Showing 1 - 10 of 192 annotations tagged with the keyword "Psycho-social Medicine"
Summary:The speaker of this poem is a nurse who is recalling and attempting to come to terms with a disturbing clinical encounter she’d had the week before. (I should note at the outset that there’s no indication in the poem as to whether the nurse is male or female. I choose to think of her as female). What had happened is that a mother had brought her five-year-old son in for treatment, and the nurse’s exam revealed that the child had second- and third-degree burns on his torso—in the shape of a cross. The mother, weeping, confessed that her boyfriend had, as a punishment, applied a cigarette to the child’s body—while the mother had held her son. Seeing the mother’s tears, the nurse considered offering the woman some Kleenex, but could not bring herself to do so. The child retrieved the box of Kleenex, then clung to his mother’s skirt, and glowered at the nurse. Then the nurse had participated with three others in prying the boy away from his mother. In the present of the poem, a week after the encounter, the nurse attempts to deal with the guilt and shame she feels in her failure of professional decorum and compassion—at having failed to rise above her moral judgment against the mother and offer the woman basic human kindness and respect. In confronting the chaos of her emotions, the nurse turns to a story she’d learned in high school: the story of St. Lawrence. The significance of her attempt to think with this story can be overshadowed, for readers, by the intensity of the clinical encounter she recalls; but her endeavor is of at least equal significance as the encounter.
Summary:The Renewal of Generosity: Illness, Medicine, and How to Live contemplates the phenomenon of generosity as it is realized in the stories of physicians and patients. For Arthur Frank, generosity is grounded in the willingness of people to give themselves over to dialogical processes of communication wherein participants best realize themselves through relational engagement: generous, dialogical communication leads to a renewal and realization of human being. Health care systems today tend to impede communicative generosity, however, and the result is a de-humanization and de-moralization of both physicians and patients. As a remedy, Frank proposes, first, that we re-figure our conceptualization of the physician-patient relationship—from the economic or business metaphor of “provider” and “client,” we should turn to the metaphorical conceptualization of “host” and “guest,” which clearly has implications for manner of treatment and communication that occurs in the relationship. In addition, Frank turns to and thinks with stories of physicians and stories of the ill to reflect on the ways that generosity is realized. Drawing on the wisdom of the striking philosophical triumvirate of Marcus Aurelius (Stoicism), Mikhail Bakhtin (Dialogism), and Emmanuel Levinas to amplify the reflections emerging from the physician and patient stories, Frank ultimately proposes “exercises” for training to generate a vivifying generosity within the medical profession, which can in turn lead to a re-humanization and re-moralization for physicians, improved care for patients, and enhanced flourishing for all.
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.
Summary:The collection is prefaced and named for a poem by Walt Whitman, The Wound Dresser, annotated in this database by Jack Coulehan. In “On Reading Walt Whitman’s ‘The Wound Dresser’” Coulehan sees Whitman as a nurse tending the Civil War wounded, and, while using some of the words and language of Whitman’s poem, imagines himself moving forward in that created space of caring for patients: “You remain / tinkering at your soldier’s side, as I step / to the next cot and the cot after that.” (p. ix) The poem introduces us to all the ‘cots’ of the book – where we step from patient to patient, through history and geography, and through the journey of medical training. The book is comprised of 4 sections without overt explanation, although there are 4 pages of Notes at the end of the book with information about select individual poems. In general, the themes of the sections can be described as: 1.) clinical care of individual patients and medical training; 2.) reflections on historical medical cases, reported anecdotes or past literary references; 3.) meditations on geographically distinct episodes – either places of travel or news items; and 4.) family memoir, personal history and the passage of time. Many of the poems have been previously published and a few are revised from an earlier chapbook. Notable among the latter is “McGonigle’s Foot” (pp 42-3) from section 2, wherein an event in Philadelphia, 1862 – well after the successful public demonstration of anesthesia was reported and the practice widely disseminated, a drunk Irishman was deemed unworthy of receiving an anesthetic. Although it is easy to look back and critique past prejudices, Coulehan’s poem teaches us to examine current prejudices, bias and discrimination in the provision of healthcare choices, pain relief and access to care. There are many gems in these 72 poems. Coulehan has an acute sensibility about the variety of human conditions he has the privilege to encounter in medical training and clinical practice. However, one of the standouts for me was “Cesium 137” based on a news report of children finding an abandoned radiotherapy source (cesium) in Goiania Brazil, playing with the glowing find and suffering acute radiation poisoning. He writes: “the cairn of their small lives / burst open…their bodies vacillate and weaken / hour by hour, consumed by innocence / and radiant desire.” (p. 68). Following another poem inspired by Whitman, Coulehan concludes the collection with a sonnet “Retrospective.” He chronicles a 40-year career along with physical aging, memories of medical training “etched in myelin,” and the search for connection across that span of career including, “those he hurt, the woman / he killed with morphine, more than a few he saved.” Ultimately, he relies on hope with fitting understatement: “His ally, hope, will have to do.” (p. 97)
Summary:This monograph is an important contribution—along with the Health Humanities Reader (2014)—to the burgeoning field of health humanities, a new academic field and the presumed replacement for (and expansion of) medical humanities. While the medical humanities included philosophy, literature, religion, and history, health humanities includes many more disciplines, and the creative arts.
Summary:In 1942, Beth Pierce was completing her internship in the new discipline of occupational therapy in a Baltimore hospital where she meets Jim, a conscientious objector who is training to become a medic. They share a love of poetry and the arts. He goes off to war and serves in the foxholes and trenches of the dreadful conditions at the front. She stays in North America serving in rehabilitation with the war wounded – young men damaged physically and mentally from the great trauma. Until 1945, they exchange a remarkable series of letters that describe the war, their parallel work with the war wounded, their hopes for the future, and gratitude for each other’s thoughts. The letters always close with “Please write.”
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.
Summary:Best Boy is a novel about Todd Aaron, a 54-year-old autistic man who has lived for 40 years in a Payton LivingCenter (sic); he was involuntarily committed to this facility. Todd has been in five previous places for congregate living, but Payton seems to be the best for him, thanks in part to a loving caregiver, Raykene. Todd has accepted the institutional “Law” of Payton and takes his drugs right on schedule, including Risperdal, an antipsychotic that slows him down, making a “roof” over him and muffling, he says, “the voice in my brain.” The story is told from Todd’s point of view, often with startling imagery: he pictures his dead parents turning into giant cigars, a raindrop “explodes,” and, when upset, he rocks back and forth and feels “volts.” Now and then he recalls that his mother called him her “best boy.”
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.