Sunday 7 January 2018

Life on the Ground Floor


I sit behind the nursing station, stomach rumbling, humbled, watching white coats flash behind curtains. It's tough to say I'm proud of these people, as I have had nothing to do with making them. Still, daily, I feel something akin to that when I watch these doctors navigate a floor full of sick and worried people. Maybe it's awe. Maybe that's what pride was supposed to be in the first place: the awe one feels at participating in something beautiful.
Like author James Maskalyk does currently, my brother used to work at St. Michael's Hospital in Toronto, and although Ken's stress levels certainly decreased when a transfer to our local hospital left him with fewer staff to supervise and essentially no commute, he still has regrets; misses the feeling of participating in the beautiful project that is St. Mike's, surrounded as it is, in Toronto's inner core, with the mentally unstable and the drug-addled and a mandate to never turn anyone away. Maskalyk captures this St. Mike's vibe beautifully, and as he also spends time mentoring at the Black Lion Hospital's nascent ER in Addis Ababa, Maskalyk is able to contrast what emergency medicine looks like in the two systems; the differences in patient complaints and the resources available to address them; the common goal of all doctors to fix bodies, alleviate pain, and allow people to face end of life with dignity. With many emergency interventions described in detail – less sanitized, and therefore, much more real and interesting than you tend to see on televised medical dramas – and many facts inserted about the state of global medicine (including some necessary criticism of well-meaning NGOs), the medical anecdotes are fascinating. Less interesting to me, however, were the personal stories of Maskalyk visiting with his aging grandfather in Northern Alberta – I could see how the personal was meant to graft onto the universal and bring it all together, but as with some jarringly overwritten passages, it just felt too crafted to me; more writerly than the reporterly tone I enjoyed in the other bits. But, that's a personal complaint, and as Maskalyk won the prestigious Hilary Weston Writers' Trust Prize for Nonfiction for Life on the Ground Floor, mine just might be a minority complaint.

In Toronto, Maskalyk's stories focus on excess: people drinking or eating too much, taking drugs and getting into fights; doctors pouring litre after litre of blood into hopeless patients; ordering expensive tests just because they're an available tool and no one pays out of pocket for them:
As cities pile people downtown, as people live longer on more medicines that make more side effects, have more surgeries and more complications, as specialization breaks bodies into smaller and smaller parts, as our population spends more time on screens than outside and grows ever more anxious, there are more people in our ER every day.
By contrast, when Maskalyk travels to Ethiopia, it's a story of need: the goatherd whose vitamin-deficiency leads to nosebleeds, but there's not enough blood or platelets available to transfuse him; family members run to the local pharmacy with the prescriptions from the ER doctors, hoping to be able to return with what their loved ones need; the cables that go missing from the ER's monitors. Mostly, Maskalyk seems to be addressing the need for an ER at all: in conjunction with his mentoring, we watch as the Black Lion graduates its first cohort of emergency medicine residents; with him, hope that some will stay on and pass their expertise and support onto future doctors; that successful outcomes in the ER will prompt the rest of the hospital to regard it as more than the place where the hopeless cases go to die.
Attrition is high. Nurses, security guards, cleaners, all quit with great frequency. The ER is a place where they are sent as punishment, to think about what mistakes they've made among the grieving. Students pass through, a tour of duty to the front lines, grateful to leave the dying behind when their month is up. At home, emergency medicine is one of the most competitive specialties for medical students, and most who apply won't get in. Here, no one knows why you would do it, because it appears that for the sickest, little can be done.
The subtitle for this book is “Letters from the Edge of Emergency Medicine”, and I thought that meant “letters” as in “epistles”. But it's meant as in “the letters of the alphabet”: In a First Aid course, I had learned the ABCs of first response (check the Airway, Breathing, and Circulation), and Maskalyk uses these as the titles of his first three chapters, and then goes on through the alphabet (i.e., F is for flow, K is for Kind, up until XY is for a man [about his grandfather, again] and Z is for ze end), and I just found that too gimmicky for an otherwise serious book. And as an example of what I found overwritten:
The airway isn't a real thing; it's empty space over which a body pulls in wind as breath, then moves it out, vibrating it into cries and words, truths and lies. The hole there, at the vocal cords, is about the width of your smallest finger. I wonder how few of the strangers we pass on the street know this secret, that their entire life depends upon something so small? When it narrows, though, they know, and silent appeal begins. 
Pleasepleasepleaseplease.
Overall, though, this is a very enjoyable read – informative and challenging. It's truly a minor complaint to say that it feels so "crafted" (the doctor dares to write artfully!), and I leave interested to read Maskalyk's first book, Six Months in Sudan, on his time with MSF.





*Won by Life on the Ground Floor. All of these books are worthy finalists, and I learned a lot, but my favourite would be Tomboy Survival Guide as the best written/most eye-opening.
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