Literature and doctoring have long been interwoven for me.
During my residency in internal medicine at Los Angeles County-USC Medical Center, I began reading the work of the late, great Charles Bukowski, a local writer, major alcoholic, and literary limit pusher. At night, at home, I’d be reading his short stories like Purple—his tales about countless involuntary ambulance trips to LA County Hospital. Invariably, on those trips, Bukowski would be cursing the EMTs through his bloody vomit and trying to fight them off as they attempted to stabilize him on the way to the emergency room (ER).
In the morning, when I drove east to work on the I-10 freeway from Santa Monica, I tried to picture where he lived, where he drank, carried on, and somehow wrote.
And, when I’d arrive in the hospital, I’d see the reality of his written life playing out in front of me. Though I never took care of Bukowski personally, nearly every time I got paged by my emergency medicine colleagues about another alcoholic being admitted to our medical team, I thought of him.
I imagined these patients we were treated to be his drinking buddies, men, and women emerging from his same stomping grounds. It allowed me to see them, if not in a more romantic way, to at least glimpse the humanity of these desperate souls. They’d roll in, assaultive, refuse medical treatment, quickly flee the hospital, and then, invariably reappear soon thereafter as they circled the drain of their lives.
After my residency, I moved back to New York and, through a series of events I could never have predicted, became an emergency medicine physician myself. I was working under Lewis Goldfrank, the director of the emergency department at NYU and Bellevue. The job was exciting, challenging, and totally unpredictable, and it provided a freedom that suited me. In my new role as an ER physician, I became acutely aware of how dysfunction in one body system can mimic the symptoms of another, and then how to tease that out so I could quickly and successfully intervene.
I loved that, as an ER doctor, I could jump in and fix many medical problems or do a quick stabilization whether at work, on a plane flight, or anywhere that the call rang out, “Is there a doctor available?”
And I started writing stories. It’s not easy to imagine (although people always ask) the array of patients and dramas that I was exposed to at Bellevue. I began to jot down my interactions and impressions and would come home after work carrying written “snippets” of an event I’d just been involved in.
Over the years, those snippets evolved into thirty short stories.
They were about those ephemeral moments doctors and nurses on the front lines experience: The moment before and the moment after, when everything changes irrevocably in patients’ and their families’ lives. The moments when all artifice is ripped away, the patient is trying to grapple with the imminent loss of life or limb or autonomy. Those moments when we, as practitioners, have a few fraught instants to turn things around. Or, sometimes, not.
Writing these stories not only tried to capture those occasions but also provided an effective, healthy way to cope with the ER chaos. Every practitioner develops different coping styles. The thing that has kept me relatively sane throughout my career has been an ironic, Borscht Belt sense of humor, which I’ve incorporated into my writing.
My first story, inspired by my experiences at Bellevue, was called The Emergency Room according to Marx and Heller. The Marx in question were the Marx Brothers, whose films I’ve watched since childhood. Their sense of the absurd, their brilliant use of language, and their irreverence were ingrained into my approach to life, and my job.
As I worked in the labyrinthine Bellevue Emergency Department, with its frequent, overwhelming onrushes of patients, family members, medics, and cops, I would be reminded of the famous stateroom scene in the film, A Night at the Opera. Groucho has unceremoniously been given a tiny, closet-sized room on a luxury liner back to New York. After he enters the room, he opens his steamer trunk and discovers stowaways Chico and Harpo (plus Alan Jones) hidden inside.
Soon, a number of people start knocking on the door and crowding into the tiny space: A manicurist with her table, the chambermaid who comes in to make the bed, then the humungous plumber and his assistant, and, a young, stylishly dressed woman who enters and asks Groucho, “Is my Aunt Minnie here?”
Groucho tells her he’s not sure, but she’s welcome to come in and take a look around. Others, including waiters bearing trays of food, appear. Finally, there is another knock at the door. Reluctantly, Groucho opens it and finds the cleaning lady, kerchief on head, pail in hand.
“I’m here to mop up," she says.
“You’re just the person I’m looking for,” Groucho replies.
I’d be reminded of that scene often in the midst of the out-of-control ER madness and would find myself searching desperately for someone to come in and mop up as well.
Those kinds of thoughts, coming amidst the chaos, would put a smile on my face and allow me to keep going, whether the cleaning woman ever showed up or not.
The other scenario, the (Joseph) Heller reference that often came to mind was from Catch-22. It’s a book I’ve read many times over the years, including introducing it to my daughter just before she entered third grade.
The scenario was a recurring image begun in the early chapters. The fighter pilot protagonist, Yossarian, is trying to comfort Snowden, the bombardier, as they return from a bombing run over Italy.
Snowden keeps saying, “I’m cold. I’m cold.”
Yossarian, as he carefully removes Snowden’s flight jacket, his flak suit, and then his shirt, keeps responding, “There, there. There, there.”
Finally, as the last layer is peeled away, Snowden’s secret is revealed, as his guts spill out on the floor. He’s been shot through the flak suit and dies in Yossarian’s arms.
Over the years, I have had countless patients who came in hiding their own “secrets,” diseases that they couldn’t or wouldn’t reveal to me until I’d figured out a way to get through the layers of their own “flak suits.”
I’ve been told that this love of humor, mixed in with the literary and film references, continues to amuse my patients and colleagues, and I’m thankful for that jibing, Jewish jocosity that has helped keep me sane throughout my career.
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