Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital

Oshinsky, David

Last Updated: May-08-2017

Redel-Traub, MD, Gabriel

Primary Category: Literature / Nonfiction

Summary:

“Few hospitals are more deeply embedded in our popular culture” than Bellevue, David Oshinsky writes in the introduction to his new book Bellevue: Three Centuries of Medicine and Mayhem at America's Most Storied Hospital. What follows, however, is not just an account of the (in)famous hospital, but a history of New York City, of disease and medicine and of America itself. Thus, the pages of Bellevue take us from Revolutionary War to Civil War, from Miasma Theory to Germ Theory, from the Spanish flu epidemic to the AIDS epidemic and from the disaster of 9/11 to the devastation of Hurricane Sandy. Along the way, the reader is introduced to giants of the medical and political world, many of whom were connected intimately to the hospital. In Oshinsky’s telling, Bellevue is a hospital of firsts. The hospital with the first ambulance corps, first in-hospital medical school, first pathology lab. It is—at the same time—a hospital rooted in tradition. It is startling in reading Bellevue, for example, to realize that halfway through the book, the doctors who are being celebrated as central to the hospital’s longevity still subscribed to Miasma theory and could do little more for their patients than bleed them and give them alcohol. Bellevue is also—and in Oshinsky’s eyes this seems most important—a hospital of immigrants. It was and is, a hospital where those for whom no one else would care could come, where no one would be turned away. Over the years, this has meant that Bellevue has opened its doors to Irish immigrants who were thought to be causing the Typhus epidemic, to Jews who were thought to be causing tuberculosis outbreaks and to homosexuals who were thought to be causing the AIDS epidemic. The demographic of patients who come to Bellevue has changed drastically throughout its history, but the underlying ethos of the hospital has been unwavering.

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I Am Nujood, Age 10 and Divorced

Ali, Nujood; Minoui, Delphine

Last Updated: May-05-2017

Saleh, Mona

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

This memoir follows the journey of Nujood Ali, a young, Yemeni child bride from a rural village. She was later named Glamour's Woman of the Year in 2008.

The memoir begins with Nujood’s escape from her husband’s house and how she made her way—alone—to a courthouse in the country’s capital where she was determined to win a divorce.

Nujood’s father pulled her of school when she was in the second grade and forced her to marry a man much older than she. At this time, the minimum legal age of marriage for girls was 15, but many families—especially in rural areas—continued to engage in marrying off daughters much younger than this. Nujood’s father’s reasoning (which echoes the reasoning of many others who engage in this practice) included having one less child to feed, preventing Nujood from being raped by strangers, and protecting her from becoming the victim of “evil rumors.” (p. 54)

In a practice common in Yemen, her father moreover stipulated that Nujood’s husband would not have sex with her until she had begun to menstruate; the husband did not wait and instead raped Nujood after they were wed.

Throughout the book, Ali and French journalist Delphine Minoui skillfully explain how women are not given choices in Nujood's part of Yemen:

“In Khardji, the village where I [Nujood] was born, women are not taught how to make choices. When she was about sixteen, Shoya, my mother, married my father, Ali Mohammad al-Ahdel, without a word of protest. And when he decided four years later to enlarge his family by choosing a second wife, my mother obediently accepted his decision. It was with that same resignation that I at first agreed to my marriage, without realizing what was at stake. At my age, you don’t ask yourself many questions.”
(p. 23)

Ali was connected with her lawyer, Shada Nasser, at the courthouse, and her case garnered both international attention and outrage. After a hearing, Ali was granted her divorce and took trips out of Yemen, including to the United States, even meeting with then Secretary of State Hillary Rodham Clinton. The memoir ends on a happy note, with Nujood starting her education again, at a new school, and definitively deciding to become a lawyer who is committed to raising the legal age of marriage in Yemen. The authors even discuss two cases of girls who were granted divorces in Yemen after Nujood and were able to use her case as legal precedence.

An article in the Huffington Post explains that while Nujood’s memoir ends on a happy and inspiring note, there is still much more work to be done. It points out that Nujood insisted on remaining in Yemen, while her American advocates believed it would be best for her and her future to remove her from her family. Nujood’s family put pressure on her to demand more and more financial compensation for her international fame. Even though her co-author and other advocates begged her to go to school, she did not complete her education. Her father used a (likely large) portion of her book proceedings to marry a third wife. The most recent update is that Nujood remarried (circumstances and consent unclear) and mothered two daughters of her own.

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The Fall

Singh, Tarsem

Last Updated: May-04-2017

Clark, Mark

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

This film focuses on the interaction between 5-year-old Alexandria and Roy, a Hollywood stuntman in the early days of film. The two are residents of a rehabilitation hospital, and both are recovering from falls they’ve taken: he’s paralyzed from the waist down as a result of a failed stunt; she’s broken her humerus as the result of a fall she’s taken in an orange orchard. (A child in a migrant family, she’s been tasked, at 5 years of age—presumably out of economic necessity—with climbing ladders to pick oranges.) Having accidentally intercepted an affectionate note—Alexandria’s child-missive—meant for the kindly but preoccupied nurse Evelyn, paralyzed Roy befriends the girl and quickly wins her over by telling her the wondrous tale of a masked bandit and his companions, all of whom have been betrayed by the evil emperor Odious, and all of whom are united in their quest for vengeance against the ruler. While Roy narrates the story, we see it take place through Alexandria’s eyes, and the characters she envisions are drawn from people in her life. The role of the heroic masked bandit she assigns to Roy himself, blended to a poignant degree with her deceased father. Alexandria sometimes interrupts and asks questions about or challenges the story’s development, whereupon Roy makes adjustments: it’s clear that the story is a co-constructed project. Roy has, however, become increasingly despondent over his paralyzed condition and over the fact that his fiancée has broken off the engagement as a result of Roy’s condition. As time goes on, Roy uses his unfolding story as a means of manipulating Alexandria to retrieve morphine from the hospital dispensary. He tries and fails to commit suicide with the pills that Alexandria supplies. In the process, he winds up bringing about a severe injury to the child. Filled with remorse and guilt, Roy alters his story such that it can be a source of separation between him and the girl: it becomes cruel and violent, and suggests that the hero is a weak, inglorious imposter who deserves to die. The anguished Alexandria protests, demanding that Roy change the story. Roy refuses, insisting that “It’s my story.” But Alexandria retorts, “It’s mine, too.” And Roy relents. The masked bandit of the story is redeemed, and Roy himself is as well. The film closes first with Roy, Alexandria, the hospital patients and staff watching the film in which Roy’s acting had led to his accident. As the scene approaches the point where the accident had occurred, Roy feels understandable anxiety; but the film has of course been edited. Roy is relieved, but turns to Alexandria, in the hopes that she is not terrified. He finds her beaming. Then the film we are watching, The Fall, shifts to a rapid series of black-and-white footage of stunts—the effect is reminiscent of the love scenes gathered at the end of Cinema Paradiso—narrated by the marveling Alexandria. Each clip features a person in imminent, catastrophic danger—who is then impossibly rescued at the last second by fortunate chance. As Alexandria blows us kisses through a character who is falling backward, we are left in a state of bewildered gratitude over this strange gift of stories we human beings offer each other—stories that assure us over and over again how, confronted with the calamities we see no way of escaping, we are nonetheless saved.

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A Mastectomy: Letter to Esther Burney

Burney, Fanny

Last Updated: May-02-2017

Mathiasen, Helle

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

A rare patient narrative from 1812 describes a mastectomy performed before the introduction of anesthesia. This letter from Frances d'Arblay (1752-1840) (née Frances [Fanny] Burney), addressed to her older sister, Esther, details her operation in Paris by one of Napoleon's surgeons.In her childhood and youth, Fanny Burney moved in the best London society; she was a friend of Dr. Johnson who admired her. She served five years at the court of George III and Queen Charlotte as Second Keeper of the Royal Robes (1786-1791). Fanny Burney married Adjutant-General in the army of Louis XVI Alexandre-Jean-Baptiste Piochard d'Arblay in 1793. He had fled to England after the Revolution. They lived in England and spent ten years in France (1802-1812).Burney's mastectomy took place 30 September 1811. The patient wrote about her experience nine months later. She chronicles the origin of her tumor and her pain. She is constantly watched by "The most sympathising of Partners" (128), her husband, who arranges for her to see a doctor. She warns her sister and nieces not to wait as long as she did. At first resisting out of fear, the patient agrees to see Baron Dominique-Jean Larrey (1766-1842), First Surgeon to the Imperial Guard.He asks for her written consent to guide her treatment; her four doctors request her formal consent to the operation, and she makes arrangements to keep her son, Alex, and her husband, M. d'Arblay, away. Her husband arranges for linen and bandages, she makes her will, and writes farewell letters to her son and spouse. A doctor gives her a wine cordial, the only anesthetic she receives. Waiting for all the doctors to arrive causes her agony, but at three o'clock, "my room, without previous message, was entered by 7 Men in black" (136).She sees "the glitter of polished Steel" (138). The extreme pain of the surgery makes her scream; she feels the knife scraping her breastbone. The doctors lift her up to put her to bed "& I then saw my good Dr. Larry, pale nearly as myself, his face streaked with blood, & its expression depicting grief, apprehension, & almost horrour" (140).Her husband adds a few lines. These are followed by a medical report in French by Baron Larrey's 'Chief Pupil'. He states that the operation to remove the right breast at 3:45pm and that the patient showed "un Grand courage" (141). She lives another twenty-nine years. It is impossible to determine whether her tumor was malignant.

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The Hidden Face of Eve: Women in the Arab World

El Saadawi, Nawal

Last Updated: Apr-27-2017

Saleh, Mona

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Dr. El Saadawi is an Egyptian feminist activist and a psychiatrist who originally published this book in Arabic in 1977. She has had a tumultuous relationship with the Egyptian government and was imprisoned after criticizing former President Anwar Sadat. During her career she worked at several universities in the United States. The Hidden Face of Eve: Women in the Arab World has seamlessly incorporated elements of memoir and critical analysis of Arab culture and Islam. El Saadawi divides the book into four sections: The Mutilated Half, Women in History, The Arab Woman, and Breaking Through. The book opens with Dr. El Saadawi recounting in the first-person her harrowing experience with female genital mutilation (a very common practice in her home country of Egypt) when she was 6 years old. She uses very descriptive, perhaps even graphic language, to describe the experience in all its horror. This early childhood memory sets the stage for the audience to bear witness to all the various types of misogyny that many Egyptian and Arab women inevitably experience.

Dr. El Saadawi then skillfully relates memories of being told, for example, to not ask too many questions because she was a girl, and states that she has never heard the word “bint” (Arabic word for girl) used in a positive fashion. These nuggets of personal experiences are inserted into an overview of the complaints of stifled sexuality and associated sequelae with which her psychiatric patients struggled. She delves into the topics of Islam’s take on non-marital sex, illegitimate children, and prostitution thrown against the backdrop of her personal experiences seeing young, poor girls who work as maids being raped and impregnated by the men of the families who employ them and then being held as the sole accountable party.

After the first section, Dr. El Saadawi broadens her focus to include the status of women starting with Eve (whom the major monotheistic religions, including Islam, believe to be the first woman on Earth). Dr. El Saadawi investigates the historical designation of women as inferior in the Jewish faith and explains that as Christianity and Islam evolved against this backdrop, they also assigned women to a similar status. She insightfully points out how femininity did not evolve independently of society but rather that femininity and a woman’s place in society (all societies) are direct reflections of socioeconomic practices or goals of that society.

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Dear Evan Hansen

Paul, Justin; Pasek, Benj ; Levenson, Steven

Last Updated: Apr-24-2017

Glass, Guy

Primary Category: Literature / Plays

Genre: Play

Summary:

Evan Hansen, an awkward, lonely high school senior, struggles with Social Anxiety Disorder. On the advice of his therapist, he pens supportive letters to himself: “Dear Evan Hansen, Today is going to be an amazing day, and here’s why. Because today all you have to do is be yourself. But also confident.”

Connor, another loner student, picks up one of Evan’s letters and, several days later, commits suicide. When Connor’s parents find the letter, they take it to be their son’s suicide note. Instead of dissuading them, Evan concocts an account of a close friendship with the classmate he barely knew, creating an email trail. Connor’s family swallows the story.

As Evan gains the attention he has always craved and comes out of his shell, he finds that he cannot stop himself. He founds the “Connor Project,” an organization dedicated to preserving his “friend’s” memory where he shares his musings on social media: “Have you ever felt like nobody was there? Have you ever felt forgotten in the middle of nowhere? Have you ever felt like you could disappear? Like you could fall, and no one would hear? ...Well, let that lonely feeling wash away…Lift your head and look around. You will be found. You will be found.” Once Evan’s postings go viral, the Connor Project becomes a veritable industry, with a budget, and fans who look to it for inspiration. As the stakes rise, the Project can flourish only by being fed more lies.

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Infidel

Hirsi, Ayaan

Last Updated: Apr-13-2017

Saleh, Mona

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

This is an autobiographical work that describes the remarkable life of Ayaan Hirsi Ali. The book begins in Somalia, where Hirsi Ali was born and spent the early part of her childhood. It is here that Hirsi Ali discusses the second-class status of girls and the harrowing practice of female genital cutting, which she describes as it happened to her and her younger sister. Although her parents were against the practice, Hirsi Ali undergoes female genital cutting by the arrangement of her maternal grandmother, who states that if the clitoris is not cut, it will grow and end up dangling between the knees of the girl. This situation speaks to the variety of immediate reasons why different cultures engage in female genital cutting. They all revolve, however, around the disempowerment of girls and women and denying their basic human right to bodily integrity and sexuality.

Due to civil unrest, Hirsi Ali and her family move around quite a bit while she is growing up, in places as distant as Saudi Arabia (where Hirsi Ali describes her childhood horror at seeing women clad in all black from head to toe), Ethiopia, and Kenya. Throughout her travels as a child and then a teenager, Hirsi Ali vacillates between being a staunch believer in Islam to questioning her faith, all while experiencing emotional, verbal, and savage physical abuse at the hands of her mother and, at one point, her Qur’an teacher.

The action quickens at an incredible pace when Hirsi Ali’s father and community arrange for her to marry a Somali man who lives in Canada, even though Hirsi Ali does not consent to the marriage. It is telling when, on the day of her wedding ceremony, Hirsi Ali has a normal day at home while her father, her new husband, and the other men in her community have a celebration without her. In the Islamic ceremony, the bride only needs to be represented by a male guardian (father, brother, uncle, grandfather, etc) and does not physically need to be present. Hirsi Ali’s husband goes back to Canada and sends for her to join him. Rather than meeting her husband in Canada, Hirsi Ali manages to make her way to Amsterdam and apply for asylum. It is here that the reader watches Hirsi Ali confront a great amount of cognitive dissonance between what her Islamic upbringing has taught her about right and wrong versus what she personally experiences in the Netherlands,

“The next morning, I decided to stage an experiment. I would walk out of the door without a headscarf. I was in my long green skirt and a long tunic, and I had my scarf in a bag with me in case of trouble, but I would not cover my hair. I planned to see what would happen...Absolutely nothing happened. The gardeners kept trimming the hedges. Nobody went into a fit...Nobody looked at me. If anything, I attracted less attention than when I was covering my head. Not one man went into a frenzy” (p. 195).

Hirsi Ali is forthcoming about having lied on her asylum application to make her more likely to be approved. In the Netherlands, Hirsi Ali works as a Somali interpreter and, against all odds, goes on to attend college and obtain a degree in political science. While all of this is happening, Hirsi Ali is repeatedly impressed by Dutch society in their social order and equality between the sexes. She sees a glaring contrast between Dutch society and the lives of immigrant and refugee communities in the Netherlands. The Dutch, in an effort to be tolerant of immigrants and engage in multiculturalism, allowed Islamic religious schools to be established. Hirsi Ali, however, sees this as a way to sanction the systematic oppression of women in a democratic country.

Hirsi Ali becomes politically active and becomes elected to the Dutch Parliament where she rails against this Dutch practice of allowing old-world religious edicts to coexist in a democratic land. As part of her fight against the sanctioning of hard-line Islam, Hirsi Ali writes a short film entitled Submission (which is the translation of the Arabic word “Islam”) that is produced by filmmaker Theo Van Gogh. The film speaks directly to the oppression of women in Islam. At what is the climax of an already exciting book, Van Gogh is killed by a Muslim man who is clearly insulted by the film. Now, a publicly recognizable figure, Hirsi Ali’s life is in grave and immediate danger, and the Dutch parliament moves her from secure location to secure location (at one point, even as far as Boston) to protect her life. She is temporarily stripped of her Dutch citizenship on the basis of having lied on her asylum application, which effectively ends her political career in the Netherlands. Hirsi Ali then re-locates to the United States.

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Admission, Children's Unit

Deppe, Theodore

Last Updated: Apr-11-2017

Clark, Mark

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

The speaker of this poem is a nurse who is recalling and attempting to come to terms with a disturbing clinical encounter she’d had the week before. (I should note at the outset that there’s no indication in the poem as to whether the nurse is male or female. I choose to think of her as female). What had happened is that a mother had brought her five-year-old son in for treatment, and the nurse’s exam revealed that the child had second- and third-degree burns on his torso—in the shape of a cross. The mother, weeping, confessed that her boyfriend had, as a punishment, applied a cigarette to the child’s body—while the mother had held her son. Seeing the mother’s tears, the nurse considered offering the woman some Kleenex, but could not bring herself to do so. The child retrieved the box of Kleenex, then clung to his mother’s skirt, and glowered at the nurse. Then the nurse had participated with three others in prying the boy away from his mother. In the present of the poem, a week after the encounter, the nurse attempts to deal with the guilt and shame she feels in her failure of professional decorum and compassion—at having failed to rise above her moral judgment against the mother and offer the woman basic human kindness and respect. In confronting the chaos of her emotions, the nurse turns to a story she’d learned in high school: the story of St. Lawrence. The significance of her attempt to think with this story can be overshadowed, for readers, by the intensity of the clinical encounter she recalls; but her endeavor is of at least equal significance as the encounter.

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The Bride Price: A Novel

Emecheta, Buchi

Last Updated: Apr-04-2017

Saleh, Mona

Primary Category: Literature / Fiction

Genre: Novel

Summary:

This is a novel set in Lagos, Nigeria among a polygamous peoples and follows the formative years of protagonist Ibo Aku-nna as she experiences the death of her father, the horror of starting menstruation, and falling in love with her teacher, Chike, of whom the elders in her family do not approve because he comes from a family that was previously enslaved.

Throughout the novel, the reader is introduced to several traditions, which speak to how women are valued less than men in this setting. For instance, when Aku-nna’s father dies, her mother must go through a special procedure for mourning, described here:

“Ma Blackie was to remain alone in the special hut; not until the months of mourning were over could she visit people in their homes. She must never have a bath. No pair of scissors nor comb must touch her hair. She must wear continually the same old smoked rags” (p. 71).

Another tradition is the concept of the bride price, which is the sum of money paid by the groom’s family to the bride’s family in exchange for her hand in marriage. The more valuable a daughter is (whether in appearance or family status), the higher the bride price. Further, if a girl’s bride price is not paid, it was the belief that the bride would die during childbirth.

When Aku-nna is sixteen, she finishes her schooling and learns that she has passed an examination that qualifies her to be a schoolteacher. At the same time, a youth with a limp in her village, named Okoboshi, sets his sights on her to become his wife. His family then kidnaps Aku-nna. When a bride is kidnapped, her bride price does not apply, and it does not have to be paid. Also, if a man cuts away a lock from a girl's hair, she becomes his wife and he, again, is not responsible for paying the bride price:

“Some youth who had no money to pay for a bride might sneak out of the bush to cut a curl from a girl’s head so that she would belong to him for life and never been able to return to her parents: because he had given her the everlasting haircut, he would be able to treat her as he liked, and no other man would ever touch her. It was to safeguard themselves against this that many girls cropped their hair very close; those who wanted long hair wore a headscarf most of the time” (p. 103).

When Okoboshi tries to have sex with Aku-nna, she refuses and says that it is because she has already lost her virginity to Chike, even though she really had not. In disgust, Okoboshi stops trying to have sex with Aku-nna and beats her savagely, vowing to keep her as his wife in name only but then marry other women, whom Aku-nna would have to serve. Through initiative and luck, Aku-nna escapes from Okoboshi’s house and elopes with Chike. Despite how much money Chike’s family tries to pay Aku-nna’s family as her bride price, they will not accept it.

Meanwhile, Aku-nna finds work as a school teacher and Chike is also successful at his work. They are very happy together for a time, and Aku-nna becomes pregnant. She struggles very much with her pregnancy and becomes quite weak as a result. One night, Aku-nna becomes sick and is admitted to the hospital, where the doctor informs her and Chike that she must undergo a Cesarean section and have her baby prematurely. A baby girl is born healthy, but Aku-nna perishes due to extreme anemia, according to her doctor. Thus, the novel ends in confirmation of the superstition that if a girl’s bride price is not paid, she will die in childbirth.

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The Renewal of Generosity: Illness, Medicine, and How to Live

Frank, Arthur

Last Updated: Mar-28-2017

Clark, Mark

Primary Category: Literature / Nonfiction

Genre: Criticism

Summary:

The Renewal of Generosity: Illness, Medicine, and How to Live contemplates the phenomenon of generosity as it is realized in the stories of physicians and patients. For Arthur Frank, generosity is grounded in the willingness of people to give themselves over to dialogical processes of communication wherein participants best realize themselves through relational engagement: generous, dialogical communication leads to a renewal and realization of human being. Health care systems today tend to impede communicative generosity, however, and the result is a de-humanization and de-moralization of both physicians and patients. As a remedy, Frank proposes, first, that we re-figure our conceptualization of the physician-patient relationship—from the economic or business metaphor of “provider” and “client,” we should turn to the metaphorical conceptualization of “host” and “guest,” which clearly has implications for manner of treatment and communication that occurs in the relationship. In addition, Frank turns to and thinks with stories of physicians and stories of the ill to reflect on the ways that generosity is realized. Drawing on the wisdom of the striking philosophical triumvirate of Marcus Aurelius (Stoicism), Mikhail Bakhtin (Dialogism), and Emmanuel Levinas to amplify the reflections emerging from the physician and patient stories, Frank ultimately proposes “exercises” for training to generate a vivifying generosity within the medical profession, which can in turn lead to a re-humanization and re-moralization for physicians, improved care for patients, and enhanced flourishing for all.

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