Wednesday, August 31, 2016

Off the Leash; Dog Medicine

By chance I picked up two different dog memoirs this month - it's rather fun, how different they are.

Off the Leash: A year at the dog park.
Matthew Gilbert (2014, Thomas Dunne Books)

Dog Medicine: How my dog saved me from myself. A memoir.
Julie Barton (2015, Penguin)

    Matthew Gilbert's Off the Leash is an anthropology of his local dog park, in Brookline, Massachusetts. Amory Park is an idyllic place, where dogs can roam and romp off-leash till one p.m. every day. Of course, there are a few mosquitoes in paradise, like the dog owners who won't clean up after their dogs, or acknowledge that they have an unusually aggressive one. If either of those characters sticks around for any length of time, the human pack will exert pressure till they either shape up or move on. 

    Gilbert was not used to being a pack animal. He's the tv critic for the Boston Globe, i.e. a professional couch potato; before he got married, he had not been a dog person at all. Partly under the influence of his dog park friends, he picks up the baby-talk ventriloquism that he had formerly scorned. 

    "It was crazy, of course, and shameless. The tangle of self and dog was intimate, psychodynamic, and pleasingly neurotic. Some people developed actual voices for their dogs, just as they'd translate their dogs' actions and facial movements into human traits." Oblique, side-by-side conversations make strangers friends.

    Gilbert tunes into his Labrador's friendliness and endless appetite for play, and it does him good. "Toby had made me a more contented, freer person, someone who lives and loves despite the outcome, someone who risks play and who no longer needs to forge excuses." Gilbert knows he is likely to outlive Toby, but the joy and love make it all worthwhile.

     Julie Barton was younger, and in far worse straits, when she acquired her Golden Retriever, Bunker. She'd moved to New York after college, following a boyfriend, and it was proving to have been a bad idea. Suffering a full-on nervous breakdown, she called her mother, who drove straight from Ohio to take her home. 

    A couple of therapists and some Prozac later, she became determined to get a puppy. A good idea, and the first productive idea she'd had in months, but it came with a wave of doubt and anxiety. How to choose? "He walked over toward me, then paused, still watching me, before coming closer and sitting down at my feet. He looked up into my eyes, his own mud-brown eyes nestled under expressive little eyebrow nubs, his tiny chin hairs glowing in the light, his orange-red paws caked with mud. In that moment, of course, I knew."

    Having a fellow-creature who needs her and cheerfully loves Barton opens up possibilities. Bunker goes with her when she starts a new life in Seattle. I don't want to say as much as I usually do about what happens from there on; Barton is a gifted story-teller, and it's her story to tell. Bunker remains a real sweetheart, and their mutual devotion remains Barton's lifeline to trust, health, and joy.

Barton's Dog Medicine is the deeper, better book, but if you're not in the mood for an emotionally intense experience, pick up Off the Leash instead.

Any Good Books
September 2016 email edition

Monday, August 1, 2016

Internal Medicine

Internal Medicine: A Doctor's Stories
Terrence Holt (Liveright, 2015)

Terrence Holt conceived of his account of internship and residency not as a memoir, but as a series of parables, "seeking to capture the essence of something too complex to be understood any other way." Not only are the patients composites of his imagination, the narrator is a transformation of Dr. Holt. "He struggles differently from the way I did, but in the end he learns things that it took me much longer to figure out." This narrator is good company. He sheds light on the uncertainty of the enterprise, both from a medical point of view – the same few symptoms apply to so many conditions – and on an interpersonal level: How do you keep listening to the patient who's been labeled a whiner, or whom you just don't like?

Part of the goal of training is to teach the young doctors how to appear confident even when they' are, inevitably, uncertain. "During those years, I always felt that I knew nothing. And no matter how much you did know, there was always more you didn't. In that vast desert of ignorance always lurked that one detail waiting to kill somebody." He's in a teaching hospital, so he is often without the complete medical record, because patients are being admitted by the house staff rather than their own doctors. Much can go amiss in this process; the history may be too complicated for the patient to remember or explain; she may be confused, demented, in shock or unconscious.

Or she may be lying, concealing something she's done, like the girl who swallowed a handful of Tylenol and damaged her liver. To assume she is lying leads to a certain cynicism that may lead directly to hardness of heart. It's always a breakthrough when the young doctor looks up from his lab results and sees a human being, but if they thought about that all the time, they'd be unable to do the work. "There is so much death and suffering and grief, and in the midst of it we still need to fill out forms, subject the sick to indignities and pain, try to eat and sleep and keep all these needy people at some kind of distance."

Dr. Holt has a chapter about some of the neediest, the patients in a mental hospital. He works a rotation in intensive care, where matters are somewhat simplified: keep the patients alive, with oxygen and antibiotics. (Or is it, kill them slowly?) And he goes out on hospice calls, where the patients are on the far side of need. But the families need something, and a doctor actually arriving with the nurse gives them a strange sort of comfort.

Three out of three people die, it's been said. Surrounded by family or alone, dimmed by morphine or amid the turmoil by a Code Blue, "in the middle of a scene with all the dignity of a food fight in a high school cafeteria. We can't cure everybody, but I think most of us treasure as a small consolation that at least we can afford people some kind of dignity at the end, something quiet and solemn in which whatever meaning resides in all of this may be – if we watch and listen carefully – perceptible."

If we watch and listen carefully. Here's hoping we can.

Any Good Books
August 1, 2016