Book review: The Way We Knew It

The Way We Knew It is a fantastic collection of short stories written by students in the MFA program at Vermont College from 1981-2006. From the start, this highly successful program employed a mentorship model in a distance learning format, which includes twice yearly on-campus intensives. Graduates of the program have published 450 books, had short stories published in prestigious publications, and won numerous awards.

This volume is a selection of short fiction produced over the first 25 years of the program and is clearly the cream of the crop. As eclectic as it is long (nearly 500 pages), there is no theme among these 30 pieces, except excellent writing. The stories take place from the Northeast Kingdom of Vermont to India, and are told from the points of view of a woman living alone in the wilderness to a scientist dying of cancer to the ghost of a serial killer's victim. They are all good enough to appear in The New Yorker or Atlantic Monthly, standard popular publications where a novel reader like me might encounter them.

Being a reader mostly of novels, I find the short story form less than fully satisfying, and The Way We Knew It is no exception. If you like short stories, though, you will love this volume. Highly recommended for literary fiction collections.

Book review: Damage Control

Courageous lawyer saves the day, gets her life together, and finds romance! The bad guys get what's coming to them and the mighty fall! If this sounds like your kind of plot, then go no further than Robert Dugoni's Damage Control. If, on the other hand, you like nuance, fully-human characters, and believable action, you might think twice about this one.

Dana Hill is a smart, beautiful, and very successful lawyer, scion of a famous Seattle attorney. She seems to have it all: the career, the house, the husband, the child. But Dana is struggling. Her marriage has never been strong and it's only getting worse; her boss never lets up on her; and she's just found a lump in her breast. In the midst of all this, her twin brother James calls, wants to talk in person but doesn't want to say what it's about over the phone. Before they can meet, however, James is murdered. What seemed like a botched burglary soon shows itself to be more complicated, and detective Michael Logan is there to get to the bottom of things. He and Dana work together to piece together why James was murdered and uncover a trail of intrigue that reaches into the highest level of Seattle's political power structure.

Damage Control is a quick read told in simple language. The story moves forward with steady momentum, and there is a chase scene that had me on the edge of my seat. Still I found it unsatisfying. The plot is littered with twists, many of which feel forced, and the "who-done-it" is easily solved by the mid-point. From then on it becomes "how-can-we-catch-the-bastard," one credulity-straining scene following on another.

The characters are even less believable than the plot. Dana is the most fully-drawn, but the most one can say about her is that she is misguided. She has fooled herself about her marriage and is poised to make the same mistake her mother made in staying with a man who doesn't love her for the sake of her child. Michael Logan is the tough cop with a heart of gold. When Dana finds out he stuck by his wife, who deteriorated slowly and died from muscular dystrophy, her heart melts. It's a no-brainer that these two will end up together. The bad guys are even more stereotyped than the good guys. Senator Robert Meyers is a monster, and the man he hired to head his security department is a psychopath.

Damage Control may make good beach reading for fans of lawyer mysteries. If you're looking for an undemanding example of the genre, then you might give it a try. Otherwise, I say, "Objection, your honor!"

Book review: How Doctors Think

Dr. Jerome Goopman's How Doctors Think is a thoughtful and engaging book that could also save your life. Replete with anecdotes, it examines the thought processes of doctors and the errors in thinking to which they are prone. It also discusses elements outside of cognition that influence medical treatments. Throughout Dr. Goopman makes suggestions for how patients can help physicians think better when things go wrong.

Doctors are people, and people make mistakes in thinking, especially in the face of uncertainty. Dr. Goopman goes over many types of cognitive errors. Some are classic, such as "availability," which is the tendency to judge how likely an event is to occur by the ease with which it comes to mind. Others are specific to doctoring, such as "diagnostic momentum." This is the tendency for physicians to accept a diagnosis once it has been made rather than reconsidering the data from scratch when treatments are not working as expected.

Dr. Goopman also discusses cultural and personal factors surrounding diagnostic mistakes. A big one is managed care, which encourages speed and standardization in order to keep costs down. While many people can be treated adequately in 15 minutes (i.e., the generally healthy), the system makes it more difficult for doctors to distinguish between the routine and the rare, which takes time and thought. Another element is temperament of both doctor and patient. If there is a good match — if,for instance, the doctor is aggressive about treatment and you like that approach — there is more likelihood of a successful outcome. If not, communication can go awry, and mistakes may follow.

This honest and eye-opening book can be a little frightening, but Dr. Goopman's aim is not to scare people. Instead, he wants to help patients help their doctors. "Doctors desperately need patients and their family and friends to help them think. Without their help, physicians are denied clues to what is really wrong." Dr. Goopman supplies a set of simple questions the patient can ask a doctor when an initial treatment does not appear to be working. Asking such questions, he contends, can stop a doctor's train of thought and refocus him.

This is essential information for patients. Dr. Goopman recognizes it might be difficult for a patient to question his physician and suggests having a family member help out. Dr. Goopman has been a patient himself and tells the story of a wrist ailment he suffered. He had the marked advantage of being a doctor, having a physician spouse, and having colleagues he knows and trusts to turn to. Still, it took him three years and as many diagnoses before his problem was solved.

I hope, therefore, that doctors will read this book, too. Patients can help, but they will not always run into physicians who are willing to reconsider diagnoses, and they need to have the resolve and resources to stick to their guns. Doctors need to be aware of their cognitive vulnerabilities and keep their minds as open as possible.

In this age of technology and managed care, sometimes we need to be able to step back and let the art, and not just the science of medicine take place. How Doctors Think is one giant leap in this direction. It's also a just plain good read. Dr. Goopman has several other books under his belt and writes regularly for The New Yorker magazine, and it shows. This book should be required for everyone, and happily, reading it won't hurt a bit.

Cross-posted to Blogcritics.