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Small: Life and Death on the Front Lines of Pediatric Surgery
As a pediatric surgeon, Catherine Musemeche operates on the smallest of human beings, manipulates organs the size of walnuts, and uses sutures as thin as hairs to resolve matters of life or death. Working in the small space of a premature infant’s chest or abdomen allows no margin for error. It is a world rife with emotion and risk. Small takes readers inside this rarefied world of pediatric medicine, where children and newborns undergo surgery to resolve congenital defects or correct the damages caused by accidents and disease. It is an incredibly high-stakes endeavor, nerve-wracking and fascinating. Life and Death on the Front Lines of Pediatric Surgery is a gripping story about a still little-known frontier. In writing about patients and their families, Musemeche recounts the history of the developing field of pediatric surgery―so like adult medicine in many ways, but at the same time utterly different. This is a field guide to the state of the art and science of operating on the smallest human beings, the hurts and maladies that afflict them, and the changing nature of medicine in America today, told by an exceptionally gifted surgeon and writer.
244 pages, Hardcover
First published January 1, 2014
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471 people want to read
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Displaying 1 - 14 of 14 reviews
September 11, 2014
SMALL is a book that delves into part of the reason why most of us no longer personally know what it feels like to bury a child.
I picked up SMALL because I am a certified hospice and palliative care nurse (CHPN) and I have sometimes held and comforted a dying baby. Holding a child who will soon be leaving this world marks your soul in a way that is hard to explain. I read SMALL because I wanted to know more about how to handle the searing, poignant pressure that comes from walking through the Valley of the Shadow of Death with a baby and his family.
Dr. Musemeche uses well-wrought words and sentences to draw the reader into the drama of innovation and chutzpa that has allowed pediatric surgeons to keep small patients alive by cutting them open and sewing them back up. SMALL had my attention from the opening sentence: "'Stitch,' I say to the scrub nurse."
Dr. Musemeche details the history of how pediatric surgeons began saying to Death: "Not today. You can't have this baby." SMALL reads more like a thriller than a history lesson. She doesn't just tell the story of heroic surgeons; she opens the rarefied world of the pediatric operating room, describing what it feels like to be a surgeon waiting for a scrub nurse to thread a needle with suture while a tiny baby lies helpless and in desperate need of the healing that stitch can bring. Dr Musemeche tells of specific surgeries she has performed, interweaving the complex history of innovation and invention that has made it possible to save her patients. She also illuminates what it feels like to speak the tender and painful words: "I am your baby's surgeon...I must talk to you, and it is not going to be easy."
SMALL is a well written book that chronicles the beautiful daring of pediatric surgeons. It tells part of the story behind why so few of us know what it feels like to hold a dying child.
I picked up SMALL because I am a certified hospice and palliative care nurse (CHPN) and I have sometimes held and comforted a dying baby. Holding a child who will soon be leaving this world marks your soul in a way that is hard to explain. I read SMALL because I wanted to know more about how to handle the searing, poignant pressure that comes from walking through the Valley of the Shadow of Death with a baby and his family.
Dr. Musemeche uses well-wrought words and sentences to draw the reader into the drama of innovation and chutzpa that has allowed pediatric surgeons to keep small patients alive by cutting them open and sewing them back up. SMALL had my attention from the opening sentence: "'Stitch,' I say to the scrub nurse."
Dr. Musemeche details the history of how pediatric surgeons began saying to Death: "Not today. You can't have this baby." SMALL reads more like a thriller than a history lesson. She doesn't just tell the story of heroic surgeons; she opens the rarefied world of the pediatric operating room, describing what it feels like to be a surgeon waiting for a scrub nurse to thread a needle with suture while a tiny baby lies helpless and in desperate need of the healing that stitch can bring. Dr Musemeche tells of specific surgeries she has performed, interweaving the complex history of innovation and invention that has made it possible to save her patients. She also illuminates what it feels like to speak the tender and painful words: "I am your baby's surgeon...I must talk to you, and it is not going to be easy."
SMALL is a well written book that chronicles the beautiful daring of pediatric surgeons. It tells part of the story behind why so few of us know what it feels like to hold a dying child.
September 12, 2014
SMALL is a riveting, poignant and fascinating account of what it is like to be a pediatric surgeon. The reader is witness to pivotal moments in the development of a relatively new specialty, and to some degree is able to tag along, in an intimate and voyeuristic association with the narrator, as she grows from a highly resourceful med student to a gifted pediatric surgeon.
Interspersed among glimpses of the author’s own professional development are captivating stories of notable pediatric surgeons as they experience struggle, invention, heartbreaking loss, public service, when treating patients who are “one-hundredth the size of the average human.”
What is unusual about Musemeche’s writing is its surgical precision – her clarity of explanation, selectivity in the choice of topics for her dozen chapters (which, incidentally read like short stories and provide measured amounts of somewhat foreign but highly digestible information) and choice cuts of descriptive passage.
This is a must-read for all of us.
My advice: Start SMALL immediately.
Interspersed among glimpses of the author’s own professional development are captivating stories of notable pediatric surgeons as they experience struggle, invention, heartbreaking loss, public service, when treating patients who are “one-hundredth the size of the average human.”
What is unusual about Musemeche’s writing is its surgical precision – her clarity of explanation, selectivity in the choice of topics for her dozen chapters (which, incidentally read like short stories and provide measured amounts of somewhat foreign but highly digestible information) and choice cuts of descriptive passage.
This is a must-read for all of us.
My advice: Start SMALL immediately.
December 28, 2025
This was an amazing book to read, as it allowed me to see the world through the eyes of a pediatric surgeon, Dr.
Musemeche. I had the opportunity to work alongside her at Mary Bridge Children's Hospital in Tacoma,WA which made the experience even more meaningful. What stood out most to me was her compassion and exceptional talent as a physician. I found it fascinating to follow the timeline of medical discoveries and learn when specific procedures were first developed. Because of these advancements, many pediatric patients are now living longer and healthier.
I thoroughly enjoyed reading this book.
dnf
May 25, 2025DNF.
Had to return to library.
Had to return to library.
September 4, 2023
A brief and exciting dive into the past, present and future of pediatric surgery. The book dives into the maverick surgeon who made the first trans-catheter IVs available, first pediatric ECMOs, first in uter prenatal operations and many more medical innovations. Throughout Small, the reader will face heary wrenching stories of little babies dying due to the lack of doctors, specialty centers or preventative care available. Dr. Musemeche pushes problems such as lack of pediatric care funding, or lack of pediatric medical devices available at non-specialty centers as well as complication arrising from preventable cases. You will also learn about the many doctor whom fought for children's lives to make pediatrics a respectable medicak field with physicians like Dr. Gibbon, Dr. Robert Gross and Dr. Barbara. Small is a great book to dive into the world of small prescision medicine and saving lives.
January 8, 2024
The author reviews the history of pediatric surgery, including its current state (10 years ago, when it was published) and promising areas of research. She illustrates the subjects with examples from her own practice. Most of the focus is on surgery for tiny babies (including preemies and fetuses) for congenital disorders, but she also covers things like childhood obesity and avoidable injuries caused by poverty. She gives stories on the development of lifesaving devices and materials that have revolutionized treatments. Most of these have been developed in the last 50 years. In the last chapter, she talks about future improvements on existing technology, such as taking cells from a person's body to grow the tissue for the needed organs or other parts, and expanded use of 3D printing - amazing! These and other technological advances noted in the book will have applications to many medical specialties as well as pediatric surgery. The book is short and easy to read. I recommend it.
August 4, 2024
Started and finished this book in a day. Incredibly hard to read at times due to the deeply emotional nature of the content (and also because so much of it is extremely explicit and made me so squeamish) and a little bit also because of the highly technical medical terms. I do not advise new parents to read this because it will make you sick and upset with worry. Kudos to the author for all of her research and devotion to this book, you can really tell this is her passion project. The chapter on childhood obesity kinda sucked a lot, though.
December 8, 2014
There is no such thing as a routine operation in a baby.
Dr. Catherine Musemeche is a pediatric surgeon who has been in practice for nearly a quarter of a century after the completion of her rigorous training, and she effectively combines her professional experiences, personal interests, and excellent writing skills in this superb book. In it she discusses the history and heroes of pediatric surgery, the challenges that she and other surgeons face in operating on tiny critically ill infants, current pressing medical issues that affect the practice of pediatricians and pediatric surgeons, and her own successes and failures throughout her career.
Dr. Musemeche provides a brief history of the development of pediatric surgery in the United States as a recognized medical specialty, and the difficulties that the first pediatric surgeons faced in gaining the respect of general surgeons, who fought against the newcomers' encroachment on their territory, and pediatricians, who initially rejected but soon championed and accepted their colleagues into their own medical society, the American Academy of Pediatrics, long before the American College of Surgeons decided to do so. She also honors some of the pioneers of pediatric surgery, including Dr. C. Everett Koop, the first full time pediatric surgeon at Children's Hospital of Philadelphia and the former U.S. Surgeon General; Dr. Stanley Dudrick, whose pioneering work on intravenous nutrition allowed children and adults with compromised gastrointestinal systems to receive sufficient intake for growth and healing via total parenteral nutrition; and Dr. Bob Bartlett, whose work on extracorporeal membrane oxygenation, or ECMO, allowed surgeons to repair formerly lethal congenital cardiac defects and save the lives of the most critically ill children whose hearts and lungs had failed.
The author's own experiences in the operating room are interspersed with the stories of these pioneers, and I found my heart rate increasing as she described several difficult cases involving fragile babies on the brink of death.
Perhaps the most interesting part of the book to the general reader will be the chapters about obesity, medical errors, preventable injuries, and the development of new surgical devices and techniques, most notably the rise of fetal surgery. The most notable and most impressive hero in Small is Dr. Barbara Barlow, the first woman to complete a pediatric surgery residency at Babies' Hospital (now Morgan Stanley Children's Hospital) of Columbia University in New York, who worked for many years as a pediatric surgeon at Harlem Hospital, an inner city public hospital that took care of thousands of victims of accidental injuries of children in their homes, and in playgrounds and streets in their neighborhoods. She was the leader of multiple successful efforts to prevent these injuries, and in 2011 she was honored with the Hero Award for contributions to public health by the Centers for Disease Control and Prevention (CDC).
One minor criticism of Small would be the absence of diagrams and photographs of the conditions and procedures that Dr. Musemeche describes in the book, although her rich descriptions of them and my medical training allowed me to easily visualize what she saw. However, this is an excellent contribution to the history of medicine and public health, which is a very enjoyable and informative book and one that I would highly recommend to all readers.
Dr. Catherine Musemeche is a pediatric surgeon who has been in practice for nearly a quarter of a century after the completion of her rigorous training, and she effectively combines her professional experiences, personal interests, and excellent writing skills in this superb book. In it she discusses the history and heroes of pediatric surgery, the challenges that she and other surgeons face in operating on tiny critically ill infants, current pressing medical issues that affect the practice of pediatricians and pediatric surgeons, and her own successes and failures throughout her career.
Dr. Musemeche provides a brief history of the development of pediatric surgery in the United States as a recognized medical specialty, and the difficulties that the first pediatric surgeons faced in gaining the respect of general surgeons, who fought against the newcomers' encroachment on their territory, and pediatricians, who initially rejected but soon championed and accepted their colleagues into their own medical society, the American Academy of Pediatrics, long before the American College of Surgeons decided to do so. She also honors some of the pioneers of pediatric surgery, including Dr. C. Everett Koop, the first full time pediatric surgeon at Children's Hospital of Philadelphia and the former U.S. Surgeon General; Dr. Stanley Dudrick, whose pioneering work on intravenous nutrition allowed children and adults with compromised gastrointestinal systems to receive sufficient intake for growth and healing via total parenteral nutrition; and Dr. Bob Bartlett, whose work on extracorporeal membrane oxygenation, or ECMO, allowed surgeons to repair formerly lethal congenital cardiac defects and save the lives of the most critically ill children whose hearts and lungs had failed.
The author's own experiences in the operating room are interspersed with the stories of these pioneers, and I found my heart rate increasing as she described several difficult cases involving fragile babies on the brink of death.
Perhaps the most interesting part of the book to the general reader will be the chapters about obesity, medical errors, preventable injuries, and the development of new surgical devices and techniques, most notably the rise of fetal surgery. The most notable and most impressive hero in Small is Dr. Barbara Barlow, the first woman to complete a pediatric surgery residency at Babies' Hospital (now Morgan Stanley Children's Hospital) of Columbia University in New York, who worked for many years as a pediatric surgeon at Harlem Hospital, an inner city public hospital that took care of thousands of victims of accidental injuries of children in their homes, and in playgrounds and streets in their neighborhoods. She was the leader of multiple successful efforts to prevent these injuries, and in 2011 she was honored with the Hero Award for contributions to public health by the Centers for Disease Control and Prevention (CDC).
One minor criticism of Small would be the absence of diagrams and photographs of the conditions and procedures that Dr. Musemeche describes in the book, although her rich descriptions of them and my medical training allowed me to easily visualize what she saw. However, this is an excellent contribution to the history of medicine and public health, which is a very enjoyable and informative book and one that I would highly recommend to all readers.
January 1, 2015
Fetal surgery is fascinating and unimaginable. I understand why no names could be used but using letters instead of pseudonyms (such as "Baby K"), as well as focusing strictly on the operating room with no backstory, made it a little more detached for me. That's probably a good thing, as I would've been a weepy mess if I had been any more invested; I definitely hugged my kids a little closer when reading.
By far, one of the most interesting chapters to me was when she talked about the differences between childhood and adult cancers. There are the obvious physiological differences, along with the difficulties designing and obtaining medical supplies for the tiniest of children. I also didn't realize (going off of her statistics, which I did not independently verify) 60% of children are enrolled in clinical trials versus only 3% of adults. The thing that really made me pause were her observations about the huge advantage children have over adults in regards to how they are cared for. Parents are the most invested caregivers and will rearrange their entire lives to ensure the best care for their children; as she says, "parents have an unique stake in the health of the child, someone they value above all else". If it is a spouse that is ill, they will still do their very best but it isn't the same as caring for a child. Parents note the smallest changes in their child's symptoms that a spouse may miss in the chaos of life. Parents make sure their children eat and drink and take their meds even when they don't want to, spouses may defer a little more.
To contrast, I lost interest when she talked about obesity and moved on from those sections quickly.
Listening to the early days and how quickly something went from an idea to an usable product (only 6 weeks from the time Tom Fogarty first produced a balloon catheter for a new technique of removing blood clots until it was first used on a patient) was almost unbelievable. I understand the needs for trials and regulations but can also understand the huge frustration of knowing something is in the works but won't be available to help your patients for years.
A Few Quotes from the Book
"Every baby makes a lengthy journey to get to this place we call 'life', but they don't all show up ready for it when they arrive."
"Will the surgeon find a nameable condition within her power to repair? Or will she encounter something not so easily fixed, a diagnosis that sentences the patient to a series of complicated operations, a situation plagued with setbacks and months of hospitalization? Even worse, will she find organs so grossly malformed or incomplete that she can only palliate and close, becoming the messenger of grief to despairing parents in a darkened hallway? The answer, only minutes away, lurks beneath the skin in the shadow of a scalpel poised and ready."
"No matter how small, this most vulnerable of humans is a potential patient, one who has captured the imagination of surgeons dedicated to rerouting gestational detours so a child can have a shot at a normal life."
Find all my reviews at:
http://readingatrandom.blogspot.com/
By far, one of the most interesting chapters to me was when she talked about the differences between childhood and adult cancers. There are the obvious physiological differences, along with the difficulties designing and obtaining medical supplies for the tiniest of children. I also didn't realize (going off of her statistics, which I did not independently verify) 60% of children are enrolled in clinical trials versus only 3% of adults. The thing that really made me pause were her observations about the huge advantage children have over adults in regards to how they are cared for. Parents are the most invested caregivers and will rearrange their entire lives to ensure the best care for their children; as she says, "parents have an unique stake in the health of the child, someone they value above all else". If it is a spouse that is ill, they will still do their very best but it isn't the same as caring for a child. Parents note the smallest changes in their child's symptoms that a spouse may miss in the chaos of life. Parents make sure their children eat and drink and take their meds even when they don't want to, spouses may defer a little more.
To contrast, I lost interest when she talked about obesity and moved on from those sections quickly.
Listening to the early days and how quickly something went from an idea to an usable product (only 6 weeks from the time Tom Fogarty first produced a balloon catheter for a new technique of removing blood clots until it was first used on a patient) was almost unbelievable. I understand the needs for trials and regulations but can also understand the huge frustration of knowing something is in the works but won't be available to help your patients for years.
A Few Quotes from the Book
"Every baby makes a lengthy journey to get to this place we call 'life', but they don't all show up ready for it when they arrive."
"Will the surgeon find a nameable condition within her power to repair? Or will she encounter something not so easily fixed, a diagnosis that sentences the patient to a series of complicated operations, a situation plagued with setbacks and months of hospitalization? Even worse, will she find organs so grossly malformed or incomplete that she can only palliate and close, becoming the messenger of grief to despairing parents in a darkened hallway? The answer, only minutes away, lurks beneath the skin in the shadow of a scalpel poised and ready."
"No matter how small, this most vulnerable of humans is a potential patient, one who has captured the imagination of surgeons dedicated to rerouting gestational detours so a child can have a shot at a normal life."
Find all my reviews at:
http://readingatrandom.blogspot.com/
December 2, 2016
Not specifically TBI.
Dr. Musemeche takes the reader, as though she were walking with you, her white coat and stethoscope swinging, behind the "authorized personnel only" automatic double doors and along the path of significant historical discoveries and events impacting the surgery of children. The title is not too filled with medical jargon and is a compelling read.
This might be too intense for parents with vulnerable children, but the historical perspective may give enough distance so one can appreciate this view from the "other side" of those caring for our babies (not matter how big / old). If you have suffered through a serious illness with your child, this book will resonate. If you are interested in medical non-fiction, this is well-written and engaging right through to the last chapter where, frankly, I was disappointed it ended.
TBI parents will find so many of the experiences feel familiar, even if the conditions aren't.
Table of contents with my comments:
The thread of life (DNA, tiny, communicating) - how absolutely tiny, tiny preemies are, talking with parents
Bunny rabbits, Boston, and babies (basic equipment like trachs, IVs) - developing devices specifically for pediatrics
The shortcut to survival (intestinal defects / malnutrition) - TPN, research (and how today's regulations make it more difficult, but safer, to explore options)
Inside out (abdominal wall defects) - "nature of materials" and developing techniques to make the horrific manageable.
Going to extremes (ECMO) - so close to home: used experimentally, saved my adult son's life unlike the child in the book.
Battlegrounds to playgrounds - (safety, public health issues) - One surgeon who truly made a difference in a creative, non-medical way
The weight of the future (obesity)
Something to celebrate (cancer) - hope, optimism in the face of dismal predicitions, resonated for me for brain injury parents
Tiny tools for tiny bodies (technology, rare diseases, cost/benefit)
Lessons (complications, errors)
Small (fetal surgery) - fetal / pediatric research vs. adult
The lost and found (organs / tissue engineering)
Dr. Musemeche takes the reader, as though she were walking with you, her white coat and stethoscope swinging, behind the "authorized personnel only" automatic double doors and along the path of significant historical discoveries and events impacting the surgery of children. The title is not too filled with medical jargon and is a compelling read.
This might be too intense for parents with vulnerable children, but the historical perspective may give enough distance so one can appreciate this view from the "other side" of those caring for our babies (not matter how big / old). If you have suffered through a serious illness with your child, this book will resonate. If you are interested in medical non-fiction, this is well-written and engaging right through to the last chapter where, frankly, I was disappointed it ended.
TBI parents will find so many of the experiences feel familiar, even if the conditions aren't.
Table of contents with my comments:
The thread of life (DNA, tiny, communicating) - how absolutely tiny, tiny preemies are, talking with parents
Bunny rabbits, Boston, and babies (basic equipment like trachs, IVs) - developing devices specifically for pediatrics
The shortcut to survival (intestinal defects / malnutrition) - TPN, research (and how today's regulations make it more difficult, but safer, to explore options)
Inside out (abdominal wall defects) - "nature of materials" and developing techniques to make the horrific manageable.
Going to extremes (ECMO) - so close to home: used experimentally, saved my adult son's life unlike the child in the book.
Battlegrounds to playgrounds - (safety, public health issues) - One surgeon who truly made a difference in a creative, non-medical way
The weight of the future (obesity)
Something to celebrate (cancer) - hope, optimism in the face of dismal predicitions, resonated for me for brain injury parents
Tiny tools for tiny bodies (technology, rare diseases, cost/benefit)
Lessons (complications, errors)
Small (fetal surgery) - fetal / pediatric research vs. adult
The lost and found (organs / tissue engineering)
December 30, 2014
From the perspective a a lay person who has long been fascinated by all things medical, this was an absolutely fascinating read. I have taken for granted the notion of the existence of such a thing as a pediatric surgeon, yet had no idea that it is a relatively recent development, in fact, still coming into it's own. The book presents case studies which in and of themselves are amazing, but the cases serve as the platform to the truly engrossing brief history of pediatric surgery, the differences between a child's body and an adult's (significantly more than just size}, the hurdles in the way of creating instruments and devices for use in these tiny bodies, the ethics and politics in this field of endeavor, and above all, the heroic ingenuity, courage, and determination of the innovators in this field. This is a book which is definitely accessible to the lay person and it is also a riveting education for anyone who is interested in the medical aspects of fetuses, preemies, and children in general. Excellent read!
June 12, 2015
I thoroughly enjoyed Small. Musemeche does a fabulous job introducing the reader to the world of pediatric surgery and all the complications of working on a child, who contrary to popular belief, is not a miniature adult. My favorite part was reading about all the advances in biomedical engineering over the years - Musemeche is great at providing a history of medical devices - the various case studies of children, and the discussion of public health and prevention. My one quibble with this book is that sometimes it veers into territory that seems more appropriate for adult surgery or general pediatrics - which is not actually a problem, but just seemed a bit off topic. An excellent read for those who enjoy science writing and learning about an interesting specialty in medicine.
Note: I received this book through LibraryThing's EarlyReviewers Program.
Note: I received this book through LibraryThing's EarlyReviewers Program.
December 2, 2016
Small takes the reader behind the "authorized personnel only" automatic double doors and along the path of significant historical discoveries and events in a readable (that is, not too filled with medical jargon) and compelling fashion.
This might be too intense for parents with vulnerable children, but it gives the view from the "other side" of those caring for our babies (not matter how big / old). If you have suffered through a serious illness with your child, this book will resonate. If you are interested in medical non-fiction, this is well-written and engaging right through to the last chapter where, frankly, I was disappointed it ended. I'm glad Musemeche's new book, Hurt, it out.
An excellent title for high school or college students contemplating a career in medicine (that classice required non-fiction summer read).
This might be too intense for parents with vulnerable children, but it gives the view from the "other side" of those caring for our babies (not matter how big / old). If you have suffered through a serious illness with your child, this book will resonate. If you are interested in medical non-fiction, this is well-written and engaging right through to the last chapter where, frankly, I was disappointed it ended. I'm glad Musemeche's new book, Hurt, it out.
An excellent title for high school or college students contemplating a career in medicine (that classice required non-fiction summer read).
January 31, 2016
A very engaging read on the past 60 years of pediatric surgery as told to us by Dr. Catherine Musemeche, a pediatric surgeon. She her own cases and those of others in the field to take us on the journey. Her work is full of hope, heartbreak, and the science of pediatric surgery both past and present. Dr Musemeche also provides us a look at what the future might hold and closes her book acknowledging the inspiration that the children provide, and the limitless power of love and courage parents show in the face of grave circumstances.
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