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...                     

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

Bald Is Beautiful

She was sitting up and resting comfortably in her hospital cot, her home-made mauve and black afghan tucked comfortably under her arms. A pale yellow handkerchief was lumped on the bedside table beside the phone. She looked up at me as I walked into the room, greeting me with her big smile and sparkling hazel eyes. Except for a few patches of sparse, fuzzy auburn hair, she was bald.

"Hi, Mom," I said, walking up to her and pulling my mask down to gently kiss her cheek, "how are you today?" Despite the heart-breaking circumstances which lead to her being a patient lying in a hospital bed, I had never seen Mom look so beautifully breath-taking. And under normal, healthy circumstances, she was already quite a beautiful person, inside and out.

Mom ran her hands over her scalp, weakly smiling. "Well, honey," she said, "I guess we can cancel the rest of my hair-dressing appointments for the year." Over the past few days, the ravaging effects of Mom's chemotherapy regiment had taken ahold, which included her hair falling out in clumps.

"Mom," I said, reassuringly, "I don't think I have ever seen you look more beautiful." I walked over to the yellow handkerchief and picked it up, examining it. Strands of her thick, wavy hair clung to it. "What do you say we just throw this out?"

"Oh, Jimmy," she said, exhaling a deep breath, "I just don't think I am ready for that yet."

I understood completely. Mom had been raised in an era where curlers and perms and colorings played an important part of a woman's presentation. And although Mom was far from vain (how could she be when she was busy raising seven kids), she thoroughly enjoyed indulging in her hair. Hair that was now gone.

Despite a custom-made wig and multiple handkerchiefs, I don't think Mom's beauty was ever more evident than when she went bald during her chemotherapy days. Her baldness only seemed to enhance her indomitable spirit. Her eyes danced more openly. Her raw facial expressions confirmed her appreciation of life. Her prominent cheekbones exuded her infinite strength And the curve of her smiling lips were only that much more welcoming, appropriately framing the beauty of her words.

Accompanying her baldness, the truth of Mom's bravery in fighting her illness could not have been any more evident.

As I go along in my typical days of being an ER physician and the father of a child who has survived his own life-threatening illness, I can only tell you, without hesitation, that this baldness that accompanies one's fight for their life is as pure and as defining of one's character as any physical attribute can be. Without any words spoken, a patient's baldness from chemotherapy reveals a fighting spirit and a commitment to continue living. It reveals a strength drawn from reservoirs most people don't recognize they have until faced with crisis.

It commands my respect. And I rightfully give it.

Recently, at my gym, I couldn't help but notice one of the trainers, Barb, working-out with a woman who wore a handkerchief over her scalp. It was obvious that this client was intimately familiar with chemotherapy. It was very inspiring, to say the least, to watch this woman physically push herself through a workout despite her recent setback.

A few weeks later, surprisingly, I saw this same woman working-out without her handkerchief. Evidently, she chose not to cover up her baldness. And she looked stunning. As Barb and she worked out beside me in the cable room, I decided I had to speak up.

"Excuse me," I said to the woman. keeping it simple, as Barb looked on, "but I just have to tell you how stunning you look. I have no idea what you are going through, but I've seen you working out and pushing yourself these past few weeks and am thoroughly impressed. I wish you the best."

Well, Barb's client blushed a little as she thanked me. And later on, Barb came up to me and said that my words were exactly what her client had needed to hear since she was having a bad day. I hadn't been sure I should have said something, but Barb reassured me that my words were quite welcomed by this brave woman.

Especially in our ER, because of our regional cancer institute, we are privileged to treat many people who are wearing their baldness proudly as they undergo chemotherapy treatments. Both male and female. From the very young to the very old. And every time I have a patient who is bald for this reason, I make sure they know that they have my utmost respect. And if it is a child, that respect is also accompanied by a pile of stickers, a coloring book, and a Popsicle, if allowed.

A few weeks back, a brave little seven year-old girl greeted me as I walked into her ER room. She had been battling acute lymphocytic leukemia and, despite some mouth sores, still managed to greet me with her fading smile. On her head, nothing but baldness. At most, just a few patches of fine blond hair clinging desperately to their homeland. I smiled back at her as I approached, hoping my eyes conveyed my happiness to meet her. I must have looked like a big giant Smurf--I had donned a blue paper gown, a blue mask, blue foot covers, and cream-colored gloves. Until we figured out her immune status, we had to protect her from us.

"Hello, May," I said, extending my hand. "It sure is nice to meet you." We talked a few minutes about school, her best friend, and who her favorite doctors at the regional Children's Hospital were. Her mother sat at May's bedside, contributing to May's memories. "May," I continued, when there was a pause in conversation, "when did you lose your hair?"

She got quiet, hesitant almost. Her mom spoke up. "About three weeks ago, doctor." "Well, May" I said, my eyes hopefully conveying my sincerity, "I've seen many patients who have lost their hair because of their medicines, but I must say that you are by far the most beautiful." May looked up at me, serious now, and locked her eyes onto mine. I didn't flinch nor did I look away.

"Seriously?" she asked. "Seriously," I replied. In her child's voice, she softly said "But I don't like it. Everybody stares at me."

"You know why, May?" I asked, grabbing her hand with my gloved one. "They aren't staring because you lost your hair. They are staring because they are amazed to see such a brave and courageous seven year-old. And that's you. Showing all these people that you can be beautiful and brave no matter what medicines you are on or no matter what disease you are fighting." She nodded at my words. "The next time someone stares at you, May, just give them your biggest smile ever!"

"Like this?" she asked before donning one of the most perfect smiles I have ever seen.

"Just like that." I told her, admiring her gaps from losing her baby teeth.

I'm not saying that if you are undergoing chemotherapy and have lost your hair, that you need to express your baldness. Hardly. Wear a wig or a bandana if you feel more comfortable. During your fight, you do what you need to do and don't worry about what the rest of us think. But if you are in my ER or if you pass a middle-aged guy who happens to take a second glance at you, don't be alarmed.

It's just me, sending you good energy and well-wishes. And recognizing your courage.

Yes, indeed. Bald is beautiful.

As always, big thanks for reading. I appreciate your time. Emma update--day 15 of 17. Swimming at the Great Barrier Reef today before beginning the long trip home tomorrow. If she comes home, that is! Australia, you have a new, wildly-excited admirer in my daughter. Thank you. See you in a few days...

Heroes Among Us--Gigi

The world just lost another angel. A hero. An ordinary person with extraordinary kindness and love.

Do you ever stop to think how often through your typical day you pass by an angel or hero and simply don't know? Busy, busy, busy. We have things to do, errands to run, and phone calls to make. We keep strangers at arm's length. And the cost of this hurriedness is simply that we fail to share and learn about one another. Every face we encounter holds a history, a story to be told, and sometimes those stories are remarkable and breathtaking. The unfortunate thing is that we will never know if we don't take the time.

Enter Gigi. Someone who always took the time.

Gigi was an EKG technician at our hospital. Almost nine years ago, as I have touched on previously, my son was diagnosed with a rare malignancy that required him to be on chemotherapy for a year. He failed to stay in remission and had to undergo a second complete year of chemotherapy to achieve remission again. Since then, he has been in remission for five years and is an extremely well-adjusted, bright, athletically-gifted boy who makes my chest swell with pride. Through his experiences, I have learned much about life, about love, about compassion, and especially about embracing the daily moments that hold the simplistic joys that many feel come only with big life-events.

What I was learning at that time in my life, however, Gigi already knew. She was frequently called down to our ER to do EKGs on patients and she could be overheard in conversation with them, asking them frank, sincere questions about their health, their lives. She seemed to really care and enjoy her interactions with each new face.

I didn't really know Gigi, however, until one day when she approached me soon after my son's initial diagnosis.

"How is your son doing?" Her voice had startled me and I looked up from my chart to find this middle-aged woman with a soft perm, intense eyes, and a big smile talking to me.

"Pardon me?" I asked, surprised at her bluntness. Most people either tiptoed around me or asked me directly about my son. I appreciated the latter approach and Gigi did too, obviously.

"Your son. I just found out about him and I'm praying for him and your family I just wanted you to know."

She was a stranger and yet, looking into her eyes, she was my immediate friend. I couldn't break my gaze with her. I knew that she got me, that she understood. She looked beyond my face and forced smile to see the hurt and anxiety that I was carrying.

"I'm Gigi," she said, holding out her hand. I took it and introduced myself. And she really did want to know about my son. How was he was doing? What medicine he was on? How was he adjusting to having a mediport? She genuinely cared and her thoughtful questions reflected that caring.

After a few minutes of conversation, she had to go do a stat EKG and I had to return to my patients. But before we parted, she asked "Can I have a hug?" A hug from Gigi, I learned that day, held more compassion that a hundred Hallmark cards. It was genuine and heartfelt--not just a quick expected pat on the back.

Through the years since, we learned much about one another's family, yet every time I saw Gigi, her first question to me would be about my son. "How's that boy doing?" His return to good health brought many authentic smiles to her face.

About a year ago, in the midst of a crazy shift, Gigi approached me with some worry on her face.

"Doc," she said, never once calling me anything else despite my urging to use my first name, "I'm really worried." She proceeded to explain that she had some abdominal bloating and intermittent pains for months but was afraid to approach her doctor. She felt it would be bad news and didn't want to face it or ruin her husband's recent retirement.

"Gigi," I said, "let's get you in a room. I want to do an exam and run some tests."

"Oh, no," she said in true Gigi fashion, "I'm off tomorrow and these patients need you today. Let me come in tomorrow to see you and I'll bring my husband along. I'll do whatever you say, but tomorrow, okay?"

Of course, Gigi. The next day, as I knew she would, she did come in with her husband. He was just as I pictured Gigi's husband to be--kind, considerate, supportive, and worried. Gigi and I had never taken our friendship beyond the hospital's walls and it was my pleasure to match her husband's face to her loving stories about him.

Unfortunately, Gigi's workup did reveal some serious findings. She had cancer. Cancer that had aggressively spread beyond its primary site.

With this news, I approached her room with a heavy heart. And knowing me as well as she did, she knew the minute I walked in the room that I held heart-breaking news.

"Just tell me, Doc. Don't sugarcoat anything."

I pulled up my chair, grasped her hand, and explained all her results very thoroughly. She cried, her husband cried, and I cried. It simply wasn't fair. Hardworking, decent, compassionate, loving--none of these traits had protected Gigi from something bad. It was her right, I felt, to only have good things occur in her life. I was really affected by her results and through the rest of my shift, I heavily relied on my Naphcon A eye-drops. It was now my turn to pray for her and her family. We admitted Gigi to continue her workup of identifying her type of cancer, its location, and its staging.

Remarkably, my son and Gigi had never met and, encouraged by my wife and I, all three of our kids made Gigi get-well posters. The next day, Cole and I hand-delivered the posters to her. She was in her hospital bed, her husband sitting in the corner, when Cole and I arrived. We knocked and walked through her room door. After looking up at us, Gigi immediately reached out her hands for Cole, who instinctively walked to her bed and sat down beside her. Gigi wrapped him in her arms and my lucky son received the same exact hug that I had received nine years earlier. If it was possible, his hug was even more magnificent than mine had been.

Through her battle, Gigi never once lost her faith or let her beautiful spirit waver. We shared hospital visits, phone calls, and cards, which never seemed to be enough to satisfy this sender's aching soul. She was, as you would expect and hope, surrounded by loving family and friends throughout her ordeal. She braved multiple rounds of chemotherapy and radiation and, despite her body's failings at times, pushed forward in attempts to beat off her disease. "I'm not doing this for me," she said, "I'm doing this for my family."

Sadly, though, Gigi passed away before the holiday season began.

Gigi was never defined by fame or fortune, but rather by compassion, kindness, and love. She embraced humanity wholeheartedly and clearly enjoyed touching the lives of others. If she hadn't taken the time with me nine years prior, reaching out to me in a dark moment of my life, I would have missed having an angel here on earth as my friend.

Gigi, I thank you for taking the time.

As always, thank you for reading. We all have a Gigi or two in our lives, hopefully more--if you want to share a little about your Gigi, feel free to in the comments. Next post will be Wednesday, January 13.