Emergency Medicine Doctor Reflects on 5 Decades of Career Experiences

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Title: Patient Care: Death and Life in the Emergency Room
Author: Paul Seward, MD
Publisher: Catapult
Publication Date: July 2018
Price: $22.95, hardcover, 240 page

The history of emergency medicine residency training is interlaced with the impetus for specialty status in emergency medicine, which began in the late 1960s and 1970s. By the mid-1960s, the number of U.S. physicians who were specialists was rapidly rising, and the number of general practitioners was declining. Hospitals were becoming more technologically advanced, and these forces in medicine, along with demographic and social changes, caused the public to progressively rely on hospital emergency rooms for care.

However, medical knowledge and a delivery system for providing high-quality emergency care were sorely deficient. In other medical fields, scientific discovery and academic growth were prerequisites for new types of medical service, but this was not the case with emergency medicine, where public demand fueled the formation of a new specialty. Drawing on a career launched in the early days of the emergency medicine specialty, Paul Seward, MD, takes the reader with him, back in time through his 5 decades of riveting emergency room (ER) experiences in Patient Care: Death and Life in the Emergency Room.

Small but Intense Book

This small book, little more than 200 pages, is organized in 21 well-crafted chapters, each a vignette that grows in intensity and wisdom as Dr. Seward’s career in the ER progresses. Prefaces are often skimmed, if read at all, but in the preface of Patient Care, Dr. Seward makes a point about who we are as humans and what life should compel us to do.

He writes: “I believe that the principal reason we are on this planet is to have our noses constantly rubbed in our obligation to care about people who are strangers to us. When I look around, I see a world in which, in every instant of our lives we are unavoidably confronted with the question of whether the quality of other people’s lives and experiences is as important as our own. If we think so, we will act in one way; if we do not, then we will act in another.”

Tragedy on a Sunny Day

Work in the ER is different from that in most medical disciplines: most of the patients are new to the doctors they encounter, and they usually see them only once. The doctor picks up the chart and reviews vital signs and the patient’s chief complaint and then proceeds to the gurney or room and begins treatment. This is far different from the long-term relationships developed between oncologists and their patients with cancer; however, there is a forced intimacy in ER work, one that comes from shocking trauma, sudden death, and breaking terrible news. The random ripping away of lives is followed by the ER doctor’s dreaded trip to the waiting room, looking into bewildered faces of family members and telling them their loved one is dead. This is especially gripping when a child dies, as Dr. Seward describes in chapter 7, perhaps the book’s most poignant vignette.

I believe that the principal reason we are on this planet is to have our noses constantly rubbed in our obligation to care about people who are strangers to us.
— Paul Seward, MD

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Dr. Seward, who writes with straightforwardly forged sentences, describes a sunny afternoon in an ER room in Ukiah, California. It was in the early 1980s, and that particular day, the ER had been extremely quiet until the radio blurted, “Med control, this is Mendocino Ambulance, please come in. We’re about 10 minutes out with a 3-year-old girl who was found in the family swimming pool a few minutes ago. She is intubated and CPR is in progress. At the moment she is unresponsive.”

Readers, particularly those with children, will pause here as the image of the innocent child forms. For the next five pages Dr. Seward describes his heroic efforts, in painstaking detail, to save this young girl’s life. The girl’s father, who was supposed to be watching her, is there, in deep shock. His wife had gone blank, as if she were also dying. It seems to go on forever. Dr. Seward knows it’s futile, but he doesn’t stop until the girl’s mother approaches the gurney, puts her hand on her daughter’s face, and says, “She’s not here anymore; it’s time to stop.”

Humanity Laid Bare

There is also humor in the peeled-back humanity of the ER. Dr. Seward recalls catheterizing a comatose patient only to have the man come to and punch Dr. Seward in the face before going back under. He writes: “I stood there, not knowing how to respond. Still with his penis in one hand and the Foley in the other, I turned and looked at the nurse who was just beyond the next bed watching. She covered her mouth. I think it was all she could do to keep from falling on the floor with laughter.”

In other experiences shared by Dr. Seward, there is a boy who is pulled from a river and brought back to life. We meet a priest on the verge of a heart attack who leaves the hospital to see old friends, a reunion that cost him his life. These stories will enthrall and renew our belief in the art of medicine. Dr. Seward rejects doctor-as-god narrative and instead highlights the essential role of his colleagues, including a pharmacist with a compelling story.

On each page of this fine book, Dr. Seward reflects on how a life in medicine tests the very foundation of the Hippocratic oath. Patient Care is highly recommended for readers of The ASCO Post