Showing 1 - 10 of 598 annotations tagged with the keyword "Physician Experience"

Queen of the Sugarhouse

Studer, Constance

Last Updated: Sep-14-2021
Annotated by:
Davis, Cortney

Primary Category: Literature / Fiction

Genre: Collection (Short Stories)

Summary:

Constance Studer's engaging "Queen of the Sugarhouse" contains nine short stories ranging in length from 9 to 21 pages, each story complete in itself.  Her nursing expertise is evident in several stories, including "Mercy" (page 3), "Shift" (page 77), "The Isolation Room" (page 95), "Testament" (page 112), "Special Needs" (page 122), and the title story, "Queen of the Sugarhouse" (page 138). 

While many of the stories specifically revolve around medicine or nursing, others examine a variety of issues, often with healthcare peripherally involved. 

In "Shelter" (page 21), a homeless vet who served in the Gulf War struggles with PTSD, the difficulty of obtaining permanent disability, the inability to find work or a suitable living space, and his quest to find treatment for his many physical problems after chemical exposure during Desert Storm.  He sees a different doctor at each appointment and no one truly helps him. "Finding today's meal or bed or beer takes all my energy, leaving me nothing left over for thinking about next week.  I am a veteran and can no longer vote because I have no home" (page 27).  Studer takes us into this man's life and struggles with clarity and empathy.


"Think Beauty" (page 37) questions what makes a woman beautiful (or believe she is beautiful) against a back story examining friendship and all that entails.  "This Middle Kingdom" (page 58) tells a story that encompasses both the heroics of a ski team that saves skiers in distress and how difficult it can be to feel compassion for those who end up in trouble because they flaunt the rules or advice of the experts--a theme quite relevant for our times. 

The book's opening story, "Mercy" (page 3) explores a nurse's various reactions after she makes an error while dispensing medication. As in every story in the collection, multiple themes weave in and out, driven by a character's decision or dilemma.  In "Mercy," we see how medical personnel can truly care for and worry about their patients; how even a small error may cause a nurse deep distress, both for her patient and for her future; how the nursing shortage leads to burnout; and how "real life" continues on in the background, in this case, a passionate love affair that leads both to marriage and to grief.  "Grief is a train that doesn't run on anyone else's schedule" (page 15).

"Shift" (page 76) tells of a physician who is devoted to his work and his patients in the ER ("His white coat flaps, stethoscope bounces as the doctor runs, its weight a comfort, like a rosary for a priest" page 76) while his wife feels neglected.  The story moves between the chaos of the ER and the story of his marriage, a love that began when the doctor was in medical school.  After his wife leaves him, the doctor sleeps with the lights on, hoping she will return.  But whenever he closes his eyes, he only sees scenes from the ER.  The story ends with words the doctor has said so often to a patient: "Please sir, lie still.  I'm going to numb you now.  Hang on, man.  Soon the pain will be gone" (page 93). 

"The Isolation Room" (page 94) follows a woman, a writer, who has been, she believes, placed unnecessarily and mistakenly in a psychiatric ward.  As we read, we wonder if this woman is truly afflicted with a mental disorder or if she is simply extremely imaginative, perhaps betrayed by her husband who arranged for her admission. The main character is likeable, often seemingly sensible, perhaps incredibly but differently talented: "Maybe to be out of her mind meant she'd finally make the leap from logical to intuitive, into her true skin, a room all her own ... a writer, that teller of lies, pursuer of truth by means other than logical, that follower of breadcrumbs through the scary forest wherever they lead?" (page 97).


"Testament" (page 112) follows a student nurse in her first month of training and touches on the care of difficult patients, their various religious beliefs, and how healthcare providers' families are not immune to illness. "Special Needs" (page 121) follows Maria, a waitress with an unexpected pregnancy and wheelchair confined brother. The title story, "Queen of the Sugarhouse" (page 137) is a poignant examination of breast cancer; the terrible trial of chemo and radiation; the complex relationship between the suffering mother and her daughter, a nurse; and how life changes when the drama of uneasy but genuine love and relationship ends.  "I think I hear Mama's voice, then
realize it's only the sound of water over rocks.  Tears are this river carrying me forward" (page 153).


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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 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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Camouflage

Nisker, Jeffrey

Last Updated: Mar-19-2021
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Plays

Genre: Play

Summary:

This short play has three characters: a woman, a man in camouflage, and a second man who turns out to be a doctor. The camouflage man talks on the phone with his unseen wife; he is angry and suspicious of what she has been doing during his absence. The doctor overhears – and thinks about confronting him, but lets it go. The woman is a victim of coercive sex in marriage. She has two places where she can take refuge, if only in her mind:  her garden and an imaginary elephant. The woman’s description of the elephant tells us that she is seeing the elephant as a reflection of herself, and it also reflects her traumatized awareness of the physical changes in her husband’s body as he helps himself to hers.

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Summary:

In this collection of autobiographical essays, Koven contemplates some unique challenges confronting female physicians: discrimination, sexism, lower annual salary on average than male counterparts, possible pregnancy and motherhood. She recalls her medical school and residency experience, describes her internal medicine practice, and highlights her role as a daughter, spouse, and mother.

Worry is a theme that works its way into many phases of Koven's life and chapters of this book. The opening one, "Letter to a Young Female Physician," introduces self-doubt and concerns of inadequacy regarding her clinical competence. "Imposter syndrome" is the term she assigns to this fear of fraudulence (that she is pretending to be a genuine, qualified doctor). She worries about her elderly parents, her children, patients, and herself. Over time, she learns to cope with the insecurity that plagues both her professional and personal life.

Some of these essays are especially emotional. "We Have a Body" dwells on the difficult subject of dying, spotlighting a 27-year-old woman who is 27 weeks pregnant and diagnosed with adenocarcinoma of the lung. "Mom at Bedside, Appears Calm" chronicles the author's terror when her young son experiences grand mal seizures and undergoes multiple brain surgeries for the tumor causing them.

Listening emerges as the most important part of a doctor's job. Koven encourages all doctors to utilize their "own personal armamentarium" which might include gentleness, exemplary communication skills, a light sense of humor, or unwavering patience. She fully endorses a concept articulated by another physician-writer, Gavin Francis: "Medicine is an alliance of science and kindness" (p228).

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Summary:

Doctor’s Choice is a collection of 16 stories by authors from and well known in the early-to-mid 20th century. I offer four summaries of the stories that I am considering using in teaching.

“Rab and His Friends” by John Brown, MD, was originally published in 1859 and is sometimes referred to as young adult literature. It was one of Brown’s most successful works. The story is told in the voice of a medical student, “John”, and begins with his reminiscence of six years earlier when he first met the old “huge mastiff” Rab, and his “master”, a carrier named James Noble. John, who had befriended Rab during medical school, next sees him ‘one fine October day’ as he was leaving the hospital. Rab was with James who was bringing his wife, Ailie, to see a doctor because “she’s got a trouble in her breest…” (p.37). Examination showed no doubt that the tumor needed to be removed. Having survived the breast amputation (without anesthesia and observed by the narrator and his fellow students), four days later Ailie’s delirium set in. With James by her side, and with tender caring, Ailie died a few days later. Soon after James took to bed “and soon died…The grave was not difficult to reopen. A fresh fall of snow had again made things white and smooth; Rab once more looked on, and slunk home to the stable” (p.46). The next week John sought out the new carrier who took over James’s business to ask about Rab. The new carrier tried to brush him off—but admitted he killed the dog, explaining that the dog was inconsolable and that he had to “brain him wi’ a rack-pin….I could do naething else”(p.46). John thought it a fitting end… “His teeth and his friends gone, why should he keep the peace and be civil?”

“Miracle of the Fifteen Murderers” by Ben Hecht, was originally published in Collier’s Magazine in 1943. The narrator of this story passes along a tale he heard from an elderly friend, a physician who was one of 15 eminent physicians that formed a secret group meeting quarterly to discuss the ‘medical murders’ they had committed. The group had been meeting for the past 20 years, but had disbanded due to the outbreak of WWII—“The world, engaged in re-examining its manners and soul, had closed the door on minor adventure” (p.139). The last meeting of the group is the subject of the tale and it describes how the newest member, a young surgeon, tricked the group into providing the diagnosis for a patient this doctor, Samuel Warner, was struggling to care for. Warner explained that his patient—who he had befriended--, a young Negro boy of “seventeen, was an amazingly talented [poet whose work] “was a cry against injustice. Every kind of injustice. Bitter and burning,” (p.149). After working hard for 2 weeks to save his life, and realizing that his diagnosis of ulcerative colitis was wrong, Warner’s scheme (a feigned medical murder) got the eminent physicians to the diagnosis: a fishbone had caused the perforation that was threatening the poet’s life. Grabbing his hat and coat—and after thanking the doctors for the diagnosis- Warner is off to save his patient’s life. A half-hour later, rising to the call as well, the other 14 doctors joined Warner in the operating room to view the life-saving procedure, allowing one of the eminent physicians to remark with a soft cackle, that “the removal of this small object….will enable the patient to continue writing poetry denouncing the greeds and horrors of our world” (p. 154). 

There was no original publication date for “The White Cottage” by L.A.G. Strong, but it has been anthologized since at least 1940. The narrator tells of a visit by a locum town-based doctor to an island nearby to help a woman give birth at her home. The perilous journey from the town to the island with the expectant father and a neighbor as navigators and rowers ends with all thoroughly drenched from a storm after nearly capsizing. Realizing that the doctor has no dry clothes to change into, the couple offers him the husband’s flannel nightgown and a blanket. The doctor, after checking the wife and estimating a number of hours of labor ahead, goes to the living room by the fire. Fearing he’s still chilled, the couple decides to make room in their bed for him. After hesitating for a moment, he climbs in next to the husband. After some small talk and an ‘order’ for the soon-to-be mother to lay on her side and have her husband rub her back, the doctor begins to assess the situation he finds himself in: “Right living was not obedience to rule: it was a balance, renewed each instant, like a tight-rope walker’s, a tension between opposites. Here, for a moment, in this bed, in this cottage, in this tiny focus of life, beneath storm and towering sky, was wisdom. Men did not possess wisdom. It possessed them. Like a light, it flickered here and there over the vast dark mass of humanity, illuminating briefly every now and then a single understanding. Here, for the moment, it possessed him; and by its light he gave thanks, and loved all men” (p. 249). After a successful delivery (and some celebratory drink and breakfast), the doctor was off to his town with a promise to return for a checkup. His new friend demurred. “No trouble man. It’s a pleasure—besides being my plain duty. Mind you, she’ll be right as rain. But I’ll come” (p.252), responded the doctor. After a silent handshake, and suddenly finding “eyes full of tears … he clambered into the boat” (p. 252).

“Doc Mellhorn and the Pearly Gates” by Stephen Vincent Benet was originally published in 1929. The story begins with an in-depth description of a humble, impish (having mastered many diversionary tricks), and independent small town doctor and the place he practices, but quickly moves to much larger realms through Benet’s use of magical realism. Doc Mellhorn has died but has not fully landed in his final destination, heaven, and decides to spend a bit of time in hell first because of the perceived lack of opportunity to practice medicine in heaven (and an off-putting encounter with an overly officious clerk at the pearly gates). When he gets to hell, he gets to work on setting up a clinic—“mostly sprains, fractures, bruises and dislocations, of course, with occasional burns and scalds… [reminding him] a good deal of his practice in Steeltown, especially when it came to foreign bodies in the eye” (p.23). After a number of months, and a confrontation with another officious bureaucrat, Doc got back on the road to his original destination, giving him some time to think about whether he was deserving of that final abode. “I’m a doctor. I can’t work miracles,” he thought. “Then the black fit came over him and he remembered all the times he’d been wrong and the people he couldn’t do anything for” (p.28).  Landing for a second time at the pearly gates, he finds family waiting for him with assurances that there’s more than just eternal peace in heaven. “They wouldn’t all arrive in first-class shape," (p.31) explains his Uncle Frank, assuring him that there will be lots of work for him to do. Uncle Frank also lets him know that a delegation is coming to meet him since Doc had “broken pretty near every regulation except fire laws, and refused the Gate first crack” (p. 32). Then, out of a phalanx of famous doctors (from a list that Doc began to create during his first, shortened visit), appeared—with “winged staff entwined with two fangless serpents”-- his top choice--- Aesculapius. “The bearded figure stopped in front of Doc Mellhorn. Welcome brother, said Aesculapius. It’s an honor to meet you, Doctor, said Doc Mellhorn. He shook the outstretched hand. Then he took a silver half dollar from the mouth of the left-hand snake” (p.32). ….I laughed out loud—and couldn’t imagine a better ending.




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Annotated by:
Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

Pearl, a plastic surgeon and former CEO of a large medical group, writes powerfully and poignantly about the major role of physician culture - the customs and rituals, traits and beliefs of doctors. This culture is entrenched through years of medical training. He decides that physician culture "can be both a virtuous force and an equally destructive influence" (p70).

Some of that culture is readily on display: attire, tools of the trade, unique medical terminology, insensitive humor, frequent handwashing. Positive aspects of physician culture include self-confidence, integrity, compassion, and selflessness. Negative elements are ingrained to keep emotions and dread at bay: detachment, callousness, denial. This culture of medicine must navigate dual interests - healing (the mission of medicine) and profit (income, status, prestige).

Pearl suggests an evolutionary pathway for physician culture that he dubs "the five C's of Cultural Change" - confront, commit, connect, collaborate, contribute. He tackles issues of sexism, racism, and elitism in American healthcare. He explores the suffering of physicians and their need to seek forgiveness - often secretly and even in cases of perceived "failure" when everything possible was done correctly. His discussion is filled with agonizing, frustrating, and loving stories about patients, family members, and colleagues (including physician suicide).

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This is a quick and personal history of the Longwood Symphony Orchestra (LSO), a group of Boston area musicians who, in their working lives, are medical personnel. The first of its kind, there are now several such orchestras across the US and scattered throughout the world, notably in Europe. Lisa Wong, a pediatrician and violinist, tells her own history of medicine and music, including her involvement with the Longwood Symphony Orchestra over some 28 years. Other stories of individual doctor/musicians are threaded throughout the book, giving us a personal look at their interdisciplinary enterprise. While their medical specialties, ages, and backgrounds vary widely, while playing in the orchestra and, various professional ranks aside, they accept the direction of the conductor. While Wong mentions antecedents of medicine and music in ancient times, she chooses Dr. Albert Schweitzer as a patron saint for the LSO.

For Wong and her fellow doctors, there are links between music and healing. Music helps keep doctors (and patients) healthy by calming the heartbeat, relaxing muscles, and lifting the mind (p. 86). Music therapy (the psychotherapeutic use of music) and music medicine (the more general uses of music, often in medical settings) can assist in patient care. For example, a dementia patient named Ruth reawakened upon hearing music. Some patients choose to listen to music in the final days of their lives (p. 184).      

For many doctors, music was an early pursuit. Neurological studies suggest that musical training helps develop “structural brain plasticity” that may show benefits in education and training. By contrast, however, sometimes musicians (doctors or not) develop overuse injuries and need specific physical therapy.           

Music has applications in mental health, hospitals in general, and community partners. The LSO has partnered with some 40 nonprofits in the Boston area. In one example, they helped grow the Asian bone marrow registry from 3,000 to 11,000 people (p. 225). An LSO concert raised $30,000 for the Mattapan Community Health Center in South Boston.  

Lisa Wong was president of the organization for 20 years. She writes, “Music goes a long way to heal entire communities. Social justice and social welfare are important determinants of health. Programs that look beyond the music are truly ‘Healing the Community through Music’” (p. 249). 

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The Beauty in Breaking

Harper, Michele

Last Updated: Sep-18-2020
Annotated by:
Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The Beauty in Breaking is the memoir of an African American physician who, in her own words, has “been broken many times” (p. xiii).  

Despite maintaining a veneer of affluence, the author, her mother and siblings live in constant fear of being battered by her father. Following one particularly vicious attack, she accompanies her injured brother to the local emergency room. That day she serendipitously discovers her calling: “As my brother and I left the ER, I marveled at the place, one of bright lights and dark hallways, a place so quiet and yet so throbbing with life. I marveled at how a little girl could be carried in cut and crying and then skip out laughing” (p. 18).  

Much later, the author (Michele Harper) undergoes a shattering breakup and divorce. She endures disappointments at work, some of which, regrettably, can only be explained by the color of her skin.    

As she picks herself up time and time again, Harper discovers her inner resilience: “The previously broken object is considered more beautiful for its imperfections” (p. xiii). She learns from the experience of her own suffering to develop compassion in her clinical work. The bulk of the Beauty in Breaking is devoted to case studies of the author’s clinical encounters with patients in the emergency room.

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