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Medical Humanities Section Newsletter - August 2006, Vol 2, #4

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circle_arrow From the Section Chair - Stepping Up, Stepping Out
circle_arrow From the Editors
circle_arrow The Great and Ancient Medicine
circle_arrow The Lesson
circle_arrow Letting the Family In
circle_arrow Dear ER Doctor
circle_arrow Lisa
circle_arrow Writer's Resources


Newsletter Index


Medical Humanities Section

 

From the Section Chair – Stepping Up, Stepping Out

Michael D. Burg, MD, FACEP

A lifetime ago—or, "back in the day" as some say—I was a booking agent for rock and roll bands. Nothing big, my only brush with fame was booking the opening act for a Van Halen concert at the Pasadena Convention Center just before the release of their debut album. The poster from that event still graces my office wall.

Actually though, fame had nothing to do with it. I simply enjoyed the fact that something I set in motion (from behind the scenes) culminated in a successful event that put performers on stage and brought joy to hundreds in the audience. It wasn’t important that no one in the auditorium knew my name.

I feel the same way now. The trusted advisor, behind-the-scenes, heard-but-not-seen role ("international man of mystery" if I’m daydreaming) suits me. Always has. I’d like to get back to that place in the Section of Medical Humanities. But, for that to happen, someone else (I’m not looking at anyone in particular) has to step up so I can step out. I promise to be a very active ex-chair, past-chair, trusted advisor, second-in-command, number two, Feste (see Twelfth Night – Shakespeare), whatever, if that’s what the next section chair desires. I’ll serve on committees, volunteer for lots of stuff, contribute to the newsletter, recruit new members, help with Artistic Expressions, etc, etc, and etc. But, there has to be a next chair for me to be an ex-chair and slink back into the shadows.

Don’t get me wrong, it’s coooool to be chair. It has been—and continues to be—a great ride and a tremendous growth experience. I’ve had the opportunity to interact with some of the most fascinating, dynamic, and creative people in emergency medicine. Together we’ve gotten a good start on some important accomplishments (the Artistic Expressions gallery at Scientific Assembly has been our most visible), and there are plenty more to come. I’m certain the next section chair will enjoy a richly rewarding experience. The section will benefit as well from new leadership and vision.

We are not scheduled to vote for a new chair this fall, but if someone volunteers, I would certainly consider leaving my post early. Otherwise, we will be holding new section elections at next year’s Scientific Assembly in Seattle, so start thinking ahead!

 

 


 

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From the Editors

Hans House, MD, FACEP

The newsletter went to press on the first anniversary of Hurricane Katrina. Around this time last year, we were not even sure New Orleans would exist, much less manage the infrastructure necessary to host a Scientific Assembly (SA). Now, confident in its ongoing recovery, we are headed there in October. Emergency physicians were the last to leave the flooded city, and now the thousands who attend SA will be one of the first conventions to return to the city. The hurricane, the flood, the tragedy, the politics, the migration away, the recovery, the first Mardi Gras since, the return of sports, the return of conventions, and the return of its people. So much can happen in a year. The news media can’t get enough of "Katrina stories," simply because there are so many aspects of the human condition to examine: in a word, humanities.

I have found New Orleans a source of creative inspiration since I first visited the city as a young child. It is a city that defies simple definition. Is it the most European American city? Or the most American Caribbean city? The beignets of Café du Monde, the hurricanes of Bourbon Street, the muddy waters of the Mississippi, and the music of the concert halls have served as whispered muses for countless artists, musicians, and writers, from Louis Armstrong to Jimmy Buffet, from William Faulkner to Anne Rice, from Tennessee Williams to John Grisham.

As you heed SA’s siren call, I want to know how New Orleans inspires you. While attending this year, you will have the pleasure to enjoy your colleagues’ photography, painting, quilting, poetry, and literature in the second annual ACEP Artistic Impressions gallery, organized this year by Marianne Gausche-Hill, MD, FACEP. Come unwind in a tranquil corner of the exhibit hall (booth #335), soothed by the player piano, courtesy of Steinway. The gallery will be open Sunday, October 15 through Tuesday, October 17, from 9:00 am to 4:00 pm each day. Dr. Gausche-Hill was assisted by Jeannette Wolfe, MD, FACEP; Gerald (Jerry) Schwartz, MD, FACEP; Michael Burg, MD, FACEP; and Ron Stewart, MD, in judging the submissions. After your visual inputs have been refreshed, head for "Open Mic Night," a new feature this year organized by Elizabeth Mitchell, MD, and listen to your colleagues play music and read their literature and poetry. The "Open Mic" is on Monday, October 16 from 7:00 pm to 9:00 pm in La Galerie 3 at the New Orleans Marriott. And make sure to include time for our annual section meeting – there is so much to discuss! The section meeting is scheduled for Sunday, October 15 from 2:00 pm – 3:30 pm in Balcony I at the New Orleans Marriott.

Finally, make a note of everything you see, hear, and do. Then, please submit a creative work for the newsletter as soon as you get home. I would like the first post-SA issue to be an all-New Orleans-themed newsletter. It could be creative writing set in Jackson Square. Or a non-fiction piece relating to the long, turbulent, yet fascinating history of the city. Or your poetic impressions of Katrina’s wake after touring the lower 9th ward. There is so much to tell. Share it with us.

 


 

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The Great and Ancient Medicine

Hans House, MD, FACEP

Imagine if one man ruled the entire known world. Imagine that such a man with all of his wealth and power amassed a vast collection of wine, spanning over 200 hundred years of viticulture. And finally, imagine that you were called upon to enter this unparalleled cellar and sample bottles until you have found the best wine in all of history.

That is precisely the glorious task that fell upon the shoulders of the Roman physician Galen of Pergamum (130-201 AD) in 170 AD. Galen, the physician to Emperor Marcus Aurelius, is best known for advancing Hippocrates’ humoral theory of disease, the four humors being blood (air), phlegm (water), yellow bile (fire), and black bile (earth). Good health was achieved by maintaining a balance between these humors. Unlike Hippocrates, who considered the humors to be systemic, Galen believed that a disease-causing imbalance could be located within a particular organ. Galen utilized "balancing" procedures, like bloodletting or purging to restore the balance, but he also developed his own pharmaceuticals. His drugs were compounded from a wide variety of substances, with sometimes as many as 70 components, both mundane and obscure. The drugs were classified by their properties – heating, cooling, drying, or moistening – and were applied so as to counteract whatever humor imbalance existed.

Wine was a particularly favored medicinal. In the four humor paradigm of disease theory, wine was considered to be "hot and dry," so it may be expected to reduce phlegm and promote yellow bile. It would be effective at treating a cold (a wet and cold disease), but not a fever (a hot and dry disease). Naturally, the higher the quality the wine, the more effective its medicinal property.

As the Romans conquered the Mediterranean and assimilated the cultures of their subjects, viticulture and winemaking spread from beyond its humble beginnings in Greece and Turkey to an Empire-wide business. Grapes were grown and fermented from Libya to Gaul (France), from Iberia (Spain) to Crete, and, of course, in every province of the Italian peninsula. Romans were no strangers to the differences in vintage or region. The very best region for Roman wine was widely considered to be Mount Falernus on the border between Latium and Campania, just south of Rome. Falernian, as the wine was known, was a white wine made from grapes grown on the slopes of the mountain. Ancient documents indicate that the grapes were picked fairly late, resulting in a heavy, sweet wine that was golden in color and could be aged for decades. The nearest contemporary equivalents would appear to be long-aged sauternes wines, such as Chateau d'Yquem. Falernian was further differentiated in quality by the altitude at which its grapes were harvested: grapes from the lowest slopes was simply known as Falernian, Caucine grew on the highest slopes, and the crème de la crème was Faustian, grown on the estate of Faustus, covering the middle slopes of the mountain.

In AD 170, Galen convinced Marcus Aurelius that as his dedicated imperial physician, he could only serve his master best by requisitioning the most effective medicine possible. "Since all that is best from every part of the earth finds its way to the great ones of the earth," he wrote, "from their excellence must be chosen the very best for the greatest of them all." So, with the Emperor’s blessing and an attending cellar-man to open and re-cork the amphorae, Galen raised a torch and descended into the musty darkness of the Palatine cellars in Rome. After reaching the lowest levels of the storerooms, wine-lover Galen headed straight for the Falernian. He started with a 20-year-old wine and then tasted earlier and earlier vintages. Galen slaved away, pulling the ceramic containers and taking a sip of each. Amphorae after amphorae, he systematically and relentlessly pursued his task. "I kept on until I found a wine without a trace of bitterness. An ancient wine which has not lost its sweetness is the best of all." Although it is unknown exactly which wine was determined to be the greatest in history, we do know that it was a Faustian Falernian, possibly a 200-year-old vintage. Marcus Aurelius must have appreciated the efforts and sacrifices of his celebrity physician, since Galen continued to be favored by the royal court for the rest of his days.

Medicine has come a long way since Galen’s time. The four humors have been replaced by the organ system approach to physiology. Humoral imbalance has fallen in favor of microbiology, DNA, and the immune system. Although wine has been strongly linked to good cardiovascular health and bloodletting persists as a therapy for hemochromatosis, almost all ancient therapies have been debunked. Most pharmaceuticals are now synthesized in mass-production factories. The physical hardships that physicians must endure, however, have not gone away. I myself have physically toiled for my patients’ benefit: countless hours studying in medical school, slaving through 36 hour days in internship, and struggling to stay focused on emergency department shifts too busy to permit a trip to the restroom. But never have I been burdened with the ominous task that befell our forefather Galen. That lucky bastard.

Reference: Standage T. A History of the World in 6 Glasses. Walker and Company, New York, 2005.

 


 

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The Lesson

Ellen Taliaferro, MD, FACEP

On July 1, 1936, at one minute shy of midnight, Dr. Brown collapsed on his bed, falling into a deep sleep. July 1 was the most dangerous day of the year in hospitals across the nation, for it was this day that all new interns began their tour of duty. Dr. Alex Brown, Chief of Staff at Saint Joseph Hospital in Denver, had been everywhere that day checking on the new crop of interns. He was exhausted.

Ring. Ring. Ring.

"Hello," he whispered into the phone.

"Hi, Doctor Brown, Sir."

It had to be one of them.

"Sir," echoed the voice.

"Yes?"

"Sir, this Dennis Green. Dr. Dennis Green, Sir. One of the new interns."

Even in his fatigue Dr. Brown could hear young Dennis call himself "Dr. Dennis Green" as though he had just stumbled onto his new title.

"Yes?"

Dr. Green plunged into his presentation of Dr. Brown’s patient who had awakened at 3:00 am with a severe nosebleed. "Sir, judging by the amount of blood on the patient’s gown and bedclothes, he lost a ‘ton of blood.’" "Doctor, just how much is a ‘ton of blood?’"

Dr. Brown asked. "Well, sir, I would say that this patient has lost at least a couple of pints."

Silence.

Meekly, the still squeaky-new Dr. Green lowered his voice and said, "Sir, could you please come to help me?"

Dr. Brown was already pulling on his trousers. He knew that a new intern would just as soon as jump off the roof of the hospital rather than admit he needed help. This might be serious.

"On my way," he mumbled into the phone. Dr. Brown doubted that his patient, a prominent Denver banker and well-known St. Joseph supporter, had "lost of ton of blood," but Dr. Brown did suspect that the banker was losing patience and confidence in St. Joseph Hospital.

Dr. Brown was at the banker’s bedside within 15 minutes. He exuded confidence while he slipped a nasal pack into the banker’s bleeding nostril. Soon, the bleeding stopped.

The nurse scooted out of the room to get new sheets.

"Where is all the blood loss?" Dr. Brown asked the intern.

"Right here, Sir," Dr. Green said, pulling back the patient’s bed sheet. The red-fading-to-brown traces of blood indicated that the patient had probably lost about ¼ cup of blood. A far cry from "at least a couple of pints," much less a "ton of blood."

Dr. Brown nodded. To the patient he said, "All’s well. See if you can get back to sleep. We’ll talk about this when I see you on rounds today."

It was 5:30 am when Dr. Brown left the room, too late to go home. Dr. Brown resigned himself to his fatigue by taking a deep breath. Next he strolled down to the blood bank. There he found a small nun dwelling inside a generous white habit. She was known to many as "SMA," short for Sister Mary Agnes.

"Hmmm," SMA remarked as she nodded at Dr. Brown. "Did one of your patients lose ‘a ton of blood’ last night?"

"Indeed," replied Dr. Brown. "How did you know?"

"Well, first, you’re here. Second, yesterday was the first day of a new intern year. But the best clue of all I found right here on the desk when I came in a few minutes ago." With that she picked up three sheets of paper from the night tech’s desk. Each sheet represented a now-canceled "Stat" requisition for a pint of blood and each sheet was signed by one Dennis Green, MD.

Dr. Brown smiled. As usual, SMA was one step ahead of him.

"When is your blood bank orientation lecture this year?"

"At seven this morning, the new interns will all be in their starched whites sitting in my shiny, tiled, white lab amphitheater waiting for their orientation lecture titled, "Introduction to the blood bank."

***

At 7: 05 am the new interns were sitting wide-eyed and beginning to grow restless. The teacher was running a few minutes late, so casual conversation began and echoed loudly off the tiled walls. Suddenly, there was a nun standing in the middle of the amphitheater. She said nothing, simply stood quietly in her voluminous white habit, her arms hidden and folded into the sleeves of her nun’s garb. No skin showed except that on her placid face.

Voices dimmed and stilled. An occasional quiet cough amplified itself and bounced about off the ceramic white walls until silence reigned once again.

Still the mysterious nun stood quietly in the middle of their circle.

The boldest intern spoke up: "Sister, are you our lecturer this hour?"

The sister pinned him in her gaze and maintained her poise of perfect neutrality.

Silence ensued. The anticipation of suspense filled the room and then faded into patient curiosity.

Without warning, the white habit exploded as the nun pulled out of her sleeve a glass bottle of outdated blood and flung it to the ceiling. The bottle ricocheted onto the wall behind the interns and then crashed to the floor, exploding and coughing up its red, sticky contents. Blood splashed everywhere. It dripped off all the walls, splattered the starched whites of the interns, and then pooled itself into small ponds of red on the floor.

Noise erupted. Some interns jumped, one screamed, and several uttered words not worthy of a nun’s ears.

The only pure white thing remaining in the lab was the mild sister. A faint metallic odor filled the air. The ticking of the wall clock punctuated the stunned silence.

The nun spoke: "And THAT, doctors, is a pint of blood." Then she disappeared.

Later, no intern could quite remember how she entered or left the amphitheater. But not one intern ever forgot, even years later, just how much of the red sticky stuff was a pint of blood.

Ellen Taliaferro, MD, FACEP, is the Medical Director of the San Mateo Medical Center Emergency Department’s Keller Center for Family Violence Intervention. She is the co-author of the Physician’s Guide to Intimate Partner Violence (with Patricia Salber, MD) and the author of WellWritingfor Health After Trauma and Abuse, a book for patients suffering from the long-term consequences of violence and abuse.


 

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Letting the Family In

Bonnie Salomon, MD, FACEP
Lake Forest Hospital Emergency Department
Lake Forest, IL

Mr. C, a middle-aged man, awoke with what he called, "just a little pain in my chest." He looked well in the ER, stable vital signs, smiling and pleasant as he could be. His electrocardiogram betrayed his hale and hearty appearance. He was having a heart attack. Just as I was on the phone with the cardiologist, Mr. C’s heart stopped, and he lost consciousness. Three times I had to start his heart with an electric shock, and three times he came back. It was touch and go. His wife was at the bedside watching everything. She held his hand and pleaded, "You can’t leave me now. Stay." And he did. He struggled through a long and rocky course, but he survived. His wife hugged me as she left the ER, and I think I hugged her more. I did the medical treatment, but perhaps she added something, too.

There was a time when I would insist family members, like Mrs. C, be whisked off to the waiting room. Sometimes this was done in a less-than-polite manner, with a snap of curtains and a quick escort. I was taught that families were obstacles, extra people in the room, and the sooner they left, the better.

Families were kept out of resuscitations as a tradition. The reasons are many—some medical, some legal, but mostly psychological. The usual medical reason was that families got in the way. They don’t understand what’s being done. They might interfere. I’ve seen some faint. A colleague once told me that if airplane passengers aren’t allowed to watch the pilots, families shouldn’t be allowed to watch resuscitations.

Fear of lawsuits also kept the curtains closed. The thinking was that families would be more apt to sue if they were watching what was being done to their loved one. Since they wouldn’t understand all the medical mumbo-jumbo, they’d be more likely to think the doctors messed up.

On a psychological level, doctors generally don’t like people watching over their shoulders at these critical and incredibly stressful moments. Not everyone wants an audience.

Yet when Mr. C’s heart stopped, I didn’t hesitate to keep his wife in the room. What happened to me and to other emergency physicians?

About ten years ago, with the rise of the patients’ rights movement, hospital traditions were scrutinized. From the office to the emergency department, what happened behind closed doors became suspect. The doctor-patient relationship widened to include the patient’s family as well. Proud fathers with video recorders had been allowed in the delivery room for years. If we allow families to see the beginning of life, the argument went, why can’t they be present at the possible end, for what might be the last precious moments?

Let’s not forget television. Reality shows and medical dramas like "ER" brought cameras right into the hospital, complete with images of bloody floors and scalpels in action. Resuscitation was no longer a mysterious ritual, practiced behind the curtain—it was on TV.

Academic studies supported this new trend. Surveys of family members showed they were grateful they were allowed to stay, and they cherished those final moments. Most families didn’t seek out an attorney to start a lawsuit—they thanked hospital administrators. They said they knew the doctors and nurses did everything they could for their loved one, because they saw it—with their own eyes.

As for Mr. C, several months later the ER secretary told me a man was there to see me. He left abruptly, before I could find him. She said he left me something. My mind raced: a subpoena, some other dastardly problem?

It was a bouquet of flowers. I ran out of the department like a dervish, and tracked him down in our parking lot.

"Thank you for the flowers," I said.

"Thank you for saving my life," he said.

I told him he and his wife did all the hard work. He smiled, got into his car, and drove home to his family.

This essay was broadcast on WBEZ, Chicago Public Radio on January 19, 2006. It appears here with permission of the author and WBEZ.

 

 


 

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Dear ER Doctor...

Pete Paganussi, MD, FACEP

6/25/04
Anytown, Anywhere 9119119
USA

Dear Emergency Room Doctor,

I am one voice; diminutive, but powerful. I am the unified voice of a multitude of millions. The voices of the millions of lives you have touched in the years gone by, distilled into a singular voice. I am writing to express my gratitude and my admiration for the job you do; and to thank you formally because so few actually take the time to.

I am writing to let you know how greatly appreciated you are, and like I said, many of us may have told you so, but very few actually take the time to put it in writing. I wrote to complain about you to the hospital administrator when I thought you a heel; but I never wrote to tell them the countless times you were a hero.

I am the voice that asked if my husband would survive the stroke he had. I am the voice that told you I had been raped, beaten, and abused. The voice that asked if I was having a heart attack, that told you the sorted and sordid details of my personal misconduct, that begged for pain medication, that cried out "Hey Doc…over here Doc" from a stretcher in the back hallway, and that told you a funny story while you sewed my leg. I am the voice that admonished you for making me wait two hours, that sniped at you about my son’s pain, that badgered you about my brother, and cursed you in my drunken rage.

The voice that told you (at least a thousand times!) as soon as we met; "No offense, but I don’t like doctors." You stood and took it all so gracefully. You answered my every question – perhaps not always with what I wanted to hear, but answered me nonetheless.

You sewed my son’s forehead, splinted my sister’s ankle, managed my mother’s diabetic crisis, intubated my boss, nasal packed my nephew, diagnosed my daughter with meningitis, and helped heal my "trash-compacted" hand. I saw you gently put your hand on a senior citizen’s shoulder, smile, and say; "Don’t worry, we’ll take good care of you here…I’m here for you." I was witness to you sternly admonishing another doctor over the phone for not wanting to help care for an unfortunate itinerant.

At times, I frustrated and thoroughly exasperated you. I wanted you to "check me for everything," and then signed out A.M.A. after you spent at least 20 minutes trying to convince me against leaving. I refused admission, refused to take my meds as directed, and refused to follow instructions. Yet you carried on, you redoubled your efforts to convince me of any folly, and allowed me the opportunity to actually participate in my care. Your indomitable spirit seemed to transcend the noise and chaos of your environment. It made you a beacon above the din and cacophony. You are a lighthouse guiding the way to safe harbor: Diogene’s lamp lighting the way in the darkness. Your work environment, I might add, most of us would find absolutely intolerable. I watched you whistle while you worked on a drunk who had just vomited a bloody mess at your feet.

How do you do it? How do you tolerate the long hours with little or no respite? You are given no time for food, the lavatory, or even a breath of air. You deprive yourself so that others may not be deprived of you and your attention.

I would like you to be my doctor always. I asked you if you had your own practice. You smiled and said, "No…I am an emergency physician, this is my home. This is where you can always find me." You then told me that these words are the kindest and loftiest of compliments to an "ER Doc" like you. Then you said, "I AM your Doctor. I am ‘everyman’s’ Doctor. I always have been, and I always will be. I am here for you, and I humbly stand and serve my fellow man." I take great comfort in knowing you are there, on duty, just for me. You stand at the ready to tackle my problems and travails, to deal with my dilemmas and misfortunes, to help me put my body and my soul back in order. Now I ask you, who else performs this kind of service? Where else on this planet of ours can you go and get this kind of treatment, no matter who you are?

God bless you and yours, Doc. I love you, and I hope you get some time this summer to enjoy your own life; time for yourself with family and friends. Remember, we are all your patients and we are all so much the better for it.

Take care and thank you again,
The Voice

cc: Hospital Administrator
The World

Pete Paganussi, MD, FACEP, lives in Oakton, Virginia, a suburb of Washington, DC. He works at Inova Fairfax Hospital, a Level One Trauma center and an affiliate teaching site of the George Washington University Emergency Medicine Residency program.

 

 


 

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Lisa

Jennifer Blair, MD
Resident Physician
University of Chicago

My sister comes home a bit past five and waits in our shared apartment. A draft copy of her novel sits hopefully on the table in the bathroom; a fresh quotation is chalked onto the blackboard we put up when we moved in. Prints of her photos I’ve never seen are stuck to the kitchen door. She’s brought a cookie jar back from our parents’ house and filled it with non-trans-fat Oreos, the kind I like. She’s rearranged the furniture, draped it with afghans.

Or she buys an assembly-required bookshelf and leaves the packaging in the living room where she tore it off. She heats up dinner, eats alone, leaves the plate to dry and harden beside the kitchen sink. She stacks empty wine bottles and jam jars on the linoleum when the recycle bin fills. She knows I won’t mind, if I even notice.

Internship’s a bitch. But I’m not the only one it’s hard on.

Lisa finished her photography degree in London the same month I finished med school. She decided to join me in Chicago. I was delighted. We hadn’t lived together after I was seventeen and off to college, with the exception of one summer, and we were both a little distracted. I was depressed and spent the hot days steeping in misery. She had a boyfriend who was always around, and they were fully absorbed in vexing each other.

We were different now. I’d recovered from my funk long ago. She had no significant other, and concentrated on her work like a laser. She had created strange and haunting photographs. She was writing, pages and pages of experimental prose, uneven and brilliant. She had boxes full of weird and wonderful books of far-out art. She read James Joyce and D.H. Lawrence. She had joined flash mobs in Trafalgar Square and was devouring Noam Chomsky. If we lived together, she would keep me from becoming a medical drone. Being around her would remind me how to try to think like E.E. Cummings or T.S. Eliot; how to juxtapose wrong words to create a perfect phrase; how to notice things like the shadows cast by buildings and the way a chalkboard looks after an intense class and the twice-removed spookiness of old postcards. We would collaborate. While she watched my prose for clichés, I would watch hers for overexuberance. We would draw comics about the funny art-world people she knew. We would set up a typewriter in the park and invite passersby to type sentences.

A few months later, Lisa’s novel sat in the bathroom. Days went by with the same page face up. I couldn’t care. These were days when I was so tired that I punched patients’ names into my Palm Pilot’s drug lookup, or nodded off upright at a stoplight. My sister could not stand to see it sitting there, and quietly removed it.

We talked. She spoke of moving out next year, of finding her own place. She complained about hairs in the sink and all my unmatched dishes, but the real issue was that we had no time together to offset these annoyances. She made me lunches every night and left them in the fridge, and that was often the sum of our interaction. When I was on call, we went days without seeing each other – I would leave at dawn, come back the next day, and go straight to bed. Then the next day I left at dawn again. On non-call evenings, there was perhaps enough time to relate the events of our days, but none to rehash them, or to talk about a book, or try cooking dessert. It was tantalizing, saddening. I found myself pleading with her, telling her I’d front-loaded some of the worst rotations; that things were bound to get better. She was skeptical. I was struck by how like a suffering marriage our relationship must have been. I was struck by how divorce would have crept into our minds.

During an unusually rough week, I threw a fit one day. I am not given to rages, but that evening the thought of returning to the hospital was too much. It was too much to get up at 4:30 every morning and come home at seven or eight, then put me on call every few days, a thirty-six hour stretch punctuated by page after page after page – the pager buzzing while I answered the previous one, over and over again – and by the casual scorn of attendings who were tired of having to work with such a green intern. Passion for medicine fell by the wayside; all I wanted was not to hurt my patients, and to stay awake. I wanted not to hate myself when an attending scolded me for forgetting the name of a patient’s neurologist, or the rate their IV fluids were flowing. I wanted not to hate them when they canceled one of my days off, the night before.

She watched me helplessly.

"I can’t bear what this is doing to you," she told me. "I can’t imagine going through this. I can’t understand why you do it. And there’s nothing, nothing I can do to help you."

"But you do help me," I said desperately. "You make me sandwiches."

Silence.

My mother remembers riding the elevator in the apartment near Johns Hopkins, where my father did his first year of residency, and listening to the other wives as they exchanged confidences. "I haven’t seen him in weeks," they would say, "and when he comes home, he’s so strung out we never have sex – we never talk – we never do anything." There came days when the unfortunate resident would come home to an empty apartment and a note. This happened so often that people joked that the notes would be dated four days ago.

Yet the fortunes of an intern do change, and the tough rotations have relented for now. This month it is shift work, so I know when I’ll be home, and it is in the emergency room, where I love to work. Now we eat breakfast together. She listens to me vent about an unsettling blind date. She shows me Josef Sudek’s evocative photos of Prague. We’ve started drawing our comic. If affection can be banked, then I’m doing all I can. There will be more lean months before residency is through.

 

 


 

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Writers’ Resources

Michael D. Burg, MD, FACEP

Every summer, The Community of Writers sponsors a series of writing seminars in Squaw Valley, CA (near Tahoe). 2007 will be their 38th year doing so. Dates are not yet available for summer 2007, but check their Web site at http://www.squawvalleywriters.org for updates. By all accounts their reputation is excellent, and the setting is stunning.

Another well-respected summer writing program is "Writing the Medical Experience," hosted by Sarah Lawrence College in Bronxville, NY (about ½ hour outside the city). Sarah Lawrence is a small liberal arts college with a sterling reputation that puts on a week-long writing seminar that will inspire you to new creative heights. Not only will you have the opportunity to share what you’ve written with others, but you’ll be taught by the likes of Richard Selzer, Rafael Campo, David Watts, and many more. Seminar dates for 2007 are July 8 – 14. More information is available about the 2006 program at http://www.slc.edu/index.php?pageID=4009#2. 2007 information should be posted shortly. I attended "Writing the Medical Experience" in 2005 and 2006. I highly recommend the "experience."

Home to the famous Iowa Writer’s Workshop, the University of Iowa offers the Iowa Summer Writing Festival every year. The program is a wide variety of weekend and one-week seminars geared for every level of writer, from the novice to the experienced author. The relaxed, encouraging atmosphere of the program is very welcoming and extremely productive. Dr. House attended this program last year and intends to participate every year. He can even hook you up with a room for the week, since he lives about a mile from campus. The 2007 dates have not yet been published, so keep an eye on their Web site: http://www.continuetolearn.uiowa.edu/iswfest/.

Other colleges and institutions probably sponsor similar programs. If you’re familiar with other highly-regarded writing seminars (particularly those focused on the medical humanities and designed for working professionals) please share them with your fellow section members through the newsletter. Information about other seminars that apply to the medical humanities is welcome as well.

 


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This publication is designed to promote communication among emergency physicians of a basic informational nature only. While ACEP provides the support necessary for these newsletters to be produced, the content is provided by volunteers and is in no way an official ACEP communication. ACEP makes no representations as to the content of this newsletter and does not necessarily endorse the specific content or positions contained therein. ACEP does not purport to provide medical, legal, business, or any other professional guidance in this publication. If expert assistance is needed, the services of a competent professional should be sought. ACEP expressly disclaims all liability in respect to the content, positions, or actions taken or not taken based on any or all the contents of this newsletter.

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