Tom Mueller's "How To Make a Killing"

I only picked up Tom Mueller’s new book How To Make a Killing: Blood, Death, and Dollars in American Medicine because Tom Mueller also wrote one of the best books I’ve ever read on whistleblowers (Crisis of Conscience).

I am no fan of American “healthcare” and think it is rapidly becoming one of the most expensive and least effective systems in the world. Actually, I don’t have to think this, I now know it (thanks to this book):

“In 1980, the year Reagan was first elected president, America spent around 9 percent of its GDP on healthcare, roughly the same as other member nations of the Organization for Economic Co-Operation and Development (OECD), and enjoyed strong medical outcomes compared to its OECD peers…In 2019, after decades of neoliberalism, the United States spent 17.6 percent of its GDP on healthcare…And America’s medical outcomes have dropped to the bottom of the OECD lit by nearly all measures: the United States currently ranks twenty-ninth in life expectancy, and thirty-third in infant mortality.” (p. 133.)

Mueller’s book is about the process and costs of dialysis (specifically) and the larger breakdown of for-profit healthcare as it is currently practiced in America (generally).

It’s also a perfect example of how nonfiction books can be a tricky beast to classify and offer to other readers. This book will primarily be given the subjects of “kidney disease” and “dialysis” and even “medicine,” but none of those quite hit the mark. It is in fact a very good investigative work on both the current practice of medicine that puts profits above patient health, as well as a readable history on the development and somewhat miraculous process of dialysis, which is the process whereby patients with advanced kidney disease have their blood cleaned (which is one of the things kidneys do) so, you know, they can keep on living.

On a regular day I would never go out looking for a book for dialysis. But it has been a great book to read, because Mueller is one of those authors who can use one very specific subject to illuminate entire other truths for you.

Consider this paragraph, which is one of my favorites in the entire book, and is about the corrupt current system of dialysis provided by for-profit corporations, but is also about one big human weakness:

“Since World War II, researchers in a range of disciplines have revealed the psychological tools that certain organizations — the Nazi Party, the Nixon White House, Enron and Purdue Pharma — use to compel basically good people within their sphere to do bad things. Many such strategies draw on deep human susceptibilities to authority and peer pressure, and operate at the subconscious level. Social and evolutionary psychologists have established that most people take their cues on what to consider morally acceptable from members of their in-group, rather than from their own conscience. When an organization creates an intense us versus them culture, often expressed in metaphors of sports and war, many of its members experience a fading of conscience, together with a heightened self-identification with that organization, and a sense that it can do no wrong.” (pp. 120–121.)

Read that paragraph a couple of times. It is a very succinct explanation of what is going wrong in health care, if not the entire world.

This book helped me learn about dialysis, and the business that is American medicine. But it also helped me learn what happens when a lot of basically good people go along with a lot of very bad ideas that are solely driven by the profit motive.

Ellen Ullman's "Life in Code."

This is now the third time I've had Ellen Ullman's book Life in Code: A Personal History of Technology, home from the library, and once again, I'm not going to finish it.

Life in codeThis is not because it's a bad book. I think it's actually a very good book. Unlike the last two times I've checked it out, this time I got through about 100 pages of it, and now it is overdue. (And it's perpetually on hold, so it's a popular book as well.)

Ullman (according to the book jacket), began her twenty-year programming career in the late-1970s/early-1980s. Evidently she is also the author of several novels and another well-known memoir, titled Close to the Machine: Technophilia and Its Discontents, which I'd never heard of. That makes sense, though; in 1997 I was still reading fantasy and studying film history, so the only nonfiction I read was biographies of James Dean and Montgomery Clift.

This book is a collection of pieces that have been written at various points in time; at the head of each chapter she tells you the year or the years when she first wrote it. This makes it a rather disjointed read (for me, anyway), but there's a lot here that made me go, "Oh, of course." A lot of things that bother me about our techie world, she talks about. She describes (in the 1994 chapter) how all programmers want to go "low," or "closer to the machine," so they can avoid the ridiculous work of creating systems for actual human users. She also describes a lunchroom conversation where all the techies try to figure out how long it would take to "wipe out a disease inherited recessively on the X chromosome." Eventually they get around to just killing every carrier. When she points out that that's what the Nazis did:

"They all look at me in disgust. It's the look boys give a girl who has interrupted a burping contest. One says, 'This is something my wife would say.'

When he says 'wife,' there is no love, warmth, or goodness in it. In this engineer's mouth, 'wife' means wet diapers and dirty dishes. It means someone angry with you for losing track of time and missing dinner. Someone sentimental. In his mind (for the moment), 'wife' signifies all programming-party-pooping, illogical things in the universe." (pp. 9-10.)

God. It's a good book. But you know the real reason I couldn't finish it? It made me so depressed I didn't think I could go on.

So I put it down and spent the rest of the weekend reading Agatha Raisin mysteries. I slept a lot better after those.

Do No Harm: Stories of Life, Death, and Brain Surgery, by Henry Marsh.

Have I ever talked in this space about how much I hate doctors and everything about the medical establishment?

Oh, wait. Yes I have. Quite a lot, actually.

So anyway. I don't like doctors. But then there's surgeons. Mostly I don't hate surgeons as much as I hate other doctors. Perhaps it's because I've had good luck with surgeons, if by "good luck" I mean they have pretty much solved the problems I went to see them for (although at least one did not shine in the department of helping me recover after surgery), and I can appreciate that.

So when I saw a review of a book by a neurosurgeon, Do No Harm: Stories of Life, Death, and Brain Surgery,* by Henry Marsh, I thought, yeah, I'm going to read that.

And it was FASCINATING. No kidding. Imagine just being a new doctor, not particularly enjoying it, when someone asks you to come along and help prepare a patient for neurosurgery, and after watching that surgery, you decide, boom, that's it, you're going to be a brain surgeon. This is basically what happened to Marsh.

I found this book endlessly fascinating. I can't say I liked the author, because he seems like the sort of doctor/surgeon/person I wouldn't much like if I met him (although if I needed him to fix a brain tumor, aneurysm, or other brain or spine problem I would be glad to see him). But I did enjoy his voice. I enjoyed his brisk descriptions, like this one, about how he hardly ever took a science class during his "private and privileged English education in a famous school," and eventually left Oxford to work as a hospital porter in the north of England, where he discovered he wanted to be a surgeon:

"Having spent six moths watching surgeons operating I decided that this was what I should do. I found its controlled and altruistic violence deeply appealing." (p. 76.)

I loved that. If there's any better description of surgery than "altruistic violence" I don't know what it is. It also makes it crystal clear to me why there are still more male surgeons than female ones.

There's some thrilling stories here, when everything went right during Marsh's surgeries on patients for an appalling number of different types of tumors, aneurysms, and other horrifying brain problems, and there's also a lot of heartbreak, when things just don't go right or (and it happens) something goes wrong due to surgeon error. Imagine having to tell someone you paralyzed them while you were trying to save them. Imagine telling a family that a patient bled to death on the operating table because you couldn't get the aneurysm clipped in the right way. I can't. I can't believe anyone can. So this book was a good reminder to me that, I may not like them, but thank goodness some people out there have the required personality to be able to cut into someone's head (and other parts), and they have terrible days. You really just have to hope you're never in a situation where their terrible day becomes YOUR terrible day.

I also liked that Marsh is a British surgeon and he had a lot to say about what goes on in the National Health Service and behind the scenes in hospitals generally.

Read it. But don't read it if you're scheduled to go into any kind of surgery any time soon.

*I love this review so much. God love The Guardian.

Nothing I'm reading is sticking in my brain.

You ever had this problem?

At last, over the last few months of 2018, my eye/face fatigue problems* seemed to right themselves, and I actually got through quite a few books. The problem is, even though I read them and I'm pretty sure I found parts of them interesting, they mostly just didn't stand out or leave anything stuck in my brain that I just had to write about. So now I could either worry about my brain fuzziness, or I could just put it down to "reading while distracted" and move on. That's the course I'm choosing.

So what books did I read a month or two ago that I already can't remember?

Safekeeping, a memoir by Abigail Thomas. It's a memoir of a lifetime of Thomas's memories, primarily about her life as a "young, lost mother, [who had] four children, three marriages, and grandchildren." I think I maybe read something about it at The Millions that made me want to get it? Anyway, there were parts of it I enjoyed, and if you look up Abigail Thomas, wow, she's had quite a life, but overall I didn't find much in her experiences that spoke to me or provided me with insight. I think mainly I was impressed that anyone could stand being married three times, and also I was mainly just jealous that she had the energy (and started young enough) to have four kids. That's about it. Anyone else read this one and had more coherent thoughts about it?

I also read a short memoir titled Heating and Cooling: 52 Micro-Memoirs, which I'm pretty sure I read about on Unruly's blog (yup, here it is). It was okay, but again, not really much I related to, and although I love me a good short book, this one was too short and its chapters too choppy, too unrelated. I just couldn't get into it.

I also tried an essay collection by Heather Havrilesky, titled What If This Were Enough?, that I really wanted to enjoy, but couldn't get past the first thirty pages of. I think her idea was okay, but I don't like to see my real thoughtful or "questioning the culture" essays anchored primarily by talk about TV shows (in one chapter she goes on for quite some time about Mad Men, and true to form here, I'm forgetting what point she was actually trying to make there). Don't get me wrong--I LOVE TV. TV and me is a true love story for the ages. But when I want quietly compelling essays, I kind of want them based on other things than TV. I kind of just want Wendell Berry, I'll admit it.

I did make it all the way through Like a Mother: A Feminist Journey through the Culture and Science of Pregnancy, by Angela Garbes but again, although it was interesting, it just felt slight. Yes, yes, yes, it's a real pain to give up drinking during pregnancy, and is it really necessary? I guess I just don't care about that argument anymore. For some reason I thought this book should feel bigger--the author handled the research nicely and shared her birth story with the level of detail I expect (a lot--don't bother telling me your birth story unless you are prepared to dish the nitty AND the gritty), but it just didn't set me on fire. It was no Labor Day, or even Pushed.

Somebody, for the love of all that's holy, recommend a book I can read and actually remember 3 days later? Thanks.

*Don't ask me, had it checked out to try and make sure it wasn't previously diagnosed eye problem getting worse or, you know, sinus or brain cancer. Everything came up healthy, so I'm just marking it down to facial/eye muscle fatigue, because that seems like the sort of dumb thing I'd have. My muscles and I have never quite operated on the same wavelength.

Forget true crime--environmental/science writing is the scariest shit out there.

For years now Mr. CR has been telling me to stop bringing home all the depressing nonfiction.

And I'd like to help him out, really I would, so then I started bringing home some more science/environmental books. And I'm damned if this stuff isn't scarier and sadder than all the usual true crime and investigative nonfiction that I usually bring home!

Water will comeOne totally scary science book I read in 2017 was Jeff Goodell's The Water Will Come: Rising Seas, Sinking Cities, and the Remaking of the Civilized World (which I found because Goodell had an essay in the also excellent Best Science Writing book that I read in October). It's a book about sea-level rise and climate changes, particularly as they pertain to low-lying cities like Miami, New York, Amsterdam, Lagos (in Nigeria), and Venice, to name just a few.

Although this book is terrifying, and the way that people are responding to rising sea levels and more powerful storms (largely ignoring all of it) is not heartening, Goodell manages to achieve a nice tone between matter-of-fact and awed. Meaning, it was nice to read a book on climate change that said, look, change is coming, maybe we can adapt, maybe we can come up with technology to save ourselves, but what is all of that going to look like?

Take, for instance, the dry journalistic tone in this exchange, when he goes into a Miami neighborhood where there's already flooding:

"While Briceno collected his water samples, I hopped and skipped over dry ground to a nearby apartment complex, where I found a woman named Maria Toubes staring at the incoming water from her second-floor doorstep. She was sixty-five and disabled, a hard life etched in her face. Inside, she had an eight-year-old niece whom she wouldn't let out of the house because of the high waters. Toubes explained that she lived on a fixed income and had moved into this neighborhood a few months earlier because it allowed her to save $200 a month on rent.

As we talked, the water continued to fise, pushing up the street in front of her house and into her driveway. It felt like we were about to float away.

'Have you seen the water this high before?'

'Sometimes it comes up even higher,' she said.

'What do you do?'

She looked at me as if I had asked a very stupid question. 'Stay inside,' she said...

A few weeks later, he [Briceno] emailed me results from the water samples at Shorecrest and around Miami Beach. The indicator that the EPA uses for fecal matter in the water is Enterococcus, which is a bacteria that is easily and reliably traceable. The EPA standard for acceptable contamination in water is 25 colony-forming units per 100 milliliters of water. According to Briceno's tests, the floodwater in Shorecrest had 30,000 CFUs." (pp. 246-247.)

No wonder Maria was telling her niece to stay inside.

It was a good read. Horrifying, but I think it's on a subject that's only going to become more apparent (and important).


Trying to figure out doctors: the start of a reading list.

I hate doctors.

I mean I really, REALLY hate doctors. You know those people who have to go to "no-fear dentistry" and "sedation dentistry" because they can't stand going to the dentist?* I'm like that with doctors. I want EVERY appointment I have with a doctor to be "sedation doctoring." Alas: no one seems to offer this.

Because I have often thought of doctors as a foreign species, I tend to read a lot of books about and by them to try and understand them better. So I've read a lot of Atul Gawande, and I read that big memoir by the doctor who was dying (When Breath Becomes Air), and I also like to read investigative works about healthcare. This month I picked up two very different books: What Patients Say, What Doctors Hear,** by Danielle Ofri, and Rachel Arneson's No Apparent Distress: A Doctor's Coming-of-Age on the Front Lines of American Medicine.

The two books were very different: the first was a bit more academic in tone, citing studies on patient-doctor communication (or lack thereof), mixed in with the doctor author's personal experiences. The second was full-on memoir about Pearson's experiences in medical school and her early jobs as a resident and doctor. As such they provided quite different reading experiences. I found the Ofri super-interesting, and enjoyed that the prose was straightforward and that she provided a lot of examples of patients who she knew, had worked with, or interviewed for her book. It was quite dense, though; as a matter of fact, I had to return it to the library because I'd had it for several months and still hadn't finished reading it. (I want to get it back.) There was a lot of information in it about the difficulties doctors sometimes have deciphering what it is patients really want, especially because language is not a perfect tool, and patients often display behavior that is confounding to their doctors...but which usually has a (at least somewhat) logical reason behind it.

The Pearson memoir was actually a very good read, and it reminded me a lot of Victoria Sweet's God's Hotel, in that Pearson is both working to provide good service as a doctor, but also has a talent for explaining the behind-the-scenes education and work of doctoring. It was an easier read and a more narrative one that I enjoyed while reading it, but looking back now, I can already hardly remember any of it. But it was good. A particular point of hers was how much medical students learn by doing--and by doing primarily on the poor and uninsured. Which gave me pause. Not that there's anything wrong with being helped by a medical student, particularly if seeing that student is your only choice (other than seeing nobody at all), but geez, imagine being on the receiving end of the first pelvic exam (or any kind of physical exam, really) that someone has given. Just the idea of that makes me shudder.

They were both quite good books, actually. I'll suggest the Pearson to anyone looking for a good thoughtful memoir, but I'm going to go back and try and read and learn from more from the Ofri.

*Ironically I have no problem going to the dentist. I have been known to fall asleep in the chair while getting my teeth cleaned.

**Please follow this link to the Washington Post review of this book; it's an excellent review. I particularly like the takeaway: "modern medicine could benefit from a better understanding of how human beings like to be treated when they’re at their most vulnerable — sick and confused and naked save for a thin paper gown. If only doctors could bill for listening."

Environmental writing is the scariest writing out there.

All through the month of September I read one True Crime book after another. Finally Mr. CR said, you have got to stop reading this stuff. (I think the subtext was: "you're freaking me out," but who knows? I've never been very good with subtext which is, let's face it, one of the reasons I prefer reading nonfiction.)

So then I took a little break and read the 2016 edition of The Best American Science and Nature Writing, edited by Amy Stewart (a writer who I love, and whose book Flower Confidential I once raved about at Bookslut).

And it was a really great collection. (As promised.) But I kept finding little tidbits like this, about the retreat of Arctic ice and other climatic changes:

"We talked about future scenarios of what we began to call, simply, bad weather. Parts of the world will get much hotter, with no rain or snow at all. In western North America, trees will keep dying from insect and fungal invasions, uncovering more land that in turn will soak up more heat...the Arctic is shouldering the wounds of the world, wounds that aren't healing." (pp. 41-42.)

And this, about the possibility of a massive earthquake in the Pacific Northwest:

"The shaking from the Cascadia quake will set off landslides throughout the region--up to 30,000 of them in Seattle alone, the city's emergency-management office estimates. It will also induce a process called liquefaction, whereby seemingly solid ground starts behaving like a liquid, to the detriment  of anything on top of it...Then the wave will arrive, and the real destruction will begin.

Among natural disasters, tsunamis may be the closest to being completely unsurvivable. The only likely way to outlive one is not to be there when it happens: to steer clear of the vulnerable area in the first place, or get yourself to high ground as fast as possible. For the 71,000 people who live in Cascadia's inundation zone, that will mean evacuating in the narrow window after one disaster ends and before another begins..." (p. 254.)

Holy crap. Everyone's keeping that pretty quiet. I had never heard of the Cascadia subduction zone.

Now, all is not doom and gloom here. There is a wide variety of topics and styles, from straightforward reporting to memoir and even some humor. By all means you should read this collection--I count it among my best reads of the year.*

*Mr. CR read it and enjoyed it too, and that's saying something.

Love a good quick nonfiction graphic novel read: Andy Warner's Brief Histories of Everyday Objects.

Every now and then I like to read a good graphic novel (fiction or non, I'm open on graphic novels, for the most part) and Andy Warner's stupendously entertaining Brief Histories of Everyday Objects did not disappoint.

Brief historiesI found this title on some booklist of nonfiction graphic novels that I linked to in a weekly Citizen Reading post a few weeks or months back, leading me to once again say, YAY book lists. You gotta love a good book list, particularly one that is outside your normal reading interests or comfort zone.

In this lighthearted history Warner examines (very briefly, in just a few cartoon panels per story) the histories of some objects that we basically could no longer imagine living without: toothbrushes, kitty litter, silk, tupperware, traffic lights, beer cans, kites, and coffee beans (among many others). The drawings are clean and easy to follow (sometimes I'm too lazy to follow graphic novel layouts when they're too dense or complicated; I remain a word girl, not a picture girl, at heart) and the facts are fun, interesting, and very succinctly written. Also, at the end of each short history, Warner throws in a few panels of "Briefer Histories," with all the tidbits of research he couldn't really fit in anywhere else, like "Ingredients in ancient toothpaste included ox hooves, eggshells, oyster shells, and charcoal. Minty fresh!" (p. 5.)

I also really enjoyed running gags throughout the stories, such as when multiple visionaries/inventors failed to cash in on their inventions. In the first such instance, a briefer history discusses how "Walter Hunt's grave in Brooklyn's Greenwood Cemetery sits in the shadow of the monument of Elias Howe, who got rich manufacturing Hunt's unpatented sewing machine." (With a picture of Hunt saying, "Rub it in, why don't you?") (p. 47.) And by the end of the book Walter Hunt and a bunch of other poor visionaries are grouped together, saying "We've decided to move in together to save on rent." (p. 177.) I'm describing it badly, but it's funny stuff.

In other news, this book has a wonderful bibliography, including many popular micro-histories, and Mr. CR gave it the highest praise he can give a nonfiction book: "Hey, that book you've got in the bathroom right now is pretty good."

Really, doctors? Luke Dittrich's "Patient H.M."

Everything I read about Patient H.M.: A Story of Memory, Madness, and Family Secrets indicated it would be a good read. And you know what? It was.

Patient hmOf course, "good" is a relative term here. The story centers on one lobotomy, performed on one man, but the author does a good job of combining the many story points: the story of "H.M."'s brain injury, seizures, and eventual treatment by lobotomy (which made him into one of the most studied psychological subjects of all time, as his lobotomy affected his memory, and how we store and process memories is a ridiculously complex process to try and understand); the history of the lobotomy procedure in general; the biography of William Scofield, a pioneering neurosurgeon; and the author's family, including his grandmother, married to his grandfather (that same William Scofield), who suffered her own mental hospitalization and horrific mid-twentieth-century treatments. Dittrich also delves into the horrifying treatment of psychological subjects like Henry Molaison, and the possessiveness of one scientist he made famous, Suzanne Corkin, and her destruction of many of the files (the raw experimental data). This last part of the book has led to some controversy; MIT, where Corkin worked, has since questioned Dittrich's facts and reporting.

So it's an interesting book on a lot of different levels. I enjoyed the good journalistic writing, although I felt the organization lacked a little something, and the book sometimes bounced around a bit too much in time and subject for me. It wasn't poorly done--this is clearly a well-researched and documented (Dittrich, in his response to MIT's questions, even provides an audio clip of one of his interviews with Suzanne Corkin) labor of love. It just means you have to pay a bit of attention to it while you read it.

But I can find no faults with the prose. This is Dittrich's re-creation of his grandmother's state of mind before she became a patient of a mental hospital and her own husband:

"There were people in the cellar. My grandmother could hear them. She had thought she was alone in the house, except for her children, who were asleep in their bedrooms. Now it appeared she was wrong. The children were asleep and my grandmother was not and she could hear people in the cellar.

She was terrified.

It was late January 1944, in a comfortable single-family home on Frankland Street in Walla Walla, Washington. My grandfather, as usual, was at work, this time on an overnight shift at the U.S. Army's McCaw General Hospital, where he served as chief of neurosurgery. Just the day before, he had come back from a weeklong conference in Spokane. They had been married for ten years, and it had always been like that, his career constantly pulling him away." (p. 51.)

The medical descriptions of brain surgery and lobotomy are also compelling:

"Without him having to ask for it, the scrub nurse passed my grandfather a long, thin tool called a flat brain sptaula, reminiscent of a shoehorn, which he inserted carefully into the hole in the right side of Copasso's forehead. He levered up that hemisphere of her frontal lobes and peered inside. He was looking for the nueral fibers connecting the lower, orbital portions of the grontal lobes to some of the deeper structures in the brain. Once he spotted his targets, he inserted another tool, a suction catheter--a very small, slender, electric-powered vacuum--and sucked the fibers out. The he retracted the sptual and the catheter and moved to the other hole." (pp. 147-148.)

I'd like to say I read a lot of this book in a state of disbelief, but I know enough about the history of lobotomies and the ridiculous shit that doctors will try, that I didn't. It was completely believable, sadly. And even once you got past all the lobotomy stuff, the experiments H.M. (an individual named Henry Molaison) had to endure, the author's personal history, well, then there was still all the stuff about the ethical treatment (or lack thereof) of patients like Molaison, and the power squibbles and squabbles that go on between medical personnel, academics, and researchers.

I don't think this book will be the huge hit that The Immortal Life of Henrietta Lacks was, simply because it is more complex, and not quite as immediately personal (if that makes any sense). Skloot's book was a bit more of a page-turner, told with more righteous indignation. But I think Dittrich's book is even more chilling in its excision of all the layers of the story. One thing I do think this book should be used for is to discuss how "nonfiction" rests so much on personal accounts and personal storytelling, that it is almost impossible to announce what is the whole truth and nothing but the truth.

Jonathan Kozol's The Theft of Memory: Read it.

I am a big Jonathan Kozol fan.

So when I saw he had a new memoir out, titled The Theft of Memory: Losing My Father, One Day at a Time, even if I wasn't particularly up to the subject matters of Alzheimer's, aging, and death, I thought I would read it.

And I was not disappointed. What makes this memoir of a dying parent particularly interesting is that Kozol's father was himself a well-known doctor, known for his "special gift for diagnosing interwoven elements of neurological and psychiatric illnesses in highly complicated and creative people." So, in a unique way, Harry Kozol (Jonathan's father) was able to make notes about and track his own decline. This gives the book an additional heartbreaking dimension.

Kozol also examines the many aspects of caring for aging parents, discussing his parents' changing relationships with him, with each other, their nursing home care, dealing with conflicting doctors' reports and inconsistencies, and his methods for finding in-home workers to help his parents stay in their own home until their deaths.

What I like best about Kozol's writing is that he seems to bring a crispness and attention to detail to memoir and "soft" science subjects like education and sociology that reads more like good scientific writing. (Joan Didion does this well too, I always think.) So yes. I think this was a valuable book to read. I will say that sometimes Kozol goes a bit too far off subject, discussing his father Harry's treatment of his famous patients, who included Eugene O'Neill. But those parts of the book are relatively brief (and actually, I skipped a few pages of the section on O'Neill's struggles), and the rest of the story makes it a worthwhile read. Cheerful, it's not. But a loving and detailed look at the challenges of caring for one's parents, combined with an appreciation for those parents' roles in shaping Kozol's own life? That it is.

Mark Schatzker's The Dorito Effect: A food book worth reading.

There are a lot of books being written these days about our food.

I've read a lot of them myself, but somewhere along the way I burned out on them. Partially this was because I worry about my family's diet, but not enough to do the massive amounts of work that are necessary to grow your own food, or even preserve or freeze it.* Partially this was also because I have the world's least sophisticated palate**, so telling me about how healthy food can also taste great is largely a waste of time.

But I must say that I found Mark Schatzker's investigative book The Dorito Effect: The Surprising New Truth about Food and Flavor to be a new take on a very overdone subject. Schatzker examines food from the viewpoint of flavor--most importantly, how the majority of our food doesn't have any, because it has mainly been produced by a huge agricultural system that must sacrifice complex flavor in order to maximize hardiness and yield.

One thing I really appreciated here was Schatzker's lean journalistic writing and emphasis on scientific studies done on the relationships between flavors in foods and their nutritious compounds. Here's your sample of the book, in which the author describes one of the reasons modern chickens taste so bland:

"In the late 1940s, a new and important feed was unleashed upon poultrydom: the 'high-energy diet.' For chickens to grow twice as fast as their recent ancestors, they needed to mainline carbs.

There was. however, a tradeoff that no one thought much about in the 1940s, or today. What the high-energy diet gains in calories, it loses in flavor. The feed is typically a blend of seeds--corn, wheat, millet, soybeans, etc.--and while some seeds (nutmeg, for example) are flavorful, the seeds we feed chicken are not. And, unlike tomatoes, a chicken doesn't make its own flavor. The taste of animal flesh is strongly influenced by what an animal eats." (p. 35.)

It's an interesting read, and even includes an appendix with a few basic suggestions for starting to improve one's diet. Sigh. I should really follow some of those.

*If I seriously gardened or preserved food I'd have even less time to read! Not. Gonna. Happen.

**For nearly ten years after I graduated from college, I ate a S'mores Pop-Tart and coffee for every breakfast, home-made meatloaf for most at-home meals (hamburger is my true medium), and candy and ice cream in massive, massive quantities. Don't tell my mom, okay? The poor woman raised me on milk my father's dairy herd produced, beef and pork my family raised itself and an awe-inspiring amount of homegrown fruits and vegetables. She was kinder to me for my first eighteen years than I have been to myself since.

Cole Cohen's Head Case: Oh my God, read it.

Next up in our week of teeny-tiny reviews: Cole Cohen's memoir Head Case: My Brain and Other Wonders.

Oh my God, you just have to read this book. Do I really have to say anything else in this review other than it's a memoir about a woman who, when she was in her twenties, was diagnosed with a HOLE THE SIZE OF A LEMON in her brain?

Just in case I do: This book is a valuable look at a person who struggled with any number of "learning disorder" diagnoses, so if you know anyone going through that sort of thing, it can be a poignant read. It's an interesting look at our health care system, and not only how we as patients hope to be treated, but also our expectations and hopes once given a diagnosis, and what it means when the comfort of having a diagnosis pales before the realization that there is not much to do with the diagnosis. It's a great coming-of-age story of a person coming to terms with her education, her parents, her relationships, and many other issues, all complicated by physical challenges.

It's not a perfect book; I can see where the organization might confuse some readers (it jumps around in time a bit), unless you are reading carefully, but it's only 221 pages long. Read it.

Here's a sample, if you still need convincing:

"I grew up during the height of the learning disability fad, the early 1990s, when ADD was on the cover of Time magazine and lunch hour at middle school brought a buyer's market for prescription Ritalin, often crushed and sniffed with a juice straw cut down to size in the girls' bathroom. Everyone was learning disabled; it's a wonder that administrators didn't just throw up their hands and shut down the public schools to let the kids roam the country with their freshly minted drivers' permits, hopped up on prescription speed and dangerously deficient of any knowledge of basic algebra." (p. 28.)

Read it. Read read read it.

A tale of two titles.

So here's two books sitting on my nightstand right now: What Should We Be Worried About? Real Scenarios that Keep Scientists Up at Night (edited by John Brockman), and Retrain Your Anxious Brain: Practical and Effective Tools to Conquer Anxiety (by John Tsilimparis).

Yes, perhaps not the best concurrent reading choices. But it turns out I'm really, really enjoying the What Should We Be Worried About? book, while I haven't really gotten that far retraining my anxious brain. The thing about my anxious brain is that it tends to run in fairly predictable circles: we're all going to die on the highway; health care costs are going to bury us all; the CRjr's are going to fall off playground equipment and directly onto their heads. Thinking about that sort of shit (plus whatever doctor or dentist appointments anyone has coming up) makes me crazy.

John Brockman's book, on the other hand? Well, that's just a bunch of super-smart people worrying about the really BIG stuff. Here's some chapter titles to illustrate what the contributors think we should be worried about:

"We are in denial about catastrophic risks"

"The fragility of complex systems"

"Are we homogenizing the global view of a normal mind?"

'The mating wars"

"The rise in genomic instability"

Contributors include Charles Seife, Nicholas Carr, Sherry Turkle, Brian Eno, Daniel Goleman, Robert Sapolsky, Nassim Nicholas Taleb, and a ton, ton more.

I have yet to read a dull chapter in this thing and although I know it's presenting a lot of big, ugly, doomsday scenarios...but I'm actually using it to fall asleep. For some weird reason it's more calming to me to worry about the big picture. Some of these speculations really make the little stuff (like: why is my back so sore? Do my brakes feel like they're going? What kind of medical help and support are my parents going to start needing? And so on and so forth) seem, well, little.

I know. It makes no sense. If you don't enjoy thinking about worst-case scenarios, the Brockman book might not be for you. It's one of the most interesting things I've read this year, though.

And I'll keep you posted if I have any luck retraining my anxious mind. Training of any kind, either of myself or others, has never been my strong point, so we'll see.

The glory years: Kids' nonfiction

I gotta tell you, all hardcore nonfiction readers should have at least one little kid. Because I'm finding that little kids really LOVE nonfiction. And it's super.

CRjr has become all about perusing the nonfiction shelves at the library. (Might I also add that taking the CRjrs to the library on a regular basis has been balm to my routine-loving soul. We go, we pick up our holds, we visit the little lizard who lives there, we wander the kids' nonfiction section, they play at the train table while I try to sneak in a chapter of whatever I'm picking up on hold, we look at pop-up books, we pick some Scooby-Doo readers off the shelf, we go. We could probably vary the order of those events, just once, but hey, why fool with a working system?)

So this week it's all sharks, manta rays, giant squids, and the moon. Last week it was body parts, trucks, and cranes. Did you know that sperm whales eat squids? And that squids have beaks on their mouths? Beaks that get stuck in whale stomachs, form little balls, and get coated with ambergris, which is whale digestive juices? That the perfume industry makes use of?

Mother Nature is a mad scientist, I tell you, and let's hear it for CRjr, taking me on the wild and wonderful tour of all things kids' nonfiction.

If a book is written about hypothetical science questions... long will it hold my interest before I decide, meh, that's enough of this?

The answer is: about 130 pages.

Last year I saw Randall Munroe's book What If? Serious Scientific Answers to Absurd Hypothetical Questions pop up in a lot of reviews and on a lot of "Best of" lists (go over to and check out their downloadable "best of nonfiction for 2014" spreadsheet--it's pretty high up on that list). And I thought, okay, I don't read enough science (or math).* Let's try it.

So I brought it home, and yeah, it is interesting. Quite interesting. And amusing, very amusing, in parts. Munroe (according to the handy-dandy book jacket) is evidently the creator of the webcomic xkcd, where people ask him absurd hypothetical questions and he answers them, to the best of his ability. Here's one:

"Is it possible to build a jetpack using downward-firing machine guns?"

And here's part of the answer:

"I was sort of surprised to find that the answer was yes!  But to really do it right, you'll want to talk to the Russians.

The principle here is pretty simple. If you fire a bullet forward, the recoil pushes you back. So if you fire downward, the recoil should push you up.

The first question we have to answer is 'can a gun even lift its own weight?' If a machine gun weighs ten pounds but produces only 8 pounds of recoil when firing, it won't be able to lift itself off the ground, let alone lift itself plus a person...

Despite growing up in the South, I'm not really a firearms expert, so to help answer this question, I got in touch with an acquaintance in Texas." And then there's a note, and the note at the bottom of the page says this:

"Judging by the amount of ammunition they had lying around their house ready to measure and weigh for me, Texas has apparently become some kind of Mad Max-esque post-apocalyptic war zone." (p. 68.)

Now that's witty. And some of the questions and answers, like "If every human somehow simply disappeared from the face of the Earth, how long would it be before the last artificial light source would go out?" are downright fascinating. So yeah, it was kind of fun. But at some point I do weary of reading what basically boils down to science factoids, even if they are written well. And because they are all hypotheticals, well, I did catch myself thinking, good lord, only a guy would have this much time and energy to expend on fantastical science hypotheticals.** But that was not a very charitable thought.

I really enjoyed the 130 pages I read, but I'm taking it back to the library with another 170 pages untouched. For my money, I still like a good old-fashioned terrifying biological read, like Carl Zimmer's Parasite Rex or David Quammen's Spillover.

*Mainly because I never understood most of the science classes I took, and I wasn't all that interested (which was most likely the biggest part of the problem).

**I'm also currently reading Rebecca Solnit's Men Explain Things To Me, which, at least while I'm reading it, is making me a bit frustrated with the male gender.

John Green: 0 for 2 on reading recommendations, thus far.

I hardly ever seek out reading recommendations, particularly from people I do not know personally. Partly this is because I almost never have a problem finding things I want to read (I currently have 59 books checked out from the library, I'm on the hold waiting list for nearly that many more, and I've always got books that I own that I still need to read). Mainly I have a problem finding enough time to read books that I just seem to keep tripping over, and that doesn't even take into account that I know several great and interesting readers who often make suggestions to me in person.

So why I was watching John Green's entire YouTube video on the 18 books you probably haven't read but which he thinks you should, I couldn't really tell you. Yes, I do like John Green. Yes, of course I enjoy listening to anyone and everyone talk about books. But how I found that video I don't know, unless it's because I somehow heard that he also recommended Tony Hawks's travel books Round Ireland with a Fridge and Playing the Moldovans at Tennis, which are two of my all-time favorite nonfiction books.

On John's recommendation (librarians: please see John Green for how to make books sound interesting; he can do so in very little time), I checked out Joshua Braff's* novel The Unthinkable Thoughts of Jacob Green and Alice Domurat Dreger's One of Us : Conjoined Twins and the Future of Normal. I am actually very sorry to report that neither one of these books really worked out for me.

There really wasn't anything wrong with Braff's novel; it seems to be a fairly standard male coming-of-age story, featuring an extremely complex relationship between Jacob and his father, but I just wasn't in the mood. (Or, I should say, I kind of just kept picking it up and reading it when I couldn't decide what else to read, but I never really WANTED to go back to reading it).

The One of Us book was a bit of a different story. It's actually quite interesting, and you wouldn't believe that a book about conjoined twins would have so much to say on so many different topics, among them what we consider to be "normal" where our bodies are concerned, and how much doctors and medical professionals are involved with helping us judge and "fix" our appearances. I thought it was a bit dry, at first, but I spent a bit more time with it today and it's actually quite the fascinating little book. Again, I'm just not quite in the right mood for it. It reminded me of Amy Bloom's superlative Normal: Transsexual CEOs, Crossdressing Cops, and Hermaphrodites with Attitude, which I would heartily recommend to anyone.

On the whole, though, I wouldn't say these were bad suggestions. And I'm going to give Green another try; he mentioned several other titles in his "18 books" video that sounded interesting. Happy weekend, all.

*Yes, he's the brother of actor Zach Braff.

The best part of God's Hotel.

So all last week I told you about Victoria Sweet's fantastic memoir, God's Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine. And even in all that blabbing, I forgot to tell you about the best part of the book: the endnotes.*

Now, normally, because I have worked as an editor and an indexer, I do at least look at the endnotes of all nonfiction books. And, depending upon how substantive they are, I do sometimes pause while reading a book to pop to the back notes and see if they add any interesting information. But Victoria Sweet's endnotes are so interesting that you could almost sit down and read them like another chapter (which I did, because I didn't get the chance while reading most of the book to flip to the back--I didn't want to lose the thread of the narrative). Not only do the notes provide even more insight into her text, they provide a wealth of just plain fascinating information. And, in one notable case, poetry:

"Page 247. 'Mr. Zed wrote a poem for Paul': Mr. Zed was part of the poetry group at Laguna Honda...The real Mr. Zed naturally wants his work to have his real name attached to it, and so do I. But as his physician, I am not supposed to reveal identifiable patient information. A compromise is that I will put anyone wishing to contact Mr. Zed in touch with him, with his permission. Since I also particularly love his [poem] 'Letter Needing No Stamp,' I quote it here:

...We must all pray that you never resign or become bitter.
As sad as things seem to be here
Without you they'd be infinitely worse.
Thank God for God
Stay in there buddy
Have a martini once in a while
Create a new universe." (p. 366.)

I did not quote the whole poem, because I just want you to go and read this whole book.

*Thank God my sister reminded me about the notes. I can blame the CRboys for Mommy Brain until the youngest one is 18, right?

Part 3: God's Hotel

Every now and then you read a nonfiction book that makes you say, Hey, there's some good ideas and thoughts here, why can't we talk about these things? And make the world a little better?

Victoria Sweet's God's Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine is just that kind of book, which is why I've been telling you about it all week.

It's a bit tough to describe just why it's such a great book. When I think of the "game-changing" nonfiction I've read, usually one quote or one overall idea stands out about it in my memory (for instance: I'll always thank John Bowe's book Nobodies: Modern American Slave Labor and the Dark Side of the New Global Economy, for the continuing insight that "the system isn't broke...the system is working exactly the way it was set up to work"). But for this book, just the overall experience of reading it and experiencing Victoria Sweet's work and world in her telling of it will stick with me.

None of her ideas, formed over her life's work in medicine, are all that earth-shattering on their own. Listen to people. Pay attention to the details. Consider the whole person when considering their health. Take time to pause and think.

You'll also notice that's a list of ideas that is nowhere to be seen in the practice of modern medicine.

Fairly early on in her narrative, Sweet discusses the consultants who came to find ways the hospital could economize (and they got a cut of the savings, naturally). One of their shocked findings was that one of the head ward nurses did nothing but sit at her station and knit. On the surface of it, that does seem like a rather damning charge. There was a head nurse who had vowed to knit blankets for the thirty-six patients in her care (most of whom were elderly women). And after the consultants were done, that nurse and eighteen other "head nurses" whose job was to stay on their ward and look after what needed to be done were cut, while the remaining staff were to be trained to be "nurse managers," and given additional work and beepers so that they weren't always on their assigned wards. Here's what Sweet says:

"It was a little-old lady ward, with thirty-six little old ladies--white-haired, tiny, and old--and sure enough, almost every one was wrapped in or had on her bed a hand-knit blanket...

I've thought a lot about those blankets since the disappearance of the head nurses and their well-run neighborhoods of wards. About what the blankets meant and what they signified. And here's the thing: The blankets made me sit up and take notice. Made me pay attention. Marked out that head nurse as especially attentive, especially present, especially caring. It put me and everyone else on notice.

I'ts not that the ladies for whom they were knitted appreciated them or even noticed them. Who did notice was--everyone else. Visiting family noticed...The Russian ambulance drivers noticed, when they rushed into the ward to pick up one of the ladies, that each was wrapped in a colorful identifying blanket.They also noticed the head nurse, sitting in the nursing station, answering the phones, arranging the charts, and directing them to the correct patient. Even the doctors noticed. The blankets put us all on notice that this was a head nurse who cared...

Because those blankets signified even more than attention and caring. The click of that head nurse's knitting needles was the meditative click of--nothing more to be done." (pp. 74-75.)

Sweet goes on to explain that of course the new system saved money, but it increased everyone else's stress and lowered care standards, which she referred to as "the inefficiency of efficiency."

Huh. "The inefficiency of efficiency." I guess this book left me with one huge unifying thought after all. This is a great book. Read it.

Part 2: God's Hotel

So this week we are talking about Victoria Sweet's superlative memoir, God's Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine.

As noted yesterday, this book is about Sweet's experiences as a doctor, working in a San Francisco hospital specifically designed to aid the poor. She also discusses her postgraduate studies of medieval medicine, and most particularly how taking care of the needy and the sick was approached by the well-known historical figure Hildegard of Bingen.

I stuck so many bookmarks in this one that they just look like an extra set of pages, sticking out the top. Let's see what I marked, shall we? (And here's an interesting note about this book: it's complex and interconnected without being a particularly challenging read. For most of these quotes I have to give you a little context.)

In one story, she is faced with a patient with a huge and horrendous bedsore, and she talks about how she views the sore not as something for her to fix (surgeons had already tried and failed) but something for her to help the patient's own body fix on its own. So this is what she says: "To see what else was needed, I had to start with a vision of Terry whole, complete, and healthy, in a future when all that was missing from her complete health was a pair of glasses. And walk my way back from that. Which I did. I walked past the repair of her teeth, the strengthening of her body, the strengthening of her will, the resolution of her depression, and the healing of her bedsore. I walked all the way back from the perfect future to the imperfect no, and then I organized my strategy forward." (p. 95.)

I love that. Not only do I wish all doctors did that, I wish I could do that in my own life, as a goal-setting technique. To see the whole person, or myself, in a state of wellness, and methodically list and (this is the important part) DO the hard, sometimes unpleasant work of getting there.

A bit more tomorrow. I feel like I am not doing this book justice--it is not one that really lends itself to the quick and pithy quote--but I will try.

Part 1: God's Hotel.

Apologies for once again going off the radar for an extended period of time. Now that the weather is nicer it's harder to convince the Little CRs to stay in and watch Peg + Cat while I type away. I can read in the backyard while I ignore them, but it's hard to drag the laptop out there to work.

In honor of the short week, I'd like to spend the next few days on an absolutely fascinating book that you definitely should read. Yes, I am recommending this one, not just "suggesting" it, as they teach you in library school. Whatever. Screw you, library school. If I want to tell someone they should read a book from now on, I'm just going to own it and tell someone to read a book. Hilariously enough, this book was recommended to me by my sister, and even though my sister is one of my best friends and our tastes are nearly exactly the same, I still put off reading this book for a while because I am just THAT independent when it comes to my reading choices. So that's fine. Don't read this one right away just because I told you to. But read it sometime.

The book is God's Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine, by Victoria Sweet. As its subtitle says, it's a book about one of the last "almshouses"--hospitals designed solely to care for the sick poor--in America: San Francisco's Laguna Honda Hospital.

Sweet is a doctor, but is one with more than just a passing interest in the history of medicine. While working at Laguna Honda, she also pursued a Ph.D. in the History of Medicine, with a special interest in the medical knowledge and practice of the Christian mystic and nun Hildegard of Bingen. In this memoir, which encompasses a large chunk of her life, she relates her experiences working at the hospital, what she learned in her Ph.D. studies, and her take on the landscape of health care has changed over the last couple of decades.

And that should be enough to pique your interest for now; if you've had any sort of dealings with the health care "system" over the past few years, I'd imagine you have some thoughts on it (and how it's been changing) yourself. More to come...