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Book review
Apr. 14th, 2008 12:52 amI just finished reading The Surgeons: Life and Death in a Top Heart Center by Charles R. Morris. It's a fascinating book. The hospital in discussion is Columbia-Presbyterian in New York. Morris "embedded" himself there, staying in the cardiac area, attending surgeries sitting in the back near the nurses, attended staff meetings, all that stuff. He opens with a little history of heart surgery and an typical patient. Incidentally, although this is written for a popular audience, he does assume some slight knowledge on the part of the reader - for example, he doesn't stop to define "comorbidity" as in "Like many heart patients, Goldfarb suffers from a variety of comorbidities..." He describes how doctors and nurses "suit up" and create a "sterile field" around the patients, and then pretty much cut-for-cut describes Mr. Goldfarb's heart valve replacement.
He describes the different specializations within cardio-thoracic surgery: it's not just "heart surgeons" in general. There's the bypass specialists, the anesthesiologists, the pacemaker-and-defibrillator surgeons (he doesn't mention it, but in my experience they are usually called electrophysiologists, or EPs), the pediatric specialists.
Of particular interest: the difference between those surgeries in which the patient is put on a heart pump, and "off-pump" surgeries. The various range of outcomes of transplants. He describes a failed pediatric transplant - the patient dies. No avoiding the tough issues. The whole way the transplant process works - he goes along with a "harvest" team to get the heart from a donor, and talks about teams from other hospitals there to harvest other organs from the same donor, and what it's like to have several different teams working on one body.
Also of interest to heart failure patients would be the discussion of the LVAD, and also the chapter on the development of "cath labs" used by cardiologists, which is something different from cardiac surgeons (if you've had an angiogram, you've been in a "cath lab.")
And there's a big section on "The Problem With Drug Companies" and another on how to determine "best practices" as well as some controversial issues about evaluating different studies on various practices and on rating the hospitals.
It's a fascinating book - this barely begins to describe it. He's a good writer, and the book moves right along; we get to know the doctors and nurses as people. He has editorial comment as well as just description of what's going on, and it's useful input for anyone who is following the US's continuing struggle over how we provide health care and to whom.
Interestingly, I also happened, quite accidentally, to recently re-read Lewis Thomas' The Youngest Science: Notes of a Medicine-Watcher and it was interesting to compare his descriptions of medical practices and hospital routines from the 1930's and 1950's to Morris's of half a century later.
He describes the different specializations within cardio-thoracic surgery: it's not just "heart surgeons" in general. There's the bypass specialists, the anesthesiologists, the pacemaker-and-defibrillator surgeons (he doesn't mention it, but in my experience they are usually called electrophysiologists, or EPs), the pediatric specialists.
Of particular interest: the difference between those surgeries in which the patient is put on a heart pump, and "off-pump" surgeries. The various range of outcomes of transplants. He describes a failed pediatric transplant - the patient dies. No avoiding the tough issues. The whole way the transplant process works - he goes along with a "harvest" team to get the heart from a donor, and talks about teams from other hospitals there to harvest other organs from the same donor, and what it's like to have several different teams working on one body.
Also of interest to heart failure patients would be the discussion of the LVAD, and also the chapter on the development of "cath labs" used by cardiologists, which is something different from cardiac surgeons (if you've had an angiogram, you've been in a "cath lab.")
And there's a big section on "The Problem With Drug Companies" and another on how to determine "best practices" as well as some controversial issues about evaluating different studies on various practices and on rating the hospitals.
It's a fascinating book - this barely begins to describe it. He's a good writer, and the book moves right along; we get to know the doctors and nurses as people. He has editorial comment as well as just description of what's going on, and it's useful input for anyone who is following the US's continuing struggle over how we provide health care and to whom.
Interestingly, I also happened, quite accidentally, to recently re-read Lewis Thomas' The Youngest Science: Notes of a Medicine-Watcher and it was interesting to compare his descriptions of medical practices and hospital routines from the 1930's and 1950's to Morris's of half a century later.
