Letters from the Edge of Emergency Medicine.
LIFE ON THE GROUND FLOOR
Letters from the Edge of Emergency Medicine.
Review by Herman Silochan
A philosophical treatise, a family
story about a grandfather with virtues and values, our human globe that
connects through pain, hope and loss, medicine is part economics, part
politics, fashionable healing fads, pharmaceuticals call the shots, but in the
end, a simple aspirin- a hundred year old medication - still goes a long way in
a very, very complex world of futuristic monitoring bedside machines.
In the emergency room, you do not
vacillate, putting off decisions, you decide now, it creates a work flow among
subordinates; to delay is to create chaos, you cannot have chaos in triage at
admittance, there are a hundred sufferers waiting in line, no, they are
depending on you, they have surrendered their lives for this diagnostic moment,
they have transferred trust. In pain there is equality, the mighty and the
lowly are in this together.
Doctors and nurses know this; that is
why they appear dispassionate as you tug their white gowns with personal
questions that go beyond the immediate need for quick assessment.
This is as true as the daily flow of
incoming at multiethnic St. Mikes here in Toronto, [possibly the best ER in the
world] or in makeshift emergencies in Addis Ababa in faraway Ethiopia, the
cradle of human kind, where coffee was discovered by a lowly goatherd a
millennia ago, and given to the world.
A funny story here in Addis: Mussolini
wanted to create a new Roman Empire, so in the 1930s, he targeted Libya and a
free land called by Europeans, Abyssinia. The Ethiopians pushed back, kicking
out the Italians, but kept something worthwhile- the espresso machine!
Walk along Queen Street here in
Toronto, to be enticed shop after eatery shop with all sorts of coffee brew, to
be mentally besieged with java exotica.
The same in fashionable Addis Ababa
with a caring culture that never went away in spite of terrible internecine
tribal ideological warfare that also engulfed, enslaved, all of northeastern
Africa. The coffee brew here is out
of this world, accompanied by the musical Amharic language, older than English,
French, Spanish and Italian. The nerve of Europeans to assume superiority. And
yet the poverty is there, access to basic medicine is a waiting game of lines
of desperate, paper wielding sick hopefuls outside the half open gates of their
version of ER, real emergency wards.
A broken collarbone in an inaccessible
tropical village invites rapid deterioration, death waits by the door even as
the family supplicates to the god of Moses, Jesus Christ, the Holy Prophet, twirling
amulets amid tears and hope. The trip to the ER in many African towns is a
journey of a lifetime.
There is a logic in placing the
Emergency Room of hospitals on the ground floor, thus the title of the book.
There is the immediate access, from the streets, the all-important triage which
determines the rapidity of doctors’ availability, trained nurses, many quite
specialized over time, the necessity of security.
After all, if you add to the mix of
incoming, people in all sorts of mental states, some suicidal, some maniacal,
weeping concerned families, the addicted which generally overwhelms the
receiving stations and the returning hypochondriacs. Triage directs to the best
availability, to minimise waiting time, at least here in Canada.
This is the story of James Maskalyk,
Dr. Maskalyk, who divides his time between Toronto’s St. Michael Hospital and
Addis Ababa with MSF, Médicins Sans Frontieres, or, Doctors Without Borders.
You decide if he is a driven adrenalin
rushed man or a modern day humble crusader, a gifted writer with a laptop. The
sparse language of his chapters keeps the reader moving, to see what is next. I
climb on his adrenalin flow.
Maskalyk works in the narrative of his
Ukrainian forebears in the Alberta wilderness, his resilient grandfather with
his treasured trap lines, where skinning a muskrat is an art as well as a joy.
But all the same, rural humanity, life’s meaning, works its way into the
measurement of all things, gives sustenance to the philosophy of healing, that
there is urgency in dealing with near death.
You shoot a moose, you must skin it
immediately, extract the edible parts, you cannot wait for the sorrow of the
dying animal to work its way into the meat. It toughens it. That urgency, the
removal of sorrow is applied to the incoming at ER.
We chat in the lobby at TVO’s offices at Yonge and Eglinton. Very quiet here. Maskalyk had just come out of the Agenda Room where veteran interviewer Steve Paikin had met all the finalists in the RBC Taylor Prize for the best Canadian literary work of nonfiction for 2017. Sorry, he did not win, but still on par with the others.
A
family story for openers. I have a
cousin, a veteran journalist who has reported for the CBC, ABC, CBS and now a
special correspondent for Public Broadcasting. This cousin was present in
Ethiopia to witness the massive famine of 1983-85 where he saw in a valley an
estimated 100,000 people who were about to die. The dreaded Haile Mengistu
Mariam was sorting out his country into friends and foes. It was another 20th
century holocaust. My cousin, as the family tells it, has been permanently affected
by that haunting panoramic scene of death that was still alive. Another version
of the heart of darkness.
How has Dr. Maskalyk been affected, 35
years after that episode, by the 21st century daily incoming of the
sick and abused into mainly makeshift ER wards, in modern Ethiopia and the
Sudan?” A reference to his other acclaimed book –Six Months in Sudan: A young
Doctor in a War-torn Village, published in 2009.
“In East Africa, this is the default world, it looks normal. You become a different person. I will have to reconcile that discrepancy. This is the challenge of our time, people are still dying of war, it is a shame for us.”We talk of Toronto, its ongoing challenge to assist those in need. We talk of Seaton House, about to close, maybe to new and better digs.“Seaton and other places like it houses the socially vulnerable,” Maskalyk says, “we dare not mitigate the consequences, we always need places for healing. If Torontonians can live in multimillion dollar homes, we can afford more Seatons.”
We touch on current medical topics,
those which have direct bearings on all Emergency Rooms in this city, and
throughout the country. Opioids and the legalization of marijuana.
On opioids, “we are mitigating the
consequences of addiction, in order to show that lives do matter, they are not
a betrayal of help, and we deal with this every day in ER. But we must bear in
mind that in Canada, there is a lack of social bond, opioid is something
covering over a wound. This moment is also too painful.”
On Marijuana and its coming legislation,
“I don’t want a stoned population, not used to cover up pain, a relief, users
shouldn’t be criminals, it’s not necessary, what we want is an intelligent
conversation, to enjoy its benefits.”
We close. “I want honesty in
medication, of what is valuable in the act of giving, in pharmaceuticals, its
only designated purpose is of helping people.
“Yes, I am overdue to visit my
grandfather in Alberta.”
February 2018.
James Maskalyk, M.D. Doubleday Canada 2017
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