Showing 631 - 640 of 807 annotations tagged with the keyword "Communication"

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.

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Annotated by:
Belling, Catherine

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Giovanni (Nanni Moretti) is a psychoanalyst. He has a beautiful wife, Paola (Laura Morante), and an adolescent son and daughter, Andrea and Irene. One Sunday morning, Giovanni gets a call from one of his patients, newly diagnosed with cancer and frantic. Instead of spending the day with his family, Giovanni attends to his patient. Andrea goes diving with friends, there is an accident, and he is killed.

The rest of the film examines the family’s bereavement. Giovanni finds his work increasingly difficult, and by the end of the film he has decided that he can no longer be a psychotherapist.

A love letter addressed to Andrea arrives from a girl called Arianna: it turns out Andrea had a secret girlfriend. Both parents become obsessed, in different ways, with contacting Arianna. Eventually she visits them, while hitchhiking with her new boyfriend, and the family drive all night along the Mediterranean coast, taking Arianna and the boy to France. Next morning, on the beach at Nice, in saying goodbye to Arianna, they seem to have made progress in continuing their life as a family without their lost son.

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Annotated by:
Jones, Therese

Primary Category: Literature / Nonfiction

Genre: Journal

Summary:

Born in Newnan, Georgia, and raised in Jackson, Florida, Cary Henderson was the first member of his family to go to college. He eventually earned a Ph.D. from Duke University and with his family, settled into an academic career as a history professor at James Madison University. In 1985, at the age of fifty-five, he was diagnosed with Alzheimer's disease.

As his ability to read and write deteriorated, Henderson began using a pocket recorder to tape what he called "the anecdotal career of an Alzheimer's patient" in order to help others "understand the world that they are now forced to live in" (4). His recorded journal spans the fall of 1991 to the summer of 1992. His wife and daughter began the long process of editing his tapes and were ultimately joined in the project by Nancy Andrews, award-winning photographer from The Washington Post, who provided images of Henderson to accompany his words.

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Annotated by:
Belling, Catherine

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Author and Oxford don, C. S. Lewis (Anthony Hopkins), lives a sheltered life as a bachelor, sharing a house with his brother. In 1952 he meets an American woman, Mrs. Joy Gresham (Debra Winger). They become friends when Joy moves to England with her young son, Douglas, divorcing her alcoholic husband; when Joy is in danger of losing her visa, Lewis agrees to marry her so that she can become a British citizen.

The marriage appears to be purely a technicality. This is in part because of Lewis’s emotional frigidity with people, which is contrasted with the profundity and energy of his engagement with books and ideas. Joy eventually confronts him about this, and at about the same time she is diagnosed with advanced cancer.

The prospect of her death disrupts Lewis’s ideas about God, suffering, and human relationships, prompting a crisis that leads him to recognize his love for her. Their legal marriage is consecrated in her hospital room and, after radiation treatment puts her in remission, Joy and her son move in with Lewis. After a few months, she dies. Lewis is left with a new knowledge of the real paradoxes of love, connection, loss, and suffering.

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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.

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Annotated by:
Bertman, Sandra

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

This book's title is from a Goethe poem, "The Holy Longing," translated from German in its entirety by Robert Bly: "And so long as you haven't experienced / this: to die and so to grow, / you are only a troubled guest / on the dark earth." Ten intensely personal essays tell of the suffering and everyday presence of pain of a severely disabled writer who has advancing multiple sclerosis, and of how, "in a very real sense, and entirely without design, death has become [her] life's work." (p. 13)

Beginning with her father's sudden death when she was a child, the essays describe her aging mother's expected death and the family's decision to take her off life support; her caretaker husband's diagnosis of metastatic cancer with uncertain prognosis; her own attempted suicide; death of friends, pets, including her beloved dog; and a young pen-pal executed on death row. If that weren't enough, a coda, her foster son's murder and again the decision to remove life-support, provides "[t]he end. For now." (p. 191)

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Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

Another Dimension is an occasional feature of the journal, Emerging Infectious Diseases, published by The Centers for Disease Control and Prevention (CDC). These essays (and occasionally poems or stories) focus on human and philosophical issues related to medical practice, scientific research, and public health. The intention of this feature is to bring a new perspective to the journal’s coverage of medical science and public health. Some of the essays include a painting or other image that draws attention to the subject matter of the essay.

Managing editor, Polyxeni Potter, with the encouragement of Joseph E. McDade, founding editor of the journal, initiated and is guiding this feature (see also the annotation of Potter: Emerging Infectious Diseases cover art). Since this is a government site, its material is freely available on-line.

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Annotated by:
Bertman, Sandra

Primary Category: Literature / Poetry

Genre: Poems (Sequence)

Summary:

David Slavitt has written his own response [Part I, "Meditation" (pp. 1-58)] to the five poems (chapters) that comprise the Old Testament's "Book of Lamentations," which he has translated here from the Hebrew [Part II, "Lamentations" (pp. 59-85)]. The poems appear in Hebrew and in English, on opposite pages. In addition there is a "Note on Translation" (pp. xiii-xiv) and a "Bibliographical Note" (pp. 87-88).

Five poems--The Book of Lamentations--express Israel's brokenness, bewilderment before God, and sorrow at the catastrophes that have beset the Jewish people through the ages. Slavitt's meditation and notes on translation prepare the reader for far more than a prosaic historical account of the destruction and biblical plights of the Jews. "A translator wants to be faithful to the original work but then discovers how fidelity to the word can mean a betrayal of the sentence." (p. xiii)

"As a boy, I knew next to nothing of Tish'a b'Av," begins the author's meditation. We learn, as he did, about "[this] worst day of the year"(p. 6)--the day in 587 B.C. that the Temple in Jerusalem was destroyed, and six centuries later on the same day, when the second temple was destroyed. Annually Tish'a b'Av is devoted to grieving "every terrible thing that happened in this world "(p. 6): Zion, Jerusalem, the Holocaust. Except for The Book of Job (see annotation in this database) and Lamentations, reading even the Torah, the most sacred text in all Judaism, is forbidden on this solemn day.

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Summer in Baden-Baden

Tsypkin, Leonid

Last Updated: Jan-31-2003
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In this novel the narrator travels by train from the present into the past and back again. The narrator boards a train in Soviet Moscow; travels to Leningrad in a compartment with some not too friendly people; stays overnight in a relative's run-down, crowded apartment; and rambles through the streets of Leningrad, stopping to visit Dostoyevsky's last place of residence, which is now a museum.

However, this framing story occupies very little of the book. During the train ride, the narrator re-imagines a much earlier trip in April 1867, as Fyodor Dostoyevsky and his young wife, Anna Grigoryevna, travel by train to Baden-Baden in Germany. They will remain abroad for four years, as Dostoyevsky indulges in his passion (and later obsession) for gambling.

In Baden-Baden he loses all their money; he pawns their belongings and loses; he begs and borrows money from friends and publishers, and loses. Each time he loses, he comes home to their rented apartment and throws himself at Anna's feet. He protests his love, berates himself, and promises to do better in the future; and Anna forgives him.

In this dream-like story, repentance and forgiveness, memory and desire, hope and despair revolve like electrons around Dostoevsky's addiction to gambling. Fyodor and Anna recall earlier events in their lives; for example, Anna remembers herself as a hesitant young secretary arriving for the first time to take dictation from the famous man; and Fyodor, the former convict, Slavophile author of Crime and Punishment, remembers being scornfully dismissed by the smooth and sophisticated Turgenev.

Within the 1867 framework, the story seems to be stuck, unable to move forward, although we know from our late 20th century perspective--as Tsypkin recalls (and invents) the events while on his train trip to Leningrad--they are part of a larger story which moves inexorably forward through time and ends at the Dostoevsky house in Leningrad (St. Petersburg), with the moving scene of Fyodor's last days. And the two stories converge as Tsypkin visits the Dostoevsky museum where those last days took place.

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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.

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