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Book: The Fifth Risk

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When I think about political campaigning, especially in the United States, I imagine a spectacle of grandeur – politicians rallying, having an immense number of supporters around them with slogans and matching hats, spitting into microphones mostly vague nationalistic rants alongside a much less emphasised political program. Their websites usually spurt out a program a bit more detailed in terms of the economy mostly, but nothing of real substance is really presented to the general public. The debates focus on broad terms like the military and healthcare, not really going in depth, the focus being mostly on the differences between the programs of the candidates – the juicy bits that can be quoted later in the press, the personal attacks.
The administrative system is formed by a significant number of agencies and an even more significant number of employees, each doing a specific task that not a lot of people are talking about, really. The pundits in the media sometimes mention certain entities and the fact that the candidates do no give proper attention to them, but the media usually makes them change their message in commentating about whatever trivial scandal is going on in the particular day, if not hour. What we are left with is a political show, a circus where wits and attacks are key in winning votes, the idea of presenting a detailed program that takes into consideration all the little aspects of an administrative challenge are left unsaid – the public is not interested and the media has very little time allocated to this type of subjects. We have to trust that the political parties are in charge of this, that they are building the teams of each candidate with experts that, at a certain point, will take care of the serious and unglamorous issues that such a task will face. But are they?
In theory, there are people that make sure that the administration that is leaving is giving proper handover to the administration that it will be replacing it – once the main candidates are known they are expected to send teams of people to meet with the current administration and make sure that continuity will be present after the elections. And it is in this moment the book by Michael Lewis really kicks in – although these things have been thought out and put in practice, even to the point in which congress pays for the teams of the political candidates, so they don’t have to do it through their campaign money, it does not happen. We are faced with a very brutal truth: candidates are focused solely on winning and will do only what will give them a competitive edge, there is no time spent on other issues, some maybe more important than a rally; but the biggest issue of all is the fact that they do not even assign experts that are willing to do such tasks, they just pass this responsibility to their son-in-laws, who are neither interested or competent enough.
The book is a grim introduction to what the administrative body of the United States is and how it works and how it has been left to work on its own – very little attention has been given to certain crucial departments, almost no interest in a proper handover. The worst of all? The people that were assigned to control these entities are corporate men that have very little experience in these areas and their main focus is to make them profitable (for them!), although they were never thought of being for profit, but for protection and help of the citizens.
Explained clearly, in layman terms, and filled with interviews and discussions with proper experts in their fields, the book is a warning to the citizens of the United States, but also to people that live in other countries – we have created a society that is very complex and we need experts to take care of the things that make our life what it is, that uphold the standard of our quality of life, and these are the real issues that politicians should really focus on – having resources to help farmers produce enough food to feed the entire country, allocation of funds to agencies that protect the public from nuclear waste that has been dumped in improper conditions, hiring meteorologists that know how to read weather predictions and inform the public when they need to defend themselves from an imminent hurricane. Sounds boring, that’s why no one wants to listen to it, but it is more important than being clever in front of a microphone.

Book: Tribe

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While the term is new, the symptoms of the disease have long been known, mostly to specialists, but also to the public – either through minor investigative journalistic research, by discovering the manifestations while caring for someone that is going through this, or by word of mouth (especially if living in areas where veterans also live). Today it is known as PTSD, post-traumatic stress disorder, but you might be familiar with it as shell shock, battle fatigue or soldier’s heart.
It has been noticed since WWI (probably even before than, but hasn’t been officially recorded until then) – where soldiers that were on the front lines have had an inability to re-enter civilian life in times of peace, experiencing severe mood swings, restlessness, lack of sleep and other psychiatric symptoms so severe that has been a leading cause in suicides among veterans.
While all nations have experienced it in all of their combats, it does seem to spike in American soldiers coming from Wars that were fought on foreign land. While soldiers in France and Great Britain that had it after the war would go on to rebuilding the buildings and infrastructure that were bombed during the war, giving them a sense of purpose and a common goal. American soldiers on the other hand returned on jet engines to a society that has not been affected by war. Merely hours from wearing full combat gear in trenches with mortars flying over head, to cruising streets in civilian gear being tortured by backfiring exhausts pipes and loose manholes that those of us that haven’t seen warfare have long ago discarded as white noise.
And this is exactly what the book is about – how the re-entering of soldiers in civilian life should be done gradually and should include a specific set of activities that would reinforce one’s purpose and ability in being useful to society. Following a series of Native American traditional customs, where people in villages were grouped into warriors, farmers, and other ocupations and had to follow strict rules for each “job descriptions”. Warriors for example were prohibited from entering the village right after the war had ended and had to go through a process of reacquainting themselves with life in times of peace – even their duties after combat changed in order to better allow them to adapt while living with what they have seen and lived through.
While the book takes what some people call a macho approach, and there is evidence to support that, it does show that the current system in dealing with veterans (usually young people that have signed for combat in high school and therefore are still extremely impressionable, but with significant numbers in all age and gender demographics) is not helping, or not helping fast enough, the high number of soldiers that are committing suicide after they return home. Ferm and well documented, Sebastian Hunger portrays a modern problem that needs to capture attention and support in order to overcome it – a war journalist, that has experienced his fair share of violent encounters, helping his colleagues, the soldiers he followed in war, in overcoming the solitude of civilian life by giving them what kept them sane for so long through the hell they went through, comradeship.

Book: The Other Side of Silence: A Psychiatrist’s Memoir of Depression

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Depression is a disease that attacks indiscriminately, no one is safe from its claws – regardless of your age, gender, education, position and so on – it will catch you in its grasp and keep you there until you find the strength to get out – and most of the time, in order to be free from it, you need both therapy and medication prescribed by a psychiatrist. It is understandable to think that people that are familiar with the disease on an academical level would see the signs early and be able to manage it, or that they have found a way in which to be immune to it. But this book proves the exact opposite, you read about the struggles of a psychiatrist suffering from depression.

In a mixture of patient stories and her own battle with depression, doctor Linda Gask gives a multilayered account of what it feels like to be surrounded by mental illness and how society, both the public and the specialists, behave around it. With a sort of detachment, she retells her life’s story and, based on it, the people she meets who are traumatized themselves or have given her some comfort, or not, from her own troubles.

There is a gap between how depression is perceived and how she tells it, her account is much more personal and reflects, even in her writing, how the cycle of negative thoughts and dramatization of certain events that are so common with depression take over your rational thinking process and makes you unaware of all the details that make life worth living – being stuck in your own thought process and not being able to get out of it and enjoy the things that are worth living for is the greatest chasm one has to face when suffering from depression. However, there is hope – and although there is no great breakthrough, things do get better with time and with proper attention to your symptoms; some diseases are manageable and curable if we just keep working on getting better – finding a good therapist that you can connect with and working closely with a psychiatrist can lead to finding the medication that will truly make a difference in your life.

By the end of the book we do see a different person, much more calmer and focused – stable in her opinions, decisions and ideas. Although she goes through years of uncertainty and has the trademark highs and lows of her affliction, with proper support she manages to see the light at the end of the tunnel. Her achievement in finding inner peace is a statement that, although the fight with your inner self is crippling, there are ways in which you can cope and eventually be free.

Book: When the Air Hits Your Brain: Tales of Neurosurgery

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When young, the greatest of challenges seem within reach – we are never more than one step behind the goal, always getting closer to where we think we need to be. We are full of hope and energy, and we are ready to take anything life puts in our way.

In the world of medicine, and especially the world of medicine of the 1980s, the greatest of challenges was neurosurgery – the peak of what you can be as a doctor. In a world without medical imaging and where the surgical knife still ruled the operating world, neurosurgery was what all ambitious medical students wanted to become. It was, and is, probably the most difficult specialty one can master, so having a glimpse of what that world is can be truly mesmerising.

Frank Vertosick Jr. brings to life that world – the ambitions of a young medical student, eager to learn and to overcome life’s obstacles by proving himself one of the best. But to become one of the best one has to pass a great series of challenges – to cut a persons head open and start exploring with scalpel in hand is not something anybody can just get up and do. There are rules, and practice always proves itself to be more complicated than the textbook you just read, even reread. Mistakes will be made, and the horror of those mistakes can break a person. The long shifts where the hospital not only becomes your home – or your second home – it becomes everything you know. With each passing day you are wiser, but more numb – there is a breaking point to this story and if you are not careful it may break you to the point you can never pull yourself back together – most doctors will suffer from depression, and others will become sociopaths – not able to distinguish the body from the mind.

Written in a beautiful and simple style, the memoirs of the the young neurosurgery resident brings to life our human nature and how fragile, and yet how strong, we truly are. The moment where saving someones life becomes more than a job, it becomes a mission that one cannot fail; a duty one owes to oneself and to the world.

Stories about colleagues and patients, and of hospitals and residencies, intertwine and give us a lecture on how to tackle life – no one is perfect, becoming the best is a long road where every mistake is a lesson we need to learn from. The story of our bodies and our diseases might not define us, but we carry it with us always, never able to run away from it as it follows us everywhere; and when the story leads to catastrophe we rely on other people for our safety and recovery, and hearing the story of how these people came to become our saviours can be truly fascinating.
The life of a doctor seen from within is astonishing, from the years of medical school to residency and to one’s own practice – years and years of studying and practising with only one goal in mind – helping people.

Book: Turtles All the Way Down

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Not much to say about the plot of the book – it’s a young adult novel, and that pretty much sums it up. There are teenagers who go through a rite of passage – the discovery of who they are and what they feel. It is the beginning of an adventure we never get to see, only the gestation of it – we are left to draw our own conclusions of what happens after this episode that we have in front of us; but, in all fairness, it is this episode that you will want to read even if you had the choice of reading one out off all of them – it is here where the big conclusions are drawn; the point of no return.

While the novel has scattered all over cliches and improbable events, it does come to a good conclusion and, rounding everything up, it does appear to make some sense. It’s nothing mind-blowing, just the usual live the life you always wanted to live kind of thing.

But the novel does get one thing perfectly right, the subject of mental illness. The main protagonist suffers from severe anxiety and OCD, and both play a very important part of the character construction and some of the plot devices.

Going through such strong emotions is perfectly captured through the thoughts and actions of the character, showing the audience again and again the torments that people everywhere and of all ages suffer every day – it is the voice not of a generation, but of an illness that does not discriminate ages and genders, that creates harm out of thin air and has, over time, claimed the most talented and brilliant of individuals.

Mental illness is not always depression or another crippling disease, sometimes it is the burden that other people do not see. Anxiety doesn’t make us incapable of leaving your bed, nor does it make you crazy in the eyes of others, but it is a slow burning fire that torments relentlessly and consumes you to the point of giving up. The series of scary thoughts that never leave your head, that just come and come to the point of exhaustion, seem less important for most people, but that doesn’t mean that people that are currently going through it and people that have overcame it do not find it important, it is as defining for an individual as birth itself.

Turtles All the Way Down is a nice, short and fun read that tackles successfully a very important topic, especially in today’s lens. Although John Green’s mental illness has caused him a great deal of pain, it is refreshing to see how the human mind can overpower its traumas and, while doing so, create art.

Book: Letters to a Young Contrarian

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Christopher Hitchens is known as one of the greatest essayists since Orwell, but also one of the world’s greatest polemicists – his oppositionist views ranging from history, religion, politics to art. Almost no subject is unknown to him and he masters the art of rhetoric like no other, every sentence comes out full of poignancy and rigour – in terms of debate he has no equal, his adversaries have mostly failed against him even in his last days, weakened by the disease that stole him much too early.

It would make sense that when looking for someone to write a book in the Art of Mentoring series no one would be more equipped to tackle this than him, even if he was opposed to the idea of being called a contrarian – he delivers a lesson in what it means to bring consistency to opposition, the art and toil one must muster in order to criticise and go against something – especially if that something is already rooted in history and minds. Not an easy feat, but necessary and important if we are ever to progress and leave behind the preconceptions developed in the infancy of our species.
Offering a history of what contrarianism is, Hitchens goes to lengths in explaining what he considers not only and art form, but an obligation. Ranging from Socrates to Emile Zola the book offers us a glimpse into what is needed for an objective opinion – what tools are needed but, more importantly, what state of mind is to be better suited for the job.

Coming from Christopher there is the inescapable feeling of being inferior, how will I ever rise to the task as well as him? But although he uses examples from his own experience which, in all fairness, coming from anyone else would seem just a gross lack of modesty, but in his case just the simple and honest truth of a life served for the pursuit of truth, it is a bit hard to relate and the idea of following in the author’s footsteps seems unlikely. However, the lessons are very useful and clear cut – you don’t need to be an expert, you just need to go through the process of informing yourself and finding your voice, as these are the absolutely necessary in performing a contrarian’s job.

Reading the book now, especially if you are a fan, is extremely hard – it just shows how much humanity has lost when Christopher has passed away – he has a voice and clarity that so unique that it will make you shudder from the very first sentences. Every topic and every lesson is treated as the most important thing and given every bit of attention it requires – nothing is left to chance. This type of rigour is one of the hallmarks that have made Hitchens so loved and so despised.

How to have and defend, or go against, an opinion is an extremely valuable lesson and an area that the twenty-first century must learn how to cherish, protect and inspire if we are ever overcome the struggles that lie ahead.

Book: In Therapy: How Conversations with Psychotherapists Really Work

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Admitting to having an emotional problem is almost always seen as a sign of weakness, we are told from an early age that we need to be strong and make the most of what we got – losing it means that we are outcasts, people which are used as a negative example in society. It is this trend that makes psychotherapy a science that is avoided, as it is considered a failure if you need it, and not what it actually is: a consultation with a professional about a part of your body that is not behaving as it should. You wouldn’t consider not seeing an orthopedist when your leg hurts, on the contrary, you would assume and consider to be exactly the thing that is needed.

One of the things that is still a mistery is what is gong in inside – what will this stranger get out from me? what if I am too embarrassed and say things that I do not anyone else to know? The ins and outs of a psychotherapy session is still a reason for concern, mostly for the same reason I mentioned before: people feel ashamed for the fact that they even consider they need to speak with somebody. Multiple shows and books have surfaced in recent years trying to inform people of what to expect and what this science actually does – this book is one of those examples.

The most basic thing is that the patient is always in control – they decide what they speak about and how many details they give. The idea is not only to speak of the things that hurt you emotionally, but to get to the center of what exactly is that is hurting you. Identifying the cause is one of the primary goals of these sessions. The therapist will listen and ask further questions about the subject you want to approach, many times the subject will creep in the conversation no matter how much we try to avoid it – but this is a good thing, because once it is out there you will feel an immense sense of accomplishment, it is now that the healing begins. The questions directed at the patient are also to find the cause of the illness even if the patient is not aware of it – this is what therapists do, and in doing it they not only help you get over what is hurting you, but they will also help you understand what the power of expressing yourself really is – a simple thing like talking can have huge benefits for your mental health.

The book offers a few mock sessions with fictional patients that deal with real life issues – we get a sense of what it means to go to therapy and what subjects are discussed there. There are couples, women, and men, and each have their own issues that they need to discuss – a great variety of issues are being dealt with and are inching away at a resolution. Also, there are examples of what happens in the first session where the therapist determines what type of therapy is needed going further – all the anxiety and trauma about seeing a psychotherapist goes away. The more you know about a thing the least possible number of things for it to scare you.

In a fast world with high amounts of stress we will inevitably face all sorts mental disorders at one stage or another – seeing a therapists will become as necessary as doing routine blood work. Preparing ourselves with information for what is needed for when such a situation appears is necessary. The recent talk shows, videos and books that have appeared in order to further educate on this aspect are extremely useful and hopefully the trend will continue until psychotherapy will be seen as the helpful hand that we need.

Book: Brain on Fire

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I have always been fascinated with memoirs, the idea of reading the exact thoughts that a person has, albeit subjective, draws me in every time. One of the best things that mass education has given us is the ability of people to write down their lives and experiences – their intimate inner workings and how they chose to deal with a certain situation or event.

Brain on Fire is definitely a memoir, but it is so much more. The level of research that has gone into writing this book is staggering, and if I was to include the gargantuan task that was needed to find the courage and energy to write this it becomes, probably, one of the most interesting books I have ever read.

As I have been dealing with my own struggles I became aware of this book – although I kept postponing reading it for quite a while – mostly because it was about a person that was trying to figure out what was wrong with them and trying to share their experience in doing so, a subject that is very close to my heart.

As a young intellectual with a writing passion that goes through a gruesome medical episode I cannot but admire the necessary effort, both physical and mental, to come up with such a composed and detailed recollection of events – as the author mentions in the book, she had to go through thousands of medical records, speak to an army of doctors and interview every person that was a part of her story in order to remember and recollect what has happened.

The memoir is also unique in the sense that it details almost a breakthrough – a young journalist that suffers what happens to be a breakdown that actually is a very rare and serious disease. Her telling of the numerous doctors and tests that she had to go through to little avail, the way in which it has traumatised her family and the ones closest to her, the way in which she felt like she was losing every sense of what herself was – a disease that was discovered only a few years before she has suffered the episode and the way in which the diagnose was made is almost like the script for a House MD episode, only that this was real and the pain and suffering was not played out, but felt.

The memoir, with its plot and medical terminology explained, is set to offer a vivid exploration into the mind and actions of a sick person, but it also wants to be a resource for people that might be going through the same experience. It is popularising autoimmune disease and informing people that a very unknown disease might be what they are really suffering from and not the more common diagnosis that they have received – the book also mentions in the final chapters the story of a father that, because he had read the experiences of the writer, was able to get the doctors treating his daughter to do the necessary test, diagnose her properly and offer her the needed treatment – so, just by the fact that one life was saved or was significantly improved by the author’s story proves that it was well worth the effort of the documentation and writing of the book.

No fiction will ever beat real life – the pain and disorders we go through on a daily basis offers us more knowledge and art that we ever hope to receive from any masterpiece – the fact that one person’s experience can make a difference in the lives of others proves that we are on the right track to becoming more knowledgeable and adapt to what difficulties lie ahead.

The story of Susannah Cahalan is one of those rare gems that, through suffering and documentation, grips the reader and makes him suffer. And through that suffering it makes the reader more compassionate and informed, and nothing is more necessary in our day and age.

The monthlong epic compacts so many emotions that it is hard to simply read the book, you have to live the despair of the person that thinks it is losing its mind; the parents of a young adult that go through a shock and a constant fear of what is about to happen; simple lives of friends and lovers that are forever changed by something that they never imagined or prepared for. And to add on top of that, the courage to bring these experiences on paper; to relieve, explore and inform.

Book: When Breath Becomes Air

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Many times, I wondered what is left of us after we pass away. What do we actually leave behind? It’s always an impossible list as I always know that something might happen that will be definitory to my life up until that point. What we need to make that list is a clear sign that our demise is near and that we will not be able to amount to much else than we already have – but even then, are we really incapable of something great that will remain as our most valuable lesson? Is the idea of death an influence when it is imperceptible or when it is all-encompassing?

Paul Kalanithi emigrated to the US along with his parents and initially followed academic studies in English literature, ultimately to follow in his father’s footsteps and become a doctor. He chose the hardest medical profession, neurosurgery, in which he became one of the most respectable and acclaimed fellows. His residency training was assimilated quickly and he became chief resident. Offers of academic research were pouring in – a remarkable career lay ahead with certain voices calling him one of the best neurosurgeons and doctors of his generation.

After experiencing night sweats, unrelenting back pain and a cough he chose to have a medical check-up that delivered the fatal news: lung cancer. A non-smoker, recently married with everything pointing to a fulminating career was drawn in the tragic story of untimely death.

The story does not end here – this is not the story of the brilliant neurosurgeon that dies of cancer and the world will never know what might have happened. The story begins here – the recollection of his childhood, the love for literature and his family and the last stand in the face of death. Treatment begins and all the ups and downs that come along with it. Hard choices are being made – he and his wife decide to have a daughter, he continues to practice his trade and decides to write a memoir.

When Breath Becomes Air is a memoir that will become a classic – it is pure and straightforward, it paints the image of a life that was lived as all lives are lived and was extraordinary in its unspectacularly dullness. A family that emigrated, a son that became a neurosurgeon and married and after a swift illness had passed away. But there is more, much more – between every line of text there is this feeling that lingers on, like tasting salt. It is simple, but it masks an incredible thirst for knowledge, a love for mankind and the art it is capable of. To study, to practice, to love, to write – each with its difficulties and rewards.

Paul Kalanithi takes us on the journey of his life, we see him as he has saw the world around him. We learn of the hardships and the joys of his life. The struggle of becoming a neurosurgeon, the passion for helping people and developing his craft, the illness and the decisions that have come alongside it, his family and the last day as a doctor. It is intense and it is real and there is nothing more to say other than that – it is a life between two covers, a real life.

To the world When Breath Becomes Air is what we will have left of Paul Kalanithi – we will remember him as a writer and only a handful of his patients that he operated on during his residency will remember him as a doctor. The illness reshaped his life and with that his destiny – he might have become the greatest neurosurgeon in the world, but today he is known as the man that documented his life and his illness, his family and his trade, in one amazing memoir that will remain his testament upon this earth. The incurable disease has stolen the son, the husband and the father from a family and the man who could have made a real difference for some patients, but it has given the world an insight to the nature of man.

Book: Being Mortal: Medicine and What Matters in the End

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One of the topics most avoided when talking about medicine is death. Sure, we are all informed about what causes premature death – like overdose of prescription pills and bad habits that will severely impact our lifespan – but never about regular end of life, when the decrepit body simply breaks down and fades away. It’s like this should never be mentioned – we will do everything in our power to save your life and get you through this – but the problem is that this battle is never won, we die and can do very little about it.

If we are to look back, like a century or so, we see that death was a norm, a tax that needed to be paid. People expected to die and didn’t make much fuss about it – the numbers of people dying at home, in their bed, surrounded by their loved ones were much higher than today. In our time we die mostly in the hospital, connected to machines and kept away from our loved ones in clear rooms in order to prolong our lives even minutes more – even though by then we are either in agony or unconscious.

Truth is that modern medicine, vaccines and hi-tech imaging machines have prolonged our lives considerably – we have moved from an average span of approximately 50 year just a few decades ago to over 70 – that is a huge increase and has brought along with it the idea that one day we might be immortal – even as we are dying today we cannot but hope that in the last minute they will find a cure and we will carry on.

Atul Gawande looks at death through multiple lenses – from hospice care to elderly homes and geriatrics. The strengths and weaknesses of modern medicine and how doctors and the population can prepare themselves for what is about to come. He calmly and rigorously goes through all the fields and stages of death in the modern world – where we should fight and where we should give up. In a small book he tackles a monumental task, that of admitting medicine is not prepared or ready to resolve the problem, and that of the patient who should know when it’s time to give up – rather than run around and try every experimental procedure it would be better to cherish the small time you have left.

In Ancient Greece it was perceived tat the gods were jealous of mortals specifically for the fact that they are so – that they are finite and can cherish each moment as it would be their last, giving them emotions and a meaning that could not be felt in any other way. This is the takeaway from the book – enjoy your life and loved ones, be aware of what our modern culture can give you and try to be at peace with yourself as you might not walk the same road twice.