BOOK REVIEWS: "Working Stiff" and "When Breath Becomes Air"

Sal Iaquinta, MD

Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner (by Judy Melinek, MD, and T.J. Mitchell) is an interesting glimpse into the life of a medical examiner. The author stresses that she worked in the “real world” of Manhattan. She clearly states that in no situation outside of television does a sexy medical examiner show up at the scene of the crime wearing high heels and spouting off subtle clues to the homicide detectives between sexual innuendos and witty remarks.

That might disappoint some readers.

But for those of us who wish Mary Roach had devoted more time to forensics in her fun book, Stiff, Dr. Melinek’s book fills the void. Don’t look for plot or fancy writing. Instead, get absorbed in details that you’ve never dreamed about. Dr. Melinek isn’t solving murders (though there are more than a few homicide victims); she’s examining dead bodies day after day. She details the elements of decompensation, the telltale signs of disease or injury, such as how the strap muscles of the neck exhibit different signs depending on whether the person hanged him- or herself or was strangled.

Her anecdotes aren’t for the faint-hearted and don’t make for dinner conversation, but I found them irresistible. I love filling my brain with factoids that I’ll never use again . . . that’s one of the reasons I went to medical school. So when Dr. Melinek described a case of transfusion-related acute lung injury and a case of anthrax, I was excited. She got to see diseases I’ll never see—how cool.

Dr. Melinek gives the book a (living) human touch. From the very beginning she talks about her father’s suicide. She draws on that horrible experience when meeting the family members of other suicide victims. The average reader won’t be expecting a pathologist who spends time talking to the families of the deceased. There’s just enough sentiment in the book to remind us that she’s been dealing with real people, not simply giving us disembodied “case reports.”

The final chapters focus on September 11, 2001. The book is not in chronological order—this tragedy took place early in her training. But saving it to the end is better, when the reader already understands the lingo and how an autopsy is performed. Her story is one that never quite hit the popular press. No one really wants to know that the Manhattan Medical Examiner’s office was overwhelmed and required a series of refrigeration trucks parked outside to hold all the body parts. But we live in a world that is becoming increasingly aware of disaster preparedness, and the Office of the Medical Examiner is part of that response. Even without the unforgettable descriptions of mangled bodies (they found a woman’s hand inside the limbless torso of a man), just the logistics of responding to such a mass casualty event are interesting.

Lastly, and unintentionally, the book helps end the battle between dog lovers and cat lovers. In Dr. Melinek’s experience, your dog will sit and mourn next to your dead body. Your cat, however, will start eating you within hours of your death.

Paul Kalanithi’s When Breath Becomes Air is the true story of a young doctor who is diagnosed with Stage IV lung cancer during his final year of neurosurgical residency at Stanford. This is a very different book from Working Stiff. When Breath Becomes Air is a literary exploration into what is important about life itself.

Dr. Kalanithi’s fascination with the brain was lifelong. After getting his master’s degree in English, he realizes that writing is a way in which our brains communicate, but the brain itself is the organ that lets us interact with the world. At the same time the brain both has free will and is governed by all the laws of physics. Somewhere biology, morality, literature, and philosophy intersect. And that somewhere is within our skulls. This realization inspires him to become a neurosurgeon. But his time and his dreams are cut short by a deadly diagnosis.

His description of neurosurgical residency is almost unnecessary except for his first brushes with death. His cadaver, a dying patient and a neurosurgeon discussing a dire situation with family members all give him insight into the sacredness of being a physician.

This book’s strength is its introspection into what it means to be alive. Paul is given choices at age 36 that most of us will never face. As he undergoes treatment, he realizes that even a great response might mean he will live five to 10 years. He ponders, with a life cut short, what will he do with his remaining time? Should he even bother to finish his training? Finish and get a job? Or should he write? Should he have a baby with his wife? What is really important?

What separates this book from others like it is that he doesn’t dwell on the misery of the treatments. Nor does he ponder Why me? His answer: Why not me? Instead he asks questions like “If the weight of mortality does not grow lighter, does it at least get more familiar?”

Distilling these two books into one sentence looks like this: Working Stiff intrigues the brain; When Breath Becomes Air touches the soul.

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Dr. Iaquinta is a San Rafael otolaryngologist.
Email: salvatore.iaquinta@kp.org