Opinion


“I believe we did not pay enough attention to birth in this country. It was a women’s issue. There’s a tendency to turn off for women’s issues, but here’s the thing: everybody is born and women’s issues matter,” said Dr Rhona Mahony, the first female master of the hospital on Holles Street.

“When you look at it, we have a third the number of doctors we should have, we’re really short on midwives in my hospital, and the Rotunda is the same. And we have these old buildings that have changed very little.”

(Times) >>>

I wonder do we – doctors and relatives – sometimes abandon relatives to further treatment that may not extend their lives without asking them how they feel about it? Treatment costs aren’t just economic, they can be emotional and spiritual as well. (Times) >

(by allanj)

First of all, I have chosen to look at the main themes and issues in this chapter. There are two main themes, the first is mortality and the second is the link between aging and death. Mortality is the theme which is constantly present throughout the chapter. The author uses a quote from Francis Quarles to emphasize this, ‘It lies in the power of man either permissively to hasten or actively to shorten, but not to lengthen or extend the limits of his natural life.’ He uses a personal experience to show us that everyone must die, using the example of his grandmother who died from a stroke. He tells us that her death was much the same as a lot of other people’s and ‘hardly unique’. He shows us that death happens to everyone, ‘it carried off James McCarty, it carried off my Bubbeh’.

When he speaks about mortality, there is a lack of sympathy from him. I believe that he uses the example of his grandmother to show us his humanity, because he himself has suffered through the death of someone close to him. I don’t think this attempt was successful however, or sufficient, as he still comes across as very unsympathetic. I researched who James McCarty was, as he is mentioned twice in the piece. I discovered that he was the author’s first patient, a fifty-two year old man who died of a heart attack while beside the author. As he died, he ‘roared’ out to the author, who did nothing, but realised after that McCarty was asking him to desist what was happening. He suggests later in the chapter that we should ‘eschew every bit of McCarty-like behaviour’ which shows his lack of sympathy towards the dying man looking for help and also comes across as quite judgemental of him. It is apparent from the chapter that the author himself is about the same age as James McCarty, if not older, so you would expect him to have a little more sympathy for the man.

He believes that everyone should die and should not try to prevent death. He includes a quote from Thomas Jefferson, ‘There is a ripeness of time for death, regarding others as well as ourselves, when it is reasonable as we should drop off and make room for another growth. When we have lived our generation out, we should not wish to encroach on another.’ His opinion is that it is older people’s duty to die as they should, and allow the younger generations to take over, ‘Old men must die, or the world would grow moldy, would only breed the past again.’ He says that the people who are researching gene therapy or growth hormone are faced with people who are hoping that these break-throughs will result in an extension of life span. ‘The lesson is
never learned-there will always be those who persist in seeking the fountain of youth’. He even goes as far as to say that wishing for a longer life span ‘demeans us’.

The second theme that is very prominent is the link between aging and dying. One quote which illustrates this theme is a quote from ‘a wise old lady’ who said ‘death keeps taking little bits of me’. He believes that death will occur regardless of disease, but with the presence of disease, death comes faster, ‘Aging may be said to be both independent and co-dependent in the sense that it certainly contributes to disease and may in turn be accelerated by it. But disease or no disease, the body continues to get older.’ He also believes that there is very little that can be done for an old person when they come in to a hospital. He asks us what should be done, if an old man presents with cancer. Should we treat him with debilitating chemotherapy only for him to die of something else a year later? Regarding treating old people, he says ‘Hope must always prove to be unjustified.’ In the end, they will die, of something, regardless of what they are in hospital for. This is a very true statement from him, but a negative and irrelevant one. You could also say that about a two month old baby who comes in with a disease, so his argument is unjustified.

I found that the author’s tone throughout the chapter was often very gleeful when talking about causes of death. He uses personification of the diseases, which I think gives him the tone of glee. He uses phrases such as ‘marauding power’, ‘of those so betrayed by their cerebral circulation’ and ‘suffocating the tissues of its victim.’ When speaking about pneumonia, he says ‘Pneumonia’s blitzkrieg has yet another way to kill- its putrid headquarters in the lung serves as a focus from which the murderous organisms can enter the bloodstream.’ I think he uses this personification to show us that it would be better to die. There are pages and pages in the chapter in which he simply describes the horrifying diseases and what they do to your body. He always describes the ‘worst case scenario’ making any illness seem horrific, to make us think that it would be preferable to die than to go through any of them ourselves. However, he is so gleeful when describing these diseases, it makes me think he could be exaggerating to emphasize his point, ‘If the stroke is extensive enough or if further complications ensue, such as decreased blood pressure or cardiac output due to failure or arrhythmia, recovery is prevented and the area of ischemia may actually increase. If it becomes large enough, the brain tissue begins to swell. Being compressed in the unyielding confines of the skull, a swollen brain is further damaged by being pushed up against its covering membranes and bony encasement, and part of it may actually be forced down through a fold in those membranes…….’ He always talks about the worst case scenario of all of these diseases, and tells us all the ‘gory’ details, which is why I think he has a gleeful tone.

He speaks quite critically of doctors, and their approach to treating geriatric diseases. He says that in the case of his grandmother, and because she died of two of the most common causes of death; stroke and pneumonia, while doctors read this chapter, ‘they may claim, her mode of death supports their worldview and argues for vigorous intervention to treat the named pathologies in order to prolong life. To me this is more sophistry than science.’ He is criticising even his medical readers, and patronisingly assuming he knows what they are thinking and criticises any who would disagree with him. He is concerned that doctors become ‘absorbed by the riddle of disease’ and want to solve the problem rather than do what is best for the patient and the hospital. However, he contradicts himself by saying, ‘The diagnosis of disease and the quest for overcoming it with his intellect are the challenges that motivate every specialist who is good at what he does.’ If a specialist is good, because he wants to solve the riddle of disease, then does that mean he wants not good doctors treating geriatric patients, because they have no motivation to solve the problem and will let the patients die? However, he then calls the doctors who know when to stop treating older patients ‘wise physicians,’ again contradicting himself.

His writing style at times is quite hard to follow. He jumps from one topic to another, and back again with no warning. For example, he opens talking about strokes and his grandmother. He describes strokes in detail, and the reader believes he has moved on Alzheimer’s disease, when he jumps back to talking about strokes. This happens in several different instances throughout the chapter, making it difficult to find any clear structure in the chapter, and at times, hard to follow his train of thought.

He is also hugely confident in his writing style, almost over confident, nearly forcing his opinions on his readers. He has an entire paragraph of questions beginning with, ‘Can there be any doubt…..?’ regarding to the points he has just made. He uses subtleties of language, such as the word ‘fortunately’ when telling us about the doctors that he agrees with, and ‘unfortunately’ when speaking about people who he disagrees with. There is an air of confidence throughout the whole chapter, leaving you less likely to question his ideas.

There is a small amount of humour throughout the chapter, which I believe he uses to lighten the dark descriptions of debilitating diseases he uses, as well as his pessimism of old age. For example, he tells us that ‘the bets assurance of longevity is to choose the right mother and father.’

Overall, I liked the themes and issues he chose to write about, mortality, aging and death. I disliked the tone with which he wrote about these themes, at times patronising and over confident. I liked hearing his perspective on geriatric doctors and what the right thing to do is involving elderly patients. I would like to read the rest of the piece, but I would read it critically, rather than believing it word for word, due to the apparent joy he takes in other people’s misery and his over confidence.

(lochrins)

This non-fiction extended essay was published in 1967, it was written by John Berger (1972 Man Booker Prize winner) and photographs are taken by Jean Mohr. It is set in rural England in an impoverished and struggling community. Berger and Mohr follow a country doctor, John Sassall, whose career serves as the focus of the essay.

John Sassall, the main character, starts his career thriving on medical emergencies, impatient with non-specific symptoms and the absence of clear-cut physical diagnoses and underlying pathology.

‘That was the happiest time of my life, doing major surgery in the Dodecanese.

He moves gradually towards an empathic listening and companionship with his patients and their families, striving to recognise who they are and the meaning of their illness to them. Physical and psychological intimacy becomes central to his relationship to his patients. Sassall establishes a brotherly relationship with his patients, which was very different to the paternal relationship which existed between most doctors and patients at the time.

‘He began to notice how people develop. A girl whom three years before he had treated for measles got married and came to him for her first confinement. A man who had never been ill shot his brains out.’

Sassall is a highly competent and dedicated physician, ’He sees to it that he stays well informed’. He feels compelled to use his occupational life in a quest to explore basic questions about the nature of human relationships and community. This need drives him to be an exceptionally good physician and to involve himself deeply in the life of his rather insular community. While Sassall is an unusual man and physician, many aspects of his experiences in dealing with patients cast light on doctor-patient relationships in general.

The simple task of turning on the electric blanket on fifteen minutes before a patient arrives shows the deep level of care Sassall has for his patients and it highlights his commitment to making them as comfortable as possible.

The consultation with the sixteen year old girl highlights Sassall’s view of the doctor-patient relationship and it also gives us an insight into his view of the doctor’s role in the community. He is very subtle in the way he address the pregnancy issue and is very quick in getting to the root of the problem.       

‘Do you like working in the laundry?’

His attempt to help the young girl find more enjoyable work is very kind and generous, and though giving her a few days off borders on unprofessional behaviour, it shows the need to be flexible in G.P practice and in medicine in general for the greater good of the patient.

Come up again on Wednesday and I’ll phone the Labour Exchange and we’ll talk about what they say’.                                                                                         

The way he consoles her is almost therapeutic. It highlights Sassall’s role in the community, he plays a key role in looking after the locals’ health, both mental and physical.                                                        

‘The fact that you’re crying means you’ve got imagination. ‘                                                                      

This essay is a reflection on the meaning of ‘good’ doctoring, the naming of illness and the ambiguity of scientific medicine in the context of general practice. Sassall is committed to the fraternal bond that develops over years with his patients. Berger illuminates, through John Sassall, the deep potential of medicine, and particularly general practice, to express solidarity with people as they move through their lives.

‘‘That’s where I live, where you’re putting that needle in.’ ‘I know’ Sassall said, ‘I know what it feels like.’’

The description of Sassall’s qualities as a doctor stand as a guide for all doctors in understanding the doctor-patient relationship and particularly for GPs in seeing their role as more than just scientific and approaching the practice of medicine in a holistic way, acting  as a guide and helper in their communities. Sassall sees the patient as the central character in the practice of medicine.

‘He was straight, not afraid of work, easy to talk to, not stand-offish, kind, understanding, a good listener, always willing to come out when needed, very thorough’

I enjoyed reading this extended essay, it cast a new light on the doctor-patient relationship which has definitely influenced and altered  how I view General Practice, and the way I see medicine’s role in society.

(reynaudc)

Oliver Sacks, British neurologist who has practised in the USA for the past 50 years has acquired a great notoriety as a prominent author especially thanks to his book Awakenings published in 1973 which was later made into the Oscar-nominated movie Awakenings by the same name and his book The Man Who Mistook His Wife for a Hat, and Other Clinical Tales. Sacks draws from his experiences as a neurologist to present a unique and insightful look into consciousness, the human mind and brain.

 

The Man Who Mistook His Wife for a Hat, and Other Clinical Tales is a collection of 24 essays relating the cases of patients presenting bizarre and even bewildering neurological conditions. The essays are divided into 4 categories:

  • Losses which presents among others the case of an amnesiac sailor, a “bodiless” woman (who’s lost her sense of proprioception) and the case of Dr. P who can’t recognize objects;
  • Excesses presents the cases where the brain is subject to too much activity as in the cases of Tourette’s syndrome;
  • Transports describes the worlds of visions and hallucinations, in which Sacks includes a personal experience of feeling like a dog whilst under the influence of amphetamines and LSD;
  • The world of the simple presents the cases of people affected by mental retardation but yet enjoy a rich and full life.

 

“Street neurologist with a sense of wonder”: interview with Sandee Brawarsky, the Lancet, 1997

In this interview Sacks is asked about how he came to the USA and how he started writing. When asked how he is seen by other neurologists he is often categorized as “a spokesman” or a sell out to “pop neurology”. It is probably his own view of himself that describes him best. He would like “to be seen as a sort of explorer, driven by, and trying to share, a strong sense of wonder.” a description which seems appropriate and well-fitting upon reading his work. Every case in the book presents a neurological condition whose implications the average reader could never have imagined and makes us wonder at the complexity of the human mind and brain.

The interview also raises the question of Dr Sacks’ motivation as a doctor, and his certain guilt in regards to writing about his patients. Does he now practice for the sake of some kind of voyeuristic desire to write his next book or for the patient’s best interest? This is a question often raised when doctors relate their experiences through art.

The Man Who Mistook his Wife for a Hat

The first case in the book is the case of Dr P. a music professor who seems completely unable to recognize objects. He is unable to recognize his students faces but able to see these same faces in water-hydrants and other inanimate objects. Upon developing diabetes and seeing an ophthalmologist he is referred to Dr Sacks. Immediately Dr Sacks is aware that something is not quite right but is unable to determine what it is. It is only upon conducting a routine neurological examination that he starts to grasp what is going wrong. Dr P. is unable to put back his shoe believing that his foot is his shoe. The situation becomes all the more bizarre when Dr P. leaves; he mistakes his wife for his hat and tries to put her on his head. The puzzlement of the narrator is made evident and is easily shared with the reader.

The next day Dr Sacks visits Dr P. at his home and performs a few tests, he first asks him to describe a rose and then a glove. Although Dr P. knows very well what these are, and is perfectly able to describe them he is unable to label them rose and glove. Sacks doesn’t describe the disease with any scientific terminology at any stage during the essay and yet through these two tests he cleverly presents it and reveals to the reader what the problem is. However the simplicity of the situation make us wonder whether or not Sacks has not used some artistic licence in presenting this condition to us in such a neat and effective way.

Other elements hint at the truthfulness of his account (or rather lack of) especially at the beginning when presenting Dr P. “Had he not always had a quirky sense of humour, and been given to Zen-like paradoxes and jests?”.  It is difficult to imagine any doctor knowing his patient so well after only two consultations. Although it seems Sacks may have used some artistic licence (or has an outstanding memory) these anecdotes and details make us relate all the more to the patient.

The essay ends with a somewhat tragic revelation on how the disease has progressed throughout the years when Dr Sacks looks at Dr P.’s paintings. “This wall of paintings was a tragic pathological exhibit, which belonged to neurology, not art.” (Which seems like a strange comment given that many great artists presented some kind of neurological condition or substance abuse which helped them produce their art).

 

I really enjoyed this book as it was easy to read, not burdened with complex scientific explanations and offered interesting insights into the complexity of the human mind whilst making every case more about the patient and his response to the disease rather than about the disease alone.

(clearyj3)

Samuel Shem’s ‘The House of God’ follows a young doctor’s internship in the eponymous ‘House of God’ hospital. Following the experiences of Dr. Basch and his colleagues, Shem’s writing ranges between insightful and crass. The satirical often veers into the farcical, while Shem’s own brand of ultra-realism can sometimes come across as exaggerated.

With that being said, there are excellent moments in the text. The sincerity of the main character is endearing and though the humour is probably more miss than hit, there are genuinely funny moments. ‘The Fat Man’, the intern’s first resident who believes that there is no patient ‘whose medical characteristics cannot be listed on a three-by-five index card’, is a prime source of humour.

However, Shem’s attempt to make the novel as realistic as possible can appear more like hyperbole. The seemingly never-ending nicknames and acronyms (GOMER, LOL, NAD…) can be tiresome and the idiomatic speech of some characters, a Chicagoan who speaks nothing but hipster and a foreign patient who shouts ‘go avay’, is simply hackneyed. ‘You dig?’

Though these elements detract from the novel, taken with a grain of salt (or more, as prescribed) ‘House of God’ can be read for what it is, a frank though perhaps exaggerated take on an intern’s story, from a man with real-life experience.

(by montgodc)

This is a very fascinating novel which for me explores two key themes. The first theme explored is introduced to us very early on in the very first paragraph of the chapter. It is this idea of Mr Grenes where he relates the condition of the building to that of the patients it contains.

“As if the very head and crown of the institution were mirroring the condition of many of the poor inmates beneath.”

Barry uses very vivid imagery to allow us to depict in our minds a very large unwelcoming building. Dr Grene does not resist the idea of a new building but he is not welcome to it. He feels that the building has almost become the heart of this mental asylum, both patients and workers alike have become a part of this building through the history shared in it. It is interesting however in the way in which he portrays this idea in relation to patients and workers, he imagines that the patients have become part of the actual solid construction of the building.

“How can we prise many of the patients out of here, when their very DNA has probably melded with the mortar of the building?”

Yet when he talks about the workers they appear to be more of the inhabitants in the building not the building itself

“Similarly the attendants and nurses have become as much part of the building as the bats in the roof and rats in the cellars.”

For me one of the most powerful parts of the story is when the hospital is referred to as the ‘lost ground of Roscommon’ this really sums up the stories of the people inside, despite the knew plan of reassessing the patients and releasing those who are found to have been held for unjust reasons the overwhelming feeling is that society had forgotten about them and by society demanding there release now it is too late for them, they are to old they have been interned for too long.

“I am not so great a fool as to think that all the ‘lunatics’ in here are mad, or evere were, or were before they came here and learned a sort of viral madness”

The introduction of Mrs Mcnulty brings into the story a character who we are told is very old, yet it is her realism that propels the story forward. She does not come across as a person who should be in a mental hospital and this helps us to then accept when her history is brought into question. For me she is a person who has just grown to accept her position and what she has.

“There will always be mice”

When she says the beauty of Dr Grene is that he is entirely humourless you are left wondering does she feel this because it allows her to read him more easily and know exactly where she stands or is it because after over 50 years in the asylum she has lost her ability to enjoy humour and so Dr Grenes lack of humour she finds refreshing and easier to deal with.

On a whole I really enjoyed reading this book it out of all the books we have read so far this one is the one I have most wanted to carry on reading and to see how it turns out. The story was well written building up an excellent basis for the story and out lining to very different yet both fascinating characters while not revealing to much committing the reader to wanting to read more.

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