Summary:

A group of eight women gather for a joint consultation with Dr. Kailey Madrona who is a devotée and colleague of the research endocrinologist, Dr. Jerilynn Prior, a professor at University of British Columbia in Vancouver. Madrona explains that she has arranged for the unorthodox group encounter because she will be leaving practice to pursue graduate studies in medical history.

Dr. Madrona leads an open-ended discussion on the physiological changes associated with perimenopause. Following the controversial research of Prior, she emphasizes that the symptoms are owing to the unbalanced rise in estrogen levels during perimenopause—a period leading up to the cessation of menstruation and continuing for twelve months after the last flow.

Some women patients are skeptical, because they have been placed on estrogen ‘replacement” medication, or they have read that their symptoms are owing to the waning of estrogen. The doctor describes the results of various trials about supplmentary estrogen, including the 2002 Journal of the American Medical Association report. She invites them to keep detailed diaries of their cycles and symptoms.

One by one the women return for private consultation, physical examination, discussion and another follow up visit. Although they have reached roughly the same physiological moment in life, they are a diverse group with different symptoms and needs. Darlene, an angry nurse, is suspicious and non-compliant. Beverley, an Asian immigrant is still hoping to become pregnant. A lesbian wishes to control her moods and hot flashes. A very hard-working waitress needs to understand her strange lack of energy. A wiry, lean athelete wants to improve her performance and is irritated by the inexplicable alterations in her abilities. Others are plagued by sweats, nausea, or migraines. They all are confused about sex.

Dr. Madrona listens to them carefully, examines them with special attention to their breasts, not their genitalia, and recommends treatment with progesterone for everyone. She also urges weight gain for most and readily volunteers personal information about her own perimenopause. All but the nurse eventually comply and are relieved of their symptoms. At the end of a year they meet for a pot-luck dinner to celebrate their recovered health and thank their doctor. Beverley is pregrant.

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Tracy Kidder met Paul Farmer in 1994 when the former was writing an article about Haiti. They next met again in 1999 but it was only when Kidder expressed an interest in Farmer and his oeuvre that Farmer emailed him back, writing "To see my oeuvre you have to come to Haiti" (17). Kidder did just that, following the peripatetic workaholic Farmer to Peru, Russia, Boston, and wherever Farmer flew, which is anywhere there is poverty and disease, especially infectious disease.

In Mountains Beyond Mountains (MBM), Kidder chronicles Farmer’s childhood, medical school years (almost a correspondence course with Farmer’s frequent trips to Haiti), his founding of Partners in Health (PIH) and the construction of the medical center in Cange, Haiti, where "Partners in Health" becomes Zanmi Lasante in Creole.

The story of Farmer’s crusade for a more rational anti-tuberculosis regimen for resistant TB; his political struggles to wrestle with drug manufacturers to lower the price of these and medicines for HIV; his charismatic establishment of a larger and larger cadre, then foundation of co-workers; the story of Jim Kim, a fellow Harvard infectious disease specialist; Farmer’s marathon house calls on foot in Haiti; endless global trips punctuated by massive email consultations from all over the world; and gift-buying in airports for family, friends and patients--these are fascinating reading. In the end one is as amazed and puzzled by the whirlwind that is Paul Farmer--surely a future Nobel Peace Prize laureate like Mother Teresa--as Tracy Kidder was and grateful to have the opportunity to read about it by such an intelligent writer.

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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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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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This book, designed to accompany an exhibition "on the frequently Excessive & flamboyant Seller of Nostrums as shown in prints, posters, caricatures, books, pamphlets, advertisements & other Graphic arts over the last five centuries," displays and comments on 183 illustrations associated with the art of quackery. As the title suggests, Helfand surveys the graphic material of quackery of England, France, and America during the modern period, although most of the material dates from the eighteenth and nineteenth centuries. In his introduction, Helfand discusses the uncertain boundaries between "regular" (now termed allopathic) physicians and their "irregular" or "empiric" counterparts--quacks.

Through the mid-nineteenth century, many practitioners of both sorts relied on pharmaceutical agents like mercury, antimony, and opium; developed trade symbols and packaging; and flaunted the honorific "Dr." and their affiliation with science. Many patients visited both regulars and irregulars, who might consult with each other. Some physicians even prescribed quacks' proprietary preparations. Helfand also notes differences, such as irregulars' lack of medical training, exaggerated advertising, refusal to disclose the contents of their products, and use of entertainment and sometimes even religion in their "medicine shows."

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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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Among the "scenes from everyday life" which constitute so-called "genre" painting in 17th Century Dutch art, the profession of medicine was often lampooned. In Gerritt Dou’s painting, the doctor is depicted as a deceiving charlatan, marketing his products with impressive but unsubstantiated claims about their effectiveness. In Dou’s hometown of Leiden, with the Blauwpoort (Blue Gatehouse) in the background left, the quack has set up shop outside the studio of a painter. [At the Web Gallery of Art on-line site, select "D" from the Artist Index, scroll down for Dou, select "Page 2".)

The artist gazes out of his window, holding the tools of his trade, a pallet and brushes. Directly beside him the quack stands under a Chinese umbrella, with stopper in his hand, and presents the patent medicine in a large glass vial to his audience. On his table is a document with a large and authoritative red seal, indicating his credentials and bolstering his credibility. On one side is a barber- surgeon’s basin, on the other is a monkey.

A crowd has gathered around, including a huntsman with a dead rabbit suspended on his rifle, a man with vegetables in a cart, and a woman with a pancake griddle and batter in a large bowl in the right foreground; she is cleaning and diapering a child. In the right foreground a woman gapes at the doctor and his medicine, unaware that her pocket is being picked. In front of her sprawls a child who holds a bread crust to bait and capture a small bird. In the left foreground is a tall, twisted and dead tree; across from it at the corner of the artist’s studio is a living tree lush with foliage.

While Nicolas Tulp (see Rembrandt’s "The Anatomy Lesson of Nicolaes Tulp") enjoyed a reputation as the "Vesalius of the North," this painting is more typical of the prevailing popular depictions of the doctor, not just in the Netherlands but elsewhere in Europe and equally subject to mockery and suspicion. At this time medical care was provided by local physicians, but also by traveling barber-surgeons whose skills and knowledge were dubious.

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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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This collection of poems combines mournful reveries of the individual and collective losses of the U.S. AIDS epidemic in the 1980s and '90s with haunting recollections of the losses of childhood. Ghost Letters begins and concludes with poems in which the memories of love and rich relationships interweave with incantations of loss and keen descriptions of caring for the dying. In between is a section of poems that recreate the sweetness and pain of the speaker's childhood and the transformation that his father's death effects on the entire family.

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This is a collection of 91 poems on medical topics by medical students, physicians in training, and attending physicians; two are Canadian and the rest American. The poems are organized by six traditional groups of medical training and advancement in the profession: Medical Student, First Year; Medical Student, Second Year, Medical Student, Clinical Years; Intern; Resident; and Attending. There are no sections for pre-meds, retired doctors, or other programs (naturopath, chiropractor).

The editors have done a good job of picking well crafted and evocative poems. A dozen have been previously published. For the most part, the poems are short, easily fitting on one page. Almost all are in free verse, although there is one group of haiku, one prose poem, and an impressive sequence of ten Shakespearean sonnets “Breughel at Bellevue” by Anna Reisman.

Many poems treat dramatic moments in training: the anatomy lab, first gynecological exams, physician-patient relationships, especially when a patient is gravely ill or dying. Several poems in the first three sections comment on the differences between the normal social world and the intense medical world of the hospital. Throughout there are references to the pressures of high-tech, unfeeling medicine. Indeed Jack Coulehan sounds this theme in his introduction; he writes that "steadiness and tenderness" are both needed in medical practice.

 

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