The Soul of Medicine: Tales from the Bedside - Hardcover

From The Washington Post's Book World/washingtonpost.com Sherwin Nuland is one of the country's most preeminent doctor-writers. To his books, he brings the perspective of over 30 years of surgical practice and a passion for medical history. The combination has appealed broadly to readers both within and without the ranks of medicine. For doctors, Nuland's voice has validated the realities of a profession from which impossible things are sometimes expected. For patients, his books were among the first to pierce the veil of mystery separating patients from their seemingly all-knowing and all-powerful physicians. The idea for Nuland's newest book, "The Soul of Medicine," is a terrific one. Over the course of his career, both as a practicing surgeon and as a clinical professor at Yale, Nuland has had the chance to work with a host of exceptionally talented doctors in a range of specialties. For "The Soul of Medicine," he has asked 16 of them to tell the story of their most memorable patient and, with two of his own additions, cobbled them together into a modern-day version of "The Canterbury Tales." Here, Canterbury is the fictionalized name of the prestigious medical institution where our storytellers' practices intersect, and the tales themselves are delivered by specialty: The Urologist's Tale, The Pediatrician's Tale and so on. Since the book ostensibly focuses on patients, it's surprising to find physicians so prominent in the stories. The doctors' personalities take over, and the patients and their diagnoses -- rare and perplexing as they may have been -- fade into the background. Far more striking than elusive diagnoses or anatomical oddities are the sometimes touching but frequently galling descriptions of the ways in which these doctors viewed and interacted with their patients and, at times, their subordinate colleagues. It is in these interactions that the book's thematic allusion to "The Canterbury Tales" seems most apt, for many of the tales feel more medieval than modern, more historical retrospective than current commentary. As an example, there is the married surgeon in the 1940s who proudly tells of bedding student nurses in a hospital construction site. When the nursing supervisor catches him, he lies to the hospital president and has her fired. Nuland appropriately chastises the "scoundrel" in his commentary following the tale, but the larger question is, given the revelation of such behavior in Samuel Shem's classic novel "House of God," why include it? Fortunately, "The Soul of Medicine" also contains far more poignant -- and relevant -- examples of physicians' human failings: an anesthesiologist who allows an obviously manic surgeon to proceed with an operation, placing the patient in grave danger; a neurosurgeon who unleashes his fury on a man who beat a boy to death, "want[ing] to be sure that [the man] could see the bits of brain clinging to my gown, the front of which was soaked in the fresh still-scarlet blood of the child he had killed." But the segues into and out of these emotional passages are rapid. As a result, the reader is not given adequate time to contemplate the life-altering moments for both patient and healer that the best of these stories reveal.
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National Book Award–winner Nuland (How We Die) turns over his latest collection to the stories of more than a dozen specialists describing their most memorable patients. What is extraordinary about Nuland's compilation is not the medical heroics but the instances of fallibility and vulnerability that prove the doctor is not just human but caring. A bronchoscopist tells of a famed thoracic surgeon who botches a procedure to recover a small cap a child has swallowed Well, chappies, he chirped, here's my chance to demonstrate the procedure again. Rather like a double feature at the cinema, yes? When that, too, fails, the frustrated surgeon must do major surgery to rectify what should have been a 10-minute fix. Even the scoundrel who gets a nurse fired rather than be caught in his own impropriety shows a recognizable humanity in his hilarious retelling of barging into a procedure unwashed and unwanted, and being chased from the premises by a mad-as-hell surgeon. Nuland adds his own commentary after many of the stories, but it's just window dressing. Here's medicine as it's actually practiced—by humans awed by the privilege of both their practice and patients. (Apr.)
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