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My Reviews of Other Books of ER Stories
(& a few books of general medical/nursing stories, too)

At the end, I'll review my own book, too. It's difficult to be objective about your own work, but I'll do my best. Along with my reviews I'll present short excerpts from most of the books.

If you're interested in medicine in general and ER in particular, you might want to read these reviews even if reviews aren't normally your cup of tea, because in some of my many tangents I address a few of the thorniest issues in medicine today. I also tell some stories I didn't include in my first ER book, and in a humorous (I think) graphic I poke fun at an uppity Harvard grad who knows less than what she thinks she does.

I'd greatly appreciate it if you'd do this:If you've read my book and would like to review it, I'd be happy to post your review (a la Amazon.com).
Please send your review to me via this page: www.myspamsponge.com/doctor.php Thank you!

If there is an ER book that I have not reviewed, I would appreciate it if you'd tell me about it.

Emergency Room—Lives Saved and Lost: Doctors Tell Their Stories
Edited by Dan Sachs, MD
Published by Little, Brown & Company, 1996, 254 pages

I liked this book. Most of the stories in it are interesting; a few are very interesting, and some are truly boring. Of course, it's virtually impossible to write such a book and have every story appeal to every reader—we all have our own ideas of what is interesting and what is not. I think that every book of ER stories should be organized into discrete stories so that a reader can skip to the next story if he doesn't enjoy the current story. This book is organized in such a fashion, but I doubt that you'll do much skipping (unfortunately, I can't say the same for some of the other books). My greatest criticism of the book? It's difficult to verbalize, but I repeatedly had the feeling that some of the contributors to this book (there were several) could have done a lot more to give the reader a more realistic idea of what life in the ER is really like. Bottom line: It's not a great book, but it's a good one, and I'd recommend that you buy it.

Excerpt: "Now, here's one for you." I looked up from the chart I was writing on. There were two police officers, both big guys, each flanking a reedy young man, boy really, dressed in shabby clothes. He stood blinking, molelike, in the bright light of the ER.
"Who, what?" Bill, the evening charge nurse, asked. He was sitting next to me. We were having a terrible day. Two unsuccessful resuscitations before 9 a.m. and since, we had been working frantically to catch up. This was an inner-city ER. The patients were a grab bag of trauma, critical cardiac cases, drug overdoses, and the like, all mixed in with sprained ankles and sore throats.

Just Here Trying to Save a Few Lives: Tales of Life and Death from the ER
by Pamela Grim, MD
Published by Warner Books, 2000, 307 pages

This book is more than just a collection of interesting stories. Dr. Grim leads readers on a fascinating journey as she reveals her innermost thoughts while working in a variety of emergency care settings. Her experiences while working in American ERs are recounted in a mesmerizing way that is certain to keep you glued to the book as the stories unfold. Then, fueled by the burnout that strikes most ER doctors, she departs on a soul-searching adventure as she toils in Third World countries plagued by war and unimaginable poverty. Her stories are intense but often bleak, thus giving readers a shockingly candid perspective on the real world of emergency medicine.

ER: Enter At Your Own Risk / How To Avoid Dangers Inside Emergency Rooms
by Joel Cohen, M.D.
Published by New Horizon Press, 2001, 199 pages

If you're like most Americans, it won't be long until either you or someone you love becomes a patient in an emergency room. And, if you're like most Americans, you will blindly trust the doctors and other ER personnel to provide optimal care. That might be a reasonable expectation in a perfect world, but we don't live in a perfect world. We live in a world in which the quality of emergency care is considerably variable from one hospital to another and from one practitioner to another and even from one minute to another. Are you willing to cross your fingers and hope that everything goes well?

Fortunately, you need not leave your fate to chance. If you follow the advice given by Dr. Cohen, you can become an intelligent participant in your care and proactively take steps to reduce a myriad number of risks, any one of which may put you at increased risk of death or disability. Or you can play the blame game, in which you or your survivors point fingers in a courtroom. That's great for lawyers, but is it good for you? Obviously not, if health means more to you than money. Malpractice attorneys like to justify their existence by believing that they're performing a useful public service: namely, punishing doctors for real or imagined errors and thereby enhancing the quality of medical care. In theory, that sounds great. In reality, that system just isn't effective.

If everyone read and followed the advice in this book, Dr. Cohen would do far more to enhance the delivery of first-rate emergency healthcare than every malpractice attorney in this country. Collectively, Dr. Cohen's advice could save billions of dollars and an untold number of tragedies. Bottom line: I don't know of any other book that offers so many helpful ER tips. If you don't read this book, some day you will probably wish you did. Even though I'm an ER doc, I learned some helpful things from Dr. Cohen. His splendid advice could help so many people in so many ways. Do yourself a favor, and read this book.

Paramedic: On The Front Lines of Medicine
by Peter Canning
Published by Ballantine Books/Fawcett Columbine, 1997, 306 pages

With the assistance of hourly doses of caffeine, I was able to read all of the boring textbooks in medical school. However, I was unable to get my blood caffeine level high enough to keep my attention focused on this book. I repeatedly—and I do mean repeatedly—had the overwhelming urge to skip ahead, desperately searching for something worth reading. I came across a few good stories, but I was irritated that I had to sift through 306 pages to find those stories. It would have been more merciful to the readers if this book had been condensed into a magazine article. Nauseatingly, the author seems obsessed with impressing the readers on how he is so politically correct and compassionate for the folks who believe that life is impossible without welfare. On the positive side, this book has a visually appealing cover, and it gives one man's "take" on what it's like to be a paramedic. Bottom line: I spent $24 for this?!? (Remind me to double or triple the price of my book the next time I reprint it, will you?)

Excerpt: We're a few blocks from Hartford Hospital after dropping off another cold and flu—a mother who met us at the curb with her four-year-old who had a runny nose and a stomachache. Ahead of us I can see the health department where I once had a top-floor office. I think if I were there now I might be at the window looking out on the feast of the snow-covered city, and gazing down longingly at the ambulance approaching, wondering about what great calls and adventures I was missing.
Something thwacks against the side of the ambulance.
"What was that?" Tom says.
I look in the side mirror.
"Are they throwing snowballs at us?" he says, braking suddenly in the middle of the street.
"It's just some kids," I say.

Rescue 471: A Paramedic's Stories
by Peter Canning
Published by Ballantine Books, 2000, 285 pages

Another book by Peter Canning. This one was written three years after his first book (reviewed immediately above), and it is interesting to note how his perspective has changed in that time. Canning was once an unabashed cheerleader for the welfare state, but he has now learned that a lack of money is not the primary reason why many poor folks are the way they are. Canning presents America's underprivileged in such a disgusting light—from their sometimes gruesome lack of hygiene to their utter apathy about sexually transmitted diseases—that U.S. taxpayers might logically wonder what, if anything, has truly changed after we've infused five trillion dollars into the "war on poverty." Sure, the poor folks now have cable TV, VCR's, microwave ovens, and designer tennis shoes, but will that make them take their garbage out to the curb instead of piling it onto their floors and countertops? Or will it make them give a hoot about the partners with whom they choose to sleep? Will it make them buy food instead of booze? Will it make them study at the public library instead of roaming around in gangs bent on terrorizing anyone they think is an easy target?

Rhetorical questions aside, all poor people are not reprehensible. However, the ones that are repugnant are, statistically speaking, more apt to pick up the phone and dial 911. Hence, Canning is more likely to see such folks in his ambulance, and I'm more likely to see them in the emergency room. This colors our perception and erodes our idealism. Canning retains a smattering of idealism, but it's clear that it has been decimated.

While there isn't one story in this book that is particularly interesting, this book is considerably better than Paramedic: On The Front Lines of Medicine. The first half of Rescue 471 is rather dull, but Canning picks up the pace in the latter half and presents his readers with passably interesting stories. Canning writes in an annoying present tense throughout this book, probably in a lame attempt to generate an artificial sense of excitement, even when this perspective is illogical, confusing, and wholly unneeded. This makes Canning sound like a blithering idiot, which he's not. There are also some rather strange inclusions in this book, such as a copy of Canning's kindergarten report card, and he repeatedly mentions his affinity for beer. Frankly, who cares? Bottom line: Apart from the drawbacks mentioned above, the primary flaw in Canning's books is that he attempts to extract too many stories from too little experience; he simply has not had enough unique experiences to make it worthwhile for him to turn them into one book, let alone two. But I bet you're dying to read his kindergarten report card, aren't you?

Dial 911
by Joan Lloyd and Edwin Herman
Published by Ballantine Books/Ivy, 1995, 230 pages
Trauma Center
by Joan Lloyd and Edwin Herman
Published by Ballantine Books/Ivy, 1997, 277 pages

I grouped these books together because they're written by the same authors and they're very similar. They're good books with a fair number of entertaining stories, and Lloyd and Herman are skilled writers who can make most stories interesting even if the stories are not inherently compelling. Nevertheless, I think they go overboard in trying to generate artificial excitement by an over-reliance upon paramedic lingo. Also, I'd prefer to have a more readily apparent delineation between the stories so that I could skip to the next story if I wasn't captivated by the current one. Bottom line: Would I buy them again? Yes.

Excerpt: This past winter was particularly harsh in Fairfax. As in most of the Northeast, we had record low temperatures and an unusual number of snowfalls.
It was 3 a.m. on a particularly cold Sunday morning in January, and Ed and I were riding our usual midnight-to-6 a.m. shift from my house. We had just returned from a call for a man with difficulty breathing and, as Ed and I turned the knob on the door to my condo, the tones went off again.
"Fairfax Police to the ambulance. Take a mutual aid for Davenport for an unknown medical emergency."
The city of Davenport doesn't have a roster of duty crews the way Fairfax has. In Fairfax, members are required to sign up for duty for at least one shift, or six hours each week.

Excerpt: Over the years, I've dealt with hundreds of children. They can be the most rewarding, the most frustrating, and the most heartbreaking of all patients. And I just love them all.
Eleven-year-old Barry Hayward woke up to the loud sounds of Hootie and the Blowfish one Wednesday morning. The clock-radio was extremely loud, but he and his mother had agreed that if Barry was going to wake up at all, the radio had to be set at a decibel level that would crack most people's eardrums. As he swam up toward consciousness, Barry realized that he really felt lousy. Since it was a school morning, his next thought was "Do I feel bad enough to get out of school today?" He lay in bed inventorying his body. Not nauseous, no sore throat—sore throats got you out of going to school really quick—no belly- or headache, nothing dramatic. He just felt yucky.

Intensive Care: The Story of a Nurse
by Echo Heron
Published by Ballantine Books/Ivy, 1987, 373 pages

Condition Critical: The Story of a Nurse Continues
by Echo Heron
Published by Ballantine Books/Ivy, 1994, 416 pages

Both are by the same author (Echo Heron). They're not ER books per se, but they do include some ER stories. Unfortunately, Heron took a handful of good stories and sprinkled them throughout the 789 pages which constitute these two books. As a writer, I include details when I think they'll materially add to the understanding, appreciation, or enjoyment of the story. In contrast, Heron's details are often an embellishment unto themselves. That's not necessarily bad, but such a skill is more appropriately expressed in writing novels than it is in rendering a book of medical stories. Heron is the prototypical "I hate doctors, and only a loving, wonderful, and dedicated person like myself can truly care about a patient" sort of nurse. I have known many fine nurses, but none of them were addled by such a self-serving and self-righteous fiction as that. Bottom line: If you value superfluous detail over genuine content, you might be able to make it through these books without falling asleep.

Excerpt: May came into town masquerading as July, and the promise of a long, hot summer got under every schoolkid's skin. Sneakers squeaked with impatience on classroom floors while their wearers waited for the sound of the last bell to free them once and for all to the world of skateboards, bicycles, and yet-to-be-built secret forts.
Not that we were any different. With only two more weeks of school it was difficult going home each day to labor over care plans in the winter setting of our desks while the sun beckoned us to warm afternoon walks along the ocean.
Somehow I had managed to stay on the bucking bronco of nursing school for the entire year, but after the fainting fiasco and the debut of my duodenal ulcer, I knew my body was trying to tell me it was time for a break. Besides, Simon's Spiderman duffel bag was so badly tattered and torn it couldn't have lasted much longer.

Excerpt: The infamous poet was led in on a gurney surrounded by an ER nurse and three San Quentin prison guards. Three guards meant he was a bad dude—a death row prisoner.
When the SQ prisoners came in with only one guard, it meant they were lightweights—nonviolent criminals, having perhaps stolen some insurance money from little old ladies or maybe embezzled a few bucks from the company. Two guards signified something more serious, like armed robbery. Three guards meant homicide and worse. The only time I'd ever seen four guards was the time the warden came in as a patient.


Tending Lives
by Echo Heron
Published by Ballantine Books/Ivy, 1998, 400 pages

Another book by Echo Heron. I chose to review this book separately, because it's distinctly different than her other books. To begin with, it's fairly interesting. There are a few great stories in the first part of the book, followed by several middling stories and dozens of ho-hum tales. Tending Lives is a collection of stories contributed by a number of nurses, some of whom have had interesting experiences and others of whom have apparently worked their entire career without witnessing a single compelling event. Bottom line: Although there aren't a lot of fabulous stories in this book, I think there are enough to make it a worthwhile purchase. Gratuitous comment: Judging from her picture on the inside back cover and comparing it to her pictures which have graced the covers of the above books, Echo Heron was an attractive woman who is now a beautiful woman. My suggestion is that she capitalize upon this and write the Echo Heron Anti-Aging Bible.

On Duty: A Nurse's Notes on Life and Death
by Carolyn Fink, RN
Published by Ballantine Books/Fawcett, 1996, 241 pages

I think Echo Heron, author of the above three books, is a good writer who just happens to be writing the wrong type of books. I wish I could be so charitable about this book—ah, heck, I won't even try. On Duty is a sophomoric, amateurish book devoid of either substance or style. The author seems to have an unfathomably low threshold for deciding what material is worthy of inclusion in the book. It's not an ER book, and it's hard to believe that it's a book of any sort. I included it only to save you from making the same mistake that I did in purchasing that book. Bottom line: I feel sorry for the trees that were sacrificed to give physical embodiment to this book. I'm not a tree-hugger, but some waste is so egregious that it cannot be condoned.

Excerpt: Carmen was a head nurse now; she had worked every floor and every shift in the hospital over the years. She had graduated from a diploma program, a three-year school that trained young nurses right in the hospital. They lived in a dormitory across the street from the hospital. None of them could be married, and many of them were right out of high school. Diploma programs are obsolete now, because nurses' training has been taken over by universities and colleges. Now student nurses can be married; they can have children and still go into training. I was glad for the change, because it means that more women from different walks of life and different backgrounds can become nurses.

[Tantalizing, isn't it?]

by Peggy Anderson
Published by Berkley Books, 1978, 344 pages

Two snippets from the book's cover that caught my eye:

  • "The shocking, inspiring, surprise bestseller . . ." I agree that it is both shocking and surprising that this book is a bestseller, and the only inspiring thing about it is that it gives boring authors hope that their books might be published. This book is even more insipid than the book listed immediately above. If you enjoy challenges, here's one for you: try to find even one story in this book that is truly interesting.
  • "Doctors don't keep you alive. I do." This juvenile opinion is probably rooted in the same area of the brain that's responsible for the "short man syndrome." Doctors and nurses work together as a team, and any nurse or doctor who disparages the contributions of other healthcare providers is an egotistical idiot.

The Nurse's Story
by Carol Gino
Published by Bantam Books, 1983, 357 pages

If the interesting material scattered throughout the 356 pages in this book were condensed into 20 pages or so, I would have liked it a lot more than I did. There are some poignant moments, such as when the author masturbated a patient because he was unable to relieve his sexual tension after he'd lost both of his arms, but there are hundreds of pages devoted to describing quotidian events that aren't very unusual or interesting. For example, she repeatedly delves into protracted discussions of her personal life, including drab details such as her search for a house to rent:

Inside there was a living room and a tiny kitchen, too small to eat in. "We could always put a table and chairs in this corner of the living room," Lil said, pointing. The bathroom was an enlarged pink tiled closet with all-new blue fixtures. Through the door on the far wall of the living room, at the foot of the stairs, there was a boiler room which held a washer, a dryer and a laundry table. Upstairs there was a large center hall almost as big as the living room; at one end of it, a small room with eight windows; at the other end, a larger room with two windows . . ."

Get the picture? This is simply too prosaic for my tastes. Her nursing tales are almost as insipid, except for those rare occasions when she turns up the wattage and unfurls an interesting story. Bottom line: Except for occasional flashes of brilliant writing, this book is not very engaging and I doubt that you would find reading it to be a worthwhile investment of your time.

EMT: Rescue!
by Pat Ivey
Published by Ballantine Books/Ivy, 1993, 249 pages

The book cover promises, "Thrilling true stories of a mobile emergency medical unit." Thrilling? Whoever wrote that either has no idea of what "thrilling" means, or they have no qualms about misleading you. This book is anything but thrilling, and it is poorly written. In reading it, I repeatedly had the impression that the author is apt to develop Alzheimer's disease. There are certain clues in the way people structure their sentences which have prognostic utility for determining if a person is predisposed to Alzheimer's disease, and it is my opinion as a physician that this author has an increased risk for acquiring Alzheimer's or a related dementia. Consequently, I feel that it would be cruel to pick on her, so I won't criticize this book any further. However, I should caution you that she is also the author of EMT: Beyond the Lights and Sirens. I haven't read that book, but I've heard some pretty nasty things said about it. (Update: I eventually read it, and it was just as insipid as EMT: Rescue!. While reading EMT: Beyond the Lights and Sirens, I kept wondering what possessed her to include such boring and irrelevant material. Then I gave some thought to her title: she doesn't mean "beyond the lights and sirens," she means "WAY beyond the lights and sirens.")

Excerpt: Like me, Holly is an only child. Perhaps that is one reason why we blossom in this extended family.
"She was looking for a place where she could make a difference," Lester, her husband of five years, told me. His pride in her was apparent. "A place where she could be appreciated," he added.
Because of job pressures, Lester was unable to commit himself to the squad. But he added "Grubnelednert" (sic) to our EMT vocabulary, and he made us laugh when we needed it the most.
"I think she initially became interested in the squad because I was," he said. "Then she realized that 'hey, this is something I can do.'"

Mini-lesson from medical school: Can a person's writing style foretell whether that person is likely to develop Alzheimer's disease later in life? Yes. Here's more information.

Emergency Room
by Caroline B. Cooney
Published by Scholastic, 1994, 214 pages

In titling this book Emergency Room, the author has done the world a disservice by expropriating a great title which could have been put to better use on a more deserving book. Since titles should be descriptive, I'll suggest a more accurate one: Bland Fictional ER Tales for Elementary School Students. Bottom line: If you're an adult who is looking for interesting stories, this isn't the book for you.

Emergency Room
by Randall Sword, MD
Published by Signet/The New American Library, 1982, 230 pages

Yet another book entitled Emergency Room, but Randall Sword, MD, the author of this book, has a brain—mercifully. The book's cover boasts "A doctor's riveting moment-by-moment true story of hospital emergency medicine . . . non-stop action that makes you think of M*A*S*H or Hill Street Blues." Not quite. This book made me think of a textbook since it's replete with textbook-like material, such as this riveting passage:

When performing artificial ventilation on a child, the rescuer should cover both the mouth and nose of the child with his mouth and use smaller breaths to inflate the lungs once every three seconds.

Does this remind you of M*A*S*H?

There are several stories in this book, and a few are actually interesting. However, this book isn't focused upon unusual ER stories (my stock in trade); instead, it's filled with run-of-the-mill ER cases that the author uses as an introduction for giving a lecture on the pertinent subject matter. This is a great book if that's what you're after, and in many ways it's superior in this regard to a somewhat similar book (The Medicine of ER) discussed below, both of which should appeal to hardcore ER fans who want to learn more of the nuts and bolts of emergency medicine.

Besides giving a series of introductory lectures on emergency medicine, the author also gives some insight into how the lives of ER physicians are affected by serving patients on welfare. According to the author (and I don't doubt this) less than 10% of the population is on welfare but 50% of all malpractice suits arise from this select group. This book was written years ago when malpractice litigation was just beginning to spiral out of control, and I suspect the author would have had a lot more to say had this book been written within the last few years. If you truly want to understand what goes on in emergency rooms or the minds of ER doctors, you have to understand how much the constant threat of being sued affects what the doctor thinks and does. Bottom line: Primarily a primer for understanding why ER doctors do what they do. As such, it's nonpareil. As a book of intriguing stories, it's a flop. In a nutshell, it's basically a PBS version of ER.

The Medicine of ER
by Harlan Gibbs, MD and Alan Duncan Ross
Published by BasicBooks/HarperCollins Publishers, 1996, 232 pages

This book is intended as a primer so that people who watch the show ER can more fully appreciate what's going on. It is not a collection of ER stories, but it's interesting nonetheless. There are a couple of errors in the book: 1) they call WD 40 "WD4" and 2) they call bretylium "beryllium" (the former is a cardiac drug, and the latter is one of the elements). Bottom line: If you're a fan of ER and you're not a doctor or a nurse, buy it.

In The Blink Of An Eye: Inside a Children's Trauma Center
by Alan Doelp
Published by Ballantine Books/Fawcett, 1989, 270 pages

A reviewer from The Baltimore Sun is quoted on the book's cover: "Fascinating, fast-paced and dramatic. The trouble with In The Blink Of An Eye is that it's over too soon."

After reading this book I wondered if some book reviewers are paid to give glowing reviews. One of the paragraphs in the book was interesting, but the remainder of the book was neither fascinating, fast-paced, or dramatic. In The Blink Of An Eye dryly explains the operations of a pediatric trauma center. Bottom line: If you're able to stay awake while reading it, you will have a fairly good understanding of the subject matter. However, don't expect to be entertained.

Talking Trauma
by Timothy Tangherlini
Published by University Press of Mississippi, 1998, 249 pages

This book is an odd amalgamation of paramedic stories and an overly cerebral analysis of the "deeper meaning" of those stories by Timothy Tangherlini (the author), who is an expert in folklore and a university professor—not a paramedic. I suspect that Tangherlini was a frustrated psychoanalyst in his prior life, but I think he should heed Freud's advice that a cigar is sometimes just a cigar.

There are a fair number of good stories in this book, but most of them are not especially interesting. Tangherlini probably justified the inclusion of the dull stories by reasoning that his analysis of their deeper meaning would make for worthwhile reading. Perhaps, if you're reading this book as a textbook in a college course in folklore. Otherwise, if you're like me, you want one good story after another.

It's tough to shock an ER doctor, but I was shocked by the content of this book. It wasn't the stories themselves, but the crude and vulgar manner in which they were told. I don't have virgin ears, and I swear whenever my computer crashes more than four times per hour, but I'd rather not read so many profane words. Bottom line: I suppose there is a gene which confers an appreciation for the analysis of folklore, but I don't have it. Is a handful of good stories worth $18? It's your call.

Learning To Play God
by Robert Marion, MD
Published by Ballantine Books/Fawcett, 1991, 272 pages

The Intern Blues: The Private Ordeals of Three Young Doctors
by Robert Marion, MD
Published by Ballantine Books/Fawcett, 1989, 362 pages

While both books are by Robert Marion, M.D., the latter book is primarily a verbal diary of internship dictated by three interns who were under the tutelage, at least indirectly, of Dr. Marion. First, the good news: there are some (but not many) good stories in these books. Now, the bad news: 1) The mantra of these books (especially the latter one) is, "We're incompetent doctors, but if we repeat our mistakes often enough, we'll delude ourselves into thinking that we're hot stuff." 2) If you're not on Prozac before reading these books (again, especially the latter one), you'd be well-advised to take it for a month or so before you subject yourself to such an unbroken continuum of gloom. I'm not averse to bitching when it adds to the story line, but reading an interminable series of pointless complaints is wearisome. Had they interjected more zest into the books, their griping wouldn't have been so noxious. 3) The Intern Blues is so poorly written that it is painful to read. How the heck that scatterbrained pablum got published is beyond me. Bottom line: Need I say more?

Excerpt: Somewhere along the line I'd developed a bad case of infectious disease phobia. It was the subspecialty of medicine about which I knew least. My problem began early in medical school: at the start of the second year I failed the final exam in microbiology. Then during the clinical clerkships of my third year my mind always seemed to wander off during rounds whenever the attending physician or senior resident turned the discussion to viruses, bacteria, or fungi. My lack of knowledge about infectious diseases troubled me: in my future life as an intern and resident, having a firm grasp of the diagnosis and treatment of communicable processes would be of extreme importance. And so, I reluctantly signed up for the infectious disease elective that was offered at Jonas Bronck Hospital.

Excerpt: I have a pretty nice white cloud right now [white cloud: good luck on call; black cloud: bad luck on call]. I still have only three patients. One's just a grower [a preemie who has no medical problems except that he weighs less than two kilograms, the necessary weight for discharge from the NICU], and the others are pretty easy also. Poor Dina, the junior resident, she's got five patients, three of whom are pretty sick, two of whom are really sick, both with NEC [necrotizing enterocolitis, a serious disorder of the intestinal tract]. I offered to take one of them but she didn't want to give them up, I guess. I'm on tomorrow, so I know I'll be picking up a sick kid who was born this afternoon, and I heard there's another preemie on the way, so I'll have at least two new ones to pick up. That'll fill out my service to five. Not exactly a piece of cake, but still pretty easy.

Note: the text in brackets [like these all-too-frequent intrusions] is actually found throughout the book. I'd be the last person in the world to criticize a reasonable number of these explanations, but a surfeit [an excessive amount] of such interjections [that which is interposed between other elements] is contraindicated [to indicate the inadvisability of] in books which purport [to profess or present the often false appearance of being or intending] to be capable of augmenting [increasing] pleasurable neurotransmission [fun].

Rotations: The 12 Months of Intern Life
by Robert Marion, MD
Published by HarperPaperbacks/HarperCollins Publishers, 1997, 349 pages

Yet another book by Robert Marion, M.D. and a new batch of interns. I suspect that Dr. Marion will still be writing books on internship even when he's living in a nursing home 30 years from now. I bought this book hoping to read some interesting ER stories. After all, how can three doctors go through internship and not have any interesting ER stories to tell? I don't know, but it happened, and this book is a testament to that seeming impossibility. Nevertheless, this book is not completely worthless. First and foremost, there are two good stories in the book. (They aren't ER stories, but I can appreciate an interesting medical story even if it doesn't occur in the emergency room. I'll give you a synopsis of the two good stories so that you don't have to read the other 320 pages of this book, unless you have a burning desire to do that for some other reason.) Second, this book is—mercifully—far more readable than The Intern Blues. Gone are the interminable brackets. Marion has also limited the content supplied by the new interns, instead substituting excerpts from his prior books (snore) and giving the reader a fresh analysis of the degree to which efforts at revising postgraduate medical education have been successful. If you're on the edge of your seat waiting for an answer to that last question, I'll spare you the agony of not knowing by giving you a succinct answer: Thanks to managed care and a number of other unpleasant stresses faced by doctors in recent years, it sucks to be a doctor these days. I suppose I could have phrased this negative assessment in a more cerebral manner, but watering down reality is a poor means of communication.

Here are the two good stories in this book:

  • During an intern's first night on call, she unsuccessfully tried to deliver a baby. She recruited the resident, and he also failed. The resident summoned the perinatal fellow (an obstetrician who is receiving advanced training) and he called for the anesthesiology resident to administer general anesthesia. Once the woman was unconscious, the fellow began twisting and pulling the baby's head with more force than he had been using. Still no luck, so he began jerking the head, which then ripped off the baby's body. The intern saw the fellow holding the head of the decapitated infant and—not surprisingly—passed out.
  • A gang member was stabbed at least 100 times in his abdomen and chest, but was resuscitated in the ER and taken to surgery. His enemies found out that they hadn't finished him off, so they returned and barged into the operating room. The surgeon convinced them that he was operating on someone else, and that the guy they were looking for had died in the ER and was now in the morgue. The gang left the OR to confirm this and were apprehended by the security guards and city police. (The original story was more interesting—but, hey, this is just a synopsis.)

Emergency!: True Stories from the Nation's ERs
Compiled by Mark Brown, MD
Published by Villard Books/Random House, 1996, 223 pages

Now this is truly a good book. It's a book of stories collected by Dr. Mark Brown, and the authors are literate, intelligent people with fantastic stories. One of the radio hosts who interviewed me after reading Dr. Brown's book told me, "Your book blew that book out of the water!" While I appreciate such a compliment, I think it would be quite difficult to write a book that's better than his. Bottom line: Buy it!

Emergency Doctor
By Lewis Goldfrank, MD and Edward Ziegler
Published by Ballantine Books/Ivy, 1987, 364 pages

Goldfrank is an expert in toxicology. Lest you forget that, we are constantly reminded of this throughout the book. In fact, it seemed to me that one-third of this book was devoted to worshiping at the Goldfrank altar, one-third was a textbook of toxicology, and the remaining third was ER stories. I can't recall any stories that were particularly outstanding (I read the book over a year ago), but this book does have some good ER tales. Goldfrank and Ziegler are undoubtedly very intelligent, and the book is well-written. Bottom line: I would have preferred reading a book in which there is one ER story after another (like mine or Brown's book), but the stories were good enough to make the overall book tolerable—well, perhaps I'm being too harsh. Compared to Brown's book, this book is not even in the same league. Nevertheless, it's considerably better than some of the other books discussed in this site. I'd buy it.

A Woman in Residence
by Michelle Harrison, MD
Published by Ballantine Books/Fawcett, 1993, 266 pages

It's been a while since I've read this book, and the only lingering impression I have is that it was boring. I can't recall even a single entertaining story in the entire book. Bottom line: Dull.

Five Patients
by Michael Crichton
Published by Ballantine Books/Random House, 1994, 242 pages

When I saw that it was written by Michael Crichton I assumed it would be a first-rate book, so I bought it. Undoubtedly, the publisher is counting on suckers like me to make the same mistake and buy the book based upon the reputation of its author. The literary quality of the book is good, but the content is so insipid that it should be a federal crime to write anything so boring. For example, Crichton treats his readers to an exhaustive explanation of the inner workings of the medical records system at the hospital he features in his book. Is this interesting? He seems to mention patients merely as an excuse to go off on the other boring tangents which fill this book. Crichton wrote Five Patients toward the end of his training in medical school and he's no doubt matured considerably as a writer in the interim. Nevertheless, you as a reader should not be subjected to such a book, which should have been put to death years ago. Bottom line: If I'd written this book, I'd be too embarrassed to let anyone read it. If I were Crichton, I'd buy it back from the publisher so that it could never be published again—thereby preventing any further degradation of his reputation.

A Not Entirely Benign Procedure: Four Years as a Medical Student
by Perri Klass
Published by Plume/Dutton Signet/Penguin Books, 1994, 286 pages

I bought this book because author Perri Klass has somehow acquired a stellar reputation as a medical author. The operative word in the preceding sentence is "somehow," as I'm sure you noticed. This namby-pamby book is a reasonably accurate but dull rendition of what it is like to be a medical student, but the book is more about Klass' circuitous introspections and exhausting analyses than it is a book of interesting stories. In fact, I was so disappointed by this book that I re-read Klass' submission in Emergency Room—Lives Saved and Lost: Doctors Tell Their Stories to see if her book may have been an aberration of her youth, similar to Crichton's Five Patients. Bottom line: The scorecard? Klass is now 0 for 2.

White Coat: Becoming a Doctor at Harvard Medical School
Ellen Lerner Rothman, MD
Published by William Morrow and Company, 1999, 335 pages

Since the author of this book is so fond of first names, I'll return the favor and call her Ellen. While Ellen's book is decidedly better than Klass' cure for insomnia (see above), there are not many interesting stories in this book. This is not entirely Ellen's fault, since four years in medical school cannot begin to compare with an equal time spent in the ER for providing interesting fodder for discussion. However, being the intelligent person that she is, Ellen has crafted some unique ways of filling 335 pages. Some of these expedients include:

  • Going on and on and on about her boyfriend/fiancé/husband, Carlos. I wouldn't have minded all these references to Carlos if Ellen had some truly interesting reasons for mentioning him repeatedly, but it is evident to me that her primary reason for talking about Carlos is that she is in love with him. By the way, she doesn't give us any juicy details of their relationship. I can think of a couple of crude allegorical phrases that describe how Ellen shortchanges her readers in this manner, but I'll leave those terms to your imagination so that I don't sully the minds of any children who happen to be reading.
  • The greatest innovation at Harvard Medical School?  Styrofoam slippers, of course!Making statements which caused me to wonder if some of her ancestors may have originated from Pluto. For example, she makes a statement about a patient wearing "green Styrofoam hospital slippers." Styrofoam? Styrofoam? I don't think Ellen has her facts straight. Like most doctors, Ellen is intelligent but her fund of general knowledge seems to be rather shaky. Another statement which made me wonder about her is when she described how she went out to dinner with Carlos and some other people from medical school. She sat across from him and spoke with him during dinner, then talked to him again in the subway on their way home. She bumped into Carlos an hour later in the residence hall they shared, yet she didn't recognize him so she introduced herself again. And you thought I was kidding about Pluto!
    Related: September 8, 2022: New study identifies how memory of personal interactions declines with age: Research identifies target for potentially developing new therapies to treat age-related cognitive decline
  • Providing details that would not be of interest to anyone. For example, she describes the color (lilac), covering material (vinyl), and placement (around the periphery) of chairs in the dayroom of a psychiatric ward. Since that undoubtedly left you spellbound and hungering for more, I will now clue you in on some more fascinating facts that you will be certain to discuss at dinner this evening with your loved ones: I am now sitting on a wooden chair with a green cushion! Mesmerized, aren't you?
  • Interjecting comments that do nothing but leave the reader wondering what possessed her to include such a statement. A prime example of this is when she mentions the sage advice of Carlos's uncle, who recommended to them that they should be certain to select a good videographer for their wedding.
  • Writing about ER. No, I don't mean discussing interesting ER cases, I mean that Ellen rants on and on about how she and her friends watch the television show ER! This hardly qualifies as a unique experience that is worthy of discussion in a book, and it comes across as puerile and amateurish. I bought this book to read Ellen's stories, not to have her tell me about how she enjoys watching make-believe ER stories on television.
Ellen and Klass are graduates of Harvard Medical School, and both of them have succeeded in tarnishing this school's undoubtedly overblown reputation. It seems to me that HMS students possess an arrogant certainty that they are qualified to write a book just because they attend HMS. I am confident that a medical student from one of those low-status offshore medical schools could write a far more compelling book. Bottom line: This book is not exactly riveting, and very few people will likely feel that it is worth the $25 list price. Care to refund my investment, Ellen?

Becoming a Doctor: A Journey of Initiation in Medical School
by Melvin Konner, MD
Published by Penguin Books, 1988, 390 pages

After reading the two books reviewed immediately above, I was ready to abandon my search for a good book about medical school and read something a bit more substantial, like Mad magazine. It is a good thing I didn't, however. The author of this book, Dr. Melvin Konner, has written an engrossing account of medical training that makes the above two books look like absolute fluff written by students from a junior high school. Dr. Konner was able to trounce those authors because their IQ, even collectively, is not in the same league as his; Konner is an exceptionally bright man and I cannot recall the last time I read a book written by a person who was so intelligent. If anything, he may be too intelligent. In the third paragraph of his Preface he quotes Dante, and in the next paragraph he made me realize that I was in trouble by stating, "In this, too, it resembles Dante's journey: one cannot easily imagine Virgil's trembling acolyte as a twenty-year-old." Well, I cannot easily imagine it, because I haven't the foggiest idea of what the heck he's talking about. I think I vaguely recall Dante's name from my year of humanities in college, but who is Virgil? And his acolyte? Talk to me about zero-order pharmacokinetics of drugs and I understand, but this stuff???

Fortunately, Dr. Konner rapidly dispenses with these impenetrable abstractions and instead provides a deep and engaging description and analysis of his medical school experiences. He has many interesting stories to tell, although these are generally more cerebral in nature and not the shocking gee whiz stories that I prefer. Nevertheless, they are eminently worthwhile to read. The value of this book, however, lies not in its stories but in its overall message: that medical education sucks and doesn't do a good job of producing compassionate physicians. (For the record, I agree.) Just because his book has a message doesn't mean that it will be of interest to only pointy-headed academics; virtually everyone who is interested in reading about the field of medicine should enjoy this book. Bottom line: This is a must-read book. The author has something to say, and he knows how to entertain you as he's relaying his message.

Heart Failure - Diary of a Third Year Medical Student
by Michael Greger, MD

This is the most bizarre and disjointed book I've ever read. Over the course of a few months I made a number of attempts to read it, and each time I was repelled by the author's seething rage and desultory prose. I eventually made it through this book, and I came away with the distinct impression that Dr. Greger is mentally unhinged. It's not that I disagree with everything he says. I agree that medical students lose much of their compassion as a result of the brutality of medical school, and I agree that the actions of doctors are profoundly influenced by the brainwashing they receive from the pharmaceutical industry. Beyond that, I couldn't disagree more with him—or his approach. Greger launches into a vitriolic denunciation of physicians in his first chapter, and his acrimony boils out through the remaining chapters and his schizophrenically organized appendices. His hatred seems to stem from his view that physicians are overpaid, and he thinks that docs are simply being ludicrous when they would like to be eventually compensated for their decade of working 110 hours a week during medical school and residency. In an era when doctors struggle to make as much in a year as some CEOs make in a day (or even an hour), it's time to put to rest the shrill timeworn harping about physician income.

Greger is surely the most cynical and jaundiced physician I've ever come across, and I think his disaffection is rooted less in reality than it is from the fact that part of his brain does not seem to be wired correctly. Here are a few quotes from his book:

  • "My latest dream was of a heavily armed gentleman who went around killing doctors, showing up at meetings with machine guns."
  • "Last night coming home I snatched a dying leaf from a tree and ripped its veins out."
  • "Another killing spree dream, this time shooting members of some cult. One woman pleaded that she has just as much a right to her opinions as I have to mine. I shot her in the face."

It's frightening that anyone should harbor so much hostility, let alone a physician. Shooting someone in the face because she disagrees with your opinion? That hardly qualifies as being a normal reaction. If I had a patient in the ER who expressed such thoughts and exhibited the same level of anger as is evident in Greger's manifesto, I would commit him for a psychiatric evaluation. (I've been through the same meat grinder as Greger, and I've done something that he has not: work in an ER for eleven years. The intensity of being an attending physician in an ER makes medical school seem as laid back as Romper Room, yet after all that I dream about snowmobiles and women—you know, normal stuff. Not killing people!) Greger appears to be a time bomb ready to explode, and one of his friends thinks likewise:

  • A friend with whom I shared my account of third year joked to an acquaintance to remember my name. "Because some day, some day... he's going to be in a tower picking off people with an assault rifle."

That was my impression, too. Oddly enough, there's sometimes a glaring disconnect between his outward persona and his inner furor:

  • . . . wherever I go, whenever I look up, people are smiling at me. I infect smiles from hallway to elevator; they can't help it. It doesn't matter that they're just smiling at my coat. The world interfaces with me with smiles. And so I smile back. All day. . . . To the team at the information desk downstairs I am the "sunshine doctor."

Well, Ted Bundy proved to us the predictive value of outward appearances. I don't know if Greger will eventually act out any of the violent imagery that was concocted in some deep antisocial crevice of his brain, but if he ever blows his cork I hope everyone in his vicinity is wearing a bulletproof vest. If Greger dreams about shooting people who have the audacity to possess opinions that don't mesh with his ideas, I'd hate to see what the Sunshine Doctor would do if he were really pissed. Bottom line: This book is a strange hodgepodge of rambling hatred that is painful to read because of its pathetic lack of organization and the author's endless execrations. Greger strikes me as being extremely intransigent, and I have a feeling that we haven't heard the last from him. Look out.

Her Own Medicine: A Woman's Journey from Student to Doctor
by Sayantani DasGupta, MD
Published by Ballantine Books/Fawcett, 1999, 214 pages

Early in the book, Dr. DasGupta mentions that she is a woman, an activist, a feminist, a "woman of color" (her parents are from India), and her mother was an activist and feminist. That's fine. What isn't fine is how she mentions these facts over and over again throughout the book. After the umpteenth repetition, I was ready to scream.

DasGupta believes that she was picked on during medical school just because she isn't a white male. That's ridiculous. I'm a white male, and it didn't take me very long to realize during medical school that a substantial proportion of the professors were sadistic and enjoyed picking on anyone who was a medical student. I escaped some of this abuse simply because I did very well in medical school, but my classmates—yes, even the white males—were viciously and unmercifully attacked by the profs.

There is one interesting story in this book about an older couple who have a sexual problem long past the time in their lives when Dr. DasGupta seems to think they should have put their sexual organs into permanent retirement. In discussing this, DasGupta reveals not only her pathetic ignorance about sex in general but also her startling lack of knowledge about the medical aspects of sexuality. Yet DasGupta implicitly believes, in spite of her unwarranted stereotyping, that she is the sensitive one who is better able to care for patients. Personally, if I were in need of a doctor I'd rather see one who is better informed and less prejudicial.

Aside from this story, the remainder of the book is disappointingly bland and it gives short shrift to many of the real issues facing medical students and physicians these days. Instead, she laboriously pouts about her myriad inner struggles that she conveniently pins on the woman-hating (she thinks) medical establishment. Bottom line: One good story, and the rest isn't worth the paper it is printed on.

Walking Out On The Boys
by Frances K. Conley, M.D.
Published by Farrar, Straus and Giroux, 1998, 245 pages

Men groping women. Men coming on to women, and making incredible jackasses of themselves in the process. Men getting drunk and acting like barbarians. Men with one thing in mind. Men whose compulsion to talk about sex is so strong that they do it at highly inappropriate times in public. Men who think that pressuring women is their God-given right. If you think that what I just described is a high school football team on an overdose of steroids, you're wrong. These sexual antics weren't perpetrated by adolescents with testosterone bubbling out their ears, they were committed by male doctors at Stanford University. Not being stupid, these demigods put two and two together and realized that they could use their power to pressure women. One of these men made a fatal mistake, though: he pressured Dr. Frances Conley, a topnotch neurosurgeon and renowned researcher at Stanford. Bad move, fella. I suppose that guy never learned that if you're going to pick a fight, you don't provoke someone who can whack you back so hard you just might rethink whether it's wise to be a bully.

As publicity spread about Dr. Conley's fight, more and more women came forward to reveal their stories. This was certainly an eye-opening book. Before reading it, I'd never given much thought about the sexual harassment of women in medicine and allied healthcare fields. Perhaps we're more civilized here in Michigan, because I've never seen or heard of any such hanky-panky. Well, let me revise that last statement: I have witnessed a lot of sexual inducement, but what I saw was women chasing men — not the other way around. But everyone knows that those California folks are trendsetters.

Dr. Conley never envisioned herself as a trendsetter, though. For years, she passively participated in the abuse until a concatenation of events convinced her that it was time to draw a line in the sand. To make a long story short, the men didn't believe she'd put up much of a fight, but she did, and they lost. Big time.

Judging from her picture on the book's cover, Dr. Conley's repeated description of herself as being "cute" is no exaggeration. Although I inferred that she was almost 60 when the picture was taken, she was still very attractive at that age — leading me to wonder how stunning she must have been years before. So is that what precipitated the abuse directed at her? I think it did, at least in part. While her main nemesis seemed to be a sexist sociopath and thus may have been compelled to act the way he did even in the absence of genuine attraction, it seems clear to me that he had the hots for Dr. Conley and some of his retaliation wasn't as much instinctive as it was a calculated response to avenge his unrequited love.

Perhaps the most chilling message in this book is that some men in positions of power are willing to use that power to stifle the careers of women. So what is an attractive woman to assume? That if she goes into medicine her pulchritude will serve as a magnet for sexual harassment? Perhaps this abuse is, unbeknownst to me, more pervasive than I think. I suppose because most of my friends are women, I can't understand men who view women as being somehow inferior. However, you shouldn't necessarily construe from that statement that I think women physicians are as competent, on average, as male physicians. There's no doubt that some are, and there's no doubt that Dr. Conley is a superior physician, not just competent. However, Dr. Conley is the epitome of a dedicated doctor: realizing that there are 24 hours in a day, she chose not to have children and she seems far more married to her career than to her spouse. That's the way it used to be for male docs. Sure, they may have had children, but they weren't the ones raising them. Now women are told they can "have it all." A woman can get married, raise a family, watch her kids play soccer, be active in church and other social functions, pursue her individuality through avocational interests AND she can be not just a doctor, but just as good as docs who live, eat, and breathe medicine. Dream on! Unless a woman was a genius who never slept, it just isn't possible for her to be SuperMom, SuperDoc, and SuperWife. Still, egged on by the politically correct rhetoric in America, some women pressure themselves to be SuperWoman not realizing that something has to give. According to one of my friends who is a woman and a doctor, what gives is often their dedication to and mastery of medicine. Her beef with female physicians is that too many of them are lackadaisical 9-to-5 docs who spend more time baking cookies, shopping, and reading Family Circle magazine than they do reading medical journals. Especially in emergency medicine and the primary care specialties (such as Internal Medicine and Family Practice, both of which draw many women) in which a doctor's knowledge base is so diverse, there just aren't enough hours in a day for a woman to be a superb doctor and everything else that society is telling her she should be. It's no wonder why some women feel so pressured.

Don't interpret this as a criticism of women. It's not. On a level playing field, women can be just as competent as men. The problem starts when women begin diluting their professional time — that's when they begin knocking their heads against the "darn, there are only 24 hours in a day" problem. Even if a woman were married to a man who is willing to share housework, the responsibilities of motherhood are not so easily met. If you're a surgeon who gets home at night after your kids are in bed, who is going to hug them when they need a hug? Your nanny? Or if you skedaddle out of the hospital early to greet your kids when they get home from school, who is going to take care of your patients in the hospital? Or do you think that patients develop problems only from 9 AM to 3 PM? Again, something has to give if you try to have it all. You can decide where you want to cut corners, but you can't avoid the reality that cutting corners will be necessary. I know that, Dr. Conley knows that, and my friend the female doctor knows that, too.

So do male doctors in positions of power have valid reasons for discriminating against women? As painful as that question is, it is a question that begs to be answered. Considering what I just said, you might surmise that the discrimination and harassment of women is a boorish way of informing women that they can't have it all. The problem is that the women, such as Dr. Conley and some other equally dedicated women mentioned in her book, who were the targets of this abuse are not the women who try to have it all and thus are the ones giving their patients the short end of the stick. When a person like Dr. Conley is targeted, it's clear that this is a real problem. In solving this problem, however, I think we should not let the pendulum swing too far and fail to acknowledge that while it is an execration to discriminate against women who are as qualified and dedicated as men, we should not penalize patients by sweeping under the carpet the fact that doctors who think they can do it all are too optimistic.

Before I read this book, its title lead me to believe that it might be a journal of whining similar to Dr. DasGupta's book, reviewed above. However, Dr. Conley is a gifted writer who presented a clear, compelling, and substantive story. On a few occasions my eyes glazed over as she droned on and on belaboring a point for the umpteenth time, but for the most part I didn't want to put the book down. My only major criticism of the book is that it is too focused on abuse of women by men. Since the core of this book hinges on some of the depredations that ensue when power is abused, I think she could have achieved a more balanced perspective by pointing out that powerful people often use their power against men, too — not just women. I've seen male docs fight one another with such a vehemence that it made the stories in Dr. Conley's book seem as pleasant as afternoon tea and cookies with a neighbor. Consequently, while I don't intend to trivialize the unfortunate reality of the abuse Dr. Conley documents, it's important to keep in mind that this abuse is but one aspect of a much larger problem. In defense of Dr. Conley, broadening the scope of this book to include other aspects of hospital politics would have diluted the message she wished to inculcate, and it would have made for a very unwieldy book. With that in mind, I suppose I'm on shaky ground by wishing that her book had a wider focus. Her book, her demeanor, her dedication, her resolve, and her competence are commendable. Dr. Conley is a great doctor and I am happy to have met her, however indirectly, by reading this book.

NOTE: If any readers — female or male — think they know how to overcome this "24 hours in a day" problem, I will gladly post your meritorious responses in this web site to help the many young women who dream of becoming doctors and good wives, mothers, friends, and neighbors. The only realistic solution I can think of is for such a woman to work part-time in a narrow specialty in which she won't be shortchanging her patients by the fact that patients aren't the top priority in her life. In other words, think dermatology or dentistry, not surgery, Internal Medicine, pediatrics, or cardiology.

UPDATE 2-22-2018: #MeToo in medicine: Women, harassed in hospitals and operating rooms, await reckoning

Emergency Room Diary
by Theodore Isaac Rubin, MD
Published by Bantam Books, 1973, 214 pages

Cool your jets. If you're like me, you probably got all hot and bothered just by reading the title, which seems to promise one heck of an interesting book. In short, it's not. The book was written by an intern who spent a whopping total of four months in an ER. As might be expected, such a limited experience didn't give him many interesting stories to write about; there are, in my opinion, a grand total of three mildly interesting stories in the book (which I'll synopsize below). With such a dearth of fodder, the author fills the remaining pages by employing the time-honored formula of including extraneous filler, such as torturing the reader with repeated discussions of his weight (do you really care if he's too fat?) and sophomorically using his rudimentary knowledge of psychiatry to overanalyze common events that aren't particularly interesting on their surface and are even less so when picked apart under a psychiatric microscope.

Another annoying aspect of this book is that the author seems overly fond of the term "self-effacing," and after a while it sticks out like a sore thumb. The author doesn't strike me as being very bright, and "self-effacing" seems to be the only highfaluting word he knows. So, like a child with a new toy, he keeps on using it.

Here are the highlights of this book:

  • A 32-year-old physician was D.O.A. after committing suicide in a bizarre manner. The doc used local anesthesia to numb his neck, which he then dissected. When he reached a major vessel (such as the jugular vein) he tied it off. After doing this a few times the circulation to his brain was cut off and he died.
  • After a freak accident at home, a 12-year-old boy walked into the ER with a 6-foot spear skewered through his mouth and neck. The child was impaled by this war souvenir when it fell toward him as he was running in his room. Extraction was complicated by the fact that the 2-foot-long tip of the spear was barbed, somewhat akin to a fish hook. Nevertheless, after six hours of surgery the spear was removed with little collateral damage.
  • A teenager presented with an irritated penis, fearing that he had VD. Evidently, the patient had never had sexual intercourse, and the irritation was attributed to excessive masturbation. The patient also expressed the perennial male fear that his penis was smaller than average, but was reassured that his size was normal.

Unfortunately, the remainder of the book is noticeably less interesting. Bottom line: Reading this book would not be a total waste of your time, but I can't imagine that anyone who read it would say, "Wow, that was an interesting book, and I'm so glad I read it."

Julia's Mother: Life Lessons in the Pediatric ER
by William Bonadio, MD
Published by St. Martin's Press, 2000, 181 pages

I was disappointed by this book in many ways. Firstly, I didn't find many "life lessons" in this book, and the ones I did find were hardly Earth-shattering. Secondly, there aren't many stories in this book, and they frequently do not pertain to the pediatric ER. Regardless of their focus, none of the stories struck me as being especially interesting—not even the story about Julia's mother, which the author attempted to figuratively use as glue to hold this book together. This book reminded me of a puffed cereal in which a tiny kernel of grain was puffed into something that appears to be large but still has very little substance to it. To fill the 181 pages in this book the publisher made liberal use of white space, excessive line spacing, and small (about 5˝" by 8˝") pages. Thirdly, his stories have a strange unfinished quality about them, and the book as a whole just scratches the surface of what goes on in pediatric emergency rooms. Finally, the technical quality of Bonadio's writing ranges from brilliant to utterly annoying.

The reviews of this book posted on Amazon.com were mostly complimentary, and after reading this book (and many others) I think I know why. In my opinion people are very fond of warm, caring, sensitive doctors, and when a warm, caring, and sensitive doctor such as Bonadio writes a book people are eager to dish out praise. But are they praising him or the book? I think it's the former. Imagine that someone who was almost universally hated such as Adolf Hitler wrote a book. Would most reviewers give him a fair shake in dispassionately judging the literary quality of his work, or would they leap at the chance to bash him? Rhetorical questions aside, I think that many people are apt to lavish praise upon authors who seem to be good guys even if their books are lackluster.

In my experience working as an ER doctor, doctors who are warm, caring, and sensitive can get away with a lot of mistakes. Even when they kill patients through errors of omission or commission, they're still often viewed with reverence. A lawsuit, or even a complaint letter? As rare as a blue moon. I know doctors who have killed more people than some mass murderers, but because those doctors are nice they don't have a black mark on their records. It was with this in mind that I questioned the care delivered by Dr. Bonadio in two of the cases described in his book:

  • In the case of Julia, the 6-year-old girl who was struck by a car and exhibited, according to Bonadio, abdominal bloating " . . . from massive internal hemorrhage." First, I should point out that this girl likely would have died regardless of what Bonadio did. Nevertheless, I wondered why he didn't clamp her descending aorta to stop the hemorrhage or rush her to the operating room? I've seen several patients present to the ER with no pulse or blood pressure after sustaining massive trauma, and they'd be walking around a day or two later complaining about how sore they were. Get it? They were alive.
  • In another case in which an infant was having a prolonged seizure, Bonadio began by saying that ". . . a convulsion in a newborn baby can cause brain damage if it persists too long. How long is too long? No one knows exactly, but it's always assumed that every minute counts. My job here is to preserve every bit of her neurologic capacity . . ." When Bonadio finally placed the IV 22 minutes later I wondered how many brain cells that poor kid lost. And Bonadio claims to be an ER doctor? When I was an attending ER physician in a teaching hospital I never would have allowed a lowly intern to take so long to achieve intravenous access; I would have pushed him out of the way and had it in 15 seconds or less. In 22 minutes I could have started the IV and had a leisurely lunch!

Bottom line: Unless you're an ER doctor (or the mother of one of the children discussed above), you probably are not particularly interested in the technical aspects of Bonadio's performance as an ER doctor. However, as a reader you undoubtedly care if the books you buy are truly interesting. The best story in this book was about a doctor who misread an x-ray as being normal when it in fact showed a broken neck, and I doubt that that story will have many people talking about it over coffee. As I previously mentioned, Bonadio's writing seems to have an unfinished quality that left me feeling as if his work was seriously deficient in something that makes a book come alive and seem engrossing.

The Blood of Strangers: Stories from Emergency Medicine
by Frank Huyler, MD
Published by University of California Press, 1999, 154 pages

In many ways this book is similar to the book discussed immediately above in that its stories are frequently not about emergency medicine, and because of the fact that this is a short book which was stretched to 154 pages only by the use of tiny pages, acres of white space, and w-i-d-e line spacing. However, I don't valuate books based upon their weight or word count; I judge them by whether or not they're filled with intriguing stories and are well-written. This book has a few poignant or interesting stories (the best of which was about a kinky, drug abusing female neurosurgeon), but many of its stories left me muttering to myself things such as "So what?" or "What is so interesting about that?" or just plain "What?" One of the reasons I was so perplexed by some of the stories in The Blood of Strangers is because Huyler occasionally displays a true gift for writing but at other times uses such awkward, almost incomprehensible phraseology that his writing is about as readily understood as an instructional manual written in English by a technician from China who received a D- in his one and only class in English. As you will quickly see if you read this book, Huyler loves to flitter back and forth from one element in a story to another. At times his use of this literary technique is superb, while at other times it appears almost scatterbrained. Bottom line: Sometimes a first-rate book, and sometimes it's anything but. Unless you have money to burn you will probably want to wait until the book is released as a paperback.

You Are the ER Doc!: True-to-Life Cases for You to Treat (read an excerpt)
by Peter Meyer, MD
Published by Avian-Cetacean Press, 2001, 159 pages

In this book, Dr. Meyer presents dozens of cases similar to what real ER doctors see in emergency rooms. Many pop quizzes are interspersed in the vignettes to test your knowledge of emergency medicine. There's no need to get sweaty palms if you haven't been to medical school, because the multiple-choice questions are easy and many of the choices are clearly tongue-in-cheek options. Nevertheless, the book is educational in addition to being entertaining.

Although this book is interesting as it is, it would be even better if the cases presented more challenging dilemmas. For example, one of Dr. Meyer's cases involved a highly intoxicated patient who assaulted a nurse and then tried to skedaddle out of the ER. Readers are then asked what intervention should be attempted, and the correct response was "call hospital security personnel and local police to stop [the patient]." You're then told that "your job is taking care of people, not subduing them." That sounds reasonable, doesn't it? Yes, but it might result in a dead patient—you'll see why in a minute. Since the patient is highly intoxicated the ER doctor is responsible for his safety, and if the boozer were allowed to leave the ER he might be run over by a truck. If that happened in real life, you can bet that an attorney would wring a few million dollars out of the doctor and the hospital. Such cases occur with alarming regularity, and I've been involved in a few near-misses that were not cut-and-dried.

In one of my cases an insane patient escaped from the ER's lock-up room where we'd place patients who were a danger to themselves or others. I saw the patient rapidly leaving the ER and ordered a security guard to restrain him. Now we're at the point where reality departs from an idealized notion of how the world should work: the guard refused, saying that it was my problem, not his. Oh yeah? So why was the hospital paying that guard—to do what he would ordinarily do, which was to stand around and gawk at pretty nurses? I immediately called 911 and had police dispatched to the ER, but you can guess the result. By the time the police arrived the patient had vanished into the cold winter night, and he was never seen again.

Flash-forward a few years. A patient had been placed in leather restraints by the day-shift physician because that patient was psychotic and highly intoxicated and stoned out of her mind by dozens of drugs (if there was a Guinness Book of World Records for simultaneous drug ingestion, this woman would win). The patient was turned over to me when I came on to work the night shift. An hour or so later one of the nurses decided that the patient wasn't kooky after all, so she took off the restraints. Predictable result? The patient made a beeline for the ER exit. One didn't need a Ouija board to know the likelihood of that.

This hospital had no security guards, so that option was not available to me. I asked a nurse to help me, but she refused because we didn't have "enough people." The hospital had a policy in which a quorum of five personnel could attempt to restrain a departing patient, but there weren't five people working at the time! (Parenthetical note to hospital administrators: you might want to drink coffee and wake up before you implement policies that aren't tailored to your hospital.) Counting myself and the two nurses working with me, I immediately announced that 60% of the quorum was good enough, but the nurses once again refused (by the way, how often is such insubordination depicted in those ER television shows?). I went after the patient and tried coaxing her back into the ER, but it's not easy to reason with a person who isn't tuned into reality. She told me she was going to walk home, but I didn't think she'd be able to stumble down dark roads for 40 miles without getting plastered by a car. It was so dark out that night that I could barely see the patient, but when she began punching me I had a fairly good idea of where she was.

Imagine that you're the ER doctor in that situation. What would you do?

(a) Inform the patient that she might damage one of the many rings on her fingers if she punched hard enough.
(b) Immediately quit your job and search for something a bit easier.
(c) Call the Psychic Hotline and request a stat consultation.
(d) Let her leave even though she had a young daughter who might be orphaned in the next minute or two.
(e) Restrain her.

Space does not permit me to describe the ending of this story and its aftermath. Suffice it to say that it was one of the most bizarre cases I've ever been involved in, and I described it in detail in my upcoming book of ER stories which is tentatively entitled ER Doctor: An Uncensored View of Unusual ER Cases. If you want to be notified when that book is published, contact me.

A Doctor's Life: Unique Stories
by William T. Close, MD
Published by Meadowlark Springs Productions, 2001, 211 pages

In this autobiographical accounting of his medical career, Dr. Close recounts many events in his extraordinary life and also gives readers a taste for the sacrifices required of physicians and their families. While reading this book's foreword (by his daughter, Glenn Close, the actress) I was struck by the fact that she seemed to do her best to put on a good face, yet she appeared to have been deeply wounded by something. But what? The answer to that mystery unfolds in the pages of A Doctor's Life in which it is evident that the author's stellar career came at the expense of his family, who were given short shrift as he toiled day and night taking care of patients. Therefore, I think that all prospective medical students should read this book and then, before they commit themselves to the field of medicine, question whether or not they're willing to make such a sacrifice. Yes, it is possible to be an excellent doctor without neglecting your family, but only if you practice in one of the 9-to-5 specialties such as dermatology or allergy/immunology. If you're a real doctor, such as Dr. Close, something has got to give: your patients, or your family. Tough choice, isn't it? The decision made by many doctors in these days of HMO-ization is to be a second-rate doctor; I can't think of any physician my age who is as intensely devoted to medicine as some of the sages who trained me. Bottom line: Apart from being a useful eye-opening tool for people thinking of becoming doctors, this book has enough interesting stories to make it a worthwhile read for anyone.

Trauma Junkie: Memoirs of an Emergency Flight Nurse
by Janice Hudson
Published by Firefly Books Ltd, 2001, 252 pages

Even though I'm an ER doctor and I've called in my share of medical helicopters to evacuate severely injured people to specialized trauma centers, the sound of a helicopter landing on the ER helipad always cranked up my pulse by a notch or two. Aircraft of any sort are exciting, and so are emergencies. Combine the two into a book, and it's bound to be interesting. Is this book? Yes. The author does a good job of immersing you in her stories, and once you begin reading this book you probably won't want to put it down. Not all of the book concerns her experiences in the CALSTAR air ambulance service; some of the material recounts her career as an ER nurse. Nevertheless, I found that material equally interesting. The only criticisms I have of the book (both of which are very minor) are:
1) The author tends to pull her punches. It seems to me that many authors are afraid to say what they really think for fear of offending some readers who possess contrasting viewpoints. I prefer that authors speak their minds, especially when their opinions were shaped by the experiences they're describing. When I began working in the ER I had virtually no opinions, but after a decade in the ER cauldron I've developed some very strong opinions. Likewise, most ER personnel I know harbor similar opinions that they're not shy about relating to one another, but when most of those folks sit down to write a book they clam up and sterilize their work.
2) The author describes the personality and appearance of several co-workers in her book, and in the center of it there's a group photo of the CALSTAR gang (in color, nonetheless). However, there isn't any accompanying caption to explain who is who.

Notwithstanding these minor flaws, Hudson produced a commendable book . . . which brings me to my next parenthetical comment. This book was published by Firefly Books Ltd, a Canadian publisher that is to the publishing world what I am to Major League Baseball. As a rule, authors (and the literary agents who represent them) do not initially seek out these unknown publishers; instead they typically present their works to major publishers and then go with the second- or third-tier publishers only if their book is rejected by the big guys. Or authors may choose to self-publish, although that's sometimes inspired by a desire to avoid the turmoil involved in working with an arrogant, bureaucratic, closed-minded, and snail-paced publisher. In any event, Hudson's book is certainly good enough so that any publisher should jump at the chance to publish it. The fact that this book was published by Firefly Books Ltd is solid evidence that major publishers often have trouble discerning what books are good and which are not. Some of the most boring books (such as On Duty: A Nurse's Notes on Life and Death and EMT: Rescue!) I reviewed on this page were published by well-known publishers. It's odd that the garbage is published by major publishers and some good books are put out by virtually unknown publishers. Want a clue as to why that happens? Those boring books were so thoroughly distilled that not one person in a million would be offended by them (except for the fact that they're utterly insipid), but Hudson managed to let a few opinions slip through that are bound to make left-wing publishers (OK, I'm being redundant) bristle. They've anointed themselves as the thought-police, and if an author's ideas do not mesh with their rigid conceptions, that author's book will be tossed in the rejection pile.

True Emergency Room Stories
by Kevin Pezzi, MD
Published by Transcope, 1998, 184 pages

Since I'm doing my own review, I'll bend over backwards to be fair and lead off with the worst comment I've ever heard about the book: one fellow was upset because he liked only half of the stories in the book. I thought, "What? If I liked half of the stories in a book, I'd be thrilled." There are at least 176 stories in my book, so he liked about 88 of the stories. With the possible exception of Mark Brown's book, I doubt I found 88 stories that I liked in all of the other books put together! Others have had much nicer things to say about my book (they're listed on the Reader Reviews page, so I won't repeat them here).

It is my belief that people are particularly interested in things that are different than what they regularly experience in their lives, and especially things that are downright bizarre. With that as my guiding light, I've included many such stories in my book. I think that people also want to get a real feel for what it's like to be an ER doctor, so I put several stories in my book that will give you the opportunity to step into my shoes, and my mind, for a while. To top it off, I added some humorous and heartwarming stories, too. Bottom line: I just received a postcard from someone who is reading my book for the second time. That's quite a compliment.

Excerpt: As Stan and Mindy walked into the ER, I guessed from their attire that they had attended the senior prom. Noticing the blood on Mindy's gown, I surmised that this was the reason for the ER visit. I was correct on both counts.
Having never attended a prom, I have only secondhand, anecdotal reports of what goes on during and after such an event. Suffice it to say that losing one's virginity after the prom is not a rare occurrence. Indeed, Stan and Mindy had succumbed to their youthful passion and consummated their long-term three-week relationship. While most women manage to lose their virginity without a subsequent visit to the ER, most women do not have to contend with Stan or someone like him. More about him in a minute.

[I'd better cut that excerpt short, since there may be children reading this. Also, I don't want to give you the impression that my book is just about sex; of the 176 stories, 21 deal with sexual matters, and another 20 or so relate to romance.]

Here is Amy's review of my book:

I first stumbled upon True Emergency Room Stories at the public library. Why it was at the library, since as far as I know, it's only available through Amazon, is beyond me. In fact, I've even gone back to the same library to re-check and it wasn't there. The Fates must have been at work.

If I could compare reading this book to anything, I would compare it to one of those first scenes in the movie, "The Matrix." More specifically, the one in which the main character Neo is given the choice between a red pill, which will let him see the world as it really is, or a blue pill, which will let him go on seeing the illusion of the matrix. Reading Dr. Pezzi's book is like taking the red pill. Things happen in emergency rooms that I never would have thought of before and are very interesting.

Furthermore, Dr. Pezzi's book is astonishingly well written. I don't think I've read any books (or at least not very many) that drew me in like this one. When I read it, I could picture everything he talked about. Of course, if you're a sappy person who cries every time you pass a dead possum on the side of the road, this might not be the best thing.

Anyone who is interested in medicine, especially emergency medicine, should read this book.

Here is Amy's review of another book:

by Samuel Finn
Published by Booklocker.com, 2002, 232 pages

Wow. This book was absolutely nothing like I thought it would be. It's an amazing story about a guy who is confused about everything; from God, to his sexuality, to his mental stability, to death, to his life in general, and is, more or less, crazy. It kind of had a "Sixth Sense" meets Ernest Hemmingway feel.

Dr. Finn did a beautiful job writing this book and it completely draws you in from the beginning. It really isn't about medicine as much as the main character Leon, but there are a lot of medical conversations concerning Leon's patients. I think the only negative thing I have to say about this book is this: foul language. I realize, of course, this is realistic, so it doesn't bother me.

Heartbeat is a very well-written book with an original story line. Anyone who likes to read about crazy people whose job involves other people's lives will love this book. I know I did.

Old medical books
Old Medical Books (General)

The Doctors

Such a generic title fails to warn potential readers that this book is a 570 page continuum of gloom. Martin Gross, the author, appears to be in dire need of Prozac or electroshock therapy, and after reading this book you'll be fortunate if you aren't needing the same. The Doctors should have been titled Lambasting the Doctors, since Gross incessantly criticizes physicians. As a group doctors are far from perfect, but it's difficult to believe they're so flawed that they deserve a million-word indictment. And even if you believe that they do, do you really want to read such a diatribe? I can't imagine that anyone would find this book interesting unless he was a malpractice attorney or someone who had a deep, burning resentment and hatred of doctors. I do not object when an author discusses malpractice since this fear is so ingrained that physicians give it at least fleeting thought every time they see patients, and much of what doctors think, say, and do while interacting with patients who have potentially serious problems is strongly colored by one recurring thought: avoiding a lawsuit. Hence, any author who ignores this facet of medicine is not giving his readers an accurate depiction of reality. Nevertheless, it is possible to discuss this subject so that it's at least reasonably interesting, but Gross does not have a knack for expressing himself in a colorful way. Bottom line: Written as it is, one page of this book is too much, and 570 pages is sheer torture.

O.R.: The True Story of a Nurse Anesthetist

Any nurse anesthetist who wishes to write a book of interesting stories faces one insurmountable problem: what an anesthetist does is generally performed in a routine manner under very controlled conditions. Hence, it's not particularly interesting. Bottom line: What's next? Gripping True Tales from the Dermatology Ward?

12, 20 & 5: A Doctor's Year in Vietnam

And oh what a year it was! From dodging artillery shells during surgery to boinking almost every semi-receptive female, author John Parrish, MD gives readers a front row seat as he fulfills his government-mandated yearlong tour of hell. His account is vivid and engaging. Anyone who reads this book is bound to have a profound admiration and respect for people who serve in our armed forces.

I firmly believe that anyone who shells out his money for a book should be treated to a no-holds-barred, tell-it-like-it-is, spill-your-guts story. Apparently Parrish agrees with me, and he treats his readers to a shockingly uncensored replay of his Vietnam experiences. Bottom line: Like any great book, this one will stay in your veins long after you've read it.

The Making of a Surgeon and A Surgeon's World

Both books are by William Nolen, MD. The first book describes his experiences while he was a surgical resident at Bellevue Hospital in New York. With five years of 100+ hour weeks stuck in a major inner city hospital, it seems like he'd have a lot of interesting things to write about, huh? Apparently not. While I never fell asleep reading it, it was only every 100 pages or so that I found something genuinely interesting. Bottom line: I'd read it only if you're embarking upon a surgical residency or are somehow enamored with quotidian details.

A Surgeon's World is markedly better. In it, Nolen appears to have loosened up as a writer, and he relates one subject after another that would make most doctors turn red, from either embarrassment or rage. There's an unwritten rule in the medical profession that some subjects are off-limits to doctors who write about their experiences, but Nolen has ignored this taboo—unlike most such authors who . . . yawn . . . can't bring themselves to tell their readers the whole story. This book is certainly no anti-doctor tirade (as is The Doctors, reviewed above), but it is an amazingly accurate depiction of what it's like to be a doctor, warts and all. Readers will be disabused of their fairy-tale conceptions of the practice of medicine while they're being entertained by a variety of interesting stories. Bottom line: An enjoyable and informative book.

Code Blue: A Writer's Guide to Hospitals, Including the ER, OR, and ICU
by Drs. Keith Wilson and David Page

Code Blue is a great introduction to hospitals for anyone interested in this topic. While the book's title suggests that it is intended as a tool for writers, I think that many other people would like to have a more comprehensive understanding of the practice of medicine in this venue. This book was unmercifully hammered by the two customers (so far) who reviewed the book on Amazon.com, both of whom rated it only one star out of a possible five. The common thread in their dissatisfactions seems to stem from the fact that this book doesn't offer a detailed explanation of everything that might possibly occur in a hospital. If such a book were to exist, it would be infinitely long and comparably expensive. Working within the bounds of practicality, I think that Drs. Wilson and Page have done a superb job of providing an overview of this subject. If you're looking for highly detailed knowledge on a specific subject you will likely need to perform further research, but that should not be construed as being a criticism of this book. Bottom line: A well-written and informative guide that will give you an insider's view of hospitals.

Take Two Aspirin and See Yourself in the Morning
by Dr. Robert Norman (M.D., I presume)
228 pages, published in 1997 by Mancorp Publishing, Inc.

Dr. Norman comes across in this book as a warm, caring, decidedly old-fashioned doctor who generally enjoys his work. Nevertheless, after reading this book I cannot fathom what inspired him to write it. Doc Norman seems to be a great guy, but this book is laudable only as a cure for insomnia. Norman describes hundreds of patient visits, the vast majority of which deal with acne, rashes, warts, minor infections, and other commonplace maladies that are anything but Earth-shattering. It took me months to read this book because I was never compelled to see what was written on the next page; the only reason I finished it was because an acquaintance loaned the book to me and I did not want to possibly offend her by returning the book unread (with its attendant implication that I do not share her vision of what constitutes a good book).

The most interesting story—excuse me, the only interesting story—in the book concerns a nutty patient who kills her child, but after a few paragraphs Norman reverted to something that is much more typical: a discussion of an eyelid rash. Very pedestrian.

For being a personable fellow, Norman chose a questionable title for this book. Does it suggest that he's merely a proponent of therapeutic minimalism, or that he's abnegating his end of the doctor-patient relationship? Who knows? Norman does a remarkable job of distancing himself from his readers in spite of his superficial warmness, and his true feelings seem to be cloaked by an impenetrable veneer. In the epilogue of his book he attempted to tantalize readers with the revelation that his gripping tales will spill over into another book. I was disappointed by this book, and there wasn't enough interesting material in it to make me want to give him a second chance.

The Solid Gold Stethoscope
by Edgar Berman, M.D.

I've never met Dr. Berman, but after reading this book I imagine that he'd be so busy cracking jokes and laughing at his humor that he wouldn't notice that people around him were not laughing. In The Solid Gold Stethoscope Berman comes across as a juvenile punster who believes that puns are the sine qua non of communication. I'm not averse to an occasional pun, but after reading this book I wondered if Berman would be less annoying if he took lithium regularly.

The message that Berman attempts to paint in this acerbic book is that the various medical specialties—and primary care doctors, too . . . Berman bashes all of them—are primarily nifty ways of separating patients from their money. His denigration of physicians has a grain of truth behind it, but his characterization is so out of touch with reality that it can only be termed a caricature.

I agree with one of Berman's many criticisms: that the practice of psychiatrists having sex with their patients is wrong even though it was ostensibly intended to help them. The supposed justification was this: since Freud thought sexual problems were the root of mental illness, sex (good sex, presumably) could also be part of the cure. Curiously, though, most psychiatrists who employed such a practice deemed it necessary only if the patient were an attractive woman. Hardly a coincidence.

I thought that this fornication practice was antiquated, but an attractive woman recently told me how a psychiatrist chased her around his office, pulled off her clothes, and then told her how beautiful she was. That must have made quite an impression, given that she was only 17 at the time. She hasn't seen another psychiatrist since . . . and that's hardly a coincidence, too.

So You Want to Be a Doctor
by Alan E. Nourse, M.D.

Many people who aspire to become doctors write to me asking for advice. To help them I've posted some information in my Q&A pages, but I haven't covered every conceivable question (and even if I had, it's always good to obtain another opinion). Dr. Nourse's book (and others in this genre) are wonderful adjuncts for helping young people decide if a career in medicine is right for them.

The primary deficiency of this book is that it ignores some of the problems that plague physicians, such as frivolous malpractice suits and the nightmare of managed care and government intervention—which might collectively influence a person to choose another career. Another problem is that this book is too formulaic and it assumes everything will go as planned. Real life is not always so simple. A case in point (albeit a happy one). After reading many books and articles about the medical school application process, I had the impression that I would be intensely grilled during the interview and asked to expound on one of the perpetual quandaries of medical ethics. I concocted some pat, coherent (I hoped) answers to the ethical dilemmas which were in vogue at that time, and I digested most of my stomach lining wondering if I'd covered all possible angles.

The interview was nothing like I'd expected. Detroit was engulfed in a blizzard when I arrived for the interview. I could barely see the hospital from where I was parked and the only visible way to reach the hospital was by climbing over two fences topped with barbed wire (hey, this was Detroit, after all). I wasn't about to let a bit of barbed wire keep me from getting an M.D. degree so I scaled the fences, deftly avoiding the razor-sharp wire, and then plopped down into some deep snow drifts. Brushing the snow off my suit and shivering as it melted in my shoes, I finally reached the hospital just in time for my interview. The doctor who interviewed me didn't waste much time in telling me that I was going to be accepted. Instead of raking me over the coals, he asked a few casual questions about my family, and that was it. What a pussycat, I thought.

Boy, was I wrong. Flash forward several months. My lab partner in medical school, John, and I were discussing our respective interviews. I was surprised to learn that John had the same interviewer as me, and I was even more surprised when John said that the interviewer screamed at him and told him he was too stupid to be a doctor—which was obviously not true, given that John was admitted and graduated. Neither of these extremes—the cordial approach I received or the pointless verbal assault unleashed upon John—were mentioned in the material I'd read. I don't wish to convey the impression that it's useless to read a book such as So You Want to Be a Doctor, but don't expect it to give you all the answers.

Life Support: Three Nurses on the Front Lines
by Suzanne Gordon

Three Nurses on the Front Lines? Doesn't that suggest that nurses are at war? Yes it does, but the war is one with which you may not be familiar. Many nurses, and the self-avowed feminist Suzanne Gordon, have declared war on doctors. Like most wars, this one includes propaganda. That's where this book fits in.

After reading Gordon's book, I came away with the impression that she thinks doctors are a genuine nemesis to patients while nurses, not surprisingly, are irreproachable angels. In short, it's doctor is bad, nurse is good. Oh, Gordon tries to camouflage her seething rage for doctors by tossing in an occasional tidbit of praise, but for the most part Gordon uses anecdotal and other selective information as evidence that doctors are the problem and nurses are the solution.

In her attempt to smear physicians, Gordon raises some rather specious arguments, such as suggesting that nurses with less training give better care than physicians with more training. Yeah, right. I might believe that argument except for two things: it contradicts common sense, and it doesn't mesh with overwhelming evidence to the contrary. Let's begin with the facts. A person can become a registered nurse (RN) after a whopping two years of college. To become a licensed physician requires several times as much training that is unquestionably far more intensive. Here's another fact that is bound to make Gordon writhe in envy: the average IQ of a medical student is 130, which qualifies as borderline genius. I've never seen any statistical average for the IQ of nurses. I'd guess that they're brighter than average, but certainly not in the borderline genius range. Yes, there are some very bright nurses, but the average nurse just isn't as intelligent as the average doctor. So, Gordon would seemingly like for you to believe that the recipe for training superior healthcare providers is to start with people of lesser aptitude and give them less training. This notion is pure hogwash.

Years ago, one of the brightest nurses I knew approached me in the ER on a fairly slow night and asked if he could "play doctor." That is, he'd do everything that I, as the real ER doctor, would do: take a history from the patient, perform a physical exam, order and interpret lab tests and x-rays, and arrive at a diagnosis and plan of treatment. Since I'd be double-checking his work, I had no qualms about this arrangement. I was surprised by a couple of things: he seemed to have trouble thinking of a plausible diagnosis, and he could not perform a complete EKG interpretation even though he had far more ER experience than me. (Most ER nurses are very good at interpreting cardiac rhythms, but I've yet to meet an RN who is skilled in interpreting a standard 12-lead EKG.) Interpreting an EKG, by the way, is a very basic thing, sort of the doctor equivalent of what alphabet blocks are for preschool children.

I certainly don't intend to disparage nurses, because I genuinely believe that they're an integral and irreplaceable part of our healthcare system. However, there is a definite difference in the aptitudes, skills, and personalities of nurses and doctors. The average doctor would not make a very good nurse, and the average nurse would not make a very good doctor. In spite of these differences, Gordon apparently believes that some of the problems associated with our healthcare "crisis" is sufficient justification for making some nurses into ersatz doctors who diagnose and treat patients without spending an hour in medical school.

One of the themes that permeates Gordon's book is the myth that nurses are more caring than doctors, which she probably uses as intellectual justification for her crusade against physicians. This, too, is hogwash. For every anecdote she gives in support of her contention, I can give her two that contradict it and show that physicians are actually more caring. Sure, nurses are more likely to hold your hand than doctors, but in my experience nurses tend to hold the hands of patients who are likeable while giving the cold shoulder—or worse—to patients who are not. For example, I couldn't begin to count the number of times I heard nurses gleefully discussing how they wanted to ram a large urinary catheter up a patient to teach him a lesson or seek revenge. I've also heard nurses discussing how they'd like to inject HIV into patients they detested. I've also seen nurses intentionally inflict pain upon irritating patients (what really seems to get the goat of nurses is verbally abusive teenage males who love to antagonize people). In the worst episode I witnessed, a group of nurses went berserk and attacked a kid who was admittedly a jerk but definitely not deserving of sadistic torture. Perhaps the most disturbing aspect of that episode was that the nurses involved in that melee actually looked like they were enjoying the retribution!

Gordon seems to fancy herself as an East-coast intellectual who can sit on her high horse and spout propaganda that is intended to influence public policy throughout our nation. My advice is that she get out in the real world some more. While the average nurse certainly isn't running around with a syringe of HIV-laden blood looking for an unruly patient to impale, the average nurse is also not the deity depicted in Gordon's book. Furthermore, the average nurse is skilled at nursing, not outwitting doctors who have substantially more training. Anyone who wants to play doctor should go to medical school, instead of mounting a PR campaign that assails doctors and glorifies nurses. No amount of hype can make up for their lack of training, and anyone who attempts to do so is being irresponsible. My Dad used to tell me that lazy people are always looking for the easy way to success. Some nurses think they've found it by being able to play doctor without having to endure the hardship of medical school and internship. Such nurses are fond of trying to make the argument that they're a cost-effective alternative to physicians for common health problems. Since I am an advocate of saving healthcare dollars whenever possible, I would strongly support how some nurses are playing doctor these days, except for one problem: many, if not most, diseases present with common signs and symptoms, even when those diseases are uncommon. So how can a nurse who purports to be an expert in common maladies know when the mélange of signs and symptoms now facing her add up to something other than a garden-variety problem? She can't. In short, she's playing Russian roulette: hoping for the right outcome, but having no way of really knowing it.

Aside from the fact that Gordon and I have remarkably different ways of interpreting reality, I didn't like this book. It is one of the least enjoyable books I've ever read. It doesn't have any notably high or especially low points; instead, it just drones on and on. Bottom line: I was going to say that Life Support needs life support, but what it really needs is to have its plug pulled.


If you're a nurse who thinks I'm being overly critical of nurses, you might want to read this discussion by a person who was a nurse before he was a doctor.

Morphine, Ice Cream, Tears: Tales of a City Hospital
by Joseph Sacco, M.D.
264 pages, published in 1989 by William Morrow and Company, Inc.

This is another book in the genre of "the trials and tribulations of interns and residents." Considering the sleep deprivation and unrelenting pressure they endure, it is not surprising that depression is fairly common in interns and residents. Dr. Sacco is no exception. He entered medicine with lofty idealism, and was so battered by his experiences that you, the reader, will likely wish you were a doctor so that you could send him a prescription for Prozac. When I looked at his picture on the back cover of the book, I was struck by his melancholic countenance. I've seen suicidal patients who looked more chipper than that! Sacco seems down in the dumps throughout most of the book, but this book has some redeeming features. Its honesty, for example. Unlike some authors who give whitewashed and sanitized depictions, Sacco doesn't pull any punches. He tells you what is on his mind. For example, he describes how we waste money taking care of people who have no hope of recovery. As a physician who shares his concern over the shameful torture that we inflict on patients with hopeless conditions just so their relatives can feel good that they did everything possible, I am glad that Sacco vented his spleen on this issue.

Sacco includes several "mini-lectures" in the book to familiarize laypeople with technical information that will help them understand subsequent discussions. If you're a doctor or nurse, you will likely be bored by these tangents, but you'll probably appreciate them if you don't have a medical background.

Much of this book is overstated. For example, his estimate of "the drugs that really work" is unjustifiably low. I understand his point (which is that many drugs are not very effective), but he isn't even close to the true number.

Sacco admits that he is a liberal who went into medicine to help people. If you keep that in mind as you read the book, you will be shocked by some of his revelations, such as the tidbit on page 161 where he thinks about ". . . throwing a patient through the window . . . ." In the next paragraph, he daydreams about his thoughts when summoned by a nurse to replace an IV on an old patient with small and frail veins, thinking "If I ever get my hands on the sorry-ass nurse who woke me up for this I'm going to tear her into little teeny, tiny bits of bloody macerated flesh. And then when I'm done with her, Mr. Small and Frail Veins, I'm going to come back in here and stick this IV into your eyeball."

I think this is a good book to read if you're considering medicine as a career. Television shows such as ER give an overly idealized and simplistic picture of reality. Sacco goes too far in emphasizing the negatives, but that will serve to balance the overly positive depictions you will likely obtain from other sources. He gives some good advice, though. For example, he begins Chapter 3 by saying:

Somebody should have told me, way back when I made the decision to become a doctor, somebody should have sat me down and said, "Kid, think twice. It ain't what it seems to be from the outside, this medical business. It has nothing to do with the hype, or the status, or the media image, or Ben Casey, or Marcus Welby, or any of that crap. The fact is that it can get very ugly and very uncomfortable, so give it a good long think before you get involved."

I couldn't agree more.

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