Pauline W. Chen
The Surgeons: Life and Death in a Top Heart Center is an ambitious account of the complicated interplay among health care economics, policy and those individuals whose professional lives drive the medical system. Morris fully immerses himself, and the reader, in the complexities of health care; what emerge are riveting and clarifying snapshots of the often unfathomable behemoth we call our health care system…What ultimately brings clarity to this bookand hope for health care reformare the stories Morris delivers along the way. There is the beleaguered nurse struggling in the middle of the night to help two surgical teams perform an organ procurement, the world-renowned cardiologist whose belief in transparency includes recounting harrowing clinical moments to some 500 colleagues, and the young surgeon, a decade after medical school, working day and night and for hours at a time standing hunched over an operating table "with no breaks for food, water or bathroom" and a salary less than that of "a kid fresh out of law school." Medicine is full of such examples, Morris writes, people "working very hard under great pressurebecause it was the right thing to do."
The New York Times
To get a nuts-and-bolts understanding of heart surgeons-from the decisions they make in the operating room to the impact of colleagues, patients and pharmaceutical companies on their jobs-Morris (The Tycoons) "embedded" himself for six months in the elite cardiac surgery center at Columbia-Presbyterian hospital in New York City. Unlike some noncardiac surgeries where music blares in the operating room, an aortic valve replacement for a retired pharmacy executive, says Morris, is a solemn affair, the calm briefly interrupted only when the patient fibrillates, his heart muscle fibers fluttering irregularly. The author finds it "exhilarating" to watch as a surgeon "basically built... a new heart" for a five-day-old baby with a major heart malformation. But even technical marvels can't save a desperately ill four-year-old girl after a heart transplant. The reserved Craig Smith, the unit's head, who gained national fame when he performed a quadruple bypass on former President Clinton, impresses readers with his skill and deep concern for his patients. From detailing the workings of the heart's chambers and valves to the bald economics of cardiac surgery-including Smith's income ($1.5 million in 2004), the hospital's billing and collection procedures and forecasts on universal health insurance-Morris masterfully breaks down complex jargon, procedures and policies for a lay audience. (Oct.)Copyright 2007 Reed Business Information
The versatile Morris (The Tycoons: How Andrew Carnegie, John D. Rockefeller, Jay Gould, and J.P. Morgan Invented the American Supereconomy, 2005, etc.) brings his customary research and observational skills to probe the heart industry. For it is an industry: fueled by discoveries, purveyed by artists and craftsmen supplied by medical schools, in demand by customers who shun the alternative. Heart disease is the number-one killer worldwide. In good hands, as the author graphically describes, even some of the worst cases-heart patients with multiple chronic ills and earlier surgery-survive to thrive. Morris spent a year at New York's Columbia-Presbyterian Hospital watching coronary bypass surgeries, transplants, valve replacements and congenital-defect corrections, performed by some of the world's best-the surgeons, anesthesiologists and nurses. No question, the doctors are dedicated (and well paid). Surprisingly, those at Columbia form a mutual-admiration society-no primal egos here. The author reiterates what the data show: If you're a patient, you would be wise to go to a top-tier hospital whose ORs are busy 24/7 rather than one performing a few procedures a year. While Columbia treats some indigent patients, Morris leaves to the end the issue of haves and have-nots, seeing only incremental changes to expand insurance coverage and lamenting the emphasis on high-cost, high-tech therapies rather than prevention. The tech focus is largely driven by R and D, he observes. Science is moving toward less invasive procedures: stents to open blocked arteries and robotic instruments working through small incisions, rather than the breaking-the-chest-bone-and-entering styles of the past. Thusinterventional cardiology, the medical specialty which allows placement of stents and angioplasties, is the hot new field, while heart surgery declines. The future may see a merger of the two specialties. The drama of surgery conveyed by an eyewitness with the smarts of an American business watcher will appeal to the general public but be of particular pertinence to patients and policymakers. Agent: Tim Seldes/Russell & Volkening Inc.