Buy now on Amazon: Cutting for Stone

This book  is a fictional story narrated in the first person by  someone who  spends most of his life in a setting that most of us would not expect to identify with or relate to. That is growing up on the grounds of a hospital in Eithopia with one’s identical twin and loving adoptive Indian parents who are physicians along with the dedicated servant staff including the daughter of one them who is your age. You only know that your biological mother was a nun who died in childbirth and your biological father was a brilliant surgeon at the hospital who fled the country  after an abortive effort of crushing the skull of your identical twin in order to try to  extract him in a stalled delivery prior to you and your brother ultimately being saved through a Caesarian section performed by your soon to be adoptive father who was internist. Shortly thereafter your adoptive fathers would marry your adoptive mother who was the Ob-Gyn physician at the hospital who happened to be out of the country at the time of the tragic circumstances of the beginning of you and your brother’s life. As unique as all these circumstances seem to be, the subsequent issues in the life of the narrator while unusual are things that do happen in the course of human events and become powerful determinants of one’s life story.  Despite being identical twins, the narrator’s brother seems to be on the “autism spectrum”, talking at a late age and usually saying very little, having minimal capacity for experiencing and expressing interpersonal emotions, although being objective to the point of ultimately developing an interest and a single minded obsession in women’s fistulas which leads him to wide recognition for his knowledge and advocacy in this arena . His directness as a young man leads him to a sexual experience with the daughter of the household servant which sets off a crescendo of events that go on through a lifetime of the characters in this book. As is so often the case of lives and events, each intersection makes a change which will be so important in another significant event  which will change another one. One misunderstanding or missed opportunity has set up a future event, which will forever change one’s life.  Because the author has chosen to follow his characters for significant portions of their life cycle we come to know them in great depth so we empathize with most of them in a very meaningful way. We do pay a price for this depth of knowledge and understanding of the characters as the author has intertwined his narrative with endless detail about external events of climate, vegetation and seemingly unrelated incidental thoughts of the characters.  I had to fight my obsessive style of not skipping sentences or paragraphs in a book as I usually deplore the style, which skims ahead for dialog or events in a wordy book although at times I lost this battle.  The final reward for reading this book is an insight into one family and a glimpse of life in Ethiopia during the regime of Halle Sal isse as well as a little bit of the feel of the revolution which disposed him . The author being a physician also writes in great detail (sometimes more than you need) about the medical issues of the people who come to the hospital and as well those of some of the characters whom you have come to care bout.  He also blends in some ethical dilemmas which not only challenged the characters but will most likely fascinate the reader. In the end the reader has taken a meaningful journey  with the narrator and the people close to him and you cannot help but feel you are the richer for it.

Hidden Impact: What You Need to Know for the Next Disaster: a Practical Mental Health Guide for Clinicians: A Practical Mental Health Guide for Clinicians, by Frederick J. Stoddard, Jr., Craig L. Katz and Joseph P. Merlino,  Published by Jones and Bartlett Publishers, Boston, 2010, 249 pages

Review originally published in the Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry

Most clinicians who have expertise in mental health aspects of disaster developed their skills in this area after they found themselves seeing patients following some tragic event. It is true that well trained clinicians know about acute stress, loss, grief and PTSD since these conditions come up in many forms with many patients. However, the application of their clinical skills in the midst and in the aftermath of disaster is a whole different ballgame. Having co-taught a course in disaster psychiatry for several years at the annual meeting of the  American Psychiatric Association, I heard this story many times as colleagues joined us for the course after experiencing a disaster in their area.

There are many courses seminars, journal articles and books which will inform you in great depth about the essential topics in disaster mental health, many of them written and edited by the editors and contributors of Hidden Impact. The book is originated from the Group for the Advancement of Psychiatry (GAP) where the authors ore members of the Committee on Disasters and Terrorism . GAP has a tradition of identifying important areas of mental health and supporting publications in these areas. In my opinion this book fits the bill as the first book on this subject you should read or if you were only reading one book this is the one to read. It is the book that you will throw in your suitcase if you find yourself traveling to a site to render care in the aftermath of a disaster

In 250 pages this is  as comprehensive a course of study on this subject as I have ever seen in a book this size. It is well written, interesting and quite practical. Each chapter starts with a vignette, which either centers on victims of a disaster or on the caretakers faced with the dilemma of dealing with the aftermath of such an event.  The book is filled with practical information such as a comprehensive check list (and I do mean comprehensive) of  what to take with you if you go into an area to render care.( ie, pack your own power, take local maps, support socks, brimmed hat, iodine for water decontamination etc. There are clinical tables and charts to be sure you don’t miss the basics such as what to expect during the impact phase (first 48 hours) acute phase (1-8 weeks), post acute phase (2 months and beyond). There are many clinical screening tables such as the one for PTSD in children. There is a discussion and review of pharmacology in disaster situations. There are chapters on the use of telepsychiatry, liability, ethics, staff support as well as some of the latest thinking on resiliency. There is also a list of useful resources including websites

You should not be surprised to  find that if you are working in a  disaster situation, you will be interacting with the media as well with community leaders who have the responsibility to make reports to the media . In this regard the topic of risk communication and “how to do it“ is well covered in a succinct chapter. By the way, your clinical skills can also be useful to members of the working press who are often traumatized by working in a disaster environment. This latter clinical issue is discussed in the chapter about  understanding and helping first  responders. It is clear that the we need to apply our knowledge of the psychological impact of disasters not only to the primary victims  but also to the secondary victims who come to the aid of others. That of course includes ourselves. Perhaps one of the most valuable tables offered in the book is a table from SAMHSA (Substance Abuse and Mental Health Services Administration) about  managing and preventing stress, which includes the signs that you may need stress management assistance and ways to help manage your own stress.

As an added bonus the book is approved for AMA PRA Category 1 CME credits with instructions for getting Continuing Medical Education Credits from the Medical Society of The State of New York.

Addendum:  This review would not be complete without mentioning a recent book which should be a companion piece to this one. It is edited also by two of the same authors Fredderick J Stoddard and Craig Katz along with Anand Pandya and includes chapters by Merlino and many others on similar and related topics. It is titled Disaster Psychiatry: Readiness, Evaluation and Treatment. Published by the American Psychiatric Press, 2011.