Stories from the ER: a doctor shows how empathy, creativity, and imagination are the cornerstones of clinical care.
To be an emergency room doctor is to be a professional listener to stories. Each patient presents a story; finding the heart of that story is the doctor’s most critical task. More technology, more tests, and more data won’t work if doctors get the story wrong. Empathy, creativity, and imagination are the cornerstones of clinical care. In Tornado of Life, ER physician Jay Baruch offers a series of short, powerful, and affecting essays that capture the stories of ER patients in all their complexity and messiness.
Patients come to the ER with lives troubled by scales of misfortune that have little to do with disease or injury. ER doctors must be problem-finders before they are problem-solvers. Cheryl, for example, whose story is a chaos narrative of “and this happened, and then that happened, and then, and then and then and then,” tells Baruch she is “stuck in a tornado of life.” What will help her, and what will help Mr. K., who seems like a textbook case of post-combat PTSD but turns out not to be? Baruch describes, among other things, the emergency of loneliness (invoking Chekhov, another doctor-writer); his own (frightening) experience as a patient; the patient who demanded a hug; and emergency medicine during COVID-19. These stories often end without closure or solutions. The patients are discharged into the world. But if they’re lucky, the doctor has listened to their stories as well as treated them.
Thanks to NetGalley and MIT Press for this review copy!
TORNADO OF LIFE is a quick read, filled with short stories about patients presenting to the emergency room and how they provoke the doctor’s thoughts and actions. For example, one of the first patients the author sees (as a brand-new doctor) is a woman, presenting with vague symptoms, but appearing well. It turns out that she may have been abused by her husband, and just needed someone to talk to, and perhaps have someone suggest a course of action for her. Baruch regrets not seeing the patient’s true needs and says that case stayed in his mind for a while. He attributes his lack of communication to his inexperience and explains to the reader why it is important to consider the whole patient, not just what they are telling you. He also says an ER doctor should not judge a patient on how they look when they show up to the ER. Sometimes the most disheveled need the least care, and vice versa.
He tells the story of a patient asking for pain meds; and is unsure if he should prescribe them. He discusses the dilemma of drug-seeking patients and how pain is unmeasurable, unlike a temperature or a heart rate. Baruch says that “do no harm” is a doctor’s first tenet, but when it comes to pain, you may be damned if you do or damned if you don’t. If someone is in real pain, he is obligated to help them. But if a patient is looking for drugs to feed his habit, then prescribing them could harm them as Baruch encourages them to continue their addiction.
Each chapter holds a new patient’s story and the lesson the ER doctor learned from the case. Communication and empathy are a recurring theme, which makes sense. An ER visit is fraught with anxiety, and it can be comforting if a caring physician examines you. Often the doctor has only a few minutes to connect with the patient, which makes getting through the layers of each person’s needs exceedingly difficult. The chapters are stand-alone stories, making the book easy to read in small bites.
Baruch touches on each of those layers in depth, ruminating on how he could have helped some patients better, how some patients helped him learn more about himself, and detailing the psychic struggle that doctors experience daily. Baruch comes across as an extremely caring and empathetic person; I would appreciate his care should I ever need to visit his ER.
The only thing that frustrated me about TORNADO OF LIFE was that I never got closure on any of the patient’s ailments. The author states that in the beginning of the book – there will only be a few details about the ER visit and then the rest of the chapter will be introspection. I found myself wanting to know more about each patient, what their diagnosis was and how they were addressed before they were discharged. I learned to put my dismay aside as I got through each chapter, understanding that the point of each story was Baruch’s rumination and a lesson learned.
This is an unusual book, as the doctor’s thoughts are shared front and center. Most books written by those in the medical field will give a great deal of detail on their patients with a bit of introspection added. TORNADO OF LIFE is the opposite, and the reader needs to take time to digest the deep thoughts Baruch shares. Reading this will give you new respect for ER doctors and all that they handle on a daily basis.
Want to read this book? You can pick up your copy here.
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