Spring Book Reviews

Catching Homelessness 
by: Josephine Ensign

Dr. Ensign taught my community health undergraduate nursing class, and this book was selected as the Health Sciences book of the year. She is such as creative, descriptive writer and paints a relentlessly driven, frustrated, young woman struggling to find meaning and follow her purpose. She doesn't spend much of the book talking about her homelessness, but paints it as stark and real as it must have felt to her. Her transition out of homelessness occurs very quickly as well, but I appreciated the drawn-out backstory. Too often we see our homeless patients as a name or for their current situation, and Dr. Ensign reminds her reader that there are rich backstories, if only we have the courage, kindness, and time to ask, and to listen. Highly recommended.





Sometimes a Great Notion 
by: Ken Kesey

Full disclosure: This book was only on my radar because a boy I liked told me it was one of his favorites. This was one of the most enjoyable pieces of fiction I have read in years. The story centers around a family dynasty of loggers in costal Oregon named the Stampers. Kesey starts several generations back filling in the genealogy and history of this family and most of the town, gradually making his way westward to the current story. He weaves in rich side character stories who play pivotal or incidental parts in the book, so that when a main character walks into The Snag, Wakonda's local bar, you feel connected to each local just like the characters do. The climactic main conflict hinges around the Stampers logging industry vs the town's logging strike. Hank Stamper is the dictionary definition of stubborn, and unyieldingly refuses to support the strike, instead striving to fill the mill's request almost single-handedly, with the help of only a few loyal family members. His brother also returns from the East Coast during this pivotal time, partly to see his old home, mostly to avenge his mother and destroy his brother. This plot ebbs and flows, and Hank's beautiful wife seems to grace both conflicts. She remains a beautiful, Stamper-defying enigma throughout the story, supporting her husband physically while you always wish to know more about her hopes and dreams. The climax is thrilling, devastating, and senseless, and everything about the story mirrors the aftermath for the rest of the book. It is hard to pick a favorite part, but the author's absolute mastery of descriptive writing at times made me smile simply reading his descriptions. Scenes came to live in front of my eyes, painting themselves with the words he arranged with ease page after page. Definitely a book I will re-read, and a timeless classic. Some say this was Ken Kesey's magnum opus, and they wouldn't be wrong.


Dear Data
by: Giorgia Lupi& Stefanie Posavec

This was kind of a fun book to peruse, and definitely would be a great coffee table conversation starter. These two graphic designers spend 52 weeks sending each other weekly postcards drawing data about their day-to-day lives. Each week, they pick a different topic, spend the week gathering data, and present it in novel, colorful ways from England and New York. The two women had only met once before deciding to do this, but their paths cross again several times during this year. They cover all sorts of topics: how often they swear, doors they pass through, places they've lived, and thoughts of jealousy, to name a few. Each woman has her own unique style preference - one thinks more linearly and with lots of symbols, and the other prefers simplistic, colorful presentation. I enjoyed appreciating their creative talent, and hopefully learned to think a little more outside the box.


Zig Zag: The Surprising Path to Greater Creativity
by: Keith Sawyer


This was also an impulse read, and part of my attempt to expand my thinking. I ended up outlining each chapter because, unlike many books with lofty promises, Sawyer rolled up his sleeves and got busy objectively summarizing research-proven ways to be more creative. He divides the creative process up into 8 parts, then breaks down each part into steps with tools to accomplish each objective. I learned a lot, and certainly gained more insight into my own strengths and shortcomings. My biggest takeaways were to not be afraid to think broadly and absurdly about problems, narrowing the scope only after approaching the problem from every conceivable angle and solution. Sometimes in healthcare we are encouraged to follow uniform, streamlined approaches which doesn't exactly leave much room for the creative process. Nevertheless, innovation is everywhere, and I have already found myself applying concepts learned in this book.

Extreme Measures: Finding a Better Path to the End of Life
by: Jessica Zitter

Written by an ICU attending turned Palliative specialist, this book should be read far and wide. Dr. Zitter describes her change of heart while placing a central one day and being castigated by the Palliative ARNP in front of her med student. While initially angry and resistant, she examines her motives and realizes there is more to patient care than preserving life at all costs. She honestly discusses holes in the medical education system which focuses more on saving, and less on transitioning. Knowing when can be an incredibly emotionally difficult, ethically ambiguous decision to make, and Dr. Zitter provides excellent language and resources for starting difficult conversations and topics which should be covered. Her own hesitance to write her advanced health care directives really resonated with me, and I ended up writing me own shortly after finishing this book. She provides so much food for thought, and intersperses patient stories with thoughts and discussion points. She doesn't lecture, but rather discusses, and sometimes leaves stories and thoughts without answers. One of her great strengths is being comfortable with uncomfortable questions, situations, or solution-less problems. Her Netflix short, Extremis, is critically acclaimed and a great easy way to start thinking about what it really means to make these decisions. Her strength comes from spending time on how unnecessarily so many people suffer at the end of their lives, but also acknowledging stories of patient's wishes respected, and families making decisions which lead to closure and peaceful deaths.

Book Reviews from Last Time to...Now

Brain on Fire
Susannah Cahalan

An Occupational Therapist at work recommended this book to me and it was a stirring, visceral read. The author was roughly my age when her brain rebelled against her body, regressing her to a wall-staring zombie incapable of taking care of herself or remembering the month of her life she almost died. She does a remarkable job of piecing together those days off of hospital records, fragmented, fuzzy memories, eyewitness accounts, and faithful diary entries from her parents. Susannah pulls you down the descent into madness with her, blindfolding you to reason, sense, and sharing every intimate detail of her deterioration. The reader gains the benefit of a healthy brain to hear the myriad of medical tests and theories, but stays in the dark as she and her parents do until the real culprit is unmasked: Anti-NMDA receptor encephalitis. You feel exhausted and relieved as she begins to recover, and feel a satisfying sense of closure as she resumes her life a changed woman, but a recovered mind. 



When Breath Becomes Air
Paul Kalanithi

Full disclosure: this book does not have a happy ending. We start toward the end of Dr. Kalanithi's story - he is sick, but the gravity and prognosis is unknown. As a health care professional, and daughter to a man who also died from cancer, this book hit close to home many times. It was a beautiful, heartfelt read. The author manages to take a heartbreaking, joyless topic and keep a positive slant throughout most of the story. He speaks to what he loves in his life cut short: learning, neuroscience and neurosurgery, writing, his background, his wife, and his family.  The story draws the reader along even as the apprehension of disease progression lurks in the background. I found myself wanting to read faster because of his masterful writing style, but dreading the relapse. His writing style waxes faintly melancholy and philosophical and when it becomes evident that he is facing an insidious, terminal disease. His book was left unfinished as he suddenly took a turn for the worse. The transcript was edited as minimally as possible, but left the reader with a sense of transition, not end. His wife, Lucy, writes the epilogue recounting his final days and hours, passing out of this life in the very place he spent so many thousands of hours saving others. I cried freely and extensively reading the final pages of this book, but his wife's strength in finishing what her husband could not stands as a testament to the profound impact he made on people's lives in all facets. This is the mark of a great doctor and a great man: a well-rounded, strong character who, even in his final months of life shares his experience for the benefits of others.

The Time Traveler's Wife 
Audrey Niffenegger 
 I didn't see the movie: this isn't my normal genre of interest. However, the fluid timeline of the book bore merit for investigation. Overall this book held my interest. However, I wouldn't count it as a classic, nor as a book I would read again. I enjoyed scenery descriptions and the idea of their life in time more than the actual plot. I found the twists dramatic and over-emotional, and although I cried like a little girl at the ending, it was because of the father daughter dynamics fresh on my own father's passing, not at the authenticity of the story. 



 
The History of Love
Nicole Krauss

"Once upon a time there was a boy who loved a girl, and her laughter was a question he wanted to spend his whole life answering." 

This sentiment from the prologue charmed me from the first pages, and kept me reading, pondering, wishing, and connected with the book's characters throughout its packed intertwined story. The book is actually three separate stories, tightly braided together, which the reader at first knows no connection between, and gradually begins to draw inferences about as the book progresses. These are my favorite kinds of novels: the author is completely in control the entire time, but starts from a seemingly arbitrary place in the story to in fact complete a full circle by the book's end. Each story feels real, grounded, and tangible. I could picture myself in Leo's horder apartment, kitchen littered with baking supplies covered in a powdery flour dust. I could hear the radiator clanking of his upstairs neighbor, and picture his face when the door is opened. I could see the pre-pubescent girl, Alma, bored and curious, sneakily opening letters and innocently missing romantic undertones from her lone male friend. I let go of time and space and reality when the stories began to come together, and let myself be wrapt up in the author's oddly satisfying, but completely heartbreaking crescendo and felt simultaneously completely let down and at peace when I read the final page. I do not expect to reread this book looking for a feel-good nothing to kill time, but rather to again appreciate the work of an author comfortable with illuminating the hidden magic of the ordinary and forgotten.

Fire Shut Up in My Bones
Charles Blow 

This book was a total impulse pick off the shelf at the library. I was instantly drawn in to the author's deep south upbringing. The introduction was quick and fiery and I wondered at where the rest of the book was headed. However, Charles takes a step back after the introduction, going back all the way to his first memory, and gradually recounting his life from there. The story was full of lovely descriptions of his deep south upbringing, peppered with character descriptions, mouth-watering meals, and places seen with significance that changed as his world expanded. He grew up in abject poverty, but he never complained or victimized his upbringing. Instead, he openly, vulnerably presented himself and his perception of life in Gibsland. I found myself rooting for him, inwardly bracing myself for the trauma I knew from the introduction was coming, but taking delight in hearing his story. His tone reflected the setting of each phase of his story. I could hear his voice in my mind, sitting beside me on a rocking chair on a hot July day, sipping sweet tea, the sound of children playing in the background and old women rocking and gossiping beside me. I ached for him when his innocence was taken, silently, in the night. I waited as his character was questioned, forged, and tested time and time again, and willed his story to be one of success, not defeat. It is, and then some. Highly recommended.

Rivers with My Dad

Epitaph - Merrit Malloy

When I die
Give what’s left of me away
To children
And old me that wait to die.

And if you need to cry,
Cry for your brother
Walking the street beside you.
And when you need me,
Put your arms
Around anyone
And give them
What you need to give to me.

I want to leave you something,
Something better
Than words
Or sounds.

Look for me
In the people I’ve known
Or loved,
And if you cannot give me away,
At least let me live on in your eyes
And not your mind.

You can love me most
By letting
Hands touch hands,
By letting bodies touch bodies,
And by letting go
Of children
That need to be free.

Love doesn’t die,
People do.
So, when all that’s left of me
Is love,
Give me away.

How My Dad Dies

I didn't picture it like this.
I pictured a darkened room, shades half-drawn, subdued sunlight negating the need for anything artificial. A neatly made hospital bed, with a single IV line connecting my dad to a single IV pole with a single IV pump and a small, clear bag.
I imagined him sleeping comfortably, and, if he stirred, pushing IV morphine myself and watching him settle back into a satisfying slumber until his breaths rattled thin and irregular and eventually stopped altogether. He would not be awake. He would not be present. He would not be in pain.

Memorial Day at 2pm my mother called me at work, never a good sign. She said he had been in so much pain all weekend he was crying. She wasn't wrong. I left work at 7:30 to come home and immediately call the on-call hospice doctor, at 9pm at the end of a 3-day weekend. My dad has always had a way with good timing. We upped his pain medicine strength and dosing schedule. I woke him up throughout the night to make sure he took his pain medicine. I eventually slept around 10 or 11 and set my alarm for 4:30am for pain medicine. By the time I woke him up, he was in a different place. He was relaxed, awakened easily, aware, and wanted to talk. So we did. For 50 minutes. He smoked a bowl, we watched the sun rise, he ate breakfast, and at last, he took his pain medicine.
It was an incredibly pleasant memory because it was impromptu and genuine. He was himself. So completely unexpected timing, but we take the memories we get whenever they happen. Life never fits neatly into perfect boxes. Sometimes the most lucid, peaceful moments come after 18 hour days and 5 hours of sleep.

I never pictured it like this.

2 weeks later, he is even thinner, if that is possible. His right leg is large and red and his right arm is small and white. DVTs. His skin would be pale if it wasn't yellow. Inconceivably, he still has a watch tan. We match. He twitches a lot, but his pain is better managed. His Hospice RN, and he, surprisingly, too, articulated that his pain is as much emotional as it is physical. When were we supposed to learn that? Because of that, we give him pain medicine for both. I never knew. Our kitchen table has been transformed into a home-cooked controlled substance cocktail lab. Blue morphine, crushed pills, and small syringes lined up methodically, with detailed recipes at the side for each time and dose we administer. The opposite of a locked pyxis requiring a fingerprint, accurate count, and audits for appropriate use. Here we leave large doses of potent opioids in unmarked syringes mixed with ativan and haldol, in whichever concentration is best, whenever we deem best. It is both strictly regimented, ever 3 hours, but also totally up to my dad - whenever he needs it. Today I gave him a morphine syringe and then my mom and I realized we didn't even know who had mixed it or what specifically it contained. This morning, he was crying from pain again, so I unflinchingly doubled his liquid morphine dose, without consulting anyone. Then I stopped to marvel at this foreign system. While polar opposite of the regimented, heavily regulated hospital system, this is no less effective. The nurse sat cross legged in my dad's bedroom on his bed in the dark and stroked his stomach in the direction of his bowels to relieve gas. Bedside nursing indeed.

I never imagined the dark humor. A close childhood friend, whom he's known for 15 years, asked me to tell him she loved him, as he is no longer receiving visitors. I joked to my brother I'd tell her my dad said "Who?"

He has begun dreaming of deceased loved ones, and speaking with people who are not physically present. I woke him up this morning and he looked behind him, mentioning he thought he heard someone. He told my mom this morning, "But I have so many places to go." The hospice RN told us she sees this commonly in people passing on to the next life, and that people from his past have come to keep him company and ease his way. This was a part I did not expect, having never seen the dying process this intimately. It's cathartic, and seems to bring a closure to this life and an invitation to the next. It is as beautiful as it is heartbreaking. A journey set in motion, and he is moving on to places where I cannot go with him.

I never imagined letting go would be so difficult. I have always loved him, and I have always wanted a peaceful death for my dad. But after spending so much time and effort on his care, it is difficult to finally see that he is transitioning, and that my part will be less needed, and will end. It is more pushing a boat away from a dock than it is scuttling a tumor-ridden dingy. This does not feel like an end, because he will not be gone. His network of loved ones lives on, as will his memories and impact on so many people. I did not imagine death would feel like a transition, instead of the end.

 In one of his last sustained, present moments, he dictated part of a post to family and friends. He ended it with,


"The river's getting rougher, and the support that I am so honored by can only help so much. When you're swimming through a class 4 rapid, it's really just you and the river."