Summary:

Baiev’s chronicle of medical life in wartime is full of incident—tragic, touching, and repeatedly traumatic:  his own life was threatened repeatedly by Russians who suspected him and Chechens who resented him for treating Russians.  Members of his extended family were killed and his father’s home was destroyed.  He straddled other boundaries:  trained in Russia, he fully appreciated how modern medicine may bring relief not available even in the hands of the most respected traditional healers, but he mentions traditional ways with the reverence of a good son of devout Muslims.  His perspective is both thoughtfully nationalistic and international.

Finally coming to the States where he couldn’t at first practice the medicine he had honed to exceptional versatility under fire, he lives with a mix of gratitude for the privilege of safety and a longing for the people he served, whose suffering was his daily work for years that might for most of us have seemed nearly unlivable.  Before writing the book, he struggled with his own post-traumatic stress, and continues to testify to the futility of force as a way of settling disputes.  Medicine is his diplomacy as well as his gift to his own people, and the Hippocratic Oath a commitment that sustained him in the midst of ethical complexities unlike any one would be likely to face in peacetime practice.

 

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Triggered in part by a trip to the Galápagos Islands, the author interweaves two parallel narratives: Darwin's "journey toward evolution" along with the related work of Alfred Russel Wallace; and the author's own journey through life, partially disabled and dependent on the specially fitted shoes that help him to walk.  Together these two narratives develop "all I have come to understand about chance and change, fear and transformation, variation and cultural context, ideas about the body that question the definition and existence of difference in all of our lives" (xvii).

Born with an unnamed congenital condition in which his fibulae are absent along with other lower limb "abnormalities," Fries underwent five major reconstructive surgeries as a child, but after those, what helped him most were special shoes that were fitted to his special body, assisting him to walk.  As an adult, however, he begins to experience back pain and knee problems.  The memoir relates, both in flashback, and in the present day, Fries's quest for a proper pair of shoes that will help him avoid yet another surgery -- the shoes he has been wearing are 20 years old and no longer do the job.  We meet Dr. Mendotti, who treated him like a peculiar specimen and offered a pharmacologic way out of his pain; shoemaker Eneslow, in a dingy Union Square office, whose shoes not only fit Fries well, but were festive in appearance -- "I felt both normal and special" (17); other practitioners of orthotics who try but fail to construct shoes that relieve Fries's pain, and finally, the gifted, patient orthoticist, Tom Coburn, who persists until he is able to provide shoes that work.  The shoes have been adapted for Fries's body, just as man has constructed adaptations that allow him to live in a variety of climates and circumstances.  Conversely, Fries, convinced he "can adapt to the circumstances in which my body places me (169)," draws from Darwin, whom he quotes: "individual differences are highly important for us, as they afford materials for natural selection to accumulate" (169).
 
Darwinian connections are invoked throughout the narrative.  The peculiar configuration of Fries's feet and shoes help him to ascend a series of mountain ladders while his partner, Ian -- who usually has to assist Fries with such physical maneuvers -- suddenly becomes fearful of the height and exposure;  back problems might have developed even without his congenital abnormalities because evolution of the capacity to walk upright included the tendency toward back pain; the role of chance in natural selection and the role of chance in the physical fact of congenital conditions; the positive role that his partner Ian's attention deficit disorder (ADD) could have played in the days of hunter-gatherers and the cultural context in which ADD is now considered to be "abnormal."
 
Fries discusses his fears -- both rational and irrational -- as well as his awareness of stigma, difference, and sameness.  The context of these discussions is usually a reminiscence about vacations in far-flung countries (Thailand, the Galápagos, Bali, Alaska, the Canadian Rockies) and physically challenging domestic locales (a Colorado River raft trip, the Beehive Mountain in Acadia National Park).  He  occasionally brings into the discussion his homosexuality, especially as his physical deformity affected sexual encounters.  The relationship between Fries and Ian is woven throughout the memoir as one of understanding, mutual need and benefit.  As the memoir ends, Fries worries about the likelihood he will need a wheelchair, but is at the same time gathering confidence in his ability to ride the Easy Flyer bicycle that Ian has discovered at the local bike shop.

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John Romulus (also known as Richard) Brinkley was a physician (in the diploma-mill sense of the word) who, in 1917, pioneered, in the U.S. at least, the notion of goat testicle transplant. "Transplant" must be understood in the loosest sense of the word since Brinkley simply removed the testicles from young goats and sewed them into the abdominal wall and scrotal tissues - without any attempt to connect blood or nervous tissues of either goat testicles or human  - of men for the alleged purpose of relieving impotence. From 1917 until his downfall at the hands of Morris Fishbein, a medical crusader esconced in the AMA, which organization Dr. Fishbein helped establish as the premier advocate of organized medicine in the U.S., Dr. Brinkley was perhaps the most recognizable physician in the U.S.

He ran for the office of Governor of Kansas in 1930 (losing by technicalities that today would have overturned the results), and established the most powerful radio station in the land, XERA, that promulgated his glandular chicanery all across the continental U.S. As a proponent of such skullduggery, Brinkley was continually in the sights of Dr. Fishbein, whose main reputation nationally was as an exposer of medical fakery. Eventually Fishbein lured Brinkley into a libel trial that resulted, in 1939, in the catastrophic downfall of an immensely talented and wealthy man who spiraled into bankruptcy and death in 3 short years.

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Ethiopia, 1954. Twin boys conjoined at the head survive a surgical separation and a gruesome C-section delivery. Their mother, Sister Mary Joseph Praise, does not. The Carmelite nun, a native of India, dies in the same place where she worked as a nurse - the operating room of a small hospital in Addis Ababa. The facility is dubbed Missing Hospital, and it is staffed by some remarkable people.

Thomas Stone is a British general surgeon. The only thing that he loves more than medicine is Sister Praise. When she dies during childbirth, he has a meltdown - abruptly fleeing the hospital and leaving Africa. Although Thomas Stone is the father of the twins, he blames the babies for the nun's death. Decades later, he is working at a prestigious medical center in Boston where he specializes in hepatic surgery and research on liver transplantation. The twins are raised by two physicians at Missing Hospital - Dr. Ghosh and Dr. Hemlatha (Hema) - who get married. Hema is an obstetrician-gynecologist. Ghosh is an internist who becomes the hospital's surgeon by necessity after Thomas Stone departs.

The fate of the twin boys, Marion Stone and Shiva Stone, is sculpted by their experiences at Missing Hospital and the growing pains of Ethiopia. The African nation is full of possibilities and mayhem. Both boys are highly intelligent and unusually bonded. Shiva is eccentric and empathic. Although he never attends medical school, Ghosh and Hema train him. Shiva becomes a world authority on treating vaginal fistulas. Marion narrates the story. He is repeatedly hurt by love. The girl of his dreams, Genet, opts to have her first sexual encounter with Shiva. Genet plays a role in hijacking an airplane and rebels against the Ethiopian government. Although innocent, Marion comes under suspicion because of her actions. He escapes the country for his own safety.

Like his father, Marion lands in America. He completes his residency training as a trauma surgeon in New York. He locates his biological father but reconciliation is difficult for both men. Genet has also come to America. She shows up at Marion's apartment, and they have sexual intercourse. Genet exposes him to tuberculosis and Hepatitis B. Marion delevelops liver failure due to hepatitis. He is going to die. Shiva and Hema travel to New York to be with Marion. Shiva proposes an experimental treatment for his brother - a living donor liver transplantation. After all, there is no better organ donor than an identical twin. Thomas Stone performs the operation along with one of Marion's coleagues. The surgery is successful. Then Shiva has bleeding in his brain and dies. Marion returns to Ethiopia and Missing Hospital. Half a century removed from his birth, Marion is back at home and still conected to his twin brother. The lobe of liver donated by Shiva is functioning perfectly.

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Pietro Brnwa, nicknamed "The Bearclaw," has embraced change - a new name, a different occupation, and a regenerated outlook. Thanks to the Federal Witness Protection Program, Pietro, who was formerly employed as a hitman by a mafia-connected lawyer, is now Dr. Peter Brown, an intern in the Department of Internal Medicine at Manhattan Catholic Hospital. His career as an assassin was motivated by the desire to avenge the murder of the grandparents who raised him. As a physician, Dr. Brown is paying off a moral debt - doing good deeds to atone for previous acts of violence including killing people.

Unfortunately, life doesn't get any easier for the hit man-turned-physician. Trouble stalks him and finds him. Everyone he loves is lost. In addition to the death of his grandparents, Dr. Brown's girlfriend, Magdalene, is gunned down in a car. His former best friend, "Skinflick" is thrown out of a window of a six-story building, survives, and is later stabbed to death by Dr. Brown.

Life might have been easier if Dr. Brown had not been recognized by a mafia acquaintance named Nicholas LoBrutto who is a patient in Manhattan Catholic Hospital. LoBrutto has stomach cancer and threatens to squeal to Dr. Brown's former crime boss. If Dr. Brown cannot keep LoBrutto alive, the mafia will be notified where to find the physician and he will be eliminated. Dr. Brown assists during LoBrutto's surgery but the mobster experiences ventricular fibrillation postoperatively. Dr. Brown's two medical students mistakenly administer intravenous potassium and LoBrutto dies.

A group of thugs quickly infiltrate the hospital and it appears likely that Dr. Brown will be exterminated. He risks his life to prevent a young woman from having her leg amputated for an erroneous diagnosis. The thugs capture Dr. Brown and detain him in the blood bank freezer. He removes a piece of bone from his own lower leg (an autofibulectomy) to use as a weapon and proceeds to kill the entire gang of murderers. Dr. Brown is sure to be dismissed from Manhattan Catholic Hospital but realizes there is still much he hopes to accomplish as a physician. With some help from friends in the Witness Protection Program (and a likely sequel to this novel on the horizon), it's a good bet that Dr. Brown is not likely to retire his stethoscope (or firearms) anytime soon.

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New York is the setting for thirteen linked stories that profile a long line of curious and sometimes loony doctors who are passionate about medical science but often lack common sense and good judgment. Beginning with Dr. Olaf van Schuler in the seventeenth century and continuing over more than 300 years with generations of his descendants (the Steenwycks), missteps and madness loom large in this inquisitive and peculiar medical family.

Most of these doctors share common goals: They strive to eliminate pain. They attempt to expand the scope of medical knowledge. They seek the soul. In their quest for cures and enlightenment, many of these physician-scientists, their relatives, and patients embrace off-beat diagnostic techniques or unproven remedies: phrenology, magnetism, bloodletting, hypnosis, radium-emitting apparatus, electrical shocks, and lobotomy.

In "The Siblings," a doctor performs a lobotomy on his sister. She dies a few months after the operation. In "The Story of Her Breasts," a woman develops rheumatoid arthritis that may or may not be caused by her silicone breast implants. She also experiences guilt and worry after encouraging her 18-year-old daughter to undergo breast augmentation. In "The Baquet," hope is undeniable and a miracle cure is mesmerizing. In the book's final story, "The Doctors," two physicians - a father and his daughter - grapple with their strained relationship and the man's progressive deterioration that might be due to Creutzfeldt-Jakob disease.

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This collection of physician experiences, colored by the necessity of the writer to protect  his patients, gives a glimpse into a medical practice of a time past-remembered by some of us, not  known by our younger colleagues.  Dr. Palmer, aka Harry Byrd, takes the reader into a rural setting and  the practice of surgery bounded by the time and the place.  Dr. Byrd, trained in Boston as a surgeon,  chooses to practice in rural Maine and to work with the culture and needs of this environment.  He  treats the reader to a viewpoint of another era of medicine and, at some level, asks the readers to  consider the lost or fading qualities of the pre-tech doctor/patient relationship.

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Also called "Dr Péan Teaching His Discovery of the Compression of Blood Vessels at St Louis Hospital," the scene takes place in a room in which the walls are interrupted by tall windows.  Daylight shines through the windows, illuminating an attractive naked young woman in the right foreground who lies seemingly anesthetized -- her eyes are closed although there is no sign of anesthesia -- on a bed of some kind that is draped loosely with sheets.  Her body is pointing away from the viewer, her head facing away from us, her long hair falling casually over the near edge of the bed.  Her breasts are fully visible, especially her right breast, while her lower body is covered.  A seated man grasps the wrist of her bent right arm, perhaps taking her pulse. His hand and arm rest directly on the woman's body -- on her abdomen and groin area.  He appears to be reading from a paper.

In the left foreground is the edge of a table that holds some surgical instruments and a glass jar containing what may be anatomic specimens.  An imposing sideburned man stands to the left, above the head of the bed and the woman.  Holding a surgical instrument in his right hand, he gesticulates with his left-hand, his mouth partly open: he is lecturing to the people in the room, some of whom are looking directly at him while others talk to each other.  Two in the audience are women -- a nun barely visible in the far background, and a nurse standing behind two men who are near the bed.  The men are all dressed in street clothes.

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This self-portrait includes two images of the artist. The first lies with her back toward us on a hospital gurney, her head to the left, apparently anesthetized. She is wrapped in a white sheet except for her lower back, which is exposed to show two large surgical cuts dripping blood. The second figure sits facing us in a chair in front of the right side of the gurney.

The sitting figure is essentially the familiar Frida Kahlo of many self-portraits--erect, beautifully dressed in colorful Mexican style, and her face composed in spite of the tear on her right cheek. The difference here is the presence of medical paraphernalia. The upright Kahlo holds in her lap a large back brace, and she seems to be simultaneously wearing the same device under her dress. In her right hand she holds a small flag with a Spanish inscription that could be translated: "Tree of hope, stay firm."

The two figures float in space just above a lifeless and deeply eroded desert landscape. In front of them, at the very bottom of the painting, is the suggestion of an abyss. The painting is divided laterally, the left side ruled over by a sun and the darker right side (the figure’s left) ruled by the moon.

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The first poem begins: "Let me be a poet of cripples, / of hollow men and boys groping / to be whole, of girls limping toward / womanhood. . . " This Whitmanesque introduction bespeaks two sides of Jim Ferris’s poetry. First, this is poetry of celebration: "I sing for cripples, I sing for you." But at the same time, the poems look unflinchingly at the failures, phoniness, and self-righteousness of the "fix it" establishment. They also portray (and celebrate) the community of suffering among the inmates destined to be "fixed."

In "Meat" (5) Ferris lays it on the line," Between four and five they bring down the meat / from recovery--those poor dopes have been simmering / up there for hours, bubbling up to the surface. . . " But even the children who have become "meat" have feelings. For example, the narrator of "Mercy" (18) expresses horror when two healthy classmates from the 8th grade manipulate the hospital rules in order to bring him a Get Well greeting. "How did these aliens get in?" he asks. "Leave now, trespassers, you who seek to gaze / on my humiliation." Perhaps the merciful will obtain mercy from God, he comments, "but not from me." In "Miss Karen" (25) the narrator sustains himself with erotic fantasies about his nurse and discovers to his mortification that he babbled these thoughts to his mother during recovery from anesthesia.

The culture of medicine looks cruel--or at least uncaring--though this crippled narrator’s eyes. "The Coliseum" (42) gives a telling description of the patient’s appearance at Grand Rounds: "You are a specimen / for study, a toy, a puzzle--they speak to each other / as if you were unconscious. . . " "Standard Operating Procedure" (44) reads like an ironic crib-sheet for orthopedic surgery: "Bust a chuck / of bone the rest of the way out; chisel it if you have to. . . He won’t remember much; kids are like animals / that way."

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