BOOK REVIEW: GOD PLAYER by Robin Cook

 

Robin Cook is one of my favourite writers for obvious reasons. He is/was a practising Surgeon who specializes in Ophthalmology (those surgeons who only operate on the eye). By now my followers already know I love doctor-writers. Michael Palmer, Robin Cook, AJ Cronin, Ben Carson, Sigmund Freud, the list is endless. Medical thrillers are my favourite casual reads. In God Player, Robin Cook outdid himself.

In my opinion the book deserves to be in the same class as the author’s bestsellers. His brilliant works; Coma, Brain and Fever rightly belong in this class as well…. Although I found Coma a tad too outlandish and delusional; a third year medical student solving a major medical mystery that even qualified doctors could not solve. Perhaps I am biased by the fact that I read the book when I was already done with medical school. It is my belief that Coma was meant for a more adolescent audience as a source of inspiration. I find it peculiar that the dark Twilight series was also meant for the same audience. I found Twilight to be extremely dark and too close to resembling the actual reality the work of fiction tries to emulate.

Back to God Player…The plot, as customary with the writer in question, is deceptively simple. A hot young trainee (Psychiatry resident) marries a great heart surgeon who dithers in drug abuse which ultimately leads to his demise. Apart from the safe stereotypes of the Psychiatrist as the sappy doctors and the Surgeons as direct servants of God, the book raises a serious and often suppressed fact that mental illness is more prevalent among doctors compared to the rest of professions. Dr. Thomas Kingsley, the self-proclaimed best Cardiac Surgeon in the country (of the United States of Armies), marries the beautiful Psychiatry intern who makes a major shift from Pathology to Psychiatry on account of a debilitating medical disorder (juvenile diabetes mellitus) she knows she will eventually succumb to.

It is deceptive to assume that Cassie is the protagonist of the story. It is actually Thomas who holds that honour. Like most Surgeons he is genital philanthropist and has the temper of big brown bear….who has sex with a lion….and sired the grumpy character in the movie Inside Out. He uses the medical license of his dead former landlord to prescribe narcotic and amphetamine drugs to himself. He hoards bottles and bottles of the orange dynamites in the second drawer of whichever desk he is sitting behind. The sharp intern-wife uses her medical wits to put pieces in the puzzle that has Thomas’ fingerprints all over the place. Add to that a bitchy mother who I assume the Harpers’ mother in Two and a Half Men was based on.

All angles added, Robin Cook deserves a star on my Robin Cook-vs-Michael Palmer contest chart. So far its neck and neck. I still have a lot of reading to do on the long list. I highly recommend this book….especially if you love medical thrillers like I do.

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BOOK REVIEW: The Judas Tree by AJ Cronin

AJ Cronin and I have a lot in common. We are both doctors and writers. We are both misunderstood. The list is quite exhaustive. Naturally I gravitated towards this book, The Judas Tree, because of the shared background and the theological connotations of the title. Theology is one of my deep interests. Judas is best known as the ultimate traitor. He betrayed his master for a paltry sum of silver coins, thirty of them to be exact. In penance for his sin he committed suicide by connecting his neck to a tree branch via a rope and letting gravity do the rest.

The book is semi-autobiographical just like most of the writer’s works. The protagonist, Dr. David Morey, is the typical rags-to-riches character of a doctor who struggled to come out of training but was blown away by one of the myriad opportunities the profession offers. He proposes to marry an innocent rural lass, Mary, and falls deathly ill will a respiratory tract infection which forces him to take to the seas for fresh air. He gets a job as the Ship Surgeon and quickly draws the attention of the well-to-do Holbrook family. His potential is undeniable. Their daughter, Dottie, throws herself at David and he is trapped in a life of luxury. He goes on to marry the spoiled brat and earn his stake in the family fortune.

Relief comes when Dottie finally dies. He starts to look back on the life he ran away from and the girl he let down. The esteemed doctor heads back home, Scotland, in search of redemption. He finds Mary also buried and Providence affords him acquaintance with Mary’s daughter Kathy whom he tries to spoil the way he always hoped to spoil her mother. This road leads to his own Judas tree, lálbero dei dannati, the Italian term for ‘the tree of lost souls.’

The language is flowery and fluid. The characters invoke such deep emotions you get the feeling that the author actually had a feel of all those emotions himself. I highly regard AJ Cronin and I highly recommend this book.

The Difference between a Surgeon and a Physician

I always stand guard against over-generalisations and over-simplifications but sometimes there is no choice but to succumb to the banalities of common literature. A surgeon is a medical doctor who specialises in doing operations (as the British say) or operating theatre procedures (as the Americans call it) while a Physician on the other hand specialises in prescribing drugs and everything else other than “cutting to effect a cure”. There are overlaps of coarse: Surgeons also prescribe medications and Physicians also do some surgical procedures. The subject of my essay however is not about the qualifications and job descriptions of the two but in the juxtaposition of personality traits that continues to pique the interest of any individual who finds themselves picking lilies, thorns and roses in the rich field that is the medical profession.

Scientific work has been done to better understand these differences. A few come to mind. Rene Warschkow et al did a comparative cross-sectional study on personality traits in Internists (the American term for Specialist Physicians) and Surgeons in Switzerland using the Frieburg Personality Inverntory and published some interesting findings. In general, Surgeons viewed themselves as having excessive achievement orientation and extraversion (talkative, energetic, enthusiastic and assertive) while their counterparts, the Physicians, admitted to having decreased aggressiveness. In the study Surgeons had the stereotype of being less inhibited, more excitable, aggressive and strained while Physicians on the other hand were almost balanced and had the stereotype of having highly developed social orientation. McCulloch et al also published interesting findings on tolerance of uncertainty, extroversion, neuroticism and attitudes to randomised controlled trials (how a doctor accepts the new science) among one thousand (1 000) Surgeons and Physicians who were mailed questionnaires and replied. Surgeons were found to be more extroverted (the talkative doctors) and less neurotic while also being more intolerant of uncertainty. However, no difference was found in the attitudes regarding clinical trials.

On the 27th of September 2013, at the International Conference on Residency Education, Dr Joseph M. Drosdeck of Wexner Medical Centre Ohio made a very fascinating presentation on his findings in a study he did on 68 Surgical participants and 124 non-Surgical participants on the Five Factor Model (also known as the Big Five Inventory Survey). I have to admit this single work of science – the Big Five Inventory Survey – has been the single most powerful driving force behing this nifty essay. Drosdeck compared five aspects of personality:

1. Extraversion (explained above)

2. Agreeableness (sympathetic, kind, mature, caring and affectionate – both hostility and indifference)

3. Conscientiousness (organised, thorough, diligent and planful). Good impluse control also falls under this category.

4. Emotional Stability (Neuroticism) – calm in the face of adversity. Low scores were associated with Anxiety, Depression and self – consciousness.

5. Openness to Experience (Intellectual, creative, artistic – Conventional andConservative) OR

Preference to familiarity

I found Drosdeck’s conclusions very fascinating. He concluded that there are indeed inherent personality differences between Surgical and non-Surgical specialties AND personality traits change during medical training. This is exactly what we ALL have known: Surgeons are born but can be made. Physicans are born but can be made. Now that I have the warm embracing cushion of fact allow me to embellish and indulge.

I know a real Surgeon. I have met him. He has a very deep voice and he loves his drink. Legend has it he once vomitted into an open abdomen while operating. He was called to an emegerncy (even though he was not on call) while lubricating and because he is a real Surgeon he responded. The patient survived, made a full recovery and the Surgeon is still a real Surgeon. I remember a particular day. I was seated somewhere in a plain dark corner while the Surgeon introduced us the meek medical students to Surgery. He said and this I remember clearly for it was during one of those few moments I actually paid attention during a lecture, “A Surgeon has eyes of an eagle, the heart of a lion, hands of a baby……”. He must have said more but I blanked out as usual. He is a politician, loves authority, thinks he’s the greatest Surgeon on earth, thinks being a Surgeon is the greatest call on earth and believes, “God’s greatest gift to mankind is a functioning anus.” He has childish tendencies. I remember one day in theatre we had a very interesting case and my other boss, the other real Surgeon, decided to grace the theatre with his presence. In came in the real Surgeon late, takes one look at the other real Surgeon and sulks his way through one of the best acts of thievery I have ever seen. I believe a Surgeon has to be a very good thief. He has to break into a home, take what he came for and leave everything as close as it was before he broke in. He has to go in, grab, fix and get the hell out of there before he gets caught. Before he gets caught by the Creator.

I know a real Physician. I have met him. He talks well, dresses well, walks fast and praises everyone….at the appointed time. He is eloquent. When he talks you have no choice but to listen. He makes sure you know that he knows what he is talking about. He smells good too. The nurses talk about him as if he invented soap. I heard one say, “He smells of water”. Not ‘like water’. OF water. He too loves authority though he seems to shun it. He is soft. Soft-spoken and very very verbose. He loves euphemisms. AIDS is not in his vocabulary but it certainly is what he knows best. It is ‘retroviraemia’. He can recite all the latest guidelines but never calls Diabetes ‘high blood sugar’ unless talking to a patient. It is ‘glycaemia’. He can do a full examination in under ten minutes and come up with ten different diagnoses. He knows all the drugs: their names, uses, dosages and everything about them that you do not want to know. He thinks “Surgeons just like cutting and nothing else”. He thinks they are not intelligent. He is very gentle. Even his handwriting is gentle and delicate.

A doctor is either a Surgeon or a Physician. Paediatricians, Radiologists, Psychiatrists, Anaesthetists, Oncologists, Gynaecologists, Haematologists, General Practitioners and the works. Every doctor is either a Physician or a Surgeon………….or a Pathologist. Now those people are different and special. They have their own category. I know a Pathologist.

On faith healing and our Medicine: KICKING THE HORNET’S NEST

 

It might appear as if the ever flourishing false prophets and popcorn faith healers have made a huge dent on the coffers of trained Physicians through their promise of instant cures which unfortunately occur less frequently than they claim to do. Quite to the contrary, the effect has been a huge boon in critical cases that failed to respond to pricey anointed oils, stickers, bangles and cucumbers who find themselves paying for expensive tests, drugs and procedures which could have been easily avoided if only they had come in sooner.

It is with despair and anger that doctors in Christian countries perpetually attend to patients who snub evidence-based medical advice in preference to consistently unreliable charms and chants conjured and propagated by those who claim to be God’s elite. It is indeed not uncommon to see a patient twice at both extremities of a spectrum of hellish experiences of deception that comprise the act of attending and believing in these myriad false churches. A typical case of a young lady coming in with abdominal pains secondary to a growing ectopic pregnancy who refuses surgery and instead opts for a US$300 one-on-one session with “my Papa” but later comes back with a ruptured tubal pregnancy that requires $600 life-saving blood transfusion on top of the surgery originally advised on rings true in the minds of most doctors practising in a Zimbabwean hospital.

The driving force of this madness is the belief in the myth that seeking professional advice or imbibing prescribed medication is a testimony of lack of faith. The notion is that one only needs prayers and impartation (through physical objects such as oils, stickers and such) for complete healing. The simple rebuttal to this draconian contention is that the Bible does not teach that. It is with utter disgust that we find these “anointed” objects actually being sold in these churches. Buying a blessing? Purchasing a miracle? Are these not the things that Jesus Christ physically and violently destroyed in the temple of Jerusalem. What is it he said about the function of churches (temples)? These false prophets and their flock might benefit from reading Mark 11:15-19. What are these churches really based on if not on the Holy Bible which they obviously have not read or choose to distort or ignore?

Here is my argument. I believe doctors are part of God’s miracles. The Son of God Himself chose a Physician (by the name of Luke) to be part of his elect Twelve. Getting professional medical treatment is not mutually exclusive with faith in God and in His healing. Doctors are simply instruments used in the grand scheme of preservation and perpetuation of life. It would most definitely be imprudent for one to pursue faith healing without at least knocking on a Physician’s door.

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