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NonfictionMedicineBiography

The Story of a Heart

Review by Jessica Wakeman

On a TV drama, performing a heart transplant is frantic. Nurses race the patient down the halls; the surgeons snap at each other. Maybe the patient’s heart stops before they are brought back to life.

That narrative couldn’t be further from the truth. As told in The Story of a Heart: Two Families, One Heart, and the Medical Miracle that Saved a Child’s Life, the process of heart transplantation can require stagnant months or years as patients and their families wait for donor organs; this is especially the case when the patients are children. One in five children in Great Britain and America might die while waiting on the transplant list, reports author and a palliative care doctor Rachel Clarke.

Clarke braids a rigorous scientific and, at times, troubled cultural history of transplant medicine with the often harrowing story of two children: 9-year-olds Keira Ball and Max Johnson. The Story of a Heart starts with a terrible car crash that Keira survived with injuries so severe that the following day, all activity in her brain ceased. But while nearly every other major organ in her body was grievously injured, her heart, miraculously, beat vigorously.

Meanwhile, a mild viral infection caused Max to have dilated cardiomyopathy—a severely  enlarged heart—and his prognosis was grim. A once active child, Max spent a year in bed, his parents aware that at any moment, a cardiac arrest could cut his life short. The day after Keira’s accident, her family removed her from life support. They placed her on a pediatric organ donor list, knowing it’s what the kind, loving little girl would have wanted. And then Keira’s heart gave Max a second chance at life. Clarke shows the psychological calculus that the recipients of transplants make, writing of Max’s parents, “They were equally aware that the only thing that could give Max what he needed to live was the death, appallingly, of someone else’s child.”

Clarke’s reportage of minor characters, like a junior doctor who happened to be driving on the same highway when Keira’s family had their car accident, also personalize the story. And not surprisingly, the narrative about Keira and Max’s families, and the team of professionals caring for them all, is very touching. Clarke never strips Keira of her humanity; the story of her heart, and her life, continues to help others in this informative, important book.

Rachel Clarke’s powerful The Story of a Heart braids the true story of a pediatric organ transplant with a rigorous history of transplant science.
NonfictionAudioMedicine

A Fatal Inheritance

Review by Tami Orendain

Lawrence Ingrassia is intimately familiar with the painful, inevitable question many face after losing multiple loved ones to cancer: Why? In his book, A Fatal Inheritance: How a Family Misfortune Revealed a Deadly Medical Mystery (9.5 hours), Ingrassia explores research on hereditary cancer predisposition and introduces families—including his own—who are grappling with what this research could mean for them.

Narrator Roger Wayne gives this topic the care and honesty it deserves. He lends a friendly, personable tone to Ingrassia’s recollections: Happy memories are read with nostalgic tenderness, while painful moments are treated with solemn respect. Historical sections telling the stories of the doctors, scientists and patients involved in the progress of research emphasize the connection between the scientific and the personal.

Listeners will find A Fatal Inheritance to be an effective overview of research on cancer and hereditary predisposition, one that achieves serious investigation while remaining intensely human.

Read our starred review of the print edition of ‘A Fatal Inheritance.’

Listeners will find A Fatal Inheritance to be an effective overview of research on cancer and hereditary predisposition, one that achieves serious investigation while remaining intensely human.
NonfictionSocial ScienceMedicine

Invisible Labor

Review by Amy Scribner

Author Rachel Somerstein experienced a traumatic cesarean section with the birth of her first child. When the epidural failed, she felt every moment of the surgery, which continued while she screamed and was restrained by nurses. After her daughter was born, Somerstein spent years trying to make sense of what had happened. 

No wonder, then, that Somerstein dove into the topic of the most common surgery in the world. The result is Invisible Labor: The Untold Story of the Cesarean Section, a sobering and deeply interesting look at the history of and debate around C-sections. Though they may account for one third of births in the United States, Somerstein’s research makes clear C-sections are still largely viewed as an inferior way to give birth. 

“When it comes to birth, the term ‘natural’ is at once fuzzy and imprecise,” Somerstein writes. “Does it mean vaginal? Vaginal and unmedicated? At home? In the water? Regardless of the definition—which changes depending on who you ask—it most definitely doesn’t include C-sections. . . . On multiple levels, the rhetoric around natural birth implies that C-sections are bad, and the mothers who have them are bad, too.”

While judgment and lack of support can impact a new mother’s well-being, in a later chapter, Somerstein explores an even more insidious side of C-sections: Women of color are more likely to feel pressure from their provider to have a C-section, given how birthing experiences and outcomes are worsened and complicated by systemic racism in medical settings. A Black woman who declines a C-section may be viewed as aggressive, whereas their white counterpart may be viewed as well-educated and decisive. 

This is a provocative and well-researched book. New motherhood can be a profoundly joyful time, yet it also can be isolating, painful and shameful, and Somerstein writes that she wrote it for mothers looking to “see themselves reflected in the story of birth.” But Invisible Labor also makes clear that we still have a long way to go in adequately supporting women’s health, and therefore, it is of value to us all.

Invisible Labor is a sobering, provocative and deeply researched look at the history of C-sections and how they impact women’s lives.
NonfictionMemoirMedicine

Committed

Review by Carla Jean Whitley

Writing saved Janet Frame’s life.

In 1951, the 27-year-old writer was scheduled for a lobotomy. She’d spent her adulthood in psychiatric facilities, and the extremely damaging practice was in its heyday. But after Frame’s debut book won a literary award, a doctor called off the procedure.

Frame is one of many authors Suzanne Scanlon references to create a throughline between reading, writing and illness in her memoir, Committed: On Meaning and Madwomen. Here, the author of novels Promising Young Women and Her 37th Year, an Index, traces her entwined reading and mental health histories.

In her early 20s, Scanlon spent more than two years in a psychiatric hospital and experienced shorter hospitalizations for several years to follow. Both during that first stint and the years since, she’s turned to books for insight into the world and her own mental health, a practice mirrored in her childhood. When her mother was dying, 8-year-old Scanlon created order from the grief and chaos around her through imaginative play. The immersive nature of this coping strategy is akin to what Scanlon now finds in literature.

Committed leaps across time, mirroring how Scanlon comes to understand her own narrative, organizing an unconventional timeline from her fragmented memories. She also plays with form, occasionally breaking from running narrative with lists explaining her illness, or switching from first- to second-person to place the reader in a scene.

Committed is also about authors who faced mental illness, among them Marguerite Duras and Sylvia Plath. Janet Frame, Scanlon writes, is “the patron saint of writers once institutionalized, the long-institutionalized, the young women everywhere told they were hopeless, what would become of them now, defined by the places where they lived.”

“What we call mental illness is so rarely portrayed with any depth or complexity,” Scanlon writes. But as she combs the archives of her reading, she finds “information about what it means to be alive in [any] shifting historical moment.” By lacing her story with literary analysis and cultural history, she creates a thoughtful reflection on how societal expectations can impact people, women in particular, and how writing and reading can provide a port in the storm.

In her stirring memoir, Committed, Suzanne Scanlon tracks her entwined reading and mental health histories.
NonfictionMedicine

A Fatal Inheritance

Review by Deborah Mason

There are families whose histories are riddled with cancer: little boys and their young fathers dying from brain cancer, toddlers succumbing to eye cancer while their young mothers are diagnosed with breast cancer. Lawrence Ingrassia, an award-winning business journalist, comes from one of those families; he lost his mother, three siblings and a nephew to cancer. His family had no idea why they were dealt such a horrific hand. Environmental factors? A virus? The rotten luck of the draw? It never occurred to them to blame their genes. Until recently, most experts believed that genetics played no role in cancer. In A Fatal Inheritance: How a Family Misfortune Revealed a Deadly Medical Mystery, Ingrassia tells the story of how wrong these experts were.

While many researchers have investigated possible genetic links to cancer, Ingrassia focuses on the work of doctors Frederick Pei Li and Joseph Fraumeni Jr. Their research eventually led to the discovery of what is now known as Li-Fraumeni Syndrome, a rare inheritable genetic mutation that increases the risk of many forms of cancer. People with LFS are likely to have cancer at a young age, even in infancy, and frequently can develop more than one type. Ingrassia’s family carries the mutation, although he didn’t inherit it.

Ingrassia weaves in the stories of his and other Li-Fraumeni families, never allowing the reader to forget the human suffering that spurred the research. His sister Gina’s story is particularly devastating. Months after Angela, the youngest Ingrassia sibling, died from abdominal cancer at 24, Gina developed a nagging cough. She was young, a long-distance runner and a nonsmoker. Her doctor thought she might have an infection. Instead, newly married and still grieving the death of her baby sister, Gina was diagnosed with a large cell lung carcinoma usually seen in smokers in their 60s. She was only 32 when she died.

Ingrassia is a brave and honest writer. He details the suffering endured by the dying and their families and acknowledges their fear, anger and confusion, as well as the many unanswerable questions around this genetic disorder. In this compassionate book, Ingrassia grants his subjects the dignity of being remembered not only for their deaths, but for their all-too-short lives.

A Fatal Inheritance recounts the discovery of how cancer can be passed down through genes, providing a compassionate look at families forever changed.
NonfictionMemoirMedicine

Facing the Unseen

Review by Priscilla Kipp

Conventional wisdom has long held that mental illness is disconnected from physical health, requiring two separate courses of treatment. In Facing the Unseen: The Struggle to Center Mental Health in Medicine, psychiatrist Damon Tweedy aims to debunk this long-standing theory. The acclaimed author of the New York Times bestseller Black Man in a White Coat, Tweedy offers what feels like a personal invitation into his office, his expertise and, most of all, his hard-earned wisdom. 

Tweedy straightforwardly describes his training through Duke University School of Medicine, including his growing frustrations with an unsatisfactory system of care. He is critical of his colleagues for overlooking, stereotyping or dismissing the “unseen” signs of mental illness, bringing issues of class, race and gender into focus. He also questions his own biases, first as an aspiring cardiologist, and then as a psychiatrist struggling to understand how mind and body work together. 

Mostly, though, Facing the Unseen is about his patients. Tweedy is an excellent storyteller, making the people whom he treats unforgettably visible in all their complexities. Their stories embody why recognizing the mind-body connection is critical. There’s Natalie (all patients’ names are pseudonyms), an Iraq war veteran with PTSD, who came to the ER desperate for help. But treating her drug withdrawal was not considered a medical priority, and she was left to seek outpatient psychiatric care elsewhere. A passionate advocate for integrated medical and psychiatric care, Tweedy cites statistics that tally addiction and opioid abuse, PTSD, depression and anxiety, and the prevalent use of prescription pills. Throughout, he uses powerful descriptions that yield keen insights, showing us how the health care system sets doctors up to fail their patients, and offering solutions that will help. 

Improving access to effective treatments by coordinated caregivers is improving, but the need for better care is also growing. Facing the Unseen sounds both an alarm and a rallying cry. 

In Facing the Unseen, Black Man in a White Coat author Damon Tweedy makes an impassioned call for better mental health care.
Science Fiction & FantasyNonfictionFictionFeaturedChildren's & YAMiddle GradeMemoirMedicine

5 longer reads for the shortest month of the year

Feature by the editors of BookPage

The Love Songs of W.E.B. Du Bois

I read the entirety of award-winning poet and novelist Honorée Fanonne Jeffers’ masterwork, all 816 pages of it, on the tiny screen of my phone during a trip throughout Washington. I can’t think of any other epic book that would be worth that kind of reading experience, but The Love Songs of W.E.B. Du Bois is special. While driving across the state, I regularly came across attempts to recognize and honor the Indigenous peoples who once populated that land, gestures that I don’t often see in the South where I live. For this reason, the long gaze of Jeffers’ novel felt like the answer to a prayer. It tells the full history of an American family—whose heritage is African, Creek and Scottish—and their centurieslong connection to a bit of Georgia land, as revealed by the research of one descendant, Ailey. It made me wish that all American lands could have their chance to tell their full stories, all the way back to the beginning.

—Cat, Deputy Editor

Empire of Pain

It is rare that a book simultaneously checks the boxes of timely, important, in-depth and narratively gripping. But the 640 pages of journalist Patrick Radden Keefe’s Empire of Pain walk the line between an impressively researched tome and a page-turning, propulsive story. Keefe’s 2021 tour de force recounts the full, damning tale of the Sackler family, spanning three generations of this American dynasty and their dealings at Purdue Pharma, the pharmaceutical company that produces the opioid pain pill OxyContin. The Sacklers worked hard to keep their name from being associated with OxyContin, and Empire of Pain makes it clear why—from their invention of the concept of marketing prescription drugs, to their tactic of offering regional sales reps monetary incentives for getting more doctors to prescribe more of their drugs, to their outright lies about how their product would not lead to addiction. It is a harrowing story of one family’s catastrophic contributions to the opioid crisis, masterfully told by a top-notch writer.

—Christy, Associate Editor

The Priory of the Orange Tree

“You have fished in the waters of history and arranged some fractured pieces into a picture . . . but your determination to make it truth does not mean it is so,” declares Ead, one of the heroines of The Priory of the Orange Tree. Reading Samantha Shannon’s 848-page novel can feel like arranging fractured pieces into a complete picture, as it depicts the intersecting journeys of four narrators from different corners of an exquisitely detailed fantasy world. Ead, Tané, Niclays and Loth each have deeply held beliefs about the nature of good and evil, and a crisis that could annihilate humanity is bringing those beliefs into conflict. I will admit that I picked up the book for its Sapphic love story, and that’s a good reason to read it. The romance was tender and gorgeous, unfolding slowly enough to surprise me even though I was looking for it. However, when the casualties become devastating, what keeps you going is the thrill of connecting fragments of history and mythology from each storyline, knowing you will “see soon enough whose truth is correct.”

—Phoebe, Subscriptions

The Vanity Fair Diaries

There are many reasons that British journalist, writer and editor Tina Brown could land on one’s radar. She’s the founding editor-in-chief of The Daily Beast, the first female editor of The New Yorker and the author of two bestselling books on the royal family. But the achievement that cemented Brown’s reputation was her miraculous turnaround of Vanity Fair. Resurrected by Condé Nast in 1983, the new VF was floundering, so the 30-year-old Brown quickly engaged talent like Dominick Dunne, Gail Sheehy and Helmut Newton, and wooed advertisers like Calvin Klein and Ralph Lauren. Controversial stories grabbed headlines; so did provocative covers (who can forget the shot of a nude, pregnant Demi Moore?). Brown loves gossip and has a sharp wit, which means her behind-the-scenes stories of the 1980s NYC glitterati alone could carry 500 pages of memoir. But she’s also honest about the mistakes she’s made and the challenge of balancing a family and career. The Vanity Fair Diaries will leave you hoping Brown chronicled her time at the New Yorker too.

—Trisha, Publisher

The Invention of Hugo Cabret

The American Library Association’s Caldecott Medal is awarded each year to “the artist of the most distinguished American picture book for children.” In 2008, it was won by this love letter to French inventor and film director George Mélies. To make a 544-page story short, it’s extraordinary, with 158 pencil drawings that will make you rethink everything you think you know about what picture books can be. The Invention of Hugo Cabret begins by inviting you to “picture yourself sitting in the darkness, like the beginning of a movie” and then captures your imagination via 21 wordless spreads. In many ways, Brian Selznick’s story is about small things that combine to form a creation greater than the sum of its parts, from a boy who lives in a train station and steals toys from the cantankerous owner of a toy booth to paragraphs filled with exquisitely yet economically observed details. Few picture books can be described as perfect, but this is one of them.

—Stephanie, Associate Editor

Correction, February 15, 2023: This article previously misspelled the name of Dominick Dunne.

February is the shortest month, but if you're looking for a long book to keep you company until March begins to roar, our editors have a few suggestions.
NonfictionMedicineHealth & Fitness

The People’s Hospital

Review by Henry L. Carrigan Jr.

As COVID-19 swept across the United States in 2020, health care professionals and patients quickly learned about the flaws in the public health system. Questions arose about equitable access to health care, the role of insurance and the quality of care in public hospitals serving uninsured people versus private hospitals serving people with private insurance. Taking the public Ben Taub Hospital—Houston’s “largest hospital for the poor . . . who cannot afford medical care”—as an example, medical researcher and practicing physician Ricardo Nuila explores these issues in The People’s Hospital: Hope and Peril in American Medicine.

Nuila has been an attending physician at Ben Taub for over 10 years, and he has discovered that “good care comes from connecting with your patients in whatever way you’re able.” Using the stories of five patients, Nuila weaves an intricate web of questions about the shortcomings of insurance and corporate medicine and reveals how Ben Taub has succeeded in providing access to health care for people who are medically and financially vulnerable.

For example, there’s Christian, a patient with chronic kidney disease who developed mysterious, debilitating knee pain. Because he was uninsured and had to pay out of pocket for his diagnosis and treatment, he traveled to a clinic in Mexico where he hoped his money would go further. A few weeks into his therapy, his knee pain diminished, and he moved back to Houston—but within weeks, he found himself facing the same medical issues again. When his kidneys started to fail and the insurance company denied him coverage, his mother admitted him to Ben Taub, where he started receiving hemodialysis on a regular basis and eventually left the hospital with hope.

Readers also meet Ebonie, who was 19 weeks into her pregnancy and experiencing dangerous levels of obstetric bleeding. After bouncing from hospital to hospital, she eventually landed at Ben Taub, where Nuila and another doctor developed a plan to deal with bleeding in the future and made sure she would be admitted to Ben Taub when it happened. Ben Taub also helped Ebonie apply for Medicaid so she would have an insurance safety net. Through his own experiences, and those of his patients and fellow health care professionals, Nuila paints a picture of a world where “people find healthcare and revere it like treasure.”

The People’s Hospital is an inspiring book that raises crucial questions about the future of American health care. Nuila illustrates that hospitals that make holistic decisions about care provide more effective and equitable treatment than those that ask simply about the ability of patients to cover expenses, reminding readers that the most effective health care systems always elevate humans and their needs over monetary gain.

Using the stories of five patients, physician Ricardo Nuila reveals how a public hospital in Houston has succeeded in providing health care to people who are the most vulnerable.
NonfictionMedicine

Random Acts of Medicine

Review by Harvey Freedenberg

Anyone seeking medical care for a serious illness wants certainty in their diagnosis and treatment. The unsettling message of Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients, and Shape Our Health, however, is that those understandable desires are often undermined by pure chance. 

In their revealing book, Harvard Medical School professor and economist Anupam B. Jena and critical care physician and health care policy researcher Christopher Worsham rely on natural experiments—studies based on collecting and analyzing data from random events occurring in the real world instead of controlled environments—to illustrate the role that randomness plays in America’s health care system. It’s a system that, in 2019 alone, spent $3.8 trillion—17.7% of the United States’ gross domestic product—and yet is “inefficient, inequitable, and poorly performing compared with other wealthy nations,” they write.

Jena and Worsham report on numerous studies, some of which they helped conduct, that attempt to answer some vexing questions: Why do children born in the fall have markedly higher influenza vaccination rates than their counterparts with summer birthdays? Why, despite similar conditions, are some patients more likely than others to receive an opioid prescription in the emergency room and maintain that prescription long after they’ve returned home? Why is an obstetrician more likely to perform an unplanned cesarean section if their previous patient’s vaginal birth presented complications? The answers, they argue, can provide critical insights into how to improve the quality of health care.

The book’s sometimes whimsical chapter titles conceal serious findings. “What Happens When All the Cardiologists Leave Town?” examines the survival outcomes for high-risk cardiac patients who are hospitalized during the annual professional conference for interventional cardiologists, versus those treated when those same cardiologists are back home. “What Do Cardiac Surgeons and Used-Car Salesmen Have in Common?” considers “left-digit bias,” a cognitive blind spot Jena and Worsham believe explains the differing care patients with heart attack symptoms who are just under 40 sometimes receive compared to those who have recently passed that milestone. 

If these unexpected insights sound familiar to readers of books like Malcolm Gladwell’s Outliers, there’s a reason. In addition to his professional duties, Jena hosts the podcast “Freakonomics, M.D.,” where he explores similar behavioral economics issues. Though their tone is occasionally lighthearted, he and Worsham repeatedly drive home a serious point: The American health care system is failing to deliver optimal care, often due to the unquestioned assumptions and inherent biases of its providers. If this provocative book can spark conversations about how to examine these persistent problems with fresh eyes, its authors have accomplished something truly important.

In their revealing book, Anupam B. Jena and Christopher Worsham illustrate the role that pure chance plays in medicine.
NonfictionSocial ScienceScienceMemoirMedicine

Take your book club on a trip through the brain

Feature by Julie Hale

In Strangers to Ourselves: Unsettled Minds and the Stories That Make Us, Rachel Aviv examines the challenges of living with mental disorders and how those disorders can define who we are. Aviv shares personal experiences and talks to a range of individuals who deal with—and find a sense of self in—mental illness. Featuring riveting firsthand reportage, moving interviews and important research, Aviv’s compassionate, revealing narrative offers a glimpse into the secrets of the human psyche while tackling tough questions about psychiatric treatment and diagnosis.

Judith Grisel mixes memoir and reportage in Never Enough: The Neuroscience and Experience of Addiction, a compelling investigation of drug use and the nature of dependency. Grisel, a former drug user who is now a neuroscientist, writes with honesty about her troubled past and grappling with substance abuse. She also looks at the unique psychology of the addict and provides possibilities for escaping the cycle of dependency. The role of genetics in addiction and the brain’s response to drugs are but a few of the book’s rich discussion topics.

In Mind on Fire: A Memoir of Madness and Recovery, Arnold Thomas Fanning offers a powerful, intimate account of a life spent wrestling with depression and bipolar disorder. Fanning’s first encounters with mental illness took place during his teenage years and left him ill-equipped to navigate daily routines. After spending time in an institution and living on the streets of London, Fanning found help in medication and therapy and achieved success as a playwright. In this poignant chronicle of living with illness, he shows that healing is possible.

Max Fisher considers the ways in which Twitter, Instagram, Facebook and other social media platforms have impacted our daily lives in The Chaos Machine: The Inside Story of How Social Media Rewired Our Minds and Our World. Bolstered by in-depth research and interviews, Fisher’s fascinating book traces the evolution of social media, the rise of sensational content and the strategies employed by popular platforms to attract users and make profits. Themes like communication, self-esteem and the human need for connection will get book groups talking. 

From neuroscience to psychology, these nonfiction titles explore the mysteries of the human mind.
NonfictionSocial ScienceMedicineBiography

Rough Sleepers

Review by Priscilla Kipp

“Rough sleepers” are homeless people who mostly choose to sleep on the streets rather than in indoor shelters. Their death rates are staggering, their health needs endless, their fates often in the hands of people who struggle to know what to do with them. However, there are some people whose mission is to care for rough sleepers, doing work that is both lifesaving and extremely frustrating. With a straightforward scrutiny that somehow sees, describes and reveals without flinching or judging, Pulitzer Prize winner Tracy Kidder offers a long, hard look at the lives of people without housing in Rough Sleepers: Dr. Jim O’Connell’s Urgent Mission to Bring Healing to Homeless People.

As a writer, Kidder is intensely immersive. In Mountains Beyond Mountains, he traveled with Dr. Paul Farmer to observe groundbreaking health care work around the world. In Rough Sleepers, Kidder documents the three years he spent with the team that cares for Boston’s homeless population, making rounds with Dr. Jim O’Connell in his van late into the night. They treated people on the street or got them into hospitals and clinics to receive care. They offered blankets and food. They listened. Kidder was given deep access to their world—to the shelters, clinics, emergency rooms, hidden hangouts—and to the life of the man leading these efforts, fondly known by his many patients as Dr. Jim.

Audiobook jacket image for Rough Sleepers by Tracy Kidder
Read our starred review of the audiobook, narrated by author Tracy Kidder.

Readers also meet some of the people who live without homes in Boston in Rough Sleepers. There’s Tony Colombo, who spends his days at a respite house helping residents and staff and his nights on the street getting into trouble. Tony’s friend BJ, having lost both legs, needs constant help keeping upright in his wheelchair. Joanne Guarino is maintaining her sobriety after 30 years on the street and remains a regular guest speaker at Harvard Medical School, where she compels students to treat homeless people with compassion.

Dr. Jim and his team are the inspiring center of Kidder’s book. Now in his 70s, the Harvard-trained physician is still the city’s “street doctor,” sustaining and nurturing relationships with society’s most marginalized and vulnerable people. He realizes his work has come at the cost of his own family life and wryly compares himself to Sisyphus. His colleagues also grapple with the personal toll such vigilant care takes. Still, they see themselves as merely necessary, not heroic. In Rough Sleepers, Kidder begs to differ.

With a straightforward scrutiny that reveals without judging, Pulitzer Prize winner Tracy Kidder offers a long, hard look at the lives of homeless people.
NonfictionScienceMedicine

The Song of the Cell

Review by Henry L. Carrigan Jr.

In 2010, oncologist Siddhartha Mukherjee’s Pulitzer Prize-winning The Emperor of All Maladies provided a stunning history of cancer and medical scientists’ ongoing research into ways to overcome it. In 2016, he delivered a similarly breathtaking treatment of genetic biology in The Gene. Now, in The Song of the Cell: An Exploration of Medicine and the New Human, Mukherjee tells the compelling story of cell biology and the ways that cellular engineering can help us rethink what it means to be human.

Drawing on case studies, interviews, visits with patients, scientific papers and historical archives, Mukherjee tries to understand life in terms of its smallest unit: the cell. As he puts it, he’s listening to a cell’s “music” when he observes its anatomy and the way it interacts with surrounding cells. For example, the genes, proteins and pathways used by healthy cells are “appropriated” or “commandeered” by cancer cells. “Cancer, in short, is cell biology visualized in a pathological mirror,” Mukherjee writes.

Such knowledge allows medical researchers and doctors to imagine how cellular therapy could modify a patient’s cellular structure to treat their disease or medical disorder. In one case, a girl named Emily Whitehead, who was diagnosed with acute lymphoblastic leukemia, received CAR T-cell therapy: Her own T-cells were extracted, modified to target her disease and infused back into her body. Although there was an initial setback because of an infection, the cellular therapy succeeded. Mukherjee includes other stories like Whitehead’s, as well as those of heroes such as Rudolf Virchow, who discovered that “it isn’t sufficient to locate a disease in an organ; it’s necessary to understand which cells of the organ are responsible”; John Snow, the founder of germ theory; and Frederick Banting and Charles Best, who discovered insulin.

According to Mukherjee, the cell sings of a new human who is “rebuilt anew with modified cells [and] who looks and feels (mostly) like you and me.” Using cellular engineering, he writes, “we’ve altered these humans to alleviate suffering, using a science that had to be handcrafted and carved with unfathomable labor and love, and technologies so ingenious that they stretch credulity: such as fusing a cancer cell with an immune cell to produce an immortal cell to cure cancer.” Captivating and provocative, The Song of the Cell encourages us to rethink historical approaches to medical science and imagine how cellular biology can reshape medicine and public health.

This captivating, provocative book from Pulitzer Prize winner Siddhartha Mukherjee encourages us to imagine how cellular engineering can reshape medicine.
NonfictionSocial ScienceMemoirMedicine

Health care with heart

Feature by Deborah Mason

As we age, most of us will experience a debilitating or life-threatening illness at some point. Two nonfiction books take an unflinching look at this reality while painting a compassionate picture of how we and our health care providers could approach illness and death with more empathy, honesty and courage.

Healing

Cover of Healing by Theresa Brown

Healing: When a Nurse Becomes a Patient is Theresa Brown’s searingly honest and deeply personal account of her experiences as a breast cancer patient. Brown, a registered nurse with a Ph.D. in English literature, has written and lectured extensively about the American health care system. As a former oncology and hospice nurse, Brown knew that patients often got a raw deal, but only after her own diagnosis did she realize how needlessly cruel that deal could be.

Brown has profound gratitude for her family, friends and medical team, who all supported her as she recovered, but she is also angry. She faced a host of necessary evils during her treatment, including invasive diagnostic procedures, painful surgeries and debilitating side effects from chemotherapy. But in a series of devastating vignettes, Brown also details the many unnecessary evils she endured in a system that favors profit over the needs of the patient: Diagnoses were delayed, questions left unanswered, test results undelivered. She was even forced to negotiate byzantine regulations on her own because her health care providers were stretched too thin to ensure that these basic duties were fulfilled effectively or graciously. Even though Brown was a seasoned health professional with extensive knowledge and professional contacts, she had to fight to be treated humanely. One can only imagine the obstacles less experienced patients must face every day.

Healing is both a moving memoir and a clarion call to action. When health care becomes a profit-making industry, dominated by hedge funds and corporate interests, we all lose. Instead, Brown argues, we must return to a system where meeting the patient’s needs—physical, emotional and social—is the priority.

★ The Day I Die

Cover of The Day I Die by Anita Hannig

In The Day I Die: The Untold Story of Assisted Dying in America, anthropologist Anita Hannig takes a different but no less passionate approach to her examination of death and dying in America. After becoming interested in how Oregon’s assisted dying law worked, Hannig embedded herself in a volunteer group that helps terminally ill patients take advantage of the law. She soon realized that the law, with its many hoops and barriers, could be like Henry Wadsworth Longfellow’s girl with the curl on her forehead. When it works, the law is very good. Hannig’s case studies of patients who have enough luck and resources to meet the demands of the statute demonstrate that assisted death can be, paradoxically, life-affirming. Autonomy can be restored to patients who have long been at the mercy of their diseases, and knowing when one will die can be an opportunity for reconciliation, reunion and gratitude.

But when things go bad, the law can be horrid. It is reasonable to have strict conditions surrounding assisted dying to ensure that the decision to end one’s life is freely made. But those conditions can have devastating effects upon patients who desperately want to die but cannot meet the requirements. Patients with ALS, for example, might lose their ability to communicate their assent before the deadline. Advanced Alzheimer’s patients are categorically denied access to assisted dying because they have lost the ability to fully understand their decision. Hannig rigorously details these and other situations in which people’s physical or mental deterioration, lack of resources or sheer bad luck result in a painfully prolonged life and terrifying death.

In her introduction, Hannig acknowledges the anthropologist’s dilemma: The act of observation is an imperfect tool for research, since it can change both the observer and the observed. However, it can also change the reader, since it is impossible to read Hannig’s book without being moved. Regardless of your stance on assisted dying, The Day I Die will make you reconsider how dying could and should be.

The personal stories in these nonfiction books set a more humane benchmark for patients and providers.

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