Showing 121 - 130 of 419 annotations tagged with the keyword "Pain"

Summary:

This collection of stories offers a sidelong view of medicine from the perspective of a thoughtful, experienced doctor of internal medicine at a teaching institution (UCSF) in an urban setting that brings a wide variety of types of patients to his door.  In a context of evident respect and admiration for even the quirkiest of them, Watts admits to the kinds of personal responses most have been trained to hide-laughter, anger, bewilderment, frustration, empathetic sorrow.  The cases he recounts include several whose inexplicabilities ultimately require action based as much on intuition as on science.  He includes several stories of illness among his own family and friends, and makes it clear in others how his professional decisions affect his home life and his own state of mind.  

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Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Triggered in part by a trip to the Galápagos Islands, the author interweaves two parallel narratives: Darwin's "journey toward evolution" along with the related work of Alfred Russel Wallace; and the author's own journey through life, partially disabled and dependent on the specially fitted shoes that help him to walk.  Together these two narratives develop "all I have come to understand about chance and change, fear and transformation, variation and cultural context, ideas about the body that question the definition and existence of difference in all of our lives" (xvii).

Born with an unnamed congenital condition in which his fibulae are absent along with other lower limb "abnormalities," Fries underwent five major reconstructive surgeries as a child, but after those, what helped him most were special shoes that were fitted to his special body, assisting him to walk.  As an adult, however, he begins to experience back pain and knee problems.  The memoir relates, both in flashback, and in the present day, Fries's quest for a proper pair of shoes that will help him avoid yet another surgery -- the shoes he has been wearing are 20 years old and no longer do the job.  We meet Dr. Mendotti, who treated him like a peculiar specimen and offered a pharmacologic way out of his pain; shoemaker Eneslow, in a dingy Union Square office, whose shoes not only fit Fries well, but were festive in appearance -- "I felt both normal and special" (17); other practitioners of orthotics who try but fail to construct shoes that relieve Fries's pain, and finally, the gifted, patient orthoticist, Tom Coburn, who persists until he is able to provide shoes that work.  The shoes have been adapted for Fries's body, just as man has constructed adaptations that allow him to live in a variety of climates and circumstances.  Conversely, Fries, convinced he "can adapt to the circumstances in which my body places me (169)," draws from Darwin, whom he quotes: "individual differences are highly important for us, as they afford materials for natural selection to accumulate" (169).
 
Darwinian connections are invoked throughout the narrative.  The peculiar configuration of Fries's feet and shoes help him to ascend a series of mountain ladders while his partner, Ian -- who usually has to assist Fries with such physical maneuvers -- suddenly becomes fearful of the height and exposure;  back problems might have developed even without his congenital abnormalities because evolution of the capacity to walk upright included the tendency toward back pain; the role of chance in natural selection and the role of chance in the physical fact of congenital conditions; the positive role that his partner Ian's attention deficit disorder (ADD) could have played in the days of hunter-gatherers and the cultural context in which ADD is now considered to be "abnormal."
 
Fries discusses his fears -- both rational and irrational -- as well as his awareness of stigma, difference, and sameness.  The context of these discussions is usually a reminiscence about vacations in far-flung countries (Thailand, the Galápagos, Bali, Alaska, the Canadian Rockies) and physically challenging domestic locales (a Colorado River raft trip, the Beehive Mountain in Acadia National Park).  He  occasionally brings into the discussion his homosexuality, especially as his physical deformity affected sexual encounters.  The relationship between Fries and Ian is woven throughout the memoir as one of understanding, mutual need and benefit.  As the memoir ends, Fries worries about the likelihood he will need a wheelchair, but is at the same time gathering confidence in his ability to ride the Easy Flyer bicycle that Ian has discovered at the local bike shop.

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The Kite Runner

Hosseini, Khaled

Last Updated: Apr-16-2009
Annotated by:
Shafer, Audrey

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In his debut novel, Dr. Khaled Hosseini tells a tale that begins in his homeland, Afghanistan, and ends in his adopted country, the United States. Amir, son of a wealthy Pashtun merchant, narrates the story. Amir and his father, Baba, are attended by two Hazara servants, Ali and his hare-lipped son, Hassan. Amir and Hassan are friends, but Amir is troubled by a guilty conscience over multiple slights and sly insults aimed at Hassan. The burden of guilt intensifies over an incident at a kite-flying contest when Amir is twelve years old.

Kite flying in Afghanistan is an intricate affair involving glass-embedded string that contestants use to slice the strings of other kites. The winner is not only the one with the last kite flying, but also the one who catches the last cut kite--the kite runner. At the close of the contest, Amir witnesses the traumatization of his friend Hassan, the finest kite runner, at the hands of an evil youth, Assef. Too shamed to help Hassan, Amir is nearly swallowed by his cowardice: the rest of the story follows the consequences of his guilt.

Amir and Baba emigrate to the United States during the Soviet invasion of Afghanistan, but Amir, as a young adult, returns during the Taliban regime in order to redeem himself and help Hassan's son. The story is filled with plot twists and revelations of secrets and hidden relationships, which enable Amir to confront some of his shortcomings. The oppression, torture, and murder of Afghanis by the Taliban are graphically depicted.

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Annotated by:
Bertman, Sandra

Primary Category: Performing Arts / Film, TV, Video

Genre: Video

Summary:

Filmed at Shands (teaching) Hospital in Florida, this documentary validates the importance of the arts and expressive therapies in all aspects of health care, including medical education. Pediatric oncologist John Graham-Pole and poetry therapist John Fox -often as a team- work with patients of all ages in groups and at the bedside.   Other physicians including a neuroscientist provide rational explanations of the release of endorphins and brain changes resulting from creative activities.  Though the healing process initiated by the reflective act of writing poetry is ostensibly the focus of the film, the documentary is permeated with the transforming effects of dance and art therapies in their ability to lessen physical and emotional pain; the importance of healing environments, not just paintings in lobbies, but in patient created ceiling tiles and wall installations; and especially the warmth, intimacy and humanity generated by exemplary physician communication skills.

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Mind Talk: The Brain's New Story

Drake, Bob

Last Updated: Mar-10-2009
Annotated by:
Shafer, Audrey

Primary Category: Performing Arts / Film, TV, Video

Genre: Video

Summary:

This documentary film explores the interdisciplinary quest to understand the mind--its relationship to the brain, to the soul, to consciousness and sentience, and to the societal implications of free will. The film begins with the crisscrossing flow of people in a train station and an overvoice expressing the existential questions of "who are we?" and, ultimately, "who am I?"

This compelling image, filmed in black and white, serves as a representation of people as humanity and as individuals, as well as a metaphor for flow, such as of time or of impulses along a neural network. Hence, already in the introduction, the viewer is aware that this film will address some of the deep philosophical questions of all time complemented by visual imagery which enhances and enlarges on the dialogue.

The film is then divided into twelve sections: The Soul, The Body, Mental Disorder, Mind to Molecule, Bit to Brain, Consciousness, Free Will, Citizenship, The Moral Brain, The Brain on Trial, The Medical Mind, and Who Am I? Experts from multiple fields such as theology, neuroscience, psychiatry, law and justice, philosophy, sociology, history of medicine, physics, computer science, and filmmaking offer insights and questions either directly to the camera, or as voice-over for other imagery.

For example, to name just a few of the numerous eminent persons in the film, there are statements by mathematical physicist Roger Penrose (Shadows of the Mind: A Search for the Missing Science of Consciousness, and The Emperor’s New Mind: Concerning Computers, Minds and the Laws of Physics), philosopher Daniel Dennett (Darwin’s Dangerous Idea: Evolution and the Meanings of Life, and Brainchildren: Essays on Designing Minds), philosopher John R. Searle (Mind, Language and Society: Philosophy in the Real World) and neurologist Antonio Damasio (Descartes’ Error: Emotion, Reason and the Human Brain). The multiple experts all address the basic question posed by the film: "What will a science of the brain add to the human story?" but the approaches to the question, and what aspects of the question are most important, vary considerably in this far ranging journey through religion, history, ethics, medicine and science.

A few of the many interesting segments of the film include sections on cognitive neuroscientist Nancy Kanwisher who studies specialization by parts of the brain, such as a face-recognition center; developmental neuroanatomist Miguel Marin-Padilla, who has studied the motor cortex for over 25 years, which he demonstrates by dissection to be smaller than the tip of his finger; and Dennett’s one-armed robot, Cog, which is "learning" in developmental stages as an infant would. Eloquent commentary is also provided by computer scientist Jaron Lanier, sociologist Howard Kaye, psychologist Nicholas Humphrey, and filmmaker Ken Burns, among others.

Much of the film deals with psychopathology and implications for morality, behavior, and responsibility for behavior (free will and crime). Segments include an interview with a patient with manic-depressive disorder, a historical note on Phineas Gage (whose dramatic wound of his frontal lobe so altered his behavior), and a lawyer, psychiatrist and judge discussing free will, diminished capacity, and the legal system.

The film concludes with some concerns about reductionism to the biologic model of the mind, the growing haziness of borders between human and artificial intelligence, and the role of psychoactive medications. Although full mapping of the brain may not lead to complete understanding of the mind, still, the film concludes, the quest is fun.

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Cutting for Stone

Verghese, Abraham

Last Updated: Mar-08-2009
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Ethiopia, 1954. Twin boys conjoined at the head survive a surgical separation and a gruesome C-section delivery. Their mother, Sister Mary Joseph Praise, does not. The Carmelite nun, a native of India, dies in the same place where she worked as a nurse - the operating room of a small hospital in Addis Ababa. The facility is dubbed Missing Hospital, and it is staffed by some remarkable people.

Thomas Stone is a British general surgeon. The only thing that he loves more than medicine is Sister Praise. When she dies during childbirth, he has a meltdown - abruptly fleeing the hospital and leaving Africa. Although Thomas Stone is the father of the twins, he blames the babies for the nun's death. Decades later, he is working at a prestigious medical center in Boston where he specializes in hepatic surgery and research on liver transplantation. The twins are raised by two physicians at Missing Hospital - Dr. Ghosh and Dr. Hemlatha (Hema) - who get married. Hema is an obstetrician-gynecologist. Ghosh is an internist who becomes the hospital's surgeon by necessity after Thomas Stone departs.

The fate of the twin boys, Marion Stone and Shiva Stone, is sculpted by their experiences at Missing Hospital and the growing pains of Ethiopia. The African nation is full of possibilities and mayhem. Both boys are highly intelligent and unusually bonded. Shiva is eccentric and empathic. Although he never attends medical school, Ghosh and Hema train him. Shiva becomes a world authority on treating vaginal fistulas. Marion narrates the story. He is repeatedly hurt by love. The girl of his dreams, Genet, opts to have her first sexual encounter with Shiva. Genet plays a role in hijacking an airplane and rebels against the Ethiopian government. Although innocent, Marion comes under suspicion because of her actions. He escapes the country for his own safety.

Like his father, Marion lands in America. He completes his residency training as a trauma surgeon in New York. He locates his biological father but reconciliation is difficult for both men. Genet has also come to America. She shows up at Marion's apartment, and they have sexual intercourse. Genet exposes him to tuberculosis and Hepatitis B. Marion delevelops liver failure due to hepatitis. He is going to die. Shiva and Hema travel to New York to be with Marion. Shiva proposes an experimental treatment for his brother - a living donor liver transplantation. After all, there is no better organ donor than an identical twin. Thomas Stone performs the operation along with one of Marion's coleagues. The surgery is successful. Then Shiva has bleeding in his brain and dies. Marion returns to Ethiopia and Missing Hospital. Half a century removed from his birth, Marion is back at home and still conected to his twin brother. The lobe of liver donated by Shiva is functioning perfectly.

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Beat the Reaper

Bazell, Josh

Last Updated: Jan-26-2009
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Pietro Brnwa, nicknamed "The Bearclaw," has embraced change - a new name, a different occupation, and a regenerated outlook. Thanks to the Federal Witness Protection Program, Pietro, who was formerly employed as a hitman by a mafia-connected lawyer, is now Dr. Peter Brown, an intern in the Department of Internal Medicine at Manhattan Catholic Hospital. His career as an assassin was motivated by the desire to avenge the murder of the grandparents who raised him. As a physician, Dr. Brown is paying off a moral debt - doing good deeds to atone for previous acts of violence including killing people.

Unfortunately, life doesn't get any easier for the hit man-turned-physician. Trouble stalks him and finds him. Everyone he loves is lost. In addition to the death of his grandparents, Dr. Brown's girlfriend, Magdalene, is gunned down in a car. His former best friend, "Skinflick" is thrown out of a window of a six-story building, survives, and is later stabbed to death by Dr. Brown.

Life might have been easier if Dr. Brown had not been recognized by a mafia acquaintance named Nicholas LoBrutto who is a patient in Manhattan Catholic Hospital. LoBrutto has stomach cancer and threatens to squeal to Dr. Brown's former crime boss. If Dr. Brown cannot keep LoBrutto alive, the mafia will be notified where to find the physician and he will be eliminated. Dr. Brown assists during LoBrutto's surgery but the mobster experiences ventricular fibrillation postoperatively. Dr. Brown's two medical students mistakenly administer intravenous potassium and LoBrutto dies.

A group of thugs quickly infiltrate the hospital and it appears likely that Dr. Brown will be exterminated. He risks his life to prevent a young woman from having her leg amputated for an erroneous diagnosis. The thugs capture Dr. Brown and detain him in the blood bank freezer. He removes a piece of bone from his own lower leg (an autofibulectomy) to use as a weapon and proceeds to kill the entire gang of murderers. Dr. Brown is sure to be dismissed from Manhattan Catholic Hospital but realizes there is still much he hopes to accomplish as a physician. With some help from friends in the Witness Protection Program (and a likely sequel to this novel on the horizon), it's a good bet that Dr. Brown is not likely to retire his stethoscope (or firearms) anytime soon.

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Unaccustomed Earth

Lahiri, Jhumpa

Last Updated: Jan-06-2009
Annotated by:
Nixon, Lois LaCivita

Primary Category: Literature / Fiction

Genre: Collection (Short Stories)

Summary:

The unusual title is borrowed from Nathaniel Hawthorne's story, "The Custom House," to suggest a shift in fortune when immigrants "strike their roots into unaccustomed earth."  Set almost entirely in the United States (the unaccustomed earth), eight separate stories are connected most obviously by cultural dissonances affecting characters who are Indian or have Indian parents.  Three of the stories, however, are linked by a strong narrative connection that is unexpected, profound, and unforgettable.

For Indian readers, the narratives describe complexities about migration patterns, cultural issues, alienation, and generational differences. The stories deal with well-educated children of immigrants who become offspring their parents barely recognize.  For other readers, the stories reveal situations about families and customs that are strangely familiar, especially those stories dealing with relationships between parents and children.
 
The forces of globalization have created and accelerated shifts that can seem staggering to all parents intent on preserving cultural patterns and traditions. Whether Indian or not, most parents experience a sense of alienation while watching their children flourish in a world that increasingly appears unfamiliar and foreign.

Not surprisingly, the stories concern strains and challenges affecting mixed relationships and/or mixed marriages and stresses on disapproving and disappointed parents, while others focus on children succumbing to drugs and alcohol(for the latter, see annotation of "Only Goodness").  All deal with some kind of emotional loss, but provide connections to feelings experienced by children and their parents in life's quiet and more kinetic negotiations.
 
The first story is about Ruma, a well-educated woman who lives in Seattle with her work-alcoholic American husband, and child, Akash.  Generational and cultural contrasts are revealed in overt and more subtle ways when her recently widowed father arrives for a short visit. Even though Ruma's complete assimilation into her non-Indian home as well as her on-going worries about her father's loneliness are major considerations, another story thread is spun, one that quietly reveals the father's thoughts about himself and a new relationship made recently during a vacation in Europe. Ruma's assumptions about her father, his loneliness, his possible dependency on her, and the Seattle vacation as a possible signal for relocating to her household turn out to be entirely wrong. 
 
The last three stories follow a boy, Kaushik, and girl, Hema, into adulthood.  In the first story, "Once in a Lifetime," Hema recalls her first memory of Kaushik when he was 9 and she was 6. The occasion was a farewell party for Kaushik's parents who were returning from the United States to live in Calcutta. The mothers, who grew up in Calcutta, but met in Cambridge, Massachusetts had become very close and were saddened by this separation.

Seven years pass before Kaushik‘s parents return to the Boston area and stay with Hema's family. Hema found the now 16-year old young man appealing, but brooding and totally uninterested in her. Even though Hema expected Kaushik to be Indian-like in behavior, he was more Americanized than she was. That the family had flown first-class shocked Hema's conservative family as did their new smoking and moderate drinking habits.

After a long search, and to the relief of Hema's parents, Kaushik's family found a  modern house on the North Shore.  Before they moved to their new home, Kaushik surprised Hema with confidential information-- his family had left India to seek treatment in Boston for his mother's breast cancer.  All medical efforts had been unsuccessful and his mother had only a short time to live.  Hema promised to keep this disclosure secret and grieved for the woman she had come to admire and love.
 
The second story in the link, "Year's End," is narrated by Kaushik.  With the opening line, "I did not attend my father's wedding," readers know that Kaushik‘s mother has died.  His father, in Calcutta for a visit, had married Chitra, a woman with two young daughters, and all would be returning to the North Shore house to live. Most of the chapter recounts the ordeal of the mother‘s dying, Kaushik‘s tremendous sense of loss, and the loneliness experienced by him at Swarthmore College.  No mention is made of Hema by the desolate narrator except to remember he had hated every day spent under her parents' roof, but later had come to think of that time with nostalgia.  

"Going Ashore" brings Hema and Kaushik together in Rome where she has a study grant and a visiting lectureship and he is on vacation from his work as an award-winning photo journalist.  Hema's parents have arranged for her to marry Navin in Calcutta.  Navin has accepted a teaching position at MIT. Until her unexpected reunion with Kaushik and the intense love affair that follows, neither had experienced any real connection with another person.  The story about them in Rome seems to represent an independence from the cultural forces that have shaped their lives, but this independence is short lived.  Ultimately, she is unable to set aside the expectations imposed by her parents.  The consequences of their final separation are more than any reader might imagine.

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Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Collection (Short Stories)

Summary:

New York is the setting for thirteen linked stories that profile a long line of curious and sometimes loony doctors who are passionate about medical science but often lack common sense and good judgment. Beginning with Dr. Olaf van Schuler in the seventeenth century and continuing over more than 300 years with generations of his descendants (the Steenwycks), missteps and madness loom large in this inquisitive and peculiar medical family.

Most of these doctors share common goals: They strive to eliminate pain. They attempt to expand the scope of medical knowledge. They seek the soul. In their quest for cures and enlightenment, many of these physician-scientists, their relatives, and patients embrace off-beat diagnostic techniques or unproven remedies: phrenology, magnetism, bloodletting, hypnosis, radium-emitting apparatus, electrical shocks, and lobotomy.

In "The Siblings," a doctor performs a lobotomy on his sister. She dies a few months after the operation. In "The Story of Her Breasts," a woman develops rheumatoid arthritis that may or may not be caused by her silicone breast implants. She also experiences guilt and worry after encouraging her 18-year-old daughter to undergo breast augmentation. In "The Baquet," hope is undeniable and a miracle cure is mesmerizing. In the book's final story, "The Doctors," two physicians - a father and his daughter - grapple with their strained relationship and the man's progressive deterioration that might be due to Creutzfeldt-Jakob disease.

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The Book of Job

Author 2, Unknown

Last Updated: Nov-25-2008
Annotated by:
Holmes, Martha Stoddard

Primary Category: Literature / Poetry

Genre: Poems (Sequence)

Summary:

Job, a prosperous but god-fearing man, is stricken with a series of misfortunes, losing his goods, his sons, and his health all as a result of a wager between God and Satan about whether or not a "perfect and upright" man will remain thus under relentless misfortune (1:1). As he sits in ashes, covered with boils, a group of friends come to mourn with and comfort him, sitting beside him for seven days and nights in complete silence "for they saw that his grief was great" (3:13).

Job proves a good bet by never following his wife's advice to "curse God and die," but he does deliver a series of lamentations and questions about his condition, countering his friends' theories about the possible causes (unacknowledged sin, primarily) for his troubles and finally asserting his desire to speak directly to God and ask Him the reason that a good man has been burdened with a host of sorrows (2:9). Job's friends, including a fourth speaker, Elihu, who was probably added into the text by a later writer, reprove him angrily.

God appears suddenly and speaks to Job from within a whirlwind, ending Job's complaints with his chastening response. Rather than offering a rationale for Job's suffering, God reminds him of the limitations of a human perspective. Ultimately God rewards Job and reprimands Job's friends.

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