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My Imaginary Illness: A Journey Into Uncertainty and Prejudice in Medical Diagnoses By Chloë G.K. Atkins; Cornell University Press A s nurses well know, medicine prefers that patients' illnesses be easily identified, named, and treated—essentially, neatly boxed and wrapped with a bow on top. Unfortunately, many people's health issues rarely present themselves that way. Such was the case with Chloë Atkins. Starting at age 21, Atkins began suffering numerous health issues, including extreme fatigue, loss of muscle con- trol, and other symptoms of a major neurological problem. Doctors could not conclusively diagnose what was wrong with her, though, and classified her disease as psychosomatic—a label in her charts that would doom her to life as a medical pariah. No medical providers would take her illness seriously, and some even acted cruelly towards her as if to punish her for wasting their time and resources. Over the coming years, she continued to deteriorate and bounced from physician to physician, hospital to hospital, and medical crisis to medical crisis without receiv- ing the help she needed. Eventually, she became a quadriplegic and was confined to a wheelchair for years. Her body was at times so paralyzed that she could not breathe on her own and had to be intubated. Only after more than a decade of mistreatment by the medical profession did a doctor finally suggest that Atkins suffered from an autoimmune neuromuscular disease called myasthenia gravis. Atkins, however, still did not pass all the tests used to officially diag- nose myasthenia gravis. Through persistence, however, she was final- ly able to find specialists who were willing to treat her as if she had myasthenia gravis and to prescribe her the medications she needs to suppress her immune system. The results were extraordinary. Though she still suffers from muscle weakness and tires easily, Atkins regained the ability to walk and perform all the other functions of daily life. Today, she is an associate professor at the University of Calgary. Atkins' story offers many lessons to nurses and other medical providers. Especially with modern medicine's emphasis on "evidence-based practice," patients who do not fit a standard, text- book presentation of a disease may fall through the cracks and be denied the treatment they desperately need. Atkins' experience also provides insight into what might happen to a patient who is written off as psychologically causing their own illness and whether those labels are more often, and unfair- ly, applied to women versus men. You can't help but wonder if a middle- aged man suffering from Atkins' same symptoms would have been told that "it's all in your head"? Besides evoking these many ethical questions and dilemmas for the medical profession, Atkins' story is also, at its heart, a com- pelling read about a patient struggling against a mysterious illness. Along the way, she finds love, hope, and the closest thing to a cure that she can get. —Lucia Hwang E very nurse has seen it at some time. We all know that sometimes nurses are our own worst enemies. We've all heard that "nurses eat their young." At one time or another, most of us have had a bullying coworker, charge nurse, or supervi- sor—the nurse who seemed to live to make others miserable. So when I saw the title of this book I had great hopes for it. And the author gets quite a lot right. Her analysis centers around "relational aggression," defined as "gossip, exclusion, teasing, tormenting, undermining, cyber- slamming, and a host of other verbal and social behaviors designed to wound another person." This is described as being mainly a female phenomenon which caused me, as a male RN, to approach this reviewing task with some sense of diffidence. I found considerable interest in the description of the problem, the examination of its extent, and the damage it causes: excess turnover, young nurses leaving the profession, even possible increased risk to patients from poor communication among caregivers. The author presents quite a number of anecdotal examples and case studies, several of which would be familiar to almost any nurse. There is also some thought-provoking work on the root causes of the prob- lem. Reading some of those comments kept my hope alive for what this book might have been: "Perhaps a sense of overt powerless- ness leads to more subtle struggles through aggres- sive behavior." Here's another: "According to the theory of oppressed groups (Fanon, 1963; Friere, 2000), people who are domi- nated by others turn on each other and become self-deprecating because they have internalized the values of the group in con- trol." And here's a good one: "What other profession expects employees to go for hours without food, drink or bathroom breaks?" But despite explicitly recognizing these causes of nurse-on-nurse aggression, the author entirely fails to take the next step: To tell us that taking power in our profession and changing those conditions is a critical part, perhaps even the critical part, of the response to rela- tional aggression. Instead, she offers a recipe for individual transformation. Rather than working to change oppressive conditions, nurses are to learn to endure them in a more functional way. Even though she makes clear that much of this aggression can be attributed to the unreasonable stresses of our work, the author—typifying the academic nurse's anti- union bias—shies away from the next logical step: banding together to change those stresses through collective action. In sum, there's a lot in this book of interest. It's too bad it fails to fulfill its full promise. —David Welch, RN 16 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 J U LY | A U G U S T 2 0 1 1 When Nurses Hurt Nurses: Recognizing and Overcoming the Cycle of Bullying By Cheryl Dellasega; Sigma Theta Tau International Books_REV 2 8/16/11 5:16 PM Page 16