Showing 41 - 50 of 125 annotations contributed by Shafer, Audrey

Torn

Young, C. Dale

Last Updated: May-25-2007
Annotated by:
Shafer, Audrey

Primary Category: Literature / Poetry

Genre: Poem

Summary:

In this poem, a young male patient receives stitches in an emergency room for a face wound from an alleyway knife fight. It seems the violence involved drugs, as a "broken syringe" is involved in the fight. However, more telling is the label that the ER doctor uses to describe the patient. The narrator of the poem, apparently an exhausted physician-in-training, is told by the ER doctor to quickly "Stitch up the faggot in bed 6."

The narrator meticulously sews his patient's wound, empathizing completely with him: "Each suture thrown reminded me I would never be safe / in that town." He too, could be ripped open "to see the dirty faggot inside." Furthermore, he ruminates that when the perpetrators of such violence themselves become victims, he would also stitch their wounds--silently, carefully, passively, "like an old woman."

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Bedside Manners

Watts, H. David

Last Updated: May-25-2007
Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

The subtitle to this collection of insightful and compassionate essays by gastroenterologist David Watts is: "One Doctor's Reflections on the Oddly Intimate Encounters Between Patient and Healer." Watts provides 48 narratives, most of which concern his patients and are written in the first person. In the preface Watts states "The stories in this book are true" (xv), that he has received permission from his patients, and that he has "disguise[d]" his patients to respect their right to privacy.

The stories cover a range of settings, from Watts's home and locations in the San Francisco Bay area, to the clinic and hospital. They also cover a range of his experience from medical school ("Sylvester" and "Love is Just a Four-letter Word") to his current position as a practitioner and an attending physician at a teaching hospital.

Stories in which Watts clearly situates himself with the patient and details the encounter are most compelling. For example, in the opening essay, "White Rabbits" and later, in "Flu Shot," Watts allows the reader to discover that patience and listening are required to in order for the patient to expose why he or she is truly there. In that space, Watts becomes present for his patient, and one learns that what may initially appear tangential is central to the patient's concern.

Watts writes of some very difficult patients and families, such as a woman who stalks him ("The Stalker's Bridegroom"), a woman who obsesses over caring for her elderly mother ("Home Remedy"), and a woman who demands narcotics ("The Third Satisfaction"). In one of the longer pieces, "Codger," Watts describes an irascible, elderly Jewish patient who skewers just about anyone with his critiques, including Watts's young son, and yet who later exposes his vulnerability by unfolding the tale of his World War II service and discovery of a Nazi death camp. It is because Watts spends time with the Codger and recognizes that the doctor-patient relationship is above all a human relationship that the doctor receives the gift of the story: this terrible experience which informed the rest of the Codger's life.

A few of the vignettes explore the therapeutic potential of poetry. For instance, in "Annie's Antidote" a piano teacher, fearful of endoscopy, asks Watts to recite one of his poems. The poem concerns the tender relationship between Watts and his son and is a metaphor for Watts's patient encounters as well: "for this is one of those moments / that turns suddenly towards you, opening / as it turns, as if we paused / on the edge of a heartbeat. . . " The poem works, the moment opens, and the woman has her endoscopy.

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The Fisherman's Son

Köepf, Michael

Last Updated: May-22-2007
Annotated by:
Shafer, Audrey

Primary Category: Literature / Fiction

Genre: Novel

Summary:

This novel of a commercial fisherman's family centers on the son, Neil Kruger, as he struggles to survive on a life raft after a comber, a huge wave, sinks his boat. The book combines his memories of growing up at Half Moon Bay south of San Francisco--the harsh lessons of the sea, his laconic father Ernie, and a disintegrating family--with the story of the illegal activities that led to this last run and his efforts to live.

Death is ever-present for fishermen. Throughout the book, the intimate killing of fish caught one by one is juxtaposed with the constant threat of human loss due to wind, storm, fog, rock, cold and waves. It is a hard-scrabble existence, as over-fishing, pollution, and price control by a few influential merchants combine to depress the fishing business.

As a boy, Neil is told by his mother not to become a fisherman. But then it is she who commands him to join his father one night. This conflict of loyalties, to the land and the sea, to his mother and his father, to religion with its hope of divine intervention and nature with its insensate brutality, cause a tension in Neil that leads him to reflect on his roles as dutiful son, eldest brother and future fisherman.

Neil's memories contain many traumatic events: the rescue of survivors from a hospital ship sunk in a collision with a tanker, the immigration tales of the tightly knit group of Half Moon Bay fishermen, the attempted rescue of one of these men during a storm, and the misadventure during a fishing escapade with his friends, including a wheelchair bound boy with polio. In addition, Neil recalls his father's worsening debility and subsequent post-operative and post-anesthetic problems. By the end of the book, the time frame of Neil's memories converges with his current crisis and time itself becomes as vast and unknowable as the sea.

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Summary:

This film combines light-hearted scenarios of poor to absurd communications with patients on issues of death and dying, with measured advice from physicians expert in such communications. In addition, a scenario of a woman physician and her patient with advanced breast cancer models a positive example for doctor-patient communication on issues of planning for death and choosing life-sustaining options.

The film opens with a madcap grim reaper dancing and singing a message from Dr. Fletcher to a patient at home: you have six months to a year to live. These same actors morph through a series of roles sprinkled through the film: a physician using medical jargon with a non-comprehending patient, an ad for a phrase book to "speak like a patient," another doctor-patient scene with the physician now graphically describing cardiopulmonary resuscitation using wild gestures, and a waiter advising a patient/patron on item selection from the Terminal Cafée menu (no vegetables!).

The experts discussing death and dying are: Michael Clement, MD; Lisa Capaldini, MD; Doriane Miller, MD; Bernard Lo, MD and Kate Christensen, MD. They offer sage advice on communication, avoidance of medical terminology (even words like 'diagnosis' and 'procedure' can be misunderstood), pain management, informing patients of anticipated poor outcome with cardiopulmonary resuscitation, asking patients what is important to them, goals of treatment, who should make medical decisions, and the setting of such discussions. Cultural sensitivity is briefly discussed, with an emphasis on respecting the patient's individuality rather than assuming a fit within cultural expectations.

The exemplary scenario demonstrates positive qualities and key points: both physician and patient are seated and dressed; the physician asks the patient if she wants another person present for the ensuing discussion and also inquires as to the quality of discussions with the spouse, whom the patient designates as the one to potentially make medical decisions; the specific fears and desires of the patient are sought; and the physician recaps what the patient says and asks her if the summary is correct. In addition, resuscitation is explained in detail. The visit concludes with the doctor encouraging future discussions and allowing decision changes.

The film ends with the finale to the opening scene. The patient slams the door on the grim reaper, who, beset by dogs, returns to Dr. Fletcher and advises the doctor to talk to his patients himself.

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The Vanishing Line

Grainger-Monsen, Maren

Last Updated: May-19-2007
Annotated by:
Shafer, Audrey

Primary Category: Performing Arts / Film, TV, Video

Genre: Video

Summary:

Maren Grainger-Monsen, a filmmaker and emergency medicine physician, chronicles her personal journey towards understanding death and dying as she explores the stories of those near death. The film uses a metaphor of the thread of life, and the three Greek Fates who control life (spinning, measuring and cutting this thread), to interweave Monsen's journey with the lives--and deaths--she encounters.

The film begins with her recollection of two experiences during her emergency medicine training: the first time she is paged to pronounce someone dead and a "crisis point"--resuscitating a patient, brought to the emergency room, who had specifically requested no resuscitation. The remainder of the film focuses on Jim Brigham, a social worker for a hospice program, whom Monsen joins for his home hospice visits and who relates the touching and memorable story of his wife's life and death.

Some of the patients Jim visits are Tex, a man dying of heart failure who had experienced a difficult, scary night; Sean, who has Lou Gehrig's disease and who needs help with paperwork and family concerns; and Anna Marie, who has lymphoma and is taken via ambulance to the hospital for comfort measures. Monsen notes how comfortable Jim is discussing death issues and how compassionate and caring he is with a recent widow in the midst of her "grief work." By contrast, Monsen admits to feelings of helplessness, vulnerability, even terror. She wishes her medical education had not been so devoid of teaching regarding death and dying.

Monsen comments on the wavering line between life and death, and whether the "medical machine" prolongs life or death. She visits a young boy left with severe brain damage following a near-drowning incident and "successful" resuscitation 5 years previously. The boy requires constant care, but his father notes that his son is "doing pretty good."

By the end of the film, Monsen has learned "how to sit with someone . . . while death walks into the room." Death no longer equates with failure. She concludes with her overvoice, "I wonder what it will be like to be a doctor who doesn't see death as the enemy."

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Fieldwork

Hicok, Bob

Last Updated: May-18-2007
Annotated by:
Shafer, Audrey

Primary Category: Literature / Poetry

Genre: Poem

Summary:

Hicok begins the poem with a statement and jocular rhetorical question that set the tone and pace: "There are two kinds of people and five hundred / seventy-one thousand, three hundred / ninety-six species of beetle but who's / counting?" Immediately we wonder what are the two types of people and who would take the trouble to write out a species count while also joking about it.

The engagement with the poem continues as we learn about the narrator's platonic friend, an entomologist, freshly returned from the Amazon with a bottled beetle and a raging fever. The narrator, alarmed at her delusional state, rushes her to the hospital ("driving / in a way that proved you can be / in two places at the same time") and good medical care. After several days she has regained enough strength to say one word--jar--which refers to the jar containing her beetle specimen. The narrator restores the jar to her, she recovers and returns to the life she loves, a life in the treetops of the Amazon jungle.

Through the course of the poem, the poet plays with all manner of philosophy and religion. The beetle's body is likened to Michelangelo's image of the finger of God reaching towards Adam. The poet plays with numbers as well, rearranging the numbers of types of people and beetles (and throwing in the number of "delicatessens where you can get a fried- / tuna sandwich on waffles"). This lightness is a disarming way to shed light on the heart of the poem--the narrator's deep caring for the scientist and the scientist's deep caring for her work of discovery.

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Annotated by:
Shafer, Audrey

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Paul Edgecombe (Tom Hanks) is in charge of death row in a 1935 Louisiana penitentiary. The cell block is nicknamed "The Green Mile?due to its green linoleum floor--the path that an inmate must walk from his cell to the room with the electric chair. Paul, a decent, moral man, treats each prisoner with respect. His life changes, however, with the admission of John Coffey (Michael Clarke Duncan), a huge African-American man convicted of the rape and murder of two young sisters. Despite his powerful build, Coffey is gentle--and possesses a miraculous, mysterious power to heal.

Coffey heals Paul's bladder infection, resurrects a dead mouse, Mr. Jingles, that is the treasure of another inmate, "Del,?and cures the warden's wife of her inoperable brain cancer. Each healing requires direct contact between Coffey and the "patient,?and is accompanied by much electric and mystical effects. Coffey takes the infection, brokenness, disease into his body and is able to expel it, though it exhausts him.

Coffey's powers extend to visions and he directly feels the pain of others. He transmits his visions of the death of the two girls to Paul--who realizes that Coffey is innocent (indeed he had been trying to "heal?the children when he was apprehended) and that another inmate on the green mile is guilty of the crime. Paul, counseled by his supportive wife (Bonnie Hunt), asks Coffey what to do. Coffey, exhausted from suffering the knowledge of the evil of the world and cognizant of his lowly position as a poor black man, asks to have the execution proceed. His only request is to watch a "flicker show.?Paul arranges for him to see a Fred Astaire movie.

The executions are graphically depicted. One is particularly gruesome because of the evilness of the whiny, rookie guard, Percy, who deliberately causes a prisoner (Del) to suffer in the extreme. After giving the orders for Coffey's execution and watching him die, Paul quits his job.

The story is framed by Paul as an old man in a nursing home. Paul "tells?his story to another elderly "inmate?as an explanation for why he was overcome when watching the Fred Astaire movie in the common room. Paul reveals that he is far older than thought possible--as is Mr. Jingles who is still alive six decades later. Paul and the mouse were "infected with life?when touched by Coffey.

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An Uncertain Grace

Salgado, Sebastiao

Last Updated: May-17-2007
Annotated by:
Shafer, Audrey

Primary Category: Visual Arts / Photography

Genre: Photography

Summary:

This powerful book of black and white photographs contains four sections labeled: I. The End of Manual Labor, 1986-, II. Diverse Images 1974-87, III. Famine in the Sahel, 1984-85, and IV. Latin America, 1977-84. In addition, photographs accompany the prose-poetry opening essay, "Salgado, 17 Times," by Uruguayan writer Eduardo Galeano and the concluding essay, "The Lyric Documentarian," by former New York Times picture editor Fred Ritchin. This oversize book concludes with a list of captions for the photographs and a detailed two-page biography of Salgado. Essentially the photographs cover Salgado’s impressive work from 1974-89.

Every image is of a person or people. Many are suffering, many are starving, grieving, keening, dying, displaced. Many are children. Many are laboring under impossibly harsh conditions such as the teeming, mud-coated manual laborers of the Brazilian Serra Pelada gold mine. An Ethiopian father anoints the corpse of his famine starved, skin and bone child with oil. An old man, squinting in the sun, leans over to touch the arm of an equally thin and weak man in a Sudanese refugee camp. Rarely, the people are smiling or celebrating.

The photographs are global: Angola, Bangladesh, Bolivia, Brazil, Chad, Cuba, Ecuador, Eritrea, Ethiopia, Mali, Mexico, Portugal, Sudan, Thailand, and more. As Galeano notes, "This much is certain: it would be difficult to look at these figures and remain unaffected. I cannot imagine anyone shrugging his shoulder, turning away unseeing, and sauntering off, whistling." (p. 7) [156 pp.]

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Annotated by:
Shafer, Audrey

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In October, 1939, Josef Kavalier arrives at the New York City apartment of his cousin Sammy Klayman after an arduous escape from Prague and the Nazi invasion. Kavalier’s escape involved hiding in the casket of the oversized Golem of Prague, and was possible due to his training with Bernard Kornblum, one of the premier illusionists in Europe. Kavalier, the son of two physicians, and older brother to young Thomas, struggles to secure the freedom of his family, and to adapt to his adopted country.

His cousin, Sammy, however, is a first generation New York City Jew, the son of a psychiatric nurse at Bellevue and a fly-by-night vaudeville actor called the Mighty Molecule. Sammy was afflicted with polio as a child, with resultant spindly but usable legs--this later prevents his entry into the armed services after the attack on Pearl Harbor.

Sammy, who changes his name to Sam Clay, forms a partnership with his cousin to create a new kind of comic book, The Escapist, with innovations such as the Luna Moth, a female superhero. Much of the book follows their energies in the comic book industry in mid-twentieth century New York.

Rosa Luxemburg Saks, Sammy and Joe form an unusual love triangle. Rosa is an artist who introduces the cousins to the art culture of NYC, including a visit from Salvador Dalí, whom Joe rescues from asphyxiation in a diving suit during a Greenwich Village party. Joe and Rosa’s relationship, however, is interrupted by World War II, when Joe, devastated by news of his family in Europe, enlists, only to survive again--this time from carbon monoxide poisoning in an Antarctic Kelvinator Naval station.

Meanwhile Sam and Rosa marry to raise her son. Sam, a homosexual at a time when such a designation was largely viewed as a disease and as Un-American, spends much of his life in denial of his yearnings. Nonetheless he is eventually forced to testify to a Senate Judiciary Committee in 1954 on the role of the comic book industry in the trumpeting of male-male relationships.

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Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: History

Summary:

In this account of early practitioners and advocates of 'inoculation,' or the use of tiny amounts of smallpox contagion to induce a mild case of smallpox and immunity, author Carrell weaves prodigious historical research with fictionalized dialogue to create a tale of two prominent figures: Lady Mary Wortley Montagu of London and Dr. Zabdiel Boylston of Boston. Both Lady Mary and Boylston suffered scarring from smallpox, and, by living in the early 18th century, both witnessed the devastation of epidemics in terms of public health and private loss.

Both were also aware of the use of inoculation to prevent severe disease in Turkey (Lady Mary visited with her ambassador husband) and in Africa (on the advice of Cotton Mather, Boylston interviewed Africans, slave and freemen, living in Boston). Both faced formidable challenges and risked personal security to promote the use of this technique. Both proved their belief in the technique by the inoculation of their own children. And both, perhaps, met. At the behest of the Royal Society, Boylston traveled to London, witnessed numerous inoculations, and presented his Boston experience to the Society.

The book also chronicles the natural course of the disease, its various symptoms, forms and popular treatments, and the political impact of smallpox on the royal families of Europe and business interests in Boston. The medical research of various doctors is detailed. In particular, selected Newgate prisoners were offered pardon in return for participation in an experiment conducted by Mr. Maitland, who also inoculated Lady Mary's children. These experiments were used to test the safety and efficacy of inoculation prior to royal inoculation.

Ultimately, detractors of inoculation ceased their vitriolic attacks, as the risks of inoculation were proven to be far lower than exposure without such protection. The success of inoculation paved the way for Edward Jenner, often called 'the father of immunology,' to successfully use cowpox to induce smallpox immunity later in the 18th century.

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