Emergency room physician Dr. Paul Austin faced a dilemma several years back when a 42-year-old house painter with a pack-a-day cigarette habit showed up complaining of chest pains. The tests showed no problems.

Austin consulted with the physician on call for patients without a primary care physician. Send him home, the doctor advised. Against his gut instinct, Austin did. Then he went home himself.

At work the next day, Austin got the word. That morning at 4:30 a.m. the housepainter had returned to the hospital and died of a heart attack. Could he have been saved if Austin had admitted him to the hospital?

"I felt prickles in my scalp and down the back of my neck. I glanced at the trash can, afraid I might vomit," Austin writes in his first book, "Something for the Pain: One Doctor's Account of Life and Death in the ER," which is now in bookstores.

With roller coaster pacing, snappy prose and medical details that don't slow the flow, Austin depicts the ER culture and how he tries to cope with the results of myriad rapid-fire decisions, self-doubt, the crazy hours and family responsibilities.

"I like working the ER," he says. "I really like the people I work with. I like the fact I do a little bit of everything."

While the book provides a look at what the white coat and stethoscope brigade faces daily here in the City of Medicine, almost as interesting is the backstory on the 53-year-old, first-time author and how he wedges writing into a profession notorious for burnout while he and his wife raise three children.

"High energy is a charitable way to phrase it," the graying Austin admits of his persona. "Hyperactive is less charitable."

In a 90-minute interview Austin pops up from his easy chair at least a half dozen times. He rummages through the accumulation of books and papers in his second-story garage apartment/study (self-built as therapy from job pressures) searching for a date. He charges up and down the exterior steps to search for something in his home on a quiet, tree-lined street in the Watts Hospital-Hillandale neighborhood.

His resume is equally active.

The High Point native studied English two years at Guilford College before quitting to build a cabin on land in Randolph County that he and his parents had purchased jointly. His half was his earnings as a high school bus driver.

He got the top on the cabin, ran out of money and surfaced in High Point as a street cleaner, then as a fire fighter. "Most fun I've ever had ... yellow hat, yellow truck," he says of the macho aspects of fighting fires and the appreciation from people.

But Austin was curious about medicine. He enrolled at UNC in the early '80s and financed his studies as a part-time nursing assistant in the hospital's emergency room. In the process he split up with his first wife and lived in an orange pup tent at Umstead State Park for two weeks until he could purchase a mobile home.

After earning an undergraduate degree in zoology in 1985, he studied four years at UNC's medical school. Three years of emergency medicine training followed at Allegheny General Hospital in Pittsburgh, Pa. A two-year teaching stint at East Carolina University's medical school ended with a return to the Triangle for the job he now holds in the ER at Durham Regional Hospital.

Books were natural for Austin, whose librarian father, Neal F. Austin, had the High Point public library named after him. In 2000, he started writing about his personal experiences. "They're some good stories on trash trucks," he says.

Austin works no more than 16, eight- to nine-hour shifts a month, which gives him time to write and be a father. His wife, Sally Somers Austin, is a full-time mom. She is also a registered nurse and a photographer.

After work he would jot down notes from his ER experiences. On his off days he would try to make sense of it at his computer.

"I don't make things up to make it better, but I do recreate dialogue as best as I can remember," he says of the immediacy he achieves in "Something for the Pain."

The N.C. Writers' Network liked the ER stories. In 2001, the prestigious Bread Loaf Writers' Conference invited him to Middlebury, Vt., for the first of what now totals five or six visits.

Since then he has been flipping in and out of writers' workshops receiving help from the likes of Ted Conover and Susan Orlean to whom, among others, he offers copious thanks. Along the way his work has appeared in obscure academic journals.

Austin hooked up with agent Michelle Tessler, who sold his book to W. W. Norton in September 2006. In June of this year, a Czech publisher purchased publication rights. In July, the Book of the Month Club bought "Something for the Pain."

"That was cool," Austin says in something of an understatement.

He approaches the learning curve of writing and the publication of his first book with a wry eye. Last year at Bread Loaf, Austin landed a coveted work-study grant as a waiter. He didn't need the money but craved the status.

"The coolest writers at Bread Loaf are the waiters," he says. "So finally I got to be a cool kid at Bread Loaf at the age of 52."

To promote his book at an independent bookstore in Charlotte, he drove a total of six hours there and back, sat beside a pile of his books for two hours chatting up whomever happened by and came away with two sales. A surgeon bought one. His stepbrother bought the other.

"I felt like 'Death of a Salesman,'" Austin recalls. "It's humbling but par for the course."

Austin is now writing a novel about a girl who has Down Syndrome, something he and his wife know firsthand. Their 21-year-old daughter has the disorder and lives in a group home.

While "Something for the Pain" is autobiographical, the novel in progress is fiction. Austin is undaunted.

"I didn't know what I was doing when I wrote the memoir, but I felt my way," he says. "I'm enjoying figuring it out as I go along."