Showing 31 - 40 of 539 annotations tagged with the keyword "Aging"

The Not-Dead and the Saved

Clanchy, Kate

Last Updated: Nov-23-2015
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

Two individuals share a struggle that is grueling, depressing, and whose outcome is probably preordained. The Mother (divorced, constantly tired, and fearful of sickness) is "not a good choice for the parent of a chronic invalid" (p. 168). The Son (smallish, clever, and born with some kind of tumor) has previously had an organ transplant (most likely kidney).

Their trek through the realm of sickness unfurls in seven scenes - all hospital wards and finally Hospice. First, the Son is an adolescent in a pediatric ward where the Machine (presumably renal dialysis) prevents his death. There he spots a baby that he dubs a "Not-Dead." She has multiple birth defects due to a chromosomal abnormality and is kept alive by technology. He intuits that while not dead, the baby is not "properly alive" either. He muses about his own status. His mother is always bedside, propping up his spirits.

Next he is in the ICU and then transferred to a medical floor. He receives a blood transfusion after disconnecting the Machine in a likely suicide attempt. Sometime later, he is back in the pediatric ward after receiving an organ transplant. The Son gets admitted to the Cardio-Respiratory unit for a severe infection. In and out of hospitals, he enrolls in college but quits. After getting married, he joins a commune of survivors of medical illnesses known as "The Saved." This collective lives on a farm and members avoid any contact with family.

The Son's health further deteriorates. He is hospitalized in terminal condition. By this time, he has his own child, a 14-month-old boy named Jaybird. In the oncology ward, doctors diagnose three tumors in the Son's brain but he refuses any treatment (surgery, radiation, or chemotherapy). He is moved to Hospice. His absent Father comes to visit and comfort him. When the Son dies, it is the Mother who is alone with him. The Son's wife, Father, Jaybird, and members of The Saved commune are all asleep in the Day Room. Only after the Son dies are the names of the Mother and the Son revealed: Julia and Jonathon.

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Best Boy

Gottlieb, Eli

Last Updated: Nov-09-2015

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Best Boy is a novel about Todd Aaron, a 54-year-old autistic man who has lived for 40 years in a Payton LivingCenter (sic); he was involuntarily committed to this facility. Todd has been in five previous places for congregate living, but Payton seems to be the best for him, thanks in part to a loving caregiver, Raykene. Todd has accepted the institutional “Law” of Payton and takes his drugs right on schedule, including Risperdal, an antipsychotic that slows him down, making a “roof” over him and muffling, he says, “the voice in my brain.”  The story is told from Todd’s point of view, often with startling imagery:  he pictures his dead parents turning into giant cigars, a raindrop “explodes,” and, when upset, he rocks back and forth and feels “volts.”  Now and then he recalls that his mother called him her “best boy.”
   
Into this stable setting come three personified disruptions. The first two are fellow patients, Terry Doon (a pun on “doom”?), a brain-injured roommate who teases, torments, and bullies Todd, and Martine Calhoun. While Terry disrupts Todd’s living space, Martine is a siren who lures him to different parts of Payton’s campus; she is also a rebel who urges him to stop taking Risperdal and shows him how to hide the drug in his hand and get rid of it later.   

The third is Mike Hinton, a day staffer who lies, manipulates, and in general mistreats Todd. Todd understands Hinton as evil and entertains violence against him—but does not act. Hinton has sex with a female patient who dies, apparently a suicide, although the language of Payton’s staff, as reported by Todd, euphemistically hides the truth.

Todd has the “Idea” of escape and sets out, on foot, to go 744 miles to “home.” A state policeman soon returns him to Payton.

Now and then Todd’s younger brother Nate calls, often while drinking. Near the end of the book, Nate and his wife Beth take Todd to his childhood home, where he had been abused physically and mentally. In a moving scene, Todd enters the only unchanged area, a crawl space and feels the return he yearned for.            

All three tormentors leave Payton, and there is a surprising resolution for Todd.  The balance and harmony of Payton’s LivingCenter are restored, and Todd, reminded by Raykene, affirms that “Somebody always loved me.” 

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Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

The author, an experienced surgeon, believes that we will be less frightened by the prospect of death if we understand it as a normal biologic process. He points out that 80 percent of deaths in this country now occur in hospitals and are therefore "sanitized," hidden from view, and from public comprehension. He describes the death process for six major killers: heart disease, stroke, AIDS, cancer, accidents/suicide, and Alzheimer's disease.But the power of the book is in its intensely personal depiction of these events and in the lessons which Nuland draws from his experiences. The message is twofold: very few will "die with dignity" so that (1) it behooves us to lead a productive LIFE of dignity, (2) physicians, patients, and families should behave appropriately to allow nature to take its course instead of treating death as the enemy to be staved off at any cost. Only then will it be possible for us to die in the "best" possible way--in relative comfort, in the company of those we love/who love us.

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Sunsets

Coulehan, Jack

Last Updated: Oct-06-2015
Annotated by:
Aull, Felice

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

The poet movingly describes the sunset of his father’s life in the context of their relationship, now, and in the recollected past. Now the son brings his crippled father to see a beautiful beach sunset, but the process is so difficult that they settle in too late to catch it. When he was younger, the son imagined that he would one day take his father on excursions to wild and beautiful places, where they would talk intimately about important matters and death was not a concern. "When I was young, I dreamed we arrived . . . with plenty of time before sunset. / The sky was glorious, and he could stand."

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The Man with Stars Inside Him

Coulehan, Jack

Last Updated: Oct-06-2015
Annotated by:
Aull, Felice
Chen, Irene

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

During the physical examination of an elderly cancer patient, the doctor considers the tell-tale symptoms of pneumonia. While the patient is dying, the physician imagines that the symptoms represent the birth of a universe and that the patient is becoming a part of the galaxy.

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Annotated by:
Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

A bicycling, bee-keeping, British neurosurgeon approaching the end of his professional career recalls some distinctive patients, surgical triumphs as well as notable failures, difficult decisions, and mistakes. Nearly thirty years of a busy neurosurgical practice are distilled into a collection of linked stories throbbing with drama - both the flamboyant kind and the softly simmering type.

Most chapters are titled after a medical condition (exceptions are "Hubris" and "Melodrama"). Some of the headings are familiar - Trauma, Infarct, Aneurysm, Meningioma. Other chapter titles flaunt delicious medical terminology that mingles the mysterious and the poetic with nomenclature such as Angor animi, Neurotmesis, Photopsia, and Anaesthesia dolorosa.

Included are riveting accounts of both mundane and seemingly miraculous patient outcomes. One success story involves a pregnant woman losing her sight due to a brain tumor that compresses the optic nerves. Her vision is restored with an operation performed by the author. Her baby is born healthy too. But tales of failure and loss - malignant glioblastomas that are invulnerable to any treatment, operative calamities including bleeding of the brain, paralysis, and stroke - are tragically common. The author describes his humanitarian work in the Ukraine. He admits his aggravation with hospital bureaucracy and is frequently frustrated by England's National Health Service.

Sometimes the shoe falls on the other foot, and the doctor learns what it is to be a patient. He suffers a retinal detachment. He falls down some stairs and fractures his leg. His mother succumbs to metastatic breast cancer. His three month old son requires surgery for a benign brain tumor.

As his career winds down, the author grows increasingly philosophical. He acknowledges his diminishing professional detachment, his fading fear of failure, and his less-hardened self. He becomes a sort of vessel for patients to empty their misery into. He is cognizant of the painful privilege it is to be a doctor.

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On the Move: A Life

Sacks, Oliver

Last Updated: Jun-22-2015

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

On the Move:  A Life describes the extraordinary life of Oliver Sacks from his childhood during World War II to shortly before its 2015 publication.  Using his journals (“nearly a thousand,” he writes), correspondence, and memories—as well as his 14 or so books—Sacks has given himself free rein to describe and analyze his long, productive, and unusual life.

A dozen chapter headings nominally corral his wide variety of interests, adventures, and travels, including his medical career, his homosexuality, and diverse writing projects.

Sacks came from an English medical family, including some observant Jews, but not him. As a youth he loved (prophetically) writing and chemistry. He rode motorcycles then and for many years to come. He did poorly on his Oxford practical anatomy exam but immediately (and drunk on hard cider) sat for a competitive essay on anatomy and won a large prize.  Later, he was warned away from bench science and focused successfully on patient care, patient narratives, and personal essays of many sorts, including A Leg To Stand On, the account of his injured leg and recovery.

Sacks left England for Canada, then the US.  He quotes from some of the journals about his travels. In LA, he worked out at Muscle Beach (setting a California squat record) and did drugs, including amphetamines. A shy man, he thought of himself as Doppelganger: Dr. Sacks by day, a black-garbed biker by night. 

Fascinated by vision and photography, Sacks includes 58 photos from the ’50s to 2006; some black and white, some in color.  These are printed together on slick paper and well illustrate his text.   

Neurology training concluded, Sacks served various institutions in New York but read widely, ever eager to find theories of brain chemistry, anatomy, perception, behavior, and more. As readers of his books know, he enjoyed using his own interests in drugs, music, and travel, as well as personal medical experiences such as his injured leg and his lack of facial recognition. He describes his meetings with patients with unusual dilemmas: the postencephalics of Awakenings, as well as people with Tourette’s syndrome, deafness, colorblindness, autism, or migraines. He became fascinated—obsessed, one might say—with these and wrote so voluminously that cuts had to be made from his huge manuscripts to yield books.

Sacks describes interaction with editors, film crews, playwrights and others wishing to collaborate. His audiences grew as he became an intermediary to the non-medical public. We read about Peter Brook, W. H. Auden, Jonathan Miller, Bob Silvers (New York Review of Books), the cartoonist Al Capp (a cousin), Abba Eban (another cousin), Stephen Jay Gould, Temple Grandin, Francis Crick, and others. One striking passage describes taking Robert DeNiro and Robin Williams to see locked-in patients in preparation for the film version of Awakenings.

In his 70s, his robust health faded. He had a melanoma in his right eye, with more than three years of treatment before it became blind. Being Sacks, he observed interesting phenomena as his vision changed, “a fertile ground of enquiry” (p. 376). His left knee was replaced. He had sciatica.   

He fell in love again after 35 years of celibacy; he dedicates his book to his partner Billy Hayes.

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Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Atul Gawande’s Being Mortal is both ambitious and synthetic, qualities that well suit his difficult subject, death.  In Western culture, there are taboos against death because it fits neither into post-Enlightenment notions of progress and perfection nor into medical notions of control, even domination of human biology. A surgeon and an investigator, Gawande draws on his patients, his family, and travels to various hospitals and other caregiving places in order to confront death and see how approaches such as hospice and palliative care can improve our understanding, acceptance, and preparation for death.

Gawande has harsh words for contemporary medicine, the supposed caregiver for the dying and their families.  Relying heavily on technique and industrial models, it ignores the deep needs of the dying and provides, instead, versions of “warehoused oblivion” (p. 188), for example long, futile stays in ICUs.

As opposed to traditional societies like India, Westerners prize the independence of individuals, a status that is, of course, never permanent. In the chapter “Things Fall Apart,” Gawande describes how longer lives are now the norm but they include chronic illnesses and inevitable decline in vitality.  Our deaths are now routinely in hospitals, not at home, and often extended—sometimes brutally—by technical support and unwillingness of doctors and families to stop aggressive treatment.       
       
Also, sadly, there are fewer and fewer geriatricians at a time when there are more and more elderly.  A good geriatrician takes a long time with each patient, is not well paid, nor does s/he do income-generating procedures. Worse yet, some training programs are being discontinued.  

Gawande illustrates his ideas with case studies of patients and describes, from time to time in the book, the elderly journeys of his grandmother-in-law and his own father.  These passages make vivid the abstract ideas of the book. But it’s not just elderly patients who face death: health calamities can come to anyone, for example, a 34-year-old pregnant woman found to have a serious cancer. Various treatments are tried without success, but family and doctors act out “a modern tragedy replayed millions of times over” (p. 183) of a medically protracted death. Finally her mother calls a halt to treatment.
               
Family members often bear a heavy load in caring for a sick elder, but many nursing homes are often worse, designed for control, not support of the patients. 

The chapter “A Better Life” describes the first in a series of places that offer much improved settings for the elderly, with birds, animals, gardens, and, in general, richer lives that have a sense of purpose.  Gawande describes hospice care, palliative care, and advanced directives (including Do Not Resuscitate orders) as improvements needed to break the norms of “treat at all costs.” The old roles of Dr. Knows-Best and Dr. Informative need to give way to physicians and others who talk with patients and families about their values, their wishes for the last days, and their preparations for death. In short, aggressive treatment should no longer be the “default setting” for hospital care.     
        
The book ends with a dozen moving pages about the death of Gawande’s father. The “hard conversations” have clarified his wishes, and hospice care has provided “good enough” days.  Pain control has done well. Then, finally, “No more breaths came.” The family travels to India to spread his ashes on the Ganges. 

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Annotated by:
Donley, Carol

Primary Category: Literature / Poetry — Secondary Category: Literature /

Genre: Poetry

Summary:

Bursting with Danger and Music  reveals Jack Coulehan’s  characteristic sensitivity to contradictions, tensions, and creative energy. The book is divided into six sections, thematically held together with such headings as “All Souls’ Day” and “Levitation.”  Many of the poems are first person narrations by patients,  physicians, and observers of the natural world.  Sometimes the patients are near death, as in “Darkness is Gathering Me” and “Slipping Away,” where they observe their own dying without fear but with wonder and even a sense of celebration:   “I’m pouring through the pores/ of this room, I’m already/ feeling the jazz and hormones begin” (p. 39). In “The Internship Sonnets,” he experiences the world of the medical intern, often scared and exhausted, who is caught between his subservient duty to the chief of medicine and his own violations of that duty, such as telling the truth to patients.  Where is his primary duty?  What ought he to do in these conflicting value systems?

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Summary:

The elegant widow Hélène (Edith Scob) lives alone with her faithful housekeeper in the cherished family home – a rambling country property outside of Paris. For her seventieth birthday, all her children and grandchildren come for a brief visit. Emphasizing their perpetual absence, they give her a portable telephone the mechanics of which baffle her. “You must set it up for me, before you go.”Hélène takes aside her eldest, Frédéric (Charles Berling) to explain her wishes for the estate, pointing out the most valuable art objects and emphasizing that the family should not feel tied to the old and costly house. Frédéric doesn’t want to listen; she is too young, he claims. He loves the house and assures her that the family will keep it. Moments later, the families pile into cars and race off. With the new phone still unconnected, Hélène is alone again, smoking in the evening gloom. Six months later, they gather once more for Hélène’s funeral. Single and living in the United States, Adrienne (Juliette Binoche) is sulky and rootless. Jérémie (Jérémie Renier) is entrepreneurial and is planning to live in Asia. Neither want to keep the house, and both could use the money from its sale. Frédéric is shattered by their indifference to the family and its traditions, but he cannot afford to buy them out. His wife sympathizes and waits. He loses the negotiatons. Yet, being the eldest and the only sib in France, he is forced to preside over the sale and dismantling of the property he loves. 

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