Thursday, June 11, 2020

Double-Knot These Threads

"...it would be interesting to find out what goes on in that moment 
when someone looks at you and draws all sorts of conclusions."

A few years back, I took care of a frail elderly gentleman who, accompanied by his wife, had come to the ER with an elbow injury after tripping over a curb in front of a local restaurant. They had been traveling from Buffalo to Cleveland and had stopped for a quick bite and a bathroom break.

Before entering his room to treat him, I had been given a heads-up by Rita, his nurse, that this patient's demeanor was abrasive and demanding. "You are going to love his wife, though," Rita added, "she is one of the sweetest women I have ever met."

Appreciating Rita's warning, I knocked on the door and entered, prepared to face this ornery fellow. What I wasn't prepared for, though, was this patient's physical appearance. He was extremely small in stature, petite almost. His legs dangled over the cot's side and swayed several feet above the tiled-floor. His clothes hung loosely off his thin frame. His fedora hat swallowed up his round, veiny face and bulbous nose. His eyes were apprehensive, his grimace distasteful. His presence, contrasting his physicality, was enormous and palpable.

In the corner of the room sat his wife, a beautiful gray-haired woman, equally frail and petite, clutching her purse. She wore a loosely-fitting flowered dress and a warm, welcoming smile. She was Sophia's twin from The Golden Girls.

To allow my patient a chance to size me up, I acknowledged his wife first, returning her welcoming smile as I greeted her. I then turned to my intensely grumpy patient and introduced myself, asking him how I could help him on his visit.

"Doctor, I need stitches," he answered, pointing to his right elbow. His voice was gruff and heavy, weighted by a thick European accent. "I hurt my knee before like this and that's what they had to do," he continued, pulling up his pressed pant leg to reveal his small bony knee with a pencil-thin scar across its cap.

This gentleman remained quite ornery during his interview, his examination and his treatment. He continued to insist that he needed stitches. He didn't, though, and it took me several minutes to convince him of this. He simply had some abrasions and skin-tears. He did need some x-rays, however, and after getting them, I explained the negative results to his wife and him. His wife smiled and clapped her hands at the good news while he simply grunted. They were a dichotomy of spirits. Gradually, though, I could see him softening towards me as his visit concluded. After cleaning his wounds and bandaging his elbow, I assured him he would be discharged shortly.

I was not surprised that within mere minutes, while sitting at my work station, this patient was standing impatiently at the nurses' counter asking what was taking so long for him to be discharged. His voice was loud and imposing, and those of us sitting paused from what we were doing to look toward the source. His fedora and pinched-up face barely cleared the height of the counter and yet he had made his presence known. After hearing his booming accented-voice again, as well as to placate him while Rita prepared his instructions, I asked him about the origin of his accent.

"Sir," I said, "I noticed your accent. Where did it originate?"

And with that question, this patient opened his heart's flood gates and willingly launched into his past, sharing an astounding story that most of us would never have imagined. He was a Holocaust survivor from Poland, he said with a quieter voice, who tragically lost his entire family at the age of eleven--his parents, his five sisters, his aunts and uncles, and all of his cousins. He survived because a local farming family took him in as "one of their own" during the war. At the age of twenty, he had saved up enough money to immigrate to America, "the greatest country in the world." After arriving penniless, he settled in Ohio where he met his wife. Together they raised four children and owned a successful business. "I've had a very very good life," he concluded.

It was a story that made you catch your breath.

As he finished, his wife approached him and put her arm around his shoulders. He looked at her and she nodded a loving reassurance to him. Not one among us sitting there had a dry eye. His abrasive personality had softened and his incredible story of survival had humanized him right before us. With this glimpse into his private life, we were all suddenly filled with empathy and compassion for this man, his wife, and this life he had fought to live. With all of us in silence, he turned slowly to go back to his room. "I'll be in my room waiting for those papers."

It was unimaginable to think we had almost missed this patient's remarkable story because it was hidden behind his rough exterior and abrupt attitude.

This patient had taught us all a very worthy lesson that day, a lesson that resonates especially in today's world. With all of the fears and uncertainties that currently exist in our society, we need to remember that behind every face of every person we encounter, whether masked or not, sits an incredible and powerful story of a life unlike ours, of a life unknown to us. Stories of resilience, of loss, of triumph, and of inspiration. Occasionally, as this patient reminded us, it just takes a little more time and effort to peel the layers back to find the good stuff of another.

With each interaction we have with one another, then, what an amazing opportunity we are given to tap into our capacity to understand one another regardless of our similarities and differences.

We need to halt the quick judgments and criticisms. We are all bound by threads of love and understanding and respect and compassion. Why are we so quick to fray these threads instead of double-knotting and strengthening them?

For the sake of skin color?
For the sake of religion?
For the sake of social background?
For the sake of gender?
For the sake of age?
For the sake of sexual preference?
For the sake of material possessions?

Please, of all things, don't let it be for the sake of consciously choosing hate over love.

None of these reasons are worth tearing down and hurting another. None of these reasons are worth crumbling the foundation of our beautiful country. All of these reasons are worth our efforts to take the time to learn more about one another.

Let's double-knot these threads that bind each of us and choose love.

As I've said before, in a society that wants to separate us based on our differences, we are reminded daily through shared tragedies and triumphs that we will always be more alike. Let's grasp these reminders tightly and make the world a better place.

A heartfelt thanks to my patient for reminding me that each of us has a life journey that most don't know about. Because of this, we should always try to be patient and kind with one another. And understanding. And respectful. And compassionate. And loving.

To me, it is the only way...


Thanks, as always, for reading. Would love to hear your thoughts and feedback. This essay is an unedited, longer version of a recent column printed in our local newspaper and posted on our local community website.  My best, Jim.

Thursday, May 14, 2020

Be Good. Do Good.

Do your little bit of good where you are.
It's those little bits of good put together that
overwhelm the world.    Desmond Tutu

Recently, my son Cole and I were enjoying an afternoon out of the house, running around town to tackle our to-do list of errands (masked, of course). We stopped at Sam's Club and Walmart, stocking up on our low supplies of food and other necessities. As an added bonus, we enjoyed the people-watching and marveled at the wide spectrum of personal flaws the other shoppers provided us.

It seemed that the Covid-19 crisis had fueled an already blossoming trend of wearing fleece pajama bottoms in public without any embarrassment. People tended to have a greasy quality to them, clearly reducing their shower time as a personal protest to the quarantine guidelines. With masks on, the eyes of these shoppers held the power of conveying a wide spectrum of gratitude, misery, frustration, happiness, and paranoia. I enjoyed interpreting these various moods and realized that zombies were alive and well, living among us.

After these stops, the SUV loaded with fresh supplies, we had just one stop left--The UPS Store. Cole had several large packages he had to send out and the store was just a few short miles away.

Pulling up to the store front, Cole and I got out and walked to the back of our vehicle and removed the packages, overloading our arms to make the delivery in one trip. We walked in together and in a short time had the packages processed. Walking out of the store, stomachs growling, we were talking about what we were going to eat for dinner. With a loaded vehicle of fresh food, our options were many.

And then, amidst our talking, Cole and I saw something that instantly grabbed out attention, almost like a grab and shake of our shoulders, halting our conversation to immediate silence.

Across the parking lot and directly opposite of us, a homeless man sat on a railing that nestled into the red siding of the back wall of a Country Fair. Beside him sat a beat-up grocery cart, filled halfway with tattered plastic bags. He wore a threadbare trench coat over his very thin frame. His hair was wispy and messed from the breeze. His face was smudged and blotchy and his legs and arms were crossed. He was watching us as we stepped from the curb toward our vehicle. Smoking a cigarette, he took a puff, stamped it into the ground and then nodded towards us.    

Seeing this man was an immediate reminder to my son and I of just how damn lucky we were. It also gave us the privilege to do a little bit of good.

Cole looked at me and I looked at him. Almost in sync, we both said "Let's give him some food." We went through our bags and pulled out an 18-inch sub, bananas, protein bars, an energy drink and water.

Cole asked if I would take this food to this gentleman and it took me back to the days when he was a child, clinging to my legs as we walked up to a homeless man in McDonalds to give him a a quarter-pounder meal (I Like The Fish). I felt the overwhelming privilege this homeless man gave my son and I to share, however, and walked toward him with the food and drink as well as a $10 bill tucked into the sub wrapping.

Approaching him, his despair became even more apparent. Although the day was chilly but not terribly cold, this man's uncovered feet were pale and roughed up. It was apparent he had probably been walking barefoot and that he also had diabetes or poor circulation.

I stopped in front of him and introduced myself to him. "Hello sir, my name is Jim. Would it be okay if my son and I gave you some food since we just went shopping?" The man didn't speak, but simply nodded yes and held out his hands. I gave him the food and, very methodically, he divided up the ante, putting the drinks in a separate plastic bag that hung from the cart's handle while placing the other food with the $10 bill into the plastic bags within the cart's basket.

When finished, he looked back to me and gave me a smile and quietly thanked me.

As I was turning to leave, I happened upon a pair of bedroom slippers that sat beside him. They were wet, frayed, and had giant holes where I imagined this man's big toes would poke out had he been wearing them.

"Sir," I said, "are those your shoes?" He nodded yes.
"Do you have any other shoes?" I asked. He nodded no.

I looked down at my feet. I was wearing for the first time a pair of new Crocs I had purchased right before the quarantine started. I looked back at him and asked "Will you take my shoes if I give them to you?"

He looked surprised at my question. He spoke again, softly enough that I had to lean into him. "I can't take your shoes." I asked him if he could fit into a size 13 and he nodded yes.

I took off my Crocs and handed them over to him. He took them from me and immediately tried them on. "They'll do," he said, now offering me a bigger smile.

One thing was missing, though. I looked back at my feet and appreciated the warm black athletic socks I had on. Within seconds, I had them off and was handing them over. "I can't take those," he said but, after my insistence, he reached out and took them.

I looked him in the eye and he looked back at me. Eyes on eyes. "I'm Richard," he said. "Hi Richard," I said, "I'm Jim. Do you need anything else?" Although I knew a lot of his needs were beyond what I could offer, I still had to ask. "Do you need to get somewhere or can I call for help for you?" I asked, thinking about how amazing our case managers in our ER were.

He assured me he was okay. "Well then, Richard, it was a pleasure to meet you." I looked him in his eyes one last time and saw his appreciation before I turned and walked away.

Walking across the parking lot and toward Cole, my bare feet ached from the pebbles and cold pavement. Yet it was exactly the walk I needed at that very moment. I could only imagine Richard's discomfort on a daily basis. Cole was standing beside the SUV and had watched everything. The encounter took less than two minutes. And in those two minutes time, Richard had provided a view to a world different than ours. We were grateful.

I handed over the keys to Cole. "You drive," I said. Backing out of our parking space, we waved goodbye to Richard as he was putting on the socks. Driving home, I had my feet up on the dashboard with the warm defrost cranked. It was a luxury not lost on me.

This story of Richard I share with you is not a self-congratulatory pat on my back, I promise. In fact, it's not even extraordinary. Rather, it's a reminder to me and maybe to you that giving truly is better than receiving. It may sound cliche, I know, but it certainly is an undeniable truth. Especially during these uneasy and frustrating times in which many among us might be dealing with new stressors that simply didn't exist in our lives just mere months ago, giving is something that can provide happiness to each of us.

Giving doesn't have to have a monetary value, either. We were just fortunate to have that opportunity with Richard to do so. The cost of giving can be minimal. A phone call. A text. A kind word. A smile. A wave. Giving that comes from your heart and soul is about as good as it gets. Giving provides gratitude. It provides appreciation. It provides love.

Giving also inspires more giving. Your giving, in whatever way you do, may have a ripple effect that you can't even begin to imagine. Who knows, maybe Richard will share his smile more with the world after enough smiles are shared and provided to him. Maybe you will be inspired to give a little more of yourself than the day before. Maybe the person who receives your gift will pay it forward and create a cascade of giving.

Through these times of quarantine and isolation, most importantly, giving increases our social connectedness. This connectedness is vital to our continued good mental health. Imagine the happy that you receive as well as give simply by saying "I love you" or "I appreciate you" to someone in your life who hasn't heard those words for quite some time from you. What a great way to nourish our relationships as well as reap the rewards that giving provides.

Everyday I consciously try to do several good deeds. Many of you out there have received a random text, a phone call, a book in the mail, a gift card, or a compliment from me (sorry, no revealing selfies). Without these connections, I would be less of a human--less compassionate, less happy, and less equipped to deal with my new daily life. My threads connecting me to my fellow man would be frayed. Likewise, I have also been the recipient of so much goodness and giving from so many people, especially during this Covid crisis. This giving from so many people has inspired me to become a better person and give more of myself.  It connects me.

I am caught in the ripple effect of giving...and I like it...I hope you are caught, too.

I would like to thank Richard for providing me with much more than I provided him. To give of oneself is a powerful privilege and he gifted that privilege to my son and me. I hope each of you have the opportunity to give of yourself and feel the beauty that accompanies your actions. I hope you feel the empowerment and connectedness that comes along with doing "your little bit of good where you are."

We are all in this together...

I hope this finds each of you feeling okay while dealing with all of the new stressors created. You are not in this alone. Please, if you have an inspiring story or comment to share, please do on my blog or on my Facebook comments. Be well. Jim 

Thursday, May 7, 2020

The Power Of A Nurse

I am only one, but still I am one.
I cannot do everything, but still I can do something.
And because I cannot do everything, 
I will not refuse to do something that I can do...Helen Keller

The car pulls into the driveway of a cape cod as the sunrise breaks through remnants of last night's fog. The driver pulls up to the garage and stares at the door, deciding to park outside. Lights are turned off. The engine is cut. The driver exhales a deep breath she didn't know she was holding. She rests her forehead into the steering wheel. A tear rolls down her cheek as a hesitant smile emerges. She thinks back to the many triumphs and defeats she bravely faced for the past twelve hours. Her fingers entwine the plastic Minnie Mouse bracelet she is wearing, given to her by a patient with leukemia. She walks into her house. Despite her sheer exhaustion, sleep will not come until after she wakes up her three kids to dress them, feed them and escort them to their bus stop.

This is the life of a nurse.

He looks as tired as he feels, despite sleeping well the night prior. It's been a thankless shift. Through the window of the nurses' station, he observes the outside rain, its drizzle rhythmically tapping a soothing beat. He signs off the last of information on his seventh patient to his replacement, sharing the important medications, vitals, activities, and care-plan in depth. He says his goodbyes, heads to the locker room and changes out of his scrubs into his street clothes. He collects his belongings, walks down a hectic hallway to enter a packed elevator, and exits through the lobby. He crosses traffic and enters a long walkway that leads to the parking garage. Here, he cannot hold back his emotions any longer. He turns around to look at the intimidating building he just left, and stares at the end window of the seventh floor. His chest heaves and he starts to cry, knowing the death of this patient will haunt him in tonight's sleep.

This is the life of a nurse.

She grabs the crockpot of baked beans and yells for the kids to hurry up. She doesn't want to be late for her family reunion. It's been a year since she's seen some of her distant cousins and she has been looking forward to revisiting her childhood memories with those who shared in them. Thankfully, her husband packed the car earlier with silverware and lawn chairs. Suddenly, her phone rings. She looks at the number and dreadfully picks up, knowing that her plans for the day are ruined. She faces the disappointed faces of her children and husband before she changes into her scrubs and clogs. Within thirty minutes, she is on her unit, a familiar place of chaos, for this unplanned shift due to mandatory on-call. She sits down on the cracked leather chair in front of her computer, wishing for the world she was sitting at a picnic bench with her family instead. 

This is the life of a nurse.

There is not one among us who has not had our lives enriched because of a nurse. From birth to now, each of us has been touched with the kindness and loving attention that a nurse has provided us. Whether it be at the doctor's office, the hospital, the medical centers with inpatient and outpatient services, or within our own homes, nurses have been a constant source of unlimited talents and skills, selfless souls who have always had the gift of propelling us forward on our life paths. They have comforted us in our down moments and genuinely rejoiced with us in the glory of good health.

They have held our hands through so many stages...always supportive...always beside us. 

I clearly remember the many nurses who have accompanied me on my life journey. My childhood doctor's nurse, holding me through my shots. My dentist's nurse, holding my hand while soothingly talking in my ear during a cavity being filled. My family practitioners' and specialists' nurses, always greeting and treating me with a big smile.

We not only remember the many nurses who have touched our lives, but also the nurses who have touched our family members' lives. I will never forget or be able to repay Nurse Rose, an energetic bundle of goodness from the local Children's Hospital who each week guided us through the chemotherapy treatments of one of my children. The same goes for Nurse Sue and Nurse Don, two of my mother's favorites nurses when she had to spend 40 days in the hospital as she bravely fought leukemia. When my mother's hair started falling out in clumps, it was Nurse Don who brought in his hairdresser clippers and made her even more beautiful than she already was.

Excuse me while I wipe my tears...

Uniquely, I have had the pleasures and memories of working beside so many incredibly talented nurses as I traveled through medical school and residency. Their names and faces are etched into my mind's vault as I fondly recall their unselfish sharing of their medical knowledge and laughter and coping skills with me. Often, it was a nurse who calmly guided me through a crisis when I stood at the bedside of a crashing patient at 4 a.m. in the ICU during my internship year.

Most of all, though, I would like to salute the nurses who I have been fortunate to work beside for the past 23 years in our chaotic trauma center's ER. Through each shift, among the memories of the triumphs and tragedies, of the heartbreaks and celebrations, and of the mundane and exciting, you have unselfishly stood beside me and encouraged me to be and give my very best to each and every patient. You are not only my coworkers, but you are my brothers and sisters.  

This is the power of a nurse.

To all of you, it has been my privilege to witness your strength and vulnerability, your discipline and strong-will, your compassion and empathy, your perseverance and endless energy, your grieving and your heartfelt rejoicing, and your gratitude and happiness while caring for the lives of ill patients who rely on you.

I have learned from you and am buoyed by you.
I am a better doctor because of you.
I am a better man and human being because of you.

This week, then, please smile as you are flooded with memories of...

...the patient who gave you a hug and a vase of flowers when she was discharged.
...the tears of happiness you shed when you helped save a patient's life.
...the compliments you received from a patient's grateful family.
...the first successful IV you placed in a squirming patient.

...the nurse mentor who guided you through your first week on your new job.
...the child who colored you a picture of yourself.
...the first thank you note you got from a patient in your work mailbox.
...the pride in your family's eyes when you received your nursing diploma.

...the first time in public a patient recognized you and thanked you for your care.
...the admiration in someone's eyes when you told them you are a nurse.
...the thank-you you received from an appreciative doctor when you caught a medical error.
...the thank-you you received from a fellow nurse you helped when their patient crashed.

...the lives you have affected by your selfless and endless compassion, love and caring.
...the hours you dedicated to always bettering yourself to be the great nurse you are.
...the accolades you have received from your volunteerism and sharing of yourself.
...the love and respect we each hold for you as you face another uncertain work day.

Nurses represent all that is good in our world, the epitome of love and compassion and empathy and selflessness. It is a special person who has this inherent recipe of characteristics and pursues one of the most noble professions in our society. Although it can be heartbreaking and demoralizing at times, thank you for seeing beyond this fog to appreciate the rewards that awaited you.

From myself, your fellow co-workers, your family and friends, and your fellow human beings, then, we send each of you a collective heartfelt thanks for the work you do, the lives you enrich and the difference you make each and every day.

Happy Nurses Week to you!!!

You are angels
You are heroes.
You are family.

You are a nurse...

Thank you for reading! Also check out Senator Walsh...Thank You for more nurse appreciation!

I dedicate this to one of my heroes, my sister Chrissie, and her forty-year nursing career. Thanks for inspiring me to be a part of the medical world (and for being a great big sissy!). 💕

Wednesday, March 18, 2020

Corona Together

This breath is a gift...
This moment is a gift...
This life is a gift...

As with every other person, I am struggling to comprehend the staggering effects that Covid-19 has had on our society in such a short time. Gone are the carefree smiles, the uncomplicated daily lives, and the thought that we and our families are immune to unexpected death. Instead, we are witnessing a collapse in society to the degree that most believe survival hinges on the amount of toilet paper and paper towel one has stockpiled.

Being an ER physician facing this dilemma on the front lines of a large emergency and trauma center, I am also bearing witness to the more daunting picture of this dilemma--the mental and physical effects Covid-19 is having on our patients as well as on all of us. Regardless of the severity of a patient's illness and diagnosis, time and again I am now witnessing an unsettling fear in their eyes, conveying a belief that somehow Covid-19 is playing a part in their (lack of) well-being. They are scared.

For the rest of us, any minor symptom is being questioned. All one has to do is cough or sneeze in public to expose just how nervous everyone is. Just yesterday, someone sneezed in our local Walmart, sparking a big argument and confrontation. We are all scared.

Friends and family have asked me my thoughts on Covid-19, maybe believing I have some special information simply from being on the front lines. And the truth is, I am not sure what to think at this point. I recently finished seven consecutive shifts in which I, along with my incredible co-workers, have been part of our hospital's evolving approach to the growing concern of Covid-19. Rightly so, these policies have changed frequently as we sort out the information amid new revelations, details, and statistics as they come in. It is safe to say that many of us have never before experienced anything like this in our careers.

It seems we are all standing on sandy beaches watching this huge wave coming at us, gaining momentum as it gets closer and closer to shore. We feel helpless. In attempts to solidify our footing, though, we are linking arms, unified in following the directions given to us. Isolate ourselves. Wash our hands. Don't touch our faces. Use elbow-bump greetings. Take extra precautions around the elderly, the young, and the immunocompromised. Don't bog down our front-line medical providers with mild symptoms.

Will this be enough to keep our firm footing once the Covid-19 wave hits? Or is this wave going to knock us on our asses? Are we prepared for the outcome of either?

Turning on the news only seems to spark more fear and hysteria. We are witnessing the devastating loss of lives in other countries. We are witnessing a lack of basic necessary food and supplies for some while others hoard. We are witnessing a collapse in our economic structure. We are witnessing the world shrink down to only what exists within the four walls of our homes.

So with all of this confusion and fear existing in our society, what are we to do? How do we make sense of all the information, true or otherwise, that is bombarding us every second of every day?

When things become complicated, sometimes the easiest approach to clarification is to simply breakdown all of the complications to their most basic forms. What follows are some of the things I will continue to do with each passing day that Covid-19 is a part of my life.

First and foremost, remember to be kind during all of this ruckus. Say "I love you" a little bit more to those you love. Wear your smile often. Be patient when you are frustrated. Call your neighbors and check in with them. Help an elderly person with their shopping in the store. Leave that extra roll of toilet paper on the shelf for the next person. Make an extra phone call a day to someone you haven't spoken to in a while. Use email and online messaging to stay connected. Help someone in need with childcare if all involved are well. Have a pizza delivered to a friend.

Be. Kind. Always.

Secondly, stay positive. I know this is a hard one, but when has a doom-and-gloom attitude ever helped a situation?  Your mental health and your physical well-being are tied together in ways that we often overlook and sometimes a better outlook depends on both a healthy mentality and physicality. Again, stay connected through phone calls, emails and messaging. Take a walk. Go to bed earlier. Nap. Stretch. Try yoga. Do your pushups and situps and planks and pull-ups while your gym is closed. Turn off the murder movies and put on the funny ones. Don't look at your retirement funds. Whatever it takes, try to greet the world with a bigger smile.

Three, use your time wisely. How many of us dreamt of having two or more weeks off from our daily lives? In essence, this is a big timeout. Use it wisely. Love yourself and learn to be comfortable being alone. Be introspective. Make changes. Evaluate your life and the things that demand your energy. Eliminate the toxic from your life (people and habits). Clean your house and dust that shelf. Go through your clothes and donate. Rearrange your rooms. Give excitement to the things that have begun to bore you.

Four, don't underestimate the power of a good book and a great song.

Five, don't let all of the confusion over Covid-19 detract you from the simplicities being asked of you from your leaders. Don't travel. Stay isolated. Do your hand-washing. Etc. Respect all the offered instructions to ensure not only your own livelihood but those around you. A simple defiance of these guidelines could have a ripple effect unlike anything you could imagine.

Six, don't engage in finger-pointing. Like me, I am sure most of you are tired of hearing the policy-makers and naysayers blame one another for the lack of testing, for the lack of preparedness, for the lack of funding, and for the lack of leadership and guidance. Corona is here now. Hindsight is 20/20. These negative behaviors and actions and words will only fog our clarity on moving forward to beat Covid-19. Don't engage. In the here and now, rather, we need to be supportive mature adults and unify in making the best decisions for ourselves based on the most recent and reliable information available. Let's be proactive. In the future, we can take the time to look back, reevaluate and learn from this.

Seven, please make wise choices and be responsible when pursuing medical care. If your symptoms are minor but you are concerned, such as a sniffle or sore throat or occasional cough, stay home or touch base with your family doctor's office for further guidance. If your symptoms include shortness of breath, lethargy, uncontrolled fevers, change in mental status or more severe symptoms, please seek immediate help.

We are great at what we do.
We are ready to save lives.
Please let us focus on the critically ill.

Finally, I want to humbly ask that you keep all of the frontline medical providers in your prayers. Instead of having the benefit of safely staying home, we will be leaving the comfort of our homes to show up for your sake.  Every minute of every hour of every day through this crisis, millions of us will be available to provide you care while risking our own health. Your unwavering support and kindnesses through this ordeal are greatly appreciated. Rest-assured we will provide each of you the best of our knowledge, our resources, our training, our energy and our compassion if you are ill and need us. We signed up willingly for our jobs out of a love to provide you with competent emergent care and we will deliver.

Standing alone on the shore, one is bound to get knocked on his ass from the Covid-19 wave. Standing together, our brigade will be successful against this wave. We have to be. We must all come together and support each other. We need to unify our thinking, our energy, and our efforts. And as we travel this treacherous path together, please remember that we are all human and need to root each other on.

I have always had a great faith in humanity. My work in the ER has provided me countless beautiful moments where I have been privileged to see the absolute best in people during the absolute worst of times. I have faith that at the end of the day, when this Covid-19 is no longer in our lives,  I will look back on these dark days and be proud of my fellow man for the dignity and pride shown through this crisis.

Please be safe. Please give your best. Please do your part.

I wish each of you a peaceful heart.
I wish each of you a calm mind.
I wish each of you good health.

We will beat this together...


Monday, August 12, 2019

A Family's Cry...

"The death of a child is the single most traumatic event in medicine. To lose a child is to lose a piece of yourself."

I walked into work yesterday morning and it only took seconds to appreciate the immense sorrow and sadness that permeated the air. My beautiful work family was despondent and deflated. Shoulders were slumped, feet were shuffling, faces wore defeat.

Something terrible had occurred during the night shift. Damn it. I felt my heart clench with the fear of anticipating the news that would cause such palpable pain to my coworkers.

Walking toward the first nurses' station, "Central" as we know it, I said brief good mornings to several nurses and techs as well as our unit coordinator, Amy. Most of them were either sitting or standing, leaning into the counter. Under the fluorescent lights, their eyes were dull. A profound fog of nothingness seemed to envelop each of them.

"Amy," I said, "what happened? What's going on?"

It took her all of five seconds to explain the catastrophe. "Dr. Jim, four children died in a house fire."

No. No. No. No. No. NO! NO! NO!

It just couldn't be. The loss of one child during any shift in the ER is devastating. But four??? No. No. No. No. No.

Damn it all, though, it happened. There was a house fire. Resuscitation efforts of the seven who had been trapped inside, five children, were initiated on scene by the same heroes that fought the fire to bring these victims out of the flaming house. Paramedics and EMTs continued the heroics, performing CPR and starting IVs and protecting and maintaining airways critically damaged from smoke inhalation and flame exposure. These patients were brought to our ER in multiple rigs that could never travel fast enough in these circumstances.

Once in the ER, the victims were cared for by multiple physicians, nurses, techs, EMTs, paramedics and unit coordinators who were each ready to give these victims the very best they had to offer. Not only were our ER and trauma teams fighting, but other departments also sent personnel to fight for the lives of these children and their mother. CPR was continued in hopes that these little hearts might start beating on their own. Life-saving IV medications were administered in attempts to jump-start injured bodies that wanted to shut down. Airways were maintained with tubes and provided ventilations in attempts to combat the swelling and damages from the fire burns and smoke inhalation. So many medical providers gave everything they could to change the fates of these patients.

I could only imagine the despair and disbelief of my coworkers as they treated these victims, using every possible means to try to save these little lives. I could only imagine their silent prayers whispered with each minute that passed without a response. I could only imagine that moment when the realization set in that perhaps they would not succeed and that their efforts would not be rewarded.

No pulse. No cardiac activity. No spontaneous breathing.

The efforts put forth to save these innocent lives were monumental and yet...no miracles.

Four children died. The fifth child died several hours later. A mother remains in critical condition.

How in the world...

...does one even begin to process and find explanation for such a profound loss of innocent lives?
...does one try to erase the images that will haunt you for the rest of your life?
...does one continue at a job where, despite all the advances of technology and medicine, you still feel a sense of failure for not being able to reverse what the fates have planned?
...does one put on a brave smile and move on to the next waiting patient that needs treated, pretending that what just happened really didn't happen?
...does one go home after a shift and pretend with your family that your heart is not bleeding?
...does one look into the eyes of your own children and not cry for the lives of these lost children?
...does one deal with this overwhelming and suffocating pain?
...does one return to a job where your heart and soul can be decimated in mere minutes, again?
...does one maintain a sense that the world is good, that life is sweet, and that love prevails?

After learning of the news and the events of the night shift, I offered as many hugs as I could. I walked down the hallway to settle in to my work area, and it was there that I found not one, but two of my partners. The first one, Dr. Kevin, is recently graduated from our residency program and is on his way to a remarkable career. He was scheduled to work 5p-3a but stayed on until 7a for obvious reasons. He is the father of three beautiful young girls. He looked exhausted. His pain, despite his attempts to smile, was evident. "Kevin," I said, "let me get you an Uber home." Of course, he refused.  "I'll be okay." He planned on going home to hug his wife and kids and have a stiff drink before settling in for some sleep.

Dr. Karen, my other partner, was the scheduled overnight doctor. Looking at her looking at me, I could see the swell of her eyes and the etched wrinkles of shock. She, like Kevin, planned on going home to hug her two boys and husband before hopefully sleeping off some of this night.

Before the overnight team left, a debriefing was held to address the events of the night and offer counseling to any of our team that might need it. As with Kevin and Karen, I bore witness to the raw pain that each of my work family carried from this tragedy. As one of my favorite nurses Debbie text me, "Keep an eye out on our friends, Jim. This is a life-changing event for them." Slowly, our fresh team arrived between 6:30a-7a and we were able to relieve our overnight staff and get them home.

In the aftermath of this tragedy, several family members checked in to be treated. Although their minds were elsewhere, I shared with them that so much love, so much pain, and so many prayers for their family were being shared by our team. Several of them searched my eyes, finding the authenticity of my words.

When a catastrophic event like this happens, especially involving the loss of children's lives, the objectivity of our jobs melt away. The self-imposed barriers we build to protect are hearts and souls are destroyed. The efforts to maintain our composure are lost. Sometimes we are asked to be superhuman when we are simply struggling to breath. The loss of a child's life will do that to us. A loss of five children's lives, well, I can't even imagine the lives that will be changed forever, the paths that have veered off from their expected course.

This family's lives. Our ER staff's. People's who might read about this tragedy. Even your's...

I know mine has.

At the end of the day, no matter what kind of lives we lead or pursue, we are all bound by the human threads that interweave each of our lives to one another. In a society that wants to separate us based on our differences, we are reminded daily through tragedy and triumph that we will always be more alike.

We are fathers. We are mothers. We are brothers and sisters. We are sons and daughters. We are friends. We are human. And we are all broken by this tragedy.

This family's pain is our pain. These lost innocent lives have brought us all to tears.

I would like to believe that angels' wings are built from broken hearts. If so, these innocent children are already fluttering overhead of those that loved them most.

May God Bless these children. May God Bless this Family and protect it from any more pain. And may God Bless each and every one of us who has lost a little piece of ourselves.

"There is no foot too small that it cannot leave an imprint on this world."
I dedicate this to all of you who fight daily for the lives of your patients...you are amazing...
Jim

Thursday, April 25, 2019

Senator Walsh...Thank You.

Senator Walsh...Thank you.

Because or your flagrant words against some of the hardest-working members of our medical community, we have united to stand against you and rally for our "card-playing" nurses.

Like most of my medical family, I was astounded and frustrated at the belittling ignorance of Senator Walsh's recent comments about the amazing nurses throughout our great country. Senator Walsh's comments were felt not only by our hard-working nurses, who give a piece of their heart and soul with each and every shift, but also by the rest of our diverse medical community. Senator Walsh's comments were arrows directed at the hearts of our nurses. Yet,  those very arrows also hit the hearts of each of us who work beside them.

We all bled at Senator Walsh's blatant disrespectful and asinine words. Being health providers, though, we did what we do best--we stopped the bleeding. We strengthened the bonds of our medical family. We rallied to our nurses' sides. We hugged our nurses, we spoke words of inspiration to our nurses, and we reminded each one that their uniqueness and intelligence and hardwork could never be diminished by the throwaway and ridiculous words of one person.

Yes, Senator Walsh, you are that one person. Your words have no power to change our nurse's inherent strengths of empathy, of compassion, and of love for the patients they are privileged to treat. Your words will be your legacy. Your words have defined you. No one in the medical field will ever hear your name spoken or printed without being reminded of your lack of intelligence, of your lack of finesse, of your lack of respect, and of your lack of understanding of one of the most professionally and personally demanding jobs in our society. We rose above your words by reminding these very nurses of just how amazing they are. You strengthened us by your ignorant words.

For uniting us and strengthening our professional bonds, we should thank Senator Walsh.

Clearly, it is obvious that Senator Walsh has no idea what demands are placed on our nurses. Due to their staggering reality of dealing with many life and death situations during each shift, we should all rejoice to witness a nurse having a few minutes of respite from these pressures--whether it be on her phone calling her children, hugging a fellow nurse, sitting down to eat a bite or two of food, or smiling and laughing with a coworker. These rare minutes of escapism for our nurses are necessary to keep moving forward during a shift that sometimes wants to pull them under.

Below, I offer several sobering examples and questions to Senator Walsh to see just how much she truly understands the demands of a nurse's job.

Senator Walsh, have you...

...ever said a silent prayer over a 17 y.o. teenager  who didn't survive a car accident?
...ever held the hand of a 38 y.o. woman, a mother of three young children, while the doctor told her she has ovarian cancer that has spread to her liver, lymph nodes, and brain?
...ever hugged a dementia patient ten times because she didn't remember the first nine?
...ever hugged a man's four adult children and his wife just minutes after he was pronounced dead?

...ever given a patient eight units of blood to try to save her from a ruptured aortic aneurysm?
...ever been called a "f...ing bitch" by a drug-seeker?
...ever been swung at or kicked by a patient who used bath salts just 30 minutes earlier?
...ever treated a patient with a heart attack, a patient with severe COPD, a frightened college girl with an STD, and a family of four with cold symptoms--all at the same time?


...ever been covered in blood that wasn't yours?
...ever been covered in vomit that wasn't yours?
...ever been covered in diarrhea that wasn't yours?
...ever been covered in urine that wasn't yours?

...ever treated a rape victim?
...ever had beads of sweat on your forehead from performing CPR on a child? on a 50 y.o man?
...ever given an extra pillow and sandwich to a patient who doesn't thank you but rather complains that they don't like ham sandwiches?
...ever had to stand between a woman and man who are arguing over a pregnancy test?

...ever gone to a funeral of a person you only knew for two hours?
...ever held your urine three hours past the point of comfort?
...ever sobbed while holding a deceased SIDS baby in a rocking chair while the baby's mother held the living twin in another?
...ever missed every other holiday with your family to spend it with people who aren't?

...ever been handed a colored drawing by a child on chemotherapy who won't survive the year?
...ever eaten only three stale donuts in a day for your meals?
...ever been verbally abused or insulted by a patient who zooms in on your worst insecurities?
...ever seen a 6-month old being fed a bottle filled with Coke?

...ever fought a flood of emotions because your patient has the same eyes as your deceased mother?
...ever hold pressure on a pumping wrist artery of a patient who tried to kill himself?
...ever had to work four hours longer than expected, knowing your kids are at home needing dinner and help with their homework?
...ever felt isolated and alone because you can't express the words or release the tears in response to the daily pressures of your job?

Senator Walsh...have you ever been villianized and insulted by someone in the public eye who truly has no understanding of the pressures and heroics of your job and accuses you of spending most of your time "playing cards?"

Senator Walsh's answer, I would assume, to most of these questions above would be a resounding "NO."

The answer to most of these questions above, when asked to a majority of our country's great nurses, would be a resounding "YES!" And trust me, those few questions above don't even begin to explore and explain the depths of demands placed on our nursing staff.

Further, there is not one nurse--I repeat, not one nurse--in our country who will ever be able to answer "No" to the question of being insulted by someone in the public eye. I'm sure public insults have been issued before, but not in such an inflammatory and dismissive way as the manner in which Senator Walsh has chosen.

I find it pretty incredible to think that one's person's ignorant words and comments have fueled our great medical community to come together to support our nurses. I, for one, could not be happier for the outpouring of support, of love, and of appreciation that has been given to our nurses in light of Senator Walsh's words. I would not be able to stand here today as a competent and content physician had it not been for my "medical sisters" and "medical brothers," those nurses who have taught me, supported me, and stood by me through the very best and the very worst of what our jobs in the Emergency Department provide us.

To those of you affected by Senator Walsh's words, I salute you. For the lives of the patients you have saved, for the lives you have fought for, and for the lives you have influenced with your tremendous care and compassion, our medical community will always be appreciative and grateful. Please never forget that.

Heartfelt thanks...♥️

As always, big thanks for reading. Our nurses are some of the most amazing people I have, or will, ever meet. The demands of their jobs are relentless and unending. The outpouring of support for them has been well-deserved and long overdue. To work side-by-side with them has been my privilege...

To further understand the crisis involving today's medical climate, visit Defining Emergency.

Feel free to share and repost! Until next time...Jim

Friday, March 8, 2019

Wallowing In It

"Sometimes shit just happens."

Just a few days ago, I finished yet another string of four hectic shifts in the ER of our incredibly busy trauma center. After saying my goodbyes to my coworkers and transferring the care of my remaining patients to my partner, I left the building through our ambulance doors, avoiding the main pedestrian entranceway where the hectic waiting room sat. 

It was a safe choice to leave this way, as it was 3 a.m. and both the ER and the waiting room were still swarming with much activity. Had I tried to navigate leaving through all the chaos of the waiting room, I would have been a target of many evil and angry stares from those patients who continued to sit there with non-emergent complaints, watching the lone TV that was looped with repeating segments regarding diet and fitness. Of course, who wouldn't want to learn the benefits of eating cauliflower and doing fifty daily sit-ups at 3 a.m., right? And I certainly didn't want to finish my night by getting the angry stink-eye from an eight year-old girl waiting three hours for her rash to be treated.   

As the sliding glass doors of the ambulance entrance opened up, a blast of cold winter air greeted me, daring me to leave the warmth of the ER. Easy decision, of course. I stepped into the waiting night.

The pathway to my car was short, just a brisk walk on the sidewalk that leads to the parking garage. I traveled it quickly, arriving at the door in just minutes. Before grabbing the handle to open it, I glanced around at the illuminated surrounding landscape, appreciating the quiet and calm that accompanies this time of night.

I shouldn't have. 

While sweeping my appreciative eyes, I noticed that just across the street, among a row of small pines, was a lone figure. It appeared to be a man, wearing a ski jacket and cap. He appeared to be squatting down toward the ground. My initial thought was that maybe this was someone in distress who needed my help. Maybe he dropped his keys, even, and was looking for them. 

Twisting my torso to get a better look, I was able to better appreciate what I was looking at. Not only was this man squatting toward the ground, but his pants were down around his ankles. His bare ass, side profile, was in plain sight.  

"What the heck is he doing?" I wondered to myself, blaming my lack of sleep for my ignorance. 

Ugh. It took me a nanosecond to figure out the situation. This man was taking a shit. Right there, under the lights, in full view, among our hospital's lovely landscaping.

Of course, this scene caught me off-guard.

I wasn't able to turn away. I stood there, my hand ready to pull the door's handle, just staring. A million questions went through my head. Why there, instead of inside our waiting room bathroom? Do you have diarrhea? Are you sick? Do you have toilet paper? Is this going to leave a mess? Are you skillful enough to miss your pants and shoes? Are you homeless? Are you a CEO of a local company? Did you hope that no one would see you? Do you do this often? Are you afraid your ass is going to get frostbite? Are you going to pick up your mess with a baggie or leave it? Did you eat corn lately? 

Finally, after a few seconds, I opened the door, got into my SUV, and drove me and my wild imagination home.

I loved the unexpectedness of this, of being caught off-guard, and couldn't help but chuckle to myself. After all, those of us who work in the ER, for the most part, have warped senses of humor. If I didn't laugh about a drunk patient vomiting on me or a patient having an accident during a rectal exam, I would never have survived my job for the past 22 years. And because we encounter body fluids every shift, whether it be blood or urine or pus or spit or vomit or phlegm or stool, nothing about this guy fertilizing those little spruce trees grossed me out. 

Let me take a moment here to send a big thank you to the inventors of shoe covers, gloves, face shields and body gowns. 

Of course, I should have predicted something like this scene would have happened after I left my shift. You see, right before leaving, a small group of us had a conversation about how much shit we had seen during our recent shifts. Literally, shit. So clearly, I had jinxed myself.

You want some recent examples about this dilemma? Okay, then...

I had a recent homeless patient, otherwise healthy and capable, who shit himself in his bed without any warning to our staff.  "Why did you do this?" the nurse asked him. "Because I didn't want to get up and go to the bathroom," he answered. Our wonderful team of aides cleaned him up, got him fresh clothing, fed him, and ultimately we were able to place him into one of our homeless shelters. A taxi was called and picked up this patient to take him. In ten minutes, though, the taxi returned, dropping this patient back off at our entrance. The reason? This patient decided to take another dump and urinate in the backseat of the taxi. "Why did you do this?" he was asked again. "Because I didn't want to wait." The upset taxi driver, of course, made it very clear that our hospital would be footing the bill to have his cab cleaned out. Sounds fair.

Also during my past shifts, two younger patients came to our ER to torment us and have their bowel movements in our ER cots. The first, a female college junior, got so drunk that she needed to be brought to us for IV fluids and monitoring. Within an hour of her arrival, an obnoxious but familiar smell began to fill up the corner hallway near her room. Yes, she had shit herself. It's amazing how some alcohol can totally absolve one from such vulgar activities. Then, to add insult to injury, after being cleaned up, she decided to show us who's the boss and she shit herself again.

The second patient, a man in his early thirties, came to us after using methadone. He, like the college student, also was stable but needed monitoring and some treatment. And he, like the college student, also decided to relieve himself during his dream state. Not long after he arrived to us, his nurse was asking for help to roll this patient and change him into some clean clothes. No, she was not wearing a smile while asking.

When patients come to us, a part of our job is to preserve their belongings while they are in gowns and being treated. Usually, these belongings are put in a clear plastic bag, with a drawstring, and kept with the patient until their disposition to either be admitted or discharged. The question was brought up--should we take these messy belongings (i.e., their stained pants and underwear) and keep them safe or do we throw them out? If we keep them safe, should we place their cell phone and wallet and keys at the bottom of the bag and then put their dirty clothes in, so that they have to wade through the muck (just like our team did during clean-up) to get them? Your thoughts?

Of course, it goes without saying that there are patients who are completely forgiven for their accidents. We are all human and each of us will have (if you haven't already) an accident along our life journey. Especially, elderly patients deserve and receive compassion and understanding when this occurs. Some of these wonderful patients are embarrassed and humbled and regretful when this happens, and my heart melts for them. Patients with a wicked case of food poisoning or stomach flu also deserve a break. The list of forgiving reasons is short, but it does exist.

Case in-point. Recently, I treated an ill but gracious female patient who came to our ER with her husband. She had a fever and a wicked case of nausea and vomiting with diarrhea. After multiple bouts of diarrhea at home, they came to us by private vehicle. Along the way, this patient had more diarrheal and vomiting accidents in their car. Everything she was wearing was soiled. Arriving to our facility, she had to walk through our security station (yes, they swept her for weapons with a wand) and our waiting room before being brought back to her room. Talk about a walk of shame! In her room, she had yet another accident. We all felt bad for her. Seriously.  

Arriving home and pulling into my driveway, my mind went from all these thoughts back to my squatting friend. Catching him in his private moment dominated my thoughts for my twenty minute ride home and took my mind in the directions above. I wondered if someday I would ever be caught squatting outside, pants down around my ankles, grunting and doing my business with reckless abandon. If so, would I have an extra Kleenex in my pocket? Would I be smiling a devilish smile while doing it? Would I do it during the day or wait until nighttime? Would someone spot me the way I spotted this fellow? If so, with my luck, it would be a newspaper reporter holding a camera.

I'm hopeful I won't ever be in this position but one never knows for sure. I'm sure this guy didn't plan on having a witness. Maybe one day, I wondered, I might be a patient in the ER having an accident. This would be a more likely scenario. If so, it will probably happen when I am elderly and obsessed with my bowel movements and the amount of daily fiber I am intaking. Or maybe I will just be an angry old man who needs to show the ER staff who's boss. 

I doubt, though, that it will happen due to me being intoxicated or high on methadone. 

After all, I don't have time for that shit.

As always, big thanks for reading. Feel free to share this essay and your thoughts.
Enjoy the day!
Jim 
           

Friday, March 1, 2019

Fleece Pajama Bottoms 2019

People will stare. Make it worth their while. 

Can someone please tell me the exact moment when fleece pajama bottoms became the fashion sensibility of America?

I can't pinpoint the moment exactly, but several years ago I began to notice that many of our ER patients were presenting for treatment wearing nice fluffy fleece bottoms. Men. Women. Old. Young. These fleece bottoms seemed to be enjoyed by a variety of the population. Most of these earlier bottoms for the younger patients were of superheroes and childhood figures, like kitties and ponies. For the older patients, it seemed like the characters from the adult-cartoons The Simpsons and The Family Guy were a big hit.

Being a new sort of fashion, I enjoyed the earlier era of these pajama bottoms. They seemed to be appropriate wear for some of our sicker patients who didn't have the energy to change out of their bed wear before coming to us for medical help. Especially the kids, who often had matching fleece blankets, I enjoyed the style of these pajamas and the apparent comfort they seemed to provide.

In no time, though, it seemed like these pajama bottoms began to be worn not only by the patient, but by family members. Little Sally, who was brought to our ER by her parents for vomiting and diarrhea, was not the only family member wearing cartoon pajama bottoms. So were Mom, Dad, and her older brother. "Little Pony is my favorite!" she exclaimed to me. I wonder if it was Mom's favorite, too, since she bore matching bottoms. It all made some sense, though. It was 10 pm and everybody was probably either getting ready for bed or in bed when the decision to bring Sally in was made.

I should have gotten more suspect of this trend, though, when over the next few weeks to months, more and more people began showing up wearing fleece pajama bottoms. Even moreso, they were being worn sometimes not by the patients, but rather by their supportive family and friends. There sat Larry in his hospital bed, with chest pain and difficulty breathing, being supported at bedside by his adult son and daughter as well as his grandson. The grandson, of course, looked handsome in his wind pants and sweatshirt. His children, however, looked less put-together--his son wearing Steeler fleece PJ bottoms while his daughter's were plastered with Lisa Simpson's face.

At 2 pm. On a weekday. In the summer. With abundant sunshine outside.

Of course, Larry was lucky to feel the love of his family at bedside, regardless of their attire. The bigger picture wasn't lost on me. Yet, it was interesting to see the fashion pendulum swinging into an area where fleece bottoms were becoming acceptable wear at all hours and in all weather.

Although I initially thought so, I can't say that this trend is related to economics. Recently, at Walmart, we discovered a whole array of very cool, bright patterned fleece pajama bottoms. Cartoon characters, Marvel superheroes, sporting team emblems, camouflage, even imitation Burberry plaids--the selection was impressive. And the cost? $11.96 for the cheapest bottoms. And the rack next to them? Sweat pants for $6.00.  

Goodbye yoga pants, khakis, jeans, and sweatpants. Fleece pajama bottoms might be here to stay. I never thought the day would come when I would rather see an old ratty pair of sweatpants on someone instead of SpongeBob fleece PJ bottoms.

Over the last few years, then, it has become common practice in our ER to treat people of all ages, from all walks of life, in all weather, in all type of medical emergency scenarios, wearing these bottoms as a staple to their outfit. It seems like Stewie Griffin's big bald baby head on PJ bottoms can go with a nice pair of boots and a cable-knit, turtleneck sweater on a middle-aged woman. SpongeBob bottoms go great with a Dallas Cowboy t-shirt and a John Deere ball cap on a college kid. And Hello Kitty--well, Hello Kitty can pretty much write her own ticket to all the various outfits she ties together. She even purrs when paired with a half shirt that says "Who needs brains when you have these." Yes, I am being serious.

Not only were these PJ bottoms being worn by patients and their families in our ER, but it seems that these fleece PJs are now a staple in public as well. Recently, I was in line at a local market during midday. Fourth in line at the check-out. And as I was assessing how long my wait would be, it suddenly struck me that the three people checking out in front of me were all in fleece pajama bottoms. The person in front of me, unfortunately, smelled and looked like he had just rolled out of bed. His hair was matted and greasy; his body smelled of yesterday's stale fart. It seemed as if his lack of effort to shower and be presentable in public was excused by wearing his Batman PJs in public. Being an eternal optimist, I was hopeful he was just delaying his shower until after he got his filet mignon cooking on the grill when he got home.

Standing behind those three, at that moment, I had a moment of serious introspection. I felt like the odd-man-out. I looked down at my clothes. A white t-shirt. Hudson jeans. Brown boots. Nike ball cap. Should I succumb and become a slave to fashion? Maybe, I wondered, a pair of My Little Pony bottoms, adult size medium, would make me feel more at peace with myself.

After sharing this story with my co-workers, they assured me that the marketplace and our emergency department are not the only privileged destinations of fleece bottoms these days. Kids are wearing these fleece PJ bottoms to school. All ages are wearing them to sporting events. To club activities. To parties. To movies. To family functions. It seems that there is no place immune to the progressive fashions of fleece PJ bottoms.

Oh wait! I don't recall any PJ bottoms on the red carpet while watching the highlights of the recent Oscars. Did I miss something? Maybe Glenn Close should have skipped her designer gown for a pair of Wonder Woman fleece bottoms. With Christian Louboutin heels, of course.  

How do you all feel about this new trend? Have you witnessed similar encounters? If you work in a medical office or in the hospital, how rampant do you think this trend is becoming? Where else have you seen this trend pushing the limits? Most importantly, have you worn your PJ bottoms out in public yourself? Be honest!

I have seen people do double takes to get a second glance at some of the people wearing the newest PJ fashions. When the PJs are clean, they don't look so bad. When they look like they haven't been washed in two weeks, well...second glance deserved. And when they stink like they haven't been washed in two weeks, a wrinkle of the nose is just as well-deserved.

I can only imagine what our grandparents would say about this fashion trend, what with the strict dress code they had when they were growing up (some even in desperate times). "Heck," I heard an elder physician at work exclaim recently when complaining about this trend, "if I ever went out in public like that, I wouldn't have ever seen the light of day again. What has happened to people?"

I guess at this point most of us are immune to the trend. Accepting of it. I do appreciate some of the eye-catching outfits that involve these PJ bottoms. Some of the designs and patterns are hip. And I appreciate the surprise factor of people wearing them, still. Of their courage, or maybe it's their apathy, of wearing them in public and incorporating them into their everyday wear. And let's be honest, it's kind of cool to see the same design being worn by an infant, her mother, and her grandmother at the same time.

Well, as long as they aren't related to me...

As I said before, and I'll say it again, I love my job and my patients. For so many reasons. After all, where else would I get to meet an attractive, sophisticated, gray-haired elderly woman wearing a trim blouse with concise lipstick and well-placed rouge...and fleece pajama bottoms with marijuana leaves patterned on them.

"I just love my hibiscus plants," she explained.

Enough said...

As always, big thanks for reading. Feel free to repost the essay and share your thoughts.
This cheeky post was written after a long stretch of rough shifts.
Enjoy the day! 
More to come...