A Snapshot Of Sad

A few weeks back, both of my girls had late-afternoon soccer practices and, since my wife was an excellent soccer player in her day, she welcomed the opportunity to go with both of them to their practices. Afterwards, their "girls-only" plans were to continue, including pursuits of some dinner, some ice cream and a little shopping. Of course.

Since Cole had his own soccer practice after school and was off from baseball for the night, this also afforded us the opportunity to have our own bonding time. After talking about it, I gave him the option of picking out a restaurant where he and I could grab a bite before going to a local golf driving range and hitting a bucket of balls.

"Should we go to Hoss's or Bob Evan's, Dad?" he asked, a big smile spreading across his face. In our family, it is a running joke about our kids always picking either Bob Evans or Hoss's to eat. Since I don't eat greasy breakfast food often, Bob Evans is my guaranteed ticket for getting an upset stomach. Worth it, though, since I can never say "no" to their big breakfast meal for dinner. Hoss's, on the other hand, is a buffet that is famous for its unlimited salad bar, which includes its choice of four soups (I'm a soup guy here) and, most importantly, a huge dessert line, complete with their own self-serving soft ice cream machine. Twists included. An obvious plus for any kid, probably.

Cole hmm'd and haa'd for a few minutes before deciding. "Hoss's it is, then," he said, adding, "unless you would rather have Bob Evans, Dad." Nope, I assured him, any decision he made would be a good one.

So off we went to Hoss's. Little did I know, though, that this visit would open up an opportunity to talk to Cole about a serious issue.

After driving the ten minutes, we arrived at Hoss's and parked our car in the lot. We hurried to the entrance, eager to dive into the salads, the soups, and the desserts.

We opened the outside double doors to enter the welcoming foyer of the restaurant, only to be greeted by three young kids creating havoc while arguing over the gumball machines. The youngest, about five or so, was on his knees trying to wedge his hand up into the exit slot of one machine. The middle child was at another machine, fumbling to put some coins in and turn the handle. The oldest child, a girl, probably around Cole's age of ten or eleven, stood in front of the second set of entrance doors, blocking our way. She was waiting to step up to the machine the middle child was at. There were no adults around.

Strikingly, and sadly, all three kids were very obese. Most remarkable, though, was the oldest child, the girl, who was around Cole's age. Easily, she must have weighed over two-hundred pounds. She had light brown hair, straight, cut in a bob, which seemed to accentuate her full cheeks and chin. She wore a fashionable short-sleeve t-shirt with a graphic logo on front. Unfortunately, though, it was several sizes too small, revealing her protruding belly from below. Her arms and legs seemed inflated and over-sized, poking out of her summer clothes. She wore thin flip-flops that did little to support her weight or fallen arches. As I took her in, she continued to block the doorway while trying to tug her middle brother away from the gumball machine so she could access it.

Cole looked up at me as if to ask what to do. I winked at him, willing to patiently wait out the arguing.

After thirty seconds or so, the other door that led to the welcoming foyer, an exit door from the inside cashier, opened up and a very obese woman in a flowing, floral-print dress walked out. She was accompanied by an equally obese elderly woman. I assumed it was the children's mother and grandmother.

The mother yelled at her kids. "Hey, you three," she said with a sharp, grating voice, "move and get out of the way. Can't you see you are blocking the door for these people." She lifted up her arm and waved her finger at her kids, who looked up to finally notice us waiting. "It's quite alright, maam," I assured her, "we are in no hurry." She gave me a brief smile. "I don't know where their manners are these days."

The girl my son's age moved to the right of our entrance door and we were able to continue on our way. I noticed my son smile at the girl as we passed. "Have a nice night," I added to the family.

After sitting down and grabbing our plates of food, I decided to question Cole about what we just saw. "Cole," I said, "what did you think of those kids at the gumball machines?"

"What do you mean, Dad?" he asked, pausing with his spoonful of chicken noodle soup in mid-air. "You mean how crazy they were trying to get the gumballs?"

"Yes," I said, "and..." He interrupted me. "And," he continued, "how big they were?" I winced a little, although I was glad he didn't use the other "f" word.

"Yes, that too." I paused to let him talk. "Well," he said, "I think they were acting crazy because their mother wasn't with them. They straightened right up, though, when she came out." He took his spoonful of soup to his mouth and swallowed it before continuing. "And they probably eat too much candy and soda or else don't exercise enough, I guess. Maybe they watch too much TV or play a lot of video games."

He was probably right. "But Cole, why do you think they eat too much candy? Because they are sad? Or bored? Or just like it?"

"Probably bored and they like it, Dad," he said, "but do people really eat because they are sad?" I assured him that they do, sometimes. "Cole, what if she (now focusing on the girl his age to make it personal) doesn't have a father in her life? Or maybe she has a father that yells at her all the time? Or what if the kids at school are mean to her? Maybe she eats candy to feel better about all of it."

"But where would she get all that candy, Dad, or the money to buy it? Do you think her mom buys it for her?" He was thinking hard now, placing his spoon on the table. Again, he hit on something big, as I thought back again to the mother and grandmother as they walked out of the exit door.

"I'm not sure," I told him, trying to lighten it up, "maybe, though, she saves all her Halloween candy through the year like you do!" We both laughed, thinking back to this past Halloween when Cole set a new house-record, bringing in over seven pounds of candy (yes, now the kids weigh it, not count it, it seems).

"Cole," I added, "do you have any classmates like this girl?" He nodded no, continuing to eat his soup. "But if you did," I continued, "you would be nice to her, right? Give her a smile? Say "hello" as you passed her in the hallway?"

"Of course, Dad," he said, not even pausing, as I remembered him smiling at this girl as we walked through the entrance way, "why wouldn't I?"

And that's where our conversation ended about this topic. My son smiling, and me looking at him with some major pride in my eyes. Although he had noticed the children, he didn't judge them or seem affected by them.

After this experience, I did a little research on childhood obesity. The most surprising thing I learned was that I overestimated the number of children who are obese, by definition, because of medical or genetic reasons. It seems that the majority of childhood obesity cases are due to social causes, a reflection of poor choices from the adult-figures in their lives. Poor exercise habits, poor dietary choices, poor discretion of computer and TV use, and the poor decision to use food as a reward or comfort can add up to some very serious issues for children. Even life-threatening. Sometimes, of course, there are some very worthwhile reasons, medical or otherwise, as to why a child is overweight.

It sure doesn't help, though, to live in a society where extreme thinness and waif-skinniness is embraced more than a healthy lifestyle is.

Which leads me to my point. Let's either start, or continue, to make our kids the number one priority in our lives. They are our legacy. They are our future. They are our treasures. Treat them as such. Eat together at meal time. Cook together. Shop together. Pursue fun physical activities as a family. Go for a walk, a hike, or play Frisbee in the yard. Play kickball. Turn off the computers and TVs and video games. Get involved in school and community functions. Read, especially before bedtime. Talk. Be fully aware of your child's life. Don't make excuses. Don't put them on your back burner. Love them.

And teach acceptance, not judgment. Especially when you don't know another's story.

Love. Peace. Harmony.

It was probably another typical evening in Cole's eyes, dinner and some fun afterwards. For me, though, it was a huge reminder of just how many times through a typical day my kids will be bombarded with "life" happenings.

I can only hope that someday our kids will walk confidently into this big, big world of ours. My bigger hope, though, is that every child out there has an adult in their life who also wishes the same for them.

As always, big thanks for reading. I see much of the above at work in the ER, but seeing it through my son's eyes gave me a new, fresh perspective. See you either Friday or Monday. Until then...

A Love Story

Before today's post, some quick business to take care of...

To my awesome readers, to Medgadget, and to Epocrates...I am truly appreciative and honored to have won the 2009 Medgadget Best Literary Medical Blog Award. Hell, I was tickled to just be nominated and ecstatic to have been chosen as a finalist. But to win? This is a very cool and distinguished award that has been bestowed upon my blog, and I thank all of you. Congratulations to the other finalists, as well. You all rock! I am humbled by the attention.

Big thanks, all, for also supporting my blog as a finalist in the 2009 Medgadget Best New Medical Blog category. The competition was fierce and I feel fortunate to have been included within that fine group of weblogs. Congratulations to the winner, SCOPE! Well done!

A special thanks to several people for my early nominations...Mike from Life In The Fast Lane, Ramona from Suture For A Living, Sunil, and Chrysalis Angel. Continued thanks to my (intelligent, faithful, and funny) readers for always being supportive of my blog, from your personal emails to your insightful comments, from your blogrolls to your tweets. You guys make me feel like I've accomplished something special. Thank you, my friends...

Finally, this Thursday, February 25, 2010, at 9 p.m., I will be a guest on the Dr. Anonymous Show, a live internet "BlogTalkRadio" show produced by a heck of a cool guy, Dr. Mike. This will be a new adventure for me and I look forward to the experience. If you have a chance to tune in, please do. And thank you, Dr. Mike, for the opportunity. I just hope I don't screw up...

The post that follows describes a gifted moment that I was fortunate to witness last week in our ER. I proudly share the story with you...

A Love Story

I noticed the two of them shortly after I arrived for my shift. I was standing at the counter, immersed in a chart, when out of the corner of my eye, I saw them walk out of their treatment room. Together.

Slowly, they walked into the hallway, looking first to their left and then to their right, wondering which way to go. One of them pointed down the hallway, grabbed the other's pale hand, and they began to walk toward their destination.

They were obviously in-sync and comfortable with one another, leaning into one another with each step. They continued to hold each other's hand as they approached me, and my eyes locked onto their steadfast grip. As they neared where I was standing, I smiled at the both of them and was rewarded with a return smile from each, doubling my investment.

"Can I help either of you?" I asked, studying their faces as they gave me their attention. Faces etched with contentment.

"No, thank you." It was said in unison. "We're just heading to the bathroom," added the one.

They passed me at a slow pace, and I continued to watch the caring that was quite evident between the two. It was my privilege, really, to observe and absorb their abounding love and obvious comfort with one another, something I don't see nearly enough in my job.

The bathroom was just thirty or so feet past me and, with no pressing patient concerns, I decided to continue watching. Their entwined hands, which had mesmerized me on their approach, looked even more beautiful and innocent, swinging in unison, as they passed and continued down the hallway, away from me. They were talking, hushed, and I noticed how their conversation was steady. Occasionally, one would steal a glance at the other.

They made it to the bathroom. The one gingerly pushed the door open for the other, helping him into the room before stepping back out into the hallway and shutting the door. Several minutes later, after some brief privacy and a few loving knocks, the door opened and they reunited. Hands were reclasped. Smiles were exchanged. Gingerly, they made their way back down the hallway, towards me and their room. Passing by me again, they both nodded.

We exchanged pleasantries. "Have a nice day" was met with "And the same to you." I wanted to say so much more, but decided to just enjoy this moment.

They passed me and I turned to watch their final few steps. Ginger steps that were unhurried and conscious. Again, hands were swung, bodies were leaned into, and familiarity enveloped their every move. I basked in their uniqueness, their special bond, hopeful that they realized just how blessed they were to have one another.

They arrived at their door and, just like with the bathroom, the older gentleman walked into the room first. Helped by the other, who followed.

How blessed was I to witness this true love story. Between...

An elderly father and his grown son.

As always, thanks for reading. Next post will be Friday, February 26. See you then...

What Do I Know?

One of the hardest parts of being a physician is that people expect you to know everything about everything. And I have to be brutally honest here. That ain't me. But, thanks to a great residency and medical school, I do know my medicine.

Heck, though, I'll be the first to admit that I've never known much about plumbing. Or electrical work. Or car engines. Or how to cut an onion without crying. Or rectal foreign bodies.

Whoa, back up! What did I just say?

Yes, you heard me right. Rectal foreign bodies. As in having something in your behind that shouldn't be there. If you need to squat over a mirror to look, then chances are something is wrong back there. Seriously wrong.

So, imagine my surprise when, in my first year of residency, I discovered that our hospital's ER, being centrally located among several prisons, got it's fair share of rectal foreign bodies.

"Wait a second, people," I wanted to scream out, "I didn't sign up for this part of the job!" As long as I was making a list, I didn't sign up to do internal pelvic exams on eighty year-old ladies with blue hair, either. Unfortunately, though, in the ER you simply don't have a choice. Besides, I was a first-year resident. That's about as low as you go on the medical totem pole. Who would have listened to my concerns?

I remember well my first "something's stuck back there" patient. One of my favorite teaching physicians, Dr. Z., held a chart out for me. "Hey, K.," he said, "there's a patient in Room 12 I'd like you to see." Looking back now, I should have known his snicker was not all that innocent.

I walked into the room to find a regular Joe sitting on his cot, his feet and legs dangling off the side, looking a little uncomfortable.

Hmmm, not a prisoner. So far, so good.

"Hello, sir. I'm Dr. K. What can I do to help you today?"

"Well," the patient stammered, "I had an accident."

"What kind of accident?"

"Well," he started, his eyeballs almost rolling up into his brain to recite his rehearsed story, "I was at the gym and after working out, I got a shower. After I was done, I walked back to my locker wrapped in a towel and as I went to sit down on the bench, the guy next to me put his hairspray bottle down and I sat on it. It was an accident."

I promise you, he did not even crack a smile. It's amazing how distracting ass pain can be, I guess. Even as a first-year resident, I knew a good story when I heard one. The storyteller in me wanted more.

"So," I said, "did the bottle scratch your skin? Leave you with a bruise? What happened to it?" I, in some twisted way, wanted to hear him admit to me that as we were talking, a Clairol hairspray bottle was still missing.

He looked at me incredulously. "Look," he said, "you're new here, right?"

"Actually, yes, I am. Why?"

"Because, I've been...," he blew out an exasperated breath before continuing, "let's just say that this isn't the first time this happened to me." That explains Dr. Z.'s smile. And what gym has multiple hairspray bottle accidents in their men's locker room?

It turns out this guy had several "accidents" in his past that brought him to the ER. And, of course, they didn't really happen at the gym. He was a local celebrity of sorts. It was my privilege to finally meet someone famous, although a few years prior, I had met Cyndi Lauper. That should count, right?

I listened to the patient's heart and lungs with my stethoscope for way too long, hoping against hope that my shift would end before I had to do the rectal exam. No such luck. After feeling his abdomen, it was time "to look back there." I stepped out of the room to bring Dr. Z. in with me. After all, he was my teaching physician for the shift (plus, he dragged me into this case).

Dr. Z. walked in. "So, Joe, I see you met Dr. K., one of our new residents. He treating you okay?"

Great, Dr. Z. and Joe were buddies. "Yeah," Joe said, eyeing me up, "he'll do."

This is where my learning curve took off.

"Okay, Joe," Dr. Z. said, "you know the routine." Dr. Z. had Joe get on all fours on his cot (yes, my mouth was gaping open, too) and, after several layers of gloves, we inspected Joe's backside poking out of his gown. No scratches. No bruises. Then we tried to manually (unfortunately, "manually" meant using my fingers, not Dr. Z.'s) grasp and remove the hair spray bottle. Although I could feel the bottom of the bottle, I was unsuccessful.

I was filled with shame from my failed attempt. I had wanted this story to have an ending where I saved the day, where all the nurses would cheer for me, a measly first-year resident, and my unlimited brilliance as I walked out of Joe's room holding up the Clairol bottle like it was some sort of treasure trophy.

Dr. Z. tried his best to cheer me up. "It's okay, K. Really. This is what residency is for--to learn how to successfully pull a hair spray bottle from a patient's ass. There'll be more." Funny guy, that Dr. Z.

We sent Joe to x-ray. Abdominal films revealed to us that, just as Joe had said, there was a stuck hair spray bottle. Just beyond our reach. I blacked out Joe's name on the x-ray and made myself a copy to frame and hang over our fireplace, but my wife refused. "Don't you even think of taking down our wedding picture!" Sometimes I wish she could be a better sport about this stuff.

Unfortunately for Joe, the bottle would have to be removed in the OR. We tried one last hurrah by using a special rectal speculum and graspers, but no such luck. Yep, Joe was heading to the OR.

While under anesthesia and completely relaxed, the GI team was able to use a scope to retrieve the missing bottle from Joe's backside. I can only hope that they got the round of applause that I had dreamed about.

I often wondered what Joe told his family and friends about his hospital visits. I mean, really, what if one of them wanted to send flowers? What do you write on that card? Please let me know if you have an idea about that--I'm blanking out.

I still don't know much about plumbing or electrical work or peeling an onion without crying. However, I'm proud to say that so many years later, I know all I need to know about rectal foreign bodies.


Thanks for reading...and enjoy your day. The next post will be Wednesday, December 16.

The Half-Load Predicament

My family does a lot of swimming in the summer, both recreational and competitive. And because of the amount of time we spend at the pool, we go through a lot of swimsuits.

This summer, while at a local department store, my wife took the girls and went looking for some extra suits while my son and I searched out swim trunks in the men's department.

While my son was looking at the boy's rack, I thumbed through the available men's options. I passed right by the tiny Speedos rack, since I'm neither European nor obese, and found a rack of board shorts, my favorites.

The designs were current and hip and I just knew I was going to look 20 again at the poolside.

Finding a pair I really liked, I peeked at the tag to confirm the size was the same as what the hanger read.

What I saw next was nothing less than disgusting. And hysterical. I could not believe what I was looking at.

There, inside the swim trunks I had planned on purchasing, was half a load of crap clinging to the inseam!

Obviously, someone had tried these trunks on underwearless, which is gross enough. But to actually leave this mess and put the shorts back? I was incredulous. It either had to be a teenager playing a vile prank or someone who simply failed to hold their wet fart. Either way, I couldn't even imagine what their crack looked like if this is how the shorts turned out.

Since my kids have fantastic senses of humor, I decided to have a little fun. "Hey," I called to my eleven year-old son, "can you come here?"

He came up to me as I stood in front of the trunks. "Yeah, Dad?"

"I really like these trunks but I can't read the size on the tag. Can you?"

"Sure." My son grabbed the clean waistband and pulled it back to read the tag. "Dad, it says thirty...OH MY GOSH!" He had spotted the mess.

He released his grip on the waistband and could barely get his words out. "There's...there's a load of...of...it's brown...OH MY GOSH! GROSS!"

I sometimes wish my humor wasn't so twisted from working in the ER, but there you go. I could hardly keep a straight face.

"Look, Dad, I'm not kidding!" I took a look to appease him. "Well," I said reflectively, fingers on chin, "I don't think that should be there."

"We have to go tell Mom and the girls!" he exclaimed, running away from me before I could stop him.

I followed him to the girls section, where he was already in the middle of the story by the time I arrived. My wife and daughters looked incredulous. In unison, when he finished, they exclaimed "NO WAY!"

My wife and girls looked at me to confirm the story. "Really?" they asked. "Really," I said.

As my son rushed off with the girls to show them this remarkable find, my wife asked me again. "This is for real?"

"Yes," I said again, "no lie. I promise. And it's disgusting."

She caught me off-guard with her next question. "Aren't you going to take them up to the front counter?"

What? I didn't even think of that. I wasn't the one who took a dump in some new board shorts in the dressing room. And, I didn't ask for this to happen. Why should I have to take them up to the front?

"Because," my wife said, "that's the right thing to do. You don't want someone buying them and taking them home, do you?" Ugh, sometimes her reasonable thinking annoyed me. "Besides," she continued, "what if someone throws them in their cart and they have food or, even worse, a toddler playing in the cart. Then what?"

I pictured a little child, blond spiral curls, pulling those board shorts playfully over her head.

Nope, it still wasn't enough for me.

"Listen," I pleaded with my wife, "if I take them to the front counter, they'll think I did it. Who's going to believe that I 'just found them on the rack?' They'll be laughing at me the minute I walk away. Security will probably follow me on hidden cameras the rest of this shopping visit."

I could only imagine. "Hey, Nancy," the security guard would yell to the lady I handed the shorts to, "there's 'the shitter' looking at tennis balls in the sporting section. Why isn't he in the toilet paper aisle?" Then they would burst into fits of laughter, all at my expense.

No, I wasn't handing the swim trunks in. No way, no how.

My wife and I walked over to the men's section to find our kids playfully pushing one another close to the stained shorts.

"Hey, kids," my wife admonished, "be careful! And don't touch them! I don't want you getting someone else's poop on yourself!" Yes, I thought, but it's okay to have your own poop on you? Since she was somewhat annoyed with me, however, I decided not to question her on that point.

She hesitantly stepped towards the shorts and peeled back the waistband. The kids and I held our breath. "Well," she said, cracking a smile at the absurdity, "that sure is something, isn't it?"

Um, yeah, it is something. Something disgusting. Something filthy. Something funny. Something hysterical. Something unexpected. Something unbelievable. Yeah, it was something alright.

"Are you going to take them to the front? Or am I going to have to?" she asked.

I held my ground. "I can't, hon'. Seriously. I just can't do it."

She huffed. "Well, whatever then." I expected her to keep her threat and grab the shorts and take them up to the front herself, but she didn't.

She grabbed the cart handle and pushed it away from the rotten, stinking shorts. "Come on, kids. Let's get out of here and get some cookies." They had earned that much. As long as they washed their hands first.

"Wait," I challenged, "I thought if I didn't take these to the front, you were."

"I changed my mind. Let's go." Good--maybe she was seeing the light of my way.

I walked away from those shorts with a heavy heart. Why I felt so responsible for a load of feces that wasn't mine, I don't know. Darn that deviant culprit for making me feel guilty for his defecation.

On our way out, my eyes searched for anyone close to having a 33w. Or a shuffle to their walk. Or brown-stained pants. No one...

Driving home, I ended up calling in the problem anonymously from my cell phone. Okay, not really. But I do wish I had thought of that at the time. It's just that, for being a level-headed guy, I was a bit flustered.

When we share this story with friends, family, and coworkers (and trust me, we got a lot of mileage out of this one), they seem to be split on what they would have done. Do you know what you would have done?

One of my coworkers, Bill, said it best. "That sure was a shitty predicament."

Yeah, you think?


My next post, an ER story, will be Monday, December 7. I assure you that my kids are very happy and well-adjusted and carry no ill-effects from this shopping trip. Thanks, as always, for reading and have a great weekend.