It's Not About The Pus

To Dr. Sandra Lee. Heartfelt thanks for humanizing medicine and for inspiring along the way...

Several years ago, my daughter Emma introduced me to some videos on YouTube of a dermatologist from California who posted her sometimes shocking but always intriguing encounters with patients who suffered from a variety of dermatologic issues. Of all of these videos, it seemed like the ones which made Emma happiest to watch were the videos in which this doctor's treatment resulted in gallons of pus draining from some part of the patient's body.

Well, okay--Emma liked pus and blackheads. Well, pus and blackheads and massive lipomas (fat-based tumors). Well, pus and blackheads and massive lipomas and big hairy moles. Well...

You get the picture.

With some great finesse and skill, and with a good mix of humor and learning, Dr. Sandra Lee, better known as Dr. Pimple Popper, was able to help many embarrassed patients survive their dermatologic issues, all the while captivating my daughter's interest. "Eewww, gross," Emma said. "Let's watch it again!"

Suddenly, my job as an ER physician was boring. Stories of heart attacks, strokes, traumas, broken bones, asthma attacks, allergic reactions, even drunks vomiting on me at 3 am--none of them held any excitement compared to the ten-year old massive cyst that Dr. Lee excised from a women's scalp or the golf ball-sized lipoma she removed from the upper back of a man who hid it by wearing a draped shirt. Yes, it was intriguing even for me to watch. How was I going to compete with Dr. Lee popping juice out of everything she touched?

I lost my daughter to the wonders of Dr. Lee. "Dr. Pimple Popper is so great, Dad!"

Not only Emma, but soon my friends and family were asking if I did "the stuff that Dr. Pimple Popper does." They too couldn't seem to get enough of the various videos posted on YouTube. And like Emma, more pus equaled more entertainment. Pus that flew across the room--well, that created a giddiness that could not be contained.  

"Yes," I would answer, "sometimes I have to drain an abscess from someone's armpit or groin due to an ingrown hair. Sometimes I have to drain abscesses from wounds, too." For good measure, I added, "And sometimes I have to drain a thrombosed hemorrhoid." I know there are many more invasive procedures we perform in the ER that could be considered similar, but I couldn't think of them quickly enough. At least, I thought, I would get asked what "thrombosed" meant, right?

I was wrong. After finding out that most of my procedures were performed on problems smaller than the size of a tennis ball, my people lost interest.

As the last few years passed, I was happy to catch an occasional YouTube video of Dr. Pimple Popper. Dr. Lee's contagious personality and warm smile, combined with her intelligence and skills, helped her to create a spectacular vehicle, by use of videos, to share the fascinations of her profession. She was a natural at bringing some amazing stuff to eager viewers who were insatiable for her.

On a recent trip with friends to Toronto to celebrate the arrival of 2019, we had returned to our hotel rooms one afternoon to rest for a few hours after a very late previous night of fun. While channel-surfing, I was excited to rediscover Dr. Lee and learn of her new television show on TLC. Desperately needing a nap, I committed myself to just watching her for ten minutes, maybe fifteen at most.

Fifteen minutes turned into two hours. In the blink of an eye.

This time, though, watching Dr. Lee was a very different experience. Yes, all of the fascinating lumps and bumps and lesions that needed squeezed, drained and excised still existed. Yes, white and brown and green and black pus still oozed from the majority of her patients. Yes, many of her patients still found brilliant ways to hide their ailments for years, under wigs and baggy clothing or with caked-on makeup.

This time though, among all the hoopla, I was able to appreciate Dr. Lee's magnificent mannerisms, her empathy, her compassion--her realness, so to speak--in dealing with her patients. Recognizing these things initially, I believe, had gotten lost within all the other excitement. I was more focused on how fast she could duck away from some flying pus rather than her gentle approach to patient care.

For example, after a patient was kindly greeted by office staff and placed in an exam room, the real magic began. Dr. Lee would softly knock on the door of the treatment room before entering, wearing a smile and exuding warmth. As she approached the patient, hand extended in greeting, she would establish eye contact with the patient and introduce herself with a gentle and calm voice (sometimes simply by her first name). From there, if anyone else was in the room, she would turn her attention to them, making sure to introduce herself, repeating the process until she was acquainted with each person in the room. After introductions, she would sit down (yes, sit!!!) and begin her interview with the patient, involving the patient's company, learning everything she could about the reasons a patient was visiting her. Respect was given and received. Eventually, a wonderful level of comfort was achieved.

I could continue on with the importance of Dr. Lee's empathy and compassion while performing a detailed exam, explaining her findings of the exam, reviewing test results and options to treatment, and mapping out the future course of dealing with a patient's ailment, but it all seems rather obvious, right?

Or does it?

You would be surprised at the number of patients who go through the process of a medical encounter only to leave with confusion, frustration, or feeling worse than prior to their encounter. No introductions. Standing at bedside with arms folded, appearing disengaged and aggravated. Rushed conversation. No updates. Abbreviated result explanations and dispositions. This is the reality of an encounter for many patients.

Ugh.

Recently, a close friend of mine had to take his elderly mother to a rural ER twice, in a span of two weeks, for some serious and concerning symptoms. To hear him talk of the vast difference in the care they received, by the same facility but different treating teams, was upsetting. During the first encounter, introductions were made, respect was given, explanations were provided, and a detailed treatment plan was initiated. During the second visit, there were no introductions by either the physician or nursing team. His mother was dismissed or hushed each time she tried to explain her symptoms in some depth. They were made to feel like a nuisance. No rechecks were performed. They sat around for five hours wondering what was going on. Their questions brought no answers. "And Jim," he said, "only about five of the twenty rooms had patients in them." My buddy's family was truly disheartened and discouraged by the encounter.

Years ago, during my emergency medicine residency in Syracuse, we had a physician who gave lectures to us on the importance of empathy and compassion. Being young-guns in a big trauma center, Dr. Ruth's lectures were not nearly as exciting to my buddies and I as compared to lectures on how to drain an expanding epidural hematoma (a potentially fatal arterial brain bleed) or perform an emergency thoracotomy in a trauma patient (rapidly opening the chest between ribs to clamp a sheared aorta or contain bleeding from a punctured heart or lung, for example).

Yet, it was during residency when I truly realized the power and magnificence of empathy and compassion in medicine. Of respect and dignity. Of smiling and bringing into a patient's room good energy. Of sitting down if even but for a few minutes. Of introductions and eye contact to all in the room, not just the patient. Of a warm handshake. Of explaining findings of the exam, of the testing and procedures to be done and the ensuing results, and of a plan moving forward. Of rechecking the patient during their medical visit. Of properly closing the loop of their visit with a goodbye or good luck wish.

Of being human.

This was a crusade I took up while working with our residents as a core faculty advisor. I became Dr. Ruth, insisting on my residents bringing their very best to each patient encounter. While empathy and compassion and ease of conversation was inherent and easier for some residents, for others more time and work needed to be invested to improve this part of their patient encounters. An investment, I stressed, that was worth pursuing.

Yes, the ER gets busy. Crazy and insanely busy. I get it. I've witness it firsthand for 22 years as an ER attending physician. However, all of these things mentioned above take just a few extra minutes. Providing anything less is met with too many excuses. Occasionally, in the emergency setting, it truly is beyond our control that we simply can not provide more empathy or time to a patient (think about a car accident with four critical victims arriving at the same time). Otherwise, if it were me or my family or friend lying in that hospital cot as a patient, I would greatly appreciate those few extra minutes of kindness and compassion provided by the treating medical personnel.

What if it was you or your family member?

Returning to Dr. Lee's TV show, then, on that lazy afternoon in Toronto, I greatly appreciated her kind approach to each patient. Sure, she might have more time working in an office setting that is more predictable and controlled compared to my working environment in a big trauma center. Sure, she is being taped to splice together some great scenes and moments of the various care she provides. Sure, anyone might give a little more of themselves if they know they are being watched. However, Dr. Lee consistently demonstrated her excellent bedside manner with each patient encounter I watched. She excelled and inspired in a part of medicine that is often ignored and overlooked, all for the sake of moving more patients in and out and increasing the billing so more profits could be made.

I could have cared less about how much pus would fly out of her next abscess or where it would land. I was enthralled on simply watching a great doctor doing her job well, from every perspective.

I hope Emma was, too.

Thanks, Dr. Pimple Popper. It was never really about the pus...

As always, big thanks for reading. What are your thoughts and experiences?   

Feel free to forward or share this post. To visit some of my favorites listed from the archives, visit Thank You...

I continue to be amazed with the amount of support and readership. My heartfelt appreciation to all...   

The Barn Door Is Open

One of the things that continually amazes me, intrigues me even, about medicine is the scale of personalities that exist within our community.  From the obnoxious "know-it-all" to the warm-hearted "everybody's friend" types, you can find just about any recipe for a personality among us.  Take a dash of kindness, a pinch of self-doubt, a teaspoon of over-eagerness, and a dollop of sharp wit, and viola, you may have this nurse during your next visit to the ER.

Me?  I'd like to think that I am a straight-shooter, the furthest orbit away from the central pedestal that so many doctors feel they deserve to be perched on.  Their livelihood depends on this precarious position.  Mine doesn't.  I ask my team to call me Jim.  I don't wear a white coat during a shift (except in the family room, where I insist on a higher level of decorum to be followed). I welcome anyone to question why I am doing something in a certain way.  I am kind and compassionate.  I love to laugh and smile among the infectious camaraderie of a good team during a rough shift   

However, I am human, too, which means I sometimes need to really fight myself during a crazy shift or odd patient-encounter to avoid cynicism, sarcasm, anger, or disappointment.  Although rare, I have had some breaking moments.  For example, to have a patient with a top-of-the-line cell phone, decked out in a designer outfit and $300 dollar running shoes, with a pack of cigarettes hanging from their pocket demand (in an irate, demanding manner) a free ride home and free prescription fills is still something I struggle with, although my answer remains the same.  "No."  And patients who have attained their medical degree via a ten minute Google search prior to their ER visit, trying to dictate the course of their treatment, can test my limits in a weaker moment.

My idols, those inspiring physicians I've encountered through my career, seem to be the "regular Joe" doctors who have a quiet confidence and a humble self-assuredness combined with a normalcy of expected kindness and respect.  They don't want their coffee brought to them, they don't want everybody to bow at their feet, and they don't feel the need to brag and show-off their endless knowledge base (a pet peeve of mine--I'd rather one show me how good they are, through their actions, rather that waste their words by telling me).  They just want to be a friend, a mentor, a good person defined by their entire world, not just their world of medicine.  Their greatness as a physician is simply an extension of their excellence as a human being.

It is a fact I stress with our residents.  "Don't emulate just one of us," I say, "but rather, skim from each of us the characteristics you want to carry with you throughout your life, your career."  I reiterate that none of us, their mentor physicians, are perfect.  We are all human.  I can only hope that they choose to combine hard-work, compassion, and humility among their other qualities.

If I ever decide to pursue a big head and an uppity view, though, about my professional accomplishments, I think I will fail miserably.  Too many times through the day I am humbled by reminders that I am nothing special.

Case in point?  Just last week, during another busy shift, I was standing in front of the counter of Room 22.  In the treatment cot lie Mr. Smith, his mental status dwindling and his extremity weaknesses gaining.  His wife, expectedly concerned and apprehensive, sat in a corner chair just a few feet to my left, watchful of her husband and our treatment team.  Her worried look, her disheveled gray hair, her furrowed brows, her dilated pupils, the way she edged her body forward on her seat, utilizing but a few inches of its support, all spoke of her love of her husband.  Of her inherent sense that something was terribly wrong.

And she was absolutely right in her suspicions.  Mr. Smith's CT scan had confirmed a significant intracranial bleed, a stroke of devastating proportions.  A stroke that limited us, between his previous strokes and extensive medical history, in our aggressiveness.  Together, the ER nurse and I had walked into the room to share their grim news with them while we contacted the neurology and neurosurgical teams.

"Mr. and Mrs. Smith," I spoke, quietly and gently, yet urgently, "I have some disheartening news.  It appears that Mr. Smith has had another stroke, this one quite involved within the entire brain."  We talked at length about the findings, our plan of action, of how aggressive they wanted our team to be, despite our hands being tied from this CVA's severity.

Mrs. Smith took the news much better than I expected, her acceptance belying her body's expressions. While her husband floated in and out of awakeness, she explained their position.  "We were told last time that the next stroke could be the final one.  It appears we have arrived at this final one, yes?"

I couldn't help but like Mrs. Smith.  Her inner strength was simply astounding.  I nodded "yes" to her, but added "Let's at least have the specialists see your husband and make their recommendations to you."

Now she nodded "yes."  "But," she added, "neither of us want heroic measures."

I understood.  "I'm just going to remain here with you a few minutes," I said, "if that's alright, while we wait for the specialists to arrive."  Although the ER was busy, I wouldn't let that fact prevent the nurse and I from providing a few minutes of necessary companionship.

And then, it happened.  Another realization of my humanness.  After removing my supportive arm from around Mrs. Smith's shoulders, I stepped back to the front of the counter, bowed my head, and cupped my hands in front of me.  I looked to the floor, to my brown Clark clogs, as I started to say a silent prayer for this family.

Instead of finishing my prayer, though, I became distracted.  Thoroughly and completely.  Because there, in this extreme moment of crisis, in the middle of my wishful thoughts for this family, I noticed my zipper.

My wide-open unzipped zipper.  How long had it been down?  I shuddered at the thought that my zipper may have been this way for several hours and through several other patient encounters.

Not only was my zipper open and lingering at its lowest possible point, but its edges were widely gaping, exposing my hunter green, 3% spandex and 97% cotton, boxer briefs.  My hip-huggers were there for the world to take in at possibly one of the most inopportune moments.  "Hello," they screamed, "look at me.  Look here!"  Ugh!  For some unexplained reason, I remember thinking the situation would have been better had I chosen to wear my tighty-whities that day.

Slowly, I tried to cover this embarrassment with my cupped hands, but to no avail.  I shifted my legs back and forth, trying to see if the sway of my motion might magically reacquaint my zipper edges.  No go.  I looked up at the nurse, who was oblivious to my predicament, and Mrs. Smith, who was not.  She was focused on my every move. It didn't help, either, that she was sitting in her chair, eye-level of my indiscretion.  Secretly, I think she was quite entertained by my distraction.  Heck, I'd go so far to say that she enjoyed watching me squirm of embarrassment.

Suddenly, though, she looked me in the eyes, her eyes sparkling with amusement and yet glistening with sadness.  I returned her gaze.  We both remained quiet. All was okay.  I abandoned any sense of correcting the situation and remained leaning against the counter.  Graciously, she turned her head from me and refocused on her husband.  As did I.  As was the nurse this entire time.

By the grace of God, I got paged overhead for a phone call.  Probably the neurologist, I thought.  I excused myself from the room and rushed to my physician station, where I yanked up my zipper before attending to any other tasks.  Later on, as we do in our twisted ER ways, the team would have a hearty laugh at my expense.

Yep, I'm human.  I put my underwear on just like the next person.  As do every one of my fellow physicians. Oh, and my zipper will occasionally fail me and that's okay.  How can one possibly get an exaggerated ego with that in mind?

I will remember Mrs. Smith and her quiet resolve, her inner strength, in the face of such a crisis.  And I'm sure she will remember me, too, but, unfortunately, not for the same reasons. 

I hope my residents take my words to heart and emulate the best I have to offer.  Which, during that shift, was this advice--never, ever go into a patient's room without checking your zipper first!

Otherwise, I'll just keep preaching kindness and compassion.  And, oh yeah, humility...

As always, big thanks for reading.  I hope this finds you all well.  On HHI for the week and having a grand ol' time.  Any embarrassing medical stories you'd like to share?  Please do... 

Hold A Hand

Our ER case manager and I recently walked out of the family room after having to tell an only-child that his 85 y.o. mother was critically ill. She was so ill, in fact, that she had required emergent intubation for her respiratory distress and was now being sedated and paralyzed. This allowed the ventilator to do all of her breathing, conserving this woman's body of some much needed energy. The patient's worsening circumstances had transpired over the past three hours at her nursing home prior to being transferred to us and, unfortunately, her son had been en route when his mother decompensated in our ER, circling the drain before our very eyes. Thus, he never got a chance to visit with her before her intubation.

As we left the family room to go back to the patient's room and continue medical management, the case manager and I walked in silence, affected by the situation at hand. I had tried to hold off this patient's intubation for a few minutes, hoping that her son might soon arrive to exchange a few words with his mother, but it didn't happen. Because the patient's living will had requested that she be a "full code" (my understanding was that she lived a fulfilling, independent life), all efforts would be employed in attempt to save her life and help her through this medical crisis. We had intubated her successfully and aggressively began her medical management.

Suddenly, the case manager stopped smack-dab in the middle of the hallway and spoke to me. "You are amazing in that room, do you know that?" I looked her in the eyes, trying to see if she had picked an inopportune moment to hassle me, to tease me the way that us ER co-workers sometimes do to lighten such heavy, burdensome moments.

She was being serious. "After introducing yourself and shaking this son's hand, you sat down on the couch beside him, touched his shoulder, introduced the rest of us, and asked him how he was doing before slowly, in words he could understand, explaining everything that had been done so far to save his mother's life."

"Yeah," I said, "so?"

She continued. "Did you not feel the tension in that room? And somehow, after you were done delivering the worst of the news, the room felt hopeful, at peace. You could see the son's face slowly accept the news you were giving him. You eased his worries by instilling that we were doing everything we can to help his mother, without falsely elevating his hopes."She paused here, taking in a deep breath. " You showed him that you cared."

"Doesn't everybody do this, though?" I said, knowing the answer before I finished asking.

The case manager laughed in a regretful, wistful kind of way. "Are you kidding? You would be appalled at some of the ways I've seen bad news delivered in that room. No introductions. No sitting down. Blurting out the bad news without any preparation to the family. Leaving without addressing any of the family's questions. Jim, you need to teach more doctors how to act and speak more appropriately in that room."

By now, we had started walking again and were standing outside of the patient's room. The son was going to be escorted back in just a few minutes.

Not one to gloat over getting a compliment, I walked back into the room and continued helping my senior resident with this patient's care. It was, once again, a thing of beauty to watch our team methodically go about each of their responsibilities and, as a result, we were soon rewarded with this patient's condition stabilizing. She was still very sick, but at least the son could now spend some time at her bedside. Which turned out to be a blessing as, in the end, this patient passed on that same evening.

Later on that night, at home, after tucking in my kids and a glass of wine in hand, I was giving much thought to our case manager's words. Just a few weeks prior, during a night shift, a nurse supervisor who had accompanied me in the family room spoke similar words to me when we were done. "The way you approach patients and their families is remarkable," she had said. I may have blushed, but her words were greatly appreciated and I viewed them as the ultimate compliment.

Why isn't everybody at their best, especially in that room? I thought to myself, though, becoming a little annoyed. When did medicine become so shifted to view patient's and their families as "its" and not as human beings, as "hes" and "shes"? When did we abandon learning patient's names and their life story? Of taking a little more time in their treatment room? When did compassion and kindness sneak out the window and rush, rush, rush sneak in. When did the the quantity of patients one treats replace the quality of care given to each individual patient, defining, in some peoples' eyes, a better physician?

Sadly, most of us in medicine know that answer. With the increasing struggles of our profession, from insurance cutbacks to legal threats, from hospital cuts of personnel to the shifting thought that patients' rights outstrip our own, medicine isn't the field it once was when I signed up for a career twenty years ago. Especially in the ER, it is now common for us to be 4-6 hours behind every day, patients now relying on us not only for emergent care but for treatment of their chronic illnesses as well as maintenance medications. Can you see the frustrations? This quantity has potential to impede on our quality, to cut into the time we spend with each patient and their family.

I recently gave an hour lecture to our residency physicians regarding kindness and compassion. I started it with a tragic video of 9/11, scenes playing out to Sarah McLachlan's "Arms Of An Angel." We then watched a synopsis of the Columbine tragedy before I started talking. There was nary a dry eye. "See this devastation, this grief, involved in such atrocious acts?" I asked the residents. "What makes this grief and loss any different from that which you will encounter in a patient's treatment room or our ER family room?" A dropping pin could be heard in the room. Grief is grief, I reiterated. Loss is loss. Death is death. Respect is necessary. Kindness and compassion are a must. Addressing such concerns, I assured the residents, is one of the most important jobs they will ever face. Put the time in and learn how to view this responsibility as a privilege and not a burden.

This lecture was never finished. Before my time was up, only half of the slides had been presented. Instead, we had spent a great deal of time talking about personal techniques on how to interact with patients and their families and how to deliver devastating news. My residents shared personal stories of their best and worst experiences. It was clearly evident that some of them were quite comfortable in their roles, while others struggled with this part of their jobs. This hour lecture on kindness and compassion had gone from the category of "light and fluffy" to receiving the respect it deserved. From the feedback of the residents, they were appreciative and definitely more cognizant of their roles in treating patients and their families.

As karma sometimes dictates, a few nights later, while reading Cutting For Stone, a brilliant fiction novel by a brilliant writer, Abraham Verghese (he who also happens to be a brilliant man of medicine), I happened upon a collection of words on page 519 that left me with goosebumps. In the novel, Dr. Thomas Stone, a leading liver transplant specialist, reads a letter from a mother of a trauma victim that he had treated. It follows:

Dr. Stone--

My son's terrible death is not something I will ever get over, but perhaps in time it will be less painful. But I cannot get over one image, a last image that could have been different. Before I was asked to leave the room in a very rough manner, I must tell you that I saw my son was terrified and there was no one who addressed his fear. The only person who tried was a nurse. She held my son's hand and said, "Don't worry, it will be all right." Everyone else ignored him. Sure, the doctors were busy with his body. It would have been merciful if he had been unconscious. They had important things to do. They cared only about his chest and belly. Not about the little boy who was in fear. Yes, he was a man, but at such a vulnerable moment, he was reduced to a little boy. I saw no sign of the slightest bit of human kindness. My son and I were irritants. Your team would have preferred for me to be gone and for him to be quiet. Eventually they got their wish. Dr. Stone, as head of surgery, perhaps as a parent yourself, do you not feel some obligation to have your staff comfort the patient? Would the patient not be better off with less anxiety, less fright? My son's last conscious memory will be of people ignoring him. My last memory of him will be of my little boy, watching in terror as his mother is escorted out of the room. It is the graven image I will carry to my own deathbed. The fact that people were attentive to his body does not compensate for their ignoring his being.

Brilliant. Simply and utterly brilliant. Thank you, Dr. Verghese.

We need to bring back kindness and compassion. We need to fix the medical field as it now exists so we can begin, again, to pay attention to that which is most import--the patient and their families. With kindness and compassion at the forefront.

Enough said.

As always, big thanks for reading. If you have had any experiences, either as a patient or as a family member sitting in that family room, that may enlighten us readers and make us better at what we do, please share...

Continued Prayers, Wishes, & Hopes

I pulled up my last-year wishes for you and found myself nodding my agreement as I read, finding that the sentiment and spirit are as strong today as when I wrote them one year ago.

My continued prayers, wishes, and hopes for you and yours...have a Blessed and Happy Holidays.

Another holiday season is upon us. For all the unbridled joy and excitement that surrounds us, however, there is an uneasiness within my core that seems to seed itself every year. I don't think I am alone.

I have seen enough heartache through the year to know that joy and excitement can be very temporary. Can you even imagine wrapping presents only to return them after the holiday season because of an untimely death, never having the chance to give them? Over the holiday season, especially, heartache seems to magnify itself into a swirling tornado ready to touch down on so many lives. I've seen a lot of energy spent outrunning that tornado.

So, for all the happiness, I still can't help but be reminded of how hard these upcoming days will be for so many. My heart goes out to them. Especially the children.

How do I remember the important things in my life? And not just over the holidays, but every day? I know I have been blessed in my life. When I think of these blessings, none of them have to do with material things but rather things that spiritually feed my soul. Companionship, loyalty, kindness, and love. And more love. These make me a better person.

So, in the spirit of this holiday season, I share just a few of my prayers, my wishes, and my hopes with you.

I pray for my family, my friends, and those in the world that are in need. I pray that my son remains in remission for another five years, and another five years after that. I pray that my mother can look down on my family and smile. I pray she knows the power of her prayers, asking a forgiving God to show my son mercy and take her in His arms instead when they were both battling their malignancies. I pray that I can be gracious in adversity, always.

I wish for my family, my friends, and those in the world to know love, to embrace kindness, and to step outside the box and give more of themselves. I wish for endless hugs. I wish for good health. I wish for every child to know warmth in their heart and comfort in their soul. I wish for peace.

I hope that the ripples from compassion will disperse beyond our wildest imaginations. I hope that random acts of kindness multiply. I hope that thoughts of others will replace thoughts of ourselves. I hope that we all remember that we are in this together. I hope that your joy, your happiness, and your excitement is not temporary but rather infinite.

I pray you have a wonderful holiday season. I wish for all your expectations to be fulfilled. I hope the most important presents you will give this holiday season are gifts you can give each day through the year.

Happy Holidays...

As always, big thanks for reading... To my amazing readers...I truly hope this holiday season is blessed and happy for you and all the people in your lives.

The Emaciated Shoulder

She paced protectively beside the hospital bed and its current patient, her grown son, the mother lioness protecting her vulnerable cub. In her hand, she gripped a small notepad, a pen snugly tucked into the coiled-wire binding. Her worried eyes peered through her small rectangular frames, suspiciously watching my arrival. Without blinking, she tucked her short gray bob behind her ears, readying their acuity to my words.

She was the mother of a son infected with HIV.

I focused on the patient. He was my age, in his early forties, with mussed up reddish-blond hair. His face wore the fatigue and ravages of his illness. His temples were sunken-in, his bluish eyes dull, his teeth fragile. Although he gave an effort to smile, his sagging skin weighed down the corners of his mouth. His body was tucked and bundled to his chin with several hospital blankets. To say that he was tired-appearing would have been an understatement.

While introducing myself, I approached him with my outstretched hand. After we shook, I turned to his mother and repeated myself. She took my hand warmly. After introductions, she opened up her notepad and asked me to spell my name, writing it on a fresh clean sheet near the pad's end. I could see most of the previous pages, worn and tattered, were filled with her busywork.

"Well, John," I said, leaning back into the room's counter, "what brought you here today that I can help you with?"

Without hesitating, John's mother began to talk. "Mother," John interrupted her, "I can tell the doctor my problems on my own." I hoped that she wouldn't take his abruptness personally, instead recognizing his attempts to cling to his independence. She quickly silenced herself, slightly embarrassed, as John began to share his story with me.

In the mid-90s, John discovered he was infected with HIV. Through his diligent compliance of lifestyle and medication, he maintained an almost non-existent viral load. He worked-out, he ate well, he enjoyed life to the fullest. Unfortunately, in the past few years, his body and illness became resistant to his previous successful approach and, suddenly, he was dealing with the ravages of advancing HIV. Weight-loss, skin issues, opportunistic infections--each and every new problem was another lost battle in his war. After his most recent diagnosis of HIV-associated lymphoma, he moved back in with his mother and began chemotherapy. He was struggling immensely from both the effects of chemotherapy and his disease.

"Look, Doc," he said, unwrapping his blankets and lifting up his gown to reveal a swollen abdomen and legs, multiple tiny, kinked, bluish-veins spotting his transparent skin, "I have so much edema now that I rely on pain medication to help with the discomfort." His predicament looked painful. In fact, this uncontrolled and worsening swelling had been the purpose of his ER visit.

We talked a little longer about his life, his illness, and his recent setbacks. And through this conversation, I noticed John's mother slowly sadden and withdraw to the chair in the corner of the room. My heart went out to her--I couldn't imagine her pain, having to watch one of her children slowly dwindle from this sometimes devastating and unforgiving illness. Her anguished face, just moments before alert, now wore a look of tattered defeat.

"John," I assured him, "let me finish my physical exam and then I will order up some medications to make you comfortable." His mother wrote in her notebook as I talked.

I continued with my examination, after closely inspecting his protuding abdomen and edematous legs. His exam was difficult. He seemed to have significant findings with every system of his body, despite his vital signs begin stable.

Finally, I asked John to sit up so that I could auscultate his lungs from a posterior approach. "Can you help me, doc?" he asked, holding out his right arm to me. "Sure, John," I answered, grabbing his hand with my right hand and placing my left on his shoulder.

And that's when it hit me. Hard. Just how terrible John's predicament was. Don't get me wrong, I fully understood just how much suffering he had been dealing with recently as his body seemed to succumb to his setbacks, but touching his right shoulder had made me catch my breath.

Under the grip of my left hand, while coaxing John's worn body to sit up, the bareness and emaciation of his right shoulder astounded me. He had absolutely no bulk to it--no muscle, no fat, no cushiony subcutaneous tissue that one typically has to their shoulder contour. Nothing. All I could feel was bone. His clavicle, his humeral head, and his shoulder blade all right there. It was remarkably sad. I shifted my fingers in a futile attempt to palpate any "meat" on his bones. There was none.

After successfully sitting John up, with his mother's help on his other side, I shifted his gown off his shoulder while listening to his lungs. My eyes fixated on his shoulder's thin, transparent skin barely accomodating the stretching from his protruding bones. I simply couldn't quit looking at the fragile shoulder, a dichotomy to John's enlarged, padded ascitic legs and abdomen. What a damn, awful disease.

I left John's room and ordered his work-up and medications. Soon after, he was much more comfortable.

A few minutes later, the secretary called me. "Dr. Jim," she said, "the mother of Room 28 is waiting at the nurses' station to talk to you." I finished with a chart and walked the hallway, finding the mother leaning into the station counter, flipping through her notepad. "Hello, maam," I said, approaching her, "I understand you wanted to talk to me?"

She looked up from her notepad, closing it, while her eyes settled on mine. "Yes, doctor, I do." She paused before continuing. "I just want to thank you for your kindness to John. I know you are just doing your job, per se, but there was something more from you, something I can't put a finger on, that made us both feel very good." She choked up as she spoke.

I grabbed her hands, one of which still held her precious notepad, and thanked her for her kind words. "My heart goes out to both of you," I continued, watching her tears progress to sobs, "what an awful disease for anybody to endure." She took her eyes from mine and looked at her feet. I thought of what to say next, the words coming quite easy. "John is so lucky and blessed to have a mother like you. You opened your home, you take notes, you accompany him to all of his appointments. We should all be so lucky." I paused before finishing. "And loved."

She looked at me again, her act of the protective mother lioness long-abandoned. "Thank you," she repeated before turning and walking back towards John's room.

We admitted John for further care.

Although I pride myself on my composure through all of the emergency department's chaos, I am only human and sometimes cannot shake a patient's affect on me. John was one such patient. It must have visibly shown, too, since several of my coworkers asked me if I was okay. "No," I answered honestly, "but I will be."

At the end of the day, we are all human. We are all in this world together. We are all united by the common threads of emotions. We are all prone to the extremes of happiness and sadness and everything between. We are all in need of compassion and kindness and love.

Especially, though, those who are suffering. And John was suffering. My greatest hope for John is that he may find much love, compassion, and kindness on his continued life journey.

There is no human being who deserves anything less.

As always, big thanks for reading.

The Quivering Finger

It is hard to believe, but today marks the six-month anniversary of my blog, StorytellERdoc. Including today's, I have posted 72 short-stories since November 19th, 2009. I look at my archive, the comment sections, and the number of cool visitors that have visited "my baby" and simply shake my head at how things transpired to get to this point.

Thank you, everybody.

I remember the first time my writing group mentioned the possibility of me starting a blog. We were sitting in Marcy and Christine's living room, getting ready to critique our submissions for the week, when I shared a funny work story. "You need to start writing these down, Jim," they said. "Yeah, right," I thought to myself. I am not a blogger. I had visited multiple sites, both medical and generic, and, although some were brilliant, I simply didn't see myself fitting into this world.

My wife loved my writing group's idea. "Jim," she said, "you haven't seen a blog that you would mimic because either you haven't found it or, more realistically, it doesn't exist. Make your blog by your own rules."

Hmmm. That seed of an idea slowly took. I started thinking of stories that affected me during my medical career, and it wasn't long before I realized the common denominators of those stories most important to me.

Number one. Compassion. Or lack thereof. In today's medical world, I sometimes get frustrated at the lack of compassion and awarenss in regards to both the medical and non-medical issues. It seems that we must move patients, at times, like cattle. See more, bill more, don't spend as much time in each room. Bullshit to that, I say. Behind every face is a story, and shame on all of us if we don't take the time to recognize those stories. Why must we avoid humanizing a patient who is already human? I wanted to bring some heartfelt emotions back to each patient's case.

Secondly, the power of some of my patient stories are simply that I strongly associate their perspective with my own life. A Mother's Cry? I have three kids. Grandpa's Grandkids? I loved my grandmother greatly and couldn't imagine seeing her die in this manner. The Complacent Eyes? My son spent two years of his young life on chemotherapy--I know those eyes well. Heroes Among Us--both Gigi and Linda? How amazing to look at someone and their approach at life only to realize that, at some point, I may have taken a misstep or two down the "for granted" pathway. These stories hit their mark on my heart.

Thirdly, the underlying humor of some patient scenarios just, plain and simple, crack me up. I love a good laugh as much as the next person. If I can't laugh at the ridiculousness of some of these work encounters and life experiences, I am in for a long, boring haul. And a short career, actually. Among others, Double Crack, The Thong Expert, Meeting Candy, The Half-Load Predicament and It Wasn't Me! can take me immediately back to that moment where I find myself cracking up all over again.

Finally, what I am most proud of, are my stories of the ordinary. Sometimes, these remarkable stories sit among the muck of normalcy and boredom and, when I finally dig them out, make me want to jump up and down and share them with the world. An example? A Love Story. When I saw that son helping his father down our ER hallway to the bathroom, I wanted everyone to stop what they were doing in our ER and look at what I was witnessing. Instead, at the time, I only shared it with Weezie, one of my favorite secretaries, before writing the words to give this scenario a life. Big Stuff, Big Words, The Fringe Benefits, and This Father's Daughter walk along the same lines.

After deciding what perspective I wanted my blog to take, I put my fiction novel on hold and attempted several short stories. I submitted them to my writing group, appreciating their honest feedback. My biggest critic, though? Easy. My wife. My awesome, incredible typically-normal every-reader wife. I would hand her a story and nervously watch her read it from the corner of my eye. Her tears, her laughter, and the "yes" and "no" nods of her head told me all I needed to know about a piece.

Armed with about twenty stories and a committment to try to post three days a week, I finally decided to give this a go. The name was settled upon and, after a breakfast date with Christine, a design to my blog was decided. She graciously and unselfishly set the blog up for me, including the incredible banner. Big kudos to her. I joke with her that she missed her calling.

Finally, I had to write a profile about myself. Have you ever done this? After confusing myself more and more, I finally just sat at the computer and ripped it out in five minutes. What you see is the unedited version. After the final sentence, "I am a writer," I was tempted to include "I am not liking this self-profiling bit at all."

After my writing group and wife gave a thumb's up to my first, introductory story, the day finally arrived for posting it. I was filled with self-doubt. What was I thinking? Why was I wasting my time? And who would want to read my words, anyway? If I could only get twenty people to read my stories, I figured, this might all be worth it.

I walked up to my computer and sat down, hovering my right index finger over the left-sided mouse button. The computer arrow sat over the "Publish Post" button on my blogspot page. A simple click and I would be officially entered into the blogging world.

I couldn't do it. I wasn't sure if I was ready to "put myself out there." I looked down at my quivering finger. I took a deep breath. I reread my first post, desperately trying to find any grammatical errors or content problems. Trying to find any problems that would warrant stalling the process. I reread the post, again.

Finally, I looked at my trembling right hand and decided to quit being a wimp about it.

Click.

And from that quivering finger and subsequent click, here I am.

A few changes have come over the past six months. Now, I write most of my stories the day before they are posted. And no critiques to them (well, occasionally my wife will still get first dibs). They are, for the most part, in their rawest, unedited form. I no longer check comments and my email every hour the first day of a posting. I don't follow my visitor numbers and stat counter nearly as often as I used to. A naturalness and inherent comfort has begun to settle in.

I want each of you to know that it has been my privilege to write this blog. Seriously. It has been incredibly humbling to think that someone would actually take time from their busy day to search out my site and read my words. If there were an award for the coolest, most honest, intelligent, and faithful readership, you, my friends, would get it. To those of you who have blogrolled me (including my very first ones, Blisschick and Seaspray) and reposted my works on your own site, a special thank-you.

Finally, as I have said before, the friendships are easily my biggest gain from this whole experience. You all hold incredible, memorable stories, and I appreciate you giving me a glimpse into your lives and bringing your kindnesses into mine.

Funny how things work out. I have always loved to write and, until a few months ago, never pictured my outlet to be in this shape and form. Thankfully, others saw this as the perfect avenue for my words. You're involvement is making this a worthwhile journey in my life.

Thank you.

As always, big thanks for reading. And bigger thanks for helping me reach this milestone. Much appreciated. Next post will be Friday, May 21. See you then...

Popsicles & Pudding

I walked by the nurses' station, casually glancing through the open doorway. Happy for what I saw, I immediately came to a halt and backed up a few steps.

Kids. Two of them. Innocent, smiling grade-schoolers. Sitting on blue vinyl-topped stools at the nurses' work counter. They were doodling in thin, grayish, hospital-issued coloring books, crayons spilled to the sides of their pages. In front of each child, a plastic pudding cup sat, a white spoon handle rising from the middle of each chocolate mess. Stickers covered the rest of their counter space, layered like replaced shingles randomly tossed from roof to ground. The kids looked happy, content.

I couldn't help but smile to myself. Another nurse had earned her wings.

As with any other profession, to be in the medical field, you must carry a certain spectrum of talents. A sufficient font of medical knowledge, of course, accompanied by a respectable work ethic. An inherent sense of the happenings in the workplace. Passion. And respect for your fellow mankind, regardless of whatever capacity you encounter them in.

Most important on my list, though? Compassion. Easily. And not just compassion, but compassion delivered with kindness. Imagine, two staff members are each giving a homeless person a turkey sandwich. One tosses the sandwich to him as he's walking out the door. End of story. The other hands the sandwich over, sharing some eye-contact and a smile, maybe even shaking hands or patting the homeless person's shoulder.

Same task accomplished. But which one delivered the compassion with kindness? Was the energy necessary to be kind in this circumstance monumental? Hardly. When I saw these kids sitting comfortably in the nurses' station, I was recognizing a nurse's compassion delivered with kindness.

As it turns out, these children were in our ER with their sick mother. Fever, vomiting, diarrhea, abdominal pain--all symptoms that made the mother nervous. A single-parent household, a single-income checking account. No local family. No available babysitters or friends. No time to be sick. No choice but to bring her two younger kids with her to the ER.

The kids were typical elementary school-age kids. Initially, when they arrived, the kids sat in the lone corner chair of the treatment room, squeezing themselves between the black, plastic armrests. While their mother changed into a hospital gown, had her vitals taken, and had an IV started, these little kids sat quietly, a little confused and a lot scared, I suppose, soaking in all the happenings. After their mother was made comfortable, the nurse ran and got each child an Italian ice and turned the television on to a suitable station for them.

Soon, as kids do, they started getting a little more comfortable and exuberant within their surroundings. The TV remote became their dodge ball. The volume was played with, the channels were flicked randomly, and some minor argument started over which child had more room in their shared chair. Finally, to help the mother get a little rest and receive her treatment in a quieter setting, the nurse removed the children, taking them to the nurses' station and setting them up with some distractions and pudding.

It worked. And that's when I happened to walk by, finding two calm, coloring kids snacking on pudding.

"Hi, guys," I said to them, looking over their shoulders at their colorings, "nice job. You both are really good at coloring."

They both looked up at me, not sure what to make of me since I wasn't their mother's doctor and they had never met me.

"Don't stop coloring on my account," I told them, "I just wanted to say that you both are doing a great job there."

They showed me their shy smiles before continuing on.

Jamie, the secretary at this station for the day, shared with me the kids' story. When she was done, I was smiling big. "Thanks for helping out with the kids, Jamie," I said, "I'm sure this wasn't in your job description."

"Not a problem" she said, herself the mother of a very nice, respectful middle-school son, "this is the fun part of my job."

Jamie told me which nurse was taking care of these kids' mother and, because I had a few free minutes, I sought her out. She was a recent graduate and had just started in our ER this past summer. Already, she had impressed me with her skills and knowledge and work-ethic. Now, I would add compassion to her list of strong credentials.

"Lindsey," I said, standing in the hallway, "do you have a minute?" "Sure," she answered, looking a little nervous, "what's up?" "It's nothing bad, Lindsey," I assured her, "I just wanted to tell you how impressed I am with the way you extended yourself to those children of the sick mother. I'm sure she really appreciates your kindness to her kids."

Lindsey blushed, asking, "Are you being serious?" I nodded my head "yes" as she searched my eyes to make sure I wasn't razzing her, that I wasn't in one of my silly, joking moods. "Completely serious," I finished, adding, "you went above and beyond making those kids feel comfortable while their mother was here getting treated. Well done."

She thanked me for acknowledging her work and then we both continued on with our work.

Before any nay-sayers speak up, I know, I know--we're not running a baby-sitting service in the ER. Flipping that coin, some might dare say that every patient deserves this customized, special treatment. Sometimes the ER setting is so damn busy, though, that despite our best intentions, we just don't have the time to devote to these extended acts of kindness. During those times when the hallways are packed with patients and chaos is smacking us around, we are focused on delivering excellent medical care. Quickly. At these times, unfortunately, the extra kindness and compassion that most of us strive to give may be sacrificed, pushed to the sidelines, to ensure our patients, sometimes with dire illnesses, receive quick, prompt emergency care.

In the midst of that day's shift, an act like Lindsey's served as a reminder of why most of us entered the medical field in the first place--to take care of patients and their families. To provide them the same treatment we would want our family to receive. To not get caught up in the rush of things and remember to be kind and extend our compassionate selves.

Lindsey didn't need to get the kids popsicles and situate them to watch TV. But she did. She didn't need to get them pudding, coloring books, stickers, crayons, and set them up outside of their mother's room, offering up her precious counter workspace and stools. But she did. Jamie didn't need the hassle of trying to accomplish her secretarial work while keeping an eye on the two kids sitting beside her. But she did it without complaint.

Despite the chaos, they extended themselves. And although Mom didn't demand it or expect it, I'm sure she appreciated the kindness shown to her kids while she lay ill in bed. What parent wouldn't?

So, a salute to Lindsey and Jamie. Makes me proud to be on their team.

I hope they treat themselves to a popsicle and pudding for a job well done.

As always, big thanks for reading. Next post will be Friday, April 2. Hope your week is going well. Until then...

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.

Be Yourself and Change The World

be the change you wish to see in the world...gandhi

I have always found music and the written word to be very influential and powerful forms of expression in my life. I simply retrace the steps of my life and a book, a quote, a song, or an artist will appear on my mind's play reel. In fact, my collection of music and books deserves some credit for defining who I am as a person.

And every year, as it comes to an end, I reexamine the year and try to determine what I did well, what I failed miserably at, and what I can do to continue improving myself and that around me on this journey we call life. I can become quite introspective, really, and can always lean to another great song or quote or book that puts my thoughts into clearer perspective.

For this year's ending and the arrival of 2010, then, I thought it would be pretty cool to pick out just one quote, just one, that would signify my hopes for myself, my family and friends, and for you for this upcoming year.

You've already read the quote at the beginning. I thumbed through so many of my favorites and kept coming back to Gandhi and his wise words. In these uncertain times, where the landscapes of politics, of medicine, of war and international relations, of our amazing country and its current conflicts, of humanity, of everything, really, seem so tempermental and fragile, I wanted to remind myself of all that I can do to make this world a better place. Cliche, I know, but still heartfelt. Simply put, I wanted a quote that would help me direct my energy towards positivity and improvement.

My second goal for this post, however, was much harder. I challenged myself to pick out one song, a favorite or otherwise, that could serve as a reminder of that which is good in this world and that which is not good but could be potentially bettered by our individual actions. For that song, click here-- http://www.youtube.com/watch?v=-Lv4yfpwTds. I challenge you not to feel something when you watch this brilliant video's stills and hear these powerful lyrics.

The common thread of both Gandhi's great words and Garth's amazing song is simply that...change. We all possess the power and energy to create a better place for ourselves, for our family, for our friends, for our children...why are we wasting time?

I hope 2010 is your year. May you all edge a little closer towards attaining your personal goals and, along the way, changing our world for the better. And if you show the world a smile along the way, all the more good.

Have a Blessed and Happy New Year!
Jim

And now, an open challenge to you. Through the comments, share with your fellow readers and I one quote or one song that has inspired you in your life. Maybe we, too, can get some inspiration from your choice for the upcoming year. As always, thanks for reading...a new medical post on Monday, January 4th, 2010!

Why Medicine?

One of the more frequently asked questions I face is "Why did you become a doctor?"

Trust me, that's a question I have asked myself on more than one occasion. In fact, I think the last time I asked myself that question, it was 4 a.m. and the obnoxious, drunk guy had just finished puking on my new running shoes. Why exactly did I become a doctor? It certainly wasn't so the kind people at Dick's Sporting Goods would know me on a first name basis.

I come from a large family, both immediate and extended. I am the fifth of seven kids, three of us boys. On my father's side, every male is or was involved in the forestry industry. This includes my father, three paternal uncles, my two brothers, and multiple cousins. Since I was a young boy, around age five, I have strong memories of waking up before the morning darkness dissipated, jumping with my father and brothers into one of the company work trucks, and heading out into the pristine Pennsylvania woods. It was expected that I, like my brothers and cousins, would someday pursue a college education in forestry and then continue in our family's international business.

I always knew, though, that I was made from a different cloth. My paternal grandmother, our family matriarch, encouraged me to pursue my dreams, even if those dreams did not include the forestry business. She knew I had a different calling and I loved her for her easy acceptance of this. As much as I enjoyed the beautiful woods, the fresh air, and hard work that came with my family's business, I needed something different.

So, until then, during summer vacations and on Saturdays during the school year, I could be found in the woods carrying a Stihl chainsaw or steering a John Deere skidder loaded with freshly cut logs down a narrow path to an accessible landing where logging trucks would pick them up. Smiling. And ducking behind the occasional tree, convinced that I had seen Bigfoot yet again.

When, then, did I discover my illuminated path toward medicine?

I'd like to say I had one defining moment where it just popped with me, that I would be a doctor, but that wasn't the case. During my tenth grade year in high school, however, multiple happenings occurred in my life that exposed me to medicine and reinforced my belief that I would be a doctor someday. That year, I lost both of my grandfathers to medical illnesses, and I was a firsthand witness to their struggles. I also witnessed my father's leg, crushed in a freak logging accident, be saved by incredible surgeons who refused to look at amputation as an option.

Personally, before these deaths and my father's injury, I also sustained an injury that reinforced my pursuit of medicine.

Chainsaw lacerations were very common in the forestry business, at least before protective chaps gained widespread use. This injury did not spare me and, as a result, I had my first and only ER experience as a patient when I needed a laceration repair.

Right after lunch on that death-defying summer day, I was trimming some obstructing tree branches to reach a felled log. Suddenly, my saw kicked back and cut into my thigh just above my left knee. At first, I thought the pain was just another tree limb poking at my leg. When I looked down and saw my cut denim pant leg outlined with a circle of red blood, though, I knew that I had just been initiated into the Lacerations Are Us Forestry Club.

Trying not to panic and fighting off the dizzying angst of near-death that accompanies a two-inch superficial laceration, I quickly ran out of the woods and jumped onto the skidder, driving it without abandon (yes, 10 mph on a rocky trail) to find Louie, one of the crew guys. Louie, not known for his strong work ethic, was only too happy to drive me to the local hospital's ER. I still don't know to this day how he could eat his bologna sandwich (with ketchup) and listen to Paul Harvey while I sat beside him in the pickup truck, hemorrhaging. And now, page two. The kid sitting beside you in the truck is bleeding to death, Louie. Put the bologna sandwich down and drive faster.

By the time we arrived at the ER, the bleeding had slowed considerably and thoughts of my family catering to my every whim after such a tragic accident waned. As Louie called my Dad from the waiting room, I was placed in an ER room, given a gown to change into, and waited for my Dad's arrival. When he arrived, he was, of course, sympathetic. His face was a hard read, though, bordering between pride for my initiation and disappointment that it wasn't worse.

What happened next for me was nothing short of a miracle. Within minutes of Dad's arrival, the doctor walked in and repaired my laceration. He was kind. He was normal. He was compassionate. And he was thoughtful enough to ask me if I wanted to watch him repair my cut. Absolutely, I said. He propped a pillow behind my back and lifted my cot upright to 90 degrees.

With precision, the doctor explained every step of my laceration repair, from numbing the wound edges with lidocaine to how he would close the laceration in two layers--the buried, dissolvable stitches that would hold my muscle together followed by the external sutures that would closely approximate my skin. Fifteen stitches later, he was done. The nurse, lacking any dramatic flare, applied a big, bulky dressing and antibiotic ointment and I was discharged to home.

Needless to say, I had seen the light. I had experienced medicine. I had been snatched from the jaws of death by the brilliance of medicine (and fifteen measly stitches). From this experience to how the rest of that year played out, I had no doubts about what I wanted to do with the rest of my life.

Is that enough to explain why I went into medicine? I hope so, although at 4 a.m. with that fresh puke all over me, I sometimes wish my personal revelations to pursue a career in medicine held more flare.

So, if you are in my ER in the middle of the night and I smell like bile, please do me a big favor and ignore the stink. And if you see me rubbing my scar above my left knee, don't pay me any attention. I'm just remembering why I went into medicine. Again.

As always, thanks for reading. I hope everyone is having a great holidays. Thanks for all the kind holiday wishes. Next post will be Wednesday, December 30. Until then...