Atul Gawande

     

 This week I am posting about Atul Gawande.  Like always, I came across Gawande at Borders (a company I will always remain loyal to).  As a general and endocrine surgeon in Brigham and Women’s Hospital in Boston, an associate professor at the Harvard School of Public Health, an associate professor of surgery at Harvard Medical School, contrbutor to The New Yorker, a former Rhodes scholar, and MacArthur fellow, Dr. Atul Gawande's scholarship is highly credible.  

At the same time, I find Gawande very accessible and enjoyable for both physicians and patients.  When I think of Gawande, I think of a very sobering writer, a surprising feat given the topics he sometimes covers including the U.S. healthcare system and medical error.  In some ways, I would guess that Gawande writes like he talks to his patients: he presents the facts and the situation and gives his most educated opinion without being inflammatory.  It is very comforting to find such journalism in our era of pundits and "news" shows.

I was lucky enough to get to hear Dr. Gawande lecture at the Cleveland Clinic a few months ago.  The focus was on the U.S. healthcare system.  I will always remember what he said on the complexity of medicine and how we were all "fooled by penicillin."  Penicillin was not the quick-fix end of infectious disease.  There will be no quick-fix for the healthcare in the United States.       

In his first collection of essays for The New Yorker, Gawande focuses on the humanity of doctors and the degree of uncertainty they must deal with while lives are on the line.  This is some of the best medical writing out there, this book was a National Book Award finalist.  In his second collection of essays, Atul Gawande writes in the same vein of fellow The New Yorker contributor, Jerome Groopman, in the performance of a physician and issues in medical practice at home and abroad.  Gawande’s sincerity and thoughtfulness in the stories he tells and perspectives he gives does not change in his follow-up book.      

nWo Sting's Brother

Tracy Kidder's Mountains Beyond Mountains  came to my attention through my AP English teacher, the same one who gave me the idea to keep a blog of these books.  The subject of the book is one of Kidder's personal friends, Dr. Paul Farmer.  If anyone ever says that advocating for social change is futile, refer them to this book.  Trained as both a medical doctor and medical anthropologist, Farmer is a relentless advocate for social justice.

In this book, Kidder recounts how he met Farmer in Haiti, where Farmer first began developing his organization, Partners in Health.  Today, PIH has projects all over the world in places such as Peru, Russia, and Rwanda.  One of the things I admire most in Farmer is his desire to create projects with lasting efficacy.  So many international health projects I hear or read about just have mission trips which are essentially band-aids.  Farmer, with his anthropological eye, is able to effectively analyze and address the issues in the places he goes.

This is a great read for anyone interested in medicine and/or social justice.  Farmer's work is something that is on my mind often since reading this book.  And if you are wondering about this post's title, Farmer's brother is Jeff Farmer, formerly known has nWo Sting, a wrestler from when I was a kid.

The Citadel

I recently finished The Citadel over spring break.  Cronin is a great writer and some day I may read one of his other books.  The comparison to Arrowsmith is warranted as the protagonist, Andrew Manson, is a young, idealistic physician who contends with a culture of corruption and materialism among his peers.

There are some really great moments in this book and as a doctor himself, Cronin is able to add a certain credibility to the medical scenes.  One of my favorite parts is when Manson has a eureaka moment diagnosing a patient, Emrys Hughes.  Hughes has had recent changes in temperament.  In the night, he goes mad and goes after his wife with a knife.  One of Manson's colleagues, Dr. Bramwell, wants to commit Hughes and needs a second opinion to do so.  He calls Manson, who wants to do his own examination and finds a better explanation:

       Emrys Hughes was in bed, and seated beside him - in case restraint should be necessary - were two of his mates from the mine...
      He went over to Emrys, and at first he hardly recognized him.  The change was not gross; it was Emrys true enough, but a blurred and altered Emrys, his features coarsened in some subtle way.  His face seemed swollen, the nostrils thickened, the skin waxy, except for a faint reddish patch that spread across the nose.  His whole appearance was heavy, apathetic.  Andrew spoke to him.  He muttered an unintelligible reply.  Then, clenching his hands, he came out with a tirade of aggressive nonsense, which, added to Bramwell's account, made the case for his removal only too conclusive.
     A silence followed.  Andrew felt that he ought to be convinced.  Yet, inexplicably, he was not satisfied.  Why, why, he kept asking himself, why should Hughes talk like this?  Supposing the manhad gone out of his mind, what was the cause of it all?  He had always been a happy, contented man - no worries, easygoing, amicable.  Why, without apparent reason, had he changed to this?  
     There must be a reason, Manson thought doggedly; symptoms don't just happen of themselves.  Staring at the swollen features before him, puzzling, puzzling for some solution of the conundrum, he instinctively reached out and touched the swollen face, noting subconsciously, as he did so, that the pressure of his finger left no dent in the [edematous] cheek.
     All at once, electrically, a terminal vibrated in his brain.  Why didn't the swelling pit on pressure?  Because - now it was his heart which jumped! - because it was not true [edema], but [myxedema].  He had it, by God, he had it!  No, no , he must not rush.  Firmly, he caught hold of himself.  He must not be a plunger, wildly leaping to conclusions.  He must go cautiously, slowly, be sure!
     Curbing himself, he lifted Emrys' hand.  Yes, the skin was dry and rough, the fingers slightly thickened at the ends.  Temperature - it was subnormal.  Methodically he finished the examination, fighting back each successive wave of elation.  Every sign and every symptom - they fitted superbly as a complex jigsaw puzzle.  The clumsy speech, dry skin, spatulate fingers, the swollen inelastic face, the defective memory, slow mentation, the attacks of irritability culminating in an outburst of homicidal violence.  Oh! the triumph of the completed picture was sublime.