2013; Volume 14, No 6, June
IAHPC book reviews
By Dr. Roger Woodruff
Palliative Care Book of the Month
NARRATIVE MEDICINE
Honoring the Stories of Illness
Rita Charon
Oxford University Press, 2006
266 pp
ISBN 978-0-19-534022-8
RRP $US26.50, £15.00
This is not a new book, but I felt it had something special for palliative care. Rita Charon is Professor of Clinical Medicine and Director of the Program in Narrative Medicine at the Columbia University College of Physicians and Surgeons in New York. I think it is appropriate to say that she is the mother of Narrative Medicine.
So what is Narrative Medicine? It’s medicine practiced with the narrative competence to recognize, absorb, interpret and be moved by the stories of illness. It provides health care professionals with practical wisdom in comprehending what patients endure in illness and what they themselves undergo in the care of the sick. And what is ‘narrative competence’? It’s about listening carefully, disciplined and considered reflective writing, mixed with training in literary understanding and appreciation; but it’s not quick or easy and involves a ‘constellation of learning’. ‘Huh?’ you may ask. I think the thesis of this book is that if you are trained to listen better to the story being told by the person who is your patient, have the skills to write about it and reflect upon it, you may become a better doctor (or nurse, or other healthcare professional). And I think I believe her.
Charon sees this as a new and better way to practice medicine, and she may well be right. From where I sit, I had trouble with how one accommodates this on a busy ward round or a fully booked morning in the office. But perhaps I’m showing my age.
I couldn’t help feeling that there was something special here for palliative care. Delving the whole person, listening to their story, seeking what they do and do not want. It’s about ‘Hearing the patient’s story’. That we may have more insight and appreciation of what we do is almost a bonus. I would recommend this book to anybody working in palliative care, as it will bring them face-to-face with issues related to the patient/healthcare professional interaction that in all probability had already been troubling them. It is not a recipe for practicing palliative care, but there are some gems here.
My only criticism relates to accessibility. For someone with Doctorates in Medicine and English, some of her descriptions of literary style were difficult to understand (or in Charon’s words, were impenetrably obscure). A second edition, with less about the history and theory of Narrative Medicine, and more about the healthcare professional/patient interface (with fewer long words) would be a delight.
Other Reviews
THE HOSPICE COMPANION 2e
Best Practices for Interdisciplinary Assessment and Care of Common Problems During the Last Phase of Life
Perry G. Fine and Matthew Kestenbaum (Eds)
Oxford University Press, 2012
186 pp
ISBN 978-0-19-984079-3
RRP $US32.95 £22.50
This is the revised and updated second edition of Hospice Companion, first published in 2008. It aims to be a pocket-sized, ready-reference for those working in hospice and palliative care. It is a little different to other manuals in that it emphasizes the multidisciplinary management of medical problems (i.e. holistic care) and it pays attention to the system and to quality (e.g. what should be documented in the medical record).
The opening chapter is about the structure and function of palliative care and the interdisciplinary team. The second is about personal, social and environmental matters, which boil down to a thorough assessment of personal and psychosocial matters. Reading through the bullet-point lists, I often had to pause, which indicated to me that a lot of thought had gone into compiling the lists.
Chapter 3 is about the management of 25 different symptoms or symptom complexes, from Air Hunger to Xerostomia. These are concisely written and pay attention to psychosocial matters in addition to the medicine, and include the goals of care and what should be documented. In general, these present the relevant information in a useable form. However, the section on Dyspnea starts with an admonishment to never delay palliative treatment with morphine or an opioid. Whilst I agree that patient comfort is very important, I think the reader should be guided to first consider the possible causes (which only appear a page or two later). Patients with a large pleural effusion or pericardial tamponade may not be helped by a substantial dose of morphine given because they were short of breath.
One more gripe—what’s with ‘emergent’ treatment? According to my dictionaries, the non-botanical meanings of ‘emergent’ are emerging and new. So emergent treatment means a new or emerging treatment. My OED, put out by the same firm that published this volume, gives a historical note that ‘emergent’ was improperly used for ‘urgent’; four hundred years ago. I would have thought ‘urgent treatment’ and ‘emergency treatment’ were unambiguous and better English.
Overall, this would be a useful introductory reference for residents and trainees on a palliative care service to help them get their head around the medicine of palliative care as well as what the system requires.
EMPATHY FATIGUE
Healing the Mind, Body, and Spirit of Professional Counselors
Mark Stebnicki
Springer Publishing Company, 2008
242 pp
ISBN 978-082611544-7
RRP $US55.00, £42.95
Written by a psychologist/counselor and based on the scenario of human-made and natural catastrophes, this book provides a good description of professional empathy fatigue, also known as compassion fatigue or professional burnout. Although we do not have to deal with mass human disasters in oncology and palliative care, compassion fatigue is a genuine problem. How to recognize it in those we supervise and in ourselves is important. Stebnicki details self-care strategies to help prevent compassion fatigue and avoid the physical, psychological and spiritual costs.
ENVIRONMENTAL GERONTOLOGY
Making Meaningful Places in Old Age
Graham Rowles and Miriam Bernard (eds)
Springer Publishing Company, 2013
320 pp
ISBN 978-0-82610-813-5
RRP $US65.00, £54.95
Here’s a topic I know very little about. I learned the difference between spaces (locations that, in and of themselves, have no meaning) and places (those same locations transformed through processes of habitation and life experience into sites of great meaning that reinforce individual and group identity). The environments in which people live out their later lives have a strong impact on their identity and provide opportunities for nourishing social interactions. This book is all about how we should design residential environments and public spaces, as well as make models of social care and human service practices to enhance the well-being, in this case, of the elderly. There are chapters about the meaning of place in residential and public spaces, creating and sustaining home-like places in residential environments, the importance of intergenerational contact, acclimatizing to assisted living, as well as a chapter on people with dementia. In the last chapter, the editors synthesize the past, present and future in designing private and public environments for creating and sustaining places. I think that they regard it very much as a work in progress. If you work in palliative care, particularly if you work in residential or long-term care facilities, this book may provide you with insights as to how the environment can affect the quality of life. If you design or manage such facilities, you should definitely read this book.
BEGINS THE NIGHT MUSIC
A Dementia Caregiver’s Journal
Samantha Mozart
2012, 186 pp
ISBN 978 147830 5668
RRP $US12.99, £7.45
‘Emma, my mother, was a sweet, beautiful woman, an accomplished watercolorist and pianist, who loved entertaining, travel and raising her toy poodles, until one day she laid down her half-finished sketch, slipped into dementia and I fell backwards into becoming her sole caregiver.’ That sounds bad enough, but it is made tougher when you know mother is 97 years old and the daughter-caregiver is 70. I give her full marks for being there with her mother, and I give her full marks for fighting with the Medicaid bureaucracy to get what her mother needed. This book will be a help and comfort to other people struggling to cope with elderly parents who are dementing.
Roger Woodruff, MD (Australia)
May 2013
Dr. Woodruff is a Lifetime Member of the IAHPC Board and Past Chair. His bio may be found here.
Note for authors and publishers: If you wish to have your book reviewed, please send to:
Dr Roger Woodruff
IAHPC Bookshop Editor
210 Burgundy St, Suite 9
Heidelberg, Victoria 3084
AUSTRALIA
Note: Review copies become property of IAHPC and are not returned to the author. Only palliative care related books which are previously approved will be reviewed. Due to the large number of requests, we can't provide exact dates of when books will be reviewed.