Showing 181 - 190 of 240 annotations tagged with the keyword "Medical Advances"

Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

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.

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Progressive Health

Dennis, Carl

Last Updated: Jan-22-2003
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Poem

Summary:

A corporate narrator ("We here at Progressive Health") thanks the poem's addressee (presumably the poet) for "being one of the generous few who've promised / To bequeath your vital organs to whoever needs them." However, the narrator goes on to point out that there is another, even more generous, step he could take, by "acting a little sooner than you expected." In fact, why not turn tomorrow morning's routine physical examination, which wouldn't ordinarily benefit anyone except the poet himself, into a splendid opportunity to save six lives?

Yes, indeed, at this very moment there are six persons whose lives are hanging by a thread in the ICU, and the poet is a good tissue match for every one of them. If he would agree to have his liver, spleen, lungs and kidneys removed, and transplanted into these patients, he would save six lives.

Of course, the poet would die, but look at the situation from a cost-benefit analysis: The poet, who is "an aging bachelor," has perhaps 20 more years of life left in him and the poems he might yet write--even assuming they are better than those he has thus far written--are not going to "raise one Lazarus from a grave / Metaphoric or literal." On the other hand, the six potential beneficiaries have a multiplier effect because of their husbands and wives, parents and children.

The great gratitude of so many people will mean that the poet will be remembered after death--"Summer and winter they'll visit your grave, in shifts, / For as long as they live, and stoop to tend it, / And leave it adorned with flowers . . ."

Alternatively, if he chooses selfishly to refuse, and to grow old and die, his friends will likely forget him after death; and, moreover, his conscience will probably be stricken by having failed to respond to these patients' needs. The poem concludes, "You could be a god, one of the few gods / Who, when called on, really listens?" [48 lines]

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Cut to the Word

Metcalf, Tim

Last Updated: Nov-12-2002
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

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)

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Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

Lance Armstrong, (currently) four time Tour de France cycling champion, is a survivor of metastatic testicular cancer. This book is largely the story of how his life changed from the moment of his diagnosis (October 2, 1996) onwards. He had been a world class cyclist prior to cancer, but his experience with cancer gave him profound insight not only into his life as a cyclist and competitor, but into life itself.

It is this latter insight which he recognizes as ultimately the most important aspect of his cancer experience. Armstrong notes: "Odd as it sounds, I would rather have the title of cancer survivor than winner of the Tour, because of what it has done for me as a human being, a man, a husband, a son, and a father." (p. 259)

Written in a conversational, straightforward tone, the book chronicles Armstrong's childhood in Texas as the son of a strong, loving, supportive, financially struggling, young mother; his beatings at the hands of a step-father; and his early excellence at endurance athletics. Armstrong became a brash powerhouse cyclist and began to enjoy the material rewards of winning while ignoring the onset of symptoms. At the time of diagnosis, the cancer had spread to his abdomen, lungs and brain.

He documents his search for optimal care, sperm banking, lack of health insurance, surgeries, chemotherapy, self-education and interactions with doctors and nurses. Through it all he acknowledges the tremendous support of his mother and friends, as well as sponsors who stuck with him with no assurance that he would survive, let alone race.

Before he was even through the first year, he decided to start a charitable organization, The Lance Armstrong Foundation, dedicated to cancer research and support of cancer survivors. Through this effort he met his future wife, Kristin Richard (Kik), and her love and support helped him through the dark days of emotional soul-searching post-treatment. The book also details her struggles with successful in vitro fertilization (They currently have a son and twin daughters).

Chapter Nine, The Tour, is an in depth look at the 1999 Tour de France which Armstrong won with the help of his US Postal Service teammates, expert coaching, and his will. This race is brutal, dangerous, and as Armstrong notes, both "a contest of purposeless suffering" and "the most gallant athletic endeavor in the world." (p. 215) He details the maneuvering in the peloton, the strategies, the stages and personalities.

The book concludes with reflections on the birth of his son, the anniversary of his cancer diagnosis, the love of his wife, and his need to ride.

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The Breast Cancer Wars

Lerner, Barron

Last Updated: Aug-28-2002
Annotated by:
Holmes, Martha Stoddard

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Written by a medical historian who is also a physician, The Breast Cancer Wars narrates how breast cancer diagnostic methods and treatments have developed from the early twentieth century. More significantly, the book describes the debates and controversies that permeated this evolution and the ways in which not only clinicians and researchers, but, increasingly, women patients/activists shaped how we view, diagnose, and treat breast cancer today.

Individual chapters explore the influential (and ultimately contested) radical mastectomy procedure of William Halsted, the development of the "war" against breast cancer as a full-blown campaign developed and conducted within the public media and consciousness of the United States as well as within medical practice and research, the intertwined development of feminism and breast cancer activism, the "fall" of the radical mastectomy, and the continuing controversies surrounding mammography and genetic testing as modes of early detection and risk assessment. Lerner draws on a range of primary sources including texts from the archives of the American Cancer Society, the papers of doctors and patients, and advertisements from popular and professional magazines throughout the century.

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Annotated by:
Sirridge, Marjorie

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

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.

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Annotated by:
Holmes, Martha Stoddard

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Born breech and deprived of oxygen for two hours, Irish poet and writer Christopher Nolan was diagnosed with cerebral palsy and is unable to speak and virtually unable to move voluntarily. His book, subtitled "The Life Story of Christopher Nolan," is narrated as a third person account of the life of "Joseph Meehan." The memoir opens with Meehan's winning the British Spastics' Society Literary Award for his first book of poetry, Dam-Burst of Dreams (1988) and ends with his last day at Trinity College, having turned down the invitation to continue his studies there towards a degree.

In the mixture of linear, traditional life narrative and lyrical, neologistic description that falls in between, the memoir addresses Meehan's birth, early life, education, and growing acclaim as a poet and writer. It recounts how his family and teachers helped develop a combination of medication, tools (a "unicorn-stick" attached to his forehead), and assistance that allowed him to type.

It details, above all, how various family, friends, and health and education professionals advocated Meehan's special-school and mainstream education and made available to him such normative life experiences as riding a pony, boating, fishing, skipping school with his mates, and going on school trips without his parents--and such unusual life experiences as becoming an award-winning writer.

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The Immortals

Borges, Jorge Luis

Last Updated: Mar-05-2002
Annotated by:
Chen, Irene

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

This short story begins with a summary of the tale of Guillermo Blake, who believed that "the five senses obstruct or deform the apprehension of reality." The narrator then relates the tale to his own experience: upon visiting his gerontologist for a check-up, he is informed of a procedure that confers immortality. The "immortals" are reduced to living brains within wooden cubes, their bodies having been replaced by "formica, steel, plastics." The narrator tries not to show his horror, but moves immediately to a different part of the country under an alias.

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Fortitude

Vonnegut, Jr., Kurt

Last Updated: Mar-05-2002
Annotated by:
Coulehan, Jack

Primary Category: Literature / Plays

Genre: Play

Summary:

In "Fortitude" Dr. Elbert Little, a Vermont family physician, visits the laboratory of Dr. Frankenstein and his trusty assistant, Dr. Tom Swift. Frankenstein has only one patient, Sylvia Lovejoy. His life work has been to keep Lovejoy alive. In 78 operations over the last 36 years, Frankenstein has replaced every one of her organs with prosthetic devices, so that now she consists of a head on a tripod, attached by tubes to various machines.

Frankenstein controls her mood, as he controls all her functions, from a "fantastically complicated" master console. Usually he makes sure that she feels joyful and loving, but last month a transistor went bad in one of the machines and she felt depressed for a while; so depressed, in fact, that she wrote to Dr. Little and asked him to bring her some cyanide.

Lovejoy's only friend is Gloria, the beautician who comes every day to care for her hair. Gloria is horrified over what Sylvia Lovejoy has become; she sees only a "spark" of the real person remaining, but she knows that the "spark" wants to die. After Frankenstein fires Gloria for speaking about death in Sylvia's presence, she sneaks back into the room when Sylvia is sleeping and puts a loaded revolver in her knitting bag.

Later, Sylvia finds the gun and tries to kill herself, but her prosthetic arms have been designed not to allow her to do that. Instead, she shoots Frankenstein, who promptly becomes the second head attached to the machines. (It seems he has designed all the prosthetic organs to be able to serve two "persons," so that he and Sylvia will be able to "live in such perfect harmony . . . that the gods themselves will tear out their hair in envy!")

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Imelda

Selzer, Richard

Last Updated: Mar-05-2002
Annotated by:
Squier, Harriet

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

A physician recounts an experience he had assisting an American plastic surgeon as he performed charity surgery in Honduras. One young woman, Imelda, dies of malignant hyperthermia prior to surgical repair of her cleft lip. After her death, the surgeon returns to the patient to finish the surgery. The narrator tries to imagine the surgeon's motivation for this act, as well as the family's reaction to it.

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