Book Review: The Brewsters written by Jeffrey P. Spike, Thomas R. Cole, and Richard Buday
Reviewed by: E. Ann Jeschke M.T.S
A real challenge for those studying to become health care professionals or ethicists is engaging real people in situations that do not easily fit into textbook answers and defy the limits of sound argumentation. In their book The Brewesters, Jeffrey P. Spike, Thomas R. Cole, and Richard Buday expose their readers to the nitty-gritty of health care professionalism, clinical ethics, and research ethics through a choose your adventure format. The novelty of The Brewsters lies not so much in the format, as in the way the book introduces theoretical concepts by encouraging readers to enter the complexity of the ethical decision making process and experience the consequences. The Brewsters requires its readers to clothe themselves in the daily challenges of six difference characters in order to embody the complexity of health care ethics. Readers of The Brewsters must be ready to roll up their proverbial sleeves and get their hands dirty by trying to figure out how to navigate common ethical dilemmas of health care. The pedagogical brilliance of this book lies in the fact that it engages the reader by making ethics real and deeply personal.
The Brewsters is organized into three main acts. The first half of each act is narrative that relates various perspectives on the Brewster's family drama. The second half of each act highlights the most pressing theoretical elements pertaining to health care professionalism, clinical ethics, and research ethics that were uncovered in the events of the narrative section. The structure works well because it allows the reader to wade through the events of the narrative unbiased by prior information. After the readers make their choices and come to the conclusion of each act, the second half functions as a pseudo answer key. This format allows the readers' decisions, whether right or wrong, to be reinforced by high-level explanation of the theories underpinning the evolving dilemmas from the previous act.
The first act begins with the reader entering the narrative as third year medical students, either Cheryl or John. Both of these characters are relaxing amidst the festivities at a pool party hosted by Dr. Enrique Hernandez. The host of seemingly prosaic choices that emerge from interactions at the party could have major ramifications for their careers even in the formative stages of medical school. When individuals are unable to stave off all the temptations posed by the combination of alcohol and a pool, Dr. Hernandez is ready to reprimand, but does not seem to take any responsibility for the context. I think this section would have been more potent if the setting had been an innocuous backyard barbeque allowing Dr. Hernandez to seem above reproach on every level.
The second act introduces the reader to two new character options, Wayne, the father of Walter Brewster from the previous act, or Julie, a registered nurse working part time in Dr. Hernandez's office while completely a master's degree. In the second act I was impressed with Dr. Hernandez's concern for the whole patient, not just a diagnosis and treatment plan. Psycho-social concerns that emerge in the clinical setting are not easy to delimit and do not come with prescriptive answers.
While I really appreciated the authors' emphasis on whole person treatment, this section could have left more room for learning from mistakes. One of the challenges of ethics in context is that individuals trying to weigh all the information may, and likely will, make erroneous decisions that are prompted by meticulous thought and the best of intentions. The tone of this section, as in the previous section, was slightly paternalistic. While this comment does not detract from the overall pedagogical value of the book, illustrating Dr. Hernandez to be a wise Socratic mentor would have made the book even more powerful. Ultimately, I must concede that the structure of an adventure novel somewhat limits robust discussion of nuances because this style is set up in binary mode that keeps the plot moving forward.
The final act continues a scene from act two where Gloria has been referred by Dr. Hernandez to a colleague's dental clinic providing the reader with two final character choices. Neither Gloria Brewster, Wayne's bombastic mother, nor Parvesh, a first year dental student, are new characters in the overall plot progression. However, the reader switches to focus on the medical concerns of Gloria Brewster in order to engage the issues of medical research ethics as either participant or research coordinator.
Of the three sections, act three was definitely my favorite. I felt like I was the protagonist in a mystery novel and was never sure where to look for new clues to solve the puzzle. It was completely enthralling and I felt tense just waiting to make the next decision. Sometimes I even got mad at certain characters for their attitude, dismissiveness, or arrogance. When I chose to read forward as Gloria I felt the distinct stress of uncertainty enter my body. When I chose Parvesh I was completely convinced I was going to get in trouble no matter what decision I made. The immediacy of the experience was wonderful and somewhat unexpected. While I definitely felt a kinship throughout the book with all the characters I chose, act three took my emotional participation to the next level. The reader who is unfamiliar with issues and theories in research ethics will particularly enjoy this section.
Ultimately, the book ends on a particularly positive note but is not hyper-idealized, which allows the reader to buy into the story throughout the entire book. More importantly, the concluding scene convinces the reader that being ethical in health care is definitely possible, but never simple.
In the introduction to The Brewsters, the authors comment on the importance of character development through moral virtue, compassion, integrity, and respect. There can be no doubt that when readers finish charting a course through The Brewsters they will feel a sense of connection to every character whether good or bad. Kinship with the characters is the real meat and potatoes of this book.
The Brewsters is a superb book for the novice or experienced individual interested in the world of health care ethics. Jeffry P. Spike, Thomas R. Cole, and Richard Buday have crafted an exciting adventure novel that successfully takes the reader into the heart of ethical deliberations in the daily lives of health care practitioners and patients. I would recommend this book to anyone who needs an excellent resource for an undergraduate medical humanities class or a medical school ethics course. It is also a delightful refresher tool for the advanced student in or practitioner of health care ethics. While The Brewsters will serve each level of reader differently, it will definitely serve every reader well.