Nonfiction

Tornado of Life: A Doctor's Journey Through Constraints and Creativity in the ER

Tornado of Life: A Doctor's Journey Through Constraints and Creativity in the ER

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  • Type：Epub+TxT+PDF+Mobi
  • Create Date：2022-08-29 20:21:36
  • Update Date：2025-09-07
  • Status：finish
  • Author：Jay Baruch
  • ISBN：0262046970
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Summary

Stories from the ER: a doctor shows how empathy， creativity， and imagination are the cornerstones of clinical care。

To be an emergency room doctor is to be a professional listener to stories。 Each patient presents a story; finding the heart of that story is the doctor's most critical task。 More technology， more tests， and more data won't work if doctors get the story wrong。 Empathy， creativity， and imagination are the cornerstones of clinical care。 In Tornado of Life， ER physician Jay Baruch offers a series of short， powerful， and affecting essays that capture the stories of ER patients in all their complexity and messiness。

Patients come to the ER with lives troubled by scales of misfortune that have little to do with disease or injury。 ER doctors must be problem-finders before they are problem-solvers。 Cheryl， for example， whose story is a chaos narrative of "and this happened， and then that happened， and then， and then and then and then，" tells Baruch she is stuck in a tornado of life。" What will help her， and and what will help Mr。 K。， who seems like a textbook case of post-combat PTSD but turns out not to be？ Baruch describes， among other things， the emergency of loneliness （invoking Chekhov， another doctor-writer）; his own （frightening） experience as a patient; the patient who demanded a hug; and emergency medicine during COVID-19。 These stories often end without closure or solutions。 The patients are discharged into the world。 But if they're lucky， the doctor has listened to their stories as well as treated them。

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Reviews

Regan ，

Thank you to Netgalley and MIT press for the ARC。Tornado of life is a beautiful product of decades of experience in emergency medicine。 Baruch's humanity seeps into every word， and I often found myself writing down excerpts to think on and remember。 Tornado of life explores the emergency room and those who enter。 We see the everything from the relatively benign to the heartbreaking。 In Tornado of Life， Baruch takes us through the lessons learned and the patients and family members who taught the Thank you to Netgalley and MIT press for the ARC。Tornado of life is a beautiful product of decades of experience in emergency medicine。 Baruch's humanity seeps into every word， and I often found myself writing down excerpts to think on and remember。 Tornado of life explores the emergency room and those who enter。 We see the everything from the relatively benign to the heartbreaking。 In Tornado of Life， Baruch takes us through the lessons learned and the patients and family members who taught them。I appreciated the care taken with writing on the patient， as well as the fact that Baruch takes us into his confidence and admits to shortcomings and how some things had to be learnt the hard way。This book is reminiscent of Critical Care by Theresa Brown in how well it navigates letting the reader in to the narrative while not commoditising the patient's experience。 All in all， this is really one of the better medical 'memoirs'， and I'd recommend it without second thought 。。。more

Allyson Dyar ，

Medicine is described by some as part science and part art。 Author Jay Baruch believes that to be a successful Emergency Room doctor （and， perhaps， a doctor in any specialty）， the doctor should stop and really listen to what the patient is saying or not saying。 Don’t just rely on the science but learn to lean on the less tangible。This isn’t the typical doctor’s discussion of what they treated during a patient’s emergency room visit， instead， while each vignette is patient centric， Dr Baruch disc Medicine is described by some as part science and part art。 Author Jay Baruch believes that to be a successful Emergency Room doctor （and， perhaps， a doctor in any specialty）， the doctor should stop and really listen to what the patient is saying or not saying。 Don’t just rely on the science but learn to lean on the less tangible。This isn’t the typical doctor’s discussion of what they treated during a patient’s emergency room visit， instead， while each vignette is patient centric， Dr Baruch discusses how he approaches the patient and his philosophy on the disease， his treatment， or what the patient’s actual problem was or could have been。 Tornado of Life would appeal to the reader of books on doctor’s perspectives on medicine but is looking for a bit more of the doctor’s philosophy concerning the art of medicine。（Ironically， I had read a previous book by Dr Baruch， Fourteen Stories: Doctors， Patients， and Other Strangers， a collection of short stories that I had reviewed and didn’t really enjoy。 At least I am enjoyed this book。）4/5 stars[Thank you to NetGalley and the author for the advanced ebook copy in exchange for my honest and objective opinion which I have given here。] 。。。more

Canadian Reader ，

My experiences in hospital emergency rooms have led me to believe that a fair number of physicians who work in them are adrenaline junkies: quick thinkers who crave stimulation and variety， don’t have long attention spans， and are there in part because ER work does not involve following up on patients as internists or primary care physicians are obligated to do。 They’re fix-it-fast or pass-them-on clinicians。 Jay Baruch himself writes:Early in my career， I was aware of a knock against emergency My experiences in hospital emergency rooms have led me to believe that a fair number of physicians who work in them are adrenaline junkies: quick thinkers who crave stimulation and variety， don’t have long attention spans， and are there in part because ER work does not involve following up on patients as internists or primary care physicians are obligated to do。 They’re fix-it-fast or pass-them-on clinicians。 Jay Baruch himself writes:Early in my career， I was aware of a knock against emergency medicine— a lack of closure。 We rarely follow a disease through to the end。 We don’t see pneumonia improve with antibiotics。 We’re not tracking the wrist fracture through healing and rehabilitation。 Dr。 G， a dean at my medical school， a prominent internist and infectious disease researcher， when learning of my intention to enter emergency medicine， said， “Emergency medicine is to internal medicine as the short story is to the novel。 And there are no great short story writers。”Evidently well acquainted with literary fiction， Baruch not surprisingly disagrees with the last statement， and in his book he disproves， or is at least an exception to， my characterization of ER doctors。 Maybe it’s because he， like fellow emergency medicine physician Frank Huyler， is a writer as well as a doctor。 Baruch is philosophical， introspective， self-critical， and sensitive to the nuances of complex situations。 He’s interested in stories， those that patients tell， as well as literary ones from such writers as Anton Chekhov and Lorrie Moore。 Stories， Baruch writes， structure experience， try to make meaning of it， but physicians can miss key elements based on cognitive shortcuts they’ve learned。 Doctors’ brains are as hardwired for stories as the next person’s， but if physicians aren’t careful， the story they create “may be very different from the one the patient is telling。” To illustrate this point， Baruch tells of a suicidal veteran with PTSD， Mr。 K， whose girlfriend called 911 after he phoned her at work， panicked， saying he had fallen。 The paramedics who found the man at home sensed “a disturbing violent intensity” emanating from him and called on police to escort him to hospital。 Mr。 K’s face was bruised， but he wouldn’t allow anyone to touch him， never mind perform scans to determine if he had a head injury。 Restraints would likely be needed to treat him。 Only when the patient’s girlfriend and sister arrived at the hospital and Baruch spoke to them did he learn that Mr。 K’s PTSD long predated his military service: he had been raped as a child。 Looking at the muscular men surrounding the man’s stretcher， ready to tie him down， Baruch was appalled by how he’d approached Mr。 K’s case。 After asking those men to step aside， the physician apologized to the patient， who had calmed somewhat and now permitted his neck and head to be examined。 But that was where it ended。 The trust had been broken; the patient would not allow a full medical workup。 Baruch reflects that Mr。 K’s “emotional state was treated as pathology that demanded a response， rather than evidence in a narrative that needed further investigation。 Despite all the harms that take place in hospitals， the ones less frequently addressed are narrative errors。” Such misinterpretations are all too common in the ER where “a pressured listener tries to understand a pressured storyteller。” Baruch’s essay collection consists mostly of stories similar to the one related above， describing doctor-patient interactions that left him feeling “lost， inadequate， confused or ashamed， unsettled， or just plain silly。” However， some essays focus on his own experience as a person with a serious heart condition， which required him to undergo major surgery at age 41。 “The practice of emergency medicine is a dance with the unexpected，” he says。 At other times， it “seems like an emotional and moral contact sport。” Among the many challenging patients at the centre of these stories are gun trauma and motor vehicle accident victims， people in the throes of heart attacks， cancer patients in crisis， exhausted caregivers accompanying parents with dementia， and aggressive or frightening patients， some of whom have blood alcohol levels two to three times the legal limit or through whose blood some other substance is coursing。 Abusive people like these are routinely kicked out of bars for their behaviour， but they cannot legally be denied emergency medical care。 Limited time and resources can force a doctor to send a homeless person， who has been drying out in an ER bed needed by someone else， back to the streets before he’s ready。 Sometimes the same individual will be back in hospital a few hours later with precisely the same problem。Baruch mentions the ideas of Arthur Frank， a sociologist known for his work on illness experience， narrative， and the ethics of care。 Frank has identified three kinds of medical narrative: restitution （the type you see in drug commercials: “take this pill and the sun will shine again”）; quest （the once-well patient journeys into the land of the ill and is transformed by his trials）; and chaos （in which “the troubles run so deep that putting language to these experiences can be difficult， if not impossible。”） Chaos narratives are commonly heard in the ER。 Baruch’s book is in fact named for a comment made by a patient who tells one of these stories。 Cheryl， brought into the ER for the ruckus she caused at a homeless shelter， had overdosed on heroin the previous night and was angry about being alive。 “I’m stuck in a tornado of life，” she told him。 Hers was an existence consisting of a myriad of problems woven into a multitude more。 A story like Cheryl’s is threatening to clinicians， Baruch says; it stirs up their own anxieties and challenges their illusions of control。 A doctor’s task is to hear the chaos narrative， not interrupting the patient but allowing her to tell the story。 In this way， enough trust can be gained to enable the physician to provide care and a sense that change is possible。I found almost all of Baruch’s forty essays fascinating， illuminating， and insightful。 They present and interpret compelling stories and are accessibly and beautifully written in clear prose。 Many are enriched by literary references or succinctly supported by the highlights of research studies。 Overall， the impression the essays leave is of Baruch’s humanity and commitment to gleaning the truth of difficult interactions with people who are stressed and in pain。 Most of the pieces are serious and searching in tone， but there are a few welcome humorous anecdotes。 One very short chapter about a wheelchair in a hospital parking lot reads like a prose poem; it put me in mind of “The Red Wheelbarrow” by William Carlos Williams。 In fact， what Williams observed about how his work as a doctor informed his writing applies equally to Baruch: “My ‘medicine’ was the thing that gained me entrance to these secret gardens of the self。 It lay there， another world， in the self。 I was permitted by my medical badge to follow the poor， defeated body into these gulfs and grottos。”A few of the essays， most notably the last， concern the coronavirus pandemic。 While Baruch’s views on Covid-19 are more moderate than those of many in the medical community， I admit to being disappointed that he isn’t more open to or informed about differing perspectives。 He cautions against demonizing those who have chosen not to take the vaccine， pointing out that their reasons are often more thoughtful and nuanced than the media would have us believe。 He nevertheless assigns too much blame for the dire outcomes and loss of life to irresponsible members of the public， failing to acknowledge the role of the mainstream media and medical spokespeople in silencing the voices of knowledgeable physicians and scientists with differing views on how to respond to such an emergency。 Many well versed in epidemiology， public health， virology， vaccinology， and infectious disease who had valuable contributions to make to the discussion were unjustly vilified and deplatformed over the last two years。 Accomplished， ethical physicians—who recognized the importance of early treatment， successfully used repurposed drugs with excellent safety records， and kept people out of hospital and off ventilators—have received no recognition or have been falsely depicted as dangerously unscientific mavericks。 Furthermore， vaccines that were rushed through inadequate clinical trials have caused significant and well documented injury。 Their maker， Pfizer， evidently aware of its own shoddy practices， attempted to block public access to its data for 75 years。 A judge decided otherwise。 Finally， one really should be concerned about the American drug regulatory body’s actual commitment to public safety when it gets around half its funding from the very pharmaceutical industry whose products it’s supposed to be stringently evaluating and vetting。 None of these facts is even passingly mentioned in Baruch’s discussion of the pandemic response。 Either he was unaware of them or worried about the professional consequences of straying too far from the unnuanced “narrative” that has dominated all our lives for the past couple of years。 For a physician interested in narratives and ethics， Baruch is surprisingly uninterested in questions of informed consent and bodily autonomy， particularly when it comes to people’s being injected with a novel experimental vaccine， inadequately trialled， without long-term safety data， and made available only under emergency-use authorization。 I state all the above as a person who did receive the vaccine， though my consent was hardly informed。My reservations about Baruch’s views on Covid-19 aside， I greatly enjoyed and highly recommend his book。 As he himself observes， all of us， at some point or another， find ourselves being tossed about by the tornado of life。Rating: 4。5Thank you to the MIT Press and Net Galley for an an advance reading copy of this book。 。。。more

Reference

google book https://www.google.com/search?tbm=bks&q=Tornado of Life: A Doctor's Journey Through Constraints and Creativity in the ER

hathitrust digital library https://babel.hathitrust.org/cgi/ls?q1=Tornado of Life: A Doctor's Journey Through Constraints and Creativity in the ER&field1=ocr&a=srchls&ft=ft&lmt=ft

The British Library https://bll01.primo.exlibrisgroup.com/discovery/search?query=any,contains,Tornado of Life: A Doctor's Journey Through Constraints and Creativity in the ER&tab=LibraryCatalog&search_scope=Not_BL_Suppress&vid=44BL_INST:BLL01&lang=en&offset=0