One-Minute Book Reviews

January 29, 2008

John Gunther’s Classic Memoir of His 17-Year-Old Son’s Courageous Effort to Survive a Fatal Brain Tumor, ‘Death Be Not Proud’

A sensitive teenager faced a devastating illness with grace and intelligence

Death Be Not Proud: A Memoir. By John Gunther. Harper Perennial Modern Classics, 224 pp., $13.95, paperback.

By Janice Harayda

You could argue that John Gunther idealizes his son, Johnny, who died of a brain tumor at the age of 17, in this classic memoir. But parents naturally want to remember the best in children they have lost. So the question isn’t whether Gunther idealizes his son but whether Johnny deserves the near-heroic portrayal he receives in this book. The answer is yes.

First published in 1949, Death Be Not Proud is a slim book that has little in common the sort of memoirs that recently have become fashionable: fat, self-dramatizing stories overstuffed with emotion and incident. Gunther describes with uncommon restraint how he and his ex-wife tried to save their son after he developed a glioma multiforme, a brain tumor that few people then survived.

During his 15-month illness, Johnny endured a series of brutal, long-shot treatments: brain surgery, mustard gas injections, a primitive form of radiation. He showed his character and vivid intellectual curiosity best after the surgery, when father asked if he knew he’d had an operation. “Of course,” Johnny said. “I heard them drilling three holes through my skull, also the sound of my brains sloshing around. From the sound, one of the drills must have had a three-eights of an inch bit.”

A bestseller in its day, Death Be Not Proud appears today on high school reading lists, and many people see it as a book for teenagers. This is a shame. A sea-change has occurred in the advice that parents of sick children get from doctors (who urged Gunther to lie to Johnny to keep him from finding out how serious his illness was). A book club might spend hours talking about just one of the questions raised by this book: Would Johnny really have been better off if his parents had taken the advice of 21st-century doctors instead of their own?

Best line: Many passages attest to Johnny’s unusual intellectual and emotional maturity. His parents once asked him, while he was in prep school, if he wanted to see some home movies taken of him when he was a child. “Only if they’re not too recent – the past is tolerable if remote enough,” Johnny replied.

Worst line: Death Be Not Proud has a scattering of lines such as, “Johnny was as sinless as a sunset” and “Everybody loved him – down to the corner cop.” If these seem too rosy, the book wears them lightly. Gunther is not trying to convince you that Johnny was perfect but to portray his struggle against cancer.

Reading group guide: I can’t link directly to the publisher’s guide, posted at www.harpercollins.com, but here’s a link to it that you can paste into your browser: http://www.harpercollins.com/books/9780061230974/Death_Be_Not_Proud/.

Published: 1949 (first edition) and 2007 (Harper Perennial Modern Classics edition).

Furthermore: John Gunther (1901–1970), one of the best-known reporters of his day, wrote the popular “Inside” series that included Inside Europe, Inside Asia and Inside U.S.A.

© 2008 Janice Harayda. All rights reserved.
www.janiceharayda.com

December 28, 2007

Take One Misdiagnosis and Call Me in the Morning – Jerome Groopman’s ‘How Doctors Think’

A Harvard Medical School professor says that physicians’ faulty logic can kill

How Doctors Think. By Jerome Groopman, M.D. Houghton Mifflin, 291 pp., $26.

By Janice Harayda

It’s flu season, and that’s bad news for you if you have an obscure disease with flu-like symptoms. Your doctors’ diagnoses might reflect a confirmation bias (a tendency to find what they expect to find), an availability error (a decision based on how easily examples come to mind) or other cognitive flaws that Jerome Groopman describes in this engaging bestseller.

Groopman’s thesis is that a doctor’s state of mind strongly affects clinical decision-making. And many of his examples are eye-opening if paradoxically commonsensical. Do doctors’ friends get better care? Not necessarily, Groopman says. A doctor might hesitate to prescribe a necessary but painful test for a friend. Do doctors favor the sickest patients, who may need their care the most? Actually, they prefer healthy ones. One social psychologist found that “the sickest patients are the least liked by doctors, and that very sick people sense this disaffection,” Groopman writes. Apparently many doctors feel they have worked in vain when a disease resists treatment and stop trying to help. How Doctors Think

Much of this is so interesting that you wish this book didn’t reflect biases of its own. One is that it slights mistakes that result from factors other than cognitive flaws, such as fatigue, poor training and inadequate supervision.  “Experts studying misguided care have recently concluded that the majority of errors are due to flaws in physician thinking, not technical mistakes,” writes Groopman, a professor at Harvard Medical School and staff writer for The New Yorker.

But when you go to the end notes of his book to look for the source of that hard-to-believe “majority,” you read: “Although the frequency of misdiagnosis has been studied, few researchers have focused on its relationship to physician cognition.” So who are those “experts” who found that most errors result from doctors’ thinking?  The notes name only one expert who found such a “majority,” a researcher who had studied “serious errors that led to malpractice claims.” But Groopman says that the majority of all errors result from physicians’ thinking, not the majority of errors that lead to malpractice suits. Either his end notes are incomplete or he misrepresents in the book some of the material he cites in the notes.

At the very least How Doctors Think leaves a different impression of the causes of mistakes than the chapters on medical errors and problem doctors in Atul Gawande’s Complications, a more cogently argued book by another physician who writes for The New Yorker.  Gawande quotes from a landmark series of papers in the New England Journal of Medicine that reported that one percent of all hospital admissions involved negligence that prolonged the stay or led to death or disability of the patient. A smaller study of the treatment of cardiac arrests found that “27 of 30 clinicians made an error in using the defibrillator – charging it incorrectly or losing too much time figuring out how to work a particular model.”

Groopman is a bit like a coach who blames the problems in baseball on the character flaws of individual players instead of the culture that produced them. He says that doctors “desperately” need patients to “help them think.” If that’s true, it reflects badly on the entire American system of medical education, training and certification, not just on individual physicians. Clearly many doctors need more than “help” thinking logically – they need to learn how to work the defibrillator.

Best line: “When a patient tells me, ‘I still don’t feel good. I’m still having symptoms,’ I have learned to refrain from replying, ‘Nothing is wrong with you.’ The statement ‘Nothing is wrong with you’ is dangerous on two accounts. First, it denies the fallibility of all physicians. Second, it splits the mind from the body. Because sometimes what is wrong is psychological, not physical. This conclusion, of course, should be reached only after a serious and prolonged search for a physical cause of the patient’s complaint.”

Worst line: Groopman says his book is for people who aren’t physicians “because doctors desperately need patients and their families and friends to help them think.”  Isn’t it bad enough that we have all those TV commercials telling us to ask our doctors if we need a certain drug because, basically, they’re too dumb to figure it out on their own? Do we need this kind of smarm from doctors, too? Groopman doesn’t mention that there are 285 doctors for every 100,000 people in the U.S. and, if he’d written his book for doctors, he might make a lot less money.

 

Recommendatiom? A good but one-sided book. If you’re interested in medical errors, consider reading the chapters called “When Doctors Make Mistakes” and “When Good Doctors Go Bad” in Atul Gawande’s Complications: A Surgeon’s Notes on an Imperfect Science (Holt/Metropolitan, 2002) www.gawande.com instead of or in addition to How Doctors Think

Editor: Eamon Dolan

Published: March 2007  www.jeromegroopman.com  and www.houghtonmifflinbooks.com

One-Minute Book Reviews is for people who like to read but dislike hype and review inflation. It is also for people who dislike long-winded weasel reviews that are full of facts and plot summaries but don’t tell you what the critic thought of the book.

© 2007 Janice Harayda. All rights reserved.

www.janiceharayda.com

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