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? And I certainly didn't want to finish my night by getting the angry stink-eye from an eight year-old girl waiting three hours for her rash to be treated.   

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? Did you eat corn lately? 

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 place 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? Your thoughts?

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 more diarrheal and vomiting accidents in their car. Everything she was wearing was soiled. 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. Talk about a walk of shame! In her room, she had yet 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? Would I be smiling a devilish smile while doing it? Would I do it during the day or wait until nighttime? Would someone spot me the way I spotted this fellow? If so, with my luck, it would be a newspaper reporter holding a camera.

I'm hopeful I won't ever be in this position but one never knows for sure. I'm sure this guy didn't plan on having a witness. Maybe one day, I wondered, I might 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. Or maybe I will just be an angry old man who needs to show the ER staff who's boss. 

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!

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...