Showing 51 - 60 of 813 annotations tagged with the keyword "Communication"

Blood Feud

Sharp, Kathleen

Last Updated: Dec-01-2015
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: History

Summary:

Beginning in 1992, Mark Duxbury and Dean McClellan are high-flying salesmen for Johnson and Johnson, Ortho branch – happily promoting the drug Procrit, (or Epogen -- erythropoietin), for anemia. The drug stimulates the bone marrow to produce more red blood cells. Developed by fledging company Amgen, it was licensed to Ortho for specific uses. Their careers take off, and they earn bonuses and stature, peaking in 1993. Soon, however, Duxbury realizes that he is being encouraged to promote the drug for off-label uses and in higher doses that will enhance sales and profits through kickbacks. He soon realizes that the drug is not safe when used in these situations. People are dying because their unnaturally thickened blood results in strokes and heart attacks.

He raises objections with his employer. For voicing concerns he is ostracized and then fired in 1998. Along with the stresses of his work, the financial difficulties and emotional turmoil, Duxbury’s home life is in tatters; his marriage falls apart and he worries about his daughter Sojourner (Sojie). He develops multiple health problems, including sleep apnea and dependency on drugs and alcohol.

Enlisting the help of the famous lawyer Jan Schlictmann (A Civil Action
), whistleblower Duxbury launches a qui tam lawsuit in 2002 against his former employer. This is a civil action under the False Claims Act, which can offer cost recovery should the charges prove warranted. The lengthy process is still going. The last ruling issued in August 2009 allowed the case to proceed. But Duxbury soon after died of a heart attack in October 2009 at age 49.

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The Physician

Gordon, Noah

Last Updated: Nov-17-2015
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

When nine-year-old Rob Cole, child of poor 11th-century English farmers, loses his mother, he is consigned to the care of a barber-surgeon who takes him around the countryside, teaching him to juggle, sell potions of questionable value, and assist him in basic medical care that ranges from good practical first-aid to useless ritual.  When, eight years later, his mentor dies, Rob takes the wagon, horse, and trappings and embarks on a life-changing journey across Europe to learn real medicine from Avicenna in Persia.  Through a Jewish physician practicing in England, he has learned that Avicenna’s school is the only place to learn real medicine and develop the gift he has come to recognize in himself.  In addition to skill, he discovers in encounters with patients that he has sharp and accurate intuitions about their conditions, but little learning to enable him to heal them.  The journey with a caravan of Jewish merchants involves many trials, including arduous efforts to learn Persian and pass himself off as a Jew, since Christians are treated with hostility in the Muslim lands he is about to enter.  Refused at first at Avicenna’s school, he finally receives help from the Shah and becomes a star student.  His medical education culminates in travel as far as India, and illegal ventures into the body as he dissects the dead under cover of darkness.  Ultimately he marries the daughter of a Scottish merchant he had met but parted with in his outgoing journey, and, fleeing the dangers of war, returns with her and their two sons to the British Isles, where he sets up practice in Scotland.

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A Lucky Life

Goldbloom, Richard

Last Updated: Nov-11-2015
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

Born into a Montreal Jewish family in 1924, Richard Goldbloom was always sensitive to minorities and at ease with difference. Jewish and Christian, French and English, music, theatre, and the arts in all forms were prevalent and valued in the family home. He became a skilled pianist and a gifted storyteller. Richard trained in medicine with his father and at McGill University then specialized in pediatrics at Harvard with the famous Charles A. Janeway at Boston Children’s Hospital.

He met the vivacious, intrepid Ruth Schwartz at McGill when they both auditioned for a play. Also Jewish, she hailed from Cape Breton Island, Nova Scotia. They married in 1945 before his studies were complete and had three children. Unlike many male physicians of his era, Richard was in awe of this tiny dynamo and attributes his happiness and success to her.

In 1967, the family moved to Halifax, Nova Scotia, where Richard became Professor of Pediatrics, Physician in Chief and director of research at the new children’s hospital. Ruth was instrumental in a wide array of philanthropic endeavors that inevitably involved her husband. She developed a remarkable museum at Pier 21, the point of arrival for generations of immigrants to Canada—a place to gather their stories and their achievements.

Many anecdotes about clinical practice and scientific innovations are told with accessible enthusiasm and gentle humor. He dispels myths, exposes hidden agendas and explains with clear examples the importance of listening to children and their parents. Underlying the entire narrative is a refreshing humility and gratitude for his “lucky life.” 

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Black Man in a White Coat

Tweedy, Damon

Last Updated: Nov-09-2015
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

This memoir focuses on the various ways in which his being an African American affected Tweedy’s medical education and early practice as a medical resident and later in psychiatry. Raised in the relative safety and privilege of an intact family, he found himself underprepared for some of the blatant forms of personal prejudice and institutional racism he encountered in his first years of medical education at Duke Medical School.  One shocking moment he recounts in some detail occurred when a professor, seeing him seated in the lecture hall, assumed he’d come to fix the lights.  Other distressing learning moments occur in his work at a clinic serving the rural poor, mostly black patients, where he comes to a new, heightened awareness of the socioeconomic forces that entrap them and how their lives and health are circumscribed and often shortened by those forces.  Well into his early years of practice he notices, with more and more awareness of social contexts and political forces, how the color line continues to make a difference in professional life, though in subtler ways.  The narrative recounts clearly and judiciously the moments of recognition and decision that have shaped his subsequent medical career.    

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Not God: A Play in Verse

Straus, Marc

Last Updated: Oct-06-2015
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

Not God is a "play in verse" with two characters, a hospitalized patient and the patient's doctor. The scare quotes indicate the fluid quality of Not God, which the author originally conceived as a sequence of poems spoken in a patient's voice. Subsequently, he added the doctor poems (monologues) to create a "dialog" between the two voices. Once again, scare quotes suggest the atypical quality of this dialogue, since the two characters express different feelings and perspectives on the situation, but do not directly address one another. The play version has received several performances at colleges and small theaters.The patient speaks first in a monologue that begins "A man's cough bounces down the hallway / like pick up sticks... " and ends with "I am here two weeks." (p. 7) It soon becomes evident that he/she has cancer and is receiving chemotherapy. The doctor has changed this person's life by speaking "one word," after which "nothing / would ever be the same again." (p. 10). The patient is knowledgeable, accepting of his/her condition, a keen observer with a good sense of humor, as in "Doldrums" (p. 19) and "Cricket" (p. 23), and a person who affirms life in spite of adversity. The doctor is burdened with the power of medical knowledge. In particular, he understands the deadly meaning of signs and symptoms: "We say / excess water and swelling of the belly, knowing / full well... / an ovarian cancer is almost certain." (p. 33) But the meaning this represents is chaos: there is nothing humane or transcendent about cancer. Unlike his baseball card collection in childhood ("Shoebox," p. 35), cancer is neither confined nor orderly. In the second act, the patient sympathizes with the doctor whose "head is so cluttered / with obligatory data." Paradoxically, the doctor must be protected because he is "filled with dying." (p. 41) The doctor becomes angry with the burden, "Why / ask me a question that only God can answer?" (p. 49) and cries out that his work is "alchemy, / potions and witches' brews." (p. 54) In the end, while dying, the patient imagines "a bridge that can cross / the Atlantic." (p. 68), while the doctor speaks a prayer, "The word cure, dear God, is always / near my lips, though I have been constrained from / saying it aloud." (p. 66)

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One Word

Straus, Marc

Last Updated: Oct-06-2015
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

In this collection (80 pages), Marc Straus speaks of the inadequacy of communication and knowledge in medicine; the pauses, the distance, the hesitations. You think you know what you are doing, "But no, they always ask the question / I never knew." ("The Log of Pi") "The question / might be so simple, so clear / that you’re unprepared to answer." ("Questions and Answers") Though words are in one way inadequate, the medical word carries great power: " . . . I knew that moment / I would say one word for her and nothing / would ever be the same again." (One Word, annotated in this database.)The poet comes to understand that he represents both sides of medicine, both the detached and distant Dr. Gold, and the warm and trustworthy Dr. Green. (See annotation of Dr. Gold & Dr. Green) Unfortunately, this knowledge only comes about after the patient has died ("Dr. Gold & Dr. Green, II"). We learn from experience, sometimes too late.

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One Word

Straus, Marc

Last Updated: Oct-06-2015
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

The speaker reflects that "life is sometimes reduced / to a single word . . . . " He remembers one incident at a bus stop, another interviewing a man "for a job in my lab." Then there was the time a woman "walked / into my office for one thing . . . . " He discovered a "fullness" in her neck and knew that the word he would say to her, the one word, would change her life: "nothing / would ever be the same again."

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Welcome to Cancerland

Ehrenreich, Barbara

Last Updated: Sep-28-2015
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

A “drive-by mammogram” leads the writer, Barbara, to a biopsy of a suspicious breast lump. She awakes from the fog of anesthesia to hear the surgeon’s bland remark: “Unfortunately, there is a cancer.” Welcome to Cancerland, a place where her identity is displaced by the vast implications of the diagnosis, another operation, and arduous months of chemotherapy. What works for her own peace of mind has little to do with the trappings of pink-ribbon sentimentalism in the survivors groups.

Barbara resorts to her knowledge of cell biology, asks to see her own tumor under the microscope, and contemplates the meaning of visualizing the malignant cells even if she does not believe the exercise can help her. She dissects the rank commercialism and denial in the survivor movement: let me die of “anything but the sticky sentimentalism in that Teddy Bear.” She decries the claims that cancer therapy makes better skin, better hair, and better people, with better bodies, especially when an implant on one side subtends a cosmetic procedure on the other.

Posting these thoughts on a chat line, she discovers that most women berate her attitude and suggest she needs a psychiatrist. But one dying woman agrees with her distress, and writes of having cancer, “IT IS NOT OK.” Admitting feminists can be found in the “survivor” community, Barbara faults its underlying tone for being coercively optimistic, infantilizing, and insulting to the dying and the dead. She is angry. Very angry, and her “purifying rage” spares no one: doctors, support groups, feminists, drug companies, and the Cancer Society. Nevertheless--and in keeping with her earlier work--she credits the women’s movement with helping to rid the world of three medical evils: the radical Halsted mastectomy, the practice of proceeding to mastectomy from biopsy without waking up the patient, and high dose chemotherapy.

Two disturbing ironies bring the essay to a close. The first, is the possibility that mammograms may not be saving or even prolonging lives, even as they detect cancers; they make women dwell in Cancerland for longer and cause too many “unnecessary” biopsies. The mammogram is a ritual, she says. The second irony lies in the role of the pharmaceutical industry which fosters the pink power movement –the ribbons, the teddy bears, the marathons-- while manufacturing the expensive poisons that seem to have anticancer side effects. These same companies, she argues, have also manufactured carcinogenic pesticides that pollute the environment. Having profitably poisoned women into having breast cancers, they continue to profit from poisons of chemotherapy.
She faults both the “cult” of the survivors movement and the American Cancer Society for their “unquestioning faith” in these imperfect instruments of action.

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Freud's Mistress

Kaufman, Jennifer; Mack, Karen

Last Updated: Jul-31-2015
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Minna Bernays is the younger sister of Martha, Sigmund Freud's wife. Her own fiancé has died and by 1895, she is reduced to joining her sister’s family in Vienna because she has abandoned her position as a companion to a demanding, prejudiced aristocrat. The six Freud children love her, but she finds them exhausting and undisciplined. Obsessed with order, housework, and social standing, and possibly suffering from psychosomatic ailments, Martha is happy to leave the care of the children to Minna. She disapproves of her husband’s theories about sexual frustration as a cause of mental distress and refuses to discuss his ideas. Nevertheless, Martha is well aware that growing anti-semitism hampers her husband’s career, and she is eager for him to succeed: he could consider a conversion of convenience, like the composer Gustav Mahler.

Minna finds herself drawn to Sigmund for his intellect and his novel ideas. She is also attracted to him physically, and he to her. She resists the temptation, but he does not and actively pursues her, inducing her to try cocaine too. He justifies it - the sex and the drugs - as necessities for mental and physical well-being and he rejects the guilt that, he claims, so-called civilization would impose.

She tries to leave by finding another job as a ladies’ companion in Frankfurt, but he follows her there. They escape for an idyllic holiday to a hotel in Switzerland, then he brings her back to the family home. But his ardor cools and she is wounded, displaced by his enthusiasm for Wilhelm Fliess and Lou Andreas-Salomé.

Soon she discovers that she is pregnant, and Freud sends her away to a “spa” for an abortion, but at the last moment, she decides to keep her baby. Sadly she miscarries and returns to the Freud family with whom she remains for more than four decades until her death in 1941.

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Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Matthew McCarthy begins his memoir of medicine internship year at Columbia University with a glimpse into his first rotation, surgery, as a Harvard medical student. He had exhibited a talent for surgery and liked it – an affinity compatible with his dexterity as a minor league baseball player and sense of team spirit. The reader meets some of McCarthy’s memorable mentors, and, although he opts to not pursue surgery as a career, McCarthy’s eye for seeking productive apprenticeships with talented housestaff and faculty allow him to guide the reader through a year of drinking from the firehose, also known as internship. Medical training is full of liminal experiences, and internship is one the most powerful and transformative.  

McCarthy’s eagerness to do well, both by his patients and by his medical colleagues and team, and his candor with revealing his mental and bodily responses to the stress and strain of the responsibilities of internship, make him an adept guide. For example, he has gulped an iced coffee and is churning at the bit to take care of a new admission on his first day of call in the cardiac care unit (CCU). His resident, called Baio in the book, tries to tell McCarthy to take it easy. But McCarthy notes, “Our orientation leaders, a peppy group of second- and third year residents, had instructed us to exude a demented degree of enthusiasm at all times, which wasn’t difficult now that my blood was more caffeine than hemoglobin.” (p 15) The previous chapter had ended with a cliffhanger – a patient life would be placed in danger because neophyte McCarthy misses the importance of a key clinical finding – what and how that plays out will wait until McCarthy guides us through the terror and exhilaration he feels as he begins his CCU rotation.  

McCarthy has a good sense of the ironic: the huge banner advertising the hospital reads “Amazing Things are Happening Here!” Indeed, not only for patients and families, but also for the many trainees and workers. We watch McCarthy successfully perform his first needle decompression of a pneumothorax; he is allowed to attempt it as he notes that he watched the video of the procedure. But unlike the video, he needs to readjust the needle several times and add on some additional tubing and water trap, which makes the scenario more true-to-life than a fictionalized ‘save.’ The author ends the chapter with congratulations from resident Baio: “Well done… Amazing things are indeed happening here.” (p 244) As McCarthy’s year continues, many things do happen, including an infected needle stick, telling bad news to a new widow, and developing a friendship with a longterm hospital patient waiting for a heart transplant.

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