Customer Reviews

Memory Lessons: A Doctor's Story

5 star:		(41)
4 star:		(14)
3 star:		(1)
2 star:		(0)
1 star:		(0)

 

 

I was expecting something with a narrow medical focus, so the breadth of topics touched in this book was an unexpected surprise. This is a beautifully-written memoir about humanity, personal aging, caring for an aging parent, life's struggles and challenges, and the spectrum of emotions that come with those challenges.

Dr. Winakur puts much of himself into the writing -- he comes across as thoughtful, empathetic, caring, dang smart, idealistic -- exactly the kind of doctor you would want for yourself or your parents. His writing is lovely and very accessible to the layperson -- it never gets bogged down with technical terms, nor is there ever a "see how smart I am" overtone that occasionally taints books of this genre. Beautiful read.

One caveat -- the fine print. Literally. The font is smaller than I'm accustomed to might be a challenge for some readers (I'm just starting to wear readers, and generally don't have an issue with most books). Though my seventies-ish mother would love this book, I would be hesitant to share it with her for that reason. The content makes it worth struggling with the fine print, but I feel that it is worth mentioning. ing.

This was a wonderful read. A story from a geriatric physician about his life and how he dealt with the age old question many of us will face, "What do we do about Dad?" As we grow older, so do our families and the roles start to change.

Not only was this an insightful story about caring for the elderly population but it was also an insightful story into the lives of the families and physicians who care for them.

The reader gets a sneak peak and some insight into our health care system, the tole's of being a doctor, and the stresses of being a caregiver.

This is a story, warmly written, about aging, death and dying, and how we chose to deal or not deal with it. A beautiful story about many of the lives the author cared for and the loses that are inevitable. May we all be as fortunate to have such a thoughtful and compassionate physician caring for us and our loved ones.

This is a wonderful book on so many levels. It is primarily a memoir of a doctor dealing with his father's descent into Alzheimer's disease. Along the way we learn of what is wrong with health care in America, the coming challenges, and some possible policy changes that could help. It also emphasizes the importance of talking to family members about their thoughts and wishes concerning end of life decisions early in life instead of too late.

This book is both heart-rending yet hopeful. It hit quite close to home to me, as my father is along the same path too. The author deftly weaves together birdwatching, pawn shops, family relationships, loss of memory, and the health care of the growing senior citizen population.

There are end-notes to support the quantitative information, and the author doesn't claim to provide any answers to how to solve the health care cost and quality problems, but he takes square aim at some causes such as "pay for procedure" mentality versus taking the time to spend 30 to 60 minutes getting a detailed health history for a patient. He notes that a ear-nose-throat doctor will be reimbursed much more for the "clean the wax out of the ears" procedure, that he will for spending time with a patient. The pharmacy industry also comes under fire for its sweetheart deal for Medicare drug coverage - the U.S. Government cannot try to negotiate for lower drug prices from the industry.

I was also shocked to hear that the committee that helps set Medicare reimbursements for various procedures is staffed primarily by physicial specialists that would stand to benefit by the current system. I wish I could send a copy of this book to all the government policy makers.

The book guides us through the history of end of life decisions, from the early 1970s when removing a respirator was considered murder, through the headline-grabbing stories such as Terri Schiavo, through today's philosophy of dieing with dignity. He illustrates this clearly through some of his patient's cases during those periods. And he acknowledges it is a tough decision, always, to determine whether it is best to go into the hospital for an operation, when the chances of getting an infection, or having deleriums, are so much higher for the oldest-old patients.

While Marcus Welby, M.D. was a fictional character, his dream of how doctors were supposed to care for patients, may have occurred with the old-fashioned country doctor named Dr. Jerald Winakur.

Winakur is a country doctor (who practices in an urban setting) in the finest sense. His book Memory Lessons, using the allegory of his father's aging process, to show both the perils and delights of modern medicine.

Winakur asks the reader to question the mire of Medicare; the focus of insurance companies and how they influence the process of medicine; to think about end-of-life issues (how do we go down that slippery slope?); the affordability for long-term care for the aged and finally how aging affects all families.

It is rare to read a book of such fine caliber, one that is so finely written, about such a difficult subject.

Winakur has done so.

I'd give this book 10 stars but I can only give it five.

This is a well written, honest book about a flawed medical delivery system and the factors that allow it to continue unchecked. Doctors do not practice in a vacuum and their increasing reliance in procedures, tests and boiler plate treatment that may ease pain but fail to touch the suffering is rooted in an overall societal reluctance to take the time, resources or risk necessary to see people as individuals who are, in sickness and in health, interdependent. To see beyond the surface to the heart and soul of each person. Jerald Winaker speaks as a respected M.D. and Geriatrician but his credibility stands on his personal journey to provide compassionate care to his old, old father. Not only does it challenge the conventional wisdom of doctors, but calls everyone to reevaluate their relationships with parents, children and spouses long before the cognitive decline begins. Poetic and informational, "Memory Lessons" offers great insight as to the mental, emotional and physical reality of dementia, both from the standpoint of the person who gives care and the person who is on the receiving end. An essential addition to the curriculum of every medical and nursing program in the country.

This is both a memoir and memorial of Winakur's father and his decline into dementia, and a memoir of the author's medical career. These two parts are intertwined through-out the book, like a climbing rose vine wrapped around a wrought iron fence, each supporting and enhancing the other.

In the biographical section we learn of Jerald Winakur's father, who was the son of Jewish immigrants. His father died when he was 7 years old, and at 16 he and his older sister worked to rebuild the family's pawnshop business to support their mother and ten siblings. His family weathered the Great Depression with difficulty, and he served five years in the Army Air Corps during WWII, and returned to the family business after the war. He kept it running successfully for years, until, when he was in his fifties, it was wantonly destroyed in the Baltimore Riot of 1968 (this was his second store, the first had been taken by the city in an act of eminent domain, ironically, taking his store for the new location of a medical school). Having lost everything, and too depressed to attempt to rebuilt another business, he takes solace in his art, a talent he had set aside to support his family, and in his bird watching. His relationships with others are difficult, he has not always gotten along well with his sons, but they are a close family. He develops cancer, and then dementia, and his family struggle over his last few years to find the best ways to take care of him while still respecting his own personhood as much as possible. Because Winakur is a geriatric specialist, he is also able to share other decisions other families have made in similarly painful circumstances, showing us that one size does not fit all. We also see how for some families painful past relationships with parents plays into decisions made out of guilt, or resentment, and how compex the questions of dealing with a family member with dementia can be, and how very human caregivers and the medical professionals are.

Winakur has also been the primary care physician for an aging community of nuns, and he shares his experiences there, as well as his studies of research by others. What he had to say about the importance of faith and community was extremely intriguing. Faith, optimism, early language skills, community- all these things play a part in fending off dementia. He refers here to the nun studies done in a community in Wisconsin- they began in 1986 and are on-going. The nuns donate their brains to science when they die so the research can continue.Aging With Grace: What the Nun Study Teaches Us About Leading Longer, Healthier, and More Meaningful Lives tells us more about this study.

In the medical section we learn about Winakur's struggles with medical school techniques which depersonalize and dehumanize the doctor-patient relationship, the way big pharma companies enriched themselves often at the expense of good doctor-patient relationships, and his frustration with the way Medicare, insurance companies, lobbying groups, and government programs (Medicare, he says, is the most egregious of these) have focused on bells and whistles, gimmicks, procedures, and technology and, by reimbursing those procedures at disproportionately higher rates have squeezed out basic, good doctoring, the sort of doctoring that comes from a compassionate, knowledgeable individual taken time to apply his knowledge and insight of a patient's personal background and medical history into working out the best care for each patient on an individual basis.

He points out that insurance companies generally follow Medicare's lead in determining what programs to cover and at what rates. Medicare's determinations are based largely on the recommendations of an AMA committee, the "secretive and subspecialist-stacked: 'Resource-based Relative Value Scale Udpdate Committee (RUC).' Twenty-three of the thirty members are appointed by medical specialty societies, and the meetings are closed and proprietary. 'seventeen of the permanent seats on the RUC are assigned to ... specialty societies... that account for a very small portion of all professional Medicare billing, such as neurosurgery, plastic surgery, pathology, and otolaryngology.' And over 90 percent of this committee's recommendations are enacted by Medicare."

He would like to see more front-line, basic, primary care physicians consulted on issues of health care and government policy- something he said did NOT happen with any previous such debates (and I suspect not with the current ones, either).

Winakur's writing is poetic, lyrical, and personal. He writes as a physician and as the loving and sometimes conflicted son of elderly parents, one with dementia, the other, his mother, nearly blind and wearing herself out as the primary caregiver. He writes of the decline of personal medical care, and the slow decline of his father, and most dementia patients, whose family members often do not connect the dots and recognize dementia until something dramatic happens. He also writes of heroes, heroes in medicine and on the home-front, who maintain their loved ones in great difficulties. He writes of the need for improvements in how care for our oldest old, and he offers suggestions. He also offers understanding and compassion.

This was a moving book, especially to my family as we work out these issues with our own difficult father and husband, gently sliding down the hill of dementia. It was affirming to read of some of the same experiences, questions, and difficulties that others in similar circumstances have gone through.

Because we are all human, because we all age and die, this book applies to all of us. It is a startling reminder of the importance of family and community. How choices we make in our youth can come back to haunt us or improve us and it is important to realize that choices are important because we lose our control to choose as we age. It is important that time and again in this tale those who have the happiest old age are not necessarily wealthy or even healthy but they have been wise in their acceptance of love and support and in accepting and supporting others when possible. This biography of his father's last years has so many lessons that we should take to heart. I am fortunate to live in a rural community where the elderly are treated with respect and given support. We have a community center where the social interaction, so lacking in many large cities, is available. Where groups meet daily, to eat lunch,play cards, plan their lives. Yet we still see those who isolate themselves, take the meals on wheels and assert that they are independent, do not need social discourse over lunch. I worry for their mental health. My father (an Alzheimer's victim) lived at home much longer because of this place and having people who were kind and supportive of someone with his condition. Why? Because in a town with a large elderly population, they are very familiar with the disease. Everyone has a relative or friend who has been victimized. All the suggestions made in this book are realized and available in my small town in a poverty area. From medical support from caring professionals to the everyday residents, this book made me apprecite the community I live in so much more. I recommend the book so highly, I think it should be required reading for anyone with the ability to read, If you pay taxes, if you breathe, if you and your family are not immortal, you need this book. Dr Winakur hits the nail on the head with his explanation of the health care crisis and how we really need reform to save ourselves.

Poignant tale of aging, the loneliness and often heartache of the aged, and the responsibility we all have for the mental and physical well being of one another.

Intertwined with this sensitive tale is a dynamic which is of deep concern for all of us - the specialization of the medical community which is leading more and more to a lack of knowledge and sensitivity between physician and patient.

A really good read for anyone, but especially for those of us dealing with the aged and the crippling effects of dementia.

This book is written by a geriatric doctor about his experiences in working as a geriatric doctor, his own experiences of aging, and his experiences with his aging parents--especially his father who has Alzheimer's.

I was not sure that I would enjoy this book, because I am not in the position of being "older", or having older parents to take care of. However, on the contrary, I found this book to be very compelling and moving. At times I felt sad or angry reading it, and at other times hopeful or wistful. I think those are the markings of a really good book....it makes you feel something.

Aside from the main focus of this book, you see a bit of what it is like to be a doctor, and also some of the more negative aspects of our health care system.

A really great read for anyone...because we will all experience aging/death at some point in our lives.

Recently my elderly father suffered some small strokes that sent him on a downward mental slide. As a result he's taking Alzheimer's medication, along with other pills to help minimize reoccurring vivid delusions (sometimes he's sure he has witnessed my 72-year-old mother committing flagrant adultery). So when I ran across "Memory Lessons" and saw it's about a son - who happens to be a doctor - dealing with his aging father's mental disintegration, I immediately ordered a copy. However, this book is not a how-to guide on elder care. Instead, it's the deeply personal story of a man's courageous but futile battle against a loved one's slow and undignified death.

Dr. Jerald Winakur has been practicing geriatric medicine for over three decades (not the most popular specialty, as we discover). With a sure writing hand he takes us through various life milestones: working in his father's pawn shop, earning his medical degree, getting married, setting up his practice, having children, and so on. But the story's overarching theme is the inexorable dissolution of the author's father, a child of the Depression who endured various setbacks only to face the loss of a hard-won identity in the winter of his life. Dr. Winakur, his hapless brother, and their longsuffering mother orbit around the disintegrating patriarch, doing all they can to hold the line but unable to prevent a mental Armageddon.

The author is brutally honest about the situation, including his frustrations, familial struggles, and perceived personal failings. I saw my own family reflected in the Winakur's bleak scenario: dealing with distressing symptoms, medication issues, and relational strain. Dr. Winakur personally demonstrates the harsh reality of enduring the death of a parent's personality, but he also shows that it's the patient's spouse who pays the greatest price, for it is he or she who often ends up as the primary caregiver until unwilling or unable to continue. Indeed, perhaps the harshest part of this book is seeing the author's mother lament her marriage and become emotionally and physically exhausted from constantly tending to her wandering, confused, and emotionally volatile husband. It was too close to home for me, since my mother's situation is fast becoming a reflection of Mrs. Winakur's.

In addition to these often difficult biographical elements, Dr. Winakur takes us on a revealing tour of the geriatric medical industry. Throughout the book he dissects various aspects of geriatric care as they apply to his elderly patients or declining father, such as assisted living, in-home nursing care, Medicare, the pharmaceutical industry, euthanasia, and even the funeral business. Although he makes some positive statements here and there, he mostly laments the current problems and growing fault lines of the American health care system, especially with a fast-approaching future containing a massive aged population requiring extensive aid. With the shortage of trained medical professionals and lack of government funding, he wonders whether our system will be able to handle the strain. Alternately hopeful and pessimistic, he offers no easy solutions.

In the end, I confess that although this book helped steady me for a trying future, it also served as a frightening reality check. If an experienced doctor who specializes in caring for the elderly, who can prescribe medicine, who can consult with other MD peers, and who knows the health care system inside and out can become a frustrated and anguished caregiver, than what is to become of those of us who lack his medical acumen, professional contacts, and higher-level income? Based on past experience with family and friends, I'm bracing myself for a difficult ride as my father begins his endgame. I can only hope that I persevere as well as the author and make good care-giving choices despite my ignorance.

If you're looking for a heartwarming end-of-life story or a tale of miraculous healing, "Memory Lessons" isn't for you. Even though the author sprinkles some good memories and experiences throughout the book, there's no real "Cocoon"-style happy ending - only the weary peace that comes when a loved one's suffering ends and the necessary business of getting on with life after such a loss begins. Dr. Winakur's personal story of life's curtain call, interweaved with an insider's take on geriatric medicine, is necessary reading. Highly recommended.