Books ER Nurses Should Read

Books by nurses:

Trauma Junkie: Memoirs of an Emergency Flight Nurse by Janice Hudson, RN

Reviewed by Megan Oakes, BSN, RN, CEN, ER Nurse, Flight Nurse

As an ER nurse turned flight nurse, I found this book to be a great read! Just like the title suggests it's a perfect read for the trauma suggests it's a perfect read for the trauma hunting, thrill-seeking, adrenaline junkie! Janice Hudson makes her audience feel like they are riding on the helicopter along side her and this quick, fun read will make you want to cry, cheer, and laugh! I highly recommend this read for the ER nurse wanting to fly, the flight nurse bored in between calls, and anyone looking for a fun read about real life events in emergency services.

"Unfortunately, if I allow myself to consider the personal lives of my patients, I can't concentrate on the work at hand. It becomes too painful."

""You guys realize there wasn't a damn thing you could have done for those firefighters. We did what we could."

I knew that, but somehow it didn't seem like we'd done enough."

Books by physicians:

Being Mortal by Atul Gawande, MD Reviewed by Skye Croom, EMT

Medicine used to be largely palliative. Not so long ago there was a time when physicians were not capable of finding cancers and other fatal diseases until it was largely too late to do anything but reduce suffering and pain the best they could. Even infections were typically fatal, not to mention the list of illnesses we now vaccinate for. Penicillin hasn’t been around for a century, and insulin will meet its centennial in a few years.

With progress, we now take for granted the role medicine plays. We are used to seeing people come into the emergency department on their deathbed and being able to give insulin, naloxone, tPA or any number of other life-saving drugs and watch them as they leave that brink. Our patients and their loved ones have become accustomed to the privilege of visiting a doctor and leaving all better, or on the track to getting all better – and perhaps we in medicine have become accustomed to it too (to some extent).

Dr. Gawande’s book Being Mortal discusses this in a new light. He delves into the idea of mortality and confronts it directly. We have soldiers coming home when before they would have died on the battlefield. We have people with chronic illness and fatal diseases surviving much longer than ever historically possible. This adaptation in medicine and the role it plays is thoroughly explored. The book especially focuses on the progression of old age – something we are better able to evaluate now that we have so many people hitting these milestones (and causing an incredulous hardship on our medical system as we are tragically underprepared).

Below are some of my favorite quotes from Dr. Gawande’s book.

"The job of any doctor, Bludau later told me, is to support quality of life, by which he meant two things: as much freedom from the ravages of disease as possible and the retention of enough function for active engagement in the world. Most doctors treat disease and figure that the rest will take care of itself. And if it doesn’t – if a patient is becoming infirm and heading toward a nursing home – well, that isn’t really a medical problem, is it?

To a geriatrician though, it is a medical problem. People can’t stop the aging of their bodies and minds, but there are ways to make it more manageable and to avert some of the worst effects." p. 41

"Functional lung capacity decreases. Bowels slow down. Glands stop functioning. Even our brains shrink: at the age of 30, the brain is a three-pound organ that barely fits inside the skull; by our 70s, gray-matter loss leaves almost an inch of spare room. That’s why elderly people are so much more prone to cerebral bleeding – the brain actually rattles around inside. The earliest portion to shrink are generally the frontal lobes, which govern judgment and planning, and the hippocampus, where memory is organized. As a consequence, memory and the ability to gather and weigh multiple ideas – to multitask – peaks in midlife and then gradually declines. Processing speeds start decreasing well before age 40. By age 85, working memory and judgment are sufficiently impaired that 40% of us have textbook dementia." p. 31

“Always examine the feet.” He described a bow-tied gentleman who seemed dapper and fit, until his feet revealed the truth: he couldn’t bend down to reach them, and they turned out not to have been cleaned in weeks, suggesting neglect and real danger. … [He said to] “inspect inch by inch – the soles, the toes, the web spaces.” p. 40

"As you get older, the lordosis of your spine tips your head forward. So when you look straight ahead it’s like looking up at the ceiling for anyone else. Try to swallow while looking up; you’ll choke once in a while. The problem is common in the elderly. You have to look down [to avoid the issue]." p. 51

Being Mortal provides insight into patient’s lives as they struggle with their loss of independence and shifting cultural role. It provides advice for assessment to determine where our patients are and what resources we may refer them for. The book quotes a not-insignificant number of interesting research to quantify some of our elderly patient’s hardships. You will learn about palliative and hospice care, the role they play, and even what to look for in a nursing home if ever you have to make that decision. There is no doubt this is a worthy title to add to anybody’s reading list, whether they are involved in the medical field, are a patient or a loved one.

The Checklist Manifesto by Atul Gawande Reviewed by David Peace, EMT-P, FPC, Flight Medic, Assistant Fire Chief

The Checklist Manifesto, by Atul Gawande, is a must read for any clinician that hates, loves or doesn’t care about checklist. If you hate using a checklist then the author will convince you that their correct use can make you a better clinician. If you love using a checklist then this book will sharpen your ability to develop highly effective checklists and deploy them in your corner of the world. If you don’t care, then you will start caring and will begin to spot their use and benefit in many of the clinical tasks you perform.

Gawande begins with a history lesson on how checklists were born and explains their potential application to medicine. He clearly demonstrates that practicing medicine continues to increase in its complexity, but human beings remain fallible and capable of error.

“Medicine has become the art of managing extreme complexity – and a test of whether such complexity can, in fact, be humanly mastered.”

Next the author takes you on a fascinating journey into how a good checklist is created and refined, then teaches you the differences between checklists that add value to your practice and ones that do not.

“Bad checklists are vague and imprecise. They are too long; they are hard to use; they are impractical. They are made by desk jockeys with no awareness of the situations in which they are to be deployed. They treat the people using the tools as dumb and try to spell out every single step. They turn people’s brains off rather than on. Good checklists, on the other hand, are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not spell out everything-a checklist cannot fly a plane. Instead, they provide reminders of only the most important steps-the ones even the highly skilled professionals using them could miss. Good checklists are above all, practical.”

Finally, the author explains how the use of a checklist can make you a better clinician rather than get in the way or slow you down.

“they improved their (patient) outcomes with no increase in skill.”

The Checklist Manifesto was a fascinating history narrative and a valuable exposition of why you should consider the checklist as a great potential tool that can be utilized to bridge the gap between human error and ever complex and sophisticated medical knowledge. Add this book to your must-read list and join me in placing a checkmark beside it when you are done.

Treatment Kind & Fair: Letters to a Young Doctor by Perri Klass, MD

Reviewed by Skye Croom, EMT

Pediatrician, mother, wife, and author, Perri Klass wrote Treatment Kind & Fair primarily as a series of essays to her son, who at the time had been accepted into medical school. This is a book I recommend not only to anybody entering in medicine – nurse, EMT, paramedic, doctor, physician assistant, tech, etc. – but to people who have been in it a while and want (or need) a reminder of the privilege that is practicing medicine.

I say privilege because it is an honor to serve the patients and their loved ones. We are involved very intimately with total strangers; we learn secrets that even their closest loved ones don’t know, we assess and touch private areas, and we are present throughout some of the greatest hardships they will face in their lives. Dr. Klass reiterates this with eloquence, recognizing the struggle that we will inevitably face, the decisions that must be made, and how everything affects us when we go home at the end of the day. She brings humor into these difficult subjects but never does it seem inappropriate or ill-designed.

Dr. Klass refreshed my young soul in medicine. Her book was strangely grounding – confronting complications in practicing medicine, being a student, leader, and educator; her words are reassuring and inspire confidence in your decision-making yet still inspires well-rounded humility. Altogether, Treatment Kind & Fair merges biography, medicine, psychology, and sociology within the same text in the perfect proportions, and earns my rating of 5/5.

Here are some of my favorite quotes:

“Going into medicine is … choosing to be in a profession that will insert you, again and again, into these moments when people’s lives change, or unravel, or come together, or turn suddenly and sharply in a new and often unwelcome direction.” p. 46

“When you can’t do anything else, listen and pay attention.” p. 42

“I hope that you will always remember … the sense of wonder that people trust you with their bodies, even their sore and painful bodies, trust your probing, and allow you to pass this boundary.” p. 71

“Before you do something to a patient, you have to ask whether it helps, whether it hurts, or whether it does nothing – and you have to ask it in a rigorous scientific way. As you move along your evidence-based way, remember to be humble.” p. 122

“Evidence-based medicine is not the whole story. Doctors are human, patients are human; personality and luck and common sense and comfort all play a role in deciding what to do at clinical decision points.” p. 125

“Make the effort to imagine and understand their lives, to put yourself in the patient’s place. Don’t wall yourself off, and don’t fool yourself into thinking that affections and emotions are somehow unprofessional. And be sure to value the people who help you and support you. Make sure you exercise your growing powers of empathy on the people around you.” p. 216

There is no shortage of clinical stories and lessons, either:

“The blood-brain barrier is a little leakier in young infants; if there are bacteria in the blood, it’s easier for that infection to get into the brain and the spinal cord and cause meningitis.” p. 107

“Children are particularly vulnerable to iron-deficiency anemia from just before their first birthday to the age of two or three, especially those who are still getting much of their protein and other nutrition from milk.” p. 179

House of God by Samuel Shem Reviewed by Mel Hollis, MSN, RN, CEN, CCRN-K, CNE, ER/Critical Care Nurse Educator

If you’re already a FERN (“F’ing ER Nurse”, pretty sure that was coined by some ICU nurse somewhere) but you haven’t ever read House of God, you need to stop what you’re doing and read House of God.

If you think you want to be a FERN read this book first - maybe while in nursing school.

What is the House of God?

Written by Samuel Shem (the pen name for psychiatrist Stephen Joseph Bergman), this is meant to be a memoir of a medical student attending BMS (Best Medical School). Roy Basch is making his way through his 1st year rotations at MBH (Man’s Best Hospital). MBH is the House of God. You will read about all of his rotations, but a thread that runs throughout is the ER. ER was a newer concept at the time of this book’s inception and, at this facility, was not a specialty with specific doctors trained to work in the ER. Rather, residents in training were largely responsible for treating those who arrived, unscheduled, to the Emergency Room. What goes unsaid is that the one constant in the ER is the nurses. They were the first experts in emergency care.

There is much in this book to cause legitimate outrage, if that’s your focus. But hold your fire and see the gold that can be found in its pages.

You’ve been using terms from this book and didn’t know it. Guaranteed. TV shows like St. Elsewhere even took its name from the book. If you haven’t heard of it, you should check it out. The 80s was a magical time of silliness and there’s a young Denzel Washington for your troubles. ER and Scrubs also leaned heavily on stories and terms from this seminal novel.

No idea if Grey’s Anatomy mentions it. Never watched more than the first few episodes. It isn’t a real medical show. Surgical residents don’t come to the ER and ambulate patients. But, I digress…

One example of how House of God is part of the fiber of the ER is the term GOMERS. You likely have heard of ER patients being referred to in this way.

What are GOMERs? It stands for “get outta my ER”

“Gomers are human beings who have lost what goes into being human beings. They want to die, and we will not let them.” Primarily, Shem was talking about elderly, generally terminally ill patients, but it’s come to mean patients who are particularly difficult.

Zebras - Dr. Cox (Scrubs) defines it best: "Newbie, do you happen to know what a zebra is? It's a diagnosis of a ridiculously obscure disease when it's much more likely that the patient has a common illness presenting with uncommon symptoms. In other words, if you hear hoof-beats, you just go ahead and think horsies -- not zebras."

Remember, though, that ER nurses, specifically in triage - NEED to think about zebras. Start with the WORST thing it could possibly be and work your way down.

Neuro position & ortho position - if you leave the side rails down while the bed is low and the patient falls out, they’ll break a hip and be “turfed” to ortho. Side Rails down and bed is high? Patient cracks their skull and is turfed to neuro. Main thing? Don’t leave the side rails down. And never, ever leave the bed up.

The most important and lasting part of this book, though, are the Laws.

The Laws of the House of God

GOMERS don't die.
GOMERS go to ground.
At a cardiac arrest, the first procedure is to take your own pulse.
The patient is the one with the disease.
Placement comes first.
There is no body cavity that cannot be reached with a #14G needle and a good strong arm.
Age + BUN = Lasix dose.
They can always hurt you more.
The only good admission is a dead admission.
If you don't take a temperature, you can't find a fever.
Show me a BMS (Best Medical Student, a student at The Best Medical School) who only triples my work and I will kiss his feet.
If the radiology resident and the medical student both see a lesion on the chest x-ray, there can be no lesion there.
The delivery of good medical care is to do as much nothing as possible.

Are the laws still relevant?

You will need to read the book to fully appreciate some. Do so, then you decide. But let me tell you some I think still are.

Gomers go to ground. Don’t doubt it. Don’t let anyone who needed help to the bathroom walk back alone and don’t even give them a cord to pull. They WILL fall. Gait belts for everybody!

At a cardiac arrest, the first procedure is to take your own pulse. I teach new ER and Critical Care nurses and I use this line all the time. I’ve added my own: Adrenaline is the enemy of clear thought and chaos is detrimental to patient care. So when you find yourself in a situation where your patient is “crumping” Take a breath.

They can always hurt you more.

This should be a reminder to all of us to maintain boundaries and take care of ourselves, because each of our MBHs will be willing to hurt us more.

The delivery of good medical care is to do as much nothing as possible. Advocate for your patients. Be sure that what we’re doing is what’s best for the patient. Not the hospital or the doctor or even the family.

Some new rules that were added some time later, but are all important:

Connection comes first. This applies not only in medicine, but in any of your significant relationships. If you are connected, you can talk about anything, and deal with anything; if you're not connected, you can't talk about anything, or deal with anything. Isolation is deadly, connection heals.
Learn empathy.
Speak up.
Learn your trade, in the world. Your patient is never only the patient, but the family, friends, community, history, the climate, where the water comes from and where the garbage goes. Your patient is the world.

Finally, let me leave you with some quotes that I hope you all take with you in your careers:

“Every (one) makes mistakes. The important thing is neither to make the same mistakes twice nor to make a whole bunch of mistakes all at once.”

“I make them feel like they’re still part of life, part of some grand nutty scheme instead of alone with their diseases, which, most of the time and especially in the Clinic, don’t hardly exist at all. With me, they feel they’re still part of the human race.”

“This is the basic human story. We are all on the same journey. Every one of us will suffer—there’s no way around it. The crucial question is not how to avoid suffering, it’s how we move through it.”

When Breath Becomes Air by Dr. Paul Kalanithi Reviewed by Charlie Lazar, BSN, CEN, CFRN, Flight Nurse

"When Breath Becomes Air" is a captivating book that dives into the emotional, metaphysical, and sensory exploration of human life and mortality--through the lens of a talented neurosurgeon/neuroscientist having to face his own acute mortality at a young age. Though he possesses a wealth of scientific and medical knowledge, Dr. Kalanithi must learn how to live, or face, his life through a different lens--a lens similar to the very patients he's operated on. This is a timeless, exceptional book that strips away the intricacies and complexity of clinical knowledge to highlight the importance of authenticity, empathy, and love towards the human race. It tackles hope, prognostication, dreams, fears, and the mixed emotions in between. This memoir will help remind clinicians-new and experienced-that among the busyness of a challenging work field, we must hold patients' experiences close to our heart, and do our best to accompany and escort anything we do with love and grace...as we all face our lives, and ultimately, our own mortality.

"When there's no place for the scalpel, words are the surgeon's only tool."

"The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can't ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving."

"Like my own patients, I had to face my mortality and try to understand what made my life living...I struggled, while facing my own death, to rebuild my old life--or perhaps find a new one."

"What patients seek is not scientific knowledge that doctors hide but existential authenticity each person must find on their own."

The Lady Whose Mouth I Set on Fire: True Tales From the ER by Dr. McAnonymous

Reviewed by Jack Rodgers MBA, BSN, RN, CEN, NREMTP FAEN, 2021 President, Chattahoochee Chapter ENA

Any book that advertises “true tales from the ER” on its cover is going to grab my attention. Add the ‘mouth on fire’ part and it becomes a must-read. What I discovered was an entertaining collection of stories shared by a doc that’s made emergency medicine his life’s work. His anecdotal ramblings are laughable, confounding, poignant, yet peppered with sarcasm all at the same time. While there are a number of these “MD Diaries” on bookshelves around the country, this one becomes relevant to me when the epilogue rolls around.

The ‘McAuthor’ goes out of his way to recognize the plethora of teammates he’s had the opportunity to work with through the years but goes above and beyond in recognizing female nurses and the courage and determination they show at work while being “insulted by patients; manipulated and abused by the system.” He goes on to close with the following: “These women bring high-tech skills and otherworldly compassion to the most earthly places; these women pour themselves out for the worst of us, giving us their very souls. I have only one word for them and that word spelled backward, is ‘evol’.”

This certainly makes me keenly aware that, in the middle of all of the chaos, our providers respect and appreciate the work that we do. A fantastic way to close a book and a career.

!ris, enod lleW

Books by Paramedics:

A Thousand Naked Strangers by Kevin Hazzard Reviewed by Nyssa Hattaway, RN and The Q Word Podcast co-host

Kevin Hazzard was a medic for Grady EMS in metro Atlanta for roughly 10 years. He is now a writer full time; this medical memoir is beautifully written. He spares no details about the realness and the rawness of what our medic friends do. This book is a must read for any emergency provider. I will be gifting it again and again.

"EMS is wild and imperfect. Just like our patients, it's dangerous and a little mad and possibly contagious." p. 8

'"When I step out of the ambulance, his father is waiting, anxious. I tell him his son died, but now he's alive. We brought him back from the dead.

He nods. "Yeah, okay. Look, he's got cigarettes in his pocket," he says, poking his head through the door. "Can you grab 'em?"

"Sir, your son just died. We saved him, but he could die again. We need to hurry. To the hospital."

"But they're right there in his coat pocket." ' p. 195

"The first miscarriage I worked was the worst. Tiny hands, fully formed, curled into fists that dangled from arms attached to the world's smallest human. Nobody told me it would be like this. I imagined blood and pain and a quiet woman. Instead, we got a person in miniature, asleep in the Tupperware. At first our patient wanted to hold him, then didn't and placed him on the stretcher. We hit a bump and the container fell off. He landed in the street, as soft as a raindrop. The process of picking him up and finding a suitable place to carry him was funereal- imagine two ashamed pall bearers in the orange glow of a streetlight." p. 235-236

"There will always be another dead body, another fetid roach-infested house. We will never escape the smells, the fluids, the unwashable ick of people deep in the throes of a communicable disease. We've run these calls- the disgusting, the foul- and we'll run them again. " p. 86

Books by Patients:

The Other End of the Stethoscope by Marcus Engel Reviewed by Chelsey Rodgers BSN, RN, & Owner of TribeRN

This book is written by a trauma patient. As a nurse, it brought a whole new perspective to the day-to-day care we provide our patients. It is a short, easy read, and it’s broken up into short stories that impacted the author. Initially, I thought Marcus was a healthcare provider who had been injured and ended up a patient, but that’s not the case! I’d recommend this book to anyone in healthcare for a simple reminder that patients are people too and have their own unique perspectives. Marcus talks about a nurse named Barb throughout the book! If you’re feeling burnt out or losing compassion a little dose of Barb will remind you what a difference you can make! As the patient is apologizing profusely Barb explains, “I’m here to take care of you. That’s what I’m here for Marcus…. That’s ALL I’m here for.” Marcus now teaches therapeutic communication to physicians and nurses at the University of Notre Dame.

Books by Educators:

Effective Communication in Multi-Cultural Health Care Settings by Gary L. Kreps, PhD and Elizabeth N. Kunimoto, PhD

Reviewed by Skye Croom, EMT

Although this is a textbook for college-level courses, and was published in 1994, it reads like something written just last year. Relatively short at 124 pages long, the book discusses inter- and intra-personal communication. There are sections focusing on group communication as well, especially within the hierarchies that are inherent to medicine. One of the great talents of the authors is putting concepts that some of us already know into words. The writing is in some ways repetitive, and there is a surprising, almost humorous amount of self-citation by the very educated and well-published Gary Kreps. When it comes to a textbook, however, it is clear and easy to read, not requiring an excessive amount of cognition to follow along – something I always appreciate because on some nights, I don’t have enough of that cognitive ability left over from my day.

Not only will this book help you as you help treat underserved cultures, including the elderly, it will help you if you have any role in education, either formal or informal. Formally, the text offers advice on leadership and serving your subordinates the best you can. As a paramedic student, I wish some of the staff I am placed with in emergency departments practiced some of the concepts outlined in the books. Inversely, reading this book widens my perspective as a student and lends advice on how to help myself – what to look for, what to be mindful of. Mindfulness, and the Golden Rule, are concepts at the core of this book.

Here are some of my favorite quotes, in no particular order:

“In effective groups, members work together cooperatively. Such groups benefit from synergy, the ability to generate greater outputs through cooperative action. Communication should be used to promote cooperation within groups, enabling group members to work together harmoniously and productively. Unfortunately, cooperation does not always occur naturally, and ineffective group communication leads more often to competition than cooperation.” p. 20

“Empowerment – meaning “to enable,” “to endow,” “to invest,” “to delegate,” “to authorize,” “to sanction” … empowering involves engaged listening by the superordinate in the relationship. Empowering a person means that you take that person seriously, and you demonstrate this by the action you take based on what you hear. Listening and acting on the information from the process reduces uncertainty, a primary barrier to effectiveness in multicultural communication.” p. 53

“There are five primary interrelated health communication problems confronting the elderly in seeking health care:

Their loss of social status within the healthcare system.
Their loss of personal independence and control over their health care treatment.
Limitations in the availability of health care services to the aged.
The growing alienation, loneliness, and boredom of the elderly within the healthcare system.
The increase in fraud and misrepresentation in health care for the elderly.” p. 94

“Be aware that interpersonal interactants seem to need a certain amount of redundancy in communication to enhance predictability, reduce entropy, and help them maintain a comfortable psychological state.” p. 116

Books by Bestselling Authors:

Stillness is the Key by Ryan Holiday Reviewed by Beau Salts, RN, B.S., Psychiatric Nurse

beausalts.com

Nursin’ ain’t easy. Take it from me, Beau Salts. I’ve been one for the past six years. Three different specialties have found me at their employ. Every one is stressful in its own way. I have yet to find a nursing job that is bliss, roses, and nirvana-topped ice cream. Please call me if you find one. Can you relate?

Even so, it remains a noble profession. And a needed profession. People need our skills, knowledge, and compassion. Not to mention our ability to stop what we’re doing and answer their call light in sixty seconds flat.

We are, in many cases, the only thing standing between life and death. And we keep showing up, despite the sometimes cantankerous, unappreciative patient and staff attitudes. Oh, and the one hundred other challenges we face on a typical shift. My hat is off to my fellow nurses. Bravo.

But our own wellbeing is also at stake here. We work in stressful conditions, and we need to take time for ourselves. Just like they tell you on airplanes to save yourself first. We can’t help anyone if we don’t help ourselves first.

As nurses, we know that stress kills. But what can we do about it? A lot of things actually. Today I will mention only one: go out and read Stillness is the Key by Ryan Holiday. I read it and it rocks. Nurses in all specialties can benefit from soaking up the knowledge in this book. Especially those working in hectic EDs.

In this book, best-selling author Ryan Holiday goes to great lengths to make a simple point: we need US time. Specifically, we need time to chill-the-heck-out. This quiet time serves to offset the craziness of our nursing adventures. Holiday refers to it as stillness.

Our mental health (quite literally), our happiness, longevity, and even our physical wellbeing are the skin we have in this game. Leave stress unchecked and sooner or later you will pay.

In psychiatric nursing, I’ve seen it lead to first psychotic breaks, substance abuse, and suicide. Many of these “victims of stress” were average, everyday people before. Like nurses. But too much crap accumulated on their plate, then multiplied, and they didn’t know how to deal with it. One day a sharp healthcare professional, the next day broken mentally and confined to a psychiatric ward. This is the reality of stress left unchecked.

A vital component of dealing with stress is the mental. Mental encompasses a lot. Stillness is the Key
zooms in on mental stillness. Stillness in this context refers to the practice of deliberately keeping our minds at peace. Despite the chaos that is going on around us. Is this possible? You bet the last alcohol swab in your cart it is.

If we do the things recommended in Stillness is the Key. In his usual style, Ryan Holiday turns to the pages of history and pulls wisdom from the minds of those that have gone before us. Minds like Michael Jordan, Johnny Cash, and even one of my childhood favorites – Mr. Rogers.

According to the book, being “in the moment” is one of the keys to the stillness we seek. “Be present. And if you’ve had trouble with this in the past? That’s okay. That’s the nice thing about the present. It keeps showing up to give you a second chance”. Wow. So much truth in that quote from the book. Love it.

You will also read about journaling. Although a simple practice, journaling remains powerful. “How you journal is much less important than why you are doing it: To get something off your chest”. Quotes like this one and dozens more are awaiting you in this read.

Nurses – thank you dearly for all you do. I hope you will pick up this book and that it serves as a regular reminder to look after yourself. You rock.

Peace,

Beau Salts

Smoke Gets in Your Eyes by Caitlin Doughty Reviewed by Nyssa Hattaway, RN and The Q Word Podcast co-host

Smoke Gets in your Eyes & Other Lessons from the Crematory is an exploration on dying, death and grieving in the United States. If you don't have a strong stomach and an appreciation of dark humor do not read this book. Doughty becomes fascinated with death after witnessing a horrific death at age 8. She advocates for death acceptance and for the reformation of western death practices through anecdotes and a hefty helping of gallows humor. She questions our American fear of death and dying. She says "you can tell a lot about a society by the way they handle their dead." Doughty knows first hand from her work in the crematory/funeral industry about the expectation that we have that our recently departed are taken from looking dead to looking "natural" and how very unnatural the expectation and the practice are.

"Setting the features" includes fillers, make up, pieces of plastic, diapering, stitching body holes closed, placing the body in plastic to contain fluids and then dressing them in their finest clothes. Then we put them in an expensive box, seal it tightly and place it inside another sealed cement box. Quite strange when comparted to other cultures and other times. You will read about those too.-endocannibalism, picking through bones with chopsticks, and burial plot rentals.

Doughty covers the origins of embalming and its great irony. It was invented during the Civil War when soldiers were killed far from home. To preserve the body, it was stuffed with sawdust or something similar and returned to the family for the wake- which was held in the living room of the family home. A practice that was created to insure that bodies returned home has lead to death and grief practice that are far removed from the home.

ER nurses are familiar with death and dying. We see horrific deaths and on rare occasions we witness a beautiful death so as ER nurses you will appreciate Doughty's observations. This book has been described as morbid, sassy, cringe-inducing and hilarious. If you like the writing of Mary Roach, I think you will enjoy Smoke Gets in Your Eyes.

". . . modern denial strategies help focus mourners on positive "celebrations of life"- life being far more marketable than death. One of the largest funeral-home corporations keeps small toaster ovens near their arrangement rooms so fresh-baked cookie smells will comfort and distract families throughout the day- fingers crossed that the chocolate chips mask the olfactory undertones of chemicals and decomposition." p. 60-61

Deep Survival: Who lives, Who Dies and Why by Laurence Gonzales

Reviewed by Ginger Locke, Creator, Medic Mindset podcast

medicmindset.com

Two people entering the same life-threatening environment can have very different outcomes. Laurence Gonzales researches and presents true stories of survival in an attempt to sort out who lives and who dies. This book centers around survival in the rough terrain and environments but ends up informing our decision-making under everyday stress. It became the basis for a talk I did called "When Things Get Wicked." I particularly enjoyed the chapter "Bending the Map" where Gonzales dissects lost person behavior and the extreme breakdown in cognition that occurs under the sheer terror of not knowing where you are in relation to safety. I likened this to the disorientation that occurs when nurses get lost in the decision-making of patient care while the patient continues to decline before their eyes. Gonzales' guidance is rooted in well-established principles of psychology and anthropology. As a bonus, he references many other survival stories that offer up a buffet of future books to read if you enjoy this one. Bon Apetite.

Things I underlined in the book:

“The word 'experienced' often refers to someone who's gotten away with doing the wrong thing more frequently than you have.”

“The world we imagine seems as real as the ones we’ve experienced. We suffuse the model with the emotional values of past realities. And in the thrall of that vision (call it “the plan,” writ large), we go forth and take action. If things don’t go according to the plan, revising such a robust model may be difficult. In an environment that has high objective hazards, the longer it takes to dislodge the imagined world in favor of the real one, the greater the risk. In nature, adaptation is important; the plan is not. It’s a Zen thing. We must plan. But we must be able to let go of the plan, too.”

“Helping someone else is the best way to ensure your own survival. It takes you out of yourself. It helps you to rise above your fears. Now you’re a rescuer, not a victim. And seeing how your leadership and skill buoy others up gives you more focus and energy to persevere. The cycle reinforces itself: You buoy them up, and their response buoys you up. Many people who survive alone report that they were doing it for someone else (a wife, boyfriend, mother, son) back home.”

Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World by Tracy Kidder, Pullitzer Prize winning author

Reviewed by Kelly Edwards, MPA, RN, CEN, FP-C – Clinical Operations Manager, Haiti Air Ambulance

"Never underestimate the ability of a small group of committed individuals to change the world. Indeed, they are the only ones who ever have." That quote by Margaret Meade could easily sum up this book. In Mountains Beyond Mountains, Tracy Kidder provides part biography, part history lesson, and part commentary on the healthcare system and wealth inequality. It relates the author’s time spent with Dr. Paul Farmer, a dynamic personality whose ‘Robin Hood’ approach to medicine in impoverished countries showed the difference a single person with like-minded people working together can accomplish.

For readers who don’t know anything about the challenges of healthcare in developing nations, the book provides frank accounts of what Dr. Farmer and his colleagues had to overcome. The author recounts time spent with Dr. Farmer and his zealous drive to improve healthcare access and delivery in Haiti and other impoverished populations. Dr. Farmer saw how culture and medicine are intertwined with each other and the importance of each individual patient and their needs. The book also conveys how poverty, medicine, and ideologies are intertwined and often resulted in the poor state of healthcare in some areas of the world.

The core of the book focuses on Dr. Farmer, starting with his early work in Haiti trying to treat tuberculosis among the neglected. As the book progresses, the author details the success and how Partners in Health was formed and grew and took their model to other countries including Russia and South America. At the center of it all is Dr. Farmer and his close colleagues fighting against established systems and bureaucrats that balked at the costs despite the obvious success Partners in Health was achieving. From the beginnings of a small clinic in Cange to programs in other countries, the journey is filled with struggle and success interspaced with the importance of human connection.

“Medical education does not exist to provide students with a way of making a living but to ensure the health of the community” was one of Virchow’s beliefs that resonated strongly with Dr. Farmer. This speaks in part of the essence of Dr. Farmer’s drive, that the moral and primary purpose of medicine is to help patients regardless of other issues. He believed a moral obligation existed for healthcare providers and that it often required sacrifice. The book is littered with examples and quips from Dr. Farmer, and others, about the nobler purpose of medicine that many profess to believe but few actually follow.

There are few iconic and revered people in Haiti, but Dr. Farmer is one of them. Perhaps Tracy Kidder paints Dr. Farmer out to be more ‘larger than life’ than he really was. A person could feel inadequate when compared to Dr. Farmer and his accomplishments. He was caring and compassionate for his patients, but often brash to those outside his circle. It is difficult to remember that he was as fallible as any of us, but his drive and commitment is extraordinary. However, he didn’t expect others to make the same scale of sacrifice and do exactly as he does, only that they needed to commit to doing the right thing for the patient above all else. Perhaps the truth is what some of his colleagues often said of his willingness to sacrifice, ‘If Paul is the standard, we are all fucked.’

At the end of this book, you may be left with a lot of conflicting emotions. You should be left with a sense of amazement at what Partners in Health accomplished. You should be angry at the systems and bureaucrats that stymie the efforts of people trying to help the impoverished. You should feel resolve to try and do more and be a better healthcare provider. You should also remember that while perhaps what Dr. Farmer and Partners in Health has done isn’t replicable, that shouldn’t stop us from trying. After all, who knows how much you may end up accomplishing if you’re determined.