Summary:

The poet beautifully captures the connection between a successful neurosurgical operation that restores "the jitterbug of impulses" of the brain, with the neighbors' "word of the cure." He likens the neighbors' conversations to "the way, in Montana prairie country, / the first telephones let the local secrets / and sorrows pour through the survey-staked / barbed-wire fences now doubling / as makeshift transmission lines."

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This collection of essays by surgeon-writer Atul Gawande (author of Complications: A Surgeon's Notes on an Imperfect Science --see annotation) is organized into three parts (Diligence, Doing Right, and Ingenuity) and includes an introduction, an afterword entitled "Suggestions for becoming a positive deviant," and reference notes. Each part is comprised of three to five essays, which illustrate, as Gawande explains in the introduction, facets of improving medical care - hence the title of the collection: Better: A Surgeon's Notes on Performance. In typical Gawande style, even the introduction contains tales of patients - a woman with pneumonia who would have fared far worse had the senior resident not paid close and particular attention to her well-being, and a surgical case delayed by an overcrowded operating room schedule. Such tales are interwoven with the exposition of themes and the detailing of the medical and historical contexts of the topic at hand.

The essays, though loosely grouped around the improvement theme, can easily be read as individual, isolated works. The concerns range widely both geographically (we travel to India and Iraq as well as roam across the United States) and topically. For instance, we learn about efforts to eradicate polio in rural south India and the dedicated people who devise and implement the program. Another essay, far flung from the plight of paralyzed children, is "The doctors of the death chamber," which explores the ethical, moral and practical aspects of potential physician involvement in the American system of capital punishment (from formulating an intravenous cocktail ‘guaranteed' to induce death to the actual administration of such drugs and pronouncement of death).

In sum, the topics of the eleven essays are: hand washing, eradicating polio, war casualty treatments, chaperones during physical examinations, medical malpractice, physician income, physicians and capital punishment, aggressive versus overly-aggressive medical treatment, the medicalization of birth, centers of excellence for cystic fibrosis treatment, and medical care in India. The afterword comprises five suggestions Gawande offers to medical students to transform themselves into physicians who make a difference, and by including this lecture in the book, what the reader can do to lead a worthy life.

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This remarkable collection of short writings, introduced by renowned poet Naomi Shihab Nye, who visited the Sutterwriters (of Sutter Hospital in Sacramento, California) to offer a workshop, provides a broad, compassionate, imaginative window into the life inside and around an urban hospital. Patients, staff, and all interested in healing through writing are invited to come and participate-with an accent on the latter: no one is invited who isn't willing to write.

Chip Spann, the editor, came to Sutter Hospital with a Ph.D. in English, and has the privilege of coordinating this fluid community of writers as part of his work as a staffmember. His conviction, voiced in an engaging introduction, is that literature is a powerful instrument of healing--both the literature we read and the literature we create--and that the experience of literature belongs in community. The individual pieces are accompanied by photographs and short bios of contributors.

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Cameron, 18, and her sister Allie, 15, have inherited their father’s large nose. Living in Los Angeles, at the epicenter of the entertainment industry, they are familiar with the social currencies of money and beauty. Their mother, a former film actress, auditioning again after years at home, is exceptionally beautiful. Cameron’s “nose job”—the rhinoplastic surgery her parents arranged for her when she entered high school—has changed her life; it is debatable whether altogether for the better. She is now popular and accepted, but also, after a history of rejection and peers’ mockery, fixated on the kinds of beauty that bring social acceptance. Her interest in photography dovetails with this fascination.

At just the time her parents decide to arrange for a similar “nose job” for Allie, who doesn’t want it, and would rather spend the summer at soccer camp, Cameron decides to use her savings, and her new legal freedom as an 18-year-old, to have breast augmentation. Her parents and most of her friends oppose it, her boyfriend most strenuously, who can’t understand why she would take the risks entailed to do something so clearly unnecessary. As the girls learn, their mother has, at the same time, decided to have a face-lift as a return-to-career move.

Both Cameron and her mother go through the surgery—Cameron at the cost of considerable pain in recovery and aware of the long-term risks and costs. Allie, on the other hand, after coming to know an aging actress who was once a beauty, makes an eleventh-hour decision to refuse surgery and with it, the impossible standards of beauty that seem to her to entrap so many like her sister.

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The Agnew Clinic by Eakins was commissioned by Dr. D. Hayes Agnew's students at the University of Pennsylvania to celebrate the seventy-year-old physician's retirement as Professor of Surgery in 1889. It was unveiled at commencement 1 May 1889. The size of the painting, the largest Eakins ever created, is 84 3/8 x 118 1/8 inches. The artist painted the work in ninety days and received a fee of $750. Its frame carries this inscription in Latin: The most experienced surgeon, the clearest writer and teacher, the most venerated and beloved man.

Dr. Agnew (1818-1892), a Pennsylvania native, was a well-respected surgeon and educator who had served in two army hospitals during the Civil War. He was best known for his competence in removing bullets, but Eakins has chosen to show him performing a lumpectomy or partial mastectomy.

The surgeon is shown standing in an enclosure, having stepped back from the operation. He is lecturing to students, faculty, and spectators seated in the operating theatre. Dr. Agnew holds a scalpel in his left hand. He is wearing a white surgical gown.

Eakins has placed the operating table with the female patient in front of Dr. Agnew. Her hair and face are visible, the ether cone just above her chin. Her right breast and arm are shown; the left breast is being operated on. A sheet covers her lower body. The sheet beneath the patient carries the inscription: University of Pennsylvania. Between Dr. Agnew and the bed we see a closed case holding the sterilized instruments. The anesthesiologist and the surgeons all wear white. Dr. Agnew's nurse, Mary Clymer, stands by the patient's waist. She is dressed in a high white cap, white apron and black dress.

Eakins illuminates Dr. Agnew, the patient and her doctors, and the nurse. The spectators sit in semi-darkness, but they are individualized by face and posture. The painting contains about thirty small portraits of doctors. Most of the doctors and spectators have been identified by name (see site at University of Pennsylvania: http://www.archives.upenn.edu/histy/features/1800s/1889med/agnewclinic.html). Eakins is standing to the extreme right, listening to a doctor who whispers to him. Because of time constraints, Eakins's mini portrait was painted by his wife, the artist Susan Macdowell Eakins.

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Dr. Pauline Chen is a transplant surgeon and hence highly trained in the surgical care of desperately ill patients. She found, however, that although she had intensive and first rate training, time and again the message she received from her mentors and peers encouraged a distance from frank discussions about dying with patients who were clearly dying. Dr. Chen successfully suppressed her urges to reflect on the meaning of illness and death. Years into her training, she finally witnessed an attending surgeon stay with a patient and the patient's wife until the patient passed away. The widow sent a thank you note to Dr. Chen for allowing a "dignified and peaceful death." (p. 101) Chen notes that observing her attending stand with the patient during death changed her profoundly: "...from that moment on, I would believe that I could do something more than cure. This narrative, then, is my acknowledgment to him." (p. 101)

Final Exam chronicles Chen's journey from medical student to attending surgeon and examines her experiences with death and serious illness - of patients, family members, friends. The memoir contains three parts: Principles, Practice, and Reappraisal - each with three chapters. The book is chronologically arranged, beginning with anatomy dissection at the start of medical school and ending with Chen as an attending arranging for hospice, thus honoring a patient's desire to die at home rather than in hospital. Chen skillfully weaves her stories around commentary on the social, cultural and philosophical issues surrounding death and the medical response to death. An introduction and epilogue bookend the text and 46 pages of extensive notes and bibliography complete the book.

Although Chen claims to have slowly and painfully awakened to the fact that patient needs extend well beyond good technical care, in fact one sees Chen emerge as a caring physician even from her initial patient contacts in medical school. Chen speaks more to her role as an Asian-American than to being a woman in a male-dominated field, but she clearly has what it takes to succeed in this extremely competitive field, including a good dose of compulsiveness and an incredible work ethic.

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This 2002 DVD, copyrighted by WHYY in Philadelphia and narrated by Blythe Danner, consists of a one-hour documentary about Philadelphia-born painter, photographer, and sculptor Thomas Eakins (1844-1916) and eight short films about different facets of his life and work. Photographs by and of Eakins, his paintings, letters, and sketches are interspersed with commentary by his biographer Elizabeth Johns, and by art historians and historians. The DVD describes Eakins’s training, art production, and aspects of his personal life.

Eakins was already an excellent draftsman, trained at Central High School in Philadelphia, but he first learned to paint during the three-plus years he spent in Paris at École des Beaux Arts. The practice there was to paint from live, nude models instead of from plaster casts, as was customary in Philadelphia. After Paris, he traveled to Spain where he visited Madrid and Seville. He developed great admiration for Goya, Ribera, and Velazquez. His letters home indicate how much he missed his family, yet also how seriously he worked on his art.

Returning to Philadelphia, Eakins set up his studio in his family's home on Mt. Vernon Street. He spent most of the rest of his life in his childhood home. Eakins painted portraits of athletes, for example, rowers and boxers. He chose sitters skilled in the arts, in medicine, business and industry, and painted family members. He always portrayed people and scenery he knew well, and athletes skilled in sports he himself loved. An excellent draftsman and highly trained painter, Eakins became a popular instructor at the Pennsylvania Academy of Fine Arts.

Pennsylvania Academy of Fine Arts had an institute policy that prohibited the use of live, nude models, especially in mixed classes, but Eakins rebelled against these rules by asking his students to model nude in the classroom and outside. Eakins also modeled in the nude himself. He photographed and painted his students in the nude. He believed that artists must study human anatomy through anatomy lectures, dissection, and observation of the body in motion. He assigned such tasks to his American students. Because of his rebellion against Academy rules, he was forced to resign.

Eakins finished his most ambitious painting, The Gross Clinic (annotated in this database) when he was 31 years old. The work, now recognized as an American masterpiece, was poorly received by his contemporaries. Much of his later production was portraits of people he asked to sit for him, including Walt Whitman. He painted a number of cowboy pictures during his stay at a North Dakota ranch where he was recuperating from depression. He also painted twenty-five portraits of Philadelphia physicians.

The last photo of Eakins in his studio, featured in the documentary, shows him seated with his back to the viewer and surrounded by the many pictures he had been unable to sell or which were rejected by his sitters. Eakins is now recognized as a major American artist, particularly in portraiture.

 

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George Stewart had always loved his best friend's wife, Catherine. After her doctor husband, Jerome Martel, is presumed to have died in a Nazi prison camp, George and Catherine marry, respectful of Martel's memory and mindful of her chronic illness. The central crisis of the story, which is introduced in the first chapter, is the surprising return of Martel a decade after his death.

Martel still burns with the passion for social justice that took him to war in Europe. The long story of their lives is narrated by George through a series of flashbacks and reminiscences, in which Catherine's illness is ever present.

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Canadian surgeon Norman Bethune, 1890-1939, (Donald Sutherland) journeys 1500 miles into China to reach Mao Zedong's eighth route army in the Wu Tai mountains where he will build hospitals, provide care, and train medics. Flashbacks narrate the earlier events of his life: a bout with tuberculosis at the Trudeau sanatorium; the self-administration of an experimental pneumothorax; the invention of operative instruments; his fascination with socialism; a journey into medical Russia; and the founding of a mobile plasma transfusion unit in war-torn Spain.

Bethune twice married and twice divorced his wife, Frances (Helen Mirren) who chooses abortion over child-rearing in her unstable marriage. By 1939, Bethune had been dismissed from his Montreal Hospital for taking unconventional risks and from his volunteer position in Spain for his chronic problems of drinking and womanizing. As his friend states: "China was all that was left." Even there, Bethune confidently ignores the advice of Chinese officials, until heavy casualties make him realize his mistake and lead him to a spectacular apology. The film ends with his much-lamented death from an infected scalpel wound.

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This short novel is the story of one man’s death, starting with his interment at the cemetery, where his daughter and older brother offer reminiscences over the coffin; and then dwelling on aspects of his life within which the seeds of death germinated and grew. The man himself is unnamed—Everyman—and his death is no different than any other. At the same time, this death is different because the dead person’s narrative voice remains behind to tell the story.

As a young boy in his father’s jewelry store, he fiddles around in a drawer of old broken watches that his father has accepted as trade-ins. The boy is a dreamer, an artist. But he goes into the advertising business to earn a living, rather than pursuing his first love, painting. He marries and divorces three times, becomes alienated from his sons by the first marriage, and winds up spending his relatively affluent, but bleak, retirement years in a New Jersey condo, maintaining at least some contact with his daughter Nancy. Meanwhile, his brother Howie becomes a fantastically successful international businessman still married to his wife of 45 years and close to his loving family.

Everyman’s brushes with death begin when he is still a child admitted to the hospital for a hernia repair and his roommate dies during the night. As a relatively young man, he experiences a close call when he collapses and is found to have a burst appendix and peritonitis. Later, he attends his father’s Orthodox Jewish funeral, where the mourners actively bury the coffin. In 1989 he experiences a massive heart attack, followed by coronary bypass surgery. In 1998 he is admitted for renal artery angioplasty. The next year he requires left carotid artery surgery. The next, placement of coronary artery stents. The next, insertion of a permanent defibrillator. Finally, he learns that the right carotid artery has now become obstructed. During the subsequent surgery, he dies: “He was no more, freed from being, entering into nowhere without even knowing it. Just as he’d feared from the start.” (p. 182)

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