Two books by doctors explore controversial, intriguing topics

Most of the time, for most people, our mistakes don't result in anyone's death. Maybe some heartache, inconvenience or embarrassment. Probably some anger. But rarely even serious physical injury.

Not so the physician. Outright carelessness aside, even a simple, honest mistake can have drastic repercussions.

This would be a touchy subject in the medical world, but Atul Gawande probes the topic with rigor, compassion and above all, candor, in Better: A Surgeon's Notes on Performance.

"The world," he writes, "is chaotic, disorganized, and vexing, and medicine is nowhere spared that reality."

Audio Renaissance has recorded the book unabridged (7.5 hours; $29.95 on CD), read by John Bedford Lloyd.

Gawande is a Boston surgeon, Harvard professor, and staff writer for the New Yorker - a superlative combination.

His first book, Complications: A Surgeon's Notes on an Imperfect Science, was a best-seller, and Better promises to follow. It is informative, thought-provoking, and simply a good read.

The book is part history. In a chapter about obstetrics, we learn about the invention of the forceps and the Apgar scale, a numeric system for assessing the health of a newborn.

It's also part ethics. If a physician is bound by code to do no harm, what role, if any, should he or she have in court-ordered capital punishment? Stay away completely? Or assist, thereby helping make someone's final moments comfortable as possible?

Each topic is knitted together with a compelling personal story - a mother in labor, a child with cystic fibrosis, a lawyer who represents patients in malpractice cases,

Gawande writes with a compelling forthrightness about his own human frailty. One challenge for hospitals is getting doctors and nurses to wash their hands more often. So when Gawande realizes one of his patients has an antibiotic-resistant infection, he ponders whether he could have been the one to infect his own patient.

In a discussion of how hospitals and physicians can become better, he mulls over where he falls on the bell curve of performance. He likes to think he is among the best. Who, after all, strives for merely average?

But, remarkably, he's willing to at least contemplate the notion that he might not be as good as he thinks he is. That alone probably means he is not just average.

The book, while occasionally technical, is easy to listen to and easy to absorb.

I'm not sure if this was the publisher's intention or simply a personal response, but the narrator, Lloyd, has just the kind of voice I'd want my doctor to have if he was telling me I had a horrible, life-altering disease. He is calm, deliberate and seems to want to connect.

Harper Audio has recorded Survival of the Sickest, an inquiry into genetics and the evolution of disease by neurogeneticist Sharon Moalem, written with Jonathan Prince. The unabridged audio version (7 hours, $29.95 on CD), is narrated by Eric Conger.

Moalem explores, with occasional wit and humor, the conundrum of why hereditary diseases that debilitate or kill us exist. Wouldn't they tend to prevent their victims from surviving long enough to have children and pass along the gene?

To answer that, he looks at why diseases occur and how they have evolved. At its simplest, the explanation is that at some point in time, the disease's benefits outweighed its negatives. It allowed us to live long enough to have children, and then killed us.

He asks - and answers - questions like why many Asians are less able than many Europeans to process alcoholic beverages. Was there ever a benefit to high cholesterol? To diabetes?

To him, the world is "a global, evolutional Macarena," where "we're all partners, sometimes leading, sometimes following, but always affecting one another's movements."

Moalem is a tad more complex than Gawande. Sometimes, as intrigued as I was, I couldn't muster a deep enough understanding to explain it later. Reading the book in its print form instead of listening might have helped.

One of the most creepy, gross and outright fascinating chapters is on how parasites get us to do their bidding.

Not that Moalem is ascribing cognition and volition to microscopic organisms, but the fact remains that we respond in ways that benefit them.

The common cold, like a heartless employer, "wants" us to drag ourselves to work so we'll spread the germs to new hosts. Conversely, malaria gets a leg up when its victims remain lethargic, unresisting vessels of blood so mosquitoes can probe and sip at will, then fly off to spread the disease.

The guinea worm, an African parasite that grows to three feet in length inside the human body, needs to lay its eggs in water. But how?

It emerges through the skin via a painful, burning sore. One of the instinctive reactions of the human host is to plunge the body part in cool water. Presto. A cloud of eggs is released, and the worms find new hosts when other humans drink the water.

Yecch.