Friday, August 7, 2020

Where To Look

"Where words are restrained, the eyes often talk a great deal."

I walked into Room 30 to find two eager sets of eyes awaiting me. One set belonged to a young man, late-twenties, muscular and imposing, sitting in a chair in the corner of the room. His eyes were hazel brown, big and inviting, relieved at seeing my entry into their sheltered world. The other set of eyes, darker brown and magnified by her gold-stemmed glasses, belonged to my patient, a woman in her early-sixties. She sat  upright in her treatment cot, knees drawn up to her chest and covered by the thin hospital-issued bed sheet.

Clearly, I had interrupted a conversation between them. Upon my entrance into their treatment room, they gave me the respect and gift of silence, a pause in which I would be able to introduce myself. As many of my fellow coworkers would confirm, this does not often happen. Rather, it is not unusual for us providers to walk into a treatment room only to wait for a patient to finish a cell phone conversation (while holding up an index finger indicating they are almost done), finish the last gulp of a bottle of soda or swallow the crumbled remains of a bag of chips. Worse yet, a patient sometimes will keep on talking to someone else in the room and behave as if we haven't even entered.

I liked this woman and man already.

Extending my hand, I introduced myself first to my patient, Ms. Loretta. "Hello, ma'am, my name is Dr. Jim and I will be taking care of you today." Turning to the man sitting in the corner of the room, I repeated myself. They were both gracious in their return greetings and I learned that the young man was her son, John.

Ms. Lorettta appeared calm, composed, and quiet as she sat in her cot. She was of short stature and delicate frame. She looked tired, her graying hair wiry and thin and a few days beyond its last washing. Her face was wrinkled. Her eyes, broody and intent, watched me closely as I leaned against the wall and asked her question after question regarding her reasons to visit our emergency department. Occasionally, she looked towards her son to supplement her answer, to clarify something she couldn't quite find the right words to describe. Each time her son was successful in filling in the blanks.

She had come to our department with several weeks of increasing abdominal pain. A diagnosis of kidney (renal) cancer several years earlier had led this patient to having several bouts of chemotherapy and the subsequent great news of achieving remission. Her complacent face, after learning her history, spoke to me--the more she shared her new symptoms with me, the more I realized that she had an inherent sense that something bad was happening in her abdomen again.

I did, too.

Her son, sitting in the corner quietly unless spoken to, appeared much more anxious than his mother. Whereas she seemed resigned to some bad news arriving in her near future, he seemed to be using his energy to avoid any possible realizations of something bad occurring. His intimidating square face, thick neck, and inflated muscles--all those hours spent at the gym to make him stronger--would be of no use to his mother in what the fates might dictate to her. He fidgeted with his hands and feet. He occasionally diverted his gaze from his mother and I to the corners of the room. He seemed to want to rewind the hands of time to a few weeks prior when his mother was symptom-free of any pain and he could keep looking to a pollyanna future with his mother being an integral part of it.

Her physical exam was concerning for the abdominal pain she complained of. She had some distension which gave her belly the appearance of holding a helium balloon within it. Her pain was diffuse, all over, and I could make her right upper quadrant be the main source of this pain when I palpated a steady pressure downward toward her liver.

We did the workup--blood and urine testing with IV-contrast CT imaging of her abdomen. Sadly, the CT scan returned showing what the patient and I had feared--the cancer was back. She had multiple metastatic lesions in her liver and the collection of some ascites, fluid build up around the organs within the abdomen.

Sigh.

I walked into Room 30 with a heavy heart. Not only did I feel for this patient and her son, but I closely identified with the heartbreak associated with the news I was about to deliver to them. It was just fourteen short years ago that I had been sitting in a corner chair of a hospital room with my mother as the patient. She had been battling leukemia and, after coming out of remission, had a battery of tests that had led to the moment when her oncologist walked into her hospital room to share the devastating news with her and me--her leukemia was more spiteful than ever and was remaining refractory to all of our attempts to fight it. I remembered the pain I felt. I remembered the complacency of my mother upon hearing the news. She had inherently known and sensed this would be her outcome. I remembered the wishing and hoping that my father and six siblings (who all rotated their visits due to living several hours away) had been with us at that very moment to divide the pain of my mother's news.

Who am I fooling? The pain of such devastating news as this isn't divided among us--the pain multiplies. Then multiplies again. And keeps exponentially growing until we all learn the appropriate ways to diminish the power it holds over us.

Entering the room, then, I wasn't surprised to see Ms. Loretta sitting quietly in her cot with John now sitting at her feet, holding her hands within his massive mitts.

Without my saying a word, Ms. Loretta knew. "It's back, isn't it." It was more of a statement rather than a question. I nodded to her. "Yes," I said, "it's back."

She asked me questions about her tests. How was her blood work? How bad was the CT scan? Did she have much time? Did she have options? John remained quiet, his eyes focused only upon his mother.

I kept answering her questions to the best of my abilities, but refused to answer the "how much time do I have" question. I assured her that we would admit her to the hospital and get the oncology specialists involved immediately to provide some guidance to the questions she was asking.

All the while, as Ms. Loretta and I were talking, I couldn't help but steal glances at her son. He was me. Fourteen years ago. Sitting with his mother. Holding her hands. Processing bad news. Staring at his hero and wishing with all of his heart that he could absorb her hurt.

He sat quietly, his anxious movements calmed with the news that he was desperately hoping to avoid. He continued to grip his mother's hands in his. His eyes remained fixed onto his mother's face. I knew exactly what he was doing--he was etching her image, her heartbreak, her attempts to be strong at this very moment, into a memory that would remain with him until the end of his days.

Eyes watching eyes watching eyes. Her expectant eyes on me. My sympathetic eyes glancing between her and him. His loving eyes on her.

Sometimes, our eyes are rewarded with the beautiful imagery they seek. Sometimes our eyes are the recorders of specific moments of our lives that we may or may not wish to remember, memories of splendor and memories of squalor. Sometimes our eyes are the conduit of the emotions of our heart and soul. Sometimes our eyes are our best friends. And sometimes our eyes are our worst enemies...

As Henry David Thoreau said, "Could a greater miracle take place than for us to look through each other's eyes for an instant?"

In this moment with Ms. Loretta and John, I appreciated the miracle of my memory from fourteen years ago simply by looking through their eyes for but an instant. An instant that I wish I could have protected them from.

Thank you, Ms. Loretta and John, for this instant...for letting me be present in your moment of painful tenderness.

Wednesday, July 22, 2020

A Love Story

The little things?
The little moments?
They aren't little...

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

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

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

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

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

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

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

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

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

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

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

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

An elderly father and his grown son.

Thanks for reading! With all of the internal restlessness and societal worries each of us are facing daily, please don't let all of life's little beautiful moments pass you by...be well and stay safe. Jim

Friday, July 17, 2020

The Witness

A picture is worth a thousand words...

The patient arrived in cardiac arrest. He had been brought to our emergency department in the middle of the night. Although he had a significant cardiac history, including bypass surgery, he was only in his late-forties. His transport from his house to our department had been less than ten minutes and the pre-hospital team had done an excellent job of intubating this patient and establishing an IV to begin resuscitation efforts.

His wife was with him. Less than fifteen short minutes before their arrival, her life had been altered forever when her husband had woken her from her deep sleep to complain that he had intense chest pain. Mere seconds later, she witnessed him pass out and become completely unresponsive.

On arrival to our ER, we found this patient to be in pulseless ventricular tachycardia--a malignant, life-threatening electrical rhythm of the heart. Following ACLS protocol, we hurriedly shocked this patient several times, performed CPR and administered multiple doses of medications to combat this rhythm.

After several very intense minutes, we were briefly able to regain a rhythm and a pulse on this patient. Despite this, he remained unresponsive and his blood pressure was minimal. We continued our efforts to stabilize this patient as we awaited cardiology's arrival.

Despite our aggressive medications and interventions, this patient returned to a pulseless ventricular tachycardia. His heart was damaged and seemed unsalvagable. More shocks followed. More medications were given. And, once again, we were able to break the bad rhythm. Like before, unfortunately, the malignant rhythms returned in just seconds.

Cardiology arrived and together we continued to fight for this man's life. His rhythms were very fragile and eventually they transitioned from pulseless ventricular tachycardia into asystole (a flat-line, so to speak). Asystole is bad, very bad, and is rarely survivable.

We were running out of options. If we were going to be able to intervene any further, we needed this patient to regain a stable rhythm. Getting him into a sinus rhythm had been hard enough initially, but now it was becoming hopeless. His heart, from previous infarctions and damage, was resistant and stubborn to our best efforts.

As the cardiologist and our ER team continued with resuscitation efforts, I went to the family room to speak to this patient's wife. She was obviously upset, and I explained her husband's dire situation. Our reality was that time was not our friend. The longer he continued in asystole and ventricular tachycardia, the less chance of his survival. She understood my words. "I always knew it would end this way," she said, her honest words reflecting her inherent sense of the situation.

Her husband's heart was damaged. Her heart was breaking.

I invited her back to be with her husband, to witness the momentous efforts we were all giving him. She wholeheartedly agreed, embracing my invitation. Although I could describe to her our efforts, I wanted her to see for herself the incredible attempts of resuscitation being provided.

A picture is worth a thousand words, as they say.

Returning to the oversized room, filled with people and shiny medical equipment, I looked at the resuscitation through her eyes. Three nurses, each scurrying with a focused determination, documenting our efforts and pushing IV medications. Two techs, one actively performing CPR while the other was readjusting the patient's blood pressure cuff. Two respiratory therapists, standing at the head of the bed, one using an oxygenated bag to ventilate this patient via his airway tube while the other prepared a mechanical ventilator, ready to be used in the event of our resuscitation succeeding. The cardiologist, standing at the patient's open side, dictating the next course of medications while I was away. The pharmacist, standing with the crash cart outside of the patient's door, repeatedly handing in the next dose of ordered medication. The case manager. My resident physician. The patient's wife. Me.

And the patient. Lying on the hospital cot. Unresponsive. In asystole. Again.

I guided her to his side, where she grabbed his hand and whispered in his ear.

Despite this many people in our big resuscitation room, the air seemed open, the frantic energy palpable. The team moved purposefully and in sync. Their caring, their vigor, their sadness, their intensity was obvious, witnessed by this patient's wife.

Unfortunately, our patient's heart became refractory to all of our best efforts and our medications no longer had any effect. I had the tech hold CPR and we confirmed asystole on several cardiac monitor leads. The portable ultrasound was brought to this patient's bedside. It confirmed our worst fears, that his heart had no squeeze, no motion, no life. His wife saw the stillness of his heart on our black-and-white screen.

Forty or so minutes had passed since the patient arrived and, as I had explained to the wife in the family room, time was not our friend. We had no other options of treatment to save this patient, her husband.

"Please, stop," the wife said. "Please, just let him go in peace."

It was a powerful moment.

With no objections, we ceased resuscitation efforts. Time of death was proclaimed. I thanked my team. I crossed myself. I conveyed my sympathies to the wife. The crowd of people slowly withdrew from the room. The lights were dimmed. The patient was covered in nice, clean blankets. The patient's wife was brought a chair, along bedside, where she sat, continuing to hold her husband's lifeless hand within her trembling own. A box of Kleenex somehow found her lap.

The family doctor was called. The coroner was notified. I dictated my note.

All methodical parts of my job. When I was done dictating, I went back into the room. As I expected, his wife was still there. I wanted to sit with her in quiet for a few moments.

"I'm so sorry for your loss," I whispered.

She nodded. "I know you tried your best." She paused, taking a deep breath, before continuing. "Thank you for letting me be with him in the end. Everybody fought so hard. I just...needed to be here."

After several minutes, I walked back out of the room, thinking about how much medicine has changed since I first finished residency in Syracuse. Not only with newer drugs and newer procedures, but it has changed with newer thinking. A few short years prior to this patient's arrest, it would have been unthinkable to invite a family member to bear witness to resuscitation efforts. Now, though, I try to offer this option to a family member if the situation allows. Much literature has evolved, strongly in favor of presenting this as an option. Clearly, this wife was empowered, her view clarified, by choosing to be with her husband at the end. It was necessary for her closure, to witness our heroic attempts.

I am glad she had this opportunity.

What would you do in a similar situation? Would you go to the bedside of your loved one and witness firsthand the resuscitation efforts? Or just wait patiently in the family room for updates?

Me? I'm not so sure what choice I would make. The thought of this choice carries much heaviness to it. I probably would. I have to wonder if my indecision or hesitation is, in part, from doing this job for a living or just my inherent spiritual make-up. Obviously, witnessing such a loss and life-altering event may not be for everyone. For those that are offered this option and choose to go to their loved one's bedside, I hope it is a healing and comforting.

Let's just hope that we never have to make this decision.

As always, big thanks for reading. This essay is an updated version first posted in 2010 and it rings just as true today as it did then. Be safe. Jim

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