When Breath Becomes Air – Paul Kalanithi (2016)

I had an amazing read of Paul Kalanithi’s autobiography called “When Breath Becomes Air.” Kalanithi was a young surgeon (aged 36) and in the final year of his neurosurgical residency when he received the troubling diagnosis of terminal lung cancer. He had none of the risk factors for this cancer, so it was totally out of the blue and arrived right at the time of his life when he’s just about to finish the arduous training and begin his “real” life of being a surgeon. He and his wife are both physicians so they know what the CT scans show, and when they hear that Kalanithi has about one year to live, what to do, what to do.

And so this short but powerful read is a meditation on what life means, both philosophically and in real life: Kalanithi is a philosopher as much as he is a surgeon and so this reads as more of an existential meander through those final months. It’s got the medical stuff in there, as well, but it’s more of an intellectual journey than you would expect, and though I am not well-versed in the old serious thinkers of yore, it was still an educational ride through this sad time.

As Kalanithi has received this terminal diagnosis, what does that mean for him (apart from the physical process of dying)? He mixes intellectual thought with thoughts of a more pragmatic nature (Which treatment should he have? Should he even attempt treatment at this point? What about having a child with his wife?), and so it’s a very thoughtful book best read slowly so you can digest what is being said.

Highly recommend this title if you’re a fan of physician authors such as Abraham Verghese or Atul Gwande – this is the same genre but a less straight-forward read due to philosophical questions Kalanithi addresses. This one definitely makes you think. (Or it did me, at any rate.)

Sorry for absence!

I was suddenly laid to waste by the flu.

Normal service will be resumed soon.

Thank you for your patience.

:-}

The Death of Ivan Ilych – Leo Tolstoy (1886)

I dug this title up as it was mentioned in my recent read of Gawande’s On Mortality book, and I’m all about following down the rabbit holes of different books and topics sometimes. Although somewhat intimidated by Russian authors (although not sure why), I picked this up with trepidation and then relaxed. It was going to be a good read.

Gawande’s reference to this Tolstoy novella meant that I knew that the plot was about a man dying, but the actual details were vague for me (which I was happy about). I opened the book one morning and then finished it that evening and it was a great read. The plot itself is pretty simple: a man works hard in his career, gets married with kids, falls off a ladder and gets slightly hurt, and then ends up dead. (And I’m not giving the game away here. This is what the story is famous for, after all.) However, it’s a lot more than that as Tolstoy (via his lead Ivan Ilych Golovin) ruminates on the process of dying and how it may affect one’s thinking.

Young Tolstoy.

Ivan Ilych has done all the “right” things in his life, he feels: he has worked hard on his career rising in the legal ranks of the municipal court, he has married well, and has a good family. So why is he so uncomfortable dying in this way? And that’s what most of this work is about – how the dying process evolves for both the participant and the family around him. It’s really quite fascinating especially after that recent read of Gawanade’s book (which also focuses on death and dying). Sounds desperately morbid (doesn’t it?) but it’s not. This dying thing happens to everyone, and as with almost anything else, the more you know the better. (At least that is how I’m approaching things).

Using the POV of Ivan Ilych himself, the story follows his thinking process as his life winds down. His pain in the side (originally triggered by that fall at home) worsens, and as it progressively gets more and more painful, he visits a few doctors trying to get his diagnosis. However, the doctors are unable to agree and give him a final diagnosis (let alone a cure) and so Ivan struggles on, unable to talk about his concerns about dying with no one, not even the medical professionals and let alone with his family.

And I find this to be so relevant with attitudes towards death today. I’ve noticed that when one has a difficult illness, people usually don’t mind acknowledging it at first when everything is mostly normal, but as time progresses and one’s prognosis worsens, many people would prefer to talk around it than actually address it face on (a la elephant in the living room). This is how Ivan Ilych’s family and friends handled the situation, and so the reader learns about the frustrations, struggles and the sheer loneliness of the person who’s doing the dying. I really don’t think that this is an untrue situation for a lot of people, but I wish it wasn’t that way.

Gawande mentioned that this novella was taught in med school in a class about death and dying, but I’m not sure how common that is across the nation. (Anyone know?) However, common or not, I think this is an excellent novella about a very common natural human process which is frequently denied or skirted around as people are uncomfortable with it (for whatever reason).

A provocative read about a pretty ordinary guy who is going through a totally natural process and who is reflecting on his life lived. Although the subject may be dark, this is extremely well written, not maudlin at all, and is a good demonstration of something that happens but most people would prefer not to talk about. It was an excellent read when paired with reading the Gawande book. Recommended.

 

The Secret Life of the Grown-Up Brain – Barbara Strauch (2010)

A random pick off the TBR shelves on the topic of learning/creativity type info triggered by the TEDx conference the other day, this was an enjoyable read about the myths (and truths) of the middle-aged brain. I have just turned 50 on my last birthday, and normally my age never crosses my mind. I consider chronological age to be irrelevant for the most part and an artificial limitation for some things, so I didn’t expect to be so curious about turning fifty. The age (and the birthday) have, for some reason, triggered some growing and changing that I had not expected and so this has been eye-opening in many ways. (And it’s not only me, it seems. From talks with friends, turning fifty does do something to you, although it varies how that manifests itself in life.)

Strauch is the medical and science editor for the NYT, and so knows how to write great journalistic stories, and this one seemed to be one of those books that one reads at just the right time.

In the U.S., aging seems to be a culturally negative thing in general and the common assumption seems to be that aging means losses of some kind: your friends/family die/move, you get stiff, you have more medical problems, it’s harder to learn stuff, you forget everything and you’re THAT much closer to developing dementia and/or dying. Suddenly, there are all these “Over the Hill” birthday cards (black for the oncoming funereal process), and AARP sends you a membership card and the next thing you know you’ll qualify for the Senior discount at Furrs and have supper at four in the afternoon.

(I’m not saying that everyone views it like that or that that is how I approach the aging process, but it doesn’t seem to be welcomed or viewed as a time to bloom, shall we say.)

Strauch’s book authoritively turns all this on its head, which was fun to read and backs it up with research. The first half of the book covers the various research studies that have proven that the middle-aged brain does not die off and that forgetting what you watched on TV last night is not a sign of oncoming dementia for most people. It’s a little too rosy in places for me and a little bit heavy on the cheerleading, but it’s also fascinating to read about the possibility of neurogenesis (growing new brain cells) and learning to focus on the strengths of an older brain.

So yes, we can forget the reason we went to the kitchen very easily, but older brains also are much better at looking at the whole picture of something (a debate, the long-term effect of something, the overall view) and additionally, middle-aged people have been found to have better control of their emotions that people in their 20’s. (Seems true in my experience for the most part.)

Some of this ability to see the bigger picture is due to having years of experience (so it’s easier to see how things fit in long-term), but it’s also linked to education. Loads of studies show that the more education that one has the lower your risk for (or the higher your resilience to) Alzheimers, so learning is good especially as you get older. (Love that.) It’s also easier to see the connections between disparate topics as you age which refers back to seeing the bigger picture more clearly.

And yes, it’s true – middle-aged brains do tend to get more easily distracted at the start of a project (“Squirrel!”) and to forget things (such as names of people). Strauch explains that this forgetting process is more of a retrieval problem than a disappearing problem – the names are there (tip of the tongue type thing). We just have to take a little more effort to get that information than we would when we were younger — just need to access it slightly differently, it seems. And we’re more likely to forget the names of people who we don’t know that well and who we haven’t seen for ages – makes sense to me really.

As for how to engage your middle-aged brain and keep it sharp and growing, Strauch (backed up by the researchers that she interviewed) is a huge proponent of exercise (i.e. regular aerobic exercise) as this has been found time and again as the only way for your brain to have neurogenesis (i.e. grow new brain cells). There’s been an age-old argument about how your brain stops growing once you’re older and it only shrinks etc. That is really not true, and Strauch has the research conclusions to prove it.

Besides, why wouldn’t you exercise? (It’s easy for me to say this as I’ve been regularly exercising since I was about six, so it’s like brushing my teeth – it doesn’t feel right if I don’t do it almost every day. I know it’s a big effort for others, but it’s so worth it that I wonder why a lot of people don’t. It’s free, generally (walking etc.), it improves almost every facet of life, it’s pretty simple… What’s not to like?)

So – I enjoyed this book for a number of reasons, but mainly because it backs up the lifestyle choices that DH and I have chosen for ourselves – regular aerobic exercise, continually learning new things, and challenging ourselves both physically and mentally. (Not all the time, I hasten to add, but the book did help us to feel good about how we live.)

Perhaps that is why I really enjoyed the book – that it supported how I think and live. It’s always nice to be told that you’re doing the right thing.

* One thing that I have decided to stop now that I’ve turned fifty (and it’s not a particularly mature thing to do) is admitting that I really hate eating raw broccoli and don’t eat it any more. Vile weed that it is. My rebellion comes in baby steps at times. :-)

Swabbing the decks…

Sometimes one needs to just swab the decks and catch up with posts, and this is what this post is. Several reviews for books that I have read recently, but for some reason or another (and not a fault of the book at all), I haven’t put together a long review for them. These, then, are the micro-reviews of some recent reads.

Happier at Home – Gretchen Rubin (2013) 
Rubin’s second happiness-related book, this one focuses more on the home front as opposed to her more general subject of her previous book. I enjoy her blog and like how she melds in philosophy, history and other subjects with the subject of happiness – she is pretty thoughtful and I appreciate her enthusiasm for life. (It’s not bossy or OTT which I like.) So, this one is more focused on how to appreciate life at home a bit more and so each chapter has a focus on a different aspect of that ranging from de-cluttering to getting stuff done. It’s not new or cutting edge info, but I enjoyed how she organized the info and she’s a good writer. She has a big emphasis on “noticing the little things” in life, which I agree with, and so I enjoyed this read. It’s more of a reminder about things than new info, and she seems to enjoy a pretty privileged life overall – however, that doesn’t make the info that she relates invalid. She’s received criticism from just repeating a lot of what she wrote in her first book in this one, but as I haven’t read that one, I didn’t get that.

How to Disappear Completely: On Modern Anorexia – Kelsey Osgood (2013)
Osgood takes a close examination of eating disorders (and especially anorexia) here, with the twist of her criticism of how society tends to veer from “condemning the victims to canonizing them”. She focuses on the way that anorexia, as an illness, has evolved over time, and how certain girls (and young women) are attracted to the shiny veneer of the disease even whilst knowing about the potentially deadly consequences. It’s a complicated argument, but I agree with it. Developing anorexia can be insidious, and a portion of that patient population are totally swallowed by the “image” that anorexia has, an image which can be sustained by the numerous pro-ana websites out there which read like a how-to manual. Osgood argues that to destroy anorexia, we must remove the glamor from it: the media coverage of eating-disordered celebrities, the lists of symptoms that proliferate and offer themselves (unwittingly) as guidelines and goals for young girls searching for an identity. It’s a fascinating argument, and I mostly agree with it.

As the author writes, “To destroy anorexia, we must devalue its currency… and leave the salacious and profitable details for the medical professionals.” It’s true that western society tends to value thin-ness in people (especially females). It’s also true that it can be competitive, diagnosis-wise, within the mental health patient population itself if you’re in a rehab type environment. (“How many diagnoses do you have? Oh, I have this many…”) Osgood also makes the point that rehab places (for anorexia patients) should not be like spas. It’s true that some are not, but some of the more high-end places are like resorts with horse-riding, acupuncture, yoga and world-class chefs. Why on earth would you want to get better if you’re in a place like that? Not that health care should degrade back to workhouse standards, but I do think that within certain groups, there is a certain panache linked with how many times you’ve been to rehab and which ones and there is pride in being a particularly complex case.

This was a provocative book on many levels and may cause unrest in the therapy world. But it’s a discussion that needs to happen.

The Great Filth: Disease, Death and the Victorian Life – Stephen Halliday (2009)

” The greatest achievements of the Victorian era was…to accept that national and local government had a responsibility for the health, education and welfare of citizens, as well as for defense against foreign invasion and domestic justice…”

As you may already know, I am a Fangirl of Victorian social history, and so this was quite a good read. I especially enjoyed and appreciated the slightly different slant that Halliday used here – instead of most of it being about doctors, this covers a lot of the public health improvements in London (and elsewhere) were due to the diligent efforts of civil engineers and architects, as well as mathematicians and others.

This title covers both the famous and infamous of Victorian medicine – the discovery of the infected well water during an epidemic (Snow et al.), the acceptance and training of midwives, the realization of good hygiene between doctor and patient, the glacial acceptance of germ theory as opposed to the miasma theory – the topics were really interesting to me (especially when considered in the light of our recent visit to the Hunterian Museum in London ).

Some of the theory behind medicine at that time is startling to the modern eye in places. Not washing one’s hands between patients? Eeuw. There was more than one cholera outbreak during the nineteenth century, one of which occurred in 1832. As medical theory at that time did not conceive of germs being in the water (as opposed to the air)*, the London Board of Health came up with the following recommendations for its citizens to prevent cholera transmission:

* Consumption of large amounts of roast beef (assuming you could afford that)
• Poorer people should eat loads of potatoes and stale bread (the mold was thought to have healing powers)
• Avoid excess fruit and vegetables (obviously not washed and cleaned at this time)
• Finally, use brandy, laudanum, ammonia, sulphuric acid for treatment/prevention and…
• Apply mix of hot bricks and boiling water to the affected areas (Yikes)

When Victorian people became ill, there were very few options with which to treat them regardless of how old you were: “Lying-In” hospitals came to the fore where pregnant women would confine themselves to wait for their oncoming birth. (Thus, the use of the word “confinement” as linked to pregnancy. Just saying anything to do with a bodily function would repel well-bred Victorians for the most part.) In fact, if you were pregnant, you sort of hoped that you wouldn’t be put into one of the maternity hospitals as the mortality rate of both mother and child were significantly higher in them than outside.) Midwives were available, but had no formal training (apart from helping at other births, perhaps), and the doctors were initially opposed to formalizing the midwife profession fearing it would take money from their side of the equation… (The more things change…)

Anesthesia was also quite a new technique, but it also increased the infection rate of the patients involved. Before anesthesia, surgery was very painful but very quick. After using anesthesia, the surgeons could take more time and care to be accurate while wielding a scalpel but the longer exposure of open wounds to the polluted air (and environment) also meant that death rates would increase for a while. Joseph Lister was the guy who helped to introduce the necessary steps in anesthesia and hygiene that would bring this death rate down. (BTW, Queen Victoria was one of the first women in the UK to ask for anesthesia during the births of some of her children. After that, there was a big trend for it, of course, when patients could afford it.)

Joseph Bazelgette, a civil engineer, was instrumental in improving the drainage in London and its surrounding areas, and in fact, when you walk along some of the embankments next to the Thames, you are walking on top of the great Victorian drains that he designed and that made such a big difference to the public’s health at that time.

“…the principal role in preventive medicine was taken, half knowingly by civil engineers…”

So, as mentioned briefly, there was a ton of good info in this book. However… (Now, I realize that this could sound nit-picky, but it still affected my reading experience nevertheless.) Halliday used different references whenever he referred to a male or female person who had played a role in this history. Men were first mentioned with first name/last name format, and then referred after that by last name only.
Women were first mentioned first name/last name format, but then referred to after that by their first names only. (So – Louis Pasteur/Pasteur or Florence Nightingale/Florence.) This irked me quite a lot as I thought it was infantilizing the women and their achievements and I was not happy with that. At first, I thought it was an editing error, but as the read continued, it was clear that it was an editing decision. My, my, my. Published in 2009 so not that old a book, so I am curious why the book was formatted in that manner…

*The word Malaria reflects this miasma theory: “Mal” is “bad” and “aria” is “air”… Fascinating when you think about it (at least to me).

The Spare Room – Helen Garner (2008)

This is a short spare novel (novella?) about some big questions in life regarding friendship. Where does your responsibility end with a dying friend who comes to stay with you? Where are your boundaries? And where are hers?

Garner has written a small novel (lengthwise – 175 pp) that packs a powerful punch. Helen has Nicola, a friend, to stay at her home whilst Nicola undergoes questionable cancer treatments that are expensive, hard to take, and unproven. During Nicola’s three-week stay, Helen sees her life turned upside down by her visitor and experiences a wide range of unexpected emotions from rage to tenderness as she cares for Nicola and her body ravaged by the “treatment” that she is receiving.

Reading this review so far, I think, makes this book sound horrendously sad – there are several such moments, but there are also moments of laughter, relief and a little girl who lives next door and comes to show Helen her newest flamenco dancing. This is more a story about friendship than anything. When a terminally ill and fairly distant friend comes to stay with you as you happen to live in the same town as the clinic, how much truth is ok? How do you tell your terminally ill friend that she is being irritating and difficult? How do you support her when she is in denial of how ineffective her treatments are? Is it your job to be brutally honest or do you let her keep that glimmer of hope even if you disagree with her choices?

This was a quick and intense read which has left me thinking and pondering what I would have done in a similar situation. The writing is succinct and without extra flourishes – perhaps reflecting how life’s priorities become pared down to the basics when you’re on the edge of dying. An unexpected ending finishes off this read. Good one.

Ten Days in the Madhouse – Nellie Bly (1887)

In the late 1880’s, a young journalist called Nellie Bly wanted to make her mark outside the usual writing restrictions accorded to most women journalists back then. (They were usually limited to the Society page and rarely given any hard news to cover.) Her editors at the New York paper The World agreed with her and so she got herself admitted to Blackwell Island (also called Welfare Island, and now called Roosevelt Island) which was America’s first municipal mental hospital. Bly wanted to prove her worth as a journalist and decided to do an expose on the conditions at the hospital and believed only by becoming admitted as a patient could the truth come out.

Charles Dickens had already previously covered conditions here in his American Notes (published in 1842) but they were from the perspective of an outsider and of a foreign traveler. This was the first time that an actual US journalist has been on the inside of the institution. (Blackwell Island has a fascinating history by the way: it was a penitentiary, a workhouse, a smallpox hospital…)

Printed as a series of first-person narrative articles, the resulting coverage was explosive for that time and for Blackwell. Originally intended as a state-of-the-art mental institution “devoted to humane and moral rehabilitation of its patients”, funding had been cut and care had been reduced to bitter and sadistic staff and unsympathetic doctors who simply ascribed any patient claims to sanity (and thus release) as delusional. A very Catch-22 situation for all the female patients who were imprisoned there and with little hope of freedom in their future.

Bly took her project very seriously and prepared deeply for her role as a mental patient: she practiced “looking like a lunatic” in the mirror, she dressed in tattered clothing, and posing as a Cuban immigrant who could not remember her history, Bly checked into a temporary boarding house for poorer women. Within twenty-four hours of pretend irrational behavior, Bly was taken by police to Bellevue Hospital for an evaluation, and then from there, pronounced “delusional and undoubtedly insane”, taken to Blackwell. (Testing was minimal at the time and was subjective and very quick.)

Bly’s detailed account of her time at Blackwell as a mental patient are harrowing to read about – patients were stripped of clothing in corridors and publicly humiliated by the nursing staff, mandatory cold baths in dirty bath water, and appalling living conditions (little heat, poor nutrition, no activities).

“I looked at the pretty lawns, which I had once thought was such a comfort to the poor creatures confined on the Island, and laughed at my own notions. What enjoyment is it to them? They are not allowed on the grass – it is only to look at. I saw some patients eagerly…lift a nut or a colored leaf on the path. But they were not permitted to keep them. The nurses would always compel them to throw their little bit of God’s comfort away…”

It’s also notable that all the patients were female and mostly poor (some couldn’t speak English) and so were powerless in this system of neglect.

“I have watched patients stand and gaze longingly toward the city they in all likelihood will never enter again. It means liberty and life; it seems so near, and yet heaven is not further than hell.”

Any patient who stood up for herself (and the other patients) or who proclaimed her sanity was invariably labeled delusional and so hospital stays to Blackwell became hamster wheels of no release for nearly all the patients imprisoned there.

Once Bly’s stay was over and she had been formally released by the newspaper’s attorney, the story went public, and one month later, Bly was giving details of her experience to a Grand Jury who then visited the hospital themselves. Prior warnings to the staff had helped to clean up the place and the patients, but Bly’s report lead to recriminations from the hospital doctors and to a fast-tracked funding increase of $1 million (enormous at the time).

This was a fascinating read, and was nicely complimented by my earlier reading of “Mad, Bad, and Sad: A History of Women and the Mind Doctors” by Lisa Appignanesi. (No post on that, but definitely not a reflection on the quality of the book or the author.) The treatment of mental health has come a long way in the past one hundred years or so, and Bly’s work helped to propel some of that change.

Gulp: Adventures on the Alimentary Canal – Mary Roach (2013)

“People are surprised to learn: They are a big pipe with a little bit around it.”

– Ton van Vliet

 

As high as the bar had been set with Mary Roach’s previous books, this one reached it (if not higher). Roach is a smart, funny and good science writer who seems to ask the same weird questions of her experts that I would want to ask – she actually does though which elevates her to Superstar status in my eyes.

After having covered large nebulous topics before, Roach’s decision to look in-depth at the human (and other animal’s) digestive system from top to bottom is perfectly done. I know I might be crossing the line here in Fangirl raving, but she is that good. Honestly.

Gulp, her latest release, covers digestion from taste buds to umm… fecal matter, and everything in between in a meandering twisting manner that takes the reader down numerous rabbit holes, but not in a digressive manner – only in a natural trailing way so that you too end up as curious as she is about things you hadn’t really thought about. Who knew that people were paid to taste pet food to make sure it’s palatable and matches the description on the tin? (I didn’t.) Once I’d read the lists of strange things that people have swallowed (on one end) and have inserted into themselves (at the other end), you start to realize the plain fact that humans are odd. No way around that, I’m afraid.

Chapters cover everything from the mechanism of swallowing to fecal matter transplants (an important medical treatment for some cases) and none of it seems irrelevant. It’s all sewn into the content of the book in a seamless manner and when you add in the wit that Roach has with her writing, it’s fascinating. Even if you didn’t really like Elvis that much, he’s got a mention here – next time I see him, I will immediately think of his bowel problems, no doubt about it. It’s thought that he died of a medical issue that was not recognized at the time as it was quite rare – megacolon. Honest. You need to read the book to find out more.

(Speaking of Elvis, the washing machine repair man who visited the other day to fix ours happened to be a competitive Elvis impersonator. That was one fascinating conversation. Seriously. I had little idea about that world…)

I love Mary Roach’s writing, and I wish that we were friends (although that might sound somewhat creepy). She is one of the funniest and smartest science writers around, and whichever Roach title you end up picking, you’ll have an entertaining journey into a topic that you had no idea you were so interested in.

Highly recommended.

(Mary Roach is also hilarious in real life when we were lucky enough to catch her on an author visit to campus. Some authors need to never read their work (as they are dreadful speakers), but Roach does everything right when she presents her writing.)

And if you don’t believe how awesome Mary Roach is, here is an NPR interview which will prove it for you.

Undress Me in the Temple of Heaven – Susan Jane Gilman (2009)

This was quite an interesting travel narrative set during the 1980’s from the perspective of two recent female undergraduates. One of the most interesting twists in the narrative (aside from the usual “foreigner in a strange land” concept) was that one of the two travelers becomes mentally ill, paranoid and delusional in a small village in rural southwest China. This would be tricky in most environments, but when it happens in a Communist country and the delusions involve talk of foreign spies, it gets a bit complicated.

Gilman does a good job of describing her adventure, but I couldn’t quite get too attached to her. Although currently a present-day journalist (at least at time of book publication), she makes surprisingly jarring and dated stereotypical comments about the people she meets and the events that occur.

I’m not sure if she did this from the perspective of “this was the 1980’s and how it was so it’s ok to say this” or whether it was along the lines of “one of my best friends is [fill in the blank] so I can say that”. Whichever it was, I found it hard to respect her after these asides. One could be argued as having “slipped through the net”. Twice is an issue and should have been addressed by the editor (although probably shouldn’t have even been written in the first place). It wasn’t continual, but it was enough to pull up the reader quite a bit and have a “What. The. ….?” moment.

An interesting story, otherwise, with a good unpredictable twist to the more typical narrative, but it was definitely marred by those flippant comments.