Showing 381 - 390 of 520 annotations tagged with the keyword "Disability"
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.
This history play narrates the rise to power through treachery and murder of Richard Plantaganet, Duke of Gloucester and last king of the House of York. Set in England during the Wars of the Roses (1455-1485), the play opens after the Lancastrian King Henry VI and his son Edward have been killed and Richard’s brother has been crowned Edward IV.
In the course of the play, Richard woos and wins Prince Edward’s widow Anne Neville and engineers the murders of his other brother (George, Duke of Clarence), his nephews, his closest advisor, possibly his wife, and other members of the court. He is crowned king but later dies a violent death in the Battle of Bosworth, defeated by Henry Tudor, Duke of Richmond, who will become the first Tudor King Henry VII.
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)
This collection of 36 poems, some of which have been published individually in various literary magazines, is primarily about dead--or nearly dead--family members: a brother and sister lost to cancer; the speaker's palsied, nearly blind father dying of Parkinson's disease; his mother's struggle with chronic arthritis and heart disease.
The collection is divided into three untitled sections. The first deals primarily with the aging and death of the speaker's parents; the second with a wider range of abandonment and death, lost loves, dreams, innocence; the third almost exclusively with his sister's six year struggle with breast cancer and dying.
At the heart of this novel is a simple love story. Dr. Bruno Sachs, a slight, stooped, and somewhat unkempt general practitioner in a French village is dedicated to his work and loved by his patients. Sachs is a solitary, self-effacing man who takes his Hippocratic duties seriously and is especially sensitive to the needs of his patients.
In addition to his private practice, Sachs works part-time at an abortion clinic, where he performs an abortion on a distraught young woman named Pauline Kasser. Soon the doctor and his patient fall in love. She moves in with him and becomes pregnant. An editor by profession, Pauline also encourages and assists Dr. Sachs in completing the book he is writing.
The story has many additional layers and dimensions. The reader views Sachs through the eyes of multiple narrators--his patients, colleagues, friends and acquaintances, all of whom write in the first person and present Bruno Sachs as "you" or "he." Thus, the reader gradually builds up a "connection" (empathy) with Sachs by synthesizing multiple glimpses of his behavior and facets of his character. At the same time, Sachs is trying to find his own voice, his own connection, by becoming a writer. At first he jots down random thoughts, then he keeps a notebook, and eventually he produces a complete manuscript.
The book has innovative structural elements that introduce other layers of meaning. For example, the 112 short chapters are organized into seven sections, corresponding with the components of a complete clinical case history: presentation (as in "chief complaint"), history, clinical examination, further investigations, diagnosis, treatment, and prognosis. Similarly, the narratives delve progressively into Sachs' "illness" and follow the "patient" through his course of "treatment."
Another structural element is the cycle of fertility and gestation. The story takes place from September through June, precisely 40 weeks, a pregnancy of nine months, during which Sachs is re-born.
The setting is a room in a home. Stretched out--half lying, half sitting--an elderly man ("the paralytic") gazes passively at a plate of food that is being held out to him by a gentleman who stands, bending toward him. In contrast to the paralytic, who wears a brown house coat, the standing men is properly dressed, but has a cloth draped over his left arm and holds a utensil in his right hand. The paralytic's arms, slightly bent, extend limply over his body; one foot rests on a stool and his lower limbs are covered with a blanket.
Hovering around the invalid with all eyes turned in his direction are several women, children, and a dog. The only figure who is not looking at the patient is a boy who kneels at his side, with an arm placed gently on the man's leg. In his stretched out position, the paralyzed man occupies a large space at the center of the picture and dominates it. The viewer's attention is further drawn to this central figure by the lighting--the background is dark while the cushion against which the man rests is light and glistens, and the man's face is bathed in light. Hence the viewer participates with the family in focusing attention on the invalid.
En route to the way to the Trojan War, warrior Philoctetes, wielder of the bow of Heracles, is bitten by a poisonous snake at the shrine of the goddess Chryse. The infected wound becomes so painful that Philoctetes’s screams of agony repel the Greek commanders, who order Odysseus to leave him on the island of Lemnos. Ten years later (the time of the play’s opening scene), Odysseus returns to Lemnos with Neoptolemus, son of the now-dead Achilles, to retrieve Philoctetes’s bow. It has been prophesied that only with this bow can Troy be conquered.
Promising him glory and honor, Odysseus convinces Neoptolemus to win Philoctetes’s trust and take the bow. Philoctetes, delighted to see any human and especially another Greek, shares his story with Neoptolemus, begs him to take him back to Greece, and entrusts him with the bow when he is overcome by a spasm of pain.
Deeply moved by witnessing Philoctetes’s misery firsthand, Neoptolemus confesses the truth to him, but tries to persuade Philoctetes to accompany him to Troy. When Odysseus appears, Neoptolemus returns the bow, declaring that only with Philoctetes himself wielding it will the prophesy be fulfilled. He asks forgiveness, and invites Philoctetes to come back with him to be healed and then on to Troy to contribute to the battle. The only thing that ends Philoctetes’s refusal is the sudden appearance of Heracles, who announces that Philoctetes and Neoptolemus must join together to take Troy.
The speaker had a childhood disability--"my strange, unruly hands"--that made tying his shoes a task to be dreaded, symbolizing failure. He addresses a caregiver who patiently ("for three years, for an hour each day") had taught him to tie his shoes. She reassured the child, "The doctors don't know / everything. You will be normal // someday. Normal."
The caregiver has also experienced bodily difficulties--from curvature of the spine caused by childhood spinal [tubercular] meningitis. She tells the child about her out of body experience ("You told me you'd died once") when she had seen herself on "the table," the "frantic" doctors calling her back "to the particular / boundaries of the flesh." She allowed them to bring her back.
Now, the adult speaker, no longer disabled, ties his shoes "by instinct," "my mind giving itself // up to the common world / of things" but when he focuses on the task, he slows down and remembers his caregiver; he becomes aware of his body, he becomes aware.
This poem is in memory of poet, John Logan (1923-1987), who, it is surmised, killed himself by jumping off a building. The speaker of the poem imagines what might have been troubling Logan, who had been disabled by strokes.
Late in 1918, the "Iolaire," a Royal Navy yacht carrying several hundred soldiers home to the Scottish islands of Lewis and Harris, sank in a storm off Stornoway Harbor. Over 240 were drowned, a crushing blow to an island community that had already lost 800 men in the Great War. The "Iolaire" tragedy served as the stimulus for this fictional account of friendship and love in the Hebrides islands during the War of 1914-1918.
At the book's center are three characters who form an emotional and spiritual triangle: Iain, a young poet who survives the European battlefields only to die by drowning in the "Iolaire" on his way home; the beautiful and vivacious Mairi, pregnant with Iain's child, but in reality in love with Callum; and Callum, a small town newspaperman whose disability keeps him out of the army, and who falls head-over-heels in love with Mairi.
Mairi leaves the island and travels to England to have her baby, planting the seeds of a future that we learn about in stages as The Dark Ship moves back and forth in time from 1916 to 1939 to 1996, and the fates of the characters are gradually revealed. In particular, we learn that after his death Iain Murray became world renowned as a soldier poet. Iain, whose friends never knew that he was a writer, left at his death a manuscript of poems, which his friend Callum Morrison arranged to have published in 1919. On the basis of that book, in MacLeod's fictional world Murray has come to rival such great first world war poets as Siegfried Sassoon and Wilfred Owen. (Murray's famous collection, called "A Private View," is appended to the novel.)