LitMed: Literature Arts Medicine Database

Letter to a Young Female Physician: Notes from a Medical Life

Koven, Suzanne

Last Updated: Feb-26-2021

Miksanek, Tony

Primary Category: Literature / Nonfiction

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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The Winter Soldier

Mason, Daniel

Last Updated: Jun-20-2020

Field, Steven

Primary Category: Literature / Fiction

Genre: Novel

Summary:

When The Winter Soldier opens, Lucius Kszelewski, youngest son of a patrician Polish family living in Vienna, is on a train bound in the dead of winter for a field hospital in the Carpathian Mountains. It is 1915, and Austria-Hungary is at war with Russia. Lucius, a medical student, has completed only six semesters of medical school, but World War I has intervened, and due to a shortage of physicians in the army the government has decreed that students may graduate early, become doctors, and immediately be commissioned. Lucius has done so and is on his way to Lemnowice, a Galician village, where he believes he will work with other physicians and finally learn to be “a real doctor.”

When he arrives, he finds that the hospital is an expropriated village church overrun by rats and ravaged by typhus, and he is the only physician. The hospital is run by a nun, Sister Margarete, assisted only by orderlies, and the patient load runs the gamut from fractures and gunshot wounds to gangrenous legs and massive head trauma. The front is only a few kilometers away, and the wounded arrive continuously; the quiet and formal Sister Margarete confidently and surreptitiously guides him through rounds, surgeries, and battlefield medicine. Lucius is initially wary of her, perhaps a bit awed by her, and ultimately falls in love with her.

The transforming event is the arrival of the winter soldier, Jozsef Horvath, brought in from the snow mute and shell-shocked, but with no visible wounds. Lucius is fascinated by diseases of the brain and mind, and this patient presents a tremendous challenge. Lucius is sure that Horvath has “war neurosis,” what the British physicians of the time were calling shell shock and what we today would call PTSD, and he is determined to understand and heal him. Lucius and Margarete make slow progress with their patient, but his attempts to care for Horvath have unintended effects, and Lucius must then deal with the consequences of his actions.

The war, and the hospital routine, go on. One day, while Lucius and Margarete are relaxing in the woods, Lucius asks her to marry him. Margarete runs off, and Lucius returns to the village, but Margarete is not there. While Lucius and the staff search for her, Lucius gets lost; he stumbles onto a battlefield and is dragooned into service with a regiment of the Austrian infantry. He escapes and tries to make his way back to the field hospital, and to Margarete, but Lemnowice has fallen to the Russians. The hospital has been evacuated—and Margarete has disappeared. Lucius’ search for her will take him across the war-torn remnant of the Empire.

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The Eye in the Door

Barker, Pat

Last Updated: Jun-08-2020

Field, Steven

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The Eye in the Door is the second volume in Pat Barker’s Regeneration trilogy (the first and third volumes, Regeneration and The Ghost Road are also annotated in this database). It continues the story of Dr. William Rivers and the soldiers he treats for shell shock, what we today would call Post-Traumatic Stress Disorder, in World War I era Britain. The action has now shifted from Craiglockhart War Hospital, near Edinburgh, to London; and while Rivers remains a primary character, seeing patients now at a London clinic, this volume focuses on Rivers’ relationship with Billy Prior, an officer who was treated at Craiglockhart after a service-related nervous breakdown.

Billy Prior, released from service on the Front and now serving on “home duty,” is working in the Intelligence Unit of the Ministry of Munitions, a domestic information-gathering and surveillance unit. England, on wartime footing, is rife with paranoia and conspiracy theories, and the primary objects of state surveillance are two groups of people felt to be disloyal or untrustworthy: conscientious objectors, or “conchies,” and homosexuals, who are seen as both abnormal and subversive. The state is unremitting in its hounding and pursuit of these two groups, and is in fact “the eye in the door,” always watching and ready to pounce.

Although Billy is an officer and has a position in the surveillance apparatus, he is living a double life, and is doubly at risk in this environment. He is bisexual; the book opens with him failing to complete the seduction of a young woman and promptly thereupon having a liaison with a fellow officer whose wife and children are out of town. This officer, who also works in the Ministry, has been vaguely threatened about his association with the presumed network of homosexual subversives. In addition, while Billy is not a pacifist, he has friends from his childhood in working-class northern England who are conscientious objectors. These friends may or may not have participated in terrorist activities, are either currently in jail or wanted by the police, and are no surer than Billy is as to exactly whose side he is on.

Prior plays a dangerous double game, attempting to use his position in the government to help his old friends, and continuing treatment with Dr. Rivers, as his past psychological traumas continue to intrude upon, and complicate, his personal and professional lives, building to a powerful conclusion.

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A Constellation of Vital Phenomena

Marra, Anthony

Last Updated: Jan-12-2020

Field, Steven

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Anthony Marra’s debut novel (published in 2013) is set in Chechnya, the rebellious Caucasus republic that broke away from Russia in 1994, was in short order mired in two wars thereafter, and ultimately lost its independence and was re-incorporated into Russia as a semi-autonomous “federal subject” state. Marra does not ease us into his story, but propels us headlong into it; it is 2004, and eight-year-old Havaa awakens to find that her father Dokka, suspected of aiding Chechen rebels, has been taken away by Russian troops, who have also burned her house to the ground. She is alive only because Akhmed, her neighbor and her father’s friend, has spirited her out of her house in the middle of the night and hidden her in his. Akhmed takes it upon himself to protect Havaa; he knows that the soldiers will be looking for her, because even though the official wars are over, Chechnya remains in the midst of a brutal battle for control, and the policy of the state is to “disappear” not only those it perceives as its enemies, but also their family members.

Akhmed manages to get Havaa to the abandoned local hospital, where he believes she will be safe. The hospital is staffed only by a smart, tough, and competent surgeon named Sonja, assisted by a nurse. Sonja is an ethnic Russian from the area who trained in London and then returned to her homeland. She agrees to shelter Havaa on the condition that Akhmed, who trained as a doctor but is painfully aware of his inadequacies in that profession (he wanted to be an artist), stay on also as her assistant surgeon. Soldiers and civilians on both sides arrive in need of care in a hospital barely functioning, with little in the way of staff or supplies.

Sonja meanwhile is searching for her sister who has disappeared into the chaos of the Chechen wars; she believes that Natasha is alive, but hasn’t heard of her, or from her, in years (we will, in the course of the novel, hear Natasha’s story and learn of another side of the underbelly of this war). She comes to believe that Akhmed may hold a key to Natasha’s whereabouts, and Sonja of course holds the key to whatever measure of safety exists for Havaa—and thus for Akhmed as well. Other locals, a local Chechen historian, his turncoat son, and various governmental and non-governmental functionaries round out the cast in the novel. Akhmed must negotiate in a world where anyone could be an informer, and one person clearly is; where the price for falling into the wrong hands could be death or worse; where federal troops and rebels vie to outdo each other in brutality; and where the rest of the population spends every waking minute simply trying to survive in a lawless society and a landscape gutted by ongoing strife. When the various narrative arcs ultimately link up the ending is a powerful one.

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The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science

Jain, Shaili

Last Updated: Jun-19-2019

Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

A psychiatrist and PTSD (post-traumatic stress disorder) specialist, Dr. Shaili Jain has written a book on PTSD and its many angles, from diagnosis to treatment to a larger perspective on cultural and historic influences on the development of traumatic stress. She weaves the story of her own family’s experience with the Partition of India and Pakistan in 1947, particularly its effect on her father and grandparents, as a way to consider the effect of trauma on family, but also how those traumas become ‘unspeakable.’

A brief but effective introduction outlines the seven parts of the book:
1. Discovering Traumatic Stress: historical perspective and the changing language to describe the effects of trauma.
2. The Brain: the physiologic and psychological underpinnings of PTSD, including effects on memory formation and retrieval.
3. The Body: such as addiction, cardiac effects and concerns at different stages of life.
4. Quality of Life: domestic and sexual violence, socioeconomic factors.
5. Treating Traumatic Stress: programs, treatment strategies and psychopharmacology.
6. Our World on Trauma: global health, large scale tragedy, terror and war.
7. A New Era: An Ounce of Prevention: resilience, accessibility of care including early and preventative care.

Additionally, almost 100 pages of notes, glossary, resources and an index provide an easy way to further explore, to use the book to look up specific topics, and underscore the heavily researched nature of the text. The book is eminently readable, with numerous, well-placed stories of patient encounters and particular experiences and manifestations of PTSD. These stories are illustrative of the concepts Jain ably explains. However, they also provide an insider’s view of what happens in the consulting room. In the prologue, Jain describes a young Afghanistan War veteran, who has been hospitalized after a violent outbreak at a birthday party: “Josh’s PTSD was fresh, florid, and untreated…. His earlier poise caves in to reality, and his face falls to anguish.” (p. xvi) We are in the room, listening to the patient, witnessing the tears of the medical student, glimpsing the attending psychiatrist’s response, and relating to Jain, as a psychiatry chief resident, as she understands that the individual before her, even as he shows classic signs of traumatic stress, remains an individual, a person in need of care.

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Frankenstein in Baghdad

Saadawi, Ahmed

Last Updated: Apr-19-2018

Galbo, MA, MILS, Sebastian

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Hadi, a junk dealer and storyteller of Baghdad’s Bataween neighborhood, scans the scene of a suicide car bombing. Hadi collects more than rubbish: amongst the smoke, dust, and the bloody debris of human bodies, he stoops to pluck the remnants of a nose from the wreckage, wraps it in a canvas sheet, and leaves the scene. Curating the remains of human bodies blasted asunder by suicide bombs, Hadi sutures bloody remnants to form a complete corpse, stowed away in his crumbling flat.

Necromania is far from the reason Hadi pursues his gory task: “I made it [the corpse] complete so that it wouldn’t be treated as trash, so it would be treated like other dead people and given a proper burial” (27). The nose from that day’s bombing was the crowning remnant that perfected the corpse. The corpse comes alive and exacts a series of perverse murders. It is rumored throughout the city that the mysterious corpse—or the “Whatsitsname” or “Criminal X,” as it is dubbed by the Iraqi Tracking and Pursuit Department—is a ruthless superhuman. Hadi’s Frankenstein stalks the streets of Baghdad to slaughter the murderer responsible for each limb comprising its body, justifying the killing spree as a “noble mission.” It realizes that, before it can destroy its final victims, the organs and limbs of its putrid body begin to rot.

Requiring new hands and eyeballs, the Baghdad Frankenstein must obliterate more people for fresh parts. The Whatsitsname realizes the corporeal conditions of his bloody mission: “My list of people to seek revenge grew longer as my body parts fell off and my assistants added parts from my new victims, until one night I realized that under these circumstances I would face an open-ended list of targets that would never end” (153). To survive, the corpse becomes entangled in an ever-widening web of killings.

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I Have a Rendezvous with Death

Seeger, Alan

Last Updated: Feb-12-2018

Duffin, Jacalyn

Primary Category: Literature / Poetry — Secondary Category: Literature /

Genre: Poetry

In Flanders Fields

McCrae, John

Last Updated: Feb-06-2018

Duffin, Jacalyn

Primary Category: Literature / Poetry

Genre: Poetry

This Side of Doctoring: Reflections from Women in Medicine

Chin, Eliza Lo

Last Updated: Nov-09-2017

Ratzan, Richard M.

Primary Category: Literature / Nonfiction

Genre: Biography

Summary:

This Side of Doctoring is an anthology published in 2002 about the experiences of women in medicine. While the essays span multiple centuries, most are from the past 50 years. They reflect on a multitude of stages in the authors’ personal and professional lives. In 344 pages divided into twelve sections, including "Early Pioneers," "Life in the Trenches," and "Mothering and Doctoring," the 146 authors recount - in excerpts from published memoirs, previously published and unpublished essays, poems and other writings, many of them composed solely for this collection - what it was then and what it was in 2002 to be a woman becoming a doctor in the U.S.. All but a handful of the authors are physicians or surgeons. There is a heavy representation from institutions on both coasts, especially the Northeast. Four men were invited to reflect on being married to physician wives. There is one anonymous essay concerning sexual harassment and a final essay from a mother and daughter, both physicians. Beginning with the first American female physicians in the mid-19th century, like historic ground-breakers Elizabeth Blackwell and Mary Putnam Jacobi, the anthology proceeds through the phases of medical school, residency, early and mid-careers, up to reflections from older physicians on a life spent in medicine. Many of the authors have names well known in the medical humanities, including Marcia Angell, Leon Eisenberg, Perri Klass, Danielle Ofri, Audrey Shafer, and Marjorie Spurrier Sirridge, to mention a few.

The essays and poems and letters have, as a partial listing, the following subjects: family influences in becoming a physician; professional friendships; marriage; children and their impact on a woman’s career in medicine; the decision not to have children; ill family members; illness as a physician; establishing one's sexuality as a physician; struggles with male physicians and their egos; mentors, both female and male; memorable patients (often terminal or dying); the life of a wife-physician, or mother-physician; the guilt and sacrifice that accompany such a dual life; the importance - and easy loss - of personal time or what internist Catherine Chang calls “self-care” (page 334). The anthology also touches on how women have changed the practice of medicine in various ways, prompted by the growing realization, as family practice physician Alison Moll puts it, "that I didn't have to practice in the traditional way" (page 185) The authors write about the wisdom of setting limits; training or working part-time or sharing a position with another woman; and the constant face-off with decisions, especially those not normally confronting an American man becoming a doctor.
One conclusion is evident before the reader is halfway through the book: there are many approaches to becoming a fulfilled female physician including finding one’s identity in the field. Implicit in most of the essays and writings is the lament from obstetrician-gynecologist Gayle Shore Mayer: "Where is the self ? There are pieces of me everywhere", (page 275) recalling a similar cry from Virginia Woolf's Orlando, another essentially female soul trying to find what Richard Selzer has called "The Exact Location of the Soul". Several authors discover that female physicians have unique gifts to offer their patients. As internist Rebekah Wang-Cheng writes, “I am a better physician because I am a mother, and I know because of my experiences as a physician that I am a better mother.” (page 151)

There are sections at the end devoted to a glossary for the lay reader, resources for women (as of 2002), and generous notes about the contributors (which section also serves as a useful index of each's contributions).

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The Wound Dresser

Coulehan, Jack

Last Updated: Nov-23-2016

Shafer, Audrey

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

The collection is prefaced and named for a poem by Walt Whitman, The Wound Dresser, annotated in this database by Jack Coulehan. In “On Reading Walt Whitman’s ‘The Wound Dresser’” Coulehan sees Whitman as a nurse tending the Civil War wounded, and, while using some of the words and language of Whitman’s poem, imagines himself moving forward in that created space of caring for patients: “You remain / tinkering at your soldier’s side, as I step / to the next cot and the cot after that.” (p. ix) The poem introduces us to all the ‘cots’ of the book – where we step from patient to patient, through history and geography, and through the journey of medical training. The book is comprised of 4 sections without overt explanation, although there are 4 pages of Notes at the end of the book with information about select individual poems. In general, the themes of the sections can be described as: 1.) clinical care of individual patients and medical training; 2.) reflections on historical medical cases, reported anecdotes or past literary references; 3.) meditations on geographically distinct episodes – either places of travel or news items; and 4.) family memoir, personal history and the passage of time. Many of the poems have been previously published and a few are revised from an earlier chapbook. Notable among the latter is “McGonigle’s Foot” (pp 42-3) from section 2, wherein an event in Philadelphia, 1862 – well after the successful public demonstration of anesthesia was reported and the practice widely disseminated, a drunk Irishman was deemed unworthy of receiving an anesthetic. Although it is easy to look back and critique past prejudices, Coulehan’s poem teaches us to examine current prejudices, bias and discrimination in the provision of healthcare choices, pain relief and access to care. There are many gems in these 72 poems. Coulehan has an acute sensibility about the variety of human conditions he has the privilege to encounter in medical training and clinical practice. However, one of the standouts for me was “Cesium 137” based on a news report of children finding an abandoned radiotherapy source (cesium) in Goiania Brazil, playing with the glowing find and suffering acute radiation poisoning. He writes: “the cairn of their small lives / burst open…their bodies vacillate and weaken / hour by hour, consumed by innocence / and radiant desire.” (p. 68). Following another poem inspired by Whitman, Coulehan concludes the collection with a sonnet “Retrospective.” He chronicles a 40-year career along with physical aging, memories of medical training “etched in myelin,” and the search for connection across that span of career including, “those he hurt, the woman / he killed with morphine, more than a few he saved.” Ultimately, he relies on hope with fitting understatement: “His ally, hope, will have to do.” (p. 97)

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