THE ER BOOK

Sunday, May 19, 2019


Twenty-five years in the ER could become a résumé for despair, but for Angels in the ER and millions of other books are available for Amazon Kindle. Editorial Reviews. Review. "We meet an amazing cast of characters who come through the He has written many books (including Angels in the ER―over , copies sold) as well as newspaper and magazine columns and. This is a collection of real-life stories that have inspired television show ER. Browse our editors' picks for the best books of the month in fiction, nonfiction.


The Er Book

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Angels in the ER book. Read reviews from the world's largest community for readers. Twenty-five years in the ER could become a résumé for despair, bu. This is the medicine we need the most, and it is administered on every page of ' Angels in the ER,' a chronicle of mankind at its best." - Richard Thomas - Film, TV . He has written many books (including Angels in the ER—over , copies sold) as well as newspaper and magazine columns and human-interest stories.

He painted such vivid pictures, without being gory or crass, that it felt like I could have been there, and I believe he has worked at his profession long enough to probably have another book's worth of stories in there. There are pieces of scripture at the beginning of some of the chapters, and one chapter delves into whether miracles exist in medicine, while another ponders the afterlife and what happens when a patient dies, and as I said, he doesn't cross any boundaries of sensibility, so I can understand why this fits onto the bookshelves at the general store.

At the same time, it wouldn't be out of place at Barnes and Noble on the general medical bookshelf. In fact, I might have seen it there in hardcover come to think of it. I definitely recommend it to anyone who likes to read about ER stories, specifically those from places in between the rural hospitals whose staffs have just enough equipment to treat the basics or stablize them for treatment to a major trauma center, and the trauma centers themselves.

View 2 comments. I read the book Angels in the ER. Ir was a great book! It was great for two main reasons. One is I loved the real stories and second I loved the medical refrence. I will give you and idea of this book and why I would definetly reccomend this book. First is the real stories. I loved the real stories! They were crazy and intense. The book includes stories of patients and their side of the stories. It showed a lot of emotion and you can almost feel the pain they are in.

The writing is very descip I read the book Angels in the ER. The writing is very desciptive. The doctor in the story uses his personal feelings in the writting also. Alll the stories featured in the book are all miracle stories. I think the book portrayes a great idea of a gurdian angel.

I want to be a surgeon when I grow up, so when I read books like this it gets me excited to go to collage and be a doctor. In the book it describes in extent medical procedures. I am a person who doesn't mind hearing about blood and guts and such, but if you are a person who doesn't like to read about blood and stuff then this is not the book for you! I would reccomend this book to someone that likes the medical field and who aspires to go into a medical carear.

I love this book just for that reason. I also think this book is for someone who thinks they don't believe in gurdian angels.

It gives you a reason and proof to believe in them! All around this was a great book. It was a little confusing because of some of the medical terms. But it gives you a better vocabulary! I loved reading the book Angels in the ER! Mar 31, hanna rated it really liked it Shelves: I wasn't expecting to like this as much as I did, I pretty much chose this book at random from a pick of ER genre books.

It was really well written and kept me interested throughout. But it consisted of a lot of quick short stories shedding light on the author's experiences as a ER doctor. I mean in that sort of situation, I'd think it's almost crucial to have faith in something bigger then yourself. So that you remai I wasn't expecting to like this as much as I did, I pretty much chose this book at random from a pick of ER genre books. So that you remain composed and sane.

Sometimes the situations are just out of your hands, and sometimes it's not. Miracles do happen, but they aren't raising people from the dead or healing the blind, sometimes a miracle can be as small as having someone hold your hand while you die or comforting you in a time of need. I like to think we can all be an angel for someone, whether that be for a stranger or not. Kindness, compassion and sympathy are all requirements in the medical field since we aren't treating diseases - we're treating people.

The last chapter nearly moved me to tears, and I hope I too can one day be as great a Dr as Angus Gaines. You will soon learn they do in fact exist, and they manifest themselves in a variety of forms. Some are nurses, a few are doctors, and many are "everyday people", passing through our doors and into our lives.

Sometimes you have to look hard for their wings. And sometimes you have to shield your eyes from the glow that surrounds them. May 24, Victoria Heflin rated it it was amazing. This is a collection of heart wrenching, tear jerking, warm feeling stories that reassured my faith once again I work in an Emergency Room, I have seen first hand life, death, and everything in-between.

In near death experiences all my patients have told me the same thing.. Every sinner has a future and saint has a past, this book of true medical miracles confirms that old saying. This book was given to me by a friend and over all it made me think about a few things. I could pick up and put down. Seems easy to read.

Loved most of the stories. Apr 07, K. Lantz rated it it was amazing. What an uplifting and eye-opening book! Before reading, I could only guess what sort of things happened in the Emergency Room.

This book serves as a sampling of the various circumstances that land people in the ER, and it also shows a sacred glimpse into the hearts of the angels who touch each other's lives in those corridors. Lesslie honors both doctors and nurses, paramedics and administrators, patients and companions. He marks some of the miracles he has experienced in his life most of w What an uplifting and eye-opening book! He marks some of the miracles he has experienced in his life most of which happen outside the hospital, incidentally and he also marks the phases of life, from birth to death in the ER.

As a human interest book written by a man of learning and faith, I say, it's worth the read. Aug 27, Tina Lewis rated it liked it. After reading the first 2 chapters, I felt confused as to the point of the book. I hadn't read anything inspiring or humorous or touching. I continued to read chapter after pointless chapter, searching for something poignant to take to heart and make the book worthwhile. I felt like I was trapped at a cocktail mixer with a very boring physician who convinced himself that what he thought were peak-experience work-related stories were absolutely fascinating to everyone within earshot.

I gave the b After reading the first 2 chapters, I felt confused as to the point of the book. I gave the book three stars because of one single chapter that was worth reading the entire book to reach.

You'll know it when you read it. There are no discussion topics on this book yet. Readers also enjoyed.

About Robert D. Books by Robert D. This interaction brings the SRP-ribosome complex to a protein translocator.

The SRP and its receptor are thought to act in concert. The SRP binds to both the exposed ER signal sequence and the ribosome, thereby inducing a pause in translation. The SRP receptor more It has long been debated whether polypeptide chains are transferred across the ER membrane in direct contact with the lipid bilayer or through a pore in a protein translocator.

The debate ended with the purification of the protein translocator, which was shown to form a water-filled pore in the membrane through which the polypeptide chain traverses the membrane. The translocator, called the Sec61 complex , consists of three or four protein complexes, each composed of three transmembrane proteins, that assemble into a donutlike structure. When a ribosome binds, the central hole in the translocator lines up with a tunnel in the large ribosomal subunit through which the growing polypeptide chain exits from the ribosome Figure The bound ribosome forms a tight seal with the translocator, such that the space inside the ribosome is continuous with the lumen of the ER and no molecules can escape from the ER Figure It is thought that a lumenal ER protein serves as a plug or that the translocator itself can rearrange to close the pore when no ribosome is bound.

Thus, the pore is a dynamic structure that opens only transiently when a ribosome with a growing polypeptide chain attaches to the ER membrane. A ribosome bound to the Sec61 protein translocator. A A reconstruction of the complex from electron microscopic images viewed from the side.

B A view of the translocator seen from the top looking down on the membrane. C A schematic drawing of more Evidence for a continuous aqueous pore joining the ER lumen and the interior of the ribosome. In this experiment, a fluorescent dye is attached to a portion of the growing polypeptide chain that is still contained within the ribosome.

A In free ribosomes, more The signal sequence in the growing polypeptide chain is thought to trigger the opening of the pore: An ER signal sequence is therefore recognized twice: This may help to ensure that only appropriate proteins enter the lumen of the ER.

As we have seen, translocation of proteins into mitochondria, chloroplasts, and peroxisomes occurs posttranslationally, after the protein has been made and released into the cytosol , whereas translocation across the ER membrane usually occurs during translation co-translationally. This explains why ribosomes are bound to the ER but usually not to other organelles.

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Some proteins, however, are imported into the ER after their synthesis has been completed, demonstrating that translocation does not always require ongoing translation. Posttranslational protein translocation is especially common across the ER membrane in yeast cells and across the bacterial plasma membrane which is thought to be evolutionarily related to the ER; see Figure To function in posttranslational translocation, the translocator needs accessory proteins that feed the polypeptide chain into the pore and drive translocation Figure In bacteria, a translocation motor protein , the SecA ATPase , attaches to the cytosolic side of the translocator, where it undergoes cyclic conformational changes driven by ATP hydrolysis.

Each time an ATP is hydrolyzed, a portion of the SecA protein inserts into the pore of the translocator, pushing a short segment of the passenger protein with it. As a result of this ratchet mechanism, the SecA protein pushes the polypeptide chain of the transported protein across the membrane. Three ways in which protein translocation can be driven through structurally similar translocators. A Co-translational translocation. Eucaryotic cells use a different set of accessory proteins that associate with the Sec61 complex.

These proteins span the ER membrane and use a small domain on the lumenal side of the ER membrane to deposit an hsplike chaperone protein called BiP, for b inding p rotein onto the polypeptide chain as it emerges from the pore into the ER lumen. Unidirectional translocation is driven by cycles of BiP binding and release, as described earlier for the mitochondrial hsp70 proteins that pull proteins across mitochondrial membranes.

Proteins that are transported into the ER by a posttranslational mechanism are first released into the cytosol , where they are prevented from folding up by binding to chaperone proteins, as discussed earlier for proteins destined for mitochondria and chloroplasts. In all of these cases where translocation occurs without a ribosome sealing the pore, it remains a mystery how the polypeptide chain can slide through the pore in the translocator without allowing ions and other molecules to pass through.

We have seen that in chloroplasts and mitochondria, the signal sequence is cleaved from precursor proteins once it has crossed the membrane. Similarly, N-terminal ER signal sequences are removed by a signal peptidase on the lumenal side of the ER membrane. The signal sequence by itself, however, is not sufficient for signal cleavage by the peptidase; this requires an adjacent cleavage site that is specifically recognized by the peptidase. We shall see below that ER signal sequences that occur within the polypeptide chain—rather than at the N-terminus—do not have these recognition sites and are never cleaved; instead, they can serve to retain transmembrane proteins in the lipid bilayer after the translocation process has been completed.

The N-terminal ER signal sequence of a soluble protein has two signaling functions. It directs the protein to the ER membrane , and it serves as a start-transfer signal or start-transfer peptide that opens the pore. Even after it is cleaved off by signal peptidase , the signal sequence is thought to remain bound to the translocator while the rest of the protein is threaded continuously through the membrane as a large loop.

Once the C-terminus of the protein has passed through the membrane, the translocated protein is released into the ER lumen Figure The signal sequence is released from the pore and rapidly degraded to amino acids by other proteases in the ER.

A model for how a soluble protein is translocated across the ER membrane. On binding an ER signal sequence which acts as a start-transfer signal , the translocator opens its pore, allowing the transfer of the polypeptide chain across the lipid bilayer more While bound in the translocation pore, signal sequences are in contact not only with the Sec61 complex , which forms the walls of the pore, but also with the hydrophobic lipid core of the membrane.

This was shown in chemical cross-linking experiments in which signal sequences and the hydrocarbon chains of lipids could be covalently linked together. To release the signal sequence into the membrane, the translocator has to open laterally. The translocator is therefore gated in two directions: This lateral gating mechanism is crucial for the insertion of transmembrane proteins into the lipid bilayer, as we discuss next. The translocation process for proteins destined to remain in the membrane is more complex than it is for soluble proteins, as some parts of the polypeptide chain are translocated across the lipid bilayer whereas others are not.

Nevertheless, all modes of insertion of membrane proteins can be considered as variants of the sequence of events just described for transferring a soluble protein into the lumen of the ER. We begin by describing the three ways in which single-pass transmembrane proteins see Figure become inserted into the ER.

In the simplest case, an N-terminal signal sequence initiates translocation , just as for a soluble protein , but an additional hydrophobic segment in the polypeptide chain stops the transfer process before the entire polypeptide chain is translocated. This stop-transfer signal anchors the protein in the membrane after the ER signal sequence the start-transfer signal has been released from the translocator and has been cleaved off Figure How a single-pass transmembrane protein with a cleaved ER signal sequence is integrated into the ER membrane.

In this hypothetical protein the co-translational translocation process is initiated by an N-terminal ER signal sequence red that functions more In the other two cases, the signal sequence is internal, rather than at the N-terminal end of the protein. Like the N-terminal ER signal sequences, the internal signal sequence is recognized by an SRP , which brings the ribosome making the protein to the ER membrane and serves as a start-transfer signal that initiates the translocation of the protein.

Internal start-transfer sequences, can bind to the translocation apparatus in either of two orientations, and the orientation of the inserted start-transfer sequence, in turn, determines which protein segment the one preceding or the one following the start-transfer sequence is moved across the membrane into the ER lumen.

In one case, the resulting membrane protein has its C-terminus on the lumenal side Figure A , while in the other, it has its N-terminus on the lumenal side Figure B. The orientation of the start-transfer sequence depends on the distribution of nearby charged amino acids, as described in the figure legend. Integration of a single-pass membrane protein with an internal signal sequence into the ER membrane.

In these hypothetical proteins, an internal ER signal sequence that functions as a start-transfer signal binds to the translocator in such a way that more In multipass transmembrane proteins , the polypeptide chain passes back and forth repeatedly across the lipid bilayer see Figure It is thought that an internal signal sequence serves as a start-transfer signal in these proteins to initiate translocation , which continues until a stop-transfer sequence is reached.

In double-pass transmembrane proteins, for example, the polypeptide can then be released into the bilayer Figure Integration of a double-pass membrane protein with an internal signal sequence into the ER membrane. In this hypothetical protein, an internal ER signal sequence acts as a start-transfer signal as in Figure and initiates the transfer of the C-terminal more The insertion of the multipass membrane protein rhodopsin into the ER membrane.

Rhodopsin is the light-sensitive protein in rod photoreceptor cells in the mammalian retina discussed in Chapter A A hydrophobicity plot identifies seven short hydrophobic more Whether a given hydrophobic signal sequence functions as a start-transfer or stop-transfer sequence must depend on its location in a polypeptide chain, since its function can be switched by changing its location in the protein using recombinant DNA techniques.

Thus, the distinction between start-transfer and stop-transfer sequences results mostly from their relative order in the growing polypeptide chain. It seems that the SRP begins scanning an unfolded polypeptide chain for hydrophobic segments at its N-terminus and proceeds toward the C-terminus, in the direction that the protein is synthesized.

A similar scanning process continues until all of the hydrophobic regions in the protein have been inserted into the membrane. Because membrane proteins are always inserted from the cytosolic side of the ER in this programmed manner, all copies of the same polypeptide chain will have the same orientation in the lipid bilayer. This generates an asymmetrical ER membrane in which the protein domains exposed on one side are different from those domains exposed on the other.

This asymmetry is maintained during the many membrane budding and fusion events that transport the proteins made in the ER to other cell membranes discussed in Chapter Thus, the way in which a newly synthesized protein is inserted into the ER membrane determines the orientation of the protein in all of the other membranes as well.

When proteins are dissociated from a membrane and are then reconstituted into artificial lipid vesicles, a random mixture of right-side-out and inside-out protein orientations usually results. Thus, the protein asymmetry observed in cell membranes seems not to be an inherent property of the protein, but instead results solely from the process by which proteins are inserted into the ER membrane from the cytosol.

Angels in the ER: Inspiring True Stories from an Emergency Room Doctor

Many of the proteins in the lumen of the ER are in transit, en route to other destinations; others, however, are normally resident there and are present at high concentrations. These ER resident proteins contain an ER retention signal of four amino acids at their C terminus that is responsible for retaining the protein in the ER see Table ; discussed in Chapter Some of these proteins function as catalysts that help the many proteins that are translocated into the ER to fold and assemble correctly.

One important ER resident protein is protein disulfide isomerase PDI , which catalyzes the oxidation of free sulfhydryl SH groups on cysteines to form disulfide S-S bonds. Almost all cysteines in protein domains exposed to either the extracellular space or the lumen of organelles in the secretory and endocytic pathways are disulfide-bonded; disulfide bonds do not form, however, in domains exposed to the cytosol because of the reducing environment there.

Another ER resident protein is the chaperone protein BiP. Like other chaperones, BiP recognizes incorrectly folded proteins, as well as protein subunits that have not yet assembled into their final oligomeric complexes. To do so, it binds to exposed amino acid sequences that would normally be buried in the interior of correctly folded or assembled polypeptide chains. The bound BiP both prevents the protein from aggregating and helps to keep it in the ER and thus out of the Golgi apparatus and later parts of the secretory pathway.

Like the hsp70 family of proteins, which bind unfolded proteins in the cytosol and facilitate their import into mitochondria and chloroplasts, BiP hydrolyzes ATP to provide the energy for its roles in protein folding and posttranslational import into the ER. The covalent addition of sugars to proteins is one of the major biosynthetic functions of the ER. Most of the soluble and membrane -bound proteins that are made in the ER—including those destined for transport to the Golgi apparatus, lysosomes, plasma membrane , or extracellular space—are glycoproteins.

In contrast, very few proteins in the cytosol are glycosylated, and those that are carry a much simpler sugar modification, in which a single N -acetylglucosamine group is added to a serine or threonine residue of the protein. An important advance in understanding the process of protein glycosylation was the discovery that a preformed precursor oligosaccharide composed of N -acetylglucosamine, mannose, and glucose and containing a total of 14 sugars is transferred en bloc to proteins in the ER.

Because this oligosaccharide is transferred to the side-chain NH 2 group of an asparagine amino acid in the protein , it is said to be N-linked or asparagine-linked Figure The transfer is catalyzed by a membrane -bound enzyme , an oligosaccharyl transferase , which has its active site exposed on the lumenal side of the ER membrane; this explains why cytosolic proteins are not glycosylated in this way.

The precursor oligosaccharide is held in the ER membrane by a special lipid molecule called dolichol , and it is transferred to the target asparagine in a single enzymatic step immediately after that amino acid has emerged into the ER lumen during protein translocation Figure Since most proteins are co-translationally imported into the ER, N -linked oligosaccharides are almost always added during protein synthesis.

The asparagine-linked N -linked precursor oligosaccharide that is added to most proteins in the rough ER membrane. For many glycoproteins, only the core more Protein glycosylation in the rough ER. Almost as soon as a polypeptide chain enters the ER lumen, it is glycosylated on target asparagine amino acids.

The precursor oligosaccharide shown in Figure is transferred to the asparagine as an intact unit more The precursor oligosaccharide is linked to the dolichol lipid by a high-energy pyrophosphate bond, which provides the activation energy that drives the glycosylation reaction illustrated in Figure The entire precursor oligosaccharide is built up sugar by sugar on this membrane -bound lipid molecule before its transfer to a protein.

5.52 Who wrote the famous "book" about the ER staff? (new info in SPOILER space) (ER)

The sugars are first activated in the cytosol by the formation of nucleotide -sugar intermediates , which then donate their sugar directly or indirectly to the lipid in an orderly sequence.

Partway through this process, the lipid-linked oligosaccharide is flipped from the cytosolic to the lumenal side of the ER membrane Figure Synthesis of the lipid-linked precursor oligosaccharide in the rough ER membrane. The oligosaccharide is assembled sugar by sugar onto the carrier lipid dolichol a polyisoprenoid; see Panel , pp.

Dolichol is long and very hydrophobic: All of the diversity of the N -linked oligosaccharide structures on mature glycoproteins results from the later modification of the original precursor oligosaccharide. While still in the ER , three glucoses see Figure and one mannose are quickly removed from the oligosaccharides of most glycoproteins.

We shall return to the importance of glucose trimming shortly. The N -linked oligosaccharides are by far the most common oligosaccharides found on glycoproteins.

Less frequently, oligosaccharides are linked to the hydroxyl group on the side chain of a serine, threonine, or hydroxylysine amino acid. These O-linked oligosaccharides are formed in the Golgi apparatus by pathways that are not yet fully understood. It has long been debated why glycosylation is such a common modification of proteins that enter the ER. One particularly puzzling observation has been that some proteins require N -linked glycosylation for proper folding in the ER, yet the precise location of the oligosaccharides attached to the protein 's surface does not seem to matter.

These chaperones are lectins that bind to oligosaccharides on incompletely folded proteins and retain them in the ER. Robert D. Yet the same pressures and stresses that make this place so challenging also provide an opportunity to experience some of life's greatest wonders and mysteries. Lesslie illuminates messages of hope while sharing fast-paced, captivating stories about discovering lessons from the ER frontline watching everyday miracles unfold holding on to faith during tragedy and triumph embracing the healing balm of hope For anyone who enjoys true stories of the wonders of the human spirit, this immensely popular book is a reminder that hope can turn emergencies into opportunities and trials into demonstrations of God's grace.

Robert Lesslie is a physician with more than 30 years of experience in fast-paced, intense ER environments. He is now the co-owner and medical director of two urgent-care facilities. He and his wife, Barbara, live in South Carolina. Compassion and lovingkindness in difficult circumstances.For some who are really nervous or worried at seeing the doctor, whatever they are feeling is probably heightened as well.

It served more than 40, patients in , up percent from Figure The unfolded protein response in yeast. Another ER resident protein is the chaperone protein BiP. With most of the services, booking is as simple as going to a website, entering a zip code and the kind of care needed, and checking available times.

When a polypeptide contains multiple, alternating start-transfer and stop-transfer signals, it will pass back and forth across the bilayer multiple times as a multipass transmembrane protein. Published August 1st by Harvest House Publishers. I enjoyed every story.