Showing 41 - 50 of 127 annotations tagged with the keyword "Medical Testing"

Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Sandeep Jauhar, M.D., Ph.D. is currently director of the Heart Failure Program at Long Island Jewish Medical Center in New York. Thus, one can assume that he is an accomplished cardiologist and administrator. It was not always so. This memoir flashes back to 10-15 years earlier when the author was casting about for a career, finally settling on medicine almost by default; it follows him to medical school (at Washington University in St. Louis) and then centers on his first year of residency training at Cornell's New York Hospital in Manhattan -- the internship year.

We learn in the introduction to the book that the author will speak freely of self-doubt about career choice, constant anxiety and feelings of inadequacy, exhaustion, and disillusionment. Which indeed he does. But Jauhar first discusses his family background: born in India and emigrating with his family to the USA at age 8; father holding a Ph.D. in plant genetics, now writing academic textbooks and still regretting that he had not been able to afford his dream of becoming a doctor; mother helping to support the family as a lab technician; older brother, Rajiv, a mentor and competitor, charming, self-assured, and unquestioningly headed for a medical career; sister, Suneeta. Sandeep (the author) undertakes graduate work in theoretical physics but as he nears completion of his doctoral degree, realizes that he probably does not have what it takes to be successful in the field. When his girlfriend, Lisa, becomes seriously ill, he begins to (re)consider medicine as a career. Against the advice of his parents who are now convinced he is a dilettante, he applies to medical school and is accepted.

Disillusionment began during the first two years of medical school: "In graduate school I had never learned to memorize . . . But now I couldn't rely on logic and reasoning; I had to commit huge swaths of material to memory" (32). He considered quitting to become a journalist, a profession that had always intrigued him, but which had been discouraged: "my father made it clear that journalism and writing were never to be considered career options because they offered no security" (33). Yet, amazingly, he was awarded a summer fellowship just before starting medical school that placed him in the Washington, DC office of Time magazine; the contacts he made then allowed him to work as a student reporter for the St. Louis Post-Dispatch during medical school and led ultimately to his ongoing and current position as a contributing medical essayist for the New York Times.

Internship for Jauhar unfolds as a series of anxiety-provoking encounters with patients and humiliating encounters with his physician superiors. Feeling inept and inadequate, he stumbles along and worries that he is harming patients. There is too much to keep track of, too many "little things that I find burdensome" (91). "Having so much to do was bad enough, but not knowing why you were doing what you were doing was terrifying . . . Patients were needy, their demands overwhelming . . . Everyone seemed to know how the place worked except me . . . The ecology on the wards was hostile; interactions were hard-bitten, fast paced" (112-113). He is in constant doubt and conflict about his career choice. Even his private life is affected -- his girlfriend Sonia, still a medical student, comes from a medical family, is strongly motivated and secure in her career choice, which aggravates his own sense of insecurity. (Reader, he married her.)

Midway through internship Jauhar suffers a herniated disk. He tries to tough it out without taking time off but his stint as "night float" at Memorial Sloan-Kettering hospital, which specializes in treating cancer patients, proves too difficult-- up all night trying to tend to the severely ill and "taking care of patients about whom you knew next to nothing" (154). He takes a brief leave followed by a reduced schedule. He recognizes that his problems are emotional as well as physical -- he is depressed. But gradually, as his neck problem improves, as he recognizes that medical professionals are actually able to help patients feel better -- his neurologist and physical therapist had "provided hope and comfort to me at a vulnerable time" (181)--, as he makes a house call to a dying patient, as his essays are published in the New York Times, and as the season moves to Spring, his depression lifts and he looks forward to his work.

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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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Annotated by:
Duffin, Jacalyn

Primary Category: Visual Arts / Painting/Drawing

Genre: Art with Commentary

Summary:

The basis for this autobiographical essay on the experience of having a malignancy are 92 illustrations, all the work of the author; they include 32 ink or woodcut sketches, 24 charcoal drawings, and many acrylic paintings (16 in full colour). Pope's images evoke the dependence, fear, loneliness, pain, and even the mutilation surrounding cancer illness and therapy.

He describes in plain language the course of his own illness, diagnosis, and treatment; he also relates the experiences of a few fellow patients. Most intriguing is his ready description of the stories behind his pictures: who posed, how he painted them, and what exactly he was trying to convey. When the book was published, Pope was in a hard-won remission from Hodgkin's Disease, but he died the following year of treatment-induced bone marrow failure.

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Annotated by:
Duffin, Jacalyn

Primary Category: Visual Arts / Visual Arts

Genre: Mixed

Summary:

The basis for this autobiographical essay on the experience of having a malignancy are 92 illustrations, all the work of the author; they include 32 ink or woodcut sketches, 24 charcoal drawings, and many acrylic paintings (16 in full colour). Pope's images evoke the dependence, fear, loneliness, pain, and even the mutilation surrounding cancer illness and therapy.

He describes in plain language the course of his own illness, diagnosis, and treatment; he also relates the experiences of a few fellow patients. Most intriguing is his ready description of the stories behind his pictures: who posed, how he painted them, and what exactly he was trying to convey. When the book was published, Pope was in a hard-won remission from Hodgkin's Disease, but he died the following year of treatment-induced bone marrow failure.

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Unwanted Inheritance

Bolin, Robert

Last Updated: Dec-27-2007
Annotated by:
Willms, Janice

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Ann, the primary protagonist, is diagnosed with and operated on for breast cancer. Her family history leads her to suspect that she may have passed the breast cancer gene on to her daughters-this assertion without having been tested. She retreats from society. Her husband leaves her and she raises two daughters, ever plagued with guilt. The two daughters, as technology advances, choose to have themselves tested. One daughter, tests positive for BRCA-2; the second daughter is not tested, but is diagnosed with breast cancer.

The mystery becomes: from which parent did the women inherit the gene? While the younger daughter struggles with her progressive cancer, the older daughter goes in search of the genetic contributor. Since this becomes a search for an answer, the answer remains up to the reader to pursue. The angst created by the unanswered questions makes up the bulk of the intrigue, and may emulate real life struggles with this particular disease.

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How Doctors Think

Groopman, Jerome

Last Updated: Aug-06-2007
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

In How Doctors Think, Jerome Groopman explores clinical decision making with a particular emphasis on the poor communication skills and cognitive errors that often lead to misdiagnosis and inappropriate treatment. He uses a narrative approach, filling the book with compelling stories that illustrate the world of patient-physician interactions. Why did a second doctor quickly conclude that Blanche Begaye suffered from aspirin toxicity, while her first doctor mistakenly diagnosed viral pneumonia? Why did several physicians fail to diagnose Maxine Carlson's ectopic pregnancy until the day it ruptured? Groopman's storytelling skill permits him to convey complex concepts (e.g. availability bias, anchoring, and Ockham's razor) through conversation and narrative.

Three major themes run throughout the book, and each is presented with several variations. The first theme is that doctors who don't listen to their patients are likely to make serious mistakes in diagnosis and treatment. The second is that doctors frequently don't have the self-awareness to understand their own errors, especially those that involve dealing with ambiguity and understanding the importance of emotions. The final theme is that that patients ought to be active participants in their own care. This is not a new message, but Groopman frames it in a new way. Given the complexity of clinical decision making, and the many cognitive errors physicians may fall prey to, patients can improve their own care by helping their doctors minimize or avoid such errors. Among other things this means asking thought-provoking questions like "What else could it be?", "What is the worst thing it could be?," or "Is it possible I have more than one problem?"

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Summary:

Tracy Kidder met Paul Farmer in 1994 when the former was writing an article about Haiti. They next met again in 1999 but it was only when Kidder expressed an interest in Farmer and his oeuvre that Farmer emailed him back, writing "To see my oeuvre you have to come to Haiti" (17). Kidder did just that, following the peripatetic workaholic Farmer to Peru, Russia, Boston, and wherever Farmer flew, which is anywhere there is poverty and disease, especially infectious disease.

In Mountains Beyond Mountains (MBM), Kidder chronicles Farmer’s childhood, medical school years (almost a correspondence course with Farmer’s frequent trips to Haiti), his founding of Partners in Health (PIH) and the construction of the medical center in Cange, Haiti, where "Partners in Health" becomes Zanmi Lasante in Creole.

The story of Farmer’s crusade for a more rational anti-tuberculosis regimen for resistant TB; his political struggles to wrestle with drug manufacturers to lower the price of these and medicines for HIV; his charismatic establishment of a larger and larger cadre, then foundation of co-workers; the story of Jim Kim, a fellow Harvard infectious disease specialist; Farmer’s marathon house calls on foot in Haiti; endless global trips punctuated by massive email consultations from all over the world; and gift-buying in airports for family, friends and patients--these are fascinating reading. In the end one is as amazed and puzzled by the whirlwind that is Paul Farmer--surely a future Nobel Peace Prize laureate like Mother Teresa--as Tracy Kidder was and grateful to have the opportunity to read about it by such an intelligent writer.

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The Fundamental Pictures

Gilbert and George

Last Updated: May-18-2007
Annotated by:
Henderson, Schuyler

Primary Category: Visual Arts / Sculpture

Genre: Sculpture

Summary:

Gilbert and George's work over the past three decades has largely consisted of grid-like photomontages - note, they consider their work to be "sculpture". These often massive works are at once easily identifiable as part of Gilbert and George's oeuvre (in part because they often have Gilbert and George in them) and unflinchingly referential: to the manufactured sheen and unnaturally bright neons of Warhol, to the confrontational exposure of Mapplethorpe's photography, and, of course, to cathedral stained glass. They draw upon these same influences in their creative self-creation, their transgressive aesthetics, and their repetition and reworking of religious and secular motifs intertwined with abstractions. Gilbert and George are insistently doubles: original and derivative, repetitive and evolving, reactionary and visionary.

The Fundamental Pictures consists of a series of some 39 scultptures, most involving juxtapositions of bodily execretia - sputum, tears, urine, semen, feces - in monumental close-up; the tears, urine and semen are captured through a microscope, dessicated and crystalized. The sensational titles of the individual works, such as 'Piss Faith' and 'Spit on Shit', are fairly accurate in describing the central themes of each work. In some of the montages, Gilbert and George appear, pink and naked, against a kaleidoscopic backdrop of bright, magnified bodily fluids; in others, they are dressed in their familiar suits. They were exhibited at the Lehmann Maupin Gallery, New York, in 1997.

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Get a Life

Gordimer, Nadine

Last Updated: Jan-02-2007
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Untouchable. Paul Bannerman considers himself a modern day leper. Diagnosed with papillary carcinoma of the thyroid at the age of 35, the white ecologist in South Africa undergoes surgery to remove the malignant thyroid gland. Four week later, he is treated with radioactive iodine to obliterate any residual cancerous cells. Paul will remain radioactive for 16 days and poses a risk to anyone in contact with him. He must be quarantined. His parents, Adrian and Lyndsay, offer to care for him in their home so that Paul will not expose his wife, Berenice (Benni), and 3-year-old son, Nickie to potentially harmful radioactivity. While at his parent’s house, Paul is isolated. Nothing of Paul’s is allowed to mingle with that of others. He spends considerable time in the garden reflecting on his life.

As Paul recovers, his parent’s marriage unravels. His mother has had a previous affair. Now his father has a fling of his own (with the tour guide) during a trip to Mexico. His dad never returns home and dies of heart failure in Norway. Paul’s mother adopts an HIV-positive 3-year-old black girl.

Benni wants to have another child, but Paul is worried. Are his radioactive sperm still capable of fertilization, and if so, will the child be somehow deformed or mutilated? Eventually conception occurs, and the baby is healthy. Paul’s most recent scan shows no signs of recurrent cancer. On the professional front, Paul gets additional good news. The environmental and conservation organization he works for has been successful in opposing and temporarily halting a mining project in the sand dunes and the development of a pebble-bed nuclear reactor. Lately, most things associated with Paul are starting to glow.        

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The Ultrasound

Divakaruni, Chitra Banerjee

Last Updated: Dec-04-2006
Annotated by:
Belling, Catherine

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

The narrator, Anju, and her cousin, Arundhati (Runu for short) are both young married Indian women who are pregnant for the first time, due to give birth within a few days of each other. The difference is that Anju lives in the United States and Runu in India. They write letters to each other, and when the story begins, Anju is planning a special telephone call to Runu because this is the day they are both due to get the results of their amniocentesis.

As Anju anticipates the phone call, she provides information about both women. She grew up in a relatively affluent family in Calcutta, went to college, and moved to San Diego with her husband, Sunil. Runu was less wealthy, and married into a large and traditional Brahmin family in the provinces. Runu is strictly controlled by her mother-in-law.

Anju receives her test results: her baby, a boy, is healthy. But Runu is expecting a girl, and because of this her family decides that she should have an abortion. She is devastated, and is planning to run away. Anju encourages her, but Anju's husband becomes angry, arguing that perhaps Runu should be obedient and have the abortion.

They argue, but then Anju remembers the ultrasound earlier that day, when she saw her son for the first time, and realizes that Runu must have had the same experience, and like her would do anything to protect the fetus. The story ends with her planning to help Runu to come to America, and imagining, almost certainly unrealistically, the future of their children together.

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