Friday, February 26, 2010

It Wasn't Me!

Forgive my warped ER humor today...and big thanks to Dr. A for the awesome adventure/interview last night. He rocks. Find it here... Doctor Anonymous.

To the nurse who "expelled gas" in the nurses' station a few weeks ago and didn't fess up to it, I have just one thing to say. Shame on you! What would your mother say?! I hope you felt bad that night when you got home and thought back to how you just sat there, quietly, while I absorbed the blame and derision meant for you.

I was raised in a conservative, Catholic family. Seven of us kids with a loving mother and a providing father who, with gusto, cherished their traditional roles. Besides the obvious rules that accompany a Catholic background, we also had an 11th Commandment: "Thou shalt not expel gas in public." In my family, the "f" word stood for "farting." To this day, I still have more trouble with that word than the real "f" word. I'm not f...... kidding, either. If we did have to "release," we were taught to leave the room and find a private spot where you could wallow in your stink all by yourself. It's a rule I still try to uphold to this day, despite my wife making the best f...... chili I have ever had.

So, a few weeks back, I sat down in the nurses' station to catch up on a chart. It was an easy-going, friendly crew, consisting of three female nurses, a female secretary, and moi. Yes, I was the only guy in the vicinity. And, of course, I wouldn't have sat down if I knew what was coming.

We were all immersed in our work when, suddenly, I smelled something rancid. No, it wasn't a pine-scented plug-in. Or the industrial-strength apple-scented spray. I would have welcomed those scents. Instead, imagine a rotten egg mixed with a touch of skunk. Seriously, it was bad. I would rather have been sitting in a neglected Johnny-on-the-Spot than in that nurses' station.

I looked up, crinkling my nose and grimacing my face, hoping that it was a patient in a surrounding treatment room, one stricken with a lower GI bleed, rather than one of my coworkers. One of my female coworkers. No such luck. My coworkers were looking around as well, noses crinkled with as much disdain as my own.

We were all silent. And suddenly, the next thing I knew, I was being glared at by all four women, supposed friends, their eyes hurling their accusing daggers in my direction. It suddenly dawned on me what they were thinking.

"Oh, no," I said, shaking my head vigorously, "it wasn't me. I didn't do it. Don't assume that just because I am the only guy around, it was me."

I was met with silence and continued stares. I felt the overwhelming urge to explain my way out of this. "Seriously," I said, giving them my puppy-dog look, "I didn't do it. Maybe it was a patient or someone walking by in the hallway. Heck," I even chanced, "maybe it was one of you."

I was met with more silence. Frustrating silence. And more continued stares. Sneers, actually. If this was half as bad as a police interrogation, just declare me guilty and throw away my key.

Finally, I heard the secretary say in a low voice "Whoever smelt it, dealt it." Hey, come on people, be fair here! I "smelt it," alright, and I had the singed nasal hairs to prove it. But I didn't "dealt it." I promise. If we did an underwear check, I would have been cleared in an instant.

"Yeah," one of the older nurses added, smirking, "to think that one of us could do that!" She quickly darted her eyes away from me as I focused on her. Okay, at least now I knew which nurse did it. I stared at her just a brief moment longer, silently hoping (in that kind, gentle Catholic way) that she would choke on her Chex cereal the following morning.

Well, of course, there was no underwear check. No confessions, either. And I refused to leave. I was not going to let some wayward, XX stink-bomb embarrass me out of my seat. Go ahead and look at me, you four co-conspirators, and think whatever you want. I don't care. Okay, maybe just a little...

Of course, before the fumes could clear, the nurses' station became Grand Central Station. The neurology team, the cardiology team, the phlebotomists--they all passed through. Yep, they all crinkled their noses. Nope, none of them had the gall to address the stink with us. I refused to leave my seat. I'm not a stupid man--I knew the moment I left they would all be pointing their fingers at me. Finally, though, after what seemed like an eternity, I was able to appreciate the returning smells of moth balls and sanitizer and floor wax and vomit and illness--the glorious smells of our ER. Welcome back!

This episode, unfortunately, was not isolated. It's happened to me in an elevator, in my writing group, in a car, at the gym, getting a haircut, and so on. Surrounded by women, the guy will always be looked at with disdain. Am I right, guys? And every time it's happened, I've gotten this primal urge to jump up and down and declare my innocence. Which, of course, just makes me look all the guiltier.

I've even had one brilliant senior resident teach me the finer points of dealing with this issue when I was under his supervision as a medical student. "What you do," he said, "is find a room with a really old patient in it. Preferably a sleeping patient. Man or woman, it doesn't matter. Then you go in and, while you pretend to check their cardiac monitor, you let it rip." He was being completely serious. "The best part, though," he finished, extremely proud of himself, totally ignoring the disbelief on my face, "is when you come out, make sure you tell the nurse that you think their patient just shit them self."

Call me crazy, but I don't think that's really the answer. After giving it some thought, though, I think I've come up with the solution. Well, besides the obvious--hiring more male nurses (simply to reduce my odds of getting undue blame) and posting the 11th Commandment on every free inch of ER wall space.

The solution? A pin. A nice, big visible lapel pin. Round. I'm thinking fluorescent colors. A bold, clear Times font, set at 60. Ready to be pulled out and worn in an instant. And, of course, what it will read goes without saying.

"It Wasn't Me!"

As always, thanks for post will be Monday, March 1. See you last shout-out to the famous and talented Doctor Anonymous. Thank you...

Wednesday, February 24, 2010

A Love Story

Before today's post, some quick business to take care of...

To my awesome readers, to Medgadget, and to Epocrates...I am truly appreciative and honored to have won the 2009 Medgadget Best Literary Medical Blog Award. Hell, I was tickled to just be nominated and ecstatic to have been chosen as a finalist. But to win? This is a very cool and distinguished award that has been bestowed upon my blog, and I thank all of you. Congratulations to the other finalists, as well. You all rock! I am humbled by the attention.

Big thanks, all, for also supporting my blog as a finalist in the 2009 Medgadget Best New Medical Blog category. The competition was fierce and I feel fortunate to have been included within that fine group of weblogs. Congratulations to the winner, SCOPE! Well done!

A special thanks to several people for my early nominations...Mike from Life In The Fast Lane, Ramona from Suture For A Living, Sunil, and Chrysalis Angel. Continued thanks to my (intelligent, faithful, and funny) readers for always being supportive of my blog, from your personal emails to your insightful comments, from your blogrolls to your tweets. You guys make me feel like I've accomplished something special. Thank you, my friends...

Finally, this Thursday, February 25, 2010, at 9 p.m., I will be a guest on the Dr. Anonymous Show, a live internet "BlogTalkRadio" show produced by a heck of a cool guy, Dr. Mike. This will be a new adventure for me and I look forward to the experience. If you have a chance to tune in, please do. And thank you, Dr. Mike, for the opportunity. I just hope I don't screw up...

The post that follows describes a gifted moment that I was fortunate to witness last week in our ER. I proudly share the story with you...

A Love Story

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

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

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

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

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

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

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

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

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

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

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

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

An elderly father and his grown son.

As always, thanks for reading. Next post will be Friday, February 26. See you then...

Monday, February 22, 2010

The Thong Expert

I had no idea that I, a small-town, naive, aah-shucks kid, would become a thong expert. For better or worse, though, thanks to my job as an ER physician, that's exactly what I've become. Just don't look for that entry on my resume!

I was attending medical school, in Philadelphia, the first time I walked into a Victoria's Secret. I was with two of my buddies and we were on the hunt for something sexy, something hot, something that would tell our girlfriends that yeah, we might be medical students, but we were hip medical students. Good luck trying to find the nerd in us that Valentine's Day!

I had never been in a Victoria's Secret before but, because my buddies seemed real comfortable about the whole thing, I tailed them through the front door. "The secret," they confided, "is not to touch anything."

I lasted less than five minutes. Okay, I'm lying. It was more like five seconds.

I felt like I should have paid a cover charge, my bobble-head taking in all the life-like mannequins modeling the newest underwear trends. I could have sworn one of them winked at me as I was checking out the intricacies of her lace borders. Easily my lowest point ever on the wishful thinking scale.

Not paying attention to where I was walking, I knocked into a table loaded with skimpy undergarments. Luckily, though, I was able to catch myself and right the table before we both hit the ground. Like a klutz, I tried to straighten a few piles of panties before giving up, realizing that never again would I hold ten thongs in my hands at one time.

My face felt flush. Ebbs of desperate sweat trickled down my back. I took a deep breath and recovered slightly. Keeping it cool, I continued walking down the aisle, pausing here and glancing there, sure that I was looking more and more at home.

My confidence, however, was short-lived. Directly in front of me, approaching, was a pretty girl with a Victoria's Secret pin on her lapel. Brandy, it said. I turned and looked behind me, hoping I wasn't the one in Brandy's line of fire. No such luck.

"Hello, sir, what can I help you with today?"

"Um, well, I um, well--I'm looking for a Valentine's Day gift for my girlfriend," I stammered.

"That's easy enough," Brandy said enthusiastically. "What size is she?"

What size is she? What size is she? WHAT SIZE IS SHE? Shit, I had no idea.

"Um, I think, well, um...I'm not sure," I said, now definitely feeling a little woozy.

Sliding her hands down her hips, Brandy asked innocently, "Is she my size?"

What??? Was this an open invitation to check her out? Did I need a coupon for this?

I passed on Brandy's invitation. "Yeah, well, I think she is," I said, eyes downward, feet pacing side-to-side. "I'm not feeling all that great, though," I mumbled, trying to escape, "so I'm going to go out in the hallway and sit down for a minute. I'll be right back." Yeah, right. Liar.

Thus, my history with Victoria's Secret. Needless to say, Karen (my eventual wife) did not get a VS outfit. I'm good for chocolate and jewelry and wine, but if she wanted a guy to buy her those skimpy outfits, she married the wrong one.

How does this relate to my life in the ER? Well, with as many thongs as I have seen in the ER, sometimes I wish I had been born in a Victoria's Secret. Then I wouldn't be so caught off guard, so queasy, each time I saw one.

Especially on a guy!

Recently, after hearing a trauma alert called for Room 29, I ran into the room to find a very belligerent middle-aged male, quite intoxicated, with multiple contusions and abrasions to his face. A victim of a barroom assault, per the paramedics. He was being both verbally and physically abusive to our staff, aggressively swinging his fists and kicking his legs at several of us. Another drunk tough guy talking big and hitting low.

We were unable to calm him down, despite our best efforts. Not knowing if he had any life-threatening injuries, we chemically sedated and paralyzed him before emergently intubating him, hooking him up to a ventilator. This ensured our safety from his flagrant behavior while we got a more thorough physical exam and ran the appropriate tests, all in a calmer manner.

After stabilizing this gentleman, one of our newly-hired aides began removing this patient's clothes so we could do a fully-exposed physical exam.

Now, picture it. Balding, middle-aged man. Scruffy, ruddy face. Gold-plated incisor. Carhartt jacket. Flannel shirt. Wrangler jeans. Steel-toe boots. All coming off.

The aide cleared his throat. I looked up to find him blushing. "Does this come off, too?"

Everybody stopped what they were doing and our eyes followed his. Oh no! This patient had on one of the skimpiest candy-apple red thongs that any of us had ever seen, frilly-lace included. And although I didn't know what size this patient wore, I would bet the thong was too small, evident by both of his testicles hanging out on either side of its sparse fabric.

I know, fricking gross. That's what I thought, too. I imagined connecting a cable between them so they could catch up with one another. Can you imagine that conversation?

"Hey, Leftie," his right testicle would say, "can you believe this asshole? Packing and suffocating us in this thin, red snatch of flimsy fabric! I'm pissed!"

"Hell, yeah. This better be the last time or I'm outta here. It's nice to breathe again. That damn thing was pressing me right low to the brown hole."

Needless to say, after the appropriate gawking was done, we cut the dainty, delicate undergarment off this patient and placed it in its own clear plastic garment bag to give to his family. The nurse placed it smack on top of his pile of possessions, no less. Accidentally, I'll assume. (Side note here--always be kind to your nurse and never, ever spit at them!)

Based on his wife's expression when the nurse handed over his clothes, this patient had some serious explaining to do. I could only imagine his testicles' flagrant screaming for mercy when she got done with them. At least, to this guy's credit, he didn't have a matching "tramp stamp" tattoo in the small of his back.

Soon after that day, I was at our local mall and passed by Victoria's Secret. Sadly, despite all the skimpily clad mannequins, all I could picture was a near-naked guy in a red thong sitting on a rickety bar stool guzzling Budweisers and slamming back shots of Jim Beam.

And they wonder how we in the medical field get jaded!

As for my wife, well, she'll just keep getting chocolate. And jewelry. And wine. And a pair of Hanes granny panties. Again.

As always, thanks for reading. Next post will be Wednesday, February 24. See you then. Big thanks for all your support and votes in the recent Medgadget Medical Blog Awards!

Wednesday, February 17, 2010

A Mother's Cry

It happened again last week. Among the hustle and bustle of a crazy shift. A pre-hospital radio call from an ambulance team that nobody ever wants to receive.

"We're bringing you a child in cardiac arrest."

Noooooooo. Word traveled quickly through our staff, and the mood immediately got very somber as everyone prepared the resuscitation room for this child. We could only pray that the child being brought to us would respond to our life-saving measures.

Nurses ran to get the intubation and IV trays, pharmacists ran to get the resuscitation cart with all the emergent medications, techs ran to get the EKG and ultrasound machines, and respiratory therapists ran to get a ventilator. Two of us physicians were working with a slew of residents, and we all reviewed our mental checklists and tried to enter our objective frames of mind. Organized frenzy.

My partner requested to be the lead physician during the resuscitation. Being young and recently-trained, he wants to save the world. We all want to save the world, I guess, but for now we'd focus our energy on saving this child. I assured him that I would stay in the room and help with the resuscitation efforts.

The ambulance arrived. With a sad nod of his head, a trusted paramedic gave answer to our searching faces. No response. Yet. We all caught our breath as our hearts plummeted.

We transferred this child to our hospital cot. We emergently intubated this child, checked for any pulses, and continued CPR when we found none. IVs were hard to establish, so I started an intraosseous line by sticking a needle into this child's left tibia. Aggressive fluids were given. Medications were administered. Ventilations were forced into uncooperative lungs.

Efforts continued. My partner followed the life-saving protocols but didn't get any response from this child. Prayers were whispered. Seconds were watched as they ticked on the clock. Slowly, as slow as any time had ever passed, a heartbreaking realization permeated the room. We might not succeed.

My partner ran to the family room to discuss options with this child's parents, while I continued to follow all the resuscitation protocols. We had nearly maximized all of our medications. And still...nothing. CPR was continued, ventilations were continued, more medications and hydration were given.

My partner returned to the treatment room. He looked at me expectantly, and I shook my head "no." My partner shared his conversation with me. Dad was still at work, and Mom was in the family room with our social workers, waiting for family to arrive. She had been invited back to watch the resuscitation efforts, but declined. Her child had been through this once before, because of chronic, ongoing medical problems, and had survived. Surely, she thought, her child could survive again.

After almost an hour of failed heroics, with absolutely no response to any of our interventions, we confirmed what we were most afraid of. There were no palpable pulses. There was no cardiac activity, confirmed on monitor and with our bedside ultrasound. There were no spontaneous respirations. There were no signs of life from this child.

There would be no miracle.

My partner asked if anyone in the room objected to his prounouncing this child's death. Nobody objected, since we had all been involved in trying to save this child's life. We knew the efforts that had been put forth were monumental. No attempt had been spared by our team to bring this child back. Unfortunately, and for unexplained reasons, the fates held different plans. My partner announced the time of death.

I requested a nurse to clip some of this patient's hair for the family. I crossed myself after my silent prayer. I fought my tears. Hell, we all fought our tears. I consoled my partner, who, like me, has three young kids of his own. Slowly, a wave of profound sadness and nothingness swept across us. What good are any of us if we can't save a child's life? My partner went out to the family room to deliver the awful news.

Then, time stood still. From two hallways away, I heard the haunting sound. A sound that I knew was coming. A sound that is played over and over in my mind for days after an event like this. A sound of profound anguish. A sound of utter disbelief. A sound of infinite pain.

A mother's cry.

Slowly, as we all knew would happen, the mournful wails of crying crescendoed, and our emergency department came to a stand-still as Mom was escorted through our halls into her little child's room.

Despite our best attempts at maintaining our objectivity, and despite the fact that there were many more patients waiting to be treated, our ER staff cried collectively and gave consoling hugs to one another. We are mothers. We are fathers. We are brothers and sisters. We are sons and daughters. We are friends. We are human. And, we were broken.

Dad arrived just minutes after Mom was escorted to the room, and the cries of desperation were repeated. This time, husky and deep. Slowly, though, his cries softened and dissipated, until there was but one lone cry that began again. Higher-pitched. Guttural. Primitive. Emanating from the womb. A cry that conveyed the raw anguish and helplessness that only such a profound loss as losing your child could bring.

God Bless this mother. God Bless this father. God Bless this child. And may God Bless and watch over this family. And all of us.

If only life were filled with just happy moments...As always, thanks for reading. Next post will be either Friday, February 19, or Monday, February 22. See you then...

Monday, February 15, 2010

Saltines & Candy

When I was a kid, I used to love saltine crackers. Love them! Give me a handful of candy or a handful of saltines, and I want those crackers. Every time. In fact, I was that little kid knocking on the neighbors' doors, asking for hand-outs, especially when Mom was making something that I didn't like for dinner. Which was rare, since Mom thrived in her kitchen, but it did happen. Have you ever had salmon parmigiana? Yep, I know. It even sounds gross. That lone entree was responsible for making me a saltine beggar, all by the age of eight.

My kids find my stories of begging for saltines fascinating. Especially since times have changed. I think I would tickle-torture my kids if I ever found out they were knocking on our neighbors' doors, asking for something to eat. They can't even begin to fathom that I, their father, knocked on Miss Lindy's or Miss Margie's front door and asked for a hand-out. After finally accepting that part, however, they just simply shake their heads at my stupidity for asking for saltines and not candy.

"Wait, wait," my oldest asked, incredulous, "so you mean you just stood there, knocked on the door until they answered it, and then just asked them to give you some crackers? Like, you begged for them?"

"Yeah, that's about it in a nutshell," I said. I swear I saw the two younger kids taking notes in their notebooks. "Dad," my youngest asked, "how do you spell 'begging?'" Yes, they were definitely taking notes.

"So, Dad," my oldest continued, "did they ever say 'no?' I mean, come on, they didn't really give you crackers every time, did they? "

"Well," I answered, ready to have some fun, "maybe once in a great while they would say 'no.' But you have to understand, I was a cute kid. I mean, really cute. It was hard to say 'no' to me."

All three of my kids rolled their eyes. I thought their synchronization was excellent until I looked over at my wife, leading the pack. She should be ashamed of herself!

"Well, I was!" I exclaimed, defensively.

"Maybe that's why they only gave Daddy the saltines," my wife chimed in, "they saved the candy for the really cute kids. Oh, and by the way, kids, did you know I used to get tons of candy from our neighbors when I was little?" Yeah, right, I thought, shaking my head. My wife can be one funny lady sometimes.

So, with much fondness and love for the basic saltine, I couldn't wait to treat a patient who arrived by ambulance at the end of my shift a few weeks back.

The chief complaint listed on the patient's chart was "Patient choked on a cracker." Hmmm, it sounded kind of serious. However, when I walked into the patient's room, all I found was a middle-aged, poorly-kept, obese gentleman sitting in the hospital cot flicking TV channels with the remote.

"Sir," I asked, after introducing myself and clicking off the TV, "what brings you to our ER tonight."

"Well, I was eating a saltine and it was kind of dry, and it made me gag." Well, yeah, I thought to myself, saltines are dry and they can make you gag, I guess, if you eat enough of them or eat them fast. But, can you still whistle?

"Okay," I said, trying to understand a little better, "so what made you come to our ER?" This guy was speaking full, clear sentences and had no obvious breathing or swallowing difficulties. I needed to figure out what was the emergency.

"Well," the guy said, "after I gagged on the dry cracker, my throat was a little scratchy. I feel better now, though."

Wait a second here. So this guy ate a saltine, gagged on it because it was dry, and then called an ambulance to transport him to our ER at 2 a.m.? Seriously? Because his throat was a little scratchy? Without any other symptoms? Nothing else? At least throw me a bone, buddy, and tell me it's hard to talk, hard to breathe, or hard to swallow. Or that you vomited all over your Lazy-Boy. Something? Anything?

"Nope," he said, "I feel great. In fact, I felt good even before the ambulance got there."

I gave him a glass of water and he chugged it in one gulp. No problem. I listened to his heart and lungs. Unremarkably clear. I felt his throat. No abnormalities. I examined his mouth and throat to the nth degree. Stable.

I'm not sure if I was just wiped-out at the end of my shift or subconsciously, somewhere deep inside, I disliked this patient for using my beloved saltine as an excuse to waste our time and resources. Unfortunately, he continued to build on my shaky foundation of frustrations.

"Hey, Doc," he said, "do you have anything to eat?"

Are you kidding me? "Yeah, buddy," I imagined myself saying, "we have some saltine crackers. Give me a second and I'll run to get you some."

Of course, I didn't really get him crackers. Or food. What I did get for him, though, were his discharge papers.

"Wait a second," he said, after I explained the obvious to him, that he was stable and really should have thought twice about using an ambulance for his transport in, "how am I going to get back home?"

"Pardon me?" I asked.

"A ride home," he answered, sarcastically, "or don't you guys do that anymore?"

"Listen, buddy," I said, getting my vocal wheels rolling, "you'll need to find your own ride. If you can't, you're welcome to wait it out in our waiting room. I'm not going to approve a transport ride, though, for you. You ate a saltine cracker and your throat got a little scratchy. End of story."

Then he made the ultimate statement. "Obviously, you have never eaten a saltine cracker. If you had, you'd know how much damage it can do back there in your throat."

Oh yeah? Is that right? I was just about to launch into my whole childhood obsession with saltines, how I knocked on all our neighbors' doors, when I realized what a waste of his time and mine that would be.

"You're right, sir," I answered instead, crossing my fingers, "I've never had a saltine cracker. Probably never will, either. I like candy."

As always, big thanks for reading. Next post will be Wednesday, February 17. See you then.

Friday, February 12, 2010


As I sat down at my computer station to finish the chart on a patient I had just treated, I heard something quite interesting. A voice, smooth and mellow, was calling out.


It was an older woman's voice. I was immediately taken back to when I was a child, in my grandparent's house, standing beneath a small, cottage-shaped clock that hung on the wall. With a new hour approaching, I held my breath, staring up at the clock, its small pendulum swinging beneath, clicking a constant, relaxed beat. Eventually, the clock chimed, a little trap door opened, and a small bird popped out and chirped it's greeting.

"Coo-coo. Coo-coo. Coo-coo." Three times, like clock-work (no pun intended). Standing outside of my memory looking-in, I saw the little boy in his summer shorts, his tanned face framed with shaggy brown hair, smiling as he looked up expectantly at the wooden bird that never failed to mark a new hour.

"Yoo-hoo. Yoo-hoo." The woman's voice snapped me back to the present.

I got up from my chair and followed the yoo-hooing until I was standing at the bedside of an elderly woman with matted soft-grey hair and empty hazel eyes. She clearly had dementia. She looked quite comfortable, though, and was mumbling something to herself between the yoo-hoos.

"Do you need help with something, maam?" I asked, straightening her sheets and tucking her in. "What can I get you?"

"Help me!" the patient screamed, "I need help."

This patient's nurse walked in just then, a younger nurse that I enjoyed working with. She was compassionate, knowledgeable, and hard-working. And apparently, at that moment, frustrated.

"Is everything all right in here, Victoria?" I asked, ready to help.

"Everything's fine. Mrs. Pello has Alzheimer's and was sent by the nursing home because the nurse there thought she was acting 'more demented' today." Victoria gave me a knowing glance. We both recognized the bullshit excuse by the nurse who sent in Mrs. Pello, trying to make her own shift easier. At our expense, of course.

"Anything wrong?" I asked. "You need me to see her?"

"Dr. P. picked up on her. We're just going to get some baseline tests and a CT scan of her head. If it's all good, she'll be heading back soon enough."

"Yoo-hoo," Mrs. Pello called out, yet again.

"On second thought," Victoria said, laughing, "if you can get her to stop yelling 'yoo-hoo' every five minutes, I would appreciate it."

"I kind of like it," I said. "It reminds me of a coo-coo clock my grandparents had when I was a kid. She sounds just like the little bird that popped..."

I was interrupted by Mrs. Pello. "Help me! I need help!" Her sudden outburst had caught Victoria and I both by surprise. Then, without pausing, Mrs. Pello continued. "Yoo-hoo. Yoo-hoo."

"Just wait," Victoria warned me, both of us chuckling, "you might like it now, but after a few hours of this, I'm not so sure."

Well, little did I know at the time, but Victoria had hit the nail right on the head. Mrs. Pello's loud "yoo-hoo" was methodical and rhythmic, an audio alarm that was set to go off every five minutes, interrupting our workday. Unfortunately, her door had to be left open so that the nurses in their station could keep a close eye on her. And the risks of sedating her outweighed the benefits. So her yoo-hooing would just have to be accepted for a few hours.

Soon after meeting Mrs. Pello, a middle-aged man, who had collapsed at home, was brought into our ER and placed in the room next door. His right side was completely flaccid (no muscle strength) and he had a facial droop. An obvious stroke. A stroke alert was called and we emergently intubated this gentleman, hooked him up to a ventilator, and aggressively treated his escalating blood pressure. This patient was critical.

And then, suddenly, in the midst of treating this crisis, there it was. "Yoo-hoo. Yoo-hoo." It was clear and resounding. Everyone who was involved in treating our stroke patient did a quick pause. "Yoo-hoo." Mrs. Pello had added another one for good measure.

"Come on, people, back to work," I said, reminding them of our task at hand.

"What the hell was that?" the neurologist and neurosurgeon asked me, intrigued. "You really don't want to know," I said, grinning. My ER team, including Victoria, was shaking their heads, obviously trying to stifle their laughs. Swiftly, we transferred the stroke patient to the OR for emergent surgery after his CT scan revealed a large hemorrhagic stroke--blood on the brain.

Unfortunately, treating the stroke patient delayed Mrs. Pello's own head CT and she continued to sit in her room, waiting. "Yoo-hoo." Yep, about every five minutes.

At another point, as a family passed by Mrs. Pello's room while being escorted to their treatment room, she started screaming out "Help me! I need help." The family's eyes widened from fright. The staff, immune to the cries, didn't even budge to help, which I'm sure thoroughly impressed this family. They had to have thought of high-tailing it and heading to another ER. Someplace where the doctors and nurses cared.

Eventually, though, Mrs. Pello went over to the radiology department for her head CT. We all cheered, looking forward to a few minutes of silence. Unfortunately, not even five minutes had passed before we got an urgent call from the CT tech. "Can someone come over right away? Mrs. Pello is screaming for help." Oops, someone forgot to warn the tech of Mrs. Pello's outbursts.

She returned from her CT scan and, thankfully, all of her workup was normal. She had been in our emergency department for approximately four hours. Well, not approximately. More like exactly! Even those of us not involved in her care were celebrating her finished work-up and immediate plans to be transferred back to her nursing home. However, due to several ongoing emergencies, it would be one more hour of waiting until the ambulance service arrived to take her back. "Yoo-hoo."

Even though I wasn't treating her, I couldn't help but go into Mrs. Pello's room several more times to make sure she was comfortable. You see, not only did her "yoo-hoo" trigger a wonderful childhood memory of that coo-coo clock, but Mrs. Pello herself reminded me of my grandmother, an amazing and fiercely-independent woman who also was stricken with dementia.

Victoria was dead-on right. After five hours of "yoo-hoos," Mrs. Pello's voice had lost most of its charm and smooth, mellow tones. Now, her cries were simply annoying. Our staff gave her a wonderful farewell, lining up in the hallway to witness her be escorted by the ambulance team back to her nursing home. I think they were just making sure that there would be no screw-ups--that Mrs. Pello was actually leaving. Do not pass go. Do not collect $200. Just get the heck out!

Me? Well, of course, I was missing Mrs. Pello and her "yoo-hoos" five minutes after she was discharged. It was too quiet! And truth be told, I don't think I was alone. I think we all were suffering from yoo-hoo withdrawal.

So, I took a deep breath, calmed my fears, made my voice smooth and mellow, and did it.


Update: One week later...
Good can hardly see my black-eye anymore. I just wish someone had warned me that Victoria knew karate!

As always, a big thanks for reading. The next post will be Monday, February 15. Happy Valentine's Day to all of you...

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Wednesday, February 10, 2010

What's Your Age?

I've never been to a carnival where I haven't stopped to watch that amazingly talented man who guesses a person's age or weight. How does he do it? And where the heck does someone learn that talent? How can he possibly come within five pounds of guessing that woman's weight, the one with knee dimples, chubby pinky fingers and five chins?

I don't give myself much credence for estimating a patient's weight. The margin of error is too big for my comfort. A patient's age, though? One through a hundred? Bring it on! One paramount rule must be followed, however, if you are going to partake. You must underestimate their age by five years of what you really think. Trust me, that rule saves a lot of hurt feelings.

By far, the hardest population for me to guess accurately is the older woman who looks years younger than her stated age. All natural. No surgery. And just a few shifts ago, I was surprised, once again, by yet another of these youthful patients.

I walked into a room to treat one Mrs. Smith. She was in our ER for a minor illness and, prior to going into her treatment room, I was able to review her chief complaint as well as her demographics. Her age was listed at 74.

I clearly walked into the wrong room. The room I walked into had a woman lying in the cot who was, at most, 50 and not a day older.

"I'm sorry, maam," I said, "I must have the wrong room. Have a nice day."

I walked back to my computer and rechecked Mrs. Smith's room number. What? I was in the right room after all? Impossible!

I walked back into Mrs. Smith's room. "Maam," I said, somewhat confused, "are you Mrs. Smith?"

"That would be me," she said, sharing her big smile with me. Real teeth and all.

I decided to have some fun with her. "Are you sure, maam? Because the person I am supposed to be treating is 74. May I take a look at your wristband?"

Mrs. Smith giggled like a six year-old school-girl as she held out her left wrist. Yes, this was the real Mrs. Smith. "Wow," I continued, "I'm sure you hear it all the time, but I have to tell you--you look wonderful! I would have never come close to guessing your age."

Mrs. Smith, in her girlish way, added a blush to her giggling. I didn't care, though, she deserved to hear how good she looked. She obviously did something right in her self-preservation, and I wanted to know what her secret was.

"Honey," she said, pondering my question, "I think it would have to be the fact that I've never used soap on my face before. Well, that," she continued, now wistful, "and having a good man by my side for 50 years."

It turns out that her husband died just a year ago. And suddenly, through her sadness, she looked much older.

Just like with Mrs. Smith, though, I am always excited to meet a patient who looks much younger than their stated age. Good for them! When I eagerly ask them what their secret is, how the heck they stay so young-looking, I tend to get one of five following answers:

1) "No soap has ever touched my face" or "I only wash my face with water."
2) "Genetics--you should have seen my parents."
3) "I drink a lot of water."
4) "I stay out of the sun."
5) "I use moisturizing lotion on my face every day."

Of all the moisturizers, the most commonly mentioned is Oil-of-Olay (sorry Ponds and Vaseline). A few years ago, in one of my health magazines, I read a letter of testament to the editor from a seventy year-old guy who, thanks to his daily use of Oil-of-Olay, claimed that he looked like a forty year-old. And, one of our nurses, Sue, tells the story of treating an eighty year-old woman who, she swears, looked like a forty year-old hottie, her skin smooth and clear, glowing and wrinkle-free. Her secret, Sue said, was Oil-of-Olay.

"But," Sue continued, lowering her voice to deliver some obvious bad news, "this woman was wearing a scarf around her head, tied under her chin, and I asked her to take it off. Well, let me tell you, this woman definitely had an eighty year-old neck, wrinkled and loose. She was embarrassed by her neck and told me that she had never put cream on it. It was terrible!"

"What did you say to her?" I asked.

"I told her, 'Yeah, honey, maybe you should have put some cream on your neck.'" I loved Sue's honesty. "I'm not kidding, though," Sue finished, "it was unsightly. I don't think that woman could go anywhere without her scarf. I know I sure wouldn't." Careful, Sue (who in her own right looked fantastic), I think I see your cat claws coming out. Meow!

Well, after seeing Mrs. Smith and hearing Sue's story, I reviewed my own chances for aging gracefully. Let's see, I have good genetics (thanks Mom and Dad!). Check. I drink a lot of water. Check. Unfortunately, my face and soap are intimately familiar with one another, so that was out. And, I love the feel of the sun on my face. Stike two.

Which left me one last thing. After that shift ended, on my drive home, I swung my car into Walmart's parking lot. Stay out of my way, people, I was on a mission. I walked into the store and quickly found the cosmetic aisle. Glancing around to make sure I didn't know anybody (since real men don't wear face lotion), I knelt down and grabbed two bottles of the liquid gold everybody had been touting. "Um, it's for my wife," I stammered to the cashier as I checked out. She couldn't have cared less. If I had known she would be this apathetic, I would have bought my wife a box of tampons. And the bulk package of toilet paper, too.

Since purchasing the lotion, I have been using it religiously, every morning without fail. And guess what? After a few months, I must admit that I am probably the best-looking 84 year-old you will ever see. Unfortunately, I'm only 42.

Maybe someday I'll head back to the carnival, pay the guessing-guy my $5, and win me a stuffed animal. Or, maybe not...maybe I'll just use my Oil-of-Olay money to buy one at Walmart. That would be much easier.

What's your secret? As always, big thanks for reading. Next post will be Friday, February 12.

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Monday, February 8, 2010

The First Time

Many of us in medicine are fortunate to treat and guide a patient through "the first time" they have a medical emergency or newly diagnosed illness. Of course, sometimes we are skeptical about that "first time" line, but more often than not my experiences have lead me to believe that the patient is telling the truth. At least in his own mind.

"I've never had a drink before tonight." (Say that with a slur, by the way.)
"Honestly, doctor, I thought the pills were Tylenol. I've never used Vicodin before."
"What? I don't know how that cucumber got up my ass! This is a first for me!
"I can't remember ever having burning like this."

You get the picture. So when a nurse ran up to me with an EKG that showed some serious abnormalities, I quickly followed her to the patient.

Surprise! I walked into a room that contained an anxious but very polished thirty-something female. She was dressed to-the-hilt in designer clothes, her make-up refined and her hair perfectly coiffed and colored. She couldn't be the owner of this EKG!

I looked at the nurse with a questioning face and she nodded her assurance to me.

I turned to the patient and introduced myself. "Maam," I said, "what brought you to our ER tonight?"

" having...a hard time breathing," the patient spoke, clutching her chest, "and my heart feels funny." I could smell the hint of alcohol when she talked, her sophistication taking a few steps back.

"Do you have any palpitations with your difficulty breathing?" I asked. She nodded yes. "Any previous heart or breathing problems?" This time, a no nod. "Any recent cough or cold symptoms?" No. "Any trauma, leg or calf pain?" Another no.

"Doctor," she said, gasping for air between her words, "I have to be honest. I tried cocaine for the first time tonight and this started right after. Does this happen to everyone?"

I should have known. This was a woman who didn't smoke, didn't have any family history of heart disease, and had no past medical history of hypertension, high cholesterol, or diabetes. No serious cardiac risk factors. In other words, healthy. Except, and this is a HUGE except, she chose to use crack cocaine. Disappointing, for sure. I could only hope that she was being honest with me, because if she was a regular user and not a first-timer, her heart could have already had significant damage before presenting tonight.

"Am I going to be alright, Doctor?"

"Maam," I said, pulling out her EKG to review it with her. "I think you should know that your EKG is showing some serious findings. It looks like your heart is straining to the point where you are having a heart attack."

"Me? A heart attack? No!" She looked at me incredulously. "Are you being serious? I'm only thirty-two." I nodded my head up and down. "Yes, I am being serious, unfortunately." There was no sugar-coating this.

The patient looked at her friend sitting in the corner who, up until now, had been very inconspicuous. "Laura, you better call Larry and tell him to get here right away. And don't tell him a thing. Just tell him I'll explain everything when he gets here." Laura stood up and wiped her nose with a tissue before giving the patient a hug. She walked out of the room with her cell-phone. I hoped we wouldn't be seeing her for treatment in a bit, too.

"Is Larry your husband?" I asked when we were alone. "Yes, he is," the patient said, "and I don't want him to know I used cocaine, okay?" I assured her that wouldn't be a problem. Well, not my problem, anyway. She could tell him as much or as little as she chose. I just had a gut feeling, though, that by this end of this day, Larry would be pissed at his wife.

"But I still don't know how this could have happened," she said. I explained to her how cocaine causes vasoconstriction, or simply spasming and tightening down, of the arteries that supply oxygenated blood to the heart muscle. If the heart muscle does not get enough oxygenated blood, then, damage can occur. If the patient is a first-time user, as this woman claimed, it's not unusual to get symptoms within three hours of use. If a patient has abused cocaine indefinitely, silent heart damage may have already occurred. In which case, she could be in very serious danger.

I explained to her what was going to happen next. "We are going to give you some aspirin and some valium, but we need to avoid a few other medications that we would normally use to treat chest pain." Cocaine changed those rules. "Also," I continued, "I want you to know that a cardiologist has been called and is going to be here shortly, to take you to the cath lab."

She just shook her head and trembled. "I know," I said, holding her hand, "it's hard to believe that cocaine can do all this."

She started crying as the nurse began pushing medications into her IV. Her vitals, thankfully, remained stable.

"I have three small kids at home," she said, shaking her head. "What was I possibly thinking?"

I could only imagine what her life would be like after we got her through this crisis. If she survived this crisis, that is. Her family would face some serious consequences for her decision-making.

I explained to her that it was very important we know if she had used cocaine in her past or, as she said, this was truly a first time for her.

"Yes," she assured me, "it was my first time. I mean, look at me. Do I look like someone who used cocaine before?"

I bit my tongue on her question. In reality, yes. She did look like someone who may have used cocaine before. Cocaine has no "look," really. Well, not clothes-wise or status-wise. But it does have a look of desperation when things go wrong, and this patient sure had that "look" now.

We got this patient to the cath lab. Luckily, she had no significant blockages and, more importantly, the medications we had given her in the ER had begun reversing the vasoconstriction before permanent damage occurred. She was going to be alright.

After his wife's successful catheterization, Larry, her husband, came down to the ER carrying a large cookie tray to thank our staff. Yes, he matched his wife's look--a pressed shirt and tie, penny-loafers, and wavy undisturbed hair. With a hint of alcohol on his breath. "I just don't understand how this could happen, though. She's too young and healthy to have had a heart attack."

I just nodded at his words, the silence floating between us like a concrete barrier. I was bound by patient confidentiality from sharing with Larry the truth of his wife's situation and, besides, it wasn't my place to tell him of her cocaine use. Instead, I diverted him and asked about the weather outside.

We shook hands and I told him to share our best wishes with his wife during her recovery. As he walked away from me, I couldn't help but think of their marriage and their three kids. Silently, I prayed that things would turn out okay for this young family.

Another "first" patient, she turned out to be. I thought back to her words. "Doctor, I have to be honest. I tried cocaine for the first time tonight and this started right after." Was it really her first time using? I hoped so, but I've been fooled before.

I can only hope, though, for her sake that this "first" will be her last.

As always, I thank you for reading. The next post will be Wednesday, February 10th. Until then, I hope you have a good start to the week. If you didn't vote yet, please do! This is the final week. I appreciate your support.

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Friday, February 5, 2010

Heroes Among Us--Linda

Dedicated to those of you who face a debilitating disease head-on, each and every are a hero.

Do me a favor. Drink a double-shot of vodka. Now, hold your arms out to your side and spin around for two minutes. It doesn't feel good, does it. The blurry vision, the slurred speech, the difficulty walking, the loss of coordination. Now, imagine that these symptoms will never go away. In fact, they'll only get worse. Every morning when you wake up and every night when you fall asleep, these symptoms will grab you and shake you, reminding you of your reality. They will become your constant companion.

Welcome to the world of Friedreich's Ataxia. A world of disappointments, of walkers, of wheelchairs, of harsh symptoms that will progress. A world where ever so slowly, your nervous system will rob you of your most basic functions. And your pride.

And welcome to Linda's world. An amazing world filled with a husband who adores her, a demanding yet accommodating job, and two happy, well-adjusted kids. A world of simple, fulfilling country living. Complete with chickens.

Today, you have a front-row seat of these two worlds colliding.

We first met Linda and her husband, Andy, in 1996, when we lived in upstate New York during my residency (refer to The MoooooER). A new marriage and work-transfers brought them our way. While we lived in a new three-bedroom house that sat smack in the middle of a cow pasture, these two brave souls bought a 100 year-old fixer-upper across the road. A house the realtor initially drove past, without stopping, figuring not to waste their time. Wrong! This house became their labor of love. And we had neighbors!

Soon after arriving, they decided that Andy would stay home and pursue his higher calling, establishing a software business. Linda continued to work hard and travel hard. She relaxed easily enough, though, and their simple life on our country lane was unmatched. I must admit, I still get a twinge of jealousy thinking about the life they continue to lead, a life we left behind.

Anyway, we enjoyed our new neighbors immensely. Linda was, and still is, bubbly and funny, strong-willed and caring, with a wicked sense of humor. Andy was, well, a pervert, but an awfully nice one at that. He made the perfect sidekick, sitting back and letting his vivacious wife shine. And shine she did. She was infectious. We would play a board game or two, enjoy drinks in front of their huge stone fireplace, and share a lot of laughs. Laughs that led to sore morning faces.

Several of our favorite stories? Easy. Linda, teasing farmers from miles around, would wear an itsy-bitsy bikini while she cut their lawn on a big John Deere mower. The farmers would drive their rusty pick-ups back and forth, hoping for a glimpse of her as she bounced over the molehills. On purpose, I think. I should have sold tickets for a front-yard seat.

And when my wife got pregnant with our first child, that was Linda knocking on our front door, holding a bag of her maternity clothes. Among them, a size 44 Kmart dress that she had worn after adding nearly 40 lbs. (with Brian) to her size 4 frame. Neither of us could picture it, but Linda swears she was sexy as hell in that threadbare, cotton tent. "Wasn't I, honey?" she asked Andy, who's answer consisted of wiping the drool from his mouth. We told her to keep the five-inch matching pumps.

Life was very good. Two beautiful smart children, Brian and Kelly, a dog, a cat, rabbits, chickens, a beautiful, remodeled home, a simple yet fulfilling country life. The circle seemed complete.

But then...

In her late thirties, Linda began to notice strange symptoms. She would slur her words, stumble for no reason, and be clumsy in the kitchen. Soon, walking took actual concentration instead of being an unconscious activity. Just imagine her thoughts. "Okay, now the left. Now the right. Now the left..." How frustrating for someone so independent and in-tune with her life!

Even more frustrating? Her lack of a medical explanation, despite numerous tests. Finally, in 2002, genetic testing provided their answer. At age 40, Linda was diagnosed with Friedreich's Ataxia (FA).

Briefly, FA is a progressive, debilitating disease that affects 1 in 50,000 people. Havoc is caused by a single gene mutation on chromosome 9. This mutation affects nervous system function, resulting in muscle weakness of both the arms and legs, loss of coordination, vision and hearing impairments, slurred speech, and extreme fatigue. Diabetes and heart disorders occur in extreme cases.

How would you react to such news? Could you imagine your life after such a diagnosis? Would you ever uncurl yourself and get back out of bed? I'm not sure I could. A simple damn gene mutation! Imagine the disbelief and hurt that Linda and her family had to work through. And those kids? Bless them and their young, innocent hearts. Their family's pain could have been our pain but for the luck of the draw.

Well, let me proudly say this. Linda is no shrinking violet. Hell, no! She never was one. Why would she become one after her diagnosis of FA? Whereas some people might have let a debilitating disease like FA back them up against a wall, Linda came out swinging. Her life, her marriage, her family, her kids--she had things to do, people to love, children to raise, a husband to adore. She had life-lessons to teach, all in the face of adversity. Grace under fire. There would be no pity.

First things first. Linda did not change her life for FA. Or her family's life, for that matter. FA would simply have to fit into their life, and the symptoms and progression of the disease would be dealt with as they came along. On her terms.

Linda did not quit her job. In fact, she took on a new position that required her to travel extensively. Often, her family accompanied her. She opened the doors of Europe, of the Pacific Northwest, of the world, actually, to her children. Something that was very important to her.

Linda and her family did become part of the FA family, a remarkable group of people who have empowered themselves to find a cure for FA. A favorite effort of theirs? Ride Ataxia. Established in 2007 by Kyle Bryant, it is a fundraising bike ride that covers hundreds of miles enroute to the National Ataxia Foundation annual meeting. Thanks to Andy, Linda rides a built-with-love, custom-made bike. And as a result of many of the FA families' efforts and fundraising, there are seven new drugs being researched, in various stages of trials, for FA treatment. A few short years ago, there were zero!

How is Linda these days? She is just fine, if you ask her. Walking can be difficult, and there are times when she needs a wheelchair. She gets tired quite easily, too, but you won't hear her complain. Her coordination and speech are a little for the worse, but the gleam in her eyes shines brighter than ever. Especially when those eyes are focused on her children. High heels, biking, running, skiing, climbing stairs--all these things have been lost and mourned. Linda's essence, her beauty, her bubbly nature, and her love of life and family, however, remain. They will not be lost in the murk of FA.

And how is her family? Of course they have their days, but they know they are living with a hero--someone who's mantra, as quoted from Abraham Lincoln, is "And in the end, it's not the years in your life that count. It's the life in your years." How incredibly blessed are they to have such a shining spirit within their four walls?!

If we could all be so lucky.

Thank you, Linda, for showing the world such amazing beauty in the face of your illness. You, my dear friend, are one of my heroes.

Even heroes need to be reminded of how special they are. Please, please take a moment and email Linda to wish her your best. Big thanks. As always, thanks for reading. Next post will be Monday, February 8.

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Wednesday, February 3, 2010

No Love For A Father

The nurse hung up the phone, shaking her head.

"I can't believe the nerve of some people," she said, clearly aggravated by the phone call. The phone call, she explained, was from a gentleman inquiring about where he should check-in when he brings his father to our ER in a few weeks.

"In a few weeks?" the nurse asked, making sure she heard right. She did.

The gentleman explained that they were moving their father from the West Coast back to our side of the country, to be closer to family, after the father's third wife recently died. The caller had heard that it would be a much quicker process for their father to get into an assisted-living facility if he came through the ER.

"Honestly, sir, that is not a reasonable expectation, unless your father is ill and needing treatment. We are an Emergency Department," she said, enunciating Emergency, "not a place to bring your healthy father for placement."

Her words fell on deaf ears. Around 1 a.m., almost two weeks to the day of that phone call, another one of our nurses walked into the nurses' station, looking incredulous.

"Get this," she said, "this family in Room 22 brought their father directly from the airport to our Emergency Room to have him placed in an assisted-living facility. And," she continued, "they're pissed that they had to wait three hours to get called back from the waiting room."

It was a busy night but, eventually, I was able to make my way to their room. Their story was somewhat familiar with me, but I wanted to learn more.

"Hello, folks," I said, introducing myself to the patient and his family, consisting of two sons and a daughter. All local folks. All dressed in sophisticated clothes and very well-kept. I tried not to be judgmental as I continued. "What brings you to our emergency room tonight?"

"How many times do we need to repeat this?" asked the one son, the obvious spokesman. And obviously obnoxious. "We need you guys to get Dad a place to live here in town."

"At this hour?" I asked, looking at my watch. "It's 2 a.m., I don't think that's going to happen, sir."

"Well," said the son, "we've been waiting since 10 p.m. It's not our fault that it's now 2."

"Even at 10, sir," I said, staring at the spokesman, "I doubt we would have been able to accommodate you." Turning my attention to the patient, I continued. "Sir, are you hurting anywhere? Do you have any injuries or health problems that seem worse to you tonight? Anything that warrants you coming to our ER?"

The patient shook his head no. It was obvious that this was not his planning. I looked back to the son and cocked my eye. He just shrugged his shoulders. After obtaining more history from the patient, I performed a thorough physical. It was stone-cold normal. Clearly, this patient was mentally and physically stable and the family was simply seeking a short-cut to finding a place for their father to live. Heck, he could even live on his own if he wanted to.

"So, just to clarify this," I said, looking at his three grown children, "you picked your father up at the airport and drove him straight to our ER, at this hour, to be placed in a living facility? Am I correct?"

They all nodded. "But all three of you live locally," I continued, "why aren't one of you opening your home to your father until you can get him into a local facility?"

"We were told by several people, including my family doctor," the son spoke, "that this was the easiest way to have Dad placed." Shame on that family doctor, I thought. "And if you can't get him in a place tonight," the son continued, "then just admit Dad until you can get him in somewhere."

It's hard to get a rise out of me, but these people were doing a darn good job. I took a deep breath and tried to clean up my thoughts of these people.

"Well," I said, looking between the patient and his ungrateful children, "unfortunately, your information is wrong. I'll call our case management team down to discuss the available options for your family, but your father has no medical emergency and I won't admit him for the reasons you want. What your father does have, though," I said, "are three children who live locally that could easily provide for him until an assisted-living facility is available."

The family just looked at me. And I stared right back, alternating between them. I wasn't going to blink first.

"Well, then," the spokesman said, "can you call the case manager down to talk to us?"

I walked out of the room, disappointed in this family's dynamics. I'm sure there was more history between this father and his three kids than I was aware of, but pick-up your father from the airport and bring him right to the local ER to dump him off? I would be ashamed of myself. Why even bother bringing him back here to live if this is how it was going to be?

Our case management team came down and, sure enough, were unable to place this patient directly into an assisted-living facility. The soonest they could arrange for his placement was in three days. Three days? People waited months for placement into a facility, and this patient would be there in three days. I guess it was a good shortcut for this family, after all.

"Three days?" said the son, "what kind of system is this? We can't wait that long. Do we have any other options?" No other options, said case management. No other options, said the nurse. No other options, I said.

The patient got dressed while his family grimaced and glared in our hallway. I seriously think they entertained the idea of leaving quickly without their father, but I kept my eye on them. I was ready to chase them down if they tried such a thing. I knew, just from observation, that they weren't above such a thought.

I have three kids of my own, and I shudder to think where a man could have gone wrong to get this kind of treatment from his own children. Did he spoil them? Did he wrong them so significantly that their refusal to take him in was justified? Or were his kids so caught up in their own lives that they had little time left for their father?

Regardless, the patient went to live with the spokesman son for three days. Three long days, per the son. I could only imagine, though, just how long those days would be for a father who felt no love from his family.

As always, thanks for reading. The next post will be Friday, February 5. Until then, if you haven't yet voted, go to Medgadget Medical Weblog Awards and vote for StorytellERdoc in both of his nominated categories. Your support and votes are appreciated! Big thanks!

Monday, February 1, 2010

Little Big Man

We are all familiar with the saying "Actions speak louder than words." It is most often used to connote something favorable and positive. Unfortunately, this quote was the first thing that popped into my head while treating a recent patient.

I had been walking down the main ER hallway, another crazy shift in bloom, when one of my favorite nurses poked her head out of a room.

"Doctor K," Carla asked, "are you free to help me out with this patient?" I didn't even need to give her an answer. When Carla beckons, I come running. Plain and simple, she is that amazing.

I walked into Carla's room to find a patient lying in bed, hands to his face, crying out for his mother. Heartbreaking. His mother was kneeling beside him, whispering quietly in her son's ear. Tears were streaming down her face, too.

The patient was seven. A sweet, scared little boy named Eddie. Eddie had been rushed to our ER to be treated for burns to his face and body. From the doorway, I could see several small blisters with surrounding redness on his bare torso.

What were the circumstances that resulted in these burns? Apparently, Eddie did not come from a good socioeconomic situation and, as a result, lived in a crowded apartment with his mother and several other family members.

The day Eddie was brought to the ER had been an especially cold one. While his family sat watching TV in a room off of the kitchen, Eddie, hoping to be useful, went alone into the kitchen. He had decided that he would warm up the apartment. He grabbed a cigarette lighter and successfully persevered in his struggle to flick the lighter's flame. With his free hand, he turned the oven's dial to "ON." Ready to be a big man and provide heat for his family, he opened the door to the gas oven. Slowly, while holding his arm stiffly in front of him, he advanced the flame into the oven.

Whoosh! A sudden flash of flame was born and jumped out at Eddie, surprising him. He instinctively yelled out as he backed away from the heat. The pain and redness to his skin was immediate. The family called 911 and, after shutting the oven door, turned off the dial. Their quick thinking stopped any further flames from spreading. Eddie, with his mother accompanying him, was brought urgently to us.

I was able to determine that Eddie's burns were "minor." His airway and breathing were stable and his burns were either first degree (superficial, like a sunburn) or second degree (partial thickness, or to the layers just below the skin surface). When you are seven and in pain, though, any burn is considered "major" in my book. Suffice it to say, Eddie's burns were significant but not life-threatening.

While giving him pain medicine, some IV hydration, and soaking his wounds, we discussed Eddie's case with our regional burn unit. They requested we transfer him to their facility for overnight observation. I agreed wholeheartedly. He was a child in pain. He deserved to be treated cautiously, tenderly.

"Eddie," I asked, after we had made him comfortable, "what made you decide to light the oven this way?"

"Mama and Aunt Pammie do it all the time," Eddie said, shyly looking over at his mother. She was now sitting in a chair, beside his cot, stroking his hand.

"To cook?" I asked, rubbing this brave little kid's shoulder.

"No. We light it and keep the door open so we can stay warm." With the colder weather, it turns out, Eddie's family supplemented their apartment's warmth this way. Eddie, after seeing his mother and aunt light the oven several times, thought that he could do it, too. My heart broke a little, in that moment, looking at this thoughtful little boy who sustained burns because he was trying to help his family. He gave his mother a feeble, lopsided grin, the morphine adding to his charm.

"Baby, it's okay," the mother said, stroking his hand. "Aunt Pammie and I should have never done that." She turned to me and continued. "I'm not going to get in trouble, am I?" Although the question seemed self-serving, I was genuinely impressed with her concern for Eddie. She handled her little man with appropriate and abundant love. She even insisted on helping Carla with Eddie's treatment. I felt only good energy with her, discerning nothing suspicious. Eddie, it seemed to me, had a mother that truly loved him.

"No, you're not," I assured her, "but let me have our social worker talk to you about your living conditions and see if there is any available help for your family. Maybe have them come out and check the place out for you."

"Thank you," she said, "We could use some help trying to get the landlord to fix some of them windows."

So, as it turns out, Eddie's injuries were not a result of being negligent or careless. They stemmed from imitating the adults in his life, who were completely unaware of the lessons they were teaching him.

Eddie's situation got me to thinking in that deep, reflective way. How many times through the day do I, as a parent, verbalize to my children what I feel are essential life lessons when, in actuality, my witnessed actions carry more weight than any of my words. Actions that can be both good or bad. Conscious or instinctive. Helpful or harmful. Deliberate or unplanned.

Witnessed or unwitnessed by young eyes. My kids' eyes. Your kids' eyes.

Eddie ended up recovering quite nicely from his injuries and his family was very appreciative for his treatment and good outcome. They could not, however, have been nearly as appreciative as I was of the important lesson they reminded me.

Thank you, Eddie, the little big man. It's not everyday I get a life-lesson from a seven year-old.

As always, thanks for reading. Next posting will be Wednesday, February 3. Thanks for your votes and support in the Medgadget Weblog Awards...much appreciated.