ER comes to real life in MD's hands

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The Night Shift: Real Life in the Heart of the E.R.

By Dr. Brian Goldman

HarperCollins, 263 pages, $30

Dr. Brian Goldman, host of the CBC Radio program White Coat, Black Art and longtime emergency physician at Mount Sinai Hospital in Toronto, is not, alas, George Clooney.

The course of one typical night shift in the emergency department, recounted here tellingly, yet lovingly, is a long way off from the sensational drama and romance of the TV drama ER.

Who wants an actor tending to you in a real medical crisis, anyway? For that, Goldman or someone like him would be just the ticket.

White Coat, Black Art listeners will recognize the broadcaster's trademark disarming candour as he attempts to puncture a sometimes tough hide that keeps the real world of medicine cloaked from public view.

Following a series of patients (each a composite of several individuals) chronologically throughout the night, Goldman use some of his anecdotes to serve as springboards to topics he's dealt with on the radio program -- medical errors for example, or the ethics surrounding personal relationships between medical practitioners and their patients.

Interviews with emergency physicians across the country round out the book, as Goldman admits Mount Sinai doesn't see a lot of victims of violent crime.

Tailoring his message toward non-experts, Goldman uses phrases like "belly pain" instead of the medical terms, and at the same time manages to avoid sounding patronizing.

On the other hand, any medical professional would be hard-pressed not to find valuable insights in this book. Meanwhile the general public gains real understanding of why wait-times can be so long, or the value of asking an ER physician a well-placed question like, "Aren't we rushing things a bit?"

Though his straightforward, unpretentious style doesn't pack the same emotional power as Dr. Vincent Lam's lush fiction in his Giller Prize-winning story collection Bloodletting & Other Cures, Goldman's clear descriptions are frequently quite moving.

Juan, for example, is brought in after passing out drunk in a bar. After some sensitive questioning, and prodded on by the memory of a former patient who was discharged too soon and committed suicide, Goldman and his resident confirm that Juan is at high risk for the same thing, and gently convince him to accept a transfer to a psychiatric hospital.

One of the best things about the book is the author's advocacy for a culture of openness and compassion in the case of medical mistakes. A friend of his makes the wry comment that judgment comes from experience, and experience comes from bad judgement.

Goldman relates his own almost comically pathetic early attempts to avoid having to intubate because a burned-out mentor during his residency failed to teach him the technique properly.

He shows how the intense sleep deprivation with which all-night shift workers contend, as well as outrageous on-call schedules, have an undeniable effect on the speed and alertness of ER staff. He exposes the reality that though residents now technically have the right to go home at a decent time, many do so only at the risk of sabotaging their career; someone assisting with your surgery may have been up for far longer than 24 hours. This is reality.

The Night Shift excels at showing how the health-care system is made up of human beings with foibles, not invincible automatons, or stars like Clooney.

It's a fascinating look at the sometimes dramatic, sometimes mundane world of life and death behind the emergency doors.

Ursula Fuchs is a Winnipeg registered nurse.

Republished from the Winnipeg Free Press print edition October 23, 2010 H8