‘The cost of saving a life’

The DO Book Club, Jan. 2022: Lightning Flowers

In the book, Katherine E. Standefer focuses on the rare metals that many complex medical devices require and the often ugly way they are obtained.

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

For those who didn’t get coal (or books about coal) in their holiday stockings, here are some recommendations for your 2022 reading list. Something old, something new and, as Monty Python might say, something completely different. If you have suggestions for books to review in this column, please submit them to thedo@osteopathic.org.

Lightning Flowers, Katherine E. Standefer (Little, Brown Spark, November 2020, 288 pp.)

We’ve probably all heard the term “medical-industrial complex,” which dates back to 1969 when it appeared in the Bulletin of the Health Policy Advisory Council. It’s an adaptation of outgoing President Dwight Eisenhower’s warning about the growth of the military-industrial complex. As the technical wizardry of medicine has advanced with near-lightning speed (devices and robots and scanners, oh my!), the device industry has become medicine’s 800-pound gorilla, influencing almost every phase and aspect of patient care.

In this book, the author focuses on the rare metals that these miracles require and the often ugly way they are obtained. Think Blood Diamond without the warfare. The narrative shifts back and forth in time (its chapters titled after dates and locations) between the author’s personal journey as an implantable device recipient (an implantable cardioverter-defibrillator [ICD]) and her search for how the raw materials it depends upon made their journey from deep in the earth on a distant continent to the facility outside Los Angeles where it was assembled.

The book is not aimed at medical professionals and so you may find yourself skimming the parts that explain the details of her underlying medical condition (long QT syndrome), workup and treatment. It also describes at length her struggles with obtaining appropriate health care providers and insurance coverage for sophisticated, high-end care.

Not surprisingly, most of the rare metal components in her ICD like gold, titanium and cobalt are found in poor or underdeveloped nations where the means of their extraction comes with harsh and sometimes brutal realities. The subtitle of the book is “My Journey to Uncover the Cost of Saving a Life” – which is really a question that could be asked of every device or product that protects us, from airbags to automatic brakes.

The story is as much a memoir of illness as it is a personal research project. But given the number of our patients who walk around with high-priced hardware tucked inside them, it’s worth the time spent reading it.

Frankenstein, Or the Modern Prometheus, Mary Wollstonecraft Shelley (Lackington, Hughes, Harding, Mavor & Jones, January 1818, 280 pp.)

I know, I know – Frankenstein? 204 years old now? SRSLY? C’mon, man.

But give me a minute, here. For too many of us, the story is indelibly intertwined with Hollywood’s era of monster movie mania. It’s what I grew up with. We use the term “Frankenstein Monster” all the time, usually incorrectly and without proper context. This book is perhaps one of the most misinterpreted stories in literary history, thanks mostly to popular culture past and present.

Also, the edition I recommend is the original 1818 one. Later editions had “improvements” by the author’s husband, the poet Percy Bysshe Shelley. These editions might be an early example of mansplaining or perhaps hepeating.

The 1818 Frankenstein may be the urtext of modern narrative medicine. For those unfamiliar, it has three nested narratives which begin not in a castle laboratory but in the wilds of the Arctic on a ship (Joseph Conrad used a similar framing device in “Heart of Darkness” in 1902). And for the record, there is no “monster.” There is The Creature, who is not hideous or inherently evil or murderous. The good doctor Victor created a human, not a humanoid.

The book is ultimately a story of hubris and abandonment. It examines a doctor’s obsession with creating life from things lifeless and then his abandonment of what he created. If there is a monster in the tale, it is the doctor.

We do Frankensteinian things all the time. Maybe not life from death but we often fundamentally change people – especially if we do procedures. And then we walk away. Prometheus gave the lightning of the Gods to humans. What is the defibrillating current that restores life if not lightning from the gods?

Two hundred and four years later, Frankenstein still a good read – and perhaps the earliest example of science fiction as we know it today. It’s a better read if you’re a physician or a med student. So read the book. Skip the movies.

The C-L Psychiatrist, Omar Mirza, DO (Roaring Sun Studios, November 2021, 58 pp.)

I have to admit I didn’t know what a “C-L Psychiatrist” was when I picked this slim volume up; now I do. It’s a clinical-liaison psychiatrist. I’ll also admit I had no idea what to expect of a medical text presented as a graphic novel. I was skeptical about the premise and the presentation when I took on the review, but now I’m not.

Too often, textbooks and monographs (this is more of the latter) are still primarily written and edited by physicians my age or older, resume building blocks in an academic career. Hence the number of expensive “bricks” on the average office bookshelf. This is a feather in comparison. And yet the information it provides and the way in which it presents it is really, well, it’s really pretty cool – a term not often used for contributions to the medical literature.

The color panels are professionally done and worthy of the Marvel Metaverse. There aren’t any BOFFs, KAPOWs or AIEEEEEE!s, so it’s not a medical comic book by any means. The wealth of information contained within flows out easily and is absorbed painlessly. It’s medical knowledge wrapped in visual storytelling. There is historical backstory and dramatic scenario illustration.

The relatively narrow focus of the book is determination of “patient agency” – competence to make or participate in personal medical decisions. A topic that’s highly relevant given today’s aging patient population and the plethora of therapeutic options available to us as physicians.

Dr. Mirza is a psychiatrist and he has written what he knows. What I believe is just as important is that he has perhaps opened up a newer and potentially more adaptive milieu for transmitting clinical knowledge in small, easily digestible bites. Especially for concise clinical subjects, I could see this approach easily (and hopefully) extending to other disciplines as well.

February’s books

For February, Joan Naidorf, DO, will review It’s All in the Delivery by Anthony Orsini, DO, and Motherhood, Medicine & Me by Rebecca Levy-Gantt, DO. We encourage all who are interested to read along (this book club can be followed at any pace)! If you are unable to get out to a local library or bookstore, we recommend checking out eBook options.

If you read Every Patient Tells a Story or any previous Book Club selection and want to share your reflections, please leave a comment below or email rraymond@osteopathic.org.

Related reading:

The DO Book Club, Dec. 2021: Every Patient Tells a Story

The DO Book Club, Nov. 2021: Station Eleven

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