Showing 21 - 30 of 192 annotations tagged with the keyword "Alcoholism"

Smoke: Poems

Bryner, Jeanne

Last Updated: Aug-15-2012
Annotated by:
Donley, Carol

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

This powerful collection by nurse-poet Jeanne Bryner addresses several themes.  She tells very difficult child abuse stories in the voices of children and health care professionals.  Nursing stories emerge from experiences on the surgical floor, in the ICU, labor and delivery, ER, etc.  In one poem nurses take a political stand for healthcare reform; in another the nurse helps a patient die; in another she listens to a patient describe how he endured the colonoscopy prep in his bathroom, then took his shotgun and blasted the plastic jug "to Kingdom Come.  That, he said, felt like justice." A whole section of the collection is devoted to writing workshops the nurse-poet led with cancer survivors, assisted living residents, former patients.

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Annotated by:
Schilling, Carol

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Open Wound is a novel crafted from the extensive documents of an unsettling, little-known, yet remarkable episode in the history of medicine.

In the summer of 1822, Dr. William Beaumont was practicing medicine at a rugged military outpost on Mackinac Island in Lake Huron, part of the Michigan territory.  His assignment as Assistant Surgeon, US Army represented about the best circumstances he could expect from his training as a medical apprentice without a university education.  In addition to soldiers and officers, Beaumont sometimes attended patients from the American Fur Company, whose warehouses shared the island's harbor.  On June 6, an accidentally discharged gunshot cratered the abdomen of an indentured, French-speaking Canadian trapper.  Fortunately for him, Beaumont served during the War of 1812 and knew how to care for devastating wounds.   With the surgeon's medical attention and willingness to house and feed the hapless trapper, Alexis St. Martin's body unexpectedly survived the assault.  But his wound didn't fully heal.  As a result, it left an opening in his flesh and ribs that allowed access to his damaged stomach.  Through the fistula, Beaumont dangled bits of food, collected "gastric liquor," and made unprecedented observations about the process of digestion.  

His clever and meticulously documented experiments, conducted on the captive St. Martin over several years, corrected prevailing assumptions about digestion.  Once thought to depend on grinding and putrification, normal digestion, Beaumont observed, was a healthy chemical process.  Any signs of putrification or fermentation indicated pathology.  In 1833 Beaumont published his thesis on the chemistry of digestion in Experiments and Observations of the Gastric Juice and the Physiology of Digestion.  Shortly before completing the book, he received a temporary leave from his military service to restart his research in Washington.  But to carry on his project, Beaumont had to persuade St. Martin-who entered and exited his physician-researcher's life several times before-to leave his growing family in Canada and once again become a research subject.  St. Martin does return, with pay, and briefly accepts his role.  But he also confronts Beaumont about whether the long confinement on Mackinac Island was more necessary for the patient's survival or the doctor's research agenda.  Or for the doctor's subsequently improved station in life. 

Although some of Beaumont's academically trained colleagues found fault with his methodologies, the farmer's son and frontier doctor did achieve a gratifying level of professional accomplishment and wealth.  To enjoy them, he had to set aside humiliations he experienced along the way, accept his lot after military service as an ordinary practitioner in St. Louis,  and weather an unforeseen turn near the end of life.    

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The Trapper's Last Shot

Yount, John

Last Updated: Dec-16-2011
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The Trapper’s Last Shot opens in 1960 when Beau Jim Early is returning home to Cocke County, Georgia, after 6 years in the U.S. Army. Beau Jim moves in with Dan, his brother, who is 15 years older and now a farmer, both of them survivors of a fire that killed their parents and drove them from North Carolina. Living with Dan in very straitened circumstances are his mean-spirited and child-abusing wife, Charlene, and Sheila, their thumb-sucking 7 year old who is about to repeat first grade, perhaps in part due to the literal pillow-smothering attacks at the hands of Charlene when she was still an infant, and assuredly in part due to the intellectually barren home life described.

Beau Jim realizes his immediate post-service dream of enrolling in college, nearby Senneca College, while learning to hustle pool with Claire, his high school classmate now mentor. Claire is a worldly wise alcoholic homosexual who has learned how to survive in the deep South as such while remaining just below the radar of his homophobic, racist white contemporaries. Somewhere amidst all this hubbub Beau Jim meets up with an old high school classmate, Yancey, and, a trifle improbably, becomes her beau as well as her Beau.

Although enjoying college and doing well, Beau Jim begins to doubt his intellectual fit as a college man, given his background and temperament. Shortly after, he and Claire suffer a beating at the hands of the stereotypically vicious local Deputy Sheriff Earl Wagner, a beating initiated by Claire’s homosexuality, which Jim had not suspected. This beating is the penultimate climactic event in the book: Jim quits college; Claire effectually disappears from view; and the focus now shifts to Dan and his struggling farm and family life.

Charlene, in a fit of pique over Dan’s decision to have her milk the cow to save money, sets the barn on fire (a fact never discovered by Dan), kills the cow and, in so doing, detonates the apocalyptic sequence of events that close this dark novel in an even more noir fashion. Dan snaps mentally, shooting to death an entire family of innocent blacks whom he knew and respected, as well as a stranger, a college student at Senneca.

The final pages, like the opening ones, provide a bookend (literally) of bleakness: we find Beau Jim working as a mason in  a new town with despicably mean white masons in a dead end job as he tries to establish a family life with Yancey and Sheila, whom Charlene is more than happy to be offloading on them. Unlike the initial pages, the ending offers a glimmer of the hope for an intact family life for Beau and Yancey and Sheila.

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Summary:

Johanna Shapiro, Director of the Medical Humanities Program at University of California Irvine School of Medicine, brings her considerable skills and experience as medical educator, writer and literary critic to this unique volume of medical student poetry. Shapiro collected over 500 poems by medical students not only from her home institution but also from other US medical schools and performed a content and hermeneutic analysis. As Shapiro carefully details in her methodology section, she treats "poetry as a form of qualitative data, and [therefore] techniques of analysis developed for other sources of qualitative data (such as interviews, focus groups, and textual narratives) can be applied to an understanding of poetry." (p. 42)

Relying on the work of Arthur W. Frank (see The Wounded Storyteller), Shapiro devises a typology of student poems: chaos, restitution (and anti-restitution), journey, witnessing, and transcendence (this last category was not Frankian in origin). These categories are developed and explicated in Chapter 2: Functions of Writing for Medical Students. As the author notes, poems traverse the boundaries between types; nonetheless, the framework of the analysis rests with this typology. Further, Shapiro explores the metaphors of topography (illness as a foreign land) and quest (student on a heroic, however tentative or confused, journey) throughout her study.

The book contains many fully reproduced medical student poems, contextualized with academic theory on medical education. Hundreds of references, particularly in the fields of narratology and medical education, are cited. After three chapters of theory and methods, eight topics are explored using the outlined analytic tools: anatomy class, becoming a physician, patient experience, doctor-patient relationship, student-patient relationship, social and cultural issues, death and dying, love and life. Prefacing each of these topics is a scholarly essay providing historical and research foundations; every chapter concludes with a summation.

Within the chapters are examples of poems, not only organized by typology, but also by content. For instance in the patient experience chapter, the topics are: "patient pleas for empathy and compassion," "patient fears and suffering," "stigmatized voices," "vulnerability/courage of child patients," and "personal experiences of illness." Within each topic/subtopic, different poems are highlighted and fully analyzed. Additionally, other poems, not reproduced, are quoted as illustrative examples. Summary arguments are provided at the conclusion of each chapter as well as in the final chapter: "Strangers in a Strange Land: What Matters to Medical Students on Their Journey and How They Tell About It."

Although Shapiro states that her purpose "is not to address the literary and aesthetic attributes and value of the poems", she also notes "when students write authentically about their own experience, the results are uniformly moving, compelling and impossible to ignore." (pp 44-5) Indeed many of the poems are rewarding to read not only for content but also for word choice, word play, imagery and narrative line. For instance, in "Ode to the Peach" Brian McMichael explores the senses Neruda or Pollitt-like: "you invite me with / your voluptuous curves / your feminine little cleft". (p 236) Another example is the humorous, self-deprecating "Piriformis" by Curtis Nordstrom relating an early clinical experience by a medical student who hopes against hope that the patient's presenting complaint will require the student to demonstrate his acumen. Unfortunately the sum total of the student's knowledge base is limited to the location of the piriformis muscle; both the student and patient are "so screwed" when, "Alas, the patient presents with / an upper respiratory infection." (p. 16)

Shapiro's sensitivity and generosity of spirit vis-à-vis the medical student experience are evident throughout the volume. She concludes that "what may be most noteworthy about the analysis of these poems is that, amidst their own difficulties and fears, time and again these students reported engaging deeply with their patients." (p 259) She hopes that medical educators will be encouraged to support "in solidarity" the "idealism and high aspirations" expressed in these student poems. (p. 260)

In a postscript, Shapiro reveals her own experiences as a poet-patient. After noting that "[m]edical students are mostly annoyingly healthy, energetic, smart, and capable young adults who like order, structure, and control", (p 261) she also acknowledges how frequently students grapple with the topic of death and dying in their poems. That her poems emerged from advising a student creative writing group demonstrates how poetry can be renewing and vital not just to the student, but to the educator as well.

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Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The journalist author investigates the hidden lives of his father and his grandfather, both physicians. He is motivated by the mysterious silence that pervaded the ancestral home in a wealthy Toronto neighborhood, and by the frightening tendency to depression and suicide that stalks his family members like an Irish curse.

He uncovers many details of the early adventures of his parents, the failure of their marriage, and his father’s doomed career. From his beginnings as a debonair socialite, the father, Jack, embarks on a promising medical career as an allergist; however, he virtually sinks into taciturn misery and alcoholic self-destruction, unable to express affection or joy. Jack’s endless travails as a patient through shock therapy, analysis, and heavy psychiatric drugs are presented in merciless detail using hospital records and interviews with caregivers. The author’s self-indulgent anger with his self-absorbed father drives the research deeper into the earlier generation, to learn about the grandfather of whom his parents rarely spoke.

The author's grandfather, Irish-born John Gerald FitzGerald (1882-1940), son of an immigrant pharmacist and an invalid mother, strode through the exciting scientific world of the early twentieth century like a medical Forrest Gump. At first, he is drawn into the new fields of psychoanalysis, psychiatry, and neuropathology; cameo appearances of Freud, Ernest Jones and C.K. Clarke light up the story. But then this elder FitzGerald is swayed by the need to control infections and produce vaccines. He travels Europe and the United States for three years learning bacteriology.

Upon his return to Canada in 1913, he fearlessly launches a Canadian-made solution, outfitting a stable and a horse farm to produce rabies vaccine and diphtheria anti-toxin. The initiative evolves into the famous Connaught Laboratories and the School of Hygiene, its academic arm. Other luminaries enter the story– such as Banting and Best of insulin fame and C.B. Farrar of psychiatry. FitzGerald served as Scientific Director of the International Health Division of the Rockefeller Foundation and as Dean of the University of Toronto medical school.

Nevertheless in his late fifties, having accomplished so much, the grandfather crashes into doubt, depression and self-destruction, believing himself a failure and consumed with guilt for some never-disclosed transgression. Did his stellar achievements, his high expectations, and his baffling demise dictate the collapse of his son Jack?

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My Life as a Doll

Kirschner, Elizabeth

Last Updated: Oct-27-2010
Annotated by:
Aull, Felice

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

In this collection, which is really a poetry memoir or lengthy poetry sequence, the speaker develops her narrative of a tormented childhood and adolescence, psychological breakdowns, and ongoing struggle in a more "normal" present.  The poems are labeled only by section, of which there are four, and are separated simply by their spacing on the page.  Section 1, "Cuckoo," reveals the origin of the poet's "life as a doll": "After my mother hit the back /of my head with the bat's /sweet spot, light cried / its way out of my body. . . . I was  . . . a doll carved out of a dog's bones . . . my life as a doll / was a life of waiting" (4-5).  Mother was an abusive alcoholic (there seems to be no father ever on the scene).

Section 2, "An Itty Bitty Ditty," concentrates on the speaker's adolescence, which was one of promiscuity and parental neglect.  "Pretty, said Mom / on the night of the prom . . . Pretty, she said as though / I were a ditty, an itty bitty / ditty not even God would pity. / Ditty gone silent.  ditty gone numb" (27).  At age 19 the poet/speaker "took a razor to my wrists"; she was pregnant with an unwanted child at age 20: "Cold walked into me and through me . . . How do you undo someone who's / already undone?" (32-33).

In the third section of the collection,"Tra-la-la," we are whisked ahead to the time when the poet is married and has an 11- year-old son.  At her son's birthday she has a psychotic break and her husband brings her to the hospital.  "When I / stepped out of the car, I sang, /  "tra-la-la," as if I were / Cinderella going to an enchanted ball"  (41).  This section is concerned with her institutionalization and psychotherapy with "Dr. Flesh."  The poet is not enamored of Dr. Flesh, who puts her on display for a group of students "who wanted to be  / just like Dr. Flesh  / who was special, / very very special / unlike me" (43) and who yawns during therapy sessions (44).  The poet also satirizes her diagnostic workup -- a 500 question survey:"Do you like golf? it asked / and when I wrote 'no' / I was diagnosed" (49).  The final section, "O Healing Go Deep," is both a railing and incomprehension about the way the poet's mother treated her, and a plea for sanity: "enough I say of my careening / craziness, of being /a thing in thin wind / running away from Mother" (59).

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Annotated by:
Spiegel, Maura

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

The story follows the final twelve or so hours in the life of a 62 year old widow, emblematically named Dante Remus Lazarescu, (Ioan Fiscuteanu). Suffering with stomach distress and a terrible headache (eventually diagnosed as a subdural hematoma and late stage liver cancer), he spends his last night being shuttled by ambulance, or rather by an ill-equipped van serving as ambulance, from hospital to hospital, unable to secure the emergency surgery that would save him. The hand-held camera and long uncut takes -some are six or more minutes- give the movie the feel of unfolding in real time. In places, it has the look of a documentary, and it has been compared to Frederick Wiseman's Hospital (1970).

Before the odyssey begins, we meet Mr. Lazarescu in the cramped, unkempt Bucharest apartment he shares with his three cats. Of his circumstances we learn that he is a retired engineer whose only daughter has emigrated to Toronto, and that despite having had ulcer surgery years earlier, Mr. Lazarescu drinks heavily. In his every encounter -with neighbors and with a string of doctors- he is reprimanded for his drinking, implicitly or explicitly blamed for his ill-health. From the television blaring in his apartment we hear news of a truck gone out of control that has rammed a tourist bus. Casualties from the accident are taxing hospital resources, which accounts in part for why this ill-smelling elderly man who appears to be drunk (but turns out to be having a cerebral bleed) is a low priority, although this doesn't account for the callousness with which he is treated by much of the medical staff.

The most significant relationship in the film is between Mr. Lazarescu and the ambulance nurse, Mioara (Luminita Gheorghiu) who shepherds him throughout the night. Almost everything we know about her is what one knows from watching someone at her job; in Puiu's hands, this vantage turns out to be richly informative. (Ms. Gheorghiu's body language speaks volumes.) Mioara and Mr. Lazarescu hardly speak to one another; they don't "open up" to one another or have a "meaningful moment," nothing to compare, for example, to the Popsicle scene between the nurse, Susie, and patient, Vivian Bearing, in Wit (see annotation). The power of the relationship in this film is in what is not overt, but what is palpable nonetheless -that Mioara's presence means very much to Mr. Lazarescu, and that doing her job includes letting him know that she is standing by him, that he is the priority, the only priority. Mioara staunchly meets the irascibility and chastisement of various physicians in her efforts to advocate for her patient as he is passed off from one hospital to the next.

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Less Than Zero

Ellis, Bret

Last Updated: Jul-30-2010
Annotated by:
Henderson, Schuyler

Primary Category: Literature / Fiction

Genre: Novel

Summary:

19 year old Clay has returned to Los Angeles for the Christmas break, his first time back after leaving for a Northeastern college.  He spends the next month meeting with his clique, going to parties and restaurants, visting a friend hospitalized for anorexia, lying on his bed at home and joining his family at the mall or for dinner.  As Clay and his friends are the progeny of LA's wealthiest, this typical return-from-college-for-the-Christmas-break story also entails driving expensive cars, steady drinking, constant smoking, copious amounts of cocaine and marijuana, and frequent sex (gay, straight; voluntary, paid-for).  Dulled by drugs and boredom, these teenagers are drawn to excesses to jolt them out of their expensively-maintained ruts: to prostitution and snuff films, to dead bodies in the street and, ultimately, to sadistic child abuse.

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Annotated by:
Schilling, Carol

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

As Audrey Young describes her process of becoming a compassionate internist in a besieged public hospital, she simultaneously argues for turning the hospital's patient care and financial practices into a model for improving health care in America.  Young, a compelling storyteller, first entered Seattle's Harborview Medical Center in 1996 as a third-year medical student on trauma surgery service.  She completed a residency there in general internal medicine and stayed on as an attending for six more years.  She stayed, she tells us, because she met physicians "committed to a vision of equality" who were "the sort of people I hoped to become" (xiii).   She also "fell in love" with "the story of a unique place" (xiii).  Young's stories of that often chaotic place, where ambulances regularly transport homeless, indigent, addicted, and mentally ill refugees from neighboring private hospitals, emphasizes the ways the Harborview staff manages to treat patients with dignity and to choose an ethic of hope in the face of dire circumstances.           

We quickly learn that at Harborview compassion is expressed concretely as actions toward patients.  Michael Copass, known as "the mostly benign dictator of emergency operations," pronounced the core of these actions in what came to be known as his commandments:  "1. Work hard.  2. Be polite.  3. Treat the patient graciously, even if he is not the president of the United States" (9).  Politeness always meant asking "'How may I help you, sir?'" regardless of the patient's social status or addiction history.  Politeness sometimes meant finding a way to reach the patient who regularly threatened the staff.  Young finds ways and creates a therapeutic bond.  But working hard and treating patients considerately also took measurable forms, such as not allowing emergency patients to wait.  Facing a flurry of admissions, the Emergency Department (ED) staff interpreted a young Ethiopian's complaints about pain as a drug addict's ploy.  Because Young glanced at the admissions board and noticed that he remained unattended for three hours--far longer than Copass could tolerate--she jumped into action.  He suffered, she discovered, from a collapsed lung. 

However, Young moves her narrative beyond individual doctor and patient encounters and into the larger, interrelated social and financial structures in which medicine is practiced.  For instance, she links meager funding for drug and alcohol rehabilitation programs with expensive ED admissions and rising healthcare costs.  In the chapter "Bunks for Drunks," Young visits an experimental residence that houses homeless addicts in furnished studios with private baths and cooking appliances.  Although residents can keep alcohol in their rooms and elect not to participate in the home's social services, including counseling, alcohol consumption and ED admissions decrease.  While the chapter points out the cost savings of such arrangements, Young further urges readers to value the dignity residents experience there.

In "Black Friday," Young details the hospital's tense, but ingenious responses to a Mass Casualty Incident, the result of carbon monoxide poisoning, which almost depleted the resources of all of Seattle's medical centers.  The final chapter, "A Vision," outlines how Harborview has tried to succeed as both a charitable institution and a business, as a provider of both indigent and luxury care, with the hope that others will follow the medical center's example.  However, in presenting her recommendations for "health justice," Audrey Young also makes the case that "seemingly ordinary citizens" are implicated in healthcare reform (231).  To enable their informed participation in making changes, Young includes an appendix with further readings and another that lists strategies for effecting reform.  

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Summary:

This is a collection of four stories and a novella with pervasive themes of death, loss, grieving, mourning, and anger; the characters live in rural parts of the upper midwest, and there is much unhappiness in their lives.

In "Catch and Release," we accompany Danny, a talented fishing guide "not quite thirty," as he floats down a stream he knows well. He and his siblings have divided his father's ashes, his portion now in a thermos. His father died suddenly, absurdly on a bathroom floor. Although Danny knows nature well (and loves it), he is angry and heartsick. Nor is religion a comfort. Bit by bit he scatters the ashes, but there is no healing ritual.

In "Bloodsport" a young man murders is wife and then kills himself. The town funeral director feels this is "utterly incomprehensible" but provides his professional services to the family and all who  come to the service and burial. He knew the young woman, Elena, and found her attractive; now he embalms her. Twenty years later he feels a "sense of shame" that men "let her down badly."

"Hunter's Moon" presents Harold, a casket salesman. Retired, he goes on long walks, trying to make sense of is life and loves. He likes naming things. His first wife left him for another woman. His daughter (pregnant and drunk) was killed by a train. His second wife left him. His third wife died of cancer. He abuses antidepressants and liquor. Sitting on his front porch, he slumps over. All night a dog keeps watch over, we assume, his dead body.

In "Matineé de Septembre" we find a reworking of Thomas Mann's "Death in Venice." In both stories, a literary figure escapes ordinary time, falling in love with a young person of the opposite sex, and falling into decadent gestures in the hope of recapturing youth. Both efforts end in failure and death. In Mann's story, the person is an older man of much literary accomplishment. In Lynch's retelling, the person is a professor and "poet of note," although not really of international fame. Actually she's a woman of inherited wealth, a wealthy snob, a narcissist, a survivor of a "perfectly bargained marriage." Her one child was stillborn. A dozen hints at her headaches suggest that she is doomed, and she dies in the last paragraph, without (as in the Mann story) the notice of the literary world.

After these grim tales comes the satiric (and also grim) novella, "Apparition." We follow one Adrian Littlefield (the last name is symbolic) who was a strait-laced pastor, then (after his wife left him) a self-help author who urged post-divorce people to live it up. The satire is trenchant. Adrian's big book is "Good Riddance." A church fundraiser with gambling allows "otherwise devout people to wallow in sin for a worthy cause." Adrian has girlfriends and one-nighters. He's an expensive speaker. Fortunately one Mary De Dona provides him with gratuitous sex, and he is saved. Now 50+, he visits the empty house where his wife once lived, learning little; his tour guide, one "Gloria" is in her 70s, married for 58 years, with grandchildren and great-grandchildren. He wishes he could have had such a life and feels "a wave of sadness." 

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