GIFTED EDUCATION NEWS-PAGE

VOLUME 17, NUMBER 3

Better: A Surgeon's Notes on Performance (2007) by Atul Gawande. New York: Metropolitan Books.

The author is a young surgeon at Brigham and Women's Hospital in Boston. He has written many essays on medical issues for The New Yorker and has a previous book entitled, Complications: A Surgeon's Notes on an Imperfect Science (2002). He is noted for the clarity of his writing on complicated medical issues, and the ability to synthesize and make reasonable generalizations from numerous medical research studies. His current book demonstrates the innovative nature of medical research, particularly the attempts by doctors and health care staff to solve difficult health issues. Gawande traveled to India to observe how doctors from this nation in cooperation with UN health teams were trying to destroy the last vestiges of polio. He followed the lead medical officer from the World Health Organization (WHO) to see how he organized and supervised a vaccination program to immunize 4.2 million children in southern India in three days. Unfortunately, many parents superstitiously denied the vaccine to their children because of religious paranoia.

Another example of medical professionals' innovative approaches to health problems is the present battle against super resistant bacteria (e.g., methicillin-resistant Staphylococcus aureus) lurking in hospitals. Gawande emphasizes that this problem exists in almost every hospital in the nation from small county medical centers to major research complexes such as the Mayo Clinic and Massachusetts General Hospital. He talked to specialized staff members who focus on educating doctors, nurses and cleaning staff about preventive techniques they should follow (e.g., hand washing between patients using gel soap dispensers located in patients' rooms and hallways), and inviting suggestions and input from all hospital staff members. Their participation in solving this problem illustrates an essential component for medical innovation - the author calls it ". . .the positive deviance idea - the idea of building on capabilities people already had rather than telling them how they had to change. . . ." (p. 25). Throughout this book, he provides many examples of how positive deviance can make far reaching changes in medical practice. Some of these are the heroic efforts of military surgeons to save lives in Iraq, the improved care provided by physicians in Minnesota of children and adults with cystic fibrosis, and the ingenious laparoscopic surgery performed in India on stomach ulcer patients.

This is an inspiring book which should help gifted students interested in a medical career to acquire a clearer understanding of some of the major medical issues yet to be resolved. The underlying idea of positive deviance will appeal to their sense of adventure in seeking to discover new knowledge. In the Afterword: Suggestions for Becoming a Positive Deviant (pp. 249-257), Guwande gives some good advice that can be applied to all fields of study:

"The choices a doctor makes are necessarily imperfect but they alter people's lives. Because of that reality, it often seems safest to do what everyone else is doing--to be just another white-coated cog in the machine. But a doctor must not let that happen--nor should anyone who takes on risk and responsibility in society.

"So find something new to try, something to change. Count how often you succeed and how often you fail. Write about it. Ask people what they think. See if you can keep the conservation going." (p. 257).

Doctors: The Biography of Medicine (1988) by Sherwin B. Nuland. New York: Vintage Books.

Nuland, a Clinical Professor of Surgery at Yale University, writes extensively about medical practice and the history of medicine. His books and essays combine the best of the scientific-analytical perspective with works of literature, poetry, history and religion to produce a humanistic interpretation of progress in the medical field. Throughout his discussions of the contributions of major theorists and researchers, he emphasizes how their intellectual struggles eventually overcame rigid adherence to ancient and invalid doctrines.

Some of the key individuals included in the book illustrate millennial battles between ignorance and superstition versus enlightened, empirically based knowledge. The Greek physician Hippocrates (ca. 460 BC - ca. 370 BC) produced a generally positive medical legacy which emphasized holistic practice based upon the careful observation of patients. He also stressed medical ethics and learning surgical techniques through observation and practice. His approach to treating patients has influenced doctors for over 2,000 years, and is most clearly expressed today through the practitioners of alternative medicine. However, the next major physician that appears in this book contributed to extensive misconceptions about the structure and function of the human body. Galen was a Greek physician who practiced medicine in the Roman Empire during the 2^nd century, and in Rome he became the personal physician to Emperor Marcus Aurelius. His major works included descriptions of human anatomy and studies of how different organs function. But these were biased by speculation and his use of animal specimens to make inferences regarding human anatomy and physiology. His errors and misconceptions had a negative influence on medicine for about 1,500 years until scholars such as Andreas Vesalius (1514-64), Ambroise Paré (1510-90) and William Harvey (1578-1657) improved the understanding of human anatomy and physiology. Vesalius conducted extensive dissections and organized accurate anatomical drawings and descriptions (De Fabrica, 1543) which greatly improved knowledge of the human body, and helped to develop more effective surgical procedures. Paré was one of the first surgeons to make systematic studies of different treatment methods, particularly as related to wound therapy. Harvey made important discoveries regarding the human circulatory system which showed how the heart functions by pumping blood in a closed system through the arteries, then back to the heart by way of the veins.

Some of the other important areas and individuals covered in this book are: the study of how diseases are related to pathological changes in anatomy (Giovanni Morgagni, 1682-1771), development of high standards of medical practice and meticulous anatomical studies (John Hunter, 1728-93), emphasis upon hygiene and antisepsis in patient care (Ignac Semmelweis, 1818-65 and Joseph Lister, 1827-1912), origins of general anesthesia (e.g., William Thomas Green Morton, 1819-68), advanced scientific medical education (William S. Halsted, 1852-1922), and pediatric cardiology (Helen Taussig, 1898-1986).

This book will increase gifted students' understanding of how the heroic efforts of dedicated medical researchers have improved knowledge of human anatomy and developed innovative medical procedures. There is no better work than Doctors: The Biography of Medicine to demonstrate the triumph of scholarship and science over ignorance and superstition. It should be noted that Nuland has recorded a series of excellent lectures based on this book (DVD and audio versions available from The Teaching Company of Chantilly, Virginia).

The Writings of Oliver Sacks, MD: Gifted Healer, Medical Researcher and Writer

Michael E. Walters

Center for the Study of the Humanities in the Schools

Dr. Oliver Sacks is both a celebrity and renowned medical doctor and researcher. It is important for educators of the gifted to learn something about his life and work because he is also an exceptionally gifted writer. His books will particularly appeal to gifted students who are interested in studying medicine and the workings of the human mind. His latest book about the links between neurology and music (Musicophilia: Tales of Music and the Brain, Knopf, 2007) has been on the best seller lists of major newspapers and magazines. It discusses (in the context of doctor-patient dialogues) various neurological disorders related to hearing, music, playing music and disruptions in musicality usually brought on by accidents, aging or strokes. Some of the neurological disorders are: loud and repetitious hallucinations of the same songs or notes, tone and rhythm deafness, the inability to integrate notes into meaningful compositions or performances, amnesia, aphasia, and Tourette's syndrome. In addition, he includes fascinating discussions of positive characteristics such as perfect pitch and synesthesia. Several of his previous books have been made into films and television documentaries; the most famous is Awakenings with Robin Williams and Robert De Niro. This book was published in 1973 and the movie version was first shown in 1990. Dr. Sacks' nonfiction books are written in narrative form, but reverberate like story telling because of remarkable doctor-patient interactions. The tales in all of his works are rooted in human experience while also relating important information about the workings of the brain and mind.

He was born in 1933 in London, England. His parents were both medical doctors, and he spent a good part of his childhood in a mentor relationship with an uncle who was a chemist. (See his memoir of growing up in England during the Second World War, Uncle Tungsten: Memories of a Chemical Boyhood, 2001.) His medical degree is from Oxford University, and he completed his residencies in neurology at Mt. Zion Hospital in San Francisco and UCLA. Since 1965 he has worked and resided in New York City. Among the institutions he has been associated with are Beth Abraham Hospital, Bronx State Psychiatric Hospital, and the Albert Einstein College of Medicine. He is now a Professor of Clinical Neurology and Clinical Psychiatry at Columbia University Medical Center.

His first book discussed the chronic condition of migraine headaches (Migraine, 1970). In addition, he wrote several other books on such topics as his experiences as a patient (A Leg to Stand On, 1984), and the psychological state of deaf people (Seeing Voices: A Journey Into the Land of the Deaf, 1989). In Awakenings (1973) he described a group of patients in Beth Abraham Hospital who were in a non-responsive "frozen" psychological state because of a type of sleeping sickness known as encephalitis lethargica. Many of them had been in a stupor since the 1920s. As a result of treatment with L-dopa, they temporarily recovered their psychological awareness and were able to function normally. Sacks is still involved with Beth Abraham through the Institute for Music and Neurologic Function. This institute uses music as part of the medical treatment for disorders such as Alzheimer's disease.

Gifted students can learn and be inspired by Sacks' techniques of medical research. In Musicophilia (2007), they will learn about his different research areas as related to his patients' unusual responses to music. The book also has an extensive bibliography. His discussion of many of the materials listed in this bibliography and his interactions with his patients is illuminating. For example, Chapter 5: Brainworms, Sticky Music and Catchy Tunes and Chapter 6: Musical Hallucinations, are excellent examples of how he explains the medical research and engages in these interactions. The main theme of these chapters is the "hallucinations in the sane (p. 77)." His experiences with patients' music disorders demonstrated that they were neurological rather than psychiatric problems. He even uses literary insights to comprehend this dynamic. There is a story by Mark Twain (A Literary Nightmare, 1876, pp. 42-43 in Sacks' book) in which the protagonist experiences repetitious "jingling rhymes." A couple of days later he meets his pastor friend who becomes accidentally infected with these jingles. Then the pastor soon accidentally infects his entire congregation. Gifted students will be well-informed and entertained by Musicophilia because the author is a great healer both as a physician and story teller.

Maurice D. Fisher, Publisher, Copyright © by Gifted Education Press, February-March 2008