Emergency Department Blogging

After an arduous day. La Belle Bianca is enfin abed. Il est à souhaiter qu'elle y reste, *silente*.

Now, with my cup of tea -- in mismatched, crackly-glazed bone china -- I am ready to face this expanse of white, thinking it cool, thinking it calm, thinking it the balm my body needs. What a foolish person (though I do like my pluck).

At issue are my reading habits: The list of tangential blogs and websites to the left of the page needs judicious editing.

I enjoy reading medical blogs -- the snarkiest and most amusing tend to be derivative (HIPAA, huzzah! HIPAA, huzzah!) of experiences in emergency medicine. The bloggers are, for the most part, terrific story tellers, with a few not-so-talented moralists interspersed for local color.

Ach! A bump in the writerly road. I am, essentially, free associating and have been brought up short by my use of the term "local color." It's not a term that I groom and keep ready on my short list of lit crit terms.

That's my field, you see, kind reader: literary criticism and the sacrifice of said organizing principle to the development of superior critical thinking skills in the 18-24 year old population of francophones within a given academic enclave. Rarefied air? Cannot get your breath? Run along to the Emergency Department -- they will take care of you!

Local color can also known as regionalism -- and is most often, these days, code for Southern
Antebellum Literature (SAL), most often code for a not-so-secret smugness in which to dress up racism, classism (all yer basic -jizms). A world apart is the later movement of the early 20th century that hoped to shore up the notion of a core, almost antediluvian (way before -bellum, even), southern identity -- a unifying movement toward definition as straightforward as movements come. Still, there's an undeniable desire within the region's -izm for goshawks -- for falconry, filial crests, and the Old World tapestry of heraldry in general.

It's all about words, and how you use them, the dialect you adopt, the dialectic that ensues.

These incredibly fascinating blogs relating to the world of emergency medicine? They are couched in extremes of local color and regionalism.

The blogosphere: "It is the perception that blogs exist together as a connected community (or as a collection of connected communities) or as a social network."

Local color. Secret code, paternalistic assumption over the power of dialect. There are moments, even, of affected "Ebonic" dialect, a whole new venue for shucking and jiving. There are many approximations as to what the Undeserving are Entitled.

Regionalism. The assertion of a special geography, say? Local color may stand alone, indeed, and demand special attention, determined to stand out. But the regionalism of these medical blogs arises from several generally unacknowledged peculiarities and disparities that mark the ED as a very different locus in the medical sphere. Perhaps a free-standing building, perhaps connected to a main hospital by tunnels; Perhaps, a vital, irreplaceable buffer between outside (health management) insanity and the inner torpor of the hospital ward. The general presumption that the patient not perfectly defined by an established clinical picture (trauma, a surgical abdomen, a classic MI) is likely from the dregs, a despised bottom feeder -- either seeking drugs, a free visit, sympathy, or some other gain -- all this unwieldy presumption makes for easy derision, a quick shift into high-handed morality and a degradation of dialect.

But how do I expect medical professionals to perform under the many pressures of insufficient means (of space, hands), misuse, abuse, fated failures? (How dare I have any expectation of them at all is probably the better question! Easy, mes chers, I have come to like your writing and all that shines through.)

And now I find that I don't want links to some of these blogs to originate from my blog -- the seething resentment and anger being that bothersome. In a highly scientific crap shoot, I read 10 entries "at random" from ED-based blogs linked here, as well as those in my private Favorite's List, and each time easily found the rancor to which I am referring.

They've every right and cause for rancor! I want to assert that their life-saving work, filled as it is with perversion of their good intent, ought to allow for almost any expressions of frustration -- because I believe that I do GET IT.

I want to assert that, because as I said, I get it, but I can't. It is not about getting their pain, understanding their problems.

No, ultimately we are each stripped of out local ism, our local color, our regionalism, and asked only to be good and fair companions of the road.

Right now, these blogs are fascinating, in and of themselves, as small ecologies of inbred, insular, jealous, and competitive communities.

Enrico over at Mexico Medical Student put up a post entitled EM Blogger "Hate": Nature or Nurture that I found a rational, reasoned, and calm assessment of the increasingly disturbing dispositions coming out of Emergency Departments. Enrico opens with a reference to a post by Sid Schwab:

<<Sid Schwab posted an entry the other day about EM blogs (I’m including nurses in what I write here) and their penchant for not only being right-of-center politically, but “vitriolic." [....]

EM has been corrupted by being made into the PCP of the disenfranchised and uneducated, as well as the pressure valve for inpatient floor inefficiency as admitted patients crowd the ED, further straining things. I get it.>>

He gets it, too. Really, you'd have to be fairly thick not to... so why the overt resentment, meanness, anger? Have a read, and see if these two gents don't do a fine job of teasing out the reasons.

And I will wait to cull the URLs à gauche.

Grosses bises!