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.

Another Birthday

Today is my birthday.  Yep, today.  On this fourth day of this fourth month of this year, I officially have turned 44.  Should I buy a lottery ticket with these numbers?  Something is whispering to me that if I ever had a realistic chance to win, it would be today.  Nah, who am I fooling--I think I'll just keep that errant dollar in my pocket.

44 is an odd age, though.  Am I middle-age?  Am I the new thirties?  Is my life half over?  Or more than half?  That thought makes me shudder.  I look at some of my patients in the ER, those in their 20's and 30's, and in my mind I am dealing with someone in my own age group.  Maybe they have less wrinkles and a fewer amount of life experiences, sure, but otherwise we are the same, aren't we?  That is until they call me "sir," a word I am growing less fond of the older I get.  And suddenly, I am reminded that no, I do not have as much in common with this college student sitting on the treatment cot in front of me as I might have thought.

Still, birthdays are pretty special when you are surrounded in your life by people who make a big deal of them.  Being one of seven kids, I've already received texts by four of my siblings and some nieces and nephews to "have a great day."  The phone calls will follow tonight, with multiple renditions (mostly bad) of the song "Happy Birthday" sung to the answering machine or myself.  When my mother was alive, she and Dad would always call and sing "Happy Birthday" in harmony from their two different receivers, Mom carrying the high notes and Dad trying to blend his deep, husky off-tune baritone to compliment her.  Since she passed on, Dad still keeps this tradition alive.  It is bittersweet, to say the least, to have Dad call and sing a solo "Happy Birthday" to me.  A big sigh typically follows, and longings for my mother's missed presence follow that.  The beauty in this, though, is that over the two years prior to Mom's lost battle to leukemia, we recorded every "Happy Birthday" sung by them to my family.

My kids and wife, though, are the real reason the excitement level in our house today is immense.  For the past week, there has been whispering between she and my kids that suddenly stops when I enter a room.  There has been hushed huddling in front of the desktop computer, a flurry of hands blocking the screen's view when I walk into the office.  There have been shopping trips to the mall, the kids returning with big grins on their faces and filled shopping bags held behind their backs.  "Don't look, Dad!"  has become the newest greeting in our house.  Tonight I will eat my favorite cake, chocolate from scratch (which includes a cup of coffee) topped with mounds of creamy peanut frosting, made lovingly by my wife from Mom's recipe.

So today, then, is the day.  My 44th birthday.  I was woken up with hugs, warm and heartfelt and accompanied by morning breath.  And chimes of "Happy Birthday, Dad!"  There is no better sweetness in this world than hearing these fluent, tender words from your children's innocent mouths.  Birthday wishes from my wife, too.  A flurry of activity followed as they got ready for school.  A grab of my hand by my youngest, who lead me to the dining room table to proudly show me the presents that await my opening.  Their homemade cards and homemade gift wrap make my smile double.

Then, too suddenly, the buses came to take my kids to school.  My wife left in the SUV to work her school-related job.  And, just like that, all of the excitement contained within our four walls just minutes earlier dissipated, a big balloon of happiness and anticipation popped... to be filled up again upon their return.  I go to sit alone in my office.

I have the morning and afternoon off, but work an odd evening into morning shift tonight.  So I sit here in my silent home, giving up the hope that cranked techno music from Robyn on YouTube will bring back all of that excitement.  It didn't.  Instead, a life lesson smacks me in the ass.  Hard.

My birthday and this swirling excitement that comes with it is not just because of the day.  Or the cake.  Or the presents.  It is because, simply, on this day, I am reminded of just how blessed I am to be surrounded by so many people in my life who love and care for me.  The simple texts, the emails, the phone calls, the snail mail birthday cards--all warm hands coming from near and far to wrap themselves around me on this day.  There are no better birthday gifts...

Sitting here, introspective and reflective of my life so far, I find that I am beyond grateful.  Grateful for it all.  The family.  The siblings and parents.  The nieces and nephews.  The cousins.  The friends.  I am a lucky guy.

After all of this, I looked at a brown envelope sitting on my desk, sent to me by one of my best friends through medical school--KT.  To know KT in this life, to have her friendship, is one of those precious gifts I sometimes take for granted.  She is, after my wife and Mom and sisters, one of the most remarkable women that I will ever know.  Her kindred spirit and friendship is unmatched.  And besides, how many other family physicians do you know still make social calls to their patients' homes?

What follows is a cursive note she sent (along with a beautiful book and two birthday cards).

Dear Jim,

     My friend, my brother...how does it feel to you to be celebrating a life so full?  I am acutely aware of the significance this year of similar double digits!
     At 11, I was hiding in the woods with my friends, telling secrets, crushing on Bobby Joe across the street (be still my heart!)  I was a child in a giant's body!
     At 22, I owned the world...I was a college graduate and I was going to medical school!  I was sizzling!  Life was mine to take!
     At 33, I was a mother, in love with my girl, struggling to mesh my original dreams of being a doctor with my dream, unexpectantly better, of motherhood.  I couldn't get enough of my daughter if I ate her!  She was and still is a force in my world!  What a ride I got, eh?
     At 44, I know contentment, really and truly.  But I also know worry...  My life and love has blossomed as my family came to be--a daughter, a son, a dog, and oh yeah, a husband.  I know I am not invisible--my achy hips let me know that every day!  But I am more alive now than ever before.  I have loved, lost, given and gained...
     What will the next half bring?  55?  66?  77? 88? And, oh yeah, I plan on doing 99.  You too?
     So, my brother in this walk...I wonder what you would say about 11, 22, 33, 44?  I think I can guess a few of the emotions.  We have been blessed in love and in friendship, haven't we?

Big hug, Jim!  Have an awesome birthday!  KT

How's that for a birthday gift?

May everyone have a birthday like mine today, where they are reminded of the beauty of the people in their lives.

Now, where are my presents???

As always, big thanks for reading.  May KT see the beauty and specialness in her writing voice here today.  To my family and friends, especially my wife and kids, thanks for making this a special day...I am smiling here.

Future Hopes

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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.

Sick-kid Season

I love kids. Always have and always will. And when it comes to sick kids, I feel fortunate to have been trained in a demanding EM residency program where the pediatric emergency department was directly attached to the main trauma center. As a result of such exposure, treating ill kids became as natural to me as treating ill adults. Those little buggers, with their fevers, snotty noses, abdominal pain, and piercing shrills, don't scare me. Some get an "A" for effort, though, pulling out all of the stops in their vain attempt to get me out of their room. Regardless, because of my comfort, I try to see the really sick kids that come through our doors during my shift.

Over the holidays, with the flu season in full swing, I treated many children who were swept up in the epidemic. Some parents simply needed reassurances that they were giving their little Johnnie and Susie all the proper care, while other parents, with their heavy concerns, were right to bring their children in for a workup, including some IV hydration and anti-emetic medication. All-in-all, there was a much heavier flow of pediatrics than what we typically see.

Walking into Room 22, then, thanks to an alert by the nurse, I knew I was about to face another sick child. "This one is 'punky', Doc," she had said, "he hardly flinched when I started his IV." Never a good sign.

I quietly pulled back the curtain to the room and entered, finding a fatigued two-year-old boy sprawled on his back on the medical cot with his cotton sheet kicked into a ball at his feet. His oversized hospital gown had one loose tie in front, opened to reveal his skinny frame. His blond bangs were sweaty, matted to his forehead, and his skin was pale. Before introducing myself to his parents, I walked up to him and felt his forehead with the back of my hand. He was "burning up," as we say and, more importantly, didn't even shrug to a stranger's touch.

I shifted my focus to his parents, walking up to the young mother sitting in a chair alongside her son's cot. She looked as wiped-out as her son, the livelihood of her existence threatened by her son's illness. She was tearful, a mother's angst clearly etched into her face. I took her right hand in the both of mine, squeezing it reassuringly. "We'll get him feeling, better," I said, nodding to her sleeping son as I spoke. She dabbed her eyes with a Kleenex and gave me a feeble smile.

Next, I walked up to the father, his disheveled baseball cap barely clinging to his head as he paced three steps back and forth in a tight corner of the room. We shook hands and I held his gaze for a few extra seconds, trying to silently reassure his concerns. He, like the mother, was young, worried, and quite upset over his son's circumstances. He looked me in the eyes and took a deep breath. "Can you really make him better, Doctor?" he asked, a glimmer of hope escaping his watchful eyes.

"Let me talk to you both, do a thorough exam of your son, and order some tests and treatment for him, okay? But yes, I do think we'll get your son to feel better by the time we are done treating him." Their son looked like several other patients we had recently treated for influenza.

Between the two of them, I learned that they were first-time parents and married. Although neither of them were ill, their son went to daycare two days a week, where they thought "a bug" was going around. He had been born full-term and was up-to-date on his immunizations. This was his first major illness, barring a few past ear infections. Over the past few days, they watched their son eat and drink less, urinate less, become less active, and start a fever that they couldn't control. Eventually, all of their son's symptoms worsened and became boggled in their minds, totally confusing them (like any first-time parents) as to what symptoms were most serious and needed addressed immediately.

That's where we came in.

After a thorough exam on this patient, I had no suspicions for focal illnesses (such as pneumonia, bronchitis, or strep throat) on this patient. His temperature was quite high (103.7) and he appeared clinically dehydrated, so we treated him with a Tylenol suppository, aggressive IV hydration, and some IV Zofran, a God-sent anti-emetic that helps control nausea and vomiting. Then we sat back and waited--one, to see how the child would respond to our interventions and two, to review the results of our blood and urine tests as they returned.

Within the hour, I was walking into my work station with another patient chart only to find Dad standing at the counter, waiting to talk to me. He was smiling.

"He's doing better already?" I asked. "Come take a look," Dad said, practically grabbing my hand and pulling me towards his son's room.

We got back to his son's room and, before opening the curtain, the father stepped aside, sweeping his arms as if welcoming me to step into his home.

Pushing aside the curtain, I was extremely happy to find their son sitting upright in bed, licking an Italian ice while watching a cartoon on the TV. He looked at me with apprehension, turned to his mother who gave him a reassuring wink, before turning his attention back toward the TV, continuing to lick his popsicle. He was a new kid.

The mother jumped from her chair, then, and rushed me, giving me a big, grateful hug. "I can't believe how good he looks," she said, muffling her words into my shoulder. "Yes," I said, happily agreeing with her, "he looks great!" She left my side and went back to her cot-side chair, sitting clumsily down before wrapping her hands back around her son's torso. Her face held the most genuine expression of thankfulness and love that could ever be.

Within the next hour, as the patient's labs returned with adequate results, the nurse and I took turns going into the room to educate the parents and answer their questions.

How frequently are they supposed to use Tylenol and ibuprofen?
What doses of Tylenol and ibuprofen are they supposed to use?
How should they use the Zofran prescription we'd be sending them home with?
What type of fluids should they give their son?
What foods would be okay to reintroduce back into his diet?
How much sleep should they let their son get?

It's easy to see how confusing it can get the first time your child has a serious illness. Their questions for us were endless and repeated several times, but we, in the medical field, all know that education and knowledge is most empowering to recover from an illness. Our patience in the parent's education is paramount. Besides making sure each of their questions were answered, we also wrote down their instructions for them to take home.

By the time we were ready to discharge this patient, he was a new kid, running around his room, drinking watered-down juice, coloring the staff pictures, and covering himself in the stickers we gave him.

To us, another successful but predicted response to our interventions with a child with the flu. To the parents, though, this was nothing short of a miracle. The clouds had parted, the rays of sunshine had dispersed before refocusing on the head of their sick child, and the gods had sung. Anyone who has had a sick child recover knows these feelings of exhilaration that follow the many pangs of doubts that haunt us during our child's illness.

I've been there...have you?

The nurse and I stood together at the counter and watched this young family walk out of our ER after being discharged. Three big smiles, plus two more if you count ours.

It was another good day in the ER...

As always, big thanks for reading. I appreciate the nominations and support for the 2010 Medgadget awards for best medical weblogs...thank you, thank you. I hope this finds you well...

Double Crack

There are occasions, in the midst of examining a patient, when I am caught off guard by some meaningless observation or physical finding.

For example, I never would have guessed that an 80 year-old grandmother named Bertha would have a tramp stamp. But, a few weeks ago, there it was, a four-leaf clover tattooed right on the small of grandma's back. It distracted me from appreciating her diamond-studded nose-ring, I'll tell you. A few days later, I treated a very pretty college student who made me wince when she shook my introduction hand within her own man-hand. And, on the same shift, I treated a college guy who didn't have one hair on his entire body, thanks to an overactive Gillette razor. Not one. Heck, even the 50 year-old conservative business man surprised me with his bilateral nipple piercings (I am thinking "ouch" even as I type that). Impressive what a double-breasted suit can hide.

These physical findings rarely play any part in treating a patient or making a diagnosis. They are simply observations that happen to be noticed during the course of a thorough physical exam. Nothing judgemental. No prejudices. Just an aspect of a patient's physicality that jumps out at you when you aren't expecting it. To each their own, I say. Whatever makes you happy and isn't harming the next fellow human being.

I think anyone who does a patient exam can relate to these surprises, though. If nothing else, these findings keep me on my toes. If truth be told, I like these unexpected discoveries--these little secret gems that a patient would probably not commonly share with his fellow man. Seriously.

Picture it. "Um, yeah, Darryl," I imagine a patient confessing at a tavern, an empty pitcher of Guinness sitting between him and his good friend, "I need to tell you something. I have seven toes on my right foot. And, I have your wife's initials trimmed in my chest hairs." Yeah...I don't think so. Lucky me, though--I get to discover those initials when I auscultate this patient's heart.

The other day, I was privy to one of my more favorite observations. Like a rare bird, the sighting of one of these is few and far between. In fact, I can count on two hands how many times I've seen this characteristic in my career. It was very exciting.

I can just picture you now, sitting on the edge of your seat, saying to yourself, "What is it? What did he see?"

Okay. I'll spill. It was the famous (drum roll, please)... "double crack."

Walking into Room 31, I had no reason to suspect that I would, in a few short minutes, be giddy over seeing another double crack. It had been a few years, easy, since my last sighting. And, to be honest, this patient did not fit my usual perception as to who would possess the double crack.

I introduced myself to this patient. A very nice person who had been suffering with some dizzy spells and a chronic cough. Nothing major, but just enough of an annoyance that, after a few weeks, he wanted to be "checked out." After a satisfactory interview, we moved on to the physical exam. Vitals were reviewed. An HEENT exam was normal. Throat and neck, good. The heart, steady and strong with a regular rhythm and no murmurs appreciated.

And then...the spotting of the double crack.

After listening to the patient's heart, I had the patient, who was in a gown, sit up in his cot, leaning forward so that I could auscultate his lungs from a posterior approach.

I had my stethoscope in my ears, listening as I had the patient take several deep breaths in and out, when I casually glanced down along the patient's mid and lower back. And there it was, the double crack, staring back at me, waiting for me to discover it's existence.

To explain the double crack, I am taken back to the first time I had to explain to my giggling kids, at a local zoo, why the baboons' bottoms were bright red. You know that color--the inflamed, captivating shade of a deep, rich sunset. "It's just part of being a baboon," I told them. No other explanation, really, was needed. The baboons' bottoms were what they were. And, as I told my kids, I don't even know if the baboon knew his own bottom makes a bright-red firetruck look dull.

Note to self--don't forget to do a google search on the baboon's red ass.

But, just like the baboon's ass, it is very hard for me to take my eyes from the double crack. And to explain why it exists? I can't. It just does.

So, as I tracked along this patient's vertebrae with my eyes, I spotted his double crack in the lumbar region. Whether it was the way this patient's skin folded, or the way the patient sat, or the way his supporting muscles ran longitudinally along his spinal column, or just where his body decided to deposit some extra fat, I really couldn't tell you. But, when I had this patient sit up in his cot, the sides of his lower back tissue folded up to meet at the mid line, creating a perfect replica of an ass crack.

I kid you not.

Starting around the upper lumbar area, the deep fold ran the length of the lower back, ending just before the tailbone region. There, a gap of about two inches of regular anatomy existed, giving good pause between the impostor crack and the beginnings of the patient's real buttock's crack. Yep, the real crack poked out of this patient's droopy underwear, challenging the impostor crack to a face-off. I couldn't have picked the better crack. Deeply creased and pressed together, that impostor crack looked like the real thing. Perfection, almost.

Thus, the double crack.

I had the patient take a few extra breaths, relishing my sighting while I made sure the patient had good air movement within his lungs.

Like the baboon and his fiery red ass, I don't think this patient knew what he was in possession of. Maybe a good thing, really. I sure wasn't going to tell him.

Could I even bill for that diagnosis? Any coders out there? Acute double crackitis. Code 191.22.3?

I came home that night and looked at my lower back in the mirror. I sat down. I stood up. I rotated. I side-bended. Nope, no double crack on me. I even made my wife look, but she couldn't spot one, either. Darn it. I secretly wanted my own double crack.

"Sorry, Jim," she said, laughing, "you'll just have to suffer through life with one crack."

I guess I'll just have to make myself an appointment to get a tramp stamp.

As always, big thanks for reading (and in this case, tolerating my silly, indecent humor). The well ran dry from a busy weekend, so I took Monday off. Thanks for understanding. See you Friday...

Yin & Yang Weekend

I just got home from an incredibly hectic shift. Arriving at 6:00 a.m., there were eight people waiting to be treated from the overnight, several waiting for over three hours. When I left at 2:30 p.m., there were, again, eight people waiting to be seen, the wait still over two hours. Not the same people, of course. But still, the feeling of accomplishment was a little lacking.

Chalk it up to the yin and yang of the ER.

This weekend holds more of the same. Much to be happy about, with a touch of sadness mixed in. The yin and yang of my life.

I'm off from work the next four days. As I type, perfect weather hovers outside my office window, an unexpected embrace of warm sunshine befriended by a slight breeze and an endless blue sky. A long-lost hug that will linger for four days, if the weather-lady is right. Just in time to welcome Easter weekend, one of my favorite holidays. Peanut butter eggs, marshmallow chicks, fruit-flavored jellybeans, big chunks of chocolate--by noon Sunday, if my family isn't on a sugar high, then shame on us. If you see my family in church, I will be the one with peanut butter breath. My wife? She'll be the one with fluorescent pink, yellow, and blue sprinkles, remnants from the marshmallow chicks, clinging to her chin.

What makes this a most happy weekend, though, would be that it's...(drum roll, please) my birthday. Yep. Easter Sunday will be my 43rd birthday. I'm surprised, really, that I am entering my mid-40s. I remember very well when 40 seemed ancient to me, and I've surpassed that. Although my mind, spirit, and body are, for the most part, preserved, I sometimes look in the mirror and wonder who the person looking back is. According to my wife, it's my father's son.

Honestly, though, I couldn't really care that it's my birthday, except for the excitement it brings to our home, to my family. For the past week, I've caught my kids and wife whispering to one another, multiple times, only to stop as I approach. "Hmmm," I'd ask, faking bamboozlement, "what are you guys talking about?" My kids, especially my youngest, can't lie to save themselves, and yet they are able to play along remarkably with this.

Our family's birthday tradition? Started by my mother and successfully passed on, I, Mr. Birthday Boy, get to pick out dinner, which this year will be perogies and fresh sausage from the local Polish market. God Bless the Polish. And my birthday cake? Like every year past, Mom's Famous Chocolate Cake, made from scratch (including one cup of brewed coffee), topped with creamy, whipped, melt-in-your-mouth peanut butter frosting.

Doesn't life sound good? And taste good? Believe me, it is all good. Especially the cake.

So for all of my yang, what is the yin? The most simple way to explain it, I guess, is with two words--Mom's cake. Now baked by "my girls," my wife and daughters, and not by Mom.

Four years ago, on April 6th, Mom died. Two days after my 39th birthday.

My memories of Mom are almost all good, barring the last few weeks of her life, when AML ravaged her beaten body. I remember my 39th birthday very well, the feelings of helplessness that day. Trying to smile on the outside while the inside was desperate to change fate. The yin and yang of my young kids trying to celebrate my birthday while Mom lay ill in her own bed, breathing her last few breaths. After years of Mom breathing her beautiful spirit into us seven kids, it was her time to exhale her last breath. And time for us to breathe her spirit into our own families, without her.

After four years, it's easier to celebrate again. Time is the great healer. Thanks to my thoughtful sister, Rosie, who photocopied each of us a copy of Mom's hand-written and manually-typed recipes (refined tips included), chocolate cake with peanut butter frosting is not the only recipe of Mom's that my family enjoys. You should taste her Apple Jewish Coffee Cake. Laminated and bound, these recipes are truly gifts that keep on giving.

This is not depression, trust me. Simply, the memories and reflections of my mother's life are quite strong during this time of year, walking hand-in-hand with the introspection of my own life. As human beings, we have the privilege to experience some of life's lows, embrace them, grow stronger and wiser from them, and use these experiences to better ourselves. An ever evolving task. From this rubble, an appreciation of life's finer moments is gained.

Do any of you know where I am coming from? Any stories to share?

A memorable holiday weekend, filled with fun and laughter, good food, and celebrations of our religious beliefs, awaits my family. I know that. And I look forward to it. Plus, don't forget about the birthday presents I'll need to unwrap! I'm easy that way--give me a good book and a great musical CD, and I'm happy. At points, though, I know my mind will wander to thoughts of my mother.

It will be okay.

After all, I know where all this sunshine came from.

As always, big thanks for reading. A Happy Easter to all of you who celebrate this holiday. Enjoy your weekend. See you next week...

Popsicles & Pudding

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

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

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

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

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

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

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

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

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

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

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

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

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

They showed me their shy smiles before continuing on.

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

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

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

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

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

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

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

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

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

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

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

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

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

Hackles Up

The city in which I work is probably, I would say, medium-sized. We have our own collection of restaurants, cultural events, sporting arenas with minor-league teams, several hospitals, and four major colleges.

You would think that our city would be large enough to not run into patients whom I have treated in the ER, but this is simply not true. There are way too many places to be recognized.

"Hey, doc," they'll say to me in a Walmart line, "do you remember me? You treated my hemorrhoid in 2003?"

Oh, that's right. Of course I remember you now. NOT! And please, sir, whatever you do, don't show me your buttocks to refresh my memory.

I do seem to have a good memory for people's faces, though, and even a better memory of their illness (as long as it's more recent than 2003!). I am much more likely to remember your heart attack, the cauliflower growth on your ear, your thickened, fungal toenail that grew overnight, or the way you cried when our most-skilled nurse put in your IV (along side your ten inch forearm tattoo!) than remember your name.

And, for the most part, if I am not pressed for time, I do enjoy seeing some of these former patients. They are usually gracious and complimentary--who wouldn't enjoy that? We don't get a chance to follow-up with ER patients like an office-setting practice does, so I appreciate hearing about how they are doing and what worked in successfully treating their illness.

There are, however, a few circumstances where I would rather not be approached.

For one, the gym. I appreciate my gym-time immensely and rely on my workouts to keep me centered. Since I have treated multiple patients who frequent my gym, I usually wear a baseball cap pulled practically down to my upper lip to remain incognito. The only problem with that, besides bumping often into the weights, is I'm not quite sure if people are looking at me because I look familiar to them or because I look like the ultimate dork.

My other issue about the gym is this: if you see me standing naked (pre or post-shower) in the locker room, please let me finish what I am doing (translation--let me get some underwear on!) before you approach and share with me. Especially if I'm bent over drying my toes! I'm not shy, really, but rarely can someone give me a good hemorrhoid or constipation story in less than ten minutes. If it is a heart attack or stroke story, I know I'm committed for a good 20-30 minutes. Let me tell you, I can grow a whole crop of goose bumps like you've never seen in that time!

So, obviously, the gym is out.

My only other issue is that I do not want former patients to share if my kids are with me.

A few years back, I was on a date with my three young kids. Just me and my kids. We had ourselves a nice meal at The Olive Garden and then went to the movies. On our way home, we stopped at the local Target to buy fingernail polish (for Daddy's famous manicures) for the girls.

A woman who works in the pharmacy section of the store is a former patient. In fact, not only have I treated her multiple times, but I have also treated her troubled, teenage children several times. The last time I had seen her was at her daughter's bedside. Unfortunately, her daughter had to be transferred to a psychiatric hospital for further care.

Now, I have never had any bad interactions with this woman or her children and, in fact, I remember having gone out of my way to show them extra kindness because of their many problems. However, as a result, this woman has tailed me through the store on several prior occasions, giving me updates, sometimes graphic, of their follow-ups. I remember being quite uncomfortable, at times, through these conversations.

On this particular day, as the kids and I were holding hands and happily walking through the store, I was hopeful that I wouldn't run into this woman.

Wrong. She spotted us almost instantly.

She came running up to us from behind, startling my kids and myself. I said hello to her and gave her a warm smile. My kids, inherently shy with strangers, crowded for space behind my back. I skipped their introduction.

"I know you'd want to know about my daughter," she started, speaking quite loudly.

"I sure would," I said quietly, kindly, "but maybe another time when I'm not with my kids, okay? We're on a date and just ran in to pick out some fingernail polish. I sure hope she's okay, though."

"Oh, sure, she's okay...now," she answered, gruffly. She didn't stop there, though. She started to tell me, in embarrassingly explicit language and detail, how her daughter had acted-out and had gotten into more recent trouble.

As she spoke, I could feel my protective hackles coming on. My kids cowered into the back of my legs, gripping my pant-legs and tugging me into them.

I interrupted her. "Maam," I repeated, now emphatically , "I am on a date with my kids and, frankly, don't feel comfortable with how you are talking in front of them. They don't need to hear of your daughter's problems."

"Well," this woman said, somewhat affronted, "they need to learn about this stuff sometime." Learn what? I thought. About your daughter's acting-out? Or, from you, how to use a swear word? Either way, I don't think so.

"No, maam," I answered, struggling to keep my cool and smile, "you're wrong. My kids don't need to learn about your family problems. And they don't need to hear such explicit language, from you or anyone. I would never condone this type of language in front of them."

The woman huffed and seemed slighted, but I didn't care. "I wish your family well," I said with sincerity, "but I'd appreciate it if you let us keep moving here. Have a good day." Without waiting for a reply, I eased my hands into my children's backs and guided them onward, toward the make-up aisle.

Although I've seen this woman several more times in Target since that interaction, I have not seen her or her children in the ER since. She does not approach me anymore, either, although several times I have nodded a "hello" to her. I do hope her family is well.

I often wonder if I handled this interaction appropriately but, at the end of the day, I need to protect my kids in the way I deem necessary. They don't deserve the intrusiveness of my job. And they certainly don't need to learn their swear words from Daddy's former ER patients.

Would any of you handled this interaction differently?

There is a silver lining in all of this, though. At least I wasn't standing naked in a locker room when this conversation happened!

As always, big thanks for reading. Next post will be March 3. See you then...

The First Time

Many of us in medicine are fortunate to treat and guide a patient through "the first time" they have a medical emergency or newly diagnosed illness. Of course, sometimes we are skeptical about that "first time" line, but more often than not my experiences have lead me to believe that the patient is telling the truth. At least in his own mind.

"I've never had a drink before tonight." (Say that with a slur, by the way.)
"Honestly, doctor, I thought the pills were Tylenol. I've never used Vicodin before."
"What? I don't know how that cucumber got up my ass! This is a first for me!
"I can't remember ever having burning like this."

You get the picture. So when a nurse ran up to me with an EKG that showed some serious abnormalities, I quickly followed her to the patient.

Surprise! I walked into a room that contained an anxious but very polished thirty-something female. She was dressed to-the-hilt in designer clothes, her make-up refined and her hair perfectly coiffed and colored. She couldn't be the owner of this EKG!

I looked at the nurse with a questioning face and she nodded her assurance to me.

I turned to the patient and introduced myself. "Maam," I said, "what brought you to our ER tonight?"

"I...am having...a hard time breathing," the patient spoke, clutching her chest, "and my heart feels funny." I could smell the hint of alcohol when she talked, her sophistication taking a few steps back.

"Do you have any palpitations with your difficulty breathing?" I asked. She nodded yes. "Any previous heart or breathing problems?" This time, a no nod. "Any recent cough or cold symptoms?" No. "Any trauma, leg or calf pain?" Another no.

"Doctor," she said, gasping for air between her words, "I have to be honest. I tried cocaine for the first time tonight and this started right after. Does this happen to everyone?"

I should have known. This was a woman who didn't smoke, didn't have any family history of heart disease, and had no past medical history of hypertension, high cholesterol, or diabetes. No serious cardiac risk factors. In other words, healthy. Except, and this is a HUGE except, she chose to use crack cocaine. Disappointing, for sure. I could only hope that she was being honest with me, because if she was a regular user and not a first-timer, her heart could have already had significant damage before presenting tonight.

"Am I going to be alright, Doctor?"

"Maam," I said, pulling out her EKG to review it with her. "I think you should know that your EKG is showing some serious findings. It looks like your heart is straining to the point where you are having a heart attack."

"Me? A heart attack? No!" She looked at me incredulously. "Are you being serious? I'm only thirty-two." I nodded my head up and down. "Yes, I am being serious, unfortunately." There was no sugar-coating this.

The patient looked at her friend sitting in the corner who, up until now, had been very inconspicuous. "Laura, you better call Larry and tell him to get here right away. And don't tell him a thing. Just tell him I'll explain everything when he gets here." Laura stood up and wiped her nose with a tissue before giving the patient a hug. She walked out of the room with her cell-phone. I hoped we wouldn't be seeing her for treatment in a bit, too.

"Is Larry your husband?" I asked when we were alone. "Yes, he is," the patient said, "and I don't want him to know I used cocaine, okay?" I assured her that wouldn't be a problem. Well, not my problem, anyway. She could tell him as much or as little as she chose. I just had a gut feeling, though, that by this end of this day, Larry would be pissed at his wife.

"But I still don't know how this could have happened," she said. I explained to her how cocaine causes vasoconstriction, or simply spasming and tightening down, of the arteries that supply oxygenated blood to the heart muscle. If the heart muscle does not get enough oxygenated blood, then, damage can occur. If the patient is a first-time user, as this woman claimed, it's not unusual to get symptoms within three hours of use. If a patient has abused cocaine indefinitely, silent heart damage may have already occurred. In which case, she could be in very serious danger.

I explained to her what was going to happen next. "We are going to give you some aspirin and some valium, but we need to avoid a few other medications that we would normally use to treat chest pain." Cocaine changed those rules. "Also," I continued, "I want you to know that a cardiologist has been called and is going to be here shortly, to take you to the cath lab."

She just shook her head and trembled. "I know," I said, holding her hand, "it's hard to believe that cocaine can do all this."

She started crying as the nurse began pushing medications into her IV. Her vitals, thankfully, remained stable.

"I have three small kids at home," she said, shaking her head. "What was I possibly thinking?"

I could only imagine what her life would be like after we got her through this crisis. If she survived this crisis, that is. Her family would face some serious consequences for her decision-making.

I explained to her that it was very important we know if she had used cocaine in her past or, as she said, this was truly a first time for her.

"Yes," she assured me, "it was my first time. I mean, look at me. Do I look like someone who used cocaine before?"

I bit my tongue on her question. In reality, yes. She did look like someone who may have used cocaine before. Cocaine has no "look," really. Well, not clothes-wise or status-wise. But it does have a look of desperation when things go wrong, and this patient sure had that "look" now.

We got this patient to the cath lab. Luckily, she had no significant blockages and, more importantly, the medications we had given her in the ER had begun reversing the vasoconstriction before permanent damage occurred. She was going to be alright.

After his wife's successful catheterization, Larry, her husband, came down to the ER carrying a large cookie tray to thank our staff. Yes, he matched his wife's look--a pressed shirt and tie, penny-loafers, and wavy undisturbed hair. With a hint of alcohol on his breath. "I just don't understand how this could happen, though. She's too young and healthy to have had a heart attack."

I just nodded at his words, the silence floating between us like a concrete barrier. I was bound by patient confidentiality from sharing with Larry the truth of his wife's situation and, besides, it wasn't my place to tell him of her cocaine use. Instead, I diverted him and asked about the weather outside.

We shook hands and I told him to share our best wishes with his wife during her recovery. As he walked away from me, I couldn't help but think of their marriage and their three kids. Silently, I prayed that things would turn out okay for this young family.

Another "first" patient, she turned out to be. I thought back to her words. "Doctor, I have to be honest. I tried cocaine for the first time tonight and this started right after." Was it really her first time using? I hoped so, but I've been fooled before.

I can only hope, though, for her sake that this "first" will be her last.

As always, I thank you for reading. The next post will be Wednesday, February 10th. Until then, I hope you have a good start to the week. If you didn't vote yet, please do! This is the final week. I appreciate your support.

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No Love For A Father

The nurse hung up the phone, shaking her head.

"I can't believe the nerve of some people," she said, clearly aggravated by the phone call. The phone call, she explained, was from a gentleman inquiring about where he should check-in when he brings his father to our ER in a few weeks.

"In a few weeks?" the nurse asked, making sure she heard right. She did.

The gentleman explained that they were moving their father from the West Coast back to our side of the country, to be closer to family, after the father's third wife recently died. The caller had heard that it would be a much quicker process for their father to get into an assisted-living facility if he came through the ER.

"Honestly, sir, that is not a reasonable expectation, unless your father is ill and needing treatment. We are an Emergency Department," she said, enunciating Emergency, "not a place to bring your healthy father for placement."

Her words fell on deaf ears. Around 1 a.m., almost two weeks to the day of that phone call, another one of our nurses walked into the nurses' station, looking incredulous.

"Get this," she said, "this family in Room 22 brought their father directly from the airport to our Emergency Room to have him placed in an assisted-living facility. And," she continued, "they're pissed that they had to wait three hours to get called back from the waiting room."

It was a busy night but, eventually, I was able to make my way to their room. Their story was somewhat familiar with me, but I wanted to learn more.

"Hello, folks," I said, introducing myself to the patient and his family, consisting of two sons and a daughter. All local folks. All dressed in sophisticated clothes and very well-kept. I tried not to be judgmental as I continued. "What brings you to our emergency room tonight?"

"How many times do we need to repeat this?" asked the one son, the obvious spokesman. And obviously obnoxious. "We need you guys to get Dad a place to live here in town."

"At this hour?" I asked, looking at my watch. "It's 2 a.m., I don't think that's going to happen, sir."

"Well," said the son, "we've been waiting since 10 p.m. It's not our fault that it's now 2."

"Even at 10, sir," I said, staring at the spokesman, "I doubt we would have been able to accommodate you." Turning my attention to the patient, I continued. "Sir, are you hurting anywhere? Do you have any injuries or health problems that seem worse to you tonight? Anything that warrants you coming to our ER?"

The patient shook his head no. It was obvious that this was not his planning. I looked back to the son and cocked my eye. He just shrugged his shoulders. After obtaining more history from the patient, I performed a thorough physical. It was stone-cold normal. Clearly, this patient was mentally and physically stable and the family was simply seeking a short-cut to finding a place for their father to live. Heck, he could even live on his own if he wanted to.

"So, just to clarify this," I said, looking at his three grown children, "you picked your father up at the airport and drove him straight to our ER, at this hour, to be placed in a living facility? Am I correct?"

They all nodded. "But all three of you live locally," I continued, "why aren't one of you opening your home to your father until you can get him into a local facility?"

"We were told by several people, including my family doctor," the son spoke, "that this was the easiest way to have Dad placed." Shame on that family doctor, I thought. "And if you can't get him in a place tonight," the son continued, "then just admit Dad until you can get him in somewhere."

It's hard to get a rise out of me, but these people were doing a darn good job. I took a deep breath and tried to clean up my thoughts of these people.

"Well," I said, looking between the patient and his ungrateful children, "unfortunately, your information is wrong. I'll call our case management team down to discuss the available options for your family, but your father has no medical emergency and I won't admit him for the reasons you want. What your father does have, though," I said, "are three children who live locally that could easily provide for him until an assisted-living facility is available."

The family just looked at me. And I stared right back, alternating between them. I wasn't going to blink first.

"Well, then," the spokesman said, "can you call the case manager down to talk to us?"

I walked out of the room, disappointed in this family's dynamics. I'm sure there was more history between this father and his three kids than I was aware of, but still...to pick-up your father from the airport and bring him right to the local ER to dump him off? I would be ashamed of myself. Why even bother bringing him back here to live if this is how it was going to be?

Our case management team came down and, sure enough, were unable to place this patient directly into an assisted-living facility. The soonest they could arrange for his placement was in three days. Three days? People waited months for placement into a facility, and this patient would be there in three days. I guess it was a good shortcut for this family, after all.

"Three days?" said the son, "what kind of system is this? We can't wait that long. Do we have any other options?" No other options, said case management. No other options, said the nurse. No other options, I said.

The patient got dressed while his family grimaced and glared in our hallway. I seriously think they entertained the idea of leaving quickly without their father, but I kept my eye on them. I was ready to chase them down if they tried such a thing. I knew, just from observation, that they weren't above such a thought.

I have three kids of my own, and I shudder to think where a man could have gone wrong to get this kind of treatment from his own children. Did he spoil them? Did he wrong them so significantly that their refusal to take him in was justified? Or were his kids so caught up in their own lives that they had little time left for their father?

Regardless, the patient went to live with the spokesman son for three days. Three long days, per the son. I could only imagine, though, just how long those days would be for a father who felt no love from his family.

As always, thanks for reading. The next post will be Friday, February 5. Until then, if you haven't yet voted, go to Medgadget Medical Weblog Awards and vote for StorytellERdoc in both of his nominated categories. Your support and votes are appreciated! Big thanks!

The MoooooER

Imagine your phone ringing. You scurry around your house, rushing to locate the handset.

You finally find it.

"Hello," you say, winded, "how may I help you?"

There's a pause.

"Hello," you repeat, "is anyone there?"

Suddenly, without warning, you get your answer.

"MMMOOOOOOOO!"

That above scenario, my friends, would be me calling you.

After my first year of residency, my wife had called me at work, quite excited, telling me she had found an amazing house for us to rent during my last two years of training.

Say what? I was surprised and didn't know we were "looking" to move from our very comfortable, two-bedroom condo just ten minutes from my hospital.

"Trust me," she reassured me, "you are going to love it."

And she was right. I did love it. Leave it to my wife to find such a great place.

The new house was about 35 minutes from the hospital, almost all country driving. It was built by Farmer Ed, an old-timer who we grew to love as family, smack in the middle of his cow and corn pastures. Farmer Ed had built this house for his planned retirement in a few years and wanted to rent it out until then. It sat comfortably on the top of a beautiful mountain range, alongside a curvy, country road where neighbors waved as you passed by. The views were endless and the sunsets spectacular. A small, friendly town sat just a few miles away.

It was not uncommon for us to wake at the break of dawn in our new house, cows milling around our bedroom window, talking to us in their language. Many a times I had dreams interrupted by Bessie's moo. Sometimes, even, it felt like Bessie and her gang were having some fun with us, staging their own version of The Sound of Music. Hey, Moo Trapp Family, go back to your hills in Austria and let me sleep!

Ashamed of myself, I must admit that I rolled over a time or two in my dreams to snuggle up to Bessie and her warm, engorged udder. "Moo," I whispered seductively in her ear. "Moo moo," she answered back, blinking her big eyes and batting her long lashes flirtatiously at me.

Okay, I just made that up. Sorry.

Anyway, my wife loves to speed walk and sometimes, on days when I was home, I would go with her. I always struggled to stay alongside her, but the country scenery and surrounding beauty did much to distract me and make the walks more tolerable and even fun.

One day, as we passed a pasture of grazing cows, on a whim, I stopped and inhaled a deep breath. Plugging my nose, from the back of my throat I forced the air out, emitting a low, guttural "moo."

"Hey," my wife said, "that was pretty good."

And you know what? It was good. I knew because the cows had stopped their grazing to look up.

I took another deep breath and mooed again. And another. And yes, another.

The cows started mooing and began walking collectively toward us. I got a little nervous, the barbed-wire fence the only thing separating my wife and me from eighty misled cows. I didn't want a mutiny on our hands. My wife, however, found this all to be quite funny.

With a little practice, I soon had the "moo" down pat. It sounded good. Heck, I'm going to forget about being humble--it was excellent!

I started mooing all the time, I think to the point where family and friends began avoiding me. I mooed on the phone, I mooed at work, I mooed at home, I mooed at parties. That would have been me who, standing alone in the corner with my drink, mooing, you carefully avoided.

I was a hit, however, with the young kids. I would get calls from our family's and friends' children to moo. Over the phone line, I'm told, my moo sounds even better. On hindsight, though, I think their parents just said this to keep me from coming over and doing it in person.

The biggest place where my moo was a hit? Easy answer--our pediatric ER.

Where I trained in residency, we had a Pediatric ER and it was here where I perfected my moo. If a child wasn't critically ill, I would have three strategies to make the visit easier: 1) Hand out stickers, 2) Hand out a popsicle, or 3) Moo. Let's face it, anyone could do strategies one or two, but three? Sorry folks, I owned that one all to myself. And truly, it was a hit. A smile usually appeared by my second moo.

So, I mooed my last two years in residency and brought my moo with me when we moooved here.

The other day, one of our residents brought his devilish, happy, handsome two-year-old son to visit our ER. He was so darn cute already, but I knew a way to make his cute factor fly through the ceiling.

I took a deep breath and plugged my nose.

"MMMOOOOOOOO!"

At first his reaction was usual--a look of bewilderment. By the second moo, however, I had him.

"Moo," I said. "Again," he said. "Moo," I repeated. "Moo-cow," he said, clapping his hands. "Moo," I said one last time. He laughed out loud and flailed his giddy arms and legs.

As I walked away, I felt like, once again, my moo had made me the cat's meow. I was all that!

Unfortunately, three patients were peering out of their rooms, wondering why there was something mooing in the ER hallways.

"It's okay, folks," I said, "go on back in your rooms, please."

At the nurse's station, I overheard one of our newer secretaries on the phone. "Yeah," she said, "some idiot is out in the hallway mooing-can you believe that?"

I almost bent over to moo in her ear from behind, but I restrained myself. Instead, I went to my telephone and called home.

"Hello," my youngest daughter answered, "how may I help you?"

A pause.

"Hello?" she repeated.

I took a deep breath and let it out.

"MMMOOOOOOOO!!!"

"Oh, hi Dad," she said nonchalantly. Then I heard her yell, "Mom, it's for you. It's Dad and he's mooing again."

I could have sworn I heard my wife's faint response. "Tell him I'm not home."


As always, thanks for reading...next post will be Monday, December 14. Have a safe and enjoyable weekend...