Autumn 2007
Editorial: The American culture and health care
Homeric wounds in ancient Greek art Explicit violence played an important part in setting the moods and carrying the story lines of the Iliad and the Odyssey, and most of the 157 wounds were carefully specified as to bodily location, weapon used, and mortality. But many centuries after bronze-age warfare, the late 6th and 5th C artists could only imagine, based upon their own recent experiences, what these wounds must have looked like. The three pieces of artwork presented here make up a brief atlas, simple but reasonable, of wounds and wound healing as seen through the careful eyes of ancient Greek artists a century before Hippocrates.
The patient who tried to cure his own cancer: Revisiting the story of Morris Abram’s leukemia This article reviews the story of how Morris B. Abram, a noted civil rights lawyer, confronted his acute myelocytic leukemia, which was diagnosed in 1973. It also evaluates Abram’s subsequent claims that he cured his disease through his “will to live” and by insisting on two novel experimental therapies. Relevant historical documents were reviewed and analyzed, most notably Abram’s autobiography and his personal papers, which are housed at Emory University. Abram was a remarkably insistent patient, embodying the type of activism later displayed by people with AIDS. But while he did demonstrate great optimism and fortitude, it is far from clear that he willed his way to survival. Nor did either of the experimental treatments likely contribute to his cure. Modern cancer patients and their families place great emphasis on “fighting” disease. Even if such efforts do not prolong survival, they provide meaning and reassurance at a difficult time.
Perspectives Patients can cause caregivers to experience a breadth of emotions and sentiments. Feeling pity for a patient is one of them. This essay explains why the author no longer feels pity for his patients, and why he thinks it will make him a better physician.
Perspectives This brief essay examines the obligations physicians assume when treating medically and mentally ill persons who are homeless. The author utilizes two different clinical vignettes in an attempt to illustrate the human consequences mentally ill persons experience when discharged from medical facilities without appropriate attention being given to their state of homelessness. The paper suggests that physicians who care for this most vulnerable population should be expected to not only provide direct medical treatment, but also to advocate for compassionate services based upon their professional covenant to care for the individual patient.
The lead files: A chronicle of ignorance, avarice, and progress Lead is a soft, blue-white, corrosion-resistant metal whose toxic effects in humans have been recognized for more than 2,000 years. Nonetheless, the battle to eliminate lead poisoning is far from over. This article cites historical milestones in the global fight against lead, reviews diverse clinical manifestations of lead poisoning, and recounts a little-known chapter in the annals of research which answers the question:
The anatomical gift My remarks were written and delivered in memoriam at an interment ceremony held by Albany Medical College. Each September, the medical students who spent the previous year learning from the men and women who gave their bodies to the anatomical gift program invite the donors' families to gather with them at an Albany cemetery in thanks and remembrance. It is an unusually moving ceremony as the students say goodbye to people they have grown to know most intimately, and the donor's families meet the future doctors who have become part of their loved ones' legacies.
Megacode Guatemala On a medical mission to a rural area of Guatemala, the author had the opportunity to attend a delivery in a small public health clinic. There, she found well trained personnel with almost no equipment. The difficulties and frustrations of the Guatemalan public health staff became obvious as they struggled together to resuscitate an infant under difficult circumstances. It is clear that education, training and experience are stymied by lack of equipment and lack of the most basic resources in Guatemala as well as in many other developing countries. Sadly, much of the equipment that is needed is available but unused and needlessly discarded here in the US. American doctors could do a great deal to ameliorate the need for basic medical equipment in the third world. Web sites of organizations which accept the donation of medical equipment are included.
Burial at sea Our ship was ten minutes out of port and my daughter, my niece, and I were in the lounge playing bingo. We were enjoying a tropical cruise. My sister-in-law, a nurse, approached suddenly and she appeared tense. “Karen needs you right away. The man in the cabin nextto yours is having a heart attack and he looks really bad.”
A fragile web of understanding The personal reflection, “A Fragile Web of Understanding,” describes an encounter that the author, a diabetologist rounding in the medical intensive care unit, had with an individual who might be described at first glance as a “difficult patient.” The conversation that ensues reveals experiences and perspectives that are foreign to the doctor, and reveal the complex interplay between past and present experiences of racism, suspicion, and mistrust that frequently underlie and influence encounters between doctors and patients. The wayward eye Two years after cataract surgery to replace the lens in his left eye, the patient began exhibiting abnormal signs in his right eye. It began with ptosis of the right lid only that resolved over several days with warm compresses. He then noticed a painless deterioration of vision in that eye that progressed at an alarming rate over a week. It was accompanied by episodic diplopia that became nearly constant. Retinal examination showed no pathophysiological changes.
Things remembered “Things Remembered” depicts a medical student bridging her newly acquired medical knowledge with the humbling realities of the human condition as she cares for a dying patient and his loved ones. Through the complex emotions of and the interactions between members of the healthcare team as each member strives to do his or her professional duties, the student gains insight into the responsibilities and the privileges of being a physician.
Wear a red robe “Wear a Red Robe” explores the emotional response of a medical student to the news thather aunt has been diagnosed with terminal lung cancer.
The Devourer of Things One of us Found in a filing cabinet Alpha-male giraffes have learned to get carotid ultrasound by age 17 Nine Holes Creation: Millennium 2000 Still, No Clue |
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