Showing 71 - 80 of 109 annotations tagged with the keyword "Physical Examination"
Author Horace Davenport is a retired professor of physiology who had a distinguished career in medical science. This book reflects his more recent interest in the history of medicine and physiology in the 19th and 20th centuries. The best summary of this transcription with commentary resides in the author's own introductory paragraph, paraphrased here: From 1899 to 1900 fourth year medical students at the University of Michigan doing their medicine and surgery rotations attended a diagnostic clinic twice a week with George Dock, A.M., M.D., professor of theory and practice of clinical medicine. Dr. Dock had a secretary make a shorthand record of everything that was said at these clinics by Dock himself, the patients, and the students.
The clinics and recording of the interactions continued until the summer of 1908 when Dr. Dock left Michigan for a position at Tulane. The typed transcripts of these sessions fill 6,800 pages. This book is Davenport's distillation and, on occasion, clarification of these documents. In these transcriptions resides not only a view of the practice of academic medicine at the turn of the 20th century, but also a glimpse at one clinician's interpretation of clinical material in his own time.
For those who have enjoyed his previous collections, this edition of new and collected poems (22 new, the rest culled from collections published from 1972-1998) will be a welcome and rich sampling of Stone's work, wide-ranging in style and subject. The three sections of new poems include a series about incidents in Serenity Gardens, his mother's nursing home; a series of "Reflections from the Middle East" that chronicle moments evocative of classical and biblical story and ethos as well as touching, comic incidents in the life of a 60-something tourist; and a short series of poems based on memories from childhood and young adulthood.
The poems tend toward narrative; many are little stories complete with plot in one to two pages of short lines; Stone's gifts for both chronicle and condensation give many of the poems a lively tension: what is told suggests how much isn't.
As a collection it is possible here to trace the stylistic development from the early poems in The Smell of Matches with their strong autobiographical focus and sense of intimate scene and situation to the recent ones, still strongly personal, but reflective, sometimes ironic, with lines that render the self-awareness of the older poet in sometimes comic flashes.
Summary:Stone's 12 line elegy leaves the reader breathless as style and content merge to create the surprise of unexpected death. During autopsy a clot is discovered in an otherwise "nearly perfect" being.
While on an airplane, Carson experiences abdominal pain. He is a divorced man in his fifties and a sales representative for a computer and information technology firm. He spends much of his time traveling and fancies himself "a connoisseur of cities." The increasingly severe stomach pain forces Carson to reschedule his business meeting and retreat to his hotel room.
His suffering mounts and he decides to visit the emergency department of the city hospital. Carson is evaluated by two young male doctors and later a middle-aged female physician. Despite blood tests and X-rays, his diagnosis remains murky and a surgical consultation is obtained. The surgeon suspects appendicitis. He postulates that Carson may have a retrocecal appendix and explains that in such cases the anatomical location of the organ often confounds the diagnosis.
Carson undergoes surgery. His appendix is indeed retrocecal and rupturing. He spends five days convalescing from the operation. During that time he acquires an intimate knowledge of the city from his stay at the hospital. The experience revitalizes him. Carson reasons that the world is miraculous in part because it is so simple yet still spectacular.
A child dies in the hospital shortly after the infectious disease consultant, Dr. Michael Grant, evaluates her. The 35-year-old physician has cause to be troubled by the patient's death. He failed to perform a careful examination, did not check the results of her most recent lab tests, and held off on ordering antibiotics. Although an autopsy was not performed, it is believed she died of sepsis.
Divorced and recently relocated to North Carolina, Dr. Grant is already depressed. Now he must worry about the possibility of a malpractice lawsuit. Jonas Williams, the father of the dead child, is also ill. He complains of fatigue, visual disturbances, confusion, night sweats, and fever. Jonas has developed unusual lesions in his throat and retina--white threads in a serpentine pattern. A biopsy of his oral lesion demonstrates the presence of osteoblasts and new bone formation. Dr. Grant becomes convinced he has stumbled onto a completely new infectious illness even though he cannot identify the causative organism.
Jonas experiences gastrointestinal bleeding as a result of a low platelet count. He dies in a trailer that has caught on fire. Dr. Grant soon develops the same symptoms as his patient. He remembers coming into contact with some of Jonas's blood. He is admitted to the hospital with massive gastrointestinal bleeding. His physician attributes the bleeding to ulcers, gastritis, and thrombocytopenia. Dr. Grant, however, believes the bleeding is due to the same mysterious disease that Jonas had.
The body of Jonas's daughter is exhumed, and there is anatomic evidence of the same bizarre changes that occurred in her father. Dr. Grant visits a cabin in the woods where Jonas had lived. He is looking for clues to the puzzling new illness. What he finds, however, is not an answer. Instead, it is a renewed appreciation for his life as well as the world around him.
This is a collection of 23 stories, five of which take the form of "letters" in which an older physician (not surprisingly, a surgeon) gives advice to an imaginary young surgeon. However, every one of the stories "fits" as a tale that might be told in such a letter--assuming the author was a wise and gifted writer, in addition to being a surgeon.
The book begins with the gift of a physical diagnosis textbook on the occasion of the young doctor's graduation ("Textbook") and ends with a reflection on "your first autopsy" ("Remains"). Among the other stories are Imelda (see annotation), Brute (see annotation), Toenails (see annotation), Mercy (see annotation), "A Pint of Blood," "Witness," "The Virgin and the Petri Dish," and "Impostor."
The title The Body in the Library suggests medicine (the body) as seen through literary eyes. True enough, this collection of stories, poems, essays, and excerpts from longer works is subtitled "A Literary Anthology of Modern Medicine." However, as Iain Bamforth points out in his introduction, nowadays we are more concerned with "the library in the body" (p. xxiv); that is, we believe the truth of human illness can be found by biochemical tests and positron scans, rather than by storytelling. In this anthology Bamforth uses literature itself to document this change in perspective. Beginning with "The Black Veil" (1836), an early sketch by Charles Dickens, Bamforth recounts the recent history of medicine as seen by poets and writers, many of whom were (and are) physicians themselves.
Part of the anthology consists of material already annotated in this database. This includes stories (e.g. Conan Doyle’s "The Curse of Eve" from Round the Red Lamp, Kafka’s A Country Doctor, and Williams’s Jean Beicke); excerpts from novels (e.g. "The Operation" from Flaubert’s Madame Bovary, "The Fever Ward" from Camus’ The Plague, and "Doctor Glas" from Hjalmar Soderberg’s novel, Doctor Glas); and essays (e.g. Virginia Woolf’s On Being Ill and John Berger’s "Clerk of Their Records" from A Fortunate Man).
However, most of the selections have not previously been noted in this database, nor do they appear in other recent anthologies. Iain Bamforth has discovered some wonderful "new" material on the medical experience. This includes several poems by the German physician-poet Gottfried Benn (pp. 151-153); and a brief piece by neurologist-writer Alfred Döblin ("My Double," pp. 177-179), in which the physician Döblin and the writer Döblin describe their respective "doubles" in rather detached and negative terms.
Another delight is the series of selections from Miguel Torga’s diary (pp. 256-278); Torga (1907-1995) was a provincial Portuguese medical practitioner for 60 years. Among the other pieces are short excerpts from plays by Georg Buchner, Jules Romains, and Karl Valentin; and poems by Weldon Kees, W. H. Auden, Philip Larkin, Dannie Abse, Robert Pinsky, Miroslav Holub , and Thom Gunn.
The narrator of this fictional autobiography is Cal Stephanides, an American of Greek descent with a hereditary 5-alpha-reductase deficiency that gives her the prepubertal anatomy (and thus the social upbringing) of a girl, but at puberty begins her transformation into ambiguity, then maleness, and then, gradually, masculinity.
The novel is a kind of biography, not just of Cal, but also of the mutant gene that causes her/his condition. It is transmitted from a small village in Smyrna, through his grandparents, who were also brother and sister and who married on the ship to America, apparently leaving behind family as well as national identity. Their Greekness and the gene come with them, and the consequences of their incest haunts Cal's grandmother, Desdemona, until the very end of the novel.
The family settles in Detroit, and a third biographical strand is the story of the Greek immigrant community in 20th century America, from Ford's assembly lines to bootlegging during the prohibition, through Detroit race riots and then to affluent suburbia.
Cal's family settles in the suburb of Middlesex, and the focus narrows to the individual. Calliope is raised as a girl, but in adolescence, Callie learns about hermaphroditism, narrowly escapes sex-assignment surgery, becomes a performer in a seventies sex show in San Francisco, and finally returns home to Middlesex, Grosse Point, Michigan, as a male. The story is framed by Cal's much later adult life as a man in Berlin, and his successful romance with a woman he meets there.
This thorough and fascinating treatment of the politics of anatomy studies in 19th-century America provides a variety of perspectives on the vexed question of how appropriately to study human anatomy while also maintaining respect for the human body and honoring the various, deeply held community beliefs, and attitudes toward treatment of the dead. Sappol seeks, as he puts it, to "complicate the cultural history of medicine in late-eighteenth- and nineteenth-century America. . . by telling it from an anatomical perspective."
That statement of his objectives hardly suggests the startling range of approaches to the topic he takes in the book's nine chapters. These cover such issues as the legacies of belief about the "personhood" of the dead human body; the status of anatomy as both a legitimate and valuable study and also as an "icon of science"; the relationship of dissection and anatomy study to medical status and professionalization; the political tensions engendered by the "traffic in dead bodies" that most often expropriated corpses from marginalized communities; and the relationship of anatomy studies to sexual commerce and sensationalist fiction.
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.