Issue link: https://nnumagazine.uberflip.com/i/198093
Books.FINAL:FINAL 2 8/21/08 11:04 PM Page 12 continuing quest for a positive, therapeutic conversation with each of my patients. MI is also about caring for your own health. "Guiding is a delicate balance between coming close enough to your patients to understand and empathize with their experiences and retaining your separate role as a healer." —kathryn donahue, rn Hospital: Man, Woman, Birth, Death, Infinity, PLUS, Red Tape, Bad Behavior, Money, God, and Diversity on Steroids By Julie Salamon; Penguin Press, 384 pp. ulie Salamon scores a home run with her remarkable new book, Hospital. Intelligently and beautifully written, Salamon's thesis is to understand the broad social determinants of healthcare in this country, who gets it, who doesn't, and why. This book reads like a virtual screenplay, as we walk through the doors of Maimonides Hospital in Brooklyn, when it opens for business in 2005, as a state-of-the-art cancer center. Almost serendipitously, Salamon came to spend a year getting to know the hospital demographic: the administrators, doctors, patients, nurses, and ancillary staff. She paints vivid and compelling portraits of them with all their faults and favors. You can love them or hate them, but you can never leave them behind. Salamon capably describes the environment of care as a dynamic matrix that exists as, and is influenced by, a whole spectrum of financial, technological, cultural, ethical, and dare I say, political factors. After all, it is an election year, and healthcare is at the forefront of the critical issues facing the American electorate. The fact that Maimonides is a cancer hospital provides more than just an interesting footnote; it could serve as a parable for what is wrong with our healthcare system, why incremental reforms are destined to fail, and why we must start over to rebuild our healthcare security infrastructure, beginning with a state-of-the-art, uniquely American, national health plan, based on the single-payer model. "Walking into the waiting room at Maimonides for the first time rekindled my first impression of New York when I was a newcomer, just out of college, feeling that same paradox- J 12 REGISTERED NURSE ical rush of being overwhelmed and utterly engaged by the motley chaos, the interplay of harshness and sentimentality, the magnitude and intimacy of human convergence." Salamon describes the hospital as a haven and source of meaning for the community, an epicenter of social forces, of compassionate and contentious people. Her first impression is not unlike the feelings we each experienced as newly minted graduate nurses, as we entered the hospital matrix when we were beginning our first job. Salamon discusses complex issues in a very readable manner. Together, we share the author's growing awareness of the social contract, her developing skills of discernment through experience, and her ability to make an assessment from all the data she has collected, in a hospital where, "there are shortages of everything except forms to fill out." Back to that home run I mentioned. In her final chapter, she recalls that healthcare reform was a major platform of Bill Clinton's presidential campaign. Sixteen years later, healthcare reform is again a major platform issue, and she asks the chairman of the hospital board, Marty Payson, about which lesson he thought Maimonides could teach people in the hospital business. "What about the big picture, national healthcare policy?" Payson answers. "I believe eventually we'll have a single-payer system, because this system is insane. It will be driven not by liberals or people like myself but by people like General Motors. The country can't afford this system. But I don't get involved in any way, shape, or form, because I can't affect it." I disagree. The future depends on our political will, and upon our belief that we can make a difference. Salamon states, "Every day at Maimonides, I was reminded that the health care system wasn't anonymous or abstract; it was the sum of individual human successes and failures, each of which could build or destroy." As we go forward, we must try to remember—against the odds posed by a greedy and corrupt health insurance industry, and by institutional and human frailty— W W W. C A L N U R S E S . O R G that healing is the heart of the matter. —deann mcewen, rn Comfortably Numb: How Psychiatry is Medicating a Nation. By Charles Barber; Pantheon, 280 pp. r. Barber has written a thoughtful and insightful book, that is really two books in one. The first, an indictment of the pharmaceutical industry and its marketing of panaceas for the human condition and lifestyle enhancements. The second, a serious look at the treatment and stigma of mental illness. As a psychiatric nurse I share his compassionate concern for the humane treatment and understanding of mental illness and his disparagement of the quick fix. This "fix," as he clearly lays out in his thesis and well-documented information, has less to do with treatment than the appearance of it, and more to do with making Big Pharma richer. The facts and statistics presented are fascinating and alarming, from the costs and the skewing of terminology to the numbers of people who are consuming these substances and how the United States has become the world's clear leader in the percentage of its population diagnosed with and treated for a mental illness. The book shows how the pharmaceutical industry has packaged serious medical conditions as simple impediments to a glorious lifestyle and that by taking the marketed "cure" one can walk happily into a golden future of glorious sunsets, love and laughter, youth and beauty, with nary a problem to ruffle one's (Botoxed!) brow. Whether "pushing" Abilify, an anti-psychotic, or Viagra for erectile dysfunction, it is clear that it is life enhancement that is being sold rather than a serious and considered approach to medical treatment. As Barber states, it is "cosmetic psychopharmacology," and I would edit that further to "cosmetic pharmacology." The benefit in numbing the populous serves the status quo and the elite. Rather than questioning the conditions that create anxiety and distress in our society and making the changes that are called for, we think the answer lies in a pill. It also further stratifies our society as M J U LY | A U G U S T 2 0 0 8