Showing 351 - 360 of 510 annotations tagged with the keyword "Hospitalization"
In her poem, "Dehiscence," Amy Haddad speaks in the voice of a nurse tending a suffering patient. The patient has "come unstitched," and, seen through the nurse's eyes, the patient's wounds are devastating: fistulas "connect bowel, liver, pancreas"; the "stench is overwhelming," telling everyone, caregiver and patient alike, that medical science has failed, that no more can be done.
Moved by her patient's suffering and her own inability to help, the nurse does what she can. She washes the patient, changes the soiled sheets, removes the dirty dressings and replaces them with clean gauze and tape. "Done," she says. Stepping back, looking from a distance, she can no longer see the patient's wounds. She "is caught," as all caregivers have been at one time or another, in "the illusion" of the patient's "wholeness."
Jose is a patient who exhibits all the classical symptoms of autism. The caregivers in his institution treat him dismissively, as though he is stupid. Sacks notices, however, that, given a pencil, Jose draws not only with amazing accuracy, but with a quality of liveliness in his representations that betokens close, insightful, and even empathetic observation and awareness. As he encourages Jose to draw, he finds his drawings diagnostically helpful, and powerful evidence of an active interior life to which they provide a valuable link.
Penny (Michele Hicks), working as a prostitute, is called to a room in a seedy hotel where she finds her client is a pair of adult conjoined twins, Blake and Francis Falls (played by identical but not conjoined twins, Mark and Michael Polish, who also co-wrote the screenplay). Shocked, she flees but later returns and, when she learns that one of the twins is ill, calls a doctor friend of hers to examine them. She cares for the twins and they become friends. At Halloween, "the only night of the year they [can pass for] normal," she takes them to a party and then back to her apartment where she and Blake almost make love while Francis, evidently the weaker twin, is sleeping.
She tells her lawyer/pimp about the twins, and he tries to persuade them to sell him their story (which he imagines in terms of separation: "The greatest divorce of all time: not who gets the kid but who gets the kidney . . . "). Offended by her betrayal, they return to their hotel room, and, apparently for the first time, the twins fight. Blake wants to get away from his brother.
The next morning Francis is ill once more, and the twins are hospitalized. Michele visits them and learns that they are dying. Francis's heart is becoming weaker, straining Blake's, and the only way to save Blake will be by separating them. Francis cannot survive separation. Penny tracks down their mother (Lesley Ann Warren), who gave them up for adoption at birth. She visits them in hospital. It emerges that Penny herself has a "retarded" child who is being raised by others. Francis's heart fails, and the twins are taken to the operating room.
Later, Penny tracks Blake down where he is now living alone in the trailer where the twins had lived before, as circus performers. The film ends with Blake, now a man with one arm and one functioning leg, telling Penny that the "story of me is over," but also that stories continue after sad endings. What makes an ending sad, he tells her, is the knowledge that the storyteller is continuing without you.
The subtitle of this memoir is "Meditations upon Returning." Richard John Neuhaus is a Catholic priest and scholar, director of the Institute on Religion in Contemporary Life in New York City and described on the book cover as "one of the foremost authorities on religion in the contemporary world." The book is a meditation on his near-brush with death as a result of colon cancer.
As Fr. Neuhaus describes it, he underwent two colonoscopies to ascertain the cause of persistent abdominal symptoms, but in both cases his colon was pronounced completely normal. However, shortly thereafter, he developed extreme abdominal pain and was taken to the hospital, where emergency surgery was performed and a colon cancer the size of a "big apple" was removed. During the first procedure, the surgeon nicked his patient’s spleen, so a second emergent procedure was required to control hemorrhaging.
The two procedures left Fr. Neuhaus very near death, but he gradually recovered over a period of several months. When introducing the story of his illness, the author comments, "several lawyers have told me my case would make a terrific malpractice suit." (p. 79) But he says he won’t sue, because it would "somehow sully my gratitude for being returned from the jaws of death." (p. 80) In fact, he has considerable praise for his surgeon.
The narrative of Fr. Neuhaus’s illness occupies a relatively small proportion of this memoir. The first three of seven chapters consist of the author’s reflections on the meaning of suffering and death, and especially the existential question of "Why me, now?" (His answer is "Why not?) In chapter five Fr. Neuhaus describes a near-death experience that changed his life, a scene in which he heard two "presences" tell him, "Everything is ready now." In much of the rest of the book, the author examines and rejects the possibility that the experience was a dream or an hallucination. He is convinced that he witnessed the "door" to a more glorious life after death, and this has, in some sense, profoundly changed his present life.
The narrator's father is in the hospital awaiting surgery that might be his last. She and her sister have been coming to the hospital regularly during his prolonged stay, and have become familiar with the cast of characters there, including an old man in a state of dementia who wanders the halls asking directions. The narrator reflects on her family, what can be spoken of and what can't, the different reactions they have to hospital regulations, crisis, impending loss.
She longs to tell her father she loves him, but is constrained by family reserve. As the family gathers at his bed before the surgery, she comes to realize some things will never be fully expressed, but must remain implicit. The unspoken is part of the loss she recognizes as she faces her father's death.
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.
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.
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)
An anthology of poetry and prose by doctors, nurses, patients, and other authors, A Life in Medicine is divided into four sections: "Physicians Must Be Altruistic"; "Physicians Must Be Knowledgeable"; "Physicians Must Be Skillful"; and "Physicians Must Be Dutiful." Each section begins with the Association of American Medical Colleges' (AAMC) definition of the physician trait examined in that section, and short "explications" precede each individual poem and prose piece, linking them to the section's overall theme.
The anthology has a preface outlining the editors' goals and Robert Coles's introduction, "The Moral Education of Medical Students." These organizational touches make the anthology a classroom-ready text for medical students. The anthology's poems and prose--many of which are stunning--were taken from previously published works and exclude many well-known and often-used pieces. But those selections are readily available elsewhere, and the editors do readers a greater service by introducing many lesser-known, but equally important, poems and essays.
Abba Kovner wrote these poems during and after his hospitalization at Sloan Kettering for throat cancer. His exile into the world of illness begins as he enters the hospital. "He fell asleep under strange skies" (p. 7) and in the hospital "the silence astounds on all / its many floors."(p. 11) [Throughout the book, Kovner refers to himself in the 3rd person.] He tries to pray: "Is there a prayer for one who prays like him / seething . . . " (p. 15) He decries "the infuriating confidence of the doctors." (p. 21) He celebrates the beauty and magnificence of New York. But then the bad news arrives: "When they told him they were going to cut away his vocal cords / entirely it was merely / a confirmation of what he already knew."(p. 31)
To the brisk, young hospital staff, he is just another patient, nothing but an "ancient shard”: "They could not imagine that this was a man / who had fought the world."(p. 36) Only Norma, the Puerto Rican night nurse, connects with him at a different, more human level. "He blushes / when Norma says: What a lovely / head of hair you have, sir!" (p. 88) As he prepares for the laryngectomy, images from the past invade his consciousness--Christmas Eve, 1941; the Vilna ghetto, where "the lice / got under your skin" (p. 68); and "a shoemaker, his name forgotten" (p. 74). The Holy Guests--the souls of Abraham, Isaac, Jacob, Joseph, Moses, Aaron, and David--also visit the sick room.
After the surgery, the conspiracy of optimism brings him along, carries him forward: "What a healthy recovery, / they said. And patted him on the shoulder / with admiration: You’re doing fine. Wow!" (p. 85) But this is at best a voiceless recovery: "From the wreckage of his voice / there arose a bubble / a tiny bubble . . . " (p. 101) Eventually, the patient leaves the hospital, leaves New York, and arrives home: "Fearful from the moment of arrival: he / watches the landing that cannot / be avoided, into / the arms / of people who love him . . . " (p. 111) He settles into a routine, lives his life as if there is nothing new, but ends at "An Ending, Unfinished" (p. 126), back at Sloan Kettering. "Where now? He asked himself . . . " What next?