Bingo Resilience

Her wary eyes, magnified from her thick-lensed spectacles, watched my every move as I pulled Room 21's curtain to the side and entered her room. In her early eighties, it was apparent to me that my entrance into her life was more important than the abdominal pain that brought her to our Emergency Department. In the corner sat a slight man with wispy gray hair poking out from the border of his baseball cap, his elbows resting on his thighs as he leaned forward in his chair. His wrinkled face and tired appearance made me question if this man was her son or husband.

I returned my gaze to this patient and gave her a smile as I approached her bedside. Her stoic face softened slightly as I watched the corners of her eyes relax. Her mouth's edges lifted slightly into a hesitant return smile. She was on guard.

Arriving to the side of her cot, I extended my hand to introduce myself. "Hello, Ms. Westin. My name is Dr. Jim and I will be taking care of you today while you are in our Emergency Department."

"Hello, Doctor," she replied, barely grasping my hand in welcome. "Please call me Bertha."

"Nice to meet you, Bertha," I answered before turning to the gentleman in the corner of the room and approaching him. Once again, I introduced myself.

"Thank you, Doctor. My name is Sam. I'm her son."

Her son. Standing closer to him, I could see that Sam had his mother's eyes--slightly hazel but more fatigued-appearing. My mind wanted to know what in his life was giving him this look of defeat.

"Nice to meet you, Sam. Thank you for being here with your mother today."

Sam nodded to my words. My response words--actively thanking him for taking the time to accompany his elderly mother to the Emergency Department--were something I had been saying for the past few years to adult children who accompanied their elder parent to our department. It was my way of acknowledging and validating their efforts in helping their ill parent in a time of need. Of putting to the side their own needs and demands. Of dropping everything at that very moment to be at their parent's side during an Emergency Room visit. This supportive action was one that I respected immensely. Often, it was the adult child who could convey just a little more history or provide just a bit more support that could make a difference in my course of treatment of their parent.

It was a loving gesture that was not lost on me.

I turned back to Ms. Bertha and began questioning her. She had developed abdominal pain in her midepigastric to left upper quadrant about four hours prior to her arrival. It was not accompanied by any nausea, vomit, diarrhea or constipation. She had no fever. She denied any chest pain, shortness of breath, or recent trauma. She denied any urinary complaints. This abdominal pain was unusual for her. It had presented soon after she had eaten a BLT sandwich for lunch. Of course, like Murphy's Laws would dictate, the pain had completely dissipated by the time I examined her.

As I questioned her, I could see her slowly letting her guard down with me. She began to smile her big, beautiful smile more easily. She became more conversive. She became down-right fun. We laughed together at some of our small talk while I finished my history-taking and began my physical exam.

Her physical exam was perfect. Nontoxic. Benign. I couldn't find a thing wrong with her.

Because of her age, we did the standard precautionary testing, including blood work, an EKG, and a urinalysis. While waiting for her test results to return, I stopped in several more times to perform recheck exams and make sure she remained comfortable. She did. Each time I stopped in, I became more and more aware of her piss-and-vinegar disposition and sense of humor. Especially talking about Bingo, she seemed to light up at the sense of fulfillment this church-going sport brought her. "Yeah," Sam added, "don't try to get between Mom and her Bingo chips." Ms. Bertha, it seemed, did not take lightly to losing a recent big prize by one empty block on her card.

Finally, I went in for the final time with all of her returned test results. All results were normal and favorable.

In the few hours I spent with her, I continued to appreciate Ms. Bertha and her son, Sam. I was happy for both her feeling better and her excellent test results. I was happier at the sense of caring that existed between mother and son. I was happiest that, at age 83, Bertha seemed to continue to enjoy life and found beauty in the simple things that it offered. I was also appreciative that losing a Bingo game still evoked passion from her.

On review of her previous visits, I had noticed that she had never been to our ER before. I questioned her on this prior to discharge.

"Ms. Bertha," I said, "I noticed you haven't been here before. What made you nervous enough to come in for your abdominal pain today?" I wanted to make sure I had covered all of my bases before safely discharging her to home.

"Oh, that was probably my doing," Sam answered. "After the past few years," Sam continued, "I didn't want to take any chances with Mom's health with her belly pain today."

"Plus," Ms. Bertha added, "I really hated my doctor the last time I had to go to the ER. That was in 1975." She paused slightly before continuing with a wink of her eye. "Don't worry, though, Dr. Jim. I really like you."

I must have blushed at her kindness because she called me out on my "red cheeks."

"Can I ask what has happened in the past few years to you, Ms. Bertha, that had made your son worry about you today?"

And then, Ms. Bertha's real story came rolling from her mouth, her words tumbling right into the pit of my heart.

With a mixture of sadness and smiles, Ms. Bertha and Sam, in the next five minutes, told me how Ms. Bertha's life had played out to this point. She had lost four children--two sons (one to cancer and one to AML with a concurrent brain tumor) and two daughters (one tragically in the late 1980s from a motorcycle accident). Her husband had died five years earlier. In the past year, she had buried two siblings. This recent loss of her siblings had convinced Sam that his mother's abdominal pain was going to bring terrible results. Sam was her only immediate family left.

When they were done sharing, I could only shake my head in disbelief. I grabbed Ms. Bertha's right hand between my two and warmly rubbed it. "Ms. Bertha," I said, "I can't even imagine how you could share your smile and piss-and-vinegar attitude (saying piss-and-vinegar made her giggle like a young school girl) with the world after all that has happened to you. What keeps you going?"

She looked me in the eyes, her magnified hazels piercing my soul.

"Bingo," she answered.

We all laughed. Her resilience and true personality made me smile. My goodbyes to Ms. Bertha and Sam were heartfelt.

As I stepped from Room 21, I was hopeful that, thanks to Ms. Bertha's inspiration, I too would find my "Bingo" someday.

I will keep looking...

As always, big thanks for reading. Ms. Bertha and her son were an inspiration to me. I am constantly amazed at the gift I have been given to meet so many diverse and beautiful people. 

What's your "Bingo?"

    




The Kick Ditch

A moment of reflection...

After finishing an amazing novel, The Fault In Our Stars by John Green, I put down my hard-copy and marveled at the power of the written word. This power was most evident by my multiple ear-tagged pages--pages that held expertly chosen words construed into sentences, paragraphs and chapters of brilliancy by this gifted author. Simply put, Mr. Green's eloquence affected my core, constantly leaving me in awe at how he pierced my emotional protective shell with his intimate portrayals and intrusions into the struggling lives of others.

At one point in this book, a main character was sitting on her lawn, staring at her aging swing set, wistfully remembering the innocent beautiful moments of her childhood. Moments that were no more. And with this visual of her swing set, I was suddenly transported back to my own childhood--back to the powder-blue swing set that sat in our family's yard alongside the lilac bushes and sandbox. Back to the rusted swing set with the plastic pony sitting under the mulberry tree at Gramma's house. Back to my small town's playground of numerous swings dangling from both rigid piping and clanging chains. Back to the numerous handmade swings crafted from wood planks and tires hanging from old roping that we hinged along obnoxiously obtrusive tree branches that overshadowed our chosen paths. Our paths of childhood...

Perhaps the most stunning visual of these revisits to my past, though, were not the swing sets and random swings themselves, but rather that linear trench of worn earth that seemed to befriend each and every swing. You know that trench, right? I would bet that each of you had at one point or another in your childhood also dragged your toe through one of these trenches during an innocent, happy moment of your promising youth.  It was a time when the big old world was held at bay and your smaller, more intimate world was all you pictured your future to be. This trench sat unassumingly right underneath each swing, below ground-level, filling up with water after a hard rainfall, catching a loose flip-flop off the ill-prepared foot of an eager child or housing that stubborn rock that lied in wait to stub our toe.

The kick ditch.

I attributed my high-flying on the swing of life to my proper leg-swinging, straightening them to touch the sky when going up and bending them at the knees to reach back as I came back down. My legs I could control. Yet, that little ditch kept my momentum going always, even allowing me push off to gain higher altitude.

This darn "kick ditch" image. After seeing it time and again with every memory of every swing I've ever screamed from, I began to think of what the kick ditch represents to me--of the many things that are present in my life that I did not give the proper attention. Things and people who have helped me with my forward momentum. Things that sit right in front of me, lost from my attention because something more glossy and glamorous distracted me.  Things that were content in sitting back within their clouds of anonymity. Things that I have not properly given the silent thanks and the appreciation they deserve.

My kids. Friends. Family. My spiritual lights and guides. Work. Simple gestures of kindness from strangers. Appreciation from patients and co-workers. Understanding and love from people whom I would least expect it. Compassion from non-judgmental people. Kick ditches that continue to support my momentum throughout my ride in life thus far. Kick ditches that I am now giving more cognizant attention.

Besides my legs, I also believed the people who stood behind me as I swung, pushing me to higher gains, would always be there. And yet, they aren't. Without blame and for a variety of reasons, it seem that the people pushing us on our swing are constantly changing with the snapshot moments of our lives. While reading this pivotal scene in the book, my mind was finally able to recognize the power of my little ditch in allowing my forward-motion. The power of my own legs to go higher and higher. All along, it may have been these "kick ditches" and my own legs that were most responsible for thrusting me forward in my life.

Recently, I turned 47 years old. Not a memorable birthday for most, but probably the year that I will remember most vividly in my lifetime. It has been a tortuously unpredictable year, a year of countless and uncontrollable changes. A year that I am blessed to have survived. A year of very intense internal work and self-reflection (accompanied with a significant amount of self-laceration). I have come to learn some really amazing things about my life and life in general. About the power of me. Clearly, I have learned that I am fractured. That each and every person around me is fractured. Mostly,  I have learned that we all have the opportunity to embrace, ignore, or further trample our fellow neighbor during life's struggles. I have learned to embrace. I have learned to appreciate those who embrace. I continue to appreciate those who want to push my swing forward. I appreciate the power of my own legs in controlling my gains in altitude. I appreciate the "kick ditches" that only want to help support my forward motion.

It is humbling to learn that our choices and behaviors can affect so many people in so many ways. It is humbling to learn that others' choices and behaviors once had the power to affect me in so many ways. I am thankful for the people who can forgive. I am regretful and sorry to the people that can't forget. I am appreciative of the people who remember the goodness that makes me special in my own way.

Most importantly, I've learned that love, kindness, compassion, friendships, and family can sustain one through just about anything. I have also come to learn sad realities; that each and every one of us have people in our lives that can judge and abandon us the minute our fractures are exposed. The people who once offered you the most support, who tirelessly pushed you on the swing, might just up and leave. If they do, are you prepared to dip your toe into your kick ditch? Are you prepared to swing your legs as hard as you can to control your own flight through life? Instead of allowing another to sit in judgment and trample you, are you prepared to offer your too-proud hand to the one who wants to help you from the ground on which you are plastered?

Don't be one who forgets that you too are human and will never be immune to your own fractures and missteps. That one day you too may need forgiveness. Be the one who offers a hand to help up a fallen neighbor so that when you need a hand, your fallen neighbor will be there for you. Be the one who forgives so that when you need forgiveness, it will come for you. Be the one who strives to see the goodness in another the same way you want someone to see the goodness in you.

Be the one who helps another swing higher when they dip their toe below ground. Be the one who keeps those around you moving forward to higher ground in their lives.

Be a kick ditch.

As always, big thanks for reading. This post festered in my mind for quite a while and I felt the need to purge before moving on to more patient stories. This past year I have learned much about the human spirit, both mine and those around me. This awareness has made me better and stronger. It has humbled me in ways that were necessary. I hope that you have the power to admit your weaknesses and triumphs from your self-reflection and internal work if you bravely embark. I hope you have the power to help a fallen being. A special thanks to those in my life who have remained true to the course of my life moving forward in the best of ways.  To my kick ditches--you know who you are. Jim






Underneath

Hello, all. Ideas and stories are gaining clarity in their stew pot, gently being brewed and tenderly stirred by my gaining energy and renewed attention to the complex range of fragile emotions and simple beauties that envelope a typical work day in a busy trauma center. I am again eager to capture in words these pure moments. In the meantime, a good friend brought to my attention the many layers of meaning to the below post. Rereading it, I found it filled with new perspective from when I originally wrote it just three short years ago. I hope you, too, find new meaning in old words.    

Walking into Room 33, my next patient, who had come to the ER complaining of cough and cold symptoms, seemed just as I had expected.  He appeared relaxed on his medical cot, lying back at 45 degrees, facing the room's door, his legs comfortably extended in front of him and his gown tied correctly behind him.  He was a few years shy of middle-age and appeared to be in good physical shape. His sandy blond hair, sprinkled with gray, framed his slightly weathered, apprehensive face.  Between coughs, he managed to give me a faint smile.

"Hello, Mr. Brown," I said, extending my gloved hand and introducing myself, "I'm Dr. Jim.  What can I do to help you in our ER today?"

He coughed before answering in raspy voice.  "I had a bad cold about two weeks ago.  It lasted about a week before going away."  Another cough.  "But now," he continued, after taking a deep breath, "it's back.  Back with a vengeance, actually." Yet another cough.  "I've had three miserable days of this stuff," he said, swirling his hand in front of his runny nose, reddened eyes, and dry lips, "and have tried every over-the counter medicine out there."  Cough.  "I just don't know what else to do."

As he spoke, my senses were acutely attuned to him.  I listened to see if he was speaking full sentences of five or six words or fragmented sentences of just a couple.  I listened for audible wheezing.  I watched to see if his diaphragm and intercostal rib muscles were struggling, under his gown, in their respiratory effort.  I noticed the skin coloring of his arms, the pink of his nails, his reddened, irritated nares, and the slight sheen to his forehead.  I listened closely to his cough, to observe if it was of a dry, hacking quality or a wet, congested effort; whether it came in short, interrupted bursts or was continuous and drawn-out.  I watched to see how quickly he recovered from these coughing spells.    

The patient probably thought that I, standing beside his cot with my stethoscope in hand and a smile on my face, was simply waiting for him to finish his coughing and complete his story.  And I was.  Of course, I was eager to learn of any other input he might share so that we could get him on the right road to recovery. What Mr. Brown didn't probably realize, though, is that as important as his providing a detailed history may be,  these obscure observational moments, wordless and symptom-producing, can provide just as much, if not more, information to a treating physician like myself.  I, for one, would much rather hear the cough than have a patient struggle in his description of it.  Penile discharges, though?  That's another story.

Back to Mr. Brown.  Even without doing my physical exam, I suspected he might be suffering from a community-acquired pneumonia.  "Sir," I said, touching his shoulder, "I'm going to perform a physical exam now."  He nodded his consent.  Starting with his head and taking my time, I closely looked in both of his ears (clear), his eyes (slightly bloodshot from his coughing spells), his nasal passages (angry red with significant turbinate swelling), and his throat (red, no exudates or swelling, mild anterior lymphadenopathy).  His tongue was dry and his breath smelled of neglect, like skipping a brushing.

Moving the exam along nice and smoothly, I next focused on his torso.  "Mr. Brown," I said, "we need to remove your gown so I can listen to your heart sounds and auscultate your lungs."  Trying to help, I untied his gown's back tie while he untied his neck.  Slowly, he pulled off his gown, somewhat hesitantly.  And after he did, I understood his reluctance.

His entire anterior torso, extending from his left shoulder to his chest to his abdomen, was a patchwork of skin-grafting.  Thin, transparent, papery patches of transposed skin were bordered by longitudinal, thickened keloid scars.  Some of the patches were less transparent and more natural-appearing, some of the scars less protruding and more flesh-colored, but it was obvious that multiple skin-grafts from multiple body sites had been a necessary, life-saving event at some point in Mr. Brown's life.

"I know, I know," he said, watching my eyes closely absorb the view of his torso.  "I never remember to mention these skin grafts.  Out of sight, out of mind, I guess."  He was almost too blase, leading me to believe that these physical scars walked hand-in-hand with his mental scars.

"May I ask what happened, Mr. Brown?"

"It happened when I was young, in elementary school.  Believe it or not, I had been playing with matches.  No, not on the playground," he chuckled here, "but in my backyard.  All I really remember is my shirt catching on fire, a lot of pain, the smell of my skin burning, and then my mother's screaming." He coughed a few times, his face mildly grimacing with the effort.

"I'm so sorry, sir," I said sincerely.  Imagine spending a large chunk of your childhood undergoing multiple reconstruction surgeries, missing school and losing friends, at a time when those things matter, in the process.  Being treated differently than the healthy kid standing next to you.  Not to mention the constant pain.  And feelings of lessened-worth.  Too many doctors appointments, no sports, lots of dressings.  I was letting my mind race in that brief minute.

I looked more closely at this patient.  Everything had seemed to change after seeing what was underneath his gown.  And now I understood his symptoms even better.

"Sir," I said, "do these scars restrict you when you need to take a really deep breath?"  He nodded "yes."  I continued.  "And do you get a lot of pain from these scars with your coughing spells?"  "Doc," the man smiled, "I think you get it.  It's been pretty hard with the colds this year, but these scars sure don't make recovering any easier."

did get it.  Because of his torso scars, his thorax, when stressed with illness, couldn't expand as easily as yours or mine. His fibrous scars and skin-grafting, lacking pliancy, prevented him from taking as full a breath as necessary.  Kind of similar to being wrapped and squeezed by an anaconda, I would imagine.  His work effort, thus, was increased.  And not exchanging air in the depths of his lungs, because of this momentous effort needed, would set him up to acquire pneumonia.

Not only this, but now I understood why he probably put a lot of effort and time into staying in decent physical shape.  "If I put on even ten pounds," he told me, rubbing the scar tissue around his umbilicus, "I start to hurt right here, from the outward pressure.  It seems any weight I gain goes right to my stomach, of course, and not my ass or legs.  Hell, I'd even take a double chin.  So I really have to be careful with my diet and exercise unless I want to have constant pain."  Talk about the pressure of eating right and hitting the gym.

Me?  I work out just so I will always look better than my brothers.  There is a lot of pressure being the best-looking boy in the family.  Clearly, he had better reasons than me to visit the gym.

After finishing Mr. Brown's exam, we got an x-ray, some baseline blood work, and an EKG.  His WBC count was slightly elevated, going hand-in-hand with a very early consolidated pneumonia viewed on x-ray.  We took no chances--he was placed on a strong antibiotic, given albuterol and atrovent nebulizer treatments and a machine to do the same at home and, probably most important, he was given a strong cough syrup with hydrocodone to ease the stress that his cough was bringing.  He was quite appreciative upon his discharge, his cough lessened and his breathing a little easier.

"Thanks, Doc," he said, after he was dressed, "this was a good visit."

Meeting Mr. Brown initially, everything was just as I had expected.  Until we removed his gown.  And then, I saw what was underneath--the physical limitations of his body during a time of illness.  And underneath this, I was fortunate to learn of his hidden strengths and the stoic fortitude that his life experiences have taught him.  He seemed the better man for it.

I gave this some thought, about how much we all have in common with Mr. Brown.  How we show the world what we think they want to see.  But underneath, don't we all have something we are hiding, just like Mr. Brown?   Something that may even be limiting our full potential?  May it be physical.  May it be mental.  May it be spiritual.  May it be all.  More importantly, underneath, buried in doubts, don't we all have more good that we can give this world of ours?  If we just get over our fear of showing... What.  Lies.  Underneath.

Mr. Brown, thank you for your trust to show me your underneath.  It made a difference.

As always, big thanks for reading. Despite our best efforts, none of us are perfect. All of us are fractured. Scarred. Some of us wear our damage more evidently than others, our physical and emotional scars recognized by both compassionate and (unfortunately) judgmental people. Ultimately, when your damage and scars are revealed, it is my hope that you be surrounded by those who recognize their own imperfections and give the kindness and compassion that they may someday need returned.  To judge another, rather than to lend a needed hand, will make the helping hand you someday seek more elusive.

A toast to all of the fractured, compassionate people in my life...

Almost A Miss

He was an ornery kind of fellow, evident by his scowl and beady, glaring eyes that greeted me upon my entrance into his room. The nurse, thankfully, had given me a heads-up on this eighty-five year-old gentleman's demeanor. With her kind warning, I felt prepared to be tested by this patient's demanding and abrupt nature.

What I wasn't ready for, though, was this man's physical appearance. He was extremely small in stature, bordering on petite. His frail elderly body, sitting upright with legs dangling over the cot's side, contrasted his enormous, palpable presence. As a felt fedora hovered above his round, veiny face and bulbous nose, his feet swayed several feet above the waxed tiled-floor.  His gray-haired wife, equally frail, was sitting quietly in the room's corner chair, clutching her purse while exuding a warm smile and warmer eyes. They appeared a dichotomy of spirits.

Upon entering the room, I acknowledged this kind woman by nodding and returning her warm greeting. "Hello, ma'am," I said, "you have a beautiful smile. Thank you for being here today with your husband."

Next, I turned to the patient to introduce myself. "Hello, sir. My name is Dr. Jim. What can I do to help you today?" I invitingly extended my right hand in greeting.

He did not embrace my hand but rather used his free right hand to point to the gauze dressing wrapped around his left elbow.

He answered in a very thick European accent. "Doctor, I need stitches."

He offered no further information, but rather continued to gaze steadily at my face. I returned his gaze, hoping my smile would soften his grimace. It didn't.

After a pause, hoping for more information but receiving none, I continued to interview him. "Sir, could you please tell me what happened that you injured your elbow? Did you fall?"

"I need stitches," he bluntly replied.

"I understand that, sir, but I just need a little more information about how you hurt your elbow." Because he was elderly, I needed to make sure a variety of other problems did not accompany his hurt elbow, such as hitting his head, spraining his neck, hurting his ribcage or abdomen, etc. Also, it was important to learn if his fall resulted from tripping, being dizzy, having chest pain, or any other variety of medical concerns. Learning the mechanism of his fall would help me gauge how in-depth to question him and how aggressively to pursue medical testing.

He ignored my question, instead initiating his own direction of conversation. "How long have you been a doctor for?"

Inside, I was smiling at this patient's piss-and-vinegar. To be eighty-five and have this much energy, regardless of how it would be interpreted by others, was pretty damn cool.

"Well, sir," I answered, "I finished medical school in 1993. I finished residency in 1997. So I guess that would mean that I have been a doctor for twenty years and have been finished with my residency training for, well (I had to do quick math in my head at this point), about 16 years."

He nodded his head in approval while turning to his wife to speak. "I guess he will be okay to fix my elbow."

I turned to find her directing a genuine and loving smile at her husband. Turning back to my patient, I continued with my questioning. "Sir, did you trip over something that made you fall or did you have a dizzy spell?"

"Doctor," he said, looking me directly in the eyes, "I tripped over an uneven sidewalk. Last time I hurt myself like this, I needed stitches right here," he continued, pulling up his pant leg to reveal a small scar on his anterior left tibia. "I need some stitches in my elbow and then you can let me go."

I asked him several more questions, straining my ears to decipher his answers through the heavy veil of his accent. Eventually, with a lot of patience and a little probing, I felt satisfied that his isolated elbow injury was not associated with more serious concerns.

As I began to gently unwrap the gauze-dressing from this patient's elbow, he began to warm to me, rhythmically raising and lowering his arm to help with my efforts. When I was finally done, I closely examined his elbow. He had a localized contusion with a superficial skin-tear of the overlying skin. This tear would not require stitches, nada one. He had minimal pain on range of motion testing to his elbow and had no further pain to his left arm.

"Well, sir," I said to him as I sat on the stool by his feet, "I have some good news for you. We will need to get an X-ray to make sure you didn't fracture your elbow, but otherwise you won't require any stitches." I explained to him that we would put steri-strips on his skin tear to approximate the edges and that stitches, as he was insisting, could actually be detrimental to his healing.

"Doctor," he replied, "I want stitches. Just like last time." Uh, oh. I felt an argument coming on. So instead of addressing him, I turned to his wife and spoke. "Ma'am," I said, "has your husband always had this much piss-and-vinegar?" At this question, both the patient and his wife burst out laughing. "Doctor," she replied, "you have no idea!"

After a little more persuasion, I was finally able to convince this patient that he did not need stitches. He willingly went to X-ray and after returning to his room, I went into his room to tell him the good news--he did not have a fracture. His wife, upon hearing the news, clapped her hands together in happiness. After a few pleasantries, I began to walk out of the room. "The nurse will be in to clean and wrap up your elbow as well as update your tetanus," I assured him, recognizing that the patient was very eager to get released from the department, "and I should have your discharge instructions ready in ten minutes."

Within two minutes of leaving his room, not surprisingly, the patient was standing at the nurses' station counter, barely visible as he strained to peek over. "Excuse me," he spoke in his drawl of words, "I am ready to go and I haven't been given my papers and my elbow hasn't be dressed yet." I looked up from my computer and smiled at him. "I am working on your instructions right now, sir, and then the nurse will be right in to get you going." Inside, again, I smiled at this gentleman's energy.

And then, the moment I almost missed…

"Doctor," he said, "can I ask you something?" As he spoke, he wife walked up beside him at the counter. She was an identical twin to Sophia on The Golden Girls.

"Of course, sir, " I said, standing up and walking towards him. "What can I help you with?"

"Well," he said, "you have a funny accent. Where are you from?" His question caught me off-guard, and with our conversation it seemed that every nurse and secretary sitting in this station also paused. I smiled at him and answered his question, explaining that I am a second-generation American of European-descent with an accent which I associate with being part country-boy (a "hick-accent," as I like to say) and part European (as one of my heroes, my paternal grandmother, had a very thick accent). And with his bold question, I returned the favor.

"And where, sir, are you from?" I asked. "I noticed that you have an accent yourself."

"You are quite right, Doctor," he answered. "I am originally from Poland." After we joked about our shared love of polka music and vodka, I asked him another question. "How old were you when you came to America?"

And with my question, this patient launched into his past history. He came to the United States at the age of twenty, alone, after WWII. When he was an innocent child of age eleven, he tragically lost his entire family in the throes of war--his parents, his five sisters, his aunts and uncles, and all of his cousins. Each and every one in his family died in concentration camps. He survived only because a farming family took him in as "one of their own" during the war. Afterwards, when he had saved enough money, he came to America to begin a new life. "And Doctor," he commented, after finishing his amazingly breath-taking story, "isn't it remarkable that after all of these years in America, I still have my accent?"

I looked around the station. Not one of us had eyes that weren't moist and glistening. This man's incredibly powerful story, portraying his resilience to the most tragic circumstances of loss and adversity, was equally heart-shattering and faith-building. We had all just been handed a rare nugget of vitality. For this man to share a sliver of his soul to us was beyond any measurable gift.

After his story, we all thanked him for sharing. Gradually, he worked his way back to his room. Without his presence at the counter, you would think that we would all have comments on such an incredible story, and yet none of us could utter a single word.

This frail elderly man was anything but frail and elderly. He was one of the strongest, most awe-inspiring patients I have ever had the pleasure to meet. And that remarkable accent of his? Thankfully, I learned from this man that his accent was probably the least remarkable thing about him.

And to think, I almost missed his story…

As always, big thanks for reading. I hope this finds each and every one of you well…a special thanks to those who have been encouraging me forward...




The Breakthrough

I smelled the patient, unfortunately, even before walking into his room to introduce myself. From the hallway, his odor of lingering stale smoke flared my nostrils, instigating childhood recollections of the wood-burning furnace at my grandmother's home. From a distance, the scent of smoke was just that--charred-burnt air, its weight clinging to my nostrils. As I approached the patient, however, the scent of smoke smoldered my wishful memories of Gramma's furnace. This was not the smell of crisp, dry maple and oak wood pieces flaming to heat a house, but rather the lingering smell of those little brittle white sticks of tobacco that come twenty to a pack.

I walked into Room 21, its closed curtain contributing to the suffocating staleness of the cigarette smoke, to find a 53 y.o. man sitting upright in hit cot, facing me. His face was wrinkled and leathery, his eyes weary. His thick gray hair was combed back away from his forehead. His lips were dry and cracked, his nose bulbous and veiny. He looked years older than what his chart conveyed. Sitting in the corner was a younger woman, maybe thirty-ish, wearing a warm smile. Her eyes danced with the kind of energy that we all wish we had.

I returned a smile to this pleasant woman while I continued to advance to this patient's cot, extending my hand in welcome to him.

"Hello, sir. My name is Dr. Jim and I will be your doctor today while you are in the ER." I turned and introduced myself to the woman in the corner as well, learning her name was Denise and identifying her as this patient's niece. I turned back to the patient. "What can I do to help you today, sir?"

He inhaled a deep, raspy breath before beginning to answer my question. "Well, Doctor," he said, "I just moved to town to live with my niece here (he paused, nodding his acknowledgment to his niece) when I got me some really bad chest pain." He assured me that his chest pain had since resolved. I quickly listened via my stethoscope to his acceptable heart and lung sounds while a flurry of activity occurred around us--an EKG, a portable chest x-ray, blood draws, and IV starts. I then continued with our conversation.

I asked him the usual questions. What was he doing when the chest pain came on? Sitting watching TV. Has he ever had problems before with his heart? Yes, three cardiac stents in his past. "And they told me I needed surgery, too, but I didn't want to go through with it." I asked him about his risk factors, for which his every answer was "Yes." Hypertension? "Yes." High cholesterol? "Yes." Diabetes? "Yes--just pills, though." Besides his own personal history, did he have a family history of heart disease? "Yes--both my parents had heart attacks."

Finally, I asked about the risk factor that I already knew the answer to. "Sir," I asked, "do you smoke?" The patient looked me in the eyes with his own intent, sincere gaze. "Not anymore I don't, Doctor." His answer intrigued me, of course, so I asked him to clarify his answer. "Well, I had my last cigarette right before the ambulance came to pick me up." Upon pressing further, the patient admitted to smoking at least two packs of cigarettes a day.

If each of us in the ER setting were given a nickel every time a smoking patient told us they had their last cigarette before seeing us, we would all be living in mansions and driving German sport cars. I would be cheering for this patient's efforts to quit, but two packs a day? This patient faced one heck of a mountain to climb over after his thirty-year habit.

We talked a little more about his health. He had required three stents total in his past, most recently in 2011. Despite his poor health, he continued to smoke and rarely took a baby aspirin a day, let alone his other required medicines for his hypertension, high cholesterol, and diabetes. "Well, sometimes I take them all, but I try to take my diabetes medicine every day."

It was here, at this pivotal moment, that the energy in the room became palpable, changing for the better. Denise stood up from her corner chair, speaking as she began to approach my side by the cot. "Uncle Bob," she said, reaching for her uncle's hand after her arrival, "that's all about to change. Now that you moved to town to live with me, we are going to make sure that you do everything right."

I liked Denise immediately. Who wouldn't? I looked from her back to her Uncle Bob, noticing the tears beginning to collect in the inner angles of his eyes. Slowly, the tears spilled over, trickling down his cheek. Denise and I remained quiet, a wistful calm settling in the room as I looked down to watch Denise's thumb stroke over the back of her uncle's trembling hand. After watching this rhythmic comforting, I looked back to Uncle Bob's face. It was contorted with a look of relief, of the knowledge that one wasn't alone in an uphill fight.

Slowly, Denise leaned in and kissed her uncle's cheek. It was sweet. It was simple. And it was an astounding privilege for me to witness such tenderness.

I stepped back from the cot and became invisible while Denise spoke to her uncle.

"Uncle Bob," Denise spoke, quietly and calmly, "Mom died two years ago, leaving us only with each other. I am glad you finally moved here to be with me and my family. Mom would have wanted you to live with me, so it's about time you got here. Now we just need to get you better so you can enjoy my children and they can get to know their Uncle Bob."

The patient, at his niece's words, completely fell apart, sobbing openly. Before exiting the room, to give Denise and her uncle the privacy they deserved, I asked him quickly again if he had any further chest pain. "No," he answered, "only a broken heart." I had hopes that his broken heart would be healed in the capable hands of his niece. And like clockwork, accompanying that thought as I walked out of the room, I overheard Denise continuing to speak. "It's all going to start by you throwing out those cigarettes of yours." Yep, I definitely liked this Denise character.

Thankfully, Uncle Bob's initial cardiac tests came back unremarkable, barring a high glucose level. He needed to be admitted for further cardiac work-up and, more importantly, to be plugged into our health-care system. With proper medical care and Denise's support, I had hopes that Uncle Bob might just be able to pull himself out from the current of neglect he created for himself.

Sometimes, when I meet a patient and their family, I get a gut-feeling that our efforts might be for naught; the familiar rut of a patient's self-negligence and non-compliance will eventually overtake any forward efforts made by the medical community. However, in most patient encounters, I do leave the room hoping and feeling that the patient's emergency room experience will make them more cognizant and energized to face their illnesses. Sometimes, this cognizance comes not from the patient themselves, but rather from a friend or family member. Thus was the case with Uncle Bob. We should all be so lucky to have a "Denise" in our corner to help us battle our way back for all of the right reasons.

I hope I don't ever have to hear from or see Uncle Bob again, for the simple wish that he conquers and controls all of his concurrent illnesses with proper outpatient management. With Denise in his corner, I think his chances of this are significantly improved. I hope I witnessed his breakthrough. And I hope if I do have to meet Uncle Bob again, instead of smelling a smokestack, I smell the refreshing scents of Irish Spring and Old Spice.

As always, big thanks for reading. More essays to come…I hope this finds you and yours well. Jim   

The Broken Bone


Although I rarely get sick with the numerous strains of “bugs” that seem to go around our community this time of year, the week prior to my return to work for my next scheduled string of four shifts was spent mainly in bed, coughing and aching and whining about how miserable I felt. Fully recovered, though, I was excited to return to the emergency department to do my fair share of stamping out disease and healing thy patient from illness and injury.

Walking into Room 21 to see my first patient of the day, however, made me cringe just a bit and suddenly, I wished I could have been back in my bed at home for just one more day.

The patient was young, in his mid-twenties, and appeared to be in significant pain. He was alone. His short-cropped hair was calmly neat, belying his grimaced, pinched face and restless arms and legs that rocked his compact body against the cot’s rails in defiance to his discomfort. His nurse, Sam, one of my favorites, was hurriedly placing an IV into the patient’s right arm.

I gently grabbed the patient’s shoulder to gain his attention, introduced myself, and asked him what brought him to our ER today.

“Doc,” he said, taking a quick gasping breath before continuing, “I was banging the shit out of my girlfriend when my penis snapped in half.” I looked from the patient’s face to Sam’s, who nodded his agreement to this patient’s history.

Ugh, I thought to myself, a fractured penis. A fractured penis!!! It had been, thankfully, several years since the last time I had seen a case like this. For some reason, despite my tolerance and calmness during any other conceived emergency illness or injury, penile or scrotal injuries always made me cringe. And I was cringing. Usually, this type of injury occurs with masturbation, unusual sexual positions, or aggressive sexual intensity, to be politically correct.

“Sir,” I said, “when and how did this happen?”

As it turned out, it had happened immediately before his arrival—about 20-30 minutes before we began treating him. And how? Despite his pain, he spoke with great pride and in great detail about his sexual prowess and escapades that lead him to our department. He painted a picture that, short of sustaining a penile fracture, all of us men have failed our partners in the sexual arena. Call it rough sex if you must. And call me a failure, then, if this was the price of success.

After his explanations, I had no doubt that I would be able to provide the detailed social history necessary on this patient’s medical chart. I imagined the pleasant dictation lady turning beet red from embarrassment as she typed his chart up. “Hey, Sally,” I pictured her saying to her co-worker, “come over here and get a load out of this patient’s story! I wonder how his girlfriend is doing?”

After examining this patient thoroughly, and confirming that he indeed fractured his penis, I ordered him up a healthy dose of pain medicine before calling the on-call urologist urgently. This patient would need emergency surgery to repair his penile injury, which really wasn’t a “broken bone,” per se (since the penis doesn’t contain any bones), but rather an insult (or tear) to the vascular columns that engorge with blood during an erection.

Finishing with a few more patients and while waiting for the urologist to arrive to see this unfortunate patient, I went back into his room to check on him and make sure he was more comfortable. He was definitely more comfortable and no longer alone. A much taller, big-boned woman with a similar shortly-cropped hairstyle sat in a chair beside the room’s sink.

I walked up to her, my hand extended, and introduced myself to her. Understandably, she could barely look me in the eye as we shook hands and she shared with me her name. During our introductions, however, her boyfriend blurted out in his pain-controlled state, “This is my girlfriend who I was banging the shit out of when all of this happened.” Talk about making an embarrassing moment more embarrassing for her. “Don’t worry about it,” I consoled her, “we will be taking good care of him.”

The patient didn’t stop there. “Hey Doc,” he said, his eyes slightly glazed over from the medications, “do you think they will be able to save my penis?” Before I could answer his question though, he continued. “Dude,” he said, now apparently more comfortable with me, “you don’t understand—without my penis, I am nothing.” He paused, took a deep breath, and got a sad look to his face. “I am nothing! Nothing…,” he repeated, remorse and fear now dripping off his words.
I reassured him that the timeline of his injury was in his favor—that presenting to us so quickly after this unfortunate event helped with his percentages of a full recovery. I told him that as soon as the urologist saw him, he would most likely go straight to the operating room.

“But, Doc,” he said, “what if they can’t save my penis. Can I get a new one?”

I assured him that most likely, they would be able to save his prized possession. Deciding to have a little fun with him, though, I continued. “But if on the small chance they can’t save your penis, penile construction/reconstruction surgery is very advanced these days. We have a catalog of new ones you can choose from.” I could only imagine him skipping the petite section and going straight to the plus section.

He looked up at me in surprise to my words. “Really?” he asked, before seeing the hint of a smile on my face. Getting the joke, he continued. “Dude, thanks. I needed that.”

Soon after, the urologist came in, examined the patient, and booked the OR suite to take the patient for immediate repair of his injury. He would need an indwelling foley catheter for 2-4 weeks while he healed from his repair, effectively taking him out of commission for a month or so. I truly wished this patient the best outcome.

Before the patient left our ER, as if things couldn’t be any more embarrassing for this patient or his girlfriend, this patient’s mother and sister came in to be at his bedside. How could you possibly explain such an injury to your mother, the one who is wearing the serious look of dread and concern for her son? Or your sister, the one who cannot contain her incessant giggling? And do you show them the injury or just trust that they would understand the explanation? Some things I just didn’t want to know. Although I am not of the moral fiber to condone lying, I sure as hell would have fabricated some type of story to divert my mother’s and sisters’ attentions if I were in the same situation as he. “Umm, Mom and sissies,” I would say to them, “I got a hernia while chasing a purse-snatcher down the street after he knocked over a 90 year-old lady.” And no, I wouldn’t show them the supposed hernia, either.

This patient, however, didn’t care. He did show his mother and sister his injury. Eeewwww, I know. That makes me cringe almost as much as the injury itself. Just as impressive, though, was that his girlfriend had an anxiety attack. Why? This was the first time she had met her boyfriend’s mother. And sister. Talk about memorable introductions to the family. Can you imagine, once again, that conversation? "Hello, Mrs. Smith, nice to meet you. I'm Ellie--the girl who broke your son's penis in half." I, for one, didn’t hold out much hope that this relationship was going to survive this ordeal. But I didn’t think the patient would show his penis to his mother, either, so I could be wrong.

Is there a moral to this story? I guess, maybe. The moral might just be that we should never ever "bang the shit out of" the ones we love. Sweet lovin’ might just be the best lovin’, right?

Oh, and one more moral to this story? Never ever show your mother your penis, no matter what state you may be in, when you are a grown man. That’s just creepy.

Thanks, as always, for reading. If this post and typical ER humor offends, my apologies. But who can blame all of us in the medical field for having warped senses of humor at certain times in our days. I hope this finds you all well…Jim.