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Site Fidelity

Boyles, Claire

Last Updated: May-16-2022
Annotated by:
Zander, Devon

Primary Category: Literature / Fiction

Genre: Collection (Short Stories)

Summary:

Site Fidelity is a collection of short stories by Claire Boyles, a writer and former farmer who currently resides in Colorado.  Each of the stories focuses on a woman or family in the American West, forming interconnected narratives that inform one another. Some share recurring characters, while others, notably “Chickens,” stands alone, connected to the rest of the collection only by its common themes.

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Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: History of Medicine

Summary:

The Invention of Medicine is both a scholarly history of early Greek medicine and a compelling mystery story. The “From Homer to Hippocrates” discussion (about 70 pages) is merely a prelude to the author’s main project, which is a careful analysis of the books attributed to Hippocrates of Cos. As a group, they have been associated with Hippocrates at least since the scholar Baccheios of Alexandra, writing in the 280s BCE, attributed them to him. The Roman physician Galen (about 170 CE) considered them products of a Hippocratic “school,” but believed they were written by many different authors, including in some cases, the great Hippocrates himself.  

The book’s highpoint is the author’s carefully reasoned hypothesis that the historical Hippocrates wrote the texts we now know as books 1 and 3 of the Epidemics, based on his practice experience in Thasos between 471 and 467 BCE. Other parts of the Epidemics were written by physicians up to several generations later who emulated Hippocrates’ naturalistic approach. The works identified as the “Hippocratic corpus” were grouped together as early as the 280s BCE as representing the school of Hippocrates because of their naturalistic, pragmatic, and ethical contents,  

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Annotated by:
Trachtman, Howard

Primary Category: Literature / Fiction

Genre: Historical Fiction

Summary:

When we think of genetics and pedigrees, we expect our traits and characteristics to be passed down in a predictable pattern from parents to children. In his book Far From the Tree , Andrew Solomon labels this transmission from one generation to the next as vertical identity. However, his book focuses on circumstances where inheritance follows what he calls a horizontal pattern. In these cases, the offspring have an inherent or acquired trait that is foreign to their parents. They land far from the anticipated spot under the tree canopy and are dramatically different from their parents. He or she must acquire their identity from a peer group that is outside the parents’ experience. One chapter in Solomon’s book focuses on genius as seen through the lens of the violinist Joshua Bell and his family. Most of us would gratefully welcome a child of genius whether in science, architecture, or music and embrace the apple that landed far from the tree. Reading Benjamin Labatut’s riveting book might cause you to rethink this thought experiment.

Nothing will quite prepare you for the literary world that Labatut has invented. It is a unique blend of fact and fantasy, an incremental layering of fictional conceits on known historical details. A stream of people from history pass through the book, some deservedly famous and others more obscure. But all of them are possessed of genius. All of the characters lived through the turbulent first third of the 20th century when quantum mechanics revolutionized the traditional understanding of physics. They confronted the challenge that this new knowledge presented to the grand view that people had held about how the universe was designed and operated.

The book opens with Fritz Haber, whose research on nitrogen fixation chemical reactions provided the basis for the production of fertilizers, pesticides and explosives. Haber’s work had diametrically opposite effects on the course of history. On the one hand, he enabled dramatic increases in agricultural crop yields and prevented global hunger. At the same time, his discoveries increased the carnage in World War I and yielded compounds that led to innumerable deaths by asphyxiation in the trenches in no-man’s land and, later, in the Nazi death camps. There is Karl Schwarzschild who was able to solve Einstein’s equations in the general theory of relativity while fighting in the German front lines during World War I. He identified the potential existence of black holes, Schwarzschild singularities, long before Stephen Hawking made them famous. Alexander Grothendieck, considered the most influential mathematician of the last hundred years, also passes through the pages of Labatut’s book. After an extraordinarily creative career in which he totally upended established concepts in geometry and number theory and other mathematical fields, he ended up abandoning his life’s work. He devoted himself to Buddhism and, retreating to a secluded village in the Pyrenees, he lived out his last years alone and unrecognized. Erwin Schrodinger is forced to enter a Swiss sanatorium to convalesce from tuberculosis. While there, under the influence of a teenage girl similarly afflicted with tuberculosis, he derives his wave equation and the Psi function to explain the wave-particle duality of light and matter. Even Schrodinger is perplexed by this discovery. He cannot reconcile himself fully to the truths of quantum mechanics and spends the rest of his scientific life trying to unify it with Einstein’s Theory of General Relativity. Finally, towering over the narrative is Werner Heisenberg. He agonizes over the discrepancy between the Newtonian physics that he has learned in the university and what he is uncovering in his research into the subatomic realm. He is overcome in a semi-mystical vision and articulates the uncertainty principle. Heisenberg realized that his matrix mathematics put an end to the stable universe created by the Enlightenment in which everything is governed by rational laws of nature and observable cause and effect.

By focusing on these men (sadly, not a woman among them) of uncommon genius, Labatut vividly illustrates how the gift of deep insight drives intense scientific creativity but also agonizing psychic pain. It is as if the awareness of hidden truths is inextricably linked to human suffering. This summary may sound pedantic and unbearably heavy. Only if you enter into Labatut’s unique literary space will you appreciate the inventiveness and intelligence of this overpowering book, all 191 pages of it. It is well worth the trip.

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Annotated by:
Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The Urge: Our History of Addiction, by Carl Erik Fisher, a psychiatrist, is really two books in one.  It is a comprehensive history of addiction from ancient times to the present day.  It is also a memoir of the author’s own struggle with addiction and an attempt “to understand how I went from being a newly minted physician in a psychiatry residency program…to a psychiatric patient” (p.ix).  

Fisher has grown up with two alcoholic parents.  Even as his mother’s drinking “suppresses her blood counts and causes her to miss the chemo sessions I have worked so hard to arrange” (p. 294), she does not stop.  Fisher’s own first drink, in high school, is a revelation.  He blows his interview for his first-choice college when he shows up late and hung over. His intelligence enables him to get by, but eventually the problem catches up with him as he begins to use Adderall and marijuana to counteract the effects of alcohol.  After sleeping through and missing his residency orientation, he is under scrutiny.  Finally, he has a drug-induced manic episode that results in his being tasered by the police, and he is forced into treatment.    

In the historical sequences of the book, we discover that one of the oldest known examples of addiction is found as far back as the Rig Veda (1000 BC).  From there we move through time, learning how Native American populations were devastated by alcohol, how Alcoholics Anonymous achieved prominence, and about the multiple challenges that persist to the present day. 

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Ward Rounds

Beernink, K. D. (Kenneth Dale)

Last Updated: Apr-25-2022
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

This is a collection of poems about patients, written by a young physician in the late 1960s. The book is organized around the theme of a hospital ward. Each poem is named for a patient and has the patient’s disease as its subtitle. The poet composed these poems during his own illness when, as he says in the original Introduction, “my patients reappeared to me, and I lived again in my mind all the many emotions we experienced together.” K. Dale Beernick died of chronic myelocytic leukemia at the age of 31 in 1969. In Ward Rounds he recounts his experiences as a medical student and house officer. He uses a variety of forms and techniques, including rhyme, blank verse, haiku, and even one villanelle. The poems vary in quality and impact. Among the best are "Penny Brown" (rheumatic heart disease), "Theodosus Bull" (delirium tremens), "Anonymous" (spontaneous abortion), and "Minnie Freeme" (post-necrotic cirrhosis).  

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The First Wave

Heineman, Matthew

Last Updated: Apr-18-2022
Annotated by:
Bruell , Lucy

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

First Wave documents the early days of the COVID-19 pandemic at Long Island Jewish Medical Center (LIJ) in New York from March through June of 2020.  It opens with a graphic scene of a rapid response team trying to save a patient with COVID whose heart has stopped.  Despite their efforts, the patient dies.  After the team pauses for a minute of silence at the bedside, the grueling work of saving lives continues. 

The film follows Dr. Nathalie Dougé, an internist who was born in the Bronx to Haitian parents. Most of her patients are Black, Hispanic or immigrant.  Two patients with COVID are essential workers: Brussels Jabon, a Filipino nurse who undergoes an emergency C-section after she is brought to the emergency room, and Ahmed Ellis, a school safety officer with the NYPD.  Both have young children and supportive families.

Nurses hold up IPads so families can Facetime with the patients.  It’s terrifying and sad for the families to see the patients on screen and not to be present when they are needed the most. It’s emotionally difficult for the healthcare team as well who are the only ones to hold a patient’s hand during these encounters.  One nurse describes the effect of holding the phone while family members have five minutes to Facetime with patients, “You become the family member, and it seems like you’re losing your family.”

The emotional toll of losing so many patients, while fearing that they too may contract the virus and bring it home to their own families, weighs heavily on the healthcare teams.  They are trained to compartmentalize, to separate work from personal life but their empathetic response to their patients follows them home.  “I think about him every night when I go home,” nurse Kelli Wunsch says of Ahmed. “I just want him to do well.”

Scene after scene of teams rushing to resuscitate a patient who has coded are interspersed with more hopeful moments of a reunion between husband and wife, the sound of the song “Here Comes the Sun” when a patient is taken off the ventilator, and the cheerful encouragement of a physical therapist working to help a patient regain enough strength and mobility to be discharged. At times the camera moves outside the confines of the hospital to the outside world:  Dr. Dougé alone at home with her dog celebrating her birthday with friends over zoom, eerily empty streets during the lockdown, and families anxiously awaiting news from the hospital.  We see bodies taken to refrigerated trucks and people cheering the health workers at 7pm from windows across the city.

In May, when protests erupt following George Floyd’s murder, Dr. Dougé, joins the protest with other frontline workers carrying a sign, “Racism is a Public Health Issue” and ”I Can’t Breathe” scrawled on her surgical mask.  Amid the “I Can’t Breathe” cries of the protestors, she relives the myriad times she has heard her patients gasping those words to her just before they are placed on ventilators. 

Both Brussel and Ahmed become stable enough to be taken off the ventilator and released from the hospital to return home to their families.  Despite their recovery from the acute phase of the illness, it is clear their health remains severely compromised.  As the cheers of the staff in the hospital lobby fade, tough work lies ahead for these patients and their families.    

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Annotated by:
Schilling, Carol

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Five years into writing about her mother’s slow decline from a respiratory illness, Joanne Jacobson was diagnosed with a rare, life-threatening blood disease. That discovery dissolved the illusion that she and her mother had separate fates. “How could I continue writing about my mother as though I were observing her from outside the circle of Illness?” Jacobson asks (27). She can’t. And Every Last Breath becomes, as its subtitle discloses, “A Memoir of Two Illnesses.” Doubling its concern, Jacobson’s memoir in essays becomes a richer, more urgent, and ironic revision of her original project.  

With writerly attentiveness, perceptive intelligence, and some impatience, the four opening essays witness the negotiations that Florence Jacobson makes with her body, her environment, and her psyche. From a distanced perspective, Jacobson wonders at her mother’s courage and stubborn animal will to go on. Her mother’s slow pace and reluctance to let go—of her possessions, her habits, her life—initially frustrate and puzzle Jacobson. She even expresses impatience with the constant sound of her mother’s oxygen pump filling the apartment, the inconvenient bulk of the oxygen canister, the tangles of tubing connecting the machine with her mother’s nostrils. 

 As Jacobson’s diagnosis closes the distance she perceived between herself and her mother, it ignites the memoir’s transformative insight. It’s first articulated at the end of the essay titled “Mirror Writing” and it sustains the rest of the memoir. Realizing that her mother might outlive her, Jacobson writes: “. . . I can no longer pretend that the ragged approach of death is likely to be smoothed by nature’s grace, or by the natural order. So long as I believed I was writing about my mother, I was able to hold mortality at a distance . . . Now in the mirror of my mother’s aging face I see myself” (29). In “Dead Reckoning,” when Jacobson learns that her blood is starved for oxygen, she hears her “own lungs fall into the thrumming motor’s pulse” of her mother’s respirator. Revising her response to the technology, she writes that it is “the sound of death being pushed mechanically away that is audible to me now—steadily asserting its nearness . . .” (63-4). Jacobson’s descriptions of her hospitalizations and treatments (“Written in Blood,” “If My Disease Were an Animal”) take her on solo flights toward her new understanding of herself and the “call to the imagination” that her experience issues (59). Jacobson’s elegant and vulnerable rendering of her efforts to survive pain, uncertainty, and terrifying treatments register her own courage and will to go on.  

The final essays bring the shared destinies of daughter and mother together. Jacobson thinks of them as “invisibly entwined, cellular,” as she recalls that mothers’ bodies can absorb their fetuses’ cells (88). In “Book of Names,” Jacobson’s closing essay, she and her mother read out the names in Florence’s heavily edited address book, tracking the alterations in the circumstances of those whose lives she’s shared. It invokes the lists in Genesis. Begotten. Then gone.

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Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

In the opening dialog, the author, Samantha Harvey, tells a friend what this book is about. 
Friend:    What are you writing?
Me:         Not sure, some essays. Not really essays. Not essays at all. Some things. 
Friend:    About what?
Me:         Not sure. This and that. About not sleeping, mainly. But death keeps creeping in. (p. 1)
That’s as good a description of the book as could otherwise be offered.

As unstructured as the book’s content is, so is the book’s format. The only breaks in the text are distinguished by infinity signs. Time stamps are placed within the text between some of these breaks. The times are sequenced during a night (or a composite of nights) when Harvey is awake between midnight and 7:30 am. Texts following the time stamps describe the acute effects of insomnia on her at those particular moments and could be read as diary or journal entries. 

Harvey’s insomnia came suddenly at the age of forty-three and morphed into an unrelenting assault that at times made her wonder if the only sleep available to her is the sleep of the dead. 
When I don’t sleep and don’t sleep and don’t sleep, I don’t want my life; neither do I have in me the propulsion (courage? know-how?) to take it. So I have to endure my life when it’s unendurable, and this is an impasse. (p. 33)

Can I escape this? The sword hangs. There is nothing to put my mind at rest – every day presents a new threat: the night. Every night is a battle, most often lost, and any victory is one day long, until its challenger comes along: the next night. I understand why people kill themselves, or break down. (p. 82)
Throughout the book, across all the text sections, and following all the time stamps, Harvey details what insomnia does to her physically, psychologically, and existentially. She desperately explores the possible causes such as menopause, fear, traffic noise, and Brexit among others, and heartbreakingly tells of all she has done to get sleep such as seeing doctors, smiling more, counting blessings, and changing behaviors. None come to any effect, as she reports to her unhelpful doctor. 
I do these things, they don’t help.
Over time they will.
Over time they haven’t.
I feel unhelpable.
Nobody is unhelpable.
I am.
Nobody is. (p. 139)
Just as Harvey had informed her friend, she takes up other topics in other forms that directly or indirectly relate to her insomnia, and sometimes do not relate at all. Among the various forms are vignettes; thoughts and obsessions; meditations; and a short story. Topics include deaths in the family (including a dog’s); peculiarities of different languages; why so many TV shows have the word “secret” in their titles (she spends “nights spent thinking about this”) (p. 67); what fuels insomnia; how worry, anxiety, and fear differ from one another; writing; time; and the relationships between science and religion, and between reason and faith. Harvey’s  background in philosophy shows. 

A year on, Harvey discerns a cure for insomnia. Using a metaphor involving swimming against waves and currents or with waves and currents, the cure is to be derived from the “wisdom in knowing that we are sometimes the cause and influencer of our own currents and tides, which we make in otherwise still waters.” She further elaborates on this idea and how it leads to a moment when “you’ll drop each night into sleep without knowing how you once found it impossible” (p. 175).


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Annotated by:
Trachtman, Howard

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

The Graduate is a movie classic from what seems like a bygone era. It is accompanied by great music by Simon and Garfunkel and has one of the most famous one-word lines in cinema history. When Benjamin Braddock is wandering aimlessly around the pool at a graduation party thrown in his honor, a friend of his parents asks him what he plans to do with his post-collegiate life. Another family friend jumps in and volunteers, “Plastics.” There are many who will also give a one-word answer to any medical school graduate searching for a career – Genetics.

In this important new book,  Kathryn Harden provides staunch support for the key role of genetics in health, disease, and in human well-being. She provides a remarkably clear primer on genetics in accessible language. Harden begins with statistical issues like the normal distribution and Bayesian priors. In her capable intellectual hands, she uses analogies that effectively move the teaching agenda forward. With recipes as a framing image for genetics, she demonstrates the relationship between the coding material in the DNA nucleotide sequence and the actual building blocks, namely the proteins that do the heavy lifting inside cells. Concepts like genetic recombination, linkage disequilibrium, and monogenic versus polygenic disorders are introduced and make perfect sense. She then builds on this foundation to consider genome-wide association studies (GWAS) which represent the powerful tool that has been introduced to explore the relationship between genetic endowment and health. That is where things start getting complicated.

When people think of medical genetics, they usually have classical Mendelian disorders in mind. They are caused by mutations in a single gene that disrupts a protein pivotal to normal health. Examples are sickle cell disease, hemophilia A, or muscular dystrophy. However, many health problems like hypertension that are associated with significant global disease burden are polygenic. This means that they are caused by less dramatic mutations in a number of genes that in the aggregate lead to the disease.  Harden details how quantitative assessment of the contribution of these minor variations in a large array of discrete genes enables the formulation of polygenic risk scores (PRS) for these conditions. These measures provide estimates of susceptibility to developing other polygenic conditions like obesity, cardiovascular disease, and diabetes.

As a psychologist, Harden’s work focuses on the application of PRS to non-medical aspects of human behavior such as impulsivity, attentiveness, job satisfaction, and executive function. The waters remain relatively calm until Harden’s fellow psychologists venture into the realm of educational achievement and lifetime income status. Harden methodically reviews relevant studies that have been done with siblings, twins, adoptees, and family trios. She dissects them and highlights when investigators have misinterpreted their data. There is a steady drumbeat of data, almost too much at times. But the overall consensus that emerges is that PRS and other measures of heritability continue to show a genetic component for these psychosocial outcomes in large population studies. The challenge that Harden raises is how to incorporate this knowledge about genetics into a better understanding of these aspects of human behavior and if and how to address abnormal manifestations.

Questions remain concerning how genetics “causes” these changes and how to interpret the findings. What is determinative? Is it genetics i.e., nature, or is it all environment i.e., nurture? There are those, like Harden, who advocate for thoughtful analysis and utilization of all the GWAS data. She highlights the difference between use of PRS to assess outcomes within populations versus between populations. In sharp contrast, there are others who resist  the introduction of genetics into psychology. Pointing to the sordid history of eugenics and its degeneration into the creation of racial hierarchies, the opponents of the Harden’s work dismiss it as unscientific at best and destructive at worst. Harden makes a compelling case for the validity of the science and a spirited defense of the thoughtful use of genetics dismiss it as unscientific at best and morally repugnant at worst.

Harden provides a strong defense of the science and statistical methods and offers a spirited argument that without acknowledging the role of genetics in human achievement, society will be unable to thoughtfully address inequalities and restore balance. Her work touches on many other pressing issues including human autonomy, agency, freewill and the role of government intervention. She outlines a social agenda that acknowledges the importance of genetics as a contributing factor. But it incorporates a recognition that its distribution in the population is solely a matter of luck and does not serve as the basis for a hierarchy of human worth. I leave it to readers to judge for themselves the validity of her proposals, but her commitment to making this world a better place is not in question.

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Fauci

Hoffman, John; Tobias, Janet

Last Updated: Mar-14-2022
Annotated by:
Yin, Ellen
Salman, Akbar

Primary Category: Performing Arts / Film, TV, Video — Secondary Category: Performing Arts /

Genre: Film

Summary:

“The Jesuit philosophy is ‘Men for Others,’” states Dr. Fauci, the titular subject of the documentary Fauci, as he explains how his public school experiences informed his medical career. Indeed, it sets the tone for the rest of a film that traces the beginning of Dr. Fauci’s career as an infectious disease physician through to his role in the creation of PEPFAR, the 2014 Ebola outbreak, and his present day responsibilities in the current pandemic. The documentary bounces primarily between the 1980s HIV/AIDS epidemic and the start of the COVID-19 pandemic in 2020. In both, we see that Dr. Fauci stands as a figure of great controversy, and we are shown his thought process in navigating the court of public opinion.

The film starts off interviewing Dr. Fauci about his childhood in Bensonhurst, Brooklyn where he was exposed to the Jesuit philosophy that would dovetail with his choice to go into public health service when he was drafted into the Vietnam War. Though he began his medical career with aspirations for a private practice on Park Avenue, Dr. Fauci realized that his true calling lay in “trying to figure out diseases that people were dying from” at the National Institute of Allergy and Infectious Diseases where he soon faced one of the greatest public health challenges of the 1980s – piecing together a way to combat a mysterious new disease that was killing more and more Americans. 

This, of course, sounds very familiar to the intended audience of the documentary. It is a parallel that Dr. Fauci himself is well aware of, stating that COVID-19 feels like a “diabolical repeat” of his experiences in the 1980s but that “the difference is [the] divisiveness dominating COVID-19 . . . we’re going to get through it in spite of this divisiveness and this politicization. We’re not going to get through it because of it.” The film leans heavily into this contrast, showcasing the evolving attitudes of many AIDS activists as Dr. Fauci went from “the enemy” to a man sitting in on ACT UP meetings and engaging in a dialogue that would culminate in a historic address at the 1990 International AIDS Conference – an address that highlighted the need for physician-scientists to incorporate the feedback of the individuals they were trying to help and reminded activists of the compassion that physician-scientists have for their patients. 

In the scenes taking place in 2020, we see an explosion of both positive and negative press coverage of Dr. Fauci as the COVID pandemic kicks into high gear. His inconsistencies regarding mask guidance, his direct challenging of President Trump, and his struggle to deal with increasing death threats against himself and his family are put on full display. The documentary does not shy away from showcasing Dr. Fauci’s vulnerability with multiple instances of a tearful Fauci recounting the deterioration of many of his AIDS patients and the “post-traumatic stress” that those experiences induced. These moments of vulnerability are threaded in with images of and commentary from his wife Christine Grady and his daughter Jennifer, a clear attempt to give us a sense of Anthony Fauci the human being and not just Dr. Fauci the public servant. 

As the film draws to a close, Fauci and his wife take a walk through the COVID-19 Memorial on the National Mall in Washington DC. “When you're involved in a race to stop a horrible disease, you always feel like you’re not doing things quickly enough, or well enough,” he reflects. “One of the most mysterious aspects of our universe is how viruses have transformed our civilization . . . And the one thing I can hope for . . . is that emerging infections do not inevitably become pandemics . . . I am optimistic that the lessons that we’ve learned will prevent that from happening.” After watching this documentary, it is an optimism that is easy to share. 

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