Showing 151 - 160 of 476 annotations tagged with the keyword "Medical Ethics"

Before the Operation

Gervex, Henri

Last Updated: Nov-14-2008
Annotated by:
Aull, Felice

Primary Category: Visual Arts / Painting/Drawing

Genre: Oil on canvas

Summary:

Also called "Dr Péan Teaching His Discovery of the Compression of Blood Vessels at St Louis Hospital," the scene takes place in a room in which the walls are interrupted by tall windows.  Daylight shines through the windows, illuminating an attractive naked young woman in the right foreground who lies seemingly anesthetized -- her eyes are closed although there is no sign of anesthesia -- on a bed of some kind that is draped loosely with sheets.  Her body is pointing away from the viewer, her head facing away from us, her long hair falling casually over the near edge of the bed.  Her breasts are fully visible, especially her right breast, while her lower body is covered.  A seated man grasps the wrist of her bent right arm, perhaps taking her pulse. His hand and arm rest directly on the woman's body -- on her abdomen and groin area.  He appears to be reading from a paper.

In the left foreground is the edge of a table that holds some surgical instruments and a glass jar containing what may be anatomic specimens.  An imposing sideburned man stands to the left, above the head of the bed and the woman.  Holding a surgical instrument in his right hand, he gesticulates with his left-hand, his mouth partly open: he is lecturing to the people in the room, some of whom are looking directly at him while others talk to each other.  Two in the audience are women -- a nun barely visible in the far background, and a nurse standing behind two men who are near the bed.  The men are all dressed in street clothes.

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Summary:

This is a collection of Elizabeth Layton's work, organized chronologically from 1977-1991. Contents include a biography and epilogue by a 27-year-old reporter (Don Lampert) who discovered, promoted, and became a dear friend of "a depressed grandmother with a handful of drawings under the bed."

Layton discovered contour drawing when she was age 68 and claims to have drawn herself out of mental illness. Her subject matter is self-portraiture, marriage, aging, depression, grandmothering, dieting, and political commentary (nuclear holocaust, capital punishment, mythology and hospital death).

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The Hospital Poems

Ferris, Jim

Last Updated: Oct-15-2008
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

The first poem begins: "Let me be a poet of cripples, / of hollow men and boys groping / to be whole, of girls limping toward / womanhood. . . " This Whitmanesque introduction bespeaks two sides of Jim Ferris’s poetry. First, this is poetry of celebration: "I sing for cripples, I sing for you." But at the same time, the poems look unflinchingly at the failures, phoniness, and self-righteousness of the "fix it" establishment. They also portray (and celebrate) the community of suffering among the inmates destined to be "fixed."

In "Meat" (5) Ferris lays it on the line," Between four and five they bring down the meat / from recovery--those poor dopes have been simmering / up there for hours, bubbling up to the surface. . . " But even the children who have become "meat" have feelings. For example, the narrator of "Mercy" (18) expresses horror when two healthy classmates from the 8th grade manipulate the hospital rules in order to bring him a Get Well greeting. "How did these aliens get in?" he asks. "Leave now, trespassers, you who seek to gaze / on my humiliation." Perhaps the merciful will obtain mercy from God, he comments, "but not from me." In "Miss Karen" (25) the narrator sustains himself with erotic fantasies about his nurse and discovers to his mortification that he babbled these thoughts to his mother during recovery from anesthesia.

The culture of medicine looks cruel--or at least uncaring--though this crippled narrator’s eyes. "The Coliseum" (42) gives a telling description of the patient’s appearance at Grand Rounds: "You are a specimen / for study, a toy, a puzzle--they speak to each other / as if you were unconscious. . . " "Standard Operating Procedure" (44) reads like an ironic crib-sheet for orthopedic surgery: "Bust a chuck / of bone the rest of the way out; chisel it if you have to. . . He won’t remember much; kids are like animals / that way."

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A Better Angel

Adrian, Chris

Last Updated: Oct-03-2008
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

A drug-addicted doctor, a dying father, and a cantankerous angel constitute a less than holy trinity. Carl is an impaired physician who is hooked on drugs. He happens to have a guiding angel following him around, but she is no guardian. Instead, she is moody and provides no protection. She offers warnings and advice. Carl met his angel when he was six years old. After being stung by wasps and experiencing an allergic reaction, she didn't lift a finger (or wing) to help him.

The angel is prescient. She can foretell who will grow up naughty or beneficent. She knows when a person will die. She tells Carl that not everyone has an angel. Only those individuals destined for greatness get an angel, but some people choose not to heed the suggestions of their spiritual attendants.

Carl is a pediatrician. He cheated in medical school and on his certifying examination but is pleased with his choice of careers: "I make my living praising the beauty of well children. I love babies and I love ketamine" (p121). His father is dying from metastatic lung cancer. Their relationship is terrible. To make matters worse, Carl cannot stomach sick adults.

His three pregnant sisters implore Carl to care for their father after discharge from the hospital. Carl reluctantly leaves San Francisco and heads to Florida. He takes his father to chemotherapy sessions, but the oncologist thinks it's time to stop further treatment. Carl administers painkillers to his dad and frequently consumes some of the prescribed morphine and Percocet for his own pleasure. The two men hardly speak to each other.

Carl's angel repeatedly implores him to reach out to the dying man. She knows that emotional and physical connection will heal both men. Carl's father longs for a storm but the weather won't deliver his wish. One night, Carl stages rainfall with the aid of the garden hose. He rests his head against his dad's chest, and they fall asleep. When morning arrives, Carl awakens and discovers that his father died during the night. The angel is weeping in the room.

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Something for the Pain

Austin, Paul

Last Updated: Sep-29-2008
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

After several years as a firefighter, Paul Austin decided to return to school and become a doctor.  Both his training as firefighter and a somewhat late start at medical school gave him an unusual perspective on his selected specialty-emergency medicine.  The book chronicles a wide variety of surprises, learning moments, and challenges from his years in the emergency room.  These are interspersed with vignettes about the interrupted home life of an emergency physician rotating into night duty three to four times a month.  The pace is lively and the stories confessional in the best sense-rich with reflection on what he has learned, often at great cost to his resilient wife and three children, one with Down syndrome.  A strong theme in the book is the importance of developing strategies for sustaining humanity and compassion even under intense pressure to be quick, clinical, and detached. 

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Summary:

A Place Called Canterbury by social historian Dudley Clendinen, former New York Times national correspondent and editorial writer, provides readers with an intimate and revealing account of aging in a particular place at a particular time--Canterbury Tower in Tampa, Florida. The story about the author's mother, Bobbie--and so many others--begins in 1994, a few years after the death of James Clendinen, Bobbie's husband of 48 years, and known to the community as the progressive editor of the Tampa Tribune. Although she had been "falling apart, a piece here, a piece there...collapsing vertebrae...bent, frail, and crooked...subject to spells and little strokes...." (p. xii),

Bobbie Clendinen was in reasonably good health. Nevertheless, her grown son and daughter did what most children their age do--they worried. When she finally agreed to move from the home where she had lived for twenty-nine years to Canterbury Towers, room 502, two bedrooms, two baths ($88,000 in cash, $1505 each month), Clendinen and his sister were relieved. She would be cared for and safe in "the small, cream colored, obsessively well-run geriatric apartment tower and nursing wing...across a broad boulevard from an arm of Tampa Bay" (see book cover).  And, so many of her old friends were already established residents!

Clendinen was fascinated by his mother's new circumstance and by what he came to regard as the new old age. As a writer, he could not resist the opportunity before him. Although he lived in Baltimore, he could come and go, but over the twelve-year period of his mother's residence--three in the Towers and nine years in the hospital wing--he spent more than 400 days as a live-in visitor, observer, listener, interpreter. This unusual arrangement provided Clendinen with a close-up view of a 21st Century phenomenon, the comings and goings of aging people in the final setting of their lives.

Canterbury is a well-run camp and life there is a soap opera. Between his exchanges with the witty rabbi and the former jitterbug champs, the enthusiasm generated by a nudity calendar proposal (declined) and the geriatric bib enterprise (thriving), the inhabitants provided Clendinen with an abundance of riches. Whether at lunch in the dining room overlooking the Bay, over daily drinks at 5pm, or in bed in the health center, everyone of this Greatest Generation had a story to tell. This ethnographic page-turner, with its cohort of named characters--the Southern Belle, the Rabbi who escaped the Holocaust, Emyfish, the ageless New Yorker, Lucile, the warm-hearted Fundamentalist, the raunchy Atheist, the crusty Yankee, the horny widower, and the maddeningly muddled Wilber--reads like fiction. Whether rich or poor, married or widowed, Clendinen listened as they spoke and in doing so became a trusted friend and chronicler of small and great events in their collective lives: childhood, Depression, World War II, medical advancements, healthcare costs, 9/11. Because Bobbie Clendinen spent so many years in the hospital wing, much of the story describes the kind of care and staff standards that we would hope for all--including ourselves. Mrs. Clendinen died at age 91.

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Annotated by:
Henderson, Schuyler

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

James Coburn turns in a startling comic performance as a psychiatrist with a Cheshire Cat grin, called upon to provide a listening ear to the President. Somewhat flattered to get the job, he accepts, and soon becomes caught up in intrigues as all the other major players in the Cold War want to capture the man who knows the President's secrets.

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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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Silvie's Life

Rogoff, Marianne

Last Updated: Apr-01-2008
Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

This book chronicles a tortured parenthood during the birth and brief life of a severely brain-damaged female infant, Silvie. Doctors predict that the child will live only a few days but instead she survives for seven months. The story is told in first person by the mother, beginning with her arduous labor during a home delivery in the presence of an experienced midwife and the family physician. The baby does not cry when she is born and turns blue even with oxygen that the doctor administers. An ambulance is summoned; "a bigger, better oxygen machine" restores the baby's color and she is brought to a hospital neonatal intensive care unit where she is artificially ventilated and fed.

In the hospital Silvie "fails" all the tests of normalcy. The doctors recommend removing artificial ventilation. "I feared, even more than I feared her death I think (and harder to admit), that they would remove the oxygen pump and the baby would live on and on and never be able to do anything at all" (14). Yet when the child does in fact breathe independently, "I took the fact that she could sustain her own breathing to mean that the baby wanted to live. It was all right to love her" (15). A few days later, however, the medical team concludes that there is nothing further they can do for the baby, that the parents should take the child home, where she will likely die within a couple of days. Upon being prodded, one physician suggests the parents give her an overdose of phenobarbital, which she is receiving for continual epileptic seizures.

At home, the parents feed Silvie by tube, medicate her, change her diapers, hold her, and learn from a friend how to swaddle her. The child never cries, does not focus her eyes on anything, rarely responds to sound or touch, and gains no weight. Whatever random responsiveness there seems to be gives the author a sense of motherhood: "I was able to survive because of my faith in these intermittent chance meetings, believing that Silvie did know when I was here and that I was holding her close in a way that meant love" (37). The parents brace themselves for Silvie's death. The husband's sister visits and councils them to actively put an end to Silvie's life, which they refuse to do. But they do not plan to take extra measures (CPR) if Silvie seems to be dying at home and when they articulate this to a social worker whom they consult to obtain respite care, it becomes clear that she would report them to Child Protective Services.

The husband quits his job as a residential counselor of emotionally disturbed teenagers to do part-time carpentry work -- he is too preoccupied to care about other people's problems. When a friend accidentally breaks the phenobarbital bottle, the parents together with the family physician decide to see how Silvie will get along without the drug. To their amazement, the baby appears slightly more alert and is able to suck from a bottle -- no more feeding tube required. But the husband reminds his wife, "The doctors warned us she might do this. This is the one and only thing she can ever learn. They said when this happened to other parents they started to believe that the baby was getting better" (59).

The parents live in limbo, attempt to live a "normal" life. When Silvie starts to lose weight at age 4 months, the doctor advises to resume tube feeding; they don't see the point, but when hospital physicians use the word, "murder," and threaten to "take over" Silvie's care, the parents relent. The baby lives but "it was the sameness of Silvie that drove you crazy . . . She slept and woke, but was awake that much different? She did not change, she did not change. Her sameness was a stone I wore, an emblem of failure, failed life" (96).

The final act for Silvie begins when the author's mother-in-law is dying of cancer in New York and a decision is made to leave the baby at home in California for several days in the care of a retired nurse. The nurse has been shown how to do the tube feeding, but while the parents are in New York she experiments with spoon feeding, then discontinues tube feeding for three days before the parents return. The parents see that Silvie has deteriorated in their absence and resume tube feeding. For the remaining couple of months the parents wait, investigate institutionalizing Silvie, and finally determine that "the way we loved Silvie meant we loved her enough to let her die" at home, with "a certain amount of fluid and nourishment for comfort, but a gradual withdrawal of excessive food. Replaced with a lot of touching and holding, stroking and whispering" (122). Silvie dies and the author is four months pregnant with the baby she and her husband have decided not to abort.

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