Review of "The Big Free"

I thought I'd better write a review on a medical fiction related novel here. Martha Boone's The Big Free is as good as any to start.

The protagonist, Elizabeth Roberts came to Charity Hospital in New Orleans, Louisiana in the eighties, to get training from Tulane Medical School Surgery and eventually to be a urologist. The training and her experience are gut wrenching, and it is only be sheer grit and a tough family background that pulled her through the gruelling selection procedure. Elizabeth came from a supportive family in South Carolina that imparted admirable values that had strengthened her.

This novel is about more than medical practice. It had something to say about sexual discrimination, wealth and poverty, and standing up to adversity.

In the period of the story, women doctors did not have it easy. Elizabeth had to share an on-call room and the adjoining bath with two other male doctors, and the beds were placed virtually next to each other. The surgical chief resident was clearly biased against female surgeons. He said,

You know, Elizabeth, you are a beautiful woman. Surely you could marry some nice Charlestonian and avoid all this mess...You know you don't really fit in here, don't you? Being somebody's nice, mannered wife should be your goal. You'd be a really nice wife.

Nevertheless, the message of the book is one of hope. [skip this paragraph if you want to avoid spoilers] Elizabeth was too busy in the ER to examine a head injury patient when he first arrived. When she found him, he had turned unconscious because of brain hemorrhage. Despite attempts to revive him and to drain the hemorrhage with burr holes, the patient died. Elizabeth apologized to the faculty during the Death and Complications Conference and was thoroughly ashamed. Despite this, she gained the friendship of a strict ER head nurse, and was admitted to Tulane Surgery for further training.

The novel is also a harsh critic of the way healthcare is run. Many of the under-privileged patients could not afford medications like antibiotics, and it was up to nurses and health care workers to purchase these for them.

...the state government of Louisiana can't even afford Tylenol for the patients we have in the hospital now. The doctors run across the street and steal it from the private hospitals.

Also, critical medical social services in the community had been withdrawn:

The budget for the social workers was cut deeply in the governer's last budget, and they now work mostly for children. Adults with social problems are mostly on their own...

The book included descriptions of interesting local superstition. Instead of trusting modern medical practice, the patients use smelly poultices which include a copper penny, some kind of animal fat, ground cockroaches, ground coffer, the dried hind foot of a rabbit supposedly found in a graveyard, and a wad of gum moss—all tied together with kitchen string. Also people believed that keeping a buckeye chestnut in the left pocket prevents death.

Also, for a sense of place, read this passage about the Mississippi River:

The river is at the bottom of our country, and it has accumulated the waste and power of all the areas that dump into it. You could not sail on this monster river. It does what it wants, and you just go along. When you sit near it, you can feel the power. It seems to say, "jump in here and I will mess you up."

And of the French Quarter:

The streets were steamy in the early morning. The smells of tea olive and jasmine mixed with walls of bougainvillea and mandevilla were intoxicating...

Now, go read this book and tell me what you think.