Showing 141 - 150 of 246 annotations tagged with the keyword "Medical Education"

The Blood of Strangers

Huyler, Frank

Last Updated: Jun-21-2006
Annotated by:
Davis, Cortney

Primary Category: Literature / Fiction

Genre: Collection (Short Stories)

Summary:

In 28 autobiographical stories, the narrator writes of his patient encounters (and self encounters) as a medical student, resident, and finally Emergency Room attending physician. "The Unknown Assailant" opens the collection, a tale of a criminal and his victim who are both brought into the doctor-narrator's emergency room. The young doctor chooses "the young one" (p. 1), not knowing he is the assailant, and works frantically to save his life. This criminal allegedly killed two men a year before, but his current victim lives and the doctor learns the story of the attack from this victim's point of view. The assailant, who slowly recovers, has "an aura about him" (p. 5) and the doctor is strangely drawn to him, thankful that this man means him no harm. Perhaps aware of the irony of healing a man who, in another environment, might kill him, the doctor helps the assailant get better.

This underlying theme--that nothing is black and white in medicine or life--shapes every story. "Prelude," is the revealing, three-page tale of a medical student's life outside the hospital juxtaposed with his first encounter with death in the anatomy lab.

Every story deals with significant issues: the physician's inner emptiness when a patient dies ("Through the Dark, Softly"), how a greater power might suddenly intervene ("Faith"), how narrow the margin is between a successful and a missed diagnosis ("Sugar"), how both patients and residents survive because of, or in spite of, their medical attendings ("A Difference of Opinion"), and how things that seem final or sinister--like death and leeches--become instruments of hope and cure ("The Dead Lake"). [Sugar and The Dead Lake have been annotated in this database.)

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The Chosen

Potok, Chaim

Last Updated: May-12-2006
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Novel

Summary:

During World War II two Jewish teenagers in New York meet under unfortunate circumstances. Reuven Malder is the pitcher and Danny Saunders the batter in a baseball game between two rival yeshivas. Danny, the son of the rebbe (or tzaddik) of a strict Hasidic sect, lines the ball straight to Reuven, hitting him in the eye. Later, Danny visits Reuven (the son of a Jewish scholar) in the hospital and they become close friends. The story takes us through the next five or six years of the boys’ lives, as the World War ends, the Holocaust is revealed, and the Jewish state in Palestine is born in dissension and violence.

Danny is destined by tradition to follow his father as tzaddik of his community, but he really desires to become a secular psychologist. Reuven is gifted in mathematics, but his desire is to become a rabbi. From his father Reuven learns about the historical roots and practices of Hasidism. At Reb Saunders’s synagogue, he experiences Hasidism in practice, especially the practice whereby the Reb makes an intentional mistake in his sermon every week and challenges Danny to identify the mistake and elucidate it from the Talmud and commentaries.

Reuven learns to hate Reb Saunders, who strangely never talks to his son, except when they are studying Talmud. Danny and Reuven both attend Hirsch College. At one point Reuven’s father, David Malter, openly supports the creation of Israel and Reb Saunders, who is violently anti-Zionist, forbids Danny to speak with or associate with Reuven.

Meanwhile, Danny has never spoken with his father about his plans to attend graduate school in psychology. Finally, the rebbe asks to see Reuven and for the first time in a year the three men meet in Reb Saunders study. The rebbe explains that he has known about Danny’s plans all along. He also explains why he raised his son in silence--it was to teach him to listen to silence, to learn compassion, to develop a soul to go with his magnificent mind.

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Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

Williams's autobiography recounts his life from his first memory ("being put outdoors after the blizzard of '88") to the composition of "Patterson" and a trip to the American West in 1950. The book's 58 short chapters epitomize the writer's episodic and impressionistic style, presenting a series of scenes and meditations, rather than a narrative life story.

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Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This is an ambitious and far-ranging book, the result of years of thinking, teaching, and working with patients. An internist at the College of Physicians and Surgeons at Columbia University, Charon sees a wide range of patients in an urban setting. Also a Ph.D. in English literature, Charon has devised a "Parallel Chart" and other means for caregivers to write personally about the dynamics between healer and patient, to read texts--narratives in particular--and, as a result, to listen better to patients, thus improving the delivery of medical care.

Charon defines narrative medicine as "medicine practiced with these skills of recognizing, absorbing, interpreting, and being moved by the stories of illness" (4). She calls this a "new frame" for medicine, believing that it can improve many of the defects of our current means of providing (or not) medical care. Caregivers who possess "narrative competence" are able to bridge the "divides" of their relation to mortality, the contexts of illness, beliefs about disease causality, and emotions of shame, blame, and fear.

Charon finds that medical care and literature share five narrative features; she argues that careful reading of narratives builds skills that improve medical care, including intersubjectivity between caregiver and patient, and ethicality. Beyond the theory, there are powerful and persuasive examples of interactions between caregiver and patient, many from Charon's own practice. A mother of a sick daughter experiences stress that makes her ill; when she sees a narrative connection, she begins to heal.

Charon sees wider applications. As caregivers understand better concepts of attention, representation, and affiliation, they become more ethical, more community minded, and better healers to their patients. Patient interviews will be different: instead of following a grid of questions, physicians will converse with patients in an open-ended way. What is most important will emerge and emerge in ways that are most beneficial to the patient. Yes, this method will take more time but it will be more efficient in the long run. Bioethics, Charon argues, has been limited by legal approaches and philosophical principles. For her, narrative bioethics offers more human values in how people feel, experience reality, and relate to each other. Finally, there are implications for social justice: why are the poor underserved in this country and in many others?

One of the most exciting and radical formulations comes late in the book: ". . . practitioners, be they health care professionals to begin with or not, must be prepared to offer the self as a therapeutic instrument" (p. 215). This notion links up fruitfully with concepts of energy medicine (v1377v), therapeutic touch (Tiffany Field), and intentionality (Wayne W. Dyer).

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Summary:

Born in 1728 the tenth child in a struggling Scottish farm family, John Hunter was a wayward and unteachable child who spent most of his time outdoors. At the age of 20, with no prospects and having lost his father and 6 siblings, he wrote for help to his older brother William, who was practicing midwifery in London and had just opened England's first anatomy school, one featuring the revolutionary opportunity for students to dissect their own cadavers.

John rode the 400 miles to London on horseback, apprenticed with great success under William, learned dissection, then surgery, and went on to become a supremely gifted anatomist and surgeon, one whose brilliant and tireless experimentation broke with ancient and outmoded medical traditions and established the foundation for modern science-based surgery. (When John arrived in London, the city's Company of Barber-Surgeons had only just dissolved to allow surgeons to organize themselves independently of barbers.)

One of his most important activities in working for his brother--and which continued when he made his own way--was the procuring of cadavers, which because of the customs of the time involved him intimately in the grisly business of grave-robbing.

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Summary:

Shannon Moffett, a medical student at Stanford University School of Medicine, became fascinated with the brain during her anatomy and neurobiology courses. She set off across the country to interview people--scientists, doctors, patients, ethicists, and religious leaders--who devote their careers trying to understand the brain and cognition. With infectious enthusiasm and energy, Moffett brings the reader to meet these dedicated people, their work, their theories and their lives.

The book contains eight chapters and hence eight mini-biographies: 1) neurosurgeon Roberta Glick, 2) cognitive neuroscientist and brain imagist John Gabrieli, 3) Francis Crick (of DNA double helix fame) and Christof Koch--scientists studying consciousness, 4) sleep researcher Robert Stickgold, 5) Judy Castelli who has dissociative identity disorder (multiple personality disorder), 6) philosopher Daniel Dennett, 7) neuroethicist Judy Illes, and 8) Zen monk Norman Fischer.

Separating the chapters are "interludes" that map neural and brain development from conception to death. The book has a reference list for each chapter and a complete index, as well as a web resource (www.shannonmoffett.com) to which the reader is directed for graphics.

The writing is compelling, direct, fresh and insightful. For example, in "Touching the Brain," we follow the exhausting lifestyle of an academic neurosurgeon who works at Cook County Hospital in Chicago as she performs surgery, teaches, attends services at a temple, drives her car, takes care of her family including two young children, rounds on patients, hosts a potluck dinner, and simultaneously discusses her reading, travel and spirituality.

Moffett aptly describes Glick with her "waist-length red hair, ... beaten-metal earrings dangling almost to her shoulders and a saffron batik dress" as someone you'd "expect to find reading storybooks to kindergartners in a public library" (8). In fact, it is Moffett's eye for accessible detail that makes not only the people, but also neuroscience come alive. Artfully woven into the text are lessons on the history of brain research and current understanding (and questions) about the brain, its meaning and function.

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Summary:

This collection contains all the stories in Arthur Conan Doyle's Round the Red Lamp, six additional medical tales (three of which are from the Sherlock Holmes oeuvre), and the published version of "The Romance of Medicine" (1910), an awards ceremony address to the medical students at St. Mary's Hospital Medical School.

Round the Red Lamp (see annotation in this database) received almost universally negative reviews when it was published in 1894. They deplored the fact that Conan Doyle wrote about such "nauseating" and "ghastly" topics. All but one of the stories deal with doctors, disease, or medical practice. (The exception is a gothic tale that has a medical student as its hero.)

For example, "Behind the Times" contrasts the behavior of old fashioned humanistic physicians with that of modern scientifically-oriented physicians; "The Doctors of Hoyland" conveys a very positive image of women physicians; "His First Operation" depicts a first-year medical student fainting in the operating room; and "A False Start" presents a humorous account of Conan Doyle's difficulties in starting his own medical practice.

The three Sherlock Holmes stories are "The Dying Detective" (1913), "The Creeping Man," (1923) and "The Blanched Soldier" (1926). "The Romance of Medicine" is an inspirational essay on professionalism and medical history, somewhat similar in tone to, and contemporaneous with, the essays of William Osler.

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What Patients Taught Me

Young, Audrey

Last Updated: Jan-17-2006
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

This collection of stories describes "a medical student's journey" (the subtitle) through the difficult terrain of clinical education. In Audrey Young's case, this is also a geographical odyssey from Seattle to Swaziland to Pocatello, Idaho, as she completes her University of Washington clinical rotations and electives. In one sense the main characters of these narratives are the patients the author encounters in clinics and hospitals. As she writes in the Preface, "Patients teach things that the wisest and most revered physicians cannot, and their lessons are in this book."

In another sense, of course, Dr. Young herself is the central character of these stories; this is an account of her journey into doctoring. The author first takes us to Bethel, a Yupik Eskimo town on the Bering seacoast of Alaska, where she had her initiation into clinical experiences in the form of a summer preceptorship. There she learns that patients are far different from textbook examples, as she confronts the social and cultural factors that influence illness and its amenability to treatment. We follow the author to assignments throughout the WWAMI network. WWAMI is the University of Washington's decentralized clinical training program (Wyoming, Washington, Alaska, Montana, and Idaho).

In Spokane she delivers a baby for the first time, supervised by an opera-loving attending physician. In Pocatello she takes care of her first critically ill neonate. In Missoula her life becomes "one of resigned solitude" in her internal medicine clerkship, where she experiences sleep deprivation and experiences sunlight only "through dusty windows."

During her fourth year, the author finds herself treating desperately ill AIDS patients without a supervising physician (he had gone to Zaire for a funeral and might be back the following week) and also without anti-retroviral drugs. However, it is in Swaziland that she learns the deep power and dignity of medicine, as exemplified by a patient who invites her to a dinner in her honor that requires killing one of his precious chickens.

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Arrowsmith

Lewis, Sinclair

Last Updated: Dec-19-2005

Primary Category: Literature / Fiction — Secondary Category: Literature / Fiction

Genre: Novel

Summary:

Martin Arrowsmith is from a tiny mid-western town. He goes to college and then to medical school in the largest town in the state. He begins to worship Gottlieb, Professor of Bacteriology, one of the few professors who is devoted to pure science instead of lucrative practice. Martin becomes Gottlieb’s assistant and annoys his professors and friends by constantly talking about methodology. He is engaged to Madeline, a rather dull graduate student in English. When he meets Leora, a nurse, he breaks his engagement to Madeline. Martin grows disenchanted with his career, leaves school, and wanders around the midwest. Finally, he marries Leora and returns to school. Now, however, he becomes a disciple of the Dean, Silva, whose science is much less precise and who is devoted to making people comfortable at all costs.

Martin sets up practice after graduation in Leora’s home town. The Swedish and German farmers find him invasive and unwilling to cater to their small-town expectations. When Martin misdiagnoses a case of smallpox, he is forced to leave town. He has by then found a new hero, Gustave Sondelius, who fights plagues abroad and returns to America to lecture. Sondelius finds him a job in a larger town as an assistant to Dr. Almus Pickerbaugh, Director of Public Health. Pickerbaugh writes popular poems against sidewalk spitting and alcohol but does little else. The town loves him. He becomes a senator and Martin takes over the department. He quickly makes enemies of the very people Sondelius pleased. He also returns to research. Between annoying the upper crust with his brusqueness and annoying the farmers by closing their diseased dairies, he is soon drummed out of town.

He is then hired as a pathologist at the Rouncefield Clinic, where he does meaningless, repetitive work. His old mentor, Gottlieb, saves him by getting him a position at the McGurk Institute in New York. The Institute is very rich and gives scientists a chance to work without the interruption of patients or a need for practical application. Martin returns to Gottlieb’s principles and discovers a cure for bubonic plague. The Institute, which is not free from economic interests, sends him off to the tropical island of St. Hubert to test his material and save the population.

Martin is determined to conduct a controlled trial. When his wife and Sondelius both die of the plague, however, he injects everyone, saves the island, and returns to New York. Gottlieb has dementia and can neither blame nor forgive Martin for his lack of scientific aplomb. Martin marries an heiress and briefly lives the rich life he always dreamed of, but finds that his new wife will not let him work. Finally, he joins a friend who has built a laboratory in Vermont and happily returns to research.

 

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The Diagnosis

McEwan, Ian

Last Updated: Oct-04-2005
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

A neurosurgeon looks forward to having a day off from work, but a promising Saturday brings only trouble. Henry Perowne is 48 years old and practices in London. Lately, he's concerned about the impending invasion of Iraq. Perowne's views on the situation have changed considerably after conversations with a patient who was tortured and imprisoned in Iraq for no apparent reason. A protest march against the looming war is held on Saturday.

On his way to play a game of squash that morning, Perowne is involved in a car accident on an otherwise deserted street. No one is injured and the two vehicles sustain only minor damage. The owner of the other car is a man in his twenties named Baxter. He is accompanied by two buddies. Perowne refuses Baxter's demand for cash to repair the car so Baxter punches the doctor. Perowne is moments away from a pummeling.

He notices that Baxter has a tremor and an inability to perform saccades. Perowne deduces that Baxter has Huntington's disease. The doctor capitalizes on the fortuitous diagnosis. He speculates that Baxter has kept the neurodegenerative disorder a secret from his sidekicks. When Perowne initiates a discussion about the illness, Baxter orders the cronies away so that he can speak privately to the doctor. The two men desert Baxter, and Perowne escapes in his car, hopeful he can still make the squash game.

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