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...   

I Feel Things...

I'm  back! Thanks to the many people in my life for their support and encouragement upon my returning--you know who you are! Please feel free to repost, share my return, and visit my archive!

Well, well, well...hello my long, lost friends. I missed you!

It seems like a long, long time since I have written a post for my blog, StorytellERdoc, and I am excited, nervous and humbled to be reentering your lives while returning to my baby.

What started as a small adventure and challenge from my writing group, with my first posting on November 19, 2009, turned into quite an amazing ride throughout the literary and social media world. The number of friends I met was staggering. I received recognition and awards. I won prizes. I was interviewed and contacted for my opinions. I got over a million hits. All of these things, though, were secondary to my intent. I simply wanted to pull you into my world, through my words, to focus on obscure life and ER moments that possessed a level of rawness and realness that connected you and I as fellow human beings. I wanted my words to be a reminder that choosing empathy and compassion over cynicism and sarcasm was possible.

On this journey, I posted 150 essays about life, patient encounters, and magnificent small moments--writings that to this day I can still read and feel the array of emotions I poured into my words. These writings made my heart swell, my eyes tear, and my smile broaden. They still do. My last post, on March 16, 2015, was not a planned exit from writing for my blog but, unfortunately, life happens and I needed to take some time to gather the bits of myself that became brittle and crumbled over the years. I had life lessons I needed to absorb. I had experiences I needed to process. I had to refocus my energy and passions and love onto the things and people that deserved my attention.

I am human and I have flaws. My life isn't perfect. Not even close. Now, though, it's in a much better place, thanks to a lot of internal work and introspection. I have more clarity.

I am back and stronger than ever. Personally, I look forward to sharing with you my journey. I hope to entwine my life experiences into my writings. Professionally, I still smile when I go to work, which is all I really need to say about that, right? The emergency department where I have worked for 22 years as an ER physician is busier than it's ever been. We are treating everything from devastating traumas to irritating hang nails. Among the 90,000 patients that we treat yearly, you can imagine the numerous interactions and situations that exist, simply waiting to be witnessed and observed.

I hope to be that witness, that observer. I hope to bring to you, through my storytelling, a perspective that is unique and intriguing in the way it unfolds the the human spirit with the laughter, the tears, the triumphs, and the pain of an encounter. Some stories will be personal, some will be professional, but all of them will be heartfelt.

In many ways, I am still the same person you got to know through my essays over the past few years. If you revisit these essays (visit the archive or try Gigi or The Witness), you will still capture my essence. As before, I still love my three amazing kids and my big forestry family. I still miss hearing my mother's voice. I still wear my heart on my sleeve. I still love my diverse friends and music and books and the gym and laughing and a good meal and sleeping in. I still love the privileges of my job--I continue to meet, accompany and treat some pretty amazing and memorable patients and their families during their stressful ER journeys.

In other ways, though, I have changed immensely. These changes will be revealed slowly, with time.

At this very moment, as I sit here in front of my computer screen, I am very nervous but grateful for the chance to enter your life with my stories. I offer my warmest thanks for your patience and time as I begin to expose my layers to you, once again.

While recently deciding to pursue this journey again, I signed into my ignored email account and was surprised to find many unopened emails from the past few years. They were wonderful, supportive, and encouraging. Some correspondences took the time to share their personal experiences and connections to my essays, and these emails made my decision to return even easier.

Let me share..."I don't remember what prompted it, but I ended up over at your blog the other day. What I thought would be a quick trip is turning into a multi-day journey back through all of the posts I read years ago. Once again, I was amazed at your gifted storytelling, your attention to detail and the way they're all seamlessly woven throughout, and the gentle, inspirational way you share with us readers perspectives we will otherwise never be able to see. Katie"

Again..."Thanks for the beautiful stories and insight from the physician's perspective. Please keep the stories coming. I look forward to each and every one. Thanks for sharing your experiences with us. They touch our hearts and many times make us smile and feel uplifted if only for but a while. Shirley"

And again..."Yours is not the first ER blog that I've read but there is an obvious difference. You don't seem to have the customary judgmental bitterness. I've been thinking about it and what makes you different from another doctor. I think part of it is that you are not afraid to feel things. Most of us spend our whole lives trying to get away from the bad/uncomfortable feelings. After a break up you stay busy and party with friends to avoid those feelings of sadness, etc. I think many ER doctors have shut themselves off from the feelings of their patients. Their goal is to become immune to the suffering by reason of self-preservation. You, on the other hand, seem to see that it's ok to be sad about something sad. You are not afraid to experience your feelings but you also don't live in them, either. I think this is why you've kept your humanity. Anyways, thank you very much for your writing. Jennifer"

So all my mumblings above come down to this...

I feel things...

I hope I can make you feel things, too...

Until next time...

As always, big thanks for reading. To all my faithful readers--hello, friends! Thank you for returning. To my new friends, thank you for giving me a chance. I look forward to sharing this incredible new journey with all of you!

Jim

The Other Side

the years teach much which the days never knew

Ralph Waldo Emerson

As I sit at our dining room table to write my first words in five months, I am realizing just how much I've missed writing about both my personal and professional life experiences. Though my family and close friends may know my reasons for this unplanned break, you, my friends and readers from StorytellERdoc, do not. So instead of diving head-first into writing a funny, planned posting, I thought I might simply change course to write and say "hello" and "how the hell are you" to each of you.

Let me briefly explain my absence. Simply, I began to have some vision problems last November, ultimately resulting in urgent surgery. Always the doctor and never the patient, this was my first real health scare. Following successful eye surgery, I was forced to take a few months time to recover. This break included absolutely no gym time and, most odd for me, no work time. Looking back on my career, I had never had so much as a week or two break from working in the ER. This inactivity, at first painfully frustrating, ultimately proved to be one of the greatest learning experiences thus far in my life.

For the first few weeks following surgery, I had to wear an eye patch, a blue, oval-shaped piece of perforated aluminum paper-taped to my face. With this new accessory, I spent much time in front of the mirror, looking to find that invincible, healthy fellow I once was. I couldn't find him. Friends tried to make me feel better, telling me I looked "sexier" with an eye-patch, but I saw through their flimsy compliment--the only way to look sexier, I reasoned while laughing with them, was to have sexy to begin with. My kids, hesitant at first, realized that patch or no patch, I was still the same Dad that I had always been. In fact, soon after surgery, Cole had a basketball game that I wanted to attend. "Cole," I asked, "is it okay if I come to your game with my patch or would you rather I stay home?" Without even a hint of pause, his resounding reply inspired me. "Of course you are coming, Dad, why wouldn't you?"

After several weeks, I was able to lose the eye patch. More importantly, with healing and some serious introspection and reflection, I was able to regain my perspective of what is most important in this journey of life. Family. Friends. Humor. Love. Compassion and kindness. Living a purposeful life.

Part of this time away included reevaluating my job differently. Although I still considered kindness and compassion at the forefront of my ER interactions with patients and their families, even I was not immune to a growing cynicism that occasionally seems to be pervading our medical field. Maybe this had even leaked itself into some previous writings. Luckily, though, I feel more privileged than I ever have, since residency even, in walking the halls of our emergency department and providing care to such a diverse and unique collection of patients. Of course, there will always be patients that are obnoxiously difficult, but my reserve to find something good in each and every patient has definitely been refueled. I've been honestly warned, however, by several of my hard-working partners. "Just give it a few months, Jim," they said, "and then see if you feel the same way about things." I can only hope that I have some great staying-power. I feel I do.

Being a patient, I have also learned and witnessed first-hand just how important a role a doctor can play in one's recovery. Luckily, I am surrounded by four absolutely incredible individuals who have prioritized being a compassionate person first and playing a doctor second, proving that one doesn't need to place himself on a pedestal to be amazing at what he can do. This all-star team of providers, however, did not come without some rearranging on my part. I removed from my team, so to speak, one nationally-recognized specialist who was less than stellar in both his personality and in his style of delivering unwanted news. Although this specialist may have been quite good at what he does, I was less than impressed with his all-around abilities to communicate. To heal well and remain positive throughout my ordeal, I insisted on only being surrounded by similar individuals.

Overall, I have much to be thankful for. An almost complete recovery. A supportive family. Supportive friends. And supportive co-workers. What could have been a terrible outcome was not. For this reason, I will always be humble and grateful. Returning to work, I was greeted with many kindnesses and friendly, encouraging words. Hugs included. I also returned to some sadness as well. One of my favorite nurses, Sue, tragically lost her son during my absence. My ordeal embarrassingly pales in comparison to this tragic event of her life. To hug her and share tears with her as she attempted to give me a warm welcome-back smile speaks volumes of her strength and character.    

So there you have it. Officially, I have now returned to my life as I know it. Playing doctor full-time. Playing Dad full-time. Attempting to be a writer again. And, most importantly, continuing to look at my wife with complete wonderment, appreciating more than ever her infinite strength, support and love. Except for the glasses outwardly, my most significant changes from my ordeal have come from within. For this, I am most appreciative. I am stronger than ever, actually. As Ralph wisely stated above, the small day-to-day battles were worth the positive hindsight of it all.

It feels so very good to be back...

As always, I thank you much for reading, my friend. More importantly, I thank you for your patience and returning to read my words.

To Like Or Dislike

I was shocked by her appearance. Although she was in her early 50s, she looked closer to 80.  Matted peroxide hair.  Dull, lifeless eyes.  Sagging skin and deep wrinkles.  Protruding cheek bones.  Cracked, dry lips with a hint of yesterday's lipstick caked in their corners.  Gray and yellow-stained teeth, some chipped. In her prime and before alcohol and cigarettes became her every thought, I could imagine an attractive, lovely woman.  Now, sadly, what sat in front of me on the hospital cot in Room 12 was nothing short of a shell of a human being.  This was a woman who lived a hard life.

She had presented to our ER in respiratory distress.  Although she already had an established diagnosis of emphysema, she continued to smoke two packs of cigarettes a day.  On top of this, she had just finished a ten-day drinking binge, the last five of which she spent either passed out or drinking.  She claimed to have not eaten in that time.  I was called to her room because she was in such dire respiratory distress.

"Maam," I said after introducing myself, "how long have you been having trouble breathing?"  She was gasping for air, her nasal folds flaring with each struggle to breath deeply in.  Through her thin hospital gown, I could see her ribcage and diaphragm heaving, compensating for her non-compliant lungs, trying to pull that extra oomph of air into her body.

"I...don't...know," she managed to answer, each word a struggle for her.  Her hands, I noticed, were pale, their spidery veins popping through her thin transparent skin.  They gripped the top rail of the cot for dear life.

Immediately, I ordered breathing treatments.  Steroids.  BiPAP (a machine with an attached mask that would force supplemented oxygenated air into the patient's lungs every time she initiated a breath).  Blood work.  A stat chest x-ray.  The rapid intubation kit and ventilator for stand-by.  I asked more questions, questions she could answer simply by nodding her head.  "If you get worse, maam," I spoke, asking the most important question of all, "we may need to insert a breathing tube into your lungs, hook you up to a ventilator, and do your breathing for you.  Do you want that if it comes to that?"

A "yes" nod.  She tried to speak.  "I've...had...that...before," she gasped.  "You've been intubated before, maam?" I repeated.  She held up two fingers of her left hand in a peace-sign.  "Twice," she said.

Within the half-hour, surprisingly, she began to turn around for us.  I spent considerable time in her room during this period, making sure she would not decompensate before our eyes.  With the additional attention of two stellar nurses and a respiratory therapist at bedside, she thrived and slowly improved.  Finally, as her lungs began to fill with more air, her nasal flaring and ribcage retractions subsided.

After stabilizing her breathing, we began to treat her other problems.  For malnutrition and dehydration, we gave her several liters of normal saline and a "banana bag," a liter of fluid supplemented with thiamine, folic acid, and multi-vitamins, giving it a yellowish-color.  For her withdrawal tremors, we gave her Ativan, a longer acting valium-derivative.  We fed her ice-chips.  We gave her anti-nausea medicine and several low doses of pain medication for her evolving alcohol-induced pancreatitis.  Her chest x-ray revealed pneumonia in both lungs, and we began antibiotics to cover her for the common community-acquired organisms as well as for aspiration organisms (only God knew if she swallowed some puke into her lungs).

Finally, after a lot of attention and energy given to her, she was at the point where I could sit down a few extra minutes with her, making sure I understood all of her history and didn't miss anything.

"Maam," I started, "have you ever tried to quit smoking?"  "Yeah," she said, her voice now a little stronger, more gruff, "but I don't really want to.  I like it."  She looked at me with challenging eyes as she said it.

"And maam," I continued, "do you consider yourself to be an alcoholic?  Have you ever had treatment for it before?"  She answered immediately.  "No, I'm not an alcoholic.  I like my booze, but I don't drink nearly as much as my husband.  Now he's an alcoholic.  But I'm not."  She enunciated "he," spitting out the word like it was poison.  Her denial was remarkable.  And expected.  "Do you want help while your hospitalized for your drinking, then?"  "Why," she asked me, "if I don't have a problem?"

I asked her about abuse.  She denied physical abuse but claimed "that he yells at me a lot."  Again, she refused to accept any counseling.

Finally, as I was finishing, she said "Can I ask you a question, Doctor?"

"Of course you can, maam," I said.  "What can I do for you?"

"Well," she said, "I don't understand why doctors can't take care of my problems.  I don't like coming here all the time for belly pain and breathing problems.  Why can't they just get it right the first time I come in?"

I was shocked.  Completely and utterly thrown off my game.  Hackles up.  The nurse, standing at the room counter with her back to us, writing on her chart, turned her head around to face the patient, her mouth gaping and shoulders tightening.  I'm sure mine were, too.  Although we don't expect appreciation, we certainly don't expect to be blamed for a patient's medical problems, either.

"Maam," I said in my calmest , most respectful voice, "you have emphysema and, yet, continue to smoke two packs a day.  You have pancreatitis and, yet, continue to drink.  You completely ignore your body's needs, not drinking water or eating food for five days.  You are hacking up phlegm and don't use your inhaler or pursue treatment of these symptoms, resulting in pneumonia.  You've been intubated twice and have come to the ER multiple times.  And you can't understand why your doctors 'can't take care of your problems'?  Have you considered that your problems might be from your own poor decisions?"

I stopped and stared at her.  She stared back.  I waited for her to speak.  I was going to stand there all day if I had to.  Finally, with the nurse now standing along her other side, the patient spoke.  "I guess you are right.  Some of these problems are my own fault."

"Not some of them, maam," I said, "all of them.  By accepting personal responsibility for them, though, maybe you can move on and start treating yourself and your body a little better."  Although I'm sure my words fell on deaf ears, I still needed to have my say.  Especially when we all worked so hard to turn this unappreciative patient around from her multiple medical problems, some life-threatening.

I grabbed the patient's hand.  "Listen, maam," I said, "I wish you well.  I want nothing but the best for you.  But if you don't change your habits, I am sure I will see you in our ER again.  And again.  And, one of these times, I fear, we won't be able to undo your problems."

I let go of her hand and turned to walk out the door.  She was admitted to the ICU and was going to be transported up shortly.  Before leaving, though, she called out.  "Doctor!"  I paused and turned around.  "Yes, maam?"  She hesitated before speaking.  "Thank you for your help today.  I'll think about the counseling, okay?"

I nodded to her.  "Good luck," I said before continuing out the door.

One of the most frustrating parts of my jobs is dealing with patients' frustrations of their medical problems, simply because of their lack of personal responsibility.  It's rampant, too.  I cannot cure patient's who do not put their own effort into their health.  None of us in the medical field can.  We are here to help you along your journey, to walk sided-by-side with you in your, hopefully, healthy path.  Of course, some people do everything right, by the book, and still have medical issues.  That's different. But if you want to eat profuse and bad meals, please don't expect us to cure it with a simple "sugar" pill. If you want to eat fatty and greasy foods, please don't get pissed at us when your cholesterol pill isn't helping.

I love my ER patients.  Seriously.  I have met some very cool people over the years, from both different and similar walks of life, simply from what I chose to do for a living.  I appreciate and enjoy learning the diverse stories that rest behind their faces.  Sometimes, though, I get frustrated.  We all do in the medical field.  At the end of the day, we are all human, whether we perch ourselves on a pedestal or not.  And, regardless, we want the best for you, the patient.

To my patients that have made my job rewarding, a simple thank you...it has been my pleasure learning about you and helping you on your healthy path.

As always, big thanks for reading...I hope this finds you all well.  Enjoy the weekend...

Scratching Below

He was a good-looking guy, my next patient.  Even before walking into his treatment room to introduce myself, I had overheard the nurses talking about him in their nursing station.  "Did you see those brown eyes of his?" his primary nurse said.  "And that hair," added a tech, "so wavy and thick."  "I like his smile," added a second nurse, one who had helped settle this patient after he arrived by ambulance.  I could only have imagined the argument between the nurses as to who would get to be this patient's primary nurse.  I had no doubt that lots of pillow fluffing, extra blankets, repeated exams and vitals, and a turkey sandwich were all in his future.

The aggressive, single, newly-graduated nurse won out.  Secretly, I had my money on her.

I walked into the room to find a gentleman in his mid-twenties, sitting upright in his cot, in a properly worn hospital gown (I had no doubt the nurse helped him put it on correctly).  He seemed tall, six-foot maybe, and weighed around a buck eighty.  He was thick-shouldered and clean-cut, in good shape, his brown hair appearing recently-cut.  He was modern and hip--tattoos poking out from the sleeves of his gown.   

The nurses were right, of course, he was a good-looking guy.  In fact, I would have even agreed with their assessment that this patient could have modeled at one point.  More for Land's End or Eddie Bauer, though.  He would have had to imbibe in plain chicken breasts and no carbs for months to make it into a Hollister or American Eagle ad.

Good-looking or not, this patient was in our ER to be treated.  And doing a quick, cursory once-over, I could tell that all was not right.  This patient's brown eyes were dilated, tracking my every move, his deer-in-the-headlights glances matching his nervousness.  He was breathing rapidly as well, fidgeting with the pulse-ox monitor clipped to his finger.  Before I could approach him and introduce myself, his anxiety was revealed in his rapid-fire speaking.  "Are you the doctor," he blurted out.  "Yes, sir," I answered, "I am your doctor today.  I'm Dr. Jim."

He paused to take me in, looking me up-and-down.  I remained quiet during his assessment of me.  Finally he spoke.  "Do you work out?"  Of all the questions and comments I was prepared for, this one surprised me.  "Yes, sir, I work out.  You, too, I take it?"  He nodded his head yes.  Obviously, physical appearances meant something to this patient.

I decided to gain control of this interview.  "Mr. Nalstead," I asked, "what brought you to our ER today.  What can we do to help you?"

"I think I'm having a heart attack, Doc."

"Why do you think that?" I asked him.  "Are you having chest pain?"  He certainly didn't come across as a patient at risk of having a heart attack.

"No," he answered, "but I'm having a hard time breathing.  And sometimes I get palpitations, like my heart is going to pound out of my chest."

I reviewed his cardiac risk factors with him.  The patient admitted to smoking and his father was being treated for hypertension but never had a heart attack, himself.  "What are you doing when you develop this 'hard time breathing?'" I asked him.

"Usually I'm just sitting, Doc, and thinking."  "About?" I asked.  He continued.  "About my kids."  "How many do you have?" I asked, guessing, from his age, one or two.  "Three," he answered.  I wasn't too far off.

"How old are they?" I continued, interested now in his social history.  And although it is hard, after working in the ER for so many years, to catch me off-guard, this patient's answer did.

"They are 22 months, 19 months, and 16 months."  He paused, staring at me, waiting to see what my reaction would be.  I wore my poker face, though.  I'm sure he was anticipating what my next question would be.  I was no Ob/Gyn, but even I could figure out that this scenario was not possible with just one mother, one woman.

After asking him, he admitted to me that "I had gone through a pretty rough period, yeah."  He had three children to three women.  In a remarkably short period of time.  Currently, none of the three mothers of his children would let him see his kids.  Whenever he thought about his kids and his lack of involvement in their lives, he started the rapid breathing, the nervous tremor, and the heart palpitations.  Raising my suspicions for an anxiety disorder.

I dug deeper.  As it turns out, this patient had had a pretty miserable childhood.  A piss-poor father-figure.  A mother who cut him down repeatedly.  Alcohol and drugs since his early teens.  Prison time.  Although he denied any recent alcohol or drug abuse to me, I suspected he was teetering on using again.  It was a vicious cycle that needed to be broken.  And he knew it.

After doing some baseline tests to make sure he was clinically sound, I sat back down with him. His testing results, I assured him, were excellent.  "So you don't think I'm having a heart attack, Doc?" he asked me.  "I'm sure," I reassured him.  We talked a little further about how he had to break his cycle of behavior, though.  "You have to," I repeated, sternly, "if not for you, then, for those three little kids out there in our community who don't know their father's love."  My words must have gotten to him--I saw the glistening brown eyes well-up before tears spilled onto his cheeks.

We offered him counseling.  He took it.  We offered him a follow-up appointment with a family doctor who was accepting patients.  He took it.  I offered him a short-term prescription for a few anxiolytics.  Six pills.  He took it.  He asked me about my social life--and I shared with him that I was married with three kids.  "Are they fun?" he asked.  I simply nodded my head "yes."  In my mind, though, I imagined my life without my kids, a thought that made me shudder. 

The patient stared me in the eyes.  "I want to do this, Doc.  I want to be a good father to my kids."  By all appearances, he appeared sincere in wanting to break the cycle he was caught up in.  I could only hope.

I left his room, after my last recheck, thinking about all of this patient's problems, problems that were buried deep below a good-looking exterior.  On the inside.  Hidden from anyone who didn't take the time to uncover the true essence of his person.  An exterior that didn't match our society's standards of what we suppose a good-looking person has within them. After all, if a woman is beautiful or a man is good-looking, why would they have any internal turmoil?  Why would we think anything but their outer beauty would be matched by their inner beauty?  What do they have to be upset about?  How could they have any problems?

It goes back to the common thought--physical beauty is temporary, spiritual beauty remains forever.  We are all guilty of judging a book by its cover, aren't we?  I know I am, despite my awareness of trying not to.  However, I have learned, with time, that I find much more pleasure from a book by opening it.  Pretty, pretty cover, maybe.  But what are the words saying inside?

Thankfully, this patient reminded me that, yeah, I am in my mid-forties, and my body and looks might be fading a bit (some characters in my life would probably argue more than "a bit"), but I have inner peace.  I am loved.  I give love.  If you make me look like an ogre, but guarantee me my love and inner peace, I will take that deal and run with it.

I walked back to my desk.  His primary nurse approached me.  "Hey," she said, "is it okay if I discharge Mr. Nalstead?"  I nodded my head "yes" to her, adding "He is a pretty nice guy, isn't he?  I hope he can turn his life around."

She looked at me like I was crazy.  "Are you kidding," she said, "he has been in jail and has three kids to three different women!  I'm not up for instant motherhood!"  She chuckled at her words. I was surprised, this response coming from her, when just a few hours prior she had been thinking this guy was the most glorious specimen to come from the human race.

Scratch below the surface...

As always, big thanks for reading.  And a big thank you for your patience with my frequency of posting... 

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... 

Underneath

A heartfelt appreciation to the readers who shared their personal stories, both devastating and hopeful, on my last post.  Your courage to share was felt and your words of wisdom were heard...thank you.

Walking into Room 33, my next patient, who had come to the ER complaining of cough and cold symptoms, seemed just as I had expected.  He appeared relaxed on his medical cot, lying back at 45 degrees, facing the room's door, his legs comfortably extended in front of him and his gown tied correctly behind him.  He was a few years shy of middle-age and appeared to be in good physical shape. His sandy blond hair, sprinkled with gray, framed his slightly weathered, apprehensive face.  Between coughs, he managed to give me a faint smile.

"Hello, Mr. Brown," I said, extending my gloved hand and introducing myself, "I'm Dr. Jim.  What can I do to help you in our ER today?"

He coughed before answering in raspy voice.  "I had a bad cold about two weeks ago.  It lasted about a week before going away."  Another cough.  "But now," he continued, after taking a deep breath, "it's back.  Back with a vengeance, actually." Yet another cough.  "I've had three miserable days of this stuff," he said, swirling his hand in front of his runny nose, reddened eyes, and dry lips, "and have tried every over-the counter medicine out there."  Cough.  "I just don't know what else to do."

As he spoke, my senses were acutely attuned to him.  I listened to see if he was speaking full sentences of five or six words or fragmented sentences of just a couple.  I listened for audible wheezing.  I watched to see if his diaphragm and intercostal rib muscles were struggling, under his gown, in their respiratory effort.  I noticed the skin coloring of his arms, the pink of his nails, his reddened, irritated nares, and the slight sheen to his forehead.  I listened closely to his cough, to observe if it was of a dry, hacking quality or a wet, congested effort; whether it came in short, interrupted bursts or was continuous and drawn-out.  I watched to see how quickly he recovered from these coughing spells.      

The patient probably thought that I, standing beside his cot with my stethoscope in hand and a smile on my face, was simply waiting for him to finish his coughing and complete his story.  And I was.  Of course, I was eager to learn of any other input he might share so that we could get him on the right road to recovery. What Mr. Brown didn't probably realize, though, is that as important as his providing a detailed history may be,  these obscure observational moments, wordless and symptom-producing, can provide just as much, if not more, information to a treating physician like myself.  I, for one, would much rather hear the cough than have a patient struggle in his description of it.  Penile discharges, though?  That's another story.

Back to Mr. Brown.  Even without doing my physical exam, I suspected he might be suffering from a community-acquired pneumonia.  "Sir," I said, touching his shoulder, "I'm going to perform a physical exam now."  He nodded his consent.  Starting with his head and taking my time, I closely looked in both of his ears (clear), his eyes (slightly bloodshot from his coughing spells), his nasal passages (angry red with significant turbinate swelling), and his throat (red, no exudates or swelling, mild anterior lymphadenopathy).  His tongue was dry and his breath smelled of neglect, like skipping a brushing.

Moving the exam along nice and smoothly, I next focused on his torso.  "Mr. Brown," I said, "we need to remove your gown so I can listen to your heart sounds and auscultate your lungs."  Trying to help, I untied his gown's back tie while he untied his neck.  Slowly, he pulled off his gown, somewhat hesitantly.  And after he did, I understood his reluctance.

His entire anterior torso, extending from his left shoulder to his chest to his abdomen, was a patchwork of skin-grafting.  Thin, transparent, papery patches of transposed skin were bordered by longitudinal, thickened keloid scars.  Some of the patches were less transparent and more natural-appearing, some of the scars less protruding and more flesh-colored, but it was obvious that multiple skin-grafts from multiple body sites had been a necessary, life-saving event at some point in Mr. Brown's life.

"I know, I know," he said, watching my eyes closely absorb the view of his torso.  "I never remember to mention these skin grafts.  Out of sight, out of mind, I guess."  He was almost too blase, leading me to believe that these physical scars walked hand-in-hand with his mental scars.

"May I ask what happened, Mr. Brown?"

"It happened when I was young, in elementary school.  Believe it or not, I had been playing with matches.  No, not on the playground," he chuckled here, "but in my backyard.  All I really remember is my shirt catching on fire, a lot of pain, the smell of my skin burning, and then my mother's screaming." He coughed a few times, his face mildly grimacing with the effort.

"I'm so sorry, sir," I said sincerely.  Imagine spending a large chunk of your childhood undergoing multiple reconstruction surgeries, missing school and losing friends, at a time when those things matter, in the process.  Being treated differently than the healthy kid standing next to you.  Not to mention the constant pain.  And feelings of lessened-worth.  Too many doctors appointments, no sports, lots of dressings.  I was letting my mind race in that brief minute.

I looked more closely at this patient.  Everything had seemed to change after seeing what was underneath his gown.  And now I understood his symptoms even better.

"Sir," I said, "do these scars restrict you when you need to take a really deep breath?"  He nodded "yes."  I continued.  "And do you get a lot of pain from these scars with your coughing spells?"  "Doc," the man smiled, "I think you get it.  It's been pretty hard with the colds this year, but these scars sure don't make recovering any easier." 

I did get it.  Because of his torso scars, his thorax, when stressed with illness, couldn't expand as easily as yours or mine. His fibrous scars and skin-grafting, lacking pliancy, prevented him from taking as full a breath as necessary.  Kind of similar to being wrapped and squeezed by an anaconda, I would imagine.  His work effort, thus, was increased.  And not exchanging air in the depths of his lungs, because of this momentous effort needed, would set him up to acquire pneumonia.

Not only this, but now I understood why he probably put a lot of effort and time into staying in decent physical shape.  "If I put on even ten pounds," he told me, rubbing the scar tissue around his umbilicus, "I start to hurt right here, from the outward pressure.  It seems any weight I gain goes right to my stomach, of course, and not my ass or legs.  Hell, I'd even take a double chin.  So I really have to be careful with my diet and exercise unless I want to have constant pain."  Talk about the pressure of eating right and hitting the gym.

Me?  I work out just so I will always look better than my brothers.  There is a lot of pressure being the best-looking boy in the family.  Clearly, he had better reasons than me to visit the gym.

After finishing Mr. Brown's exam, we got an x-ray, some baseline blood work, and an EKG.  His WBC count was slightly elevated, going hand-in-hand with a very early consolidated pneumonia viewed on x-ray.  We took no chances--he was placed on a strong antibiotic, given albuterol and atrovent nebulizer treatments and a machine to do the same at home, and, probably most important, he was given a strong cough syrup with hydrocodone to ease the stress that his cough was bringing.  He was quite appreciative upon his discharge, his cough lessened and his breathing a little easier.

"Thanks, Doc," he said, after he was dressed, "this was a good visit."

Meeting Mr. Brown initially, everything was just as I had expected.  Until we removed his gown.  And then, I saw what was underneath--the physical limitations of his body during a time of illness.  And underneath this, I was fortunate to learn of his hidden strengths and stoic fortitude that his life experiences taught him.  He seemed the better man for it.

I gave this some thought, about how much we all have in common with Mr. Brown.  How we show the world what we think they want to see.  But underneath, don't we all have something we are hiding, just like Mr. Brown?   Something that may even be limiting our full potential?  May it be physical.  May it be mental.  May it be both. More importantly, underneath, buried in doubts, don't we all have more good that we can give this world of ours?  If we just get over our fear of showing... What.  Lies.  Underneath.

Mr. Brown, thank you for trusting me to show me your underneath.  It made a difference.

As always, big thanks for reading.  I hope this finds you having a good week...

Future Hopes

Vote for StorytellERdoc for Best Literary Blog at the Medgadget Medical Blog Awards! Thanks for your support...

After another recent shift with a predominance of patients suffering from lingering flu symptoms, I decided to swing by our local Walmart to stock up on our home supply of pediatric medications, just in case. Some acetaminophen, ibuprofen, decongestant, and cough suppressant would hopefully get us through the rest of this winter season. And, of course, what a great variety of favorite flavors--orange, bubble gum, berry, and grape. Heck, some of them taste so good that faking the flu for the little cups of "candy" might be to my kids' benefit.

Unfortunately, on the way to the pharmacy area, one of the first aisles I always encounter is the candy and gum aisle. Not a good thing for me, since I have quite a recent fascination and taste for Gobstoppers, a Wonka jawbreaker product (don't tell my dentist). The yellow psychodelic boxes scream at me from their shelf, "Jim, come and put a couple of us in your cart," and regardless how much I fight it, the pull is too strong.

Needless to say, my kids love going to Walmart with me.

On this particular day, then, I walked to the mid-aisle to grab a few boxes of the candy. I wasn't alone in the aisle, though. To the right of the Gobstoppers, two parents stood looking at the shelf of big Hershey chocolate bars, immersed in a conversation (yes, I listened) of milk chocolate versus dark chocolate. To my left, a grocery cart with a makeshift, rigged-up kiddy car, driver seats and steering wheels included, on its handle-end. Two kids sat in those seats--an approximate four-year old girl and a three-year old boy. The Gobstoppers sat waiting for me between the parents and kids.

As I approached the family, I was caught off-guard with the screaming and fighting going on with the young kids. In fact, at one point, as I was kneeling down to grab the boxes of candy, I was appalled to find the little boy trying to punch his sister in the face, her hands rapidly moving to block each of his thrown punches, protecting herself. Still on my knees, I looked toward the parents, who must have completely tuned-out their kids. I was just about to say something when the little boy stopped, but not before his sister screamed out, "Get the hell off me, God damn it!" Still no reaction from the parents.

After this, I stayed kneeling, observing these peculiar parenting skills (or lack of) while looking at a box of Junior mints. While I was debating getting the mints, the little girl and boy started to talk to one another. About me! I actually wrote the conversation down in the pharmacy because it had shocked me much. It went like this.

Little girl: "Who the hell is that guy?" I looked at them looking at me.

Little boy: "I don't know, but if he gets close enough, I'm going to kick the shit out of him."

Little girl: "That will be fun. Try to knock him out." For good measure, she added, "God damn it." Again.

I was disheartened. I was shocked. I was annoyed with the parents for not addressing such obnoxiousness from their young kids. I looked from the kids to the parents, who had quickly glanced our way before figuring their conversation about chocolate was more important. I looked back to the kids again, before standing up and walking away with my Gobstoppers. I was upset and figured this was the best option for me, at that time. I knew it wasn't the kids' faults, but rather their parents. Their role models. But I wondered to myself, "What kind of adults are these kids going to become?"

This happening got me to thinking about our society. For the most part, we all know great kids in our lives, from our own to our friends' and families'. To raise respectful, kind, compassionate and loving kids and guide them appropriately into adulthood, when we choose this road of parenthood, should be the primary goal in each of our lives. We may not always succeed, darn it, but we have to try our best and throw our energy into the effort. Because that effort translates into the brilliance of the future generation coming up to govern our world.

These parents demonstrated no effort. And, unfortunately, they are not alone.

How many of us see the changing pattern with our society's kids. Talking back to well-meaning adults. Not respecting our elders (at least hold the door open for them and smile!). Tolerating vulgar language and meaningless violence via computer games and TV. Not respecting one another's uniqueness. Forgetting manners. Immersing oneself into texting instead of holding actual conversation. Avoiding volunteerism and chores. Placing more importance on material possessions rather than relationships.

Although I see both ends of the spectrum every day in the ER, I can only imagine the stories a teacher can tell.

I carried this Walmart story with me for a few weeks, bummed at the behavior of those children, constantly on vigil to find a hopeful story to balance out this disappointment. And then, the other day during an ER shift, I found it.

I walked into Room 17 to see my next patient, a nine-year old girl who had sustained minor anterior chest burns after bumping into her mother, who had been holding a pot of boiled water. Because the room was quiet and calm, I was quite surprised to find five people in total in the room, four kids and their mother. The mother was standing to the patient's right, beside the cot, while the oldest and youngest children, girls, shared a corner seat and their brother sat to their left on a stool.

Despite a TV in the room, it was not on, and the children all sat with an opened book before them, reading. Mom was whispering to her daughter with the burns, consoling her with her words and touch, gently stroking the back of her hand and her ribboned braids.

I walked up to Mom and the patient and introduced myself. "Hello, Doctor," the patient said, bravely trying to smile over her discomfort. She melted my heart, trying to be respectful while a three inch patch of skin lay peeled from her body between her clavicles. The mother turned to the other children. "Say 'hello' to Sissy's doctor," she said, and I was greeted with three more genuine smiles and greetings. They spoke with a bashful confidence that I fully appreciated.

We talked, the mother and patient and I, for quite a bit about what happened that brought them to our ER. After a stable exam, the nurse came in to clean the burn and show Mom how to care for it the next few days at home.

While finishing with this patient, I felt compelled to share with Mom how impressed I was by her kids. Not once did they talk without calling me 'sir' or the nurse 'maam'." They took turns, one at a time, to step up to their sister's cot to be supportive of her. No arguing or fighting, only kind words were uttered. No scowls, only warm smiles were worn. They were unabashed with their hugs and physical contact, sharing their seats and coats with one another. The mood and energy of the room was lighthearted and fantastic.

"Your kids," I shared with Mom before discharge, "are absolutely wonderful. It has been such a pleasure to see how well-behaved and loving they are with one another and with you. Even most of our staff has commented on their excellent behavior. Well done, Mom."

Mom was somewhat embarrassed by my compliment. "Trust me," I assured her, "I mean my words. What a wonderful job you are doing raising such fine young kids." As I spoke, the kids all grinned, bumping into one another with their elbows and bodies. I looked at all of them and smiled.

Mom thanked me, shyly, before explaining that she was a single parent. "Although I get tired by the end of the day, things seem to be going quite well with the kids." How could they not? This was an amazing woman, a role model for all, well aware of the importance of raising good children. And she was accomplishing, on her own, what two parents with less children weren't.

A hero.

After complimenting the children on their behavior and their impeccable church clothing, I ran to the freezer and grabbed four Italian ices. Grape. And lots of stickers from the nursing station. Just some small gestures to acknowledge their good behavior.

My hopes for our future have been restored. It took a few weeks, but I'm back to focusing on the good of our children. Thanks to the brilliant unselfishness of a great mother...

As always, big thanks for reading. Well done job to the mother of these four children! Also, thanks for your support in the recent Medgadget Medical Blog Awards voting. It continues until Sunday at midnight. If you enjoy my blog and posts, I would greatly appreciate your support and vote.

Take A Picture

Like anyone else who works in the ER, I wish I could take pictures and videotape some of our more absurd, inebriated patients. Of course, though, I can't--patient confidentiality and all that blah-blah stuff. But how great would it be to sit a patient down, after they sobered up, and show them how ridiculous their behavior was while in our care? Maybe, even, send a copy to their proud parents or spouse.

Personally, if I ever had twelve beers and ten shots of tequila before proceeding to crap and vomit all over myself, I would like a picture or two to convince me it really happened.

It was 2 am and I was standing at the counter of our nursing station nearest the ambulance bay doors, finishing a chart while dreaming about going home within the next hour, when the doors suddenly swung open and a prehospital team proceeded to wheel a disheveled patient into our ER hallway. Usually, the team contacts us by radio to alert us of their pending arrival with a patient, so their unannounced visit was a surprise to all of us.

The chief paramedic shrugged. "Sorry," he said, "but we picked her up at a bar just a few blocks away and didn't have time to call."

On their cot, obviously intoxicated, sat a peroxide-blond female, in her mid-twenties, with her head slumped to her right side and her breasts barely contained by her skimpy halter. Her hair was messed, the hairspray she spritzed earlier in the evening unintentionally spiking clumps in all directions. Her face was streaked with tears, darkened trails of waterproof-less mascara collecting at her chin. Drool gathered at her mouth's angles.

So, so pretty.

Of course, I was intrigued. "She was at the bar," the paramedic continued, "drinking for the past three hours, when her friends got concerned because she wasn't 'acting right.' Remembering she had diabetes, they called us to come 'check her out.' When we got there, she was passed out on a bench in front of the tavern, a puddle of vomit at her feet. Her finger stick was 87, so we decided to bring her in. She doesn't have any signs of trauma, doc."

Well, thank you fellas.

As the paramedic was speaking, as if on cue, the patient cocked her one eye open and, realizing she had an audience, started wailing and shrieking, her cry alternating between forced hiccups and gasping sobs. The hallway filled with various heads poking out of the treatment rooms, wondering how a hyena ended up in our ER.

"Room 23," the charge nurse said. The paramedics hurried off with their patient.

A few minutes later, walking back to my computer station, I passed Room 23, slowing down to check-out what was going on with our new patient (yes, I was nibshitting). I'm glad I did, though, if for no other reason than to find the paramedic holding this patient in both arms, a hero carrying his damsel-in-distress, while transferring her dead-weight from his cot to ours. I stopped and waved to him, laughing, and he shook his head in disgust. "Sometimes I hate my job," he muttered with a smile.

I stopped in and did a brief primary exam, listening to the patient's heart and lungs, confirming her stable vitals, and making sure she had no evidence of trauma. She didn't. All the while, she kept asking for the bouncer from the bar. Over and over and over. "Maam," I finally said, "nobody came with you. I'm sure the bouncer had to stay to finish out his shift."

"Ahh," she slurred, "screw him. He has a small penis, anyway." As she spoke, she pinched her thumb and index finger an inch apart from one another, giggling to herself while amusing us. "How do you know that?" her nurse, Barb, asked. "Well, duh," the patient replied, "I can hardly feel him when we have sex." I almost threw up in my mouth from her sharing so much (or so little) information.

So, so classy.

As the nurse removed this patient's clothing to put her in a gown, we discovered that the patient had on three layers of compression garments around her middle--a spanx, a girdle, followed by another spanx. For those of you not familiar with spanx (and I wasn't, so the nursing staff kindly informed me), it is a stretchy, spandex-type piece that, after you hold your breath and squeeze yourself into it, acts like a casing to your sausage body. Miraculously, you look thinner and more fit. Without going to the gym or watching your diet. Your difficulty breathing, profuse sweating, and pinched-up, cyanotic face, though, might just be dead-giveaways that you are wearing one.

"Why in God's name," Barb continued, not learning her lesson about asking questions from before, "are you wearing three of these? I've never seen anything like this."

"Well, duh," the patient answered again, "maybe so I can get laid by a guy who likes skinny girls." I get it--three layers tripled her chances.

I'm assuming that she was assuming that she looked more attractive all squished into her itty-bitty jeans and shirt with the help of her garments, but really? Did she think this situation through? What guy, one who was probably out drinking at the same bar as her, would be able to remove three of these things? Would the effort be worth it? Would his spanx-removal talent have a big payoff? Sober, I doubt any guy would be able to succeed in getting this patient out of her spanx, but throw some drinks into the equation and what do you have? Besides the fumbling, frustrated fingers of her date? Failure, through and through.

All the while, the patient continued talking in a slurring half-whisper, occasionally bursting out in giggles from her self-amusement. Several times, she belched so obnoxiously that it would have made any beer-guzzling, football-watching male proud. And one time, she dug her finger so high up her nose for a booger that I think her elbow was resting on her chin. Needless to say, I was fascinated by her influenced behavior and lack of awareness.

Finally, though, my biggest shock of the evening came from what the nurse shared with me. It seems that as the tech and nurse finished undressing the patient for observation, they were unpleasantly surprised to find this patient and all her southern female parts barely covered by her thong underwear.

Her American flag thong underwear!!! Three square inches of red, white, and blue fabric.

I was never less proud to be an American.

For various reasons, I found this news appalling. And so did the nurse and tech. Never before, in my vast experiences, did I see some skimpy underwear fashioned in this manner. When did a manufacturer start finding it appropriate to place the American flag, our sacred national symbol, on a little triangular patch that covers a woman's privates. Or worse (I'm shuddering here), a man's? I mean, let's reason this out. If our flag touches the ground, out of respect, isn't the protocol to attempt to lift it up from the ground (if possible) and, if not, burn it. Yet, it's perfectly okay for someone to wear our prideful flag pressed against their privates? Something about this thought just didn't sit right with me.

Let's be proactive. I say we gather all the existing American flag thongs out there and have ourselves a big--no, make that huge-- bonfire. Quite honestly, though, that's one bonfire I would probably dread attending.

I did get to eventually leave at my scheduled time, 3 am, after signing out my active patients to the overnight doctor. The patient, who had no sober friends or family available to come take her home, did fine throughout the night's observations, barring the occasional outbursts of swearing, drunk mumbling, and promiscuous suggestions. When she sobered up, however, according to the morning team, she turned out to be a very nice, pleasant young woman who just happened to "have a rough night."

"She could have been your sister or mine," the nurse added.

"Umm, no," I thought to myself, "I don't think so." I wasn't about to picture any of my sisters in an American flag thong, let alone being ridiculously drunk while holding their thumb and index finger an inch apart.

My final thought...maybe I don't need to take a picture or videotape this stuff, after all. Really, the mental image is reminder enough for me. Who needs a timeless picture to document such dread? Or the nightmares that would follow? If anything, I guess you can just take a picture of me, the treating physician. I'll give you permission. Just excuse my gaping mouth, my surprising eyes, and my befuddled expression when you get it printed...

As always, big thanks for reading. If you own a pair of American flag thong underwear, do me a big favor and throw them out. STAT! See you soon...

Keep Your Cranky

Although the majority of my emergency department time is spent in a local 36-bed trauma center, I continue to work a few shifts each month in the small rural hospital near my childhood hometown, several hours away. It is a great change of pace, treating the local folks, while affording me a chance to spend a few evenings with my father and siblings' families.

Last week, I had to drive through white-out blizzard conditions during my most recent two-hour trip, taking approximately four hours each way because of the weather. White knuckles, breath-holding, tense and contracted muscles, stress headaches, and bouts of complaining to myself in the car--these were all part of the package deal. I imagined the cozy, 12-bed emergency department awaiting my arrival, however, and kept plugging along the icy roads, refusing to abandon my place in the thirty-car line of traffic. Going 20 mph. And braking every five seconds. Yep, good times, as any of you ever caught traveling in a snow storm are familiar with.

Arriving at the small ER, then, I was pleasantly surprised to see the festive decorations that adorned the department. Gold, shimmery garland draped the nursing station. Felt stockings and striped candy canes hung in random fashion along the glass enclosure walls. A Christmas tree was standing tall, twinkling and proud, in a nook of inactive space in the corner. It felt Norman Rockwelly and old-fashioned, and I felt welcomed. 'Tis the season.

The first of my scheduled shifts was quite hectic. From my prime seating in front of the ambulance bay doors, I was able to appreciate the outdoor weather. Blustery gusts of snow and heavy thick blankets of engorged snowflakes descended and tormented, without pause, the small town through the day. Although I felt worry and concern for anyone out in this weather, a blazing fireplace, a good book, and a glass of wine were the only things that would have added to the enjoyment and appreciation I felt for this crazy weather.

Three hours into my shift, though, I remembered what the first snowstorm of the season means to an ER staff. Multiple MVCs (multiple vehicle collisions). First-time-of-the-season shovelers developing chest pain as they try to clear their sidewalks. Frequent falls resulting in contusions and broken bones and lacerations. Cough and cold symptoms magnified tenfold with every ten degree drop. Frostbite. And on...and on...and on...

By mid morning, we were swamped. And I loved it. All twelve beds were filled and the waiting room was starting to spill over. The multiple ambulance runs to pick up and drop off ill patients created a steady, rhythmic sense of humming chaos. Despite the craziness, the staff I was working with (many of them friends from my childhood) continued to smile while pushing onward. I was proud to be part of such a team, their hardwork quite evident. We were providing excellent care in a very efficient manner, discharging and admitting and transferring patients left and right.

So, was it really a surprise to me to find that, eventually, all good things come to an end and this run of busy but gratifying work would be interrupted by something unpleasant? I guess not, although I could still hope, right?

The unpleasantness came early afternoon, in the form of a man's booming, angry voice resonating from the hallway. I had been in Room 2 at the time, examining a new patient, an elderly female with dizziness.

"If you'll excuse me, maam," I said, "I need to go see what's going on in the hallway."

I left her room and shut the sliding glass door. Several nurses were in the hallway already, standing in front of a 60ish man, his mouth moving while he leaned forward into his walker. The obvious source of the angry yelling.

"Excuse me, sir," I said, walking between the nurses and right up to him, "what seems to be the problem?"

If any of you have seen the movies Grumpy Old Men and Grumpier Old Men, picture a shorter version of Walter Matthau with slightly more gray hair peeking out from his baseball cap. A pinched-up face. Angry, flaring eyes and a reddened, ruddy complexion. His flannel shirt was untucked from his blue denim pants. And his hands were balled into fists while maintaining his grip on his walker.

Those angry, flaring eyes didn't take long to focus on me. "Who the hell are you?" he asked, practically spitting on me with his disgust.

"I'm Dr. Jim, the emergency room doctor on shift for the day," I said, keeping my cool. "And you are...?" I deliberately left the question open.

"I'm the God-damned boyfriend of Room 6, if any of you lazy sons-of-bitches care," he screamed out, "and I need somebody from this God-damned first-aid station to tell me what the hell is going on with her."

I was surprised at this man's behavior, wondering to myself if he had tipped a few back during lunch. The level of rudeness and obnoxious behavior I encounter through my shifts continues to amaze me. Trying to placate this man would turn out to be an obvious failure.

Room 6, this patient's girlfriend, contained a woman in her 60s who had lingering burping and belching for six months. Today, this day of stormy weather, was the day she decided to pursue her symptoms, for no other reason than just "because I figured it was time to get checked out." She was right to come in, since her EKG revealed signs of heart ischemia that were confirmed by her elevated cardiac enzymes via blood work. I had seen and treated her immediately upon her arrival to our ER, as well as checked-in with her multiple times, making sure her symptoms had resolved and explaining the results of her tests. Currently, the cardiologist was on his way to the ER to make further recommendations.

At no time during this woman's hour stay did a boyfriend present himself. She had been in the room alone.

"Sir, keep your voice down," I told him, "we have a lot of sick patients in this ER today. And when did you get here," I continued, "since I've been in your girlfriend's room multiple times in the past hour."

"Me, too," piped in Marsha, the patient's nurse.

"I just got here," he said, shaking his head in disgust, "and nobody made it a point to explain things to me." He continued to rant and rave, insulting anyone associated with the small rural hospital.

"That's not true," Marsha disputed, "I explained everything I knew to you, just a few minutes ago, after you walked into your girlfriend's room. I even offered you a chair, coffee, a blanket."

"Regardless, sir," I said, proud of Marsha, "you could have asked in a much better way than walking into the hallway and screaming like this for everyone to hear." He eyed me up, surprised at my confronting him on his behavior. "Now," I said, "these are your two choices. Either leave the department and wait in the waiting room, or go back into your girlfriend's room and act like a gentleman. After she answers your questions, I'll be in to answer anything further. With her permission, of course."

There was a standoff. He eyed me. I eyed him. The nurses all held their breath. Finally, he spoke. Or yelled. "Screw you. I'm going to go, God-damn it, and feed her God-damn mutt of a dog. But I'll be back," he said.

Before leaving, he tried one last parting shot. "I envy your God-damn generation," he muttered, "none of you know what hard work is. Not a single one."

Well, I thought back to my 14 hour days working with my father's crews in the woods when I was a teenager. I thought about waking up in my childhood on Saturdays and Sundays to cut and stack firewood and cut grass. I thought about the numerous chores our parents expected of us. I thought about the endless sleepless nights I spent, first studying through college, then medical school, and finally through residency, before some semblance of normalcy finally arrived to my life.

"Sir, you don't know me or any of the nurses, do you?" I asked, sweeping my hand towards them. He nodded "no." "Then how," I continued, "can you say such a rude thing? I would never consider insulting you the way you've insulted our staff. It's not necessary and your bad attitude isn't helping anyone. It's time for you to go."

"Well," he stammered, "even if you aren't lazy, most of your God-damn generation is."

And with that, he continued on his way out of our "first-aid station," decorated to celebrate the joy of the wondrous holiday, shaking his head in disgust until he walked through the waiting room doors.

After he left, our staff regrouped in the nursing station. Amazingly, not one person was affected negatively by this gentleman. Everyone had the good sense to dispel his insults and demeaning behavior without a second thought. "I can only hope," I warned them all, "that I'm not that grouchy when I get older."

I visited Room 6, the girlfriend. She was still clear of all her symptoms, but looked teary-eyed. "I'm so sorry for his behavior," she said, obviously hearing the conversation that had just occurred in the hallway, "he's like that all the time. But Doctor, just so you know, your staff treated me wonderfully today." She assured me, upon my questioning, that she was safe and not being abused physically. She declined any counseling offers. "He's a dog with a big bark and no bite," was how she put it. I wanted to ask her "Why?" Why in the world would she stay with a man so unpleasant, so abrupt and obnoxious? But I didn't. We all have our reasons for living our lives the way we do, and she was no exception. Besides, the world was continuing to revolve and I was needed in several other rooms.

An hour later, Mr. Crank was back. Before even entering his girlfriend's room, he walked himself right through the nursing station, stopping on its edge. "Now what the hell is going on?" he yelled, lifting his walker from the floor before banging it back down, startling me from the chart I was working on.

And the conversation continued as before--him insulting our staff and hospital with vulgar language, me giving him the option of either going to his girlfriend's room or the waiting room. In my book, this was his last chance, and I conveyed it respectfully to him.

He walked to his girlfriend's room, entered it, and shut the glass door behind him. Surprisingly, he was only in there for a minute or two before opening the door, walking into the hallway and out the ER while muttering to himself. Whereas before he had conveyed, with his body language, some misplaced pride, this time while walking past our nursing station he looked like a man who had just been brow-beatened. No doubt, the girlfriend had the last say in this matter.

Throughout this holiday season, we will have many opportunities to spread good cheer and love. Compassion and kindness. And endless smiles. Or, we will have opportunities to spread poison and malignant anger. Hurtful words and deliberate insults. And pinched-up frowns.

The choice is yours. The choice is mine. Just remember to pause and look at the infinite garland, the Christmas trees, the stockings, and the candy canes--all of the beauty of the season that surrounds us. Notice and acknowledge the smiles on the faces you pass. Remember your inner child's spirit and reflect on the deeper meaning of this holiday.

I can only hope your choice fills your heart with warmth.

And I wish for nothing less for Mr. Crank.

As always, big thanks for reading. Despite our respectful attempts to break through Mr. Crank's grumpy exterior, we were unsuccessful. Darn it! I hope this finds you well and ready for the holiday season and all it brings your way...see you early next week.

I Got Me Some Flu

I am one of those people who has avoided the flu shot, at least for the past six years. Outside of diligently receiving it during the few years that my son, Cole, and my mother were on chemotherapy, I find that the constant bombardment of exposures to various infections during a typical shift in my emergency department has given me the small doses of immunity needed to remain healthy and infection-free.

Although I'm not one to ascribe to the notion that the flu vaccination is the cause of a multiple sequalae of ailments after receiving it, several years ago I myself had developed an odd peripheral neuropathy after my third yearly shot. After multiple MRIs and blood work, including a spinal tap, failed to reveal the reason, I have since avoided the flu shot on this basis. And my peripheral neuropathy, thankfully, is a thing of the past.

Do I think the peripheral neuropathy was due to the flu shot? It depends on the day you ask me. After witnessing the flu shot being blamed for everything from causing heart attacks to promoting cancer, though, I was hesitant to put the blame on it for my own symptoms. I was young (in my thirties), healthy, and in great physical shape. I was admittedly stressed out, however, between Cole's relapse from remission and my mother's battle with leukemia, all the while desperately struggling to show the world nothing but a smile on my face. We all know how important a healthy mental state translates into physical well-being (known as "psychosomatic" in the medical community), so I had obvious other reasons, besides receiving a recent flu shot, to suspect my body's failings.

That said, I think the flu shot is a wonderful option for people who pursue it after an informed decision, and I have no doubt that it is responsible for saving a significant number of lives, especially those from the populations of being elderly, young, or immunocompromised.

It's just not for me.

Recently, after having several days off during this past Thanksgiving holiday, I returned to work, on Sunday, only to learn that the nasty GI bug had exploded in our community. Diffuse abdominal cramping, nausea with uncontrolled vomiting, diarrhea, fevers, aching muscles, headache--it seems this little bug was responsible for a multitude of holiday gifts to a multitude of people from every background. Gifts, unfortunately, that kept on giving. According to one of our senior resident physicians, during his prior day's shift, he treated twenty patients, seventeen of which had this flu syndrome. And, it seemed, the virus was working its way through our staff.

Uggggggghhhh. Welcome back to me.

I took every precaution I typically take before starting my shift. I got the industrial, kill-everything wipes (in the container warning to wear gloves before touching them) and wiped down my phone, my computer and its keyboard, my workspace counter, my pen, my stethoscope, my chair handles, etc. If there was a chance I was going to touch it during my shift, it got wiped. I may have even gone overboard, obtaining a clean bed sheet, folding it several times, and putting it on the cloth chair I was using. In my mind, I ridiculously believed I had effectively halted any bug from climbing from the navy blue seat, through my khakis, through my underwear, to my skin, where it would multiply and overtake me, unselfishly sharing all of its pleasant symptoms with me. I'm surprised at myself, on hindsight, that I didn't soak the bed sheet in ammonia first.

I'd be damned if I was going to get that nasty flu.

As usual, I made sure to put on latex gloves, from the hallway station, before entering any patient's room. Every time. Without exception. I wasn't going to be shaking any hands or touching any bed railings if I could help it. When necessary, I also donned a mask and disposable body gown, rendering me as a wrapped mummy. You can only imagine the screams from the pediatric patient who, on a normal basis, suffers from white-coat syndrome now being approached by a tall blob of a person bulkily wrapped in pastel-yellow paper, purple latex gloves, and a light-blue mask, two eyes peeking out of its top border. I think I would probably scare myself, even.

For added precaution, to make sure I didn't pass anything on to my family, I stripped myself immediately after walking into our mudroom from a shift, depositing my clothes in the washer and running quite briskly through the house to our bedroom shower, where I proceeded to scrub myself down. I'm hopeful I won't hear from any of our neighbors claiming to see, through our house windows, a naked man running around. Make that a sexy naked man, thank you very much.

So, after all of my precautions and not getting the flu for the past six years, I was pretty confident that I wouldn't be one of the unfortunate many getting ill during this recent outbreak. Nope, not me. Get out of here, you nasty bug, and find someone else to populate a new colony in.

Fast forward to my third and final shift. Tuesday evening. Eight hours into my ten-hour shift. Me, sitting at my computer in my tan cords and long-sleeved rugby shirt, happily typing in orders on yet another patient, thinking about having off the next four days.

And suddenly, just like that, I heard it. And then felt it. A loud gurgle, followed by a wave of cramping. "On no," I thought to myself, "it must be the fish sandwich and steak fries I ate for dinner." How easy our minds can hide the truth from us, sometimes. Despite my denial, the gurgling continued and the cramping waxed and waned. Finally, the shift over, I drove home, mumbling useless prayers, barely making it into my house before visiting the bathroom.

What a great way to spend a few days off! After missing basketball practices with my son and youngest daughter, skipping family meals, taking numerous small sips of water with repeated doses of ibuprofen, and imbibing in several warm baths followed by extended naps (yesterday from 1 p.m. to 5 p.m.), I am actually able to stand up from bed this morning without getting dizzy. I am hopeful that the cause of these past two days of misery is now on its way out.

I even missed writing group last night, which speaks volumes of just how miserable I was.

Are there any benefits to having the flu? Heck yeah. Like I just mentioned, the warm baths and extended naps. Trust me, those two things alone almost made being sick worth it. And being pampered by the family; for example, having a cup of tea made lovingly (after threatening to lick her face) by my youngest, Grace. However, if I am being honest, I don't think I was pampered nearly enough by my kids or wife. Whether it was simply avoiding me to prevent getting the flu themselves, or possibly avoiding my incessant manly whining, I'm really not sure. A moan from me, though, was more often met with laughter rather than concern. Maybe I was imagining it, in my febrile delirium, but I don't think so.

When I'm done finishing this post, I may go lick the clean rim of my wife's coffee mug before replacing it back on the shelf. That would teach her to give me more lovin' when I'm near-death.

Not really, of course. After all, at some point during my recovery, she and the kids carried up all of the numerous boxes of Christmas decorations from the basement and began to transform our house into a welcoming winter wonderland. What an appreciated, beautiful sight for me to behold after being bed-ridden for a few days.

If anything, though, now I may just have to reconsider the flu shot.

Oops, I have to run--the bathroom is calling for me. I hope this finds you all flu-free and healthy during this post-Thanksgiving season.

Flu shot or no flu shot? That is the question...

I'm back. As always, big thanks for reading. I hope you all had full bellies during this past Thanksgiving holiday. See you soon.