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Dr. Cassell examines the social and cultural forces that encourage the practice and teaching of a medicine that is governed by the disease theory. This theory discounts the impact of illness on the patient and ignores the suffering that the patient is experiencing. Cassell does not debunk science and technology, rather he encompasses them within the moral enterprise of medicine as tools for helping patients.
The ability to provide compassionate attention to the patient as individual (i.e., with unique values, life experiences, family interactions, etc.), trustworthiness and self-discipline are required characteristics of a "good physician." Cassell illustrates and personalizes the philosophical shift towards focusing on the sick person with stories and anecdotes.
This autobiographical account of Dr. Lown's five decades of practice and research in cardiovascular medicine is both a history of the field and a history of a man passionately interested in people and healing. The book is divided into six sections: Hearing the Patient: The Art of Diagnosis; Healing the Patient: The Art of Doctoring; Healing the Patient: Science; Incurable Problems; The Rewards of Doctoring; and The Art of Being a Patient.
The first three sections comprise the bulk of the book: Lown chronicles his early medical training and career through stories of memorable patients, anecdotes about key role models (particularly Dr. Samuel A. Levine), and histories of medical mistakes, diagnostic acumen, and his remarkable research innovations. These achievements include the introduction of intravenous lidocaine, cardioversion and defibrillation, and development of the coronary care unit.
The core of the book, however, is about how deeply Lown cares for his patients. He states, “This book is a small recompense to my patients, ultimately my greatest teachers, who helped me to become a doctor.” The book contains many reflections on medical practice, such as this definition of medical wisdom: “It is the capacity to comprehend a clinical problem at its mooring, not in an organ, but in a human being.”
In a thoughtful chapter on death and dying, Lown muses on his emotional and spiritual responses to encounters with death, and bemoans the medical profession's increasing tendency to “put technology between us and our patients, to spare us the grief of failing to confront our own mortality.” In the final chapter, Lown takes an unusual twist, and writes a treatise to patients on how to get the doctor to truly pay attention to them and what are reasonable expectations to have of one's doctor.
Summary:A woman admitted to a hospital for cancer treatment describes her progressive loss of identity, from the trading of clothes for a hospital gown to her gradual hair loss. Feelings about the loss of hair (shame, embarrassment, nonchalance) reflect how she confronts the illness; in time, she is ready to face the world again.
Mother is set in the 1930's and deals with a woman's difficult life, low self-esteem, and sense of having inherited tragedy and misfortune from her mother. Even though she finally marries, and unexpectedly conceives long after her husband and she had given up trying, her outcome is destined to be unhappy. She goes into premature labor, and gives birth to a stillborn child.
When she finally wakes up, she is weak, and cannot remember anything about the delivery. Her paternalistic physician, her husband, and the hospital staff withhold from her the news that her child has died. One night, in her frustration and need, and believing that her child is in the nursery "in the basement," she searches the basement corridors for her child. Outside the morgue she begins to hemorrhage and despite the efforts of her physician, she dies.
Summary:Sea Creatures is Dr. Vernon Rowe's first collection and contains forty-eight poems divided into two sections: "Creatures of the Inland Seas" and "Out Far and In Deep." The poems are succinct and focused. Much of the imagery is derived from nature, as in the title poem, where the poet-neurologist-helicopter pilot likens his descent through the sky to a dive into a deep and ancient ocean. Poems in the first section are directly related to the poet's life as a physician; works such as "Paralyzed" "Brahms' First, First Movement" and "Wasted" are empathic portrayals of patients.
Summary:The Stone Diaries recount the life of Daisy Goodwill (1905-199? [sic]). "[W]ife, mother, citizen of our century," her son closes the benediction of her memorial service. Yet Daisy is also the orphaned daughter of an orphan--her dramatic birth a turning point for her father, the neighbours--and a social outcast. Daisy becomes a happy child, a lifelong friend, a college graduate, a consummate gardener, a cultivator of stories, a pragmatist, a romantic, a widow twice (once scandalously, once more ordinarily) . . . . In short, the diaries of "Day's Eye" bear witness to the extraordinary lives of seemingly ordinary "citizens."
A young man is traveling through France with a companion. They pass near a well-known "Mad House" and decide to visit. His companion introduces him to the superintendent, Monsieur Maillard, then leaves. The superintendent informs the young man that the hospital has given up the system of management it was famous for. Previously, patients were allowed complete freedom. The practice had finally proved too dangerous and Maillard promises to show the young man the alternative system he installed after dinner. He escorts the young man to a banquet table crowded with guests and laden with food.
To the visitor, the dinner guests seem rather mad as they take turns describing and then demonstrating the delusions of patients. But Maillard assures him that the lunatics are locked up; the guests are keepers. Maillard says the new system was invented by Doctors Tarr and Fether. He describes the dangers of the former system used. In one instance, he says, patients rebelled and imprisoned their keepers while they themselves enjoyed the wines and beauty of the grounds.
Suddenly, there is a crash at the boarded-up windows. The visitor thinks it is the escaped madmen. It turns out, however, to be the keepers who were indeed imprisoned by the madmen, tarred and feathered and kept on a diet of bread and water. Maillard, the former superintendent, had gone mad himself and organized the rebellion.
Laqueur writes about his experiences as a volunteer at the Home for Jewish Parents. The elderly he meets there have lived fantastically broad lives, many having fled from eastern Europe in front of the German armies of World Wars I and II. Laqueur explains how different their impressions of world events are from his.
He notes the variety of responses the residents have to their own aging process and that of others. Those who are still mobile and mentally alert avoid those who are not. Some residents cling to life and self-respect, others abandon it. Over all, Laqueur is reassured by his visits. If these people have made it this far through such a crazy century, certainly he, too, can go on.
In this long poem (47 quatrains), Annandale visits his doctor after years of absence and tells the doctor his story. When his wife Miriam died, he mourned her, "wept and said that all was done." Then he met Damaris, "who knows everything, / Knows how to find so much in me." Damaris, who became his second wife, comforts and accepts him. Even though sometimes "her complexities / Are restive" and she becomes angry, soon "She folds her paws and purrs again.
Annandale tells this story of late life happiness, then leaves the doctor's office. He never reaches home: "There was a sick crash in the street, / And after that there was no doubt, / Of what there was." In the last five quatrains, the doctor reflects on what he did for Annandale after the accident ("the one thing to do")--euthanasia.
This book offers an insightful, well-reasoned interpretation of the nature of medicine. Hunter, an English professor who teaches and coordinates humanities programs at a medical school, observed first-hand how an academic medical center functions--she joined various teams during their multiple rounds and conferences for two years. In sum, she "behaved rather like an ethnographer among a white-coated tribe." The resultant book details the profound importance of narrative in medicine.
Narrative is integral to the medical encounter, to communications by and about the patient, and to the structure and transmission of medical knowledge. For example, the patient's story is told to and interpreted by the physician, who then tells another story of the patient, in case format to other physicians, and records that story in a formulaic chart entry. Hunter observes that most of the rituals and traditions of medicine and medical training are narrative in structure, and explains why narratives such as cautionary tales, anecdotes, case reports and clinical-pathological conferences are central, not peripheral, to medicine. The thesis is further developed to maintain that, if the narrative structure of medicine is fully recognized by physicians, they will attend to their patients better and acknowledge the details and importance of their patients' individual life stories.