Cover Image: Tornado of Life

Tornado of Life

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Member Reviews

Combining an essay form with his experience as a physician, Jay Baruch in 'Tornado of Life: A Doctor's Journey through Constraints and Creativity in the ER' created an unusual yet very compelling medical nonfiction book. 

The author's approach to storytelling requires adaptation. You'll be disappointed if you expected a sequence of intriguing and/or challenging medical cases like the 'Code Black' or 'ER' series. Instead, the author bases his book on the premise that '{S}tories reveal how people face, cope, succumb, and surmount the obstacles in their lives and make their way in a world we all share. They serve as portals of social interaction that pipe us emotionally into the experience of another.' (The quote may differ in the published version.)

Fictionalizing actual patients, partly because of privacy matters, partly due to showcase his points, Jay Baruch treats each ailment as a story, each person as a storyteller. The storyteller tries to tell his/her story that is more than just a headache or cancer to a doctor, under tremendous pressure, in a limited time frame. The doctor must unravel what is said and, more importantly, what the patient fears or cannot describe. 

I strongly recommend 'Tornado of Life,' not to medical nonfiction appreciators but more to short story/novel writers. The author's rich, tight language (I didn't notice any repetitions of words, phrases, and thoughts) and analysis of Anton Chekhov make the book a handy tool for those seeking inspiration. 

Minus one star from my ratings corresponds to the incomplete, in my opinion, chapters that describe one medical encounter in the ER without further analysis. The reader may find himself/herself unaware of the reasons behind the author's decision to include this or that episode. 

I received an advance review copy through Netgalley, and I am leaving this review voluntarily.
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This book reads like a philosophical text about how to interact with patients. I like to read books about other healthcare providers' stories but this one relied quite heavily on literature already written on the importance of listening and gathering information and this particular physician's interpretation of it. Not having gone to medical school, I am not sure what, if any, teaching is done on open ended questions and actually treating your patient, not the numbers. This is something I can say is emphasized in nursing school. 

Overall, in terms of patients' experiences I found the book sorely lacking. If I wanted to read pontification pieces I would have gone for that genre. 

On a side note, this author tends to delve into poetry for the answers to the universe and I hate poetry...
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Thank you to Netgalley and MIT press for the ARC.

Tornado of life is a beautiful product of decades of experience in emergency medicine. Baruch's humanity seeps into every word, and I often found myself writing down excerpts to think on and remember. 

Tornado of life explores the emergency room and those who enter. We see the everything from the relatively benign to the heartbreaking. In Tornado of Life, Baruch takes us through the lessons learned and the patients and family members who taught them.

I appreciated the care taken with writing on the patient, as well as the fact that Baruch takes us into his confidence and admits to shortcomings and how some things had to be learnt the hard way.

This book is reminiscent of Critical Care by Theresa Brown in how well it navigates letting the reader in to the narrative while not commoditising the patient's experience. 

All in all, this is really one of the better medical 'memoirs', and I'd recommend it without second thought
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Medicine is described by some as part science and part art. 

Author Jay Baruch believes that to be a successful Emergency Room doctor (and, perhaps, a doctor in any specialty), the doctor should stop and really listen to what the patient is saying or not saying. Don’t just rely on the science but learn to lean on the less tangible.

This isn’t the typical doctor’s discussion of what they treated during a patient’s emergency room visit, instead, while each vignette is patient centric, Dr Baruch discusses how he approaches the patient and his philosophy on the disease, his treatment, or what the patient’s actual problem was or could have been. 

Tornado of Life would appeal to the reader of books on doctor’s perspectives on medicine but is looking for a bit more of the doctor’s philosophy concerning the art of medicine.

(Ironically, I had read a previous book by Dr Baruch, Fourteen Stories: Doctors, Patients, and Other Strangers, a collection of short stories that I had reviewed and didn’t really enjoy. At least I am enjoyed this book.)

4/5 stars

[Thank you to NetGalley and the author for the advanced ebook copy in exchange for my honest and objective opinion which I have given here.]
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I had a hard time reading this book because of the way it was written, I couldn't get into it, I enjoyed the stories with the ER patients but not the rest of the book, which seemed more like a disseration.
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My experiences in hospital emergency rooms have led me to believe that a fair number of physicians who work in them are adrenaline junkies: quick thinkers who crave stimulation and variety, don’t have long attention spans, and are there in part because ER work does not involve following up on patients as internists or primary care physicians are obligated to do. They’re fix-it-fast or pass-them-on clinicians. Jay Baruch himself writes:

<i>Early in my career, I was aware of a knock against emergency medicine— a lack of closure. We rarely follow a disease through to the end. We don’t see pneumonia improve with antibiotics. We’re not tracking the wrist fracture through healing and rehabilitation. Dr. G, a dean at my medical school, a prominent internist and infectious disease researcher, when learning of my intention to enter emergency medicine, said, “Emergency medicine is to internal medicine as the short story is to the novel. And there are no great short story writers.”</i>

Evidently well acquainted with literary fiction, Baruch not surprisingly disagrees with the last statement, and in his book he disproves, or is at least an exception to, my characterization of ER doctors. Maybe it’s because he, like fellow emergency medicine physician Frank Huyler, is a writer as well as a doctor. Baruch is philosophical, introspective, self-critical, and sensitive to the nuances of complex situations. He’s interested in stories, those that patients tell, as well as literary ones from such writers as Anton Chekhov and Lorrie Moore. Stories, Baruch writes, structure experience, try to make meaning of it, but physicians can miss key elements based on cognitive shortcuts they’ve learned. Doctors’ brains are as hardwired for stories as the next person’s, but if physicians aren’t careful, the story they create “may be very different from the one the patient is telling.” 

To illustrate this point, Baruch tells of a suicidal veteran with PTSD, Mr. K, whose girlfriend called 911 after he phoned her at work, panicked, saying he had fallen. The paramedics who found the man at home sensed “a disturbing violent intensity” emanating from him and called on police to escort him to hospital. Mr. K’s face was bruised, but he wouldn’t allow anyone to touch him, never mind perform scans to determine if he had a head injury. Restraints would likely be needed to treat him. Only when the patient’s girlfriend and sister arrived at the hospital and Baruch spoke to them did he learn that Mr. K’s PTSD long predated his military service: he had been raped as a child. Looking at the muscular men surrounding the man’s stretcher, ready to tie him down, Baruch was appalled by how he’d approached Mr. K’s case. After asking those men to step aside, the physician apologized to the patient, who had calmed somewhat and now permitted his neck and head to be examined. But that was where it ended. The trust had been broken; the patient would not allow a full medical workup. Baruch reflects that Mr. K’s “emotional state was treated as pathology that demanded a response, rather than evidence in a narrative that needed further investigation. Despite all the harms that take place in hospitals, the ones less frequently addressed are narrative errors.” Such misinterpretations are all too common in the ER where “a pressured listener tries to understand a pressured storyteller.” 

Baruch’s essay collection consists mostly of stories similar to the one related above, describing doctor-patient interactions that left him feeling “lost, inadequate, confused or ashamed, unsettled, or just plain silly.” However, some essays focus on his own experience as a person with a serious heart condition, which required him to undergo major surgery at age 41. 

“The practice of emergency medicine is a dance with the unexpected,” he says. At other times, it “seems like an emotional and moral contact sport.” Among the many challenging patients at the centre of these stories are gun trauma and motor vehicle accident victims, people in the throes of heart attacks, cancer patients in crisis, exhausted caregivers accompanying parents with dementia, and aggressive or frightening patients, some of whom have blood alcohol levels two to three times the legal limit or through whose blood some other substance is coursing. Abusive people like these are routinely kicked out of bars for their behaviour, but they cannot legally be denied emergency medical care. Limited time and resources can force a doctor to send a homeless person, who has been drying out in an ER bed needed by someone else, back to the streets before he’s ready. Sometimes the same individual will be back in hospital a few hours later with precisely the same problem.

Baruch mentions the ideas of Arthur Frank, a sociologist known for his work on illness experience, narrative, and the ethics of care. Frank has identified three kinds of medical narrative: restitution (the type you see in drug commercials: “take this pill and the sun will shine again”); quest (the once well patient journeys into the land of the ill and is transformed by his trials); and chaos (in which “the troubles run so deep that putting language to these experiences can be difficult, if not impossible.”) Chaos narratives are commonly heard in the ER. Baruch’s book is in fact named for a comment made by a patient who tells one of these stories. Cheryl, brought into the ER for the ruckus she caused at a homeless shelter, had overdosed on heroin the previous night and was angry about being alive. “I’m stuck in a tornado of life,” she told him. Hers was an existence consisting of a myriad of problems woven into a multitude more. A story like Cheryl’s is threatening to clinicians, Baruch says; it stirs up their own anxieties and challenges their illusions of control. A doctor’s task is to hear the chaos narrative, not interrupting the patient but allowing her to tell the story. In this way, enough trust can be gained to enable the physician to provide care and a sense that change is possible.

I found almost all of Baruch’s forty essays fascinating, illuminating, and insightful. They present and interpret compelling stories and are accessibly and beautifully written in clear prose. Many are enriched by literary references or succinctly supported by the highlights of research studies. Overall, the impression the essays leave is of Baruch’s humanity and commitment to gleaning the truth of difficult interactions with people who are stressed and in pain. Most of the pieces are serious and searching in tone, but there are a few welcome humorous anecdotes. One very short chapter about a wheelchair in a hospital parking lot reads like a prose poem; it put me in mind of “The Red Wheelbarrow” by William Carlos Williams. In fact, what Williams observed about how his work as a doctor informed his writing applies equally to Baruch: “My ‘medicine’ was the thing that gained me entrance to these secret gardens of the self. It lay there, another world, in the self. I was permitted by my medical badge to follow the poor, defeated body into these gulfs and grottos.”

A few of the essays, most notably the last, concern the coronavirus pandemic. While Baruch’s views on Covid-19 are more moderate than those of many in the medical community, I admit to being disappointed that he isn’t more open to or informed about differing perspectives. He cautions against demonizing those who have chosen not to take the vaccine, pointing out that their reasons are often more thoughtful and nuanced than the media would have us believe. He nevertheless assigns too much blame for the dire outcomes and loss of life to irresponsible members of the public, failing to acknowledge the role of the mainstream media and medical spokespeople in silencing the voices of knowledgeable physicians and scientists with differing views on how to respond to such an emergency. Many well versed in epidemiology, public health, virology, vaccinology, and infectious disease who had valuable contributions to make to the discussion were unjustly vilified and deplatformed over the last two years. Accomplished, ethical physicians—who recognized the importance of early treatment, successfully used repurposed drugs with excellent safety records, and kept people out of hospital and off ventilators—have received no recognition or have been falsely depicted as dangerously unscientific mavericks. Furthermore, vaccines that were rushed through inadequate clinical trials have caused significant and well documented injury. Their maker, Pfizer, evidently aware of its own shoddy practices, attempted to block public access to its data for 75 years. A judge decided otherwise. Finally, one really should be concerned about the American drug regulatory body’s actual commitment to public safety when it gets around half its funding from the very pharmaceutical industry whose products it’s supposed to be stringently evaluating and vetting. None of these facts is even passingly mentioned in Baruch’s discussion of the pandemic response. Either he was unaware of them or worried about the professional consequences of straying too far from the unnuanced “narrative” that has dominated all our lives for the past couple of years. For a physician interested in narratives and ethics, Baruch is surprisingly uninterested in questions of informed consent and bodily autonomy, particularly when it comes to people’s being injected with a novel experimental vaccine, inadequately trialled, without long-term safety data, and made available only under emergency use authorization. I state all the above as a person who did receive the vaccine, though my consent was hardly informed.

My reservations about Baruch’s views on Covid-19 aside, I greatly enjoyed and highly recommend his book. As he himself observes, all of us, at some point or another, find ourselves being tossed about by the tornado of life.

Rating: 4.5

Thank you to the MIT Press and Net Galley for an an advance reading copy of this book.
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Somewhere in Tornado of Life there is a book, but not as currently written. While the author gives some interesting insights into the people who visit the ER, their stories and pains, as well as some insight into how the author experienced being an ER physician, the book itself is a tornado of pieces strung together and the essence is virtually impossible to distill. I wanted to read this book as I severely broke my ankle in December, 2021, and I wanted to see if I could find a part of my ER story (something I am still trying to elucidate): - some fellow travelers, if you will, in the book.

I was very confused by the author’s shifting voice. He was very clear when he told the stories of the patients he writes about. In fact, explaining and reflecting on the ER experience as unique stories is an excellent undertaking. But the book, for me, didn’t quite make it. There was a lot of rambling that I generally skipped because I felt it was a distraction from what the author was trying to say. And, the essential question, is he writing from the point of view of an ER physician or a story teller, is not answered., and I found this to be a serious detriment.

I think this book needs a surgical scrubbing so it’s essence is there. Because Jay Baruch definitely has stories to tell. But he’s not yet finished, in my opinion.

Five stars for the stories, two stars for the writing = two stars overall,. No, this is not a mathematical calculation.

I received this book as an ARC from the publisher and NetGalley. All opinions in this review are solely mine.
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TORNADO OF LIFE is a quick read, filled with short stories about patients presenting to the emergency room and how they provoke the doctor’s thoughts and actions. For example, one of the first patients the author sees (as a brand new doctor) is a woman, presenting with vague symptoms, but appearing well. It turns out that she may have been abused by her husband, and just needed someone to talk to, and perhaps have someone suggest a course of action for her. Baruch regrets not seeing the patient’s true needs and says that case stayed in his mind for a while. He attributes his lack of communication to his inexperience and explains to the reader why it is important to consider the whole patient, not just what they are telling you. He also says an ER doctor should not judge a patient on how they look when they show up to the ER. Sometimes the most disheveled need the least care, and vice versa. 
He tells the story of a patient asking for pain meds; and is unsure if he should prescribe them. He discusses the dilemma of drug-seeking patients and how pain is unmeasurable, unlike a temperature or a heart rate. Baruch says that “do no harm” is a doctor’s first tenet, but when it comes to pain, you may be damned if you do or damned if you don’t. If someone is in real pain, he is obligated to help them. But if a patient is looking for drugs to feed his habit, then prescribing them could possibly harm them as Baruch encourages them to continue their addiction. 
Each chapter holds a new patient’s story and the lesson the ER doctor learned from the case. Communication and empathy are a recurring theme, which makes sense. An ER visit is fraught with anxiety, and it can be comforting if you are examined by a caring physician. Often the doctor has only a few minutes to connect with the patient, which makes getting through the layers of each person’s needs very difficult. The chapters are stand-alone stories, making the book easy to read in small bites. 
Baruch touches on each of those layers in depth, ruminating on how he could have helped some patients better, how some patients helped him learn more about himself, and detailing the psychic struggle that doctors experience daily. Baruch comes across as an extremely caring and empathetic person; I would appreciate his care should I ever need to visit his ER.
The only thing that frustrated me about TORNADO OF LIFE was that I never got closure on any of the patient’s ailments. The author states that in the beginning of the book - there will only be a few details about the ER visit and then the rest of the chapter will be introspection. I found myself wanting to know more about each patient, what their diagnosis was and how they were addressed before they were discharged. I learned to put my dismay aside as I got through each chapter, understanding that the point of each story was Baruch’s rumination and a lesson learned. 
This is an unusual book, as the doctor’s thoughts are shared front and center. Most books written by those in the medical field will give a great deal of detail on their patients with a bit of introspection added. TORNADO OF LIFE is the opposite, and the reader needs to take time to digest the deep thoughts Baruch shares. Reading this will give you new respect for ER doctors and all that they handle on a daily basis.
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