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This posthumously published collection of essays by Dr. Klawans, an eminent neurologist and writer, explores the interactions between patient, family and neurologist and the implications of specific neurologic diseases. Klawans's special interest in neurology is movement disorders, such as Huntington's chorea and Parkinson's disease, but his outside interests range from evolutionary biology to classical music. His essays, therefore, focus on single patients or families, but the author weaves thoughts about his other interests into each "case."
The book is divided into two sections, "The Ascent of Cognitive Function" and "The Brain's Soft Spots: Programmed Cell Death, Prions, and Pain." In a brief preface, Klawans declares that this book is "more than just a set of clinical tales about interesting and at times downright peculiar patients" from his 35 years of practice, but rather it "humbly grapples with the 'whys' of our brain, not the 'hows.'" (pp. 9-10) In the preface, as well as in one essay, Klawans acknowledges the work and impact of fellow neurologist-writer Oliver Sacks ("Oliver is truly the father of us all." p 12).
The title essay concerns a six-year-old girl who was found, locked and completely speech-deprived, in a closet. Because she is still within the window of opportunity for language acquisition, "Lacey" quickly learns to speak, unlike Victor, the Wild Boy of Aveyron, whose story was immortalized in the François Truffaut film, L'enfant Sauvage. Klawans uses these stories as a launch pad to discuss the evolution of language, including a proposal that the cavewoman, not the man, was responsible for development of the human species as she taught her offspring language.
Other chapters focus on patients with epilepsy, Parkinson's disease, localized and hemispheric stroke, "painful-foot-and-toe syndrome, " and Creutzfeldt-Jakob disease. Two particularly memorable chapters concern Huntington's chorea and Refsum's disease. The chapter, "Anticipation," explores the profound ethical concerns of genetic testing for Huntington's chorea as applied to three generations of one particular family. In the chapter, "The Hermit of Thief River Falls," Klawans recollects his first year as a neurology resident, and his care of a reclusive patient with a rare eponymous illness, Refsum's disease--just in time for a visit by Refsum himself, a famous Norwegian neurologist.
The book concludes with a speculative "afterthought" about genetics, evolution, and the importance of extended "juvenilization" --the protracted post-natal development of Homo sapiens. This essay intertwines some of the threads regarding speech development and evolutionary biology, particularly brain development, that were introduced earlier in the text.
A young boy tells us, "My cat Barney died last Friday. I was very sad." Barney's mother suggests he think of ten good things to tell about Barney at his funeral. The story details his feelings and, from his perspective, the way his parents and friend Annie deal with the loss, ritual of burial and questions of afterlife (heaven, Barney's whereabouts now).
After the funeral, and after helping his father in the garden, comes a new and comforting understanding--the tenth good thing is that Barney's body becomes part of the cyclical process of nature. Fertilizing trees, grass and "helping grow flowers," the boy tells his mother as she tucks him into bed, is "a pretty nice job for a cat."
The author of this memoir is a poet and writer who developed systemic lupus erythematosis (SLE) during her first year at the University of Pennsylvania. Initially, her condition was difficult to diagnose, which led to her first negative encounters with physicians and the health care system. Later, Ms. Goldstein developed unusual neurological manifestations of SLE. Once again, she had trouble convincing her doctors that her symptoms were not only real, but also disabling. She was fortunate enough to come across a few good physicians who respected her as a person and earned her trust.
Despite her chronic illness, Ms. Goldstein thrived throughout college and graduate school. She approached each new challenge with such a positive attitude that some of her doctors considered her emotionally unstable. (I guess they thought it would be more "normal" for her to lose hope and turn herself into an invalid.) Her graduate work in literature focused on the new field of literature and medicine.
This stark and sensual poetry collection is divided into three sections. The first, "Graveyard Shift," introduces the narrator's themes: the keen observation of suffering; the questioning of God's role in such suffering; the way caregivers and patients meld in shared moments of trauma; the struggle to integrate the reality of death and grief into a life outside the healthcare arena.
A longer second section, "Lessons," contains a chronology of poems that broaden the poet's themes. Suffering becomes personal through sexual abuse ("The Burning"), death of a baby ("To the Woman in the Next Bed," "Waiting Room," "Last Lullaby for the Dead Child"), and breast cancer ("Keeping Watch"); the mystery of God's role becomes the narrator's religious quest.
The final section, "The Ones Who Come," opens these themes to the universal: children and adults lost to "the holocausts" of war, poverty, and illness ("Lizard Whiskey: A Parting Gift from Viet Nam," "After the Siege," "The Ones Who Come," "The Man Who Stays Sane"), and how history repeats these cycles of birth, suffering, and death.
A small boy overhears his parents discussing the memory loss of a ninety-six year old neighbor who lives next door in the old people's home. He tries to discover the meaning of "memory" by asking the other residents who tell him, respectively, it's something warm, something sad, something that makes you laugh, something precious as gold.
Young Wilfrid gathers his own "memories" to bring to Miss Nancy, his favorite neighbor because she, too, has four names. Each of his treasures, a freshly laid egg for warmth, a toy puppet for laughter, his grandfather's war medal for sorrow, and his precious football stimulate warm reminiscences for Miss Nancy Alison Delacourt Cooper and smiles and smiles for the two of them.
Corky Nixon is a patient in a ward of amputees in a military hospital for casualties of the Korean War. He has lost both legs. The head nurse on the ward has been given the nickname "Old Ironpuss" because she is so fierce and strict and unattractive, showing, as Corky says, "no warmth, no sympathy, no concern" (131). By implication, she is unfeminine. All the patients fear and hate her.
On Christmas Eve, a severely injured patient, Hancock, is brought in. He is conscious but catatonic. Corky is outraged that "Old Ironpuss" should be taking care of Hancock (he says that so sick a patient should get "the best damn-looking nurse in Christendom"!). Corky tries to get Hancock to talk, but is interrupted when the nurse comes in and berates Hancock for being such a difficult patient. Corky is outraged and complains to the colonel, who then points out that Hancock, reacting to the nurse's diatribe, has roused himself, talked back, and begun to recover.
He tells Corky that in cases like this, kindness and sympathy don't work and that the best treatment is the provocation of anger. Corky accepts this, and decides to collaborate with the nurse by having all the men in the ward stage the loud singing of Christmas carols with bawdy new lyrics, ostensibly to irritate her. In the midst of this chaotic display of good spirits, we see "Old Ironpuss" listening to their spirited defiance, and then turn away, alone, weeping.
Atheist theologian and ex-priest, Bernard, takes a leave from his college in the grey, industrial town of Rummidge, UK, to escort his unwilling father, Jack, to Hawaii at the request of his elderly aunt, Ursula, who is dying of cancer. Bernard's domineering sister, Tess, is strongly opposed. To save on costs, they join a charter tour.
On the day of arrival, Jack is hit by a car and confined to hospital. Bernard spends many days traveling between his dad's bedside and Ursula's in an inadequate nursing home. The near-but-far separation between the aged siblings gives Bernard time and opportunity to discover their past.
The exotic, touristic "paradise" on earth and an affair with Yolande, driver of the car that struck his father, awaken Bernard to the sensual pleasures of existence. Ursula, always portrayed as the selfish black sheep, had been sexually abused as a child by her oldest brother Sean--venerated as a hero by the family for his death in the war. A lad at the time, Jack knew of the abuse.
With credible evidence and an impressive lack of self-pity, Ursula explains to Bernard that the experience ruined her marriage and her life. She wants Jack's apology. With the help of his sister and his lover, the newly secular Bernard brings about a reconciliation to the greater peace of all involved, including himself.
This novel is the fictionalized account of author Thomas Moran's real-life experience as a patient with disseminated chicken pox. During his five months in hospital, much of that time on a ventilator, Moran experienced "coma visions" and near death which he retells here through his alter ego, James Blatchely, a man who struggles to remain emotionally alive in spite of the virus's physical assault. Blatchely does this by observing, befriending, and then fantasizing a life for his two Irish nurses--Brigit who, he discovers, uses drugs to endure the pain she witnesses daily in Intensive Care, and Nuala, with whom he falls in love.
Through the depiction of Blatchely's erratic, inching descent toward death, readers gain visceral insight into a patient's encounter with critical illness--but the real heroes of this book are the nurses. We observe them through Blatchely's eyes, and they are the force that enables him to survive, if not in body, at least in mind. This beautifully written novel creates a world in which both patients and caregivers are fully human, bound together by their shared experience of the patient's illness and by the life the imagination enjoys when the body cannot.
The story takes place in the course of one night during the 1820's in the Australian outback. Carney, an Irish convict-turned-revolutionary, is scheduled for execution in the morning. Two soldiers guard him at the lonely outpost. An officer named Adair arrives to interrogate Carney, in the hope that he might betray his surviving comrades, especially Dolan, the leader of the insurrection.
The officer and the prisoner keep a vigil through the long cold night. Carney tells about his impoverished life in Ireland and his goal of achieving freedom for himself and his countrymen. Adair, too, is Irish. He remembers his own, more privileged life in Dublin.
The uneducated Carney asks, "Why is there so much injustice in the world?" Adair has no answer. At dawn Carney asks permission to wash in the stream before he is executed. The officer allows him to do so, and the convict presumably jumps on a horse and successfully flees. It is clear that Adair has permitted his charge to escape.
The writer describes her experience as a cancer patient, thrust into "the Land of the Sick" by the diagnosis and treatment of lung cancer four years earlier. Although she is not ill, the fear of mortality embedded in a diagnosis of cancer is a dragon that haunts her existence.
To cope with the dragon she relies on talismen: her doctors, personal will, and her garden peas, an emblem of everyday life and its constant renewal. The talismen create the semblance of control over her situation. She observes that "doctors and patients are accomplices in staging a kind of drama" and that the patient and her continued well-being become talismen for the doctor too.