The Blood of Strangers: true stories from the emergency room

Frank Huyler<em> Fourth Estate, 182pp

Most of the doctors I know are keen to dismiss the notion that they ever went into medicine with the idea of serving humanity, of making a difference. What attracted them, they claim, was the power, the money, the nurses, the selfish euphoria of being able to save lives, rather than saving lives for the sake of it. But I don't really believe them. I prefer to imagine that they have gone into medicine with the purest of intentions, but that they have been altered by the difficulty of their experiences: too many unanswered and unanswerable questions, too many arguments over funding, too many deaths, too little sleep, too much pain and despair, and an incremental but inevitable acknowledgement of their powerlessness.

Such an optimistic belief is borne out by these 28 intense vignettes from the emergency rooms and intensive care units of Albuquerque, New Mexico. Roughly chronological, they chart the early years of Huyler's medical career, from his time as a student through his internship and first experiences as a fully qualified doctor. In the early stories, there is an obvious feeling for, and involvement with, his patients, but this gradually recedes. By the last story, his compassion is fully fatigued.

And it is no wonder that his emotions get sterilised and put away, given what he has to deal with. Patients in apparently good health take a sudden turn for the worse, deteriorate and die. Another, "as nearly dead as a human being can be" and receiving the most confused type of care, makes a complete recovery. Then there are the dying children, the grieving relatives, the smell of decay, sleeplessness, the daily, hourly, exposure to events and circumstances that most of us have to deal with once or twice in a lifetime. It's enough to drive the physicians mad, and it does. One commits suicide; another murders his boyfriend. A neurosurgeon resorts to drugs, witchcraft and promiscuity.

Huyler's release valve is to write about it all, and we should be glad that he does, for this is an excellent collection. Unsentimental, wry, pared-down and self-critical, The Blood of Strangers is billed as a series of true stories, but the tone and style owe more to high-quality fiction than to reportage or diary writing. He chooses his descriptions and similes with surgical accuracy: "his head, the bones of his skull, felt loose, like gravel and warm bread" and "each mechanical breath filled his right lung, with a faint whooshing sound, like feathers brushed across a rough surface".

As small slices of life (or death), these stories work well enough on their own, but are best read together, as they become more than the sum of their parts. Huyler builds a picture of the emergency room and its shifting cast of characters as a lurid, claustrophobic setting, and his infrequent forays out of it - to see a film, to sleep, to recall his childhood in Brazil - allow us welcome breaths of untainted air. In this forsaken world, all that can be relied on is the rational order of surgical procedure and medical protocol. We come to understand that we cannot expect a doctor to care about his patients, and that it doesn't matter so long as he cares about his job - the joy of inserting a needle into the chest cavity and watching a collapsed lung expand into the space, or the cold satisfaction of making a perfect row of stitches across a man's face, even if he is already dead.

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