Summary:

As Audrey Young describes her process of becoming a compassionate internist in a besieged public hospital, she simultaneously argues for turning the hospital's patient care and financial practices into a model for improving health care in America.  Young, a compelling storyteller, first entered Seattle's Harborview Medical Center in 1996 as a third-year medical student on trauma surgery service.  She completed a residency there in general internal medicine and stayed on as an attending for six more years.  She stayed, she tells us, because she met physicians "committed to a vision of equality" who were "the sort of people I hoped to become" (xiii).   She also "fell in love" with "the story of a unique place" (xiii).  Young's stories of that often chaotic place, where ambulances regularly transport homeless, indigent, addicted, and mentally ill refugees from neighboring private hospitals, emphasizes the ways the Harborview staff manages to treat patients with dignity and to choose an ethic of hope in the face of dire circumstances.           

We quickly learn that at Harborview compassion is expressed concretely as actions toward patients.  Michael Copass, known as "the mostly benign dictator of emergency operations," pronounced the core of these actions in what came to be known as his commandments:  "1. Work hard.  2. Be polite.  3. Treat the patient graciously, even if he is not the president of the United States" (9).  Politeness always meant asking "'How may I help you, sir?'" regardless of the patient's social status or addiction history.  Politeness sometimes meant finding a way to reach the patient who regularly threatened the staff.  Young finds ways and creates a therapeutic bond.  But working hard and treating patients considerately also took measurable forms, such as not allowing emergency patients to wait.  Facing a flurry of admissions, the Emergency Department (ED) staff interpreted a young Ethiopian's complaints about pain as a drug addict's ploy.  Because Young glanced at the admissions board and noticed that he remained unattended for three hours--far longer than Copass could tolerate--she jumped into action.  He suffered, she discovered, from a collapsed lung. 

However, Young moves her narrative beyond individual doctor and patient encounters and into the larger, interrelated social and financial structures in which medicine is practiced.  For instance, she links meager funding for drug and alcohol rehabilitation programs with expensive ED admissions and rising healthcare costs.  In the chapter "Bunks for Drunks," Young visits an experimental residence that houses homeless addicts in furnished studios with private baths and cooking appliances.  Although residents can keep alcohol in their rooms and elect not to participate in the home's social services, including counseling, alcohol consumption and ED admissions decrease.  While the chapter points out the cost savings of such arrangements, Young further urges readers to value the dignity residents experience there.

In "Black Friday," Young details the hospital's tense, but ingenious responses to a Mass Casualty Incident, the result of carbon monoxide poisoning, which almost depleted the resources of all of Seattle's medical centers.  The final chapter, "A Vision," outlines how Harborview has tried to succeed as both a charitable institution and a business, as a provider of both indigent and luxury care, with the hope that others will follow the medical center's example.  However, in presenting her recommendations for "health justice," Audrey Young also makes the case that "seemingly ordinary citizens" are implicated in healthcare reform (231).  To enable their informed participation in making changes, Young includes an appendix with further readings and another that lists strategies for effecting reform.  

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Summary:

In 2008, editor and physician Paul Gross launched a new online publication, "Pulse--voices from the heart of medicine" (published by the Department of Family and Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center). This anthology contains every poem and first-person narrative published during Pulse's first year, arranged in five sections corresponding to publication date and not to theme: Spring, Summer, Autumn, Winter, and Spring.  Paul Gross, in his introduction, states "After more than a decade of practice as a family doctor, I came to appreciate that the science I'd learned in medical school, though powerful and useful, was also incomplete . . . . it contained much truth about illness and healing, but not the whole truth" (xvii).  Like many other caregivers, Gross discovered "that writing and sharing my healthcare stories with others was therapeutic" (xviii).  He looked to "Sun Magazine" as an example of how first person narratives, both prose and poems, could turn "hurts and triumphs into something potentially beautiful, funny or moving" (xviii). 

The poems and prose that arrive every Friday online to Pulse's thousands of subscribers (and the selections in this anthology) are carefully screened by the editors according to these guidelines: the stories have to be first-person, and they have to be true, recounting the writer's own experience.  Submissions are accepted from any person involved in healthcare.  The language used must be "clear, simple language.  No medical jargon. No arcane literary devices" (xx).  Gross and his editors decided that Pulse would not be a medical journal nor a literary magazine--its purpose fell outside the perimeters of both genres--and so Pulse, and this anthology, offers work that is, in a refreshing and honest way, different from the slick or more polished poetry and prose that might be found elsewhere.

In reading this anthology from cover to cover, and so from season to season, I found that the poems and prose seemed to fall into several categories: Personal musings, in which authors relate healthcare experiences that engender intimate and revealing narratives about their own lives--among the best of these are "Well Baby Check," p.3; "Finding Innisfree," p. 31; "First Patient," p. 39; "Losing Tyrek," p. 45; "Carmen's Story," p. 62; and "Chemo? No Thanks," p. 106.  Other pieces are commentaries on the other side of healthcare, the one that cries out for reform and affects both patients and caregivers.  Among the best of these are "Redesigning the Practice of Medicine," p. 9; "A Brush with the Beast," p. 22; "Rx," p. 60; "Halloween Horrors," p. 69; and "Brain Cutting," p. 136.

Other pieces are humorous ("Aunt Helen Sees a Ghost," p. 6) or political ("My War Story," p. 11), and many poems and prose pieces speak of patient encounters or about being a patient, some more anecdotal, relating a specific incident that affected the author ("Once," p. 41) and others multi-layered, some relating medical student or intern experiences ("Jeannie," p. 48; "A View from Nepal," p. 87; "Ripped from the Headlights," p. 90; "Snowscape," p. 97; "First Night Call," p. 100; and "Wounded Messenger," p. 114.)  The "category" I found most interesting and most unique are the selections I will call "confessions."  These writings--demonstrating openess and bravery on the part of the authors--tell of regrets, mistakes, sorrows, wrong calls and other mishaps that occur, daily, in the practice of healthcare.  In these, the most human face of caregiving is revealed.  Although most of the pieces in this anthology contain elements of "confession," the most specifically revealing include "Mothers and Meaning," p. 14; "Physician's Exasperation," p. 44; "Confidential," p. 53; "My Patient, My Friend," p. 73; and "Apologies," p. 104.

Editor's note: Coincidentally, a recent relevant paper on confessional writing by physicians expounds further on this topic:"Bless Me Reader for I Have Sinned: physicians and confessional writing" by Delese Wear and Therese Jones (Perspectives in Biology and Medicine, Vo. 53, No.2, Spring 2010, pp. 215-30).

 

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Driving-school instructor Marco (Marcello Mastroianni) feels unwell, especially in the mornings; his stomach swells, and he develops emotional lability. His wife, the hairdresser Irène (Catherine Deneuve), is sympathetic – but only to a point--and insists he seek help.

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The author, a young physician, guides the reader in temporal sequence through her years as a medical student, medical resident at several levels, and into the final days of her formal training. The format of the work is anecdotal, that is, a series of memorable patient encounters that seem to shape the writer's developing attitude toward her chosen profession. The precise time frame of the experiences is not clear, but this is an acknowledged story of growing into the practice of medicine as a trainee at Bellevue Hospital.

In describing her interactions with her patients, Dr. Ofri reveals her own doubts about her ability to accomplish some of the things expected of her as "healer." As she grows more confident with experience, she begins to challenge some of the rituals in which medical education seems mired. Each of the chapters is a self-contained story focused on a particular patient, some of which have been published previously as free standing essays. The composite is the physician-writer's personal narrative of her own growth and change.

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The title refers to a Veteran’s Administration hospital regulation concerning the withholding of full medical benefits if an ailment is not specifically related to military service. In an oftentimes comic battle between the forces of good--physicians and vulnerable patients--and those of evil--the administrators and their minions--the story has currency and direct appeal to viewers.

The Darth-Vader-like administrators are self-serving, inhumane bureaucrats with emotions that run the gamut "from A to B" (Dorothy Parker). Physicians, especially the character played by Ray Liotta, but also his dedicated colleagues, are imaginative and non-rule abiding in their central concerns: the patients. They listen to stories and sympathize; in addition, they turf, lie, steal, and do whatever is necessary to protect, serve, and treat their patients. When the government denies a heart bypass, for example, the docs schedule prostate surgery for the official record and do, instead, the needed heart surgery.

At times, it’s as if the Marx Brothers or the Keystone Cops have donned white coats to sneak around the hospital with patient-centered antics. In the absurd bureaucracy, viewers, perforce, must cheer enthusiastically for the merry band of renegade docs.

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This memoir purposefully intertwines a personal and professional coming of age with the chronic illness that shaped it. Roney's stories of her adolescence, college years, and beyond (she is now a graduate student approaching her fortieth birthday) integrate the story of her diagnosis with juvenile diabetes around age 12 and her changing approaches to living with, rather than simply "managing," her illness.

How diabetes inflected Roney's development as a woman, including such issues as body image; food, eating, and weight; and sexuality and love relationships, is a recurrent focus, with her unsatisfactory relationships with men often taking center stage. One chapter addresses her decision, in the face of fears about blindness, to become a writer instead of a visual artist. Other sections address travel and exercise, both explored as solo experiences and as struggles negotiated in the company of friends and strangers. Roney's experiences with family members and medical professionals in the context of her illness are an occasional focus.

While in most of the memoir Roney positions herself as an ill person in relationships with healthy people, in two sections she explores her relationship to others with diabetes: a woman her own age whose illness has made her completely blind, and her aging cat. Throughout the memoir, Roney moves from her own experience to broader philosophical reflections on the social construction of illness, especially the way that interpersonal relationships shaped by "invisible" disabilities like diabetes reflect cultural beliefs about illness and how it changes personhood.

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James Lang was diagnosed with Crohn's disease in 1996, when he was twenty-six years old. Five years later, however, a particularly severe bout with Crohn's, including a hospital stay, dramatically changed his relationship to the disease. Lang's memoir explores his ongoing relationship to Crohn's disease, both in the context of medical reassessments and diagnostic adjustments and in relation to his personal and professional development in his first year as a tenure-track professor of college English.

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Protagonist Mary Lennox, "as tyrannical and selfish a little pig as ever lived," is nine years old when she wakes one morning in India to an empty house, forgotten by all in the chaos of a cholera epidemic that has killed her pretty young mother, British army captain father, and most of their servants. The novel charts Mary’s removal to England and her physical, psychological, and moral development on the Yorkshire estate of her widowed uncle Archibald Craven, a reputed "hunchback." As part of her own maturation, Mary catalyzes growth and healing in (and between) her mildly spinally disfigured uncle and his "invalid" son Colin.

The secret garden of the title is Mary’s aunt Lilias’s creation. It has been virtually abandoned since the accident that resulted in Colin’s premature birth and Lilias’s death. Colin himself, while overprotected by the servants, is ignored by his depressed father and hidden in the estate. Mary discovers and rehabilitates both the secret garden and her secret cousin with the help of the working-class Sowerby family, including the servant Martha, her brother Dickon (a boy in tune with nature), and their mother Susan. Archibald, travelling across Europe to escape his sadness, is called back to the garden by a dream of his dead wife and returns to find Colin healthy and walking.

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Cortney Davis follows her 30 year career in nursing, from her experience as a student nurse washing a patient's feet, to dealing as a nurse practitioner with life and death issues in an inner city OB/GYN clinic. Her essays present epiphanies where she realizes what is important in a confusing and ambiguous situation, why she writes poetry even though she is exhausted from her daily work in the clinic, why she is a nurse when the job  sometimes seems overpowering and depressing.  The positive connections with patients--through kindness, caring, truth-telling, touch-outweigh the difficulties.  Tedious routines are often transformed by spiritual insights and empathy. And sometimes what seems like a miracle inserts itself in a time of grief. Whether she is talking to a man in a coma or treating a sexually-abused teenager, her focus is on the care of the patient.

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Before Jamie Weisman went to medical school and became a physician she wanted to be a writer. As she struggled to make a career out of writing, she was forced to acknowledge that the obscure, life-threatening condition that had plagued her since adolescence could not be factored out of her plans. Writers don't have easy access to affordable health insurance and her monthly intravenous infusions of antibodies and interferon were very expensive. Yet they were essential to fend off infection, for she had an immune system malfunction.

Of course, finances were not the only reason that Weisman decided to go into medicine. As is often the case, her own experience of illness was an important motivating factor, as was the fact that her father, of whom she is very fond, was a physician. This memoir describes significant stages of Weisman's illness, her interaction with the physicians she consulted, and the issues she grapples with as she pursues her life as a physician, wife, and mother (she graduated from Emory University's school of medicine in 1998 and practices dermatology).

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