Showing 1 - 10 of 78 annotations tagged with the keyword "Heart Disease"

The Wound Dresser

Coulehan, Jack

Last Updated: Nov-23-2016
Annotated by:
Shafer, Audrey

Primary Category: Literature / Poetry

Genre: Poetry

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)

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The Heart

de Kerangal, Maylis

Last Updated: Apr-25-2016

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The story of The Heart is a simple, linear structure.  A car accident renders a young Frenchman, Simon, brain-dead. A medical team proposes harvesting organs, and his parents, after some turmoil, agree. That’s the first half of the book, the provenance of this specific heart. The second half describes its delivery for transplantation. Administrators find recipients, one of them a woman in Paris. Simon’s heart is transported there by plane and sewn into her chest. All this in 24 hours.  
            
The narration is complex, with flashbacks, overlapping times, and literary art that is compelling. There are 28 sections to the story but without numbers or chapter headings, and these are often broken up into half a dozen shorter sections. We have an impression of stroboscopic flashes on the action, with high intensity focus. These create a mosaic that we assemble into dramatic pictures. Even major characters arrive without names, and we soon figure them out.  
 

Simon.  He’s called the donor, although he had no choice in the matter. At 19 years of age he’s trying to find a path in life.  A Maori tattoo is a symbol for that search. He has a girlfriend, Juliette. He fades away as a character (except in others’ memories) and his heart takes center stage.  

Marianne and Sean, Simon’s parents.  Her emotions, as we would expect, range widely, especially during discussion of whether Simon’s organs can be transplanted. Father Sean has a Polynesian origin and cultural heritage.


Pierre Révol, Thomas Rémige, and Cordélia Owl are respectively the ICU physician, nurse, and the transplant coordinator. These are vividly drawn, with unusual qualities. Skilled professionals, they are the team the supplies the heart.  

Marthe Carrare, Claire Méjan, and Virgilio Breva are a national administrator, the recipient, and a surgeon. Described in memorable language, they are the receiving team.              

The characters’ names give hints of de Kerangal’s range. S
ince the 1789 Revolution Marianne has been a well-known French national symbol for common people and democracy, but Virgilio Breva is from Italy and Cordélia (recalling King Lear) Owl (as in wise?) has a grandmother from Bristol, England. We learn of personal habits regarding tobacco, peyote, sex, and singing. Medicine is part of a larger world of people of many sorts.              

Even minor characters, such as Simon’s girlfriend Juliette and other medical personnel are touching and memorable.
             

These characters animate the story with their passion, mystery, even heroism. While we don’t know the final outcome of the implanted heart, the text shows the professionalism of the medical team, the French national system that evidently works, sensitive care of patients and families, and in the last pages, rituals of affirmation for medical art and for patients.
             

There is richness in de Kerangal’s style. At times it is direct, reflecting the thoughts of characters. At times it is ornate, even baroque. She uses many images and metaphors, often with large, epic qualities. A very long sentence about the over-wrought parents describes them as “alone in the world, and exhaustion breaks over them like a tidal wave” (p. 141).  The style uses many similes, often with dramatic and unexpected comparisons. There are references to geology, astronomy, even American TV hospital drama. The style is at times lyric…we might say “operatic.”  One page about Cordélia is very, very funny.
        
  
In a different tone, the details of medicine, law, and ethics are carefully presented, and visual imagery puts us in the hospital rooms, the OR, and crowded streets around a soccer game. Throughout it appears that translator Sam Taylor has done an admirable job. 
             

The text invites us to consider large visions of wholeness. All the major characters seek some comprehensive unity to their lives, and they avoid orthodoxies such as religion, patriotism, and economic gain. Sean has his Polynesian heritage and boat-building passion, which he has shared with Simon. Cordélia, at 25, is an excellent nurse, wise beyond her years in some ways, but is as dazzled by a man as any teenaged girl. Nurse Rémige has his master’s in philosophy, loves the song of rare birds, and is, himself, a serious singer.  

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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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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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Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Matthew McCarthy begins his memoir of medicine internship year at Columbia University with a glimpse into his first rotation, surgery, as a Harvard medical student. He had exhibited a talent for surgery and liked it – an affinity compatible with his dexterity as a minor league baseball player and sense of team spirit. The reader meets some of McCarthy’s memorable mentors, and, although he opts to not pursue surgery as a career, McCarthy’s eye for seeking productive apprenticeships with talented housestaff and faculty allow him to guide the reader through a year of drinking from the firehose, also known as internship. Medical training is full of liminal experiences, and internship is one the most powerful and transformative.  

McCarthy’s eagerness to do well, both by his patients and by his medical colleagues and team, and his candor with revealing his mental and bodily responses to the stress and strain of the responsibilities of internship, make him an adept guide. For example, he has gulped an iced coffee and is churning at the bit to take care of a new admission on his first day of call in the cardiac care unit (CCU). His resident, called Baio in the book, tries to tell McCarthy to take it easy. But McCarthy notes, “Our orientation leaders, a peppy group of second- and third year residents, had instructed us to exude a demented degree of enthusiasm at all times, which wasn’t difficult now that my blood was more caffeine than hemoglobin.” (p 15) The previous chapter had ended with a cliffhanger – a patient life would be placed in danger because neophyte McCarthy misses the importance of a key clinical finding – what and how that plays out will wait until McCarthy guides us through the terror and exhilaration he feels as he begins his CCU rotation.  

McCarthy has a good sense of the ironic: the huge banner advertising the hospital reads “Amazing Things are Happening Here!” Indeed, not only for patients and families, but also for the many trainees and workers. We watch McCarthy successfully perform his first needle decompression of a pneumothorax; he is allowed to attempt it as he notes that he watched the video of the procedure. But unlike the video, he needs to readjust the needle several times and add on some additional tubing and water trap, which makes the scenario more true-to-life than a fictionalized ‘save.’ The author ends the chapter with congratulations from resident Baio: “Well done… Amazing things are indeed happening here.” (p 244) As McCarthy’s year continues, many things do happen, including an infected needle stick, telling bad news to a new widow, and developing a friendship with a longterm hospital patient waiting for a heart transplant.

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Someone

McDermott, Alice

Last Updated: Feb-13-2014
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Marie Commeford, daughter of Irish Catholic immigrants who grows up in Brooklyn, narrates her life story in episodes rich with reflection on the losses, failed fantasies, illnesses, and disappointments of a life at the edge of poverty, which is also rich with love and poetry and humor and the stuff of which wisdom is made.  The story unfolds as memory unfolds, in flashbacks and reconstructions shaped by a present vantage point from which it all assumes a certain mantle of grace.   From the opening story in which a neighbor girl slips on the steps to a basement apartment and is killed, to repeated glimpses of a blind veteran who umpires the neighborhood boys' street games, to the bereaved families Marie meets when she works for the local undertaker, to her gradual discovery of her brother's closeted homosexuality, and to her aging mother's death, the story keeps reminding us of how much of life is coming to terms with the "ills that flesh is heir to," and also how resilience grows in the midst of loss.  Because much of the story represents the vantage point of a child only partially protected from hard things, it invites us to reflect on how children absorb large and hard truths and learn to cope with them. 

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Immortal Bird: A Family Memoir

Weber, Doron

Last Updated: Feb-10-2014
Annotated by:
Schilling, Carol

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Damon Weber's proud father, Doron, has written a searing memoir that enfolds a story of parental love and loss into a medical exposé. By the time Damon turned four, he had two open-heart surgeries to correct a congenital malformation that affected circulation to his lungs. His parents were led to believe that after the surgeries, their effervescent, sociable, academically and artistically talented son was set for life. However, as Damon turned 12, they became concerned about what his father calls "his unsprung height," his shortness of breath, and a strange protrusion in his abdomen (40). Returning to his attending physician, they were surprised that she withheld information from them about a condition known as PLE (protein-losing entropy), which can manifest months or years after the kind of surgery (Fontan) their son underwent. PLE enlarges the liver and allows proteins to leak from the intestines. Without adequate protein, Damon's body could not grow. His father worried that they might have passed the established window of opportunity to treat the complication.

The memoir, which reads like an extended eulogy to a beloved son, fuses scenes of family life with difficult medical decisions aimed at reversing the effects of PLE. However, none of the interventions succeed, leaving a heart transplant as Damon's last hope. As Weber recounts each decision leading to the transplant, he exposes flaws in the way hospital systems operate, in the way families are treated, and in the care provided by the medical team that lobbied to perform the transplant. Damon died after his transplant physician made herself scarce after misdiagnosing a post-operative complication, and an inattentive hospital staff ignored his parents' justifiable alerts to ominous symptoms. Scenes of the hospital staff waiting impatiently at the door to Damon's room to remove the machines sustaining and monitoring him, as his distraught parents say good-bye, are disturbing. When the Webers initiate a lawsuit, the transplant physician cannot locate Damon's medical records. The narrative fully absorbs Weber's sorrow and anger.

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Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

The author was the first blind physician to be licensed in Canada. Her autobiography is also an autopathography.

From her anger over developing severe diabetes as a teenager, through her relentless pursuit of a scientific degree and medical school, through a brief failed marriage – followed by the tragedy of completely losing her sight while still in training, to a rewarding and responsible career as a palliative care physician and educator.

Sustained by her religious faith and by loyal family members and friends, Poulson explains choices, compromises and supports that allowed her to continue studying and working in Montreal and later in Toronto.

Her complications from diabetes were numerous, and included heart disease for which she required surgery. Then she developed breast cancer, which eventually metastasized. In closing her narrative, she knows it will likely take her life.

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My Heart

Mehmedinovic, Semezdin

Last Updated: Jun-27-2013
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

A 50-year-old man is showering when he experiences pressure in his chest and throat associated with profound fatigue. An ambulance is called, and the emergency medical personnel inform him that he is having a heart attack. As he lays bare on his bed, his emotions switch from shock to indifference to a sense of calm with acceptance of impending death.

The narrator is a poet and a foreigner. In the hospital, his complicated name gets truncated to "Me'med" for convenience. He emigrated with his family from Zagreb to America in 1996, but still wakes from sleep haunted by memories of Kalashnikovs firing in Sarajevo.

He has stents placed in two obstructed coronary arteries and is immediately asymptomatic. At the Washington, D.C. hospital where he is treated, the narrator encounters a collection of fellow-foreigners: an elderly Slovak roommate suffering from Alzheimer's disease, a young Somali nurse, an African echocardiographer, and an Indian physician. A few days later, when he is discharged from the hospital, he feels fear and insecurity even though his medical problem has been fixed.

The narrator's world is now different. He is no longer who he was. When he returns to his apartment, hints (cigarettes and ashtrays) of his prior life are missing. He has a chance to change, another opportunity to restart his life.

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Open Heart

Wiesel, Elie

Last Updated: Feb-01-2013

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Elie Wiesel, 82-years-old, has pain that he thinks is in his stomach or esophagus, perhaps caused by his chronic acid reflux.  After tests, however, doctors diagnose cardiac illness and insist on immediate surgery. Reluctant to go to the hospital, Wiesel dawdles in his office. When he does go, doctors believe a stent will do the job. Instead, the intervention becomes a quintuple bypass.

This brief memoir—a scant 8,000 words—presents the “open heart” of a gifted writer as he contemplates his open-heart surgery, his past life, and the future. He asks himself basic, even primal questions about life, death, and the nature of God.            

Although a man with an extraordinary career—prizes, fame, honorary doctorates, friends in high places, professorships—Wiesel experiences and describes ordinary feelings of anxiety, pain, and doubts about his cardiac emergency and possible death. His stylistic gifts describe frankly and vividly a patient’s fears. As many have observed, patients with a serious disease have two difficulties, the disease itself and their emotional responses to that disease.  As Wiesel is wheeled into the OR, he looks back on his wife and son; he wonders whether he will ever see them again.            

He writes that his “thoughts jump wildly; I am disoriented.” He recalls a friend undergoing similar surgery; she died on the table. He says he can’t follow the jargon of physicians. The texture of the prose is rhapsodic, jumping from the present to memories, many of them about war, his past surgeries, or important family events. This short book has 26 “chapters,” some just half a page; they are like journal entries.

As he slowly recovers, he feels pain and has visions of hell, including the concept of ultimate judgment. “Evidently, I have prayed poorly…; otherwise why would the Lord, by definition just and merciful, punish me in this way?” (p. 38).  Because he has a “condemned body,” he feels he must search his soul. In the longest chapter of the book, he reviews several of his writings.

Wiesel asks some of the questions from his famous novel Night (La nuit, 1958).  If there is a God, why is there evil? Auschwitz, he says, is both a human tragedy and “a theological scandal” (p. 67). Nonetheless, he affirms, “Since God is, He is to be found in the questions as well as in the answers” (p. 69).

At the end, he still has some pain but feels much gratitude for his continuing active life and for his grandchildren.

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