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T.B. Harlem

Neel, Alice

Last Updated: Mar-01-2017
Annotated by:
Teagarden, J. Russell

Primary Category: Visual Arts / Painting/Drawing

Genre: Painting

Summary:

The Alice Neel painting, T.B. Harlem, can be seen at the National Museum of Women in Arts in Washington, D.C.

We are looking at a young man who has tuberculosis (TB) and who is at home recovering from a surgical procedure designed to collapse a part of his lung that is infected. He looks sick. His presentation conveys how TB can be called “consumption.” From this picture, however, we can tell that it is not just the subject’s body that is being consumed, but also his spirit and any reservoir of hope.  

The painting appeared on the cover of the June 8, 2005 issue of the Journal of the American Medical Association (JAMA).  In his accompanying essay, William Barclay, a pulmonary specialist, surmises that “thoracoplasty” was the surgical procedure used for this person. The procedure involves the removal of several ribs so that the soft tissue the ribs held up collapses upon the lung and closes it off. Barclay calls thoracoplasty “the most radical form of collapse treatment” at the time. He also notes how Neel captured the anatomical consequences of the procedure:
His body forms a graceful sigmoid curve, for a thoracoplasty always resulted in a thoracic scoliosis from the pull of the muscles on the side not operated on, with a compensatory cervical scoliosis in the opposite direction.  

A white wound dressing on the left side of the subject’s chest draws our attention because of its brightness and because the subject’s right hand is pointing to it. It’s not covering the surgical incision because that’s on his back. Barclay suggests that the dressing is covering a wound that opened up a track from the skin to the chest lining or to the lung (i.e., a fistula). The dressing takes the shape of a cross, which made the writer of the text accompanying the painting at the museum where it hangs wonder if we are to see the subject as a martyr in the form of Christ.

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This is an ethnographic work written by a Swedish anthropologist who has lived in Cairo, Egypt for several years curating the cultural tropes that are woven into the lives of her traditional Egyptian subjects. Malmström sets the scene for her work by describing a 1994 incident wherein CNN broadcast live the female genital cutting of a young girl in Egypt. A secret practice made public, Malmström uses this event to springboard her commentary on how female genital cutting is practiced, experienced, and viewed among Egyptians.  

Female genital cutting is defined as the partial or total removal of external female genitalia for non-medical (i.e. cultural) reasons. This is largely a practice carried out in Africa and some parts of the Middle East. Egypt has one of the highest global rates of female genital cutting, and the cutting usually occurs at the age of 9 years. Many reasons are cited for the cutting, and in Egypt it is done to decrease a woman’s sex drive as well as to fit the standards of beauty (i.e. labia minora are considered unattractive). It had usually been performed by a traditional practitioner, but more recently, this human rights violation has been medicalized in Egypt and is often performed by doctors in an operating room using anesthesia. Even though Egyptian law and Muslim as well as Coptic Christian clerics have issued bans on female genital cutting, the practice continues in secrecy.  

Malmström starts her book by saying that female genital cutting may actually be carried out in large part as Egyptian political protest against the West. She uses excerpts from interviews with women of different generations, social strata, and degree of devotion to Islam to describe their different experiences and opinions on topics that center around womanhood and the many components of womanhood in Egypt.  

While the title suggests that Malmström will tackle female genital cutting  head-on throughout this piece, she actually takes a more circuitous route. She spends several chapters describing other woman-centric issues to familiarize the reader with Egyptian culture. For instance, Malmström describes how sexuality is expected to be expressed at different points in life: in girlhood, adolescence, and after marriage. She focuses on how Egyptian women are expected to straddle many expectations regarding sexuality depending on the context: sexually receptive to the husband only, for instance, but not so much so that the husband struggles to satisfy her.
  One of the most telling quotes regarding the meaning of womanhood is,

“A woman should always be soft towards a man...She should never accuse her husband of anything or argue with him. A woman should be strong and never show her true feelings. A woman must be beautiful. A woman will win through beauty, softness, and through cooking....A woman should not show her sadness because of him [her husband], since she turns ugly, loses her health and eventually, her husband. She should be even softer towards him and give him everything in life” (p. 169).  

Malmström delves into the centrality of cooking, pain, and endurance of suffering in the lives of traditional women and how these items, as well as being “cut” are seen as necessary to the satisfactory construction of Egyptian female identity. This exploration of many parts of womanhood in Egypt allows the reader to attempt to engage in a nuanced understanding of female genital cutting in the context of a broader, textured Egyptian culture. 

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Annotated by:
Teagarden, J. Russell

Primary Category: Performing Arts / Film, TV, Video

Genre: TV Program

Summary:

The Knick was inspired by the Knickerbocker Hospital, founded in Harlem in 1862 to serve the poor. In this 20-part TV series spread out over two seasons, the fictional Knick is somewhere in the lower half of Manhattan around 1900. The time covered during the series is not marked in any distinct way. The characters don’t age much, and although fashion and customs remain static during the series, the scope and significance of advancements that come into play were actually adopted over a longer time than the episodes cover.   

The series builds on some known history. The central character, the chief surgeon Dr. John Thackery, is modeled on a famous surgeon of the time, Dr. William Halsted, in both his surgical adventurism and in his drug addictions. The character Dr. Algernon Edwards, who is an African-American, Harvard-educated, and European-trained surgeon, is based in part on Dr. Louis T. Wright, who became the first African-American surgeon at Harlem Hospital during the first half of the 20th century.  

Storylines of human drama and folly run through the series. Among them are medical cases both ordinary and bizarre, heroic successes and catastrophic failures, loves won and lost, gilded lives and wretched existences, honor and corruption, racism and more racism. Within and around these storylines are the scientific, medical, and industrial advances of the period, as well as the social contexts that form fin de si
ècle hospital care and medical research in New York City.
 

Some of the industrial advances we see adopted by the hospital include electrification, telephone service, and electric-powered ambulances. We see that transitions to these new technologies are not without risks and catastrophes: patients and hospital staff are electrocuted, and when the ambulance batteries died -- a frequent occurrence-- many of the patients they carried died, too.

Medical advances integrated into various episodes include x-rays, electric-powered suction devices, and an inflatable balloon for intrauterine compression to stop bleeding. Thackery is a driven researcher taking on some of the big problems of the day, such as making blood transfusions safe, curing syphilis, and discovering the physiologic mechanisms of drug addiction. We see how he learns at the cost of his patients, or rather his subjects. We also glimpse movements directed at population health. For example, epidemiological methods are applied to find the source of a typhoid outbreak, which drew from the actual case of Mary Mallon (aka, Typhoid Mary). Shown juxtaposed to the advances epidemiology was then promising is the concurrent interest that was rising in eugenics and its broad application to control for unwanted groups. Research ethics and regulations were a long way off.


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INTRODUCTION            
Writing for all the co-authors, Rita Charon challenges “a reductionist, fragmented medicine that holds little regard for the singular aspects of a person’s life” and protests “social injustice of the global healthcare system” (p.1). She gives a history of narrative medicine, lists its principles, and summarizes the book’s chapters, mentioning that several come as pairs that present theory then practice. The six principles are “intersubjectivity, relationality, personhood and embodiment, action toward justice, close reading (or slow looking), and creativity” (p. 4).
The basic thesis is that healthcare can be improved by narrative medicine because “narrative competence can widen the clinical gaze to include personal and social elements of patients’ lives vital to the tasks of healing” (p. 1). 
This is a dense, theory-laden book from the group at Columbia University. The summaries below touch of some of the major points.   

PART I, INTERSUBJECTIVITY             
Ch. 1, Account of Self: Exploring Relationality Through Literature

Maura Spiegel and Danielle Spencer describe the richness of literature that allows readers to respond creatively. In clinical settings, a caregiver may similarly listen attentively and help co-construct a narrative with the patient. Literature can help us explore “the limits of rationality and positivism” (p. 29) and move from “a model of autonomy to one of relationality” (p. 34). 

Ch. 2, This is What We Do, and These Things Happen:  Literature, Experience, Emotion, and Relationality in the Classroom.

Spiegal and Spencer write that current medical education does a poor job of helping future physicians with their emotions.  Clinicians profit from a more integrated self and will listen better to patients and respond to them.      

PART II, DUALISM, PERSONHOOD, AND EMBODIMENT            
Ch. 3, Dualism and Its Discontents I:  Philosophy, Literature, and Medicine

Craig Irvine and Spencer start with three literary examples that illustrate separation of mind and body. This dualism has pervaded modern medicine, causing losses for patients and caregivers, especially when there are power imbalances between them.  The “clinical attitude” (p. 81) dehumanizes both caregivers and patients.           

Ch. 4, Dualism and Its Discontents II:  Philosophical Tinctures
Irvine and Spencer argue that both phenomenology (appreciative of embodied experience) and narrative hermeneutics (privileging reciprocal exchange of persons) help us move beyond dualism.  Theorists Edmund Pellegrino (also a physician), Richard Zaner, and Fredrik Svenaeus help us understand how caregivers and patients should relate. 

Ch. 5, Deliver Us from Certainty: Training for Narrative Ethics

Craig Irvine and Charon write that various humanistic disciplines “recognize the central role narrative plays in our lives” (p.111). There is, however, “indeterminacy” in stories that “cannot be reduced by analyzable data” (p. 113). Narrative ethics urges us to consider issues of power, access, and marginalization for both the teller and the listener. The authors review recent ethical traditions of principalism, common morality, casuistry, and virtue-based ethics. They believe that narrative ethics, emerging from clinical experience and now allied with feminist and structural justice frameworks, will provide a better approach for many reasons. “Narrative ethics is poised to integrate the literary narrative ethics and the clinical narrative ethics” (p. 125).  

PART III, IDENTITIES IN PEDAGOGY            
Ch. 6, The Politics of the Pedagogy: Cripping, Queering and Un-homing Health Humanities

Sayantani DasGupta urges attention to issues of power and privilege in classrooms, lest they “replicate the selfsame hierarchical, oppressive power dynamics of traditional medicine” (p. 137). “Cripping” and “queering” provide new perspectives on knowledge, for example the untested binaries of physician/patient, sick/well, elite/marginalized, teacher/student. Drawing on disability studies, health humanities, and queer politics, DasGupta challenges “medicalization” and the “restitution narrative” (p. 141).  

PART IV, CLOSE READING            
Ch. 7, Close Reading: The Signature Method of Narrative Medicine

Charon stresses “the accounts of self that are told and heard in the contexts of healthcare” (p. 157). Close reading, traced from I. A. Richards through reader response theorists, is “a central method” for narrative medicine (p. 164). Close reading enhances attentive listening, and both of these deepen relationality and intersubjectivity, allowing for affiliation between caregiver and patient (pp. 175-76). Such linkages aid healthy bodies and minds, even the world itself (p. 176).             

Ch. 8, A Framework for Teaching Close Reading

Charon describes how she chooses texts and provides prompts for responsive creative writing. She illustrates “the cardinal narrative features—time, space, metaphor, and voice” (p. 182) in literary works by Lucille Clifton, Henry James, Galway Kinnell, and Manual Puig.  

PART V, CREATIVITY            
Ch. 9,  Creativity: What, Why, and Where?

Nellie Hermann writes that “healthcare in particular has a vexed relationship to the notion of creativity,” in part because of issues of control (pp. 211-12); values of “evidence based” and “numbers-driven” medicine are also factors. Narrative medicine, however, “is about reawakening the creativity that lives in all of us” (p. 214).            

Ch. 10, Can Creativity Be Taught?

Hermann reports on techniques used in the College of Physicians and Surgeons at Columbia, including prompts and a Portfolio program. A “Reading Guide” helps clinical faculty (and others) respond to student writing. Responses to writing can nourish the “creative spark.”  

PART VI, QUALITATIVE WAYS OF KNOWING            
Ch. 11, From Fire Escapes to Qualitative Data: Pedagogical Urging, Embodied Research, and Narrative Medicine’s Ear of the Heart

Edgar Rivera Colón suggests that “we are all lay social scientists of one kind or another,” seeing people in action in various contexts. He affirms an “assets-based approach to public health challenges, as opposed to a deficits-based and pathology-replicating paradigm” (p. 259). We are all embodied actors in relationship to power, privilege, and social penalty. Research through interviews and participant observation show “meaning worlds” in tension with “systemic inequality and structural violence” (p. 263). 

Ch. 12, A Narrative Transformation of Health and Healthcare

Charon presents and analyzes a case study of patient Ms. N. as treated by internist Charon. They’ve been working together for decades. Charon writes up her perceptions and shares them with Ms. N. Speaking together, they “became mirrors for one another” (p. 274). Psychiatrist Marcus discusses transference and transitional space in that experience. A caregiver as witness can shift healthcare from “instrumental custodianship to intersubjective contact” (p. 288).            

Ch. 13, Clinical Contributions of Narrative Medicine

Charon describes applications of narrative medicine, all with the aim of improving healthcare. She describes techniques for interviews of patients, writing methods, and ways to improve the effectiveness of healthcare teams, as well as changes in clinical charts and other narrative descriptions of patients.

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Diabetes

Dickey, James

Last Updated: Feb-01-2017
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

In the first part of this poem ("Sugar"), Dickey gives a wonderful series of images of diabetic symptoms: "I thirsted like a prince," "my belly going round with self- / made night-water," "having a tongue / of flame . . . . " The doctor preaches insulin and moderation. The poet tries to comply. He seems to accept this new life, "A livable death at last."In the poem's second part ("Under Buzzards"), the poet and his "companion" climb to a point on Hogback Ridge where they see buzzards circling. Seeing the birds of death, he reflects on his life and illness. Is all this medicine and moderation worthwhile? What will they accomplish? Regarding the body, the poet writes, "For its medical books is not / Everything: everything is how / Much glory is in it . . . . " In the end he takes "a long drink of beer."

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States of Grace

Lipman, Mark; Cohen, Helen

Last Updated: Jan-24-2017
Annotated by:
Grogan, Katie

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

States of Grace follows Dr. Grace Dammann, a pioneering HIV/AIDS physician, as she navigates life following a catastrophic motor vehicle accident that leaves her severely physically disabled. Before the accident Grace was a devoted caregiver at work and at home. She was the co-founder of one of the first HIV/AIDS clinics for socioeconomically disadvantaged patients at San Francisco’s Laguna Honda Hospital, honored for her work by the Dalai Lama with a 2005 Unsung Heroes of Compassion Award. She was also the primary breadwinner and parent in her family with partner Nancy "Fu" Schroeder and adopted daughter Sabrina, born with cerebral palsy and HIV. During a routine commute across the Golden Gate Bridge in May 2008, Grace was struck head-on by a car that veered across the divide.  She miraculously survived—her mind intact, her body devastated. She endured a prolonged coma, innumerable surgeries, and a marathon of rehabilitation. The documentary picks up Grace’s story when she is finally discharged for good. She returns home to acclimate to a radically altered life, one where she is wheelchair-bound and dependent on others for simple tasks of daily living. The film captures the rippling effects of the accident on all dimensions of Grace’s life—personal, professional, psychological, spiritual, and economic—focusing especially on how Grace’s disability turns the family dynamic on its head. Fu becomes the primary caregiver to both Grace and Sabrina, Grace becomes a care-receiver, and as Grace describes “Sabrina’s position in the family [is] radically upgraded by the accident. She is so much more able-bodied than I am.” We witness her frustrations with the limitations of her paralyzed body and see her, at one point, arguing with Fu about her right to die if she continues to be so impaired. Some of Grace’s ultimate goals (to walk again, to dance again, to surf again) remain unattainable at the film's conclusion, but she sets and exceeds new ones. Grace “comes out” as a disabled person in medicine, returning to Laguna Honda Hospital as its first wheelchair-bound physician, where she is appointed Medical Director of the Pain Clinic. She resumes the caregiver role, but with an intimate knowledge of the lived experience of pain, suffering, and disability.

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Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The subtitle is accurate enough: “A Memoir of a Family and Culture in Crisis,” although the author J.D. Vance is, in fact, the focal point of view throughout, from his childhood to his success as an adult. Few young people made it out of the hills to enjoy stable and successful lives, but J.D. was one of them, earning a degree at Ohio State University, then a law degree at Yale. While recounting his life, he also describes his relatives and neighbors, and he interprets the many dilemmas of his hillbilly culture. 
 
Vance was born in 1984 and grew up in Jackson, Kentucky, a poor town following the collapse of coal mining. His family was beset with poverty, alcoholism, mental instability, and more. His mother had nine miscarriages and suffered from addictions; she had multiple husbands. The culture around him suffered from domestic violence, drug abuse, hoarding, unemployment, honor defended by fists, knives, or guns, as well as bad financial habits, bad diets, obesity, lack of exercise, sugary drinks, dental problems, and what he calls “emotional poverty.”  There was welfare abuse and, in general “a chaotic life.”  He credits his grandparents, other relatives, various teachers and professors for supporting him, guiding him, and comforting him when he was hurt, angry, and/or confused.
 

Like many other hillbillies, J.D. moved some hundred miles north into southern Ohio, where steel companies provided jobs—that is, until they closed, like many other employers in the Rust Belt. There also, hillbillies were left without income and social problems increased. Stores and restaurants closed. Payday lenders and cash-for-gold shops took their place. Drug dealers and users took over empty houses.  

After high school, Vance joined the Marines. He credits the military for teaching him discipline, persistence, and for developing his self-respect. For his success at Yale, he thanks his professors, his girlfriend (later wife), and classmates for helping him understand customs of New England society. One example: he leaves a banquet to call his girlfriend; she instructs him on how to handle the nine pieces of unfamiliar silverware surrounding his plate.  

The last three chapters (11, 12, 13) and the conclusion analyze his experience on more conceptual terms, including the “social capital” prized by the the New England world, social instability of the culture he was raised in, and “adverse childhood experiences” (or ACEs), the psychologists’ phrase for the damaging events children experience in a culture of poverty, violence, and limited futures. He writes that governmental child services have policies that don’t understand the important roles of aunts, uncles, and grandparents in subcultures that rely on extended families.  Indeed, faithful to his mother, he, as an adult, provides specific help to her. 


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Manchester by the Sea

Lonergan, Kenneth

Last Updated: Jan-09-2017
Annotated by:
Teagarden, J. Russell

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Lee Chandler is approaching middle age and working as a maintenance man for an apartment complex in Quincy, Massachusetts. We get a sense for his days as we watch him shovel snow from the walks, unclog toilets, fix leaks, and argue with tenants. We get a sense for his nights as we watch him at a bar drink himself into a fighting mood and then watch him fight. He returns to his sparse subterranean apartment that he shares with no one to sleep off the beer and the bruises. He’ll do it again the next day.  

Lee takes a call as he’s shoveling snow. His older brother Joe is in the hospital in Manchester. He would not get there before Joe dies. A few days later Lee finds out he’s now guardian to Joe’s teenage son Patrick. This is not a responsibility he knew about or welcomed, and one that anchors him to his hometown of Manchester. He doesn’t want to stay in Manchester. Through a series of flashbacks, we find out that it’s not the struggles that come with taking on the responsibility of a rambunctious teenager that makes him want to leave again, it’s the unspeakable tragedy he experienced there years before. He blames himself for this tragedy, as did his wife Randi, and many of the townspeople.  

Over the next few months, Lee is busy making burial arrangements for his brother, situating his nephew, and looking for work while being reminded regularly of what causes his profound suffering. He also experiences fresh assaults. One in particular is the reemergence of his now ex-wife Randi. She attends Joe’s funeral forcing him to bear the sight of her with a new husband and in the late stage of pregnancy. A little later he encounters her in town with her newborn child in a buggy. She wants to make amends for her contribution to his suffering. Lee’s response to Randi’s entreaties is gracious but lifeless, and explains how he gets through the days. He has no internal resource to muster responses to anything, good or bad. He’s hollowed out. “There’s nothin’ there,” he tells Randi.
 

We’re given no reason to expect there will ever be anything there again for the rest of Lee’s life through a conversation he has with Patrick. Lee has arranged for a family friend to adopt Patrick so that he could leave Manchester for a job in Boston. When Patrick pushes him to stay, Lee confesses: “I can’t do it. I can’t beat it. I can’t beat it.”

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Dothead

Majmudar, Amit

Last Updated: Jan-06-2017
Annotated by:
Kohn, Martin

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

Dothead is Amit Majmudar’s 5th book (and 3rd collection of poetry). It is far-ranging in its reach and style, perhaps best described by the heading of its table of contents, “Kedgeree Ingredients.” Kedgeree, as one unfamiliar with the word (like me) discovers on the page facing the table of contents (in a photocopy of a dictionary page), is “a mess of rice cooked with butter and dal….” Among other (con) textual surprises in this book are an opening epigraph from Dr. Seuss- “It is fun to have fun/But you have to know how,” a passport photo of the author at about age 3 above his book jacket biosketch, and the title of the final poem in the collection, “Invocation.”  Front and center in a number of poems is the issue of identity, perhaps most tellingly in the title poem, “Dothead,” where an Indian-American teenager confronts his white classmates. In “T.S.A.” the poem’s speaker faces off against the airport screeners claiming solidarity with :
             "my dark unshaven brothers
whose names overlap with the crazies and God fiends,
             ourselves the goateed other”  (p.5)
His identity as a poet is beautifully expressed through “Steep Ascension,” a poem “for John Hollander” (the epigraph unfortunately is not included in this volume) that ends:
          “But John, I told him, beauty is a fire
                    those who burn hardest labor coldly for

and I for one will hold your labors dear,
          the music of meaning, the artistry that dares
                    to conjure walls that it might conjure doors” (p.25). 

Among his “political” poems, are two about children: one gunned down ("Lineage")  and one abused (“Invocation")” that begins:
“The arms I sing. Forget the man. there is
no other epic. Sing the arms of kids,
the ones with pustules all along their veins” (p. 100).
The longest poem, a prose poem, is “Abecedarian” that weaves together Adam and Eve and the speaker’s discovery of oral sex.  



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The Wilderness

Harvey, Samantha

Last Updated: Dec-13-2016
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Jake Jameson is an architect who came of age in immediate post World War II London. He grew up in “the wilderness” of the English moors and peat bogs far from London. He returns to this wilderness with a wife and an infant son, and to where his mother, a childhood friend, and many memories still live. We read about his successful career, his Jewish mother and her flight from her native Austria, his marriage to Helen and her unexpected death after about 30 years of marriage, his infidelities, his son’s incarceration in a prison he designed, his daughter’s death as a young child, and how eventually the wilderness he lived in moved from the moors to his brain. We don’t learn all of this easily because it comes in one form through Jake’s damaged memory and in another form through the tellings of more reliable witnesses. We are left in our own confused state about certain parts of story until the corrections and clarifications come later in the book. For example, we can go far into the novel thinking that Helen could have died from falling from a cherry tree until we learn near the very end that she died from a stroke, probably.

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