Showing 1 - 10 of 97 annotations tagged with the keyword "Euthanasia"

The Last Days of Ptolemy Grey

Mosley, Walter

Last Updated: Mar-07-2016
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Walter Mosley writes in various genres but is probably best known for his mysteries. His 2010 novel, The Last Days of Ptolemy Grey, could be considered another one of his mysteries, but the mystery plot takes a secondary role. Featured more prominently is the struggle the main character, Ptolemy Grey, has with dementia.   

The reader first encounters Ptolemy Grey when he is 91 years old and living alone in an apartment he has inhabited in South Central LA for more than 60 years. Both he and the apartment are in appalling shape. The apartment is cluttered, disorganized, and dysfunctional—as is his aging brain. He knows his mind is failing and seems to him as if it “had fallen in on itself like an old barn left unmended and untended through too many seasons.” (p.153)

Throughout the novel, Mosley presents aspects of dementia and some of its oddities. For example, while Ptolemy is riding on a bus through his town, certain sights trigger clear memories from his childhood 80 years before. At the same time he is unsure where he is going or why. Mosley also shows how people can possibly realize they are slipping into dementia, for example, when Ptolemy stops talking to a friend once “he could see in her eyes he wasn’t making sense.” (p. 122)

Ptolemy’s great-grandnephew Reggie provides him with the assistance he needs to barely maintain his lonely existence in squalid conditions. When Reggie dies, a new person comes into his life. Robyn, a 17-year-old orphan living with Ptolemy’s grandniece, begins to straighten out his apartment and then his mind.    

As Robyn gets Ptolemy’s apartment more organized and functional, Ptolemy’s mind starts to get more organized and functional as well, but only a bit more. Unsatisfied with his progress, Robyn takes Ptolemy to a physician who has an experimental drug for dementia. Ptolemy is told that if he takes the drug he will regain his mental acuity but probably not live more than a few weeks, or months, at best. Without hesitation he takes the drug—“I wanna make it so I could think good for just a couple a mont’s, Doc” (p. 126)—and rapidly regains many memories and mental capacities. During the time he has with his newfound mental agility, Ptolemy is able to make good on a commitment from his childhood and to solve the mystery of Reggie’s death. While the experimental drug enables Ptolemy to wrap up his business, it also produces a rather violent end to his life.

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Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

The author, an experienced surgeon, believes that we will be less frightened by the prospect of death if we understand it as a normal biologic process. He points out that 80 percent of deaths in this country now occur in hospitals and are therefore "sanitized," hidden from view, and from public comprehension. He describes the death process for six major killers: heart disease, stroke, AIDS, cancer, accidents/suicide, and Alzheimer's disease.But the power of the book is in its intensely personal depiction of these events and in the lessons which Nuland draws from his experiences. The message is twofold: very few will "die with dignity" so that (1) it behooves us to lead a productive LIFE of dignity, (2) physicians, patients, and families should behave appropriately to allow nature to take its course instead of treating death as the enemy to be staved off at any cost. Only then will it be possible for us to die in the "best" possible way--in relative comfort, in the company of those we love/who love us.

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Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Atul Gawande’s Being Mortal is both ambitious and synthetic, qualities that well suit his difficult subject, death.  In Western culture, there are taboos against death because it fits neither into post-Enlightenment notions of progress and perfection nor into medical notions of control, even domination of human biology. A surgeon and an investigator, Gawande draws on his patients, his family, and travels to various hospitals and other caregiving places in order to confront death and see how approaches such as hospice and palliative care can improve our understanding, acceptance, and preparation for death.

Gawande has harsh words for contemporary medicine, the supposed caregiver for the dying and their families.  Relying heavily on technique and industrial models, it ignores the deep needs of the dying and provides, instead, versions of “warehoused oblivion” (p. 188), for example long, futile stays in ICUs.

As opposed to traditional societies like India, Westerners prize the independence of individuals, a status that is, of course, never permanent. In the chapter “Things Fall Apart,” Gawande describes how longer lives are now the norm but they include chronic illnesses and inevitable decline in vitality.  Our deaths are now routinely in hospitals, not at home, and often extended—sometimes brutally—by technical support and unwillingness of doctors and families to stop aggressive treatment.       
       
Also, sadly, there are fewer and fewer geriatricians at a time when there are more and more elderly.  A good geriatrician takes a long time with each patient, is not well paid, nor does s/he do income-generating procedures. Worse yet, some training programs are being discontinued.  

Gawande illustrates his ideas with case studies of patients and describes, from time to time in the book, the elderly journeys of his grandmother-in-law and his own father.  These passages make vivid the abstract ideas of the book. But it’s not just elderly patients who face death: health calamities can come to anyone, for example, a 34-year-old pregnant woman found to have a serious cancer. Various treatments are tried without success, but family and doctors act out “a modern tragedy replayed millions of times over” (p. 183) of a medically protracted death. Finally her mother calls a halt to treatment.
               
Family members often bear a heavy load in caring for a sick elder, but many nursing homes are often worse, designed for control, not support of the patients. 

The chapter “A Better Life” describes the first in a series of places that offer much improved settings for the elderly, with birds, animals, gardens, and, in general, richer lives that have a sense of purpose.  Gawande describes hospice care, palliative care, and advanced directives (including Do Not Resuscitate orders) as improvements needed to break the norms of “treat at all costs.” The old roles of Dr. Knows-Best and Dr. Informative need to give way to physicians and others who talk with patients and families about their values, their wishes for the last days, and their preparations for death. In short, aggressive treatment should no longer be the “default setting” for hospital care.     
        
The book ends with a dozen moving pages about the death of Gawande’s father. The “hard conversations” have clarified his wishes, and hospice care has provided “good enough” days.  Pain control has done well. Then, finally, “No more breaths came.” The family travels to India to spread his ashes on the Ganges. 

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Hurt Hawks

Jeffers, Robinson

Last Updated: Mar-22-2015
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

"Hurt Hawks" is a narrative poem about a wounded hawk in free verse of 27 lines divided by the poet into two parts. Part I, which is 17 lines long, describes the setting of the poem in third person. Part II is 10 lines long, written in first person, and comprises the resolution of the carefully constructed tension set up in Part I. Some critics feel that Part II is sufficiently different in style and focus that it was originally an altogether separate poem (see below). Succinct yet lyrical, elegaic yet harsh, Hurt Hawks is, like the hawk that is the center of the poem, fiercely and unrelentingly an advocate of the natural - as opposed to the civilized - world. Hawks held a special place in Jeffers' heart, whether it be this poem or the longer "Cawdor," "Give Your Heart to the Hawks" (the name of a 1933 collection of his poetry), or "Hawk Tower," the edifice that he built for his family in 1920 on Carmel Point in California.

Part I sets the stage for the action in Part II, an Ecce Homo stage where the Homo is an injured hawk living in and around the poet—who makes clear, however, that the hawk is not a prisoner, either in the poet's eyes or its own. The poem opens with:

The broken pillar of the wing jags from the clotted shoulder,
The wing trails like a banner in defeat,
No more to use the sky forever but live with famine
And pain a few days:

Midway through Part II, Jeffers notes that

We had fed him six weeks, I gave him freedom,
He wandered over the foreland hill and returned in the evening, asking for death,
Not like a beggar, still eyed with the old
Implacable arrogance.

This poem is arguably not only Jeffers' most famous poem but often the only one still taught, when Jeffers is taught at all, in undergraduate courses. One reason for the inclusion of this poem in the curriculum is the famous first line of Part II, "I'd sooner, except the penalties, kill a man than a hawk." Aside from its popularity and this rather striking sentiment, the poem has proved a fertile source of discussion amongst critics for other reasons. First is the striking shift in voice from Part I to Part II, leading some to state that this poem was welded together from two distinct poems. Secondly, the plural "Hawks" in the title is mysterious and unclear since there is only one hawk mentioned in the poem—or is there? One interpretation of the plural is that in fact Jeffers and his family harbored two hawks and only the second was killed. Tim Hunt feels the second injured hawk in the poem refers to the saddened, or emotionally hurt hawk, i.e., the poet of Part II.

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Death of Sarpedon

Euphronios

Last Updated: Apr-20-2014
Annotated by:
Bertman, Sandra

Primary Category: Visual Arts / Sculpture

Genre: Red-figure vase

Summary:

This early Greek painting depicts an episode from Homer's Iliad where Sarpedon, a hero of the Trojan War, is killed by the spear of Patroklos, an enemy warrior. Zeus watches as his son "dies raging" (Iliad, transl. Richmond Lattimore, book 16, line 491). Two winged figures who represent Sleep and Death gently lift the still-bleeding Sarpedon off the battlefield. Standing stoically behind Sleep and Death, are Laodamas and Hippolochos, two Trojan warriors who were killed in battle prior to Sarpedon.

Euphronios, one of the first to work in the red-figure method, uses his simple but skillful technique to draw the hero's body at the moment it succumbs to death. Especially vivid are the three open wounds on Sarpedon's body from which blood spills to the ground. Sarpedon's eyes are closed, his limp hands drag along the ground. Zeus, powerless to prevent his son's suffering and death, sends the god Hermes to attend to his son's burial. Hermes, in turn, summons the caretakers Sleep and Death to transport Sarpedon to his grave.

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Summary:

Five Days at Memorial is the book length expansion  of the New York Times Sunday Magazine article that the author, a Pulitzer Prize-winning physician-journalist, published in 2009. The book, the result of years of research and literally hundreds of interviews, chronicles the five days (August 28 to September 1, 2005) during which the medical staff remaining at Memorial Hospital in New Orleans tried to care for the patients -- over a hundred of them stranded, like the staff, in a hospital without water or electricity --following the flooding wrought by Hurricane Katrina.

After an 8 page prologue, the book is divided into two sections, "Deadly Choices" (228pp, the narrative of those five days) and "Reckoning" (256pp, the legal battles over the injections of midazolam (a sedative) and morphine by some of those staff and prosecuted as homicide -- what others called "euthanasia.") "Deadly Choices" relates almost hourly the five days inside Memorial from the viewpoint of patients, patients' relatives, physicians, nurses, administrators of Memorial, Tenet (the holding company owning and running Memorial) and LifeCare -- the long-term care area within Memorial devoted to the care of terminally ill and debilitated patients -- owned by a separate company. Ethical and legal questions of triage, DNR, record-keeping, accountability, communication (primarily the failure thereof) and leadership are on almost every page. At the heart of this book, however, is the mystery of the unexplained deaths of so many patients during those five days. (On September 11, 2005, a disaster mortuary team recovered 45 bodies from many different places in Memorial, page 234). The crux of the mystery of these deaths is the manner in which nine in particular died in the beleaguered hospital on the fifth and last day when, paradoxically, relief had become real and effective and inclusive, seemingly obviating such injections.

The final pages of "Reckoning" deal with the fallout - historical, ethical, political and medical -- and current events relevant to these five days and the almost two years following. (The final verdict of not guilty -- the actual wording was "Not a true bill" since it was a grand jury declining to indict the one physician, Anna Pou, and the two nurses, Cheri Landry and Lori Budo -- was rendered on July 24, 2007). There are a map of Memorial Hospital and a cast of characters at the front of the book and extensive notes, bibliography and index at the end.

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Primary Category: Literature / Fiction

Genre: Collection (Short Stories)

Summary:

This collection of 16 short stories focuses on doctors and patients in San Francisco, where a wide variety of wealth and culture impact the delivery of medical care.  Further, there are many restrictions—financial, bureaucratic, ethical, and legal —that limit what doctors can do, especially in cases of patients near death.

The author, Louise Aronson, is a geriatrician who knows this terrain very well, having trained in San Francisco and worked as a physician there. A skilled writer and close observer, she has created dramatic and often funny stories that reveal social and bioethical complexity. About half the stories describe end-of-life issues for the aged and the dilemmas for their physicians and families.

In ‘The Promise,” Dr. Westphall orders comfort care only for an elderly patient who has suffered a massive stroke, but a hospital gives full treatment because there was no advance directive and the daughter told the attending to do “what he thought best.”

When Dr. Westphall sees this barely functioning patient in a skilled nursing facility seven months later, he tenderly washes her face and hair—although the text teases us that he might have been prepared to kill her.

In “Giving Good Death,” a doctor is in jail charged with murder; he has fulfilled the request of Consuela, a Parkinson’s patient, to help her die. When it appears that she may have died for other reasons, he is released, his life “ruined.” He leaves San Francisco, and, we surmise, medicine. In three other stories, doctors also leave the profession: the cumulative stresses of work and family and/or a sense that it’s not the right path bring them to that choice.

On the other hand, one of the longer pieces “Becoming a Doctor” celebrates the profession, despite all the rigors of training including sexism against women. 

The stories bring multicultural insights; we read of people from China, Cambodia, Latin America, India, Russia, and the Philippines. Some are African-American; some Jewish, some gay. These different backgrounds color notions of health, death, and medical care. There are also pervasive issues of poverty and, at another extreme, professionalism that is hyper-rational and heartless.

Indeed, a recurring theme is care and love for people, no matter their background or current health status. A surgeon realizes (regrettably too late) that the secret of medical care is “caring for the patient—for anyone—just a little. Enough, but not too much” (p. 135). 

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The Anatomy Lesson

Morley, John David

Last Updated: Jan-23-2013
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Fiction

Genre: Novel

Summary:

One of two sons of a broken U.S.-Dutch family, Kiddo chooses to live off the Dutch welfare system spending his state alms on drugs. Although he realizes it is but the bleakest of efforts not to come to grips with a difficult relationship with his older brother, Morton, Kiddo perseveres, forming an uneasy alliance with Pietje, a woman who also knows Morton.

The novel is told by Kiddo with contributions to the multi-faceted story in the form of letters from Morton, who gives up a brilliant future as a genius in physics to travel around the world, and diary entries by Pietje, who has some unpleasant truths to tell about Kiddo's world. Morton, known as Mort, writes Kiddo that he has cancer and not long to live, returning home to die. Honoring the dying request of his brother, Kiddo attends Mort's autopsy (yes, the play on Morte/Mort proves irresistible to Morley, or is it Mor(te)ley), a fairly gruesome scene. This proves not to be the death of Mort/Morte/Death for Kiddo and he requires help from Pietje and more introspection before Kiddo can lay his brother's bones to rest.

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The Courtroom

Layton, Elizabeth

Last Updated: Apr-26-2012
Annotated by:
Bertman, Sandra

Summary:

This is an aerial view of a comatose patient being force-fed by a funnel leading directly into her stomach. Surrounding the consultation table are six (identifiable) black-robed supreme judges gleefully pouring nutritious foods (grapes, fish, Quaker Oats, peanut butter, water and 7-Up) into her. Two tiny symbols, the scales of justice and a red-white-and-blue eagle contribute to the otherwise empty courtroom decor.

In the upper right corner, barely visible, is an open door with a "Keep Out" sign dangling from its knob, through which a doctor and nurse peer in. Four tiny red paper-doll figures holding hands, symbolizing the family, are also by this door. Hanging precariously over the patient and consultation table is an ugly, large, bare 25-watt light bulb.

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Summary:

McMurphy (Jack Nicholson) escapes work on a prison farm by feigning mental illness, but he finds himself in a far more coercive institution than the one he left behind. The other men, both sane and insane, are just like him: they hide in the locked ward from the law, their families, or the despair of their own lives.

McMurphy animates the dull monotony with fractious games, pranks, and excursions, but he encounters stiff opposition from the head nurse, Mildred Ratched (Louise Fletcher), whose system provides her with pills and electroshock to maintain control. When the nurse discovers that McMurphy has smuggled two women into the ward, she threatens to tell the mother of young Billy (Brad Dourif). Billy commits suicide and an enraged McMurphy tries to strangle Ratched. McMurphy is lobotomized and returned to the ward only to be smothered by his friend Bromden, who then escapes.

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