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Book Review: Monday Mornings

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Book Review:
Monday Mornings
By Sanjay Gupta, M.D. -- Grand Central Publishing, N.Y., 2012

When this book was released, as a great fan of Dr. Sanjay Gupta, I immediately marched down to my local Barnes and Noble and picked up a copy of his novel. Yes, a novel -- not a medical guidebook.

For those unfamiliar with the ubiquitous Dr. Gupta, he is the CNN senior medical correspondent, a practicing neurosurgeon, and a frequent reporter on 60 Minutes and other network shows. He is a most affable doctor who dares to run marathons, and live and eat right to model what he preaches. But a novelist? That is really pushing the scalpel, so to speak.

I was intrigued by the novel's hook: As readers, we would be taken into the closed-door meetings that doctors have after a death (or near-death) of a patient to review what happened, and thereby to learn. These are called "M & M" rounds; that stands for morbidity and mortality, and they are not sugar coated. As a practicing physician myself I have been to (and led) my share of M & M meetings; in my specialty, psychiatry, they usually take the form of "psychological autopsies" -- when after the death (often by suicide) of a patient, clinical staff meet to carefully review what happened and determine what could be done better to prevent another tragedy in the future.

Monday Mornings, the book's title, are when the M & M conferences for surgery occur at the unforgiving hour of 6 a.m. in the remarkable Chelsea Hospital (choose which great hospital you think this may be) where doctors are heroes, ambitious and driven to be number one, kindly or unforgiving jerks, and (over time) revealed to be drawn from the same "crooked timber of humanity" that we all are.

Gupta, with his writing partner David Martin (whom he generously acknowledges), gives us both a medical tale and a moral tale. The medical tale is about surgeons and ER doctors, primarily, whose astounding feats of diagnostic acumen and extraordinary operative and emergency interventions seem to occur far more often than the usual doldrums that I have seen characterize hospital routines. Gupta's fictional neurosurgeons and ER jocks practice medicine on a thin tightrope that no one can repeatedly cross without falling off. In other words, there is no shortage of dramatic cases gone awry to summon the bleary doctors to face the unsparing critique of their peers before dawn on Monday mornings. Upon reading what goes on at Chelsea Hospital (where doctors, we are told, are apt to forgo great earnings to be great), you may wonder whose hands you will be in if you hit your head, have a stroke, or enter an ER in some grave medical state.

The M & M conferences are depicted with blunt narrative force. Surgeons' heads are (figuratively) cracked open by the pointed inquiries of the chief of neurosurgery and other daunting white-coated legends, egos are deflated, and lessons are burned into the cortices of all those attending. I thought that the careful dissection of what happened, and why that typifies a serious psychological autopsy -- also to prevent a future deadly outcome -- seems far less bloody than what happens in surgery, or at least in Gupta's surgical circles. Is one approach better than the other to get doctors to pay attention and do better next time?

The book's moral tale is no less forceful. Like Icarus, full of hubris, these physicians fly too high and too close to the sun's searing rays. Down is the only direction when that happens. There is a great deal of human carnage by the end of the novel, with no major protagonist spared as I took the body count. Grief darkened so many doctors' doorsteps -- ushered in by events at times seemingly just, at times deeply unjust or sometimes by life's indifference to it all.

What saved the book for me were the few tales of human transformation catalyzed by these unwelcome occasions of error and loss. These were the stories that left me feeling that the greatest medical miracle of all is human resilience.

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The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.

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