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Code Gray: Death, Life, and Uncertainty in the ER
Code Gray
is a “provocative and meaningful” (Theresa Brown, New York Times bestselling author of Healing) narrative-driven medical memoir that places you directly in the crucible of urgent life-or-death decision-making, offering insights that can help us cope at a time when the world around us appears to be falling apart.
In the tradition of books by such bestselling physician-authors as Atul Gawande, Siddhartha Mukherjee, and Danielle Ofri, this beautifully written memoir by an emergency room doctor revolves around one of his routine shifts at an urban ER. Intimately narrated as it follows the experiences of real patients, it is filled with fascinating, adrenaline-pumping scenes of rescues and deaths, and the critical, often excruciating follow-through in caring for patients’ families.
Centered on the riveting story of a seemingly healthy forty-three-year-old woman who arrives in the ER in sudden cardiac arrest, Code Gray weaves in stories that explore everything from the early days of the Covid outbreak to the perennial glaring inequities of our healthcare system. It offers an unforgettable, “discomfiting, and often bracing” (Bloomberg Businessweek) portrait of challenges so profound, powerful, and extreme that normal ethical and medical frameworks prove inadequate. By inviting you to experience what it is like to shift in the ER from a physician’s perspective, we are forced to test our beliefs and principles. Often, there are no clear answers to these challenges posed in the ER. You are left feeling unsettled, but through this process, we can appreciate just how complicated, emotional, unpredictable—and yet strikingly beautiful—life can be.
In the tradition of books by such bestselling physician-authors as Atul Gawande, Siddhartha Mukherjee, and Danielle Ofri, this beautifully written memoir by an emergency room doctor revolves around one of his routine shifts at an urban ER. Intimately narrated as it follows the experiences of real patients, it is filled with fascinating, adrenaline-pumping scenes of rescues and deaths, and the critical, often excruciating follow-through in caring for patients’ families.
Centered on the riveting story of a seemingly healthy forty-three-year-old woman who arrives in the ER in sudden cardiac arrest, Code Gray weaves in stories that explore everything from the early days of the Covid outbreak to the perennial glaring inequities of our healthcare system. It offers an unforgettable, “discomfiting, and often bracing” (Bloomberg Businessweek) portrait of challenges so profound, powerful, and extreme that normal ethical and medical frameworks prove inadequate. By inviting you to experience what it is like to shift in the ER from a physician’s perspective, we are forced to test our beliefs and principles. Often, there are no clear answers to these challenges posed in the ER. You are left feeling unsettled, but through this process, we can appreciate just how complicated, emotional, unpredictable—and yet strikingly beautiful—life can be.
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First published February 21, 2023
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February 19, 2023
After reading many medical books, I stumbled onto this one and was prepared to hear the detailed stories of ER patients. That;'s not what I found. I also didn't find the things a physician learns in medical story.
Instead, I was treated to 24 hours in an emergency room that could be anywhere, and inside the mind of an ER Doctor, a very special doctor, who was able to put into practice the reason he became a doctor in the first place - he wanted to help people.
From the beginning of the book when he treats a deceased patient's family with tenderness and care, doing the unthinkable in terms of time and money, by paying more attention to the deceased woman's husband. From there the reader is taken inside the reasons a doctor does what he does.
It's a rare opportunity to understand a little of what makes a good doctor a good doctor.
Instead, I was treated to 24 hours in an emergency room that could be anywhere, and inside the mind of an ER Doctor, a very special doctor, who was able to put into practice the reason he became a doctor in the first place - he wanted to help people.
From the beginning of the book when he treats a deceased patient's family with tenderness and care, doing the unthinkable in terms of time and money, by paying more attention to the deceased woman's husband. From there the reader is taken inside the reasons a doctor does what he does.
It's a rare opportunity to understand a little of what makes a good doctor a good doctor.
February 19, 2023
You should read this book.
As an emergency room physician in a New York City hospital, Dr. Farzon Navhi is inherently qualified to describe the trial and tribulations of working in an ER. As an outstanding writer and an ER physician, he is uniquely qualified to tell the story in a way that will keep you turning pages deep into the night.
Code Gray: Death, Life, and Uncertainty in the ER begins with a somewhat lengthy (though not overbearing) prologue that describes the dark days of the beginning of the COVID epidemic. Navhi weaves text messages sent between health care providers with insight that can only be gained by standing on the front lines into a gripping story set in what must have felt like hand his colleagues had descended into a previously unknown level of hell.
The book then describes a single pre-pandemic night shift in a New York City hospital. If you've ever been unfortunate enough to visit a large urban ER in the middle of the night, you probably think you know something of the general chaos that ensues. But you haven't experienced it from a ER doctor's perspective. Yet.
Dr. Nahvi's first patient arrives in the ER with paramedics giving her CPR. That patient's story is cleverly intertwined throughout the shift as Nahvi and the team of professionals it takes to make an ER function press their way through the evening.
If you have any interest in the practice of medicine, or our health care system, Code Gray is a fascinating and enlightening read. If you have zero interest in medicine or the health care system, Code Gray is a fascinating and enlightening read. The life-lessons it contains were a pleasant surprise. You don't need to be an Ivy League graduate, as Nahvi is, to grasp how his experiences translate into valuable insight on living life.
Code Gray is extremely well-written, a terrific story, a historical look at a once-in-a-century pandemic, and a primer on how attitude and self-reflection can help you live a more enriching life. I'm not sure what else anyone could ask from a book.
You should read this book.
Publication date February 21, 2023.
Special thanks to Netgalley, Simon & Schuster, and Dr. Farzon A. Navhi for providing the Advance Reader Copy of Code Gray. This review is my honest and personal opinion.
As an emergency room physician in a New York City hospital, Dr. Farzon Navhi is inherently qualified to describe the trial and tribulations of working in an ER. As an outstanding writer and an ER physician, he is uniquely qualified to tell the story in a way that will keep you turning pages deep into the night.
Code Gray: Death, Life, and Uncertainty in the ER begins with a somewhat lengthy (though not overbearing) prologue that describes the dark days of the beginning of the COVID epidemic. Navhi weaves text messages sent between health care providers with insight that can only be gained by standing on the front lines into a gripping story set in what must have felt like hand his colleagues had descended into a previously unknown level of hell.
The book then describes a single pre-pandemic night shift in a New York City hospital. If you've ever been unfortunate enough to visit a large urban ER in the middle of the night, you probably think you know something of the general chaos that ensues. But you haven't experienced it from a ER doctor's perspective. Yet.
Dr. Nahvi's first patient arrives in the ER with paramedics giving her CPR. That patient's story is cleverly intertwined throughout the shift as Nahvi and the team of professionals it takes to make an ER function press their way through the evening.
If you have any interest in the practice of medicine, or our health care system, Code Gray is a fascinating and enlightening read. If you have zero interest in medicine or the health care system, Code Gray is a fascinating and enlightening read. The life-lessons it contains were a pleasant surprise. You don't need to be an Ivy League graduate, as Nahvi is, to grasp how his experiences translate into valuable insight on living life.
Code Gray is extremely well-written, a terrific story, a historical look at a once-in-a-century pandemic, and a primer on how attitude and self-reflection can help you live a more enriching life. I'm not sure what else anyone could ask from a book.
You should read this book.
Publication date February 21, 2023.
Special thanks to Netgalley, Simon & Schuster, and Dr. Farzon A. Navhi for providing the Advance Reader Copy of Code Gray. This review is my honest and personal opinion.
February 12, 2023
Well written and extremely informative. The first part of the book deals with the pandemic at its start. Until you read this, or if you are a health care worker or have a family member who is, I don't think you can really appreciate what heroes they were. Dr. Nahvi does an amazing job sharing his thoughts and beliefs while realistically understanding the constraints our health care system is under. Thanks to Netgalley, the author and publishers for an advanced copy in exchange for my honest opinion.
August 12, 2023
Wow! What a great book! Before I started, I was expecting a compilation of “crazy” emergency room stories, but instead this book was about the humanity, feelings, internal struggles, helplessness, emotional wins and losses of Dr Nahvi and his patients and their family members while he was practicing at a NYC ER. It’s really well done. And now he practices in Concord, NH. He comes across as a genuinely kind, good, caring person.
September 22, 2023
I love medical non-fiction books. I also love medical TV shows. I've read many books of this subject. This one was a bit different. It wasn't the usual "this is what happens" in an ER, hospital, etc. The focus of the book was on one event in the ER and what it meant for the family, the medical profession, and humanity in general. It was interesting to see his take on it and the fact he left you questioning everything. I enjoyed this book. The only reason that I didn't give it a 5 star rating is because of the lack of "this is what happens". I love to read about the action. Otherwise, this was a good book.
August 23, 2023
I was absolutely enthralled by the prologue, & the rest of the book was very good as well. While I understand the purpose was to show that the experiences in the ER are as extraordinary in daily life as the chaos of Covid, I really enjoyed that glimpse into the experience from a doctors perspective. The chapters were well thought out, & I enjoyed hearing about his experiences working within a medical system that has so many flaws, while trying to put his patients first.
June 14, 2023
First person account of what it’s really like to work in the ER in NYC esp during Covid. I love hearing about the medical world so this was very revealing and gripping.
August 28, 2023
Interesting but far from profane.
March 25, 2024
At parts repetitive and a bit slow, but overall an interesting look into life as an ER doctor
February 12, 2024
Very short and light read. Centers around one tragic case with other stories sprinkled in.
September 4, 2024
I really enjoyed this
December 6, 2023
For people who want to know the basics about emergency departments and doctors.
May 31, 2023
@Chris - pretty eye opening but written in a very negative way. I didn't like how he demonized hospital administration during COVID - things were changing every day and no one knew what to do.
October 10, 2023
I liked this a lot. Very accurate, really wants you to ask the hard questions of life.
November 22, 2023
Insightful book by an ER doctor on some of his encounters in the emergency room. The first part is what he dealt with during Covid. THe second part is a lot about a few patients that stuck with him for one reason or another- drunk homeless patients that you don’t know how to treat. And a young woman who dies from an ectopic pregnancy. Sad and fascinating.
May 3, 2023
Four and a half stars. Good, engaging quick read about a doctor’s day to day life in the ER. It appealed to me after having spent many hours in hospitals with my elderly parents. I have a respect and appreciation for these healthcare workers.
April 29, 2023
I’ve read many medical books and found this one a refreshing addition to the mix. Nahvi is an excellent storyteller who thoughtfully addresses issues of morality, medical ethics, and healthcare reform. He does not, as he signposts in the prologue, offer easy answers to the questions he poses nor happy endings to stories that have none.
The book’s ending lines are among the best I’ve read in a long while.
The prologue, focused on it was on the pandemic, was compelling. I worked in a hospital when COVID-19 reared its deadly head. He shared the fragility of provider’s health and their comical and grotesque bargains when supplies ran short: How often can one re-use a mask? Is baking a respirator in the oven enough to kill germs and if so, at what temperature?
The opening was a teaser in my view, a hook to the reader until the author pivoted by saying, I WAS going to write a book just about the pandemic, but … I think the prologue would have been better as a short story.
Stylistically, I have but one pet peeve. Martin Luther King Jr. was a skilled orator who employed the cadence and rhythm of repetition for impact. He would begin his sentences with a phrase and repeat that several times for emphasis, to drive home a point. Apparently, Dr. Nahvi, a rap enthusiast, likes this approach … a lot. The doctor used it every 5-10 pages. The doctor used it twice. The doctor used it thrice. It became a distraction, as it was such a predictable sentence framework. A stronger editor would have reined him in. A stronger editor would have … well, you get the point.
The book’s ending lines are among the best I’ve read in a long while.
The prologue, focused on it was on the pandemic, was compelling. I worked in a hospital when COVID-19 reared its deadly head. He shared the fragility of provider’s health and their comical and grotesque bargains when supplies ran short: How often can one re-use a mask? Is baking a respirator in the oven enough to kill germs and if so, at what temperature?
The opening was a teaser in my view, a hook to the reader until the author pivoted by saying, I WAS going to write a book just about the pandemic, but … I think the prologue would have been better as a short story.
Stylistically, I have but one pet peeve. Martin Luther King Jr. was a skilled orator who employed the cadence and rhythm of repetition for impact. He would begin his sentences with a phrase and repeat that several times for emphasis, to drive home a point. Apparently, Dr. Nahvi, a rap enthusiast, likes this approach … a lot. The doctor used it every 5-10 pages. The doctor used it twice. The doctor used it thrice. It became a distraction, as it was such a predictable sentence framework. A stronger editor would have reined him in. A stronger editor would have … well, you get the point.
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December 13, 2023Very rarely, I come across a book that captures the essence of my professional experience as an emergency physician. As an avid reader and reviewer, I have read several medical memoirs that came close. They tend to be compilations of the most moving (and awful) experiences in the lives of the physicians and staff of the emergency department.
I am pleased to say that in this book, “Code Gray: Death, Life and Uncertainty in the ER,” author Farzon Nahvi, MD, has absolutely captured the essence of the great privilege, joy, despair and uncertainty of working in a modern urban emergency department. As an emergency physician in New York City during the early months of 2020 through the first wave of the deadly COVID-19 pandemic, Dr. Nahvi draws back the opaque curtain on what was really happening and how frontline medical staff were sharing information and trying to figure out how to treat the novel coronavirus.
Read our entire review and see more book club selections on The DO!
I am pleased to say that in this book, “Code Gray: Death, Life and Uncertainty in the ER,” author Farzon Nahvi, MD, has absolutely captured the essence of the great privilege, joy, despair and uncertainty of working in a modern urban emergency department. As an emergency physician in New York City during the early months of 2020 through the first wave of the deadly COVID-19 pandemic, Dr. Nahvi draws back the opaque curtain on what was really happening and how frontline medical staff were sharing information and trying to figure out how to treat the novel coronavirus.
Read our entire review and see more book club selections on The DO!
This entire review has been hidden because of spoilers.
March 8, 2023
To borrow from another reader, "This is a better read for those people who know very little about emergency rooms, and need a fundamental level base explanation."
I found the prologue on Covid interesting and was glad to see there was a bit of support around the country in the texting, as God knows, the front line employees needed it! But as far as the book itself, I just didn't find it all that interesting.
As a realistic person with a lot of medical knowledge literally from advocating for myself, I'd be pissed to see the charade of prolonging the calling of death just to put on a show for the living. Not to mention the fact of the cost of everything pumped into my dead body.
What I'd like to see is a book on what the damned insurance companies have done to our healthcare on the front lines. The author alluded to it a bit, but not near enough for the general public to see and understand what has happened to us all!
I found the prologue on Covid interesting and was glad to see there was a bit of support around the country in the texting, as God knows, the front line employees needed it! But as far as the book itself, I just didn't find it all that interesting.
As a realistic person with a lot of medical knowledge literally from advocating for myself, I'd be pissed to see the charade of prolonging the calling of death just to put on a show for the living. Not to mention the fact of the cost of everything pumped into my dead body.
What I'd like to see is a book on what the damned insurance companies have done to our healthcare on the front lines. The author alluded to it a bit, but not near enough for the general public to see and understand what has happened to us all!
April 12, 2024
The book starts out with an email chain between various doctors during the Covid-19 crisis. Those conversations reveal that doctors knew very little about the virus and the best ways to treat patients during those early months. Often they were handcuffed by their hospital's administration in their response. Dr. Nahvi detailed the routine he went through every day when he came home from his shift, the precautions he took to avoid spreading the virus to his wife. If you remember those early days, the public knew very little and the doctors knew just a bit more.
The rest of the book follows patients as he goes through a typical shift, obviously written before the prologue Covid year.
The story of a woman patient who arrives deceased (her name is Lola) is juxtaposed with other patients he sees that night. She came in with no pulse, no breathing and yet they continued compressions to revive her with no positive response. Those actions were performed much for her husband benefit as he watched. They knew the futility, but wanted to show that they were doing all they could, until she was pronounced.
The patient stories he told demonstrated that in the ER, there is no black and white. There were ethical considerations that put decisions in the gray area. A drunk came in several times a day, having passed out. He didn't want the help the doctors recommended, only to sleep it off, be discharged to have the cycle repeat itself. Talking to him was a futile task.
He is often asked, when it is revealed he is an ER doctor, what the most interesting thing he has seen or treated.
"Instead, I often feel the need to change the subject. Asked about the misfortune of death, I deflect to a story about a patient who came in seeking assistance in removing a Magic Marker from his rectum. Asked about the misery death leaves in its wake, I steer the conversation toward a prisoner who learned to swallow forks in order to get transferred out of his jail cell and into the infirmary. Asked about death itself, I do not tell about the gunshot victims who died, but about the rare one who survived. I describe the miracles performed by our trauma surgeons as they fillet a young man's thorax wide open massage his heart out of his chest cavity, sew up the hole that the bullet made as it plowed through the chambers of his heart, and ultimately place his heart beating on its own once more, back inside his chest."
He was later required to fill out forms detailing the death of Lola. She came in already gone, so he had no idea of what brought about her death. He knew that she had complained of abdominal pain before she passed out. The answer came in the form of the blood drawn when she had arrived. One result revealed that she was pregnant. (Her husband had said that they were trying but had been unsuccessful.) The quandary he faced was should he reveal that fact to the husband? Was he the father or was there someone else? What would she have wanted to tell him? Had she intended to keep the child? (Ultimately she had an ectopic pregnancy which grew outside the womb and ultimately burst causing internal bleeding) Would revealing her pregnancy have provided some solace in the loss of his wife? Grey areas abounded...
"A clerk pointed me toward a death certificate to fill out. A nurse asked me to check a box to indicate whether Lola's body was destined for the morgue or the autopsy room The bureaucratic demands of our job stand in stark contrast to its more human elements. When one has just walked a man through the slow internalization of the death of his wife, it is difficult to appreciate the value of check boxes, classifications codes and billing procedures. Compounding matters, the medical world seems to embrace a particularly absurd version of bureaucratic demands."
Bureaucracy demands black and white, but reality is anything but.
He recalls a time when he was requested to administer chemotherapy to a patient who didn't know that she had cancer. Her family knew, and her oncology doctor was told not to tell her. He was in a quandary about his position in this drama. Was it ethical to treat her for cancer without her knowledge? In reality, she knew all along but just didn't tell them.
Despite his education and experience, he often felt inadequate with the advice and medicine he had to offer, often with treatments being rejected, as with the alcoholic who just wanted to sleep it off.
He reveals the coding and billing systems often seemed unethical and cold.
"My hospital's billers and coders would extract my note (about Lola's care) from our computer system. Sitting in offices located in building that are a world away from the clinical environment in which we work, they would apply sophisticated software that would scour it for its most profitable phrases. Then, using a sort of free market alchemy, they would turn these words into revenue. 'Strive to five' is a mantra of this process--a playful phrase that our billers and coders use to emphasize the importance of reaching a level five billing code, the most profitable one in an emergency room.
Ultimately, these billers and coders would generate not a condolence letter, but a bill."
"Life is raw, it is fragile, and it is beautiful. Often, it is discomfiting. When we find that it is, we should treat these discomfiting bits of life in much the same way we treat a sculpture in a museum. We should inspect it and take the time to walk around it, analyzing it from every angle and appreciating the way every ray of light bounces off each of its different surfaces. We might find that what may look ordinary from one perspective may be extraordinary from another.
Our everyday lives are meaningful and profound. It is worth slowing down to take a closer look."
I am glad I read this book, and I have a real appreciation for those that serve us in the medical profession.
The rest of the book follows patients as he goes through a typical shift, obviously written before the prologue Covid year.
The story of a woman patient who arrives deceased (her name is Lola) is juxtaposed with other patients he sees that night. She came in with no pulse, no breathing and yet they continued compressions to revive her with no positive response. Those actions were performed much for her husband benefit as he watched. They knew the futility, but wanted to show that they were doing all they could, until she was pronounced.
The patient stories he told demonstrated that in the ER, there is no black and white. There were ethical considerations that put decisions in the gray area. A drunk came in several times a day, having passed out. He didn't want the help the doctors recommended, only to sleep it off, be discharged to have the cycle repeat itself. Talking to him was a futile task.
He is often asked, when it is revealed he is an ER doctor, what the most interesting thing he has seen or treated.
"Instead, I often feel the need to change the subject. Asked about the misfortune of death, I deflect to a story about a patient who came in seeking assistance in removing a Magic Marker from his rectum. Asked about the misery death leaves in its wake, I steer the conversation toward a prisoner who learned to swallow forks in order to get transferred out of his jail cell and into the infirmary. Asked about death itself, I do not tell about the gunshot victims who died, but about the rare one who survived. I describe the miracles performed by our trauma surgeons as they fillet a young man's thorax wide open massage his heart out of his chest cavity, sew up the hole that the bullet made as it plowed through the chambers of his heart, and ultimately place his heart beating on its own once more, back inside his chest."
He was later required to fill out forms detailing the death of Lola. She came in already gone, so he had no idea of what brought about her death. He knew that she had complained of abdominal pain before she passed out. The answer came in the form of the blood drawn when she had arrived. One result revealed that she was pregnant. (Her husband had said that they were trying but had been unsuccessful.) The quandary he faced was should he reveal that fact to the husband? Was he the father or was there someone else? What would she have wanted to tell him? Had she intended to keep the child? (Ultimately she had an ectopic pregnancy which grew outside the womb and ultimately burst causing internal bleeding) Would revealing her pregnancy have provided some solace in the loss of his wife? Grey areas abounded...
"A clerk pointed me toward a death certificate to fill out. A nurse asked me to check a box to indicate whether Lola's body was destined for the morgue or the autopsy room The bureaucratic demands of our job stand in stark contrast to its more human elements. When one has just walked a man through the slow internalization of the death of his wife, it is difficult to appreciate the value of check boxes, classifications codes and billing procedures. Compounding matters, the medical world seems to embrace a particularly absurd version of bureaucratic demands."
Bureaucracy demands black and white, but reality is anything but.
He recalls a time when he was requested to administer chemotherapy to a patient who didn't know that she had cancer. Her family knew, and her oncology doctor was told not to tell her. He was in a quandary about his position in this drama. Was it ethical to treat her for cancer without her knowledge? In reality, she knew all along but just didn't tell them.
Despite his education and experience, he often felt inadequate with the advice and medicine he had to offer, often with treatments being rejected, as with the alcoholic who just wanted to sleep it off.
He reveals the coding and billing systems often seemed unethical and cold.
"My hospital's billers and coders would extract my note (about Lola's care) from our computer system. Sitting in offices located in building that are a world away from the clinical environment in which we work, they would apply sophisticated software that would scour it for its most profitable phrases. Then, using a sort of free market alchemy, they would turn these words into revenue. 'Strive to five' is a mantra of this process--a playful phrase that our billers and coders use to emphasize the importance of reaching a level five billing code, the most profitable one in an emergency room.
Ultimately, these billers and coders would generate not a condolence letter, but a bill."
"Life is raw, it is fragile, and it is beautiful. Often, it is discomfiting. When we find that it is, we should treat these discomfiting bits of life in much the same way we treat a sculpture in a museum. We should inspect it and take the time to walk around it, analyzing it from every angle and appreciating the way every ray of light bounces off each of its different surfaces. We might find that what may look ordinary from one perspective may be extraordinary from another.
Our everyday lives are meaningful and profound. It is worth slowing down to take a closer look."
I am glad I read this book, and I have a real appreciation for those that serve us in the medical profession.
August 8, 2024
This was a powerful read and not for the faint of heart. Personal disclaimer: I used to work in and Emergency Department in America and all of the accounts and criticisms of the American Healthcare system and the Emergency department ring true from my experience. It's an emotional storm of moments that show how complicated and frustrated getting proper Healthcare or affording it can be. The first third of this book was an epilogue criticizing the gross mismanagement of the Covid Outbreak and how America screwed the proper precautions and support and supplies of PPE was restricted to the cost of millions of lives. Check it out if you want to take a look into the world of Emergency Medicine.
April 3, 2023
I obviously picked this up because I work in the ER, but I really think anyone could learn a lot from this.
March 3, 2023
This is a better read for those people who know very little about emergency rooms, and need a fundamental level base explanation. Not only for/ of the personnel. Emergency Rooms have, IMHO, within the USA (even at trauma centers) degraded in protocols, exchanges of information, sustaining accurate prognosis or treatment etc. etc. (medications applied absolutely) since BEFORE the COVID period. I can't imagine what depths they have gotten to presently within a city of, just a thrown away figure, of say 2 to 5 million people in the city proper. Let alone in the density of NYC per square mile, as this was. I know Chicago's have. Even the highest status burbs' and BIG NAME hospitals- they have. Specialty treatment is one thing, emergency room quite another.
This will give you an inkling of why. With simple, simple bottom line and very personal opinion and methods used from an emergency room doctor himself. On duty during the first to the last days of pandemic run- with all that encompassed.
Having daughters-in-law and granddaughters and friends and step-daughter all being nurses. And a few Emergency Room nurses are in there too- this is mild in comparison to most reality. The step-daughter though- no longer a nurse- got burnt out after about 14 years and now works in a rescue pet facility. (She was bitten and spit upon too many times to count- and that is NO exaggeration.) Being the research person for cops and nurses in degree programs during the '90's - little surprises me. Have I heard the tales! But overall tech itself, digitalizing, all the various computer cross overs, putting many medical associations into big packs of administration "head" and P R advertising? All of those things lead to the "know betters" never "knowing better". Most especially about equipment, placements, or utility of access. In anything, really- but the paper and the theory talk. So this book will give you a bit of an insight into all that.
This will be helpful for you too, if you do not know any of the procedure methods and protocol for very quick death scenes or telling individuals the very worst news they are ever going to hear. But other than that- this read was no more than a 3 star.
This will give you an inkling of why. With simple, simple bottom line and very personal opinion and methods used from an emergency room doctor himself. On duty during the first to the last days of pandemic run- with all that encompassed.
Having daughters-in-law and granddaughters and friends and step-daughter all being nurses. And a few Emergency Room nurses are in there too- this is mild in comparison to most reality. The step-daughter though- no longer a nurse- got burnt out after about 14 years and now works in a rescue pet facility. (She was bitten and spit upon too many times to count- and that is NO exaggeration.) Being the research person for cops and nurses in degree programs during the '90's - little surprises me. Have I heard the tales! But overall tech itself, digitalizing, all the various computer cross overs, putting many medical associations into big packs of administration "head" and P R advertising? All of those things lead to the "know betters" never "knowing better". Most especially about equipment, placements, or utility of access. In anything, really- but the paper and the theory talk. So this book will give you a bit of an insight into all that.
This will be helpful for you too, if you do not know any of the procedure methods and protocol for very quick death scenes or telling individuals the very worst news they are ever going to hear. But other than that- this read was no more than a 3 star.
March 16, 2023
“In this way, I have come to learn, that as much as our code blues and code blacks may capture our attention, it is ultimately the code grays that we experience – the subtle moments where what we feel and believe about the world itself is put to the test – that are the most important dramas we face in the emergency room and beyond.” (p. 140)
I hope that pointing out how he explains the title of his book, Code Gray, is the most helpful I can be in this review. He keeps to this theme throughout, revealing his personal angst and trials in learning to be an effective and humane ER physician. One who knows there are no obvious cases, diagnoses, or “protocols” to deal with the patients and their families. All are unique by their circumanstance, nuances, and unknowns. The caring ER physician must gauge all these factors in a matter of minutes. Dr. Nahvi’s attention to the ethical issues in each situation is amazing, and we all hope we’d get HIS kind of ER physician.
This is not a litany of ER episodes, as I was expecting. Instead, he creates one ER case and follows it through the book, explaining the medical and ethical issues at each phase, emphasizing his insistence, to himself, that he be compassionate and human even as other patients are waiting in nearby rooms. (I’ll add that the case he follows through the book is most intriguing.)
A note: He also gives us his take on the current woes of health insurance and hospital administration, but this is significant to his perspective and does not interrupt his main theme.
I hope that pointing out how he explains the title of his book, Code Gray, is the most helpful I can be in this review. He keeps to this theme throughout, revealing his personal angst and trials in learning to be an effective and humane ER physician. One who knows there are no obvious cases, diagnoses, or “protocols” to deal with the patients and their families. All are unique by their circumanstance, nuances, and unknowns. The caring ER physician must gauge all these factors in a matter of minutes. Dr. Nahvi’s attention to the ethical issues in each situation is amazing, and we all hope we’d get HIS kind of ER physician.
This is not a litany of ER episodes, as I was expecting. Instead, he creates one ER case and follows it through the book, explaining the medical and ethical issues at each phase, emphasizing his insistence, to himself, that he be compassionate and human even as other patients are waiting in nearby rooms. (I’ll add that the case he follows through the book is most intriguing.)
A note: He also gives us his take on the current woes of health insurance and hospital administration, but this is significant to his perspective and does not interrupt his main theme.
March 12, 2023
The early part of this book focuses on the start of the pandemic and consists of a series of text messages among ER physicians across the country. The lack of knowledge and best practices was common, and I appreciated how these doctors relied on one another for suggestions and advice.
The author does an excellent job of portraying the life inside of an ER, which is often chaotic. There are so many moving parts in caring for a patient which can include a large number of people involved in the care team. The doctor caring for a patient in the ER truly is a conductor of the orchestra. While there are patients in an ER who are facing life or death, there are many patients who actually don't belong there and could be better served if they had better access to a primary care physician. This includes patients who are told they have to wait weeks when they call for an appointment with their doctor, as well as patients, such as the homeless who don't have a doctor.
as a former ER administrator in a large NYC medical center, this book truly resonated with me. There is so much uncertainty, particularly when very little may be known about the patient's medical history. While patients often complain about their long waits in the ER, upon reading this book, they may have more empathy for their providers, once they understand the complexities that are involved. I thought this book was very well written and gave a very realistic view of life in an ER.
The author does an excellent job of portraying the life inside of an ER, which is often chaotic. There are so many moving parts in caring for a patient which can include a large number of people involved in the care team. The doctor caring for a patient in the ER truly is a conductor of the orchestra. While there are patients in an ER who are facing life or death, there are many patients who actually don't belong there and could be better served if they had better access to a primary care physician. This includes patients who are told they have to wait weeks when they call for an appointment with their doctor, as well as patients, such as the homeless who don't have a doctor.
as a former ER administrator in a large NYC medical center, this book truly resonated with me. There is so much uncertainty, particularly when very little may be known about the patient's medical history. While patients often complain about their long waits in the ER, upon reading this book, they may have more empathy for their providers, once they understand the complexities that are involved. I thought this book was very well written and gave a very realistic view of life in an ER.
February 18, 2024
While Nahvi approaches it with some literary qualities since the overarching story of Lola and her husband Anthony is interwoven into the entire book with the resolution of the likely culprit of her death being revealed at the tail-end of this short focused story about life as an ER doctor, it's more a short story collection of musings. The stories are unevenly distributed across the book. There are times that I was looking for the takeaway or the message in why he was sharing the story whether it be a personal reflection he had or a larger-scale conversation about the monolith of medicine in America (as evidenced by the German friend who shared without a qualm about his less-than-stellar review of the American hospital he was being treated at for a gash on his leg and the surprise that was as a first-world country), but the profound moment in each story never really came or wasn't as memorable as it could have been.
Not to discount the perspective he provides or the stories he shares, which are glimpses into a world that few experience either as patients or ER doctors/nurses/technicians will ever have.
A collection that documents this point in his career was a fine enough read.
Not to discount the perspective he provides or the stories he shares, which are glimpses into a world that few experience either as patients or ER doctors/nurses/technicians will ever have.
A collection that documents this point in his career was a fine enough read.
March 6, 2023
I heard an interview with the author on Fresh Air, and was intrigued. The first chapter of this book, the one about covid, was hastily and poorly written. I was pretty disappointed and almost gave up on the book completely. The author had sounded so clear and thoughtful of the radio. However, the chapter must have been written as a bit of a necessary afterthought; when writing a physician's memoir during the epidemic, I suppose it has to be addressed. I was very pleased, then, that the rest of the book was wonderful. Several things made it compelling, from the fact that it's a peek into a life (that of an ER doc) so different from my own, to the thoughtful considerations about life and death. But what I appreciated most was the core message about the importance of becoming comfortable with the "gray zone." Of balancing opposing truths at once. Of making place for nuance. This isn't just important in medicine; it's largely absent from a lot of our interactions in this polarized time in history. I believe that nuance and shades of gray are not only more honest and realistic, but also lead to more productive and compassionate human cooperation.
March 11, 2023
This book is penned by an emergency room physician who endured the COVID-19 pandemic inside a NYC hospital in a time of panic, uncertainty, and frustration amid rampant patient deaths due to COVID.
Dr. Nahvi includes several group chats from young ER physicians texting one another during this time frame - highlighting the absurdities of low staffing, the lack of PPE supplies, and the minute-by-minute changing health department regulations. They were building the plane as they were flying it - this group of docs were all the 'tip of the spear' as the first wave of COVID hit NYC.
This volume reminded me of Atul Gawande, another physician and prolific medical writer. The author focuses on several patient cases, sharing the intimate details and intricacies of patient consent, family notifications, and the bureaucratic minutiae of endless paperwork. Michele Harper's book, Beauty in the Breaking also comes to mind as a similar ER doc's medical memoir.
Farzon offers a thoughtful meditation on the practice of present-day ER medicine by a current provider - trying to hold on to his humanity.
Dr. Nahvi includes several group chats from young ER physicians texting one another during this time frame - highlighting the absurdities of low staffing, the lack of PPE supplies, and the minute-by-minute changing health department regulations. They were building the plane as they were flying it - this group of docs were all the 'tip of the spear' as the first wave of COVID hit NYC.
This volume reminded me of Atul Gawande, another physician and prolific medical writer. The author focuses on several patient cases, sharing the intimate details and intricacies of patient consent, family notifications, and the bureaucratic minutiae of endless paperwork. Michele Harper's book, Beauty in the Breaking also comes to mind as a similar ER doc's medical memoir.
Farzon offers a thoughtful meditation on the practice of present-day ER medicine by a current provider - trying to hold on to his humanity.
June 29, 2023
This book is well-written and makes some points about ERs, hospitals, life and death, and mostly about how doctors think and feel. It starts with a prologue about the beginning of the Covid epidemic at ground zero, New York City. It was traumatic for the hospital workers, not to mention the patients, many of whom died, including medical personnel. And of course the patients' families.
The rest of the book mostly follows one case, a young-ish woman who came in to the ER already dead, and what the author and his crew did to try to cushion the blow to her husband. Other stories are mixed in, but we never get to see their conclusions.
For me, the book was okay but kind of meh. I got the point, and understand why he wanted to write about it. But I didn't need the main story spread out across the whole 200+ pages. (Sometimes that works, but not for me this time.) And though it's about the ER, there's not much of the feel of many patients coming through; the book is focused on a few specific, and mostly grim, cases.
Maybe someone who hasn't read a bunch of doctor/hospital books would like it better, or maybe I just wasn't in the right mood.
The rest of the book mostly follows one case, a young-ish woman who came in to the ER already dead, and what the author and his crew did to try to cushion the blow to her husband. Other stories are mixed in, but we never get to see their conclusions.
For me, the book was okay but kind of meh. I got the point, and understand why he wanted to write about it. But I didn't need the main story spread out across the whole 200+ pages. (Sometimes that works, but not for me this time.) And though it's about the ER, there's not much of the feel of many patients coming through; the book is focused on a few specific, and mostly grim, cases.
Maybe someone who hasn't read a bunch of doctor/hospital books would like it better, or maybe I just wasn't in the right mood.
March 19, 2023
This contemplative book begins with the COVID pandemic, but then moves to a day in the life of the author as an ER doctor, interspersed with some of his previous medical cases. However, this book is not gunshots and drama, but instead a thoughtful pondering on the constant uncertainty and unresolved emotional trauma that medical staff grapple with throughout their careers. Nahvi challenges readers to confront life's thorny questions and slow down enough to truly ponder them and the issues that bring them to light, while also sharing his own unanswered questions and second guessing that have been a part of his growth as a physician. There is death and pain and hard stories throughout the book, but ultimately I was left with the comfort of knowing that doctors like the author exist in our world and that his uncertainty is a sign of wisdom and compassion.
Source: public library print copy
Source: public library print copy
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