Frank Huyler, Berkeley and Los Angeles, University of California Press, 1999, 154 pages, £12.50 hc.

“I did my best, matching up the creases of his skin, easing the bright half-moon of the needle in and out, daubing away the dark blood that rose in little balls from the needle point, tying my knots like a fly fisherman. The thermostat in the room was turned up all the way, but he was cold—I could feel it through my gloves. After a while his face began to lose distinction to me. The wound stood out, became an entity unto itself. The earlier intimacy I had felt—bending over him as he lay there, my breath all around him—began to recede into the task.”(page 31)

Emergency medicine must have a good theatrical agent. It is hard to turn on the TV without seeing a slice of blood-soaked action from Casualty or life-and-death decisions from ER. Most viewers know how to boss around a resuscitation team while manually reducing a fractured femur and counselling the survivors. Thus emergency medicine has become a ratings-grabbing adrenaline-driven cliché. Frank Huyler's excellent book of stories is not more of the same. His cool, precise prose cuts through to the core of medicine—the patients', and the doctors', emotional response to their plight.

Huyler presents a series of twenty-eight brief stories, all narrated by a young emergency medicine doctor, like Huyler himself. This narrative has the ring of direct observation tempered by the need for confidentiality and dramatic structure. There are some common characters but each tale essentially stands alone. Some depict the drama of the emergency room but use the tension created to interrogate the participants' reactions. In “Needle” a quick-thinking doctor diagnoses and treats a tension pneumothorax. “I realised that I had saved him, that he was alive because of me.”(page 32) Common fare for TV doctors, you might think. But “Needle” ends with the doctor visiting his patient on the intensive care unit (ICU) “savouring him, taking something for myself”.(page 51) The heroic, skilful doctor is revealed as somehow predatory towards the man he has saved.

Huyler is adept at portraying the range of human behaviour to be observed in the emergency room. A Munchausen patient's familiarity with medical routine is described with humour and dignity; “‘I'm having chest pain’, he replied. And before I could ask - ‘it's a ten out of ten’.”(page 37) While his son lies critically injured a father tends the body of another victim of the same car crash. The attending surgeon observes:

“It suddenly seemed very important that I look closely, as closely as I could, at this man taking on for the moment the role of the father to the dead son, kissing him softly, holding his hand, then turning back to me and the doorway.”(page 44)

The doctors in the emergency room are minutely detailed. A frighteningly disturbed drug-addicted neurosurgeon is portrayed in “Speaking in Tongues”. It would be easy to demonise this doctor, who “when she'd had a really bad day (would) go to the farmers' market and buy a live chicken. She'd take it home and light candles and put on music and cut the chicken's throat with a straight razor.”(page 112) But Ruth, the neurosurgeon, is allowed a strange dignity, carrying on seeing patients even after a damning drug test has been taken. (page 110) On a rare night off, Huyler's narrator takes another resident on a date. This is an occasion for a brutally honest analysis of the ambitious doctor:

“She might have been kind, in another life, but wasn't, at least right now, and neither was I. There was cruelty in us both, as we took turns with the incompetent anesthesia residents, the lesbian gynecologists, the pathetic surgeon drunk on rounds. We were after weakness, real or otherwise, and there was a grim joy in our voices, a kind of complicity, as if we were letting each other in on a rare secret.”(page 118)

Students of the medical humanities should particularly take note of Dr Whistler in “Burn” as he throws literary references around an operating theatre like rusty scalpels.(page 96-page 7)

The Blood of Strangers could hardly be bettered as a vehicle for ethical discussion. The true complexity of an ethical narrative is laid bare in “The Short Arm of Chromosome 4”. The desperate struggle of a family as they try to recover a member afflicted by Huntington's disease from the ER is a truly remarkable piece of writing. (page 45-page 7) In fewer than 1,000 words Huyler animates ethical discussion of this disease in a way that the wordiest ethical system would fail to.

The Blood of Strangers is a truly important work of medical literature. Again and again Huyler's narrative both chimes with my own experience of medicine and suggests different ways of considering the struggle between impassive doctor/technician and the human within. This is a book likely to develop self reflection and empathy in the medical reader. Consider “Prelude”, describing the experience of a student dissector. How many of us who have dissected will recognise this memory. How few of us could convey its meaning so well.

“Our cadaver was sixty-two-years-old, and after a while, when we had gotten used to it, we cut around his tattoos and saved them, like a little pile of photographs which we left by his intact head. Mother. A red rose, and a woman's silhouette. The United States Navy.

“When we reached it, the cancer in his lung felt like sand under the blade. I felt it in my hands long after the lesson was over. Foreign, grey like fog or gravel, there in the apex. It was strong and frightening, because even as we reduced him to pieces I knew that he was real, that he had stories to tell, that he had looked out at the sea from the decks of ships. I could feel it when I chose to. Mostly I chose not to. Mostly it was anatomy.”(page 10–page 11)