Showing 31 - 40 of 79 annotations in the genre "Essay"
Subtitled "What happens when patients find out how good their doctors really are," this article starts with an important statement: "Every illness is a story, and Annie Page's began with the kinds of small unexceptional details that mean nothing until seen in hindsight."
This is the introduction to a look at a child with cystic fibrosis and how her family sought the best care for her.
The author, Dr. Atul Gawande, goes on not only to tell their story but also the story of the way in which the understanding of this disorder has increased and the unusual rigor with which centers that specialize in the disease are evaluated.
He also includes stories of other sufferers to emphasize the importance of surveillance of their care.
These stories allow him to generalize about the way physicians' care is evaluated in general by the public and our medical organizations and how difficult it is to be at the high end of the Bell Curve. The author concludes, "When the stakes are our lives and the lives of our children, we expect averageness to be resisted."
Fifty-two year old Pete, the hospital mailman, suddenly experiences severe abdominal pain. He is evaluated and treated in the emergency room. His diagnosis is acute surgical abdomen, but the exact cause of his pain is still unknown. The surgeon-narrator determines that the severity of Pete's condition mandates exploratory surgery. During the operation, "an old enemy" (18) is encountered--pancreatitis.
Afterwards, the surgeon assures Pete that he will get better. One week later though, the mailman dies. His death has been painful. An autopsy is scheduled, but the surgeon deliberately arrives 20 minutes late. He does not want to view the intact body of his deceased patient. No matter, the pathologist has waited for him to arrive before beginning the post-mortem examination. The pathologist closes Pete's eyelids before starting the autopsy, mindful of how the mailman's "blue eyes used to twinkle" (21) when he delivered the mail everyday.
Selzer tells four stories of surgical loss: a surprise loss on the operating table, the drowning of a sick child in a flood in wartime Korea, the sudden death of a professor due to a perforated ulcer, and the loss of some facial mobility in a young woman following the removal of a tumor in her cheek. As we move from one vignette to the next, the narrator's mood goes from despair to accepting to redeemed, with various forms of love the agent.
Selzer begins by describing an anonymous painting of Vesalius at the dissecting table, about to cut into the cadaver in front of him, yet glancing over his shoulder at a crucifix on the wall behind him. He then tells two medical stories in which spirituality has played a crucial role.
In the first, a man who has repeatedly refused to have a brain cancer operated on turns up one day healed, attributing it to the holy water a family member brought back from Lourdes. In the second, the Dalai Lama's personal physician does rounds in an American hospital and, using ancient techniques, diagnoses correctly, and in some detail, a case of congenital heart disease.
Ten "forms of devotion" are described briefly in one or two pages of accessible, everyday prose: Faith, Memory, Knowledge, Innocence, Strength, Imagination, Prayer, Abundance, Wisdom, Hope. Each is illustrated with an engraving of an allegorical image with Latin and gothic German text. In the first mini-essay, the narrator contends that "the faithful are everywhere." She demonstrates that faith in a future and in immortal continuity is the driving force, not only for religious folk, but for anyone who goes to school, gets up each day, drives to work, embarks on a journey, takes a pill.
The following mini-essays show how each of the forms of devotion are wielded by "the faithful" to carry on valiantly confronting the challenges of ordinary existence. Faith and Hope together beget power. By the end, the reader senses a certain irony--as if the writer is not a member of the faithful. She may acknowledge and sometimes envy their resolute success, but does she share it? Perhaps not, and we are left wondering if she even admires it.
What appear to be early-twentieth-century anatomical engravings of various body parts--eye, tongue, spine, breast, legs, foot, genitalia--accompany a male narrator's thoughts about his wife and their relationship. He describes the "good days" and "bad days" in their mundane life. He suspects that she may be having an affair and wonders if he should have one too. Her disturbing restlessness is felt "in [his] bones," but he avoids confronting it, hoping that they will continue happy.
A woman describes the male body, beginning with the torso--neck, chest, belly, genitals--then the appendages, the back, and finally the head. Her description features the appearance and uses of these anatomical parts from the perspective of female taste and needs. The essay is illustrated with strategically placed images of the human form in exotic settings, taken from Bernard Siegfried Albinus's remarkable treatise of anatomy of the mid-eighteenth century.
The narrator has four loves--one for each chamber of her heart: right atrium, right ventricle, left atrium, left ventricle: music (from her mother), painting (from her husband), language (shared with her son), and light. Each section, introduced by an anatomical engraving of the heart, describes how the love entered and developed in her life. Their relative importance is related to the size and thickness of the cardiac chambers. Carefully placed engravings of domestic scenes and landscapes, mostly nineteenth century, complete the essay.
The author comments initially that most physicians become involved in the stories of their patients' lives--as witnesses, chroniclers, and players. He uses as an example the story of a physician's role in the death of Anton P. Chekhov. Another interesting example is the book, A Fortunate Man (see this database), the story of an English country doctor who matures in the profession and comes to recognize the task of the doctor as one to help his patients feel recognized.
Dr. Verghese believes that all patients seen by physicians are in the midst of a story that begins the moment they walk through the portals of a hospital or a clinic. He sees the challenge as engaging the patient and the family in finding an "epiphany," even if that epiphany is simply the understanding that there is nothing more that can be done medically. In his conclusion he says that as physicians we should be ministers of healing, storytellers, storymakers, and players in the stories of our patients and ourselves.
The author, Samuel Shem, opens these reflections by saying that he was a writer before he was a doctor. His early answers to questions about healing came from stories he read. "Life as it should be in addition to life as it is" became the "motor" of his writing. He loved stories that he heard from patients and the "few humane doctors" he met and decided he would be able to understand people better by writing about experiences with them.
Shem's experience as an intern spawned The House of God (see this database) and he sees writing about his training as an example of the use of resistance when he saw "something unjust, cruel, militaristic or simply not right." He recommends the following to resist the inhumanities in medicine: (1) Learn our trade in the world, (2) Beware of isolation, (3) Speak up, (4) Resist self-centeredness. He says that the healing essence of narrative is in "we," meaning the patient and the physician.