Something for the Pain: Compassion and Burnout in the ER

by Paul Austin

"A stunning account of the chaos of the emergency room." ― Boston Globe In this eye-opening account of life in the ER, Paul Austin recalls how the daily grind of long, erratic shifts and endless hordes of patients with sad stories sent him down a path of bitterness and cynicism. Gritty, powerful, and ultimately redemptive, Something for the Pain is a revealing glimpse into the fragility of compassion and sanity in the industrial setting of today’s hospitals.

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

304 pages, Paperback

First published October 21, 2009

About the author

Paul Austin was named a 2007 tuition scholar at the Bread Loaf Writers' Conference. A former firefighter, he has more than twenty-five years of experience working in emergency rooms. He lives in Durham, North Carolina.

This Paul Austin is not the same Paul Austin who wrote, "Return of the Lost One," or who co-wrote "I Am a Woman." If anyone knows how to remove these titles from my profile, please let me know.

Reviews

[Leigh-ann · Rating 2 out of 5]

I was surprised at how many people seemed to love this book, when I really didn't like it much at all. I'd describe it as an ER doctor's journey from being a huge jerk to being slightly less of a jerk. As one example, the author complains about his inability to sleep at home during the daytime, growing ever more furious with his young children for having the audacity to laugh or watch TV. He also complains about tossing and turning because the room isn't dark enough. You'd think the guy would be smart enough to buy an eye mask and a cheap pair of earplugs, but no, he almost resorts to child abuse because he's sleep-deprived, and eventually chooses to sleep in a hotel. I have to sleep during the daytime, and I have a houseful of dogs, cats, and chatty parrots. I have a $20 eye mask from Sharper Image and a $2 package of earplugs from Target, and I sleep like a baby. I guess that makes me smart enough to be Chief of Surgery.

[Chris · Rating 5 out of 5]

A candid, deeply moving glimpse into the life of an ER doctor -- as well as a dad and a spouse. When I'm next in an ER, I hope I have a physician as kind and wise and empathetic as Paul Austin.

[Mazola1 · Rating 4 out of 5]

Something for the Pain is basically a collection of essays about the author's experiences as an emergency room doctor. They deal with not only the expected horrible traumas and tragedies of the emergency room seen by Austin, but also with his struggles to combine family with the often overwhelming demands of his job. What emerges is a picture of a real human being, with strenghts and weaknesses shown. Some of Dr. Austin's stories show him at his best, while others reveal mean, petty or uncaring aspects of himself. The book is interesting and fast paced, and Dr. Autin's selection of which stories and incidents to tell is pitch perfect.

[Laura · Rating 4 out of 5]

In the first half of this book, I craved more in-depth stories from the ER and the medical terms and processes that go along with each case. It was what I had expected from the title, and of course my medical interest run deep. But by the end, I came to really appreciate the book as a memoir of a man's life rather than just his career.

On a personal note, the fact that the author chose to go back to college after several years of hiatus and a variety of fairly unrelated jobs and pursue a medical career is quite inspiring to me. With a bachelor's degree and an interest in the health field, it gives me hope that over the next couple years I will come to the point in my life where I will finally pursue that master's and end up with a fast-paced, enriching, stressful, humbling, and fulfilling job.

[Sue · Rating 3 out of 5]

Among the comments on the back of this book is one by a physician who is also an assistant professor of emergency medicine. She states, "If you are considering a career in emergency medicine, you must read this book." I believe that is probably excellent advice. I would add that, if you think you might end up in an ER someday being treated by someone who has made a career of emergency medicine, you should also read this book.

Dr. Austin's writing is simple and straight forward, and he is honest about the incredible toll -- both physical and emotional -- that a lifetime of work in an emergency room takes. The hectic pace, the erratic schedule, the chronic sleep deprivation, the grinding responsibility -- all play havoc with a doctor's physical health, mental stability, and personal relationships. I, for one, could NEVER be an ER doc, even assuming I could master the academic challenges of medicine. I plan to remember this the next time I -- God forbid -- find myself in the ER, and I will THANK that doctor for being willing to put up with it all!

[❦. · Rating 3 out of 5]

I thought this was an interesting book.

I don't work in a medical field but compassion / empathy burn out can be found in any job serving the public and I thought that was interesting. I don't read a lot of non-fiction but I find loss of compassion and empathy to be something that's not discussed enough and I like that this tried to bring it to the table to be talked about. The writing style is very good and it didn't read dry like other non-fiction books. I appreciated that.

[Wealhtheow · Rating 3 out of 5]

Dr. Paul Austin's account of his years in the ER. He mixes tales of patients and treatment in the ER with his own struggles with stress, shift work, and family troubles. I expected this book to have a lot more self-aggrandizing or guilt trips in it, but Austin comes across as very thoughtful, able to laugh at himself, be patient with others, and note his own strengths and weaknesses.

[lola · Rating 4 out of 5]

This is the most human doctor book I've ever read. This is high praise not only because I have read almost every g-damn doctor book out there, because those people are usually flesh-colored robots who can't write for shit.

In this memoir, Paul Austin curses, loses it, lusts after his wife, and beautifully communicates the trajectory of an ER doctor, from training to practice, focusing on how to maintain compassion (sanity) in the face of the meat grinder that is shift work in medicine. He also cracked me up a lot.

I'm glad I read it right after Pauline Chen's Final Exam, because they're two great tastes that taste great together. Final Exam is the theory, and Something for the Pain is the practice.

[Bodega · Rating 5 out of 5]

As a junior doctor who has just finished rotating through the emergency department, this book is pretty much spot on. The rotating shift work placed a huge toll on my body and routine is something I have found myself constantly yearning for. I noticed some of my behaviours mirroring that of Paul Austin, and found great strength and support in reading about a more experienced doctor's experiences. The book made me appreciate getting over night shifts in a more well-rounded way and taking control of my basic need for sleep and relaxation in my downtime. I also enjoyed reading about the way Dr Austin interacted with paediatric patients. I used his play technique after reading the chapter, and have found my paediatric examinations are now far smoother and more entertaining for me, the parent and patient. Overall, even though my work in the ED pales to the duration of Dr Austin, I thought it was excellent and very representative on my experience so far. I'd highly recommend it to all doctors rotating through the ED who are grappling with the discomfort of shift work.

[Tim Dees · Rating 5 out of 5]

This is a very frank account of an emergency room doctor in a medium-size city in the South. He described his path to becoming a physician, some both humorous and tragic ER cases, and the difficulty physicians of all specialties have with balancing home and professional life.

ER does have a mixed bag of professional complications. They generally work defined shifts, so when they're off duty, there's no after-hours call or hospital rounds to make. That is offset with the need to work extended and/or overnight shifts, which lead to disrupted sleep patterns and interference with home life.

[Donna McCaul Thibodeau · Rating 5 out of 5]

I really enjoyed this book. It's written by Dr. Paul Austin about his experiences as he trained and then became an ER doctor. He's very honest and shows both the good and the bad. Very well written, I read it in one sitting. If I ever end up in the ER, I hope I'm lucky enough to have a doctor like this one.

[Linus Williams · Rating 5 out of 5]

Dr. Austin doesn't pull any punches in this memoir of life in the ER. He details how his schedule and the patients he encounters affects his life at home and his own mental health. ER medicine is a tough specialty and Dr. Austin brings it to life very vividly. Highly recommend for those who want to get a taste of the ER through somebody else's eyes.

[Jarrad]

Well written description of the realities of working as an emergency physician. The pleasure of figuring out a difficult diagnosis and the despair of having your entire life screwed up by your schedule. The title of "Compassion and Burnout in the ER" is very apt, as it explores both very well.

[Mish · Rating 5 out of 5]

An incredibly open, and honest look at life in the ER--and how that work, and that schedule, affects your life, from a doctor who lived it.

Incredibly brutal, honest, but also clear. The life is not for everyone.

[Sheryl · Rating 5 out of 5]

Great Read!

[Sue · Rating 4 out of 5]

I've read several physician memoirs (mostly, many years ago), but I don't remember one from an ER physician. His memoir skillfully conveyed the pressure of the ER, the stresses on his personal life, & how he changed & matured over the years. I found it quite gripping.

[Beth · Rating 3 out of 5]

3 and a half stars. I have a better appreciation and understanding of how an ER works. I enjoyed this author's writing style.

[Convenience Store Person · Rating 4 out of 5]

A quick read and an interesting account of the complexities of life in and out of the Emergency Room. Paul Austin does a great job of capturing the emotional turmoil that is inherent in working in a medical setting that continuously deals with life or death decisions as well as a constantly shifting emotional environment. The book is classified as a memoir (something I hadn't realized when I first picked it up) and though I wished he had focused more on the problems within the medical setting, I realized it was impossible to truly encapsulate the stress of working in an ER without also recounting the pressures of home life and balancing work with personal endeavours.

The chapter titles give very clear indications as to what the next section will be talking about and I found the book to be compulsively readable - it was easy to simply keep chewing through the next chapter until the book was done. While this is a subjective account as to the chaos of the ER, I'd recommend this to anyone interested in taking a glimpse into the daily insanity of the field of emergency medicine.

[Allison · Rating 4 out of 5]

This is a combination personal narrative of the life of author Paul Austin and a behind-the-scenes look at a busy ER. Either one would have been enough for a fascinating book, but somehow combining the two diluted the power of each. A college dropout who went on to become a carpenter and firefighter before returning to school and eventually becoming a doctor, Austin is also a good writer. I found myself intrigued by all the facets of his life and just wished the narrative of his life had gone into greater depth. I felt the same way about his presentation of tales in the ER. Every time he got into a compelling story, his shift was over and he was heading home. Frankly he spent more time complaining about his lack of sleep and searching for the perfect bedtime routine than he did on any medical drama.
Not a bad book, but it could have been so much more.

[Brooke || FindingMyFavoriteBook · Rating 5 out of 5]

As I read this book, I felt like I was on another shift in the ER. Probably not what I would typically look forward to on a day off, to be back in the ER...but those of us who work there will appreciate the draw we have to patients who need our help. We can’t help it.

I loved Paul Austin’s story of the ER. I found myself saying, “Yep. Been there. Heard that. Done that. Had a patient just like that. Felt the same burnout. Felt the same joy in a save...felt the same heartbreak in a loss.”

If you want to know what it feels like to work in an ER, read this book. If you are a family member of an ER provider and want to understand why this person comes home every shift drained, tired, unable to make simple decisions, grouchy or withdrawn...read this book. If you are an ER provider yourself...read this book. Because you will know you are not alone!

[Christina King · Rating 4 out of 5]

Moving and gentle view into the world of emergency doctors

I’ve read a few of these, and have laughed with brittleness at the sometimes dark humor this clinical arena inspires. It was a relief to read this book...calm, soothing, like that cool salve you place on a raw wound. The emotions are real, honest, and visceral...but not in a gut-wrenching way. It’s more a gentle exposure of the clinician’s heart, acknowledging what we feel and making space for both compassion and compartmentalization. Thank you.

[Dan Stern · Rating 4 out of 5]

This book was an excellent, honest account of the struggles of an ER resident, and doctor. Dr. Austin hits the nail on the head with his tales of late nights, losses felt, and the ebb and flow of the emergency room. Unlike Gray's Anatomy or ER, he tells the true side of what really goes on at 3 am on a Tuesday. He addresses grief, anger and loss, and his frustrations with himself. I loved this book and I think it was a very well-written, candid look into his interesting life, both personally and professionally, and how the two were impossibly intertwined.
One person found this helpful

[Bobbe · Rating 5 out of 5]

I loved this book. Paul Austin does a remarkable job describing the pressures of the medical life focused on ER rotating shifts and finding the balance between focus (especially sleep deprived), medical decision-making, and compassion. Each chapter is an anecdote. Each is engaging and compelling. Having worked as an RN and experienced many of the emotions Austin describes, this book resonated with me. I believe Chris Bojahlian referenced it in his credits in The Red Lotus, which is how I found it.

[Abby · Rating 4 out of 5]

While at times I didn't enjoy his writing style, his words made me feel something. While I am no where near a doctor, I have felt many of the emotions he shared in the acute setting. We have all seen the various toll the emergency setting takes on those trying to help people. We often sacrifice our own wellbeing for others which inevitably leads to broken relationships and poor lifestyle choices. But we keep showing back up, because we can't stop. Everyone in the emergency rooms should be celebrated and thanked for the time spent in a windowless dungeon absorbed in other people's worst days.

[Nancy Guess · Rating 5 out of 5]

Read it in a day

The first few pages are fraught with typos and I cringed, but that was the last of those and the book took off. Very interesting and informative. I have spent more hours in the ER lately with my elderly parents than I have ever dreamed. I wanted to get an insight to the workings. Job well-done. I wish Dr Austin and his family the best. This book is worth the read.

[Jamey Mast · Rating 5 out of 5]

Well written insight into a world many of never want to enter.

A great read I could not put it down. Made me think about how much we rely on our drs to make the right choices and make it all go away. Some times we need to remember we need to help them help us and remember to tell thank you great job even when we think they are wrong.

[Corinne · Rating 4 out of 5]

As a nuclear medicine technologist, I know all too well about trying to work and not make mistakes after spending all night being called in on various ER cases. It's a bit scary to hear how sleep deprived some docs are - and they're treating patients - you and me. The book is well written, interesting and a quick read.

[Pancha · Rating 2 out of 5]

Meh, it was ok. What I really want is case studies with a dash of memoir, and this was memoir with a bit of medicine.

[RachaelStarrReads · Rating 5 out of 5]

I work in ER registration, and read this during a rare, slow night shift. Great read!

[Maya Assaf · Rating 4 out of 5]

I'd give this a solid 3.75 stars.

I think Paul was incredibly vulnerable, showing the sides that burnout can create in you and at the effect that had on his family, and own mental wellbeing.

This book did not go the route I expected. I had anticipated a greater emphasis on the emergency room, patient interactions, crazy medical situations, interesting stories, etc. But this is much more of a memoir, with the ER in background of this doctors life. He speaks to his experiences in medical school, residency, and the beginning of his career and development of his family.

For me, the most interesting part of this book was his discussion on empathy and compassion, and how changing the porosity of your empathy makes you an effective healthcare worker in an emergency setting. When there is a 7-year old drowning victim on the table, thready pulse, walking the line between death and life, you cannot view them as a person. if you allow yourself to feel the enormity of the child dying in front of you, you'll freeze. You can't make any decisions.
You have to view it as an airway, because we know how to manage an airway. Then breathing, circulation, etc.

It's sounds cold, and is certainly a shock, but to work in an ER one has to develop the skill to learn how (and when) to stop processing people as human so you can save their lives. Then, in a different setting you can open that empathy porosity, like the aperture of a camera, and show kindness in a situation when it is needed.

I somewhat read this in preparation for my transition to becoming an ER nurse, partially because I found it in the thrift store. Definitely has some good pearls, not technical at all, and Paul has had a nuanced life. I would definitely read his other book if I could find it.