Showing 801 - 810 of 825 annotations tagged with the keyword "Communication"
This collection of vignettes follows the growth and development of one internist as he reflects on some of the critical experiences that shaped him as physician. The common thread of the work is the celebration of the relationship that can, and perhaps should, be built between the physician and his or her patient in the course of caring: this relationship is the sacred space of the title.
The author accomplishes his self-imposed task of describing this space by presenting situations in his practice life that illustrate the concept. The chronological structure of the collection enables the reader to study the maturation of the author as a self-reflective practitioner over the many decades of his professional life. Many of the stories are very funny; others are wrenching; all are gently told.
Laurence "Tubby" Passmore is a successful scriptwriter for a television sitcom, in his mid-fifties, married and the father of two grown children. He is indecisive and inexplicably depressed, unhappy with himself, his fat body, bald head, wonky knee, and impending impotence. At least, he is confident in his marriage to Sally, an attractive, self-made academic who enjoys sex; on weekly jaunts to London, he maintains a supportive but platonic relationship with the earthy Amy.
Seeking to alleviate his woes, he dabbles in acupuncture and aromatherapy and regularly attends a blind physiotherapist and a woman psychiatrist; the latter counsels him to write a journal. His wife suddenly announces her wish for a divorce and the television network invokes a contractual obligation to make unwelcome demands on his skills. These events shatter his unappreciated but complacent "angst" and deepen his identity crisis.
Laurence scrambles to rediscover himself. He reads the gloomy, Kierkegaard--because he identified with the titles--and he travels to the existentialist's Copenhagen. He pushes the boundaries of his relationship with Amy in a maudlin trip to Tenerife. He befriends a philosophic squatter, called "Grahame" (with an "e" no doubt to distinguish him from Graham Green whose "writing is a form of therapy" is an epigraph to this book). He flies wildly off to Los Angeles hoping to rekindle a one-night stand "manqué." Finally he recalls and tracks the Irish Catholic, Maureen, his first girlfriend from forty years before. Maureen has suffered too--the death of her son and breast cancer; he finds her on the Road to Compostella.
Summary:Canadian artist, Robert Pope (d.1992), devoted the last years of his short life to documenting his decade-long experience as a patient with Hodgkin's Disease. Shortly after his diagnosis he was influenced by the 1945 autobiographical novel of Elizabeth Smart, By Grand Central Station I Sat Down and Wept. Pope's early work explored the interconnectedness and pain of individuals bound by an imperfect love, in Smart's case for a married man. After his disease went into remission, he began to paint the patient's perspective on illness, hospitals, visitors, family, and health-care providers in a series of images that suggest the lighting of de la Tour, the photographic immediacy of Doisneau, and the menacing surrealism of de Chirico. His book, Illness and Healing: Images of Cancer (1991), became a bestseller.
An intern in internal medicine is frustrated by his weekly clinics; he seems unable to understand why most of his patients come to see him, why they seem happy when they leave, and wonders when he is going to have the chance to do "real" medicine, such as ordering tests and making sophisticated diagnoses. One day, he sees an elderly woman who had been worked up over the years for "heart pain" without finding a diagnosis. In the past she had seen other residents for no discernible reasons.
At this visit, the author recognizes that she seems upset, encourages her to talk, realizes that she reminds him of his grandmother. The woman reluctantly admits she has fallen in love with a younger man. The resident is respectful towards her, and recognizes the beautiful woman she had once been. He begins to realize that she has experienced much that he hasn't, and that she has much to teach him about life and about being human.
A surgical intern has participated in 86 year old Mrs. Byrnes's abdominal surgery, where extensive metastases from ovarian cancer are found. The surgeons take biopsies, confirm the diagnosis, and close her abdomen, knowing that her case is not treatable. Later that day, it falls to the intern to inform Mrs. Byrne of what they found.
The author describes how he avoided the task, finding other chores to do, appealing to the attending physician to not make him talk to the patient. The attending insists, and the author finally finds the nerve to talk with his patient. Much to his surprise, she has already suspected that she has cancer, tells him not to be upset, and assures him he did his best. The author discovered that learning to be a doctor meant being open to learning from his patients.
The physician author is puzzled about what he can do to help a young woman who comes to him for treatment of her chronic abdominal pain. She has had every test, seen every specialist, and has no clear diagnosis. Only on the third visit, which she has initiated, does he discover that she was sexually assaulted at age 14. He is the only person she has told.
He immediately feels out of his element, and asks her to see a psychiatrist. She refuses, and insists he handle her care. He sets up open-ended visits to allow her time to talk, and looks for help in the medical literature and from a psychiatrist colleague.
Over time, as they explore her feelings and experiences, his patient gains self esteem and transforms herself into a confident, beautiful woman, planning on travel, school, and career. After her last visit with him, he realizes, "I had been chosen to receive a gift of trust, and of all the gifts I had ever received, none seemed as precious."
A woman, Rose, describes her childhood during the depression as she struggled with issues of her own identity and her jealousy toward her younger sister, Sophie, who suffers from cerebral palsy and seizures. Rose watches as Sophie is born, as her parents argue, as Sophie is held closely by their mother during her seizures, and as Sophie is given two birthday parties each year. She fantasizes about how life might be if her sister were dead, and imagines her sister hanging from a rack like the animals at the slaughterhouse. Finally, she discovers that Sophie actually needs her and loves her.
The narrator, now a grown man, relates the story of his brother Del's troubled life and early death. The real story, however, concerns the narrator himself, as he reflects on his relationship with Del, his father's behavior toward both of them, and on the possibility that he (the narrator) played a role in Del's death.
When the narrator was fourteen, older brother Del--drunk at the time--was struck and killed by a train as he walked along the tracks. But the central event in the story is the narrator's betrayal of Del. Although Del had saved him from falling off a grain elevator roof, the narrator had falsely blamed Del for the near-fatal accident, out of fear of the father's fury, and because "After years of being on the receiving end, it wasn't in my nature to see Del as someone who could be wronged . . . ." [p. 57]
"My father had good reason to believe this lie . . . . " [p. 55] The incident occurred shortly after Del had been released from a juvenile detention facility--detained there for trying to strangle the narrator and threatening their father with a shotgun.
The narrator (later) finds in Del's notebook an essay revealing Del's intention to reform. But with the passage of time after the grain elevator episode, Del reverts to delinquent behavior; a year later he is dead. The narrator never reveals to his father the truth and the family never discusses Del's death.
At times, over the years, as the narrator searches for meaning and closure he believes he can "take all the loose ends of my life and fit them together perfectly . . . where all the details add up . . . ." [p. 68] In the end, however, we are left wondering whether this is possible--for the narrator--or for anyone.
This first novel is written in English by a native Indian who makes her home in India. It is the tale of Esthappen (Estha for short) and his fraternal twin sister, Rahel, and their divorced mother, Ammu, who live in the south Indian state of Kerala. Ammu, a Syrian Christian, has had no choice but to return to her parental home, following her divorce from the Hindu man she had married--the father of Estha and Rahel.
The story centers on events surrounding the visit and drowning death of the twins' half-English cousin, a nine year old girl named Sophie Mol. The visit overlaps with a love affair between Ammu and the family's carpenter, Velutha, a member of the Untouchable caste--"The God of Loss / The God of Small Things." (p. 274)
Told from the children's perspective, the novel moves backward from present-day India to the fateful drowning that took place twenty-three years earlier, in 1969. The consequences of these intertwined events--the drowning and the forbidden love affair--are dire. Estha at some point thereafter stops speaking; Ammu is banished from her home, dying miserably and alone at age 31; Rahel is expelled from school, drifts, marries an American, whom she later leaves. The narrative begins and ends as Rahel returns to her family home in India and to Estha, where there is some hope that their love for each other and memories recollected from a distance will heal their deep wounds.
In the past, the father has tried to help the child cope with earache by showing him how the ear works, providing a visual image of the ear's anatomy from the encyclopedia. It didn't help the pain. Now that the father is chronically ill, his adult son tries to help, but cannot (even with an encyclopedia that purports to contain the entire world) produce a visual image, or metaphor, to explain the illness, or "what brought us here." Instead, he gives his father a Walkman, hoping that the music will "help him pass the hours in dialysis."
The son can see his father's blood, circulating in the dialysis machine (just as the father helped the son visualize what was happening in his sore ear), but the son cannot feel (or see, or hear--or, even though he's a poet, find a metaphor to convey) what it is like to be his father. This isolation is ironically emphasized by the son's gift: because of the Walkman, the father falls asleep "to a music I can't hear / And for which there is no metaphor."