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Cries and Whispers : VITAL LINES: Contemporary Fiction About Medicine, Jon Mukand, editor (A Thomas Dunn Book/St. Martin's Press: $22.95; 439 pp.)

February 17, 1991|Perri Klass | Klass is a physician and author. Her most recent book is "Other Women's Children" (Random House), a novel

For most people, contact with the medical system is fraught with anxiety--powerlessness; a sense of helplessness in the face of unfamiliar jargon; terror, always, of disaster. In this collection of fiction about medicine, these themes recur, as if many of the writers hoped, by making fiction out of this experience, to give back to frightened patients some ability to speak for themselves, to express their fear and their anger. Eloquent voices describe the sensations of people in the grip of illness, of people watching their relatives struggle with hospitals.

"Hospital gowns, like examining tables, are designed for convenience of doctors, easy access. I play the fighter and am allowed to wear tops and bottoms of men's pajamas with the name of the hospital in an allover pattern in Christmas colors. Not bad, but why no collar? The back of my neck is cold." Like the narrator of Layle Silbert's story, "Losses," many of the characters concentrate on the deprivations of dignity, large and small, which are visited on those whose bodies have betrayed them, gone over to the enemy.

In these stories, many patients cry out the feelings they are too well-behaved even to whisper to their doctors. "Doctor" by Thelma Nason begins, "Dear Doctor, How can you calmly light a cigarette when my insides are retching? How can you calmly cross your legs when I want to fall to my knees in front of you and beg you to take back those words 'seriously crippled . . . had hoped for better results.' "

But this collection is much more than a series of accounts of illness and its indignities, doctors and their insensitivities. It is a collection of stories, a remarkably varied assortment of narratives, all connected because each somehow concerns medicine. Some are stories about patients; others about doctors and nurses.

The editor of the collection, Jon Mukand, a physician and a poet, points out in his long and interesting introduction that there are many connections between fiction and medicine: "The patient can be viewed as a text, the medical encounter as a literary analysis. Much of what doctors do, when approaching patients, is to construct a coherent narrative. Using our own specialized and almost impenetrable jargon, we attempt to impose on the confusion of pain and illness a discipline of identifiable signs and symptoms, of distinct pathological processes, a chronology of cause and effect."

The collection is organized by theme; there are, for example, sections on "Women," on "Disability," on "the Medical Environment." In some ways, this gives the book an initially disconcerting aspect, the air of a textbook rather than an anthology of fiction. However, there are no reading-comprehension questions at the ends of these sections, and in fact this volume should be read to appreciate the complexity of both fiction and medicine, rather than to teach lessons about any specific topic. The variety of fiction offered here is too rich, too articulate, too powerful to be used to point out specific morals.

There are some familiar stories in this book: Raymond Carver's "Cathedral," Joyce Carol Oates' "How I Contemplated the World From the Detroit House of Correction and Began My Life All Over Again," and others by well-known authors. These stories seem particularly interesting to reread in this context, surrounded by other, much less familiar pieces of writing with overlapping themes.

(There also are a couple of selections which are not obviously fiction: A wonderful piece, "An Infected Heart," about a cardiology team taking care of a man who says he was burned when saving a family from a burning house, is a first-person narrative by John Stone, himself a cardiologist.)

There are unexpected stories making fiction of unlikely medical situations. "Fertility Zone" by Patricia Eakins is a remarkably affecting story about a nurse's aid, herself trying desperately to get pregnant, describing a medical miracle: a baby delivered by Caesarean section of a woman who is brain-dead after a car accident. It is this narrator who detours on her way to see the miracle baby, and stops to speak to the comatose mother. "Now you're dead, and tomorrow you'll be deader. I'm worried no one told you right out, you gave birth to a fine girl. I know you'd like to hold her, your good red kid bawling for life. I'd like to hold her myself," she says.

Thus, from personal tragedy, from large agonies and from small erosions of personal dignity, writers fashion fiction. There are the dramas of medical headlines, there are the confusions and dilemmas of those who give care, and, above all, there are the strong and healthy voices of those who receive it.

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