Book Summary: The Immortal Life of Henrietta Lacks by Rebecca Skloot

The Immortal Life of Henrietta Lacks is a diary of the woman, who is not very well known, but whose tissues were made of the immortal HeLa cells that have led to the discovery of some of the most important medications ever to be created. Henrietta Lacks is the reason that many of us are alive today – yet hardly anyone is aware of her existence.

The book starts out describing Henrietta’s finding of a lump on her cervix that she monitored as it grew extremely fast and went purple in colour, before she visited the doctors.

Henrietta Lacks’ family was not very wealthy, with their employment being on their Tobacco Plantation, yet the people using HeLa cells have developed a multi-million pound industry. The book is centred around the ethical dilemmas in medicine surrounding race, freedom of information and rules surrounding ownership of human materials. These issues led to the complete denial of the Lacks family to speak to people about Henrietta’s life as they believed that people were once again trying to make money out of them, whilst they ‘got no money’ out of the HeLa industry meaning that they could not afford their own medical care or education. Therefore this book is very special as Skloot put in effort and lots of time to build up a relationship with the Lacks family in order to find out the story of Henrietta Lacks and educate them on the importance of HeLa cells.

Henrietta was not given enough information about the condition she had, nor the treatment she was given leading to a complete breakdown in relationship and trust between the Lacks family and medical professionals.  The racial divide at the time of Henrietta Lacks’ life was very prominent so black people were seen as inferior to white people, worsening Henrietta’s quality of care. It disgusted me that Henrietta was unaware of the infertility caused by having a hysterectomy – with the doctor’s notes stating that ‘she would not have gone through with the treatment’ had she been fully informed about the treatment’s side effects. This is completely wrong and inhumane, and would be considered a complete failure in the NHS system today as now everyone has the right to be informed about treatment options, and has the right to deny any treatment that they do not wish to have. The Lacks family felt that ‘white doctors experimented on her because she was black’ and that John Hopkins ‘killed’ her. Henrietta Lacks died of metastatic cervical cancer on 4th October 1951.

The Immortal Life of Henrietta Lacks also explores the horror and outrage of the population as a consequence of the introduction of genetic engineering. People imagined ‘two-headed toads’ and that ’70 percent of babies would be grown in culture’. This horror is sometimes still expressed today with the fear of ‘designer babies’ being one example that is often talked about in the press. Furthermore, Skloot talks about the introduction of mass production of cells using culture mediums and Henrietta Lacks’ immortal cells. This new industry allowed more black people, particularly women, to be involved in scientific projects.

A huge problem faced when HeLa cells became commercially used was the question of whether to reveal who the woman was behind the cells. Hence, she became known as HeLa. People were interested to know who’s cells were helping to make all of the new scientific discoveries. However, revealing her name would have been breaching patient confidentiality laws. The family later stated that they would have preferred to have her name known so that they could have lived a more comfortable life and would have been made aware far sooner of the medical advances that were made as a consequence of Henrietta’s cells. Henrietta Lane and Henrietta Larson were names guessed to be the name of the owner of HeLa cells, but Henrietta Lacks was ‘never’ guessed.

A further ethical question is whether it was right to test potential transmission of cancer on Ohio prison inmates, who we would now consider too vulnerable to give consent to trials. It is very sad to hear that the inmates were not told that cancerous cells were being injected into them, breaching many current day human rights laws – although this, interestingly, did not breach the Hippocratic Oath. Stories of white people kidnapping black people for medical research led to the development of the Ku Klux Klan.

In addition, whether medical professionals should be allowed to map deceased people’s genomes is an ethical question. Scientists mapped Henrietta Lacks’ genome, using blood tests (described as ‘cancer tests’ to the family) of her relatives to study their DNA.

Henrietta’s daughter, Deborah, became very proud of her mum by the end of the book as Skloot educated her on the importance of HeLa cells and how they have helped a huge number of people due to their assistance in hundreds of scientific discoveries including chemotherapy, gene mapping and the polio vaccine.

 

Emily Buchanan

Book Summary: Your Life in my Hands by Rachel Clarke

I have spent most of the summer revising for my UKCAT and enjoying reading lots of books on holiday.

This book is focussed around current issues in the NHS from the perspective of a Junior Doctor, including negative feelings leading to striking beginning on 12th January 2016. It was written very recently so gives an up-to-date record of how our doctors feel about political decisions that are being made surrounding the NHS.

Your Life in My Hands continuously praises the work of the doctors and healthcare teams in England, and shows the dedication and compassion needed by the teams to continue to come to work and save lives, even when they feel that the government is working against them. I learned that doctors must be good at fast decision making and assertive in order to deliver news to patients and their families, as well as patient.

It is made clear that Clarke believes the government used the press to blame doctors’ lack of care and commitment to their patients as the reason they did not turn up to work in 2016. The real reason is the opposite in that they care so much about the patients and are being stopped by NHS guidelines and financial budget set out by politicians, preventing them from helping those in need, as well as already working weekends and wanting to be paid for these extra hours, and staff shortages. The hospital environment is now unsafe and Clarke states that every trust is suffering as much as the time of ‘scandal’ at Mid Staffordshire NHS Trust in 2013. The government using the press to blame Junior Doctors for the NHS’ issues has negative effects on the relationship and trust between doctors and their patients.

I found it very interesting reading that Jeremy Hunt breached patient confidentiality when responding to the social media spread of the hash tag #ImInWorkJeremy. This is shocking as he should be setting the example to all staff at the NHS to respect patients and their confidentiality, in order to maintain a strong patient-doctor relationship.

Some medical knowledge I learned by reading this book is the ‘ABC’ method of immediate assessment of A&E patients. A is for airway, B for breathing and C for circulation. It is important to check peoples’ voice, chest, hands and pulse for any abnormalities.

I love Clarke’s description of medicine as ‘reading a human body like a book and applying hard science to fixing its frailties’ because it captures both the need for strong academics as well as care needed to be a doctor.  I also liked how Clarke talked about being a doctor as an ‘honour’, ‘privilege’ and ‘calling’. I am extremely keen to be a doctor and would be honoured to follow my passion at university.

Clarke talks about the sadness of medical professionals after preventable deaths and how the government’s NHS policies are currently stopping the staff from doing their best, and may lead to many avoidable failures of the system.

The book touches on mental health of junior doctors, including high suicide rates and depression. It was sad to hear about a new doctor crying in the doctors’ mess saying that the work they are expected to is ‘unsafe, unfair and inhumane’. It is therefore important to look up to people more experienced than yourself in the medical profession and work as a team, in order to learn from their knowledge and experience. However, everyone is of equal value so should all take responsibility for simple tasks such as answering the phone.

The NHS has got to a point where it is so severely understaffed that it no longer follows what it was originally set out to be by Sir Robert Francis who wanted safe staffing as a priority, particularly encouraging NICE to be used to develop evidence-based guidelines.

Your Life in My Hands is focussed on the less glamorous parts of NHS medicine, including the long working hours, hospital overflows (eg. Worcester Royal Hospital was forced to put patients in decontamination rooms as there were not sufficient beds in January 2017), and less pay compared to other countries’ medical professionals. It is the dedication and commitment that medical professionals show to the NHS’ key values that inspires me to work hard for my application to medical school. Clarke’s finishing statement of ‘his life is in the hands not of one doctor but of the nation’ is extremely powerful as it shows the reliance on each of us to pay taxes in order for the government to fund the NHS to save our lives when needed, as well as reminding the reader that the NHS is an institution that we should be extremely proud to have in our country as we all help each other out when funding this institution that offers healthcare free at the point of use for all residents, whatever a person’s background is.

 

Emily Buchanan

 

Book Summary: In Stitches by Dr Nick Edwards

In Stitches is written by a doctor who has worked in many hospitals and is training to become a Consultant. I really enjoyed this book as I learned a lot about the NHS and the reality of being a doctor. Dr Edwards covers a lot of material including NHS reforms, management, funding, certain illnesses, current problems in our population, the future of medicine and feelings about being a doctor, through case studies – ensuring that the information is always interesting to read and not just lists of NHS regulations!

Dr Edwards feels that managers are not directly at fault for the problems in our NHS, but that it is ‘unintended consequences’ of new policies brought about by the government which are to blame. He believes that some new policies have lead to failures, damaging patient care and the NHS’ reputation. He talks about a brief history of the NHS including that its creation was overseen by Nye Bevan in 1948 and that underfunding appeared to start in 1997. I was interested to find out that 1997 was therefore the year that the ‘4-hour rule’ was introduced – a rule which states that 98% of patients must be seen and admitted or discharged within four hours’. Dr Evans feels that this rule is now outdated. Measures are often taken in order to ensure hospitals do not breach this rule for example by moving curtains to fake admittances, adjust figures and cancelling operations in order to increase bed space. He also expresses in In Stitches that he feels that he is ‘no longer allowed to do good-willed gestures’ as he must constantly ensure he is not breaching NHS rules. This is a shame as it means that doctors are not able to fulfil their role (‘not allowed to do the job properly’) and use the ‘gold standard skills’ that they spend a long time learning at medical school, for fear of breaching regulations. Dr Edwards talks about this leading to patients no longer receiving the level of care that they require and deserve.

Medical conditions that I read about in this book are addiction, Type 2 Diabetes, psychosis and schizophrenia, atrial fibrillation and appendicitis. Most of these conditions were linked with Cannabis, Alcohol, Cocaine and Heroin.

Being a doctor can be extremely difficult. Dr Edwards expresses that you must be ‘mentally strong’ and able to ‘cope with stress’ to be a doctor and must be able to detach yourself from patients in order to provide the best quality of care. Detaching yourself from your patients is extremely important to ‘protect’ yourself from mental health problems. In addition, I learned that it is okay to have a limit in your ability and important to understand that sometimes it is best to let ‘nature take its course’ when you have ‘treated the patient to the best of your ability’. Dr Edwards also talked about enjoyment of working with lots of different people from all cultures, and getting the ‘buzz’ from working in a high-pressure environment.

Problems of the NHS that he talks about in In Stitches are wasted funding, long hours and the postcode lottery. Dr Edwards noticed that many members of staff were often not needed at certain times including when there are hardly any cars in the car park but there are often two car parking attendants sitting around who are employed by the NHS, and when operations are cancelled due to shortage of beds but surgeons remain in work, waiting around needlessly. Furthermore, he stresses the importance for need to cut down number of hours in Junior Doctors’ shifts. Long hours leads to severe tiredness and this directly affects patients’ care negatively. Dr Edwards asked himself the question ‘Would I have treated her the same way if I had not been exhausted?’ showing that his mood was affecting his ability to work. The postcode lottery is something often discussed as a problem surrounding the NHS as it could be said that some people have better access to medical facilities than others, depending on where they live. Dr Edwards suggests that this may not actually be the case and that it is just the local area’s advertisement or lack of advertisement of the other medical facilities on offer (as opposed to just A&E) that affects the number of people using them and therefore affects the number of people coming to A&E.

Solutions offered to some problems include improving saving of patient test results as money is wasted repeating tests and preventing unnecessary admission to wards in order to reach targets. The money that these activities cost could be put to better use elsewhere for example for more personalised care for the elderly by home visits, investment into specialist units and improvement of quality of care homes.

To conclude the book, Dr Edwards assures the reader that ‘the good bits outweigh the bad bits’ but clearly believes that it is important to understand both the positives and negatives of being a doctor before applying to medical school. He then goes on to suggest that it is most important to look after yourself under the pressurising conditions of working in a hospital, in order to be the most benefit to your colleagues and your patients. The book also raised the question whether it is ethically correct to treat someone, even when it is against their wishes.

Emily Buchanan