Extra Cream And Crescent Moons

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Pit Stop

I walked up to the closed door and paused , exhaling a deep breath weighted with disappointment, trying to clear my thoughts for the conversation about to come. My clenched fist was briefly suspended, mid-air, ready to knock. Beyond the door, I could hear muffled conversation and movement.

A calm, pretty woman stood beside me. An emergency department case manager. She held a notebook and pen, ready to jot down any useful information that might be shared with us by the room's occupants.

I turned to the case manager. "Are you ready, Cindy?" I asked, making sure she was prepared for the gravity of this unfortunate situation. She nodded "yes," confident in her skills during such adversity.

I turned back to face the beige, chipped door of the family room and knocked lightly. The noises of conversation and movement suddenly ceased, and I could easily imagine the stillness and anticipation that pervaded the room.

I rotated the door handle, gently pushing the door forward before stepping into the room. The air and energy of the room were stale and suffocating, especially after leaving the hallway atmosphere of chaos. My eyes darted quickly, taking in the whole of the room. On the couch, two elderly people, a man and a woman, sat on either side of a middle-aged woman, their hands linked in unity. The two corner chairs were filled with a middle-aged man in one, a college-aged boy in the other. All five people focused intensely on our arrival, their dilated eyes wary for the news I was about to bring them.

Before sharing my news, I briefly introduced both myself and Cindy and learned that this room contained the patient's wife, his in-laws, his brother, and his son. After shaking hands, I deliberately continued to hold on to the wife's hand while her father rubbed her back.

"It's not good, is it?" the wife asked me. I shook my head "no" to her question before saying the word out loud. "No," I reiterated, "it's not good. Despite all of our attempts, we can't seem to get your husband's heart beating again."

I had left Room 17 for the family room with a dismal feeling. The woman's husband, in his late 50's, had collapsed at work and, despite being intubated, having immediate CPR and being given all the appropriate life-saving medications by our prehospital team, still had not responded to any medical interventions. He had arrived at our facility ten minutes earlier, thirty minutes after his collapse. After several attempts of high-Joule defibrillations and multiple escalating doses of medications, our team remained unsuccessful in our resuscitation attempts. I had left his room with the patient in asystole, a malignant situation where the heart was not making any electrical signals to stimulate itself to beat. It was not looking good.

For the next several minutes, I explained to the family, with earnest, what our medical team was doing in attempts to resuscitate their loved one. After I finished, the wife stood from the couch and dropped to her knees, half in prayer and half in disbelief. "Please, Gary," she wailed in a desperate voice, "don't leave me yet. I want to talk to you one last time."

After helping her back to her feet, I offered her to come to Gary's room with me to be with him during our resuscitation efforts. She accepted.

The patient's wife, Cindy and I walked back to Room 17. As we neared it, I explained the focused commotion she would witness when we walked into the room--three nurses, several techs, a senior resident physician, a pharmacist, a respiratory therapist, and several others all scurrying in their efforts to help her husband, who would be lying on his cot in the middle of all of this activity.

I pulled back the curtain to the room and walked in, surprised to see that CPR was not currently in progress. I introduced Gary's wife to the team and guided her to Gary's side before seeking out my chief resident as to what transpired in the last few minutes. It seemed that right before we had entered the room, Gary 's heart rhythm had switched from asystole to ventricular tachycardia, another life-threatening rhythm. However, this rhythm responded to our team's electrical shock and Gary, still unresponsive, now had a faint pulse accompanied by a normal sinus rhythm. After being down for forty plus minutes, this was nothing short of a miracle. A well-timed miracle corresponding to his wife, on her knees in the family room, pleading with him to hold on.

We encouraged her to talk as much as she wanted to her husband.

And so she did. With tears brimming her reddened eyes, she remained near her husband's left ear, continuously whispering her hushed encouragements and pleas while stroking his hair. Soon after, her son and the patient's brother also were escorted in to be with the patient. Their expressions of disbelief as they walked into the room were heart-breaking.

We called the cardiology team who, after arriving at this patient's bedside in minutes, prepared to take him to the cath lab. Unfortunately, his outlook was tenuous. I was skeptical, after 45 minutes of resuscitation, if Gary would have a positive outcome. Even if he survived, there was no predicting how mentally capable he would be after such a long time in cardiac arrest. If not to survive, why else would he be hanging on?

Suddenly, I thought back to Gary's wife dropping to her knees, begging for a last chance to talk with her husband. I thought of Gary and how, out-of-the-blue, he suddenly regained a faint pulse after multiple failed previous aggressive attempts to jump-start his heart. I looked at his wife, his brother and his son currently holding Gary's hands and whispering their loving words into his ear.

Was this the reason?

I was searching for some sense in this nonsensical situation. Possibly, I realized, I might have been over-analyzing the whole situation, trying to understand how Gary could possibly still be alive. Quite frankly, though, after 45 minutes without a pulse, Gary should not have been successfully resuscitated. Was the whole reason of Gary's lingering due to something beyond our control--the fates cooperating to let his wife and family have several more minutes with him? For proper goodbyes? Or was it because his body really was responding to all of our heroic measures and would heal itself with our modern interventions?

I was eager to know how our efforts would be interpreted by fate. Watching Gary being wheeled down the hallway, from Room 17 to the cardiac cath lab, with his family by his side, I was hopeful that there might be just a sliver of a chance at his full recovery. If not, though, just seeing his family have the opportunity to be with him, to speak to him, to accompany him so he wouldn't be alone during his passage, was enough of an explanation for me.

I got my answer when I returned for my scheduled shift the next day.

Although Gary had still been alive at the end of my previous shift, he never regained consciousness. Per Cindy, he peacefully passed soon after, in the evening, surrounded by his loving family.

He had hung on for all the right reasons...

As always, big thanks for reading. I wish much peace for Gary's family. I also hope this finds you all well. See you again later this week...

The Willing Caregiver

I imagine the world as a vast, boundless frontier weathered by our swirling human emotions and complicated energies--hurricanes of intense heartbreak and tornadoes of joyous, unbridled celebrations, with every weather pattern in between. Sunshine and rain included.

If I could gather this world, foolishly believing that I could sweep my arms and hands through the unsuspecting air to collect a smaller, more-contained version of reality, I know with absolute sureness that what I would be left with is a typical day's worth of experiences in the emergency department. It is a microcosm of something similar to big life.

So many patients, so many illnesses, so many human interactions. So many words of comfort. So many experiences bombarding us daily. And try as we might to protect ourselves, building brick-by-brick our fortress of emotional barriers, ultimately, we cannot help but let some of our patients weave their very own threads into our personal life blankets.

I walked into Room 20 to treat my next patient, a woman in her mid-seventies. Because of a life-long battle with diabetes and its resulting circulatory problems, she was now permanently wheelchair-bound. She sat upright in her cot, in a hospital gown, without any blankets covering her. At the base of her right thigh, poking out from her gown, was a puckered-up cork of skin, where her leg had healed from an above-knee amputation. On her left-side, her leg extended just slightly lower, below knee-level, where, again, the rest of her leg had been amputated secondary to gangrene several years prior.

She was petite and frail. Despite a high fever and feeling ill, she sported a recently washed-and-set hairdo. She also wore some light makeup and dark lipstick, appearing well-cared for. The smell of her room, however, suggested otherwise--it permeated with the familiar stench of a Depend diaper that was overdue to be changed, most likely saturated with stale urine.

In her room's corner, sitting quietly and patiently, was her only child. A son, probably in his late-forties to early-fifties. He appeared fidgety at times, but was very attentive to both myself and his mother. He was, as it turned out, his mother's only living relative.

And her primary caregiver.

"Hello," I said to both of them, extending my hand to shake first the patient's and then her son's. "I understand you're here because you don't feel well, Mrs. Smith. Is that right?"

"Yes," she answered, slightly nodding her head as she spoke in a high-pitched, whispery voice, "I think I probably have a urine infection." She was probably spot-on, since that can be one of the most common causes of illness and fever in an elderly woman. She went on to explain the burning she experienced with recent urinations and her need for wearing Depend diapers because of the resulting incontinence.

"Have you had a urine infection before?" I asked her.

"A few months ago, yes, but otherwise I've been lucky, knock on wood," she answered, lightly knocking her closed fist against her imagined wooden temple. She then went on to explain to me that her right stump had healed beautifully from her recent surgery and had little reason to suspect that this might be the problem.

After reviewing the rest of her history and performing a stable physical exam, I ordered the patient's tests. And sure enough, she had a UTI, just like she suspected. With the help of some Tylenol, we were able to break her fever and by the time her blood results returned stable, she had been cleaned up and was feeling much better, with an IV dose of antibiotic finishing its run into her left arm's receptive vein.

I explained the results to her and her son, who, despite his mother's good response, had remained quietly sitting in the corner. He was edged forward on his seat, however, as if eager to say something.

"Sir," I said, "you look like you have something to say."

"Well," he said, glancing between his mother and myself, "do you think it's my fault that Mom got the urinary infection? I'm still learning how to help care for her."

"Michael," the patient answered quickly, "of course not. These things happen."

I liked her answer, but his question opened a floodgate of mine. "Why would you ask that, Michael?" I asked him, intrigued.

As it turns out, Michael, this patient's successful, independent son, had sold his out-of-town condo, sacrificed a current relationship, and moved back to our region and into his mother's home, all to take care of his mother after her second amputation.

"Do you have a medical background, Michael?" I asked him, amazed at his devotion. He nodded "no" to my question. "Have you ever been a caregiver before?" I continued, fully understanding just how much weight now sat on his shoulders.

The patient chimed in. "I told him to stay put, but he wouldn't hear of it. I feel bad he's halted his life to help me with mine."

"Mom, I wouldn't have it any other way. You talked me out of returning after your first surgery," he spoke shyly, pausing to nod at her left leg, "but there was no way I was going to stay away after this recent amputation. Unfortunately, I think your urine infection is from me not cleaning you well enough."

Now, imagine being a grown child, with no previous caregiver experience or medical background, halting the life that you've created only to move in with your sick parent. Your parent of the opposite sex, no less. Assuming care that included bathing responsibilities, bathroom runs, feedings, cleanings, appointment dates, and on and on and on.

And on. This was role reversal at its most intimate level.

Michael became an official caregiver. A frightening word for some, a privileged word for others. Regardless, it is a word that many people rightfully now use to describe themselves. Whether it be a sick child, a parent, a spouse, a partner, a grandparent, a relative, a neighbor, or a friend, there are currently 49 million people in our country who provide care in either a professional or personal sense.

Suddenly, I looked at this son in a new light. With no obvious agenda, he was doing what he felt was the right thing for his needing parent. And with his new responsibilities, he was going to be facing a whole new world of emotional weather.

Without any warning, my memories transported me back to when my father, my six siblings, and myself committed ourselves to providing 100% of Mom's home care during her last few months of battling leukemia. Although filled with much learning and many surprises, I think I can say that we all became extremely appreciative of the effort involved in taking total and complete care of a loved one. We were grateful for the experience, though none moreso than Mom, whose beauty and bravery during her last few days only magnified under our personal and steady care.

The patient spoke again, bringing me back to the present. "Michael," she said half-heartedly, "I wish you would have just agreed to put me in a nursing home like I wanted you to do."

"Mom," he responded emphatically, "I won't hear of it. At least not now. If things get too complicated, then we'll talk about it again. But wouldn't you rather be home, still? Seriously?" The patient took her time answering. "Yes," she finally admitted, "yes, I would rather remain home. But not if it means you are going to stop living your own life."

"I'm fine with it, Mom. I would never have moved back if I wasn't. And quite honestly, there is no where I would rather be right now than here, helping you the best I can."

Their smiles reflected off one another while another brick crumbled and fell from my fortified emotional barrier.

I finished the patient's treatment with a case management consult to ensure that Michael and his mother would benefit from several available resources, including home nursing visits. Walking out the door, I wished them both luck. But before leaving, I had to ask. "Michael, did you help your mother with her makeup, hair and clothes today?"

They both laughed. "Yes, he did," the patient answered. "How do you think he did?" Now it was my turn to laugh with the patient and good son. "I think he did a darn good job," I answered, "you look very nice, maam." I turned to Michael. "Well done, buddy." And I'm sure he knew I wasn't talking about how his mother looked that day.

Now, if only he would learn how to change a Depend diaper...

As always, big thanks for reading. And especially for bearing with me through a few weeks of barren writing. Much happening, but all good. I dedicate this post to all of you who have intimate knowledge of the sacrifices and hardwork necessary to be a great caregiver. See you back in a few days...

Kung Fu Fighting

I love a distraction. Especially in the ER. Sometimes the distraction can be subtle and minor, one that I have to search out to find. Other times, though, a distraction can be glaringly obvious, practically smacking me in the face. Whatever the diversion, these moments can make a hectic, chaotic day in the ER much more tolerable. Not to mention fun.

Although it's usually the patients who provide the main attraction, occasionally it can be the waiting family or friends of the patient. For example, Aunt Alice's nose mole and smeared lipstick might make me do a double-take, detracting from the attention I would otherwise have given her nephew, the patient. Grandpa Ben isn't fooling anyone about his gas problem either, sitting over in the room's corner wearing a smug smile, shifting around on his chair before releasing another foul air biscuit.

The possibilities of distractions are endless and, quite frankly, most welcomed by my receptive self.

A few weeks back, I had a two-for-one zinger--both an intriguing patient and her entertaining boyfriend. The patient herself had a significant history of anxiety, bipolar depression, and schizophrenia and, while at an appointment at her mental health clinic, she had become extremely anxious and began to hyperventilate, ultimately passing out. This lead to her trip to our ER via the ambulance service. Her boyfriend, I was told, met her after she arrived.

Walking into Room 22, I found an anxious-appearing, thirty-ish, blond woman with extremely poor dentition. In fact, one of her front teeth was angled outward, barely hinged to her gums, and her tongue seemed to constantly caress this wayward tooth. Her blue eyes seemed out of focus, glazed-over even, probably a result of the valium given to her by the prehospital team. She fidgeted with her hands while her right foot rhythmically rubbed up and down her left shin. Her room smelled quite strongly of stale cigarette smoke.

Standing in the obscure corner of the treatment room was this patient's boyfriend. He was a small man, maybe 5'5", balding with a gathered ponytail. As I took his appearance in, he looked shyly down at his feet while pressing his hands together in front of him, prayer-like. Interestingly, he had no shirt on, just sandals and some worn jeans. His chest was sunken-in and fuzzy. His abandoned white t-shirt rested on the room's only counter top.

Between the two of them, I would have been quite content to spend the rest of my shift hanging out in their room, people-watching. I had a feeling that this interaction would be a memorable one.

The patient eyed me suspiciously as I approached her with my hand extended, ready to introduce myself. While in the middle of saying my name and explaining that I would be her doctor during this ER visit, I heard a loud exhalation followed by a hum originate from behind me, from the corner where the boyfriend stood. Quite frankly, it startled me.

I turned my head to look at the boyfriend, only to find him performing exaggerated motions of what I assumed to be some form of martial arts. After several moments of unorganized, flailing movements, he quit humming and folded his hands back together, bowing his head to me. Although I'm sure he didn't mean it to be, his actions and behavior were quite comical, and I fought myself from laughing out loud.

"Eddie," the patient shrieked, bringing my attention back to her, "cut that shit out. I ain't gonna watch your bogus karate while I'm lying here sick."

At this, Eddie began to hum loudly (again), keeping his head bowed, his hands folded, and his eyes closed. Suddenly, though, as if an "on" button had been pushed, he launched into another routine of air karate, randomly slicing and jabbing his hands while awkwardly kicking his feet outward. For his grand finale, he did a spin kick, almost tripping and falling to the ground on his landing. After collecting himself, he again folded his hands, bowed his head, and nodded to me before closing his eyes.

Funny, but I didn't feel threatened or in danger. I was, however, completely and totally mesmerized.

"Eddie," screamed the patient again, "if you do that one more time, I'm going to climb out of my bed and come over there to kick your ass. Got it?" Eddie apparently didn't, or else simply chose to ignore the patient's threats, remaining in his deep meditative state.

I tried to diffuse the situation. "Eddie," I said, smiling, "that's some really good stuff. Are you a professional?"

I had barely finished my question when the patient chimed in, laughing hysterically at my question. "Professional? You've got to be kidding!" she exclaimed, now choking on her words. "Hell, he's just making all of this shit up as he goes along."

"Well," I said, "his routine sure impressed the heck out of me." I was telling the truth, too. His routine was unlike any I had ever seen before.

With this, Eddie bowed forward again, I assume in thanks of my words.

"Bullshit," the patient said, emphatically, "he doesn't know shit about karate or anything else. Tell him, Eddie." I looked from the patient to Eddie and, after he remained silent in his own world, back to the patient again. "Oh, that's right, I forgot," she added, now sarcasm dripping from her words, "you don't talk during your karate sessions. How could I have forgotten?" She rolled her glazed eyes as she spoke.

Ouch. For her sake, I could only hope that Eddie would never try out his routine on her.

They became the couple of the moment in our ER. When they were alone in their room, there seemed to be a quietness, a calm, to the area. But the moment someone, anyone, walked into the room, the show began. A loud exhalation by Eddie. Humming. Eddie's routine of his remarkable abilities, capped off by his spin kick and landing. The bowing of his head and folding of his hands in conclusion. The girlfriend's free earful of screaming at Eddie for his ridiculousness. The exit of the person who entered.

The nurse walked out of Room 22, shaking her head and laughing after witnessing this same show that I did. So did the x-ray tech. And EKG tech. "Is this for real?" I heard several of our staff ask, after checking out the scene on their own.

"It is," I assured them.

After clearing the patient with a good physical exam and several tests, we quickly discharged her, if only to get Eddie out before he hurt someone or himself.

You can't buy a ticket for this stuff. And you surely can't make it up. The only thing you can do, really, is appreciate these distractions that come with a job in the ER. Well, that and closely inspect the room's corners to make sure there isn't a hidden camera trying to record your response for some reality TV show. That you've been set-up, somehow.

I look forward to the next distraction to arrive. Somehow, as sure as time keeps ticking, I know I won't be disappointed.

Hiiiiii-yaaaah!

As always, big thanks for reading. I hope you have a great, distracting weekend...

The Emaciated Shoulder

She paced protectively beside the hospital bed and its current patient, her grown son, the mother lioness protecting her vulnerable cub. In her hand, she gripped a small notepad, a pen snugly tucked into the coiled-wire binding. Her worried eyes peered through her small rectangular frames, suspiciously watching my arrival. Without blinking, she tucked her short gray bob behind her ears, readying their acuity to my words.

She was the mother of a son infected with HIV.

I focused on the patient. He was my age, in his early forties, with mussed up reddish-blond hair. His face wore the fatigue and ravages of his illness. His temples were sunken-in, his bluish eyes dull, his teeth fragile. Although he gave an effort to smile, his sagging skin weighed down the corners of his mouth. His body was tucked and bundled to his chin with several hospital blankets. To say that he was tired-appearing would have been an understatement.

While introducing myself, I approached him with my outstretched hand. After we shook, I turned to his mother and repeated myself. She took my hand warmly. After introductions, she opened up her notepad and asked me to spell my name, writing it on a fresh clean sheet near the pad's end. I could see most of the previous pages, worn and tattered, were filled with her busywork.

"Well, John," I said, leaning back into the room's counter, "what brought you here today that I can help you with?"

Without hesitating, John's mother began to talk. "Mother," John interrupted her, "I can tell the doctor my problems on my own." I hoped that she wouldn't take his abruptness personally, instead recognizing his attempts to cling to his independence. She quickly silenced herself, slightly embarrassed, as John began to share his story with me.

In the mid-90s, John discovered he was infected with HIV. Through his diligent compliance of lifestyle and medication, he maintained an almost non-existent viral load. He worked-out, he ate well, he enjoyed life to the fullest. Unfortunately, in the past few years, his body and illness became resistant to his previous successful approach and, suddenly, he was dealing with the ravages of advancing HIV. Weight-loss, skin issues, opportunistic infections--each and every new problem was another lost battle in his war. After his most recent diagnosis of HIV-associated lymphoma, he moved back in with his mother and began chemotherapy. He was struggling immensely from both the effects of chemotherapy and his disease.

"Look, Doc," he said, unwrapping his blankets and lifting up his gown to reveal a swollen abdomen and legs, multiple tiny, kinked, bluish-veins spotting his transparent skin, "I have so much edema now that I rely on pain medication to help with the discomfort." His predicament looked painful. In fact, this uncontrolled and worsening swelling had been the purpose of his ER visit.

We talked a little longer about his life, his illness, and his recent setbacks. And through this conversation, I noticed John's mother slowly sadden and withdraw to the chair in the corner of the room. My heart went out to her--I couldn't imagine her pain, having to watch one of her children slowly dwindle from this sometimes devastating and unforgiving illness. Her anguished face, just moments before alert, now wore a look of tattered defeat.

"John," I assured him, "let me finish my physical exam and then I will order up some medications to make you comfortable." His mother wrote in her notebook as I talked.

I continued with my examination, after closely inspecting his protuding abdomen and edematous legs. His exam was difficult. He seemed to have significant findings with every system of his body, despite his vital signs begin stable.

Finally, I asked John to sit up so that I could auscultate his lungs from a posterior approach. "Can you help me, doc?" he asked, holding out his right arm to me. "Sure, John," I answered, grabbing his hand with my right hand and placing my left on his shoulder.

And that's when it hit me. Hard. Just how terrible John's predicament was. Don't get me wrong, I fully understood just how much suffering he had been dealing with recently as his body seemed to succumb to his setbacks, but touching his right shoulder had made me catch my breath.

Under the grip of my left hand, while coaxing John's worn body to sit up, the bareness and emaciation of his right shoulder astounded me. He had absolutely no bulk to it--no muscle, no fat, no cushiony subcutaneous tissue that one typically has to their shoulder contour. Nothing. All I could feel was bone. His clavicle, his humeral head, and his shoulder blade all right there. It was remarkably sad. I shifted my fingers in a futile attempt to palpate any "meat" on his bones. There was none.

After successfully sitting John up, with his mother's help on his other side, I shifted his gown off his shoulder while listening to his lungs. My eyes fixated on his shoulder's thin, transparent skin barely accomodating the stretching from his protruding bones. I simply couldn't quit looking at the fragile shoulder, a dichotomy to John's enlarged, padded ascitic legs and abdomen. What a damn, awful disease.

I left John's room and ordered his work-up and medications. Soon after, he was much more comfortable.

A few minutes later, the secretary called me. "Dr. Jim," she said, "the mother of Room 28 is waiting at the nurses' station to talk to you." I finished with a chart and walked the hallway, finding the mother leaning into the station counter, flipping through her notepad. "Hello, maam," I said, approaching her, "I understand you wanted to talk to me?"

She looked up from her notepad, closing it, while her eyes settled on mine. "Yes, doctor, I do." She paused before continuing. "I just want to thank you for your kindness to John. I know you are just doing your job, per se, but there was something more from you, something I can't put a finger on, that made us both feel very good." She choked up as she spoke.

I grabbed her hands, one of which still held her precious notepad, and thanked her for her kind words. "My heart goes out to both of you," I continued, watching her tears progress to sobs, "what an awful disease for anybody to endure." She took her eyes from mine and looked at her feet. I thought of what to say next, the words coming quite easy. "John is so lucky and blessed to have a mother like you. You opened your home, you take notes, you accompany him to all of his appointments. We should all be so lucky." I paused before finishing. "And loved."

She looked at me again, her act of the protective mother lioness long-abandoned. "Thank you," she repeated before turning and walking back towards John's room.

We admitted John for further care.

Although I pride myself on my composure through all of the emergency department's chaos, I am only human and sometimes cannot shake a patient's affect on me. John was one such patient. It must have visibly shown, too, since several of my coworkers asked me if I was okay. "No," I answered honestly, "but I will be."

At the end of the day, we are all human. We are all in this world together. We are all united by the common threads of emotions. We are all prone to the extremes of happiness and sadness and everything between. We are all in need of compassion and kindness and love.

Especially, though, those who are suffering. And John was suffering. My greatest hope for John is that he may find much love, compassion, and kindness on his continued life journey.

There is no human being who deserves anything less.

As always, big thanks for reading.

The Power Of A Voice

This morning in church, I closed my eyes to fully absorb the priest's deep, husky, richly-layered voice which emanated from the alter and, suddenly, I was transported back ten years, to a time in my life when I was buoyed by this same powerful voice, the one speaking to me now as I sat in my maple pew on this cold, rainy Sunday morning.

Ten years earlier, I had been up all night, uncomfortably spooning with my wife in a lazy-boy recliner in my son's hospital room, waiting anxiously for morning to come. Neither of us wanted to leave Cole's side. Neither of us wanted morning to come, either. Morning would bring surgeons and specialists who would transport my son to the operating room, to debulk and biopsy a neck mass discovered the day prior. A day prior that was filled with haunting, harrowing memories of being told, after several emergency CT scans, that my son had something "seriously wrong." The news of the tumors in his neck and chest, accompanied by swollen lymph nodes, had collapsed our world.

Finally, five a.m. arrived. The early light of another day, confirmation that the world wouldn't stop with our sorrow, began slivering between the room's vertical blinds. I rolled off the lazy-boy, covering my wife with our shared blanket, before gingerly tiptoeing to the crib. I watched my son's chest rise and fall, his complacent, peaceful face giving no indication of the cellular war raging in his tiny body.

I was mesmerized, surrounded by my son's clouds of pure innocence, as I clung to the bars of his crib, trying to make reason with this path my son was suddenly placed upon. I listened to his steady breathing. I watched his little eyelids flutter. I wondered at the shadows of beautiful angles that his bent limbs created under his blanket. No different than the day before and, yet, the knowledge of his devastating illness now changed everything.

Suddenly, around 6 a.m., the room's phone screamed out, ringing to interrupt my trance.

"Hello," I answered, supposing it was someone from the hospital's staff.

"Hello, Jim," the familiar voice spoke, "it's Father Tom." Of course, I knew it was Father Tom. He needed no introduction to my ears, ever. Just hearing his calm voice, resonating with love and concern, wrapped a blanket of comfort around my aching heart. He continued. "I'm calling to see if you or Karen need anything." I should have expected our beloved priest to be checking in with us during our turmoil. Just not this early.

"Father Tom," I whispered into the phone, "we're okay. We have a tough day ahead of us, though. Please just keep Cole in your thoughts and prayers through the day and we'll let you know, as soon as surgery is over, what we are facing."

"Jim," he spoke again, his voice steady and strong, "I don't think you understand. I'm downstairs in your hospital lobby. I'm on my way up to your room but wondered if you or Karen needed some coffee or a bagel, even."

"What, Father Tom?" I asked, confused. "You mean you are here? Right now? In the Children's Hospital?" The hospital was at least two hours from our home, which meant that he would have had to have left by 4:00 a.m. to get to us at this time.

"You don't think I would stay away on a day like today, do you, Jim?" he asked. I couldn't answer, my wonder and thankfulness of his presence choking my words. A few moments of silence followed as he waited patiently for my answer. "No," I finally said, before continuing, "and Father Tom, thank you."

With that phone call, on that fateful day, Father Tom's voice ingrained itself into my memory.

And from that simple phone call, Father Tom's magnificent voice continued to harmonize much of the discord in my life. That day alone, in which Cole came through his surgery, Father Tom stood in a circle with us in the family room, hands joined, offering that consoling voice in prayer and reassurance. Later, when I asked him "Why? Why? Why?" my son was chosen to bear his burden, to have to fight for his life at a young age of two, his voice cracked, one of only a few times I have heard this. "I can't answer that, Jim," he had said, "but I can only pray that at some point in Cole's life, on his journey, the answers of why will become more evident." Yes, Father Tom, I can see some of those answers already.

Through those trying years, including an additional year of chemotherapy for Cole when he came out of remission and my mother's eventual death from leukemia, Father Tom, his voice in tow, continued to grace all of our lives. Whether at our home for lunch or dinner, or whether a Sunday morning sermon, his distinguished, distinctive voice, with its classy delivery, never failed me. Even before delivering my mother's eulogy, he approached me. "The grace of God is with you," he had said, clasping my face between his hands at her funeral, "you will do your mother proud as she sits there on your shoulder with you."

Unfortunately, as with our Catholic religion, priests can be reassigned to another parish after several years of service, and this was no different for Father Tom. He moved over an hour away, assigned to another parish, too far for us to travel for services . We did surprise him one Sunday but, otherwise, relied on emails, phone calls, and rare dinners to catch up. It wasn't the same.

I had lost my spiritual guidance, of sorts. I missed the power of his voice and wise words. And I missed my friend.

Thankfully, though, Father Tom informed our family at the beginning of this past summer that he would be returning to our area, to a parish just twenty minutes from our home-base parish. I couldn't wait for the day to arrive.

Today, finally, was that day. Today, on this gloriously cold, autumn day, I was blessed to sit in church, beside my healthy son, my lovely daughters, and my beautiful wife, listening to the voice of an angel.

The missing voice that I couldn't replace in my life.

The voice of Father Tom.

As always, big thanks for reading. Anybody's voice in your life that you rely/relied on? See you midweek...

The Saving Brother

I heard the patient's agonizing scream emanate from Room 31 just seconds before Nurse Carla ran up to me. "Dr. Jim," she said, grabbing me by my arm, "I need you in 31 right away." Her face was flushed, her voice edged with concern. Carla, usually calm and collected, had me worried with her nervousness.

As we hurried down the hallway toward the room, we were greeted by yet another gut-wrenching scream. Somebody was hurting. And hurting bad. We hear many types of screams in the ER--demented screams, angry screams, excited screams, drunken screams, etc.--but this primal scream from being in extreme pain was by far the worst.

"What's going on, Carla?" I asked her, intrigued as to what I was going to find when I walked through Room 31's doors.

"Bad burns," she said, "and trust me, your heart's going to drop over this one."

We walked into the room and I was surprised to find an eighteen year-old male patient sitting upright in his cot, completely naked. He was alone and crying. He was thinly-built with shoulder-length blond hair, his face painfully scrunched-up as a result of his despair. His hands were alternating between flailing and holding his genitals. The nauseating smell of burnt skin and hair permeated the room.

I rushed to his side while Carla assumed position on his other side, preparing to start an IV. On a quick, cursory exam, I saw that he had apparent burns to his lower abdomen, his inguinal areas, and his penis and scrotum. Poor kid.

I quickly introduced myself to him. Through abbreviated, gasping words, he told me his name was Matthew.

"Matthew," I said, "we are going to start an IV and give you some pain medication to make you more comfortable, okay?" He nodded his agreement while grimacing from his discomfort. I continued. "After we get you a little more comfortable, we'll talk about what happened. In the meantime, I need to perform a physical exam to see what the extent of your burns are."

Carla had an IV established before I was even done talking. "Morphine?" she asked. "Morphine," I answered, "and lots of it." After giving her some further orders for IV fluid hydration, she hurriedly left the room.

I looked closely at Matthew's head and face. He had no singed nasal hairs, no burnt eyebrows or lashes. I had him spit in a container. His sputum was clear. He had no stridor or difficulty breathing. All good findings to suggest his burns didn't affect his airway. His heart sounds were excellent. His lung sounds were clear. His abdomen, barring the lower skin burns, was soft and without pain. His extremities revealed him to have redness and blistering to the palms of both hands.

Next, as Carla administered the morphine, I focused on his burned privates. His entire penis was red and blistered but, thankfully, the burns were not circumferential. A band of burns that completely encircled the penis would have had potential to cut off the blood-supply to the distal part and that would have been very bad. Matthew's scrotum was also burned, red with significant blistering covering its entire surface. His groin area and proximal thighs on both sides were also a bright, angry red and blister-filled. His anus and rectal area had been spared.

Because of the location of his partial-thickness and potentially full-thickness burns, Matthew needed to be emergently transferred to a burn-unit with his injuries.

After making quick arrangements for his transfer, I returned to Room 31 to find a much more comfortable patient. Several nurses, including Carla, were bent over Matthew tending to his burns.

"Matthew," I said, "do you feel better." Groggy from the pain medications, he smiled a goofy grin at me. "I sure do, Doctor. Thank you."

He then went on to explain to me how he had received his burns. His younger ten year-old brother had been playing with fireworks when Matthew had happened upon him. His younger brother, Matthew continued, was holding an M-80 in his hands, lit, and was trying to slide it down a tube that wasn't wide enough. Matthew, watching with horror, saw the wick of the firework burn down to almost nothing and he decided to act.

"I ran up to my brother, Doctor, and grabbed the tube with the M-80 sticking out of it. I thought it was going to blow up in his face, so I snatched the tube and held it against my belly so it wouldn't hurt him."

As you can probably guess, the M-80 blew while Matthew was pressing it against himself. Although the force of the M-80 missed causing him significant injury, Matthew's clothes caught on fire, resulting in his burns. Matthew was a hero.

"Is your little brother okay?" I asked. "I think so," he answered, "he and my mom should be here soon."

I liked this young man. Here was a respectful, saving brother who risked his manhood, his life actually, to keep his younger brother out of harm's way. I had no doubt that if the exact scenario repeated itself, he would do the same thing.

Within minutes after our discussion, I greeted Matthew's mother and younger brother in the hallway outside of his room. They were both distraught and crying, their tear-stained faces looking expectantly at me for some good news. Especially the younger brother.

I put my arm around his trembling shoulders while I addressed them both. "Matthew is much more comfortable now," I reassured them, "but I have some concerns about how bad his burns may be. We're going to transfer him to the regional burn center so he will get the best available care possible for his burns."

The mother nodded. "Please do whatever you have to do to get Matthew better, Doctor."

I escorted them into Matthew's room, where the younger brother immediately bolted to Matthew's side, hugging him. "It's all my fault," he muttered between his free-flowing tears. "I'm sorry, Matt." The guilty weight of the younger brother was heartbreakingly evident. Matthew, as I knew he would, put his protective arm around his younger brother. "It's alright, bro. I'm just glad that you are okay." Mom came up then, wrapping her arms around both of her sons. Carla and I stepped out to give them some privacy.

We transferred Matthew to the burn unit without incident. Prior to his leaving, we wished him well and told his mother to please keep us posted as to his recovery. We all wanted Matthew to have the best of outcomes.

A few weeks later, waiting in my work mailbox, was an update letter from the receiving burn unit regarding Matthew's condition. I eagerly ripped it open, nervous about the news it contained. Thankfully, it held the best news possible. Matthew hadn't required any skin grafting and, although his burns were significant, they expected a full recovery without any permanent injury or damage.

Sometimes, things turn out just the way you hope they will. Cheers to Matthew.

As always, big thanks for reading. See you Friday...

A Third Look

I sometimes wonder what the commotion of our emergency department must look like through the eyes of a patient or their family. Imagine walking down the hallway to visit Aunt Lucy only to have a half-naked patient, his gown loosely-tied and his junk hanging out, walking at you from the other direction. Or seeing an unresponsive patient on a cot being rushed into a room with a paramedic sitting on top of him, performing CPR. Or hearing the drunk patient in the next room violently vomiting and gagging while filling-in the space between with obscenities.

The imagery and sounds that come from our busy shifts must haunt some of these visitors not familiar with the day-to-day workings of an ER.

Better yet, I wonder what these same patients and their families think when they see our staff's occasional blase' attitude. It has to be something pretty remarkable and out of the ordinary to get us to cringe or flinch or react, it seems. Which, I'm sure, comes across as uncaring to some. Trust me, though, it's not that the staff doesn't care, it's just that with the constant bombardment of these scenes, we have become somewhat immune to being caught off-guard.

When was the last time I did a double-take, you ask? Easy. It was two weeks ago. I had been standing at a counter in the nurses' station, finishing a chart, when I looked up to find one of our male techs helping a female patient stand from her cot. She had needed to go the bathroom and had insisted on using the hallway bathroom. She was a short but heavy woman, mid-forties, frosted blond hair, wearing a gown and nothing else. I presumed it had been tied up in the back.

Wrong.

As the tech helped this woman out of her room and down the hallway, away from me, I glanced to make sure she was steady on her feet. She was. But after what I saw, I wasn't. This woman's very robust ass was hanging out of her gown. Evidently, her gown hadn't been tied correctly. Now, I can handle the robust ass part. That's not a problem. If I've seen one robust ass in my career, I've seen a hundred. But what made me look twice at this one was the very tiny triangular patch of bright orange at the small of this patient's back.

"Noooooo," I thought to myself, "that can't be a thong. Can it?" A small part of me, although not a fan of them, hoped it was a "tramp stamp," a tattoo. For some reason, I would have accepted this a little better. As much as I hate tramp stamps, I hate thongs even that much more.

So, what did I do next? Heck yeah--I looked a third time. And disappointingly, I realized that the itsy-bitsy patch of orange was fabric. No tramp stamp for this classy patient. Straining my eyes, I couldn't see the rest of the thong, though, as it seemed to disappear among the fleshy cheeks.

With my mouth gaping, I watched the tech and the patient arrive at the bathroom, where he helped the patient in before stepping out and giving her some privacy. Afterwards, I looked behind where I was standing, only to find one nurse, one radiology tech, and two family members from another room (they had been asked to step into the hallway while a portable chest x-ray was being taken) standing in the hallway, watching the same scene I had just witnessed.

Their mouths were gaping, too.

I walked to the tech waiting outside the bathroom for this patient. "Hey, Mike," I said, "you have to cover up this patient when she comes out. Her backside and thong are hanging out for everybody to see."

"A thong?" he asked, "No way." I understood his amazement--this patient wasn't our typical, narcissistic thong wearer. "Trust me," I answered, pointing down to the family members looking our way, "they got a free show."

Mike ran and got one of our scratchy hospital-issued blankets and tried to cover up this patient's backside as she exited the bathroom, but she refused. "Get that thing off me," she yelled, "I don't care who sees me!" Good for her for being proud of her robust ass. If only we could all be that confident.

Mike earned his paycheck that day. As the patient walked back to her room, Mike grasped her elbow for support while using his other hand to hold the back edges of her gown together. No easy feat on his part, but he handled it like a champ. Single-handedly, he got this movie's rating reduced from an "R" to "PG.

Sometimes, the noise can be just as disturbing. Just a few days ago, we had a pleasantly demented elderly woman sent to us from a local nursing home for a variety of medical complaints. Usually, if we can, we place this type of patient near the nursing station to keep a closer watch on them (in the event they try to climb out of their beds). Unfortunately, though, this patient was prone to frequently screaming out "Help me!" Every few minutes. In a loud, high-pitched, shrilly voice. For three full hours. Behind her partially-closed glass doors.

Imagine being one of the patients or families who bore witness to these screams. After a few minutes, the staff easily got used to them (although I'm sure most of them would have preferred a little more quiet). I'll bet, though, that it was probably somewhat disconcerting for several families to think a patient was screaming out for help and not finding the staff reacting.

Unbelievably, about forty-five minutes before Ms. "Help me!" was discharged back to her nursing home, an elderly demented man was brought to our ER and placed in a parallel hallway near the same nursing station. And can you guess what he was prone to yelling out? "Owww!" Yes, "owww!" Drawn out in a raspy, deep, masculine voice.

Suddenly, we had these two patients prompting each other. "Help me!" was followed by "Owww!" "Owww!" was followed by "Help me!" This duo had impeccable, precise timing in their forty-five minutes of togetherness.

We all shook our heads. The hilarity of the moment, unfortunately, was tinged with some sadness to the reality of their situations. In another thirty years, I thought, that could be me uncontrollably yelling out something. Something suave, I can only hope.

After the woman was discharged, the elderly man continued with his "Owww"s for a few more minutes before tapering off completely. Maybe he realized, through his dementia, that he was Simon without his Garfunkel. Or Hall without his Oates. Better yet, Ike without his Tina.

As for the patients and families that heard this duo's chorus, we offered several reassurances that these patients were okay and not in any pain. Hopefully, the families we didn't get a chance to offer an explanation to won't be scared off from returning the next time they need emergency care.

The families that saw the orange thong, though? I don't expect we'll ever see them again...

As always, big thanks for reading. Any of you have a funny story to share? I hope you have a great weekend...