In Pain by Travis Rieder

First the simple description, which I wrote immediately after closing In Pain by Travis Rieder:

A fascinating memoir and exploration of how we mishandle pain management in America.


And, now a deeper description:

In Pain is part memoir, part analysis. The memoir portion is the story of author Travis Rieder's personal experience with opioids after his foot was crushed and degloved (the skin almost entirely removed) in a motorcycle accident. His injury was so severe that he had to be heavily medicated to cope with the pain. But, he had one doctor who was a bit conservative about medicating him and another who came up with a non-opioid solution to cover the time between doses when he got "behind" the pain and was in agony for an hour or two while he waited for the next opioid dose.

After the surgeries, Rieder was on a heavy regimen of regular painkillers and he thought he was doing pretty well until one of his doctors disagreed. He shouldn't need that much pain medicine, anymore. But, out of all of the doctors he'd dealt with (including the one who helped him manage his dosages in the first place) not a single one was willing to work with him on tapering off his opioid medication so that he could learn to live with minor pain and the least pain medication possible. Not even a pain management clinic would take him. And, he wasn't an addict so he didn't technically belong in rehab. One doctor made a "tapering" recommendation that shocked me. I wasn't surprised when Rieder, upon following his advice, went through a miserable withdrawal. What surprised me was that he didn't slow it down. Instead of cutting out an entire dose every 4 hours (that's an example; I didn't write down the specific details), maybe he could cut out half a dose twice a day?

At any rate, Rieder was dependent upon the opioid medication he took but not addicted. And, here is where the meat of the book lies. What's the difference between dependence and addiction? Who is responsible for helping people who are dependent on to drugs taper off of them as safely and easily as possible? Why don't doctors seem to know anything about how to safely dispense or taper opioids? And, what can be done to keep people from literally dying by the thousands during the opioid epidemic? Is there a way to prevent needle-borne disease and accidental overdose? Is there a way to keep people in chronic pain from getting entirely cut off from painkillers and ending up in such agony that suicide seems the only solution?

Because Rieder is a bio-ethicist and works with doctors, there was actually no reason at all that he should have had to go through the horror of withdrawal without help. He had friends he could have turned to. But, Rieder mentions, because we think of addicts as people without will, he was ashamed of his dependence and it didn't even occur to him to reach out. Imagine what it must be like for people without the resources he could have called upon.

Highly recommended - I'm going to hand this book to my doctor, the next time I see him, and may even buy a copy or two to pass around. I am so impressed. The author mentions ideas that challenge our strict, puritan thought process. Needle exchange programs to keep people from getting HIV, for example, often make Christians cringe. "We're encouraging drug use!" they say. Rieder disagrees. If they're going to use needles anyway, why not make doing so safe? Non-opioid medicines that work equally well or sometimes even better than opioids (depending on the kind of pain) are withheld by hospitals because they cost more — opioids are cheap. Why allow hospitals to refuse the use of a medication merely because it will affect their bottom line?

Doctors need more training on how and when to dispense pain medication and how to taper people off of it. There's more. I'm babbling because I think In Pain is such an important book. He also talks about the fact that the worst of the opioid crisis has actually passed, and yet legislators are writing panic legislation that punishes people who actually need regular pain medication ("legacy" patients) for long-term conditions. This is true where I live. It ties the hands of the prescribing physician, threatening them with losing their license if they go over draconian prescribing guidelines.

I received a copy of In Pain from HarperCollins in return for my unbiased review. If I could, I'd pass it out to every doctor in the country; at the moment it's a new release and a bit on the expensive side, but I will at least buy one copy to pass around and hope it comes back to me. Know any billionaires in need of a mission? I've got one for them. My thanks to HarperCollins!



©2019 Nancy Horner. All rights reserved. If you are reading this post at a site other than Bookfoolery or its RSS feed, you are reading a stolen feed. Email bookfoolery@gmail.com for written permission to reproduce text or photos.

Wonder Women by Sam Maggs

[Emma Edmonds] knew she deserved a military pension, but she also knew it would be difficult to convince the government she truly had fought in the war (even though it's probable that nearly four hundred women were active in the Civil War). So she did the most dramatic thing possible: at a reunion of her Michigan Infantry division, she showed up in full skirts and was like, "Hey guys, it's me, Franklin!" Everyone was utterly confused until her colonel admitted, "I recall many things which ought to have betrayed her, except that no one thought of finding a woman in a soldier's dress."

~ fr. p. 112 of Wonder Women, Advance Reader Copy (some changes may have been made to the final print version)


Wonder Women: 25 Innovators, Inventors, and Trailblazers Who Changed History by Sam Maggs is packed full of mini biographies of women for whom the term "kick-ass" is maybe a little mild. Going back as far as hundreds of years, author Sam Maggs tells stories of women with amazing skills and talents who refused to hide their abilities or let them die away for the sake of the menfolk.

Told in a breezy, modern style, Wonder Women describes the challenges each of these amazing women faced and how and why most of these historical powerhouses have fallen into obscurity. The short reason: men like taking credit, if not outright stealing, the work of people they consider inferior.

Each small chapter opens with an illustration and a quotation. The opening chapter, for example, describes Wang Zhenyi, a Chinese astronomer, mathematician, and poet who was active in the 18th century. Her quote:

"It's made to believe Women are same as Men; are you not convinced Daughters can also be heroic?"

The contents are divided into the following sections:

• Women of Science
• Women of Medicine
• Women of Espionage
• Women of Innovation
• Women of Adventure

At the end of each of these sections is a Q & A with a living woman who has experienced or is currently working in a male-dominated field:

• Dr. Lynn Conway - Computer Scientist, Electrical Engineer, and Science Educator
• Dr. Buddhini Samarasinghe - Molecular Biologist, Cancer Researcher and Founder of STEM Women
• Lindsay Moran - Author, Journalist, and Former CIA Operative (I reviewed her book: Blowing My Cover)
• Erica Baker - Engineer
• Mika McKinnon - Field Geophysicist, Disaster Researcher, and Science Writer

Highly recommended - Wonder Women is the kind of book that ought to be required reading for both sexes -- girls, so they know they can do whatever they choose if they're willing to put out the effort, boys so they don't go around thinking girls are inferior. I don't know the age range -- although, admittedly, I'm actually skeptical of age ranges, anyway, knowing that some children are into adult novels and nonfiction well before adulthood -- but I know I would have enjoyed it around the age of 10-12 and I wouldn't limit it to pre-high schoolers. The writing style is very modern. Sometimes that bothered me (particularly when the author said "skillz" rather than spelling the word "skills" properly) but I do think that style makes Wonder Women particularly accessible to the younger crowd and that is, of course, its intended audience.

Quirk Books is having a pre-order promotion. Included in the offer is a set of wallpapers for phone, tablet, and desktop (free with purchase) and a drawing for signed, framed prints. Click through this link to read about it and find the sign-up widget:

Pre-Order Offer: Wonder Women by Sam Maggs

The Quirk Books website is an awfully fun place to hang out, by the way. I highly recommend bookmarking it for future fun.

©2016 Nancy Horner. All rights reserved. If you are reading this post at a site other than Bookfoolery  or its RSS feed, you are reading a stolen feed. Email bookfoolery@gmail.com for written permission to reproduce text or photos.

From the stacks - Spillover by Quammen, The Sparrow by Mary Doria Russell

I just recently acquired Spillover by David Quammen and The Sparrow by Mary Doria Russell (the former purchased after book buddies talked about it; the latter via Paperback Swap after a lengthy wait). Both are books I enjoyed for completely different reasons.

I bought Spillover after eavesdropping on a conversation between Jill of Rhapsody in Books and Michele of A Reader's Respite. Subtitled "Animal Infections and the Next Human Pandemic," the book is about diseases that cross the animal-human barrier, how scientists isolate such diseases, find the animals from which diseases spill over to humans and work backward to find reservoir animals (those who continue to carry the disease, with or without the disease infecting its hosts), why viruses are particularly scary, which are most likely to cause devastation if they aren't stopped quickly enough during an outbreak, how diseases have traveled and been contained in the past, etc.

At around 600 pages, Spillover goes pretty deep into the history and origins of quite a few terrifying illnesses, like Ebola, SARS, Marburg, and AIDS. My timing was interesting. As I began reading this book, my cousin (an epidemiologist who used to work for the CDC) was sharing articles about the latest Ebola outbreak in Western Africa. The outbreak had been going on for around 3 months without being contained and was not yet making the national news but the numbers (cases and deaths) were just beginning to outpace previous outbreaks. Now, of course, the disease has exploded; the latest outbreak is unprecedented in many ways and I think, if anything, we're probably not concerned enough, at least in the right ways. The panic about Americans being flown home under careful conditions was silly. It's the idea of someone infectious hopping a plane without realizing they're infectious that's of concern. [Update: I guess we'll see how that goes, since Ebola has arrived in the U.S. in an uncontained manner.]

I also learned that I've been misled into believing that deer are responsible for Lyme disease. They are not, and mass killings of deer have been proven not to lower incidents, but deer killings for reduction of Lyme disease are still occurring.

Spillover is both fascinating and terrifying. When you read it, you'll find yourself thinking you should always, always wear a medical-grade mask on airplanes, possibly gloves. You'll wash your hands more frequently and worry about the person coughing nearby. It's a bracing read. But, it's also an important one. I had no idea, for example, that the SARS outbreak of a few years ago really was a "pandemic", an epidemic that traveled around the world. It's so difficult to tell whether or not the news is blown out of proportion that I really thought it was no big deal. Fortunately, that particular pandemic was contained before it became as deadly as it could have but it is extremely easy to acquire and is a vicious killer with a high death rate. And, then there's AIDS, a slow-moving but long-lived pandemic that we have come nowhere close to conquering. David Quammen has since written a book entirely about the search for the reservoir of AIDS. Spillover was published in October of 2012 by W. W. Norton and Co.  My thanks to Jill and Michele for talking about it. I love a good, messy medical read and highly recommend it to those interested in medical history.

Also, if you're interested in following non-inflammatory news about Ebola and other emerging illnesses and outbreaks, CIDRAP is by far the best online site.

The Sparrow by Mary Doria Russell originally came to my attention via Les's review at Prairie Horizons. I added the book to my wish list at Paperback Swap and waited. It was a long wait. I just happened to receive my copy about a week or two before Trish of Love, Laughter, and a Touch of Insanity (link leads to Trish's post about The Sparrow) began talking about doing a Sparrow Read-along.

I'm snatching the description from Goodreads:

In 2019, humanity finally finds proof of extraterrestrial life when a listening post in Puerto Rico picks up exquisite singing from a planet which will come to be known as Rakhat. While United Nations diplomats endlessly debate a possible first contact mission, the Society of Jesus quietly organizes an eight-person scientific expedition of its own. What the Jesuits find is a world so beyond comprehension that it will lead them to question the meaning of being "human". Worlds like "provocative" and "compelling" will come to mind as you read this shocking novel about first contact with a race that creates music akin to both poetry and prayer. 

The book is written from two perspectives. It's not a spoiler to say that Emilio is the only survivor of the expedition. You know from the beginning that he has returned both physically and emotionally damaged. He's extremely ill, badly injured, traumatized and depressed. He's also unwilling to speak about what happened on Rakhat. Scenes from after Emilio's return are interspersed with those from the past, describing the discovery of the signal from Rakhat, the decision to launch an expedition, the personalities involved and what happened once they arrived. As Emilio heals, his story unfolds.

The Sparrow is an emotional, exhausting read. As I was reading I noticed that people used words like "gutted" to describe how they felt. One mentioned feeling shocked midway through the reading. I didn't feel a real emotional punch till near the end. Some of the deaths were unexpectedly violent and particularly gut-wrenching. Emilio's experience, though, was the part that moved me the most. You have a vague idea what happened to him but not the details, till near the end of the book. It was what happened to Emilio and how he ended up blaming himself that made me feel queasy with horror. But, I closed the book feeling satisfied and tired and ready to chatter about it. There's plenty to discuss, so it was a good book for a read-along and definitely one I'd recommend, particularly for book group discussion. I didn't love it. It sounds like I did but from a macro viewpoint it was not a favorite; it's a book with elements that I adored, some that I disliked. I was alternately engrossed and bored, inspired and wearied. I loved the characterization and the mode of transportation to Rakhat, more than anything. My thanks to Trish for the nudge. I probably would have just plunked The Sparrow on the shelf and waited till it called to me. I'm glad I read it with a group, instead.

©2014 Nancy Horner. All rights reserved. If you are reading this post at a site other than Bookfoolery  or its RSS feed, you are reading a stolen feed. Email bookfoolery@gmail.com for written permission to reproduce text or photos.

The Paramedics by James O. Page

The Paramedics by James O. Page
Copyright 1979 
Backdraft Publications 
Source: Author

This is probably the weirdest way I've ever read a book and the story behind it is rather an interesting one. The short version: someone put me in touch with the author, who loaned me one of the 6 remaining copies of The Paramedics from his personal shelves and gave me permission to photocopy it for my own use. I returned the original to the author and put the copied pages in sheet protectors then snapped them into a three-ring binder. 

Jim Page died in 2004 so it's been quite some time since my first reading (and I'm pretty sure I didn't finish reading The Paramedics, the first time) but I was reminded of the book because my exercise time falls during reruns of Emergency! on MeTV and the author was a consultant for the TV show.

The Paramedics is a history of Emergency Medical Services in the U.S. The portions dedicated to the current state of emergency medicine in the field are well and truly outdated, of course, but the book is still of interest to anyone curious about how paramedics came into being. I first read The Paramedics in the late 90s and didn't remember a thing, so I found it surprising in many ways.

Emergency medicine in the field (meaning, emergency response for needs of regular citizens, as opposed to the field medicine of military practice during war) really began as a response to the need for quicker cardiac care when cardiologists discovered that minutes could mean the difference between life and death for heart attack victims. Treatment expanded from cardiac care to other emergency needs, like trauma, as it became apparent that trauma was another area in which time saved lives. But, EMS was very much a regional thing -- both in method and level of training -- that varied dramatically from one place to another; and, it took quite some time before the creation of national standards.

I found a few facts particularly fascinating. One is that most of the early paramedics were firefighters but in at least one case it was policemen who were the first EMS trainees and sometimes private ambulance attendants received training while cities or counties lagged behind. I also found it fascinating that some private ambulance services (previously burly men in white coats who merely loaded and carried patients to the hospital for a fee, like a cab service for the infirm) fought tooth and nail to prevent EMS becoming a branch of their local fire services because they feared a major loss of business. Eventually, it became apparent that private ambulance services could actually profit from switching to non-emergency transport, which was and still is needed.

It was also interesting to find that the same problems that plague paramedics today (burnout, back injuries, abuse of the system by citizens who hoped for a free bus ride, so to speak) were a problem nearly from the beginning of EMS.

There is a bit of background information about Emergency! in The Paramedics but the focus is on real-life events. I actually have a booklet that Jim Page wrote about the show, specifically, but I have no idea what's become of that.

Recommended but almost impossible to find - A fascinating look at how Emergency Medical Services originated. The Paramedics used to be in hot demand amongst EMS professionals (I don't know whether or not that's still the case) but it's long since gone out of print and it is nearly impossible to locate a copy.

I noticed there's one rating at Amazon. The reader says he bought his copy for $99 and sold it for $249. Whoa. And, his opinion was, "It was too much like it was screaming 'look at us'."  The Paramedics was written when the whole concept of EMS was still a very new and shiny thing so I didn't really have any problem with that undercurrent of pride, although I do agree that Page was not a brilliant writer. He was solid enough, in my opinion, and the fact that he was present at the beginning gives the book a nice, personal touch. Also, where else are you going to find photos of paramedics wearing bushy mustaches and plaid pants?

©2014 Nancy Horner. All rights reserved. If you are reading this post at a site other than Bookfoolery  or its RSS feed, you are reading a stolen feed. Email bookfoolery@gmail.com for written permission to reproduce text or photos.