Showing 291 - 300 of 436 annotations tagged with the keyword "Cancer"
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.
Giovanni (Nanni Moretti) is a psychoanalyst. He has a beautiful wife, Paola (Laura Morante), and an adolescent son and daughter, Andrea and Irene. One Sunday morning, Giovanni gets a call from one of his patients, newly diagnosed with cancer and frantic. Instead of spending the day with his family, Giovanni attends to his patient. Andrea goes diving with friends, there is an accident, and he is killed.
The rest of the film examines the family’s bereavement. Giovanni finds his work increasingly difficult, and by the end of the film he has decided that he can no longer be a psychotherapist.
A love letter addressed to Andrea arrives from a girl called Arianna: it turns out Andrea had a secret girlfriend. Both parents become obsessed, in different ways, with contacting Arianna. Eventually she visits them, while hitchhiking with her new boyfriend, and the family drive all night along the Mediterranean coast, taking Arianna and the boy to France. Next morning, on the beach at Nice, in saying goodbye to Arianna, they seem to have made progress in continuing their life as a family without their lost son.
Author and Oxford don, C. S. Lewis (Anthony Hopkins), lives a sheltered life as a bachelor, sharing a house with his brother. In 1952 he meets an American woman, Mrs. Joy Gresham (Debra Winger). They become friends when Joy moves to England with her young son, Douglas, divorcing her alcoholic husband; when Joy is in danger of losing her visa, Lewis agrees to marry her so that she can become a British citizen.
The marriage appears to be purely a technicality. This is in part because of Lewis’s emotional frigidity with people, which is contrasted with the profundity and energy of his engagement with books and ideas. Joy eventually confronts him about this, and at about the same time she is diagnosed with advanced cancer.
The prospect of her death disrupts Lewis’s ideas about God, suffering, and human relationships, prompting a crisis that leads him to recognize his love for her. Their legal marriage is consecrated in her hospital room and, after radiation treatment puts her in remission, Joy and her son move in with Lewis. After a few months, she dies. Lewis is left with a new knowledge of the real paradoxes of love, connection, loss, and suffering.
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)
Abba Kovner wrote these poems during and after his hospitalization at Sloan Kettering for throat cancer. His exile into the world of illness begins as he enters the hospital. "He fell asleep under strange skies" (p. 7) and in the hospital "the silence astounds on all / its many floors."(p. 11) [Throughout the book, Kovner refers to himself in the 3rd person.] He tries to pray: "Is there a prayer for one who prays like him / seething . . . " (p. 15) He decries "the infuriating confidence of the doctors." (p. 21) He celebrates the beauty and magnificence of New York. But then the bad news arrives: "When they told him they were going to cut away his vocal cords / entirely it was merely / a confirmation of what he already knew."(p. 31)
To the brisk, young hospital staff, he is just another patient, nothing but an "ancient shard”: "They could not imagine that this was a man / who had fought the world."(p. 36) Only Norma, the Puerto Rican night nurse, connects with him at a different, more human level. "He blushes / when Norma says: What a lovely / head of hair you have, sir!" (p. 88) As he prepares for the laryngectomy, images from the past invade his consciousness--Christmas Eve, 1941; the Vilna ghetto, where "the lice / got under your skin" (p. 68); and "a shoemaker, his name forgotten" (p. 74). The Holy Guests--the souls of Abraham, Isaac, Jacob, Joseph, Moses, Aaron, and David--also visit the sick room.
After the surgery, the conspiracy of optimism brings him along, carries him forward: "What a healthy recovery, / they said. And patted him on the shoulder / with admiration: You’re doing fine. Wow!" (p. 85) But this is at best a voiceless recovery: "From the wreckage of his voice / there arose a bubble / a tiny bubble . . . " (p. 101) Eventually, the patient leaves the hospital, leaves New York, and arrives home: "Fearful from the moment of arrival: he / watches the landing that cannot / be avoided, into / the arms / of people who love him . . . " (p. 111) He settles into a routine, lives his life as if there is nothing new, but ends at "An Ending, Unfinished" (p. 126), back at Sloan Kettering. "Where now? He asked himself . . . " What next?
A lonely neurosurgical resident becomes involved with a comatose patient. Susan, a dying woman with an inoperable brain tumor, is the subject of a research study. Scientists are attempting to discern her thoughts with the aid of computers. The resident serendipitously stumbles onto a program that successfully translates the electrical activity of Susan's brain into speech. He labels the computer program a failure (but saves a copy for himself) so that others are unable to eavesdrop on her dreams.
He spends nights listening to her thoughts and soon begins communicating with Susan, sharing his own secrets with her. When the resident learns that the research project is about to be terminated, he decides that Susan is in desperate need of human contact. He kisses her and presumably has sexual intercourse with the comatose woman. The next morning he is found asleep beside her and is dismissed from the hospital.
This collection of 36 poems, some of which have been published individually in various literary magazines, is primarily about dead--or nearly dead--family members: a brother and sister lost to cancer; the speaker's palsied, nearly blind father dying of Parkinson's disease; his mother's struggle with chronic arthritis and heart disease.
The collection is divided into three untitled sections. The first deals primarily with the aging and death of the speaker's parents; the second with a wider range of abandonment and death, lost loves, dreams, innocence; the third almost exclusively with his sister's six year struggle with breast cancer and dying.
Frank Carveth (Art Hindle) has a wife, Nola (Samantha Eggar) who is mentally ill (the exact nature of her "breakdown" is never made clear, but it is implied that she was abused as a child). Nola is an in-patient at the Somafree Institute of Psychoplasmics run by Dr Hal Raglan (Oliver Reed). Raglan treats patients by engaging in intense role play encounters in which he takes the part either of parent or child to the patient.
The result of his approach is the somatization of emotional problems, his logic apparently being that allowing psychopathology to manifest in the (medically treatable) body liberates the less accessible psyche from illness or harmful emotions. So, for instance, a man with unresolved anger against his father develops sores all over his body during therapy. Their healing enacts his catharsis.
There are problems, however: another patient attributes his terminal cancer to Raglan's therapy, saying "psychoplasmics . . . encouraged my body to revolt against me and it did." Most terrifying of all is Nola's rage. It expresses itself in the form of strange buds that appear on her abdomen. These develop into external wombs, or amniotic sacs, from which she keeps giving birth to deformed and malevolent children.
These children, "the brood," literally enact her rage, escaping from Somafree to attack and kill anyone who is the object of Nola's anger, including both her parents and, eventually, Dr. Raglan himself. When the brood turns on Candy, Frank and Nola's actual daughter, Frank strangles his wife, and her evil offspring die with her.
At the heart of this novel is a simple love story. Dr. Bruno Sachs, a slight, stooped, and somewhat unkempt general practitioner in a French village is dedicated to his work and loved by his patients. Sachs is a solitary, self-effacing man who takes his Hippocratic duties seriously and is especially sensitive to the needs of his patients.
In addition to his private practice, Sachs works part-time at an abortion clinic, where he performs an abortion on a distraught young woman named Pauline Kasser. Soon the doctor and his patient fall in love. She moves in with him and becomes pregnant. An editor by profession, Pauline also encourages and assists Dr. Sachs in completing the book he is writing.
The story has many additional layers and dimensions. The reader views Sachs through the eyes of multiple narrators--his patients, colleagues, friends and acquaintances, all of whom write in the first person and present Bruno Sachs as "you" or "he." Thus, the reader gradually builds up a "connection" (empathy) with Sachs by synthesizing multiple glimpses of his behavior and facets of his character. At the same time, Sachs is trying to find his own voice, his own connection, by becoming a writer. At first he jots down random thoughts, then he keeps a notebook, and eventually he produces a complete manuscript.
The book has innovative structural elements that introduce other layers of meaning. For example, the 112 short chapters are organized into seven sections, corresponding with the components of a complete clinical case history: presentation (as in "chief complaint"), history, clinical examination, further investigations, diagnosis, treatment, and prognosis. Similarly, the narratives delve progressively into Sachs' "illness" and follow the "patient" through his course of "treatment."
Another structural element is the cycle of fertility and gestation. The story takes place from September through June, precisely 40 weeks, a pregnancy of nine months, during which Sachs is re-born.
Tim Metcalfe is an Australian general practitioner who gave up medical practice to become a full-time poet and writer. A statement on the back cover summarizes the process in relation to this collection of 38 poems: " ’Cut to the Word’ is a moving account of one man’s transition from doctor to poet." He begins with the customary initiation: "We were introduced, respectfully, / to the volunteer dead . . . " (p. 13) He discovers the limitations and uncertainties of his new profession: "In tense moments / I wish my stethoscope / was all they want it to be." (p. 18) And the omnivorous demands of medicine: "I come home from work / and there it is: the family / the oldest crying / at the youngest crying / at her mother’s anger / at her crying . . . " (p. 21)
Metcalfe carries the reader through a series of short, incisive poems describing the doctor’s day-to-day work ("Morning Session, " pp. 47-50), as well as through a number of disturbing poems about the world of mental illness, but the book’s climax--so to speak--arrives with "The Doctor’s Complaint, " in which the physician heals herself "by laying down her stethoscope / and walking right out / of that in-patient clinic." At the end the poet writes, "Like a patient I have learned silence . . . Fine steel scissors in hand, / I cut to the word." (p. 63)