Showing 81 - 90 of 108 annotations tagged with the keyword "Physical Examination"

The Case of Dr. Sachs

Winckler, Martin

Last Updated: Nov-27-2002
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Novel

Summary:

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.

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Cut to the Word

Metcalf, Tim

Last Updated: Nov-12-2002
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

Tim Metcalfe is an Australian general practitioner who gave up medical practice to become a full-time poet and writer. A statement on the back cover summarizes the process in relation to this collection of 38 poems: " ’Cut to the Word’ is a moving account of one man’s transition from doctor to poet." He begins with the customary initiation: "We were introduced, respectfully, / to the volunteer dead . . . " (p. 13) He discovers the limitations and uncertainties of his new profession: "In tense moments / I wish my stethoscope / was all they want it to be." (p. 18) And the omnivorous demands of medicine: "I come home from work / and there it is: the family / the oldest crying / at the youngest crying / at her mother’s anger / at her crying . . . " (p. 21)

Metcalfe carries the reader through a series of short, incisive poems describing the doctor’s day-to-day work ("Morning Session, " pp. 47-50), as well as through a number of disturbing poems about the world of mental illness, but the book’s climax--so to speak--arrives with "The Doctor’s Complaint, " in which the physician heals herself "by laying down her stethoscope / and walking right out / of that in-patient clinic." At the end the poet writes, "Like a patient I have learned silence . . . Fine steel scissors in hand, / I cut to the word." (p. 63)

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The Anatomist

Andahazi, Federico

Last Updated: Oct-21-2002
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Novel

Summary:

This historical novel is set in 16th century Venice, where the great anatomist and physician Mateo Colombo has just been charged with heresy and placed under house arrest. The book proceeds in a series of short frames or fragments, presenting Colombo’s story from a wide variety of perspectives, ranging from the perspective of Mona Sofia, the most prestigious whore in Venice, to that of Leonardino, the crow who waits each morning to scavenge an eyeball or piece of flesh from one of the anatomist’s cadavers.

What is Colombo’s heresy? True, he has consistently violated the Papal Bull of Pope Boniface VIII that forbid obtaining cadavers for dissection, but his scholarly eminence and friendship with Pope Paul III have protected him from recrimination. His heresy is far worse than simply ignoring a Papal Bull; in fact, Mateo Colombo has discovered a dangerous new anatomical structure, the clitoris!

Mateo was called to the bedside of an unconscious holy woman named Inés de Torremolinos. In the process of examining her, the physician was amazed to discover "between his patient’s legs a perfectly formed, erect and diminutive penis." (p. 105) He took hold of the strange organ and began massaging it. As he did so, there was an amazing response in his patient: "(Her) breathing became hoarser and then broke into a loud panting . . . Her lifeless features changed into a lascivious grimace . . . " (p. 107) Subsequent research undertaken with Mona Sofia, the resplendent whore, as well as with cadavers, confirmed the significance of Colombo’s discovery.

At his hearing before the High Tribunal, Colombo explains his findings, which are far too complex and subtle to summarize (pp. 138-165). The finding of greatest interest, however, is that "there is no reason to believe that there exists in women such a thing as a soul." (p. 151) In fact, Colombo contends he has proven that the "amor veneris" or clitoris performs in women "similar functions to those of the soul in men, " although its nature "is utterly different since it depends entirely on the body." (p. 153)

You’ll have to read the book to discover what the verdict of the High Tribunal of the Holy Office was and Mateo Colombo’s fate.

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The Breast Cancer Wars

Lerner, Barron

Last Updated: Aug-28-2002
Annotated by:
Holmes, Martha Stoddard

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Written by a medical historian who is also a physician, The Breast Cancer Wars narrates how breast cancer diagnostic methods and treatments have developed from the early twentieth century. More significantly, the book describes the debates and controversies that permeated this evolution and the ways in which not only clinicians and researchers, but, increasingly, women patients/activists shaped how we view, diagnose, and treat breast cancer today.

Individual chapters explore the influential (and ultimately contested) radical mastectomy procedure of William Halsted, the development of the "war" against breast cancer as a full-blown campaign developed and conducted within the public media and consciousness of the United States as well as within medical practice and research, the intertwined development of feminism and breast cancer activism, the "fall" of the radical mastectomy, and the continuing controversies surrounding mammography and genetic testing as modes of early detection and risk assessment. Lerner draws on a range of primary sources including texts from the archives of the American Cancer Society, the papers of doctors and patients, and advertisements from popular and professional magazines throughout the century.

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The Use of Force

Williams, William Carlos

Last Updated: Mar-05-2002
Annotated by:
Aull, Felice

Primary Category: Literature / Fiction — Secondary Category: Literature / Fiction

Genre: Short Story

Summary:

A physician is summoned to make a housecall on a family with whom he has had no prior contact. He quickly sizes up the situation: the household is poor but clean; the patient is a female child whose parents are nervously concerned, dependent on, yet distrustful of the doctor. The child's beauty and penetrating stare make an immediate impression on him.

Concerned that diphtheria may be the cause of illness, he uses his customary professional manner to determine whether or not the child has a sore throat. But the child will have none of it and "clawed instinctively for my eyes." The attempt at an examination rapidly escalates into a physical "battle" as the physician, convinced that it is crucial to see the child's throat "and feeling that I must get a diagnosis now or never," becomes ever more enraged and forceful while the girl continues to resist with all her strength, and the parents are in an agony of fear for her health and embarrassment over her behavior.

This is no longer a professional encounter. The doctor admits at the beginning of the struggle to having "fallen in love with the savage brat" and recognizes that he is behaving irrationally. The closing sequence could as easily be depicting a rape as a forced throat examination.

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Washing Your Feet

Ciardi, John

Last Updated: Mar-05-2002
Annotated by:
Aull, Felice

Primary Category: Literature / Poetry

Genre: Poem

Summary:

From the mundane to the profound, from the body as physical preoccupation to the body as sacred, the poet explores in 21 highly personalized lines the significance and symbolism of the human body. Washing your feet without giving it a thought means you are in good health; struggling to do it because of overweight is a reminder of mortality. This (any) physical act "should be ritual . . . memorial, meditative, immortal." It conjures up an image of the Degas ballet dancers washing their feet, and then, remarkably, that " . . . they also seemed to be washing God’s feet."

But the creative power of Degas is yet another reminder of the author’s limitations. He is vulnerable, mortal and not creative enough to gain immortality by producing a masterpiece: "It is sad to be naked and to lack talent."

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Baptism by Rotation

Bulgakov, Mikhail

Last Updated: Aug-22-2001
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

A young doctor, recently assigned to a country hospital, is fraught with anxiety, especially over his lack of experience with obstetrical problems. One night the midwives call him; a woman is having a difficult labor. The fetus is presenting in a transverse position. The doctor must reach internally and “turn it around by the foot,” as Anna Nikolaevna, the seasoned midwife, reminds him.

The doctor has never performed this procedure. He buys time by going back to his room to consult the textbook (under the pretext of going for cigarettes). Finally, he can't avoid it any longer. He performs the rotation. It works! Both mother and baby are saved.

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Fine?

Haddix, Margaret Peterson

Last Updated: Aug-13-2001
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Fiction

Genre: Short Story for Young Adults

Summary:

The story begins as an MRI technician assures Baily that "Contrary to popular opinion, . . . this is not a torture device." The test was ordered because her arm suddenly went numb and she suddenly lost most of her vision during algebra class. With no idea what's wrong, Baily speculates about the possibility of a brain tumor, about how disease will change her life, about early death. She is uncomfortable with her mother's cheery reassurances, which consist mostly of simple theories like the possibility that Baily was reacting to missing lunch, but wants them, nonetheless.

Since the pediatric wing is full, she is put in a room with an old woman for observation overnight. The nurse runs her through a series of highly irrelevant questions about her physical health from drug use to dentures. Then her mother is required to leave for the night. In the morning they take her for an EKG before her mother can get there; Baily returns to her room in a state of morbid conviction that she's dying, which is finally overturned when the doctor comes in to explain to her that she had a classic case of severe migraine.

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Complaint

Williams, William Carlos

Last Updated: Jul-05-2001
Annotated by:
Nixon, Lois LaCivita

Primary Category: Literature / Poetry

Genre: Poem

Summary:

The narrator describes a housecall to a woman in labor. It is past midnight in winter time when the road is frozen. The doctor enters the house where the "great woman" is in misery; she is "sick," "perhaps vomiting," about to give birth to her tenth child. He exclaims to the reader "Joy! Joy!" knowing that the situation is as bleak as the wintry landscape, and, in fact, joyless. He will offer compassion and "pick the hair from her eyes."

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August

Young, C. Dale

Last Updated: May-31-2001
Annotated by:
Shafer, Audrey

Primary Category: Literature / Poetry

Genre: Poem

Summary:

August is divided into two sections: "On the Corner of Fourth & Irving" and "To Marie Curie." The narrator, on a street corner in San Francisco near the teaching hospitals and medical school of University of California, San Francisco, meditates on the recurrence of lymphoma in a patient. Evening is approaching, fog blows in from the ocean, and the city pigeons are unsettled--landing and taking flight.

The meditation includes a tribute to Madame Curie and her discovery of the effects of radium. The patient had had a good chance of cure by radiation treatment--unfortunately, this patient is in the twenty percent who are not cured. The narrator, probably a physician-in-training due to the load of textbooks, had read the patient's chest x-ray as negative (normal) previously.

By the end of the poem, we learn that the physician had felt enlarged lymph nodes in this patient's neck today and he bluntly states: "I have failed. He has not been cured." The poem closes with the sound of the wind and the "beating and beating of wings."

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