Furthermore: Where the Headlines Take You

Dying, Quality of Life, and Decision-Making

Have you considered what you would do if you were diagnosed with a terminal illness? Many people choose to fight, seeking the aid of skilled specialists, researching experimental treatments, and looking for any possible avenue that could lead to an unexpected good result. Others prefer to step back from the struggle to win out over disease, and instead ask their doctors to focus on palliative care – controlling their pain, and helping them try to live comfortably and well for however long they have. This second route, it turns out, may actually help people live longer than they would under aggressive treatment, a finding which is contrary to many people's instincts.

Our society has a history of intense debate on end of life issues, and as science and technology advance, new questions arise. Dr. Lewis M. Cohen's new book No Good Deed explores some of this tricky territory, using as a framework the true story of a terminally ill patient, two nurses who treated her, and the nurse's aide who accused them of murder. This is a fast-paced story, and it raises a variety of challenging ethical questions. Cohen does a good job of exploring the conflicts while also clearly explaining the science, and respecting the intelligence of his readers.

What, then, is the role of the physician in caring for terminally ill patients? Dr. Eric J. Cassell argues that the relief of suffering is the central role of medicine. In his book The Nature of Suffering and the Goals of Medicine, Cassell lays out a philosophical framework for integrating the science of medicine with the art of caring for the ailing. For example, Cassell explains that classical disease theory considers the patient as essentially a container for the illness: no matter which person is affected by an illness, the result is the same. A more accurate view, he says, takes illness as a process, rather than a discrete event. Illness happens to a person over the course of time, and it affects that particular individual in a specific and personalized way – and doctors must understand this if they are to attend to that individual's actual well-being.

All this begs the question, how do doctors actually manage this work of considering the patient and his or her illness, treating an ailment, and tending to a sick person's suffering? Dr. Jerome Groopman's How Doctors Think sheds some light on these questions, by taking readers through the diagnostic and clinical methodology in which new doctors are trained, and examining how physicians in practice actually make decisions day-to-day. It's an interesting window into a subject that will ultimately be of direct interest to most of us, since sooner or later, nearly everyone needs to see a doctor for something.

If you are eager to read more about health, medicine, and related topics, be sure to take a look at the library's list of Medical Nonfiction That Reads Like Fiction!

A Gut Check You Can Take to the Bank

Last week the New York Times reported on an unusual medical case involving a husband/wife transplant. The uncommon aspect of this transplant procedure was not the relationship between the donor and recipient. What was striking about this operation was the material being donated, bacteria from the husband gastrointestinal tract. The patient had lost 60 pounds in eight months due to constant and debilitating diarrhea. By delivering a serum made out of her husband's stool and saline solution, the attending doctor was able to alleviate this life threatening condition, literally, overnight. It turns out that the flora of the wife's gut had been colonized by microbes outside the typical spectrum of those that are useful and productive within the human body. Bacteria from her husband's body were able to flourish and provide the necessary digestive assistance allowing her to make a full and speedy recovery.

Though written with children in mind, Poop Happened: A History From the Bottom Up is a resource of great fecundity. The bacteriotherapy described above (also referred to as a fecal transplant) is a relatively novel application for excrement, especially when compared to the history detailed in Poop Happened. Sarah Albee's work underscores the historical methods used to deal with all matters excremental and does not shy away from details. From knights in armor to astronauts, everyone has to go sooner or later. But how? Poop Happened takes a peek at the particulars of evacuation but also addresses the larger issues of public health related to effective waste treatment and what can happen when that treatment is unavailable or just plain hasn't been invented yet!

Anne Maczulak's The Five Second Rule and Other Myths About Germs: What Everyone Should Know About Bacteria, Viruses, Mold and Mildew acknowledges that many of our most strongly held beliefs about microbes are unduly biased. The bathroom is not the dirtiest room in your house and only a small percentage of the micro-organisms in our surroundings could be considered pathogens. For the most part we live in harmony with, and require the assistance of, the wee beasties in our environment. Maczulak's writing style is direct and informative and she provides plenty of examples to illustrate her overarching themes. The Five Second Rule reads a bit like a text book which lends its directives a certain gravity. Helpful sidebars distill in the most important information into an easy to reference format.

Just what would our world be like without microbes? Is such a thing desirable, or even possible? Idan Ben-Barak would answer those last to questions with a resounding, "No." Without micro-organisms we would perish in days if not hours. So why are people so fixated on eliminating these unseen life forms? Ben-Barak's The Invisible Kingdom: From the Tips of Our Fingers to the Tops of Our Trash, Inside the Curious World of Microbes takes a magnifying glass to the many issues that inform our gut reactions to bacteria, fungi and viruses. His conclusion is that they are not only essential and inextricably interwoven into our environment, they may just be a source of salvation. Microbes could be the key to eliminating radioactive waste and may provide a delivery device for helpful medicines. In short, we may do better to increase rather than decrease our reliance on the invisible creatures with which we share our world.

Medical Miracle

Last week, the world learned the identity of the person who received the first successful face transplant performed in the U.S. – Connie Culp of Ohio underwent a 22-hour operation last December during which doctors replaced about 80% of her face with tissue from a donor. Amazing, right?

Connie Culp's groundbreaking procedure sounds like science fiction, but other transplant surgeries have proven so sucessful that they don't get much comment from the public. Curious about how we got this far? Check out Transplant: From Myth to Reality. In a straightforward but engaging style, author Nicholas L. Tilney traces the history of organ transplantation from ancient times to the present, with an especial focus on the development of kidney and heart transplants during the middle of the 20th century.  If you're still curious, you can find more current information and facts about organ transplants at the National Library of Medicine's health information website MedlinePlus.

In order for people to receive organ transplants, someone has to donate their organs. Some organs are donated from living donors – often family members or other loved ones. But there are organs, like the heart and corneas, that no one wants to do without. These are gifts from beyond the grave, given by with the consent of the donor or their family (in Oregon and Washington, you can register as an organ donor at Donate Life Northwest). In her book Body Brokers, Annie Cheney explores a related, but much shadier world, in which "body brokers" buy and sell human remains for medical research and training, commercial use by medical gadget companies, and for use in military bomb tests. Horrific! But fascinating.

Lesley A. Sharp discusses some of the same questions in her book Bodies, Commodities, and Biotechnologies, but she takes more of a sociological angle. What is the value we place on a donor's body, and how do we memorialize the people who donate their organs? What does it mean for human body parts to function as commodities, with monetary value placed on their transfer and use? Can we manage the ethcial challenges of transplants between species? These are lofty questions, and Sharp's analysis is probing and intelligent, but eminently accessible.

On a lighter, more ironic note, transplants, transplant surgery, and transplant patients have always been fodder for fiction, of the human drama sort and the more speculative, science fiction sort. And sometimes these stories are, as they say, ripped from the headlines. When convicted killer Gary Gilmore was executed by the state of Utah in 1977, he asked that his organs be donated for transplant. The British punk rock group the Adverts wrote a hit song, "Gary Gilmore's Eyes," in which the singer wakes up more than a little startled to realize that he's been given the gift of a murderer's sight. Here are the Adverts performing the song on Top of the Pops in August, 1977:

(You can also get "Gary Gilmore's Eyes" on CD at the library. It's on Crossing the Red Sea With The Adverts, and on disc two of No Thanks!: The 70s Punk Rebellion.)

Cover Your Cough

Ironically, I don't pay much attention to the news-news, if you know what I mean. So when a colleague came to me a few days ago with a look of horror on her face and said, "I'm going to Mexico in a couple weeks!", I didn't get it. And when I congratulated her on it (because that seemed like the right thing to do) and she looked at me like I had lost my mind, it dawned on me that perhaps I was missing something...and that something was swine flu. Which is, again, ironic, because plague-like pandemics are one of my very favorite topics to read about! There are so many riveting and downright scary stories out there, both true and made up, about blights taking out major sections of the population - or the entire population in the case of The History of the Dead - that it's almost too hard to choose...

The first book I want to talk about it is a fascinating recommendation I got from Emily-Jane. It's Sandra Hempel's The Strange Case of the Broad Street Pump and details the true story of John Snow, a doctor in Victorian England, who through determination and scientific investigation (an unknown practice at the time) discovered that cholera was being spread through contaminated drinking water and not just "bad air". This is one of those non-fiction books that read more like a thriller!

Back in college I studied history and one fine day William H. McNeill came to my school and read from his book Plagues and Peoples. In my previous years of studying history I had never heard anyone mention that blankets full of smallpox were just as important to the shaping of mankind's history as the Battle of the Bulge. McNeill and his book intrigued me, and though there have been many books written on similar topics since Plagues and Peoples, in my opinion this is one of the best.

One of my all-time favorite authors is Connie Willis, and one of my favorite books by her is called The Doomsday Book. This award-winning story mixes time-travel, an influenza epidemic in 2054, and the Black Death of 1348. I remember being on the edge of my seat with worry over the characters I had grown so fond of, and Willis does a brilliant job creating a believable future-world while describing with historic accuracy the plague of the Middle Ages.

For more information on swine flu, both the state of Oregon and Multnomah County have set up web pages with up-to-date information. And we here at the library are also keeping folks informed!