Medical Humanities Online First

Tales from the Uncertain Country and Other Stories

Moore, J. R. — 2012-04-29T02:01:36-07:00

Tall tales and telling truths

Tales from the Uncertain Country and Other Stories is a collection of 41 contes or short stories by the French Canadian author Jacques Ferron (1921–1985). Although Ferron is considered among the most celebrated authors of modern Quebec literature, his numerous novels, plays, short stories, essays and poetry are little known outside French speaking Canada.

In this collection of tall stories local folk lore and geography combine with themes of religion, death and what it is to be a doctor. Most stories relate to the inhabitants of the community in which he worked but others are more bizarre and include a bull turning into a lawyer, a lonely cow's ghost longing for lost traditions and a bear emerging from hibernation leading a column of abandoned blind lunatics to freedom. My favourite character is Aunt Donatienne, a ‘proper lady, literally tight cheeked to say the least’ who after the...

Prevention of tetanus during the First World War

Wever, P. C., van Bergen, L. — 2012-04-29T02:01:36-07:00

The emergence of tetanus in wounded soldiers during the first months of the First World War (WWI) resulted from combat on richly manured fields in Belgium and Northern France, the use of modern explosives that produced deep tissue wounds and the intimate contact between the soldier and the soil upon which he fought. In response, routine prophylactic injections with anti-tetanus serum were given to wounded soldiers removed from the firing line. Subsequently, a steep fall in the incidence of tetanus was observed on both sides of the conflict. Because of fatal serum anaphylaxis associated with administration of serum at a time when purification methods still needed to be improved, it must be presumed that tens to hundreds of men might have died as a result of the routine administration of anti-tetanus serum during WWI. Yet anti-tetanus serum undoubtedly prevented life threatening tetanus among several hundred thousands of wounded men, making it one of the most successful preventive interventions in wartime medicine. After the abrupt fall in tetanus incidence in 1914 due to introduction of anti-tetanus serum, the incidence of the disease tended to become even lower as the war went on. This was probably due to earlier and more thorough surgical treatment, consisting of opening, cleaning, excision and drainage of wounds as early as possible. In this overview, recent battlefield findings from the Meuse-Argonne offensive in 1918 are used to illustrate common practices employed in the prevention of tetanus during WWI.

Narrating stroke: the life-writing and fiction of brain damage

Zimmermann, M. — 2012-04-19T02:01:25-07:00

Cerebro-vascular events are, after neurodegenerative disorders, the most frequent cause of brain damage that leads to the patient's impaired cognitive and/or bodily functioning. While the medico-scientific discourse related to stroke suggests that patients experience a change in identity and self-concept, the present analysis focuses on the patients' personal presentation of their experience to, first, highlight their way of thinking and feeling and, second, contribute to the clinician's actual understanding of the meaning of stroke within the life of each individual. As stroke ‘victims’ necessarily speak from the position of having undergone very abrupt degeneration followed by being confronted with a gradual relocation within their ‘recovery’, the present study addresses how narrative texts describe the condition, that is, the insult itself and its impairing consequences for body and mind, and how patients portray themselves within their illness. Furthermore, given that all illness narrative must remain non-representative, especially when exploring conditions that impair cognitive abilities, autobiographically inspired fiction, equally, contributes to neuroscientific perspectives on embodiment: it gives further insight into how the condition is perceived and alerts us to those aspects of the experience that are understood as particularly momentous.

Number Me?

Barron, D. S. — 2012-04-04T02:03:12-07:00

Oh numbers, numbers what do you mean?

Could it be that I am not as I seem?

Are my thoughts and hopes as I lay awake

Something you with symbols can calculate?

And my mind, the thing I think is pure Me

Obey equations? You mean it's not free?

My silent me-ness, my intimate life

Is no more than a fancy traffic light?

As enzymes and atoms concatenate

Or catalyse to keep my steady state

Are you there, in shadows, calling the shots?

Directing towards the most probable plots?

And what of that thing I once called my soul?

Have mechanisms too this from Me stole?

Have love and mercy and hope no more worth?

Am I resigned to emotional dearth?

If Me results from my neurons and brain

With no spark, no soul, no God at the reins

How could I hope for a more perfect dawn?

For justice? For peace? For life when breath's gone?

And how will my children know good from bad?

And where now is my...

The glial trees

Zimmerman, E. — 2012-03-13T02:02:56-07:00

I will chop the mesquite today.

Autoclave the axe at 121°C,

Soft tissue blade.

And till the beds, leaving

The furrows of your brain to fallow:

A grey, nitrate-sucking matter.

To arbitrate

Between arteries and roots.

With my pinking-shears.

Deep pause.

For the Winged Reaper who will burn this malignant tare.

No. The axe is laid unto the root.

I will chop the mesquite today.

Autoclaved the axe at 121°C.

And the weight-bearing exercise sprigs

Osteoblasts from the dry chunk-bark—mixing

Mud and skull.

Inoperable! The iron mocks between my strawberry hands,

Which pray

That I will regret having sold

Your black appaloosas.

Aren't you proud to see me fell it?

As if your body still were able to trim and

Sing, and muck the stalls.

Here, a widening hole, undaunted

By my surgical knots, brimming

With the blood from last night's monsoon.

Oh! In the angiogenesis,

There were romantic intentions and,

100 acres of myelin sheath.

How did we come here, to

This desert. And how do we exit but

By the white lightning's crack.

Contributors

EZ is the sole contributor to this poem.

Competing...

The embodiment of lyricism in medicine and Homer

Bleakley, A., Marshall, R. J. — 2012-03-06T02:01:45-08:00

Improving the quality of communication between doctors and their patients and colleagues is of vital importance. Poor communication, especially within and across clinical teams working around patients in pathways of care, leads to avoidable medical error, where an unacceptable number of patients are severely harmed or die each year. The figures from such iatrogenesis have now reached epidemic proportions, constituting one of the major killers of patients worldwide. Despite 30 years' worth of explicit attention to teaching communication skills at undergraduate level, communication in medicine is failing to improve at an acceptable rate. The authors suggest a rather unusual approach to this dilemma of ‘communication hypocompetence’—thinking medicine lyrically—as an extension of thinking with Homer's little-discussed lyrical aesthetic. A key part of the problem of communication hypocompetence is the well-researched phenomenon of ‘empathy decline’ in students, where ‘hardening’ and cynicism occur as over-determined ego defences. Empathy decline may be a symptom of the repression of the lyrical genre in medicine, where the epic, tragic and dark comic genres dominate. The lyrical genre emphasises coming to know the patient as a person and an individual. Importantly, central to performing the lyric genre is the heightened use of the senses in taking a history, physical examination and diagnostic work. Framing medicine as lyrical work challenges undue emphasis on ‘cure’ at the expense of humane ‘care’.

Manic depression in literature: the case of Virginia Woolf

Koutsantoni, K. — 2012-03-02T02:01:17-08:00

The steady growth of the discipline of medical humanities has facilitated better understanding of the symptoms and signs of mental health conditions and the feelings of the humans experiencing them. In this project, the arts have been seen as enabling re-engagement of the practitioner with the patient's own perceptions and feelings. With respect to the association between creativity and bipolar disorder in particular, work within medical humanities has meant that mentally ill creative individuals have been subject to scientific scrutiny and investigation, rather than continuing to be viewed as naively romanticised cases of mental illness. This paper is an attempt to supplement traditional literary criticism by examining Virginia Woolf's history of bipolar disorder through a medical humanities lens. I will provide an overview of Woolf's history of manic-depressive episodes, their symptoms and manifestation, look back on her circumstances during their occurrence, and observe the author's losing battle to salvage her identity in the throes of the disease. The aim is to offer further insight into Woolf's psychopathology and to gain some understanding of the causes and progression of the condition that led to her death by suicide.

A happy doctor's escape from narrative: reflection in Saturday

Belling, C. — 2012-02-18T02:01:21-08:00

The humanities have, in their application to medicine, become almost synonymous with narrative. When medical education turned to ‘reflection’ as a means to nurture coherent and ethical professional identity, interventions tended to take narrative as their primary form. Even while promoting ‘mindfulness’ as complete engagement in the present moment, proponents of reflection sometimes subsume reflection under the category ‘narrative’. The author offers a reading of Ian McEwan's novel Saturday, the account of the thoughts of a London surgeon over the course of one day, attending to the novel's reflective and lyrical as well as its narrative passages, in order to suggest that, rather than grouping the various forms that constitute ‘literature’ into a single instrumental method for producing more professional and ethical doctors, it might be valuable to attend to the various modes that constitute literary discourse, of which narrative is only one.

Get into Reading as an intervention for common mental health problems: exploring catalysts for change

Dowrick, C., Billington, J., Robinson, J., Hamer, A., Williams, C. — 2012-02-18T02:01:21-08:00

There is increasing evidence for the efficacy of non-medical strategies to improve mental health and well-being. Get into Reading is a shared reading intervention which has demonstrable acceptability and feasibility. This paper explores potential catalysts for change resulting from Get into Reading. Two weekly reading groups ran for 12 months, in a GP surgery and a mental health drop-in centre, for people with a GP diagnosis of depression and a validated severity measure. Data collection included quantitative measures at the outset and end of the study, digital recording of sessions, observation and reflective diaries. Qualitative data were analysed thematically and critically compared with digital recordings. The evidence suggested a reduction in depressive symptoms for Get into Reading group participants. Three potential catalysts for change were identified: literary form and content, including the balance between prose and poetry; group facilitation, including social awareness and communicative skills; and group processes, including reflective and syntactic mirroring. This study has generated hypotheses about potential change processes of Get into Reading groups. Evidence of clinical efficacy was limited by small sample size, participant attrition and lack of controls. The focus on depression limited the generalisability of findings to other clinical groups or in non-clinical settings. Further research is needed, including assessment of the social and economic impact and substantial trials of the clinical effectiveness and cost-effectiveness of this intervention.

Graphic medicine: comics as medical narrative

Williams, I. C. M. — 2012-01-25T15:30:00-08:00

Among the growing number of works of graphic fiction, a number of titles dealing directly with the patient experience of illness or caring for others with an illness are to be found. Thanks in part to the Medical Humanities movement, many medical schools now encourage the reading of classic literature to gain insight into the human condition. Until recently, the medium of comics (the term is used in the plural to refer to both the physical objects and the attendant philosophy and practice surrounding them) has received little attention from healthcare scholars, even though some authors argue that graphic fiction is, in fact, a form of literature. This paper suggests that it is time that the medium was examined by healthcare professionals and studies some acclaimed comic works. Drawing on the principles of narrative medicine, this paper will ask whether comics and graphic novels could be used as a resource for health professionals, patients and carers.

A systematic review and thematic analysis of cinema in medical education

Darbyshire, D., Baker, P. — 2012-01-25T15:30:00-08:00

The use of cinema in medical education has the potential to teach students about a variety of subjects, for instance by illustrating a lecture on communication skills with a clip of Sir Lancelot Spratt (Doctor In The House, 1954) demonstrating a paternalistic, doctor-centred approach to medicine or nurturing an ethical discussion around palliative care and dying using the cinematic adaptation of American playwright Margaret Edson's Wit (2001). Much has been written about this teaching method across several medical academic disciplines. It is the aim of this review to assimilate the various experiences in order to gain an insight into current expertise. The results are presented by the following headings under which the articles were examined: the source journal, year of publication, article type, theme, content, target, authors, if a clip or the entire film was used, and if any feedback was documented. This is followed by a chronological account of the development of the literature. Such an approach will allow the reader to gather specific information and contextualise it. This review does not critically appraise the quality of the evidence nor does it determine its validity, rather it is hoped that having read the review educators will know where to locate previous accounts of work that will help them develop more engaging pedagogy.

Ethical reflections on the thoughts and lives of Kurosawa's doctors

Asai, A., Maki, S., Kadooka, Y. — 2012-01-25T15:30:00-08:00

The year 2010 marked the centenary of the birth of Akira Kurosawa (1910–1998), whose works have been reassessed favourably in the last couple of years in Japan. During his lifetime, Kurosawa directed and produced three films whose chief characters are medical doctors: Drunken Angel (1948), The Quiet Duel (1949) and Red Beard (1965). This paper discusses these three films and examines the thoughts and lives of the three protagonists from the perspective of modern medical ethics. The films depict contemporary ethical and social problems, and deal with paternalism, a healthy professional life and the proper place for human reason in medicine, all of which still give rise to debate in modern medical settings. They are very impressive in their portrayal of extreme paternalism, excessively professional lives and disproportionate reliance on rationality. The doctors are role models in certain situations and are examples of how not to behave in other situations. On the one hand, they are devoted to helping their patients, with their self-sacrifice firmly based on humanity and medical ethics. On the other hand, they perform unwelcome favours and are unhealthy role models who might harm others through narrow-minded attitudes about human beings, a fixed view of life and inflexible ideas about medicine. In this sense, they can be regarded as a rather mixed blessing. These films provide us with an opportunity to simultaneously recognise the importance of modern ethical principles and the significance of ‘old’ ethical values.

Together and waiting

Moran, D. T. — 2012-01-06T23:32:48-08:00

The people in the waiting room at the hospital

cannot help but wonder just what is wrong

with everyone else.

The old woman in the borrowed wheelchair.

The man with the bandaged right hand.

The brown child whose mother is crying.

Someone has taped paper flowers to the wall.

A person in a green outfit will come for them soon.

They will learn, one at a time, the names of

The old woman in the borrowed wheelchair.

The man with the bandaged right hand.

The brown child whose mother is crying.

They all just want to be OK,

for the person in the green outfit to tell them so.

Then they can be happy again, happy

to be gone from the waiting room at the hospital.

And they can forget

the colors of the paper flowers taped to the wall

and the names they had learned one at a time.

Competing interests

None.

Provenance and peer review

Not commissioned; internally peer reviewed.

Illness as a condition of our existence in the world: on illness and pathic existence

Martinsen, E. H., Solbakk, J. H. — 2012-01-02T12:34:59-08:00

This paper seeks to find different ways of addressing illness as an experience essential to the understanding of being a human being. As a conceptual point of departure, we suggest the notion of ‘pathic existence’ as developed by the German physician and philosopher Viktor von Weizsäcker (1886–1957). Through an analysis of his conceptualisation of the pathic and of pathic categories, we demonstrate how this auxiliary typology may be of help in unveiling different modes of ill-being, or Kranksein. Furthermore, we show how illness plays a paradigmatic role in this type of existence. We discuss how von Weizsäcker's claim of illness as "a way of being human" indicates how such a view of the illness existence both differs from and touches upon other streams of thought within the philosophy of medicine and medical ethics. Finally, we highlight some of the normative implications emerging from this perspective of relevance in today's medicine.

The colour of scrambled eggs: a dramatic monologue

Hamdar, A. — 2011-11-24T15:36:34-08:00

I drive and look for the gallery. No sign indicates its existence but I find it. It's not an art gallery ... only a wig gallery. We want to buy wigs. Like sheep we flock to Beirut's oldest wig specialist. Natural hair, horse's hair, hair made of nylon ... at Bechara Karkafi's Gallery. The women reject the horse's hair. But the price of natural hair is too expensive. Maybe it's taken directly from a dead woman's head.

"No, no, not always! Some women just sell their hair for money", Monsieur Karkafi explains.

Dead or poor heads ... it doesn't matter. The price of natural hair is still too expensive. Half the women opt for horse's hair, never for nylon hair.

The gallery is already full when I arrive ... with wigs and bald heads. Curls, bobs, chignons, updos and wispy fringes! Long razor cut layers, subtle layering, medium straight and squared bangs!

"Didn't you...

Race, gender and the impossibilities of care

Swartz, L. — 2011-11-21T21:14:44-08:00

Informal care work is indispensible to healthcare but is often invisible. Using my own experience with carers who looked after my dying mother, I explore the submerged racial and gender politics of care work, issues which have a particular relevance in South Africa. I raise the question of whether it is possible for powerful professionals like myself to engage with care workers in ways which do not reproduce patterns of exclusion and exploitation. Telling of and thinking about ‘private’ stories which are intimate and visceral experiences may help us to think more clearly and more visibly about the politics of care work.

Quintessence

Williams, A. — 2011-11-11T12:30:05-08:00

Like you,

I am a human being.

Like you,

I didn't choose this journey to our common destination.

I don't want a simple route and just take in the view.

I want to take in as many detours as I can and enjoy the ride.

For it is the journey and not the destination which is what really matters.

On the other side, I'm sure God will understand.

Well, I'm hoping so.

There are some things I can do, others not so well, and some never at all. I know that.

You don't need to tell me.

I don't want my family beaten apart by what will never be.

Respect them.

If I should have any brothers or sisters, remember they have a childhood too.

Take what I am and go from there.

I very often have medical problems which require a lot of medicines,

(some foul tasting!!!)—often many times a day—

and lots of trips to hospitals, clinics and to other places.

As I'm amongst friends, I'll...

Furry friend or foe?

Almeida, J. — 2011-10-28T07:24:26-07:00

The Beaver is a dark, complex and well-made film about bipolar disorder, that also explores the inevitability of its inheritance across three generations of men in a middle-class American family. Directed by Jodie Foster, who also co-stars with off-screen friend Mel Gibson, it tells two stories: that of Walter Black, father and CEO of a failing toy company and that of Porter, his teenage son, who is struggling to deal with the negative feelings he has towards his depressed father, while facing the fear that he is becoming just like him.

In the opening scenes, we discover that Walter is a middle-aged married father of two, who has lacked energy and has been sleeping excessively for the past 2 years. Depressed in mood and without motivation, he is described as "like a dead man who didn't have the good manners to leave his body". His prescribed medications aren't helping and his...

Victorian illness narratives and their meanings: a book review of Tuberculosis and the Victorian Literary Imagination

McKechnie, C. C. — 2011-10-28T07:24:26-07:00

Katherine Byrne's new book Tuberculosis and the Victorian Literary Imagination is a welcome addition to the recent medical humanities scholarship on the interrelationship between literature and medicine in nineteenth-century Britain. It fits well with other studies in Gillian Beer's Cambridge Studies in Nineteenth Century Literature and Culture series such as Miriam Bailin's The Sickroom in Victorian Fiction: The Art of Being Ill (1994), Pamela K Gilbert's Disease, Desire, and the Body in Victorian Women's Popular Novels (1997), and Janis McLarren Caldwell's Literature and Medicine in Nineteenth-Century Britain from Mary Shelley to George Eliot (2004). It furthers recent study on the interrelationship between tuberculosis and literature in the work of, for example, Clark Lawlor's Consumption and Literature: The Making of the Romantic Disease (Palgrave, 2006).

Byrne's well-researched book provides an impressive array of historical sources on tuberculosis, rescued from the annals of time, and makes interesting and important cultural connections between Victorian...

The war against bacteria: how were sulphonamide drugs used by Britain during World War II?

Davenport, D. — 2011-10-03T17:16:13-07:00

Penicillin is often considered one of the greatest discoveries of 20th century medicine. However, the revolution in therapeutics brought about by sulphonamides also had a profound effect on British medicine, particularly during World War II (WWII). Sulphonamides were used to successfully treat many infections which later yielded to penicillin and so their role deserves wider acknowledgement. The sulphonamides, a pre-war German discovery, were widely used clinically. However, the revolution brought about by the drugs has been either neglected or obscured by penicillin, resulting in less research on their use in Britain during WWII. By examining Medical Research Council records, particularly war memorandums, as well as medical journals, archives and newspaper reports, this paper hopes to highlight the importance of the sulphonamides and demonstrate their critical role in the medical war effort and their importance in both the public and more particularly, the medical, sectors. It will present evidence to show that sulphonamides gained importance due to the increased prevalence of infection which compromised the health of servicemen during WWII. The frequency of these infections led to an increase in demand and production. However, the sulphonamides were soon surpassed by penicillin, which had fewer side-effects and could treat syphilis and sulphonamide-resistant infections. Nevertheless, despite these limitations, the sulphonamides drugs were arguably more important in revolutionising medicine than penicillin, as they achieved the first real success in the war against bacteria.

Now, a month beyond

Moran, D. T. — 2011-09-22T14:27:39-07:00

We would like it to be different

But it can never be different.

We try to talk about it even more,

As if the words were a salve,

but there are not the right words, not

even the wrong words arranged well.

We want to go back, to do it

all again, but with our eyes wide.

We would have listened for noises.

We might have detected the scent of it in the room.

We would like it to begin again

from where it left us off.

But we will not find you there.

We will not locate ourselves there.

We have come to know too much.

The very air has been fouled, the light eclipsed.

Squinting will not clarify any of it, nor bending to it.

We know well we have come too late.

The clock has circled past midnight.

We might have stopped you,

but the door was locked

from the inside, as you had left it.

We might have found you in time but

you were done with time and

the...

Some of my friends

Moran, D. T. — 2011-08-23T21:26:23-07:00

Some of my friends

are becoming concerned.

About lumps where there

were none before.

Some thing which

does not look right.

Their comforts undermined by

pains sharp or dull.

The need to draw breath

into deeper places.

Some are feeling vulnerable.

Their eyes are clouding,

words appearing to dissolve,

sounds soft and muffled.

Some of my friends

need procedures and

further testing.

They will have to

travel to someplace

far and unfamiliar

and wait.

They will try to recall

when sleep came easy.

Now they might have

to be kept overnight,

have blood let by

girls named Betty.

Lie beneath beams

which will turn their

skin to rice paper.

All of their functions

will be distilled

to graphs and digits.

Some of my friends

seem to be wearing out.

Their pink becoming grey.

Their tightness loosened.

Some will be told today.

Competing...

'Declaring'

White, J. — 2011-08-19T12:15:00-07:00

The nurse stops me as I'm on my way past the desk: "Doctor, thank goodness you're here! Your patient Mr Jones passed away a while ago. Can you declare him?" Hmmm. Mr Jones, 90-something years old; I operated on him a few days ago, but post-op he kind of gave up the ghost. I had been expecting him to go downhill, but I hadn't actually heard he had died.

On the walk to the room it occurs to me, I haven't done this for a very long time. At least 10 years. I mean, when does a consultant surgeon ever have to declare one of his patients dead? It's a task usually done by those on the lowest rungs of the ladder, in the lonely early morning hours. That's not me any more. I wonder if I can remember how to do it. It should be simple enough, right? I...

Looking into the neonatal isolette

van Manen, M. — 2011-06-29T03:45:38-07:00

In my everyday professional life, I encounter the medical isolette as a structural unit that houses a single sick or premature child within an acrylic glass enclosure. The unit is designed so as to incubate the developing child by providing warmth, quiet, humidity and security. Small openings allow wires or tubes to hook up the child to technological instruments, monitors and specialised medicine dispensers. Larger portholes allow limited access for the hands of those who take care of the child. The baby is enclosed in a dwelling place in the sense that an isolette may be regarded as the child's bedroom. But it is a place of limited room, for no larger person can physically enter by virtue of its scaled infantile interiority. I tend to think of it as a dorm somehow akin to a crib, bassinet or some other more ordinary baby equipment. Yet is there something...

In passing

Kelley-Chew, L. — 2011-06-27T01:24:54-07:00

The last time I saw my grandmother Po alive,

she wore brown twill slacks, a thin apron,

perfume of water lily, ginger, jasmine.

Now her face is bloated, rounder than I remember.

Hair white at the roots, tips still purple

from her do-it-at-home dye kit.

Tubes removed from her throat; the army of machines

stands down. My grandfather bent over her body,

anointing her cheek with tiger balm,

repeating yesterday we were shopping,

yesterday we were grocery shopping. I imagine them

pushing a cart down an aisle of apples.

Grandfather's fingers trace the deep lines of Po's hands,

the words come softly through his lips

won't be long till I am walking with you.

I see first Po's bound feet under the sheet:

crippled since infancy, finally resting.

Obsolete relics, long abandoned.

How many times I unwrapped layered strips

of cotton to wash her...

Mister

Didwania, A. — 2011-06-24T07:37:35-07:00

naked in a gown

open in the back

waiting

the lab left a bruise

did you say,

‘I look good’

palpitations

it's not racing?

just my nerves

you caught me

in the cafeteria

bacon and eggs

Doctor

I've called you Mister

hoping you remember

what it is like (to be sick)

Competing interests

None.

Contributors

AD is the sole contributor to this submission.

Provenance and peer review

Not commissioned; internally peer reviewed.