Showing 181 - 190 of 565 annotations tagged with the keyword "Physician Experience"
Maren Grainger-Monsen, a filmmaker and emergency medicine physician, chronicles her personal journey towards understanding death and dying as she explores the stories of those near death. The film uses a metaphor of the thread of life, and the three Greek Fates who control life (spinning, measuring and cutting this thread), to interweave Monsen's journey with the lives--and deaths--she encounters.
The film begins with her recollection of two experiences during her emergency medicine training: the first time she is paged to pronounce someone dead and a "crisis point"--resuscitating a patient, brought to the emergency room, who had specifically requested no resuscitation. The remainder of the film focuses on Jim Brigham, a social worker for a hospice program, whom Monsen joins for his home hospice visits and who relates the touching and memorable story of his wife's life and death.
Some of the patients Jim visits are Tex, a man dying of heart failure who had experienced a difficult, scary night; Sean, who has Lou Gehrig's disease and who needs help with paperwork and family concerns; and Anna Marie, who has lymphoma and is taken via ambulance to the hospital for comfort measures. Monsen notes how comfortable Jim is discussing death issues and how compassionate and caring he is with a recent widow in the midst of her "grief work." By contrast, Monsen admits to feelings of helplessness, vulnerability, even terror. She wishes her medical education had not been so devoid of teaching regarding death and dying.
Monsen comments on the wavering line between life and death, and whether the "medical machine" prolongs life or death. She visits a young boy left with severe brain damage following a near-drowning incident and "successful" resuscitation 5 years previously. The boy requires constant care, but his father notes that his son is "doing pretty good."
By the end of the film, Monsen has learned "how to sit with someone . . . while death walks into the room." Death no longer equates with failure. She concludes with her overvoice, "I wonder what it will be like to be a doctor who doesn't see death as the enemy."
Dr. Pauline Chen is a transplant surgeon and hence highly trained in the surgical care of desperately ill patients. She found, however, that although she had intensive and first rate training, time and again the message she received from her mentors and peers encouraged a distance from frank discussions about dying with patients who were clearly dying. Dr. Chen successfully suppressed her urges to reflect on the meaning of illness and death. Years into her training, she finally witnessed an attending surgeon stay with a patient and the patient's wife until the patient passed away. The widow sent a thank you note to Dr. Chen for allowing a "dignified and peaceful death." (p. 101) Chen notes that observing her attending stand with the patient during death changed her profoundly: "...from that moment on, I would believe that I could do something more than cure. This narrative, then, is my acknowledgment to him." (p. 101)
Final Exam chronicles Chen's journey from medical student to attending surgeon and examines her experiences with death and serious illness - of patients, family members, friends. The memoir contains three parts: Principles, Practice, and Reappraisal - each with three chapters. The book is chronologically arranged, beginning with anatomy dissection at the start of medical school and ending with Chen as an attending arranging for hospice, thus honoring a patient's desire to die at home rather than in hospital. Chen skillfully weaves her stories around commentary on the social, cultural and philosophical issues surrounding death and the medical response to death. An introduction and epilogue bookend the text and 46 pages of extensive notes and bibliography complete the book.
Although Chen claims to have slowly and painfully awakened to the fact that patient needs extend well beyond good technical care, in fact one sees Chen emerge as a caring physician even from her initial patient contacts in medical school. Chen speaks more to her role as an Asian-American than to being a woman in a male-dominated field, but she clearly has what it takes to succeed in this extremely competitive field, including a good dose of compulsiveness and an incredible work ethic.
Summary:The Cuban-American physician-poet Rafael Campo tells a story in this poem. His speaker is both a curandero, or folk healer, and a modern-day American physician. Returning home after a trauma-filled day at the Emergency Ward, the speaker immerses himself in a soothing bath with "Twenty different herbs at first (dill, spices / From the Caribbean, aloe vera)." He weeps and prays to his patron saint and curandero St. Rafael, who has the same name as the poet himself. Rafael announces his arrival: "Rafael, / He says, I am your saint." The speaker tells his healer about two female patients he has seen that day, one, an abused wife, and the second a little girl killed on her tricycle. St. Rafael listens, touches the speaker, and carries him to bed. Sleep "takes the world away."
The authors analyze developments in the scientific article in Europe from the seventeenth century to the present. They devote a chapter to "style and presentation" in each century, and a separate chapter to "argument" more specifically in each century, in French, German, and English examples. They find a remarkable similarity of style already evident in seventeenth-century examples, demonstrating that scientific authors were already addressing an international audience. Seventeenth-century articles show an "impression of objectivity" and "a movement toward a more impersonal style" (47), although the English examples were somewhat more personal, less quantitative, and less interested in explanation than were the French examples, and the prose overall is hardly what we would currently expect from a scientific article.
Although the eighteenth-century examples should, perhaps, be considered part of a larger period that included the seventeenth century, Gross et al do track a movement from impersonal to personal style, nominal to verbal style, and minimal presentation to more elaborate presentation during this period. Also, the French examples continue to approximate more closely to twentieth-century norms of scientific style, reflecting their more professionalized community. Overall, the authors characterize much of the eighteenth century as a period of "consolidation and altered emphasis," with "relative stability" of style (116), although the last quarter of the eighteenth century showed a sharp rise in standardization and standards for accuracy and precision.
Gross et al note that nineteenth-century prose still addresses amateurs as well as professionals, and they comment on its persistent difference from "the highly compressed, neutral, monotonal prose" of late-twentieth-century science(137). However, the English and German examples do become more professional in their use of impersonal style, and examples demonstrate a consolidation toward a more "homogeneous communicative style" (138). They also note that the nineteenth century exhibits a "master presentation system approaching maturity," with "title and author credits, headings, equations segregated from text, visuals provided with legends, and citations standardized as to format and position," as well as standardized introductions and conclusions (138).
They find that the combination of an increasing "passion for factual precision" and systematization produces more careful theorizing generally in science during this period, even as individual sciences specialize and diverge (158). Increased attention is given to the process by which facts are linked to theory, and to the role of evidence, governed by an "overriding need for explicitness" (160).
Twentieth-century examples include shorter sentences with more information packed into each by way of "complex noun phrases with multiple modifications in the subject position, noun strings, abbreviations, mathematical expressions, and citations" (186). The scientific article is now generally marked by high incidence of passive voice and low incidence of personal reference, along with a "master finding system" made up of "headings, graphic legends, numbered citations, numbered equations, and so on" (186). They argue that the current state of the scientific article reflects an evolutionary process whereby "current practices are a consequence of the selective survival of practices that were, persistently, better adapted to the changing environments of the various scientific disciplines over time" (212).
In 1921, the twenty-four year-old Scottish medical graduate, Andrew Manson, takes up an assistant’s position in a small Welsh mining town. He is idealistic, but he quickly learns that his training is inadequate and that his hemiplegic employer will never return to practice. Manson must do all the work for a pittance and bad food. He befriends another assistant, the surgeon Phillip Denny, whose fatal flaw is devotion to drink. Together they solve the town’s problem with typhoid by blowing up the sewer.
Manson’s escape comes in a new job in a larger town and marriage to the equally idealistic Christine. She encourages him to continue his studies and to conduct research on the relationship between dust inhalation and tuberculosis. The results include higher degrees and international recognition, but they also bring about the wrath of the town’s antivivisectionists. To add to the gloom, Christine looses a much wanted pregnancy and the ability to have children.
The Mansons leave Wales for London, where Manson hopes to extend his research within a government agency. Quickly disillusioned by bureaucracy, he is lured into society practice and slowly abandons his ideals in exchange for prestige and wealth. Christine is increasingly unhappy, but his response is annoyance with her and an affair with a married woman. When one of his new associates botches an elective operation on a trusting patient, he realizes the colleague is nothing more than a society abortionist and that he and his new friends are little better.
He decides to sell his practice and renews contact with Denny to establish a group consulting practice "on scientific principles" in a carefully chosen Midland town. He also helps the tubercular daughter of an old friend to an unorthodox (but effective) pneumothorax in a clinic run by Stillman, an American who does not have an MD. Just as he and Christine have rediscovered joy in each other and their future together, she is killed in a freak accident. Only days later in the depths of grief, he is brought before the General Medical Council on charges of unprofessional conduct laid by his former associates. He acquits himself brilliantly and leaves with his old friend Denny for work in the Midlands.
Sultana, a doctor who escaped her illiterate nomadic background to study and work in France, returns to her native Algeria when she hears of the death of her former lover and fellow physician, Yacine. She is treated with hostility, but defiantly stays in Yacine’s place at the clinic. Vincent, a Frenchman who is the baffled recipient of a perfectly matched kidney from a young Algerian woman, travels to the desert to explore the culture of this unknown person whose death has brought him back to life.
Sultana and Vincent meet through their common friendship with the furtive, questioning children, Dalila and Alilou. Vincent and Salah, Yasmine’s best friend, both fall in love with Sultana, but she seems indifferent to them. The violence and suspicion of the town leaders causes her to regress into anorexia and mutism, during which she is tormented by the horrible memory of the loss of her parents. Her three male friends and the village women help her to recover a sense of self worth, but she must flee when the leaders set fire to their dwellings. A glimmer of optimism can be found in the aspirations of the children and the solidarity of the women.
Summary:A collection of short stories loosely connected to each other by centering on the experiences of four people from their first encounters during medical school and continuing into young middle age.
A saxophone-playing, divorced psychiatrist, Dr. Denis, is baffled by the unexplained arrival of a new patient in his mental hospital. The highly intelligent newcomer, called Rantes, has extraordinary gifts and spends long hours in the yard facing southeast, where he claims to receive communications from his home planet. He is visited by the saintly Beatriz, who works in a church, and Denis asks her questions about Rantes.
The bond between the three people begins to transgress the ordinary boundaries between doctor and patient, and culminates in an excursion to a concert in the park. Charmed by Beethoven's "Song of Joy," Rantes instigates generalized waltzing and takes over from an inexplicably obliging conductor. Back in the asylum, the other patients feel the vibrations emanating from Rantes' concert and engage in a good-humored romp. The doctor is reprimanded for the embarrassing situation, and begins to doubt the integrity of the psychiatric enterprise. A weakened Rantes dies after electroshock therapy and the film ends in ambiguity.
The first seven episodes in the made-for-TV series tracing the remarkably credible story of a woman physician in 1890s London. Newly graduated in medicine, Eleanor Bramwell (Jemma Redgrave) is the daughter of Robert (David Calder), a distinguished physician. He would like her to join him in his private practice, but she has other plans. Bright and ambitious, she is well qualified to pursue her goal of surgery; however, these qualities do not protect her from the chauvinism of her male superiors, including the influential and basically well-meaning Sir Herbert Hamilton (Robert Hardy). In anger and frustration, she leaves the academic hospital, garners philanthropic support from Lady Cora Peters (Michele Dotrice Dotrice) and opens the charitable "Thrift Infirmary,"
In a poverty stricken district. There she is joined by the quiet Scots surgeon Dr. Joe Marsham (Kevin McMonagle) and competent Nurse Carr (Ruth Sheen) of crusty exterior and soft core. Together they encounter a series of clinical problems that clearly document not only the medicine and social values of the late Victorian era, but the troubles of those who live and work in poverty.
Idealistic, nervous, and rigid, Andrew Manson (Robert Donat) takes his first medical job as an assistant to a doctor in a Welsh mining community. The greedy wife of his invalid employer obliges Manson to hand over most of his earnings. But he finds a local kindred spirit in the outspoken Dr. Denny (Ralph Richardson). In a drunken prank, they blow up the town sewer forcing the unwilling government to repair a notorious source of typhoid.
Manson marries a beautiful school teacher (Rosalind Russell) who leaves her beloved classroom to follow him to an even larger mining town. There he is employed by a group practice run on a capitation basis by the miners. In their evenings, the Mansons investigate the problem of chronic cough in miners, linking it to tuberculosis and coal dust--a discovery that they publish. But suspicious miners destroy their laboratory and force them to London and poverty.
A chance encounter with a wealthy hysteric and an old mate (Rex Harrison) raises Manson’s social standing. He opens a Harley Street practice and makes a fortune. His wife regrets the loss of his ideals and the death of his research. She begs him to remember how happy they were in poverty when each day was a noble challenge to take "the citadel" of life. Denny returns to entice Manson into a new group practice funded by community insurance, but Manson flatly refuses. Denny’s accidental death and a blunder by an elite, unethical Harley Street surgeon bring Andrew back to his idealistic senses.
The film closes with his eloquent self defense against charges of irregular practice for having intervened (successfully) in the case of a little girl with tuberculosis. Manson assists as the child is treated gratis with the controversial new pneumothorax operation administered by an American who does not hold a medical degree. Whether or not Manson keeps his license, the audience is confident that his sense of purpose has been restored and that his wife loves him more than ever. He will return both to the comfortably compatible pursuits of research and serving the sick poor.