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some historical context for how the ancient or pre-modern medical community used to conceive of that body system. Sometimes, however, the body works in mysterious ways. Take, for instance, 74-year-old Mary. She exhibited all the symptoms of a heart attack, but the contrast dye showed no blockage. She was found to be instead suffering from takotsubo cardiomyopathy, where the shape of the heart becomes irregular, with a narrow top and bulbous bottom. This condition can happen to people who have suffered a trauma or loss, and is known as "broken-heart syndrome." Coinci- dentally enough, Mary had just lost her husband of nearly 60 years just three weeks earlier. The hospital kept Mary for monitoring, and within a week, her heart had returned to its original, healthy shape. In the book, Case's own father would also become a hospital patient, himself needing cardiac surgery for aortic stenosis and then another operation for vessel blockages in his legs. Though of course she would not be his nurse in the hospital, she uses all her powers of nursing to care for him out of the hospital, monitoring his long recov- ery, changing his wound dressings, and worrying how the medical procedures change him, change his thinking, moods, personality. Case's stories also touch on some current events when she volun- teers at refugee centers in France, and when she retells what it was like to work in her department after the 2017 terrorist attack on London Bridge pedestrians. These stories will echo with familiarity for RNs who have volunteered with Registered Nurse Response Network or worked through disasters. What's striking about Case's entire book and her stories of the many patients she has encountered and cared for, however, is how there are zero stories of patients denied care by insurance com- panies, patients worried about paying for their care, patients facing bankruptcy because of medical treatment, or patients making impossible choices between medical care and some other basic necessity of life. Because Case works in and all her patients are cov- ered by the United Kingdom's National Health Service (NHS), these are nonexistent problems. Her book focuses very much on the nature of nursing and what nurses do. I can't help but think that she for sure would have written a wholly different book if she were a nurse practicing in the United States. —Lucia Hwang In Pain: A bioethicist's personal struggle with opioids By Travis Rieder; Harper One minute you're a young dad of a beautiful toddler with a great job and a loving partner, feeling happy and healthy riding your motorbike one splendid Sat- urday morning in May, and the next minute you have been broadsided by a van and your entire left foot is so man- gled that the bones are protruding from what used to be the bottom. So starts the story of Travis Rieder's descent into and eventual emergence from the world of managing pain through opioids. A bioethicist, the first part of Rieder's book simply tells his story: He suffered a severe trauma from the acci- dent and underwent major surgery to save his foot. He was started on morphine in the ambulance and prescribed an array of different and higher-dose opioids through surgery and recovery to manage his excruciating pain. When one of Rieder's doctors eventually becomes alarmed by the combined, high daily doses of opioids and tells him he needs to be "getting off the pills now," he is given barely any guidance for how to taper off the drugs or what to expect, and the little advice he did receive was wrong. Rieder manages to drop all his doses over the course of a month, but it was a month of living hell. He endured terrible with- drawal symptoms, and all his efforts to find professional medical help during this process resulted in dead ends. At the end of it, he is finally off opioids, but he is not only angry but deeply disturbed that the medical community so easily and willingly prescribed these drugs for him, but seemed to have not a clue how nor felt any responsibility toward him to wean him from these powerful opioids. "My problem was not a one-off," writes Rieder. "The challenge here is systemic, baked into the way our health care is structured. The doctors who prescribed my medication somehow didn't see it as their job to help me get off that medication." Later, he writes: "The year of my accident—2015—nearly a quarter- billion prescriptions were written. That's more than 620,000 each day. So it's not as if the need for withdrawal management should be sur- prising. And yet, it's apparently no one's job." This book details his exploration, research, and conclusions into how to tackle this problem. Rieder covers a lot of ground in In Pain, first explaining to readers how all perception of pain, because it is experienced in the brain, is subjective based on the person suffering it. (Hence the need for the 0-10 scale, no matter how imperfect.) He gives readers a history of opioids and the societal bias against "junkie" drug addicts, back- ground on the pendulum swings in medical community attitudes between prohibiting and embracing opioids, an explanation on the difference between dependence and addiction, a survey of harm reduction strategies in the fight against the opioid epidemic (There's actually three epidemics according to Rieder: the oldest was heroin, the second was prescription opioid, and the third current one is com- bined and complicated by even more dangerous drugs like fentanyl) and the solid public health argument backing them, and more. We learn that Bayer introduced heroin to the world and claimed it was non-addictive. We learn about Purdue's completely unsubstantiated but heavily marketed claim that OxyContin was less addictive due to the extended-release feature of the drug—and how a nation of doctors believed it. We learn that research shows a regimen of acetaminophen and ibuprofen can be as effective or almost as effective as low-dose opioids to relieve pain, that long-term opioid therapy is shown to actually not be very effective for sufferers of chronic pain, and that there are many other first-line options for managing pain than automatically turning to opioids. Of course, to reduce pain from events like trauma and surgery, opioids can and should be used, but Rieder argues that "anyone who prescribes opioids is obligated to work to mitigate the harm of dependence and withdrawal (or, further: addiction and over- does) or to make sure that the patient has access to someone who will." Above all, Rieder argues for nuance in approaching the problem. People with opioid use disorders vary in their degree of disorder, how long they've been that way, and their willingness and ability to address their disorder. In Pain is definitely a worthwhile read for nurses and other medical providers, or simply anyone wanting valuable context for better under- standing the opioid epidemic. One question that entered my mind while reading this book was how much of an obstacle lack of money and access to medical care or addiction treatment factored into the opioid epi- demic, and how a Medicare for All system would at least guarantee everybody a single standard of care. As a profession that administers and even prescribes these drugs, we're sure you will recognize the 20 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G O C T O B E R | N O V E M B E R | D E C E M B E R 2 0 1 9