My youngest sister (she's ten years younger than me, which either makes her very young or me very old, I'll choose the former) is starting medical school in the fall. I think there is a certain futility in giving medical students or pre-medical students advice outside of the purely practical--never pass up a free meal, sleep when you can, that kind of thing--because there are certain things that you will never, ever believe, and certain lessons that you will not be ready to absorb until you've gone through the experience of learning them firsthand. In that sense, medical school is much like that final scene in Oz (as in "The Wizard of Oz," not the HBO series set in prison with all the riots and butt-raping) where the scarecrow asks the Good Witch of the North:
SCARECROW
Then why didn't you tell her before?
GLINDA
Because she wouldn't have believed me. She had to learn it for herself.
Medical students, there are things that I can tell you about medicine, but you'll never believe me. You'll just have to learn them for yourselves. However, let it not be said that I didn't try.
Therefore, I would like to now present to you my list of the five books I think that every student should read before starting medical training, be it for your MD, DO, PA, nursing degree, or what have you. Note that my own book is not among them, though if you would like to read it nonetheless when it comes out, I certainly wouldn't dissuade you.
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1. The Spirit Catches You And You Fall Down (by Anne Fadiman)
The story of a young first-generation Hmong girl with epilepsy, her interface with the American healthcare system, and the catastrophic culture clash that ensued. I read a review that called this a tragedy of Shakespearean proportions, and I think that's pretty much right on the money. I also think this is one of the best books about the medicine I have ever read. Sensitive and beautifully written, this book dares you to choose sides, turns your expectations inside-out, and showed me more than anything that medicine should be treated more like an art than a religion.
I read this book early in my Pediatrics residency (long-time readers remember that I did two years of Peds before switching to Anesthesia) and it completely changed my life. I wish I could say that I remember the lessons from this book every day when I deal with my actual patients, but that's why it bears frequent re-reading; I must have read this book at least ten times in the past five years.
2. And The Band Played On (by Randy Shilts)
I first read this book I think in tenth grade, when I was writing a Social Studies paper about the history of the AIDS epidemic. (Grade on the paper: A minus, but this particular teacher was known for his grade inflation, so it probably was a pretty crappy paper. I do remember printing it out on my dot matrix printer as well, the sound of which always reminded me of sitting in a dentist's office.)
I know that for some people, just reading the subtitle, "Politics, People, and the AIDS Epidemic" is enough to send you to running for the door (or to say that it sounds like something you'd be assigned--read: forced--to read in some college Poli-Sci class), but hear me out. Written more than twenty years ago by Randy Shilts, who I believe since succumbed to the epidemic himself, it is a journalistic work to be sure, but written in such a way that can best be described as cinematic. It's an exciting book to read. It's a tragic book to read. AIDS has been part of our landscape for so long now it's hard to imagine living in a world before we even knew what the disease did, how it was spread, or that it was caused by a virus. The steps in the healthcare process, in the political process, the small acts of craven ignorance and everyday heroism depicted along the way are unforgettable. We live in a world now where AIDS is a household name. Everyone should read about this time not so long ago when it was not.
3. Complications (by Atul Gawande)
I'm pretty sure that by now I don't need to convince anyone that Atul Gawande is a great writer, but let me just say it again. He's a great writer. His writing is more process-oriented than personal, but I think some of the best parts of the book are the personal bits--the part where he talks about his first experience putting in a central line as an intern, the part where he talks about the decision process of choosing a surgeon for his own son, born with a congenital heart defect. Moreover, Gawande highlights his approach to medicine in his own subtitle, "A Surgeon's Notes on an Imperfect Science." Medicine is imperfect. We are imperfect. It is in acknowledging these imperfections and how we strive to be better than we already are that makes the difference.
4. Singular Intimacies (by Danielle Ofri)
I once heard a book editor complain about the glut of doctors who were pedaling around book proposals or manuscripts in various stages of completion about the medical training process. "Every doctor has stories," he said, "but not every doctor can write. The problem is, they don't know that." And I will freely admit to you, I have lived in fear ever since I heard that insider comment that I am yet another in a long line of doctors who has more stories to tell than the talent to tell them.
Danielle Ofri has stories, and she tells them well. This book is basically a memoir of a young doctor in training, starting with her days as a medical student up through her graduation from residency. Most of the chapters (more like vignettes) existed as standalone stories in one for or another; she was widely published in a variety of magazines prior to coming out with her first book, and is now the Editor-in-Chief and co-founder of the Bellevue Literary Review, which is a literary journal that publishes works related to medicine and health.
What strikes me most about Ofri's first book is her fearlessness in admitting her own failures, her own weaknesses, her own moments of doubt throughout the early years of her training. We've all been there, but not everyone can so nakedly capture that feeling that one has as a medical student, an intern, that first night as the senior resident on the floor, of "I-don't-quite-know-what-I'm-doing-but-now-I-have-to-pretend-like-I-do." In a world of medicine being depicted as large-than-life and heroic, her humanizing the scope of medical training is wonderful and refreshing.
5. Walk on Water (by Michael Ruhlman)
I've read this book many, many times, and each time, I can't put it down until I've read it cover-to-cover. Michael Ruhlman is a journalist (I think he may have been a sports writer in a prior incarnation) who spends several months with a team of pediatric cardiothoracic surgeons at the Cleveland Clinic, headed by chief surgeon Roger Mee.
5. Walk on Water (by Michael Ruhlman)
I've read this book many, many times, and each time, I can't put it down until I've read it cover-to-cover. Michael Ruhlman is a journalist (I think he may have been a sports writer in a prior incarnation) who spends several months with a team of pediatric cardiothoracic surgeons at the Cleveland Clinic, headed by chief surgeon Roger Mee.
Now, this may be the anesthesiologist in me speaking, but there's nothing I find more distasteful than the "Surgeon as God" narrative, and so I picked up this book with some hesitation. But this book is nothing like that. That is not to say that the surgical skill displayed is not remarkable (it is) or that the scenes in the OR are not heart-pounding (they are), or the stories of the tiniest lives saved not awe-inspiring (they totally are). But the bigger picture of this book is the evolution of medicine, how far we've come in such a short time, where we are now, and how much farther we still have to go when it comes to saving our youngest and sickest patients. It also marvels at the craft of medicine, the skill, and how to be the very, very best at a certain field, it takes more than just hard work and dogged persistence--in some ways, you have to be kind of a freak of nature. Roger Mee is very, very good at what he does, which is pediatric open-heart surgery, and therefore he feels it is his responsibility to do just that, whether he likes it or not.
(As an aside, I have to say that I trained in Pediatrics for two years, and worked in the PICU and NICU where I took care of scores of post-op complex congenital heart patients. However, there were certain passages in the book where Ruhlman, a layperson, discusses the physiology of the Fontan or the challenges of the Norwood, and I understood the surgery in far more clarity than any of the cardiologists or surgeons I'd worked with had ever been able to explain to me. He is a gifted writer, and speaks fluently in the foreign language of medicine. Bravo.)
* * *
There is one theme at the core of all these books, more overt in some than in others, but a central thread in all good medical non-fiction nonetheless. Which brings me back to my original point. If I could give young healthcare professionals one piece of advice, one word to live by, it would be this: humility. Be humble. Yes, all the standard advice still applies: work hard, sweat the details, treat your patients as you'd want your family to be treated--but I think humility is probably the most important quality for a young doctor, for any doctor to have.
Admit when you don't know something. Admit when you've failed. Admit when your goals exceed your reach, when the skills required exceed your experience, but never stop trying to push that limit. Know when to stop, know when to ask for help, and above all, be aware of your own limitations while trying constantly to exceed them. That's the most important thing in medicine. If you think you know everything there is to know, not only will you always be wrong, but you'll wall yourself off against learning anything new. So be humble. Know what it is that is just outside your reach, and spend your entire life trying to get there.
(As an aside, I have to say that I trained in Pediatrics for two years, and worked in the PICU and NICU where I took care of scores of post-op complex congenital heart patients. However, there were certain passages in the book where Ruhlman, a layperson, discusses the physiology of the Fontan or the challenges of the Norwood, and I understood the surgery in far more clarity than any of the cardiologists or surgeons I'd worked with had ever been able to explain to me. He is a gifted writer, and speaks fluently in the foreign language of medicine. Bravo.)
* * *
There is one theme at the core of all these books, more overt in some than in others, but a central thread in all good medical non-fiction nonetheless. Which brings me back to my original point. If I could give young healthcare professionals one piece of advice, one word to live by, it would be this: humility. Be humble. Yes, all the standard advice still applies: work hard, sweat the details, treat your patients as you'd want your family to be treated--but I think humility is probably the most important quality for a young doctor, for any doctor to have.
Admit when you don't know something. Admit when you've failed. Admit when your goals exceed your reach, when the skills required exceed your experience, but never stop trying to push that limit. Know when to stop, know when to ask for help, and above all, be aware of your own limitations while trying constantly to exceed them. That's the most important thing in medicine. If you think you know everything there is to know, not only will you always be wrong, but you'll wall yourself off against learning anything new. So be humble. Know what it is that is just outside your reach, and spend your entire life trying to get there.
(Any books to add to this list? Let us know in the comments section! For the five I picked here, there's another twenty I left out. What are your favorites?)