Showing 1 - 10 of 891 annotations tagged with the keyword "Doctor-Patient Relationship"

Nervous System

Meruane, Lina

Last Updated: Dec-13-2021
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Ella needs time for finishing her doctoral dissertation on black holes she has been writing for years and thinks an illness could provide the time: “Just enough to take one semester off, to not have to teach all those planetary sciences classes to so many distracted students whom she had to instruct evaluate forget immediately (p. 6). Before she can decide which illness would best suit her purposes, a mysterious illness finds her.
 A sudden cramp shoots down the spine and then, stillness... (p. 9)
An unbearable stinging had settled into her shoulder neck ember... (p. 10)
She felt an invisible wound wrapping her up and suffocating her... (p.10)
A slight numbness that starts in the shoulder and extends along the arm to the elbow until it reaches the back of her right hand, the fingers where it all started. (p. 12)
Inflammatio. In flames. En llamas. Ardor without romance. (p. 10)
Quickly, then, the story shifts from Ella’s dissertation odyssey to her diagnostic odyssey. As she makes her way along this journey during the first chapter, other characters come into the picture: El, Ella’s long-term boyfriend and forensic scientist, is one. The others in her family history are “the Father,” “the Mother,” “the Brother,” and “the Twins”—none are ever named (neither, really, is Ella or El because they are “she” and “he,” respectively in Spanish). Except for the Twins, each of the subsequent four chapters center on one of these characters and how they figure into the family history. Just as in the first chapter, the stories are told through and around the health challenges each character faced; all harrowing, many life-threatening, and some metaphorical.

Ever present in these histories is the story of Ella’s birth mother,“genetic Mother”. She died giving birth to Ella. Ella’s stepmother, “the Mother,” is called at different times, “the volunteer Mother,” “the replacement Mother,” and “the living Mother.” The Brother, alternatively known as “the Firstborn,” shares with Ella her birth mother and was born nine years before her. The Twins, known separately as “the Boy Twin” and “the Girl Twin,” came after the Father remarried. Another dimension shaping the stories is both the Father and the replacement Mother work as practicing physicians. 

Ella’s prominence in each chapter makes her our witness to El’s recovery after an explosion rips through his mass grave excavation site, and his many surgeries for separate gastrointestinal troubles; the Mother’s aggressive and brutal breast cancer treatment; the Firstborn’s recurring bone fractures (an “osseous enigma”); and the Father’s bleeding ulcers and life-threatening hemorrhagic complications from prostate surgery. 

The author, Lina Meruane, structured the book in a somewhat unconventional form. She delineates sections within each chapter with asterisks centered on the page (“***”), and these sections rarely comprise more than two paragraphs. Dialog is neither separated from other text nor signaled with quotation marks. The text moves back in forth in time, from here to there in place (presumably somewhere in South America), and sometimes takes the form of pensées rather than plot narrative. But, overall, the book moves towards resolving some mysteries surrounding family history.

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Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: History

Summary:

In a 1976 Archives of Neurology essay, the neurologist Robert Katzman successfully argued for relabeling “senility” as “Alzheimer’s disease.” He urged rejecting various forms of dementia and senility as common consequences of aging, and accepting them as a disease requiring all the attention any other important disease deserves. Now medicine and society had a problem—"The Problem of Dementia,” the famed physician Lewis Thomas called it in a 1981 essay published by the popular magazine Discover, and he noted that, suddenly, “a disease of the century” had arisen (p. 3).

Forty years on, Jason Karlawish thinks there is still a problem, but in keeping with Katzman’s call, he refers to “The Problem with Alzheimer’s.” Based on the history he covers and the experiences he shares in this book, nothing of much significance has occurred since “The Problem of Dementia” became the “The Problem of Alzheimer’s.”

Karlawish is a physician who cares for people with Alzheimer’s and a researcher delving into “issues at the intersections of care, ethics, and policy” (p. 5).  He draws on his experiences in this book, which he describes as “the story of how once upon a time, Alzheimer’s disease was a rare disease, and then it became common, and then it turned into a crisis.” Karlawish wants to answer why during the time between Thomas’ essay and the year 2010, “nothing really changed,” and how that could be the case in “the richest and most powerful nation.” (p. 6) He tells this story in four parts.

The first part concentrates on efforts clinicians and researchers were making following Thomas’ call to distinguish Alzheimer’s disease from normal aging, other dementia types (e.g., frontotemporal, Lewy body), and precursor syndromes (e.g., minimal cognitive impairment). They were looking for definitive clinical patterns, imaging studies, diagnostic tests, and pathologic markers for the disease. 

In the second part, Karlawish goes back in time to when Alois Alzheimer first found what are known today as “plaques” in the brain of a patient who had an early onset of severe, progressive dementia. He traces the attention this finding drew to eventual advances in imaging and biochemistry aimed at diagnosis. Karlawish also covers how a cascade of events over the decades following Alois Alzheimer’s finding disrupted the pursuit of a pathophysiological basis for dementia. These events included the rise and dominance of Freudian psychology; followed by two world wars; the cold war; the overshadowing of AIDS; Medicare political and funding constraints; tussles among patient advocacy groups; loss of asylums where care and research had coexisted; clinical failure of the first drug; and the continued debate over whether dementia is a consequence of aging or is a disease. 

Karlawish moves on in the third and fourth parts to cover what “we will have to learn to live with the disease so as to improve the lives of persons...to provide the care they need to live well at home...and repair the broken system” (p. 171). Success in his view requires integrated biological, psychological, and social components. He reports the progress on each of these three fronts: some failed approaches continue to fail (such as drugs targeting amyloid); some psychological interventions show promise (though at times causing moral tension); some of the social configurations engineered for Alzheimer’s patients, families, caregivers, and society have produced triumphs and some disasters. He has much to say about why and how this search must go on, but with some much-needed course corrections. 

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How To Be Depressed

Scialabba, George

Last Updated: Nov-28-2021
Annotated by:
Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

How To Be Depressed  is a book with a most unusual structure.  It is introduced by an essay entitled “Intake” that was previously published in a literary magazine.  The bulk of the book, “Documentia,” is taken up by an edited selection of the author’s psychiatric records from 1969 to 2016. It is rounded out by an interview with the author and by his “Tips for the Depressed.”   

Author George Scialabba ascribes his “exceptionally flimsy…shock absorbers” to his “constantly worried” parents (p.3).  While studying at Harvard he becomes involved with a strict religious organization. After leaving that group he undergoes a crisis of faith and his first episode of depression. Paralyzed by self-doubt, he drops out of graduate school and begins a cycle of clerical jobs that are beneath his intellectual capability. After many years he gradually wins distinction as a freelance essayist.  However, due to his incapacitating symptoms he never has a steady writing job and has difficulty attaining financial security.  

In his introduction, Scialabba tells us that “the pain of a severe clinical depression is the worst thing in the world.  To escape it, I would do anything” (p.1).  As attested to by the notes of his well-meaning psychiatrists and psychotherapists, he has diligently applied himself to a wide variety of treatments.  Sadly, if anything he gets worse over time, and eventually requires electroconvulsive therapy. 

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Annotated by:
Field, Steven

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Most of us are aware that the discipline of Palliative Care, with its focus on excellent pain management, other comfort measures, and psychosocial and spiritual counseling, has made a dramatic difference in the way patients are treated near or at the end of life.   However, for most of us, knowledge of Palliative Care is usually limited to how it functions in so-called “first world” countries.  What is Palliative Care like in areas around the world that have less-effective systems of health care delivery? 

Lucy Bruell’s documentary, Oli Otya:  Life and Loss in Rural Uganda, aims to tell this story.  Bruell, an award-winning documentarian (and coincidentally—and full disclosure—the Editor-in-Chief of the NYU Literature, Arts, and Medicine Database), follows a husband-and-wife team, an internist and a palliative care specialist, who travel each year to Uganda to volunteer with a small palliative care service based in a rural hospital.  Along with the team nurse, nursing assistant, and spiritual counselor, and a medical student who has accompanied them for this trip, they see patients in the hospital, the clinic, and most of the time, in the patients’ homes, often covering many miles in a day in this rural area of the country. 

It is the stories of these patients that constitute the heart of the film.  A woman who has been catastrophically burned in a revenge crime, a man with metastatic cancer who can no longer walk, a woman with end-stage rheumatic heart disease who insists on gifting the team with a live chicken for their work, a young man with a progressive neurodegenerative disease whose mother ascribes his behavior to demons—we meet these and other patients as the team makes its rounds, interacts with villagers and herbalists, and fights to overcome shortages of critical medicines.

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Practice

Berlin, Richard

Last Updated: Oct-26-2021
Annotated by:
Kohn, Martin

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

Practice is Richard Berlin’s third book of poetry (two of which are chapbooks) in addition to two prose books. It contains 64 poems and is fronted by an essay, “Why Doctors Need Poetry”. A few pages of notes at the end helpfully explain the context for 15 of the poems. As Dr. Berlin explains at the beginning of his opening essay: “Most of the poems in this volume first appeared in my column, ‘Poetry of the Times,’ a feature of Psychiatric Times”, which, at the time of publication of this volume he had been writing for 16 years. This—and many more poems in other journals, anthologies, and books— all from a man who began writing poetry in “mid-life”. Evident in the poems in this collection is a person experiencing much more than medical/psychiatric practice, but a full cornucopia of life: his love of art, music, food, nature, and the people he shares this bounty with. The collection, presented in three sections, weaves through all of these rich encounters, with only the final section, the shortest of the three, having more of a focus on family, friends and late of the year poems.

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Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

This is a poem by one physician-poet, Richard M Berlin, a well published psychiatrist in Massachusetts, that celebrates the life and work of another physician-poet, John Stone, and recounts the effects of the latter’s poetry on Dr. Berlin over thirty years. The poem was published twice, once in JAMA in 2006 and again in Psychiatric Times in August 2008, shortly before John Stone died in his sleep of cancer in November.

The poem is 24 lines in free verse with no stanza breaks. As the title indicates, it is an occasional poem. The occasion? Poet A reading the admired work of Poet B, like Keats’s “On First Looking into Chapman’s Homer”. In his poem Berlin commemorates the occasion of his having just read Stone’s 2004 volume of poetry, Music from Apartment 8. The title of Stone’s volume derives from Stone’s mother’s address in Decatur, Georgia. Consisting of five sentences, the poem begins with an account of his reading Stone’s poetry as “a hiker” who stops to “admire the view of snow-capped peaks.” The second sentence records the Berlin’s reflections “three decades later” of Stone and the premature death of Berlin's father. Following this thought, the poet compares Stone’s poetry to the compass his father would have been had he lived longer, Stone’s compass directing him to the possibility of his writing poetry as well, a poetry originating with our patients’ heartbeats. The penultimate sentence is a prayer that Stone is “drinking deep from whatever stream brings you to your knees.” Berlin ends with the further hope that Stone will be able to hear Berlin’s “boots striding behind” Stone’s, “both soles still strong.” There is no published record that I could find that Stone read Berlin’s poem.

In a subsequent essay, Berlin discusses this poem and the history of his relationship to Stone and the latter’s poetry. (1)

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Freud on My Couch

Berlin, Richard

Last Updated: Aug-11-2021
Annotated by:
Davis, Cortney

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

Richard Berlin is the author of two poetry chapbooks and three full-length poetry collections.  "Freud on My Couch," Berlin's fourth full-length collection, consists of 46 poems divided into six sections, and a "Notes" section at the end.  As in his previous collections, Berlin writes as a physician, husband, father, friend, lover of music--and as a man who understands that he and his patients share a common and fragile humanity.

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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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The Empathy Exams

Jamison, Leslie

Last Updated: Aug-02-2021
Annotated by:
Zander, Devon

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

Leslie Jamison starts The Empathy Exams with a quote from The Self-Tormentor by Terence, first in Latin, then in English: “I am human: nothing human is alien to me.”  In beginning this way, she sets up the book to explore the human condition and what it means to relate to one another with caring despite the interpersonal complications that can often arise. Through a series of nonfiction essays (some initially published elsewhere) she explores how we express our feelings and process those of others. To do this, Jamison uses a number of different lenses, large and small, including ultramarathons, immigration, incarceration, a Morgellons disease conference, and more.  

The book takes its name from the first essay in which Jamison juxtaposes her experience as a standardized patient for students in medical school with being an actual patient. She specifically explores the ways in which empathy is created/manufactured and extended in medicine, both from medical professionals and loved ones.

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The Ministry of Bodies

O'Mahony, Seamus

Last Updated: Jul-26-2021
Annotated by:
Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Starting eight months before his retirement, a gastroenterologist chronicles a myriad of encounters between himself and others - patients and their family members, colleagues, administrators, hospital staff, and even drug reps. He has worked for many years at a large Irish hospital dubbed the "ministry." His professional work there is divided between the endoscopy unit (where he performs colonoscopies and EGDs), medical wards, an outpatient clinic, and the ER.

Given his specialty, the roster of patients tilts heavily towards gastrointestinal problems: alcoholic cirrhosis, GI bleeding, chronic diarrhea, and abdominal pain. But additionally, his days are filled with patients presenting with a variety of medical problems including pneumonia, mental health issues, heart failure, serious fractures, dementia, seizures, anemia, and cancer. He attends to many frail elderly folks in the emergency department. His interactions with patients range from intense to jovial, from unexpected to heart-wrenching. For example, a woman with chronic abdominal pain asks the doctor if she might be suffering from PTSD. When asked why she thinks that might be possible, her reply is "My son hung himself. I found him" (p191).

The doctor is beleaguered by frequent, and at times wacky, emails generated by the hospital bureaucracy as well as unproductive meetings. He must cope with his own health problems too (a vitreous detachment, arthritic hands, and unexplained nosebleeds). He decries the "foolishness" of excessive medical testing and overtreatment and cites the case of a young woman with irritable bowel syndrome who already had over 1,200 test results logged in the hospital lab. He describes the ministry as "an oasis of kindness and comfort" but "also a place of chaos and conflict, of institutional cruelty" (p8).

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