Last May, I decided it
was the right time to write some reflections on the two decades plus I spent in
emergency medicine. A band from my teen
years came to me, Ten Years After. Then
came their song, I’d Love to Change the
World.
I wrote a close friend
in Athens and told him I had the song.
He knew what I meant. After the
song, there would be connections. And
after the connections, there would be words.
I waited. I learned that Alvin Lee, the lead singer and
wild guitarist of Ten Years After, was dead.
I mourned him.
And still no words. No story line. A few images.
Lumbar puncture, infant, H. Flu on a gram stain; IV ampicillin and
chloramphenicol. Seamless teamwork,
efficiency. A mostly happy, distant
world.
Sitting here now,
feeling an internal deadline approaching (the year’s end), I ask myself why the
story is so hard to access. And I think
there are twenty-two years of full-time E.R., demanding testimony. And it all happened so fast. The pace wows me as I look back from here. How do I capture this fabric of experiences,
describe the settings and amazing co-workers, the transformation within and
without? Two decades. Two very different
emergency departments? Pain, elation,
hope, disillusionment, the whole raw spectrum of sensation and emotion.
I did my first ER shift
in early July, 1983. I’d finished a
rotating internship in Toronto. After
four years of medical school and a year of internship, I still loved medicine,
although I was already feeling estranged from the medical culture attached to
it.
How did I get
there? Already, thinking back, I can see
the messiness and humanity of a personal process that probably could not happen
in today’s more sterile, more regulated and less vital world of medicine.
There was a point where
I really dug medicine, the kind you find in crazy thick textbooks. I liked lists of differential diagnoses and etiologies. I could have drifted into internal medicine
under the right conditions, perhaps, there was a leaning in that direction for
a while. Something, after all, did
compel me to subscribe to a year of the esteemed New England Journal of
Medicine. And yet it faded. I was reading a lot of fiction, and doing
some writing then, and maybe I just had a hard time sitting with staff
physicians who showed off book trivia concerning books they’d never read or
fully grasped. That was not the kind of
doctor I wanted to be. I wanted real, I
wanted every moment of my career to speak for itself.
And I think it went
deeper. I was angrier, more alienated,
in ways that extended beyond the world of medicine. For whatever reason, the E.R. found me, more
than I found the E.R. I found myself
shirking retractor holding duty in the O.R. or attending M&M rounds when I could
be seeing patients in the ER.
I finished my internship
with an ICU elective, where I started enough lines and did enough procedures to
prepare me for the fast-paced world of emergency medicine.
Back then, there was a
big book, which amongst other things, listed the addresses of all the hospitals
in Ontario. I wrote to every ER director
within one hundred kilometers of Toronto.
Most of the hospitals were still in the dark ages (even for 1983) and
staffing their E.R.s with family physicians.
But the Kitchener and Cambridge hospitals had already moved to full-time
E.R. physicians.
I was hired at Cambridge
Memorial Hospital to cover a maternity leave.
I remember going for my interview and the E.R. director, Lorne Wilson, took
me around and tested my knowledge on a few cases. I remember one was a burn and I thought to
myself – five years of intense medical training and I’ve learned about esoteric
renal and parasitic diseases I’ll never see – and nobody thought to teach me
how to care for a partial thickness burn on a human forearm.
I waited day by day for
the regulatory college to send me my license.
They were in no hurry, but the hospital was. I guess the bureaucrats weren’t worried about
labour pains they would not have to feel.
They did send me my official
papers in due course, and I got to work.
(Meanwhile it would take
me many more years to realize the cost of our health care system as a profligacy
of bureaucrats who had never experienced the immediacy of a paediatric resuscitation
or multiple traumas coming off the highway began to take over our health care
system.)
In those earliest days,
there were four of us covering a hospital E.R.
We worked fourteen-hour night shifts and ten-hour days – shift lengths
that I can barely grasp from my current perspective, with all the changes in E.R. overcrowding and dysfunction and all the changes in myself.
But there I was,
starting out, backed by experienced E.R. nurses who led my initiation, by
weekly E.R. residency rounds that alternated between Toronto General Hospital and
Sunnybrook Health Sciences Centre. I was swept along,
into something far bigger than I initially recognized.
In trauma psychology, we
speak of state-specificity and memory.
Access to certain memories is to a large extent based on the intensity
of arousal during the event whose recalling we attempt to evoke. It’s in this
sense that military veterans often seem emotionally disconnected from the
stories they tell. Yet, place them back
in combat and their recollections of previous war experiences become crisp and
congruent and vivid.
I sense that may be part
of why the words have been so slow in emerging.
I cannot put it back to the test by returning, but I admit that I did go
to the gym before starting this.
Somewhere, as I write, my body begins to rekindle a sense of urgency, of
mission, of incredible stamina.
In his song, Alvin Lee,
who had his own beliefs and determination, sings of freaks and hairies, dykes and fairies, and asks, where is sanity? He already senses the threat to art, the
bottomless greed of the commercial enterprise.
It’s 1970, with the Vietnam war winding down but still seriously deadly
and with three more years of life left in killing currents. The terms have changed, and the words of his
song sound naïve by contemporary standards.
Our E.R.s have freaks, yes, and gangbangers, and lost souls on hallway
stretchers, cokeheads and methheads and the daily increasing flocks of form
one’d suicidal despairing waiting for psych beds that don’t exist. Like Alvin, maybe the lessen in all this is
that we do change the world, we change ourselves, we change art and medicine …
but they change us as well … and lurking in the background, less compelling
than these spent passions and tragic, human scenes, is the continued presence of
our insatiable greed. A greed forever encouraging us to forget and to slide back into our befores ...
Nothing survives,
perhaps, other than stories, which will outlast medicine as we know it. This one will continue. Stay tuned.
Nice song !
Unfortunately our world today has changed to worse and also there is no more
such band as "Ten Years After" were ...
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