Dannie Abse “Case History”: poem
As “Case History” makes clear, Dannie Abse brought to the practice of medicine his full identity as a Jew, a Welshman, and a physician. His willingness to reflect on his duty to consider the welfare of his patient while acknowledging his barely contained fury is wonderfully expressed.

Felicia Nimue Ackerman “Applicants”: short story
Ackerman examines the emotional calculations that may determine the fate of a desperately ill patient. Eligibility for expensive and technically sophisticated transplant surgery rests on many factors. Ackerman’s incisive short story explores some of the criteria not always understood, including the presumed value of a close relationship with a potential caregiver. From the perspective of the applicant, the cost of receiving care may not be quantifable using conventional means.

Henri Barbusse “The Eleventh”: short story
Long before the advent of Managed Care, Henri Barbusse contemplated the spiritual costs of care that is rationed. “The Eleventh” evokes all the dimensions of suffering in a world ruled by the unequal distribution of scarce resources. Ordinarily when we consider Managed Care, we focus on the needs and frustrations of the ill and those who represent them. Barbusse shows the moral devastation of those who carry out the rules of scarcity; he provides a measure of the real costs to a whole culture in which not enough care can be given.

Joy Harjo “Three Generations of Native American Women’s Birth Experience”: essay
When she writes of the births of her two children, Harjo, a Native American writer and activist, soberly contrasts the experiences: one, when she was barely sixteen, and the other, four years later. She embeds each experience in the history of her family and her tribe, and implicitly in the experience of childbirth in a world divided by race and generation. Harjo walks between and within these worlds, allowing the reader to share a series of complex birth stories whose meaning is still evolving.

Leslie Nyman “Wisteria”: short story
Being present at the death of a patient remains one of the greatest challenges and rewards of giving care. Leslie Nyman was a registered nurse for fifteen years, and her short story comes to us from that perspective. “Wisteria” evokes memory and nostalgia, in which in a patient, who drifts in and out of reality, frightens a young and inexperienced nurse.

Jonathan Shay “Betrayal of ’What’s Right’”: excerpt, non-fiction
Jonathan Shay, MD, PhD, has now written two books about his work with traumatized veterans of the Viet Nam war; this excerpt is from the first, Achilles in Vietnam. Shay treats and studies trauma in the context of the Trojan War, as reported by Homer. The juxtaposition of ancient literature and contemporary suffering serves to enlarge and deepen the veterans’ and the reader’s understanding of the immediate and long-term consequences of physical and emotional trauma.

“It has helped me better understand the duties of my co-workers, the stresses they face, and the importance of listening to the patient. The information and insight I have learned will help me provide better service to the hospital staff and patients.”

“[It] broadened the scope of my experience interacting with such a range of individuals within our organization. There is no other such unique opportunity [that is so] very enriching. It gives me hope for the health of the organization within the larger healthcare system.”

“It helped me to better understand the other cultures and not to be so hasty in making judgments until I had all the facts and understood more about their medicine.”

“I gained more respect for diverse cultures and the ways things are seen in relationship to medicine.”

“I am a clerk. Patients walk in the front door and come to me for answers whether the question has to do with my department or not (Primary Care)... Angry veterans come in everyday and get angry with the system, etc...[Our discussion of Achilles in Vietnam helped me understand that] it isn’t me [they are angry with], it’s what they live with. I can better separate myself from their anger instead of taking it personally.”

“I was having some difficulty interacting with a staff member from a group outside of my own team. As we got to know each other better through this program we...came to appreciate each other in new ways. The project that we were working on went on to become very successful.”