Monday, November 30, 2009

Cheetos and Painkillers

We pretty much went paperless in our ER several years ago. In paper's place, I now have a computer that lists all of the patients in the ER, their complaints, their vital signs, and their medical histories.

All at my disposal with the click of a mouse. Yes, mine is a powerful finger!

The nurses enter most of this medical information in triage or at a bedside computer in the patient's room. Occasionally, they will enter little tidbits of information that are quite funny. I live for these innocent commentaries.

"Patient's toupee keeps shifting on his head."
"Patient had smelly flatus during interview." (Is there any other kind?)
"Patient refused to put on gown but did adjust her halter top."
"Patient getting long lingering hugs from her 'brother'."
"Patient did not wash his hands after showing me his hernia."
"Patient used to smoke but quit three hours ago."
"Patient is constipated and tried to disimpact himself in our bathroom."

Yes, it's these little subtle comments that sometime tell me the most about a patient. And sometime warn me to shake the patient's hand with a glove on when I introduce myself!

So, after clicking to treat the patient in Room 29, directly across the hall from the nurses' station, I scanned the computer screen for the patient's information.

She was 24, complaining of abdominal pain for three days, and had no entertaining nursing comments charted. Another serious, legitimate patient.


As I walked into the room, I was surprised to find a young woman sitting comfortably on the bed, just finishing a small bag of Cheetos. In the corner of the room, accompanying her, was her husband, his hands dipped into a small bag of Doritos. Both had orange fingers. They must have been snacking for a while.

Now, if you had significant enough abdominal pain that brought you to the ER, don't you think you would pass on the Cheetos? I know I would. And trust me--nothing comes between me and my Cheetos!

I introduced myself to the patient and her husband but skipped my customary handshake. I didn't want orange fingers, too.

"What brings you here today, maam?"

The patient mumbled something that I couldn't understand.

"I'm sorry, can you say that again?"

The patient held up her finger to me, her way of telling me to wait. She nimbly jumped from the bed, went to the counter in the room, picked up a 20 oz. Pepsi that was nearly full, and proceeded to chug it down to within an inch of the bottom. As she put the Pepsi back down, I noticed that there was a second, though empty, bag of Cheetos sitting on the counter.

She spoke a little more clearly now, thanks to the Pepsi washout, although I could still see the orange crumbs clinging to her chin and orange saliva building up in the creases of her lips.

"You're the doctor, right?" I nodded yes to her question. She grabbed her left abdomen. "Oh," she started moaning, "oh my God! Help me, Doctor! My stomach hurts so bad." I think I actually saw her suppress a smile.

She was serious. Seriously a bad actress. She could have at least practiced in front of a mirror.

And maam, I'm so sorry, but Julia Roberts just called. She wants her Oscar back.

I asked this patient some specific, in-depth questions and got only the sketchiest of responses.

"Well," I said, after finishing my interview and performing a stone-cold normal physical exam, "I'm happy to say that you have a good exam. And your blood and urine work that the nurse ordered in triage came back normal, too."

"What?" she shrieked. "You mean to tell me I just waited four hours to have you tell me I'm okay?"

"Maam," I gently pointed out, "your vital signs are good, your exam is unremarkable, and frankly, you ate two bags of Cheetos and chugged a 20 oz. Pepsi. I think whatever was hurting your belly is already passing you by."

She looked very unhappy while she nervously glanced over to the corner at her husband.

"Umm," she said, "I need some pain pills."

"Pardon me?" I asked.

Now, I am a very compassionate doctor and rarely hesitate to provide pain relief with strong medications when needed. In fact, I sometimes get teased by our nurses for being a "candy man." So I promise you, I was not taking this patient's complaints lightly. It's just that between her complaints, her actions, her exam and her test results, my suspicions of her having a serious illness were so low that all she was going to get from me was Tylenol.

"Tried that. It doesn't work."

"Well, I'm sorry. You won't be getting any pain medication with your visit today."

She eyed me, I eyed her, she eyed her husband, he eyed me, I eyed him.

I was eyed out.

"You sure I can't have any pain pills? Just a couple. I'm hurting so bad." She was now holding the other side of her belly, not remembering it was the left side that was hurting before.

And then, in the midst of her drama, she did something unexpected and glorious.

She burped.

A big, nasty, bullfrog burp.

I think after that, she knew it was over. I shook my head no to her request, wished her good luck, and advised her to return if she got a fever or her symptoms worsened or changed.

"Yeah, whatever," she mumbled as she easily jumped up from the bed to get dressed.

I went back to my computer screen to get her discharge instructions ready and noticed that she had another page that I hadn't scrolled down on.

There, on page two, sat my warning from her nurse.

"Patient's 19th visit this year."

Maybe she just likes the Cheetos from our waiting room vending machine.

I hope everyone had a great Thanksgiving weekend. Thanks for reading. Next post will be Wednesday, December 2. See you then.

Friday, November 27, 2009

Pass The Clicker

In the spirit of this Thanksgiving holiday, a humorous peek into my home life...

I'm a typical guy who, if given the chance, will sit on my leather sofa with TV remote in hand and slowly meld into the cushion, oblivious to the fact that I am watching for the third time the same episode of "Trading Spaces" or that I may not have changed my underwear in two days. With this in mind, my wife and I made a decision about four years ago to cancel all but our most basic cable channels.

Who am I kidding! If I'm going to be honest here, she made the decision. I had no say. I still get teary-eyed thinking back to that awful day.

To complicate matters, the cable company screwed up our cancellation. Yes, they lowered our bill from $50 to $16, but they kept forgetting to reduce our cable plan to the basic package. As a result, we continued to get all the big package channels. All for the fantastic price of $16! Can you imagine how frustrating it was for me to hear my wife call the cable company ten times, requesting them to come and "fix the problem."

I saw no problem. We were getting a hundred channels for $16. Where's the problem?

"The problem is that it's dishonest," she replied.

I think her honesty may be the death of me.

Now, though, with the kids growing older and outgrowing PBS (our only kid-friendly channel among our huge selection of 12 channels), we were faced with another dilemma. What could they watch? We were stuck between "SpongeBob SquarePants" and "CSI." There was no gray zone of good television for our kids.

Low and behold, we discovered our favorite television series on DVD. We made trips to Walmart, Target, and Best Buy and were frequent visitors on We snatched up "Little House on the Prairie," "The Waltons," "Happy Days," "Laverne and Shirley," "Leave It To Beaver," "Gilligan's Island," and "The Brady Bunch." There's more, but these were the shows that made the biggest impact.

Our kids were in heaven. If they liked Season 1 of something, we moved on to Season 2. And Season 3. And Season 4. I'm going to be honest here--I thoroughly enjoyed revisiting these classics. Probably more than the kids.

I discovered that I did not attain much personal growth traveling from my childhood into adulthood. I still liked Mary more than Laura. I rooted for Jan over Marcia, Marcia, Marcia. Laverne made me laugh, but Shirley held my heart in her hand. Did I really think Richie Cunningham was cool? And Mary Ann versus Ginger? Let me tell you, if you put your hair in pigtails and wear a red-checkered shirt and tie the bottom in a knot around your waist, I'll eat the scraps from your plate.

Mrs. Cleaver remained my fantasy mother. Just once I wanted to wake up and find my own mother, awesome though she was, serving me breakfast in full makeup and an evening gown! I remember Mom rolling her eyes when I asked her to play along with me on that. Nope, it didn't happen.

And how could I not mention Eddie Haskell, my idol? I got tired of my friends and family mentioning that I was his twin, but he did teach me that good manners and sincere politeness could take you far. Thank you very much. And by the way, did I mention how nice you look today?

I could not let this moment pass without mentioning how much I still love Grandma Walton. Not for the physical reasons, mind you, but just for the fact that I had never known someone who was so moody and sour. It was a new experience to watch such a crotchety character. I was so thankful she wasn't my grandma. I can only imagine what kind of mood Grandma Walton would be in the first time her bladder didn't hold out. Can you even imagine her shrilling voice? "John Boy, get over here right now and change my diaper!" Ugh. Keep writing, John Boy, and get yourself out of that house. Because up on those mountains, my friend, you wash the diapers by hand. In the cold creek.

The biggest hit for my kids, though, was and still is "I Love Lucy." Although I didn't see this one coming, my wife did. My daughters, 13 and 8, love everything about Lucy. And my son, 11, cheers right along with the girls. The candy factory line, the grape-stomping, the vitameatavegamin commercial--you know what I'm talking about. We all have our favorites--are you thinking of yours right now? Just hearing my kids gut-busting laughter from a show that is 50+ years old is a miracle in and of itself. It's hard to believe, but the episodes only seem to have gotten funnier.

We recently traveled to Hilton Head and instead of playing music overhead in the car, my wife and I listened to the episodes that the kids were watching. Better than music, I tell you, better than music.

And I know what you are thinking--NO, we are not pathetic!

I think a visit to Lucy's museum in her hometown of Jamestown, N.Y. is going to happen someday soon. I just need someone to promise me that it won't be a bust.

Okay, so maybe that's a little pathetic. But they just might have a picture of Lucy in pigtails wearing a red-checkered tied-at-the-waist shirt. Then who's going to have the last laugh?

Now, pass me my clicker. Peter's just about to say "Porkchops...and applesauce."

Thanks for post will be Monday, November 30.

Wednesday, November 25, 2009



What do you hear? Silence? Commotion?

During yet another crazy, bustling ER shift, I squeezed into a sliver of unused counter space at one of our nurses' stations to finish writing on a chart. I was facing one of my favorite secretaries, Louise, who sat opposite from where I was standing.

"Is it me or is it loud in here tonight?" she asked.

Besides being good at what she does, "Weezie" also was born and bred in our hospital's town and seemed to know everyone. "That's my great aunt's best friend's nephew's son's girlfriend--well, ex-girlfriend, I mean. They broke up last week." Some of my heartiest laughs at work have come from Weezie. You should have heard her three-year rant after turning 50 about still getting her period! The first time she missed her period, I should have bought her a Georgia O'Keefe print to celebrate! There would be one more unclipped Tampax coupon in the Sunday paper that week.

"Way too loud, Weezie," I answered, still writing.

She was right, too. It was deafening. And now that she brought it to my attention, my ears were hurting. The ER seems to be very moody, bipolar almost, in how quickly the atmosphere can change. And judging from the volume tonight, we were in a manic phase. Without looking, I knew there was a full moon.

I stopped writing and looked up from my chart, appreciating the bedlam. Looking down one hallway and into the next, all I could see were patients lying in cots lining the halls, nurses and techs scrambling in and out of rooms, pacing family members, ambulance crews waiting with their patients for a room assignment, and security taking their usual strolls.

"I think this might be one of the worst," she said. Those were big words coming from Weezie.

I went back to finishing my chart, hoping this most recent patient would recover from her stroke symptoms.

And then it happened.



It was the most momentous, most sudden silence I have ever appreciated at work.

I knew that whatever was going on was huge, HUGE--nothing can silence an ER like this!

Debating whether to look up or not, it was Weezie's voice that convinced me.

"Oh my God," she exclaimed. Weezie exclaiming? This must be colossal!

I looked up at Weezie, her mouth gaping, and I followed her pointing finger.

Staggering down the hallway, towards us, was a middle-aged man. Moving slowly. Passing by patients and their families. He seemed real nice and friendly, nodding to this patient and waving to that one, in a vote-for-me kind of way. I'm quite sure, though, that he wasn't running for public office.

And, oh yeah. I may have forgotten to mention--the guy was butt-naked!!!

There was no gown, no clothes, no shoes even. His pudgy, hairy middle-aged body was there for the world to see. If not the world, at least our lucky ER. Who knew that little Susie was going to have her appendix taken out and see her first naked stranger!

I would like to say that I rushed over to help this gentleman cover up but I, like everyone else, was so completely stunned that I couldn't move. Couldn't budge from my spot. Couldn't shut my gaping mouth, either. I had seen much craziness in my career but nothing that stunned a crowd quite like this. Boy, did I like this guy.

It had been upwards of a minute before security responded to this kind gentleman's wayward stroll. With an armload of blankets, they covered him up and coaxed him back into his room. Right before he stepped back in, he peeked out to give us, his adoring fans, one last wave! Yes, with his hand. I hope for his sake this guy had a lot of alcohol on board.

It turns out this patient, who I'm proud to say wasn't mine, had fallen asleep at a bar counter and had been brought to us by the police to observe and "check out." Somewhere during the ER's chaos, this gentleman, who the nurse had rightfully checked in on many times, was able to climb out of bed, strip off his gown, and take a lovely, relaxing stroll. I think this could qualify in the "memorable stroll" category--mine, not his. He wouldn't remember a thing.

After the guy's last wave to us, we all looked around at one another. Our faces were indistinguishable--we all wore masks of disbelief. It took just one brief smile, one quick laugh from one of the techs, and we all burst out howling at the absurdity of the situation.

"Alright, Weezie," I said, after we had caught our breath, "who was that?"

"Why are you asking me? How would I know?" she asked, incredulously.

This was a first from Weezie. But if you ask me, I'll bet it was her sister's ex-husband's old high school teacher's third cousin, twice-removed.

Next posting will be Friday, November 27. I'd like to wish everyone a blessed Thanksgiving holiday. If you eat too much, tough, I don't want to see you in my ER! Thanks for visiting and reading my posts...

Monday, November 23, 2009

The Saddest Night

Recently, my thirteen year-old daughter did a school report on my job, focusing on the emergency room setting and what my role within all the chaos was. While we were in the emergency room touring and taking anonymous pictures for her power-point presentation, she found a new appreciation for what I did when a young knifing victim was brought in by ambulance.

Because my only purpose that day was to help her collect information and take pictures, I didn't go into the patient's room and obviously shielded her from any gore. She was mesmerized by all the commotion. We waited around until we received word that the eighteen year-old would be okay. I could see her exhale at the news and, in a moment of tenderness, look at me with saddened eyes. I could not have given her a clearer perspective of what I am sometimes called to treat.

During the drive home, she was quiet and affected. Slowly, though, I was able to pull her from her private thoughts and talk aloud about what she had seen.

"Dad," she asked thoughtfully, "what was the saddest patient you ever took care of?"

"Oh, honey," I said, "you don't really want to know that, do you?"

After a little more convincing, she had me scanning my brain for my most haunting "sad" cases, which I could count on way too many hands. In an odd way, I think as an ER doc you build a protective wall and tuck your memorable cases neatly behind it, adding it to the "sad" list, the "happy" list, the "traumatic" list, the "old-people" list, the "funny" list, the "you're never going to believe it" list--endless lists of cases that touch your essence.

Look at me, even now, protecting myself by calling these encounters "cases" and not "patients." Shame on me. But trust me, it's a big, big wall.

Anyway, her sweet voice brought me back to reality. "Please, Dad. Just tell me."

I decided to face down her request. She was thirteen and she was persistent. So I broke and shared with her one of my most heart-wrenching moments.

It had been one of those long, endless overnight shifts early in my career. There had been no time to breathe as one critical patient after another continued to present to the ER, even up until 6 a.m. We had just received word that an elderly gentleman who had presented to our ER with low blood pressure and severe abdominal pain (a quickly made diagnosis of a ruptured abdominal aortic aneurysm) had died "on the table" during surgery, this after transfusing him with six units of blood while waiting for the cardiovascular team to arrive.

My nursing staff and I were beaten up, unable to shake this moment of our failed heroics.

"Well, this night sure can't get any worse," Lisa, one of our best nurses, said. She should have known better. She had barely finished speaking before the prehospital radio sounded off.

An ambulance was bringing us a SIDS (sudden infant death syndrome) baby just discovered by her parents.

Our team was sullen and quiet as we waited in one of our resuscitation rooms for the ambulance's arrival. Within minutes, the paramedics rushed through the door carrying a lifeless little body, about eight months or so. Following them were two young, frantic parents carrying another living child of the same age. The SIDS baby was a twin. As our social worker took the living baby from dad's arms, my medical team and myself urgently examined the tiny patient lying on the cot, allowing the parents to stay in the room with us.

Sadly, it was too late. Death had visited this child hours before and we had no arsenal to reverse this devastating event. We later had learned through the paramedics that this family of four shared one mattress, tucked in the corner of a rundown studio apartment. When mom had rolled over during the night, she had discovered that her baby "felt cold."

When you "pronounce" a patient (declare their death and exact time of death) in the emergency room, at least two phone calls must be made--to the coroner, in case an investigation or autopsy is necessary, and to the family doctor. These are "must-dos" for me professionally, but are hardly the things I feel are necessary to begin a family's healing.

We sat the parents in rocking chairs and gave mom her little baby. We had the social worker bring in the other child and handed her to dad. I stood in the corner of the resuscitation room, lights dimmed, absorbing two parents with two children, one living and one dead, rocking slowly back and forth, enveloped in their grief. I had held their hands, shared their misery (as a parent, I was witnessing one of the most earth-shattering nightmares any parent could have), and had chosen my useless, sympathetic words carefully. There was but one thing left to do.

I went and found Lisa and asked her if we could please clip a few strands of the deceased infant's hair to give to the family. This was something I had learned from our pediatric trauma center during residency. It can be a vital part of a family's healing process. The hair was tangible, something to hold when a memory isn't sufficient, something to smell, something to touch with trembling fingers, something to press against a broken heart. If not now, a day would come when the family would be thankful to have this possession.

As Lisa and I quietly reentered the room, I will never, ever forget the scene that awaited us.

Mom was still holding the deceased twin while the living twin sat in dad's lap, her grasp within reach of her twin sister. Her hand was on her deceased sister's head, gently patting it, quietly twisting the dark strands around her fingers, almost as if urging her sister to wake up and play. The potency of this action--the playful innocence of her little hand wrapped in her dead sibling's hair--was a moment of both stunning serenity and infinite devastation that I will carry with me always.

I finished the story and looked over at my daughter, her big brown eyes fixed on my face.

"Dad," she asked quietly, "did you cry?"

"Honey," I said to her, choking up, "I still do."

My next post will be Wednesday, November 25. I promise it will light-hearted...

Thursday, November 19, 2009

I Am...

I am...

Hmmm, what am I? I don't think I ever had trouble describing myself before, but as I sit here in front of this blank screen, I realize that I don't quite know how to start an honest description of myself. I will try my best, though, so you have an understanding of my perspective in the stories I will share.

First and foremost, I am not perfect. Who is, really? My attempts to have the perfect life have all been in vain and, instead of fighting that fight, I have come to realize with age that my imperfections may be much more interesting.

Secondly, I am observant. I seem to grasp the smaller life moments that may be missed or may seem mundane to someone without a searching eye. It's these simple, boring moments that hold so much more excitement. These moments of rawness and realness make me thankful to be walking the path that I am on.

So what path is that? Well, quite simply, I am a husband. I am a father. I am a friend, a son, a brother, and uncle, a nephew, an athlete, a writer, a lover of books, of music, of nature...I could make this an endless, if boring, list. It is funny to think, though, that the thing I worked the hardest for in my life is probably the thing I want least to define me.

What is that, you ask yourself? Well, I am also an emergency medicine physician.

Unlike some of my comrades, I am not in need of a pedestal to stand. I don't have a big ego. I actually view sharing my occupation with someone as detrimental. The stigmas attached to being a physician can range from absolute adoration to pure disgust. It seems this scale directly correlates with the person's age; the older a person, the more adoration. Well, maybe barring the seventy year-old lawyer. Who needs these projected feelings?

Another reason I don't share? Do you know how many people want to tell you about their hemorrhoids once they find out that you are a physician? Or their bowel movements? Or that thick, fungal toenail they've had for ten years? And please, whatever else, don't ask me to look at that mole on your back that's going to remind me of a head of broccoli.

These reasons alone are enough to keep me from sharing with the typical person what I do. I would like to think that neurosurgeons aren't spared these stories either, but that may be wishful thinking.

So from you, my friend, I ask a favor. Be patient and give me time to unwrap my layers to you. My stories will be funny. My stories will be heartbreaking. My stories will be personal. My stories will be professional. My stories will be your glimpse into a life that may differ from yours. It is my hope that you enjoy them, that something from my experiences may touch your core.

Until next time...thanks for visiting.

New posts will start Monday, November 23 and follow a MWF schedule.