Wednesday, April 23, 2014

Bingo Resilience

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"Bingo," she answered.

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

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

I will keep looking...

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

What's your "Bingo?"


Friday, April 11, 2014

The Kick Ditch

A moment of reflection...

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

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

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

The kick ditch.

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

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

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

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

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

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

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

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

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

Be a kick ditch.

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