Showing 21 - 30 of 419 annotations tagged with the keyword "Pain"

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Atul Gawande’s Being Mortal is both ambitious and synthetic, qualities that well suit his difficult subject, death.  In Western culture, there are taboos against death because it fits neither into post-Enlightenment notions of progress and perfection nor into medical notions of control, even domination of human biology. A surgeon and an investigator, Gawande draws on his patients, his family, and travels to various hospitals and other caregiving places in order to confront death and see how approaches such as hospice and palliative care can improve our understanding, acceptance, and preparation for death.

Gawande has harsh words for contemporary medicine, the supposed caregiver for the dying and their families.  Relying heavily on technique and industrial models, it ignores the deep needs of the dying and provides, instead, versions of “warehoused oblivion” (p. 188), for example long, futile stays in ICUs.

As opposed to traditional societies like India, Westerners prize the independence of individuals, a status that is, of course, never permanent. In the chapter “Things Fall Apart,” Gawande describes how longer lives are now the norm but they include chronic illnesses and inevitable decline in vitality.  Our deaths are now routinely in hospitals, not at home, and often extended—sometimes brutally—by technical support and unwillingness of doctors and families to stop aggressive treatment.       
       
Also, sadly, there are fewer and fewer geriatricians at a time when there are more and more elderly.  A good geriatrician takes a long time with each patient, is not well paid, nor does s/he do income-generating procedures. Worse yet, some training programs are being discontinued.  

Gawande illustrates his ideas with case studies of patients and describes, from time to time in the book, the elderly journeys of his grandmother-in-law and his own father.  These passages make vivid the abstract ideas of the book. But it’s not just elderly patients who face death: health calamities can come to anyone, for example, a 34-year-old pregnant woman found to have a serious cancer. Various treatments are tried without success, but family and doctors act out “a modern tragedy replayed millions of times over” (p. 183) of a medically protracted death. Finally her mother calls a halt to treatment.
               
Family members often bear a heavy load in caring for a sick elder, but many nursing homes are often worse, designed for control, not support of the patients. 

The chapter “A Better Life” describes the first in a series of places that offer much improved settings for the elderly, with birds, animals, gardens, and, in general, richer lives that have a sense of purpose.  Gawande describes hospice care, palliative care, and advanced directives (including Do Not Resuscitate orders) as improvements needed to break the norms of “treat at all costs.” The old roles of Dr. Knows-Best and Dr. Informative need to give way to physicians and others who talk with patients and families about their values, their wishes for the last days, and their preparations for death. In short, aggressive treatment should no longer be the “default setting” for hospital care.     
        
The book ends with a dozen moving pages about the death of Gawande’s father. The “hard conversations” have clarified his wishes, and hospice care has provided “good enough” days.  Pain control has done well. Then, finally, “No more breaths came.” The family travels to India to spread his ashes on the Ganges. 

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Annotated by:
Donley, Carol

Primary Category: Literature / Fiction — Secondary Category: Visual Arts / Painting/Drawing

Genre: Graphic Memoir

Summary:

A nurse-poet well-known for her empathic descriptions of patients, Cortney Davis suddenly found herself in the hospital bed with a life-threatening condition.  Although she is a masterful writer, she could not find words to capture what she experienced as a patient.  Instead, she started painting her emotions—fear, suffering, and loneliness expressed through color, line, and tone.  The first of 12 paintings in this pathography shows her lying naked on a white slab, not literally what happened but expressive of how vulnerable and helpless she felt.  Each of the 12 paintings carries an emotional and spiritual truth—often raw and miserable.  Davis accompanies each painting with a brief commentary about how and when the painting was done, explaining, for instance, why some of the figures have no facial features. But the vivid paintings speak for themselves, and they add a different way of knowing not available through words.

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Hurt Hawks

Jeffers, Robinson

Last Updated: Mar-22-2015
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

"Hurt Hawks" is a narrative poem about a wounded hawk in free verse of 27 lines divided by the poet into two parts. Part I, which is 17 lines long, describes the setting of the poem in third person. Part II is 10 lines long, written in first person, and comprises the resolution of the carefully constructed tension set up in Part I. Some critics feel that Part II is sufficiently different in style and focus that it was originally an altogether separate poem (see below). Succinct yet lyrical, elegaic yet harsh, Hurt Hawks is, like the hawk that is the center of the poem, fiercely and unrelentingly an advocate of the natural - as opposed to the civilized - world. Hawks held a special place in Jeffers' heart, whether it be this poem or the longer "Cawdor," "Give Your Heart to the Hawks" (the name of a 1933 collection of his poetry), or "Hawk Tower," the edifice that he built for his family in 1920 on Carmel Point in California.

Part I sets the stage for the action in Part II, an Ecce Homo stage where the Homo is an injured hawk living in and around the poet—who makes clear, however, that the hawk is not a prisoner, either in the poet's eyes or its own. The poem opens with:

The broken pillar of the wing jags from the clotted shoulder,
The wing trails like a banner in defeat,
No more to use the sky forever but live with famine
And pain a few days:

Midway through Part II, Jeffers notes that

We had fed him six weeks, I gave him freedom,
He wandered over the foreland hill and returned in the evening, asking for death,
Not like a beggar, still eyed with the old
Implacable arrogance.

This poem is arguably not only Jeffers' most famous poem but often the only one still taught, when Jeffers is taught at all, in undergraduate courses. One reason for the inclusion of this poem in the curriculum is the famous first line of Part II, "I'd sooner, except the penalties, kill a man than a hawk." Aside from its popularity and this rather striking sentiment, the poem has proved a fertile source of discussion amongst critics for other reasons. First is the striking shift in voice from Part I to Part II, leading some to state that this poem was welded together from two distinct poems. Secondly, the plural "Hawks" in the title is mysterious and unclear since there is only one hawk mentioned in the poem—or is there? One interpretation of the plural is that in fact Jeffers and his family harbored two hawks and only the second was killed. Tim Hunt feels the second injured hawk in the poem refers to the saddened, or emotionally hurt hawk, i.e., the poet of Part II.

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Annotated by:
Aull, Felice

Primary Category: Visual Arts / Painting/Drawing

Genre: Painting

Summary:

Swiss artist Ferdinand Hodler painted his model and lover Valentine Godé-Darel in a series of drawings and paintings after she became ill and was dying of cancer (of the reproductive organs). For a painter of that time to focus his/her work on a dying individual over a period of many months (1914-1915) was highly unusual. In this painting, Valentine's head and face are seen in side view in the left of the picture. She is lying down with her head partly elevated and sunken into a pillow. Her features are bony with high cheekbones and a prominent nose. Her eyes are closed, her mouth open. Blue is a featured color, forming the background as well as tinting her face. Hodler also favored blue in many of his landscape paintings. The woman's head and face are carefully drawn but the pillow and bedclothes are sketchy, drawing the viewer's attention immediately to the dying woman and holding it there.

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Summary:

Originally intended as a frontispiece, El sueño de la razon produce monstruos is number 43 in the series Los Caprichos (1799) by Francisco José de Goya y Lucientes. Also one of his roughly 40 self-portraits, this ambiguous picture shows a seated male figure with his ankles crossed leaning over to his right as he rests his elbows and head on a desk. The male figure wears an ankle-length coat, breeches, stockings, and shoes. His hair is long, his face invisible. On top of the desk, under his right elbow, we see a paintbrush or writing instrument. The side of the desk, in the lower left corner, bears the title of the work. On the floor to the man's right crouches a lynx. Owls with huge wings and expressive eyes surround him. The owl on his right holds out a paintbrush. A cat with watchful eyes perches behind his back. Above the human figure large bats are flying; the largest one at the top right has a goat-like head.

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Summary:

This anthology is a sequel to Pulse: The First Year (2010). Both anthologies are comprised of postings to the website “Pulse: voices from the heart of medicine,” an online publication that sends out short poems and prose pieces every Friday. As the website subtitle suggests, the topics are from the medical world, the writing is personal (not scientific), and the writers give voice to feelings and perceptions from their direct experience as care-givers, patients, or family members of patients. All the pieces are short (typically one to five pages), usually with a tight subject focus. For example, in "Touched," Karen Myers reports how massage has helped her muscular dystrophy. 

The postings in the second anthology originally appeared from April 2009 through December of 2010. Because the 87 pieces appear in the order they were published, they don’t have linear coherence. Therefore the editors of have thoughtfully provided four indices in the back of the book: by author, by title with summaries, by healthcare role, and by subject/theme.

Prose pieces vary widely in style and technique. The poems are almost all free verse, although some poets have used regular stanzas. “Depression Session,” (p. 157) is an 18-line poem by a physician about a difficult mental patient. Many of the pieces explore the intensity of medical subjects with impacts on doctor, patient, and/or family. Some of them show limits of medicine. “Pearls before swine” (p. 191) relates the experience of a third-year medical student in a rotation at the office of a racist and sexist physician. “Babel: the Voice of Medical Trauma” (p. 158) dramatically tells the story of a poorly handled birth at a hospital.  

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Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Linden, a professor of neuroscience, has written a book for a general audience on the subject of touch. A synthetic thinker, he combines insights from science, anatomy, neurophysiology, psychology, and social behavior. He argues that touch pervades much of human experience: “From consumer choice to sexual intercourse, from tool use to chronic pain to the process of healing, the genes, cells, and neural circuits involved in the sense of touch have been crucial to creating our unique human experience” (p. 5). Case studies of medical oddities enliven his account.

Chapter One, “The Skin is a Social Organ,” draws on a wide range of examples, from NBA players to vampire bats. Touch is especially important to the development of human newborns. Lab experiments have shown that the attitude of the toucher can influence the experience of the touched. English and American cultures are touch aversive.

Chapter Two discusses the neurophysiology of touch, the sensory nerves and the neurons that link to the spinal cord or to the brain. Lively examples include string players, 1900-era women with “underwear-shaped numbness,” and the Braille writing system for the blind. 

In Chapter Three, “The Anatomy of a Caress,” Linden explores further the tactile fibers that relay touch. “A caress communicates that you are safe,” he writes, and the C-tactile system is the main route from skin to the brain.

Chapter Four, “Sexual Touch,” moves beyond caress all the way to orgasm, detailing the roles of touch receptors and brain activity as well as the wide variety of personal and social contexts.

Chapter Five looks at nerve endings of human skin that detect chili peppers as hot and mint as cool. Vampire bats have another version that detect heat, useful for locating blood vessels on “donors.”

Chapter Six, “Pain and Emotion,” opens with Pakistani children who do not feel pain; they have a genetic mutation that influences a sodium channel in neurons. Pain itself varies with people’s emotions, experience, and expectations. Some mindfulness practices (yoga, Tai Chi, meditation) can lessen chronic pain.

Chapter Seven, “The Itchy and Scratchy Show,” discusses river blindness and shingles, among other topics.

Chapter Eight, “Illusion and Transcendence,” provides a helpful overview of sensory nerves and their connection to various parts of the brain. Some stimuli activate the “emotional-affective-cognitive portions,” while others activate “sensory-discriminative centers.” Touch, in general, often has strong social meanings but does not, for Linden, imply any supernatural dimensions.  

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On Bittersweet Place

Wineberg, Ronna

Last Updated: Nov-18-2014
Annotated by:
Nixon, Lois LaCivita

Primary Category: Literature / Fiction

Genre: Novel

Summary:

This story centers on Lena, an immigrant teen from Ukraine, whose entire family has been traumatized and uprooted by family deaths during a violent pogrom.  Relocated to Chicago, in a tiny apartment on Bittersweet Place, the family struggles to survive in the years prior to World War I. Wineberg’s tale of disrupted life and resettlement is weighted by formidable issues that stretch beyond the ordinary range of family experiences. 

Lena, the intelligent, highly observant and resilient adolescent, narrates an unvarnished tale of survival for the extended family clustered together in this strange new world, but especially for herself.  While the family’s economic and financial circumstances are difficult, her own life is made worse by an unkind teacher, mean-spirited classmates, and hormonal impulses.  Her uncle touches her inappropriately, a favorite uncle goes mad, a cousin dies, and her mother, who is unfamiliar with the new world setting and mores, drives her crazy. 

Nevertheless, Lena is a clear-eyed survivor exhibiting a surprising toughness of character and determination. For example, her introduction to sex is far more direct than might occur with most girls of that time.  In addition, when her teacher fails cruelly to support her artistic talents, she shows amazing defiance.   When she discovers that her father has a beautiful female friend, undoubtedly a lover, her consideration of this circumstance does not render the crushing blow that might be expected.  In retrospect she is more adult, more mature than most young women might be in each of these situations.  She is a remarkable young woman with a spirited edge.

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Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Criticism

Summary:

This is a compendium of original critical essays on a wide range of topics written by a diverse group of scholars of what has traditionally been called "medical humanities." The editors argue for a change of name to "health humanities," pointing out that "medical" has a narrow frame of reference - evoking primarily the point of view of physicians and their interaction with patients, as well as the institution of biomedicine. Such a focus may exclude the myriad allied individuals and communities who work with patients and their families. The editors quote Daniel Goldberg, who notes that the health humanities should have the primary goal of "health and human flourishing rather than  . .  the delivery of medical care" (quoted on page 7).

The three editors are innovative contemporary scholar-educators in the field of medical/health humanities. They advocate Megan Boler's "pedagogy of discomfort" (quoted on page 8) and wish to provide students and educators "an opportunity to examine critically the origins and nature of their personal beliefs and values, beliefs and values embedded in the curriculum and the learning environment, as well as institutional policies - all of which intersect" . . and influence quality of care (8). In their own work and in this Reader the editors favor an approach to health humanities education and research that "challenge[s] the hegemony of a biomedicine that contributes to disparities and the discrimination of persons who don't quite fit the codified and naturalized norms of health."

The book is divided into 12 parts, each comprising three or four chapters: Disease and Illness, Disability, Death and Dying, Patient-Professional Relationships, The Body, Gender and Sexuality, Race and Class, Aging, Mental Illness, Spirituality and Religion, Science and Technology, and Health Professions Education. At the end of each section there is "an imaginative or reflective piece" on the topic. A wide range of disciplines is represented, including disability studies, history, bioethics, philosophy, literature, media studies, law, and medicine. Some of the authors are well-known and have been practicing their profession for many years (for example, Arthur Frank, Sander Gilman, Anne Hudson Jones, Martha Montello, John Lantos) while others have entered the field more recently and are gaining increasing attention (for example, Rebecca Garden, Daniel Goldberg, Allan Peterkin, Sayantani DasGupta).

The Reader is well documented: there are footnotes at the end of most chapters, a references section of 50 pages, notes on contributors, and a 72-page index.

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Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

In the course of sharing her own experience of breast cancer diagnosis and treatment, the writer offers personal reflections on coping with each of a number of specific challenges most American women with breast cancer face:  desperation, fear, sadness, anger, guilt, overwhelming choices about treatment, side-effects of treatment, grief, adjusting to a new "normal," shifts in relationship, and rethinking spirituality.  She raises hard questions in a compassionate way, encouraging readers to use the experience of illness as an occasion for examining and growing into a new phase of psycho-spiritual maturity.

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