IN THE EMERGENCY ROOM, DOCTORS NEED DETECTIVE SKILLS—AND EMPATHY: Why I went looking for inspiration in the ER

A tenacious ER doctor is the heroine in my new thriller about a deadly pathogen, THE RED LOTUS. My time researching the novel with ER doctors left me gobsmacked and grateful. They ARE going to get sick as a part of our front line of defense in this pandemic. Thank God they are strong, empathetic, and courageous — and have great senses of humor. Here is an essay I wrote about them, and why the star of THE RED LOTUS works in a New York City emergency room.

This essay appeared originally this week in Crime Reads.

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Ask ER docs for the most bizarre things they’ve ever seen in the emergency room and, invariably, they will tell you tales of inappropriate objects they have plucked from different parts of the human body. One ER doctor showed me the X-rays of them she keeps on her phone. Others will tell you of the little kids who’ve eaten Legos (lots of Legos) or wedged tiny Barbie stilettos up even tinier nostrils.

But then they’ll sit back and tell you why they choose the emergency room—and the answers surprised me. I expected they were all adrenaline junkies. And while some admit they take satisfaction in saving lives when the ER has become the sort of apocalyptic madness we see on TV, many of them are actually closet detectives and view their work rather cerebrally. As Mike Kiernan, an ER doc in Middlebury, Vermont told me, “Don’t forget: Arthur Conan Doyle was a physician before he created Sherlock Holmes.”

Holmes, of course, was the literary world’s first great sleuth, a fictional detective who, in essence, used one of a doctor’s principal tools to solve crime: pattern recognition. (Recall how important deductive reasoning was to the master detective: “You know my method. It is founded upon the observation of trifles.”) When it isn’t, for instance, a broken leg from a skiing accident or a deep gash on the thumb from slicing a bagel—one of the more common reasons people wind up in New York City emergency rooms on the weekend—it’s about deciphering the clues. Is this college student’s headache a migraine or is he simply hungover? Or is there more to it than that? Does this elderly woman have the flu or is it an entirely new virus? Being an ER detective can be especially challenging because, often enough, you are seeing someone in the small hours of the morning, or you’re exhausted from a 12 hour shift, or it’s one of those moments when the ER really is in chaos.

And then there is the danger: during a pandemic, ER doctors are on the front lines and many of them will wind up sick themselves. They work well aware of this risk.

I learned about ER docs while researching my new novel, The Red Lotus, because the main character is an emergency room physician. And an important part of who we are is what we are: what we do for a living. As a college freshman I took a literature course called “Perspectives on the Professions,” and it has stayed with me. We read books that focused on how characters were molded by their occupations, such as James Gould Cozzens’s classic courtroom drama, The Just and the Unjust, and Scott Turow’s account of his first year at Harvard Law School, One L. As Scott Fitzgerald taught us, “Action is character,” and a whole lot of the action in our lives occurs while we are at work.

As a novelist, my characters’ jobs are often critical to both who they are and what happens in the story. Sometimes, my books have even had titles that telegraph my obsession with the nexus between what we do and who we are: Midwives. The Flight Attendant. Water Witches.

The emergency room is also one of those places we all see and, often, we see when we are at our very worst. We are in quite literal pain, we may be scared, and we may even be embarrassed. (Another reason people wind up in emergency rooms? They have just tripped over their pet.) Our breath may be toxic because it’s three in the morning or we may be holding a small child in desperate need of a fresh diaper. Kiernan said you can always tell what season it is in Vermont by the injuries and illnesses he sees: the snowmobile versus the tractor, the flu versus Lyme disease.

And so, in addition to being detectives, I think ER doctors are especially empathetic—and they experience just as much trauma as any first responder. Talk to an ER doc or trauma surgeon who’s helped care for the wounded after a mass shooting and you will witness their countenance change almost the way a war veteran’s does while recalling combat. (And then there are those ER physicians such as Rebecca Siegel, who told me that when she was an EMT and first year medical student in Israel, she was among those attacked in a mass shooting, but was uninjured—and, thus, would be among those involved in patient triage.)

Those two personality attributes, investigative curiosity and empathy, were crucial in the creation of the main character in The Red Lotus, Alexis Remnick. The novel is a thriller about—among things—a cyclist who’s found dead on a bike tour in Vietnam, but it’s also about the legacies of the Vietnam War and what it means to discover the one we love has been lying to us all along. But there are myriad scenes set in a New York City emergency room, some of which reveal bits and pieces of who Alexis is as a human being and some of which are critical to move the plot forward. An example of the former is Alexis’s time in the ER cubicle with an elderly patient whose heartburn is likely the symptom of something much worse; an example of the latter is when she digs a bullet from the biceps of the man who will become her boyfriend and with whom she will journey to Vietnam.

But like all ER physicians, she is also asking questions and always trying to think outside the box – even when she realizes she herself is in spectacular amounts of danger.

And I think that gets at the main thing I learned while researching The Red Lotus: Sometimes the best detectives wear scrubs.

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THE RED LOTUS is now on sale. Even in the midst of a quarantine, the novel is available wherever you buy or download books.

Chris Bohjalian

Chris Bohjalian is the author of nineteen books, including his forthcoming novel, The Sleepwalker. His other novels include the New York Times bestsellers Midwives, The Sandcastle Girls, The Guest Room, and The Double Bind.

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