Showing 11 - 20 of 144 annotations tagged with the keyword "Medical Mistakes"

Annotated by:
Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

A bicycling, bee-keeping, British neurosurgeon approaching the end of his professional career recalls some distinctive patients, surgical triumphs as well as notable failures, difficult decisions, and mistakes. Nearly thirty years of a busy neurosurgical practice are distilled into a collection of linked stories throbbing with drama - both the flamboyant kind and the softly simmering type.

Most chapters are titled after a medical condition (exceptions are "Hubris" and "Melodrama"). Some of the headings are familiar - Trauma, Infarct, Aneurysm, Meningioma. Other chapter titles flaunt delicious medical terminology that mingles the mysterious and the poetic with nomenclature such as Angor animi, Neurotmesis, Photopsia, and Anaesthesia dolorosa.

Included are riveting accounts of both mundane and seemingly miraculous patient outcomes. One success story involves a pregnant woman losing her sight due to a brain tumor that compresses the optic nerves. Her vision is restored with an operation performed by the author. Her baby is born healthy too. But tales of failure and loss - malignant glioblastomas that are invulnerable to any treatment, operative calamities including bleeding of the brain, paralysis, and stroke - are tragically common. The author describes his humanitarian work in the Ukraine. He admits his aggravation with hospital bureaucracy and is frequently frustrated by England's National Health Service.

Sometimes the shoe falls on the other foot, and the doctor learns what it is to be a patient. He suffers a retinal detachment. He falls down some stairs and fractures his leg. His mother succumbs to metastatic breast cancer. His three month old son requires surgery for a benign brain tumor.

As his career winds down, the author grows increasingly philosophical. He acknowledges his diminishing professional detachment, his fading fear of failure, and his less-hardened self. He becomes a sort of vessel for patients to empty their misery into. He is cognizant of the painful privilege it is to be a doctor.

View full annotation

Polio: An American Story

Oshinsky, David

Last Updated: Sep-16-2014
Annotated by:
Willms, Janice

Primary Category: Literature / Nonfiction

Genre: History

Summary:

 In his introduction, the author summarizes the history of polio’s first appearance as an epidemic in the United States, the ensuing research, subsequent applications of new information, attempts at abatement and ultimate success in the development of preventative measures.

Embedded in the successes and failures of the research applications are the details of human interactions.  Their impact on the goal of achieving near extinction of polio in America constitutes a dramatic subplot, which the historian adroitly weaves into the work.

For the reader who has only a sketchy knowledge of this important period in medical research, this history provides details of human exchanges, conflicts and resolutions necessary to bring the scientific developments to fruition.  Central among the multiple struggles rests the basic disagreement between Jonas Salk and Albert Sabin, two of the most prominent scientists working against the clock to develop the most effective and safest form of immunization.  Each new surge of the disease added to the urgency of the problem as well as to the question of the best solution.  Salk felt strongly that the immune system should be stimulated by a killed virus preparation, while Sabin was equally convinced that only the living virus could provide this need.  Each view had its own cadre of supporters and of opponents.

Funding issues also troubled those fighting the polio epidemics.  The March of Dimes is credited with raising a record $55 million in the fight against polio in early 1954, becoming the first major infectious disease battle to benefit from a concerted public awareness campaign and demonstrating the power of such volunteer driven efforts to supplement public and other private funding efforts.

View full annotation

A Little Something

Haddaway, Richard

Last Updated: May-13-2014

Primary Category: Literature / Fiction

Genre: Novel

Summary:

A Little Something is a story of a medical catastrophe for a family: at a baseball game, 10-year-old Justin is struck in the face by a foul ball. He seems OK initially, but he has a loose tooth. His father takes him to a dentist, where, left unattended, he has a drug reaction and loses consciousness. Paramedics take him to a hospital, but he does not wake up. He becomes the still center of the book; three circles form around him.  The closest circle includes the attending neurologist Dr. Goldstein and, of course, his parents. His mother Kath is a pediatric physician; she follows closely the medicine involved and knows well the hospital where Justin is being treated. His father Sam is an introverted financial man; he measures everything in numbers. Their marriage is stressed even before the accident. Kath’s nurse at her clinic, Jonesie, is a steady support. Granny, a Licensed Vocational Nurse, comes to watch over Justin. In a moving scene, she bathes the unconscious boy.

A second circle includes other family and friends, the clientele of Kath’s pediatric clinic, the children, and their parents. These are largely Latino, underserved in Fort Worth, Texas, of 2001. (Kath has chosen a medical specialty that earns less money than other fields—in contrast to her money-grubbing mother, who is satirically portrayed.) Next door to the clinic is a firehouse, where Justin has visited and made friends. The blue-collar firemen are public servants who help make a community work.

A third circle is less defined but contextual for the novel: country folks, like Granny, who are not intellectual but practical. They believe in keeping going no matter what, a folk wisdom of realistic, durable hope.

For three-quarters of the novel there’s suspense about Justin’s recovery. At one brief moment, Sam is sure of a turnaround when he sees (or thinks he sees) a smile on Justin’s face. For nine days Sam and Kath experience hope, anger, exhaustion, expressed rage, confusion, and continuous uncertainty.

Finally there is “the meeting,” a gathering of the doctor, the family, Kath’s faithful clinic nurse Jonesie, and Father Red, a Catholic priest from Justin’s school.  Dr. Goldstein says there is no hope for recovery and gives the medical details of Justin’s brain death, which has both anatomical and legal certainty.

Kath and Sam decide to disconnect Justin from life support and allow organ donation. When Justin must be transferred from the children’s hospital to the neighboring one, Sam carries him in his arms. A surprise ritual is an honor guard of firemen who line the path of the procession.

We read the specifics of disconnecting the vent tube, watching the heart race on the monitor, then the flat line of the still heart. Father Red reads from the Book of Common Prayer. An hour later, a helicopter takes off from the hospital with Justin’s donated heart.

An Epilogue six months later describes a Thanksgiving dinner at the firehouse. Sam and Kath are closer now, and he plans for them a trip to Hawaii. There’s has been, however, no easy “closure,” and the couple combines memories with mourning. 

            

View full annotation

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.

View full annotation

Stitches

Small, David

Last Updated: Mar-03-2014
Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Graphic Memoir

Summary:

While the author's surgery for throat cancer when he was 14 years old, and its aftermath are the central events in this graphic memoir, Stitches is more essentially the story of a dysfunctional family. The memoir begins when David Small is six, growing up in Detroit, drawing, and observing the body language of his often silent parents and brother. Tension fills the house. David's mother's face is in an almost permanent scowl and the "mere moving of her fork a half inch to the right spelled dread at the dinner table" (16).  She slams pots and kitchen cabinet doors while David's radiologist father lets loose on a punching bag in the basement and his brother beats drums. David is in a constant struggle to avoid his mother's fury, which author/artist David depicts as a tidal wave. His father is remote, puffing silently on his pipe.
 
When David is 11 a female friend of the family, the wife of a surgeon, draws attention to a growth on David's neck, which his parents have either failed to notice or knowingly ignored. In due time the neck is x-rayed. The surgeon-friend diagnoses a sebaceous cyst and recommends an operation. With the mother's frequent protests about lack of money--in spite of an extended shopping spree the parents undertake-- it is three and a half more years before the surgery takes place. David undergoes the procedure with relative equanimity, the hospital and medical staff being familiar -- people he "thought of as my extended family, my protectors" (160). When he wakes up from the surgery, his father assures him that nothing is wrong but that he will need a second operation by a specialist. Uncharacteristically, his mother asks if there is anything she can get for him.

Waking up from the second surgery, David has no voice -- one vocal cord and his thyroid gland have been removed. "The fact that you now have no voice will define you from here on in" (186). Later, when changing his bandage by himself, he discovers a long, ugly array of stitches on the side of his neck. He has nightmares, and on one sleepless night as he wanders the house, discovers a letter written by one of his parents to "mama" which says, "of course the boy does not know it was cancer" (204). The accumulated silences and parental betrayal trigger David's delinquent behavior and  time in a boarding school, from which he runs away three times; ultimately he is expelled with a recommendation to get psychiatric help. Reluctantly, his mother drives him to a psychoanalyst -- "it's like throwing money down a hole, if you ask me" (247) -- but this intervention turns David's life around. The analyst, depicted by the author as a tall, fully clothed white rabbit, explains to David, "your mother doesn't love you" (255).  "It was such a relief to hear" said Small in an interview. Another truth is eventually revealed by David's father, who takes David out to dinner to tell him, after a lengthy silence, that the numerous x-ray treatments for sinus infections he had given the young David must have caused the throat cancer: "two-to-four hundred rads. I GAVE YOU CANCER" (286-287).

 

View full annotation

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.

View full annotation

The Way of the Physician

Needleman, Jacob

Last Updated: Dec-02-2013
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Jacob Needleman, a philosopher concerned with "applying philosophy to the questions of everyday life," taught medical ethics at San Francisco State University (SFSU). In this highly personal book he addresses what it means to be a "good doctor" and the role of physicians in contemporary society. The book is structured as a series of imaginary letters addressed to his childhood idol, the physician who treated him when he was 12 years old.

The aged Dr. Kaufman responds to these letters, although we see only the philosopher’s side of the correspondence. Toward the end of the book, Needleman makes a pilgrimage to Philadelphia to visit his ailing mentor. They talk for a while, then when the old man takes a nap, Needleman spends the rest of the day conversing with Dr. Kaufman’s daughter, a pediatrician who in some sense represents the "good" medicine of the future, just as her father represented the "good" medicine of the past.

In these letters the author addresses the deep questions of character and motivation in the form of a personal narrative. He recalls his experiences as a boy, his ambition to become a doctor, and several incidents from his life as an autopsy assistant and hospital orderly. For example, there is the bizarre story of the young man transporting an amputated leg by elevator; he accidentally drops the leg to the floor and the wrappings flip open, much to the astonishment of others on the elevator.

"People don’t trust science; people trust people." (p. 15) Similarly, Jacob Needleman writes, people don’t trust or distrust medicine as an institution; they trust or distrust doctors. "To be a good doctor, one must first of all be a good (person). And to be a good (person) one has to begin by discovering in oneself the desire for truth . . . truth is the only effective force." (p. 68)

To facilitate this quest for truth, Needleman describes in these letters a four-seminar sequence he teaches at SFSU: "To whom is the physician responsible?," "The art of living and the art of medicine," "Care," and "The financial disease of modern medicine." (pp. 71-72) Through these seminars the author hopes to re-awaken in prospective physicians the quest for truth, and the possibility of care, that he believes have been submerged by technology and infected by the financial disease. Dr. Kaufman’s daughter serves as a real-life example of the possibility of cultivating the contemporary version of the "good doctor."

View full annotation

The Doctor

Dubus, Andre

Last Updated: Sep-26-2013
Annotated by:
Terry, James

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

The doctor in question is Art Castagnetto, an obstetrician out for a morning jog who encounters a terrible accident. A young neighborhood boy has been pinned underwater by a concrete slab. Art rushes to a nearby house to summon aid, then tries vainly to move the slab, knowing by feel that the boy is still alive and struggling. The fire department arrives too late. Devastated by this death, Art realizes two days later that he should have improvised a snorkel from a garden hose and saved the boy.

View full annotation

Handle With Care

Picoult, Jodi

Last Updated: Mar-16-2013
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

At five years old, Willow O’Keefe has lived a life rich in love and exceptional learning; she reads beyond her years and has memorized a startling compendium of unusual facts.  She has also sustained over 50 broken bones, two of them in utero.  She has osteogenesis imperfecta, a congenital defect in the body’s production of type 1 collagen that leaves bones very brittle.  People with the disease generally suffer many fractures and often other conditions—exceptionally small stature, hearing loss, and bowed limbs.  Willow’s parents and older sister have organized their lives for five years around protecting her from damage and helping her heal from her many broken bones.  Though Amelia, her older sister, loves Willow, her parents’, Charlotte and Sean’s, intense focus on Willow’s condition often leaves her jealous and disgruntled.  Things go from bad to worse when their mother learns that a lawsuit for “wrongful birth” is legal in New Hampshire, and could bring them the money they need to cover Willow’s many medical expenses.  Such a step, however, means losing a best friend, since the obstetrician who oversaw Charlotte’s pregnancy and Willow’s birth, and who ostensibly overlooked signs of the disease and failed to warn the parents, has been Charlotte’s best friend for years.  A “wrongful birth” suit is based on the claim that medical information about a congenital defect was withheld that might have been grounds for a decision to abort the pregnancy.  Though Charlotte insists this drastic step is the best thing they can do to insure a secure future for Willow, Sean finds it repugnant enough finally to leave home.  It is clear that even a win will be a pyrrhic victory, and indeed, the outcome is ambiguous, costly, and life-changing for everyone concerned.

View full annotation

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). 

View full annotation