2020 L&H DISCUSSION SCHEDULE - Facilitator Notes

Book:  Twas the Nightshift Before Christmas by Adam Kay

Facilitator: Jenny Cochrane, MA

 Christmas Eve is a joyous, festive time spent relishing family, friends, or even alone time as everyone awaits the bells of Santa’s sleigh. Unless you’re one of millions of healthcare workers across the world for whom Christmas Eve is a shift unlike any other. In ‘Twas the Night Shift Before Christmas, Adam Kay deep dives into his journals to give us a sense of what it’s like being on the front lines of healthcare on one of the most emotional nights of the year—Christmas Eve. He recounts the joy of babies born, the heartbreak of lives lost—made somehow more painful amid cardstock stockings and rubber glove tree décor, and the insane shenanigans of the drunk and disorderly who find their way to the hospital with turkey bones stuck up their noses or baubles stuck up their backsides. Prepare to laugh and cry through a night shift you won’t soon forget!  

Book: The Broken Ladder: How Inequality Affects the Way We Think, Live and Die by Keith Payne

Facilitator: Mark Matheson, DPhil

We look forward to our discussion of Keith Payne’s The Broken Ladder: How Inequality Affects the Way We Think, Live, and Die.  Payne is a psychologist, and he’s interested in both the material facts of inequality and its psychological consequences for people both up and down the social “ladder.”  In addition to considering the effects of actual poverty and wealth, he argues that “status”—our perception of our relative position in the social whole—is an important determinant of wellbeing.  The sections of the book exploring health and medical care in the context of social inequality will be of interest to our group, and Payne also has much to say about politics, business, and race.  This well-received book from 2018 should provide an abundance of provocative topics for conversation, and it’s unquestionably relevant in the context of material inequality in the United States, which is both already precipitous and increasing.  (A recent study revealed that the 55 richest Americans have as much wealth as the poorest 168 million.) We are excited to explore this fundamental problem in our collective life.

Book: Grunt: The Curious Science of Humans at War by Mary Roach

Facilitator: Jenny Cochrane, MA

Everything in the military is engineered to win wars, including the people. With her characteristic wit and humor, Grunt: The Curious Science of Humans at War” Mary Roach examines the mental, emotional, and physical toll a human soldier in a warzone endures and how everything from a soldier’s haircut, uniform, and even cleaning regimen is designed to ensure victory in battle. Grunt covers everything from how the zippers on a soldier’s uniform can be a problem for snipers; how war—both simulated and real—affects hearing and, by association, balance and gait; how amputee actors help military medics prepare for the gore and horror of war wounds; and how the food a soldier consumes can mean the difference between staying alert and alive or being lethargic and dead. “Take a tour of duty with Roach, and you’ll never see our nation’s defenders the same way again!” 

Book: The Farewell (film) directed by Lulu Wang

Facilitator: Rachel Borup, PhD

The Farewell premiered at the 2019 Sundance Film Festival.  It tells the story of a Chinese family’s decision to hide their grandmother’s terminal cancer diagnosis from her, and, instead, stage a wedding as a way to gather all the family members together against for a final “farewell.”  The film is written and directed by Lulu Wang and is based on her own experiences, which she originally presented on the radio program, This American Life.  The film raises interesting questions about different cultural attitudes toward death, and also manages to be surprisingly funny and touching.  

Wed, Aug 12

Book: In Pain: A Bioethicist's Personal Struggle with Opioids by Travis Rieder

Facilitator: Gretchen Case, PhD, MA

Travis Rieder begins In Pain with the motorcycle accident that severely damaged his foot, but the story does not follow a typical recovery narrative. Instead Rieder shares the extraordinary—and yet so increasingly common—path he took to manage his terrible pain with prescribed opioids and then to manage his withdrawal from those same medications. Rieder, a bioethicist, brings keen insight to the historical and structural problems that underlie the problem of opioid use and addiction. He paints a tragically clear picture of what it is like to be a person in pain, who wants to stop using opioids, confronting a medical system that is not prepared to help. 

Book: The Tangled Tree: A Radical New History of Life by David Quammen

Facilitator: Maureen Mathison, PhD

First used by Charles Darwin, the metaphor Tree of Life has been used to study how species are related (the trunk), evolved, and differentiated (as seen in the branching) to persist. For Darwin and others early thinking was that species evolved vertically, that is, traits were passed down to offspring; mutations were in response to environment so that through natural selection the fittest could survive. With vertical thinking much of the focus in research was on inheritance and change through genetic mutation. Genetic research opened up the study of evolution and led biologists to examine how evolution occurred through gene loss, gene creation and gene duplication. And more.
David Quammen’s book, The Tangled Tree: A Radical New History of Life, takes up Darwin’s metaphor augmenting a unique perspective to explanations of evolution that impact human nature and health. The book traces various scientists and their contributions to thinking about evolution, from Charles Darwin to Tsutomu Watanabe (who identified horizontal gene transfer, which accounts for drug resistant bacteria), and to Carl Woese, who redefined evolutionary processes with his discovery of a third “domain of life.”
In a lively volume, Quammen relays the history of evolution through the history of key scientists and their contribution to its study. With the knowledge that early life may have been less competitive than thought, and that mutations occur between species, the idea that we are of the same origen and that traits are only passed on through offspring has become uprooted and the metaphor of the tree has been made circumspect, and thus tangled.

Book: That Good Night: Life and Medicine in the Eleventh Hour by Sunita Puri

Facilitator: Susan Sample, PhD, MFA

Palliative medicine, a relatively new medical specialty, often is mistaken for hospice or dismissed as “giving up” on seriously ill patients.  In her eloquent memoir, Sunita Puri, M.D., director of palliative medicine at the University of Southern California Keck Hospital and cancer center, invites readers into patient rooms where she share their intimate stories of suffering but also trust, honesty, dignity, and compassion.  Physicians help patients live; equally important, she says, doctors can help patients live well, even at the end of their lives. Puri, the daughter of Indian immigrants, follows her mother, an anesthesiologist, into medicine but finds herself curiously drawn to the limits of medical care where uncertainty, not the possibility of yet more procedures, reigns. In prose candid yet reassuring, Puri gently encourages physicians and the public alike to accept our mortality.  Her memoir and the questions it raises seem especially pertinent during the coronavirus pandemic, which will be a good place to begin our discussion.    

Book: Inheritance: A Memoir of Genealogy, Paternity and Love by Dani Shapiro

Facilitator: Rachel Borup, PhD

On a whim, the writer Dani Shapiro and her husband decided to take DNA tests. Shapiro received the shock of her life when her results revealed that the man she'd always known as her father, a pillar in the tight-knit orthodox Jewish community in which she grew up, was not her biological father. This realization turns upside down her sense of self, her cultural identity, and her confidence in the world as she knew it. Inheritance is the true story of her quest to find her biological father and come to terms with the new facts of her life. 

Book: Man’s 4th Best Hospital by Samuel Shem

Facilitator: Susan Sample, PhD, MFA

Fast forward forty years:  Roy Basch, M.D., and colleagues who suffered through their internship years in the 1970s at the hospital known as House of God are recruited to work at a new “Future of Medicine Clinic:  Care, Compassion, and Cancer.” It is part of a fictional academic medical center known as Man’s Best Hospital--until it dropped to number four in national rankings. The reasons?  Electronic medical records, hospital mergers, corporate medicine, and insurance companies: villains Basch and his friends battle in this comic sequel to Shem’s The House of God.  The 1978 novel, a cynical view of medical training that “scandalized prominent reviewers within the health care community,” continues to be a favorite.  Shem—a psychiatrist whose real name is Stephen Bergman—said he wrote his new novel “to resist injustice, and the danger of isolation, and the healing power of good connection.”  One of the questions we will discuss is whether the book or novels in general can fulfill that intention.  Please note: you do not have to read Shem’s original novel; the sequel should stand on its own merit.  

Wed,
March 11

Book: RX: A Graphic Novel by Rachel Lindsay

Facilitator: Gretchen Case, PhD, MA

Rx: A Graphic Memoir is cartoonist Rachel Lindsay’s first book, telling her compelling personal story of how working on marketing campaigns for antidepressant medication, in order to have health insurance coverage for her own bipolar disorder, contributed to her declining health and hospitalization. Rx addresses intimate, personal issues of illness as well as broader, public issues of the US health care system.”

Wed, February 12

UU Hosp Large Conf Rm W1220

Book: In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope by Rana Awdish

Facilitator: Susan Sample, PhD, MFA  

 Seven months into her first pregnancy, Rana Awdish checked into the emergency department of the Detroit hospital where she was completing her training as a critical care physician.  She would lose not only the pregnancy and most of her blood volume; she would suffer septic shock, a stroke, liver tumors, miscarriage, and multiple surgeries over the ensuing months.  As she transformed from physician to patient, Dr. Awdish also experienced indifference and disregard from her doctors, which she attributes to medical education:  “I knew we valued the cure, the goal, the win.  We were far less comfortable in the gray, shadowed area of suffering.”  Too often, doctors are bound to the disease, rather than the patient; they emotionally detach from patients.  To do otherwise is to risk losing control, and, as she notes, “risk carries with it an inherent degree of vulnerability.”  Yet, it is precisely through exploring vulnerability--“a dark hole at the center of a flurry of what was otherwise highly proficient, astounding skillful care”—that physicians will connect to patients and colleagues.  As Awdish notes, “I didn’t understand that open channels would replenish my supply of self.  That there was reciprocity in empathy.”

 As you read Awdish’s memoir, note her comments on word choice as she repeatedly draws attention to the necessity of a shared language between doctors and patients.  Do you agree? Note also how she tells her story, frequently foreshadowing what will happen.  This technique eases some of the medical suspense, but does it heighten other aspects of her message?  From a patient’s point of view, do you find her suggestions for improving medical training insightful or not?

Book: Also Human: The Inner Lives of Doctors by Caroline Elton

Facilitator: Mark Matheson, D. Phil

Caroline Elton is a vocational psychologist who has worked with doctors, mostly in England, for the past twenty years.  In her book Also Human: The Inner Lives of Doctors (2018), she offers brief case histories of many of the doctors who have sought her professional help.  Elton acknowledges the longstanding image of the doctor as an embodiment of stoic strength, and she notes how sensitive it is to talk about doctors as being subject to disease and disability, especially of a psychiatric kind.  She takes the reader through many issues that can arise in a doctor’s life, including the emotional difficulties experienced during medical training, the pressures of choosing a specialization, finding oneself sexually attracted to a patient, and the inclination to leave medicine altogether because of a bad patient outcome.   Elton discusses responses within medicine to address the problems of stress and anxiety doctors experience, including greater institutional awareness of these issues, Schwartz Rounds, and the lesser-known Balint groups.  The substance of the book is Elton’s reporting of case histories and the findings of broader medical surveys, and the reader also gets a rather extensive account (incidentally) of how medical institutions function in the U.K. Some might wish for a more engaged analysis of a number of issues raised in the text, including the alleged “conspiracy of silence” among doctors on mental health issues in the profession, but the stories Elton relates are thought-provoking, and they will certainly provide valuable material for discussion and reflection when our group meets in January.