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A Diary Without Dates

Bagnold, Enid

Last Updated: Oct-24-2013
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

"A Diary Without Dates" is Enid Bagnold's World War I memoir of her experiences over roughly a year and a half as a member of the V.A.D. (Voluntary Aid Detachment), or what we would today call a nurse's aide. Assisting the Sisters (both lay and religious nurses), the author attended to the day-to-day (mostly non-clinical) needs of wounded soldiers (almost entirely British) recovering from often horrific wounds in the Royal Herbert Hospital in Woolwich, 8 miles southeast of London. These poor men often stayed in the Royal Herbert for many months. It is a slim volume which the author wrote at the age of 28 and published in 1918. Divided into three arbitrary divisions ("Outside the Glass Doors", "Inside the Glass Doors", "'The Boys ...'") of roughly equal content (the last devotes, on the whole, more detail to individual "Tommies", referred to as "The Boys"), the book recounts the author's observations and fairly critical views of the relationships between nurses, physicians, V.A.D's, and visitors. Apparently the book was not well received by war authorities, leading to Bagnold's dismissal from her position.

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Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Each chapter in this book explores the forms and effects of humor in healthcare, mostly in hospital settings, beginning with a touching account of a person who worked as a hospital clown, visiting patients, enlivening staff, haunting the halls of a hospital where she became a beloved and important reminder that the disruptions of illness can be reframed in ways that make them more tolerable and bring patients back into communities from which they often feel exiled.  In subsequent chapters Carter, who himself went through cancer treatment, and writes from that experience as well as from his experience as a volunteer in an ER, draws from his compendious collection of medical jokes and stories to provide examples of the kinds of humor that help nurses and doctors, as well as patients and their families, get through the days.  Some of it is edgy and ironic, some broad and slapstick, some wordplay that helps to domesticate the often alienating discourse of clinical medicine.  His point is to provide some analytical categories and ways of understanding the kinds of humor that can be helpful-not simply to share a collection of jokes and stories, but the book does, especially in the final chapters, provide a sizeable collection of those, ranging from puns (including what he calls "groaners") to patient stories that in various ways turn medicine on its head.

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Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

The pediatrician-author of this autobiography was the first Jewish professor of medicine at the prestigious McGill University.

Born in Montreal in 1890, Alton was an only child whose immigrant father was an itinerant merchant with somewhat shady dealings. The shy boy developed hemoptysis and was sent away from home and family to the healthier air of Denver on the erroneous suspicion of tuberculosis.

He overcame shyness and found an ability to speak in acting and “declaiming” passages from Shakespeare. Literature remained a lifelong passion. Notwithstanding the quotas on Jewish students, he attended McGill medical school, followed by residency in the United States where he encountered many luminaries of twentieth-century pediatrics.  

Upon his return to Montreal, he confronted entrenched anti-semitism, but was instrumental in founding the Jewish General Hospital and a children’s hospital. He witnessed exciting medical discoveries and, like many other pediatricians, championed initiatives for child health that relied on social intervention.

The book closes with a few case histories of small patients, many of whom fell ill because of parental and societal ignorance.

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Annotated by:
Willms, Janice

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

The writer opens the volume by discussing the ways in which the poetry created by the affected person differs from the narrative form of describing the experience of illness—the classic “pathography.”  The essays in the collection demonstrate, by using examples, some of the unique qualities of the poem as an alternative to a prose narrative progression as well as the ambiguities introduced by the language of poetry. The discussions of the poetry presented provide the reader with guidance to the acceptance of poems in their “own terms” in order to understand the poet’s internal sense of the meaning of illness.  By allowing new and different information to become available for consideration the careful reader may gain new insights into the lives of those who are ill or disabled.

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Summary:

The great French actress Sarah Bernhardt (1844-1923) conducted an affair with her doctor, gynecologist Samuel Pozzi (1846-1918) in the decade before he married. They remained friends, and she always called him her Docteur Dieu (doctor god).

The handsome physician was a leading light in French gynecology and in the Paris arts community. Clad in his red dressing gown, Pozzi was the subject of John Singer Sargent's wonderful portrait (1881), which spawned erotic legends about him.

At first happy, Pozzi’s marriage degenerated into coldness, but his wife would not grant him a divorce. He then established a long-standing, public relationship with Emma Fischhof. During the Dreyfus affair, which unmasked the horror of entrenched anti-Semitism in France, physician and actress both fought against the ill treatment of the Jewish officer.

In 1915 and at Sarah’s insistence, Pozzi amputated her painful leg. Three years later, he was shot and killed by a disgruntled and delusional patient who blamed him for a minor illness.

 

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Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

The author was the first blind physician to be licensed in Canada. Her autobiography is also an autopathography.

From her anger over developing severe diabetes as a teenager, through her relentless pursuit of a scientific degree and medical school, through a brief failed marriage – followed by the tragedy of completely losing her sight while still in training, to a rewarding and responsible career as a palliative care physician and educator.

Sustained by her religious faith and by loyal family members and friends, Poulson explains choices, compromises and supports that allowed her to continue studying and working in Montreal and later in Toronto.

Her complications from diabetes were numerous, and included heart disease for which she required surgery. Then she developed breast cancer, which eventually metastasized. In closing her narrative, she knows it will likely take her life.

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The Soul of the Nurse

Robinson, Elizabeth

Last Updated: May-23-2013
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

In her reflections on the vocation of nursing Robinson explores many myths and archetypes that give shape and energy to the identity of the nurse as it has evolved in Western culture, including the stories of Hygeia, Baubo, Hermes, Hecate, Cassandra, and the Dionysian Maenad.  The ancient stories of each of these figures and others articulate particular constraints, conventions, and conflicts involved in caregiving, especially in the ways women assume the role of caregiver.  She explains at the outset that she deals particularly with women in nursing, though now many men are nurses, since traditionally it has been a profession deeply shaped by cultural notions of female roles.  Another layer of this exploration is a chapter on the nurse in popular culture that considers ways in which the figure of the nurse has been both elevated and debased, made comic or tragic, sidelined or sexualized.  The multidimensionality of the nursing vocation and, consequently, the challenge it poses to women who enter it, is strongly emphasized throughout the six chapters, which together depict the work of nursing as a soul journey. This journey challenges nurses in new ways to work within institutions that suppress important aspects of their power to do healing work at a level of intimacy generally not accessed by doctors.

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Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

F. González-Crussi, professor emeritus of Pathology at the Feinberg School of Medicine at Northwestern University, has written several books on medicine and the human body. Carrying the Heart deals with five basic organ systems; he styles them as Digestive, Scatology, Respiratory, Reproductive, and Cardiovascular.

In his Foreword, he rejects a mechanical view of the body and medicine that treats patients as passive protoplasm. He seeks to engage the imagination of his readers so that they can become active participants in health care.

For each system, González-Crussi assembles an eclectic wealth of materials: views of authors from classical times onwards, scientists who changed perceptions of the body, his own hands-on view as a pathologist, parallel organs in other mammals, and, usually, an extended narrative of a person with an unusual anatomical history. These are highly personal essays, “rhapsodies,” we might say, which stitch together unusual and interesting facts, observations, and interpretations. It’s impossible to guess what will be on the next page, and the discoveries are many. A gifted stylist, González-Crussi writes with both erudition and wit. 

For “Digestive,” he cites Livy, Paracelsus, Joan Baptista van Helmont, and others before turning to Thomas Bartholin, who questioned the notion that the stomach was somehow the “king” of the body and the seat of the soul. González-Crussi writes, “the gastric cardia admits and stores impure food, without this having any discernible effect on the soul. Nor is the soul damaged by performers at circuses and country fairs who lower swords and knives into the stomach” (p.7). The text marches on through Réamur, Spallanzani and others, before turning to the well-known story of Dr. William Beaumont and his patient Alexis St. Martin, who had a hole in his side (from a gunshot). Beaumont experimented with materials placed directly into the stomach.

Next in the digestive process are the bowels, discussed on “Scatology,” literally the study of scat or excrement. González-Crussi is fascinated by cultural values of “death, putrescence, and dissolution” that attach to our scat. He draws on Rabelais, Luther, the Gnostics, Chuang-tzu, and the Aztecs for the views on the contents and process of the bowels—more than the nature of the actual bowels themselves. The next 30 pages deal with enemas, including the modern (and discredited) notion of “auto-intoxication” a justification bruited about even today for colonics.

Oddly enough, the enema theme continues in the “Respiratory” essay, because there were “smoke enemas” for some 200 years. Page 104 shows a French illustration of interlocked tubes for this purpose; indeed the same illustration graces the slipcover for the book. González-Crussi draws on Anaximenes, Pirandello, Plutarch, Hawthorne, and others. Some 15 pages describe a famous tuberculosis patient, Frederic Chopin, although perhaps he was actually a cardiac patient.

Part I of “Reproductive” is “Female.” We quickly learn that “The uterus is placed between the bladder and the rectum. As a piece of real estate, the uterus would be much devalued by the condition of the neighborhood” (p. 152). Nonetheless, the uterus is “immunologically privileged,” fending off germs that might infect a fetus (which in itself is “half foreign” because of the father’s genes). Drawing on many commentators, González-Crussi discusses menstruation, and pregnancy, although not genital pleasure or orgasm. Some insightful pages explore the normal death of cells within our body.

Part II, “Male” discusses erections, side-curving penises, and the famous penises of Napoleon, Rasputin, and Jesus.

The last essay, “Cardiology” briefly explores two types of knowing (from the heart, from the brain) before a lengthy retelling of the Lay of Ignauer; this strange story ends with women whom he has seduced eating his cooked heart. The last section discusses Harvey’s discovery of the heart as a pump. The final two pages see a new consideration of the heart as a second brain.

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Open Heart

Wiesel, Elie

Last Updated: Feb-01-2013

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Elie Wiesel, 82-years-old, has pain that he thinks is in his stomach or esophagus, perhaps caused by his chronic acid reflux.  After tests, however, doctors diagnose cardiac illness and insist on immediate surgery. Reluctant to go to the hospital, Wiesel dawdles in his office. When he does go, doctors believe a stent will do the job. Instead, the intervention becomes a quintuple bypass.

This brief memoir—a scant 8,000 words—presents the “open heart” of a gifted writer as he contemplates his open-heart surgery, his past life, and the future. He asks himself basic, even primal questions about life, death, and the nature of God.            

Although a man with an extraordinary career—prizes, fame, honorary doctorates, friends in high places, professorships—Wiesel experiences and describes ordinary feelings of anxiety, pain, and doubts about his cardiac emergency and possible death. His stylistic gifts describe frankly and vividly a patient’s fears. As many have observed, patients with a serious disease have two difficulties, the disease itself and their emotional responses to that disease.  As Wiesel is wheeled into the OR, he looks back on his wife and son; he wonders whether he will ever see them again.            

He writes that his “thoughts jump wildly; I am disoriented.” He recalls a friend undergoing similar surgery; she died on the table. He says he can’t follow the jargon of physicians. The texture of the prose is rhapsodic, jumping from the present to memories, many of them about war, his past surgeries, or important family events. This short book has 26 “chapters,” some just half a page; they are like journal entries.

As he slowly recovers, he feels pain and has visions of hell, including the concept of ultimate judgment. “Evidently, I have prayed poorly…; otherwise why would the Lord, by definition just and merciful, punish me in this way?” (p. 38).  Because he has a “condemned body,” he feels he must search his soul. In the longest chapter of the book, he reviews several of his writings.

Wiesel asks some of the questions from his famous novel Night (La nuit, 1958).  If there is a God, why is there evil? Auschwitz, he says, is both a human tragedy and “a theological scandal” (p. 67). Nonetheless, he affirms, “Since God is, He is to be found in the questions as well as in the answers” (p. 69).

At the end, he still has some pain but feels much gratitude for his continuing active life and for his grandchildren.

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Summary:

This book describes San Francisco’s Laguna Honda Hospital, where Victoria Sweet worked as a doctor for 20 years. In the tradition of the Hôtel-Dieu in Paris (literally “God’s Hotel”), Laguna Honda cares for the sickest and poorest patients, many staying there indefinitely because there is no alternative for them. Sweet learns from her long experience at Laguna Honda that “Slow Medicine” has benefits, that a holistic or unified view of patients works best, and that the reductionism and specialization of modern medicine has limitations and costs. During these years Sweet becomes fascinated by the medieval abbess Hildegard of Bingen and earns a Ph.D. focusing on medieval medicine. At the same time (and increasingly) various forces—economic, legal, political, bureaucratic—cause many changes at Laguna Honda, mostly contrary to Sweet’s vision of medicine.

            Part history, part memoir, part social criticism, the book is informative, entertaining, and important for its discussion of the care of our least-well-off citizens and for its perspectives on modern, Western medicine.         

            There are three intertwining strands to this engaging book: Sweet’s medical evolution as a physician, the changes in Laguna Honda, and her investigations of Hildegard of Bingen and other spiritual matters.

            Sweet joins up with Laguna Honda initially for only two months, but she finds the hospital and her work there so fascinating that she stays for 20 years. As an almshouse, Laguna Honda takes care of indigent patients, most with complicated medical conditions, including mental illness and dependencies on alcohol and/or drugs. Many of these cases come from the County Hospital with continuing (but not carefully reviewed) drug treatments. Every 15 or 20 pages, Sweet describes the dilemmas of a particular patient, and her medical (and personal) attention to that patient. The cases are vivid and instructive.

   Clearly Laguna Honda is a major figure on the book; we can even consider it (or “her”) a beloved character and a teacher to the young Dr. Sweet, who learns three principles from her work there: hospitality, community, and charity. 

Because Laguna Honda is old-fashioned in many ways, Sweet reads her own X-rays, goes the to lab to see results, and spends large amounts of time with each patient. Laguna Honda has an aviary, a farm with barnyard, and a solarium; such features help to heal the whole person. While respectful of modern medicine, Sweet slowly learns that a careful review of a patient through Slow Medicine is more accurate and more cost-efficient than standard, reductionist, high-tech medicine. She comes to respect approaches from “premodern” medicine, including that of Hippocrates and Hildegard.

  The second strand is the evolution of Laguna Honda itself. Sweet describes a variety of pressures: the recommendations of consulting firms, rulings from the Department of Justice, a lawsuit, financial difficulties (including fiscal mismanagement), administrators focused on a narrow concept of efficiency, a utilization review board, forms and more forms, and a pervasive sense that modern (including Evidence Based Medicine) is always good. All these and more create a “relentless pressure squeezing the hospital’s Old Medicine into the New Health Care” (p. 322). Sweet demonstrates that her Slow Medicine can actually save money in the long run. Confident that her way is better, she proposes an “ecomedicine unit” that she would match against the modern, “efficient” units in a two-year experiment. (For more information on her concept of ecomedicine proposal, see http://www.victoriasweet.com/.)

            As the hospital is “modernized,” many important features of the old place are gone and many “new and improved” aspects don’t work. Somehow there are no rooms for physicians in the new building while there is plenty of space for administrators and managers. A sophisticated computer system doesn’t work. Sweet doesn’t say “I told you so” directly, but we get the picture.

            The third strand is Sweet’s investigations of spirituality and pilgrimage. She is fascinated by Hildegard’s notions of the healing power of nature, the ability of the body to heal itself, and wholeness as an aim for a person and for a community. Sweet attends a Swiss conference on Hildegard. She hikes the pilgrimage route from France to Santiago de Compostela in four installments and considers notions of pilgrimage. She feels called to pursue her ecomedicine project and to write this book.           

            By the end of the book, both Sweet and Laguna Honda have changed and are now headed in different directions. 

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