ETHICAL CHALLENGES: WHO SAYS YOU’RE DEAD?

You know how you’re not supposed to judge a book by its cover?  You probably shouldn’t judge a book by its title, either. Who Says You’re Dead?, by Jacob M. Appel, M.D., is one of those books with an unfortunate title. The subtitle, “Medical and Ethical Dilemmas for the Curious and Concerned”, gives a much more accurate sense of what the book is about.  I can’t be the only person who sees that title and thinks immediately of Monty Python and the Holy Grail (sort of a cross between “Bring Out Your Dead” and “What Makes You Think She’s a Witch?”, for those of you who are, as I am, serious fans of that silly movie).  And even if your mind doesn’t leap to Monty Python, the title would make you think it’s a book about end of life issues only, maybe depressing stuff about what kinds of things the medical establishment will do to you as you get closer to death.  If those associations keep you from reading this engrossing and fascinating book, then the book needs a better title.

Basically, the book is a series of scenarios, each one followed by a short discussion of the ethical (and in some cases, legal) issues that would help you decide what the characters in the scenario should do.  It’s a very fast read, the chapters all being short and lively, but it could easily provide deep conversations for weeks, if not months. If you’re thinking you could probably guess what the issues he raises are, you’re probably wrong  I was surprised at some of the questions and intrigued by the ethical and philosophical issues raised by many of them. He does talk about the obvious possibilities: a family wants to have a child to be the source of organs for a very ill older child; a person who tells a doctor about a crime he committed but then doesn’t want the doctor to reveal that to anyone; a celebrity who wants to jump the line for an organ donation; a person whose condition can be treated only by a hideously expensive drug; people who want to clone the leader of their cult, and the like. But he also raises some other, less obvious but no less interesting issues: the doctor who had been a criminal before medical school, the patient with a genetic disease who doesn’t want his doctor to tell his family about the nature of his disease, the patient who wants surgery to prevent himself from acting on his darker fantasies, the parents who want growth attenuation treatment for a severely disabled child, the possibility of implanting human neurons in the brain of a mouse, and even more.  Each situation is presented as a question for the reader: should this be allowed? What should the doctor do in these circumstances? Is this something society should encourage?

So many of these questions turn on issues of autonomy and consent, and the discussions force you to think about what the limits of personal autonomy are, how far a person should be allowed to go when it comes to his or her own body, or the bodies of his or her children, at what point the medical profession should intervene and stop a person from taking particular actions.  Can a person make an irrevocable decision about his or her future, as in the case of someone preparing a Psychiatric Advanced Directive refusing, for her future self, any psychiatric drugs? When medical resources and/or funds are limited, how should care be rationed? Should decisions about who gets treated and how be made on a case by case basis or should we set some rules about these tough situations?  Who gets to make those rules?

The issues are heavy and the ethical questions deep and profound, but don’t get the impression this is a difficult book to read. Each chapter is short and to the point, and you could easily read half a dozen or more at one sitting, while waiting in a doctor’s office, for example. The author’s sense of humor sneaks through in the descriptions of the characters in the various scenarios: frequently the doctor involved is someone with a famous name, such as Dr. Kildare, Dr. Strange, Dr. Hawkeye Pierce, Dr. Jekyll, which adds a touch of lightness.  

So ignore the title and pick this book up for a fascinating read, a tour through the more difficult and challenging aspects of modern medicine.

FEBRUARY BOOK GROUP: THE INVENTION OF WINGS

Thanks to everyone who came to the last meeting of the Field Notes Book Group, where we had a vigorous and interesting discussion of Britt-Marie Was Here, by Fredrik Backman. We also chose the book for our February meeting: The Invention of Wings by Sue Monk Kidd. We’ll be meeting on February 15 from 11 to 12:30, and the books will be available here at the library within the next few days.

The Invention of Wings, which was a bestseller and an Oprah book club selection, is a historical novel about two women, Sarah Grimke (an actual historical figure) and her slave handmaid, Handful (also known as Hetty) in the early 19th century. In alternating chapters, Handful and Sarah narrate their lives and their relationships with their families, the limits of their worlds, and each other over the thirty years in which they’re together.  Kidd’s gift for creating characters and bringing worlds to life (demonstrated in her earlier bestseller, The Secret Life of Bees) comes to the fore here, creating a vivid picture of antebellum Charleston, the world of slaves and the world of the more privileged members of that society.

It should be an interesting read and lead to a lively discussion, so pick up a copy this week and then join us in February.

THE ABC’S OF A GOOD NURSE: HOW TO TREAT PEOPLE

I confess to being a sucker for books written by people in particular professions I am unlikely ever to engage in: books about valiant teachers working with students with serious disabilities or handicaps, brain surgeons (one of the best books in that genre I’ve ever read was When the Air Hits Your Brain, by Frank Vertosick), midwives, nurses.  So when I saw How to Treat People, subtitled A Nurse’s Notes, by Molly Case, how could I resist?

Case writes about her training, her work as a qualified nurse, and her family’s experiences with the medical profession.  She’s English, so there are some differences between the health care system she works in and our health care system, and it takes a little while to get used to some of her references (HDU for High Density Unit, which doesn’t seem to have an American equivalent, for instance), but some things about nursing are universal, and most of the stories she tells about her experiences and her patients could have happened anywhere.

From the evidence of her book, Molly Case is an excellent nurse, modest and competent, empathetic and generous of heart. She talks about her first experiences of the death of a patient, her experiences with patients who are suffering from various kinds of dementia, and the whole range of medical problems nurses deal with.  There’s one especially funny story about a patient being prepared for surgery who had interesting metal jewelry that had to be removed (I wouldn’t dream of spoiling the fun of it), and moving stories about Molly’s father’s medical issues and his surgery, which turns her from a nurse to a daughter (albeit one well informed about medical procedures) again. She’s the kind of nurse I would want to have attending me if I were in a hospital.

The book is not organized chronologically. Over the course of the book, you do learn about her childhood, her early training, her family background, but the information is spread out throughout the book, sprinkled among anecdotes about the various aspects of nursing care and her experiences with her patients and other medical professionals. I didn’t feel at all confused by her organization, which follows the order of things nurses check with a new patient: airway, breathing, circulation, disability, exposure.  For each category, she explains why it’s important, how a nurse checks it, a little background of how historically this particular aspect was checked, and then some anecdotes about her experiences with this part of a nurse’s assessment. 

Informative, charming, vivid and moving, How to Treat People is a fine look at what happens on the other side of the hospital bed.

MULTIPLE FUTURES, ALL STRANGE: DEAD ASTRONAUTS

If you’re the kind of reader who wants a straightforward narrative, with characters who remain more or less the same throughout the book, if you want all the questions the book raises to be answered by the end of the book, you should probably not read Dead Astronauts, by Jeff Vandermeer.  However, if you have ever read any other books by Vandermeer (such as the Southern Reach trilogy, which start with Annihilation, a wonderful — but definitely strange — book), you will not be expecting a linear narrative or ordinary characters.  You will be expecting experimental writing, fascinating ideas, plots that circle back on themselves and then turn in a completely different direction, and characters who may not be human in any sense, who could, in fact, be anything.  In that case, you are going to love Dead Astronauts.

It’s a hard book to describe. It’s dystopian, set in a world where, at least at one time, there was an all-powerful Company that, as far as we can tell, more or less destroyed the human population.  There are three characters, one of whom, Grayson, the lone astronaut survivor of a space disaster, is definitely human, the other two of whom can at least appear human. Chen, whose background is kind of opaque, has worked for the Company in the past, and has joined with the others to take down the Company in at least one timeline. Moss is a still more interesting character, a shapeshifter of extraordinary abilities, possibly created by the Company.  Moss has chosen to take on a human shape to be with Grayson, though Moss is willing to try different forms to destroy the Company.

The three of them have been fighting against the Company endlessly; they are always defeated, but they come back repeatedly in the hope of finding the right combination of circumstances, the right version, in which they can actually defeat the Company.  There are recurring creatures they encounter, the duck with the broken wing, the blue fox, the Leviathan, and over the course of the book we come to learn the backgrounds of those characters (sort of; there’s a certain stream of consciousness narration in some of the stories of the other characters), and get a sense of how all these creatures work together and why they do some of the things they do. 

Vandermeer has a terrifying imagination.  There are certain things in this book — the wall of globes, the dinner at the secret garden — that will haunt my dreams for some time (I’m not going to go into more detail; when you read the book, you’ll see what’s so appalling about those particular scenes).  While the book is set in the future, many of the terrible things happening in the book grow naturally out of things we are already seeing (only magnified and extended).  

The book can be challenging to read; there’s one chapter which consists of two sentences, repeated for pages (the sentences are : “They killed me. They brought me back.”), and another in which one paragraph about the joys foxes enjoy when there are no people is repeated for pages (with a variation stuck in the middle, so you do have to pay attention).  There are pages with one paragraph each, there are places where the typeface clues you in as to who’s telling the story (that’s another of the stories in the book that haunts my nightmares) and what it’s about. You have to pay attention. You have to be willing to let go of preconceived ideas about what a book looks like or reads like.

It’s worth it.  The ride is rocky and disturbing in places, but you come out of it with a sense of a vivid, terrible future, yet with some small sprinklings of hope.  

NEW YEAR, NEW READING CHALLENGE

Once again we’re facing the beginning of a new reading year, and how better to expand your reading horizons than to join with us in the 2020 Field Library Reading Challenge?  This year we’re going to try to keep it simple: 12 categories, one for each month, some pretty easy to fulfill, some a little more challenging.  If you’re interested, just let me know and I’ll sign you up.  Then each month you’ll get a list of the books that qualify for a particular category, and the lists will also, of course, be published here on the blog.

Ready to join me?  Here’s the challenge:

2020 READING CHALLENGE READING LIST READ THE FIRST BOOK IN A SERIES READ A BOOK ABOUT U. S. PRESIDENT (S) READ A BOOK ABOUT HUMAN BIOLOGY OR HEALTH READ A BOOK SET IN NEW YORK OR BY A NEW YORK AUTHOR READ A

See you on the other side, and all along the way!

 

THE BEST BOOKS OF 2019, AS FAR AS I’M CONCERNED

This is the time of year when everybody’s putting together their “best of 2019” lists, so who am I to buck the trend?  Many of these lists run to 10 or even 20 books, but I’m only limiting my selections to (a) books I actually read during 2019, (b) books that were published during 2019, and (most important) ( c) books that stood out, that I really, really liked.  Most of the books I’ve written about this year are books I’ve enjoyed (I’m not one of those people who likes to write bad reviews of anything), but the ones I’m listing here went above and beyond and stick with me months later. Your mileage may vary, of course, but these are my top choices.

NONFICTION

Yes, I do read nonfiction, and even write about it sometimes. There were two nonfiction books this year that really stood out.  These are not listed in order of importance or quality; as far as I’m concerned, they’re equal.

The Five: The Untold Lives of the Women Killed by Jack the Ripper, by Hallie Rubenhold, is the kind of book that turns accepted history on its head.  How many books are there about Jack the Ripper, speculating about his identity, luxuriating in the details of exactly what he did to his victims and when?  This is the first I’ve seen that focuses instead on the victims, the women who just happened to be in the wrong place at the wrong time, and the author does a terrific job of bringing them to life for us, challenging the standard story that he was killing prostitutes by showing us that most of them weren’t what we would call prostitutes.  What they had in common was poverty, and poverty in Victorian England was often a death sentence for women. One of the best things about this book, in my opinion, was the way the author brings you through the woman’s life up until the moment before she’s killed, skips the details of how she was killed, and then looks at the aftermath for her friends and family. If you were reluctant to read this book because you were afraid of violence and gore, don’t be. It’s not that kind of Jack the Ripper book; it’s much better.

Midnight in Chernobyl: the Untold Story of the World’s Greatest Nuclear Disaster, by Adam Higginbotham, is another of those books that tells the story of something you think you already know, and illuminates it in ways you couldn’t imagine.  This is probably the most terrifying book I read all year, made all the more chilling because every detail of it is verified and documented. Reading this is like watching the kind of horror movie where you’re screaming at the screen for the characters not to do what you know they’re going to do.  There are descriptive passages that H. P. Lovecraft would have given his eye teeth to have written; there is suspense the likes of which the best thriller writers would envy. It is appalling and vivid and terrifying and one terrific read.

FICTION

Every year there’s at least one book I recommend to everybody I encounter at the library.  This year, that book was Hollow Kingdom, a debut novel (amazingly) by Kira Jane Buxton.  When I describe the book to people with one sentence, I tell them it’s the zombie apocalypse as seen through the eyes of a domesticated crow named S.T. (the initials stand for an obscene description of the crow by his human), and I can see people turning off at the thought. Trust me, though, it is not your typical zombie apocalypse.  For one thing, nobody uses the Z word. For another thing, our main narrator (there are multiple narrators for brief parts of the book, almost all of them animals, giving us different insights into what’s going on worldwide) is such a vivid character, funny and touching at the same time. For another thing, what’s going on with humans (called mofo’s in the book; this is what S.T.’s human, Big Jim, used to call people) is only a small part of the book. Human beings are being destroyed and destroying things, but the focus of the book is how the animals who survive are creating their own world without us.  I have to confess, there were times during my reading of this book that I had to stop because I was so moved, not just by the fate of the humans, but by S.T.’s sorrow and longing for human beings. The book has everything: humor, tears, adventure, thought-provoking reflections, characters you care about deeply, and even a satisfying ending (it’s not necessarily the ending I would have chosen, but it works and it’s satisfying). Keep an eye out for Kira Jane Buxton: judging by this book, she’s quite talented and packs quite a punch.

And yes, in any year in which Jo Nesbo publishes a Harry Hole novel (not frequent enough for my taste), you know I’m going to pick his book as one of the best of the year.  This year his book was Knife, and as one of my co-workers remarked, nobody has ever seen me get so excited about a knife before.  Jo Nesbo is a fiendish writer, and, despite his undue cruelty to his main character, his plotting is better than ever.  If you’re a fan of these dark and enthralling books, I don’t need to tell you anything other than that there’s a new Harry Hole book; if you’re not a fan but you’re interested in dark thrillers that take you by the throat and keep you frantically turning pages till you reach the end, you should start at the beginning of the series and check Nesbo out.

And here’s to all the good books we haven’t yet encountered in 2020!  Happy reading to us all!