Showing 521 - 530 of 606 annotations contributed by Coulehan, Jack

Aequanimitas

Osler, William

Last Updated: Feb-03-1997
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

Osler’s famous essay was first delivered as a valedictory address at the University of Pennsylvania School of Medicine in 1889. Osler urges the graduates to develop two qualities or virtues. First is the "bodily" virtue of imperturbability or "a judicious measure of obtuseness." This means the outward expression of calmness and coolness, even under difficult circumstances. This virtue suggests that physicians should be relatively "insensible" to the slings-and-arrows of patient care, always maintaining a degree of detachment from their patients.

The complementary "mental" virtue is aequanimitas, which is the personal quality of calmly accepting whatever comes in life. These virtues, however, should not lead to "hardness" in dealing with patients. Osler also urges his students and colleagues to develop the other gentlemanly virtues of courage, patience, and honor.

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What Is a Profession?

Scarlett, Earle

Last Updated: Feb-03-1997
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

Scarlett writes about the tradition of medicine in a recognizably British (Canadian) voice. He presents a definition of a profession that features social responsibility and duty to serve others, and notes that "an organized profession does not seek to advance the money-making feature of professional activity." Scarlett identifies seven "pillars" (principal qualities) of the physician, or any other professional: technical skill, social responsibility, knowledge of history, knowledge of literature and the arts, personal integrity, faith that there is some meaning and value in life, and "the grace of humility."

Scarlett critiques the medical profession in two ways. First, physicians are not skeptical enough and willing enough to correct their errors. Secondly, professional qualities have declined "at the hands of the scarcely literate pushing public . . . . " As a result of this, some physicians now believe that "all this rhetoric about the essential nobility of the medical profession is a load of old rubbish" (p. 129).

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The Embroidered Towel

Bulgakov, Mikhail

Last Updated: Jan-31-1997
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

A young doctor, just graduated, arrives at the country hospital to which he is assigned. He is fraught with anxiety because of his inexperience, especially when he meets the seasoned feldsher and midwives, who sing the praises of his predecessor. During the night his first patient arrives: a girl who was caught in a brake (a machine for threshing flax) and is now mangled and near death. No one expects her to live. The feldsher whispers, “She'll die now.” Yet the doctor feels compelled to try to save her, despite his ignorance. He amputates a leg, he continues treatment, the girl hangs on. Eventually she recovers. The new doctor has established his reputation in the district.

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All We Need of Hell

Lesser, Rika

Last Updated: Jan-31-1997
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

In this collection of poems, the author details her descent into the hell of bipolar disorder and the re-integration of her life, thanks to lithium therapy. In "Other Lives" she describes herself as "mother of none, good friend to all, / who for no apparent reason, / tries to kill herself, twice." She writes angrily to the psychiatrist who misdiagnosed her and prescribed the wrong medication: "Your first mistake was to see me at all. / Your second, prescribing the Elavil." (in "Shocking Treatment") While she misses the productivity and "rush" of her hypomanic episodes, she realizes this is the price she has to pay to avoid another "two years of pain or nothing, numbness."

As the author's health improves, she cares for friends who are dying of AIDS and for the dying father of a friend: "I'm learning, as I nurse / my father that the worst / would be protection from / death's reality." (in "For Jean") The collection is interlaced with a series of poems called "Black Stones" in which the author encounters very directly the reality of death. In the last of these, she cries out the words of her friend Matthew who has just died: "Rika, dear friend, live and live and live!"

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Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

William Osler served as one of Walt Whitman’s physicians from 1884, when he moved to Philadelphia to become Professor of Medicine at the University of Pennsylvania, until 1889, when he left Philadelphia for Baltimore. Osler was introduced to Whitman by a mutual friend, Dr. Richard Maurice Bucke, Whitman’s avid disciple and biographer. After his stroke of 1873, Whitman suffered from recurrent episodes of illness (perhaps small strokes?). Osler first paid a call to Whitman’s home in Camden at Bucke’s request and subsequently visited him on numerous occasions.

Published in this book for the first time is Osler’s unfinished 1919 manuscript for a lecture recounting his relationship with Whitman. Much of the book is a gloss on this short manuscript. The book actually deals as much (or more) with the remarkable figure of Richard Maurice Bucke, Whitman’s spokesman and the developer of a theory of "cosmic consciousness," as it does with the two title characters. In sum, Whitman respected Osler, but did not particularly like his sunny, optimistic bedside manner. Osler respected Whitman, but for the most part did not like his poetry. (Leon, however, discovered some handwritten notes on Osler’s copy of Leaves of Grass that suggest Osler grew in his later years to appreciate Whitman’s poetry.)

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The Culture of Pain

Morris, David

Last Updated: Jan-31-1997
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

On the first page, Morris summarizes his project in this book: to "describe how the experience of pain is decisively shaped or modified by individual human minds and by specific human cultures. It explores what we might call the historical, cultural, and psychosocial construction of pain." Contemporary Western culture tries to convince us that pain is nothing but an aspect of disease and, therefore, a medical problem. But pain only exists in human experience; nerve impulses are not pain.

In calling our attention to the social and cultural meanings of pain, Morris begins with Tolstoy's short novel, The Death of Ivan Ilyich (see this database). He then presents various images of human suffering: gender-based pain, as in Charlotte Perkins Gilman's, The Yellow Wallpaper (see this database: annotated by Felice Aull, also annotated by Jack Coulehan); religious views, as in the stories of Job and the Christian martyrs; the aesthetic ideal, as manifested in the romantic idea of the sublime as painful; social uses, as in satire and torture (see Kafka's In the Penal Colony, annotated in this database); the relationship between pain and sex, as in the work of Marquis de Sade; and tragic pain, as evidenced in Sophocles' Philoctetes.

Throughout the book, Morris refers to the "invisible epidemic" of chronic pain that exists in the United States today. This epidemic of chronic pain can be adequately understood and treated only by approaching it with a cultural model, rather than a disease model.

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The Good Doctor

Mates, Susan Onthank

Last Updated: Jan-31-1997
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

Helen van Horne, the good doctor, has left her solitary practice as a physician in rural East Africa to become chief of the Department of Medicine at City Hospital. She is a tough, hard-as-nails woman who has given up the comforts of marriage, family, and human indiscretion for her profession. While the folks in South Bronx initially "hate" her because of her skin color, they soon learn that van Horne is a model of rectitude, dedication, and compassion. The Hispanic chief resident becomes her disciple.

Van Horne's yearning for human comfort and sexual gratification brings her into intimate contact with a lazy, irresponsible, but charming male student. Out of weakness, she tells the failing student that he will pass the rotation, but is later challenged by the chief resident, who has left her own lazy husband and dedicated herself to be "just like you." Van Horne realizes her own weakness, allows the failing grade to be recorded, then contemplates (but rejects) suicide.

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Laundry

Mates, Susan Onthank

Last Updated: Jan-31-1997
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

A physician stands in the laundry, folding her baby’s diapers, and thinks about Mr. Dantio, who died of wildly metastatic cancer. She reflects on the development of her relationship with Mr. Dantio during the time that she was pregnant. Toward the end, he developed a lung infiltrate, maybe a type of pneumonia. There was a chance that a biopsy might have helped--perhaps he had a treatable infection--but she recommended against it. Now she wonders about this decision. She wonders also about what the other physicians think of her: "you don’t really want to be a doctor anyway, you must be conflicted to have a child . . . . " She remembers seeing Mrs. Dantio in the supermarket shortly after her husband died, and crying with her. She asks herself: Will I ever be a REAL doctor, "because in moments of great stress I revert to my native tongue."

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Ambulance

Mates, Susan Onthank

Last Updated: Jan-31-1997
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

A medical student at Lincoln Hospital in the south Bronx is called to the Emergency Room, where a gang war is going on. She plunges through fighting bodies in the waiting room to reach the treatment area, where she is enlisted to ride an ambulance with a critically injured and intubated patient. During the trip, the ambulance jerks, the tube comes out, and the student tries but fails to ventilate him with mouth-to-mouth respiration. At the other hospital, she is turned away from the cafeteria because her clothes are blood-soaked. The patient dies. Although she feels terrible, her friend Marie, a practical nurse, comforts her with a touch of ordinary love, a photo of her new grandchild.

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The Good Doctor

Mates, Susan Onthank

Last Updated: Jan-31-1997
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Collection (Short Stories)

Summary:

Twelve contemporary stories set in Rhode Island and New York City. Major themes include the pain of cultural dislocation and cross-cultural experience ("Theng," "Shambalileh," "My German Problem"); human frailty and self-deception ("Sleep," "Juilliard"); and the personal and moral dimensions of medical practice. See the separate annotations for Laundry, The Good Doctor and Ambulance--three stories which are particularly relevant to Literature and Medicine.

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