Sunday, October 25, 2009

The First American, by H.W. Brands

The First American: The Life and Times of Benjamin Franklin, by H.W. Brands

Benjamin Franklin was a scientist, inventor, philosopher, author, scholar, businessman, and diplomat—a true Renaissance man. I knew the highlights (creator of the first public library and first fire department, inventor of bifocals and the Franklin stove and the lightning rod, one of the drafters of the Declaration of Independence, Ambassador to France, ...) but was still surprised at how much else there was to the man. He was an accomplished musician and composer and even invented an instrument: the armonica. He was one of the founders of the University of Pennsylvania, organized the Pennsylvania Militia, and established the first hospital in North America. He even charted and named the Gulf Stream during his many Atlantic crossings. Frankin had a wry sense of humor as well; Poor Richard’s Almanack contains some of his funniest work, with my favorite being the aphorism, “Force shits upon reason’s back.”

Despite being known as one of the fathers of the Revolution, originally Franklin believed that America should remain a part of Britain but governed separately (like Canada) instead of directly by Parliament. As he spent more and more time in England he became disgusted by the corruption of the British government and after a public humiliation he changed his beliefs. “The essence of the Revolution was the triumph of virtue over vice.” I was saddened to read about how venal Parliament was at this point in history; the descriptions could easily apply to our American government of today. Regardless, the examination of Franklin’s politics were the most interesting parts of the book. While no McCullough, Brands has written an excellent book.

First Sentence:
Cotton Mather was the pride of New England Puritanism.

Tuesday, October 20, 2009

A Slight Trick of the Mind, by Mitch Cullin

A Slight Trick of the Mind, by Mitch Cullin

Sherlock Holmes is a character that has captivated the world and authors continue to craft tales about his exploits 120 years after his introduction. Sadly, Cullin decided to join the ranks of Holmesian writers; A Slight Trick of the Mind is a truly terrible effort. Holmes is 93 here, and long since retired. He is still healthy enough to travel to Japan, where he finds his host wants information about someone from Holmes’ past; Holmes doesn’t remember this man, but lies to make his host feel better. Lying to obtain information is something that fits with Holmes’ character, but to do so simply comfort a stranger seemed at odds with the myth. Cullin also sees fit to replace Irene Adler as “the woman” in Holmes’ life with a beauty that has no apparent intellectual depth. These jarring departures from the accepted mythology are I suppose intended to make us look at the famous detective from another angle, but instead simply rang false.

It is unfortunate that the main character is the famous Sherlock Holmes, actually. The story is well-written and the depiction of a mentally sharp mind that is losing touch with his surroundings is both honest and heartbreaking. Familial bonds are also examined from various viewpoints in a fairly significant fashion. If the protagonist was anyone but Holmes, my opinion would have been very different; the fact remains that this is a Sherlock Holmes mystery, however, and that caused the entire premise to suffer greatly.

First Sentence:
Upon arriving from his travels abroad, he entered his stone-built farmhouse on a summer’s afternoon, leaving the luggage by the front door for his housekeeper to manage.

Saturday, October 17, 2009

Complications, by Atul Gawande

Complications: A Surgeon’s Notes on an Imperfect Science, by Atul Gawande

I have a fair amount of distrust for the medical profession. Much of this distrust is admittedly irrational; I project unpleasant personal experiences with individuals onto the entire profession which I know is unfair. The physician that operated on my wife’s brain tumor and saved her life a decade ago has my endless thanks, but the dozen of separate doctors that before the procedure kept sending her home with a migraine diagnosis have had a more profound impact on my opinions. When I came across this account of the industry written by a surgeon, I was interested to see if my views could be altered.

Gawande does a fantastic job of honestly looking at how we educate and train surgeons. There simply isn’t any way to gain experience other than doing something, and every surgeon at one point conducts his first operation. This makes sense to me, but I was a bit disturbed at how the doctors aren’t always forthcoming about this fact. While we all want to think that our doctors are the ones directly caring for us, the reality is that interns do a huge amount of the work. I agree with the conclusion that some deception here makes for a more comfortable patient, it seems unfair to be charged the same regardless of the experience of the person wielding the scalpel.

Another interesting discussion is on how mistakes are handled in medicine. Gawande looks at research into defects from many professions and concludes, “Not only do all human beings err, but they err frequently and in predictable, patterned ways.” He goes on to say malpractice lawsuits don’t reduce errors, and in fact probably contribute to them because it makes the industry less likely to admit mistakes which is a key part of reducing or eliminating them in the future. Academic hospitals are trying to counter this aversion to admitting errors in a weekly meeting called a Morbidity and Mortality Conference but this is an internal, private discussion. It seems that the profession at large could greatly benefit from sharing the results of these meetings, but with our culture’s seeming love affair with lawsuits I don’t see more public airings of mistakes happening anytime soon.

After my pleasant discovery that at least the author is frustrated at the difficulty in improving health care, a discussion about a doctor’s responsibility to steer patients to do the “right thing” renewed my original cynical view. Gawande believes that a doctor should hold his beliefs in a higher regard than the patients. “A good physician cannot simply stand aside when patients made bad or self-defeating decisions—decisions that go against their deepest goals.” This kind of arrogant thinking drives me crazy: when I talk with my doctor I want to be presented with all options and consequences, not just the one the physician believes I should choose.

It is comforting to see that at least one surgeon recognizes that there are many more things that can be done to improve quality, but the reality that virtually none of these are likely is unfortunate. Gawande does a good job of demonstrating his heart and honesty, and he made what I see as a largely arrogant profession much more personable. I thoroughly enjoyed reading this, but I still cast a largely cynical eye towards modern medical practices.

First Sentence:
The patient needed a central line.

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