Showing 1 - 10 of 615 annotations contributed by Coulehan, Jack

Physician Assisted Suicide and Euthanasia

Sulmasy, Daniel; Rubenfeld, Sheldon

Last Updated: Nov-01-2022
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

Physician-Assisted Suicide and Euthanasia, edited by Shelton Rubenfeld and Daniel Sulmasy, is an unusual collection of scholarly essays in that it combines essays about Nazi euthanasia with others that deal with contemporary PAD (Physician Aid in Dying) and questions whether there might be a relationship between the two. This perspective is understandable, given the book’s origin. The Center for Medicine after the Holocaust, an organization with the mission “to challenge doctors, nurses, and bioethicists to personally confront the medical ethics of the Holocaust and to apply that knowledge to contemporary practice and research,” invited a group of North American and Israeli palliative care specialists and medical ethicists in 2018 to visit German sites associated with Third Reich euthanasia programs.  The intensive discussions that followed resulted in this provocative collection of papers.  

Dr. Timothy Quill is among the writers supporting the moral probity and legalization of PAD, while Drs. Diane Meier and Daniel Sulmasy present strong arguments against the practice.

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Stuck

Larson, Heidi J.

Last Updated: Sep-20-2022
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Medical Anthropology

Summary:

Stuck was published shortly before the Covid pandemic when the American vaccine wars, with all their hostility, misinformation, and political baggage, lay more than a year in the future. In Stuck, Heidi J. Larson, Professor of Anthropology and Director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, approaches vaccine rejection as a complex moral and cultural phenomenon, rather than as a simple issue of ignorance or a marginal point-of-view. In a sense, anti-vaccine rumors are the tip of an iceberg, reflecting and perpetuated by deep underlying concerns, like perceived threats to personal or cultural values, distrust of government, misperception of risks and benefits, or a combination of these. The claim that compulsory immunization violates personal freedom is especially prominent today.  

Rumor is a major source of vaccine rejection. The author discusses in detail the case of Andrew Wakefield and his contention that MMR (measles, mumps, rubella) vaccine causes autism. This belief, based on a 1998 paper in The Lancet (later retracted) has been shown to be false by numerous large-scale studies, but is accepted by perhaps millions of people throughout the world.  

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Editing Humanity

Davies, Kevin

Last Updated: Jun-28-2022
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: History of Medicine

Summary:

Editing Humanity explores the history, biology, sociology, and ethical import of CRISPR (“clustered regularly interspaced short palindromic repeats”), the major new DNA technology indicated in the book’s subtitle, “The CRISPR Revolution and the New Era of Genome Editing.”  Using CRISPR, researchers can manipulate the DNA of animals, plants and microorganisms with extremely high precision. In particular, scientists now have the potential to customize the human genome.  

What is CRISPR? To quote Davies, “CRISPR is a small subsection of the bacterial genome that stores snippets of captured viral code for future reference, each viral fragment (or spacer) neatly separated by an identical repetitive DNA sequence.” (p. 23) When the cell is reattacked by a virus, an RNA copy of that virus’ stored “signature” forms a DNA-splitting complex that destroys the incoming virus. In 2012, Jennifer Doudna, of the University of California, Berkeley, and Emmanuelle Charpentier, of the Max Planck Institute, Berlin, demonstrated that CRISPR could be engineered to edit any gene. One could, for example, replace a disease-causing mutation in any DNA segment with the healthy variant, thus preventing genetic disease.  

The author, Kevin Davies is a geneticist and science writer whose previous books include Cracking the Genome and DNA: The Story of the Genetic Revolution.  In Editing Humanity, he discusses an array of actual and potential applications of CRISPR technology, including human disease prevention by altering susceptibility of animal vectors, improving farm productivity, and even resurrecting extinct species. However, the most powerful and controversial topic is genetic manipulation of the human embryo. Davies devotes several chapters to the cautionary tale of the young Chinese scientist He Jiankui who engineered the world’s first gene-edited babies, and the scandal and disgrace that followed. (He was convicted in China of “illegal medical practice” and sentenced to prison.)

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A Matter of Death and Life

Yalom, Irvin; Yalom, Marilyn

Last Updated: Jun-02-2022
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

After 65 years of marriage, two life-partners face the prospect of final separation, as one of them develops multiple myeloma. This is the crisis that led Irvin Yalom, eminent psychiatrist, novelist, and pioneer of existential psychotherapy, and his wife Marilyn, acclaimed feminist author and historian, to collaborate in writing the story of their journey through Marilyn’s final months of life. In the resulting book, Irvin and Marilyn write alternating chapters until Marilyn becomes unable to write. After her death, Irvin continues with the story of his bereavement.  

Marilyn’s chapters include reflections on love and illness, ranging from Emily Dickinson and Henry James to Paul the Apostle. She frequently expresses her gratitude: “I can still talk, read, and answer my emails. I am surrounded by loving people in a comfortable and attractive home.” (p. 20) Most of all, she is thankful for her husband, “the most loving of caretakers.” (p. 15) Yet, as her disease progresses, she comes “to the understanding that I would never be the same again—that I would pass through days of unspeakable misery while my body would decline and weaken.” (p. 76) She decides to pursue the option of physician-assisted suicide, which is legal in California, when her suffering becomes overwhelming.  

In his chapters, Irvin resists this decision, maintaining hope for additional “good” life, despite all evidence to the contrary. Near the end, Marilyn’s pain and other symptoms become so severe that she cries out, “It’s time, Irv. It’s time. No more, please. No more.” (p. 139) Her physician arrives, confirms her intention, and surrounded by her whole family, Marilyn sucks the liquid through a straw and quietly passes away.

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The Steel Windpipe

Bulgakov, Mikhail

Last Updated: Jun-02-2022
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

A little girl is brought to the rural hospital by her mother, who throws herself at the feet of the young doctor, “Please do something to save my daughter!” It seems that she has been suffering from a sore throat and is now having difficulty breathing. The doctor looks into her throat; diphtheria is evident.At first he scolds the mother for not having brought the girl earlier. Then he suggests surgery: a tracheotomy. The doctor knows this is the only way he might save the child, but he is consumed by anxiety because he has never performed the procedure. At first the mother objects to surgery, but then relents. The tracheotomy is successful and the child survives.

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The Sleeping Beauties and Other Stories of Mystery Illness

O'Sullivan, Suzanne

Last Updated: May-23-2022
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Longform journalism

Summary:

In Sweden, hundreds of children lie unconscious for months or even years in their homes or hospitals. Full neurologic evaluation, including MRIs, EEGs, and other studies reveal no abnormalities.  None of these children are Swedish. They are immigrants from the Near East or former Soviet republics, whose families are seeking permanent asylum in Sweden. If asylum is granted, the children gradually recover. Neurologists have named this mysterious illness “resignation syndrome” and classified it a functional neurological disorder.  

Suzanne O’Sullivan, an Irish neurologist, set out in 2018 to study children suffering from resignation syndrome, a project that led her to investigate other outbreaks of mysterious illness around the world. In The Sleeping Beauties, O’Sullivan discusses many such disorders, ranging from grisi siknis in Nicaragua (convulsions and visual hallucinations) to a form of sleeping sickness in Kazakhstan. These disorders have several features in common: absence of findings on medical and psychiatric tests, contagiousness (i.e. they seem to spread rapidly among populations in close contact), and significant morbidity.  

Dr. O’Sullivan notes “there is a disconnect between the way mass psychogenic disease is defined and discussed by the small number of experts who study it and how it is understood outside those circles.” (p. 257) The public finds reports of such illnesses difficult to believe. In the United States, we tend to believe that such illness, if it exists at all, occurs only in “backward” cultures and not in our enlightened society. On the contrary, the author presents “Havana syndrome,” as a case of mass psychogenic disease that first appeared among American diplomats in the Cuban capital in 2016. No consistent brain abnormalities have ever been found, and extensive study has ruled-out the possibility of a sonic weapon.  Dr. O’Sullivan believes that Havana syndrome is very likely a functional neurologic disorder occurring against “a background of chronic tensions within a close-knit community.” (p. 257)

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The Invention of Medicine: From Homer to Hippocrates

Lane Fox, Robin

Last Updated: May-13-2022
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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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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Secret Wounds

Berlin, Richard

Last Updated: Aug-06-2021
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

In Secret Wounds, his second full length collection of poetry, psychiatrist Richard Berlin continues his exploration of the inner world of medicine with a sequence of 73 poems that flow seamlessly, uninterrupted by grouping into topics or sections. In the first poem, “Lay Down Sally,” the author attends a man dying on dialysis, and concludes with “A nurse hangs the morphine. / I write my blue notes.” In the last, “The Last Concert of Summer,” he reflects on his long experience with the sick and suffering, ending the poem with, “I place a stethoscope in my ears and listen / to the heart when I’ve run out of things to say.” In between, the poems reflect varied incidents, topics, conflicts, and wounds, as they occur from medical education (“Teaching Rounds,” “Touch,” “On Call, 3 AM”) through a life in medical practice (“Rage,” “The Scientists,” “How a Psychiatrist Parties”) to something like enlightenment (“Note to Pablo Neruda,” “A Psychiatrist’s Guitar,” “End of Summer”).

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From Reading to Healing: Teaching Medical Professionalism through Literature

Stagno, Susan; Blackie, Michael

Last Updated: May-30-2019
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Anthology (Mixed Genres)

Summary:

The subtitle of this collection explicitly states its purpose and implies its audience. The content includes essays on teaching, as well as a number of canonical stories taught in medical humanities courses. The first section consists of key texts that present a rationale for teaching narrative literature to medical and other health professions students. This is followed by five sections, each of which covers an aspect of that rationale, i.e. narrative exploration of  professional boundaries, empathy and respect, authority and duty, stigma, and truth-telling and communication.  

Within each section, several essays describe teaching considerations or techniques, often focusing on a specific story or novel. For example, in “A Novel Approach to Narrative Based Professionalism: The Literature Classroom in Medical Education” by Pamela Schaff and Erika Wright (p. 72), the authors describe how Pat Barker’s novel Regeneration stimulates discussion of doctor-patient antipathy, doctor-patient intimacy, and interprofessional communication. From Reading to Healing also includes the full text of many stories relevant to the essays; for example, “Toenails” (Richard Selzer),“The Most Beautiful Woman in Town” (Charles Bukowski), “The Speckled Rash” (Mikhail Bulgakov), “The Death of Ivan Ilyich” (Leo Tolstoy), “The Use of Force” (William Carlos Williams) and “The Birthmark” (Nathaniel Hawthorne).   

In addition to stories and novels, From Reading to Healing presents essays on teaching with film, religious literature, and even comics, cf. “Assisting Students in the Creation of a Class Oath Using Comics,” by Michael Redinger, Cheryl Dickson, and Elizabeth Lorbeer (p. 217)

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