The Andromeda Strain by Michael Crichton

18726080The United States government is given a warning by the pre-eminent biophysicists in the country: current sterilization procedures applied to returning space probes may be inadequate to guarantee uncontaminated re-entry to the atmosphere. Two years later, seventeen satellites are sent into the outer fringes of space to collect organisms and dust for study. One of them falls to earth, landing in a desolate area of Arizona. Twelve miles from the landing site, in the town of Piedmont, a shocking discovery is made: the streets are littered with the dead bodies of the town’s inhabitants, as if they dropped dead in their tracks.

Review:

While I’ve watched Crichton before (ER, Jurassic Park) I hadn’t read any of his novels.  The Andromeda Strain is a natural entry point for me – medicine! science fiction! – and I ended up really liking it. The story is easy to sum up: the US government searches for organisms in space… and finds them.

The good:

  • The plot starts coming and it just keeps coming.
  • Medicine and doctors are important in figuring out what the Andromeda strain is and I got a kick out of thinking about diagnoses along with the doctors.  In that sense it’s puzzle mystery, and we get much of the info needed to reason things out as the story moves along, often in primary source format.  Huzzah for MDs writing fiction!
  • The book was written almost 50 years ago and it’s interesting to see what aged well and what didn’t.  Many of the medical gadgets still feel high tech while the computer references come off as quaint.  I don’t hold this against Crichton, quite the opposite, it strikes my fancy.
  • Andromeda StrainWhile the writing isn’t amazing it fits the mold aimed for, namely narrative nonfiction of a past event many people may have forgotten or never known about.  In that sense it reminded me of Command and Control.
  • Despite that the story doesn’t take itself too seriously.  There are a couple of moments I said “Oh.” along with a character, and there are some laugh out loud funny lines as well.  And the “References” listed at the end are a fun touch.
  • Crichton respects the reader.  He hints and points at things obliquely for us to figure out… and lets them be.  No knocking facts over our heads, no “did ya see that there, hmmmm?”  When a writer respects the reader I’m much more likely to respect them.

The not-so-good:

  • Not a lot of time is spent on characterization.  The space given is used well, but I’d like to see more.
  • Major Bechdel test fail, and I don’t remember a single character of color.  The 1971 movie took steps to correct this, making one of the scientists female and casting several people of color.
  • The “Odd-Man Hypothesis” is stupid idea and needs to die like now.
  • The ending is abrupt and bound to annoy some people.

All in all an engrossing read, perfect for a lazy summer day, a plane ride, or breaking a reading slump.  Especially recommended if you’re into medicine, or science fiction with a side of thriller.

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A Thousand Naked Strangers: A Paramedic’s Wild Ride to the Edge and Back by Kevin Hazzard

25111005A former paramedic’s visceral, poignant, and mordantly funny account of a decade spent on Atlanta’s mean streets saving lives and connecting with the drama and occasional beauty that lies inside catastrophe.

In the aftermath of 9/11 Kevin Hazzard felt that something was missing from his life—his days were too safe, too routine. He signed up for emergency medical training and became, at age twenty-six, a newly minted EMT running calls in the worst sections of Atlanta.

Combining indelible scenes that remind us of life’s fragile beauty with laugh-out-loud moments that keep us smiling through the worst, A Thousand Naked Strangers is an absorbing read about one man’s journey of self-discovery—a trip that also teaches us about ourselves.

Review:

Being an EMT is a crazy job.  It’s your duty to keep people alive long enough to get to the hospital.  Sometimes they’re dead before you arrive at the scene.  Other times it’s a spry-looking man complaining about a toothache.  And sometimes you drive past the address you were given because the shooting hasn’t stopped yet.

Hazzard joined this world for ten years and takes us along for the ride.  A word of warning for the squeamish – there’s a fair share of gore and gallows humor, and know that the nature of the job doesn’t lend itself to overflowing empathy.  I didn’t bother me but I work in medicine so your mileage may vary.

The writing is good and the crazy stories are indeed batshit crazy.  Hazzard gets at the soul of the job when he writes,

Medics don’t have to be heroic or tough or even good people.  They simply have to enjoy the madness…. [It’s] a willingness to walk in unprotected when we clearly should walk away.  A desire to take part but just as often to bear witness.

But mainly he does it

Because it’s fun.

I listened on audio and am so glad I did – Hazzard is a natural storyteller and George Newbern does an amazing job with the narration.  He gets all the jokes, the pauses and nuances right on, to the point that I thought the author was reading his own work.

A Thousand Naked Strangers may not be for everyone but I really enjoyed it – a nice addition to my first responder memoir shelf.

The Language of Kindness: A Nurse’s Story by Christie Watson

36750090Christie Watson spent twenty years as a nurse, and in this intimate, poignant, and remarkably powerful book, she opens the doors of the hospital and shares its secrets. She takes us by her side down hospital corridors to visit the wards and meet her most unforgettable patients.

In the neonatal unit, premature babies fight for their lives, hovering at the very edge of survival, like tiny Emmanuel, wrapped up in a sandwich bag. On the cancer wards, the nurses administer chemotherapy and, long after the medicine stops working, something more important–which Watson learns to recognize when her own father is dying of cancer. In the Pediatric Intensive Care Unit, the nurses wash the hair of a little girl to remove the smell of smoke from the house fire. And the stories of the geriatric ward–Gladys and older patients like her–show the plight of the most vulnerable members of our society.

Review:

I’m not sure I can be completely fair reviewing this book – a section early on made me mad and ended up tainting it for me.  I’ll get to that in a minute.

But first, let me say that this is a well-written account of being a nurse in England.  Watson is drawn to some of the most emotional parts of the hospital – mental care, emergency, palliative care, neonatal intensive care – so expect heart-wrenching, as well as heart-warming, stories.  We watch Watson grow from a nursing student that’s duped by psych patients to a knowledgeable practitioner of one of the most noble arts.

I learn then that nursing is not so much about tasks, but about how in every detail a nurse can provide comfort to a patient and a family. It is a privilege to witness people at the frailest, most significant and most extreme moments of life, and to have the capacity to love complete strangers.

She talks how hard the work is – not only long hours and lifting heavy patients, but also the emotional toll.  I think most understand nursing isn’t easy, but I’m not sure we all appreciate how punishing it can be.

Compassion fatigue is common when caring for people who have suffered trauma. The nurse repeatedly swallows a fragment of the trauma—like a nurse who is looking after an infectious patient, putting herself at risk of infection. Caring for negative emotions puts her at risk of feeling them, too. And taking in even a small part of tragedy and grief, and loneliness and sadness, on a daily basis over a career is dangerous and it is exhausting.

As you can see the writing is good, and Watson’s stories are interesting and affecting… but I’m having a hard time getting over the fact that she throws my profession under the bus.

Many of you probably know that I’m a medical interpreter who helps non-Japanese speakers communicate with doctors and staff at a Japanese hospital.  It’s an important job because without correct and complete information about symptoms, family history, and so many other things it’s difficult to arrive at a correct diagnosis and provide adequate care.

Strike one – Watson calls interpreters “translators”.  It’s a distinction many don’t know (translators = written word, interpreters = spoken), so I can let that slide.  But then there’s strike two – she continues and says that in the emergency department they forgo calling qualified interpreters because using family members is faster and easier.

There are arguments against [interpretation] from non-experts; a suspicion, on the part of the nurses and doctors, that the words are being softened and not translated precisely, but it’s quicker than finding a[n interpreter].

There aren’t just arguments – it comes down to professional ethics and morals.  It is a health provider’s duty to provide the best care, and asking a daughter or brother to relay important, detailed, technical information under stress can go wrong in so many ways.  Interpreter codes of ethics state that even professionals shouldn’t interpret for friends and family, the conflict is so great.  Watson blithely dismissing the right of limited English speakers to have a qualified interpreter, to have access to critical information about their health in a language they understand, makes me see red. Looking at the importance she places on ethics in other parts of the book it becomes galling. Gah.

I admit it, I pretty much glowered at the chapters after that.  The writing and stories brought me around again so I can still recommend the book to fans of medical non-fiction, but not as wholeheartedly as I would like.

Invisible: How Young Women with Serious Health Issues Navigate Work, Relationships, and the Pressure to Seem Just Fine by Michele Lent Hirsch

33931697Though young women with serious illness tend to be seen as outliers, young female patients are in fact the primary demographic for many illnesses. They are also one of the most ignored groups in our medical system–a system where young women, especially women of color and trans women, are invisible.

And because of expectations about gender and age, young women with health issues must often deal with bias in their careers and personal lives. Not only do they feel pressured to seem perfect and youthful, they also find themselves amid labyrinthine obstacles in a culture that has one narrow idea of womanhood.

Lent Hirsch weaves her own harrowing experiences together with stories from other women, perspectives from sociologists on structural inequality, and insights from neuroscientists on misogyny in health research. She shows how health issues and disabilities amplify what women in general already confront: warped beauty standards, workplace sexism, worries about romantic partners, and mistrust of their own bodies. By shining a light on this hidden demographic, Lent Hirsch explores the challenges that all women face.

Review:

Part memoir, part anecdote, and part research, Invisible does an amazing job looking at women society deems “too young” or “too pretty” to be sick.

The good:

  • The book is own voices for both health issues and being queer, which is awesome in its own right, and her conscientious efforts mean…
  • …it may be the most intersectional book I’ve ever read. Lent Hirsch mentions how each woman interviewed identifies and the range across race, sexuality, religion, and gender is amazing.  She goes into how each of these identities affect how a woman interacts with health care as well as friends, family, coworkers, and romantic partners.
  • This care is reflected in own voices reviews for Invisible.  My favorite is by Corvus who identifies as Queer, trans, and disabled.  They write, “This is the first book of this kind that I have read – that was not specifically about LGBTQ populations – that didn’t let me down.”  Their whole review is wonderful, go check it out here.
  • There’s a thoughtful discussion with several people about using the word “disability” in relation to themselves, and why they do or don’t embrace it.  There are many answers to this question and I like how so many different angles are covered.
  • Large sections of the text are straight from discussions the author had with women of all sorts.  While reading I thought – if a straight cis white man wrote this book he would only grab the juiciest quotes and summarize the rest through the lens of his own experience.  Lent Hirsch, however, has each amazing woman speak for herself and the book is stronger for it.
  • Even though my own experience as a patient is thankfully limited there are still parts that hit close to home.

    The new pharmacist was great.  He never commented on my looks or how my body made him feel.  What a low bar I was holding him to: he was ‘great’ because he didn’t harass me.

The not-so-great:

  • Only one thing here – I would have liked the 30,000 foot level writing to be stronger.  There are themes that could have been developed to make the book gel as a cohesive whole and their lack feels like a lost opportunity.

Invisible is an insightful look at what women of all sorts go through while dealing with chronic illness.  It’s a must read if you have any tiny bit of interest in the subject – I loved it.

Thanks to Beacon Press and Edelweiss for providing a review copy.

Better: A Surgeon’s Notes on Performance by Atul Gawande

1580804Atul Gawande explores how doctors strive to close the gap between best intentions and best performance in the face of obstacles that sometimes seem insurmountable. Gawande’s gripping stories of diligence, ingenuity, and what it means to do right by people take us to battlefield surgical tents in Iraq, to labor and delivery rooms in Boston, to a polio outbreak in India, and to malpractice courtrooms around the country. He discusses the ethical dilemmas of doctors participation in lethal injections, examines the influence of money on modern medicine, and recounts the astoundingly contentious history of hand washing. And Gawande gives us an inside look at his own life as a practicing surgeon, offering a searingly honest firsthand account of work in a field where mistakes are both unavoidable and unthinkable.

Review:

Medicine is unforgiving because every mistake could be a disaster.  Wrong prescription, wrong dose, wrong operation site, wrong treatment… any of these could kill a patient.  But how can you be error-free every time, never mind a job with so many technical details and judgement calls?

Perfection is impossible, of course, so Gawande looks at how doctors can improve their performance.  The three main sections cover diligence, doing right, and ingenuity, and while the stories are interesting only a few moments have stuck with me.  For example check out this cystic fibrosis doctor working with a teenager:

At school, new rules required her to go to the nurse for each dose of medicine during the day. So she skipped going. “It’s such a pain,” she said…. Warwick proposed a deal. Janelle would go home for a breathing treatment every day after school and get her best friend to hold her to it. She’d also keep key medications in her bag or her pocket at school and take them on her own. (“The nurse won’t let me.” “Don’t tell her,” he said, and deftly turned taking care of herself into an act of rebellion.)

Points of brilliance like this and the afterward with tips on how to become a “positive deviant” are my highlights.  Gawande’s writing is as good as ever but this isn’t as game-changing as The Checklist Manifesto. I’ll get back to you once I read Being Mortal. 😉

Extreme Measures: Finding a Better Path to the End of Life by Jessica Nutik Zitter

32311672In medical school, no one teaches you how to let a patient die.

Zitter started her career as an ICU doctor, one of the more intense specialties in medicine.  It’s your job to do stuff to turn around patient problems – put them on breathing machines and kidney machines when organs stop functioning, place a tube so they can be fed, use medications to stabilize blood pressure or prevent a clot.  It’s your job save a patient’s life, so why would you stop when there’s another procedure or a different medication you’ve yet to try?

This, she says, is why doctors are so awful at helping their patients have a good death.  A patient dying is akin to failure and no one, especially highly trained professionals with a wealth of options and technology at their disposal, wants to fail.  Add in a family that wants you to “do everything”, and it’s a recipe for more and more machines and care that will make it impossible for the patient to die peacefully at home.  Zitter calls it the “end-of-life conveyor belt” and she got certified in palliative care to help people navigate and possibly avoid it.

This book is an extension of that work.  She details how and why we got to this point and what we – both patients and health care professionals – can do to guide people towards the death they want.  Patient stories are woven through to illustrate what things look like when they go right, go wrong, or just… go.  End of life care is a minefield of pitfalls and potential missteps and she doesn’t shy away from any of it.

It’s a bit of a side note, but I want to give Zitter a great big hug for discussing my profession of medical interpreting in a chapter about cultural values.  She includes the interpreter as part of the care team, asking about cultural differences and how to approach a thorny topic.  In my experience interpreters can be treated like walking dictionaries, more a thing than a person, and it means a lot to me that Zitter accurately depicts and advocates for the important work we do.

The author reads the audiobook and I really liked it, though I did have to crank up the speed a little bit more than usual.  I liked it so much that I went back and relistened to sections so I could add them to my notebook word for word.  Here’s some of the wisdom she drops:

The human being is unknowable.  Unless, maybe, you ask.

While I may be the expert on the patient’s disease I am not the expert on the patient.

Sometimes it isn’t that the doctor needs to work harder to elicit the patient’s values, but that those values are simply different from the doctor’s.  Yet another lesson in listening.

An amazing must read for anyone with anything do to in medicine, and highly recommended to everyone else.

…and because I have an inkling it will come up in the comments – no, I haven’t read Atul Gawande’s Being Mortal yet. 🙂  I hope to get to it sooner rather than later.  I’m curious to see how a surgeon approaches these same issues and where the two doctors’ views converge and divide.

Do No Harm: Stories of Life, Death, and Brain Surgery by Henry Marsh

24510511In neurosurgery, more than in any other branch of medicine, the doctor’s oath to “do no harm” holds a bitter irony. Operations on the brain carry grave risks. Every day, leading neurosurgeon Henry Marsh must make agonizing decisions, often in the face of great urgency and uncertainty.

If you believe that brain surgery is a precise and exquisite craft, practiced by calm and detached doctors, this gripping, brutally honest account will make you think again. With astonishing compassion and candor, Marsh reveals the fierce joy of operating, the profoundly moving triumphs, the harrowing disasters, the haunting regrets, and the moments of black humor that characterize a brain surgeon’s life.

Review:

You know you’ve read a lot of medical nonfiction when you think, “This is an alright book by a neurosurgeon discussing the intricacies of brain surgery, but I’ve read better.”  (For the record I like When the Air Hits Your Brain by Frank T. Vertosick Jr. more.)

Marsh hits all the expected beats and themes – surgery that goes well despite all odds, surgery that doesn’t go well despite all efforts, kids you don’t want to see die, adults who face death with dignity. The cases are engaging and the writing solid.

But I’m not sure I get along with Marsh as a person.  He’s nearing the end of his career, which is good in that we can see how hospital conditions and doctor training have changed over time.  These changes, though, are often framed in terms of the good ol’ days and how they compare with the bad ol’ now.  For example, an anesthetist refused to do a big surgery at 4 pm because she didn’t have childcare for the evening.

“But we can’t cancel it,” I protested.  “She was cancelled once already!”

“Well I’m not doing it.” …

For a few moments I was struck dumb. I thought of how until a few years ago a problem like this would never have arisen… I envy the way in which the generation who trained me could relieve the intense stress of their work by losing their temper, at times quite outrageously, without fear of being had up for bullying and harassment.

Oh, I’m sorry that asshole-ry is no longer tolerated.  Geesh.  This doesn’t take away from the amazing work Marsh has done in his life, including humanitarian work in rural Ukraine, but neurosurgeon as god thing turns me off.

In sum the book is good but there’s better out there – check out Vertosick’s first.

The Education of a Coroner: Lessons in Investigating Death by John Bateson

32920307Marin County, California is a study in contradictions. Its natural beauty attracts thousands of visitors every year, yet the county also is home to San Quentin Prison, one of the oldest and largest penitentiaries in the country. Marin ranks in the top one percent of counties nationwide in terms of affluence and overall health, yet it is far above the norm in drug overdoses and alcoholism, and comprises a large percentage of suicides from the Golden Gate Bridge.

Ken Holmes worked in the Marin County Coroner’s Office for thirty-six years, starting as a death investigator and ending as the three-term, elected coroner. As he grew into the job—which is different from what is depicted on television—Holmes learned a variety of skills, from finding hidden clues at death scenes, interviewing witnesses effectively, managing bystanders and reporters, preparing testimony for court to notifying families of a death with sensitivity and compassion.

Complete with poignant anecdotes, The Education of a Coroner provides a firsthand and fascinating glimpse into the daily life of a public servant whose work is dark and mysterious yet necessary for society to function.

Review:

As a lover of medical and medically-adjacent nonfiction I happily dug into Education of a Coroner.  CSI without all the fake glamour? I’m there!

The jacket copy makes it sound like the book is from Holmes’ point of view but we’re actually following the author, a professional acquaintance.  Bateson goes through Holmes’ records and conducts a series of interviews that form the backbone of the book.  I found myself wishing he had done more synthesis of the material and gotten into Holmes’ head instead of quoting him verbatum.  There’s a big difference between “Holmes thought” and “When I asked Holmes about it he said, ‘Well, I thought…'”

Luckily this distance only occurs in the sections dealing with Holmes’ career.  A large portion book is chock-a-block with fascinating cases from his 36 years on the job – suicides that may not have been suicides, genius (and not so genius) murder methods, clues that make or break an investigation.

As a medical interpreter I found the chapter on death notifications the most interesting.  If Holmes tried to couch the news in niceties it wouldn’t be conveyed at all.

He also learned to avoid saying something like “she succumbed” or “she didn’t survive” or “it was fatal”.  he had to say the word dead or killed.  If he didn’t, if he said something like, “Unfortunately, she didn’t make it,” the next questions were “How bad was it?” “Where is she?” “Can I go talk to her?” because the person didn’t hear. It was way too much information coming from a total stranger without any context or preamble.

All in all Education of a Coroner is a fun read for those who want to know what the job involves in real life.  While I found the beginning and end slow the amazing cases in the middle make up for it.

Thanks to Scribner and Edelweiss for providing a review copy.

The Laws of Medicine by Siddhartha Mukherjee

25409816Over a decade ago, when Siddhartha Mukherjee was a young, exhausted, and isolated medical resident, he discovered a book that would forever change the way he understood the medical profession. The book, The Youngest Science, forced Dr. Mukherjee to ask himself an urgent, fundamental question: Is medicine a “science”? Sciences must have laws—statements of truth based on repeated experiments that describe some universal attribute of nature. But does medicine have laws like other sciences?

Dr. Mukherjee has spent his career pondering this question—a question that would ultimately produce some of most serious thinking he would do around the tenets of his discipline—culminating in The Laws of Medicine. In this important treatise, he investigates the most perplexing and illuminating cases of his career that ultimately led him to identify the three key principles that govern medicine.

Review:

I’ve been meaning to read Mukherjee for a while now, especially considering how highly regarded Emperor of all Maladies is. That tome is 571 pages, though, so I thought The Laws of Medicine would be a better introduction.

And straight off I can tell you that I like his writing and his style.  He neither dumbs down examples nor overexplains details.  I want to read more… especially because this book is so short.

Clocking in at under 100 pages, it introduces the three laws of medicine Mukherjee devised.  One is more aimed at research than clinical practice, and one is dead obvious to anyone who has studied medicine (even this lowly interpreter) but they’re still good points and worthy of the attention.

What hurts the most for me is that book could have been longer.  The idea of laws could be better explored, corollaries proposed and debated, and exceptions that prove the rule gone over.  As it stands the information is sufficient but not satisfying.

I listened to the audiobook and like the reader and the way it is produced.  Having the author read the introduction is always a nice touch.

While I liked The Laws of Medicine it didn’t affect me as much as What Doctors Feel and other medical non-fiction does.  But that’s okay – I’m viewing it as a tantalizing preview of Mukherjee’s longer, more in-depth work.  Onward!

What Patients Say, What Doctors Hear by Danielle Ofri

32820244Despite modern medicine’s infatuation with high-tech gadgetry, the single most powerful diagnostic tool is the doctor-patient conversation, which can uncover the lion’s share of illnesses. However, what patients say and what doctors hear are often two vastly different things.

Patients, anxious to convey their symptoms, feel an urgency to “make their case” to their doctors. Doctors, under pressure to be efficient, multitask while patients speak and often miss the key elements. Add in stereotypes, unconscious bias, conflicting agendas, and the fear of lawsuits and the risk of misdiagnosis and medical errors multiplies dangerously.

Though the gulf between what patients say and what doctors hear is often wide, Dr. Danielle Ofri proves that it doesn’t have to be. Through the powerfully resonant human stories that Ofri is celebrated for, she explores the high-stakes world of doctor-patient communication that we all must navigate. Reporting on the latest research studies and interviewing scholars, doctors, and patients, Ofri reveals how better communication can lead to better health for all of us.

Review:

I’m a Japanese⇔English medical interpreter so when I saw the title of Ofri’s latest book I cheered.  Doctor-patient communication – she’s talking about my life!

Medical conversations are examined from all sides.  Is it better to let a complaining patient get their whole litany out at once, or should each point be addressed as it comes up?  Can the placebo affect be utilized in conversation?  How can stereotypes be overcome?  Is it ever okay to lie to a patient?

Each topic is covered with both anecdotes based on Ofri’s patients (vignettes!) and research studies.  All kinds of strategies to improve communication are covered, from how to listen actively to when disclosing personal details is a good idea. I especially like how the studies are dissected journal club style, with weaknesses pointed out along with the strengths.  For example, one study found that doctors that scored low on an empathy test had patients with worse outcomes, but:

Maybe the low-empathy doctors had dismal hygiene and the resulting BO was too distracting for the patients to pay attention to their diabetes.  Maybe the offices of the high-empathy doctors offered cloth gowns rather than paper gowns, so their patients weren’t experiencing frostbite and thus better able to hear what the doctor was saying.  You never know what the confounding factors might be…

As an interpreter I enjoyed the stories and insight but didn’t come away with many pearls I can use myself.  It’s part of the job – I speak other people’s words and can’t outright change the direction of the conversation.  I did pick up some tips, though, particularly how using different wording can change how information is received.

What Patients Say, What Doctors Hear is a trove of information for healthcare professionals, who can expect to learn practice-changing pearls, and frequent patients will appreciate the peek into their doctor’s head. If you are not one of those two groups, though, you may want to start with a different Ofri book.

Thanks to Beacon Press and Edelweiss for providing a review copy.