Summary:

The description on the cover of this collection of essays states that it is "candid firsthand accounts of the profound experiences that transform medical students into doctors". It is edited by a woman breast surgeon (Susan Pories) who teaches students in the Harvard Medical School Patient-Doctor Course; a MD/MBA candidate (Sachin Jain) who anticipates a career as a clinician , scholar and activist; and a psychiatrist (Gordon Harper) who is director of the Patient-Doctor III course at Harvard. The short forward is by physician-writer Jerome Groopman. The 44 essays are divided into sections by theme: Communication, Empathy, Easing Suffering and Loss, and Finding a Better Way. I found it helpful to read the short biographies of each student in the back of the book, before reading that student's essay.

The diversity of the essayists is very wide which makes for a broad look at many important issues. There are several subjects that we tend to avoid (student response to the nude body, the presence of students when end of life decisions are being made, the tensions between caring for a patient and having to do something which causes pain, trying to think of patients a people as well as complex biomedical problems). One of the editors wishes that the book will help people understand the working of the hospital and the many ways in which new doctors learn. The book is certainly a personal look at the teaching hospital from the students' view.

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This work, originally entitled "Three Women," is a semi-autobiographical story of Willa Cather, her mother and grandmother, four younger children--all boys--the father, and a servant girl, who all lived together in a small midwestern town. The roles of the three women are beautifully described: the gentle grandmother who cared for and taught the children, her daughter, a displaced "southern belle" who was spoiled in many ways but wise and loving with her children, and her granddaughter, a teenager set upon her own needs and ambitions but dutiful toward her family.

Another part of the story is the relationship of this family to a well educated neighbor couple who "kept a tender watch over the comings and goings of the household." It was in their home that the granddaughter found a library she could use and encouragement for her studies. Eventually it was this couple who made it possible for her to attend college.

The gradual, unnoticed deterioration of the grandmother ended with her death. The response of the family to this event is well described. Also the empathic relationship between the grandmother and the servant girl is very poignant. Even the death of a family cat adds to the depth of the story in a metaphorical way.

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In this sequel to his earlier seem-autobiographical novel, House of God, Shem (this time using both his pseudonym and his real name) describes the experience of a physician in the first year of a psychiatry residency in a prestigious private psychiatric hospital. In this first hand account it is assumed that the author is the resident, Dr. Roy Basch; he describes not only his experiences with a variety of patients but also with the other doctors and the staff members of the institution. It is not a happy place and in the telling of the story there is a biting irony and a sense of the absurd.

It is obvious from the first that Dr. Basch is very serious about becoming a psychiatrist but that he is also searching for meaning and connections. He finds that colleagues may often hurt you more than your patients. Another issue addressed is that of competing psychiatric theories, particularly the competition between pharmacologic treatment and psychoanalysis. Issues about drug treatment trials and the questionable way in which they are conducted also receive attention, as does the problem of insurance coverage for hospitalization.

The fact that psychiatrists often specialize in their own defects becomes a reality to Dr. Basch. There are not many exemplary people in this book--hopefully it exaggerates the real situation. There is, surprisingly, a sort of poignant positive ending.

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This made-for cable film is based on the real-life story of Dr. Gisella Perl (Christine Lahti) as told in her autobiographical book, I Was a Doctor at Auschwitz. Originally published in 1948 and reprinted in 1997, the book is hard to find now. The film tells how Dr. Perl, a Jewish Hungarian gynecologist, is imprisoned and forced to be a camp doctor in Auschwitz during World War II.

Dr, Perl lost her parents, husband, and son during the war years. She had to relive her horrifying experiences and difficult moral choices as she faced an immigration panel in the U.S. in order to get her American citizenship after the war. Accused of collaborating with the Nazis, she was eventually exonerated and practiced in New York, later immigrating to Israel where she did important work. There were many other talented women who also fought to live but failed in their quests and Dr. Perl tells of the spirits of these women also.

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Subtitled "What happens when patients find out how good their doctors really are," this article starts with an important statement: "Every illness is a story, and Annie Page's began with the kinds of small unexceptional details that mean nothing until seen in hindsight."

This is the introduction to a look at a child with cystic fibrosis and how her family sought the best care for her.

The author, Dr. Atul Gawande, goes on not only to tell their story but also the story of the way in which the understanding of this disorder has increased and the unusual rigor with which centers that specialize in the disease are evaluated.

He also includes stories of other sufferers to emphasize the importance of surveillance of their care.

These stories allow him to generalize about the way physicians' care is evaluated in general by the public and our medical organizations and how difficult it is to be at the high end of the Bell Curve. The author concludes, "When the stakes are our lives and the lives of our children, we expect averageness to be resisted."

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Gabriel Garcia Marquez was born in 1928 and is best known in the English-speaking world for his novel, One Hundred Years of Solitude, which appeared early in his career in Spanish (1967) and later in English (1970). He was awarded the Nobel Prize in Literature in 1982 and in 1988 published the novel, 0008 (see annotation), which received considerable attention for its evocative story of love and memory.

Garcia Marquez's autobiography is recent (2002, 2003); it covers the first twenty-seven years of his life in Columbia, ending in 1955 when he is sent as a journalist to Geneva to cover the Big Four Conference for his newspaper in Bogota. Although he remained in Europe for three years after that the book does not cover that period.

Garcia Marquez was born in Aracataca, Columbia in his grandparents' home, the first child in a family that grew to include ten younger siblings. He had a hectic childhood being reared by his parents' large extended family, which included several children sired by his father with women other than his mother.

Finances were always tenuous; when he worked as a journalist he was an important supporter of the family. He received a broad classical education at the Jesuit College in Bogota, where he began his writing career. Later he studied law and journalism but did not finish law school. He read extensively from all genres of literature.

Garcia Marquez's family relationships and personal experiences were traumatic in many ways as was the political situation in Columbia. It was a tumultuous initiation to a life of creative writing. His words quoted on the flyleaf describe the book: "Life is not what one lived, but what one remembers and how one remembers it in order to recount it."

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The author comments initially that most physicians become involved in the stories of their patients' lives--as witnesses, chroniclers, and players. He uses as an example the story of a physician's role in the death of Anton P. Chekhov. Another interesting example is the book, A Fortunate Man (see this database), the story of an English country doctor who matures in the profession and comes to recognize the task of the doctor as one to help his patients feel recognized.

Dr. Verghese believes that all patients seen by physicians are in the midst of a story that begins the moment they walk through the portals of a hospital or a clinic. He sees the challenge as engaging the patient and the family in finding an "epiphany," even if that epiphany is simply the understanding that there is nothing more that can be done medically. In his conclusion he says that as physicians we should be ministers of healing, storytellers, storymakers, and players in the stories of our patients and ourselves.

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The author, Samuel Shem, opens these reflections by saying that he was a writer before he was a doctor. His early answers to questions about healing came from stories he read. "Life as it should be in addition to life as it is" became the "motor" of his writing. He loved stories that he heard from patients and the "few humane doctors" he met and decided he would be able to understand people better by writing about experiences with them.

Shem's experience as an intern spawned The House of God (see this database) and he sees writing about his training as an example of the use of resistance when he saw "something unjust, cruel, militaristic or simply not right." He recommends the following to resist the inhumanities in medicine: (1) Learn our trade in the world, (2) Beware of isolation, (3) Speak up, (4) Resist self-centeredness. He says that the healing essence of narrative is in "we," meaning the patient and the physician.

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This film is based on the true life story of Lucille Teasdale, one of Canada's first female physicians. She received many refusals for positions in Canadian hospitals so she joined an Italian colleague to work in a Catholic mission hospital in Uganda. She and her colleague later married and continued their work at the hospital where they trained nurses and doctors, sheltered refugees, and gradually modernized their facilities. They spent their lives caring for the lost, sick, and dying in a world of poverty, tribal conflict, and civil war.

A daughter was born to them. The child resented her mother's commitment to the patients in the hospital. After being sent to Italy for school, she finally recognized her parents' dedication and became a physician herself, working in Italy and helping to support the hospital. Dr. Lucille contracted AIDS from surgical injuries but continued to work until her death in 1996.

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This is an excellent review of the authors' choices of the ten greatest medical discoveries. They arrived at the ten selected after narrowing five thousand or more possibilities down to one hundred and then finally down to ten based on these three components in the field of medicine: 1) structure and function of the human body, 2) diagnosis of medical conditions and 3) treatment of such maladies. Finally the ten selected were approved by four avid and informed physician collectors of rare and important medical publications.

Chronologically, the anatomical observations of Vesalius come first with his publication of the Fabrica in 1543. Harvey's discovery of the circulation of the blood is considered the single most important discovery. Leeuwenhoek gets credit as the founder of bacteriology, but Koch and Pasteur are included in a discussion of this discovery. Jenner gets his just recognition for introducing vaccination and Roentgen for discovering the X-ray beam.

Crawford Long is recognized for the initial use of surgical anesthesia and Fleming for the discovery of penicillin. More unlikely choices are Ross Harrison for tissue culture, Anichkov for the relation of cholesterol to atherosclerosis and Wilkins, rather than Watson and Crick, for the DNA story.

Each chapter describes not only the discovery but also tells the life stories of the chosen "discoverers" and others who contributed to extension and usefulness of the discoveries. The authors conclude that it is not genius so much as curiosity and the ability to conduct methodological investigations that distinguish these men.

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