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Books.FINAL:FINAL 2 8/21/08 11:04 PM Page 13 those that cannot afford the "cure" drop further through the cracks. Barber shows how independent scientific studies are ignored as Big Pharma, like other powerful industries, has taken over its own regulation and pushes its own selective studies presenting the desired outcomes, while ignoring or minimizing side effects and negative results. Meanwhile, the cost rises. The second part of the book provides real alternatives that require time, qualified practitioners, and ongoing work by the treatment team and the patient, while eschewing empty promises of a quick fix or utopian outcome. I would recommend this book as a must read for all in the mental health field, medicine in general, and all of us who are concerned about the state of healthcare in this country and the increasing role of the pharmaceutical industry in setting the parameters of treatment at tremendous cost. There is no doubt there have been some real and valuable breakthroughs and that drug therapy is a useful and often necessary part of medical treatment today. Tremendous risks exist, however, and Barber makes clear that by unquestioningly accepting this dynamic as a society, we are buying into a dangerous illusion that will leave us more than numb.—barbara williams, rn The Caregiver: A Life With Alzheimer's By Aaron Alterra; Cornell University Press, 213 pp. his is a rare book; an unsentimental and beautifully told inside view of how life changes for a New England elderly couple when the wife is diagnosed with Alzheimer's disease. Authored by husband Aaron Alterra, a professional writer, The Caregiver takes the reader through the time when Alterra first notices that Stella's memory loss seems to be more serious than your average senior moment, to diagnosis, to the limited treatment available, to managing and coordinating home care for Stella as her mind and body deteriorate, to fighting Medicare to pay up for some of her care, and finally to her death. Alterra deftly weaves his inner thoughts, emotions, memories, and even musings with factual observations of Stella's decline and a straight account of what it is like to seek the best possible care for someone you've been married to for more than 60 years. T J U LY | A U G U S T 2 0 0 8 We quickly learn that the medical establishment doesn't quite know what to do with Alzheimer's. Most of the "treatment" for Alzheimer's is not medical care per se, but simply care. As one psychiatrist early on advised Alterra, "It might be helpful if you thought of yourself as the physician...Alzheimer's is not usually a doctor-intensive disease. It's more aide-and-caregiver intensive...After the first flurry of diagnosis there may be very little medically to do. Alzheimer's is not a disease that responds to surgery or massive medication." Alterra begins to understand and accept the nature of the disease, but still fights tooth and nail to get his wife into a clinical trial which he hopes will stave off the worst a little longer. Her body cannot process the most common Alzheimer's drug, tacrine. Stella is accepted into a double-blind trial, but Alterra does not want to risk her receiving the placebo and even goes so far as to break open one of her pills and ask his small-town crime lab to analyze whether it's an active drug. The author begins attending Alzheimer's support groups for caregivers where he learns how to make the mental, emotional, and life adjustments necessary to cope with the disease. How do you convince your loved one to stop driving? What can you do to prevent him from wandering away? How do you react when your loved one not only doesn't recognize you, but treats you as an annoyance—without appreciation for the care you give—or even with hostility? Beyond the day-to-day challenges of caregiving, though, Alterra excels at posing and pondering questions of self, of the patient's right to know, of autonomy, of obligation, of relationships. How much should he be informing Stella about her condition and what's to come if she won't remember it in a minute anyway? Is she really agreeing to a contract if he is holding her hand to sign the form? Meanwhile, Stella slips farther and farther into Alzheimer's. At first she simply lost memory of how things were connected; she'd mix up how to get the car started or make dinner in the afternoon. Then she started having trouble walking, toileting, eating, washing, dressing. Soon the "daycare" center that Stella was too highfunctioning for in the early stages of her disW W W. C A L N U R S E S . O R G ease was rejecting her because she required too much physical care. Soon she is requiring 50, 60, then 90 hours a week of home care assistance. By the end of year three, she is wheelchair bound. Alterra quickly learns that Medicare covers almost none of these expenses. Medicare will cover the cost when Stella breaks a hip because she is disoriented, or contracts pneumonia or develops bed sores, but not the cost of the aides because of a ludicrous Catch-22 he discovers. Medicare will only cover aides if a patient is homebound. Even though Stella lives in a wheelchair and can't get anywhere by herself, she is disqualified because Alterra sends her to a daycare program a few days a week to keep up some social interaction and stimulation. Even if Medicare accepted that Stella was homebound, Alzheimer's is "chronic" and not covered. Their situation highlights some of Medicare's shortcomings and the very real need to improve and expand upon the system in areas such as caring for Alzheimer's patients. It also draws attention again to the need for a single-payer healthcare system where these types of illnesses can be handled consistently and with compassion. Given that some five million Americans currently live with Alzheimer's, one out every 10 people age 65 and older will get Alzheimer's, and that those odds worsen to one of every two for people age 85 and older, this book is required reading for everyone. If you don't end up as the patient, you'll likely be the caregiver. This book gives us all insight into exactly what that means.—lucia hwang Contagious: Cultures, Carriers, and the Outbreak Narrative By Priscilla Wald; Duke University Press, 373 pp. antastical tales such as urban legends and teen slasher films commonly reflect deep-seated societal beliefs about sexuality, morality, and race. With Contagious, Priscilla Wald presents yet another form of the 20th-century morality tale. Using both actual and fictional American outbreaks over the past century, Wald clearly shows the reader how the outbreak narrative of each unfurls across a stage of deeply-rooted racism, nationalism, homophobia, and gender expectations. Among the figures studied by Wald is the infamous Mary Mallon, better known by the unfortunate epithet of "Typhoid Mary." A cook employed in the New York City area in the early 1900s, Mallon infected a series of employers F REGISTERED NURSE 13