StorytellERdoc

Think About Mama

noreply@blogger.com (StorytellERdoc) — Thu, 15 Apr 2021 15:47:00 +0000

"If you think a mother's pain is unimaginable, you should see her strength."

You were visiting your mother when, while in another room, you became unresponsive and fell to the floor. She heard the thump of your fall and raced into the room to find you pale and barely breathing. Drug paraphernalia sat beside you.

Your mother screamed. She cried. She fell to her knees and tried to wake you, slapping your cheek and compressing your chest and forcing her own breath into your mouth. You did not respond.

Your mother frantically called 911. Within minutes, the paramedics arrived. With quick and concise care, they administered several large doses of Narcan to you. Within seconds, you began to cough and gag before finally taking a deep breath. Your eyes fluttered and then finally opened. In your daze, you saw your mother's heartbroken eyes staring back at you. Her prayers were answered.

You survived.

In the ER, I was your doctor. I interviewed both you and your mother and learned what had just happened at her house. I learned that you recently had some success with drug rehabilitation after struggling with your addiction for over a decade. Your relapse today, at your mother's home, was a complete shock to her. Her pain was palpable. Despite her attempts at being brave, her tears and etched wrinkles and fearful eyes shared what her heart felt. She had hoped that your struggles were behind you. Instead, her hopes were decimated once again.

You were quite upset and in tremendous turmoil for letting down the world and your "Mama". You knew the pain you inflicted on her but were clearly unable to stop it, still searching for the path of releasing the power that addiction held over you. I saw the tremble of your arms as you wrapped them around her as a way to apologize.

I examined you and observed you until I was certain that you were medically safe. You napped a bit during your observation and during this, your mother and I had a chance to talk. She shared a bit about her pain and struggles with your addiction, about how it had changed her own life. She had adjusted her dreams for you too many times to count, once hoping that you would rule the world and now only wishing that you could exist without your addiction. As a fellow parent, I couldn't begin to imagine the shifting perspective of her dreams for you, her only child.

Finally, I discharged you. I prescribed you a Narcan kit and offered you our available resources for addiction and drug abuse. You refused our resources, including an assessment for inpatient care, assuring me you had your "team" of support and would reach out to them about your relapse. I was hopeful that your assurances were sincere, especially for your mother's sake. I had faith in you.

As you walked down the hallway to leave, I noticed you lean into your mother, her left arm wrapped around your waist. I was mesmerized by her strength and undeniable love for you. As you both rounded the bend, she turned back to find me watching. She mouthed a "thank you" to me and gave me the hint of a small smile. Her gesture and gratitude made me catch my breath.

Today was a good day for you and your mother. You survived your overdose. Many don't. I hope that someday that hint of a smile on your mother's face turns into one so big that her face cannot contain it, all because your efforts to healing and overcoming your addiction succeed. I pray she is spared the devastation and pain of anything less.

Each day we are given is a gift. We are not guaranteed tomorrow. With each day, I hope we can all find a little time to appreciate our gift and maybe even take a few minutes to make it a better one for those around us. If you know of anyone struggling with addiction, like this Mama or her child, why don't you take a moment today to reach out to them, whether by text or a phone call or a visit, and share some of your good stuff with them.

Share your love.

Share your compassion.

Share your support.

Share your healing words.

Share your presence.

If you are too embarrassed or uncomfortable to do this, think about this mother going to bed at night and crying herself to sleep, praying her child survives another day. Think about her and her child's loneliness and isolation and suffering as they deal with addiction. Imagine the depths of their pain. Imagine if it were you. Imagine the good you could bring to their world today with your heartfelt gesture of kindness and love.

We are all human and we are all imperfect. We should never sit in judgment of another. When we bear witness to another's struggle, choose to be a person of inspiration. You can change the world of another with your words and your actions. It would be exactly what we would hope for if we were that person struggling. You have the power to make an impact. Please rise up and make a difference today in the life of another, like this Mama and her child.

Thanks to those of you who continue to nourish my faith in my fellow man. You make me proud to be a part of this big big family of mankind.

And...I wish that someday peace and calm and happiness will flood this mother's heart.

A Time To Heal

noreply@blogger.com (StorytellERdoc) — Thu, 05 Nov 2020 20:01:00 +0000

So much of the world is broken

and I want to be part of its healing...

The election is over. It was turbulent and intense. It was frustrating and anxiety-provoking. It was hopeful and disappointing. It was the roller coaster ride we all anticipated it to be.

Yet, we all remain in limbo, sitting in this awful gray zone of the unknown, wondering if our candidate will be declared the winner or if we will need to accept that the other guy pulled it off. We want to know now and yet we may not find out for days or weeks. We are each sitting in the fog of our own hopes and fears, our minds racing, wondering what the future will bring each of us after we find out concretely who will lead our country into the next four years. We are thinking about our families, our planet, our economy, our employment, our foreign friendships and enemies, and our own welfare.

Our worries are overwhelming. We are exhausted.

On every level, each of us are in some need of healing. We are each guilty of letting ourselves become immersed in negativity and conflict. Our minds are tumultuous, our spirits are deflated, and our bodies are broken-down.

We need a reset.

It is time to begin the healing. It is time to step out of the unrest, the exhaustion, and the negativity. It is time to step into the hopes and positive actions of returning our society to one of kindness, of acceptance, of unwavering support, and of unity. It is time to calm our minds, buoy our spirits, and nourish our bodies.

Is this easier said than done? Hopeless? Is this a pollyanna view trying to avoid acceptance of damages that may be permanent? Do we need to accept that this may be our new standard of living? Should we throw our frustrated hands in the air and expect everyone else to do the work to heal our society while we just sit on the sidelines and critique their attempts?

The answers to these questions should be easy. Inherently, we all want to be proud of our country, be proud of one other, and provide the best opportunities to our families and ourselves. We all want to be successful, useful, comfortable, and appreciated. We all want to show the world that despite our conflicts with one another, we are united in our efforts to garner respect and glorify all that is great about our nation.

So what are we waiting for?

We live in a society focused on dividing one another into clusters based on our differences--our sex, our race, our bank account, our appearance, our intellect, our sexual orientation, our occupation, etc. Focusing on these differences affords each of us the opportunity to critique and judge another if we choose to be this type of person. It opens up the opportunity to create conflict and negativity. Focusing on our differences without celebrating them will breed disrespect and division.

Please don't be this person and you will already be part of the healing.

Thus, we arrive at our current political situation. We have become clustered into two camps. Sadly, these two camps are ignoring any of their common ground and focusing on their differences. Energy is being used to blatantly divide, to minimize, to inflame, and to disrespect the other. We are arguing that one's belief system is the superior one. There can only be one "right" view. We have lost sight that one's political views do not define the whole of their being.

Ugh! All of this fruitless energy is being devoted to exploiting our differences rather than celebrate them.

Throughout all of these shenanigans, we have lost our capacity to have empathy. We no longer offer compassion or kindness to someone with a differing political view. Instead, we ostracize and judge. Rather than respectfully and patiently listening to an opposing view, we have raised our voices in hopes of drowning out a differing opinion.

Now, the election is over. It is time to veer away from all of this anger. It is time to lower our voices. It is time to stop the disrespect and judgments and negativity. We can't continue this current environment and expect to thrive. It just won't happen.

How can we thrive once again? Try opening your heart back up to being unselfish and doing random acts of kindness. Choose compassion and forgiveness when you feel inflamed. Choose to celebrate, once again, another person for the whole of their goodness rather than focus on their differences from you. Choose civility and love instead of hostility and hate. With focused energy on your conscious choices, you will make our path to healing a smoother one.

We all have basic wants and needs that interweave us to one another no matter how hard we try to distance ourselves. We all have a voice and want to be heard. We all want respect, happiness, to feel included and be a part of something bigger, and to have our dreams and needs be fulfilled. We all need love, compassion, acceptance, and an opportunity to better ourselves. If we recognize that our basic wants and needs are the same as the person standing behind us in the grocery line, no matter our differences, we will heal.

As we try to navigate forward in this politically-charged society, we are facing very important crossroads. Do we let things continue as they are and eventually bleed-out, both individually and as a country? Or do we commit to changing our thinking and behaviors and begin the healing process that will lead us back to our more compassionate paths once again?

I have faith in myself. I have faith in you. I have faith in us. I have faith in my country.

The election is over. Half of the country is going to be disappointed and the other half will celebrate. Any energy we invest at this point to change the outcome will be futile. So reset. Step out of the negativity this election brought you. Accept what will be and move on in a positive manner. Look for common ground again with those you disagreed with. Other important issues still exist that need our best energy and attention.

It is time to begin your healing. Because the more healing you do for yourself, the more healing you do for me and the rest of us.

And then we will be stronger as a country, once again.

And then we can focus on other issues that desperately need our attention and energy, once again.

And then we can show kindness and compassion and love to each other, once again.

And then we can be unified rather that divided, once again.

And then, we can all be proud to be citizens of this great country. Once again.

Thanks for reading. Wishing for you peace in your heart and calm in your soul. Jim

Where To Look

noreply@blogger.com (StorytellERdoc) — Fri, 07 Aug 2020 14:22:00 +0000

"Where words are restrained, the eyes often talk a great deal."

I walked into Room 30 to find two eager sets of eyes awaiting me. One set belonged to a young man, late-twenties, muscular and imposing, sitting in a chair in the corner of the room. His eyes were hazel brown, big and inviting, relieved at seeing my entry into their sheltered world. The other set of eyes, darker brown and magnified by her gold-stemmed glasses, belonged to my patient, a woman in her early-sixties. She sat upright in her treatment cot, knees drawn up to her chest and covered by the thin hospital-issued bed sheet.

Clearly, I had interrupted a conversation between them. Upon my entrance into their treatment room, they gave me the respect and gift of silence, a pause in which I would be able to introduce myself. As many of my fellow coworkers would confirm, this does not often happen. Rather, it is not unusual for us providers to walk into a treatment room only to wait for a patient to finish a cell phone conversation (while holding up an index finger indicating they are almost done), finish the last gulp of a bottle of soda or swallow the crumbled remains of a bag of chips. Worse yet, a patient sometimes will keep on talking to someone else in the room and behave as if we haven't even entered.

I liked this woman and man already.

Extending my hand, I introduced myself first to my patient, Ms. Loretta. "Hello, ma'am, my name is Dr. Jim and I will be taking care of you today." Turning to the man sitting in the corner of the room, I repeated myself. They were both gracious in their return greetings and I learned that the young man was her son, John.

Ms. Lorettta appeared calm, composed, and quiet as she sat in her cot. She was of short stature and delicate frame. She looked tired, her graying hair wiry and thin and a few days beyond its last washing. Her face was wrinkled. Her eyes, broody and intent, watched me closely as I leaned against the wall and asked her question after question regarding her reasons to visit our emergency department. Occasionally, she looked towards her son to supplement her answer, to clarify something she couldn't quite find the right words to describe. Each time her son was successful in filling in the blanks.

She had come to our department with several weeks of increasing abdominal pain. A diagnosis of kidney (renal) cancer several years earlier had led this patient to having several bouts of chemotherapy and the subsequent great news of achieving remission. Her complacent face, after learning her history, spoke to me--the more she shared her new symptoms with me, the more I realized that she had an inherent sense that something bad was happening in her abdomen again.

I did, too.

Her son, sitting in the corner quietly unless spoken to, appeared much more anxious than his mother. Whereas she seemed resigned to some bad news arriving in her near future, he seemed to be using his energy to avoid any possible realizations of something bad occurring. His intimidating square face, thick neck, and inflated muscles--all those hours spent at the gym to make him stronger--would be of no use to his mother in what the fates might dictate to her. He fidgeted with his hands and feet. He occasionally diverted his gaze from his mother and I to the corners of the room. He seemed to want to rewind the hands of time to a few weeks prior when his mother was symptom-free of any pain and he could keep looking to a pollyanna future with his mother being an integral part of it.

Her physical exam was concerning for the abdominal pain she complained of. She had some distension which gave her belly the appearance of holding a helium balloon within it. Her pain was diffuse, all over, and I could make her right upper quadrant be the main source of this pain when I palpated a steady pressure downward toward her liver.

We did the workup--blood and urine testing with IV-contrast CT imaging of her abdomen. Sadly, the CT scan returned showing what the patient and I had feared--the cancer was back. She had multiple metastatic lesions in her liver and the collection of some ascites, fluid build up around the organs within the abdomen.

Sigh.

I walked into Room 30 with a heavy heart. Not only did I feel for this patient and her son, but I closely identified with the heartbreak associated with the news I was about to deliver to them. It was just fourteen short years ago that I had been sitting in a corner chair of a hospital room with my mother as the patient. She had been battling leukemia and, after coming out of remission, had a battery of tests that had led to the moment when her oncologist walked into her hospital room to share the devastating news with her and me--her leukemia was more spiteful than ever and was remaining refractory to all of our attempts to fight it. I remembered the pain I felt. I remembered the complacency of my mother upon hearing the news. She had inherently known and sensed this would be her outcome. I remembered the wishing and hoping that my father and six siblings (who all rotated their visits due to living several hours away) had been with us at that very moment to divide the pain of my mother's news.

Who am I fooling? The pain of such devastating news as this isn't divided among us--the pain multiplies. Then multiplies again. And keeps exponentially growing until we all learn the appropriate ways to diminish the power it holds over us.

Entering the room, then, I wasn't surprised to see Ms. Loretta sitting quietly in her cot with John now sitting at her feet, holding her hands within his massive mitts.

Without my saying a word, Ms. Loretta knew. "It's back, isn't it." It was more of a statement rather than a question. I nodded to her. "Yes," I said, "it's back."

She asked me questions about her tests. How was her blood work? How bad was the CT scan? Did she have much time? Did she have options? John remained quiet, his eyes focused only upon his mother.

I kept answering her questions to the best of my abilities, but refused to answer the "how much time do I have" question. I assured her that we would admit her to the hospital and get the oncology specialists involved immediately to provide some guidance to the questions she was asking.

All the while, as Ms. Loretta and I were talking, I couldn't help but steal glances at her son. He was me. Fourteen years ago. Sitting with his mother. Holding her hands. Processing bad news. Staring at his hero and wishing with all of his heart that he could absorb her hurt.

He sat quietly, his anxious movements calmed with the news that he was desperately hoping to avoid. He continued to grip his mother's hands in his. His eyes remained fixed onto his mother's face. I knew exactly what he was doing--he was etching her image, her heartbreak, her attempts to be strong at this very moment, into a memory that would remain with him until the end of his days.

Eyes watching eyes watching eyes. Her expectant eyes on me. My sympathetic eyes glancing between her and him. His loving eyes on her.

Sometimes, our eyes are rewarded with the beautiful imagery they seek. Sometimes our eyes are the recorders of specific moments of our lives that we may or may not wish to remember, memories of splendor and memories of squalor. Sometimes our eyes are the conduit of the emotions of our heart and soul. Sometimes our eyes are our best friends. And sometimes our eyes are our worst enemies...

As Henry David Thoreau said, "Could a greater miracle take place than for us to look through each other's eyes for an instant?"

In this moment with Ms. Loretta and John, I appreciated the miracle of my memory from fourteen years ago simply by looking through their eyes for but an instant. An instant that I wish I could have protected them from.

Thank you, Ms. Loretta and John, for this instant...for letting me be present in your moment of painful tenderness.

A Love Story

noreply@blogger.com (StorytellERdoc) — Wed, 22 Jul 2020 16:06:00 +0000

The little things?
The little moments?
They aren't little...

I noticed the two of them shortly after I arrived for my shift. I was standing at the counter, immersed in a chart, when out of the corner of my eye, I saw them walk out of their treatment room. Together.

Slowly, they walked into the hallway, looking first to their left and then to their right, wondering which way to go. One of them pointed down the hallway, grabbed the other's pale hand, and they began to walk toward their destination.

They were obviously in-sync and comfortable with one another, leaning into one another with each step. They continued to hold each other's hand as they approached me, and my eyes locked onto their steadfast grip. As they neared where I was standing, I smiled at the both of them and was rewarded with a return smile from each, doubling my investment.

"Can I help either of you?" I asked, studying their faces as they gave me their attention. Faces etched with contentment.

"No, thank you." It was said in unison. "We're just heading to the bathroom," added the one.

They passed me at a slow pace, and I continued to watch the caring that was quite evident between the two. It was my privilege, really, to observe and absorb their abounding love and obvious comfort with one another, something I don't see nearly enough in my job. Or in life.

The bathroom was just thirty or so feet past me and, with no pressing patient concerns, I decided to continue watching. Their entwined hands, which had mesmerized me on their approach, looked even more beautiful and innocent, swinging in unison as they passed and continued down the hallway, away from me. They were talking, hushed, and I noticed how their conversation was steady. Occasionally, one would steal a glance at the other.

They made it to the bathroom. The one gingerly pushed the door open for the other, helping him into the room before stepping back out into the hallway and shutting the door. Several minutes later, after some brief privacy and a few loving knocks, the door opened and they reunited. Hands were reclasped. Smiles were exchanged. Gingerly, they made their way back down the hallway, towards me and their room. Passing by me again, they both nodded.

We exchanged pleasantries. "Have a nice day" was met with "And the same to you." I wanted to say so much more, but decided to just enjoy this moment.

They passed me and I turned to watch their final few steps. Ginger steps that were unhurried and conscious. Again, hands were swung, bodies were leaned into, and familiarity enveloped their every move. I basked in their uniqueness, their special bond, hopeful that they realized just how blessed they were to have one another.

They arrived at their door and, just like with the bathroom, the older gentleman walked into the room first. Helped by the other, who followed.

How blessed was I to witness this true love story. Between...

An elderly father and his grown son.

Thanks for reading! With all of the internal restlessness and societal worries each of us are facing daily, please don't let all of life's little beautiful moments pass you by...be well and stay safe. Jim

The Witness

noreply@blogger.com (StorytellERdoc) — Fri, 17 Jul 2020 17:11:00 +0000

A picture is worth a thousand words...

The patient arrived in cardiac arrest. He had been brought to our emergency department in the middle of the night. Although he had a significant cardiac history, including bypass surgery, he was only in his late-forties. His transport from his house to our department had been less than ten minutes and the pre-hospital team had done an excellent job of intubating this patient and establishing an IV to begin resuscitation efforts.

His wife was with him. Less than fifteen short minutes before their arrival, her life had been altered forever when her husband had woken her from her deep sleep to complain that he had intense chest pain. Mere seconds later, she witnessed him pass out and become completely unresponsive.

On arrival to our ER, we found this patient to be in pulseless ventricular tachycardia--a malignant, life-threatening electrical rhythm of the heart. Following ACLS protocol, we hurriedly shocked this patient several times, performed CPR and administered multiple doses of medications to combat this rhythm.

After several very intense minutes, we were briefly able to regain a rhythm and a pulse on this patient. Despite this, he remained unresponsive and his blood pressure was minimal. We continued our efforts to stabilize this patient as we awaited cardiology's arrival.

Despite our aggressive medications and interventions, this patient returned to a pulseless ventricular tachycardia. His heart was damaged and seemed unsalvagable. More shocks followed. More medications were given. And, once again, we were able to break the bad rhythm. Like before, unfortunately, the malignant rhythms returned in just seconds.

Cardiology arrived and together we continued to fight for this man's life. His rhythms were very fragile and eventually they transitioned from pulseless ventricular tachycardia into asystole (a flat-line, so to speak). Asystole is bad, very bad, and is rarely survivable.

We were running out of options. If we were going to be able to intervene any further, we needed this patient to regain a stable rhythm. Getting him into a sinus rhythm had been hard enough initially, but now it was becoming hopeless. His heart, from previous infarctions and damage, was resistant and stubborn to our best efforts.

As the cardiologist and our ER team continued with resuscitation efforts, I went to the family room to speak to this patient's wife. She was obviously upset, and I explained her husband's dire situation. Our reality was that time was not our friend. The longer he continued in asystole and ventricular tachycardia, the less chance of his survival. She understood my words. "I always knew it would end this way," she said, her honest words reflecting her inherent sense of the situation.

Her husband's heart was damaged. Her heart was breaking.

I invited her back to be with her husband, to witness the momentous efforts we were all giving him. She wholeheartedly agreed, embracing my invitation. Although I could describe to her our efforts, I wanted her to see for herself the incredible attempts of resuscitation being provided.

A picture is worth a thousand words, as they say.

Returning to the oversized room, filled with people and shiny medical equipment, I looked at the resuscitation through her eyes. Three nurses, each scurrying with a focused determination, documenting our efforts and pushing IV medications. Two techs, one actively performing CPR while the other was readjusting the patient's blood pressure cuff. Two respiratory therapists, standing at the head of the bed, one using an oxygenated bag to ventilate this patient via his airway tube while the other prepared a mechanical ventilator, ready to be used in the event of our resuscitation succeeding. The cardiologist, standing at the patient's open side, dictating the next course of medications while I was away. The pharmacist, standing with the crash cart outside of the patient's door, repeatedly handing in the next dose of ordered medication. The case manager. My resident physician. The patient's wife. Me.

And the patient. Lying on the hospital cot. Unresponsive. In asystole. Again.

I guided her to his side, where she grabbed his hand and whispered in his ear.

Despite this many people in our big resuscitation room, the air seemed open, the frantic energy palpable. The team moved purposefully and in sync. Their caring, their vigor, their sadness, their intensity was obvious, witnessed by this patient's wife.

Unfortunately, our patient's heart became refractory to all of our best efforts and our medications no longer had any effect. I had the tech hold CPR and we confirmed asystole on several cardiac monitor leads. The portable ultrasound was brought to this patient's bedside. It confirmed our worst fears, that his heart had no squeeze, no motion, no life. His wife saw the stillness of his heart on our black-and-white screen.

Forty or so minutes had passed since the patient arrived and, as I had explained to the wife in the family room, time was not our friend. We had no other options of treatment to save this patient, her husband.

"Please, stop," the wife said. "Please, just let him go in peace."

It was a powerful moment.

With no objections, we ceased resuscitation efforts. Time of death was proclaimed. I thanked my team. I crossed myself. I conveyed my sympathies to the wife. The crowd of people slowly withdrew from the room. The lights were dimmed. The patient was covered in nice, clean blankets. The patient's wife was brought a chair, along bedside, where she sat, continuing to hold her husband's lifeless hand within her trembling own. A box of Kleenex somehow found her lap.

The family doctor was called. The coroner was notified. I dictated my note.

All methodical parts of my job. When I was done dictating, I went back into the room. As I expected, his wife was still there. I wanted to sit with her in quiet for a few moments.

"I'm so sorry for your loss," I whispered.

She nodded. "I know you tried your best." She paused, taking a deep breath, before continuing. "Thank you for letting me be with him in the end. Everybody fought so hard. I just...needed to be here."

After several minutes, I walked back out of the room, thinking about how much medicine has changed since I first finished residency in Syracuse. Not only with newer drugs and newer procedures, but it has changed with newer thinking. A few short years prior to this patient's arrest, it would have been unthinkable to invite a family member to bear witness to resuscitation efforts. Now, though, I try to offer this option to a family member if the situation allows. Much literature has evolved, strongly in favor of presenting this as an option. Clearly, this wife was empowered, her view clarified, by choosing to be with her husband at the end. It was necessary for her closure, to witness our heroic attempts.

I am glad she had this opportunity.

What would you do in a similar situation? Would you go to the bedside of your loved one and witness firsthand the resuscitation efforts? Or just wait patiently in the family room for updates?

Me? I'm not so sure what choice I would make. The thought of this choice carries much heaviness to it. I probably would. I have to wonder if my indecision or hesitation is, in part, from doing this job for a living or just my inherent spiritual make-up. Obviously, witnessing such a loss and life-altering event may not be for everyone. For those that are offered this option and choose to go to their loved one's bedside, I hope it is a healing and comforting.

Let's just hope that we never have to make this decision.

As always, big thanks for reading. This essay is an updated version first posted in 2010 and it rings just as true today as it did then. Be safe. Jim

Double-Knot These Threads

noreply@blogger.com (StorytellERdoc) — Thu, 11 Jun 2020 19:10:00 +0000

"...it would be interesting to find out what goes on in that moment
when someone looks at you and draws all sorts of conclusions."

A few years back, I took care of a frail elderly gentleman who, accompanied by his wife, had come to the ER with an elbow injury after tripping over a curb in front of a local restaurant. They had been traveling from Buffalo to Cleveland and had stopped for a quick bite and a bathroom break.

Before entering his room to treat him, I had been given a heads-up by Rita, his nurse, that this patient's demeanor was abrasive and demanding. "You are going to love his wife, though," Rita added, "she is one of the sweetest women I have ever met."

Appreciating Rita's warning, I knocked on the door and entered, prepared to face this ornery fellow. What I wasn't prepared for, though, was this patient's physical appearance. He was extremely small in stature, petite almost. His legs dangled over the cot's side and swayed several feet above the tiled-floor. His clothes hung loosely off his thin frame. His fedora hat swallowed up his round, veiny face and bulbous nose. His eyes were apprehensive, his grimace distasteful. His presence, contrasting his physicality, was enormous and palpable.

In the corner of the room sat his wife, a beautiful gray-haired woman, equally frail and petite, clutching her purse. She wore a loosely-fitting flowered dress and a warm, welcoming smile. She was Sophia's twin from The Golden Girls.

To allow my patient a chance to size me up, I acknowledged his wife first, returning her welcoming smile as I greeted her. I then turned to my intensely grumpy patient and introduced myself, asking him how I could help him on his visit.

"Doctor, I need stitches," he answered, pointing to his right elbow. His voice was gruff and heavy, weighted by a thick European accent. "I hurt my knee before like this and that's what they had to do," he continued, pulling up his pressed pant leg to reveal his small bony knee with a pencil-thin scar across its cap.

This gentleman remained quite ornery during his interview, his examination and his treatment. He continued to insist that he needed stitches. He didn't, though, and it took me several minutes to convince him of this. He simply had some abrasions and skin-tears. He did need some x-rays, however, and after getting them, I explained the negative results to his wife and him. His wife smiled and clapped her hands at the good news while he simply grunted. They were a dichotomy of spirits. Gradually, though, I could see him softening towards me as his visit concluded. After cleaning his wounds and bandaging his elbow, I assured him he would be discharged shortly.

I was not surprised that within mere minutes, while sitting at my work station, this patient was standing impatiently at the nurses' counter asking what was taking so long for him to be discharged. His voice was loud and imposing, and those of us sitting paused from what we were doing to look toward the source. His fedora and pinched-up face barely cleared the height of the counter and yet he had made his presence known. After hearing his booming accented-voice again, as well as to placate him while Rita prepared his instructions, I asked him about the origin of his accent.

"Sir," I said, "I noticed your accent. Where did it originate?"

And with that question, this patient opened his heart's flood gates and willingly launched into his past, sharing an astounding story that most of us would never have imagined. He was a Holocaust survivor from Poland, he said with a quieter voice, who tragically lost his entire family at the age of eleven--his parents, his five sisters, his aunts and uncles, and all of his cousins. He survived because a local farming family took him in as "one of their own" during the war. At the age of twenty, he had saved up enough money to immigrate to America, "the greatest country in the world." After arriving penniless, he settled in Ohio where he met his wife. Together they raised four children and owned a successful business. "I've had a very very good life," he concluded.

It was a story that made you catch your breath.

As he finished, his wife approached him and put her arm around his shoulders. He looked at her and she nodded a loving reassurance to him. Not one among us sitting there had a dry eye. His abrasive personality had softened and his incredible story of survival had humanized him right before us. With this glimpse into his private life, we were all suddenly filled with empathy and compassion for this man, his wife, and this life he had fought to live. With all of us in silence, he turned slowly to go back to his room. "I'll be in my room waiting for those papers."

It was unimaginable to think we had almost missed this patient's remarkable story because it was hidden behind his rough exterior and abrupt attitude.

This patient had taught us all a very worthy lesson that day, a lesson that resonates especially in today's world. With all of the fears and uncertainties that currently exist in our society, we need to remember that behind every face of every person we encounter, whether masked or not, sits an incredible and powerful story of a life unlike ours, of a life unknown to us. Stories of resilience, of loss, of triumph, and of inspiration. Occasionally, as this patient reminded us, it just takes a little more time and effort to peel the layers back to find the good stuff of another.

With each interaction we have with one another, then, what an amazing opportunity we are given to tap into our capacity to understand one another regardless of our similarities and differences.

We need to halt the quick judgments and criticisms. We are all bound by threads of love and understanding and respect and compassion. Why are we so quick to fray these threads instead of double-knotting and strengthening them?

For the sake of skin color?
For the sake of religion?
For the sake of social background?
For the sake of gender?
For the sake of age?
For the sake of sexual preference?
For the sake of material possessions?

Please, of all things, don't let it be for the sake of consciously choosing hate over love.

None of these reasons are worth tearing down and hurting another. None of these reasons are worth crumbling the foundation of our beautiful country. All of these reasons are worth our efforts to take the time to learn more about one another.

Let's double-knot these threads that bind each of us and choose love.

As I've said before, in a society that wants to separate us based on our differences, we are reminded daily through shared tragedies and triumphs that we will always be more alike. Let's grasp these reminders tightly and make the world a better place.

A heartfelt thanks to my patient for reminding me that each of us has a life journey that most don't know about. Because of this, we should always try to be patient and kind with one another. And understanding. And respectful. And compassionate. And loving.

To me, it is the only way...

Thanks, as always, for reading. Would love to hear your thoughts and feedback. This essay is an unedited, longer version of a recent column printed in our local newspaper and posted on our local community website. My best, Jim.

Be Good. Do Good.

noreply@blogger.com (StorytellERdoc) — Thu, 14 May 2020 20:15:00 +0000

Do your little bit of good where you are.
It's those little bits of good put together that
overwhelm the world. Desmond Tutu

Recently, my son Cole and I were enjoying an afternoon out of the house, running around town to tackle our to-do list of errands (masked, of course). We stopped at Sam's Club and Walmart, stocking up on our low supplies of food and other necessities. As an added bonus, we enjoyed the people-watching and marveled at the wide spectrum of personal flaws the other shoppers provided us.

It seemed that the Covid-19 crisis had fueled an already blossoming trend of wearing fleece pajama bottoms in public without any embarrassment. People tended to have a greasy quality to them, clearly reducing their shower time as a personal protest to the quarantine guidelines. With masks on, the eyes of these shoppers held the power of conveying a wide spectrum of gratitude, misery, frustration, happiness, and paranoia. I enjoyed interpreting these various moods and realized that zombies were alive and well, living among us.

After these stops, the SUV loaded with fresh supplies, we had just one stop left--The UPS Store. Cole had several large packages he had to send out and the store was just a few short miles away.

Pulling up to the store front, Cole and I got out and walked to the back of our vehicle and removed the packages, overloading our arms to make the delivery in one trip. We walked in together and in a short time had the packages processed. Walking out of the store, stomachs growling, we were talking about what we were going to eat for dinner. With a loaded vehicle of fresh food, our options were many.

And then, amidst our talking, Cole and I saw something that instantly grabbed out attention, almost like a grab and shake of our shoulders, halting our conversation to immediate silence.

Across the parking lot and directly opposite of us, a homeless man sat on a railing that nestled into the red siding of the back wall of a Country Fair. Beside him sat a beat-up grocery cart, filled halfway with tattered plastic bags. He wore a threadbare trench coat over his very thin frame. His hair was wispy and messed from the breeze. His face was smudged and blotchy and his legs and arms were crossed. He was watching us as we stepped from the curb toward our vehicle. Smoking a cigarette, he took a puff, stamped it into the ground and then nodded towards us.

Seeing this man was an immediate reminder to my son and I of just how damn lucky we were. It also gave us the privilege to do a little bit of good.

Cole looked at me and I looked at him. Almost in sync, we both said "Let's give him some food." We went through our bags and pulled out an 18-inch sub, bananas, protein bars, an energy drink and water.

Cole asked if I would take this food to this gentleman and it took me back to the days when he was a child, clinging to my legs as we walked up to a homeless man in McDonalds to give him a a quarter-pounder meal (I Like The Fish). I felt the overwhelming privilege this homeless man gave my son and I to share, however, and walked toward him with the food and drink as well as a $10 bill tucked into the sub wrapping.

Approaching him, his despair became even more apparent. Although the day was chilly but not terribly cold, this man's uncovered feet were pale and roughed up. It was apparent he had probably been walking barefoot and that he also had diabetes or poor circulation.

I stopped in front of him and introduced myself to him. "Hello sir, my name is Jim. Would it be okay if my son and I gave you some food since we just went shopping?" The man didn't speak, but simply nodded yes and held out his hands. I gave him the food and, very methodically, he divided up the ante, putting the drinks in a separate plastic bag that hung from the cart's handle while placing the other food with the $10 bill into the plastic bags within the cart's basket.

When finished, he looked back to me and gave me a smile and quietly thanked me.

As I was turning to leave, I happened upon a pair of bedroom slippers that sat beside him. They were wet, frayed, and had giant holes where I imagined this man's big toes would poke out had he been wearing them.

"Sir," I said, "are those your shoes?" He nodded yes.
"Do you have any other shoes?" I asked. He nodded no.

I looked down at my feet. I was wearing for the first time a pair of new Crocs I had purchased right before the quarantine started. I looked back at him and asked "Will you take my shoes if I give them to you?"

He looked surprised at my question. He spoke again, softly enough that I had to lean into him. "I can't take your shoes." I asked him if he could fit into a size 13 and he nodded yes.

I took off my Crocs and handed them over to him. He took them from me and immediately tried them on. "They'll do," he said, now offering me a bigger smile.

One thing was missing, though. I looked back at my feet and appreciated the warm black athletic socks I had on. Within seconds, I had them off and was handing them over. "I can't take those," he said but, after my insistence, he reached out and took them.

I looked him in the eye and he looked back at me. Eyes on eyes. "I'm Richard," he said. "Hi Richard," I said, "I'm Jim. Do you need anything else?" Although I knew a lot of his needs were beyond what I could offer, I still had to ask. "Do you need to get somewhere or can I call for help for you?" I asked, thinking about how amazing our case managers in our ER were.

He assured me he was okay. "Well then, Richard, it was a pleasure to meet you." I looked him in his eyes one last time and saw his appreciation before I turned and walked away.

Walking across the parking lot and toward Cole, my bare feet ached from the pebbles and cold pavement. Yet it was exactly the walk I needed at that very moment. I could only imagine Richard's discomfort on a daily basis. Cole was standing beside the SUV and had watched everything. The encounter took less than two minutes. And in those two minutes time, Richard had provided a view to a world different than ours. We were grateful.

I handed over the keys to Cole. "You drive," I said. Backing out of our parking space, we waved goodbye to Richard as he was putting on the socks. Driving home, I had my feet up on the dashboard with the warm defrost cranked. It was a luxury not lost on me.

This story of Richard I share with you is not a self-congratulatory pat on my back, I promise. In fact, it's not even extraordinary. Rather, it's a reminder to me and maybe to you that giving truly is better than receiving. It may sound cliche, I know, but it certainly is an undeniable truth. Especially during these uneasy and frustrating times in which many among us might be dealing with new stressors that simply didn't exist in our lives just mere months ago, giving is something that can provide happiness to each of us.

Giving doesn't have to have a monetary value, either. We were just fortunate to have that opportunity with Richard to do so. The cost of giving can be minimal. A phone call. A text. A kind word. A smile. A wave. Giving that comes from your heart and soul is about as good as it gets. Giving provides gratitude. It provides appreciation. It provides love.

Giving also inspires more giving. Your giving, in whatever way you do, may have a ripple effect that you can't even begin to imagine. Who knows, maybe Richard will share his smile more with the world after enough smiles are shared and provided to him. Maybe you will be inspired to give a little more of yourself than the day before. Maybe the person who receives your gift will pay it forward and create a cascade of giving.

Through these times of quarantine and isolation, most importantly, giving increases our social connectedness. This connectedness is vital to our continued good mental health. Imagine the happy that you receive as well as give simply by saying "I love you" or "I appreciate you" to someone in your life who hasn't heard those words for quite some time from you. What a great way to nourish our relationships as well as reap the rewards that giving provides.

Everyday I consciously try to do several good deeds. Many of you out there have received a random text, a phone call, a book in the mail, a gift card, or a compliment from me (sorry, no revealing selfies). Without these connections, I would be less of a human--less compassionate, less happy, and less equipped to deal with my new daily life. My threads connecting me to my fellow man would be frayed. Likewise, I have also been the recipient of so much goodness and giving from so many people, especially during this Covid crisis. This giving from so many people has inspired me to become a better person and give more of myself. It connects me.

I am caught in the ripple effect of giving...and I like it...I hope you are caught, too.

I would like to thank Richard for providing me with much more than I provided him. To give of oneself is a powerful privilege and he gifted that privilege to my son and me. I hope each of you have the opportunity to give of yourself and feel the beauty that accompanies your actions. I hope you feel the empowerment and connectedness that comes along with doing "your little bit of good where you are."

We are all in this together...

I hope this finds each of you feeling okay while dealing with all of the new stressors created. You are not in this alone. Please, if you have an inspiring story or comment to share, please do on my blog or on my Facebook comments. Be well. Jim

The Power Of A Nurse

noreply@blogger.com (StorytellERdoc) — Thu, 07 May 2020 16:46:00 +0000

I am only one, but still I am one.

I cannot do everything, but still I can do something.

And because I cannot do everything,

I will not refuse to do something that I can do...Helen Keller

The car pulls into the driveway of a cape cod as the sunrise breaks through remnants of last night's fog. The driver pulls up to the garage and stares at the door, deciding to park outside. Lights are turned off. The engine is cut. The driver exhales a deep breath she didn't know she was holding. She rests her forehead into the steering wheel. A tear rolls down her cheek as a hesitant smile emerges. She thinks back to the many triumphs and defeats she bravely faced for the past twelve hours. Her fingers entwine the plastic Minnie Mouse bracelet she is wearing, given to her by a patient with leukemia. She walks into her house. Despite her sheer exhaustion, sleep will not come until after she wakes up her three kids to dress them, feed them and escort them to their bus stop.

This is the life of a nurse.

He looks as tired as he feels, despite sleeping well the night prior. It's been a thankless shift. Through the window of the nurses' station, he observes the outside rain, its drizzle rhythmically tapping a soothing beat. He signs off the last of information on his seventh patient to his replacement, sharing the important medications, vitals, activities, and care-plan in depth. He says his goodbyes, heads to the locker room and changes out of his scrubs into his street clothes. He collects his belongings, walks down a hectic hallway to enter a packed elevator, and exits through the lobby. He crosses traffic and enters a long walkway that leads to the parking garage. Here, he cannot hold back his emotions any longer. He turns around to look at the intimidating building he just left, and stares at the end window of the seventh floor. His chest heaves and he starts to cry, knowing the death of this patient will haunt him in tonight's sleep.

This is the life of a nurse.

She grabs the crockpot of baked beans and yells for the kids to hurry up. She doesn't want to be late for her family reunion. It's been a year since she's seen some of her distant cousins and she has been looking forward to revisiting her childhood memories with those who shared in them. Thankfully, her husband packed the car earlier with silverware and lawn chairs. Suddenly, her phone rings. She looks at the number and dreadfully picks up, knowing that her plans for the day are ruined. She faces the disappointed faces of her children and husband before she changes into her scrubs and clogs. Within thirty minutes, she is on her unit, a familiar place of chaos, for this unplanned shift due to mandatory on-call. She sits down on the cracked leather chair in front of her computer, wishing for the world she was sitting at a picnic bench with her family instead.

This is the life of a nurse.

There is not one among us who has not had our lives enriched because of a nurse. From birth to now, each of us has been touched with the kindness and loving attention that a nurse has provided us. Whether it be at the doctor's office, the hospital, the medical centers with inpatient and outpatient services, or within our own homes, nurses have been a constant source of unlimited talents and skills, selfless souls who have always had the gift of propelling us forward on our life paths. They have comforted us in our down moments and genuinely rejoiced with us in the glory of good health.

They have held our hands through so many stages...always supportive...always beside us.

I clearly remember the many nurses who have accompanied me on my life journey. My childhood doctor's nurse, holding me through my shots. My dentist's nurse, holding my hand while soothingly talking in my ear during a cavity being filled. My family practitioners' and specialists' nurses, always greeting and treating me with a big smile.

We not only remember the many nurses who have touched our lives, but also the nurses who have touched our family members' lives. I will never forget or be able to repay Nurse Rose, an energetic bundle of goodness from the local Children's Hospital who each week guided us through the chemotherapy treatments of one of my children. The same goes for Nurse Sue and Nurse Don, two of my mother's favorites nurses when she had to spend 40 days in the hospital as she bravely fought leukemia. When my mother's hair started falling out in clumps, it was Nurse Don who brought in his hairdresser clippers and made her even more beautiful than she already was.

Excuse me while I wipe my tears...

Uniquely, I have had the pleasures and memories of working beside so many incredibly talented nurses as I traveled through medical school and residency. Their names and faces are etched into my mind's vault as I fondly recall their unselfish sharing of their medical knowledge and laughter and coping skills with me. Often, it was a nurse who calmly guided me through a crisis when I stood at the bedside of a crashing patient at 4 a.m. in the ICU during my internship year.

Most of all, though, I would like to salute the nurses who I have been fortunate to work beside for the past 23 years in our chaotic trauma center's ER. Through each shift, among the memories of the triumphs and tragedies, of the heartbreaks and celebrations, and of the mundane and exciting, you have unselfishly stood beside me and encouraged me to be and give my very best to each and every patient. You are not only my coworkers, but you are my brothers and sisters.

This is the power of a nurse.

To all of you, it has been my privilege to witness your strength and vulnerability, your discipline and strong-will, your compassion and empathy, your perseverance and endless energy, your grieving and your heartfelt rejoicing, and your gratitude and happiness while caring for the lives of ill patients who rely on you.

I have learned from you and am buoyed by you.
I am a better doctor because of you.
I am a better man and human being because of you.

This week, then, please smile as you are flooded with memories of...

...the patient who gave you a hug and a vase of flowers when she was discharged.
...the tears of happiness you shed when you helped save a patient's life.
...the compliments you received from a patient's grateful family.
...the first successful IV you placed in a squirming patient.

...the nurse mentor who guided you through your first week on your new job.
...the child who colored you a picture of yourself.
...the first thank you note you got from a patient in your work mailbox.
...the pride in your family's eyes when you received your nursing diploma.

...the first time in public a patient recognized you and thanked you for your care.
...the admiration in someone's eyes when you told them you are a nurse.
...the thank-you you received from an appreciative doctor when you caught a medical error.
...the thank-you you received from a fellow nurse you helped when their patient crashed.

...the lives you have affected by your selfless and endless compassion, love and caring.
...the hours you dedicated to always bettering yourself to be the great nurse you are.
...the accolades you have received from your volunteerism and sharing of yourself.
...the love and respect we each hold for you as you face another uncertain work day.

Nurses represent all that is good in our world, the epitome of love and compassion and empathy and selflessness. It is a special person who has this inherent recipe of characteristics and pursues one of the most noble professions in our society. Although it can be heartbreaking and demoralizing at times, thank you for seeing beyond this fog to appreciate the rewards that awaited you.

From myself, your fellow co-workers, your family and friends, and your fellow human beings, then, we send each of you a collective heartfelt thanks for the work you do, the lives you enrich and the difference you make each and every day.

Happy Nurses Week to you!!!

You are angels
You are heroes.
You are family.

You are a nurse...

Thank you for reading! Also check out Senator Walsh...Thank You for more nurse appreciation!

I dedicate this to one of my heroes, my sister Chrissie, and her forty-year nursing career. Thanks for inspiring me to be a part of the medical world (and for being a great big sissy!). 💕

Corona Together

noreply@blogger.com (StorytellERdoc) — Wed, 18 Mar 2020 17:59:00 +0000

This breath is a gift...
This moment is a gift...
This life is a gift...

As with every other person, I am struggling to comprehend the staggering effects that Covid-19 has had on our society in such a short time. Gone are the carefree smiles, the uncomplicated daily lives, and the thought that we and our families are immune to unexpected death. Instead, we are witnessing a collapse in society to the degree that most believe survival hinges on the amount of toilet paper and paper towel one has stockpiled.

Being an ER physician facing this dilemma on the front lines of a large emergency and trauma center, I am also bearing witness to the more daunting picture of this dilemma--the mental and physical effects Covid-19 is having on our patients as well as on all of us. Regardless of the severity of a patient's illness and diagnosis, time and again I am now witnessing an unsettling fear in their eyes, conveying a belief that somehow Covid-19 is playing a part in their (lack of) well-being. They are scared.

For the rest of us, any minor symptom is being questioned. All one has to do is cough or sneeze in public to expose just how nervous everyone is. Just yesterday, someone sneezed in our local Walmart, sparking a big argument and confrontation. We are all scared.

Friends and family have asked me my thoughts on Covid-19, maybe believing I have some special information simply from being on the front lines. And the truth is, I am not sure what to think at this point. I recently finished seven consecutive shifts in which I, along with my incredible co-workers, have been part of our hospital's evolving approach to the growing concern of Covid-19. Rightly so, these policies have changed frequently as we sort out the information amid new revelations, details, and statistics as they come in. It is safe to say that many of us have never before experienced anything like this in our careers.

It seems we are all standing on sandy beaches watching this huge wave coming at us, gaining momentum as it gets closer and closer to shore. We feel helpless. In attempts to solidify our footing, though, we are linking arms, unified in following the directions given to us. Isolate ourselves. Wash our hands. Wear a mask. Don't touch our faces. Use elbow-bump greetings. Take extra precautions around the elderly, the young, and the immunocompromised. Don't bog down our front-line medical providers with mild symptoms.

Will this be enough to keep our firm footing once the Covid-19 wave hits? Or is this wave going to knock us on our asses? Are we prepared for the outcome of either?

Turning on the news only seems to spark more fear and hysteria. We are witnessing the devastating loss of lives in other countries as well as our own. We are witnessing a lack of basic necessary food and supplies for some while others hoard. We are witnessing a collapse in our economic structure. We are witnessing the world shrink down to only what exists within the four walls of our homes.

So with all of this confusion and fear existing in our society, what are we to do? How do we make sense of all the information, true or otherwise, that is bombarding us every second of every day?

When things become complicated, sometimes the easiest approach to clarity is to simply breakdown all of the complications to their most basic forms. What follows are some of the things I will continue to do with each passing day that Covid-19 is a part of my life.

First and foremost, remember to be kind during all of this ruckus. Say "I love you" a little bit more to those you love. Wear your smile often. Even behind a mask, the eyes show it. Be patient when you are frustrated. Call your neighbors and check in with them. Help an elderly person with their shopping in the store. Leave that extra roll of toilet paper on the shelf for the next person. Make an extra phone call a day to someone you haven't spoken to in a while. Use email and online messaging to stay connected. Help someone in need with childcare if all involved are well. Have a pizza delivered to a friend.

Be. Kind. Always.

Secondly, stay positive. I know this is a hard one, but when has a doom-and-gloom attitude ever helped a situation? Your mental health and your physical well-being are tied together in ways that we often overlook and sometimes a better outlook depends on both a healthy mentality and physicality. As before, stay connected through phone calls, emails and messaging. Take a walk. Go to bed earlier. Nap. Stretch. Meditate. Try yoga. Do your pushups and situps and planks and pull-ups while your gym is closed. Turn off the murder movies and put on the funny ones. Don't look at your retirement funds. Whatever it takes, try to greet the world with a bigger smile.

Three, use your time wisely. How many of us dreamt of having this respite from our typical daily lives? In essence, this is a big timeout. Use it wisely. Love yourself and learn to be comfortable being alone. Be introspective. Make changes. Evaluate your life and the things that demand your energy. Embrace the good stuff. Eliminate the toxic (people and habits). Clean your house and dust that shelf. Go through your clothes and donate. Rearrange your rooms. Give excitement to the things that have begun to bore you.

Four, don't underestimate the power of a good book and a great song.

Five, don't let all of the confusion over Covid-19 detract you from the simplicities being asked of you from your leaders. Don't travel. Follow isolation guidelines. Do your hand-washing. Wear a mask. Etc. Respect all the offered instructions to ensure not only your own livelihood but those around you. A simple defiance of these guidelines could have a ripple effect unlike anything you could imagine.

Six, don't engage in finger-pointing. Like me, I am sure most of you are tired of hearing the policy-makers and naysayers blame one another for the lack of testing, for the lack of preparedness, for the lack of funding, and for the lack of leadership and guidance. Corona is here now. Hindsight is 20/20. These negative behaviors and actions and words will only fog our clarity on moving forward to overcome Covid-19. Don't engage. In the here and now, rather, we need to be supportive mature adults and unify in making the best decisions for ourselves based on the most recent and reliable information available. Let's be proactive. In the future, we can take the time to look back, reevaluate and learn from this.

Seven, please make wise choices and be responsible when pursuing medical care. If your symptoms are minor but you are concerned, such as a sniffle or sore throat or occasional cough, stay home or touch base with your family doctor's office for further guidance. If your symptoms include shortness of breath, lethargy, uncontrolled fevers, change in mental status or more severe symptoms, please seek immediate help.

We are great at what we do.
We are ready to save lives.
Please let us focus on the critically ill.

Finally, I want to humbly ask that you keep all of the first responders and frontline medical providers in your prayers. Instead of having the benefit of safely staying home, we will be leaving the comfort of our homes to show up for your sake. Every minute of every hour of every day through this crisis, millions of us will be available to provide you care while risking our own health. Your unwavering support and kindnesses through this ordeal are greatly appreciated. Rest-assured we will provide each of you the best of our knowledge, our resources, our training, our energy and our compassion if you are ill and need us. We signed up willingly for our jobs out of a love to provide you with competent emergent care and we will deliver.

Standing alone on the shore, one is bound to get knocked on his ass from the Covid-19 wave. Standing together, our brigade will be successful against this wave. We have to be. We must all come together and support each other. We need to unify our thinking, our energy, and our efforts. And as we travel this treacherous path together, please remember that we are all human and need to root each other on.

I have always had a great faith in humanity. My work in the ER has provided me countless beautiful moments where I have been privileged to see the absolute best in people during the absolute worst of times. I have faith that at the end of the day, when this Covid-19 is no longer in our lives, I will look back on these dark days and be proud of my fellow man for the dignity and pride shown through this crisis.

Please be safe. Please give your best. Please do your part.

I wish each of you a peaceful heart.
I wish each of you a calm mind.
I wish each of you good health.

We will beat this together...

A Family's Cry...

noreply@blogger.com (StorytellERdoc) — Mon, 12 Aug 2019 15:48:00 +0000

"The death of a child is the single most traumatic event in medicine. To lose a child is to lose a piece of yourself."

I walked into work yesterday morning and it only took seconds to appreciate the immense sorrow and sadness that permeated the air. My beautiful work family was despondent and deflated. Shoulders were slumped, feet were shuffling, faces wore defeat.

Something terrible had occurred during the night shift. Damn it. I felt my heart clench with the fear of anticipating the news that would cause such palpable pain to my coworkers.

Walking toward the first nurses' station, "Central" as we know it, I said brief good mornings to several nurses and techs as well as our unit coordinator, Amy. Most of them were either sitting or standing, leaning into the counter. Under the fluorescent lights, their eyes were dull. A profound fog of nothingness seemed to envelop each of them.

"Amy," I said, "what happened? What's going on?"

It took her all of five seconds to explain the catastrophe. "Dr. Jim, four children died in a house fire."

No. No. No. No. No. NO! NO! NO!

It just couldn't be. The loss of one child during any shift in the ER is devastating. But four??? No. No. No. No. No.

Damn it all, though, it happened. There was a house fire. Resuscitation efforts of the seven who had been trapped inside, five children, were initiated on scene by the same heroes that fought the fire to bring these victims out of the flaming house. Paramedics and EMTs continued the heroics, performing CPR and starting IVs and protecting and maintaining airways critically damaged from smoke inhalation and flame exposure. These patients were brought to our ER in multiple rigs that could never travel fast enough in these circumstances.

Once in the ER, the victims were cared for by multiple physicians, nurses, techs, EMTs, paramedics and unit coordinators who were each ready to give these victims the very best they had to offer. Not only were our ER and trauma teams fighting, but other departments also sent personnel to fight for the lives of these children and their mother. CPR was continued in hopes that these little hearts might start beating on their own. Life-saving IV medications were administered in attempts to jump-start injured bodies that wanted to shut down. Airways were maintained with tubes and provided ventilations in attempts to combat the swelling and damages from the fire burns and smoke inhalation. So many medical providers gave everything they could to change the fates of these patients.

I could only imagine the despair and disbelief of my coworkers as they treated these victims, using every possible means to try to save these little lives. I could only imagine their silent prayers whispered with each minute that passed without a response. I could only imagine that moment when the realization set in that perhaps they would not succeed and that their efforts would not be rewarded.

No pulse. No cardiac activity. No spontaneous breathing.

The efforts put forth to save these innocent lives were monumental and yet...no miracles.

Four children died. The fifth child died several hours later. A mother remains in critical condition.

How in the world...

...does one even begin to process and find explanation for such a profound loss of innocent lives?
...does one try to erase the images that will haunt you for the rest of your life?
...does one continue at a job where, despite all the advances of technology and medicine, you still feel a sense of failure for not being able to reverse what the fates have planned?
...does one put on a brave smile and move on to the next waiting patient that needs treated, pretending that what just happened really didn't happen?
...does one go home after a shift and pretend with your family that your heart is not bleeding?
...does one look into the eyes of your own children and not cry for the lives of these lost children?
...does one deal with this overwhelming and suffocating pain?
...does one return to a job where your heart and soul can be decimated in mere minutes, again?
...does one maintain a sense that the world is good, that life is sweet, and that love prevails?

After learning of the news and the events of the night shift, I offered as many hugs as I could. I walked down the hallway to settle in to my work area, and it was there that I found not one, but two of my partners. The first one, Dr. Kevin, is recently graduated from our residency program and is on his way to a remarkable career. He was scheduled to work 5p-3a but stayed on until 7a for obvious reasons. He is the father of three beautiful young girls. He looked exhausted. His pain, despite his attempts to smile, was evident. "Kevin," I said, "let me get you an Uber home." Of course, he refused. "I'll be okay." He planned on going home to hug his wife and kids and have a stiff drink before settling in for some sleep.

Dr. Karen, my other partner, was the scheduled overnight doctor. Looking at her looking at me, I could see the swell of her eyes and the etched wrinkles of shock. She, like Kevin, planned on going home to hug her two boys and husband before hopefully sleeping off some of this night.

Before the overnight team left, a debriefing was held to address the events of the night and offer counseling to any of our team that might need it. As with Kevin and Karen, I bore witness to the raw pain that each of my work family carried from this tragedy. As one of my favorite nurses Debbie text me, "Keep an eye out on our friends, Jim. This is a life-changing event for them." Slowly, our fresh team arrived between 6:30a-7a and we were able to relieve our overnight staff and get them home.

In the aftermath of this tragedy, several family members checked in to be treated. Although their minds were elsewhere, I shared with them that so much love, so much pain, and so many prayers for their family were being shared by our team. Several of them searched my eyes, finding the authenticity of my words.

When a catastrophic event like this happens, especially involving the loss of children's lives, the objectivity of our jobs melt away. The self-imposed barriers we build to protect are hearts and souls are destroyed. The efforts to maintain our composure are lost. Sometimes we are asked to be superhuman when we are simply struggling to breath. The loss of a child's life will do that to us. A loss of five children's lives, well, I can't even imagine the lives that will be changed forever, the paths that have veered off from their expected course.

This family's lives. Our ER staff's. People's who might read about this tragedy. Even your's...

I know mine has.

At the end of the day, no matter what kind of lives we lead or pursue, we are all bound by the human threads that interweave each of our lives to one another. In a society that wants to separate us based on our differences, we are reminded daily through tragedy and triumph that we will always be more alike.

We are fathers. We are mothers. We are brothers and sisters. We are sons and daughters. We are friends. We are human. And we are all broken by this tragedy.

This family's pain is our pain. These lost innocent lives have brought us all to tears.

I would like to believe that angels' wings are built from broken hearts. If so, these innocent children are already fluttering overhead of those that loved them most.

May God Bless these children. May God Bless this Family and protect it from any more pain. And may God Bless each and every one of us who has lost a little piece of ourselves.

"There is no foot too small that it cannot leave an imprint on this world."
I dedicate this to all of you who fight daily for the lives of your patients...you are amazing...
Jim

Senator Walsh...Thank You.

noreply@blogger.com (StorytellERdoc) — Thu, 25 Apr 2019 17:56:00 +0000

Senator Walsh...Thank you.

Because or your flagrant words against some of the hardest-working members of our medical community, we have united to stand against you and rally for our "card-playing" nurses.

Like most of my medical family, I was astounded and frustrated at the belittling ignorance of Senator Walsh's recent comments about the amazing nurses throughout our great country. Senator Walsh's comments were felt not only by our hard-working nurses, who give a piece of their heart and soul with each and every shift, but also by the rest of our diverse medical community. Senator Walsh's comments were arrows directed at the hearts of our nurses. Yet, those very arrows also hit the hearts of each of us who work beside them.

We all bled at Senator Walsh's blatant disrespectful and asinine words. Being health providers, though, we did what we do best--we stopped the bleeding. We strengthened the bonds of our medical family. We rallied to our nurses' sides. We hugged our nurses, we spoke words of inspiration to our nurses, and we reminded each one that their uniqueness and intelligence and hardwork could never be diminished by the throwaway and ridiculous words of one person.

Yes, Senator Walsh, you are that one person. Your words have no power to change our nurse's inherent strengths of empathy, of compassion, and of love for the patients they are privileged to treat. Your words will be your legacy. Your words have defined you. No one in the medical field will ever hear your name spoken or printed without being reminded of your lack of intelligence, of your lack of finesse, of your lack of respect, and of your lack of understanding of one of the most professionally and personally demanding jobs in our society. We rose above your words by reminding these very nurses of just how amazing they are. You strengthened us by your ignorant words.

For uniting us and strengthening our professional bonds, we should thank Senator Walsh.

Clearly, it is obvious that Senator Walsh has no idea what demands are placed on our nurses. Due to their staggering reality of dealing with many life and death situations during each shift, we should all rejoice to witness a nurse having a few minutes of respite from these pressures--whether it be on her phone calling her children, hugging a fellow nurse, sitting down to eat a bite or two of food, or smiling and laughing with a coworker. These rare minutes of escapism for our nurses are necessary to keep moving forward during a shift that sometimes wants to pull them under.

Below, I offer several sobering examples and questions to Senator Walsh to see just how much she truly understands the demands of a nurse's job.

Senator Walsh, have you...

...ever said a silent prayer over a 17 y.o. teenager who didn't survive a car accident?
...ever held the hand of a 38 y.o. woman, a mother of three young children, while the doctor told her she has ovarian cancer that has spread to her liver, lymph nodes, and brain?
...ever hugged a dementia patient ten times because she didn't remember the first nine?
...ever hugged a man's four adult children and his wife just minutes after he was pronounced dead?

...ever given a patient eight units of blood to try to save her from a ruptured aortic aneurysm?
...ever been called a "f...ing bitch" by a drug-seeker?
...ever been swung at or kicked by a patient who used bath salts just 30 minutes earlier?
...ever treated a patient with a heart attack, a patient with severe COPD, a frightened college girl with an STD, and a family of four with cold symptoms--all at the same time?

...ever been covered in blood that wasn't yours?
...ever been covered in vomit that wasn't yours?
...ever been covered in diarrhea that wasn't yours?
...ever been covered in urine that wasn't yours?

...ever treated a rape victim?
...ever had beads of sweat on your forehead from performing CPR on a child? on a 50 y.o man?
...ever given an extra pillow and sandwich to a patient who doesn't thank you but rather complains that they don't like ham sandwiches?
...ever had to stand between a woman and man who are arguing over a pregnancy test?

...ever gone to a funeral of a person you only knew for two hours?
...ever held your urine three hours past the point of comfort?
...ever sobbed while holding a deceased SIDS baby in a rocking chair while the baby's mother held the living twin in another?
...ever missed every other holiday with your family to spend it with people who aren't?

...ever been handed a colored drawing by a child on chemotherapy who won't survive the year?
...ever eaten only three stale donuts in a day for your meals?
...ever been verbally abused or insulted by a patient who zooms in on your worst insecurities?
...ever seen a 6-month old being fed a bottle filled with Coke?

...ever fought a flood of emotions because your patient has the same eyes as your deceased mother?
...ever hold pressure on a pumping wrist artery of a patient who tried to kill himself?
...ever had to work four hours longer than expected, knowing your kids are at home needing dinner and help with their homework?
...ever felt isolated and alone because you can't express the words or release the tears in response to the daily pressures of your job?

Senator Walsh...have you ever been villianized and insulted by someone in the public eye who truly has no understanding of the pressures and heroics of your job and accuses you of spending most of your time "playing cards?"

Senator Walsh's answer, I would assume, to most of these questions above would be a resounding "NO."

The answer to most of these questions above, when asked to a majority of our country's great nurses, would be a resounding "YES!" And trust me, those few questions above don't even begin to explore and explain the depths of demands placed on our nursing staff.

Further, there is not one nurse--I repeat, not one nurse--in our country who will ever be able to answer "No" to the question of being insulted by someone in the public eye. I'm sure public insults have been issued before, but not in such an inflammatory and dismissive way as the manner in which Senator Walsh has chosen.

I find it pretty incredible to think that one's person's ignorant words and comments have fueled our great medical community to come together to support our nurses. I, for one, could not be happier for the outpouring of support, of love, and of appreciation that has been given to our nurses in light of Senator Walsh's words. I would not be able to stand here today as a competent and content physician had it not been for my "medical sisters" and "medical brothers," those nurses who have taught me, supported me, and stood by me through the very best and the very worst of what our jobs in the Emergency Department provide us.

To those of you affected by Senator Walsh's words, I salute you. For the lives of the patients you have saved, for the lives you have fought for, and for the lives you have influenced with your tremendous care and compassion, our medical community will always be appreciative and grateful. Please never forget that.

Heartfelt thanks...♥️

As always, big thanks for reading. Our nurses are some of the most amazing people I have, or will, ever meet. The demands of their jobs are relentless and unending. The outpouring of support for them has been well-deserved and long overdue. To work side-by-side with them has been my privilege...

To further understand the crisis involving today's medical climate, visit Defining Emergency.

Feel free to share and repost! Until next time...Jim

Wallowing In It

noreply@blogger.com (StorytellERdoc) — Fri, 08 Mar 2019 17:17:00 +0000

"Sometimes shit just happens."

Just a few days ago, I finished yet another string of four hectic shifts in the ER of our incredibly busy trauma center. After saying my goodbyes to my coworkers and transferring the care of my remaining patients to my partner, I left the building through our ambulance doors, avoiding the main pedestrian entranceway where the hectic waiting room sat.

It was a safe choice to leave this way, as it was 3 a.m. and both the ER and the waiting room were still swarming with much activity. Had I tried to navigate leaving through all the chaos of the waiting room, I would have been a target of many evil and angry stares from those patients who continued to sit there with non-emergent complaints, watching the lone TV that was looped with repeating segments regarding diet and fitness. Of course, who wouldn't want to learn the benefits of eating cauliflower and doing fifty daily sit-ups at 3 a.m., right? And I certainly didn't want to finish my night by getting the angry stink-eye from an eight year-old girl waiting three hours for her rash to be treated.

As the sliding glass doors of the ambulance entrance opened up, a blast of cold winter air greeted me, daring me to leave the warmth of the ER. Easy decision, of course. I stepped into the waiting night.

The pathway to my car was short, just a brisk walk on the sidewalk that leads to the parking garage. I traveled it quickly, arriving at the door in just minutes. Before grabbing the handle to open it, I glanced around at the illuminated surrounding landscape, appreciating the quiet and calm that accompanies this time of night.

I shouldn't have.

While sweeping my appreciative eyes, I noticed that just across the street, among a row of small pines, was a lone figure. It appeared to be a man, wearing a ski jacket and cap. He appeared to be squatting down toward the ground. My initial thought was that maybe this was someone in distress who needed my help. Maybe he dropped his keys, even, and was looking for them.

Twisting my torso to get a better look, I was able to better appreciate what I was looking at. Not only was this man squatting toward the ground, but his pants were down around his ankles. His bare ass, side profile, was in plain sight.

"What the heck is he doing?" I wondered to myself, blaming my lack of sleep for my ignorance.

Ugh. It took me a nanosecond to figure out the situation. This man was taking a shit. Right there, under the lights, in full view, among our hospital's lovely landscaping.

Of course, this scene caught me off-guard.

I wasn't able to turn away. I stood there, my hand ready to pull the door's handle, just staring. A million questions went through my head. Why there, instead of inside our waiting room bathroom? Do you have diarrhea? Are you sick? Do you have toilet paper? Is this going to leave a mess? Are you skillful enough to miss your pants and shoes? Are you homeless? Are you a CEO of a local company? Did you hope that no one would see you? Do you do this often? Are you afraid your ass is going to get frostbite? Are you going to pick up your mess with a baggie or leave it? Did you eat corn lately?

Finally, after a few seconds, I opened the door, got into my SUV, and drove me and my wild imagination home.

I loved the unexpectedness of this, of being caught off-guard, and couldn't help but chuckle to myself. After all, those of us who work in the ER, for the most part, have warped senses of humor. If I didn't laugh about a drunk patient vomiting on me or a patient having an accident during a rectal exam, I would never have survived my job for the past 22 years. And because we encounter body fluids every shift, whether it be blood or urine or pus or spit or vomit or phlegm or stool, nothing about this guy fertilizing those little spruce trees grossed me out.

Let me take a moment here to send a big thank you to the inventors of shoe covers, gloves, face shields and body gowns.

Of course, I should have predicted something like this scene would have happened after I left my shift. You see, right before leaving, a small group of us had a conversation about how much shit we had seen during our recent shifts. Literally, shit. So clearly, I had jinxed myself.

You want some recent examples about this dilemma? Okay, then...

I had a recent homeless patient, otherwise healthy and capable, who shit himself in his bed without any warning to our staff. "Why did you do this?" the nurse asked him. "Because I didn't want to get up and go to the bathroom," he answered. Our wonderful team of aides cleaned him up, got him fresh clothing, fed him, and ultimately we were able to place him into one of our homeless shelters. A taxi was called and picked up this patient to take him. In ten minutes, though, the taxi returned, dropping this patient back off at our entrance. The reason? This patient decided to take another dump and urinate in the backseat of the taxi. "Why did you do this?" he was asked again. "Because I didn't want to wait." The upset taxi driver, of course, made it very clear that our hospital would be footing the bill to have his cab cleaned out. Sounds fair.

Also during my past shifts, two younger patients came to our ER to torment us and have their bowel movements in our ER cots. The first, a female college junior, got so drunk that she needed to be brought to us for IV fluids and monitoring. Within an hour of her arrival, an obnoxious but familiar smell began to fill up the corner hallway near her room. Yes, she had shit herself. It's amazing how some alcohol can totally absolve one from such vulgar activities. Then, to add insult to injury, after being cleaned up, she decided to show us who's the boss and she shit herself again.

The second patient, a man in his early thirties, came to us after using methadone. He, like the college student, also was stable but needed monitoring and some treatment. And he, like the college student, also decided to relieve himself during his dream state. Not long after he arrived to us, his nurse was asking for help to roll this patient and change him into some clean clothes. No, she was not wearing a smile while asking.

When patients come to us, a part of our job is to preserve their belongings while they are in gowns and being treated. Usually, these belongings are put in a clear plastic bag, with a drawstring, and kept with the patient until their disposition to either be admitted or discharged. The question was brought up--should we take these messy belongings (i.e., their stained pants and underwear) and keep them safe or do we throw them out? If we keep them safe, should we place their cell phone and wallet and keys at the bottom of the bag and then put their dirty clothes in, so that they have to wade through the muck (just like our team did during clean-up) to get them? Your thoughts?

Of course, it goes without saying that there are patients who are completely forgiven for their accidents. We are all human and each of us will have (if you haven't already) an accident along our life journey. Especially, elderly patients deserve and receive compassion and understanding when this occurs. Some of these wonderful patients are embarrassed and humbled and regretful when this happens, and my heart melts for them. Patients with a wicked case of food poisoning or stomach flu also deserve a break. The list of forgiving reasons is short, but it does exist.

Case in-point. Recently, I treated an ill but gracious female patient who came to our ER with her husband. She had a fever and a wicked case of nausea and vomiting with diarrhea. After multiple bouts of diarrhea at home, they came to us by private vehicle. Along the way, this patient had more diarrheal and vomiting accidents in their car. Everything she was wearing was soiled. Arriving to our facility, she had to walk through our security station (yes, they swept her for weapons with a wand) and our waiting room before being brought back to her room. Talk about a walk of shame! In her room, she had yet another accident. We all felt bad for her. Seriously.

Arriving home and pulling into my driveway, my mind went from all these thoughts back to my squatting friend. Catching him in his private moment dominated my thoughts for my twenty minute ride home and took my mind in the directions above. I wondered if someday I would ever be caught squatting outside, pants down around my ankles, grunting and doing my business with reckless abandon. If so, would I have an extra Kleenex in my pocket? Would I be smiling a devilish smile while doing it? Would I do it during the day or wait until nighttime? Would someone spot me the way I spotted this fellow? If so, with my luck, it would be a newspaper reporter holding a camera.

I'm hopeful I won't ever be in this position but one never knows for sure. I'm sure this guy didn't plan on having a witness. Maybe one day, I wondered, I might be a patient in the ER having an accident. This would be a more likely scenario. If so, it will probably happen when I am elderly and obsessed with my bowel movements and the amount of daily fiber I am intaking. Or maybe I will just be an angry old man who needs to show the ER staff who's boss.

I doubt, though, that it will happen due to me being intoxicated or high on methadone.

After all, I don't have time for that shit.

As always, big thanks for reading. Feel free to share this essay and your thoughts.

Enjoy the day!
Jim

Fleece Pajama Bottoms 2019

noreply@blogger.com (StorytellERdoc) — Fri, 01 Mar 2019 13:00:00 +0000

People will stare. Make it worth their while.

Can someone please tell me the exact moment when fleece pajama bottoms became the fashion sensibility of America?

I can't pinpoint the moment exactly, but several years ago I began to notice that many of our ER patients were presenting for treatment wearing nice fluffy fleece bottoms. Men. Women. Old. Young. These fleece bottoms seemed to be enjoyed by a variety of the population. Most of these earlier bottoms for the younger patients were of superheroes and childhood figures, like kitties and ponies. For the older patients, it seemed like the characters from the adult-cartoons The Simpsons and The Family Guy were a big hit.

Being a new sort of fashion, I enjoyed the earlier era of these pajama bottoms. They seemed to be appropriate wear for some of our sicker patients who didn't have the energy to change out of their bed wear before coming to us for medical help. Especially the kids, who often had matching fleece blankets, I enjoyed the style of these pajamas and the apparent comfort they seemed to provide.

In no time, though, it seemed like these pajama bottoms began to be worn not only by the patient, but by family members. Little Sally, who was brought to our ER by her parents for vomiting and diarrhea, was not the only family member wearing cartoon pajama bottoms. So were Mom, Dad, and her older brother. "Little Pony is my favorite!" she exclaimed to me. I wonder if it was Mom's favorite, too, since she bore matching bottoms. It all made some sense, though. It was 10 pm and everybody was probably either getting ready for bed or in bed when the decision to bring Sally in was made.

I should have gotten more suspect of this trend, though, when over the next few weeks to months, more and more people began showing up wearing fleece pajama bottoms. Even moreso, they were being worn sometimes not by the patients, but rather by their supportive family and friends. There sat Larry in his hospital bed, with chest pain and difficulty breathing, being supported at bedside by his adult son and daughter as well as his grandson. The grandson, of course, looked handsome in his wind pants and sweatshirt. His children, however, looked less put-together--his son wearing Steeler fleece PJ bottoms while his daughter's were plastered with Lisa Simpson's face.

At 2 pm. On a weekday. In the summer. With abundant sunshine outside.

Of course, Larry was lucky to feel the love of his family at bedside, regardless of their attire. The bigger picture wasn't lost on me. Yet, it was interesting to see the fashion pendulum swinging into an area where fleece bottoms were becoming acceptable wear at all hours and in all weather.

Although I initially thought so, I can't say that this trend is related to economics. Recently, at Walmart, we discovered a whole array of very cool, bright patterned fleece pajama bottoms. Cartoon characters, Marvel superheroes, sporting team emblems, camouflage, even imitation Burberry plaids--the selection was impressive. And the cost? $11.96 for the cheapest bottoms. And the rack next to them? Sweat pants for $6.00.

Goodbye yoga pants, khakis, jeans, and sweatpants. Fleece pajama bottoms might be here to stay. I never thought the day would come when I would rather see an old ratty pair of sweatpants on someone instead of SpongeBob fleece PJ bottoms.

Over the last few years, then, it has become common practice in our ER to treat people of all ages, from all walks of life, in all weather, in all type of medical emergency scenarios, wearing these bottoms as a staple to their outfit. It seems like Stewie Griffin's big bald baby head on PJ bottoms can go with a nice pair of boots and a cable-knit, turtleneck sweater on a middle-aged woman. SpongeBob bottoms go great with a Dallas Cowboy t-shirt and a John Deere ball cap on a college kid. And Hello Kitty--well, Hello Kitty can pretty much write her own ticket to all the various outfits she ties together. She even purrs when paired with a half shirt that says "Who needs brains when you have these." Yes, I am being serious.

Not only were these PJ bottoms being worn by patients and their families in our ER, but it seems that these fleece PJs are now a staple in public as well. Recently, I was in line at a local market during midday. Fourth in line at the check-out. And as I was assessing how long my wait would be, it suddenly struck me that the three people checking out in front of me were all in fleece pajama bottoms. The person in front of me, unfortunately, smelled and looked like he had just rolled out of bed. His hair was matted and greasy; his body smelled of yesterday's stale fart. It seemed as if his lack of effort to shower and be presentable in public was excused by wearing his Batman PJs in public. Being an eternal optimist, I was hopeful he was just delaying his shower until after he got his filet mignon cooking on the grill when he got home.

Standing behind those three, at that moment, I had a moment of serious introspection. I felt like the odd-man-out. I looked down at my clothes. A white t-shirt. Hudson jeans. Brown boots. Nike ball cap. Should I succumb and become a slave to fashion? Maybe, I wondered, a pair of My Little Pony bottoms, adult size medium, would make me feel more at peace with myself.

After sharing this story with my co-workers, they assured me that the marketplace and our emergency department are not the only privileged destinations of fleece bottoms these days. Kids are wearing these fleece PJ bottoms to school. All ages are wearing them to sporting events. To club activities. To parties. To movies. To family functions. It seems that there is no place immune to the progressive fashions of fleece PJ bottoms.

Oh wait! I don't recall any PJ bottoms on the red carpet while watching the highlights of the recent Oscars. Did I miss something? Maybe Glenn Close should have skipped her designer gown for a pair of Wonder Woman fleece bottoms. With Christian Louboutin heels, of course.

How do you all feel about this new trend? Have you witnessed similar encounters? If you work in a medical office or in the hospital, how rampant do you think this trend is becoming? Where else have you seen this trend pushing the limits? Most importantly, have you worn your PJ bottoms out in public yourself? Be honest!

I have seen people do double takes to get a second glance at some of the people wearing the newest PJ fashions. When the PJs are clean, they don't look so bad. When they look like they haven't been washed in two weeks, well...second glance deserved. And when they stink like they haven't been washed in two weeks, a wrinkle of the nose is just as well-deserved.

I can only imagine what our grandparents would say about this fashion trend, what with the strict dress code they had when they were growing up (some even in desperate times). "Heck," I heard an elder physician at work exclaim recently when complaining about this trend, "if I ever went out in public like that, I wouldn't have ever seen the light of day again. What has happened to people?"

I guess at this point most of us are immune to the trend. Accepting of it. I do appreciate some of the eye-catching outfits that involve these PJ bottoms. Some of the designs and patterns are hip. And I appreciate the surprise factor of people wearing them, still. Of their courage, or maybe it's their apathy, of wearing them in public and incorporating them into their everyday wear. And let's be honest, it's kind of cool to see the same design being worn by an infant, her mother, and her grandmother at the same time.

Well, as long as they aren't related to me...

As I said before, and I'll say it again, I love my job and my patients. For so many reasons. After all, where else would I get to meet an attractive, sophisticated, gray-haired elderly woman wearing a trim blouse with concise lipstick and well-placed rouge...and fleece pajama bottoms with marijuana leaves patterned on them.

"I just love my hibiscus plants," she explained.

Enough said...

As always, big thanks for reading. Feel free to repost the essay and share your thoughts.
This cheeky post was written after a long stretch of rough shifts.
Enjoy the day!
More to come...

It's Not About The Pus

noreply@blogger.com (StorytellERdoc) — Tue, 19 Feb 2019 16:23:00 +0000

To Dr. Sandra Lee. Heartfelt thanks for humanizing medicine and for inspiring along the way...

Several years ago, my daughter Emma introduced me to some videos on YouTube of a dermatologist from California who posted her sometimes shocking but always intriguing encounters with patients who suffered from a variety of dermatologic issues. Of all of these videos, it seemed like the ones which made Emma happiest to watch were the videos in which this doctor's treatment resulted in gallons of pus draining from some part of the patient's body.

Well, okay--Emma liked pus and blackheads. Well, pus and blackheads and massive lipomas (fat-based tumors). Well, pus and blackheads and massive lipomas and big hairy moles. Well...

You get the picture.

With some great finesse and skill, and with a good mix of humor and learning, Dr. Sandra Lee, better known as Dr. Pimple Popper, was able to help many embarrassed patients survive their dermatologic issues, all the while captivating my daughter's interest. "Eewww, gross," Emma said. "Let's watch it again!"

Suddenly, my job as an ER physician was boring. Stories of heart attacks, strokes, traumas, broken bones, asthma attacks, allergic reactions, even drunks vomiting on me at 3 am--none of them held any excitement compared to the ten-year old massive cyst that Dr. Lee excised from a women's scalp or the golf ball-sized lipoma she removed from the upper back of a man who hid it by wearing a draped shirt. Yes, it was intriguing even for me to watch. How was I going to compete with Dr. Lee popping juice out of everything she touched?

I lost my daughter to the wonders of Dr. Lee. "Dr. Pimple Popper is so great, Dad!"

Not only Emma, but soon my friends and family were asking if I did "the stuff that Dr. Pimple Popper does." They too couldn't seem to get enough of the various videos posted on YouTube. And like Emma, more pus equaled more entertainment. Pus that flew across the room--well, that created a giddiness that could not be contained.

"Yes," I would answer, "sometimes I have to drain an abscess from someone's armpit or groin due to an ingrown hair. Sometimes I have to drain abscesses from wounds, too." For good measure, I added, "And sometimes I have to drain a thrombosed hemorrhoid." I know there are many more invasive procedures we perform in the ER that could be considered similar, but I couldn't think of them quickly enough. At least, I thought, I would get asked what "thrombosed" meant, right?

I was wrong. After finding out that most of my procedures were performed on problems smaller than the size of a tennis ball, my people lost interest.

As the last few years passed, I was happy to catch an occasional YouTube video of Dr. Pimple Popper. Dr. Lee's contagious personality and warm smile, combined with her intelligence and skills, helped her to create a spectacular vehicle, by use of videos, to share the fascinations of her profession. She was a natural at bringing some amazing stuff to eager viewers who were insatiable for her.

On a recent trip with friends to Toronto to celebrate the arrival of 2019, we had returned to our hotel rooms one afternoon to rest for a few hours after a very late previous night of fun. While channel-surfing, I was excited to rediscover Dr. Lee and learn of her new television show on TLC. Desperately needing a nap, I committed myself to just watching her for ten minutes, maybe fifteen at most.

Fifteen minutes turned into two hours. In the blink of an eye.

This time, though, watching Dr. Lee was a very different experience. Yes, all of the fascinating lumps and bumps and lesions that needed squeezed, drained and excised still existed. Yes, white and brown and green and black pus still oozed from the majority of her patients. Yes, many of her patients still found brilliant ways to hide their ailments for years, under wigs and baggy clothing or with caked-on makeup.

This time though, among all the hoopla, I was able to appreciate Dr. Lee's magnificent mannerisms, her empathy, her compassion--her realness, so to speak--in dealing with her patients. Recognizing these things initially, I believe, had gotten lost within all the other excitement. I was more focused on how fast she could duck away from some flying pus rather than her gentle approach to patient care.

For example, after a patient was kindly greeted by office staff and placed in an exam room, the real magic began. Dr. Lee would softly knock on the door of the treatment room before entering, wearing a smile and exuding warmth. As she approached the patient, hand extended in greeting, she would establish eye contact with the patient and introduce herself with a gentle and calm voice (sometimes simply by her first name). From there, if anyone else was in the room, she would turn her attention to them, making sure to introduce herself, repeating the process until she was acquainted with each person in the room. After introductions, she would sit down (yes, sit!!!) and begin her interview with the patient, involving the patient's company, learning everything she could about the reasons a patient was visiting her. Respect was given and received. Eventually, a wonderful level of comfort was achieved.

I could continue on with the importance of Dr. Lee's empathy and compassion while performing a detailed exam, explaining her findings of the exam, reviewing test results and options to treatment, and mapping out the future course of dealing with a patient's ailment, but it all seems rather obvious, right?

Or does it?

You would be surprised at the number of patients who go through the process of a medical encounter only to leave with confusion, frustration, or feeling worse than prior to their encounter. No introductions. Standing at bedside with arms folded, appearing disengaged and aggravated. Rushed conversation. No updates. Abbreviated result explanations and dispositions. This is the reality of an encounter for many patients.

Ugh.

Recently, a close friend of mine had to take his elderly mother to a rural ER twice, in a span of two weeks, for some serious and concerning symptoms. To hear him talk of the vast difference in the care they received, by the same facility but different treating teams, was upsetting. During the first encounter, introductions were made, respect was given, explanations were provided, and a detailed treatment plan was initiated. During the second visit, there were no introductions by either the physician or nursing team. His mother was dismissed or hushed each time she tried to explain her symptoms in some depth. They were made to feel like a nuisance. No rechecks were performed. They sat around for five hours wondering what was going on. Their questions brought no answers. "And Jim," he said, "only about five of the twenty rooms had patients in them." My buddy's family was truly disheartened and discouraged by the encounter.

Years ago, during my emergency medicine residency in Syracuse, we had a physician who gave lectures to us on the importance of empathy and compassion. Being young-guns in a big trauma center, Dr. Ruth's lectures were not nearly as exciting to my buddies and I as compared to lectures on how to drain an expanding epidural hematoma (a potentially fatal arterial brain bleed) or perform an emergency thoracotomy in a trauma patient (rapidly opening the chest between ribs to clamp a sheared aorta or contain bleeding from a punctured heart or lung, for example).

Yet, it was during residency when I truly realized the power and magnificence of empathy and compassion in medicine. Of respect and dignity. Of smiling and bringing into a patient's room good energy. Of sitting down if even but for a few minutes. Of introductions and eye contact to all in the room, not just the patient. Of a warm handshake. Of explaining findings of the exam, of the testing and procedures to be done and the ensuing results, and of a plan moving forward. Of rechecking the patient during their medical visit. Of properly closing the loop of their visit with a goodbye or good luck wish.

Of being human.

This was a crusade I took up while working with our residents as a core faculty advisor. I became Dr. Ruth, insisting on my residents bringing their very best to each patient encounter. While empathy and compassion and ease of conversation was inherent and easier for some residents, for others more time and work needed to be invested to improve this part of their patient encounters. An investment, I stressed, that was worth pursuing.

Yes, the ER gets busy. Crazy and insanely busy. I get it. I've witness it firsthand for 22 years as an ER attending physician. However, all of these things mentioned above take just a few extra minutes. Providing anything less is met with too many excuses. Occasionally, in the emergency setting, it truly is beyond our control that we simply can not provide more empathy or time to a patient (think about a car accident with four critical victims arriving at the same time). Otherwise, if it were me or my family or friend lying in that hospital cot as a patient, I would greatly appreciate those few extra minutes of kindness and compassion provided by the treating medical personnel.

What if it was you or your family member?

Returning to Dr. Lee's TV show, then, on that lazy afternoon in Toronto, I greatly appreciated her kind approach to each patient. Sure, she might have more time working in an office setting that is more predictable and controlled compared to my working environment in a big trauma center. Sure, she is being taped to splice together some great scenes and moments of the various care she provides. Sure, anyone might give a little more of themselves if they know they are being watched. However, Dr. Lee consistently demonstrated her excellent bedside manner with each patient encounter I watched. She excelled and inspired in a part of medicine that is often ignored and overlooked, all for the sake of moving more patients in and out and increasing the billing so more profits could be made.

I could have cared less about how much pus would fly out of her next abscess or where it would land. I was enthralled on simply watching a great doctor doing her job well, from every perspective.

I hope Emma was, too.

Thanks, Dr. Pimple Popper. It was never really about the pus...

As always, big thanks for reading. What are your thoughts and experiences?

Feel free to forward or share this post. To visit some of my favorites listed from the archives, visit Thank You...

I continue to be amazed with the amount of support and readership. My heartfelt appreciation to all...

4, 3, 2, 1 And 90.

noreply@blogger.com (StorytellERdoc) — Tue, 12 Feb 2019 14:08:00 +0000

Everyone you meet is fighting a battle you know nothing about.
Be kind.
Always.

One of the largest problems in our ER, it seems, is that there is a subset of patients who visit us on a routine basis. Commonly known as "the regulars," these familiar faces are sprinkled throughout our day between all our other patient visits. Whether it be for chronic pain, for chronic illness, for companionship, simply to have a place to hang out for a few hours, or to get some food, we are often inundated with these patients at the most inopportune times. Three trauma patients, four chest pain patients, two stroke patients, seven respiratory distress patients, three lacerations, two compound fractures, and five sick kids--and arriving between all of this organized commotion of providing good care are Johnny, Sally, and Herb, with a combined total of over two hundred visits between them.

It is a real problem in our ER. It is a real problem nationwide.

Of course, the most compassionate thing to do would be to sit down and spend some time with these patients. Human to human. Heart to heart. It seems like most of these patients simply exist in our society without participation. Unfortunately, though, this is not our reality. We just don't have the time among all the other serious happenings in our ER that require our attention. We can consult our case managers to evaluate options of living arrangements, of providing adult services, and to spend a few extra minutes with these patients, but they too are often overwhelmed with what's required from them in our busy ER. Hopefully, between the attention given to them between myself, the nursing staff, our aides, and our case managers, their needs for that day's visit are met.

As an outsider without experiences in the ER, it might be hard to fathom this problem existing to such a degree. So imagine your sick child with a high fever and trouble breathing, your sick friend or family member who has chest pain or a facial droop with difficulty talking, or yourself after a car accident being brought to us because your leg is deformed with a bone sticking out, and you can easily understand what patients require more of our time and attention. Sadly, it is not Johnny, Sally, or Herb. You would want us, your treatment team, to be fully invested and immediately available to you or your loved one in such a dire time.

On the rare occasion that our ER is not busy and one of our regulars show up, though, I do like to take the time to sit down and learn a bit more about them. These moments when I have this opportunity, I am usually surprised at some of the things I learn from our regulars. Their stories are compelling--some of these patients experienced things that I never will, whether it be heartaches or triumphs. It is from these talks that I am usually the one leaving the encounter more enriched and appreciative. These folks are resilient and intelligent--some are quite the masters of storytelling and all of them have life stories that are intriguing.

On a recent shift, still busy but not overwhelming, I had the pleasure to treat Kevin, another one of our regulars, and spend a little more time with him than I would usually be afforded. In his mid-fifties, Kevin was homeless. He was frail and had unfortunately progressed to relying on a walker, due to a multitude of medical problems, for ambulation. His last visit to our ER was just three days prior.

Walking into Room 22, then, it didn't surprise me to see Kevin sitting in his cot and his royal blue walker sitting in the room's corner. Several tan plastic bags (with a local market's emblem) occupied both his walker's seat as well as a maroon hospital chair. These bags contained all his life's belongings. His beat-up brown Carhartt jacket filled the second chair.

"Kevin," I said, entering the room after knocking on the metal frame and pulling aside the curtain, "it's good to see you this morning." Extending my hand to his, we shook as I took in his appearance. Kevin looked tired, wiped-out, skinnier and worse for the wear since the last time I had seen him. His full head of gray hair and beard were matted and unkempt. His blue eyes were dull. Nasal hairs met his upper lip. A patch of keratosis on his left temple was scaly and pale. His pointed nose and thin lips added sadness to his narrow, long face. His arms and legs were wiry and bony. He was frail.

Kevin looked intently at me, holding tightly a large cup of coffee in his left hand. "Hi Doc," he said, his voice hushed, as it was usually. "My stomach is upset and I feel like I have to puke." After speaking, he took a long drink of his coffee.

"Sorry to hear this, Kevin," I said. His ability to drink coffee, despite his complaints of nausea and stomach pain, was not lost on me.

After asking him a multitude of questions (diarrhea or constipation? fever? where is the pain? how long have you had it? constant or intermittent? ever have this pain before? etc.), it was clear from Kevin's nonspecific answers that he might have had other goals, rather than acute illness, for visiting our ER this day.

"Maybe my belly hurts sometimes, Doc."
"I'm not sure how long I've felt this way."
"No, I didn't puke, but I thought I was going to yesterday."
"Sometimes I have a good shit in the morning. Sometimes I don't."
"This coffee helps my stomach, Doc. Can I have more?"
"Do you still have packs of crackers?"
"It's cold out there today."
"I might need to stay in the hospital for a few days, right?"

You could see the natural progression of his answers and what his intent was in coming to the ER.

I performed a detailed exam and found him, despite his chronic medical issues, to be stable and well from an emergency perspective. Labs were drawn, a urine sample sent, an EKG performed. All his results were favorable. Kevin deserved this workup to make sure he was safe.

"Kevin," I asked, after finishing the interview and physical exam and reviewing his results, "is there anything else we can help you with today? It seems that your exam and results are okay today, so this is a good visit."

And this is where Kevin broke me and exposed the weaknesses of our system and my job. "So, Doc," he asked, his dull eyes fixing on mine, "you are going to just send me back into the world then?"

Ugh! What a question. "Yes, Kevin," I said, "we are going to have to send you back into the world."

"Why can't you admit me? Even for just tonight?" He took another swig of his coffee.

My hands were tied. I certainly couldn't admit him--the hospital isn't for this purpose. Yes, we could see what we could do about his safety. Yes, we could feed him. Yes, we could spend a few extra minutes with him this visit. In fact, Kevin's nurse, Nurse Pearl, was as invested in Kevin as much as I was. Even more. With her blond hair, calm voice, caring demeanor and big heart, Nurse Pearl was the perfect nurse to care for Kevin during his visit this day. She spent much of her free time with him--she cleaned him up, washed his face and even put hospital-issued socks on his feet. I commended her for her compassion to which she replied, "There's something about being clean and washing one's face that makes people feel human again."

Together, we formulated a plan. We agreed to try to find Kevin some food. She and I agreed to get our case management team involved to see what our options in helping Kevin might be on this day.

After five minutes, we reconvened in Kevin's room. He had already put on his Carhartt jacket and was packing his filled plastic bags into the small compartments on his walker. "Kevin," we said, proud of ourselves, "here are a few things we found to help you." And we spilled our contents in front of him.

Four breakfast bars.
Three juice boxes.
Two turkey sandwiches.

Kevin seemed quite grateful for this attention and supplies.

Nurse Pearl and I were on the same page. Handing out food in the ER under these circumstances can sometimes be quite conflicting among my co-workers. Some are of the belief that we shouldn't, as it might encourage more visits among these patients. Others, like Nurse Pearl and I, believe that these patients will be returning regardless of the food handouts. The root of this problem, to us, lies deeper. It seems too many of our patients are lacking support, proper care (including mental health issues), and safe environments during their hardest of times. The answer? I wish I had one... do you? Discussing this dilemma with my 89 year old father, though, was simplified to this. "Jimmy," he said, "you have to do the right thing--if you can help feed a person who's hungry, why wouldn't you?"

After the case management consultation, we were able to help place Kevin into a shelter. In fact, Nurse Pearl went so far as to arrange a taxi to safely transfer Kevin to the shelter. Prior to leaving, Kevin could not contain his gratitude. "Thank you, sir." "Thank you, ma'am." Have a nice day." "This is really great." "I am really happy."

One community shelter.

All in all, it was a good day for Kevin. More importantly, if was a good day for Nurse Pearl, myself and our support team. We were reminded that empathy and compassion for one another must never be lost or forgotten during these privileged encounters.

Ninety minutes.

The amount of time Kevin was in our ER, reminding us of the the real reasons most of us chose to go into medicine.

Some things you just can't learn in a textbook. You learn it from your heart.

As always, big thanks for reading. What are your thoughts? It was wonderful to have the time to spend with Kevin, which isn't always the case in our extremely busy ER/trauma center.

Feel free to forward or share this post.

Thanks to each of you for the overwhelming response to my return. Your comments on here as well as Facebook, email, and Instagram have been generous, kind, and inspiring... I am grateful.

To Care Or Not

noreply@blogger.com (StorytellERdoc) — Fri, 08 Feb 2019 12:41:00 +0000

I dedicate this to each of you who have cared for or are currently caring for an ill parent or family member.

Recently, due to the stress that several of my dearest friends have been experiencing in caring for their elderly parents, I am even more appreciative and respectful of my privilege in caring for elderly patients who have attentive and loving adult children who accompany them to our ER.

Although this may seem like it should be the standard, you would be surprised at just how many elderly patients present to our emergency department alone. At times, it is heart-breaking to hear their shared stories of being the lone survivor of their family, of being estranged from their children, or of having geographical factors contribute to their aloneness in presenting to me for care. So when an adult child is present, I make it a point to not only introduce myself to them, but also to thank them for being available for their parent. Including them in providing more history and in discussions about testing and treatment plans for their parent benefits not only their parent, but also myself and my team. I am grateful for their presence and input.

A few months back, however, I had both the pleasure and discomfort of witnessing two vastly different situations in how adult children interacted with their parents.

The first interaction came early in my day shift. I had just rounded the corner of one of our busier hallways near our noisy triage area to find a favorite aide leading a family from our waiting room down the hallway toward their assigned room. The family consisted of two middle-aged adults, a teen-aged boy, and an elderly woman who relied on a walker to ambulate. As the tech led this family, it became clear to me that the elderly woman was struggling, lagging behind the others. Noticing this, I stepped forward as the aide simultaneously stepped back to help this woman continue forward with less struggle.

The woman, who was wearing a simple purple dress with white walking shoes, with messed shoulder-length grey hair, was quite appreciative for our efforts. She paused to look with her wrinkled face first at the aide, and then to me on her other side, rewarding me with a warm, generous smile. Even tired, she had a gleam in her eyes that conveyed her gratitude.

Sadly, the members of her family didn't want to be bothered. Asking the aide for their mother's room number, they continued down the hallway at their own rushed pace, walking into the opened door of Room 31, which was about 50 yards away. The aide and I glanced at one another, with a look of bewilderment, before continuing onward in guiding this patient. By the time we got to Room 31, the patient's family had already turned on the TV, both adults sitting in provided maroon chairs and the teen-age kid sitting on the edge of the bed.

Ugh. The aide and I continued to lead the patient into the room. Together, after asking the teen-ager to get off the bed, the aide and I eased the patient onto a stepping stool before hoisting her into the bed. We sat the back up for her to be more comfortable. All the while, the three family members, who I learned later to be her son, her daughter, and grandson, focused all their attention onto a sporting event on the TV.

You get the picture, right? Clearly, this was not to be another love story I would bear witness to and write about between an adult child and his parent (visit A Love Story). I am not naive enough to believe that all parents are perfect, and that some may have made mistakes or caused pain to a child--I am simply stating that as an outsider, this is a hard scenario for me to witness.

I left the room as the aide was changing this patient into a gown. Later, she found me.

"Can you believe that family? I would never ignore my mother that way. They were so annoyed to be here and didn't even say a word to her!" The family bordered on making Lauren angry, and that wasn't a good thing.

As I was not this patient's treating physician, I shared the story with my partner, who was treating the patient. His experience was disheartening. It seemed the family was completely uninvested in their mother's care, opting to ignore her while they watched TV before visiting the cafeteria to eat, returning only to act annoyed that they still had to wait for her results. After it was decided that this patient would be admitted, the family, instead of waiting for their mother's room number and assignment, left. Their mother would be transported to her admission room without any supportive family accompanying her.

Later in the shift, thankfully, I was privileged to witness an outpouring of love between a parent and her grown children during a visit.

Margie, my 72 year-old patient, was a beautiful spirit trapped in a failing body. Her short brown-dyed hair, her worried face, her clear eyes with underlying dark circles, her protruding cheekbones, and her thin frail body sat upright in her cot, covered in several warm blankets in attempts to help her chills and aches. Despite her fragility, she greeted me in sassy way.

"Well, hello there. Are you going to be my doctor today?" she asked as I entered her room

"I am, ma'am," I said, extending my hand to her. Her hand, cool and boney, felt fragile in my grip.

"Good then," she said, "let's get busy and figure out what is wrong with me."

Immediately, I liked Ms. Margie. She had a coy yet innocent way about her.

In the corner of her room sat her three adult children, two women and a man. All three were attractive and had their mother's clear eyes. They appeared nervous, of course, and I sensed that their mother's reason for being here was going to be a serious one. I walked over to them and introduced myself to each of them, shaking their hands and learning their names. As customary, I thanked them for being in the ER with their mother.

"You do know how much you are loved, right Ms. Margie?" I said, starting the conversation. "You have not one, not two, but three children with you tonight. How wonderful and blessed are you. I don't see this much support too often."

"I am a lucky lady," she said pensively. At that, one of the daughter's spoke up. "No, Dr. Jim, we're the lucky ones." I liked these children as much as I liked their mother.

As I interviewed Ms. Margie, it was refreshing to see how all three kids were involved in her life and knowledgeable about her symptoms. It seemed all three of them, each with their own family to attend to, took turns spending an unselfish amount of time with her. Several years prior, her husband and their father had passed. Ms. Margie, with her fierce independent streak, insisted on remaining at her home and the kids did everything possible to continue making her comfortable.

As I gathered information from Ms. Margie and her kids about her symptoms, I felt my concern for her well-being exponentially increase. She smoked although "I've really been trying to quit, Dr. Jim." She had several months of significant weight loss with increasing fatigue and weakness and, despite her children's urging, refused to see a doctor until several weeks prior to her visit with me. Finally, with her continued deterioration, she agreed to her children's requests to come to the ER for some workup.

Her workup was heart-breaking. Initially, her chest x-ray revealed a pretty large mass in her lung. While Ms. Margie was over in the radiology department getting both a CT of her chest and brain for further investigation of this mass, I stopped into her room to visit with her kids.

"Are you all doing okay?" I asked, opening up a chance for them to express their concerns.

And they did. "Is it cancer?" I answered that I was very suspicious of this, yes. "Is Mom going to die?" I told them that we had several bridges to cross to figure out exactly what it was and what we could do about their mother's results. "Should we share any bad results with Mom?" Yes, I said. I told them that most patients inherently have a feeling when something isn't right, and their mother was one of those patients who would not want any of the results sugar-coated.

They continued to ask questions, all rooted from a very deep, endless well of love for their mother.

Finally, one of the daughter's broke down and started crying. I walked over to her and gave her a hug. "I'm so sorry," I said, "but I think your mother, no matter what her results, is going to have the best support ever from you three." My compliment was sincere--Ms. Margie was blessed, no matter her results, to have these three children accompany her on this journey.

Unfortunately, Ms. Margie's results were devastating. Lung cancer--a huge mass residing in the right middle lobe. Brain metastasis--multiple lesions sprinkled throughout. Bone metastasis--"cystic lesions" consistent with cancer in her vertebrae.

Damn it all.

I went into the room and sat on the edge of her bed, explaining Ms. Margie's results to her while her three children crowded around her, holding her hands and stroking her hair. Though brave faces were attempted, tears fell plentiful and freely. Mine included. We admitted Ms. Margie to the hospital to have a variety of consultations and begin her journey of fighting cancer.

Despite such different situations involving adult children accompanying their ill parent to the ER, the depth of emotions I felt, whether good or bad, ran deep. I felt such despair over what I witnessed regarding the mother with her walker being ignored by her family. I felt such despair for Ms. Margie and her kids, too. The difference, though, was that this despair for Ms. Margie was minimized by the amount of hope, by the infinite love, and by the sincere compassion that her children provided unabashedly to her. The power of their presence and investment in her well-being was magnificent.

Ms. Margie was transported to her admission room with her three caring kids beside her.

I get it. Some parents failed their children. And some didn't. And the ripples from these relationships travel far. I understand that some of these relationships have a reason to be strained and forced. With all of these factors, though, I'm a pretty damn privileged guy when I get to bear witness to the unselfishness and unabashed love an adult child has for their ill parent.

I love my job...

As always, big thanks for reading. Have a great weekend. To my dear friends and each of you who are involved and invested in your parent's care, my hat is off to you. Big kudos for your unselfishness and love. Please feel free to share your thoughts or experiences.

Also, big thanks for the amazing support I received upon my return essay. It feels good to be back.

I Feel Things...

noreply@blogger.com (StorytellERdoc) — Tue, 05 Feb 2019 14:41:00 +0000

I'm back! Thanks to the many people in my life for their support and encouragement upon my returning--you know who you are! Please feel free to repost, share my return, and visit my archive!

Well, well, well...hello my long, lost friends. I missed you!

It seems like a long, long time since I have written a post for my blog, StorytellERdoc, and I am excited, nervous and humbled to be reentering your lives while returning to my baby.

What started as a small adventure and challenge from my writing group, with my first posting on November 19, 2009, turned into quite an amazing ride throughout the literary and social media world. The number of friends I met was staggering. I received recognition and awards. I won prizes. I was interviewed and contacted for my opinions. I got over a million hits. All of these things, though, were secondary to my intent. I simply wanted to pull you into my world, through my words, to focus on obscure life and ER moments that possessed a level of rawness and realness that connected you and I as fellow human beings. I wanted my words to be a reminder that choosing empathy and compassion over cynicism and sarcasm was possible.

On this journey, I posted 150 essays about life, patient encounters, and magnificent small moments--writings that to this day I can still read and feel the array of emotions I poured into my words. These writings made my heart swell, my eyes tear, and my smile broaden. They still do. My last post, on March 16, 2015, was not a planned exit from writing for my blog but, unfortunately, life happens and I needed to take some time to gather the bits of myself that became brittle and crumbled over the years. I had life lessons I needed to absorb. I had experiences I needed to process. I had to refocus my energy and passions and love onto the things and people that deserved my attention.

I am human and I have flaws. My life isn't perfect. Not even close. Now, though, it's in a much better place, thanks to a lot of internal work and introspection. I have more clarity.

I am back and stronger than ever. Personally, I look forward to sharing with you my journey. I hope to entwine my life experiences into my writings. Professionally, I still smile when I go to work, which is all I really need to say about that, right? The emergency department where I have worked for 22 years as an ER physician is busier than it's ever been. We are treating everything from devastating traumas to irritating hang nails. Among the 90,000 patients that we treat yearly, you can imagine the numerous interactions and situations that exist, simply waiting to be witnessed and observed.

I hope to be that witness, that observer. I hope to bring to you, through my storytelling, a perspective that is unique and intriguing in the way it unfolds the the human spirit with the laughter, the tears, the triumphs, and the pain of an encounter. Some stories will be personal, some will be professional, but all of them will be heartfelt.

In many ways, I am still the same person you got to know through my essays over the past few years. If you revisit these essays (visit the archive or try Gigi or The Witness), you will still capture my essence. As before, I still love my three amazing kids and my big forestry family. I still miss hearing my mother's voice. I still wear my heart on my sleeve. I still love my diverse friends and music and books and the gym and laughing and a good meal and sleeping in. I still love the privileges of my job--I continue to meet, accompany and treat some pretty amazing and memorable patients and their families during their stressful ER journeys.

In other ways, though, I have changed immensely. These changes will be revealed slowly, with time.

At this very moment, as I sit here in front of my computer screen, I am very nervous but grateful for the chance to enter your life with my stories. I offer my warmest thanks for your patience and time as I begin to expose my layers to you, once again.

While recently deciding to pursue this journey again, I signed into my ignored email account and was surprised to find many unopened emails from the past few years. They were wonderful, supportive, and encouraging. Some correspondences took the time to share their personal experiences and connections to my essays, and these emails made my decision to return even easier.

Let me share..."I don't remember what prompted it, but I ended up over at your blog the other day. What I thought would be a quick trip is turning into a multi-day journey back through all of the posts I read years ago. Once again, I was amazed at your gifted storytelling, your attention to detail and the way they're all seamlessly woven throughout, and the gentle, inspirational way you share with us readers perspectives we will otherwise never be able to see. Katie"

Again..."Thanks for the beautiful stories and insight from the physician's perspective. Please keep the stories coming. I look forward to each and every one. Thanks for sharing your experiences with us. They touch our hearts and many times make us smile and feel uplifted if only for but a while. Shirley"

And again..."Yours is not the first ER blog that I've read but there is an obvious difference. You don't seem to have the customary judgmental bitterness. I've been thinking about it and what makes you different from another doctor. I think part of it is that you are not afraid to feel things. Most of us spend our whole lives trying to get away from the bad/uncomfortable feelings. After a break up you stay busy and party with friends to avoid those feelings of sadness, etc. I think many ER doctors have shut themselves off from the feelings of their patients. Their goal is to become immune to the suffering by reason of self-preservation. You, on the other hand, seem to see that it's ok to be sad about something sad. You are not afraid to experience your feelings but you also don't live in them, either. I think this is why you've kept your humanity. Anyways, thank you very much for your writing. Jennifer"

So all my mumblings above come down to this...

I feel things...

I hope I can make you feel things, too...

Until next time...

As always, big thanks for reading. To all my faithful readers--hello, friends! Thank you for returning. To my new friends, thank you for giving me a chance. I look forward to sharing this incredible new journey with all of you!

Jim

It's All Innocent

noreply@blogger.com (StorytellERdoc) — Mon, 16 Mar 2015 15:00:00 +0000

Happy Monday, everybody!

Although I pride myself on catching the obscure snapshots of typical life moments that occur daily while dealing with patients and their families in the emergency department, occasionally there are times when I am so focused on the task at hand that I completely fail to see a glaring moment of obvious humor, sadness, or tenderness. At times like this, then, I am glad to have our hard-working nurses and techs with me in the room to bear witness to such events.

For example, recently I treated a 62 year-old retired kindergarten teacher who presented to our emergency department for a nosebleed. By appearances, she was exactly what you would picture a retired kindergarten teacher to look like--perfectly permed grey hair, kind eyes, folded "liver-spotted" hands resting in her lap, and the perfect amount of wrinkles at the corners of her eyes and mouth. If not for the actively dripping blood from her left nare (nostril) and the gory blood stains on her white cardigan sweater, I would have sworn she was there to simply to review my ABCs with me while I shoveled down a few cookies with a glass of cold milk.

Upon a brief interview, I learned that she had been feeling fine while visiting friends in our town. Suddenly, after a hard sneeze she started oozing blood from her nose. "I think I am allergic to my friend's cat." I smiled. Those of us in medicine know that most illnesses can be blamed on three things--cats, the flu shot, and fibromyalgia (public notice-->please do NOT get in a tizzy because I DO believe in the diagnosis of fibromyalgia).

Despite attempts at pinching and stuffing tissue after tissue into her nasal passage, this WWII Polish immigrant could not take care of the situation on her own. She learned that packing a bleeding nose was not as easy as packing potatoes into the perfect perogie. Thus, it was our team's pleasure to get to meet and treat Ms. Ilene for her medical issues.

After examining Ms. Ilene, I explained to her the process we would pursue in stopping her nosebleed. Initially, we would pack her nose with some cotton pledgets soaked in a vasoconstriction solution to shrink the diameters of her bleeding vessels. After five minutes, we would remove the pledgets. Finally, we would insert a modern-day torpedo-shaped product, coated with a clot-inducing mesh, and inflate it with air to the point where it would press against her septum to tamponade the bleeding vessel. She would keep this packing for several days to prevent further bleeding.

"Ms. Ilene," I warned her, "this may be a bit uncomfortable for you." By previous experiences, nosebleeds sometimes were a breeze to treat and other times could be quite a dastardly experience for the patient. Regardless, I loved treating nosebleeds, and she had a significant one that required us to be a bit more aggressive.

Just as we had explained, we successfully placed and removed the soaked pledgets. Moving on to the "Rocket," I prepared Ms. Ilene for the next step. "Ms. Ilene, this is the most difficult step. I apologize beforehand if it causes you any discomfort while I insert this," I said, sweeping my hand toward the apparatus.

With the nurse standing on Ms. Ilene's right side, holding a suction-wand in her one hand and Ms. Ilene's hand with her other, I inserted the "Rocket" like a pro. It was a much easier procedure than I anticipated.

"Wow," Ms. Ilene said, "that slipped in easy."

What followed, then, were several more comments caught by the nurse that I was oblivious to. She caught me up to speed between her giggles, though, after-the-fact in the nursing station.
"Doctor, you were really good at slipping it in."
"Is it in far enough?" (I had assured her that I had inserted the device far enough).
"I am glad it slipped in so easy."
"That wasn't bad at all for my first time."
"Wow, you inserted it deep!"
"Thank you for being so gentle."

In-the-moment and focused on the next task at-hand of inflating the rocket, though, I still couldn't understand why the nurse was grinning.

With a ten cc syringe, then, I began to inflate the "Rocket." "Ms. Ilene," I warned, "you are going to feel the 'Rocket' start to get more firm. The firmer it gets, though, the better it will do it's job."

"Good," she said, "make it nice and hard. Whatever it takes."

Again, another chuckle from the nurse. I remained oblivious.

Slowly, I inflated the "Rocket." One cc. Two cc. Three, four, five, six ccs. "How are you doing, ma'am?" I asked, pausing to give Ms. Ilene a little respite.

"I definitely feel it getting firmer," Ms. Ilene answered. "Good, then," I answered, palpating her exterior nose, "just what we want. I would like to inflate it just a little bit more."

She agreed. I proceeded. Seven cc. Eight cc. "How is that?" I asked, palpating her nose again. I was happy with the progress of things.

"Well," Ms. Ilene said, "it definitely feels firm. It is uncomfortable, but if you need to make it harder, go ahead and do your thing."

I swore I heard the nurse chuckle again. What the heck? I looked at her and could see the smiling squint of her eyes resting above the top edge of her mask. I gave her a questioning look.

Nine cc. "There, Ms. Ilene," I said, palpating her nose and briefly looking into her nasal passage, happy with my findings. "I think that is all we need to do. I think this is going to work out well for you."

"Good," she replied. " That wasn't nearly as bad as I thought it would be."

"Feel here," I said, guiding her finger to her lateral edge of her left nose, "see how firm that feels--that is exactly what we want. This will do the job."

"Yes, that definitely is swollen and firm," she confirmed.

I assured her that she was the perfect patient and that everything about her packing went really smoothly. I thanked her for being brave. After cleaning up a bit, the nurse and I walked out of the room and into the nursing station.

"What was so funny?" I asked the nurse, who sat down in her seat and covered her face with her hands to muffle her laughs. She couldn't control the shaking of her shoulders.

"Are you kidding?!" she exclaimed finally, after catching her breath. "You seriously did not get how funny that conversation would have been to someone standing outside of her room?"

I seriously didn't. After being refreshed about the conversation, though, I felt my face getting heated. I know I was turning red. And trust me, I am a hard one (no pun intended) to embarrass at this point in my career.

I dreaded going back into Ms. Ilene's room after being made aware of the conversation. Was she just as oblivious as I was as to how our conversation could have been interpreted by someone with wandering ears? However, after observing her for 30 minutes, I had no choice but to go back in to explain her blood results and my happiness with her vitals signs and end-result of the procedure. I requested for the nurse to accompany me, but she claimed she had an IV to start in another room. I knew, though, that there was no IV start and that she wanted me to face the situation on my own.

I slowly approached Ms. Ilene's room like a little kid about to face his parents for a well-deserved scolding. Slowly, I pulled her door open and slid her room's curtain to the side. I peered inside. I breathed a deep breath out. She was napping.

I touched her shoulder. "Ms. Ilene," I whispered. I shook her shoulder again. Slowly, she opened her eyes. She gazed around the room and took in her surroundings before fixing her eyes onto me. "Oh," she said, "it's you."

"How are you feeling?" I asked.

"I feel really well, Doctor," she answered. She paused before continuing. "I really want to thank you again for being so gentle about everything."

Ugh! I looked closely at her but could not see any hints of her being coy. She appeared to mean this very innocently. Darn the nurse for tainting such a nice encounter!

Gladly, I discharged Ms. Ilene from our department to followup with our ENT services in 48 hours since she would still be in town visiting her friend. I also advised that it would be okay for her to take an antihistamine for a few days if, in fact, an allergy to the cat was the main cause.

Later on, while rethinking this encounter, I realized that there are probably many moments in the emergency department, due to the highly personal nature of things, that could be interpreted as something more than the innocent interaction it really is. Thankfully, though, we carry on through these moments and keep them at the professional level they deserve to be. Well, most of the time...

Soon after, unfortunately, word associations began to process in my mind.

Nosebleed. Source. Allergy. Cat. Kindergarten teacher. ABCs. Reading. Dr. Seuss. The Cat In The Hat....Hmmmm, I wondered if Dr. Seuss ever had any innocent moments that could have been interpreted by an outsider as something coy or devious or silly. Did these moments happen everywhere in our lives or were these moments of innuendos predominant in the emergency department and the medical field?

I found my answer while perusing lists of Dr. Seuss's books to confirm that the emergency department is not isolated by such silliness. And there, within the lists, I found my answer.

The name of Dr. Seuss' book, the greatest of all childhood authors, that made me smile at the silliness of it all? Drum roll please...

There's A Wocket In My Pocket.

Enough said. I am on my way to the library right now to check it out.

As always, big thanks for reading. I hope this silly and embellished humor starts your week off right. It feels good to be writing again...

Where To Look

noreply@blogger.com (StorytellERdoc) — Mon, 09 Mar 2015 14:57:00 +0000

Big thanks to my many encouraging friends...it is with you in mind that I have returned with another post.

I walked into Room 30 to find two eager sets of eyes awaiting me. One set belonged to a young man, late-twenties, muscular and imposing, sitting in a chair in the corner of the room. His eyes were hazel brown, big and inviting, relieved at seeing my entry into their sheltered world. The other set of eyes, darker brown and magnified by her gold-stemmed glasses, belonged to my patient, a woman in her early-sixties. She sat upright in her treatment cot, knees drawn up to her chest and covered by the thin hospital-issued bed sheet.

Clearly, I had interrupted a conversation between them. Upon my entrance into their treatment room, they gave me the respect and gift of silence, a pause in which I would be able to introduce myself. As many of my fellow coworkers would confirm, this does not often happen. Rather, it is not unusual for us providers to walk into a treatment room only to wait for a patient to finish a cell phone conversation (while holding up an index finger indicating they are almost done), finish the last gulp of a bottle of soda or swallow the crumbled remains of a bag of chips. Worse yet, a patient sometimes will keep on talking to someone else in the room and behave as if we haven't even entered.

I liked this woman and man already.

Extending my hand, I introduced myself first to my patient, Ms. Loretta. "Hello, ma'am, my name is Dr. Jim and I will be taking care of you today." Turning to the man sitting in the corner of the room, I repeated myself. They were both gracious in their return greetings and I learned that the young man was her son, John.

Ms. Lorettta appeared calm, composed, and quiet as she sat in her cot. She was of short stature and delicate frame. She looked tired, her graying hair wiry and thin and a few days beyond its last washing. Her face was wrinkled. Her eyes, broody and intent, watched me closely as I leaned against the wall and asked her question after question regarding her reasons to visit our emergency department. Occasionally, she looked towards her son to supplement her answer, to clarify something she couldn't quite find the right words to describe. Each time her son was successful in filling in the blanks.

She had come to our department with several weeks of increasing abdominal pain. A diagnosis of kidney (renal) cancer several years earlier had led this patient to having several bouts of chemotherapy and the subsequent great news of achieving remission. Her complacent face, after learning her history, spoke to me--the more she shared her new symptoms with me, the more I realized that she had an inherent sense that something bad was happening in her abdomen again.

I did, too.

Her son, sitting in the corner quietly unless spoken to, appeared much more anxious than his mother. Whereas she seemed resigned to some bad news arriving in her near future, he seemed to be using his energy to avoid any possible realizations of something bad occurring. His intimidating square face, thick neck, and inflated muscles--all those hours spent at the gym to make him stronger--would be of no use to his mother in what the fates might dictate to her. He fidgeted with his hands and feet. He occasionally diverted his gaze from his mother and I to the corners of the room. He seemed to want to rewind the hands of time to a few weeks prior when his mother was symptom-free of any pain and he could keep looking to a pollyanna future with his mother being an integral part of it.

Her physical exam was concerning for the abdominal pain she complained of. She had some distension which gave her belly the appearance of holding a helium balloon within it. Her pain was diffuse, all over, and I could make her right upper quadrant be the main source of this pain when I palpated a steady pressure downward toward her liver.

We did the workup--blood and urine testing with IV-contrast CT imaging of her abdomen. Sadly, the CT scan returned showing what the patient and I had feared--the cancer was back. She had multiple metastatic lesions in her liver and the collection of some ascites, fluid build up around the organs within the abdomen.

Sigh.

I walked into Room 30 with a heavy heart. Not only did I feel for this patient and her son, but I closely identified with the heartbreak associated with the news I was about to deliver to them. It was just eight short years ago that I had been sitting in a corner chair of a hospital room with my mother as the patient. She had been battling leukemia and, after coming out of remission, had a battery of tests that had led to the moment when her oncologist walked into her hospital room to share the devastating news with her and me--her leukemia was more spiteful than ever and was remaining refractory to all of our attempts to fight it. I remembered the pain I felt. I remembered the complacency of my mother upon hearing the news. She had inherently known and sensed this would be her outcome. I remembered the wishing and hoping that my father and six siblings (who all rotated their visits due to living several hours away) had been with us at that very moment to divide the pain of my mother's news.

Who am I fooling? The pain of such devastating news as this isn't divided among us--the pain multiplies. Then multiplies again. And keeps exponentially growing until we all learn the appropriate ways to diminish the power it holds over us.

Entering the room, then, I wasn't surprised to see Ms. Loretta sitting quietly in her cot with John now sitting at her feet, holding her hands within his massive mitts.

Without my saying a word, Ms. Loretta knew. "It's back, isn't it." It was more of a statement rather than a question. I nodded to her. "Yes," I said, "it's back."

She asked me questions about her tests. How was her blood work? How bad was the CT scan? Did she have much time? Did she have options? John remained quiet, his eyes focused only upon his mother.

I kept answering her questions to the best of my abilities, but refused to answer the "how much time do I have" question. I assured her that we would admit her to the hospital and get the oncology specialists involved immediately to provide some guidance to the questions she was asking.

All the while, as Ms. Loretta and I were talking, I couldn't help but steal glances at her son. He was me. Just eight short years ago. Sitting with his mother. Holding her hands. Processing bad news. Staring at his hero and wishing with all of his heart that he could absorb her hurt.

He sat quietly, his anxious movements calmed with the news that he was desperately hoping to avoid. He continued to grip his mother's hands in his. His eyes remained fixed onto his mother's face. I knew exactly what he was doing--he was etching her image, her heartbreak, her attempts to be strong at this very moment, into a memory that would remain with him until the end of his days.

Eyes watching eyes watching eyes. Her expectant eyes on me. My sympathetic eyes glancing between her and him. His loving eyes on her.

Sometimes, our eyes are rewarded with the beautiful imagery they seek. Sometimes our eyes are the recorders of specific moments of our lives that we may or may not wish to remember, memories of splendor and memories of squalor. Sometimes our eyes are the conduit of the emotions of our heart and soul. Sometimes our eyes are our best friends. And sometimes our eyes are our worst enemies...

As Henry David Thoreau said, "Could a greater miracle take place than for us to look through each other's eyes for an instant?"

In this moment with Ms. Loretta and John, I appreciated the miracle of my memory from eight years ago simply by looking through their eyes for but an instant. An instant that I wish I could have protected them from.

Thank you, Ms. Loretta and John, for this instant...may you both be rewarded for letting me be present in your moment of painful tenderness.

As always, big thanks for reading. This essay is dedicated to a whole new group of readers who have contacted me or encouraged me to keep on keeping on with my essays. Please feel free to share your "instants" with us...

Defining Emergency

noreply@blogger.com (StorytellERdoc) — Thu, 10 Jul 2014 11:50:00 +0000

I originally wrote this piece in December, 2010. Recently, I learned that it has been "reborn" in the social media world with over 120k shares from just one resource (thank you, KevinMD). Please feel free to share your thoughts and experiences...

Emergency, as per the all-knowing Webster, is defined as an unforeseen combination of circumstances or the resulting state that calls for immediate action. Furthermore, an emergency is also defined as an urgent need for assistance or relief.

These definitions sound pretty spot-on, right? When thinking about emergency room settings, even, one can easily correlate the words of Webster to what one would necessitate to be a situation requiring emergency medical treatment. A trauma. Broken bones. A heart attack. A stroke. A seizure. Respiratory distress. A cardiac arrest. The list goes on and on and on. When a critical illness or injury occurs, then, we should all be thankful that we live within a society where emergent, life-saving medical care is available.

Lately, though, it seems the system meant to provide this care is being bogged down by questionable decision-making. Instead of providing emergent care, it seems I spend at least half of my emergency room time now playing doctor to chronic illnesses. To pain control issues. To mildly elevated blood pressure readings. To months of nonspecific weaknesses and fatigue. To office appointments sent to the ER because "we are overbooked today." And our ER is not alone. I hear the frustration of my colleagues and see first-hand how overworked most of us who provide health care in the ER setting have become.

A month back, I was in the middle of a very busy shift. Several patients with chest pain (one requiring immediate catheterization), two patients with respiratory distress (one from skipping dialysis and one from a COPD exacerbation), and three patients from a motor vehicle collision presented almost simultaneously to our ER. Within minutes, all of these critical patients had been treated with efficient, appropriate life-saving care. The team on deserved kudos for doing their job well and making a difference in these patients' outcomes.

Walking back to the nursing station, then, I was surprised to find our secretary being berated by a gentleman in his thirties at the counter. His voice was loud and menacing. His face was pinched with anger. His fists were clenched by his side.

"Whoa," I said, walking up to him, standing between him and the secretary, "what seems to be the problem, sir?"

"We've been waiting two hours to be seen by a doctor!" he exclaimed. "What the hell is going on around here?"

Are you kidding? All he had to do was look for himself to find the organized commotion that was occurring in our ER setting. What followed was the briefest of conversations.

"Sir," I asked, "what brought you to our ER today?"
"My daughter's left ear is hurting her."
"For how long?" I asked.
"Two hours," he replied.

Two hours of ear pain? I get it--maybe he was worried about his daughter. I would be as well. But my daughter would also have gotten Tylenol and Advil and watched her daddy patiently wait for their turn to be treated once the dire situation had been explained. Better yet, we would have probably waited until the morning when a call could be placed to her personal physician.

I explained to him that we had multiple critical patients brought to us and we would be with his daughter as soon as possible. "We're all trying our best, sir," I added, "but you're going to need to be a little more patient."

The father stared me in the eye. I stared back. Finally, he blurted out what he had been thinking to say. "Well, then," he spoke, sarcasm dripping from his pathetic words, "try harder." It didn't end there, though. He continued. "This is bullshit waiting two hours to be seen."

Before I could respond, he turned his back and huffed himself back into Room 27 where, the nurse shared with me, his eleven year-old daughter comfortably sat watching TV. "And," the nurse added, "I had already explained to him why they were waiting to be seen."

After this, one of our regulars who had been to our ER over 200 times (since we started tracking in March of 2006) arrived via ambulance. Then a gentleman carrying a big bottle of Mountain Dew was escorted from his ambulance, by foot, into our ER because his main complaint was "I just want to take a nap and was too far from my apartment." Next, an asymptomatic patient with elevated blood pressure for three years, non-compliant with her medications for financial reasons (yes--I noticed the pack of cigarettes hanging from her purse), was sent to us from her family doctor to be cured on the spot. "Go right to the ER," she was told.

Can you appreciate the obviousness of the long waiting times in the emergency department? Although we all pride ourselves on providing expedient care, a four to six hour wait is sometimes the reality for some of our noncritical patients.

As if to hammer the point home, my last patient during my shift that night (I was working 5pm to 3am) was a sixteen year old female who had presented to our ER, via ambulance at 2am, with her mother.

I walked into her room to find this patient and her mother both lying in the cot, laughing while watching TV, the patient in no obvious distress. I introduced myself to them before I started asking questions. "What can I do to help you tonight? What brought you to our emergency room?"

The girl looked at her mother and started giggling, my first sign that she would survive whatever her ailment may be.

"Well," she said shyly, "I've had some burning when I pee for about a week. And," she added, not done "I have something gross leaking from down there (she swept her hand towards her pelvis as she spoke)." Upon further questioning, I learned that she had been diagnosed with a yeast infection from her family doctor one month ago but failed to get her prescription filled. I also learned that she was sexually active with not one, but two partners. Unprotected.

I was disheartened. "What made you come to the ER at 2am when these symptoms have been going on for over a week?" I asked, hoping there was some rhyme or reason to her seeking out emergent care at this time. There wasn't. Her answer to my question--"Why not?" I didn't even approach her on why she came in by ambulance. Some things are better not known, I guess, especially at 2am.

I'm not sure this is the system that was imagined when emergency departments started gaining favor in our society. Don't get me wrong, though. I, like all of my colleagues, are 100% committed to providing respectful and appropriate care to anyone who shows up in our department, whether it be a critical, life-threatening illness or a chronic "nuisance," so to speak.

I can only hope that people will be patient and understanding as we all cope with the evolving changes that seem to be occurring with our health care system. And my hat is off to all the medical folks who work hard, day after day, treating our fellow mankind as best we can within this currently accepted system. Because, even as bogged down as we can sometimes become, what an awesome privilege we have in meeting and greeting and treating our fellow kind. Of helping them out in their time of need.

As always, big thanks for reading. Please feel free to share any ideas or opinions you may have had in dealing with your local emergency department...my best, Jim.

Helium-Filled Dreams

noreply@blogger.com (StorytellERdoc) — Wed, 02 Jul 2014 10:00:00 +0000

Despite the furious pace of the emergency department, he sat within his private bubble of calm on a hallway cot situated just outside the entrance of Room 31. He sat upright, facing the opposite direction from which I approached, with the thinning brown hair of his broad occiput splayed across the upper edge of his pillow. From this approach, I paused for several seconds to appreciate this serene, surreal view of a patient who appeared unaffected despite the scurrying of several staff and ambulance teams around him.

I had signed onto his chart hoping he would be a quick in-and-out patient among the endless sea of critically-ill patients that arrived at our doors that evening. He was 24 years old and his complaint seemed minor--diarrhea and nausea with vomiting for less than twelve hours. His care wouldn't take that long, I figured.

I approached his right side from behind, lightly touching his right shoulder as I came to a stop beside him. He remained facing forward despite my touch.

I leaned into his ear. "Hi, Michael. My name is Dr. Jim and I will be taking care of you this evening."

Slowly, Michael turned his face toward me. "Hello, Dr. Jim," he answered, his voice mumbled and slurred as if his tongue were thickened and glued to his inner cheek. I strained to interpret his simple response.

Our eyes connected, his widely-set in the perimeters of his orbits. Through his smudged and thickened outdated spectacles, I was able to look at magnified brown eyes, lightly speckled along the edges of their irises with black flecks. His eyes danced with glimmers of fluorescent reflections, conveying a false sense of happiness. His smile emerged in response to my smile. His eyes bore into my face, searching for a judgment that never came.

Michael had Down's Syndrome.

I continued to look at Michael. I smiled at him. He continued to smile at me. I soaked in his enlarged eyes, innocent and searching. I noticed his broad forehead, his thinning hair, his scant eyebrows that horizontally framed his upper eyelids. I noticed his cheeks and jawline, sprinkled with brown sparse whiskers. I noticed his poor dentition, a chipped upper front tooth demanding my immediate attention. I noticed his thick neck sprouting from his dingy white t-shirt. A thin, white hospital blanket bunched and wrinkled at his girthy midsection. Old, worn-out basketball sneakers escaped the lower portion of the blanket.

"Michael," I said, returning my eyes to find his gaze still in the process of measuring me up, "it is my pleasure to meet you. What can I help you with tonight?"

Michael took a deep breath before exhaling his story. He wasn't feeling well. More specifically, he was feeling tired and rundown. He felt that he was developing some diarrhea but, when I pressed for more specifics, he simply said he had "gone the bathroom three times today" instead of his typical one time. "I mean poop, Dr. Jim," he clarified. He also stated that while eating his dinner, he felt like he "was going to puke." He denied any further complaints as I patiently went through a list of symptoms. His actual feelings of nausea had since resolved after his arrival to our emergency department.

But this is where his story got good.

"Michael," I said, "what specifically did you eat that made you feel like you were going to throw up?" I was trying to confirm that Michael just had an adverse effect to something that didn't agree with him rather than developing a food poisoning or a case of gastroenteritis. Unlikely, given his symptoms were improved, but I wanted to be thorough nonetheless.

Michael went on to explain that he was just placed in a City Mission for the first time earlier in the day. He was sure that it was the food that made him "get sick." It was simple food, he explained, "some mashed potatoes and gravy and a roll with butter and some green beans." He paused a few seconds before adding, "And it definitely tasted better than the food in jail."

My mind began racing to ask all of the questions that were now bustling inside my head. I went with the most obvious question first. "Michael, how do you know what food in jail tastes like?"

"I just spent forty days in jail for violating my parole. So I ate a lot of meals there."

"Parole for..."

"Breaking and entering," he answered, completing my sentence. I did another glance over of this person sitting in front of me.

"Michael, you didn't hurt anyone, did you?" He assured me he didn't. He said that he had entered a distant relative's apartment without permission to stay overnight on the couch. His relative hadn't taken kindly to this action, from what I could gather. Following this, he was caught stealing from a grocery store.

"Michael," I continued, "why are you staying at a City Mission? Are you homeless?"

"Yes," he answered. I asked him about his family. "All I have is my mom, and she can't take me in because she is on a fixed income."

It was at this moment, I remember quite vividly, that I excused myself for a minute from Michael. I explained to him that I wanted to find a room to perform his exam in and also go check to see if the blood work ordered on him in triage had returned. Actually, though, I had removed myself from Michael's interview because I had visited almost every spectrum of my emotions, from pity and sorrow to fear and shame, during our session.

After asking a nurse if she could move Michael into any available room so I could continue with my exam, I sat down at my work station and took a deep breath. I contemplated why Michael and his history had moved me in such a way. After all, I felt quite lucky to meet so many different people from so many different walks of life. Over my numerous years as an ER doctor, I have met people that I never would have had the fortune, or misfortune (as some would say), to otherwise meet. Michael continued this path.

Michael, in his simple ways, stirred a variety of my emotions that I was having trouble reconciling. He was viewed a criminal by our legal system. I'm not naive to think that there was probably more to his story about being imprisoned. And yet, he was without a supportive family. He was homeless. He had Down's Syndrome. He was probably without hope. Ugh.

My thoughts immediately went to my sister, Susie, who has had a long and fulfilling career as a Special Education Teacher. It was she who got me to volunteer for my first Special Olympics as a teenager. That experience, not unlike this one with Michael, had left me with many strong emotions even then. Hope probably being the strongest of them. Hope that the world treated the participants in those Special Olympics with respect and kindness and compassion and love. I thought about how Susie probably affected more lives with her hopes and dreams than what she would even give herself credit for.

As Michael's doctor, as my sister a teacher to many of her students, as parents to any child--aren't we all humans connected by the threads of hope on the blankets of one another's life journey? Don't we hope that with time and patience, with supportive attention and an abundance of love, and then with more love, each person we encounter in our lives will propel forward just from the experience of knowing us?

Was Michael propelled forward in his life because he knew these things? Did Michael's mother ever hope for him to become a criminal? Homeless? A lost soul in the fabric of our society? I hope not. Did she hope for help in raising Michael to become the best that he could become with his abilities? Did she lose hope for Michael somewhere along his journey? Does she sit at home hoping that Michael will be found amongst the debris that has become his life? Is she so apathetic that she no longer holds any hopes for Michael at all? Did she lose hope for herself?

Did Michael ever feel hope for a future that would lead to a productive, happy life? Was he nurtured to be someone with self-worth and a firsthand knowledge of how to receive and give love? Was he surrounded by anyone who only hoped for his best?

I realized that with Michael, as his story unfolded for me, I found myself hoping more and more for a better tomorrow for him. I hoped that his past hadn't permanently damaged him. I hoped that Michael could see himself as someone of worth in our society. I hoped that people were involved in Michael's life who appreciated his presence.

I realized that Michael was stirring hope within me...

Michael's exam was normal. His blood work returned within normal limits. I gave Michael a sandwich, something to drink, and most importantly, I made a point to sit with him several times before his consult with social services concluded and discharge from our emergency department was completed. Adult services would be following with him.

I hope he felt that we cared.

I hope my helium-filled dreams for each human I encounter will always remain a part of me. I have Michael to thank for reminding me of the important stuff...

As always, a huge thanks for returning to read my words. I hope this finds each of you well and enjoying a beautiful summer season. My heartfelt thanks for those who sent me personal emails. My best, Jim...

Bingo Resilience

noreply@blogger.com (StorytellERdoc) — Wed, 23 Apr 2014 16:15:00 +0000

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"Bingo," she answered.

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

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

I will keep looking...

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

What's your "Bingo?"

The Kick Ditch

noreply@blogger.com (StorytellERdoc) — Fri, 11 Apr 2014 14:05:00 +0000

A moment of reflection...

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

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

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

The kick ditch.

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

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

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

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

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

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

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

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

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

Be a kick ditch.

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

Underneath

noreply@blogger.com (StorytellERdoc) — Mon, 10 Feb 2014 12:21:00 +0000

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 the stoic fortitude that his life experiences have taught him. He seemed the better man for it.

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

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

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

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

Almost A Miss

noreply@blogger.com (StorytellERdoc) — Mon, 16 Sep 2013 12:01:00 +0000

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

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

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

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

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

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

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

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

"I need stitches," he bluntly replied.

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

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

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

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

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

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

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

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

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

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

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

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

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

And then, the moment I almost missed…

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

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

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

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

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

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

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

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

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

And to think, I almost missed his story…

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