Bertold Brecht: A Worker’s Speech to a Doctor

We know what makes us ill.
When we’re ill word says
You’re the one to make us well
For ten years, so we hear
You learned how to heal in elegant schools
Built at the people’s expense
And to get your knowledge
Dispensed a fortune
That means you can make us well.
Can you make us well?
When we visit you
Our clothes are ripped and torn
And you listen all over our naked body.
As to the cause of our illness
A glance at our rags would be more
Revealing. One and the same cause wears out
Our bodies and our clothes.
The pain in our shoulder comes
You say, from the damp; and this is also the cause
Of the patch on the apartment wall.
So tell us then:
Where does the damp come from?
Too much work and too little food
Make us weak and scrawny.
Your prescription says:
Put on more weight.
You might as well tell a fish
Go climb a tree
How much time can you give us?
We see: one carpet in your flat costs
The fees you take from
Five thousand consultations
You’ll no doubt protest
Your innocence. The damp patch
On the wall of our apartments
Tells the same story.

This Magnificent Dappled Sea

 by David Biro

This book is by a dermatologist and writer.  I own a copy but listened to it on Audible.com.  The story centers on an Italian boy with leukemia and his bone marrow transplant (BMT). All of the characters are alive. Especially memorable are Nina (the nurse), Luca (the patient), Joseph (the bone marrow donor). The story has many layers -- from the science of bone marrow transplantation, to complex family relationships in Italy and Brooklyn. The subplots will resonate with me for some time. I give this the strongest recommendation! 

 

Albert R. Jonsen Obituary

Albert R. Jonsen, 89, Dies; Brought Medical Ethics to the Bedside

A former Jesuit priest and leader in bioethics, he believed that an ethicist should be part of a patient’s medical team when hard decisions have to be made.

 

By Gina Kolata

NY Times Nov. 16, 2020

 

Albert R. Jonsen, who brought the field of bioethics to the bedside and whose way of reasoning influenced generations of medical ethicists, died on Oct. 21 at his home in San Francisco.

 

His legacy is important. 

Full NY Times Obituary.  (If you can't open the link, I can send you a pdf.)

About Miranda-Med

Miranda by John William Waterhouse (1849 - 1017)

In 1885, when John Shaw Billings started the database which would, over time, morph into PubMed he recognized the hopelessness of trying to keep abreast of the literature.  In addition, he was cognizant of how trivial most of what passes for “the literature” is when he wrote:

There is a vast amount of effete and worthless material in the literature of medicine.  Our preparers of compilations and compendiums, big and little, acknowledged or not, are continually enlarging the collection, and for the most part with material that has been categorized as ‘superlatively middling, the quintessential extract of mediocrity.

        Over the past 132 years, the situation has only gotten worse.  Today, the National Library of Medicine (NLM) indexes over 3500 journals in MEDLINE (searchable via PubMed).  What physician could keep up with even those in his own specialty. even if all one did was pore over medical periodicals?

What we are proposing to form is a Virtual Journal Club for the medical humanities.  Each month, the members will post the one or two articles they deem most inspiring from their chosen journals.  The references will be stored on this web site (Miranda-Med) for retrieval and open-access whenever possible.

We will also include books that deal with humane aspects of health care.  There are some classics and each year a few new titles are added to the canon.

If you are interested, please consider joining our Miranda-Med Hui.

Suggested Journals

Annals of Internal Medicine

British Medical Journal

Journal of the American Medical Association

Lancet

New England Journal of Medicine

New York Times

The Miranda-Med Philosophy

As articulated by Robertson Davies, in The Cunning Man:

[We] don't decry research. Some fine things are done.

Not nearly enough for the amount of money spent. Too much machinery, too much administration, and not enough brains and intuition. Research harbors a lot of second- and third-rate people.

The huge labs are what monasteries were before Henry the VIII took the axe to them. More humanism and less science – that's what medicine needs. But humanism is hard work and a lot of science is just Tinkertoy®.

Coronavirus by the Numbers

This is a lucid article in the March 6, 2020 NY Times. Link.

A mathematician who studies the spread of disease explains some of the figures that keep popping up in coronavirus news.

The news of coronavirus epidemics around the world involves a flood of numbers that are a challenge for any nonscientist to digest. In this useful article Dr. Kucharski to help us navigate some of these numbers, and tells us which ones we should pay attention to.

The article is well-worth reading.

Also read:

Preventing a covid-19 pandemic Link.

by John Watkins, Consulting Epidemiologist, Public Health Wales, Cardiff, UK

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m810 (Published 28 February 2020) Cite this as: BMJ 2020;368:m810 

We should plan on the assumption that most of the population may contract the virus with few or no long term effects, while harnessing vital secondary healthcare resources to treat the small percentage of people who become seriously ill.

Ink Rx/Paramedical Tattoos

Using tattoos to blend in rather than stand out is a relatively new enterprise. The pigments and techniques of paramedical tattooing aren’t standardized, but paramedical tattoo artists across the country are quickly establishing reputations for using flesh-toned pigments to camouflage imperfections, scars and discolorations.

One of the most common requests is for tattoos of areolas after having mastectomies. 

Mr. Catalano doesn’t charge for paramedical tattoos. A GoFundMe page established last year brought in more than $12,000, allowing him to donate his skills — at least for the time being. Each Wednesday (called “Wellness Wednesday”), he does up to eight reconstructive tattoos in his small shop.

This is a fascinating article in the February 16, 2020  NY Times.

Fingernail Tattoos after an Industrial Accident

Eewy Body Dementia

by Sharon Ostfeld-Johns
Annals of Internal Medicine, January 14, 2020
Free Full Text

This is a graphic medical essay about scabies (Norwegian type) and its effects on a medical resident's life.  It brilliantly comments on scabies, health anxiety and cyberchoindria.  One can appreciate how delusional parasitophobia can be a sequela in some people.  Fortunately, the author was not one of them.  The combination of text and drawings is a great way to tell the story.

Here is the first page: