Book review: Life on the Ground Floor

Maggie Hulbert is a medical student in the Class of 2020 at Queen's University

 

(Doubleday Canada, 2017)

Dr. James Maskalyk describes emergencies “as a sign of life taking care of itself” in his most recent memoir, Life on the Ground Floor. Throughout his book, the reader is left to wonder what exactly Maskalyk means by this. It is an ominous phrase that, at first glance, reads more like a repackaged “survival of the fittest” for emergency departments. However, through deft and emotional storytelling, Maskalyk urges us to look beyond this stark message of Darwinism and see that emergencies are the purest form of life helping life, or “life taking care of itself”.

Life on the Ground Floor reads in a similar way; uncomfortably blunt, then striking in its sincerity. It hits the ground running in its opening chapter by describing the life-threatening sign of stridor with an urgency that would be ironic if it weren’t so captivating. Initially, Maskalyk’s style of writing is jarring. He uses short, sparse sentences and alternates freely between narrating the patient’s feelings (“pleasepleaseplease”) to confronting the reader (“Have you seen a look of pure panic?”) in one paragraph. But this style lends itself well to conveying the intense sensory experience of shifting between the emergency department of a busy Toronto hospital and one in the developing Addis Ababa’s Black Lion Hospital, the two locations where Maskalyk splits his time.

Maskalyk manages to connect these two impossibly different places through the common themes of burnout, mistakes, and passion in their respective emergency departments. In the Toronto ER, burnout stems from the sheer volume of patients seeking care, a bed, or a meal. This contributes directly to the mistakes Maskalyk describes; after a draining overnight shift, he gets home and realizes with panic that he forgot to hand over one of the many patients he saw that night. In Addis, the burnout-mistake connection looks a little different. Burnout occurs in a large part from the discrepancy between public and private care and the constant frustration of being asked to do so much with so little. Having to choose which patients should receive a ventilator would wear down any physician, and the Addis emergency residents confront this impossible decision daily. While medical errors are most certainly a global phenomenon, the most poignant mistakes described in the book are those made by foreign philanthropists who want to “make a difference” in Addis. Ambulances with flat tires, empty orthopaedic surgery suites, obstetrical ultrasound courses with no provision of ultrasounds… efforts that could have gone so much further had they been tailored to what the Black Lion Hospital truly needed.

However, physicians in both places have an undeniable passion for what they do and why they do it. For Maskalyk, there is a sense of logic in treating the sickest first, no matter their income, race, class, or ability. Life on the Ground Floor is proof of the importance of this ‘sickest first’ principle, and ultimately accomplishes Maskalyk’s goal by showing us that life will take care of itself — if you have access to an emergency department.