Extra Cream And Crescent Moons

I just realized that I have passed my one-year anniversary for my blog, StorytellerDoc. It has been an amazing ride, thus far, and I am grateful for all the amazing positives and new friends that have come my way with this endeavor. Thank you... Now, for a post that drifts way off my beaten path.

I pride myself on working hard to stay in good physical shape and maintaining a healthy lifestyle. This, despite my love of scoop Fritos and Nibble With Gibbles potato chips. I come from good genetic stock, however, which makes "fighting the fight' a bit easier. Regardless, though, my frequent trips to my fitness club are a mental necessity with physical benefits that I've grown to rely on in keeping some sanity with my often stressful job.

I've been at the same club for thirteen years. And in those thirteen years, I have seen many new faces and also continue to see many familiar faces. On days when I don't really want to be there, it is nice to see that familiar face pushing themselves at one of the weight stations. Especially when that face is worn by an 80 year-old woman who is kicking ass at the leg abductor machine. Or the middle-aged guy who just finished doing twenty pull-ups.

Some of those faces, both new and old, I have also seen in the ER as patients. For that reason, I often wear a baseball cap pulled down quite low, just edging my eyebrows. Believe it or not, I was more embarrassed to run into the college girl who I recently treated for PID than she was. At least I know not to follow her on the machines she just sat at. Even more necessary, I plug my Koss earplugs into my mp3 player and crank some great, energetic music. That way, if a former patient wants to talk to me about their thrombosed hemorrhoids or that nasty fungal infection that just won't go away, I can feign not hearing them. "What's that, sir?" or "Did you say something, maam?" I may have been guilty in saying that once or twice during a workout.

A few years back, my gym started a program, I think it's called "Silver Sneakers," which gives elderly people a membership discount, encouraging them to work out. This is all good and fine. In fact, I look at some of these remarkable people and am truly inspired by their effort and commitment. However, I like to work out at the same time (mid morning to early afternoon) as the Silver Sneakers folks do, which at times has begun to frustrate me.

Let me reiterate here that I truly am impressed by most of these folks. I can only hope to be in my 70s and 80s and push myself the way some of these people do in the club. But, darn it anyway, some of them are causing me to think about joining another gym. And I'm a creature of habit. After thirteen years, I don't want to join another facility. But here's why--and if any of my following supportive arguments upset you, I apologize for it beforehand.

Several months back, I began to notice that sometimes walking into the men's locker room, before starting my workout, held a dangerous risk. The entrance to it has a C-curve, which prevents those out in the gym area from getting a direct view. Unfortunately, upon walking in, I have been greeted one too many times now by the naked old guy, just finishing from his shower, standing in front of his locker, bent over, drying his toes. And more drying. And still, more drying. I didn't know that drying your toes (did I mention naked?) can be a ten-minute ordeal. But for some, I guess it can be a meticulous process.

So, just go along with me here. Are you picturing the guy? Because, while he is drying his toes, his weighty scrotum with its ten-pound hernia is swinging back and forth, welcoming all who enter the locker room to have a great workout. Trust me, it's hard to be inspired to work out after that. Really, if that is what I have to look forward to in another thirty years, I may just pack it in now.

I have also witnessed many men clipping their toenails (some while sitting naked on a stool). So sometimes, either standing in front of my locker or trying to walk through to get to my locker, I haphazardly step on little slivers and shreds of discarded nails and cuticles. What the hell is this? I actually have a buddy who left the gym because of this. Me? I am made of stronger stock, I guess, than my buddy. I still feel the need to complain about it, though.

Anyone need any talcum powder? Cologne? There is plenty of that after a shower, too. Unfortunately, though, it's not mine. Nothing, and I mean nothing, freshens me up better before a workout than to walk through the obnoxious cloud of baby powder and cheap cologne. I have actually worked out before and thought to myself, "What is that stink?," only to realize that the stink was me. And I don't even wear Stetson cologne!

Just a few months back, I walked into the locker room to be welcomed by another naked man, bent over, drying his toes, with his pendulous scrotum wishing me a "good morning." All well and good now, since I am becoming immune to such greetings. But this guy, at least 80, had something I haven't seen before on the Silver Sneakers folks. Because of the club's free tanning promotion, this guy had an all-over tan--all over except for two very pale half-moons at the inferior creases of his buttocks. In laymen terms, he had two curvy spots of non-tanned skin from where his ample ass doubled-over while he was laying in the tanning bed. If I only knew his name, I would probably tell his family on him.

We interrupt this post to bring you a joke. Someone, please turn on my microphone (tap, tap--okay, it's working). Imagine me talking to this guy's grandkids. "Hey kids," I could say, "what is one-half moon plus one-half moon?" The kids would yell out their answer, "One!" "Nope," I would answer, pausing to build their anticipation before answering, "one-half moon plus one-half moon doesn't equal one, sillies, it equals your grampa's ass!" Well, maybe they would be right--grampa was showing me his full moon.

If that wasn't bad enough, last week when I walked into the locker room, there was actually a naked gentleman with his left leg drawn up onto his stool, actively squeezing hemorrhoid cream in his buttock's crack. I kid you not! At least I think it was hemorrhoid cream. I was horrified, hurrying past him before he could ask me to help him out or, better yet, accidentally spray some cream in my eye as I walked by. What's next, the public insertion of a suppository?

Although I view being observant and cognizant of my surroundings one of my best strengths, especially in the ER, I am learning that I may just need to put on some blinders the next time I pull into my gym parking lot. That way, I won't notice any more of the following:

The woman in spandex walking around the track with a saggy, incontinent bottom.
The crescent sweat stain on the seat of the weight machine from the person before me.
The gentleman who's comb-over is not combed-over while he does the bench press.
The fashion trend of wearing two different socks with your walking Reeboks.
The extremely curly hair that is on the water fountain push button.
The inadvertent forgetfulness of putting on a bra before working out.

Should I go on? Trust me, there is a lot more. Or do you get the idea?

Regardless, I am extremely proud of all of my fellow gym-mates. After all, despite any of my misgivings, they are there, at the gym, giving it their best in maintaining good health. Good for them, I say. And because of this, I have never once gone to the front desk and complained. Nor would I. If I did, I wouldn't have anymore of those special "Good morning!" greetings upon walking into the locker room. I just need to get over a few small issues, I suppose.

On second thought, if you'll excuse me, I'm going to go fill out my membership form for Curves.

See what so many years in the ER has done to my sense of humor? As always, big thanks for reading! Please come back... I hope this finds you well and wishing you a good week. Jim

The Coumadin Goose-Egg

Despite the light drizzle of rainfall, she pushed the grocery cart filled with her unwashed clothes to the local laundromat. It was Tuesday and, like any other Tuesday, it was laundry day. Despite her dislike of rain, habit and her dirty clothes dictated that she make this journey.

Her apartment was just a few short blocks from the laundromat. Being elderly and recently widowed, a local laundromat, a supermarket, and a bus stop were on her short list of requirements for her new apartment's location. She had never taken the time to learn how to drive when her husband was alive. On hindsight, though, she should have insisted that he teach her. Now, she relied on public transportation and her steadfast grocery cart, given to her from the local grocer's manager when she had asked him about buying one.

She smiled to herself as she remembered that recent day. "This ones' an old one," the manager had said as he patted the cart's handlebar, refusing her money, "just take ol' Bessie and get some good use out of her, okay?" She blushed before taking Bessie, not quite sure how to deal with the random kindness of a stranger.

As she pushed her cart slowly along the sidewalk, she came to a slight decline just a half-block from her destination. Even in dry weather, she had fretted about guiding her cart down this gentle-sloping hill. Now, with the rain-slicked walks, she stopped at the top and appreciated the wet sheen of the approaching pathway. She briefly contemplated turning around and returning another day to wash her clothes.

She should have.

Slowly, after deciding to proceed to the laundromat, she guided her filled-cart down the sloping walk. One step. Another. And another. Her hands tightly gripped the cart's handlebar, her elderly, frail forearms beginning to burn from the effort it took to maintain her sliding cart.

Another step. And another. The muscles of her arms tremored. Her calves tightened. She leaned her body back, struggling to keep the cart from careening out of her control.

It was all in vain. Just a few short yards into this declining slope, she lost control of her cart. It began to slip and slide over the sidewalk, pulling her resisting body along, her hands still death-gripping the handlebar. It veered towards the left, almost jumping the curb and joining the local traffic, before she was able to over-correct the cart and steer it right.

The cart jumped the sidewalk and smacked right into a telephone pole. And, unfortunately, so did she.

I walked into Room 22 to find a very sweet-appearing elderly woman in her late seventies. She was sitting upright in her treatment cot, a hospital gown loosely draping her frail body, answering her nurse's interview questions with her matching frail, high-pitched voice. One that crackled with nervousness. On her room's counter, I noticed a pair of comfortable leather beige shoes, old and well-worn. Beside her shoes, a pair of pastel-blue pants. Polyester, of course. And on top of the pants, a blood-soaked floral shirt.

"Mrs. Taylor," I said, extending my hand as I entered, "I'm Dr. Jim. Nice to meet you, maam." She looked up at me and gave me a feeble smile, extending her hand, cold and covered in paper-tissue skin and blue-ribbon, spidery veins. I took it between both of my gloved ones.

"Maam," I continued, "what happened that brought you by ambulance to our ER, today?" Despite asking, I already knew the answer. Whether it was my nearness or the brightness of the overhead fluorescent lighting, I could now appreciate the significant cephalohematoma of her right frontal region. Othewise known as a contusion. Or, for those of you in my age group, a "goose-egg" or "goose-bump." You know, those big swollen bumps that our mothers used to hold the flat edge of a table-knife against to reduce the swelling when we were young and had just fallen off our bikes.

Anyway, Mrs. Taylor's goose-egg was quite impressive, covering most of her right forehead with the lower border extending into her upper brow and eyelid on the same side. Even her nasal bridge was swollen. Overlying the goose-bump, a superficial abrasion seeped a touch of thin, watery blood. The overall injury gave this kind woman a lopsided, deformed appearance suggesting that she just went ten rounds with Rocky.

Mrs. Taylor, in-depth, told me what happened. It was important to her that I understood two things. One, that she was a recent widow and missed her husband terribly. And two, that she had tried everything in her power to stop her cart from going out-of-control.

I patted her shoulder. "I understand, Mrs. Taylor. Thank you for sharing that with me."

What complicated Mrs. Taylor's history, besides Mrs. Taylor being elderly, was the fact that she was on coumadin, a blood-thinning medication that is used in the treatment and prevention of clots and, in Mrs. Taylor's case, for an irregular heart rhythm that otherwise increases the likelihood of stroke. I knew this, from the sheer size of her injury as well as the thin, watery blood oozing from the site.

I asked her a few more questions. Had she lost consciousness? No. Did her neck hurt? No. Did she have numbness or tingling or weakness in any of her extremities? No. Any chest pain, shortness of breath, or abdominal pain? Again, no. No arm, leg, or pelvis pain, either. On exam, outside of her impressive contusion, she didn't have any other significant findings. Well, unless you count her damaged pride.

I sent her, frail smile and all, to the CT scanner, where we imaged her head, her neck, and her facial bones. We were overly-cautious in her testing as her injury was considered a "distracting injury," meaning that with all of her attention focused on her goose-egg, she might not realize if she had neck pain. Thankfully, though, her reports came back well. No skull fractures or intracranial bleeding, just the large collection of swelling and bleeding outside of her skull cap in the frontal region. Her neck CT? Negative. Her facial bones CT? A questionable non-displaced distal tip nasal fracture. Her coumadin level had been in therapeutic range.

I discussed all of Mrs. Taylor's results with her. "Thank you, dear," she said, after I explained her next course of action. Since she was on coumadin, despite not having any significant bleeding within her intracranial space, we were going to admit her to the medical service for overnight observation. This is our hospital's protocol. Had she had a significant brain bleed, she would have been admitted to trauma and neurosurgery services and had her coumadin's effects reversed.

I never saw family or friends during the time Mrs. Taylor spent with us in our ER. Despite her frailty, though, she demonstrated a piss-and-vinegar attitude and resilience that assured our nurses and myself that she would be okay. She was one neat lady.

My one wish, though, for Mrs. Taylor? Well two, actually. One, I wished she had learned to drive at some point in her life. I meet too many elderly women who's husbands did all the driving so "I never had to learn." Of course, though, that would probably be me stuck behind her driving 15 mph in a 45 mph speed-zone. And two, I wished her husband had still been alive to hold a table-knife against her big ol' goose-egg.

Just like my mom used to do.

As always, big thanks for reading. I hope you had a great weekend. Next post will be Wednesday, June 9. See you then...