Showing 1 - 10 of 2802 Literature annotations

Summary:

This is a gripping, informative, and well-researched book about human blood. An accomplished journalist, Rose George, covers a variety of topics, largely in the U.S., Britain, and Canada but also in Nepal, India, and South Africa. She describes many current issues, provides historical background, and speculates on future technologies, such as replacement of blood by other fluids. There are nine sections:

 “My Pint”  While the book’s title refers to the author's volume of blood, this chapter’s title refers to a single pint she is donating. We read about blood supply (donated and stored blood) in the U.S. and—by contrast—in India.

“The Most Singular and Valuable Reptile” refers to the leech. This arresting chapter describes both historical and  modern uses of leeches to gather blood from humans. She visits a company called Biopharm in Wales where leeches are raised and prepared for shipment to medical clinics and hospitals.  

 “Janet and Percy” is a historical chapter focusing on Dame Janet Maria Vaughan, a central figure in creating the Blood Transfusion Service in England during WWII and Percy Oliver, who guided its predecessor, the London Blood Transfusion Service.  

“Blood Borne.”  This chapter describes Khayelitsha, South Africa, “the ugly backside of Cape Town” (p. 100): a place of poverty, crime, rape, sexual predation, and HIV. While rich nations provide assessment and treatment for people with HIV, poor nations have many citizens infected with the virus and, over time, rising rates of infection. 

 “The Yellow Stuff” describes the plasma portion of blood; it can be frozen (as FFP) and used as a filler for bleeding or trauma patients. Unlike blood—which can only be given without payment—plasma can be collected from paid donors. It is a largely traded commodity, part of a multi-billion dollar industry worldwide. Plasma carries Factor VIII, a crucial protein for clotting blood; hemophiliacs lack this and are at risk for death by bleeding externally or internally. Some plasma has been tainted, for example by HIV.

“Rotting Pickles.”  In Western Nepal (and other places), menstruation is taboo. George writes, “We are in a minority among species, and among mammals, to bleed every month.” She reviews historical views of women’s periods, mostly negative. Worldwide, there are many taboos, but also some educational efforts for public health that are helpful in impoverished areas.  

 “Nasty Cloths.” This tells the unusual story of an Indian man named Muruga, “a poorly educated workshop helper” who became a leader in creating sanitary protection for menstruating women. Worldwide, the feminine hygiene industry is some $23 billion. George also reviews related history, including Toxic Shock Syndrome from tampons.  

 “Code Red.” Bleeding is often a fatal factor in trauma, even with the best efforts to transfuse blood into the patient, unit after unit. George observes open chest techniques at a resuscitation. She reviews breakthroughs in blood typing, component therapy, and “buddy transfusions.”  

“Blood like Guinness: The Future.” George starts with images from the past: vampires, human drinkers of blood, past and, even, present. She interviews a purveyor of the concept that “young blood” is healthier than older blood. Can there be, discovered or created, blood substitutes that also save lives? 

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The Slap

Tsiolkas, Christos

Last Updated: Mar-12-2019
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In Melbourne, Australia, Hector and Aisha are hosting a big barbecue for their families and friends who come with several children. Hector’s somewhat controlling Greek parents appear too, bringing along too much food and their chronic disapproval of his non-Greek wife despite the two healthy grandkids and her success as a veterinarian. Aisha’s less-well-off friends, Rosie and Gary, arrive with their cherubic-looking son, Hugo, who at age three, is still breastfed and being raised according to a hippie parenting style that manages to be both sheltering and permissive. Hugo has a meltdown over a cricket game, which the older kids have let him join.  He raises a bat to strike another child, when Hector’s cousin, Harry, intervenes to protect his own son. Hugo kicks Harry who slaps him. Rosie and Gary call it child abuse and notify the police. 

The aftermath of the slap is told in several fulsome chapters, each devoted to a different individual’s perspective: among them, Hector, Aisha, Harry, Rosie, Hector’s father, and the teenaged babysitter Connie. Harry is rendered miserable by Rosie and Gary’s aggressive lawsuit against him. Connie believes she is in love with a philandering, substance-abusing Hector who in turn has unscrupulously led her on. Recognizing its alienation of her friends, Rosie sticks to her legal pursuit of Harry although she worries about the drain on their meagre finances, the exposure of Gary's drinking, and the anticipated criticism of their parenting style. Aisha is fed up with her husband’s edginess and submission to his parents, and she flirts with escape in the form of a handsome stranger at a conference. 

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Annotated by:
Kohn, Martin

Primary Category: Literature / Plays

Genre: Play

Summary:

First published in 1898, Chekhov’s “A Doctor’s Visit”  has been ably adapted as a short play by physician-playwright, Guy Fredrick Glass. In addition to the original characters, in his adaptation Glass has added a new character, a medical student, Boris, as a foil and interlocutor for the work’s main character, Dr. Korolyov. Staging directions and scene setting also add dramatic dimensions to the story, as do elaborations of conversations including  comedic encounters with the governess, Christina Dmitryevna, and a display of "compassionate solidarity" (see Coulehan annotation ) with the doctor’s patient, Liza. The primary theme of the story stays true in this adaptation—Korolyov’s impressions of the patient viewed from a cold objective stance are changed as he develops personal insights into the social and political nature of her (and his) malaise.

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His Favorites

Walbert, Kate

Last Updated: Mar-06-2019
Annotated by:
Trachtman, Howard

Primary Category: Literature / Nonfiction

Genre: Novel

Summary:

Kate Walbert’s recent book, His Favorites, is a compact 149 page novella that seems to be a direct outgrowth of the #MeToo movement, a work consciously addressed to women who have experienced sexual abuse from those in power over them. But linking the book to current events does an injustice to the artistry of this exquisitely constructed work. Ms. Walbert embeds her story of sexual exploitation in adolescence and focuses on a teenager who is abused by her popular English teacher in a prestigious boarding school.

Jo Hadley’s story begins abruptly. To outward appearances, she is a typical adolescent more concerned with how she looks, having a good time, and hanging out with friends than reading the Great Books. Suddenly, while driving a golf cart around the course on a lazy summer night, a close friend is violently thrown over side, strikes a tree head first, and dies instantaneously.
Only later do we learn about the profound impact this accident has had on Joy and her family. Joy is forced to transfer out of her neighborhood public school and enroll in the Hawthorne School. But Joy is clearly talented, adapts quickly to her new circumstances, and is placed in a special writing program for gifted students. There she falls under the tutelage of a charismatic 34-year old teacher, called Master. He has a reputation for running an irreverent, highly charged classroom and is always trailed by a legion of admiring young women from his advanced writing class.

Jo’s horrific s encounter with Master in his residential suite is followed by a failed effort to report Master’s behavior to the school leadership. We learn about Jo’s parents and the disintegration of her family after the accident. We meet her schoolmates. One is an attractive member of Master’s retinue who resurfaces several years after graduation in New York and who still seethes with resentment at her treatment by Master. A second classmate is musically gifted but far less stylish than the students in Master’s English seminar. She becomes the target of a cruel hazing prank that reverberates in Joy’s mind with the passage of time. As the book reaches its conclusion, the context in which Joy is relating her story is unexpectedly revealed, which casts all of her recollections in an entirely new light.  The storyline is disjointed and the vantage point shifts frequently. But the narrative is gripping and novella’s structure is exquisitely built on apt description and poignant allusions to other works in the literary canon including the novel A Separate Peace by John Knowles and The Loneliness of the Long-distance Runner by Alan Sillitoe.

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Annotated by:
Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Biography

Summary:

In That Jealous Demon, My Wretched Health (subtitled “Disease, Death and Composers”), Jonathan Noble, a retired surgeon gives us the medical and psychiatric history of seventy classical music composers. Chapters are organized by illness, ranging from cancer to syphilis to alcoholism.  Famous composers such as Schubert and Shostakovich predominate, but many lesser-known composers, ranging from Jeremiah Clarke to Gerald Finzi, are also included.  

Mozart is one composer whose cause of death has long been the subject of controversy, and the various theories are comprehensively explored here. However, the author goes even further, developing a detailed medical case study of the composer beginning in childhood.  He examines the toll that Leopold Mozart’s exploitation took on his prodigy son’s constitution, what Wolfgang’s appearance in the surviving portraits has to say about his general health, and even whether he may have had Tourette’s Syndrome. Finally, the author ties all of this together, methodically refuting or confirming each diagnosis, offering far deeper analysis than one would expect to find in a standard biography.  

Another example, the case of Tchaikovsky, reads like a veritable whodunit. The composer’s activities during the last two months of his life are scrutinized, with the likely causes of death systematically disproven or confirmed.  

A list of composers who suffered accidental or violent deaths provides some surprises. You will learn that Lully accidentally stabbed himself with his conductor’s baton, and that Alkan may have been crushed to death by a bookcase upon pulling his Talmud off a shelf.

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Heart: A History

Jauhar, Sandeep

Last Updated: Feb-05-2019
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: History

Summary:

The author, Sandeep Jauhar, attributes his “obsession” with the human heart to family history, which includes fatal heart attacks that took both of his grandfathers from him, and to the beginnings of his own coronary artery disease revealed on screening tests. That he became a practicing cardiologist, though after first becoming a PhD-level theoretical physicist, is no surprise then.  

It was this obsession with the heart and his chosen profession that drove him to write this book, which he says, “is about what the heart is, how it has been handled by medicine, and how we can most wisely live with—as well as by—our hearts in the future.” (p. 10) In form, the book is a series of brief accounts of selected events in the history of medicine involving the human heart and circulatory system, interwoven with personal anecdotes and reflections. 
 

Some of the historical events and developments include how the heart and circulatory system work, and the methods used to assess how well they are working such as echocardiography and coronary catheterization. How heart-lung bypass, first person to person then mechanical, made cardiac surgery possible is described, as are many of the surgical procedures it enabled to treat coronary artery disease and to replace malfunctioning valves. Nonsurgical procedures Jauhar explains encompass those for intervening during acute heart attacks (e.g., angioplasty, stents, thrombolysis), managing life-threatening heart rhythm disturbances (e.g., external and implantable pacemakers and defibrillators, radio-frequency ablation), and replacing parts or all of the heart (e.g., coronary artery bypass, heart valve replacement, left ventricular assist devices, heart transplant). Little mention is made about the use of drugs despite having contributed to both important advances and surprising failures in heart disease. 
 

Topics related to the heart indirectly include the effects of emotions and psychological problems (e.g., stress), social determinants of disease (e.g., social economic status), and wellness concepts (e.g., diet, exercise). Some history of heart disease and the reduction of deaths from it over the past several decades are also touched upon. Parts of the book take the form of memoir, which add to his previous two books (Intern: A Doctor’s Initiation and Doctored: The Disillusionment of an American Physician).

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Summary:

Geoffrey West sounds like the perfect dinner guest. He has lived a fascinating life and his professional persona has evolved over time from theoretical physicist to global scientist. He is a distinguished professor at the Santa Fe Institute and is one of those rare people who knows something interesting and worthwhile about just about everything.

In Scale, West examines networks that provide the basis for complex systems: biological systems like the human circulatory system, coastal ecosystems, and man-made systems like urban communities and global corporations. He identifies three defining features shared by each. First, the networks serve the entire system and fill the entire space that is available. Second the terminal units in the networks share common design features and are essentially the same, whether they are the capillaries that provide nutrients and oxygen to peripheral tissues or the electrical outlets that enable access to the grid for home appliances.First, the networks serve the entire system and fill the entire space that is available. Second the terminal units in the networks share common design features and are essentially the same, whether they are the capillaries that provide nutrients and oxygen to peripheral tissues or the electrical outlets that enable access to the grid for home appliances. Finally, there is a natural selection process at work that is constantly optimizing the network function. West emphasizes that these defining features of complex systems are present in biological systems like the human circulatory system, coastal ecosystems, and man-made systems like urban communities and global corporations.

These common features enable West to identify fairly simple mathematical formulas that predict the relationship between changes in size and efficiency of complex systems. In general, in biological systems size and energy consumption are scaled sublinearly, i.e., metabolic rate does not increase to the same extent as size. The limits to growth occur because of the increased demands for maintenance of the system. What makes Scale an innovative work is West’s effort to apply the scaling laws derived from observations in nature to man-made complex systems such as cities and companies. He identifies two distinct components in these human systems, the materials that constitute the infrastructure and the creative work that is produced. West then demonstrates that while the physical demands of these complex human systems, such as roads, electricity, and water supply, which mirror the metabolic requirements of biological  systems, increase sublinearly, the productive output  like wages, theaters, and patent activity, which have no parallel in non-human biological systems, increase supralinearly. Moreover, this inventive works requires a proportionately increasing input of resources as size increases. West tries to draw lessons about the rational limits to growth by extrapolating from the scaling laws that underlie biological complex systems to the two components of the artificial systems created by mankind. West cautions against blind reliance on “big data” alone to solve the pressing social problems confronting mankind. Instead, he advocates for delineation of underlying mathematical principles to guide the analysis of the growth of cities and companies and rational future planning.

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Summary:

In 2006, Emergency medicine trainee, Damon, and his wife, Trisha, have two boys, Thai (age 4) and Callum (age 2.5).  All is well in their lives until Callum begins vomiting for no apparent reason.  He is found to have medulloblastoma, an aggressive brain tumour, for which the only possible hope for a cure comes from surgery and six cycles of ever more arduous chemotherapy with stem cell recovery at Toronto’s Hospital for Sick Children. The little family moves to Toronto and commits to supporting Callum as best they can, ensuring that he is never alone even during his long weeks of reverse isolation. They also try to keep Thai nearby, involved and aware, with the help of a local school and grandparents. But Callum dies during the last cycle of treatment.  

Saddened, exhausted, and bereaved, Damon and Trisha go back to their home town and try to (re)construct their lives, slowly returning to studies and work. They find meaning in creating tangible and intangible memorials to their lost son, and they find purpose in the more difficult task of moving forward, never losing the pain of grief. They adopt a little girl. Damon knows that Callum is always with him and the experience of his illness and death has dramatically infused his work as a physician.

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Taking Care of Time

Davis, Cortney

Last Updated: Jan-02-2019
Annotated by:
Kohn, Martin

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

In this volume by the esteemed nurse-poet/writer, Cortney Davis, are 43 previously published poems (some revised for this collection), assembled in 3 sections-- the middle section featuring her long poem, "Becoming the Patient," that recounts through 10 shorter poems her time "in the hospital."

The poems in the surrounding sections describe in beautiful and intimate detail her patients' lives and the call to and practice of nursing. Featured throughout are battles won and lost-- with disease, with the medical staff, and as the title-- taking care of time-- suggests, the finitude we all face. No matter the difficulties of hospital life-- whether as practitioner or patient-- its familiarity  provides grounding and comfort in these poems as, for example, heard through the speaker of "First Night at the Cheap Hotel" who tells us:

"Being here is like being sick in a hospital ward
without the lovely, muffling glove of illness.
In hospital, I would be drowsy, drugged into a calm
that accepts the metal door's clang,
the heavy footfall right outside my door.
All these, proof of life,
and there would be a nurse too, holding my wrist,
counting and nodding, only a silhouette in the dark" (p.67)

And if sometimes the experiences and images become too hard to bear, the skillful nurse-poet can, as Cortney Davis does in "On-Call: Splenectomy," "tame them on page” (p.52).

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A Mind Unraveled: A Memoir

Eichenwald, Kurt

Last Updated: Jan-02-2019
Annotated by:
Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Kurt Eichenwald shares his experiences living with epilepsy in an electrifying narrative. Beginning with staring spells as a child and then later on generalized convulsions with loss of consciousness, he experiences as many as 4 seizures a week between the ages of 18 to 30. After that, the seizures become milder and less frequent. Coincidentally, his wife, father, and older brother are physicians and his mother a nurse.

Eichenwald describes his encounters with multiple neurologists, the best of them being Dr. Naarden. Unfortunately, other health professionals are portrayed as incompetent, careless, lacking empathy, or even unscrupulous. Multiple mishaps with prescribed anticonvulsant medications are chronicled – drug side effects, toxic levels of medicines, and a bout of bone marrow suppression. He suffers broken ribs, cuts and wounds, burns, and is even blanketed by deep snow due to seizures.

Eichenwald acknowledges the toll that epilepsy exacts on roommates, friends, and family. He admits to lots of fear and guilt. At one point, he seriously considers suicide by overdosing. Everyday life is hardly ever ordinary: “Now I was scared every day, checking where I stood for dangers, wondering when consciousness would disappear” (p157). A large section of his account details the discrimination he encounters at Swarthmore College in Pennsylvania in the early 1980’s. The school dismisses him because of his uncontrolled epilepsy. He successfully fights their decision and returns to graduate. Obtaining and holding a job is complicated by his illness, but Eichenwald becomes a journalist who works for the New York Times.




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