Showing 41 - 50 of 251 annotations tagged with the keyword "Medical Education"

What the Dying Heart Says

Toomey, John

Last Updated: Feb-16-2015
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

The nameless narrator has been hospitalized for months. A terrible accident while driving his Jeep. He survived, more or less. The other occupants of the vehicle - his wife and two children - did not. He watched them die. A traumatic brain injury and locked-in syndrome have left him unable to communicate. Although his body is useless, he assures us that he is completely lucid and resentfully aware of his circumstances. He desperately wants to die and admits, "I am already dead with grief" (p. 245).

The medical team caring for him won't call it quits. The narrator's brother, Tommy, informs them that his sibling would not wish to be kept alive in his current condition. But Professor Carson, the attending physician, insists that treatment will continue because the patient is not dead. Only one doctor, a compassionate Croatian female intern, comes forward as an ally of the narrator. She wonders out loud, "What man would want to live? Now?" (p. 242).

Even as the narrator's physicians prepare him for a brain-computer interface, he voicelessly implores Tommy to "convince these bastards to let me go" (p. 244) - to no avail, of course. Dying of a broken heart and helplessly being kept alive despite a shattered one, the narrator is doomed to a survival he does not want and to remembering the gruesome loss of his family that he cannot escape.

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Annotated by:
Nixon, Lois LaCivita

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Although Dr. Helman’s untimely death did not permit a final editing by this prodigious writer, the published edition is not a book-in-progress. An Amazing Murmur of the Heart: Feeling the Patient’s Beat represents a powerful and persistent continuation of observations and themes that grew out of medical education, close observations of physicians and patients, and his studies in anthropology. All of these forge an approach to patient care that is out of the ordinary.  

As his previous writings suggest, Helman is passionate about medicine but concerned, equally about the emergence of those who fail to listen and to those who might be called techno-doctors.  While professing his appreciation of and attraction to the magic machine or computer, he is mindful of its absence of emotion and ambiguity.  “For this post-human body is one that exists mainly in abstract, immaterial form.  It is a body that has become pure information.” (p. 11)

Chapters are comprised of stories about patients and their care providers, each representing complex facets that defy precise measurement, answers and conclusions.  As Helman steadily notes, the physician must be an archeologist:

Most patients present their doctors with only the broken shards of human life—the one labeled infection, disease, suffering and pain each of these shards is only a small part of a much larger picture….the doctor will have to try and reconstruct the rest. (p.66)

In general, the chapters illustrate first an initial review of medical history, and then specific patient stories.  Of the two, the story is most important.  “Mask of Skin,” for example, begins with an overview of skin from Vesalius to the present: largest organ, stripped bare by anatomists, penetrated by disease, later scanned and X-Rayed, tattooed, re-fitted by surgeons, etc.   That said, Helman the physician-anthropologist, moves from science to specific stories about patients whose skin may cover profound experiences, psychic and otherwise, that might be overlooked by a dermatologist.   Although skin is involved in each of that chapter’s stories, the willing physician must dig deeper in his observations and caring manner to make more profound discoveries.      

In a chapter entitle “Healing and Curing” the author describes an old friend, a practitioner who provides advice about patient care that ”was not included in his medical texts”.  Patients are more than a diagnosis dressed in clothes.  Doctors must make patients “feel seen, listened to, alive”.  Always patients should be regarded as people who happen to be sick.  From his admired colleague Helman learned to be an attentive listener  to the "tiny, trivial, almost invisible things" in patient encounters and stories. To truly heal as well as cure requires the doctor to empathise with what the patient is feeling thereby requiring both an act of imagination and of the heart.  The chapter, of course, continues with with stories that illustrate the points enunciated by his colleague and accepted by his disciple. 

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Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Criticism

Summary:

This is a compendium of original critical essays on a wide range of topics written by a diverse group of scholars of what has traditionally been called "medical humanities." The editors argue for a change of name to "health humanities," pointing out that "medical" has a narrow frame of reference - evoking primarily the point of view of physicians and their interaction with patients, as well as the institution of biomedicine. Such a focus may exclude the myriad allied individuals and communities who work with patients and their families. The editors quote Daniel Goldberg, who notes that the health humanities should have the primary goal of "health and human flourishing rather than  . .  the delivery of medical care" (quoted on page 7).

The three editors are innovative contemporary scholar-educators in the field of medical/health humanities. They advocate Megan Boler's "pedagogy of discomfort" (quoted on page 8) and wish to provide students and educators "an opportunity to examine critically the origins and nature of their personal beliefs and values, beliefs and values embedded in the curriculum and the learning environment, as well as institutional policies - all of which intersect" . . and influence quality of care (8). In their own work and in this Reader the editors favor an approach to health humanities education and research that "challenge[s] the hegemony of a biomedicine that contributes to disparities and the discrimination of persons who don't quite fit the codified and naturalized norms of health."

The book is divided into 12 parts, each comprising three or four chapters: Disease and Illness, Disability, Death and Dying, Patient-Professional Relationships, The Body, Gender and Sexuality, Race and Class, Aging, Mental Illness, Spirituality and Religion, Science and Technology, and Health Professions Education. At the end of each section there is "an imaginative or reflective piece" on the topic. A wide range of disciplines is represented, including disability studies, history, bioethics, philosophy, literature, media studies, law, and medicine. Some of the authors are well-known and have been practicing their profession for many years (for example, Arthur Frank, Sander Gilman, Anne Hudson Jones, Martha Montello, John Lantos) while others have entered the field more recently and are gaining increasing attention (for example, Rebecca Garden, Daniel Goldberg, Allan Peterkin, Sayantani DasGupta).

The Reader is well documented: there are footnotes at the end of most chapters, a references section of 50 pages, notes on contributors, and a 72-page index.

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Summary:

Following the 9-11 terrorist attacks, approximately 20 New York University medical students volunteered to work with the Office of the Chief Medical Examiner of the City of New York (OCME) attached to the NYU School of Medicine to sort, catalogue and identify human remains recovered at Ground Zero. On September 11, Barry Goldstein, Adjunct Professor of Humanism in Medicine at NYU, was to begin teaching a course on aspects of photography to medical students. After 9-11, Goldstein decided to photograph and interview the volunteer medical students in order to document their individual experiences and memories of the events of September 11 and their personal reflections of working with the dead.

Photographed with a simple black background in the "scrubs" they wore while working in the morgue, and with a personal "prop" of their choosing, the colour portraits are intensely sorrowful and candid. Goldstein, who is an experienced portrait photographer, observed that "for reasons I still find unclear, these students were surprisingly adept at absenting themselves from the entire process of picture taking. As a result, the masks that we generally put on for the world when faced with a camera were absent." Accompanying each student's image is an excerpt from his/her interview about memories of working in the morgue and the meaning of that work.

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Annotated by:
Willms, Janice

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

According to the editor’s introduction, this collection is based on the AMSA (American Medical Student Association) assertion that the physician must be a humanist, a communicator and an advocate as well as a scientist.  To support these and related commitments, it offers essays that demonstrate how and under what circumstances the introduction of creative arts into the lives of professional care providers and their patients and families may be achieved.  Included in some essays are general themes, while in others there are very detailed descriptions of methodology. Others utilize more standard research designs and outcomes.

What creative arts are included in the discussions?  Visual arts, drama, music, and story-telling stand out in terms of potential and, in some cases, already demonstrated applicability to a medical practice.  Some of the essays propose art forms that can be translated into a useful frame for health practitioners, artists and/or patients and their families.

Some essays include assessment of research projects or various designs of methodologies for using creative art in the medial professional education environment.  Others rely on personal experiences using the arts in the learning and teaching of skills such as communication with peers, patients, family and friends.

The volume is divided into four sections.  The first cluster of essays considers using the arts to illustrate empathy in encounters among providers and recipients of health care services.  This is demonstrated in a variety of settings as disparate as end-of-life situations and dental training programs.

The second section includes examples of drama, music and drawing as part of caring for caregivers.  Through group settings and peer support, art serves as a stress reducer for those whose work involves the highly emotional situations health professionals often encounter.

Section three explains and demonstrates the narrative reflective process, in which experiences and stories are shared among those persons involved as patients, family members and caregivers.  The special situation of interviews in pediatrics is given attention in one portion of this section.

The final section addresses the question of using art to explore troublesome issues that demand change or special attention.  Included are ethical dilemmas and the need for health professions to build bridges to the community at large.

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The Anatomy Lesson

Siegal, Nina

Last Updated: Jun-17-2014
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In 1632, at the age of only 26, Rembrandt finished a large (85.2 in × 66.7 in) oil painting that was destined to become one of his best known works and certainly one of the linchpins in the nexus between the graphic arts and the medical humanities. "The Anatomy Lesson of Dr. Nicolaes Tulp" depicts the dissection of the flexor tendons of the left arm of a cadaver by the eponymous doctor while an attentive audience of his peers, identifiable members of the medical and anatomical community of early 17th century Amsterdam, looks on. Nina Siegal's novel tells her imagined back story of this richly illustrated anatomy lesson which, once you read her captivating novel, will make you ask yourself, as I did, why no one has thought fit to do so heretofore.

Using multiple first person narrators, Siegal examines the characters (some historical, others wholly fictional) and events leading up to the anatomy lesson and Rembrandt's artistic rendering of it. Inventing a life for Aris Kindt (born Adriaen  Adriaenszoon), the historically real career criminal whose recently judicial hanging provides the body we see in the painting, Siegal provides him with Flora, a lover who is carrying his illegitimate child at the time of his public - and quite raucous - hanging. Growing up in Leiden, in the same neighborhood as Flora and Rembrandt himself, Kindt was the physically and emotionally abused son of a leather worker and, in Siegal's imagination, a petty but persistent thief hanged for his inveterate and irremediable life of crime. As was the custom of the day, his body was legally assigned to an anatomist for public dissection. With a non-linear narrative, organized into brief chapters entitled for body parts, Siegal traces the beginnings of three of the protagonists - Kindt, Flora, and Rembrandt. She constructs  how their lives intersect not only before, during and after the hanging, but also in more philosophical strokes, namely the medical, theological and artistic tapestry on which this image rests. There are several minor characters, like Tulp and his family; Jan Fetchet, the "famulus" responsible for securing and preparing Kindt's body immediately following the hanging; and even René Descartes, who seems to have been in town during this momentous occasion pursuing his own polymathic research, which included anatomy at the time.  Siegal adds a few reports dictated by a fictional modern- day conservator offering her interpretation of many of the details of Rembrandt's masterpiece, details that serve to highlight aspects of Siegal's narrative, such as the possible artistic re-implantation of Kindt's amputated right hand.

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Summary:

The author is a practicing neurosurgeon, one of only two hundred or so women in this specialty which numbers about 4,500. She was the first woman to be admitted to her neurosurgery residency program. Her father was a surgeon and she was definitely influenced by him and says that, as the oldest of four children, it was always expected that she would become a doctor; but she didn't decide for sure until partway through her second year of college.

Once in medical school her decision for neurosurgery as her specialty came very easily. Oliver Sacks's writing had a significant influence on her decision. She was also influenced by her college sweetheart who became her husband and who also chose to train as a neurosurgeon. He is not practicing now and they do not have children.

Her description of her long years of training are interestingly related with many individual patient stories and also many descriptions of her teachers and peers. She takes time to describe how she views the specialty itself and its power structure and all that entails. Among the interesting chapters are two about her research years, one at the center for cognitive brain imaging at Carnegie-Mellon and one as a fellow in Epilepsy Surgery. The author was fascinated with the complexity of brain function and its relation to anatomical structure with which she was much more familiar.

Firlik found that she loved "life on the learning curve" and that her curiosity was broad. About her last year as Chief Resident she said "I have had my hand in saving lives and I have had my hand in helping to end them: I'm not talking about murder, of course. I am talking about helping people die" (227). She was able to write this book because she kept a journal during her training.

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Arena

Moore, Frank

Last Updated: Jan-29-2014
Annotated by:
Aull, Felice

Primary Category: Visual Arts / Painting/Drawing

Genre: Oil on canvas

Summary:

This painting depicts what in some respects mimics an anatomy amphitheater, but the title, "Arena," tells us that what is going on here is more spectacle than instruction. Painted in 1992, early in the AIDS epidemic, when rapid decline and death from the disease was almost unavoidable, this complex artwork catalogs some of what was taking place in society at the time. A shaft of window light illuminates the center where a masked doctor is examining a Caucasian patient while a nurse, similarly masked, stands nearby. A large white plume of smoke or steam is emanating from the patient's head. The examination is being filmed and narrated.
 
In the lower right-hand corner a dark skinned patient attached to an IV is lying on a gurney. An attendant has his back toward the patient, whom he seems to be ignoring as he speaks with another white clad hospital worker. If one follows a diagonal from the ignored patient through to the central figures, toward the upper left, another patient, covered completely by a sheet and apparently dead, is being wheeled out of the arena. Adjacent to this scene are people seated cross-legged on the floor, listening to a speaker reading from a book while a Buddha floats above him. [According to art critic Klaus Kertess, the reader is poet John Giorno, "who instructed Moore in Buddhist practice" (Toxic Beauty, p. 11)]. In the lower left, a vendor wheels his cart, selling soda and sausages, adding to the carnival atmosphere. Just ahead of him an elderly woman holds a flattened out body in her arms.
 
To the upper right, police barricades and struggling policeman attempt to hold back a group of protesters carrying a sign saying "Who's in Charge?". In the upper center, two skeletons stand in front of a screen and hold banners bearing Latin inscriptions. An instructor is pointing to drawings on the screen - molecules and cell membranes. Other skeletons are positioned at the edges of the painting, also bearing banners, and in the lower center two skeletons stand in front of a fruit tree. One of these skeletons holds what seems to be a heart dripping blood. Several figures dressed in costume are posing or dancing. The curved rows of the arena are sparsely populated and include skeletons of various animals as well as two men who are injecting themselves in the arm. Robotic figures appear here and there in the painting.

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The Way of the Physician

Needleman, Jacob

Last Updated: Dec-02-2013
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Jacob Needleman, a philosopher concerned with "applying philosophy to the questions of everyday life," taught medical ethics at San Francisco State University (SFSU). In this highly personal book he addresses what it means to be a "good doctor" and the role of physicians in contemporary society. The book is structured as a series of imaginary letters addressed to his childhood idol, the physician who treated him when he was 12 years old.

The aged Dr. Kaufman responds to these letters, although we see only the philosopher’s side of the correspondence. Toward the end of the book, Needleman makes a pilgrimage to Philadelphia to visit his ailing mentor. They talk for a while, then when the old man takes a nap, Needleman spends the rest of the day conversing with Dr. Kaufman’s daughter, a pediatrician who in some sense represents the "good" medicine of the future, just as her father represented the "good" medicine of the past.

In these letters the author addresses the deep questions of character and motivation in the form of a personal narrative. He recalls his experiences as a boy, his ambition to become a doctor, and several incidents from his life as an autopsy assistant and hospital orderly. For example, there is the bizarre story of the young man transporting an amputated leg by elevator; he accidentally drops the leg to the floor and the wrappings flip open, much to the astonishment of others on the elevator.

"People don’t trust science; people trust people." (p. 15) Similarly, Jacob Needleman writes, people don’t trust or distrust medicine as an institution; they trust or distrust doctors. "To be a good doctor, one must first of all be a good (person). And to be a good (person) one has to begin by discovering in oneself the desire for truth . . . truth is the only effective force." (p. 68)

To facilitate this quest for truth, Needleman describes in these letters a four-seminar sequence he teaches at SFSU: "To whom is the physician responsible?," "The art of living and the art of medicine," "Care," and "The financial disease of modern medicine." (pp. 71-72) Through these seminars the author hopes to re-awaken in prospective physicians the quest for truth, and the possibility of care, that he believes have been submerged by technology and infected by the financial disease. Dr. Kaufman’s daughter serves as a real-life example of the possibility of cultivating the contemporary version of the "good doctor."

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Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

The pediatrician-author of this autobiography was the first Jewish professor of medicine at the prestigious McGill University.

Born in Montreal in 1890, Alton was an only child whose immigrant father was an itinerant merchant with somewhat shady dealings. The shy boy developed hemoptysis and was sent away from home and family to the healthier air of Denver on the erroneous suspicion of tuberculosis.

He overcame shyness and found an ability to speak in acting and “declaiming” passages from Shakespeare. Literature remained a lifelong passion. Notwithstanding the quotas on Jewish students, he attended McGill medical school, followed by residency in the United States where he encountered many luminaries of twentieth-century pediatrics.  

Upon his return to Montreal, he confronted entrenched anti-semitism, but was instrumental in founding the Jewish General Hospital and a children’s hospital. He witnessed exciting medical discoveries and, like many other pediatricians, championed initiatives for child health that relied on social intervention.

The book closes with a few case histories of small patients, many of whom fell ill because of parental and societal ignorance.

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