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Bold, Tireless, Sometimes Bumbling, Emergency Medicine Forges Its History

Scheck, Anne

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The early leaders of emergency medicine were different from the leaders in other fields. They were less educated, less academic, more Midwestern. And as is the way with people who push the edges and like to take risks, these nonconformist, pioneer emergency physicians were interesting characters. In their bold, tireless, and sometimes bumbling and fractious paths, one finds the story of emergency medicine in America — at first tenuous, one wrong turn away from dissolution, then gaining momentum, then taking off like a rocket to become a new and distinct medical specialty.

This is the summary of emergency medicine offered by Brian Zink, MD, who has put into text that “tenuous” journey, those “nonconformist” characters, and their “bold, fractious” march toward forming a new specialty into a new and unprecedented book, Anyone, Anything, Anytime: A History of Emergency Medicine.

It is a nearly 300-page account of the specialty's birth, a colorful chronicle of observations and insights from the founding members, who noted, for example, that during the Vietnam era, wounded Americans were more likely to receive good urgent care from a surgical specialist in a remote jungle than on the streets of their own hometowns.

To Dr. Zink, who has loved to put words to paper since he was a boy — winning a prize for his poetry at age 10 — the book was a “labor of love.” He began five years ago when he served as the president of the Society for Academic Emergency Medicine, and heard a colleague say “someone should write a history of the field while the founders are still around.” He could not have agreed more, and decided to dedicate himself to the task.

Crediting a supportive wife and three kids, Dr. Zink said he was able to pound out the prose by rising early, working late, and taking a sabbatical for one part of his effort. Unlike most first-time authors, he had no trouble lining up a publisher, but finding time was a problem.

In general, he squeezed in as much time as he could here and there, but it wasn't just the writing that consumed days and weeks; it took hours and hours of interviewing, of note-taking, of tape-recording, and of transcribing to get the material he needed to even begin to write the book. From the start, he wanted it to have “zest,” to be a history direct from sources, character-driven, and rich in detail.

The result is that it's not the kind of book likely to be “reviewed by medical history scholars,” he said, adding, “but that doesn't bother me.”

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Maverick Physicians

As Dr. Zink puts it in his introduction: “Emergency medicine came about in a different manner than the traditional medical specialties. It was bred by new social and political conditions, borne out of service needs, and nurtured by a few maverick physicians. It developed as an outsider looking in — a populist favorite shunned by the medical establishment.”

From descriptions of those early, critical beginnings right up until the conclusion of the book, Dr. Zink chronicles the jumps and jolts along the road to formal recognition of the specialty and of the implementation of training programs for a profession that now is seen as the front line of American medicine.

In language that is always vibrant without ever seeming melodramatic, Dr. Zink recounts how the early founders waged feisty fights with the American Medical Association, other specialty groups, and even themselves in the struggle to establish the specialty. “I didn't want it to come across as … the history of emergency medicine from A to B and on,” said Dr. Zink, now an associate professor of emergency medicine and an associate dean for student programs at the University of Michigan.

“I didn't want it to come across as … the history of emergency medicine from A to B and on.” - Dr. Brian Zink

Instead, the book is an oral history, but unlike those penned by other authors, in which personal recollections fill pages of print, Dr. Zink has woven the anecdotes of emergency medicine's founders together in a chronology, one that is at times poignant. It includes the trail of anguish suffered by young “ER” physicians who toiled in a field regarded as the fringe of medicine, and follows the trajectory of their maverick efforts, which seemed to fly in the face of that reputation: heroic, life-saving deeds that demonstrated time and again to those pioneers that they were doing vital, important, groundbreaking work and that they would eventually prevail.

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‘Diligent and Accurate’

Peter Rosen, MD, who wrote the forward to the book, and calls Dr. Zink a “diligent and accurate” recorder of the events, noted that the book wasn't just a quest for knowledge but downright anger that fueled his early research in emergency medicine, at least part of the time. He tells the story of an encounter with his dean at the University of Chicago to illustrate the point. The dean told him in an apparently smug, everybody-knows-this kind of way that “there is no biology in emergency medicine.”

“He said, ‘When I have my heart attack, I want a cardiologist to take care of me,’” Dr. Rosen recalls in the book. “I said, ‘That's all very well and good, but how do you know you had a heart attack?’” The reply: “Well, I have chest pains.”

“And what if you don't have chest pain? What if you have nausea?” Dr. Rosen inquired, apparently stumping the esteemed administrator.

“It was the first time it had ever occurred to him that maybe you couldn't run an emergency department with 47 different medical specialties,” Dr. Rosen remembered. “I got so pissed at him that I went out and wrote a paper.”

In fact, if there is a single thread running through the book, it seems to be that this kind of fiery determination, even defiance, was the hallmark of those early advocates of the specialty. No amount of put-downs, no level of patronization, not even outright snubbing by their colleagues deterred that early band bent on forming the specialty.

In the end, Dr. Zink noted that the book underscores the very nature of the specialty, a field in which the demand for high performance arises simply from being what it is: emergency medicine. He concludes with a few, sparse paragraphs likely to strike a big chord among even the newest emergency physicians. It is the story of a young doctor being confronted with a near-dead baby, blue-black from epiglottitis. The young physician confesses: “I've never done a tracheostomy on a child before,” but then he proceeds to do just that, making the cut and sparing the baby's life.

The physician who revived the baby was a very young John Wiegenstein, MD, who went on to become a pillar in emergency medicine. Much later in his career, the late Dr. Wiegenstein learned what happened to the baby. The tiny boy he saved grew up and went to medical school, and became — what else? — an emergency physician. He now serves as an ED director in western Michigan.

© 2006 Lippincott Williams & Wilkins, Inc.

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