Bloodletting & Miraculous Cures

by Vincent Lam

Published by Doubleday Canada

350 pages, 2006

Rage Therapy

by Daniel Kalla

Published by Tor/Forge

304 pages, 2006





Emergency Fiction

Reviewed by Linda L. Richards


We barely think about emergency medical practitioners. Maybe we even try not to. They only come to mind in, you know, emergencies, when they're suddenly the most important person in our life. For a few hours. A broken collarbone, a dislocated shoulder, a heart attack, water breaking a couple of weeks early. Should any of these things happen we're on the emergency physician with head-spinning speed: our best chance at moving through crisis unscathed.

Without crisis, the emergency physician ceases to exist for us. Let's face it, it's pretty easy to associate them with vague maybes, and none of those possibilities are pleasant. But in the slender band of context we hold for emergency room physicians, part of it isn't for the creation of great literature. Speed with a suture, perhaps. The elegant wielding of a defibrillator, maybe. Putting words to paper in a way that makes the heart sing beyond a prescription pad? Not a chance.

Now, all of the above form part of a sort of universal truth: so in a publishing year when two emergency room physicians release books destined for wide acclaim in their chosen arenas of storytelling, one can't help but wonder if it's some sort of sign. And while two does not an epidemic make (as either of these authors could certainly tell you) it is at least enough of a sampling to make you pay attention, perhaps group them together for review.

And so, here we are.

It can be argued that in his Giller Award-winning Bloodletting & Miraculous Cures, Vincent Lam shows us too much behind the scenes of the emergency room doors. To be honest, it was certainly more than I needed or wanted to see. And while I'm not a squeamish reader, being present for an emergency cesarean or a heart attack is not anything I had ever planned on. Beyond that, Lam showed me something I'm sure I really, really didn't need to see: the man behind the curtain. And emergency room physicians are just men, just women. As starkly -- plainly -- human as you or I. I don't think that's a piece that life requires me to understand.

"Have you got it?" says Nigel.

"Yeah, I've got it." He slips the tube down the back of the mouth and thinks he sees the tip at the door of the vocal cords.

"Are you sure?" says Nigel.

"Absolutely," says Fitz.

He isn't sure. Relax. He breathes. Doesn't matter, probably.

But the idea of dealing with the emergency physician as living, breathing human is not the point of Bloodletting & Miraculous Cures. Instead what we get are a dozen connected and beautifully executed stories. Lam gives us a delicately wrought glimpse into the lives of a handful of students -- determined Ming, stalwart Chen, roughshod Fitz and sweet but doomed Sri -- as they move through medical school then enter the bloody arena of high speed medicine. Don't be confused: this is not ER or Gray's Anatomy or even House where, in one way or another, we're led to see the inner workings of places not usually open to us.

With Lam's book, we do get to see those things, but it's almost a side issue. The inner bloody messes we're really being allowed to see are those inside these four intelligent humans and we don't see their stories as much as we see their souls. In Lam's hands, even some of the hard-core medical stuff is beautiful. "For months now," Lam writes, "Janice had heard the sound of her baby's heart during checkups at Dr. Ming's office. Each time it felt like a growing voice, a surging message in the fetal staccato of cardiac rhythm."

It's heady stuff. Some of it is lovely. And a lot is difficult to look at straight on.

In three books so far -- Pandemic, Resistance and now Rage Therapy -- Vancouver ER physician Daniel Kalla takes a very different approach. Not for Kalla, Lam's slow motion examinations of human condition. Kalla might well grow to be the James Patterson or John Grisham of the medical world. The insights he brings from the world of medicine in general and emergency medicine in particular inform and shape his writing, but Kalla is here to tell us a story, so just grab your seat and hang on.

In his latest novel, Rage Therapy, Kalla introduces us to Seattle-area psychiatrist Joel Ashman. Joel is dealing with the violent death of Stanley Kolberg, his friend, mentor and ex-partner. He's also still reeling from the loss three years earlier of his own pregnant wife.

Joel finds himself drawn into the police work on his mentor's death by homicide detective Ethan Devonshire -- "Dev" -- and his beautiful green-eyed partner, Claire Shepherd. Joel finds himself oddly compelled by Claire, something that surprises him, since he's been true to the memory of his wife since she died.

While the investigation of Dr. Kolberg's murder presses forward, Joel is reminded of the death of one of his patients the previous year. Though we're told that Angela Connor's death was a suicide, we see the events leading up to and around that suicide in flashbacks narrated by Joel throughout the book. And when both deaths seem to be tied to S&M and patient abuse, no one is more surprised than our narrator.

Like Lam, Dr. Kalla brings the detachment learned in the emergency room into his fiction with the sort of ease that might occasionally make more sensitive readers choke:

Kneeling closer, I caught a slight hissing sound. I wasn't sure if the noise came from his lips or the holes in his chest, until I noticed the blood bubbling in his mouth and saw his neck muscles contract in a respiratory effort .... As soon as I touched his cool skin, my fingers turned sticky as if dipped in glue. I slid them up and down the side of his neck, before finding a faint, rapid beat.

Um, ewww!

I don't think either Lam or Kalla are bringing us this careful gore in an effort to make things more exciting. That is, none of the violence in either book feels gratuitous and the excitement comes organically and from numerous sources: no non-essential disturbances are required. But this is their world: the world of blood with a glue-like consistency and a world where sometimes you have to scream for an epi and occasionally the crash cart comes late -- too late. You don't just see an autopsy, you watch while the coroner makes "Y-incisions across the chest and belly (causing the usual mess of bowels to spill out)."

Kalla is not the stylist that Lam is, but what he lacks in delicacy, he makes up for with a sort of raw energy and power. Rage Therapy is a compelling story. It's layered and nuanced and occasionally even surprising. Flashes of dry wit are an unexpected and welcome bonus.

The concept of emergency room physician as flawed and fallible human is not an easy one. In a way, it's more comfortable to keep them where they've always been: invisible and godlike behind the emergency room's busy doors. This brace of books, however, shows that they're no longer willing to stay there. The gain is all ours. | December 2006


Linda L. Richards is the editor of January Magazine and the author of the Madeline Carter novels: Mad Money, The Next Ex and Calculated Loss.