“Critical” and “Seven Signs of Life”: Two Great Reads From the Frontlines of Intensive Care Medicine

Abstract

In 2019, 2 UK Intensive Care doctors—Dr Matt Morgan and Dr Aoife Abbey—produced separate, highly worthwhile books on a similar topic. Critical and Seven Signs of Life cover life and death in the intensive care unit (ICU), and specifically what it is like to ply this trade. These reviewers believe that both deserve your valuable time and attention and our commendation. One of your reviewers (P.G.B.) is a 20-year clinical veteran eager to reflect, and the other (J.D.B.) is a science undergraduate eager to learn. Our joint enjoyment suggests that these books have wide appeal and that they are complementary, not duplicative. Both books are relevant for those we care for (namely future patients and trainees; eager to understand the ICU) and for those caring for us (our families and colleagues; eager to understand who they live and work with). There is no shortage of autobiographical books about doctoring. Bestselling doctor-authors include—but are certainly not limited to—Henry Marsh (Do No Harm, 2015, and Admissions, 2017, Picador), Adam Kay (This is Going to Hurt, 2017, Picador), Rachel Clarke (Your Life in My Hands, 2017, John Blake), Atul Gawande (Complications, 2002; Better, 2007; Being Mortal, 2014, Macmillan), and Oliver Sacks (too many to list, Simon and Schuster). It is worth emphasizing that Morgan and Abbey have not just delivered “me-too” books contrived to feed the public’s seemingly insatiable appetite. The market may be crowded, but Morgan (a clinician researcher from Cardiff) and Abbey (a clinician educator from Coventry) have shone a light on areas of the hospital that have been hitherto relatively ignored, namely ICUs. Both also use a relatable, disarming, and humble storytelling style. This is the first book for both, and both are early- to midcareer. Therefore, they might come in for criticism for being too young to be writing what could be classified as memoirs. However, both have oodles of experience writing. Morgan crafts regular opinion pieces for the British Medical Journal (https://drmattmorgan.com) and Abbey blogged as the British Medical Association’s “secret doctor” (https://www.bma.org.uk/news/secret-doctor-blog). Just like their previous online writing, these books are neither textbook nor novel, but a mix of description, reflection, education, and popular science. Critical by Dr Matt Morgan encompasses 9 chapters and 320 pages. Each chapter includes 1 or more patient stories in order to highlight a body system. Chapter 1 focuses on the respiratory system via Vivian, a polio sufferer and the first mechanically ventilated ICU patient. Chapter 2 focuses on the immune system, chapter 3, on skin and bones, so on and so forth. Each chapter includes a pertinent explanation of medical practice or biology. For example, Chapter 4, “The Heart,” teaches readers how to perform cardiopulmonary resuscitation. Whether Morgan’s stories end in recovery, death, or disability, readers have the opportunity to better understand the why, what, and how of each treatment. They might also understand when, why, and how it gets stopped. Critical also helps explain why intensive care matters. It could even stimulate more informed dialogue among health care workers, policy makers, and the public. Seven Signs of Life also delivers approximately 288 pages of stories from the frontlines of contemporary ICU. It also centers around patients and covers the 4 Ws: what, when, why, and why not. The difference is that Abbey subdivides by emotion, not biology. She deploys 7 feelings—fear, grief, joy, distraction, anger, disgust, and hope—to create 7 chapters from what she cleverly calls the “seven signs of life.” Abbey is equally skilled at explaining complex medicine simply and is refreshingly candid. Her book should also leave readers with a better understanding, not only of medicine but also of the thoughts and feelings of doctors. These are often hidden from patients. Memoirs can feel indulgent but, in our opinion, Abbey gets the balance right between explanation and confession. Medical autobiographies could easily slip into a lazy narrative of hero doctor and helpless patient. In contrast, Morgan and Abbey readily admit their imperfections and vulnerabilities. No book will be perfect for all, and some readers may want more science and less sentiment. Perhaps not every clinician will want to invest precious downtime reading more materia medica, and some may want to hear more from patients, less from providers, and stories from all parts of the globe. Regardless, we believe these 2 books were worth our time, our funds, and our bandwidth. Moreover, while there is a trend toward discussing complex issues via brief tweets, we remain fans of long form narrative. We thank these 2 talented author-clinician-scientists for humanizing the ICU. Peter G. Brindley, MD, FRCPCDepartments of Critical Care Medicine and Anesthesiology and Pain MedicineDossetor Ethics CentreUniversity of AlbertaEdmonton, Alberta, Canada[email protected] Jack D. Brindley, BScDepartment of NeurosciencesUniversity of AlbertaEdmonton, Alberta, Canada