Author Interview: Something for the Pain: One Doctor’s Account of Life and Death in the ER
Something for the Pain: One Doctor’s Account of Life and Death in the ERby Dr. Paul Austin
Interview by Kathryn Magendie
Dr. Paul Austin has been “knee-deep in emergencies” for his entire adult life. In his twenties, he was a full-time firefighter, and since then he has worked in emergency rooms as a nursing assistant, a medical student, a resident physician, and most recently, as an attending physician. Dr. Austin spent three years in residency training in emergency medicine, and then two years as an assistant professor of emergency medicine. For the past fourteen years, Austin worked in a group that serves a hospital that sees fifty-eight thousand patients a year.
R&T: Paul, when your reader turns the last page of SOMETHING FOR THE PAIN, what do you want them to take away from the experience?
Austin: I hope that readers will come away with a sense of what it's like to work in an emergency room. TV shows are good at creating dramatic moments, and are very good at reproducing the background noise of a busy ER, so they give the viewer the feeling that they are experiencing "the real thing." And within the limits of the medium, they do a good job: they capture the conflict, the occasional violent patient, and the short-term stress of making critical decisions with limited information. But they do not show the long-term damage done by the short-term stress.
R&T: Such as?
Austin: Emotional meltdown or disconnection. People who remain emotionally engaged during an emergency are rarely effective. They freeze up and can't function, or they take in the emotion and store it up until they have an outburst of their own. I know. I've done both. The only way I've learned to stay effective in an emergency is to become detached: detached from the suffering I am witnessing, and detached from the possible outcome of the case I'm working on. If I internalize the fact that the lifeless form on the stretcher is someone's three-month-old, I will not be efficient in the moment of the resuscitation: I concentrate on "working the problem." One of the highest compliments you can pay an ER doc, is to say, "He's a machine."
R&T: But who wants a machine for a doctor?
Austin: Exactly. And who wants a machine for a husband, or wife? Mom, or Dad? And who wants to go through life, as a machine?
R&T: So, what do you do?
Austin: I do the best I can. One morning several years ago, a mother rushed into our ER with a floppy, blue, infant. Our most skillful nurses tried, and failed, to establish an intravenous line. In this situation, the life-saving intervention is to hold the chubby little leg in your left hand, and with your right hand, jam a needle the size of a finishing nail down through the skin and muscle and into the bone itself. The IV fluid runs into the marrow, and from there, into the bloodstream. If you can wiggle the needle, it's not in the bone. It should feel solid – like a nail driven into wood.
So, that's what I did, without hesitation. I felt a crunchy little "pop" as the needle broke through the cortex, and into the marrow. It was quick, brutal, and effective.
But when I talked with the mother, her face drained of color, I had to soften the edge I'd brought forward to resuscitate her child. I had to unclench my shoulders, my face, and my voice. If I hadn't, the harshness I had summoned to skewer her infant's flesh would've wounded a woman who was already burdened with the visceral knowledge that her child may not survive. She had after all, brought us the silent, breathless girl her own two arms.
The effort of opening and closing the emotional aperture is exhausting work, but I believe it is essential. If I remained habitually detached, I would lose connection with my family, coworkers, and patients. If I did it long enough, I'd lose connection with myself. On the other hand, if I remained fully open to the pain and suffering in which I work, I would be paralyzed; unable to spike a needle into an infant's leg.
R&T: Is that hard? The opening and closing of the aperture of your heart?
Austin: Sure, it is. But it beats the alternatives.
R&T: Switching gears a little, what is the writing life to you, and how important is it to your sense of well-being?
Austin: Writing has opened my life in ways that I never would have predicted: I have met so many wonderful writers at conferences, and via e-mail correspondences. Writing continues to open doors for me: Doors into a fuller understanding of my work and life, as well as into a fuller understanding of my family, coworkers, and patients.
R&T: At book signings, do you get the, “Say, Doc, I have this pain in my shoulder…think you could give it a lookee loo?” And if so, how do you handle that? And, how do you steer the conversation at book readings back to your book when it strays to topics concerning health, or do you see that as a “problem?”
Austin: So far, I've not had anyone ask for a "curbside consult," about a personal medical problem. But at every reading, someone has complained about the way uninsured patients clog up the ER with non-emergencies. Other people in the audience nod their heads, and murmur their irritation. The first few times it happened, I tried to explain how uninsured patients "abusing the system" accounted for a very small percentage of the overcrowding that ER's across the country are experiencing. The biggest problem is having to "board" patients who need to be admitted to the hospital, but for whom a bed is not available – the research is clear on this. But this answer doesn't seem to satisfy the person with the complaint, and the book isn't about this issue, so I've learned to nod my head and say, "Long waits sure are frustrating for the patients and for the docs and nurses," and then move on.
R&T: As you wrote about your more stressful/painful experiences in the ER and at home, was it difficult to relive them, or more a catharsis?
Austin: I'm not sure. I don't think it was really cathartic, but somehow through the process of the ten, fifteen, twenty revisions that I've done on each story, I have more fully come to terms with them. The emotional freight of the story seems to dissipate as I struggle to get the words on the page right.
R&T: How do you feel about the writing life versus the physician life? Yes, they are different “things” – but I mean, how does each fill that SPOT inside of you that needs filling and could you give up one for the other?
Austin: So far, I don't think I've really experienced the "writing life." I just go out to my room above the garage and write my ass off every day I'm off-duty. I have been to some writers' conferences sponsored by The North Carolina Writers Network and the Bread Loaf Writers' Conference. The writers I've gotten to know have been so generous in sharing what they know about the craft of writing, and have offered so much encouragement. For me, it has been very helpful to tag along with some people who are further down the path. And I've tried to be encouraging to other writers who may not be as far along as I am. I think that reading people whose writing you admire, and finding a mentor, are two fundamental steps in learning to write.
The two activities have a lot in common with each other. I think of both activities as a practice. And, they both require close observation of people and their interactions. As a doctor, and as a writer, I am challenged to recognize important details. Every illness has a story, so I have spent my entire working life eliciting stories from people, and trying to understand them. Perhaps, the most striking similarity between the two endeavors is the importance of perseverance and relentless effort.
When I was an undergraduate trying to get into medical school, there were a lot of people in my organic chemistry class that were a lot smarter than I was. And God knows, at Bread Loaf, you couldn't throw a cat without hitting a writer who brought more talent to the keyboard than I did. My response has been to outwork them. Other people may be smarter, and more talented, but I am willing to harder, and longer. And I never quit.
R&T: So, how are your friends, colleagues, and family reacting to the publication of your book? Anyone nervous you may have exposed them in some way? Do YOU feel exposed?
Austin: Yes and no. So far, the nurses and docs at work have liked the book, and have said they're glad that someone has finally written a book that really shows what it is like to work in an ER. If anything, reading the book seems to have made it possible for other people to reveal things about themselves. After talking with me about the book, which shows a rough patch in my marriage, a guy told me that he and his wife got divorced during his internship. There are a couple of scenes in the book where I am sleep-deprived, and very hostile to my family. Almost all of the nurses and docs I work with have shared with me times that they lost their composure after working a string of night shifts.
Having said all of this, however, one nurse laughed and said, “I know a lot more about Sally's breasts than I ever wanted to know!" I wasn't aware of having written that much about my wife's breasts. I should probably re-read parts of it.
R&T: *laugh* I don’t remember Sally’s breasts, either! But, I do remember her strength and calm. Paul, do you imagine some people may come to the ER with SOMETHING FOR THE PAIN clutched in their bloody hands and ask you to autograph it? Or their family member shoving the book at you while you are frantically working over their loved one?
Austin: I doubt that would ever happen, but if it did, they'd go to the front of the line.
R&T: *laughing* With your book’s publication, do you believe you will be seen/interpreted differently now as a Physician and a Man by both your peers and those who come to the ER?
Austin: Sort of. Most of folks – nurses, docs, nursing assistants, ward clerks, and housekeepers – are excited for me. The book gives us something to talk about. I think it will be rare that a patient will have read the book – unless it really takes off.
R&T: Any advice for emerging writers?
Austin: A writing teacher one time told me, "It's a war of attrition. Don’t attrish." That is some of the wisest advice I've been given.
R&T: How did you and your agent find each other?
Austin: It took me about four years to find an agent. That was probably due to the fact that I started looking for an agent four years before the book was ready. I had several agents I had met at writers' conferences "nibble at the hook," but then things fizzled out. Finally, about three years ago, I started searching for an agent on the Internet. When I got home from work late at night, too jazzed up to sleep, but too exhausted to write, I did searches. After Googling the term, "literary agents actively seeking new writers," I made a list of about 25 agents. For the next few weeks, I researched each agent – to see if they had been interviewed in Poets and Writers, or had were guests at legitimate writers' conferences. That narrowed it down to 20 legitimate, solid, agents. Then I sent a query letter that lit up the sky with interest. Twelve agents asked to see the first few chapters.
R&T: How did you write that query letter?
Austin: After crafting, revising, reworking, and re-drafting a solid, boring, query letter, I finally, in one quick flash wrote an opening that seemed to work: "For twenty years, I've worked in emergencies. First as a fire fighter, and now as a physician. My book, Something For the Pain, is about the way my job almost wrecked my family." I think it was that action verb, "wrecked," that caught their eye. But who really knows what agents are thinking?
R&T: How do you overcome what some call “writer’s block,” or just plain, “I don’t feel like writing?” Especially with your schedule, was this an issue, or is writing the soothing part of your day (other than restful sleep, that is!)?
Austin: Knock on wood; I've not had a time I didn't feel like writing. I can always write something – even if it sucks. When I find that I'm writing stuff that bores me, I usually take a walk, or go exercise. I don't understand it, but I've come to trust the process: breaking a sweat seems to open things up. Then all I have to do is to jot down the thought, and the next time I sit down, I know where to start.
R&T: Finally, where can our readers find SOMETHING FOR THE PAIN, and, what are you working on next?
Austin: If people want a signed copy, they can go to my website – Paul Ethan Austin.Com, where they will find a link to The Regulator Bookshop, our local, independent, bookstore. Otherwise, they can get it at any of the major bookstores - Amazon, Barnes & Noble, Borders, and Powell's.
In terms of my next book: So far, I've been pretty busy trying to get SOMETHING FOR THE PAIN off the runway. But, I have started a novel about a family with a daughter with Down syndrome. Of course, I have no idea of how to write a novel, but I didn't now how to write a medical memoir either. I'm sort of nervous about it, but I have finally learned to trust the process – sit at the keyboard, type as hard as I can go, and hope that in revision it will turn into writing.
R&T: Thank you, Paul, for taking time to do this interview with me.
Austin: It was my pleasure.
For more on Dr. Paul Austin, visit his Web site
Read a review of SOMETHING FOR THE PAIN
Kathryn Magendie is a writer, freelance editor, and Co-Managing Editor at The Rose & Thorn. Visit her website , her GOT YOG? or her personal blog.
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