Being Mortal: Medicine and What Matters in the End – Atul Gawande (2014)

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“One has to decide whether one’s fears or one’s hopes

are what matters most.”

Passing by the New Release shelf at the local library, I quickly noticed a new title out by Dr. Atul Gawande, one of my fav authors and an experienced surgeon at Brigham and Women’s Hospital. He’s also an excellent writer who has often published medical-related essays in places such as the New Yorker and elsewhere. He’s also written a few other titles, all with a medical connection and mostly very good. (I’d class his “Complications” title as excellent really. You should check him out if he’s a new author to you.)

This new title focuses on human mortality and the role that medicine plays in the lives of aging Americans and then death. Medicine can do many things, but its main role has developed over time to sustain life through addressing medical problems. And you know, medicine is very good at that. However, with medicine being an art (as opposed to a science with a definite right and wrong answer), physicians are not always so skilled with squidgy end-of-life issues (including the dying process prior to death).

This sounds such a morbid and depressing book, but Gawande takes a very serious topic and asks tough questions (of himself and of others): When should expensive medical approaches stop if a patient is terminally ill? Who should decide that point and when? Is it the doctors? The family (especially if the patient is very ill and unable to voice concerns)? The patient him- or herself (if it’s possible at that point)?

Obviously, it should be the patient in question, but end-of-life issues can be extremely difficult to talk about for the many players in that situation. It can be frightening and confusing for everyone involved, but I totally agree with Gawande when he writes that this tough conversation should be a normal part of the living (and dying) process. That’s where physicians need to be in a leadership capacity, not in telling families what to do but in finding out what the actual patient wants. Does s/he want endless life-saving measures at the end point? Or just relieve the pain and suffering?

By taking real-life cases of patients (terminal and otherwise), Gawande talks us through the decision process of how the medical world treats terminal and elderly people. Medicine can prolong a life for much longer than perhaps is best for the patient, but what does the person in question really want? That is where the hole is in most medical care – there is often little consideration of what the patient in question really wants — what is important to them and not what their family members (or their health care team) want. It gets complicated for everyone unless someone skilled in the dying process can jump in and ask the right questions.

This is not an easy book to read, but it’s so helpful as it normalizes the aging/dying process for millions of Americans. A lot of people have prepared for their actual death with wills and other legal documents signed and in the lawyer’s office. Where there is often a gap is the actual process of dying: the months/weeks/days when one slowly loses one’s health. (Gawande calls this the ODTAA Syndrome: One Damn Thing After Another when a person’s health starts to fail like dominoes.) Some people will, of course, die suddenly but millions of people will have a long journey ahead of them in the dying process, so Gawande also addresses the cultural treatment of the elderly and the infirm with regard to assisted living, nursing homes, and the tough battle it can be when adult children take over the decision-making process and players disagree about the next steps. It’s a debate between the issues of safety and happiness. Which is more important?

A very provocative read for me. I was diagnosed with pancreatic cancer in 2001, and as I had a fairly weird type of tumor, it took a good six months to get a correct diagnosis and then a plan of action. The following six months (and the following treatment) pretty much changed my life on several levels, one of which was addressing and accepting my mortality. (Well, we all will die, really, but pancreatic cancer has an extremely high mortality rate so this had to be addressed. However, it’s not always easy to start the discussion.) BTW, I’m all good and fine now, and I have a “new” normal in my life now – I’m very happy that I have this chance.

Knowing that it was quite possible that I could be dead by the end of the year changes one’s perspective and forces one to live more in the moment: life is made up of small moments so how to make sure those little things are good? I’m not going to go all Deep and Meaningful on you, but suffice to say, Gawande’s book contains much needed timely advice for everyone, sick or not. When your loved one is in the ICU intubated is not the time to have these dialogues.

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The Boy Who Harnessed the Wind – William Kamkwamba (2009)

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The Boy Who Harnessed the Wind was honestly one of the more inspirational stories I’ve come across this year in my reading journey. Kamkwamba has a great story to tell via a sly sense of humor about the world into which he was born in Malawi, and this was a super story to read.

William (as the author is named) grows up in a rural village in Malawi, a place that is small enough that there is no reliable electricity (should you be able to afford it), no efficient lighting, hard to access water, and little schooling. There is a small village center where bartering can take place, but apart from that, there is little for an ambitious and smart young man to do.

Apart from these challenges, the area where he grows up is faced with ongoing famine (due to poor rain and non-sustainable agricultural practices), corrupt government officials, little public health and little access to ongoing education. Infant mortality is high, and babies are named by their families to reflect the parents’ fears:  “Simkhalitsa (“I’m dying away”), Malazani (“Finish me off”) or perhaps Phelanuni (“Kill me quick”).  All this combined with a widely held belief in spirits, spells and witchdoctors made it a challenging environment to learn new and different things.

What’s a teenager to do?

malawi_turbineWilliam does go to school regularly, but when the drought and the famine arrive, his family’s crops fail and their income goes down enough to pull him out of school for long periods of time. Severe famine goes on with fatal results throughout the region, and there seems to be nothing they can do but wait for rain. The government at that time refuse to acknowledge the hunger plight, so there is little outside help – any outside agencies who try to help find their resources snatched by corrupt officials up and down the chain.

With no school, he (and a couple of friends) start fiddling around with radios, an important source of information for the villagers, and with no electricity, radios became vital to hear updated weather reports and other info. Most of the electronics in the village are old and starting to fail, so William and his cohort start taking radios apart and then putting them back together in working order. Business grows and soon they are the village radio menders.

At the same time, William has some spare time when he is not working in the field, and wanting to learn more about electronics, he visits his village’s three-shelf library and reads what’s there. He can only read during the day though as electricity is sporadic at best (and so no lights at night), but what he learns opens the door for his creativity. What if he could build something that would give his family and the village regular electricity? What about getting regular access to water to save the village women having to trek two hours each way and carrying heavy buckets back to their homes?

Over time, William realizes that the answer is to build a small wind turbine. But how? He has no tools, no money, and no ready-made parts. People prefer to believe in spirits and witchcraft more than science, and there’s not even a word for wind turbine in the Malawian dialect he speaks, so he calls it “magesti a mphego” (electric wind).

williamkamkwambaHowever, he does have access to a scrapyard, and as he learns more and more about physics and how energy could be manufactured, William explores the discarded scrap for pieces that could be useful: a broken shock absorber, an old tractor fan, a spinning bicycle wheel and its frame… As for tools, he has to create those himself as well: he melts an old bicycle spoke over flames to hammer it into a screwdriver. It was incredible to me that in the midst of this environment, he had the ingenuity, the will and the rudimentary knowledge to follow this path.

As one speaker said at an African-based TED conference:

“Africans bend what little they have to their will… where the world sees trash, Africa recycles. Where the world sees junk, Africa sees rebirth…”

And finally, in the end, William succeeds in building his working wind turbine. And he doesn’t stop there: he goes on to experiment with biofuel (goat poo boiling in his mother’s best cooking pot), water-well pumping. And all this without access to internet, regular school, reliable light or electricity, and one big book from the library. If William succeeded with just his basic tools, imagine what he (and other similar kids) could achieve if they had access to more sophisticated educational resources…

As William notes towards the end of the book:

“I went to sleep dreaming of Malawi, and all things made possible when your dreams are powered by your heart.”

An amazing and inspirational read. If you’re struggling with a problem, perhaps you could read this and get a whole new perspective on your situation. If William achieved this in a small rural village in Malawi, what could you do with what you have where you are?

(There are also YA and elem school versions of this story which is cool, I think. It’s a story worth sharing.)

The Secret Life of the Grown-Up Brain – Barbara Strauch (2010)

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A random pick off the TBR shelves on the topic of learning/creativity type info triggered by the TEDx conference the other day, this was an enjoyable read about the myths (and truths) of the middle-aged brain. I have just turned 50 on my last birthday, and normally my age never crosses my mind. I consider chronological age to be irrelevant for the most part and an artificial limitation for some things, so I didn’t expect to be so curious about turning fifty. The age (and the birthday) have, for some reason, triggered some growing and changing that I had not expected and so this has been eye-opening in many ways. (And it’s not only me, it seems. From talks with friends, turning fifty does do something to you, although it varies how that manifests itself in life.)

Strauch is the medical and science editor for the NYT, and so knows how to write great journalistic stories, and this one seemed to be one of those books that one reads at just the right time.

In the U.S., aging seems to be a culturally negative thing in general and the common assumption seems to be that aging means losses of some kind: your friends/family die/move, you get stiff, you have more medical problems, it’s harder to learn stuff, you forget everything and you’re THAT much closer to developing dementia and/or dying. Suddenly, there are all these “Over the Hill” birthday cards (black for the oncoming funereal process), and AARP sends you a membership card and the next thing you know you’ll qualify for the Senior discount at Furrs and have supper at four in the afternoon.

(I’m not saying that everyone views it like that or that that is how I approach the aging process, but it doesn’t seem to be welcomed or viewed as a time to bloom, shall we say.)

Strauch’s book authoritively turns all this on its head, which was fun to read and backs it up with research. The first half of the book covers the various research studies that have proven that the middle-aged brain does not die off and that forgetting what you watched on TV last night is not a sign of oncoming dementia for most people. It’s a little too rosy in places for me and a little bit heavy on the cheerleading, but it’s also fascinating to read about the possibility of neurogenesis (growing new brain cells) and learning to focus on the strengths of an older brain.

So yes, we can forget the reason we went to the kitchen very easily, but older brains also are much better at looking at the whole picture of something (a debate, the long-term effect of something, the overall view) and additionally, middle-aged people have been found to have better control of their emotions that people in their 20’s. (Seems true in my experience for the most part.)

Some of this ability to see the bigger picture is due to having years of experience (so it’s easier to see how things fit in long-term), but it’s also linked to education. Loads of studies show that the more education that one has the lower your risk for (or the higher your resilience to) Alzheimers, so learning is good especially as you get older. (Love that.) It’s also easier to see the connections between disparate topics as you age which refers back to seeing the bigger picture more clearly.

And yes, it’s true – middle-aged brains do tend to get more easily distracted at the start of a project (“Squirrel!”) and to forget things (such as names of people). Strauch explains that this forgetting process is more of a retrieval problem than a disappearing problem – the names are there (tip of the tongue type thing). We just have to take a little more effort to get that information than we would when we were younger — just need to access it slightly differently, it seems. And we’re more likely to forget the names of people who we don’t know that well and who we haven’t seen for ages – makes sense to me really.

As for how to engage your middle-aged brain and keep it sharp and growing, Strauch (backed up by the researchers that she interviewed) is a huge proponent of exercise (i.e. regular aerobic exercise) as this has been found time and again as the only way for your brain to have neurogenesis (i.e. grow new brain cells). There’s been an age-old argument about how your brain stops growing once you’re older and it only shrinks etc. That is really not true, and Strauch has the research conclusions to prove it.

Besides, why wouldn’t you exercise? (It’s easy for me to say this as I’ve been regularly exercising since I was about six, so it’s like brushing my teeth – it doesn’t feel right if I don’t do it almost every day. I know it’s a big effort for others, but it’s so worth it that I wonder why a lot of people don’t. It’s free, generally (walking etc.), it improves almost every facet of life, it’s pretty simple… What’s not to like?)

So – I enjoyed this book for a number of reasons, but mainly because it backs up the lifestyle choices that DH and I have chosen for ourselves – regular aerobic exercise, continually learning new things, and challenging ourselves both physically and mentally. (Not all the time, I hasten to add, but the book did help us to feel good about how we live.)

Perhaps that is why I really enjoyed the book – that it supported how I think and live. It’s always nice to be told that you’re doing the right thing.

* One thing that I have decided to stop now that I’ve turned fifty (and it’s not a particularly mature thing to do) is admitting that I really hate eating raw broccoli and don’t eat it any more. Vile weed that it is. My rebellion comes in baby steps at times. :-)

Ten Days in the Madhouse – Nellie Bly (1887)

book239In the late 1880’s, a young journalist called Nellie Bly wanted to make her mark outside the usual writing restrictions accorded to most women journalists back then. (They were usually limited to the Society page and rarely given any hard news to cover.) Her editors at the New York paper The World agreed with her and so she got herself admitted to Blackwell Island (also called Welfare Island, and now called Roosevelt Island) which was America’s first municipal mental hospital. Bly wanted to prove her worth as a journalist and decided to do an expose on the conditions at the hospital and believed only by becoming admitted as a patient could the truth come out.

Charles Dickens had already previously covered conditions here in his American Notes (published in 1842) but they were from the perspective of an outsider and of a foreign traveler. This was the first time that an actual US journalist has been on the inside of the institution. (Blackwell Island has a fascinating history by the way: it was a penitentiary, a workhouse, a smallpox hospital…)

Nellie_BlyPrinted as a series of first-person narrative articles, the resulting coverage was explosive for that time and for Blackwell. Originally intended as a state-of-the-art mental institution “devoted to humane and moral rehabilitation of its patients”, funding had been cut and care had been reduced to bitter and sadistic staff and unsympathetic doctors who simply ascribed any patient claims to sanity (and thus release) as delusional. A very Catch-22 situation for all the female patients who were imprisoned there and with little hope of freedom in their future.

Bly took her project very seriously and prepared deeply for her role as a mental patient: she practiced “looking like a lunatic” in the mirror, she dressed in tattered clothing, and posing as a Cuban immigrant who could not remember her history, Bly checked into a temporary boarding house for poorer women. Within twenty-four hours of pretend irrational behavior, Bly was taken by police to Bellevue Hospital for an evaluation, and then from there, pronounced “delusional and undoubtedly insane”, taken to Blackwell. (Testing was minimal at the time and was subjective and very quick.)

Bly’s detailed account of her time at Blackwell as a mental patient are harrowing to read about – patients were stripped of clothing in corridors and publicly humiliated by the nursing staff, mandatory cold baths in dirty bath water, and appalling living conditions (little heat, poor nutrition, no activities).

“I looked at the pretty lawns, which I had once thought was such a comfort to the poor creatures confined on the Island, and laughed at my own notions. What enjoyment is it to them? They are not allowed on the grass – it is only to look at. I saw some patients eagerly…lift a nut or a colored leaf on the path. But they were not permitted to keep them. The nurses would always compel them to throw their little bit of God’s comfort away…”

It’s also notable that all the patients were female and mostly poor (some couldn’t speak English) and so were powerless in this system of neglect.

“I have watched patients stand and gaze longingly toward the city they in all likelihood will never enter again. It means liberty and life; it seems so near, and yet heaven is not further than hell.”

Any patient who stood up for herself (and the other patients) or who proclaimed her sanity was invariably labeled delusional and so hospital stays to Blackwell became hamster wheels of no release for nearly all the patients imprisoned there.”

Once Bly’s stay was over and she had been formerly released by the newspaper’s attorney, the story went public, and one month later, Bly was giving details of her experience to a Grand Jury who then visited the hospital themselves. Prior warnings to the staff had helped to clean up the place and the patients but Bly’s report lead to recriminations from the hospital doctors and to a fast-tracked funding increase of $1 million (enormous at the time).

This was a fascinating read, and was nicely complimented by my earlier reading of “Mad, Bad, and Sad: A History of Women and the Mind Doctors” by Lisa Appignanesi. (No post on that, but definitely not a reflection on the quality of the book or the author.) The treatment of mental health has come a long way in the past one hundred years or so, and Bly’s work helped to propel some of that change.

Mexico Reading Mash-Up

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Had a great vacation to Cabo san Lucas which was just what the doctor ordered. Work has been incredibly busy — we had a multi-million dollar project to complete, and our entire office was moving to a different building — so I was very ready to sit on the beach and do nothing more involving than read a book and drink one of the many tropical drinks that were offered all day.

So – basically, that is what I did alongside having great organic chef-cooked food and my favorite sound: plangent which refers to the sound of the waves as they coil over and break into the beach. Cabo is situated so that it has enormous waves which make an enormous crashing sound when they break on the sand – waking up to this is a great way to start the day and then continue as I find it to be one of the most relaxing sounds. (That and rain against the window – bliss.)

So, along with this blissful experience was the reading. Interestingly, I didn’t read as much as I usually do as I was so bone-tired from all the office palaver, but I did have a few good reads.

book227Methland:  Death and Life of an American Small Town – Nick Reding.

A hard-hitting straight-on approach to the U.S. rural “Meth Epidemic” that was brought to the fore in the early to mid 2000’s, Reding’s journalistic background came in very useful when he was carefully weaving the multiple strands of all the different components that he found to be involved in this public health problem, and although a bit dry in places, the overall result was eye-opening when you look at it from a worldwide perspective. It’s so complex and involves so many levels that it’s amazing that any impact has been made at all, let alone any positive impact.

From my work in public health (and otherwise), I was aware of meth and its role in crime, poverty and other communal issues but after reading this, I have a more complete idea of the various roles played by international governments, lobbyists, international drug cartels, law enforcement, trade policies et al. – the list is much more extensive and more involved than I had thought. Reding also takes the perspective of how meth is affecting small town rural America, and living in a rural area of Texas, it was fascinating to wonder how many small towns in the surrounding community are probably enmeshed in this issue. And then, as DH is a homicide detective and former SWAT and patrol police officer, I see that substance abuse is widely linked with the crime that occurs. (Alcohol plays a big role in violent crimes as well as meth. I have never heard of anyone doing something violent when they’ve done weed, except perhaps over-enthusiastically open a bag of Cheetos or similar…)

Reding uses the narrative structure of following a few key characters who Reding meets during a visit to one of the small towns in Iowa. As time passes, he gets to know these guys and uses them as a thread while he introduces all the other players. Although meth seems to be rather a remote problem as I have a happy, healthy and productive life, I now see how people can quite easily fall into the trap of meth. (In fact, a person I knew at university is now a meth addict and if it could happen to him, it could happen to almost anyone.) It’s a question of choices, yes – but also other things and one or two poor choices can push a person one way or the other depending on the mix of circumstances and environment.

Obviously, there is no way that I am an expert on meth or other drugs or addiction itself, but after having read Methland, I at least have a better idea of the enormity of the drug problem and how pernicious it can be. Although this may not be a happy read, it is thought-provoking and well researched. It also came across as a very balanced look at a hot issue.

So – as mentioned, this was a mostly very interesting look at a widespread problem and I would recommend it to anyone interested in learning more about the drug industry, Big Pharma, and how a perfectly ordinary person can get sucked into that world.

Dunster – John Mortimerbook228

After having been slammed at work, I was looking for a non-complicated fairly straight-forward story to read on the beach, and knew that Mortimer could deliver that, so found this whilst I was trawling through my TBR shelves. Dunster (of the title) is an old school friend of the protagonist whose philosophy of life is total honesty no matter what the consequences. Obviously, there are unforeseen results, and so this leads to a good read involving possible war crimes, television personalities, amateur acting, and a divorce. It’s billed as a mystery, but there isn’t much of that – instead, it’s more of a drama than anything. Mortimer is a great author who writes consistently enjoyable books, and was perfect for a light beach read.

And then I whipped through an Agatha Christie (Elephants Can Remember) – good old-fashioned mystery with some unpredictable twists). I am learning that it’s hard to go wrong with Christie (at least so far).

There were a couple of other titles by a new-to-me author, but that’s in another post…

So – not the mega amount of reading as usual, and that’s ok. I had a lovely time and got to reboot a bit. Aaaaahhh….

Gulp: Adventures on the Alimentary Canal – Mary Roach (2013)

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“People are surprised to learn: They are a big pipe with a little bit around it.”

– Ton van Vliet

 

As high as the bar had been set with Mary Roach’s previous books, this one reached it (if not higher). Roach is a smart, funny and good science writer who seems to ask the same weird questions of her experts that I would want to ask – she actually does though which elevates her to Superstar status in my eyes.

After having covered large nebulous topics before, Roach’s decision to look in-depth at the human (and other animal’s) digestive system from top to bottom is perfectly done. I know I might be crossing the line here in Fangirl raving, but she is that good. Honestly.

Gulp, her latest release, covers digestion from taste buds to umm… fecal matter, and everything in between in a meandering twisting manner that takes the reader down numerous rabbit holes, but not in a digressive manner – only in a natural trailing way so that you too end up as curious as she is about things you hadn’t really thought about. Who knew that people were paid to taste pet food to make sure it’s palatable and matches the description on the tin? (I didn’t.) Once I’d read the lists of strange things that people have swallowed (on one end) and have inserted into themselves (at the other end), you start to realize the plain fact that humans are odd. No way around that, I’m afraid.

Chapters cover everything from the mechanism of swallowing to fecal matter transplants (an important medical treatment for some cases) and none of it seems irrelevant. It’s all sewn into the content of the book in a seamless manner and when you add in the wit that Roach has with her writing, it’s fascinating. Even if you didn’t really like Elvis that much, he’s got a mention here – next time I see him, I will immediately think of his bowel problems, no doubt about it. It’s thought that he died of a medical issue that was not recognized at the time as it was quite rare – megacolon. Honest. You need to read the book to find out more.

(Speaking of Elvis, the washing machine repair man who visited the other day to fix ours happened to be a competitive Elvis impersonator. That was one fascinating conversation. Seriously. I had little idea about that world…)

I love Mary Roach’s writing, and I wish that we were friends (although that might sound somewhat creepy). She is one of the funniest and smartest science writers around, and whichever Roach title you end up picking, you’ll have an entertaining journey into a topic that you had no idea you were so interested in.

Highly recommended.

(Mary Roach is also hilarious in real life when we were lucky enough to catch her on an author visit to campus. Some authors need to never read their work (as they are dreadful speakers), but Roach does everything right when she presents her writing.)

And if you don’t believe how awesome Mary Roach is, here is an NPR interview which will prove it for you.

Tangles – Sarah Leavitt (2012)

Tangles - Sarah LeavittA movingly portrayed description of how the author’s mother, a smart woman who “loved ferociously”, succumbed to Alzheimer’s disease and how her family coped with it. Done in sequential art, each segment of the graphic novel is carefully drawn and is really a very effective means of allowing the reader to experience some of the family’s thoughts and feelings as the disease progresses in their mother.

This is a poignant book and not very easy to read at times, especially if you yourself have a vibrant active mother, as it’s difficult to watch her go downhill as the disease progresses. Despite this, it completely sucked me in and I read it in one afternoon. It was so sad to watch as Alzehimer’s removed the original character of her mother, and replaced it with an unpredictable stranger who looked just like their mom (for most of the time).

The title “Tangles” refers to several things really:  her mother was an avid gardener, but as Alzheimer’s progressed further, the mother would pull out weeds and her flowers at the same time, and gradually, her prized garden became full of weeds and overgrown brambles. This was also imagery used for the state of her mother’s brain, which was really effective. Additionally, her mother’s personal hygiene went downhill (due to the severity of the disease) and as her hair was not brushed regularly (without help), that also became tangled. This was especially poignant as her mother had been scrupulous with her cleanliness before she became sick.

It’s sad, but it handles an awful situation with grace and class without giving the impression of a perfect family. They had problems (as any other family would), and the story is very realistically told. I really feel for families who have to care for someone with this disease …

This was a poignant and powerful read.

The Art of Travel – Francis Galton (1854)

book159Subtitle: Shifts and Contrivances Available in Wild Countries

A how-to manual of how to explore countries back in the Victorian days.  Incredibly detailed and was THE go-to book for beginning explorers at the time.

Who should explore?

Qualifications for a Traveller [sic].–If you have health, a great craving for adventure, at least a moderate fortune, and can set your heart on a definite object, which old travelers [sic] do not think impracticable, then–travel by all means. If, in addition to these qualifications, you have scientific taste and knowledge, I believe that no career, in time of peace, can offer to you more advantages than that of a traveller[sic]. If you have not independent means, you may still turn travelling to excellent account; for experience shows it often leads to promotion, nay, some men support themselves by travel. They explore pasture land in Australia, they hunt for ivory in Africa, they collect specimens of natural history for sale, or they wander as artists.

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In addition, the explorer does not necessarily need to be powerful – “it is rather those who take the most interest in their work that succeed the best…”.  Additionally, he needs to have Good Temper (as “tedious journeys are apt to make companions irritable”) and as for the problem of Reluctant Servants: “leaders should make great allowance for the reluctant co-operation of servants; they have infinitely less interest in the success of the expedition than their leaders…”

“Neither sleepy nor deaf men are fit to travel quite alone.”

If natives want to bring their wives, it’s fine as well:  “a woman will endure a long journey nearly as well as a man, and certainly better than a horse or bullock”… “It is in the nature of women to be fond of carrying weights; you may see them in omnibuses and carriages, always preferring to hold their baskets or their babies on their knees, to setting them down on the seats by their sides.”

Equipment suggestions range from large (rafts and pontoons for 1-2 men) to sealing wax and pens for writing letters. (Triple H pencils are the best tool though – less smudging when damp.) Don’t forget to take a small table or two and a stool, and do remember your protractor and your iron. (Unwrinkled clothes are important in the bush.)  A hare’s foot comes in handy for cleaning lenses and you can easily make your writing ink if need be from burnt sticks and a bit of milk. (Milk is always handy when you’re exploring, I think.)

Pay for help from the locals in beads, but don’t forget that “there is infinite fastidiousness shown by savages in selecting beads…” The following colors are the most popular ones: dull white, dark blue, and vermilion red, all of a small size.

food1pngTransportation should include an ass, a small mule, a horse, an ox and a camel but note that it is “very inconvenient” to take more than six pack animals as whenever one gets loose, the progress of the overall exhibition is seriously slowed.  This volume also contained copious information of the “theory of tea-making” including using a make-shift teapot (of course, since it’s English).

Huge detail down to how to label your medicine tins – always label the bottom of the tins as the lids can get mixed up.  A handy emetic is a “charge of gunpowder in a tumblerful  of warm water of soapsuds…” Satisfy your thirst by drinking water with a teaspoon – just as effective as drinking glassfuls and will “disorder the digestion very considerably less”…  Mercury (mixed with chewed up old tea leaves and added with spit) can make a good lice repellent when worn in a bag of material as a necklace, but only lasts about one month until it needs to be renewed.  Blisters in new boots can be prevented by putting raw egg into the boot to soften the leather. And cats can’t stand high altitude and it can be fatal for them (according to one Dr. Tschudi).

flagcommOh, and if someone ends up being half-drowned, don’t hang them upside-down by their feet for the water to come out of their mouths. That’s ‘ineffective.”

An artery cut might be able to be stopped if you pour boiling grease into it (ouch), but this is a “barbarous treatment, and its success is uncertain…”

With regard to transporting fragile research instruments, Galton recommends entrusting them to “some respectable old savage, whose infirmities compel him to walk steadily. He will be delighted at the prospect of picking up a living by such easy service…”

Everything is included: how to measure how far your expedition has traveled (whether by wagon or a cantering horse), the lunar measurements of the night sky, the best way to climb trees or go down a cliff (but remember – “it is nervous work going over the edge of a cliff for the first time”), what size and shape to make an axe blade…

It seems that almost everything (if not everything) has been covered in this book.  Make your own snow glasses using a piece of soft wood with a slit cut into it (a la Esquimaux[sic]).  Holding a horse’s tail as they walk ahead of you can help you up steep hillsides.  Bite a cow’s tail to make him/her stand up from lying position.

An explorer traveling and making notes noted this about asses:

The instincts of the mulish heart form an interesting study to the traveller[sic] in the mountains. I would (were the comparison not too ungallant) liken it to a woman’s; for it is quite as uncertain in its sympathies, bestowing its affections when least expected, and, when bestowed, quite as constant, so long as the object is not taken away.

pithhelmetAnd don’t, for God’s sake, wear linen. (It is “by universal consent a dangerous dress wherever there is a chance of much perspiration, for it strikes cold upon the skin when wet. The terror of Swiss guides…and of Italians…is largely due to their wearing linen shirts.”)

If you need a pith helmet, you can buy them in London under the Opera Colonnade in Pall Mall, and a dressing gown never goes unused. (“It is a relief to put it on in the evening…”)

If you’re stuck out in the cold without shelter, it’s recommended that you creep within the warm and reeking carcass of a recently-dead horse (a la Bear Grylls, although this particular case is referenced to Napoleon’s troops).  Speaking of animals, Galton also tells you how to avoid on-rushing animals attacking you (except a buffalo who “regularly hunts man, and is there peculiarly dangerous.”) Instructions are also included for crocodile-shooting. (You never know…)

findingwater

And if you’re traveling to a “rich but imperfectly civilized country”, one option for making certain that you always have a small capital to fall back on is to bury jewels in your flesh (the left arm is recommended at the spot chosen for vaccinations). You make a gash, put the jewel(s) in and allow the flesh to grow over them as it would a bullet. (You could also put the jewels into a small silver tube which might be less irritable to your body as it heals.)  Good idea if you’re concerned about robbery.

So – I bet you get the idea. This is THE manual for exploring for Victorian explorers. With so many topics and such detail, I don’t think it was a small book but I bet if you weren’t the poor person carrying it, that would be ok.  A fascinating read.

Don’t forget your pith helmet when you leave the house today.

backpack

Columbine – Dave Cullen (2009)

This was an accidentally timely choice of book title to read as I had ordered it through ILL, and it arrived the day before the Aurora and Wisconsin shootings the other week. After having immersed myself in this investigative journalistic work, I hope that the Aurora authorities and Wisconsin authorities handle their mass shooting incidents more successfully than they did at Columbine.

So much tragedy, so much heart break, so many mistakes (and I must say lies) from different groups and people.

Cullen is a well respected journalist having written for NYT, WaPo, The Times (UK) and other huge print outlets so he knows of what he writes and he has the credibility and experience to do a good job. Additionally, he has covered the Columbine incident from the very day that it happened so is well regarded and is considered to be one of the leading experts on school shootings. (Shame that there has be an expert in that subject, but I suppose that is life.)

The two high school shooters (whose names I won’t say as I don’t want to promote them in any way) left so many red flags as to their plans that in looking back, it looks negligent that so few picked up on them. From what I can tell from reading this, it seems that the two boys were involved in the juvenile justice system for the year or two before, but there was no communication (or little) between the different agencies so no one had the whole picture. The end conclusion of Cullen’s work is that the school shooting in Columbine was preventable which seems to be heart-rending and frustrating.

But again, hindsight can be perfect vision and so it seems like it was a “perfect storm” of egotism and poor investigative work that hampered the handling of this. Cullen seems to be a neutral party (in that he is media and is not paid by any governmental agency) and so I can only assume that what he has written is fair and balanced. And if it is, then the Sheriff’s department of Jefferson County (and its leadership) should be groveling in shame at how they (mis-)handled all the reports. According to Cullen, there were years of cover-up and lying from the department to prevent affected families and media from knowing all the facts, and the department certainly doesn’t look good throughout this book.

Thirteen people (both students and faculty) were killed and numerous others were wounded both physically and mentally. In the wake of such an incident, the media (nationwide – not one outlet more than another generally) created myths and legends about the shooting, and this book is Cullen’s effort to try and correct those myths that have been repeated so often that they seem to be true.

This is a tough book to read. There were times that I was reading (and Cullen was describing the blow-by-blow shooting) that I had to put the book down and take a breather. Although Cullen is arriving at this via investigative journalism, there is a narrative angle when he imagines what the killers were saying and doing at the time of the shooting. Yes, Cullen had access to the journals, diaries, websites and reports related to all this, but still, I think there is a leap to go from what they say to reporting that “this was how they felt and what they said” when (a) he wasn’t there and (b) no one can refute him whether they survived the shooting or not as trauma affects memory so badly.

So – keeping this in mind, most of the book is a look at how the two boys behaved in their childhood and how they planned for this shooting. (Cullen argues that it was originally intended to be a bombing more than a shooting, but the bombs were miscalculated and did not explode as planned. If they had, there would have been hundreds more victims.) There is a well researched ongoing discussion about psychopaths and whether the two shooters fit that diagnosis. There is discussion about the role of religion in how the actual community reacted to this event, and there is a focus on the role of the school system and its administrators.

However, again, it’s all hindsight and hard to prove definitively. This is not a criticism of Cullen in any way. It’s just a reminder that the book presents the info as set in stone and absolute when in fact, it’s only conjecture. However, who is to say that what he says is not true? Not I, and if I were Cullen, I expect I would have drawn the exact same conclusions with the information that he had. The exact truth is unknown and always will be, but I do think that Cullen has done a good job here. He has written a gripping book without resorting to extremism on either end of the spectrum. He has an opinion, obviously, but it’s supported and explained from his investigation. It’s something that we will never know what exactly happened and why.

Despite this limitation, the work that went into this book was extensive. Cullen must have combed through thousands of pages of paperwork and talked hours in one-on-one interviews with victims and other affected people. One point that was made crystal clear was that it’s quite amazing how much power an agency (such as the Sheriff’s department) can hold in terms of what information they release and what they don’t. Yes, there is the Open Records Act, but there are exceptions to this, and the Sheriff’s department took full advantage of that, covering up some of their own people’s mistakes in the process. It would have looked less bad if they had actually admitted their errors. As it was, they end up looking up foolish and incompetent. The Sheriff at the time has now retired and so there are different personnel there now, which is good. The guy who was there before, if the facts are true, seems to be a complete and utter ass.

A very interesting book (especially when linked with the recent Aurora shooting news and the Wisconsin shooting news) which questions a lot of assumptions that are made about the characteristics of a school shooter. These guys did not match a “profile” of any kind. They didn’t “snap” because they were bullied. They didn’t try and get revenge on the athletes. They were two pretty ordinary boys, one a narcissistic leader/psychopath, and the other a guy who really wanted to be like him. I don’t think their parents were to blame (and in fact, I feel for them in many ways as I feel for the families of the victims.) As mentioned, there were several red flags in their behavioral choices, but are they only obvious because we have the whole picture now?

A provocative book about a provocative subject, and one that is sure to cause discussion regardless of where you stand on the political (or religious) spectrum.

Fascinating mull by Cullen on-line at The Daily Beast (07/20/2012) about recent research on how a mass shooter may think…

And a NYT story on the Aurora shooting (again from Cullen).

The Storm at the Door – Stefan Merrill Block (2011)

Based on a true story from his family, author Stefan Merrill Block has written an intriguing (and slightly confusing) story about how mental illness affected one East Coast family back in the 1960’s. Block’s grandfather is the subject of the novel, and it is he (and his possible bipolar disorder) that form the foundation of the plot. Mental illness of any sort was never mentioned with many families (and still isn’t in some cases), and was often seen as a source of shame and something to be hidden. So when Frederick Merrill, the author’s grandfather, showed signs of being unpredictable and having poor impulse control in his behavior, one particular event leads his wife, Katherine, and her family to have him voluntarily committed to a fictional mental hospital based on the real-life McLean Hospital. However, even though Frederick was “voluntarily” committed, he cannot be released when he want to go, having to wait until the doctors at the hospital believe he is “better.” However, there is the problem of how to prove you are not mentally ill when you don’t know what your illness really is. How do you know how to be sane?

So, Frederick’s original commitment turns into a months-long endeavor that leaves Katherine in the difficult position of raising their three daughters alone, with little money, and with one parent existing out in a cloud of unmentionable illness. It was the big Elephant in the Room syndrome, as all the family and friends knew that Frederick had been ill. It was just not acceptable (or polite) to ever mention it more than “he had a nervous breakdown” or (more likely) “he went to have a rest”. (Very similar to how mental illness and/or addiction is treated in the case of celebrities nowadays.)

So Katherine struggles to maintain an air of normalcy in a very abnormal situation and without knowing what was really going on with her husband. The clinic doctors kept Frederick’s health information very close to their chests, and would not keep her informed as to his progress, and both Frederick and Katherine were forbidden to contact each other for “therapeutic reasons”. This story has been compared to “One Flew Over the Cuckoo’s Nest” and it is quite similar in that way in its depiction of how power plays a big role in mental health care.

It’s a compelling story of how one family tries to cope with an unmentionable illness that has no time line, no name and no particular symptoms. Frederick himself is not told his diagnosis, and realizes that he has little power to get a release from the hospital by himself – only by “playing the game” that the doctor in charge requires him to do. It’s quite remarkable how circular this power game is – the doctor refuses to let Frederick or his family know what is going on but they know that the only way to get a release is to make the doctor happy. But how? He is in charge of a game with unknown rules, unknown goals, and rules that keep changing.

There are some good descriptions of some of Frederick’s hospital co-patients, and it is very sad to think that this story (and thus the description of the mental treatments) was close to the truth. Frederick is forced to have ECT with the hopes of him forgetting a transgression that he witnessed between his doctor and a nurse. Unruly patients are sometimes shuttled off to have lobotomies when they become difficult, and a power-hungry crew of young and untrained male orderlies retain control of the unit once the doctors have left for the day.

The title, “The Storm at the Door”, refers to the idea (I think) that however safe and sound your own home is inside, once you step out of the door, it’s a harsh world. It might also refer to the idea that mental illness is also just outside the door for some people and families, whether they want to admit it or not.

Structurally, this book worked pretty well once I got the hang of it. Chapters alternate the omniscient POV of a present-day grandson (the author) looking back at his grandfather Frederick (during his time as a patient) and then looking at his grandmother Katherine as she tries to cope with the changes and lack of information over the years. It was also in present tense (which can be annoying but wasn’t in this case).

A pretty good read, and thanks to Rachel at Book Snob  for sending it to me.