Notes on Under the Ether Dome by Stephen A. Hoffmann,M. D. discussion

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General consensus about the text

  • Quality of being unsure. Author has not made a stance for his statements. He hops on many things, for instance, humour, philosophy and etc.
  • Is the author actually telling the truth or just creating a myth for the sake of having reader’s to enjoy a good read? There is no concrete proof.
  • The text lacks brutal truth. The author seems to have twisting contradictions. It is more of a good read rather than a memoir.

First issue: Is the use of donor bodies dignified in medical school?

  • Not really dignified as it is for learning purpose since all of us are novices. Some of us may feel that it’s just flesh and bones. Some have a growing sense of guilt for ruining the donor’s bodies. It all comes down to individual. It is up to us to make the best out of the donor bodies
  • All of us accepted the fact that dissection became more of normality as the weeks progressed.

Second issue: The relationship hierarchy between medical students, residents and consultants. Intimidating consultants etc. feature in both fiction and non-fiction literature and film. Why does this relationship exist, are there are any pros or cons to it?

  • It is a norm to see all types of people with different personalities in the hospital.
  • The consultants might have the urge to put the fresh graduates in their places as some may feel cocky/arrogant in the beginning.
  • Why the hierarchy? We’re humans after all. Being under pressure from the system, patients, and personal life. The hospital is an uncomfortable environment for learning purpose. Hence, the attitude is rationalised.
  • However, there is a line between humiliation and instructions. Everyone has the right for respect.

Third issue: What makes the career so appealing despite frequent stories of people being unhappy and frustrated within the profession, strikes etc.

  • There are always a few exceptions of doctors who do not fall into the hierarchy. These are the ones who inspire the rest to follow their footsteps.



Student notes on Stephen Hoffman’s Under the Ether Dome extract

(by carrollgr)

  1. 1.     Themes

Formation of the Doctor

From this text I gained an insight into how the knowledge and training we receive in medical school will impact on our lives and careers as physicians. It is clear that the author believes his training began on the first day of medical school though at the time this was not evident to him. It is only on later reflection that he realises his first day stands to him in later life as he deals with his patients.

Modern Outlook vs. Old-fashioned Teaching

Though the author describes their lecture hall as “antiquated”, the general training of these medical students seems to be quite modern in approach. Yes, they do spend hours studying from books and yes, there is a huge emphasis on the science of the human but they are also in contact – however small – with patients from first year. They take courses in psychology, medical ethics and literature. It could be argued that with all of the theory they must learn that it could be easy to lose sight of why they were learning all of this in the first place, however, the author describes how they were brought back to reality numerous times, especially when they met the first patent of the clinic.


Building Blocks

This theme had quite a strong impact on me, it brought about the realisation that what we learn in school is all because people before us made discoveries which established the principles we learn today. It wasn’t that this was an alien concept or one that was terribly insightful (it could almost go without saying); it was just that I hadn’t explicitly thought about it before. Once I read it though I realised how thankful we should be to the researchers, scientists, engineers and doctors who went before us. Were it not for them we could not even hope to be trusted by a patient. As the author of this passage says, it was not until one hundred years ago or so that physicians could even dream of treating a patient effectively. Medicine is a new science, one which is dependent on the discoveries and advances enjoyed by the other, perhaps more established, disciplines.


History of Medicine

The History of medicine was another prevalent theme in this passage not only because it was a subject studied in school but also because it seemed to be a shadow that the author felt he was under a lot of the time. Whether it is in the lecture theatre or the hospital, the author here felt that he was under the watchful eye of his predecessors. As well as that, the author talks of a few “distinguishing traits” of the medical profession, when his anatomy instructor faints on the first day, the students are quick to offer solutions despite their “ignorance”. As he puts it, “we make up for our ignorance by firing off opinions with seeming conviction and a vengeance”, this together with the “shadow of history”  that loomed over them in the lecture hall points to a profession that takes itself very seriously.



  1. 2.     Issues


Why is it that all of the nurses mentioned in the passage women while the surgeon, the professor and the consultant mentioned explicitly are men? Perhaps this is purely a coincidence; however it would be interesting to know when this piece was written to see whether or not these gender roles are in line with the time. No one else’s gender is revealed in the extract, even the author’s, so it is difficult to say whether or not sexism is present. My argument for it would be that while gender is not brought up very often, the author repeatedly writes “she” and “her” for the nurse while for residents and interns no gender is mentioned.


Role of the Patient

The author of this piece seems to believe that medicine should be patient-centred “…strong consensus of what was essential in the care of the patient emerged” yet later the “humble patient role” is mentioned. This is in reverence to the elderly man in the wheelchair who spoke for himself when offered the chance by the “eminent physician who led the clinic, his name emblazoned in red script on his knee-length white coat”. While the rest of the passage focuses on the patient as an underdog (an analogy I quite like) there is something unsettling about the patient occupying a humble role while the doctor wears his pristine coat and decides when the patient can speak – he hands him the microphone. The image of the patient as a “sallow and drawn” individual, bound to his wheelchair is very upsetting, especially as the doctor talks about his medical history and ailments to a hall full of strangers. It is true that the doctor then asks the man for his input and what he has to say about physicians is positive, however the fact that the man lights up and is so surprised at being asked to voice his opinion only compounds the issue, that patients are rarely given a voice.

Also the author admits that the clinics “helped me remember what I had come to medical school for in the first place”, perhaps opening up the issue that medical schools in which little to know placement is offered leads students to lose track of why they chose to study medicine in the first place as the theory and constant memorising takes over their lives.

Another point which I feel is important is the author’s guilt for practicing on patients. When he must suture the head of a young man for the first time he feels out of his depth and guilty that this man who trusts him does not know of his inexperience. He later reflects that no matter how long a doctor has been practicing, they are always honing their craft and perfecting it with every patient.



Leading on from the previous point, the author sees patients as the poor underdog and while they seem to really support the patient “(I) instinctively sensed a need to take their side”, not all patients would like to be seen as underdogs who want the doctor to “sympathise” with them.

Enthusiasm becomes exhausting and unbelievable in Stephen Hoffman’s ‘Under the Ether Dome’ extract

(by fdonnel)
It was clear from the start of Stephen Hoffman’s “Under The Ether Dome” that the writer had a great head on his shoulders – a maturity and ability to see into the heart of matters. This is evident from the start as he says “Our subject after all was people”- which showed a solid understanding of the fact that medicine is about people and their individual all-round situations and not just the science of their disease.
He appreciates the role played by those physicians that went before him and pays due respect – he refers to Newton’s belief that he himself would only find success in life by “standing on the shoulders of the giants that preceded him”.
He appreciates the footsteps he is following in and wonders if he will “prove equal to the task” before him.
He seems a very holistic thinker, both scientifically and non-scientifically, he questions whether medicine’s “reductionist attempts” really uncover the true essence of human physiology and anatomy which seem to “politely rebuff” the efforts of those who try to uncover “her infinite wisdom”.
He sees the diagnosis and treatment of disease as but a sub-section of the subject of medicine, which he views to be more anthropology than mere physiology and pathology; “Our education provided us with a broad mandate to learn what we could about people, and to that end, almost everything qualified as important.”
The enthusiasm and intrigue expressed by the writer in absolutely every little thing he learned in medical school, however, soon became exhausting, not to mention unbelievable. Instances of him and his classmates “edging forwards in their seats” in lecture halls, coupled with constant intrigue in every and any detail passed onto him by his professors were far too frequent and, in the opinion of a current stressed, knowledge saturated medical student, completely unbelievable.
The writer could again be seen letting his imagination run away with himself when he talks of his love of Medical Literature and how he would incorporate the fiction found in his beloved stories into his everyday rotations. His tendancy to look through “the lens of fiction” at real cases in order to gain a fresh, new perspective was, although a nice idea, somewhat OTT. Fiction is generally, by nature, something special and extraordinary and to think that it would be used in such a hands-on way with real patients does not sit well with this future health professional/occasional patient.
Hoffman displays great integrity when he hesitates to go through with his first suturing attempt on an actual patient as he doubts his fledgling skills. He puts the welfare of the patient before his own personal development as a professional and this is an admirable quality. He incites a certain poignancy when he refers to the gift of potential self-sacrifice given by patients in teaching hospitals when interns are let loose on the wards and he prays “One accepts it and hopes that it will have a return for others one day”.
Hoffman’s enthusiasm in this extract certainly rubbed off on me and reminded me of the importance of starting as one means to go on in medical school as we see that the qualities of integrity and respect he encompassed from the start of his studies stayed with him all the way to his clinical beginnings.