“Better” and “The Checklist Manifesto”

I chanced upon a book called “Better” by Dr. Atul Gawande while browsing in a small bookshop in Rangashankara a few months back. The synopsis looked good, and I picked it up for casual reading. And what a find it was!

Dr. Atul Gawande is a surgeon at Brigham and Women’s Hospital in Boston, and has written extensively in The New Yorker and Slate about medicine and public health. I later also read “The Checklist Manifesto” by the same author, and was very impressed with his writing. Some of the content in the books includes material from his essays. Both books are extremely lucid, and very understandable for a layperson like me. I have not yet read his other books like “Complications”, which are next in my to-read list.

Better” contains a bunch of thought-provoking essays, which deal with various important non-clinical issues in medicine. These articles include topics like the necessity of washing hands when dealing with patients, the enormity of the task of polio vaccination and eradication, the surgeons that deal with war injuries, the dilemma of doctors who are asked to administer the drugs for a death penalty, dealing with insurance and litigations, etc.

The Checklist Manifesto” describes his efforts to promote the use of checklists in the healthcare system in the United States. He uses a number of convincing examples from a variety of fields such as flight pilots in the aviation industry, the construction industry, etc. Just making a laundry list is not enough though. It needs to be structured and worded properly so it is actually useful.

One example given in the book has really stuck with me. He talks of a successful revival case study of a little Austrian girl who had drowned in a pond in the Austrian Alps and was beneath the surface for 30 minutes, and whose heart was not beating for 2 hrs. The checklists and procedures that were put in place by the team of doctors in that remote hospital played a crucial role in executing a perfectly choreographed rescue operation involving a thousand different steps to be performed in a particular order. You can read more about this excellent case study here.

If you like reading medicine related articles/books, I would strongly recommend reading “Better”, as well as some of the articles on his website, www.atulgawande.com.

Long Walk to Freedom

One of the greatest leaders of our times, Nelson Rolihlahla Mandela aka Madiba, was born on this day, 96 years ago. On this occasion, Google has put out a beautiful doodle. Last month, I finally got around to reading his excellent autobiography- “Long Walk to Freedom”. This is probably the best autobiography I have ever read. I think it gives a wonderful insight into the life of a charismatic leader.

The book is very lucidly written and flows very smoothly. It is a very candid and detailed account of his life. His vivid descriptions of his early childhood, his college years, his various escapades, his activities in the African National Congress, his numerous trials, his underground life, his militant activities etc are very interesting to read. He has of course described his successes in great detail. But I was very impressed to see him owning up to his mistakes, his prejudices and his shortcomings as well. His political ideologies, and their evolution over time, based on changing circumstances, are penned well.

His descriptions of his years in Robben Island are unparalleled. What stands out is his resolve to not be broken by the 27 years of oppression in prison, and his determination to come out of it with the will to lead a nation on a path devoid of apartheid. A quote from Invictus comes to mind, where Francois Pienaar says of Mandela: “I was thinking about how you spend 30 years in a tiny cell, and come out ready to forgive the people who put you there.”

After Robben island, when he was moved to Pollsmoor prison and later to Victor Verster prison, he had various rounds of negotiations with President De Klerk for the abolition of apartheid. These are covered in good detail, culminating in his release in 1990 and the first ever multi-racial election in 1994, when he became the first non-white President of South Africa. I would have liked his Presidential years to be covered in the book as well. But that period was excluded as this book was published in 1995, and the sequel was never published.

Finally, a quote from the book that illustrates the great person that he was:

Prison and the authorities conspire to rob each man of his dignity. In and of itself, that assured that I would survive, for any man or institution that tries to rob me of my dignity will lose because I will not part with it at any price or under any pressure.

I am fundamentally an optimist. Whether that comes from nature or nurture, I cannot say. Part of being optimistic is keeping one’s head pointed towards the sun, one’s feet moving forward. There were many dark moments when my faith in humanity was sorely tested, but I would not and could not give myself up to despair. That way lay defeat and death.

On Winning the Parent Lottery

The title of this post refers to a statement from the book and the talk, “The Last Lecture“, by Randy Pausch, a Computer Science professor at CMU, who had pancreatic cancer, to which he succumbed in July 2008. In his book, Randy talks about how you have don’t have any control over who your parents are, and how they influence your life the most in your formative years, which in turn determines to a large extent, the shape your life takes.

Recently I read three books on stories of women oppression- “A Thousand Splendid Suns“, “Not Without My Daughter” and “Princess: A True Story of Life Behind the Veil in Saudi Arabia“, based in Afghanistan, Iran and Saudi Arabia respectively. All three are excellent books, and I highly recommend reading them all; especially the first one. I shudder to think what would have become of me if I were to have been born in a family/country that had no concept of women’s rights whatsoever.

I feel *so* lucky to have been born and brought up in India, by excellent, very well educated parents who have been most supportive and encouraging of all my ambitions, my goals and my interests in life. I very much consider myself to have won the parent lottery, hands down.

On Reading Books v/s Reading Blogs

Manas has an excellent post about “Book-as-Blog“, where he makes the case for splitting books into chapters or even smaller units, and publishing them as blogposts.

While I don’t have any numbers for justifying this thought, anecdotal evidence through conversations with a lot of friends is enough to convince me that this is a great idea. I have heard so many friends complain that these days they spend most of the time reading stuff on the net, and that they dont have much time, or patience to read a book sitting down. I personally wish I had more time to just lie down and read some book (which btw I managed to do on a recent vacation). The only reading I get done these days is on a flight or train. (Hmm, here’s one advantage of a long-distance relationship).

There is no doubt that reading a book online does not come anywhere close to the charm of reading a book while holding it in your hand. But then, same is the case with newspapers. And don’t we all read most, or maybe all of our news online these days? Maybe books are going that way as well.

On the point of reading books in PDFs, one chapter after another, v/s reading them broken down one chapter at a time via blogposts- I think it’s just due to the lack of time and the lack of attention span that we have developed, and come to accept in this Internet era. This reminded me of the article in The Atlantic, titled “Is Google Making Us Stupid“, by Nicholas Carr, which talks about how the online era is actually making humans more and more stupid by giving them all the information online. Although I don’t agree with most of the article, a few of the points he makes are quite valid. It is true that our reading habits have changed a lot due to the presence of the Internet, blogs and all other online stuff.

It seems to me that reading books as blogs is the way to go, especially for those that spend every single waking moment on the Internet.

On Becoming Fearless: A Must Read For Every Woman

Recently I read the book, “On Becoming Fearless… In Love, Work, and Life“, by Arianna Huffington of “The Huffington Post” fame. It is an excellent read, and I would recommend all women to read it. She talks about fearlessness as not really the absence of fear, but the ability to overcome the fear that every single one of us- man or woman- has, in some form or another. A lot of the thoughts in there resonated very well with me. However, I did not buy her arguments in some of the chapters- especially the one on god. I highly recommend reading at least some of the chapters- the ones on fearless about the body, love, work, leadership, and about changing the world.

Here’s an interesting excerpt from the book, that hit spot on:

Beyond the major moments of fear in our lives, there are many other times when we sacrifice our personal truth to go along, be approved of, or just plain be “nice”. Because despite all our advances, there’s still a huge premium on women being “accomodating” and “team players” who don’t “rock the boat”. As Marlo Thomas once said, “A man has to be Joe McCarthy to be called ruthless. All a woman has to do is put you on hold.”

Most girls are brought up with the “be nice” philosophy. If they are forthright or tomboyish (read: rude, daredevils), they are smirked at by everyone around. It takes a lot of courage and persistence to keep that attitude going. Even for a die-hard tomboy like me (S.E.S. junta: does that sound familiar?), there have been lots of moments when these exact fears had crept in, and I was unable to overcome those, thus forcing me to be “nice”. At some point, I learned to overcome these and just adopt the screw-you attitude. Over the last few years- especially after going to the US, I have become a lot more self-confident, fearless and aggressive. In spite of that, once in a while, I do get called a “mouse”; although these occasions are quite rare these days. I do have a long way to go before I can claim to be able to overcome the fears that I have in life..

Talking about sacrificing personal truth in order to be nice- there are times when our opinions are very different from those that are being discussed on the table. Now, whether to argue tooth-and-nail about these opinions with some random Joe Schmoe, or to let go and just nod your head along, is a dilemma we face quite commonly. Most of the times I just go along with the flow, not because I want to be nice or anything, but just because I don’t want to militantly argue about some random topic with someone, whose opinions I don’t care much about. Now if I know that someone very well (like say Niket) and we differ in opinions, I will of course argue my heart out.

There are times though when random people say random things and you don’t respond, thinking you don’t care what that random person thinks; and then a couple of hours later, you realize that you do actually care about that statement, because the fact that you did not give a fitting response at that time has been bugging you a lot. This happens to me especially when the statement is made about sensitive topics like diversity, women’s issues, independence etc. This, I would definitely consider as sacrificing personal truth.

Some of the other discussions on fearless about body, work etc. are also very interesting. To every woman I know- rather than worrying about “how will I look at the holiday party if I wear x y or z” or about “what will my boss think of me if I say or do x y or z”, please do yourself a favor and go read the book…

Contrasting Scenes at Two Train Stations

A couple of years ago, on our way back to the bay area from Salt Lake City by Amtrak, our train- the California Zephyr- was delayed by about 3 hours. We were stuck at the station, with about 25-30 other passengers, and one station master. There was pin drop silence in the waiting room, as everyone was sitting quietly, either dozing off or reading, or just starting into thin air.

I was reading the book, “Collected Fiction” by Ruskin Bond, where he was describing a scene at a train station in India. It was a beautiful description, one that brought vivid memories of buzzing train stations to mind. What a sharp contrast it was, to the scene that I was experiencing on that cold night in Salt Lake City. Here’s the excerpt that I was reading, from the short story, “The Last Tonga Ride”, by Ruskin Bond:

‘Do not worry about the train, it never leaves on time, and no one expects it to. If it left at nine o’clock, everyone would miss it.’

Bansi was right. We arrived at the station at five minutes past nine, and rushed on to the platform, only to find that the train had not yet arrived.

The platform was crowded with people waiting to catch the same train or to meet people arriving on it. Ayah was there already, standing guard over a pile of miscellaneous luggage. We sat down on our boxes and became part of the platform life at an Indian railway station.

Moving among piles of bedding and luggage were sweating, cursing coolies; vendors of magazines, sweetmeats, tea and betel-leaf preparations; also stray dogs, stray people and sometimes a stray station-master. The cries of the vendors mixed with the general clamour of the station and the shunting of a steam engine in the yards. ‘Tea, hot tea!’ Sweets, papads, hot stuff, cold drinks, toothpowder, pictures of film stars, bananas, balloons, wooden toys, clay images of the gods. The platform had become a bazaar.

The station bell clanged, and in the distance there appeared a big, puffing steam engine, painted green and gold and black. A stray dog with a lifetime’s experience of trains, darted away across the railway lines. As the train came alongside the platform, doors opened, window shutters fell, faces appeared in the openings, and even before the train had come to a stop, people were trying to get in or out.

For a few moments there was chaos. The crowd surged backward and forward. No one could get out. No one could get in. A hundrend people were leaving the train, two hundred were getting into it. No one wanted to give way.

The problem was solved by a man climbing out of a window. Others followed his example and the pressure at the doors eased and people started squeezing into their compartments.

Grandmother had taken the precaution of reserving berths in a first-class compartment, and assisted by Bansi and half-a-dozen coolies, we were soon inside with all our luggage. A whistle blasted and we were off! Bansi had to jump from the running train.

Our train finally arrived at 2:00 am. All passengers queued up at the doors and boarded the train wordlessly, in single file. After 15 minutes, the train took off, leaving the sole station master behind at the platform.