Thoughts on Rachel Cusk’s A Life’s Work

(by Conor O’Donovan, first-year med student, TCD)

Author

• Rachel Cusk, born in Canada in 1967.
• Spent most of childhood in Los Angeles.
• Moved to England where she finished her second-level eduction in a convent school.
• Read English at New College, Oxford.
• Has written several works of fiction, and won literary prize for some of them.
• Praised as one of the most promising young contemporary writers.

A Life’s Work

• Published in 2001.
• Whether it was the author’s aim or not, this book provides a sympathetic voice for those whom she believes do not have confidence in their own intuition in dealing with the mental and physical anguish involved in pregnancy and childbirth.
• She wishes to share her experiences of this time in her life, as she goes through them, for the benefit of those in a position of fear, similar, perhaps, to her own:

◦         “For now, this is a letter, addressed to those women who care to read it, in the hope that they find some companionship in my experiences.”

• The book was criticised for being almost too harshly honest and giving what many regarded as a very bleak outlook on motherhood.
• What is undeniable is that Cusk presents the darker, more frightening and grim aspects of her experiences. Her perspective is shaded with fear of pain and change, and marred throughout by feelings of self-doubt and inadequacy. She feels isolated, as if she is alone in going through her experiences, both physical and psychological.

Fears

• What is clear from the first few paragraphs is that Cusk recognises a permanent barrier between mind and body. These are two separate, independent entities that she strives to maintain in such a way, as if to say that by doing so she can keep each in order and under control.
• Soon comes her realisation that a reconnection between these two parts of her is to be forced upon her by her pregnancy and the incumbent birth of her daughter. It is beyond her control, not to mind her choice:

◦         “In pregnancy, the life of the body and the life of the mind abandon the effort of distinctness and become fatally and historically intertwined.”

• Another thing that becomes glaringly obvious from the first few pages is Cusk’s fear of the pain involved in the impending labour and parturition. What makes this fear worse is the fact that she, somewhat guiltily believes herself to be incapable of dealing with the pain when it comes:

◦         “I would feel not only pain but terror that I had felt it, that I had registered an injury so small when the fact of this great and mysterious agony lay so immovably in my future.”

• I get the feeling from some of the words she uses, that Cusk may not have planned the pregnancy. Quite apart from considering it as an act of her readiness to move on to the next stage in life, as I imagine having a child would be for many women, what comes across from the author is that she feels the pregnancy was forced upon her, that it was not of her own conscious volition that she undertook the challenge of procreating. She uses the unusual metaphor of a prison to describe pregnancy, and what is particularly worrying is the way she equates giving birth to escaping from the prison:

◦         “Knowing the pain which every inmate must endure as a condition of their release.”

Later she remarks:

◦         “My sex has become an exiguous, long-laid, lovingly furnished trap into which I have inadvertently wandered and from which now there is no escape.”

• One of the conditions of carrying a child that Cusk finds particularly difficult to manage, or get her head around, is the curtailing of her independence of mind and body that accompanies it. It is as if she must reshape herself to fit the mould of expectant mother, and this, for her, is too much of a challenge to readily do. Cusk clearly values her freedom of spirit, and she deals with hostility toward anything that impinges upon this right of hers. An interesting point to note here is the way that the processes of motherhood are traditional, they have been handled in a similar way for years and that Cusk is becoming part of this legacy, whether she likes it or not. She calls it “The biological destiny of women”. She is essentially powerless to alter its course, “as if I had boarded a train”, she writes.

Metaphor

• Cusk enters into a four-page metaphor about a walking holiday in the Pyrenees, that I feel encompasses each of the points I have made up to now. She likens her pregnancy to a mountain and giving birth to climbing down from its summit. We could draw parallels between this idea of a mountain and Cusk’s view of her own body, but we won’t go into that.
• The challenge she feels in returning to her much-loved state of distinction between mind and body comes across in her saying “I cannot reconnect with my route without going all the way back down the mountain”.
• This also brings to mind the point that Cusk feels the pregnancy forced upon her. The task of descending the slope is one that she in a sense did not choose.
• Her fear of the pain that childbirth will bring is evident in the words:

◦         “Like a stone I begin to skip and bounce, cartwheeling in the air. I am, I realise, utterly unprepared to meet pain, even though I know that very soon I will probably break my neck.”

• Despite the fact that she seems to value her independence highly, it comes across that when she is faced with having to climb down the mountain by herself, without any direct help, but only instruction, this realisation of having an utterly personal challenge ahead of her is frightening:

◦         “Filled with self-pity, I am angered that he does not intend to take me down himself.”

Changes

• The cognitive changes Cusk expects in herself: the intuitive responses that should give her confidence in her ability to handle the approaching childbirth do not come, and this frightens her.
• She only sees the physical changes that occur in her body, as she “become[s] a cocoon”.
• The season changes to winter, and as the physical changes of her pregnancy continue, we get a hint that Cusk is suffering symptoms akin to those of seasonal affective disorder:

◦         “Winter draws in. I begin to feel a more or less constant despair at my predicament. In the mornings, when I wake up, I observe the rising mountain of my stomach and have to fight surges on intense claustrophobia.

• One of the things that affects her more than anything else is how her pregnant state has become an excuse for people to invade her personal space. She can no longer be anonymous, insignificant, or free to act and think as she would like to, under normal circumstances. She says:

◦         It is the population of my privacy, as if the door to my room were wide open and stragers were in there, rifling about, that I find hard to endure. … I am not living freely but in some curious tithe.”

• The author feels insulted in a way that others can take advantage of the obvious nature of her condition to infer information about her. It is one of those things that impinges on her sense of freedom, and thus she finds it hard to tolerate.

Natural Birth

• In the midst of all the pregnancy literature she must sift through, she finds a concept that is immensely attractive to her, i.e. that of natural birth. In what I feel is Cusk’s attempt to shrug off “the disempowerment” she feels, she clutches to the idea of going without medical intervention in her daughter’s birth. By taking an active step out of her own conscious intention, she can comfort herself that she is retaining some sense of her own free will.
• What is attractive to Cusk is the thought that natural birth “doesn’t hurt”. She likes the idea that “Pain… has been created by its expectation”. If she ceases to expect the pain, then she will not have to suffer it.
• Also, it seems she is taking some consolation in the fact that, as far as I can tell, natural birth is a concept promoted and practised by women. There is a hint of feminism in Cusk’s denouncing of the role men have to play in the abstraction and dramatisation of childbirth. According to the house of thought that supports natural birth, it is men who conjure up all the ill feelings of pain and risk during labour:

◦         “as long as you realise that hospital is a place where MEN are, and hence that as soon as you set foot in one your chances of artificial rupture of membranes, chemical induction of labour, electronic foetal monitoring, stalled labour, epidural, paralysis, forceps delivery, Caesarean section and the need for the baby to be artificially respirated afterwards are greatly increased.”

• It becomes clear that Cusk’s push for a natural birth at home is little more than another attempt to avoid the pain that she so fears. The little potential for comfort she may have gained from the prospect of having a natural birth is weak and her hopes are transient. It isn’t long before her hope is easily crushed by more reason to fear pain, as she eyes the midwife’s toolkit sitting menacingly in her bedroom.

◦         “In its dense, concentrated blackness, like a bomb, I see a long moment of forestalled horror, of disbelief, of dammed-up but pressingly, explosively imminent reality.”

Birth

• Again, we see the hint of seasonal affective disorder, as spring comes and she expects this to bring with it a sense of readiness for the birth that is no longer very far away.

◦         “The year is creaking on its hinger: soon it will open and let in the light of spring. I have been waiting for this light as for the signal of my readiness, but it never comes.”

• In the midst of the panic surrounding the discovery of the reverse-oriented placenta, Cusk sees her daughter’s face, and for the first time the thought of the foetus as another, real human being enters her head. The prospect of being obligated to remain in hospital and undergo intense medical intervention terrifies her, and she flees the building.

◦         “I am told I must now remain in hospital. Rebelliously, desperately, I discharge myself and go home.”

• In the author’s description of the obstetric ward and her encounter with the consultant obstetrician, the Caesarean section procedure is likened to the removal of a growth or a cyst, without, perhaps, giving the event its due significance.

◦         “I ask whether the baby is ready to be removed and am assured that it is. He has delivered babies like kittens, like feathers, like thoughts, babies that hardly exist.”

• During, the procedure, Cusk undergoes what could be considered an assault, though she has come to the somewhat apathetic conclusion that there is now no point in putting up a defence, since this would be futile, similar to every other effort she has made to maintain her own sense of well-being and autonomy in this pregnancy.

◦         “Now that I have been given a day, an hour and a demarcated sphere of anxiety, I grow mute and limp with acceptance. … I don’t know to which front to send my defences, where to concentrate my powers of endurance, and so I give up and hang my head.”

• The moment when her daughter is taken out of the womb and begins to breathe is beautifully described by the author, though there is little of the emotion and sentiment that one might expect. It is as if the beginning of her daughter’s life is a sort of celestial event or change in the universe that occurs. There is no reference to the biological importance of the event.

◦         “Some transfer of significance has occurred: I feel it, feel the air move, feel time begin to pour down a new tributary. The world adjusts itself.”

• At this point, we see the only mention of the baby’s father in the whole chapter. He is not referred to as husband, partner or any other term that may hold emotional significance for Cusk. It opens up again the idea that the baby was forced upon her, as if the pregnancy was unplanned, a task to be faced by her and her alone, without the help of the father.

Style

• Makes a great argument for the point brought forward at last week’s session, that much of our communication is done by metaphor and simile, where words are used that mean something entirely different, with the intention of conveying a particular slant on a topic. Cusk frequently does this, to great effect, I believe:

◦         “I fear my soul is being uncaged and allowed to fly away.”

• Her tone is predominantly devoid of positive emotion, preferring to dwell on the more sinister, harmful and threatening aspects of what she describes. Although she tells us intimately of the fears she suffered throughout her eight months of carrying the foetus, there is no reference made to any joyous spin on things. Even the jokes she makes are delivered in a cold, dry manner.

◦         “If you’d been born a hundred and fifty years ago, he says, you’d be dead by now. I reply that most people would and he laughs uncomprehendingly.”

• Most of the events of the pregnancy are narrated in the active voice – “I make”, “I say”, “I feel”. I believe this accentuates the fact that the book is a recount of her experiences, as she underwent them, and not simply a bare telling of the facts of what happened to and around her during this time of her life.

 

Thoughts on An Insistent Tide story by Vincent Lam

(by Ian McBride, first-year medical student TCD)

An Insistent Tide is a short story about one woman’s journey through the final stages of child birth and how situations changes quickly and don’t always go according to plan.

We join Janice in a dream just before her water’s break. She is dreaming she is lying on a beach with water flowing around her thighs. At first she seems at peace in a trance like state but then begins to feel pain as her uterus expels the water as series of “waves”. A bird fly’s high over head, its spirit is described as rising which perhaps represents the foetus about to become a baby. This dream as well as the later ones shows how the mind is in tune with the body.

She is awoken by a call from her husband, when she tells him her waters broke he seems hesitant to accept this, suggesting she gets a plumber. Then when she says she is in labour he asks “Why do you say that?” suggesting she doesn’t know her own body. We feel as if the relationship between the two isn’t very close. I would expect as a woman approaches birth of her child it would bring partners closer together.

Next Janice arrives at the hospital where she is examined by her doctor, called Dr. Ming. Janice seems to have respect for Dr. Ming as she seems relaxed in her presence. We see Janice is a little annoyed with Dr. Ming’s vague answers when she replies to how long labour will last when she says “That depends”.

When she thinks back to the books about pregnancy she read, she refers to them lie exam preparation, showing that a few months ago giving birth seemed like a distant event and she was more concerned with her day to day living. This is completely understandable considering all the other changes she would have to adjust to. Sections which bored her at the time now seem very relevant.

When Janice goes for her ultra-sound she describes the equipment as a “wand” implying it is like magic, while words like “hissed” suggest a more sinister side to the equipment. We then are once again reminded of the distance in Janice’s relation with her partner when she forces “a casual disregard for her husband’s absence” when Dr. Ming asks about his absence. This distance is almost painfully echoed when she refers to being able to contact her husband in North America as giving “the illusion that he was nearby”. When Janice says she has to go as the contractions get worse Oliver asks “Did you bring the champagne?” which really makes one question his priorities and concern for his wife.

Janice then enters another dream, this time induced by laughing gas. Once again she is on a beach but there are two birds this time. We sense something is wrong when the fish start to nip furiously at her thighs. Suddenly one bird appears to collapse and the other dives after it. The one who fell most likely represents her child whose face she felt she should recognise while the second one was Dr. Ming who is trying to save her child. This is confirmed when she wakes up to find Dr. Ming trying to find out why the unborn child’s heart rate is dropping. For me this really shows the fate Janice has in Dr. Ming when she knows in her dreams Dr. Ming will come to help as soon as her body feels the child is in danger. This shows once again that mind and body are intertwined with each other.

Yet conscious Janice still doesn’t seem to recognise that something is wrong when she remarks naively “That’s wonderful” to Dr. Ming’s comment that she can feel the umbilical chord. Eventually she the gravity of the situation hits her when she realises her baby will suffocate. Dr. Ming seemed to want her to figure this out for herself instead of telling her straight away. This highlights that doctors sometimes have difficult things to say and they need to develop ways of dealing with this.

Dr. Ming decides instantly that a Caesarean section is required. Janice is shocked by the sudden change in plans, she had always imagined thing to go gradually wrong. This shows how health care staff always have to be prepared for the worse. Janice was shocked by how a simple decision changed so much for her.

Janice shows remarkable control when her husband calls asking about videos at such a crucial time yet she just  tells him  to get them if he wants as she does not want to burden him with news of the current incident.

As Janice is whisked towards the Caesarean Section room she is told “everything will be fine” but Janice sees this as just a mantra that they would say no matter how things were. As she passes other rooms she hears women grunting and men shouting “Push, Push”. This reminds her and us that every minute of everyday new children are being born and women becoming new mothers.

When she reaches the room we sense an element of desperation on the team as they try to get an anaesthetist. Yet no matter how many times they are paged they do not turn up. This shows the understaffing that is present in many hospitals and reminds us that the staff are human and can’t be everywhere at once.

We once again see that Dr. Ming is very experienced when she spins into her gown. While previously we saw that the mind and body are closely linked she is still unable to stop the contractions and her baby from crushing the umbilical cord. She feels hopeless, describing herself as “dissolving into this table”. Yet suddenly survival instinct seems to take over her when she shouts “you don’t need the anaesthetist”. Dr. Ming looks shocked yet relieved that she is now able to do the procedure despite breaking away from normal practice. Janice almost instantly questions her decision but it has been made. She is then dosed with morphine, injected with the local anaesthetic lidocaine and her skin is frozen. Through out the procedure Janice issues a series rhetorical questions trying to distract herself from the pain. She seems to become separated from her body as she hears herself screaming as if from the outside.

She then enters another dream in which a “gravity lower within her … had been removed” but it is replaced with pain. She wakes to see herself being stitched up with the “movement of a bird’s nest-building”. This image is poignant as if her womb is getting ready for the next child whenever it may come. The story ends with Janice no-longer feeling pain.

 

Thoughts on Sherwin B Nuland’s How We Die

(by Jamie Peoples, first-year medical student, TCD)

-          From the start, the author sets out in stark terms the threat posed by stroke – 1/3 die, 1/3 left severely disabled

-          Engages reader by opening with a personal account stroke and it’s risk factors – “sedentary Jewish ladies”

-          Alludes to articles purpose – discussion of how elderly people die- “risk is 30x as great”

-          Discusses mechanics of stroke – defines as “deficit in neurologic function resulting from a decrease in blood flow through some specific artery supplying the brain” – “completion of atherosclerotic process” – “embolus (propelled up) into the brain plugging an already compromised vessel” … Here he invites the reader to see the common thread between stroke and many other causes of death – Ischemia – NYC chief Med. Ex. “every case …the underlying physiological cause is a breakdown in the body’s oxygen cycle.”

-          Occlusive stroke contrasted with haemorrhagic stroke- 40% mortality, ¼ of all strokes, with elderly cases typically due to hypertension

-          Importance of oxygen to the brain – Neuronal sensitivity to Ischemia – “within 15 to 30 minutes of the onset of deprivation” irreversible destructive changes begin

-          Cerebrovascular diseases make up range of commonest killers of elderly

-          Disagreement between (in general) statisticians/ lab-based doctors vs. Author and geriatricians – does life have its natural limits, beyond which people die even without disease/accident?

-          Dr Leo Cooney “ we wish to improve Q.of.Life, not prolong its duration”

-          Evidence from elaborate studies suggest “aging process goes on”

-          Author argues for appropriateness of classifying “Death form old age”

-          Frequent references throughout literary history suggest humanity’s longstanding awareness of this state of affairs e.g. Homer:  “As one generation flourishes, another decays,” Thomas Jefferson: “When we have lived our generation out, we should not wish to encroach on another.”

-          Process of replacement evidently is necessary in nature

-          Mechanism is currently unknown, though two main theories are “Wear and Tear” and “Genetic Tape.”

-          Former postulates that continual progressive damage to cells and organs by toxins, pollutants, microbes etc (or random DNA transmission errors) results in the cell being less able to transmit DNA to its daughter cells.

-          Latter proposes that aging process is dictated by genetic factors, laying out a “sequential program” which progressively shuts down necessary physiological functions, which perhaps occur at different rates in different individuals.

-          Genetic tape argument strengthened by Hayflick’s research, demonstrating orderly process of cell death in fibroblast cells. Also, humorous reference to “picking the right parents” alludes to a statistically significant correlation between parent and child age of mortality.

-          Various other factors also suggested, e.g. Lipofuscin, hormonal changes, cross linking of collagen etc. Apoptosis could also play role, and its process of initiation translation into protein of the myc gene is suggestive of an analogous “Death gene” with a wider remit

-          85% of aging population die of 1 out of 7 conditions : Decreased resistance to infection, mentally depressing states like Alzheimer’s + dementia, hypertension, atherosclerosis, adult onset diabetes, obesity or cancer

-          Frequently more than one factor is present at time of death, and the author personally asserts that these conditions are commonly seen by pathologists.

-          The author conducted research into 23 patients dying after the age of 84, and reports that he observed common failings & overall deterioration which amounted to a loss of vitality occasioned by starvation and suffocation of the tissues (common thread of atherosclerosis, either cardiac or cerebral.)

-          Author comments that death among the elderly is not a result of discreet disease but rather the inevitable consequence of a “progression called aging.”

-          Author hypothesizes there may be a common cause for all these interrelated conditions, and envisions the hypothalamus, which allows adaptation to environment by metabolically regulating  growth and development, could cause eventual aging

-          We are presented with a clinical circumstance, in which we are invited to question whether or not intervention should be attempted if the patient has underlying non-fatal, but possibly related condition. Author suggests examining various rates and extent of progression is desirable for the best outcome.

-          Author hypothesizes that life has a finite length therefore, of around 100-110 years, which is our species-dependent lifespan. Though life expectancy has increase, the author contends that maximum possible life expectancy has remained constant at this level, for example citing the oldest confirmed human being 114 years old.

-          Different apparent maximum lifespans in different species appear to be inversely proportional to the number of offspring, with the longer time for offspring to mature a potential factor in human longevity.

-          Desire to prolong life is evident throughout history, a mission characterised by the author as “those who persist in seeking the fountain of youth.”  HOWEVER author maintains that we should be replaced as part of the natural order “eyes of youth (allows for)…everything constantly being seen anew.” Tennyson is evoked to further this point: “old men must die; or the world would grow mouldy and would only breed the past again.”

-          In the author’s opinion, we should not attempt to persist beyond our given time, because the author feels this places an unacceptable emotional burden on relatives and financial burden on public resources.

-          Moreover, for the author, it is life’s very finiteness which gives impetus to attempt rewarding endeavours, and believes the natural order gives the framework necessary to evaluate our relationship with the generations which follow us

-          Closing his article with a quotation from the French social philosopher Michel de Montaigne (“the utility of living consists not in the length of days but in the use of time”), the author invites us to the conclusion that knowledge of life’s end is what confers the value of time and life.

 

Screening of a film based on Bulgakov’s Notes

On Tuesday 23rd of this month at 8.15pm, as part of the Dublin Film Festival there’s a screening at the Light House cinema of Aleskey Balabanov’s take on Bulgakov’s Notes of a Young Doctor. It sounds very gruesome (“Sick-bags at the ready” is how the blurb opens), but if any of you are interested in going, let me know and I’ll book a bunch of tickets so we can go as a group.

See this article for more information >>> http://www.kinokultura.com/2009/25r-morphia-ob.shtml

 

Thoughts on Mikhail Bulgakov’s Country Doctor’s Notebook

(by Kristine Sjaastad, first-year medical student in TCD)

The author`s name is Mikhail Bulgakov. He was born on May 15 1891 in Russia. Although he has a medical degree, he worked most of his life as an author and director in Moscow`s artistic theatre. He is known for fantastic and honest motives, sartiric comments, and hidden critisism to economical and political situations happening in the Sovjet Union at the time he was alive.

Main caracter is driven to the hospital, Muryvo hospital.

The first thing that strikes me is the environment: It is dark, wet and cold. he describes himself as paralized, cold, regretfull and frightened. The bulding is “peeling, with windows black as gravestones”. I notice that he is comparing his future home to a cemetary.

His colleagues are very proud of the clinic, and the last doctor working there, Leopold Leopoldovich. This is where I see his first true insecurity about himself, as he resents this admiration they have for him, as he realizes what he has to live up to.

The second insecurity is the constant fear of a hernia of any kind, how he struggles to remember what to do if this was to happen. He thinks of himself as a sham, a pretender. He is also scared of not being successful.

1 peak:

The first patient comes, and its nothing like a hernia. The patient is a young girl who needs an amputation. He gives orders in voice that is not his own, clearly showing a different personality now, the more clearheaded doctor in himself taking control over the situation. However, during the prosess, he is still not confident, and hesitates about if it was the right desicion. Even when the patient has recovered a few months later, and his sucsess is a fact, he fears the hernia.

2 peak:

A young girl has diphteria, and her throat is completely blocked up. Her mother has kept her at home for five days, something that sets the doctor out in a rage. Again, he arranges a tracheotomy, in a voice not like his own. Again his insecurity is clear in his head, his hesitation and doubt over own actions. The other operation is also successfull, and people gain a huge respect for him.

There are three things that stands out for me reading this short story, all of them are worries or thoughts that I have had about the world of Medicine, and working as a doctor. First of all, it is the way he seems to appear a lot more confident than he is. You need to do this to create a trust between yourself and the patient and people affected, but sometimes you dont have a clue about what you are doing. This seems to me very difficult to act out. Secondly, I notice the way blame is placed to clear  concience. He is thinking “please dont die here so that I can come out of this with some credit”. In the Norwegian hospitals, the ranking of power creates an “all man for his own” attitude that demands everyone taking full responsibility over all actions. He gets angry with the monther and tries to tell her its her fault. “What more can I do now?” “Why is she dying? I can`t prove that she would have died anyway”  Thoughts like that scares me a little. Will I be thinking the same, or will I be sad that a four year old girl is dying?

the third thing standing out is the universal case of sleep deprivation in the medical world. He is tired when he arrives and exshausted at the end. I find it interesting to see that this has not changed, although the story is written a hundred years ago.

 

Thoughts on Joyce Carol Oates’ story “Angel of Mercy”

(by Cillian Keogh, first-year medical student, TCD)

The story revolves around two nurses, from different generations, whose paths and duties intertwine. The paragraphs of the passage meander, forming a link between the nurses from the beginning.

The first nurse we are presented with is an anonymous “striking blonde girl” named R-. She is the most modern of the protagonists, living in the 2000s.

The other nurse featured is the “red-haired” Agnes O’Dwyer. She is also given the alias ‘Angel of Mercy’ because of the heinous acts she committed in the 1960s.

The ‘Angel of Mercy’ sees herself as a heroine, a panacea for all the patients’ illnesses. She heals them by killing them, ‘giving them mercy’.

 

Ireland as a patient …

… and politicians as the doctors (Martyn Turner cartoon on front page of Irish Times)

http://www.irishtimes.com/newspaper/images/2010/0205/frontpageimage.jpg?ts=1265370033

 

The Blizzards ‘Trust Me I’m A Doctor’ lyrics

(As mentioned by Professor Onora O’Neill in her Swan lecture the other night >>>)

I love my friends cos they’ve got no standards,
Morals or ethics in the quest for braggin’ rights.
We take a plane to a foreign country,
Loaded with [booze] and a head of white lies.
Trust me, trust me, I’m a doctor.
Trust me, trust me, I’m a doctor.
I know, I know what I’m doing.
I know, I know what I’m doing girl.

Numb and imune to my advances -
Calls for a plan of radical action.
We are a team here, and it’s simple,
Back each other up when these girls ask questions.
Trust me, trust me, I’m a doctor.
Trust me, trust me, I’m a doctor.
I know, I know what I’m doing.
I know, I know what I’m doing girl.

[She hears what], what she wants to hear,
Yeah, whisper in her ear that anything could happen.
You’ll never see this girl again, she’ll just disappear,
No-one gets hurt and we all have a nice time.
Trust me, trust me, I’m a doctor.
Trust me, trust me, I’m a doctor.
I know, I know what I’m doing.
I know, I know what I’m doing girl.

Trust me, trust me, I’m a doctor.
Trust me, trust me, I’m a doctor.
Take me, take me back to your place.
Take me, take me back to your place.
Don’t say “no sir” [that's not a reasonable] reason.
Don’t say “no sir” [that's not a reasonable] reason.

 

In the papers

Doctor’s treatment ‘appalling’, mother tells court > When he put to Ms McGillin that the final decision on the medication was hers, she said: “Someone has to take responsibility for what happened to my daughter”. >> Independent

Surgeon with HIV seeking damages > Among claims in the case is that absence of mandatory screening of hospital patients for HIV exposed the surgeon to a risk of harm. >> Irish Times

Oscar the cat predicts 50 deaths in nursing home > Dr Dosa suggests that Oscar is able to detect chemical changes that accompany death >>Independent

Brain-injured patient’s thoughts ‘read’ by scanner > Dr Adrian Owen, assistant director of the Medical Research Council’s cognition and brain sciences unit at ­Cambridge University, believed that the patients who responded in the study were probably “perfectly consciously aware”, although he knew others would disagree >>Guardian

 

Notes on Professor Onora O’Neill Swan lecture on Intelligent Accountablity

(Disclaimer: these are merely my notes on the Baroness’s lecture, and therefore not necessarily an accurate summary of what was said. This version in the J Med Ethics of a symposium on the limits of informed consent may be more useful >>> click here)

The three traditional concerns of medical ethics described by a medic as referrals, confidentiality & billing! Enormous changes in medicine (technology, budgets, expectations) led to a rejection of self-regulation and calls for accountability.  Important expression of the shift: David Rothman’s Strangers at the Bedside [link to review in Medical History]. A new era of thinking on ethics emerging in the 70s/80s saw a rejection of paternalism as a model for medical practice. The trap of professional capture: whereby the needs of the regulated inevitably win out over those of the public in any system developed by the professionals themselves.

Public accountability has taken over as a principle determining obligations (especially second order ones); an auditing process such that all stakeholders can be satisfied. However, problems arise in relation to patient consent: a almost “mindless” pursuit of anti-paternalism ideals. Patient consent is the goal of the consent procedures, but there are limitations: to protect against coercion, deception, manipulation etc.