Friday, January 29, 2010

Baby Mama

It's not everyday that we have a patient come to our ER and insist on not letting any family or friends come back to the room with them. Enter Crystal.

Crystal was a very sweet, intoxicated young woman who, after a night of drinking, had slipped and fallen. Her injuries appeared to be minor. Whether it truly was a gopher hole or just the alcohol, though, we'll never know.

Soon after she arrived, we got a call from the front lobby informing us that Crystal had a gentleman caller that would like to come back to her treatment room with her. Maybe keep her company. Maybe bring her some food. Maybe hog her cable TV from her.

Crystal perked up at this news. "Nuh, uh," she exclaimed, her head bobbing left-to-right, "I don't think so! I don't want that loser coming back here with me."

Well, it was a slow night. Both the nurse and I wanted our medical note to be thorough, so we decided to pursue more of the social history. And, a juicy social history was just what we needed to light a fire under our dragging asses.

"Who's the loser, Crystal?" asked the nurse. "And are you sure," I added, "that you want to turn someone away that cares about you?"

"Hell, no," she said, snickering, "that guy out there don't care about me. He can just pack-up his sorry ass and get the hell out of here. He's only here because he wants me to give him his cell phone back." She smacked her lips as she spoke, clearing her spittle with the crook of her arm. Real anger causing her to foam at the mouth.

"Then why don't you just give it back to him?" I asked. "Yeah," added the nurse, "why not just give the poor guy his phone back?" God, did we make an awful team! Starsky and Hutch had everything on us.

"'Cause it's mine, now. If he wants to go and disrespect me like he did, then I ain't giving him his damn phone back." She pulled out a phone much more modern and shinier than my six-year old navy Nokia.

We still weren't at the source of the problem just yet. You could feel the tension, though, emanate from Crystal and swirl about our heads.

"Okay, Crystal," I said, getting the show on the road, "let's just forget it and move on with your workup. We have to check a urine pregnancy test to make sure you're not pregnant and then we need to do a few x-rays, some..."

Crystal interrupted me. "I'm not pregnant. That loser hasn't touched me in a month."

"Okay," I said, "spill it or else we need to keep moving here, Crystal." Our curiosity was beginning to bite our dragging asses, not light a fire like we had hoped.

Crystal took a deep breath, ready to spill. The nurse turned from the counter, where she had been writing her note, to listen. "Me and Johnnie," Crystal began," well, we ain't been getting along very much lately. We went out drinking tonight to try to patch things up. While we was out, he asked me to hold his phone so he could go to the bathroom." We were listening intently now. She continued. "Well, while he was in the bathroom, I started going through his phone contacts."

"Uh, oh," the nurse said, "you shouldn't have done that. But what did you find?" This tenacious nurse got an "A" for effort.

"What did I find? What did I find? Here," Crystal yelled, holding up the shiny phone and playing with its buttons, "this is what I found!"

We looked at what she pulled up on the cell phone screen. It was a pretty picture of her, smiling. Below her picture were two big letters. B. M.

The nurse and I both looked at Crystal's picture with the big initials under it. I knew Crystal didn't start with a "B," so I was curious to see where this was going.

"See how he disrespected me?" she asked both of us. "He has B.M.under my name. Now I ain't in medicine or nothing, but I ain't stupid. I know what B.M. stands for."

Just to make sure we were on the same page, I wanted to clarify this with her. "Bowel movement?"

"Yeah, bowel movement. How's that for disrespect? He thinks I'm a piece of shit, that bastard." She was so angry and upset that she started foaming at the mouth again. Who could blame her, really. I don't know if I would like being known as B.M. in my circle of friends, either.

"What did he say when you asked him about it?"

"That's just it. He says to me, 'It don't stand for bowel movement, you fool!' He says it stands for 'baby mama.' But I ain't no idiot."

"Do you have kids with him?" the nurse asked, stealing my thoughts.

"Well, yeah, one, but that ain't the point." Say what? Not the point? Boy, I lost the connection between the dots there.

"But that is the point," the nurse said. "Is he a good daddy to your kid? He treats you well?"

"Yeah, he's good to us."

"And he's not in the medical field, either?" the nurse asked, clearly heading towards fixing the situation.

"No, he's not," she said. "He always says he's smart enough to be a doctor, but that's about it."

"Then," the nurse said, "he means what he says. B.M. Baby mama--it makes sense to me. If you are willing to 'throw his ass out' over that one, then I think you are going to have regrets later."

Crystal got quiet and, eventually, her balloon of anger deflated. She spoke, quietly. "Yeah, you're right. Maybe he did just mean 'baby mama.' I guess I'll let him come back with me. But," she added, "only if he's got me some food."

The nurse patted her on the shoulder. "Sounds good. Let me go get him."

I had to leave the room before I started laughing. B.M. Baby mama? Bowel movement? Be mine? Bite me? Bloody Mary? No, I got it. Big Mac! That's my favorite. Where did it end? If Johnnie really did mean 'bowel movement', though, when he typed those initials under Crystal's picture, then I was impressed. And even more impressive, if he came up with 'baby mama' on the sly, then maybe he should become a doctor, after all! Because we're smart, you know.

I let Crystal know what her work-up would entail and then left her room. Heading back to the nurses' station to put in her orders, I passed Crystal's nurse escorting a young, confident man.

Must be Johnnie--Crystal's B.D. (baby daddy). And he was holding a bag of food from B.K. (Burger King). So I knew there wouldn't be a B.M. (bowel movement, oops, I mean Big Mac) in the bag. I could only hope that things would work out for Johnnie and his B.M. (baby mama).

P.S. I have one massive H.A. (headache) right now.

As always, thanks for reading. If you haven't done so yet, please go vote at Medgadget's Medical Weblog Awards. I would greatly appreciate your support in both categories. If you have voted already, a big thanks. Next post will be Monday, February 1. Enjoy your weekend.

Wednesday, January 27, 2010

Blogging & Me

Ladies and gentlemen, today's regularly scheduled post on StorytellERdoc has been interrupted due to an emergency. Paramedics are currently performing CPR and applying defibrillator pads to my chest. Why, you might ask? Quite simply, I am shocked (yes, pun intended) at the recent events that have transpired with my blog.

It all started with a wonderful email I received on January 13 of this year.

"I have been reading your blog since early December and I have to say thank you for the most amazing writing. I shared your "Tupperware" piece with colleagues here and shared a link via Twitter; it got passed on so many times that it came back to me via people I don't know."

Now, how amazing is that? In and of itself, that was enough reward for me. But, kind Carrie continued.

"Congratulations on being nominated for awards on --The 2009 Medical Weblog Awards Nominees. I have no affiliation with that blog or any of the blogs listed. I just happened to notice you made the cut and I was happy you did. Looking forward to future stories."

Say what? I was shocked. Pure mouth-gaping, breath-holding, sphincter-tightening shock. After reading this email a second time, though, I thought I might be getting pranked by one of my smart-ass friends. Why do I let those types into my life?

So, I clicked on the forwarding link and sure enough, there was my blog name, listed under two categories--"Best New Medical Weblog (est. in 2009)" and "Best Literary Medical Weblog."

I was even more shocked. And humbled. And honestly, happy beyond belief. I don't Twitter and I don't Facebook. And, although I enjoyed reading some excellent blogs here and there, I surely didn't know the first thing about blogging and computers in general.

Enter my creative writing group. An amazing group filled with the most impressive types of personalities. In fact, you will intimately meet all of these people in a future post (they should be very afraid!). Five of us, meeting weekly, submitting our works to be critiqued, dissected, reworked, and complimented amongst one another. Complete trust. It was this group that convinced me, after enough sharing of my silly stories, to write them in a format that might be shared with others. What? And put down my fiction novel that was two-thirds done? Are you crazy? Am I?

"Just do it," they said, led by Christine, our gifted and fearless leader. And so I did. Christine and I met for coffee, exchanging ideas, pictures, colors, and concepts and, before I knew it, she had completed my blog site. Thanks, Christine, for the awesome banner and site! And thanks to my wife, who helped me clear the rubble to come up with such a cool name.

Now, I just needed to put words to paper. How should I start? I worried myself too much because the minute I started writing, the stories streamlined from my fingertips to keys to computer screen. I LOVED writing my posts. But would others take to my words? And between work, family, my regularly scheduled life, and my stalled novel, when would I have time to write three stories a week? Would the sacrifice be worth it? In mid-November, 2009, I took the chance with my first post.

And quite simply, yes, it has been worth it. Ten-fold. No, a hundred-fold. Make that infinite-fold. Every early morning and late night, every struggle to capture that escaping thought and word, every rewrite--hell yeah, totally worth it.

Today, I learned that I have been named a finalist in the Medgadget Weblog Awards in both categories! Again, flabbergasted. And appreciative. I'm so naive that I didn't even know they narrowed the nominees down to six finalists. After showing my kids my name on the finalist list, they were beyond excited! At the prospect of winning an iTouch or to see my name on the list, though, I don't really know. But regardless, their smiling faces were my trophy. Thank you to the judges and all of you involved in my nominations for this very cool recognition.

I don't want to get mushy here, but I sincerely wish to thank you--my intelligent, faithful, funny, and cool reader. To be brutally honest, I have already felt more accolades than I ever expected, simply from your acceptance of me and my blog. I wish I could list and thank each of you personally.

Finally, I must mention the friendships. From the earliest comments on my first post, I am amazed at the number of incredible people I have met simply from commenting, from following blogs, and from privately emailing. Some of your personal stories are incredible, but all of your stories are memorable. And real. Thanks for the friendship and for allowing me a glimpse into your life and respecting your glimpse into mine.

I had hoped for my blog to be compassionate, humorous, heartfelt, and above all else, show the beautiful resilience and positive perspective of the human spirit in crisis. I hope I am succeeding.

Thank you, my friends...

As always, thanks for reading. If you get the chance, head over to Medgadget and vote. Thanks for your support. The next "regularly" scheduled post will be Friday, January 29. See you then. And to my little big girl, Gracie, Happy 9th Birthday! ILY

Monday, January 25, 2010

Please Cath Me!

I want you to reminisce to when you were 21. Remember those days? The good years. When nothing ached. When the bills weren't big. When your biggest decisions were what to wear, how to fix your hair, and who to go out with.

When you could pee without a struggle.

Now, hold on, don't assume this is about me. It's not. I'm way, way too young to worry about that problem just yet (I think I just heard my wife laughing).

This is about my next patient, a local 21 year-old college student.

I live in a town where we have four colleges. Really great, fantastic schools. As a result, though, a portion of our ER patient population are college kids not from this area. Anonymous kids who aren't afraid to come see us so we can cure their "drip" or "discharge." Well, at least until the next time. But, all in all, good normal kids.

So, imagine my surprise when a nurse walked into the nurses' station and asked me to urgently see her new patient. A man who couldn't urinate. A 21 year-old man who couldn't urinate. Now, we're used to the older male patients who can't urinate, but 21?

"Are you kidding me?" I asked, waiting for her to say "Gotcha."

"I wish," she answered, all business-like, "and he's really uncomfortable."

Well, at 21, there isn't much to hold the flow back. A UTI. An STD. A kidney stone. Trauma. Neurological disease. Medications. Crazy. I ran through my internal list as I approached his room.

I walked into the room to find a young man writhing in his cot. "Please cath me!" he exclaimed before I could even introduce myself. Now, this was a first for me. Go back to when you were 21 again and tell me if you knew what catheterizing even was (heck, I'm not sure I could have even spelled it!). How did this kid? And what was his story?

It turns out this was a heck of a nice kid who had this happen to him once before. He had a phobia about airplane bathrooms and urinating at 15,000 feet. He was on a return flight, after a visit to home, when he felt the urge to urinate, just as Murphy's Laws would dictate. Thinking ahead, he believed he would have enough time to relieve himself in the terminal once he landed and before catching his connecting flight. Wrong!

His airplane didn't land in time, instead circling in the air waiting for its clearance. This poor kid's kidneys didn't know this, though. They kept filtering his blood and dripping more and more urine through their connecting tubes into his bladder. A dripping faucet filling up the clogged sink. Drip. Drip. Drip. By the time the kid had landed an hour later, he was in misery.

With only five minutes to catch his connecting flight, he hobbled through the airport, passing several bathrooms. Can you imagine making such a decision? Should he keep running to make his connection or should he stop to urinate, miss his flight, and then sit around and wait for the next unknown connecting flight?

He opted to catch his connecting flight. He told me he spent half of the hour flight in the airplane bathroom trying to go, ignoring all the knocks. He was obviously unsuccessful. Even without a phobia, I wouldn't be able to relieve myself with someone knocking on the door, either. Ducking down from the low ceiling, rocking back and forth from turbulence, staring down at that ridiculous metal basin they call a toilet, and then multiple knocks on the door? Sorry, bud, no can do. They need to get some Depends dispensers!

An hour and a half later, he was my patient. I ran and got our portable bedside ultrasound and hurriedly placed its probe on this kid's belly. Sure enough, he had a bladder big enough to fill a backyard pool. Eight-feet deep, no less!

The bladder is a tricky organ. Once it is stretched enough from filling with urine, the nerve fibers convey to your brain the need to find the nearest bathroom, do not pass go, and relieve yourself. In this kid's case, though, his bladder continued to fill beyond its capabilities to contract. Thus, he had a bladder screaming at him but no longer able to squeeze out the urine. An "atonic bladder" for those of you hoping to answer the final question on Jeopardy someday. This can be quite an uncomfortable predicament. A catheter was his only answer.

The nurse, relishing her role as a patient advocate, hip-checked me out of the way the second I was done with my ultrasound. She had a catheter in her hand and she was ready to save another life (her second one that day if you count the dental pain patient she and I had treated earlier!).

Unfortunately, the nurse was unsuccessful in passing the "too-big" catheter into his bladder.

"Hey, Doctor K," she yelled loud enough for three rooms over to hear, "can you grab me the smallest catheter in the med closet or, better yet, a pediatric one?"

Say what? Are you kidding me? He's 21, for God's sake, don't insult his manhood this way! Where are all the understanding male nurses when you need one? I made a mental to tell the nurse that if I ever needed anything less than a garden hose for a catheter, she better not yell it out to the other rooms, thank you. If I'm being honest, though, if I do need a garden hose, I would be okay with her letting the whole ER know (that better not be my wife I hear laughing again!).

The nurse was successful in placing the smaller pediatric catheter in this patient and immediately, almost one liter of urine drained out. Before he was discharged, he had drained two liters of urine. Can you imagine? Two liters! I am not embellishing here, we have markers on the collecting bag. And let me tell you, the day I can fill a two-liter Coke bottle in one squirt is the day I'll win a pissing--oops, I mean bragging--contest!

The patient did awesome. As soon as the urine started flowing out, he was a different person. We tested him for a UTI, a kidney stone, and STDs and he passed with flying colors. That's my boy! We offered to let him wear the catheter home with a draining bag attached to his leg, but he refused.

"What, are you kidding me? You mean wear this thing to class tomorrow?" he asked incredulously. I understood completely. I could only imagine what a chick-magnet a catheter with a leg-bag would be in college. Picture it--biology class. Pretty girl on his left, speaking to him. "Excuse me, but is it me or does it smell like a nursing home in here?" A pause and then she'd continue. "And why is your left thigh so much bigger than your right?"

When he left, without his catheter, he couldn't have been more appreciative...and comfortable...and homesick.

"Please cath me!"

Yeah, right--I'll take quotes you'll never hear a 21 year-old say for $200, Alex.

As always, a big thank you for reading. Next post will be Wednesday, January 27. A shout-out to all of you who have blogrolled me, twittered me forward, and have left cool insightful comments. And to those who have nominated and are supporting me for the 2009 Medical Webblog Awards at, I thank you. I am very humbled...

Friday, January 22, 2010

Shirley's Tumbler

I wish there was more reason and less rhyme in the ER.

For example, I might sign on to see a gentleman with urinary symptoms who ends up having an abdominal aortic aneurysm. Likewise, I might sign on to see an elderly woman with twenty medical problems who ultimately has nothing but some loneliness issues. Hug, please!

So when I signed on to treat a recently-retired man with back pain, chronic by history but exacerbated by recently lifting some grocery bags, I assumed it would be an easy, clear-cut case. "Me lift heavy bag, me back go 'crunch,' me try Tylenol but it no work, me come to ER." See how easy that can be? Wrong!

I walked into his room to introduce myself. I found a pleasant, mildly-distressed, sophisticated gentleman lying in his cot. In the corner chair, an equally sophisticated woman sat on edge. She introduced herself as his wife.

"Sir," I said after introductions, getting to the point, "I understand you hurt your back."

"Yes, he did," the woman jumped in. "It was stupid, really. He forgot to tell the grocery cashier not to put as many things in each bag. You know how they like to load those bags up when you ask for paper inside of plastic."

"Thank you, maam," I said, redirecting my questions and attention back to her husband. "And sir, did you have any trauma or falls or direct blows to your back recently."

Again, the woman answered. "No, he didn't." She waved her hand as if to dismiss his symptoms. "He does this all the time." She directed her attention from me back to her husband. "I warned you before you went shopping today, Leonard, not to let her do that." Leonard glared at his wife. I understood how he felt.

"Do you have any chest pain, shortness of breath, or abdominal pain, sir?" I asked.

I heard her grating voice again and, I must admit, I cringed. "No, he doesn't. But he has a trip planned to Vegas tomorrow and I want you to tell him he can't go, not in this condition. How the hell is he going to sit on a plane for three hours?" She looked at him and shook her head. "Stupid, I tell you."

"Well, maam," I said with restraint, "let me finish asking him some questions, do an exam, and then I'll be able to make that determination. And," I added, "I would like your husband to answer my questions from now on. When we are done, I'll give you a chance to share any more information that you feel is necessary."

From the look I got from her, I do believe she thought I had asked her for one of her lungs. That would be meaningless, though--she could still survive. Give me both of them, maam.

I looked from her to her husband, who was now glaring at his wife. And what do you know? The guy had a husky, deep, authoritative voice. "Shirley, just shut the hell up. You're embarrassing me. I don't know why you had to bring me here and I don't know why you just can't sit there and be quiet."

Uh, oh. I could smell the danger in their dynamics.

"Sir, I continued, trying to shortcut an argument, "let's get back to my questions. Do you have any traveling pain, numbness, or tingling or is the pain just sitting in your lower back?"

"Just right here, doctor," he said politely, placing his hand over his lower back region. "No where else." Well, I'll be damned--this guy finally got to answer a question! Sweet, golden silence emanated from the corner.

"Do you have any urinary symptoms at all? Burning? Going more frequently? Anything out of the ordi..."

I was interrupted by his wife. "No," she said, "Leonard doesn't have any problems pissing."

Okay, I had had enough now. "Maam," I said, giving her my undivided attention, "I appreciate you trying to help, but I am going to ask you to leave the room if you interrupt your husband and I one more time. You can't possibly know first-hand how he is urinating and, unless he can't talk, I want to know directly from him. Is that clear?" I got a huff and a dismissive look from Shirley, right before she turned her attention upward to a room corner--her way to let me know I was now going to be ignored. "Thank you," I said, refusing to be baited.

Leonard and I were able to finish reviewing his history without any further interruptions. I asked Shirley if she would like to add anything else, and she looked back from the room's corner to Leonard. "Oh, what? Now what I have to say is important? No thank you!" Poor Leonard--my heart went out to him, kind of the way your heart goes out to that baby wart hog that the lionesses trap in Africa.

Leonard's exam was consistent with a lumbar strain or, simply, a pulled back. I explained my findings to both Leonard and his wife and also explained that, with his history and age, I wanted to obtain both a urinalysis and some basic lumbar x-rays to make sure he didn't compress a vertebrae. I also had the nurse give him a pain shot to get him more comfortable. A big, big shot. He deserved it.

"Yeah, yeah, yeah," Shirley said impatiently, "but what about telling him he can't go to Vegas in the morning." Fingernails on a chalkboard, I tell you.

What I had to say next to Leonard, however, hurt me more than I'd care to admit. I took a deep breath. "Leonard," I said, putting my hand on his shoulder, trying not to gag on my words, "your wife is right." There, I got it out. "A fresh strain on your back is not going to let you enjoy this trip and, in fact, may hamper your healing to the point where you might do some worsening damage."

Leonard wore a look of extreme dejection. Who could blame him, really. This trip to Vegas was with "the guys" but, more importantly, without Shirley. I was proud of Leonard, actually, for holding back the tears I knew would be coming if this were my situation. I tried to imagine it--me, my big crocodile tears, and a box of tissues, hiding from Shirley in our house attic.

I finally left their room. Honestly, I was exhausted. Leonard's case was quite simple and the amount of energy I used in his room was unexpectedly huge. No rhyme or reason. I needed coffee, stat. I debated calling the grocery store to speak to the cashier. "WTF?" I was going to say, reminding her to put only one canned good in each bag. Really, though, you and I both know she was innocent, an easy target for my frustrations. I was above that, wasn't I?

Well, Shirley stepped out of the treatment room soon after I did. After his nurse, Natalie, gave him his pain shot, I explained to her how frustrated I had been from the interactions with Leonard's wife. "Did you get frustrated, too?" I asked Natalie.

"Yes, but it's about to get better soon," she said, knowing something I didn't.

I went in and checked on Leonard a short time later and, thankfully, he was alone and his pain was much improved. His tests had come back favorable and I explained these results to him.

"Thank you, doctor," he said, "and hey, I'm sorry for my wife's behavior. I don't know why she always has to be such a nag." Don't worry, I assured him, it was all good. I appreciated his acknowledgement, though.

After observing Leonard for about an hour, I went in to check on him and plan a discharge. And guess who was back? Yep, Shirley was, sitting in the corner chair, drinking from a big tumbler.

I reviewed Leonard's results with her and she didn't interrupt me once. Nada. She seemed genuinely pleased and happy with his results and treatment. "Thank you, doctor" she said, once I had finished. I staggered from her unexpected words and, thankfully, the wall behind me supported my sway. Of course I'm embellishing, but she did throw me for a loop. I wished Leonard the best, though, and after advising him of his treatment plan, left his room shaking my head.

"What happened in there?" I asked Natalie. "Why is she so calm and pleasant now?"

Natalie laughed at me. "Did you see her big tumbler?" I nodded yes. "Well, it's not water that's in there." Initially, I was puzzled at what Natalie was getting at but then, suddenly, lightening struck me and things became very clear. And sad.

"Alcohol?" I asked. "Of course," she said.

It seems Shirley and Leonard and their marriage were well-known to our ER staff, barring me, and several of their previous arguments had been quite memorable. Shirley's "tumbler run" was just as famous as those arguments. And necessary, Natalie assured me. "Otherwise," she said, "I think we'd have to get security involved. Possibly the police. Those two can go at it like you wouldn't believe."

I slowly nodded my head, not really sure what to make of Natalie's words or Shirley's tumbler. That tumbler was able to do the impossible--drown out Shirley's abrasiveness. Although my sympathies had always been there for Leonard, I now felt some creeping forward for Shirley.

"They were pretty tame today," Natalie continued, interrupting my thoughts, her smirk evident, "they must have liked you."

"Listen, Natalie, can you do me two favors?" She nodded and I continued. "One, get a social worker in there to discuss counseling options, both for their marriage and Shirley's drinking problem." Natalie nodded. "And two," I continued, "get someone to drive them home."

Natalie touched base with me a few minutes later. "All done," she said. "Their daughter Lisa and her husband are reluctantly coming to pick them up. And Shirley and Leonard kicked the social worker out of their room--they didn't have 'any God-damn problems, for Christ's sake.'"

Shirley and Leonard, my best to you. And a personal plea. The next time you come together to our ER, if I'm working, bring me a tumbler, too. For Christ's sake, I'll need it...

Enjoy your weekend. As always, thanks for reading. Next post will be on Monday, January 25.

Wednesday, January 20, 2010

I Like The Fish

A few years back, I took my two older children out on a "Daddy-date" that culminated with a sit-down lunch at McDonalds.

As we sat eating our meal in the pleather booth, complete with a beautiful busy intersection view, we noticed a homeless person pushing a rusty grocery cart across the road's crosswalk, towards us. Cars were flying by, barely stopping, their horns honking as if that would make this person go faster. Or, as I'm sure some hoped, go away.

"What is that man doing, Daddy?" my son asked, his hand, holding a french fry, paused in the air.

"Why don't we just watch and see where he goes, buddy," I said, hoping the man would reach our side of the road quickly.

The man did make it across the street. He continued to push his cart towards our direction. At this point, my kids were now completely entranced. Nuggets were getting cold, ketchup was drying on french fries, and Happy Meal toys were all but forgotten. And yet, none of us could take our eyes off this lonely figure now struggling with his cart to cross the curb into our parking lot.

Slowly, he advanced up the sidewalk, eventually pushing his cart right up to the building, outside our viewing window. My kids continued to watch closely, absorbing everything about this man that they could. Sadly, I was prepared to avert my eyes, as most of us as adults do, if he would look in at us and see us watching him.

Up close, he was in a sad state. The fall weather was turning cold and this gentleman was obviously struggling to stay atop of the falling temperatures. He was dressed in layers, finished by a top coat that was scrappy at best. Underneath, his exposed shirt was torn and tattered. He wore half-fingered gloves, slender dirty fingers poking out of the frayed edges. Long, scraggly hair poked out from beneath a fragile ski-cap, complimenting his unkempt beard. His pants and boots were in disarray and threadbare.

He parked his shopping cart against the building, returning to it twice to check on it and push it tighter in. Finally, happy with his park-job, we saw a brief smile cross his face as he looked in on us. Taking a note from my children, I did not avert my eyes but, rather, appreciated the raw kindness emanating from his quick glance.

"Daddy, he's coming in!" my daughter squealed. "Can we buy him his lunch?" But of course, I told her.

Slowly, he made his way into the restaurant. My kids spun on their seats, turning to watch the gentleman enter through the doorway. Sadly, as he entered, an exiting couple took a step back, away from his approach. It was, I can only assume, to ensure that they wouldn't get this man's contagious misfortune.

He walked into the restaurant and despite the stares and mumbling, walked up to a booth near ours, head held proudly up. He wiped the table off with his fingerless gloves and then proceeded to spread out a rumpled newspaper he pulled from his pocket.

"Come on, kids. Let's go get a hamburger for this gentleman." The kids eagerly jumped from our booth.

As the man continued to customize his booth table, we walked up to the counter and ordered a Quarter-Pounder Value Meal. "Don't forget to super-size it," my son added. Of course, I assured him, thinking that would be the best additional 35 cents I'll ever spend. We also got him an x-large coffee to go with his Coke.

Excited but nervous, the kids and I approached the gentleman's booth, me holding the coffee and the kids carrying the large drink and bag of food.

"Excuse me, sir," I said, offering over the coffee, "but we thought maybe we could buy you some lunch today."

The man raised his eyes from his table to meet mine. We looked at one another briefly before he turned to closely look over both kids. I felt their free hands tightly grip my pant leg. Finally, he focused on the bag of food.

I took the bag of food from my daughter and the soda from my son and placed them on the table beside the coffee. The cat had definitely gotten my kids' tongues, so I spoke.

"We got you the Quarter-Pounder Meal with a big coke and french fries. We got you coffee, too, in case you wanted to warm up."

"I like the fish."


"I like the fish."

Oh, my. The kids looked up at me as he finished talking. I was surprised and a little hurt, to be honest, for this gentleman's lack of appreciation. I mean, come on, free food and drinks! I quickly admonished myself and reasoned through his behavior, though. Being homeless or down-and-out doesn't mean he still can't have likes and dislikes. Suddenly, I appreciated and respected this man's gumption all the more.

Looking down at my kids expectant faces, I knew what we needed to do.

"Sir, I'm sorry we didn't ask you first. Besides the hamburger, is everything else okay? What else do you need?"

He was a man of few words. "Fish," he said, "and hot chocolate. No coffee."

Okay, I thought, we can do that. We hiked back up to the counter, got his order right this time, and carried a fish sandwich meal and hot chocolate back to his table.

He hadn't touched the previous bag of food or either drink while we were gone, but when we returned to the table, he eagerly took the bag holding the fish sandwich from us, looked in, and smiled a big smile when he saw the sandwich.

Slowly, he looked up from the bag. His smile continued, floating there under his ruddy cheeks, and he passed it on to my daughter, then my son, and finally to me. Priceless. We all returned his smile with our own. Such pure delight from something so simple.

"Do you need anything else, sir? Anything at all?"

He nodded his head no to any further offers of help. "Thank you," he spoke softly, quietly, our ears straining to hear his words. I'm sure it was for the food, but a part of me hoped that it might just be for treating him with respect and decency.

We walked back to our seat and gathered our things, cleaned off our table, and threw out our garbage. I couldn't help but wonder what the man would do with the hamburger and extra drinks. Oh well, they were his now.

As we walked out, my shy daughter surprised me. Just before the exit door, she turned around and yelled out to the smiling man eating a fish sandwich alone in his McDonald's booth. "Bye!"

The real surprise, though, was on all of us. Hearing my daughter's voice, this man stopped mid-bite, looked up at us, and waved a goodbye wave.

His attention went quickly back to his fish sandwich, but I could only hope that my kids' attention was focused on seeing beyond this man's misfortunes and seeing him simply as another fellow being, one who deserved a little respect and kindness in our big, infinite world.

Sadly, we haven't seen this man since... as always, thanks for reading. Next post will be Friday, January 22.

Monday, January 18, 2010

The Amazing Race

To understand this next patient, you need to do me a favor. Ball your hand into a fist. Now, rotate your fist either way as far as you can. When you can't rotate any farther and your forearm muscles feel tense and strained, imagine that you are Stretch Armstrong and continue rotating your fist for a full rotation. Pretty amazing, yes? Now, do the impossible and imagine another full rotation. And then another.

This is exactly what happened to Javier's testicle. Javier, a handsome but frantic eight year-old, had presented to our ER around 10 a.m. just a few weeks back. He had been born with an undescended testicle and had been closely followed by our pediatric urologist, who most recently had seen him just a month prior. Because his testicle had finally decided to spontaneously show up for this life, Javier's doctor was debating whether to surgically anchor his testicle down to keep it in place. Yep, a suture from his testicle to his scrotum.

Unfortunately, on the morning Javier had presented to our ER, he had awoken at 2 a.m. with sudden and severe left-sided groin pain. He was comfortable lying perfectly still, but the minute he moved or someone approached him to palpate his groin area, he was beside himself. You couldn't help but feel sorry for the poor kid who, despite his pain, was trying his best to be courageous.

After some morphine and a brief exam, in which he wouldn't even let me get close enough to thoroughly examine his genitalia, we proceeded with a very quick workup to figure out where his pain originated from. His urinalysis came back clean, just as I expected. Good blood work. The test that I most needed was an ultrasound of his affected testicle. To complete this test, because he was in such intense pain, we needed to give Javier an additional generous dose of morphine. The ultrasound tech was then able to manipulate Javier's scrotum to view his left testicle.

Sure enough, the ultrasound revealed that he has no blood flow to his testicle--a diagnosis of "torsion" of the testicle. So, from above, your fist = Javier's testicle. All the vessels that lead to and from his testicle had been twisted and rotated to the point that they closed off and were no longer delivering significant blood to the testicle.

Javier was in danger of losing his boyhood. Cringe-worthy stuff, I must say. I'd cry, too. I could only hope someone would be kind enough to load me up on morphine. And lots of it.

Javier, by this time, had been in pain for approximately nine hours. Time was "of-the-essence," so to speak, to save his testicle (after 6-8 hours, we begin to seriously worry). There are several manipulations one can sometimes attempt in the ER to save the testicle but, again, I couldn't get near Javier's testicle to really palpate it, let alone manipulate it. I was very close to giving Javier some anesthesia in our ER in an attempt to urgently "unrotate" his testicle. Thankfully, though, his pediatric urologist was close-by (from our earlier alert to her) and arrived in just minutes to take Javier to the OR. The race was on to save his testicle.

After establishing the diagnosis, I had a chance to go spend some time with Javier and his family. Javier and his uncle were well-versed in English, but his father wasn't. Fortunately, his uncle did a fantastic job of translating and by the end of our conversation, Javier's father had given permission to surgically repair Javier's testicle.

Poor Javier, though, was crying inconsolably now, probably as much from the fear of the unknown as from the pain of his testicle. More morphine, please.

I should have saved my drawings explaining the testicular torsion from that day. If I may say so, they were beautiful. Stunning, actually...NOT. They were a complete mess, like most of my attempts at drawing are. I should probably spend more time at home practicing how to draw a realistic testicle, so I'll be ready the next time. I would just need to be very careful about where I leave these practice drawings lying around. And who knows, maybe with a little practice I'll become the male version of Georgia O'Keefe!

What explanation Javier and his family understood best, though, was my fist and my attempt to rotate it. They understood that this "was not good" for the testicle. Bad, actually. To reinforce the seriousness of the situation, I brought a medical book into the room and was able to show them a legitimate picture of the testicle and how it had rotated on itself.

I have great news to share with you, though. Javier still has two functioning testicles! Oh, he sure does! Yes, yes--of course I'll wait for the cheers to die down. After the pediatric urologist made her scrotal incision, she was able to unrotate Javier's testicle and it immediately "pinked-up," meaning blood-flow had been reestablished. She later shared that his testicle probably survived this long because of two reasons; 1) his testicle rotated only a couple times, and loosely at that, and 2) the rotations probably didn't completely cut off his blood supply and a trickle flow of blood may have sustained the testicle. Lucky ball! She tacked it down so that this would hopefully not happen again to brave Javier. Yep, a suture from his testicle to his scrotum (did I mention this already?).

Regardless, I'm just happy that Javier can still face his world with two functioning balls. Let's face it--there is a reason we call them "jewels," and, as any guy will testify, it's better to face the world with two of them instead of one.

If things hadn't worked out for Javier, though, he would still have had one functioning testicle and worse things than that exist. I'm just glad that, in a few years, he won't have to go pick out a life-like prosthesis. Hmmm--decisions, decisions. A steel ball? Wooden? Saline-filled? I personally would go for the steel ball, after living through residency. Come to think of it, though, imagine what a chick-magnet a ten-pound prosthetic testicle could have been for Javier, regardless of what it was made of!

Initially, I thought we had helped Javier win The Amazing Race, saving his testicle and all. But after thinking the prosthesis thing through, maybe not.

Sorry, buddy.

Hats off to Javier for being a brave little boy. As always, thanks for reading. The last round of comments were very cool. Next post will be Wednesday, January 20.

Friday, January 15, 2010

Antisocial & Cynical Me

Recently, while in the middle of a conversation with an old high school classmate at a family gathering, a middle-aged woman who I had never met before ran up to me.

"Are you a doctor?" she blurted abrasively, stepping between my friend and me.

"Pardon me?"

"I said, 'Are you a doctor?' That man over there (she pointed to my father, who was in the middle of his own conversation) says that you are and that you'd be able to help me."

Ughhh! I've had several conversations with my father about not referring me "consults," especially when I'm holding a beer in my hand at a party.

Unfortunately, my father likes to play by his own rules. And when you're nearing eighty, there's only one rule--"I'll do whatever I want." He's even had friends run up to the house to "ask me something" or "take a look at this" while I'm in town visiting. As I said before, ughhh!

After I realized that this was not a joke, I had no choice but to listen this woman out.

"Anyway, I got bit by a bug last week, right here," she spoke, sweeping her forearm in front of me, revealing a small pimple, "and it won't go away. What can you do?"

Well, I knew what I could do. It involved my steel-toe boots and this woman's ass. I was at a party, for God's sake! Or, I guess I could have set down my beer and grab the defibrillator paddles for this life-threatening emergency.

Instead, I decided to take another long sip of my draft beer. A perfectly chilled beer that was hitting the spot. Hmm--decisions, decisions. I knew this would make me look extra attentive and reflective about her question, me there dragging out that sip and pondering her illness. I mean, I wanted to look like I cared, right?

Unfortunately, I spilled some beer on my shirt during my pondering. Make that attentive, reflective, and clumsy.

She continued waving her arm in my face, anticipating my diagnosis.

"Well," I started, "if you had come to the ER while I was working, I might have tried to lance it, but I doubt there would be any drainage. Since it's small and hardly red or swollen, though, I think you will be alright just to use warm soaks on it and give it time to heal itself."

She started to open her mouth but I cut her off.

"No, it doesn't need antibiotics," I said.

"How did you know?" she asked, surprised.

You know how I know? I'll tell you how I know. Everybody wants antibiotics when they have a problem. Heck, President Obama should have just sent each family a four-pack prescription of amoxicillin instead of tax relief money. The economy would be kicking like no tomorrow, all problems solved.

She looked down at her arm again, my eyes following her's back to the minuscule bump. I hope she didn't expect me to pop that menacing pimple with my own gloveless fingers! Give me one more beer, though, and just maybe...I think I could do it, using the same technique we all used when popping our face pimples in puberty. Thankfully, though, I was of clear mind.

I was hopeful that we were done, but oh no.

"Hey," she continued, "look at this." She pulled her short-sleeve shirt from her left shoulder to expose her bra strap, her bra, and unfortunately, her boob. She was hardly fazed. Did I mention I was at a party with a lot of people around?

"Oops," she said, pulling up her bra but still exposing a shiny new scar on her anterior shoulder.

"Wow," I said, taking another long, reflective sip of what was left of my beer.

"Shoulder replacement," she said, a proud smile creeping onto her face.

"Wow," I repeated again, now making a mental list of how I could possibly repay my father for this referral. Would it be wrong or considered rude to give your eighty year-old father a wedgie? Could adult services come after me for that?

"Yeah," this woman continued, "my doctor said I was the best patient to ever have this done."

I nodded my head. The old "you're my best patient" line, successful once again.

Actually, I must admit, this woman was very nice and pleasant, in her own way, but I really didn't want to go down that road with her of all her past medical problems. I can spot that trap ten miles away. And I was at a party holding a beer, not working in the ER. I'm sure I would have enjoyed her company if not for her forearm pimple and shoulder scar.

I'm sure of it. Almost sure. Pretty sure. Okay, not sure at all. Actually, probably not. Alright, nope, I wouldn't have enjoyed her company regardless.

After she finally left, I got back to my classmate, who was flabbergasted.

"Does that happen often?"

"Yes, unfortunately, it does," I said, keeping my answer short. I really wanted to whine and complain about just how often this does happen, whether my father is around or not, but I reminded myself that nobody really wants to hear about someone else's problems.

"That's cool," said my classmate, "because I've been meaning to ask you about this toenail..."

Needless to say, I haven't been to a party since. Well, okay, maybe just one or two...

As always, thanks for reading. Sincere gratitude to all who have recently blogrolled or twittered my posts--I appreciate your support. Next post will be Monday, January 18.

Wednesday, January 13, 2010

The Pink Shiny Booger

It was late into the evening shift when I walked into a room to find a very embarrassed mother holding her toddler girl in the corner chair.

I introduced myself to Mom and then asked what brought her and her child to the ER this night.

"This," she answered, holding up a light-pink bead necklace. Mom explained that it was from a toddler game that involved spinning an arrow and collecting jewelry at various stops on the board. I am familiar with the game, actually, having won it a rare time or two against my kids (yes, my proudest moment as a father). Lucky for this little girl, I didn't have time to play tonight.

"Somehow," Mom continued, "Rachel broke the pink necklace and was able to pry apart several of the beads. Right before going to bed, we noticed this." With that, she placed her hand gently on Rachel's forehead and extended her neck, giving me a clear view of a smooth, shiny pink "booger" in Rachel's left nostril.

I had to smile. If you are a parent and have never had to deal with a foreign body in your child's ear or nose, consider yourself lucky. I'm knocking on wood, but we never had to deal with this problem, either. Something tells me, though, that I just jinxed myself. Rachel's mother, however, would not be included in this lucky group.

Rachel's mother continued to tell me everything they did to try to get this pink booger out. Q-tips. Tweezers. Tickling Rachel to make her laugh. Having her blow out of her nose. Hanging her from her feet for an hour from the house beams. Relax, just joking there. If anything, though, Mom felt their efforts may have made the bead go further up.

I taught Mom what to do at home if this ever happens again. Sit Rachel upright. Have her breath through her mouth. Have her take a deep breath in through her mouth and blow forcefully out of her nose, while plugging the unobstructed nostril. Sometimes, parents have even tried to blow forcefully in their kid's mouth to achieve the same response.

When all else fails, or if there is ever any struggle to swallow or breath, an immediate ER visit is necessary. With Rachel, who was quite comfortable sitting in her mother's lap, our options were simply to retrieve the bead with a suction-tip catheter, a hooked probe, or "alligator forceps," these very cool long-nosed forceps that reach easily into fairly tight spaces. Among the options for Rachel, we used the forceps first.

We got lucky with our alligator forceps on the first attempt. Rachel, cooperating and lying comfortably on her back in the cot, was a stellar patient. She let me reach into her nose and grasp the pink bead quite easily.

As I pulled out the bead, we all clapped for Rachel while she clapped along. Mom was relieved, obviously. Rachel, after getting an Italian ice and a handful of stickers, was discharged to home with an ENT follow-up appointment.

"That was too easy," the nurse commented as we watched Rachel and Mom leave.

An hour later, guess who was back. Yep, you're good--Rachel and her mother. They were requesting me.

I walked into the room, already laughing and shaking my head. "What happened?" I asked Mom.

If Mom was embarrassed before, now she was outright frustrated. "You'll never believe it," she started. "While we were here earlier, my husband cleaned up the game and swept the floor in Rachel's bedroom. When we returned home, guess (she nodded at Rachel as she spoke) who found a lone bead under her bed?"

I knew the answer. Mom continued. "I tried to do everything I could, but I just can't get this bead out. I am so embarrassed to be here again."

As she finished talking, Mom, being a good sport, started a laughing fit of her own. It was funny. "On top of it all," she continued, "Rachel couldn't be happier to be here again--she thinks she's getting more stickers and another ice." I looked down at Rachel, cuddling into her mother's lap, who returned my look with a sheepish grin. No doubt about it--she was cute as heck, pink booger or no pink booger.

Well, another bead, same nostril. We repeated what we did earlier to get Rachel's bead out and, knock on wood, it worked again. In my pretend stern voice, I told Rachel "no more beads." Mom was going to have to watch her like a hawk for the next few weeks. In fact, I think Mom wanted a pair of the alligator forceps to take home with her.

Needless to say, Rachel left without any new stickers or an Italian ice, at Mom's request. We understood completely. I was hopeful they wouldn't reward Rachel with a visit from the "pink booger fairy," either. Two bucks for two beads and I suspect they would become ER regulars.

I was happy when my kids outgrew that particular game--no shiny, colored boogers for my family, thank you very much. I'll take the yellow or green boogers any day. At least that way I know it will eventually either drip out or be swallowed. As for Rachel and her mother? I haven't seen them again since, but it I'm estimating correctly, I think Rachel is approaching the age where she'll start playing Monopoly soon. And Chinese checkers. And eating popcorn. And peanuts.

I'll be ready...

As always, thanks for reading...much appreciated. Next post will be Friday, January 15.

Monday, January 11, 2010

Heroes Among Us--Gigi

The world just lost another angel. A hero. An ordinary person with extraordinary kindness and love.

Do you ever stop to think how often through your typical day you pass by an angel or hero and simply don't know? Busy, busy, busy. We have things to do, errands to run, and phone calls to make. We keep strangers at arm's length. And the cost of this hurriedness is simply that we fail to share and learn about one another. Every face we encounter holds a history, a story to be told, and sometimes those stories are remarkable and breathtaking. The unfortunate thing is that we will never know if we don't take the time.

Enter Gigi. Someone who always took the time.

Gigi was an EKG technician at our hospital. Almost nine years ago, as I have touched on previously, my son was diagnosed with a rare malignancy that required him to be on chemotherapy for a year. He failed to stay in remission and had to undergo a second complete year of chemotherapy to achieve remission again. Since then, he has been in remission for five years and is an extremely well-adjusted, bright, athletically-gifted boy who makes my chest swell with pride. Through his experiences, I have learned much about life, about love, about compassion, and especially about embracing the daily moments that hold the simplistic joys that many feel come only with big life-events.

What I was learning at that time in my life, however, Gigi already knew. She was frequently called down to our ER to do EKGs on patients and she could be overheard in conversation with them, asking them frank, sincere questions about their health, their lives. She seemed to really care and enjoy her interactions with each new face.

I didn't really know Gigi, however, until one day when she approached me soon after my son's initial diagnosis.

"How is your son doing?" Her voice had startled me and I looked up from my chart to find this middle-aged woman with a soft perm, intense eyes, and a big smile talking to me.

"Pardon me?" I asked, surprised at her bluntness. Most people either tiptoed around me or asked me directly about my son. I appreciated the latter approach and Gigi did too, obviously.

"Your son. I just found out about him and I'm praying for him and your family I just wanted you to know."

She was a stranger and yet, looking into her eyes, she was my immediate friend. I couldn't break my gaze with her. I knew that she got me, that she understood. She looked beyond my face and forced smile to see the hurt and anxiety that I was carrying.

"I'm Gigi," she said, holding out her hand. I took it and introduced myself. And she really did want to know about my son. How was he was doing? What medicine he was on? How was he adjusting to having a mediport? She genuinely cared and her thoughtful questions reflected that caring.

After a few minutes of conversation, she had to go do a stat EKG and I had to return to my patients. But before we parted, she asked "Can I have a hug?" A hug from Gigi, I learned that day, held more compassion that a hundred Hallmark cards. It was genuine and heartfelt--not just a quick expected pat on the back.

Through the years since, we learned much about one another's family, yet every time I saw Gigi, her first question to me would be about my son. "How's that boy doing?" His return to good health brought many authentic smiles to her face.

About a year ago, in the midst of a crazy shift, Gigi approached me with some worry on her face.

"Doc," she said, never once calling me anything else despite my urging to use my first name, "I'm really worried." She proceeded to explain that she had some abdominal bloating and intermittent pains for months but was afraid to approach her doctor. She felt it would be bad news and didn't want to face it or ruin her husband's recent retirement.

"Gigi," I said, "let's get you in a room. I want to do an exam and run some tests."

"Oh, no," she said in true Gigi fashion, "I'm off tomorrow and these patients need you today. Let me come in tomorrow to see you and I'll bring my husband along. I'll do whatever you say, but tomorrow, okay?"

Of course, Gigi. The next day, as I knew she would, she did come in with her husband. He was just as I pictured Gigi's husband to be--kind, considerate, supportive, and worried. Gigi and I had never taken our friendship beyond the hospital's walls and it was my pleasure to match her husband's face to her loving stories about him.

Unfortunately, Gigi's workup did reveal some serious findings. She had cancer. Cancer that had aggressively spread beyond its primary site.

With this news, I approached her room with a heavy heart. And knowing me as well as she did, she knew the minute I walked in the room that I held heart-breaking news.

"Just tell me, Doc. Don't sugarcoat anything."

I pulled up my chair, grasped her hand, and explained all her results very thoroughly. She cried, her husband cried, and I cried. It simply wasn't fair. Hardworking, decent, compassionate, loving--none of these traits had protected Gigi from something bad. It was her right, I felt, to only have good things occur in her life. I was really affected by her results and through the rest of my shift, I heavily relied on my Naphcon A eye-drops. It was now my turn to pray for her and her family. We admitted Gigi to continue her workup of identifying her type of cancer, its location, and its staging.

Remarkably, my son and Gigi had never met and, encouraged by my wife and I, all three of our kids made Gigi get-well posters. The next day, Cole and I hand-delivered the posters to her. She was in her hospital bed, her husband sitting in the corner, when Cole and I arrived. We knocked and walked through her room door. After looking up at us, Gigi immediately reached out her hands for Cole, who instinctively walked to her bed and sat down beside her. Gigi wrapped him in her arms and my lucky son received the same exact hug that I had received nine years earlier. If it was possible, his hug was even more magnificent than mine had been.

Through her battle, Gigi never once lost her faith or let her beautiful spirit waver. We shared hospital visits, phone calls, and cards, which never seemed to be enough to satisfy this sender's aching soul. She was, as you would expect and hope, surrounded by loving family and friends throughout her ordeal. She braved multiple rounds of chemotherapy and radiation and, despite her body's failings at times, pushed forward in attempts to beat off her disease. "I'm not doing this for me," she said, "I'm doing this for my family."

Sadly, though, Gigi passed away before the holiday season began.

Gigi was never defined by fame or fortune, but rather by compassion, kindness, and love. She embraced humanity wholeheartedly and clearly enjoyed touching the lives of others. If she hadn't taken the time with me nine years prior, reaching out to me in a dark moment of my life, I would have missed having an angel here on earth as my friend.

Gigi, I thank you for taking the time.

As always, thank you for reading. We all have a Gigi or two in our lives, hopefully more--if you want to share a little about your Gigi, feel free to in the comments. Next post will be Wednesday, January 13.

Friday, January 8, 2010

Not A Hussie

The way our ER is designed, one of the patient treatment rooms, Room 15, sits directly across from a physician work station, a place where we can sit to do our charting, catch up on computer work, use a telephone, and review computerized radiographs.

We have several similar stations throughout the ER, but this one is unique because of the direct view it shares with Room 15. Despite our best efforts to keep the curtain drawn and the sliding glass door closed to this room, there are many moments when a patient and their family can "people-watch" us in the midst of a shift. I actually feel like someone might toss me some peanuts if I clap my hands and dance for them.

It works the other way, too. A screaming dementia patient can ebb away at your last thread of sanity in the middle of a crazy shift. The smell from a patient with a lower GI bleed can give you dry heaves, and the lingering apple-scented spray used to cover the smell only makes things worse. Even the conversations that are overheard, from critiques of the physical characteristics of our nursing and physician staff to the sharing of in-depth personal confessions and secrets, are enough to make one wish for an instant cement-block wall. Graffiti optional.

During one recent shift, because of the noise emanating from Room 15, I was quite happy not to be sitting at this particular station. One of my partners was, however, and I needed to talk to him.

As I walked down the hallway towards the station, the screaming and ruckus only intensified. I found the physician and connecting nursing station bare of any warm bodies and suddenly, I was worried about the happenings in Room 15.

I walked quickly into the room to see if I could be of any help. What I found was one of our recently-hired graduate nurses, Michelle, at the bedside of an elderly woman who obviously suffered from dementia. The patient was aimlessly yelling and aggressively trying to climb out of her bed. Michelle was struggling to get the patient back into her cot and despite her best efforts, this 100 lb. frail little lady was succeeding and now standing at the foot of her bed, all in the blink of an eye.

"Michelle," I asked, walking to the patient's other side as I spoke, "where is everybody? What can I do to help?"

"I think the patient in Room 18 crumped and everybody ran in to help" she answered. "Can you help me get Mrs. K. back into her bed?"

"Of course," I said, thinking this would probably be the easiest thing I would be asked to do during this shift.

Together, we tried to coax Mrs. K. back into her cot. Unsuccessfully. Mrs. K. had other ideas, I suspect, of taking a self-tour of our ER. It seems for every step back we convinced her to take, she took two forward. And she was a strong woman! Why does it seem that the more frail a patient appears, the bigger their can of whoop-ass? She was whooping us, no doubt about it. Heck, I thought, she wasn't even my patient!

Finally, I had had enough. Michelle and I were simply not going to win this battle. I work out often and although this woman's spirit was big, she did just weigh 100 lbs. So with that, I bent over, scooped up Mrs. K. in my arms, and easily placed her back in her bed. Problem solved. In fact, I suspect Mrs. K. enjoyed the ride. As soon as we got her back in bed, fluffed her pillow, and covered her with a warm blanket, she started napping, her outburst a thing of the past.

Guess what, though? After I picked up Mrs. K., I found my right arm, the arm I used to scoop her up, soaking wet.

"Michelle," I asked, "what do you think this is from?"

"Ughh, gross," she said, staring at my drenched arm. "Maybe she had an accident."

Do you think? I looked at my arm and my mind went rampant imagining what the wet was from. The best I could hope for was that it was something yellow. You gotta love Mrs. K. She showed me who was boss after all.

I went to our sink and scrubbed my arms with disinfectant soap. Twice. Three times. When I was done, I smothered myself in antimicrobial gel. That should take care of the juicing I just received.

Wrong. Soon after I returned back to my patients, I discovered a rash starting on my right arm. Only my right. The one that had the wet stuff on it. I looked at it and wondered, as you would, what the hell???

It was definitely a urticaric rash, better known as hives. What could Mrs. K. possibly have given me? Had she been a promiscuous hussie in her youth? Did her urine contain uranium? Was I allergic to recycled apple juice? I was cursing myself for being a good Samaritan. Was getting a rash on my arm worth this?

Of course it was. I would have helped Mrs. K. and Michelle again in an instant.

I went and washed my arms again. Twice. Three times. Then I took 50 mg of Benadryl and changed into a long-sleeved shirt.

I obsessively kept checking my arms. And after about fifteen minutes, I noticed something that made me feel a lot better. Made me smile, actually.

My left arm was getting a rash on it, too.

Why would I possibly be happy to be getting the rash on my left arm, too? Easy. If the rash were only on my right arm, then that unknown wet stuff would have been the source. But...if both of my arms were afflicted with the rash, then it obviously had to be from either the soap or antimicrobial gel I used. My left arm never had anything wet on it.

Washing my arms six times and smothering them with gel twice had gotten to me. Mrs. K., thankfully, had nothing to do with my affliction after all. And sure enough, after about an hour, the rash started going away. On both arms. Shame be gone.

Mrs. K., I owe you an apology. I didn't really think you were a promiscuous hussie in your youth. I promise. In fact, I really enjoyed meeting you as you reminded me of my grandmother. And wherever you are, I hope you are well and still showing the world your indomitable spirit!

Just not in Room 15.

As always, thanks for reading. Next post will be Monday, January 11th. Have a great weekend.

Wednesday, January 6, 2010

Another Notch In The ER Cot

I know there is a "mile-high" club for airplane travelers who are, to say the least, adventurous and daring. But is there a club I don't know about that involves an ER treatment room and the flimsy cot in it?

The other day, during another busy shift, I walked into Room 31, ready to treat a new patient. What I walked into, however, caught me off-guard. In fact, I think I blushed. And after everything I've seen and treated in the ER over these past years, to get me to blush is a major accomplishment.

Lying in the cot, covered by a thin papery sheet, was a very "loving", shall we say, young couple. They were in the midst of some passionate maneuvering--four tangled arms wrapped around one another, shirts rumpled and pulled up, shoes kicked off to the side of the cot, and mussed up hair. My timing couldn't have been better. Lucky me. A front row ticket to an amateur peep show.

Maybe in my twenties, I would have been more enamoured about this situation but, to be honest, I'm in my early forties now--the only thing I felt was a little frustration. And, guessing from my warm cheeks, embarrassment. Well, some wonderment too--who in their right mind looks around an emergency treatment room and gets "in the mood?" Is it the gowns? At least this explained why the room curtain and sliding door were closed.

I cleared my throat and skipped my usual greeting. 'What's going on in here?" I asked, trying to sound like my father, stern and all-knowing.

Surprised, the girl sat up. "Oh my gosh," she giggled, hardly embarrassed, "we got a little bored after waiting for so long to be seen."

"I'll tell you what. I'm going to step out of this room for one minute, and when I come back in, I expect you to both be presentable. If not, you will both be escorted out of the ER by security. Do I make myself clear?"

They both nodded their heads at me, the middle-aged doctor who interrupted their cheap thrills.

I walked back to the nurses' station shaking my head. I wasn't buying the bored routine. Each patient room has its own television, complete with a remote control and more cable channels than I get at home. Each room also has a filled magazine rack and its own telephone for local calls. We even have available wireless internet if someone is so inclined to bring in their laptop with them. Outside of a pillow, a warm blanket, and a two-day old turkey sandwich with fresh lemon jello, what more could a waiting patient want?

Obviously, some privacy. And some form of birth-control.

I found the nurse for Room 31 and after making her aware that our patient had just been actively trying to get pregnant in our ER, we both walked back to the room together. Maybe, we joked, they would name the baby after one of us.

The curtain and sliding doors were both open. We walked into the room. The twentyish male companion was sitting meekly in the corner chair, the patient in the treatment cot. They were both dressed.

This time, I introduced myself and their nurse. "So," I said, after introductions, "which one of you might be the patient? Because from what I walked in on earlier, I would think that neither of you is sick enough to visit us in our ER."

After some putzing around, we got to the reason. The patient, it turns out, had missed her period and came to our ER for a pregnancy test. Yes, I am being serious. She got sent to the ER's acute-care side instead of our express wing after telling the triage nurse she had abdominal pain, thinking it would get her seen faster when, in fact, it tripled her wait time. The triage nurse, trying to move things along, had ordered the pregnancy test and some basic blood work.

There must be a higher power--her pregnancy test was negative.

This whole scenario, though, got me thinking that maybe there was some club I wasn't aware of, a club that nobody filled me in about since they know I work in the ER. This isn't the first time I've caught a couple fooling around in a cot. It's happened before and I would be disillusioned to think it wouldn't happen again. The common denominator, though, seems to be that they are all younger people, ranging from their late teens into their twenties.

I guess that rules my wife and I out. Initially, after catching this last couple, I had started making plans to take my wife to our ER to spend the night and find out what we were missing. And I was going to splurge, yessirree. No regular treatment room for my honey. I was going to get us one of those big trauma rooms with the really sturdy cot. Warm blankets. Cable TV. Pack our own sandwiches and pillows. Get a baby-sitter for the kids. All I had to do was register one of us, embellish some medical symptoms, give our insurance information, and the room would be ours.

"Hey honey," I would have said, "pack up your suitcase and jump in the car. I'm taking you on an overnight excursion. You don't need to pack a nightgown, either. Where we're going, they have plenty of them." If those prospects didn't intrigue her, what would? "Oh yeah," I'd add, "don't forget our insurance cards!"

In the midst of all this planning, though, it hit me--I probably wouldn't get a good night's sleep in the ER sharing a trauma cot with my wife. And, as I think I mentioned, I am in my early forties now. I held both my hands out and weighed the situation. A good night's sleep at home versus joining some obscure "notch in the ER cot" club. I yawned as I thought about it and with my yawn, the answer came quite easily.

So, this brings me back to my original question. Is there an ER club similar to the "mile-high" club that I don't know about? Do I really want to know? And does it have a nickname? I do like "notch in the ER cot" but I made that up on the fly--I would hope the name would be something better and more original than that.

Finally, if any of you are members to either club, keep it to yourself. I don't want to know. Now, if you'll excuse me, I'm going to get a good night's sleep.

As always, thanks for post will be Friday, January 8th. Let me know if you think of any good nicknames...

Monday, January 4, 2010

ER Tupperware

I am only going to warn you once, so please pay attention. Beware of any patient carrying Tupperware or Gladware in the ER. Chances are slim at best that they are carrying food in those containers. What is in them, then? Oh, my friend, I could write a book on what people have brought us using those containers.

It happened again to me last night in the middle of my overnight shift. I should have known better, but I must have been tired.

A very nice elderly woman, a retired government worker, presented to the ER for complaints of two days of coughing with phlegm production. She had no fever, no difficulty breathing, no difficulty speaking, stable vital signs, and no change in her daily routine. She just thought that she needed "checked out" at 5 a.m. while a snowstorm raged outside our ER doors. She came by ambulance.

"I've had the cough for a few days, doctor, and wanted to make sure it wasn't pneumonia. I never had it but heard it can get pretty bad."

"Well, maam, do you feel bad?" I asked, trying to get to the root of her buried complaint. Sometimes you have to dig and dig and dig to find that complaint and, still, all you're left with is an empty hole.

"Oh no, not at all. I feel great." Her words were followed by a sweet, innocent, old lady smile.

Hmmm, I thought, scratching my chin after performing a perfect exam. 5 a.m. Raging snowstorm. Feels great. What oh what should I do.

I sent her to x-ray for a quick two-view of her chest that, of course, came back negative.

After she returned from radiology, I repeated a brief exam, still stable, and explained the results of her negative chest x-ray to her. She nodded her head in agreement with my words and after I was done speaking, she stood up, went to her room's counter, and pulled her Samsonite purse from it. She carried the purse back to her cot and sat back down, opening it. She pulled out her wallet, two books, a rosary, a red Jolly Rancher, and a paper-clipped bundle of papers before finding what she was looking for.

"Oh, yes dear, here it is."

I watched her with excitement, wondering what she was going to pull out to show me.

Slowly, she began pulling her hand from her bag. Was she going to show me a winning lottery ticket, a rare signature from Abraham Lincoln, or heck, maybe even some banana-flavored Laffy Taffy?

I held my breath. As her hand lingered in the purse, teasing me, my tension mounted. Finally, she pulled out the object.

Nooooooooooooooo! I wanted to scream. And run fast.

She held up a blue-tinted disposable plastic Tupperware container for me.

The best defense is a good offense, of course, so I didn't waste any time. "Is that a snack, maam? Did you bring some leftovers to eat in our ER tonight while you were waiting?"

"Oh no, doctor, I think you really need to see what I've been coughing up." She tapped the lid as she spoke. How could I refuse this little old lady's request? I couldn't.

I stepped forward as she peeled the lid off the container. There better be a gold nugget in there, I thought to myself. But no, not even close.

"See," she said, "isn't that just awful?"

I peered hard into the container to see what she was seeing. I couldn't see anything awful, just a string of clear spittle beautifully draping the inside walls of the container, like garland around the front door. Her partial upper plate sat smack on the bottom, a small puddle dispersed around its edges.

"Oh, there you are," the woman said, snatching up the wet partial and plopping it into her mouth. I made a silent plea with God. Please, dear God who is all kind and good, if you can get me out of this room in the next minute, I will shovel my neighbor's driveway. Or shave my head. Or never make another bowel movement joke again.

Now the woman held her breath in anticipation of my exam of her spittle.

"Oh yes, maam," I spoke, choosing my words carefully, "I see what you mean. That's some mighty clear phlegm you got there. Isn't that something how it sticks to the sides like that?"

"Yeah," she nodded, somewhat panicked, "tell me about it. Does that mean something? Is it bad when it sticks to the sides? Am I going to be alright?"

I answered her. "Yes, maam, you are going to be alright. Spittle clinging to the side doesn't mean anything more to us than usual spittle. And more good news. Everything about your visit looks okay--nothing we need to worry about or treat with antibiotics. Just work hard to keep bringing up that extra spit and if you get a fever or worsening symptoms, you can always come back for a recheck."

She seemed happy enough with that. But I knew one more question was coming my way.

"Um, doctor," she spoke, holding out her container, "do you want to keep this and send it to lab or something?"

Well, heck yeah, I thought to myself. I would like to keep your container and send it to lab, maam--if it were April Fool's Day. But otherwise, no, I don't feel any overwhelming urge to keep your container.

"Do you want me to throw it out?" I asked, reaching for it.

She pulled the container back towards her. "Oh no," she said, emphatically, "I'll take this home and reuse it."

I may have swallowed back a little phlegm of my own, thinking of what she would store in there next. A piece of lasagna? Leftover baked beans? Pennies from 1982? Jelly packets from a restaurant? Tomorrow morning's bowel movement? You know, the constipated one that she could slice like a stick of pepperoni?

I wonder if this is what Tupperware and Gladware had in mind when they marketed these useful containers.

The kind woman packed up her container and put it back in her Samsonite. She repacked her other things, too, which made me kind of sad. I had been eyeing up that Jolly Rancher.

"Well then, maam. You take care of yourself, okay? And again, always feel free to come back or visit your family doctor if you need to."

She reached out and shook my hand. "God Bless You, Doctor."

What a sweetie-pie, yes? After helping her out of her room, I looked down at my watch. More than five minutes had passed since my plea-bargain with God. There would be no extra shoveling for me when I got home that morning.

As always, thank you for reading. Next post will be Wednesday, January 6. Stay warm...

Friday, January 1, 2010

Be Yourself and Change The World

be the change you wish to see in the world...gandhi

I have always found music and the written word to be very influential and powerful forms of expression in my life. I simply retrace the steps of my life and a book, a quote, a song, or an artist will appear on my mind's play reel. In fact, my collection of music and books deserves some credit for defining who I am as a person.

And every year, as it comes to an end, I reexamine the year and try to determine what I did well, what I failed miserably at, and what I can do to continue improving myself and that around me on this journey we call life. I can become quite introspective, really, and can always lean to another great song or quote or book that puts my thoughts into clearer perspective.

For this year's ending and the arrival of 2010, then, I thought it would be pretty cool to pick out just one quote, just one, that would signify my hopes for myself, my family and friends, and for you for this upcoming year.

You've already read the quote at the beginning. I thumbed through so many of my favorites and kept coming back to Gandhi and his wise words. In these uncertain times, where the landscapes of politics, of medicine, of war and international relations, of our amazing country and its current conflicts, of humanity, of everything, really, seem so tempermental and fragile, I wanted to remind myself of all that I can do to make this world a better place. Cliche, I know, but still heartfelt. Simply put, I wanted a quote that would help me direct my energy towards positivity and improvement.

My second goal for this post, however, was much harder. I challenged myself to pick out one song, a favorite or otherwise, that could serve as a reminder of that which is good in this world and that which is not good but could be potentially bettered by our individual actions. For that song, click here-- I challenge you not to feel something when you watch this brilliant video's stills and hear these powerful lyrics.

The common thread of both Gandhi's great words and Garth's amazing song is simply that...change. We all possess the power and energy to create a better place for ourselves, for our family, for our friends, for our children...why are we wasting time?

I hope 2010 is your year. May you all edge a little closer towards attaining your personal goals and, along the way, changing our world for the better. And if you show the world a smile along the way, all the more good.

Have a Blessed and Happy New Year!

And now, an open challenge to you. Through the comments, share with your fellow readers and I one quote or one song that has inspired you in your life. Maybe we, too, can get some inspiration from your choice for the upcoming year. As always, thanks for reading...a new medical post on Monday, January 4th, 2010!