Being Mortal

Medicine and What Matters in the End 

by Atul Gawande

     Traditionally, people used to live with their grown children or extended families when they grew old and became incapacitated. Now it's far more common (at least here) for the elderly to live in nursing homes or assisted living units. There's also the option of in-home hospice care, but I think what few would really want is where many end up in their final moments- holding on until the very end suffering from unpleasant procedures or unconscious, tethered in a hospital bed. This very thoughtful and sobering book looks at all those scenarios, describing the history of how nursing homes and assisted living became a thing, looking at how they've changed over the years, and examining whether those options really are in the best interest of the elderly people they serve. The doctor (I must read more by him!) also looks carefully at what people actually want as the end of their lives draws near- what's most important to them, and how can it be achieved. It's not always seeking every last treatment that has the smallest chance of a positive outcome. It's usually the simple things that begin to matter most- being close to family and friends, maintaining some autonomy, feeling like their lives have had worth . . . There are a lot of poignant examples from people Dr. Gawande has known- his own acquaintances, patients, friends, and finally, in a very personal and moving account, his own father. It's difficult to read at times and makes you think about the hard things that nobody really wants to discuss, but points out how important those discussions are before they become crucial. I'm very glad I read this.

Rating: 4/5             282 pages, 2014

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Making the Rounds with Oscar

the Extraordinary Gift of an Ordinary Cat
by David Dosa, M.D.

In spite of it's serious subject matter, this book was a light read- I finished it in two days. The author is a doctor who works at a nursing home that provides end of life care, where many of the patients have dementia. This nursing home welcomes animals- there are six cats in residence (also a bird, I think but that didn't get much mention). The cats provide comfort and distraction to the residents. One of them, Oscar, caught the attention of visiting family members and staff- he's not a very social cat, but when a patient is within a few hours of death, Oscar enters the room and sits on the bed until the end. The doctor was skeptical about this at first, until he started asking details and opinions from those who had seen Oscar performing his vigils. He couldn't deny there was something unusual- and very comforting- in the cat's behavior. Most of the book is actually stories about patients and their families, especially how they come to terms with later stages of Alzheimer's, and make difficult decisions about care and treatment. The cat kind of feels like a side note for most of this. I found it all very thoughtful and compassionate, a good read even though it's not mainly about the cat, as the cover might lead you to expect. There is some speculation near the end about how Oscar could actually know when someone was near death- he never appeared to be wrong- and maybe it was from a scenting a chemical given off by cell death. Like how dogs can sniff cancer. There's also mention of cases where people have been ill, and their cat sits with them unusually close, for longer periods, sometimes never leaving the bed. Certainly seems like they can sense more than we often give them credit for.

Rating: 3/5              225 pages, 2010

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Born on a Blue Day

Inside the Extraordinary Mind of an Autistic Savant
by Daniel Tammet

Daniel is a very high-functioning autistic person with savant syndrome- he has an extraordinary ability to recall and compute large numbers- due in large part to his unique way of visualizing them as distinct shapes and colors. He has synesthesia with both numbers and words. And he suffered from epilepsy as a child. This memoir describes how he grew up, isolated in many ways yet enjoying his own sensations and obsessions (especially collecting things) and only when he was older having a desire to interact with peers learning to navigate social interactions and tasks like shopping or finding his way on bus routes. He describes difficulties in school, living in a large family (nine siblings!) and how he calms himself in stressful situations. How he volunteered to work overseas teaching English as a second language, how his aptitude for learning languages works, how he once memorized and recited 22,000 digits of the number pi to break a world record! (It took five hours to make the recitation). And finally, how he discovered that he's gay, fell in love, and moved in with his partner, living independently and successfully started a business creating a website to help people learn foreign languages. It's astounding. Most of all to me, the very different way in which he visualizes and understands the world. Last year I watched a documentary made about him and I was just blown away. Even the mental games he tells of playing as a child, with numbers, I can't really comprehend. Although the writing style is a bit dry, he recalls incidents with a lot of detail- even from a young age. Some of them sad, to see how peers at first shunned him, and teachers misunderstood. His story of overcoming challenges living with autism and finding his way in the world, to living independently with someone he loves and even finding religion, is very inspiring.

Rating: 3/5               226 pages, 2006

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The Immortal Life of Henrietta Lacks

by Rebecca Skloot

Finished this one yesterday and had to organizing my thoughts around it. It's about a black woman from a small town in Virginia (now unincorporated) who died of cancer in the fifties. Samples of her tumor were taken and the cells continued to multiply in the lab indefinitely (usually cell samples loose vitality after a certain number of divisions have occurred). This was a huge thing for not only cancer research- enabling studies that had been difficult before- but also, it turns out, a mind-boggling amount of other types of research. Henrietta's cells became known as the HeLa cell line, and were involved in erradicating polio, mapping genes, testing effects of radiation, developing an HPV vaccine and much more. The doctor and researchers who first took and grew the cells in culture gave them away freely to any other researcher who wanted them- free dissemination of knowledge and materials helped science expand. But since then, the cell line has been produced in labs and sold to researchers in staggering quantities as a medical industry. 

During all this time, Henrietta's family knew nothing about what happened to their mother's cancer cells. Some of them barely knew what a cell was. It was twenty years after her death when they first heard that not only had a sample been taken of her tumor, but that it had been so widely used in medical research, with some huge profits (for some). Meanwhile her family and descendants couldn't even afford doctor visits. The author worked very hard to meet the family, hear their story, and educate them on what had happened. She took Henrietta's daughter -who had no memory of her own mother- with her on reporting trips to find out what had happened to her sister, Henrietta's oldest daughter who had been sent to an institution at a young age, for example. To the labs in John Hopkins where she saw her mother's living cells in a vial and under the microscope lens. They read articles that had been written about her mother's cancer cells, and found original medical records that finally revealed to the family how Henrietta had been treated during her cancer treatment (she suffered a lot). Needless to say, although it provided a lot of closure and answered tons of questions the daughter and other family members had about their mother's life, it also caused them much pain to learn some things. 

This book is so full. It's about Henrietta's life, and the lives of other poor black people in the forties and fifties, how deplorably they were sometimes treated by the medical community (often viewed as free research subjects). It's about how the family is doing fifty years later, their strengths and their struggles. It's about the efforts the author had to make to learn all that was put into this book, the personal journey and discoveries. It's about how medical research works, pointing out quite clearly that tissue samples are still taken from patients on a regular basis, often without their knowledge or consent, building an immense database of material for researchers to work with. And how it could all fall apart if suddenly the research community had to throw those samples away, or had a dearth of material if people were given the right to refuse their tissues being kept and used in that way. This hit home for me, because not so long ago one of my children was participating in an outpatient program via a hospital. Part of the consent form includes this: 

Use of Biological Samples. During your care at the facility, biological samples . . . might be collected from you for the purposes of your care. Sometimes, after your visit there might be excess or leftover biological samples no longer needed for your care. These samples are usually discarded. However, sometimes these samples might be used for research within our hospitals and occasionally made available to researchers. . . The research can help answer questions about the causes of diseases, how to prevent them, or even how to treat them. Please note that for this kind of research, (i) there might be no practical way to inform you about the details or results of the research.... (ii) generally, no results on tests performed on your samples during the research can be returned to you or entered into your health record. (iii) it is not likely that you will directly benefit from the research, and (iv) there are no plans to compensate or recognize you for use of your samples or any discoveries made during the research. When these samples are used in this manner, your privacy is safeguarded consistent with applicable federal and state privacy laws.

So I knew this, and I was okay with it, because what else am I going to do, refuse treatment? The huge thing here is, back when a sample was taken from Henrietta Lacks, there were no laws in place protecting her privacy- the samples were marked with an abbreviation of her name, and eventually someone leaked the name to a journalist. The terrible thing is the manner in which the family found out- it was literally a shock to them- and then there's the great disparity between how much money was generated by growth and sales of the HeLa cells, and the poverty Henrietta's family continued to live in. To many people, this doesn't seem right. I feel like a lot of these things never should have happened, but then what about all the great strides science made thanks to those very cells. When Henrietta's daughter and other family members realized what it meant, how greatly those immortal cancer cells had contributed to science, they were rightfully proud. 

I could say so much more, but really you should read the book. Highly recommended.

 

Rating: 4/5             2010

The Transgender Teen

by Stephanie Brill and Lisa Kenney

The authors are the founder, and the executive director of an organization called Gender Spectrum, dedicated to helping us understand gender diversity. The book has fourteen pages of detailed references from studies, reports, documentaries and interviews. Subtitle: A Handbook for Parents and Professionals Supporting Transgender and Non-Binary Teens. I'm a parent here. We are trying to be supportive but I have to be honest- it's difficult. I won't have a lot to say solid about this book because there's still many things I don't understand, and other things that are too personal to our family right now. When you're still learning about something- a very large and complicated something with a ton of pressure to get it right because your child's health and well-being is possibly at stake- it's hard to even see if the sources I have at hand are accurate or not. How can I judge the material when I don't have a lot of background information or experience with it? It took me a long time to get through this book- I read it in pieces over the past few months. Really, that should tell me something perhaps- the last book I struggled through had its own issues, which I'm kinda blind to while I'm reading. This one sounded great while I was in the pages- definitions explaining unfamiliar terminology, outlines of adolescent developmental stages, reassurances that you're not alone, explanations of the unique stressors gender diverse teens go through, ideas on how to foster resiliency and so on- but when I sit back and think about it all, I feel rather let down. Seems like it touched shallowly on many things but never gave answers to the hard questions or concrete enough details in the examples. Also quite a lot of the material is repetitive so that gets boring, frankly. I was still feeling good about it though until I start looking at other reviews on the big site that's swallowing the world, and Goodreads. Now some scrutiny throws doubts on how biased the book might be, how lacking in critical information or discussion of the negatives. I received this book from a facilitator at a parent support workshop I attended. I'm going to pass it on to another parent- and continue looking for more material to read.

Rating: 3/5               336 pages, 2016

Intensive Care

More Poetry and Prose by Nurses
edited by Cortney Davis and Judy Schaefer

This was among a box of books my sister once gave to me (she's a nurse). It's a collection of poetry, short stories and a few essays written from personal experiences. (There's a prior volume called Between the Heartbeats). As I'm not terribly keen on poetry, and the book has more than twenty authors, this was a rather uneven read for me. Some pieces just didn't speak to me at all, or were difficult for me to connect to. Others were downright disturbing, or very very sad. Especially of innocent people suffering, stricken by illness or worse injured by outright cruelty. The stories and poems span a wide range of nursing experiences- from students practicing their technique to men or women years into the job, or others looking back after a long career. There are nurses in the usual hospital setting I would expect, but also many stories from remote areas in poor countries, from refugee camps, from the front lines in battle zones. There are stories of frustration and burnout, of exhaustion and misunderstandings. And also those of tenderness, of compassion and deep caring. Quite a few tell of a particular patient or experience that had a profound impact on an individual nurse. I skimmed over a few, puzzled over others, but found many resonating with sensitivity or tense with discomfort, letting me glimpse what it's like to do such work.

Several that really struck me: "The Color of Blood" by Victoria May Collett- how a scrub nurse experiences working alongside a renowned heart surgeon- the thrill and stress and strain. "Water Story" a poem by Cortney Davis. "We Do Abortions Here" by Sallie Tisdale- the subject is exactly that. And these lines from "What Nurses Do: the Marriage of Suffering and Healing":  The rhythm of a heart repeats itself like vows / in a chapel full of light, but we are gathered / here because this man's heart choked after forty years /  . . . and now something as old as love / must be the pencil that helps the heart write / its good-byes across our screen.

Rating: 3/5                           269 pages, 2003

Irritable Hearts

a PTSD Love Story
by Mac McClelland

The author is a human rights reporter who witnessed some terrible things. Many difficult assignments to disaster zones, culminating in travel to Haiti after the devastating 2010 earthquake where her particular focus was to investigate the prevalence of rape among survivors in tent camps. What she found was horrific. She went into shock, had a breakdown and upon returning home, found she could not escape flashbacks of things she'd seen, panic attacks, outbursts of anger or self-loathing, and frightening dissociation- not being able to feel parts of her body at all. She had post traumatic stress disorder, and describes years of struggling to heal, with the help of a therapist, many different techniques to strengthen her mind and body (mindfulness, yoga, self-defense class etc, occasionally medication though she really shied away from that avenue). Through it all she was supported by the love of her boyfriend- a French soldier she had met briefly while on assignment, it became a long-distance relationship and eventually they tried living together. Wow, that that sounded difficult.

McClelland thankfully does not share details about the atrocities she witnessed that brought on her PTSD, but she is frank about the effects it had on her everyday life, in particular her sex life. Her methods of dealing with this are disturbing to read (or were for me) and honestly could be triggering for many - please be advised if you are interested in reading this book you might want to avoid it if you have suffered from sexual abuse or have thoughts of self harm. McClelland received a lot of criticism for what she wrote (initially as an article) but personally, I see her as an intelligent, sensitive and brave woman- she shared so honestly what it is like to live with her condition. Also shares some research she did into PTSD, especially among war veterans and how it affects their families as well (many spouses and children end up with PTSD themselves, from living alongside someone with severe symptoms). A lot of the book seems to drag on with her pain, confusion and exasperation that her symptoms never seem to let up, but in the final twenty pages there is some hope- the coping skills she has learned are becoming easier to employ, her episodes are becoming less frequent, she is more accepting of herself and of the love her husband gives her.

There's so much more to this book- things from her past, difficulties her partner also went through, strength of friendships, struggles with her work- but I can't possibly mention it all. I must say, it was a very difficult read. I had to put it down several times. It also clarified for me- I understand a little better some things I read in Hi, Anxiety that baffled me at first. Like the psychological need some people feel to face pain, fear and aggression, in order to heal.

I borrowed this book from the public library. Found it browsing the mental health section, it just caught my eye.

Rating: 4/5                          308 pages, 2015

Calming Your Anxious Child

Words to Say and Things to Do
by Kathleen Trainor, PsyD

My kids have anxiety (in different ways, and only one of them is actually diagnosed). I think I probably do to some extent as well- as it seems to run in the family. I picked up this book just wanting to learn more about what's appropriate or helpful to say in certain situations. I was honestly surprised at how relevant, practical and comprehensive this book is. It all feels very familiar. Either I have seen some of the behaviors the author describes, in those around me (not just family but also acquaintances and other people I've known) or recognize them in myself. Lots of people probably have a little bit of anxiety, OCD, avoidance tendencies etc, it's not really a problem until it becomes overwhelming and interferes with everyday life, as the author points out.

Well, the author works a lot with children. She uses a particular method of cognitive behavior therapy that is very structured. The steps are to recognize problematic thoughts and behaviors caused by anxiety, rate their level of difficulty (in overcoming), map out strategies for improvement, come up with positive thoughts to replace negative ones, decide on a reward system, and track progress. It's very much centered on getting kids involved in their own treatment, letting them feel they're in control of changing how they think and feel. The examples- all from real patient cases- sounded like problems I have seen many people face (or heard about). Some I really wondered how the method would work, in particular with an older kid who was resentful at even being in the therapist's office and didn't see anything wrong with his life- but in the end it did.

There are, in this book, kids who won't sleep on their own, worry constantly about their health, stress to the point of illness over schoolwork, feel a compulsive need to be clean, avoid all outside situations (preferring to play computer games literally all day), pull out their own hair, have specific phobias, and more. And we're talking to the point of disrupting the entire family life- the girl who was afraid of dogs, for example, got so terrified she would not play outside for fear of encountering a dog in the neighborhood, or go to any friend's house if they had a dog. There was a kid so petrified of bugs he would run screaming from the house to his car whenever he had to go somewhere. A very small child with a severe phobia of water after suffering a burn from boiling hot water that spilled on her, would have panic attacks if even a drop landed on her arm. She couldn't take a bath, walk outside when it was raining, go swimming, etc. Some of the situations looked very simple on the surface until the therapist started helping them examine things, others looked very complicated and confusing until they sat down and figured out the root cause. (The beginning of the book explains the biological causes of anxiety, how the brain works in terms of fear response, and how culture or family situations can sometimes add to it). There was also a section about helping kids overcome PTSD caused by traumatic situations, which was a bit hard to read, but very eye-opening.

I thought at first this book would be boring or clinical, but in fact it was interesting and I felt like I learned a ton. Not that I would implement a program based on what I read alone, but it sure did make me aware of how things can be dealt with, especially  how kids can literally train their brains to think/feel differently, and to have more compassion for people who struggle with certain aspects of anxiety.

Borrowed from the public library.

Rating: 4/5                249 pages, 2016

Hi, Anxiety

Life with a Bad Case of Nerves
by Kat Kinsman

I thought reading about anxiety symptoms in the fictional story A Quiet Kind of Thunder (panic attacks, selective mutism) was bad enough, but in this book- a true account- the anxiety is truly debilitating. Author Kinsman describes feeling jittery, worried and out-of-sorts since early childhood- her behavior often earning her taunts from other children, later on making it hard to find or keep a job, travel, make appointments on the telephone, get in a car and drive somewhere, or even just leave the house. The physical manifestations painful, annoying and interrupting her life, the mental unending ragged self-criticism and fearful thoughts wore her down. She describes going through a series of unhelpful and judgmental (or at least perceived to be so) doctors, mentions quite a few different medications, and relates a period of self-induced (and yes very gradual) withdrawl from one particular psychotic med which sounded like a horrific experience. The part about her stint working in a dungeon as a dominatrix took me by surprise (thankfully not too much detail) but I was even more surprised at my reluctant respect for what she did there: giving other people the pain they somehow needed to feel. She tells about a series of relationships that ended badly, and then the sudden wonder of finding a good one- and her life got so much better after that. Not completely well, never healed, always with this illness to live with- but more manageable when she felt loved. Though she questioned and doubted that for a long time. And then she got a better job, in spite of her fears at being inadequate, and then she decided to just tell everyone: I suffer from anxiety: I have a mental illness. To share and get out of the box of silence. I personally don't know what it's really like to live with debilitating anxiety, but I appreciate that Kinsman could share her story, and she relates the overwhelming response she received from other people who had felt the same fears, and thought they were alone.

It's not exactly linear in fashion, but for once that didn't bother me in a book. Some parts are from her childhood, others more present in time. It seems that sections describing particular fears intersperse with chapters about life events more or less chronological in order, but it still skips around a lot and I just took things as they came. It's not all dark- there's quite a lot of humor and overall I did like reading this one.

Borrowed from the public library.

Rating: 3/5                 221 pages, 2016

Depression and Bipolar Disorder

Your Guide to Recovery
by William R. Marchand, M.D.

Following No Love Allowed, I wanted to know more about bipolar and this was the only other book on the subject when I browsed the shelf, though I have since made a to-read list from the catalog. It's a very thorough guide (as far as I can tell) on mood disorders- mostly concerning depression and bipolar but also others such as anxiety. The book details what is known about mood disorders and brain chemistry, how a diagnosis is reached, what to expect when visiting doctors, how treatment choices are made, management of symptoms, prevention of relapse and more. It's all very methodical and straightforward. Not much about what it's like to live with the disorder, or to know someone who has it, but more about how to seek treatment and manage care. I appreciate that the author outlined his credentials, explained how trials are done on medications, what risk factors actually mean and how to find credible sources of information. It all appears to be very useful and factual. I feel it's a bit unfair for me to give this book a rating, because I didn't really read all of it- I skipped lots of pages that had charts on medications, forms to track symptoms and the like. Or parts that just weren't that interesting. But I did go through it entirely front-to-back and feel like I learned quite a lot from what I did read- the majority.

Borrowed from the public library.

Rating: 3/5                 360 pages, 2012

Coping with Gender Dysphoria

by Ellen McGrody

I have to admit, I find the many various ways in which non-binary persons identify themselves and the use of pronouns other than he/him and she/her, plus the discovery of new terms I never heard of before, sometimes confusing. So I decided to read about it, starting with this book found browsing at the public library. It's rather basic, aimed at teens, and I think covers all important points leading to further reading. The book starts by identifying what all those different terms mean (including, yes, a few I hadn't heard of before- such as demigirl), the difference between gender identity and sexuality, the importance of individuals in presenting as the gender they identify with- whether that be via their clothing and hairstyle, change of name, selective pronouns, etc. Everyone's unique, and will feel a different need to feel comfortable with their body and self. The emotional and psychological distress caused by a person's inner identity not matching their physical body is (as far as I understand it) the dysphoria. Not every non-binary person feels dysphoria. Some are so distressed by it, their mental health is seriously affected. The book details how to find help and support, starting with family and friends, community groups and health care providers.

I really learned more than I expected to, here- in spite of how short the book is. I didn't know what the term clocked meant, outside of a boxing ring, for example. I didn't know about the incident at Stonewall Inn in New York, 1969- which is now commemorated each year with Pride events in June. I'm struggling a bit to recognize what microagressions are (another new term for me). I appreciate the book points out that non-binary people are not anything new. Many cultures have long recognized them: in India they are identified as third gender, in Samoa non-gender conforming people are called fa'afafine and in some Native American cultures they are referred to as two-spirit (and there's even a photo of one such individual, an assigned male in female Zuni dress). I'm sure there's more, but the book only mentioned these. I'm learning.

One very nice thing about this book: it's full of lovely photographs, of young people from all different races, and genders across the spectrum, many whom look very happy to be who they are.

Rating: 3/5             112 pages, 2018

The Real Doctor Will See You Shortly

A Physician's First Year
by Matt McCarthy

Narrative of a doctor's training year working in a New York City hospital as intern, this one caught my eye browsing library shelves. Probably because I had Farmer's work on my mind, which not surprisingly the author references once himself. Compared to an older book I've read about internship, this one is very modern (so modern that I got a little tired of the author referencing popular TV shows and describing his co-workers by what famous actor their looks or manners reminded him of). (Also tedious is his frequent use of swear words in tense situations- particularly the F one). But mostly it was a good read, one I constantly found interesting and hard to put down. Even when some scenes were distressing. McCarthy did a small stint in surgery- realized it wasn't for him- and then worked in the critical care unit, then intensive care, also doing some time in general practice. The book is really about how his skills as a doctor were built up- from nervous and fumbling to confident and leading teams himself. He describes the structure of the hospital; the different teaching styles various supervising residents gave him, panicky moments when he made a wrong diagnosis, the checks that saved his butt from serious error, the difficulties in figuring out what was wrong with unconscious (or just uncooperative) patients, the long hours and incredible stress of it all.

A lot of it is not only about his learning curve in practicing medicine- how to actually do procedures, use the equipment, etc.- but about how he gradually develops a better bedside manner, starts to connect with his patients, finds the balance between keeping himself dispassionate (so he can think critically about a case) and showing the patient that someone cares. Some of the doctor-patient interactions he describes are very touching, others actually nerve-wracking. He describes his euphoria at being part of a team that literally brings a person back from death- and the depression when it goes the other way. The second half of the book also has a lot of internal quandry and fear, as he accidentally gets a needle stick from a patient with a serious, highly infectious disease- then has to take a severe regimen of medication proactively, while waiting for his own diagnosis. It really gave him some perspective on how patients might feel about their treatment.

Borrowed from the public library.

Rating: 3/5              323 pages, 2015

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Girl, Interrupted

by Susanna Kaysen

Please be aware of spoilers below.

I first read this story about mental health a long time ago. Prompted to revisit it because honestly, I saw a copy in my teen's stack from the library and I wondered what she would find there. I couldn't recall the book clearly myself. Poking around online didn't help- the only detailed info I could locate pointed out things about the film, not the book- which apparently added more shock value to the story. I haven't seen the movie. But from several online reviews, seems like it has quite a bit of sex and scenes of death- from suicide. I can tell you, having just finished the book- there is no actual sex in it. The characters talk about it: one time they have a discussion about blow jobs (the taste) and another time speculate if they had a boyfriend visiting, could they manage to "do it" between nurse checks (fifteen or ten-minute increments). Kaysen herself mentions that she went out with a teacher one time, and he kissed her- but in a therapy session she lets the doctor believe they slept together, and apparently the film carried that idea further. As for the suicide- well, it is discussed a lot in the story- the author constantly thought about it, and one time they hear that a former patient committed suicide after going home. That's it. In case you want to know!

What is it mostly about? How the author found herself in a mental hospital as a teen, after what seemed to her a very brief interview with a psychiatrist. She was moody, she practiced self-harm, her perception of time had serious lapses, she struggled with uncontrollable thoughts that looped and spiraled downwards- but really, she wondered what she was doing there. She tells about the other young women on the ward with her- most of them seem to have more serious issues than herself, until the day she starts to wonder- frantically- if she has substance, if there are bones beneath her own skin- and injures herself in a quest to find out. I think that was the most disturbing thing to read about. On the whole, I found it to be bluntly honest, frankly questioning, a bit snarky at times. The writing is also very lyrical and refreshing at times, and once again I really enjoyed her voice.

I was surprised how much of this reminded me of I Never Promised You a Rose Garden. Not the symptoms, but the atmosphere. Kaysen's memoir is placed during the late sixties- cold packs, electric shock and isolation were still common treatments. The feel of the ward is so similar- sitting in the hall outside the nurse station, waiting to make it back outside- or not. On a side note, she managed years later, to get hold of the records from the hospital, and reprinted some of the pages in the book- showing what the nurses and doctors had written about her, what their actual diagnosis was. Comparing that to the inner thoughts she shares about her time spent there, is interesting and puts some perspective on things. Kaysen is discharged after two years, able to hold a job and maintain a relationship, but still often questioning herself- wondering am I sane? are you?

Rating: 4/5             169 pages, 1993

Thursday's Child

by Victoria Poole

What a great story. It's about a seventeen-year-old athlete from a large New England family who suddenly became gravely ill. For a long time his family thought he just had nasty colds that kept recurring, but it turned out he had heart disease- a childhood illness had damage his heart muscle and it became enlarged. His stricken parents kept the news of Sam's illness to themselves for a while, then broke it to the family: without a new heart, Sam was going to die. The parents took him to California where heart transplants were being done as experimental surgery (at the time, only 310 had been performed in the entire world). There followed a barrage of tests- was Sam sick enough to warrant receiving a heart? was he strong enough- mentally and physically- to face the risks? Through it all he kept a remarkably upbeat attitude. The family rallied around him to help, but it was still an ordeal- parents taking turns travelling to and fro California and New England for the duration of his treatment and recovery. Frightening times when his body began to reject the new heart, then recovered for a while. Very long time in intensive care. Joy at being in the outside world again, experiencing life- differently- but life he was extremely glad for. So many details are probably different nowadays about what heart transplant patients go through, but this is one inspiring read (and fairly well-written too).

Sadly, I learned from reading a few reviews online that Sam lived only five more years after his heart transplant- but lived them to the fullest. I believe he died from complications of his medications.

Found at a library sale.

Rating: 3/5         370 pages, 1980

Challenger Deep

by Neal Shusterman

I am tired. I am probably not going to do this book justice, but I actually finished it two days ago, and need to say something. It's a story about mental illness. A teen who suffers from schizophrenia. He has feelings of paranoia and confusion about what's really going on- half the time living in his own head, an elaborate inner world which increasingly overlaps with reality. Gradually relationships with his family and friends erode, until finally his parents make the tough decision to commit him to a mental hospital. I thought this book was really well done. The depiction of the inner universe the kid often inhabited was fascinating- he thinks he's on an oceangoing ship (that usually gets nowhere), peopled by a half-mad captain, a talking parrot and variety of nameless crew members (all full of suspicions and delusions of their own). Things there get stranger and stranger (some parts reminded me of Kafka's writings) while he struggles to keep a grip on reality, to discern between one world and the other. The dialog and wordplay is wonderful, the narrative often very sad, but also full of hope. He has snarky conversations with his therapist, struggles through the effects of different medications, makes a few friends among other patients and staff, and finally emerges at the end- not completely better, but definitely more in control.

The book brought to mind one I had read long ago- I Never Promised You a Rose Garden- aptly enough, as they're both about a teenage schizophrenic. I think it was the convincing elaborateness of the inner world that reminded and intrigued me.

The one thing I did not like about the book was the artwork. In the story, the main character designs computer game characters with his friends, who proclaim him "a great artist" and the loose line scribbles did not at all seem to represent the kind of art I imagined. Then I read the afterword: the drawings were made by the author's son, who himself had a mental illness. I immediately felt ashamed of my criticism.

Rating: 4/5            308 pages, 2015

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In Africa with Schweitzer

by Dr. Edgar Berman

I knew very little about Albert Schweitzer before picking up this memoir at The Book Thing out of curiosity. Schweitzer was a brilliant philosopher, theologian and a virtuoso on the organ. His great loves were writing, studying religion and music. As far as I understand it, he was Lutheran and wished to travel to then-French colonized Africa to preach to the natives, but the church declined to send him because his historical studies of the life of Jesus were considered heretical. So at the age of thirty he took a three-year course at a medical school and then went to Gabon to set up a hospital in the jungle on the edge of a river. There was no other medical care available in the area at the time, people would travel from hundreds of miles away. Schweitzer treated the impoverished native people for myriad diseases and injuries, in appallingly primitive conditions, while indulging in his desire to preach the gospel (his view of it, over the supper table more or less) to them. Schweitzer received the Nobel Prize in 1953 for his humanitarian work. He used the money to build a sanatorium for lepers on his hospital grounds. He ran his hospital, living in rough conditions without electricity and many other conveniences, for some fifty years.

Anyway, this book was written by a surgeon who deliberately volunteered to go work at the hospital in Gabon because he wished to get to know the famous man, and question him personally about his views. He was honest about his intentions and Schweitzer reportedly said well, if you work hard and prove yourself, we'll get to know each other. So part of the book is about conditions in the hospital, how the local people were treated, how the staff was managed, certain medical cases and surgeries the author assisted at or performed himself. The rest of it relates the private talks he had with Schweitzer (which some of the staff resented, as they were not on such close terms with the man in spite of having been there much longer, and had to often act as interpreters for these conversations as well). They discussed religion, medicine, music, touched a bit on recent history- the atrocities of WWII were painfully close and that subject often avoided- and especially Schweitzer's personal philosophy of reverence for all life. He had a pet deer, pig, owl and myna bird, and allowed various monkeys, goats and chimpanzees to roam the hospital grounds freely. I liked reading the few descriptions of the animals. One incident where an elderly tribesman brought his wounded, ill dog in for treatment, which Schweitzer took quite seriously, was very touching.

In all, the description of work at the hospital was very interesting, the chapters on philosophy and religion could get tedious- either because they were frankly over my head, or simply outside of my interest. There was an obvious contrast when the author once went downriver to perform an emergency surgery at another small hospital (because its surgeon was drunk, a state he cultivated to forget the horrors he had survived as a prisoner of the Nazis). This other hospital had more modern, pristinely clean facilities which impressed the author, but the surgical tools were so crude he had difficulty performing the operation. After several months spent working at Schweitzer's hospital and living in awe of the man's company, the author returned home, obviously relieved at having modern comforts again. He returned once more to Gabon some twenty years later, after Schweitzer had died and the hospital was run differently, and reflected upon the improvements made, but the loss of "spirit" that had once pervaded the place.

I looked up some stuff after reading this book. The hospital still exists in Gabon, it is now a world heritage site. The original buildings are part of a museum, and newer ones operate as a research and medical facility providing care to the locals.

Rating: 3/5                308 pages, 1986

Mortal Lessons

Notes on the Art of Surgery
by Richard Selzer

This is so different from most other books I've read. It's a surgeon waxing eloquent on the craft and skill of his occupation. He talks about disease in the most interesting way, describes opening the body and moving into its depths to find ailments and organs as if navigating a landscape. Speaks with passion, and respect for the wonders of the human body. It's not really a book of case studies, more a selection of snapshots that show how the surgeon felt about his work, reflections on the meaning of it, looking at how his patients responded to treatment. Or didn't- some of them died under his hands. It is surprisingly, baldly honest- describing in detail many things that are hard to face- an abortion, an amputation, an explorative surgery that goes wrong, the process of embalming or autopsy. I've read a few books about medicine, hospital work, and the like, but never with things described the way they are here.

It's also an old book, and of course outdated in lots of things. Much of it admitting no understanding, no hope for cure, or putting forth mistaken ideas. I was surprised and kind of annoyed that he goes on and on in one chapter about how horrible alcohol is for the liver- and yet spends another chapter extolling his smoking habit. It's illustrated here and there with woodcuts, engravings and lithographs from the Yale Medical Library- they're not dated but give the work a feeling of more antiquity. I saw someone's comment online that this book is funny- but I guess you'd have to be a surgeon yourself to see the humor in it. I found it really interesting. Funny? not so much. The last part of it digresses from the main subject matter. Some short writings describing his childhood, his father's practice. There's an essay on being carsick- something he suffered a lot from as a child- and another rather weird one about birdwatching (which he apparently was not very good at).

And yet for all its flaws, the book was a thing I wondered at. It made me see the inner workings of the body in such a different way. Its words are so vivid, so alive.

Rating: 3/5       219 pages, 1974

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Doctor in Love

by Richard Gordon

In this installment of the Doctor series, young Gordon is still pretty fresh out of medical school. He's given up hopes of passing the exams to become a surgeon and establishes himself in a general practice instead. Far from being resigned and resentful at giving up his dreams of surgery, he pitches himself into the practice with eagerness to do his best- I admire that attitude. When the residing doctor goes on extended leave for his own medical problems, Gordon has to run the practice with all its upheavals- an irritatingly irresponsible partner, lack of staff and so on. There's also stories about the various lodging houses and odd flatmates (as before) and a new development when he falls in love with a new partner (surprised that this doctor is a woman), sets his sights on marriage and goes house-hunting. All good tales, and it still got a few chuckles out of me, but somehow I wasn't quite as entertained this time around. I think because there simply weren't as many medical stories, no case studies. It wasn't as much about how he practiced medicine, as his dealings with co-workers, prospective employees, annoying roommates, his new love interest and the like. It was interesting to see the different mindsets from the fifties- still a lot of stereotypes about women, although feminism was a newfangled idea here- and also the National Health system seemed to be new as well. There were a lot of complaints about it, from doctors and patients alike, and comparisons to the "old way" of doing things. So it's a bit of a historical read, as well. Light fun, but one I'm not going to keep. I had to make myself finish it.

Rating: 2/5       188 pages, 1957

Doctor at Large

by Richard Gordon

This third installment of Ostlere's Doctor series (I don't have the second volume) follows young Dr. Gordon soon after qualifying. Searching hopelessly for a good job. Filling in as assistant for different general practices- varying widely in quality and all which turn out to be intolerable circumstances. Or just don't last. So he ends up back at St. Swithin's hospital, working as assistant to the house surgeon, trying to polish his skills and keeping an eye out for a better position. There's flirtations with nurses, dealings with unscrupulous hiring agencies, to-and-fro with his friends and rivals. Lots of laugh-out-loud moments. Some puzzlement from this reader at bygone practices- I don't quite know enough to be sure, but every time the young doctor groaned that a practice didn't have the most up-to-date instruments and equipment, I felt sure that the items he mentioned would nowadays be found in a museum! And I did wonder at how many surgeries involved removing the stomach. It seemed to be a certain surgeon's favorite procedure. Did that really cure the ailments they were hoping to? All in all, a good fun read.

Rating: 3/5      208 pages, 1955

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Doctor in the House

by Richard Gordon

From the fifties, the retelling of a young man's forays through medical school at an imaginary teaching hospital in London called St. Swithin's. As the author was a surgeon himself, I'm pretty sure he was drawing on his own experiences (probably with embellishments) and gather that the picture of medical practice in that bygone era is more or less accurate. It's full of humorous incidents and very lighthearted. My knowledge is very general from a layman's perspective, but I was still horrified at some of the ways patients were treated- surgery was used to cure all manner of ills that seemed entirely unrelated, for one thing. Most of it though, is about life as a student- dealing with roommates, inscrutable professors, cramming for exams, ineffectively trying to date nurses and so on. The shock of being presented with his first cadaver to dissect. How quickly the students got used to such things. The chapter where he was sent out on midwifery rounds, on a rickety bicycle through damp streets to dirty tenement houses, reminded me so much of The Midwife. I felt sorry for the patients the medical students had to practice on, but they often seemed proud of the attention their ailments garnered! It's an amusing read and the writing even reminds me a bit of James Herriot.

I picked this book (and two of its sequels) at random from a secondhand sale once. Never heard of them before. I've found out that they were very popular in the sixties, the author (whose real name is Gordon Ostlere) wrote thirty-seven books in the series, and there was a television show made. Apparently the first handful of Doctor books are semi-autobiographical, after that they (according to wikipedia) get fictional, including a lot more "sexual innuendo and farce." I have a hunch I'll prefer the early novels. Not to go searching for, but if I come across more on book-hunts I'll probably pick them up.

Rating: 3/5       190 pages, 1952