Reviewed by Jenna Kwon
Summary:
Written amidst the pandemic tumult, "Tornado of Life'' was published last year offering a glimpse into the experiences of healthcare workers in the ER. The book’s essays illuminate behind-the-scenes narratives, intertwined with the author’s personal journey. They explore themes of affliction, mortality, and the enduring human spirit. Jay Baruch, an award-winning Emergency Medicine doctor/writer who has been in both caregiver and patient roles, embraces the vulnerabilities inherent to both. His writing vividly captures the impacts medicine can have while shedding light on the complexities of healthcare.
I once came across the analogy that a doctor's encounter with a patient resembles holding a crystal ball together, only to hand it back upon exiting the room. This metaphor, both deceptively simple and intriguingly abstract, takes on a fresh meaning for me after reading "Tornado of Life.'' The act of holding the crystal ball, which I understand as a problem to be solved, amidst the frenetic setting of the ER assumes an almost luxurious quality.
As a medical student, I’ve often contemplated the weight of that figurative ball. How willing are patients to share it with their physicians? How much of it should be held by physicians? How long do hospitals and institutional frameworks allow physicians to contemplate it? And in the end, can the problem ever truly be cleared up?
"Tornado of Life'' remarkably addresses all these questions. The author adeptly navigates the myriad constraints that physicians routinely face. While I occasionally found myself skipping between chapters (a testament to their concise readability), I couldn't evade the sense of vulnerability intrinsic to the medical profession—depicted as “two imperfect humans straining to connect under imperfect circumstances.”
In this light, it becomes evident that, regardless of physicians’ expectations about the metaphorical ball, holding it presents its own set of challenges. The author notes the need for an “imaginative leap beyond the realm of ‘what is’ and into the terrain of ‘what could’ and ‘what might be’.” For example, Dr. Baruch points out “many people who commit suicide don’t want to die. They want to end their pain,” underscoring the intricate layers of human suffering that physicians must navigate.
The book highlights other factors, referred to as “constraints” by the author, that further complicate the field of medicine. Patients might respond to a physician’s greeting with, “Help? I don’t need your help.” Physicians are expected to prescribe antibiotics to patients with vital signs suggesting sepsis as soon as possible, yet not too hastily in case alternative explanations arise later.
Despite these complexities, however, these pages often hint at the possibility of clearing up—or at least mitigating—the problem. Physicians would, for instance, try “to understand people’s motivations and to withhold judgment along the way” and discover that it is love of family rather than selfishness that blinds a particular patient to the risk of COVID-19. Inviting the reader to bask in the patient’s heartfelt gratitude, the book reminds us of the importance of comprehending patients’ “why” with sensitivity and clarity while conforming to external expectations. These moments are what transform the clinical journey from a daunting academic pursuit into a captivating voyage of healing, capable of alleviating a patient’s problem.
While conventional wisdom advises against judging a “book” by its cover, I confess to occasionally doing just that, as it often leads me precisely to what I seek. In a similar vein, "Tornado of Life'' delves into the very whirlwind of the questions I held, unveiling the underlying meanings of both “you don’t want to be the patient everyone remembers” and “remember that patient.”
The Writer Writes Back
So, Jenna, the last I checked, medical students aren’t bathing in time. I’m honored you spent some of those rare moments reading Tornado of Life, and offering such astute comments, and thrilled to join you in conversation in Our Break Room.
Writing has always been my method of working through problems, hearing myself think, and recognizing when I’m not completely honest with myself. Most of my scribbling is private. My notebooks enjoy quiet lives in my closet. Sometimes, an urgency takes hold, and a story or an essay begins to assert itself.
What’s the right thing to do when the “right thing” is the very thing in question? Sometimes, there’s no map for caring for others. These moments can be uncomfortable. In Tornado of Life, I wanted to be honest about that discomfort.
I often find myself writing against overly cozy and convenient narratives, especially when the reality is messy.
I can't care for patients unless I care for their stories. I better understand their troubles, fears, and hopes for the future through their stories and silences. Often, they share experiences that are difficult to put into words. Most important is what's left out, and we must be aware of the gaps in their stories.
I believe we all have these moments, whether at work or home; they are fragile, embarrassing, scary, or overwhelming, and because of that, we keep them to ourselves.
Human connection is built on stories. We make ourselves known to ourselves and others through the stories we share. The words we use, the tone and phrasing, the way we lean in or resist as listeners.
I entered medicine as an English major who loved stories. I soon realized the practice of caring for others is a creative act. There is so much unacknowledged uncertainty and discomfort in the practice of medicine. Before jumping to answers, we must know when to step back and consider whether we’re asking the right questions.
These experiences can be hard to put into words and listen to. These are often small moments through the eyes of medicine—which prioritizes big data, recognizable scripts, and algorithmic thinking—but profound moments for patients.
What troubles us, we don’t talk about, not in public anyway. We'll offer up the tale of an exciting diagnosis, but we're more withholding about feelings of uncertainty or vulnerability. In this book, I share my struggles with these quiet earthquakes that unsettled and destabilized me over my career.
In the ER, I’m often reminded of this line from the wonderful novelist Colum McCann: “I sit here thinking how much courage it takes to live an ordinary life.” Caring for patients means being open and attentive to lives in crisis, large and small. All my writing bubbles up from a place of distress, trouble, and an impulse to work things out on the page. Three decades into my emergency medicine career and three books into my writing life, I can safely confess that I’m still a work in progress. If I’m an expert at anything, it’s knowing how to struggle more honestly on the page and at the bedside.