Showing 61 - 70 of 381 annotations tagged with the keyword "Cross-Cultural Issues"

Annotated by:
Schilling, Carol

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

As Audrey Young describes her process of becoming a compassionate internist in a besieged public hospital, she simultaneously argues for turning the hospital's patient care and financial practices into a model for improving health care in America.  Young, a compelling storyteller, first entered Seattle's Harborview Medical Center in 1996 as a third-year medical student on trauma surgery service.  She completed a residency there in general internal medicine and stayed on as an attending for six more years.  She stayed, she tells us, because she met physicians "committed to a vision of equality" who were "the sort of people I hoped to become" (xiii).   She also "fell in love" with "the story of a unique place" (xiii).  Young's stories of that often chaotic place, where ambulances regularly transport homeless, indigent, addicted, and mentally ill refugees from neighboring private hospitals, emphasizes the ways the Harborview staff manages to treat patients with dignity and to choose an ethic of hope in the face of dire circumstances.           

We quickly learn that at Harborview compassion is expressed concretely as actions toward patients.  Michael Copass, known as "the mostly benign dictator of emergency operations," pronounced the core of these actions in what came to be known as his commandments:  "1. Work hard.  2. Be polite.  3. Treat the patient graciously, even if he is not the president of the United States" (9).  Politeness always meant asking "'How may I help you, sir?'" regardless of the patient's social status or addiction history.  Politeness sometimes meant finding a way to reach the patient who regularly threatened the staff.  Young finds ways and creates a therapeutic bond.  But working hard and treating patients considerately also took measurable forms, such as not allowing emergency patients to wait.  Facing a flurry of admissions, the Emergency Department (ED) staff interpreted a young Ethiopian's complaints about pain as a drug addict's ploy.  Because Young glanced at the admissions board and noticed that he remained unattended for three hours--far longer than Copass could tolerate--she jumped into action.  He suffered, she discovered, from a collapsed lung. 

However, Young moves her narrative beyond individual doctor and patient encounters and into the larger, interrelated social and financial structures in which medicine is practiced.  For instance, she links meager funding for drug and alcohol rehabilitation programs with expensive ED admissions and rising healthcare costs.  In the chapter "Bunks for Drunks," Young visits an experimental residence that houses homeless addicts in furnished studios with private baths and cooking appliances.  Although residents can keep alcohol in their rooms and elect not to participate in the home's social services, including counseling, alcohol consumption and ED admissions decrease.  While the chapter points out the cost savings of such arrangements, Young further urges readers to value the dignity residents experience there.

In "Black Friday," Young details the hospital's tense, but ingenious responses to a Mass Casualty Incident, the result of carbon monoxide poisoning, which almost depleted the resources of all of Seattle's medical centers.  The final chapter, "A Vision," outlines how Harborview has tried to succeed as both a charitable institution and a business, as a provider of both indigent and luxury care, with the hope that others will follow the medical center's example.  However, in presenting her recommendations for "health justice," Audrey Young also makes the case that "seemingly ordinary citizens" are implicated in healthcare reform (231).  To enable their informed participation in making changes, Young includes an appendix with further readings and another that lists strategies for effecting reform.  

View full annotation

The Odds of Recovery

Friedrich, Su

Last Updated: Jun-01-2010
Annotated by:
Aull, Felice

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

This is an imaginative documentary film by director-producer Su Friedrich, of her experiences with health problems, physicians, the health-care system, and how these affected her relationship with her female partner over a period of more than two decades. The narrator-subject takes us through her numerous surgeries, hormonal (prolactin) imbalance, and her growing disenchantment with the traditional health-care system.

She films herself: getting dressed into the "humiliating" paper garb prior to being examined by her physician; in exchanges with her various physicians; reading from medical texts and self-help books as she tries to understand her condition(s); taking t'ai chi classes and preparing herbal potions; gardening and doing needle work. As the film ends, she is grappling with the prospect of menopause, but she feels that she has taken charge of her body and of her own care, that she tends herself as she tends her garden.

View full annotation

Annotated by:
Davis, Cortney

Primary Category: Literature / Literature

Genre: Anthology (Mixed Genres)

Summary:

In 2008, editor and physician Paul Gross launched a new online publication, "Pulse--voices from the heart of medicine" (published by the Department of Family and Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center). This anthology contains every poem and first-person narrative published during Pulse's first year, arranged in five sections corresponding to publication date and not to theme: Spring, Summer, Autumn, Winter, and Spring.  Paul Gross, in his introduction, states "After more than a decade of practice as a family doctor, I came to appreciate that the science I'd learned in medical school, though powerful and useful, was also incomplete . . . . it contained much truth about illness and healing, but not the whole truth" (xvii).  Like many other caregivers, Gross discovered "that writing and sharing my healthcare stories with others was therapeutic" (xviii).  He looked to "Sun Magazine" as an example of how first person narratives, both prose and poems, could turn "hurts and triumphs into something potentially beautiful, funny or moving" (xviii). 

The poems and prose that arrive every Friday online to Pulse's thousands of subscribers (and the selections in this anthology) are carefully screened by the editors according to these guidelines: the stories have to be first-person, and they have to be true, recounting the writer's own experience.  Submissions are accepted from any person involved in healthcare.  The language used must be "clear, simple language.  No medical jargon. No arcane literary devices" (xx).  Gross and his editors decided that Pulse would not be a medical journal nor a literary magazine--its purpose fell outside the perimeters of both genres--and so Pulse, and this anthology, offers work that is, in a refreshing and honest way, different from the slick or more polished poetry and prose that might be found elsewhere.

In reading this anthology from cover to cover, and so from season to season, I found that the poems and prose seemed to fall into several categories: Personal musings, in which authors relate healthcare experiences that engender intimate and revealing narratives about their own lives--among the best of these are "Well Baby Check," p.3; "Finding Innisfree," p. 31; "First Patient," p. 39; "Losing Tyrek," p. 45; "Carmen's Story," p. 62; and "Chemo? No Thanks," p. 106.  Other pieces are commentaries on the other side of healthcare, the one that cries out for reform and affects both patients and caregivers.  Among the best of these are "Redesigning the Practice of Medicine," p. 9; "A Brush with the Beast," p. 22; "Rx," p. 60; "Halloween Horrors," p. 69; and "Brain Cutting," p. 136.

Other pieces are humorous ("Aunt Helen Sees a Ghost," p. 6) or political ("My War Story," p. 11), and many poems and prose pieces speak of patient encounters or about being a patient, some more anecdotal, relating a specific incident that affected the author ("Once," p. 41) and others multi-layered, some relating medical student or intern experiences ("Jeannie," p. 48; "A View from Nepal," p. 87; "Ripped from the Headlights," p. 90; "Snowscape," p. 97; "First Night Call," p. 100; and "Wounded Messenger," p. 114.)  The "category" I found most interesting and most unique are the selections I will call "confessions."  These writings--demonstrating openess and bravery on the part of the authors--tell of regrets, mistakes, sorrows, wrong calls and other mishaps that occur, daily, in the practice of healthcare.  In these, the most human face of caregiving is revealed.  Although most of the pieces in this anthology contain elements of "confession," the most specifically revealing include "Mothers and Meaning," p. 14; "Physician's Exasperation," p. 44; "Confidential," p. 53; "My Patient, My Friend," p. 73; and "Apologies," p. 104.

Editor's note: Coincidentally, a recent relevant paper on confessional writing by physicians expounds further on this topic:"Bless Me Reader for I Have Sinned: physicians and confessional writing" by Delese Wear and Therese Jones (Perspectives in Biology and Medicine, Vo. 53, No.2, Spring 2010, pp. 215-30).

 

View full annotation

War Dances

Alexie, Sherman

Last Updated: Mar-23-2010
Annotated by:
Kohn, Martin

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

I believe the best way to describe this partly autobiographical story is as an illness travelogue. Alexie prepares his reader for a strange journey by making the first stop his discovery of a dead cockroach in his suitcase. This allusion to The Metamorphosis works wonderfully well for the Kafkaesque remainder of the journey.  His bodily journey moves from loss of hearing to possible meningioma to his doctor's proclamation that his "brain is beautiful." His existential/psychological/cultural journey, triggered by his bodily suffering, moves in multiple directions: to time spent with his dying father, his own experience with hydrocephalus, his grandfather's death in WWII, and his loving relationships with his children, wife and brother-in-law.

View full annotation

Annotated by:
Aull, Felice

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

The film opens on the Coeur d'Alene Indian Reservation -- called "the rez" by its inhabitants -- in 1998. Immediately there is a flashback to July 4, 1976 when the community was celebrating "white man's Independence Day" in drunken abandon. Accidentally Arnold Joseph (Gary Farmer) sets an uncontrollable fire to his neighbor's house, killing the couple who live there. But Joseph catches the baby, Thomas, when he is thrown out of a second story window from the burning house. The rescued Thomas (Evan Adams) is brought up by his grandmother and along side of Victor (Adam Beach), Arnold Joseph's son of about the same age. Joseph keeps on drinking but is in despair about the conflagration and its consequences.

12-year-old Victor watches sullenly while his parents drink until one night he smashes all their beer bottles. This action is a wake-up call for Victor's mother, Arlene (Tantoo Cardinal), who insists that she and Arnold both stop drinking. She chases Arnold out of the house; he leaves, never to return, while Victor watches, sobbing. These elements of the story occur in flashbacks while the 20-year-old Victor and Thomas travel by bus to retrieve whatever they can of Arnold Joseph, who has died outside of Phoenix. The remaining story unfolds in that forsaken spot where Joseph lived in a trailer and befriended Suzy Song, a young Indian woman originally from New York.

View full annotation

Push

Sapphire

Last Updated: Mar-22-2010
Annotated by:
Wear, Delese

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Narrated by Precious Jones, a 16-year-old African-American girl pregnant for the second time with her father's child, Push is a novel tracing her movement from anger, illiteracy, resignation, and self-contempt to some version of hope. The voice of Precious, raw and almost unintelligible at the beginning of the story, is changed when a courageous African-American teacher relentlessly inspires Precious, along with several other seemingly doomed teenagers, to learn to read, to discover what and how they feel, and to put it all down in a diary. The novel ends with everything uncertain and unfinished, but with a young woman changed by the appearance of self-respect.

View full annotation

The Bonesetter's Daughter

Tan, Amy

Last Updated: Mar-22-2010
Annotated by:
Wear, Delese

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The Bonesetter's Daughter is divided into two major stories. One is the story of Ruth, an American-born Chinese woman, a ghostwriter for self-help books, in a relationship with a white man, stepmother to his two teenaged daughters, and finally, daughter of LuLing, who Ruth fears is becoming demented. Ruth begins to realize what her mother's memory loss means to both of them: for her mother, an increased need for attention, for Ruth, disappearing stories that could help Ruth understand her family and render a feeling that she is part of a larger story.

The second major story is that of LuLing, which Ruth discovers in the form of documents LuLing had given her several years earlier, written in Chinese, LuLing's attempt to hold on to fading memories of her life in China. This story within a story--LuLing's life in a village called Immortal Heart; the secrets passed on by her nursemaid Precious Auntie (who, we learn, is also her mother); a cave where bones are mined that may be the teeth of Peking Man; tales of ghosts and curses--parallels in many ways the present-day issues confronting Ruth: an inability to speak up to her partner and his two daughters; why she remains a ghostwriter, without a voice of her own; an increasingly problematic and confusing relationship with her mother. Answers to both women's puzzles and problems unfold as LuLing's story is translated in its entirety, providing answers through memory and words that could not be spoken, only recorded.

View full annotation

Summary:

This edited anthology, which includes poems, essays, short stories, and other creative forms (e.g., a radio diary, a letter to a social service agency), is organized into sections that include Body and Self, Diagnosis and Treatment, Womanhood, Family Life and Caregiving, Professional Life and Illness, and Advocacy. Most works found their way into this collection through a call for submissions, although a few selections are well known, such as Lynne Sharon Schwartz's "So You're Going to Have a New Body !," or an excerpt from Rachel Naomi Remen's Kitchen Table Wisdom (see annotations). In addition, the anthology also includes essays by scholars such as Arthur W. Frank and Rita Charon, who theorize gendered illness narratives.

View full annotation

Only Goodness

Lahiri, Jhumpa

Last Updated: Mar-22-2010
Annotated by:
Wear, Delese

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

Perhaps the strongest piece in Jhumpa Lahiri's collection Unaccustomed Earth "Only Goodness" is the story of an American Bengali family and their alcoholic son Rahul. He takes his first drink in high school when he visits his sister Sudha at college. By the time he is dismissed from college several years later, he is an alcoholic who has devastated his parents and destroyed their high expectations for him. The once precocious and promising Rahul returns to live in his parents' home and finds work in a laundromat. Other disappointments and fractures to their relationship occur as he becomes further estranged from them. Finally serious about his recovery, he sends a postcard to Sudha, now living in London with her British husband and their baby, and asks to visit them. The visit goes very well until Rahul gets drunk while babysitting his infant nephew and leaves him alone in the bathtub as he is passed out in bed. Sudha, unable to make excuses for him, asks him to leave their home the following morning.

View full annotation

Echoes of War

Brown, S., H., ed.

Last Updated: Feb-23-2010

Primary Category: Literature / Literature

Genre: Anthology (Mixed Genres)

Summary:

This is an anthology of 32 pieces, many directly relating to war and its aftermath, or, in general, kinds of violence humans inflict upon each other and the ensuing suffering: hence the title, "echoes of war." The pieces include short fiction, essay, a dozen poems, and a photo collection. Since none are lengthy, this is a good reader to supplement other longer texts or to serve as an anthology for a reading group. A short essay, "Suggested Longer Readers," mentions some three dozen pivotal topics, including "homecoming" and "sense of identity." 

View full annotation