"it's the emergency department calling. We're hoping you can come in early."
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6:25 PM. "Dr. Goldman, it's the emergency department calling," says an ER ward clerk named Vivica.
At the dinner table, my family sees me flinch. "Sorry to bother you," she says, "but the department is backing up. We're hoping you can come in early."
There are times I want to let these calls go to voicemail. I don't get the time I need to transition from Sunday dinner with my wife, kids, and mother-in-law to the high-stress environment of a downtown big-city ER.
"It's no bother at all," I reply. "On my way."
"An overlap shift introduced to help the ER cope with surging patient volumes at night."
*In some hospitals, casino shifts are split night shifts.
Patients' problems are exponentially more complex than they were fifteen years ago. While technology has leaped forward, so have the challenges of diagnosis.
Staff must be prepared to see, diagnose, and treat any condition. From the routine to the bizarre, the intensity never drops.
Names have been changed. The trauma is real. These are the cases that keep doctors awake at night.
She stumbled in. Slurred speech. Erratic behavior. The blood test confirmed alcohol intoxication. But her family was adamant: she did not drink alcohol. Dr. Goldman had to solve a puzzle that sounded impossible, leading to a diagnosis of the extremely rare Auto-Brewery Syndrome.
Read the diagnosis →She was young. Vibrant. She came in with what looked like a minor complaint. In the chaos of a busy night, it's easy to triage her as low priority. But something didn't sit right. A second look revealed the unthinkable: untreated cancer lurking beneath the surface of a twenty-something.
Find out what happened →It's the new reality of Canadian healthcare. Doctors forced to treat life-threatening conditions in the waiting room because there are no beds. It's dangerous. It's frustrating. And it's happening right now in an ER near you.
See the reality →It's not just the big city hospitals. Dr. Goldman travels to places like Perth to witness the "first-order care" delivered in tiny rural hospitals. Meet heroes like Dr. Alan Drummond, who hold the line with limited resources but unlimited dedication.
Meet the rural heroes →Dr. Nic Sparrow doesn't wait for patients to come to the ER. As the founder of KERPA, he goes to them. He drives a fully equipped emergency room on wheels into some of the most remote parts of British Columbia, bringing life-saving care directly to the scene where it's needed most.
Ride along with KERPA →Kaitlin Stockton refused to stay silent when she saw the safety of patients and workers at risk. In a bold move that shook the system, she sued the health authority, exposing the dangerous conditions on the front line and demanding accountability.
Read the full account →Fifteen years ago, Dr. Brian Goldman wrote the bestseller The Night Shift. It was a wake-up call. It showed us the cracks in the system.
But things have changed.
We have incredible leaps in technology. We have ER physicians with more know-how than ever before. But the problems? They are exponentially more complex.
This isn't just a sequel. It's a new diagnosis for a system on the edge. It's raw, revealing, and more urgent than ever.
Dr. Brian Goldman is not your typical physician. He is an ER veteran and the voice behind CBC Radio’s White Coat, Black Art.
For decades, he has been pulling back the curtain on the culture of medicine. In The Casino Shift, he goes deeper than ever before. He exposes the frustration, the burnout, and the raw passion of colleagues who stand on the line between life and death.
Discussing the realities of the Casino Shift and the current state of emergency medicine.
"The Casino Shift is a real-life take on The Pitt and a warning to all who care about Canada's fractured health care system. A must-read."
"Dr. Goldman lifts the facade of emergency medicine, revealing the impossible weight behind every choice."
"Early in this gripping book, Dr. Goldman, tells the reader to 'buckle up' because it is going to be a 'bumpy ride.' Good advice! This book is a fast-paced journey through the challenges of being a doctor—and a patient—in the current Canadian healthcare system."
For interview requests and other media inquiries.
The Casino Shift | Stories from an ER on the Edge
