User:Arianna Pomares/sandbox

= Ward No.6 =

Summary
Revolving around philosophical and social conflicts, this story is set in a provincial mental asylum and explores the interactions occurring between a doctor and the members of his town. Andrey Yefimitch Ragin is the head doctor of a small town and although his position is favorable, he finds himself distressed with the mediocracy surrounding him. His deep desire to be submerged in intellectual conversation is satisfied by one of the patients in the mental ward adjacent to the hospital. This ward consists of five patients, referred to as lunatics, and a behavior enforcing soldier. The doctor seldomly visited the ward, but the one time he did, he became captivated by a paranoid patient that challenged his view on suffering. Ivan Gromov, although in a mental ward, was one of the sane members of the town, an eloquent man capable of engaging in the sort of intellectual conversation that the doctor had long been searching for. Gromov denounces the injustice he sees everywhere, while Dr. Ragin insists on ignoring injustice and other evils; partially as a result of this way of thinking, he neglects to remedy the shoddy conditions of the mental ward.

To the people of the town, it was quite flabbergasting that the doctor was spending an excess amount of time in the mental ward. Consequently, rumors were spread questioning the mental stability of Ragin, and wether or not he was fit to continue being the doctor of the town. Such was the concern of the townspeople, that they created a council to judge Ragin's sanity, and ultimately deemed him insane. Ragin was not made aware of this absurd diagnosis but rather was persuaded by a man, Mihail Averyanitch, to go on vacation because he was not acting like himself lately, and surely a vacation would rid him of his peculiar behavior. Despondency followed Ragin on vacation, and isolated him further from society. Having spent all of his money on vacation and loaning it to Averyanitch, Ragin returned to town and found himself without a job and without a penny to fall on. With no where left to turn, Ragin moved in to the residency where the hospital chef lived and found himself spiraling down the rabbit hole.

The epitome of Ragin's destruction was marked when Averyanitch along with the new doctor of the town, Hobotov, visited Ragin in his new living headquarters. Such social displeasure provoked Ragin to spew vile words and even launch a bottle of bromide at the horrified visitors. It was at that moment that all hope was lost for Ragin, and Dr. Hobotov was convinced that Ragin should be admitted to the mental ward. Discretely, Hobotov lured Ragin into the mental ward under the pretext that there was a patient with a curious lung case. Once both of them were in the ward, Hobotov slipped out, and left Ragin trapped against his will. Now faced with the same future as Gromov's, Ragin understood that suffering was not a creation of the mind that could be whisked away by changing one's mentality. No longer an esteemed doctor, Ragin fought with futile efforts to be released from the ward but was instead faced with the beatings that were accustomed to the other members of the ward. Ragin's enlightenment came at the cost of his destruction; becoming a patient of the asylum triggered an apoplectic stroke in Ragin that ended his life after one day in the ward. What once were five lunatics, became six, and marked Ward No.6.

Characters

 * Dr. Andrey Yefimitch Ragin - the doctor of a small town, had aspirations for a clerical career but was persuaded otherwise by his father. A man of tall stature with a simplistic means of living, who appreciated intelligence and honesty but lacked strength of will and leadership. Ragin possessed a thirst for intellectual conversation that was quenched when he met Ivan Gromov. His frequent visits to the mental ward of the hospital resulted in his involuntary admittance to the ward as a patient himself. Distraught with the turn of his fate and indignation, Ragin had a stroke after a day of incarceration at the mental ward no.6.
 * Ivan Dmitritch Gromov - one of the patients of ward no. 6, described to be excited, gentle, agitated, but most notably with a paranoia of persecution. The slightest of noises would cause Gromov to look over his shoulder in fear of the police arresting him for a crime he had not committed. Gromov challenged Ragin's viewpoint on suffering, arguing that in order to understand the suffering of others, the doctor would have to experience suffering himself. He ultimately became the only person that Ragin wished to converse with and even fought alongside him to be released from the ward, with no success.
 * Mihail Averyanitch - a postmaster that believed himself to be friends with Ragin, feelings which were not reciprocated by the other party. Was often concerned with the mental state of Ragin and even dragged him along on a vacation in a futile attempt to restore the sanity of the doctor. Eventually, Ragin blew the fuse on Mihail, insulting him with words and even throwing a bottle of bromide at him.
 * Yevgeny Fyodoritch Hobotov - the young district doctor that arrived to the town to assist Ragin in the hospital. Formed part of the council that diagnosed Ragin to be mentally unstable and then took over Ragin's post in the hospital. After having witnessed Ragin's outburst provoked by his and mikail's visit, he lured Ragin into the mental ward under the pretext of visiting a patient with an interesting lung complication.
 * Sergey Sergeyitch - was the medical assistant of Ragin yet he had his own practice in the town. Spied on Ragin during one of his conversations with Gromov and found it incredulous that the doctor was spending an excess amount of time with a mental patient. Aided in the spread of rumors that Ragin should be institutionalized in the ward.
 * Nikita - the guard of the ward in charge of maintaining the behavior of the patients, a task which he executed happily with beatings and harsh treatment. Had respect for Ragin and referred to him as "your honour" however he did not release Ragin from the ward upon request, and instead gave him a beating as he often did to the other patients for misbehavior.
 * Daryushka - was the chef of the hospital kitchen; would strictly follow Ragin's meal schedules and became alarmed when instead of asking for his usual beer, Ragin was conversing with Gromov. After Ragin was forced to abandon his living quarters in the hospital, Daryushka covered for him when he could not pay the landlady due to loss of employment. She also visited the doctor in the mental ward once he was trapped.
 * Moiseika - "the Jew Moiseika" was the only patient of the ward that was allowed to leave. When venturing into the town, he would try and gather any scraps by begging. All of which he brought back from town was confiscated by Nikita. He found pleasure in caring for his companions of the mental ward.
 * Semyon Lazaritch - barber of the ward patients, only mentioned once in the story but is noted to mistreat the patients in a similar manner as Nikita.

Existential Crisis
"Ragin's illumination of truth comes at the moment of death, too late to live in wisdom."

Throughout the story, Ragin struggles with an internal battle of deciding wether or not his life is of any value. In the hospital, he behaves as if his actions as a doctor have no impact on the lives of others, deeming death to be the outcome of any medical situation. He is the doctor of the town and esteemed with honor, yet he does not use his position to make a difference in the conditions of the hospital and the ward. Ragin was a knowledgeable man that let life pass by him, merely repeating each day in a robotic manner. While on vacation with Mihail, Ragin spent his hours laying on the sofa contemplating life and death. Although a life span is the longest thing a person will experience, he felt that once death took place, one simply evaporated and left no trace in the universe. He found no point in living if the life would be forgotten once gone. And so he carried on each day not caring if the world around him was falling apart because for a very long time, the world in him was already lost.

Society
"A hospital where the sane are locked up for their madness and the cynical serve the state by acquiescing."

In Ward No.6 the asylum consisted of five patients, and then six once the doctor was admitted. Of those six patients, two were sane and locked up against their will. The determination of their sanity was not diagnosed by a doctor rather by society deeming their actions unfit. When Ragin was seen with Gromov more often than not, the town folk began spreading rumors behind his back about his actions instead of asking him why he was speaking to the mental patient. Such actions highlighted the misplaced value of the townspeople, more concerned with the latest gossip than with desmonstrating compassion. The town constructed a council with unqualified people to judge the sanity of Ragin without his consent, and once a diagnosis was concluded, it was not communicated to Ragin. Furthering the crisis existing in the town created by Chekhov, it was socially acceptable for the patients of the ward to be punished with physical beatings. While Ragin was still in charge of the hospital, he made no efforts to put a stop to the abuse of the mental patients, and as a result he received the same treatment when he became a patient of the ward. Misplaced values were also observed in the hospital, where robbery was common and integrity was not. Had the town focused its energy on punishing the thieves instead of the mental patients, then perhaps their health care system would have been comparable to that of a larger city.

Neglect
"A physician could leave no human mark on human misery & nonetheless persisted in treating the sick, sowing corn and planting trees."

The hospital and ward that the story revolved around were both in dilapidating conditions. Maintenance of sanitation was nonexistent, thus probably why the majority of the patients in the hospital would be admitted but not released. The hospital was swarming with thieves composed of employees and patients that would rob food, medicine, and any readily available supply. All of the problems existing in the hospital were not unknown to Dr. Ragin but he felt no use in improving medical conditions because at the end of the day, death was inevitable so why prolong a life that had an expiration date. Even though a young Ragin had aspirations for a clerical career, he did not demonstrate the compassion of a priest when dealing with his patients, neglecting to perform surgery.

Suffering
"To cultivate indifference to suffering is to aim at a living death for to feel is to live."

A vast dialogue occurred between Ragin and Gromov, exploring the fruiting of suffering and its relationship to love. As much as Ragin wanted to help and relieve the suffering of Gromov, the latter said it would be impossible for the doctor to do so because he had never felt suffering. Gromov argued that in order for one to be compassionate with the suffering of others, it was necessary to experience suffering first hand. Not only was suffering necessary for compassion, but it enabled a being to appreciate love and life, a message that Ragin did not understand until he became a member of the ward. As a doctor, Ragin argued that it did not matter if he was inside the ward like Gromov or outside, nor did the clothes and food that they ate matter, because suffering was mental and one could make it disappear upon request. Those words were easily said at the point in the story which he could leave the ward upon desire, but once his freedom was removed, he understood the suffering experienced by Gromov. Their shared suffering united them in an attempt to escape from the ward, a futile attempt, but for the first time, doctor and patient were on the same level.

Part I
Before the Holocaust, medical experiments had been long underway and are what transitioned into a genocide. This first part of the book describes in detail the four stages that took place before the Holocaust. Starting with coercive sterilization, proceeding to the killing of children and then adults; medical reasonings were used to justify the actions of Nazi doctors. The progression of the killings began legally with sterilization laws and then turned into illegal actions that were permitted by the government. This time period was referred to as Nazi Germany, in which the Nazi party took over and brainwashed most citizens.

Sterilization and the Nazi Biomedical Vision
The biomedical vision consisted of a racial cleanse, an idea that could not be openly presented to the public. To gently introduce the idea, doctors employed coercive strategies so that people would participate in their medical procedures. The first of these procedures was targeting individuals with an illness and persuading them to undergo sterilization. By removing the ability of these individuals to reproduce, the doctors were practicing a form of epigenetics, in which they were selecting for the traits they wanted to be passed along to future generations. This process came to be accepted by most doctors and even patients because sterilization laws were passed; this legal measure normalized the process.

"Euthanasia": Direct Medical Killing
Although sterilizing an individual has permanent consequences, the patient remained with life. However, it was not long before doctors transitioned from targeting physically fit individuals with mental illnesses, to targeting parents whose child had a mental illness. Children aren't fit to reproduce so they weren't sterilized, instead their parents were convinced that it was better if the child was euthanized. This form of killing came with a purpose, one of which was sold to parents who then agreed to allow such procedures on their children. Since children don't form part of the work force, this did not have an impact on the economy and therefore did not cause as much of an outrage as when adults were targeted.

Resistance to Direct Medical Killing
Many doctors willingly participated in the racial cleanse, but a minority of the doctors objected the ideology and even tried to resist. Those who tried to resist did so by downplaying the diagnosis of their patients. They found it better to release their patients to family members instead of sending them to state hospitals, where euthanasia would be their only ticket out. The resistance of doctors along with that of the people, lead to the ending of the T4 program, in which individuals deemed as incurable were subjected to euthanasia. Often times, the diagnosis of being incurable was questionable, leaving family members feeling as though the death was unjustified.

"Wild Euthanasia" : The Doctors Take Over
Resisting may have ended T4 but it created this sense of secrecy amongst the doctors, who now found themselves employing their medical procedures incognito. By removing the public eyes away from themselves, the doctors were now faced with a freedom of selecting which patients to kill and how. Adolf Hitler was regarded as the number one physician, and those below him followed in his ideologies of killing with the justified purpose of cleansing their race. Wild euthanasia references the widespread killing that occurred after T4 ended, however it turned out that the solution to the problem becomes more grave than the problem itself. While this was happening, the gas chambers that had been banned in the West, were being relocated to the East.

Participants
A recollection of some of the doctors that had a role in pre-Holocaust stages are mentioned in this chapter. Lifton was able to interview and question these doctors, writing down some of their reflections. Some doctors shared the mentality that their actions were justified by the cause, and proceeded to share that their superiors provided moral reassurance. There were those doctors that knew their actions were wrong, but had no way of escaping the regime; often times the doctors did not know what they were signing up for when they were recruited. A military promotion for a doctor involved being relocated to a killing center and having to execute most patients. There was one doctor that was able to leave the killing center but he did so on good terms with the regime by saying that he was not a psychiatrist and therefore, he did not belong there; other doctors did not have such luck.

Bringing "Euthanasia" to the Camps: Action Special Treatment 14f13
Project T4 spawned into special treatment 14f13, which was the extension of the original project into the concentration camps. Officers and physicians that took part in T4 were recruited to assist with 14f13. Although the killing method was the same, carbon monoxide poisoning in a chamber, the screening process was a lot swifter and eventually was removed. Initially, patients willingly participated in the treatment because they were told they'd be going to a resting home, turns out there was no return. With the screening process removed, the only quality necessary was for someone to identify as a Jew. And in that manner, groups of Jews were sent to gas chambers; a process that would also be described as euthanasia by Nazis. To them, it was unworthy life that they were removing, so their actions were not wrong.

Part II
The ideology driven by Adolf Hitler received so much support from doctors and Nazis that it was possible for them to set up concentration camps in which mass medical killings occurred. One of the largest camps was Auschwitz, a place described as the "anus of the world." Although it was mostly Jews that were taken to this camp, people from other groups were also executed under the plan to create the pure race. This second part of the book begins with the transportation of the victims to the camps, their arrival, life at the camp, and how different members of the camp adjusted and evolved.

The Auschwitz Institution
Auschwitz began as a concentration camp in which political prisoners were taken; these camps were set up shortly after the Nazis rose to power. Since the people taken to these camps were originally prisoners, it was not difficult for the Nazis to set up various camps. Auschwitz was also deemed to be a work camp, the dwellers were forced to work under inhumane conditions, a combination which ultimately left to death; which of course, was the intent of the SS doctors. In its last and worst stage, Auschwitz was an annihilation camp, where anyone labeled as undesirable was sent to be killed, prisoner or not. This was one of dominant locations in which the mass murder of Jews occurred, namely because it was positioned in a place that facilitated travel and communication as well as privacy.

Selections on the Ramp
Arriving at Auschwitz involved a train trip of several days worth, standing up in a crowd with no idea of the final destination. The train stops and the people were unloaded at the ramp, met with screams and a sense of urgency, all in the middle of the night to avoid detection. Lines of five were then formed to begin the selection process. Common questions involved age, and profession. Age would determine whether the person was to walk to the camp or take a bus, while profession determined whether the person would be useful or dispensable. Once people realized that profession made a life or death difference, they began to lie about their profession.

Selections in the Camp
Selections began at the ramps and extended into the camps where people were destined either for work or for extermination. It was the idea of a chief physician that those unfit to work should be sent to the chambers, this highlights the heavy influence that doctors had during the Holocaust. There was randomness in the selection; described by a survivor who was skipped on a selection day even though her physical condition was in a worse state than those next to her. There was even randomness in the time that the selections took place, it could happen at 4 in the morning in 4 in the afternoon, and sometimes even on holidays. And on extreme occasions, whole camp groups, Czech, Gypsy, etc., were taken to the gas chambers; these orders came from high in command and involved the death of thousands of people at a time.

Socialization to Killing
For such a large scale annihilation to occur, there had to be cooperation amongst those executing the plan. And as was such on behalf of Nazi doctors, although reactions to the killings were different, the common factor was compliance. There were the extreme doctors that enjoyed partaking in the killings and even worked over time, there were those that felt in no particular way and simply did their job, and then there were those who were against the killings but still, they did their job. This chapter describes the doctors to be normalized with the events taking place in the camp, some even had a good sense of humor, contrary to the type of behavior expected at a death camp.

Prisoner Doctors: The Agony of Selection
There were the SS doctors and then there were the prisoner doctors. Once the chiefs decided to spare doctors from the chambers, prisoner doctors were held at a higher standard than the rest of the prisoners. This placed them in a position where the prisoner doctors were grateful because their life was spared, however it meant that they might have to live through the death of a loved one. Some prisoner doctors described that in the camps, an urge of survival kicks in and diminishes all other feelings. At that point, the life of the prisoner doctors depended on the SS doctors who shared with them the knowledge of medicine but used it to end lives instead of to save.

Prisoner Doctors: Struggles to Heal
Conflicted with the guilt of having their lives spared and having to witness as others died, prisoner doctors made an effort to heal and save lives. They urged for the creation of more hospital buildings, while the SS doctors wanted less. Regardless, both doctors engaged in a paradoxical relationship where the SS doctors wished to learn from the prisoner doctors, who in turn, just wanted to be recognized as a human beings. Observing the experimental procedures conducted by the SS doctors was described to have felt as unreal at the time for the prisoner doctors. One simply could not believe what was going on.

Prisoner Doctors: Collaboration with Nazi Doctors
When the instinct of survival kicked in, the prisoner doctors did anything as long as their life was spared. One of the doctors described that the killings would have gone on anyway; except that if he refused to comply someone would take his place, so it was better for him to remain alive and comply. And like that, the prisoner doctors collaborated with the SS doctors, obeying their orders. There was even discrimination amongst the prisoners themselves, with groups setting themselves apart instead of acting as equals. It was noted that Polish doctors were more likely to send Jews to the chambers, opposed to sending other Polish prisoners.

Killing with Syringes: Phenol Injections
The gas chambers was a method to quickly kill large amounts. But there were other killing methods in which doctors experimented with the human body. One of the most common methods was phenol injections. The process seemed normal because the prisoner patients were taken to an examination room and treated with a drug, except that drug was phenol and would lead to death. This was another form of euthanasia in which the killing served the purpose of eliminating an incurable person.

The Experimental Impulse
The killings conducted by the SS doctors that have been described so far occurred with two purposes. The first purpose involved carrying out the biomedical vision of the Nazi's and the second stemmed from the physician's curiosity. Sterilization and castration were experiments that were supported by the regime because it aided in the racial cleanse. Experimental procedures conducted on identical twins were not part of the regime's ideology but the doctors were allowed to do as they pleased, and so they carried on like mad scientists.

"A Human Being in an SS Uniform": Ernst. B.
Not many doctors showed sympathy with the prisoners of the camp, but Ernst B was one of those who did. He gained a repertoire of being a good doctor, to the extent that during his trial, prisoner doctors testified on his behalf, which led to his acquittal. Lifton described him to be a pleasant man when they met for the interview and he had to mentally remind himself that no matter how good this man had been, it doesn't change the fact that he too, was an SS doctor.

Dr. Auschwitz: Josef Mengele
As the title of this chapter suggests, Josef Mengele was another Nazi doctor, one that particularly stood out because of his bloodlust. This was a man that was known in Auschwitz because he was everywhere, and to be everywhere meant that he was actively participating in the killings. He was keen on making selections and ensuring that twins were spared for his medical experiments. His attempts to evade his criminal punishments were large, but a vast number of testimonies were brought forth against him.

Healing-Killing Conflict: Eduard Wirths
Eduard Wirths was one of the doctors that embodied the healing-killing paradox. He was described by the prisoners as a kind man, and yet he was also the same man that set up the system of selections at the camp. This was a man that experimented on patients, but instead of doing it himself, would order others to do it for him. His arrival at Auschwitz stemmed from the need to reduce the typhus epidemic, which he did successfully, but then he would experiment by transferring blood from infected individuals to non-infected individuals.

Part III
After the genocide was discovered, and the Holocaust was ended, people were left in disbelief as to how such actions of crime could have undergone and for so long. Part III of the book provides an analysis to the moral conflicts faced by the doctors and faces the reality of the genocide. Lifton explores the behavior individually and collectively of the doctors and discusses how the socialization to killing could have come about.

Doubling: The Faustian Bargain
Doubling is a principle used to describe the separation of the self into two distinct parts. The doctors had to identify themselves as a father/husband at home, but also as an Auschwitz doctor at work. Both selves had to coexist in order for the doctor to thrive. Lifton describes an internal dialect between the two selves in which the doctor is convinced that he needs his Auschwitz self to survive and be able to go home to his family. The death at the camp had to evoke some type of guilt in the doctors but this guilt was met with the persuasion that the actions were for the benefit of their race.

The Auschwitz Self: Psychological Themes in Doubling
To carry on with a full blown genocide, the doctors had to have a firm believe in the cause. The healing-killing paradox was fueled by Adolf Hitler, who convinced the Nazi's that a racial cleanse was necessary to heal their race. Such cleanse came at the expense of millions of lives of people from other groups, but the vision was presented so clearly that many doctors and soldiers fed into it. Some doctors even considered this as an opportunity for medical research and advancements.

Genocide
The mass elimination of a group was not foreign to history, but it was never something that was approved. The Nazis conducted their genocide in a legal manner and so cleverly that it lasted for years. The Holocaust mostly refers to the elimination of Jews, but that was not the only group targeted by the Nazis; Gypsis, Russians, and Poles were also victims. The killings arose in a time of war where reassurance was needed and proceeded into mass murders so that the German race would be the last one standing. The biomedical vision was portrayed as a cure, and so many felt the need to be healed, that they did anything to obtain the cure.

= The Midnight Meal and Other Essays About Doctors, Patients, and Medicine = The Midnight Meal and Other Essays About Doctors, Patients, and Medicine is a series of essays written by Jerome Lowenstein, nephrologist and professor of medicine. Based on his experiences in the hospital as a resident, he recollects his stories in the form on a book and reflects on the changes that have occurred in medical practice. This book was first published in 1997 by Yale University.

Summary
Emerging from the viewpoint of a medical resident, the book begins with a note that although many lives are lost at a hospital, the process can be alleviated with proper human care. The phrase midnight meal stems from meals that the staff of the hospital would have at the end of the day during after hours. While having leftovers from the cafeteria, different members of the staff would come together and discuss the leftovers of their day. It was a time and place in which stories would be shared as a method to release pent up emotions, to teach others on how to avoid the same scenarios, or to reflect on how to perform their jobs better. Jerome Lowenstein drew attention to the relationships that circulate within a hospital, be it physician to patient, physician to coworker, or even person to person. When emotions are heightened and the stakes are high, it is difficult to remain calm and easy to make mistakes; such experiences are recounted in these 3-4 page long essays. Written in the pages are the stories of patients that present symptoms of a disease or bear the trauma of an illness; Lowenstein addresses the difficulty that can be encountered when trying to treat the two. Medical school taught the residents how to care for the disease but residents were faced with the challenge of caring for the patient bearing the disease.

Early in the book, Lowenstein mentions that the technological advances in medicine, have somewhat made it harder for physicians to establish a connection with their patients. Before the existence of shifts and strict management of work hours, staff members did not leave until their work was done for the day. Once the clocking in system was put in place, a resident's job did not end once he was done but rather once the shift was up and the replacement team had arrived. The sharing of stories had ceased, and now it was a transfer of information that would happen rather quickly so that the next team could get started right away. This arrival of morning and night shifts brought about the end of the midnight meals.

Essays

 * The Midnight Meal: A meal shared by colleagues during which they would discuss the days events, and work on constructing a better tomorrow.
 * The Biomolecular Revolution: Discoveries in science changed the manner in which medicine was taught and approached. The job of teaching now fell on the hands of researches and not professors.
 * Can You Teach Compassion? A question posed by Lowenstein as he realized that the medical students were becoming desensitized with patients. He made an emphasis that patients should not be judged based on their medical state and rather tried to be understood based on their life stories.
 * Coughs, Clouds and Ice: The effect of language on health care is explored in this essay. Lowenstein mentions that the advancements in medical language has driven a wedge between the physician and a patient. Difficulties in communication can make it hard for the physician to effectively treat the patient, and for the patient to receive a feeling of satisfactory care.
 * Treating Chronic Illness: A time in which chronic illnesses were terminal has been replaced with a time in which the illnesses are now treatable. Treatable, that is, not curable. And so the patients with these chronic illnesses have been assigned to internists that are now viewed differently than decades prior because of their new task.
 * Patients as Teachers: Saul was a leukemia patient of the hospital, but before that he was a journalist and writer. Throughout the treatment of his illness he established and retained his identity, while learning that of others. That served as a lesson to his caregivers that patients are much more than symptoms on a piece of paper.
 * Reassurance and the Warning on the Label: Often times, families yearn to hear reassurance from doctors, but now it comes with a warning label to prevent the establishment of false hope and legal repercussions.
 * Defending the Common Cold: Described by Lowenstein as the perfect illness because it can be diagnosed based off the symptoms and its treatment is effective and guaranteed. Is alluded to natural selection and survival of the fittest because it has been around since prehistoric times.
 * Asymmetry: This term is used to describe the feelings on behalf of the patient and the physician that are mutually reciprocated. In the face of possible death, both experience a fear of loss.
 * On Drawing Blood: Drawing blood, is one of the many techniques that young medical students perform on patients while having very minimal experience. Lowenstein mentions the discrepancy that occurs between confessing the actual level of practice, or facing rejection from the patient as a result.
 * The Vital Signs: Discusses the transition that medical students face when going from practicing on colleagues to examining patients. It is a situation that can evoke discomfort in the care giver and anxiety in the receiver.
 * The Dummy and the Standardized Patient: A medical student related a story in which we was tasked with the effort of saving a dummy while being tested. It was a moment in which he reflected that the amount of effort he put into saving the dummy was higher than that of an actual patient because he was being tested.
 * Holding the Blood Gas Report: The blood gas report is symbolic of for the medical students that find their cases in the hospital to be flying by without a moment allowed for them to stop and reflect. One of the students had been sent to retrieve a blood gas report but by the time ten minutes that he took to return, the patient has passed away and removed from the room
 * The Narrative Instinct: Narratives serve as a tool of communication for those who are experiencing a disease or an illness. Stories, so long as they are heard, can provide useful information for health care providers.
 * The Weight of Shared Lives: Truth Telling and Family Caregiving: A chronic illness not only changes the life of the patient but also that of family members, who now become an extended version of healthcare.
 * AIDS: This was an infection that brought about many precautions when providing healthcare to patients. Gloves and proper safety disposal of items were crucial to prevent further spread of AIDS.
 * A Marriage Without Divorce: Lowenstein helps a patient on leukemia come to terms with the side effects of the treatment by giving her the option of divorcing the treatment.
 * Shaky Evidence: Lowenstein draws attention to the basis of medicine stemming from evidence, and questions how reliable the evidence is. He points out that often times it is difficult to test a treatment because human trials are minimal and often unreflective as to how patients will respond.
 * A Critical Incident: This incident refers to a moment in which Lowenstein witnessed the chief of service commit an act of kindness towards a cancer patient. The act was as simple enough as removing dentures upon the patients request but it touched the patient and those watching.
 * The Homeless Man on Morning Rounds: When a nurse described this patient as homeless during morning rounds, it sparked the curiosity of Lowenstein. His brief questions on the personal life of the patient, allowed the staff to view him in a better light in comparison to just knowing him as a homeless man.
 * Numbers, Numbers: Numbers are prominent in healthcare, and their close study has resulted in the obsession of monitoring slight changes in numbers by patients and physicians. Numbers can be reflective of illness on an individual level but also on a global scale.
 * Alternative Medicine: Lowenstein provides his viewpoint of alternative medicine and informs readers that it was becoming something national recognized. This form of medicine focuses on healing the body without necessarily using medicine and common medical practices.
 * Bellevue Hospital: The hospital in New York that has encompassed the career of Lowenstein for forty plus years. It was a place for growth, and it seeded this very book.