BOOK REVIEW: Gifted Hands by Ben Carson

I would like to state from the outset that the full title of this book is in actual fact Gifted Hands: The Ben Carson Story. It is an autobiography written, with the aid of Cecil Murphey, by the celebrated Neurosurgeon Prof Benjamin Carson  who fought against all odds to reach the pinnacle of a field many associate with great intellect.

The sole purpose of the book is to inspire youngsters into believing in themselves and using their ability to read to widen their world understanding. Since its publication in 1990 the book has been so successful that some schools in the United States of America have adopted it into their curriculum and various reading clubs and scholarships have been named after the author.

Ben, along with his elder brother Curtis, was born and grew up in American slums and was raised by a single, uneducated and God-fearing mother who also writes a letter to the reader at the beginning of the book. His father deserted them when the author was only 8 years old to be with his other family for he was a bigamist. The boy’s mother could hardly cope with meeting the family’s financial demands and only survived by doing menial jobs such as house-cleaning.

Ben did not do so well academically when he was in elementary school to the extent of being ridiculed by his classmates and earning the title, “class dummy”. All this changed when his mother made a radical change in the house rules. Sonya (the author’s mother) was so inspired by the reading habits of the successful people whose houses she cleaned that she forced her children to read at least two books a week and write a report on each book read. Television watching was reduced to a couple of shows a week. As if by magic Ben’s and Curtis’ grades started to shoot up and they never faltered ever since.

The young disadvantaged boy would climb up the academic ranks to becoming a Presidential candidate in the 2016 US elections. He lost in the Republican primary elections but this candidature in itself was just icing on the cake. He was already well-accomplished. He was the first Neurosurgeon to successfully do hemispherectomies (removing half the brain) in epileptic patients, separate cranial conjoined twins (twins with fused heads) and myriad other innovations in the field of Neurosurgery. What I found particularly interesting was his appointment as the Chief of Paediatric Neurosurgery at Johns Hopkins Medical Institutions at the tender age of just 33!

I highly recommend this book.

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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.

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.

PERILS OF AN INTERN DOCTOR: Part One

He cannot escape from the fear. The fear of making a fatal mistake; the fear of exposing his own ignorance; the fear of being personally held accountable for the smallest of mistakes and ultimately the fear of turning out to be a bad doctor. The life of a medical intern is hell on earth with glimpses of heavenly beauty: the beauty of delivering a newborn baby in distress, the beauty of repairing God’s anatomy back to functionality and the beauty of life itself.

Almost all medical schools on the entire planet set aside a protracted period of trial after one acquires a medical degree. The ultimate outcome of that process is the validation, mostly by certification, that one is SAFE to be a caretaker of human life. Note the main requirement is SAFETY not COMPETENCE. Competence can essentially be easily faked (for example by cramming textbook paragraphs) but safety is much more measurable and consequently difficult to imitate. Safety is expected to exude from a doctor, it is supposed to be a lifestyle rather than a choice. Ever since the days of Hippocrates (and probably earlier) the doctrine of primum non nocere – first of all do no harm – has been placed as the cardinal requirement for one to be called a medical doctor.

When one graduates from medical school he/she is either timid or over-confident. Those who fall within the interim spectrum can tentatively be termed the ‘born doctors’. These are the young doctors who seem to have everything under control. Nothing seems to faze them; they feel and act well-equipped right from the beginning of their internship. Academic success in medical school is not in itself a guarantee for entry into this esteemed group. If anything good grades in medical school put one at risk of falling into the over-confident group just as much as poor grades demote the other outliers to the fringes of the ‘timid’ category.

There is however a unique set of medical interns that deserves special mention. These are the over-confident, narcissistic but ignorant young doctors who think going to medical school in itself sets them apart from and above their “lesser intelligent” counterparts in all other fields (they do not even recognise the prowess of physicists, mathematicians and the lot). They hold their heads up high, look down upon nurses and other ancillary hospital staff and absolutely loathe counsel or correction from the whole gamut of the “lesser intelligent”. They stubbornly carry this attitude throughout their internship and come out as half-baked but seemingly ‘safe’ doctors.

When the novice doctor sets foot inside a hospital for the first time after the gruelling years as a medical student he/she cannot help but try to identify themselves. The question in their heads is “what kind of doctor am I going to be?”.

ON STRIKING DOCTORS: In Defence of the Hippocratic Oath

Doctors are a fraternity. Let us agree on that at once. Common folklore and popular press have long painted a romantic portrait of the typical doctor; a secretive, money-hungry quack protected by his own. In all fairness the Hippocratic Oath does weigh heavily on that. It bestows on the art of medicine an oath of brotherhood ordained by the Greek gods themselves. Apollo, Aesculapius and Hygeia were among the gods all doctors swore on. I find it interesting that doctors made oaths TO gods and not to fellow men. In essence the oath was not meant for patients but for gods who were thought to be the ultimate protectors of mortals’ health and well-being.

A naughty argument can be proposed here that by virtue of the Hippocratic Oath being based on long-debunked Greek mythology, its merits are thus annulled by the shear force of overwhelming spiritual allegiance viz Christianity, Islam, Judaism et cetera which in turn translates to swearing an oath to these ‘false gods’ as blasphemy in itself. As a Christian doctor myself I never took the Hippocratic Oath. I refused to swear upon gods whom I do not know. It follows that any true Christian who believes in the same God I believe in will not bring up and throw the Hippocratic Oath in my face when I withdraw my services in protest against personal injustice. The same applies for my fellow Muslim and Jewish doctors. Religion in itself nullifies the Hippocratic Oath as a hard and fast rule of how the rights and commitments of a doctor should be viewed.

The second part of the Hippocratic Oath basically seals the fraternity paradox. It defines the profession as a family; – “I will pay the same respect to my master in the science (arts) as I do to my parents, and share my life with him and pay all my debts to him. I will regard his sons as my brothers and teach them the science, if they desire to learn it, without fee or contract.” Of cause this is way way outdated!! If this does not nullify the Hippocratic Oath as an outdated piece of literature that should be studied more by Greek History graduates than by medical students then I honestly do not know what will.

The proceeding paragraphs moderate the tone by their pragmatic sound; primum non nocere. Simple translation: first of all do no harm….even to an unborn fetus. Oh yes, that’s right. The Hippocratic Oath EXPLICITLY  forbade doctors from performing abortions. If you believe in the right to choice and favour abortions then again you do not have the right to throw the Hippocratic Oath into a doctor’s face. The simple logic is either you take all of it or none of it. The rest of the Hippocratic Oath delineates the fundamental ethics of the profession; ‘know your limit’, ‘know when to refer’, confidentiality and integrity. It is unfortunate that every critic of the profession chooses to restrict his arguments to these later passages without taking the whole document in its entirety.

This Oath has become a heavy load on the modern doctor. His actions are judged according to a mythical oration’s interpretation of the code of ethics which should govern how ‘physicians’ drilled holes into the skulls of patients who were ‘hysterical’ to let the bad spirits out of their minds. The document is as old as the ‘medicine’ it pays reverence to. It simply does not have a place in modern society. Its significance is as hallowed as the Magna Carter but that does not mean the Queen of England lies between the Bishop and God Himself.

 

 

 

 

BOOK REVIEW: NATURAL CAUSES by MICHAEL PALMER

If you have read any of Michael Palmer’s books and have an aversion to surprises then this book is perfect for you. Just like all the other works by the author the book follows the typical ‘hot-shot doctor who is framed for medical negligence and seeks revenge while falling unexpectedly in love’ plot.

The ‘hot shot’ doctor in this book is Sarah Baldwin a resident in Obstetrics and Gynaecology at the Medical Center of Boston who also has had impressive alternative medicine training. The hospital at which she works is ridiculed by a local newspaper columnist who has a vendetta against everything the hospital stands for; a blend of scientific and alternative medicine. Three patients die under exactly the same circumstances and the only connection among them is Sarah’s alternative medicine prescriptions. She seeks vengeance and pacification all the while falling in love with her attorney. The ending is as much surprising as it is heart-wrenching.

Michael Palmer, just like his rival Robin Cook, was an accomplished physician who blended his diverse medical knowledge with drama to produce multiple novels which have shaped the course of the medical thriller genre. It is difficult to analyse the author without comparing him with Cook just as it is exacting to review Isaac Asimov without collating his works with those of Arthur C. Clarke . All four however have oftentimes been caught up with the redundancy that bedevils serial writers.Natural Causes bares testimony to that. It is in itself a good thriller provided you have not read any of Palmer’s other books.

A SILENT MIND KILLS

That slimy pulp of tissue between your ears cannot function without functioning. The mind was meant to be used; when it stops working you lose your humanity. Note my graciousness to Science by stipulating the non-functionality of the brain as the loss of one’s humanity and not the end of one’s life. Reference is made to the thousands of patients on ventilator machines whose brains have thrown in the towel.

It is such a pity that the majority of this species voluntarily shut down their super chip. They have chosen to be sparkling tube gazers (couch potatoes), assassins of anything with more than two full stops and religious zealots who worship Time. Ever since our ancestors invented learning words have become the most lethal weapons in human existence. The more words one knows the more power they possess (thus explaining the power women have).

An idle mind, a silent mind, creates a vacuum in which unfiltered thoughts, ideas, emotions, beliefs and such invade docile nerve cell circuits. A lot of Science has been published on the subject and almost every blog in existence has had a say on the value of reading. Even Spiritualists bow down to the power of words; The Bible, The Quran, and other sacred texts. If the evidence is so overwhelming why do people continue to choose to destroy themselves? Have their minds been taken over by “neuronal viruses” in the form of thought insertion and withdrawal as in a classical Schizophrenic patient? Psychotic perhaps? What if everyone is mad expect for those who read? Open a book, read and save your humanity.

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