Jack McGann 3/16/11

1Better By: Atul Gawande

Pages read: 69

In this section of the book, the author, Atul Gawande, tells stories about his performances and actions at the hospital (work). Atul is a surgeon, and the hospital name has not been given yet. So far, he has admitted about the lack of amount of times he washes his hands at work and says most doctors don’t as much as they should. He educates his audience about how hand washing was first thought of by a Vienesse obstrician, one hundred forty years ago, named Ignac Semmelweis.
Ignaz_Semmelweis_1860.jpg
Ignaz (Ignac) Semmelweiss: July 1, 1818- August 13, 1865
He states that before hand washing in hospitals, doctors themselves were to blame for maternal deaths after birth. Few people listened to his idea, and he later had gotten fired for constantly pestering others into washing their hands. Even now with all the bright yellow and red signs warning people to washing their hands, multi-thousand dollar sinks in hospitals, special soaps, and sanitizers created and offered, people and doctors still refu
se to wash their hands as much as they should.
Later, he describes a case of polio in India, a disease thought to have been eliminated years ago. Then, Atul gives examples of other diseases that were fought against with campaigns, spending millions and billions of dollars. The World Health Organization came up with a term, “mop-up”, which is, in other words, a campaign to immunize all susceptible children surrounding a new case. This “mop-up covered fifty thousand square miles in India. People who are infected with poliovirus aren’t able to swallow or breathe on their own, due to the paralyzed cells in the brain stem. The only way people can survive with this virus is if they are fed through a tube and ventilated by a machine. This virus can also obstruct control over limbs and
abdominal muscles. Eventually, a miracle happened and a vaccine for the virus was created, which was given to 440,000 children. In little time, polio had disappeared from the city. Polio-large.jpgAfter reading this section of the book, I must say I have chosen the right book. I am not interested in pursuing a career in the medical field, but I enjoy learning about this topic and reading personal stories from someone in the real world. Although, a lot of this book has facts and examples, which can bore me after a while. I feel that this book may get old as time goes on, but that doesn’t stop me from continuing to read.

Items to research:
Average Citizen of India
Poliovirus
Penicillin
Mop-Up
WHO (World Health Organization) kjhgkajdhgfkdsjghflkajhsdflkajshfdlaksjdhfalkjsdhflksadjhfa Child in India receiving oral polio vaccine

2 Better By: Atul Gawande
Pages read: 69-130

The second section of the book I read was very similar to the first. Again, he describes his memoirs, but this time he starts out by telling a story that wasn’t about a personal experience in the hospital or in another country; it took place in a courtroom. A dermatologist had surgically removed a cancerous wart from a patient of his, who was unhappy about the scar and tried suing the dermatologist for malpractice. Hundreds of crazy lawsuits like this happen all the time. Atul was sued for accidently tripping a women and injuring her shoulder when he was in Harvard medical school for just one week. He “failed to diagnose the broken shoulder” at the scene of the incident.
Gawande also goes into detail about a lawyer named Barry Lang’s career. Lang is the stereotype of a malpractice lawyer, with his appearance of: old age, bald head, short in height, had a loud mouth, and constantly paced back and forth, rolling his eyes. Before this job, he was actually a doctor. For 23 years he was an orthopedic surgeon, and was good at it. He changed careers not for the pay, but because he simply thought he would be good at it, and was tired of doing hip replacements for years for his old job.
In my last reading checkpoint, I said that the memoirs might get old/boring after a while. The author does a great job by changing the theme of the stories though and each one interests me in a different way. This theme was more about the law rather than experiences in the hospital or describing times in surgery. I am looking forward to what else this book is about.

Items to Research
-Average salary of orthopedic surgeon malpractice-lawyer.jpg
-Barry Lang
-U.S. health care basics

3 Better by: Atul Gawande
Pages read: 130- 200

In the third section of the book I read, the author does not talk about his actions in the past. He starts out by talking about executions for criminals in the United States. Ways of executing have changed very much over time. As early as 1976, the government thought it would be appropriate to execute by shooting. It has changed to hanging, to death in a gas chamber, to electrocution, to finally injection of lethal fluids. The reason it has changed is because they are too difficult to watch or too painful and inhumane. Doctors and pediatricians are also able to help out with the execution process, as long as they don’t inject the drugs. The doctor will sit behind a curtain, watching a heart rate monitor and let the warden, who is in charge of the execution, know when the criminal is dead. The doctors are also able to insert the IV into the criminal’s vein. Usually the veins are hard to find because the criminals are either

overweight, addicted to drugs, or both.
He also discussed a case where an eleven-year-old girl was diagnosed with a non-Hodgkin’s cancer in her chest. Most people who are diagnosed are cured after chemotherapy. After she was given chemotherapy three different times, the tumor did not shrink one bit. She was eventually taken home, where she died at one in the morning, Easter Monday. He also told a story about a baby that was born prematurely in the parking lot of the hospital it was to be delivered at. The baby appeared blue in color and had steam coming off because of the cold weather. This lead into a discussion about pregnancy and birth.

In the last section, I became a little bored with the subjects he described. This time, I was quite interested in the topics he discussed. Executions don’t interest me, but I had always wondered what went on during them and why they changed their ways. The story about the young girl was a little hard for me to read because I just can’t imagine that happening to anyone, and it sounds like such a bad story. Another thing that interested me was the discussion of birth. In health class, which I took last semester, we were not taught as much as the author wrote in the book.


Items to research:
- EKG process
- Potassium Chloride used for Execution
- The “Apgar effect”
- A “Pitocin drip
- Hodgkin’s cancer symptoms

4 Better by: Atul Gawande
Pages Read: 196-248
The last section of the book I read can be described in one word: interesting. Atul starts out by explaning a case when a baby girl had been born with a disease with symptoms of a higher chloride level than normal. This disease is called cystic fibrosis, and people with this disease are lucky to live to forty years of age. It is a genetic disease and causes all sorts of problems with digestion, breathing, and prespiration. The doctors that diagnosed the disease in the girl let her parents know after several tests, that she would live to forty years of age.
cystic-fibrosis.jpg
The chapter this part is in is called “Bell Curve” and describes what the graph of “Results of all Centers Treating Cystic Fibrosis”, it would look life a dorsal fin on a shark.
Later, he writes about his learnings as he went around interviewing and examining medical cases. He gave a number of disgusting things that have happened to people and the process of diagnosis to surgery. When some operations are scheduled, it sometimes can take a week before they are fixed up. Men in prison who needed medical attention were treated very poorly. About 50 metal cots were lined up and some were needed to be shared, or men would be forced to lie on the floor. Basic equipment is lacking in the medical ward, causing deaths.
The last section was something new this time and did interest me. Although, the story about the little girl upset, just like all the stories about the children in this book. The prison part got me thinking. I understand that the men in prison have made some pretty bad decisions but that doesn’t mean they deserve to live any less or get any less medical attention than anybody else. This is a book I would definitely recommend to someone interested in the medical field. Someone who gets bored about the same subject after a while may not enjoy this as much.

Cystic Fibrosis
Atul's travel to India
Medical ward in Prisons