Showing 31 - 40 of 385 annotations tagged with the keyword "Cross-Cultural Issues"
Although Dr. Helman’s untimely death did not permit a final editing by this prodigious writer, the published edition is not a book-in-progress. An Amazing Murmur of the Heart: Feeling the Patient’s Beat represents a powerful and persistent continuation of observations and themes that grew out of medical education, close observations of physicians and patients, and his studies in anthropology. All of these forge an approach to patient care that is out of the ordinary.
As his previous writings suggest, Helman is passionate about medicine but concerned, equally about the emergence of those who fail to listen and to those who might be called techno-doctors. While professing his appreciation of and attraction to the magic machine or computer, he is mindful of its absence of emotion and ambiguity. “For this post-human body is one that exists mainly in abstract, immaterial form. It is a body that has become pure information.” (p. 11)
Chapters are comprised of stories about patients and their care providers, each representing complex facets that defy precise measurement, answers and conclusions. As Helman steadily notes, the physician must be an archeologist:
Most patients present their doctors with only the broken shards of human life—the one labeled infection, disease, suffering and pain each of these shards is only a small part of a much larger picture….the doctor will have to try and reconstruct the rest. (p.66)
In general, the chapters illustrate first an initial review of medical history, and then specific patient stories. Of the two, the story is most important. “Mask of Skin,” for example, begins with an overview of skin from Vesalius to the present: largest organ, stripped bare by anatomists, penetrated by disease, later scanned and X-Rayed, tattooed, re-fitted by surgeons, etc. That said, Helman the physician-anthropologist, moves from science to specific stories about patients whose skin may cover profound experiences, psychic and otherwise, that might be overlooked by a dermatologist. Although skin is involved in each of that chapter’s stories, the willing physician must dig deeper in his observations and caring manner to make more profound discoveries.
In a chapter entitle “Healing and Curing” the author describes an old friend, a practitioner who provides advice about patient care that ”was not included in his medical texts”. Patients are more than a diagnosis dressed in clothes. Doctors must make patients “feel seen, listened to, alive”. Always patients should be regarded as people who happen to be sick. From his admired colleague Helman learned to be an attentive listener to the "tiny, trivial, almost invisible things" in patient encounters and stories. To truly heal as well as cure requires the doctor to empathise with what the patient is feeling thereby requiring both an act of imagination and of the heart. The chapter, of course, continues with with stories that illustrate the points enunciated by his colleague and accepted by his disciple.
Annie Howard is beginning high school in Tacoma, Washington in 1950, four years after her father returned from World War II, having been blinded in combat. Her mother has opened her own beauty salon as a way of coping with her husband’s disability and the loss of earning power it has meant. Annie loves her father, and maintains a close relationship with him, but is dismayed by his recurrent depressions and his steady refusal to get a guide dog, go out into the world, and respond to invitations to volunteer with an organization that helps other veterans similarly afflicted. As the school year begins she meets two new friends, a Dutch brother and sister—refugees whose parents were killed in the war and who now live with an aunt and uncle. Through them, and ultimately through her father, Annie learns some hard truths about the lasting effects of trauma, about the role of acceptance in healing, and about how a more grown-up love involves willingness to accompany others through some of the darker dimensions of suffering.
Summary:Marie Commeford, daughter of Irish Catholic immigrants who grows up in Brooklyn, narrates her life story in episodes rich with reflection on the losses, failed fantasies, illnesses, and disappointments of a life at the edge of poverty, which is also rich with love and poetry and humor and the stuff of which wisdom is made. The story unfolds as memory unfolds, in flashbacks and reconstructions shaped by a present vantage point from which it all assumes a certain mantle of grace. From the opening story in which a neighbor girl slips on the steps to a basement apartment and is killed, to repeated glimpses of a blind veteran who umpires the neighborhood boys' street games, to the bereaved families Marie meets when she works for the local undertaker, to her gradual discovery of her brother's closeted homosexuality, and to her aging mother's death, the story keeps reminding us of how much of life is coming to terms with the "ills that flesh is heir to," and also how resilience grows in the midst of loss. Because much of the story represents the vantage point of a child only partially protected from hard things, it invites us to reflect on how children absorb large and hard truths and learn to cope with them.
Summary:The author of this long, compassionate and often startling treatise on identity interviewed over three hundred families to elicit stories about raising exceptional children, stories that also come from these exceptional children ('exceptional' is the term chosen to describe the children in the author's material about the book).
Summary:Isserley is an alien whose assignment on earth is to abduct male (preferably muscular and burly) hitchikers for their processing, in a subterranean area under a barn in Scotland where she and her fellow aliens are based, as farmed animals that are castrated, made mute by tongue-amputation and fattened up in pens like calves for their veal. After a few months, they are eventually slaughtered and butchered for meat and then transported back to Isserley's native land, which is portrayed as a dark, arid, unpleasant place where meat is a rare and expensive delicacy.
Summary:Benjamin Rubin is completing his surgical residency in a Tel Aviv hospital when the director of the hospital asks him to accompany him and his wife to India to rescue their daughter who is critically ill. This invitation distresses him, as he recognizes in it a way of removing him from competition for a position in surgery at the hospital. He makes the trip, however, and is entranced by Indian culture and mysticism, and, eventually, not by the daughter but by the mother he accompanied. Back in Tel Aviv, he has a brief affair with the mother, moves into an apartment she owns, leaving his mother's home, and, to allay his obsession with an unavailable woman, marries an independent-minded woman who has also traveled in India and absorbed Buddhist spirituality and Eastern philosophy she discovered there. Working as an anesthesiologist, Benjy continues in that setting, conflicted about both work and life, unable to connect deeply with any of those whose love he has received or sought. Eventually his wife leaves with their baby daughter to return to India, where she has found a spiritual home, and Benjy remains in a divided state of mind in a divided country where his own spiritual heritage remains to be plumbed.
Kitty Fane is a beautiful young woman whose mother has raised her to make a suitable match. But Kitty refuses a number of suitors; several years pass and eventually she is reduced to marrying Walter, the colonial bacteriologist in Hong Kong. Walter is a shy and awkward man who loves Kitty passionately, but has no idea how to express it; Kitty is charming and socially adept, but vacuous. In Hong Kong Kitty engages in a yearlong affair with Charles Townsend, the assistant colonial secretary, and a married man whose celebrity potential far eclipses Walter's stolid scientific work. The novel opens when Walter discovers his wife's infidelity.
Kitty believes that Townsend is madly in love with her and prepared to divorce his wife and sacrifice his career to marry her. Walter, who suffers from a broken heart, gives Kitty an ultimatum--either Townsend must promise to divorce his wife and marry her, or Kitty must accompany Walter to a city in the interior where he has volunteered to go to fight the cholera epidemic. Townsend demurs; Kitty is crushed; and the desperately unhappy pair travels to the cholera-ridden city, where they move into the house of the newly-dead missionary.
There, Walter (who is also a medical doctor) sets to work, day and night, to institute public health measures and care for dying patients. Meanwhile, Kitty meets Waddington, the British consul, a cynical alcoholic, who is at heart a good and honest person; and the French nuns, who labor tirelessly to care for orphans and the ill. Impressed by the nuns' selflessness, Kitty begins to devote herself to assisting them and trying to understand their spirituality.
When he learns that Kitty is pregnant, Walter asks if it is his child; Kitty responds, "I don't know." This completes the destruction of Walter's heart, and he soon dies of cholera--presumably as a result of experimenting on himself to find a cure. Kitty learns that the nuns, the soldiers, and all the people of the city consider Walter a saint, who has sacrificed himself for their welfare. However, while Kitty has learned to respect her husband, she could never love him.
Kitty stays only briefly in Hong Kong before returning home to London. Shortly before her arrival, she learns that her mother, whom she believes is responsible for her (Kitty's) shallowness, has died. The novel ends with Kitty vowing to bring up her daughter as a strong and independent woman, and preparing to move with her father to the Bahamas, where he has recently been appointed Chief Justice.
Eloy’s grandmother—his abuela—is dying of cancer. She has been his faithful companion, teacher and refuge in a home where his parents often fight and his older brother seems to have lost interest in him. He believes the only thing that will save her now is for him to make the annual pilgrimage on foot to the chapel at Chimayo, 17 miles from their New Mexico home, but his parents, both of who work full time, can’t go with him and won’t hear of his going alone. Desperate for a miracle, and believing she can be saved by the blessed soil distributed at the chapel where many seem to have experienced miracles of healing, he sets out in secret early in the morning. On the way a friendly dog begins to follow him and, despite Eloy’s efforts to get rid of him, travels the entire 17 miles with him, sharing the water Eloy reluctantly offers him from the canteen that once belonged to his grandfather. Much of the story follows Eloy’s thoughts as he travels, and the small difficulties and surprises along the way. As he finally sees the chapel in the distance, he hears his brother driving by slowly in his low-rider with tinted windows. Angry at the brother who has given him no support so far and seems to be mocking him, Eloy flips him the finger. Later, as he stands in line for the sacred soil, his brother enters the chapel with their abuela on his arm. She explains to Eloy that she is indeed going to die, and that God has other ways of answering prayers. She sees that Eloy has been sent a companion, and encourages him to bring the dog, whom he has now named, home with him. His parents, who have steadily refused to let him have a dog, accept him, and Eloy comes to new terms with his grandmother’s approaching death.
This collection of 16 short stories focuses on doctors and patients in San Francisco, where a wide variety of wealth and culture impact the delivery of medical care. Further, there are many restrictions—financial, bureaucratic, ethical, and legal —that limit what doctors can do, especially in cases of patients near death.
The author, Louise Aronson, is a geriatrician who knows this terrain very well, having trained in San Francisco and worked as a physician there. A skilled writer and close observer, she has created dramatic and often funny stories that reveal social and bioethical complexity. About half the stories describe end-of-life issues for the aged and the dilemmas for their physicians and families.
In ‘The Promise,” Dr. Westphall orders comfort care only for an elderly patient who has suffered a massive stroke, but a hospital gives full treatment because there was no advance directive and the daughter told the attending to do “what he thought best.”
When Dr. Westphall sees this barely functioning patient in a skilled nursing facility seven months later, he tenderly washes her face and hair—although the text teases us that he might have been prepared to kill her.
In “Giving Good Death,” a doctor is in jail charged with murder; he has fulfilled the request of Consuela, a Parkinson’s patient, to help her die. When it appears that she may have died for other reasons, he is released, his life “ruined.” He leaves San Francisco, and, we surmise, medicine. In three other stories, doctors also leave the profession: the cumulative stresses of work and family and/or a sense that it’s not the right path bring them to that choice.
On the other hand, one of the longer pieces “Becoming a Doctor” celebrates the profession, despite all the rigors of training including sexism against women.
The stories bring multicultural insights; we read of people from China, Cambodia, Latin America, India, Russia, and the Philippines. Some are African-American; some Jewish, some gay. These different backgrounds color notions of health, death, and medical care. There are also pervasive issues of poverty and, at another extreme, professionalism that is hyper-rational and heartless.
Indeed, a recurring theme is care and love for people, no matter their background or current health status. A surgeon realizes (regrettably too late) that the secret of medical care is “caring for the patient—for anyone—just a little. Enough, but not too much” (p. 135).
Elie Wiesel, 82-years-old, has pain that he thinks is in his stomach or esophagus, perhaps caused by his chronic acid reflux. After tests, however, doctors diagnose cardiac illness and insist on immediate surgery. Reluctant to go to the hospital, Wiesel dawdles in his office. When he does go, doctors believe a stent will do the job. Instead, the intervention becomes a quintuple bypass.
This brief memoir—a scant 8,000 words—presents the “open heart” of a gifted writer as he contemplates his open-heart surgery, his past life, and the future. He asks himself basic, even primal questions about life, death, and the nature of God.
Although a man with an extraordinary career—prizes, fame, honorary doctorates, friends in high places, professorships—Wiesel experiences and describes ordinary feelings of anxiety, pain, and doubts about his cardiac emergency and possible death. His stylistic gifts describe frankly and vividly a patient’s fears. As many have observed, patients with a serious disease have two difficulties, the disease itself and their emotional responses to that disease. As Wiesel is wheeled into the OR, he looks back on his wife and son; he wonders whether he will ever see them again.
He writes that his “thoughts jump wildly; I am disoriented.” He recalls a friend undergoing similar surgery; she died on the table. He says he can’t follow the jargon of physicians. The texture of the prose is rhapsodic, jumping from the present to memories, many of them about war, his past surgeries, or important family events. This short book has 26 “chapters,” some just half a page; they are like journal entries.
As he slowly recovers, he feels pain and has visions of hell, including the concept of ultimate judgment. “Evidently, I have prayed poorly…; otherwise why would the Lord, by definition just and merciful, punish me in this way?” (p. 38). Because he has a “condemned body,” he feels he must search his soul. In the longest chapter of the book, he reviews several of his writings.
Wiesel asks some of the questions from his famous novel Night (La nuit, 1958). If there is a God, why is there evil? Auschwitz, he says, is both a human tragedy and “a theological scandal” (p. 67). Nonetheless, he affirms, “Since God is, He is to be found in the questions as well as in the answers” (p. 69).At the end, he still has some pain but feels much gratitude for his continuing active life and for his grandchildren.