Showing 191 - 200 of 232 annotations tagged with the keyword "Public Health"
This memoir begins in Africa, where Dr. Grim is with Médecins sans Frontières managing a meningitis outbreak in Nigeria. Conditions are appalling, but she has come here because of burnout: "so I won't be back home and in the ER" (11). Later in the book, she describes her other "escapes" from the Emergency Room, caring for war refugees in the Balkans.
The book centers, however, on life in an American emergency department, as Grim remembers it from the vantage point of Africa (where she does eventually become nostalgic for well-stocked supply cupboards and a more comprehensible chaos). She organizes her stories into a series of "Lessons in Emergency Medicine," in which she addresses the reader directly. After going through a step-by-step account of death in the ER, illustrated with several moving and alarming cases, she concludes: "Congratulations: you have successfully declared someone dead. Now, as an encore . . . you'll get to do it all over again" (28).
The ironic, even bitter, tone warns us of the difficulty of working in such perpetually crisis-ridden circumstances, but it does not conceal a vulnerability that seems necessary to doing the job well, such as when Grim has to tell a family that the father has died of the heart attack he had at his daughter's wedding: "you just stood there," she says, "looking at the corsage, the tuxedo and the pearls . . . You had no idea what to say and you don't really remember what you finally came out with" (26).
The stories are organized around several lessons: "How to deliver a baby," "How to crack a chest," "How to write a prescription" (which includes a discussion of addiction to prescription medication and a withering account of the doctor who overprescribes), and, as if it's as inevitable as the rest, "How to burn out."
By the book's final chapter, emergency medicine has merged, along with the vaccination of refugee children and the impossibility of treating tetanus in Nigeria, into the story of almost unreasonable determination in the face of endless frustration--but this, Grim shows in her final chapter, "Why I do what I do," is the point. Against this backdrop her final story, about the rescue of a child, makes its point: the feeling of saving a life explains all the rest.
Warren here supposedly presents the papers of a late friend, detailing the interesting cases he had encountered as a physician. In fact, the "cases" are sensational short stories, presented as a novel due to the framing chapter introducing the narrator's "Early Struggles" to make a living as a physician. Other stories investigate typically Gothic themes like ghosts, duels, graverobbing, elopements, and broken hearts, with other scandalous problems like gambling, dissipation, murder, domestic abuse, and suicide. Medical topics include mental illness, epilepsy, hysterical paralysis ("catalepsy"), cancer, toothache, consumption, syphilis, heart disease, alcoholism, disease of the spine, gout, amaurosis (blindness), puerperal hemorrhage, measles, and stroke ("apoplexy").
It is 1832. Europe is in turmoil of revolution and soon to be ravaged by cholera. Italians who resist the Austrian occupation of their country have fled to southern France where they are ruthlessly pursued and killed by special agents. Handsome, young, Angelo Pardi (Olivier Martinez), is an Italian fugitive whose wealthy but revolutionary-minded mother has purchased his rank of colonel. Upon learning that a friend has betrayed his cell of resistors, he determines to return to Italy carrying the funds raised for a defense.
But cholera has struck southern France. Roads and rivers are barricaded, quarantine is enforced, and he encounters death, decay, fear, and angry crowds who accuse every stranger of having caused the epidemic. Pardi meets an anxious doctor who teaches him a treatment for cholera, but moments later the doctor defies his own treatment to die of the illness caught from his patients.
As Pardi runs from both Austrian and French pursuers, he falls through a tiled roof into the life of the abandoned Pauline de Théus (Juliette Binoche). With almost comic formality, he becomes her chivalrous guide--her "angel(o)"--and leads her safely to her elderly husband through an improbable series of narrow escapes, including cholera itself. The doctor's dubious treatment comes in handy not only for saving her life but also as a pretext for nudity in their chaste relationship. A few years later, peace and health returned, Madame de Théus receives a letter from Italy. Her husband knows that he ought to let her go, but the credits roll as she gazes at the Alps and contemplates her decision.
Frank is an emergency medic and ambulance driver working night shifts for Our Lady of Mercy hospital in Hell's Kitchen, New York City. The novel begins with Frank's resuscitation of an elderly man called Mr. Burke, who has had a heart attack, and ends a couple of days later with Mr. Burke's death in the hospital. Frank is haunted by the patients he has failed to save, some of whom inhabit his experience like kinds of ghosts.
Most insistent is a teenage girl called Rose who died during an asthma attack, in part because Frank was unable to intubate her in time. He is also unable to forget his marriage, which ended because of the deadening effects of his work. And now Frank is also haunted by doubts about the value of restoring life.
He has successfully started Mr. Burke's heart, but the man is brain dead. Frank thus watches as Mr. Burke's family is first given hope and then must learn that there is none. Frank almost falls in love with Mr. Burke's drug-addicted and disillusioned daughter, Mary, perhaps seeing in her an opportunity for a mutual restoration to health.
But when her father finally dies--when the attending realizes that the patient's struggle hasn't been the "survival instinct" but rather a "fight to die"--she blames Frank, who recognizes that his purpose is not simply to keep people alive (or to bring them back from the dead), but rather that "saving lives" means preserving their value, somehow, in his memory. He walks away from the hospital, and when he gets home, Rose--her ghost, and Frank's own symbol for all the patients he hasn't resurrected--is waiting there, to forgive him.
The film covers two days in the life of Frank Pierce (Nicolas Cage), a burned-out EMT (emergency medical technician) working the socio-economic underside of Manhattan. From the beginning, Frank is upset because recently all his patients have been dying on him, and he is haunted throughout by the hallucinated ghost of Rose, a young woman who collapsed on the street and died, apparently because he could not intubate her correctly.
Frank is highly stressed, he has no life outside his work, and he is self-medicating with alcohol. He tries to quit, but his boss keeps him on by promising time off in the future. In the film's first action, Frank does manage to miraculously resuscitate Mr. Burke, a heart-attack victim, but the patient winds up in the hospital with a very bad prognosis, so even that "saving" works against Frank.
Frank has encounters with numerous patients, many of them street people whose lives are out of control, some of whom are ER (Emergency Room) regulars, such as the demented young Noel (Marc Anthony). He also deals with (and is dealt with by) several highly idiosyncratic EMT partners in his ambulance rounds (John Goodman and others). Frank gets to know Mary Burke (Patricia Arquette), the daughter of the heart-attack victim, and they tentatively move toward being a couple who might help each other survive their lives.
Near the end, Frank, who knows Mr. Burke had tried to tear out his tubes during a brief moment of consciousness, and who feels he has been getting pleading messages from him to end his agonies, surreptitiously takes him off life support long enough for him to die. The physician who responds to the code decides not to attempt resuscitation of this patient who had already been resuscitated 14 times that day. Frank goes to tell Mary that her father has died (but not how), and exhaustedly falls asleep on her breast, apparently having forgiven himself because he has in some sense finally "saved" Mr. Burke.
In this book Robert Coles elucidates the nature of moral leadership by presenting a series of narratives about moral leaders. These are individuals who have made significant contributions to the author's moral development, mostly through personal interaction, but in some cases through their writings or their influence on other people.
The subjects include public personages like Robert Kennedy, Dorothy Day (of the Catholic Worker), Danilo Dolci (a Sicilian community organizer), Dietrich Bonhoeffer, and Erik Erikson; writers who have influenced Coles, such as Joseph Conrad and Ralph Waldo Emerson; and "ordinary" persons whom he encountered over the years in his studies of the moral lives of children.
The "ordinary" person category is most extraordinary. Coles draws heavily on personal interviews that reconstruct the courageous narratives of people like Andrew Thomas, a young Mississippian who worked on the voter registration project during the summer of 1964; Donita Gaines, one of the first black teenagers to "integrate" an all-white high school in Atlanta in 1961; and Albert Jones, a parent who volunteered to drive the school bus that carried black children in 1967 from Roxbury to a previously all-white school in South Boston.
However, the clearest and most powerful narrative that emerges from this book is that of the author himself, as he develops from young, socially conscious child psychiatrist to a middle-aged man seeking to understand what it means to be a moral leader in today's world.
Sam Daniels (Dustin Hoffman) and his wife (Rene Russo) are both working for a federal infectious disease laboratory, but their marriage is on the rocks. A mysterious lethal illness, remarkably like Ebola fever, breaks out at various sites in America, all eventually connected to a pet shop that received a monkey from an illegal smuggling operation. Most cases are immediately isolated and contained, but a town in California develops an epidemic of the new disease.
The lab is called in and the military enforces a strict quarantine that divides families and prevents anyone from leaving the area. One worker dies quickly and Sam's wife falls ill. The crass General Donald McClintock (Donald Sutherland) is convinced that the nation can be saved only by the annihilation of the town by a gigantic bomb.
A plane sets out on the gruesome mission. Meanwhile, Hoffman leaps from a helicopter onto the cargo ship where the sailor-smuggler has just died leaving a photo of the monkey carrier. Sam makes a televised appeal for help locating the cute but dangerous, little monkey; a terrified mother responds and the creature is snatched from the arms of her child.
With military snipers in hot pursuit, Sam returns to the town, radioing the baffled bomber pilots with a barrage of reasons why they should ditch their mission of destruction. He puts the tiny monkey to work producing anti-sera and vaccines, which--in only a matter of minutes!--rescue the town, his wife, and his marriage. The pilots disobey orders and dump their bomb in the sea.
Peppered with a plethora of black and white stills, this book is a compilation of a physician's film reviews and reflections on how movies have mirrored the changes in medical care and in society's attitudes towards doctors and medicine over the last sixty years. Ten chapters blend a chronological approach with a thematic perspective: Hollywood Goes to Medical School; The Kindly Savior:
From Doctor Bull to Doc Hollywood; Benevolent Institutions; The Temple of Science; "Where are All the Women Doctors?"; Blacks, the Invisible Doctors; The Dark Side of Doctors; The Institutions Turn Evil; The Temple of Healing; More Good Movie Doctors and Other Personal Favorites.
The appendices (my favorite) briefly note recurring medical themes and stereotypes ("You have two months to live," "Boil the Water!"). Formatted as a filmography, the appendices reference the chapter number in which the film is discussed, the sources of the photographs, and a limited index.
This is a scholarly book and the author, who is an exceptionally good writer, has gone to great lengths to search out original source material, much of which has not been examined by previous authors. Instead of retelling Elizabeth Blackwell's story she relates in some detail that of Sarah Adamson Dolley, another important pioneer woman physician who was the third woman medical graduate in America. She also was one of the eight founding members of the earliest society of women physicians in the United States.
The book also details the period in the late eighteen hundreds and early nineteen hundreds which was referred to as "maternalist medicine," when women began to pursue their careers in public health. After being "sidelined" in the first half of this century, the numbers of women physicians began to slowly increase, greatly aided by the new women's movement and the equal opportunity era.
Dr. More does an excellent job of bringing together the history of women physicians with the history of medicine from 1850 until the present. Her descriptions of women physicians' lives and problems are evenly presented and make interesting reading. The evolution of medical education in general is also well described. Her conclusion is not unexpected--that the greatest obstacle facing women practitioners today is the need to accommodate the demands of childbearing and child rearing with their professional lives.
Raina is 17, living alternately on the streets with a boyfriend addicted to hard drugs and at home with an abusive mother, also an addict. She has been victimized by a succession of her mother's live-in boyfriends and lost a young brother to an accidental overdose: he swallowed some of his mother's pills while the mother slept and seven-year-old Raina was watching him.
Margaret Johnson is 45, Raina's teacher at an underfunded, overcrowded public school where Raina's life of squalor is more typical than not. Her own story is told in chapters that alternate with Raina's story and with the texts of autobiographical compositions Raina gives her but refuses to discuss. Only when Raina finds herself pregnant, shortly after her boyfriend has been killed in a drug-related accident, does she take Ms. Johnson up on her repeated offers of help.
She lives at the teacher's home for awhile, runs away to her own home, unused to kind treatment and afraid she'll disappoint the teacher and be thrown out, goes to a shelter, has her baby, and finally returns, having nowhere to go. Ms. Johnson, with some hesitation, takes her and the baby in and the three begin to work out a life together, knowing it will involve difficult change, but willing to bet on love against the odds.