Careers and writing lessons ~ by Tom Combs

Like many of you writing is not my first career. I’m a retired emergency physician. I’m honored to have been asked to share thoughts on writing.

To discuss writing it seemed reasonable to share some of my personal story and how it led to my two very different careers.


I was a Minneapolis kid from a big family. After a solid grade school education I spent aimless high school years accomplishing little (authority issues/knucklehead).

My family culture pushed me to apply for college. I was accepted despite poor high school grades due to SAT and ACT test scores. I had no objective in mind. The initial years I majored in partying and what I now refer to as “misdirected studies”.

I matured, met my wife-to-be Michele, and though a number of experiences came to believe in the dream of a career in medicine. I applied myself and after years of study and work I was lucky enough to be accepted to the U of MNMedical School.

I obtained my medical degree in 1984 and started my internship at Hennepin County Medical Center. There I was introduced to the relatively new specialty of emergency medicine. I knew immediately it was a good fit for me. I did three years of emergency medicine specialty training at the University of Cincinnati. I then returned to Mpls and an emergency room position in a busy, inner-city, level one trauma center. I spent most of my life there working day, evening, and nights from 1985 to 2007. Emergency medicine dominated my life.

Besides being the destination for the sickest and most grievously injured among us, ERs are the safety net for our society. Emergency departments care for everyone - those that are the sickest, the most critical, the poorest, and the most vulnerable. No one is turned away. It is the resource for victims of illness, violence/crime, natural disaster, mental illness, substance abuse, and those who have nothing and no one.

It’s a place where every hour round-the-clock people present with life-changing and, not rarely, life-ending crises. Working in emergency medicine you know that the worst thing that happens to anyone in your community will end up coming to you and your team.

In addition to “typical” critical illness and accidents, every day and night mental health crises, drug and alcohol tragedies, and both the victims and perpetrators of the worst imaginable crimes are cared for in the emergency department.

When police have individuals who are too violent for them to control they are brought to the emergency department. When people are acutely psychotic, suicidal, or homicidal they are brought to the ER. The ER is a world very few people are aware of and much different than anything I experienced growing up in my solid and intact family.

I’ve worked many shifts where multiple, grievously injured patients present at the same time all with lethal injuries. Car crashes with entire families in desperately injured.

I’ve taken care of five gang members who arrived by ambulance within minutes of one another who had minutes to live due to gaping stab wounds to their chests and collapsed lungs. The tubes I needed to drive into their chests to restore their collapsed lungs and manage their internal bleeding resulted in so much blood jetting out that my legs were soaked and my saturated shoes squished with each footstep.

Most cases are not as dramatic but the urgency is often no less and the diagnoses more difficult. And it always matters that you get it right…

That was my world in emergency medicine. It was my career. It was my endlessly challenging professional life for over 20 years. My work as an emergency medicine physician was a huge part of who I was.

On November 7, 2007 everything changed.

It was 5:31 p.m. and I was at home when a bomb went off in my head.

That’s what it felt like. The medical term is subarachnoid hemorrhage and it is the result of an aneurysm - an abnormal blood vessel that had burst in my brain.

Nearly 50% of people who experience this die immediately. 60 to 70% % die in the first hours and days. Those that survive typically have the significant compromise of a major stroke.

I spent 10 days in the neuro-intensive care unit though I don’t remember much of that time. I was lucky. I didn’t have any weakness or problems with movement but I did have cognitive issues. I couldn’t read for months and had ongoing issues with operational memory and attention. I was not able to multitask and was easily distracted. I was not reliable enough to babysit. I could not enter my credit card number on the internet and had to write where I parked my car for about 18 months.

Not surprisingly I lost my job as an emergency physician.

After about two years of rehab and healing I had recovered my reading ability enough that I entertained the idea that perhaps I could write. I hoped that I might be able to create for others the incredible pleasure and satisfaction that I enjoyed in reading a good book.

I started taking writing courses. In my first course I learned the most important lesson of my now 12-plus year writing career.

I’d attended a writing course with about 30 other students for 10 weeks. We had assignments each week yet they’d never been collected. A woman in the class asked if we were to ever get any individual feedback.

The instructor assigned the following. Each of us was to write a dramatic scene. He broke the class into four person groups and advised that we should make four printed copies of our scene and the next week we could exchange copies with those in our group - in the final week we would critique and workshop one another’s writing.

I attempted to write a scene reflecting an experience I had as a young physician. Here were the events I attempted to describe:

In my three years of working and emergency medicine training at the U of Cincinnati, I was also the helicopter flight physician. If a first responder felt a patient or patients were in desperate enough circumstances they could summon the air care helicopter to the scene. I carried the flight beeper while working my shifts in the ER. When the beeper went off I needed to hand off my current patients to colleagues (and nurses) to watch over while I ran to the flight elevator and rode to the helipad on the roof of the hospital.

On this day I climbed into the thundering helicopter and as we dove off the pad I put on my headphones. The dispatcher advised we were in route to a 30s-year-old black female who had been pulled unresponsive from a swimming pool. Our reported ETA was four minutes.

In those minutes I ran through the dozens of possible causes and interventions that might be involved – hoping there was something that could be done. As the helicopter touched down I saw two paramedics performing CPR. I exited the helicopter, ducked under the blades and ran to their side and assessed the patient – desperately looking for any possible way to save her life.

This type of experience and critical thinking was a regular experience for me. It was clear everything that could be done, had been done. She was gone. We stopped CPR. I had to pronounce the her dead.

We flew back to the hospital with her body on board. I returned to the ER and continued with the cares of my patients and the multiple other new patients that were flooding the ER. I was waiting for the physician’s worst job.

In these situations the hospital staff contact family members and advise them to “come to the ER”. They do not inform of death.

An hour or so later the charge nurse informed me that members of the deceased woman’s family had arrived. I made my way through the packed and noisy ER waiting room into the adjoining small, windowless room designated as the family room.

A 50s-year-old black female wearing clothes that look suitable for an office job was seated with one hand held to her mouth and the other gripped by a perhaps 10-year-old thin black boy who stood leaning tight against her. He wore a T-shirt, faded jeans too short for his legs, and bright red Converse tennis shoes with the tongues hanging out.

The woman and child’s postures and expressions radiated dread.

It was my job to inform this mother that her daughter was dead… to tell this young boy that his mother was forever gone. There is no way to soften such a reality.

They were bludgeoned by news and clutched one another in their agony. In their grief they showed dignity, courage, an incredible togetherness, and love. It made my throat clench and eyes water.

Approaching sirens intruded reminding me I needed to get back to the ER to other patients. I gently squeezed the woman’s shoulder and asked if there was anything I could do for them. She looked up with tears streaming and patted my hand as if she were comforting me.

As I turned to leave the boy left his grandmother’s side and stood in front of me. He looked me in the eye and said, “Did you try everything for my mom?”

I met his gaze, nodded while my heart ached, and answered, “We tried everything.”

He paused, nodded and then extended his hand. I shook his hand with my heart aching.

“Thank you,” he said. “Now it’s up to me to take care of my Grandma and little sister.”

That was the scene I tried to write for the assignment. Its impact on me has never faded. I could not have read it aloud.

The last week our group met to share critiques. One guy in my group had a Masters in screenwriting – not sure why he was in this entry level class – but he said “let’s do his first” referencing my scene to the two young women who completed our group.

The first young woman held up my few pages and said. “I really didn’t like it. The doctor was just so cold.”

The second woman nodded, “Yeah. He really just didn’t care at all.”

The screenwriter added, “Yeah. There’s something here but it’s a mess.”

I did not say a word. Totally shocked. How was it possible they’d got it so “wrong”?

As I processed their response I recognized an incredible lesson in writing. What had I learned?

It didn’t matter what was in my memory, heart and mind. What mattered were the words on the page.

The words I’d written did not make the experience and emotion accessible to my classmates. I’d failed to provide the words that allowed the readers to share in the powerful, poignant reality I’d experienced. In all scenes, factual or those we’ve created, the drama and feeling we seek to share must be communicated by the words on the page.

Talent, craft and artistry are factors that direct us on how to accomplish the magical shared alchemy. The critical lesson I learned is what the author’s essential task actually is and that the words on the page determine if we are successful.

Do the words on the page communicate the essence of the experience? Do they allow the reader to feel what stirs us as the author?

Clearly what I had written failed to communicate the meaning and intensity of what had occurred. I needed to learn to put words on the page with the skill and artistry necessary to create a unique but shared experience. To allow the reader to engage—to feel.

This recognition was the most significant writing lesson I’ve learned. Perhaps this sounds overly simplistic to others but this awareness is an essential guide for me in my writing efforts. Will the words on the page allow the reader to experience what I’m hoping they will? Do the words allow them to engage? To care? To feel?

I continue with my efforts to make that happen as I work on book #4 in my medical mystery-thriller series.

I hope my long-winded recounting may help you in your efforts to accomplish the challenges we face.

Thank you!

Tom Combs

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Listen to Tom Combs' podcast episode here.