Showing 131 - 140 of 150 annotations tagged with the keyword "Medical Mistakes"
Dr. Ernest Lash, single and around 40, discovers his enthusiasm and love for psychoanalysis, the talking therapy, after several years of practice as a psychopharmacologist. As the novel opens, we meet a smart, somewhat smug and self-absorbed Dr. Lash who practices from his office located in the privileged community surrounding Sacramento Street in San Francisco. He has an active psychoanalytic practice, ambition for respect and notice by the seniors of his professional community, and some aspiration to greater success as a theoretician and writer on the subject of psychoanalysis. Central to his character is a love for his work, where it appears that pride in technique and outcome shadows genuine concern for his patients and their unhappiness.
Early in the novel, a male patient, Justin, who has been working with Ernest for several years, announces that he is leaving his wife, Carol, for another woman. Ernest is pleased since he views the marriage between Justin and Carol as unhealthy, while a bit dismayed that Justin fails to acknowledge Ernest's contribution in helping Justin develop the confidence to take this step. Justin ends his relationship with Ernest Lash--feeling that he no longer needs his help--as the beginning of the novel takes an intriguing direction.
Justin's now abandoned wife, Carol, in a state of betrayal and desire for vengeance--she has a hateful attitude toward all psychiatrists after her psychotherapist of many years ago had an affair with her--decides to enter therapy with Dr. Ernest Lash in the hope of seducing him. She disguises herself with a name change and enough distortion of her past and present so that Dr. Lash will not be able to connect her to Justin. She wishes to expose him as a charlatan, and destroy his career.
Carol is an attorney, and smart. Dr. Ernest Lash is lonely and drawn to Carol. The therapy sessions and the progression of their relationship are central to Yalom's exploration of the intersubjective experience, where strangers struggle with the ambiguity of their own motives and intentions in the intimate world of psychoanalysis. Who is giving, who is receiving? Who is being helped, and who is helping?
Yalom weaves this central element of the plot with many other relationships. Dr. Marshal Streider is a senior psychoanalyst with ambitions for national recognition and a preoccupation with money. He is Dr. Ernest Lash's supervisor. He takes great pride in the fact that he treats many wealthy patients, and is engaged in his own boundary dilemmas when he invests, using insider information from one of his patients.
Dr. Seymour Trotter is a senior psychoanalyst who is condemned and removed from psychoanalytic practice after entering a sexual relationship with one of his patients. We learn that Seymour Trotter was once president of the American Psychiatric Association, and a mentor to Marshal Streider. His maxim, "My technique is to abandon all technique" (p. 7), both haunts and guides Ernest Lash throughout the novel as Ernest grapples with his own passions and temptations, while striving in his goal to achieve humane and healing therapy for his patients.
Perri Klass, who had already written of her medical school education (A Not Entirely Benign Procedure: Four Years as a Medical Student, see this database), took notes, made dashed journal entries, and saved sign-out sheets and other written memorabilia during her internship and residency in pediatrics at The Children’s Hospital in Boston, Massachusetts. Because she is a writer, she looked at her experiences in medical training with an eye towards what stories were happening. This book then is a compendium of stories and essays (some previously published) about Klass’s pediatrics training.
Klass reflects on the difficulties of being a writer and physician: "I have been a double parasite, not only learning off patients, but also writing about them, turning the agonies of sick children into articles, using them to point little morals either about my own development as a doctor or about the dilemmas of modern medicine." (p. 297) But she also notes the benefits of writing during training: "between life at the hospital and with my family, it seemed that all my time was spoken for, and spoken for again. I needed some corner of my life which was all my own, and that corner was writing . . . I could describe the astonishing contacts with life and death which make up everyday routine in the hospital." (p. xvii)
Part of the book concerns issues of women in medicine; Klass debunks the mystique of the "superwoman"--the professional, wife and mother rolled up into one incredible ball of efficiency and perfection--with a month of laundry spilling over the floor. Klass, as a successful writer, struggles with this label and includes an essay on her experiences with a "crazy person" who anonymously and publicly accuses her of plagiarism in the midst of the stress and responsibilities of residency.
However, most of the book is about being a new doctor--the terror, the patients, the procedures, the other doctors and staff. She writes of first nights in the Neonatal Intensive Care Unit, delivery room crises, adolescents with chronic illnesses, and her struggles as a sleep and time deprived mother.
She addresses difficult issues: moral dilemmas, suffering, loss, the rape and abuse of children, children with AIDS. Throughout the book is a concern for the patient’s experience, as well as the doctor-in-training’s experience. After her first night on call caring for very premature infants she notes: "Maybe my first patient and I have more in common than I realized: we are both too immature to be out in the world, but with a lot of help, we may just make it." (p. 15)
With regret, Veta Simmons (Josephine Hull) decides to have her affable brother Elwood P. Dowd (James Stewart) committed to an asylum. His drinking and his unshakeable delusion of Harvey, a six-foot rabbit who is his constant companion, are interfering with her plans to find her daughter a suitable mate.
The young doctor is a psychiatric zealot, and when Veta claims that she is so fed up that she can sometimes "see that rabbit," he cleverly commits her instead. The error is discovered and rectified, but the gentle manners of Dowd (and his rabbit) eventually convince the young doctor, his nurse, their boss, and even Veta herself that he does not deserve to be locked up. They release him at the very moment he is about to receive a new chemical treatment guaranteed to rid him of the delusion. Dowd happily sets out to share the rest of his life with Harvey.
Eleanor Lightbody (Bridget Fonda) and her husband Will (Matthew Broderick) travel to the Battle Creek Sanitarium for the cure. On the train, they meet Charlie Ossining (John Cusak) who hopes to make his fortune in the booming breakfast food industry. The san is run on strict rules of vegetarianism and sexual abstinence by John Harvey Kellogg (Anthony Hopkins), inventor of the corn flake. Regular enemas, exercises, outings and baths are prescribed, but Will repeatedly breaks the rules and is lured into liaisons with a chlorotic fellow patient and his nurse.
Eventually, he and Eleanor turn to other unconventional treatments, which are not sanctioned by Kellogg, including nudism and sexual stimulation. Meanwhile Charlie joins up with George Kellogg (Dana Carvey), the Doctor's adopted but estranged son, who taunts his father when he is not extorting money from him. George sets the san on fire, but is reconciled with Kellogg during the conflagration when he sobs "Daddy give us a cuddle." The Lightbodys go home to a moderate pursuit of health.
A woman medical student finds herself in a hierarchical dilemma while rotating through her internal medicine clerkship. She is helping to take care of a middle-aged man who has been hospitalized for a diagnostic work-up. As a consequence of invasive procedures ordered by his physicians to determine the cause of his symptoms, the patient has suffered serious complications and is moribund. The doctors are evasive with the patient and his family, who beseech the medical student for an explanation. Even though she has been instructed by the physicians to refer all issues back to them, she follows her own convictions and tells the truth: "Your father is dying."
As a result of this "insubordination," she is called in to see the head of the department, a man of "legendary diagnostic skill" with a long tenure at the hospital. He says that he will have her dismissed, and launches into a long diatribe, making the case for a paternalistic medicine in which the patient needs to believe that the physician is omniscient and possesses quasi-magical healing powers. "Miracle, mystery, and authority," he says, are at the heart of what physicians can do for their patients and to undermine these is to do harm to the vast majority of the sick. Having made his point, he terminates the interview but reinstates the student, who, it is suggested, is so grateful (for his advice or for not being dismissed?) that she kisses him.
In the fall of 1907, Will and Eleanor Lightbody, a wealthy, neurotic couple from Peterskill, New York travel to Battle Creek, Michigan to immerse themselves in the routine of the famous sanitarium run by corn-flake inventor, Dr. John Harvey Kellogg. They meet Charlie Ossining who is seeking his fortune in the fickle market of Battle Creek's breakfast food industry. The Lightbodys have just lost their infant daughter and Eleanor is taking Will to the "san" for the cure. An inveterate meat-eater with a sexual appetite, Will was addicted, first to alcohol, and then, to opium, after his wife spiked his coffee with an off-the-shelf-remedy for drink.
At the sanitarium, they must occupy separate rooms, refrain from sex, and piously eat inflexible non-meat diets. Therapies include five daily enemas, exercises, "radiated" water, and an electrical "sinusoidal bath," which accidentally fries one of the residents. Kellogg is gravely disappointed in Will's inability to toe the "physiologic" line, but he is more deeply disturbed by his adopted son, George, whose chosen life on the street is a perpetual embarrassment.
Worried about his sexual prowess and deprived of his wife, Will becomes obsessed with his beautiful nurse and opts for the stimulation of an electrical belt; equally frustrated and bent on self-starvation, his wife turns to the quack "Dr Spitzvogel" who specializes in nudism and "manipulation of the womb." Brought to their senses by humiliation, Will and Eleanor go home.
Meanwhile, Charlie has joined with George Kellogg and borrowed from Will to keep his business afloat, but he realizes that he has been swindled. He only narrowly escapes jail, during a fiery commotion created by George who is then murdered by his adoptive father.
This is a collection of stories and sketches by a practicing neurologist. Most of the material is clinical and autobiographical. In "Mrs. Bachman" a new patient enters the doctor's office, carrying a thick stack of medical records. It all started in 1946 and no doctor has ever found the explanation of her condition. Meanwhile, the doctor is wearing contact lenses for the first time. His eyes begin to tear. Mrs. Bachman thinks that he is crying over her misfortune. She consoles him, "I want you to know that you are the kindest, most sympathetic man I have ever met."
In "Intensive Care" an elderly woman is agitated after a seizure. The staff try unsuccessfully to calm her. Finally, her husband approaches and kisses her. She settles peacefully and they hold hands.
The doctor in "Continuing Medical Education" finally discovers metastatic breast cancer as the cause of a psychotherapist's neck pain, long after he and other physicians had told her again and again that the "driving mechanism" of her chronic pain was "unresolved anger and frustration." In a longer essay, "The Narrow Bridge," the author reflects on the meaning of healing, "Healing helps us find a place in this world for ourselves and for each other."
William Morton first introduced ether anesthesia in 1846. This was followed shortly by nitrous oxide and chloroform. Within a few years, surgical anesthesia was being used throughout the United States. However, widespread acceptance did not mean universal usage. Physicians and surgeons debated the risks and benefits of anesthesia. Anesthesia was thought to be dangerous. Some argued that pain was a necessary part of life, that it made people stronger, and/or that it was a punishment from God. Others argued that anesthesia constituted an abuse of medical power.
Surgeons took care to select appropriate patients for anesthesia, while performing surgery without anesthetics on others. Women, people of higher social and economic classes, and people of the white race were thought to be more sensitive to pain than men, the poor, and Negroes and American Indians. Likewise, the young experienced pain more than the elderly. Certain procedures (e.g. major limb amputations and prolonged tissue dissection) were also thought to require more anesthetic than others (e.g. natural childbirth or ENT surgery). These beliefs carried over into practice, as evidenced by records from the Massachusetts General Hospital and other hospitals in the mid-19th century.
Dr. Hertzler leads the reader, topically and generally chronologically, through the nature of the practice of medicine in rural America from the 1880's through the 1930's. His early narratives are those of a child observing the ravages of epidemic diseases in the face of medical futility.
The remainder of the work, divided into subject headings, is devoted to anecdotes and observations on such things as horse and buggy home visits, kitchen surgery, the proprietary hospital and physician education. Having served not only as a rural practitioner, but as a professor of pathology at academic centers and a consulting surgeon, Hertzler draws on a wide experience over a period of time known for rapid advances in basic biological science which would, near the end of the narrator's life, open the way for technological medicine as we know it today.
A nephrologist is named in a lawsuit after serving as a consulting physician in a diabetes case. The diabetic patient had had a serious infection and later his leg was amputated; he apparently felt the doctors neglected the seriousness of his condition. When the dialysis unit treating this patient requests to transfer his care to the author, whose unit is in the patient's home town, the author is uncertain what to do.
The author is angry about the law suit, and his colleagues counsel him to refuse to take this patient. But after realizing that the lawsuit was merely a reflection of the patient's suffering, and that he needs the same compassion and care as any other human being, the author agrees to accept the patient. The author discovers that his patient is a meek, gentle man; over time, he helps him come to terms with his illness, his disability, and his approaching death. Eventually the patient drops his malpractice suit.