Showing 1 - 10 of 169 annotations tagged with the keyword "Racism"

Dothead

Majmudar, Amit

Last Updated: Jan-06-2017
Annotated by:
Kohn, Martin

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

Dothead is Amit Majmudar’s 5th book (and 3rd collection of poetry). It is far-ranging in its reach and style, perhaps best described by the heading of its table of contents, “Kedgeree Ingredients.” Kedgeree, as one unfamiliar with the word (like me) discovers on the page facing the table of contents (in a photocopy of a dictionary page), is “a mess of rice cooked with butter and dal….” Among other (con) textual surprises in this book are an opening epigraph from Dr. Seuss- “It is fun to have fun/But you have to know how,” a passport photo of the author at about age 3 above his book jacket biosketch, and the title of the final poem in the collection, “Invocation.”  Front and center in a number of poems is the issue of identity, perhaps most tellingly in the title poem, “Dothead,” where an Indian-American teenager confronts his white classmates. In “T.S.A.” the poem’s speaker faces off against the airport screeners claiming solidarity with :
             "my dark unshaven brothers
whose names overlap with the crazies and God fiends,
             ourselves the goateed other”  (p.5)
His identity as a poet is beautifully expressed through “Steep Ascension,” a poem “for John Hollander” (the epigraph unfortunately is not included in this volume) that ends:
          “But John, I told him, beauty is a fire
                    those who burn hardest labor coldly for

and I for one will hold your labors dear,
          the music of meaning, the artistry that dares
                    to conjure walls that it might conjure doors” (p.25). 

Among his “political” poems, are two about children: one gunned down ("Lineage")  and one abused (“Invocation")” that begins:
“The arms I sing. Forget the man. there is
no other epic. Sing the arms of kids,
the ones with pustules all along their veins” (p. 100).
The longest poem, a prose poem, is “Abecedarian” that weaves together Adam and Eve and the speaker’s discovery of oral sex.  



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Ordinary Grace

Krueger, William

Last Updated: Aug-02-2016
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Fiction — Secondary Category: Literature /

Genre: Novel

Summary:

Frank Drum, 13, and his younger brother Jake are catapulted into adulthood the summer of 1961 in their small Minnesota town as they become involved in investigation of a series of violent deaths.  Their father, a Methodist minister, and their mother, a singer and musician, can’t protect them from knowing more than children perhaps should know about suicide, mental illness, and unprovoked violence.  The story is Frank’s retrospective, 40 years later, on that summer and its lasting impact on their family, including what he and his brother learned about the complicated ways people are driven to violence and the equally complicated range of ways people respond to violence and loss—grief, anger, depression, and sometimes slow and discerning forgiveness.  

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Summary:

This is the third book in a series on the history of medicine and medical education by Kenneth M. Ludmerer, a practicing physician and historian of medicine at Washington University of St. Louis. The first, Learning to Heal: The Development of American Medical Education, published in 1985, dealt with the history of medical schools and medical education in the US from their origins in the 19th century to the late 20th century. In 1999 he published Time to Heal: Medical Education from 1900 to the Era of Managed Care. This book, Let Me Heal: The Opportunity to Preserve Excellence in American Medicine, published in 2015, is a sweeping history of graduate medical education in the United States from its inception to the current day.

In 13 chapters and 431 pages (334 pages of text, 97 of reference and index), Ludmerer traces the residency from early apprenticeship days to its metamorphosis (at Johns Hopkins, of which he is a justly proud medical school alumnus) into the embryonic form of what we now call an internship and residency. Giants like “The Four Doctors” (to use the title of John Singer Sargent’s famous portrait of William S. Halsted, William Osler, Howard A. Kelly and William H. Welch - but known simply as “The Big Four” at Hopkins) were the godfathers of the American postgraduate medical model which emphasized clinical science, teaching, patient care and research. The rise of acute care teaching hospitals as the venue of postgraduate medical education, and not the medical school or university, is an interesting story and one which Ludmerer tells in great detail over a number of chapters. It is one replete with predictable turf wars, professional turmoil and politics, and societal change in all aspects of the 20th century. This last phenomenon receives its due attention in every chapter but is dissected in meticulous detail in the final chapters dealing with the Libby Zion case, duty hours and the increasing role of the Accreditation Council for Graduate Medical Education (ACGME) in postgraduate medical education.

Beginning in the 1930’s, American medicine grew increasingly specialized and, in the ensuing decades, subspecialized, much to the consternation of pre-WW II general practitioners who, suddenly and for the first time, found themselves in the minority, in numbers and in influence, of their own profession. Concomitant with the phenomenon of specialization was the imprimatur by academic medicine of the structured, sanctioned residency as the sole route to specialty practice with, of course, the birth of associated accrediting agencies. Along with the move, physically, academically and politically, of postgraduate medical education to acute care teaching hospitals, the control of this education moved from medical schools to the profession at large.

Ludmerer deftly describes the “era of abundance”, the salad days of postgraduate medical education in the 1950’s and 1960’s when giants still made rounds on the floors of postgraduate medical venues; funds were plentiful; outside criticism was an as yet unborn bête noir; and social, economic and governmental curbs were only a tiny distant cloud in an otherwise blue sky. Ludmerer is correct in attributing much of medicine’s professional and social hegemony as well as its transient immunity to criticism in this era to the following evident successes of medicine: antibiotics; initial inroads into antineoplastic therapies; startling technological innovations in imaging; a burgeoning spate of life-saving vaccines; and spectacular advances in surgery, especially pediatric, cardiothoracic and transplant. Fatal diseases of the 1930’s and 1940’s were now often cured in days and of historical interest only.

Like all salad days, those of medicine eventually succumbed to new historical forces: foreign medical graduates in the workplace; the ever-growing financial burden of the residency; and economic pressures like Medicare and its associated regulation. There were other factors, too: professional and societal expectations of standardization and quality care; the explosion in subspecialties; the horrid wastefulness of unnecessary diagnostic tests and therapies borne of an earlier undisciplined abundance; the supercession of the intimate primary physician-patient relationship by the fragmented care of specialists and the rising supremacy of technology over personalized histories and careful physical examinations (why percuss the abdomen when you can get a CAT scan?). Dissatisfaction amongst residents is a dominant theme Ludmerer rightly raises early and often: the conflict and tension between education and service, between reasonable work and “scut”, between being a student and a worker (at times, quite a lowly one).

”High throughput” - the much more rapid turnaround time between admission to an hospital and discharge - has radically changed forever the entire nature of postgraduate medical education, and not for the better in the eyes of the author and of this reviewer, who were fellow residents a lifetime ago at Washington University in St. Louis. This decreased length of stay, a result of the remarkable improvements in diagnosis and therapy mentioned above, meant that the working life of providers (attending physicians, residents, physician assistants and nurses) was in high gear from admission to discharge, thereby increasing tension, likelihood for error and, exponentially, the workload for the resident while simultaneously and irrevocably damaging the possibility of a meaningful, careful provider-patient relationship (like a friendship, of which it is a subspecies, such relationships can not be rushed) and decreasing opportunities for learning. Medicare; changing patient populations; societal and professional disgruntlement; the Libby Zion mess and the ensuing cascade of regulations from all sides, but most especially the ACGME - all receive careful and systematic treatment in the final chapters of this monograph.

Ludmerer ends with a chapter listing what he sees as opportunities for achieving (or re-achieving) excellence. Indeed, he has made it the book’s subtitle. They are the following: a plea for the ACGME to revise its 2011 duty-hour regulations; an equally earnest hope that interns and residents will soon realize a more manageable patient load; a related wish for academic medicine to decrease the unfortunate occurrence of economic exploitation of house officers; a suggestion that this annotator shares, i.e., that the process of supervision, improved (but inadequately) with recent ACGME requirements, be further strengthened; and a hope that medical schools will restore teaching to the central place in the institutional value system it used to enjoy. Ludmerer issues a call for the more vigorous promotion of “an agenda of safety and quality in patient care” (page 312) and suggests that the education of residents be expanded to include venues outside in-patient sites. Elsewhere in the book, he also expresses the expectation that the inclusion into clinical teaching of private patients alongside “ward” patients, more feasible with recent improvements in the re-imbursement of medical care, be routine and maximized to the enjoyment and benefit of all concerned.

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Call the Midwife

Worth, Jennifer

Last Updated: Dec-15-2015
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Many are familiar with these stories from the author's practice as a midwife among the urban poor in London's East End in the 1950s.  Each piece stands alone as a story about a particular case. Many of them are rich with the drama of emergency interventions, birth in complicated families (most of them poor), home births in squalid conditions, and the efforts of midwives to improve public health services, sanitation, and pre- and post-natal care with limited resources in a city decimated by wartime bombings.  As a gallery of the different types of women in the Anglican religious order that housed the midwives and administered their services, and the different types of women who lived, survived, and even thrived in the most depressing part of London, the book provides a fascinating angle on social and medical history and women's studies.

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The Physician

Gordon, Noah

Last Updated: Nov-17-2015
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

When nine-year-old Rob Cole, child of poor 11th-century English farmers, loses his mother, he is consigned to the care of a barber-surgeon who takes him around the countryside, teaching him to juggle, sell potions of questionable value, and assist him in basic medical care that ranges from good practical first-aid to useless ritual.  When, eight years later, his mentor dies, Rob takes the wagon, horse, and trappings and embarks on a life-changing journey across Europe to learn real medicine from Avicenna in Persia.  Through a Jewish physician practicing in England, he has learned that Avicenna’s school is the only place to learn real medicine and develop the gift he has come to recognize in himself.  In addition to skill, he discovers in encounters with patients that he has sharp and accurate intuitions about their conditions, but little learning to enable him to heal them.  The journey with a caravan of Jewish merchants involves many trials, including arduous efforts to learn Persian and pass himself off as a Jew, since Christians are treated with hostility in the Muslim lands he is about to enter.  Refused at first at Avicenna’s school, he finally receives help from the Shah and becomes a star student.  His medical education culminates in travel as far as India, and illegal ventures into the body as he dissects the dead under cover of darkness.  Ultimately he marries the daughter of a Scottish merchant he had met but parted with in his outgoing journey, and, fleeing the dangers of war, returns with her and their two sons to the British Isles, where he sets up practice in Scotland.

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Black Man in a White Coat

Tweedy, Damon

Last Updated: Nov-09-2015
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

This memoir focuses on the various ways in which his being an African American affected Tweedy’s medical education and early practice as a medical resident and later in psychiatry. Raised in the relative safety and privilege of an intact family, he found himself underprepared for some of the blatant forms of personal prejudice and institutional racism he encountered in his first years of medical education at Duke Medical School.  One shocking moment he recounts in some detail occurred when a professor, seeing him seated in the lecture hall, assumed he’d come to fix the lights.  Other distressing learning moments occur in his work at a clinic serving the rural poor, mostly black patients, where he comes to a new, heightened awareness of the socioeconomic forces that entrap them and how their lives and health are circumscribed and often shortened by those forces.  Well into his early years of practice he notices, with more and more awareness of social contexts and political forces, how the color line continues to make a difference in professional life, though in subtler ways.  The narrative recounts clearly and judiciously the moments of recognition and decision that have shaped his subsequent medical career.    

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Fire Shut Up in My Bones

Blow, Charles

Last Updated: Oct-11-2015
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Blow’s account of growing up in rural Louisiana, exposed to negligence, sexual molestation, violence, and loss focuses on a child’s strategies of survival first, and then on sexual confusion, social ambition, and discovery of the gifts that led him to his life as a writer for the New York Times.  A major theme in the memoir is his learning to claim his bisexuality after years of secrecy and shame.  That emergent fact about his identity, along with moving to New York after a life in the rural South required an unusual level of self-reflection and hard, costly choices that challenged norms at every level.  His account of learning to assume a leadership role in a college fraternity and deciding to finally leave it behind offers a particularly vivid example of what it takes to resist perpetuating rites of humiliation and conformity designed to curb individuation.     

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The Story of Beautiful Girl

Simon, Rachel

Last Updated: Oct-02-2015
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

On a stormy night in 1968, Martha, a retired, widowed schoolteacher in rural Pennsylvania opens her door to find a young couple, she white, he African American, wrapped in blankets, drenched, and silent.  Letting them in changes her life.  They have escaped together from a nearby mental institution most locals simply call "The School."  The young woman has recently given birth.  When Martha lets them in, her life changes forever.  Supervisors from "the School" show up at the door, the young man escapes, and the young woman, memorably beautiful, is taken back into custody.  The only words she is able to speak out of what we learn has been a years-long silence are "Hide her."  Thus she leaves her newborn baby to be raised by a stranger.  The remaining chapters span more than forty years in the stories of these people, linked by fate, love and the brutalities of an unreformed system that incarcerated, neglected, and not infrequently abused people who were often misdiagnosed.  Homan, the young man who loved Lynnie, the beautiful girl from the institution, was deaf, not intellectually disabled.  Lynnie was simply "slow," but a gifted artist who recorded many of the events of her life in drawings she shared only with the one attendant who valued and loved her.  Though her pregnancy resulted from being raped by a staff member, the deaf man longs to protect her and care for the baby.  Years separate them; Homan eventually learns signing; Lynnie's sister befriends her and an exposé results in the closure of the institution.  Over those years Lynnie and Homan witness much cultural change in treatment of people like them who were once systematically excluded.  They find social identities that once would have been entirely unavailable to them.  And eventually, after literal and figurative journeys of discovery, they rediscover each other.  

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Medicine: My Story

Berris, Barnet

Last Updated: Aug-25-2015
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

Born in 1921 to Jewish immigrant parents, “Barney” Barnett describes his life in medicine and education, from his earliest love of science and learning through his medical and residency education in general internal medicine, his success as an academic physician, and finally his judicious decision to retire.

An important leitmotiv is the antisemitism of the University of Toronto that kept him from a residency position (he went to Minneapolis) and a staff position (he was offered a one-year fellowship on a low salary in 1951).  Even after he was accepted as a staff member at the Toronto General Hospital (TGH), he was not promoted. Although he referred many patients to his TGH colleagues, only six ever returned the favor in the thirteen years he was there. Ironically, his Jewish background plucked him from this pedestrian position directly to the seat of Physician in Chief of Toronto’s Mount Sinai hospital (founded 1922) when finally it became a teaching hospital in 1964. 

While maintaining a practice in internal medicine, Berris became a liver specialist and researcher who introduced liver biopsy to Toronto. Known as a consummate diagnostician, he endeavored to enhance the research profile of his institution, integrating it with bedside instruction. He served on examining committees for the Royal College of Physicians and Surgeons, candidly describing the subjectivity of the process. He also served on many committees of the College of Physicians of Ontario, including discipline
, and describes the process used to investigate complaints with case examples.

His story includes vivid descriptions of some of the most famous figures in Canadian medical history, his teachers and colleagues – J.B. Grant, Arthur W. Ham, William Boyd, Ray Farquharson, K.J.R.Wightman, Arthur Squires, and Arnold Aberman. He was once involved with the care of the wife of David Ben-Gurion and Queen Elizabeth II.

Little is told of his personal life, although he admits that he often neglected his family for the press of work. His first wife, Marie, was a social worker; they had three children, one now a physician. She died of ovarian cancer; to care for her, he stepped down as chief in 1977.  In 1984, he married Thelma Rosen, an expert in education and widow of a pediatrician colleague. Together they went on a year’s sabbatical that allowed him to work in Singapore, Stanford University, and Sheila Sherlock’s lab at the Royal Free Hospital in London.

Some of the most engaging chapters contain clinical vignettes: stories about patients, the diagnostic workup, and their outcomes.  Like Richard Goldbloom (A Lucky Life
) and without diminishing his native abilities (which must have been considerable), he modestly attributes most of his success to luck.  

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Freud's Mistress

Kaufman, Jennifer; Mack, Karen

Last Updated: Jul-31-2015
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Minna Bernays is the younger sister of Martha, Sigmund Freud's wife. Her own fiancé has died and by 1895, she is reduced to joining her sister’s family in Vienna because she has abandoned her position as a companion to a demanding, prejudiced aristocrat. The six Freud children love her, but she finds them exhausting and undisciplined. Obsessed with order, housework, and social standing, and possibly suffering from psychosomatic ailments, Martha is happy to leave the care of the children to Minna. She disapproves of her husband’s theories about sexual frustration as a cause of mental distress and refuses to discuss his ideas. Nevertheless, Martha is well aware that growing anti-semitism hampers her husband’s career, and she is eager for him to succeed: he could consider a conversion of convenience, like the composer Gustav Mahler.

Minna finds herself drawn to Sigmund for his intellect and his novel ideas. She is also attracted to him physically, and he to her. She resists the temptation, but he does not and actively pursues her, inducing her to try cocaine too. He justifies it - the sex and the drugs - as necessities for mental and physical well-being and he rejects the guilt that, he claims, so-called civilization would impose.

She tries to leave by finding another job as a ladies’ companion in Frankfurt, but he follows her there. They escape for an idyllic holiday to a hotel in Switzerland, then he brings her back to the family home. But his ardor cools and she is wounded, displaced by his enthusiasm for Wilhelm Fliess and Lou Andreas-Salomé.

Soon she discovers that she is pregnant, and Freud sends her away to a “spa” for an abortion, but at the last moment, she decides to keep her baby. Sadly she miscarries and returns to the Freud family with whom she remains for more than four decades until her death in 1941.

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