After reading the first chapter, ‘Emergency Doctor’ was not really a book I thought I would enjoy. For me personally, it felt a little slow, too laden with details and didn’t really have the spark that I tend to look for in books.
However, I must admit it did hook me and I do look back fondly on it. So here I am dedicating a post to this book which actually provided a lot of insight into a doctor’s life.
‘Emergency Doctor’ is really just a series of accounts about life in the Emergency Department at the Bellevue Hospital, however very quickly it becomes more than that. You build a relationship with the key characters, both the doctors and patients, and I believe this allows you to feel the atmosphere that is being reported. You are able to see both perspectives: the doctors who have dedicated their life to helping people and of course the patients, who come from a variety of situations. You sympathise with the doctors as they deal with difficult patients, recurring patients who seem to not take advantage of the help or mainly people who are just simply very worried and therefore not at their best. You empathise with the patients who come in with varying conditions and feel the pain that is at the centre of their world.
Although this may not be clear from my photo, there are many cut up post-it notes sticking up from the pages. These post-its signify places that were of interest to me and I’ll share a few that still remain with me after a while since I’ve finished the book.
(Of course I can’t find anything now because there’s too many post-it notes.)
- There is a case where a patient has been diagnosed with having a grand mal seizure who does not want to make a report to his employer. Later it is clarified that he is a pilot. Goldfrank (a doctor at Bellevue with whom Edward Ziegler, the author, cooperated with) was then quoted to have said “this was one of the rare cases where the obligation of the physician to honour the confidentiality in treating a patient runs right up against our responsibilities to society”. Here, of course, is the classic case of a patient not wanting to reveal his medical condition because of the threat this could impose on his job, especially as he has a family to support. However, it is also the doctor’s duty to inform the airline as the pilot would be endangering the lives of many more people, and, as Goldfrank explains, there is a very thin line between patient confidentiality and the welfare of society, especially in such a responsible job like a pilot.
- “On Old Olympia’s Towering Tops/ A Finn And German Viewed Some Hops” is a mnemonic used by many doctors to indicate the succession of questions asked depending on the 12 cranial nerves: Optic, Olfactory, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Auditory, Glossopharyngeal, Vagus, Spinal accessory and Hypoglossal, to confirm injury to the brain. (Ok, I didn’t remember this but found it when I was flicking through.)
- Another mnemonic, but now for the first evaluation of a traumatized patient: “ABCDE”. A for airway-making sure it is open. B for breathing. C for circulation. D for disability, specifically neurological. E for exposure, expose the patient completely to avoid overlooking any hidden injuries.
- The five key parts of diagnostic perceptions: blood pressure, pulse, depth and rate of breathing, temperature and level of consciousness. Next comes vital signs: the colour of the patient, whether white (possible shock), blue (not enough oxygen), bright red (too many red blood cells) or yellow (jaundiced). Then motor status: writhing, hunched, immobile or uncoordinated.
- There’s plenty of other interesting facts concerning emergency medicine (such as the fact that nylon should be used to close wounds in the Emergency Department and not silk because there is only 2 to 3% infection rate rather than 10 to 15% with silk), but I’ll let you find out the rest of those yourself. Of course this book was first published quite a while ago (in the 80s I believe) so, as always, medicine has evolved but there’s still a lot you can take away.
I found that highlighting relevant pieces of information really helped me to focus on the key points among the pages bursting with information. And so, to conclude, I will leave you with my two stand out quotes:
- [When talking about working with the homeless] Goldfrank: “you appreciate the most basic aspects of humanity what’s left when all the trimmings of society are removed…We’re fighting to preserve the integrity of the individual and uphold each person’s potential strength. When you understand this…you grasp the human experience in a way that I think equips you to work with all human beings.”
- And, most importantly: “as care givers our responsibility is to see the worth of each person as a human being and to give them all you’ve got. And you can’t just give them cold and detached attention-even if it meets the technical standards of good care. There has to be some feeling to it, some warmth. Even the down-and-out are very perceptive-of your beliefs, your philosophy, the way you treat them and the way you look at them.”