'Tis The Season

Although I have been meaning to post for the past week, the end of summer and a stack of shifts have kept me from fulfilling my intentions. I had no problem posting three times a week during this past school year and can only hope that my writing resumes as the kids return to school and the household takes on a familiar, old calm. Thank you, friends, for your patience.

That being said, it seems that another return-to-school season is upon us. Advertisement fliers, spam emails, classroom notifications, clothes and sneaker shopping, and the accompanying pressure to squeeze in every last unfulfilled summer moment during these final few weeks are at an all-time high. Fun, yes, but not how I would choose to spend a sunny, warm, lakeside day--fighting off the crowds at the local sporting goods store to buy a heavy-duty, cool-looking knapsack before they run out.

At work earlier last week, then, imagine my surprise when I realized that within the hubbub of excitement of school's return and summer's ending, I missed the approach of yet another season--football season. A season filled with devoted fans and amazing plays and incredible athleticism. And, if you happen to work in an emergency department, you know the other truth--it is a season sometimes filled with unfortunate injuries.

I walked into Room 30 to see my next patient, a fifteen year-old male coming straight to us from his school's football field. His first "official" football practice, full pads included, had just finished. Practice was six hours, from 8 a.m. to 2 p.m.

Somewhere around noon, this patient had taken a hard tackle and had gotten knocked to his left side, injuring his left shoulder. Despite his pads. And despite his pain, the patient had kept quiet about his discomfort and had finished out practice. He hadn't wanted his friends or coaches to think he was "wimping out." When his mother arrived to pick him up, however, he told her his shoulder "wasn't feeling right." That's when they decided to visit us.

The patient was a big, husky boy, from the corn-fed, steak-and-potatoes species. He lay in his cot, on his right side, while his mother and father and younger sister hovered near him. He greeted me with a smile as I walked into the room.

"Hi, Seth," I said, shaking his right hand after introducing myself to his family, "what the heck happened to you on your first day of practice?"

His head, topped with a mop of curly brown hair, shook with disappointment. "I don't know," he answered, his half-boy, half-man voice cracking, "I practiced all summer without pads and today, the first day of practice with full pads on, I get hurt. Go figure."

After reviewing his history and performing an exam, which revealed intense shoulder pain (at the proximal humerus), we sent him for x-rays. While he was gone, I checked in with the family.

"What do you think, doctor?" the father asked me. "Honestly," I replied, "I think he broke it." The parents shook their heads. "I knew we shouldn't have let him play," his mother mumbled before turning to me to explain, "this is his first year doing this sport." It seems he had grown significantly in the past year and wanted to give football a try.

Sure enough, his x-rays revealed a horizontal, transverse (a clean line), non-displaced fracture of his proximal humerus. Although treatment for this type of injury is a minimum of 4-6 weeks of wearing a sling, Seth's football season, by the look on his mother's face, was probably not going to resume after that time.

It's a tough call, this sport. I think of Charles Dicken's famous line, "It was the best of times, it was the worst of times... ," when it comes to football. Although the sport is awfully exciting, it does come with an increased risk of injury. We've all seen those clips of devastating injuries. In fact, I'm sure many of us know someone personally who may have gotten hurt playing this great Americansport. For me, it was my tough, older brother, Johnnie, hospitalized when I was a kid from sustaining a head concussion during a football game. And between me and you, I still don't think he is right (a "little brother" dig there). What to do?

Despite my hesitations, three years ago, when my nine year-old son approached my wife and I about playing, we hmm'ed and hah'ed over our decision. Ultimately, we chose to let him play. Being a good athlete, we watched him successfully play running back the past three years, taking his share of hits but never losing a game during this time. This year, though, he wants a break. And we're fully supporting his decision. Instead of football games, it will be soccer games for him this fall. Somehow, we think watching three of his friends get hurt last year (a concussion, an ankle injury, and blunt abdominal trauma) may have influenced his decision.

I have to be honest, though, I will miss the cheering crowds, the steaming hot dogs, the warm ciders and hot chocolates. I will miss the camaraderie with other parents and the announcer's voice providing the play-by-play and cheap jokes.

And I will miss the football action.

As I am finishing this post, I am reminded of a local high school football star who I treated a few years back. He was one of several children of a single mother who had gotten a full scholarship to one of our prestigious private schools to play football. Unfortunately, he had come to our ER, with his mother and coach, after sustaining a head injury during football practice. "They said," his mother voiced, love and concern dripping from her words as she stood trembling beside her son's cot, "that he was knocked out cold for five minutes." The coach, who had witnessed the injury, nodded his agreement.

Fortunately, this respectful, young man, he with the caring mother, did not show any significant injury on his CT scan. Because of the significance of his impact, his loss of consciousness, and his flattened, groggy affect, however, I did not want him to practice or play any football for at least two weeks, until he was cleared clinically and with cognitive testing by his private doctor. Another head injury layered on top of this one could potentially have had a catastrophic outcome.

The coach took the news worst of all. "He has several college scouts coming this Friday to watch him play." I shook my head "no." Call me conservative or overly-cautious, I don't care. I didn't want this young man taking another hit like the one that brought him to us. At least not in the near future.

The patient took the news quite well, but it was his mother that I was most impressed by. "Doctor," she said with earnest, "I promise you that Tyler will not be playing for the next few weeks. It is more important for me to have my son around for a long, healthy life than it is for him to play a few risky weeks of football. No victory is worth those odds." She turned to the coach. "If those scouts want him bad enough, they can come back another time."

Wise woman. Wise words.

I followed him the rest of the season via the sports section in our newspaper. As Mom had promised, Tyler didn't play for those two weeks. Tyler did, however, go on to have a full recovery and receive a full Division I football scholarship.

To all the football players, coaches, and fans, I salute you with a personal toast. To you, I wish the merriest and healthiest of football seasons.

As always, big thanks for reading. C, thanks for the kick in the pants via email today. I hope you all have a great weekend.

"Yoo-Hoo"

As I sat down at my computer station to finish the chart on a patient I had just treated, I heard something quite interesting. A voice, smooth and mellow, was calling out.

"Yoo-hoo."

It was an older woman's voice. I was immediately taken back to when I was a child, in my grandparent's house, standing beneath a small, cottage-shaped clock that hung on the wall. With a new hour approaching, I held my breath, staring up at the clock, its small pendulum swinging beneath, clicking a constant, relaxed beat. Eventually, the clock chimed, a little trap door opened, and a small bird popped out and chirped it's greeting.

"Coo-coo. Coo-coo. Coo-coo." Three times, like clock-work (no pun intended). Standing outside of my memory looking-in, I saw the little boy in his summer shorts, his tanned face framed with shaggy brown hair, smiling as he looked up expectantly at the wooden bird that never failed to mark a new hour.

"Yoo-hoo. Yoo-hoo." The woman's voice snapped me back to the present.

I got up from my chair and followed the yoo-hooing until I was standing at the bedside of an elderly woman with matted soft-grey hair and empty hazel eyes. She clearly had dementia. She looked quite comfortable, though, and was mumbling something to herself between the yoo-hoos.

"Do you need help with something, maam?" I asked, straightening her sheets and tucking her in. "What can I get you?"

"Help me!" the patient screamed, "I need help."

This patient's nurse walked in just then, a younger nurse that I enjoyed working with. She was compassionate, knowledgeable, and hard-working. And apparently, at that moment, frustrated.

"Is everything all right in here, Victoria?" I asked, ready to help.

"Everything's fine. Mrs. Pello has Alzheimer's and was sent by the nursing home because the nurse there thought she was acting 'more demented' today." Victoria gave me a knowing glance. We both recognized the bullshit excuse by the nurse who sent in Mrs. Pello, trying to make her own shift easier. At our expense, of course.

"Anything wrong?" I asked. "You need me to see her?"

"Dr. P. picked up on her. We're just going to get some baseline tests and a CT scan of her head. If it's all good, she'll be heading back soon enough."

"Yoo-hoo," Mrs. Pello called out, yet again.

"On second thought," Victoria said, laughing, "if you can get her to stop yelling 'yoo-hoo' every five minutes, I would appreciate it."

"I kind of like it," I said. "It reminds me of a coo-coo clock my grandparents had when I was a kid. She sounds just like the little bird that popped..."

I was interrupted by Mrs. Pello. "Help me! I need help!" Her sudden outburst had caught Victoria and I both by surprise. Then, without pausing, Mrs. Pello continued. "Yoo-hoo. Yoo-hoo."

"Just wait," Victoria warned me, both of us chuckling, "you might like it now, but after a few hours of this, I'm not so sure."

Well, little did I know at the time, but Victoria had hit the nail right on the head. Mrs. Pello's loud "yoo-hoo" was methodical and rhythmic, an audio alarm that was set to go off every five minutes, interrupting our workday. Unfortunately, her door had to be left open so that the nurses in their station could keep a close eye on her. And the risks of sedating her outweighed the benefits. So her yoo-hooing would just have to be accepted for a few hours.

Soon after meeting Mrs. Pello, a middle-aged man, who had collapsed at home, was brought into our ER and placed in the room next door. His right side was completely flaccid (no muscle strength) and he had a facial droop. An obvious stroke. A stroke alert was called and we emergently intubated this gentleman, hooked him up to a ventilator, and aggressively treated his escalating blood pressure. This patient was critical.

And then, suddenly, in the midst of treating this crisis, there it was. "Yoo-hoo. Yoo-hoo." It was clear and resounding. Everyone who was involved in treating our stroke patient did a quick pause. "Yoo-hoo." Mrs. Pello had added another one for good measure.

"Come on, people, back to work," I said, reminding them of our task at hand.

"What the hell was that?" the neurologist and neurosurgeon asked me, intrigued. "You really don't want to know," I said, grinning. My ER team, including Victoria, was shaking their heads, obviously trying to stifle their laughs. Swiftly, we transferred the stroke patient to the OR for emergent surgery after his CT scan revealed a large hemorrhagic stroke--blood on the brain.

Unfortunately, treating the stroke patient delayed Mrs. Pello's own head CT and she continued to sit in her room, waiting. "Yoo-hoo." Yep, about every five minutes.

At another point, as a family passed by Mrs. Pello's room while being escorted to their treatment room, she started screaming out "Help me! I need help." The family's eyes widened from fright. The staff, immune to the cries, didn't even budge to help, which I'm sure thoroughly impressed this family. They had to have thought of high-tailing it and heading to another ER. Someplace where the doctors and nurses cared.

Eventually, though, Mrs. Pello went over to the radiology department for her head CT. We all cheered, looking forward to a few minutes of silence. Unfortunately, not even five minutes had passed before we got an urgent call from the CT tech. "Can someone come over right away? Mrs. Pello is screaming for help." Oops, someone forgot to warn the tech of Mrs. Pello's outbursts.

She returned from her CT scan and, thankfully, all of her workup was normal. She had been in our emergency department for approximately four hours. Well, not approximately. More like exactly! Even those of us not involved in her care were celebrating her finished work-up and immediate plans to be transferred back to her nursing home. However, due to several ongoing emergencies, it would be one more hour of waiting until the ambulance service arrived to take her back. "Yoo-hoo."

Even though I wasn't treating her, I couldn't help but go into Mrs. Pello's room several more times to make sure she was comfortable. You see, not only did her "yoo-hoo" trigger a wonderful childhood memory of that coo-coo clock, but Mrs. Pello herself reminded me of my grandmother, an amazing and fiercely-independent woman who also was stricken with dementia.

Victoria was dead-on right. After five hours of "yoo-hoos," Mrs. Pello's voice had lost most of its charm and smooth, mellow tones. Now, her cries were simply annoying. Our staff gave her a wonderful farewell, lining up in the hallway to witness her be escorted by the ambulance team back to her nursing home. I think they were just making sure that there would be no screw-ups--that Mrs. Pello was actually leaving. Do not pass go. Do not collect $200. Just get the heck out!

Me? Well, of course, I was missing Mrs. Pello and her "yoo-hoos" five minutes after she was discharged. It was too quiet! And truth be told, I don't think I was alone. I think we all were suffering from yoo-hoo withdrawal.

So, I took a deep breath, calmed my fears, made my voice smooth and mellow, and did it.

"Yoo-hoo."

Update: One week later...
Good news...you can hardly see my black-eye anymore. I just wish someone had warned me that Victoria knew karate!

As always, a big thanks for reading. The next post will be Monday, February 15. Happy Valentine's Day to all of you...

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