The Checklist Manifesto: How to Get Things Right by Atul Gawande will finish off my trio of must-read medical books. A hospital, as the saying goes, is no place for sick people. It’s filled with potential disasters to your health, infections, missed diagnoses, dosage mistakes (think Dennis Quaid and the Heparin debacle with his newborn twins) and other complications that pop up from human error and in a hospital, human error seems a pretty sure bet.

But Dr. Peter Pronovost, a critical care specialist at the Johns Hopkins medical center in Baltimore, thought he knew how to minimize human error. The plan he put into effect was, as Dr. Atul Gawande describes in this book:

” . . . an idea so simple that it seemed downright loopy. In 2001 Dr. Pronovost borrowed a concept from the aviation industry: a checklist, the kind that pilots use to clear their planes for takeoff. In an experiment Dr. Pronovost used the checklist strategy to attack just one common problem in the I.C.U., infections in patients with central intravenous lines. Central lines can be breeding grounds for pathogens; in the Hopkins I.C.U. at the time, about one line in nine became infected, increasing the likelihood of prolonged illness, further surgery or death. He wrote down the five things that doctors needed to do when inserting central lines to avoid subsequent infection. Washing hands, wearing hospital gowns etc. but knew that about one-third of the time doctors were skipping at least one of these critical steps. What would happen if they never skipped any? He gave the five-point checklist to the nurses in the I.C.U. and, with the encouragement of hospital administrators, told them to check off each item when a doctor inserted a central line — and to call out any doctor who was cutting corners. The nurses were strict, the doctors toed the line, and within one year the central line infection rate in the Hopkins I.C.U. had dropped from 11 percent to zero.”

Dr. Atul Gawande, who in addition to practicing medicine, is also a popular writer for “The New Times,” heard about this study and wrote a series of articles on it and then decided to turn those into a book. As he states so elegantly,

“If something as simple as a list that reminds medical personnel to wash their hands and introduce themselves by name and job to everyone in the operating room can improve care, that’s reason enough to take the checklist concept seriously. What a powerful insight this is: In an age of unremitting technological complexity, where the most basic steps are too easy to overlook and where overlooking even one step can have irremediable consequences, something as primitive as writing down a to-do list to “get the stupid stuff right” can make a profound difference.”

-Norma

I have written about Alice Walker before. In case you don’t know, Alice is Rebecca Walker’s mother. As I read more and more by and of Alice Walker, I became more interested in her daughter, Rebecca. I then found that she is a published and well-respected author and activist in her own right. I have had her memoir, Black, White and Jewish, on my bedside table for some time but was afraid  I would not have the time to finish. So I when I realized that she had edited collection of short essays from different authors writing about their own family life, I thought I could at least read one. Well, I am almost finished with One Big Happy Family. It has been a thought-provoking read. I recommend it to anyone who is interested in learning more about the great variance of family structures.

While I knew that a new collection of essays, The World Has Changed: Conversations with Alice Walker, was coming out in April, I learned this weekend that Alice has a book of poetry coming out in September 2010: Hard Times Require Furious Dancing.

Alice also has quite an informative website these days. Rebecca has one as well. Sadly–and while both are inspiring women–Rebecca and Alice have not had very good relations. If you have read both of their works, you would understand why I add this comment. When I read Alice and Rebecca, I do not admire them so much because I relate or agree with everything they say, what keeps me reading is the privilege of witnessing a woman’s development. Both of them are very adept at showing show how they work through life’s intricacies. And I think that this is what keeps me reading One Big Happy Family–I can witness and learn from so many different types of families dealing with life.

There are lots of great reasons why independent bookstores should be supported, and the other day I read an article that reminded me of what is perhaps MY favorite part of exploring independent bookstores (and also it’s one of my favorite parts of working at one): our displays!   Believe it or not, the piles of books you trip over when you walk in are actually lovingly, carefully crafted selections of what we think you should read.  There’s such a great chance of stumbling upon something lovely that you never figured you’d read just by walking around and looking.

Since March is National Women’s History Month, we’ve put together an appropriate display that ranges from Grace Kelly to Joan of Arc, and which also happens to include a recently released book I’ve just begun: The Immortal Life of Henrietta Lacks.  It’s one of the most bizarre stories I’ve ever heard and since I’ve not read the entire book yet, I’ll just try to condense the premise here.  The story itself is enough to spark anyone’s interest.

Henrietta Lacks was born in Virginia in 1920, the daughter of a tobacco farmer.  She went on to marry her first cousin and move up to Maryland, where she gave birth to five children.  She and her family were poor, and when Henrietta died at age 31 due to complications brought on by cervical cancer, she was buried without a tombstone in a family cemetery back in Virginia.  To this day nobody knows exactly where her body is buried.

What most people – her family included – didn’t know about Henrietta when she died was that when she was being treated at Johns Hopkins for her cervical cancer, her cells were taken without her permission.  In fact, she didn’t even know they were taken.  Researchers took a look at them and found out they could be kept alive and grown – something scientists had been desperate to succeed in doing.  The cells of this African-American woman who died poor and young and in pain were named ‘HeLa’, and it’s thanks to HeLa that a polio vaccine was developed.

HeLa has since been mass produced and used to help doctors research AIDS and cancer, study gene mapping, and realize the effects of the atom bomb, among other things.  They’ve been mailed to curious scientists all over the world and here’s a neat fact: 50 million metric tons of her cells have now been grown.

Another kicker is that Henrietta’s family only found out about her still-living cells about 20 years after her death.  They didn’t get any profits from her ‘immortality’, and in what feels like an unbelievably cruel twist, they couldn’t afford health insurance.

It’s an alarming story that raises confounding questions about race, class, science, and bioethics.  Author Rebecca Skloot writes with authority and sensitivity, and so far I can’t put the book down.  As I said, it’s on our women’s history month display, but it also goes beyond that – it’s a science book, a history book, and a civil rights book too.  I don’t think I’ve ever read anything so fascinating.

Susie

Watch out for the Jacksonians interviewed at Lemuria via Skype!

Our Hero Capt’n Max got in his airship and left.

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With characters dancing in the fullness of life.

With music flowing from sentences.

With cleverness of shock and awe.

With flypaper humor that stuck memorably,

always creating joyful grins and belly laughs.

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Barry’s words of wisdom bombed our minds

and touched our souls.

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His writing woke us up to this wild crazy life around us.

We thank Barry for the smiles and words he left us.

His great gifts.

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Bon Voyage, Dear One, We will miss you.

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Lemuria.