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!
Posted by Emily-Jane
There's a continuing problem in journalism – in order for something to be news, it has to be, well, new. This means that anomalous stories about shocking events, celebrities, and scandals get lots of press, while everyday problems languish. Los Angeles Times reporter Jill Levoy bucked this trend when she created the blog Homicide Report as a vehicle to report on the everyday murders that plague Los Angeles. The blog reports on every Los Angeles County death that is ruled as a homicide by the county coroner, and it acts as an interactive database of homicide deaths since 2007, when it began publication. The victims of Los Angeles County homicides are overwhelmingly Black or Latino, and overwhelmingly male, and most of their deaths would never make the news otherwise – their deaths are examples of that sort of sincere everyday problem that so often doesn't make the news.
Homicide Report honors the life and humanity of each of L.A.'s homicide victims, marking their passing, and helping to provide Angelenos with a larger set of information about the true map of lethal human conflict in their community. Slide over to the world of comic book fiction, and you'll find a similar theme in Potter's Field, by Mark Waid and Paul Azaceta. The hero, a mystery man who goes by the name John Doe, has developed a whole network of contacts (janitors, cops, morgue workers) who help him in his quest to identify each and every person buried in New York City's graveyard for unclaimed and unidentified bodies. Doe isn't solving crimes or meting out retribution, he's simply honoring forgotten people by giving them back their names. Potter's Field is dark, poignant, and ultimately, compassionate – and Azaceta's drawings are absolutely lovely.
People have always made an effort to mark the deaths of loved ones. One way that this manifests in contemporary culture is the roadside crosses and memorials friends and family erect after someone has died in a traffic accident. Holly Everett made a careful study of roadside crosses in Texas, and published her study of their place in folk culture in Roadside Crosses in Contemporary Memorial Culture. The book has many photographs and descriptions of Texas roadside crosses, but I found Everett's discussion of their symbolism to be the most interesting part of the book. In that section, she argues that roadside crosses memorialize the dead and help survivors remember them; serve as educational tools, reminding passerby of their mortality and encouraging road safety; mark especially dangerous intersections; and act as expressions of protest and a desire for social change. Roadside Crosses is essentially an academic text, but Everett's writing is clear and her observations and analysis should be interesting to anyone who is intrigued by the use of roadside memorials. And, need I mention, it's really the only book on the topic!
Death customs and rituals often honor change, rebirth, and the cycle of life. And although in most contemporary human cultures, corpses do not decompose gently or physically foster the arrival of new life, dead bodies are used as instruments of new growth through learning, in anatomy laboratories. Every medical student learns the basics of human anatomy through the practice of dissection using real human corpses. And, surprisingly, around a hundred years ago it was typical for groups of medical students to have their photograph taken with their cadavers. Dissection: Photographs of a Rite of Passage in American Medicine, 1880-1930, by John Harley Warner and James M. Edmonson, collects hundreds of these rare images, and puts them in context with a series of essays about where cadavers came from and how they were used in dissection labs, about the development of medical schools in the U.S., and about the culture of medical students during this period.
(If you're fascinated to learn more about the history of medical dissection, corpses, and the like, I can also recommend Body of Work: Meditations on Mortality from the Human Anatomy Lab, by Christine Montross, and Stiff: The Curious Lives of Human Cadavers, by Mary Roach.)
Posted by Emily-Jane
Surgical teams in three quarters of Oregon hospitals have started using a simple tool to make operations safer, and it’s cut down on mistakes by 30%! This new tool is a short checklist developed by the World Health Organization (though we have our own version in Oregon), and it gives nurses, technicians, and doctors a methodical way to make sure they have all their ducks in a row. Do we all know each other by name? Check! Do we have the right patient and do we know what operation we’re performing? Check! Does this person have any allergies? Check! Have we removed all the sponges, surgical towels, needles, and instruments we used in this person’s body? Check!
Are you fascinated to learn more about how this works? I’ve got the book for you: The Checklist Manifesto, by Atul Gawande (a surgeon and professor at Harvard Medical School who also writes for The New Yorker). Gawande examines checklists in construction, investing, aviation and other fields, but he focuses on checklists in his own profession, medicine. Here’s what I found most fascinating: research has shown that surgeons are so rock star-like that it’s hard for other members of a surgical team to interrupt if they notice something’s amiss. It’s too intimidating! But, when people are polite and friendly, it makes that interruption feel collegial instead of confrontational – that is, if everyone has to say “Hi everyone, I’m Dr. So-and-so and I’m the anesthesiologist” (or whatever), they’re more likely to speak up when something’s wrong.
Safety checklists were first developed in aviation, and even those of us who have never once fantasized about being behind the controls of a jet airplane have seen this in action. Before takeoff in every commercial flight, flight attendants (whose main job is promoting safety, although they will also get you a ginger ale if you ask nicely) take their passengers through a miniature safety training. If that doesn’t do it, you can always review the information in the safety card in your seat pocket. Eric Ericson and Johan Pihl’s Design for Impact explains the history of airline safety cards, and reproduces hundreds of elegant, amusing, and instructive examples from the last fifty years of safer flying.
Everyone knows that scientists have to follow careful safety protocols – Professor Max Axiom, Super Scientist teaches kids the basics of science experiment safety measures in Lessons in Science Safety. This helpful comic from Donald B. Lemke, Thomas K. Adamson, Tod Smith and Bill Anderson gets readers ready to learn basic lab science safely with sections on preparing for the lab, working safely, handling accidents, and cleaning up. Entertaining and instructional!
Posted by Emily-Jane
"Please have your photo ID, co-payment, and insurance card ready."
"Take a seat in the waiting area and they'll call you when the Doctor is ready."
"Hello, Doctor."
"Goodbye, Doctor."
A visit to the doctor can sometimes feel like a trip to the drive-through window. Estimates for the average length of an office visit range from 20 minutes to as little as seven minutes. A movement in primary care aims to change that. Longer visits, monthly fees rather than insurance reimbursements, and fewer visits to costly specialists are some of the features that come from creating patient-centered practices. Advances in technology have allowed some doctors to get off the treadmill of seeing 25 patients a day and reduce their pace to seeing 10 to 12 patients a day.
If you're curious about the snap decisions doctors make in those brief visits Jerome Groopman's How Doctors Think is a must-read. Through compelling case studies and interviews with fellow physicians, Groopman describes how the training and clinical experiences that doctors have had can influence their diagnoses and lead to errors. Delving into the realms of cognition and perception, the book reports on such fascinating studies as one that tracked doctors' eye movements while reviewing chest x-rays. He uses his own experiences seeking treatment for hand and wrist problems to compare and contrast the styles of two physicians. He also includes an epilogue that walks step-by-step through an office visit with the questions you as a patient should be asking.
Just the title of this book lets you know you're in for quite a ride: Hospital: Man, Woman, Birth, Death, Infinity, Plus Red Tape, Bad Behavior, Money, God, and Diversity on Steroids. Whew! Julie Salamon spent a year at Brooklyn's Maimonides Medical Center, a microcosm of the multicultural community that surrounds it and fertile ground for portraying the vibrant daily life within its walls. Salamon has a direct reportage style that will make you feel like you are following along with her as she sits in on consultations, follows patients through the labyrinth of hospital treatment, and listens in on feuding doctors. Giving just enough background information to keep her narrative flowing, Salamon's book is a rich and nuanced look at medicine as practiced in a modern hospital.
Have you ever had surgery? You should call your surgeon and thank him or her for going to medical school. Through the Middle Ages, your surgeon might also have been a barber, and prior to the 1840's your surgery would have been performed without anesthesia. Esteemed historian Roy Porter uses his deep knowledge of history to tell the story of how medicine was practiced before--before anesthesia, before antibiotics, and even before botox. Blood and Guts: a Short History of Medicine does include a short chapter on modern medicine, but the focus is on the past. This title includes a great section of further reading for each chapter.
For more great reads on medicine, check out the excellent booklist Medical Nonfiction that Reads Like Fiction.
Posted by Kate
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.)
Posted by Emily-Jane
