Patient Care: Death and Life in the Emergency Room

by Paul Seward

A boy is pulled from a river and brought back to life: Will he be the same child he was? A priest on the verge of a heart attack leaves the hospital to see old friends: Is an evening of reunion worth the risk of death?

Recalling remarkable cases—and people—from a career launched in the first days of the specialty of Emergency Medicine, Dr. Paul Seward leads us in his memoir through suspenseful diagnoses and explorations of anatomy. By his side, we learn to distinguish nursemaid's elbow from a true broken arm. We learn how our breathing and swallowing mechanisms resemble a practical joke.

But when a baby’s heart stops and a young doctor forgets what to do, the situation is far from funny. Within the conditions of great stress and rapid decision-making that are routine in the ER, Dr. Seward shows us that physicians must be more than technicians of the body; they must be restorers of the human. Whether it is comforting anxious family or subjecting a distressed patient to tough procedures—resulting, once, in a patient’s punching our doctor—on every shift, a physician learns the difficult work of caring for strangers.

Yet this is a physician who rejects doctor-as-god narratives. He highlights the essential role of nurses and other colleagues, including a pharmacist whose story is hard to forget. Throughout Patient Care, Dr. Seward reflects on how a life in medicine tests what it means to put ethics into practice.

Genres: Nonfiction, Medical, Medicine, Memoir, Audiobook, Health, Biography Memoir

170 pages, Kindle Edition

First published July 1, 2018

Reviews

[Tucker Almengor · Rating 4 out of 5]

Many thanks to Catapult for sending me a copy in exchange for an honest review

and here I though i didn't have hypochondria

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[India M. Clamp · Rating 4 out of 5]

Die Entscheidung, Arzt zu werden, ist keine leichte Sache. Dr. Paul Seward Antwort auf "Warum“ sollte bald "eingehend und detailliert untersuchen, was ein Mensch wirklich ist. Und dann auf die Implikationen des Gelernten zu reagieren" war eine ungewohnte fremde Reaktion, die jedoch zur Voraussetzung wurde, um Notarzt zu werden. Über einundzwanzig groteske Fälle wird berichtet.

Etwas über Seward offenbart sich in den Fragen, die er stellt. Solche finden sich bei einem Praktiker mit einem scharfen Auge für Details, einem empathischen Modus operandi und seiner Fähigkeit zu wissen, wann das Roboterregime verworfen und eine Lösung angewendet werden muss, die das Ergebnis eines Patienten ohne Pareil und eine Flucht vor dem "Cowboy" -Ansatz bringt - üblich an Notärzte.

"Er war ein Drogendealer, der mit einer Pfeife auf den Kopf getroffen worden war ... der Kopf hatte sich geschlossen und Flüssigkeit gesammelt "Hydrocephalus ", das Kind weinte nicht oder bewegte sich nicht viel."
--- Paul Seward, MD

Demut ist ein bekanntes Leitmotiv, eine ruhige Stimme und ein zugängliches Auftreten, selbst wenn man einen Mann beschreibt, der eine Gartenschere hatte, die feierlich aus seinem Nacken (Mittelpunkt) ragte, als er von einem Mann angegriffen wurde, mit dem er zusammengearbeitet hatte. Vom Schlagen - beim Einsetzen eines Foley bei einem männlichen Patienten - bis zum Schließen der Akte eines 22-jährigen komatösen Patienten, der Straßenarzneimittel verkauft hat (Pre-Attacke), glänzt er. Düster.

[Stacee · Rating 4 out of 5]

I am a huge fan of reading books that are sort of behind the scenes, especially if they’re medical in nature, so I was all over this one. Sadly, it got lost in other review books and I just found it today.

I really enjoyed the format of the book. Each chapter spans a case and it made it able to focus on one story, one patient, and one set of symptoms.

The tone of the book is fantastic. Nothing was too doctor-y and the medical terms were easily explained. Everything was easy to understand and it really felt like sitting in someone’s living room, talking about their day at work.

Overall, it was captivating storytelling about an important and intriguing field.

**Huge thanks to Catapult for providing the arc free of charge**

[Sandy · Rating 4 out of 5]

I’m glad that I listened to an audio of this novel, as some of the medical terms and jargon that was used, I know that I would’ve had a hard time pronouncing had I read the novel. I enjoyed listening to this novel as Dr. Seward recalls his medical practice and he shares stories about working in the ER.

Seward describes some of his most interesting cases that he has had the opportunity to experience in his lifetime. These cases are not always his most successful cases but they’re ones that meant something to him. The novel teaches, the novel shows you what it is like to be on the other side of the table, and the novel shows you the emotions, that are not only one-sided. Great book and a short one also.

[Anita · Rating 4 out of 5]

This memoir details emergency room cases by a long-time doctor. I enjoy reading medical related books, and this one was very interesting, with a variety of different medical problems and interesting patients. It details the illness/procedure without being so technical that the average person can’t understand it. The book also talks about some of the medical ethics doctors must deal with and their own feelings about the cases they treat. A good read if you like medical non-fiction. 4.25/5 stars.

[Maggie Carr · Rating 4 out of 5]

4☆ | published summer 2018 | fans of untold stories of ER

Dr. Seward rejects doctor-as-God narratives to write frankly about moments of failure, and champions the role of his colleagues in health care. And, for all the moral dilemmas here, there is plenty of wit and humor, too. (See the patient who punches the doctor.) Readers of Patient Care will find themselves thinking along with Dr. Seward: “What is the right thing to do? What would I do?”

[Wanda · Rating 4 out of 5]

This memoir, gathered from Dr. Seward’s 40 years as an emergency medicine physician, is thoughtful and well written. Each chapter covers just one patient and focuses as much on the person as on the medical treatment they received. It touches on the ethical dilemmas that sometimes arose and is generous in acknowledging the entire emergency department team. The epilogue, where the author finds himself as a patient in the ED, is in my opinion the best part of the book.

[Laura Trout · Rating 4 out of 5]

I really enjoyed this book. I have been an RN for 30 years in many roles. If all health care providers could be like Dr Seward, emergency rooms would be a far safer and kinder place. He writes in a way anyone can understand and explains in a way I found better than how I taught nursing students.

[Erika · Rating 4 out of 5]

Seward berättar om fall han mött under sitt arbete som läkare på olika akutvårdsavdelningar. Jag som är svag redan för sjukhusserier och tycker att det mesta som gäller människokroppens uppbyggnad och funktion är fascinerande gottade mig åt att han tar sig tid att förklara fakta. Dessutom uppskattar jag åtminstone inledningsvis hans ödmjuka förhållningssätt till sina egna misstag och de sjuksköterskor som hindrat honom från att begå ännu fler – fast mot slutet börjar jag tycka att han drar fram den där ödmjukheten en gång för mycket. Ändå fint att ta del av berättelser om och insikter från akutvården.

[Laura · Rating 4 out of 5]

My favorite genre of book tbh

[Moriah · Rating 2 out of 5]

I listened to this on audiobook. It was okay. I felt like it was relatively repetitive and didn’t seem much like the person cared.

[Dan Stern · Rating 4 out of 5]

Dr. Paul Seward presents his fifty years plus as an emergency room physician with humor and with his expertise in hand. Yes, after so many years, you can usual,y handle with care any problem that is presented. But, it is those previous years, learning on the job, so to speak, but with mentors surrounding you, that your real base begins. Your presence, your attitude, how you interact with the patient and his family makes you the health care professional you are. It is often said that in some cases if you don’t laugh you will cry. In the Emergency Department you do a lot of both. I would sometimes tell my patients that we expect a lot of our patients, sending them home so early post op, but they usually survive. At some point, I explain we may send them home with a kit, with instructions and they can perform their own surgery. Kidding, sure, but with a barbed point. Dr.Seward gives us examples of his patient care, with his own words what each patient went through, how they got to the ED, and how he cared for his patients and families.

Dr. Seward is the kind of physician you want to encounter, Intelligent, caring and with the expertise needed to keep you alive. His stories are rich and filled with his patient and collegial encounters that brings a guffaw or as with his first story, a few tears. His is a profession that can be so rewarding, and at the same time, very sad. Life may slip through his fingers no matter what he does. But, to have this kind of physician with you is every person’s wish. At the same time as a health care professional, we hope for the same kind of care when we present to the ED. I remember waiting for my daughter to arrive in the ED after an auto accident, accompanying her to X-ray and to the scans and then trembling when she was found whole and not in danger. Adrenaline keeps us going until it doesn’t. This is one of the better books on life in the emergency department, told first hand. I hope many people read about Dr Seward’s life in the ED, it will assist you in becoming a better advocate for your own health care.

[Dkettmann · Rating 5 out of 5]

(audiobook version)
Very enjoyable, and easily digested memoir of the many years/decades of Dr Seward's career as an Emergency Medicine Physician. The book is almost exclusively the play-by-play and accounting of care given to many interesting cases that came in to his ED. No fluff on the history of his schooling or personal effects of this stressful job. No sidebar chapter devoted to a reflective and introspective camping trip. And it feels like those things would have dragged it down. It is well compressed in to the interesting bits, and never left me hanging.

It does seem to differ a bit from other peer works in that there are no shootings presented and only one unusual stabbing. No outrageous psych cases nor other near-common tropes of the ED books I've read before. It is kind of nice and gives a less chaotic feel.

Great book, glad I read it. Recommended for fans of the genre.

[Michelle Murphy · Rating 5 out of 5]

I love Seward's writing style - it comes from the heart and feels like he's across the table from me, sharing his stories over a cup of coffee. He's frank in his descriptions and vulnerable (to criticism by some). While describing the emergence of emergency medicine as its own specialty, Seward shares various cases throughout his career which highlight his humanity & compassion, the successes and failures. Ethical questions give you plenty to think about and his style and wit make the reading at times funny, poignant and heart-breaking, while remaining respectful. Ever respectful. When you're a patient in emergency services, it can feel like you're an inanimate object being passed through various tests & procedures which Seward confirms but then he hits upon the magical moment where the object of his attention becomes fully human. A joy to read.

[Kimberly Newcomb · Rating 5 out of 5]

I won Patient Care and I received it on 5/1/2018, I was in between books at the time and started reading it. first story grabbed my attention. Short ER stories and with a family members in medicine and having a little knowledge of the medical field, I could relate to some of the stories, especially the first one and the gentleman in the coma. Wonderful book, just finished it. its a fast quick east read.

[Samuel Thompson · Rating 4 out of 5]

“when your nation, your government, and even your family have all abandoned you, you can still come to the emergency room” (213)

Clever book; well written.

[Ginny · Rating 4 out of 5]

3 1/2 stars

[Michelle · Rating 4 out of 5]

Well told stories of a doctor's experiences in ERs.

[Joanna Taylor Stone · Rating 3 out of 5]

If you are going to narrate an audiobook that includes basic medical terms, please learn how to pronounce them. Every time this narrator said asystole and pronounced it "asis stoli" I almost took a hammer to my phone.

[Diana Mack · Rating 5 out of 5]

dr paul seward recalls his beginnings as a doctor and how he arrived in emergency medicine. he recalls certain cases that are etched in his mind.
I work in the medical field and I enjoy reading about medicine and I enjoy watching medical shows. this book is amazing. dr seward's tone is not of "I am a DOCTOR" but pulls you into what he is seeing and how he will treat it. the stories have good endings and sad endings. one story "nova"; I cannot get it out of my head.
more doctors should follow in dr seward's footsteps in how he approaches people and medicine. it also will help me in my work as I realize that how someone presents is not necessarily what is happening to that person
highly highly recommended

[Dr. Ulrich Aldag · Rating 5 out of 5]

A great book for young people considering to become MDs as well as for all of us.

An unpretentious book that shows what medicine is really all about.
A must-read for any young person who is considering to study medicine, and a reassuring advice for all of us who most likely will end up in an ER once in our lifetime when help is most urgently needed.

[Ed · Rating 3 out of 5]

More like death and some life in the emergency room. I thought it was interesting that the author freely admits to not remembering all the details of some of his experiences. Most of the stories end with his patients dying but Seward tells them in such a way that most of the stories are not sad just a matter of fact.

[Carl · Rating 4 out of 5]

Very straight-forward and compassionate. The episodes provided in the book were all real-world and the author did a very good job in presenting them in a way that held your attention. All medical language was thoroughly explained without being verbose or condescending. I walked away with a renewed appreciation for both the gift and complexity of life and death.

[Lewis Faulkner · Rating 5 out of 5]

Unbelievably wonderful and interesting!

I did not know the author, and I am not someone from the medical field. I selected this book as research material for a novel I am writing. Like one ER patient said to a doctor, “I was terrified *who* you would be,” I was also interested in who the *author* would be. This doctor is exceptionally good at communicating with non-medical people. I would recommend this book to anyone I know. All of the stories used in the book were much more interesting and real than anything I ever saw on TV. And the author had an exception way of telling the stories. If you are looking for a book that will make you go into a medical career, this is it! One story of a drowned child literally brought me to tears. Other stories were funny or puzzles I was trying to figure out as the author told them. Exactly the right length and a phenomenal read!!!

[Lewis Faulkner · Rating 5 out of 5]

I did not know the author, and I am not someone from the medical field. I selected this book as research material for a novel I am writing. Like one ER patient said to a doctor, “I was terrified *who* you would be,” I was also interested in who the *author* would be. This doctor is exceptionally good at communicating with non-medical people. I would recommend this book to anyone I know. All of the stories used in the book were much more interesting and real than anything I ever saw on TV or the movies. I was literally hearing everything the doctor thought and felt I was right there, next to him, seeing the ER procedure--but with cliff notes. And the author had an exception way of telling the stories. If you are looking for a book that will make you go into a medical career, this is it! One story of a drowned child literally brought me to tears. Other stories were funny or puzzles I was trying to figure out as the author told them. Exactly the right length and a phenomenal read!!!

[Antonio Stark · Rating 3 out of 5]

My second book in my deep dive into the world of medicine. Paul Seward is an Emergency Medicine doctor as the field was developing (and was called an ER doctor), and his notes are as thrilling as they are educational. From his journey as a pediatrician occasionally staffing the ER to being involved with ER full-time marks a unique sense of dealing with emergencies and handling life-critical operations at breakneck speed. As I read this book while readying for research about space medicine, I was struck by the level of similarity ER situation will have with conditions in outer space, where respiratory failures, unit breaches, chemical imbalances spreading throughout the body, infections rapidly deteriorating organs are all likely scenarios that must be dealt with limited equipment before the patient could be sent off for specialized care. Highly informative.

[Anna Petrov · Rating 5 out of 5]

This was a good book and Dr. Seward explained the medical jargon well. This was an easy read, I think it took me a little over a week to finish, and I’d definitely read it again. After shadowing in the ED, I was curious about more stories of challenging patients and circumstances. Even though I shadowed for around 4-5 months, I definitely have not seen enough. I would read a book like this again of a clinician sharing HIPAA-friendly stories to prepare possible/future healthcare providers. I also think this would be a good read for someone ignorant to how medicine and the ED operates, even though some stories were from decades ago. The chapter about the baby with anencephaly was rough, and I actually appreciate the dark humor Dr. Seward added in this chapter, it made it easier for me to picture a realistic coping mechanism and conversation among staff members and that patient.

[Lynda · Rating 5 out of 5]

Great stories in this book. As a retired PA, I love reading about medical situations, and this book did not disappoint. Dr. Seward is a compassionate doctor who loves his profession, values ALL his coworkers, and deeply cares for the patient. His stories drew me in and often tugged at my heart. I recommend the book even if medical stories don’t usually interest you because you don’t like blood and gore. That is all carefully and thoughtfully filtered out of these stories without sacrificing the tension of some very dire cases. It’s a quick read and each chapter is different story from the ER.

[Labbylover19732 · Rating 5 out of 5]

should be required reading in medical and nursing schools

I have been a RN >27 years and worked in the Ed for a while . I found this book fascinating in its technical and at the same time, incredibly human approach. The author is very precise in his explanations, as well as presenting the very real human side of ED life. He truly understands the phrase, “In secret to taking care of the patient is caring for the patient”. Thank you, Dr Seward, for your years of caring and service

[Betsy · Rating 3 out of 5]

The author says that he wants to give the reader the true feeling of working in an emergency room. To a certain extent he succeeds. However I suspect that there are long hours of boring ordinary problems like cases of flue or minor injuries. The situations he includes in his book are of the more dramatic sort that do not occur every day. It also seems that he works in a much more efficient and well staffed ER than most of us are accustomed to. For me, at least, waits are measured in hours, not minutes.