Twelve Patients: Life and Death at Bellevue Hospital (The Inspiration for the NBC

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For anyone seeking to understand medicine from the patient perspective, Twelve Patients is a must-read. Dr. Manheimer eloquently describes life and experiences inside a major public hospital in twenty-first century America. Particularly poignant are the stories that highlight the complex inter-relationship between the mind and the body and how our feelings and those of our patients dramatically affect medical outcomes." - Carol A. Bernstein, MD The opening chapters of Twelve Patients are compelling enough to overcome the book’s flaws. We meet Juan Guerra, a 59-year-old career criminal dying of cancer. Manheimer’s description is of a basically decent person who had little chance in life. Despite multiple incarcerations, drug problems, and terminal illness, Guerra has managed to keep his family together, including his devoted wife of 35 years. The hospital staff secures his freedom so he can go home to die. When embarking upon this book, I had seen a BBC2 programme about nursing in Mexico 'The Toughest Place to be a ... Nurse'

Burke, R.E.; Fahn, S.; Jankovic, J.; Marsden, C.D.; Lang, A.E.; Gollomp, S.; Ilson, J. Tardive dystonia: Late-onset and persistent dystonia caused by antipsychotic drugs. Neurology 1982, 32, 1335. [ Google Scholar] [ CrossRef] [ PubMed] Dr. Eric Manheimer, until recently medical director of New York City’s Bellevue Hospital, has added to the genre with Twelve Patients: Life And Death At Bellevue Hospital. Manheimer is the first to proudly explain Bellevue’s history. Octavio Salcedo, an illegal immigrant working in the States, also develops a squamous cell carcinoma, but is less fortunate that his doctor. At age 32, his body is literally rotting from cancer; one leg, beyond rescue, has been amputated at the hip. There’s nothing for him but a morphine pump. He wishes to die at home, in Mexico, where he can be with his children. His young wife stands by staunchly, soon to be a penniless widow with small children. Again, we are shown the tremendous lengths Manheimer and his excellent staff will go to so the Salcedos may have their final wish. Their heroic efforts will leave only the most heartless reader dry-eyed. Ostrem, J.L.; Starr, P.A. Treatment of dystonia with deep brain stimulation. Neurotherapeutics 2008, 5, 320–330. [ Google Scholar] [ CrossRef] [ PubMed]

Sako, W.; Goto, S.; Shimazu, H.; Murase, N.; Matsuzaki, K.; Tamura, T.; Mure, H.; Tomogane, Y.; Arita, N.; Yoshikawa, H.; et al. Bilateral deep brain stimulation of the globus pallidus internus in tardive dystonia. Mov. Disord. 2008, 23, 1929–1931. [ Google Scholar] [ CrossRef] [ PubMed]

I finished the book, but I did not enjoy the read. I did not care for his writing style, and I skimmed portions waiting for the author to get the point. He also had this odd habit of introducing upfront the ethnic origin of every non-white character in the book, and it seems he might have been the only American born character in the book the way it reads. It's actually annoying. I think he was going for ethnic diversity, but is that what he thinks every single time he sees to an immigrant - cataloging their ethnic origin? Coubes, P.; Cif, L.; El Fertit, H.; Hemm, S.; Vayssiere, N.; Serrat, S.; Picot, M.C.; Tuffery, S.; Claustres, M.; Echenne, B.; et al. Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: Long-term results. J. Neurosurg. 2004, 101, 189–194. [ Google Scholar] [ CrossRef] [ PubMed] Kefalopoulou, Z.; Paschali, A.; Markaki, E.; Vassilakos, P.; Ellul, J.; Constantoyannis, C. A double-blind study on a patient with tardive dyskinesia treated with pallidal deep brain stimulation. Acta Neurol. Scand. 2009, 119, 269–273. [ Google Scholar] [ CrossRef] He was the only one of the family to survive what Francois Maurois, in his introduction, calls the "human holocaust" of the persecution of the Jews, which began with the restrictions, the singularization of the yellow star, the enclosure within the ghetto, and went on to the mass deportations to the ovens of Auschwitz and Buchenwald. There are unforgettable and horrifying scenes here in this spare and sombre memoir of this experience of the hanging of a child, of his first farewell with his father who leaves him an inheritance of a knife and a spoon, and of his last goodbye at Buchenwald his father's corpse is already cold let alone the long months of survival under unconscionable conditions. While infamous for its mental hospital, Bellevue has long been more than a mental care facility. From its beginnings in 1763, Bellevue is the longest-running hospital in the United States. Its services are extensive, its facilities state-of-the-art. Manheimer is justifiably proud to work there.

Funding

Lerner, V.; Miodownik, C. Motor Symptoms of Schizophrenia: Is Tardive Dyskinesia a Symptom or Side Effect? A Modern Treatment. Curr. Psychiatry Rep. 2011, 13, 295–304. [ Google Scholar] [ CrossRef] [ PubMed] The author's youthfulness helps to assure the inevitable comparison with the Anne Frank diary although over and above the sphere of suffering shared, and in this case extended to the death march itself, there is no spiritual or emotional legacy here to offset any reader reluctance. Access-restricted-item true Addeddate 2022-01-03 20:08:55 Bookplateleaf 0008 Boxid IA40314909 Camera Sony Alpha-A6300 (Control) Collection_set printdisabled External-identifier Manheimer intends more than 12 sharp little medical biographies. He uses each case as a springboard from an ailing individual to greater social ills. While these digressions are intended to edify, Manheimer’s impassioned asides lose urgency with unnecessary repetition. Sako, W.; Morigaki, R.; Mizobuchi, Y.; Tsuzuki, T.; Ima, H.; Ushio, Y.; Nagahiro, S.; Kaji, R.; Goto, S. Bilateral pallidal deep brain stimulation in primary Meige syndrome. Park. Relat. Disord. 2011, 17, 123–125. [ Google Scholar] [ CrossRef] [ PubMed]

Vidailhet, M.; Vercueil, L.; Houeto, J.-L.; Krystkowiak, P.; Benabid, A.-L.; Cornu, P.; Lagrange, C.; Du Montcel, S.T.; Dormont, D.; Grand, S.; et al. Bilateral Deep-Brain Stimulation of the Globus Pallidus in Primary Generalized Dystonia. N. Engl. J. Med. 2005, 352, 459–467. [ Google Scholar] [ CrossRef][ Green Version]

Acknowledgments

Morigaki, R.; Mure, H.; Kaji, R.; Nagahiro, S.; Goto, S. Therapeutic Perspective on Tardive Syndrome with Special Reference to Deep Brain Stimulation. Front. Psychiatry 2016, 7, 207. [ Google Scholar] [ CrossRef] [ PubMed][ Green Version] The title of this book, 'Twelve Patients', is a bit inaccurate. There are twelve stories in the book about patients and their care, however the author also has his own medical story to tell. The author, Eric Manheimer, is the Medical Director of Bellevue Hospital in New York City. He has throat cancer. So nestled among the 12 stories chosen, is his regiment and life altering condition, as he oversees Bellevue. Captivating samplings of one doctor’s tour of duty inside the country’s oldest and perhaps most illustrious public hospital.

In the book, Manheimer said, "I wanted to tell the story of the social and political things festering in this country, but I wanted to tell the patients' stories that could narrate it ... So I went through the notebooks and chose 12 patients that illustrated 12 important themes." Damier, P.; Thobois, S.; Witjas, T.; Cuny, E.; Derost, P.; Raoul, S.; Mertens, P.; Peragut, J.-C.; Lemaire, J.-J.; Burbaud, P.; et al. Bilateral Deep Brain Stimulation of the Globus Pallidus to Treat Tardive Dyskinesia. Arch. Gen. Psychiatry 2007, 64, 170–176. [ Google Scholar] [ CrossRef][ Green Version] Although I share Manheimer’s views, I found Twelve Patients uneven reading. Manheimer is an excellent physician who genuinely cares not only for his patients, but for his staff, as well. His respect for everyone, from nurses to hospital cleaning personnel, is evident and welcome. But the self-congratulatory ego sneaking into the proceedings is not.So I was really interested to read the book on which the series is based. Apart from the author's own experience as a medical director (and cancer patient) the series has little in common with the book, which is a pity as the stories Manheimer tells are very interesting. Many of his patients are from Guatemala and we learn much about the challenges they have faced in escaping from poverty and brutality. He and his wife have travelled there extensively and he provides a very useful potted political history of the country. Franzini, A.; Marras, C.; Ferroli, P.; Zorzi, G.; Bugiani, O.; Romito, L.; Broggi, G. Long-term high-frequency bilateral pallidal stimulation for neuroleptic-induced tardive dystonia. J. Neurosurg. 2005, 102, 721–725. [ Google Scholar] [ CrossRef] Magariños-Ascone, C.; Regidor, I.; Gómez-Galán, M.; Cabañes-Martínez, L.; Figueiras-Méndez, R. Deep brain stimulation in the globus pallidus to treat dystonia: Electrophysiological characteristics and 2 years’ follow-up in 10 patients. Neuroscience 2008, 152, 558–571. [ Google Scholar] [ CrossRef] Manheimer counts himself amongst the 12 patients. He developed a squamous cell carcinoma near his throat, necessitating grueling treatment—platinum chemotherapy and radiation. His weight dropped from a healthy 155 pounds to a skeletal 123. Unable to swallow, he dripped Ensure through a line into his belly. Radiation left him too exhausted to function. Ill and depressed, he withdrew, indifferent even to his grandson’s birth. He attributes much of his recovery to wife Diana. If his suffering helps him connect to his patients, he doesn’t say so. In providing medical care for these people who have already suffered so much, Manheimer also battles with the constraints of the US health care system. He shows how treatment regimes can sometimes confuse diagnoses and disguise underlying problems - he clearly favours a more hands-off and holistic approach to patient care - but his critique of the overall system is more subtle than one might expect.