Monday, January 16, 2017

When Breath Becomes Air: book review

Book Review: WHEN BREATH BECOMES AIR by Paul Kalanithi 2016 Penguin/Random Publishing
As a boy growing up in the desert town of Kingman, Arizona, Paul Kalanithi was certain he would never become a doctor like his father or so many others in his family. His father was never home until late at night. Friendly, offering brief encouragement or advice, but hardly ever available. If asked what he wanted to study in college, Paul was vague---maybe writing; maybe something about life's meaning . . . something about the mind . . .
During his senior year in college, his class visited a home for people who had had severe brain injuries. The place was a storehouse, really; a place for those whose families had long ago given up visiting them, a place to exist, but not to live. “Only later would I realize that brains give rise to our ability to form relationships and make life meaningful. Sometimes, they break.”
Some of his classmates graduating from Stanford headed for New York to pursue life in the arts, but that didn't quite seem to fit him. He couldn't let go of the question: Where did biology, morality, literature, and philosophy all come together? The answer came to hm, “Set aside the books and practice medicine.” It would take him a couple of years to make up for the lack of chemistry and physics in his previous studies, but he gained admission to a whole new world at Yale Medical school.
Many books have been written about the medical school experience and the exotic diseases the student may encounter. Kalanithi's visit to 'the home for broken brains' apparently stuck firmly in his mind. He thought he might become a psychiatrist, studying diseases of the mind.
But he saw that the brain was the physical engine that operated the mind, and he resolved to become a neurosurgeon. Speculation on theories of psychiatry gave way to what he called the 'moral mission of medicine' which is fixing what is wrong. “The patient is more important than the paperwork.”
The training period for a brain surgeon is among the most demanding and lengthy that a medical school graduate can undergo---six to eight more years beyond the four years of college plus the four years of medical school. Increasing responsibility of the senior surgical resident requires twelve- to fourteen-hour days on duty, regardless of fatigue. Speed and technique are not the only things that matter. Talking with the patient and family at the right pace; always leaving room for hope, takes time and empathy. It almost destroyed his marriage. He and Lucy met in first-year med school---she entered internal medicine--- and they were very much in love, but she was beginning to feel the strain of his continual duties in the hospital, and suggested marriage counseling.
During the last year of training – chief neurosurgical resident – he experienced chest pain and weight loss. He and Lucy have a rare afternoon taking in the sun at a San Francisco park. Lucy glimpses his phone screen displaying some search results: “frequency of cancers in thirty- to forty-year-olds.” He didn't want to discuss it. She didn't accompany him on a trip a few days later; said she had some things she needed to sort out. He began suffering intolerable, screaming-in-pain back spasms; cut his trip short. Back at home he told her he had cancer. She knew. The distance between them vanished. “I will never leave you,” she promised.
Paul was admitted to the hospital as a patient. His new doctor, Emma Hayward, came into the room to introduce herself to him and his family (most of them doctors too.) He supposed she could tell him about survival statistics.
No,” she said, “Absolutely not. We can talk about treatment later. And about going back to work, too, if that's what you'd like to do. I'll see you Thursday after the tests I've ordered are back.” His family contacted many of their fellow doctors to find out the best treatment for him. To their surprise they found that most recommended Dr. Hayward as not only world-renowned, but compassionate, knowing when to push and when to hold back.
And with that, the future Paul and Lucy had anticipated for so long evaporated. But his curiosity and intellect remained fully active. Some conditions are universal; one he had always seen and accepted was that death comes to each one of us. What is it that makes my life worth living? he asked. Dr. Hayward laid it out for him: What do you want to accomplish?
There were several things. He had already begun healing his marriage by opening his thoughts to Lucy. They discussed whether to have a child. Whether to return to the practice of surgery, or to take a professorship. Above all, he wanted to write this book, to encourage people to not give up living just because of a diagnosis. “A diagnosis is not the end,” to quote Dr. Hayward, “or even the beginning of the end. It is just the end of the beginning.”

Monday, January 9, 2017

Endangered: book review

Book Review: ENDANGERED, by C. J. Box (regional author) fiction Penguin Publishing, 2015
Wyoming State Fish and Game Warden Joe Pickett finds twenty-one dead sage grouse among shotgun shells at the side of a back-country road. Not only is Joe offended by the wanton killing, but the federal government has been talking about putting sage grouse on the endangered list. Placing their wide-spread prairie habitat off-limits to ranchers, coal miners, timber companies, and clean energy developers would affect Wyoming's whole economy.
While Joe collects the necessary scene photos and a sampling of empty shotgun shells, he gets a call from the county sheriff. A deputy has found a trauma victim in a ditch, barely alive, no ID. “But from the description, Joe, it could be your daughter April.” April Pickett had turned eighteen the previous year, and had run off with a local rodeo cowboy, Dallas Cates. They have rarely heard from her since.
Joe hurries back to town to meet his wife Marybeth at the local hospital. The victim is indeed April, unconscious and unresponsive from blunt head injuries. The Life Flight helicopter arrives from the trauma center in Billings, Montana; Marybeth is allowed to ride with her daughter, with Joe to follow. Joe is certain that Dallas did it.
The Cates family is a scraggly lot, living on twelve acres about twenty miles from town.The father, Eldon, runs a hunters guide business, and services septic tanks outside hunting season. Bull, the oldest son, is not very bright, but powerfully muscled. Joe had once caught Bull and his wife Cora Lee with a six by six elk three days before hunting season opened, and has won their permanent anger. The second son, Timber, is doing a three-year sentence at Rawlins state prison, for carjacking a tourist when his own car ran out of gas. Dallas is the youngest, and his mother's favorite, because he's going to make the family famous with his rodeo stardom. The mother, Brenda, is the brains of the outfit. She now makes a pre-emptive visit to the sheriff''s office to express her sympathy for the Pickett family. She would have brought Dallas too, she says, but he is recovering from serious injuries from his latest bull ride at the rodeo in Houston. She says April left her son severalweeks ago for another rodeo star and they haven't seen her since.
Sheriff Mike Reed and county prosecutor Dulcie Schalk share Joe's doubts about Brenda's story, but have no hard evidence to go on. Things get complicated when April's purse is found on loner Tilden Cardmore's property, not far from where April had been found. Tilden is totally anti-government and uncooperative, defending his home with multiple firearms.
Further, Annie Hatch and Revis Wentworth, of the federal Sage Grouse Task Force arrive to investigate the “sage grouse massacre”, demanding details and documentation when Joe needs to keep ahead of the Cates family. The outlook for April is still in doubt; the neurosurgeon is keeping her in induced coma until the swelling in her brain decreases. And Nate, an old friend of Joe's appears on the scene in time to get shot by Eldon Cates and get admitted to the same intensive care unit, just down the hall from April. His girl friend, Liv Brannon, gets kidnapped by Brenda to keep her from contacting the police.
Brenda appears to be getting more mentally deranged with each passing day. She keeps the girl she has kidnapped in a pit under her husband's machine shop out back. Brenda has never had a daughter, and wants a woman to talk to and comb her hair. At the same time, Liv is made aware that Brenda intends her never to leave this pit alive.

Author C. J. Box handles his characterizations and many-faceted plot very well. This action subgenre can get out of hand if too many characters find themselves improbably situated in just the right place at just the right time---the reader may feel that his stamina and belief are being tested, thus breaking the story's spell. But this story kept me reading to the end. Box lives in Wyoming; this is his fifth Joe Pickett novel.