When an ER doctor becomes an ER patient

An ER doctor describes the "perspective shift" that happens when you go from doctor to patient

Published August 28, 2022 10:00AM (EDT)

Blurred emergency in hospital (Getty Images/vm)
Blurred emergency in hospital (Getty Images/vm)

Excerpted from "Tornado of Life: A Doctor’s Journey Through Constraints and Creativity" by Dr. Jay Baruch, used with permission from The MIT Press. Copyright 2022.

Pushed through the ER entrance on a gurney. A voice directed the medics to a treatment bay. Hands removed my shirt and attached wires to my chest and finger. Monitors stood at my head, passing judgments. I eyed the fast heart rate and low oxygen level in my blood as if the numbers belonged to someone else. In Providence, Rhode Island, where I'm an ER doc, these monitors are my allies. Now, I was in a North Carolina ER, sweat-soaked, breathing hard, caked in vomit, and my scalp a bloody mess.

Doctors and nurses spoke to me and across me. Visual noise competed for my attention: scrubs, white coats, medic uniforms, and in the distance, police and patients on gurneys. My throbbing head was alert to strange background chatter — alarms and urgent hospital-wide announcements, including code words for a life that needs saving and a Jell-O spill that requires mopping.

My EKG showed an injury pattern seen with people having an acute heart attack. I tried to inform my fretting doctors the ugly-looking EKG was better than it once was. It's hard to reconcile the past when the disorienting present feels like a carnival

That evening, I had torpedoed an after-dinner stroll with my wife and son on the University of North Carolina campus by passing out. We were visitors this Labor Day weekend to the USA Baseball National Training Complex in nearby Cary. My son was selected to join other thirteen-year-old baseball players from New England for a few days of humility at the hands of teams from California, Georgia, Texas, and other hothouses of baseball talent. The beating from the sun was equally relentless that day. Later, my head lost a scuffle with the sidewalk, as heads often do.

I also aspirated souvlaki with yogurt dressing into my lungs. Oxygen had to compete with my partially digested dinner. "A Mediterranean diet is healthy as long as you keep it out of your lungs," I whispered to my doctor, my voice raspy, my chest burning with each inhalation. I forced a few deep breaths hoping the oxygen level would rise. The monitor wanted nothing to do with my parlor tricks.

Another large IV. More blood samples. A second EKG. Chest X-ray — "take a deep breath and hold." Sitting up on the ER gurney — breathing was easier — I found myself the object of attention and the subject of an experience. I was a citizen healthcare provider, fluent in the language. I understood the patois pocked with abbreviations — low pulse ox, ST elevations —  and terms like hypoxia, tachycardia, and soft blood pressure spoken around me. And yet, at that moment, the entire situation felt strange and otherworldly. I thought, "How can any patient not feel intimidated and lost in this space?"

My perspective shift could be explained by my unexpected position, the result of wearing an uncomfortable gown and not a stethoscope. But it also diminishes my experience by slotting it into a category with other stories where the doctor finds insight after being a patient. My story becomes a type of story, and in doing so, ceases to be mine.

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I have a healthy suspicion for neat narratives, the cozy moral. Life is messy and difficult to penetrate. In medicine, there's a tendency to force experiences into a script or into a diagnosis. I'm not saying such gestures are wrong or untrue; they're just inauthentic in certain situations. 

Even as I write these words, I struggle to fully understand how we come to describe and understand our experiences. In "The Poetics of Space," Gaston Bachelard writes, "We must look for centers of simplicity in homes with many rooms. . . . In a palace, 'there's no place for intimacy.'" Hospital ERs, spaces with rooms upon rooms, designed with more empathy for technology than humans, risk leaving patients feeling like uninvited but tolerated guests. The challenge becomes taking these spaces and creating simplicity and intimacy that coexist with monitors, fear, and patients' complicated narratives. 

Syncope is the medical term for a transient loss of consciousness with spontaneous recovery resulting from inadequate blood flow to the brain.

I wasn't the medical trainwreck suggested by my medical history, though I recognized my problems were difficult to ignore. Open-heart surgery. Mitral valve repair. Atrial fibrillation. Multiple cardiac ablations. A period of rate-related cardiomyopathy that weakened the heart muscle. For a time, I was on the same medications as my heart failure patients. And yet, recovery put that turmoil in the past. With denial's expert help, I considered myself healthy.

Luckily, my wife contacted the on-call physician for my internist, who had access to previous EKGs. The concerning changes in my EKG were old, a remnant of prior injury and surgery. My doctors sighed in relief. My response was more somber. I could ignore my past struggles, pretend they no longer matter, but indelible tracings remain. The body betrays as much as it conceals.

Syncope is the medical term for a transient loss of consciousness with spontaneous recovery resulting from inadequate blood flow to the brain. Interestingly, another meaning for syncope is to contract a word by omitting middle sounds or letters. When you pass out, you become cut off from your experience and the return feels like an unwrinkling of the senses. Voices floated in my head, then entered my ears as strange faces emerged into tighter focus. "Dude, you passed out," a slurred voice said, standing over me, holding a red solo cup. It was the opening home game for the University of North Carolina football team, and there were parties everywhere.

"Dude. You have a few?"

I tried to tell him I hadn't been drinking, but he kept asking. I can only assume people were partying hard and hitting the ground harder on this beautiful and festive evening. His brain made assumptions and created a believable story. It was easier to marvel at my condition than to be curious about it.

The sound of my son's voice settled me. "You okay? Don't touch your head, Dad. You're bleeding." He was half-naked, pressing his T-shirt to my bleeding scalp, terrified.

Once in the back of the ambulance, lying on the gurney, I felt the doors slam closed more than I heard them. I saw my wife frantically talking to the medics, who were pointing and directing her to the hospital. The sunlight had softened into nightfall when EMS started the engine. Red lights strobed through the street, dispersing onlookers. I followed my wife and son, running to our car, their bodies growing smaller as we pulled away, thinking, "I'm not making it to the hospital, I'll never see my family again."

This emotional run-in with my mortality had happened only once, the day before my heart surgery. Then, I met it by peddling the exercise bike. This time, I sank into the gurney and closed my eyes. There was a foreboding symmetry to this disorientating experience, for it was Labor Day, ten years earlier, when I nearly passed out while working in the ER. I convinced colleagues that I was fine. The next day I was admitted to the hospital with rapid atrial fibrillation and pneumonia. The day after that, they diagnosed my lousy heart valve. I started accumulating medical problems like cheap coins, and my journey as a doctor–patient began.

"Stay with us," the medic said. I didn't like his tone, reassurance with a vibrato of contained panic. He told me he was starting an IV in my arm. I worried that the large gauge needle didn't hurt, that I was calm even though I couldn't breathe. I heard the medics discuss my case over the radio — my EKG, low oxygen level, and soft blood pressure. That's a worrisome story, I thought, bathing in sweat.

I was thinking on that moment later in the ER, after my doctors and nurses left me alone, and the medics rolled in a guy whose heart wasn't beating at all. I heard the familiar orders of the code through the curtain separating us — the call and response. I tried hard not to imagine my naked body on the stretcher getting cardiopulmonary resuscitation (CPR) and having a breathing tube pushed down my throat into my airway. I wondered what went through his mind when his heart stopped. Did he sense he was about to die? Was he convincing himself the discomfort was only indigestion? Was death a welcome relief from pain and dependency or a source of sudden fear? These questions became a matter of surprising urgency. I could tell from their tone the doctors didn't expect this resuscitation to be successful. It wasn't long before the time of death was called, the team dispersed, and the poor guy was left alone, just as I've done after codes throughout my career.

My wife came into the room, her worry taking on a different type of pale. "That's the first time I've ever seen a dead person," she said.

I peeked through the gaps in the portable curtains. The nurses wrapped the body in a white sheet. A life, however, can't be bundled that easily. They wheeled his body away. I hoped he was off to a viewing room filled with teary-eyed family and friends. His doctors, I knew too well, weren't thinking about the man anymore. They were busy with the bureaucracy of death. Talk to any family. Fill out the death certificate. Call the medical examiner and the organ bank. Having no responsibility for him, I had the luxury to mull over the life left behind.

My wife came into the room, her worry taking on a different type of pale. "That's the first time I've ever seen a dead person," she said.

In that moment, I thought back to my ambulance ride, the belief that I wasn't going to make it to the hospital. What if I was the code called overhead? What if I was the first dead person my wife and son ever saw? Thinking on certain possibilities produced a pain so unlike anything else that it's easier not to consider it. What's in the "it"? Fear of dying? The distress of leaving the people I love so much? I'm still rummaging through the "it."

There's an unfathomable gravity to the ER space, where lives in crisis pass through and some depart forever. We can't forget the word "patient" is derived from the Latin patiens, which means "to suffer." Whether it's failing bodies, bad choices, the fear of losing control, or morphing identities, suffering is a deeply personal matter. Sometimes, it's the story that runs beneath or in between the stories being told, undetected by beeping monitors.

The embarrassment was unbearable. I had passed out in front of my son. I was bloodied and covered in vomit. A father wants to display strength to his son. That's hard when you can't even compete against gravity. I was told he was terrified when I hit the ground. Apparently, I jerked a little, too. Probably myoclonic jerks. Intellectualizing the experience is easier than imagining what my son was feeling, especially when I passed out just when my wife left him to look out for me as she ran for the car.

An ER patient should have time to ruminate on matters such as death and fear and embarrassment, but I discovered we get interrupted, too. EMS pushed a mouthy drunk driver into the newly emptied spot on the other side of the screen. "Keep your neck collar on," I heard a doctor or a nurse say, followed by mechanical words I've used so many times myself: "We're trying to help you.

ERs and hospitals are designed to be healing spaces, but people are the sources of intimacy and warmth. Stories open up to other stories once you try to tell it. I remember the jokes the CT techs told me as they moved me into the scanner, the concern from a former medical student now training in emergency medicine, afraid of violating privacy laws but she saw my name on the board, the nurse who swaddled me in blankets when I couldn't stop shivering throughout the night. I was discharged from the hospital the following morning to fly home, where I became sicker and then slowly recovered.

A story is a house with many rooms. Bringing order to any story is challenging. The present can't always shake memory's shadows or prevent thoughts about the future from echoing off the walls.

You don't want to be the patient everyone remembers. When intense experiences populate a typical ER shift, the background blurs, making it hard for a singular experience to stand out.

Before this incident in Chapel Hill, I spent a few years in atrial fibrillation, an irregularly irregular heart rhythm. I continued to run three to four miles most days of the week. My heart raced, and over time it became damaged and weakened from overwork, a condition called cardiomyopathy. Simple walking made me breathless. I collapsed on the couch when I came home from an ER shift. I needed a last-ditch ablation, and if it didn't hold, my cardiologist mumbled the word transplant. My body was the problem, but the deep hurt, I later realized, was the possibility of not being able to provide for my family, of being a reduced version of myself, and thus, becoming a different self altogether.

The cardiac ablation was a success. Electrophysiologists must first map the heart's aberrant electrical impulses, a feat as astonishing and inscrutable as a city power grid. Then they zap these intruders, erecting a line of defense so my sinus node, the heart's steady pacemaker, can do its work uninterrupted. Some experiences are harder to map. I've rewritten this piece countless times. I can't describe the scene in the ambulance, pulling away from my wife and son, without tears filling my eyes. I was scared, aware that my medical knowledge couldn't protect me. We strive for strength and resilience, but to get there we must sometimes tip a respectful nod to vulnerability and frailty.

Around five years after passing out, I was invited to give a late-afternoon talk at a Midwest medical school where the newly installed emergency medicine chair was none other than the ER attending who supervised my care that evening in Chapel Hill. We shook hands and exchanged pleasantries. After a few minutes, I realized he didn't remember caring for me. I jogged his memory, but I was convinced his acknowledgment was nothing more than politeness. I felt slighted, then happy. You don't want to be the patient everyone remembers. When intense experiences populate a typical ER shift, the background blurs, making it hard for a singular experience to stand out. Luckily, my notable experience was, for him, just another case.

Excerpted from "Tornado of Life: A Doctor's Journey Through Constraints and Creativity" by Dr. Jay Baruch, used with permission from The MIT Press. Copyright 2022.

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