Where No One Should Live

Book Title: Where No One Should Live

Author: Sandra Cavallo Miller

Publication Information: Reno, NV, University of Nevada Press, 2021, 264 pp., $26.00, hardcover

Where No One Should Live is a fictional account of family physician educator and public health expert Dr Maya Summers. Set in Phoenix, Arizona, it chronicles Dr Summers’ work tracking mosquito-borne illnesses, spearheading disaster preparedness, and advocating for necessary health regulations in her community. Many of us will see a reflection of our busy lives here, as her public health work intersects with days working in academic family medicine. She navigates past trauma, heartbreak, and budding romance. Halfway through, she becomes a key player in solving a residency mystery—but this review is without spoilers! The story weaves together romance, mystery, public health, and academic family medicine. Like many of us in family medicine, this book does a lot of different things.

Perhaps as a result of the many facets of the novel, there was less opportunity for character study and growth. The mystery, romance, and even horse-rearing plots interwoven with the medical anecdotes move the story forward. Though the culprit at the center of the mystery was easy for me to guess, I was still entertained by how the author let the story unfold and wove ties to medicine into it. As a work of fiction, it was light and entertaining, capably done if slightly predictable. My favorite part of Where No One Should Live was the depiction of the daily life of family medicine and public health. It felt accurate, if dramatized—forgivable for a work of fiction! It was refreshing to see academic family medicine represented in its many roles, from clinic preceptor and resident advisor to inpatient medicine, end-of-life, and, of course, direct cradle-to-grave clinical caregiver.

I also deeply enjoyed the many references to a breadth of public health issues, from West Nile virus and rabies to helmet use, the opioid epidemic, and disaster response. It was a great reminder of how powerful a public health approach to health problems in a community can be; at the same time, all these vignettes were well woven into the story. Unlike public health stories I’m used to hearing in the news (even pre-COVID-19), these rarely felt like doomsday predictions and had plausible, action-oriented solutions. A valuable bonus is the extensive list of references in the end of the book used to inform these parts of the book.

There were a couple places where I did find the representation of academic family medicine disappointing. There was a cringeworthy lack of professional boundaries between two supporting characters. A female resident is portrayed as overly flirtatious while her leering male attending goes uncorrected by his peers. Inappropriate and unprofessional behavior does happen in family medicine academia,¹ and I applaud the author for bringing attention to that issue. However, it is a disservice to portray the victim as if she were asking to be objectified. Dr Miller gets it right in that, too often, inappropriate behavior is not addressed. However, victims rarely welcome or solicit that behavior. Dr Miller introduces complex public health topics in a very understandable and accessible way elsewhere in the book, contrasting a current state with an ideal state (eg, of helmet use, opioid deaths). I would have liked to have seen similar treatment of the very real problem of sexual harassment and gender bias in medicine.

The second instance where the book rang false for me was in the approach to a struggling learner—a paucity of formative feedback led up to an abrupt academic probation. It blindsided not only the character but me as the reader. My experience in resident education differs, though I concede that it probably happens as described in the book sometimes. This choice was perhaps meant to illuminate that. Still, I would have appreciated if one of the characters had more directly examined the role of the residency in remediation—how could they all have done better by that resident? Both subplots could make an interesting touchstone in a faculty development session or faculty book club.

The above critiques notwithstanding, I think family medicine educators could use this work with learners. It could make an interesting and unique introduction to the fields of family medicine, public health, or both. In the case of family medicine, this is likely to be most effective in the preclinical or early clinical years, since the target audience is laypeople. If you have ever found yourself frustrated with medical TV drama, even when it is close to right, this book will give you a similar feeling. Nothing is inaccurate, in fact, most of the medical aspects of the book ring quite true! That said, being a work of fiction, readers will sense that the work doesn’t quite reflect real life. Thus, it might do quite well paired with a real-life account to balance that flavor of fiction. For a public health focus, Where No One Should Live would make a great preface to something like Mountains Beyond Mountains,² or Prevention Diaries.^3,4 This work is a great way to get learners interested—the added drama and romance support engagement. A first-hand, real-life account would add empowerment—here’s what true attention to public health can do in the real world! Similarly, to introduce learners to family medicine, it might be nice to pair this work with nonfiction reflections from general family medicine, such as Windblown,5,6 or A Country Doctor Writes.^7,8 Where No One Should Live is a charming window into family medicine and public health, disguised as a fun read well-suited to any book club. The same can’t be said for many nonfiction medical works. Using both with learners could prove to be a powerful way to gain interest and follow up with real-life proof that Dr Miller really did have it right. As she says in her dedication: “Family physicians do everything. They do it all, all the time” (p. 256).