Wednesday, December 31, 2014

Small: Life and Death on the Front Lines of Pediatric Surgery

Book 77 of my 2014 Reading Challenge

Small: Life and Death on the Front Lines of Pediatric Surgery 
by Catherine Musemeche, MD

Summary (via Goodreads)
As a pediatric surgeon, Catherine Musemeche operates on the smallest of human beings, manipulates organs the size of walnuts, and uses sutures as thin as hairs to resolve matters of life or death. Working in the small space of a premature infant's chest or abdomen allows no margin for error. It is a world rife with emotion and risk. Small takes readers inside this rarefied world of pediatric medicine, where children and newborns undergo surgery to resolve congenital defects or correct the damages caused by accidents and disease. It is an incredibly high-stakes endeavor, nerve-wracking and fascinating.
Small: Life and Death on the Front Lines of Pediatric Surgery is a gripping story about a still little-known frontier. In writing about patients and their families, Musemeche recounts the history of the developing field of pediatric surgery--so like adult medicine in many ways, but at the same time utterly different. This is a field guide to the state of the art and science of operating on the smallest human beings, the hurts and maladies that afflict them, and the changing nature of medicine in America today, told by an exceptionally gifted surgeon and writer.

My Opinion
Fetal surgery is fascinating and unimaginable. I understand why no names could be used but using letters instead of pseudonyms (such as "Baby K"), as well as focusing strictly on the operating room with no backstory, made it a little more detached for me. That's probably a good thing, as I would've been a weepy mess if I had been any more invested; I definitely hugged my kids a little closer when reading.

By far, one of the most interesting chapters to me was when she talked about the differences between childhood and adult cancers. There are the obvious physiological differences, along with the difficulties designing and obtaining medical supplies for the tiniest of children. I also didn't realize (going off of her statistics, which I did not independently verify) 60% of children are enrolled in clinical trials versus only 3% of adults. The thing that really made me pause were her observations about the huge advantage children have over adults in regards to how they are cared for. Parents are the most invested caregivers and will rearrange their entire lives to ensure the best care for their children; as she says, "parents have an unique stake in the health of the child, someone they value above all else". If it is a spouse that is ill, they will still do their very best but it isn't the same as caring for a child. Parents note the smallest changes in their child's symptoms that a spouse may miss in the chaos of life. Parents make sure their children eat and drink and take their meds even when they don't want to, spouses may defer a little more.  

To contrast, I lost interest when she talked about obesity and moved on from those sections quickly.

Listening to the early days and how quickly something went from an idea to an usable product (only 6 weeks from the time Tom Fogarty first produced a balloon catheter for a new technique of removing blood clots until it was first used on a patient) was almost unbelievable. I understand the needs for trials and regulations but can also understand the huge frustration of knowing something is in the works but won't be available to help your patients for years.

A Few Quotes from the Book
"Every baby makes a lengthy journey to get to this place we call 'life', but they don't all show up ready for it when they arrive."

"Will the surgeon find a nameable condition within her power to repair? Or will she encounter something not so easily fixed, a diagnosis that sentences the patient to a series of complicated operations, a situation plagued with setbacks and months of hospitalization? Even worse, will she find organs so grossly malformed or incomplete that she can only palliate and close, becoming the messenger of grief to despairing parents in a darkened hallway? The answer, only minutes away, lurks beneath the skin in the shadow of a scalpel poised and ready."

"No matter how small, this most vulnerable of humans is a potential patient, one who has captured the imagination of surgeons dedicated to rerouting gestational detours so a child can have a shot at a normal life."

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