Showing 261 - 270 of 361 annotations tagged with the keyword "Catastrophe"
This masterful collection of essays was written by Gawande while he was a general surgery resident. The book consists of fourteen essays divided into three sections: Fallibility, Mystery, and Uncertainty. Although some of the essays fall clearly within the boundaries of the section title (such as "When Doctors Make Mistakes" and "When Good Doctors Go Bad" in the Fallibility section), others cross boundaries or don’t fall as squarely in these general themes ("Nine Thousand Surgeons," an anthropological essay on the cult and culture of a major surgical convention, is also located in the Fallibility section). Nevertheless, the many pleasures of the individual essays, the range of topics explored in depth, and the accuracy of the medicine portrayed are the true strengths of this work.
The book begins Dragnet-style with an Author’s Note: "The stories here are true." (p. 1) And it is this attention to fidelity that makes the essays so compelling. Because even when the truths are hard--the terrible acknowledgment by the medical neophyte about lack of skill and knowledge, the mistakes in judgment at all levels of doctoring, the nature of power relations and their effects on medical pedagogy and on the doctor-patient relationship, the gnawing uncertainties about so many medical decisions--the author confronts the issues head on with refreshing rigor, grace and honesty.
Many of the essays reference scientific and medical research (historical and current) as part of the exploration of the topic. This information is imbedded within the essay, hence avoiding a dry recitation of statistical evidence. Typically, the reader’s interest in an essay is immediately piqued by a story about a particular patient. For example, the story of an airway emergency in a trauma patient, her oxygen saturation decreasing by the second as Gawande and the emergency room attending struggle to secure an airway, surgical or otherwise, sets the scene for "When Doctors Make Mistakes."
This leads to a meditation on not only the culture of the Morbidity and Mortality Conference, with its strange mix of third-person case narrative and personal acceptance of responsibility by the attending physician (see Bosk, Charles, Forgive and Remember: Managing Medical Failure, U. Chicago Press, 1981 for an in depth analysis of this culture), but also a positive examination of the leadership role that anesthesiologists have played in improving patient safety via research, simulator training and systems improvement.
Gawande’s journalistic verve takes him beyond the confines of his own hospital and training to interview patients and physicians on topics as diverse as incapacitating blushing ("Crimson Tide"), chronic pain ("The Pain Perplex"), malpractice and incompetence ("When Good Doctors Go Bad") and herniorraphy ("The Computer and the Hernia Factory"). In addition, he visits his own post-operative patients at home ("The Man Who Couldn’t Stop Eating" and "The Case of the Red Leg") which gives a longer view of postoperative recovery and a broader exposure to patients’ perspectives.
Some of the most telling moments come with the introduction of his children’s medical problems into the text. These range from the relatively straightforward (a broken arm, but a chance to comment on detection of child abuse in the emergency room) to the downright parental nightmare scary (severe congenital cardiac defect in their oldest child and a life-threatening respiratory infection in their prematurely born youngest).
These last two experiences are introduced to provide an angle on issues of choice. Choice of a fully trained, attending physician rather than a fellow to provide follow-up cardiac care for their oldest, and the choice to opt out of the decision-making process for whether to intubate the trachea of the youngest and hence leave the medical decisions up to the care team.
This book's title is from a Goethe poem, "The Holy Longing," translated from German in its entirety by Robert Bly: "And so long as you haven't experienced / this: to die and so to grow, / you are only a troubled guest / on the dark earth." Ten intensely personal essays tell of the suffering and everyday presence of pain of a severely disabled writer who has advancing multiple sclerosis, and of how, "in a very real sense, and entirely without design, death has become [her] life's work." (p. 13)
Beginning with her father's sudden death when she was a child, the essays describe her aging mother's expected death and the family's decision to take her off life support; her caretaker husband's diagnosis of metastatic cancer with uncertain prognosis; her own attempted suicide; death of friends, pets, including her beloved dog; and a young pen-pal executed on death row. If that weren't enough, a coda, her foster son's murder and again the decision to remove life-support, provides "[t]he end. For now." (p. 191)
David Slavitt has written his own response [Part I, "Meditation" (pp. 1-58)] to the five poems (chapters) that comprise the Old Testament's "Book of Lamentations," which he has translated here from the Hebrew [Part II, "Lamentations" (pp. 59-85)]. The poems appear in Hebrew and in English, on opposite pages. In addition there is a "Note on Translation" (pp. xiii-xiv) and a "Bibliographical Note" (pp. 87-88).
Five poems--The Book of Lamentations--express Israel's brokenness, bewilderment before God, and sorrow at the catastrophes that have beset the Jewish people through the ages. Slavitt's meditation and notes on translation prepare the reader for far more than a prosaic historical account of the destruction and biblical plights of the Jews. "A translator wants to be faithful to the original work but then discovers how fidelity to the word can mean a betrayal of the sentence." (p. xiii)
"As a boy, I knew next to nothing of Tish'a b'Av," begins the author's meditation. We learn, as he did, about "[this] worst day of the year"(p. 6)--the day in 587 B.C. that the Temple in Jerusalem was destroyed, and six centuries later on the same day, when the second temple was destroyed. Annually Tish'a b'Av is devoted to grieving "every terrible thing that happened in this world "(p. 6): Zion, Jerusalem, the Holocaust. Except for The Book of Job (see annotation in this database) and Lamentations, reading even the Torah, the most sacred text in all Judaism, is forbidden on this solemn day.
Summary:The author begins by avowing that he would never "mourn the majesty and burning of the child's death." He expresses the utter inadequacy of mere words to describe any child's passing.
This poem--"not graveyard roses"--is the poet's gift to her dead friend Bulgakov. He was defiant and steadfast in the face of all the tragedies of his "high, stricken life." While others may not raise their voices to praise Bulgakov (because of the danger of doing so in Stalinist Russia), "one voice at least / Must break that silence, like a flute." The poet remarks how amazing it is that she who has lost so much in her life should now be eulogizing "one so full of energy / And will" who "only yesterday" was "hiding the illness crucifying him." [20 lines]
Summary:Dominating the image, a vengeful Satan with arms outstretched stands upon Job's prone body dispensing boils from a vial with his left hand while shooting arrows at him with his right. Job's head is thrown back and his hands are lifted off the ground in a sign of agony. His weeping wife kneels at his feet. The background is minimal yet dramatic with its dark swirling clouds, bright setting sun, and Satan's huge blood red wings.
A dark comedy about an upper-middle class blended family living the technology overloaded, mall-mad contemporary American life in a small midwestern town until catastrophe strikes. Jack Gladney teaches Hitler studies at the College-on-the-Hill. He is married to his fourth wife Babette, who reads tabloids to the blind and teaches posture classes to senior citizens. Together, they have four children, and a quirky extended family.
Interspersed in the noisy, chaotic family relationships is the central questions that obsesses Jack and Babette: who will die first? Death is everywhere in this story--on TV, radio, at the mall, in Hitler studies, and at home. Then an industrial accident releases an "airborne toxic event"--a lethal cloud of Nyodene D. to which Jack is exposed.
Absurd, witty, and almost plausible, the catastrophe answers his question about who will die first, but tells him nothing about death itself. What is the meaning of death, and, by implication, life? In the final section, dying Jack goes to hospital and meets nun Sister Hermann Marie and questions her about her faith. She explains that her piety is only a pretence: . . . "we are here to embody old things, old beliefs. The devil, the angels, heaven, hell. If we did not pretend to believe these things the world would collapse." (p. 318)
Responding to the suppression of an historic event barely recalled today--5000 Madrid civilians executed for revolting against the invading Napoleonic French army--Goya painted a monumental canvas. The painter depicts fear and defiance in the enlarged white eyes of the patriots still alive, some shielding their eyes and faces with their hands. Profuse blood seeps from the dead lying in groups all over the ground as the firing squad of well-equipped professional soldiers massed together (only their backsvisible to the viewer), shoot at alarmingly close range unarmed, shabbily dressed peasants.
Strong light from a single lantern illuminates the face and body of one white shirted condemned man on his knees, eyes wide-open, leaning forward, arms outstretched, Christ-like, at the moment he is being shot. The powerless, innocent and grieving victims, next to be sacrificed, are hemmed in by a barren hill behind which looms the outline of barely visible city buildings, including a church.
In a preface written in 1957, the author recounts the origin of "Requiem." Akhmatova spent 17 months waiting in line outside a prison in Leningrad for news of her son. One day a woman shivering in the crowd identified Akhmatova and whispered, "Can you describe this?" The poet answered, "I can." This sequence of poems is the result.
In "Dedication" Akhmatova sets the scene: "We rose / and each day walked the wilderness, / trudging through silent streets and square, / to congregate, less live than dead." (p. 101) In this time "when only the dead / could smile . . . " she addresses her son, "At dawn they came and took you away. / You were my dead." (p. 103) For "seventeen months I have cried aloud," but there is no relief, and "nothing is left but dusty flowers, / the tinkling thurible, and tracks / that lead to nowhere." (p. 107)
She addresses death; she welcomes madness: "Already madness lifts its wing / to cover half my soul." (p. 111) In the end the poet's requiem is not only for those who died in Stalin's terror, but also for those who remained alive, for those who waited at the gates: "for all who stood outside the jail, / in bitter cold or summer's blaze, / with me under that blind red wall." (p. 115)
En route to the way to the Trojan War, warrior Philoctetes, wielder of the bow of Heracles, is bitten by a poisonous snake at the shrine of the goddess Chryse. The infected wound becomes so painful that Philoctetes’s screams of agony repel the Greek commanders, who order Odysseus to leave him on the island of Lemnos. Ten years later (the time of the play’s opening scene), Odysseus returns to Lemnos with Neoptolemus, son of the now-dead Achilles, to retrieve Philoctetes’s bow. It has been prophesied that only with this bow can Troy be conquered.
Promising him glory and honor, Odysseus convinces Neoptolemus to win Philoctetes’s trust and take the bow. Philoctetes, delighted to see any human and especially another Greek, shares his story with Neoptolemus, begs him to take him back to Greece, and entrusts him with the bow when he is overcome by a spasm of pain.
Deeply moved by witnessing Philoctetes’s misery firsthand, Neoptolemus confesses the truth to him, but tries to persuade Philoctetes to accompany him to Troy. When Odysseus appears, Neoptolemus returns the bow, declaring that only with Philoctetes himself wielding it will the prophesy be fulfilled. He asks forgiveness, and invites Philoctetes to come back with him to be healed and then on to Troy to contribute to the battle. The only thing that ends Philoctetes’s refusal is the sudden appearance of Heracles, who announces that Philoctetes and Neoptolemus must join together to take Troy.