Today is my birthday. Yep, today. On this fourth day of this fourth month of this year, I officially have turned 44. Should I buy a lottery ticket with these numbers? Something is whispering to me that if I ever had a realistic chance to win, it would be today. Nah, who am I fooling--I think I'll just keep that errant dollar in my pocket.
44 is an odd age, though. Am I middle-age? Am I the new thirties? Is my life half over? Or more than half? That thought makes me shudder. I look at some of my patients in the ER, those in their 20's and 30's, and in my mind I am dealing with someone in my own age group. Maybe they have less wrinkles and a fewer amount of life experiences, sure, but otherwise we are the same, aren't we? That is until they call me "sir," a word I am growing less fond of the older I get. And suddenly, I am reminded that no, I do not have as much in common with this college student sitting on the treatment cot in front of me as I might have thought.
Still, birthdays are pretty special when you are surrounded in your life by people who make a big deal of them. Being one of seven kids, I've already received texts by four of my siblings and some nieces and nephews to "have a great day." The phone calls will follow tonight, with multiple renditions (mostly bad) of the song "Happy Birthday" sung to the answering machine or myself. When my mother was alive, she and Dad would always call and sing "Happy Birthday" in harmony from their two different receivers, Mom carrying the high notes and Dad trying to blend his deep, husky off-tune baritone to compliment her. Since she passed on, Dad still keeps this tradition alive. It is bittersweet, to say the least, to have Dad call and sing a solo "Happy Birthday" to me. A big sigh typically follows, and longings for my mother's missed presence follow that. The beauty in this, though, is that over the two years prior to Mom's lost battle to leukemia, we recorded every "Happy Birthday" sung by them to my family.
My kids and wife, though, are the real reason the excitement level in our house today is immense. For the past week, there has been whispering between she and my kids that suddenly stops when I enter a room. There has been hushed huddling in front of the desktop computer, a flurry of hands blocking the screen's view when I walk into the office. There have been shopping trips to the mall, the kids returning with big grins on their faces and filled shopping bags held behind their backs. "Don't look, Dad!" has become the newest greeting in our house. Tonight I will eat my favorite cake, chocolate from scratch (which includes a cup of coffee) topped with mounds of creamy peanut frosting, made lovingly by my wife from Mom's recipe.
So today, then, is the day. My 44th birthday. I was woken up with hugs, warm and heartfelt and accompanied by morning breath. And chimes of "Happy Birthday, Dad!" There is no better sweetness in this world than hearing these fluent, tender words from your children's innocent mouths. Birthday wishes from my wife, too. A flurry of activity followed as they got ready for school. A grab of my hand by my youngest, who lead me to the dining room table to proudly show me the presents that await my opening. Their homemade cards and homemade gift wrap make my smile double.
Then, too suddenly, the buses came to take my kids to school. My wife left in the SUV to work her school-related job. And, just like that, all of the excitement contained within our four walls just minutes earlier dissipated, a big balloon of happiness and anticipation popped... to be filled up again upon their return. I go to sit alone in my office.
I have the morning and afternoon off, but work an odd evening into morning shift tonight. So I sit here in my silent home, giving up the hope that cranked techno music from Robyn on YouTube will bring back all of that excitement. It didn't. Instead, a life lesson smacks me in the ass. Hard.
My birthday and this swirling excitement that comes with it is not just because of the day. Or the cake. Or the presents. It is because, simply, on this day, I am reminded of just how blessed I am to be surrounded by so many people in my life who love and care for me. The simple texts, the emails, the phone calls, the snail mail birthday cards--all warm hands coming from near and far to wrap themselves around me on this day. There are no better birthday gifts...
Sitting here, introspective and reflective of my life so far, I find that I am beyond grateful. Grateful for it all. The family. The siblings and parents. The nieces and nephews. The cousins. The friends. I am a lucky guy.
After all of this, I looked at a brown envelope sitting on my desk, sent to me by one of my best friends through medical school--KT. To know KT in this life, to have her friendship, is one of those precious gifts I sometimes take for granted. She is, after my wife and Mom and sisters, one of the most remarkable women that I will ever know. Her kindred spirit and friendship is unmatched. And besides, how many other family physicians do you know still make social calls to their patients' homes?
What follows is a cursive note she sent (along with a beautiful book and two birthday cards).
Dear Jim,
My friend, my brother...how does it feel to you to be celebrating a life so full? I am acutely aware of the significance this year of similar double digits!
At 11, I was hiding in the woods with my friends, telling secrets, crushing on Bobby Joe across the street (be still my heart!) I was a child in a giant's body!
At 22, I owned the world...I was a college graduate and I was going to medical school! I was sizzling! Life was mine to take!
At 33, I was a mother, in love with my girl, struggling to mesh my original dreams of being a doctor with my dream, unexpectantly better, of motherhood. I couldn't get enough of my daughter if I ate her! She was and still is a force in my world! What a ride I got, eh?
At 44, I know contentment, really and truly. But I also know worry... My life and love has blossomed as my family came to be--a daughter, a son, a dog, and oh yeah, a husband. I know I am not invisible--my achy hips let me know that every day! But I am more alive now than ever before. I have loved, lost, given and gained...
What will the next half bring? 55? 66? 77? 88? And, oh yeah, I plan on doing 99. You too?
So, my brother in this walk...I wonder what you would say about 11, 22, 33, 44? I think I can guess a few of the emotions. We have been blessed in love and in friendship, haven't we?
Big hug, Jim! Have an awesome birthday! KT
How's that for a birthday gift?
May everyone have a birthday like mine today, where they are reminded of the beauty of the people in their lives.
Now, where are my presents???
As always, big thanks for reading. May KT see the beauty and specialness in her writing voice here today. To my family and friends, especially my wife and kids, thanks for making this a special day...I am smiling here.
Today is my birthday. Yep, today. On this fourth day of this fourth month of this year, I officially have turned 44. Should I buy a lottery ticket with these numbers? Something is whispering to me that if I ever had a realistic chance to win, it would be today. Nah, who am I fooling--I think I'll just keep that errant dollar in my pocket.
44 is an odd age, though. Am I middle-age? Am I the new thirties? Is my life half over? Or more than half? That thought makes me shudder. I look at some of my patients in the ER, those in their 20's and 30's, and in my mind I am dealing with someone in my own age group. Maybe they have less wrinkles and a fewer amount of life experiences, sure, but otherwise we are the same, aren't we? That is until they call me "sir," a word I am growing less fond of the older I get. And suddenly, I am reminded that no, I do not have as much in common with this college student sitting on the treatment cot in front of me as I might have thought.
Still, birthdays are pretty special when you are surrounded in your life by people who make a big deal of them. Being one of seven kids, I've already received texts by four of my siblings and some nieces and nephews to "have a great day." The phone calls will follow tonight, with multiple renditions (mostly bad) of the song "Happy Birthday" sung to the answering machine or myself. When my mother was alive, she and Dad would always call and sing "Happy Birthday" in harmony from their two different receivers, Mom carrying the high notes and Dad trying to blend his deep, husky off-tune baritone to compliment her. Since she passed on, Dad still keeps this tradition alive. It is bittersweet, to say the least, to have Dad call and sing a solo "Happy Birthday" to me. A big sigh typically follows, and longings for my mother's missed presence follow that. The beauty in this, though, is that over the two years prior to Mom's lost battle to leukemia, we recorded every "Happy Birthday" sung by them to my family.
My kids and wife, though, are the real reason the excitement level in our house today is immense. For the past week, there has been whispering between she and my kids that suddenly stops when I enter a room. There has been hushed huddling in front of the desktop computer, a flurry of hands blocking the screen's view when I walk into the office. There have been shopping trips to the mall, the kids returning with big grins on their faces and filled shopping bags held behind their backs. "Don't look, Dad!" has become the newest greeting in our house. Tonight I will eat my favorite cake, chocolate from scratch (which includes a cup of coffee) topped with mounds of creamy peanut frosting, made lovingly by my wife from Mom's recipe.
So today, then, is the day. My 44th birthday. I was woken up with hugs, warm and heartfelt and accompanied by morning breath. And chimes of "Happy Birthday, Dad!" There is no better sweetness in this world than hearing these fluent, tender words from your children's innocent mouths. Birthday wishes from my wife, too. A flurry of activity followed as they got ready for school. A grab of my hand by my youngest, who lead me to the dining room table to proudly show me the presents that await my opening. Their homemade cards and homemade gift wrap make my smile double.
Then, too suddenly, the buses came to take my kids to school. My wife left in the SUV to work her school-related job. And, just like that, all of the excitement contained within our four walls just minutes earlier dissipated, a big balloon of happiness and anticipation popped... to be filled up again upon their return. I go to sit alone in my office.
I have the morning and afternoon off, but work an odd evening into morning shift tonight. So I sit here in my silent home, giving up the hope that cranked techno music from Robyn on YouTube will bring back all of that excitement. It didn't. Instead, a life lesson smacks me in the ass. Hard.
My birthday and this swirling excitement that comes with it is not just because of the day. Or the cake. Or the presents. It is because, simply, on this day, I am reminded of just how blessed I am to be surrounded by so many people in my life who love and care for me. The simple texts, the emails, the phone calls, the snail mail birthday cards--all warm hands coming from near and far to wrap themselves around me on this day. There are no better birthday gifts...
Sitting here, introspective and reflective of my life so far, I find that I am beyond grateful. Grateful for it all. The family. The siblings and parents. The nieces and nephews. The cousins. The friends. I am a lucky guy.
After all of this, I looked at a brown envelope sitting on my desk, sent to me by one of my best friends through medical school--KT. To know KT in this life, to have her friendship, is one of those precious gifts I sometimes take for granted. She is, after my wife and Mom and sisters, one of the most remarkable women that I will ever know. Her kindred spirit and friendship is unmatched. And besides, how many other family physicians do you know still make social calls to their patients' homes?
What follows is a cursive note she sent (along with a beautiful book and two birthday cards).
Dear Jim,
My friend, my brother...how does it feel to you to be celebrating a life so full? I am acutely aware of the significance this year of similar double digits!
At 11, I was hiding in the woods with my friends, telling secrets, crushing on Bobby Joe across the street (be still my heart!) I was a child in a giant's body!
At 22, I owned the world...I was a college graduate and I was going to medical school! I was sizzling! Life was mine to take!
At 33, I was a mother, in love with my girl, struggling to mesh my original dreams of being a doctor with my dream, unexpectantly better, of motherhood. I couldn't get enough of my daughter if I ate her! She was and still is a force in my world! What a ride I got, eh?
At 44, I know contentment, really and truly. But I also know worry... My life and love has blossomed as my family came to be--a daughter, a son, a dog, and oh yeah, a husband. I know I am not invisible--my achy hips let me know that every day! But I am more alive now than ever before. I have loved, lost, given and gained...
What will the next half bring? 55? 66? 77? 88? And, oh yeah, I plan on doing 99. You too?
So, my brother in this walk...I wonder what you would say about 11, 22, 33, 44? I think I can guess a few of the emotions. We have been blessed in love and in friendship, haven't we?
Big hug, Jim! Have an awesome birthday! KT
How's that for a birthday gift?
May everyone have a birthday like mine today, where they are reminded of the beauty of the people in their lives.
Now, where are my presents???
As always, big thanks for reading. May KT see the beauty and specialness in her writing voice here today. To my family and friends, especially my wife and kids, thanks for making this a special day...I am smiling here.
A heartfelt appreciation to the readers who shared their personal stories, both devastating and hopeful, on my last post. Your courage to share was felt and your words of wisdom were heard...thank you.
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."
I 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 stoic fortitude that his life experiences 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 both. 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 trusting me to show me your underneath. It made a difference.
As always, big thanks for reading. I hope this finds you having a good week...
A heartfelt appreciation to the readers who shared their personal stories, both devastating and hopeful, on my last post. Your courage to share was felt and your words of wisdom were heard...thank you.
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."
I 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 stoic fortitude that his life experiences 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 both. 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 trusting me to show me your underneath. It made a difference.
As always, big thanks for reading. I hope this finds you having a good week...
Our ER case manager and I recently walked out of
the family room after having to tell an only-child that his 85 y.o. mother was critically ill. She was so ill, in fact, that she had required emergent intubation for her respiratory distress and was now being sedated and paralyzed. This allowed the ventilator to do
all of her breathing, conserving this woman's body of some much needed energy. The patient's worsening circumstances had transpired over the past three hours at her nursing home prior to being transferred to us and, unfortunately, her son had been en route when his mother decompensated in our ER, circling the drain before our very eyes. Thus, he never got a chance to visit with her before her intubation.
As we left the family room to go back to the patient's room and continue medical management, the case manager and I walked in silence, affected by the situation at hand. I had tried to hold off this patient's intubation for a few minutes, hoping that her son might soon arrive to exchange a few words with his mother, but it didn't happen. Because the patient's living will had requested that she be a "full code" (my understanding was that she lived a fulfilling, independent life), all efforts would be employed in attempt to save her life and help her through this medical crisis. We had intubated her successfully and aggressively began her medical management.
Suddenly, the case manager stopped smack-dab in the middle of the hallway and spoke to me. "You are amazing in that room, do you know that?" I looked her in the eyes, trying to see if she had picked an inopportune moment to hassle me, to tease me the way that us ER co-workers sometimes do to lighten such heavy, burdensome moments.
She was being serious. "After introducing yourself and shaking this son's hand, you sat down on the couch beside him, touched his shoulder, introduced the rest of us, and asked him how he was doing before slowly, in words he could understand, explaining everything that had been done so far to save his mother's life."
"Yeah," I said, "so?"
She continued. "Did you not feel the tension in that room? And somehow, after you were done delivering the worst of the news, the room felt hopeful, at peace. You could see the son's face slowly accept the news you were giving him. You eased his worries by instilling that we were doing everything we can to help his mother, without falsely elevating his hopes."She paused here, taking in a deep breath. " You showed him that you cared."
"Doesn't everybody do this, though?" I said, knowing the answer before I finished asking.
The case manager laughed in a regretful, wistful kind of way. "Are you kidding? You would be appalled at some of the ways I've seen bad news delivered in that room. No introductions. No sitting down. Blurting out the bad news without any preparation to the family. Leaving without addressing any of the family's questions. Jim, you need to teach more doctors how to act and speak more appropriately in that room."
By now, we had started walking again and were standing outside of the patient's room. The son was going to be escorted back in just a few minutes.
Not one to gloat over getting a compliment, I walked back into the room and continued helping my senior resident with this patient's care. It was, once again, a thing of beauty to watch our team methodically go about each of their responsibilities and, as a result, we were soon rewarded with this patient's condition stabilizing. She was still very sick, but at least the son could now spend some time at her bedside. Which turned out to be a blessing as, in the end, this patient passed on that same evening.
Later on that night, at home, after tucking in my kids and a glass of wine in hand, I was giving much thought to our case manager's words. Just a few weeks prior, during a night shift, a nurse supervisor who had accompanied me in the family room spoke similar words to me when we were done. "The way you approach patients and their families is remarkable," she had said. I may have blushed, but her words were greatly appreciated and I viewed them as the ultimate compliment.
Why isn't everybody at their best, especially in that room? I thought to myself, though, becoming a little annoyed. When did medicine become so shifted to view patient's and their families as "its" and not as human beings, as "hes" and "shes"? When did we abandon learning patient's names and their life story? Of taking a little more time in their treatment room? When did compassion and kindness sneak out the window and rush, rush, rush sneak in. When did the the quantity of patients one treats replace the quality of care given to each individual patient, defining, in some peoples' eyes, a better physician?
Sadly, most of us in medicine know that answer. With the increasing struggles of our profession,
from insurance cutbacks
to legal threats,
from hospital cuts of personnel
to the shifting thought that patients' rights outstrip our own, medicine isn't the field it once was when I signed up for a career twenty years ago. Especially in the ER, it is now common for us to be 4-6 hours behind every day, patients now relying on us not only for emergent care but for treatment of their chronic illnesses as well as maintenance medications. Can you see the frustrations? This quantity has potential to impede on our quality, to cut into the time we spend with each patient and their family.
I recently gave an hour lecture to our residency physicians regarding kindness and compassion. I started it with a tragic video of 9/11, scenes playing out to Sarah McLachlan's "Arms Of An Angel." We then watched a synopsis of the Columbine tragedy before I started talking. There was nary a dry eye. "See this devastation, this grief, involved in such atrocious acts?" I asked the residents. "What makes this grief and loss any different from that which you will encounter in a patient's treatment room or our ER family room?" A dropping pin could be heard in the room. Grief is grief, I reiterated. Loss is loss. Death is death. Respect is necessary. Kindness and compassion are a must. Addressing such concerns, I assured the residents, is one of the most important jobs they will ever face. Put the time in and learn how to view this responsibility as a privilege and not a burden.
This lecture was never finished. Before my time was up, only half of the slides had been presented. Instead, we had spent a great deal of time talking about personal techniques on how to interact with patients and their families and how to deliver devastating news. My residents shared personal stories of their best and worst experiences. It was clearly evident that some of them were quite comfortable in their roles, while others struggled with this part of their jobs. This hour lecture on kindness and compassion had gone from the category of "light and fluffy" to receiving the respect it deserved. From the feedback of the residents, they were appreciative and definitely more cognizant of their roles in treating patients and their families.
As karma sometimes dictates, a few nights later, while reading
Cutting For Stone, a brilliant fiction novel by a brilliant writer, Abraham Verghese (he who also happens to be a brilliant man of medicine), I happened upon a collection of words on page 519 that left me with goosebumps. In the novel, Dr. Thomas Stone, a leading liver transplant specialist, reads a letter from a mother of a trauma victim that he had treated. It follows:
Dr. Stone--My son's terrible death is not something I will ever get over, but perhaps in time it will be less painful. But I cannot get over one image, a last image that could have been different. Before I was asked to leave the room in a very rough manner, I must tell you that I saw my son was terrified and there was no one who addressed his fear. The only person who tried was a nurse. She held my son's hand and said, "Don't worry, it will be all right." Everyone else ignored him. Sure, the doctors were busy with his body. It would have been merciful if he had been unconscious. They had important things to do. They cared only about his chest and belly. Not about the little boy who was in fear. Yes, he was a man, but at such a vulnerable moment, he was reduced to a little boy. I saw no sign of the slightest bit of human kindness. My son and I were irritants. Your team would have preferred for me to be gone and for him to be quiet. Eventually they got their wish. Dr. Stone, as head of surgery, perhaps as a parent yourself, do you not feel some obligation to have your staff comfort the patient? Would the patient not be better off with less anxiety, less fright? My son's last conscious memory will be of people ignoring him. My last memory of him will be of my little boy, watching in terror as his mother is escorted out of the room. It is the graven image I will carry to my own deathbed. The fact that people were attentive to his body does not compensate for their ignoring his being.Brilliant. Simply and utterly brilliant. Thank you, Dr. Verghese.
We need to bring back kindness and compassion. We need to fix the medical field as it now exists so we can begin, again, to pay attention to that which is most import--the patient and their families. With kindness and compassion at the forefront.
Enough said.
As always, big thanks for reading. If you have had any experiences, either as a patient or as a family member sitting in that family room, that may enlighten us readers and make us better at what we do, please share...
Our ER case manager and I recently walked out of
the family room after having to tell an only-child that his 85 y.o. mother was critically ill. She was so ill, in fact, that she had required emergent intubation for her respiratory distress and was now being sedated and paralyzed. This allowed the ventilator to do
all of her breathing, conserving this woman's body of some much needed energy. The patient's worsening circumstances had transpired over the past three hours at her nursing home prior to being transferred to us and, unfortunately, her son had been en route when his mother decompensated in our ER, circling the drain before our very eyes. Thus, he never got a chance to visit with her before her intubation.
As we left the family room to go back to the patient's room and continue medical management, the case manager and I walked in silence, affected by the situation at hand. I had tried to hold off this patient's intubation for a few minutes, hoping that her son might soon arrive to exchange a few words with his mother, but it didn't happen. Because the patient's living will had requested that she be a "full code" (my understanding was that she lived a fulfilling, independent life), all efforts would be employed in attempt to save her life and help her through this medical crisis. We had intubated her successfully and aggressively began her medical management.
Suddenly, the case manager stopped smack-dab in the middle of the hallway and spoke to me. "You are amazing in that room, do you know that?" I looked her in the eyes, trying to see if she had picked an inopportune moment to hassle me, to tease me the way that us ER co-workers sometimes do to lighten such heavy, burdensome moments.
She was being serious. "After introducing yourself and shaking this son's hand, you sat down on the couch beside him, touched his shoulder, introduced the rest of us, and asked him how he was doing before slowly, in words he could understand, explaining everything that had been done so far to save his mother's life."
"Yeah," I said, "so?"
She continued. "Did you not feel the tension in that room? And somehow, after you were done delivering the worst of the news, the room felt hopeful, at peace. You could see the son's face slowly accept the news you were giving him. You eased his worries by instilling that we were doing everything we can to help his mother, without falsely elevating his hopes."She paused here, taking in a deep breath. " You showed him that you cared."
"Doesn't everybody do this, though?" I said, knowing the answer before I finished asking.
The case manager laughed in a regretful, wistful kind of way. "Are you kidding? You would be appalled at some of the ways I've seen bad news delivered in that room. No introductions. No sitting down. Blurting out the bad news without any preparation to the family. Leaving without addressing any of the family's questions. Jim, you need to teach more doctors how to act and speak more appropriately in that room."
By now, we had started walking again and were standing outside of the patient's room. The son was going to be escorted back in just a few minutes.
Not one to gloat over getting a compliment, I walked back into the room and continued helping my senior resident with this patient's care. It was, once again, a thing of beauty to watch our team methodically go about each of their responsibilities and, as a result, we were soon rewarded with this patient's condition stabilizing. She was still very sick, but at least the son could now spend some time at her bedside. Which turned out to be a blessing as, in the end, this patient passed on that same evening.
Later on that night, at home, after tucking in my kids and a glass of wine in hand, I was giving much thought to our case manager's words. Just a few weeks prior, during a night shift, a nurse supervisor who had accompanied me in the family room spoke similar words to me when we were done. "The way you approach patients and their families is remarkable," she had said. I may have blushed, but her words were greatly appreciated and I viewed them as the ultimate compliment.
Why isn't everybody at their best, especially in that room? I thought to myself, though, becoming a little annoyed. When did medicine become so shifted to view patient's and their families as "its" and not as human beings, as "hes" and "shes"? When did we abandon learning patient's names and their life story? Of taking a little more time in their treatment room? When did compassion and kindness sneak out the window and rush, rush, rush sneak in. When did the the quantity of patients one treats replace the quality of care given to each individual patient, defining, in some peoples' eyes, a better physician?
Sadly, most of us in medicine know that answer. With the increasing struggles of our profession,
from insurance cutbacks
to legal threats,
from hospital cuts of personnel
to the shifting thought that patients' rights outstrip our own, medicine isn't the field it once was when I signed up for a career twenty years ago. Especially in the ER, it is now common for us to be 4-6 hours behind every day, patients now relying on us not only for emergent care but for treatment of their chronic illnesses as well as maintenance medications. Can you see the frustrations? This quantity has potential to impede on our quality, to cut into the time we spend with each patient and their family.
I recently gave an hour lecture to our residency physicians regarding kindness and compassion. I started it with a tragic video of 9/11, scenes playing out to Sarah McLachlan's "Arms Of An Angel." We then watched a synopsis of the Columbine tragedy before I started talking. There was nary a dry eye. "See this devastation, this grief, involved in such atrocious acts?" I asked the residents. "What makes this grief and loss any different from that which you will encounter in a patient's treatment room or our ER family room?" A dropping pin could be heard in the room. Grief is grief, I reiterated. Loss is loss. Death is death. Respect is necessary. Kindness and compassion are a must. Addressing such concerns, I assured the residents, is one of the most important jobs they will ever face. Put the time in and learn how to view this responsibility as a privilege and not a burden.
This lecture was never finished. Before my time was up, only half of the slides had been presented. Instead, we had spent a great deal of time talking about personal techniques on how to interact with patients and their families and how to deliver devastating news. My residents shared personal stories of their best and worst experiences. It was clearly evident that some of them were quite comfortable in their roles, while others struggled with this part of their jobs. This hour lecture on kindness and compassion had gone from the category of "light and fluffy" to receiving the respect it deserved. From the feedback of the residents, they were appreciative and definitely more cognizant of their roles in treating patients and their families.
As karma sometimes dictates, a few nights later, while reading
Cutting For Stone, a brilliant fiction novel by a brilliant writer, Abraham Verghese (he who also happens to be a brilliant man of medicine), I happened upon a collection of words on page 519 that left me with goosebumps. In the novel, Dr. Thomas Stone, a leading liver transplant specialist, reads a letter from a mother of a trauma victim that he had treated. It follows:
Dr. Stone--My son's terrible death is not something I will ever get over, but perhaps in time it will be less painful. But I cannot get over one image, a last image that could have been different. Before I was asked to leave the room in a very rough manner, I must tell you that I saw my son was terrified and there was no one who addressed his fear. The only person who tried was a nurse. She held my son's hand and said, "Don't worry, it will be all right." Everyone else ignored him. Sure, the doctors were busy with his body. It would have been merciful if he had been unconscious. They had important things to do. They cared only about his chest and belly. Not about the little boy who was in fear. Yes, he was a man, but at such a vulnerable moment, he was reduced to a little boy. I saw no sign of the slightest bit of human kindness. My son and I were irritants. Your team would have preferred for me to be gone and for him to be quiet. Eventually they got their wish. Dr. Stone, as head of surgery, perhaps as a parent yourself, do you not feel some obligation to have your staff comfort the patient? Would the patient not be better off with less anxiety, less fright? My son's last conscious memory will be of people ignoring him. My last memory of him will be of my little boy, watching in terror as his mother is escorted out of the room. It is the graven image I will carry to my own deathbed. The fact that people were attentive to his body does not compensate for their ignoring his being.Brilliant. Simply and utterly brilliant. Thank you, Dr. Verghese.
We need to bring back kindness and compassion. We need to fix the medical field as it now exists so we can begin, again, to pay attention to that which is most import--the patient and their families. With kindness and compassion at the forefront.
Enough said.
As always, big thanks for reading. If you have had any experiences, either as a patient or as a family member sitting in that family room, that may enlighten us readers and make us better at what we do, please share...
I have to admit, I wasn't one to really appreciate the offbeat behaviors and attachments that otherwise seemingly normal people develop with a family pet. I mean, really, have you ever seen a pet owner kissing their dog, tongue-to-tongue? Or letting their kitty-kitty-kitty lick them all over their face? Or letting their pet gerbil nibble the lettuce off of their nose? I'm surprised at the lack of short-term memory some of these owners must have to
not have remembered watching their pet lick themselves...everywhere...just a few minutes before their face bath. I'll repeat myself...
everywhere. I still cringe to think that before licking their owner's face, a dog may have been going to town on his anus. And that's just the boy dog.
It wasn't just the licking, though, but also that foreign language that I couldn't quite grasp. "Here, Muffy," the cat owner might say in a baby-talk voice, "come give your mommy a big kissy-kissy here on my lips." At least with the baby talk with a human baby, you eventually come to the conclusion that it will cease when the kid turns one, maybe two. An end is in sight, yes? But with cats? I don't think so. I think one is looking at 10-20 years of baby talk, minimum, with a pet cat. God forbid the day I scratch a dog behind the ears and whisper "goochie-goochie-goo." No way, no how--not for me.
I grew up around pets, yes, but they were at my grandparent's farm
and they were outdoor pets. Besides several pigs, lots of chickens, and a little house full of rabbits, several cats and dogs were also part of the lot. They remained outside, though, and were well taken care of with their own private houses and feeding stations. We talked normal English to them. We pet them and fed them regular pet food from the 50 lbs. bag. They didn't wear designer outfits but, instead, relied on their genetics to thicken or shed their hair, depending on the season. The names rush me now--Sweet Pea, Prince, Trixie--and they were all awesome dogs, my buddies actually, when I was visiting for an afternoon or overnight. I don't think the dogs minded their lack of indoor living, judging by their playful run through the gorgeous, rich, adventurous farmlands.
So, with this upbringing, it seemed a little off to me that so much energy would be spent by an owner on making their pet so extremely comfortable within an indoor setting. Wouldn't the pet hair all over the floor and clothes be a deterrent enough? I've seen my share of ER patients with their clothing covered in pet hair. Cringe-worthy, I tell you.
Enter Ruby. Our family pet. Our yellow lab. I have to chuckle when I call her "yellow," though, because, if anything, she is actually pure snowy-white.
Most important? She spends the majority of her time indoors. Yes, I know, I'm eating crow. But she has single-handedly changed my way of thinking when it comes to indoor pets.
Five years ago, in March, our Ruby was born. Around the same time that Ruby was born, my mother passed away. Like any other family who has suffered a loss, try as we might, a certain "funk" seemed to linger around our house. Smiling was, at times, a chore. Sad realizations of Mom's death would interrupt happy moments. We needed to change things up.
My wife and her sister had a suggestion. Maybe it was time for us to get a family dog, something we had considered in the past but rejected. Sandy's family had two beautiful labs, both from the same breeder. This particular breeder focused her attention on two of the dogs' attributes--their gentle, mild disposition and their beautiful white coat. And she would not sell a person a dog unless she approved of them and the home her dogs would be joining.
Yeah, I'll think about it, I thought to myself. The breeder didn't have any available pups from the upcoming litters, giving me some available thinking time. Or so I thought. Because a few days later, Sandy called to say that the breeder had an about-to-be-born litter with one more pup than was supposed, confirmed by ultrasound.
"June said the pup is yours if you want it," Sandy said, exciting our family at the prospect.
Thus, the process began. First, we had to be interviewed by the breeder, June, a gruff woman with a heart of gold, whose profound love for her dogs was very evident. She, thankfully, felt that us receiving one of her puppies was meant to be. After a successful interview (brow-glistening included) and tour of her comfortable home, she led us to her enclosed back porch and the most beautiful litter of pups imaginable. And there, jumping on her hind paws and trying to get our attention, was our Ruby. Leaning into the enclosure, trying to climb out to us. The kids were sold. My wife was sold. And me? Standing there looking at the wrinkly, yelping little bundle of goochie-goochie-goo that so quickly took to our family, I knew I was hooked. Even if I hadn't been, I knew I was outnumbered.
Ruby, named for Mom's birthstone, came home with us in early May. Five years ago. Lifting that "funk" that had clouded our air for the whole spring.
Yeah, the carpets now get shampooed and vacuumed more frequently. Yeah, my socks have white fur stuck to them occasionally. Yeah, sometimes a leftover snack will disappear off the kitchen counter. Yeah, sometimes stepping in a pile of poop in the yard is annoying. Yeah, sometimes our house smells like wet dog after a walk in the rain. Worse, I've had to learn that dogs have gas just like humans.
And you know what? Who cares. Really, for all the love and smiles that she has brought to our lives, Ruby can certainly shed and traipse some dirt through the house occasionally. All it takes is one look at Ruby cuddling with the kids at bedtime to know that some things are worth the inconvenience. She is, quite simply, an important part of our family--our fourth kid, even.
So yeah, I've talked the (baby) talk. "Where's my Ruby, Ruby, Ruby?" you might hear me say when I get home from work. Without shame. That might be me on my knee, kneeling at her face level, tickling her ears while I whisper "We love you, Ruby." That would be my eyes, gleaming, as I throw the tennis ball and she chases it down, returning it at my feet.
My favorite thing about Ruby, though? Late at night, while we are all sleeping, she does her rounds, nudging open each of the kid's bedroom door and checking on them. Even my wife and I are included in her rounds. And if she suspects anything unusual, she can be found lying at the base of our stairs, ready to protect us as necessary. Otherwise, you'll find her randomly sleeping in one of the bedrooms, at the foot of the bed, every night. Snoring and farting. And fitting in beautifully.
Many of our family and friends now have indoor pets, most of them making adjustments similar to us, and we are happy to be included in this group. And, patients that come in with hair on their clothes no longer make me cringe. Well, except for the frail, elderly woman who has the hair of ten cats clinging to her wool sweater. Excuse me while I go sneeze...okay, I'm back. But I can easily picture these patients, in their home, cuddling up to their pets, their smiles bigger and better than any medicine I might possibly prescribe.
If you ever wondered about or considered an indoor pet, but opted out, reconsider. I am living proof of the convert that exists in all of us.
Happy 5th Birthday, Ruby! We hope you like your raw-hide presents and doggy-cake!
Now...get over here and give me a big kissy-kissy...
As always, big thanks for reading. This post is dedicated to my sister Rosie's little Havanese, Maggie, who will only drink bottled water and snack on mini-marshmallows! And my sister Susie's dog, Knuckles, who was the king of all self-lickers! LOL Have a good weekend...
I have to admit, I wasn't one to really appreciate the offbeat behaviors and attachments that otherwise seemingly normal people develop with a family pet. I mean, really, have you ever seen a pet owner kissing their dog, tongue-to-tongue? Or letting their kitty-kitty-kitty lick them all over their face? Or letting their pet gerbil nibble the lettuce off of their nose? I'm surprised at the lack of short-term memory some of these owners must have to
not have remembered watching their pet lick themselves...everywhere...just a few minutes before their face bath. I'll repeat myself...
everywhere. I still cringe to think that before licking their owner's face, a dog may have been going to town on his anus. And that's just the boy dog.
It wasn't just the licking, though, but also that foreign language that I couldn't quite grasp. "Here, Muffy," the cat owner might say in a baby-talk voice, "come give your mommy a big kissy-kissy here on my lips." At least with the baby talk with a human baby, you eventually come to the conclusion that it will cease when the kid turns one, maybe two. An end is in sight, yes? But with cats? I don't think so. I think one is looking at 10-20 years of baby talk, minimum, with a pet cat. God forbid the day I scratch a dog behind the ears and whisper "goochie-goochie-goo." No way, no how--not for me.
I grew up around pets, yes, but they were at my grandparent's farm
and they were outdoor pets. Besides several pigs, lots of chickens, and a little house full of rabbits, several cats and dogs were also part of the lot. They remained outside, though, and were well taken care of with their own private houses and feeding stations. We talked normal English to them. We pet them and fed them regular pet food from the 50 lbs. bag. They didn't wear designer outfits but, instead, relied on their genetics to thicken or shed their hair, depending on the season. The names rush me now--Sweet Pea, Prince, Trixie--and they were all awesome dogs, my buddies actually, when I was visiting for an afternoon or overnight. I don't think the dogs minded their lack of indoor living, judging by their playful run through the gorgeous, rich, adventurous farmlands.
So, with this upbringing, it seemed a little off to me that so much energy would be spent by an owner on making their pet so extremely comfortable within an indoor setting. Wouldn't the pet hair all over the floor and clothes be a deterrent enough? I've seen my share of ER patients with their clothing covered in pet hair. Cringe-worthy, I tell you.
Enter Ruby. Our family pet. Our yellow lab. I have to chuckle when I call her "yellow," though, because, if anything, she is actually pure snowy-white.
Most important? She spends the majority of her time indoors. Yes, I know, I'm eating crow. But she has single-handedly changed my way of thinking when it comes to indoor pets.
Five years ago, in March, our Ruby was born. Around the same time that Ruby was born, my mother passed away. Like any other family who has suffered a loss, try as we might, a certain "funk" seemed to linger around our house. Smiling was, at times, a chore. Sad realizations of Mom's death would interrupt happy moments. We needed to change things up.
My wife and her sister had a suggestion. Maybe it was time for us to get a family dog, something we had considered in the past but rejected. Sandy's family had two beautiful labs, both from the same breeder. This particular breeder focused her attention on two of the dogs' attributes--their gentle, mild disposition and their beautiful white coat. And she would not sell a person a dog unless she approved of them and the home her dogs would be joining.
Yeah, I'll think about it, I thought to myself. The breeder didn't have any available pups from the upcoming litters, giving me some available thinking time. Or so I thought. Because a few days later, Sandy called to say that the breeder had an about-to-be-born litter with one more pup than was supposed, confirmed by ultrasound.
"June said the pup is yours if you want it," Sandy said, exciting our family at the prospect.
Thus, the process began. First, we had to be interviewed by the breeder, June, a gruff woman with a heart of gold, whose profound love for her dogs was very evident. She, thankfully, felt that us receiving one of her puppies was meant to be. After a successful interview (brow-glistening included) and tour of her comfortable home, she led us to her enclosed back porch and the most beautiful litter of pups imaginable. And there, jumping on her hind paws and trying to get our attention, was our Ruby. Leaning into the enclosure, trying to climb out to us. The kids were sold. My wife was sold. And me? Standing there looking at the wrinkly, yelping little bundle of goochie-goochie-goo that so quickly took to our family, I knew I was hooked. Even if I hadn't been, I knew I was outnumbered.
Ruby, named for Mom's birthstone, came home with us in early May. Five years ago. Lifting that "funk" that had clouded our air for the whole spring.
Yeah, the carpets now get shampooed and vacuumed more frequently. Yeah, my socks have white fur stuck to them occasionally. Yeah, sometimes a leftover snack will disappear off the kitchen counter. Yeah, sometimes stepping in a pile of poop in the yard is annoying. Yeah, sometimes our house smells like wet dog after a walk in the rain. Worse, I've had to learn that dogs have gas just like humans.
And you know what? Who cares. Really, for all the love and smiles that she has brought to our lives, Ruby can certainly shed and traipse some dirt through the house occasionally. All it takes is one look at Ruby cuddling with the kids at bedtime to know that some things are worth the inconvenience. She is, quite simply, an important part of our family--our fourth kid, even.
So yeah, I've talked the (baby) talk. "Where's my Ruby, Ruby, Ruby?" you might hear me say when I get home from work. Without shame. That might be me on my knee, kneeling at her face level, tickling her ears while I whisper "We love you, Ruby." That would be my eyes, gleaming, as I throw the tennis ball and she chases it down, returning it at my feet.
My favorite thing about Ruby, though? Late at night, while we are all sleeping, she does her rounds, nudging open each of the kid's bedroom door and checking on them. Even my wife and I are included in her rounds. And if she suspects anything unusual, she can be found lying at the base of our stairs, ready to protect us as necessary. Otherwise, you'll find her randomly sleeping in one of the bedrooms, at the foot of the bed, every night. Snoring and farting. And fitting in beautifully.
Many of our family and friends now have indoor pets, most of them making adjustments similar to us, and we are happy to be included in this group. And, patients that come in with hair on their clothes no longer make me cringe. Well, except for the frail, elderly woman who has the hair of ten cats clinging to her wool sweater. Excuse me while I go sneeze...okay, I'm back. But I can easily picture these patients, in their home, cuddling up to their pets, their smiles bigger and better than any medicine I might possibly prescribe.
If you ever wondered about or considered an indoor pet, but opted out, reconsider. I am living proof of the convert that exists in all of us.
Happy 5th Birthday, Ruby! We hope you like your raw-hide presents and doggy-cake!
Now...get over here and give me a big kissy-kissy...
As always, big thanks for reading. This post is dedicated to my sister Rosie's little Havanese, Maggie, who will only drink bottled water and snack on mini-marshmallows! And my sister Susie's dog, Knuckles, who was the king of all self-lickers! LOL Have a good weekend...
I walked towards Room 22 to see my next patient, an elderly woman who was found lying on the kitchen floor of her private home. She lived alone. Because of her advancing dementia, she was unable to provide any history as to how long she had been down or the circumstances that lead to her being on the floor. Unfortunately, due to the strong smell of stale urine and feces that permeated the hallway outside of her room, it was a safe assumption that she had been down for quite a while.
Not yet fully aware of how disheartening this patient's case would be, I opened the room's partially-closed glass door before sliding back the room's privacy curtain. I stepped into this patient's room as this patient stepped into my consciousness.
What I stepped into was sad. No, heartbreaking. The patient, rolled onto her left side by our staff and lying fully exposed on her treatment cot, was being tenderly wiped and cleaned by two of our ER nurses, one standing behind the patient while the other stood in front. Despite the slightly-dimmed room lights, I could appreciate the momentous task these nurses had of cleaning the hardened stool and human waste from this patient's neglected body.
I looked to unflappable Charlene, the nurse standing in front of the patient, who was shaking her head in frustration. "This is bad," she said, "really bad." She went on to explain that the patient was found by her two children, a son and daughter, on the floor of her kitchen, conscious but covered in human waste. Her own. The prehospital team believed she had been down at least several days. According to Charlene, the paramedics, our local experts on witnessing the best and worst of living conditions, said that this patient's home was among the worst conditions they had ever encountered. "There were multiple mounds of strewn garbage, numerous puddles of drying urine, and smeared feces everywhere you looked," Charlene said, repeating their words.
I shook my head. Although I hadn't yet learned the particulars to this patient's social situation, I had seen my share of elderly patients who were brought to our ER for treatment after they had been discovered incapacitated in their home, whether ill from a trip and fall or, worse, a catastrophic medical event like a stroke or heart attack. Unfortunately, they might sometimes lay there for several days, alone and possibly in pain, frightened of never being found.
The thought of a patient suffering in this manner always makes me shudder.
Descriptions of poor living conditions sometimes accompanied these patients, as well, but none to the degree that Charlene described. "Seriously, Dr. Jim, the prehospital team said that feces was even smeared on the kitchen counter." Maybe this patient simply struggled after going down, making a bigger mess of things.
I briefly observed this patient's body--her frailness, her thin, cachectic limbs, her slightly protruding belly, her transparent pale skin, her matted-down silvery hair, her deep facial wrinkles--before walking towards her head and squatting down to her face level, ready to introduce myself. "Maam," I said, caressing the right side of her face as I spoke, "I'm Dr. Jim and I will be taking care of you today." The patient stirred as I continued to stroke her face. And then, quite suddenly, she opened her eyes, searching eyes of hazel brown, that stared back into mine. After sizing me up, she gave me a big, confused, wondrous smile, the familiar smile of a good-natured dementia patient.
"Do you hurt anywhere, maam?" I asked, beginning my exam while the nurses continued to clean her. "No," she said feebly, shaking her head. I looked in her ears, her mouth, her nose. I listened to her heart, her lungs, her abdomen. I palpated every part of her body, rotating and flexing her joints to make sure she had no clinical evidence of fractures.
Outside of the obvious signs of dehydration and her frail body breaking down at her pressure points, I was happy not to find any obvious signs of injury or acute medical illness. Now, we could pursue a thorough heart and brain workup (including a head CT to rule-out a stroke) as well as several clearance x-rays and some additional urine and blood studies. More importantly, social services could be called to pursue further information on this patient's living conditions and social situation.
It was near the end of my physical exam on this patient, though, when I began to see the situation more clearly. As the nurses continued to clean the patient and I stood beside the patient auscultating her abdomen, the room's curtain flew back and a very meticulous, very well-dressed, very put-together woman hurried into the room. She was middle-aged.
"May I help you, maam?" I asked, pulling my stethoscope from my ears as both nurses looked toward the woman, taking her in as I'm sure I had done.
"Yes, I'm her daughter," the woman answered with severe enunciation, taking a corner chair while nodding towards the patient. I waited briefly for her next question, a question that never arrived--"How is my mother doing?"--while taking in her neatly highlighted hair, her pressed wool pants, her polished heels, her matching argyle blazer, the multiple bands of gold that hovered on her neck and wrists, her ring-covered fingers, her painted face. I looked back at the patient, now rolled to her other side, and back at this daughter again.
The dichotomy of the situation was startling.
I leaned against the wall, giving the situation a few minutes to play itself out. The nurses continued their diligent work, occasionally glancing at the daughter, while the daughter continued to sit comfortably in her corner chair. And watch. I didn't expect her to offer her help bathing her mother. And she didn't. I had hoped that she might offer to hold her mother's hand, though, or whisper some encouragement in her ear. But she didn't. No moments of tenderness or love ever came.
Finally, I went up to this daughter and introduced myself and the two nurses. "Can you please tell me what happened with your mother?" I asked, eager to hear what she could contribute to her mother's story.
"Well, we, my brother and I, hadn't heard from Mother for a couple nights, so we called her. When we got no answer, we went over to her house and found her on the kitchen floor."
"Any signs of trauma?" I asked. "No," she answered. "Any blood?" "No." "Was your mother awake when you arrived?" "Yes." "Did she complain initially of any pain or have any difficulty breathing?" "No."
After finishing my questions, none with answers that would change our treatment plan, I asked this daughter about the living conditions the paramedics had described.
"Oh, that," the daughter said, blase, "we think Mother may have tried to get back up several times and failed, creating such a big mess." I nodded my head, hoping this was the extent of it, hoping that there wouldn't be anything more to this story when social services investigated. But, by Charlene's account, the paramedics had said the whole house was in disarray, not just the kitchen. "My brother is over cleaning Mother's house now as we speak," the daughter added.
I continued. "And your mother has dementia but lives alone, I see?" She nodded 'yes.' "Why hadn't anyone seen her for at least a couple days? How often do you check on her? Who cooks and cleans for her?"
The daughter shifted in her chair. "Well, either my brother or I go over every day, but both of us were busy and thought the other had been over. We were wrong. We have a cleaning maid and meals delivered, too, but not on weekends."
Although most of the answers seemed adequate, something still made me uncomfortable about this case. Something I couldn't put my finger on. At this point, though, I saw this daughter's eyes glisten. "Maam," I said, acknowledging her first signs of compassion, "I'm sorry if these questions might upset you, but they must be asked. Your mother's health and care depend on your answers." She nodded her understanding.
After a few more minutes of talking with the daughter, I said goodbye to both her and her mother, but not before thanking the nurses for yet another awesome job of patient care. They are worth far more than what their paycheck reflects. I made a conscious decision to leave the rest of the social questions to our case management team and focus on the patient's medical care.
Unfortunately, the patient's kidneys had begun failing her, both from her moderate dehydration and from being clogged with muscle-wasting metabolites (rhabdomyolysis). She was admitted, obviously, for further medical care before ultimately being placed into a safe nursing home environment. She would never again be left alone at home.
I refuse to sit in judgment of this daughter. And the son I never met. But in my line of work, a healthy dose of suspicion is sometimes what the doctor must order. So I did. I have to trust that our system works.
I have several friends who recently lost their fathers. Just last week, my brother-in-law suddenly lost his mother. My world is filled with people who, regretfully, have lost one or both parents. Who have lost their spiritual guiders. Who would give anything to have just a few more minutes with their deceased parent. Who would do things a bit differently than this patient's family, I'm sure.
I know I would.
As always, big thanks for reading. This post is dedicated to those who give of themselves to benefit an elderly person in their lives. May your kindness and compassion be returned tenfold...see you again in a few days.
I walked towards Room 22 to see my next patient, an elderly woman who was found lying on the kitchen floor of her private home. She lived alone. Because of her advancing dementia, she was unable to provide any history as to how long she had been down or the circumstances that lead to her being on the floor. Unfortunately, due to the strong smell of stale urine and feces that permeated the hallway outside of her room, it was a safe assumption that she had been down for quite a while.
Not yet fully aware of how disheartening this patient's case would be, I opened the room's partially-closed glass door before sliding back the room's privacy curtain. I stepped into this patient's room as this patient stepped into my consciousness.
What I stepped into was sad. No, heartbreaking. The patient, rolled onto her left side by our staff and lying fully exposed on her treatment cot, was being tenderly wiped and cleaned by two of our ER nurses, one standing behind the patient while the other stood in front. Despite the slightly-dimmed room lights, I could appreciate the momentous task these nurses had of cleaning the hardened stool and human waste from this patient's neglected body.
I looked to unflappable Charlene, the nurse standing in front of the patient, who was shaking her head in frustration. "This is bad," she said, "really bad." She went on to explain that the patient was found by her two children, a son and daughter, on the floor of her kitchen, conscious but covered in human waste. Her own. The prehospital team believed she had been down at least several days. According to Charlene, the paramedics, our local experts on witnessing the best and worst of living conditions, said that this patient's home was among the worst conditions they had ever encountered. "There were multiple mounds of strewn garbage, numerous puddles of drying urine, and smeared feces everywhere you looked," Charlene said, repeating their words.
I shook my head. Although I hadn't yet learned the particulars to this patient's social situation, I had seen my share of elderly patients who were brought to our ER for treatment after they had been discovered incapacitated in their home, whether ill from a trip and fall or, worse, a catastrophic medical event like a stroke or heart attack. Unfortunately, they might sometimes lay there for several days, alone and possibly in pain, frightened of never being found.
The thought of a patient suffering in this manner always makes me shudder.
Descriptions of poor living conditions sometimes accompanied these patients, as well, but none to the degree that Charlene described. "Seriously, Dr. Jim, the prehospital team said that feces was even smeared on the kitchen counter." Maybe this patient simply struggled after going down, making a bigger mess of things.
I briefly observed this patient's body--her frailness, her thin, cachectic limbs, her slightly protruding belly, her transparent pale skin, her matted-down silvery hair, her deep facial wrinkles--before walking towards her head and squatting down to her face level, ready to introduce myself. "Maam," I said, caressing the right side of her face as I spoke, "I'm Dr. Jim and I will be taking care of you today." The patient stirred as I continued to stroke her face. And then, quite suddenly, she opened her eyes, searching eyes of hazel brown, that stared back into mine. After sizing me up, she gave me a big, confused, wondrous smile, the familiar smile of a good-natured dementia patient.
"Do you hurt anywhere, maam?" I asked, beginning my exam while the nurses continued to clean her. "No," she said feebly, shaking her head. I looked in her ears, her mouth, her nose. I listened to her heart, her lungs, her abdomen. I palpated every part of her body, rotating and flexing her joints to make sure she had no clinical evidence of fractures.
Outside of the obvious signs of dehydration and her frail body breaking down at her pressure points, I was happy not to find any obvious signs of injury or acute medical illness. Now, we could pursue a thorough heart and brain workup (including a head CT to rule-out a stroke) as well as several clearance x-rays and some additional urine and blood studies. More importantly, social services could be called to pursue further information on this patient's living conditions and social situation.
It was near the end of my physical exam on this patient, though, when I began to see the situation more clearly. As the nurses continued to clean the patient and I stood beside the patient auscultating her abdomen, the room's curtain flew back and a very meticulous, very well-dressed, very put-together woman hurried into the room. She was middle-aged.
"May I help you, maam?" I asked, pulling my stethoscope from my ears as both nurses looked toward the woman, taking her in as I'm sure I had done.
"Yes, I'm her daughter," the woman answered with severe enunciation, taking a corner chair while nodding towards the patient. I waited briefly for her next question, a question that never arrived--"How is my mother doing?"--while taking in her neatly highlighted hair, her pressed wool pants, her polished heels, her matching argyle blazer, the multiple bands of gold that hovered on her neck and wrists, her ring-covered fingers, her painted face. I looked back at the patient, now rolled to her other side, and back at this daughter again.
The dichotomy of the situation was startling.
I leaned against the wall, giving the situation a few minutes to play itself out. The nurses continued their diligent work, occasionally glancing at the daughter, while the daughter continued to sit comfortably in her corner chair. And watch. I didn't expect her to offer her help bathing her mother. And she didn't. I had hoped that she might offer to hold her mother's hand, though, or whisper some encouragement in her ear. But she didn't. No moments of tenderness or love ever came.
Finally, I went up to this daughter and introduced myself and the two nurses. "Can you please tell me what happened with your mother?" I asked, eager to hear what she could contribute to her mother's story.
"Well, we, my brother and I, hadn't heard from Mother for a couple nights, so we called her. When we got no answer, we went over to her house and found her on the kitchen floor."
"Any signs of trauma?" I asked. "No," she answered. "Any blood?" "No." "Was your mother awake when you arrived?" "Yes." "Did she complain initially of any pain or have any difficulty breathing?" "No."
After finishing my questions, none with answers that would change our treatment plan, I asked this daughter about the living conditions the paramedics had described.
"Oh, that," the daughter said, blase, "we think Mother may have tried to get back up several times and failed, creating such a big mess." I nodded my head, hoping this was the extent of it, hoping that there wouldn't be anything more to this story when social services investigated. But, by Charlene's account, the paramedics had said the whole house was in disarray, not just the kitchen. "My brother is over cleaning Mother's house now as we speak," the daughter added.
I continued. "And your mother has dementia but lives alone, I see?" She nodded 'yes.' "Why hadn't anyone seen her for at least a couple days? How often do you check on her? Who cooks and cleans for her?"
The daughter shifted in her chair. "Well, either my brother or I go over every day, but both of us were busy and thought the other had been over. We were wrong. We have a cleaning maid and meals delivered, too, but not on weekends."
Although most of the answers seemed adequate, something still made me uncomfortable about this case. Something I couldn't put my finger on. At this point, though, I saw this daughter's eyes glisten. "Maam," I said, acknowledging her first signs of compassion, "I'm sorry if these questions might upset you, but they must be asked. Your mother's health and care depend on your answers." She nodded her understanding.
After a few more minutes of talking with the daughter, I said goodbye to both her and her mother, but not before thanking the nurses for yet another awesome job of patient care. They are worth far more than what their paycheck reflects. I made a conscious decision to leave the rest of the social questions to our case management team and focus on the patient's medical care.
Unfortunately, the patient's kidneys had begun failing her, both from her moderate dehydration and from being clogged with muscle-wasting metabolites (rhabdomyolysis). She was admitted, obviously, for further medical care before ultimately being placed into a safe nursing home environment. She would never again be left alone at home.
I refuse to sit in judgment of this daughter. And the son I never met. But in my line of work, a healthy dose of suspicion is sometimes what the doctor must order. So I did. I have to trust that our system works.
I have several friends who recently lost their fathers. Just last week, my brother-in-law suddenly lost his mother. My world is filled with people who, regretfully, have lost one or both parents. Who have lost their spiritual guiders. Who would give anything to have just a few more minutes with their deceased parent. Who would do things a bit differently than this patient's family, I'm sure.
I know I would.
As always, big thanks for reading. This post is dedicated to those who give of themselves to benefit an elderly person in their lives. May your kindness and compassion be returned tenfold...see you again in a few days.
Hey All!Thank you, thank you, thank you...to Medgadget, to Epocrates, and to Lenovo, for uniting our community by offering a glimpse of the numerous, amazing medical blogs "out there" through your annual contest. Like last year, my eyes are a little brighter to such infinite talent in the medical writing world. Thank you for your energy brought to this endeavor. To my fellow nominees and winners, my heartiest congratulations on your recognition. Well-deserved and well-placed, each and every one of you. To my fellow nominees and finalists in the Best Literary category, it is truly my honor and pleasure to be listed beside each of you. A reward in and of itself. Thank you for your passionate words and eloquent insights. Finally, to my readers--my amazing, faithful, insightful, intelligent, and devoted readers--I thank you always for your support, for embracing my words, and for making this such a thrilling personal experience. Your friendships and kindnesses outweigh any awards or votes I may ever receive. Thank you...There are times when I simply cannot believe that I have been blogging for over a year. November, 2009, in fact, was the official start of this endeavor and now, with the blink of an eye, we sit in the year 2011 with anticipation for another spring and summer to roll around.
When I had first started out, I was diligent and adamant about posting three stories a week, aiming for Monday, Wednesday, and Friday. Although it was extremely hard work and, at times, exhausting, the rewards were worth it. I remember being in Hilton Head, last March, and staying up until 3 am to finish a post for that Wednesday. Of course, the next day I was a mess on the tennis courts, but I reasoned it was a small price to pay.
As some of you may have noticed, then, I've slacked off a bit since those days of three posts a week. It was late fall/early winter when I finally was able to breath out and
not carry around too much guilt if I didn't get several postings done in one week. Sure, I think about writing a story here and a story there, but it was also nice to focus a little more on work, on family, and, especially, on my kids. Something had to give and, unfortunately, it was my blogging.
That said, I am going to try harder to pick up the pace again. Some weeks may entail only one posting, some weeks two. I think the days of three postings a week, though, may be behind us. I thank you, though, for sticking this out with me. The only reason I am still going, of course, is because you, the reader, have been so committed. For that, I thank you.
Finally, I have been asked repeatedly over the past year if there are any posts that are my absolute favorites. It's a question that I can't answer. I view my posts, my stories, as works of literature (in a feeble sort of way), and I don't know if I can pick out a batch of favorites. I do know that the majority of my stories focus on compassion and kindness and those little, obscure moments of humanity that many might miss. When I finish another posting, if I am smiling, then I know I have done some good.
Intrigued by the question, though, I did review my library of postings and was able to pull out several that really hit home with me. And my readers. If you are a new reader to my blog, this might be a great way to catch up on some of my perspective. If you are a tried and true steady reader, these old stories might be a fun read (again). I thank you for visiting some of my older works. So, onward...
If you want to learn a bit more about me;
Against The NormThe Quivering FingerBlogging & MeMore about my family;
My Buddy, For AlwaysDear AustraliaThe Fringe BenefitsThe Beaten PathSad;
A Mother's Cry Grandpa's GrandkidsHeroes Among Us--GigiA Love StoryThe Emaciated ShoulderNo Second ChancesThis Father's DaughterTalk-worthy;
The Damaged Eyes of AlcoholismThe Appreciative CashierNo Love For A FatherThe Pit StopThe WitnessPlease Make Her ComfortableFunny;
SsshhhThe Half-Load Predicament All Bound UpMy John Deere CapDouble CrackIt Wasn't Me! How's that for a start? Looking at the list myself, I keep wanting to add to it...it's hard for me to pick one "baby" over another. Some of the funnies, even, have gotten me into trouble. Can you do me a favor, though? I would love to hear from you--to know what previous postings or stories may have hit home with you, hit that raw nerve or made you smile or burst out laughing. Even from ones I haven't mentioned.
Again, big thanks and kudos for all of your support over the past year. I am a lucky and fortunate guy. Happy (and sad) reading...and have a great weekend. See you next week...
Jim
Hey All!Thank you, thank you, thank you...to Medgadget, to Epocrates, and to Lenovo, for uniting our community by offering a glimpse of the numerous, amazing medical blogs "out there" through your annual contest. Like last year, my eyes are a little brighter to such infinite talent in the medical writing world. Thank you for your energy brought to this endeavor. To my fellow nominees and winners, my heartiest congratulations on your recognition. Well-deserved and well-placed, each and every one of you. To my fellow nominees and finalists in the Best Literary category, it is truly my honor and pleasure to be listed beside each of you. A reward in and of itself. Thank you for your passionate words and eloquent insights. Finally, to my readers--my amazing, faithful, insightful, intelligent, and devoted readers--I thank you always for your support, for embracing my words, and for making this such a thrilling personal experience. Your friendships and kindnesses outweigh any awards or votes I may ever receive. Thank you...There are times when I simply cannot believe that I have been blogging for over a year. November, 2009, in fact, was the official start of this endeavor and now, with the blink of an eye, we sit in the year 2011 with anticipation for another spring and summer to roll around.
When I had first started out, I was diligent and adamant about posting three stories a week, aiming for Monday, Wednesday, and Friday. Although it was extremely hard work and, at times, exhausting, the rewards were worth it. I remember being in Hilton Head, last March, and staying up until 3 am to finish a post for that Wednesday. Of course, the next day I was a mess on the tennis courts, but I reasoned it was a small price to pay.
As some of you may have noticed, then, I've slacked off a bit since those days of three posts a week. It was late fall/early winter when I finally was able to breath out and
not carry around too much guilt if I didn't get several postings done in one week. Sure, I think about writing a story here and a story there, but it was also nice to focus a little more on work, on family, and, especially, on my kids. Something had to give and, unfortunately, it was my blogging.
That said, I am going to try harder to pick up the pace again. Some weeks may entail only one posting, some weeks two. I think the days of three postings a week, though, may be behind us. I thank you, though, for sticking this out with me. The only reason I am still going, of course, is because you, the reader, have been so committed. For that, I thank you.
Finally, I have been asked repeatedly over the past year if there are any posts that are my absolute favorites. It's a question that I can't answer. I view my posts, my stories, as works of literature (in a feeble sort of way), and I don't know if I can pick out a batch of favorites. I do know that the majority of my stories focus on compassion and kindness and those little, obscure moments of humanity that many might miss. When I finish another posting, if I am smiling, then I know I have done some good.
Intrigued by the question, though, I did review my library of postings and was able to pull out several that really hit home with me. And my readers. If you are a new reader to my blog, this might be a great way to catch up on some of my perspective. If you are a tried and true steady reader, these old stories might be a fun read (again). I thank you for visiting some of my older works. So, onward...
If you want to learn a bit more about me;
Against The NormThe Quivering FingerBlogging & MeMore about my family;
My Buddy, For AlwaysDear AustraliaThe Fringe BenefitsThe Beaten PathSad;
A Mother's Cry Grandpa's GrandkidsHeroes Among Us--GigiA Love StoryThe Emaciated ShoulderNo Second ChancesThis Father's DaughterTalk-worthy;
The Damaged Eyes of AlcoholismThe Appreciative CashierNo Love For A FatherThe Pit StopThe WitnessPlease Make Her ComfortableFunny;
SsshhhThe Half-Load Predicament All Bound UpMy John Deere CapDouble CrackIt Wasn't Me! How's that for a start? Looking at the list myself, I keep wanting to add to it...it's hard for me to pick one "baby" over another. Some of the funnies, even, have gotten me into trouble. Can you do me a favor, though? I would love to hear from you--to know what previous postings or stories may have hit home with you, hit that raw nerve or made you smile or burst out laughing. Even from ones I haven't mentioned.
Again, big thanks and kudos for all of your support over the past year. I am a lucky and fortunate guy. Happy (and sad) reading...and have a great weekend. See you next week...
Jim
Vote for StorytellERdoc for Best Literary Blog at the Medgadget Medical Blog Awards! Thanks for your support...After another recent shift with a predominance of patients suffering from lingering flu symptoms, I decided to swing by our local Walmart to stock up on our home supply of pediatric medications, just in case. Some acetaminophen, ibuprofen, decongestant, and cough suppressant would hopefully get us through the rest of this winter season. And, of course, what a great variety of favorite flavors--orange, bubble gum, berry, and grape. Heck, some of them taste so good that faking the flu for the little cups of "candy" might be to my kids' benefit.
Unfortunately, on the way to the pharmacy area, one of the first aisles I always encounter is the candy and gum aisle. Not a good thing for me, since I have quite a recent fascination and taste for Gobstoppers, a Wonka jawbreaker product (don't tell my dentist). The yellow psychodelic boxes scream at me from their shelf,
"Jim, come and put a couple of us in your cart," and regardless how much I fight it, the pull is too strong.
Needless to say, my kids
love going to Walmart with me.
On this particular day, then, I walked to the mid-aisle to grab a few boxes of the candy. I wasn't alone in the aisle, though. To the right of the Gobstoppers, two parents stood looking at the shelf of big Hershey chocolate bars, immersed in a conversation (yes, I listened) of milk chocolate versus dark chocolate. To my left, a grocery cart with a makeshift, rigged-up kiddy car, driver seats and steering wheels included, on its handle-end. Two kids sat in those seats--an approximate four-year old girl and a three-year old boy. The Gobstoppers sat waiting for me between the parents and kids.
As I approached the family, I was caught off-guard with the screaming and fighting going on with the young kids. In fact, at one point, as I was kneeling down to grab the boxes of candy, I was appalled to find the little boy trying to punch his sister in the face, her hands rapidly moving to block each of his thrown punches, protecting herself. Still on my knees, I looked toward the parents, who must have completely tuned-out their kids. I was just about to say something when the little boy stopped, but not before his sister screamed out, "Get the hell off me, God damn it!" Still no reaction from the parents.
After this, I stayed kneeling, observing these peculiar parenting skills (or lack of) while looking at a box of Junior mints. While I was debating getting the mints, the little girl and boy started to talk to one another. About me! I actually wrote the conversation down in the pharmacy because it had shocked me much. It went like this.
Little girl: "Who the hell is that guy?" I looked at them looking at me.
Little boy: "I don't know, but if he gets close enough, I'm going to kick the shit out of him."
Little girl: "That will be fun. Try to knock him out." For good measure, she added, "God damn it." Again.
I was disheartened. I was shocked. I was annoyed with the parents for not addressing such obnoxiousness from their young kids. I looked from the kids to the parents, who had quickly glanced our way before figuring their conversation about chocolate was more important. I looked back to the kids again, before standing up and walking away with my Gobstoppers. I was upset and figured this was the best option for me, at that time. I knew it wasn't the kids' faults, but rather their parents. Their role models. But I wondered to myself,
"What kind of adults are these kids going to become?"
This happening got me to thinking about our society. For the most part, we all know great kids in our lives, from our own to our friends' and families'. To raise respectful, kind, compassionate and loving kids and guide them appropriately into adulthood, when we choose this road of parenthood, should be the primary goal in each of our lives. We may not always succeed, darn it, but we have to try our best and throw our energy into the effort. Because that effort translates into the brilliance of the future generation coming up to govern our world.
These parents demonstrated no effort. And, unfortunately, they are not alone.
How many of us see the changing pattern with our society's kids. Talking back to well-meaning adults. Not respecting our elders (at least hold the door open for them and smile!). Tolerating vulgar language and meaningless violence via computer games and TV. Not respecting one another's uniqueness. Forgetting manners. Immersing oneself into texting instead of holding actual conversation. Avoiding volunteerism and chores. Placing more importance on material possessions rather than relationships.
Although I see both ends of the spectrum every day in the ER, I can only imagine the stories a teacher can tell.
I carried this Walmart story with me for a few weeks, bummed at the behavior of those children, constantly on vigil to find a hopeful story to balance out this disappointment. And then, the other day during an ER shift, I found it.
I walked into Room 17 to see my next patient, a nine-year old girl who had sustained minor anterior chest burns after bumping into her mother, who had been holding a pot of boiled water. Because the room was quiet and calm, I was quite surprised to find five people in total in the room, four kids and their mother. The mother was standing to the patient's right, beside the cot, while the oldest and youngest children, girls, shared a corner seat and their brother sat to their left on a stool.
Despite a TV in the room, it was
not on, and the children all sat with an opened book before them, reading. Mom was whispering to her daughter with the burns, consoling her with her words and touch, gently stroking the back of her hand and her ribboned braids.
I walked up to Mom and the patient and introduced myself. "Hello, Doctor," the patient said, bravely trying to smile over her discomfort. She melted my heart, trying to be respectful while a three inch patch of skin lay peeled from her body between her clavicles. The mother turned to the other children. "Say 'hello' to Sissy's doctor," she said, and I was greeted with three more genuine smiles and greetings. They spoke with a bashful confidence that I fully appreciated.
We talked, the mother and patient and I, for quite a bit about what happened that brought them to our ER. After a stable exam, the nurse came in to clean the burn and show Mom how to care for it the next few days at home.
While finishing with this patient, I felt compelled to share with Mom how impressed I was by her kids. Not once did they talk without calling me 'sir' or the nurse 'maam'." They took turns, one at a time, to step up to their sister's cot to be supportive of her. No arguing or fighting, only kind words were uttered. No scowls, only warm smiles were worn. They were unabashed with their hugs and physical contact, sharing their seats and coats with one another. The mood and energy of the room was lighthearted and fantastic.
"Your kids," I shared with Mom before discharge, "are absolutely wonderful. It has been such a pleasure to see how well-behaved and loving they are with one another and with you. Even most of our staff has commented on their excellent behavior. Well done, Mom."
Mom was somewhat embarrassed by my compliment. "Trust me," I assured her, "I mean my words. What a wonderful job you are doing raising such fine young kids." As I spoke, the kids all grinned, bumping into one another with their elbows and bodies. I looked at all of them and smiled.
Mom thanked me, shyly, before explaining that she was a single parent. "Although I get tired by the end of the day, things seem to be going quite well with the kids." How could they not? This was an amazing woman, a role model for all, well aware of the importance of raising good children. And she was accomplishing, on her own, what
two parents with less children weren't.
A hero.
After complimenting the children on their behavior and their impeccable church clothing, I ran to the freezer and grabbed four Italian ices. Grape. And lots of stickers from the nursing station. Just some small gestures to acknowledge their good behavior.
My hopes for our future have been restored. It took a few weeks, but I'm back to focusing on the good of our children. Thanks to the brilliant unselfishness of a great mother...
As always, big thanks for reading. Well done job to the mother of these four children! Also, thanks for your support in the recent Medgadget Medical Blog Awards voting. It continues until Sunday at midnight. If you enjoy my blog and posts, I would greatly appreciate your support and vote.
Vote for StorytellERdoc for Best Literary Blog at the Medgadget Medical Blog Awards! Thanks for your support...After another recent shift with a predominance of patients suffering from lingering flu symptoms, I decided to swing by our local Walmart to stock up on our home supply of pediatric medications, just in case. Some acetaminophen, ibuprofen, decongestant, and cough suppressant would hopefully get us through the rest of this winter season. And, of course, what a great variety of favorite flavors--orange, bubble gum, berry, and grape. Heck, some of them taste so good that faking the flu for the little cups of "candy" might be to my kids' benefit.
Unfortunately, on the way to the pharmacy area, one of the first aisles I always encounter is the candy and gum aisle. Not a good thing for me, since I have quite a recent fascination and taste for Gobstoppers, a Wonka jawbreaker product (don't tell my dentist). The yellow psychodelic boxes scream at me from their shelf,
"Jim, come and put a couple of us in your cart," and regardless how much I fight it, the pull is too strong.
Needless to say, my kids
love going to Walmart with me.
On this particular day, then, I walked to the mid-aisle to grab a few boxes of the candy. I wasn't alone in the aisle, though. To the right of the Gobstoppers, two parents stood looking at the shelf of big Hershey chocolate bars, immersed in a conversation (yes, I listened) of milk chocolate versus dark chocolate. To my left, a grocery cart with a makeshift, rigged-up kiddy car, driver seats and steering wheels included, on its handle-end. Two kids sat in those seats--an approximate four-year old girl and a three-year old boy. The Gobstoppers sat waiting for me between the parents and kids.
As I approached the family, I was caught off-guard with the screaming and fighting going on with the young kids. In fact, at one point, as I was kneeling down to grab the boxes of candy, I was appalled to find the little boy trying to punch his sister in the face, her hands rapidly moving to block each of his thrown punches, protecting herself. Still on my knees, I looked toward the parents, who must have completely tuned-out their kids. I was just about to say something when the little boy stopped, but not before his sister screamed out, "Get the hell off me, God damn it!" Still no reaction from the parents.
After this, I stayed kneeling, observing these peculiar parenting skills (or lack of) while looking at a box of Junior mints. While I was debating getting the mints, the little girl and boy started to talk to one another. About me! I actually wrote the conversation down in the pharmacy because it had shocked me much. It went like this.
Little girl: "Who the hell is that guy?" I looked at them looking at me.
Little boy: "I don't know, but if he gets close enough, I'm going to kick the shit out of him."
Little girl: "That will be fun. Try to knock him out." For good measure, she added, "God damn it." Again.
I was disheartened. I was shocked. I was annoyed with the parents for not addressing such obnoxiousness from their young kids. I looked from the kids to the parents, who had quickly glanced our way before figuring their conversation about chocolate was more important. I looked back to the kids again, before standing up and walking away with my Gobstoppers. I was upset and figured this was the best option for me, at that time. I knew it wasn't the kids' faults, but rather their parents. Their role models. But I wondered to myself,
"What kind of adults are these kids going to become?"
This happening got me to thinking about our society. For the most part, we all know great kids in our lives, from our own to our friends' and families'. To raise respectful, kind, compassionate and loving kids and guide them appropriately into adulthood, when we choose this road of parenthood, should be the primary goal in each of our lives. We may not always succeed, darn it, but we have to try our best and throw our energy into the effort. Because that effort translates into the brilliance of the future generation coming up to govern our world.
These parents demonstrated no effort. And, unfortunately, they are not alone.
How many of us see the changing pattern with our society's kids. Talking back to well-meaning adults. Not respecting our elders (at least hold the door open for them and smile!). Tolerating vulgar language and meaningless violence via computer games and TV. Not respecting one another's uniqueness. Forgetting manners. Immersing oneself into texting instead of holding actual conversation. Avoiding volunteerism and chores. Placing more importance on material possessions rather than relationships.
Although I see both ends of the spectrum every day in the ER, I can only imagine the stories a teacher can tell.
I carried this Walmart story with me for a few weeks, bummed at the behavior of those children, constantly on vigil to find a hopeful story to balance out this disappointment. And then, the other day during an ER shift, I found it.
I walked into Room 17 to see my next patient, a nine-year old girl who had sustained minor anterior chest burns after bumping into her mother, who had been holding a pot of boiled water. Because the room was quiet and calm, I was quite surprised to find five people in total in the room, four kids and their mother. The mother was standing to the patient's right, beside the cot, while the oldest and youngest children, girls, shared a corner seat and their brother sat to their left on a stool.
Despite a TV in the room, it was
not on, and the children all sat with an opened book before them, reading. Mom was whispering to her daughter with the burns, consoling her with her words and touch, gently stroking the back of her hand and her ribboned braids.
I walked up to Mom and the patient and introduced myself. "Hello, Doctor," the patient said, bravely trying to smile over her discomfort. She melted my heart, trying to be respectful while a three inch patch of skin lay peeled from her body between her clavicles. The mother turned to the other children. "Say 'hello' to Sissy's doctor," she said, and I was greeted with three more genuine smiles and greetings. They spoke with a bashful confidence that I fully appreciated.
We talked, the mother and patient and I, for quite a bit about what happened that brought them to our ER. After a stable exam, the nurse came in to clean the burn and show Mom how to care for it the next few days at home.
While finishing with this patient, I felt compelled to share with Mom how impressed I was by her kids. Not once did they talk without calling me 'sir' or the nurse 'maam'." They took turns, one at a time, to step up to their sister's cot to be supportive of her. No arguing or fighting, only kind words were uttered. No scowls, only warm smiles were worn. They were unabashed with their hugs and physical contact, sharing their seats and coats with one another. The mood and energy of the room was lighthearted and fantastic.
"Your kids," I shared with Mom before discharge, "are absolutely wonderful. It has been such a pleasure to see how well-behaved and loving they are with one another and with you. Even most of our staff has commented on their excellent behavior. Well done, Mom."
Mom was somewhat embarrassed by my compliment. "Trust me," I assured her, "I mean my words. What a wonderful job you are doing raising such fine young kids." As I spoke, the kids all grinned, bumping into one another with their elbows and bodies. I looked at all of them and smiled.
Mom thanked me, shyly, before explaining that she was a single parent. "Although I get tired by the end of the day, things seem to be going quite well with the kids." How could they not? This was an amazing woman, a role model for all, well aware of the importance of raising good children. And she was accomplishing, on her own, what
two parents with less children weren't.
A hero.
After complimenting the children on their behavior and their impeccable church clothing, I ran to the freezer and grabbed four Italian ices. Grape. And lots of stickers from the nursing station. Just some small gestures to acknowledge their good behavior.
My hopes for our future have been restored. It took a few weeks, but I'm back to focusing on the good of our children. Thanks to the brilliant unselfishness of a great mother...
As always, big thanks for reading. Well done job to the mother of these four children! Also, thanks for your support in the recent Medgadget Medical Blog Awards voting. It continues until Sunday at midnight. If you enjoy my blog and posts, I would greatly appreciate your support and vote.
Good day, everyone. Briefly, it is that time of year when the prestigious Medgadget Medical Blog Awards are upon us, and I have humbly been chosen as a finalist in the Best Literary Medical Weblog category for 2010. If you enjoy my blog and posts, especially from 2010, I would greatly appreciate your support for this award. Simply click on the highlight above and go vote for StorytellERdoc! As always, thanks for reading and especially for your support! Now, on to the post...I rolled open the sliding glass door of Room 33, pushing aside the privacy curtain as I entered into the treatment room to see my next patient. By the nurse's triage note, she was a woman in her mid-thirties who presented to our emergency department with a history of leukemia and a recent complaint of bruising.
Running through my mental checklist prior to entering, I was hopeful that this patient was actively undergoing chemotherapy, which would be the best explanation for her bruising (low platelets as a result of her medications). If she was in remission and
not actively receiving chemotherapy, however, the bruising could signify, among other things, a return of her leukemia. The bruising might just be letting us know that her bone marrow was ill and not able to produce healthy, viable cells.
Sigh. I thought back to Christmas Day a few years back when my mother, in remission from her leukemia, nicked her fingertip while cutting a dinner roll at the kitchen sink. A little nick of bleeding that we struggled to control. "It's back, Jim," Mom had said, knowing the truth, sadness creeping into her eyes as she watched me dress her cut. I, playing the dutiful son, reassured her that all would be okay when, in truth, it turned out not to be.
Stepping into this patient's room, then, I was prepared for the worst but hoping for the best.
Two women greeted me as I walked into the room--the patient, sitting upright on her cot, wearing a flimsy hospital gown and loose-fitting pajama bottoms, and a woman of similar age sitting beside the cot in a hospital chair. They were obvious sisters, resembling each other quite strongly. Especially when they smiled their warm smiles.
"Hello," I said, walking up to the patient and taking her hand in my gloved ones as I absorbed her appearance, "I'm Dr. Jim. A pleasure to meet you, maam." She was fatigued-appearing, trying to smile the listlessness from her face. Despite her attempts, she looked so very tired. Her eyes were hazel and apprehensive, closely watching me study her. Her skin was smooth, maybe a touch pale, and her cheekbones gaunt. Her lips were slightly dry. The hospital gown loosely hung from her shoulders.
I turned to her sister, introducing myself to her as well. As it turns out, she was the older of the two. She, like her ill sister, had hazel eyes that, perhaps, sparkled a bit more, reflecting her bigger reservoir of energy. Her skin was creamy rather than pale. Where her sister was gaunt, this woman's face was healthy, lacking her sick sister's bony jawline and cheekbones. Her smile, the obvious family trait, was as genuine as her sister's. Looking at her sister, it was easy to imagine what the patient might look like on a typically healthy day.
For all the similarities, though, there existed two glaring differences between these siblings. Whereas the healthy sister had beautiful, coarse chestnut hair, the patient wore a black and yellow bandanna to her eyebrows, obviously covering her hair loss. The other thing? The patient's arms and upper chest were covered by varying stages of bruises--older, yellowish-brown ones to younger angry, purplish ones. The ravages of battling a malignancy.
"Maam," I said to Lisa, the patient, "are you actively on chemotherapy for your leukemia or are you currently in remission?" I held my breath in anticipation of her answer.
Lisa hesitated before answering. "I guess both, Doctor Jim," she said. "I am currently in remission but still take maintenance chemotherapy." In many cancer therapies, there is both an "induction" phase and "consolidation" phase of chemotherapy. Induction therapy is the aggressive initial round(s) of chemotherapy, whereas consolidation (think of maintenance) typically is started after the cancer has been halted or significantly "beaten back" by the induction round.
"Do you know which chemotherapy regiment you are on, Lisa?" I asked, relieved and happy with both of her answers to my questions. Her bruising, I suspected, was most likely due to low platelets from her medicines.
She nodded her head no. "I can never remember the long names of them."
"Let me try," I said, "are you on ara-C and idarubicin?"
Lisa and her sister both looked at me with surprise. "Yes," Lisa said, "those are it. How did you know?" I briefly explained that I had some familiarity with leukemia and the agents used to fight it.
After interviewing Lisa as her sister sat bedside, holding her hand and contributing to Lisa's history, I learned that she had done beautifully with her induction phase of chemotherapy and had quickly entered remission after a few months. Thus far, she had only received one round of maintenance chemotherapy, the week prior.
The amazing thing? Lisa didn't even live in our hometown. She grew up here but was currently living in the South, having returned, with her doctor's permission, to visit her family for an extended weekend. She had no family to help her battle her leukemia in Tennessee and her coming home was the first time she got to see her immediate family since she was diagnosed. "That's alright, though," she said, "I know everybody's prayers are with me."
The supportive sister, sitting beside the bed stroking her ill sister's hand, suddenly burst into sobs. Gasping for air, she tried to talk. "I...wanted...to...come...down, Leeessaaa, but...couldn't..."
What a pivotal moment. Obviously, the healthy sister carried a lot of guilt and pain around for not being physically closer to help her ill sister through her torments. Whether it be kids, a job, or other responsibilities, though, I can only imagine the heaviness the healthy sister endured with each mile she was separated from her sister.
Lisa reached over to her sister and rubbed her hand through her sister's thick hair. "Oh, sister, sister," Lisa said quietly, reflectively, "I know you want to be with me. Trust me, I do. But I'm okay--really, I am. Between my friends, I am well-taken care of."
"But," the healthy sister continued, her face now looking as listless as her sister's, "I
want to be there, by your side. It's not fair."
"It never is," Lisa said, "but your daily phone calls and cards and endless prayers have been felt. I promise." Lisa lifted her sister's chin up so that she could gaze into her sister's eyes and slowly, before me, her sister's face gained back its strength and tranquility.
I walked out of the room, aware of the impact of what I had just witnessed. For all the tragic and heartbreaking illnesses that occur in the world, how many of the sufferers endure an unavoidable physical separation from their loved ones and must go at fighting their illness on their own? And can you imagine being a son, a daughter, a brother, a sister, a parent, or a best friend that has to sit on the sidelines, miles away, from someone you love who is suffering with a serious illness? It was obvious these two sisters would have preferred nothing less than to be geographically closer to one another to rely and lean on each other during Lisa's travails.
The magnified pain from both Lisa and her sister, as a result of their physical separation, was a reminder to me of how lucky my family was to be able to "circle the wagons" when one of us got ill. If only everybody could be so fortunate.
I wish that for you and your family if ever the time would come.
Lisa's platelets were low, just as we thought, and she was admitted overnight for several platelet transfusions. I promised her she would be discharged in the morning. She promised me she was going to talk to her sister, reassure her all was okay, and gingerly approach her about being her possible stem cell donor. "Lisa," I said, "that would be wonderful! You know your sister loves you and would be a donor in a heartbeat if your bone marrow matches. I'll keep you both in my thoughts."
And I do...especially for the lesson they taught me that day. Thank you, sister, sister.
As always, big thanks for reading...see you early next week. Jim
Good day, everyone. Briefly, it is that time of year when the prestigious Medgadget Medical Blog Awards are upon us, and I have humbly been chosen as a finalist in the Best Literary Medical Weblog category for 2010. If you enjoy my blog and posts, especially from 2010, I would greatly appreciate your support for this award. Simply click on the highlight above and go vote for StorytellERdoc! As always, thanks for reading and especially for your support! Now, on to the post...I rolled open the sliding glass door of Room 33, pushing aside the privacy curtain as I entered into the treatment room to see my next patient. By the nurse's triage note, she was a woman in her mid-thirties who presented to our emergency department with a history of leukemia and a recent complaint of bruising.
Running through my mental checklist prior to entering, I was hopeful that this patient was actively undergoing chemotherapy, which would be the best explanation for her bruising (low platelets as a result of her medications). If she was in remission and
not actively receiving chemotherapy, however, the bruising could signify, among other things, a return of her leukemia. The bruising might just be letting us know that her bone marrow was ill and not able to produce healthy, viable cells.
Sigh. I thought back to Christmas Day a few years back when my mother, in remission from her leukemia, nicked her fingertip while cutting a dinner roll at the kitchen sink. A little nick of bleeding that we struggled to control. "It's back, Jim," Mom had said, knowing the truth, sadness creeping into her eyes as she watched me dress her cut. I, playing the dutiful son, reassured her that all would be okay when, in truth, it turned out not to be.
Stepping into this patient's room, then, I was prepared for the worst but hoping for the best.
Two women greeted me as I walked into the room--the patient, sitting upright on her cot, wearing a flimsy hospital gown and loose-fitting pajama bottoms, and a woman of similar age sitting beside the cot in a hospital chair. They were obvious sisters, resembling each other quite strongly. Especially when they smiled their warm smiles.
"Hello," I said, walking up to the patient and taking her hand in my gloved ones as I absorbed her appearance, "I'm Dr. Jim. A pleasure to meet you, maam." She was fatigued-appearing, trying to smile the listlessness from her face. Despite her attempts, she looked so very tired. Her eyes were hazel and apprehensive, closely watching me study her. Her skin was smooth, maybe a touch pale, and her cheekbones gaunt. Her lips were slightly dry. The hospital gown loosely hung from her shoulders.
I turned to her sister, introducing myself to her as well. As it turns out, she was the older of the two. She, like her ill sister, had hazel eyes that, perhaps, sparkled a bit more, reflecting her bigger reservoir of energy. Her skin was creamy rather than pale. Where her sister was gaunt, this woman's face was healthy, lacking her sick sister's bony jawline and cheekbones. Her smile, the obvious family trait, was as genuine as her sister's. Looking at her sister, it was easy to imagine what the patient might look like on a typically healthy day.
For all the similarities, though, there existed two glaring differences between these siblings. Whereas the healthy sister had beautiful, coarse chestnut hair, the patient wore a black and yellow bandanna to her eyebrows, obviously covering her hair loss. The other thing? The patient's arms and upper chest were covered by varying stages of bruises--older, yellowish-brown ones to younger angry, purplish ones. The ravages of battling a malignancy.
"Maam," I said to Lisa, the patient, "are you actively on chemotherapy for your leukemia or are you currently in remission?" I held my breath in anticipation of her answer.
Lisa hesitated before answering. "I guess both, Doctor Jim," she said. "I am currently in remission but still take maintenance chemotherapy." In many cancer therapies, there is both an "induction" phase and "consolidation" phase of chemotherapy. Induction therapy is the aggressive initial round(s) of chemotherapy, whereas consolidation (think of maintenance) typically is started after the cancer has been halted or significantly "beaten back" by the induction round.
"Do you know which chemotherapy regiment you are on, Lisa?" I asked, relieved and happy with both of her answers to my questions. Her bruising, I suspected, was most likely due to low platelets from her medicines.
She nodded her head no. "I can never remember the long names of them."
"Let me try," I said, "are you on ara-C and idarubicin?"
Lisa and her sister both looked at me with surprise. "Yes," Lisa said, "those are it. How did you know?" I briefly explained that I had some familiarity with leukemia and the agents used to fight it.
After interviewing Lisa as her sister sat bedside, holding her hand and contributing to Lisa's history, I learned that she had done beautifully with her induction phase of chemotherapy and had quickly entered remission after a few months. Thus far, she had only received one round of maintenance chemotherapy, the week prior.
The amazing thing? Lisa didn't even live in our hometown. She grew up here but was currently living in the South, having returned, with her doctor's permission, to visit her family for an extended weekend. She had no family to help her battle her leukemia in Tennessee and her coming home was the first time she got to see her immediate family since she was diagnosed. "That's alright, though," she said, "I know everybody's prayers are with me."
The supportive sister, sitting beside the bed stroking her ill sister's hand, suddenly burst into sobs. Gasping for air, she tried to talk. "I...wanted...to...come...down, Leeessaaa, but...couldn't..."
What a pivotal moment. Obviously, the healthy sister carried a lot of guilt and pain around for not being physically closer to help her ill sister through her torments. Whether it be kids, a job, or other responsibilities, though, I can only imagine the heaviness the healthy sister endured with each mile she was separated from her sister.
Lisa reached over to her sister and rubbed her hand through her sister's thick hair. "Oh, sister, sister," Lisa said quietly, reflectively, "I know you want to be with me. Trust me, I do. But I'm okay--really, I am. Between my friends, I am well-taken care of."
"But," the healthy sister continued, her face now looking as listless as her sister's, "I
want to be there, by your side. It's not fair."
"It never is," Lisa said, "but your daily phone calls and cards and endless prayers have been felt. I promise." Lisa lifted her sister's chin up so that she could gaze into her sister's eyes and slowly, before me, her sister's face gained back its strength and tranquility.
I walked out of the room, aware of the impact of what I had just witnessed. For all the tragic and heartbreaking illnesses that occur in the world, how many of the sufferers endure an unavoidable physical separation from their loved ones and must go at fighting their illness on their own? And can you imagine being a son, a daughter, a brother, a sister, a parent, or a best friend that has to sit on the sidelines, miles away, from someone you love who is suffering with a serious illness? It was obvious these two sisters would have preferred nothing less than to be geographically closer to one another to rely and lean on each other during Lisa's travails.
The magnified pain from both Lisa and her sister, as a result of their physical separation, was a reminder to me of how lucky my family was to be able to "circle the wagons" when one of us got ill. If only everybody could be so fortunate.
I wish that for you and your family if ever the time would come.
Lisa's platelets were low, just as we thought, and she was admitted overnight for several platelet transfusions. I promised her she would be discharged in the morning. She promised me she was going to talk to her sister, reassure her all was okay, and gingerly approach her about being her possible stem cell donor. "Lisa," I said, "that would be wonderful! You know your sister loves you and would be a donor in a heartbeat if your bone marrow matches. I'll keep you both in my thoughts."
And I do...especially for the lesson they taught me that day. Thank you, sister, sister.
As always, big thanks for reading...see you early next week. Jim
I love kids. Always have and always will. And when it comes to sick kids, I feel fortunate to have been trained in a demanding EM residency program where the pediatric emergency department was directly attached to the main trauma center. As a result of such exposure, treating ill kids became as natural to me as treating ill adults. Those little buggers, with their fevers, snotty noses, abdominal pain, and piercing shrills, don't scare me. Some get an "A" for effort, though, pulling out all of the stops in their vain attempt to get me out of their room. Regardless, because of my comfort, I try to see the really sick kids that come through our doors during my shift.
Over the holidays, with the flu season in full swing, I treated many children who were swept up in the epidemic. Some parents simply needed reassurances that they were giving their little Johnnie and Susie all the proper care, while other parents, with their heavy concerns, were right to bring their children in for a workup, including some IV hydration and anti-emetic medication. All-in-all, there was a much heavier flow of pediatrics than what we typically see.
Walking into Room 22, then, thanks to an alert by the nurse, I knew I was about to face another sick child. "This one is 'punky', Doc," she had said, "he hardly flinched when I started his IV." Never a good sign.
I quietly pulled back the curtain to the room and entered, finding a fatigued two-year-old boy sprawled on his back on the medical cot with his cotton sheet kicked into a ball at his feet. His oversized hospital gown had one loose tie in front, opened to reveal his skinny frame. His blond bangs were sweaty, matted to his forehead, and his skin was pale. Before introducing myself to his parents, I walked up to him and felt his forehead with the back of my hand. He was "burning up," as we say and, more importantly, didn't even shrug to a stranger's touch.
I shifted my focus to his parents, walking up to the young mother sitting in a chair alongside her son's cot. She looked as wiped-out as her son, the livelihood of her existence threatened by her son's illness. She was tearful, a mother's angst clearly etched into her face. I took her right hand in the both of mine, squeezing it reassuringly. "We'll get him feeling, better," I said, nodding to her sleeping son as I spoke. She dabbed her eyes with a Kleenex and gave me a feeble smile.
Next, I walked up to the father, his disheveled baseball cap barely clinging to his head as he paced three steps back and forth in a tight corner of the room. We shook hands and I held his gaze for a few extra seconds, trying to silently reassure his concerns. He, like the mother, was young, worried, and quite upset over his son's circumstances. He looked me in the eyes and took a deep breath. "Can you really make him better, Doctor?" he asked, a glimmer of hope escaping his watchful eyes.
"Let me talk to you both, do a thorough exam of your son, and order some tests and treatment for him, okay? But yes, I do think we'll get your son to feel better by the time we are done treating him." Their son looked like several other patients we had recently treated for influenza.
Between the two of them, I learned that they were first-time parents and married. Although neither of them were ill, their son went to daycare two days a week, where they thought "a bug" was going around. He had been born full-term and was up-to-date on his immunizations. This was his first major illness, barring a few past ear infections. Over the past few days, they watched their son eat and drink less, urinate less, become less active, and start a fever that they couldn't control. Eventually, all of their son's symptoms worsened and became boggled in their minds, totally confusing them (like any first-time parents) as to what symptoms were most serious and needed addressed immediately.
That's where we came in.
After a thorough exam on this patient, I had no suspicions for focal illnesses (such as pneumonia, bronchitis, or strep throat) on this patient. His temperature was quite high (103.7) and he appeared clinically dehydrated, so we treated him with a Tylenol suppository, aggressive IV hydration, and some IV Zofran, a God-sent anti-emetic that helps control nausea and vomiting. Then we sat back and waited--one, to see how the child would respond to our interventions and two, to review the results of our blood and urine tests as they returned.
Within the hour, I was walking into my work station with another patient chart only to find Dad standing at the counter, waiting to talk to me. He was smiling.
"He's doing better already?" I asked. "Come take a look," Dad said, practically grabbing my hand and pulling me towards his son's room.
We got back to his son's room and, before opening the curtain, the father stepped aside, sweeping his arms as if welcoming me to step into his home.
Pushing aside the curtain, I was extremely happy to find their son sitting upright in bed, licking an Italian ice while watching a cartoon on the TV. He looked at me with apprehension, turned to his mother who gave him a reassuring wink, before turning his attention back toward the TV, continuing to lick his popsicle. He was a new kid.
The mother jumped from her chair, then, and rushed me, giving me a big, grateful hug. "I can't believe how good he looks," she said, muffling her words into my shoulder. "Yes," I said, happily agreeing with her, "he looks great!" She left my side and went back to her cot-side chair, sitting clumsily down before wrapping her hands back around her son's torso. Her face held the most genuine expression of thankfulness and love that could ever be.
Within the next hour, as the patient's labs returned with adequate results, the nurse and I took turns going into the room to educate the parents and answer their questions.
How frequently are they supposed to use Tylenol and ibuprofen?
What doses of Tylenol and ibuprofen are they supposed to use?
How should they use the Zofran prescription we'd be sending them home with?
What type of fluids should they give their son?
What foods would be okay to reintroduce back into his diet?
How much sleep should they let their son get?
It's easy to see how confusing it can get the first time your child has a serious illness. Their questions for us were endless and repeated several times, but we, in the medical field, all know that education and knowledge is most empowering to recover from an illness. Our patience in the parent's education is paramount. Besides making sure each of their questions were answered, we also wrote down their instructions for them to take home.
By the time we were ready to discharge this patient, he was a new kid, running around his room, drinking watered-down juice, coloring the staff pictures, and covering himself in the stickers we gave him.
To us, another successful but predicted response to our interventions with a child with the flu. To the parents, though, this was nothing short of a miracle. The clouds had parted, the rays of sunshine had dispersed before refocusing on the head of their sick child, and the gods had sung. Anyone who has had a sick child recover knows these feelings of exhilaration that follow the many pangs of doubts that haunt us during our child's illness.
I've been there...have you?
The nurse and I stood together at the counter and watched this young family walk out of our ER after being discharged. Three big smiles, plus two more if you count ours.
It was another good day in the ER...
As always, big thanks for reading. I appreciate the nominations and support for the 2010 Medgadget awards for best medical weblogs...thank you, thank you. I hope this finds you well...
I love kids. Always have and always will. And when it comes to sick kids, I feel fortunate to have been trained in a demanding EM residency program where the pediatric emergency department was directly attached to the main trauma center. As a result of such exposure, treating ill kids became as natural to me as treating ill adults. Those little buggers, with their fevers, snotty noses, abdominal pain, and piercing shrills, don't scare me. Some get an "A" for effort, though, pulling out all of the stops in their vain attempt to get me out of their room. Regardless, because of my comfort, I try to see the really sick kids that come through our doors during my shift.
Over the holidays, with the flu season in full swing, I treated many children who were swept up in the epidemic. Some parents simply needed reassurances that they were giving their little Johnnie and Susie all the proper care, while other parents, with their heavy concerns, were right to bring their children in for a workup, including some IV hydration and anti-emetic medication. All-in-all, there was a much heavier flow of pediatrics than what we typically see.
Walking into Room 22, then, thanks to an alert by the nurse, I knew I was about to face another sick child. "This one is 'punky', Doc," she had said, "he hardly flinched when I started his IV." Never a good sign.
I quietly pulled back the curtain to the room and entered, finding a fatigued two-year-old boy sprawled on his back on the medical cot with his cotton sheet kicked into a ball at his feet. His oversized hospital gown had one loose tie in front, opened to reveal his skinny frame. His blond bangs were sweaty, matted to his forehead, and his skin was pale. Before introducing myself to his parents, I walked up to him and felt his forehead with the back of my hand. He was "burning up," as we say and, more importantly, didn't even shrug to a stranger's touch.
I shifted my focus to his parents, walking up to the young mother sitting in a chair alongside her son's cot. She looked as wiped-out as her son, the livelihood of her existence threatened by her son's illness. She was tearful, a mother's angst clearly etched into her face. I took her right hand in the both of mine, squeezing it reassuringly. "We'll get him feeling, better," I said, nodding to her sleeping son as I spoke. She dabbed her eyes with a Kleenex and gave me a feeble smile.
Next, I walked up to the father, his disheveled baseball cap barely clinging to his head as he paced three steps back and forth in a tight corner of the room. We shook hands and I held his gaze for a few extra seconds, trying to silently reassure his concerns. He, like the mother, was young, worried, and quite upset over his son's circumstances. He looked me in the eyes and took a deep breath. "Can you really make him better, Doctor?" he asked, a glimmer of hope escaping his watchful eyes.
"Let me talk to you both, do a thorough exam of your son, and order some tests and treatment for him, okay? But yes, I do think we'll get your son to feel better by the time we are done treating him." Their son looked like several other patients we had recently treated for influenza.
Between the two of them, I learned that they were first-time parents and married. Although neither of them were ill, their son went to daycare two days a week, where they thought "a bug" was going around. He had been born full-term and was up-to-date on his immunizations. This was his first major illness, barring a few past ear infections. Over the past few days, they watched their son eat and drink less, urinate less, become less active, and start a fever that they couldn't control. Eventually, all of their son's symptoms worsened and became boggled in their minds, totally confusing them (like any first-time parents) as to what symptoms were most serious and needed addressed immediately.
That's where we came in.
After a thorough exam on this patient, I had no suspicions for focal illnesses (such as pneumonia, bronchitis, or strep throat) on this patient. His temperature was quite high (103.7) and he appeared clinically dehydrated, so we treated him with a Tylenol suppository, aggressive IV hydration, and some IV Zofran, a God-sent anti-emetic that helps control nausea and vomiting. Then we sat back and waited--one, to see how the child would respond to our interventions and two, to review the results of our blood and urine tests as they returned.
Within the hour, I was walking into my work station with another patient chart only to find Dad standing at the counter, waiting to talk to me. He was smiling.
"He's doing better already?" I asked. "Come take a look," Dad said, practically grabbing my hand and pulling me towards his son's room.
We got back to his son's room and, before opening the curtain, the father stepped aside, sweeping his arms as if welcoming me to step into his home.
Pushing aside the curtain, I was extremely happy to find their son sitting upright in bed, licking an Italian ice while watching a cartoon on the TV. He looked at me with apprehension, turned to his mother who gave him a reassuring wink, before turning his attention back toward the TV, continuing to lick his popsicle. He was a new kid.
The mother jumped from her chair, then, and rushed me, giving me a big, grateful hug. "I can't believe how good he looks," she said, muffling her words into my shoulder. "Yes," I said, happily agreeing with her, "he looks great!" She left my side and went back to her cot-side chair, sitting clumsily down before wrapping her hands back around her son's torso. Her face held the most genuine expression of thankfulness and love that could ever be.
Within the next hour, as the patient's labs returned with adequate results, the nurse and I took turns going into the room to educate the parents and answer their questions.
How frequently are they supposed to use Tylenol and ibuprofen?
What doses of Tylenol and ibuprofen are they supposed to use?
How should they use the Zofran prescription we'd be sending them home with?
What type of fluids should they give their son?
What foods would be okay to reintroduce back into his diet?
How much sleep should they let their son get?
It's easy to see how confusing it can get the first time your child has a serious illness. Their questions for us were endless and repeated several times, but we, in the medical field, all know that education and knowledge is most empowering to recover from an illness. Our patience in the parent's education is paramount. Besides making sure each of their questions were answered, we also wrote down their instructions for them to take home.
By the time we were ready to discharge this patient, he was a new kid, running around his room, drinking watered-down juice, coloring the staff pictures, and covering himself in the stickers we gave him.
To us, another successful but predicted response to our interventions with a child with the flu. To the parents, though, this was nothing short of a miracle. The clouds had parted, the rays of sunshine had dispersed before refocusing on the head of their sick child, and the gods had sung. Anyone who has had a sick child recover knows these feelings of exhilaration that follow the many pangs of doubts that haunt us during our child's illness.
I've been there...have you?
The nurse and I stood together at the counter and watched this young family walk out of our ER after being discharged. Three big smiles, plus two more if you count ours.
It was another good day in the ER...
As always, big thanks for reading. I appreciate the nominations and support for the 2010 Medgadget awards for best medical weblogs...thank you, thank you. I hope this finds you well...
A few months back, I had been cleaning out my overflowing desk folders when I happened upon one filled with lots of letters and pictures and cards from my kids. Some older, some more recent. All of them precious.
Of course, despite the folder's bulge and disarray, not a single thing would be discarded. I wouldn't even think of it. And in a Clark Griswold moment (when he was sitting alone in his house attic watching old family videos) , I leaned back in my office chair and began to rummage through the collection, slowly being taken back to moment after memorable moment of my children's childhoods thus far. Deep sighs, silent smiles, and bittersweet emotions rushed me.
Yes, time certainly does fly by. Darn it all. If only a rewind button or a pause button had been invented to control the pacing of our lives, I'm certain that we would all be pushing it frequently. Shamelessly. Without abandon. Heck, I could almost guarantee my finger would be calloused from my efforts.
While reviewing the collection that sat in front of me, though, I was reminded time and again of one giant thought--that I am a lucky guy. A very, very lucky guy. Two beautiful daughters and one resilient son. Kind and compassionate, all of them. Various notes printed in crayon and colored pictures documenting the world from their view were soon scattered all over my desk, my lap, and taped to my office walls.
What follows is one of the pieces, currently hanging on my office book shelf, that I am allowed to share with you, courtesy of my son, written several years ago as a homework assignment in third grade for Mrs. F. My heartfelt thanks from me to her. And to heck with grammar and punctuation and new paragraphs. The beautiful childlike cursive and use of "my dad" ten times is all I really needed.
My Inspiration
My Inspiration is my dad because he teaches me things I need to know. He also helps me when I need him or if I get hurt my dad is there to help. My dad is a great cook and my favorite thing he makes are egg whites. My dad helps me in my baseball skills and helps me in other sport. My dad has helped me so much in my fort in the woods. My dad drives me places I need to go like baseball practice and baseball games. At night my dad would come in my room and say goodnight. Then we would play this game. My dad works so hard so we can do things we want to do like go on vacation. My dad helps me clean up the yard when my mom says to clean the yard by myself. When I grow up I want to be just like my dad.
Cole in 3-F
As soon as I had read this piece, I stood from my office chair and hurried myself into our foyer, to the northern wall, where my favorite picture of my buddy and I was hanging in an antique frame among the numerous other framed pictures. I stood on my tiptoes, barely reaching its lower border, until I successfully lifted it from its hanging nail.
I returned to my office and sat back down, focusing on the picture. Immediately, I was taken back ten years to the beautiful North Carolina coastline. To our family vacation. To a healthy Cole. To the summer before Cole would spend a full year on his induction chemotherapy to beat his illness.
I posted the picture above. In case you don't know, I am the one on the right, with the wedgie.
I still look at this picture often, always amazed to think that it was taken at a time when our life was pollyanna, when bad things happened to other people--not to us. I look at my son's little hand, raised up into my own, and feel the surge of the bond from our contact. I carry a sand pail in my right hand, ready to tackle another project together, my buddy and I. Together. Regardless if it entails building a sand castle or fighting a life-threatening illness. I am there for my kids, always.
Finally, look at the view that faced us as we walked forward. The big, big ocean, although only a small part of our bigger, bigger world. The enormity of symbolism in this picture staggers me. Come hold my hand, Cole, I must have thought, I'll take care of you. And together, we head on into the waves, into the roughening path that life sometimes leads us on.
Blindly and unknowing, we walked, but with a strength and a conviction that any obstacle will be faced to the best of our ability.
And although it took a couple hard-fought battles, we won Cole's war. He won his war.
I don't think I need to tell you who my inspiration is...
As always, big thanks for reading. I do cook more than egg whites, I promise. And my wife does help pick up the yard, sometimes (she asked me to let you know--lol). I hope this finds you well and that you are both inspiring and inspired in your own life...
A few months back, I had been cleaning out my overflowing desk folders when I happened upon one filled with lots of letters and pictures and cards from my kids. Some older, some more recent. All of them precious.
Of course, despite the folder's bulge and disarray, not a single thing would be discarded. I wouldn't even think of it. And in a Clark Griswold moment (when he was sitting alone in his house attic watching old family videos) , I leaned back in my office chair and began to rummage through the collection, slowly being taken back to moment after memorable moment of my children's childhoods thus far. Deep sighs, silent smiles, and bittersweet emotions rushed me.
Yes, time certainly does fly by. Darn it all. If only a rewind button or a pause button had been invented to control the pacing of our lives, I'm certain that we would all be pushing it frequently. Shamelessly. Without abandon. Heck, I could almost guarantee my finger would be calloused from my efforts.
While reviewing the collection that sat in front of me, though, I was reminded time and again of one giant thought--that I am a lucky guy. A very, very lucky guy. Two beautiful daughters and one resilient son. Kind and compassionate, all of them. Various notes printed in crayon and colored pictures documenting the world from their view were soon scattered all over my desk, my lap, and taped to my office walls.
What follows is one of the pieces, currently hanging on my office book shelf, that I am allowed to share with you, courtesy of my son, written several years ago as a homework assignment in third grade for Mrs. F. My heartfelt thanks from me to her. And to heck with grammar and punctuation and new paragraphs. The beautiful childlike cursive and use of "my dad" ten times is all I really needed.
My Inspiration
My Inspiration is my dad because he teaches me things I need to know. He also helps me when I need him or if I get hurt my dad is there to help. My dad is a great cook and my favorite thing he makes are egg whites. My dad helps me in my baseball skills and helps me in other sport. My dad has helped me so much in my fort in the woods. My dad drives me places I need to go like baseball practice and baseball games. At night my dad would come in my room and say goodnight. Then we would play this game. My dad works so hard so we can do things we want to do like go on vacation. My dad helps me clean up the yard when my mom says to clean the yard by myself. When I grow up I want to be just like my dad.
Cole in 3-F
As soon as I had read this piece, I stood from my office chair and hurried myself into our foyer, to the northern wall, where my favorite picture of my buddy and I was hanging in an antique frame among the numerous other framed pictures. I stood on my tiptoes, barely reaching its lower border, until I successfully lifted it from its hanging nail.
I returned to my office and sat back down, focusing on the picture. Immediately, I was taken back ten years to the beautiful North Carolina coastline. To our family vacation. To a healthy Cole. To the summer before Cole would spend a full year on his induction chemotherapy to beat his illness.
I posted the picture above. In case you don't know, I am the one on the right, with the wedgie.
I still look at this picture often, always amazed to think that it was taken at a time when our life was pollyanna, when bad things happened to other people--not to us. I look at my son's little hand, raised up into my own, and feel the surge of the bond from our contact. I carry a sand pail in my right hand, ready to tackle another project together, my buddy and I. Together. Regardless if it entails building a sand castle or fighting a life-threatening illness. I am there for my kids, always.
Finally, look at the view that faced us as we walked forward. The big, big ocean, although only a small part of our bigger, bigger world. The enormity of symbolism in this picture staggers me. Come hold my hand, Cole, I must have thought, I'll take care of you. And together, we head on into the waves, into the roughening path that life sometimes leads us on.
Blindly and unknowing, we walked, but with a strength and a conviction that any obstacle will be faced to the best of our ability.
And although it took a couple hard-fought battles, we won Cole's war. He won his war.
I don't think I need to tell you who my inspiration is...
As always, big thanks for reading. I do cook more than egg whites, I promise. And my wife does help pick up the yard, sometimes (she asked me to let you know--lol). I hope this finds you well and that you are both inspiring and inspired in your own life...
Like anyone else who works in the ER, I wish I could take pictures and videotape some of our more absurd, inebriated patients. Of course, though, I can't--patient confidentiality and all that blah-blah stuff. But how great would it be to sit a patient down, after they sobered up, and show them how ridiculous their behavior was while in our care? Maybe, even, send a copy to their proud parents or spouse.
Personally, if I ever had twelve beers and ten shots of tequila before proceeding to crap and vomit all over myself, I would like a picture or two to convince me it really happened.
It was 2 am and I was standing at the counter of our nursing station nearest the ambulance bay doors, finishing a chart while dreaming about going home within the next hour, when the doors suddenly swung open and a prehospital team proceeded to wheel a disheveled patient into our ER hallway. Usually, the team contacts us by radio to alert us of their pending arrival with a patient, so their unannounced visit was a surprise to all of us.
The chief paramedic shrugged. "Sorry," he said, "but we picked her up at a bar just a few blocks away and didn't have time to call."
On their cot, obviously intoxicated, sat a peroxide-blond female, in her mid-twenties, with her head slumped to her right side and her breasts barely contained by her skimpy halter. Her hair was messed, the hairspray she spritzed earlier in the evening unintentionally spiking clumps in all directions. Her face was streaked with tears, darkened trails of waterproof-less mascara collecting at her chin. Drool gathered at her mouth's angles.
So, so pretty.
Of course, I was intrigued. "She was at the bar," the paramedic continued, "drinking for the past three hours, when her friends got concerned because she wasn't 'acting right.' Remembering she had diabetes, they called us to come 'check her out.' When we got there, she was passed out on a bench in front of the tavern, a puddle of vomit at her feet. Her finger stick was 87, so we decided to bring her in. She doesn't have any signs of trauma, doc."
Well, thank you fellas.
As the paramedic was speaking, as if on cue, the patient cocked her one eye open and, realizing she had an audience, started wailing and shrieking, her cry alternating between forced hiccups and gasping sobs. The hallway filled with various heads poking out of the treatment rooms, wondering how a hyena ended up in our ER.
"Room 23," the charge nurse said. The paramedics hurried off with their patient.
A few minutes later, walking back to my computer station, I passed Room 23, slowing down to check-out what was going on with our new patient (yes, I was nibshitting). I'm glad I did, though, if for no other reason than to find the paramedic holding this patient in both arms, a hero carrying his damsel-in-distress, while transferring her dead-weight from his cot to ours. I stopped and waved to him, laughing, and he shook his head in disgust. "Sometimes I hate my job," he muttered with a smile.
I stopped in and did a brief primary exam, listening to the patient's heart and lungs, confirming her stable vitals, and making sure she had no evidence of trauma. She didn't. All the while, she kept asking for the bouncer from the bar. Over and over and over. "Maam," I finally said, "nobody came with you. I'm sure the bouncer had to stay to finish out his shift."
"Ahh," she slurred, "screw him. He has a small penis, anyway." As she spoke, she pinched her thumb and index finger an inch apart from one another, giggling to herself while amusing us. "How do you know that?" her nurse, Barb, asked. "Well, duh," the patient replied, "I can hardly feel him when we have sex." I almost threw up in my mouth from her sharing so much (or so little) information.
So, so classy.
As the nurse removed this patient's clothing to put her in a gown, we discovered that the patient had on three layers of compression garments around her middle--a spanx, a girdle, followed by another spanx. For those of you not familiar with spanx (and I wasn't, so the nursing staff kindly informed me), it is a stretchy, spandex-type piece that, after you hold your breath and squeeze yourself into it, acts like a casing to your sausage body. Miraculously, you look thinner and more fit. Without going to the gym or watching your diet. Your difficulty breathing, profuse sweating, and pinched-up, cyanotic face, though, might just be dead-giveaways that you are wearing one.
"Why in God's name," Barb continued, not learning her lesson about asking questions from before, "are you wearing three of these? I've never seen anything like this."
"Well, duh," the patient answered again, "maybe so I can get laid by a guy who likes skinny girls." I get it--three layers tripled her chances.
I'm assuming that she was assuming that she looked more attractive all squished into her itty-bitty jeans and shirt with the help of her garments, but really? Did she think this situation through? What guy, one who was probably out drinking at the same bar as her, would be able to remove three of these things? Would the effort be worth it? Would his spanx-removal talent have a big payoff? Sober, I doubt any guy would be able to succeed in getting this patient out of her spanx, but throw some drinks into the equation and what do you have? Besides the fumbling, frustrated fingers of her date? Failure, through and through.
All the while, the patient continued talking in a slurring half-whisper, occasionally bursting out in giggles from her self-amusement. Several times, she belched so obnoxiously that it would have made any beer-guzzling, football-watching male proud. And one time, she dug her finger so high up her nose for a booger that I think her elbow was resting on her chin. Needless to say, I was fascinated by her influenced behavior and lack of awareness.
Finally, though, my biggest shock of the evening came from what the nurse shared with me. It seems that as the tech and nurse finished undressing the patient for observation, they were unpleasantly surprised to find this patient and all her southern female parts barely covered by her thong underwear.
Her American flag thong underwear!!! Three square inches of red, white, and blue fabric.
I was never less proud to be an American.
For various reasons, I found this news appalling. And so did the nurse and tech. Never before, in my vast experiences, did I see some skimpy underwear fashioned in this manner. When did a manufacturer start finding it appropriate to place the American flag, our sacred national symbol, on a little triangular patch that covers a woman's privates. Or worse (I'm shuddering here), a man's? I mean, let's reason this out. If our flag touches the ground, out of respect, isn't the protocol to attempt to lift it up from the ground (if possible) and, if not, burn it. Yet, it's perfectly okay for someone to wear our prideful flag pressed against their privates? Something about this thought just didn't sit right with me.
Let's be proactive. I say we gather all the existing American flag thongs out there and have ourselves a big--no, make that huge-- bonfire. Quite honestly, though, that's one bonfire I would probably dread attending.
I did get to eventually leave at my scheduled time, 3 am, after signing out my active patients to the overnight doctor. The patient, who had no sober friends or family available to come take her home, did fine throughout the night's observations, barring the occasional outbursts of swearing, drunk mumbling, and promiscuous suggestions. When she sobered up, however, according to the morning team, she turned out to be a very nice, pleasant young woman who just happened to "have a rough night."
"She could have been your sister or mine," the nurse added.
"Umm, no," I thought to myself, "I don't think so." I wasn't about to picture any of my sisters in an American flag thong, let alone being ridiculously drunk while holding their thumb and index finger an inch apart.
My final thought...maybe I don't need to take a picture or videotape this stuff, after all. Really, the mental image is reminder enough for me. Who needs a timeless picture to document such dread? Or the nightmares that would follow? If anything, I guess you can just take a picture of me, the treating physician. I'll give you permission. Just excuse my gaping mouth, my surprising eyes, and my befuddled expression when you get it printed...
As always, big thanks for reading. If you own a pair of American flag thong underwear, do me a big favor and throw them out. STAT! See you soon...
Like anyone else who works in the ER, I wish I could take pictures and videotape some of our more absurd, inebriated patients. Of course, though, I can't--patient confidentiality and all that blah-blah stuff. But how great would it be to sit a patient down, after they sobered up, and show them how ridiculous their behavior was while in our care? Maybe, even, send a copy to their proud parents or spouse.
Personally, if I ever had twelve beers and ten shots of tequila before proceeding to crap and vomit all over myself, I would like a picture or two to convince me it really happened.
It was 2 am and I was standing at the counter of our nursing station nearest the ambulance bay doors, finishing a chart while dreaming about going home within the next hour, when the doors suddenly swung open and a prehospital team proceeded to wheel a disheveled patient into our ER hallway. Usually, the team contacts us by radio to alert us of their pending arrival with a patient, so their unannounced visit was a surprise to all of us.
The chief paramedic shrugged. "Sorry," he said, "but we picked her up at a bar just a few blocks away and didn't have time to call."
On their cot, obviously intoxicated, sat a peroxide-blond female, in her mid-twenties, with her head slumped to her right side and her breasts barely contained by her skimpy halter. Her hair was messed, the hairspray she spritzed earlier in the evening unintentionally spiking clumps in all directions. Her face was streaked with tears, darkened trails of waterproof-less mascara collecting at her chin. Drool gathered at her mouth's angles.
So, so pretty.
Of course, I was intrigued. "She was at the bar," the paramedic continued, "drinking for the past three hours, when her friends got concerned because she wasn't 'acting right.' Remembering she had diabetes, they called us to come 'check her out.' When we got there, she was passed out on a bench in front of the tavern, a puddle of vomit at her feet. Her finger stick was 87, so we decided to bring her in. She doesn't have any signs of trauma, doc."
Well, thank you fellas.
As the paramedic was speaking, as if on cue, the patient cocked her one eye open and, realizing she had an audience, started wailing and shrieking, her cry alternating between forced hiccups and gasping sobs. The hallway filled with various heads poking out of the treatment rooms, wondering how a hyena ended up in our ER.
"Room 23," the charge nurse said. The paramedics hurried off with their patient.
A few minutes later, walking back to my computer station, I passed Room 23, slowing down to check-out what was going on with our new patient (yes, I was nibshitting). I'm glad I did, though, if for no other reason than to find the paramedic holding this patient in both arms, a hero carrying his damsel-in-distress, while transferring her dead-weight from his cot to ours. I stopped and waved to him, laughing, and he shook his head in disgust. "Sometimes I hate my job," he muttered with a smile.
I stopped in and did a brief primary exam, listening to the patient's heart and lungs, confirming her stable vitals, and making sure she had no evidence of trauma. She didn't. All the while, she kept asking for the bouncer from the bar. Over and over and over. "Maam," I finally said, "nobody came with you. I'm sure the bouncer had to stay to finish out his shift."
"Ahh," she slurred, "screw him. He has a small penis, anyway." As she spoke, she pinched her thumb and index finger an inch apart from one another, giggling to herself while amusing us. "How do you know that?" her nurse, Barb, asked. "Well, duh," the patient replied, "I can hardly feel him when we have sex." I almost threw up in my mouth from her sharing so much (or so little) information.
So, so classy.
As the nurse removed this patient's clothing to put her in a gown, we discovered that the patient had on three layers of compression garments around her middle--a spanx, a girdle, followed by another spanx. For those of you not familiar with spanx (and I wasn't, so the nursing staff kindly informed me), it is a stretchy, spandex-type piece that, after you hold your breath and squeeze yourself into it, acts like a casing to your sausage body. Miraculously, you look thinner and more fit. Without going to the gym or watching your diet. Your difficulty breathing, profuse sweating, and pinched-up, cyanotic face, though, might just be dead-giveaways that you are wearing one.
"Why in God's name," Barb continued, not learning her lesson about asking questions from before, "are you wearing three of these? I've never seen anything like this."
"Well, duh," the patient answered again, "maybe so I can get laid by a guy who likes skinny girls." I get it--three layers tripled her chances.
I'm assuming that she was assuming that she looked more attractive all squished into her itty-bitty jeans and shirt with the help of her garments, but really? Did she think this situation through? What guy, one who was probably out drinking at the same bar as her, would be able to remove three of these things? Would the effort be worth it? Would his spanx-removal talent have a big payoff? Sober, I doubt any guy would be able to succeed in getting this patient out of her spanx, but throw some drinks into the equation and what do you have? Besides the fumbling, frustrated fingers of her date? Failure, through and through.
All the while, the patient continued talking in a slurring half-whisper, occasionally bursting out in giggles from her self-amusement. Several times, she belched so obnoxiously that it would have made any beer-guzzling, football-watching male proud. And one time, she dug her finger so high up her nose for a booger that I think her elbow was resting on her chin. Needless to say, I was fascinated by her influenced behavior and lack of awareness.
Finally, though, my biggest shock of the evening came from what the nurse shared with me. It seems that as the tech and nurse finished undressing the patient for observation, they were unpleasantly surprised to find this patient and all her southern female parts barely covered by her thong underwear.
Her American flag thong underwear!!! Three square inches of red, white, and blue fabric.
I was never less proud to be an American.
For various reasons, I found this news appalling. And so did the nurse and tech. Never before, in my vast experiences, did I see some skimpy underwear fashioned in this manner. When did a manufacturer start finding it appropriate to place the American flag, our sacred national symbol, on a little triangular patch that covers a woman's privates. Or worse (I'm shuddering here), a man's? I mean, let's reason this out. If our flag touches the ground, out of respect, isn't the protocol to attempt to lift it up from the ground (if possible) and, if not, burn it. Yet, it's perfectly okay for someone to wear our prideful flag pressed against their privates? Something about this thought just didn't sit right with me.
Let's be proactive. I say we gather all the existing American flag thongs out there and have ourselves a big--no, make that huge-- bonfire. Quite honestly, though, that's one bonfire I would probably dread attending.
I did get to eventually leave at my scheduled time, 3 am, after signing out my active patients to the overnight doctor. The patient, who had no sober friends or family available to come take her home, did fine throughout the night's observations, barring the occasional outbursts of swearing, drunk mumbling, and promiscuous suggestions. When she sobered up, however, according to the morning team, she turned out to be a very nice, pleasant young woman who just happened to "have a rough night."
"She could have been your sister or mine," the nurse added.
"Umm, no," I thought to myself, "I don't think so." I wasn't about to picture any of my sisters in an American flag thong, let alone being ridiculously drunk while holding their thumb and index finger an inch apart.
My final thought...maybe I don't need to take a picture or videotape this stuff, after all. Really, the mental image is reminder enough for me. Who needs a timeless picture to document such dread? Or the nightmares that would follow? If anything, I guess you can just take a picture of me, the treating physician. I'll give you permission. Just excuse my gaping mouth, my surprising eyes, and my befuddled expression when you get it printed...
As always, big thanks for reading. If you own a pair of American flag thong underwear, do me a big favor and throw them out. STAT! See you soon...
