Summary:

View full annotation

Summary:

This collection of 16 short stories focuses on doctors and patients in San Francisco, where a wide variety of wealth and culture impact the delivery of medical care.  Further, there are many restrictions—financial, bureaucratic, ethical, and legal —that limit what doctors can do, especially in cases of patients near death.

The author, Louise Aronson, is a geriatrician who knows this terrain very well, having trained in San Francisco and worked as a physician there. A skilled writer and close observer, she has created dramatic and often funny stories that reveal social and bioethical complexity. About half the stories describe end-of-life issues for the aged and the dilemmas for their physicians and families.

In ‘The Promise,” Dr. Westphall orders comfort care only for an elderly patient who has suffered a massive stroke, but a hospital gives full treatment because there was no advance directive and the daughter told the attending to do “what he thought best.”

When Dr. Westphall sees this barely functioning patient in a skilled nursing facility seven months later, he tenderly washes her face and hair—although the text teases us that he might have been prepared to kill her.

In “Giving Good Death,” a doctor is in jail charged with murder; he has fulfilled the request of Consuela, a Parkinson’s patient, to help her die. When it appears that she may have died for other reasons, he is released, his life “ruined.” He leaves San Francisco, and, we surmise, medicine. In three other stories, doctors also leave the profession: the cumulative stresses of work and family and/or a sense that it’s not the right path bring them to that choice.

On the other hand, one of the longer pieces “Becoming a Doctor” celebrates the profession, despite all the rigors of training including sexism against women. 

The stories bring multicultural insights; we read of people from China, Cambodia, Latin America, India, Russia, and the Philippines. Some are African-American; some Jewish, some gay. These different backgrounds color notions of health, death, and medical care. There are also pervasive issues of poverty and, at another extreme, professionalism that is hyper-rational and heartless.

Indeed, a recurring theme is care and love for people, no matter their background or current health status. A surgeon realizes (regrettably too late) that the secret of medical care is “caring for the patient—for anyone—just a little. Enough, but not too much” (p. 135). 

View full annotation

Summary:

Soldier Girls is an exhaustively researched, intimate report by a journalist of the lives and deployments of three women in the Indiana National Guard, who, through serving together in Afghanistan, become friends. Each of the women joined the Guard prior to 9/11/2001, mostly for economic reasons. Thorpe selected women who were vastly different in age and background.  Debbie Helton becomes a grandmother during deployment and has served in the guard for decades - she is eager to be deployed. Michelle Fischer (a pseudonym) is newly out of high school, has liberal political views and sees the Guard as a way to pay college tuition. Desma Brooks is a single mother of three with a fractured and unreliable support system. All three have alcohol and or drug dependency issues. Brooks and Helton are deployed a second time - to Iraq.

 As one of the women, Fischer, notes, the Bush wars were an ‘economic draft' (p. 374) The struggles to find adequate housing, reliable partners, good schools, decent jobs, and to avoid the morass of drug dealing, which particularly surround Fischer and Brooks, are paramount in their lives.   

View full annotation

Summary:

Carol Levine's anthology of stories and poems about the intimate caregiving that takes place within families and among friends and lovers reminds us that the experience of illness reaches beyond clinicians and patients. It can also touch, enrich, and exasperate the lives of those who travel with patients into what Levine calls the land of limbo. This land oddly resembles the place where some Christian theologians believe lost souls wander indefinitely between heaven and hell. For Levine the limbo of familial caregiving is an unmapped territory. In it caregivers perform seemingly endless medical, social, and psychological labors without professional training and with feelings of isolation and uncertainty. Caregiving in this modern limbo, created by contemporary medicine's capacity to extend the lives of those with chronic conditions and terminal illnesses, has become, according to Levine, "a normative experience" (1).

By compiling this useful selection of well known and less familiar stories and poems, Levine increases the visibility of the experience of familial caregiving among works of literature about medicine. While illness literature is typically classified by disease or disability, Levine focuses instead on the relationships between caregivers and those being cared for. Her collection organizes the literature into five parts: Children of Aging Parents; Husbands and Wives; Parents and Sick Children; Relatives, Lovers, and Friends; and Paid Caregivers who assist families. The literature in each section tends nonetheless to represent particular conditions: dementias, including Alzheimer's disease, cancer, and frailty in the first two sections; childhood cancer, hyperactivity, and mental illness in the third; AIDS in the fourth. 

Probably the most familiar and powerful works include Rick Moody's "Whosoever: The Language of Mothers and Sons," Ethan Canin's "We Are Nighttime Travelers," Alice Munro's "The Bear Came over the Mountain" (the source for the film "Away from Her"), Lorrie Moore's "People Like That Are the Only People Here," and several poems: Mark Doty's "Atlantis" and selections by Donald Hall, Jane Kenyon, James Dickey, and Raymond Carver.

These and the less familiar works offer disparate responses from both caregivers and those they care for. The narrator of Tereze Gluck's "Oceanic Hotel, Nice" thinks "what a bad person I was to not even want to touch his feet. . . it made me shudder" (220). The wife in Ann Harleman's "Thoreau's Laundry" cannot place her husband with Multiple Sclerosis in a nursing home because "his presence, however diminished, was as necessary to her as breathing" (116). The caregiver in "Starter" by Amy Hanridge "didn't want to be the person people feel bad about" (180).  Several stories explore the limits of obligation. As is often the case, the son in Eugenia Collier's "The Caregiver" is sick himself, failing to schedule his own doctor's appointments and dying before his mother. Marjorie Kemper's witty, exuberant "God's Goodness" plays out an unexpected relationship between a dying teenage boy and his Chinese immigrant aide, while his parents remain in the background.

Carol Levine's brief introduction to the collection explains that she excluded excerpts from memoirs and selected only very recent literature, almost all from the past three decades. A Resources section at the end includes some introductory medical humanities resources and practical resources for caregivers.

View full annotation

Summary:

Leonardo da Vinci – the name alone evokes images of an artistic virtuoso, the Renaissance man, the mind behind the Mona Lisa. Though known best as an artist, his work extended beyond paintings into a myriad of disciplines, with notebook entries documenting his studies of optics, bird flight, comparative anatomy, hydraulics, and countless others. And yet what has been obscured by the shadow cast by his prolific career are the details of how a young man from a town called Vinci became Leonardo da Vinci. What did he do every day? What did he eat? Who were his friends? Did he even have any? We tend to immortalize Leonardo as a god, and yet he was human after all, not unlike the rest of us. This realization should encourage us to study one of history’s most celebrated humans, and see if we ourselves might be able unlock our own inner genius.

Walter Isaacson aids us in this study with his thoroughly researched biography of Leonardo da Vinci. He adds this to his growing portfolio of biographies of history’s great minds, including Benjamin Franklin, Albert Einstein, and Steve Jobs. In this most recent biography, Isaacson takes us through the life and times of Leonardo, highlighting milestones of his career, while also underscoring some of the seemingly trivial habits that were signatures of Leonardo’s personality and worldview.

Born of illegitimacy and openly gay, Leonardo was no stranger to defying convention. In fact, many of his grandest discoveries were a result of his willingness to challenge commonly accepted wisdom. Yet his greatest asset was his relentless curiosity and unquenchable thirst for knowledge, a recurring theme of Isaacson’s biography and of Leonardo’s life. Intertwined with this curiosity was his tendency to draw connections across disciplines, blurring the lines between art and science. Everything that Leonardo produced – whether his sketches of war machines, his treatises on anatomy, or his timeless portraits – was a manifestation of his desire for unifying knowledge.

View full annotation

Summary:

This is a gripping, informative, and well-researched book about human blood. An accomplished journalist, Rose George, covers a variety of topics, largely in the U.S., Britain, and Canada but also in Nepal, India, and South Africa. She describes many current issues, provides historical background, and speculates on future technologies, such as replacement of blood by other fluids. There are nine sections:

 “My Pint”  While the book’s title refers to the author's volume of blood, this chapter’s title refers to a single pint she is donating. We read about blood supply (donated and stored blood) in the U.S. and—by contrast—in India.

“The Most Singular and Valuable Reptile” refers to the leech. This arresting chapter describes both historical and  modern uses of leeches to gather blood from humans. She visits a company called Biopharm in Wales where leeches are raised and prepared for shipment to medical clinics and hospitals.  

 “Janet and Percy” is a historical chapter focusing on Dame Janet Maria Vaughan, a central figure in creating the Blood Transfusion Service in England during WWII and Percy Oliver, who guided its predecessor, the London Blood Transfusion Service.  

“Blood Borne.”  This chapter describes Khayelitsha, South Africa, “the ugly backside of Cape Town” (p. 100): a place of poverty, crime, rape, sexual predation, and HIV. While rich nations provide assessment and treatment for people with HIV, poor nations have many citizens infected with the virus and, over time, rising rates of infection. 

 “The Yellow Stuff” describes the plasma portion of blood; it can be frozen (as FFP) and used as a filler for bleeding or trauma patients. Unlike blood—which can only be given without payment—plasma can be collected from paid donors. It is a largely traded commodity, part of a multi-billion dollar industry worldwide. Plasma carries Factor VIII, a crucial protein for clotting blood; hemophiliacs lack this and are at risk for death by bleeding externally or internally. Some plasma has been tainted, for example by HIV.

“Rotting Pickles.”  In Western Nepal (and other places), menstruation is taboo. George writes, “We are in a minority among species, and among mammals, to bleed every month.” She reviews historical views of women’s periods, mostly negative. Worldwide, there are many taboos, but also some educational efforts for public health that are helpful in impoverished areas.  

 “Nasty Cloths.” This tells the unusual story of an Indian man named Muruga, “a poorly educated workshop helper” who became a leader in creating sanitary protection for menstruating women. Worldwide, the feminine hygiene industry is some $23 billion. George also reviews related history, including Toxic Shock Syndrome from tampons.  

 “Code Red.” Bleeding is often a fatal factor in trauma, even with the best efforts to transfuse blood into the patient, unit after unit. George observes open chest techniques at a resuscitation. She reviews breakthroughs in blood typing, component therapy, and “buddy transfusions.”  

“Blood like Guinness: The Future.” George starts with images from the past: vampires, human drinkers of blood, past and, even, present. She interviews a purveyor of the concept that “young blood” is healthier than older blood. Can there be, discovered or created, blood substitutes that also save lives? 

View full annotation

Summary:

Dr. R. K. Smile, MD, founder of Smile Pharmaceuticals, Inc. (SPI), enjoys a sudden lurch into fortune and celebrity. Dubbed the ‘Little King’ by his Atlanta-based Indian community, Dr. Smile is a towering medical authority, philanderer and philanthropist, known to be both generous and avaricious. His pinnacle pharmaceutical coup, the patent that has earned him billionaire status, is InSmile™, a sublingual fentanyl spray designed for terminally ill cancer patients. Dr. Smile’s entrepreneurial vim, however, hardly stems from benevolent medical research, but rather an ‘excellent business model’ that he observed on a visit to India during which a Bombay ‘urchin’ handed him a business card that read, ‘Are you alcoholic? We can help. Call this number for liquor home delivery.’ The blunt practicality of building a market around sating addiction strikes the doctor as entirely sensible. Often wistful about India’s ‘old days,’ Dr. Smile fondly recounts the insouciance of neighborhood dispensary hawkers, their willingness to ‘hand out drugs without a doctor’s chit.’ Though admitting that ‘it was bad for [their] customers’ health but good for the health of the business,’ Dr. Smile yearns to replicate a similar culture of delinquent pharmacology, an unregulated market capable of profiting from supply-and-demand forces but indifferent to the wellbeing of its patrons. 

In the meantime, Dr. Smile’s wife, Mrs. Happy Smile, a simpering and daft socialite, envisions grand branding prospects that will globalize the Smile name through ostentatious publicity—inscribed name placards at the ‘Opera, art gallery, university, hospital […] your name will be so, so big.’ She refers to the worldwide reputation of the OxyContin family, the proliferation of the family’s name and esteemed place among prestigious cultural institutions: ‘So, so many wings they have,’ she says, ‘Metropolitan Museum wing named after them, Louvre wing also, London Royal Academy wing also. A bird with so, so many wings can fly so, so high.’ 

InSmile™ sales drive Dr. Smile’s burgeoning drug trade, as his prescription becomes preferred to conventional OxyContin highs due to its ‘instant gratification’ in the form of an oral spray. While SPI fulfills special house-calls for American celebrities and customers in ‘gated communities from Minneapolis to Beverly Hills,’ it also ships millions of opioid products to places such as Kermit and Mount Gay, West Virginia—communities, outside fictional contexts, that bear real-world vestiges of the opioid epidemic (West Virginia has the highest rate of drug overdose in the United States). Through a lecture series scheme, Dr. Smile bribes respected doctors to publicize and prescribe the medication, further entrenching the dangerous drug in medical circles.

As the SPI empire collapses following a SWAT-led arrest of his wife, Dr. Smile muses indignantly on his reputation and the ingratitude of his clients. Tugged again by nostalgia for the old country, he justifies his drug trafficking by likening it to quotidian misdemeanors, instances when one could circumvent the inconveniences of India’s law by knowing how to pull the venal strings of corrupt systems—like cutting a long ticket queue at the rail station, he says, by paying a little extra at a backyard office; or bribing government officers to stamp customs papers required to ship restricted antiques abroad—‘We know what is the oil that greases the wheels.’ With this deleterious mindset, combining nostalgia and entrepreneurial greed, Dr. Smile’s future is uncertain, but he is resolved to return—after all, he says, ‘I have lawyers.’

View full annotation

Summary:

The Eye in the Door is the second volume in Pat Barker’s Regeneration trilogy (the first and third volumes, Regeneration and The Ghost Road are also annotated in this database).  It continues the story of Dr. William Rivers and the soldiers he treats for shell shock, what we today would call Post-Traumatic Stress Disorder, in World War I era Britain.  The action has now shifted from Craiglockhart War Hospital, near Edinburgh, to London; and while Rivers remains a primary character, seeing patients now at a London clinic, this volume focuses on Rivers’ relationship with Billy Prior, an officer who was treated at Craiglockhart after a service-related nervous breakdown. 

Billy Prior, released from service on the Front and now serving on “home duty,” is working in the Intelligence Unit of the Ministry of Munitions, a domestic information-gathering and surveillance unit.  England, on wartime footing, is rife with paranoia and conspiracy theories, and the primary objects of state surveillance are two groups of people felt to be disloyal or untrustworthy:  conscientious objectors, or “conchies,” and homosexuals, who are seen as both abnormal and subversive.  The state is unremitting in its hounding and pursuit of these two groups, and is in fact “the eye in the door,” always watching and ready to pounce. 

Although Billy is an officer and has a position in the surveillance apparatus, he is living a double life, and is doubly at risk in this environment.  He is bisexual; the book opens with him failing to complete the seduction of a young woman and promptly thereupon having a liaison with a fellow officer whose wife and children are out of town.  This officer, who also works in the Ministry, has been vaguely threatened about his association with the presumed network of homosexual subversives.   In addition, while Billy is not a pacifist, he has friends from his childhood in working-class northern England who are conscientious objectors.  These friends may or may not have participated in terrorist activities, are either currently in jail or wanted by the police, and are no surer than Billy is as to exactly whose side he is on.  

Prior plays a dangerous double game, attempting to use his position in the government to help his old friends, and continuing treatment with Dr. Rivers, as his past psychological traumas continue to intrude upon, and complicate, his personal and professional lives, building to a powerful conclusion.

View full annotation

Summary:

Dr Hunter’s 75th birthday in April 1948 falls forty years to the day after he started practice in the little prairie town of Upward. He is retiring, moving away to the big city of Saskatoon, and the citizens have gathered to say fare-well. They celebrate in the patient lounge of the new hospital soon to open bearing the name of this long-time servant of all Upward’s needs--physical, mental, social. The doctor has donated his late wife’s piano and the board is already planning to sell it for much-needed cash. It tinkles softly, unwelcome songs are awkwardly sung, coffee and sandwiches served, while the crowd of locals chatters away sotto (and not so sotto) voce, with each other and the doc. 

Over the course of the evening, forty years of memories unfold: births, couplings, deaths, desires, hostilities, random acts of kindness and of spite. Folks sidle up to the doc to express thanks for his support and wisdom. The pharmacist wishes he had prescribed more pills. The journalists want him to spill secrets for a feature article in the local rag. The minister engages him in a debate over the existence of God and the meaning of life—both of which the medic denies. Gossips watch, whispering to each other about the doctor’s imagined survival and his dead wife whose alleged frigidity justified his supposed numerous infidelities. 

Shopkeeper Sarah’s revisits her embarrassed memories of adolescent attraction, that ripened into adult affection and pleasure that the doctor has long treated her son Dunc with almost fatherly care, taking him and the big but isolated Ukrainian boy, Nick, on house calls. Home from overseas with an English war-bride and now running the store, Dunc presides over the evening, trying to smooth conflicting undercurrents. The gossips speak sweetly to the newcomer bride and behind her back predict the marriage will fail.

It emerges that the incoming young medic will be Nick, once mercilessly bullied as a “hunky kid” by a few shiftless bigots still languishing in Upward. They are convinced that he is returning to extract his revenge. The old doctor defends Nick in his final words and urges his patients to help the young successor. He knows that they can briefly come together in a crisis, but he scolds them for their chronic lack of charity to strangers and to each other.

View full annotation

Summary:

Lucy is a novel named for the female hybrid offspring born of a bonobo mother and human father, a creature called, at various times, a "humanzee" since the bonobo, a great ape found in the Congo in Africa, is occasionally referred to as a pygmy chimpanzee. The result of artificial insemination by her father, Donald Stone, a British anthropologist in the Congo with aims to improve the human species, Lucy is a very human looking 15 year old girl.

The novel begins in medias res when Jenny Lowe, an American primatologist whose camp is near Dr. Stone's, is awakened by the sound of gun fire from nearby insurgents.   She goes to Dr. Stone‘s camp, finds the anthropologist and an adult female bonobo lying on the ground, both dead from gun shot wounds. Near the two bodies is a living teen aged girl, Lucy, whom she rescues and manages to spirit back to her home base, Chicago, where Jenny‘s friend and lover, Harry Prendeville, a charismatic surgeon, awaits her. Lucy enrolls in high school, her genetic heritage kept secret from all save Jenny who discovers -- in one of several nods to Mary Shelley's Frankenstein -- Dr. Stone's notebooks.

Lucy meets and becomes best friends with Amanda Mather, a classmate (this relationship is far from clearly a strictly heterosexual one) and becomes the state wrestling champ because of her bonobo-inherited skill, strength and speed. When Lucy contracts a viral disease that bonobos, not humans, acquire and her secret is about to be exposed (Jenny, Amanda and Harry now all know), Lucy does what all 15 year olds would do in 2010 (the book is set in present time) - she outs herself on Facebook. (O tempora, O mores!)

The novel now enters the accelerated phase of denouement with expected and unexpected reactions from TV, the violent right (think Mickey the Gerund in Cast of Shadows in this database), Congress and the public. Without revealing too much plot as a spoiler, suffice it to say that a governmental scheme to abduct Lucy for the purpose of NHP (non-human primate) experimentation becomes a reality with devastating consequences that allow for a thrilling read with its share of tragedy and triumphs and ending with an unusual yet fulfilling conclusion satisfying for most concerned, especially Lucy and those who love her.

View full annotation