(++++) IN OLDEN TIMES

Music for Lute by Francesco Spinacino, Joan Ambrosio Dalza, and Marchetto Cara. Hopkinson Smith, lute. Naïve. $16.99.

Rachmaninoff: All-Night Vigil. The Clarion Choir conducted by Steven Fox. Pentatone. $15.99.

     The lute has a long history of implying archaism in music: think of Beckmesser tuning his lute in Die Meistersinger von Nürnberg as Wagner’s method both of scene-setting and of implying just how out-of-date the views of the town clerk are. But in the right hands, the lute brings a great deal of beauty and expressiveness to music even if the notes themselves are 500 years old. And Hopkinson Smith’s hands are certainly the right ones. Smith, who also plays guitar and the fascinating vihuela (shaped like a guitar, tuned like a lute), pays tribute to some little-known, very early composers for lute on an enthralling new Naïve CD. The composers are so early and unfamiliar that even the dates of their lives are imprecise: Francesco Spinacino’s birth year is unknown and he died around 1507; Joan Ambrosio Dalza’s birth year is also unknown, and he died in 1508; and while Marchetto Cara’s birth year is given as 1470, his year of death is uncertain – it was circa 1525. At such a temporal distance, the exact years matter far less than the quality of the music, which is uniformly high – even if not yet developed to the heights of a century later by composers such as John Dowland and Thomas Campion. Although Smith includes some of his own reconstructions along with works that have come down to today in playable form, his stylistic sensitivity and knowledge of his instrument render transitions from an original to a reconstructed work seamless. And while his six-course lute, strung appropriately for the time of this music, is modern – dating to 1977 – it is meticulously modeled on the instruments of the 16^th century. The result of all the care taken by Hopkinson is that distinctly old-style music played on a distinctively old-fashioned instrument serves both as a time capsule and as a highly engaging contemporary experience. The individual pieces are remarkably varied in mood and effect: some bright, some crepuscular, some intricate, some comparatively straightforward, some dancelike, some less rhythmically regular. The works by Cara are a bit different from the others, being in a genre known as frottola, based on secular Italian songs. However, most listeners will not hear significant stylistic differences among the composers or within each individual composer’s work. But hey will notice that the 21 tracks on the disc, ranging in length from less than two minutes to more than five, are not only attractive miniatures in themselves but also, in Hopkinson’s presentation, part of a larger whole that provides a kind of survey of early-16^th-century lute music and explores ways in which works of a very distant time period can still speak to and please audiences half a millennium later.

     Rachmaninoff’s All Night-Vigil (Vespers, Op. 37) is much more recent than the lute works played by Hopkinson, dating “only” to about a century ago: 1915. But this a cappella choral work, literally intended for all-night performance – in a sequence moving slowly toward daybreak, to symbolize the Resurrection of Christ – has roots that go much deeper and much further into the past. And it is because of their acknowledgment of those roots that the Clarion Choir’s performance on the Pentatone label moves beyond the excellent and into the outstanding. Under Artistic Director Steven Fox, who not coincidentally is an expert in Rachmaninoff’s choral music, the choir performs the entire All-Night Vigil and additionally includes several instances of the original chants on which Rachmaninoff based his work. The movements called (in English) “O Gladsome Light,” “Now Lettest Thou,” “Praise the Name of the Lord,” “Troparion: Today Salvation Is Come,” and “Troparion: Thou Didst Rise from the Tomb,” are all preceded by the chants that Rachmaninoff modified and expanded – sometimes to a small degree, sometimes to a more-substantial one – in his work. Rachmaninoff’s troparia (a troparion is a short, usually single-stanza hymn used in Orthodox religious services) are especially interesting when juxtaposed with the chants that form their basis, since there is considerable subtlety and care in the composer’s modifications even though the versions in All-Night Vigil are not significantly longer than the originals. The remarkable purity of the Clarion Choir’s massed sound is highly impressive throughout this CD: so clear is the enunciation, so careful the balance, so well-managed the rhythmic flow, that it often sounds as if a single multifaceted voice is singing, not a group of more than two dozen individuals. The blending of ranges is superb, the care with which the music is shaped is uniformly excellent – and while there are numerous attentive and top-notch performances available of Rachmaninoff’s All-Night Vigil, this one is truly special in every way. The only possible quibble with the disc is that the original versions of the five chants are sung immediately before Rachmaninoff’s corresponding movements: purists who want to hear the Rachmaninoff straight through will need to skip those originals and juxtapose them with Rachmaninoff’s at some later time, if they so desire. Of course, if the originals had been clustered at the end of the CD as a kind of appendix, it could be argued that there was a missed opportunity to hear the old chants immediately succeeded by Rachmaninoff’s modified ones: there is no arrangement that could possibly please every audience. The Clarion Choir’s estimable handling of this All-Night Vigil, however, really should please anyone interested in Rachmaninoff’s choral masterpiece – whether or not a listener is an Orthodox believer or, in fact, associates specifically with any religious or spiritual tradition at all.

(+++) THE PERSONALIZED PIANO

Tchaikovsky: Sleeping Beauty—excerpts (arranged by Mikhail Pletnev); Chopin: Rondo in E-flat, Op. 16; Ravel: Gaspard de la Nuit. Tetiana Shafran, piano. Steinway & Sons. $17.99.

Rachmaninoff: Piano Sonata No. 2; Scriabin: Piano Sonata No. 5; Nikolai Medtner: Sonata in E minor, Op. 25, No. 2 (“Night Wind”); Danza Festiva. Kenny Broberg, piano. Steinway & Sons. $17.99.

Bartók: Improvisations on Hungarian Peasant Songs; George Lewis: Endless Shout; Chopin: Four Mazurkas, Op. 41; Wang Lu: Constellations Apart; Janáček: In the Mists. Jacob Greenberg, piano. Furious Artisans. $16.99.

     Let it be stipulated that there is a never-ending supply of wonderful piano music out there, some familiar and worth hearing/interpreting again and again, some unfamiliar and well worth the acquaintance. Let it be further stipulated that there appears to be a never-ending supply of absolutely first-rate pianists waiting to deliver the music to audiences – pianists with fine technique, interpretative skill, insightful approaches, and welcome confidence in projecting their readings for audiences to enjoy and think about. What is interesting is the combinatorial aspect of these stipulations: many new recordings eschew standard pairings or combinations of works, avoid traditional arrangements such as chronological sequences, and invite audiences to journey with performers into their personal views not only of interpretation but also of the way otherwise unrelated pieces can fit together to produce a satisfying recital. The personalization has obvious benefits in giving audiences insight beyond the norm; it also has obvious limitations in requiring audiences to accept and appreciate the juxtapositions of works from different times, different aesthetics, different structures, in the same way the performers do. Without this sameness of interest and orientation, the personalization of performance falls a bit flat.

     Two new and very fine Steinway & Sons recordings show different aspects of a personal approach to piano recitals. Tetiana Shafran offers two extended suites of differing sensibilities, separated by a single work from an earlier time – and all three pieces are ones that listeners will likely find familiar, although not in this specific combination. The Mikhail Pletnev arrangement of Tchaikovsky’s Sleeping Beauty is a charmer, created knowingly and often cleverly by a pianist/conductor with a fine sense of the ways in which a piano reduction of an opulent score can (and cannot) hope to reproduce the effects of a fully orchestrated ballet. The contrasts between chordal passages and runs are handled particularly well by Shafran, who tends perhaps to overuse the sustaining pedal from time to time in the piano’s lower range – but who, for that very reason, offers exceptionally effective distinction between the heavily dramatic and lightly lyrical elements of the score. Shafran is actually at her best in the more-delicate portions of the music, with a sure sense of the rhythm and an effective way of maintaining the sense of a ballet while also allowing Pletnev’s strictly pianistic touches to come through to good effect. Next on the CD, as a sort of palate cleanser, is Chopin’s Rondo in E-flat, Op. 16, in which Shafran is particularly good at contrasting the lighter upper-register elements with the more-emphatic ones lower on the keyboard. If there is a criticism here, it is that the performance is a touch episodic – the “building blocks” of the work are quite clear, but some listeners will likely prefer a stronger sense of straight-through flow. And then there is Ravel’s Gaspard de la Nuit, one of the most-often-played showpieces from its time period and one whose opening Ondine is ideally suited to Shafran’s style and sensitivity to nuance. The genuinely spooky elements of Le Gibet are less effective here, although Shafran’s willingness to play sections of this tone painting very quietly does a good deal to increase its atmospheric power. The opening of Scarbo is quite effective as well, with the rests producing a strong sense of anticipation. Shafran negotiates the stop-and-start elements of the score and its constantly flickering quality with understanding and apparent ease, although the totality lacks a certain demonic quality to show that the sprite is something less than innocently mischievous. Still, the pianism here and throughout the CD is first-rate, and for listeners interested in this specific performer and this specific choice of repertoire, the disc has much to recommend it.

     If Shafran casts a fairly wide net for her repertoire picks, Kenny Broberg chooses one that produces a much more tightly knit program. Everything he performs is Russian and from the early 20^th century, so this disc has a cohesiveness that enables Broberg all the more effectively to differentiate among the specific pieces and their composers. Broberg plays the second (1931) version of Rachmaninoff’s Piano Sonata No. 2, and clearly relishes the dramatic elements of the work, which stride forth with power here and form a very strong contrast with the more-lyrical sections – which, however, sometimes get short shrift by comparison. One key to effective performance of this sonata is appreciation of its unifying elements, with portions of the first and second movements reappearing in the third; and Broberg is clearly aware of this, playing in a way that allows the sonata to sprawl (as it sometimes does) while still communicating its foundational structure. Scriabin’s Sonata No. 5 dates to 1907 (the original version of the Rachmaninoff is from the same time period: 1913) and is the composer’s first in a single movement. Its very considerable technical difficulty appears to pose no challenge to Broberg, and its highly compressed form fits Broberg’s interpretative skills even better than does the much-more-expansive Rachmaninoff. The musical complexities are quite evident in this reading, coming across not as virtuosic per se but as necessary to communicate the sonata’s underlying ideas. Nikolai Medtner’s vast “Night Wind” sonata, the second of the 14 he wrote, dates to 1911 and is on an even larger scale than Rachmaninoff’s, which is really saying something. It is a two-movement work whose 18-minute first movement is in 15/8 time – possibly the longest-lasting piece with that time signature ever written. As Rachmaninoff did, Medtner establishes linkages within the sonata that create an underlying unity, but the sensibility of Medtner’s work is quite different: the first movement is in sonata form, with a recurring triplet figure at the opening that becomes a unifying feature of the movement itself and the whole sonata – while the second, 15-minute movement is in effect an improvisation-like fantasia based on the first movement’s introduction. This is not only a difficult work to play but also a difficult one to hear, because it is so big, so complex and so unremittingly forceful. There are flashes of beauty throughout, but the main impression of the music is one of unrelenting drama. Broberg is at his best in the sonata’s headlong sections, seeming impatient in its slower and more-reserved elements to get back to all the intensity. He carries the work forward with admirable attentiveness to its moods throughout, and takes the very unusual label of the second movement to heart: Allegro molto sfrenatamente (“fast and very dissolute”). This is an exceptional sonata that is heard less often than it deserves, likely because of its prodigious technical and emotional difficulty – Broberg’s highly impressive performance makes a very strong case for the best pianists to undertake it more frequently. The CD concludes with another Medtner work as a short encore: Danza festiva, which is No. 3 from the composer’s eight Forgotten Melodies, Op. 38. Dating to 1918-1920, this modestly scaled little work contrasts strongly with everything else on the disc: it is unassuming, pleasantly rhythmic, possessing its share of virtuoso elements – but with a clear intention to entertain above all. In Broberg’s performance, it does that very well indeed.

     In contrast to Broberg’s focus on a single nation and time period, Jacob Greenberg is all over the place both geographically and temporally in a new Furious Artists recording. More than Broberg’s recording or Shafran’s, Greenberg’s requires the audience to resonate to the performer’s very individualistic selection of works – some of which may be familiar but some of which certainly are not: Constellations Apart by Wang Lu is a world première recording. Greenberg seems to have chosen the pieces here because they reflect the cultural elements underlying the work of various composers, but that is a pretty thin connection: listeners will probably do best with this recording by simply absorbing the highly varied sounds of the music on offer and making up their own minds about ways in which the pieces relate to or reflect each other – or don’t. In any case, Greenberg’s performances do full justice to the works. Bartók’s Improvisations on Hungarian Peasant Songs, dating to 1920, is a set of eight movements nominally drawing on folk music but in fact expanding it into new realms: the third movement, for example, is polytonal, while the dissonant sixth is bitonal and features one hand playing only the piano’s black keys while the other plays only the white ones. Next on Greenberg’s CD is George Lewis’ Endless Shout (1994/2018), a four-movement jazz-based work whose first and last movements have the catchiest titles (Smashing Clusters and Doin’ the Hicty-Dicty). Some grounding in jazz is necessary to get the full effect of what Lewis is after here, since the piece is in part a tribute to jazz pianists of several types, with the movements varying in style accordingly. However, even without familiarity with those specific pianists, listeners will enjoy Greenberg’s handling of the quicksilver mood changes of the movements and their differing styles. The piece does follow the Bartók somewhat uneasily, though – and having it followed in turn by Chopin’s Four Mazurkas, Op. 41, is genuinely jarring. If the cultural underpinnings of the Bartók pieces are Hungarian and those of the Lewis work essentially African American, then those of Chopin are distinctly Polish – but it is not the “Polishness” of these dances that attracts pianists or audiences to them, and indeed the cultural provenance of the material is merely a jumping-off point for works that, despite being well-known and frequently played, still offer performers and listeners alike new and frequently surprising things to hear. Chopin’s music, which dates to 1840, is followed by the Wang Lu work, an extended single-movement piece written as recently as 2021 and dedicated to Greenberg. The Chinese cultural underpinnings of Constellations Apart are not easy to discern from the music itself, and they do not really seem to be Lu’s point in any meaningful way. Although inspired by the technique used for the qin, which is played by pressing a string with a finger of the left hand while plucking with the right, Lu’s music does not and really cannot duplicate that effect on the piano. Instead, what we get here is a contemporary attempt to treat the piano as both a stringed instrument and a member of the percussion family – an intriguing concept, actually, although the work makes its points fairly early and then continues somewhat longer than the material can justify. Greenberg concludes this highly individualistic CD with Janáček’s In the Mists, a four-part cycle from 1912 that is filled with frequent rhythmic changes and that justifies its title by being written entirely in keys with five or six flats and hence a “misty” sound. Impressionistic and atmospheric throughout its 14 minutes, the cycle certainly reflects Czech culture – Janáček generally based his music on the sound and accentuation of the Czech language. And Greenberg certainly plays the music with feeling and careful attention to its harmonic language and rhythmic structure. But the “cultural underpinnings” element of this CD nevertheless feels like a stretch in terms of giving listeners a reason to hear these particular pieces in this particular sequence. Like the Shafran and Broberg discs, Greenberg’s is most likely to appeal to people who, for reasons of their own and because of their own taste, find their own musical interests and feelings to be in accord with the ones that led these artists to select these specific works for presentation in these specific sequences.

(+++) THEATRICALITY

Heinrich Marschner: Overtures and Stage Music, Volume 1. Czech Chamber Philharmonic Orchestra Pardubice conducted by Dario Salvi. Naxos. $13.99.

Music for Solo Bassoon with Piano, Bass and Drums. Eric Van der Veer Varner, bassoon; Lisa Leonard, piano; Scott Davis, bass; Juanmanuel Lopez, drums. MSR Classics. $14.95.

     Wagner’s three earliest operas, which are very rarely performed, showed him absorbing the influence of three major composers of his time and beginning to move toward his own style, which differed significantly from theirs. The second opera, Das Liebesverbot, was a Wagnerian channeling of Rossini; the third, Rienzi, has clear parallels with the grand and grandiose works of Meyerbeer. And the very first, Die Feen, was in effect a tribute to – or more accurately an internalization of – the works of Heinrich August Marschner (1795-1861). Marschner’s use of melodrama, his creation of antiheroic central characters, his expansion of the lower range of the orchestra, and his development of supernatural protagonists with mortal failings, all influenced Wagner to a considerable degree; and two Marschner operas – Der Vampyr and Hans Heiling – stand the test of time rather well. Dario Salvi’s foray into Marschner’s theatrical music is therefore very welcome – but the first volume of this planned multi-CD series on Naxos is, unfortunately, not a high point. On the plus side, it is packed with world première recordings: the overture to Der Kyffhäuser Berg; excerpts from Schön Ella and Ali Baba, oder Die vierzig Räuber; and the overture to Die Wiener in Berlin. In fact, only one short piece on the disc, the overture to Der Holzdieb, has previously been recorded. Unfortunately, the music here is rather thin gruel and does not really foreshadow the operatic innovations and dramatic intensity that Marschner was later to produce. These pieces for the stage were written from 1816 to 1825, and while they are workmanlike enough and show some skill in orchestration, they are not particularly creative musically or particularly trenchant dramatically. They are, by and large, formulaic contributions to stagings of plays: four of the seven excerpts from Schön Ella, for example, are entr’actes. Short and modestly atmospheric, most of the pieces on the disc would serve their stage purposes well, including the ballets incorporated into both Schön Ella and Ali Baba. The use of brass is the most distinctive element in these works, and is especially notable in the March from Schön Ella, which dispenses with strings altogether – but is undermined by its considerable repetitiveness, which may have served the play well but does not make the material very listenable. Everything on the disc gets knowing, careful and well-paced performances from the Czech Chamber Philharmonic Orchestra Pardubice under Dario Salvi, but hopefully later volumes in this series will contain music of greater substance that will leave a stronger impression of the quality of Marschner’s work.

     The theatrical elements are matters of expression rather than direct ties to any stage material on an MSR Classics disc featuring the final recordings by bassoonist Eric Van der Veer Varner (1974-2019), who died of a heart attack in Thailand while on a performing-and-teaching tour. The five composers whose works are offered here – four contemporary and one from an earlier era – approach the bassoon in a wide variety of ways that, collectively, show just how expressive, lyrical and dramatic the instrument can be under the right circumstances and in the right hands. Songs for Wicked Children, by Amber Ferenz (born 1973), is for bassoon and piano. It is a suite of four short movements with very intriguing titles: “Toys Left in the Rain,” “Strangers Have the Best Candy,” “Lost: Green Parrot,” and “Shark-Infested Pudding.” The first movement is lyrical; the second has gentle swing; the third, also rather gentle, explores the bassoon’s lower register; and the finale is bouncy, with just a hint of wickedness. Jazz Suite by Ken Cooper (1941-2003) is for the interesting combination of bassoon with piano, string bass and drums. True to its title, it contains jazzy elements in all five of its movements. It is not particularly innovative – the second movement, “Moderate Jazz Waltz,” and the fourth, “Animated,” sound especially derivative – but it is well-designed to showcase the bassoon’s multifaceted potential in the jazz idiom. Compostela by Jenni Brandon (born 1977) is an ambitious work: a 16-minute piece for unaccompanied bassoon that is somewhat overextended but that does an admirable job of taking the instrument through its entire range of both notes and expressive potential. There are two works on the CD by Max Lenz (born 1887-death year unknown). Both are for bassoon and piano, and both evince considerable, rather dry humor. Der Angeber (“The Boaster”) neatly uses the comedic capabilities for which the bassoon remains well-known, while The Tale of an Old Bassoonist pretends to a level of grandiosity in its piano introduction and then systematically dismantles any pretentiousness once the bassoon enters and thereafter. The underlying theatricality of both works – largely in the form of farce – comes through effectively and delightfully. The disc concludes with Mathematics, another bassoon-and-piano work, this one by Alyssa Morris (born 1984). Its three movements are “Geometry,” “Trigonometry,” and “Integral Calculus,” and if the music does not seem directly reflective of any of those titles, it is well-structured throughout and rather challenging to perform, requiring delicate breath control. The contrast between the expansive second movement and the leap-filled and rhythmically awkward third is especially pronounced. Eric Van der Veer Varner plays every work here as if it is a masterpiece, even though none rises to that level and several are closer to being trifles. Whether on his own or accompanied, he displays a sure command of each composer’s style and total comfort with capabilities that many people are unlikely even to realize that the bassoon possesses. The disc will be a special delight for bassoonists, but even casual listeners will find plenty here to surprise, delight and engage them.

(++++) IN THE BORDERLANDS

Saving Grace: What Patients Teach Their Doctors about Life, Death, and the Balance in Between. By David D. Alfery, M.D. Wipf and Stock. $21.

     Most people are no more aware of the guts of medical practice than they are aware of their own internal digestive tract. That is probably just as well: in neither case is the subject pretty, and it is probably best simply to accept the topic as is and go on with one’s everyday focuses in life with a degree of abandon and willful ignorance. That is, until something goes wrong. When it does, to the point of requiring surgical intervention, we put our lives quite literally in the hands of surgeons and, to an extent that most people do not think about, in those of anesthesiologists.

     Patients rarely meet those who administer anesthesia until very shortly before surgery, but it is those doctors (and CRNAs, Certified Registered Nurse Anesthetists, and in some cases CAAs, Certified Anesthesia Assistants) who must carefully keep a patient balanced on a knife’s edge (or scalpel’s edge) between wakefulness and enormous pain on the one side, and death on the other. This is a twilight world, a life-and-death border that modern anesthesia straddles comfortably when all goes well, far less comfortably when anything goes wrong, and always with a certain awareness that the practitioners of anesthesia are not entirely sure of why it works. “I sometimes wonder if patients would be so trusting if they knew how much we still don’t know about general anesthesia,” writes anesthesiologist David D. Alfery, who has boiled down the lessons of his 36-year career into 15 single-word-titled chapters (“Respect,” “Dignity,” “Fragility,” “Unfathomable,” etc., although “Allegiance” is repeatedly and embarrassingly misspelled) that collectively bring readers behind the curtain of mystery where so much of the enormous complexity of modern medicine is concealed.

     Saving Grace is, for example, a place to learn about the innocuously named “quiet rooms,” which “are found throughout a hospital, in every hospital, and one is always adjacent to an ICU. Nothing good happens in them. …Lighting is muted. They are invariably small, cheerless, non-descript spaces usually consisting of a few chairs, a table and lamp, and perhaps a sofa, where families are brought to learn in private that the worst of their fears has been realized.”

     The book is also a place to find out how doctors used to estimate the likely survival of burn victims: “We calculated expected patient mortality by adding the percentage of body surface with third degree burns to the patient’s age.”

     And it is a place to learn just who all those people in the operating room are – for patients awake enough to see the team together. There may be one surgeon and sometimes a second, “but in most cases a specially trained surgical assistant was present to help.” There is a “surgical scrub nurse, the person who would hand instruments to [the surgeon] and who’d take them back after they’d been used...[and] would load sutures, hand [the surgeon] a suction catheter when needed, and provide anything else that was required to be sterile.” There is also “a circulating nurse, whose job was to ‘circulate’ around the room, open requested sterile equipment for the scrub nurse, document what was going on, run to the blood bank if needed, send blood samples for laboratory work, update the patient’s family on how surgery was progressing, and so forth.” And there is, of course, the person administering anesthesia, keeping the patient delicately suspended between this world and the next.

     Crucially – and this was not always the case – in surgery today, “at any time, any person present in the OR has the authority to stop an operation from proceeding if they feel an unrecognized danger is present, until that danger is addressed.”

     There are dangers aplenty detailed in Saving Grace, as the book explores the entire range of emotions that patients, families and medical personnel alike experience in cases of serious, often life-threatening and sometimes life-ending circumstances. The “families” element is particularly moving and important, given Dr. Alfery’s realization that pain relief for a patient in extremis is less for the patient than for family members enduring the observation of what is going on: “If you depress consciousness to the point where a patient is not aware of anything around them, where they can no longer respond to the voice of a loved one because they are too asleep to hear it, their body still responds to the pain. It does so by writhing back and forth or by moaning. Those are elemental reactions that a patient is unaware of, just as one is unaware of turning over in bed when asleep or what goes on under anesthesia. The moaning and writhing are nevertheless agonizing for a family to witness.” And this means that if anesthesia or pain-relief medicine, or both, can be used to suppress the outward signs of a pain that the patient is not actually aware of feeling, then the pain that the family is feeling can be alleviated.

     This holistic approach to medicine leads naturally into the elements of Saving Grace dealing with Dr. Alfery’s journey of faith, which occurs alongside and within his growing medical expertise. The religious elements of the book are its most tepid and least successful, but are inevitable in a work brought out by a religious publisher such as Wipf and Stock. It takes little imagination for anyone who has ever had any contact with severe disease and the people who treat it to understand that there is a spiritual dimension to medicine, a whole set of circumstances unexplainable on any currently known or understood scientific basis. The idea that doctors do their work with the highest scientific attentiveness while still acknowledging that some of what happens to patients is beyond their ken is scarcely surprising; the best doctors are consistently humbled by the realization of everything that they do not know. Nevertheless, it is not the faith-focused elements of Dr. Alfery’s book that make it compulsively readable and consistently revelatory. It is the behind-the-scenes information on modern medicine and the place of anesthesiology within it that makes Saving Grace such an impressive achievement.

     For those used to endless discussions about the impersonal elements of medicine today – at least medicine in developed countries, whose contrast with less-developed ones is made clear when Dr. Alfery writes about his time doing medical mission work in Romania – it is salutary to read here, “Don’t ever think your doctors, your nurses, your aides, and anyone else involved in patient care doesn’t feel the same emotions in these horrible situations that you do. We are all part of the same devastating humanity.” Think of that comment as a counterbalance to all the more-often-written complaints about impersonality, limits on time with patients, insurance disputes, deductibles and co-pays, the unaffordability of sophisticated medicines, and all the rest.

     Some years ago, when there were fewer anti-cancer drugs than there are today and meticulous targeting of the medicines was far less possible, oncologists used to say that the objective of the dosage was to measure enough medicine to kill the patient – and then to back off just a little bit. In some ways, there used to be a similar “almost over the life-and-death border but not quite” approach to anesthesia. But if the cruder drugs and methods of the past have now been supplanted by more-precise anesthetics and much-more-precise methods of administering them, there remains the pesky fundamental fact that nobody really knows just how and why general anesthesia works. It is necessary for patients – and doctors – to take its effectiveness on faith. And that is, in its own way, as much a testament to the spirituality that remains in medicine and science as any overt discussion of personal conversion and belief.