Showing 1 - 5 of 5 annotations contributed by Bruell, Lucy

Annotated by:
Bruell, Lucy

Primary Category: Literature / Nonfiction

Genre: Longform journalism

Summary:

Emergency Doctor is a riveting, informative account of the workings of the Emergency Department at Bellevue Hospital in New York City, the oldest public hospital in the country.  On any given day, tourists, residents, the wealthy and those who live in shelters come to the Emergency Department, some with life threatening injuries and others who need little more than a hot meal and a shower.  No one is turned away.  

Published in 1987, the book was written by a former editor at Reader’s Digest in cooperation with Dr. Lewis Goldfrank, the former Director of Emergency Services and a leading toxicologist.  Goldfrank’s personal story of his path to emergency medicine and his experience in creating the Emergency Department out of what was once known as the Emergency Room frame the narrative, but the main focus is on the day to day activities of the patients and staff in the Emergency Department.  Because Bellevue is NYC’s main trauma center, the book is rich with stories of trauma including construction accidents, cardiac arrests, fires and suicide attempts among others.  Even the title chapters-- "A Question of Poison," "An Alkaloid Plague," "The Case of the Crazed Executives," for example—convey the urgency and medical detective work needed for each person who comes through the triage area. 
“We don’t know if a patient is alive or dead when we first see him,” Dr. Goldfrank says.  “And we’re never sure what we’re going to find, or what kind of emergency medicine we may be called upon to practice—surgery, neurology, pediatrics, psychiatry, cardiology, obstetrics. (p118)   Accident victims are stabilized in the trauma area and rushed to the operating room. People with cancer, or TB, children who have been abused, broken bones, suicide attempts, accidental or intentional poisoning and overdoses—all must be evaluated and decisions made whether they should be admitted to a medical floor, the operating room or perhaps kept for observation.

Beyond medical expertise, however, working in the Emergency Department requires a large dose of compassion to cope with the needs of patients who rely on the Emergency Department for basic care for their chronic conditions such as asthma,  and social services because they lack a place to live or have no means of support.   Perhaps they need to detox from alcohol or have mental health issues.  “Emergency medicine demands the most intense involvement personally and intellectually,” observes Dr. Stephen Waxman. “Every area of clinical medicine is practiced, every emotion is taxed.”  (p 119)      



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Brief Encounters

Shapiro, Ben

Last Updated: Sep-12-2014
Annotated by:
Bruell, Lucy

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

In the photograph, the camera frames the window of a rundown motel room on a snowy evening. Inside, a young mother in a pale green nightgown sits on the side of a bed gazing sadly at her sleeping baby curled up on the far side of the mattress.  This is one of the hauntingly beautiful images in “Brief Encounters,” a documentary about the photographer Gregory Crewdson and his project “Beneath the Roses.“

The son of a Brooklyn psychoanalyst, Crewdson and his family spent summers at a lakeside cottage near Pittsfield in western Massachusetts.  It is to this area, with its abandoned shops and dilapidated buildings, that Crewdson returns over and over again to search for settings for his intricately composed photographs.  These towns, he says in the film’s narration, “were really backdrops for a more submerged psychological drama,” one that blurs the line between reality and fiction. Crewdson approaches his photographs as if making a film, with a crew of as many as 60 people and a cast composed of the townspeople he encounters in his travels.  But unlike a film, the photographs capture a single moment in time.  For Crewdson, what happens before and after is of no interest to him. Rather, he is concerned with just that one frame, “a perfect moment.”

Crewdson creates his worlds as a way to explore his own anxieties, fears and desires.  The images he constructs are exquisitely detailed and psychologically complex, inviting multiple interpretations by viewers. An engaging narrator, he directly addresses his own fear of failure, how he struggles to overcome it and to continue working despite periods of self-doubt.

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Summary:

Jerome Lowenstein is a nephrologist, author, and founder of the Bellevue Literary Press and the Humanistic Aspects of Medicine Education seminar program at the NYU School of Medicine.  In this thoughtful and illuminating book of essays he explores the patient/physician relationship in a world where medicine has embraced technology and scientific advances in the laboratory at the risk of neglecting the humanistic underpinnings of the field.

Dr. Lowenstein graduated from medical school at NYU in the late 1950s and spent nearly his entire professional career at NYU Medical Center and Bellevue Hospital. When he was a resident, long before work hour limits were instituted, the house staff gathered in the cafeteria at midnight to dine on the days’ leftovers.  This communal meal “provided a fine opportunity to communicate with colleagues directly, rather than by beeper and phone, about many of the days ‘medical leftovers,’ ” (1) sharing information as well as the frustrations and rewards of caring for patients.  “The Midnight Meal” poses the challenge of retaining the core of relationships, both between patient and physician and among colleagues in the rapidly changing world of medicine today.

In the essay, “Can You Teach Compassion,” Dr. Lowenstein tells his readers about the student who responded to the question with “I don’t know if you can teach compassion, but you surely can teach the opposite.” (13) The student was referring to how students become “desensitized” during their clinical years to the suffering of their patients, sometimes to the point of using derogatory terms to describe them. Dr. Lowenstein argues that teaching attendings can and should encourage students to learn about their patients. He writes how he once interrupted an intern who began to present a case by stating: “This is the first hospital admission of this thirty-five year old IVDA.”  Dr. Lowenstein asks: “Would our thinking or care be different if you began your history by telling us that this is a thirty-five-year-old Marine veteran who has been addicted to drugs since he served with valor, in Vietnam?” (17) Learning about the lives of their patients, Lowenstein emphasizes, does not detract from the clinical picture, but rather enhances it.  

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Annotated by:
Bruell, Lucy

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Extremely Loud and Incredibly Close, directed by Stephen Daldry, features an all star cast including Tom Hanks, Sandra Bullock, Max Von Sydow, Zoe Caldwell and John Goodman, but the true star is Thomas Horn as ten year old Oskar Schell who loses his father on 9/11.  The film opens at his father's funeral; Oskar refuses to leave the limousine-- the coffin is empty, and without his father's body to mourn, death remains an abstraction.

Oskar refers to 9/11 as the "worst day."  First to arrive home on 9/11 from early dismissal at school, he hears the last phone messages from his father who is waiting for the firemen to rescue him.  Before his mother comes home, he swaps the answering machine to keep the messages hidden from his mother and grandmother, possibly to protect them from hearing the anguish in his father's voice or to preserve the special relationship he had with his father.  In a flashback we learn that Fred Schell, an amateur scientist, is concerned about his son's timidity. To help Oskar overcome his shyness, he invents searching expeditions that require Oskar to talk with others. One involves a search in Central Park for clues to the lost sixth borough of New York City.  Oskar's skill at tracking clues comes into play when he finds a key labeled "Black" in his father's belongings and begins a search that he hopes will lead him to discover something his father meant for him. 

The film is adapted from the novel of the same title by Jonathan Safer Foer.  The storyline has been streamlined for the screenplay, but the emotional turbulence that permeates the lives of the Schell family is exquisitely portrayed.  Sandra Bullock as the grieving widow must deal with her son's rage that it was she who was spared instead of her husband.  Despite her overwhelming grief, she watches over Oskar in a way that allows him to experience the search on his own, and it is only later that he discovers that she watched his every move, out of love.  Oskar will never get his father back, but he is able to come to terms with the loss and to move ahead with his father's silent encouragement always close at hand.

Max von Sydow plays Oskar's long lost grandfather, a character that was fully developed in the novel but not in the film. For instance, his refusal to speak, answering questions with a "yes" and "no" tattooed on either hand and writing on a pad for more explicit responses, remains a mystery that begs for further explanation.

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Annotated by:
Bruell, Lucy

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Extremely Loud and Incredibly Close takes the reader inside the mind of nine year-old Oskar Schell who lost his father in the collapse of the Twin Towers.  Oskar lives with a terrible secret − on that day he arrived home from school shortly after the planes hit the towers and listened to messages from his father on the answering machine.  Hoping to protect his mother from the awful truth and not wanting to face his own helplessness − after all, his father was usually at his jewelry store, and it was just a tragic coincidence that he was attending a meeting at Windows on the World − Oskar hides the machine and replaces it with a new one.  In the days that follow, he accompanies his mother and paternal grandmother to the cemetery with his father’s empty coffin and vows to find out all he can about his father’s death.

Oskar begins by searching his father’s closet.  In a blue vase he finds an envelope with the name “Black” written on it and a small key inside.  Determined to find the lock that this special key will open, Oskar sets out on a journey through the city, contacting all of the Blacks in the telephone book.  As he searches for clues about his father and tries to make sense of a world transformed by terrorism, he connects with people who are enveloped in their own grief and overwhelmed by the world outside themselves. 

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