Showing 371 - 380 of 478 annotations tagged with the keyword "Medical Ethics"

The Use of Force

Williams, William Carlos

Last Updated: May-03-2001

Primary Category: Literature / Fiction — Secondary Category: Literature / Fiction

Genre: Short Story

Summary:

A doctor is called to the home of a poor, immigrant family. A beautiful little girl is quite ill. As diphtheria has been going around, the doctor attempts to examine her throat. The girl, however, won't open her mouth. She fights him off and all attempts to cajole her into compliance fail. Yet, the doctor is resolved to see that throat. He forces the girl's father to hold her down, while he manages to wrest open her mouth after a long battle. She does, in fact, have diphtheria.

View full annotation

Summary:

The film covers two days in the life of Frank Pierce (Nicolas Cage), a burned-out EMT (emergency medical technician) working the socio-economic underside of Manhattan. From the beginning, Frank is upset because recently all his patients have been dying on him, and he is haunted throughout by the hallucinated ghost of Rose, a young woman who collapsed on the street and died, apparently because he could not intubate her correctly.

Frank is highly stressed, he has no life outside his work, and he is self-medicating with alcohol. He tries to quit, but his boss keeps him on by promising time off in the future. In the film's first action, Frank does manage to miraculously resuscitate Mr. Burke, a heart-attack victim, but the patient winds up in the hospital with a very bad prognosis, so even that "saving" works against Frank.

Frank has encounters with numerous patients, many of them street people whose lives are out of control, some of whom are ER (Emergency Room) regulars, such as the demented young Noel (Marc Anthony). He also deals with (and is dealt with by) several highly idiosyncratic EMT partners in his ambulance rounds (John Goodman and others). Frank gets to know Mary Burke (Patricia Arquette), the daughter of the heart-attack victim, and they tentatively move toward being a couple who might help each other survive their lives.

Near the end, Frank, who knows Mr. Burke had tried to tear out his tubes during a brief moment of consciousness, and who feels he has been getting pleading messages from him to end his agonies, surreptitiously takes him off life support long enough for him to die. The physician who responds to the code decides not to attempt resuscitation of this patient who had already been resuscitated 14 times that day. Frank goes to tell Mary that her father has died (but not how), and exhaustedly falls asleep on her breast, apparently having forgiven himself because he has in some sense finally "saved" Mr. Burke.

View full annotation

Summary:

This is the second anthology from Donley and Buckley derived after many years of teaching "What's Normal?"--a literature and medicine course at Hiram College where they explore the cultural and contextual influences upon the concept of normality. With the first anthology, The Tyranny of the Normal, the editors focused on physical abnormalities (see this database for annotation). In this second anthology, the focus is exclusively on mental and behavioral deviations from societal norms. With this edition, Donley and Buckley present their case that, as with physical abnormalities, there is a similar tyranny of the normal that "dominates those who do not fit within the culture's norms for mental ability, mental health and acceptable behavior (xi)".

The anthology is divided into two parts. Part I is a collection of essays that introduce various clinical and bioethical perspectives on the subject of mental illness. These essays bring philosophic and analytic voices to the topic. Stephen Jay Gould's terrific essay on Carrie Buck and the "eugenic" movement in the United States in the early part of the 20th century illustrates one of the major themes that can be found throughout the anthology.

Oliver Wendell Holmes wrote the majority opinion in the 8-1 Supreme Court decision that sealed Buck's fate. Gould begins his essay reminding his readers of the often referenced Holmes quote, "three generations of imbeciles are enough." He then takes us on a fascinating historical adventure that uncovers a deeper and more complicated drama that led to this unfortunate period in American history, and the tragic incarceration and sterilization of Carrie Buck.

This essay, as with other stories, poems, and drama in the anthology, contemplates the relationship between societal values and mental illness, and illustrates how society through medicine can turn to the myth of "objective" diagnostic labels as a way to compartmentalize and control behavior and imaginations that are "abnormal." D. L. Rosenhan's essay from "On Being Sane in Insane Places" further illustrates the failure of the mental illness label. Irvin Yalom's story from Love's Executioner and Other Tales of Psychotherapy provides an example of what is possible when diagnostic labels are avoided, when health care professionals with power turn with humility, curiosity, and kindness toward others, substantiating that these qualities are far more powerful than statistical notions of "normal."

Part II is a collection of fiction, poetry and drama. Intended as a complement to part I, part II engages the reader in the lived experience of the narrators. It is divided into six sections. Section one considers children and adolescent experience of mental illness. Included are Conrad Aiken's "Silent Snow, Secret Snow," an excerpt from Susanna Kaysen's Girl, Interrupted (see annotation in this database), and an excerpt from Peter Shaffer's Equus (see annotation).

Section two includes stories that capture the world of mental disability and retardation. An excerpt from Of Mice and Men and Eudora Welty's short story Lilly Daw and the Three Ladies are included. Charlotte Perkins Gilman's The Yellow Wallpaper (annotated by Felice Aull; also annotated by Jack Coulehan) is in section three where women's experiences with mental disorders is the theme (these are annotated in this database).

Section four and five focus on men and mental illness. War experience is considered in the works of Toni Morrison and Virginia Woolf. Section six concludes the anthology. Alzheimer's disease and dementia are examined in Robert Davis's My Journey into Alzheimer's Disease, and in the story, "A Wonderful Party" by Jean Wood.

View full annotation

Lives of Moral Leadership

Coles, Robert

Last Updated: Mar-20-2001
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

In this book Robert Coles elucidates the nature of moral leadership by presenting a series of narratives about moral leaders. These are individuals who have made significant contributions to the author's moral development, mostly through personal interaction, but in some cases through their writings or their influence on other people.

The subjects include public personages like Robert Kennedy, Dorothy Day (of the Catholic Worker), Danilo Dolci (a Sicilian community organizer), Dietrich Bonhoeffer, and Erik Erikson; writers who have influenced Coles, such as Joseph Conrad and Ralph Waldo Emerson; and "ordinary" persons whom he encountered over the years in his studies of the moral lives of children.

The "ordinary" person category is most extraordinary. Coles draws heavily on personal interviews that reconstruct the courageous narratives of people like Andrew Thomas, a young Mississippian who worked on the voter registration project during the summer of 1964; Donita Gaines, one of the first black teenagers to "integrate" an all-white high school in Atlanta in 1961; and Albert Jones, a parent who volunteered to drive the school bus that carried black children in 1967 from Roxbury to a previously all-white school in South Boston.

However, the clearest and most powerful narrative that emerges from this book is that of the author himself, as he develops from young, socially conscious child psychiatrist to a middle-aged man seeking to understand what it means to be a moral leader in today's world.

View full annotation

The Forbidden Zone

Borden, Mary

Last Updated: Dec-20-2000
Annotated by:
Willms, Janice

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

By the author's own admission, this memoir is a collection of fragments taken from her memory of bits and pieces of her four year experience as a nurse in an evacuation hospital unit following the front lines up and down the European theatre during World War I. The work is fragmented because this experience was fragmented.

The first few chapters are dream-like descriptions of the men marching into battle and crawling back, or being carried back. The second collection of short vignettes dips--just a wee bit--into some of the individual soldiers' immediate stories. The latter segment of the book deals in more detail with the operations of the field hospital, some of its personnel, and some of the patients. Finally, the author treats the reader to a handful of poems, perhaps unnecessary, since the entire memoir is like one giant poem.

View full annotation

Summary:

Second Opinions, Jerome Groopman's second collection of clinical stories, illuminates the mysteries, fears, and uncertainties that serious illness evokes in both patients and doctors. The book is divided into 8 chapters, each a clinical story involving a patient with a life-threatening illness, plus a prologue and epilogue written by Groopman. The stories focus on people who face myelofibrosis, acute leukemia, hairy cell leukemia, breast cancer, and marrow failure of unknown cause. Two chapters are Groopman's personal accounts of his firstborn son's near fatal misdiagnosis, and of his grandfather's Alzheimer's dementia.

View full annotation

Annotated by:
Belling, Catherine

Primary Category: Literature / Nonfiction

Genre: Journal

Summary:

In this journal, Murray traces a month-long rotation he spends as attending physician in the ICU (Intensive Care Unit) of San Francisco General Hospital. For each of the 28 days, Murray presents the patients he sees, both new and ongoing, along with commentary on the care of each patient and on broader issues raised by their cases.

In the course of the month, we encounter sixty patients, fifteen of whom die in the ICU. The patients are apparently quite typical for the hospital: cases are dominated by HIV, pneumonia, tuberculosis, and drug abuse, or all four. The ICU is not a very safe place: there are twelve cases of iatrogenic pulmonary edema, and several of hospital-acquired infections.

Murray candidly presents both the triumphs and the limitations of contemporary intensive care while giving us vivid glimpses into the lives of both patients and staff. In his epilogue, Murray asks some tough questions about the value of intensive care units, and discusses palliative care, patients' rights to the withholding and withdrawing of life-sustaining therapy, and even physician-assisted suicide, as "more humane"--and economically responsible--alternatives to intensive care in cases of advanced terminal illness (270).

He describes the ICU as a "battleground" where people who are "clinging to life" can "fight for it" (275). This is its value. But the battles need to be better understood and winning must be carefully evaluated. Murray concludes that the last few decades' medical and technical advances in critical care now need to be matched by ethical ones.

View full annotation

Annotated by:
Bertman, Sandra

Primary Category: Literature / Nonfiction

Genre: Criticism

Summary:

Peppered with a plethora of black and white stills, this book is a compilation of a physician's film reviews and reflections on how movies have mirrored the changes in medical care and in society's attitudes towards doctors and medicine over the last sixty years. Ten chapters blend a chronological approach with a thematic perspective: Hollywood Goes to Medical School; The Kindly Savior:

From Doctor Bull to Doc Hollywood; Benevolent Institutions; The Temple of Science; "Where are All the Women Doctors?"; Blacks, the Invisible Doctors; The Dark Side of Doctors; The Institutions Turn Evil; The Temple of Healing; More Good Movie Doctors and Other Personal Favorites.

The appendices (my favorite) briefly note recurring medical themes and stereotypes ("You have two months to live," "Boil the Water!"). Formatted as a filmography, the appendices reference the chapter number in which the film is discussed, the sources of the photographs, and a limited index.

View full annotation

Souvenir

Phillips, Jayne Ann

Last Updated: Aug-04-2000
Annotated by:
Holmes, Martha Stoddard

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

Kate, a doctoral student, has chosen to move far away from the small town in which she grew up and in which her widowed mother (a school superintendent) and brother (an insurance man) still live. Kate's life is solitary, punctuated by unsatisfactory and transitory sexual relationships with men; she has headaches and wonders if "there were an agent in her body, a secret in her blood making ready to work against her" (p. 180).

While her mother disagrees with Kate's life choices, their long-distance relationship is sisterly, playful, and intimate. Kate sends her mother Valentine's Day cards, "a gesture of compensatory remembrance" since her father's death six years earlier (177). One year Kate forgets to send the card; soon after, her mother is suddenly hospitalized for tests that reveal a brain tumor.

Kate's brother insists that if she wants to come home, she must keep quiet about the likelihood of the tumor's malignance and the risk that the upcoming surgery will result in paralysis. He argues that their mother is terrified and that there is no point in making her more afraid. Kate objects to the concealment of the truth but complies unwillingly with her brother's request.

She gains permission to take her mother for a ten-minute walk outside, just time enough to take a ferris wheel ride. As their car reaches the top of the wheel, Kate is clearly upset. Her mother comforts her, saying, "I know all about it . . . I know what you haven't told me" (196).

View full annotation

In the Surgical Theatre

Levin, Dana

Last Updated: Jul-06-2000
Annotated by:
Davis, Cortney

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

In this complex poetry collection (divided into three sections, "Body," "Home," and "World"), the author moves from the specifics of the individual diseased or dying body to the more universal realm of suffering and politics. Not so much a poet of narratives as a conjurer of images, Levin writes from changing points of view: first as a man, then as a woman; as a surgeon, then a patient.

Poet Louise Gl├╝ck's introduction states that the book's power "derives from ambiguity: the raised scalpel-healing that looks like assault," and Levin's raw imagery is indeed both challenging and celebratory. In the opening poem, "Lenin's Bath," we watch with Dr. Sergei Debov as Lenin's corpse is tenderly submerged in a vat of embalming fluid. Debov imagines the germs that crawl along the cadaver "seeking a way in."

In the next poem, "Eyeless Baby," the reader becomes a caregiver searching a deformed infant's face that is nothing but a single nostril and a cleft palate. In "Bathhouse, 1980," we see (as the blind baby cannot) through a young homosexual man's eyes both the human longing for passion and the viral "scourge" that, again, seeks entrance. The angels that gather in the bathhouse's corner become nurses ("The Nurse") who swarm like moths over a hospitalized patient's body.

This interweaving of place and point of view continues throughout, creating a magical, disturbing world in which a reader can be both body ("The Baby on the Table") and healer ("In the Surgical Theatre"). Other powerful poems include "Personal History," "The Beautiful Names" (in which a young boy learns to name the sexual organs and so discovers their beauty), and "Witness."

View full annotation