Monday, September 16, 2013

Almost A Miss

He was an ornery kind of fellow, evident by his scowl and beady, glaring eyes that greeted me upon my entrance into his room. The nurse, thankfully, had given me a heads-up on this eighty-five year-old gentleman's demeanor. With her kind warning, I felt prepared to be tested by this patient's demanding and abrupt nature.

What I wasn't ready for, though, was this man's physical appearance. He was extremely small in stature, bordering on petite. His frail elderly body, sitting upright with legs dangling over the cot's side, contrasted his enormous, palpable presence. As a felt fedora hovered above his round, veiny face and bulbous nose, his feet swayed several feet above the waxed tiled-floor.  His gray-haired wife, equally frail, was sitting quietly in the room's corner chair, clutching her purse while exuding a warm smile and warmer eyes. They appeared a dichotomy of spirits.

Upon entering the room, I acknowledged this kind woman by nodding and returning her warm greeting. "Hello, ma'am," I said, "you have a beautiful smile. Thank you for being here today with your husband."

Next, I turned to the patient to introduce myself. "Hello, sir. My name is Dr. Jim. What can I do to help you today?" I invitingly extended my right hand in greeting.

He did not embrace my hand but rather used his free right hand to point to the gauze dressing wrapped around his left elbow.

He answered in a very thick European accent. "Doctor, I need stitches."

He offered no further information, but rather continued to gaze steadily at my face. I returned his gaze, hoping my smile would soften his grimace. It didn't.

After a pause, hoping for more information but receiving none, I continued to interview him. "Sir, could you please tell me what happened that you injured your elbow? Did you fall?"

"I need stitches," he bluntly replied.

"I understand that, sir, but I just need a little more information about how you hurt your elbow." Because he was elderly, I needed to make sure a variety of other problems did not accompany his hurt elbow, such as hitting his head, spraining his neck, hurting his ribcage or abdomen, etc. Also, it was important to learn if his fall resulted from tripping, being dizzy, having chest pain, or any other variety of medical concerns. Learning the mechanism of his fall would help me gauge how in-depth to question him and how aggressively to pursue medical testing.

He ignored my question, instead initiating his own direction of conversation. "How long have you been a doctor for?"

Inside, I was smiling at this patient's piss-and-vinegar. To be eighty-five and have this much energy, regardless of how it would be interpreted by others, was pretty damn cool.

"Well, sir," I answered, "I finished medical school in 1993. I finished residency in 1997. So I guess that would mean that I have been a doctor for twenty years and have been finished with my residency training for, well (I had to do quick math in my head at this point), about 16 years."

He nodded his head in approval while turning to his wife to speak. "I guess he will be okay to fix my elbow."

I turned to find her directing a genuine and loving smile at her husband. Turning back to my patient, I continued with my questioning. "Sir, did you trip over something that made you fall or did you have a dizzy spell?"

"Doctor," he said, looking me directly in the eyes, "I tripped over an uneven sidewalk. Last time I hurt myself like this, I needed stitches right here," he continued, pulling up his pant leg to reveal a small scar on his anterior left tibia. "I need some stitches in my elbow and then you can let me go."

I asked him several more questions, straining my ears to decipher his answers through the heavy veil of his accent. Eventually, with a lot of patience and a little probing, I felt satisfied that his isolated elbow injury was not associated with more serious concerns.

As I began to gently unwrap the gauze-dressing from this patient's elbow, he began to warm to me, rhythmically raising and lowering his arm to help with my efforts. When I was finally done, I closely examined his elbow. He had a localized contusion with a superficial skin-tear of the overlying skin. This tear would not require stitches, nada one. He had minimal pain on range of motion testing to his elbow and had no further pain to his left arm.

"Well, sir," I said to him as I sat on the stool by his feet, "I have some good news for you. We will need to get an X-ray to make sure you didn't fracture your elbow, but otherwise you won't require any stitches." I explained to him that we would put steri-strips on his skin tear to approximate the edges and that stitches, as he was insisting, could actually be detrimental to his healing.

"Doctor," he replied, "I want stitches. Just like last time." Uh, oh. I felt an argument coming on. So instead of addressing him, I turned to his wife and spoke. "Ma'am," I said, "has your husband always had this much piss-and-vinegar?" At this question, both the patient and his wife burst out laughing. "Doctor," she replied, "you have no idea!"

After a little more persuasion, I was finally able to convince this patient that he did not need stitches. He willingly went to X-ray and after returning to his room, I went into his room to tell him the good news--he did not have a fracture. His wife, upon hearing the news, clapped her hands together in happiness. After a few pleasantries, I began to walk out of the room. "The nurse will be in to clean and wrap up your elbow as well as update your tetanus," I assured him, recognizing that the patient was very eager to get released from the department, "and I should have your discharge instructions ready in ten minutes."

Within two minutes of leaving his room, not surprisingly, the patient was standing at the nurses' station counter, barely visible as he strained to peek over. "Excuse me," he spoke in his drawl of words, "I am ready to go and I haven't been given my papers and my elbow hasn't be dressed yet." I looked up from my computer and smiled at him. "I am working on your instructions right now, sir, and then the nurse will be right in to get you going." Inside, again, I smiled at this gentleman's energy.

And then, the moment I almost missed…

"Doctor," he said, "can I ask you something?" As he spoke, he wife walked up beside him at the counter. She was an identical twin to Sophia on The Golden Girls.

"Of course, sir, " I said, standing up and walking towards him. "What can I help you with?"

"Well," he said, "you have a funny accent. Where are you from?" His question caught me off-guard, and with our conversation it seemed that every nurse and secretary sitting in this station also paused. I smiled at him and answered his question, explaining that I am a second-generation American of European-descent with an accent which I associate with being part country-boy (a "hick-accent," as I like to say) and part European (as one of my heroes, my paternal grandmother, had a very thick accent). And with his bold question, I returned the favor.

"And where, sir, are you from?" I asked. "I noticed that you have an accent yourself."

"You are quite right, Doctor," he answered. "I am originally from Poland." After we joked about our shared love of polka music and vodka, I asked him another question. "How old were you when you came to America?"

And with my question, this patient launched into his past history. He came to the United States at the age of twenty, alone, after WWII. When he was an innocent child of age eleven, he tragically lost his entire family in the throes of war--his parents, his five sisters, his aunts and uncles, and all of his cousins. Each and every one in his family died in concentration camps. He survived only because a farming family took him in as "one of their own" during the war. Afterwards, when he had saved enough money, he came to America to begin a new life. "And Doctor," he commented, after finishing his amazingly breath-taking story, "isn't it remarkable that after all of these years in America, I still have my accent?"

I looked around the station. Not one of us had eyes that weren't moist and glistening. This man's incredibly powerful story, portraying his resilience to the most tragic circumstances of loss and adversity, was equally heart-shattering and faith-building. We had all just been handed a rare nugget of vitality. For this man to share a sliver of his soul to us was beyond any measurable gift.

After his story, we all thanked him for sharing. Gradually, he worked his way back to his room. Without his presence at the counter, you would think that we would all have comments on such an incredible story, and yet none of us could utter a single word.

This frail elderly man was anything but frail and elderly. He was one of the strongest, most awe-inspiring patients I have ever had the pleasure to meet. And that remarkable accent of his? Thankfully, I learned from this man that his accent was probably the least remarkable thing about him.

And to think, I almost missed his story…

As always, big thanks for reading. I hope this finds each and every one of you well…a special thanks to those who have been encouraging me forward...

Sunday, August 18, 2013

The Breakthrough

I smelled the patient, unfortunately, even before walking into his room to introduce myself. From the hallway, his odor of lingering stale smoke flared my nostrils, instigating childhood recollections of the wood-burning furnace at my grandmother's home. From a distance, the scent of smoke was just that--charred-burnt air, its weight clinging to my nostrils. As I approached the patient, however, the scent of smoke smoldered my wishful memories of Gramma's furnace. This was not the smell of crisp, dry maple and oak wood pieces flaming to heat a house, but rather the lingering smell of those little brittle white sticks of tobacco that come twenty to a pack.

I walked into Room 21, its closed curtain contributing to the suffocating staleness of the cigarette smoke, to find a 53 y.o. man sitting upright in hit cot, facing me. His face was wrinkled and leathery, his eyes weary. His thick gray hair was combed back away from his forehead. His lips were dry and cracked, his nose bulbous and veiny. He looked years older than what his chart conveyed. Sitting in the corner was a younger woman, maybe thirty-ish, wearing a warm smile. Her eyes danced with the kind of energy that we all wish we had.

I returned a smile to this pleasant woman while I continued to advance to this patient's cot, extending my hand in welcome to him.

"Hello, sir. My name is Dr. Jim and I will be your doctor today while you are in the ER." I turned and introduced myself to the woman in the corner as well, learning her name was Denise and identifying her as this patient's niece. I turned back to the patient. "What can I do to help you today, sir?"

He inhaled a deep, raspy breath before beginning to answer my question. "Well, Doctor," he said, "I just moved to town to live with my niece here (he paused, nodding his acknowledgment to his niece) when I got me some really bad chest pain." He assured me that his chest pain had since resolved. I quickly listened via my stethoscope to his acceptable heart and lung sounds while a flurry of activity occurred around us--an EKG, a portable chest x-ray, blood draws, and IV starts. I then continued with our conversation.

I asked him the usual questions. What was he doing when the chest pain came on? Sitting watching TV. Has he ever had problems before with his heart? Yes, three cardiac stents in his past. "And they told me I needed surgery, too, but I didn't want to go through with it." I asked him about his risk factors, for which his every answer was "Yes." Hypertension? "Yes." High cholesterol? "Yes." Diabetes? "Yes--just pills, though." Besides his own personal history, did he have a family history of heart disease? "Yes--both my parents had heart attacks."

Finally, I asked about the risk factor that I already knew the answer to. "Sir," I asked, "do you smoke?" The patient looked me in the eyes with his own intent, sincere gaze. "Not anymore I don't, Doctor." His answer intrigued me, of course, so I asked him to clarify his answer. "Well, I had my last cigarette right before the ambulance came to pick me up." Upon pressing further, the patient admitted to smoking at least two packs of cigarettes a day.

If each of us in the ER setting were given a nickel every time a smoking patient told us they had their last cigarette before seeing us, we would all be living in mansions and driving German sport cars. I would be cheering for this patient's efforts to quit, but two packs a day? This patient faced one heck of a mountain to climb over after his thirty-year habit.

We talked a little more about his health. He had required three stents total in his past, most recently in 2011. Despite his poor health, he continued to smoke and rarely took a baby aspirin a day, let alone his other required medicines for his hypertension, high cholesterol, and diabetes. "Well, sometimes I take them all, but I try to take my diabetes medicine every day."

It was here, at this pivotal moment, that the energy in the room became palpable, changing for the better. Denise stood up from her corner chair, speaking as she began to approach my side by the cot. "Uncle Bob," she said, reaching for her uncle's hand after her arrival, "that's all about to change. Now that you moved to town to live with me, we are going to make sure that you do everything right."

I liked Denise immediately. Who wouldn't? I looked from her back to her Uncle Bob, noticing the tears beginning to collect in the inner angles of his eyes. Slowly, the tears spilled over, trickling down his cheek. Denise and I remained quiet, a wistful calm settling in the room as I looked down to watch Denise's thumb stroke over the back of her uncle's trembling hand. After watching this rhythmic comforting, I looked back to Uncle Bob's face. It was contorted with a look of relief, of the knowledge that one wasn't alone in an uphill fight.

Slowly, Denise leaned in and kissed her uncle's cheek. It was sweet. It was simple. And it was an astounding privilege for me to witness such tenderness.

I stepped back from the cot and became invisible while Denise spoke to her uncle.

"Uncle Bob," Denise spoke, quietly and calmly, "Mom died two years ago, leaving us only with each other. I am glad you finally moved here to be with me and my family. Mom would have wanted you to live with me, so it's about time you got here. Now we just need to get you better so you can enjoy my children and they can get to know their Uncle Bob."

The patient, at his niece's words, completely fell apart, sobbing openly. Before exiting the room, to give Denise and her uncle the privacy they deserved, I asked him quickly again if he had any further chest pain. "No," he answered, "only a broken heart." I had hopes that his broken heart would be healed in the capable hands of his niece. And like clockwork, accompanying that thought as I walked out of the room, I overheard Denise continuing to speak. "It's all going to start by you throwing out those cigarettes of yours." Yep, I definitely liked this Denise character.

Thankfully, Uncle Bob's initial cardiac tests came back unremarkable, barring a high glucose level. He needed to be admitted for further cardiac work-up and, more importantly, to be plugged into our health-care system. With proper medical care and Denise's support, I had hopes that Uncle Bob might just be able to pull himself out from the current of neglect he created for himself.

Sometimes, when I meet a patient and their family, I get a gut-feeling that our efforts might be for naught; the familiar rut of a patient's self-negligence and non-compliance will eventually overtake any forward efforts made by the medical community. However, in most patient encounters, I do leave the room hoping and feeling that the patient's emergency room experience will make them more cognizant and energized to face their illnesses. Sometimes, this cognizance comes not from the patient themselves, but rather from a friend or family member. Thus was the case with Uncle Bob. We should all be so lucky to have a "Denise" in our corner to help us battle our way back for all of the right reasons.

I hope I don't ever have to hear from or see Uncle Bob again, for the simple wish that he conquers and controls all of his concurrent illnesses with proper outpatient management. With Denise in his corner, I think his chances of this are significantly improved. I hope I witnessed his breakthrough. And I hope if I do have to meet Uncle Bob again, instead of smelling a smokestack, I smell the refreshing scents of Irish Spring and Old Spice.

As always, big thanks for reading. More essays to come…I hope this finds you and yours well. Jim   

Monday, March 4, 2013

The Broken Bone

Although I rarely get sick with the numerous strains of “bugs” that seem to go around our community this time of year, the week prior to my return to work for my next scheduled string of four shifts was spent mainly in bed, coughing and aching and whining about how miserable I felt. Fully recovered, though, I was excited to return to the emergency department to do my fair share of stamping out disease and healing thy patient from illness and injury.

Walking into Room 21 to see my first patient of the day, however, made me cringe just a bit and suddenly, I wished I could have been back in my bed at home for just one more day.

The patient was young, in his mid-twenties, and appeared to be in significant pain. He was alone. His short-cropped hair was calmly neat, belying his grimaced, pinched face and restless arms and legs that rocked his compact body against the cot’s rails in defiance to his discomfort. His nurse, Sam, one of my favorites, was hurriedly placing an IV into the patient’s right arm.

I gently grabbed the patient’s shoulder to gain his attention, introduced myself, and asked him what brought him to our ER today.

“Doc,” he said, taking a quick gasping breath before continuing, “I was banging the shit out of my girlfriend when my penis snapped in half.” I looked from the patient’s face to Sam’s, who nodded his agreement to this patient’s history.

Ugh, I thought to myself, a fractured penis. A fractured penis!!! It had been, thankfully, several years since the last time I had seen a case like this. For some reason, despite my tolerance and calmness during any other conceived emergency illness or injury, penile or scrotal injuries always made me cringe. And I was cringing. Usually, this type of injury occurs with masturbation, unusual sexual positions, or aggressive sexual intensity, to be politically correct.

“Sir,” I said, “when and how did this happen?”

As it turned out, it had happened immediately before his arrival—about 20-30 minutes before we began treating him. And how? Despite his pain, he spoke with great pride and in great detail about his sexual prowess and escapades that lead him to our department. He painted a picture that, short of sustaining a penile fracture, all of us men have failed our partners in the sexual arena. Call it rough sex if you must. And call me a failure, then, if this was the price of success.

After his explanations, I had no doubt that I would be able to provide the detailed social history necessary on this patient’s medical chart. I imagined the pleasant dictation lady turning beet red from embarrassment as she typed his chart up. “Hey, Sally,” I pictured her saying to her co-worker, “come over here and get a load out of this patient’s story! I wonder how his girlfriend is doing?”

After examining this patient thoroughly, and confirming that he indeed fractured his penis, I ordered him up a healthy dose of pain medicine before calling the on-call urologist urgently. This patient would need emergency surgery to repair his penile injury, which really wasn’t a “broken bone,” per se (since the penis doesn’t contain any bones), but rather an insult (or tear) to the vascular columns that engorge with blood during an erection.

Finishing with a few more patients and while waiting for the urologist to arrive to see this unfortunate patient, I went back into his room to check on him and make sure he was more comfortable. He was definitely more comfortable and no longer alone. A much taller, big-boned woman with a similar shortly-cropped hairstyle sat in a chair beside the room’s sink.

I walked up to her, my hand extended, and introduced myself to her. Understandably, she could barely look me in the eye as we shook hands and she shared with me her name. During our introductions, however, her boyfriend blurted out in his pain-controlled state, “This is my girlfriend who I was banging the shit out of when all of this happened.” Talk about making an embarrassing moment more embarrassing for her. “Don’t worry about it,” I consoled her, “we will be taking good care of him.”

The patient didn’t stop there. “Hey Doc,” he said, his eyes slightly glazed over from the medications, “do you think they will be able to save my penis?” Before I could answer his question though, he continued. “Dude,” he said, now apparently more comfortable with me, “you don’t understand—without my penis, I am nothing.” He paused, took a deep breath, and got a sad look to his face. “I am nothing! Nothing…,” he repeated, remorse and fear now dripping off his words.
I reassured him that the timeline of his injury was in his favor—that presenting to us so quickly after this unfortunate event helped with his percentages of a full recovery. I told him that as soon as the urologist saw him, he would most likely go straight to the operating room.

“But, Doc,” he said, “what if they can’t save my penis. Can I get a new one?”

I assured him that most likely, they would be able to save his prized possession. Deciding to have a little fun with him, though, I continued. “But if on the small chance they can’t save your penis, penile construction/reconstruction surgery is very advanced these days. We have a catalog of new ones you can choose from.” I could only imagine him skipping the petite section and going straight to the plus section.

He looked up at me in surprise to my words. “Really?” he asked, before seeing the hint of a smile on my face. Getting the joke, he continued. “Dude, thanks. I needed that.”

Soon after, the urologist came in, examined the patient, and booked the OR suite to take the patient for immediate repair of his injury. He would need an indwelling foley catheter for 2-4 weeks while he healed from his repair, effectively taking him out of commission for a month or so. I truly wished this patient the best outcome.

Before the patient left our ER, as if things couldn’t be any more embarrassing for this patient or his girlfriend, this patient’s mother and sister came in to be at his bedside. How could you possibly explain such an injury to your mother, the one who is wearing the serious look of dread and concern for her son? Or your sister, the one who cannot contain her incessant giggling? And do you show them the injury or just trust that they would understand the explanation? Some things I just didn’t want to know. Although I am not of the moral fiber to condone lying, I sure as hell would have fabricated some type of story to divert my mother’s and sisters’ attentions if I were in the same situation as he. “Umm, Mom and sissies,” I would say to them, “I got a hernia while chasing a purse-snatcher down the street after he knocked over a 90 year-old lady.” And no, I wouldn’t show them the supposed hernia, either.

This patient, however, didn’t care. He did show his mother and sister his injury. Eeewwww, I know. That makes me cringe almost as much as the injury itself. Just as impressive, though, was that his girlfriend had an anxiety attack. Why? This was the first time she had met her boyfriend’s mother. And sister. Talk about memorable introductions to the family. Can you imagine, once again, that conversation? "Hello, Mrs. Smith, nice to meet you. I'm Ellie--the girl who broke your son's penis in half." I, for one, didn’t hold out much hope that this relationship was going to survive this ordeal. But I didn’t think the patient would show his penis to his mother, either, so I could be wrong.

Is there a moral to this story? I guess, maybe. The moral might just be that we should never ever "bang the shit out of" the ones we love. Sweet lovin’ might just be the best lovin’, right?

Oh, and one more moral to this story? Never ever show your mother your penis, no matter what state you may be in, when you are a grown man. That’s just creepy.

Thanks, as always, for reading. If this post and typical ER humor offends, my apologies. But who can blame all of us in the medical field for having warped senses of humor at certain times in our days. I hope this finds you all well…Jim.  

Tuesday, February 19, 2013

A Hug Is A Hug Is A Hug

Sometimes as human beings, despite all the layers we consciously build upon the shell of our souls to shelter us, define us, and project an image to others of what we hope we are, our basic inherent quality of goodness emerges on its own free will. A kind word, a gentle touch, a hint of a smile, an understanding patience--these are all things that escape uncontrollably in moments where our consciousness is left behind, running to catch up to our spontaneous reaction in a moment of crisis for another. 

Of all of these unconscious acts of inherent kindness and compassion, though, none ranks higher than a heartfelt hug. Not a light tap on the back, or the fake kiss of a cheek, but rather a hug that emerges from the tightened embrace from one to another that, for the briefest of moments, conveys the wordless caring that we all crave to receive. Like cake batter in waxed pleated cupcake sheaths, these hugs are ready to emerge, when fed warmth, to spill out of us into the want of another.

It was one of these moments, of private hugs and hushed whispers, that I was recently privy to witness in the trauma hallway of our department. Suprisingly, however, it was given from the most unlikely of persons.

Trauma patients are typically the most complex of all our patients, with a wide spectrum of issues ranging from life-threatening physical injuries to the endless abyss of psychological and social tolls from the unexpected event. Like trauma patients before her and trauma patients since, Room 18 held an unfortunate patient (in her early twenties) who presented via helicopter from a car-accident scene. She had been a front-seat passenger who, due to a multi-car collision and the twisted secrets of fate, sustained both severe physical injuries and, more importantly, powerful psychological injuries that would be life-long. Sadly, her mother, the driver of their car, had died at the scene of the accident.

Although I wasn’t the primary ER attending treating this unfortunate patient, I poked my head into the room to see if I could help in any way with her treatment. The mood of the room was somber, an understandable heaviness weighing down any spirit of knowing our quick actions might help this patient recover fully from her physical injuries. The bright lighting that reflected off shiny metal cots and posts and equipment could do nothing to deflect the pain and misery of this patient’s future. Of her impending misery. Of a future life where her mother would not be available to share a secret ingredient to a recipe, to consult over whether to serve ham or turkey on Christmas day, or to call “just because.” Nor did the room’s sterility help clean our own pain for this patient’s tragic loss. Adding to the senselessness, we later learned that the mother’s unselfish reaction in the crash had been to swerve their car in a direction that would protect her daughter from being directly hit, or t-boned. This patient’s mother had given her own life so that her daughter might keep hers.

After this patient was stabilized, it was shared with her that her mother had not survived the crash. Her mournful wails and cries after learning her cruel truth could be heard the hallway through. As tragedy’s effect usually does to each of us in the emergency department, we paused in this moment, recognizing the profoundness of change in one of our patient’s lives.

Eventually, family members trickled in and supported this patient as further emergency treatment was provided to her. Occasionally, I would pass by a pair or group of family standing in the hallway, outside of the patient’s curtained room, hugging and whispering to one another, trying their best to simultaneously provide and receive support. With each pass, I would slow down just a bit and nod my sympathies, wishing I could sponge even just a tad of despair from their shoulders.

It was soon after that Amelia, one of our “regulars,” was placed in the only available room, Room 17, next to the unfolding trauma tragedy. Ms. Amelia was an elderly woman with an extensive mental health history who had signed into our ER, yet again, for a multitude of miniscule complaints. Although she was well-known to much of our staff, I had only met Amelia one prior time a few years earlier.

I walked into Room 17 to introduce myself to Amelia, only to find the room empty. Reentering the hallway, I couldn’t help but notice two younger people fully embraced by the strong, steady arms of their slight, grey-haired grandmother. It was a breathtaking scene—the younger boy and older teen-aged girl leaning their heads into the gathering arms of this strong woman. I walked slowly by, looking for the nurse to ask her where our patient had disappeared. Not finding the nurse, I ran to the lounge for a quick bathroom break.

Returning down the hallway, I happened upon the same scene playing out that I had just passed by, the shorter older woman still embracing the younger two people while turning her head and softly taking turns whispering into each’s ear. It was a touching scene, one that struck me as both comforting and tragic.

Suddenly, though, I heard the hallway nurse yell out, and turned my attention to the young, blonde nurse who was doing the yelling. “Amelia,” the nurse scolded as she approached the same group of three from the opposite direction as me, “leave this family alone.” I was confused. I looked to the group of three. I looked at the nurse. And I looked back to the group of three just as the nurse touched the older woman on the shoulder and spoke again. “Please, Amelia,” she pleaded, “you need to go back into your room and leave this family to themselves.” The nurse’s voice cracked, begging of Amelia to not put up any resistance.

I stood still, staring at the scene. I looked at the group of three breaking apart, the older woman lingering to release the younger people from her arms, being urged on by the nurse. I looked at her pained face, watching as she whispered her last words to the young family members, releasing them hesitantly from her grip as the nurse coaxed her towards Room 17. And suddenly, with amazing clarity, the truth of the scenario smacked me in the face. Amelia, my next patient with the psychiatric history, was the “grandmother” who had been embracing two of the family members of the trauma patient.

“Well, I’ll be,” I whispered to myself while approaching Room 17’s doorway. The beauty of Amelia’s gestures were not lost on me, but I readied myself to have a serious discussion with her about privacy issues and respect and all of that stuff. Any family such as this trauma patient’s deserved their privacy in the depths of such crisis. Before entering the room, however, while I was putting a pair of latex gloves on in the hallway, I overheard the two recipients of Amelia’s hugs speak.

“She was a nice lady, wasn’t she?”

“Yes, she was,” the other responded simply. “I wonder what she is here for?”

“I don’t know,” the first answered, “but I hope she is alright.”

I paused to absorb the enormity of the moment, realizing that kindnesses can come from the most unexpected people in the most unexpected places at the most unexpected times. Despite Amelia’s personal struggles, most of which I could only imagine in her daily dealings with mental illness, she gave of herself that which she could, some heartfelt hugs. Hugs that appeared to be received with the intent for which they were given. Those hugs of Amelia’s, well, that was a darn-special privilege of mine to get to witness—one stranger comforting others in their moment of crisis.

Maybe all of this stuff the nurses warned me about Amelia were a thing of the past.

I walked into Room 17, extending my hand in greeting. “Hello, Amelia,” I said with renewed faith in our patient, “I’m Dr. Jim. What can I do to help you today?”

She mumbled something as she paced beside her cot. “Pardon me?” I asked her. The medical student accompanying me gave me a look that he, too, did not make out her words.

She wasted no time in speaking up. “What the hell is wrong with you people I should be out there with those people they need me don’t make me come back in here.” She spoke quickly, hauntingly, in one long exasperated breath.

Even though I knew Amelia wouldn’t like my explanation, I quietly explained to her that, although her hugs were welcomed and appreciated and quite nice, actually, we all had to respect the trauma family’s privacy at such a profound moment of sadness. I reassured her, though, that her actions were a privilege for me to watch and that the family appeared to appreciate her gesture.

“Now,” I continued, “what can I do to help you today?”

“Get me the hell out of here,” she said, glaring at me. “I don’t need to be in no room next to where bad stuff happens.”

I offered to try to find her another room, but she turned the offer down. When I asked her what her complaints were that I could help her with in the emergency room, she ignored me. “I want to leave,” she said with conviction. I made her assure me that she had no pains anywhere. I was reassured by her words that she was having no feelings of despair or urges to hurt herself. Thankfully, she had also assured several of the staff that she was not depressed or having any ideations to harm herself. And judging by her hugs, it appeared that all she wanted to do at this very moment was to help others in need.

“Amelia,” I said calmly and kindly, “are you sure you are going to be alright?” She nodded her head yes. After her hallway hugs, I think she truly forgot what reasons she had that had brought her to our ER that day. I discharged her from our ER without any workup after she passed my screening exam and a consultation with our case managers.

I can’t forget, though, why I think Amelia was there. I think that sometimes, in some mysterious ways, things happen in our daily lives that defy explanation. For unexplained reasons and circumstances, Amelia chose to visit our ER on a day when a few others were in need of a heartfelt hug.

And from Amelia, that got just that.

As always, big thanks for reading. I hope this finds you well. And to those of you who have continued urging me to write, I thank you. Your kindness has been felt…Jim