Customer Reviews

The Soul of Medicine: Tales from the Bedside

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

 

 

This is the third book I've read by Nuland, a great writer, educator, and medical historian. I've even had the privilege of hearing him speak at my own medical school graduation some years ago. Yet, in reading his anecdotes and thoughts about those of his colleagues, one cannot help but wonder if there is more to medical practice than simply recalling a few odd stories. I'd say that the true "soul" of medicine is not found in the extraordinary but rather the mundane, day-to-day life of the practitioner who truly is making a difference in the lives of patients, whether he knows it or not. The stories collected here, although entertaining, come across as exceptions to the rules, and therein lies the "Soul" of my review.

The author has made his twenty year writing career by telling tales of medicine practiced and how the body works in clear layman's terms (see "How We Live" and "How We Die"). This latest work tells how old time medicine worked with all its arrogance, errors, and healing. The first story describes in full gory detail the operation on teenager Jimmy who had fecal matter leak into his chest. They operated without reviewing his chart and possibly without legal consent. The writing is entertaining and the author lets the reader make their own judgment.

Having previously purchased five of Nuland's books, I almost didn't buy this one. However, I found it quite enjoyable and quite different. The "Tales" of the various "memorable cases" from many specialists were quite interesting, and the "narrator's" commentaries on most of them were interesting as well. It is fortuitous, perhaps, that I read this book just as the National debate on health care reform is reaching rather absurd dimensions, and if nothing else, it gave me some perspective and in some cases comedy relief. I believe that writing like Nuland's can really shed important light on some of the core issues of health and healing, for those who want to gain wisdom and not just add to the chaos and confusion.

Not only are all of the authors almost (if not equally as) eloquently prolific as Nuland himself, the stories contained are often heart-wrenching, humorous, and some brought me to tears in a matter of a few pages. Hat off to you this time, Nuland, good show.

In "The Soul of Medicine," Dr. Sherwin Nuland has collected reminiscences from a variety of doctors, offering "a sort of Canterbury Tales of medicine." Each chapter is written in the first person by a particular specialist in such fields as neurology, nephrology, pediatrics, and anesthesiology. In some cases, Nuland follows up with a commentary of his own. Some of the stories are tragic and others comical, but all are thought-provoking. Certain facts have been altered to disguise the identity of the people involved. However, the author assures us that the cases and medical details are accurate.

This is fascinating overview of the significant changes that have revolutionized the practice of medicine in the last half century. With MRIs, PET and CAT scans, and other advanced tools at their disposal, physicians are better equipped to make diagnoses that in the past might have eluded them. Of course, conscientious practitioners still take careful medical histories and conduct thorough physical examinations. In addition, they try to keep in mind the crucial role of communication and mutual respect between healer and patient. The anecdotes in this book demonstrate that, although most doctors are hard-working and dedicated people who take their awesome responsibilities seriously, they are also flawed human beings who, at times, make costly mistakes. The best among them, on the other hand, heroically fight to restore their patients to good health. Nuland adds that, in the last three decades or so, an ever increasing number of women have been entering medical school. We no longer hear that it is futile to educate female physicians who will inevitably drop out to have a family.

Whether his or her patient has an advanced malignancy, a chronic medical condition, or unexplained symptoms, each doctor/narrator reminds us that life is finite and unpredictable and that to awaken healthy each day is a gift not be taken lightly. As Dr. Nuland states in his epilogue, even with the sophisticated machinery and cutting-edge techniques that are now commonplace in major hospitals, "judgment will always be the most difficult aspect of the art of medicine." Sometimes, in spite of a dedicated practitioner's best efforts, a patient's condition will worsen. "The Soul of Medicine" is a poignant and informative work and a worthy addition to Dr. Nuland's well-received chronicles about how we confront disease, aging, and death.

Having read Dr. Sherwin B. Nuland's outstanding book "How We Die" I was naturally interested when I heard that he had published another book related to his medical interests. I have spent the better part of my life in medical related careers where it is common practice to discuss the unusual events of the day precisely to keep them unusual. Now in "The Soul of Medicine," Dr. Nuland is simply including us in the "surgical grand rounds" and sharing with us some of what has made his life exciting.

For some unknown reason, Nuland has fashioned his book roughly on the model of Chaucer's Canterbury Tales so that the 20 plus tales that are told have 20 "different" tale tellers. You'll read the Surgeon's Tale, the Urologist's Tale, the Cardiologist's Tale, etc. I was unable to discern any order based on the tellers specialty nor for that matter was every tale related to its teller. Hence the puzzlement over the Chaucer analogy. I was also somewhat confused as to whether he was telling each story in the actual words of the specialist from who he heard the story or whether he had put his story in the mouth of a specialist who might have had reason to hear or participate in the creation of the story.

The stories themselves are delightful. You'll find yourself turning pages way too quickly so that the 20 tales and the 207 pages are soon behind you. You find yourself wishing there were 5 or 10 more stories or wondering why the author stopped so soon.

There is nothing in the book that requires the reader to have a medical education. Just the normal brush with medical and nursing care. Nuland's stories remind me a little of the gynecologist who worked in my hospital. He carried around with him a standard vaginal speculum somewhat like other doctors carry a stethoscope. The shock was supposed to amuse you and remind you that he (the gynecologist) was not a normal person. So Nuland's stories have a little shock value to remind us that we're not dealing with normal people in normal jobs.

For example in the first tale <spoiler alert> a patient is discovered to have a chest cavity filled with feces. Normal people would find that only mildly alarming given that there's intestines & all in that general area so Nuland has to explain why that is not an expected condition.

Some stories are heart warming, some are inane, some are just quirky. It is the package of the whole that makes it "The Soul of Medicine."

Lastly, one minor complaint on the parchment-like jacket cover - it doesn't hold up well and it isn't transparent enough to show the illustration on the hard cover.

Sherwin Nuland is one of those rare breeds who is as skilled with the pen (or word processor) as the scalpel. In this highly readable and accessible book, he undertakes his own medical spin on The Canterbury Tales. He has a succession of pseudonymous doctors from varying specialties relate their first-person stories of their most memorable patients.

Underlying Nuland's book is the belief that, amidst all the high tech diagnostic tools, medicine and doctors have lost some of the close human touch and old-fashioned history-taking that is key to diagnosis and recovery. Perhaps true, but the tech genie is out of the bottle and unlikely to go back in. That, plus insurance reimbursement schemes pegged to ten-minute interchanges with patients do not allow for leisurely history-taking.

The Soul of Medicine is a forgettable book.

I was drawn to this book by a quote on the cover from Atul Gawande praising Sherwin Nuland's writing. As a medical student and a huge fan of Gawande, I was excited to start what I hoped would be an inspirational and interesting read. The Soul of Medicine was neither.

The book is structured like a Canterbury Tales of medicine. There are twenty-some short stories, each titled in the form of "The Surgeon's Tale," "The Cardiologist's Tale," and the like. It's a device that I never quite understood and found more distracting than anything. Nuland is the "Narrator," but he isn't the "I" that is telling the stories. Except for sometimes when they are his stories, then he is both the Narrator and the storyteller. Although it's easy to sort through, it distracts from the stories themselves. Some stories are followed by a short commentary by Nuland, which either provides some insight into an ethical issue encountered by the physician in the story or a history on a subject discussed in the preceding anecdote.

'The stories are, on the whole, unremarkable. There are several I will remember for their content, medical insight, or ethical dilemma; one that I will remember for being utterly useless ("The Dermatologist's Tale); and the rest seem to be there just to fill space. Most of the stories stick to the following format: a short description of the patient, perhaps a short description of the doctor, doctor quickly diagnoses patient, a short description of medical condition, outcome, the end. There is very little substance here. The occasional Narrator commentary will add a worthwhile thought, but at the end of the book, I found myself bored, uninspired, and behind in my studies.

A better title for the book might have been Random Medical Stories. If you want good medical writing, read Atul Gawande.

Some of the stories in this book are what one would expect for a book called "The Soul of Medicine"--and others have no place in this book. The story of a surgeon getting caught sleeping with a nurse and then getting the nursing supervisor fired to prevent himself from getting in trouble is absolutely inappropriate in this book.

That said, the book is an easy read. It is just not what I expected.

A very uneven collection of what one hoped would be memorable true-to-life medical stories. Rather, the quality ranges from the truly fascinating and emotional to a frankly boring style of outright lecturing and philosophical monologues. As a result, the interest level fluctuates.