Tag Archives: medicine

Real Lives, Real Medicine

In medical school, Matt McCarthy dreamed of being a different type of doctor – the sort of mythical, unflappable physician who could reach unreachable patients. But when a new admission to the critical care unit almost died during his first night on call, he found himself scrambling. Visions of mastery faded as he prayed to simply survive a brutally demanding and challenging near-year as a new doctor.

The Real Doctor

The Real Doctor Will See You Shortly: A Physician’s First Year by Matt McCarthy (Crown, $27.00, 323 pages)

“After 10 months of being an intern, I no longer experienced life like a normal person… I now viewed everything through the lens of medicine. It wasn’t something I had planned or particularly wanted, it just happened.”

The Real Doctor Will See You Shortly is a very well written, engaging and entertaining look at what Dr. Matt McCarthy – a one-time minor league baseball pitcher who wrote the memoir The Odd Man Out – calls the “wonderfully insane” world of medicine. While serving as an intern in New York City, McCarthy was to practice – in the most literal sense – at both the massive Columbia/NYU Medical Center with 2,478 beds and the small 201-bed Allen Hospital (Motto: “Amazing things are happening here.”). McCarthy experienced a needle stick early on while treating a patient with HIV and Hepatitis C. In this sense, he became a patient himself, receiving prophylactic treatment and resting while waiting to find out if he had infected himself with one or both of these conditions.

McCarthy draws on the reader’s empathy by focusing not just on himself but also on two infirm patients: Benny, a middle-aged, seemingly healthy individual waiting endlessly for a heart transplant donor; and Carl Gladstone, a university professor whose life is nearly destroyed by a sudden heart attack. We see that, as with many things in life, luck and timing may override fate.

McCarthy goes from being a resident “who had been practicing medicine for less than a week” to a full-fledged hospital physician and Cornell University assistant professor of medicine. It’s an amazing journey, one well worth experiencing.

Highly recommended.

Joseph Arellano

Note: If you enjoyed reading Complications, Better, or Being Mortal by Dr. Atul Gawande or One Doctor by Brendan Reilly, M.D., you will want to consider reading The Real Doctor Will See You Shortly.

A review copy was provided by the publisher.

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Another Roundup

Quick Looks at Books

True Strength: My Journey from Hercules to Mere Mortal and How Nearly Dying Saved My Life by Kevin Sorbo (Da Capo Lifelong)

The overly-long title gives you some idea of what this memoir is about.   The actor who played Hercules on TV was hit with a series of puzzling strokes that disabled him for quite a long time.   The first half of this true tale is interesting, but then the reader fully expects to find out – in the second half of the telling – what caused the strokes and/or how Sorbo was cured.   Neither happens and nothing much of interest (other than Sorbo’s getting married and having children) occurs in the last 140 or so pages.

This is the type of account that, if boiled down to six or seven pages, would have made for a heck of an interesting magazine article.   Unfortunately, at 276 pages it just seemed to go on and on without resolution.

The Me Generation by Me: Growing Up in the ’60s by Ken Levine (Ken Levine)

Levine writes about much of the growing up male territory covered so well previously by Bob Greene.   Levine, however, grew up in the greater Los Angeles area rather than in the Midwest.   While there are a lot of funny bits in this memoir, a good amount of the (Jewish-American) humor seems forced – more Woody Allen, if you will, than Jerry Seinfeld.   Not that there’s anything wrong with that.

God’s Hotel: A Doctor, A Hospital and a Pilgrimage to the Heart of Medicine by Victoria Sweet (Riverhead Books)God's Hotel (B&N)

This medical memoir is best summed up in the quote, “The secret in the care of the patient is in caring for the patient.”   Dr. Sweet, who has practiced medicine for more than two decades at the Laguna Honda Hospital in San Francisco, is a doctor who truly cares for the most indigent of patients; and she cares for the human-paced hospital which barely survived a closure scare.   At a time when some still wish to debate the benefits of a national health care system, Sweet explains why we should “still believe and act as if taking care of the sick poor is something that a society should do.”

Sweet goes on to explain how a physician can learn lessons from patients, such as the fact that “medicine no longer (needs to seem) so complicated.”   A hospital should still be just that rather than a dreaded modern “health care facility.”   Sweet also details how literally dangerous it can be for a budget-cutting hospital administrator to meet and get to know the patients – actual human beings and not just “residents” – for whose lives he’s ultimately responsible.

Most readers will find themselves wishing that Dr. Sweet could be their own personal M.D., providing medical care that’s less technology and more about instinct, feeling and a sense of bonding.   Oliver Sacks said this book “should be required reading.”   Indeed.   Well recommended.

How We Age: A Doctor’s Journey into the Heart of Growing Old by Marc E. Agronin, M.D. (Da Capo Lifelong)

HowWeAge_358“…the burden of illness and the proximity of death force a special bond (between a health care professional and) patient and family.”

Marc Agronin, a psychiatrist for the Miami Jewish Health Systems is another caring doctor who has written about his relationships with elderly patients in How We Age.   Agronin makes clear that he’s also learned much from them:  “…no matter how many years I’ve practiced, I still find myself a student to the life lessons offered by these (patients).”   He specifically learns that his patients, no matter what their illness or psychological state, generally die with dignity and prior to their expiration, they acquire “the crowning glory of old age” (Cicero) – namely wisdom.   “Wisdom serves to calm (the) maelstrom (of decay), providing a way of thinking, feeling, and experiencing that brings order, harmony, and, for many, a great measure of happiness.”

To his credit, Dr. Agronin also – like Dr. Sweet – rejects the notion that the business of medicine has evolved into nothing more than “a business transaction between strangers.”   In his view, a doctor or psychiatrist and patient should be no less than truly friends, if not more.   Highly recommended.

Joseph Arellano

Review copies were provided by the publishers or authors.

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Have You Ever Been Mellow?

The Other Side of Normal: How Biology is Providing the Clues to Unlock the Secrets of Normal and Abnormal Behavior by Jordan Smoller (William Morrow, $27.99, 390 pages)

“When it comes to the human mind, we’ve long had an uneasy relationship with the concept of normal.”

Author Jordan Smoller has written a book with a purpose.   Smoller invites the reader to consider taking a new look at what is considered normal human behavior.   As an associate professor at both the Harvard Medical School and the Harvard School of Public Health, he has the background and experience that make this book a compelling read.

There are multiple threads of thought that weave together as Smoller provides a survey of the approaches taken in psychology, psychiatry and biological research since the late 1880s.   Moreover, he states that the notion of normal has historically been viewed from the extremes of abnormality.   Smoller sees a continuum of behavior with abnormality arranged at the ends.   Rather than viewing mental disorders as sitting on one side of a bright line, a new approach would begin at the center of normal and establish how far normal extends before the abnormal is encountered.

A charming phrase that stayed with this reviewer is “the intersection of genes and experience.”   Smoller and others in his field have been examining brain/mind function with the intent of clarifying whether the old nature vs. nurture concept for determining causality for behaviors holds true in the 21st Century.   In light of the recent findings related to the human genome, genes are now seen as present in a person at birth and they are often activated by experience and exposure to nature (nurturing).   That is to say, genes and nature are dependent upon each other for bringing about human behavioral development.

This is a book that approaches textbook status.   A reader is well served to have some familiarity with or a strong curiosity about perceptions of normal.   To his credit, Smoller takes the time to explain in detail the study of genes and experience that he is so committed to recasting in a new format.   The Diagnostic and Statistical Manual of Mental Disorders (DSM) is referenced frequently throughout the text.   It has been a help for practitioners in the past and now, in Smoller’s view, it has become a hindrance due to a universal perception that it is “The” source for determining a diagnosis of mental disorder.

In the DSM, diagnoses are pigeonholed within rigid parameters and, in some cases, arranged and categorized in ways that hinder helpful treatment.   Alternatively, Smoller makes a strong case for exploring methods for effective treatment that are likely found outside of the current framework.   Practitioners are seeking cures at all levels – genetics, re-conditioning therapy, cognitive and behavioral therapy, and pharmaceuticals.   A new view of their methods for determining appropriate treatment seems like a breath of fresh air.

Much is at stake as normal is being fine-tuned.   Differentiating normal from abnormal has a measurable impact when viewed from the perspective of health insurance coverage as well as the setting of qualifying criteria for disability payments.   Hopefully, Smoller and his associates will prevail in their efforts to de-stigmatize mental illness and provide better treatment for people whose position on the continuum is outside the range of normal.

Well recommended.

Ruta Arellano

A review copy was provided by the publisher.   The Other Side of Normal is also available as a Nook Book and Kindle Edition download.

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Heaven

Proof of Heaven: A Novel by Mary Curran Hackett (William Morrow; $14.99; 336 pages)

Grief never ceases to transform.

proof-of-heaven

Mary Curran Hackett has drafted a stirring and remarkable, life-affirming novel.   This is the story of a very sick and courageous five-year-old boy, Colm, who suffers from a rare disease that will kill him within two years.   He knows this and wants simply to see the father he’s never known before he departs this earth.

Colm’s mother, Cathleen, is an intensely religious Irish-American Catholic woman who will do anything to extend her son’s life, although she knows that “if her son were a dog, they would have put him out of his misery already.”   This includes taking him on a pilgrimage to the Abbey of San Damiano in Italy in the hope that Colm will be cured by a miracle.

Colm was one of a kind.

Colm’s disease is idiopathic, meaning that its origins and treatments are unknown to the medical world.   Colm suffers strokes  which put him into a condition of appearing to be dead before he returns to consciousness.   Colm believes that he has literally died on at least one or two occasions, and comes to accept that there’s nothing waiting for him after his death.

Colm (pronounced “calm”) is quite reminiscent of the character Tim Farnsworth in the novel The Unnamed by Joshua Ferris.   Farnsworth comes to give up hoping that the medical profession will save him, and he remains – despite having a wife and family – ultimately alone in his struggle against a unique, crippling disease.   Colm also thinks of himself as being alone, despite the smothering efforts of Cathleen to protect him, until a potential savior – a physician – arrives on the scene.

Dr. Gaspar Basu is a man who lost a son at an early age in India, and comes to love Colm as a type of replacement for his late son Dhruv.   Dr. Basu also comes to fall in love with Cathleen.   And so, he installs a pacemaker in Colm’s chest – in the hope of preventing further near-death experiences for Colm and agrees to accompany Colm and Cathleen on their journey to Italy.   Dr. Basu also joins with Colm’s uncle in supporting Colm’s efforts to find his father who was last known to be living as a musician in Los Angeles.

…by Colm’s seventh birthday he hadn’t had any other near-death experiences after leaving Italy.   To Cathleen it was a sign that God was answering some of her prayers.   Colm may not have been physically healed, but at least he hadn’t died again.   Perhaps the worst was behind him.   Perhaps the miracle took…

proof-of-heaven-rear

The other details of the story should be left for the reader to discover.   Kudos to Hackett for presenting a real world, gritty, yet soaring tale in which humans must make their own choices between hope and hopelessness (in a spiritual sense).   And rest assured that  once you’ve finished reading Proof of Heaven you may well look at life and its inevitable conclusion in a new way.

He had loved her.   She had loved him.

It was enough.

Highly recommended.

Joseph Arellano

A review copy was provided by the publisher. 

“…it was the tale of one boy’s search for heaven that brought me to tears.   I loved this book.”   Shelley Shepard Gray, author of Christmas in Sugarcreek

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America

The Destiny of the Republic: A Tale of Madness, Medicine and the Murder of a President by Candice Millard (Doubleday, $27.95, 352 pages)

Imagine that you are in charge of making decisions for a major publisher.   A writer presents you with a new novel based on the following story:  A very young (49-year-old) President of the United States is elected and quickly stalked by a madman.   The president serves only 6 months before he is shot by this crazy person.   As the shooting takes place, one of the men standing alongside the president has been present at three presidential assassinations (although he is in no way connected to the assassins).   The physician in charge of saving the president cannot locate the bullet in the president’s body, and turns to a world-famous inventor for his assistance in creating a new machine that will find it.   Despite their best efforts, the president does not survive and the vice-president – a political hack who is against everything the former president stood for – assumes office.   This new leader throws aside his former supporters, and proceeds to fully implement the dead president’s political agenda.

No doubt you would reject this fictional tale as being beyond the bounds of believability.   And you might be right, except for the fact that this all, in fact, occurred in 1880.   As documented in The Destiny of the Republic, one truly fascinating account of the events surrounding the assassination of President James A. Garfield, and the assumption of the high office by Chester A. Arthur, these events happened.   The genius inventor who attempted to save the life of the president (in the days before x-rays) was Alexander Graham Bell.   The witness to Garfield’s assassination was Robert Todd Lincoln, “…the only man to be present at three of our nation’s four presidential assassinations.”   And President Arthur, a product of the New York State spoils (political patronage) sytem, was to be the man who enacted civil service reform.   Arthur came to be known as the Father of Civil Service, a title that would likely have been Garfield’s, had he survived being shot.  

“Assassination can no more be guarded against than death by lightning, and it is best  not to worry about either.”   James A. Garfield

This is a detailed and moving version of the events surrounding the life and death of James Garfield of Ohio, a man who was very much in love with his wife; a woman who nearly preceded him in death.   Garfield was to die, not from the bullet that lay harmlessly encased in body fat within his frame, but from medical malpractice and incompetence.   In modern times Garfield, like President Reagan, would have survived his  injuries and returned to the White House.

Garfield turned to the doctors closest to him, and asked what chance he had of surviving.   “One chance in a hundred,” the doctor gravely replied.   “We will take that chance, doctor,” Garfield said, “and make good use of it.”

The reader will come to see that Garfield was a very courageous man who suffered at the hands of a medical team that hastened his death.   Alexander Graham Bell and Chester Arthur also come to life as fascinating characters; Bell as an imperfect but well-meaning genius, and Arthur as a man who reluctantly but boldly grew into the role that destiny selected for him.   (Arthur was not born to greatness, but grew into it when the nation desperately needed a leader to fill Garfield’s very large shoes.)

This true story is very cinematic in nature and might well make for an excellent film filled with multiple larger-than-life characters.   Thanks to Candice Millard, it is a story that will not longer be a blip in the history of the United States.   If you know of a young person who is interested in reading about the history of our country, consider presenting this book to him or her as a very valuable present.

Highly recommended.

Joseph Arellano

A review copy was received from the publisher.   The Destiny of the Republic will be released on September 20, 2011.   “What an exceptional man and what an exciting era Millard has brought to elegant life on the page!   After reading The Destiny of the Republic, you’ll never think of James A. Garfield as a ‘minor’ president again.”   Hampton Sides, author of Hellbound on His Trail

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This Ain’t No Disco

A Fierce Radiance by Lauren Belfer (Harper Perennial; $15.99; 560 pages)

“There was no statute of limitations on murder.”

Lauren Belfer has produced a grand, glorious and occasionally disappointing tale of medicine, war, love and other things in this 560 page historical novel.   This is primarily a fictional account of the discovery and development of penicillin soon after the United States was dragged into World War II.   Belfer sets the scene well, convincing the reader that Pearl Harbor was an overwhelming experience for the average American; quite comparable to 9/11.

The primary character is one Claire Shipley, a photographer for Life magazine which provides her with the credentials to witness history in the making.   In this role, Claire comes to meet and fall in love with James Stanton, the physician who is heading the government’s military-based efforts to develop the new drug on a massive scale.   Claire can relate to the importance of Stanton’s mission as her daughter died from a blood-borne disease at a young age, a disease that might have been halted by penicillin.

One early surprise about this novel is that Stanton reports to a civilian authority figure in Washington, D.C. – a man by the name of Vannevar Bush.   Bush, a key scientist and organizer of the project that led to the development of the atomic bomb, comes across as a very serious and intelligent figure, yet with a touch of playfulness.   With Bush, Belfer succeeds in bringing a lesser-known historical figure to life.

She also succeeds, at least during the first half of A Fierce Radiance, in juxtaposing two stories, the story of the medicine, science and sheer luck behind the development of a life saving drug, and a love story.   Claire and James meet the love of their lives when they meet each other, but each has issues and problems that make their becoming a couple unlikely.   Each has perhaps seen too much of life by the time they’ve met.

If Belfer has played it safe to this point, she soon gambles with the reader’s patience and understanding.   This is because a murder affecting one of the major characters occurs, turning a two-headed story into a three-headed one.   Now the novel is not just about the war and medicine and love during wartime, it also becomes a murder mystery.   It seems at first a bit much especially when – wouldn’t you know it – a New York City Police Department detective (wise and grizzled) enters the scene.

Of course, the author has provided herself with a very broad field to work in here; one can tie together a lot of loose ends in close to 600 pages.   What Belfer does so well is to write in a voice that makes the reader feel “calmed and safe.”   There’s a patience and politeness in the voice that will seem familiar to readers of Anna Quindlen and to those who have read the other recent novel about life in the U.S. during World War II, The Postmistress by Sarah Blake.   It’s as if the oh-so-calm voice does take us back to an earlier time with ease.

Yet there are at least two problems with the telling.   First, the omniscient point of view of the narrator becomes tiring and also keeps the reader from knowing each of the characters as well as we would like.   Because the omniscient (godlike) narrator goes into the mind of every character, the author skimps on well-rounded character development.   This becomes frustrating to the reader and may be a major reason the omniscient voice is used less and less in today’s popular fiction.

Next, while Belfer has written a story that reads like an overly long screenplay, if it were made into a film, most viewers would be very far from satisfied with the ending.   The author does not take the easy way out…  she ends the story with a whimper rather than with a bang.   In this she may have successfully reflected the happenings of life in a truer way than it might be displayed in a tightly scripted and highly dramatic Hollywood-style ending.   This may well be to the author’s credit but it is asking a lot – in fact, far too much – of a reader to devote more than 550 pages to a story that sometimes sizzles before it blandly fizzles out.

Joseph Arellano

A review copy was received from the publisher.   A Fierce Radiance will be released in trade paperback form on March 29, 2011.


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Simple Twist of Fate

The Immortal Life of Henrietta Lacks by Rebecca Skloot (Broadway; $16.00; 400 pages)

henreitta lacks

This begins as an excellent biography of a woman who might have remained unknown but for a miracle of medicine.   “At the age of twenty-one, Henrietta stared through the train window at rolling hills and wide-open bodies of water for the first time, heading toward a new life.”   Henrietta Lacks died in 1951 of cervical cancer but her cells are still alive.   To be exact, only her cancer cells continue to live but they may live for up to 100 years if frozen.   They are the so-called HeLa cells that are used by researchers throughout the world to advance the knowledge of how to fight and halt disease.

Author Rebecca Skloot has taken on the challenge of melding a family’s story with a tale of medicine and law.   The personal story is engaging and quite well done.   The reader will come to feel that he or she not only becomes acquainted with Henrietta Lacks, but also her late daughter Deborah, and her other children and grandchildren.   And, as Skloot gracefully notes, they are quite beautiful grandchildren.

This reader felt the telling was less effective when addressing the medical and legal issues.   That’s because the case is made that Henrietta’s cells were, in effect, stolen from her by Johns Hopkins Hospital.   Yet once you’ve read through two-thirds of the book, you learn that Hopkins explicitly met the medical research standards (and the legal requirements) of the day.   Indeed, it was a different time.   A relation of this reviewer gave consent for a cancer biopsy in 1950 in a northern California hospital.   Only later did the relative learn that her stomach cells were only removed in California; the cell slides were mailed to Johns Hopkins for the medical research and analysis.

There’s also an apparent contradiction in the events.   We’re told repeatedly that Henrietta did not consent to having her cells used for medical research.   Yet, her husband did authorize an autopsy and there’s also a reference to a death-bed conversation during which Henrietta was said to have told a physician that she was pleased that others might benefit from an examination of her cancerous cell tissues.   But even if this conversation never happened, the law at the time was what it was.

The author tells  us that the rights of research subjects were largely unprotected until 1966.   Yes, and this means that a lot of time is spent reviewing and debating the medical morality of an earlier time.   It is a moot point.

Henrietta’s daughter Deborah is the appealing figure in this account.   She is the family member who argued – passionately and perhaps appropriately – that one cannot hold yesterday’s medical professionals to today’s ethical and moral standards.   Deborah, in fact, jumps off the pages of The Immortal Life of Henrietta Lacks as the person who is brought back to life in the telling.

The descendents of Henrietta Lacks have never benefited from the use of her cells, leaving aside the issue of whether they were properly appropriated.   They have not received any money, and although HeLa cells are sold for medical research, the family does not have health care.   This is truly a shame, an injustice, and it is hoped that Skloot’s account will – in highlighting this issue – change things.

Henrietta Lacks deserves to be remembered, as does Deborah Lacks.   Rebecca Skloot has provided the tombstone that Henrietta’s family could never afford.   This true account is at its best when paying tribute to a woman whose life, in death, has benefited countless individuals worldwide.

It is encouraging to hope and think (and perhaps pray) that this account will result in a better life for the children, beautiful grandchildren and great-grandchildren of Henrietta and Deborah Lacks.   That would be the greatest tribute of all.

Highly recommended.

Joseph Arellano

This book was purchased by the reviewer.   

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