“Illness as Metaphor” by Susan Sontag

This is an unusual book in that it does not discuss what it is like to be sick, just how we perceive those that are sick. Specifically, Sontag focuses on cancer and tuberculosis. Tuberculosis was a disease of the Victorian era, while cancer is more modern. She goes through works of literature, history, and even science fiction in her analysis. Although this was published in the 70s, it’s amazing to see how little has changed in the perception of these diseases today.

One point that I found fascinating was how those with these sicknesses reflect the ills of society. Tuberculosis is a disease of passions, of excesses. Those with TB are said to acquire a mysterious aura, to the point where some people wanted to get TB to be more appealing to ladies. In contrast, cancer is an individual disease that destroys us from the inside out. Someone with cancer wastes away, their hair falling out and confined to a bed hooked up to chemo. It is associated with repressing emotions. Both diseases’ portrayals reflect the society around them to an extent. Victorian era people would repress their sexuality for fear of taboos, while today we find ourselves increasingly more cut off from each other and only interact through the internet.

Sontag’s point with this is that we have all of these misconceptions about sickness, we think that these diseases are a punishment on the sick, we think that only certain personality types contract these diseases, etc. However, that is not the case. Acknowledging these misconceptions that we hold will lead to a better treatment of the sick, and a better understanding of their troubles. Only then can we alleviate their suffering.

“The Checklist Manifesto” by Atul Gawande

This book is titled a “manifesto” and it certainly seems like it. This is Gawande making his case for surgeons and those in medicine to adopt a checklist for use in their operating rooms to make sure that they don’t forget the little details in their work. Having said that, it reads more as a narrative about how he came to the conclusion that checklists would be beneficial (almost essential) in medicine.

This narrative starts with Gawande wondering how big buildings and other works of architecture are built. It’s not that different from surgery after all, you have a project that needs to be completed within a time frame, and mistakes could be disastrous. Turns out that construction workers use an enormous checklist with everything that has to be done, and when. The amount of knowledge involved in constructing a building is far beyond any one person’s capabilities, so there is input from all of the different utilities and builders in forming the list. Then to deal with unexpected problems, they have a schedule of when people will meet with each other and discuss aspects of the building before moving forward. Even their collaboration is built into the schedule!

From there, Gawande describes how pilots and air crew have a similar game plan, and their training is such that they always turn to a checklist when taking off, landing, or dealing with crises. They also have a solid foundation in teamwork when flying. That’s why occurrences like the miracle on the Hudson happened, the entire crew worked together to make it happen. And the pilots had a checklist.

In the early 2000s there was a series of meetings involving physicians from around the world to make surgeries safer. Gawande suggested a sort of checklist to standardize procedures and remind surgeons of the basics. There were many pitfalls, such as cutting the checklist down and not including everything in it, but in the end the trial of the checklist system was a rather unexpected success!

Of course, some doctors are loathe to use it. As far as I can tell, their main objection is pride. They think that they don’t need these little reminders, they are on top of things. However as numerous anecdotes point out, yeah, you do need the checklist. Gawande himself shares an instance where using the checklist saved his patient’s life. He also points out that if we had a drug that improved performance as much as the checklist, hospitals all over the world would be fighting for it. But since it’s a boring checklist, implementing it has been a struggle.

Besides thinking about checklists, this book also made me think about leadership. Gawande doesn’t hesitate to point out the fact that most surgeons run their operating rooms like a dictatorship and often nurses are reluctant to point out when they might have forgotten something. Using a checklist and going through the items as a team created a better sense of unity in the OR and fostered teamwork. As a leader, you have to think of the balance between you telling people what to do and everyone working together. Gawande argues for more collaboration, especially within medicine. Architects have learned that there is too much information for one person to know everything, but medicine has yet to catch up. Where do I fall on that scale? I like to think that I’m very collaborative, but where could I improve? Clearly the checklist system has implications beyond those suggested here, and is an important tactic for anyone in a leadership role.

“The Language of God” by Francis Collins

I wasn’t expecting much from this book. I’m not much of a believer myself, and I regard anyone who tries to change my mind with a veeeeeery healthy dose of skepticism. But as I continued through this book, a few things set it apart in my mind.

First of all, Collins isn’t trying to convince anyone that you NEED God in your life. What he’s saying is that science and religion CAN be compatible. Whether or not you actually have the two in your life is up to you. Just know that you have the option.

Second, Collins frames his points in a series of questions (or objections) and answers. In this way, the thoughts that pop up to the reader are readily addressed in the book. Many of his responses come from other religious scholars, primarily C.S. Lewis. Clearly he has done his research. Many of the responses are also put into the context of Collins’ life and the doubts that he went through.

Which is another nice aspect of the book, Collins takes us through his own journey as an agnostic and eventually to faith. As a scientist, it’s nice to see the path that he has taken and be able to relate to the various steps along the way. Collins was in charge of the Human Genome Project, so the science that he explains is very well-written and accurate as well.

Finally, at the end he includes a brief section on bioethics and how religious views play into that. It’s so refreshing to hear a religious perspective that denounces all of the crazies out there that deny evolution or are stubbornly against stem cell research without bothering to learn about what they are. Once again, Collins demonstrates that he has done the background research and is amazingly capable of translating it to an ordinary audience.

I’m not any more of a religious person for reading this book, but I feel as though I have a more nuanced understanding of it and how it interacts with science. And a little understanding can make all the difference, give it a shot if you are religious, a scientist, or both.

“Better: A Surgeon’s Notes on Performance” by Atul Gawande

Medicine is usually seen as a field where improvement is based on new innovations, where research gives the push to make things better. However, as Gawande illustrates here, improvements need to come from doctors themselves, through introspection and a willingness to be open about our areas of weakness.

He brings up a number of issues that I had never considered before. For example, there is a chapter dedicated to doctors who assist with fatal injections being used on death row inmates. I had never thought about that much, but it does make sense to have a doctor there, to make sure that the injection isn’t botched. But it also makes sense that the official stance of the American Medical Association (AMA) is against this. They see it as a breach of a doctor’s responsibility to heal and provide life to patients, not taking it away. Gawande tracked down a number of doctors involved in lethal injections and shares their stories and reasons for participating.

There are more mundane topics covered, such as hand washing and protocol for performing potentially intimate physical examinations. What makes medicine specifically so interesting is its blend of social and scientific factors. The way you handle yourself with a patient matters just as much as the care you are giving them. In the physical examinations chapter, he discusses how doctors can use chaperones to lessen this, as well as simply in general keeping their patients informed of what is about to happen to their bodies.

At the end of the book, Gawande gives some tips to those in the medical field who want to be doing the best that they possibly can. In list form, these are “ask an unscripted question,” get to know the patient or your co-worker as a person and not just a part of your job; “don’t complain,” a doctor’s life is hard but that doesn’t mean that you have to dwell on that; “count something,” observe what around you works and what doesn’t; “write something,” keep your mind sharp by noting down observations; and “change,” be willing to change yours and others behaviors to make medicine a better place. Just through these suggestions, you can see Gawande’s focus on the humanity of medicine, his desire to see his patients as people. You can also see his desire to make medicine better by using the skills we already have. By appealing to the instincts that doctors already possess, he is trying to take the resources we all have and point them towards a goal. Which builds off of a number of chapters, whether it’s doctors monitoring their hand washing or surgeons in India performing surgery with whatever meager tools around them.

I think anyone can learn from this book, whether you are involved in the medical field or not. But having an interest in medicine doesn’t hurt here, as the stories he is telling are fascinating and eye-opening. Any job can use a healthy dose of introspection to make it better, whether you are in business or just a student. The point is to learn from the work that Gawande has done here in a specific field and then apply it to whatever field of your choosing. I can’t wait to see what you accomplish.