Emergency Doctor: Terrifying, Tragic, and Triumphant Stories from Bellevue's Legendary ER

by Edward Ziegler

Hundreds of people slam through its doors every gun-shot cops, battered kids, drug addicts, and suicides, destitute drunks, homeless people, AIDS sufferers, and accident victims. It's a bizarre parade of humanity looking for help -- in the one place they know they can find it. Welcome to the frontline trenches of the emergency room of the legendary Bellevue Hospital. Here, an army of doctors and nurses faces the onslaught of young and old, rich and ragged, sick and dying. All day, all night. All year.This is their story -- an around-the-clock drama of the a crane falling on a hapless pedestrian; a crazed executive wearing two-thirds of a three-piece suit; a pretty paralegal aide struggling with an on-the-job cocaine overdose; a trauma victim of an East River helicopter crash clinging to life. It's terrifying, tragic, triumphant ... and true.

Genres: Medicine, Medical, Nonfiction, Memoir, Health Care, Science, Health

384 pages, Paperback

First published January 1, 1987

Reviews

[Chris · Rating 2 out of 5]

2.5 stars. Better suited for those without any background in health care, too much explanation of what acronyms stand for, lab tests, disease pathology etc. that a health care professional would already know. It slows down the reading of some interesting cases and a peek into what an urban ED dealt with in the 1980's and I must admit much is still unfortunately seen in the world of the urban ED with less & less access to care, increased poverty & homelessness and the violence that often occurs in our inner cities. However, much is quite dated, if you want a look at the functioning, cases and treatment in a more contemporary urban ED, I recommend viewing The Pitt.
I did love the way Dr. Goldfrank (the collaborator on the book) emphasized the need to be patient-focused no matter their background or ability to pay. Ziegler often chose cases to discuss that highlighted the expert & painstaking work Dr. Goldfrank did in the area of toxicology. Many of the chapters grouped topics or types of illnesses or injuries together. There are some things we still do today in the education and training realm such as required classes in ATLS, ACLS, PALS and "moulage day" to keep people's skills up to date.
Also, this was written in the era of the HIV/AIDS epidemic. The initial responses to managing those with AIDS is reminiscent of how we responded to COVID, another unknown virus when it first appeared.
There is an afterword in this paperback edition that was written in 2004 that touches on some changes in patient management but focused more on the much-needed renovation in the ED and the long-awaited for establishment of an Emergency Medicine residency program.

[Claudia · Rating 2 out of 5]

This book was on my Amazon wishlist and I got it for Christmas. I just got around to reading it this summer, and I fully expected to zip through it, devouring story after story that reminded me of my career in Emergency Medicine. I. Was. Wrong. I had to force myself to keep reading. There was so much back story that I really got bogged down in the biographical, geographical, historical, and medical details (that I already knew). This book would be good if you are a non-insider (for want of a better term) to emergency medicine/medical services. 

There were lots of cases mentioned, but few were followed through their entire course of treatment in the Emergency Department (ED - the preferred term for what was previously called the ER or Emergency ROOM). Most of the cases mentioned were just a stepping off point for the history of that disorder, or it's treatment, or the social implications thereof. Don't get me wrong, all of those things are interesting and important, but they weren't what I got this book hoping I would find. Honestly, I wanted to work (vicariously) again.

Many of the issues that plagued Bellevue in the 80s (the setting of this book) are still issues faced in EDs today: homelessness, overuse by "frequent flyers", poor continuity of care, lack of primary care (using the ED as primary care), IV drug use, alcoholism. One issue that was paramount in the 80s was AIDS. HIV is still ever present, but it is no longer the death sentence that it was in the days when emaciated patients presented with Kaposi's Sarcoma and Pneumocystis pneumonia. Now, thanks to antiretroviral therapy, HIV doesn't necessarily turn into AIDS, and HIV has become more of a chronic illness that is managed by a lifetime of medication and less of a sentence to certain, premature death. "With appropriate treatment, a 20-year-old with HIV infection can expect to live to reach 71 years of age." (https://www.medicinenet.com/hiv_treat...)

The book reminded me how much has changed in 35+ years...what Emergency Medicine was like way back when...cassettes in Dictaphones, paper charts, lack of EMTALA (Emergency Medical Treatment and Active Labor Act, passed in 1986) laws to keep patients from being 'dumped'. MAST (Military Anti Shock Trousers) pants, KEDs (Kendricks Extracation Device), and air splints have all gone the way of the dinosaur.

Goldfrank quotes Hippocrates: "Discussing money before caring for the sick lacks propriety." Yet he fears that "financial triage" is already eroding medical ethics and leading some to forget that "the health providers' responsibility is above all the health of the patient." (p.184)

Emergency Doctor also reminded me how far EMS has come in the 35+ years since this book was written. One scene describes a man who attempted suicide by jumping from a wall on the Brooklyn Bridge, landing on a taxi driving below. His condition is described: "He was still breathing even though his back appeared to be shattered. To try to insert a tube into his throat would risk doing further injury because that would mean moving the neck. Doubtless that would reduce whatever slight chance for survival he had. But it was clear from the gross injuries to his cervical spine that it would be impossible to make an adequate assessment of his airway in the field. About all that could be done was to place an oxygen mask over his mouth and nose and rush him to Bellevue." (p.188) As a medic, that made me cringe. Although the outcome would likely be the same in this case (death), ignoring a compromised airway because one can't intubate without c-spine injury is anathema. First, there's the ABCD's:Airway, Breathing, Circulation, Disability...in that order of priority. Second, we can intubate without further injury to the c-spine by using certain techniques. Third, medics can now do what was ultimately done at Bellevue for this patient: perform a cricothyrotomy (a "cric" in EMS slang) where the persons' throat is incised and a tube is inserted through the incision into the trachea. "Scoop and run" might have merit in the urban setting where the trauma center is a mere blocks away (by Google Maps estimation it is 15 minutes from the Brooklyn Bridge to Bellevue) but in most situations, 15 minutes of a compromised airway=probable brain death.  

Some things in the book are only foreshadowings of problems we deal with now. Back then, it was DRGs (Diagnostic Related Groups) and HMOs (Health Maintenance Organizations) that threatened to reduce patients to numbers, rather than people who are sick. Now there are many more gatekeepers practicing medicine without a license. Chief among them are insurers (#Anthem, I'm looking at you), who feel they can deem (after the fact) what was or was not an emergency, thereby denying payment. So the person with chest pain waits to go to the ED because "it might not be a heart attack and insurance might not pay" and then dies because it WAS indeed a heart attack. (https://www.healthleadersmedia.com/fi...)

Overall, I think Emergency Doctor is aimed at the layperson in the 1908s, not a medical professional in 2018. Time to retire, doctor.

[AJ Payne · Rating 3 out of 5]

It took me a very long time to read this book (about two months or so). Not for lack of interest, but for some reason I couldn't just lose myself in it the way I like to.

I found it quite good, and very interesting. Since it was published 25 years ago I found the perspective on emergency medicine and treating the poor to be interesting, and a lot of it is likely the same. I also thought the passages on HIV/AIDS were fascinating, especially when there was hopeful optimism that AZT drug trials would work and the drug would be put on the market for AIDS patients. It is sometimes strange to remember that true therapy for AIDS isn't very old.

So, I liked this book, and definitely learned a lot from it, but I didn't like it as much as I wanted to. Though, I am more motivated to read the other books I have on my to-read lists that are about, or take place in, Bellevue. I also enjoyed the perspective shared on drug abuse, alcoholism, and the poor (which were overwhelmingly the issues treated in the Bellevue emergency room in the book).

I do recommend it as a primer and interesting look into the early days of a separate field of emergency medicine. Sort of a precursor to the show ER.

[Pablo · Rating 5 out of 5]

Cientos de personas acuden a sus puertas cada día: heridos de bala, adictos, suicidas, personas sin hogar, y más. Es el destino de los que buscan ayuda, y quizás ese sea el único lugar donde pueden encontrarla: La sala de emergencias del legendario Hospital Bellevue de New York, donde un ejército de médicos, enfermeras y diversos miembros de su staff lo ven todo, día tras día, noche tras noche, los 365 días del año.
En Bellevue las luces nunca se apagan y no se hacen diferencias a la hora de atender a cualquier usuario; tampoco se les cobra ningún ticket, análisis y/o estudio.
Es la línea de fuego en donde las exigencias del mundo médico son muy altas para mantenerse alerta ante cualquier eventualidad.
--
En este libro, Edward Ziegler nos cuenta el día a día del Dr. Lewis R. Goldfrank, director del departamento de Emergencias en Bellevue desde 1979 y autor de diversos títulos académicos sobre el tema.
A través de las páginas vamos conociendo al staff, sus historias e inquietudes, así como también muchísimas anécdotas acerca de pacientes que han pasado por allí y que han quedado en la memoria colectiva de todo el personal.
El libro también contiene diversos ejemplos de cómo se maneja un departamento de emergencias, así como también principios y reglas a aplicar ante cualquier peligro o amenaza (Algo que Goldfrank sabe bien puesto que ha sido uno de los pioneros de la Medicina especializada en Emergencias en el mundo y también el creador del postgrado en esta área en Estados Unidos).
Honestamente, me ha parecido un libro muy bueno. Ya desde el principio me di cuenta de que realmente me iba a gustar, puesto que arranca con un ritmo frenético, como si fuese una serie de TV del estilo ER, Chicago Hope o House ( Hay variados capítulos en donde se mencionan patologías raras que me recordaron a esta última serie).
La historia de cómo Goldfrank llegó a ser médico también es más que interesante. Comenzó en los Estados Unidos pero pronto abandonó porque el paradigma médico que se impartía en aquella época no concordaba con la visión que el tenia acerca de la profesión y, cuando ya casi había decidido no seguir, unos amigos de su padre le recomendaron irse a estudiar a Bruselas en la mejor universidad pública de aquél país.
Casi sin pensarlo se fue con sus dos hijos y esposa a un lugar extraño, teniendo que aprender un idioma que casi ni hablaba.
Terminó su carrera allá y también su esposa (Ambos trabajando en empleos de medio tiempo) para luego trasladarse a NY a finalizar su rotación. Ahí fue donde descubrió su amor por la medicina de Urgencias y se decidió a convertir al departamento de Emergencias donde dio sus primeros pasos como médico en el más eficaz, siempre comprometido al cuidado del usuario ante todo lo demás.
--

Son cinco estrellas para mí. El desarrollo y exigencia de la Medicina de Emergencias me parece algo admirable para quienes dieron los primeros pasos dentro de esta especialidad para poder profesionalizarla, a principio de los años 70.
Las salas de Emergencia son lugares que hasta en la actualidad siguen sin tener el reconocimiento que merecen dentro de la comunidad médica pero que los usuarios debemos valorar muchísimo, pues allí se encuentran personas que dejan casi todo el tiempo de su día y su vida por el bienestar de los usuarios.
Lo recomendaría como inspiración para estudiantes de medicina, o también para cualquier persona que quiera conocer la intrahistoria de las Salas de Emergencia.

[Janette · Rating 2 out of 5]

This was a long book with a font that was on the small side, so not exactly the kind of "friendly" books I prefer. It had a little bit of interesting information, but was largely a slog to read in spite of my interest in medicine and--especially--Emergency Medicine. Ziegler's experience as a Reader's Digest editor was extremely evident in writing that was often flowery and bloated, rather than to-the-point. Had Ziegler had a better editor, the book probably could have been about 1/3 shorter. It was also written in the '80s and, even with an afterward benned in 2004, it was still quite dated. But the biggest flaw for me was the book's leftist slant. The bias was mostly subtle so didn't fully raise its ugly head until the final few chapters, but it was very offputting and seemed like a total copout. I mean, it's always easier to blame everyone else for the problems one's city is facing than it is to blame oneself for voting decisions and their inevitable outcomes, right? So the authors conveyed an air of supercillious hypocrisy that I found hard to take. In conjunction with the generally poor writing, it wasn't a particularly enjoyable read.

[Kait Schultz · Rating 1 out of 5]

I love learning the inner workings of hospitals and have loved reading other medical drama non fiction books but this one sucks. It has been on my bedside table for months consistently putting me to sleep within 3 pages for all that time.

It was written in the 1980’s and boy has it aged terribly. The author makes racist, transphobic, homophobic, fat phobic, and xenophobic remarks throughout the book. Some may be a testament to the time but boy clean up your act! My copy was an issued reprint in the early 2000s and they didn’t fix all the terrible accounts and comments of diverse patients. Harper Collins editors and publishers, let’s step it up.

Besides the rampant ‘phobic’ remarks the book was simply slow and tried to cover too many issues and patients. I would have enjoyed a deep dive into a few stories instead.

The only reason I finished this book was because I am sick, bored, and stubborn.

[Hajar ih]

يأتي مئات المرضى يومياً إلى قسم الطوارئ، تتنوع الحالات فتجد بعضهم نتيجة حادث سيارة، إطلاق نار، محاولة انتحار ومحاولة أخذ جرعة مخدرة.

مرحباً بك في الخط الأول في المستشفى: غرفة الطوارئ، حيث الغرفة التي لا تغلق في جميع أيام السنة وساعاتها ودقائقها. يحكي الكتاب صعوبة تخصص طب الطوارئ وعن الأحداث التي يواجها الطبيب يومياً

[Ryan · Rating 5 out of 5]

I thought the book was mentally stimulating--providing a future doctor with a background to disease and illnesses that most other books don't go into. I also liked many of the stories and found them to be deep into the social problems as well as the physical.

[Matt · Rating 3 out of 5]

Fun read. I liked taking a break from med school textbooks and getting a better glimpse of the challenges and enjoyments of being a practicing physician. It got repetitive and less captivating after a while for me, hence only 3 stars.

[Rook · Rating 4 out of 5]

3.5

[Eric Bias · Rating 4 out of 5]

A little slow to start, but I eventually got really into it. Would recommend!

[Sharon Burke · Rating 5 out of 5]

excellent perspective about the ER experience - exciting stories

[Logan Webster · Rating 3 out of 5]

Interesting

[Mari · Rating 4 out of 5]

A thouroughly enjoyable read! This book, unlike all the other doctor books I've read (I think) is co-authored and therefore written in third person. While Dr. Goldfrank is the "main character," the book also follows other doctors and nurses at Bellevue. I never appreciated what an incredible place Bellevue is until reading this -- generally, the only time I ever hear of it is on Law & Order, talking about the psych ward. But what clearly emerges from this book is that the caliber of care is extraordinary, for whomever comes through the doors, regardless of whether they can pay. It could stand an update; this is particularly clear in the chapter discussing HIV/AIDS (though there is an afterward, written after 9/11). Also, only one of the thirty-some chapters discusses children and some of the terrible situations that the ED sees. But overall, great stories, about everything imaginable, and characters portrayed as genuine and caring individuals. Highly recommended.

[Yoursexylibrarian · Rating 4 out of 5]

I thought this book would be more like the ER shows on TV. It's not at all like that. The author starts out very slow, giving much background on how emergency medicine first emerged at Bellevue and the background of Dr. Goldfrank, who is considered the father of emergency medicine as we know it today. This book is worth the reader's efforts. My favorite part of the book is the chapter about how the AIDS virus was initially discovered and how those patients were first treated; this was eye-opening and completed the history of HIV for me. This book is not a quick light read for the beach. Best save this book for the snowy days of winter or for a sleepless night.

[Kailyn · Rating 2 out of 5]

This book wasn’t bad but it wasn’t great either. I enjoyed the patients and their cases but I found myself bored which lead to skipping a few pages here and there. I don’t care why the author became a doctor or where he went to school. I don’t care to hear about your mother, father, wife, or children either. I’m nosey and I just wanna read about the nonsense that goes on in the emergency room, that’s all. The author rambled unnecessarily. This book could’ve been 100 pages shorter without all the “fluff”. I didn’t find it particularly enjoyable to read as it kinda has me in a reading slump.

[T0 · Rating 2 out of 5]

A bit outdated, the books stories stem from 80's. I found it a bit laborious to read, with plenty of descriptions of mundane tasks and conversations. The book has some kind of educational features, of topics such as a aggressive hypersensitivity reaction known as anaphylactic shock and other conditions encountered at ER.

[Hannah · Rating 4 out of 5]

Fast-paced to the point of being dizzying, Emergency Doctor slams you into the midst of the bustling Bellevue emergency department in New York in the 80's. It was eye opening to realize more of the extreme dynamics that go into emergency medicine, and chilling to see how some of the current issues American health care is facing were foreshadowed twenty years ago.

[Rahul · Rating 5 out of 5]

Great description of the profession of emergency medicine. The stories really make the reader think about the U.S. healthcare system (although it has changed since this book was published). Also cool were the tidbits of medical/clinical knowledge thrown in there to make the stories clearer. Would definitely recommend for pre-medical, or even current medical, students.

[Heidi · Rating 2 out of 5]

I hate to do this but I could not even finish this book. I am really into any medical nonfiction book I can get my hands on but this one was really lacking any great moments. Not one of the good medical books out there (coming from a medical student).

[Haven · Rating 4 out of 5]

Very interesting. Written from the perspective of one of the top trauma/poison control M.D's in the country.

[Giselle · Rating 4 out of 5]

The book reminds me of how to saves lives. Thumbs up to all doctors and to all health care providers including me! KUDOS!!!!. :D

[Kaysee Leong · Rating 2 out of 5]

A laborious read but contains valuable insight to the ER and the different toxic (e.g. Alcohol, drugs) in our everyday lives. Especially enjoyed the chapter on homeless people