Heart attacks. Car accidents. Gun-shot injuries. The list of traumas that might land someone in a hospital emergency room runs long. Frank Huyler has probably seen them all.
An emergency medicine doctor in Albuquerque, Huyler's first book, 1999's The Blood of Strangers, wove together vignettes depicting his entry into the world of medicine with personal memoir. Kirkus Reviews described the book at the time as a collection of "utterly engrossing, moving, poetic accounts." The same could easily be said for Huyler's new book of essays, White Hot Light: Twenty-Five Years in Emergency Medicine, published this week by HarperCollins, which explores similar professional and personal terrain from a later vantage point. The linked essays illuminate the lives Huyler encounters in his work—from the Iraq veteran whose brain is filled with shrapnel to the fake rock star with end-stage liver disease. Huyler depicts the crises he treats with vivid and cinematic detail, but the book is less about the salacious depiction of trauma than it is an investigation into the vulnerabilities and resiliencies of human nature. His patients' stories intermingle with those from his own life: visiting his aging father; attending the wedding of an old friend with acute lymphocytic leukemia; his own motorcycle accident.
A tenured faculty member at University of New Mexico's School of Medicine and ER doctor at University of New Mexico Hospital, Huyler also is the author of The Laws of Invisible Things and Right of Thirst; his poetry has appeared in The Atlantic Monthly, The Georgia Review and Poetry, among others.
This week, SFR presents an excerpt from White Hot Light accompanied by an interview with the author about writing, emergency medicine and, of course, the impact of COVID-19 in the hospital setting.
The following interview has been edited for style, clarity and space.
SFR: Both your new book and The Blood of Strangers interweave vignettes from the emergency room with memoir. What made you decide to revisit the form of your first book?
Frank Huyler: That first book was written basically at the end of my residency…and [when] I was just starting out in practice. Inevitably, when you get to a certain age, you start reflecting back on your life and the choices you've made and so on. I realized I had a different view of medical practice than I did at that time. My perceptions had changed, and I had gotten older, and you want to try to ask yourself questions like, 'have you learned anything from these experiences?'…'Have you made any progress?' So, I thought it was time to have another look at that world. I had the chance to go to a writer's colony, the MacDowell Colony [while on sabbatical], and to really think back over the past 20 years or so and revisit that material…through a lens of a little more experience and age.
I’m guessing I’m not the first person to ask if you were influenced at all by William Carlos Williams’ The Doctor Stories, at least with the first book?
I was influenced. Absolutely. I think that's a great collection and I actually read that in medical school. I wouldn't say it was a complete model, but…I think the approach is very similar. One of the compelling things, particularly about The Doctor Stories, for me, is how undated it is. This was a different age entirely in terms of medical practice, but the stories themselves seem so alive and current. So that appealed to me, that notion of exploring the timeless elements of medicine, rather than anything specific to our age.
What drew you to emergency medicine specifically? Is it unusual for a doctor to spend an entire career in an ER setting or is that the only spot for that specialty?
It is a specialty; people sometimes have misperceptions about that. It's a specialty just like pediatrics or internal medicine or surgery or anything else. It's the newest specialty in medicine and, at this point, people who work in most emergency rooms are trained in emergency medicine. The difference in emergency medicine training is that it's very broad. So, you're seeing people in all different categories—from kids to old people and so on—with an emphasis on things that are bad that can be dangerous in a temporal setting. So, it's sort of like your job is to identify serious conditions as quickly as you can and to do what interventions you can, but mostly it's a diagnostic specialty and it's sorting out people who are dangerously ill from those who are not—and that's trickier than it sounds.
Is a particular kind of person drawn to that, someone who really enjoys pressure? Stress?
Yeah. And I have to say, my personality does not really fit terribly well with my specialty choice. My choice to do emergency medicine—part of me is drawn to the intensity of it, certainly—but I made a somewhat calculated decision when I was young that I wanted to have time to do other things outside of medicine, specifically write. And it's one of the specialties that allows you to do that. It allows you to be in the thick of it in a real way when you're working, and then to have the time around it to do other things. I'm probably naturally an internist at heart.
There’s lots of fictional TV doctors and now, because of COVID-19, it also feels as though actual doctors have more of a visible presence on the news. What’s your sense of the public perception of doctors’ work? Is that something you’re trying to address in your writing?
I'm certainly not interested in the dramatic heroics and the ego validation that…a lot of doctor shows, at least traditionally, are about. I'm much more interested in what it reveals about our lives in general. There's certainly well-worn paths around the idea of being Sherlock Holmes or House, somebody figuring out…this rare diagnosis and there's this basic notion that…the best doctors are those who can reason their way to an elegant perfect solution. But that's not true to the world; those kinds of things occur hardly at all. What you're really trying to do is check the boxes, be thorough. It's not so much about the intellect as much as it is about casting a wide net and being appropriately cautious when you need to be.
You have a House moment in your book, though, when you diagnose AIDS in one of your patients by being old enough to remember AIDS.
That was not an intellectual moment; that was a moment of memory. It wasn't that I was like, 'wow, I'm so smart that I figured that out.' It was more like, 'that guy looks like an AIDS patient' because I've seen them in the way that the younger generations of physicians just haven't.
There’s another side to public perception, which is mistrust of Western medicine, of doctors. Is it warranted? What do you think has contributed to it?
I think that's a large topic. And there's a lot of reasons why people are mistrustful. One is the profit motive in medicine, and the expense and the perception of monetary interest on the part of the medical system, which is absolutely accurate, incidentally. The other is the resistance to any kind of authority…There's an anti-authoritarian streak in America, where people want to believe in their own individual liberties and choices and they're suspicious of expertise. And frankly, in many cases, most of the time, most of our lives, we're not sick, so most people are not sick most of the time for most of their lives. So, a lot of these notions about mistrust of Western medicine are largely academic most of the time.
And there are certain things that Western medicine is very bad at: complaints that are hard to pin down, for example. Western medicine is very bad at navigating the difference between the physical and the mind/body intersection point. And also—this shouldn't be underestimated—there's a very great coldness in Western medicine; there's a clinical white coat, bright lights, needles, tests, that sort of thing; it's not a welcoming or warm environment at all. In fact, it's a pretty terrifying environment and it's unpleasant to be a patient. People don't want that: People want warmth and emotional support and the sense that whomever is seeing them cares about them. We live in a time, particularly now, where it's very hard to make people feel that way.
We’re publishing a chapter excerpt called The Gun Show, which contains short vignettes of people injured or killed by gun violence whom you ended up treating in the ER. I’m wondering if, aside from the detachment you need to do your work, it’s had an impact on your political position one way or another.
I wasn't out to make this a political treatise but, yes, do I have political views. Am I in favor of gun control? 100 percent. We've been seeing a lot of shootings recently and…a lot of it has to do with simple availability of handguns. I realize this is very controversial in America—because I can see the arguments for the Second Amendment at times—but, nonetheless, there's a wholesale absurdity to these young guys killing each other for no reason.
And a craft question about that chapter: Can you talk about the lyrical repetition about learning how each incident happened.
I thought it brought a resonance to the story in a way that a poem might, a little bit, that was the intent. There are unique circumstances [in each shooting] but patterns endlessly repeated with slight variations. That's something that you do see a lot of in emergency medicine is patterns of behavior, patterns of events that repeat and repeat and repeat.
You seem to see more abject and depressing sights in one shift than most of us will ever see in our entire lives. What do you think has made you and makes other medical professionals able to handle so much human suffering? Is it constitutional? Is it training? Is it both?
I think one of the things people tend to dramatically overstate is human sensitivity. People are pretty tough, everybody, and this idea that people who work in emergency rooms are some sort of different breed is just not true. We all get used to things. There's an essential sort of toughness among people, and you see it in many parts of the world. One of the consequences of privilege or wealth in a wealthy society is this notion of hyper-sensitivity: 'How can you take this?' People have been taking things like this forever, and there's a lot of people also in their lives who go through things far worse.
But, obviously, you need some level of detachment when you’re treating people who have been beaten by their partners or are dying of cancer or are having a heart attack. Is it hard to keep that balance between detached but not indifferent, which seems what you depict in the book?
That's exactly right. People go through a great predictable psychological pattern when they start doing this stuff. When medical students start off, they are super earnest and emphatic a lot of the time and then they very rapidly change and…kind of go the other way, which is black humor and real detachment…which are all…about distance. I think what you want is a kind of sincerity about trying to do what you can within the limits of what you can do while protecting yourself. You want to find some sense of a little bit of human warmth in all of this, not only because it helps you be more invested in your work, but also because one of the problems and casualties in this kind of work is it bleeds out into your personal life and your perception of the world as a whole. You have to try to remember [that you're] working in a selected dark environment: Most people are not being run over and shot. Most of the time, people are doing just fine. Most of the time, people don't have metastatic cancer.
The book begins with an epigraph from JM Coetzee: “I don’t think we are ready to die, any of us, not without being escorted.” The first half of the book seems as though you’re focused specifically on people who are alone and isolated— and this was pre-COVID when you were writing this. Was that a concern?
I can't speak to other societies, but I can say I think America is a very isolated lonely place for many and the idea of solitude and loneliness in the face of events is something I think is deeply and inherently terrifying for most people. That was absolutely a theme I was trying to explore, and in the second half of the book [I was] trying for a little bit more light.
You grew up in Iran, Brazil and Japan. Do you think your upbringing influenced your perception?
I think it did. I grew up basically as an expatriate as a kid, not in the United States, and so I've always been a little bit uneasy wherever I am. I'm an American, obviously, but I've never felt completely American, if that makes sense. One of the reasons I think I saw the COVID pandemic coming a little more clearly was because of that experience; because I know how small the world is; I know how interlocked it is. I have this basic perception that the other, the far away, is really not so far away, and I think that came from probably my childhood.
Let’s talk about COVID-19. You wrote a piece for VICE at the outset of the pandemic expressing concern about hospital preparedness. How are things now?
The problems that we've seen are almost exclusively national. The hospitals in New Mexico in the early spring, like many hospitals, were caught off guard, like everybody was caught off guard. But I think the hospitals have caught up and are doing the best they can at this point, including UNMH, and a lot of people are working very hard. The problem is we're faced with just unbelievably disgraceful national failures that make [everyone's] jobs very hard, and one of them is testing. There are rapid tests that can come back in an hour and we don't have enough of them; the PPE situation is just a terrible disgrace across the country.
…Hospitals are on their own and they've been struggling to try to adjust to this new reality and they have and New Mexico has actually done very well compared to other states, thanks to the governor. She did a great job and we also have some scientists—particularly at Sandia National Lab and Los Alamos working with the Department of Health—and they've done a lot. As a result, New Mexico is a lot better [than surrounding] states, but we're still up against it…and now the weather is cooling and the schools will likely reopen at some point and flu season is coming. So that combination is very ominous.
So our declining cases aren’t comforting to you?
It's certainly better than if it was up…it's encouraging to see, but people need to not think we are not facing a major, major challenge ahead, which is winter, flu season and open schools, and that is a very daunting prospect.
Has COVID-19 completely changed your work?
It's absolutely completely changed our work. We've divided up the emergency room into COVID and non-COVID areas. We're trying to separate and distinguish patients with COVID from patients who don't have COVID—that's a great challenge. The screening test that you use is probably 50 or 60 percent accurate because you have a lot of asymptomatic and pre-symptomatic infection, and it's very important to keep it out of the general patient population. Right now, the prevalence here in New Mexico is still, relative to other parts of the country, low enough so things are functioning, but we still remain at risk for surges and cases that are going to put a huge strain on us.
The title of the book, White Hot Light, seems to reference both a Ray Bradbury quote you use, “Let the world burn through you. Throw the prism light, white hot, on paper,” and an image at the end of the book of the New Mexico winter sun: “If you let it, it will fill your windshield with white hot light, and blind you in the mirror with its power.” I took this all to mean that you were placing great importance on not letting these individual stories blur together—that you wanted to illuminate them.
Yes. It's also sort of like the rising sun of the morning—that transcendent quality—hopefully of illumination and grace and, so, the attempt at both illumination and grace.
THE GUN SHOW
He was in his twenties, in a uniform, the driver of an armored van. He'd been ambushed outside of town, in the desert, by men with rifles. They'd fled before they got the money.
The top of his skull was gone. His brain had a delicate pink hue, and a strange beauty to it, like a jellyfish unfolding in the water.
We learned the story from the police.
She was seventeen, getting off the school bus, and caught in the crossfire between two rival gang members. At first we could not find the wound, because it was a small-caliber handgun, but she lay there dead on the gurney, anyway, and finally we rolled her and saw it—a tiny blue hole, the size of a pencil eraser, high on the nape of her neck, covered by her long dark hair.
We learned the story from the paramedics.
He died quickly, and he was unlucky, because it was only a .22, and it hit him in the right side, right above the belt line, and went through his aorta. He had been running for his life up the ramps of a parking garage. His assailant shot him through the gap from the level below.
We learned the story from the police.
They were sisters, nine and ten, lying beside each other on adjacent gurneys in the trauma room. Someone had mistaken their house for another, and fired blindly from a car with an assault rifle. The girls were sleeping together in the same bed upstairs. My girl had a perfect red crease through her earlobe from the bullet, but that was all. She lay quietly and looked up at me, and didn't cry. Her sister beside her, on the other side of the curtain, was dead.
We learned the story from the papers.
He was in his thirties, and came by helicopter, and was still alive. Someone had called an ambulance from the house in a little town on the Colorado border. He had two small-caliber holes in his forehead, placed very closely together, wounds that radiated experience and lethal calculation. Meth, they said. A professional killing.
We learned the story from the flight crew.
He was in his teens from the reservation, shot six times in the head with a .22 rifle, and everyone was drunk, and no one really knew what the story was, but the flight crew said it was a domestic dispute. He was alive, but his face was swollen and bruised and distorted, his lips puffy and his pink tongue protruding a little around the endotracheal tube.
She was clutching her belly and fading in and out, her dark skin pasty and gray, and you see that only toward the end. The wound was low, beneath her belly button. The surgeons saved her by a whisker. The police didn't know the story—only that she was in a car, in a parking lot, with the motor running. Someone had seen a man near the car.
His son frightened him, and he was trying to get him out of the house, and when he told him he had to go, the boy fired a single shot from a pistol into his chest.
He came in almost alive, still moving a little, and what I remember most was his startled, staring blue eyes and the way he kept opening and closing his mouth and flicking out his tongue like a snake. I haven't seen this before or since.
They opened his chest in the trauma room, but it was too late. We learned the story from the police.
He was drunk, and harmless, but he tried to get into the wrong house, the next house over, because the houses look alike there. He kept banging on the windows and then he started kicking the front door. The father met him in the threshold with a shotgun.
Twelve gauge, right through the chest, just below the heart and just above the belly, and I thought he was dead for sure, that he had no chance with a wound like that, from that close, with that kind of weapon, but he made it to the OR alive and defied us all and somehow the surgeons saved him. No charges were filed.
We learned the story from the police.
He was a cop alone at night, and he pulled over the car when the plate lit up as stolen, and when he approached, the man opened the door and came out firing as he ran into the darkness. He was hit twice in the belly and once in the hip. The vest saved him, but his hip was shattered. He lay there on the gurney and stared furiously at the ceiling, tight-lipped and disciplined, crying out only when we moved him.
Later, I walked out into the hall to a sea of blue uniforms.
We learned the story from the police.
They were kids in a party house all night, and he owed another boy sixty dollars and told him that he didn't have it. The boy shot him through the chest with a 9 mm handgun. Then everyone was awake, and panicking, and they didn't know what to do.
They carried him outside, to the park, and left him beneath a tree, and though it was early in the morning, someone saw him under the tree and called an ambulance.
I never found out how long he was beneath the tree.
We learned the story from the papers.
She was an old woman, with a sign around her neck with her name and phone number in case she wandered, and her husband had shot her through the temple before killing himself because, as we learned later, he was sick also and could no longer care for her.
She lay there, blinded by the wound, with the sign, muttering incoherently, with frail papery skin, and perhaps she weighed eighty-five pounds.
I can't remember how we learned the story because it was a long time ago. But I remember her because of the sign.
He lay beneath me, a young man in his thirties, in office clothes, and looked directly up at me as I stood over him in my gown and mask. He told me his wife's cell phone number, that he was allergic to penicillin, and that he was going to die. He said all three things calmly, in the same tone.
He'd gone to work on an ordinary day. Another man had come into the offices, firing indiscriminately before shooting himself as the sirens grew nearer.
It was breaking news, and even then the story was on TV, but I didn't know any of that.
I told him we'd take care of him. I told him we would save him, because I always do. But he was right. When they say that there, in the trauma room, in that tone, they are speaking with an animal's authority.
We learned the story from the police.
From the book: WHITE HOT LIGHT by Frank Huyler. Copyright © 2020 by Frank Huyler. Reprinted courtesy of Harper Perennial, an imprint of HarperCollins Publishers.