first, "Graveyard Shift," introduces the narrator's themes: the keen observation of suffering; the questioning of God's role in such suffering; the way caregivers and patients meld in shared moments of trauma; the struggle to integrate the reality of death and grief into a life outside the healthcare arena.

A longer second section, "Lessons," contains a chronology of poems that broaden the poet's themes. Suffering becomes personal through sexual abuse ("The Burning"), death of a baby ("To the Woman in the Next Bed," "Waiting Room," "Last Lullaby for the Dead Child"), and breast cancer ("Keeping Watch"); the mystery of God's role becomes the narrator's religious quest.

The final section, "The Ones Who Come," opens these themes to the universal: children and adults lost to "the holocausts" of war, poverty, and illness ("Lizard Whiskey: A Parting Gift from Viet Nam," "After the Siege," "The Ones Who Come," "The Man Who Stays Sane"), and how history repeats these cycles of birth, suffering, and death.

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Margo Billis and her son, Matthew, barely endure a strained and rather twisted relationship. She is a 73 year old woman dying from cancer. Despite her illness, she continues to provide for her lazy, 40 year old son who still lives at home.

Matthew's condition might also be described as terminal in an emotional and psychological sense. He claims to suffer from endogenous depression and wastes most of his life sleeping for long periods of time in his garish green bedroom. His mother implores him to get a job but all he seems capable of is wallowing in self-pity.

Matthew has neither empathy nor sympathy for his mother's misery. One day he finds his mother dead in her bed. Her safe is open and contains $14,000, some undeposited but endorsed checks, a bottle of 200 morphine tablets along with a prescription for morphine, half a carton of cigarettes, and Hummel figurines. Matthew transports her corpse to the freezer in the garage where she will remain until he is ready to announce her death. Realizing he can co-sign her checks and forge her signature, he has finally found a job to his liking.

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The writer describes her experience as a cancer patient, thrust into "the Land of the Sick" by the diagnosis and treatment of lung cancer four years earlier. Although she is not ill, the fear of mortality embedded in a diagnosis of cancer is a dragon that haunts her existence.

To cope with the dragon she relies on talismen: her doctors, personal will, and her garden peas, an emblem of everyday life and its constant renewal. The talismen create the semblance of control over her situation. She observes that "doctors and patients are accomplices in staging a kind of drama" and that the patient and her continued well-being become talismen for the doctor too.

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Leandra lives alone in the backwoods of North Carolina where she makes a small but sufficient living repairing antique dolls for a dealer who sells them to collectors. The broken and ragged dolls occupy an old "mourner's bench" in her one-room cabin. For ten years she has lived in relative contentment, though she carries the pain of a trip to Boston when her sister bore a defective child who died.

The sister committed suicide soon thereafter. During that visit, as Leandra's sister withdrew into late-pregnancy depression and hostility, Leandra and Wim took comfort in one another's presence and finally fell in love. But after the suicide, Leandra returns to North Carolina with no intention of ever seeing Wim again.

Now, ten years later, he shows up on her doorstep, wanting to spend the final months of his life with her; he has inoperable brain cancer. He knows what course it is likely to take. He wants only to see her, but she insists that if he is to reenter her life, she wants to see him through all of it, even the worst parts.

They weather and cherish the days with gentle humor, frankness, careful sharing of memory, and the deepest love either has ever experienced. Leandra's neighbor, a friend from childhood, helps Wim build an extension onto Leandra's little cabin, one of several ways he finds to "provide for her" as he wishes he could have earlier.

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Julia Sweeney performs on film the dramatic monologue that she wrote and performed "live" on stage. The period of her life on which she focuses are the nine months of her brother's dying, when he and her parents moved into her home--an idyllic bungalow that she had set up for herself, following her recent divorce. Instead of having the opportunity to enjoy the freedom of being single again, she is thrust into the thicket of family relationships, the sadness of her brother's poor health, and the demands made by his treatment for lymphoma.

Her parents, she says, have always been for her a "source of comedy, or a reason to be in therapy." These are the resources Sweeney is able to tap as she comments with humor and insight on living like a child in her own home, as her mother takes over the household and bickers with her father, who is drinking too much. But even as she jokes about the clash in lifestyles between herself and her parents (after all, she hasn't lived with them for 16 years), she weaves into the narrative the nature of life with her brother, whom she accompanies for his daily radiation treatments and whom she ministers to as he undergoes chemotherapy.

While not minimizing the seriousness of her brother's illness, she (as well as he) can find the surreal humor in their medical encounters. Thus Julia Sweeney describes how, when scar tissue prevents further injection into his spinal fluid and the doctors recommend a brain "shunt" for that purpose, assuring them that other patients "love their shunts," brother Mike not only agrees to the procedure, but adopts the slogan, "I love my shunt" for every conceivable situation.

The surreal becomes the real when Julia learns that she too has cancer--a rare form of cervical cancer that will require a hysterectomy. Even as she describes her shock and horror at this new blow, Sweeney takes comfort in Mike's sense of humor: he accuses her of getting even with him for taking "the cancer spotlight." Her narration of picking up her own pathology slides and of making the decision not to have her ova ("eggs") harvested and fertilized are both funny and poignant.

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Editors Angela Belli, professor of English at St. John’s University in New York, and Jack Coulehan, physician-poet and director of the Institute for Medicine in Contemporary Society at the State University of New York at Stony Brook, have selected 100 poems by 32 contemporary physician-poets for this succinct yet meaty anthology. The book is subdivided into four sections, each of which is prefaced by an informative description and highlights of the poems to follow.

Section headings take their names from excerpts of the poems contained therein. There are poems that describe individuals--patients, family members ("from patient one to next"), poems that consider the interface between personal and professional life ("a different picture of me"), poems that "celebrate the learning process" ("in ways that help them see"), and poems in which the poet’s medical training is brought to bear on larger societal issues ("this was the music of our lives").

Several of the poems have been annotated in this database: Abse’s Pathology of Colours (9); Campo’s Towards Curing AIDS (13) and What the Body Told (94); Coulehan’s Anatomy Lesson (97), I’m Gonna Slap Those Doctors (21), The Dynamizer and the Oscilloclast: in memory of Albert Abrams, an American quack (129); Moolten’s Motorcycle Ward (105); Mukand’s Lullaby (33); Stone’s Talking to the Family (79) and Gaudeamus Igitur (109).

Other wonderful poems by these authors are also included in the anthology, e.g. Her Final Show by Rafael Campo, in which the physician tends to a dying drag queen, finally "pronouncing her to no applause" (11); "Lovesickness: a Medieval Text" by Jack Coulehan, wherein the ultimate prescription for this malady is to "prescribe sexual relations, / following which a cure will usually occur" (131); "Madame Butterfly" by David N. Moolten, in which the passengers in a trolley car are jolted out of their cocoons by a deranged screaming woman (142).

Space prohibits descriptions of all 100 poems, but each should be read and savored. Some others are particularly memorable. "Carmelita" by D. A. Feinfeld tells of the physician’s encounter with a feisty tattooed prisoner, who ends up with "a six-inch steel shank" through his chest as the physician labors futiley to save him (23). In "Candor" physician-poet John Graham-Pole struggles with having to tell an eight-year old that he will die from cancer (27). Audrey Shafer writes of a Monday Morning when she makes the transition from the "just-awakened warmth" of her naked little son to tend to the patient whom she will anesthetize "naked under hospital issue / ready to sleep" (72).

In "The Log of Pi" Marc J. Straus muses about being asked "the question / I never knew" that he "pretend[s] not to hear" whose "answer floats on angel’s lips / and is whispered in our ear just once" (113). Richard Donze wants to know why "Vermont Has a Suicide Rate" (132). Vernon Rowe remembers the "hulk of a man" who shriveled away from an abdominal wound and begged, " ’Let me go, Doc,’ / and I did" (44).

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Nick and Fran move into an old house with their family: Miranda, thirteen, Nick's daughter from a previous marriage (her mother has been hospitalized with depression); eleven-year-old Gareth, Fran's son (who was almost aborted); and a toddler, Jasper, the child of both. Fran is pregnant again. Nick tries to hold them together as a family, but must also take care of Geordie, his grandfather, who is dying of cancer at the age of 101.

Geordie believes that what's killing him is a bayonet wound he received in World War I. As his disease progresses, the old man relives the war, especially the battle in which his brother died, with increasing vividness. After Geordie's death, Nick learns that in the battle he had killed his wounded brother who may, he thinks, otherwise have survived.

Geordie tells the story in an interview with a historian working on memory and war, and confesses that he hated his brother. She gently tells him that "a child's hatred" is different, but he--like the novel itself--refuses to see this as mitigation. Geordie's tale resonates both with what Nick learns about the house he bought--in 1904 the older children of the family living there were believed to have murdered their two-year-old sibling--and with Gareth and Miranda's resentment of Jasper, which has near-fatal consequences.

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