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IDs 1) Alcohol Sponge- Mercy, Seltzer Doctor was supposed to kill the guy, but he sterilizes him, showing

hes not ready to kill the patient. It goes against the doctors profession. Emotional turmoil: he cant decide if hes doing bad or doing good The patient is ready to go, but the doctor isnt ready 2) If this is dot A It is Geometry: Imelda, Seltzer Dr. Francis shows his expertise in this statement, and it also shows his mechanical approach toward doing his work. Ironically, despite his expertise, the outcome was unfavorable. The girl died because of drug poisoning. In addition, to the medical student, the doctors methodic approach makes the process seem dehumanizing to him. 3) Dr. Smith: The Doctors of Hoyland by Doyle Dr. Ripley (male doctor) Dr. Ripleys prejudice and conservativeness led him to accept misconceived perceptions on a female doctor, but Dr. Smith challenges his perception, proving to him that she is a adept doctor. Placebo Effect: Brody, Storytelling in Medicine Medicine isnt just b y treatment by surgery or medications. Suggests that a more productive outlook will result more favorable outcomes then aggressive treatment that is prevalent in American medicine. 4) I would have liked to have told him what I know now Seltzer, Imelda th e medical student attempts to rationalize why the Dr. Francis went back and fixed the girls face even though she had been placed in the morgue. The doctor wants to create order in his life, trying to make sense of the traumatic events. The girl was supposed to die after she has been fixed, not before. 5) Mustard Poultice: Orwell, How the poor Die (Hot cup on sores, pus sucks, painful) all the patient s and doctors observe the procedure that is amusing for the doctors but embarrassing for the patients. Doctors are unaffected and take notes for medical studies. Even though he was screaming and in pain, he was just left there and seemed as a number. 6) Carmelita Lester: Terkel, from Working, 7) Voodoo Death: psychological, Brody, Storytelling Medicine Connection from spirituality and body health 8) American medicine is aggressive Payer, The Virus in the Machine The American attitude that something has to be done even if there is no certainty that the procedure would be beneficial 9) Dr. Foster: Doyle, A Medical Document Average General Practitioner talks about his patients as job talk or conversational chat with other doctors. Doyle is critiquing that the doctor is disconnect with his patients. 10) Iona: Chekhovs Misery A carriage driver whose son passed away last week. Chekhov dramatizes that the carriage driver had no one to talk to, leaving him with only his horse who shows compassion and patience to hear his story. (Like Ann Weiss wants to talk about her problems, but no one would listen to her.) (Euthanasia, Seltzer: We are different from the flies in that we all die alone, shows 11) Dehumanizing Institution: Terkel, from Working A term used by Kitty Scanlan to express her belief that the hospital treats their patients as objects. Patients are objectified by their illnesses, and treatment 12) We humans have no such fraternity, but each of us must buzz and spin and knock alone. Seltzer, Mercy The patient is asking the doctor to relief his pain with death, but the doctor cant bring himself to kill the patient. The quote explains how the patient must buzz and spin alone before his death because humans have no such fraternity. 13) But the hunted news I get from some obscure patients eyes is not trivial Williams, the Practice What he sees in his patients eyes are not trivial. Poetry is his outlet, and medicine is his feed. He cannot be a doctor without writing, and he writes from his experiences as a doctor to make him feel complete. 14) Anne Weiss: Carvers A Small Good Thing She is forced to changed her per spective on the world after being thrown out of her own world. 15) Hospital X: Name of the hospital in Orwells How the Poor Die The institution itself doesnt pride itself in its exterior appearance, A very generic name for a hospital It is part of the whole dehumanizing aspect where patients are numbers and seem as specimen for examinations rather than human beings. Short Answer: 1) Cancer in Illness as Metaphor * Disease of the other *Lack of passion *Defined as abnormal growth *Sontag argue that cancer should not be used as metaphors * destructive to the patient *stereotype *Repression 8) Korolyov in A Doctors Visit Parents called the doctor because she believed her daughter is sick. Others think she is sick, and she thinks she is sick. No actual physical ailment. Doctor is taken back when she confide to him that she is not really sick but just need a friend. *Doctor is different situations 12) The child in Use of Force Studs Terkels Working explores the nature of work and how people feel about what they do through interviews with people in the working class. Terkel effectively use his ability to get others to look into themselves and explore what they do best and their emotions toward their works. Carvers A small, Good thing delves the death of a young boy and failures of communication. Scotty, his by car on this birthday, mother order ed birthday cake, scottys unconscious, cake is forgotten as the parents are too focused on their sons health, doctor reassures parents

Dr. Francis checks on the child. He looks tanned and meticulous dressed, showing that he has life outside the hospital while the parents have none. Eating is a small, good thing in a time like this, the baker comforted. Commentary: Carvers story highlights the parents anxiety, Ann Weiss whose life has been Initially, Ann Weiss disliked the baker who was not jolly and exchange very few words with her. Doctor Francis, however, initially appeared as a handsome, big shouldered and tanned who seems to be someone to trust in a crisis. Carver switches these presuppositions of character, at the end of the story. It is the baker who would bring comfort and the doctor who would disappoint. Carver uses food as a cultural object appealing to our customary senses, a space ship and launching pad under a sprinkling of white stars. Scottys birthday cake has the qualities of mos t other American birthday cakes for young boys. Betsy De Lacy Patient representative, uses euphemism to demand money from patients, doesnt feel she represent the patient but rather the c ashiers in the collection department, argues that people see the hospitals as money first and health second (admittance form) Carmelita Lester: a practical nurse who loves her job, her work doesnt leave her mind, she is attached to the people she tak es care of, calling them her babies, has a different cultural value, In America, people do not keep their old people at home, whereas in her country, the old people stay in the home until they die and normally their children would take care of them, she devoted herself to being a good nurse after her experience being in the hospital where she was sick and the nurses were negligent or provided horrible care Cathleen Moran, hospital aid, dislikes her job but does it for the income, mirroring as she was treated as a child, she admired the nun who was tough and brutal and claim that her character is reflective of the rigid discipline she experienced as a child, paradoxical, hated the nuns and emulated her since she was an orphan so she didnt really have any other parental figure or role model to look u p to, hides her feeling of vulnerability and sensitivity with discipline and detachment with the patients

Kitty Scanlan: Assertion that A hospital is a dehumanizing institution because of its rigid status system (Agreeable/Convincing) The cleaning lady turns out to be the best person for the patients because she sees the patients as a poor lady whos sick rather than arms or legs or kidneys or bladders. Scanlan also raises a good question of the use of prolonging an alcoholics life if ultimately he is sent back to his world surrounde d by his loneliness. As the goal of a doctor is to always heal and sometime cure In a metaphor, Scanlan describe being sick as a transition back into infancy, where one becomes dependent on the care of others. I strongly agree with this; having had pneumonia and being hospitalized for 4 days and placed under 10 days of home care, I was very reliant on my familys support and care. Betsy De Lacy: Gain some insights into the challenges of being a patients representative or also known as the collector. Discuss the rising cost of healthcare Discuss Obamacare and Lacy supports this Id like to see one insurance for all people Although Lacy is ambitious to think of medical care for everyone, she is pragmatic and acknowledges some people would not be happy. Carmelita Lester: I have never been inside a nursing home or know much about the environment of a nursing home. I feel a slight pity for the people who have to live in nursing homes instead of being with their families for whatever reasons. Media also portrays a nursing home as a lackluster and lonely place or families throw the elderly into because they are tired of taking care of the person Cathleen Moran Gives me the impression as if I was holding onto to a job that I didnt like or care about Moran runs into all these social issues with the patients because she does not have concerns for them and view them almost as nuisances from completing her work She relates to her past about the nun, and how the nuns brutal and stern manner has influenced her character.

Dr. Stephen Bartlett In contrast to Cathleen Moran who hates her job and is only working for the money, Dr. Stephen Bartlett takes pride in being a dentist, takes pride in his work and creativity, which is required even in dentistry. Sontag, Illness as a Metaphor - Using metaphors is destructive to the patient causes the patients to feel embarrassed of their illness and tend to hide their illnesses because of fear of rejection from society or judgment - Best to not to talk about illness using metaphors because language carry certain connotations and provoke certain emotions and associations to the illness, and often times, they are not true - TB, once thought as of as a disease of passion that makes the person attractive and sexy, turns out to be a lung bacterial infection - Sontag makes the argument that just because people dont know about cancer, a prevalent disease in modern society, they should not try to describe the illness using metaphor terms because there are associations and emotions that are carried with those words that may be destructive to patients and cause them to feel embarrassed or even shameful of their illness. Payer, Medicine and Culture One would prefer using minimal amounts of drugs and relying on the placebo effect to treat the illness, whereas, in America, patients are given drugs even if it is not certain that the drugs are beneficial for the patients. Even American patients prefer using drugs over other treatment remedies that may be just as effective. Women who have their pubic hair shaved before giving births had more infections than women who did not. The practice, however, is still continued because of the some puritanical feeling that pubic hair should be shaved. Ignorance, our first reaction is always negative if we dont describe i t first Rejection on study results, chauvinistic Americans view their body as a machine. That vacations are set to recharge their batteries rather than to gain new insights or understand their soul. Thus, there is this mechanistic approach to medicine, where if something in wrong, a doctor should prescribe medicine or do something to fix it. Spanish doctor; will have two sutures, but in Belgian, where sutures are appreciated, he would put in six sutures. Understanding the cultural basis for these mistakes can perhaps prevent them. Payer, The Virus in the Machine Medical care is delivered by doing something onto the body even when nothing is better More Diagnostic tests, more aggressive the surgery, higher doses, and more aggressive American can do attitude, diseases could be conquered, The once limitless lands gave rise to a spirit that anything was possible Bloodletting in American medical practice Convinced practitioners and patients that they were heroic, bold courageous, manly, and patriotic. Cesarean section is most commonly performed in the United States Overestimate of their skills and underestimates of the risks Risk of doing something is lower than the risk of doing nothing Atavistic: relating to something ancient or ancestral Even the law has an influence on the aggressive treatment on American physicians. They worry that if they do not do something, they may be sued. In the face of unknown risks and benefits, it was better to do something than to do nothing. Media pushes public views and public policies Death is never considered natural. Journalists are told to never write in an obituary that someone died of natural causes. Wastebasket diagnoses: When doctor dont know what is wrong with the patient, they at tribute it to a virus. Patients feel that they not doing enough without reducing their salt to treat their high blood pressure, even though it is not necessary. Like bloodletting in the past, reducing salt ingestion is similar in that it shows Americans favor treating disease by exclusion rather than inclusion. (Something deep in American roots) . Frenchman: goes on vacation to rest and change ideas American goes to recharge his batteries View their bodies as a machine Belief in the body as plumbing, coupled with the can do attitude, Doctors keeping terminally ill patients and even brain-dead patients alive on machine often neglecting the needs of the chronically ill and often the emotional needs of the acute ill. Mecicine is not the inevitable result of medical progress but of choices that arise from our cultural biases. Better Medicine = > understanding of our biases, < memory of the frontier past, > focus on the patients Selter, Readings focus on doctors being in unfamiliar situations

Doctors having to decide whether or not to tell the prostitute about her illness outside of his professional life (Ability to diagnose is a burden) Mercy: Doctors emotional struggle on whether to fulfill the wishes of the men and his families but possibly going agai nst his ethics, Do no harm. His ethics are questioned> whether he should kill the man or not. Imelda: Hugh Franciscus, chief of plastic surgery, tall vigorous, muscular and precise in his technique Detached from his patients to avoid being emotionally attached to his patients. His coping mechanism going back to the girls face and fix it demystifying the fantasies surrounding cancer, Sontag shows cancer for what it is -- just a disease. ancer, she argues, is not a curse, not a punishment, certainly not an embarrassment and, it is highly curable, if good treatment is followed. Military metaphor Drawing out the similarities between.Sontag shows that both diseases were associated with personal psychological traits. Onc e TB now Cancer She believed that wrapping disease in metaphors discouraged, silenced, and shamed patients. The consultation: burden in having to diagnose and give the bad news, doctors cannot separate their professional and personal lives, these two often cross, put in an unfamiliar situation HC 26 8/12/13 Elements of Storytelling: Setting: (environment, time, imagery) the visual cues of what something look like Ie: the bolted seat --> School institution forcing students to behave a certain way Conflict that leads to a resolution Moral or lesson: ***Intentional Fallacy: Think that the author wants us to think a certain way, but we cant know for sure. Characters: Character learns things, then youre suppose to learn something out of that Narration***: Who tells the story? First-person narration or third person narration or omniscient narration affects how we read it and how we understand it Theme: Meaning of the work that the reader can extract Plot: how the story is structured A small, good thing: Carver is dramatizing the perplexity of Scottys health The parents feel anxious because they dont know what the outcome will be The parents feel helpless. At work, Howard is authoritative, and Ann know what she does. Their entire is thrown out of center. Time is suspended. The y dont know whether it is day or night. Their daily activities become meaningless. Sleepwalking through their lives because they are unable to act. Did not expect a tragedy at the heart of the story with the title A Small Good Thing Carver plays with the motif with what we consider natural Parent going to a bakery buying a birthday cake decorated with a spaceship and launching pad Interactions with the baker: Not friendly, minimum exchange of words, the necessary information Character name; Ann Weiss, Weise (German=White) Ann (average, plain) Average white Ann seems to have little experience with anything outside her world. When faced with a crisis, she seems uniquely incapable of coping with it. Negro family: Word choice: Negro Ann is st uck in the past, in a sense. Her failure to move forward is exemplified. Doctor Francis***: Hes detached, a professional necessity. He just spouts meaningless rhetoric calling it a deep sleep ins tead of a coma. He doesnt seem to be concern of the parents anxiety and grief. Three piece suit, well cuffed, well combed: the description shows he is on a different plane Hes very patronizing to the parents. He called Ann her little mother. He talks to Howard even when the Ann is asking the q uestion. Gender based problem Doctor Francis doesnt take responsibilities. Hes claiming its not his fault.

Dealing with the grief Baker: unfeeling, angry, bitter man Reader expects a violent ugly scene Baker takes an important step: Stopping his work, putting his things down, to take time down from the middle of it is a commitment is a big step for the baker He understands perhaps from his personal loss or past events Smell of bread: desire of gratification Daylight under fluorescent light: Enlightenment is something that is not dependent on light itself

He provides them more understanding and further insight than the doctor The bread: Heavy bread, but rich; taste of molasses and coarse grain Their previous life was mechanical, that they have not been opened to new experiences. Carver shows an essential sadness, shows us how to deal with it. Complications: A Surgeons Notes on an Imperfect Science Atul Gawande Surgery is not quite as predictable as we like to think Adaptability and resilience in the face of things that are unexpected How a writer structure a work: Give us the perspective of a surgeons Young doctor, on trauma duty, in roll a patient, one of his early experiences, having to deal with this type of dramatic situation where someones life or death falls in his hands Gawande is an effective writer: 1) starting his writing with an anecdote 2) in medias res in a middle of thing as opposed to describing his background as surgeon Grabs the readers attention 3) Gawande does it like its show The gurney wheels were whizzing, IV bags swinging, people holding doors open for us to pass through The adrenaline rush of the moment that the doctor needs to make his best decision In the moment, it seemed like the right thing to do. In retrospect, perhaps alternate actions may have been better. Morbidity and mortality Medicine is a living practice, having to collate knowledge with experience. Purpose: To shows an as aspect of experience, what he gained from his years as a surgeon Think about each individual author and their works Think about it thematically, Group stories together Selter: Doctors are put in conflicting situations, place in situations that not part of the normal training Situations that test their ethics and humanities Perceptual differences are enormous. People think they know what theyre doing, think they know how other see them, but something happens and their perception ero de. People think of them different The Consultation The doctor is bored, not very engaged, impression that hes just sleepwalking through the medical convention Theres a weight/burden to be able to diagnose peoples ills The control of the story go back and forth The prostitute fears of getting a scare if she has her tumor surgically removed because it would ruin her profession. Story about identity, the way we present ourselves Mercy Professional demeanor, doctor-patient interaction, Ethics of American doctors: Euthanasia is legal. (People can die with dignity) Seltzer dramatizes the doct ors conflict of how to treat something Flies: short life cycle, bang against the windows then die Humans being arent like the flies Imelda seemingly cold figure to being someone who feels a great deal of empathy with the girl and the mother When Imeldas picture come up on the screen, hes remind of moment when things he expected to happen do not go the way they should be. Dr. Franciscus is a mentor to the medical student. Experience to Hondurus was expecially poignant Fallibility of doctor: shady ethical practice See Dr. Franciscus freeze, not knowing to cope with his feelings Dr. F was not able to go back to the level of productivity he had Common themes: Difficulty that doctor goes through with their professional profile Medical situations Personal needs and impulses Doctors of Hoyland Doctor who has a monopoly on a medical practice in town Female doctors winds out taking up most of the business in town, Dr. Ripley falls in love with her, she rejected him to devote to study of science Dr. Ripley is sexist Doyle is dramatizing an issue in medical education, the way that women are not respected The doctor accepts what his life is and doesnt try to improve. (character flaw) Hes a standard small town physician. A Medical Document Doctors recount the tales of their patients as if they are just table talks. Women giving birth, husband is handcuffed to her If she has to feel pain, he has to too. Gossiping and telling fun stories They think that doctors are the only ones who can understand the experiences they go through

Doyle sees doctors being too distant from their patients, too comfortable with themselves They downplay their points when they learned that their stories were being recorded. The ways we think about our medical professional are very stereotypical Williams The Use of Force Diphtheria: highly communicable, needs to be quarantine, she wants to go to school the next day, girl is resistant Parents: they dont know what to do Drama, conflict, difficulty of doctor of doing his job well, the use of force, he feels incredible by this whole experience, she feels shes been violated, no good choices, no happy endings The Practice When he knows hed be telling them things that would be impactful, thats an immensous power. Chekhoss Misery The horse allows him to have a contharses, opportunity to talk about his loss A world where people are left on their own/isolated and they are left to deal with it Class differences , people getting in and out of the cab and they don t care about the life of the driver, Chekhov is showing that people have personal lives A Doctors Visit Girl suffers from loneliness and depression. She needs counseling. She needs therapy. Chekhov is documenting a social problem that has a medical relevance George Orwell Patients are treated like specimen People who dont have access to healthcare often have no choice but to accept these expedients People are objectified. It is shameful that people are treated this way, that they are seem as numbers rather than by their names. August 14, 2013 Starts with a general concept Sontag: great intellectual, novelist, premier literary American critic Primary Thesis: Because we tend think of illness metaphorically, we tend to think of comparatively, Increases patients anxiety, Increases peoples attitude toward those who got ill Coping strategy / a healthy way of living life Begins the essay with a metaphor Illness is the night-side of life, intentionally Borromean Ring: Things that are intertwined. If you take at one out, the others are no longer intertwined Illness and disease highlight (punitive or sentimental views Tend to simplify illness Science has made dramatic leaps, eradicating some diseases. Polio vaccines, cancer research is ongoing, Stigmatized for having the illness TB, historically, was considered as fate God wants it TB was known to be a scourge. In literature: Rose cheeks, lung disease, people glowing TB became a metaphor in romantic literature, in the idea that somebody who has TB showing the signs of weight loss, would be seen having a higher spiritually. Cancer: Invasive, something that comes into us and attacks us Cant pinpoint the causality Because cancer bears such a stigma, particularly with organs near with reproductive organs, have symptoms they can look for in checkups Language used + cultural attitude affect the way people are treated, the patients decision about their illness and intergrad ing into society Sontags ending: Were always using one thing to stand for another, giving it more significance than it should have Language has an inherent melodramatic quality. Culture Bias in Medical Science Cultural interference doesnt a allow a consistency of healthcare, globally We dont have symbiotic information in order to absorb the knowledge of other countries Americans tend to be resistant to other things from the world

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