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worldview and your work will be greatly informed for the better by reading this book. I highly recommend it. —Lucia Hwang Slow Medicine: The way to healing By Victoria Sweet; Riverhead Books Victoria Sweet is a proponent of what she calls the "Slow Medicine" move- ment, in which medical providers basically take the time and effort to look at a person holistically, taking into account not only what is physio- logically and psychiatrically going on with a patient, but what is happening socially, emotionally, environmentally, and even spiritually. Slow Medicine views human beings much like plants that will naturally grow and thrive given the right nutrients and condi- tions. Doctors and nurses are much like gardeners who caretake and nurture their charges, removing obstacles to and helping establish conditions for health. "Fast Medi- cine," in contrast, views the human body as a machine, albeit an intricate one, and medical providers as mechanics who can fix this organ or that condition with an operation, procedure, or prescrip- tion drugs. Sweet sees the pros and cons of being a practitioner of both, but definitely believes that modern medicine has swung too far in the Fast Medicine direction and personally strives to find the right balance between the two. Sweet's explains her journey to Slow Medicine through a chronolog- ical telling of her career and how she came into her own as a physician, and the book is mainly vignettes of various patients she has encoun- tered who taught her this or that lesson over the years. The structure is a little predictable and contrived, but the stories get through. One point that is hammered over and over again in her stories is that it is absolute- ly critical to thoroughly, physically examine the patient and, often, meet their families to get the patient's full history, or story. She starts off the book relating a serious medical episode her father experienced. Her 93-year-old father, who had a history of seizures, had suffered another seizure, likely because he had forgot- ten to take his medication. He was admitted to the local hospital and mistakenly diagnosed as having had a stroke. Even when Sweet pointed out this error to the staff, nobody seemed to be able to cor- rect this in his electronic health records. The hospital kept treating him as if he had had a stroke, and, frustrated, restrained, tranquil- ized, cathetered, and being treated for something he didn't need to be treated for, his condition quickly deteriorated to the point where Sweet gave him a 50-50 chance of surviving. Desperate to get him discharged, Sweet's family actually asked that he be released to hos- pice, where he quickly regained his strength and fully "recovered." Disturbed by the entire near-death experience, Sweet sits down with her father's 812-page electronic health record, his chart, and tries to decipher what happened. She found no story about her father's care, only page after page after page of pharmacy orders and nursing notes, which were just checked boxes. "No one took respon- sibility for the story," said Sweet. "The essence of Medicine is story— finding the right story, understanding the true story, being unsatisfied with a story that does not make sense." Registered nurses who spend the most time with patients and their families understand the importance of looking at a patient in his or her entirety, and will cheer Sweet's "slow" approach to medicine. The problem, however, is that Sweet does not directly address or offer solutions to how practitioners are supposed to be able to employ Slow Medicine in the context of our current corporate, prof- it-driven healthcare system. To maximize the bottom line, employers and insurance companies push nurses and doctors to spend less time, employ technologies that prevent face-to-face examinations, discourage narrative charting, rely on pharmaceuticals, and basical- ly, get patients in and out as quickly as possible—often prematurely. At one point, while working at a community clinic in, we surmise, the 1970s (she doesn't actually give dates), Sweet meets a high-level regional administrator, a portent of the future, who declares that "Doctors are health-care providers and patients are health-care consumers. It's the economic model." Sweet does not instinctively see her work or patients in this way and this view is antithetical to her own. "My patients didn't choose to spend money on health care," she writes. "They didn't have any money to spend and then they got sick. Then they came to the clinic or the hospital and depended on me and mine to get them better." To buck this paradigm, Sweet hints at the power healthcare workers hold, but unfortunately does not elaborate her line of think- ing to its logical, full conclusion [Eliminate profit in healthcare!]. In one story, the workers at the community clinic want a raise, but management refuses—though Sweet, through a short stint in man- agement, knows full well the clinic can easily afford the raises. At a union meeting, the employees run through their options. They rule a strike out as "unethical" (with which we National Nurses United RNs clearly don't agree). They bemoan their lack of leverage. Suddenly, Sweet realizes that they have all the leverage: The work- ers are powerful because they do all the work. "Downstairs was the clinic. There was nothing Upstairs [management] that wiped a single tear or bandaged a single cut. We didn't need Carlos and Upstairs. They needed us," Sweet writes. She suggests that, as a protest, they move the entire clinic outside and see patients like normal. "But we won't bill. We'll still care for our patients Downstairs but there will be no money for Upstairs." Sadly, the clinic employees did not get a chance to carry out their radical plan because a mole within the group informed the executive director, who, the next day, acquiesced to their raise. "So we never did get to try out my vision, which I regret to this day. I have never forgotten the power of that moment…as all of us health-care workers realized we had the power to make the changes that needed to occur. If we would only decide to use it." Registered nurses make many appearances in Slow Medicine, and it's obvious that Sweet has tremendous respect for them. There's Kathy, who improvises a trach tube on the street with a penknife and a cop's soda straw and whose tenacity and caring save another patient from an exploding aneurism. There's Becky, who knew "everything there was to know about everyone in town" so that she could, "without betraying any confidences…convey to us what was really going on with each patient." There's Nurse David, who is "fear- less and kind" in caring for AIDs patients during the 1980s epidem- ic, and who himself succumbs to the disease. Sweet ends the book urging a return to Slow Medicine and pre- dicting a time when healthcare will incorporate the best aspects of slow and fast, but I find it a little naïve to think that will happen with- out actively fighting for it, and that's where I find the book weakest. But as an introduction to the concepts and simply for the pleasure of the stories, Slow Medicine is still a worthwhile read. —Lucia Hwang J U LY | A U G U S T | S E P T E M B E R 2 0 1 7 W W W . 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