Purge: Rehab Diaries

Purge: Rehab Diaries
by Nicole Johns
2009
274 pages
ISBN: 978-1-58005-274-0
Cincinnati Public Library

I got this book out of the Cincinnati Public Library when I saw it on the "New Books" shelf. That particular library visit was during Brain and Behavior II (which included pretty much all of the psychiatry that we're going to see). I thought that this might be a useful read because while I think that I know a decent amount about most types of psychiatric treatment, I didn't feel like I really knew much of anything about the treatment of eating disorders.

For the purpose of learning more about inpatient eating disorder treatment, this book was certainly useful for me. I think that it was also useful for me in that it is forcing me to face the reality that I actually have somewhat limited sympathy for eating disordered patients. I find them frustrating. I feel this way even though I believe that their disease is a real one. There were points in this book, when Johns sneaks off to purge after a meal, and I literally wanted to reach into the book and slap her upside the head. This is a woman who has serious heart arrhythmia at the age of 22 due to her eating disorder. She really needs to stop vomiting. Really. Now.

Now as someone that is very seriously considering a career in child and adolescent psychiatry, this is obviously an issue that I am going to have to work on, so I have to admit that it is useful to be able to acknowledge it at this point in my life. I'm not sure really what I'm going to do about it, but I guess admitting that you have a problem is the first step, and I admit that I really have a problem here, and that deep down inside, I not-so-secretly want to feed those girls a cheeseburger. I think they'll feel better.

To be fair, I think that part of my struggle is that Johns expresses some of the stereotypes that so often go with eating disorders that I personally think undermine my ability to take them seriously as medical disease. She describes herself as a perfectionist and an overachiever that is looking for control in her life, over and over again. I know that perfectionism is linked to eating disorders and on and on, but I am an upper middle class, over-achieving, perfectionist, white woman from the east coast, notorious for putting unreal expectations on herself. And seriously, I love a good cookie. Too much really. I need to stop with the cookies.

There is a part of me that realizes that because I fit the demographic of this disease but find it so foreign, so unimaginable, that should make the idea that it is genetic/medical/biochemical all the more legit. Because it's not just being a perfectionist. Really. And it's not just always wanting more from yourself. There is something else going on there. But the patients and doctors and general public so often attribute this disease to women taking control of the an area of their life that they can control when they feel that other parts of their life have gotten out of hand. I think that's a VERY bad way to think about it. Because, really, that description includes the words "something they CAN control" with regards to the eating/exercising/purging habits of these women. And I have to believe, if I want to have sympathy for them, if I want to ever be able to develop into someone that hopes to be able to deal these patients in any sort of therapeutic way, that it is not something that they can truly control. I have to believe that they have lost control and that the goal of treatment is to help them find it. Because if starving themselves or throwing up after all their meals IS a choice, then I want to feed them a cheeseburger. With Bacon.

Johns does a good job of capturing that out of control feeling, and she does a decent job painting a picture of eating disorder treatment in a way that I think was useful for me to encounter. This is an adequate memoir for what she says in the prologue she is trying to accomplish, but as one of the recent crop of memoirs from people too young to be seriously writing memoirs, it's really middling.

That's not to say that reading this is not going to affect my thinking, because it has. It challenged me, but that is more because it made me realize something a little bit ugly in myself than because it is an outstanding piece of writing. Still, for what I got, I am grateful. The thought process that pops into my head listening to people describe their eating disordered behavior is different and downright mean when compared to that which is in my head during accounts of other psychiatric disorders. That's something that I am going to have to deal with, something that I am glad I can admit to myself now, while I have a long time to wrestle with it. Because if nothing else was clear in this book, these women need some help.

Coppola: A Periatric Surgeon In Iraq

Coppola: A Pediatric Surgeon in Iraq
by Dr. Chris Coppola
2009
259 pages
ISBN: 978-0-9840531-1-7
ARC from LibraryThing Early Reviewers

For better or for worse, LibraryThing has pegged me as a reader of medical memoirs, and when one comes up in the Early Reviewers list, if I request it, you can bet that I'll get sent a copy. Since I joined a year an a half ago, I've gotten ARCs of Weekends at Bellevue, Brain Surgeon, and The Addict. I'm not complaining about this per say, especially since I would have wanted to read these books anyway, but I wish that they had also pegged me as the compulsive reader of fiction that I am, and sent me The Angel's Game and Last Night in Twisted River when those were on the list. I certainly will read and review every medical memoir they send my way for free, but there are other books that I want to read more and I hate to think that I don't get them because I've been pigeon-holed. Such is life.

That being said, Coppola: A Pediatric Surgeon in Iraq is one of the better medical memoirs I've read. In the book, Dr. Chris Coppola recounts his experiences during his two tours of duty in Iraq as a surgeon with the US Air Force. Coppola manages to achieve the perfect balance in his writing between the action of clinical cases and using his experiences to inform a discussion of the ethical and cultural issues he encountered and the challenges of military life.

Dr. Coppola's unique position as a specialist in pediatric surgery means he has a skill set sorely lacking in the current Iraqi medical system. Throughout both tours, he struggles to find balance between his compassion and sense of obligation to the young patients he encounters and the realities of his position, the position of the US military, and the medical treatment available in Iraqi hospitals outside of the American medical base. There are times when he fights hard for his patients when others disagree with his call, and times when he is forced to turn patients away. He makes a compelling argument for the role of pediatric specialists in war hospitals, especially given the rate of civilian casualties in the IED era. Dr. Coppola is not shy about calling the problems of military medicine to the forefront of our attention, while at the same time making it clear that he has found satisfaction in his service.

Overall, this is a strong memoir that calls to mind some important issues that come with our current presence in Iraq, many of which likely extend to our increasing presence in Afghanistan. It is a timely and important read, and one that I would certainly suggest to other people in the medical field and outside it.

Kill as Few Patients as Possible

Kill as Few Patients as Possible
Oscar Landon, M.D.
c. 1987, 1997
Ten Speed Press: Berkley, CA
109 pages

Andrew, in his infinite awesomeness, sent me this book as a random present. It's a collection of essays "on how to be the world's best doctor" written by a witty guy with a private internal medicine practice out in California.

There's 56 essays in all, each a page or two long, most of which are highly amusing. Each essay is titled with a simple word or phrase meant to be read as the rules for becoming, "the world's best doctor" (Landon claims you can't officially have that title until after his death, but by reading and following the rules, you can be next in line when he heads to the big waiting room in the sky.)

The tone of the book is interesting, and I recommend it (as a very quick read) to anyone that's interested in medicine. (I'm obsessed with doctors, which of course is how Andrew knew that I would like it.)

Some of the rules are clearly good advice that I hope I will be able to follow as a physician someday. "If You Can't Save Your Patient's Life, Find Someone Who Can," is about recognizing when you need to send someone to a specialist in another area, and knowing the best one to send them to. "Make a Housecall and Be a Legend In Your Own Time," is self explanatory. "Call in Death as a Consultant," is a great reminder that patients trust you, and that a mistake on your part could be *very* bad, so you should keep the worst in mind and try to catch everything. And of course, the title "Kill as Few Patients as Possible," a goal that all doctors should aspire to.

Others of the rules are clearly good advice that apply to my life (and maybe yours) right now. "When You Make a Mistake So Horrible It Is To Die Over, Don't," reminds you also not to drink or mope too much over it either. "Don't Be Late For Your Own Happy Hour," reminds that there is a time to stop working and that you should put that into your schedule as well (And also suggests reading every day, good stuff. ) "Execute Insurance Forms at Dawn," means get the unpleasantness out of the way right away rather than letting it build up and hang over your head (as I often do.) And of course "Since Death is Very Still, Keep Moving" (Most of the time I think that I have that one almost down.)

Still, there's some advice that I am suspect of. "If You Don't Believe in Prescribing Valium For Your Anxious Patients, Be Sure To Take One Yourself," I'm not sure that giving all anxious people highly addictive medication is a good idea. In fact, in general I think that Dr. Landon is a little too comfortable with "doctor's little helper." Of course, this in part comes from the perspective of someone that knows that she doesn't like the way she feels when taking that whole class of medications, so perhaps don't take me too seriously. Maybe he's right. I don't have anxious patients, yet. 'Take Up A Hobby and Become a Multifaceted Bore Instead of a Simple One" seems to come out against my nature as a person that likes to do a lot (too much). Again, maybe I will give up my sketchbook and ultimate and all that jazz once I too have patients to worry about, but for the love of God, I hope not. I do think that people need hobbies and interests, even people with big important time consuming jobs. An article in this month's issue of scientific American Mind on burnout actually suggests that people with those kinds of jobs need a way to relax that much more. But I digress. Dr. Landon also seems to have a more lax attitude about journal reading than I plan to have, but then again, we all know that I am an obsessive reader, so I suppose that we can't hold it against him. (Unless that is you want to be treated with the most up and coming treatment for your random disease, in which case, you might want a better journal reader doing the treating, but again, I digress.)

There is some advice I just can't follow: Rule #1 "Be Jewish"

And then there's some advice that, in my opinion, is just plain BAD. I won't go into the whole tirade on why I disagree with, "Don't Let A Shrink Take Credit For Giving Your Patient Prozac," but if you would like to read my 176 page thesis on the topic, I suppose I could send you a pdf.

But despite my occasional differences in opinion, this book is highly enjoyable. He's amusing, if sometimes a little off, and it's a quick read. Future doctors of America should pick it up. It has a couple doses of reality that are probably good for all of us as we study for the MCATs and beyond. (Patients die, its horrible, but true. I still, after all my years of wanting to be a doctor, have a lot of trouble with that idea. I hope that will help to make me better.)

And remember, the best advice in the book, "Praise Nurses," saved me about 45 minutes of work, just today.

In other words, just be nice to people.