ALiEM Book Club: Beyond the ED – Recommendations by Dr. Ed Newton
“That is part of the beauty of all literature. You discover that your longing are universal longings, the you’re not lonely and isolated from anyone. You belong. ”
– F. Scott Fitzgerald
If the mark of a person are the people they have directly influenced, then Dr. Ed Newton is in rarefied company. He trained in Emergency Medicine at LAC+USC at a time where there were serious concerns about the legitimacy and the long-term future of the field. After finishing a fellowship in medical toxicology, he has held nearly every position in the LAC+USC Department of Emergency Medicine. He is a former Program Director, Vice-Chair, and Chair. During his time he had played a direct role in shaping the careers of people like Drs. Billy Mallon, Stuart Swadron, Jan Shoenberger, Mel Herbert, and a long list of who’s who in Emergency Medicine. Beyond the department, his influence stretches nationally through his work with AAEM, SAEM, ACEP, ABEM and the AMA and internationally through his work in Haiti, Ghana, Nepal, Mexico, India, and Sierra Leone.
Knowing him, you are struck not by his gravitas but by his gentleness and depth of thought. We are excited by the opportunity to have him share his recommendations in this Book Club: Beyond the ED post and to give you a sliver of the Ed Newton that has touched so many of us.
Dr. Ed Newton
I acquired my love of reading in High School. It was an act of self-preservation. My mind numbed by trying to learn Latin and Greek declensions (yes I am that old) whose purpose in my life was never entirely clear, I developed the habit of reading every novel I could get my hands on rather than doing the assigned homework. I read all of Steinbeck, Hemingway, Faulkner, Dickens, Agatha Christie, Raymond Chandler, Saul Bellow, Sinclair Lewis, Phillip Roth, and many lesser known but excellent writers. I was either last in my class or, on a good semester, second to last. Although my knowledge of Latin and Greek has suffered until this day, surprisingly I emerged quite well educated and very well-read. During my college years, first doing a BA in World History, I expanded my reading to include many of the great works of philosophy, political science, and sociology. After degrees in Microbiology and Medicine, my reading expanded into a whole array of scientific topics. Many of these books have influenced me in important and lasting ways but these are some that I think are important to read or just really good writing that I think you will find enjoyable:
Green Parrots: A War Surgeon’s Diary – Gino Strada (2005) [Amazon Link]
This is a small book with an introduction by Howard Zinn and an appendix that reprints the United Nations Charter of Human Rights passed in 1948. In between there is the story of Gino Strada, an Italian cardiothoracic surgeon who relates his experiences in war zones dealing mainly with civilian casualties from shrapnel and land mines. It is not a work of great literature but it is moving and shows the sadism and cruelty of war, particularly in modern conflicts in which civilian populations are specifically targeted. In 1993 he founded the medical group called Emergency USA funded largely by the Italian people and staffed by paid physicians and nurses. Emergency has built hospitals in war zones in Iraq, Kurdistan, Afghanistan, Somalia, Angola, Rwanda, Sierra Leone, Cambodia, and Sudan among many others. In each of these war-torn areas the land is strewn with unexploded ordinance and land mines that make the land unusable for agriculture and pose a constant risk to the local populations long after the “war” has ended. The “Green Parrot” is a land mine that was scattered from airplanes by the Soviets in Afghanistan. Because it resembles a toy, these land mines are usually picked up by curious children and brought home. Because they don’t explode immediately there is often a group of children around them when they do explode. These mines blow off the hands of anyone holding them and often severely injure the face and eyes so that the children are rendered blind. They serve no military purpose other than maiming children. One hundred and sixty countries have signed and ratified the Ottawa Treaty to ban the production, distribution and use of antipersonnel mines. The US, Russia and China did not ratify this treaty and should be pressured to do so.
This book affected me to the point that I joined Emergency USA on their medical advisory board and spent some time at their congress in Italy where they now are providing much of the medical care to the refugees who are being plucked from the Mediterranean, and at one of their hospitals in Sierra Leone where it is basically the only modern hospital in the country. Gino Strada is a household name in Europe but is virtually unknown in the US. That should change.
Cutting for Stone – Abraham Verghese (2009) [Amazon Link]
This is a novel written by a physician. The story is the saga of twin brothers who are initially conjoined who are raised in an Ethiopian hospital. Their mother, a nurse from India who runs the hospital dies during childbirth; the father is a British surgeon who abandons the infants right after their birth. It takes place in Ethiopia during the reign of Haile Selassie and describes the violent dissolution of his empire. The hospital is mainly performing Obstetrics and some of the medical descriptions are really vivid and accurate and medical professionals will find it interesting. I won’t go through the entire plot line but there were many parts of this book that were very moving and well-written. The whole structure of story has a kind of symmetry and resolves well in the end. The writing conveys the feeling of being in Africa, with the little details and the patient, abiding and joy of the people in spite of endless frustrations. I have spent some time in Africa and I have become interested in African literature and art. Chinua Achebe (Things Fall Apart) and Chimamanda Adichie (Half a Yellow Sun) are two excellent writers whom I would recommend in addition to this book.
Epigenetics: The Ultimate Mystery of Inheritance – Richard Francis (2011) [Amazon Link]
I hesitate to recommend a book that I haven’t completely finished reading (almost finished) but I have enjoyed and learned a lot about an emerging science. The study of genetics has undergone a tremendous evolution(sorry) recently with the Human Genome Project that has identified the base sequences of the entire genome. The next step is to determine what function those genes perform. The third step, which is epigenetics, is to determine what controls the genes. It asks which genes in the pluripotential genome will be turned on or off in a given individual and why? Epigenetics is the study of alterations in genes by methylation (turning off) or demethylation (turning on) specific genes based on the cellular environment. It is the answer to the “nature vs nurture” debate. As with most black or white questions, the answer is definitely grey. The genes are there in one allelic form or another (nature) but the environment has a large influence on the activity of the genome (nurture) and ultimately a person’s phenotype is the result of those two elements. The author cites many genetic studies of populations that have undergone specific stressors or environmental conditions. For example, populations that had experienced famine in their lifetimes had different expressions of genes than those who had not experienced famine. Interestingly the offspring of the famine patients also had the same gene expressions! So the methylation state of your genome is transmissible in the sperm and egg. As an analogy, the genome is the deck of cards, epigenetics is the hand a cell is currently playing based on its environment. Because this is a relatively new field of scientific study, the state of the art is still very theoretical and even conjectural. But that is what makes science fun. The subject matter is a little dry but the writing is very accessible to anyone with a basic understanding of genetics and the material is important in understanding the environmental impact on cancer, metabolic syndrome and many other diseases.
Johnny Got His Gun – Dalton Trumbo (1939) [Amazon Link]
Back to the war theme. This is a well-known novel that many people have already read but it had a great impact on me when I read it many years ago. The impact was similar to a kick in the gut. The story takes place in a hospital room entirely in the mind of the patient. The patient was a soldier who had all of his senses destroyed by a bomb, no arms or legs, no hearing or sight, his face destroyed. His entire world was an isolation tank, and like people in isolation tanks he began to hallucinate and ultimately became psychotic. It has a powerful anti-war message that landed Trumbo in trouble with Joe McCarthy’s HUAC investigations and ultimately had him “blacklisted”. He continued to write screenplays under different names though and won several academy awards for film classics such as Spartacus, Exodus, Roman Holiday, etc. I chose this book because of the recently released biopic of Trumbo’s life that catalogs all of his travails. Even if you disagree with his political stance, he was a gladiator for freedom of expression and he suffered a gladiator’s fate.
I could have picked many other great books. Naomi Klein’s Shock Doctrine would be among them but Jerry Hoffman beat me to it. “A Constellation of Vital Phenomena” by Anthony Parra, “All the Light We Cannot See” by Anthony Doerr, “The Orphan Master’s Son” by Adam Johnson, “A Fine Balance” by Rohinton Mistry, “Zorba the Greek” by Nikos Katzantzakis, and “The Kite Runner” by Khaled Hosseini are some excellent novels that I have read recently. Non-fiction works that I love include “Towards a Psychology of Being” by Abraham Maslow, “Guns, Germs and Steel” by Jared Diamond, and “Ethics for a New Millenium” by the Dalai Lama.
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