My Spinning Head

My head is spinning. Seriously spinning.

Let me see. A combined twelve years of elementary school and high school. Four years of college. Four years of medical school. One year of internship. And three years of residency. Oh yeah, don't forget about the thirteen years of "life" I've had since all of this formal schooling and training has finished.

Yet, for all of this experience and hard work, I felt abandoned. Confused. Wayward. Standing in the middle of a store aisle. I ended up looking to my left, ready to plead for a stranger's help. I looked to my right, hopeful that some angelic vision enveloped in a bright, shining aura would proclaim the answer to my question. And I looked ahead of me, acutely aware of all of my options.

Which cough and cold medicine should I buy?

You might laugh but, seriously, how does the common person do this? Here I am, with all of this medical knowledge and ER experience in my back pocket, and even I can't make a decision to what I should buy in this endless cough and cold medicine aisle.

It started out simple enough. Traveling down the fourteen hours to Hilton Head these past few days, staying in a hotel room halfway through the trip, lots of car time with some lingering kid-coughs, closed continuous car circulating air, and, before I could blink, my wife has a runny nose, sinus congestion, and headache. And is feeling rundown. And is achy everywhere. And has a sore throat. And a fever, "well, maybe I don't have a fever but I feel warm." I'm sure it was brewing before we left but, unfortunately, presented itself at the start of our vacation.

The thing is, my wife never gets sick. Seriously. She takes her vitamins, she exercises, she eats her vegetables, and not from a can, mind you (that would be me and my love-affair with young, tender peas). She consistently partakes in all the things that I only do on a sporadic basis. But, here we are, on vacation, and she's the one whose ass is dragging. I would take one for the team, in a heartbeat, if I could spare her this misery. But, I have to admit, for once, it's nice to not be the adult in the house getting the kids' spill-off illnesses.

She's not a complainer (of the two of us, that would be me), so when she asked me if there were any medications she could take to feel better, I knew she was not feeling well.

We went out as a family to WalMart to buy her some medication for her symptoms. The irony of it--driving fourteen hours to go to a store that exists five minutes from our home--was not lost on me. But to our credit, we did try the local grocery store first.

I walked into the store, very clear about what kind of medicines she needed to get back on track. How hard could this be, really? She and the kids grabbed a cart to fill-up on our needed supplies for a week of condo-living. I searched out the pharmacy section. "I'll meet up with you in a few minutes," I had said. On hindsight, a stupid statement.

I found the cough and cold medication aisle quickly. I started picking up the boxes to read the active ingredients. Cough suppressant? Cough expectorant? Nasal decongestant? Antihistamine? After sorting through all of those options, then, I had to decide if I wanted acetaminophen (Tylenol) or ibuprofen (Motrin or Advil). Okay Jim, I comforted myself, just take your time and start over.

I decided a different approach--let's go with the proclamations on the front of the box. Cold Multi-Symptom (regular or severe), Sinus Congestion, Headache and Sinus, Cough and Headache, Sore Throat and Cough, Sore Throat, Cough, and Sinus...you get the picture. If nothing else, I appreciated the selling of every single variable you could squeeze out of the common cold.

So picture it, you are at the store shopping and you see a guy scratching his head, rubbing his chin, pacing back and forth, picking up a box off the shelf just to replace it back in seconds, and that would be me. With all of my infinite medical wisdom.

I finally sorted through all of these options before realizing, "Wait, she'll need both a daytime and a nighttime medication." I sure didn't want my wife to get tired in the daytime during our time at Hilton Head, right? Possibly risk sleepwalking through our vacation? So, guess what? She'd need the nighttime version, too. Unfortunately, though, the daytime formula I had decided on didn't have an alternate nighttime version (it's usually just an addition of some form of antihistamine). So what did I do? Well, of course, I started over.

The minutes dragged, the active ingredients blurred, and the box-front symptoms united to form one big blob of an illness. Finally, after much frustration, I picked out what I thought was the best option for my wife's illness.

"Daddy," I heard my youngest call, just as I was wrapping up my choice. Looking down the aisle, I saw my smiling family approach me. "What took you so long?"

I held up the boxes I chose for my wife to see. I must have looked like the village idiot, extreme pride radiating from my pathetic face, eagerly anticipating my wife's approval of the two $2.68 boxes of miracles. Please, please, I remember thinking, tell me how good I did.

What she asked next was like fingernails on my brain's chalkboard. "What about the liquid, Jim? How's that?" I think I stomped my feet, my mind screaming "No, no, no" while my voice remained silent. "Or," she continued, walking down the aisle, scanning the options, "maybe I'll just do gel-caps." She looked at several boxes quickly, scanning each's front and back in just short of ten seconds. "Yeah," she said, "I think these will do." She had found a combo-box of both daytime and nighttime medication with, evidently, just the right active ingredients to treat her symptoms.

I think I'll just place this whole experience in the "knows too much," category, thank you very much. I might just be giving myself too much credit, though, on that one.

Now, if you don't mind, I have to go take a couple Tylenol for my headache. Or maybe Motrin. Oops, I mean Aleve...

As usual, big thanks for reading. Next post follows on Wednesday, March 17. Hope everyone is well...see you then...

Hackles Up

The city in which I work is probably, I would say, medium-sized. We have our own collection of restaurants, cultural events, sporting arenas with minor-league teams, several hospitals, and four major colleges.

You would think that our city would be large enough to not run into patients whom I have treated in the ER, but this is simply not true. There are way too many places to be recognized.

"Hey, doc," they'll say to me in a Walmart line, "do you remember me? You treated my hemorrhoid in 2003?"

Oh, that's right. Of course I remember you now. NOT! And please, sir, whatever you do, don't show me your buttocks to refresh my memory.

I do seem to have a good memory for people's faces, though, and even a better memory of their illness (as long as it's more recent than 2003!). I am much more likely to remember your heart attack, the cauliflower growth on your ear, your thickened, fungal toenail that grew overnight, or the way you cried when our most-skilled nurse put in your IV (along side your ten inch forearm tattoo!) than remember your name.

And, for the most part, if I am not pressed for time, I do enjoy seeing some of these former patients. They are usually gracious and complimentary--who wouldn't enjoy that? We don't get a chance to follow-up with ER patients like an office-setting practice does, so I appreciate hearing about how they are doing and what worked in successfully treating their illness.

There are, however, a few circumstances where I would rather not be approached.

For one, the gym. I appreciate my gym-time immensely and rely on my workouts to keep me centered. Since I have treated multiple patients who frequent my gym, I usually wear a baseball cap pulled practically down to my upper lip to remain incognito. The only problem with that, besides bumping often into the weights, is I'm not quite sure if people are looking at me because I look familiar to them or because I look like the ultimate dork.

My other issue about the gym is this: if you see me standing naked (pre or post-shower) in the locker room, please let me finish what I am doing (translation--let me get some underwear on!) before you approach and share with me. Especially if I'm bent over drying my toes! I'm not shy, really, but rarely can someone give me a good hemorrhoid or constipation story in less than ten minutes. If it is a heart attack or stroke story, I know I'm committed for a good 20-30 minutes. Let me tell you, I can grow a whole crop of goose bumps like you've never seen in that time!

So, obviously, the gym is out.

My only other issue is that I do not want former patients to share if my kids are with me.

A few years back, I was on a date with my three young kids. Just me and my kids. We had ourselves a nice meal at The Olive Garden and then went to the movies. On our way home, we stopped at the local Target to buy fingernail polish (for Daddy's famous manicures) for the girls.

A woman who works in the pharmacy section of the store is a former patient. In fact, not only have I treated her multiple times, but I have also treated her troubled, teenage children several times. The last time I had seen her was at her daughter's bedside. Unfortunately, her daughter had to be transferred to a psychiatric hospital for further care.

Now, I have never had any bad interactions with this woman or her children and, in fact, I remember having gone out of my way to show them extra kindness because of their many problems. However, as a result, this woman has tailed me through the store on several prior occasions, giving me updates, sometimes graphic, of their follow-ups. I remember being quite uncomfortable, at times, through these conversations.

On this particular day, as the kids and I were holding hands and happily walking through the store, I was hopeful that I wouldn't run into this woman.

Wrong. She spotted us almost instantly.

She came running up to us from behind, startling my kids and myself. I said hello to her and gave her a warm smile. My kids, inherently shy with strangers, crowded for space behind my back. I skipped their introduction.

"I know you'd want to know about my daughter," she started, speaking quite loudly.

"I sure would," I said quietly, kindly, "but maybe another time when I'm not with my kids, okay? We're on a date and just ran in to pick out some fingernail polish. I sure hope she's okay, though."

"Oh, sure, she's okay...now," she answered, gruffly. She didn't stop there, though. She started to tell me, in embarrassingly explicit language and detail, how her daughter had acted-out and had gotten into more recent trouble.

As she spoke, I could feel my protective hackles coming on. My kids cowered into the back of my legs, gripping my pant-legs and tugging me into them.

I interrupted her. "Maam," I repeated, now emphatically , "I am on a date with my kids and, frankly, don't feel comfortable with how you are talking in front of them. They don't need to hear of your daughter's problems."

"Well," this woman said, somewhat affronted, "they need to learn about this stuff sometime." Learn what? I thought. About your daughter's acting-out? Or, from you, how to use a swear word? Either way, I don't think so.

"No, maam," I answered, struggling to keep my cool and smile, "you're wrong. My kids don't need to learn about your family problems. And they don't need to hear such explicit language, from you or anyone. I would never condone this type of language in front of them."

The woman huffed and seemed slighted, but I didn't care. "I wish your family well," I said with sincerity, "but I'd appreciate it if you let us keep moving here. Have a good day." Without waiting for a reply, I eased my hands into my children's backs and guided them onward, toward the make-up aisle.

Although I've seen this woman several more times in Target since that interaction, I have not seen her or her children in the ER since. She does not approach me anymore, either, although several times I have nodded a "hello" to her. I do hope her family is well.

I often wonder if I handled this interaction appropriately but, at the end of the day, I need to protect my kids in the way I deem necessary. They don't deserve the intrusiveness of my job. And they certainly don't need to learn their swear words from Daddy's former ER patients.

Would any of you handled this interaction differently?

There is a silver lining in all of this, though. At least I wasn't standing naked in a locker room when this conversation happened!

As always, big thanks for reading. Next post will be March 3. See you then...

What's Your Age?

I've never been to a carnival where I haven't stopped to watch that amazingly talented man who guesses a person's age or weight. How does he do it? And where the heck does someone learn that talent? How can he possibly come within five pounds of guessing that woman's weight, the one with knee dimples, chubby pinky fingers and five chins?

I don't give myself much credence for estimating a patient's weight. The margin of error is too big for my comfort. A patient's age, though? One through a hundred? Bring it on! One paramount rule must be followed, however, if you are going to partake. You must underestimate their age by five years of what you really think. Trust me, that rule saves a lot of hurt feelings.

By far, the hardest population for me to guess accurately is the older woman who looks years younger than her stated age. All natural. No surgery. And just a few shifts ago, I was surprised, once again, by yet another of these youthful patients.

I walked into a room to treat one Mrs. Smith. She was in our ER for a minor illness and, prior to going into her treatment room, I was able to review her chief complaint as well as her demographics. Her age was listed at 74.

I clearly walked into the wrong room. The room I walked into had a woman lying in the cot who was, at most, 50 and not a day older.

"I'm sorry, maam," I said, "I must have the wrong room. Have a nice day."

I walked back to my computer and rechecked Mrs. Smith's room number. What? I was in the right room after all? Impossible!

I walked back into Mrs. Smith's room. "Maam," I said, somewhat confused, "are you Mrs. Smith?"

"That would be me," she said, sharing her big smile with me. Real teeth and all.

I decided to have some fun with her. "Are you sure, maam? Because the person I am supposed to be treating is 74. May I take a look at your wristband?"

Mrs. Smith giggled like a six year-old school-girl as she held out her left wrist. Yes, this was the real Mrs. Smith. "Wow," I continued, "I'm sure you hear it all the time, but I have to tell you--you look wonderful! I would have never come close to guessing your age."

Mrs. Smith, in her girlish way, added a blush to her giggling. I didn't care, though, she deserved to hear how good she looked. She obviously did something right in her self-preservation, and I wanted to know what her secret was.

"Honey," she said, pondering my question, "I think it would have to be the fact that I've never used soap on my face before. Well, that," she continued, now wistful, "and having a good man by my side for 50 years."

It turns out that her husband died just a year ago. And suddenly, through her sadness, she looked much older.

Just like with Mrs. Smith, though, I am always excited to meet a patient who looks much younger than their stated age. Good for them! When I eagerly ask them what their secret is, how the heck they stay so young-looking, I tend to get one of five following answers:

1) "No soap has ever touched my face" or "I only wash my face with water."
2) "Genetics--you should have seen my parents."
3) "I drink a lot of water."
4) "I stay out of the sun."
5) "I use moisturizing lotion on my face every day."

Of all the moisturizers, the most commonly mentioned is Oil-of-Olay (sorry Ponds and Vaseline). A few years ago, in one of my health magazines, I read a letter of testament to the editor from a seventy year-old guy who, thanks to his daily use of Oil-of-Olay, claimed that he looked like a forty year-old. And, one of our nurses, Sue, tells the story of treating an eighty year-old woman who, she swears, looked like a forty year-old hottie, her skin smooth and clear, glowing and wrinkle-free. Her secret, Sue said, was Oil-of-Olay.

"But," Sue continued, lowering her voice to deliver some obvious bad news, "this woman was wearing a scarf around her head, tied under her chin, and I asked her to take it off. Well, let me tell you, this woman definitely had an eighty year-old neck, wrinkled and loose. She was embarrassed by her neck and told me that she had never put cream on it. It was terrible!"

"What did you say to her?" I asked.

"I told her, 'Yeah, honey, maybe you should have put some cream on your neck.'" I loved Sue's honesty. "I'm not kidding, though," Sue finished, "it was unsightly. I don't think that woman could go anywhere without her scarf. I know I sure wouldn't." Careful, Sue (who in her own right looked fantastic), I think I see your cat claws coming out. Meow!

Well, after seeing Mrs. Smith and hearing Sue's story, I reviewed my own chances for aging gracefully. Let's see, I have good genetics (thanks Mom and Dad!). Check. I drink a lot of water. Check. Unfortunately, my face and soap are intimately familiar with one another, so that was out. And, I love the feel of the sun on my face. Stike two.

Which left me one last thing. After that shift ended, on my drive home, I swung my car into Walmart's parking lot. Stay out of my way, people, I was on a mission. I walked into the store and quickly found the cosmetic aisle. Glancing around to make sure I didn't know anybody (since real men don't wear face lotion), I knelt down and grabbed two bottles of the liquid gold everybody had been touting. "Um, it's for my wife," I stammered to the cashier as I checked out. She couldn't have cared less. If I had known she would be this apathetic, I would have bought my wife a box of tampons. And the bulk package of toilet paper, too.

Since purchasing the lotion, I have been using it religiously, every morning without fail. And guess what? After a few months, I must admit that I am probably the best-looking 84 year-old you will ever see. Unfortunately, I'm only 42.

Maybe someday I'll head back to the carnival, pay the guessing-guy my $5, and win me a stuffed animal. Or, maybe not...maybe I'll just use my Oil-of-Olay money to buy one at Walmart. That would be much easier.

What's your secret? As always, big thanks for reading. Next post will be Friday, February 12.

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