Any patient who approaches the triage desk of an emergency wants to know two things. The first is pragmatic: "How long." The second is unspoken, and likely unacknowledged, as she looks over the nurse's shoulder and through an open doorway for a glimpse of the world behind: What goes on in there? Our culture is awash in entertainment set in hospitals and emergency rooms, from the frenetic action of ER to the scrubs-shedding calisthenics of Grey's Anatomy. What television drama has less interest for is the unvarnished narrative, the simple experiences at the initial point of contact, when people must admit they are sick and seek help from doctors and nurses to whom they are unknown. Brian Goldman's The Night Shift succeeds at being that narrative.
The book is organized along the lines of a single night shift - not an actual night shift, of course, not even an average one, but an anthology of a shift where prototypical patients fill the stretcher bay at Toronto's Mount Sinai Hospital, each one with a narrative that encapsulates some aspect of physician experience in the ER. We meet those who show up for no good reason, and those who appear too late; those who will be helped and those for whom this will be their last visit.
Brian Goldman uses these remembered and now anonymized patients as a starting point for setting off in different, often disparate, directions. He not only talks us through their medical problems as we accompany him to the bedside, but uses their journey through the ER as an exploration into how such a department, and the health-care system it fronts, works (or doesn't work).
Through all of this, Goldman relates his personal history, how he has seen the ER evolve and how he too has changed as a doctor and as a person. Last, he digresses into topics he has covered so well on his CBC radio show, White Coat, Black Art: confidentiality, the frustrations and challenges of health-care delivery, the tensions between nurses and doctors and the boundary issues that confront doctors in the course of a practice. This is ambitious, and runs the risk of creating an unfocused narrative that touches on, but only pretends to understand, the topics at hand. (Which I imagine is the definition of a bad night as a doctor in the ER).
Luckily, Goldman, whom one suspects is an old hand at triaging, handles these challenges quite well. A major reason why he is able to pull this off is the structure of the book - which seems almost ingeniously appropriate. With its frequent page breaks and headings where we are reminded of the passing minutes and hours, it makes following these different corridors of experience not only seem reasonable, but natural. In that way, the book itself is very reminiscent of time spent in the ER, one's attention shifting from case to case, sorting through memories and responsibilities, bringing past experience to bear on the urgent matters at hand.
Aside from his curiosity, Goldman's most notable asset is his candour, which he liberally applies to himself as well as others. He readily admits to his own shortcomings and insecurities, and relates how he has tried to overcome them. He also describes how his attitudes, to subjects such as pain control, have changed over the course of a career without sounding like a man rationalizing or apologizing. In this way, his chronicling of the problems other physicians encounter never seems sanctimonious, since it is always informed with an appreciation of the randomness of misfortune and a sense of foreboding that awaits each new patient interaction.
There are a few slips in the book, mostly editorial, and many of which may be overlooked by a non-medical audience. Among them, we are told that Pantoloc is a medication that works by "blocking Histamine receptors," whereas even a neurologist like me can tell you that it is a proton-pump inhibitor; and seizures are attended to quickly "in case the patient dies." (We treat quickly so that patients don't die; we buy malpractice insurance in case they do). The prose is appropriately utilitarian, and so it comes as a bump in the road when Goldman informs us of what amounts to a personal manifesto: "I'm on a mission to take the hypocritical stick out of medicine's ass. To do a 'stick-ectomy,' if I can coin a word." Phrases like that made me appreciate his more restrained style; some words are best left uncoined.
The Night Shift has many satisfactions. It offers a great deal to both the lay public and those inside the health professions who continue to benefit from Goldman's honesty and curiosity. The highest compliment I can pay it is to say it read like a progress note written by an experienced colleague, a person hoping for the best and working to that end.
Liam Durcan is head of clinical neurology at the McGill University Health Centre. In a previous life, he has written fiction, including A Short Journey by Car and Garcia's Heart.