The Intern Blues

The Book of the Week is “The Intern Blues, The Timeless Classic About the Making of a Doctor” by Robert Marion, published in 2012.  This ebook documents the internship experiences of three medical school graduates in the mid 1980’s.

At that time, interns were “on call”– had to work eighteen to twenty-four hours in a row, usually overnight, in a hospital every three days. Every month for an entire year, the interns in this ebook were assigned to a different unit such as pediatrics, neonatal intensive care, or the emergency room, at a medical center in the Bronx in New York City.

The hospital staff was kept busy treating patients with conditions whose causes were poverty-related— people in poor health, and those who suffered physical harm from violence and drugs. Many patients and their families had psychological problems. One intern remarked, “…we have two psychotic crackheads roaming around the ER, we also had two psychotic crackheads who were paranoid and had no idea what was going on, which is a wonderful combination.”

Severely sleep-deprived, along with doing a ton of paperwork and presentations, the interns had to admit patients, keep “…track of names, symptoms, physical findings, lab results, and treatments…”  They witnessed life-or-death situations for which they felt they were not psychologically prepared. They had to tell patients’ families that their loved ones had died, make serious decisions on whether to report child abuse to the authorities (which was a whole bureaucratic process itself), deal with difficult nurses and lab technicians, not to mention their supervisors; all this, along with the extremely stressful circumstances surrounding the AIDS epidemic.

On top of that, one of the three interns became pregnant during her internship. Read the book to learn how that worked out for her, and to get an insider’s view of what it was like to be a medical intern a few decades ago.

The Cure

The Book of the Week is “The Cure” by Geeta Anand, published in 2008. This ebook tells the emotional, suspenseful story of how a family coped with three disabled children, two of whom were suffering from a genetic disease for which a cure is yet to be found.

In the late 1990’s, John Crowley’s daughter and son were both diagnosed with Pompe disease, a muscle disorder. Patients, with varying severity, “have imperfectly produced acid alpha-glucosidase enzyme” which results in paralysis, obstructed breathing, and, if left untreated, death before the age of five.

Even though Crowley possessed the personality, talents, skills, education and privileged background that one would think would allow him access to a life-saving enzyme to save his children, he had to face numerous obstacles. The father naturally fell into the role of entrepreneur to do so. His wife provided invaluable emotional support and around-the-clock care of the children with the help of nurses; not to mention the running of the household.

Nevertheless, lots of genetic and environmental luck determines whether patients become fully cured and/or whether the quality of their lives improves significantly, or whether they die– even when they are sufficiently fortunate to take part in a trial of a new life-saving medicine. Death would be inevitable without the medicine.

Every patient is different. There are many different criteria the U.S. Food and Drug Administration considers when deciding whether to approve particular medical products for sale. Money plays a major part in whether a new product ever sees the light of day. A young medical research company raises funds through venture capitalists, and because the whole operation carries extremely high risks, if the company achieves success– the rewards, fittingly, are also extremely high.

Scientists must do years of preclinical testing on animals to make sure a new medicine works sufficiently well before even considering administering it to humans. In the United States, possible deadly consequences and possible future litigation motivate the scientists to act with integrity by performing tightly controlled experiments, so as not to have to fudge research results.

Another aspect of drug development, is avoiding a conflict of interest such as that in Crowley’s situation. He played a pivotal role in the race to bring a medicine to market; it appeared he was doing it to get the medicine for his own children.

The estimated annual expense of the enzyme for each child was $200,000, and $1 million for all future annual medical expenses, including the enzyme, plus wheelchairs, nurses, ventilators, catheters, etc.

Read the book to learn of the Crowley family’s experiences with American biotechnology.

Cracked

The Book of the Week is “Cracked” by Dr. Drew Pinsky with Todd Gold, published in 2004.

The author of this ebook, a doctor, recounts his experiences treating drug addicts in a rehabilitation facility. Many of his patients were subjected to various kinds of childhood abuse that “…caused them to feel helpless, powerless, and in grave danger.” They became distrustful, and had difficulty making social connections and processing emotions. Many had parents who were addicts.

Some people are genetically predisposed to becoming addicts. One fifth of people entering rehab are addicted to marijuana, and usually, alcoholism runs in their families. People may develop lesions on the brain after just a couple of exposures to the drug ecstasy. Many people turn to shoplifting as a substitute thrill to opiate abuse in trying to quit their addiction.

At the start of addiction, the nucleus accumbens in the brain changes so that the body thinks that controlled substances such as heroin, alcohol, cocaine, etc., are necessary for survival. Beating an addiction requires rewiring some of the noncognitive parts of the brain.

Sadly, American society pressures its citizens to derive emotional comfort from material possessions, an unhealthy practice. “We forget that people feel best when they’re interacting, talking, helping, and creating with other people… face to face, particularly in times of adversity or when they’re feeling threatened.”

Read the book to learn the stories of typical addicts, the detrimental behaviors of their loved ones, and of the author’s frustrations with his patients’ stingy insurance companies.

A First-Rate Madness

The Book of the Week is “A First-Rate Madness, Uncovering the Links Between Leadership and Mental Illness” by Nassir Ghaemi, published in 2011. This book describes the leadership abilities of John F. Kennedy, Martin Luther King, Abraham Lincoln, various Civil War generals, Adolf Hitler, George W. Bush, Tony Blair and Ted Turner, as determined by their mental health, or lack thereof.

The author argues that most people who have mental illness are not insane all the time; they merely have abnormal moods, such as depression or mania some of the time. He claims that mentally ill political and military leaders are heroic in times of crisis, and mediocre during peaceful, uneventful times; the opposite is true for mentally healthy leaders. This concept can be applied to the corporate world, too.

“In a strong economy, the ideal business leader is the corporate type… He may not be particularly creative… all is well only when all that matters is administration… When the economy is in crisis… the corporate executive takes a backseat to the entrepreneur…” It is rare to find someone who is an excellent leader under both extreme and normal conditions.

Ghaemi contends that “…depression led to more, not less realistic assessments of control over one’s environment, an effect that was only enhanced by a real-world emotional desire…” In other words, people prone to clinical depression have a more acute sense of reality than those who are not, a concept called “depressive realism.”

When the mentally healthy leader faces a crisis, he handles it poorly, because having suffered little in his youth, he “…hasn’t had a chance to develop resilience that might see him through later hardships” and has not developed the ability to empathize. George W. Bush was one such leader. To boot, he had “hubris syndrome.” Getting drunk on power, like many mentally healthy leaders, made him “…unwilling and even unable to accept criticism or correctly interpret events that diverge from their own beliefs. Hubris syndrome worsens with duration and absoluteness of one’s rule.”

Read the book to understand the psychology behind the successes and failures of the aforementioned leaders.

High Priest

The Book of the Week is “High Priest” by Timothy Leary, published in 1995.  This is a personal account of a man who, in the late 1950’s and early 1960’s, developed a reputation for experimenting with brain-altering chemicals such as LSD.  He used students as guinea pigs at his Harvard University laboratory.

Some of Leary’s impressionable charges unwisely updated their parents on their religious and philosophical enlightenment; others “quit school and pilgrimaged eastward to study yoga on the banks of the Ganges.” Unsurprisingly, the parents and school administrators felt that Leary was a bad influence, and he was fired. He attempted to relocate his spiritual profiteering to Mexico, but was busted in 1963 for failing to obtain authorization to run a business there. He then took his allegedly raunchy, psychoactive, disease-spreading endeavors in the dark arts to Antigua in the West Indies.

Read the book to learn the details of this ideological character’s psychedelic research results.

Destiny of the Republic

The Book of the Week is “Destiny of the Republic” by Candice Millard, published in 2011.

In 1880, James A. Garfield was a humble soul. He, like Abraham Lincoln, did not traverse the country making speeches because stumping was “considered undignified for a presidential candidate.”

Garfield actually did not want to become the 20th president of the United States, but he was elected anyway. He was inaugurated in 1881, in March– the month in which presidents took the oath of office until 1933– when transportation to Washington, D.C. had been sufficiently improved.

At the time, the Secret Service sought to eliminate counterfeit money, not provide security for the president. He had no bodyguards. It was thought there was no way to prevent a determined public from harming him. So he did not worry about assassination.

On orders from God, a deranged man named Charles Guiteau shot Garfield in a train station. While Garfield lay on the extremely unsanitary floor, a doctor “inserted an unsterilized finger into the wound in his back, causing a small hemorrhage…” and a big infection.

If the president had been shot only fifteen years later, he would have been X-rayed and would have undergone antiseptic surgery. However, at the time, the American medical community was still resistant to accepting Lister’s theories on antisepsis, and instead exhibited arrogant, distrustful behavior.

Read the book to learn the destiny of the United States at this fateful turn of events.

All Creatures Great and Small

The Book of the Week is “All Creatures Great and Small” by James Herriot, published in 1993. This is a lighthearted account of Herriot’s training as an aspiring rural veterinarian in 1930’s England. A crotchety yet experienced character showed him the ropes. The author gradually developed confidence in curing the afflictions of pigs, cows, horses, etc. The job was suitable for neither the squeamish nor faint of heart.

Healing Hearts

The Book of the Week is “Healing Hearts” by Kathy E. Magliato, M.D., published in 2010. This is a personal account detailing one woman’s experiences trying to balance her medical training and career, with her family life.

She details various issues, including but not limited to: the long, rigorous road to becoming a full-fledged doctor in her specialty; the discrimination she faces in a male-dominated field; the job emergencies that cut into quality time with her family; and the healthcare crisis in the United States.

Magliato and her husband have a combined 43 years of education and training in medicine. She, in cardiac surgery; he, in liver transplants. She describes the hardships she faces when passionately attempting to save lives. She must ignore her own physical needs while standing for, say, fifteen hours in a row to help provide patients with a replacement heart, or veins or valves. She needs to hold particular medical instruments in place for many minutes without flinching, lest she harm the patient.

Magliato predicts a collapse of the American health care system. The reason is simply that health insurance companies do not pay what hospitals bill them; rather, they pay what they feel like paying. An insurance company might be billed $385,000 for heart surgery hospitalization, but it might pay the hospital only $54,000.

“…a hospital is ecstatic whenever it collects more than 10% of the bill. How can hospitals not only survive but be able to deliver state of the art care when their price is not met? They can only increase their quantity until the hospital is full. They can only cut their costs until the delivery of quality health care is jeopardized.”

Against Medical Advice

The Book of the Week is “Against Medical Advice” by James Patterson and Hal Friedman, published in 2008. This book discusses the struggle of a teenage boy (Friedman’s son) with various psychological disorders; obsessive-compulsive disorder and Tourette’s syndrome among them.

Cory tried to live a normal life, but by his teen years, he had fallen woefully behind socially and educationally. He had friends, but they were misfits like himself. At one point, he tried checking into an institution but found his life was not improving. However, the law required him to stay there a certain number of days, unless his parents signed a document stating he was refusing to accept the judgement of professionals about his treatment.

A last-ditch effort saw Cory enter an extremely radical program– a survival camp, of sorts– in which kids were forced to cooperate with each other in a harsh environment, or literally face death.

Read the book to learn how Cory fared.

Coronary

The Book of the Week is “Coronary, A True Story of Medicine Gone Awry” by Stephen Klaidman, published in 2007. This book recounts what happens when people are afflicted by certain aspects of human nature:  greed, power-hunger and fear. It is a sensational story, the kind even tabloids could not fabricate.

In the 1990’s and single-digit 2000’s, there was a cardiac surgeon, one Dr. Moon, who exhibited the first two aspects in spades– instilling dire panic in impressionable patients, telling them that their clogged arteries could kill them at any second, and therefore, they had to be scheduled for triple or quadruple bypass surgery within the week. Those patients underwent the rigorous, dangerous, and worst of all– in the vast majority of cases– unnecessary procedure, taking weeks to recover, getting saddled with medical bills.

Dr. Moon loved the control he had over people, and enjoyed a lavish lifestyle. His reputation was sterling, due to word-of-mouth and great public relations (people truly believed he saved their lives). The hospital where he committed his medical malpractice was one owned by the then-disreputable holding company, National Medical Enterprises (which later changed its name to Tenet Healthcare).

Wait, there’s more! There were other greedy parties involved in the story. Three people saw what was really happening, and found a way to capitalize on the situation. They brought a Qui Tam lawsuit against the doctor and his accomplices. This means they accused him of bilking Medicaid and Medicare out of big bucks by billing the federal government for unnecessary surgeries. They were expecting to reap a large reward for reporting the errant doctor.

Read the book to learn the sordid details and outcome of this extreme saga.