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
Showing posts with label ER. Show all posts
Showing posts with label ER. Show all posts
Tuesday, February 5, 2019
Wednesday, June 20, 2012
Have A Little...
Faith. A simple word with complicated meaning. It is a seed buried deep within our spiritual cores, ready to be nourished and blossom with the sprinklings of tragedy. It is a belief that things will work out, despite our lack of vision for fate's secretive reasons of the bumpy journey we must endure. It is an inherent hope that has either sustained us or has failed us miserably. Yes, to me, this is faith.
We all have known faith. Embraced it. Bargained with it. Coddled it within our breaking hearts. Placed it on a pedestal of worship. I have, too. With undertones that may be religious, spiritual, or meditative, we lean against its pillars of reassurance. Sometimes, as they say, it is all we have to cling to during desperate times.
Working in an emergency room for 16 years, I have seen faith present its various faces many times. It may be within the circle of a grieving family, their hands clasped in prayer. It may be in the young mother's eyes, watchful of her sick child lying in a hospital cot. It may be in the older gentleman's anguished cries as I share the devastating results of his wife's testing. It may be in the silent strength of the obvious love of a dying man's partner. It may be in the ER staff's comforting whispers. Faith cannot be contained, especially in tragic circumstances. I tend to think it is a part of the coping fabric that threads all of our lives.
Why do I think that? Because, those moments of my life where I had to believe in something more, where I had to dig deep within the rubble of my soul to scrape a little bit of sanity, were during intense, personal moments. My son's illness. My mother's death. My grandmother's death. A life-threatening injury to my father. I swear, when my mother and my son were both simultaneously enduring chemotherapy, I stared faith right in the face and bargained with it. Threatened it, even. "If something happens to my son," I uttered to invisible universal ears while pulling at my hair, "I will never forgive you for it." Yes, I know faith. It has been my best friend and my worst enemy.
After my son's initial diagnosis, I stood in the hospital corridors outside of his pediatric room, disheartened and in disbelief. Cole had just returned from the OR where a mediport had been placed in preparation for an aggressive initial round of chemotherapy. My spiritual guidance, Father Tom, stood beside me, recognizing my slipping faith. "Why Cole?" I asked, over and over, tearful and angry. "Why couldn't it have been me? What kind of world do we live in for a child to endure this?"
Father Tom, in his infinite wisdom, answered my pleas with words that I still carry to this day. His words, to me, exemplify the true nature of faith. "Jim," he said, his voice husky and comforting, his arm wrapped around my trembling shoulders, "I can't answer your questions. I wish I could, but I can't." He paused slightly, choosing his words. "I can only pray that at some point in Cole's life, on his journey, the answers of 'Why?' will become more evident. That the reasons will be more clear to all of us of why he was chosen to endure this illness." In other words, in staring at a big, suffocating fog of nothingness, Father Tom was telling me that I must have faith.
How does one do that?
At my rock bottom, the openness of my mind was staggering. I listened to any words of support and encouragement, my hopes and faith hinging onto any little hint of a better tomorrow. I'd walk away from family and friends, my mind reeling and spitting out their words to suit my recovery, my belief system. Ultimately, I learned to believe that all things in our lives happen for a reason. I had to arrive at the belief that Cole would survive and thrive, that the years we will have together would be many. To not arrive at this point would have meant a certain death in an unattainable part of my core. I was learning to survive by walking the path that my faith created.
Cole survived. And as I type these words, I whisper a silent thank you to those universal ears of faith that fulfilled my every request.
Every day, though, followed by every week, every month, and every year, there is more profound sadness, more tragedy, that requires us to dig deep and rediscover our faith. To recommit ourselves to examine our morals and ideals while we cope with a crisis. A few years back, another setback occurred in my life, plummeting me even farther into my spiritual well. Cole had veered from remission while my mother concurrently fought a losing battle against leukemia. And I was back to the same dark place that I had turned my back on just a few years earlier.
Again, though, my faith sustained me. It wasn't easy. But now, with things going well, especially after my very own first health setback, I sit here and appreciate the moments of goodness in my life. I have learned, from these various experiences, to give my attention to faith during the good times, too. My faith has been tested and tried and, fortunately, has sustained me in my times of need. It is my time to feed some nourishment back, during the good times, to those who have surrounded me with smiles and encouragement and and unwavering friendship and love. A phone call. A card. A lunch date. A smile. Some kind words.
It is a two-way street that I have learned to travel with faith.
Where does your life sit right now, on this very day? Are things going well for you? Are you facing crisis? Are you recovering from or approaching a trying moment? Are you engaged in the environment surrounding your life? How is your support system? And, most importantly, how is your faith? Do you think maybe that little seed patiently waiting to sprout within you, in a moment of need, might appreciate a little attention now? If so, give it some. Sow it. Water it. Feed it. Coddle it. Embrace it. The effort taken now to examine and understand your faith will reap you rewards when you most need them.
All around me, including dear family and friends, including strangers and patients in the ER, I see daily struggles occurring. At times, I feel helpless and out of sorts, my seat on the sidelines but a useless location to witness another's misery. But I know, from continuing to grow as a compassionate and kind person, that good times will prevail if one can just hang in there. So, please, just hang in there.
And have a little...
Working in an emergency room for 16 years, I have seen faith present its various faces many times. It may be within the circle of a grieving family, their hands clasped in prayer. It may be in the young mother's eyes, watchful of her sick child lying in a hospital cot. It may be in the older gentleman's anguished cries as I share the devastating results of his wife's testing. It may be in the silent strength of the obvious love of a dying man's partner. It may be in the ER staff's comforting whispers. Faith cannot be contained, especially in tragic circumstances. I tend to think it is a part of the coping fabric that threads all of our lives.
Why do I think that? Because, those moments of my life where I had to believe in something more, where I had to dig deep within the rubble of my soul to scrape a little bit of sanity, were during intense, personal moments. My son's illness. My mother's death. My grandmother's death. A life-threatening injury to my father. I swear, when my mother and my son were both simultaneously enduring chemotherapy, I stared faith right in the face and bargained with it. Threatened it, even. "If something happens to my son," I uttered to invisible universal ears while pulling at my hair, "I will never forgive you for it." Yes, I know faith. It has been my best friend and my worst enemy.
After my son's initial diagnosis, I stood in the hospital corridors outside of his pediatric room, disheartened and in disbelief. Cole had just returned from the OR where a mediport had been placed in preparation for an aggressive initial round of chemotherapy. My spiritual guidance, Father Tom, stood beside me, recognizing my slipping faith. "Why Cole?" I asked, over and over, tearful and angry. "Why couldn't it have been me? What kind of world do we live in for a child to endure this?"
Father Tom, in his infinite wisdom, answered my pleas with words that I still carry to this day. His words, to me, exemplify the true nature of faith. "Jim," he said, his voice husky and comforting, his arm wrapped around my trembling shoulders, "I can't answer your questions. I wish I could, but I can't." He paused slightly, choosing his words. "I can only pray that at some point in Cole's life, on his journey, the answers of 'Why?' will become more evident. That the reasons will be more clear to all of us of why he was chosen to endure this illness." In other words, in staring at a big, suffocating fog of nothingness, Father Tom was telling me that I must have faith.
How does one do that?
At my rock bottom, the openness of my mind was staggering. I listened to any words of support and encouragement, my hopes and faith hinging onto any little hint of a better tomorrow. I'd walk away from family and friends, my mind reeling and spitting out their words to suit my recovery, my belief system. Ultimately, I learned to believe that all things in our lives happen for a reason. I had to arrive at the belief that Cole would survive and thrive, that the years we will have together would be many. To not arrive at this point would have meant a certain death in an unattainable part of my core. I was learning to survive by walking the path that my faith created.
Cole survived. And as I type these words, I whisper a silent thank you to those universal ears of faith that fulfilled my every request.
Every day, though, followed by every week, every month, and every year, there is more profound sadness, more tragedy, that requires us to dig deep and rediscover our faith. To recommit ourselves to examine our morals and ideals while we cope with a crisis. A few years back, another setback occurred in my life, plummeting me even farther into my spiritual well. Cole had veered from remission while my mother concurrently fought a losing battle against leukemia. And I was back to the same dark place that I had turned my back on just a few years earlier.
Again, though, my faith sustained me. It wasn't easy. But now, with things going well, especially after my very own first health setback, I sit here and appreciate the moments of goodness in my life. I have learned, from these various experiences, to give my attention to faith during the good times, too. My faith has been tested and tried and, fortunately, has sustained me in my times of need. It is my time to feed some nourishment back, during the good times, to those who have surrounded me with smiles and encouragement and and unwavering friendship and love. A phone call. A card. A lunch date. A smile. Some kind words.
It is a two-way street that I have learned to travel with faith.
Where does your life sit right now, on this very day? Are things going well for you? Are you facing crisis? Are you recovering from or approaching a trying moment? Are you engaged in the environment surrounding your life? How is your support system? And, most importantly, how is your faith? Do you think maybe that little seed patiently waiting to sprout within you, in a moment of need, might appreciate a little attention now? If so, give it some. Sow it. Water it. Feed it. Coddle it. Embrace it. The effort taken now to examine and understand your faith will reap you rewards when you most need them.
All around me, including dear family and friends, including strangers and patients in the ER, I see daily struggles occurring. At times, I feel helpless and out of sorts, my seat on the sidelines but a useless location to witness another's misery. But I know, from continuing to grow as a compassionate and kind person, that good times will prevail if one can just hang in there. So, please, just hang in there.
And have a little...
Tuesday, April 24, 2012
The Other Side
the years teach much which the days never knew
Ralph Waldo Emerson
As I sit at our dining room table to write my first words in five months, I am realizing just how much I've missed writing about both my personal and professional life experiences. Though my family and close friends may know my reasons for this unplanned break, you, my friends and readers from StorytellERdoc, do not. So instead of diving head-first into writing a funny, planned posting, I thought I might simply change course to write and say "hello" and "how the hell are you" to each of you.Let me briefly explain my absence. Simply, I began to have some vision problems last November, ultimately resulting in urgent surgery. Always the doctor and never the patient, this was my first real health scare. Following successful eye surgery, I was forced to take a few months time to recover. This break included absolutely no gym time and, most odd for me, no work time. Looking back on my career, I had never had so much as a week or two break from working in the ER. This inactivity, at first painfully frustrating, ultimately proved to be one of the greatest learning experiences thus far in my life.
For the first few weeks following surgery, I had to wear an eye patch, a blue, oval-shaped piece of perforated aluminum paper-taped to my face. With this new accessory, I spent much time in front of the mirror, looking to find that invincible, healthy fellow I once was. I couldn't find him. Friends tried to make me feel better, telling me I looked "sexier" with an eye-patch, but I saw through their flimsy compliment--the only way to look sexier, I reasoned while laughing with them, was to have sexy to begin with. My kids, hesitant at first, realized that patch or no patch, I was still the same Dad that I had always been. In fact, soon after surgery, Cole had a basketball game that I wanted to attend. "Cole," I asked, "is it okay if I come to your game with my patch or would you rather I stay home?" Without even a hint of pause, his resounding reply inspired me. "Of course you are coming, Dad, why wouldn't you?"
After several weeks, I was able to lose the eye patch. More importantly, with healing and some serious introspection and reflection, I was able to regain my perspective of what is most important in this journey of life. Family. Friends. Humor. Love. Compassion and kindness. Living a purposeful life.
Part of this time away included reevaluating my job differently. Although I still considered kindness and compassion at the forefront of my ER interactions with patients and their families, even I was not immune to a growing cynicism that occasionally seems to be pervading our medical field. Maybe this had even leaked itself into some previous writings. Luckily, though, I feel more privileged than I ever have, since residency even, in walking the halls of our emergency department and providing care to such a diverse and unique collection of patients. Of course, there will always be patients that are obnoxiously difficult, but my reserve to find something good in each and every patient has definitely been refueled. I've been honestly warned, however, by several of my hard-working partners. "Just give it a few months, Jim," they said, "and then see if you feel the same way about things." I can only hope that I have some great staying-power. I feel I do.
Being a patient, I have also learned and witnessed first-hand just how important a role a doctor can play in one's recovery. Luckily, I am surrounded by four absolutely incredible individuals who have prioritized being a compassionate person first and playing a doctor second, proving that one doesn't need to place himself on a pedestal to be amazing at what he can do. This all-star team of providers, however, did not come without some rearranging on my part. I removed from my team, so to speak, one nationally-recognized specialist who was less than stellar in both his personality and in his style of delivering unwanted news. Although this specialist may have been quite good at what he does, I was less than impressed with his all-around abilities to communicate. To heal well and remain positive throughout my ordeal, I insisted on only being surrounded by similar individuals.
Overall, I have much to be thankful for. An almost complete recovery. A supportive family. Supportive friends. And supportive co-workers. What could have been a terrible outcome was not. For this reason, I will always be humble and grateful. Returning to work, I was greeted with many kindnesses and friendly, encouraging words. Hugs included. I also returned to some sadness as well. One of my favorite nurses, Sue, tragically lost her son during my absence. My ordeal embarrassingly pales in comparison to this tragic event of her life. To hug her and share tears with her as she attempted to give me a warm welcome-back smile speaks volumes of her strength and character.
So there you have it. Officially, I have now returned to my life as I know it. Playing doctor full-time. Playing Dad full-time. Attempting to be a writer again. And, most importantly, continuing to look at my wife with complete wonderment, appreciating more than ever her infinite strength, support and love. Except for the glasses outwardly, my most significant changes from my ordeal have come from within. For this, I am most appreciative. I am stronger than ever, actually. As Ralph wisely stated above, the small day-to-day battles were worth the positive hindsight of it all.
It feels so very good to be back...
As always, I thank you much for reading, my friend. More importantly, I thank you for your patience and returning to read my words.
Friday, June 3, 2011
To Like Or Dislike
I was shocked by her appearance. Although she was in her early 50s, she looked closer to 80. Matted peroxide hair. Dull, lifeless eyes. Sagging skin and deep wrinkles. Protruding cheek bones. Cracked, dry lips with a hint of yesterday's lipstick caked in their corners. Gray and yellow-stained teeth, some chipped. In her prime and before alcohol and cigarettes became her every thought, I could imagine an attractive, lovely woman. Now, sadly, what sat in front of me on the hospital cot in Room 12 was nothing short of a shell of a human being. This was a woman who lived a hard life.
She had presented to our ER in respiratory distress. Although she already had an established diagnosis of emphysema, she continued to smoke two packs of cigarettes a day. On top of this, she had just finished a ten-day drinking binge, the last five of which she spent either passed out or drinking. She claimed to have not eaten in that time. I was called to her room because she was in such dire respiratory distress.
"Maam," I said after introducing myself, "how long have you been having trouble breathing?" She was gasping for air, her nasal folds flaring with each struggle to breath deeply in. Through her thin hospital gown, I could see her ribcage and diaphragm heaving, compensating for her non-compliant lungs, trying to pull that extra oomph of air into her body.
"I...don't...know," she managed to answer, each word a struggle for her. Her hands, I noticed, were pale, their spidery veins popping through her thin transparent skin. They gripped the top rail of the cot for dear life.
Immediately, I ordered breathing treatments. Steroids. BiPAP (a machine with an attached mask that would force supplemented oxygenated air into the patient's lungs every time she initiated a breath). Blood work. A stat chest x-ray. The rapid intubation kit and ventilator for stand-by. I asked more questions, questions she could answer simply by nodding her head. "If you get worse, maam," I spoke, asking the most important question of all, "we may need to insert a breathing tube into your lungs, hook you up to a ventilator, and do your breathing for you. Do you want that if it comes to that?"
A "yes" nod. She tried to speak. "I've...had...that...before," she gasped. "You've been intubated before, maam?" I repeated. She held up two fingers of her left hand in a peace-sign. "Twice," she said.
Within the half-hour, surprisingly, she began to turn around for us. I spent considerable time in her room during this period, making sure she would not decompensate before our eyes. With the additional attention of two stellar nurses and a respiratory therapist at bedside, she thrived and slowly improved. Finally, as her lungs began to fill with more air, her nasal flaring and ribcage retractions subsided.
After stabilizing her breathing, we began to treat her other problems. For malnutrition and dehydration, we gave her several liters of normal saline and a "banana bag," a liter of fluid supplemented with thiamine, folic acid, and multi-vitamins, giving it a yellowish-color. For her withdrawal tremors, we gave her Ativan, a longer acting valium-derivative. We fed her ice-chips. We gave her anti-nausea medicine and several low doses of pain medication for her evolving alcohol-induced pancreatitis. Her chest x-ray revealed pneumonia in both lungs, and we began antibiotics to cover her for the common community-acquired organisms as well as for aspiration organisms (only God knew if she swallowed some puke into her lungs).
Finally, after a lot of attention and energy given to her, she was at the point where I could sit down a few extra minutes with her, making sure I understood all of her history and didn't miss anything.
"Maam," I started, "have you ever tried to quit smoking?" "Yeah," she said, her voice now a little stronger, more gruff, "but I don't really want to. I like it." She looked at me with challenging eyes as she said it.
"And maam," I continued, "do you consider yourself to be an alcoholic? Have you ever had treatment for it before?" She answered immediately. "No, I'm not an alcoholic. I like my booze, but I don't drink nearly as much as my husband. Now he's an alcoholic. But I'm not." She enunciated "he," spitting out the word like it was poison. Her denial was remarkable. And expected. "Do you want help while your hospitalized for your drinking, then?" "Why," she asked me, "if I don't have a problem?"
I asked her about abuse. She denied physical abuse but claimed "that he yells at me a lot." Again, she refused to accept any counseling.
Finally, as I was finishing, she said "Can I ask you a question, Doctor?"
"Of course you can, maam," I said. "What can I do for you?"
"Well," she said, "I don't understand why doctors can't take care of my problems. I don't like coming here all the time for belly pain and breathing problems. Why can't they just get it right the first time I come in?"
I was shocked. Completely and utterly thrown off my game. Hackles up. The nurse, standing at the room counter with her back to us, writing on her chart, turned her head around to face the patient, her mouth gaping and shoulders tightening. I'm sure mine were, too. Although we don't expect appreciation, we certainly don't expect to be blamed for a patient's medical problems, either.
"Maam," I said in my calmest , most respectful voice, "you have emphysema and, yet, continue to smoke two packs a day. You have pancreatitis and, yet, continue to drink. You completely ignore your body's needs, not drinking water or eating food for five days. You are hacking up phlegm and don't use your inhaler or pursue treatment of these symptoms, resulting in pneumonia. You've been intubated twice and have come to the ER multiple times. And you can't understand why your doctors 'can't take care of your problems'? Have you considered that your problems might be from your own poor decisions?"
I stopped and stared at her. She stared back. I waited for her to speak. I was going to stand there all day if I had to. Finally, with the nurse now standing along her other side, the patient spoke. "I guess you are right. Some of these problems are my own fault."
"Not some of them, maam," I said, "all of them. By accepting personal responsibility for them, though, maybe you can move on and start treating yourself and your body a little better." Although I'm sure my words fell on deaf ears, I still needed to have my say. Especially when we all worked so hard to turn this unappreciative patient around from her multiple medical problems, some life-threatening.
I grabbed the patient's hand. "Listen, maam," I said, "I wish you well. I want nothing but the best for you. But if you don't change your habits, I am sure I will see you in our ER again. And again. And, one of these times, I fear, we won't be able to undo your problems."
I let go of her hand and turned to walk out the door. She was admitted to the ICU and was going to be transported up shortly. Before leaving, though, she called out. "Doctor!" I paused and turned around. "Yes, maam?" She hesitated before speaking. "Thank you for your help today. I'll think about the counseling, okay?"
I nodded to her. "Good luck," I said before continuing out the door.
One of the most frustrating parts of my jobs is dealing with patients' frustrations of their medical problems, simply because of their lack of personal responsibility. It's rampant, too. I cannot cure patient's who do not put their own effort into their health. None of us in the medical field can. We are here to help you along your journey, to walk sided-by-side with you in your, hopefully, healthy path. Of course, some people do everything right, by the book, and still have medical issues. That's different. But if you want to eat profuse and bad meals, please don't expect us to cure it with a simple "sugar" pill. If you want to eat fatty and greasy foods, please don't get pissed at us when your cholesterol pill isn't helping.
I love my ER patients. Seriously. I have met some very cool people over the years, from both different and similar walks of life, simply from what I chose to do for a living. I appreciate and enjoy learning the diverse stories that rest behind their faces. Sometimes, though, I get frustrated. We all do in the medical field. At the end of the day, we are all human, whether we perch ourselves on a pedestal or not. And, regardless, we want the best for you, the patient.
To my patients that have made my job rewarding, a simple thank you...it has been my pleasure learning about you and helping you on your healthy path.
As always, big thanks for reading...I hope this finds you all well. Enjoy the weekend...
She had presented to our ER in respiratory distress. Although she already had an established diagnosis of emphysema, she continued to smoke two packs of cigarettes a day. On top of this, she had just finished a ten-day drinking binge, the last five of which she spent either passed out or drinking. She claimed to have not eaten in that time. I was called to her room because she was in such dire respiratory distress.
"Maam," I said after introducing myself, "how long have you been having trouble breathing?" She was gasping for air, her nasal folds flaring with each struggle to breath deeply in. Through her thin hospital gown, I could see her ribcage and diaphragm heaving, compensating for her non-compliant lungs, trying to pull that extra oomph of air into her body.
"I...don't...know," she managed to answer, each word a struggle for her. Her hands, I noticed, were pale, their spidery veins popping through her thin transparent skin. They gripped the top rail of the cot for dear life.
Immediately, I ordered breathing treatments. Steroids. BiPAP (a machine with an attached mask that would force supplemented oxygenated air into the patient's lungs every time she initiated a breath). Blood work. A stat chest x-ray. The rapid intubation kit and ventilator for stand-by. I asked more questions, questions she could answer simply by nodding her head. "If you get worse, maam," I spoke, asking the most important question of all, "we may need to insert a breathing tube into your lungs, hook you up to a ventilator, and do your breathing for you. Do you want that if it comes to that?"
A "yes" nod. She tried to speak. "I've...had...that...before," she gasped. "You've been intubated before, maam?" I repeated. She held up two fingers of her left hand in a peace-sign. "Twice," she said.
Within the half-hour, surprisingly, she began to turn around for us. I spent considerable time in her room during this period, making sure she would not decompensate before our eyes. With the additional attention of two stellar nurses and a respiratory therapist at bedside, she thrived and slowly improved. Finally, as her lungs began to fill with more air, her nasal flaring and ribcage retractions subsided.
After stabilizing her breathing, we began to treat her other problems. For malnutrition and dehydration, we gave her several liters of normal saline and a "banana bag," a liter of fluid supplemented with thiamine, folic acid, and multi-vitamins, giving it a yellowish-color. For her withdrawal tremors, we gave her Ativan, a longer acting valium-derivative. We fed her ice-chips. We gave her anti-nausea medicine and several low doses of pain medication for her evolving alcohol-induced pancreatitis. Her chest x-ray revealed pneumonia in both lungs, and we began antibiotics to cover her for the common community-acquired organisms as well as for aspiration organisms (only God knew if she swallowed some puke into her lungs).
Finally, after a lot of attention and energy given to her, she was at the point where I could sit down a few extra minutes with her, making sure I understood all of her history and didn't miss anything.
"Maam," I started, "have you ever tried to quit smoking?" "Yeah," she said, her voice now a little stronger, more gruff, "but I don't really want to. I like it." She looked at me with challenging eyes as she said it.
"And maam," I continued, "do you consider yourself to be an alcoholic? Have you ever had treatment for it before?" She answered immediately. "No, I'm not an alcoholic. I like my booze, but I don't drink nearly as much as my husband. Now he's an alcoholic. But I'm not." She enunciated "he," spitting out the word like it was poison. Her denial was remarkable. And expected. "Do you want help while your hospitalized for your drinking, then?" "Why," she asked me, "if I don't have a problem?"
I asked her about abuse. She denied physical abuse but claimed "that he yells at me a lot." Again, she refused to accept any counseling.
Finally, as I was finishing, she said "Can I ask you a question, Doctor?"
"Of course you can, maam," I said. "What can I do for you?"
"Well," she said, "I don't understand why doctors can't take care of my problems. I don't like coming here all the time for belly pain and breathing problems. Why can't they just get it right the first time I come in?"
I was shocked. Completely and utterly thrown off my game. Hackles up. The nurse, standing at the room counter with her back to us, writing on her chart, turned her head around to face the patient, her mouth gaping and shoulders tightening. I'm sure mine were, too. Although we don't expect appreciation, we certainly don't expect to be blamed for a patient's medical problems, either.
"Maam," I said in my calmest , most respectful voice, "you have emphysema and, yet, continue to smoke two packs a day. You have pancreatitis and, yet, continue to drink. You completely ignore your body's needs, not drinking water or eating food for five days. You are hacking up phlegm and don't use your inhaler or pursue treatment of these symptoms, resulting in pneumonia. You've been intubated twice and have come to the ER multiple times. And you can't understand why your doctors 'can't take care of your problems'? Have you considered that your problems might be from your own poor decisions?"
I stopped and stared at her. She stared back. I waited for her to speak. I was going to stand there all day if I had to. Finally, with the nurse now standing along her other side, the patient spoke. "I guess you are right. Some of these problems are my own fault."
"Not some of them, maam," I said, "all of them. By accepting personal responsibility for them, though, maybe you can move on and start treating yourself and your body a little better." Although I'm sure my words fell on deaf ears, I still needed to have my say. Especially when we all worked so hard to turn this unappreciative patient around from her multiple medical problems, some life-threatening.
I grabbed the patient's hand. "Listen, maam," I said, "I wish you well. I want nothing but the best for you. But if you don't change your habits, I am sure I will see you in our ER again. And again. And, one of these times, I fear, we won't be able to undo your problems."
I let go of her hand and turned to walk out the door. She was admitted to the ICU and was going to be transported up shortly. Before leaving, though, she called out. "Doctor!" I paused and turned around. "Yes, maam?" She hesitated before speaking. "Thank you for your help today. I'll think about the counseling, okay?"
I nodded to her. "Good luck," I said before continuing out the door.
One of the most frustrating parts of my jobs is dealing with patients' frustrations of their medical problems, simply because of their lack of personal responsibility. It's rampant, too. I cannot cure patient's who do not put their own effort into their health. None of us in the medical field can. We are here to help you along your journey, to walk sided-by-side with you in your, hopefully, healthy path. Of course, some people do everything right, by the book, and still have medical issues. That's different. But if you want to eat profuse and bad meals, please don't expect us to cure it with a simple "sugar" pill. If you want to eat fatty and greasy foods, please don't get pissed at us when your cholesterol pill isn't helping.
I love my ER patients. Seriously. I have met some very cool people over the years, from both different and similar walks of life, simply from what I chose to do for a living. I appreciate and enjoy learning the diverse stories that rest behind their faces. Sometimes, though, I get frustrated. We all do in the medical field. At the end of the day, we are all human, whether we perch ourselves on a pedestal or not. And, regardless, we want the best for you, the patient.
To my patients that have made my job rewarding, a simple thank you...it has been my pleasure learning about you and helping you on your healthy path.
As always, big thanks for reading...I hope this finds you all well. Enjoy the weekend...
Tuesday, May 31, 2011
The Appreciative Cashier
With every breath, may we remember you, the brave and proud soldier, who has given more of yourself than any of us have the right to ask. God Bless each and every one of you. Originally posted on March 5, 2010, this essay is my thank you.
Sometimes, in the midst of a crazy shift and six-hour patient waiting times, I can easily forget that I signed up for this job. This forgetfulness can lead to extreme frustration, which only leads to a vicious cycle of being more and more short-fused and less appreciative of our jobs. I don't like these types of days, and I am grateful when I'm reminded that our jobs are not isolated in these frustrations.
A few years back, I was at a local store waiting in a very long cash-out line. It seemed that several cashiers had called in sick and the store was trying to cope as best as they could. I picked the shortest of the waiting lines and still was about eight customers back.
I clearly remember the grumbling. It seemed that everyone had an opinion of either how to make things go quicker or shared their thoughts that they would never return to this particular store again. How dare they make us wait like this? What were we, cattle or something? I smiled, correlating this to how our ER waiting room mood must be on those hectic days.
Slowly, but steadily, my line advanced to where I was next, following a gentleman who wore an armed-service ball cap. He had grumbled along with everyone else and, by the look on his face, was tired of the waiting. He placed his merchandise on the counter as the cashier greeted him.
"Hello, sir," she said, with a warm smile, "I'm sorry about your long wait. Did you find everything you were looking for?" Her pleasantness, apparently, remained unscathed.
The gentleman ignored her as he pulled out his wallet and a few bills. The cashier, her hair mussed and her make-up long past the point of retouch, was not to be deterred. She continued scanning his merchandise while she spoke. "Oh my, is that your hat, sir?" she asked, pointing to his cap. "I see it states that you are a veteran of the Army."
He touched the brim of his hat as he sized her up, finally returning her smile. "Well, yes, I was in the Army during the Korean War."
"Well, then," she said, now pausing and giving him her undivided attention, "I would like to thank you for your service to our country."
Hey, wait a second here! I had just witnessed something pretty special and neat. I was so caught-off guard and pleased by this cashier's actions that I could only imagine how this gentleman now felt. In fact, he was a completely different fellow after that--talking and joking around until she finished cashing him out.
I was next. "I have to tell you," I said to her after her kind greeting, "that how you handled that gentleman was great. You made his day with your kind words."
"Thank you, but I really do mean it. My grandfather and my father were both in the Army, and my brother is in Iraq right now. I can't even imagine what it would be like to go to war, you know?" She went on to tell me that every customer who goes through her line wearing some form of armed-service clothing gets a "thank you" from her.
She was an inspiration. Despite everything falling apart around her, she never once thought to be huffy or rude and, more so, was handing out compliments and immersing her customers in kindness. She demonstrated that grace-under-fire is not a lost art. If I could, I would have offered her a job in our ER. And lots and lots of money.
Several weeks after this, my wife, my kids and I drove a few hours to a nearby city's zoo, much larger than our local one. We were having a perfect zoo-kind-of-day, sunny and warm, with all the animals out and about within their exhibits. As we were walking down a paved, gently-sloping pathway, away from the exhibits of pacing polar and grizzly bears, we approached a gentleman in a wheelchair, coming from the opposite direction. He had bilateral below-the-knee amputations and was being pushed by what looked to be an adult grandchild. The man was wearing a matching t-shirt and baseball cap.
They read "United States Army."
As we were about to pass him, I stopped and looked at the both of them. "Excuse me," I asked, "but do you need any help pushing your wheelchair up the hill?"
"Why, no," the man in the wheelchair answered, his grandson nodding his agreement, "but thank you for asking. He looked at my children, who had halted by my side, and gave them a crooked, toothy, friendly smile.
I have to admit, I was nervous about what I said next. "Sir," I said, focusing on his clear brown eyes, "I can't help but notice your shirt and cap. Did you serve in the Army?" Was it any of my business?
He didn't seem to mind my question, although he did seem surprised that I had noticed. "Yes," he answered, "that's where I lost both of these." He nodded his attention to his partial legs before clasping his hands to his denim-covered knees. "Lost 'em in Vietnam when I was 24."
"Well, sir," I said, taking a note from the department store cashier, "I thank you for your service to our country. Because of you, my family knows what freedom is." I held out my hand and he took it, shaking it vigorously. I shook his grandson's hand next, and then we parted.
Walking away, I turned back for one last look at an everyday hero, a war veteran. Lucky for me, he was doing the same. Our eyes met. I'm not sure what he read in mine (hopefully profound appreciation), but I saw the gratefulness emanating from his. I smiled before turning back to my family.
My kids, ages nine, seven, and five at the time, were completely mesmerized. "Daddy," they asked, "did you know that man? And what happened to his legs?" No, I didn't know him, I answered them, before trying my best to explain how he had lost his legs, fighting for our country and defending our freedom.
After my wife and I answered our kids' questions the best we could, we continued on with our day, enveloped in our freedom, each of us walking on two good legs. My family on the paved path, me on a cloud. Man, did that interaction feel good!
As a result of the appreciative cashier, I try to greet every ER patient who has served in the armed forces with a heartfelt thanks. Try it sometime...it will make their day. And yours, too.
To think, this happened only because some cashier, during a busy, hurried moment, was able to remember the more important things in life. She made a difference. And I was there to witness it.
As always, big thanks for reading. And, big thanks to the families of our current soldiers and veterans for our freedom. Thank you, thank you...
As always, big thanks for reading. And, big thanks to the families of our current soldiers and veterans for our freedom. Thank you, thank you...
Tuesday, February 8, 2011
Future Hopes
Vote for StorytellERdoc for Best Literary Blog at the Medgadget Medical Blog Awards! Thanks for your support...
After another recent shift with a predominance of patients suffering from lingering flu symptoms, I decided to swing by our local Walmart to stock up on our home supply of pediatric medications, just in case. Some acetaminophen, ibuprofen, decongestant, and cough suppressant would hopefully get us through the rest of this winter season. And, of course, what a great variety of favorite flavors--orange, bubble gum, berry, and grape. Heck, some of them taste so good that faking the flu for the little cups of "candy" might be to my kids' benefit.
Unfortunately, on the way to the pharmacy area, one of the first aisles I always encounter is the candy and gum aisle. Not a good thing for me, since I have quite a recent fascination and taste for Gobstoppers, a Wonka jawbreaker product (don't tell my dentist). The yellow psychodelic boxes scream at me from their shelf, "Jim, come and put a couple of us in your cart," and regardless how much I fight it, the pull is too strong.
Needless to say, my kids love going to Walmart with me.
On this particular day, then, I walked to the mid-aisle to grab a few boxes of the candy. I wasn't alone in the aisle, though. To the right of the Gobstoppers, two parents stood looking at the shelf of big Hershey chocolate bars, immersed in a conversation (yes, I listened) of milk chocolate versus dark chocolate. To my left, a grocery cart with a makeshift, rigged-up kiddy car, driver seats and steering wheels included, on its handle-end. Two kids sat in those seats--an approximate four-year old girl and a three-year old boy. The Gobstoppers sat waiting for me between the parents and kids.
As I approached the family, I was caught off-guard with the screaming and fighting going on with the young kids. In fact, at one point, as I was kneeling down to grab the boxes of candy, I was appalled to find the little boy trying to punch his sister in the face, her hands rapidly moving to block each of his thrown punches, protecting herself. Still on my knees, I looked toward the parents, who must have completely tuned-out their kids. I was just about to say something when the little boy stopped, but not before his sister screamed out, "Get the hell off me, God damn it!" Still no reaction from the parents.
After this, I stayed kneeling, observing these peculiar parenting skills (or lack of) while looking at a box of Junior mints. While I was debating getting the mints, the little girl and boy started to talk to one another. About me! I actually wrote the conversation down in the pharmacy because it had shocked me much. It went like this.
Little girl: "Who the hell is that guy?" I looked at them looking at me.
Little boy: "I don't know, but if he gets close enough, I'm going to kick the shit out of him."
Little girl: "That will be fun. Try to knock him out." For good measure, she added, "God damn it." Again.
I was disheartened. I was shocked. I was annoyed with the parents for not addressing such obnoxiousness from their young kids. I looked from the kids to the parents, who had quickly glanced our way before figuring their conversation about chocolate was more important. I looked back to the kids again, before standing up and walking away with my Gobstoppers. I was upset and figured this was the best option for me, at that time. I knew it wasn't the kids' faults, but rather their parents. Their role models. But I wondered to myself, "What kind of adults are these kids going to become?"
This happening got me to thinking about our society. For the most part, we all know great kids in our lives, from our own to our friends' and families'. To raise respectful, kind, compassionate and loving kids and guide them appropriately into adulthood, when we choose this road of parenthood, should be the primary goal in each of our lives. We may not always succeed, darn it, but we have to try our best and throw our energy into the effort. Because that effort translates into the brilliance of the future generation coming up to govern our world.
These parents demonstrated no effort. And, unfortunately, they are not alone.
How many of us see the changing pattern with our society's kids. Talking back to well-meaning adults. Not respecting our elders (at least hold the door open for them and smile!). Tolerating vulgar language and meaningless violence via computer games and TV. Not respecting one another's uniqueness. Forgetting manners. Immersing oneself into texting instead of holding actual conversation. Avoiding volunteerism and chores. Placing more importance on material possessions rather than relationships.
Although I see both ends of the spectrum every day in the ER, I can only imagine the stories a teacher can tell.
I carried this Walmart story with me for a few weeks, bummed at the behavior of those children, constantly on vigil to find a hopeful story to balance out this disappointment. And then, the other day during an ER shift, I found it.
I walked into Room 17 to see my next patient, a nine-year old girl who had sustained minor anterior chest burns after bumping into her mother, who had been holding a pot of boiled water. Because the room was quiet and calm, I was quite surprised to find five people in total in the room, four kids and their mother. The mother was standing to the patient's right, beside the cot, while the oldest and youngest children, girls, shared a corner seat and their brother sat to their left on a stool.
Despite a TV in the room, it was not on, and the children all sat with an opened book before them, reading. Mom was whispering to her daughter with the burns, consoling her with her words and touch, gently stroking the back of her hand and her ribboned braids.
I walked up to Mom and the patient and introduced myself. "Hello, Doctor," the patient said, bravely trying to smile over her discomfort. She melted my heart, trying to be respectful while a three inch patch of skin lay peeled from her body between her clavicles. The mother turned to the other children. "Say 'hello' to Sissy's doctor," she said, and I was greeted with three more genuine smiles and greetings. They spoke with a bashful confidence that I fully appreciated.
We talked, the mother and patient and I, for quite a bit about what happened that brought them to our ER. After a stable exam, the nurse came in to clean the burn and show Mom how to care for it the next few days at home.
While finishing with this patient, I felt compelled to share with Mom how impressed I was by her kids. Not once did they talk without calling me 'sir' or the nurse 'maam'." They took turns, one at a time, to step up to their sister's cot to be supportive of her. No arguing or fighting, only kind words were uttered. No scowls, only warm smiles were worn. They were unabashed with their hugs and physical contact, sharing their seats and coats with one another. The mood and energy of the room was lighthearted and fantastic.
"Your kids," I shared with Mom before discharge, "are absolutely wonderful. It has been such a pleasure to see how well-behaved and loving they are with one another and with you. Even most of our staff has commented on their excellent behavior. Well done, Mom."
Mom was somewhat embarrassed by my compliment. "Trust me," I assured her, "I mean my words. What a wonderful job you are doing raising such fine young kids." As I spoke, the kids all grinned, bumping into one another with their elbows and bodies. I looked at all of them and smiled.
Mom thanked me, shyly, before explaining that she was a single parent. "Although I get tired by the end of the day, things seem to be going quite well with the kids." How could they not? This was an amazing woman, a role model for all, well aware of the importance of raising good children. And she was accomplishing, on her own, what two parents with less children weren't.
A hero.
After complimenting the children on their behavior and their impeccable church clothing, I ran to the freezer and grabbed four Italian ices. Grape. And lots of stickers from the nursing station. Just some small gestures to acknowledge their good behavior.
My hopes for our future have been restored. It took a few weeks, but I'm back to focusing on the good of our children. Thanks to the brilliant unselfishness of a great mother...
As always, big thanks for reading. Well done job to the mother of these four children! Also, thanks for your support in the recent Medgadget Medical Blog Awards voting. It continues until Sunday at midnight. If you enjoy my blog and posts, I would greatly appreciate your support and vote.
After another recent shift with a predominance of patients suffering from lingering flu symptoms, I decided to swing by our local Walmart to stock up on our home supply of pediatric medications, just in case. Some acetaminophen, ibuprofen, decongestant, and cough suppressant would hopefully get us through the rest of this winter season. And, of course, what a great variety of favorite flavors--orange, bubble gum, berry, and grape. Heck, some of them taste so good that faking the flu for the little cups of "candy" might be to my kids' benefit.
Unfortunately, on the way to the pharmacy area, one of the first aisles I always encounter is the candy and gum aisle. Not a good thing for me, since I have quite a recent fascination and taste for Gobstoppers, a Wonka jawbreaker product (don't tell my dentist). The yellow psychodelic boxes scream at me from their shelf, "Jim, come and put a couple of us in your cart," and regardless how much I fight it, the pull is too strong.
Needless to say, my kids love going to Walmart with me.
On this particular day, then, I walked to the mid-aisle to grab a few boxes of the candy. I wasn't alone in the aisle, though. To the right of the Gobstoppers, two parents stood looking at the shelf of big Hershey chocolate bars, immersed in a conversation (yes, I listened) of milk chocolate versus dark chocolate. To my left, a grocery cart with a makeshift, rigged-up kiddy car, driver seats and steering wheels included, on its handle-end. Two kids sat in those seats--an approximate four-year old girl and a three-year old boy. The Gobstoppers sat waiting for me between the parents and kids.
As I approached the family, I was caught off-guard with the screaming and fighting going on with the young kids. In fact, at one point, as I was kneeling down to grab the boxes of candy, I was appalled to find the little boy trying to punch his sister in the face, her hands rapidly moving to block each of his thrown punches, protecting herself. Still on my knees, I looked toward the parents, who must have completely tuned-out their kids. I was just about to say something when the little boy stopped, but not before his sister screamed out, "Get the hell off me, God damn it!" Still no reaction from the parents.
After this, I stayed kneeling, observing these peculiar parenting skills (or lack of) while looking at a box of Junior mints. While I was debating getting the mints, the little girl and boy started to talk to one another. About me! I actually wrote the conversation down in the pharmacy because it had shocked me much. It went like this.
Little girl: "Who the hell is that guy?" I looked at them looking at me.
Little boy: "I don't know, but if he gets close enough, I'm going to kick the shit out of him."
Little girl: "That will be fun. Try to knock him out." For good measure, she added, "God damn it." Again.
I was disheartened. I was shocked. I was annoyed with the parents for not addressing such obnoxiousness from their young kids. I looked from the kids to the parents, who had quickly glanced our way before figuring their conversation about chocolate was more important. I looked back to the kids again, before standing up and walking away with my Gobstoppers. I was upset and figured this was the best option for me, at that time. I knew it wasn't the kids' faults, but rather their parents. Their role models. But I wondered to myself, "What kind of adults are these kids going to become?"
This happening got me to thinking about our society. For the most part, we all know great kids in our lives, from our own to our friends' and families'. To raise respectful, kind, compassionate and loving kids and guide them appropriately into adulthood, when we choose this road of parenthood, should be the primary goal in each of our lives. We may not always succeed, darn it, but we have to try our best and throw our energy into the effort. Because that effort translates into the brilliance of the future generation coming up to govern our world.
These parents demonstrated no effort. And, unfortunately, they are not alone.
How many of us see the changing pattern with our society's kids. Talking back to well-meaning adults. Not respecting our elders (at least hold the door open for them and smile!). Tolerating vulgar language and meaningless violence via computer games and TV. Not respecting one another's uniqueness. Forgetting manners. Immersing oneself into texting instead of holding actual conversation. Avoiding volunteerism and chores. Placing more importance on material possessions rather than relationships.
Although I see both ends of the spectrum every day in the ER, I can only imagine the stories a teacher can tell.
I carried this Walmart story with me for a few weeks, bummed at the behavior of those children, constantly on vigil to find a hopeful story to balance out this disappointment. And then, the other day during an ER shift, I found it.
I walked into Room 17 to see my next patient, a nine-year old girl who had sustained minor anterior chest burns after bumping into her mother, who had been holding a pot of boiled water. Because the room was quiet and calm, I was quite surprised to find five people in total in the room, four kids and their mother. The mother was standing to the patient's right, beside the cot, while the oldest and youngest children, girls, shared a corner seat and their brother sat to their left on a stool.
Despite a TV in the room, it was not on, and the children all sat with an opened book before them, reading. Mom was whispering to her daughter with the burns, consoling her with her words and touch, gently stroking the back of her hand and her ribboned braids.
I walked up to Mom and the patient and introduced myself. "Hello, Doctor," the patient said, bravely trying to smile over her discomfort. She melted my heart, trying to be respectful while a three inch patch of skin lay peeled from her body between her clavicles. The mother turned to the other children. "Say 'hello' to Sissy's doctor," she said, and I was greeted with three more genuine smiles and greetings. They spoke with a bashful confidence that I fully appreciated.
We talked, the mother and patient and I, for quite a bit about what happened that brought them to our ER. After a stable exam, the nurse came in to clean the burn and show Mom how to care for it the next few days at home.
While finishing with this patient, I felt compelled to share with Mom how impressed I was by her kids. Not once did they talk without calling me 'sir' or the nurse 'maam'." They took turns, one at a time, to step up to their sister's cot to be supportive of her. No arguing or fighting, only kind words were uttered. No scowls, only warm smiles were worn. They were unabashed with their hugs and physical contact, sharing their seats and coats with one another. The mood and energy of the room was lighthearted and fantastic.
"Your kids," I shared with Mom before discharge, "are absolutely wonderful. It has been such a pleasure to see how well-behaved and loving they are with one another and with you. Even most of our staff has commented on their excellent behavior. Well done, Mom."
Mom was somewhat embarrassed by my compliment. "Trust me," I assured her, "I mean my words. What a wonderful job you are doing raising such fine young kids." As I spoke, the kids all grinned, bumping into one another with their elbows and bodies. I looked at all of them and smiled.
Mom thanked me, shyly, before explaining that she was a single parent. "Although I get tired by the end of the day, things seem to be going quite well with the kids." How could they not? This was an amazing woman, a role model for all, well aware of the importance of raising good children. And she was accomplishing, on her own, what two parents with less children weren't.
A hero.
After complimenting the children on their behavior and their impeccable church clothing, I ran to the freezer and grabbed four Italian ices. Grape. And lots of stickers from the nursing station. Just some small gestures to acknowledge their good behavior.
My hopes for our future have been restored. It took a few weeks, but I'm back to focusing on the good of our children. Thanks to the brilliant unselfishness of a great mother...
As always, big thanks for reading. Well done job to the mother of these four children! Also, thanks for your support in the recent Medgadget Medical Blog Awards voting. It continues until Sunday at midnight. If you enjoy my blog and posts, I would greatly appreciate your support and vote.
Friday, February 4, 2011
Sister, Sister
Good day, everyone. Briefly, it is that time of year when the prestigious Medgadget Medical Blog Awards are upon us, and I have humbly been chosen as a finalist in the Best Literary Medical Weblog category for 2010. If you enjoy my blog and posts, especially from 2010, I would greatly appreciate your support for this award. Simply click on the highlight above and go vote for StorytellERdoc! As always, thanks for reading and especially for your support! Now, on to the post...
I rolled open the sliding glass door of Room 33, pushing aside the privacy curtain as I entered into the treatment room to see my next patient. By the nurse's triage note, she was a woman in her mid-thirties who presented to our emergency department with a history of leukemia and a recent complaint of bruising.
Running through my mental checklist prior to entering, I was hopeful that this patient was actively undergoing chemotherapy, which would be the best explanation for her bruising (low platelets as a result of her medications). If she was in remission and not actively receiving chemotherapy, however, the bruising could signify, among other things, a return of her leukemia. The bruising might just be letting us know that her bone marrow was ill and not able to produce healthy, viable cells.
Sigh. I thought back to Christmas Day a few years back when my mother, in remission from her leukemia, nicked her fingertip while cutting a dinner roll at the kitchen sink. A little nick of bleeding that we struggled to control. "It's back, Jim," Mom had said, knowing the truth, sadness creeping into her eyes as she watched me dress her cut. I, playing the dutiful son, reassured her that all would be okay when, in truth, it turned out not to be.
Stepping into this patient's room, then, I was prepared for the worst but hoping for the best.
Two women greeted me as I walked into the room--the patient, sitting upright on her cot, wearing a flimsy hospital gown and loose-fitting pajama bottoms, and a woman of similar age sitting beside the cot in a hospital chair. They were obvious sisters, resembling each other quite strongly. Especially when they smiled their warm smiles.
"Hello," I said, walking up to the patient and taking her hand in my gloved ones as I absorbed her appearance, "I'm Dr. Jim. A pleasure to meet you, maam." She was fatigued-appearing, trying to smile the listlessness from her face. Despite her attempts, she looked so very tired. Her eyes were hazel and apprehensive, closely watching me study her. Her skin was smooth, maybe a touch pale, and her cheekbones gaunt. Her lips were slightly dry. The hospital gown loosely hung from her shoulders.
I turned to her sister, introducing myself to her as well. As it turns out, she was the older of the two. She, like her ill sister, had hazel eyes that, perhaps, sparkled a bit more, reflecting her bigger reservoir of energy. Her skin was creamy rather than pale. Where her sister was gaunt, this woman's face was healthy, lacking her sick sister's bony jawline and cheekbones. Her smile, the obvious family trait, was as genuine as her sister's. Looking at her sister, it was easy to imagine what the patient might look like on a typically healthy day.
For all the similarities, though, there existed two glaring differences between these siblings. Whereas the healthy sister had beautiful, coarse chestnut hair, the patient wore a black and yellow bandanna to her eyebrows, obviously covering her hair loss. The other thing? The patient's arms and upper chest were covered by varying stages of bruises--older, yellowish-brown ones to younger angry, purplish ones. The ravages of battling a malignancy.
"Maam," I said to Lisa, the patient, "are you actively on chemotherapy for your leukemia or are you currently in remission?" I held my breath in anticipation of her answer.
Lisa hesitated before answering. "I guess both, Doctor Jim," she said. "I am currently in remission but still take maintenance chemotherapy." In many cancer therapies, there is both an "induction" phase and "consolidation" phase of chemotherapy. Induction therapy is the aggressive initial round(s) of chemotherapy, whereas consolidation (think of maintenance) typically is started after the cancer has been halted or significantly "beaten back" by the induction round.
"Do you know which chemotherapy regiment you are on, Lisa?" I asked, relieved and happy with both of her answers to my questions. Her bruising, I suspected, was most likely due to low platelets from her medicines.
She nodded her head no. "I can never remember the long names of them."
"Let me try," I said, "are you on ara-C and idarubicin?"
Lisa and her sister both looked at me with surprise. "Yes," Lisa said, "those are it. How did you know?" I briefly explained that I had some familiarity with leukemia and the agents used to fight it.
After interviewing Lisa as her sister sat bedside, holding her hand and contributing to Lisa's history, I learned that she had done beautifully with her induction phase of chemotherapy and had quickly entered remission after a few months. Thus far, she had only received one round of maintenance chemotherapy, the week prior.
The amazing thing? Lisa didn't even live in our hometown. She grew up here but was currently living in the South, having returned, with her doctor's permission, to visit her family for an extended weekend. She had no family to help her battle her leukemia in Tennessee and her coming home was the first time she got to see her immediate family since she was diagnosed. "That's alright, though," she said, "I know everybody's prayers are with me."
The supportive sister, sitting beside the bed stroking her ill sister's hand, suddenly burst into sobs. Gasping for air, she tried to talk. "I...wanted...to...come...down, Leeessaaa, but...couldn't..."
What a pivotal moment. Obviously, the healthy sister carried a lot of guilt and pain around for not being physically closer to help her ill sister through her torments. Whether it be kids, a job, or other responsibilities, though, I can only imagine the heaviness the healthy sister endured with each mile she was separated from her sister.
Lisa reached over to her sister and rubbed her hand through her sister's thick hair. "Oh, sister, sister," Lisa said quietly, reflectively, "I know you want to be with me. Trust me, I do. But I'm okay--really, I am. Between my friends, I am well-taken care of."
"But," the healthy sister continued, her face now looking as listless as her sister's, "I want to be there, by your side. It's not fair."
"It never is," Lisa said, "but your daily phone calls and cards and endless prayers have been felt. I promise." Lisa lifted her sister's chin up so that she could gaze into her sister's eyes and slowly, before me, her sister's face gained back its strength and tranquility.
I walked out of the room, aware of the impact of what I had just witnessed. For all the tragic and heartbreaking illnesses that occur in the world, how many of the sufferers endure an unavoidable physical separation from their loved ones and must go at fighting their illness on their own? And can you imagine being a son, a daughter, a brother, a sister, a parent, or a best friend that has to sit on the sidelines, miles away, from someone you love who is suffering with a serious illness? It was obvious these two sisters would have preferred nothing less than to be geographically closer to one another to rely and lean on each other during Lisa's travails.
The magnified pain from both Lisa and her sister, as a result of their physical separation, was a reminder to me of how lucky my family was to be able to "circle the wagons" when one of us got ill. If only everybody could be so fortunate.
I wish that for you and your family if ever the time would come.
Lisa's platelets were low, just as we thought, and she was admitted overnight for several platelet transfusions. I promised her she would be discharged in the morning. She promised me she was going to talk to her sister, reassure her all was okay, and gingerly approach her about being her possible stem cell donor. "Lisa," I said, "that would be wonderful! You know your sister loves you and would be a donor in a heartbeat if your bone marrow matches. I'll keep you both in my thoughts."
And I do...especially for the lesson they taught me that day. Thank you, sister, sister.
As always, big thanks for reading...see you early next week. Jim
I rolled open the sliding glass door of Room 33, pushing aside the privacy curtain as I entered into the treatment room to see my next patient. By the nurse's triage note, she was a woman in her mid-thirties who presented to our emergency department with a history of leukemia and a recent complaint of bruising.
Running through my mental checklist prior to entering, I was hopeful that this patient was actively undergoing chemotherapy, which would be the best explanation for her bruising (low platelets as a result of her medications). If she was in remission and not actively receiving chemotherapy, however, the bruising could signify, among other things, a return of her leukemia. The bruising might just be letting us know that her bone marrow was ill and not able to produce healthy, viable cells.
Sigh. I thought back to Christmas Day a few years back when my mother, in remission from her leukemia, nicked her fingertip while cutting a dinner roll at the kitchen sink. A little nick of bleeding that we struggled to control. "It's back, Jim," Mom had said, knowing the truth, sadness creeping into her eyes as she watched me dress her cut. I, playing the dutiful son, reassured her that all would be okay when, in truth, it turned out not to be.
Stepping into this patient's room, then, I was prepared for the worst but hoping for the best.
Two women greeted me as I walked into the room--the patient, sitting upright on her cot, wearing a flimsy hospital gown and loose-fitting pajama bottoms, and a woman of similar age sitting beside the cot in a hospital chair. They were obvious sisters, resembling each other quite strongly. Especially when they smiled their warm smiles.
"Hello," I said, walking up to the patient and taking her hand in my gloved ones as I absorbed her appearance, "I'm Dr. Jim. A pleasure to meet you, maam." She was fatigued-appearing, trying to smile the listlessness from her face. Despite her attempts, she looked so very tired. Her eyes were hazel and apprehensive, closely watching me study her. Her skin was smooth, maybe a touch pale, and her cheekbones gaunt. Her lips were slightly dry. The hospital gown loosely hung from her shoulders.
I turned to her sister, introducing myself to her as well. As it turns out, she was the older of the two. She, like her ill sister, had hazel eyes that, perhaps, sparkled a bit more, reflecting her bigger reservoir of energy. Her skin was creamy rather than pale. Where her sister was gaunt, this woman's face was healthy, lacking her sick sister's bony jawline and cheekbones. Her smile, the obvious family trait, was as genuine as her sister's. Looking at her sister, it was easy to imagine what the patient might look like on a typically healthy day.
For all the similarities, though, there existed two glaring differences between these siblings. Whereas the healthy sister had beautiful, coarse chestnut hair, the patient wore a black and yellow bandanna to her eyebrows, obviously covering her hair loss. The other thing? The patient's arms and upper chest were covered by varying stages of bruises--older, yellowish-brown ones to younger angry, purplish ones. The ravages of battling a malignancy.
"Maam," I said to Lisa, the patient, "are you actively on chemotherapy for your leukemia or are you currently in remission?" I held my breath in anticipation of her answer.
Lisa hesitated before answering. "I guess both, Doctor Jim," she said. "I am currently in remission but still take maintenance chemotherapy." In many cancer therapies, there is both an "induction" phase and "consolidation" phase of chemotherapy. Induction therapy is the aggressive initial round(s) of chemotherapy, whereas consolidation (think of maintenance) typically is started after the cancer has been halted or significantly "beaten back" by the induction round.
"Do you know which chemotherapy regiment you are on, Lisa?" I asked, relieved and happy with both of her answers to my questions. Her bruising, I suspected, was most likely due to low platelets from her medicines.
She nodded her head no. "I can never remember the long names of them."
"Let me try," I said, "are you on ara-C and idarubicin?"
Lisa and her sister both looked at me with surprise. "Yes," Lisa said, "those are it. How did you know?" I briefly explained that I had some familiarity with leukemia and the agents used to fight it.
After interviewing Lisa as her sister sat bedside, holding her hand and contributing to Lisa's history, I learned that she had done beautifully with her induction phase of chemotherapy and had quickly entered remission after a few months. Thus far, she had only received one round of maintenance chemotherapy, the week prior.
The amazing thing? Lisa didn't even live in our hometown. She grew up here but was currently living in the South, having returned, with her doctor's permission, to visit her family for an extended weekend. She had no family to help her battle her leukemia in Tennessee and her coming home was the first time she got to see her immediate family since she was diagnosed. "That's alright, though," she said, "I know everybody's prayers are with me."
The supportive sister, sitting beside the bed stroking her ill sister's hand, suddenly burst into sobs. Gasping for air, she tried to talk. "I...wanted...to...come...down, Leeessaaa, but...couldn't..."
What a pivotal moment. Obviously, the healthy sister carried a lot of guilt and pain around for not being physically closer to help her ill sister through her torments. Whether it be kids, a job, or other responsibilities, though, I can only imagine the heaviness the healthy sister endured with each mile she was separated from her sister.
Lisa reached over to her sister and rubbed her hand through her sister's thick hair. "Oh, sister, sister," Lisa said quietly, reflectively, "I know you want to be with me. Trust me, I do. But I'm okay--really, I am. Between my friends, I am well-taken care of."
"But," the healthy sister continued, her face now looking as listless as her sister's, "I want to be there, by your side. It's not fair."
"It never is," Lisa said, "but your daily phone calls and cards and endless prayers have been felt. I promise." Lisa lifted her sister's chin up so that she could gaze into her sister's eyes and slowly, before me, her sister's face gained back its strength and tranquility.
I walked out of the room, aware of the impact of what I had just witnessed. For all the tragic and heartbreaking illnesses that occur in the world, how many of the sufferers endure an unavoidable physical separation from their loved ones and must go at fighting their illness on their own? And can you imagine being a son, a daughter, a brother, a sister, a parent, or a best friend that has to sit on the sidelines, miles away, from someone you love who is suffering with a serious illness? It was obvious these two sisters would have preferred nothing less than to be geographically closer to one another to rely and lean on each other during Lisa's travails.
The magnified pain from both Lisa and her sister, as a result of their physical separation, was a reminder to me of how lucky my family was to be able to "circle the wagons" when one of us got ill. If only everybody could be so fortunate.
I wish that for you and your family if ever the time would come.
Lisa's platelets were low, just as we thought, and she was admitted overnight for several platelet transfusions. I promised her she would be discharged in the morning. She promised me she was going to talk to her sister, reassure her all was okay, and gingerly approach her about being her possible stem cell donor. "Lisa," I said, "that would be wonderful! You know your sister loves you and would be a donor in a heartbeat if your bone marrow matches. I'll keep you both in my thoughts."
And I do...especially for the lesson they taught me that day. Thank you, sister, sister.
As always, big thanks for reading...see you early next week. Jim
Monday, January 10, 2011
Take A Picture
Like anyone else who works in the ER, I wish I could take pictures and videotape some of our more absurd, inebriated patients. Of course, though, I can't--patient confidentiality and all that blah-blah stuff. But how great would it be to sit a patient down, after they sobered up, and show them how ridiculous their behavior was while in our care? Maybe, even, send a copy to their proud parents or spouse.
Personally, if I ever had twelve beers and ten shots of tequila before proceeding to crap and vomit all over myself, I would like a picture or two to convince me it really happened.
It was 2 am and I was standing at the counter of our nursing station nearest the ambulance bay doors, finishing a chart while dreaming about going home within the next hour, when the doors suddenly swung open and a prehospital team proceeded to wheel a disheveled patient into our ER hallway. Usually, the team contacts us by radio to alert us of their pending arrival with a patient, so their unannounced visit was a surprise to all of us.
The chief paramedic shrugged. "Sorry," he said, "but we picked her up at a bar just a few blocks away and didn't have time to call."
On their cot, obviously intoxicated, sat a peroxide-blond female, in her mid-twenties, with her head slumped to her right side and her breasts barely contained by her skimpy halter. Her hair was messed, the hairspray she spritzed earlier in the evening unintentionally spiking clumps in all directions. Her face was streaked with tears, darkened trails of waterproof-less mascara collecting at her chin. Drool gathered at her mouth's angles.
So, so pretty.
Of course, I was intrigued. "She was at the bar," the paramedic continued, "drinking for the past three hours, when her friends got concerned because she wasn't 'acting right.' Remembering she had diabetes, they called us to come 'check her out.' When we got there, she was passed out on a bench in front of the tavern, a puddle of vomit at her feet. Her finger stick was 87, so we decided to bring her in. She doesn't have any signs of trauma, doc."
Well, thank you fellas.
As the paramedic was speaking, as if on cue, the patient cocked her one eye open and, realizing she had an audience, started wailing and shrieking, her cry alternating between forced hiccups and gasping sobs. The hallway filled with various heads poking out of the treatment rooms, wondering how a hyena ended up in our ER.
"Room 23," the charge nurse said. The paramedics hurried off with their patient.
A few minutes later, walking back to my computer station, I passed Room 23, slowing down to check-out what was going on with our new patient (yes, I was nibshitting). I'm glad I did, though, if for no other reason than to find the paramedic holding this patient in both arms, a hero carrying his damsel-in-distress, while transferring her dead-weight from his cot to ours. I stopped and waved to him, laughing, and he shook his head in disgust. "Sometimes I hate my job," he muttered with a smile.
I stopped in and did a brief primary exam, listening to the patient's heart and lungs, confirming her stable vitals, and making sure she had no evidence of trauma. She didn't. All the while, she kept asking for the bouncer from the bar. Over and over and over. "Maam," I finally said, "nobody came with you. I'm sure the bouncer had to stay to finish out his shift."
"Ahh," she slurred, "screw him. He has a small penis, anyway." As she spoke, she pinched her thumb and index finger an inch apart from one another, giggling to herself while amusing us. "How do you know that?" her nurse, Barb, asked. "Well, duh," the patient replied, "I can hardly feel him when we have sex." I almost threw up in my mouth from her sharing so much (or so little) information.
So, so classy.
As the nurse removed this patient's clothing to put her in a gown, we discovered that the patient had on three layers of compression garments around her middle--a spanx, a girdle, followed by another spanx. For those of you not familiar with spanx (and I wasn't, so the nursing staff kindly informed me), it is a stretchy, spandex-type piece that, after you hold your breath and squeeze yourself into it, acts like a casing to your sausage body. Miraculously, you look thinner and more fit. Without going to the gym or watching your diet. Your difficulty breathing, profuse sweating, and pinched-up, cyanotic face, though, might just be dead-giveaways that you are wearing one.
"Why in God's name," Barb continued, not learning her lesson about asking questions from before, "are you wearing three of these? I've never seen anything like this."
"Well, duh," the patient answered again, "maybe so I can get laid by a guy who likes skinny girls." I get it--three layers tripled her chances.
I'm assuming that she was assuming that she looked more attractive all squished into her itty-bitty jeans and shirt with the help of her garments, but really? Did she think this situation through? What guy, one who was probably out drinking at the same bar as her, would be able to remove three of these things? Would the effort be worth it? Would his spanx-removal talent have a big payoff? Sober, I doubt any guy would be able to succeed in getting this patient out of her spanx, but throw some drinks into the equation and what do you have? Besides the fumbling, frustrated fingers of her date? Failure, through and through.
All the while, the patient continued talking in a slurring half-whisper, occasionally bursting out in giggles from her self-amusement. Several times, she belched so obnoxiously that it would have made any beer-guzzling, football-watching male proud. And one time, she dug her finger so high up her nose for a booger that I think her elbow was resting on her chin. Needless to say, I was fascinated by her influenced behavior and lack of awareness.
Finally, though, my biggest shock of the evening came from what the nurse shared with me. It seems that as the tech and nurse finished undressing the patient for observation, they were unpleasantly surprised to find this patient and all her southern female parts barely covered by her thong underwear.
Her American flag thong underwear!!! Three square inches of red, white, and blue fabric.
I was never less proud to be an American.
For various reasons, I found this news appalling. And so did the nurse and tech. Never before, in my vast experiences, did I see some skimpy underwear fashioned in this manner. When did a manufacturer start finding it appropriate to place the American flag, our sacred national symbol, on a little triangular patch that covers a woman's privates. Or worse (I'm shuddering here), a man's? I mean, let's reason this out. If our flag touches the ground, out of respect, isn't the protocol to attempt to lift it up from the ground (if possible) and, if not, burn it. Yet, it's perfectly okay for someone to wear our prideful flag pressed against their privates? Something about this thought just didn't sit right with me.
Let's be proactive. I say we gather all the existing American flag thongs out there and have ourselves a big--no, make that huge-- bonfire. Quite honestly, though, that's one bonfire I would probably dread attending.
I did get to eventually leave at my scheduled time, 3 am, after signing out my active patients to the overnight doctor. The patient, who had no sober friends or family available to come take her home, did fine throughout the night's observations, barring the occasional outbursts of swearing, drunk mumbling, and promiscuous suggestions. When she sobered up, however, according to the morning team, she turned out to be a very nice, pleasant young woman who just happened to "have a rough night."
"She could have been your sister or mine," the nurse added.
"Umm, no," I thought to myself, "I don't think so." I wasn't about to picture any of my sisters in an American flag thong, let alone being ridiculously drunk while holding their thumb and index finger an inch apart.
My final thought...maybe I don't need to take a picture or videotape this stuff, after all. Really, the mental image is reminder enough for me. Who needs a timeless picture to document such dread? Or the nightmares that would follow? If anything, I guess you can just take a picture of me, the treating physician. I'll give you permission. Just excuse my gaping mouth, my surprising eyes, and my befuddled expression when you get it printed...
As always, big thanks for reading. If you own a pair of American flag thong underwear, do me a big favor and throw them out. STAT! See you soon...
Personally, if I ever had twelve beers and ten shots of tequila before proceeding to crap and vomit all over myself, I would like a picture or two to convince me it really happened.
It was 2 am and I was standing at the counter of our nursing station nearest the ambulance bay doors, finishing a chart while dreaming about going home within the next hour, when the doors suddenly swung open and a prehospital team proceeded to wheel a disheveled patient into our ER hallway. Usually, the team contacts us by radio to alert us of their pending arrival with a patient, so their unannounced visit was a surprise to all of us.
The chief paramedic shrugged. "Sorry," he said, "but we picked her up at a bar just a few blocks away and didn't have time to call."
On their cot, obviously intoxicated, sat a peroxide-blond female, in her mid-twenties, with her head slumped to her right side and her breasts barely contained by her skimpy halter. Her hair was messed, the hairspray she spritzed earlier in the evening unintentionally spiking clumps in all directions. Her face was streaked with tears, darkened trails of waterproof-less mascara collecting at her chin. Drool gathered at her mouth's angles.
So, so pretty.
Of course, I was intrigued. "She was at the bar," the paramedic continued, "drinking for the past three hours, when her friends got concerned because she wasn't 'acting right.' Remembering she had diabetes, they called us to come 'check her out.' When we got there, she was passed out on a bench in front of the tavern, a puddle of vomit at her feet. Her finger stick was 87, so we decided to bring her in. She doesn't have any signs of trauma, doc."
Well, thank you fellas.
As the paramedic was speaking, as if on cue, the patient cocked her one eye open and, realizing she had an audience, started wailing and shrieking, her cry alternating between forced hiccups and gasping sobs. The hallway filled with various heads poking out of the treatment rooms, wondering how a hyena ended up in our ER.
"Room 23," the charge nurse said. The paramedics hurried off with their patient.
A few minutes later, walking back to my computer station, I passed Room 23, slowing down to check-out what was going on with our new patient (yes, I was nibshitting). I'm glad I did, though, if for no other reason than to find the paramedic holding this patient in both arms, a hero carrying his damsel-in-distress, while transferring her dead-weight from his cot to ours. I stopped and waved to him, laughing, and he shook his head in disgust. "Sometimes I hate my job," he muttered with a smile.
I stopped in and did a brief primary exam, listening to the patient's heart and lungs, confirming her stable vitals, and making sure she had no evidence of trauma. She didn't. All the while, she kept asking for the bouncer from the bar. Over and over and over. "Maam," I finally said, "nobody came with you. I'm sure the bouncer had to stay to finish out his shift."
"Ahh," she slurred, "screw him. He has a small penis, anyway." As she spoke, she pinched her thumb and index finger an inch apart from one another, giggling to herself while amusing us. "How do you know that?" her nurse, Barb, asked. "Well, duh," the patient replied, "I can hardly feel him when we have sex." I almost threw up in my mouth from her sharing so much (or so little) information.
So, so classy.
As the nurse removed this patient's clothing to put her in a gown, we discovered that the patient had on three layers of compression garments around her middle--a spanx, a girdle, followed by another spanx. For those of you not familiar with spanx (and I wasn't, so the nursing staff kindly informed me), it is a stretchy, spandex-type piece that, after you hold your breath and squeeze yourself into it, acts like a casing to your sausage body. Miraculously, you look thinner and more fit. Without going to the gym or watching your diet. Your difficulty breathing, profuse sweating, and pinched-up, cyanotic face, though, might just be dead-giveaways that you are wearing one.
"Why in God's name," Barb continued, not learning her lesson about asking questions from before, "are you wearing three of these? I've never seen anything like this."
"Well, duh," the patient answered again, "maybe so I can get laid by a guy who likes skinny girls." I get it--three layers tripled her chances.
I'm assuming that she was assuming that she looked more attractive all squished into her itty-bitty jeans and shirt with the help of her garments, but really? Did she think this situation through? What guy, one who was probably out drinking at the same bar as her, would be able to remove three of these things? Would the effort be worth it? Would his spanx-removal talent have a big payoff? Sober, I doubt any guy would be able to succeed in getting this patient out of her spanx, but throw some drinks into the equation and what do you have? Besides the fumbling, frustrated fingers of her date? Failure, through and through.
All the while, the patient continued talking in a slurring half-whisper, occasionally bursting out in giggles from her self-amusement. Several times, she belched so obnoxiously that it would have made any beer-guzzling, football-watching male proud. And one time, she dug her finger so high up her nose for a booger that I think her elbow was resting on her chin. Needless to say, I was fascinated by her influenced behavior and lack of awareness.
Finally, though, my biggest shock of the evening came from what the nurse shared with me. It seems that as the tech and nurse finished undressing the patient for observation, they were unpleasantly surprised to find this patient and all her southern female parts barely covered by her thong underwear.
Her American flag thong underwear!!! Three square inches of red, white, and blue fabric.
I was never less proud to be an American.
For various reasons, I found this news appalling. And so did the nurse and tech. Never before, in my vast experiences, did I see some skimpy underwear fashioned in this manner. When did a manufacturer start finding it appropriate to place the American flag, our sacred national symbol, on a little triangular patch that covers a woman's privates. Or worse (I'm shuddering here), a man's? I mean, let's reason this out. If our flag touches the ground, out of respect, isn't the protocol to attempt to lift it up from the ground (if possible) and, if not, burn it. Yet, it's perfectly okay for someone to wear our prideful flag pressed against their privates? Something about this thought just didn't sit right with me.
Let's be proactive. I say we gather all the existing American flag thongs out there and have ourselves a big--no, make that huge-- bonfire. Quite honestly, though, that's one bonfire I would probably dread attending.
I did get to eventually leave at my scheduled time, 3 am, after signing out my active patients to the overnight doctor. The patient, who had no sober friends or family available to come take her home, did fine throughout the night's observations, barring the occasional outbursts of swearing, drunk mumbling, and promiscuous suggestions. When she sobered up, however, according to the morning team, she turned out to be a very nice, pleasant young woman who just happened to "have a rough night."
"She could have been your sister or mine," the nurse added.
"Umm, no," I thought to myself, "I don't think so." I wasn't about to picture any of my sisters in an American flag thong, let alone being ridiculously drunk while holding their thumb and index finger an inch apart.
My final thought...maybe I don't need to take a picture or videotape this stuff, after all. Really, the mental image is reminder enough for me. Who needs a timeless picture to document such dread? Or the nightmares that would follow? If anything, I guess you can just take a picture of me, the treating physician. I'll give you permission. Just excuse my gaping mouth, my surprising eyes, and my befuddled expression when you get it printed...
As always, big thanks for reading. If you own a pair of American flag thong underwear, do me a big favor and throw them out. STAT! See you soon...
Tuesday, December 21, 2010
Defining Emergency
Emergency, as per the all-knowing Webster, is defined as an unforeseen combination of circumstances or the resulting state that calls for immediate action. Furthermore, an emergency is also defined as an urgent need for assistance or relief.
These definitions sound pretty spot-on, right? When thinking about emergency room settings, even, one can easily correlate the words of Webster to what one would necessitate to be a situation requiring emergency medical treatment. A trauma. Broken bones. A heart attack. A stroke. A seizure. Respiratory distress. A cardiac arrest. The list goes on and on and on. When a critical illness or injury occurs, then, we should all be thankful that we live within a society where emergent, life-saving medical care is available.
Lately, though, it seems the system meant to provide this care is being bogged down by questionable decision-making. Instead of providing emergent care, it seems I spend at least half of my emergency room time now playing doctor to chronic illnesses. To pain control issues. To mildly elevated blood pressure readings. To months of nonspecific weaknesses and fatigue. To office appointments sent to the ER because "we are overbooked today." And our ER is not alone. I hear the frustration of my colleagues and see first-hand how overworked most of us who provide health care in the ER setting have become.
A month back, I was in the middle of a very busy shift. Several patients with chest pain (one requiring immediate catheterization), two patients with respiratory distress (one from skipping dialysis and one from a COPD exacerbation), and three patients from a motor vehicle collision presented almost simultaneously to our ER. Within minutes, all of these critical patients had been treated with efficient, appropriate life-saving care. The team on deserved kudos for doing their job well and making a difference in these patients' outcomes.
Walking back to the nursing station, then, I was surprised to find our secretary being berated by a gentleman in his thirties at the counter. His voice was loud and menacing. His face was pinched with anger. His fists were clenched by his side.
"Whoa," I said, walking up to him, standing between him and the secretary, "what seems to be the problem, sir?"
"We've been waiting two hours to be seen by a doctor!" he exclaimed. "What the hell is going on around here?"
Are you kidding? All he had to do was look for himself to find the organized commotion that was occurring in our ER setting. What followed was the briefest of conversations.
"Sir," I asked, "what brought you to our ER today?"
"My daughter's left ear is hurting her."
"For how long?" I asked.
"Two hours," he replied.
Two hours of ear pain? I get it--maybe he was worried about his daughter. I would be as well. But my daughter would also have gotten Tylenol and Advil and watched her daddy patiently wait for their turn to be treated once the dire situation had been explained. Better yet, we would have probably waited until the morning when a call could be placed to her personal physician.
I explained to him that we had multiple critical patients brought to us and we would be with his daughter as soon as possible. "We're all trying our best, sir," I added, "but you're going to need to be a little more patient."
The father stared me in the eye. I stared back. Finally, he blurted out what he had been thinking to say. "Well, then," he spoke, sarcasm dripping from his pathetic words, "try harder." It didn't end there, though. He continued. "This is bullshit waiting two hours to be seen."
Before I could respond, he turned his back and huffed himself back into Room 27 where, the nurse shared with me, his eleven year-old daughter comfortably sat watching TV. "And," the nurse added, "I had already explained to him why they were waiting to be seen."
After this, one of our regulars who had been to our ER over 200 times (since we started tracking in March of 2006) arrived via ambulance. Then a gentleman carrying a big bottle of Mountain Dew was escorted from his ambulance, by foot, into our ER because his main complaint was "I just want to take a nap and was too far from my apartment." Next, an asymptomatic patient with elevated blood pressure for three years, non-compliant with her medications for financial reasons (yes--I noticed the pack of cigarettes hanging from her purse), was sent to us from her family doctor to be cured on the spot. "Go right to the ER," she was told.
Can you appreciate the obviousness of the long waiting times in the emergency department? Although we all pride ourselves on providing expedient care, a four to six hour wait is sometimes the reality for some of our noncritical patients.
As if to hammer the point home, my last patient during my shift that night (I was working 5pm to 3am) was a sixteen year old female who had presented to our ER, via ambulance at 2am, with her mother.
I walked into her room to find this patient and her mother both lying in the cot, laughing while watching TV, the patient in no obvious distress. I introduced myself to them before I started asking questions. "What can I do to help you tonight? What brought you to our emergency room?"
The girl looked at her mother and started giggling, my first sign that she would survive whatever her ailment may be.
"Well," she said shyly, "I've had some burning when I pee for about a week. And," she added, not done "I have something gross leaking from down there (she swept her hand towards her pelvis as she spoke)." Upon further questioning, I learned that she had been diagnosed with a yeast infection from her family doctor one month ago but failed to get her prescription filled. I also learned that she was sexually active with not one, but two partners. Unprotected.
I was disheartened. "What made you come to the ER at 2am when these symptoms have been going on for over a week?" I asked, hoping there was some rhyme or reason to her seeking out emergent care at this time. There wasn't. Her answer to my question--"Why not?" I didn't even approach her on why she came in by ambulance. Some things are better not known, I guess, especially at 2am.
I'm not sure this is the system that was imagined when emergency departments started gaining favor in our society. Don't get me wrong, though. I, like all of my colleagues, are 100% committed to providing respectful and appropriate care to anyone who shows up in our department, whether it be a critical, life-threatening illness or a chronic "nuisance," so to speak.
I can only hope that people will be patient and understanding as we all cope with the evolving changes that seem to be occurring with our health care system. And my hat is off to all the medical folks who work hard, day after day, treating our fellow mankind as best we can within this currently accepted system. Because, even as bogged down as we can sometimes become, what an awesome privilege we have in meeting and greeting and treating our fellow kind. Of helping them out in their time of need.
Salute!!!
As always, big thanks for reading. I wish a blessed holiday season to each and every one of you...
These definitions sound pretty spot-on, right? When thinking about emergency room settings, even, one can easily correlate the words of Webster to what one would necessitate to be a situation requiring emergency medical treatment. A trauma. Broken bones. A heart attack. A stroke. A seizure. Respiratory distress. A cardiac arrest. The list goes on and on and on. When a critical illness or injury occurs, then, we should all be thankful that we live within a society where emergent, life-saving medical care is available.
Lately, though, it seems the system meant to provide this care is being bogged down by questionable decision-making. Instead of providing emergent care, it seems I spend at least half of my emergency room time now playing doctor to chronic illnesses. To pain control issues. To mildly elevated blood pressure readings. To months of nonspecific weaknesses and fatigue. To office appointments sent to the ER because "we are overbooked today." And our ER is not alone. I hear the frustration of my colleagues and see first-hand how overworked most of us who provide health care in the ER setting have become.
A month back, I was in the middle of a very busy shift. Several patients with chest pain (one requiring immediate catheterization), two patients with respiratory distress (one from skipping dialysis and one from a COPD exacerbation), and three patients from a motor vehicle collision presented almost simultaneously to our ER. Within minutes, all of these critical patients had been treated with efficient, appropriate life-saving care. The team on deserved kudos for doing their job well and making a difference in these patients' outcomes.
Walking back to the nursing station, then, I was surprised to find our secretary being berated by a gentleman in his thirties at the counter. His voice was loud and menacing. His face was pinched with anger. His fists were clenched by his side.
"Whoa," I said, walking up to him, standing between him and the secretary, "what seems to be the problem, sir?"
"We've been waiting two hours to be seen by a doctor!" he exclaimed. "What the hell is going on around here?"
Are you kidding? All he had to do was look for himself to find the organized commotion that was occurring in our ER setting. What followed was the briefest of conversations.
"Sir," I asked, "what brought you to our ER today?"
"My daughter's left ear is hurting her."
"For how long?" I asked.
"Two hours," he replied.
Two hours of ear pain? I get it--maybe he was worried about his daughter. I would be as well. But my daughter would also have gotten Tylenol and Advil and watched her daddy patiently wait for their turn to be treated once the dire situation had been explained. Better yet, we would have probably waited until the morning when a call could be placed to her personal physician.
I explained to him that we had multiple critical patients brought to us and we would be with his daughter as soon as possible. "We're all trying our best, sir," I added, "but you're going to need to be a little more patient."
The father stared me in the eye. I stared back. Finally, he blurted out what he had been thinking to say. "Well, then," he spoke, sarcasm dripping from his pathetic words, "try harder." It didn't end there, though. He continued. "This is bullshit waiting two hours to be seen."
Before I could respond, he turned his back and huffed himself back into Room 27 where, the nurse shared with me, his eleven year-old daughter comfortably sat watching TV. "And," the nurse added, "I had already explained to him why they were waiting to be seen."
After this, one of our regulars who had been to our ER over 200 times (since we started tracking in March of 2006) arrived via ambulance. Then a gentleman carrying a big bottle of Mountain Dew was escorted from his ambulance, by foot, into our ER because his main complaint was "I just want to take a nap and was too far from my apartment." Next, an asymptomatic patient with elevated blood pressure for three years, non-compliant with her medications for financial reasons (yes--I noticed the pack of cigarettes hanging from her purse), was sent to us from her family doctor to be cured on the spot. "Go right to the ER," she was told.
Can you appreciate the obviousness of the long waiting times in the emergency department? Although we all pride ourselves on providing expedient care, a four to six hour wait is sometimes the reality for some of our noncritical patients.
As if to hammer the point home, my last patient during my shift that night (I was working 5pm to 3am) was a sixteen year old female who had presented to our ER, via ambulance at 2am, with her mother.
I walked into her room to find this patient and her mother both lying in the cot, laughing while watching TV, the patient in no obvious distress. I introduced myself to them before I started asking questions. "What can I do to help you tonight? What brought you to our emergency room?"
The girl looked at her mother and started giggling, my first sign that she would survive whatever her ailment may be.
"Well," she said shyly, "I've had some burning when I pee for about a week. And," she added, not done "I have something gross leaking from down there (she swept her hand towards her pelvis as she spoke)." Upon further questioning, I learned that she had been diagnosed with a yeast infection from her family doctor one month ago but failed to get her prescription filled. I also learned that she was sexually active with not one, but two partners. Unprotected.
I was disheartened. "What made you come to the ER at 2am when these symptoms have been going on for over a week?" I asked, hoping there was some rhyme or reason to her seeking out emergent care at this time. There wasn't. Her answer to my question--"Why not?" I didn't even approach her on why she came in by ambulance. Some things are better not known, I guess, especially at 2am.
I'm not sure this is the system that was imagined when emergency departments started gaining favor in our society. Don't get me wrong, though. I, like all of my colleagues, are 100% committed to providing respectful and appropriate care to anyone who shows up in our department, whether it be a critical, life-threatening illness or a chronic "nuisance," so to speak.
I can only hope that people will be patient and understanding as we all cope with the evolving changes that seem to be occurring with our health care system. And my hat is off to all the medical folks who work hard, day after day, treating our fellow mankind as best we can within this currently accepted system. Because, even as bogged down as we can sometimes become, what an awesome privilege we have in meeting and greeting and treating our fellow kind. Of helping them out in their time of need.
Salute!!!
As always, big thanks for reading. I wish a blessed holiday season to each and every one of you...
Friday, December 10, 2010
Keep Your Cranky
Although the majority of my emergency department time is spent in a local 36-bed trauma center, I continue to work a few shifts each month in the small rural hospital near my childhood hometown, several hours away. It is a great change of pace, treating the local folks, while affording me a chance to spend a few evenings with my father and siblings' families.
Last week, I had to drive through white-out blizzard conditions during my most recent two-hour trip, taking approximately four hours each way because of the weather. White knuckles, breath-holding, tense and contracted muscles, stress headaches, and bouts of complaining to myself in the car--these were all part of the package deal. I imagined the cozy, 12-bed emergency department awaiting my arrival, however, and kept plugging along the icy roads, refusing to abandon my place in the thirty-car line of traffic. Going 20 mph. And braking every five seconds. Yep, good times, as any of you ever caught traveling in a snow storm are familiar with.
Arriving at the small ER, then, I was pleasantly surprised to see the festive decorations that adorned the department. Gold, shimmery garland draped the nursing station. Felt stockings and striped candy canes hung in random fashion along the glass enclosure walls. A Christmas tree was standing tall, twinkling and proud, in a nook of inactive space in the corner. It felt Norman Rockwelly and old-fashioned, and I felt welcomed. 'Tis the season.
The first of my scheduled shifts was quite hectic. From my prime seating in front of the ambulance bay doors, I was able to appreciate the outdoor weather. Blustery gusts of snow and heavy thick blankets of engorged snowflakes descended and tormented, without pause, the small town through the day. Although I felt worry and concern for anyone out in this weather, a blazing fireplace, a good book, and a glass of wine were the only things that would have added to the enjoyment and appreciation I felt for this crazy weather.
Three hours into my shift, though, I remembered what the first snowstorm of the season means to an ER staff. Multiple MVCs (multiple vehicle collisions). First-time-of-the-season shovelers developing chest pain as they try to clear their sidewalks. Frequent falls resulting in contusions and broken bones and lacerations. Cough and cold symptoms magnified tenfold with every ten degree drop. Frostbite. And on...and on...and on...
By mid morning, we were swamped. And I loved it. All twelve beds were filled and the waiting room was starting to spill over. The multiple ambulance runs to pick up and drop off ill patients created a steady, rhythmic sense of humming chaos. Despite the craziness, the staff I was working with (many of them friends from my childhood) continued to smile while pushing onward. I was proud to be part of such a team, their hardwork quite evident. We were providing excellent care in a very efficient manner, discharging and admitting and transferring patients left and right.
So, was it really a surprise to me to find that, eventually, all good things come to an end and this run of busy but gratifying work would be interrupted by something unpleasant? I guess not, although I could still hope, right?
The unpleasantness came early afternoon, in the form of a man's booming, angry voice resonating from the hallway. I had been in Room 2 at the time, examining a new patient, an elderly female with dizziness.
"If you'll excuse me, maam," I said, "I need to go see what's going on in the hallway."
I left her room and shut the sliding glass door. Several nurses were in the hallway already, standing in front of a 60ish man, his mouth moving while he leaned forward into his walker. The obvious source of the angry yelling.
"Excuse me, sir," I said, walking between the nurses and right up to him, "what seems to be the problem?"
If any of you have seen the movies Grumpy Old Men and Grumpier Old Men, picture a shorter version of Walter Matthau with slightly more gray hair peeking out from his baseball cap. A pinched-up face. Angry, flaring eyes and a reddened, ruddy complexion. His flannel shirt was untucked from his blue denim pants. And his hands were balled into fists while maintaining his grip on his walker.
Those angry, flaring eyes didn't take long to focus on me. "Who the hell are you?" he asked, practically spitting on me with his disgust.
"I'm Dr. Jim, the emergency room doctor on shift for the day," I said, keeping my cool. "And you are...?" I deliberately left the question open.
"I'm the God-damned boyfriend of Room 6, if any of you lazy sons-of-bitches care," he screamed out, "and I need somebody from this God-damned first-aid station to tell me what the hell is going on with her."
I was surprised at this man's behavior, wondering to myself if he had tipped a few back during lunch. The level of rudeness and obnoxious behavior I encounter through my shifts continues to amaze me. Trying to placate this man would turn out to be an obvious failure.
Room 6, this patient's girlfriend, contained a woman in her 60s who had lingering burping and belching for six months. Today, this day of stormy weather, was the day she decided to pursue her symptoms, for no other reason than just "because I figured it was time to get checked out." She was right to come in, since her EKG revealed signs of heart ischemia that were confirmed by her elevated cardiac enzymes via blood work. I had seen and treated her immediately upon her arrival to our ER, as well as checked-in with her multiple times, making sure her symptoms had resolved and explaining the results of her tests. Currently, the cardiologist was on his way to the ER to make further recommendations.
At no time during this woman's hour stay did a boyfriend present himself. She had been in the room alone.
"Sir, keep your voice down," I told him, "we have a lot of sick patients in this ER today. And when did you get here," I continued, "since I've been in your girlfriend's room multiple times in the past hour."
"Me, too," piped in Marsha, the patient's nurse.
"I just got here," he said, shaking his head in disgust, "and nobody made it a point to explain things to me." He continued to rant and rave, insulting anyone associated with the small rural hospital.
"That's not true," Marsha disputed, "I explained everything I knew to you, just a few minutes ago, after you walked into your girlfriend's room. I even offered you a chair, coffee, a blanket."
"Regardless, sir," I said, proud of Marsha, "you could have asked in a much better way than walking into the hallway and screaming like this for everyone to hear." He eyed me up, surprised at my confronting him on his behavior. "Now," I said, "these are your two choices. Either leave the department and wait in the waiting room, or go back into your girlfriend's room and act like a gentleman. After she answers your questions, I'll be in to answer anything further. With her permission, of course."
There was a standoff. He eyed me. I eyed him. The nurses all held their breath. Finally, he spoke. Or yelled. "Screw you. I'm going to go, God-damn it, and feed her God-damn mutt of a dog. But I'll be back," he said.
Before leaving, he tried one last parting shot. "I envy your God-damn generation," he muttered, "none of you know what hard work is. Not a single one."
Well, I thought back to my 14 hour days working with my father's crews in the woods when I was a teenager. I thought about waking up in my childhood on Saturdays and Sundays to cut and stack firewood and cut grass. I thought about the numerous chores our parents expected of us. I thought about the endless sleepless nights I spent, first studying through college, then medical school, and finally through residency, before some semblance of normalcy finally arrived to my life.
"Sir, you don't know me or any of the nurses, do you?" I asked, sweeping my hand towards them. He nodded "no." "Then how," I continued, "can you say such a rude thing? I would never consider insulting you the way you've insulted our staff. It's not necessary and your bad attitude isn't helping anyone. It's time for you to go."
"Well," he stammered, "even if you aren't lazy, most of your God-damn generation is."
And with that, he continued on his way out of our "first-aid station," decorated to celebrate the joy of the wondrous holiday, shaking his head in disgust until he walked through the waiting room doors.
After he left, our staff regrouped in the nursing station. Amazingly, not one person was affected negatively by this gentleman. Everyone had the good sense to dispel his insults and demeaning behavior without a second thought. "I can only hope," I warned them all, "that I'm not that grouchy when I get older."
I visited Room 6, the girlfriend. She was still clear of all her symptoms, but looked teary-eyed. "I'm so sorry for his behavior," she said, obviously hearing the conversation that had just occurred in the hallway, "he's like that all the time. But Doctor, just so you know, your staff treated me wonderfully today." She assured me, upon my questioning, that she was safe and not being abused physically. She declined any counseling offers. "He's a dog with a big bark and no bite," was how she put it. I wanted to ask her "Why?" Why in the world would she stay with a man so unpleasant, so abrupt and obnoxious? But I didn't. We all have our reasons for living our lives the way we do, and she was no exception. Besides, the world was continuing to revolve and I was needed in several other rooms.
An hour later, Mr. Crank was back. Before even entering his girlfriend's room, he walked himself right through the nursing station, stopping on its edge. "Now what the hell is going on?" he yelled, lifting his walker from the floor before banging it back down, startling me from the chart I was working on.
And the conversation continued as before--him insulting our staff and hospital with vulgar language, me giving him the option of either going to his girlfriend's room or the waiting room. In my book, this was his last chance, and I conveyed it respectfully to him.
He walked to his girlfriend's room, entered it, and shut the glass door behind him. Surprisingly, he was only in there for a minute or two before opening the door, walking into the hallway and out the ER while muttering to himself. Whereas before he had conveyed, with his body language, some misplaced pride, this time while walking past our nursing station he looked like a man who had just been brow-beatened. No doubt, the girlfriend had the last say in this matter.
Throughout this holiday season, we will have many opportunities to spread good cheer and love. Compassion and kindness. And endless smiles. Or, we will have opportunities to spread poison and malignant anger. Hurtful words and deliberate insults. And pinched-up frowns.
The choice is yours. The choice is mine. Just remember to pause and look at the infinite garland, the Christmas trees, the stockings, and the candy canes--all of the beauty of the season that surrounds us. Notice and acknowledge the smiles on the faces you pass. Remember your inner child's spirit and reflect on the deeper meaning of this holiday.
I can only hope your choice fills your heart with warmth.
And I wish for nothing less for Mr. Crank.
As always, big thanks for reading. Despite our respectful attempts to break through Mr. Crank's grumpy exterior, we were unsuccessful. Darn it! I hope this finds you well and ready for the holiday season and all it brings your way...see you early next week.
Last week, I had to drive through white-out blizzard conditions during my most recent two-hour trip, taking approximately four hours each way because of the weather. White knuckles, breath-holding, tense and contracted muscles, stress headaches, and bouts of complaining to myself in the car--these were all part of the package deal. I imagined the cozy, 12-bed emergency department awaiting my arrival, however, and kept plugging along the icy roads, refusing to abandon my place in the thirty-car line of traffic. Going 20 mph. And braking every five seconds. Yep, good times, as any of you ever caught traveling in a snow storm are familiar with.
Arriving at the small ER, then, I was pleasantly surprised to see the festive decorations that adorned the department. Gold, shimmery garland draped the nursing station. Felt stockings and striped candy canes hung in random fashion along the glass enclosure walls. A Christmas tree was standing tall, twinkling and proud, in a nook of inactive space in the corner. It felt Norman Rockwelly and old-fashioned, and I felt welcomed. 'Tis the season.
The first of my scheduled shifts was quite hectic. From my prime seating in front of the ambulance bay doors, I was able to appreciate the outdoor weather. Blustery gusts of snow and heavy thick blankets of engorged snowflakes descended and tormented, without pause, the small town through the day. Although I felt worry and concern for anyone out in this weather, a blazing fireplace, a good book, and a glass of wine were the only things that would have added to the enjoyment and appreciation I felt for this crazy weather.
Three hours into my shift, though, I remembered what the first snowstorm of the season means to an ER staff. Multiple MVCs (multiple vehicle collisions). First-time-of-the-season shovelers developing chest pain as they try to clear their sidewalks. Frequent falls resulting in contusions and broken bones and lacerations. Cough and cold symptoms magnified tenfold with every ten degree drop. Frostbite. And on...and on...and on...
By mid morning, we were swamped. And I loved it. All twelve beds were filled and the waiting room was starting to spill over. The multiple ambulance runs to pick up and drop off ill patients created a steady, rhythmic sense of humming chaos. Despite the craziness, the staff I was working with (many of them friends from my childhood) continued to smile while pushing onward. I was proud to be part of such a team, their hardwork quite evident. We were providing excellent care in a very efficient manner, discharging and admitting and transferring patients left and right.
So, was it really a surprise to me to find that, eventually, all good things come to an end and this run of busy but gratifying work would be interrupted by something unpleasant? I guess not, although I could still hope, right?
The unpleasantness came early afternoon, in the form of a man's booming, angry voice resonating from the hallway. I had been in Room 2 at the time, examining a new patient, an elderly female with dizziness.
"If you'll excuse me, maam," I said, "I need to go see what's going on in the hallway."
I left her room and shut the sliding glass door. Several nurses were in the hallway already, standing in front of a 60ish man, his mouth moving while he leaned forward into his walker. The obvious source of the angry yelling.
"Excuse me, sir," I said, walking between the nurses and right up to him, "what seems to be the problem?"
If any of you have seen the movies Grumpy Old Men and Grumpier Old Men, picture a shorter version of Walter Matthau with slightly more gray hair peeking out from his baseball cap. A pinched-up face. Angry, flaring eyes and a reddened, ruddy complexion. His flannel shirt was untucked from his blue denim pants. And his hands were balled into fists while maintaining his grip on his walker.
Those angry, flaring eyes didn't take long to focus on me. "Who the hell are you?" he asked, practically spitting on me with his disgust.
"I'm Dr. Jim, the emergency room doctor on shift for the day," I said, keeping my cool. "And you are...?" I deliberately left the question open.
"I'm the God-damned boyfriend of Room 6, if any of you lazy sons-of-bitches care," he screamed out, "and I need somebody from this God-damned first-aid station to tell me what the hell is going on with her."
I was surprised at this man's behavior, wondering to myself if he had tipped a few back during lunch. The level of rudeness and obnoxious behavior I encounter through my shifts continues to amaze me. Trying to placate this man would turn out to be an obvious failure.
Room 6, this patient's girlfriend, contained a woman in her 60s who had lingering burping and belching for six months. Today, this day of stormy weather, was the day she decided to pursue her symptoms, for no other reason than just "because I figured it was time to get checked out." She was right to come in, since her EKG revealed signs of heart ischemia that were confirmed by her elevated cardiac enzymes via blood work. I had seen and treated her immediately upon her arrival to our ER, as well as checked-in with her multiple times, making sure her symptoms had resolved and explaining the results of her tests. Currently, the cardiologist was on his way to the ER to make further recommendations.
At no time during this woman's hour stay did a boyfriend present himself. She had been in the room alone.
"Sir, keep your voice down," I told him, "we have a lot of sick patients in this ER today. And when did you get here," I continued, "since I've been in your girlfriend's room multiple times in the past hour."
"Me, too," piped in Marsha, the patient's nurse.
"I just got here," he said, shaking his head in disgust, "and nobody made it a point to explain things to me." He continued to rant and rave, insulting anyone associated with the small rural hospital.
"That's not true," Marsha disputed, "I explained everything I knew to you, just a few minutes ago, after you walked into your girlfriend's room. I even offered you a chair, coffee, a blanket."
"Regardless, sir," I said, proud of Marsha, "you could have asked in a much better way than walking into the hallway and screaming like this for everyone to hear." He eyed me up, surprised at my confronting him on his behavior. "Now," I said, "these are your two choices. Either leave the department and wait in the waiting room, or go back into your girlfriend's room and act like a gentleman. After she answers your questions, I'll be in to answer anything further. With her permission, of course."
There was a standoff. He eyed me. I eyed him. The nurses all held their breath. Finally, he spoke. Or yelled. "Screw you. I'm going to go, God-damn it, and feed her God-damn mutt of a dog. But I'll be back," he said.
Before leaving, he tried one last parting shot. "I envy your God-damn generation," he muttered, "none of you know what hard work is. Not a single one."
Well, I thought back to my 14 hour days working with my father's crews in the woods when I was a teenager. I thought about waking up in my childhood on Saturdays and Sundays to cut and stack firewood and cut grass. I thought about the numerous chores our parents expected of us. I thought about the endless sleepless nights I spent, first studying through college, then medical school, and finally through residency, before some semblance of normalcy finally arrived to my life.
"Sir, you don't know me or any of the nurses, do you?" I asked, sweeping my hand towards them. He nodded "no." "Then how," I continued, "can you say such a rude thing? I would never consider insulting you the way you've insulted our staff. It's not necessary and your bad attitude isn't helping anyone. It's time for you to go."
"Well," he stammered, "even if you aren't lazy, most of your God-damn generation is."
And with that, he continued on his way out of our "first-aid station," decorated to celebrate the joy of the wondrous holiday, shaking his head in disgust until he walked through the waiting room doors.
After he left, our staff regrouped in the nursing station. Amazingly, not one person was affected negatively by this gentleman. Everyone had the good sense to dispel his insults and demeaning behavior without a second thought. "I can only hope," I warned them all, "that I'm not that grouchy when I get older."
I visited Room 6, the girlfriend. She was still clear of all her symptoms, but looked teary-eyed. "I'm so sorry for his behavior," she said, obviously hearing the conversation that had just occurred in the hallway, "he's like that all the time. But Doctor, just so you know, your staff treated me wonderfully today." She assured me, upon my questioning, that she was safe and not being abused physically. She declined any counseling offers. "He's a dog with a big bark and no bite," was how she put it. I wanted to ask her "Why?" Why in the world would she stay with a man so unpleasant, so abrupt and obnoxious? But I didn't. We all have our reasons for living our lives the way we do, and she was no exception. Besides, the world was continuing to revolve and I was needed in several other rooms.
An hour later, Mr. Crank was back. Before even entering his girlfriend's room, he walked himself right through the nursing station, stopping on its edge. "Now what the hell is going on?" he yelled, lifting his walker from the floor before banging it back down, startling me from the chart I was working on.
And the conversation continued as before--him insulting our staff and hospital with vulgar language, me giving him the option of either going to his girlfriend's room or the waiting room. In my book, this was his last chance, and I conveyed it respectfully to him.
He walked to his girlfriend's room, entered it, and shut the glass door behind him. Surprisingly, he was only in there for a minute or two before opening the door, walking into the hallway and out the ER while muttering to himself. Whereas before he had conveyed, with his body language, some misplaced pride, this time while walking past our nursing station he looked like a man who had just been brow-beatened. No doubt, the girlfriend had the last say in this matter.
Throughout this holiday season, we will have many opportunities to spread good cheer and love. Compassion and kindness. And endless smiles. Or, we will have opportunities to spread poison and malignant anger. Hurtful words and deliberate insults. And pinched-up frowns.
The choice is yours. The choice is mine. Just remember to pause and look at the infinite garland, the Christmas trees, the stockings, and the candy canes--all of the beauty of the season that surrounds us. Notice and acknowledge the smiles on the faces you pass. Remember your inner child's spirit and reflect on the deeper meaning of this holiday.
I can only hope your choice fills your heart with warmth.
And I wish for nothing less for Mr. Crank.
As always, big thanks for reading. Despite our respectful attempts to break through Mr. Crank's grumpy exterior, we were unsuccessful. Darn it! I hope this finds you well and ready for the holiday season and all it brings your way...see you early next week.
Monday, November 22, 2010
Extra Cream And Crescent Moons
I just realized that I have passed my one-year anniversary for my blog, StorytellerDoc. It has been an amazing ride, thus far, and I am grateful for all the amazing positives and new friends that have come my way with this endeavor. Thank you... Now, for a post that drifts way off my beaten path.
I pride myself on working hard to stay in good physical shape and maintaining a healthy lifestyle. This, despite my love of scoop Fritos and Nibble With Gibbles potato chips. I come from good genetic stock, however, which makes "fighting the fight' a bit easier. Regardless, though, my frequent trips to my fitness club are a mental necessity with physical benefits that I've grown to rely on in keeping some sanity with my often stressful job.
I've been at the same club for thirteen years. And in those thirteen years, I have seen many new faces and also continue to see many familiar faces. On days when I don't really want to be there, it is nice to see that familiar face pushing themselves at one of the weight stations. Especially when that face is worn by an 80 year-old woman who is kicking ass at the leg abductor machine. Or the middle-aged guy who just finished doing twenty pull-ups.
Some of those faces, both new and old, I have also seen in the ER as patients. For that reason, I often wear a baseball cap pulled down quite low, just edging my eyebrows. Believe it or not, I was more embarrassed to run into the college girl who I recently treated for PID than she was. At least I know not to follow her on the machines she just sat at. Even more necessary, I plug my Koss earplugs into my mp3 player and crank some great, energetic music. That way, if a former patient wants to talk to me about their thrombosed hemorrhoids or that nasty fungal infection that just won't go away, I can feign not hearing them. "What's that, sir?" or "Did you say something, maam?" I may have been guilty in saying that once or twice during a workout.
A few years back, my gym started a program, I think it's called "Silver Sneakers," which gives elderly people a membership discount, encouraging them to work out. This is all good and fine. In fact, I look at some of these remarkable people and am truly inspired by their effort and commitment. However, I like to work out at the same time (mid morning to early afternoon) as the Silver Sneakers folks do, which at times has begun to frustrate me.
Let me reiterate here that I truly am impressed by most of these folks. I can only hope to be in my 70s and 80s and push myself the way some of these people do in the club. But, darn it anyway, some of them are causing me to think about joining another gym. And I'm a creature of habit. After thirteen years, I don't want to join another facility. But here's why--and if any of my following supportive arguments upset you, I apologize for it beforehand.
Several months back, I began to notice that sometimes walking into the men's locker room, before starting my workout, held a dangerous risk. The entrance to it has a C-curve, which prevents those out in the gym area from getting a direct view. Unfortunately, upon walking in, I have been greeted one too many times now by the naked old guy, just finishing from his shower, standing in front of his locker, bent over, drying his toes. And more drying. And still, more drying. I didn't know that drying your toes (did I mention naked?) can be a ten-minute ordeal. But for some, I guess it can be a meticulous process.
So, just go along with me here. Are you picturing the guy? Because, while he is drying his toes, his weighty scrotum with its ten-pound hernia is swinging back and forth, welcoming all who enter the locker room to have a great workout. Trust me, it's hard to be inspired to work out after that. Really, if that is what I have to look forward to in another thirty years, I may just pack it in now.
I have also witnessed many men clipping their toenails (some while sitting naked on a stool). So sometimes, either standing in front of my locker or trying to walk through to get to my locker, I haphazardly step on little slivers and shreds of discarded nails and cuticles. What the hell is this? I actually have a buddy who left the gym because of this. Me? I am made of stronger stock, I guess, than my buddy. I still feel the need to complain about it, though.
Anyone need any talcum powder? Cologne? There is plenty of that after a shower, too. Unfortunately, though, it's not mine. Nothing, and I mean nothing, freshens me up better before a workout than to walk through the obnoxious cloud of baby powder and cheap cologne. I have actually worked out before and thought to myself, "What is that stink?," only to realize that the stink was me. And I don't even wear Stetson cologne!
Just a few months back, I walked into the locker room to be welcomed by another naked man, bent over, drying his toes, with his pendulous scrotum wishing me a "good morning." All well and good now, since I am becoming immune to such greetings. But this guy, at least 80, had something I haven't seen before on the Silver Sneakers folks. Because of the club's free tanning promotion, this guy had an all-over tan--all over except for two very pale half-moons at the inferior creases of his buttocks. In laymen terms, he had two curvy spots of non-tanned skin from where his ample ass doubled-over while he was laying in the tanning bed. If I only knew his name, I would probably tell his family on him.
We interrupt this post to bring you a joke. Someone, please turn on my microphone (tap, tap--okay, it's working). Imagine me talking to this guy's grandkids. "Hey kids," I could say, "what is one-half moon plus one-half moon?" The kids would yell out their answer, "One!" "Nope," I would answer, pausing to build their anticipation before answering, "one-half moon plus one-half moon doesn't equal one, sillies, it equals your grampa's ass!" Well, maybe they would be right--grampa was showing me his full moon.
If that wasn't bad enough, last week when I walked into the locker room, there was actually a naked gentleman with his left leg drawn up onto his stool, actively squeezing hemorrhoid cream in his buttock's crack. I kid you not! At least I think it was hemorrhoid cream. I was horrified, hurrying past him before he could ask me to help him out or, better yet, accidentally spray some cream in my eye as I walked by. What's next, the public insertion of a suppository?
Although I view being observant and cognizant of my surroundings one of my best strengths, especially in the ER, I am learning that I may just need to put on some blinders the next time I pull into my gym parking lot. That way, I won't notice any more of the following:
The woman in spandex walking around the track with a saggy, incontinent bottom.
The crescent sweat stain on the seat of the weight machine from the person before me.
The gentleman who's comb-over is not combed-over while he does the bench press.
The fashion trend of wearing two different socks with your walking Reeboks.
The extremely curly hair that is on the water fountain push button.
The inadvertent forgetfulness of putting on a bra before working out.
Should I go on? Trust me, there is a lot more. Or do you get the idea?
Regardless, I am extremely proud of all of my fellow gym-mates. After all, despite any of my misgivings, they are there, at the gym, giving it their best in maintaining good health. Good for them, I say. And because of this, I have never once gone to the front desk and complained. Nor would I. If I did, I wouldn't have anymore of those special "Good morning!" greetings upon walking into the locker room. I just need to get over a few small issues, I suppose.
On second thought, if you'll excuse me, I'm going to go fill out my membership form for Curves.
See what so many years in the ER has done to my sense of humor? As always, big thanks for reading! Please come back... I hope this finds you well and wishing you a good week. Jim
I pride myself on working hard to stay in good physical shape and maintaining a healthy lifestyle. This, despite my love of scoop Fritos and Nibble With Gibbles potato chips. I come from good genetic stock, however, which makes "fighting the fight' a bit easier. Regardless, though, my frequent trips to my fitness club are a mental necessity with physical benefits that I've grown to rely on in keeping some sanity with my often stressful job.
I've been at the same club for thirteen years. And in those thirteen years, I have seen many new faces and also continue to see many familiar faces. On days when I don't really want to be there, it is nice to see that familiar face pushing themselves at one of the weight stations. Especially when that face is worn by an 80 year-old woman who is kicking ass at the leg abductor machine. Or the middle-aged guy who just finished doing twenty pull-ups.
Some of those faces, both new and old, I have also seen in the ER as patients. For that reason, I often wear a baseball cap pulled down quite low, just edging my eyebrows. Believe it or not, I was more embarrassed to run into the college girl who I recently treated for PID than she was. At least I know not to follow her on the machines she just sat at. Even more necessary, I plug my Koss earplugs into my mp3 player and crank some great, energetic music. That way, if a former patient wants to talk to me about their thrombosed hemorrhoids or that nasty fungal infection that just won't go away, I can feign not hearing them. "What's that, sir?" or "Did you say something, maam?" I may have been guilty in saying that once or twice during a workout.
A few years back, my gym started a program, I think it's called "Silver Sneakers," which gives elderly people a membership discount, encouraging them to work out. This is all good and fine. In fact, I look at some of these remarkable people and am truly inspired by their effort and commitment. However, I like to work out at the same time (mid morning to early afternoon) as the Silver Sneakers folks do, which at times has begun to frustrate me.
Let me reiterate here that I truly am impressed by most of these folks. I can only hope to be in my 70s and 80s and push myself the way some of these people do in the club. But, darn it anyway, some of them are causing me to think about joining another gym. And I'm a creature of habit. After thirteen years, I don't want to join another facility. But here's why--and if any of my following supportive arguments upset you, I apologize for it beforehand.
Several months back, I began to notice that sometimes walking into the men's locker room, before starting my workout, held a dangerous risk. The entrance to it has a C-curve, which prevents those out in the gym area from getting a direct view. Unfortunately, upon walking in, I have been greeted one too many times now by the naked old guy, just finishing from his shower, standing in front of his locker, bent over, drying his toes. And more drying. And still, more drying. I didn't know that drying your toes (did I mention naked?) can be a ten-minute ordeal. But for some, I guess it can be a meticulous process.
So, just go along with me here. Are you picturing the guy? Because, while he is drying his toes, his weighty scrotum with its ten-pound hernia is swinging back and forth, welcoming all who enter the locker room to have a great workout. Trust me, it's hard to be inspired to work out after that. Really, if that is what I have to look forward to in another thirty years, I may just pack it in now.
I have also witnessed many men clipping their toenails (some while sitting naked on a stool). So sometimes, either standing in front of my locker or trying to walk through to get to my locker, I haphazardly step on little slivers and shreds of discarded nails and cuticles. What the hell is this? I actually have a buddy who left the gym because of this. Me? I am made of stronger stock, I guess, than my buddy. I still feel the need to complain about it, though.
Anyone need any talcum powder? Cologne? There is plenty of that after a shower, too. Unfortunately, though, it's not mine. Nothing, and I mean nothing, freshens me up better before a workout than to walk through the obnoxious cloud of baby powder and cheap cologne. I have actually worked out before and thought to myself, "What is that stink?," only to realize that the stink was me. And I don't even wear Stetson cologne!
Just a few months back, I walked into the locker room to be welcomed by another naked man, bent over, drying his toes, with his pendulous scrotum wishing me a "good morning." All well and good now, since I am becoming immune to such greetings. But this guy, at least 80, had something I haven't seen before on the Silver Sneakers folks. Because of the club's free tanning promotion, this guy had an all-over tan--all over except for two very pale half-moons at the inferior creases of his buttocks. In laymen terms, he had two curvy spots of non-tanned skin from where his ample ass doubled-over while he was laying in the tanning bed. If I only knew his name, I would probably tell his family on him.
We interrupt this post to bring you a joke. Someone, please turn on my microphone (tap, tap--okay, it's working). Imagine me talking to this guy's grandkids. "Hey kids," I could say, "what is one-half moon plus one-half moon?" The kids would yell out their answer, "One!" "Nope," I would answer, pausing to build their anticipation before answering, "one-half moon plus one-half moon doesn't equal one, sillies, it equals your grampa's ass!" Well, maybe they would be right--grampa was showing me his full moon.
If that wasn't bad enough, last week when I walked into the locker room, there was actually a naked gentleman with his left leg drawn up onto his stool, actively squeezing hemorrhoid cream in his buttock's crack. I kid you not! At least I think it was hemorrhoid cream. I was horrified, hurrying past him before he could ask me to help him out or, better yet, accidentally spray some cream in my eye as I walked by. What's next, the public insertion of a suppository?
Although I view being observant and cognizant of my surroundings one of my best strengths, especially in the ER, I am learning that I may just need to put on some blinders the next time I pull into my gym parking lot. That way, I won't notice any more of the following:
The woman in spandex walking around the track with a saggy, incontinent bottom.
The crescent sweat stain on the seat of the weight machine from the person before me.
The gentleman who's comb-over is not combed-over while he does the bench press.
The fashion trend of wearing two different socks with your walking Reeboks.
The extremely curly hair that is on the water fountain push button.
The inadvertent forgetfulness of putting on a bra before working out.
Should I go on? Trust me, there is a lot more. Or do you get the idea?
Regardless, I am extremely proud of all of my fellow gym-mates. After all, despite any of my misgivings, they are there, at the gym, giving it their best in maintaining good health. Good for them, I say. And because of this, I have never once gone to the front desk and complained. Nor would I. If I did, I wouldn't have anymore of those special "Good morning!" greetings upon walking into the locker room. I just need to get over a few small issues, I suppose.
On second thought, if you'll excuse me, I'm going to go fill out my membership form for Curves.
See what so many years in the ER has done to my sense of humor? As always, big thanks for reading! Please come back... I hope this finds you well and wishing you a good week. Jim
Wednesday, November 3, 2010
The Willing Caregiver
I imagine the world as a vast, boundless frontier weathered by our swirling human emotions and complicated energies--hurricanes of intense heartbreak and tornadoes of joyous, unbridled celebrations, with every weather pattern in between. Sunshine and rain included.
If I could gather this world, foolishly believing that I could sweep my arms and hands through the unsuspecting air to collect a smaller, more-contained version of reality, I know with absolute sureness that what I would be left with is a typical day's worth of experiences in the emergency department. It is a microcosm of something similar to big life.
So many patients, so many illnesses, so many human interactions. So many words of comfort. So many experiences bombarding us daily. And try as we might to protect ourselves, building brick-by-brick our fortress of emotional barriers, ultimately, we cannot help but let some of our patients weave their very own threads into our personal life blankets.
I walked into Room 20 to treat my next patient, a woman in her mid-seventies. Because of a life-long battle with diabetes and its resulting circulatory problems, she was now permanently wheelchair-bound. She sat upright in her cot, in a hospital gown, without any blankets covering her. At the base of her right thigh, poking out from her gown, was a puckered-up cork of skin, where her leg had healed from an above-knee amputation. On her left-side, her leg extended just slightly lower, below knee-level, where, again, the rest of her leg had been amputated secondary to gangrene several years prior.
She was petite and frail. Despite a high fever and feeling ill, she sported a recently washed-and-set hairdo. She also wore some light makeup and dark lipstick, appearing well-cared for. The smell of her room, however, suggested otherwise--it permeated with the familiar stench of a Depend diaper that was overdue to be changed, most likely saturated with stale urine.
In her room's corner, sitting quietly and patiently, was her only child. A son, probably in his late-forties to early-fifties. He appeared fidgety at times, but was very attentive to both myself and his mother. He was, as it turned out, his mother's only living relative.
And her primary caregiver.
"Hello," I said to both of them, extending my hand to shake first the patient's and then her son's. "I understand you're here because you don't feel well, Mrs. Smith. Is that right?"
"Yes," she answered, slightly nodding her head as she spoke in a high-pitched, whispery voice, "I think I probably have a urine infection." She was probably spot-on, since that can be one of the most common causes of illness and fever in an elderly woman. She went on to explain the burning she experienced with recent urinations and her need for wearing Depend diapers because of the resulting incontinence.
"Have you had a urine infection before?" I asked her.
"A few months ago, yes, but otherwise I've been lucky, knock on wood," she answered, lightly knocking her closed fist against her imagined wooden temple. She then went on to explain to me that her right stump had healed beautifully from her recent surgery and had little reason to suspect that this might be the problem.
After reviewing the rest of her history and performing a stable physical exam, I ordered the patient's tests. And sure enough, she had a UTI, just like she suspected. With the help of some Tylenol, we were able to break her fever and by the time her blood results returned stable, she had been cleaned up and was feeling much better, with an IV dose of antibiotic finishing its run into her left arm's receptive vein.
I explained the results to her and her son, who, despite his mother's good response, had remained quietly sitting in the corner. He was edged forward on his seat, however, as if eager to say something.
"Sir," I said, "you look like you have something to say."
"Well," he said, glancing between his mother and myself, "do you think it's my fault that Mom got the urinary infection? I'm still learning how to help care for her."
"Michael," the patient answered quickly, "of course not. These things happen."
I liked her answer, but his question opened a floodgate of mine. "Why would you ask that, Michael?" I asked him, intrigued.
As it turns out, Michael, this patient's successful, independent son, had sold his out-of-town condo, sacrificed a current relationship, and moved back to our region and into his mother's home, all to take care of his mother after her second amputation.
"Do you have a medical background, Michael?" I asked him, amazed at his devotion. He nodded "no" to my question. "Have you ever been a caregiver before?" I continued, fully understanding just how much weight now sat on his shoulders.
The patient chimed in. "I told him to stay put, but he wouldn't hear of it. I feel bad he's halted his life to help me with mine."
"Mom, I wouldn't have it any other way. You talked me out of returning after your first surgery," he spoke shyly, pausing to nod at her left leg, "but there was no way I was going to stay away after this recent amputation. Unfortunately, I think your urine infection is from me not cleaning you well enough."
Now, imagine being a grown child, with no previous caregiver experience or medical background, halting the life that you've created only to move in with your sick parent. Your parent of the opposite sex, no less. Assuming care that included bathing responsibilities, bathroom runs, feedings, cleanings, appointment dates, and on and on and on.
And on. This was role reversal at its most intimate level.
Michael became an official caregiver. A frightening word for some, a privileged word for others. Regardless, it is a word that many people rightfully now use to describe themselves. Whether it be a sick child, a parent, a spouse, a partner, a grandparent, a relative, a neighbor, or a friend, there are currently 49 million people in our country who provide care in either a professional or personal sense.
Suddenly, I looked at this son in a new light. With no obvious agenda, he was doing what he felt was the right thing for his needing parent. And with his new responsibilities, he was going to be facing a whole new world of emotional weather.
Without any warning, my memories transported me back to when my father, my six siblings, and myself committed ourselves to providing 100% of Mom's home care during her last few months of battling leukemia. Although filled with much learning and many surprises, I think I can say that we all became extremely appreciative of the effort involved in taking total and complete care of a loved one. We were grateful for the experience, though none moreso than Mom, whose beauty and bravery during her last few days only magnified under our personal and steady care.
The patient spoke again, bringing me back to the present. "Michael," she said half-heartedly, "I wish you would have just agreed to put me in a nursing home like I wanted you to do."
"Mom," he responded emphatically, "I won't hear of it. At least not now. If things get too complicated, then we'll talk about it again. But wouldn't you rather be home, still? Seriously?" The patient took her time answering. "Yes," she finally admitted, "yes, I would rather remain home. But not if it means you are going to stop living your own life."
"I'm fine with it, Mom. I would never have moved back if I wasn't. And quite honestly, there is no where I would rather be right now than here, helping you the best I can."
Their smiles reflected off one another while another brick crumbled and fell from my fortified emotional barrier.
I finished the patient's treatment with a case management consult to ensure that Michael and his mother would benefit from several available resources, including home nursing visits. Walking out the door, I wished them both luck. But before leaving, I had to ask. "Michael, did you help your mother with her makeup, hair and clothes today?"
They both laughed. "Yes, he did," the patient answered. "How do you think he did?" Now it was my turn to laugh with the patient and good son. "I think he did a darn good job," I answered, "you look very nice, maam." I turned to Michael. "Well done, buddy." And I'm sure he knew I wasn't talking about how his mother looked that day.
Now, if only he would learn how to change a Depend diaper...
As always, big thanks for reading. And especially for bearing with me through a few weeks of barren writing. Much happening, but all good. I dedicate this post to all of you who have intimate knowledge of the sacrifices and hardwork necessary to be a great caregiver. See you back in a few days...
If I could gather this world, foolishly believing that I could sweep my arms and hands through the unsuspecting air to collect a smaller, more-contained version of reality, I know with absolute sureness that what I would be left with is a typical day's worth of experiences in the emergency department. It is a microcosm of something similar to big life.
So many patients, so many illnesses, so many human interactions. So many words of comfort. So many experiences bombarding us daily. And try as we might to protect ourselves, building brick-by-brick our fortress of emotional barriers, ultimately, we cannot help but let some of our patients weave their very own threads into our personal life blankets.
I walked into Room 20 to treat my next patient, a woman in her mid-seventies. Because of a life-long battle with diabetes and its resulting circulatory problems, she was now permanently wheelchair-bound. She sat upright in her cot, in a hospital gown, without any blankets covering her. At the base of her right thigh, poking out from her gown, was a puckered-up cork of skin, where her leg had healed from an above-knee amputation. On her left-side, her leg extended just slightly lower, below knee-level, where, again, the rest of her leg had been amputated secondary to gangrene several years prior.
She was petite and frail. Despite a high fever and feeling ill, she sported a recently washed-and-set hairdo. She also wore some light makeup and dark lipstick, appearing well-cared for. The smell of her room, however, suggested otherwise--it permeated with the familiar stench of a Depend diaper that was overdue to be changed, most likely saturated with stale urine.
In her room's corner, sitting quietly and patiently, was her only child. A son, probably in his late-forties to early-fifties. He appeared fidgety at times, but was very attentive to both myself and his mother. He was, as it turned out, his mother's only living relative.
And her primary caregiver.
"Hello," I said to both of them, extending my hand to shake first the patient's and then her son's. "I understand you're here because you don't feel well, Mrs. Smith. Is that right?"
"Yes," she answered, slightly nodding her head as she spoke in a high-pitched, whispery voice, "I think I probably have a urine infection." She was probably spot-on, since that can be one of the most common causes of illness and fever in an elderly woman. She went on to explain the burning she experienced with recent urinations and her need for wearing Depend diapers because of the resulting incontinence.
"Have you had a urine infection before?" I asked her.
"A few months ago, yes, but otherwise I've been lucky, knock on wood," she answered, lightly knocking her closed fist against her imagined wooden temple. She then went on to explain to me that her right stump had healed beautifully from her recent surgery and had little reason to suspect that this might be the problem.
After reviewing the rest of her history and performing a stable physical exam, I ordered the patient's tests. And sure enough, she had a UTI, just like she suspected. With the help of some Tylenol, we were able to break her fever and by the time her blood results returned stable, she had been cleaned up and was feeling much better, with an IV dose of antibiotic finishing its run into her left arm's receptive vein.
I explained the results to her and her son, who, despite his mother's good response, had remained quietly sitting in the corner. He was edged forward on his seat, however, as if eager to say something.
"Sir," I said, "you look like you have something to say."
"Well," he said, glancing between his mother and myself, "do you think it's my fault that Mom got the urinary infection? I'm still learning how to help care for her."
"Michael," the patient answered quickly, "of course not. These things happen."
I liked her answer, but his question opened a floodgate of mine. "Why would you ask that, Michael?" I asked him, intrigued.
As it turns out, Michael, this patient's successful, independent son, had sold his out-of-town condo, sacrificed a current relationship, and moved back to our region and into his mother's home, all to take care of his mother after her second amputation.
"Do you have a medical background, Michael?" I asked him, amazed at his devotion. He nodded "no" to my question. "Have you ever been a caregiver before?" I continued, fully understanding just how much weight now sat on his shoulders.
The patient chimed in. "I told him to stay put, but he wouldn't hear of it. I feel bad he's halted his life to help me with mine."
"Mom, I wouldn't have it any other way. You talked me out of returning after your first surgery," he spoke shyly, pausing to nod at her left leg, "but there was no way I was going to stay away after this recent amputation. Unfortunately, I think your urine infection is from me not cleaning you well enough."
Now, imagine being a grown child, with no previous caregiver experience or medical background, halting the life that you've created only to move in with your sick parent. Your parent of the opposite sex, no less. Assuming care that included bathing responsibilities, bathroom runs, feedings, cleanings, appointment dates, and on and on and on.
And on. This was role reversal at its most intimate level.
Michael became an official caregiver. A frightening word for some, a privileged word for others. Regardless, it is a word that many people rightfully now use to describe themselves. Whether it be a sick child, a parent, a spouse, a partner, a grandparent, a relative, a neighbor, or a friend, there are currently 49 million people in our country who provide care in either a professional or personal sense.
Suddenly, I looked at this son in a new light. With no obvious agenda, he was doing what he felt was the right thing for his needing parent. And with his new responsibilities, he was going to be facing a whole new world of emotional weather.
Without any warning, my memories transported me back to when my father, my six siblings, and myself committed ourselves to providing 100% of Mom's home care during her last few months of battling leukemia. Although filled with much learning and many surprises, I think I can say that we all became extremely appreciative of the effort involved in taking total and complete care of a loved one. We were grateful for the experience, though none moreso than Mom, whose beauty and bravery during her last few days only magnified under our personal and steady care.
The patient spoke again, bringing me back to the present. "Michael," she said half-heartedly, "I wish you would have just agreed to put me in a nursing home like I wanted you to do."
"Mom," he responded emphatically, "I won't hear of it. At least not now. If things get too complicated, then we'll talk about it again. But wouldn't you rather be home, still? Seriously?" The patient took her time answering. "Yes," she finally admitted, "yes, I would rather remain home. But not if it means you are going to stop living your own life."
"I'm fine with it, Mom. I would never have moved back if I wasn't. And quite honestly, there is no where I would rather be right now than here, helping you the best I can."
Their smiles reflected off one another while another brick crumbled and fell from my fortified emotional barrier.
I finished the patient's treatment with a case management consult to ensure that Michael and his mother would benefit from several available resources, including home nursing visits. Walking out the door, I wished them both luck. But before leaving, I had to ask. "Michael, did you help your mother with her makeup, hair and clothes today?"
They both laughed. "Yes, he did," the patient answered. "How do you think he did?" Now it was my turn to laugh with the patient and good son. "I think he did a darn good job," I answered, "you look very nice, maam." I turned to Michael. "Well done, buddy." And I'm sure he knew I wasn't talking about how his mother looked that day.
Now, if only he would learn how to change a Depend diaper...
As always, big thanks for reading. And especially for bearing with me through a few weeks of barren writing. Much happening, but all good. I dedicate this post to all of you who have intimate knowledge of the sacrifices and hardwork necessary to be a great caregiver. See you back in a few days...
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