Nobility in small things A surgeon's path

Columbia University surgeon Smith, whose daily email updates about Covid-19 went viral in 2020, debuts with a vivid, warts-and-all memoir. After college in the 1970s, Smith was aimless, halfheartedly entering and then leaving a graduate biology program at Dartmouth before finding work as a telephone lineman. Eventually, and despite submitting a bizarre personal statement about organ-playing, Smith was accepted to medical school at Case Western Reserve University in Ohio, which set him on a long path to becoming the chair of Columbia's surgery department. Smith documents his early struggles with winning self-deprecation ("My ignorance of botany was exceeded only by my indifference," he writes of being tapped to lead a botany lab at Dartmouth) that carries through to his descriptions of medical school, his early career successes, and eventually, his much-publicized 2004 open-heart surgery on former president Bill Clinton. Sections on Covid are graver, but never melodramatic, as Smith catalogs the devastation caused by federal mismanagement in the early months of the pandemic. He opens up about his personal life, too, discussing his lifelong panic attacks and recounting the still-unexplained death of his two-month-old daughter, Lydia, in 1983. It amounts to an occasionally humorous and always intriguing account of a life well-lived. (Oct.)

Reflections from an esteemed physician. Cardiothoracic surgeon Smith, who performed a coronary bypass operation on Bill Clinton in 2004, makes his book debut with a forthright memoir about his roundabout path to medicine and the commitment and accountability inherent in being a physician. When the pandemic shut down elective surgeries from March to May 2020, the author, chief cardiothoracic surgeon at Columbia Presbyterian Hospital, wrote 59 daily email updates to everyone in his department. Hoping "to inform and reassure, and--possibly--to inspire," he found himself sharing "surprising extrospection and intimacy," a project he continues here. An awkward, accident-prone child, Smith endured many hospital stays. Though comfortable in that environment, he did not feel compelled to follow in his grandparents' steps to become a doctor. After graduating from Williams College, he worked as a lineman, earning his first post-college degree from the Framingham pole climbing school. Graduate study in biology took him to Dartmouth, but he soon decided on medical school instead. During his residency, he was drawn to surgery because of its challenges. "Every year," he writes, "a surgeon is doing more surgery, more difficult surgery, and doing it better." However, he was undecided about a specialty until he scrubbed on a cardiac surgery case: "I was hooked and never looked back. It was bold and complex, there was risk, every stitch seemed to matter, and feedback was immediate. Get it right or the patient might not leave the room alive." Besides recounting many medical cases (Clinton's led to unforeseen complications) and reflecting on hospital culture, Smith reveals the social anxiety leading to "autonomic storms" that beset him for decades. "Social life became a minefield," he admits, until he devised strategies to help him cope. The author underscores a physician's responsibility to the patient. Certainly, surgeons must face "the personal impact of bad outcomes," but, he asserts, should not seek to minimize that risk to maximize their own wellness. A candid picture of a surgeon's life. Copyright (c) Kirkus Reviews, used with permission.