BYLINE: Staff

SECTION: REVIEWS; Fiction; Pg. 28

Winner of Canada's Giller Prize, Lam puts all the sex, and death and sleep deprivation crucial to any hospital drama in his debut story collection about doctors in the making. Thankfully Lam, an emergency room physician, looks beyond blood and guts to examine the conflicted hearts and minds of the four medical students sleepwalking their way through the required tests, dissections and all-night emergency room shifts. The stories trace an almost endless stretch of education and service that puts their stamina and skills to the test: Fitz (short for Fitzgerald) has a not-so-secret drinking problem, the fallout from which that lands him an unexpected job; Ming, the main cast's only woman, has a cold scientist's outlook that both aids and hinders her; Sri's heart breaks for anything that comes near his scalpel-be it a tattooed cadaver or a rambling psychotic; and dispassionate Chen struggles, like Sri, to balance compassion with his desire to succeed. The stories' quiet strength lies not in the doctors' education but in Lam's portrayal of the flawed humans behind the surgical masks. This collection made a big splash in Canada, and, as Weinstein Books' first title, is poised to do the same in the U.S. (Sept.)

THE VOGUE 20
WHAT'S HOT FOR SUMMER (& COOL FOR FALL)

SECTION: WHAT'S HOT FOR SUMMER (& COOL FOR FALL); PEOPLE ARE TALKING ABOUT; Pg. 88 Vol. 197 No. 07

11. great escapes … Finally, two debut story collections examine modern life with Chekhovian grace: Nalini Jones's India-set What You Call Winter (Knopf) and ER doctor Vincent Lam's Giller Prize-winning Bloodletting and Miraculous Cures (Weinstein Books).-m.o.

A star is assigned to books of unusual merit, determined by the editors of Kirkus Reviews.

A searing, perfectly paced set of linked stories that explores the careers and relationships of four Toronto doctors.

Ming, Chen, Fitzgerald and Sri are young physicians whose lives intertwine both casually and intimately as they navigate the painstaking (and often painful) road to becoming physicians. We first meet Ming and Fitzgerald in Ottawa as they are studying for their pre-med exams and cautiously entering a relationship doomed by Ming's career-obsessed immigrant parents, the ghosts of abuse by her older cousin and, above all, the knowledge that Ming will be accepted to medical school and Fitzgerald will not. He does follow her, eventually, but not before she has linked herself with a more appropriate boyfriend, her lab partner, Chen. The tension between the characters pales, though, when they graduate and begin their careers. Each must face situations that test their abilities, their integrity and their strength. A paranoid mental patient, for example, who is obsessed with his neighbor and also convinced that she is trying to poison him, causes Sri to momentarily doubt his own sanity. And Fitzgerald wonders how to care, both physically and mentally, for a hostile patient brought to the hospital in shackles by unsympathetic police officers. When Sri is diagnosed with pancreatic cancer, the tables turn on him, and his role as a life-saver ironically becomes futile when he cannot save his own. The stories culminate in a health crisis of a much larger scale, when Fitzgerald contracts the SARS virus from a patient, and then passes it to Chen, who examines him. The two wait in quarantine, once romantic rivals, now reliant on one another, and suddenly their profession seems to be at once pointless and more important than ever.

Tender insight into the fascinating emotional and social implications of a career that is, inherently, so much more than a job.

BYLINE: Jennifer Armstrong

SECTION: THE REVIEWS: BOOKS; Pg. 82 No. 952

Lam's M.D. training pulses through this novel-in-stories about young Canadian docs in obvious ways, from the anxiety of getting into med school to the drudgery of dissections to the dire stakes of everyday patient care. But it also shows up in subtler details. In painfully visceral descriptions, Lam explores an alcoholic doctor with SARS and a pregnant patient undergoing a C-section without proper anesthesia. It's hard not to compare stories about doctors' overlapping lives, loves, and patients to Grey's Anatomy, but Bloodletting cuts deeper in the way only books can and without any McNicknames or supply-closet hookups. A-

LAM ''The reason that someone comes to the emergency room...is that they have had a plot twist.''

For his debut book, a collection of 12 linked stories about aspiring physicians called Bloodletting & Miraculous Cures, Vincent Lam became the youngest winner of Canada's prestigious Giller Prize. And talk about writing what you know: Lam, now 33, completed the book between shifts at Toronto East General Hospital, where he works as an E.R. doctor and is working on Cholon, Near Forgotten, a novel set in Saigon during the Vietnam War, due next fall. Fred McKindra spoke to Lam about his dual careers.

ENTERTAINMENT WEEKLY: Would you consider yourself a doctor who writes, or a writer who heals?
VINCENT LAM: That totally depends on what I'm doing right then. When I'm in the hospital, I'm a doctor. And when I'm writing, the writer side comes to the fore. So I've thought about this exact question, in terms of what to do going forward, and I really have not been able to say that one wins out over the other. It's funny, the way I became interested in medicine was kind of tangential, and the first thing I wanted to do was I wanted to write.

So you decided to be a writer first?
I decided to be a writer first, so you would think that the writer stays primary. But I got the idea of doing medicine. And I thought a lot of the writers who I admire have gone out into the world and done stuff. And so I want to emulate them. I don't really want to go fight in a war. I'm not interested in violence and guns, and any of that sort of thing. I don't mind blood. Maybe the best to do would be to become a doctor. But what I realized very, very quickly was that it wasn't going to work out exactly as I planned. It's not that simple. I really felt taken by the whole enterprise of doing medicine and helping people. The thing about leaning medicine is that if you learn it the way it's meant to be learned, you immerse yourself in it, you throw yourself into it, then it changes you.

What's the change?
Before I became a doctor, before I started spending a lot of time with really tragic things, there were a lot of things I took for granted. It would never have occurred to me that it's so great just to be walking down the street. You see that bad things can happen really suddenly, and healthy people can suddenly find themselves in the midst of all sorts of health problems.

Tell me about the role of a doctor as storyteller.
The reason that someone comes to the emergency room in the first place, is that they have had a plot twist. Their life is going along in such a such direction, and then boom, something happens. And that's when they come to me. And so basically what they're looking for is an interpretation of that plot twist. As well as treatment, some way to make it better.

Tell me about your process.
When I'm drafting, I give myself total license, and I overwrite and try to be as uncritical as possible, and I usually come out with 40 pages of crap.

Typed?
Typed. Then I look at it, and the sentences are horrible. I have a weakness for run-on sentences when I draft. I change verb tense with no conceivable explanation. I start off using one name at the beginning of the story and end up using a different name by the end. But then I take a hard critical look, and I'm ruthless when I edit. I think, ''Okay, you had your chance to be free, so now get out the old scalpel and snip, snip, snip.'' I always take this particular brand of blue pen that I like, and I draw arrows and I'll cut out part of the paragraph, and then think, ''Oh, that should go up here.'' It looks like a war zone after I'm done.

Vincent Lam's first book of fiction, "Bloodletting & Miraculous Cures," comes to the United State an already proven deal. The story collection won Canada's prestigious Giller Prize in 2006, the first time a premiere work ever had the honor, and "Bloodletting" was a best-seller in that country. Weinstein Books was so sure about the book that the new publishing house not only made "Bloodletting" its first acquisition but also will publish Lam's forthcoming first novel.

"Bloodletting" is worthy of all that attention.

An emergency physician in Toronto, Lam writes from experience, and with accuracy and confidence. He even includes an 11-page medical glossary. The loosely connected, layered stories of "Bloodletting" follow four young doctors-in-training into their medical careers - two successful, one not and one prematurely stunted.

The book opens with a tentative courtship between Ming and Fitz, two undergraduates in Ottawa hoping to get into medical school. Ming, unable to escape the unbending expectations of her disapproving immigrant parents, insists that their relationship remain secret. After she gets into medical school, she moves to Toronto, leaving Fitz behind. In her first year, she meets two fellow students, Chen and Sri, with whom she spends a semester dissecting a cadaver - Murphy, as Sri calls him.

By the time Fitz follows Ming to Toronto and medical school a year later, their lives have shifted in ways both expected and surprising. Ming, Fitz, Chen and Sri quickly graduate from cadavers to living individuals, although death is always a looming, sometimes unavoidable outcome. Bloodletting - whether from injury or in an attempt to heal - is constant, miraculous cures happen rarely if ever, and calling the time of death is all too frequent.

As the most ambitious of the foursome, Ming seems to have the most balanced life, sleeping and waking at regular hours, bringing new lives into the world even as others depart too quickly. Like the rigid study plan that originally got her into medical school, her life remains well ordered and predictable, and she moves through it with even, if detached, determination.

In sharp contrast, Fitz is out of control, forced out of his hospital career with barely his credentials, much less his dignity, intact. On call as the attending physician for emergency air evacuations, he never knows where he might be each day, crisscrossing the world, chasing the next desperate call for help, never finding his own salvation.

Back at the Toronto hospital, Chen's career eventually settles into a sleep-deprived existence in the emergency room, where he works long hours in the middle of the night. While most people slumber peacefully - including his doctor wife - Chen dazedly tries to save the medically needy while dealing with the emotionally desperate.

Sri, a vulnerable loner hoping to make human connections, goes beyond his resident-on-call duties to seek out a psychotic patient at his home, arriving just in time to keep the patient alive and prevent injury to others. Sri also attends to the surviving family of a man brought in DOA whose demise presents questions to which the man's wife and son must seek out the final sordid answers.

With four distinct narrative threads that mingle, diverge and ultimately come together, "Bloodletting" is a swift, dynamic read. From story to story, Lam unveils his characters' lives in careful ellipses, leaving clues like puzzle pieces to twist this way and that, each detail eventually dovetailing to form a picture.

Lam's characters are flawed, and while they sometimes have the ability to save, they are hardly miracle workers. They get frustrated and tired, they aren't always sure of their choices, they don't always like what they're doing or the patient they're treating. And, in case they get too convinced of their power to heal, they learn that in the blink of an eye a doctor can become a patient.

What makes "Bloodletting" so remarkable is its depth. The stories are entertaining on their own, but if you delve more deeply, you'll find human lessons sketched out with subtlety.

From interracial and generational relationships to sexual abuse to medical school admissions ethics to the failure of the medical insurance system (yes, even in Canada!), it's all here, and so much more.

Lam entertains and educates with fluidity and style, and that just might be a miraculous cure of the literary kind.

Terry Hong is media arts consultant at the Smithsonian Asian Pacific American Program.

This article appeared on page E - 2 of the San Francisco Chronicle

BYLINE: Moira Macdonald, Special to The Seattle Times

SECTION: ROP ZONE; Books; Pg. K9

Setting foot in a hospital can be like visiting a foreign country: The language is strange, the customs and dress at times mystifying (is that man in scrubs a doctor, or a janitor?), the pace entirely its own. Canadian physician Vincent Lam, making his fiction debut with the short-story collection "Bloodletting & Mysterious Cures," arrives as a welcome guide. His book, winner of Canada's 2006 Giller Prize for fiction, lets us peek behind those swinging doors at the end of a hospital's echoing hallway; we overhear conversations, gaze at patient charts, let out our breath at the end of a failed resuscitation.

Lam's writing is both minimalist and elegant, like a taut line of stitches perfectly placed. The book's dozen interwoven stories feature four main characters: Fitz, Ming, Chen and Sri, all known primarily by their last names.

They go through medical school together, learn to work with cadavers (theirs is christened Murphy, "a dignified but comfortable name"), listen to emergency-room patients who may or may not be delusional, fall in and out of love with each other and gradually become comfortable with their new identities.

"Contact Tracing," the book's most haunting story, takes us inside the SARS epidemic in a Toronto hospital's respiratory isolation unit. A group of nurses participates in a lottery to decide who will take care of the SARS patients, with a union rep efficiently drawing tags from a box. Among those with red tags, "some cried openly, or left the room to do so."

Fitz, himself a patient in one of those isolation rooms, ponders his role reversal: a patient, still called doctor. While uncomfortable with the title, he cannot leave it behind; it was, he reflects, "his best and last and only piece of clothing which, despite its flaws, could hardly be discarded."

Moira Macdonald is the movie critic for The Seattle Times.

By ABIGAIL ZUGER, M.D.
Published: October 2, 2007

For all the griping about the sad state of the medical profession, immigrant families have never stopped propelling their children firmly in its direction. North American hospitals are increasingly staffed by these obliging children, some greeting patients with the exotic inflections of the newly arrived, some already assimilated into the pure vernacular.

They are doctors like Ming, Chen and Sri, who, along with their colleague Fitzgerald, grow from pre-med students into veteran doctors in Vincent Lam’s collection of intertwined short stories. Published in 2006 in Canada, where it won the Giller Prize for fiction, this lovely book breaks ground on several fronts, not the least of which is its depiction of the tentacles of obligation and expectation encircling these young people.

Doctors who write about medicine tend to dwell on the big themes: life, death, suffering, hope and the rest. Dr. Lam, a Toronto physician, covers that territory, too, but he also takes a pioneering look at the particular situation of the modern immigrant doctor, suspended by strong and often opposing ties to profession, cultural heritage and family, with patients who may seem as alien as if from Mars.

Thus, early in the book, Ming, Chen and Sri, medical students in Toronto, contemplate the tattoos over the biceps of their medical school cadaver with detached concern, as they would the hieroglyphics of an ancient civilization. They can decipher “RCAF — 17th Squadron” and the crude cartoons of Spitfire planes etched beneath it without much problem, but “The Lord Keeps Me — Mark 16” on the shoulder has them perplexed.

“‘It’s one of the four books in the second half,’ said Chen.

“‘What is that part?’

“‘Umm ... I don’t know...’

“‘It must mean something,’ said Sri.

“‘I’ll look it up for you,’ said Chen ...

“‘The manual shows,’ Ming said, ‘to cut here.’”

Ming is the classic pre-med overachiever, a plodder who specializes in brute memorization as she strategizes to ace exams. She votes to cut right through the tattoo, because that is where the textbook says to cut. She becomes an obstetrician; we glimpse her years later, a seasoned professional, thrust into a once-in-a-lifetime emergency that gives her no alternative but, for once, to break all the rules.

Sri, soft-hearted beyond all necessity or common sense, votes to preserve the tattoo. “You should respect a man’s symbols,” he says. “My mother told me that. Look at his arm. These are his symbols.” Even after years of training, Sri’s intractable kindness leads him away from the beaten path, as he wanders alongside patients more like a guardian angel than a medic.

Chen, a bland, pleasant, responsible guy, is descended from Chinese expatriates in Vietnam (like Dr. Lam himself) with an extended family scattered over the globe. As a medical student, he spends a summer in Australia, trying his best to minister to his dying grandfather, a vice-ridden, womanizing patriarch as colorful as Chen himself is colorless. Chen becomes an E.R. physician (again like Dr. Lam), working shifts that vary between stultifying and terrifying. He commutes to work in a fast, expensive car, playing an aggressive game of chicken with the drivers in the next lane, the kind of reckless risk-taking behavior he cannot indulge in anywhere else.

All are recognizable types, drawn with precision and affection. Fitzgerald, though, is a little different: he is more a novelist’s creation, a real tragic hero. The only Anglo among them, an incompetent with chopsticks, he is the true outsider in the group, an obsessive philosopher always just a little out of step with his colleagues and his profession.

The others never question their place in medicine; Fitz never stops questioning his, until he is plunged directly into the SARS outbreak that gripped Toronto hospitals in 2003. The rest of the world may have forgotten those few months of terror, but hospital workers in Canada glimpsed the apocalypse, as we clearly see here.

This is not a perfect book. It has its share of blood-and-guts cowboy medicine suitable only for network TV, and a few too-facile resolutions of various improbable plot twists. Still, Dr. Lam, whose mentors include the author Margaret Atwood, has enough talent to sculpture a story considerably more nuanced than the usual thinly disguised autobiography doctors like to call fiction. Presumably much of the book is, in fact, memoir, but the joints between the imagined and the recalled are seamless, and the fiction does its job of turning mirror into magnifying glass.

Readers will have become fully immersed in these characters before they realize that each has only one name. The students Ming, Chen, Fitz and Sri graduate from medical school to become Dr. Ming, Dr. Chen, Dr. Fitzgerald, Dr. Sri. Are they all going by their last names alone, a macho band in green scrubs? Are they icky-sticky first-name doctors like Oprah’s Dr. Phil? Do the Asians have the tongue-twisting ethnic names that have forced them to create short nicknames, yet one more sacrifice of identify? We never find out.

Perhaps it is simply a demonstration that a single name suffices for people whose other name quickly becomes “Doctor.” So the wily author both distances us from his characters, and draws us near.

By EVAN HUGHES
Published: October 28, 2007

In “Night Flight,” one of the best of the linked stories in Vincent Lam’s first book, a Toronto physician named Dr. Fitzgerald takes a jet to Guatemala to treat a tourist who’s had a stroke. In the middle of the night a local doctor tells Fitzgerald that a recent CT scan and a neurosurgeon were unavailable, and the pair discuss the grave outlook. “We do not say it directly,” Lam writes, “but we talk around the regret of a lost opportunity: the narrow time frame in which an expanding death in the form of a bloody intracranial expansion can perhaps be drained, can sometimes be sucked out like an evil spirit to leave the scintillating brain intact.”

After the patient dies on the flight out, his wife asks if the better treatment available at home might have made a difference. Fitzgerald lies to her “with the greatest tenderness I have within me.” Later the same day, in the story’s closing scene, Fitzgerald sits with his assistants in a hot tub and plays a parlor game in which they ask one another to choose between various hypotheticals, like “being famous and destitute, or rich and anonymous.”

That ending could make Fitzgerald seem callous. But by now Lam has fully brought him to sympathetic life. We know, for example, he’s the kind of man who’d prefer not to know if his spouse had a one-night affair; and we’ve learned, a number of stories and years earlier, that he lost his beloved girlfriend, Ming, to an affair he was only too aware of. In a later story, “Contact Tracing,” Fitzgerald contracts SARS and ends up in isolation alongside Chen, the doctor who took his girlfriend away.

Lam excels at this kind of steady accumulation of truths, a tangling of action and incident that renders judgment of the characters difficult, and futile besides. The writing is often lovely — Fitzgerald, jilted by Ming, longs “to tip over the meniscus of anger that grew like water perched higher than the rim of a glass” — and generally understated. So subtle is the narration, and so committed is Lam to the primacy of showing over telling, that dramatic potential sometimes goes underrealized. In “Contact Tracing,” for example, when Chen breaks through a glass partition to save Fitzgerald when he stops breathing, the scene is recounted through a banal evening news clip, lending an otherwise harrowing story an air of anticlimax.

Lam is better when he emphasizes the inherent strength of his material. He is himself an emergency physician and thus brings to mind Somerset Maugham, William Carlos Williams and Chekhov — the first a former medical student and the others doctors for the whole of their literary careers. But Lam’s work fits better among that of nonfiction writers like Jerome Groopman, Sherwin Nuland and Atul Gawande. He writes what is sometimes called “documentary fiction,” providing an insider’s view of his field, replete with the stark juxtapositions — notably the privilege of the treater with the powerlessness of the treated — and the moral hazards that characterize the profession. Some of the best stories in “Bloodletting & Miraculous Cures” read like journalistic dispatches from the medical front lines, with careful psychological characterization added. As such, Lam’s book represents a promising demonstration of fiction’s unique power: to bring the news that stays news, in Ezra Pound’s formulation, and to allow the reader to see through the eyes of those who experience events firsthand.

In “Eli,” a disturbing and unusually raw story, Fitzgerald must treat a raving man who has been arrested and probably brutalized by the police officers who have brought him to the hospital. The patient shakes loose from the cops and bites Fitzgerald, breaking the skin and jolting him into this thought: “Within blood the idea of death can flow.” Fitzgerald castigates “Officer 6982” for losing hold, and then we wait to see which way the doctor’s sympathies will turn. He attends to the unruly man and, with a biting tone that is, to Lam’s credit, hard to interpret, Fitzgerald tells the police what they were waiting to hear: “Multiple bruises consistent with accidental injury.” Fitzgerald ends his shift and drives away shaken and exhausted. Seeing a passing police cruiser, he doesn’t look to see “the faces of the officers in that car” — a skillful closing line.

In “Night Flight,” Fitzgerald notes, from the airplane, a fire below in the Guatemalan fields. Told it’s an intentional fire to process the sugar cane out of leaves, his response also provides an apt description of Lam’s achievement: “controlled burn.”

Evan Hughes has written for The London Review of Books, The New York Review of Books and The Boston Globe.

BYLINE: Christine Montross,; who is a resident in psychiatry at Brown University and the author of "Body of Work: Meditations on Mortality from the Human Anatomy Lab"

SECTION: STYLE; Pg. C05

During my first tentative days as a medical student, a mentor explained the transition into doctorhood this way: "There are suddenly three things that separate you from everyone else: You touch and cut open a dead body; you ask people socially inappropriate questions and they answer you; and you can walk into a room and ask someone to take off his clothes, and he will do it." With that shift, I would learn, came both the power and powerlessness of doctoring: the defiant salvation of a sick or injured life right alongside our helplessness in the face of the body's failings.

The central characters in Vincent Lam's award-winning collection of stories, "Bloodletting & Miraculous Cures," struggle as their identities undergo this very transition. Lam's narratives orbit around four doctors-in-training, two of whom -- Ming and Fitz -- are first introduced to us as undergraduates clamoring for medical school admission. We meet the others, Sri and Chen, when they join Ming beside a cadaver in their first-year gross anatomy class.

As a collection of stories, "Bloodletting & Miraculous Cures" is relatively unencumbered by the need to share with us how this transition takes place. Instead, the book gains power from its leaps between one story and the next. In the earliest tales, the characters are full of the unsettled angst of doctors-to-be. Fitz is a lovelorn and idealistic student who chafes at the regurgitation that his pre-med classes require. Chen, after only his first year in medical school, is called "doctor" by his family and asked to gauge precisely when his terminally ill grandfather will die. As the characters resurface in later stories, their reticence and dissonance have totally gone, and we are struck by how quickly they have become dispassionate and jaded cogwheels in medicine's machinery.

Readers (patients, all of us) who hope to find within these stories glimpses of a sense of altruism that drives doctors to devote their lives to healing will come away disappointed and disillusioned. Ming, Chen, Sri and Fitz are our windows into a side of medicine that is bleak and stained. Their hospital world is fueled by ego and ambition and is incessantly challenged by the fact of death. When the once-idealistic Fitz is bitten by a patient who has a gash on his head, he retaliates by closing the wound with painful and imprecise staples rather than the more appropriate sutures. Chen -- who lovingly describes the quirks of his family members in "A Long Migration," one of the most successful stories in the collection -- is reduced by the book's end to an angry and detached ER doc who delivers a mocking tirade about an obese patient to a consulting physician. In what feels like a mythic exchange, we witness these young doctors lose their own souls as they save their patients' lives.

And yet the transformation of Lam's characters does not make us despise them so much as it makes us recognize and resent the system of medical training we see them straining beneath. Like the real-world doctors they represent (and, in all likelihood, the author himself, an emergency physician in Toronto), Ming, Chen, Sri and Fitz work ridiculous hours at a breakneck pace. They perform heroic acts and save others' lives, but in the process they lose the ability to nourish and sustain themselves. It is as if they spend so much time defying death that they begin to see themselves as impervious to it. As a result, when they leave the hospital, they drive too fast, drink too much, fall asleep at the wheel -- in essence, put at risk the very lives they work all week to save.

This tension -- watching the best and the brightest careen away from humanity and toward self-destruction -- gives "Bloodletting & Miraculous Cures" its unmistakable Hollywood sheen. Lam's dramatic flourishes of plot contribute to this feel. A patient has a fatal heart attack while being serviced by a prostitute. Sri, in his first year of residency, goes to the apartment of a paranoid psychotic patient and arrives just in time to foil a homicide. And Ming performs an emergency C-section on an unanaesthetized patient to save a fetus in distress.

While these crises lure readers with a kind of sensational voyeurism into medicine, the truth is that Lam doesn't need that artifice. There are many quieter moments of lovely writing in the book, often coupled with sharp insight. The most powerful of Lam's stories is "Night Flight," in which the drama of a medevac team lifting a stroke victim out of Guatemala fades behind more compelling questions: How far should one go to preserve a life, especially when the odds of any meaningful success are slim to none? Is a doctor ever entitled to withhold medical details from a patient's family to spare them anguish?

In this collection, Lam deftly illuminates the line physician and patient must walk together -- hope and health on one side, cynicism and sickness on the other. We see in cold light what is at risk when the balance slips too far in either direction. In the end, "Bloodletting & Miraculous Cures" asks how much of death's burden should rest on the shoulders of those we ask to fight against it.