ALiEM Bookclub: Beyond the ED – Recommendations by Dr. Jerry Hoffman
“If I have seen further, it is by standing on the shoulders of giants.”
As colleagues in Emergency Medicine (EM) and education we can trace both our roots and see our branches. For many of us, including the bloggers, podcasters, mythbusters, and the skeptics can trace our journey back to Dr. Jerry Hoffman. Dr. Hoffman is internationally known as one of the founders of EM, the lead author of the NEXUS study, one of the hosts of EM abstracts, and the original EM skeptic. It is our distinct pleasure to have Dr. Hoffman contribute to this ALiEM bookclub series.
Dr. Jerry Hoffman
When Taku first asked me to participate in this lovely series, I responded with an enthusiastic “yes.” I now realize how foolhardy that was, since for me choosing an extremely limited number of books to recommend is a well nigh impossible task! As Winston Churchill (or perhaps it was Mark Twain, or William Osler, or Oscar Wilde … or one of those other famous people who always seems to get the credit for virtually every witty aphorism) once wrote, “I apologize for writing such a long letter, but I simply didn’t have time to write a shorter one.” I almost used that as an excuse to submit a very long essay with a great many recommendations … but ultimately did spend the extra time needed to do what he asked for in the first place.
Fortunately for me, my erudite friend Lewis Goldfrank has already listed a few books that I love, so at least I could eliminate them effortlessly.
Like Lewis, I have chosen two works each of fiction and non-fiction. I have to start out by recusing myself from including wonderful medical books by friends of mine (including the must-read pair “Overtreated” and “Overdiagnosed,” by Shannon Brownlee and by Gil Welch, respectively, Mark Brown’s bitterly funny and disturbing “Emergency!” and outstanding works by David Newman, Ray Moynahan, Leana Wen & Josh Kosofsky, Howard Brody, Geri-Ann Galanti, Ann Fadiman, and John Abramson).
Some readers may be surprised that I’m also staying away from books about big Pharma, even though there are more than a handful that are a great read, and truly important.
Mountains Beyond Mountains by Tracy Kidder
So – my first non-fiction choice is Tracy Kidder’s stunning “Mountains Beyond Mountains.” [Amazon Link] This fabulous book is “medical” only in the sense that it centers on Dr. Paul Farmer, a physician (and medical anthropologist) who somehow managed to bring truly effective treatment to an entire region of AIDS patients in the poorest part of desperately impoverished Haiti – despite the active animosity and death threats of that country’s brutal dictatorship; even worse, from the dictatorship’s point of view, Farmer helped empower some of Haiti’s poorest and most marginalized citizens. He was successful in large part because he did precisely that – involved, and empowered, the people most in need – so that in fact it wasn’t really him helping them, but him facilitating their helping themselves.
Kidder’s book is extraordinary – because of the beautiful the writing, and because of Farmer’s amazing work … but also because of the amazing person Farmer so clearly seems to be. Reading about him I was reminded of my dear friend Bob Simon, who – despite being as about as far as it is possible to be on the political spectrum from Farmer (or indeed from me) – seems in some ways almost a carbon copy of Farmer. That’s because both of them are clearly too stupid to understand that the things they’re attempting to do are impossible – and by failing to recognize this obvious truth … they actually accomplish things most of us would never even imagine trying. In addition, the Paul Farmer we read about reminds me of Bob in his ability to engage fully, and win the love of, just about everyone around him – including even those who disagree with his belief system … but couldn’t agree more with his goals, and couldn’t feel more in awe of his huge heart.
Shock Doctrine by Naomi Klein
The brilliant German pathologist Rudolph Virchow once said “all politics is nothing but medicine writ large.” (It really was Virchow who said this.) So my second non-fiction choice is “medical” in that it focuses on a critically important disease in contemporary society (and to some extent on its potential cure). Although there are a great many other important books with a social-economic-political theme, it isn’t that hard to pick Naomi Klein’s “Shock Doctrine” [Amazon Link] as my must read choice. I believe it is the single most important book I’ve ever read about politics (with the possible exception of Herman and Chomsky’s “Manufacturing Consent”). Klein thoughtfully and articulately explains how people with great wealth and power explicitly manipulate social and economic crises to frighten the rest of us into acting against our own interests, and she backs up her analysis with detailed sets of facts. Most of what she describes was known to me even before I read her book – but her ability to tie together so many various threads clarified a great deal for me, and made me feel like I truly understand the root processes better than I ever had before. Finally, while this book is a devastating critique of our contemporary governance, which makes clear that those who currently wield tremendous influence over our media, and our economic system, and our governments, will fiercely defend existing structures that inevitably produce vast inequality, and so much human misery – she also provides a basis for hope, and even a bit of a blueprint for how, together, we may be able to create meaningful change.
As for fiction, I’m staying away from my two favorite contemporary writers, Cormac McCarthy and Barbara Kingsolver, as I simply couldn’t choose from among their many wonderful novels. (I’m also staying away from too-many-to-mention classics.)
City of Thieves by David Benioff
My first choice, then, is David Benioff’s masterful “City of Thieves.” [Amazon Link] There are a handful of other recent wonderful books in the setting of war, but “City of Thieves” is (along with “All Quiet on the Western Front”) my favorite ever, for its extraordinarily beautiful writing, its powerful evocation of place and circumstance, its unflinching depiction of both individual and systemic cruelty, and, finally, its refusal to abandon the hope that our wonderful better nature can somehow overcome our selfsame very dark and cruel instincts.
Emma and Otto and Russell and James by Emma Hooper and The Revised Fundamentals of Caregiving by Jonathan Evison
My last choice is actually a pair of novels that are “medical” in that they show us how to remain vibrant in the face of fearful human (physical) frailty. Emma Hooper’s lyrical and lovely “Emma and Otto and Russell and James” [Amazon Link] deals with growing old, and living with the increasing onslaught of dementia. I stress “living with,” rather than something like “surviving” or “dying with,” because this novel is fundamentally an affirmation of the human spirit, and the possibility of living a full life even as profound limitations begin to encroach. That is similarly the subject of Jonathan Evison’s wonderful “The Revised Fundamentals of Caregiving.” [Amazon Link] Despite a title suggesting a technical manual or self-help book, this is in fact a moving reflection on dealing with physical and emotional limitations, as well as with loss. Both these beautiful novels are anything but simplistic, and in the final analysis each of them reminds us how much wonder there is in the world, if only we try hard enough to find it.
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