Wednesday, June 20, 2012

Have A Little...

Faith.  A simple word with complicated meaning.  It is a seed buried deep within our spiritual cores, ready to be nourished and blossom with the sprinklings of tragedy.  It is a belief that things will work out, despite our lack of vision for fate's secretive reasons of the bumpy journey we must endure.  It is an inherent hope that has either sustained us or has failed us miserably.  Yes, to me, this is faith.

We all have known faith.  Embraced it.  Bargained with it.  Coddled it within our breaking hearts. Placed it on a pedestal of worship. I have, too.  With undertones that may be religious, spiritual, or meditative, we lean against its pillars of reassurance.  Sometimes, as they say, it is all we have to cling to during desperate times.

Working in an emergency room for 16 years, I have seen faith present its various faces many times.  It may be within the circle of a grieving family, their hands clasped in prayer.  It may be in the young mother's eyes, watchful of her sick child lying in a hospital cot.  It may be in the older gentleman's anguished cries as I share the devastating results of his wife's testing.  It may be in the silent strength of the obvious love of a dying man's partner.  It may be in the ER staff's comforting whispers.  Faith cannot be contained, especially in tragic circumstances.  I tend to think it is a part of the coping fabric that threads all of our lives.

Why do I think that?  Because, those moments of my life where I had to believe in something more, where I had to dig deep within the rubble of my soul to scrape a little bit of sanity, were during intense, personal moments.  My son's illness.  My mother's death.  My grandmother's death.  A life-threatening injury to my father.  I swear, when my mother and my son were both simultaneously enduring chemotherapy, I stared faith right in the face and bargained with it.  Threatened it, even.  "If something happens to my son," I uttered to invisible universal ears while pulling at my hair, "I will never forgive you for it." Yes, I know faith.  It has been my best friend and my worst enemy.

After my son's initial diagnosis, I stood in the hospital corridors outside of his pediatric room, disheartened and in disbelief.  Cole had just returned from the OR where a mediport had been placed in preparation for an aggressive initial round of chemotherapy.  My spiritual guidance, Father Tom, stood beside me, recognizing my slipping faith.  "Why Cole?" I asked, over and over, tearful and angry.  "Why couldn't it have been me?  What kind of world do we live in for a child to endure this?"

Father Tom, in his infinite wisdom, answered my pleas with words that I still carry to this day.  His words, to me, exemplify the true nature of faith.  "Jim," he said, his voice husky and comforting, his arm wrapped around my trembling shoulders, "I can't answer your questions.  I wish I could, but I can't."  He paused slightly, choosing his words.  "I can only pray that at some point in Cole's life, on his journey, the answers of 'Why?' will become more evident.  That the reasons will be more clear to all of us of why he was chosen to endure this illness."  In other words, in staring at a big, suffocating fog of nothingness, Father Tom was telling me that I must have faith.

How does one do that?

At my rock bottom, the openness of my mind was staggering. I listened to any words of support and encouragement, my hopes and faith hinging onto any little hint of a better tomorrow. I'd walk away from family and friends, my mind reeling and spitting out their words to suit my recovery, my belief system.  Ultimately, I learned to believe that all things in our lives happen for a reason. I had to arrive at the belief that Cole would survive and thrive, that the years we will have together would be many.  To not arrive at this point would have meant a certain death in an unattainable part of my core.  I was learning to survive by walking the path that my faith created.

Cole survived.  And as I type these words, I whisper a silent thank you to those universal ears of faith that fulfilled my every request.

Every day, though, followed by every week, every month, and every year, there is more profound sadness, more tragedy, that requires us to dig deep and rediscover our faith.  To recommit ourselves to examine our morals and ideals while we cope with a crisis.  A few years back, another setback occurred in my life, plummeting me even farther into my spiritual well.  Cole had veered from remission while my mother concurrently fought a losing battle against leukemia.  And I was back to the same dark place that I had turned my back on just a few years earlier.

Again, though, my faith sustained me.  It wasn't easy.  But now, with things going well, especially after my very own first health setback, I sit here and appreciate the moments of goodness in my life.  I have learned, from these various experiences, to give my attention to faith during the good times, too.  My faith has been tested and tried and, fortunately, has sustained me in my times of need.  It is my time to feed some nourishment back, during the good times, to those who have surrounded me with smiles and encouragement and and unwavering friendship and love. A phone call. A card. A lunch date. A smile. Some kind words.

It is a two-way street that I have learned to travel with faith.

Where does your life sit right now, on this very day?  Are things going well for you?  Are you facing crisis?  Are you recovering from or approaching a trying moment?  Are you engaged in the environment surrounding your life? How is your support system?  And, most importantly, how is your faith?  Do you think maybe that little seed patiently waiting to sprout within you, in a moment of need, might appreciate a little attention now?  If so, give it some.  Sow it.  Water it. Feed it.  Coddle it.  Embrace it. The effort taken now to examine and understand your faith will reap you rewards when you most need them.

All around me, including dear family and friends, including strangers and patients in the ER, I see daily struggles occurring.  At times, I feel helpless and out of sorts, my seat on the sidelines but a useless location to witness another's misery. But I know, from continuing to grow as a compassionate and kind person, that good times will prevail if one can just hang in there. So, please, just hang in there.

And have a little...                     

Tuesday, May 1, 2012

The Interview

A few years back, my wife and I were sitting on our living room couch watching the local evening news when a segment ran regarding a patient's option, often neglected, to interview a physician prior to agreeing to receive care from that particular caretaker. The interview, the segment continued, could involve questions ranging from professional training to personal attitudes and outlooks on life. Not a bad idea, I reasoned, if the required care was non-emergent. A physician sharing a similar perspective of his patient's well-being could only be beneficial, right? But in an emergency room setting, wouldn't this type of interview only delay necessary treatment? I couldn't imagine a patient with crushing chest pain taking the time to ask me of my residency training (Upstate NY) or how I felt about fitness training (all for it).

Of course, I was wrong. My following shift, I encountered an older, scholarly-looking gentleman who had presented to our department with complaints of acute abdominal pain. After introducing myself to both himself and his wife, I began to ask the patient important history questions when he suddenly interrupted me.

"Doctor," he asked, "before I agree to let you treat me, can you tell me where you went to medical school?" Although surprised, after watching the news segment just two days earlier, I anticipated that an encounter like this would eventually happen. "In Philadelphia," I answered. "And where in your class did you graduate?" "In the top ten percent," I replied. His questions kept coming. "And where did you complete your residency?" "Did you serve as chief resident your final year?" "How long have you been working in this emergency room?" As I patiently answered his questions, I began to wonder if the word "acute" was the right word to describe his abdominal pain.

Finally, though, he appeared satisfied with his interview. "Okay," he said, "I give you permission to treat me."

"Well, sir," I said, deciding to turn the tables on him, "I am not sure I want to treat you." I caught him off-guard. He looked inquisitively at me as I paused for good effect before continuing. "I have one question I want to ask you before I agree to treat you."

"Okay, Doctor," he said, "what is it?"

I took a deep breath and smiled as I spoke. "How will you be paying me for your visit today?" We both laughed. Regardless of his answer, he knew I would be his treating physician.

I hadn't thought about this encounter until just recently, after I had walked into Room 17 to introduce myself and examine a patient my resident was currently treating.

In the dimly-lit room, I found Bertha, alone without company, lying in a cot with hospital blankets pulled up to her chin. She was a 93 year-old woman sent to us from a local rehabilitation unit with complaints of chest pain. She had been placed there recently to recover from a bout of pneumonia. Bertha looked her age, appearing frail in size, her tiny body barely poking it's physicality into her covering sheets. Her face was graced with creviced wrinkles and framed with an unkempt gray bob. Her hazel eyes, however, belied her years. They were fierce and focused, guarded even, glistening with anticipation as I approached to introduce myself.

"Hello, ma'am," I said, reaching for her hand under her covers, "my name is Dr. Jim and I will be following your treatment today with Dr. Brad, one of our resident physicians who I am supervising."

She looked me carefully up and down as I continued. "Is your chest pain gone?" She nodded yes to my question. "Do you need anything right now?" She nodded no. "Is it okay, ma'am, if I listen to your heart and lungs?" She nodded yes.

I pulled my stethoscope from around my neck, placing it's diaphragm on her chest wall while inserting the listening buds into my ears. While bent over her and listening, I watched her face closely, appreciating her unique eyes. Suddenly, though, her lips moved. Unable to hear her, I stood up while removing the ear buds. "What is that, ma'am?" I asked.

With a soft, quiet voice, she asked me "Where did you go to medical school?" I told her. "And where did you do residency?" I answered her again. "Do you enjoy being a doctor?" I told her yes, very much so. I wasn't sure if another interview was in my future, so I flipped the coin on her.

"Why do you ask, ma'am?" I questioned her. "Did you once work in the medical field?"

She shook her head. "No, I didn't. But my daughter was going to be a nurse." I waited for her to continue but she seemed absorbed in her memory. "What happened?" I finally asked, my curiosity peaked. "Unfortunately," Bertha answered, sadness sweeping across her face, "she wrecked her car late one night while driving home from a training shift and died. She was nineteen."

I grabbed Bertha's hand again and held it, humbly reminded that every face I encounter holds a story. And quite honestly, I could not even begin to imagine the pain that would come with losing a child. "I'm so sorry," I said, stroking the back of her hand.

"Don't be," she said, "I still had a wonderful life." She went on to explain that she had six children total, four of which were still alive but unfortunately not nearby geographically. This explained why she had been placed into a rehab unit from her assisted-living arrangement while recovering from pneumonia. "They are here, though," she said, lightly tapping her heart with her free hand.

After another pause, I had to ask my next question. "What happened to your other child?" "Oh," she answered thoughtfully, "we had a retarded son that died in adulthood. My husband and I managed to care for him at home until he passed." She went on to proudly explain that it was no small feat to raise a mentally-challenged child in earlier days--that most were institutionalized. "And your husband?" I asked. "Well, he and I were married for 53 years before he passed away. That was quite a few years ago. But, we managed to stay together and keep our love the whole time." We talked a few more minutes, her insightful words leaving a significant imprint upon me.

Finally, I finished my exam. Before leaving her, I thanked Bertha for her time and for sharing her life story with me. Happily, she did very well for us in the ER and was admitted to observation.

Just returning from my recent unplanned medical leave, I felt Bertha's story grab my shoulders and shake me. Not just shake me, but rattle my soul. My encounter with her was a well-timed reminder of just how privileged I was to be an emergency physician.

And suddenly, it dawned on me. I was the one who benefited most from the interview process with a patient. Sure, there is history-taking involved with my job, to find out the specifics of an illness that might help me provide the most focused and complete care to a patient. But this other "stuff," this personal information that a patient shares with me, isn't this more like an interview? I don't necessarily need to know everything a patient shares, but doesn't it all provide a much more complete picture of the person I am trying to help? And, besides, can't some of my patients' shared life experiences help me along my own life's journey?  

A resounding yes and yes, if you ask me. I think I'm going to call the local news station and thank them for their meaningful segment...

As always, big thanks for reading. Also, a HUGE thank you to all the personal emails and posted comments from my last posting. Your warm welcomes and kind words are greatly appreciated. I have some of the coolest readers ever...                 

Tuesday, April 24, 2012

The Other Side

the years teach much which the days never knew
Ralph Waldo Emerson
As I sit at our dining room table to write my first words in five months, I am realizing just how much I've missed writing about both my personal and professional life experiences. Though my family and close friends may know my reasons for this unplanned break, you, my friends and readers from StorytellERdoc, do not. So instead of diving head-first into writing a funny, planned posting, I thought I might simply change course to write and say "hello" and "how the hell are you" to each of you.

Let me briefly explain my absence. Simply, I began to have some vision problems last November, ultimately resulting in urgent surgery. Always the doctor and never the patient, this was my first real health scare. Following successful eye surgery, I was forced to take a few months time to recover. This break included absolutely no gym time and, most odd for me, no work time. Looking back on my career, I had never had so much as a week or two break from working in the ER. This inactivity, at first painfully frustrating, ultimately proved to be one of the greatest learning experiences thus far in my life.

For the first few weeks following surgery, I had to wear an eye patch, a blue, oval-shaped piece of perforated aluminum paper-taped to my face. With this new accessory, I spent much time in front of the mirror, looking to find that invincible, healthy fellow I once was. I couldn't find him. Friends tried to make me feel better, telling me I looked "sexier" with an eye-patch, but I saw through their flimsy compliment--the only way to look sexier, I reasoned while laughing with them, was to have sexy to begin with. My kids, hesitant at first, realized that patch or no patch, I was still the same Dad that I had always been. In fact, soon after surgery, Cole had a basketball game that I wanted to attend. "Cole," I asked, "is it okay if I come to your game with my patch or would you rather I stay home?" Without even a hint of pause, his resounding reply inspired me. "Of course you are coming, Dad, why wouldn't you?"

After several weeks, I was able to lose the eye patch. More importantly, with healing and some serious introspection and reflection, I was able to regain my perspective of what is most important in this journey of life. Family. Friends. Humor. Love. Compassion and kindness. Living a purposeful life.

Part of this time away included reevaluating my job differently. Although I still considered kindness and compassion at the forefront of my ER interactions with patients and their families, even I was not immune to a growing cynicism that occasionally seems to be pervading our medical field. Maybe this had even leaked itself into some previous writings. Luckily, though, I feel more privileged than I ever have, since residency even, in walking the halls of our emergency department and providing care to such a diverse and unique collection of patients. Of course, there will always be patients that are obnoxiously difficult, but my reserve to find something good in each and every patient has definitely been refueled. I've been honestly warned, however, by several of my hard-working partners. "Just give it a few months, Jim," they said, "and then see if you feel the same way about things." I can only hope that I have some great staying-power. I feel I do.

Being a patient, I have also learned and witnessed first-hand just how important a role a doctor can play in one's recovery. Luckily, I am surrounded by four absolutely incredible individuals who have prioritized being a compassionate person first and playing a doctor second, proving that one doesn't need to place himself on a pedestal to be amazing at what he can do. This all-star team of providers, however, did not come without some rearranging on my part. I removed from my team, so to speak, one nationally-recognized specialist who was less than stellar in both his personality and in his style of delivering unwanted news. Although this specialist may have been quite good at what he does, I was less than impressed with his all-around abilities to communicate. To heal well and remain positive throughout my ordeal, I insisted on only being surrounded by similar individuals.

Overall, I have much to be thankful for. An almost complete recovery. A supportive family. Supportive friends. And supportive co-workers. What could have been a terrible outcome was not. For this reason, I will always be humble and grateful. Returning to work, I was greeted with many kindnesses and friendly, encouraging words. Hugs included. I also returned to some sadness as well. One of my favorite nurses, Sue, tragically lost her son during my absence. My ordeal embarrassingly pales in comparison to this tragic event of her life. To hug her and share tears with her as she attempted to give me a warm welcome-back smile speaks volumes of her strength and character.    

So there you have it. Officially, I have now returned to my life as I know it. Playing doctor full-time. Playing Dad full-time. Attempting to be a writer again. And, most importantly, continuing to look at my wife with complete wonderment, appreciating more than ever her infinite strength, support and love. Except for the glasses outwardly, my most significant changes from my ordeal have come from within. For this, I am most appreciative. I am stronger than ever, actually. As Ralph wisely stated above, the small day-to-day battles were worth the positive hindsight of it all.

It feels so very good to be back...

As always, I thank you much for reading, my friend. More importantly, I thank you for your patience and returning to read my words.