Monday, April 27, 2015

Being Mortal by Atul Dawande

Being Mortal
by Atul Gawande
5 stars - well written and informative

Everybody dies. Everybody. It's the only certainty of the human condition. And yet, it is the very aspect of our existence that is talked about the least. No more so than amongst family members and the medical community. 

So let's talk about it.

Dr. Gawande is a surgeon at Boston's Brigham and Women's Hospital and the author of several previous books focused on how to improve the care given by medical professionals. In this book he tackles the end of life. Whether it comes gradually due to the wearing out of age or unexpectedly due to disease. In either case, talking about what can and cannot be done, what should and should not be done is critical.

The first part of the book discusses options for senior citizens, some good, some bad. Nursing homes, assisted living, in-home care. The second half focuses on terminal illness in people of all ages.

Throughout the book, Dr. Gawande gives specific examples of how to have important conversations. He discusses finding a way to allow people to continue to be the "authors of their lives" regardless of circumstances. By that he doesn't mean total freedom, but rather to identify the specific aspects of a person's life that has value to them. It even means freedom that might include risk of injury, but that also provides a quality of life, as opposed to just existing. 

Three questions that he asks patients repeatedly;
  1. What are your biggest fears and concerns?
  2. What goals are most important to you?
  3. What trade-offs are you willing to make and what ones are you not?
The medical community is woefully unprepared to handle an aging population or to assist end of life decisions. Medical programs offer, at most, one class on geriatrics and possibly a lecture on end of life. Dr. Gawande is an advocate of making end of life education a more prominent part of every doctor's training.

My 84 year old mother gave me this book. She told me to read it and then we would talk. It made me realize how little I understood about her wishes at this point in her life. That, despite the fact that I am her medical proxy. I will have that conversation, and soon. Does it make me sad? Yes. Do I want to talk about it with her? Nope. But if I do, if we are clear with each other, then no matter what the future holds, I can be confident that I am helping her have the life that she wants for as long as she can and that's a good thing. That's a gift we all need.

Saturday, April 25, 2015

Revolutionary by Alex Myers

by Alex Myers
5 stars - almost late for work finishing up, just couldn't stop reading
ALR Blue - some calvary horses in battle, but nothing graphic

Revolutionary is a fictional account of the time historical figure, Deborah Sampson, spent as a soldier in the Revolutionary Army of the United States. 

If you want some background on Deborah Sampson, check out this link.

In her early twenties, Ms. Sampson is looking at a rather grim life. She comes from a poor family and has served as an indentured servant and is now a weaver of cloth. But the world frowns on a woman making her way on her own and she is viewed as a rather unsavory character and her circumstances invite ill treatment, from men and women alike.

She longs to be free and so she borrows male clothing and, under the name Robert Shurtlieff, signs up to serve in the Revolutionary army. She's able to carry out the deception and does her duty with diligence and bravery.

Alex Myers is a gifted author. He combines just the right blend of adventure, history, and observations on the lines we draw between men and women to keep this reader hooked throughout. His characters are rich and conflicted about the war, their lives, their loves.

While much has changed regarding the freedom of men and women to express their true natures, we continue, even in this country, to slot people into "appropriate" roles. Every time I go shopping to pick out toys or clothing for my two grandsons, I despair over the sorting, from infancy on, of items into "for boys" and "for girls." Nowhere is this more apparent than in the clothing department where the girls' department is overrun with pink and lace and the boys' choices are limited to drab colors and conservative cuts. 

And we still struggle with behavior issues. In the workplace, authoritative women are often viewed as "bitchy" and empathetic men as unable to lead. 

And now, a confession. When I was a child, I yearned to be a boy. Not because I wanted a penis or to date girls, but because, growing up in the sixties and seventies, it was clear that my nature would be more acceptable if I were male. Not just that, but I saw the opportunities granted to boys that were withheld from girls. It wasn't until I was in sixth grade that girls were even allowed to wear trousers to school. Prior to that, skirts and dresses were mandatory in public school and any deviants would be sent home to change. Ugh. 

I'm keeping my fingers crossed that Mr. Myers has another novel in the works. It would jump to the top of my reading queue in a flash. 

Tuesday, April 21, 2015

The Year They Tried to Kill Me by Salvatore Iaquinta

The Year They Tried to Kill Me
by Salvatore Iaquinta, MD
5 stars - let's just say, good thing I read this on my day off because I couldn't stop once started
ALR Blue - all people

YES! What a wonderful book! I'm considering keeping it for my collection (I had to buy it as it was not in the library network). Of course, I could donate it and then take it out again later, maybe, we'll see.

Anyway, what's it all about? The Year They Tried to Kill Me is Dr. Iaquinta's memoir about his first year of surgical residency in Oakland California. Sleep deprivation, goofy patients, goofy doctors, odd ailments, it's all there. Also some sad stuff.

What makes this work is Dr. Iaquinta's writing style. Sure, we learn a lot about how residency programs work and even a little about surgery, but we also learn about how it feels to be in the middle of all that and how patients can make doctors feel. 

Sure, you want your surgeon to be God, right? But at the end of the day, he or she is a human being. A human being who sometimes laughs at inappropriate jokes, gets impatient, fumbles, and, most of the time, gets things right.

Here's a nice tidbit to give you an idea of the style. Dr. Iaquinta is describing his response to one of the senior physicians.

Franklin continued to try and burrow under my skin. Whenever he admonished Evan and me, he focused only on me. I think he wanted me to shoot my mouth off so he could let loose a satisfying berating. But I didn't give him that pleasure. Instead, I learned to look at him blankly with my mouth hanging open as if I were too dumb to know how to breathe through my nose. I ensured that I looked like an idiot by not blinking while also focusing my eyes a foot behind him.

Hey! Has this guy been studying me? That's the same way I treat doofus heads at work. 

On his first laproscopic surgery:

I couldn't believe the fools were letting me do this operation. Sure, I'd been through medical school, but I'd never practiced sticking long instruments into a patient's abdominal cavity. One wrong move and I could poke into their liver or perforate their bowel. That would end the fun real quick for both of us.

There are some serious moments, too. Never fear. It's clear Dr. Iaquinta cares about his patients. He frets when he can't help or worries that he might have made a wrong decision. He's also honest about the toll residency takes on one's personal life. 

Final note. This book is self-published, so buy it, OK? Maybe if he sells enough copies he'll get the attention of a publisher and be encouraged to write some more. In the meantime, you can like his Facebook page here

Monday, April 20, 2015

Soldier fo Change by Stephen Snyder-Hill

Soldier of Change
From the closet to the forefront of the gay rights movement
by Stephen Snyder-Hill
4 stars - 5 for content, 3 for writing style
ALR Green - Snyder-Hill loves his dogs

Captain Stephen Snyder-Hill. U.S. arm officer. Veteran of the war in Iraq. Homosexual.

Soldier of Change is Snyder-Hill's story, told in his own words, of growing up gay and serving as an army officer during "Don't Ask, Don't Tell" (DADT). It's a complex and hopeful narrative. Prior to DADT, an individual discovered to be a homosexual would be immediately dismissed from service. After DADT, things became worse in many ways as fellow servicemen and women would use every trick in the book to "out" individuals. 

It's a story about the constant fear that plagues members of the LGBT community. Who can I come out to? Who will wish me harm if they know? And while we've made significant strides towards equality for all people in the United States, it still isn't free and clear. At one point, Snyder-Hill ponders how things would be somehow easier if there were just a "Homosexual" sign on his forehead. At least that way, the haters would hate on first meeting.

As a long time ally of the LGBT community, I found this book to be a good reminder of the responsibility I have to continue zero tolerance for remarks and actions that target this group. That means saying something when there are off-hand remarks made, no matter who makes them. I find this to be something I have to do more often than I'd like in the workplace. Despite all the tolerance training mandated by my company, there are still comments made that make my hair stand up and I don't let them pass. Nor should anybody. 

There's a lot of good information in this book and Snyder-Hill seems like a nice chap. I did, however, deduct a star for a somewhat clunky writing style. That's OK. Still worth reading. 

Saturday, April 18, 2015

Trapped Under the Sea by Neil Swidey

Trapped Under the Sea
One engineering marvel, five men, and a disaster ten miles into the darkness
5 stars - a non-fiction tale that reads like a thriller
ALR Blue - no animals

Boston Harbor. Once the dirtiest harbor in America, now a poster child for the importance of large scale environmental projects. Except for, well, things did not go without any hitches.

When Doug MacDonald took over the MWRA (Massachusetts Water Resource Authority), the Deer Island waste water treatment project was already behind schedule and over budget. When large government contracts total in the millions or billions of dollars, failure to meet the schedule affects the entire community. In this case, the community being the Commonwealth of Massachusetts, whose taxpayers were shouldering the expense of the massive harbor clean up project.

Trapped Under the Sea tells the story of the final stages of the project. A ten mile tunnel has been dug under the harbor. It's a dead end tunnel which will ultimately channel treated waste water out and into the sea where it can dissipate without causing the pollution which plagued Boston for so long. The tunnel has been dug and all that remains is removing the plugs from the pipes through the ocean floor which will ultimately serve as outtake. 

But how to accomplish it? With the light and ventilation systems already removed from the tunnel, there is no breathable air. The tunnel itself, while large enough to accommodate a vehicle for the first several miles, chokes down progressively to about ten feet in diameter, and the plugs themselves are at the ends of pipes a mere 30 inches in diameter.

The Deer Island waste water treatment facility is an engineering marvel. Almost in spite of the missteps along the way. This is a cautionary tale about the implicit danger in big, low bid government contracts. So many hands touching the project. Who is ultimately responsible for the safety of the workers? How much risk will a "working man" be willing to take just to put food on the table? When things to wrong, who is left holding the bag?

When you read this book, and I hope you will, don't just think about government contracts. Think about big business. Think about the next time you get competitive bids on a home improvement project. Because once you are locked and loaded, that low bid might not seem like such a bargain anymore. 

The prose is on the edge of your seat type stuff. Mr. Swidey did his homework and one is readily transported into that tunnel. There's plenty of information about the major players, how big contracts work, OSHA, oversight, professional divers, and the aftermath of when things go wrong.

His Epilogue is, perhaps, the most important part of the book. I won't spoil things for you, but he sums up what happened and how human nature can work against the greater good. Here's my favorite quote:

The more people do something without suffering a bad outcome, the harder it becomes for them to remain aware of the risks associated with the behavior.

Sunday, April 12, 2015

Duel with the Devil by Paul Collins

Duel with the Devil
The story of how Alexander Hamilton and Aaron Burr teamed up to take on America's first sensational murder mystery
4 stars - a little history lesson that goes down smoothly
ALR Blue - no animal characters

It's the turn of the century, to 1800, and America is a young country just finding its way. New York City is a mess. Lack of clean water causes annual plagues of the deadly yellow fever, police are mostly thugs, and politicians and businessmen are duping the public. 

The court system, such as it is, has little notion of fair trial for murder and other extreme crimes. With no such thing as police detectives or procedure, most crimes are tried based on hearsay and circumstantial evidence alone. The death penalty is the punishment of choice. Prison is equally deadly.

Enter one corpse discovered in the early days of 1800 down a well which was dug and abandoned by the bloated, corrupt corporation in charge of bringing clean water into the city. Alexander Hamilton and Aaron Burr are rising legal stars. They decide to take on the trial of the accused murderer as his defense team and set to making history.

Well, things haven't changed much. The Internet, my friends, is not responsible for crazed mobs acting on their version of the truth prior to, during, and after high profile trials. The notion that the hapless carpenter who stands accused might, perchance, actually be innocent, is not one that the masses consider. And so we have an entire city riveted on what is transpiring in the courtroom.

It's fascinating stuff and very well written (well, what else would you expect from NPR's Literary Detective). In addition to the trial itself, the reader is offered a rather unsavory look into the machinations of a young America. Let's just say I've got no desire to teleport back to early nineteenth century NYC. Yuck.

Friday, April 10, 2015

Life After Life by Kate Atkinson

Life After Life
by Kate Atkinson
529 pages
3 stars - uneven
ALR Green - some dogs come and go in minor roles

On a cold and snowy night in 1910, Ursula Todd is born, the third child of a wealthy English banker and his wife. She dies before she can draw her first breath. On that same cold and snowy night, Ursula Todd is born, lets out a lusty wail, and embarks upon a life that will be, to say the least, unusual. For as she grows, she also dies, repeatedly, in any number of ways.

Things started out pretty well. Ursula is born, she dies, she is born again, she lives, for a bit, then she dies, then she is born again, lives a little longer, etc. That was all very cool. In fact the first half of the book was great. We see Ursula get further along in life every time. Her ability to survive is hinged on the tiniest of decisions or, sometimes, a quirk of fate. I liked that. The reader gets to ponder how the smallest breath of wind can somehow alter the path of life in significant ways. Change one thing and everything changes.

As the author keeps rewinding Ursula's history, we get to see both the richness and arbitrariness of life. She is born in 1910 which means that as her story progresses, World War II breaks out and viewing the war from all sorts of angles was an interesting exercise.

Sadly, Ms. Atkinson loses the rhythm of the story somewhere after the midpoint. The chapters between life and death increase in length until the book completely bogs down in a 100 page chapter that abandons the original concept. I was plunged into a less compelling story about Ursula's doings in London during the height of the war. No more dying, just living.

Too bad. Still, three stars because I think it's worth a read. That said, watch out for the ending. Of all the ways the book could have ended, I would have never guessed the ending Ms. Atkinson selected and it was disappointing. 

Wednesday, April 1, 2015

Honor Bound by W.E.B. Griffin

Honor Bound
by W.E.B. Griffin
3 stars - kind of a 1950's style vibe
ALR Green - no animal characters

Wow! This guy sure writes a lot of books. Yet, this is the first of his works that I've read (at least that I remember).

So this was pretty good. Not sure if I liked it for the story as much as the style. It reminded me a lot of other books I've read that were written in the 50's (yeah, this was written in the 90's, but that Griffin guy was born in 1929 so he's kind of old school). So maybe it made me nostalgic in a weird "books I read as a kid" kind of way. Forget about women characters. It's all about the guys, with women pretty much as objects of desire and not much else. In fact, forget about character development in general. We're mostly here for the plot, right? That's OK as long as your expectations are set appropriately.

The point is the story. It's World War II and those Germans are up to no good all sneaking ships into neutral Argentinian waters to restock their Nazi subs. Time to call in the Marines! Just three of them. That's all you need. Hoorah for the Americans! Three Marines are picked to go undercover into Argentina with the mission of blowing up the supply ship. Ka-boom! Causalities not important. Naughty bad guys. 

But how to accomplish their mission? Who can they trust? To make matters worse, there are Nazis hanging out in Argentina. What? Yup, just one or two sent to bring home the body of an Argentinian pilot who was flying around over Russia and got shot down. Oh, and maybe to do a little spying of their own. And those generals and other high ranking Argentinians. Like whose side are they on anyway? Watch out!

You get the picture.

It's funny how you learn about books. I was in a conversation with a couple of guys at work, one of whom is from Bolivia and has a Germanic name. That got us to talking about Germans in South America during and after World War II which got one of the guys talking about some books he read about just that topic. So there you go. 

EPIc Dog Tales by Dorothy Wills-Raftery

EPIc Dog Tales
by Dorothy Wills-Raftery
available from Arctic House Publishing
5 stars - Oh yeah!
ALR Green

Dorothy Wills-Raftery has long been a champion of dogs with epilepsy. This magnificent book represents the culmination of her work collecting stories of dogs with epilepsy from around the world. The final result is beautiful and will touch the heart of any dog lover.

Each two page spread has photos of an epi dog along with words about the life of the dog. Canine epilepsy is, tragically, quite common and there is as yet no marker to determine genetic predisposition to seizures nor any guaranteed treatment for them. 

While some owners and their dogs will struggle, sometimes in vain, to fight the disease, others manage to survive and prosper. Treatment is typically via trial and error and the drugs can have devastating side effects.

I strongly recommend this book to anybody whose life has been touched by the companionship of a dog. Epilepsy itself is secondary to the words and photos which tell stories of our human / dog bond. 

My Mango, Relentlessly Huge, has his own two page spread and his section is written in Mango's own words. You know it! Heck, you should buy the book just for that!

Right now, the book is only available directly from Arctic House Publishing. That's cool, because a portion of every sale goes to research into canine epilepsy. Consider this as a gift to yourself or to somebody who just likes reading dog stories. I bought a copy to give to my vet to have on hand for clients whose dogs are suffering from seizure disorders. It's all good.