Before the body says no

I used to think that emergency medicine was codes. Running traumas. Delivering the occasional surprise baby. Cutting open chests (well, I’d leave that to trauma surgery if possible). Now I work in a much smaller hospital where it’s rarely a heart attack or bad forestry or farming accident. Usually, it’s coughs and colds. Even when I worked at a bigger centre, I was surprised by how many codes weren’t ambulances patching a CTAS 2 (an urgent case) with their sirens wailing, but a nurse telling you that bed 12 can’t breathe. In other words, the crises build up from the patients who are in house already. They sensibly came to the hospital earlier, when they already knew they “feel pas bien,” as we say in Franglish. Read: Dear Doctor, are you intuitive? So, I shouldn’t have been surprised yesterday when they asked for my medical expertise at the Las Vegas writing conference. “Richard,” from northern Europe, had stayed in the sun on the Vegas sidewalk this morning, which meant he was not acclimatized to temperatures of about 120 degrees Farehnheit, even for five minutes. Richard is normally intelligent, organized, and on the go. Today he spoke more slowly and fumbled when he tried to pick up his hotel card from the table. His friend “Selena” had already given him water, a sports drink, chips, and chocolate (water and electrolytes), which he took. He could walk and talk and didn’t have any pupillary defects or lateralizing signs, but still seemed out of sorts. Read: The sixth sense "Is there anything else he should do?” Selena asked me. "Just lie down with his legs up or sit with his head between his legs,” I said. Richard wanted to keep working, but he agreed to move to a lying down/legs up position, so he was still in the room but at least not fighting against gravity, which was good because it turned out he had a history of vasovagal syncope. At break time, I started to gather Richard’s things, and Selena asked if I wanted to check on him. He still looked like heat illness. He felt chilled, and after I asked permission to touch him, I noted his sweaty, goose-pimpled skin. “You’d be better off going to your room where you can lie down and adjust your temperature,” I told Richard. “You’re not going to get anything else done. Sleep. We don’t want you to faint.” He didn’t want to miss the writing workshop, which is a big deal. I myself haven’t attended one of these workshops for the past four years, because of COVID-19, my family, and the fact that I reduce my transcontinental flights to protect the environment. I understood his devotion to writing, but part of medicine is simply giving people permission to rest. Richard covered his eyes. “I don’t know why I ended up in the sun. It was stupid. I was working so hard—“ "That’s why,” I said gently. “You were working so hard, not sleeping, and then you started making bad decisions.” "I was writing for hours,” he whispered. “I kept waking up at night, too.” I nodded. “You’ve probably heard of ‘When the body says no,’ when you’re very driven and won’t stop, your body forces you down. I’m like that too.” Richard cried when Selena and I took him to his hotel room. I could tell this embarrassed him. I know men aren’t given space to express their emotions. Our society scorns weakness, but none of us is perfect. Society tells us that rest is for the weak or the dead, which is a lie. Rest is joy. Rest and “weakness” can mean connection. Richard is a high-powered executive who plans to retire soon and switch over to writing full-time. He kept the day job longer than he wanted to make sure his children would be looked after. His writing is critically acclaimed and well-loved. Up until now, mostly, he and I had talked about writing and leveraging success. In that moment, when Selena held Richard and he sobbed, I witnessed the more vulnerable side of him. I turned away to give them privacy, but it told me more about him, and about the depth of their friendship, than I had glimpsed in years of workshops. Selena knew how to look after Richard because she had been sick too, and her husband had experienced heat illness before he thoroughly figured out how to avoid Vegas heat. “How many times have you looked after me?” Selena asked him. “Now let me help you.” I quietly quoted Leonard Cohen: Ring the bells we still can ring, There’s a crack in everything. That’s how the light gets in. Medicine usually doesn’t mean the big wins or head-scratching cases. It can be small but meaningful stories. I learned a few things yesterday. I also live in a colder climate but had literally gone walking in the heat for 80 minutes by myself the day before, which ultimately gave me a headache, but no long-lasting effects. Richard going down reminded me that we are all built differently, and it’s always best to err on the side of caution when it comes to health. Much as I love writing, we should never make it more important than the writer. Just like medicine is never more important than the doctor. If you need to rest, please do. I bought Sark’s book Succulent Wild Women partly because she talks about her friend Isobel, who says, “My dear, you are looking extremely nappish! Come inside and lie down immediately.” I wished my parents would say this to me. So now I say it to you: Sit. Lie down. Hug yourself. You are safe. Rest.

Before the body says no

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