Friday, October 22, 2010

Kung Fu Fighting

I love a distraction. Especially in the ER. Sometimes the distraction can be subtle and minor, one that I have to search out to find. Other times, though, a distraction can be glaringly obvious, practically smacking me in the face. Whatever the diversion, these moments can make a hectic, chaotic day in the ER much more tolerable. Not to mention fun.

Although it's usually the patients who provide the main attraction, occasionally it can be the waiting family or friends of the patient. For example, Aunt Alice's nose mole and smeared lipstick might make me do a double-take, detracting from the attention I would otherwise have given her nephew, the patient. Grandpa Ben isn't fooling anyone about his gas problem either, sitting over in the room's corner wearing a smug smile, shifting around on his chair before releasing another foul air biscuit.

The possibilities of distractions are endless and, quite frankly, most welcomed by my receptive self.

A few weeks back, I had a two-for-one zinger--both an intriguing patient and her entertaining boyfriend. The patient herself had a significant history of anxiety, bipolar depression, and schizophrenia and, while at an appointment at her mental health clinic, she had become extremely anxious and began to hyperventilate, ultimately passing out. This lead to her trip to our ER via the ambulance service. Her boyfriend, I was told, met her after she arrived.

Walking into Room 22, I found an anxious-appearing, thirty-ish, blond woman with extremely poor dentition. In fact, one of her front teeth was angled outward, barely hinged to her gums, and her tongue seemed to constantly caress this wayward tooth. Her blue eyes seemed out of focus, glazed-over even, probably a result of the valium given to her by the prehospital team. She fidgeted with her hands while her right foot rhythmically rubbed up and down her left shin. Her room smelled quite strongly of stale cigarette smoke.

Standing in the obscure corner of the treatment room was this patient's boyfriend. He was a small man, maybe 5'5", balding with a gathered ponytail. As I took his appearance in, he looked shyly down at his feet while pressing his hands together in front of him, prayer-like. Interestingly, he had no shirt on, just sandals and some worn jeans. His chest was sunken-in and fuzzy. His abandoned white t-shirt rested on the room's only counter top.

Between the two of them, I would have been quite content to spend the rest of my shift hanging out in their room, people-watching. I had a feeling that this interaction would be a memorable one.

The patient eyed me suspiciously as I approached her with my hand extended, ready to introduce myself. While in the middle of saying my name and explaining that I would be her doctor during this ER visit, I heard a loud exhalation followed by a hum originate from behind me, from the corner where the boyfriend stood. Quite frankly, it startled me.

I turned my head to look at the boyfriend, only to find him performing exaggerated motions of what I assumed to be some form of martial arts. After several moments of unorganized, flailing movements, he quit humming and folded his hands back together, bowing his head to me. Although I'm sure he didn't mean it to be, his actions and behavior were quite comical, and I fought myself from laughing out loud.

"Eddie," the patient shrieked, bringing my attention back to her, "cut that shit out. I ain't gonna watch your bogus karate while I'm lying here sick."

At this, Eddie began to hum loudly (again), keeping his head bowed, his hands folded, and his eyes closed. Suddenly, though, as if an "on" button had been pushed, he launched into another routine of air karate, randomly slicing and jabbing his hands while awkwardly kicking his feet outward. For his grand finale, he did a spin kick, almost tripping and falling to the ground on his landing. After collecting himself, he again folded his hands, bowed his head, and nodded to me before closing his eyes.

Funny, but I didn't feel threatened or in danger. I was, however, completely and totally mesmerized.

"Eddie," screamed the patient again, "if you do that one more time, I'm going to climb out of my bed and come over there to kick your ass. Got it?" Eddie apparently didn't, or else simply chose to ignore the patient's threats, remaining in his deep meditative state.

I tried to diffuse the situation. "Eddie," I said, smiling, "that's some really good stuff. Are you a professional?"

I had barely finished my question when the patient chimed in, laughing hysterically at my question. "Professional? You've got to be kidding!" she exclaimed, now choking on her words. "Hell, he's just making all of this shit up as he goes along."

"Well," I said, "his routine sure impressed the heck out of me." I was telling the truth, too. His routine was unlike any I had ever seen before.

With this, Eddie bowed forward again, I assume in thanks of my words.

"Bullshit," the patient said, emphatically, "he doesn't know shit about karate or anything else. Tell him, Eddie." I looked from the patient to Eddie and, after he remained silent in his own world, back to the patient again. "Oh, that's right, I forgot," she added, now sarcasm dripping from her words, "you don't talk during your karate sessions. How could I have forgotten?" She rolled her glazed eyes as she spoke.

Ouch. For her sake, I could only hope that Eddie would never try out his routine on her.

They became the couple of the moment in our ER. When they were alone in their room, there seemed to be a quietness, a calm, to the area. But the moment someone, anyone, walked into the room, the show began. A loud exhalation by Eddie. Humming. Eddie's routine of his remarkable abilities, capped off by his spin kick and landing. The bowing of his head and folding of his hands in conclusion. The girlfriend's free earful of screaming at Eddie for his ridiculousness. The exit of the person who entered.

The nurse walked out of Room 22, shaking her head and laughing after witnessing this same show that I did. So did the x-ray tech. And EKG tech. "Is this for real?" I heard several of our staff ask, after checking out the scene on their own.

"It is," I assured them.

After clearing the patient with a good physical exam and several tests, we quickly discharged her, if only to get Eddie out before he hurt someone or himself.

You can't buy a ticket for this stuff. And you surely can't make it up. The only thing you can do, really, is appreciate these distractions that come with a job in the ER. Well, that and closely inspect the room's corners to make sure there isn't a hidden camera trying to record your response for some reality TV show. That you've been set-up, somehow.

I look forward to the next distraction to arrive. Somehow, as sure as time keeps ticking, I know I won't be disappointed.


As always, big thanks for reading. I hope you have a great, distracting weekend...

Thursday, October 14, 2010

The Emaciated Shoulder

She paced protectively beside the hospital bed and its current patient, her grown son, the mother lioness protecting her vulnerable cub. In her hand, she gripped a small notepad, a pen snugly tucked into the coiled-wire binding. Her worried eyes peered through her small rectangular frames, suspiciously watching my arrival. Without blinking, she tucked her short gray bob behind her ears, readying their acuity to my words.

She was the mother of a son infected with HIV.

I focused on the patient. He was my age, in his early forties, with mussed up reddish-blond hair. His face wore the fatigue and ravages of his illness. His temples were sunken-in, his bluish eyes dull, his teeth fragile. Although he gave an effort to smile, his sagging skin weighed down the corners of his mouth. His body was tucked and bundled to his chin with several hospital blankets. To say that he was tired-appearing would have been an understatement.

While introducing myself, I approached him with my outstretched hand. After we shook, I turned to his mother and repeated myself. She took my hand warmly. After introductions, she opened up her notepad and asked me to spell my name, writing it on a fresh clean sheet near the pad's end. I could see most of the previous pages, worn and tattered, were filled with her busywork.

"Well, John," I said, leaning back into the room's counter, "what brought you here today that I can help you with?"

Without hesitating, John's mother began to talk. "Mother," John interrupted her, "I can tell the doctor my problems on my own." I hoped that she wouldn't take his abruptness personally, instead recognizing his attempts to cling to his independence. She quickly silenced herself, slightly embarrassed, as John began to share his story with me.

In the mid-90s, John discovered he was infected with HIV. Through his diligent compliance of lifestyle and medication, he maintained an almost non-existent viral load. He worked-out, he ate well, he enjoyed life to the fullest. Unfortunately, in the past few years, his body and illness became resistant to his previous successful approach and, suddenly, he was dealing with the ravages of advancing HIV. Weight-loss, skin issues, opportunistic infections--each and every new problem was another lost battle in his war. After his most recent diagnosis of HIV-associated lymphoma, he moved back in with his mother and began chemotherapy. He was struggling immensely from both the effects of chemotherapy and his disease.

"Look, Doc," he said, unwrapping his blankets and lifting up his gown to reveal a swollen abdomen and legs, multiple tiny, kinked, bluish-veins spotting his transparent skin, "I have so much edema now that I rely on pain medication to help with the discomfort." His predicament looked painful. In fact, this uncontrolled and worsening swelling had been the purpose of his ER visit.

We talked a little longer about his life, his illness, and his recent setbacks. And through this conversation, I noticed John's mother slowly sadden and withdraw to the chair in the corner of the room. My heart went out to her--I couldn't imagine her pain, having to watch one of her children slowly dwindle from this sometimes devastating and unforgiving illness. Her anguished face, just moments before alert, now wore a look of tattered defeat.

"John," I assured him, "let me finish my physical exam and then I will order up some medications to make you comfortable." His mother wrote in her notebook as I talked.

I continued with my examination, after closely inspecting his protuding abdomen and edematous legs. His exam was difficult. He seemed to have significant findings with every system of his body, despite his vital signs begin stable.

Finally, I asked John to sit up so that I could auscultate his lungs from a posterior approach. "Can you help me, doc?" he asked, holding out his right arm to me. "Sure, John," I answered, grabbing his hand with my right hand and placing my left on his shoulder.

And that's when it hit me. Hard. Just how terrible John's predicament was. Don't get me wrong, I fully understood just how much suffering he had been dealing with recently as his body seemed to succumb to his setbacks, but touching his right shoulder had made me catch my breath.

Under the grip of my left hand, while coaxing John's worn body to sit up, the bareness and emaciation of his right shoulder astounded me. He had absolutely no bulk to it--no muscle, no fat, no cushiony subcutaneous tissue that one typically has to their shoulder contour. Nothing. All I could feel was bone. His clavicle, his humeral head, and his shoulder blade all right there. It was remarkably sad. I shifted my fingers in a futile attempt to palpate any "meat" on his bones. There was none.

After successfully sitting John up, with his mother's help on his other side, I shifted his gown off his shoulder while listening to his lungs. My eyes fixated on his shoulder's thin, transparent skin barely accomodating the stretching from his protruding bones. I simply couldn't quit looking at the fragile shoulder, a dichotomy to John's enlarged, padded ascitic legs and abdomen. What a damn, awful disease.

I left John's room and ordered his work-up and medications. Soon after, he was much more comfortable.

A few minutes later, the secretary called me. "Dr. Jim," she said, "the mother of Room 28 is waiting at the nurses' station to talk to you." I finished with a chart and walked the hallway, finding the mother leaning into the station counter, flipping through her notepad. "Hello, maam," I said, approaching her, "I understand you wanted to talk to me?"

She looked up from her notepad, closing it, while her eyes settled on mine. "Yes, doctor, I do." She paused before continuing. "I just want to thank you for your kindness to John. I know you are just doing your job, per se, but there was something more from you, something I can't put a finger on, that made us both feel very good." She choked up as she spoke.

I grabbed her hands, one of which still held her precious notepad, and thanked her for her kind words. "My heart goes out to both of you," I continued, watching her tears progress to sobs, "what an awful disease for anybody to endure." She took her eyes from mine and looked at her feet. I thought of what to say next, the words coming quite easy. "John is so lucky and blessed to have a mother like you. You opened your home, you take notes, you accompany him to all of his appointments. We should all be so lucky." I paused before finishing. "And loved."

She looked at me again, her act of the protective mother lioness long-abandoned. "Thank you," she repeated before turning and walking back towards John's room.

We admitted John for further care.

Although I pride myself on my composure through all of the emergency department's chaos, I am only human and sometimes cannot shake a patient's affect on me. John was one such patient. It must have visibly shown, too, since several of my coworkers asked me if I was okay. "No," I answered honestly, "but I will be."

At the end of the day, we are all human. We are all in this world together. We are all united by the common threads of emotions. We are all prone to the extremes of happiness and sadness and everything between. We are all in need of compassion and kindness and love.

Especially, though, those who are suffering. And John was suffering. My greatest hope for John is that he may find much love, compassion, and kindness on his continued life journey.

There is no human being who deserves anything less.

As always, big thanks for reading.

Monday, October 4, 2010

The Power Of A Voice

This morning in church, I closed my eyes to fully absorb the priest's deep, husky, richly-layered voice which emanated from the alter and, suddenly, I was transported back ten years, to a time in my life when I was buoyed by this same powerful voice, the one speaking to me now as I sat in my maple pew on this cold, rainy Sunday morning.

Ten years earlier, I had been up all night, uncomfortably spooning with my wife in a lazy-boy recliner in my son's hospital room, waiting anxiously for morning to come. Neither of us wanted to leave Cole's side. Neither of us wanted morning to come, either. Morning would bring surgeons and specialists who would transport my son to the operating room, to debulk and biopsy a neck mass discovered the day prior. A day prior that was filled with haunting, harrowing memories of being told, after several emergency CT scans, that my son had something "seriously wrong." The news of the tumors in his neck and chest, accompanied by swollen lymph nodes, had collapsed our world.

Finally, five a.m. arrived. The early light of another day, confirmation that the world wouldn't stop with our sorrow, began slivering between the room's vertical blinds. I rolled off the lazy-boy, covering my wife with our shared blanket, before gingerly tiptoeing to the crib. I watched my son's chest rise and fall, his complacent, peaceful face giving no indication of the cellular war raging in his tiny body.

I was mesmerized, surrounded by my son's clouds of pure innocence, as I clung to the bars of his crib, trying to make reason with this path my son was suddenly placed upon. I listened to his steady breathing. I watched his little eyelids flutter. I wondered at the shadows of beautiful angles that his bent limbs created under his blanket. No different than the day before and, yet, the knowledge of his devastating illness now changed everything.

Suddenly, around 6 a.m., the room's phone screamed out, ringing to interrupt my trance.

"Hello," I answered, supposing it was someone from the hospital's staff.

"Hello, Jim," the familiar voice spoke, "it's Father Tom." Of course, I knew it was Father Tom. He needed no introduction to my ears, ever. Just hearing his calm voice, resonating with love and concern, wrapped a blanket of comfort around my aching heart. He continued. "I'm calling to see if you or Karen need anything." I should have expected our beloved priest to be checking in with us during our turmoil. Just not this early.

"Father Tom," I whispered into the phone, "we're okay. We have a tough day ahead of us, though. Please just keep Cole in your thoughts and prayers through the day and we'll let you know, as soon as surgery is over, what we are facing."

"Jim," he spoke again, his voice steady and strong, "I don't think you understand. I'm downstairs in your hospital lobby. I'm on my way up to your room but wondered if you or Karen needed some coffee or a bagel, even."

"What, Father Tom?" I asked, confused. "You mean you are here? Right now? In the Children's Hospital?" The hospital was at least two hours from our home, which meant that he would have had to have left by 4:00 a.m. to get to us at this time.

"You don't think I would stay away on a day like today, do you, Jim?" he asked. I couldn't answer, my wonder and thankfulness of his presence choking my words. A few moments of silence followed as he waited patiently for my answer. "No," I finally said, before continuing, "and Father Tom, thank you."

With that phone call, on that fateful day, Father Tom's voice ingrained itself into my memory.

And from that simple phone call, Father Tom's magnificent voice continued to harmonize much of the discord in my life. That day alone, in which Cole came through his surgery, Father Tom stood in a circle with us in the family room, hands joined, offering that consoling voice in prayer and reassurance. Later, when I asked him "Why? Why? Why?" my son was chosen to bear his burden, to have to fight for his life at a young age of two, his voice cracked, one of only a few times I have heard this. "I can't answer that, Jim," he had said, "but I can only pray that at some point in Cole's life, on his journey, the answers of why will become more evident." Yes, Father Tom, I can see some of those answers already.

Through those trying years, including an additional year of chemotherapy for Cole when he came out of remission and my mother's eventual death from leukemia, Father Tom, his voice in tow, continued to grace all of our lives. Whether at our home for lunch or dinner, or whether a Sunday morning sermon, his distinguished, distinctive voice, with its classy delivery, never failed me. Even before delivering my mother's eulogy, he approached me. "The grace of God is with you," he had said, clasping my face between his hands at her funeral, "you will do your mother proud as she sits there on your shoulder with you."

Unfortunately, as with our Catholic religion, priests can be reassigned to another parish after several years of service, and this was no different for Father Tom. He moved over an hour away, assigned to another parish, too far for us to travel for services . We did surprise him one Sunday but, otherwise, relied on emails, phone calls, and rare dinners to catch up. It wasn't the same.

I had lost my spiritual guidance, of sorts. I missed the power of his voice and wise words. And I missed my friend.

Thankfully, though, Father Tom informed our family at the beginning of this past summer that he would be returning to our area, to a parish just twenty minutes from our home-base parish. I couldn't wait for the day to arrive.

Today, finally, was that day. Today, on this gloriously cold, autumn day, I was blessed to sit in church, beside my healthy son, my lovely daughters, and my beautiful wife, listening to the voice of an angel.

The missing voice that I couldn't replace in my life.

The voice of Father Tom.

As always, big thanks for reading. Anybody's voice in your life that you rely/relied on? See you midweek...