Showing 21 - 30 of 105 annotations tagged with the keyword "Impaired Physician"

The Great Mysterious

Landvik, Lorna

Last Updated: Feb-12-2010
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Geneva Jordan, a successful stage actress in New York, reluctantly agrees to stay for a month with her thirteen-year-old nephew who has Down syndrome so that his parents can take a long-postponed and much-needed vacation. She is unmarried and has no children herself, has always found herself a little intimidated about close interaction with the boy, and leads a complicated personal and professional life in New York which the requisite month in Minnesota will interrupt.

Nevertheless, she takes on the job and gradually finds herself adapting to rural life, substitute parenthood, and the special needs of her nephew. She makes friends with the mother of Rich's best (and only real) friend, Conrad, who has cerebral palsy. After the month is over, she returns to New York, only to realize that her life lacks a dimension that caregiving gave it.

She also realizes she left a good man behind in Minnesota--a local divorced father who has become an unsought love interest. Nevertheless, she remains on stage and in the city until the death of her nephew's friend calls her back to Minnesota, and to the man with whom she can finally imagine taking on a family life of her own.

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The Tennis Partner

Verghese, Abraham

Last Updated: Jan-20-2010
Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

A Doctor's Story of Friendship and Loss, this book is, in a sense, a sequel to Verghese's earlier memoir, My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS (see this database). The Tennis Partner tells the parallel stories of Verghese's disintegrating marriage as he establishes new roots in El Paso, Texas and of his new deep friendship with a (male) medical student who shares his passion for tennis. Both men are struggling to re-establish order in their personal lives: Verghese, in easing himself out of a dying marriage while trying to maintain a close relationship with his two sons; David (the tennis partner), in remaining drug-free and successfully completing medical training, which had been interrupted by his addiction.

Verghese, an experienced physician trained in infectious disease and an expert on AIDS treatment, relishes his role as David's mentor; David, a former tennis "pro," enjoys teaching Verghese how to play better. Playing tennis together for the sheer joy of it, each finds release. Tennis becomes the route through which each can unburden himself to the other, seeking solace in a difficult time. Through it "we found a third arena outside of the defined boundaries of hospital and tennis court . . . at a time in both our lives when friendship was an important way to reclaim that which had been lost." (339)

While the reader suspects that David must have a drug problem because the Prologue to the book, narrated in the third person, describes a "young doctor from El Paso" in drug treatment, Verghese the biographer has no inkling of the problem until one-third into his first person narrative. He is shocked, but in some ways the bonds of their friendship are strengthened. Each has only the other as a confidant.

David, however, has another addiction: women. The friendship becomes increasingly complicated as Verghese tries to remain both supportive and objective. Eventually David resumes "using" and Verghese must decide how to respond, both professionally and on a personal level. The turmoil in both lives ends tragically for David and causes profound grief in Verghese.

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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.

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Morphine

Bulgakov, Mikhail

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

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

Bomgard, a young doctor recently transferred from a rural area to a small town hospital, receives an urgent message from Polyakov, the doctor who replaced him. Polyakov has become ill; he needs medical help. Before Bomgard can respond, however, Polyakov arrives at the hospital, dying of a self-inflicted wound. In his last moments, he gives Bomgard a notebook, on which is recorded the story of Polyakov's addiction to morphine.

Polyakov first took morphine to relieve an abdominal pain. He found that it also relieved his despair over the loss of his lover, an opera singer in Moscow. Morphine relieved his loneliness and improved his work. He gradually increased the dose until he became hopelessly dependent on the substance. He failed in his attempts to break the habit at a clinic in Moscow. Eventually there is nothing in life but the drug and Polyakov suicides.

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Summary:

Dr. Thomas Graboys is an eminent Boston cardiologist who developed Parkinson's disease in his late 50s. Shortly after his wife died in 1998, Graboys noticed unusual fatigue and mental sluggishness. He attributed these symptoms to grief, but they continued and he later experienced episodes of stumbling, falling, and syncope. During 2003 Graboys confided to his diary that it was "increasingly difficult to express concepts." ( p. 30) He also noticed tremor, problems with dictation, and frequent loss of his train of thought, symptoms "typical of Parkinson's." (p. 24)

While Graboys recorded these concerns in his diary, outwardly he denied that anything was wrong, even to family and close friends.  In fact, his denial continued until the day in 2003 when a neurologist friend accosted him in the parking lot and pointedly asked, "Tom, who is taking care of your Parkinson's?" (p. 27) Dr. Graboys faced an even more difficult challenge in 2004 when he developed the vivid, violent dreams and memory lapses that led to a diagnosis of Lewy body dementia, a form of progressive dementia sometimes associated with Parkinson's disease. With the cat out of the bag at last, the author finally began to confront the issue of professional impairment. In mid-2005 Graboys's colleagues seized the initiative and told him that "it was the unanimous opinion of my colleagues that I was no longer fit to practice medicine." (p. 36)

Writing now with the assistance of journalist Peter Zheutlin, Graboys reviews these events with unblinking honesty. He confronts his anger and denial, but also reveals the thoughtful, generous and passionate side of his character. "What will become of me?' This is the question that now lies at the center of Dr. Graboys' personal world. He knows that his loss of mental and physical control will worsen. With almost superhuman effort and his family's strong support, the author has been able to adapt to his limitations and maintain a sense of meaning in his life. Will that continue? In a chapter entitled "End Game," he addresses the question of suicide. Reflecting on his condition, especially the dementia, Graboys asks, "Will I lose myself, my very essence, to this disease?" (p. 161)

In the last chapter, Graboys acknowledges that he has no "simple prescription that will help you or someone you love live a life beyond illness, or tell you how to tap the hope that lives within." (p. 181)  However, he then goes on to make several suggestions of the advice-manual variety: "Use your family and friends as motivation to live life with as much grace as you can muster." "Find a safe place... to unburden yourself of anger." "Acceptance is key to defusing anger, stress, and self-pity."  "Use your faith in God, if you believe in God."  (pp. 181-182)

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The Echo Maker

Powers, Richard

Last Updated: Nov-19-2009
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Mark Schluter, a 27 year old beef-processing plant worker, becomes involved in a car crash outside Kearney, Nebraska, the locus of this novel. The car crash---on February 2, 2002, a date that the author wishes to impress the reader as one that seems too numerically mystical (02/02/02) to be co-incidental--clearly has mysterious elements about it since it occurred far outside town on desolate flat country roads and amidst the tire tracks of another car. Too, just after Mark is hospitalized, there appears an undecipherable note of anonymous provenance:

I am No One
but Tonight on North Line Road
GOD led me to you
so You could Live
and bring back someone else.

Mark has an initially troublesome route to recovery, including a temporary ventriculostomy to relieve the pressure in his head. Meanwhile his only sibling, Karin, 31, rushes to his side from Sioux City, a move that becomes permanent and costs her her job. Mark eventually awakens but with an unusual mis-identification syndrome, called the Capgras syndrome (more commonly encountered in patients with psychiatric condition), in which the patient fails to recognize those closest to him as such. For a Capgras patient, there is a disconnect between the visual ability to recognize their faces and emotional response to them as close relatives or friends. He recognizes the visual similarity but considers the significant other an impostor.

This rupture in the usual see-sister's-face-acknowledge-as-sister apparently occurs, in the Capgras syndrome, in connections between one's "primitive" or "reptilian" brain, including the amygdala, and the cortex. Much is made of this failure of neuronal circuits to connect, and reminds one of the parable in His Brother's Keeper (see database) about the Chinese Emperor and the failure of the transmission of a message to explain the pathophysiology of amyotrophic lateral sclerosis. As Karin remembers the neurologic explanation, " 'His amygdala, she remembered. His amygdala can't talk with his cortex" [original italics] (80). This amygdala-cortex dichotomy becomes, in behavioral terms, feeling versus reason. As discussed by the two neurologists involved in Mark's case, "But no emotional ratification. Getting all the associations for a face without that gut feeling of familiarity. Pushed to a choice, cortex has to defer to amygdala"; "So it's not what you think you feel that wins out, it's what you feel you think" (131).

Out of desperation, Karin emails a request to Gerald Weber, a famous cognitive neurologist-author modeled primarily after Oliver Sacks but with a little A. R. Luria, whose "To find the soul it is necessary to lose it" is the epigraph of the novel. From the time Weber meets Mark and Karin, the book becomes an intricately entangled design of various metaphysical threads all of which, directly or indirectly, revolve around Mark's syndrome and identity--in fact the identity of all the characters. Karin becomes involved-- re-involved-- with two men from her earlier days in Kearney, Robert Karsh, a developer, and Daniel Riegel, a conservationist. Later the two men become ideologically more opposed than ever when Karsh tries to develop the annual nesting grounds of the cranes, Grus canadensis, who return to Kearney, thousands of them, every February. Barbara Gillespie, a guardian angel to Mark at the extended care rehab center, and Gerald Weber, until then a man happily married to a prototypically liberal intellectual woman, Sylvie Bolan, become romantically drawn to each other. Weber's own doubts about his work and his public image after unprecedentedly critical reviews of his latest book torment him and lead to concerns about his own identity as a physician who may be using, rather than trying to understand, his patients.

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The Oath

Baiev, Khassan

Last Updated: Nov-15-2009
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Baiev’s chronicle of medical life in wartime is full of incident—tragic, touching, and repeatedly traumatic:  his own life was threatened repeatedly by Russians who suspected him and Chechens who resented him for treating Russians.  Members of his extended family were killed and his father’s home was destroyed.  He straddled other boundaries:  trained in Russia, he fully appreciated how modern medicine may bring relief not available even in the hands of the most respected traditional healers, but he mentions traditional ways with the reverence of a good son of devout Muslims.  His perspective is both thoughtfully nationalistic and international.

Finally coming to the States where he couldn’t at first practice the medicine he had honed to exceptional versatility under fire, he lives with a mix of gratitude for the privilege of safety and a longing for the people he served, whose suffering was his daily work for years that might for most of us have seemed nearly unlivable.  Before writing the book, he struggled with his own post-traumatic stress, and continues to testify to the futility of force as a way of settling disputes.  Medicine is his diplomacy as well as his gift to his own people, and the Hippocratic Oath a commitment that sustained him in the midst of ethical complexities unlike any one would be likely to face in peacetime practice.

 

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Beat the Reaper

Bazell, Josh

Last Updated: Jan-26-2009
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Pietro Brnwa, nicknamed "The Bearclaw," has embraced change - a new name, a different occupation, and a regenerated outlook. Thanks to the Federal Witness Protection Program, Pietro, who was formerly employed as a hitman by a mafia-connected lawyer, is now Dr. Peter Brown, an intern in the Department of Internal Medicine at Manhattan Catholic Hospital. His career as an assassin was motivated by the desire to avenge the murder of the grandparents who raised him. As a physician, Dr. Brown is paying off a moral debt - doing good deeds to atone for previous acts of violence including killing people.

Unfortunately, life doesn't get any easier for the hit man-turned-physician. Trouble stalks him and finds him. Everyone he loves is lost. In addition to the death of his grandparents, Dr. Brown's girlfriend, Magdalene, is gunned down in a car. His former best friend, "Skinflick" is thrown out of a window of a six-story building, survives, and is later stabbed to death by Dr. Brown.

Life might have been easier if Dr. Brown had not been recognized by a mafia acquaintance named Nicholas LoBrutto who is a patient in Manhattan Catholic Hospital. LoBrutto has stomach cancer and threatens to squeal to Dr. Brown's former crime boss. If Dr. Brown cannot keep LoBrutto alive, the mafia will be notified where to find the physician and he will be eliminated. Dr. Brown assists during LoBrutto's surgery but the mobster experiences ventricular fibrillation postoperatively. Dr. Brown's two medical students mistakenly administer intravenous potassium and LoBrutto dies.

A group of thugs quickly infiltrate the hospital and it appears likely that Dr. Brown will be exterminated. He risks his life to prevent a young woman from having her leg amputated for an erroneous diagnosis. The thugs capture Dr. Brown and detain him in the blood bank freezer. He removes a piece of bone from his own lower leg (an autofibulectomy) to use as a weapon and proceeds to kill the entire gang of murderers. Dr. Brown is sure to be dismissed from Manhattan Catholic Hospital but realizes there is still much he hopes to accomplish as a physician. With some help from friends in the Witness Protection Program (and a likely sequel to this novel on the horizon), it's a good bet that Dr. Brown is not likely to retire his stethoscope (or firearms) anytime soon.

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A Better Angel

Adrian, Chris

Last Updated: Oct-03-2008
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

A drug-addicted doctor, a dying father, and a cantankerous angel constitute a less than holy trinity. Carl is an impaired physician who is hooked on drugs. He happens to have a guiding angel following him around, but she is no guardian. Instead, she is moody and provides no protection. She offers warnings and advice. Carl met his angel when he was six years old. After being stung by wasps and experiencing an allergic reaction, she didn't lift a finger (or wing) to help him.

The angel is prescient. She can foretell who will grow up naughty or beneficent. She knows when a person will die. She tells Carl that not everyone has an angel. Only those individuals destined for greatness get an angel, but some people choose not to heed the suggestions of their spiritual attendants.

Carl is a pediatrician. He cheated in medical school and on his certifying examination but is pleased with his choice of careers: "I make my living praising the beauty of well children. I love babies and I love ketamine" (p121). His father is dying from metastatic lung cancer. Their relationship is terrible. To make matters worse, Carl cannot stomach sick adults.

His three pregnant sisters implore Carl to care for their father after discharge from the hospital. Carl reluctantly leaves San Francisco and heads to Florida. He takes his father to chemotherapy sessions, but the oncologist thinks it's time to stop further treatment. Carl administers painkillers to his dad and frequently consumes some of the prescribed morphine and Percocet for his own pleasure. The two men hardly speak to each other.

Carl's angel repeatedly implores him to reach out to the dying man. She knows that emotional and physical connection will heal both men. Carl's father longs for a storm but the weather won't deliver his wish. One night, Carl stages rainfall with the aid of the garden hose. He rests his head against his dad's chest, and they fall asleep. When morning arrives, Carl awakens and discovers that his father died during the night. The angel is weeping in the room.

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Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Sandeep Jauhar, M.D., Ph.D. is currently director of the Heart Failure Program at Long Island Jewish Medical Center in New York. Thus, one can assume that he is an accomplished cardiologist and administrator. It was not always so. This memoir flashes back to 10-15 years earlier when the author was casting about for a career, finally settling on medicine almost by default; it follows him to medical school (at Washington University in St. Louis) and then centers on his first year of residency training at Cornell's New York Hospital in Manhattan -- the internship year.

We learn in the introduction to the book that the author will speak freely of self-doubt about career choice, constant anxiety and feelings of inadequacy, exhaustion, and disillusionment. Which indeed he does. But Jauhar first discusses his family background: born in India and emigrating with his family to the USA at age 8; father holding a Ph.D. in plant genetics, now writing academic textbooks and still regretting that he had not been able to afford his dream of becoming a doctor; mother helping to support the family as a lab technician; older brother, Rajiv, a mentor and competitor, charming, self-assured, and unquestioningly headed for a medical career; sister, Suneeta. Sandeep (the author) undertakes graduate work in theoretical physics but as he nears completion of his doctoral degree, realizes that he probably does not have what it takes to be successful in the field. When his girlfriend, Lisa, becomes seriously ill, he begins to (re)consider medicine as a career. Against the advice of his parents who are now convinced he is a dilettante, he applies to medical school and is accepted.

Disillusionment began during the first two years of medical school: "In graduate school I had never learned to memorize . . . But now I couldn't rely on logic and reasoning; I had to commit huge swaths of material to memory" (32). He considered quitting to become a journalist, a profession that had always intrigued him, but which had been discouraged: "my father made it clear that journalism and writing were never to be considered career options because they offered no security" (33). Yet, amazingly, he was awarded a summer fellowship just before starting medical school that placed him in the Washington, DC office of Time magazine; the contacts he made then allowed him to work as a student reporter for the St. Louis Post-Dispatch during medical school and led ultimately to his ongoing and current position as a contributing medical essayist for the New York Times.

Internship for Jauhar unfolds as a series of anxiety-provoking encounters with patients and humiliating encounters with his physician superiors. Feeling inept and inadequate, he stumbles along and worries that he is harming patients. There is too much to keep track of, too many "little things that I find burdensome" (91). "Having so much to do was bad enough, but not knowing why you were doing what you were doing was terrifying . . . Patients were needy, their demands overwhelming . . . Everyone seemed to know how the place worked except me . . . The ecology on the wards was hostile; interactions were hard-bitten, fast paced" (112-113). He is in constant doubt and conflict about his career choice. Even his private life is affected -- his girlfriend Sonia, still a medical student, comes from a medical family, is strongly motivated and secure in her career choice, which aggravates his own sense of insecurity. (Reader, he married her.)

Midway through internship Jauhar suffers a herniated disk. He tries to tough it out without taking time off but his stint as "night float" at Memorial Sloan-Kettering hospital, which specializes in treating cancer patients, proves too difficult-- up all night trying to tend to the severely ill and "taking care of patients about whom you knew next to nothing" (154). He takes a brief leave followed by a reduced schedule. He recognizes that his problems are emotional as well as physical -- he is depressed. But gradually, as his neck problem improves, as he recognizes that medical professionals are actually able to help patients feel better -- his neurologist and physical therapist had "provided hope and comfort to me at a vulnerable time" (181)--, as he makes a house call to a dying patient, as his essays are published in the New York Times, and as the season moves to Spring, his depression lifts and he looks forward to his work.

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