Showing 71 - 80 of 108 annotations tagged with the keyword "Impaired Physician"
The narrator, Rick, is let out of rehab to live with his older brother, Philip, who is a doctor in Detroit. He will work at a mundane job in Philip's lab. The awkwardness of their encounter slowly evaporates and Rick begins to enjoy life with his family, especially his two young nephews. But he is concerned about Philip's weary appearance, so reminiscent of their father.
It emerges, quickly and to Rick's surprise, that Philip runs an abortion clinic. The clinic is subject to constant harassment by a persistent group of religious, "right-to-lifers," who taunt the doctors, the workers, the patients, and their families at home. Rick struggles to control--even avoid--his feelings; and he tries (unsuccessfully) to suppress the desire to befriend patients.
Eventually, he is reconciled to his new task through an unwelcome fixation on one patient. But angry urges to protect her and his brother well up. After weeks of pent-up rage and fear, he hides a gun, loses control, and begins shooting aggressive protestors. The murder is "nothing"; it's "just like killing babies."
A country doctor, Gregory Ovchinnikov, begins his daily rounds in the hospital. He soon notes that his assistant, Smirnovsky, is drunk. When the assistant refuses to obey an order and snaps back at him, Ovchinnikov hits the man in his face. The angry physician then rushes out of the ward and goes back to his lodgings.
At first, he considers demanding that the town council fire Smirnovsky. Later, after he goes back to work, Orchinnikov begins to wonder about the enormity of his unprofessional act--perhaps the town council will fire him. Strangely, when the assistant comes to apologize, the doctor indicates that it is he--the doctor--who has behaved inexcusably. The assistant is stunned, but decides to complain to the council. Of course, the council demands that the (lower class) Smirnovsky apologize to the (upper class) Ovchinnikov.
The new interns, Roy Basch (Tim Matheson), Chuck (Howard Rollins, Jr.) and Wayne Potts (Michael Sacks), begin their year of internal medicine training in a busy city hospital under construction. After initial introductions led by the vague staff man and vapid chief resident, they become the specific charges of the cynical resident doctor "Fats" (Charles Haid). Fats teaches them attitude and language: how to "buff" (improve) and "turf" (transfer) "gomers" (Get Out of My Emergency Room)--the words used to describe management of incurable, hateful patients who "never die," regardless of the abuse the clumsy housestaff might inflict. But Fats has heart.
Soon, they fall under the command of the militaristic and lonely woman resident, Jo Miller (Lisa Pelikan), who cannot bring herself to withhold treatment, even at a patient's request. She blames underlings for the failings of medicine and nature, as well as herself.
Wayne throws himself from the hospital roof because of a misplaced sense of guilt over a patient's demise. Roy falls in love with the nurse, Molly (Kathryn Dowling), but nearly loses her as he begins to emulate Jo's cold, calculating style. He is "rescued" in the nick of time by his friends, Fats, and the death of a physician patient (Ossie Davis) whom he admires. With recovered equanimity and renewed anger over the suicide of his fellow intern, Roy refuses to go on with his residency.
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.