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Under the aegis of the Association of American Medical Colleges and its journal, Academic Medicine, the editor of the Medicine and the Arts column has collected 100 selections for publication in this volume. Each selection is made up of a piece of literature or art relevant to the medical humanities, followed by a commentary that elucidates or elaborates upon the contribution of the primary piece to the practice of medicine.
Given the wide-ranging nature of the art and literature in this collection, essentially every keyword listed in this database could come into play; those denoted above identify broad categories under which fall the works discussed. The artists represented vary from poets of the classical period, to ancient and modern painters, to writers who study the human condition in their fiction or essays. The scope is enormous; the adventure daunting.
This is one of several histories or collections of documents concerning the ill-fated Donner Party westward trip of 1846-47. The wagon train of inexperienced and irregularly prepared families and individuals were California-bound from Illinois. Their misfortunes seem to have begun when they chose to follow the directions of a man who suggested a "short-cut."
Following upon a dreadful passage through the Wahsatch [sic] Mountains and then across the salt flats west of the Great Salt Lake, the group attempted the Sierra Nevada mountains too late in the fall to precede the snow and the cold. For the months of November through March, the party ( now cast asunder and without leadership) made various attempts at wintering over versus futile assaults on the pass.
From the diaries and other records surrounding this misadventure, the historian puts together a summation of the horrors of the cold, starvation, and growing hopelessness of being trapped and ill-prepared for a winter in the wilderness. Based on some of the diary entries, a sense of the extent of desperation that resulted in cannibalism is made available to the reader of today.
Summary:Hilfiker describes a number of his own medical errors. He is concerned with the physical, emotional, social, and economic consequences of medical mistakes, all of which have grown as medicine's ability to cure disease has grown. Hilfiker contends that physicians are poorly equipped to cope with their own mistakes. The nature and practice of medicine are such that it is often possible to conceal mistakes from patients. Should they be concealed? Hilfiker says not. He implies that there are few (if any) circumstances which warrant deception.
Summary:This short autobiographical account gives a flavor of American medical practice in the early part of the 20th century. It also sketches the medical "persona" and the human character of the author's father.
In this chapter from late in his autobiography Williams focuses on his subjective experience in caring for patients. The unusual truthfulness of patients in need, their "coming to grips with the intimate conditions of their lives," inspires him both personally and artistically, as a poet. The things that patients reveal about themselves and about the human condition not only keep him going as a physician; they are the stuff of poetry, the human truths that lie beneath the "dialectical clouds" we construct to protect ourselves from contact in everyday life.
Ruth Picardie was a journalist working in London. Shortly after her marriage in 1994 to Matt Seaton, also a journalist, she found a breast lump. After testing, she was told it was benign. Two years later, and a year after giving birth to twins, the lump enlarged and this time she was diagnosed with advanced, inoperable breast cancer. She rapidly developed bone, liver, and brain metastases and died in September 1997, aged 33.
This book consists of a selection of Picardie's e-mail correspondence during the last year of her life, the columns she wrote for the Observer newspaper (a series about dying she called "Before I say goodbye"), readers' letters responding to her column, and an introduction and epilogue by her husband. While not, then, strictly a memoir, this collection of texts constitutes an intimate view of a witty, angry young woman undergoing an intolerable illness.
The expected elements are there: diagnosis, chemotherapy, radiation, hope, the loss of hope. What is unexpected is the way these are presented, and the vividness with which we share the prospect of saying good bye to her children, her gradual detachment from her husband, and, as the brain metastases spread, the loss of coherence and the appalling silencing of her powerful voice.
In The Mysteries Within, Sherwin Nuland takes the reader on a guided tour of selected organs inside the human body. Beginning with the stomach, he progresses along to visit the liver, spleen, heart, uterus, and ovaries. At each point he addresses various historical and contemporary beliefs, as promised in the book's subtitle, "A Surgeon Reflects on Medical Myths." Nuland brings to this endeavor the patented mixture of personal story, elucidation of medical history, and plain old good writing that characterizes all of his books.
For example, he devotes the first three chapters to the stomach. The first consists mostly of a brilliant clinical tale in which a six-week-old baby is found to have a wax bezoar in his stomach. The second and third provide a cogent survey of beliefs about the stomach's function, beginning with Greek humoral theory, continuing through van Helmont and the iatrochemists, and ending with Ivan Petrovich Pavlov and his seminal monograph, The Work of the Digestive Glands.
Van Helmont and his mentor, Paracelsus, appear again and again in later chapters as the earliest champions of the idea that the body runs by means of chemical processes (iatrochemistry). However, as Nuland points out, Paracelsus has left us two different legacies. One is his devotion to chemistry and experimentation, which eventually led to modern biological science. The other is his devotion to alchemy and mysticism, which makes him as well a forerunner of contemporary irrational systems of healing.
Summary:Berger writes shortly after the death of his mother. He remembers how as a child he had a morbid fear that his parents would die in the middle of the night. But his mother has lived for a long time. Now Berger reflects on his mother's secrets. She was forever stoic and had an air of mystery that Berger thinks caused him to become a writer--he had to try to fathom the mystery. On her death bed, he learns her secret-- she has had a happy life.
In 1871 the Polaris, a rebuilt tugboat commissioned by the U.S. Navy, set sail with a dual mission: planting the stars and stripes on the North Pole and providing scientific data and specimens for the Smithsonian Institution. A number of poor decisions were made early on in the planning and initiation of the expedition, including an inadequately structured vessel, a vague power distribution lacking a clear absolute authority, and a sailing captain with a significant alcohol problem.
The power struggles begin early. By the third month of the voyage the ship is in physical trouble and the designated expedition head (Charles Francis Hall) has died suddenly of an unexplained illness. There is no leader and the struggle for control erupts between the German scientist/physician who is responsible for the scientific mission and the drunken whaleboat captain who is responsible for keeping his ship and crew safe.
Bad weather, terrible luck, and lack of discipline result in the loss of the Polaris, the splitting of the crew onto separate ice floes, and several months of harrowing experience trying to survive the Arctic winter and hope for rescue. The good news is that everyone except Mr. Hall miraculously survives the ordeal. The subsequent Naval inquiry into the failed endeavor ends without resolution as to the cause of Hall’s death despite hints from crew members that it was not natural. In 1968, long after all crew members had expired, Hall’s grave was located and forensic samples proved that he had died of arsenic poisoning.
Spencer Nadler, a surgical pathologist for over 25 years in southern California, offers 8 essays, as well as an introduction, epilogue and 9 full color histopathology plates in this collection. As he explains in the introduction, Nadler began his training in surgery, but, during a required year of surgical pathology, he finds his true vocation: "I realized a flair for surgical pathology that I had never demonstrated in surgery." (p. xix) However, over the years, he realizes he misses patient contact--these essays, written over 10 years, are forays into an unusual relationship: the pathologist-patient relationship.
Each essay is about a different patient (or other contact) and tissue. One of the most compelling is the first, "Working Through the Images," in which a woman (Hanna Baylan) with metastatic breast cancer seeks Nadler out so that she may view her cancer cells. She arrives in his office unannounced at 6 p.m. and he proceeds to not only show her the slides, but to listen to her. He becomes a witness to her pain, loneliness, sorrow and hope.
"For years I have processed thousands of such cases, determined the manifold forms of disease, but I've never been an intimate part of anyone's illness, never felt the connections of cells to a larger self." (p. 12) During later visits, Baylan cries in his arms and even brings her youngest son in to meet Nadler and view her cells. By this time, Nadler is completely connected to her: "This is heartrending to me, for I have come to love her . . . I can no longer think of Hanna in terms of the cells I see on her slides." (p. 21)
Other chapters highlight fat and bariatric surgery; neurologic disorders such as brain tumor, Parkinson's, Alzheimer's and paraplegia; heart disease; sickle cell disease; and palliative care. Each chapter conveys Nadler's visual sophistication and ability to graphically describe cells. For instance, within a fat cell "a large fat globule steamrolls other cell contents flat against the outer membrane until it bulges like a mozzarella." (p. 32) More importantly, Nadler ably extends his cellular acuity to the larger human dimension.