Doctor

Doctor, Doctor! Medical Fiction and Non-Fiction
Updated January 2007

Rescuing Jeffrey by Richard Galli (Non-Fiction/Memoir)

On July 4, 1998, 17-year-old Jeffrey Galli dove into a swimming pool. When he didn't emerge, his friends ran for help, and his parents pulled him from the pool, saving his life; subsequently they learn that he has been paralyzed from the neck down and will spend his life dependent on a ventilator for breathing.

In this memoir of the first ten days of Jeffrey's accident and hospitalization, his father recreates the immense sadness, the horror, and the gut-wrenching decisions that his family faced. Chief among these was his own conviction that the most humane choice they could make was to turn off the ventilator and let Jeffery die in order to spare him a life robbed of any independent physical activity and without the potential to pursue their vision of a happy life.

The family's struggle to decide on the best course of action is presented so well that the reader feels the anguish of this horrible choice. Perhaps the most moving sections were when Jeffrey awoke each day and had to face his paralysis anew--his father there to explain to him time and again the circumstances and consequences of the accident. An incredibly moving read about parenthood and life.

Atul Gawande’s account of his personal experiences as a surgeon-in-training is easily one of the most accessible and fascinating books about medical science I have ever read.

Although his narrative includes many examples of cases he personally has worked on, Gawande avoids self-congratulation and martyrdom and focuses instead on what the work with various patients and their ailments has taught doctors—and can teach us—about the wonders and limitations of science and medicine.

“Medicine is, I have found, a strange and in many ways disturbing business,” Gawande writes. “The stakes are high, the liberties taken tremendous. We drug people, put needles and tubes into them, manipulate their chemistry, biology, and physics, lay them unconscious and open their bodies up to the world. We do so out of an abiding confidence in our know-how as a profession. What you find when you get in close, however—close enough to see the furrowed brows, the doubts and missteps, the failures as well as the successes—is how messy, uncertain, and also surprising medicine turns out to be.”

Some of that messiness and uncertainty is the focus of Part I of Gawande’s book, “Fallibility,” in which he examines some of the successes—and failures—of modern medicine and its practitioners. In discussing his training as a surgeon and outlining some of the errors he made as a beginning doctor, Gawande acknowledges, without using this claim as an excuse for his own weaknesses, that “We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals…There is a science in what we do, yes, but also a habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.”

Doctors make mistakes, Gawande says, but errors can be reduced significantly with better training and, not surprisingly, constant practice. He cites the case of Shouldice Hospital, located outside of Toronto. At Shouldice, hernia operations cost ½ what they do elsewhere, take half the time, and patients have only a 1% chance of getting another hernia. “There’s probably no better place in the world to have a hernia repaired,” Gawande writes. What makes their work so special? It’s simply this: that at Shouldice, dozens of doctors do nothing but hernia operations all day long—thousands of operations a year. And that specialization has made them nearly perfect. Many surgical errors may result from surgeons not specializing, Gawande acknowledges, and he offers numerous examples of life-altering—and life-ending errors—but, he argues, mistakes are an inevitable part of life. Human error is almost unavoidable, though repetition and education do make an enormous difference over time. “Doctors will sometimes falter,” he writes. “And it isn’t reasonable to ask that we achieve perfection. What is reasonable is to ask that we never stop reaching for it.”

In the second portion of the book, Gawande examines mysteries that medicine has been unable to fully explain—why we feel pain, for example, and where pain originates, and why some people feel more pain than others. He traces the study of pain and offers fascinating research that suggests their may be a neurological basis for pain, and that pain can be managed mentally. He also examines the phenomena of nausea and vomiting, and offers and unusual case study of a woman with untreatable vomiting of an unknown origin. Finally, he looks at overeating and obesity and explains “Roux-en-Y” surgery—the latest development in treated morbid obesity that surgically alters the digestive systems and so far, has offered the best long-term treatment for obesity. In all of these examinations, Gawande employs fascinating case studies to illustrate and personalize the information, and he offers some insightful observations about what these phenomena—pain, nausea, and obesity—can teach us about being human

Gawande’s analysis of modern Western medicine—and surgery in particular—examines, without pretending to explain—the assorted struggles that face doctors as they attempt to serve people. Numerous case studies highlight dilemmas that doctors face in offering care and attempting to make the most of science and their own talents. A fascinating, absorbing read.

Dan Kennedy’s daughter, Becky, has achondroplasia, a condition which occurs about once in every 30,000 birth. The disorder is the most common form of dwarfism and limits a fully grown adult’s stature to about 3 ½ feet and causes other abnormalities, most notably body-limb disproportion.

From the time he learned that Becky was a dwarf, Kennedy began a quest to “find meaning and purpose in Becky’s having a life-altering genetic difference.” His quest leads him on a tour through the history of dwarfs and dwarfism. He examines the treatment of smaller-statured people throughout history, paying special attention to dwarfs in the entertainment industry and the treatment of dwarfs in WWII concentration camps. His discoveries often make him uncomfortable, and he worries for his daughter’s future, knowing that her difference will always be obvious, and that she will need extra support in order to ward off inappropriate questions, stares from strangers, and discrimination in the workplace and society.

Kennedy, who is the editor of the web page for the Little People of America (an organization offering support to people with dwarfism and their families and friends), also explains the genetic mechanisms behind dwarfism and its transmission, and explains the controversial “extended limb-lengthening” surgery that allows people with some types of dwarfism to grow to average height. Because the surgery is lengthy and involves numerous, painful follow-ups, and because it doesn’t change the person’s genetic make-up (a dwarf is always a dwarf and retains the same likelihood of passing on the genes for dwarfism whether he or she becomes taller through surgery or not), Kennedy questions whether it is truly necessary—after all, the only real reason for performing it so that a person will look more normal and experience a few more life conveniences).

Little People does a good job touching on some of the major issues affecting parents of and people with dwarfism, and readers will find themselves moved by the difficult questions he asks about parenting and being a person with such a visible difference than others. Anyone interested in learning more about dwarfism will find Little People enlightening.

In the Little World: A True Story of Dwarfs, Love, and Trouble by John Richardson

In 1997, Richardson was assigned to write an article on the Little People of America Convention in Atlanta, an annual gathering t6hat brings together hundreds of people with dwarfism and offers community and education to people who are often isolated by their disorders. Richardson became intrigued by the story and the relationships he developed with people at the convention, and stayed in contact with several of his new acquaintances after they left the convention.

In this full-length extension of his original piece, he traces the lives of a young couple, dwarfs who met over the Internet and see each other for the first time at the LPA Convention; a teenager from Australia with severe health problems related to her dwarfism and whose mother's personal life spirals out of control after the convention; and a cantankerous woman who becomes a close friend but whose contact with Richardson is interrupted frequently by misunderstandings between the two. His relationships with these people offers him a unique insight into the world they inhabit, with its social and physical challenges.

Throughout the book, Richardson examines our society's perception of what it means to be beautiful, as well as what it means to be part of a subculture determined entirely by one's physical attributes. He offers a brief and readable introduction to dwarfism (there are over two hundred varieties) and the attendant social and medical problems that can plague people with dwarfism. Reading his account of their struggles and triumphs is both enlightening and entertaining.