Showing 1 - 10 of 696 Nonfiction annotations

Summary:

Naomi Oreskes and Erik Conway examine the successful efforts of a few scientists to jam the spokes in the wheel of science, delaying needed mitigations (e.g., regulations) to protect individuals, vulnerable populations, nations, and the earth.

The authors chose the well-known and controversial debates around second hand tobacco smoke, acid rain, the strategic defense initiative, the ozone hole, global warming, and the pesticide DDT as the substrate for their investigation. Each issue involves a large accumulation of evidence of the dangers it presents to humans. And each provoked skepticism and opposition from related industries, contrarian scientists, and anti-regulation politicians and institutes. Industry opposes regulations that could threaten their businesses. Free market ideologists do not want regulations that could threaten capitalism and accelerate a slide into socialism. 

Faced with mounting scientific evidence and general agreement amongst credible researchers, those whose interests were threatened needed a strategy to win that didn’t rely on scientific evidence. The tobacco industry led the way by hiring “a public relations firm to challenge the scientific evidence that smoking could kill you,” (p. 15) and to ensure that “scientific doubts must remain.” (p. 16) The authors drew from publicly available documents to best convey this idea:

‘Doubt is our product,’ ran the infamous memo written by one tobacco industry executive in 1969, ‘since it is the best means of competing with the ‘body of fact’ that exists in the minds of the general public.’ (p. 34)

The industry realized, however, that renowned scientists would be needed “to merchandize doubt,” (p. 33) and so they recruited some. First among them was Frederick Seitz. He was a physicist who had been involved in the atomic bomb program during World War II and later in Cold War weapons programs. He knew next to nothing about the science showing the harm of tobacco smoke. However, his time as president of the National Academy of Sciences and as president of Rockefeller University accorded him credibility on all matters of science, at least to constituencies outside of science. His attacks on the science showing the harms of tobacco smoke had a lot to do with the decades it took before governments and the public took meaningful actions.

This became the approach opponents took against of science-based initiatives they wanted to scuttle. Seitz was recruited for other campaigns, but so were other physicists with similar backgrounds to form what Oreskes and Conway call a “small network of doubt mongers.” (p. 213) They make a point that this network only threw darts—poisonous darts—at the science they targeted and never once contributed their own original research to support their opposition to any scientific findings or consensus.

Oreskes and Conway tie the motives of these scientists primarily to their fierce devotion to liberty, which then meant fighting Communism and any other forms of socialism. They suggest that some degree of curmudgeonry and contrarianism is involved as well, but they focus more on political ideologies as the primary drivers for these people:

they were working to ‘secure the blessings of liberty’…if science was being used against those blessings—in ways that challenged the freedom of free enterprise—then they would fight it as they would fight any enemy. For indeed, science was starting to show that certain kinds of liberties are not sustainable—like the liberty to pollute.” (p. 238-239)

The authors hold the news media responsible for much of what the doubt mongers accomplished, specifically faulting them for applying the “fairness doctrine”—each side of an argument will get equal time—to the point of absurdity.

it especially does not make sense to dismiss the consensus of experts if the dissenter is superannuated, disgruntled, a habitual contrarian, or in the pay of a group with an obvious ideological agenda or vested political or economic interest. Or in some cases, all of the above. (p. 272-273)

The news media, they assert, are the gatekeepers and should be able to distinguish charlatans and snake oil salesmen from legitimate scientists. In this role, they failed as far at the authors are concerned. There can be no network of doubt mongers without a news media that either can’t or won’t call them out.

In contrast, the authors give the scientists who didn’t call out the doubt mongers a more forgiving critique. For the most part, they say, scientists facing a fight will retreat to their labs and concentrate on their work—they’re discovers, not fighters. On them, “intimidation works.” (p. 265)

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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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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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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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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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Annotated by:
Davis, Cortney

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

When poet and writer Amy Nawrocki was nineteen years old, a college student returning home after her freshmen year, she suffered a sudden and mysterious illness.  She was transformed, in an eye-blink, from an active young woman to a bed bound and comatose patient.  "There is nothing to embellish--I got sick, I fell into a deep sleep, I woke up.  No fairy tale" (page 3).  Months of her life went missing: this brief and lovely memoir is her attempt to reconstruct those hours and those experiences.  She begins with reflections on journal entries written before her illness began, giving the reader (and herself) a persona, a personality, a living breathing young woman who already writes, who lives in her head, and who always felt "totally comfortable" in her body (page 3). Then we lose her, as she lost herself.  She re-visions the story of her months of suffering and recovering from encephalitic coma through the various medical records and family memories she gathers in order to reconstruct the missing pieces of her life. "The coma girl has detached herself from me. I have to dream her up or rely on what others saw, eye witnesses who had to detach themselves in a different way" (page 21). Coming back into life after a serious illness is a strange and often prolonged journey.  Nawrocki writes, "Waking up took as long as sleeping" (page 33).  And in this waking up time, she begins to see who she was (or how she looked to others) during those blank months. "The images still frighten me. My face was a mess; hair cropped short, puffed up without styling, ragged, like I just woke up. My eyes seemed empty but weirdly wild" (page 35). During her recovery, the author begins journaling again. "In my college notes, I focused on the art of reflection; after the illness, I wanted mainly to observe" (page 42).  And in recovery, she begins to build memories once again. She lists her recollections during weeks in rehab, and she remembers "the final trip home, a cake decorated with blue and yellow icing waiting for me" (page 45).

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Summary:

In this remarkable anthology, 51 women and men describe their nursing school experiences, from initial fears and anxieties to increasing confidence and appreciation of the profession.  Jeanne Bryner, in her Introduction, explains how she and Cortney Davis deliberately sought a diverse group of nurse-writers, from recent nursing graduates in their twenties to seasoned veterans in their nineties.  Their collection includes different races, nationalities, social and economic classes, and education levels.  What the contributors have in common besides being nurses is that they are gifted writers able to capture in poetry or prose the transforming moments of their lives. Nursing students reading this anthology will recognize many kindred souls, struggling with the same uncertainties and apprehensions, wondering how they will ever accomplish all this, but also gaining command of the profession, relishing its special rewards, valuing patients as their ultimate teachers. All readers will understand what is so special about nursing .




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Summary:

This entertaining and wide-ranging book discusses the importance of the human foot and many related topics. There are five alliteratively named chapters.  

1. Destiny

Drawing on anthropological research, Rinzler discusses the deep history of humans and their primate ancestors. Our bipedalism—our upright stance—preceded our large brain, making possible a larger diet and working well with our bodies as they evolved away from other primates. She discusses the idealized ratios of Leonardo’s Vitruvian man. Leonardo considered our foot as “a masterpiece of engineering and a work of art” (p. 6).  

2. Disability
Rinzler discusses historical senses of disability, notably clubfoot. She mentions various people with a clubfoot:  Joseph Goebbels, Sir Walter Scott, King Tut, Cludius I, Dudly Moore, Kristi Yamaguchi, and Mia Hamm; the last are two successful athletes. Rinzler reviews the history of surgical approaches, many of which were harmful. X-ray and sonography provided new insights, and genetics may have further promise, given that families and ethnic groups often have higher instances of clubfoot.  

3. Difference
This chapter describes the anatomy of the foot, bones, arches, tendons, and on as well as artistic representations and, of course, ballet and other forms of dance. A footprint is as individual as the much-used fingerprint. In Nazism and the American south, a flat foot was discriminated against as Jewish or Negro. Various treatments have been proposed for flat feet.  

4. Diet
Gout has been known since antiquity, but only in modern times has the underlying biochemistry and, now, genetic heritage been understood. The chapter mentions many famous names of people who suffered from gout. rheumatism, or corns. The closing pages discuss pharmaceutical approaches.  

5. Desire
The foot as sexual symbol: Rinzler discuss folklore (Cinderella’s slipper), pheromones, and Biblical topics: God’s feet, footwashing, and feet as symbols for sex and urination. Foot fetishism can be understood in terms of the lavish sensory innervation that links to our brain. Discussion mentions the bound feet of China, the folktale The Red Shoes, also Fifty Shades of Grey, Sex and the City, and Judy Garland’s red shoes in The Wizard of Oz

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