Life on the Ground Floor: Letters from the Edge of Emergency Medicine

Truthfully I didn’t expect to be able to get through this book. Two reasons. The first being that I have a super weak stomach and the smell of hospitals makes me dizzy and light headed. The second is that I typically start dry-heaving at the slightest suggestion of a medical procedure and/or illness. This is usually immediately followed by nausea. Going to physio nauseates me, and no one is even sick there.

None of that happened, although I had flashbacks to watching House and Grey’s Anatomy, even though those television shows are nothing like this book at all. Medical drama tends to bleed together under a wash of my own anxiety, I guess.

But Life on the Ground Floor: Letters from the Edge of Emergency Medicine produced no such reactions. Reasons unknown. Perhaps it was too distractingly interesting.

James Maskalyk breaks the book up into his time in an emergency room in a busy Toronto hospital, and his time training Ethiopia’s first emergency doctors in a teaching hospital in Addis Abada. The differences in environment are horrifying. In Ethiopia, even if the ER doctors know what to do, they cannot do anything for their patients. There’s no blood, or no platelets, or no bed, or no critical piece of equipment or medicine. Instead, they learn, they plan for next time.

Meanwhile, doctors in Toronto seem more strapped for compassion, awash in every medical tactic they could need except more time. I think the outcome is simply: don’t get sick or seriously injured. Just don’t.

Emergency Rooms, and the people running them, remain interesting and mysterious. Maskalyk doesn’t glamourize the ER: there are no wonderful last minute saves as found on TV, but he does humanize it. At least, he acknowledges his own shortcomings and the shortcomings in the systems that keep us alive, when we need them.

If it wasn’t for the hospital inducing nausea, I might even thrive in an ER, where order on disorder is enforced and where the clarity of decision is paramount. Immediacy of decision is paramount.

Writes Maskalyk: “Never delay a decision when you have enough information to make it, and always follow a decision as closely as possible with an action. If you don’t, indecision and inaction multiply into chaos. Decisions create order.”

In agency work (and probably most professional settings these days where subjectivity is an element of the final outcome), if you make a decision when you have the information required to make it, someone will doubtlessly complain that they weren’t consulted and didn’t have any say in the final decision. Their feelings are hurt. The decision maker is scolded. The outcome from backtracking to remake decisions based on everyone’s opinion is invariably chaos but the consequences are so mild, no one cares. What an unnecessarily rotund way of working.

No wonder nothing gets done on time or on budget. ERs have no such luxury.

I am equally envious of the squashing of interruptions.

“Decisions are what keep things flowing in the ER and they must be made in the face of evolving emergencies. It is rare to finish a thought without an x-ray technician saying “Your patient can’t sit up” or an overhead page suggesting the man you passed in the waiting room, bleeding and glaring, has lost what little shit he had left. Unless the interruption involves a sudden collapse of the first three letters of the alphabet [Airway, Breathing, Circulation], I’ve learned that it is best to finish what you’ve set out to accomplish, let the interrupters wait with their business until you finish what’s yours.”

For this single-mindedness, we should be grateful.

James Maskalyk was at Event 60 (James Maskalyk in Conversation with Kathryn Gretsinger) at the 2017 Vancouver Writers Festival.

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