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Book Review: small – Life and Death on the Front Lines of Pediatric Surgery

Created October 17, 2014 by Chivas Owle

SMALL is a special sneak peek into the beautiful, scary, and often daring world of pediatric surgery. Dr. Catherine Musemeche describes her work with a surgical precision, crafting an experience not often found in literature. From the first pages of the book she invites the reader to scrub in with her and experience the joys, frustrations, wonder, excitement, and anxiety that are the hallmark of her field. It is a world you simultaneously won’t want to leave behind and will not be able to endure a moment longer.

The author states in the introduction that her objective in writing this book was two-fold: to give the reader the experience of being a pediatric surgeon and to bring to life the stories of the giants who made the field possible. The first objective is an unqualified success; the second is a bit more muddled.

The writing style is immersive and leaves the reader feeling like they are standing beside the pediatric surgeon during the surgery (and sometimes right in her shoes). It is easy to imagine yourself looking over her shoulder, looking though magnifying instruments to see the procedures she is using to give her patient a chance at life. You can practically feel the scalpel in your hand. The pace of the stories is lightning fast and full of tension, leaving the reader to feel breathless with anticipation of what will happen next. You can cut the tension she is generating with a knife while seconds tick by during a high-risk operation. Frankly, the tension can be unbearable.

This makes parts of the book difficult to read, as does the inherent tragedy of the miracle of life having been perverted to disastrous ends. The author spares no detail in describing the myriad of ways development can go awry and what she and her elk can (and cannot) do to set them right. You can practically feel the crushing weight of the boulder of hope the parents have placed on her back (or in her hands). People who are squeamish thinking about cutting into babies or inserting needles into teeny tiny veins need not apply. Even people who do not think of themselves as squeamish may learn something new about themselves while reading this book. This is somewhat mitigated by the sense of awe and wonder the author sprinkles throughout the book as well as the poetic language she clearly has a gift with.

Intricate details about the history of the field are given. While some people may find this peek into the history of pediatric surgery to be fascinating, it can also break up the much more compelling parts of the story where the author invites you into the surgery suite and compels you to imagine what it is like to have the huge burden of such a small life in your hands. To put it bluntly, some parts of the book are overly concerned with history lessons rather than the much more interesting experience of being a pediatric surgeon. That said, the author is successful in introducing the founding fathers of the field as well as explaining the difficulty they experienced in being recognized as a distinct specialty. The level of interest in this subject matter will undoubtedly vary. Likewise some parts are overly concerned with lengthy explanations of boring technical details. Perhaps for people without a background in medicine these parts are more interesting.

The difficulty of writing on medical subject matter for a broad audience cannot be understated. Dr. Musemeche does a commendable job breaking down dense subject matter into digestible pieces. For readers with a medical background it can slow down an otherwise breakneck pace and can become boring. Anyone with formal education in medicine who reads books written on the topic for a lay audience has likely experienced the frustration of wanting to skip explanations that are familiar to them and this book will be no exception. She does a good job balancing the need to explain terms, procedures, and medical concepts with keeping the narrative moving forward. The book is easily accessible for both a medical and lay audience.

Crafting a book as compelling as SMALL is no, ahem, small matter. Dr. Musemeche should feel proud of bringing to life the world of pediatric surgery in a way that is accessible to anyone. SMALL is recommended for anyone interested in the field of pediatric surgery as well as anyone who is up for a soul-searching, life-changing roller coaster ride of a book that celebrates the miracle of life while acknowledging the heart ache of loss. You will never look at a neonatal unit or the people who work in them the same way again. Bravo Dr. Musemeche, bravo.

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