Showing 51 - 60 of 78 annotations tagged with the keyword "Anesthesia"
While on an airplane, Carson experiences abdominal pain. He is a divorced man in his fifties and a sales representative for a computer and information technology firm. He spends much of his time traveling and fancies himself "a connoisseur of cities." The increasingly severe stomach pain forces Carson to reschedule his business meeting and retreat to his hotel room.
His suffering mounts and he decides to visit the emergency department of the city hospital. Carson is evaluated by two young male doctors and later a middle-aged female physician. Despite blood tests and X-rays, his diagnosis remains murky and a surgical consultation is obtained. The surgeon suspects appendicitis. He postulates that Carson may have a retrocecal appendix and explains that in such cases the anatomical location of the organ often confounds the diagnosis.
Carson undergoes surgery. His appendix is indeed retrocecal and rupturing. He spends five days convalescing from the operation. During that time he acquires an intimate knowledge of the city from his stay at the hospital. The experience revitalizes him. Carson reasons that the world is miraculous in part because it is so simple yet still spectacular.
Three doctors confront catastrophe during a civil war in a central African country. The physician-narrator is new to the jungle and enticed by the power, risk, and control attached to his role as a trauma surgeon. His friend, Stefan, is a gifted French surgeon with years of experience who advocates a "philosophy of disaster." Chaswick is an eccentric anesthesiologist. Headquartered in a Catholic mission, these medical volunteers operate on a large number of injured refugees, many of them victims of brutal attacks by rebel soldiers and armed civilians using machetes.
While performing surgery, the narrator is shot in the shoulder by a young rebel soldier. The doctor's life is spared due to the resourcefulness of his colleagues. As the three physicians escape with their lives, the hundreds of refugees left behind in the medical mission are presumably being slaughtered.
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 is an excellent review of the authors' choices of the ten greatest medical discoveries. They arrived at the ten selected after narrowing five thousand or more possibilities down to one hundred and then finally down to ten based on these three components in the field of medicine: 1) structure and function of the human body, 2) diagnosis of medical conditions and 3) treatment of such maladies. Finally the ten selected were approved by four avid and informed physician collectors of rare and important medical publications.
Chronologically, the anatomical observations of Vesalius come first with his publication of the Fabrica in 1543. Harvey's discovery of the circulation of the blood is considered the single most important discovery. Leeuwenhoek gets credit as the founder of bacteriology, but Koch and Pasteur are included in a discussion of this discovery. Jenner gets his just recognition for introducing vaccination and Roentgen for discovering the X-ray beam.
Crawford Long is recognized for the initial use of surgical anesthesia and Fleming for the discovery of penicillin. More unlikely choices are Ross Harrison for tissue culture, Anichkov for the relation of cholesterol to atherosclerosis and Wilkins, rather than Watson and Crick, for the DNA story.
Each chapter describes not only the discovery but also tells the life stories of the chosen "discoverers" and others who contributed to extension and usefulness of the discoveries. The authors conclude that it is not genius so much as curiosity and the ability to conduct methodological investigations that distinguish these men.
In this collection of 11 short stories, pediatrician-author Perri Klass primarily explores the world of women and their multiple and complex roles as mother, mother-to-be, friend, spouse, lover and professional. Parenthood--its glories, heartaches, tensions and mysteries--plays a prominent role in many of the stories. There is also a close look at woman-woman friendship--at what women say to their best friends and the nuances of the emotional responses to what is said or left unsaid.
Several stories feature single mothers: "For Women Everywhere" (a woman is helped through labor by her best friend), "Rainbow Mama" (a woman cares for her son during his diagnosis and initial treatment of leukemia), and "City Sidewalks" (a woman finds a baby on the sidewalk on Christmas Eve as she rushes to pick up her child from day care).
"In Necessary Risks," an anesthesiologist deals with work and her high energy preschool daughter while husband and easy-to-raise son head out to a dude ranch. In "The Trouble with Sophie," another high energy, dominant daughter wreaks havoc in kindergarten as well as with her concerned parents. In addition to the anesthesiologist, two other physician-mothers are featured in "Freedom Fighter" and "Love and Modern Medicine."
Parenting a newborn whilst handling other tasks is a theme featured in "Intimacy" (a high school biology teacher celebrates her first night of uninterrupted sleep as she both enjoys and envies her single friend's sex life) and in "Dedication" (a writer takes his stepson to a chess tournament while his biologist wife and newborn enjoy breastfeeding at home). Woman friendships are prominent in "For Women Everywhere," "Freedom Fighter," and "The Province of the Bearded Fathers." Grief and sudden infant death syndrome are themes of "Love and Modern Medicine."
Summary:This short story begins with a summary of the tale of Guillermo Blake, who believed that "the five senses obstruct or deform the apprehension of reality." The narrator then relates the tale to his own experience: upon visiting his gerontologist for a check-up, he is informed of a procedure that confers immortality. The "immortals" are reduced to living brains within wooden cubes, their bodies having been replaced by "formica, steel, plastics." The narrator tries not to show his horror, but moves immediately to a different part of the country under an alias.
In mid-19th century London, a young nurse is found brutally strangled at the Royal Free Hospital. One of the hospital's Board of Governors, Lady Callandra Daviot, engages her friend former Inspector William Monk to investigate the killing. The victim was not an ordinary Victorian nurse, most of whom were poorly educated, morally suspect, and distinctly lower class. Rather, the dead woman came from a middle class family and was an outspoken professional who had worked side-by-side with Florence Nightingale in the Crimea.
In fact, Nurse Prudence Barrymore had had pretensions of studying to become a doctor--an unthinkable goal for a Victorian woman! As Monk and his colleague, Hester Latterly--another Crimean nurse--investigate the inner workings of the Royal Free Hospital, they soon discover a quagmire of secret passions and deceit.
Monk gains access to letters from Nurse Barrymore to her married sister that appear to incriminate Sir Herbert Stanhope, the hospital's leading surgeon and a paragon of propriety. Was Sir Herbert Nurse Barrymore's secret lover? As Sir Herbert's trial progresses, it appears that he was, but then events suddenly take an unexpected turn.
Some interesting and very odd characters (including a few scientists and researchers) inhabit the eleven short stories in this collection. In "Concerning Mold Upon the Skin, Etc.," Anton van Leeuwenhoek creates his first microscope and becomes so absorbed by the invisible worlds revealed to him that he neglects his own family. "Nowhere" is the tale of an old anatomy professor who aspires to spice up the curriculum by obtaining a corpse for his students to study. "Tumbling" recounts the difficult life of a young woman understandably haunted by the possibility that she may inherit Huntington’s chorea from her father and her inspired liberation of over one thousand laboratory mice.
In "Chloroform Jags," a professional midwife self-experiments with chloroform "not to escape time but to dissolve time." Other stories describe the execution of an elephant; the murder of a physician who happens to be an important figure in the French Revolution; a woman with a talent for insomnia who has not slept for six months; a psychoanalyst and his patient; an eighteenth century blind beekeeper; and Dorothea Dix, an early advocate for the humane treatment of the mentally ill.
Peppered with a plethora of black and white stills, this book is a compilation of a physician's film reviews and reflections on how movies have mirrored the changes in medical care and in society's attitudes towards doctors and medicine over the last sixty years. Ten chapters blend a chronological approach with a thematic perspective: Hollywood Goes to Medical School; The Kindly Savior:
From Doctor Bull to Doc Hollywood; Benevolent Institutions; The Temple of Science; "Where are All the Women Doctors?"; Blacks, the Invisible Doctors; The Dark Side of Doctors; The Institutions Turn Evil; The Temple of Healing; More Good Movie Doctors and Other Personal Favorites.
The appendices (my favorite) briefly note recurring medical themes and stereotypes ("You have two months to live," "Boil the Water!"). Formatted as a filmography, the appendices reference the chapter number in which the film is discussed, the sources of the photographs, and a limited index.
Written by surgeon and renowned author Sherwin B. Nuland, this book offers both a detailed look into the workings of the human body and a glimpse into the heart and work of the author. Furthermore, it is also a philosophical treatise on the wonder of human life and the beauty of "animal economy." As a human biology text for the layman, the book explicates the major organ systems of the human body, such as the nervous system (including the sympathetic nervous system), the cardiovascular system, the gastrointestinal tract, the immunologic and hematologic systems (including coagulation, cell lines, lymphatics), and the urogenital system (including reproduction and childbirth).
Nuland intertwines dramatic stories of his surgical patients with the systems review. For instance, the book begins with the near death of a woman by hemorrhage from a ruptured splenic artery aneurysm. Another dramatic story involves the near death of a young diabetic woman from bacterial overgrowth in the gut. The reader also hears the patients' versions of their illness experiences--Nuland gives direct quotes from what they have said or written about their experiences. Through it all, Nuland expresses his awe and wonder at the workings and capabilities of the human body.