Rating: 3.5

A couple of years ago, I serendipitously came across physician Michael D. Stein’s Accidental Kindness, a memoir focusing on empathy in medical practice. Impressed and moved by it, I was pleased to receive a pre-publication copy of Stein’s new book which considers the working lives of his patients. The Covid-19 pandemic got Stein, a primary care doctor “in a mid-sized industrial city in the northeastern United States”, thinking about the working-class “essential workers” who comprised the greater part of his practice. During the pandemic, these were the people who, out of pure necessity, continued to work outside the home—often at low-paying jobs with minimal or no benefits—while others had the luxury of making their living while staying in place.

Stein points out that in 2019, the year before Covid struck, 62% of America’s top-quarter income earners could work remotely compared to only 9% of the bottom quarter. It’s no surprise, then, that the latter, invisible to those who worked from home, were the ones most likely to fall ill from the virus. The 2020 (first-year-of-Covid) death rates by risk order were highest in construction workers, transportation workers (truck and public-transit drivers), and retail workers. Correctional officers, home-health aides, nurses, cooks, factory workers, and “material movers” (who operate bulldozers and related equipment) were also badly affected.

As the pandemic subsided, Stein, who has always admired mechanically inclined people able to problem solve and fix things that he cannot, began making a point of asking his patients about their work lives. In this impressionistic, mosaic-like book, he presents well over 100 individual voices of workers who perform an enormous variety of hands-on jobs. One-half of the labour force in the US is employed in working class jobs defined as manual labour, service industry, and clerical work. In A Living we hear from a large number of manual labourers (builders; heavy-equipment operators; foundry and factory workers; installers of flooring and insulation; and heating and plumbing specialists—to name a few) as well as from service industry workers (restaurant/fast-food/bartending staff; personal support, nursing-home, and childcare workers; hair dressers; and exterminators—among others). If the voices of clerical workers are included, I honestly don’t remember them. Few if any jobs come up more than once, and only one worker is heard from multiple times. This is Dennis, a clammer who, for some undisclosed reason, has fallen on hard times, is unemployed and drinking too much. Through fifteen entries, which appear at regular intervals throughout the book, we follow his journey back to his boat and see him reclaiming his identity and his energy, with Dr. Stein gently urging him on.

The text is organized into five parts: Identity, Losses, Connection, Survival, and Structure. Each section begins with a brief essay by the author and is interspersed with occasional statistics, facts, and pithy commentary related to the lives of workers. Stein makes clear that although he discusses some policies that affect workers, his book is not about the sociology of occupational hazards or the inequality of labourers. He also points out that not all of those he features are even poor. Yes, there are some who feel trapped in hated work, but others like their jobs, take pride and find meaning in them, and are, in fact, restless when not working. The various challenges of betrayal by workmates, generational differences on the job, being employed in family businesses where work-life boundaries become blurry, single parenthood or child-support payments, substance abuse, and mental illness often come up in patient comments. These offer plenty for the reader to contemplate.

Most of the text is given over to the words of the patients themselves. Each entry is extremely brief, rarely more than three paragraphs long, and often as short as one. Some are dryly humorous; others are insightful and astute. “Knowledge,” writes the author, “is necessary to be good at anything” and working with one’s hands is a kind of thinking. I couldn’t agree more.

Stein does not explain how he collected the words of his patients. Did he tell them about his project and make notes after appointments? Did he, with his patient’s permission, make audio recordings? It would have been interesting to know. (It’s my understanding doctors cannot, in fact, record patients —at least, that’s the case in Ontario—but patients can tape doctors.) The individuals that Stein presents were, of course, in his office for medical reasons, and though he observes that health is intimately tied to the work people do, his patients’ illnesses and conditions are rarely mentioned.

The author notes that the peculiarities of our jobs are seldom known to others. This book shines a light on work most of us don’t think about. Because some of the occupations were so unfamiliar to me, I wished there were footnotes or a glossary to clarify job-specific technical terms. Overall, however, I found this to be an engaging, informative, and stimulating book. I recommend it.

Thank you to Net Galley and the publisher for providing me with an advanced reader copy.

This was such an interesting read. It was dense with a lot of information, but that is what is expected when reading a non-fiction essay collection. I think it was very informative and interesting. I liked the way the stories are written , and how they tied together


Thank you to NetGalley, to the author, and to the publisher for this complementary ARC in exchange for my honest review!!!

"A Living" by Dr. Michael D. Stein is a modern "Working." Stein captures the lives of his working-class patients in revelatory snippets. This makes for a quick but absorbing read. The author makes it clear how critical the working class is to our economy. It's a thought-provoking stuff. Worth the read. Thanks to #netgalley and #melvillehousepublishing for the opportunity to preview this book.

Patients who trust their lives to their doctor will tell him or her intimate details about their work. Learn the honest way workers feel about their hands-on jobs, and come to appreciate all essential workers more.