{'fraction_non_alphanumeric': 0.03458394466568854, 'fraction_numerical': 0.0037727939635296584, 'mean_word_length': 4.392090395480226, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Reading medical memoirs.

I always feel a little trepidation when I pick up a medical memoir. The titles promise much (eg, Fourth Uncle in the Mountain: Memoirs of a Barefoot Doctor in Vietnam or Daktari: A Surgeon’s Adventures With the Flying Doctors of East Africa), but the books rarely deliver. The stories are usually formulaic. As Christine Gleason writes in her memoir: “Some of the stories are unbearably sad. . . . Others tell of babies who survived and did well, against seemingly impossible odds. And a few of the stories are downright embarrassing, . . . ” So why read another physician memoir? Because, even though they all cover roughly the same territory, they can, when the stories are well constructed, provide us with insights into our own life and work. They can surprise us. William Carlos Williams developed the template. His stories start with a call to see a patient. At first, the case seems simple. The doctor sets out to make quick work of it. Then, a surprising turn occurs. The pediatrician is ambushed by feelings that are often both unprofessional and all too human. Then, “ . . . the commonplace, prosaic, and trivial events in ordinary life” lead to “a sudden revelation of a person’s true character or the sudden understanding of the meaning of an event.” Sue L. Hall pulls this off in the story of an exchange transfusion gone bad. She had just reassured the anxious parents that this would be a routine procedure. But she does it too quickly, and the baby develops severe acidosis and then goes into ventricular fibrillation. Hall now thinks, “[h]ow could I have taken a baby who was in prefect health— except for his blood group incompatibility—and brought him to the brink of death?” She beautifully captures the sense of impending catastrophe: “My breath still felt frozen inside of me, but I had to shake it loose so I could inhale. I would need all my breath to outrun the freight train I felt barreling up behind me. Get the baby off the track, I thought.” The image of an onrushing train is powerful but not quite right. Her terror was particularly powerful because it followed her own carelessness. Because of that, the experience will shape the way she practices medicine for the rest of her life: “You can’t be too careful.” The story is the first in her collection. Even though she manages to save the baby, she is left with a nagging worry that all pediatricians must know: “I hoped I had not just created another disabled child.” That fear runs through each of these memoirs. Each author describes a case in which they struggle to decide whether it is appropriate to resuscitate a baby born at the borderline of viability. The birth weights of these babies outline the trajectory of pediatrics over the last thirty years. Mohrmann started her pediatrics residency in 1973, Gleason in 1979, and Hall a few years later. For Mohrmann, it was a baby who weighed 1000 g at birth. She wonders, “[s]hould we be resuscitating this child? Even if he survived— and I was by no means sure he would—did he not run an enormous risk of being significantly damaged by that long hypoxic period? Were we just ‘creating’ a baby likely to have severe cerebral palsy? Had my automatic rescue reflexes done something truly immoral here?” Hall, describing decisions regarding a baby who weighed 750 g, worries “ . . . that if she survived, she would have brain damage, mental retardation, or cerebral palsy. She could become blind or deaf. Was all of this highly sophisticated intensive care truly in the family’s best interests? Or the child’s?” For Gleason, the focus of concern is an oddly vibrant baby who weighed 450 g: “In those days, most of the littlest ones died . . . the ones who lived often seemed to have suffered devastating injuries—especially to their brains.” In each case, in spite of their doubts, the doctors and parents decide to treat the babies. In each case, the outcomes are surprisingly good. The implicit message is that pushing boundaries is good, that we must dare to innovate. Doctors clearly write, in part, to crystallize their own thoughts and feelings. Such writing can overcome the temptation to forget the emotionally difficult stuff. Physicianwriter Martin Winkler has this in mind when he analyzes his own motives: “I think that writing, for a doctor like for anyone else, is a way to take the measure of what we don’t remember, what we don’t retain. You write to try to knit up the holes in evanescent reality with bits of string, tie knots in transparent veils, knowing that they’re going to tear open somewhere else. One writes against memory, not with it. One writes to measure loss.” Clinical practice may encourage the opposite approach. Gleason notes that, in the neonatal intensive care unit (NICU),