SEATTLE - Emily Transue saw death for the first time in July, 1994.
Then a medical student in the first days of clinical work in a hospital in New Hampshire, the former Toledoan wondered how to react to an experience that nothing in life or the classroom had prepared her for.
"Amid the jumble of predictable emotions - sadness, fear, confusion, a certain excitement - I felt wrenchingly and terribly alone," she writes in the prologue to her book, On Call: A Doctor's Days and Nights in Residency (St. Martin's Press, 2004).
"I did the only thing I could think of. I sat down that afternoon and wrote it all down. If I could tell my mother, my brother, my friend in film school, exactly what had happened, then I wouldn't be alone. And maybe, while trying to make them understand, I would come to understand it, too."
That first story, sent to family and friends via e-mail, led to many more - and eventually, to the book. Writing was her way of processing and sharing her experiences with people outside medicine, and making sure that those experiences didn't isolate her from them, explained the 1988 graduate of St. Ursula Academy in a recent phone interview from her home in Seattle.
"By the time I got to residency, I had been doing that for two years and had published a couple stories in a couple places, and I kept doing it. So by the end of residency I had a stack of stories. I hadn't deliberately set out to write a book," Dr. Transue said.
She is now a general internist at a private multispecialty clinic and a clinical assistant professor in the department of medicine at the University of Washington. Dr. Transue has friends in Toledo but no family members still living here. Her book is dedicated to her mother, Harriet Adams, former director of women's studies at the University of Toledo, now a lawyer in Washington.
Published in August, the book has received some national exposure. On Call was excerpted in the August issue of Self magazine, a publication aimed at women ages 18 to 34. Self promotes overall well-being, including health, fitness, nutrition, beauty, and style.
In addition, the book has been praised by Publishers Weekly as "an intriguing picture of a side of medicine many people never see."
She focuses on patients (their stories sad, inspiring, humorous), against a background of medical data and hospital life (some situations and ailments presented in graphic detail), and how both shaped her personal and professional journey through residency in internal medicine at the University of Washington.
It begins on the first morning - when she comically takes a wrong turn on the way to her assigned clinic and winds up locked in a psychiatric ward - and ends three years later on its last night. "Just getting through these years has been the hardest thing I've ever done . . . . it was residency, not medical school, that transformed me from a student into a physician," she writes.
The names of the patients, other physicians, and staff were changed, except for a fellow resident identified only as Chris. The patients in the book all gave the project their blessing.
One wonders how she found the time and energy to write. As she reflects at one point, when the clinic director has added a new patient to her schedule at the end of a long day, "Does he have any idea, any memory, of what it's like to be a resident? To be always exhausted, always overworked and overtired, always having more to do than can be done? To carry more responsibility than you know enough to be comfortable with, to be drained and afraid all the time?"
Dr. Transue said she found time to write because she had to: "The stories that I wrote were the things that demanded to be written - the things that stayed there in my head that I couldn't get out or I had to get out."
In whatever time she could find during the day, Dr. Transue scribbled notes to herself about key events and conversations, then quickly filled in the rest in short bursts at the end of the day. "It was such an important thing to me to take these experiences out of my head, to get them out of me," she said.
In addition to being therapeutic, the writing helped her relate to patients as people, not just cases. "It's very easy to turn off when you're so tired and working so hard and seeing so much loss," Dr. Transue said.
That's why her work today includes teaching a writing elective for medical students, "focusing on the importance of stories to what we do," she explained.
She said it's easier to maintain a personal connection with patients she sees in her practice these days than with those she treated when she was a resident, "partly because in general everybody's not in crisis." And with time and experience comes the skill of staying connected without taking on everyone's pain, she pointed out. "You can't feel everything with everybody."
Twenty-six years old when she began her residency, Dr. Transue, now 33, graduated from Yale University in 1992 and received her M.D. from Dartmouth Medical School in 1996. She considered going into neuroscience, she said, but "I realized the research side wasn't where my heart was."
She believes her residency experience was fairly typical.
"I always hesitate to speak for anyone else's experience, but I get e-mail after e-mail and call after call from people who say, 'It was just like that for me.' Feeling scared, wondering if you're doing the right thing - I think that's pretty close to being universal," she said.
At the time, though, she thought she was alone in her feelings of inadequacy. "You think everyone else knows what they're doing."
There may be another book in the future, Dr. Transue said.
"I have been working on some stories about being in practice, which is very different [from residency]," she said. "You have much longer relationships [with patients] and you're watching people through ups and downs and really getting to know them and be part of their lives.
"Everyone wonders if they're going to be in it," she joked.
Contact Ann Weber at: firstname.lastname@example.org or 419-724-6126.47.60356 -122.3294