HOPE EMERGES

Macenka, a Pulitzer Prize–nominated reporter for the Richmond Times-Dispatch, details the leading edge of trauma treatment at the Polytrauma Rehabilitation Center, where service members with horrifying injuries receive sensitive, well-rounded care.

At McGuire Veterans Affairs Medical Center in Richmond, Va., the PRC—one of five around the country—provides intensive rehabilitative care to service members and veterans with severe injuries to more than one organ system, often including the brain. In late 2011, Macenka received approval to witness the PRC’s inner workings. Over 18 months, he followed administrators, doctors, therapists and staff as they treated several patients trying to find a new normal; those patients’ stories are told here in vivid detail. Macenka also describes the families’ points of view, from the first phone call with the bad news through the months of life-juggling rearrangements and the sometimes-heartbreaking decisions that must follow. Three key principles have made the Richmond PRC “the crown jewel in the VA”: “managing records quickly and efficiently, building relationships with the patients, and involving the family and other caregivers in the process.” This “relationship-based medicine,” much more personalized and extensive than most people get through managed care, is especially important for treating traumatic brain injuries, since—in a phrase used several times—no two brain injuries are alike. Some patients, despite everything the PRC can do, don’t survive; for others, marriages can fail, dreams fade, and bitterness can be difficult, though not impossible, to overcome. Well-written and absorbing, this book convincingly shows the value of relationship-based medicine and the high costs in time and money of severe, multiorgan injuries. Patients become people, and Macenka’s interviews show the heartening generosity and incredible dedication of caregivers, both outside and inside the Richmond PRC. Most Americans, of course, can’t access or can’t afford this crown-jewel treatment, a fact Macenka mentions but doesn’t dwell on; nevertheless, that topic might have been worth exploring. Hopefully, more trauma centers will follow PRC’s example.

A well-researched, compassionately observed study of intensive rehabilitation, its complexities and, most of all, its people.