Thursday, April 25, 2019

Senator Walsh...Thank You.

Senator Walsh...Thank you.

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

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

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

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

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

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

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

Senator Walsh, have you...

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

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


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

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

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

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

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

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

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

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

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

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

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

Heartfelt thanks...♥️

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

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

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

Friday, March 8, 2019

Wallowing In It

"Sometimes shit just happens."

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

It was a safe choice to leave this way, as it was 3 a.m. and both the ER and the waiting room were still swarming with much activity. Had I tried to navigate leaving through all the chaos of the waiting room, I would have been a target of many evil and angry stares from those patients who continued to sit there with non-emergent complaints, watching the lone TV that was looped with repeating segments regarding diet and fitness. Of course, who wouldn't want to learn the benefits of eating cauliflower and doing fifty daily sit-ups at 3 a.m., right? 

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

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

I shouldn't have. 

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

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

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

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

Of course, this scene caught me off-guard.

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

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

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

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

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

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

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

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

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

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

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

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

Arriving home and pulling into my driveway, my mind went from all these thoughts back to my squatting friend. Catching him in his private moment dominated my thoughts for my twenty minute ride home and took my mind in the directions above. I wondered if someday I would ever be caught squatting outside, pants down around my ankles, grunting and doing my business with reckless abandon. If so, would I have an extra Kleenex in my pocket? I would hope it wouldn't come to that. Furthermore, I wondered if I would ever be a patient in the ER having an accident. This would be a more likely scenario. If so, it will probably happen when I am elderly and obsessed with my bowel movements and the amount of daily fiber I am intaking. 

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

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

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

Friday, March 1, 2019

Fleece Pajama Bottoms 2019

People will stare. Make it worth their while. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Enough said...

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


Tuesday, February 19, 2019

It's Not About The Pus

To Dr. Sandra Lee. Heartfelt thanks for humanizing medicine and for inspiring along the way...

Several years ago, my daughter Emma introduced me to some videos on YouTube of a dermatologist from California who posted her sometimes shocking but always intriguing encounters with patients who suffered from a variety of dermatologic issues. Of all of these videos, it seemed like the ones which made Emma happiest to watch were the videos in which this doctor's treatment resulted in gallons of pus draining from some part of the patient's body.

Well, okay--Emma liked pus and blackheads. Well, pus and blackheads and massive lipomas (fat-based tumors). Well, pus and blackheads and massive lipomas and big hairy moles. Well...

You get the picture.

With some great finesse and skill, and with a good mix of humor and learning, Dr. Sandra Lee, better known as Dr. Pimple Popper, was able to help many embarrassed patients survive their dermatologic issues, all the while captivating my daughter's interest. "Eewww, gross," Emma said. "Let's watch it again!"

Suddenly, my job as an ER physician was boring. Stories of heart attacks, strokes, traumas, broken bones, asthma attacks, allergic reactions, even drunks vomiting on me at 3 am--none of them held any excitement compared to the ten-year old massive cyst that Dr. Lee excised from a women's scalp or the golf ball-sized lipoma she removed from the upper back of a man who hid it by wearing a draped shirt. Yes, it was intriguing even for me to watch. How was I going to compete with Dr. Lee popping juice out of everything she touched?

I lost my daughter to the wonders of Dr. Lee. "Dr. Pimple Popper is so great, Dad!"

Not only Emma, but soon my friends and family were asking if I did "the stuff that Dr. Pimple Popper does." They too couldn't seem to get enough of the various videos posted on YouTube. And like Emma, more pus equaled more entertainment. Pus that flew across the room--well, that created a giddiness that could not be contained.  

"Yes," I would answer, "sometimes I have to drain an abscess from someone's armpit or groin due to an ingrown hair. Sometimes I have to drain abscesses from wounds, too." For good measure, I added, "And sometimes I have to drain a thrombosed hemorrhoid." I know there are many more invasive procedures we perform in the ER that could be considered similar, but I couldn't think of them quickly enough. At least, I thought, I would get asked what "thrombosed" meant, right?

I was wrong. After finding out that most of my procedures were performed on problems smaller than the size of a tennis ball, my people lost interest.

As the last few years passed, I was happy to catch an occasional YouTube video of Dr. Pimple Popper. Dr. Lee's contagious personality and warm smile, combined with her intelligence and skills, helped her to create a spectacular vehicle, by use of videos, to share the fascinations of her profession. She was a natural at bringing some amazing stuff to eager viewers who were insatiable for her.

On a recent trip with friends to Toronto to celebrate the arrival of 2019, we had returned to our hotel rooms one afternoon to rest for a few hours after a very late previous night of fun. While channel-surfing, I was excited to rediscover Dr. Lee and learn of her new television show on TLC. Desperately needing a nap, I committed myself to just watching her for ten minutes, maybe fifteen at most.

Fifteen minutes turned into two hours. In the blink of an eye.

This time, though, watching Dr. Lee was a very different experience. Yes, all of the fascinating lumps and bumps and lesions that needed squeezed, drained and excised still existed. Yes, white and brown and green and black pus still oozed from the majority of her patients. Yes, many of her patients still found brilliant ways to hide their ailments for years, under wigs and baggy clothing or with caked-on makeup.

This time though, among all the hoopla, I was able to appreciate Dr. Lee's magnificent mannerisms, her empathy, her compassion--her realness, so to speak--in dealing with her patients. Recognizing these things initially, I believe, had gotten lost within all the other excitement. I was more focused on how fast she could duck away from some flying pus rather than her gentle approach to patient care.

For example, after a patient was kindly greeted by office staff and placed in an exam room, the real magic began. Dr. Lee would softly knock on the door of the treatment room before entering, wearing a smile and exuding warmth. As she approached the patient, hand extended in greeting, she would establish eye contact with the patient and introduce herself with a gentle and calm voice (sometimes simply by her first name). From there, if anyone else was in the room, she would turn her attention to them, making sure to introduce herself, repeating the process until she was acquainted with each person in the room. After introductions, she would sit down (yes, sit!!!) and begin her interview with the patient, involving the patient's company, learning everything she could about the reasons a patient was visiting her. Respect was given and received. Eventually, a wonderful level of comfort was achieved.

I could continue on with the importance of Dr. Lee's empathy and compassion while performing a detailed exam, explaining her findings of the exam, reviewing test results and options to treatment, and mapping out the future course of dealing with a patient's ailment, but it all seems rather obvious, right?

Or does it?

You would be surprised at the number of patients who go through the process of a medical encounter only to leave with confusion, frustration, or feeling worse than prior to their encounter. No introductions. Standing at bedside with arms folded, appearing disengaged and aggravated. Rushed conversation. No updates. Abbreviated result explanations and dispositions. This is the reality of an encounter for many patients.

Ugh.

Recently, a close friend of mine had to take his elderly mother to a rural ER twice, in a span of two weeks, for some serious and concerning symptoms. To hear him talk of the vast difference in the care they received, by the same facility but different treating teams, was upsetting. During the first encounter, introductions were made, respect was given, explanations were provided, and a detailed treatment plan was initiated. During the second visit, there were no introductions by either the physician or nursing team. His mother was dismissed or hushed each time she tried to explain her symptoms in some depth. They were made to feel like a nuisance. No rechecks were performed. They sat around for five hours wondering what was going on. Their questions brought no answers. "And Jim," he said, "only about five of the twenty rooms had patients in them." My buddy's family was truly disheartened and discouraged by the encounter.

Years ago, during my emergency medicine residency in Syracuse, we had a physician who gave lectures to us on the importance of empathy and compassion. Being young-guns in a big trauma center, Dr. Ruth's lectures were not nearly as exciting to my buddies and I as compared to lectures on how to drain an expanding epidural hematoma (a potentially fatal arterial brain bleed) or perform an emergency thoracotomy in a trauma patient (rapidly opening the chest between ribs to clamp a sheared aorta or contain bleeding from a punctured heart or lung, for example).

Yet, it was during residency when I truly realized the power and magnificence of empathy and compassion in medicine. Of respect and dignity. Of smiling and bringing into a patient's room good energy. Of sitting down if even but for a few minutes. Of introductions and eye contact to all in the room, not just the patient. Of a warm handshake. Of explaining findings of the exam, of the testing and procedures to be done and the ensuing results, and of a plan moving forward. Of rechecking the patient during their medical visit. Of properly closing the loop of their visit with a goodbye or good luck wish.

Of being human.

This was a crusade I took up while working with our residents as a core faculty advisor. I became Dr. Ruth, insisting on my residents bringing their very best to each patient encounter. While empathy and compassion and ease of conversation was inherent and easier for some residents, for others more time and work needed to be invested to improve this part of their patient encounters. An investment, I stressed, that was worth pursuing.

Yes, the ER gets busy. Crazy and insanely busy. I get it. I've witness it firsthand for 22 years as an ER attending physician. However, all of these things mentioned above take just a few extra minutes. Providing anything less is met with too many excuses. Occasionally, in the emergency setting, it truly is beyond our control that we simply can not provide more empathy or time to a patient (think about a car accident with four critical victims arriving at the same time). Otherwise, if it were me or my family or friend lying in that hospital cot as a patient, I would greatly appreciate those few extra minutes of kindness and compassion provided by the treating medical personnel.

What if it was you or your family member?

Returning to Dr. Lee's TV show, then, on that lazy afternoon in Toronto, I greatly appreciated her kind approach to each patient. Sure, she might have more time working in an office setting that is more predictable and controlled compared to my working environment in a big trauma center. Sure, she is being taped to splice together some great scenes and moments of the various care she provides. Sure, anyone might give a little more of themselves if they know they are being watched. However, Dr. Lee consistently demonstrated her excellent bedside manner with each patient encounter I watched. She excelled and inspired in a part of medicine that is often ignored and overlooked, all for the sake of moving more patients in and out and increasing the billing so more profits could be made.

I could have cared less about how much pus would fly out of her next abscess or where it would land. I was enthralled on simply watching a great doctor doing her job well, from every perspective.

I hope Emma was, too.

Thanks, Dr. Pimple Popper. It was never really about the pus...

As always, big thanks for reading. What are your thoughts and experiences?   

Feel free to forward or share this post. To visit some of my favorites listed from the archives, visit Thank You...

I continue to be amazed with the amount of support and readership. My heartfelt appreciation to all...   

Tuesday, February 12, 2019

4, 3, 2, 1 And 90.

Everyone you meet is fighting a battle you know nothing about. 
Be kind.
Always.

One of the largest problems in our ER, it seems, is that there is a subset of patients who visit us on a routine basis. Commonly known as "the regulars," these familiar faces are sprinkled throughout our day between all our other patient visits. Whether it be for chronic pain, for chronic illness, for companionship, simply to have a place to hang out for a few hours, or to get some food, we are often inundated with these patients at the most inopportune times. Three trauma patients, four chest pain patients, two stroke patients, seven respiratory distress patients, three lacerations, two compound fractures, and five sick kids--and arriving between all of this organized commotion of providing good care are Johnny, Sally, and Herb, with a combined total of over two hundred visits between them.

It is a real problem in our ER. It is a real problem nationwide.

Of course, the most compassionate thing to do would be to sit down and spend some time with these patients. Human to human. Heart to heart. It seems like most of these patients simply exist in our society without participation. Unfortunately, though, this is not our reality. We just don't have the time among all the other serious happenings in our ER that require our attention. We can consult our case managers to evaluate options of living arrangements, of providing adult services, and  to spend a few extra minutes with these patients, but they too are often overwhelmed with what's required from them in our busy ER. Hopefully, between the attention given to them between myself, the nursing staff, our aides, and our case managers, their needs for that day's visit are met.

As an outsider without experiences in the ER, it might be hard to fathom this problem existing to such a degree. So imagine your sick child with a high fever and trouble breathing, your sick friend or family member who has chest pain or a facial droop with difficulty talking, or yourself after a car accident being brought to us because your leg is deformed with a bone sticking out, and you can easily understand what patients require more of our time and attention. Sadly, it is not Johnny, Sally, or Herb. You would want us, your treatment team, to be fully invested and immediately available to you or your loved one in such a dire time.

On the rare occasion that our ER is not busy and one of our regulars show up, though, I do like to take the time to sit down and learn a bit more about them. These moments when I have this opportunity, I am usually surprised at some of the things I learn from our regulars. Their stories are compelling--some of these patients experienced things that I never will, whether it be heartaches or triumphs. It is from these talks that I am usually the one leaving the encounter more enriched and appreciative. These folks are resilient and intelligent--some are quite the masters of storytelling and all of them have life stories that are intriguing.

On a recent shift, still busy but not overwhelming, I had the pleasure to treat Kevin, another one of our regulars, and spend a little more time with him than I would usually be afforded. In his mid-fifties, Kevin was homeless. He was frail and had unfortunately progressed to relying on a walker, due to a multitude of medical problems, for ambulation. His last visit to our ER was just three days prior. 

Walking into Room 22, then, it didn't surprise me to see Kevin sitting in his cot and his royal blue walker sitting in the room's corner. Several tan plastic bags (with a local market's emblem) occupied both his walker's seat as well as a maroon hospital chair. These bags contained all his life's belongings. His beat-up brown Carhartt jacket filled the second chair.

"Kevin," I said, entering the room after knocking on the metal frame and pulling aside the curtain, "it's good to see you this morning." Extending my hand to his, we shook as I took in his appearance. Kevin looked tired, wiped-out, skinnier and worse for the wear since the last time I had seen him. His full head of gray hair and beard were matted and unkempt. His blue eyes were dull. Nasal hairs met his upper lip. A patch of keratosis on his left temple was scaly and pale. His pointed nose and thin lips added sadness to his narrow, long face. His arms and legs were wiry and bony. He was frail.

Kevin looked intently at me, holding tightly a large cup of coffee in his left hand. "Hi Doc," he said, his voice hushed, as it was usually. "My stomach is upset and I feel like I have to puke." After speaking, he took a long drink of his coffee.

"Sorry to hear this, Kevin," I said. His ability to drink coffee, despite his complaints of nausea and stomach pain, was not lost on me.

After asking him a multitude of questions (diarrhea or constipation? fever? where is the pain? how long have you had it? constant or intermittent? ever have this pain before? etc.), it was clear from Kevin's nonspecific answers that he might have had other goals, rather than acute illness, for visiting our ER this day.

"Maybe my belly hurts sometimes, Doc."
"I'm not sure how long I've felt this way."
"No, I didn't puke, but I thought I was going to yesterday."
"Sometimes I have a good shit in the morning. Sometimes I don't."
"This coffee helps my stomach, Doc. Can I have more?"
"Do you still have packs of crackers?"
"It's cold out there today."
"I might need to stay in the hospital for a few days, right?"

You could see the natural progression of his answers and what his intent was in coming to the ER.

 I performed a detailed exam and found him, despite his chronic medical issues, to be stable and well from an emergency perspective. Labs were drawn, a urine sample sent, an EKG performed. All his results were favorable. Kevin deserved this workup to make sure he was safe.

"Kevin," I asked, after finishing the interview and physical exam and reviewing his results, "is there anything else we can help you with today? It seems that your exam and results are okay today, so this is a good visit."

And this is where Kevin broke me and exposed the weaknesses of our system and my job. "So, Doc," he asked, his dull eyes fixing on mine, "you are going to just send me back into the world then?"

Ugh! What a question. "Yes, Kevin," I said, "we are going to have to send you back into the world."

"Why can't you admit me? Even for just tonight?" He took another swig of his coffee.

My hands were tied. I certainly couldn't admit him--the hospital isn't for this purpose. Yes, we could see what we could do about his safety. Yes, we could feed him. Yes, we could spend a few extra minutes with him this visit. In fact, Kevin's nurse, Nurse Pearl, was as invested in Kevin as much as I was. Even more. With her blond hair, calm voice, caring demeanor and big heart, Nurse Pearl was the perfect nurse to care for Kevin during his visit this day. She spent much of her free time with him--she cleaned him up, washed his face and even put hospital-issued socks on his feet. I commended her for her compassion to which she replied, "There's something about being clean and washing one's face that makes people feel human again."

Together, we formulated a plan. We agreed to try to find Kevin some food. She and I agreed to get our case management team involved to see what our options in helping Kevin might be on this day.

After five minutes, we reconvened in Kevin's room. He had already put on his Carhartt jacket and was packing his filled plastic bags into the small compartments on his walker. "Kevin," we said, proud of ourselves, "here are a few things we found to help you." And we spilled our contents in front of him.

Four breakfast bars.
Three juice boxes.
Two turkey sandwiches.

Kevin seemed quite grateful for this attention and supplies.

Nurse Pearl and I were on the same page. Handing out food in the ER under these circumstances can sometimes be quite conflicting among my co-workers. Some are of the belief that we shouldn't, as it might encourage more visits among these patients. Others, like Nurse Pearl and I, believe that these patients will be returning regardless of the food handouts. The root of this problem, to us, lies deeper. It seems too many of our patients are lacking support, proper care (including mental health issues), and safe environments during their hardest of times. The answer? I wish I had one... do you? Discussing this dilemma with my 89 year old father, though, was simplified to this. "Jimmy," he said, "you have to do the right thing--if you can help feed a person who's hungry, why wouldn't you?"

After the case management consultation, we were able to help place Kevin into a shelter.  In fact, Nurse Pearl went so far as to arrange a taxi to safely transfer Kevin to the shelter. Prior to leaving, Kevin could not contain his gratitude. "Thank you, sir." "Thank you, ma'am." Have a nice day." "This is really great." "I am really happy."

One community shelter.

All in all, it was a good day for Kevin. More importantly, if was a good day for Nurse Pearl, myself and our support team. We were reminded that empathy and compassion for one another must never be lost or forgotten during these privileged encounters.

Ninety minutes.

The amount of time Kevin was in our ER, reminding us of the the real reasons most of us chose to go into medicine.

Some things you just can't learn in a textbook. You learn it from your heart.

As always, big thanks for reading. What are your thoughts? It was wonderful to have the time to spend with Kevin, which isn't always the case in our extremely busy ER/trauma center. 

Feel free to forward or share this post.

Thanks to each of you for the overwhelming response to my return. Your comments on here as well as Facebook, email, and Instagram have been generous, kind, and inspiring... I am grateful.

Friday, February 8, 2019

To Care Or Not

I dedicate this to each of you who have cared for or are currently caring for an ill parent or family member. 

Recently, due to the stress that several of my dearest friends have been experiencing in caring for their elderly parents, I am even more appreciative and respectful of my privilege in caring for elderly patients who have attentive and loving adult children who accompany them to our ER.

Although this may seem like it should be the standard, you would be surprised at just how many elderly patients present to our emergency department alone. At times, it is heart-breaking to hear their shared stories of being the lone survivor of their family, of being estranged from their children, or of having geographical factors contribute to their aloneness in presenting to me for care. So when an adult child is present, I make it a point to not only introduce myself to them, but also to thank them for being available for their parent. Including them in providing more history and in discussions about testing and treatment plans for their parent benefits not only their parent, but also myself and my team. I am grateful for their presence and input.

A few months back, however, I had both the pleasure and discomfort of witnessing two vastly different situations in how adult children interacted with their parents.

The first interaction came early in my day shift. I had just rounded the corner of one of our busier hallways near our noisy triage area to find a favorite aide leading a family from our waiting room down the hallway toward their assigned room. The family consisted of two middle-aged adults, a teen-aged boy, and an elderly woman who relied on a walker to ambulate. As the tech led this family, it became clear to me that the elderly woman was struggling, lagging behind the others. Noticing this, I stepped forward as the aide simultaneously stepped back to help this woman continue forward with less struggle. 

The woman, who was wearing a simple purple dress with white walking shoes, with messed shoulder-length grey hair, was quite appreciative for our efforts. She paused to look with her wrinkled face first at the aide, and then to me on her other side, rewarding me with a warm, generous smile. Even tired, she had a gleam in her eyes that conveyed her gratitude.

Sadly, the members of her family didn't want to be bothered. Asking the aide for their mother's room number, they continued down the hallway at their own rushed pace, walking into the opened door of Room 31, which was about 50 yards away. The aide and I glanced at one another, with a look of bewilderment, before continuing onward in guiding this patient. By the time we got to Room 31, the patient's family had already turned on the TV, both adults sitting in provided maroon chairs and the teen-age kid sitting on the edge of the bed. 

Ugh. The aide and I continued to lead the patient into the room. Together, after asking the teen-ager to get off the bed, the aide and I eased the patient onto a stepping stool before hoisting her into the bed. We sat the back up for her to be more comfortable. All the while, the three family members, who I learned later to be her son, her daughter, and grandson, focused all their attention onto a sporting event on the TV. 

You get the picture, right? Clearly, this was not to be another love story I would bear witness to and write about between an adult child and his parent (visit A Love Story). I am not naive enough to believe that all parents are perfect, and that some may have made mistakes or caused pain to a child--I am simply stating that as an outsider, this is a hard scenario for me to witness. 

I left the room as the aide was changing this patient into a gown. Later, she found me.

"Can you believe that family? I would never ignore my mother that way. They were so annoyed to be here and didn't even say a word to her!" The family bordered on making Lauren angry, and that wasn't a good thing. 

As I was not this patient's treating physician, I shared the story with my partner, who was treating the patient. His experience was disheartening. It seemed the family was completely uninvested in their mother's care, opting to ignore her while they watched TV before visiting the cafeteria to eat, returning only to act annoyed that they still had to wait for her results. After it was decided that this patient would be admitted, the family, instead of waiting for their mother's room number and assignment, left. Their mother would be transported to her admission room without any supportive family accompanying her.

Later in the shift, thankfully, I was privileged to witness an outpouring of love between a parent and her grown children during a visit.

Margie, my 72 year-old patient, was a beautiful spirit trapped in a failing body. Her short brown-dyed hair, her worried face, her clear eyes with underlying dark circles, her protruding cheekbones, and her thin frail body sat upright in her cot, covered in several warm blankets in attempts to help her chills and aches. Despite her fragility, she greeted me in sassy way.

"Well, hello there. Are you going to be my doctor today?" she asked as I entered her room

"I am, ma'am," I said, extending my hand to her. Her hand, cool and boney, felt fragile in my grip.

"Good then," she said, "let's get busy and figure out what is wrong with me."

Immediately, I liked Ms. Margie. She had a coy yet innocent way about her.

In the corner of her room sat her three adult children, two women and a man. All three were attractive and had their mother's clear eyes. They appeared nervous, of course, and I sensed that their mother's reason for being here was going to be a serious one.  I walked over to them and introduced myself to each of them, shaking their hands and learning their names. As customary, I thanked them for being in the ER with their mother.

"You do know how much you are loved, right Ms. Margie?" I said, starting the conversation. "You have not one, not two, but three children with you tonight. How wonderful and blessed are you. I don't see this much support too often."

"I am a lucky lady," she said pensively. At that, one of the daughter's spoke up. "No, Dr. Jim, we're the lucky ones." I liked these children as much as I liked their mother.

As I interviewed Ms. Margie, it was refreshing to see how all three kids were involved in her life and knowledgeable about her symptoms. It seemed all three of them, each with their own family to attend to, took turns spending an unselfish amount of time with her. Several years prior, her husband and their father had passed. Ms. Margie, with her fierce independent streak, insisted on remaining at her home and the kids did everything possible to continue making her comfortable.

As I gathered information from Ms. Margie and her kids about her symptoms, I felt my concern for her well-being exponentially increase. She smoked although "I've really been trying to quit, Dr. Jim." She had several months of significant weight loss with increasing fatigue and weakness and, despite her children's urging, refused to see a doctor until several weeks prior to her visit with me. Finally, with her continued deterioration, she agreed to her children's requests to come to the ER for some workup.

Her workup was heart-breaking. Initially, her chest x-ray revealed a pretty large mass in her lung. While Ms. Margie was over in the radiology department getting both a CT of her chest and brain for further investigation of this mass, I stopped into her room to visit with her kids.

"Are you all doing okay?" I asked, opening up a chance for them to express their concerns.

And they did. "Is it cancer?" I answered that I was very suspicious of this, yes. "Is Mom going to die?" I told them that we had several bridges to cross to figure out exactly what it was and what we could do about their mother's results. "Should we share any bad results with Mom?" Yes, I said. I told them that most patients inherently have a feeling when something isn't right, and their mother was one of those patients who would not want any of the results sugar-coated.

They continued to ask questions, all rooted from a very deep, endless well of love for their mother.

Finally, one of the daughter's broke down and started crying. I walked over to her and gave her a hug. "I'm so sorry," I said, "but I think your mother, no matter what her results, is going to have the best support ever from you three." My compliment was sincere--Ms. Margie was blessed, no matter her results, to have these three children accompany her on this journey.

Unfortunately, Ms. Margie's results were devastating.  Lung cancer--a huge mass residing in the right middle lobe. Brain metastasis--multiple lesions sprinkled throughout. Bone metastasis--"cystic lesions" consistent with cancer in her vertebrae.

Damn it all.

I went into the room and sat on the edge of her bed, explaining Ms. Margie's results to her while her three children crowded around her, holding her hands and stroking her hair. Though brave faces were attempted, tears fell plentiful and freely. Mine included. We admitted Ms. Margie to the hospital to have a variety of consultations and begin her journey of fighting cancer.

Despite such different situations involving adult children accompanying their ill parent to the ER, the depth of emotions I felt, whether good or bad, ran deep. I felt such despair over what I witnessed regarding the mother with her walker being ignored by her family. I felt such despair for Ms. Margie and her kids, too. The difference, though, was that this despair for Ms. Margie was minimized by the amount of hope, by the infinite love, and by the sincere compassion that her children provided unabashedly to her. The power of their presence and investment in her well-being was magnificent.

Ms. Margie was transported to her admission room with her three caring kids beside her.

I get it. Some parents failed their children. And some didn't. And the ripples from these relationships travel far. I understand that some of these relationships have a reason to be strained and forced. With all of these factors, though, I'm a pretty damn privileged guy when I get to bear witness to the unselfishness and unabashed love an adult child has for their ill parent.

I love my job...

As always, big thanks for reading. Have a great weekend. To my dear friends and each of you who are involved and invested in your parent's care, my hat is off to you. Big kudos for your unselfishness and love. Please feel free to share your thoughts or experiences. 

Also, big thanks for the amazing support I received upon my return essay. It feels good to be back.

Tuesday, February 5, 2019

I Feel Things...

I'm  back! Thanks to the many people in my life for their support and encouragement upon my returning--you know who you are! Please feel free to repost, share my return, and visit my archive!

Well, well, well...hello my long, lost friends. I missed you!

It seems like a long, long time since I have written a post for my blog, StorytellERdoc, and I am excited, nervous and humbled to be reentering your lives while returning to my baby.

What started as a small adventure and challenge from my writing group, with my first posting on November 19, 2009, turned into quite an amazing ride throughout the literary and social media world. The number of friends I met was staggering. I received recognition and awards. I won prizes. I was interviewed and contacted for my opinions. I got over a million hits. All of these things, though, were secondary to my intent. I simply wanted to pull you into my world, through my words, to focus on obscure life and ER moments that possessed a level of rawness and realness that connected you and I as fellow human beings. I wanted my words to be a reminder that choosing empathy and compassion over cynicism and sarcasm was possible.

On this journey, I posted 150 essays about life, patient encounters, and magnificent small moments--writings that to this day I can still read and feel the array of emotions I poured into my words. These writings made my heart swell, my eyes tear, and my smile broaden. They still do. My last post, on March 16, 2015, was not a planned exit from writing for my blog but, unfortunately, life happens and I needed to take some time to gather the bits of myself that became brittle and crumbled over the years. I had life lessons I needed to absorb. I had experiences I needed to process. I had to refocus my energy and passions and love onto the things and people that deserved my attention.

I am human and I have flaws. My life isn't perfect. Not even close. Now, though, it's in a much better place, thanks to a lot of internal work and introspection. I have more clarity.

I am back and stronger than ever. Personally, I look forward to sharing with you my journey. I hope to entwine my life experiences into my writings. Professionally, I still smile when I go to work, which is all I really need to say about that, right? The emergency department where I have worked for 22 years as an ER physician is busier than it's ever been. We are treating everything from devastating traumas to irritating hang nails. Among the 90,000 patients that we treat yearly, you can imagine the numerous interactions and situations that exist, simply waiting to be witnessed and observed.

I hope to be that witness, that observer. I hope to bring to you, through my storytelling, a perspective that is unique and intriguing in the way it unfolds the the human spirit with the laughter, the tears, the triumphs, and the pain of an encounter. Some stories will be personal, some will be professional, but all of them will be heartfelt.

In many ways, I am still the same person you got to know through my essays over the past few years. If you revisit these essays (visit the archive or try Gigi or The Witness), you will still capture my essence. As before, I still love my three amazing kids and my big forestry family. I still miss hearing my mother's voice. I still wear my heart on my sleeve. I still love my diverse friends and music and books and the gym and laughing and a good meal and sleeping in. I still love the privileges of my job--I continue to meet, accompany and treat some pretty amazing and memorable patients and their families during their stressful ER journeys.

In other ways, though, I have changed immensely. These changes will be revealed slowly, with time.

At this very moment, as I sit here in front of my computer screen, I am very nervous but grateful for the chance to enter your life with my stories. I offer my warmest thanks for your patience and time as I begin to expose my layers to you, once again.

While recently deciding to pursue this journey again, I signed into my ignored email account and was surprised to find many unopened emails from the past few years. They were wonderful, supportive, and encouraging. Some correspondences took the time to share their personal experiences and connections to my essays, and these emails made my decision to return even easier.

Let me share..."I don't remember what prompted it, but I ended up over at your blog the other day. What I thought would be a quick trip is turning into a multi-day journey back through all of the posts I read years ago. Once again, I was amazed at your gifted storytelling, your attention to detail and the way they're all seamlessly woven throughout, and the gentle, inspirational way you share with us readers perspectives we will otherwise never be able to see. Katie"

Again..."Thanks for the beautiful stories and insight from the physician's perspective. Please keep the stories coming. I look forward to each and every one. Thanks for sharing your experiences with us. They touch our hearts and many times make us smile and feel uplifted if only for but a while. Shirley"

And again..."Yours is not the first ER blog that I've read but there is an obvious difference. You don't seem to have the customary judgmental bitterness. I've been thinking about it and what makes you different from another doctor. I think part of it is that you are not afraid to feel things. Most of us spend our whole lives trying to get away from the bad/uncomfortable feelings. After a break up you stay busy and party with friends to avoid those feelings of sadness, etc. I think many ER doctors have shut themselves off from the feelings of their patients. Their goal is to become immune to the suffering by reason of self-preservation. You, on the other hand, seem to see that it's ok to be sad about something sad. You are not afraid to experience your feelings but you also don't live in them, either. I think this is why you've kept your humanity. Anyways, thank you very much for your writing. Jennifer"

So all my mumblings above come down to this...

I feel things...

I hope I can make you feel things, too...

Until next time...

As always, big thanks for reading. To all my faithful readers--hello, friends! Thank you for returning. To my new friends, thank you for giving me a chance. I look forward to sharing this incredible new journey with all of you!

Jim