“The Heart” by Maylis de Kerangal (translated by Sam Taylor)

This is a work of fiction centering around a heart transplant. Which means that our young donor, Simon, dies less than 20 pages in. This definitely isn’t a depressing story; it is more about life than it is about death. The narrative intimately describes the lives of everyone involved in this procedure, from Simon’s friends to the nurse in the ICU to the recipient of his heart.

The writing (and the translation) of this book is absolutely gorgeous, sentences seem to flow on ad infinetum giving the story a unique pacing and feel. Actions are often written as long descriptions, giving the reader an impression of motion and occurrences that meld together to create the scene rather than a direct line of cause and effect. It flows beautifully and makes it a joy to read.

Of course, this book also discusses the symbolic nature of the heart, through Simon’s girlfriend and love of surfing. Repeatedly it is wondered if the recipient of his heart will enjoy hearing the sound of waves, if the heart will retain some memory of being Simon’s. But the story is more based on realism than anything else, so the recipient never has any knowledge of Simon, and hospital policies of anonymity are accurately described.

The story begins by describing the heart within Simon, but it ends with the surgeons closing up the incisions on the recipient. We never get to hear about how the heart does under new management, or what the recipient even feels with it inside her. It’s an interesting choice for an ending, and one that makes it clear that the focus of this story is on the heart itself, not on the lives around it. It’s an interesting take on modern medicine, and one that blends together the symbolic and medical aspects of heart transplants.

“Being Mortal” by Atul Gawande

This book is essentially about how we take care of those who are about to die in contemporary society. And no surprise, we’re going about it in the wrong way. Medicine tends to push for patients to always try a different treatment, another surgery, keep doing something to attack the disease. However, if you aren’t strong enough for the continued treatment, this actually shortens your lifespan and increases suffering.

Now the alternative is to talk and come to terms with your inevitable death in order to plan for it. But no one wants to do that! We’d rather live with the illusion that we are going to live forever, and keep striving to maintain perfect health, even when our bodies are crumbling beyond repair. What with the fact that some patients are termed “fighters” it can seem as though the alternative is giving up and giving in to the disease. But we are all going to die at some point, and it is essential to recognize when this is going to happen and meet it with grace. It can be hard for doctors, and families, to have conversations about this and how to proceed, but they prove essential to dying on your own terms and in the way that you want to go.

Gawande gives several tips to facing this conversation. Don’t be Dr. Informative, presenting all the different options and letting the patient pick from them. Instead, be a doctor that sees the whole picture and tries to take the patient’s wishes into account for how they want to live. What does the patient understand about their situation? What are their fears? What would they define as a good life? What are they willing to compromise now for the chance of something better later? The answers to these questions probably won’t be obvious, even for those close to the patient, but they give clear directions on how to proceed with treatment.

Having watched my grandparents succumb to disease a few years ago, I now realize how well they had it, but also what we could have done better. I have no idea if my dad had them answer these questions, but maybe I should have talked to them on my own, and asked how I could make their end of life better. I was in high school and while I wasn’t scared of death I still didn’t want to face it. Taking care of them was on my list of things to avoid around the house, not embrace.

For all that though, my grandparents had it pretty good. They were not stuck in a hospital where they had no autonomy and couldn’t make any choices about their lives, they lived at home with us up until the end. My parents made sure that they had the help and support that they needed. They were able to maintain control and keep their family around them until the end.

I’m not sure how my grandparents wanted to spend the end of their days, but I think they were comfortable and happy. I just wish that I was there for them more. Having read this book, I think I will be there for whoever needs me next.

“Adventures of a Female Medical Detective” by Mary Guinan

This book was really interesting! It’s written by Dr. Guinan who has spent most of her life working for the CDC on public health issues. I had never really considered public health an exciting field before, but she’s been all over the world working to eradicate smallpox and educate the public on STDs.

The various stigmas that she has faced as someone working on STDs demonstrate how important it is that the public have access to accurate information about diseases and that we continually work against myths. Many of the AIDS patients that she saw were abandoned by their families and wasting away. Her work with syphilis was similar, people saw it as a way to punish sinners.

It's a short read, but an interesting one. I wish that she went into more detail about her own life, but my guess is that she wanted to stay focused on the cases that she was presenting. There’s a varied mix of them, including when she was an expert witness and when she was in India combatting smallpox. She’s lived a full life, and it’s fascinating to hear about her adventures.

"The Gene: An Intimate History" by Siddhartha Mukherjee

This is Mukherjee's second book, after "The Emperor of all Maladies" and it is just as prolific as the first one. He describes this as a prequel to "Emperor" in the sense that cancer is a genetic disease, so in describing cancer he is describing how genes go wrong. While both books compliment each other, it is also fine to read them separately. Honestly, this book is very similar to "Emperor", nearly all the comments that I had for one apply to the other.

When Mukherjee titled this "An Intimate History" he meant it. Similar to "Emperor" there are many stories of patients and their lives, as well as the researchers who sought to help them. In this novel he also brings in his own family (similar to Carla from "Emperor") to illustrate how genes have impacted him personally through his family tree.

Mukherjee takes us through genetics and the idea of a gene all the way from Mendel and Darwin to the present day. He does not shy away from ethical dilemmas, and discusses the future and the wonders we will be able to perform then. But he cautions against taking this power too far, after all there are no "right" or "wrong" genes, just genes that are better suited to different environments.

He also includes a brief discussion on genetic investigations into sexuality and gender. While he presents a good overview of the findings, he leans heavily towards the genes = gender idea (note that I did not say genitals, I am referring to the Y chromosome here, which can be suppressed and results in what is considered as female genitalia), which I am hesitant about. Because there will always be one person who reads that and disagrees and is alienated by the text. So there could be more nuance to that discussion, but the science appears sound, just be cautious treading here.

One thing that I was surprised he didn't talk about was GMOs, or genetically modified organisms. These are usually crops that have been altered to express different genes. Such as rice that is more water-resistant, or corn with added nutrients. There has been a lot of controversy over GMOs lately, since people think that they are dangerous and only want "natural" foods. Which is kind of funny really, as there is no such thing as "natural" crops, we have been selecting genes for centuries and breeding the best ones, creating GMOs is akin to taking that process and speeding it up a little. There is nothing dangerous about it. Anyways, while Mukherjee ignores GMOs, he does talk about stem cell research which is more interesting anyways.

Another great book from Mukherjee that makes science accessible to the general public. I would highly recommend it, whether you are studying genetics or just mildly interested in the field.