•  Book Review: Stories From the ER

Julia's Mother
By William Bonadio, MD
St. Martin's Press
192 pp $22.95

As a pediatric emergency room doctor, William Bonadio learned early in his career that his talents would be needed by many more people than the children rushed in by ambulance crews. Parents, too, would need his care: tender care, yet calm and unemotional, of a kind not taught in the lectures of medical school classes.

The mother in the title of this gracefully written account of a pediatrician's labors is waiting in the Quiet Room of a big city children's hospital. During this nighttime vigil, Bonadio, on call as the chief emergency room doctor, has been leading a medical team trying to save the life of 6-year-old Julia as she lies on the resuscitation table. The child has been hit by a car while crossing the street to school -- a direct hit, it appears, from the evidence of her bloodied body, now stilled by zero blood pressure and the absence of breath or a pulse.

After an hour of IVs, compressions, transfusions, and drugs, Julia dies. "What do I say to this mother?" Bonadio asks himself as he leaves the ER arena for the Quiet Room. Arriving, he can only offer: "I'm sorry. She did not make it."

Reflecting on the wrenching experience of losing a child that he had in his care barely an hour, and then bringing the mournful word to her mother, Bonadio understands the inadequacy of those words: "This is all I can bring forth -- I have nothing else, there is nothing left to give her. Like a deaf man singing an aria. Yet those words beat down on her with the consecutive inevitability of hammer blows. She would not have heard any more. In the insupportable moment, time is everywhere -- and her face passes through all of the ages. She turns hard away from the light and heat of it, covers herself only with already sapless arms, and swoons low to the floor, deeply sobbing.

Throughout this slim volume of 192 pages, Bonadio writes in the first person. He creates a great immediacy, much of it ER-dramatic, which is to be expected, and much of it spiritual, which isn't. The writing is in the tradition of classic storytelling: Set a scene, put people in it, and then report the interaction.

Bonadio's prose goes beyond providing the details of following protocols to include his reflections about his vocation as a children's doctor. While in college and thinking about taking pre-med courses, he recalls asking his family doctor, "Was it worth it? Would you do it all over again?" He remembers the answer: "He said yes, without a doubt -- because there is no other job in the world like being a doctor. No other work can make such a difference in other people's lives. Sometimes in a small way, sometimes in a big way. They trust you, depend on you in a crisis. They remember what you do for them. It's such a privilege to be allowed to practice medicine. ... I never forgot what he said."

One of the most detailed accounts of patient care involves Grace, a newborn brought in with critical epileptic convulsions. Her parents hover at the bed. The mother tells Bonadio: "Grace is my first baby. We just went home from the nursery, and everything was going fine. I just fed her an hour ago. How can she be so sick now? Is she going to have to stay in the hospital?"

A nurse eases the parents away from the bed so Bonadio can start an IV, draw blood, order lab tests, decide on a medication, and try to move ahead with confidence. "This confidence," he writes, "is what all doctors work to attain their entire career. It comes only after many years of managing many cases, of struggling through them in all their different permutations. Then one day it seems the tumblers click into place -- a door opens, and you see the job with a new clarity. It's a mysterious thing, intuitive -- like gaining the gift of an extra faculty which can instantly transform the few facts before you into a clear mental blueprint showing the best possible route for proceeding."

After half an hour, Grace's convulsions are calmed. She is transferred to the ICU, where she is listed as stable and monitored by specialists who make the next medical decision. Bonadio will not see her again: "You come to realize over the years working ER that your name is seldom remembered after your part is done, and that it's rare to hear if what you did ultimately made a difference. ... That's the reality of it. Even though sometimes you need more, it's often all you get; and in that morsel of certainty, you must learn to savor a confidential feast of personal satisfaction. It's a private shining."

A weakness in Julia's Mother is the author's failure to cite any instances where he botched a case. He states that "you can never be perfect" in the practice of medicine. "It's inevitable -- every ER doctor has at least one nightmare story to tell. About the one you missed. You can't get through an ER career without it happening at least once."

If so, which time -- or times -- did Bonadio mess up? He doesn't say. Instead, he describes in some detail how a colleague committed a grave error involving a patient with a spinal cord injury: a major misreading of an x-ray that led to a blundered diagnosis. It was Bonadio who caught the error on a later shift. But of his own misplays we learn nothing.

Missing also are the specifics about the location of the city and hospital where Bonadio toils. It is only "Children's Hospital." Is that the one in Seattle? Washington DC? Or where? The doctor also keeps a tight lip about his nonprofessional life. We aren't told whether or not he has children of his own or what effect his night-shift hospital work has on his wife or partner -- indeed, whether he even has one.

Bonadio does report that he is a runner, one with a taste for long, 7-mile lopes along country roads: "An hour of hard exercise recharges [the body] with a bonus energy which lasts far into an overnight shift. I can feel it helping when I need that extra gear to get through it." The closest the author comes to a personal revelation is that his father was an elementary school janitor for 37 years and urged his son not to be a janitor. "Go to college to be a doctor."

Bonadio did, and then some. He also became a gifted writer -- in a modest way, he tells his story much in the tradition of such physician writers as William Carlos Williams, Robert Coles, and George Sheehan.

Bonadio ends his story as he began: with Julia's mother. She called the doctor on Oct. 15, 1999, a year to the day after her daughter died. She seeks emotional comfort to ease the still aching loss. Bonadio gives it, in full measure. His generosity of spirit shows him at his best, a physician going beyond health care to extending personal care. That he has written so well about this side of medicine shows that he cares about his readers as well. Genuinely so.

-- Colman McCarthy is a former columnist for the Washington Post. He is the director of the Center for Teaching Peace in Washington, DC, and the winner of a 2001 Excellence in Journalism award for an opinion series from the Northern California Chapter of the Society of Professional Journalists.

First published October 20, 2000
Last updated November 21, 2007
Copyright © 2000 Consumer Health Interactive

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