St. Michael’s emergency doctor and bestselling author, Dr. James Maskalyk pulls back the curtain on life in the emergency department in his award-winning memoir, Life on the Ground Floor: Letters from the Edge of Emergency Medicine. A recent finalist for the prestigious 2018 RBC Taylor Prize, Dr. Maskalyk won the Hilary Weston Writers' Trust Prize for Nonfiction last year.
Dr. James Maskalyk can read people. After more than a decade working on the frontlines of emergency medicine in places from Canada to Cambodia, he can spot the sickest person in a crowd in an instant – “It’s an energetic read of a body coming apart” – and predict which patients will follow up about their care after discharge – a unique skill that’s sharpened his vision in a fast-paced, high-stakes environment.
In his memoir, he gives readers a rare glimpse at life in the emergency department (ED) at Black Lion Hospital in Addis Ababa, Ethiopia – where he practices and teaches – and St. Michael’s Hospital here in Toronto, both bustling, high-adrenaline spaces crowded with more and more people every day.
“In the last 10 years, as the downtown’s bloomed, there’s not a day when there’s not dozens of people waiting in our ED,” says Dr. Maskalyk. “There’s no quiet time of day anymore. There used to be a time when the ED would get quiet around three or four in the morning, more or less, but not anymore.”
And it shows no signs of slowing. The ongoing influx of people moving to Toronto’s downtown core, coupled with an aging population battling multiple complex and chronic conditions, will certainly contribute to the impending busyness of emergency rooms.
Currently, St. Michael’s Emergency Department – originally built to accommodate 45,000 patients per year – sees more than 77,000 patients annually and growing. That’s more than 200 people a day with health-care issues that run the gamut from a sprained ankle to a heart attack, to a gunshot wound or a drug overdose.
To effectively respond, Dr. Maskalyk and his colleagues have to be ready to react instantaneously. The ED is fast-paced and perpetually changing; a place where decisions have to be made quickly amid relentless interruptions; priorities need to be constantly shifted; and compassion must never be compromised.
But even the most high-functioning individuals can find themselves on the fast-track to burnout. A study by the Workplace Safety and Insurance Board found that three in five health-care workers suffered from “role overload,” a situation that can be damaging to both physical and mental health, and lead to reduced productivity, increased absenteeism and greater staff turnover. Dr. Maskalyk isn’t surprised, “You can really lose sight of what you need when you’re faced with the immense needs of other people, and that can create the conditions that lead to burnout and dissatisfaction.”
Part of the self-care he practices is mindfulness, a form of meditation that involves focusing one’s awareness on the present moment. In addition to reducing stress, mindfulness has been found to improve memory and lead to better decision-making. For Dr. Maskalyk, it helps him pay better attention to his patients so he can make a real connection with them. “The more I pay attention to that intention, the better the outcome is. And I can be a better doctor.”
For Dr. Maskalyk, emergency medicine is about more than sewing people back up; it’s about humanizing what can oftentimes be a very impersonal experience and learning to better read patients so questions about the conditions of sickness – many of which have nothing to do with their bodies – can be addressed. “I can see a better future and part of that is changing the conditions that create health and happiness for people.”
ABOUT THE EMERGENCY DEPARTMENT AT ST. MICHAEL'S
To prepare for the future, St. Michael’s Hospital recently opened the first phase of its new Slaight Family Emergency Department, a state-of-the-art acute area purpose-built for patients with urgent injuries and illnesses. As downtown Toronto’s only trauma centre, St. Michael’s cares for an incredibly diverse, inner-city patient population that continues to grow. The ED’s new acute area is twice the size of the previous location, with wider hallways to reduce overcrowding and single-patient rooms to maximize privacy and minimize noise. The revitalization and expansion of the hospital’s ED is expected to be complete in 2019. Work on phase two which involves building a new mental health area and trauma bay is currently underway. Thanks to generous donor support, we will be better equipped to accommodate growing volumes of patients in a better-designed environment.
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