Summary:

Selzer begins by describing an anonymous painting of Vesalius at the dissecting table, about to cut into the cadaver in front of him, yet glancing over his shoulder at a crucifix on the wall behind him. He then tells two medical stories in which spirituality has played a crucial role.

In the first, a man who has repeatedly refused to have a brain cancer operated on turns up one day healed, attributing it to the holy water a family member brought back from Lourdes. In the second, the Dalai Lama's personal physician does rounds in an American hospital and, using ancient techniques, diagnoses correctly, and in some detail, a case of congenital heart disease.

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Ten "forms of devotion" are described briefly in one or two pages of accessible, everyday prose: Faith, Memory, Knowledge, Innocence, Strength, Imagination, Prayer, Abundance, Wisdom, Hope. Each is illustrated with an engraving of an allegorical image with Latin and gothic German text. In the first mini-essay, the narrator contends that "the faithful are everywhere." She demonstrates that faith in a future and in immortal continuity is the driving force, not only for religious folk, but for anyone who goes to school, gets up each day, drives to work, embarks on a journey, takes a pill.

The following mini-essays show how each of the forms of devotion are wielded by "the faithful" to carry on valiantly confronting the challenges of ordinary existence. Faith and Hope together beget power. By the end, the reader senses a certain irony--as if the writer is not a member of the faithful. She may acknowledge and sometimes envy their resolute success, but does she share it? Perhaps not, and we are left wondering if she even admires it.

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What appear to be early-twentieth-century anatomical engravings of various body parts--eye, tongue, spine, breast, legs, foot, genitalia--accompany a male narrator's thoughts about his wife and their relationship. He describes the "good days" and "bad days" in their mundane life. He suspects that she may be having an affair and wonders if he should have one too. Her disturbing restlessness is felt "in [his] bones," but he avoids confronting it, hoping that they will continue happy.

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A woman describes the male body, beginning with the torso--neck, chest, belly, genitals--then the appendages, the back, and finally the head. Her description features the appearance and uses of these anatomical parts from the perspective of female taste and needs. The essay is illustrated with strategically placed images of the human form in exotic settings, taken from Bernard Siegfried Albinus's remarkable treatise of anatomy of the mid-eighteenth century.

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The narrator has four loves--one for each chamber of her heart: right atrium, right ventricle, left atrium, left ventricle: music (from her mother), painting (from her husband), language (shared with her son), and light. Each section, introduced by an anatomical engraving of the heart, describes how the love entered and developed in her life. Their relative importance is related to the size and thickness of the cardiac chambers. Carefully placed engravings of domestic scenes and landscapes, mostly nineteenth century, complete the essay.

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The author comments initially that most physicians become involved in the stories of their patients' lives--as witnesses, chroniclers, and players. He uses as an example the story of a physician's role in the death of Anton P. Chekhov. Another interesting example is the book, A Fortunate Man (see this database), the story of an English country doctor who matures in the profession and comes to recognize the task of the doctor as one to help his patients feel recognized.

Dr. Verghese believes that all patients seen by physicians are in the midst of a story that begins the moment they walk through the portals of a hospital or a clinic. He sees the challenge as engaging the patient and the family in finding an "epiphany," even if that epiphany is simply the understanding that there is nothing more that can be done medically. In his conclusion he says that as physicians we should be ministers of healing, storytellers, storymakers, and players in the stories of our patients and ourselves.

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The author, Samuel Shem, opens these reflections by saying that he was a writer before he was a doctor. His early answers to questions about healing came from stories he read. "Life as it should be in addition to life as it is" became the "motor" of his writing. He loved stories that he heard from patients and the "few humane doctors" he met and decided he would be able to understand people better by writing about experiences with them.

Shem's experience as an intern spawned The House of God (see this database) and he sees writing about his training as an example of the use of resistance when he saw "something unjust, cruel, militaristic or simply not right." He recommends the following to resist the inhumanities in medicine: (1) Learn our trade in the world, (2) Beware of isolation, (3) Speak up, (4) Resist self-centeredness. He says that the healing essence of narrative is in "we," meaning the patient and the physician.

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St. Luke’s Hospital was founded in 1750 to provide free care to the impoverished mentally ill. It mixed benevolence with "unconscious cruelty" in the treatments used by the "practitioners of old," from restraints and drugs to swings and a key to force-feed recalcitrant patients. Dickens describes this gloomy edifice as he saw it on December 26, 1851, although he notes a "seasonable garniture" of holly.

The inhabitants of St. Luke’s largely sit in solitude. Dickens decries the absence of "domestic articles to occupy . . . the mind" in one gallery holding several silent, melancholy women, and praises the comfortable furnishings--and the relative "earnestness and diligence" of the inmates--in another. He uses statistics to show the prevalence of female patients, "the general efficacy of the treatment" at St. Luke’s, and the unhealthy weight gain of the inhabitants due to inactivity. Dickens describes the behavior of various distinctive inhabitants during the usual fortnightly dance, the viewing of a Christmas tree, and the distribution of presents.

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Another Dimension is an occasional feature of the journal, Emerging Infectious Diseases, published by The Centers for Disease Control and Prevention (CDC). These essays (and occasionally poems or stories) focus on human and philosophical issues related to medical practice, scientific research, and public health. The intention of this feature is to bring a new perspective to the journal’s coverage of medical science and public health. Some of the essays include a painting or other image that draws attention to the subject matter of the essay.

Managing editor, Polyxeni Potter, with the encouragement of Joseph E. McDade, founding editor of the journal, initiated and is guiding this feature (see also the annotation of Potter: Emerging Infectious Diseases cover art). Since this is a government site, its material is freely available on-line.

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In this chapter (no. 43) from his autobiography, Williams seeks to describe the poetry of medicine, the almost indescribable quality (Williams frequently refers to it as "it" and "the thing") that draws him to his practice. Clearly it is not anything medical-technical. He particularly disparages surgery and the idea that you can cure by merely cutting. Rather, it involves seeing each patient as "material for a work of art"(287), by which he seems to mean a natural showing of strong character or selfhood under pressure of difficulty. In a strong central passage Williams calls medicine "the thing which gained me entrance to these secret gardens of the self"(288).

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