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. 😉

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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.

Curry: Eating, Reading, and Race by Naben Ruthnum

34144408By grappling with novels, recipes, travelogues, pop culture, and his own upbringing, Naben Ruthnum depicts how the distinctive taste of curry has often become maladroit shorthand for brown identity. With the sardonic wit of Gita Mehta’s Karma Cola and the refined, obsessive palette of Bill Buford’s Heat, Ruthnum sinks his teeth into the story of how the beloved flavor calcified into an aesthetic genre that limits the imaginations of writers, readers, and eaters. Following in the footsteps of Salman Rushdie’s Imaginary Homelands, Curry cracks open anew the staid narrative of an authentically Indian diasporic experience.

Review:

A deep and thoughtful look at what Ruthnum calls “currybooks”, or books of the South Asian diaspora.  Curry has adapted to the many parts of the world it has been brought to, with spices and cream added and subtracted to cater to the tastes of a particular people.  Likewise, currybooks charge form based on different factors but have nostalgia, authenticity, and the idea of getting back to one’s roots as overarching themes.

Is there a problem with these expectations in the genre?  Only that they constrain and limit the potential methods of expression for brown writers.

Ruthnum examines novels, cookbooks, movies, and touches on his own experience as the son of Mauritian immigrants.  The writing is well-done and interesting, falling more on the educational side of things than entertaining.  There’s nothing wrong with that,  but go in knowing that Curry will require (and reward) your mental effort.  My e-copy is full of highlights that I suspect I’ll be returning to as I read more books set in and by authors from this part of the world.

Great for those interested in representation, the immigrant experience, race, and how they’re expressed in literature.

Thanks to Coach House Books and Edelweiss for providing a review copy.

Vacationland: True Stories from Painful Beaches by John Hodgman

34802624John Hodgman has written a memoir about his cursed travels through two wildernesses: from the woods of his home in Massachusetts, birthplace of rage, to his exile on the coast of Maine, so-called Vacationland, home to the most painful beaches on Earth

Vacationland is also about Hodgman’s wandering in the metaphoric wilderness of his forties, those years when dudes especially must painfully stop pretending to be the children of bright potential they were and settle into the failing bodies of the wiser, weirder dads that they are.

Other subjects covered include the horror of freshwater clams, the evolutionary purpose of the mustache, which animals to keep as pets and which to kill with traps and poison, and advice on how to react when the people of coastal Maine try to sacrifice you to their strange god.

Short review:

Do you like John Hodgman?  Then you’ll like this book. Go get it!

Longer review:

You’ve probably heard of and like Hodgman already via This American Life, the “I’m a PC” Mac ads, or his podcast Judge John Hodgman.  I was lucky enough to meet him at a book signing years ago and can confirm that he is a stellar human being.  (He signed my book “I know you are not a villain”, so it must be so.)

I am I biased? Sure. But his awesome human-ness is what comes out in this memoir essay collection. And first up is that he recognizes his white, upper middle class privilege and calls himself out throughout the book.

I am grateful to be reminded at how vigilant I need to be about my skin and its thinness and the responsibilities both entail.

The essays range over the course of Hodgman’s life but concentrate on his second act, namely being a middle-aged, once-kinda-famous dad who vacations in Maine. Come for the stories, stay for the amazing writing, humor, and insight.  It’s very Ira Glass-y in that bits of story are followed by pulling back to get a wider view.

We said good-bye to our new friends, who seemed happy to leave.  I do not know where they went in their lives after that, but I have learned to be comfortable with that.

A turn away from his books of fake facts, the essays of Vacationland are funny and earnest and make you glad that there’s a guy like John Hodgman out there, sharing his thoughts with the world.  A must read for Jh fans as well as a starting place for those unfamiliar.

Thanks to Viking and Edelweiss for providing a review copy.

Tears We Cannot Stop: A Sermon to White America by Michael Eric Dyson

33395053As the country grapples with racist division at a level not seen since the 1960s, one man’s voice soars above the rest with conviction and compassion. In his 2016 New York Times op-ed piece “Death in Black and White,” Michael Eric Dyson moved a nation. Now he continues to speak out in Tears We Cannot Stop—a provocative and deeply personal call for change. Dyson argues that if we are to make real racial progress we must face difficult truths, including being honest about how black grievance has been ignored, dismissed, or discounted.

“The time is at hand for reckoning with the past, recognizing the truth of the present, and moving together to redeem the nation for our future. If we don’t act now, if you don’t address race immediately, there very well may be no future.”

Review:

A must-read primer to race in America, especially for people who are new to racial justice.  Aimed specifically at white people but readable by anyone, Dyson explains why history, police brutality, and white fragility matter.

Don’t be put off by the fact that the author is a minister – he’s not pushing a god on anyone, much appreciated by this agnostic.  Using the framework of a sermon Dyson goes through the stages of white guilt, the construction of whiteness, the specter of slavery, and more.  As a primer he avoids going overly deep, which is perfect for what he’s doing.  Other authors have covered the specifics elsewhere and he lists dozens of them if you’d like to read more.

What gets to me is that the people who need to read this most – whites with no grounding in racial justice – are the least likely to pick it up.  So read it yourself and put it in other people’s hands.  We need to get the message out.

American Fire: Love, Arson, and Life in a Vanishing Land by Monica Hesse

32191677The arsons started on a cold November midnight and didn’t stop for months. Night after night, the people of Accomack County waited to see which building would burn down next, regarding each other at first with compassion, and later suspicion. The arsonist seemed to target abandoned buildings, but local police were stretched too thin to surveil them all. Accomack was desolate—there were hundreds of abandoned buildings. And by the dozen they were burning.

A mesmerizing and crucial panorama with nationwide implications, American Fire asks what happens when a community gets left behind. Hesse brings to life the Eastern Shore and its inhabitants, battling a punishing economy and increasingly terrified by a string of fires they could not explain. The result evokes the soul of rural America—a land half gutted before the fires even began.

Review:

I went into this book blind, knowing nothing about the Accomack fires, and Hesse is a surefooted and well-spoken guide.  She spent months living on the Eastern Shore and it shows in the way she paints the community and pulls us into the crime.  While the culprit is pointed out early on the whydunit aspects kept me reading – what would drive someone to do this?  What does it mean when you’ll do literally anything for someone?

The reporting and particulars of the case are handled exceptionally well, with the crimes, apprehension, interrogation, and court aspects carrying equal weight.  However, I was hoping that Hesse would spend more time digging into the social and economic trends that led to Ammomack’s fall in the first place.  Many factors are briefly touched on – the importance of the railroad, the rise of chicken farming – but it never gets to the point of an overarching theme.

Even though I was hoping for more thematic heft American Fire is a fascinating look at what happens when you find an arsonist in your midst.

On Tyranny: Twenty Lessons from the Twentieth Century by Timothy Snyder

33917107An historian of fascism offers a guide for surviving and resisting America’s turn towards authoritarianism.

Timothy Snyder is one of the most celebrated historians of the Holocaust. With Twenty Lessons, Snyder draws from the darkest hours of the twentieth century to provide hope for the twenty-first. As he writes, “Americans are no wiser than the Europeans who saw democracy yield to fascism, Nazism and communism. Our one advantage is that we might learn from their experience.”

Twenty Lessons is a call to arms and a guide to resistance, with invaluable ideas for how we can preserve our freedoms in the uncertain years to come.

Review:

I came across Snyder’s 20 Lessons Facebook post soon after the election of Donald Trump and immediately saved it.  The lessons are simple – believe in truth, be wary of paramilitaries, take responsibility for the face of the world – but we need to hear and be reminded of them.  Totalitarianism has a way of sneaking up on you and Snyder is determined not to let that happen.

This book is those twenty lessons, fleshed out.  Sorta.  Historical examples are added and context is hinted at, but I would like a more detailed explanation of what has gone before. While the book clocks in at 120 pages it’s thanks to the formatting more than anything.  I would have finished it in one sitting if not interrupted (silly work).

If you haven’t seen the viral post On Tyranny is a great introduction to how power is taken away from the people.  If you’re looking for a deeper explanation you may want to tackle Hannah Arendt’s The Origins of Totalitarianism instead.

300 Arguments by Sarah Manguso

I’m having trouble writing this review and one of Manguso’s “arguments” (aka aphorisms) explains why:

29875902I like writing that is unsummarizable, a kernel that cannot be condensed, that must be uttered exactly as it is.

She succeeds, time and time again, at doing just that.  Some of the arguments are memorizable and I want to have them on the tip on my tongue, the same way I can spout ‘many hands make light work’ and ‘she who hesitates loses’ on command.

Worry is impatience for the next horror.

Happiness begins to deteriorate once it is named.

Others are slightly longer, sometimes funny, and no less true.

Every year it feels like a greater insult when a student arrives late with no excuse.  I’m going to die so many years before you do! I want to say, pointing to the clock.

The first beautiful songs you hear tend to stay beautiful because better than beauty, which is everywhere, is the memory of first discovering beauty.

300 Arguments a rarity, a book that you can re-re-re-re-re-read and never stop marveling.  Five awe-filled stars.

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.