HAF Book Club: May poll and discussion

[Sandra Craft]

Complications: A Surgeon's Notes on an Imperfect Science by Atul Gawande. Gawande, a surgeon, argues that medicine isn't an exact science and therefore mistakes are inevitable. He then explores the line between that potential for error and the humanity necessary to make doctors good at what they do.   (269 pages)

Laughing Without an Accent: Adventures of an Iranian American, at Home and Abroad by Firoozeh Dumas. A collection of humorous vignettes by the author of Funny in Farsi, primarily centered on the misadventures of her Iranian immigrant family.  (256 pages)

Monster of God, by David Quammen.  The significance of alpha predators (specifically, in this book, the Asiatic lion, crocodiles, tigers and brown bears) and the humans who live alongside them.  (528 pages)

Pilgrim at Tinker Creek, by Annie Dillard.  Dillard's personal narrative highlights one year's exploration on foot in the Virginia region through which Tinker Creek runs. The result is an exhilarating tale of nature and its seasons.  (288 pages)

The Poisoner's Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York, by Deborah Blum.  The Poisoner's Handbook opens one riveting murder case after another in this chronicle of Jazz Age chemical crimes where the real-life twists and turns are as startling as anything in fiction.  (319 pages)

A Primate's Memoir: A Neuroscientist's Unconventional Life Among the Baboons by Robert M. Sapolsky.  Two stories in one: the documentary of a life studying and living with baboons in the wild; and the memoirs of living in some of the wilder parts of Africa---food, housing, travelling, historical anecdotes about the various native relations and interactions, between Hutu, Tutsi, Masai, Kikuyu, Mau Mau, etc. (the most famous participants in the most famous disturbances in recent Africa).   (304 pages)

Quackery: A Brief History of the Worst Ways to Cure Everything, by Lydia Kang and Nate Pederson.  Looking back with fascination, horror, and not a little dash of dark, knowing humor, Quackery recounts the lively, at times unbelievable, history of medical misfires and malpractices.  (344 pages)

[Dark Lightning]

Heh heh, May Pole. 

[Sandra Craft]

Heh heh, May Pole. 

[Davin]

I'm finishing a book right now, I'll pick the book up and start reading on the 11th.

[Sandra Craft]

Here's my review from FB:

Right off the top, Gawande is a wonderful writer -- I think even if I had no interest in this subject I would have found this book fascinating reading.

The book is divided into three parts: Fallibility, Mystery, and Uncertainty. I won't lie, I found the Fallibility part unsettling to read, sometimes terrifying, being as it was all about things going wrong. Which they do in the careers of even the best doctors, and who knows when you as a patient may collide with one of these missteps on the part of your own trusted doctor?

The most infuriating chapter here was "When Good Doctors Go Bad" as it made plain the medical profession suffers from the same "protect our own" mentality as the police force does. And we see what that comes to with the police.

"Hank Goodman [not his real name] is a former orthopedic surgeon. He is fifty-six years old and stands six feet one, with thick, tousled brown hair and out-size hands that you can easily imagine snapping a knee back into place. He is calm and confident, a man used to fixing bone. At one time, before his license was taken away, he was a highly respected and sought-after surgeon. 'He could do some of the best, most brilliant work around,' one of his orthopedic partners told me. When other doctors needed an orthopedist for family and friends, they called on him. For more than a decade, Goodman was among the busiest surgeons in his state. But somewhere along the way things started to go wrong. He began to cut corners, became sloppy. Patients were hurt, some terribly. Colleagues who had once admired him grew appalled. It was years, however, before he was stopped.
. . .

In medicine, we all come to know such physicians: the illustrious cardiologist who has slowly gone senile and won't retire; the long-respected obstetrician with a drinking habit; the surgeon who has somehow lost his touch. On the one hand, strong evidence indicates that mistakes are not made primarily by this minority of doctors. Errors are too common and widespread to be explained so simply. On the other hand, problem doctors do exist. Even good doctors can go bad, and when they do, colleagues tend to be almost entirely unequipped to do anything about them."

Frightening.

Mystery is about some of the things that still elude understanding even after years of research. Things from ancient superstitions about the full moon to how and why pain is perceived, how and why we become hungry and what causes uncontrollable nausea and blushing.

For obvious reasons, the chapter on hunger and appetite were particularly interesting, and depressing, for me. Apparently it's good luck trying to control your appetite, esp. over time. Bariatric surgery seems to have the best results but even when it's a success over a long period, it's for wildly varying reasons.

As Gawande points out: "We are a species that has evolved to survive starvation, not to resist abundance."

The final part, Uncertainty, covers autopsy (which has gone from being almost universally done to nearly non-existent), Sudden Infant Death Syndrome, the evolution of the patients rights in deciding their own treatment (and why it's both good and bad for patients), and the role of intuition in a doctor's diagnosis.

This last, called "The Case of the Red Leg" was particularly engrossing. A young woman with a skin infection that looked like and had all the symptoms of mere cellulitus (very common and easily treated) turned out to be necrotizing fasciitis (aka, the flesh-eating bacteria, rare and incredibly lethal). Something that wouldn't have become known if Gawande hadn't recently seen another patient die horribly from necrotizing fasciitis and couldn't ignore the nagging feeling that the young woman's apparent cellulitus was a wolf in sheep's clothing.

What she went thru to save both her leg and her life makes for horrendous reading (honestly, if it had been me, I'd have told the doctors to just take the leg off) but is a fascinating demonstration of what medical science is capable today.

Very much recommended, and I'll be looking for Gawande's other books.

[Davin]

I did like the writing style a lot in this one. Very clear and detailed without overuse of less common words or over explaining.

I also found the first part of the book unsettling, I found most of the book unsettling. I have never been in an extreme health emergency that required surgery, so I have no personal experience to work off of. I understand that people need to learn, and that the people they need to learn on are put in a slightly higher risk. It is a necessary risk. I do feel like, based on how the author described putting a needle in, that maybe there is a better way to both let the new doctor try a few times, and then let someone who knows what they are doing come in and do it right. I don't know though, all I have is this book (a few other books) and no personal experience. And I know that explaining common mistakes in my field (even mistakes made by seasoned developers), to non-programmers is also difficult and a bunch them also think they can just pipe up with a solution.

The doctors going bad part was very disturbing. It is a broken system. But I also get that fixing that system is not very easy. We have all these boards and reviews and much more, but it seems to be mostly theater. Like the security theater we have to suffer through in an airport, we also get a kind of public confidence in doctors theater. Not very inspiring, because, as a non-expert in medical shit, I probably won't know when a doctor is behaving badly or not.

One part that disturbed me greatly was the patient consent part. The author seemed to have a very condescending opinion of informing and allowing the patient to consent. Even so far as to say that patients don't really want to make decisions. Oddly, this was one of the places where citations were missing. The author claims that most often the patient relinquishes consent, but does not provide the source for the claim or the circumstances the patients were in or how that worked. Does that mean that the patient was informed about the procedure the doctor is recommending and then consents to it, so that means the patient wanted the doctor to make the decision for them? Or does it mean something else? We don't know and can't find out. Anyway, consent is important even if one goes with the recommended treatment.

The last case was very interesting, and it was a tough choice to make. Sandra already gave that a better review than I can.

It was a good book and an interesting read. I would recommend it.