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Emergency: real stories from Australia’s emergency department doctors

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Edited by Dr Simon Judkins, 2015, Penguin Random House, RRP $32.99, 260 pages

Review by Adrian Rollins, editor, Australian Medicine

It’s not surprising so many television dramas are set in hospital emergency departments, where life is portrayed at being lived at an intensity well beyond the norm.

In this celluloid world, every day is filled with raw human emotions, adrenaline-pumping action, wrenching life-and-death decisions, and a heady mix of tragedy and triumph against the odds.

This may be one of the rare instances where reality matches – and in some cases, exceeds – the imagination of the dramatists.

In Emergency, 26 physicians give outsiders an intriguing glimpse into what it really means to be on the medical frontline.

In well-crafted and frequently moving accounts, they relay both the what of the job – retrieving everyone from toddlers to octogenarians from the brink of death – and its consequences: the lasting emotional effects of these experiences, which are often pushed to one side in the heat of the moment, but resonate loudly in the all-too rare moments for quiet reflection.

Take the story of the emergency doctor dangling over the edge of a conveyor belt to comfort a trapped worker whose legs have been crushed and amputated in a garbage compactor.

Or the physician who finds himself wading through puddles of blood to treat a stream of bullet-riddled gang members brought to hospital from the badlands of Cape Town.

Or the gut-wrenching realisation for a resuscitation team that, despite their herculean efforts, they have been unable to revive a two-year-old who strangled herself playing with a cord dangling from the blinds above her bed.

The stories in the collection traverse the breadth and depth of emergency medicine practice.

Readers are transported from major Australian city hospitals to the PNG highlands, to Uluru, Sydney Harbour and bleak industrial estates.

They witness the exhilaration that comes from saving a life, and the trauma that can accompany losing one.

They also get a glimpse into the challenges of practising this exacting craft – the marathon hours, the high levels of stress, the frustrations caused by inadequate resources, the seemingly endless demand for help, and the lack of time and space to reflect.

But what shines through, and what television scriptwriters tend to overlook, is the commitment to patients that overwhelms all else.

It is what drove Dr Mark Little to try just one more time after 75 minutes of failed attempts to revive a 60-year-old builder who had suffered a cardiac arrest – this time to succeed.

It is apparent in the tortured reaction of staff to the death of a toddler, despite their valiant attempts.

“This is fucked,” Dr Judkins recalls one nurse saying. “Why does this happen? This is not right.”

“This is why we do the job,” he responds, articulating his philosophy that, while they were unable to save this particular life, they had the skill to save others, “and that’s incredible”.

AMA Vice President Dr Stephen Parnis, an emergency physician in Melbourne, says it is not just about saving lives.

Relating the experience of advising and supporting a favourite uncle during a four-year battle with bile duct cancer, Parnis reflects that some of the most rewarding aspects of the job come from caring for the dying: “To ease their anxiety and pain, to calm their fears, to share that time with them, is a privilege”.

Practising emergency medicine is not for everyone, and the risk of burnout can be high.

The hours are long and often unsociable – after all, medical emergencies can happen any time – and the demands can be relentless.

But it is clear that for those who shared their experiences in Emergency, the connection with patients, the chance to save lives – or, on occasion, to ease death – and the satisfaction that comes from working as part of a well-drilled team, more than make up for these inconveniences.