Showing 31 - 40 of 109 annotations tagged with the keyword "Physical Examination"

Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

Late in the twentieth century, the young doctor Goodheart fails in a city practice and accepts a salaried position in the country.  Even there his difficulties persist. A challenging patient—the Reverend Pastor--refuses a tiny muscle biopsy that would not only confirm the diagnosis of trichinosis, but establish the doctor’s reputation. “I would rather die than let myself be skewered alive!” the pastor shouts (p. 11).

Deeply discouraged Goodheart wanders into the country at twilight, sighing, “If only there were a means of making the human body as transparent as jelly fish” (p. 13). Suddenly a woman appears in a blaze of light. She is “Electra the spirit of the twentieth century” (p. 15). She gives the astonished doctor a box and bids him open the lid. The nearby tree immediately becomes “as transparent as a jelly fish” (p.17). Next the box, judiciously aimed, illuminates the inner workings of a frog.

Goodheart applies his box to the ailing pastor and sees parasites teaming throughout his body. Then he effects a dramatic cure with helminthotoxin made from the worms themselves—a treatment that had been invented sometime during the century.

The box proves to be a simple electrical device, easily replicated. Declining financial recognition, to the vexation of his wife, Goodheart communicates the workings of the box to the world with no mention of Electra. But fame and riches flow his way and he dies in old age an honored man.

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A Face of Stone

Williams, William Carlos

Last Updated: Jul-08-2009
Annotated by:
Woodcock, John

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

The overworked doctor-narrator finds himself extremely irritated by the requests of a poor immigrant couple in their twenties to examine their infant. He spouts an alarming number of cultural and economic prejudices and tries to avoid seeing them. They persist, however, and the doctor examines the child, whom he finds healthy. The husband then asks if the doctor can examine his wife. The doctor flashes his anger again but agrees.

He finds her legs extremely bowed, probably from severe childhood rickets, and asks the husband about her history. It turns out that she had grown up in Poland during World War I and had lost all her family. As he hears of the woman's suffering, the doctor becomes empathetic, suddenly understanding the couples' fearful tenacity which had so annoyed him before. The woman responds in kind, and the doctor-patient relationship changes significantly for the better.

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This collection of stories offers a sidelong view of medicine from the perspective of a thoughtful, experienced doctor of internal medicine at a teaching institution (UCSF) in an urban setting that brings a wide variety of types of patients to his door.  In a context of evident respect and admiration for even the quirkiest of them, Watts admits to the kinds of personal responses most have been trained to hide-laughter, anger, bewilderment, frustration, empathetic sorrow.  The cases he recounts include several whose inexplicabilities ultimately require action based as much on intuition as on science.  He includes several stories of illness among his own family and friends, and makes it clear in others how his professional decisions affect his home life and his own state of mind.  

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Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Triggered in part by a trip to the Galápagos Islands, the author interweaves two parallel narratives: Darwin's "journey toward evolution" along with the related work of Alfred Russel Wallace; and the author's own journey through life, partially disabled and dependent on the specially fitted shoes that help him to walk.  Together these two narratives develop "all I have come to understand about chance and change, fear and transformation, variation and cultural context, ideas about the body that question the definition and existence of difference in all of our lives" (xvii).

Born with an unnamed congenital condition in which his fibulae are absent along with other lower limb "abnormalities," Fries underwent five major reconstructive surgeries as a child, but after those, what helped him most were special shoes that were fitted to his special body, assisting him to walk.  As an adult, however, he begins to experience back pain and knee problems.  The memoir relates, both in flashback, and in the present day, Fries's quest for a proper pair of shoes that will help him avoid yet another surgery -- the shoes he has been wearing are 20 years old and no longer do the job.  We meet Dr. Mendotti, who treated him like a peculiar specimen and offered a pharmacologic way out of his pain; shoemaker Eneslow, in a dingy Union Square office, whose shoes not only fit Fries well, but were festive in appearance -- "I felt both normal and special" (17); other practitioners of orthotics who try but fail to construct shoes that relieve Fries's pain, and finally, the gifted, patient orthoticist, Tom Coburn, who persists until he is able to provide shoes that work.  The shoes have been adapted for Fries's body, just as man has constructed adaptations that allow him to live in a variety of climates and circumstances.  Conversely, Fries, convinced he "can adapt to the circumstances in which my body places me (169)," draws from Darwin, whom he quotes: "individual differences are highly important for us, as they afford materials for natural selection to accumulate" (169).
 
Darwinian connections are invoked throughout the narrative.  The peculiar configuration of Fries's feet and shoes help him to ascend a series of mountain ladders while his partner, Ian -- who usually has to assist Fries with such physical maneuvers -- suddenly becomes fearful of the height and exposure;  back problems might have developed even without his congenital abnormalities because evolution of the capacity to walk upright included the tendency toward back pain; the role of chance in natural selection and the role of chance in the physical fact of congenital conditions; the positive role that his partner Ian's attention deficit disorder (ADD) could have played in the days of hunter-gatherers and the cultural context in which ADD is now considered to be "abnormal."
 
Fries discusses his fears -- both rational and irrational -- as well as his awareness of stigma, difference, and sameness.  The context of these discussions is usually a reminiscence about vacations in far-flung countries (Thailand, the Galápagos, Bali, Alaska, the Canadian Rockies) and physically challenging domestic locales (a Colorado River raft trip, the Beehive Mountain in Acadia National Park).  He  occasionally brings into the discussion his homosexuality, especially as his physical deformity affected sexual encounters.  The relationship between Fries and Ian is woven throughout the memoir as one of understanding, mutual need and benefit.  As the memoir ends, Fries worries about the likelihood he will need a wheelchair, but is at the same time gathering confidence in his ability to ride the Easy Flyer bicycle that Ian has discovered at the local bike shop.

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Deenie

Blume, Judy

Last Updated: Mar-14-2009
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Fiction

Genre: Novel for Young Adults

Summary:

Deenie is an attractive seventh-grader whose mother, determined that her good looks not be wasted, is pushing her toward modeling. When she tries out for the cheerleading team, however, Deenie's gym teacher notices her slightly crooked posture and refers her to an orthopedist who diagnoses adolescent idiopathic scoliosis. Both Deenie and her mother are horrified. Deenie decides an operation to "fix it" is the lesser of two evils when the alternative is to wear a brace for four years, but the doctor assures her the brace is the appropriate treatment.

Wearing the brace, initially merely a source of embarrassment, frustration, and anger, gradually makes Deenie aware of other kids with whom she has avoided contact because of various "handicaps." Her relationships within the family and among friends shift because of this new self-awareness and of others' varied capacities to accommodate to her new limitations.

The most gratifying discovery for her is that the boy with whom she has been developing a first romance does not find the brace a barrier either to friendship or to the tentative intimacies of early love. The subtheme of developing sexuality complements the novel's focus on body image as a crucial aspect of adolescent psychology.

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Body of Work is a cleverly crafted memoir - or, rather, the first chapter of a memoir - of the author's medical school experience at Brown University School of Medicine in Providence, Rhode Island. Ms Montross relates the chronological course of her team's dissection of a female cadaver with no discernible umbilicus and whom they therefore name Eve. (She neglects to comment on Eve's ribs and whether she has the normal complement or a supernumerary, more masculine, rib.) As she and her team of four (later three as one student drops out of school) proceed with the orderly dismantling of Eve, bone by bone, nerve by nerve and blood vessel by blood vessel, she uses this experience as a springboard to analyze her and her team's emotional reactions to the often unnatural process of deconstructing, literally (at times with a saw), a former person now cadaver, as well as the gradual, almost imperceptible acculturation that transmogrifies medical students into doctors. In fact, she devotes the final pages to this metamorphosis and what it means to the person undergoing the transition from caring student to detached physician, and whether one can retain enough caring, while remaining sufficiently detached to function as one must as a clinician, to become both a whole person and competent physician: "How much of becoming a doctor demands releasing the well-known and well-loved parts of my self?" (page 209)

Although it primarily revolves about the axis of her gross anatomy (cadaver dissection) course, the author's narrative includes tangents that have variably relevant relationships to this course, e.g., a trip to Italy to inspect first hand the anatomy theater of Vesalius in Padua and the Basilica of St. Anthony; another trip to the anatomical wax sculptures museum in Bologna, where the author also observes the "incorrupt corpse of Santa Caterina" in a "small church called Corpus Domini" (pages 223-224); interspersed histories of the traffic of corpses for dissection, including the infamous Burke and Hare story; some flash-forwards to her second and third years; and a prolonged narration of the final illnesses of her grandmother and grandfather. This last bit of family history is worth the price of the book alone. Despite the apparently incongruous collection of such asides, the author makes it work smoothly, if not seamlessly.

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Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This is another wonderful book from Dr. Sacks. The subtitle, “Tales of Music and the Brain,” is accurate: we have a charming and informative mixture of stories of patients and the neurophysiology that interprets how music is processed and performed. The book is synthetic in combining cases from his practice, other clinical reports, letters from correspondents, references to medical literature, and even Sacks’s own personal experiences with music.

Sacks finds that humans have a “propensity to music,” something “innate” in human nature, perhaps like E. O. Wilson’s biophilia. “Our auditory systems, our nervous systems,” he writes, “are indeed exquisitely tuned for music” (xi). Although humans have been involved with music for millennia, it is only in the last few decades that medical imaging (functional MRI, PET) has shown what areas of the brain are active when music is heard.

While humans routinely enjoy music, the book emphasizes unusual events and neurological patients, in short, departures from the norm. Sacks—himself a lover of music—reports on his own experiences with hallucinatory music and anhedonia (loss of pleasure) in hearing music. He describes going to hear the great baritone Dietrich Fischer-Dieskau but finding that he could not, on that day, perceive the beauty of the music. Another condition “amusia,” or loss of musical ability, can be chronic, acquired, or temporary.

Some patients have had injuries or diseases of the brain that change how music is perceived. A man hit by lightning is suddenly obsessed with piano music. Another man (who survived a brain infection) has amnesia about many things but can still make and conduct music at a professional level. The concert pianist Leon Fleisher visits Sacks to discuss his dystonia, or loss of muscle function in one hand (with implications for the brain). Rolfing and Botox helped him heal and he returned to two-handed performances.

Sacks discusses other phenomena that involve brain structures, for example, perfect pitch; persons with this ability have “exaggerated asymmetry between the volumes of the right and left planum temporale” (128). People who experience synesthesia (perceiving notes as colors) have cross activation of neurons in different areas of the brain. Professional musicians (and patients with Tourette’s) demonstrate cortical plasticity, that is they have expanded areas of the brain for particular uses. Children with Williams syndrome have brains influenced by a microdeletion of genes on one chromosome; they have some cognitive deficits and also a great responsiveness to music. For some conditions, the brain determines all; for others, behavior components are also important.


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Summary:

Janis Caldwell, who practiced emergency medicine for five years before getting her Ph.D. in English, examines the philosophy and practice of nineteenth-century British literature and medicine in this book. In an erudite introduction, she explains what she means by the "double vision" of "Romantic materialism," "Romantic because [physicians and authors] were concerned with consciousness and self-expression, and materialist because they placed a particularly high value on what natural philosophy was telling them about the material world" (1). These writers' intellectual context, influenced by natural theology, was dualist, including both the Book of Scripture and the Book of Nature. Their methodology "tacked back and forth between physical evidence and inner, imaginative understanding" (1), giving rise to the two-part "history and physical exam" familiar to physicians today.

The book examines this dual hermeneutic in six influential sites over the course of the century. In Chapter Two, Caldwell reads early-nineteenth-century debates over vitalism in the context of Mary Shelley's Frankenstein, arguing against the materialist-spiritualist divide so often cited in that period. She also brings readings of the novel into line with contemporary theories of physiologic sympathy. Next, she turns to the enormously influential sage Thomas Carlyle, arguing that he broadens the body/soul model to include both natural and supernatural aspects of the world. Again rejecting the notion of a philosophical dualism that prohibits mixing differing approaches, she argues, both Carlyle and the anatomist Richard Owen enthusiastically endorse a more heterodox vision of the world, in which we learn from both natural and spiritual enquiry.

The fourth chapter reads Emily Brontë's Wuthering Heights in the context of contemporary popular treatises on children's health and child-rearing. Caldwell argues that Brontë's image of the Romantic child, as emblematized in Cathy and Heathcliff, and characterized as "a more social, empirical, physical, literal version of childhood," derives in part from the "domestic medical texts which function as a sort of secular scripture in the Brontë household" (74). She suggests that the dualist language of natural theology, which combined spiritual and natural interpretation, and which was well-known in the Bronte household, influenced Emily's mixture of religious and medical concepts in her portrait of Romantic childhood.

Chapter Five contrasts Emily Brontë's version of childhood to that of her sister, Charlotte Bronte, in Jane Eyre and Villette. Charlotte Brontë, argues Caldwell, inclines more to the professional version of medicine, less suspicious of physician authority and more likely to experiment (in her fiction) with alternative medical theories such as phrenology. In an extended discussion of theories of literalization and metaphor, using Ricoeur to argue that the literalization of a metaphor returns us to the fact but also reinvigorates the metaphor through its dissonance with the fact. Caldwell proposes that the supposed "coarseness" of Brontë's novels is linked to her use of literalization.

A chapter on Darwin posits that "Darwin's thought arises directly out of ... Romantic materialism" (117). Although by the end of his life Darwin had renounced literary reading, the "dialectic of Romantic materialism" (shaped by Romantic literature as well as science) appears in "Darwin's preferred scientific method," in his rhetoric, and in the narrative structure of his scientific autobiography (123-24).

Caldwell's final chapter provides a significant new reading of the genre of the medical case history, by studying George Eliot's Middlemarch in the light of the bipartite structure of "the patient's narrative and the physical exam" (143). Emphasizing the negotiations between doctors and patients in the mid-nineteenth century, and calling for similar negotiations today, Caldwell navigates the differing critical positions on George Eliot's novel, weighing whether the narrator "participates in the systematic, totalizing knowledge of the pathologist" or undercuts that knowledge (156). Caldwell concludes that the narrator of Middlemarch practices a "hermeneutic circling" that shuttles back and forth between incommensurate perspectives, part and whole, nature and spirit, seeking "a partial and provisional, rather than absolute or positive, knowledge" (160). The book ends with a call to return the term "clinical" to its full meaning, not just of detachment, but of engaged practice.

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Doctor and Doll

Rockwell, Norman

Last Updated: Oct-29-2007
Annotated by:
Mathiasen, Helle

Primary Category: Visual Arts / Painting/Drawing

Genre: Oil on canvas

Summary:

Doctor and Doll is part of the collection of the Norman Rockwell Museum in Stockbridge, Massachusetts. The triangular composition depicts an elderly general practitioner seated in a Windsor chair. A little girl is holding her doll out to him, watching intently as the doctor pretends to listen to her doll's heart through his stethoscope. The fact that the little girl comes to his office and stands up before her doctor suggests that she is coming in for a check-up.

The doctor's large black bag on top of the rug by his feet indicates he makes house calls. Behind the two figures is an old-fashioned desk. On top of the desk are several thick volumes, two brass candlesticks, and two pictures. The image on the left may represent a group of doctors in the style of Rembrandt. On the wall we see a large, framed document which has the word "Registration" on it.

The doctor is wearing a dark suit, cravat, and highly polished, black shoes. He turns his head to the right and upwards as he concentrates on his task. His patient, the little girl, is dressed in heavy shoes, stockings, wool skirt, jacket, scarf, and red beret and mittens. She has removed her doll's dress and holds the dress close to her left side with her elbow. The colors of the painting are dark, but the doctor's head with its gray hair, the doll, and the child's serious face are illuminated.

The girl's red beret, mittens, and the doctor's ruddy cheeks and nose give warmth to the picture. Clearly, the doctor is empathetic and kind, and the little girl trusting. Rockwell paints the ideal country doctor taking time to reassure his young patient that he will do her no harm. His gray hairs make him look fatherly.

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Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

Part of a series, "Letters to a Young . . . [fill in the career]," this collection of essays by pediatrician-author Perri Klass is addressed to her son Orlando during the recent period when he was applying to medical school. The essays follow a chronological sequence, beginning with the decision to apply to medical school, the first two years of medical school, learning how to examine and talk to patients, residency training, physicians as patients, making mistakes, grappling with the most fundamental human issues in medicine, and the mingling of professional work and life.

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