Something for the Pain, Book Review Example

Dr. Paul Austin’s book, Something For The Pain, is a frank and sensitive account of the emotional impact that the stress of being a healthcare professional can have on the professionals themselves.  In it he recounts the challenges that he faced during the course of his long career as an emergency room doctor in keeping some sort of balance between his work and his life, the emotional effects that a very stressful job in medicine can have on the practitioner over time, and the challenges of taking care of and caring for patients who are in extremely difficult situations.

Different Facets of Caring

Dr. Austin presents many ideas in this book, but the focus is all on different facets of caring. The most obvious facet of this is that of caring for the patient.  He begins by describing how he felt when he was beginning his clinical rotations as a medical student: “solving medical problems while at the same time showing compassion was no longer a lecture topic – it was for real” (Austin, 2008, p.40).  But he also talks about how this feeling can change over the course of a healthcare career, describing the “caring curve” that many professionals go through: a study found that premed students’ level of empathy declines as they progress in their education, and although it spikes up again once they begin to practice medicine, it never achieves its original level (Austin, 2008, p.39).  His struggles with this give shape to much of the book.

The other facet of caring which Dr. Austin delves into, particularly in the last few chapters of the book, is the aspect of self-caring.  He is very honest about his own challenges in trying to cope with the stress – both mental and physical – of his job and of the toll that it takes on both him and his family. The breaking point seems to come when, in his desperate need for sleep, he chases his own family out onto their porch, yelling and frightening them.  He admits that “for one brief instant, I had come close to hurting Sam.  It scared me.” (Austin, 2008, p. 165). It is after this that he realizes that he needs to make changes in his life in order to continue to cope with the stresses of his job, and during the course of his therapy, he realizes that “before I could take care of other people, I had to take care of myself – I had to get enough sleep, exercise, and eat reasonably nutritious food” (Austin, 2008, p.203).  The changes help him, and he acknowledges that “Sally and the kids noticed the difference. I was happier. They enjoyed being around me” (Austin, 2008, p.207).  Burnout is something that nearly all caregivers can go through, from doctors right down to CNA’s and those who are for family members in the home, and learning to take care of oneself when one is a caregiver is a very important lesson indeed. Thus the title of this book becomes not only about the pain of the patients, but also the pain of the people who are caring for them and how the caregivers must cope with this.

Opinion of the Author’s Ideas

Dr. Austin presents his ideas on caring in an honest but still compassionate way that anyone in the healthcare field can relate to, particularly those who have experience in emergency medicine.  He does not romanticize the role that he plays in the emergency room; instead, he comes off as being very human from the beginning of the book, stating in the very first chapter of the book that “Mistakes are inevitable. I’d made them in the past and would make them again in the future.  But I was pretty sure I hadn’t this shift.  And I could accept that as good enough” (Austin, 2008, p.23).  It is hard, as a medical worker, to accept that you will make mistakes, since this could put the people who you are trying to care for in jeopardy; however, because healthcare professionals are human, mistakes will be made and this is a burden that anyone who has worked in healthcare has carried at one point or another in their career.  He is also very frank about the problems which he himself had in regards to coping with the physical and mental stress of the job.  This is particularly apparent in the scene where he describes breaking down his own door when his wife does not hear him knock in the chapter entitled “Splinters”, which seems to not only be describing the door, but his own emotional life: “I must be feeling more stress than I thought,” he tells his wife (Austin, 2008, p.141), and this will resonate with anyone who has worked in healthcare and let their job stress spill over into their home life.  All in all, this book is a very realistic account of the challenges that people face when they are in highly stressful jobs which deal with matters of life and death and of the emotional toll this can take on them.

Life Experiences in Relation to This Book

With a background as an EMT, it was very easy to relate to this book and to the kind of experiences which Dr. Austin recounts from his many years in emergency medicine. The chapter on suicide, “Tucker Put His Gun to His Head” was a particularly hard one to read: there is always something about suicide that is more difficult to deal with than, for instance, a fatal accident. Both result in the death of a patient, but it always seems much harder to deal with both for the families and for healthcare workers when that death was self-inflicted.  The first time you take someone to ER because they have tried to kill themselves is something that you never forget: in this instance, it was a woman who had lost her child over a year ago and had been in a tailspin of depression and unable to cope with the pain of her loss.  She overdosed on her medications and died on the way to the hospital and could not be resuscitated.  Trying to get your mind around how much pain someone has to be in to end their own life is not something that it is ever possible to do completely, and there is often a feeling of inadequacy at being unable to save someone that Dr. Austin seems to understand and empathize with.

The other chapter which was difficult to read because of past experiences was “Somebody’s Baby”, where Dr. Austin writes very frankly about what is like to be present at the death of a child: “…when it’s a kid, you want to work a code as long as you can. It’s human nature” (Austin, 2008, p.186).  He is right about this: even after you have been in healthcare for a long time, there is something that still feels unnatural and wrong about a child dying.  Once, on rotation as an EMT student, there was a baby brought in with severe RSV; the baby was blue and not breathing and though the doctors and respiratory therapists worked on that infant with everything they had, they were unable to bring him around and they had to pronounce.  It is still upsetting to think about that, even though it happened years ago; reading this book, with the openness that Dr. Austin discusses the emotional pain of these situations, is very reassuring that caregivers who have had similar situations have also felt the similar emotions of grief and pain.

Policy Issues in Something For The Pain

There would, in my opinion, be no drastic differences made in the way this book was written, and it is particularly admirable that Austin writes so feelingly about two important healthcare policies which have a major impact on American life: health insurance coverage in regard to drug and alcohol treatment and emergency room treatment for anyone who needs it.

The best example of Austin’s attitude towards the state of drug and alcohol rehab is the scene where he is trying to treat Mr. Smith, the alcoholic who is also suffering from suicidal ideation.  Dr. Austin outlines the situation pretty clearly: “if you have insurance that covers substance abuse, you can go into a private rehab center.  If not, you go home and follow up with the Durham County Substance Abuse Services the next morning. The only exception is if you’re suicidal…they’ll [the rehab center] allot a bed to a county resident who’s suicidal and needs rehab.  If those beds are full, you go to a state hospital” (Austin, 2008, p.170). His concern about the lack of or inconsistency in healthcare coverage for alcohol/drug rehab is a valid one, and one shared by the Center for Disease Control (CDC) in their paper entitled “Policy Issues and Challenges in Substance Abuse Treatment”. They note that “substance abuse treatment’s low priority is reflected in limited insurance coverage” (Center for Disease Control, 2002, p.1) and that “as substance abuse treatment increasingly comes under managed care, resources are being more tightly controlled. This has resulted in decreases in types, duration and intensity of services provided” (CDC, 2002, p.1).  Austin’s suggestion of taxing alcohol to help fund rehab programs is, at least an intriguing one, similar to the tax put on cigarettes to help fund smoking cessation programs.

His attitude towards health insurance is commendable: he states bluntly that “I am an ER doctor.  If you come through the doors of my department, I’ll take care of you regardless of your ability or inclination to pay….I am proud of the fact that ER doctors do not turn anyone away” (169). Austin is referring to the Emergency Medical Treatment and Labor Act (EMTALA) of 1986, which Congress passed to require that hospitals who offer emergency service and accept Medicare funding give those services to anyone who requests in without regard to that patient’s ability to pay: the hospital must, at the very least, perform a medical screening exam (MSE) and either treat the patient or, in unable to do so, arrange for a transfer to a facility that can (Centers for Medicare and Medicaid Services, 2014 , p.1).   This concept of care for all who need it is a central one to emergency medicine: when someone’s life is in immediate jeopardy for whatever reason, then a question of insurance coverage or financial status should not be a barrier between the clinician and the patient or affect the clinician’s duty to treat the patient to the best of his or her ability.

Impact of this Book on Medical Professionals

This book would be useful for medical professionals such as doctors, nurses, EMT’s, or anyone else who performs direct patient care, particularly in an emergency setting. It includes a frank discussion of emotionally sensitive issues such as how clinicians should or do act in cases, for instance, of a suicide or the death of a child.  Austin does not over-dramatize these issues, but he does discuss the emotional impact it can have on the healthcare providers who are working with patients who are mentally or emotionally unstable or who have just been through enormous trauma. He notes that “part of being an ER doctor is that you often have to care more about people than they do about themselves” (Austin, 2008, p.153) and this is something that can hold true for clinicians no matter which branch of medicine that they practice in.  Also, his journey towards realizing that caring for himself is part of his journey as a caregiver, and his wry comment that “I don’t know why it took me so long to figure out that I’d have to treat myself better if I planned to stay at such a stressful job” (Austin, 2008, p. 176) is one that any healthcare provider should take to heart.  The lesson that taking care of oneself is essential to taking care of others could have a major impact on how clinicians deal with the inherent stresses in day-to-day practice and hopefully avoid the danger of burnout, which is a major problems for healthcare practitioners at all levels.

In short, this is a caring and sensitive book — written by someone with vast experience in the healthcare field– that speaks to the challenges of being a healthcare professional.  Its advocacy of self-care to help the provider be able to care for others is an important, and often little-discussed part of being in the medical field. It would be an important addition to classes across the healthcare spectrum, particularly those whose work will lead them to the stresses – and joys – of direct contact with the patients whom they are caring for.

References

Austin, Paul (2008).  Something for the Pain: One Doctor’s Account of Life and Death in the ER.  New York, NY: W.W. Norton and Company

Center for Disease Control (2002).  Policy Issues and Challenges in Substance Abuse Treatment. Washington, D.C.: Center for Disease Control

Center for Medicare and Medicaid Services. The Emergency Medical Treatment and Labor Act. Washington, D.C.: Center for Medicare and Medicaid Services