Hits and Misses

Hits and Misses

Thursday, October 29, 2015

Atul Gawande's Being Mortal

The human condition is such that we all live with a contradiction.  Consider the Classical syllogism:  "All men are mortal.  I am a man.  Therefore, I am mortal."  When pressed, we reluctantly assent to its truth for our species, but nearly all of us refuse to believe it in our heart's core.  The eventuality of our own death is postponed, pushed off into the indeterminate future, far from now.  And even then, we fondly hope, a medical miracle may defeat death, if not forever, at least until we're really, really old.

Atul Gawande's Being Mortal:  Medicine and What Matters in the End (Metropolitan Books, 2014) goes a long way to blowing this fantasy out of the water.  Doctors are very skilled at performing operations to deal with specific problems.  But Gawande--a surgeon himself--points out that by recommending and performing these operations, doctors are being unwittingly cruel because their patients consent to them in the hope that they can continue to live longer--much longer.  The MD knows this is a stop-gap operation but doesn't want to depress the patient with that information.  The patient, meanwhile, is desperate to hold on to life, to do everything possible rather than "give up," and often doesn't want to disappoint the family.  Too often, this gap in communication remains unbridged.  The doctor does not admit that such surgery, even if successful, will only extend the patient's life a relatively short time and may well make the patient's quality of life even worse.  The  patient, on the other hand, never divulges to the doctor that the additional span of life being hoped for is on the order of twenty years

Being Mortal casts a wide net, covering the historical reasons why hospitals became the place to die and how they have begun to be succeeded by hospices, which offer palliative care focused on a patient's quality of life.  What sets Being Mortal apart, however, is less its analysis of the medical practices involving the terminally ill than its empathetic exploration of what happens when individuals approach the end.  Among other things, this is a book about specific individuals, and Gawande makes every one of them memorable.  Gawande is refreshingly candid about how difficult it is to engage in straightforward, honest conversations with a dying person.  Although I don't believe he ever uses this term, Gawande argues for a collaborative model of care for the terminally ill. The doctor not only provides information on what can be done but also asks the patient about his or her preferences about how to live and how to die.  He argues that the family needs to be brought into this collaboration as well, both to become informed about the patient's wishes and to ensure that the doctor does not make all the decisions. 

The last part of Being Mortal deals with the death of Gawande's own terminally ill father, a surgeon himself (his mother is also a doctor) who eventually opts for hospice care.  By writing about his own family's experiences, he illuminates a better way of dealing with the limited time left to an individual and how this process in turn can help the family cope with that death when it comes.  Described this way, it may sound barren, even cold.  It is not.  Rather, it is a moving account that makes the reader empathize with the entire family. 

This is a heart-warming book, humane in the best sense of the word.  Atul Gawande's Being Mortal:  Medicine and What Matters in the End deserves to be read by every adult in this country:  it is that good and that important. 

Saturday, October 10, 2015

Vickery's Advanced Gunsmithing: a Review

W. F. Vickery's Advanced Gunsmithing, which first appeared in the Samworth series of publications in 1940, has been reprinted this year by Skyhorse Publishing.  As the subtitle states, this is "A Manual of Instruction in the Manufacture, Alteration, and Repair of Firearms," and for once this is precisely what this book is about.  After a preliminary survey of shop equipment, Vickery explains "Barrel Changing and Its Adjustments," proceeds to "Chambering, Boring, and Reaming Tools," and then gives a clear account of "Rifling Tools and the Rifling of Barrels."  Actions and their alterations come next, then "Sights, Scopes, and Small Parts."  And so Vickery proceeds:  after rifles, shotguns; then rimfires; then pistols.  The following chapters discuss hand tool procedures, soldering and brazing, heat treatment, and bluing.  The last two chapters cover making cartridge dies and reloading tools.

I mentioned earlier that the subtitle is accurate.  So, too, the title:  this book covers advanced gunsmithing.  The beginner like me can learn from it, but not as much, I imagine, as the more experienced gunsmith will learn.  As in any craft, the more you know, the more you realize what you don't know.  Advanced Gunsmithing is valuable both for Vickery's broad coverage and for the insight he provides into methods of work current seventy-five years ago.  Like other Skyhorse paperback reprints, it is relatively inexpensive, so it should be a useful addition to any gunsmith's reference library.

Vickery is one of the clearest writers I have ever read, in no small part because he knows how to move from one aspect of a given task to the next.  It seems a bit odd, therefore, that this carefully arranged exposition has neither a table of contents nor an index.  I have never seen the original 1940 edition of Vickery's Advanced Gunsmithing or the limited edition published by Wolfe in 1988, so I don't know whether these omissions were present in the original or due to Skyhorse.  In any case, be advised:  it's a good idea as you read to make a running list on the end pages of the topics that interest you.