Showing 121 - 130 of 425 annotations tagged with the keyword "Professionalism"

Summary:

This is a collection of approximately 45 pathographies-essays, memoirs, biography, autobiography, poems, and reflections on illness experiences -grouped loosely into four categories of related subject matter. These categories are: Illness and Identity: Dynamics of Self and Family; Concealing Illness, Performing Health; Agency and Advocacy; Medicine at the Margins. The majority of the pieces are written by non-health care academics about their experiences with a wide variety of illnesses. A few have been written by or with health care professionals.

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Summary:

Body of Work is a cleverly crafted memoir - or, rather, the first chapter of a memoir - of the author's medical school experience at Brown University School of Medicine in Providence, Rhode Island. Ms Montross relates the chronological course of her team's dissection of a female cadaver with no discernible umbilicus and whom they therefore name Eve. (She neglects to comment on Eve's ribs and whether she has the normal complement or a supernumerary, more masculine, rib.) As she and her team of four (later three as one student drops out of school) proceed with the orderly dismantling of Eve, bone by bone, nerve by nerve and blood vessel by blood vessel, she uses this experience as a springboard to analyze her and her team's emotional reactions to the often unnatural process of deconstructing, literally (at times with a saw), a former person now cadaver, as well as the gradual, almost imperceptible acculturation that transmogrifies medical students into doctors. In fact, she devotes the final pages to this metamorphosis and what it means to the person undergoing the transition from caring student to detached physician, and whether one can retain enough caring, while remaining sufficiently detached to function as one must as a clinician, to become both a whole person and competent physician: "How much of becoming a doctor demands releasing the well-known and well-loved parts of my self?" (page 209)

Although it primarily revolves about the axis of her gross anatomy (cadaver dissection) course, the author's narrative includes tangents that have variably relevant relationships to this course, e.g., a trip to Italy to inspect first hand the anatomy theater of Vesalius in Padua and the Basilica of St. Anthony; another trip to the anatomical wax sculptures museum in Bologna, where the author also observes the "incorrupt corpse of Santa Caterina" in a "small church called Corpus Domini" (pages 223-224); interspersed histories of the traffic of corpses for dissection, including the infamous Burke and Hare story; some flash-forwards to her second and third years; and a prolonged narration of the final illnesses of her grandmother and grandfather. This last bit of family history is worth the price of the book alone. Despite the apparently incongruous collection of such asides, the author makes it work smoothly, if not seamlessly.

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The Memory Keeper's Daughter

Edwards, Kim

Last Updated: Mar-27-2008
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Because he can't reach the hospital in a winter snowstorm, Dr. David Henry ends up assisting his own wife in the birth of their twin children at his clinic with the help of his nurse, Caroline. The boy is fine; the girl has Down symdrome. While his wife is as yet unaware, he gives the girl baby to Caroline to take to an institution. Norah, his wife, remains unaware that she give birth to two children, yet is haunted by some sense of loss she can't name. Caroline, unable to leave the baby in an unappealing institutional setting, makes a snap decision to keep her. She leaves town, renewing communication later with the baby's father, and raises her as a single mother until she meets a man who is willing to marry her and love Phoebe as a daughter.

Only after Dr. Henry dies suddenly does his wife discover the existence of her daughter, through photographs sent to him over the years by Caroline, and then a visit from Caroline and Phoebe. Sadly, but with a will to choose life on strange and demanding terms, Norah and her son, Phoebe's brother, choose to enlarge their circle of family to include a loving relationship with Phoebe, clearly her own person, and the woman and man who have cared for her.

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Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Sandeep Jauhar, M.D., Ph.D. is currently director of the Heart Failure Program at Long Island Jewish Medical Center in New York. Thus, one can assume that he is an accomplished cardiologist and administrator. It was not always so. This memoir flashes back to 10-15 years earlier when the author was casting about for a career, finally settling on medicine almost by default; it follows him to medical school (at Washington University in St. Louis) and then centers on his first year of residency training at Cornell's New York Hospital in Manhattan -- the internship year.

We learn in the introduction to the book that the author will speak freely of self-doubt about career choice, constant anxiety and feelings of inadequacy, exhaustion, and disillusionment. Which indeed he does. But Jauhar first discusses his family background: born in India and emigrating with his family to the USA at age 8; father holding a Ph.D. in plant genetics, now writing academic textbooks and still regretting that he had not been able to afford his dream of becoming a doctor; mother helping to support the family as a lab technician; older brother, Rajiv, a mentor and competitor, charming, self-assured, and unquestioningly headed for a medical career; sister, Suneeta. Sandeep (the author) undertakes graduate work in theoretical physics but as he nears completion of his doctoral degree, realizes that he probably does not have what it takes to be successful in the field. When his girlfriend, Lisa, becomes seriously ill, he begins to (re)consider medicine as a career. Against the advice of his parents who are now convinced he is a dilettante, he applies to medical school and is accepted.

Disillusionment began during the first two years of medical school: "In graduate school I had never learned to memorize . . . But now I couldn't rely on logic and reasoning; I had to commit huge swaths of material to memory" (32). He considered quitting to become a journalist, a profession that had always intrigued him, but which had been discouraged: "my father made it clear that journalism and writing were never to be considered career options because they offered no security" (33). Yet, amazingly, he was awarded a summer fellowship just before starting medical school that placed him in the Washington, DC office of Time magazine; the contacts he made then allowed him to work as a student reporter for the St. Louis Post-Dispatch during medical school and led ultimately to his ongoing and current position as a contributing medical essayist for the New York Times.

Internship for Jauhar unfolds as a series of anxiety-provoking encounters with patients and humiliating encounters with his physician superiors. Feeling inept and inadequate, he stumbles along and worries that he is harming patients. There is too much to keep track of, too many "little things that I find burdensome" (91). "Having so much to do was bad enough, but not knowing why you were doing what you were doing was terrifying . . . Patients were needy, their demands overwhelming . . . Everyone seemed to know how the place worked except me . . . The ecology on the wards was hostile; interactions were hard-bitten, fast paced" (112-113). He is in constant doubt and conflict about his career choice. Even his private life is affected -- his girlfriend Sonia, still a medical student, comes from a medical family, is strongly motivated and secure in her career choice, which aggravates his own sense of insecurity. (Reader, he married her.)

Midway through internship Jauhar suffers a herniated disk. He tries to tough it out without taking time off but his stint as "night float" at Memorial Sloan-Kettering hospital, which specializes in treating cancer patients, proves too difficult-- up all night trying to tend to the severely ill and "taking care of patients about whom you knew next to nothing" (154). He takes a brief leave followed by a reduced schedule. He recognizes that his problems are emotional as well as physical -- he is depressed. But gradually, as his neck problem improves, as he recognizes that medical professionals are actually able to help patients feel better -- his neurologist and physical therapist had "provided hope and comfort to me at a vulnerable time" (181)--, as he makes a house call to a dying patient, as his essays are published in the New York Times, and as the season moves to Spring, his depression lifts and he looks forward to his work.

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The Birth House

McKay, Ami

Last Updated: Mar-15-2008
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Dora Rare, the only girl child born in multiple generations of her family is encouraged by her mother to establish a bond with Miss Babineau, an odd isolated midwife, whose wisdom on health matters is much sought after by the local women in their small Nova Scotia community. Gripping and intimate encounters with her neighbours as birthing mothers and as women seeking control over their fertility lead Dora to accept a role as Marie’s successor. When arrogant, young Dr Gilbert Thomas comes to town with his strong ideas about science and birth, he is appalled at the practices of the local women; he also resents the competition. Dora embarks on a difficult marriage herself and seeks temporary refuge in the United States where she witnesses a new kind of independence.

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Sicko

Moore, Michael

Last Updated: Jan-08-2008
Annotated by:
Duffin, Jacalyn

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

The movie opens with a shot of a young man stitching up a laceration in his own knee. Another describes how he had to select which of two severed fingers would be re-attached because he could not afford both operations. They are among the millions of Americans without health insurance. But, the narrator says, the movie is not for them; rather it is for the majority of U.S. citizens who do have medical insurance and believe themselves protected.

Through a series of riveting vignettes, for-profit health care is shown to tyrannize the well, ruin the ill, and destroy families. It also erodes the psychological and moral fiber of the people working in the industry. Excursions to England, Canada, France and Cuba are presented in a series of encounters with physicians and patients, none of whom believe that they would be better off in the United States. A French doctor opines that he earns an adequate salary for a good quality of life. Even those seated in a Canadian waiting room profess satisfaction with the care given and understanding about delays. When asked why anyone would accept to pay the expenses of others, an elderly golfer explains patiently that it is what we do for each other in a caring society. Ex-pat Americans gather at a bar to describe their positive experiences with foreign health and maternity care.

Interviews with emotionally distraught people who have worked in the insurance industry reveal the relentless pressure to deny coverage and its reward system that favors those who generate the biggest savings. Special attention is given to Dr. Linda Peeno who testified before Congress in 1996, confessing that she had harmed people for the economic benefit of the insurance industry.

Moore gathers up a group of people whose sorry dilemmas within the U.S. system have left them with serious health problems. He escorts them to Cuba where physicians and nurses are only too pleased to diagnose and treat their illnesses– for free. The movie ends with an exposé of the superior health care given prisoners at Guantanamo and Moore’s stunt at trying to bring the unhappy Americans there for treatment.

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Summary:

In 1999, eighteen years after Project HOPE began publishing the journal "Health Affairs," the founding editor, John Iglehart, began a new column: Narrative Matters. This book contains 46 of the 80 essays published to date, and an inspiring foreword by Abraham Verghese. The essays are contained in eight chapters-- "Writing to Change Things: Essays on the Policy Narrative," "Dollars and Sense: Hard Financial Realities," "Bearing Witness: Patient's Stories," "The Maddening System: Frustrations and Solutions," "Trouble in the Ranks: Professional Problems," "Drug Resistance: Battling Undue Influences," "Disparity Dilemmas: Stories on Race and Ethnicity," and "Values and Choice: Stories of Practical Ethics." Familiar voices include those of Fitzhugh Mullan (one of the editors), Abigail Zuger, Howard Brody, Richard Lamm, John Lantos, Danielle Ofri, and Carol Levine. The essays in the first section strike an important cautionary tone, reminding readers that the plural of anecdote too often is taken for policy and that the repetition of anecdote should not be seen as evidence.

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Annotated by:
Woodcock, John

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Fifty-something Canadian professor of history and lifelong womanizer Rémy (Rémy Girard) lies in an overcrowded hospital with a fatal illness. Family and friends gather, including Rémy’s estranged son Sébastian (a wealthy financier played by Stéphane Rousseau) from overseas, and Rémy’s ex-wife (Dorothée Berryman) and several previous romantic partners. Rémy and Sébastian fight painfully about Rémy’s philandering, but after a plea from his mother Sébastian decides to make things better for his father, even if they have not been reconciled.

This he does in many ways, most of which involve spending lots of money and many of which are highly irregular or illegal. For example, he arranges to have his father taken into the U.S. for an expensive PET scan that would have required six months’ wait to have free in Canada. And he arranges through Nathalie (Marie-Josée Croze), a childhood friend who is now a heroin addict, to provide a regular supply of heroin to control his father’s pain, which the hospital apparently is not able to do with morphine.

These and other extraordinary measures work for Rémy, and the process of caregiving brings Sébastian and his father closer. (Rémy’s only problem seems to be the feeling that his life has been wasted because he has not left his mark--and he gets help with that, paradoxically, through several conversations with Nathalie.) For his last few days, Rémy and ensemble move to a friend’s lakeside cabin, where the conversation is witty, intellectual, and sexually frank, and the mood upbeat and conciliatory.

In the face of Rémy’s imminent demise, all is forgiven, and others seem to gain insight about their lives. Rémy’s last act is peacefully nodding to a sorrowful Nathalie to begin the series of heroin injections that will end his life. In a final dig at the establishment, the heroin is administered through an IV provided on the sly by a hospital nurse.

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The Fruit of the Tree

Wharton, Edith

Last Updated: Oct-29-2007
Annotated by:
Garden, Rebecca

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The novel opens with a young surgical nurse, Justine Brent, nursing a mill worker whose arm has been mangled by a carding machine. She soon meets John Amherst, the mill’s assistant manager who works passionately to reform the dangerous conditions at the mill and to improve the living conditions of the workers. Amherst recognizes Justine’s intelligence and sympathy, but he quickly forgets about her when he meets and falls in love with the new mill owner, Bessy Langhope.

The narrative skips ahead three years. John Amherst has learned that his now-wife Bessy has no real interest in his plan to reform the mill, although she initially appeared to be moved by the workers’ misery. In fact, her insistence on luxury, which is funded by the profit from the mills, thwarts his desire to use her controlling interest to make significant changes. The couple encounters Justine, who knew Bessy in school. When the somewhat sickly Bessy invites her to be a private nurse to herself and her stepdaughter, Justine, who is exhausted from “difficult cases,” accepts. Justine attempts to shore up John and Bessy’s increasingly troubled marriage without success. When John is abroad, Bessy has an accident while riding her horse. Paralyzed, in constant pain, and slowly dying, Bessy is attended by a physician who advances his career with the technological feat of keeping Bessy alive, ostensibly until her husband and her father arrive to say their goodbyes. When Bessy begs Justine to let her die, Justine secretly gives her a fatal dose of morphine, an act that the physician suspects.

The narrative skips ahead again to over a year later when Amherst, who has inherited the mills from Bessy, invites her family to celebrate the opening of an emergency hospital he has built in the mill town. Justine, who had stayed on after Bessy’s death as her stepdaughter’s nurse, and Amherst become reacquainted. Their shared social and intellectual interests develop into love, and they marry. The physician who had cared for Bessy and who had, earlier, asked Justine to marry him, had developed an addiction, one that had begun while he was treating Bessy. Beginning to sink into financial ruin, he blackmails Justine. Eventually, Amherst finds out that Justine killed Bessie with morphine and, horrified, rejects her.

Justine confesses her act to Bessy’s father and negotiates a deal: She will remove herself from their lives if he allows Amherst to continue his work at the mills. Bessy’s father accepts the deal, and Justine disappears for many months until Bessy’s daughter becomes ill and begs to be reunited with Justine. A family friend explains to Amherst Justine’s arrangement to protect him and convinces him that she has suffered suitable penance. Justine is reunited with Amherst when he celebrates the opening of a gymnasium for the mill workers, a project he credits Bessy with having designed. Justine, who knows that Bessy had in fact designed the gymnasium for her private estate, a project that would have drained the funds for improving the mills, keeps silent and subverts her knowledge to her husband’s perception of the facts.

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Doctor and Doll

Rockwell, Norman

Last Updated: Oct-29-2007
Annotated by:
Mathiasen, Helle

Primary Category: Visual Arts / Painting/Drawing

Genre: Oil on canvas

Summary:

Doctor and Doll is part of the collection of the Norman Rockwell Museum in Stockbridge, Massachusetts. The triangular composition depicts an elderly general practitioner seated in a Windsor chair. A little girl is holding her doll out to him, watching intently as the doctor pretends to listen to her doll's heart through his stethoscope. The fact that the little girl comes to his office and stands up before her doctor suggests that she is coming in for a check-up.

The doctor's large black bag on top of the rug by his feet indicates he makes house calls. Behind the two figures is an old-fashioned desk. On top of the desk are several thick volumes, two brass candlesticks, and two pictures. The image on the left may represent a group of doctors in the style of Rembrandt. On the wall we see a large, framed document which has the word "Registration" on it.

The doctor is wearing a dark suit, cravat, and highly polished, black shoes. He turns his head to the right and upwards as he concentrates on his task. His patient, the little girl, is dressed in heavy shoes, stockings, wool skirt, jacket, scarf, and red beret and mittens. She has removed her doll's dress and holds the dress close to her left side with her elbow. The colors of the painting are dark, but the doctor's head with its gray hair, the doll, and the child's serious face are illuminated.

The girl's red beret, mittens, and the doctor's ruddy cheeks and nose give warmth to the picture. Clearly, the doctor is empathetic and kind, and the little girl trusting. Rockwell paints the ideal country doctor taking time to reassure his young patient that he will do her no harm. His gray hairs make him look fatherly.

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