Showing 501 - 510 of 651 annotations tagged with the keyword "Disease and Health"

Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

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.

View full annotation

Richard III

Shakespeare, William

Last Updated: Feb-22-2003
Annotated by:
Holmes, Martha Stoddard

Primary Category: Literature / Plays

Genre: Play

Summary:

This history play narrates the rise to power through treachery and murder of Richard Plantaganet, Duke of Gloucester and last king of the House of York. Set in England during the Wars of the Roses (1455-1485), the play opens after the Lancastrian King Henry VI and his son Edward have been killed and Richard’s brother has been crowned Edward IV.

In the course of the play, Richard woos and wins Prince Edward’s widow Anne Neville and engineers the murders of his other brother (George, Duke of Clarence), his nephews, his closest advisor, possibly his wife, and other members of the court. He is crowned king but later dies a violent death in the Battle of Bosworth, defeated by Henry Tudor, Duke of Richmond, who will become the first Tudor King Henry VII.

View full annotation

Annotated by:
Davis, Cortney

Primary Category: Literature / Literature

Genre: Anthology (Mixed Genres)

Summary:

An anthology of poetry and prose by doctors, nurses, patients, and other authors, A Life in Medicine is divided into four sections: "Physicians Must Be Altruistic"; "Physicians Must Be Knowledgeable"; "Physicians Must Be Skillful"; and "Physicians Must Be Dutiful." Each section begins with the Association of American Medical Colleges' (AAMC) definition of the physician trait examined in that section, and short "explications" precede each individual poem and prose piece, linking them to the section's overall theme.

The anthology has a preface outlining the editors' goals and Robert Coles's introduction, "The Moral Education of Medical Students." These organizational touches make the anthology a classroom-ready text for medical students. The anthology's poems and prose--many of which are stunning--were taken from previously published works and exclude many well-known and often-used pieces. But those selections are readily available elsewhere, and the editors do readers a greater service by introducing many lesser-known, but equally important, poems and essays.

View full annotation

Annotated by:
Bertman, Sandra

Primary Category: Visual Arts / Painting/Drawing

Genre: Watercolor on wood

Summary:

Dominating the image, a vengeful Satan with arms outstretched stands upon Job's prone body dispensing boils from a vial with his left hand while shooting arrows at him with his right. Job's head is thrown back and his hands are lifted off the ground in a sign of agony. His weeping wife kneels at his feet. The background is minimal yet dramatic with its dark swirling clouds, bright setting sun, and Satan's huge blood red wings.

View full annotation

The Dead Alive and Busy

Shapiro, Alan

Last Updated: Jan-16-2003
Annotated by:
Bertman, Sandra

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

This collection of 36 poems, some of which have been published individually in various literary magazines, is primarily about dead--or nearly dead--family members: a brother and sister lost to cancer; the speaker's palsied, nearly blind father dying of Parkinson's disease; his mother's struggle with chronic arthritis and heart disease.

The collection is divided into three untitled sections. The first deals primarily with the aging and death of the speaker's parents; the second with a wider range of abandonment and death, lost loves, dreams, innocence; the third almost exclusively with his sister's six year struggle with breast cancer and dying.

View full annotation

Philoctetes

Sophocles

Last Updated: Nov-11-2002
Annotated by:
Holmes, Martha Stoddard

Primary Category: Literature / Plays

Genre: Play

Summary:

En route to the way to the Trojan War, warrior Philoctetes, wielder of the bow of Heracles, is bitten by a poisonous snake at the shrine of the goddess Chryse. The infected wound becomes so painful that Philoctetes’s screams of agony repel the Greek commanders, who order Odysseus to leave him on the island of Lemnos. Ten years later (the time of the play’s opening scene), Odysseus returns to Lemnos with Neoptolemus, son of the now-dead Achilles, to retrieve Philoctetes’s bow. It has been prophesied that only with this bow can Troy be conquered.

Promising him glory and honor, Odysseus convinces Neoptolemus to win Philoctetes’s trust and take the bow. Philoctetes, delighted to see any human and especially another Greek, shares his story with Neoptolemus, begs him to take him back to Greece, and entrusts him with the bow when he is overcome by a spasm of pain.

Deeply moved by witnessing Philoctetes’s misery firsthand, Neoptolemus confesses the truth to him, but tries to persuade Philoctetes to accompany him to Troy. When Odysseus appears, Neoptolemus returns the bow, declaring that only with Philoctetes himself wielding it will the prophesy be fulfilled. He asks forgiveness, and invites Philoctetes to come back with him to be healed and then on to Troy to contribute to the battle. The only thing that ends Philoctetes’s refusal is the sudden appearance of Heracles, who announces that Philoctetes and Neoptolemus must join together to take Troy.

View full annotation

The Lesson

Hearle, Kevin

Last Updated: Nov-11-2002
Annotated by:
Aull, Felice

Primary Category: Literature / Poetry

Genre: Poem

Summary:

The speaker had a childhood disability--"my strange, unruly hands"--that made tying his shoes a task to be dreaded, symbolizing failure. He addresses a caregiver who patiently ("for three years, for an hour each day") had taught him to tie his shoes. She reassured the child, "The doctors don't know / everything. You will be normal // someday. Normal."

The caregiver has also experienced bodily difficulties--from curvature of the spine caused by childhood spinal [tubercular] meningitis. She tells the child about her out of body experience ("You told me you'd died once") when she had seen herself on "the table," the "frantic" doctors calling her back "to the particular / boundaries of the flesh." She allowed them to bring her back.

Now, the adult speaker, no longer disabled, ties his shoes "by instinct," "my mind giving itself // up to the common world / of things" but when he focuses on the task, he slows down and remembers his caregiver; he becomes aware of his body, he becomes aware.

View full annotation

Summary:

This collection is a wide-ranging view of physician poets writing not only about their professional roles, but about themselves and those around them as human beings. The anthology came about as a tribute to one of its major contributors, poet-physician Rita Iovino who spent many years of her life working with other physician writers and their creative natures.

All of the 29 contributors are physicians and the range of subject matter is broad. The collection is divided into subject matter clusters: Of Medical Matters; Of Love Matters; Of Family Matters; Of Natural Matters; Of Life and Death Matters; Of Philosophical Matters; Of Holy Matters; and two prose essays on the role of poetry in the lives of physicians.

View full annotation

Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

Lance Armstrong, (currently) four time Tour de France cycling champion, is a survivor of metastatic testicular cancer. This book is largely the story of how his life changed from the moment of his diagnosis (October 2, 1996) onwards. He had been a world class cyclist prior to cancer, but his experience with cancer gave him profound insight not only into his life as a cyclist and competitor, but into life itself.

It is this latter insight which he recognizes as ultimately the most important aspect of his cancer experience. Armstrong notes: "Odd as it sounds, I would rather have the title of cancer survivor than winner of the Tour, because of what it has done for me as a human being, a man, a husband, a son, and a father." (p. 259)

Written in a conversational, straightforward tone, the book chronicles Armstrong's childhood in Texas as the son of a strong, loving, supportive, financially struggling, young mother; his beatings at the hands of a step-father; and his early excellence at endurance athletics. Armstrong became a brash powerhouse cyclist and began to enjoy the material rewards of winning while ignoring the onset of symptoms. At the time of diagnosis, the cancer had spread to his abdomen, lungs and brain.

He documents his search for optimal care, sperm banking, lack of health insurance, surgeries, chemotherapy, self-education and interactions with doctors and nurses. Through it all he acknowledges the tremendous support of his mother and friends, as well as sponsors who stuck with him with no assurance that he would survive, let alone race.

Before he was even through the first year, he decided to start a charitable organization, The Lance Armstrong Foundation, dedicated to cancer research and support of cancer survivors. Through this effort he met his future wife, Kristin Richard (Kik), and her love and support helped him through the dark days of emotional soul-searching post-treatment. The book also details her struggles with successful in vitro fertilization (They currently have a son and twin daughters).

Chapter Nine, The Tour, is an in depth look at the 1999 Tour de France which Armstrong won with the help of his US Postal Service teammates, expert coaching, and his will. This race is brutal, dangerous, and as Armstrong notes, both "a contest of purposeless suffering" and "the most gallant athletic endeavor in the world." (p. 215) He details the maneuvering in the peloton, the strategies, the stages and personalities.

The book concludes with reflections on the birth of his son, the anniversary of his cancer diagnosis, the love of his wife, and his need to ride.

View full annotation

Christ Stopped at Eboli

Levi, Carlo

Last Updated: Aug-28-2002
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Christ stopped at Eboli, say the southern Italians, meaning that they are "not Christian," uncivilized, forgotten, and deprived. Physician, writer, and painter, Levi was arrested and 'exiled' from his home in Turin for opposing Fascism during the Abyssinian war (1935). This is the memoir of his life as a political prisoner under house arrest in a malaria-ridden village in Lucania (Basilicata).

The peasants immediately seek his advice for their ailments, but the two local doctors are jealous, as well as incompetent, and they have him stopped. Grinding poverty, illness, superstition, and despair work on each individual in different ways; but the peasants move with the cycle of seasons and religious festivals. The feast of the black Madonna (Chapter 12) and an unforgettable pig castration (Chapter 19) are vividly described. In the 'atmosphere permeated by divinities' (p. 151), the animal, human, and spiritual spheres combine (Chapters 8, 13, 15).

The closing chapters are a political meditation. Deprivation and isolation make the south an irrelevant and different country to the powerful middle class that runs the Fascist party. In return, Fascism finds no supporters here other than corrupt, petty officials. Levi contends that "the State" of any political stripe will never solve the problems of southern Italy until peasants are involved.

View full annotation