Senior ophthalmologists share the best of what they’re reading this summer. Share what you’re reading and send your review to our book review editor, Robert L. Stamper, MD, at scope@aao.org.
Mount Misery
By Samuel Shem
Reviewed by Alfredo A. Sadun, MD, PhD
How does one follow up on the amazing success of “House of God?”
I don’t think I know of any of my physician contemporaries who haven’t read this book. “House of God” came out in 1978 and described, with exaggeration, satire and comedy, the grueling emotional grind of a medical internship.
Samuel Shem, a pseudonym for Stephen Bergman, was so shaken up by this experience (at Beth Israel, Harvard) that he wrote the book as a form of expiation. Then, in a probably state of emotional burnout, he switched fields to psychiatry. Which brings us to “Mount Misery,” the story of Samuel Shem’s psychiatry residency.
This second novel of his provides a fascinating look into the world of psychiatry and mental illness through the eyes of the sensitive and naïve resident, Dr. Roy Basch. Like so many psychiatry residents, Basch finds himself drawn to the study of psychiatry because of his own struggles with mental illness. Basch grapples with the ethical dilemmas and moral complexities of the field and with the classical balance during any residency between learning, providing service and working towards the institution’s needs.
The institutional needs here are grossly exaggerated, but that’s the point and what makes this book so relevant to modern medicine. Most of the doctors in the book are less interested in their patients' mental health and more on things that make their own lives better or easier. So, the attendings concentrate on such things as drug company research grants and kickbacks, easy insurance money and their own professional advancements.
This is epitomized by a corrupt and abusive hospital administrator, a manipulative mentor and several staff doctors who are only focused on their own academic careers, relationships with pharmaceutical companies and maintaining the status quo even at the expense of the patients who are not afforded much compassion.
Basch's own experiences with depression and anxiety are part of his journey of self-discovery as a psychiatry resident. In the telling of his tale, Freudian analysis is completely skewered. We are also shown the ways in which mental illness impacts personal as well as professional relationships. The novel concludes that empathy and compassion should be the foundational stones for our dealings with patients with mental illness. Without giving much detail, Basch makes a pitch for cognitive psychology instead of more traditional analysis.
Although the dialogues are invariably sharp and witty, the strength of the book is the exploration of complex professional motivations and perspectives on the part of world-famous medical school academicians. In this regard, psychiatry is not so different from other specialties, including ours of ophthalmology. And Harvard Medical School is not so different from our own academic institutions. Through Basch’s eyes, I saw the fallout of medical school politics that hurt patients and residents in training. Though exaggerated the values and politics had the ring of truth and this excess of general academic politics made me cringe. I hope it’s not nearly that bad.
Cobalt Red: How the Blood of the Congo Powers Our Lives
By Siddharth Kara
Reviewed by Robert L. Stamper, MD
For the past several decades, I suspect, like most people, I have plugged the charger in for my cell phone, laptop, tablet, toothbrush, etc. without thinking at all about the origins of rechargeable technology, much less the people who make it possible.
Perhaps, I have appreciated the creative geniuses from Silicon Valley that designed the technology I am using but never gave a thought to the people at the supply chain bottom that make it possible. Siddharth Kara, an internationally known scholar and expert on modern day slavery spent two years researching the mining practices that provide the essential minerals that enable our rechargeable world.
Currently, rechargeable consumer electronics and electric vehicles almost exclusively use lithium-ion batteries to supply power. These batteries depend on lithium and even more on cobalt to function. More than half of the world’s reserves of cobalt are found in the Democratic Republic of Congo.
The Congo, for more than a century and a half has supplied the world including the U.S. with diamonds, uranium, palm oil and rubber. Very little of the benefits of these resources have trickled down to the average citizen while international corporations and corrupt local leaders have been enriched. About three-fourths of Congo’s inhabitants live below the poverty line. In recent years, the Chinese have taken the place of the predecessor European exploiters and are estimated to control the majority of the world’s supply of cobalt.
Through direct inspections of the mining sites (usually under the intense scrutiny of armed soldiers) and personal interviews of miners, their families and some supervisorial people, Kara has provided the details of a form of slavery as cruel and deadly as any of the more well-known ones of history.
Mining rights for cobalt and lithium (amongst other minerals) are granted by the government to mining companies originally owned by the government but now largely owned by Chinese companies who split a fraction of the proceeds with the government. Cobalt is found in veins (like gold). Most of the companies use large excavating equipment to mine but machines can’t find veins, so large swathes of land are turned into huge pits. However, the percentage of cobalt per cubic foot of machine digging is relatively small. The people who work for these companies are salaried at almost reasonable levels with health benefits.
However, the best way to find the high-yield veins is by hand digging trenches and tunnels. So, people from surrounding villages are recruited either by economic necessity or by military power and forced to work as artisanal miners (i.e., independent contractors). They receive no salary or benefits. They work 12- to 14-hour shifts in often dangerous conditions with no protection from the toxic dust and suffocating tunnels far beneath the ground. They face the constant possibility of a collapse of the tunnel where they are entombed. They put rocks into sacks which they are forced to sell to local negociants, mostly from China, at $1 or $1.50 per sack.
A good miner can fill maybe two of these sacks in a long exhausting day. The women wash the rocks in polluted ponds. The children are yanked from school as young as 10 or 11 to dig. If there is an on-the-job injury, tough luck. The next child is pulled out of school to fill the absence so the family can eat. The negociants sell the sacks to intermediaries who then sell them back to the mining company and the ore is mixed with that mined by machine. If the miner tries to sell his sack outside the system, he faces a beating or even a bullet.
Despite the tens of thousands of people caught up in this system, the process allows the mining companies, the government and the end-users like Apple, Samsung, Dell, Tesla, etc. to claim that there is no child labor or forced labor involved in their products. Everyone turns a blind eye to this inhumane system. And when cobalt no longer is desperately needed, the people of the Congo will be left with a devastated landscape and an unimaginable human disaster. The author suggests some simple changes that could help improve things significantly. For me, this was a sad and highly disturbing wake-up call.
The Wager: A Tale of Shipwreck, Mutiny, and Murder
By David Grann
Reviewed by J. Kemper Campbell, MD
David Grann’s latest book combines elements of C.S. Forester’s Horatio Hornblower sagas and the “Mutiny on the Bounty” movies with equal parts of William Golding’s “Lord of the Flies” and Daniel Defoe’s “Robinson Crusoe,” while adding a dollop of Erle Stanley Gardner’s “Perry Mason” series as a garnish.
A successful nonfiction author must be astute in choosing historic events which are both unfamiliar and compelling to the general reader. The skillful writer can then generate enough suspense to propel the narrative. This book attains these goals admirably and, thus, expect no spoilers in this review. Eight pages of color plates and five maps of the areas traveled enhance Grann’s descriptive prose.
Grann again demonstrates that his ability to make long-deceased characters come alive is unsurpassed. His research and documentation of the voyage are meticulous, including his personal follow-up to the forlorn and frigid region of South America where the castaways were marooned.
Readers who have never sailed will find themselves drawn into this voyage as if caught by the treacherous currents of Patagonia. They will also be appalled by the danger involved in sailing wooden ships into uncharted waters while simultaneously risking death from the diseases of typhus and scurvy.
Neither does Grann shrink from recognizing the class distinctions and racial prejudices of 18th century English society. These rigid rules of “civilized behavior” begin to fade as the men struggle to survive. Birthright eventually matters less than strength of character. In summary, any reader who craves a seafaring adventure which is destined to become a number one best-seller should accompany the men on their perilous journey.
The Climate Book
By Greta Thunberg
Reviewed by Samuel Masket, MD
A few short years ago Greta Thunberg, now 20, got the attention of many in the world when at age 15 she led a school strike in her native Stockholm to increase public awareness of and governmental action toward the impact of man-made climate change on the future of the environment.
Presently, she has amassed a large number of authors to contribute their expertise in a wide variety of fields related to the climate. The result is a very powerful book that she edited and also included several chapters of her own. In all there are about 80 short chapters covering subjects that vary from oceanography, impact of cattle production and a meat-based diet, social scientists, philosophers, engineers, economists, agricultural experts, mathematicians, etc. all who share their views on the imperative nature of aggressive and far-reaching changes in our approach to human behavioral induced global warming.
The information garnered from each chapter should serve as a wakeup call to governmental leaders, but the response has been apathetic at best. As many of the chapters suggest, the changes will, by necessity, induce hardships among wealthy nations and for inhabitants of the Global North; this is a tough sell for politicians attempting to be elected or to remain in office.
There are numerous eye-opening facts throughout the book. It is remarkable to learn that a very small number of polluters (oil companies, etc.), 100 in all, account for 70% of all carbon emissions. It is the latter that contributes most to global warming. What is equally as concerning, despite increased awareness of environmental changes, one third of all anthropogenic (man-made) carbon dioxide emissions since the Industrial Revolution have occurred since 2005; the trend is not improving. Owing to this, some of the authors predict that by mid-century (as soon as 25 years from now) 1 billion people will live on uninhabitable land, with immeasurable but massive geopolitical fallout.
It is interesting, and daunting at the same time, to note that in the past nations have mobilized rapidly for war, as in the case of World War II, and in response to the recent pandemic, but the environmental crisis that we face fails to generate an appropriate response, according to the authors. One writer excoriates the media for not properly taking charge of the opportunity to create the mind set necessary for the task at hand.
Each chapter is laden with information that should serve as a wakeup call to all of us, but as mentioned above, humans and corporations must change activities. Let’s consider a diet rich in beef, with the hamburger as the yardstick. Producing the 10 grams of protein needed for a hamburger, results in the emission of 2 to 10 kilograms of carbon dioxide and requires 5 to 35 square meters of land. It also requires 100 to 600 liters of water for irrigation and 40 to 80 grams of nitrogen fertilizer (which, in turn results in additional greenhouse gas emissions). A switch to a plant-based diet would reduce all those figures by nearly 90% according to one chapter’s author.
Although occasionally tedious and very alarming at times, and the fact that some of the information is duplicated by some authors, the book raises many important concerns about our climate and how we are failing to heed the warnings of those in the know. I consider this book to be vital for all to read. Many of the chapters finish with quotes by the author. I find these two to be enlightening:
“Change is often the hardest just before you make it. We too easily focus on what we think we are losing, finding it so much harder to imagine what we might gain.”
“Nationalism, military power and geopolitical disparities are fundamental to the dynamics that have repeatedly stymied efforts to reach a global agreement on rapid decarbonization.”