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Retired ER Physician Paul Seward Reflects on His Career


Published August 22, 2018 at 10:00 a.m.

Paul Seward - CALEB KENNA
  • Caleb Kenna
  • Paul Seward

When Paul Seward began his career as an emergency room physician in the 1970s, being called an "ER doc" wasn't considered a sign of respect. It was an insult.

In those days, Seward recalled, many of the doctors who worked with him in the emergency room were residents training to become surgeons or cardiologists, or else they'd "somehow made a wrong choice." It was widely assumed that a doctor with 30 years of experience who chose to work in the ER was, as Seward put it, "crazy, an alcoholic or had one too many divorces" and was there to cover his alimony payments.

"The concept that it was fun," he added, "just never occurred to them."

For nearly 50 years, Seward wore the label of ER doc proudly and found his work challenging, rewarding and, yes, even fun. Now 75, the retired Vermont physician has published a memoir, titled Patient Care: Death and Life in the Emergency Room, about his career spent in the medical trenches, from small-town community hospitals to urban trauma centers.

Seward agreed to an interview recently in his Middlebury home, where he lives with his wife, Linda, who's a retired nurse, and their dogs. Gray-haired, with a matching, closely trimmed beard, Seward is as lean as a marathon runner, which he was for many years. Remarkably, he can count on one hand the number of times he's been to the ER as a patient — and he went only once as an adult.

Visiting Seward's home is revealing. In one room, his wife sat at a computer screen engrossed in a session of EverQuest II, a fantasy-themed massively multiplayer online role-playing game, which Seward likened to 3D chess.

"I'm not as hard-core as she is," Seward said. "I just like to wander around, kill things and take their stuff."

On one wall of the living room hangs a framed Latin quote, the same one that Carl Jung had inscribed over his home doorway in Switzerland: "Vocatus atque non vocatus, Deus aderit." It translates as "Called or not called, God is there." On another wall is an Old Testament verse stitched in needlepoint: "What does the Lord require of you but to do justice, and to love kindness, and to walk humbly with your God?"

The religious décor notwithstanding, Seward describes himself as a spiritual but not religious man. During his interview, the conversation ranged widely, from near-death experiences to loop quantum gravity to the philosophy of the mind, the last of which Seward studied for more than 40 years and wrote about in numerous publications.

Born in New York City, Seward attended boarding school in Lake Placid, N.Y., before going on to Stanford University and then Harvard Medical School. He did his internship in pediatrics before switching to emergency medicine in the mid-1970s.

"As a pediatrician, I always asked myself what I would do if I were at a party and an adult fell down. I would ask if he'd had his baby shots," Seward said jokingly. "So, I eventually learned how to take care of grown-ups."

Seward entered emergency medicine before it had evolved into its own specialty. In those years, he noted, civilian ER medicine was still incorporating lessons learned from the Korean War's mobile army surgical hospitals, or M.A.S.H. units, as well as from the field trauma care administered by combat medics in Vietnam. (Seward himself was drafted and served stateside in the "Yellow Berets," or physicians who worked for the Public Health Service.)

In the '70s, Seward explained, it was widely assumed that an ER doc knew less than every other medical specialist in the hospital. Consider, he noted, the powerful paralytic drugs that are used to intubate, or insert a breathing tube, into a patient's trachea; for years, only anesthesiologists were allowed to administer them. However, by the time he retired in 2017, Seward and his fellow ER doctors had the most experience at intubations and were the ones teaching the procedure to medical students.

But Patient Care isn't about the evolution of emergency medicine, nor is it a macho narrative of medical heroism or a voyeuristic tell-all of the unusual objects ER patients have gotten lodged in various orifices.

Instead, Seward's book is a humble, occasionally humorous and often philosophical reflection on the medical mysteries that he tried to unravel, the choices he made and, ultimately, the life-or-death consequences of those decisions. Each of the book's 21 chapters tells the story of a different patient, some of whom came into the ER with mundane complaints, others with baffling ailments. Still others died and were brought back to life.

Seward deftly describes those conditions and procedures without getting mired in arcane medical jargon or the minutiae of human anatomy. Most impressively, he has written a 240-page book about his nearly half-century career as a physician without straying into the thorny issues involving Big Pharma, the insurance industry or the shortcomings of the American health care system.

First and foremost, Patient Care is about people — how they die, how they live and what working in the ER taught Seward about both.

"I believe that the principal reason we are on this planet is to have our noses constantly rubbed in our obligation to care about people who are strangers to us," he writes in the book's preface. "Our instinct to care for our family and our tribe does not extend to them. That kind of care must be learned. And, in my opinion, the ER is the place that, if you are paying any attention at all, will teach you that lesson."

Seward began writing this book, he explained, while still living in New Hampshire a few years ago. At the time, he'd tried to enroll in an online creative writing class through Southern New Hampshire University. But when he realized the class was full, he signed up for the nonfiction class instead. In fact, the first two chapters of Patient Care began as homework assignments. His professor was so impressed by his storytelling that Seward decided to write a memoir, hoping it would interest a general audience as well as emergency department professionals.

In a sense, Patient Care was also a way for Seward to exorcize the ghosts that have haunted him for much of his career. Of the thousands of patients he treated over the years, Seward chose to include those whose stories left indelible impressions on him — for good or ill.

In one chapter, for instance, Seward writes about the near drowning of a 10-year-old boy who, by all objective standards, shouldn't have survived. He'd been pulled from a canal near Augusta, Ga., after being underwater for more than 15 minutes. By the time Seward saw him in the ER, his heartbeat had flatlined. After another 20 minutes of attempted resuscitation, the trauma team's efforts seemed pointless, and Seward braced himself to break the news to his parents. Then, inexplicably, the child's heart began beating again.

"I have no explanation for that. None," Seward said in the interview. "It's the only time that ever happened so dramatically for me, but there it is. And I don't take credit for it."

In another chapter, Seward recounts the story of a man whose symptoms of chronic obstructive pulmonary disease stymied his every effort to ease the patient's labored breathing.

"No matter what I did, he kept getting worse and worse and worse, until he died," Seward recalled, in the interview. "To this day, I don't know why nothing worked. Have I thought of that guy once a month for the rest of my life? Sure."

Such stories are central to Seward's book, and not just because they highlight how life in the ER can be a cosmic crapshoot. They also reveal an often-overlooked component of the job: living with the burden of stupid mistakes, wrong decisions and unfavorable outcomes. Indeed, Seward said that one of the most important lessons he taught his medical students — one, he emphasized, that no one ever taught him — was that, in order to be an ER doc, one had to be "willing to live with that face on the ceiling" for the rest of their lives.

"If you can't do this work because you can't stand this pain, who's going to do it?" he'd tell his students. "People who don't care."

It's easy to see how much Seward cared, and still cares, about his profession and the patients he treated. On the day of his interview, he wore his cellphone, keys and watch clipped to his waist. One could envision him adding a stethoscope, forceps and laryngoscope to his makeshift utility belt, as though he were ready to jump back into the trenches if duty called.

In fact, when asked what he misses most about being an ER doc, Seward didn't hesitate.

"Doing it," he answered quickly. "I had a sense of myself ... which I don't have anymore."

Though Seward maintains his medical license, he acknowledged that he'd no longer be "safe" in the ER because he's out of practice and his memory isn't what it used to be. As he put it, "The ER is no place for an old man.

"I have been pretending to be a caring physician for my whole life," Seward added, echoing a sentiment he expressed in the book. "I have no idea if I've succeeded, but I know what it felt like to try. That's what this book is about."

Patient Care: Death and Life in the Emergency Room by Paul Seward, Catapult, 240 pages. $24.45 hardcover. Seward reads from his book on Wednesday, September 12, 7 p.m. at Phoenix Books Burlington

The original print version of this article was headlined "Healing Agent"