Showing 291 - 300 of 419 annotations tagged with the keyword "Pain"

Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

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.

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Annotated by:
Belling, Catherine

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

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.

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Annotated by:
Bertman, Sandra

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

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)

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Annotated by:
Bertman, Sandra

Primary Category: Literature / Poetry

Genre: Poems (Sequence)

Summary:

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.

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Annotated by:
Bertman, Sandra

Primary Category: Visual Arts / Painting/Drawing

Genre: Watercolor on wood

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.

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Annotated by:
Belling, Catherine

Primary Category: Literature / Literature

Genre: Anthology (Mixed Genres)

Summary:

This is a rich and diverse anthology of poetry and of prose extracts, both fictional and non-fictional, about becoming a parent. It is organized into three chronological sections: "First Stirrings," about becoming and being pregnant (or of having a pregnant partner: the father’s perspective is refreshingly well-represented throughout), "The Welcoming," about labor and birth, and bringing home the newborn, and "Now That I am Forever With Child," about being the parent of an infant.

Each section contains a cross-section of views, from, for instance, Elizabeth Spires’s languid letter to the fetus inside her to Rosemary Bray’s candid account of her ambivalence about being pregnant; from Julianna Baggott’s thoughts on the Madonna and child, and A. S. (Antonia Susan) Byatt ’s rather frightening description of giving birth in a British hospital in the 1960s, to Hunt Hawkins’s sad poem about holding his dying newborn daughter; and from Jesse Green’s memoir as a gay parent adopting a son to Kate Daniels’s prayer for her children.

The anthology ends with the powerful poem by Audre Lorde that gives its title to the book’s last section. Lorde encapsulates the astonishing change of focus and identity at the heart of becoming a parent.

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D Day, 1994

Coulehan, Jack

Last Updated: Nov-11-2002
Annotated by:
Belling, Catherine

Primary Category: Literature / Poetry

Genre: Poem

Summary:

In this five-stanza free verse poem the speaker, a physician, observes the patient, a young man dying of cancer and suffering pain in the arm he has lost to the disease. The patient watches television, and sees the fiftieth-anniversary commemoration of D Day, the Allied landing in France in World War II. The old soldiers, the war veterans, are enviable for the "honor" provided by the source of their losses and injuries, the sense of meaning that comes from winning a war, which is so unlike the arbitrary and passive suffering of cancer in which, as the speaker says, there's "no honor."

The patient has asked whether a scan would explain the pain in his phantom limb; the physician muses that a scan is the wrong place to look, not just because there is no arm to scan, but because what the cancer patient really lacks is a story which can make sense of and justify his misery. The veterans have such a story. Although they are aging and have suffered, the speaker longs to give his patient "their battles," the sense of significance and value (a story recognized by the whole world, as the TV broadcast indicates) which cancer lacks.

The poet plays with the "D's" of D Day: "deception, danger, death," are all inherent in the world, but seldom accessible to confrontation as they are in war (to this extent war is like the scan, making the sources of pain visible and so manageable). A fourth "D" is added, for "deliverance," implying that the "old men's stories" of battles and victory compensate for their suffering in a way that nothing can for the cancer patient.

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Philoctetes

Sophocles

Last Updated: Nov-11-2002
Annotated by:
Holmes, Martha Stoddard

Primary Category: Literature / Plays

Genre: Play

Summary:

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.

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Love and Friendship

Lurie, Alison

Last Updated: Aug-28-2002
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Daughter of a wealthy businessman, tall, beautiful Emily Stockwell Turner falls out of love with her stolid professor husband, Holman, halfway through their first semester at a small college for men in northern New England. She is lonely and miserable in this remote place. Encouraged by her confidante and fellow faculty wife, Miranda, she embarks on a secret affair with the college musician, Will Thomas.

Divorced and sexually experienced, Will initiates Emmy into the powerful romance of physical love. But their on-again, off-again relationship is fraught by its own secrecy, Holman's jealous suspicions, Will's infidelities, Emmy's lies, Miranda's disingenuous disinterest, and the not-so-irrational hatred that Freddy, Emmy's four-year old son, bears Will.

Emmy and Will take ever greater risks with their clandestine encounters; eventually they admit to being truly in love and she decides to join him in his move to New York City. But Holman falls ill and nearly loses his contract position at the University when he tries to kill a student demonstrator whom he wrongly suspects of being Emmy's lover. Emmy postpones her departure indefinitely, because Holman "needs" her more.

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Miniature Man

Brown, Carrie

Last Updated: Aug-20-2002
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

In a mountainous village in Spain, a man in the prime of his life has labored fifteen years constructing a museum of miniatures that no one has yet seen. Just before completing his project, the artist Gregorio has an accident and both his hands are terribly crushed by a piece of marble. There is little hope that he will ever regain complete use of his hands.

Gregorio is treated by the town's elderly physician, Dr. Xavia. The doctor narrates the story and also dreams about the contents of the mysterious museum. One day Dr. Xavia finds that the door to the museum is unlocked and has been open all along for anyone wanting to enter it. The doctor discovers that the three story building housing the museum contains a complete and perfect recreation of the village that he finds both familiar and strange.

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