Direct Red

One expects of a surgeon that she will be completely confident, completely expert, and extremely precise --- she is cutting away at a living person's body and one wants not a single wasted stroke, not a single guess or uncertainty in that cutting. The prose of this book is just so --- precise, exact, succinct and minimalist; prose designed not to delight with prolixity but to describe as sparingly and exactly as possible just what doing surgery is like. I deeply appreciated this narrow focused writing -- my young daughter, still in college and already an EMT, loves the thought of cutting em open and fixing em up --- so I wanted someone to tell me about this without long complicated attempts to be prosey. Weston accomplishes this with admirable style. Her writing conveys in its topological tonality just what I wanted to know about a surgeon --- how she can cut into a living human being, how her emotions play in that moment, and what she is thinking as it happens. I wont describe what she has already described, I can only recommend a night spent with this book as one that wont go away easily...the imagery sticks, particularly as I drive by a local hospital I used to totally ignore. This book in its accurate cuts seems so much more satisfying than all the dramatic overblown plot-driven drivel on television about doctors and surgeons, who must be emotionally wrought and yet resolve each dilemma in an hour with time out for commercials. I thank Dr. Weston so much for her insights and sharing them in what must have been a difficult writing experience, one in which I suspect she had to pare much to get to the essence.

Gabriel Weston, an ear, nose and throat surgeon, has written an engaging and moving book about her surgical training in London. The book is organized around "themes" that she found important in training and is not a traditional memoir. Her story emerges in a series of connected essays. For me the book was highly engaging. Each theme/chapter lets Weston give her view about some aspect of surgery and what these realities meant to her. Her observations are illustrated by stories of cases and patients. Some of these are funny, as the story of her first time having to hold and manipulate a patient's penis, commented upon by other reviewers. Some are depressing (incompetent or indifferent surgeons). Some are moving. The most memorable of the latter for me was that of the twenty year old DJ who came to the ER, a picture of health and fitness (Weston calls him "beautiful"), complaining of a persistent, dull abdominal ache and of constipation. Examination and standard tests were normal and Weston sent him home, telling him to drink more fluids. In three days he returns with the same story. Now thoroughly uneasy, Weston consults with her senior resident, and a CT scan reveals a bowel cancer requiring immediate surgery. The surgery finds the cancer hopelessly advanced. A week later the patient is dead. Each day of that final week Weston visits him to offer what physical comforts she can, though she has no idea what to say in the face of his tragedy. Here is the big question of the book: Can one become a surgeon, with the attributes that all surgeons must have (strong ego, distance from patients, competiveness, great confidence and others) without becoming indifferent or callous? This is Weston's struggle, one that she partially resolves by book's end. I found this book excellent, but it presents a difficulty that may repel some. Weston states that, to protect patient confidentiality and avoid "dishonor to valued colleagues," none of the stories in the book is strictly true and none of the characters is entirely real. This may result from British libel law (strict and heavily biased toward claimants). Weston hopes that the book is nonetheless "entirely authentic if not entirely true." The book describes Weston's effort to be a good surgeon without losing human feeling, and this effort seems truly reported.

First of all, I thoroughly enjoy medically based shows and books. If this is also you, this is your kind of book too. Gabriel Weston's past; as an English-major, shows in this wonderfully written book. Her writing is spare, but descriptive, thoroughly enjoyable to read and hard to put down. I would have finished this book in one day, if life had not intervened. The stories are fictional, as the author indicates and makes a point, that this tells the story more completely and protects the patients as well. I tend to agree. However in this world where doctors are sued, for the slightest mistake, I'm sure this offers her some protection as well. She does not portray herself as always the best patient's advocate. In fact she chides herself for not doing this well early on in her career due to ambition. The stories are all told with a single heading for a chapter name. The years progress in her chapters as well, with the last story happening at a turning point in her career. The chapters are: Speed, Sex, Death, Voices, Beauty, Hierarchy, Territory, Emergencies, Ambition, Help, Children, Appearances, Changes, Home. Not to take away from the author's excellent stories, I won't attempt to tell them. However I will say, the chapters capture the essence of them, so now the title "Territory" evokes the particular story told. You see the complicated emotions involved: the need to please superiors, the pride of being a physician, the advocacy of the patient and lastly and sometimes forgetten, the humanity of understanding the needs of another human being when it comes to making choices in their lives. Her stories tell of the dilemma of ego versus advocate, where getting ahead as a doctor, necessitates a hard veneer, ignoring pain and a depersonalization of the patients you treat. However, it goes beyond the expected level of hardening, to competition for perfection and how lesser illness reduce your status and greater ones increase it. So the types of patients you treat or not, reflect on you. Sadly, it does affect the standard of care you as a patient receive. This book illustrates the author's learnings and feelings as a physician in this complicated system. In many ways the patient general well being is secondary. Sadly this impersonal system affects the patient in the most personal of ways. Hard to put down, well written and gives you pause to think; an excellent book.

People write books for many different reasons. Books written by doctors about the medical profession have a built-in hook: the drama that plays out when illness or trauma strikes. We've all been there and none of us enjoyed it. Whatever the focus of the book--history, memoir, opinion, even fiction--the dire or heartwarming vignettes keep the reader turning pages. Direct Red: A Surgeon's View of Her Life-or-Death Profession isn't any of those books, though I found it a page-turner. Gabriel Weston, a British MA in English, decided at the late age of 23 to train as a doctor, and chose surgery as a good fit for her naturally competitive personality. British medical training and academic medicine have always been known for their intense competition to advance from the horde of first-year doctors to a position as resident. Only the toughest and best advance. Weston was on her way up the steps of that pyramid and became a member of the Royal College of Surgeons in 2003, aiming at a career as a consultant ear, nose and throat surgeon in the National Health Service. As an organizing principle for "Direct Red," Weston distilled "a mixture of things that have happened and things that might have happened." She wrote essays or chapters based on themes "that have been prominent in [her] surgical experience" -- some of them Beauty, Hierarchy, Territory, Sex, Death. Each essay uses stories of patients and of the pressure cooker world of the teaching hospital to explore the author's moral questioning. The writing is sometimes poetic in defiance of her topic: "Once you have seen the bloom of a decent surgical incision, nothing in nature looks bright by comparison." The English scholar and the surgeon are both very much in evidence throughout. Weston included a number of heart-rending case histories and situations, but always elegantly closed the loop on her theme. "Direct Red" was published in February 2009 in England. The British press loved the book and the author, and many editorial reviews read it as a wake-up call: arrange your life so that you never need surgery because it's terrifying beyond belief. I read the book very differently; I see a person with an intense, personally depleting job and the skill to process it by writing. Weston stated that she wanted to write a book about life "seen through the prism of surgery." In her opening she describes her mantra when she feels faint in the OR after too many hours of standing: she recites the names of the dyes used to stain tissue before it goes under the microscope. Direct red is one of those illuminating substances--a fitting title for a book more abstract than many of its genre. I found her clarity of expression fascinating. If you have no aversion to the medical metaphor, read this book. Linda Bulger, 2009

I chose this book as one of my monthly Vine selections because just about a year ago, while in London, I was hit by a van, taken to St Thomas' Hospital, went through the ER, put in a ward of three other women, operated on for a broken femur, and then spent a week recovering and learning how to get around with crutches (the British ones are far superior to the American ones), before returning to the States and going through two weeks of in-patient rehab. So I went through almost every stage of the British National Health Service, and, while I wasn't happy to have this happen to me, I was pleased at the care I was given, from the ER, to the surgery, and finally, to the initial rehab and care in St Thomas'. First rate at every juncture. But, while in hospital, I became very curious about British medical training. I felt a little sorry for my - excellent - surgeon because he was referred to as "Mr", rather than "Dr", even with his post-medical school training. Gabriel Weston's "memoir" of her training and early years of practice in London, really is not for every reader. There's plenty of blood and gore as she describes events and patients - most of whom she merges to make one patient represent many. She's a good writer, with a nuanced voice. Buy and read only if you're interested in medicine, or specifically, British medical policies. Weston's book helped me a little in putting things together in my experience last year.