Related topics: •  Book Review: Julia's Mother

Just Here Trying to Save a Few Lives:
Tales of Life and Death from the ER
By Pamela Grim, MD
Warner Books
306 pp $23.95

The Blood of Strangers: Stories From Emergency Medicine
By Frank Huyler
Henry Holt
160 pp $19.95

In the good old days, there were doctors like Marcus Welby and Ben Casey -- unruffled and benevolent types who cured the sick with their wisdom as much as with treatment. They knew that they knew everything, but wielded this knowledge lightly, emanating decency and humanity while exercising velvet-fisted authority over patients, subordinates, and the entire hospital staff.

But the public image of doctors has changed since those days -- due, at least in part, to the depiction of the adrenaline-fueled, morally compromised universe of ER and House, MD. Now two beautifully written memoirs of life in the emergency room offer edgy, disturbing accounts of doctors' inner turmoil, their vacillation between feelings of helplessness and grandiosity, the ethical ambiguities they confront on a daily basis, and the haunting impact on their psyches of the stress and chaos and violence permeating their world.

The portrait is not a pretty one, but it is riveting. And it feels wholly authentic. The narrators and other medical professionals in these books are not the unalloyed heroes we are used to seeing; rather, they can be egocentric, voyeuristic, and obsessed with their power over life and death. They take drugs, yell at each other and their patients, have nervous breakdowns, and often lose their capacity for compassion and empathy. In short, these books are not designed to convince people they should go into the doctoring business.

Pamela Grim, the author of Just Here Trying to Save a Few Lives, writes with a powerful and unrelenting urgency. Whether she's delivering a crack baby, treating refugees in war zones, splitting open the chest of a shooting victim to repair his damaged heart, collapsing from stress and fatigue, or getting shot at by an ER patient outraged at having to wait for treatment, she manages to convey both the horror of the task and the emotional toll it all takes on her and her colleagues.

Here she describes the visage of one of her burnt-out emergency room co-workers: "It's the look of someone who has spent years in a room filled with all the losers of the world, and who has become, through all this, just another loser as well, another crazy guy stalking the hallways, an addict at the end of the line, a would-be suicide more pathetic than tragic," she writes. "There Murray stood, face twitching like mad, silent as the grave. I saw that face as my face in ten years, fifteen, my face superimposed on his. But would I recognize that look if I was wearing it?"

There's virtually nothing uplifting in this dark account, so 300 pages of it can be a bit hard to take; after a while the descriptions of bullet wounds, whacked-out patients, blood-spewing organs, and emotionally stunted doctors start to resemble one another. But Grim -- and there's no disputing the appropriateness of her last name -- succeeds remarkably well in providing a compelling glimpse into the ugliness of her professional existence.

Her tale is not just dark, but darkly funny, as when she ruminates on whether she should trade in the disputable pleasures of vaccinating near-dead refugee babies to accept a job performing hair transplants in posh surroundings with New Age music cooing in the background. Or when she relays the cynical attitudes and emergency room banter that the staff maintains to keep the full horror at bay. When some doctors want to keep working on a shooting victim who is already brain dead, one of the nurses advises them to "give it up... Isn't it obvious that the wheel may be spinning but the hamster is gone?"

Grim rarely alludes to her or anyone else's personal life, and that, in a way, is the point. This absence lends the book an intensely claustrophobic quality, which reinforces her depiction of the work as something that isolates practitioners from all those inhabiting the world outside the emergency room.

"Things happened in that small clutch of examining rooms that no one else had ever seen," she writes. "And if you tried to talk about it, to your spouse or your few friends who did not work in ER, you would get the fisheye -- a look of suspicion and disbelief. They didn't really want to know; they certainly didn't want to believe, and you couldn't blame them... Everyone in that other world, the 'real' world, lived in a cocoon of safety. You didn't want to be the one to tell them how much of an illusion that cocoon is."

The Blood of Strangers is a more nuanced and lyrical -- but in many ways creepier -- tale of life on the medical front lines. Frank Huyler is a poet as well as an emergency room physician, and he captures with startling eloquence the complex psychological terrain of what he sees and feels every day. The doctors who populate these wards are emotional wrecks, troubled, tormented, and disconnected from anything and anyone beyond the next emergency.

Tony, the medical student with whom Huyler shares a cadaver in anatomy class, is arrested for murdering his lover with an overdose of anesthetic. Ruth, a brilliant British neurosurgeon in her 40s, attends raves, snorts coke, and smokes dope. And many of these upright medical professionals treat their patients as objects over whom they wield a seductive power rather than as fully sentient beings.

Huyler himself is hardly immune from these megalomaniacal tendencies and, to his credit, does not shirk from portraying his own. When he inserts a speculum into the vagina of a frightened 15-year-old girl, he writes that "there's no avoiding the power of that moment, what floats out of you like a secret... You feel dark, ashamed, you do not like what you see in yourself." And here he is describing what it's like to tell family members that the person they love might die: "It's one of the rare moments when I feel powerful. Events emerge with my voice, families hang on my every word. A dark vanity, vaguely resisted."

Huyler's language is evocative throughout, even when he is describing the bleakness of the situation. In fact, his ability to marshal everyday images to convey gruesome realities endows his descriptions with remarkable power. A collapsed lung is "crumpled like a wet handkerchief." The cancer in the lung of the cadaver he dissects feels "like sand under the blade." When a surgeon touches her scalpel to the skull of a man suffering from a subdural hematoma, "a little blue-red worm of drying blood began twisting from the slit like toothpaste, and suddenly the clot spurted out of the man's head like a plum."

When a man in a coma arrives at the intensive care unit, Huyler is assigned the task of suturing the lacerations stretching from his scalp down to his mouth. He does so, "tying my knots like a fly fisherman," and the next day returns to check his work. "His face looked whole; only the thin blue lines of nylon sutures betrayed the extent of his wound," he writes. "It was only after at least a minute of admiring the job that I realized that the sound of the ventilator, my constant companion in the room the day before, was absent, and that the man was dead."

What these two books don't answer -- what they perhaps can't answer -- is this question: Are the emotional peculiarities of these physicians, their inability to relate, the result of their work in the wards? Or does the work simply attract this type of person? In any event, all those considering a career in emergency medicine should read both accounts before coming to a final decision. They'll learn a hell of a lot more about the true nature of the job than they will in an entire semester of anatomy lectures.

-- David Tuller, a former staff writer for the San Francisco Chronicle, has written for The New York Times, the Washington Post, and Salon.com. He is also the author of Cracks in the Iron Closet: Travels in Gay and Lesbian Russia (Faber &Faber, 1996).

First published October 20, 2000
Last updated March 6, 2008
Copyright © 2000 Consumer Health Interactive