Winter 2005
ARTICLES Beijing Morning China is undergoing enormous change as it takes its place as a world leader. The physician-patient relationship has been compromised over the past decade, as evidenced by increasing dissatisfaction among patients and physicians. The issues responsible for this concerning trend are quite complex and surprisingly relevant to medicine in the United States. The dynamics shaping these changes may include: economic constraints, evolution of an entrepreneurial consumer society, policital reform, changes in societal values, and an impossibly short time frame for change. These issues are presented and analyzed from the unique personal experiences of a Westerner who lived and work in health care policy in China for three years.
Cortisone and the burning cross
Demon, quack, scientist, or saint: Depictions of doctoring in the operatic literature A musical work, like other art forms, is a mirror and window into the cultural ideas and anxieties of the period in which it was written. During the first half of the nineteenth century, medical practitioners were the subject of critique, satire, and occasionally admiration, in popular culture. In particular, the operatic repertoire offers a diverse range of literary and musical representations of physicians. The four operas explored in this paper-L'Elisir d'Amore by Donizetti, Wozzeck by Berg, Les Contes d'Hoffmann by Offenbach, and La Traviata by Verdi-have libretti written during the first half of the nineteenth century. Although the texts were written within 40 years of each other, each work presents a different portrayal of the medical practitioner. To understand the diversity of these popular perceptions, this paper examines the physician character in each opera, and analyzes the musical devices that reinforce and enhance the text.
Dead men walking: Reflections on Cotard's syndrome and homelessness In 1880, Jules Cotard, the eminent Parisian neurologist, identified an unusual clinical syndrome he described as "delire des negations." In this rare psychiatric disorder, a constellation of symptoms are spun into a core delusion of nihilism. In other words, the person who suffers from this order might deny his own existence, hold to the belief that he is dead, or even reject the existence of the physical world. Although this is a syndrome not frequently encountered in contemporary psychiatric practice, this essay describes the development of Cotard's syndrome in two homeless persons who were treated in a shelter-based psychiatric clinic. The writer examines how the cultivation of this central delusion of nihilism would, paradoxically, make sense in the life of a person who experiences the devastating effects of homelessness in our contemporary society.
Rectal fumigation: A core rewarming practice from the past Forced introduction of warm smoke, per rectum, into the intestinal cavity was a common resuscitative measure in the 16th and 17th centuries. Called rectal fumigation or smoke clyster, this practice reached its zenith during William Cullen's time in the 1700s. Many therapeutic endeavors of those days carried little merit, and some were patently harmful. Rectal fumigation, however, was an exception. Historical evidence suggests that this practice might have induced core rewarming in hypothermic persons, especially after drowning. This may have been the basis for its effectiveness and longevity. By the early 1800s, however, the practice of warm smoke introduction, per rectum, had been abadoned. Core rewarming, although by other means, continues to be an effective and contemporary treatment for accidental hypothermia.
An unlikely muse: The Bellevue Literary Review arises from a legendary city hospital
PERSPECTIVES Scenes from childhood A child encounters an eccentric neighbor, but does not recognize that she is a battered woman. His fear of her melts when she plays the piano for him. His mother and neighbors appear to be aware of the family problem. They are supportive of the woman, but do not act to stop this domestic violence. The grown child realizes the nature of the problem, and calls on physicians to become more aware that this scourge persists to this day, and to act to prevent this abuse.
We must turn our disease treatment centers into true health centers
Coffee, doughnuts, and mortality A 36-year-old patient in excellent health with a minor eye problem died suddenly during surgery. This exceptional case was discussed at the Department of Anesthesiology morbidity and mortality conference. The physician at the podium, who had been responsible for the patient's well-being during the operation, displayed an unchecked outpouring of grief and self-doubt in a shared intimate and painful moment Medical school training minimizes the importance of emotions. Physicians fear that showing sorrow, regret, disappointment or failure make them appear weak. Most physicians have a spectacular view of mankind. However, in no occupation is the range of success and failure so great, from saving a life to being responsible for a death. Physicians do not control the patient's fate, but we must accept the difficult lesson that regardless of how smart they are, how many years of training or how well prepared they are, they cannot always alter the path their patients are destined to follow.
POETRY Lament for a son The Mountain Paintbrush Skeletons Vers la Flamme The Gift House call, Case 1822, 1958 Immortality at Seventy-Five Doc Blades |
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