The Saving Brother

I heard the patient's agonizing scream emanate from Room 31 just seconds before Nurse Carla ran up to me. "Dr. Jim," she said, grabbing me by my arm, "I need you in 31 right away." Her face was flushed, her voice edged with concern. Carla, usually calm and collected, had me worried with her nervousness.

As we hurried down the hallway toward the room, we were greeted by yet another gut-wrenching scream. Somebody was hurting. And hurting bad. We hear many types of screams in the ER--demented screams, angry screams, excited screams, drunken screams, etc.--but this primal scream from being in extreme pain was by far the worst.

"What's going on, Carla?" I asked her, intrigued as to what I was going to find when I walked through Room 31's doors.

"Bad burns," she said, "and trust me, your heart's going to drop over this one."

We walked into the room and I was surprised to find an eighteen year-old male patient sitting upright in his cot, completely naked. He was alone and crying. He was thinly-built with shoulder-length blond hair, his face painfully scrunched-up as a result of his despair. His hands were alternating between flailing and holding his genitals. The nauseating smell of burnt skin and hair permeated the room.

I rushed to his side while Carla assumed position on his other side, preparing to start an IV. On a quick, cursory exam, I saw that he had apparent burns to his lower abdomen, his inguinal areas, and his penis and scrotum. Poor kid.

I quickly introduced myself to him. Through abbreviated, gasping words, he told me his name was Matthew.

"Matthew," I said, "we are going to start an IV and give you some pain medication to make you more comfortable, okay?" He nodded his agreement while grimacing from his discomfort. I continued. "After we get you a little more comfortable, we'll talk about what happened. In the meantime, I need to perform a physical exam to see what the extent of your burns are."

Carla had an IV established before I was even done talking. "Morphine?" she asked. "Morphine," I answered, "and lots of it." After giving her some further orders for IV fluid hydration, she hurriedly left the room.

I looked closely at Matthew's head and face. He had no singed nasal hairs, no burnt eyebrows or lashes. I had him spit in a container. His sputum was clear. He had no stridor or difficulty breathing. All good findings to suggest his burns didn't affect his airway. His heart sounds were excellent. His lung sounds were clear. His abdomen, barring the lower skin burns, was soft and without pain. His extremities revealed him to have redness and blistering to the palms of both hands.

Next, as Carla administered the morphine, I focused on his burned privates. His entire penis was red and blistered but, thankfully, the burns were not circumferential. A band of burns that completely encircled the penis would have had potential to cut off the blood-supply to the distal part and that would have been very bad. Matthew's scrotum was also burned, red with significant blistering covering its entire surface. His groin area and proximal thighs on both sides were also a bright, angry red and blister-filled. His anus and rectal area had been spared.

Because of the location of his partial-thickness and potentially full-thickness burns, Matthew needed to be emergently transferred to a burn-unit with his injuries.

After making quick arrangements for his transfer, I returned to Room 31 to find a much more comfortable patient. Several nurses, including Carla, were bent over Matthew tending to his burns.

"Matthew," I said, "do you feel better." Groggy from the pain medications, he smiled a goofy grin at me. "I sure do, Doctor. Thank you."

He then went on to explain to me how he had received his burns. His younger ten year-old brother had been playing with fireworks when Matthew had happened upon him. His younger brother, Matthew continued, was holding an M-80 in his hands, lit, and was trying to slide it down a tube that wasn't wide enough. Matthew, watching with horror, saw the wick of the firework burn down to almost nothing and he decided to act.

"I ran up to my brother, Doctor, and grabbed the tube with the M-80 sticking out of it. I thought it was going to blow up in his face, so I snatched the tube and held it against my belly so it wouldn't hurt him."

As you can probably guess, the M-80 blew while Matthew was pressing it against himself. Although the force of the M-80 missed causing him significant injury, Matthew's clothes caught on fire, resulting in his burns. Matthew was a hero.

"Is your little brother okay?" I asked. "I think so," he answered, "he and my mom should be here soon."

I liked this young man. Here was a respectful, saving brother who risked his manhood, his life actually, to keep his younger brother out of harm's way. I had no doubt that if the exact scenario repeated itself, he would do the same thing.

Within minutes after our discussion, I greeted Matthew's mother and younger brother in the hallway outside of his room. They were both distraught and crying, their tear-stained faces looking expectantly at me for some good news. Especially the younger brother.

I put my arm around his trembling shoulders while I addressed them both. "Matthew is much more comfortable now," I reassured them, "but I have some concerns about how bad his burns may be. We're going to transfer him to the regional burn center so he will get the best available care possible for his burns."

The mother nodded. "Please do whatever you have to do to get Matthew better, Doctor."

I escorted them into Matthew's room, where the younger brother immediately bolted to Matthew's side, hugging him. "It's all my fault," he muttered between his free-flowing tears. "I'm sorry, Matt." The guilty weight of the younger brother was heartbreakingly evident. Matthew, as I knew he would, put his protective arm around his younger brother. "It's alright, bro. I'm just glad that you are okay." Mom came up then, wrapping her arms around both of her sons. Carla and I stepped out to give them some privacy.

We transferred Matthew to the burn unit without incident. Prior to his leaving, we wished him well and told his mother to please keep us posted as to his recovery. We all wanted Matthew to have the best of outcomes.

A few weeks later, waiting in my work mailbox, was an update letter from the receiving burn unit regarding Matthew's condition. I eagerly ripped it open, nervous about the news it contained. Thankfully, it held the best news possible. Matthew hadn't required any skin grafting and, although his burns were significant, they expected a full recovery without any permanent injury or damage.

Sometimes, things turn out just the way you hope they will. Cheers to Matthew.

As always, big thanks for reading. See you Friday...

My John Deere Cap

I am a small-town boy now living in a big town. I graduated high school with 92 friends and, although I enjoy my big town, I miss the values and ways that accompany small-town living. Apparently, I'm not alone in my thinking, since four of my six siblings still live in our small town, all within a few miles of my parents' home.

Part of being small-town is that the work and entertainment varies greatly. Work, besides the obvious, may also include mill and factory work, forestry, and farming. Entertainment may include cow-tipping, four-wheeling, snowmobiling, hiking, fishing and hunting. And sports. How did I almost forget about our small-town sports?

Most recently, after visiting my family, I brought one of my dad's baseball caps home to big-town with me. It was a bright-green John Deere hat, one I had borrowed to wear outside for an afternoon while visiting. Besides breaking-in easily, it fit well.

Now, how many of you are familiar with farming? And forestry? John Deere is a stellar company, one that has stood up through the worst of our economy. My father's business relies on the excellence of their heavy-machinery products, especially their skidders and bulldozers. The people who don their John Deere hats are typically farmers and industrial sorts, salt-of-the-earth types. In my small-town hometown, when you wear a John Deere cap, you wear it with pride.

Returning home to big town, it didn't take long for me to learn that wearing a John Deere hat in a suburban area seems to make certain people assume that you are "slow" or "a hick." Or that you are a country-music lover. Or that you pick your nose freely in a big crowd.

That assumption would be wrong. Completely off-base, actually. Frankly, though, I couldn't care less what other people want to assume, but I find it surprising that this assumption actually exists. Anybody who is familiar with farming or knows a farming family is aware that these are some of the most intelligent, brilliant, and hard-working people you will ever come across. What one assumes might be a simple mind could actually be quiet confidence, introspective intelligence, and humility. I'll take this person over a dim-witted owner of a suit and European car any day.

My father and my brothers? Kind and humble, intelligent and easy-going. After obtaining their college degrees, my brothers chose to follow in my father's successful forestry footsteps. If someone chooses to judge them based on the cap they're wearing or their Carhartt overalls, it won't take that person long to realize that their judgment was premature. And it will only take minutes for my brothers to intellectually bulldoze through those wrong assumptions.

Anyway, back to the John Deere cap. I returned to my big town and proudly started wearing my green baseball cap everywhere--to hockey games, the local mall, my children's sporting events, and restaurants. About the only place I didn't wear my cap was at work in the ER. Don't think, though, that I didn't give that some thought.

The first time I noticed that I was being treated differently, for lack of a better word, was in an up-scale department store check-out line. The cashier spoke freely, easily, to the people ahead of me. Then it was my turn. And it was as if the cashier had a control switch to slow down her voice. And s..l..o..w.. down she did, even going so far as to raise her slowed-down voice while she gave me my change back.

"H..e..r..e.. i..s.. y..o..u..r.. c..h..a..n..g..e.., s..i..r..," she shouted, nearly exhausting herself.

I thanked her and walked away scratching my head, puzzled, and not quite connecting that it was all about my John Deere cap.

Next, I was at a local hockey game and the beer caller--you know, the one walking up and down the aisle with a tray of beers to sell--kept stopping beside me and asking if I was ready for a beer yet. Why, I wondered, was he just stopping to ask me? And again, he talked slower. And louder. I would have given him the benefit of the doubt, except I had heard him talk in regular voice to the people across the aisle from me. As bad as I wanted that damn beer, though, I passed each and every time.

More scenarios followed and by then, I knew the reason. My green John Deere cap. Each time, I walked away not knowing whether to smile at these sporadic ignorances or just brush off them off. I do have to say, though, that it was enlightening, this social experiment for one that I was conducting, to see how certain people responded to my cap.

Most recently, I was at my eleven year-old son's basketball game. I, with another father, had run the clock and kept the score during the home games all season. Before the start of this particular game, the referee approached our table to review some last-minute rules. Of course, he talked in normal voice to the other father before turning to me.

"D..o..n..'t.. f..o..r..g..e..t.. t..o.. s..e..t.. t..h..e.. c..l..o..c..k.. f..o..r... ." You get the idea.

After the ref finished and walked away to start the game, the other father turned to me and asked "What was that?" I pointed to my hat and he looked up, read it, and said "You're kidding, right?" He must have been a small-town boy himself. But no, I assured him, I wasn't kidding.

Well, I'm still wearing my hat. Only now, I don't give much thought to the occasional slow-talker whom I may encounter. This experience has enlightened my perceptions of how quickly others can judge you without knowing you. It's not only my John Deere cap, either. It can be cowboy boots, a certain hairstyle, the car you drive, where you're from, your accent, and how you're dressed, among many other things. That list is l..o..n..g.. .

If anything, now I'm a bit more guarded about my first impressions when I walk into a patient's ER room. Heck yeah, first impressions matter. I'm not denying that. But we should give the person an opportunity to show their true colors before we label them as a simpleton, or otherwise. In fact, why do we even need to label them? And what's wrong with being a simpleton? The medical field seems to be filled with them.

So, if you own a John Deere hat, wear it with pride. Let me hear you yell, "Hell, yeah!" Or, better yet, yell "H..e..l..l.. y..e..a..h!"

And if any of you know a good place to purchase some Yosemite Sam mud-flaps, I would be anxious to hear from you. I've been looking for a set to put on my European car.

As always, big thanks for reading. Next post will be Friday, March 5. See you then...