Showing 181 - 190 of 825 annotations tagged with the keyword "Doctor-Patient Relationship"

Summary:

This is a collection of stories from Dr. Remen’s own life and from her practice as a pediatrician and psychiatrist. She works with many cancer patients and others who are terminally ill as well as with the chronically ill. Her stories record patients and their families finding what is authentic and meaningful in their lives when they have been forced deeply into their own vulnerability. She also speaks from her lifelong struggle with Crohn’s disease.

View full annotation

Annotated by:
Aull, Felice

Primary Category: Literature / Literature

Genre: Anthology (Mixed Genres)

Summary:

Editor Helman is a physician and anthropologist as well as a published author of short stories, essays, and a medical anthropology textbook. For this anthology he has selected short stories, case studies, memoir and novel excerpts whose purpose is "to illustrate different aspects of [the] singular but universal relationship" between doctors and patients (1). In the introduction he discusses how these selections illustrate storytelling in medicine; the unique experience of individual illness; differences between fast-paced contemporary technological specialized medicine, and an older more leisurely medicine where the physician employed all his/her senses to diagnose illness, doctors made house calls, and patients recovered over time, or died.

The anthology is subdivided into three parts: "Doctors," represented by the work of Mikhail Bulgakov, Franz Kafka, Sir Arthur Conan Doyle, and Rachel Naomi Remen; "Patients," represented by authors Renate Rubenstein, Ruth Picardie, Rachel Clark, Clive Sinclair, W. (William) Somerset Maugham, and O. Henry; and "Clinical Encounters," with work by Oliver Sacks, Cecil Helman, William Carlos Williams, A. J. (Archibald Joseph) Cronin, Anton P.Chekhov, and Moacyr Scliar. (In total there are 16 selections.) Each piece is preceded by a paragraph of biographical information about its author and an introduction to the text.

View full annotation

Angels in America

Kushner, Tony

Last Updated: Jan-12-2010
Annotated by:
Donley, Carol

Primary Category: Literature / Plays

Genre: Play

Summary:

Angels in America is really two full-length plays. Part I: Millennium Approaches won the 1993 Pulitzer Prize for Drama. This play explores "the state of the nation"--the sexual, racial, religious, political and social issues confronting the country during the Reagan years, as the AIDS epidemic spreads.

Two of the main characters have AIDS. One, Prior, is a sane, likeable man who wonders if he is crazy as he is visited by ghosts of his ancestors, and selected by angels to be a prophet (but the audience sees the ghosts and angels too). The other main character, Roy Cohn, based on the real political figure, is a hateful powerbroker who refuses the diagnosis of AIDS because only powerless people get that sickness.

A rabbi opens the play, saying that in the American "melting pot" nothing melts; three Mormons try to reconcile their faith with the facts of their lives. Belize, an African-American gay nurse, is the most compassionate and decent person in the play, along with Hannah, the Mormon mother who comes to New York to try to untangle the mess of her son and daughter-in-law’s marriage. In contrast to their commitment, Prior’s lover, Louis, abandons him in cowardly fear of illness. The play portrays a wide range of reactions to illness, both by the patients and by those around them. Included is the realization that much of the nation’s reaction is political and prejudiced.

The second play, Part II: Perestroika (winner of a Tony Award), continues the story, with the angel explaining to Prior that God has abandoned his creation, and that Prior has been chosen to somehow stop progress and return the world to the "good old days." Prior tells the angel he is not a prophet; he’s a lonely, sick man. "I’m tired to death of being tortured by some mixed-up, irresponsible angel. . . Leave me alone."

Ironically, Belize is Roy Cohn’s nurse, as Cohn--even as he is dying in his hospital bed--tries to manipulate the system to get medication and special treatment, and to trick the ghost of Ethel Rosenberg into singing him a lullaby. Meanwhile, the Mormon mother, Hannah, manages to help save the sanity and integrity of her daughter-in-law, Harper; and she also is a good caregiver for Prior.

At the end of the play, we see Prior, Louis, Belize, and Hannah sitting on the rim of the fountain in Central Park with the statue of the Bethesda angel. They say that when the Millennium came, everyone who was "suffering, in the body or the spirit, [and] walked through the waters of the fountain of Bethesda, would be healed, washed clean of pain."

These four characters represent Jews and Christians and agnostics; homosexuals and heterosexuals; blacks and whites; men and women; caregivers and patients; two generations--the American mix, in this case, caring about each other. Somehow, although the real angels in this play seem inept and reactionary, these folks together at the Bethesda angel fountain seem competent contributors to the future.

View full annotation

Summary:

This story follows John and Aileen Crowley and their three children, the two youngest of whom have a rare "untreatable" genetic disease. Pompe disease gradually degenerates muscle until patients cannot breathe or sit up; it also dangerously enlarges the heart. Determined to try to save his children, John Crowley started up a biotech company to develop an enzyme that would replace the non-functioninging one in his children. Others researchers in other companies were trying different approaches. Everyone made mistakes and created problems along the way.

Finally, in "the mother of all experiments," the four promising drug developments were tested against each other in a double-blind trial. After five years of development, the "special medicine" was finally given to the Crowley children. Daughter Megan, a real fighter and outgoing personality, won over the hearts of the researchers. Interesting conflict of interest issues increase the tension in this race for a cure.

View full annotation

Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Criticism

Summary:

The author, a scholar of autobiography and other forms of life writing, has expanded his scholarship to include what he calls "autopathography"--autobiographical narratives of illness and disability. This book is the result of an extensive study of such narratives. The works discussed are full-length and recently published--most were published in the 1980s and 1990s. Couser is particularly interested in issues of narrative authority, in how autopathography can be counterdiscursive to the prevailing biomedical narrative, and, especially, in how autopathography is counterdiscursive to the cultural stigmatization and marginalization that often accompany illness or disability ["insofar as autobiography is the literary expression of the self-determined life" (182)].

Since social/cultural counterdiscourse is of particular importance to Couser, he has focused on four specific illnesses/disabilities that have been associated with stigma: breast cancer, AIDS, paralysis, and deafness (182). His analysis of each condition is diachronic because he is searching for "the enrichment of the genre by successive writers who defy, complicate, or refine its conventions" (44). In addition, Couser asks, to what extent do authors "integrate illness narrative into a larger life narrative?" (14). He considers who narrates illness stories (biographer or autobiographer), how the stories are constructed, whether and how they achieve a "comic plot" and narrative closure.

The book's introduction (chapter 1, "Human Conditions--Illness, Disability, and Life Writing") provides a framework, relating what will follow to current issues in life writing, "identity politics," the culture of medicine, and illness experience, as well as to other work on illness narratives such as Anne Hunsaker Hawkins's Reconstructing Illness: Studies in Pathography and Arthur Frank's The Wounded Storyteller (annotated in this database).

Chapter 2, "Medical Discourse and Subjectivity," develops further the questions of narrative authority, representation, and resistance to a dominant medical or cultural narrative. Each subsequent section--breast cancer, AIDS, paralysis, deafness--is prefaced by an informative discussion of the cultural and narrative issues that are relevant to the particular condition; the subsequent analyses of individual texts further elaborate these themes.

View full annotation

Illness as Experience

Volandes, Angelo

Last Updated: Jan-09-2010
Annotated by:
Aull, Felice

Primary Category: Performing Arts / Film, TV, Video

Genre: Video

Summary:

This short documentary film was made by Angelo Volandes while he was a fourth year medical student at Yale, as part of his senior thesis. It describes the life of Ray, a 70 year old dermatology patient who has suffered from neurofibromatosis since he was a teenager. Severely disfigured by this condition, Ray has led a life of social ostracism, loneliness, physical discomfort, and stoic depression.

Angelo introduces the film, frankly describing his own "visceral reaction" when he first encountered Ray in clinic. Ray and his long-time physician, Dr. Braverman, alternately discuss how Ray’s condition has affected every aspect of his life. Although Ray has endured more than 30 operations to remove the tumors that become infected, itch, and plague him, it is social ostracism that has most powerfully altered his life.

The camera follows Ray as he shops in the supermarket while doctor and patient describe what an ordeal this can be. Worse than suffering the stares of fellow shoppers is being treated like a contagious carrier of the plague by the checkout clerk, who refused to handle Ray’s money. Ray tells how incidents like these have landed him in the Emergency Room numerous times, out of sheer emotional upset.

View full annotation

Codeine Diary: A Memoir

Andrews, Tom

Last Updated: Jan-09-2010
Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Contrary to what the title might suggest, this is not a memoir of drug addiction. Writer and poet Tom Andrews has hemophilia, and codeine is the analgesic he requires during excruciatingly painful internal bleeding episodes. In this diary, begun while recovering from a leg injury, Andrews reflects on his particular experience of life and hemophilia. He makes clear that " . . . hemophilia is only one of the stories my life tells me . . . " (p. 29)

The memoir interweaves the author's physical, emotional, and existential journey through the convalescent period with flashbacks of childhood and his relationship with his ailing brother, now dead, to whose memory the book is dedicated. Brother John's fatal illness with kidney disease shaped--and continues to shape--Tom's life as much as did the hemophilia.

On the one hand their parents' concern for John took Tom out of the spotlight and allowed him to pursue his own interests. These extended to motorcycle racing, playing in a punk band, and setting a record for continuous hand clapping--at age 11--that was recorded in the Guinness Book of World Records. On the other hand, Tom's guilt over surviving John's early death may account for an almost reckless disregard of his own precarious physical condition. A constant subtext is the deep grief and abiding love of the living brother for the dead one.

But this is not a mournful book. It is an engaging memoir that provides unusual access and insight into the world of hemophilia, especially with regard to the painful "bleeds." It is the sense of exile and separation from others that is most disturbing for Andrews when in the throes of unrelieved pain. He takes us through the mental concentration required to endure this pain and the liberating relief to mind and spirit provided by codeine. Memory, perception, and writing provide the additional resources he needs to re-connect with the world.

View full annotation

Annotated by:
Miksanek, Tony

Primary Category: Literature / Literature

Genre: Anthology (Mixed Genres)

Summary:

This anthology culls 1,500 excerpts from approximately 600 works of literature primarily written in the past two centuries and representing all major genres--the novel, drama, poetry, and essay. These brief selections highlight how literature portrays the medical profession and also provide ample evidence of many recurrent themes about the doctor-patient relationship and the personal lives of physicians present in the pages of fiction.

The book is organized into eleven chapters devoted to the following subjects: the doctor's fee, time, bedside manner, the medical history and physical examination, communication and truth, treatment, detachment, resentment of the medical profession, hospital rounds, social status, and the doctor in court. Many well-known authors including Anton P. Chekhov, Sir Arthur Conan Doyle, Ernest Hemingway, Thomas Mann, W. (William) Somerset Maugham, Leo Tolstoy, Tennessee Williams, and William Carlos Williams are featured in this anthology but less notable writers are also introduced. A twenty-three-page bibliography of primary and secondary sources is a useful element of the book.

View full annotation

This Lovely Life

Forman, Vicki

Last Updated: Jan-03-2010
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Vicki Forman's twins, Evan and Ellie, were born in 2000 at twenty-three weeks' gestation.  Fetuses could legally be aborted up to twenty-four weeks, but rules regulating treatment of extremely premature babies differed from one hospital to another.  Daughter of a doctor, Forman knew how slim were the chances of survival and how great the chances of serious disability if either of the twins did survive.  Grieving, but realistic, she and her husband asked for a DNR order, but learned that such orders did not strictly apply to the situation of children like their twins.  Instead, the line between  the parents' authority and the doctors' remained blurry and decision-making vexed not only by technical and emotional complications, but by conflicting legal guidelines as they made their way through many months of hospitalization and home treatment of their surviving son.

Ellie, the daughter, died at four days.  Evan lived for eight years with disabilities that completely reorganized family life, and required constant monitoring, management of equipment, and careful orchestration of parental relationship to their older child, Josie, and their special-needs child.  Much of the narrative covers the period of hospitalization during Evan's early months and the negotiations between parents, physicians, and other caregivers.  It also touches on Forman's own emotional responses to the strenuous learning curve required of a parent who suddenly finds herself with a special-needs child.

View full annotation

The Country Doctor

Balzac, Honore de

Last Updated: Dec-29-2009
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The country doctor, Monsieur Benassis, practices in a village called Voreppe at the base of the Grande Chartreuse Mountains. He is a seedy and unkempt, but very kind-hearted, bachelor of 50 who lives with his authoritarian housekeeper. Benassis was brought up in the country, but had lived for many years in Paris where he enjoyed a dissipated life and loved two women. He left the first, only to learn later that she bore him a son and died of heart disease. Later his illegitimate son died.

His second love, Evelina, broke off their engagement when her parents objected to the suitor’s sordid past. Benassis became very depressed and considered suicide. After visiting a monastery in the Grand Chartreuse region, he decided to move to Voreppe and devote his life to serving the poor rural people. He not only practices medicine, but over the years has also initiated a number of economic and community development projects in the area.

Above the village is a hamlet that contains a dozen cretins among the thirty families who live there. Cretinism is common in the region. Dr. Benassis decides that it would be good for the public health to have all the cretins sent to an asylum in Aiguebelle, some distance away. When Benassis becomes mayor, he arranges to have the cretins transported to Aiguebelle, despite opposition from the local people. One cretin remains "to be fed and cared for as the adopted child of the commune."

Benassis later moves the other inhabitants of the hamlet to a new, more fertile, site in the valley and installs an irrigation system for them. At the end of the novel, Benassis has a stroke and dies. He is the first to be buried in the new cemetery.

View full annotation