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Handle With Care

Picoult, Jodi

Last Updated: Mar-16-2013
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

At five years old, Willow O’Keefe has lived a life rich in love and exceptional learning; she reads beyond her years and has memorized a startling compendium of unusual facts.  She has also sustained over 50 broken bones, two of them in utero.  She has osteogenesis imperfecta, a congenital defect in the body’s production of type 1 collagen that leaves bones very brittle.  People with the disease generally suffer many fractures and often other conditions—exceptionally small stature, hearing loss, and bowed limbs.  Willow’s parents and older sister have organized their lives for five years around protecting her from damage and helping her heal from her many broken bones.  Though Amelia, her older sister, loves Willow, her parents’, Charlotte and Sean’s, intense focus on Willow’s condition often leaves her jealous and disgruntled.  Things go from bad to worse when their mother learns that a lawsuit for “wrongful birth” is legal in New Hampshire, and could bring them the money they need to cover Willow’s many medical expenses.  Such a step, however, means losing a best friend, since the obstetrician who oversaw Charlotte’s pregnancy and Willow’s birth, and who ostensibly overlooked signs of the disease and failed to warn the parents, has been Charlotte’s best friend for years.  A “wrongful birth” suit is based on the claim that medical information about a congenital defect was withheld that might have been grounds for a decision to abort the pregnancy.  Though Charlotte insists this drastic step is the best thing they can do to insure a secure future for Willow, Sean finds it repugnant enough finally to leave home.  It is clear that even a win will be a pyrrhic victory, and indeed, the outcome is ambiguous, costly, and life-changing for everyone concerned.

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Primary Category: Literature / Fiction

Genre: Collection (Short Stories)

Summary:

This collection of 16 short stories focuses on doctors and patients in San Francisco, where a wide variety of wealth and culture impact the delivery of medical care.  Further, there are many restrictions—financial, bureaucratic, ethical, and legal —that limit what doctors can do, especially in cases of patients near death.

The author, Louise Aronson, is a geriatrician who knows this terrain very well, having trained in San Francisco and worked as a physician there. A skilled writer and close observer, she has created dramatic and often funny stories that reveal social and bioethical complexity. About half the stories describe end-of-life issues for the aged and the dilemmas for their physicians and families.

In ‘The Promise,” Dr. Westphall orders comfort care only for an elderly patient who has suffered a massive stroke, but a hospital gives full treatment because there was no advance directive and the daughter told the attending to do “what he thought best.”

When Dr. Westphall sees this barely functioning patient in a skilled nursing facility seven months later, he tenderly washes her face and hair—although the text teases us that he might have been prepared to kill her.

In “Giving Good Death,” a doctor is in jail charged with murder; he has fulfilled the request of Consuela, a Parkinson’s patient, to help her die. When it appears that she may have died for other reasons, he is released, his life “ruined.” He leaves San Francisco, and, we surmise, medicine. In three other stories, doctors also leave the profession: the cumulative stresses of work and family and/or a sense that it’s not the right path bring them to that choice.

On the other hand, one of the longer pieces “Becoming a Doctor” celebrates the profession, despite all the rigors of training including sexism against women. 

The stories bring multicultural insights; we read of people from China, Cambodia, Latin America, India, Russia, and the Philippines. Some are African-American; some Jewish, some gay. These different backgrounds color notions of health, death, and medical care. There are also pervasive issues of poverty and, at another extreme, professionalism that is hyper-rational and heartless.

Indeed, a recurring theme is care and love for people, no matter their background or current health status. A surgeon realizes (regrettably too late) that the secret of medical care is “caring for the patient—for anyone—just a little. Enough, but not too much” (p. 135). 

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Night Duty

Breznik, Melitta

Last Updated: Feb-27-2013
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The first person narrator of this debut novel is a young pathologist, a woman who relates the story of her family over the course of the book. The story is bleak: a young German woman marries an Austrian soldier in WWII, moves to Austria with him and has three children - two sons (one of whom dies as a youth following abdominal surgery) and the narrator-daughter. In a running commentary, almost hallucinatory at times,  the narrator offers brief descriptions of  a traditional preliminary internship year during which she acts as a pathologist, cares for in-patients, and even makes a futile ambulance call to a fatally injured man in a freight yard.  Yet, virtually the entire novel revolves around her family:her father (whose tuberculosis is briefly described),  a factory worker with dreams of  inventing an electronic security relay (never realized); intermittent holidays of evanescent family happiness; and a long threnody about her father's eventual death at the end of the book from a hopeless and domestically abusive alcoholism. Her detailed description of his death traumatizes everyone around her and leads to a rupture in the family.

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Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

F. González-Crussi, professor emeritus of Pathology at the Feinberg School of Medicine at Northwestern University, has written several books on medicine and the human body. Carrying the Heart deals with five basic organ systems; he styles them as Digestive, Scatology, Respiratory, Reproductive, and Cardiovascular.

In his Foreword, he rejects a mechanical view of the body and medicine that treats patients as passive protoplasm. He seeks to engage the imagination of his readers so that they can become active participants in health care.

For each system, González-Crussi assembles an eclectic wealth of materials: views of authors from classical times onwards, scientists who changed perceptions of the body, his own hands-on view as a pathologist, parallel organs in other mammals, and, usually, an extended narrative of a person with an unusual anatomical history. These are highly personal essays, “rhapsodies,” we might say, which stitch together unusual and interesting facts, observations, and interpretations. It’s impossible to guess what will be on the next page, and the discoveries are many. A gifted stylist, González-Crussi writes with both erudition and wit. 

For “Digestive,” he cites Livy, Paracelsus, Joan Baptista van Helmont, and others before turning to Thomas Bartholin, who questioned the notion that the stomach was somehow the “king” of the body and the seat of the soul. González-Crussi writes, “the gastric cardia admits and stores impure food, without this having any discernible effect on the soul. Nor is the soul damaged by performers at circuses and country fairs who lower swords and knives into the stomach” (p.7). The text marches on through Réamur, Spallanzani and others, before turning to the well-known story of Dr. William Beaumont and his patient Alexis St. Martin, who had a hole in his side (from a gunshot). Beaumont experimented with materials placed directly into the stomach.

Next in the digestive process are the bowels, discussed on “Scatology,” literally the study of scat or excrement. González-Crussi is fascinated by cultural values of “death, putrescence, and dissolution” that attach to our scat. He draws on Rabelais, Luther, the Gnostics, Chuang-tzu, and the Aztecs for the views on the contents and process of the bowels—more than the nature of the actual bowels themselves. The next 30 pages deal with enemas, including the modern (and discredited) notion of “auto-intoxication” a justification bruited about even today for colonics.

Oddly enough, the enema theme continues in the “Respiratory” essay, because there were “smoke enemas” for some 200 years. Page 104 shows a French illustration of interlocked tubes for this purpose; indeed the same illustration graces the slipcover for the book. González-Crussi draws on Anaximenes, Pirandello, Plutarch, Hawthorne, and others. Some 15 pages describe a famous tuberculosis patient, Frederic Chopin, although perhaps he was actually a cardiac patient.

Part I of “Reproductive” is “Female.” We quickly learn that “The uterus is placed between the bladder and the rectum. As a piece of real estate, the uterus would be much devalued by the condition of the neighborhood” (p. 152). Nonetheless, the uterus is “immunologically privileged,” fending off germs that might infect a fetus (which in itself is “half foreign” because of the father’s genes). Drawing on many commentators, González-Crussi discusses menstruation, and pregnancy, although not genital pleasure or orgasm. Some insightful pages explore the normal death of cells within our body.

Part II, “Male” discusses erections, side-curving penises, and the famous penises of Napoleon, Rasputin, and Jesus.

The last essay, “Cardiology” briefly explores two types of knowing (from the heart, from the brain) before a lengthy retelling of the Lay of Ignauer; this strange story ends with women whom he has seduced eating his cooked heart. The last section discusses Harvey’s discovery of the heart as a pump. The final two pages see a new consideration of the heart as a second brain.

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Open Heart

Wiesel, Elie

Last Updated: Feb-01-2013

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Elie Wiesel, 82-years-old, has pain that he thinks is in his stomach or esophagus, perhaps caused by his chronic acid reflux.  After tests, however, doctors diagnose cardiac illness and insist on immediate surgery. Reluctant to go to the hospital, Wiesel dawdles in his office. When he does go, doctors believe a stent will do the job. Instead, the intervention becomes a quintuple bypass.

This brief memoir—a scant 8,000 words—presents the “open heart” of a gifted writer as he contemplates his open-heart surgery, his past life, and the future. He asks himself basic, even primal questions about life, death, and the nature of God.            

Although a man with an extraordinary career—prizes, fame, honorary doctorates, friends in high places, professorships—Wiesel experiences and describes ordinary feelings of anxiety, pain, and doubts about his cardiac emergency and possible death. His stylistic gifts describe frankly and vividly a patient’s fears. As many have observed, patients with a serious disease have two difficulties, the disease itself and their emotional responses to that disease.  As Wiesel is wheeled into the OR, he looks back on his wife and son; he wonders whether he will ever see them again.            

He writes that his “thoughts jump wildly; I am disoriented.” He recalls a friend undergoing similar surgery; she died on the table. He says he can’t follow the jargon of physicians. The texture of the prose is rhapsodic, jumping from the present to memories, many of them about war, his past surgeries, or important family events. This short book has 26 “chapters,” some just half a page; they are like journal entries.

As he slowly recovers, he feels pain and has visions of hell, including the concept of ultimate judgment. “Evidently, I have prayed poorly…; otherwise why would the Lord, by definition just and merciful, punish me in this way?” (p. 38).  Because he has a “condemned body,” he feels he must search his soul. In the longest chapter of the book, he reviews several of his writings.

Wiesel asks some of the questions from his famous novel Night (La nuit, 1958).  If there is a God, why is there evil? Auschwitz, he says, is both a human tragedy and “a theological scandal” (p. 67). Nonetheless, he affirms, “Since God is, He is to be found in the questions as well as in the answers” (p. 69).

At the end, he still has some pain but feels much gratitude for his continuing active life and for his grandchildren.

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Propofol

Kirchwey, Karl

Last Updated: Jan-23-2013
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Poetry

Genre: Poem

Summary:

"Propofol" is a 20 line poem of five quatrains each with an a-b-a-b rhyming scheme. Appearing in the June 30, 2008 New Yorker magazine, it is a description of the Classical allusions and hallucinatory experience surrounding the administration of the hypnosedative, propofol, to the speaker-patient for an undescribed medical procedure.

It involves a whimsical conversation, of sorts, between the patient and the physician. After the patient references many of the Greek and Roman materials (moly, mandragora), art ("Euphronios' famous calyx-krater" [http://en.wikipedia.org/wiki/Euphronios_krater]) and deities (Somnus, Hypnos, Morpheus) involved with sleep and death ("Sleep and Death were brothers"), the physician is made to ask why the patient is there - one presumes, and only hopes, he in fact knows!

The poem ends with the onset of what is known as procedural sedation ("A traveller/approached the citadel even while I was speaking,/seven seconds from my brain; then it was snuff."). The final two lines describe the image - apparently now in the hallucinating patient's head - of Félicien Rops' 1879 painting "Pornokrates", in the Musée provincial Félicien Rops, Namur, France (http://www.museerops.be/tech/drawing/pornokrates.html), the genesis of which Rops described thus in a 1879 letter to Henri Liesse:

"I did this in four days in a room of blue satin, in an overheated apartment, full of different smells, where the opopanax and cyclamen gave me a slight fever conducive towards production or even towards reproduction."[quoted at the Musée provincial Félicien Rops site.]

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Art Work

Byatt, A. S. (Antonia Susan)

Last Updated: Jan-23-2013
Annotated by:
Sirridge, Marjorie

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

The Matisse art work which forms the center for this story is the painting, "Le Silence Habité des Maisons," which shows a parent and child with featureless faces sitting at a table while looking together at a book. This painting is described as the reader is introduced to a family of artists and their unusual housekeeper, Mrs. Brown.

The mother is the design editor of a magazine, A Woman’s Place, and the father is a rigid, relatively unsuccessful painter. There are two children in the family. Mrs. Brown provides the cement to keep the family together and learns from them ways to develop her own unusual kind of art. Interpersonal relationships are fragile and personal needs are great. There is a surprise ending.

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Medusa's Ankles

Byatt, A. S. (Antonia Susan)

Last Updated: Jan-23-2013
Annotated by:
Sirridge, Marjorie

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

This is the story of the experiences of a middle aged university teacher when visiting her regular beauty salon. A copy of Matisse’s painting, "Rosy Nude" is part of the decor of the salon and is actually what attracts her to the salon in the first place. The main character’s self image and her desire to maintain a natural appearing hairstyle are central to the story.

Her relationship with the owner, who is her personal hair dresser, is also central and the body images of him and others who work in the shop or are customers add interest and color to the story. The conclusion is theatrical and unexpected and points out the many differences in the way we view ourselves and the way in which we are viewed by others.

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Annotated by:
Sirridge, Marjorie

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

This is a story of the interactions of an art student and her assigned mentor, with whom she is at odds, and the interactions of the mentor with a university professor who has been given the task of arbitration between the student and the mentor. The problem for the student and the mentor is that they have totally divergent views of Matisse as a painter of women's bodies.

The mentor sees these paintings as beautiful but they are abhorrent to the student, who has developed an eating disorder as part of her rebellion against the emphasis on female pulchritude. The painting "La Porte Noire" is used to describe the mentor's great admiration for Matisse's amazing use of color.

The university professor brings to the encounter with the mentor her astute understanding of the problem, but also some of her personal issues; this interaction includes a subtle description of the many possible reasons for suicide attempts. The story skillfully describes academic conflict, unhealthy human behaviors, and the importance of skillful arbitration.

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Musee des Beaux Arts

Auden, W.

Last Updated: Jan-23-2013
Annotated by:
Aull, Felice

Primary Category: Literature / Poetry

Genre: Poem

Summary:

This thought-provoking poem is best read with a representation of the painting to which it refers in view (the painting, Landscape with the Fall of Icarus by Pieter Bruegel, is reproduced in On Doctoring). Auden considers the nature of human suffering: "how it takes place / While someone else is eating or opening a window or just walking / dully along . . . . " For each individual life affected by personal catastrophe (in the painting, Icarus falling from the sky into the ocean), there is the rest of humankind which must go about its daily business, either oblivious or unable to assist (in the painting, Icarus might almost be overlooked, flailing in the lower corner of the picture while the ploughman in the foreground has his back turned). Life, and death go on although the sufferer, and sometimes those who are paying attention, find this inconceivable. And what about the ship "that must have seen / Something amazing" but "had somewhere to get to"? What is the context in which suffering is noticed, what obligations exist, what can and cannot be remedied?

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