Friday, July 25, 2008

Literature & Medicine: Physician-Assisted Suicide

More and more medical schools and health care worker training programs are beginning to include the humanities into their curricula; the terms "Literature & Medicine" or "Medical Humanities" grace many course catalogs (no matter the length or breadth of material covered).

A neat pairing of literature and life can be found in two recent oral history interviews (Goodwin and Toffler) and the novel The Idiot by Fyodor Dostoyevsky. The issue of physician assisted suicide is not a new one, and it is one which is unlikely to go away.

Compare some of Goodwin's comments on his first experiences as a physician:
Because the, you know, when, I notice the huge difference between death in hospitals and death in practice. And at that time, I was doing house calls. And I would do house calls on really ill patients who might have been into hospital, out of hospital. And I was dealing with two men, one dying of cancer of the prostate. The other, dying of complications from, he had a pulmonary disease and he also had prostate cancer. And looking after these patients in their homes with a supportive family environment, it was so different, you know, it was so heartwarming to be with those patients as both these men died. And then comparing that process with death in hospital, where the patient and family was all so often sort of shunted aside and tended to be sort of, not ignored, but sort of misled at times. “Oh, I don’t think things are quite so bad.” To sort of facing the idea that a patient was going to die was difficult for the medical profession. And that was part of my evolution.

The other part of my evolution was being approached by two men who wanted aid in dying. And the first time, it was just a shock. This couple came into my office. I had met them socially. They were new patients. And he just came right out with it. He said, “I’m dying. I’ve had this cancer for eight years. I’ve had all the treatment that’s possible. And I’m dying.” And he explained why he wanted to end the process, and it was overwhelming reason. But when he said, “I want you to help me to die,” Matt, literally I felt as though the blood had frozen in my veins. I just had this cold sensation all over.
with those of the fictional patient Ippolit, who is dying of consumption (Pevear and Volokhonsky translation):
I decided to die in Pavlovsk, at sunrise, and to do it in the park, so as not to trouble anyone in the dacha....

I recognize no judges over me and know that I am now beyond all judicial power. Not long ago I was amused by a certain supposition: what if I should suddenly take it into my head now to kill whomever I like, even a dozen people at once, or to do something most terrible, that is simply considered the most terrible thing in the world, what a quandary the court would find itself in before me, with my two- or three-week term and with torture and the rack abolished!...

But if I do not recognize any judgment over me, I know all the same that I will be judged, once I have become a deaf and speechless defendant. I do not want to go without leaving a word of reply--a free word, not a forced one--not to justify myself--oh, no! I have nothing to ask forgiveness for from anyone--but just because I myself want it so.

First of all, there is a strange thought here: who, in the name of what right, in the name of what motive, would now take it into his head to dispute my right to these two or three weeks of my term? What court has any business here? Who precisely needs that I should not only be sentenced, but should graciously keep to the term of my sentence? Can it really be that anyone needs that? For the sake of morality? If, in the bloom of health and strength, I were to make an attempt on my life, which 'could be useful to my neighbor,' and so on, then I could understand that morality might reproach me, out of old habit, for having dealt with my life arbitrarily, or whatever. But now, now, when the term of the sentence has been read out to me? What sort of morality needs, on top of your life, also your last gasp...

Literature can help bridge the gap between the physician's experience and that of the patient, helping each side to understand the position of the other.

Thursday, July 24, 2008

Evans Carlson's Legacy of Friendship; and, Update on the electrical apparatus

Donation number eleven for this month came to us on Tuesday morning from Dr. Charles Grossman.

The book Evans Carlson's Legacy of Friendship: 30 years of the Evans F. Carlson Friends of the People's Republic of China (Portland: The Friends, 2005) appears to be uniquely held, now, by the OHSU Library. Edited by Dr. Grossman and written in large part by Ralph Crawshaw, M.D., and Liu Baiyu, the book "describes the thirty-year story" of the Friends group, which was begun in 1974 and has organized group trips, lectures, publications, and exchanges between American and Chinese groups. The group has had a particular interest in fostering communication between Chinese and American physicians.

The 279-page book includes many photographs of the Friends members, their activities, their trips to China, and, passim, information about OHSU, the Primate Center, and physicians in the Portland area.

Brig. Gen. Evans Carlson, leader of the eponymous Raiders, became interested in the Chinese people and Chinese communism in the late 1930s when he served as a military observer there. In the introduction, Grossman writes that he "knew Evans and Peggy for a few short months before he died. He had been one of my heroes and 'role models' when I was a young man." In Grossman's opinion, Carlson resigned from the military in 1939 "when they [the U.S. government] refused to let him tell the truth about what he had learned in China."

The book will serve as an interesting and novel window on Sino-American relations over the decades, and will certainly provide new perspectives on Oregon medical culture.

And, an update: on the electrical apparatus we received from the Neurological Sciences Institute recently. Two neurologists agree that it is a machine for peripheral nerve stimulation and/or nerve conduction studies. Portable EEG units didn't come out until well after 1937, the latest possible date of manufacture for our piece. Mystery solved!

Wednesday, July 23, 2008

A different look: Modern nursing uniforms

Last week, we received a donation of a modern nursing uniform, one worn by a student at the University of Oregon School of Nursing in 1965. A much more practical and modern cut to the dress and cap, in comparison with the student uniforms of yesteryear. She even donated the shoes!

Tuesday, July 22, 2008

Final event: lecture tonight

The Portland installation of the NLM traveling exhibit Changing the Face of Medicine: Celebrating America's Women Physicians is drawing to a close. The exhibit will remain on display in the Collins Gallery of the Multnomah County Library Central Branch through August 1, but tonight is the final programming event. The lecture is free and open to the public, so please join us for:

Esther Clayson Pohl Lovejoy, M.D.: Changing the Face of Medicine in Oregon and Across the World
Tuesday, July 22, 6:30-8 p.m.
U.S. Bank Room, Central Library, 801 S.W. 10th Ave.

Learn about Esther Clayson Pohl Lovejoy, M.D., an 1894 graduate from the University of Oregon Medical School and a key figure in progressive era Oregon public health and suffrage campaigns. Kimberly Jensen, professor of history at Western Oregon University and author of Mobilizing Minerva: American Women in the First World War, traces Lovejoy’s accomplishments from her medical service in the First World War to directing and expanding the American Women’s Hospitals, an international medical relief service for civilians and refugees. As organizer and first president of the Medical Women’s International Association, Lovejoy developed an international vision for cooperation among medical women which continued throughout her life.

Monday, July 21, 2008

When I was your age....

Old timers often criticize young folk for whining about problems in their young lives. Youngsters of today might be interested to know that kids in Oregon in the late 1930s could be remanded to a child guidance clinic for the following reasons:

Conduct:
anti-social
automatisms
begging
destructive
disobedience
erratic
crying
fighting
forgery
crushes
housebreak
immoral
indecent
lying
purse snatching
refuse talk
running away
sex deliquency
stealing
temper
truancy
unmanageable
unreasonable speeches

Education:
failing
poor grades
reading difficulty
retarded
slow

Habits:
continual vomiting
enuresis
dirty language
faulty food habits
masturbation
spasms
soiling
untidy

Personality:
aggressive
depressed
effeminate
emasculate
day dreaming
immature
insolent
introvertive
irritable
lack of concentration
marked sex interest
nervous
negativistic
peculiar
recessive
resentful
seizures
speech defect
unsocial
unstable
excessive fears
fainting spells

Other:
convulsions
determination of handedness
nightmares
poor training
suspected mental difficulty
vocational guidance
inability to walk
marked slowness of movement

Still feel like whining? Be glad you can, even if you may be hassled by an old timer. (List courtesy of Child Guidance in Oregon with recommendations of the Governor's Special Committee, July 1, 1937.)