Demystifying Medicine One Month at a Time

Tag: medical memoir

Book: “The Devil Wears Scrubs”

We are in a boom time for news and information about all things medical. The same democratization of information that allows us to look up information on our own (hello, Drs. Google and Wikipedia) has also brought myriad new voices to the public’s discourse through multiple outlets: blogging, social media, podcasting, etc.

Medical bloggers and influencers, people with a proclivity for making complicated concepts clear, have many opportunities to straddle the worlds of old and new media as they hone their voices and ‘build their brands.’ New media exposure can lead to more traditional tracks like book publishing.

Medical books have always been a popular genre. With the rise of self-publishing, this is no doubt even more true today. Medical books most often take the form of self-help (“what you need to know about this diet or disease”), odysseys (“my cancer story”), predictions (“The Creative Destruction of Medicine”) polemics (“why the U.S/Canada/U.K./Obamacare is so good/bad/other) and, of course, memoir (“how I survived internship/residency”).

Memoirs usually are good for their shock value, some laughs, and some broader life lessons learned by the subject/author. I’ve read many “I survived internship” stories, and they invariably contain a scene involving a rectal exam, stool, and shame. (Guilty as charged.)

The most famous tell-all memoir of internship is Samuel Shem’s (aka Stephen Bergman) fictionalized version of his first year at Boston’s Beth Israel hospital, or what he called “The House of God.” Bergman blew the lid off of the inhuman culture that exists in medical training, where we expect trainees to become indoctrinated in the ways of ‘the system’ and turn students’ idealism on its head.71zIJYuuziL._SL1500_

The most recent internship memoir I’ve come across is “The Devil Wears Scrubs,” by Freida McFadden. It’s a self-published, slightly fictionalized account of the first month of McFadden’s internship. She had a rocky start.

My belief is that people think medical memoir has staying power as a genre because of the vicarious thrills of what it takes to become a doctor. In reality, I think the fascination is much more of along the lines of, “Holy crap! I can’t believe someone’s life could be so awful.”

Dr. McFadden (also a nom de plume, like the aforementioned Dr. Shem) writes well and is a good humorist–both in eviscerating the evil resident who lords over her (“Alyssa”) and in being self-deprecating as she realizes to her horror that she is unable to muster feeling for patients that die (though not always), as it’s one less work item on her to-do list.

Dr. McFadden is alternatively known as Dr. Fizzy, Fizzy McFizz, and Doctor Cartoon. As a cartoonist, she has lampooned the medical profession and its system of training for years in her brutally honest cartoons. They were collected in a previous book, “A Cartoon Guide to Becoming a Doctor.”

I’d recommend “The Devil Wears Scrubs” to anyone in or considering going to medical school. It’d make a good gift for any family member thinking along those lines. If you’re a lay reader and enjoy the medical memoir genre, you’ll find the book accessible. McFadden does a good job of showing how one can maintain her humanity in a system designed to squeeze it out of us.

I asked Dr. McFadden if she thought “Alyssa” would see her book. “Unlikely,” she wrote back to me. “Although if I had her address, I’d anonymously send her a copy!”

County [Updated]

Those of you that like to see behind the veil of medical care in the U.S. will enjoy the new book by Dr. David Ansell: County: Life, Death, and Politics at Chicago’s Public Hospital.

Ansell began internship at Cook County Hospital in 1978. He stayed there seventeen years.

Along the way, he got involved in politics, fighting the good fight for the poor and disenfranchised of Chicago. He co-authored the landmark 1986 New England Journal of Medicine article understatedly titled “Transfers to a Public Hospital,” that led to the passage of EMTALA that same year.

[EMTALA is the law that was enacted to prevent “patient dumping,” the practice of transferring patients from one emergency room to another (such as Cook County) because of a patient’s lack of insurance.]

Dr. Ansell was responsible for another success: he helped establish a breast cancer screening program for women at Cook County. Prior to his work, it was believed by many that only specialized breast surgeons could implement such a screening program. Ansell fought medically and politically to achieve better access for poor and uninsured women, in addition to showing that disease screening could adequately be handled by frontline health personnel and not just specialists.

Part of what made the book so interesting for me was the recent history of Chicago and the stories of Ansell’s colleagues at County–many of whom I’ve been lucky to meet and learn from over the years:

There’s Quentin Young, social activist and physician who doctored to MLK and Jesse Jackson, among others. There’s husband and wife team Gordy Schiff and Mardge Cohen, who have inspired generations of Chicago medical students to put their progressive values out front when thinking about their profession. There’s also Renslow Sherer, a pioneer in developing AIDS treatment both at home and abroad, and someone I’ve been blessed to call a colleague for the last few years.

County is an excellent exploration of one doctor’s professional development over a lengthy career. Ansell, in an NPR radio interview, was asked about the poor conditions at the hospital. He likened it to working in the developing world. He and his colleagues were “Doctors within Borders,” as contrasted with the esteemed NGO that works globally in humanitarian disasters.

One thing Ansell didn’t touch on: He now is Chief Medical Officer at Rush, a major academic teaching hospital in Chicago. He made the leap from anti-establishment to major power player in the Chicago health stratosphere. I would have appreciated learning more of his mindset as he made this transition to leadership. I wonder, too, about reconciling values from his longhair days of picketing and demanding change to the more cloistered world of institutional change in the executive suite.

Maybe I’ll ask those questions diplomatically when I interview him.

[UPDATE: Abigail Zuger reviewed County in the NY Times. Link here.]

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