A Totally Unauthorized Reading Group Guide to ‘The Last Lecture’ by Randy Pausch

A Totally Unauthorized Reading Group Guide to ‘The Last Lecture’ by Randy Pausch

10 Discussion Questions
The Last Lecture
By Randy Pausch with Jeffrey Zaslow
Source: One-Minute Book Reviews
http://www.oneminutebookreviews.wordpress.com

This guide for reading groups and others was not authorized or approved by the author, publisher or agent for the book. It is copyrighted by Janice Harayda and is only for your personal use. Its sale or reproduction is illegal except by public libraries, which may make copies for use in their in-house reading programs. Other reading groups that would like to use this guide should link to it or check the “Contact” page on One-Minute Book Reviews to learn how to request permission to reproduce the guide.

After learning that he had terminal pancreatic cancer, Randy Pausch gave an upbeat valedictory lecture at Carnegie Mellon University, where he teaches computer science. He called his talk “Really Achieving Your Childhood Dreams” and explained in it how he had accomplished most of what he set out to do in life. Enlivened with humor and showmanship, his lecture drew millions of visitors to its posting on YouTube and made Pausch a star on the Internet. His talk also inspired The Last Lecture, a collection of short essays written with Wall Street Journal columnist Jeffrey Zaslow, which became a No. 1 bestseller on the New York Times “Advice, How-To and Miscellaneous” list.

Discussion Questions

Please note that the page numbers below come from the large-type edition of The Last Lecture (Thorndike, 2008), the only one available when this guide was prepared.

1. When someone asked what he wanted on his tombstone, Pausch said: “Randy Pausch: He Lived Thirty Years After a Terminal Diagnosis.’” [Page 247] If you were to write his epitaph, what would it say?

2. Summing up a theme of his lecture and book, Pausch writes: “We cannot change the cards we are dealt, just how we play the hand.” [Page 32] This is one of many clichés he admits he loves and uses liberally in The Last Lecture. Did he succeed in making any old ideas fresh? How did he do it?

3. Pausch began his lecture “Really Achieving Your Childhood Dreams” by saying he wasn’t going to deal with big questions of religion or spirituality, and he sticks to that pattern in The Last Lecture. How does the book benefit or suffer from his decision?

4. The Last Lecture recycles much of what Pausch said in his valedictory lecture at Carnegie Mellon and expands some of it. Should people who’ve watched the talk also read the book? Why? What does the book give you that the lecture doesn’t?

5. Pausch could have called his book The Last Lectures, because he structures it as a series of mini-lectures instead of one long lecture. How well does this technique work?

6. The Last Lecture balances general advice such as “dream big” with specific tips – for example, about how to work well in small groups. “Instead of saying, ‘I think we should do A, instead of B,’ try ‘What if we did A, instead of B?’” [Page 190] Which, if any, of the tips struck you as most helpful?

7. Many cancer patients are bombarded with the advice to “be optimistic” or “think positively.” This approach has led to a medical backlash alluded to in the chapter “A Way to Understand Optimism.” Pausch says his surgeon worries about “patients who are inappropriately optimistic or ill-informed”: “It pains him to see patients who are having a tough day healthwise and assume it’s because they weren’t positive enough.” [Page 249] What is Pausch’s view of this? Is he appropriately or inappropriately optimistic? Why?

8. Many people who have heard about The Last Lecture may be tempted to give the book to someone who has had a devastating diagnosis, or who is perhaps dying, hoping it will provide comfort or cheer. What would you say to them? Is this a book for the living or the dying?

9. The Last Lecture comes from Mitch Albom’s publisher and literary agent and has a small format similar to that of Tuesdays With Morrie. These similarities – let’s face it – could be a kiss of death for some people, especially critics who see Albom as an icon of saccharine and dumbed-down writing. What would you say to someone who didn’t plan to read The Last Lecture because, “One Mitch Albom is enough”?

10. If you were going to give your own “last lecture,” what would you say?

Vital Statistics:
The Last Lecture. By Randy Pausch with Jeffrey Zaslow. Hyperion, 224 pp., $21.95. Published: April 2008.

A review of The Last Lecture appeared on One-Minute Book Reviews on May 30, 2008. If you are reading this guide on the home page of the site, scroll down to find the review. If you are reading this guide on the Internet, click on this link to find it www.oneminutebookreviews.wordpress.com/2008/05/30/.

Watch Pausch’s talk “Really Achieving Your Childhood Dreams” and read an excerpt from The Last Lecture at www.thelastlecture.com.

Furthermore: Pausch posts updates on his health at download.srv.cs.cmu.edu/~pausch/news/index.html.

Janice Harayda is an award-winning critic who has been the book columnist for Glamour, the book editor of the Plain Dealer and a vice-president of the National Book Critics Circle www.bookcritics.org.

One-Minute Book Reviews is for people who like to read but dislike hype and review inflation. Totally Unauthorized Reading Group Guides appear on the site frequently but not on a regular schedule. They usually deal with books for which publishers have provided no guides or guides that are inadequate – for example, because they encourage cheerleading for books instead of thoughtful discussion. To avoid missing these reviews, please bookmark the site or subscribe to the RSS feed. If you would like to see the guides continue, it would be extremely helpful if you would link to them.

© 2008 Janice Harayda. All rights reserved.

www.janiceharayda.com

The Best Line in ‘The Last Lecture’ — Randy Pausch’s ‘Deathbed Conversion’

A review of the bestseller The Last Lecture www.thelastlecture.com will appear soon on One-Minute Book Reviews. In the meantime I’ve been watching the lecture that the author Randy Pausch gave after learning that he had terminal pancreatic cancer, which made him a star on YouTube and led to a book contract. Here’s the best line in the lecture:

“I have experienced a deathbed conversion. I just bought a Macintosh.”

Second best line:

“If you have any herbal supplements or remedies, please stay away from me.”

You can hear the lecture or learn more about the book by clicking on the link in the first line of this post. Pausch gave his lecture, entitled “Really Achieving Your Childhood Dreams,” at Carnegie Mellon University, where he is a professor.

(c) 2008 Janice Harayda. All rights reserved.

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

Coming Tomorrow — John Gunther’s Classic Memoir of His Son’s Death From a Brain Tumor, ‘Death Be Not Pround’

Many school reading lists include John Gunther‘s classic memoir of his 17-year-old son’s fight to survive a deadly brain tumor, Death Be Not Proud. And perhaps for that reason, some people have come to see it as a book for teenagers. But the book was an adult bestseller in its day and popular among many ages. What does it offer to readers today? One-Minute Book Reviews will consider the reasons for the enduring appeal of the book tomorrow.

(c) 2008 Janice Harayda. All rights reserved.

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.

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

The ‘Tyranny of Positive Thinking’ and Cancer Patients — A Physician-Author Says That It’s Not Always Best to Tell People to ‘Be Optimistic’

Can you give too much encouragement to people who are ill?

By Janice Harayda

Not long ago, I reviewed Betty Rollin’s Here’s the Bright Side and objected to its theme that all human suffering holds “a hidden prize waiting to be found.” I argued that some losses are so sad — the death of a child, say — that urging people to find their “bright side” is cruel.

Later I read some interesting, related comments by Jimmie Holland, chair of Department of Psychiatry and Behavioral Sciences at the Memorial Sloan-Kettering Cancer Center. They appeared in an article Leslie Brody wrote about caring for her husband, who has pancreatic cancer, for the New Jersey daily, The Record, on May 20, 2007.

“Think twice before telling the patient to ‘be positive,’” Brody wrote. She added:

“Dr. Jimmie C. Holland, author of The Human Side of Cancer and a pioneer in the psychological aspects of the illness, has written about the ‘tyranny of positive thinking.’ When people insist patients should ‘be optimistic,’ they imply that those who get sicker may be to blame for not trying hard enough to stay upbeat and conquer the disease.

“Holland says a patient’s mind-set might help him stick to a grueling chemo regimen, but it’s less clear whether attitudes and emotions in themselves can affect tumor growth or the body’s response. Patients — and their families — should feel free to vent depressing and anxious thoughts without being judged.

“Instead of saying ‘Chin up,’ or, ‘You’ll be fine,’ it’s better to say, ‘Hang in there,’ or ‘We’re thinking of you,’ or ‘We’re hoping for the best.’”

Links: To read the original review of Here’s the Bright Side, click here www.oneminutebookreviews.wordpress.com/2007/08/21/. To read about The Human Side of Cancer, click here www.humansideofcancer.com.

© 2007 Janice Harayda. All rights reserved.

www.janiceharayda.com