Showing 161 - 170 of 229 annotations tagged with the keyword "Anatomy"
This masterful collection of essays was written by Gawande while he was a general surgery resident. The book consists of fourteen essays divided into three sections: Fallibility, Mystery, and Uncertainty. Although some of the essays fall clearly within the boundaries of the section title (such as "When Doctors Make Mistakes" and "When Good Doctors Go Bad" in the Fallibility section), others cross boundaries or don’t fall as squarely in these general themes ("Nine Thousand Surgeons," an anthropological essay on the cult and culture of a major surgical convention, is also located in the Fallibility section). Nevertheless, the many pleasures of the individual essays, the range of topics explored in depth, and the accuracy of the medicine portrayed are the true strengths of this work.
The book begins Dragnet-style with an Author’s Note: "The stories here are true." (p. 1) And it is this attention to fidelity that makes the essays so compelling. Because even when the truths are hard--the terrible acknowledgment by the medical neophyte about lack of skill and knowledge, the mistakes in judgment at all levels of doctoring, the nature of power relations and their effects on medical pedagogy and on the doctor-patient relationship, the gnawing uncertainties about so many medical decisions--the author confronts the issues head on with refreshing rigor, grace and honesty.
Many of the essays reference scientific and medical research (historical and current) as part of the exploration of the topic. This information is imbedded within the essay, hence avoiding a dry recitation of statistical evidence. Typically, the reader’s interest in an essay is immediately piqued by a story about a particular patient. For example, the story of an airway emergency in a trauma patient, her oxygen saturation decreasing by the second as Gawande and the emergency room attending struggle to secure an airway, surgical or otherwise, sets the scene for "When Doctors Make Mistakes."
This leads to a meditation on not only the culture of the Morbidity and Mortality Conference, with its strange mix of third-person case narrative and personal acceptance of responsibility by the attending physician (see Bosk, Charles, Forgive and Remember: Managing Medical Failure, U. Chicago Press, 1981 for an in depth analysis of this culture), but also a positive examination of the leadership role that anesthesiologists have played in improving patient safety via research, simulator training and systems improvement.
Gawande’s journalistic verve takes him beyond the confines of his own hospital and training to interview patients and physicians on topics as diverse as incapacitating blushing ("Crimson Tide"), chronic pain ("The Pain Perplex"), malpractice and incompetence ("When Good Doctors Go Bad") and herniorraphy ("The Computer and the Hernia Factory"). In addition, he visits his own post-operative patients at home ("The Man Who Couldn’t Stop Eating" and "The Case of the Red Leg") which gives a longer view of postoperative recovery and a broader exposure to patients’ perspectives.
Some of the most telling moments come with the introduction of his children’s medical problems into the text. These range from the relatively straightforward (a broken arm, but a chance to comment on detection of child abuse in the emergency room) to the downright parental nightmare scary (severe congenital cardiac defect in their oldest child and a life-threatening respiratory infection in their prematurely born youngest).
These last two experiences are introduced to provide an angle on issues of choice. Choice of a fully trained, attending physician rather than a fellow to provide follow-up cardiac care for their oldest, and the choice to opt out of the decision-making process for whether to intubate the trachea of the youngest and hence leave the medical decisions up to the care team.
Abba Kovner wrote these poems during and after his hospitalization at Sloan Kettering for throat cancer. His exile into the world of illness begins as he enters the hospital. "He fell asleep under strange skies" (p. 7) and in the hospital "the silence astounds on all / its many floors."(p. 11) [Throughout the book, Kovner refers to himself in the 3rd person.] He tries to pray: "Is there a prayer for one who prays like him / seething . . . " (p. 15) He decries "the infuriating confidence of the doctors." (p. 21) He celebrates the beauty and magnificence of New York. But then the bad news arrives: "When they told him they were going to cut away his vocal cords / entirely it was merely / a confirmation of what he already knew."(p. 31)
To the brisk, young hospital staff, he is just another patient, nothing but an "ancient shard”: "They could not imagine that this was a man / who had fought the world."(p. 36) Only Norma, the Puerto Rican night nurse, connects with him at a different, more human level. "He blushes / when Norma says: What a lovely / head of hair you have, sir!" (p. 88) As he prepares for the laryngectomy, images from the past invade his consciousness--Christmas Eve, 1941; the Vilna ghetto, where "the lice / got under your skin" (p. 68); and "a shoemaker, his name forgotten" (p. 74). The Holy Guests--the souls of Abraham, Isaac, Jacob, Joseph, Moses, Aaron, and David--also visit the sick room.
After the surgery, the conspiracy of optimism brings him along, carries him forward: "What a healthy recovery, / they said. And patted him on the shoulder / with admiration: You’re doing fine. Wow!" (p. 85) But this is at best a voiceless recovery: "From the wreckage of his voice / there arose a bubble / a tiny bubble . . . " (p. 101) Eventually, the patient leaves the hospital, leaves New York, and arrives home: "Fearful from the moment of arrival: he / watches the landing that cannot / be avoided, into / the arms / of people who love him . . . " (p. 111) He settles into a routine, lives his life as if there is nothing new, but ends at "An Ending, Unfinished" (p. 126), back at Sloan Kettering. "Where now? He asked himself . . . " What next?
Tim Metcalfe is an Australian general practitioner who gave up medical practice to become a full-time poet and writer. A statement on the back cover summarizes the process in relation to this collection of 38 poems: " ’Cut to the Word’ is a moving account of one man’s transition from doctor to poet." He begins with the customary initiation: "We were introduced, respectfully, / to the volunteer dead . . . " (p. 13) He discovers the limitations and uncertainties of his new profession: "In tense moments / I wish my stethoscope / was all they want it to be." (p. 18) And the omnivorous demands of medicine: "I come home from work / and there it is: the family / the oldest crying / at the youngest crying / at her mother’s anger / at her crying . . . " (p. 21)
Metcalfe carries the reader through a series of short, incisive poems describing the doctor’s day-to-day work ("Morning Session, " pp. 47-50), as well as through a number of disturbing poems about the world of mental illness, but the book’s climax--so to speak--arrives with "The Doctor’s Complaint, " in which the physician heals herself "by laying down her stethoscope / and walking right out / of that in-patient clinic." At the end the poet writes, "Like a patient I have learned silence . . . Fine steel scissors in hand, / I cut to the word." (p. 63)
This historical novel is set in 16th century Venice, where the great anatomist and physician Mateo Colombo has just been charged with heresy and placed under house arrest. The book proceeds in a series of short frames or fragments, presenting Colombo’s story from a wide variety of perspectives, ranging from the perspective of Mona Sofia, the most prestigious whore in Venice, to that of Leonardino, the crow who waits each morning to scavenge an eyeball or piece of flesh from one of the anatomist’s cadavers.
What is Colombo’s heresy? True, he has consistently violated the Papal Bull of Pope Boniface VIII that forbid obtaining cadavers for dissection, but his scholarly eminence and friendship with Pope Paul III have protected him from recrimination. His heresy is far worse than simply ignoring a Papal Bull; in fact, Mateo Colombo has discovered a dangerous new anatomical structure, the clitoris!
Mateo was called to the bedside of an unconscious holy woman named Inés de Torremolinos. In the process of examining her, the physician was amazed to discover "between his patient’s legs a perfectly formed, erect and diminutive penis." (p. 105) He took hold of the strange organ and began massaging it. As he did so, there was an amazing response in his patient: "(Her) breathing became hoarser and then broke into a loud panting . . . Her lifeless features changed into a lascivious grimace . . . " (p. 107) Subsequent research undertaken with Mona Sofia, the resplendent whore, as well as with cadavers, confirmed the significance of Colombo’s discovery.
At his hearing before the High Tribunal, Colombo explains his findings, which are far too complex and subtle to summarize (pp. 138-165). The finding of greatest interest, however, is that "there is no reason to believe that there exists in women such a thing as a soul." (p. 151) In fact, Colombo contends he has proven that the "amor veneris" or clitoris performs in women "similar functions to those of the soul in men, " although its nature "is utterly different since it depends entirely on the body." (p. 153)
You’ll have to read the book to discover what the verdict of the High Tribunal of the Holy Office was and Mateo Colombo’s fate.
This is an excellent review of the authors' choices of the ten greatest medical discoveries. They arrived at the ten selected after narrowing five thousand or more possibilities down to one hundred and then finally down to ten based on these three components in the field of medicine: 1) structure and function of the human body, 2) diagnosis of medical conditions and 3) treatment of such maladies. Finally the ten selected were approved by four avid and informed physician collectors of rare and important medical publications.
Chronologically, the anatomical observations of Vesalius come first with his publication of the Fabrica in 1543. Harvey's discovery of the circulation of the blood is considered the single most important discovery. Leeuwenhoek gets credit as the founder of bacteriology, but Koch and Pasteur are included in a discussion of this discovery. Jenner gets his just recognition for introducing vaccination and Roentgen for discovering the X-ray beam.
Crawford Long is recognized for the initial use of surgical anesthesia and Fleming for the discovery of penicillin. More unlikely choices are Ross Harrison for tissue culture, Anichkov for the relation of cholesterol to atherosclerosis and Wilkins, rather than Watson and Crick, for the DNA story.
Each chapter describes not only the discovery but also tells the life stories of the chosen "discoverers" and others who contributed to extension and usefulness of the discoveries. The authors conclude that it is not genius so much as curiosity and the ability to conduct methodological investigations that distinguish these men.
In this collection Richard Selzer brings together 25 stories from his previous books, along with two new stories, Avalanche (see this database) and "Angel, Tuning a Lute." The unifying theme is the world of medicine and healing, which Selzer explores with a keen eye and compassionate heart. These stories are firmly grounded in the foibles, suffering, and exultation of the human body.
In the Introduction Selzer sketches the path by which he became a surgeon-writer and he indicates the origin of some of the stories. Particularly interesting are the stories that do homage to literary and historical figures; for example, "Poe's Light-house," which grew out of a fragment Edgar Allan Poe wrote in his last delirium, and "The Black Swan," a re-writing of a Thomas Mann novella (Mann's The Black Swan is annotated in this database).
Likewise, the story of how "Avalanche" was written is an interesting tale in itself. Selzer's description of pruning the story from his journal reminds me of Michelangelo's comment that the sculpture already exists in the block of marble. The sculptor merely removes the unnecessary stone. The Doctor Stories contains many of Selzer's tales that have become part of the Literature and Medicine canon; these include, for example, "Tube Feeding," "Sarcophagus," Imelda, Mercy, Brute, and Four Appointments with the Discus Thrower. (See this database for annotations of the latter four.)
From the mundane to the profound, from the body as physical preoccupation to the body as sacred, the poet explores in 21 highly personalized lines the significance and symbolism of the human body. Washing your feet without giving it a thought means you are in good health; struggling to do it because of overweight is a reminder of mortality. This (any) physical act "should be ritual . . . memorial, meditative, immortal." It conjures up an image of the Degas ballet dancers washing their feet, and then, remarkably, that " . . . they also seemed to be washing God’s feet."
But the creative power of Degas is yet another reminder of the author’s limitations. He is vulnerable, mortal and not creative enough to gain immortality by producing a masterpiece: "It is sad to be naked and to lack talent."
In The Mysteries Within, Sherwin Nuland takes the reader on a guided tour of selected organs inside the human body. Beginning with the stomach, he progresses along to visit the liver, spleen, heart, uterus, and ovaries. At each point he addresses various historical and contemporary beliefs, as promised in the book's subtitle, "A Surgeon Reflects on Medical Myths." Nuland brings to this endeavor the patented mixture of personal story, elucidation of medical history, and plain old good writing that characterizes all of his books.
For example, he devotes the first three chapters to the stomach. The first consists mostly of a brilliant clinical tale in which a six-week-old baby is found to have a wax bezoar in his stomach. The second and third provide a cogent survey of beliefs about the stomach's function, beginning with Greek humoral theory, continuing through van Helmont and the iatrochemists, and ending with Ivan Petrovich Pavlov and his seminal monograph, The Work of the Digestive Glands.
Van Helmont and his mentor, Paracelsus, appear again and again in later chapters as the earliest champions of the idea that the body runs by means of chemical processes (iatrochemistry). However, as Nuland points out, Paracelsus has left us two different legacies. One is his devotion to chemistry and experimentation, which eventually led to modern biological science. The other is his devotion to alchemy and mysticism, which makes him as well a forerunner of contemporary irrational systems of healing.
Collegiate Assessor Kovalyov wakes up one morning and discovers that his nose is missing. At the same time in another part of St. Petersburg, Kovalyov's barber finds the nose in his breakfast roll. However, the barber, desiring to disassociate himself from the strange incident, proceeds to toss the nose into the Neva River. A little later, Kovalyov happens to see his nose riding in an elegant carriage and wearing the uniform of a State Councillor (a higher rank than Collegiate Assessor). He demands that the nose give itself up, but is rudely rebuffed.
At first neither the police nor the newspaper offer any help, but later a police officer, who happened to observe the barber throwing an object into the river, returns the lost nose to Kovalyov. However, a new problem arises. How will he re-attach the nose to his face? For this he consults a doctor, who recommends letting nature take its course, "it's best to stay as you are, otherwise you'll only make it worse." Poor nose-less Kovalyov! He becomes the laughing stock of St. Petersburg, until one morning he wakes up and finds his nose re-attached firmly to his face.
Paula Henning (Franka Potente) is a brilliant medical student from Munich, who comes second in the Robert Koch competition winning a place at the prestigious Heidelberg medical school. Medicine is a family tradition, but Paula has little respect for her father's boring suburban practice. Instead, she takes inspiration from her dying grandfather, an academic doctor, who celebrates her decision.
En route to Heidelberg she meets the stunningly beautiful and highly sexed Gretchen (who stood first in the competition) and David, a 22 year-old lad with cardiomyopathy and multiple piercings. Gretchen is interested in partying; Paula is serious, studies all the time, and ignores fellow student Caspar (Sebastian Blumberg) who strives for her attention. When David appears on the dissecting table with no obvious cause of death and "rubbery blood," Paula begins investigating. She determines his death is due to Promidal--a drug developed by The Anti-Hippocratic Society (or "AAA!").
This clandestine group engages in unethical anatomical research on living subjects to "better" the human race. Her classmates scorn her conspiracy theory, but she is drawn deeper into the mystery when Gretchen disappears only to reappear as a perfectly dissected, plasticized cadaver. Paula nearly succumbs to the same fate with her lover, Caspar (who turns out to be an incognito history student writing his thesis on the AAA! ). The ending is happy, although Paula must reckon with the discovery that her venerated grandfather was a member of the "AAA!".