Showing 71 - 80 of 105 annotations tagged with the keyword "Impaired Physician"
Subtitled "The Story of a Gifted Young Obstetrician's Mistake and the Psychologist Who Helped Her," this is an absorbing account of a young female physician's torment following the difficult delivery of a baby who was soon thereafter diagnosed with cerebral palsy. "Doctor Amelia" seeks counseling after she has taken an indefinite leave of absence from her practice and faculty position. The book intertwines reconstructed counseling sessions in the voice of the doctor-patient, with the therapeutic strategy and personal reflections of her therapist, author Dan Shapiro.
The obstetrician enters therapy because she has lost confidence in her professional abilities. Once deeply engaged in her chosen profession, she has lost her enthusiasm for it and feels "numb." Her marriage is under strain. When asked if she is suicidal, she hesitates and then denies she is. Shapiro thinks there may be trouble ahead, and so does the reader. Gradually, Doctor Amelia reveals the incident that triggered her changed emotional state. She had delayed performing a cesarean section on a patient who was in extended labor and whose baby was showing deceleration of its heartbeat rate. A few weeks later, the baby's pediatrician informed Doctor Amelia that the baby had cerebral palsy and now the baby's parents are filing a lawsuit.
The headstrong beauty Marcella Boyce, who has acquired radical political views while at school, returns home and becomes engaged to Aldous Raeburn, the son of her father's neighbor Lord Maxwell and a moderately conservative politician and landowner. Marcella champions Jim Hurd, a local poacher accused of murder (who is prosecuted by Raeburn): she nurses his grieving wife and dying, consumptive son and arranges his legal representation by Edward Wharton, a Socialist politician and Raeburn's romantic rival.
After Hurd's execution, Marcella breaks off her engagement, trains as a nurse, and turns her reformist efforts toward the London poor instead of the rural poor in rural villages. She refuses Wharton's offer of marriage and finally accepts Raeburn's hand.
The play takes place over a several-year period in the provincial town in which the Prozorov sisters and their brother Andrei live. Olga, the oldest, is a high school teacher; Masha is unhappily married to a teacher in the same school; and Irina and Andrei have dreams of moving back to Moscow. Vershinin, the new Army commander, joins the group of military hangers-on around the Prozorov home, a group that also includes the ineffectual doctor, Chebutykin, who lets everyone know that he has forgotten all the medicine he ever knew.
As time passes, Andrei marries Natalya and devotes himself to gambling, while Natalya has babies and takes over the household. Masha has a romantic affair with Vershinin; Natalya commits adultery with the school administrator. A fire rages through the town, but Chebutykin is drunk and unable to help the victims. In the end, just before the Army contingent moves to another post, Irina's fiancee is killed in a duel.
The framing story of this novel is simple: an elderly literary agent receives word that a person named Yvonne Bloomberg would like to meet with him. When he at last visits the woman, he discovers that she was an acquaintance from their youth--Yvonne Roberts--and she wishes to publish the journal that a mutual acquaintance, Dr. Simmonds, had bequeathed her. The agent agrees to read this journal, which provides most of the novel's text. A series of letters that appear in the last few pages indicate that, indeed, the journal is accepted for publication.
The journal recounts the first six months of 1950. Dr. Simmonds is an unmarried general practitioner nearing his 40th birthday. He has mixed feelings about his practice and his patients. For example, he likes Michael Butler, an irascible middle-aged man dying of cancer, but he dislikes many of his other patients, including Anton Bloomberg, a repulsive Jew with a "hooked nose," "too thick lips," and a "wheezing chest." (p. 25)
Bloomberg originally consults Simmonds about his young wife's frigidity; she simply will not perform her wifely duties. Simmonds himself is attracted to Bloomberg's beautiful young Yvonne, who mysteriously sends him a copy of a novel called Doctor Glas, published in 1905 by the Swedish author Hjalmar Soderberg [see annotation in this database]. Dr. Glas is the fictional journal of a doctor who treats Rev. Gregorius, a 57-year-old minister and his young wife. The wife complains that her husband's sexual advances are repulsive. From this point on, the story of Dr. Simmonds parallels in many ways that of Dr. Glas, a parallelism which Simmonds records in his journal and struggles to understand. Dr. Glas ultimately murders Rev. Gregorius.
Simmonds becomes obsessed with Yvonne Bloomberg and imagines that she is attracted to him. They interact in a variety of social settings, including a forum in which he suggests that he approves of euthanasia. She speaks to him of her husband's unwelcome advances. He considers killing her husband under the guise of treating his asthma, but shies away from taking that step. However, when Anton Bloomberg fails to respond to repeated injections of adrenalin during a severe asthmatic attack, Simmonds gives him morphine (which could kill him), then immediately relents and calls for an ambulance. Bloomberg recovers, but is permanently brain damaged.
Subsequently, Yvonne is free to spend the next 50 years living with her real lover (Hugh Fisher), and the two of them take care of her childlike husband. Simmonds, however, sinks into melancholy and several years later commits suicide.
This is a story of a day in the life of 12-year-old Albert Abrams in Brownsville, Brooklyn, during the Depression summer of 1934. Albert’s father is an irascible middle-aged general practitioner whose practice is getting smaller and smaller. Most of his patients can’t pay; and many have left Dr. Abrams to go to younger doctors, or to specialists. Albert’s mother is a refined literary-type lady who never complains about their life in the deteriorating neighborhood, even though all of their middle-class friends have moved elsewhere.
Albert is a brilliant young man ("the highest IQ in the school"), but his greatest desire is to be "one of the boys." He is small, skinny, and poor at sports. The other kids make fun of him because of his "rich" father. The novel describes a long day of verbal and physical harassment; its highlights are a critical punchball game between the white kids, mostly Jewish, and black kids of Longview Avenue, and a fistfight in which Albert actually "beats" one of his perennial nemeses. In the evening there is a fire in which Yussel Melnick, an old Talmudic scholar, is burned to death.
Peeking out from behind his son’s story is the image of Dr. Abrams, a man who once was the star of his medical school class, but whose career long ago failed to "take off" because of his bluntness, bad-temper, and general difficulty getting along with other professionals. He is portrayed as a man truly committed to his patients, but also prone to yelling at them and hounding them for payment. As the day progresses, it becomes evident that Dr. Abrams has been losing his grip; he has episodes of confusion and appears to be on the verge of a nervous breakdown. In the end, stimulated by love for his son, he rouses himself from suicidal ruminations.
The 58 year old plastic surgeon who narrates this story has plenty of problems. He drinks too much and his surgical skills are deteriorating. His wife Maya, a neurosurgeon young enough to be his daughter, has a miscarriage not long after her father dies from a brain tumor. The narrator is plagued by an obsession with butterflies.
He seems to have inherited his unnatural interest in these insects from both his father and grandfather. Strangely, the pursuit of butterflies has brought only tragedy to these men. Maya believes her husband's butterfly collection is a curse so she destroys it. Her action seems insufficient to liberate the narrator from the burden of his ancestors. He is convinced that his destiny was dictated by his family years ago.
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.
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.
This long-lined poem is an eloquent and angry diatribe directed toward the god who wasn't there, a god who, if he had been present to them, would have saved the poet's father and his family from another god who DID appear in their lives, the god of amphetamine.
The god of amphetamine is "the god of wrecked / lives, and it's only he who can explain how my doctor father, / with a gift of healing strangers and patients alike, left so many / intimate dead in his wake." He is the god of diet pills, of the "rampant mind," and of "tiny, manic orderings in the midst of chaos." He is also the god of terrible and destructive scenes in the poet's family, because, in fact, the poet's father was the high priest of this god, "preaching its gospel, lifting it like a host and / intoning . . . Put out your tongue and receive it." [37 lines]
At the heart of this novel is a simple love story. Dr. Bruno Sachs, a slight, stooped, and somewhat unkempt general practitioner in a French village is dedicated to his work and loved by his patients. Sachs is a solitary, self-effacing man who takes his Hippocratic duties seriously and is especially sensitive to the needs of his patients.
In addition to his private practice, Sachs works part-time at an abortion clinic, where he performs an abortion on a distraught young woman named Pauline Kasser. Soon the doctor and his patient fall in love. She moves in with him and becomes pregnant. An editor by profession, Pauline also encourages and assists Dr. Sachs in completing the book he is writing.
The story has many additional layers and dimensions. The reader views Sachs through the eyes of multiple narrators--his patients, colleagues, friends and acquaintances, all of whom write in the first person and present Bruno Sachs as "you" or "he." Thus, the reader gradually builds up a "connection" (empathy) with Sachs by synthesizing multiple glimpses of his behavior and facets of his character. At the same time, Sachs is trying to find his own voice, his own connection, by becoming a writer. At first he jots down random thoughts, then he keeps a notebook, and eventually he produces a complete manuscript.
The book has innovative structural elements that introduce other layers of meaning. For example, the 112 short chapters are organized into seven sections, corresponding with the components of a complete clinical case history: presentation (as in "chief complaint"), history, clinical examination, further investigations, diagnosis, treatment, and prognosis. Similarly, the narratives delve progressively into Sachs' "illness" and follow the "patient" through his course of "treatment."
Another structural element is the cycle of fertility and gestation. The story takes place from September through June, precisely 40 weeks, a pregnancy of nine months, during which Sachs is re-born.