Anne Biccard — Holding My Breath Further Exploits of an ER Doctor
With Anne Biccard — Holding My Breath Further Exploits of an ER Doctor
In short
Johannesburg emergency doctor Anne Biccard returns to talk about her second memoir, Holding My Breath. She describes writing between quiet shifts, the drug cases that upended her assumptions, why the third COVID wave was the most disempowering, the short-term memory loss she had after catching the virus, and her running scoreboard against "Grim", the Grim Reaper. The one takeaway: Biccard did not choose emergency medicine as a specialty; it did not exist as one when she qualified, and she stayed for more than 25 years.
How did Anne Biccard end up working in emergency medicine?
She fell into it rather than chose it. When she qualified there was no specialty in emergency medicine, so doctors worked in the ED as an in-between or part-time job while training in something else. She has now been doing it for more than 25 years, describing it as what she does and what she is good at.
When does a doctor working seven days a week find time to write a book?
In the gaps. She works a six-to-two shift seven days a week, which leaves afternoons for the farm and a long drive that gives her thinking time. Quiet six o'clock mornings allow some writing at work, and during early COVID the hospital was so empty she wrote a great deal.
Why did she write a second book so soon after the first?
She started the morning after sending the first manuscript off. It was a quiet morning in the ED, she wondered what to do next, and decided to carry on writing about the previous day's work. The second book followed roughly eighteen months to two years later.
What is the story behind the migrating nipple?
A man reported that overnight his right nipple had moved to his armpit, then said it had moved back before she could examine him. Examination found no medical explanation; he admitted using crystal meth, which can cause visual hallucinations. He later returned unconscious from an overdose and was resuscitated.
What did the case of the unconscious 70-year-old woman teach her?
That doctors adjust their expectations to a patient's presumed lifestyle. Every test came back unrevealing and she went to ICU still undiagnosed, until family asked whether she had started using again. She was a heroin addict — something Biccard would have tested for first in a 20-year-old.
Why was the third COVID wave the hardest for her?
Because nothing the profession knew worked. Medicine's usual protocols and strategies failed, and if a patient was going to die of COVID it felt like nothing could change that. CPR on advanced COVID patients had, in her words, zero per cent success. She calls the loss of agency profoundly disempowering.
What happened when she caught COVID herself?
A colleague spotted she looked unwell, tested her and sent her home; she waited in the car park to hand over. She was not very ill but lost her sense of taste and smell entirely, and for two or three months afterwards had short-term memory loss, forgetting patients between x-rays.
Who or what is "Grim" in her books?
Grim is the Grim Reaper, whom she pictures as a male energy with a scoreboard between them — his name on the top left, hers on the top right. He always wins in the end, but she takes satisfaction in occasionally getting a point on the board.
What does she plan to do after emergency medicine?
Move into teaching and write at least one more book. Another book is already in the production line. She hopes to be old enough to retire from the ED in about two years, says she feels about a hundred and sixty years old, and wants to give something back to doctors coming up.
In their words
as I keep working I keep getting more stories to tell so I keep writing them down
when your patient starts to sweat you must start to sweat
if that patient was going to die from COVID it felt to us that there was nothing we could do to change that outcome
it's like you put something down and you know it's there you reach out to pick it up and it's gone and it's just an empty space
the underlying thing is he's always gonna win isn't he you know at the end of the day there's no escape but it is nice to to give him a little tussle every now and again
Key takeaways
- Biccard did not choose emergency medicine as a specialty; it did not exist as one when she qualified, and she stayed for more than 25 years.
- The second book began the morning after she submitted the first, prompted by a quiet shift and the question of what to do next.
- Unusual cases from the books double as teaching material, because an anecdote teaches younger doctors better than a dry algorithm.
- Assumptions about a patient's age and lifestyle can delay diagnosis, as with the 70-year-old heroin user nobody thought to test.
- The third COVID wave caused lasting distress among staff less because of the deaths than because of the sense of having no agency at all.
- Her own COVID infection left her with total loss of taste and smell and two to three months of short-term memory loss.
Show notes
In this episode, I chat with Anne about her second book, we find out what she has been up to since we last spoke and why she decided to write a second book.
Holding My Breath is a candid, heart-breaking and very funny memoir of life in one of Johannesburg’s busiest emergency rooms. Biccard’s warmth and humanity shine through the often harrowing tale, creating an unputdownable, uplifting and inspiring book.
The first customer today reports that the previous night, his right nipple had moved away from its usual location. He noticed its absence when he looked in the mirror and found it in his armpit.
‘Wow,’ I say with a slight frown. I have never heard of a migrating nipple before. ‘Let’s have a look.’ I slide the door shut and motion to him to pull his T-shirt off.
‘Oh, it has moved back now,’ he says.
Dr Anne Biccard is a medical doctor who lives and works in Johannesburg, South Africa. She studied psychology and then medicine at the University of the Witwatersrand. She lives with her partner on a small farm where they provide a home to rescued greyhounds (and some other creatures)
Frequently asked questions
Does her family or her partner appear in the books?
Barely. She says the books are about her work persona rather than her home persona — family, her partner and the farm sit in the background, but the story starts when she walks through the double doors.
Does she enjoy the adrenaline of the emergency room?
No. She says she is not an adrenaline person, has never done extreme sports, and would prefer a calm day with everything under control. Given the choice again she might not have chosen the ED.
What frightens her most in the ED?
Not patients who arrive already dead, but those who look fine while she can see what is about to go wrong in the next few minutes — because then she has to act.
Why was the sedation of the woman with the dislocated ankle so difficult?
Propofol affects people very differently and a millilitre or two too much can stop breathing. The woman metabolised it unusually fast, waking every time her foot was touched, even after enough to sedate two adults.
Are the books available in other formats?
Both are available digitally, and the first book, Saving a Stranger's Life: The Diary of an Emergency Room Doctor, is also available as an audiobook.
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