Extra Cream And Crescent Moons

I just realized that I have passed my one-year anniversary for my blog, StorytellerDoc. It has been an amazing ride, thus far, and I am grateful for all the amazing positives and new friends that have come my way with this endeavor. Thank you... Now, for a post that drifts way off my beaten path.

I pride myself on working hard to stay in good physical shape and maintaining a healthy lifestyle. This, despite my love of scoop Fritos and Nibble With Gibbles potato chips. I come from good genetic stock, however, which makes "fighting the fight' a bit easier. Regardless, though, my frequent trips to my fitness club are a mental necessity with physical benefits that I've grown to rely on in keeping some sanity with my often stressful job.

I've been at the same club for thirteen years. And in those thirteen years, I have seen many new faces and also continue to see many familiar faces. On days when I don't really want to be there, it is nice to see that familiar face pushing themselves at one of the weight stations. Especially when that face is worn by an 80 year-old woman who is kicking ass at the leg abductor machine. Or the middle-aged guy who just finished doing twenty pull-ups.

Some of those faces, both new and old, I have also seen in the ER as patients. For that reason, I often wear a baseball cap pulled down quite low, just edging my eyebrows. Believe it or not, I was more embarrassed to run into the college girl who I recently treated for PID than she was. At least I know not to follow her on the machines she just sat at. Even more necessary, I plug my Koss earplugs into my mp3 player and crank some great, energetic music. That way, if a former patient wants to talk to me about their thrombosed hemorrhoids or that nasty fungal infection that just won't go away, I can feign not hearing them. "What's that, sir?" or "Did you say something, maam?" I may have been guilty in saying that once or twice during a workout.

A few years back, my gym started a program, I think it's called "Silver Sneakers," which gives elderly people a membership discount, encouraging them to work out. This is all good and fine. In fact, I look at some of these remarkable people and am truly inspired by their effort and commitment. However, I like to work out at the same time (mid morning to early afternoon) as the Silver Sneakers folks do, which at times has begun to frustrate me.

Let me reiterate here that I truly am impressed by most of these folks. I can only hope to be in my 70s and 80s and push myself the way some of these people do in the club. But, darn it anyway, some of them are causing me to think about joining another gym. And I'm a creature of habit. After thirteen years, I don't want to join another facility. But here's why--and if any of my following supportive arguments upset you, I apologize for it beforehand.

Several months back, I began to notice that sometimes walking into the men's locker room, before starting my workout, held a dangerous risk. The entrance to it has a C-curve, which prevents those out in the gym area from getting a direct view. Unfortunately, upon walking in, I have been greeted one too many times now by the naked old guy, just finishing from his shower, standing in front of his locker, bent over, drying his toes. And more drying. And still, more drying. I didn't know that drying your toes (did I mention naked?) can be a ten-minute ordeal. But for some, I guess it can be a meticulous process.

So, just go along with me here. Are you picturing the guy? Because, while he is drying his toes, his weighty scrotum with its ten-pound hernia is swinging back and forth, welcoming all who enter the locker room to have a great workout. Trust me, it's hard to be inspired to work out after that. Really, if that is what I have to look forward to in another thirty years, I may just pack it in now.

I have also witnessed many men clipping their toenails (some while sitting naked on a stool). So sometimes, either standing in front of my locker or trying to walk through to get to my locker, I haphazardly step on little slivers and shreds of discarded nails and cuticles. What the hell is this? I actually have a buddy who left the gym because of this. Me? I am made of stronger stock, I guess, than my buddy. I still feel the need to complain about it, though.

Anyone need any talcum powder? Cologne? There is plenty of that after a shower, too. Unfortunately, though, it's not mine. Nothing, and I mean nothing, freshens me up better before a workout than to walk through the obnoxious cloud of baby powder and cheap cologne. I have actually worked out before and thought to myself, "What is that stink?," only to realize that the stink was me. And I don't even wear Stetson cologne!

Just a few months back, I walked into the locker room to be welcomed by another naked man, bent over, drying his toes, with his pendulous scrotum wishing me a "good morning." All well and good now, since I am becoming immune to such greetings. But this guy, at least 80, had something I haven't seen before on the Silver Sneakers folks. Because of the club's free tanning promotion, this guy had an all-over tan--all over except for two very pale half-moons at the inferior creases of his buttocks. In laymen terms, he had two curvy spots of non-tanned skin from where his ample ass doubled-over while he was laying in the tanning bed. If I only knew his name, I would probably tell his family on him.

We interrupt this post to bring you a joke. Someone, please turn on my microphone (tap, tap--okay, it's working). Imagine me talking to this guy's grandkids. "Hey kids," I could say, "what is one-half moon plus one-half moon?" The kids would yell out their answer, "One!" "Nope," I would answer, pausing to build their anticipation before answering, "one-half moon plus one-half moon doesn't equal one, sillies, it equals your grampa's ass!" Well, maybe they would be right--grampa was showing me his full moon.

If that wasn't bad enough, last week when I walked into the locker room, there was actually a naked gentleman with his left leg drawn up onto his stool, actively squeezing hemorrhoid cream in his buttock's crack. I kid you not! At least I think it was hemorrhoid cream. I was horrified, hurrying past him before he could ask me to help him out or, better yet, accidentally spray some cream in my eye as I walked by. What's next, the public insertion of a suppository?

Although I view being observant and cognizant of my surroundings one of my best strengths, especially in the ER, I am learning that I may just need to put on some blinders the next time I pull into my gym parking lot. That way, I won't notice any more of the following:

The woman in spandex walking around the track with a saggy, incontinent bottom.
The crescent sweat stain on the seat of the weight machine from the person before me.
The gentleman who's comb-over is not combed-over while he does the bench press.
The fashion trend of wearing two different socks with your walking Reeboks.
The extremely curly hair that is on the water fountain push button.
The inadvertent forgetfulness of putting on a bra before working out.

Should I go on? Trust me, there is a lot more. Or do you get the idea?

Regardless, I am extremely proud of all of my fellow gym-mates. After all, despite any of my misgivings, they are there, at the gym, giving it their best in maintaining good health. Good for them, I say. And because of this, I have never once gone to the front desk and complained. Nor would I. If I did, I wouldn't have anymore of those special "Good morning!" greetings upon walking into the locker room. I just need to get over a few small issues, I suppose.

On second thought, if you'll excuse me, I'm going to go fill out my membership form for Curves.

See what so many years in the ER has done to my sense of humor? As always, big thanks for reading! Please come back... I hope this finds you well and wishing you a good week. Jim

The Pit Stop

I walked up to the closed door and paused , exhaling a deep breath weighted with disappointment, trying to clear my thoughts for the conversation about to come. My clenched fist was briefly suspended, mid-air, ready to knock. Beyond the door, I could hear muffled conversation and movement.

A calm, pretty woman stood beside me. An emergency department case manager. She held a notebook and pen, ready to jot down any useful information that might be shared with us by the room's occupants.

I turned to the case manager. "Are you ready, Cindy?" I asked, making sure she was prepared for the gravity of this unfortunate situation. She nodded "yes," confident in her skills during such adversity.

I turned back to face the beige, chipped door of the family room and knocked lightly. The noises of conversation and movement suddenly ceased, and I could easily imagine the stillness and anticipation that pervaded the room.

I rotated the door handle, gently pushing the door forward before stepping into the room. The air and energy of the room were stale and suffocating, especially after leaving the hallway atmosphere of chaos. My eyes darted quickly, taking in the whole of the room. On the couch, two elderly people, a man and a woman, sat on either side of a middle-aged woman, their hands linked in unity. The two corner chairs were filled with a middle-aged man in one, a college-aged boy in the other. All five people focused intensely on our arrival, their dilated eyes wary for the news I was about to bring them.

Before sharing my news, I briefly introduced both myself and Cindy and learned that this room contained the patient's wife, his in-laws, his brother, and his son. After shaking hands, I deliberately continued to hold on to the wife's hand while her father rubbed her back.

"It's not good, is it?" the wife asked me. I shook my head "no" to her question before saying the word out loud. "No," I reiterated, "it's not good. Despite all of our attempts, we can't seem to get your husband's heart beating again."

I had left Room 17 for the family room with a dismal feeling. The woman's husband, in his late 50's, had collapsed at work and, despite being intubated, having immediate CPR and being given all the appropriate life-saving medications by our prehospital team, still had not responded to any medical interventions. He had arrived at our facility ten minutes earlier, thirty minutes after his collapse. After several attempts of high-Joule defibrillations and multiple escalating doses of medications, our team remained unsuccessful in our resuscitation attempts. I had left his room with the patient in asystole, a malignant situation where the heart was not making any electrical signals to stimulate itself to beat. It was not looking good.

For the next several minutes, I explained to the family, with earnest, what our medical team was doing in attempts to resuscitate their loved one. After I finished, the wife stood from the couch and dropped to her knees, half in prayer and half in disbelief. "Please, Gary," she wailed in a desperate voice, "don't leave me yet. I want to talk to you one last time."

After helping her back to her feet, I offered her to come to Gary's room with me to be with him during our resuscitation efforts. She accepted.

The patient's wife, Cindy and I walked back to Room 17. As we neared it, I explained the focused commotion she would witness when we walked into the room--three nurses, several techs, a senior resident physician, a pharmacist, a respiratory therapist, and several others all scurrying in their efforts to help her husband, who would be lying on his cot in the middle of all of this activity.

I pulled back the curtain to the room and walked in, surprised to see that CPR was not currently in progress. I introduced Gary's wife to the team and guided her to Gary's side before seeking out my chief resident as to what transpired in the last few minutes. It seemed that right before we had entered the room, Gary 's heart rhythm had switched from asystole to ventricular tachycardia, another life-threatening rhythm. However, this rhythm responded to our team's electrical shock and Gary, still unresponsive, now had a faint pulse accompanied by a normal sinus rhythm. After being down for forty plus minutes, this was nothing short of a miracle. A well-timed miracle corresponding to his wife, on her knees in the family room, pleading with him to hold on.

We encouraged her to talk as much as she wanted to her husband.

And so she did. With tears brimming her reddened eyes, she remained near her husband's left ear, continuously whispering her hushed encouragements and pleas while stroking his hair. Soon after, her son and the patient's brother also were escorted in to be with the patient. Their expressions of disbelief as they walked into the room were heart-breaking.

We called the cardiology team who, after arriving at this patient's bedside in minutes, prepared to take him to the cath lab. Unfortunately, his outlook was tenuous. I was skeptical, after 45 minutes of resuscitation, if Gary would have a positive outcome. Even if he survived, there was no predicting how mentally capable he would be after such a long time in cardiac arrest. If not to survive, why else would he be hanging on?

Suddenly, I thought back to Gary's wife dropping to her knees, begging for a last chance to talk with her husband. I thought of Gary and how, out-of-the-blue, he suddenly regained a faint pulse after multiple failed previous aggressive attempts to jump-start his heart. I looked at his wife, his brother and his son currently holding Gary's hands and whispering their loving words into his ear.

Was this the reason?

I was searching for some sense in this nonsensical situation. Possibly, I realized, I might have been over-analyzing the whole situation, trying to understand how Gary could possibly still be alive. Quite frankly, though, after 45 minutes without a pulse, Gary should not have been successfully resuscitated. Was the whole reason of Gary's lingering due to something beyond our control--the fates cooperating to let his wife and family have several more minutes with him? For proper goodbyes? Or was it because his body really was responding to all of our heroic measures and would heal itself with our modern interventions?

I was eager to know how our efforts would be interpreted by fate. Watching Gary being wheeled down the hallway, from Room 17 to the cardiac cath lab, with his family by his side, I was hopeful that there might be just a sliver of a chance at his full recovery. If not, though, just seeing his family have the opportunity to be with him, to speak to him, to accompany him so he wouldn't be alone during his passage, was enough of an explanation for me.

I got my answer when I returned for my scheduled shift the next day.

Although Gary had still been alive at the end of my previous shift, he never regained consciousness. Per Cindy, he peacefully passed soon after, in the evening, surrounded by his loving family.

He had hung on for all the right reasons...

As always, big thanks for reading. I wish much peace for Gary's family. I also hope this finds you all well. See you again later this week...

The Willing Caregiver

I imagine the world as a vast, boundless frontier weathered by our swirling human emotions and complicated energies--hurricanes of intense heartbreak and tornadoes of joyous, unbridled celebrations, with every weather pattern in between. Sunshine and rain included.

If I could gather this world, foolishly believing that I could sweep my arms and hands through the unsuspecting air to collect a smaller, more-contained version of reality, I know with absolute sureness that what I would be left with is a typical day's worth of experiences in the emergency department. It is a microcosm of something similar to big life.

So many patients, so many illnesses, so many human interactions. So many words of comfort. So many experiences bombarding us daily. And try as we might to protect ourselves, building brick-by-brick our fortress of emotional barriers, ultimately, we cannot help but let some of our patients weave their very own threads into our personal life blankets.

I walked into Room 20 to treat my next patient, a woman in her mid-seventies. Because of a life-long battle with diabetes and its resulting circulatory problems, she was now permanently wheelchair-bound. She sat upright in her cot, in a hospital gown, without any blankets covering her. At the base of her right thigh, poking out from her gown, was a puckered-up cork of skin, where her leg had healed from an above-knee amputation. On her left-side, her leg extended just slightly lower, below knee-level, where, again, the rest of her leg had been amputated secondary to gangrene several years prior.

She was petite and frail. Despite a high fever and feeling ill, she sported a recently washed-and-set hairdo. She also wore some light makeup and dark lipstick, appearing well-cared for. The smell of her room, however, suggested otherwise--it permeated with the familiar stench of a Depend diaper that was overdue to be changed, most likely saturated with stale urine.

In her room's corner, sitting quietly and patiently, was her only child. A son, probably in his late-forties to early-fifties. He appeared fidgety at times, but was very attentive to both myself and his mother. He was, as it turned out, his mother's only living relative.

And her primary caregiver.

"Hello," I said to both of them, extending my hand to shake first the patient's and then her son's. "I understand you're here because you don't feel well, Mrs. Smith. Is that right?"

"Yes," she answered, slightly nodding her head as she spoke in a high-pitched, whispery voice, "I think I probably have a urine infection." She was probably spot-on, since that can be one of the most common causes of illness and fever in an elderly woman. She went on to explain the burning she experienced with recent urinations and her need for wearing Depend diapers because of the resulting incontinence.

"Have you had a urine infection before?" I asked her.

"A few months ago, yes, but otherwise I've been lucky, knock on wood," she answered, lightly knocking her closed fist against her imagined wooden temple. She then went on to explain to me that her right stump had healed beautifully from her recent surgery and had little reason to suspect that this might be the problem.

After reviewing the rest of her history and performing a stable physical exam, I ordered the patient's tests. And sure enough, she had a UTI, just like she suspected. With the help of some Tylenol, we were able to break her fever and by the time her blood results returned stable, she had been cleaned up and was feeling much better, with an IV dose of antibiotic finishing its run into her left arm's receptive vein.

I explained the results to her and her son, who, despite his mother's good response, had remained quietly sitting in the corner. He was edged forward on his seat, however, as if eager to say something.

"Sir," I said, "you look like you have something to say."

"Well," he said, glancing between his mother and myself, "do you think it's my fault that Mom got the urinary infection? I'm still learning how to help care for her."

"Michael," the patient answered quickly, "of course not. These things happen."

I liked her answer, but his question opened a floodgate of mine. "Why would you ask that, Michael?" I asked him, intrigued.

As it turns out, Michael, this patient's successful, independent son, had sold his out-of-town condo, sacrificed a current relationship, and moved back to our region and into his mother's home, all to take care of his mother after her second amputation.

"Do you have a medical background, Michael?" I asked him, amazed at his devotion. He nodded "no" to my question. "Have you ever been a caregiver before?" I continued, fully understanding just how much weight now sat on his shoulders.

The patient chimed in. "I told him to stay put, but he wouldn't hear of it. I feel bad he's halted his life to help me with mine."

"Mom, I wouldn't have it any other way. You talked me out of returning after your first surgery," he spoke shyly, pausing to nod at her left leg, "but there was no way I was going to stay away after this recent amputation. Unfortunately, I think your urine infection is from me not cleaning you well enough."

Now, imagine being a grown child, with no previous caregiver experience or medical background, halting the life that you've created only to move in with your sick parent. Your parent of the opposite sex, no less. Assuming care that included bathing responsibilities, bathroom runs, feedings, cleanings, appointment dates, and on and on and on.

And on. This was role reversal at its most intimate level.

Michael became an official caregiver. A frightening word for some, a privileged word for others. Regardless, it is a word that many people rightfully now use to describe themselves. Whether it be a sick child, a parent, a spouse, a partner, a grandparent, a relative, a neighbor, or a friend, there are currently 49 million people in our country who provide care in either a professional or personal sense.

Suddenly, I looked at this son in a new light. With no obvious agenda, he was doing what he felt was the right thing for his needing parent. And with his new responsibilities, he was going to be facing a whole new world of emotional weather.

Without any warning, my memories transported me back to when my father, my six siblings, and myself committed ourselves to providing 100% of Mom's home care during her last few months of battling leukemia. Although filled with much learning and many surprises, I think I can say that we all became extremely appreciative of the effort involved in taking total and complete care of a loved one. We were grateful for the experience, though none moreso than Mom, whose beauty and bravery during her last few days only magnified under our personal and steady care.

The patient spoke again, bringing me back to the present. "Michael," she said half-heartedly, "I wish you would have just agreed to put me in a nursing home like I wanted you to do."

"Mom," he responded emphatically, "I won't hear of it. At least not now. If things get too complicated, then we'll talk about it again. But wouldn't you rather be home, still? Seriously?" The patient took her time answering. "Yes," she finally admitted, "yes, I would rather remain home. But not if it means you are going to stop living your own life."

"I'm fine with it, Mom. I would never have moved back if I wasn't. And quite honestly, there is no where I would rather be right now than here, helping you the best I can."

Their smiles reflected off one another while another brick crumbled and fell from my fortified emotional barrier.

I finished the patient's treatment with a case management consult to ensure that Michael and his mother would benefit from several available resources, including home nursing visits. Walking out the door, I wished them both luck. But before leaving, I had to ask. "Michael, did you help your mother with her makeup, hair and clothes today?"

They both laughed. "Yes, he did," the patient answered. "How do you think he did?" Now it was my turn to laugh with the patient and good son. "I think he did a darn good job," I answered, "you look very nice, maam." I turned to Michael. "Well done, buddy." And I'm sure he knew I wasn't talking about how his mother looked that day.

Now, if only he would learn how to change a Depend diaper...

As always, big thanks for reading. And especially for bearing with me through a few weeks of barren writing. Much happening, but all good. I dedicate this post to all of you who have intimate knowledge of the sacrifices and hardwork necessary to be a great caregiver. See you back in a few days...