This Father's Daughter

She was 50. Prior to being transported to our ER, her only complaint had been for non-traumatic elbow pain over the past two weeks. She was on no medications and had no significant medical history.

She was at home, preparing to visit her doctor for a scheduled visit, when she collapsed. Because she didn't drive, her elderly father had planned on swinging by to pick her up. He had just called and spoken to her minutes earlier to let her know he would be there shortly.

He arrived at her front door and knocked. No answer. He rang the doorbell. Again, no answer. Panic set in. This was not like his daughter to not greet him when she was expecting him. He knocked again, harder. Nothing. He kept his finger pressed to the doorbell, hoping his daughter would hear its continuous ringing and come to the door. She didn't. He tried turning the doorknob, but it was locked. He banged his aging shoulder against the door. It didn't budge.

He remembered the spare key she had given him months ago. "I'll never need this," he had said, trying to give it back, but his daughter had insisted he put it in his glove compartment. He stepped off the concrete porch pad and ran down the sidewalk, back to his pickup truck to retrieve the key. He found it, hidden under a pile of napkins.

Returning to the door, he struggled to fit the key into the lock. As a father, he knew something was wrong, very wrong. With trembling fingers, he finally succeeded in properly jamming the key into the door's lock. He turned the doorknob, barely breathing now, his mind racing of the possibilities he would encounter.

The door opened. He stepped into the small kitchen and yelled his daughter's name. No response. He listened to hear if the shower was running, but it wasn't. He strained his ears for anything, any sound of activity that would reassure him he was overreacting.

That's when he heard the moan. It was garbled and low, guttural almost. He followed the sound into his daughter's bedroom. That's where he found her, lying on the floor, beside the telephone nightstand.

He tried to rouse her, but he couldn't. Knowing something was terribly wrong, he dialed 911. Waiting for the prehospital team to arrive, he sat down on the floor beside her, caressing her head. Talking quietly to his daughter, he filled her ear with the promises that everything would be okay. It had to be, since they were all each other had.

The ambulance team arrived. After briefly interviewing her father and performing an exam, they prepared the daughter for transport to our emergency department. They were concerned that this patient may have had a stroke. They offered the elderly father a ride in the ambulance, with his daughter, but he decided to follow them in his pickup.

In the ER, the prehospital radio went off. They reported that a 50 year-old woman with a sudden onset of right-sided weakness and garbled speech was being transported to our facility. There had been no signs of trauma. Confirming that the time frame was adequate, a stroke alert was called in preparation of this patient's arrival. She would be a perfect candidate for tPA therapy if she did indeed suffer a stroke that was not hemorrhagic.

I, with the rest of our ER team, waited for this patient's arrival in Room 26. In three short minutes, she was being wheeled through our ambulance bay doors and down our hallway. Quickly, we were able to slide the patient from the prehospital stretcher to our hospital cot, all the while listening to the medical report given by one of the paramedics.

Her vital signs revealed that her blood pressure was quite high. She had no fever, her respirations were slow and erratic, and her pulse was normal. On exam, she had a flaccid right side, was nonverbal except for her occasional moaning, and teetered between some minimal form of consciousness and being unresponsive. It appeared that this patient had suffered some catastrophic brain event.

We emergently intubated this patient, both to protect her airway as well as ensure adequate oxygenation to her ill body. After a repeated exam by the neurology team, the patient was hurried to the CT scanner to determine the extent of her stroke.

While she was out of our department, escorted to CT by our nurse, the respiratory therapist, and a neurology resident, I went to the family room to speak to this patient's father. I was accompanied by our social worker and nursing supervisor.

I knocked on the door, opening it slowly to reveal a gentleman in his mid-seventies, tearful and distraught, running his hands through thin wisps of graying hair as he sat in the corner wing-backed chair. He had the look of a hard-working, honest man, dressed in a pressed flannel shirt and brown Dickie pants. He was alone.

"Sir," I said quietly, after introducing myself and my team, "I'm so sorry about what you are going through. Can you tell me what happened or anything that might help us with your daughter's care?"

With great detail, he told me about their plans to visit her family doctor that morning regarding her elbow. He was not aware that she had any medical problems. "She's a hard worker, that one. Never had time to be sick, really." He shared how he went to pick her up, only to find her collapsed beside her bed prior to his calling the ambulance. I listened intently, watching this father struggle to be stoic in his misery.

After maybe five minutes, a faint knock on the family room door preceded one of our nurses stepping in and interrupting our conversation. "Dr. Jim," she said, "can you come here, please."

I excused myself, leaving the father with our social worker and nursing supervisor. I stepped into the hall. "What is it?" I asked the nurse, herself wearing a worried look on her face.

"The CT scan, it's bad. The radiologist wanted me to get you."

I rushed to our physician work space, pulling up the patient's head CT images on the computer panel while I dialed the radiologist's number. What I saw saddened me. This patient had a significant brain hemorrhage, one that was shifting her brain from its midline and filling her ventricles with blood. The radiologist confirmed what I was looking at--that this patient most likely had a ruptured brain aneurysm. I called neurosurgery and the OR stat, since this patient needed emergent decompression of her brain's swelling and bleeding. Her problems were life-threatening.

I went back to the family room, where I sat down opposite the father. His expectant eyes bore into me. Slowly and deliberately, I explained all of the results to him. He unabashedly cried, his shoulder's shaking. "She's all I have left," he muttered. I was affected by his emotions and, looking at the tearful social worker and nursing supervisor, I knew that I wasn't alone.

We escorted the patient's father back to Room 26, where he was able to sit with his daughter as we awaited the go-ahead from the OR. I hovered in the room with several techs, the patient's primary nurse, and a respiratory therapist, overseeing the quick preparations of getting his daughter ready for surgery. I continued to watch the father, unable to turn away from the deep grief and ache that enveloped him.

This patient was taken to the OR. Thankfully, she made it through her emergent neurosurgery. She remained far from a successful outcome, however, since her following few days after surgery would be fragile and tenuous.

Usually, I follow-up with these types of emergent cases, the types that pull at my heartstrings. But, for this case, I didn't. I couldn't. I thought of this patient and her father frequently, yes, but I couldn't bear to think of this father losing his adult-daughter. I was willing to risk not learning of a possible successful outcome if it meant I also didn't learn of a sad, heartbreaking one.

I recognize what I am doing. I am protecting myself, adding another cement block to that protective shell that surrounds my heart. Building it up. Tearing it down. It is a constant but necessary struggle for each of us in the medical field.

I hope and pray, though, that this patient did well. After all, this father's daughter was all he had left.

As always, big thanks for reading. Next post will be Monday, April 19. I hope you have a great weekend...

The Family Room

It's in every emergency department.

Empty, it's just another shell of a sparsely decorated hospital room, lacking vibe and energy.

But when you fill it with nervous, hopeful family members awaiting news of their critically-ill family member, it is transformed into a room that can barely contain every possible extreme of human emotion.

It is The Family Room.

So, you ask, why is this room known as The Family Room?

This is the room where the families of the most extremely sick patients are placed while the medical team uses every available effort in their medical arsenal to save a life. It's a place for family to be alone, to comfort themselves in the face of adversity. These may be families of trauma victims, heart attack victims, stroke victims, or any other critical illness. Because the family room is usually situated on the edge of the department, it is usually quieter, more calming, and private. A far cry from the commotion that usually accompanies the room in which resuscitating a patient is happening.

Don't be fooled, though. This is no ordinary room. Physically, it may look like any other decorated hospital room, with a few extra vases and boxes of tissues thrown in, but that's where the similarities end. It is a room that demands and deserves respect. It is a room that I imagine as my friend, absorbing and buffeting and protecting all within it from the swirls of anger and the clouds of desperation. Sometimes, just sometimes, the mood is joyful. More often than not, however, this is a room where dreadful news is delivered to a family not prepared for such news.

Our own family room is just as I described above. It sits in the corner of our department, nestled between our waiting room on one side and the entrance hallway to our department on the other. It's painted beige and coral with a flowery border at the top--comfort colors, I guess. Short shag navy rug. Two of the corners hold lamps, usually lit for better ambiance. The furniture consists of two love seats and two wing-backed chairs, a couple in dark blue floral patterns, the other in pink and coral. Slightly better quality fabric and stuffing than the standard hospital furniture, but not by much.

How do I know these details? It's amazing the small things that I notice when I'm trying to blink back my own tears in sharing a family's misery. Sometimes I'm transported back to tenth grade when I counted Christmas tree ornaments on our church tree during my grandfather's funeral, all in the hopes of distracting my impending tears. 157 ornaments on the tree closest to the Virgin Mary.

I rarely deliver news alone to a family waiting. Either the ER social worker or the supervising nurse accompany me, sometimes both. I wear my long, official white coat to respect the gravity of the situation.

Imagine that moment right before walking into the family room with bad news. I hesitate at the door, take a deep breath, and remember that my words and support will be paramount to the family. I open the door, usually to be greeted by several anxious family members either pacing or sitting well beyond the edge of their chairs. After introductions of myself and my team, I ask them how they are each related to the patient.

Then, the hard part follows. I sit close to the spouse or family. Sometimes, I am offered a hand to hold and I eagerly take it. If the patient has already died, I make it a point to not linger and share the news almost immediately. It is important to be blunt but heartfelt, using the words "dead," "expired," and "we did everything we could." It has been shown that a family needs to hear several variations of the word "dead" so that the news sinks through their despair. Reassurances are given that everything possible was done.

If the patient is still alive, I review with the family everything being done to save their loved one. I explain any prehospital treatment, what we are currently doing for the patient in the ER, and give the family a brief opportunity to ask questions. We sometimes need to review the patient's living will or DNR status and to what level efforts should be pursued. Family members may even be invited to witness the resuscitation.

Through all of this, I don't lose eye contact. I focus on each person in the room, letting my eyes say something different from my words. "I'm so sorry" is the most simple and heartfelt offering.

As an ER doctor, I have a protective shell around me that I can usually maintain. But in the family room, I am different. It is not rare for me to leave with tears in my eyes, and that does not shame me. It is my privilege and blessing, really, to accompany a family through some of their darkest moments. I appreciate their acceptance of my presence during their misery. Who am I to bear witness to their profound loss?

I have been told by several staff members that my greatest gift is how I interact in that family room. But, for whatever I bring to that room, it is but a feather compared to the weight I carry away from it each and every time I meet another family.

I am humbled by this part of my job. And respectful of the family room's role in our ER.


Thank you, as always, for reading. I am grateful...may your week go well. Next post will be Wednesday, December 23.

No Second Chances

In residency, I was fortunate to train at a university hospital that had a burn center, one of approximately 125 centers in the U.S. As a result, we treated victims of all types of burns. While some burns were minor, many were quite significant, requiring months of both physical and psychological treatment. Death was the result of the worst of these burns.

I was working a twelve-hour shift when an ambulance called in. They were bringing us an elderly woman from her nearby residence. She had been drinking and had fallen asleep while smoking a cigarette. A fire ensued. Both her nightgown and couch had been extremely flammable, resulting in very serious burns to her body.

"It's bad, Doc," the paramedic said, ending his call.

Within minutes, the ambulance arrived. Our trauma team was activated and between the ER and trauma teams, we were ready to treat this patient.

Remarkably, this patient came in talking and not in much pain, which was worrisome. "I want to go home!" she said emphatically, obviously intoxicated.

Her injuries were profound. The skin on her arms, her legs, and her torso, both front and back, was either charred or translucent gray, indicative of full thickness burns. She had minor redness and blistering to her face and anterior neck. Her hair and eyebrows were singed.

It's daunting to see a patient so badly burned and not in significant pain. Very disturbing. The smell of her burnt skin and hair permeated the ER.

If I may, I'll briefly explain burns. They are classified by the type and by the depth of burn. Types include electrical, contact, steam, gas burns, thermal, etc. This patient sustained thermal fire burns. Unfortunately, she also sustained secondary contact burns, where the couch and her nightgown melted into her skin. Depths of burns are classified into three categories: superficial (or first-degree) burns, partial thickness (or second-degree) burns, and full thickness (or third degree) burns. Superficial and partial thickness burns, which this patient had on her face and neck, result in pain. Full thickness burns, the worst of burns, extend through the skin and soft tissue beneath it, burning, among other things, nerve endings. Thus, the reason this patient wasn't in extreme pain.

This was bad news. She had partial and full-thickness burns to at least 70% of her body (a morbid percentage). She was going to die from these burns.

Another grim fact was that most of her burns were circumferential, meaning that they completely circled, or wrapped around, her torso and extremities. With serious burns, there is significant swelling and edema. Circumferential burns, in essence, are a tourniquet, preventing the skin from expanding and compensating for this edema. With increasing pressure from the edema, the deep blood vessels are compromised and blood flow is diminished, initially to the extremities and ultimately to the vital organs.

I knew we only had minutes to talk to her and explain the gravity of her injuries. She was in disbelief. I explained that her injuries were-life threatening and how the swelling from her burns would quickly advance to her throat and close her airway.

"I'll do whatever you need if you can just call my daughter," she said, the morbid news settling in. "And can I have a smoke? I'm nervous."

No smoke, but my attending gave me permission to quickly call her daughter. The nurse ran and got a portable phone and I dialed the out-of-town daughter's number. A woman picked-up. Thankfully. It was her daughter. The patient told me to "tell my daughter everything," so I did.

I quickly introduced myself. "Maam," I said, "I'm sorry to call you with this news, but I'm standing at your mother's bedside in the emergency room. She's been involved in a serious burn accident and her injuries are life-threatening. She asked that I call you."

"Will she be okay? Was she drinking?" the daughter asked hurriedly.

I stepped away from the patient and lowered my voice. "Well, yes, it appears she has been drinking. And I'll be honest with you, maam, she's probably going to die from her injuries. She insisted we call you before we place a breathing tube in her airway to protect it from her burns and swelling. She'll be hooked to a ventilator after that."

"Oh, no," the daughter said, hesitating before speaking again. "I haven't spoken to my mother in years. We're estranged."

How damn heartbreaking. "Do you have any other family?" I asked. "No, it's just me. I'm an only child, like my mother. My father died when I was young. We were never in touch with his family."

It's so profoundly sad how many cases emotionally play out this way.

I moved on. "Can you talk to her? Again, she asked us to call you. If there are any words needed to be said, now would be the time to say them." The daughter lived five hours away and it was doubtful she would make it in time to see her mother.

I heard the daughter sobbing as I walked back to the patient's bedside. "Here's your daughter," I said to the patient, placing the phone to her ear.

All around this patient, it was organized chaos. She was receiving excellent medical care--attention to her burns, aggressive IV fluid hydration, and pain medicine. Preparations to intubate her were underway.

We, however, were in our own bubble. I was only interested in one thing--allowing this conversation between mother and daughter to occur. I stood by her cot, near her head, holding the phone as close as I could. I turned my head away, in essence to give her some privacy.

The patient sobbed. "I'm so sorry, baby." "I know, I know." "I love you, too." "I'll see you when you get here."

How sad to summarize all your regrets and feelings into a thirty second conversation.

This patient had been in our ER less than five minutes, tops, but by the time we hung up from her daughter, she was already getting stridorous, a sign that her airway was compromised. We needed to intubate her. I repeated our concerns and she agreed. Her eyes searched mine and she whispered, "It's bad, huh?" "Yes, maam. I'm so sorry, but your injuries are very bad."

We sedated her with adequate medications and successfully intubated her.

After the intubation, as expected, her swelling and edema worsened. Ultimately, this restricted her breathing and compromised her blood flow. Her vital signs became unstable. Before transferring her to the Burn Unit, the trauma team performed escharotomies. These are linear lengthwise incisions through the skin and soft tissue, along the lateral sides of the patient's extremities and torso. This procedure helped to relieve the increasing pressure from the swelling. Despite this, she continued to decompensate.

I learned a lesson that day. Yes, she received excellent and necessary medical treatment. But making that phone call, well, in the end, it was that phone call that was probably the most important thing we offered this patient in her hour of need.

Sadly, she would not be a miracle patient. And there would be no further reconciliation. Her daughter arrived just hours after this patient had passed.


As always, thanks for reading...the next post will be Friday, December, 11. It will be lighthearted.

Big Stuff, Big Words

I have become quite good at reading people within the first few minutes of meeting them. It comes with the job, actually. Thirty patients (and their families) a shift and rest assured, after 16 years in the ER, I have been exposed to many different personalities. I am a poker player of sorts, keeping my personal feelings hidden behind my smile while I measure up the alpha male, the needy daughter, and the nosy neighbor, all begging for more attention than the actual patient.

With all the family dynamics swirling around a patient's room, it is important for me to swiftly figure out the who, what, when, where and how so that I can attend to the patient's illness. You would be amazed how just one person can affect the entire ER experience, either positively or negatively.

And in Room 12, that one person happened to be a father of two boy, ages 10 and 12.

I walked into the room to find the ten year-old boy lying on the treatment cot, his forearm bent in the shape of an "L", obviously broken. The nurse was starting an IV to give him some morphine. Sitting in the corner of the room was this patient's twelve year-old brother, his face tear-stained and agonized, looking as hurt if not more than his younger brother. Pacing nervously alongside the patient's cot was their father.

Nothing really too much out of the ordinary.

Except the tension in the room was explosive. Something wasn't adding up.

And then Dad opened his mouth to speak to the son in the corner and it all made sense.

"I hope you're happy, damn it. Just look at your brother's arm. What the hell is wrong with you?"

Whoa, back up here. As the nurse was starting the IV, she looked up in the middle of Dad's rant to give me "the look," a warning that all was not good in this room. I interrupted Dad to introduce myself.

Dad bit his tongue during the introduction, but as soon as I asked what happened, Dad jumped right back in where he left off.

"He's always causing problems...pain in my ass...doesn't care about anyone but himself..."

His rant against his older son continued and the more he spoke, the more his son's shoulders shook from silent sobbing. The younger son with the broken arm sat silent, his pained expression speaking volumes.

The story played out that the two brothers were in the front yard playing soccer. Soon after, bored from kicking the ball, they started tackling one another. It was then that the older brother tackled his younger brother and, in the midst of the tackle, broke his younger brother's arm.

An accident, pure and simple. I could see it, the nurse could see it, and I know as you read this you see it.

Dad didn't see it. And I was finding it difficult to give him some benefit of doubt during his family's stressful crisis.

After several more hurtful insults, I had had enough.

"Come outside into the hallway with me, Dad. We need to talk."

In the hallway, Dad tried to start all over again with how his older son was a "problem child" and always created conflict in their family, but I halted him. Rarely have I met a "problem child" that didn't have a "problem adult" in his life.

I took a deep breath, not wanting to be anything but professional during this conversation. Deep down, though, my insides were screaming. I wanted to grab this guy and shake him, make him take an outside look at what he was doing to his older son.

"Listen, sir, I understand you're upset. But you have the power to make this a better experience for both of your sons right now. As things stand, your words are only making the situation worse."

"But damn it, he's got..."

I stopped him. "I've heard you already. And so has the nurse. And so have both of your sons. What I am asking of you is to go back in the room, find something nice to say to your older son, and then sit on the cot with your younger son and help him get through this visit. I don't want any more negative talk from you while we help your family, okay?"

I stared at him and he was silent. "Okay?" I asked again, more loudly.

He shook his head yes.

We walked back into the room. I looked at Dad. He was ready to talk to the son in the corner.

"See," the father said, "now you got me in trouble. I hope you're happy with yourself."

I was shocked. And angry. And frustrated with this man who, I felt, was clearly not appreciating the blessings of having children.

He looked at my face and, for once, I failed to hide my emotions. He did not say another word while we fixed his son's fracture.

After successfully reducing the broken arm, we sent the younger son to X-Ray for post-reduction films. We had Dad accompany him. I hung back with the older son.

Over popsicles, we got better acquainted. He shared that his dad said "a lot of mean things" to him. Words "that hurt sometimes." He assured me, though, that this was the extent of his father's unkindness. "He treats me okay most of the time," he added.

"You know this isn't your fault, right?"

He thought I meant his brother's broken arm. "But it is. I shouldn't have tackled him so hard."

"No, but that's not your fault, either. Things like this happen between brothers. I'm talking about the angry words you hear from your dad. Some parents love their kids very much but just don't know how to pick the right words to tell them."

He nodded while he looked down at his sneakers. I continued. "I have no doubt that you are a good son and brother." We talked a few more minutes that culminated with a smile from him.

Dad had calmed down before his son was discharged. Prior to leaving, I had an instinct that he wanted to say something to me--something apologetic, by his expression. But he didn't. A part of me, though, could only hope that he had looked in the mirror and didn't like what he had seen.

The nurse planned to arrange follow-up with this family.

Sometimes, despite our best efforts and resources in the ER, life and fate will continue to play out the way they were destined to.

Darn it all.


Next post will be Friday, December 4. See you then...and hats off to the caring nurse who provided more than just good medical care for this family.

Pass The Clicker

In the spirit of this Thanksgiving holiday, a humorous peek into my home life...

I'm a typical guy who, if given the chance, will sit on my leather sofa with TV remote in hand and slowly meld into the cushion, oblivious to the fact that I am watching for the third time the same episode of "Trading Spaces" or that I may not have changed my underwear in two days. With this in mind, my wife and I made a decision about four years ago to cancel all but our most basic cable channels.

Who am I kidding! If I'm going to be honest here, she made the decision. I had no say. I still get teary-eyed thinking back to that awful day.

To complicate matters, the cable company screwed up our cancellation. Yes, they lowered our bill from $50 to $16, but they kept forgetting to reduce our cable plan to the basic package. As a result, we continued to get all the big package channels. All for the fantastic price of $16! Can you imagine how frustrating it was for me to hear my wife call the cable company ten times, requesting them to come and "fix the problem."

I saw no problem. We were getting a hundred channels for $16. Where's the problem?

"The problem is that it's dishonest," she replied.

I think her honesty may be the death of me.

Now, though, with the kids growing older and outgrowing PBS (our only kid-friendly channel among our huge selection of 12 channels), we were faced with another dilemma. What could they watch? We were stuck between "SpongeBob SquarePants" and "CSI." There was no gray zone of good television for our kids.

Low and behold, we discovered our favorite television series on DVD. We made trips to Walmart, Target, and Best Buy and were frequent visitors on Amazon.com. We snatched up "Little House on the Prairie," "The Waltons," "Happy Days," "Laverne and Shirley," "Leave It To Beaver," "Gilligan's Island," and "The Brady Bunch." There's more, but these were the shows that made the biggest impact.

Our kids were in heaven. If they liked Season 1 of something, we moved on to Season 2. And Season 3. And Season 4. I'm going to be honest here--I thoroughly enjoyed revisiting these classics. Probably more than the kids.

I discovered that I did not attain much personal growth traveling from my childhood into adulthood. I still liked Mary more than Laura. I rooted for Jan over Marcia, Marcia, Marcia. Laverne made me laugh, but Shirley held my heart in her hand. Did I really think Richie Cunningham was cool? And Mary Ann versus Ginger? Let me tell you, if you put your hair in pigtails and wear a red-checkered shirt and tie the bottom in a knot around your waist, I'll eat the scraps from your plate.

Mrs. Cleaver remained my fantasy mother. Just once I wanted to wake up and find my own mother, awesome though she was, serving me breakfast in full makeup and an evening gown! I remember Mom rolling her eyes when I asked her to play along with me on that. Nope, it didn't happen.

And how could I not mention Eddie Haskell, my idol? I got tired of my friends and family mentioning that I was his twin, but he did teach me that good manners and sincere politeness could take you far. Thank you very much. And by the way, did I mention how nice you look today?

I could not let this moment pass without mentioning how much I still love Grandma Walton. Not for the physical reasons, mind you, but just for the fact that I had never known someone who was so moody and sour. It was a new experience to watch such a crotchety character. I was so thankful she wasn't my grandma. I can only imagine what kind of mood Grandma Walton would be in the first time her bladder didn't hold out. Can you even imagine her shrilling voice? "John Boy, get over here right now and change my diaper!" Ugh. Keep writing, John Boy, and get yourself out of that house. Because up on those mountains, my friend, you wash the diapers by hand. In the cold creek.

The biggest hit for my kids, though, was and still is "I Love Lucy." Although I didn't see this one coming, my wife did. My daughters, 13 and 8, love everything about Lucy. And my son, 11, cheers right along with the girls. The candy factory line, the grape-stomping, the vitameatavegamin commercial--you know what I'm talking about. We all have our favorites--are you thinking of yours right now? Just hearing my kids gut-busting laughter from a show that is 50+ years old is a miracle in and of itself. It's hard to believe, but the episodes only seem to have gotten funnier.

We recently traveled to Hilton Head and instead of playing music overhead in the car, my wife and I listened to the episodes that the kids were watching. Better than music, I tell you, better than music.

And I know what you are thinking--NO, we are not pathetic!

I think a visit to Lucy's museum in her hometown of Jamestown, N.Y. is going to happen someday soon. I just need someone to promise me that it won't be a bust.

Okay, so maybe that's a little pathetic. But they just might have a picture of Lucy in pigtails wearing a red-checkered tied-at-the-waist shirt. Then who's going to have the last laugh?

Now, pass me my clicker. Peter's just about to say "Porkchops...and applesauce."


Thanks for reading...next post will be Monday, November 30.

Ssshhh

Ssshhh.

What do you hear? Silence? Commotion?

During yet another crazy, bustling ER shift, I squeezed into a sliver of unused counter space at one of our nurses' stations to finish writing on a chart. I was facing one of my favorite secretaries, Louise, who sat opposite from where I was standing.

"Is it me or is it loud in here tonight?" she asked.

Besides being good at what she does, "Weezie" also was born and bred in our hospital's town and seemed to know everyone. "That's my great aunt's best friend's nephew's son's girlfriend--well, ex-girlfriend, I mean. They broke up last week." Some of my heartiest laughs at work have come from Weezie. You should have heard her three-year rant after turning 50 about still getting her period! The first time she missed her period, I should have bought her a Georgia O'Keefe print to celebrate! There would be one more unclipped Tampax coupon in the Sunday paper that week.

"Way too loud, Weezie," I answered, still writing.

She was right, too. It was deafening. And now that she brought it to my attention, my ears were hurting. The ER seems to be very moody, bipolar almost, in how quickly the atmosphere can change. And judging from the volume tonight, we were in a manic phase. Without looking, I knew there was a full moon.

I stopped writing and looked up from my chart, appreciating the bedlam. Looking down one hallway and into the next, all I could see were patients lying in cots lining the halls, nurses and techs scrambling in and out of rooms, pacing family members, ambulance crews waiting with their patients for a room assignment, and security taking their usual strolls.

"I think this might be one of the worst," she said. Those were big words coming from Weezie.

I went back to finishing my chart, hoping this most recent patient would recover from her stroke symptoms.

And then it happened.

Ssshhh.

Silence.

It was the most momentous, most sudden silence I have ever appreciated at work.

I knew that whatever was going on was huge, HUGE--nothing can silence an ER like this!

Debating whether to look up or not, it was Weezie's voice that convinced me.

"Oh my God," she exclaimed. Weezie exclaiming? This must be colossal!

I looked up at Weezie, her mouth gaping, and I followed her pointing finger.

Staggering down the hallway, towards us, was a middle-aged man. Moving slowly. Passing by patients and their families. He seemed real nice and friendly, nodding to this patient and waving to that one, in a vote-for-me kind of way. I'm quite sure, though, that he wasn't running for public office.

And, oh yeah. I may have forgotten to mention--the guy was butt-naked!!!

There was no gown, no clothes, no shoes even. His pudgy, hairy middle-aged body was there for the world to see. If not the world, at least our lucky ER. Who knew that little Susie was going to have her appendix taken out and see her first naked stranger!

I would like to say that I rushed over to help this gentleman cover up but I, like everyone else, was so completely stunned that I couldn't move. Couldn't budge from my spot. Couldn't shut my gaping mouth, either. I had seen much craziness in my career but nothing that stunned a crowd quite like this. Boy, did I like this guy.

It had been upwards of a minute before security responded to this kind gentleman's wayward stroll. With an armload of blankets, they covered him up and coaxed him back into his room. Right before he stepped back in, he peeked out to give us, his adoring fans, one last wave! Yes, with his hand. I hope for his sake this guy had a lot of alcohol on board.

It turns out this patient, who I'm proud to say wasn't mine, had fallen asleep at a bar counter and had been brought to us by the police to observe and "check out." Somewhere during the ER's chaos, this gentleman, who the nurse had rightfully checked in on many times, was able to climb out of bed, strip off his gown, and take a lovely, relaxing stroll. I think this could qualify in the "memorable stroll" category--mine, not his. He wouldn't remember a thing.

After the guy's last wave to us, we all looked around at one another. Our faces were indistinguishable--we all wore masks of disbelief. It took just one brief smile, one quick laugh from one of the techs, and we all burst out howling at the absurdity of the situation.

"Alright, Weezie," I said, after we had caught our breath, "who was that?"

"Why are you asking me? How would I know?" she asked, incredulously.

This was a first from Weezie. But if you ask me, I'll bet it was her sister's ex-husband's old high school teacher's third cousin, twice-removed.


Next posting will be Friday, November 27. I'd like to wish everyone a blessed Thanksgiving holiday. If you eat too much, tough, I don't want to see you in my ER! Thanks for visiting and reading my posts...

The Saddest Night

Recently, my thirteen year-old daughter did a school report on my job, focusing on the emergency room setting and what my role within all the chaos was. While we were in the emergency room touring and taking anonymous pictures for her power-point presentation, she found a new appreciation for what I did when a young knifing victim was brought in by ambulance.

Because my only purpose that day was to help her collect information and take pictures, I didn't go into the patient's room and obviously shielded her from any gore. She was mesmerized by all the commotion. We waited around until we received word that the eighteen year-old would be okay. I could see her exhale at the news and, in a moment of tenderness, look at me with saddened eyes. I could not have given her a clearer perspective of what I am sometimes called to treat.

During the drive home, she was quiet and affected. Slowly, though, I was able to pull her from her private thoughts and talk aloud about what she had seen.

"Dad," she asked thoughtfully, "what was the saddest patient you ever took care of?"

"Oh, honey," I said, "you don't really want to know that, do you?"

After a little more convincing, she had me scanning my brain for my most haunting "sad" cases, which I could count on way too many hands. In an odd way, I think as an ER doc you build a protective wall and tuck your memorable cases neatly behind it, adding it to the "sad" list, the "happy" list, the "traumatic" list, the "old-people" list, the "funny" list, the "you're never going to believe it" list--endless lists of cases that touch your essence.

Look at me, even now, protecting myself by calling these encounters "cases" and not "patients." Shame on me. But trust me, it's a big, big wall.

Anyway, her sweet voice brought me back to reality. "Please, Dad. Just tell me."

I decided to face down her request. She was thirteen and she was persistent. So I broke and shared with her one of my most heart-wrenching moments.

It had been one of those long, endless overnight shifts early in my career. There had been no time to breathe as one critical patient after another continued to present to the ER, even up until 6 a.m. We had just received word that an elderly gentleman who had presented to our ER with low blood pressure and severe abdominal pain (a quickly made diagnosis of a ruptured abdominal aortic aneurysm) had died "on the table" during surgery, this after transfusing him with six units of blood while waiting for the cardiovascular team to arrive.

My nursing staff and I were beaten up, unable to shake this moment of our failed heroics.

"Well, this night sure can't get any worse," Lisa, one of our best nurses, said. She should have known better. She had barely finished speaking before the prehospital radio sounded off.

An ambulance was bringing us a SIDS (sudden infant death syndrome) baby just discovered by her parents.

Our team was sullen and quiet as we waited in one of our resuscitation rooms for the ambulance's arrival. Within minutes, the paramedics rushed through the door carrying a lifeless little body, about eight months or so. Following them were two young, frantic parents carrying another living child of the same age. The SIDS baby was a twin. As our social worker took the living baby from dad's arms, my medical team and myself urgently examined the tiny patient lying on the cot, allowing the parents to stay in the room with us.

Sadly, it was too late. Death had visited this child hours before and we had no arsenal to reverse this devastating event. We later had learned through the paramedics that this family of four shared one mattress, tucked in the corner of a rundown studio apartment. When mom had rolled over during the night, she had discovered that her baby "felt cold."

When you "pronounce" a patient (declare their death and exact time of death) in the emergency room, at least two phone calls must be made--to the coroner, in case an investigation or autopsy is necessary, and to the family doctor. These are "must-dos" for me professionally, but are hardly the things I feel are necessary to begin a family's healing.

We sat the parents in rocking chairs and gave mom her little baby. We had the social worker bring in the other child and handed her to dad. I stood in the corner of the resuscitation room, lights dimmed, absorbing two parents with two children, one living and one dead, rocking slowly back and forth, enveloped in their grief. I had held their hands, shared their misery (as a parent, I was witnessing one of the most earth-shattering nightmares any parent could have), and had chosen my useless, sympathetic words carefully. There was but one thing left to do.

I went and found Lisa and asked her if we could please clip a few strands of the deceased infant's hair to give to the family. This was something I had learned from our pediatric trauma center during residency. It can be a vital part of a family's healing process. The hair was tangible, something to hold when a memory isn't sufficient, something to smell, something to touch with trembling fingers, something to press against a broken heart. If not now, a day would come when the family would be thankful to have this possession.

As Lisa and I quietly reentered the room, I will never, ever forget the scene that awaited us.

Mom was still holding the deceased twin while the living twin sat in dad's lap, her grasp within reach of her twin sister. Her hand was on her deceased sister's head, gently patting it, quietly twisting the dark strands around her fingers, almost as if urging her sister to wake up and play. The potency of this action--the playful innocence of her little hand wrapped in her dead sibling's hair--was a moment of both stunning serenity and infinite devastation that I will carry with me always.

I finished the story and looked over at my daughter, her big brown eyes fixed on my face.

"Dad," she asked quietly, "did you cry?"

"Honey," I said to her, choking up, "I still do."




My next post will be Wednesday, November 25. I promise it will light-hearted...