The patient was in severe pain, and vocalizing it. To complicate matters, he spoke no English, and so his yells had no descriptive quality to us -- they were just noise with emotional inflection. When we brought him into the emergency room, I was surprised to find that the doctor spoke a little of his language and could communicate in basic terms. The patient, blinded by his fear and pain, listened little to the doctor. It was the middle of the night, and the ER was empty and eerily quiet. Staff directed us to place him on a bed as far from the front desk as possible, so they wouldn't have to listen to his continuous moans.

We settled the patient on to a bed and I started making up the ambulance cot with fresh sheets. The doctor came by and looked at me. "Good work, guys," he said, and I said "Thank you" before I realized that he was being sarcastic. He was sharing a joke with me at the expense of the patient -- ribbing us for ruining the nice quiet of his ER. "We appreciate it," he said. "You owe us one," I replied.

I'd forgotten the casual contempt for suffering that is so common in emergency medicine. For all but the most relentlessly optimistic or emotionally dead, it's a necessity, a mechanism to filter out information that could paralyze you. You have to have a means of remaining separate from patients, or the compelling gravity of their pain will pull you into a place where you cannot help. Or so goes the story. I believe it's a necessary defense, but still one that is unpleassant to construct. It means controlling the very impulse which moves me into emergency medicine in the first place. I see in others clear signs that it is a wall that, once begun, sometimes continues to grow to monstrous proportions, shielding the helpers so completely that they feel no impulse to show respect or humanity to those they help.

I slept very little between calls. The day after a sleepless night at the ambulance has a strange and slightly surreal character to it. The excitement of the night before, paved over with exhaustion, renders me a little flat-affect. On one hand, I am determined to drink life to the lees*, savor that which I see denied to others. Yet my body wants nothing more than sleep. I'm a buzzing ball of contradiction.

Bizzy Bee

I have more work than I can possibly do. For a startup consulting business, this is a good thing; I'll take the stress of deadlines over the stress of hunger any day. Unfortunately, the relentless pace has suddenly fueled a burst of distracting creative energy, bringing on a cascade of ideas for other cool projects that would be way more interesting to work on than my paying gigs. Yesterday I decided that I need to create a website entirely using Flash, a piece of software that I don't even own. I tried to explain to myself and Susan that this was the fuel for a new generation of site design and I need to be on top of it, blah blah blah, but the real reason was that the prospect of playing with a new creative toy was immensely more engaging than the tasks currently sitting on my plate and staring at me accusingly.

While in the shower I began to see the intersection of characters that might populate a story or book. I've flirted with the idea of a book before, but it has thus far proved to be an unrequited love. Now, in the moment when I have absolutely no time to devote to the task, the characters show up in the bathroom with me and start debating story lines. Someone from an old story that never concluded appeared and asked if he might have another go-round. I couldn't just chase them out and tell them I really needed to get dressed before we could talk about such things. What if they get pissed off and won't talk to me any more?

Later in the evening I had something of a revelation. If I put away enough money from all the projects I'm doing now, I could take a few weeks off later this fall and do nothing but write. Finally I could shut up with this shit about writing a book and actually start doing it. Maybe it would stall out, crash and burn, but the characters in my bathroom would see that I made the effort. They might tell their friends, and lure in some more sophisticated characters who would help me out when I tried again.

* Interestingly, "lees" are the dregs, the sediment that builds up in wine during fermentation. I never knew this until today, despite having used the expression before. [back]