Showing 41 - 50 of 651 Nonfiction annotations

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Atul Gawande’s Being Mortal is both ambitious and synthetic, qualities that well suit his difficult subject, death.  In Western culture, there are taboos against death because it fits neither into post-Enlightenment notions of progress and perfection nor into medical notions of control, even domination of human biology. A surgeon and an investigator, Gawande draws on his patients, his family, and travels to various hospitals and other caregiving places in order to confront death and see how approaches such as hospice and palliative care can improve our understanding, acceptance, and preparation for death.

Gawande has harsh words for contemporary medicine, the supposed caregiver for the dying and their families.  Relying heavily on technique and industrial models, it ignores the deep needs of the dying and provides, instead, versions of “warehoused oblivion” (p. 188), for example long, futile stays in ICUs.

As opposed to traditional societies like India, Westerners prize the independence of individuals, a status that is, of course, never permanent. In the chapter “Things Fall Apart,” Gawande describes how longer lives are now the norm but they include chronic illnesses and inevitable decline in vitality.  Our deaths are now routinely in hospitals, not at home, and often extended—sometimes brutally—by technical support and unwillingness of doctors and families to stop aggressive treatment.       
       
Also, sadly, there are fewer and fewer geriatricians at a time when there are more and more elderly.  A good geriatrician takes a long time with each patient, is not well paid, nor does s/he do income-generating procedures. Worse yet, some training programs are being discontinued.  

Gawande illustrates his ideas with case studies of patients and describes, from time to time in the book, the elderly journeys of his grandmother-in-law and his own father.  These passages make vivid the abstract ideas of the book. But it’s not just elderly patients who face death: health calamities can come to anyone, for example, a 34-year-old pregnant woman found to have a serious cancer. Various treatments are tried without success, but family and doctors act out “a modern tragedy replayed millions of times over” (p. 183) of a medically protracted death. Finally her mother calls a halt to treatment.
               
Family members often bear a heavy load in caring for a sick elder, but many nursing homes are often worse, designed for control, not support of the patients. 

The chapter “A Better Life” describes the first in a series of places that offer much improved settings for the elderly, with birds, animals, gardens, and, in general, richer lives that have a sense of purpose.  Gawande describes hospice care, palliative care, and advanced directives (including Do Not Resuscitate orders) as improvements needed to break the norms of “treat at all costs.” The old roles of Dr. Knows-Best and Dr. Informative need to give way to physicians and others who talk with patients and families about their values, their wishes for the last days, and their preparations for death. In short, aggressive treatment should no longer be the “default setting” for hospital care.     
        
The book ends with a dozen moving pages about the death of Gawande’s father. The “hard conversations” have clarified his wishes, and hospice care has provided “good enough” days.  Pain control has done well. Then, finally, “No more breaths came.” The family travels to India to spread his ashes on the Ganges. 

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Annotated by:
Schilling, Carol

Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

Carol Levine began a roiling odyssey as a caregiver when a car accident left her husband paralyzed and in need of 24-hour care. She regards her husband’s survival as “a testament to one of American medicine's major successes — saving the lives of trauma patients.” But once he returned to their home, Levine encountered a healthcare system that was fragmented, chaotic, and inequitable. Unprepared to address chronic care, it remained oblivious to her needs as her husband’s primary medical “provider,” as they would say. Written nine years after the accident and eight years into her care giving, Levine’s essay recounts the stress and isolation she experienced attempting to navigate that system, to perform unrelenting chores, and to sustain her employment. Her job was, after all, the source of her husband’s managed care insurance, which regularly managed to leave Levine with unpaid bills. Even her work in medical ethics and healthcare policy could not help her locate the assistance she needed to assure the well being of her husband or herself.  Or of other care-giving families.

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Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Nonfiction

Genre: Biography

Summary:

This Side of Doctoring is an anthology published in 2002 about the experiences of women in medicine. While the essays span multiple centuries, most are from the past 50 years. They reflect on a multitude of stages in the authors’ personal and professional lives. In 344 pages divided into twelve sections, including "Early Pioneers," "Life in the Trenches," and "Mothering and Doctoring," the 146 authors recount - in excerpts from published memoirs, previously published and unpublished essays, poems and other writings, many of them composed solely for this collection - what it was then and what it was in 2002 to be a woman becoming a doctor in the U.S.. All but a handful of the authors are physicians or surgeons. There is a heavy representation from institutions on both coasts, especially the Northeast. Four men were invited to reflect on being married to physician wives. There is one anonymous essay concerning sexual harassment and a final essay from a mother and daughter, both physicians.   Beginning with the first American female physicians in the mid-19th century, like historic ground-breakers Elizabeth Blackwell and Mary Putnam Jacobi, the anthology proceeds through the phases of medical school, residency, early and mid-careers, up to reflections from older physicians on a life spent in medicine. Many of the authors have names well known in the medical humanities, including Marcia Angell, Leon Eisenberg, Perri Klass, Danielle Ofri, Audrey Shafer, and Marjorie Spurrier Sirridge, to mention a few. 

The essays and poems and letters have, as a partial listing, the following subjects: family influences in becoming a physician; professional friendships; marriage; children and their impact on a woman’s career in medicine; the decision not to have children; ill family members; illness as a physician; establishing one's sexuality as a physician; struggles with male physicians and their egos; mentors, both female and male; memorable patients (often terminal or dying); the life of a wife-physician, or mother-physician; the guilt and sacrifice that accompany such a dual life; the importance - and easy loss - of personal time or what internist Catherine Chang calls “self-care” (page 334).
  The anthology also touches on how women have changed the practice of medicine in various ways, prompted by the growing realization, as family practice physician Alison Moll puts it, "that I didn't have to practice in the traditional way" (page 185)  The authors write about the wisdom of setting limits; training or working part-time or sharing a position with another woman; and the constant face-off with decisions, especially those not normally confronting an American man becoming a doctor. 
One conclusion is evident before the reader is halfway through the book: there are many approaches to becoming a fulfilled female physician including finding one’s identity in the field.  Implicit in most of the essays and writings is the lament from obstetrician-gynecologist Gayle Shore Mayer: "Where is the self ? There are pieces of me everywhere", (page 275) recalling a similar cry from Virginia Woolf's Orlando, another essentially female soul trying to find what Richard Selzer has called "The Exact Location of the Soul".
 Several authors discover that female physicians have unique gifts to offer their patients. As internist Rebekah Wang-Cheng writes, “I am a better physician because I am a mother, and I know because of my experiences as a physician that I am a better mother.” (page 151) 

There are sections at the end devoted to a glossary for the lay reader, resources for women (as of 2002), and generous notes about the contributors (which section also serves as a useful index of each's contributions).

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Annotated by:
Lam, Gretl

Primary Category: Literature / Nonfiction — Secondary Category: Visual Arts / Visual Arts

Genre: History

Summary:

This book examines the rise of the obesity epidemic through the perspectives of art, literature, and medicine, particularly in Britain, with brief mention of continental Europe and North America. In the first chapter, the authors set the scene by explaining the medical significance of obesity: namely, how and why obesity leads to illness. The remainder of the book is devoted to discussing historical perceptions of obesity, the history of eating, the history of exercise, and the history of weight loss remedies. Historical perceptions of obesity are addressed from several angles, including the business of “fat folk” circus freaks; the portrayal of obese figures in art, from Paleolithic stone sculpture to seaside post cards to modern film; and the depiction of obese figures in writing, from Chaucer to J. K. Rowling. Throughout the book, the authors are careful to emphasize that obesity is not simply a self-inflicted product of gluttony and sloth, but a condition brought about by many factors, including genetics and social influences. They conclude the book by urging society to take a more aggressive stance against obesity by reminding readers that obesity kills.

David Haslam is a general practitioner in the United Kingdom, He is also Clinical Director of Britain’s National Obesity Forum, a charity formed in 2000 to increase awareness of obesity as a medical condition. Fiona Haslam is a historian of medicine and art, with a doctorate from the University of St. Andrews. She is also the author of From Hogarth to Rowlandson: Medicine in Art in Eighteenth Century Britain (Liverpool University Press, 1996). 

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Medicine and Art

Emery, Marcia; Emery, Alan

Last Updated: Mar-18-2015
Annotated by:
Lam, Gretl

Primary Category: Literature / Nonfiction — Secondary Category: Visual Arts / Painting/Drawing

Genre: History

Summary:

Medicine and Art discusses the evolution of medicine and the changing role of the physician in society as depicted through art. The book is organized in rough chronological order, beginning with a copper statue of Imhotep of Egypt and a vessel featuring Hippocrates of Greece. Artworks depicting Ayurvedic, Tibetan, Persian, Chinese, North American Indian, and African medicine are also included, but the main focus of this book is Western medicine as portrayed in European and American paintings. These paintings take the reader through history, from nuns caring for the sick in the 1300s to quacks attracting gullible customers in the 1600s to the use of the stethoscope and the start of vaccination. The final artwork is a 2001 embroidery piece by Louise Riley depicting the link between patient and medical researcher.

The book features 53 images that are organized into 53 bi-fold layouts, with a written description and discussion of the artwork on the left hand page and an image of the artwork on the right hand page. These images are generously sized, taking up much of the page, and the vast majority are in color. Concise paragraphs explain the image by providing both medical and art historical context. 

Alan E.H. Emery and Marcia L.H. Emery are the husband and wife team who compiled this book. Alan E.H. Emery is a distinguished British neurologist, medical genetics researcher, and amateur oil painter. Marcia L.H. Emery
is a librarian and a psychologist.

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Summary:

In 1847, one of every six women whose babies were delivered by the medical students and supervising doctors at Allgemeine Krankenhaus (General Hospital) in Vienna died of puerperal fever (also known as childbed fever). In contrast, the incidence of this disease in women delivered by hospital midwives was dramatically lower and puerperal fever was quite rare when mothers had their babies born at home.While a few physicians (most notably Alexander Gordon and Oliver Wendell Holmes) realized that childbed fever was a contagious process, it was Semmelweis who identified the nature of the problem as stemming from the failure of obstetricians and medical students to wash their hands and change their clothing, especially after performing autopsies or doing surgery. He mandated that doctors and students wash with a disinfectant (chloride of lime) before examining any woman in labor.Despite the dramatic reduction of maternal mortality on his obstetrical unit, his ideas and methods were not well received. Semmelweis was reluctant to conduct experiments on animals to prove his theory and resisted publishing his findings in any medical journal. When he finally did write a book, The Etiology, the Concept, and the Prophylaxis of Childbed Fever, it was difficult to read and failed to impress many obstetrical experts.With his health failing and his behavior increasingly erratic and inappropriate, Semmelweis was committed to a state-run mental hospital. He died two weeks later. The official cause of death was sepsis secondary to an infection of his finger. The author is convinced, however, based on the autopsy report and findings upon exhumation of the body in 1963, that Semmelweis was beaten to death by the staff at the asylum. He may well have been suffering from Alzheimer's presenile dementia at the time.

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Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Linden, a professor of neuroscience, has written a book for a general audience on the subject of touch. A synthetic thinker, he combines insights from science, anatomy, neurophysiology, psychology, and social behavior. He argues that touch pervades much of human experience: “From consumer choice to sexual intercourse, from tool use to chronic pain to the process of healing, the genes, cells, and neural circuits involved in the sense of touch have been crucial to creating our unique human experience” (p. 5). Case studies of medical oddities enliven his account.

Chapter One, “The Skin is a Social Organ,” draws on a wide range of examples, from NBA players to vampire bats. Touch is especially important to the development of human newborns. Lab experiments have shown that the attitude of the toucher can influence the experience of the touched. English and American cultures are touch aversive.

Chapter Two discusses the neurophysiology of touch, the sensory nerves and the neurons that link to the spinal cord or to the brain. Lively examples include string players, 1900-era women with “underwear-shaped numbness,” and the Braille writing system for the blind. 

In Chapter Three, “The Anatomy of a Caress,” Linden explores further the tactile fibers that relay touch. “A caress communicates that you are safe,” he writes, and the C-tactile system is the main route from skin to the brain.

Chapter Four, “Sexual Touch,” moves beyond caress all the way to orgasm, detailing the roles of touch receptors and brain activity as well as the wide variety of personal and social contexts.

Chapter Five looks at nerve endings of human skin that detect chili peppers as hot and mint as cool. Vampire bats have another version that detect heat, useful for locating blood vessels on “donors.”

Chapter Six, “Pain and Emotion,” opens with Pakistani children who do not feel pain; they have a genetic mutation that influences a sodium channel in neurons. Pain itself varies with people’s emotions, experience, and expectations. Some mindfulness practices (yoga, Tai Chi, meditation) can lessen chronic pain.

Chapter Seven, “The Itchy and Scratchy Show,” discusses river blindness and shingles, among other topics.

Chapter Eight, “Illusion and Transcendence,” provides a helpful overview of sensory nerves and their connection to various parts of the brain. Some stimuli activate the “emotional-affective-cognitive portions,” while others activate “sensory-discriminative centers.” Touch, in general, often has strong social meanings but does not, for Linden, imply any supernatural dimensions.  

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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:

Soldier Girls is an exhaustively researched, intimate report by a journalist of the lives and deployments of three women in the Indiana National Guard, who, through serving together in Afghanistan, become friends. Each of the women joined the Guard prior to 9/11/2001, mostly for economic reasons. Thorpe selected women who were vastly different in age and background.  Debbie Helton becomes a grandmother during deployment and has served in the guard for decades - she is eager to be deployed. Michelle Fischer (a pseudonym) is newly out of high school, has liberal political views and sees the Guard as a way to pay college tuition. Desma Brooks is a single mother of three with a fractured and unreliable support system. All three have alcohol and or drug dependency issues. Brooks and Helton are deployed a second time - to Iraq.

 As one of the women, Fischer, notes, the Bush wars were an ‘economic draft' (p. 374) The struggles to find adequate housing, reliable partners, good schools, decent jobs, and to avoid the morass of drug dealing, which particularly surround Fischer and Brooks, are paramount in their lives.   

The women bond not only due to their shared gender, but also due to their mutual sense of humor. For example, to distinguish her tent from the dozens of similar ones on the base in Afghanistan, Brooks orders 50 plastic pink flamingos to decorate the ‘lawn.'   

In Afghanistan, the women are part of the support troops, doing such jobs as fixing AK-47s for the Afghan National Army. Nonetheless, even there, they are in harm's way, with the potential for injury or death from mortars, buried bombs (landmines) and improvised explosive devices (IEDs). In Iraq, Brooks is exposed to danger daily, as she drives an armored vehicle  usually in the navigation spot of a long convoy, third in line. She suffers traumatic brain injury after driving too close to and detonating a large IED.    

Thorpe weaves the three stories together of the women into a seamless whole. She chooses to follow the post-deployment lives of the women, and it is after demobilization that the heartaches truly develop. For example, Helton, who had always been upbeat and extraordinarily generous with her nurturing, turns inward and suffers depression. Fischer finds it difficult to relate to anyone without a military background, yet feels alienated from veterans who continue with a gung-ho attitude. And Brooks's children, who felt abandoned by their mother, act out in different and difficult ways.   

Issues of military sexual trauma are introduced, though none of the main characters experiences MST. However, all are harassed, to varying degrees. Sexuality is a prominent theme, both heterosexual and homosexual. "Don't ask, don't tell" was the policy during their deployments. Partners during deployment are different than those at home, and infidelity is common on base, further dividing military from civilian life.   

A particularly poignant side-story is that of the translator, Abkar Khan, introduced on page 171: "He was movie-star handsome, with a square jaw, high cheekbones, chiseled lips, and an aquiline nose." Abkar accomplished what no amount of cultural sensitivity training might - he gave a face and voice to the people the troops had been sent to help: soldiers would later relate "that getting to know Abkar was the single greatest thing that would happen to them in Afghanistan - he was what gave meaning to their deployment". (p. 172) Abkar marries his first cousin in an arranged marriage, temporarily realizes his dream to work in the United States, then returns for a lucrative but dangerous job of translating in interrogations.   

Posttraumatic stress disorder, post deployment risky behavior, traumatic brain injury, and bone and joint injury due to maneuvers required while wearing heavy equipment and protective clothing are discussed. Despite the large numbers of sexual partners, no sexually transmitted diseases are discussed, but one minor character does get an abortion after a relationship with a superior officer (these relationships, though forbidden, seem common). As noted in the book, the costs of the wars in Iraq and Afghanistan go far beyond the activities in the war theaters themselves, but continue on in the lives of the returned troops, and the families of all those who were deployed.       

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