Jay Baruch, M.D., was an English major in college before he went to medical school. This may have made him, in his own words, “a very neurotic medical student,” but it also gave him an unusual skill set. Amid the organized chaos of life as an emergency room physician, he uses writing to clarify and expand his thoughts.
Baruch’s latest book is “Tornado of Life: A Doctor’s Journey Through Constraints and Creativity in the ER,” which he will discuss on Feb. 11 for this year’s Cindy Wool Memorial Seminar, presented by the University of Arizona College of Medicine and Jewish Philanthropies of Southern Arizona.
A professor of medicine at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, and an ER physician for more than 30 years, Baruch has also written two acclaimed short story collections, “What’s Left Out” and “Fourteen Stories: Doctors, Patients, and Other Strangers.”
For Baruch, paying attention to patients’ stories — not only what they say, but what they don’t — is a crucial clinical skill.
He was well trained to recognize and treat acutely ill and injured patients. “Unfortunately, my patients’ bodies didn’t always read the same textbooks and journal articles that I did,” he says, adding that the most frustrating part of emergency medicine is “working with uncertainties and stories that felt less like nuts to be cracked and more like messy first drafts.”
A medical encounter can be compared to improvisation, Baruch says: “It’s unscripted and unpredictable, and requires thinking on our feet, curiosity, and following possible threads instead of closing them off.” Sometimes a patient may be too ill to speak, and their story comes in fragments from family members or the emergency medical services crew who brought them to the hospital.
A patient named Cheryl, a heroin addict, provides the title for “Tornado of Life.” Her messy, complex story forces Baruch to walk a tightrope, “honoring the severity of her difficulties without giving the impression that I was throwing up my hands in defeat.”
Although Baruch can treat Cheryl’s broken toe, consult psychiatry about her suicide attempt, and suggest a multidimensional approach to her substance use disorder (medication-assisted treatment for her withdrawal symptoms, counseling with a peer recovery coach, naloxone training to reverse an overdose), he may never find out how her story turns out — ER doctors rarely get that kind of closure.
Mirroring the pace of the ER, “Tornado of Life” is composed of short, powerful, poignant chapters.
In “When Loneliness Is an Emergency,” Baruch invokes a short story, “Misery,” by another writer/doctor, Anton Chekhov.
“I reread ‘Misery’ often — shorter than most articles in medical journals, it’s arguably more clinically significant,” he writes. “‘To whom shall I tell my grief’ may sound strange to our ears. But when the answer is ‘No one,’ it cuts across time and place and feels achingly current.”
“Tornado of Life” encompasses the COVID-19 pandemic, beginning with the first wave in 2020, when little was known about the disease, protective gear was scarce, many patients were dying, and families were not allowed to visit them in the hospital. Baruch recalls Carlos E, a patient who comes to the ER only because his boss insists. Carlos E has a slight fever, nausea, vomiting, loose stools, abdominal discomfort – all symptoms recently added to the list for COVID-19. He’s also recently visited family in New York, a pandemic hotspot at the time. Baruch administers a COVID-19 test and is about to send Carlos E home to await the results, which will take days. But when Baruch is typing his notes, an act that makes him think in a different way than if he were dictating, Carlos E’s symptoms suddenly suggest a different story: they are the classic signs of appendicitis. The COVID-19 story had almost overwhelmed the obvious.
With compassion, humility, and flashes of humor, Baruch writes about various problems doctors face, from angry patients to the opioid crisis to the overloaded health care system. While solutions to many of these problems must be addressed at a system level, he believes caring for a patient in ER must begin with being open to their story.
Amy Hu, M.D., a clinical assistant professor of psychiatry at the UA College of Medicine, says she invited Baruch to speak because his themes of “creativity, ambiguity, and discomfort” align with the focus of the medical humanities curriculum “and are values integral to a humanistic and empathic practice of medicine.”
The free seminar, which begins at 5 p.m., is open to all members of the community. It is sponsored by the Cindy Wool Memorial Seminar Fund, housed at the Jewish Community Foundation. Register here to attend in person at the UA Health Sciences Innovation Building or virtually via Zoom.
