Showing 151 - 160 of 473 annotations tagged with the keyword "Medical Ethics"

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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Annotated by:
Davis, Cortney

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

A woman is pregnant. She is a nurse married to a physician, Jeff, and they have a young son, Willie. The couple is pregnant with their second child. Long before her due date, the woman--author Susan LaScala--begins experiencing signs of premature labor. Because she is a nurse, because she is married to a doctor who takes call, she doesn't want to over-react or bother her obstetrician unnecessarily. But when vague aches turn into cramps, the author enters, as a patient, the world she had known, until then, only as a caregiver.

It is impossible, in a brief annotation, to describe fully the richness of this memoir. Because the author is a nurse, she brings to the story of the premature birth and survival of her daughter, Sarah, a wonderful double vision: LaScala tells this tale not only as a mother and a patient but also as a clinician able to explain, in simple language, the complex technologies used to sustain the life of her one pound nine ounce baby. The author's rendering of the bells and whistles of neonatal medicine, whether describing the process of intubating a preemie (p. 23) or ultrasounding a baby determined to survive (p. 182-3) are precise and haunting.

Equally compelling (and instructive for caregivers) are the author's candid revelations of how it feels to be a patient. She takes to "grading" the doctors and nurses--an "A" for the staff that lets her see her newborn girl (p. 3), and a "C" for a nurse with "No kind words. No warmth" (p.11). She describes her own bodily sensations in language both lovely and informing: the pushing and tugging she feels during her C-Section is a "quiet violence" (p.21); standing beside her daughter during the ventilator weaning process she feels "a witch's brew of fear and panic mixing and growing inside" (p. 225).

In an introduction, physician Barbara Wolk Stechenberg, describes the "gift" that the author has given by writing this memoir. The author has allowed Dr. Stechenberg, who was part of the team that saved Sarah, "a rare glimpse into two worlds" (p. xii). One was the world of intensive care nurses and how "they truly are the primary caregivers" (p. xii). The other world was that of physicians, who "may feel we are empathic and caring, but we really have no idea of the emotional roller coaster many of our parents are riding" (p. xii).

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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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Night Nurse

Macy, Dora

Last Updated: Feb-25-2008
Annotated by:
Garden, Rebecca

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Nurse Lora Hart is working on a private case with two young children who are suffering from malnutrition. They live in a wealthy and chaotic household. Their father is dead, and their mother, who is an alcoholic, and her fortune have fallen into the clutches of her scheming brother-in-law and her thuggish chauffeur, both of whom have been her lovers, among others. The physician caring for the children has been bribed by the children’s uncle, who wants the children to die so that he can marry his sister-in-law and claim her fortune. Nurse Hart secretly defies the physician’s orders and nurses the children back to health. She weathers an attempted rape and a sock on the jaw in the course of her duty at the troubled home. She makes use of her bootlegger boyfriend (this is a Prohibition-era novel) to set up the chauffeur who hit her, and when she learns that the chauffeur has raped her employer’s older daughter, she promises to testify against him in court, even though that results in her being fired from the case and blackballed from hospital work.

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