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On the Toss of a Coin by Michael Wise
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On the Toss of a Coin

by Michael Wise

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Personal insights from a Professor of Dentistry into experiences of sepsis, ITU, kidney failure and kidney transplant. Valuable for any clinical staff who want to better support patients. Easy reading. Powerful. ( )
  DrGordonCaldwell | Sep 19, 2017 |
"He who has a why to live can bear almost any how. "
-Friedrich Nietzsche,” Maxims and Arrows"

"I can and I will."
-Michael Wise

Before Jan 21, 2009, Michael Wise knew that life could change on the toss of a coin--literally. In 1902, Wise's Jewish grandfather, great uncle, and their families fled religious persecution in Poland. On reaching Belgium, they decided that they might be in a better position to help each other if one family travelled on to Britain while the other stayed put in Belgium. When the coin was tossed, luck had it that Wise's grandfather and his family would travel to England. His grandfather's brother stayed in Belgium for a time and then moved to Paris. Ultimately, though, Wise's great uncle and his family returned to Poland, where they ended up dying in the Holocaust.

Now, in January 2009, Wise was to have his own encounter with the randomness of existence. Wise was a vital, fit, and professionally accomplished 62-year-old professional with a busy dentistry practice that was run to exacting standards. As an innovative expert in complex restorative dentistry who had written a textbook on the subject, Wise was in demand as a lecturer and instructor. He had taught his techniques to many. In 2007, he had been voted 2nd in a national survey about the most influential dental professionals in the UK. Everything was about to change.

It all began rather mundanely. It was mid-January, 2009, and Wise was feeling under the weather. At first it was a general flu-like sense of malaise. Wise's symptoms progressed to include sweating and a mildly elevated temperature, then to vomiting, diarrhea, and shaking. By the morning of January 21st, Wise was very ill indeed. He has minimal recollection of his wife helping him out of the bath that day, of her phoning for an ambulance, and of being transported to London's University College Hospital, where a team headed by a contact of theirs, a specialist in intensive care, was awaiting him. He was suffering from septicaemia, a rare blood infection, caused by Hemolytic Group A Streptococcus, bacteria that usually give rise to sore throats. When these microbes invade the bloodstream, they release poisons that damage organs--an extremely serious condition known as toxic shock syndrome. Although the source of the bacteria that threatened Wise's life was not definitively determined, he does offer a few hypotheses.

Because Wise was in considerable distress, doctors placed him in a medically induced coma (according to his account) for some days. (The accounts of Wise's wife and son that are included at the end of the book make no mention of coma, however--only intubation and sedation.) Wise writes that he possessed a certain level of awareness (particularly of voices) while sedated. At one point, for example, he heard a physician speculating that Wise had had a catastrophic stroke. Wise's dreamlike states alternated with periods of strange philosophical rumination. Eventually, he regained something resembling full, but hazy consciousness.

Wise goes on to relate the very significant obstacles he faced in order to return to life. Toxic shock had left him with acute kidney injury. He was in renal failure, which meant he would need to undergo dialysis for four-hour periods three times a week. Sometimes the kidneys will, after a time, recover; Wise's did not. Additionally, his respiratory function was compromised due to one lung being filled with fluid, his toes were gangrenous, and his heart was damaged. He would need considerable physiotherapy to regain strength and would require surgery to deal with the necrotic tissue on his feet. Wise also dealt with a host of other problems: itchiness, fatigue, hypotension (low blood pressure), changes in how his senses perceived the world (hearing was heightened; distance vision was diminished), short-term memory loss, and increased emotional sensitivity which left him prone to tears. He also experienced a significant setback about seven months after the crisis: a second bout with septicaemia, this time due to staphylococcal bacteria, which had likely gained entry into the bloodstream through the permanent jugular catheter used for dialysis.

When a biopsy confirmed that Wise's kidney function was irrevocably lost, doctors asked him if he was interested in being placed on the transplant list. He was. The problem, of course, is that the wait can be as long as three to four years. He and his family decided that searching out a living donor willing to part with a kidney was the better option. A donor came forward. The second half of On the Toss of a Coin, addresses issues (including the legalities), tests, and procedures leading up to the transplant, as well as the operations--the donor's and his own--and their aftermath.

One of the things I learned from Wise's book is that the donated kidney is placed in a different location from that of the patient’s existing kidneys: in the front part of the lower abdomen (the pelvic or groin area); the failing kidneys are left alone. After the operation, the patient finds numerous tubes sprouting from his body (some for drainage, a urinary catheter, IV catheter, and a central line). Anti-rejection drugs are promptly commenced, and the patient is ordered to drink copious amounts of water. Ongoing immunosuppression must occur in organ-transplant patients so that their bodies do not reject the donor organ; however, this places recipients at increased risk for infection, lymphoma, and skin cancer. Certain foods are verboten--pate, shellfish, raw fish, raw eggs, blue cheese, and soft cheeses--as they can lead to infection. After the operation, what amazed Wise the most was the complete absence of the nausea that had been an omnipresent companion for over a year. However, an exhausting and frightening new one appeared at fifteen-minute intervals for the next two weeks: the dramatic urge to urinate.

As dire as Wise's condition sounds (and it was dire), his memoir is not a gloomy read. Neither is it a Pollyannaish account of triumph over adversity. A good measure of realism informs this account of life-altering illness. Wise openly admits to envy of others' good health and the normal kidney function they entirely take for granted, and he confesses to being dispirited at times. Wise also makes valuable observations about health care and the experience of being critically ill--including details about emotional, psychological, sexual, professional, and financial aspects. He is keenly observant and doesn't fail to comment on the corporatization of medicine. One facility actually posted a mission statement about the "maximization of shareholder return". As a health professional himself, Wise was also taken aback by some of the dangerous, substandard disinfection and sterilization practices he saw. A frequent refrain in the memoir concerns the failure of some physicians to regard patients holistically (not just as "the damaged heart" or "the failing kidneys"). Some doctors appear to be unable to recognize and alleviate the fear that many people feel in a medical setting. Waiting for dialysis gave Wise many opportunities to listen in on conversations of other seriously ill patients, to note the degree to which they had misconstrued doctors' words, and discover just how poorly they understand their condition, treatment, and prognosis. Wise acknowledges that while these may seem like small matters to some, " 'little' things are not so little when you are ill and feeling vulnerable."

So, how did Michael Wise keep going in the face of such obstacles? While he finds meaning and continuity in his Jewish heritage and traditions, he makes clear that he is not a "believer". In fact, according to him, it is tremendously beneficial to be free of the notion that sickness is preordained or visited upon people because of past sins. As far as he is concerned, illness is "just one of those things that happen". For Wise, the love and support of family and friends, as well as the care provided by knowledgeable and dedicated medical professionals, are the critical things--but humour, philosophy, and memories of the determination, fortitude, and resilience of family members born before him also played significant roles.

Wise's perceptions and judgements are often astute, and many of his personal anecdotes are amusing or compelling. Having said that, I found one serious problem with the book: the quality of the writing itself. The manuscript did not receive the revision and editing it required (and deserved) to turn it into a top-notch memoir. The content is definitely there, but the material needed to be better organized. For example, some of the footnotes are unnecessary, and some medical and statistical details that are less germane to the story itself would be better placed at the end of the book in an "Afterword". The opposite should have happened with the accounts of Wise’s family members. Rather than placing these at the end as appendices, it would have made more sense (and been less repetitive) to integrate key aspects of Priscilla’s and David’s statements into the main body of the text. Some stories and jokes, though clearly treasured by the author, distract from the main story and should have been cut.

Overall, leaner, cleaner, more concise communication and the correction of grammatical and punctuation errors would have made the reading experience smoother and more pleasurable. At 368 (print) pages, this is a long book. I think the final section, "Reflections", which is rather rambling and repeats information already addressed, should have been left out entirely. Sometimes less is more, and that applies here. I wish Dr. Wise's book had been written with a professional writer who could have eliminated the excess, cleared up the muddy language, and shaped the material for maximum effect and wide readership.

I would like to thank Netgalley and Cameron Publicity and Marketing for providing me with a digital copy of this book for review. I salute Michael Wise for his grit and determination. I rooted for him as I read his informative book and thank him for sharing his story. ( )
  fountainoverflows | Mar 5, 2017 |
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