The Golden Smile

A few years back, I met a very endearing patient. Sweet and likable. Polite and respectful. The interaction was thoroughly enjoyable, fun even, and by the time I had finished treating her in our ER, Miss Claire had wormed her way onto my favorite patient list. Maybe even into my heart.

I had walked into her treatment room not quite knowing what to expect. By the triage report, Miss Claire seemed a little off-center. She had complaints of some shortness of breath for the past two weeks. And she smoked. However, she didn't have any complaints of a recent cough or cold and denied any chest pain or recent trauma. She believed, according to her nurse's charting, that "my next-door neighbors are spraying fumes through the wall that are making me sick." Interestingly, she did have a psychiatric history, although the nurse didn't specify.

Armed with this knowledge, I slid the glass door to her treatment room open, pushing the privacy curtain aside as I stepped in. And as I did, I was greeted by one of the biggest, most genuine smiles I think I have ever seen.

Miss Claire was sitting upright in her cot, alone, just waiting for someone, anyone, to walk into her room. She didn't have a book or magazine. Her TV wasn't turned on. She was just patiently and good-naturedly waiting. And that anyone who walked in? Well, lucky me.

I held out my hand as I approached this smiling patient, feeling a very nice vibe to the room.

"Hello, Miss Claire. My name is Doctor Jim and I'll be taking care of you today."

"Hello, Dr. Jim. I'm sure glad to meet you, sir," she replied, taking my extended hand into the both of hers, warm and soft, and squeezing it gently. Still smiling.

I had a chance to take in her unique appearance as we made small talk. For being on the young side of fifty, Miss Claire certainly didn't look her age. She had smooth, unwrinkled skin, barring the furrowed creases at her lips' edges. Her laugh lines. She had dreadlocks, thickly-braided and black, pulled back from her face and tied in a loose bundle at her neck's nape. She had high cheekbones that danced and small ears that wiggled with each facial expression.

It was hard to pinpoint the exact charm of her warm smile. Her eyes, richly-browned chestnuts, were alive and sincere to the moment. Her smile itself, well, it encompassed the bulk of her face's frame. Full lips outlined her white, rectangled teeth. And the topper? She had a gold-plated incisor that sparkled, with just the slightest head movement, from the overhead lights.

Her golden smile.

I sat on the available bedside stool and got down to business. "Miss Claire," I said, "I read the nurse's notes about what brought you here today. Do you mind if I ask you a few more questions?"

"I would be glad to answer any of your questions, Dr. Jim."

I reviewed her complaints, listening to her patiently explain, again, that she was having shortness of breath, for over two weeks, that she felt was most likely due to her neighbors infiltrating her walls with fumes. "What kind of fumes, maam?" I asked. "Oh, I don't know," she said, not losing her smile, "I guess 'carvon mitoxide' or something like that. And sometimes the fumes smell like frying bacon."

On review, she didn't have a fever. Or a cold. Or chest pain. Or any calf trauma (a cause of lower extremity blood clots that can occasionally travel to the lungs). Nothing suspicious, really, that would raise my hackles to think she might have a serious illness.

"And maam," I continued, "may I ask you about your mental history?"

"Of course you can, Dr. Jim." She had a history of bipolar depression. And sometimes, she admitted, she heard voices. "But I'm on medicine for all of that," she assured me. She was not having any suicidal or homicidal ideations. She had never tried to harm herself or anyone else. She did have a counselor and did meet with him on a regular basis. With all of my questions, she proudly faced them head-on. And with a beguiling pleasantness.

She had even gone so far as to have her apartment supervisor come to her residence and "check things out." Everything had checked out fine, including a normal "carvon mitoxide" reading.

I really liked this woman. And to her credit, she was easy to like.

I proceeded with my exam. Great vital signs. Good pulse-ox. A completely normal exam, including regular heart sounds and clear aerations of her lungs on auscultation. Given Miss Claire's age and waiting time, her nurse had ordered an EKG, a CXR, a d-dimer (a nonspecific blood test that, if positive, increases suspicion for a blood clot), and a carbon monoxide level. Ultimately, the results all returned favorably.

At one point, after I had reviewed Miss Claire's EKG and CXR, I stopped in her room to explain those results and let her know that her blood tests should be returning shortly.

She was still smiling.

I decided to slow down for a few minutes and, after walking to her bedside, sat down on the vacant stool. "You know, Miss Claire," I said, relaxing, "you have one of the most welcoming and kind smiles I think I have ever seen. What a great way for you to greet the world."

"Thank you, Dr. Jim. There ain't no sense in showing the world anything else, now, is there?" I nodded my agreement at this wise woman. "And," she continued, "you seem to be smiling as much as me, sir." I thanked her back, flattered by her genuine compliment, before we continued on and had ourselves a fine ten-minute conversation.

After her normal blood work returned, I had two conversations on Miss Claire's behalf. One, to her counselor, who, upon learning I was calling on behalf of Miss Claire, said "Isn't she the sweetest lady?" Her counselor was going to follow up with her the next morning. The second call was to Miss Claire's family doctor. Although I think Miss Claire's complaints were based on a mild paranoia, I wanted her family doctor to follow her closely in the event she needed any further, non-emergent work-up, including allergy testing. The office nurse gave me a follow-up appointment, ending our conversation with "Isn't she a pleasure?" She certainly was that.

I entered Miss Claire's room one last time, explaining to her the disposition and follow-up plan. I assured her that I was quite pleased with her test results. "If you're pleased, then I'm pleased, Dr. Jim."

"I am pleased, Miss Claire," I replied, before hesitantly continuing. "It was a pleasure meeting you today, maam. A privilege, really. And whatever you do, don't ever lose that smile of yours."

After our goodbyes, Miss Claire shuffled down the ER hallway toward the exit, her discharge papers in hand. I lingered in the hallway, watching her leave, appreciating her warm greeting to every person she passed, whether it was a faint "hello" or a friendly nod of her head. Or both. I smiled to myself, watching the wonders of her kindness in action.

What a beautiful individual.

Golden smile and all.

As always, big thanks for reading. A special thanks to Dr. Kevin, from KevinMD.com, for kindly requesting and reposting one of my earlier works yesterday. I am honored. Have a great weekend. See you Monday, May 3...

It Wasn't Me!

Forgive my warped ER humor today...and big thanks to Dr. A for the awesome adventure/interview last night. He rocks. Find it here... Doctor Anonymous.

To the nurse who "expelled gas" in the nurses' station a few weeks ago and didn't fess up to it, I have just one thing to say. Shame on you! What would your mother say?! I hope you felt bad that night when you got home and thought back to how you just sat there, quietly, while I absorbed the blame and derision meant for you.

I was raised in a conservative, Catholic family. Seven of us kids with a loving mother and a providing father who, with gusto, cherished their traditional roles. Besides the obvious rules that accompany a Catholic background, we also had an 11th Commandment: "Thou shalt not expel gas in public." In my family, the "f" word stood for "farting." To this day, I still have more trouble with that word than the real "f" word. I'm not f...... kidding, either. If we did have to "release," we were taught to leave the room and find a private spot where you could wallow in your stink all by yourself. It's a rule I still try to uphold to this day, despite my wife making the best f...... chili I have ever had.

So, a few weeks back, I sat down in the nurses' station to catch up on a chart. It was an easy-going, friendly crew, consisting of three female nurses, a female secretary, and moi. Yes, I was the only guy in the vicinity. And, of course, I wouldn't have sat down if I knew what was coming.

We were all immersed in our work when, suddenly, I smelled something rancid. No, it wasn't a pine-scented plug-in. Or the industrial-strength apple-scented spray. I would have welcomed those scents. Instead, imagine a rotten egg mixed with a touch of skunk. Seriously, it was bad. I would rather have been sitting in a neglected Johnny-on-the-Spot than in that nurses' station.

I looked up, crinkling my nose and grimacing my face, hoping that it was a patient in a surrounding treatment room, one stricken with a lower GI bleed, rather than one of my coworkers. One of my female coworkers. No such luck. My coworkers were looking around as well, noses crinkled with as much disdain as my own.

We were all silent. And suddenly, the next thing I knew, I was being glared at by all four women, supposed friends, their eyes hurling their accusing daggers in my direction. It suddenly dawned on me what they were thinking.

"Oh, no," I said, shaking my head vigorously, "it wasn't me. I didn't do it. Don't assume that just because I am the only guy around, it was me."

I was met with silence and continued stares. I felt the overwhelming urge to explain my way out of this. "Seriously," I said, giving them my puppy-dog look, "I didn't do it. Maybe it was a patient or someone walking by in the hallway. Heck," I even chanced, "maybe it was one of you."

I was met with more silence. Frustrating silence. And more continued stares. Sneers, actually. If this was half as bad as a police interrogation, just declare me guilty and throw away my key.

Finally, I heard the secretary say in a low voice "Whoever smelt it, dealt it." Hey, come on people, be fair here! I "smelt it," alright, and I had the singed nasal hairs to prove it. But I didn't "dealt it." I promise. If we did an underwear check, I would have been cleared in an instant.

"Yeah," one of the older nurses added, smirking, "to think that one of us could do that!" She quickly darted her eyes away from me as I focused on her. Okay, at least now I knew which nurse did it. I stared at her just a brief moment longer, silently hoping (in that kind, gentle Catholic way) that she would choke on her Chex cereal the following morning.

Well, of course, there was no underwear check. No confessions, either. And I refused to leave. I was not going to let some wayward, XX stink-bomb embarrass me out of my seat. Go ahead and look at me, you four co-conspirators, and think whatever you want. I don't care. Okay, maybe just a little...

Of course, before the fumes could clear, the nurses' station became Grand Central Station. The neurology team, the cardiology team, the phlebotomists--they all passed through. Yep, they all crinkled their noses. Nope, none of them had the gall to address the stink with us. I refused to leave my seat. I'm not a stupid man--I knew the moment I left they would all be pointing their fingers at me. Finally, though, after what seemed like an eternity, I was able to appreciate the returning smells of moth balls and sanitizer and floor wax and vomit and illness--the glorious smells of our ER. Welcome back!

This episode, unfortunately, was not isolated. It's happened to me in an elevator, in my writing group, in a car, at the gym, getting a haircut, and so on. Surrounded by women, the guy will always be looked at with disdain. Am I right, guys? And every time it's happened, I've gotten this primal urge to jump up and down and declare my innocence. Which, of course, just makes me look all the guiltier.

I've even had one brilliant senior resident teach me the finer points of dealing with this issue when I was under his supervision as a medical student. "What you do," he said, "is find a room with a really old patient in it. Preferably a sleeping patient. Man or woman, it doesn't matter. Then you go in and, while you pretend to check their cardiac monitor, you let it rip." He was being completely serious. "The best part, though," he finished, extremely proud of himself, totally ignoring the disbelief on my face, "is when you come out, make sure you tell the nurse that you think their patient just shit them self."

Call me crazy, but I don't think that's really the answer. After giving it some thought, though, I think I've come up with the solution. Well, besides the obvious--hiring more male nurses (simply to reduce my odds of getting undue blame) and posting the 11th Commandment on every free inch of ER wall space.

The solution? A pin. A nice, big visible lapel pin. Round. I'm thinking fluorescent colors. A bold, clear Times font, set at 60. Ready to be pulled out and worn in an instant. And, of course, what it will read goes without saying.

"It Wasn't Me!"

As always, thanks for reading...next post will be Monday, March 1. See you then...one last shout-out to the famous and talented Doctor Anonymous. Thank you...