Showing 61 - 70 of 437 annotations tagged with the keyword "Professionalism"
Jerome Lowenstein is a nephrologist, author, and founder of the Bellevue Literary Press and the Humanistic Aspects of Medicine Education seminar program at the NYU School of Medicine. In this thoughtful and illuminating book of essays he explores the patient/physician relationship in a world where medicine has embraced technology and scientific advances in the laboratory at the risk of neglecting the humanistic underpinnings of the field.
Dr. Lowenstein graduated from medical school at NYU in the late 1950s and spent nearly his entire professional career at NYU Medical Center and Bellevue Hospital. When he was a resident, long before work hour limits were instituted, the house staff gathered in the cafeteria at midnight to dine on the days’ leftovers. This communal meal “provided a fine opportunity to communicate with colleagues directly, rather than by beeper and phone, about many of the days ‘medical leftovers,’ ” (1) sharing information as well as the frustrations and rewards of caring for patients. “The Midnight Meal” poses the challenge of retaining the core of relationships, both between patient and physician and among colleagues in the rapidly changing world of medicine today.
In the essay, “Can You Teach Compassion,” Dr. Lowenstein tells his readers about the student who responded to the question with “I don’t know if you can teach compassion, but you surely can teach the opposite.” (13) The student was referring to how students become “desensitized” during their clinical years to the suffering of their patients, sometimes to the point of using derogatory terms to describe them. Dr. Lowenstein argues that teaching attendings can and should encourage students to learn about their patients. He writes how he once interrupted an intern who began to present a case by stating: “This is the first hospital admission of this thirty-five year old IVDA.” Dr. Lowenstein asks: “Would our thinking or care be different if you began your history by telling us that this is a thirty-five-year-old Marine veteran who has been addicted to drugs since he served with valor, in Vietnam?” (17) Learning about the lives of their patients, Lowenstein emphasizes, does not detract from the clinical picture, but rather enhances it.
Summary:In this collection of "clinical tales," to use Oliver Sacks' term, Sue Hall, an experienced neonatologist who spent some years as a social worker before medical school, tells a remarkable range of stories about newborns in the NICU and their parents. As memoir, the stories record moments in a life full of other people's traumas, disappointments, anxieties, and hard-won triumphs where her job has been to hold steady, find a balance point between professionalism and empathy as young parents go through one of the hardest kinds of loss. Each story is told with clarity and grace, sketching the characters deftly and offering useful medical information along the way on the assumption that many who read the book will do so because they are facing similar challenges and decisions. Each story is followed by a two- to three-page "Note" giving more precise medical background and offering further resources for those who have particular interest in the kind of case it was.
Summary:It started with a faint. Javier Miranda, a generally healthy 69-year-old man living in Venezuela, attributes his episode of dizziness to the summer heat and humidity. His only child, Andres Miranda, is a physician whose intuition tells him something is seriously wrong with his father. The doctor obtains blood work and schedules a CT scan and MRI of the brain for Javier. The medical work-up reveals rapidly progressing lung cancer with metastases to the brain. Violating his credo of complete honesty with patients, Dr. Miranda lies to his father and reassures him instead. Dr. Miranda's mother died when he was just 10 years old. Now his father's remaining lifespan has dwindled to a couple of months. The doctor must find a way to break the bad news to his dad.
Summary:Parts of medical history read like detective novels. The discovery of the source of cholera by Dr. John Snow in London in 1854 is one of those episodes. The Ghost Map tells the story of Snow's pioneering work in what have now become standard epidemiological methods. Tracing a cholera outbreak to a local pump in a poor section of London involved many door-to-door visits working with people who weren't always cooperative, incurring the suspicion and/or ridicule of both them and the medical professionals with whom he worked. In the course of the story the author offers reflections on the organization of cities and on public hygiene. Snow, an out-of-the-box thinker, also helped develop surgical anesthesia.
In 1974, a student befriends Pärssinen, the gardener of his apartment complex in the town of Turku, Finland. Pärssinen invites him to drink and watch pornographic movies from his extensive collection. One night when both are full of alcohol, the gardener stops a girl on a bicycle, rapes and strangles her, and tosses the body in a lake. The drunken student is a baffled witness. The body resurfaces several months later, but the case is never solved. Her name was Pia.
More than thirty years later, in 2007, another girl, Sinikka, goes missing. Her bicycle is found with traces of her blood right beside the memorial shrine to Pia at the place of her murder. The retired cop, Ketola, is convinced that solving this new crime will also solve the old one.
At the same time, far away in Helsinki, Timo Korvensuo and his wife are entertaining friends. He is a successful real estate agent with a lovely, kind wife and two children, a boy and a girl. News of the missing girl greatly disturbs Timo and he leaves home headed to Turku telling his family it is for business. The reader realizes that Timo must be the unnamed student who witnessed the first murder.
In parallel with the police investigation, Timo’s abject wanderings in Turku seem to be centered on (re-)finding and perhaps outing the original killer. Police discover that Sinikka’s parents are consumed with guilt for the difficulties they have had with their adolescent daughter; they fear she has been snatched, perhaps killed, before they could patch things up. The father is a suspect.
Timo finds Pärssinen again and learns that he is unaware of the copycat crime. The police also also visit Pärssinen as a person of interest, but nothing comes of it. Timo goes to Pia’s mother, still living in the same home, to express his sorrow for her loss.
SPOILER ALERT! Primed by Ketola, Pia’s mother contacts the police. They raid Timo’s home in Helsinki and find child pornography on his computer. They know he cannot have committed the recent crime, but they are convinced that he killed Pia. As the noose tightens, Sinikka reappears alive and well from a hiding place in the forest. She staged the second crime as bait to lure the true killer in a plan she had cooked up for Ketola. Timo commits suicide and the police close both cases, but they are wrong.
Summary:Open Wound is a novel crafted from the extensive documents of an unsettling, little-known, yet remarkable episode in the history of medicine.
The foreground of this painting is dominated by a "pieta" type grouping. One woman hovers closely over what appears to be a dying man, while another comforts a small child. This part of the canvas is underlighted. The colors are rich earth tones. The figures are non-Caucasian.
In the background, in harsh light, is a group of identical looking starkly white men. In fact, their faces are almost skeletal. All are in suits, three are seated, with four others standing behind the seated figures. They look very much like a "tribunal."
In 1953 Alice Neel created a series of ink and gouache drawings depicting the last weeks of her mother's life, which were spent in a New York city hospital. One of these is at the Robert Miller website linked to this annotation. In the drawing, a black nurse comforts a prone elderly lady. The pale hues of the painting--blue, black, white--evoke a somber mood and imply sickness. This sense of despair is augmented by a harsh cityscape background beyond a dark river, which the viewer sees through a window.
Compassion counters these desolate surroundings, however, for a bond is apparent between the nurse and elderly patient. The nurse's hands rest on the patient in a partial cradling gesture, and the trajectory of the lines made by the nurse's arms and hands and the elderly patient's flowing hair establishes a visual and emotional link. The connection between the two figures is supplemented by the thin smiles on both women's faces.
Summary:Mary Sutter has been trained as a midwife by her widowed mother, and has demonstrated an unusual aptitude. She is an eager learner, but her deepest desire is to be a surgeon. No medical school will take her, however. As reports reach her home town of Albany of the escalation toward civil war around Washington DC, and in the wake of a disappointment in love, she decides to board a train and offer her services to Dorothea Dix as a nurse. Though Miss Dix refuses her on the grounds of her youth, Mary finds her way into apprenticeship with a surgeon who, as the numbers of injured climb, needs all the hands he can get. Slowly and grudgingly, he comes to accept her as a competent assistant and, eventually, to teach her as a respected apprentice, and the remarkable companion she has become to him. She learns surgery in the most grueling circumstances possible, amputating shattered limbs of young men, many of whom die anyway of infection or water-borne diseases. In the course of her sojourn in Washington she meets John Hay and, through him, President Lincoln, whose compassionate attention she manages to direct to the dire need for medical supplies. Two men love her not only for her intelligence and courage, but for the passion she brings to the hard-won skill that, though it cannot save her brother from the respiratory illness that is rampant in the camps, or her sister from a disastrous childbirth, saves many lives and makes a wider way for women of her generation who find themselves called to medicine.