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Tag: surgery

Under The Knife by Arnold Van de Laar

In Under the Knife, surgeon Arnold Van de Laar uses his own experience and expertise to tell the witty history of the past, present, and future of surgery.
From the story of the desperate man from seventeenth-century Amsterdam who grimly cut a stone out of his own bladder to Bob Marley’s deadly toe, Under the Knife offers all kinds of fascinating and unforgettable insights into medicine and history via the operating theatre.
What happens during an operation? How does the human body respond to being attacked by a knife, a bacterium, a cancer cell or a bullet? And, as medical advances continuously push the boundaries of what medicine can cure, what are the limits of surgery?
From the dark centuries of bloodletting and of amputations without anaesthetic to today’s sterile, high-tech operating theatres, Under the Knife is both a rich cultural history and a modern anatomy class for us all.

Thanks to NetGalley for this ARC!

I have read many medical history books before but none of them were as gruesomely interesting as this one. The juxtaposition of the gory surgeries and the dry writing makes for an excellent read. So many different surgeries are discussed in this book, it seems, that there should be something for everyone. If you are a fan of spurting blood, swollen intestines, gangrene, and reading about a man performing surgery on himself without anesthesia, then this book is definitely for you. If you are the squeamish type, stop reading immediately and find something else.

Each one of the 28 chapters discusses a different type of surgery, complete with history and famous examples. Some of the people van de Laar writes about are JFK, Bob Marley, Lenin, and Napoleon. I can honestly say that I learned multiple new facts in each chapter. This, plus the straight-up medical language (that may be incomprehensible to most people) made this book a winner for me. I have a medical background so this was an easy read, but I can see most people trying to figure out some of the jargon and getting discouraged. The author does provide many explanations and word sources (such as Latin or Italian) as well as a glossary at the end, but there is also a good deal of medical verbiage. The chapter also brings us into the present time, and how this surgery is performed using clean instruments and updated techniques.

As I mentioned before, the gore factor is extremely high. I don’t recall ever experiencing this level of detail, even in books containing Hannibal Lecter. A simple sentence telling us that the Sun King only bathed once or twice in his lifetime, and generously opened a window so a visitor could have fresh air speaks volumes. Can’t you just smell the stench from here?!?

There are also chapters on eunuchs, ancient Rome, and bloodletting. The detail in which van de Laar describes each procedure is magnificent. Facts just keep unrolling on the page, with minimal asides for the human detail found in so many other books written by doctors (such as Sandeep Jauhar or Atul Gawande). The book is nearly devoid of emotion; there are only procedures and facts.

I absolutely loved this book. I also may never be able to get some of the gory images out of my mind – but that’s ok.

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The Cost of Cutting by Paul Ruggieri, MD

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The Cost of Cutting was a book I picked up for a pleasure read from the library. Ruggieri also wrote Confessions of a Surgeon, which I enjoyed very much. The difference between the two books is that Cost is mostly about the money, and directly blames healthcare/insurance/government for the woes of doctors, and Confessions is mostly about activity in the hospital; more medicine oriented.

Cost will preface each chapter with a medical case and then peel away layers, explaining what the patient needs, how he is supposed to pay for it, how much profit the hospital will make (or not), and then Ruggieri ultimately rails against the system. I found this style of writing to be both good and bad.

I’ll admit, I picked this book up to gain some insight into hospitals and learn more about medical billing. There were a lot more facts and figures about healthcare than surgery, and this made for a rather flat book at times. That being said, I did learn a lot of interesting and scary things, such as: medical equipment sales reps may be INSIDE the surgery suite, guiding the surgeon as he uses robotic arms or the DaVinci system for the first time! Also: Medicare and Medicaid pays such small amounts for hospital stays that doctors can “cherry pick” which cases they will take…or not. The needs of the patient fall by the wayside if that person has no insurance at all, and with the passing of the Obamacare /Affordable Health Act, hospitals are forced to give up profits to handle cases, thereby forcing doctors in turn to take cases regardless of patient needs or wants.

For example: A woman needs surgery, and her doctor sends her to a specialist. The specialist has operating privileges at 2 hospitals. The hospital accountants/powers that be are pushing more surgeries towards Hospital One for profit. thus the surgeon tells the patient she will be going to Hospital One. This woman is upset because she heard bad things about the place, a friend of hers got awful care, and refuses to go there. The surgeon is caught in the middle between his patient’s wish and his boss. In the book, the patient wants to go to her preferred place, Hospital Two, and the surgeon gets upbraided for it. He strongly advises the woman to choose Hospital One, and she does, reluctantly. I’ll let you read how things work out yourself…no spoilers!

This is not how I’d like my surgery/medical care to be handled–would you? And let’s not even get started on hospital billing–how obscure codes control how things are handled by the insurance. Medical billing is a lucrative practice, a long cry from the “old days” when a doctor would give you a handwritten bill. We have all heard about the $300 aspirin or $1000 bandage billed to someone who has been in the hospital.

Ruggieri offers up solutions on how to make things better, and explains why hospitals are all about profits instead of medicine. Even if you have no interest in medical stories, I urge you to read this, simply to gain more awareness of how to protect yourself should you need surgery. Leave everything in the doctor’s hands? The implications are truly frightening.

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