Urgent alphabet

Urgent alphabet; The ABC of the ER (CD and book); Vincent Hanlon; Night Shift Productions, Lethbridge, Alta; 2000; Within Canada Cdn$20; outside Canada US$20; Order from Box 1582, Lethbridge AB T1J 3K4, or; online at www.abc-er.com (prices include shipping)

FIGURE A is for Airway, B is for Bloody Nose. So begins Vincent Hanlon's CD and photo essay on the alphabet soup of medical practice in the emergency room. In ER life, the ABCs are among many letters that roll off the tongue - IV, ABGs, CHF, NAD. Hanlon, in a mood varying from the whimsical to the deeply reflective, conjures up a poignant story for every letter. Accompanying the CD's 26 vignettes is a smartly designed booklet containing the text of each piece and images from the author's photo study, ER Nights. Co-produced by friend and ER colleague David Cebuliak, these short essays and poems thrust into the comedy, drama, blood and guts of a typical emergency room. The cover of the CD bears the warning: "Not a user's guide." And so it isn't, at least on the surface. But with each essay, poem and image I feel guided to a mood or moment that I have often experienced in emergency work.

Figure.

In addition to his own voice, Hanlon uses the voices of long-time friends from the media and the drama world. Introducing many of the pieces is a voice familiar to many emergency physicians who follow the Emergency Medical Abstracts tapes: Jerome Hoffman (who is eloquently eulogized in the piece entitled "J is for Jerry, Rick & Tom"). How delightful to hear the same voice that urges caution when using cardiac markers in evaluating chest pain, quoting the Buddha in the sombre "M is for mistake":

I am the owner of my deeds. Whatever I do, good or bad, I shall become heir to it.

The ABC selections come in very different flavours. The first essay confronts the most basic and feared domain in the ER: "A is for airway." The listener is taken to the high stress of a resuscitation scene and invited to take a moment to stand back and reflect on the drama. As the very frontier of life is reached and the ET tube is passed, the searing words of King Lear express the moment of utmost grief:

No, no, no life! Why should a dog, a horse, a rat, have life And thou no breath at all?

Word play is everywhere; in this piece, the elusive vocal cords, like heaven itself, have gates of pearly white.

The next scene moves from the sublime to the ribald. A bewildered patient confronts the armamentarium of epistaxis treatment in "B is for bloody nose." The laughter here erupts from the realization that the worlds faced by the patient and staff are very different.

Further down the alphabet, past Falls and Guts, is Headache. As in "D is for dead," "P is for pill" and "X is for x-ray," the role of ritual is played out. Evoking the medieval practice of trephination, Hanlon reminds us that modern medicine, too, has its incantations and spells.

I murmur a quiet benediction. I acknowledge the formidable powers of Life Stress and Vascular Spasm, Lunar Cycle and Rogue Virus. The stream of words defies comprehension.

Hanlon masterfully recreates the ambience of a particular ER moment in "N is for night shift." Anyone who has been there will understand the shiver of cold that greets the 5 a.m. nadir, and smell the odour of alcohol and profanity that taints the darkened air. The predecessor of "Night," "M is for mistake," also sets off a certain feeling - the shadow of self-doubt or potential error that lurks behind every patient encounter. "Q is for ..." captures the apprehension of calamity that can interrupt a slow shift at any moment.

I could go on. Every piece is well crafted and evokes a thought, mood or impression culled from the years of drama that Hanlon has witnessed in the ER. But this punchy work is more than just a collection of images. In all of his writing, Hanlon manages to twist the usual perspective so that common experiences are seen in an unexpected way. Thus, the catastrophe of a fall is carried on a cascade of voices while "Z is for zygoma" shifts from studied medical analysis of facial trauma to the "Biff!" and "Pow!" of comic-book fights.

Who would listen to this CD? I played it for a few friends; the nonmedical people laughed at the ironic or comic sketches, but many of the slower, more sober essays that rely on direct experience of the ER were not fully appreciated. I think, though, that anyone with direct or indirect experience of the emergency room, whether as patient, staff or family member would enjoy this collection. I have listened to it several times over, but henceforth will play it mostly one or two pieces at a time. As in the works of his cited teachers - emergency medicine gurus Jerry Hoffman and Rick Bukata, and the Trappist visionary Thomas Merton, there is much wisdom in Hanlon's irony, humour and reflection. If we take each piece as a short meditation, the human face of the ER might become a little more visible on the next shift.