Showing 1 - 10 of 3219 annotations

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This important and much needed book describes the psychological difficulties of doctors in training and in practice and the woeful lack of support to them from teachers, colleagues, and institutions. When there are over 50 percent of doctors suffering burnout (or depression, even suicide), shouldn't we see and ameliorate this "significant public health crisis" (p. 263)?
Carolyn Elton is a vocational psychologist who has spent the last 20 years working with doctors in England and the U.S.  She has worked with over 600 doctors in a wide variety of specialties. 
  
 
Introduction: “Medicine in the Mirror”
Elton starts with a real-life email from a desperate medical student. She cites examples of med. students who commit suicide, studies of depressed doctors, and surveys that show impacts on medical care for all of us when it is given by doctors suffering from poor morale.

Ch. 1, "Wednesday's Child" discusses young doctors suddenly thrown into clinical practice; many are unready for the stress, and many training programs do not support them sufficiently.

Ch. 2,  "Finding the Middle." Many senior doctors are inhospitable to young doctors, especially those trained in other countries, for example India. There’s hope for sharing and support in  Schwartz Rounds, where staff (clinical and nonclinical) meet and discuss issues.

Ch. 3,  "Which Doctor." We learn that many troubled doctors have chosen the wrong specialty for them, often because of a specific illness in their families. They should have more time to chose or, even, to change specialties.

Ch. 4, "Brief Encounter."  Psychological concepts of transference and counter-transference are helpful in understanding sexual issues (examining patients' sex organs, homosexuality, sexism, inappropriate humor, attraction to a patient, even past sexual abuse). Many of these are common but so taboo that they are ordinarily—and unfortunately—not discussed in training. 


Ch. 5, “Role Reversal.” The book’s title “also human” is front and center here, because doctors become sick, injured, or otherwise compromised so that they must have medical assistance. Regrettably, other doctors often dismiss such problems or even blame the doctor for causing them or not overcoming them. Further, doctors often try to avoid a sick role. Psychological dilemmas and physical disabilities are often stigmatized.

Ch. 6, “Leaky Pipes.” Women doctors are often ill-treated, especially in surgery, where “surgical culture embodies masculinity” (p. 152). Women wishing to have children and family life in general are seen as slackers. Women doctors often “leak out” from hospital work to part-time community-based roles.


Ch. 7, “Risky Business.” Once again, we read that there is bias against Asian, black, disabled, or female doctors.  Specific examples and studies from social science make this dramatically clear. This unfortunate dynamic makes careers in medicine for such doctors “psychologically risky” (p. 192).

Ch. 8, “No Exit.” For many reasons it is hard to quit medical school, later training, or work in medicine, even when this is the best choice. Doctors often feel pain, even guilt when patients die, and they have little support.

Ch. 9, “Natural Selection.” Reviewing many problems already discussed, Elton summarizes: “sometimes the dream of training as a doctor turns out to be a nightmare in reality” (p. 229).  There’s bias in selection of students, reliance on tests with limited accuracy, insensitivity to the whole person, and inappropriate retention of students who should not become doctors. The Darwinian chapter title is ironic; much of the medical world as structured today is not natural.

Epilogue, “There’s No Such Thing as a Doctor.” This arresting subtitle brings us back to the personhood of doctors, who have psychological needs right along with the rest of us. Regrettably, “doctors’ psychological needs are denied, ignored, not thought about. Unmet” (p. 258). Sexism and racism are common. Lister’s reforms took a long time but are now pervasive and standard; can we similarly expand better care for doctors?  “Improving the emotional well-being of the medical workforce requires interventions that tackle three interconnected levels—the individual, the organization, and the culture of medicine as a whole” (p. 265).

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Summary:

Barbara Ehrenreich wants to manage her health and all that is available to address various aspects of it. She makes clear that she will do the managing and has written this book to reflect on how she plans to do it.  Ehrenreich explains why managing her health is necessary. She puts it this way:

We would all like to live longer and healthier lives; the question is how much of our lives should be devoted to this project, when we all, or at least most of us, have other, often more consequential things to do (p. xv)  

Ehrenreich doesn’t reject the project of getting longer and healthier lives per se, but she believes that what this project requires isn’t always worth the results it produces. The time and energy needed could be put towards better ends.  

Like many other critics, Ehrenreich details how Biomedicine often comes up short on outcomes for all the time, effort, and money it requires from the people it serves. She covers the familiar territories of over diagnosis and over utilization of health care products and services, and goes further to suggest that many common medical practices are more ritualistic and humiliating than evidence-based and effective.

Unlike other critics, Ehrenreich takes on other activities directed at health outside of Biomedicine. She questions whether the physical fitness industry delivers on its promises to produce healthier lives and especially whether there is a net benefit based on the time and energy required from people who take it on. She crosses to the other side of the mind-body continuum when she next aims at the “madness of mindfulness” (p. 71).  She finds the mindfulness movement offers more hubris than solutions.  

Ehrenreich worries that the combined effects of the authority of Biomedicine, the physical fitness frenzy, and the madness of mindfulness have created a social context that treats death as something that can be avoided or at least delayed. This social context thereby implies that not actively engaging in efforts to fight off death “can now be understood as a suicide” (p. 97).

Ehrenreich offers some reasons for why these efforts to improve health and prolong life do not always produce benefits that in her view are worth pursuing to the exclusion of other activities resulting in a better life (or death). Drawing on examples from cell biology and immunology, she suggests that what is at work are disease processes too complex for the human mind to apprehend completely combined with the human impulse to  simplify, which lead to practices, procedures, and prescriptions that in the best case are ineffective and in the worst case harmful.   

At the end of the book, Ehrenreich laments the efforts health care professionals, nonprofit organizations, government agencies, and commercial entities make to push older people into commitments for “successful aging.” Those making these efforts argue “aging itself is abnormal and unacceptable” (p. 164).  This commitment requires older people to spend a lot of time in clinics, gyms, and wellness classes—“The price of survival is endless toil,” is how Ehrenreich formulates it (p. 163).  She doesn’t think this price is worth what is required of people who are supposed to benefit, and advises her friends to insist “on a nonmedical death, without the torment of heroic interventions to prolong life by a few hours or days” (p. 208).

I continue to elude unnecessary medical attention and still doggedly push myself in the gym, where, if I am no longer a star, I am at least a fixture. In addition, I retain a daily regimen of stretching, some of which might qualify as yoga. Other than that, I pretty much eat what I want and indulge my vices, from butter to wine. Life is too short to forgo these pleasures, and would be far too long without them (p. 207).

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Histories

Guglani, Sam

Last Updated: Sep-18-2018
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Collection (Short Stories)

Summary:

One British hospital. Seven days and nights. Plenty of perspectives from those who work there, train there, and are treated there. Over the course of one week (October 24 thru October 30), the characters in these connected stories spill their secrets and shame, tout their triumphs and tragedies. And the danger of professional and emotional exhaustion looms very large: "Maybe this is how doctors and nurses finally burn out. Past their failures, their hours, all their inhaled sadness" (p40). What ultimately triggers burnout is "the accrued weight of so many tiny things" (p41).

Readers are privy to the thoughts and sometimes nuanced actions of medical personnel - attending physicians, residents, a medical student, and nurses. The musings of a hospital chaplain, cleaning woman, medical secretary, hospital porter, and patients (a hairdresser and a farmer) are also divulged. But the protagonist is the hospital. More than a physical structure, it is a kind of human hive with many strata of workers, occupants, and those (MD's) at the top. The hospital is portrayed as "a place of brokenness," propped up with occasional promises of hope and the might of technology. But decay can be insidious as some physicians no longer appear capable of compassion or empathy.

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Annotated by:
Teagarden, J. Russell

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Andrew Solomon’s 2012 book Far From the Tree is a study of families with children who are different in all sorts of ways from their parents and siblings to degrees that altered and even threatened family functions and relationships. Years after its publication, director Rachel Dretzin collaborated with Solomon to produce this documentary based on his book. At the time of filming, the children were already adults or were well into their teens. The film looks at how the families came to accept these children and how they sought—with varying success—happiness.  

The documentary focuses on five family scenarios: homosexuality (Solomon’s own story); Down syndrome; dwarfism; murder; and autism. Anyone in these families or anyone who knew these families would never invoke the familiar idiom “the apple doesn’t fall far from the tree” when talking about these children. These apples fell far from the tree, and Solomon builds on that twist to the idiom to characterize the relationship between the affected children and their families as “horizontal.” By extension, Solomon characterizes the relationship of children who are not different from their parents and siblings in any appreciable manner as “vertical.” 

Only one of the original characters from the book appears in the documentary; the other families are newly “cast.” The film captures the lives of these families with all their challenges and successes, and intercuts footage from home videos the families provided. Dretzin also filmed interviews with parents and in some cases their children. The footage and interviews show how families evolved in their acceptance of their children and their situations as best they could. The best was still heartbreak for some, but real happiness was achieved for others. 

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Annotated by:
Schilling, Carol

Primary Category: Literature / Nonfiction — Secondary Category: Visual Arts /

Genre: Memoir

Summary:

Devan Stahl’s opening essay in this unusual book explores the tension between her lived experience of being diagnosed with multiple sclerosis (MS) in her twenties and her physicians’ biomedical descriptions of it. While that tension is a familiar theme in patients’ narratives, Stahl’s approach is fresh and generously collaborative. Stahl, a bioethicist, focuses her brief narrative on her uneasy hours inside MRI machines and with clinicians who read the images. Stahl encouraged her sister, artist Darian Goldin Stahl, to transmute her physicians’ diagnostic tools into printmaker’s works, which bring personal meaning and sisterly solidarity to Devan’s experience. Devan then invited Darian and four humanities scholars to write reflective commentaries on her narrative, Darian’s images, and the commentaries themselves. The result is a richly layered, multi-vocal reflection on what Devan Stahl has accepted as “the dark gift of bodily frailty” (xxvii).

Darian Stahl’s prints were inspired by the drawings of Renaissance anatomist Andreas Vesalius that the sisters admired. Unlike their modern counterparts, the older images placed bodies in humanly built and natural environments that are rich with metaphor and theological implications. Darian’s photographic silkscreened and stone lithographic prints, some of which accompany her essay, imaginatively relocate her sister’s MRI scans in domestic spaces that suggest both Devan’s present state: her spine captured in a glass kitchen jar. And her future: a ghostly figure (actually Darian’s) at the base of the staircase that Devan will someday have trouble climbing. Making art became an act of caregiving.

The scholarly essays affirm that a single diagnosis can set in motion processes of interpretation in the context of family, community, academic discipline, and culture. But in this context, they too are expressions of caring for Devan. Literary and health humanities scholar Therese Jones writes that Stahl’s narrative “testifies to [her] hope of transcending or at least managing the alienation and incoherence of a disrupted life” (49). Literature professor Kirsten Ostherr links the Stahls’ collaborative projects with the patient empowerment movement, where creative expression offers one way to resist “the technomediated patient narrative” (71). Two of Devan Stahl’s theological studies professors contribute the remaining essays. Ellen T. Armour believes that the Stahls’ projects suggest the value of engaging the medical humanities in pastoral practice and vice versa, especially to challenge biomedicine’s claims to mastery and its “disavowal of vulnerability” (89). Jeffrey P. Bishop, who is also a physician, understands a patient’s position within the asymmetric power of medicine. Yet he also resists “the power ontology that animates so much of the West” (102). He offers instead a vision of accepting “the dark gift” of the fragility of the body, which can be both humbling and liberating (105). Viewing one of Darian’s images, he writes, “calls me out of myself” (105).

In Devan Stahl’s final reflection on her colleagues’ commentaries and her sister’s art, she concludes that sharing her experience has revealed both a “power in submission” and her responsibility to other patients (112). Her discovery leads her to a “new image” of herself and acceptance of Bishop’s observation: “Flesh calls the self into question” (115, 103).

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Annotated by:
Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

After a combined twelve years of medical training and working on hospital wards, this British physician leaves the medical profession. Using his diary written during a stint in the National Health Service (NHS) from 2004-2010, he recalls his experiences as a young doctor.

He describes the making of a doctor and a physician's life as "a difficult job in terms of hours, energy, and emotion" (p196) and recounts the overwhelming exhaustion and toll on his personal life. He chooses OB/GYN as his specialty partly because "I liked that in obstetrics you end up with twice the number of patients you started with, which is an unusually good batting average compared to other specialties" (p32). As for his bedside manner, "I went for a 'straight to the point' vibe - no nonsense, no small talk, let's deal with the matter in hand, a bit of sarcasm thrown into the mix" (p163).

Days are filled with doing prenatal visits, vaginal deliveries, caesarean sections, gynecologic surgeries, and lots of women's health issues. Night shifts are often hellacious as they "made Dante look like Disney" (p5). He must handle emergencies, break bad news, deal with intra-uterine deaths, and once gets sued for medical negligence. The anecdotes are sometimes tender and heart-tugging, other times wacky and gross. Consider this diary entry dated 12 March 2007: "a lump of placenta flew into my mouth during a manual removal and I had to go to occupational health about it" (p92).

The final diary entry chronicles a catastrophe. An undiagnosed placenta previa results in the delivery of a dead baby. The mother is hemorrhaging, requires an emergency hysterectomy, and is headed to the ICU. The author sits alone crying for one hour. For the next six months, he never laughs. He quits medicine and lands a job as a comedy writer and editor for television. Seriously.




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Annotated by:
Thomas, Shawn

Summary:

What is an atlas? To most people, an atlas is a collection of maps constructed by cartographers who meticulously plot the surface of the earth, inch by inch. In the medical field, we use the word atlas to refer to textbooks of human anatomy, but the endeavor is much the same, and no less painstaking – the human body is quite complex, after all. Though some anatomy atlases are famous for their beautiful depictions of anatomical structures, it is more important that they are accurate. What good would a map be otherwise?  

Yet this quest for accuracy is founded on an inherent dishonesty. Anatomy atlases are supposed to be our guides to the human body, but in reality, they depict the anatomical structures of only a human body. Every person is different, and that goes for their underlying anatomy as well. That being said, these minor variations are fairly unimportant for learners at the novice level. At the same time, one can’t help but feel like these books have been stripped of the key element that defines what it means to be human.
 

It is fitting that an artist would be the one to bring light to this issue. Laura Ferguson, Artist-In-Residence in the Master Scholars Program in Humanistic Medicine (MSPHM) at the NYU School of Medicine, has lived nearly her whole life with scoliosis. She saw in her own story the tendency of clinicians to boil a person down to a diagnosis – normal or abnormal. For doctors, this categorization is often necessary. But the artist recognizes that a person is more than just the sum of their parts. Laura saw past the medicalization of her anatomy and cherished the beauty of her curved spine.  

Laura’s arrival at the medical school ushered in a renewed focus on the humanism of medicine, starting with the Art & Anatomy seminar she began in 2009, open to students, doctors, researchers, and all other staff members at NYU Langone Health. In the seminar, students spend 90 minutes a week undertaking illustrations of various anatomical specimens: bones, organs, and even cadavers in the anatomy lab.  

Now almost a decade into this project, Laura has showcased her students’ work in her recent book Art & Anatomy: Drawings, co-edited by Katie Grogan, Associate Director of the MSPHM. Unlike with other anatomy books, the goal for her students was never to be “accurate”; such a word has limited meaning in the world of art. Instead, Laura taught students to observe things that they had never taken the time to see before. Then, she encouraged them to draw what they saw, as they saw it. The result is the compilation of drawings into a different kind of atlas – an atlas of the mind, of creative spirit, and of humanistic expression.

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The Language of Kindness

Watson, Christie

Last Updated: Aug-21-2018
Annotated by:
Davis, Cortney

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Author Christie Watson begins her memoir with these words: "I didn't always want to be a nurse." Indeed, the first several pages of the introduction give witness to Christie's many interests, her career starts and stops, and a peek into what she names her "flightiness," including leaving school at age sixteen to move in with her older boyfriend and his four lodgers (page 5).  Then, still sixteen years old, she begins working with the "Spastics Society" helping to assist disabled adults.  This is the first time she sees nurses in action, and one of them offers Christie a suggestion: "You should do nursing. They give you a grant and somewhere to live" (page 6).  At age seventeen, the author enters nursing school--and like most nursing students, she is "terrified of failure." During her health screening blood draw, Christie faints; a nurse suggests she rethink her career.  But Christie persists, graduates, then spends twenty successful years in nursing.  This memoir--densely written, action packed--is her account of her work especially in the Special-Care baby Unit, in the medical ward, and in Accident and Emergency.  The author brings us as well into the cancer ward, pediatric ICU,  and the geriatric ward, painting vivid portraits of her patients and the many acts of kindness she offers them along the way.

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Taking Care of Time

Davis, Cortney

Last Updated: Aug-14-2018
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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Annotated by:
Perkins, Sam

Primary Category: Literature / Nonfiction

Genre: Longform journalism

Summary:

Olivia Laing, a British novelist and writer on cultural and social issues, tackles the phenomenon of loneliness as a pervasive condition that is both a symptom and a cause of malaise, dysphoria and depression. The book is thoroughly referenced and has an extensive, useful bibliography. Laing begins by describing her own loneliness when she moved to New York City. Somewhat reclusive by nature, she spent hours in her apartment, connected to  the outside world through social media, email and Skype. This leads her to examine the nature of loneliness, its causes and impact on the individual. She then turns to the lives and works of artists who specifically dealt with their own loneliness -- as inspiration, subject matter and personal burden: Edward Hopper; Andy Warhol and his assailant Valerie Solanas; the artist and AIDS activist, David Wojnarowicz; outsider artist, Henry Darger; singers Klaus Nomi and Billie Holliday; tech entrepreneur, Josh Harris, and painter Jean-Michel Basquiat. Laing weaves in pertinent research (Klein, Harlow, Bowlby, Ainsworth, Weiss, Turkel) and expertly ties their findings to her subjects’ creative lives. Her section on Josh Harris’ radical social media experiments is a pertinent reminder of technology’s role in fostering loneliness. A recurrent theme is that social isolation “leads to a decline in social sophistication which itself leads to further episodes of rejection.” Among the results, she says, are that lonely people are more susceptible to sickness and more likely to die before their time.  


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