(+++) COPING WITH ILLNESS IN REALITY AND FICTION

Your Healthy Pregnancy with Thyroid Disease: A Guide to Fertility, Pregnancy, and Postpartum Wellness. By Dana Trentini and Mary Shomon. Da Capo. $16.99.

Ms. Bixby’s Last Day. By John David Anderson. Walden Pond Press. $16.99.

     Limited in audience but of considerable interest, even importance, to the readers they target, these two books – nonfiction for adults and fiction for preteens – serve a similar foundational purpose: to help people understand and cope with diseases and their consequences. Your Healthy Pregnancy with Thyroid Disease is a typical self-help-in-healthcare book in the way it merges medical information with personal stories of many people who have “been there.” In this case, “there” is in the throes of thyroid problems, which affect some 10% of Americans (possibly more) and are in many cases undiagnosed. Some of the 30-million-plus people with thyroid disease are women of childbearing years (thyroid conditions are more common in women than men). Dana Trentini and Mary Shomon both have thyroid illness themselves and are both advice-givers on the subject and advocates for those dealing with it. Their book encapsulates much of the information they provide on an ongoing basis at their Web sites, www.hypothyroidmom.com and www.thyroid-info.com. Thyroid conditions, when not diagnosed and properly treated, can lead to a host of pregnancy-related problems, including infertility, miscarriage, stillbirth, low birth weight, postpartum depression and even cognitive problems in children. Both Trentini and Shomon have had thyroid-related miscarriages, and their personal knowledge of the trauma and the not-always-adequate treatments for their condition gives their book considerable power. It also, however, places it firmly in the camp of “we know better than doctors” books, in which anecdotal reports by patients take precedence over (admittedly imperfect) medical treatment. The undercurrent of mistrust of healthcare professionals is unhelpful here and in other books of this type. But it is certainly true that women who find out more about the thyroid and their own thyroid conditions, and learn what to watch for and watch out for when trying to become pregnant and carry children to term, can do a much better job of working with their doctors to find the best personalized treatment regimens. In thyroid disease as in so much of the rest of medicine, one size does not fit all. This is where Your Healthy Pregnancy with Thyroid Disease is most helpful: that first word, your, points toward the sort of individualized approach that doctors today are often far too harried and busy to offer. Women with thyroid disease will especially appreciate the step-by-step advice in Part 3 of the book, “Your Healthy Pregnancy Plans from Preconception to Postpartum,” which offers separate chapters on hypothyroidism, hyperthyroidism, and such conditions as goiter and thyroid cancer. Postpartum care gets rather short shrift here (only a dozen pages), but the basic information is well-presented and useful. The other parts of the book are “Your Thyroid and Its Role,” “Your Thyroid, from Preconception to Postpartum,” and “Into the Future.” The last of these is strident and demanding, not only of the medical profession (“Doctors need to listen and learn,” “Universal thyroid screening is essential in pregnancy”) but also of medical research (“A study of T4/T3 and NDT in pregnancy is overdue”). This is understandable in light of the authors’ personal experience and narrow focus, and their underlying recommendation to their readers is a good one in light of the insurance-driven reality that doctors are hard-pressed to give patients enough time and personal attention: “Do the research so that you know more about thyroid disease than your doctor.” The resources at the back of Your Healthy Pregnancy with Thyroid Disease are good places to start. Respectfully partnering with medical professionals, rather than hectoring them, would be a good place to continue.

     There is no “story arc” in Your Healthy Pregnancy with Thyroid Disease, since it is a factual book, but Trentini and Shomon are careful to begin and end it on an optimistic note and to provide balancing positive elements throughout when discussing negatives about thyroid disease and its treatment. Books that can provide story arcs are able to teach about illness in different ways. Thus, a novel such as John David Anderson’s Ms. Bixby’s Last Day can approach the topic with fluidity, communicating ups and downs not only of the person with the disease but also of those affected by it because they are affected by her. In this case, the person who is too ill to finish school is the much-loved teacher of the title. The protagonists of the story are three of her students: Topher, Brand and Steve. It has to be accepted from the start that none of these four characters is or will be deeply developed: Ms. Bixby is a prototypical wonderful, unforgettable teacher, and the three boys are defined by their typecast attitudes and approaches to life – there is nothing deep about any of them. None of that really matters, though, because the purpose of Ms. Bixby’s Last Day is not characterization. What Anderson is after is a kind of “emotional life of preteen boys” story, starting when sixth-graders Topher, Brand and Steve decide to make Ms. Bixby’s final day at school a memorable one even though she has just been diagnosed with pancreatic cancer and will be unable to finish the term – and continuing as the boys realize that “last day” may mean more than simply the last day of a school year. Anderson makes Ms. Bixby 35 years old, which is plenty old enough for middle schoolers to consider her a seasoned adult (despite her pink-streaked hair) – but not so old as to have students in the target age range think that anything really serious is about to happen to her. As Topher, Brand and Steve narrate their different parts of the book, as realization dawns on all of them that something really major is in fact going on with Ms. Bixby, readers are supposed to be swept into the uncertainty and emotional turmoil that each boy faces in his own way – as disbelief and denial gradually turn into necessary but deeply troubling acceptance of the severity of Ms. Bixby’s illness. The point here is that there are only a few teachers “who make the torture otherwise known as school somewhat bearable,” and Ms. Bixby is one of them; and as Topher, Brand and Steve try, singly and together, to show her how much she means to them, readers are subtly encouraged to think of good teachers they have known – and how important such teachers are and will always be to them. Whether this message will get through effectively to sixth-grade boys in general is uncertain, but Anderson definitely tries hard, and if he layers on a little too much emotion a little too thickly (sometimes a lot too thickly), he does so in a good cause – showing that teachers are people, too, not only when they are well and doing their jobs of subjecting sixth-graders to education but also when illness becomes, must become, a bigger determinant of their future than anything that happens in the classroom.