Moral Crossroads in the ER with Jay Baruch, MD
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What is the premise of Jay Baruch’s memoir *Tornado of Life*?
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You're listening to The Nocturnist Conversations. I'm Emily Silverman. When patients come to the ER with a heart attack or a broken bone, doctors know exactly what to do to make them feel better. But often patients' problems aren't as straightforward as they seem, and ER doctors have to turn to things like storytelling as a way to make sense of their chaotic day-to-day work. This is the subject of emergency medicine physician Jay Baruch's latest memoir, Tornado of Life, a doctor's journey through constraints and creativity in the ER. Jay is a professor of emergency medicine at Brown University's Alpert Medical School and an incredibly thoughtful writer with a background in bioethics. In my conversation with Jay, we talk about what it means to bring a narrative lens to medicine, even to ER medicine, which is grounded in the very briefest of encounters.
We also talk about the importance of embracing uncertainty, which is a very timely topic since The Nocturnist is planning to produce an entire podcast documentary series on the topic of uncertainty next year. But before we go on, let's hear an excerpt from Jay's book, Tornado of Life.
Hug or Ugg Thawne was bouncing on the edge of a stretcher, a homeless woman in her late 50s, feet drumming on the scuffed tiles like that of an impatient schoolgirl. She was hurling insults at EMS when they rolled her into the ER. They had found her asleep outside the police station. The triage nurse knew her from previous visits, mental health problems and substance use, cocaine mostly, sometimes heroin. I extended my hands and introduced myself. When I stepped into the exam room, she popped upright. Hi, doctor, she said, grabbing my hand. Without letting go, before I could even say another word, she looked up at me with desperate bloodshot eyes and asked for a hug. A hug, I said. Yes, doctor, she said.
She ranted about living in shelters and how sure she'd made mistakes in her life, but don't believe the EMS bullshit about drugs. Maybe a little crack and a nip here and there, but she's no addict. And what could she do when she has nobody, nobody in the world to prove them wrong? Just a hug, she begged. The weight of each passing second counted against me as I took in her sun roughened face. The wrinkles scuffed with dirt and her dirty jeans and oversized t-shirt. The air around her smelled of someone going through a tough time, old sweat, stale cigarettes and greasy food. In my emergency medicine education, I was trained to respond quickly to a wide variety of urgent situations. At no time did I come across one that was urgent in this way.
My muscles tensed, my heart cramped. I opened my arms. We hugged. To be completely honest, she hugged me.
Thank you for that reading, Jay.
Thank you. It's great to be here, Emily.
It's great to see you. I think last time I saw you, we were in Ireland.
It was fantastic.
For the audience, Jay and I have met in person a couple of times in Providence, Rhode Island, which is where you're based. And then also most recently this summer in Galway, Ireland at the .md conference. So that was so much fun to hang with you there.
I was, and your family, and to hear you speak. It was fantastic.
So let's talk a little bit about this book, Tornado of Life. I really enjoyed reading it. And I think one of my favorite things about the book is how you continually come back to this idea of story and of narrative. But before we get there, I thought maybe we could back up a bit and you could share with us how you landed in emergency medicine.
I get that question a lot. I never intended to go into emergency medicine. I was an English major in college, and I thought I was going to be an English professor and write. My love of stories actually emerged from a couple of courses I took as an undergrad, one of them which involved going to a local hospital and talking to patients.
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Chapters
8 chapters
1
What is the premise of Jay Baruch’s memoir *Tornado of Life*?
0:00–6:26
2
How does Jay describe the first patient encounter that inspired the book’s opening story?
6:26–13:03
3
Why did Jay originally choose emergency medicine instead of a career in English?
13:03–19:47
4
What does a 30‑year career in the ER feel like physically and emotionally?
19:47–25:44
5
How does Jay use daily writing to capture and process patient stories?
25:44–32:25
6
What is the ‘expectation gap’ and how can clinicians recognize it?
32:25–37:46
7
How does Jay differentiate narrative errors from medical errors?
37:46–42:46
8
What lessons does Jay share about navigating uncertainty and compassion in emergency medicine?
42:46–48:25