Showing 81 - 90 of 246 annotations tagged with the keyword "Medical Education"

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Suzanne Poirier has studied over 40 book-length memoirs describing medical training in the United States. These texts vary in format from published books to internet blogs, in time (ranging from 1965 to 2005), and in immediacy, some reporting during medical school or residency while others were written later--sometimes many years later.

A literary scholar and cultural critic, Poirier analyzes these texts thematically and stylistically, finding pervasive and regrettable (even tragic) weaknesses in medical education. Her three major points are these: such training (1) ignores the embodiment of future doctors, (2) is insensitive to the power relationships that oppress them, and (3) makes it difficult to create a nurturing relationship--especially by tacitly promoting the image of the lone, heroic physician.

While some of these repressive features have improved in the last decade or so--in contrast to the momentous scientific progress--there is a general failure to deal with the emotional needs of persons in training as they confront difficult patients, brutal work schedules, and mortality, both in others and in themselves.

In her conclusion, Poirier describes some contemporary efforts to help medical students write about their feelings, but she also sees the negative consequences of "an educational environrment that is inherently hostile to such exercises" (169).  Her challenge is this: " "Emotional honesty is a project for all health professionals, administrators, and professional leaders" (170).

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The Hospital for Bad Poets

Hallman, J. C.

Last Updated: Jul-09-2009
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

Two months after he starts writing poetry, the narrator collapses. The maid finds him on the floor. An ambulance arrives at the scene. Two EMT's - Mike and Bob - check the condition of the novice poet. Their assessment includes the patient's orientation, his chief complaint, his favorite form of poem (the sonnet), and the last time he used iambic pentameter. Mike reads the poet's unfinished villanelle that remains stuck in a Smith Corona typewriter. The EMT deems it awful. The ambulance crew generates a list of possible diagnoses that includes an aneurysm in the language center of the brain and (more plausibly) writer's block. The duo decide that the narrator requires evaluation in the hospital for bad poets. All of their ambulance patients receive supplemental oxygen during transport. Every poet additionally gets a copy of verse by Rainer Maria Rilke to read during the trip.

The hospital for bad poets is a teaching hospital. A swarm of medical students participate in the evaluation of the narrator. His working diagnosis is "chronic acuteness." A young physician, Dr. Krupp, takes charge of the case. He also reads the narrator's incomplete poem and agrees with the opinion of Mike the EMT. The poem stinks. Dr. Krupp listens to the narrator's breath sounds and commands him to recite poetry during the examination. The physician announces, "Poetry is the equivalent of ventilation. Poets breathe for one another, they breathe for all of us" [p 147]. Dr. Krupp decides that the narrator's problem is serious enough to warrant hospital admission for one week's worth of observation. The doctor then scurries off to treat another poet whose situation is much more serious than the narrator's.

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Born in 1921 in Belarus (White Russia), the author lost his father (a doctor) as a baby and was raised by his mother who worked as a surgical nurse and midwife. He excelled in school and was on the verge of entering medical school, but the political upheaval of World War II drew him away from studies.
 
Drafted to serve in the Polish army, the eighteen year-old became a sergeant in charge of a platoon by June 1939 fighting against Germany along its border with Poland. Three months later he was captured and imprisoned in cruel conditions. By November, he escaped and began a long walk home, helped by strangers, only to find that the Soviets had taken over. Arrested again, this time for being anti-Communist, he spent January to June 1941 in a Soviet prison, and narrowly avoided execution when the Russians retreated at the German invasion of Minsk. Another return home was met with the tragic news that his mother had been killed when German bombs hit the hospital in which she worked.

Enraged by the succession of destructive invaders, Ragula helped create a nationalist freedom army, the Eskradon, ironically with German support, and a Bulletin to inform citizens and lobby for better conditions. By the time World War II drew to an end he was married to Ludmila (in 1944) and on the move, seeking a medical education.

As refugees, the couple moved to Marburg, Germany in 1945, where Ragula began medical school. But money was always a problem and the post-war restructuring of Europe made them fearful. Hearing of a program for refugees in Louvain, Boris entered Belgium illegally in 1949 and finally completed his medical degree in 1951 at age thirty-one. In 1954, the couple settled in the medium-sized town of London Ontario, Canada. There Ragula interned and set up a family practice. He and Ludmila raised their family of four in peaceful security that contrasted starkly with their own upbringing.

Precocious in promoting health, Ragula campaigned tirelessly against smoking, inactivity, and overeating, and he worked in aboriginal communities, convinced that a doctor's role was to prevent disease as much as it was to treat it.  Here too he found enemies and friends.
 
In 1963, Ragula was involved in a non-related kidney donation between patients-a selfless act that touched him deeply. For him, it represented the pinnacle of scientific achievement and epitomized how humans should care for one another.

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Summary:

John Romulus (also known as Richard) Brinkley was a physician (in the diploma-mill sense of the word) who, in 1917, pioneered, in the U.S. at least, the notion of goat testicle transplant. "Transplant" must be understood in the loosest sense of the word since Brinkley simply removed the testicles from young goats and sewed them into the abdominal wall and scrotal tissues - without any attempt to connect blood or nervous tissues of either goat testicles or human  - of men for the alleged purpose of relieving impotence. From 1917 until his downfall at the hands of Morris Fishbein, a medical crusader esconced in the AMA, which organization Dr. Fishbein helped establish as the premier advocate of organized medicine in the U.S., Dr. Brinkley was perhaps the most recognizable physician in the U.S.

He ran for the office of Governor of Kansas in 1930 (losing by technicalities that today would have overturned the results), and established the most powerful radio station in the land, XERA, that promulgated his glandular chicanery all across the continental U.S. As a proponent of such skullduggery, Brinkley was continually in the sights of Dr. Fishbein, whose main reputation nationally was as an exposer of medical fakery. Eventually Fishbein lured Brinkley into a libel trial that resulted, in 1939, in the catastrophic downfall of an immensely talented and wealthy man who spiraled into bankruptcy and death in 3 short years.

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Annotated by:
Bertman, Sandra

Primary Category: Performing Arts / Film, TV, Video

Genre: Video

Summary:

Filmed at Shands (teaching) Hospital in Florida, this documentary validates the importance of the arts and expressive therapies in all aspects of health care, including medical education. Pediatric oncologist John Graham-Pole and poetry therapist John Fox -often as a team- work with patients of all ages in groups and at the bedside.   Other physicians including a neuroscientist provide rational explanations of the release of endorphins and brain changes resulting from creative activities.  Though the healing process initiated by the reflective act of writing poetry is ostensibly the focus of the film, the documentary is permeated with the transforming effects of dance and art therapies in their ability to lessen physical and emotional pain; the importance of healing environments, not just paintings in lobbies, but in patient created ceiling tiles and wall installations; and especially the warmth, intimacy and humanity generated by exemplary physician communication skills.

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Cutting for Stone

Verghese, Abraham

Last Updated: Mar-08-2009
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Ethiopia, 1954. Twin boys conjoined at the head survive a surgical separation and a gruesome C-section delivery. Their mother, Sister Mary Joseph Praise, does not. The Carmelite nun, a native of India, dies in the same place where she worked as a nurse - the operating room of a small hospital in Addis Ababa. The facility is dubbed Missing Hospital, and it is staffed by some remarkable people.

Thomas Stone is a British general surgeon. The only thing that he loves more than medicine is Sister Praise. When she dies during childbirth, he has a meltdown - abruptly fleeing the hospital and leaving Africa. Although Thomas Stone is the father of the twins, he blames the babies for the nun's death. Decades later, he is working at a prestigious medical center in Boston where he specializes in hepatic surgery and research on liver transplantation. The twins are raised by two physicians at Missing Hospital - Dr. Ghosh and Dr. Hemlatha (Hema) - who get married. Hema is an obstetrician-gynecologist. Ghosh is an internist who becomes the hospital's surgeon by necessity after Thomas Stone departs.

The fate of the twin boys, Marion Stone and Shiva Stone, is sculpted by their experiences at Missing Hospital and the growing pains of Ethiopia. The African nation is full of possibilities and mayhem. Both boys are highly intelligent and unusually bonded. Shiva is eccentric and empathic. Although he never attends medical school, Ghosh and Hema train him. Shiva becomes a world authority on treating vaginal fistulas. Marion narrates the story. He is repeatedly hurt by love. The girl of his dreams, Genet, opts to have her first sexual encounter with Shiva. Genet plays a role in hijacking an airplane and rebels against the Ethiopian government. Although innocent, Marion comes under suspicion because of her actions. He escapes the country for his own safety.

Like his father, Marion lands in America. He completes his residency training as a trauma surgeon in New York. He locates his biological father but reconciliation is difficult for both men. Genet has also come to America. She shows up at Marion's apartment, and they have sexual intercourse. Genet exposes him to tuberculosis and Hepatitis B. Marion delevelops liver failure due to hepatitis. He is going to die. Shiva and Hema travel to New York to be with Marion. Shiva proposes an experimental treatment for his brother - a living donor liver transplantation. After all, there is no better organ donor than an identical twin. Thomas Stone performs the operation along with one of Marion's coleagues. The surgery is successful. Then Shiva has bleeding in his brain and dies. Marion returns to Ethiopia and Missing Hospital. Half a century removed from his birth, Marion is back at home and still conected to his twin brother. The lobe of liver donated by Shiva is functioning perfectly.

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Summary:

This survey of the history of women in medicine begins in the mid 19th century and moves forward to the late 20th Century.  The twelve historical studies are divided by the editors into three sections, largely chronological.  The first section focuses on the 19th century women best known for their breakthrough into the male bastion of regular medicine in America.  There is, in addition to the more traditional studies, a look at the role of a Chinese woman physician in Progressive Era Chicago.  Section two takes the reader into the early 20th century Womens' Health Movement, including a fresh look at the narrative forms of Our Bodies, Ourselves.  Section three examines the mid-late 20th century position of women in American medicine and an interesting discourse on the impact of Western women physicians on issues of childbearing in Asia during the early part of the same century.

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Beat the Reaper

Bazell, Josh

Last Updated: Jan-26-2009
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Pietro Brnwa, nicknamed "The Bearclaw," has embraced change - a new name, a different occupation, and a regenerated outlook. Thanks to the Federal Witness Protection Program, Pietro, who was formerly employed as a hitman by a mafia-connected lawyer, is now Dr. Peter Brown, an intern in the Department of Internal Medicine at Manhattan Catholic Hospital. His career as an assassin was motivated by the desire to avenge the murder of the grandparents who raised him. As a physician, Dr. Brown is paying off a moral debt - doing good deeds to atone for previous acts of violence including killing people.

Unfortunately, life doesn't get any easier for the hit man-turned-physician. Trouble stalks him and finds him. Everyone he loves is lost. In addition to the death of his grandparents, Dr. Brown's girlfriend, Magdalene, is gunned down in a car. His former best friend, "Skinflick" is thrown out of a window of a six-story building, survives, and is later stabbed to death by Dr. Brown.

Life might have been easier if Dr. Brown had not been recognized by a mafia acquaintance named Nicholas LoBrutto who is a patient in Manhattan Catholic Hospital. LoBrutto has stomach cancer and threatens to squeal to Dr. Brown's former crime boss. If Dr. Brown cannot keep LoBrutto alive, the mafia will be notified where to find the physician and he will be eliminated. Dr. Brown assists during LoBrutto's surgery but the mobster experiences ventricular fibrillation postoperatively. Dr. Brown's two medical students mistakenly administer intravenous potassium and LoBrutto dies.

A group of thugs quickly infiltrate the hospital and it appears likely that Dr. Brown will be exterminated. He risks his life to prevent a young woman from having her leg amputated for an erroneous diagnosis. The thugs capture Dr. Brown and detain him in the blood bank freezer. He removes a piece of bone from his own lower leg (an autofibulectomy) to use as a weapon and proceeds to kill the entire gang of murderers. Dr. Brown is sure to be dismissed from Manhattan Catholic Hospital but realizes there is still much he hopes to accomplish as a physician. With some help from friends in the Witness Protection Program (and a likely sequel to this novel on the horizon), it's a good bet that Dr. Brown is not likely to retire his stethoscope (or firearms) anytime soon.

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The film opens with the discovery of Dr. Victor Frankenstein's will in his Transylvanian village. A skeleton, presumably Dr. Frankenstein's, and a man wrestle for the box holding the will. The man wins, takes it to a town meeting where the will is read and calls for the transfer of the property to the dead scientist's grandson, Frederick. Following this scene we meet the grandson, Dr. Frederick Frankenstein (Gene Wilder), a surgeon who is busy instructing medical students in clinical neuroanatomy (comparing the brain to a cauliflower). When asked about his grandfather by a medical student, Freddy, who pronounces the family name "Fron kon steen", declares that Victor was "a cuckoo". The student is relentless in pursuing the family ties, exasperating Freddy, who finally plunges a scalpel into his thigh, a sight gag paying homage to Peter Sellers' stabbing himself with a letter opener in A Shot in the Dark (1964). When the courier from Transylvania arrives, he persuades Freddy to return to his ancestral castle for the execution of the will. A hilarious railroad platform scene in which Freddy bids goodbye to his "beautiful, flat-chested" (as described in the online original etext of the script by Gene Wilder) fiancée, Elizabeth (Madeline Kahn), only highlights the incredibly neurotic natures of the two lovers -- Wilder as a possessed but wacky scientist and Kahn as a narcissistic and apparently remote and shallow woman.

In Transylvania, Freddy and the viewers meet the remainder of the major characters. Inga (Teri Garr), a bosomy and mindless but beautiful and dedicated blonde, escorts him to the castle, where he meets the hunchback Igor, played by the incomparable Marty Feldman, who instructs Freddy, with one of the lines all Young Frankenstein addicts love to quote, to "walk this way", by which he means with a limp and a cane, not directions to anywhere at all. After remarking that the huge castle doors have huge knockers (which they do) -- which Teri Garr winsomely mistakes for a compliment on her equally huge knockers -- Freddy and his entourage enter the castle and meet Frau Blücher (played magnificently by Cloris Leachman), the spinster who keeps the castle, nourishing an undying flame for Freddy's dead grandfather. Soon Freddy and Inga discover, by means of a secret passageway behind a  -- surprise! surprise! -- revolving bookcase wall in Freddy's room, his grandfather's hidden subterranean laboratory (Brooks used the same electrical apparatus as the 1931 Frankenstein film) and scientific journals. With the materials and methods now at hand, Freddy undergoes a spiritual transformation, embracing his forebear's obsession with creating life from dead bodies, rejecting his earlier rejection of Victor's work as "Doo-Doo!".

At this juncture we move into the scientific creation mode and of course meet the Monster, exuberantly portrayed by the talented Peter Boyle. When Igor tries to steal a brain from a neighboring morgue there occurs the infamous mix-up of an "Abnormal" brain (labelled "DO NOT USE THIS BRAIN!") for the intended brain of H. Delbrück ("the finest natural philosopher, internal medicine diagnostician and chemical therapist of this century" and also the author of 17 cookbooks) making at least this viewer wonder if Mel Brooks had in mind a real scientific genius, Max Delbrück, who had received, only 5 years before, a Nobel Prize in Physiology or Medicine in 1969 for his work on bacteriophages.

The predicted spoofs ensue: the actual process of transforming the very large corpse of Peter Boyle into the very large body of the living Monster (with Inga remarking, after Freddy states that for the experiment to be a success, the monster must have enlarged body parts, that he "vould have an enormous schwanzstucker" -- a pseudo-German/Yiddish word that everyone in the audience immediately comprehends); the inclusion of Gene Wilder's rendition of the legendary exclamation, "It's alive!" by Colin Clive in the 1931 Frankenstein; the monster's mercurial disposition; the wildly comic scene with the Monster meeting the Blind Man (Gene Hackman); the Monster's fascination with music and antipathy to fire -- they all give rise to set pieces of Brooks's unique mix of lowbrow comedy with intellectual puns, Yiddish asides and the ubiquitous combination of visual and physical jokes.

After Elizabeth unexpectedly arrives in Transylvania we witness an apparently unlikely, and therefore uproariously believable, liaison with the Monster outside the castle, with Madeline Kahn eventually taking on the classic Marge Simpson type hairdo of Elsa Lanchester in the 1935 Bride of Frankenstein. The last important scene before the ending involves Freddy nostalgically summoning the Monster back to his natal castle for a transference of Freddy's calm brain to the Monster's. The ending, with the Monster a fully acculturated and now sophisticated man about town, and with Freddy and Inga still in love in Transylvania, is a brilliant win-win result for Freddy, Inga, Elizabeth and the Monster, although hardly predictable. Without giving away too much of the denouement, suffice it to say that the movie ends on a high note transforming, as it were, a linguistic pun into a musical one.

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Something for the Pain

Austin, Paul

Last Updated: Sep-29-2008
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

After several years as a firefighter, Paul Austin decided to return to school and become a doctor.  Both his training as firefighter and a somewhat late start at medical school gave him an unusual perspective on his selected specialty-emergency medicine.  The book chronicles a wide variety of surprises, learning moments, and challenges from his years in the emergency room.  These are interspersed with vignettes about the interrupted home life of an emergency physician rotating into night duty three to four times a month.  The pace is lively and the stories confessional in the best sense-rich with reflection on what he has learned, often at great cost to his resilient wife and three children, one with Down syndrome.  A strong theme in the book is the importance of developing strategies for sustaining humanity and compassion even under intense pressure to be quick, clinical, and detached. 

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