A Wedding is the Portal to the Mystery of Marriage

Congratulations Meg and Tyler!

This past weekend we celebrated the wedding of our dear friends Tyler Jordan and Meg McCall.  It was an event filled with the the grace of  God, expressed in a truly perfect Spring evening, in the love of parents, friends and the blessed couple.  It was conducted in all the glorious, meticulous yet casual elegance of the South Carolina coast.  All of our children were in the wedding party (along with many other wonderful folks). I was privileged to be able to deliver this short reflection at the wedding.  Thanks to Meg and Tyler for including me!

A wedding is a beautiful thing. It is a celebration, and in life’s troubles we celebrate too little. At a wedding we smile, and cry. We laugh and dance, we eat and drink and send a new couple on their way into life. A wedding is an event where others witness and affirm our vows, in order that others may help hold us to our promises. Wedding ceremonies are much valued in our time, and we spend great amounts of time and treasure to make weddings beautiful and memorable, to make wedding dreams come true.

However, despite its beauty and wonder, the wedding is not an end in itself. It is a gateway which serves to fuse two into one. When a man and woman walk through that gateway, through that portal, they enter into a beautiful mystery.

Beyond the vows, the veil, the ring and the kiss lies previously unseen, unknown garden of their common life together. That life is a new creation waiting to be unveiled and explored, shaped and molded hour by hour, day by day, year by year over a lifetime. In so doing they are living in the spirit and tradition of Adam and Eve all over again.

St. Paul says that this is a great mystery. In Ephesians 5:31-32 he says, after a profound explanation of the relationship of husband and wife, ‘For this reason a man shall leave his father and mother and hold fast to his wife, and the two shall become one flesh. This is a profound mystery, but I am talking about Christ and the church.’ We’ll circle back to that last bit in a moment.

Here Paul uses the Greek word Musterion, which means ‘a mystery that can be revealed or discovered through God’s revelation.’

The mystery of marriage is not ineffable, because God who created it is constantly teaching us through it. It is not beyond comprehension. It does, however, require that we be committed in order that we understand its riches and metaphor. It cannot be approached tentatively, with one foot in to test the water, but all in, with all our hearts.

To comprehend the mystery of marriage we can only cross the portal, and in faith and hope and love leap headfirst into the unknown. And it is an unknown.

Dating and courting and all the time we spend together before the vows are exchanged are critical. They help us to learn who it is that we can indeed spend a lifetime loving. But something different and mystical happens when we take the plunge of matrimony. Suddenly, the world takes on a different light in the power and energy of the fusion of two into one.

Through the mystery of marriage, through the great unknown garden of life together, we learn small things. That our beloved is beautiful to us first thing in the morning and last thing at night. That our beloved is a human with frailties, failings and annoying habits, but that they are no worse than our own. We wonder, at times, why they stay with us; at others why we stay with them. And then we all laugh at the fact that we both ask the same questions.

We learn that the one we committed ourselves to is cherished and precious like nothing we ever grasped or imagined.

We learn to be humble and thankful in times of joy and gracious and hopeful in times of suffering. We learn the mystery that those words, so often spoken about richer or poor, sickness and health, take on very real meaning in the hot forging fires of life.

We learn that whatever else may fall apart, whatever else may evaporate before our eyes, whatever trials life visits upon us, if we are together we can endure.

Marriage is the first place where we perhaps truly understand what it means to love someone so much we would rather see ourselves suffer or die than have it happen to our partner.

It is hard to impress upon the young, but in a marriage properly tended, in our own small Garden of Eden, love only grows deeper and wider with every passing year, every financial struggle, every wrinkle, every illness, every success and every day, or night, spent together.

Ultimately we find that looks and wealth come and go, but as we are made more and more into one, the greatest gift is their hand in ours, their warm body sleeping next to our own. This is an ageless, timeless blessing.

This is part of the mystery. The discovery that love is not contingent. That it is not contingent on youth or beauty, success or power. That it simply grows; possibly deepest in trouble, despite how we all hate to pass through it.

Over the years and decades, we become mysteriously intertwined. We are made one by our vows, but we are transformed into one by time, by shared stories, by shared goals and struggles, by neurochemistry… for all we know by genetics as each physiology impacts the other.

If you doubt me, ask those people you know who have loved long and well. It is hard to put into words, but in marriage, in time, the things we thought valuable and desirable fade away, and we desire our beloved above nearly all.

So much so that we cannot fathom, especially in youth, the phrase ‘tell death do we part.’

But that’s where the mystery delves deeper and more wonderful. What we are learning in the mystery of marriage, as wonder after wonder reveal themselves, is that our marriage is a microcosm of the love of Christ for the church.

It teaches us to love unconditionally as he does. It teaches us to love without fail, with no term limits or expiration date. It teaches us to love when we are wounded and when we are hopeful. It teaches us to forgive and love more and more. And it teaches us that all of this is an end, THE end, in itself. We do not love for meals or laundry, for support or company. We love because in love we reach God.

And there is one more thing. This love of Christ for the church will carry us beyond. The painful mystery of separation in this life is not in our power to overcome. But it is in his power. And that is the promise.

Our love for our spouse will be interrupted one day. But it will go on for all eternity in the Kingdom of God as every tear is dried and every sorrow comforted. And in that place we will see the kind of love for all that we in our mortality took a lifetime to learn for only one.

A mystery indeed.

And today, we are witnesses as the story of wonder and mystery begins once again in these two young lives about to become one..

So let there be joy and laughter in all our hearts as we witness things far beyond our comprehension and realize that mystery is all around us today.

Mothers are People First

Mothers are People First

This was my Mother’s Day column in the Greenville News.

http://www.greenvilleonline.com/story/opinion/2017/05/12/mothers-day/101521348/

I have been graced by a long line of mothers. I had two grandmothers who loved me dearly, and who (though they have passed from this life) remain dear to my memory. My own mother Sharon was, and remains, a wonderful woman who raised me gently and with endless help and encouragement. My mother-in-law Carma has ever been kind to me, and treats me like a son.

My wife Jan is an incredible mother, who has dedicated her life to our children, going so far as to homeschool them for many years. She is indulgent and patient with them and they are always in her thoughts and fervent prayers. She is a Godly mother like all of the mothers in my life.
Having praised these women, let me say something shocking that we forget all too often on Mother’s Day. Although we seem to have a ‘cult of mama’ here in the South, mothers are just people like all the rest of us. They are capable of love and hatred, they can be supportive and destructive. They may lift their children up or tear them down. (Both the stuff of various books and movies.) They have good and bad days, and decades. Mothers were once mere girls, then they were lovers or wives. Along the way they accumulated hopes, dreams, stories, successes, failures and wounds of their own.
Because they were not born mothers, but become mothers, they bring all of these things with them when they bear, or adopt, children. So into the wonder and chaos of motherhood they bring their humanity. And humans, mother or other, are imperfect.
These imperfect people we call mothers are often subject to some nasty treatment. Sometimes, we confine them to their maternal roles. As if all they are capable of is producing and raising kids for the future. Jobs? Degrees? Achievements? Passions? Irrelevant, as some women are subordinated to motherhood by their families, and are not encouraged to attain the full glory of the various reasons for which God put them on the earth.
On the other hand, modern society often says to moms, ‘sure, you can choose to be a full-time mother, but what a disappointment you’ll be to all of the women of the world! Career and education are so much more useful and interesting than caring for mere children! What a waste of your potential!’ As if raising human beings, loving and caring for them, were no more exciting or important than having fish in an aquarium. While ‘choice’ is a powerful mantra, the choice some women make to focus on motherhood is sometimes unfairly viewed as failure.
The third option is perhaps cruelest of all. It tells mothers to be everything. Raise perfect children, and feed them lovely, healthy meals, engage them in all activities and make them super students. Simultaneously, rise meteoric through the corporate world! Never say no to a new project, a new goal, a better job! Stay thin and beautiful and do all things as they appear in glossy magazines. ‘Bring home the bacon, fry it up in a pan,’ or else be a pathetic loser.
Mothers, meanwhile, struggle with just being people. Like everyone else they have fears and anxieties, sorrows and addictions, illnesses mental and physical. Some mothers are close to ideal, others will wound the ones they bore. Some, overwhelmed by their own troubles, simply cannot raise children, while others make it look effortless. There are those mothers who are stars in business, government, professions, athletics or other fields. And yet, all too many never have good jobs or educations. Some mothers land in jail.
The thing is, mothers are are neither gods nor angels. And it is cruel of us to expect them to be either. They will not always accomplish everything they dream of and sometimes their children will be less than they had hoped despite their best efforts. Sometimes children will be disappointed with their mothers, fairly or not. This is reality. This is life in a fallen world.
In the end, we should celebrate the many gifts and sacrifices of all mothers. Simultaneously we must remember that mothers deserve, as do their children, to be loved for who they are. And given grace despite who they are.
So love your mom this Mother’s Day! But along with dinner, flowers or the assorted gift offerings you bring, give her the freedom to be perfectly imperfect. Just like you and just like me.
Happy Mother’s Day moms!

Emergency Medicine: a Model for Unity

This is my April EM News column.  I hope you enjoy it!

http://journals.lww.com/em-news/Fulltext/2017/04000/Life_in_Emergistan__A_Model_for_Unity_and.12.aspx

How do you define yourself? How do you describe yourself? In the past, I have tried to avoid immediately categorizing myself by my profession. I always agreed with The Little Prince:

“Grown-ups love figures…When you tell them you’ve made a new friend they never ask you any questions about essential matters. They never say to you ‘What does his voice sound like? What games does he love best? Does he collect butterflies?’ Instead they demand ‘How old is he? How much does he weigh? How much money does his father make?’ Only from these figures do they think they have learned anything about him.”
-Antoine de Saint-Exupery, The Little Prince.
Taken from https://www.goodreads.com/work/quotes/2180358-le-petit-prince

And yet, we do this constantly. Physicians especially love to divide ourselves into groups. Each group has its own characteristics. Most of those reading this (but not all) are EM docs (ER docs if you’re older), also known sometimes as ‘pit docs.’ There are internists, or fleas. Surgeons, or cutters. Anesthesiologists, or gas passers. Pediatricians, or pediatrons. Radiologists, or shadow doctors. Orthopedists, or carpenters. (I kid!) This is a natural division as our specialties are our big, nerdy fraternities and sororities. They are the places we learn to make our living, establish habits of thought and behavior, create world-views and life-long friendships.
Unfortunately, it goes much further than specialty. We are divided between rural and urban, and there are significant problems in that chasm, as physicians in urban teaching centers sometimes have little knowledge of the stark limitations of the rural setting when we call for help or transfers. ‘You don’t have a surgeon? You don’t have an ICU?’ Likewise, rural physicians often forget that even ‘the big house,’ eventually reaches capacity and can’t take transfers; and the presence of the large center (or a helicopter) is no excuse for sloppy care on the outside.
We are also demarcated by into ‘community vs academic.’ In my medical wanderings over the past few years, I have found that this is a point of contention with many community physicians. Research, treatment pathways, algorithms, check-lists and new imperatives seem to constantly emanate from academic centers and flow to the community hospital and its citizens. Community physicians, many of whom have lived through countless swings of the medical pendulum and associated policy changes, are often reasonably skeptical of the latest study, the latest rule about pain medications or sepsis protocols. They feel cut-off from what they perceive is a connection between academics and policy-makers, and they feel particularly excluded if, later in life, they have an interest in entering academia, which seems like a closed club.
Physicians are also increasingly divided by gender and sexuality, as we see various physician advocacy groups pop-up. That’s fine, I suppose, so long as it doesn’t split us further apart but serves as a source of encouragement and connection for the members of those groups. (It becomes toxic when it is used as an exclusionary tool. I was told once that my opinion in a debate was less relevant because I was a ‘straight white male.’)
However, our divisions seem to be at their worst when it comes to politics. And it’s a pity, really, because we have such potential to be models for the rest of the world. I have seen physicians argue politics in person and online. I have been part of some of those debates, and it can be very, very ugly. I have recently withdrawn from most political dialog because it wastes time, causes anger and accomplishes nothing.
But I will give this ‘opinion’ and stand by it. I’ve worked with physicians who were Christian like me, Muslim, Hindu and atheist. I have worked beside ardent progressives and hard-core conservatives who make me look like a socialist (and that’s tough to do). I have worked with physicians who were gay and straight, rural and urban, academic and purely clinical. I’ve laughed and cried with them, eaten with them, encouraged and been encouraged by them. And I’d do it all over again. Because when it comes to our job, our real job of treating the sick, easing suffering and saving the dying, all of our differences evaporate into vapor.
So identify yourself by whatever category you wish. But never forget that we can serve as a model for unity, a model for the greatness of all free people, when we do our jobs well, and do them together for the good of others.
Now, what’s your favorite food? What’s your hobby? Tell me about your wife, husband and children. Because those categories interest me more than all the rest.

Pandora’s Pill Bottle. (A poem about the narcotic epidemic)

Pandora’s Pill Bottle

‘Patients who suffer from painful conditions
Should always be treated by caring physicians,
Who never forget to give good medications
For problems from fractures to awful menstruation.’

‘The fifth vital sign is your bright guiding light
The pain scale will lead you to do what is right,
So doctor remember to show some compassion
Since giving narcotics is now quite the fashion!’

Thus we were told for a decade or two
As patients stopped breathing and turned rather blue.
But hospitals loved their new high survey scores
And doctors were turned into pill-writing whores.

Yet things are now changing across the whole nation.
There’s blame all around and new drug regulations.
‘What were you thinking? What were you doing?’
‘How could this happen? Someone will start suing!’

In ER’s and clinics and every location
We docs shake our heads with increasing frustration.
We did what they told us despite all our fears
And Pandora’s Pill Bottle spilled out for years.

The pain scale betrayed us and caused too much trouble
The fifth vital sign is a big popping bubble.
The statistics we’re reading have left us quite nauseous.
So we’re trying new things to save lives and be cautious.

Dear doctors it’s you that must make these decisions!
Push back against administrative derision!
And when those ‘above us’ make policy errors
Stand in for the truth to prevent further terrors.

Easter is Bright Because Good Friday was Dark

My column in today’s Greenville News. Happy Easter friends!

He is Risen Indeed!

http://www.greenvilleonline.com/story/opinion/contributors/2017/04/14/commentary-easter-hope-everlasting/100413278/
Everything is bursting into bloom and the days are warmer all the time. Although I prefer winter, I recognize the gifts of Spring; green hay fields and newly planted gardens; long, warm days filled with the promise of summer break and cool swimming-pools. There is even great beauty in families on Easter Sunday, all awash in bright pastels, father dressed up and proud, mother hovering in dress and hat, children clean until they find the candy, the dog or both. What a wonderful time it is!
Yes, it’s a bit cliche and it’s a little old-fashioned; not necessarily bad things really. Still, there are those who even say the whole Easter thing is a bit of a joke if not a hoax. That all we Christians do at Easter is revisit old pagan fertility rites and slap on new names (well, new for about 2000 years).
Maybe there’s some truth there. Our churches have Easter egg hunts, after all. We give our kids stuffed rabbits, known for their reproductive prowess. Stores even sell flowery crosses made of chocolate. Innocuous enough, but I fear that in our safe, easy celebrations we have lost all sense of what the cross was in its common ancient usage. A candy cross probably would have horrified all but the most jaded Roman citizen who had witnessed its use as a form of execution.
On the other hand, maybe the irony is just part of the message. God winking at us as he tells a cosmic joke. Easter is about the power to take a thing from very bad to very beautiful; from hopeless to hopeful, from dead to alive, and theologically, from sinner to redeemed!
After all, behind bunnies and delicately dyed eggs, candy and ham dinners, flowers and sunshine, there remains the gasping, bloody, brutalized body of the Son of God, the healer, the miracle bringer, the lover of the despised. Behind beautiful dresses and baskets filled with fake grass is Jesus, hanging on crude wood, affixed with iron spikes and rope, taunted to the end, stabbed in the side as the sky filled with angry clouds and the ground shook enough to shake a disciplined, armed Centurion. Behind all the joy and sweetness lies the stone over the tomb where Jesus’ dead form lay. Beneath the bright colors of Easter, making it possible, is the gray, black grief of all who loved him, followed him and hoped in him.
But Easter morning turned misery inside-out. It turned tragedy into an inconceivable miracle on the morning when the tomb was empty and Jesus’ clothes were found lying on the stone where life himself had lain lifeless. Then out from the tomb he came. ‘Up from the grave he arose,’ as the hymn says. From the tomb exploded hope. From his death issued life; from the grave burst the power to transform bitter hatred into immense love. And the message that what seems beyond repair, lost forever, is neither. This is a message the world needs now more than ever.
The perspective of history is a relevant reminder as we seem to believe, somehow, that injustice, cruelty, tyranny, poverty and suffering are things we have only just discovered and that their resolution seems hopeless. Hardly. He confronted them all those centuries ago; with his blood.
Indeed, from Jesus’ passion came the ‘love, joy, peace, patience, kindness, goodness, gentleness and self-control’ (and yes, tolerance) that made so much we take for granted possible. We dismiss it all as so much of a fairy tale. Then we try every generation to recreate what he did with arguments, policies and laws.
Yet nothing compares to the transforming power of Easter, an explosion of wonder and laughter painted in breathtaking, shocking contrast on a canvas of pain and fear.
Easter is a brightly colored celebration of God’s power over sin and death. It allows us to celebrate new life with color and flowers, with candy and all the trappings of childish pleasures; even those rooted in pagan times, for it seems to me those things were resurrected for his use too.
Easter is no longer a fertility party, but a time when joy finally makes sense, because the cross and the tomb could not hold the lover of our souls. And thanks to that, death, sin and fear cannot enslave us either.
The cruel cross and rolled stone makes every Easter egg brighter and every chocolate bunny sweeter indeed. A beautiful holy joke if ever there was one.

Rural Suicide and Mental Health; my column today at Politico.com.

Here’s a column of mine, published today at Politico.com.  Everyone wants to make these issues into right/left battles.  I was asked to write this, and it concerns mental health, which is a topic very important to anyone in emergency medicine.  I have written for publications of various political orientation and I’ve tried not to let the liberal/conservative division limit me too much.

http://www.politico.com/agenda/story/2017/04/suicide-er-rural-hospitals-000398

Thanks!

Edwin

 

Can we Change our Minds?

It’s easy to be excited about facts when they support our own opinions. It’s nice to believe that uncomfortable facts are fake. Likewise, it’s comforting to believe that everyone who disagrees with us is ignorant. When the truth is so obvious, we say, how could anyone but an uneducated bumpkin deny it? And yet, it seems that much of our knowledge is incomplete and that our deeply held beliefs may be more fragile than we imagine.
I was thinking about this recently when I listened to a podcast about evolution. It was a discussion about some events that happened last November at the venerable Royal Society in London. It turns out that some well-respected scientists think that perhaps evolution isn’t just due to ‘random mutation and natural selection over time.’
According to some researchers at the meeting, our DNA is even more amazing than previously believed. It appears that external stressors change the way plant and animal DNA works so that creatures adapt much more rapidly than we thought. This doesn’t necessarily mean evolution is wrong; but certainly our understanding of it is probably incomplete.
This poses a challenge to some beliefs that have been held in exactly the same way by scientists, and the lay public, for a very, very long time. Can we handle the change in paradigm? Could we ‘adapt’ if we suddenly found out that evolution is a bit off? After saying for years that it was a not a theory but a hard fact?
The science of medicine changes all the time. For the past 20 years, physicians in training were taught that they should never hesitate to boldly give narcotic pain medication to patients who asked for them. Because after all, ‘why would anyone mislead their doctor?’ And who were physicians to judge? We were told, ‘you can’t create an addict in the ER.’
Except, according to some pesky researchers, it appears you can. Some people can become addicted after a very short course of pain medication. They’re just wired that way. And now pain pills and heroin are killing people in staggering numbers. Our venerable, white-coat clad instructors were wrong. (What? Physicians and professors wrong? Perish the thought…) And now we have to face the facts and change our behaviors as doctors.
New, intriguing information presents itself all the time in many areas of study. The bacteria in our guts may have to do with obesity and mental health. Litter boxes may contribute to human mental illness due to a parasite cats sometimes carry. Socialism in Venezuela is a disaster. Foreign aid sometimes worsens international crises. Who knows what’s next?
But what if we discovered a slam-dunk gene for religious faith that was so powerful that those who had it couldn’t help but believe? Could their detractors still regard them as simpletons or haters? What if we learned that the absence of that gene made for equally solid atheists? How would we believers treat them? What if some transgender people really have a body dysmorphic problem like anorexia? Or that there is a genetic marker that indeed makes them identify with another gender? What if discussing it isn’t hatred, bigotry or compromise, but compassion? What if we find, someday, that the science of climate change isn’t settled?
Obviously science advances. We love that idea until it bumps into us. What do would do when science, or new historical information, or some other new finding puts our personal beliefs in question? Can we let go of our political correctness? Or religious rigidity? Can we stop calling our opponents rude names? Are we OK with new facts when they contradict ideas dear to us?
It’s hard to let go. But just as we look back on our ancestors and smile about their quaint beliefs, someone will eventually do the same to ours. It will likely be the case that we were wrong about many things in ways we could never have imagined.
As times change and knowledge grows, we should all be a lot kinder in the way we view the opinions of others and cautious in the way we view ours own. Today’s unassailable fact could become tomorrow’s flat earth. A little humility, a little willingness to open our eyes and the courage change our minds, are probably in order all around.

Grandmothers as an ER Preventative Measure

This is my column in the latest edition of the Daily Yonder.  Enjoy and share as you see fit. Link followed by text.

Life & Limb: Grandmothers — An Ounce of Prevention for a Pound of ‘Freak Out’

 
I have a theory that engaged, wise grandmothers could save families a lot of money by helping avoid hospital visits. Personally, my grandmothers were very important to my well-being as a child. Not only did they feed and dote on me, they kept me healthy and safe. I remember the time I made a spear out of a sharpened stick. (OK, one of the times.) I was running with it, and as I drew back my arm to fling it across the field I must have stumbled. It ended up going through the top of my shoe and between two toes, scraping them on the way to the ground.
I limped to the big white house under the maples where Grandma Leap helped me take off my blood-soaked shoe, cleaned the wound, probably applied Merthiolate (didn’t we all spend our summers painted orange?), and said ‘don’t tell your grandpa, he worries!’ Maybe she knew he’d take my now cool, blood-stained spear away. I was none the worse for the wear.
I have seen injuries like this time and time again in the emergency room. Relatively minor affairs; scrapes, bumps, bruises, stings, nevertheless brought to the hospital by anxious mothers and fathers, new to parenthood or simply far more worried than necessary.
I also remember the smell of Vicks Vaporub, slathered across my coughing, wheezing chest. I remember cool cloths applied during fevers. My grandmothers had those simple skills down pat. Honestly, I don’t ever remember coming to the hospital for a fever as a child. And yet, fever is one of the most common complaints for which parents bring kids to the hospital.

‘He started having a fever an hour ago, so we rushed him to the hospital!’
‘Did you give him anything for the fever?’
‘Nope, we just came straight away. We freaked out and decided it was better safe than sorry!’

I hear that a lot. There was a bruise. ‘I freaked out.’ There was a tick, ‘I freaked out.’ There was a rash. ‘I freaked out.’ The baby’s nose was congested. ‘I freaked out.’ Freaking out never helps anything. And from what I can remember, it was simply something my grandmothers never did. Their job was to draw on centuries of collected cultural and family wisdom, apply personal experience, mix it all with loving attention (and food), and bring calm to all situations. Or bring switches as the situation required.
I’m not suggesting that a family member is all that’s necessary in times of medical need. And admittedly, there are plenty of grandmothers who are as ‘freaked out’ as everyone else. (I’ve met them.) Furthermore, lots of grandmothers and grandfathers are already doing this job as primary caregivers of their children’s children. God bless them.
However, it seems to me that we have an unholy confluence of problems that make people seek healthcare for things our ancestors wouldn’t, or couldn’t have. First of all, families are separated for various reasons from wise older relatives; or don’t have any. Second, people have 24/7 access to online health information that often only increases fear. Third, we have enormous numbers of young individuals and parents who never learned much about their bodies. Add that to the general increase in anxiety that mental health workers report across the land, and families are completely overwhelmed by the sorts of ailments that have afflicted mankind since well before modern medicine existed.
It seems to me that with our long history of self-sufficiency, and our deep-rooted connections to place and family, rural America should be one of those places where grandmothers could make a real difference in an era of limited medical access, coupled with enormous medical anxiety.
Maybe, in the mountains, valleys, bayous and plains that make up rural America we can be health pioneers! What we need to do first is educate young people about how to give simple medical care to themselves and others. First-responder and First-Aid/CPR courses are a great place to start. Second, those of use who are more experienced can reach out to young people and young families; neighbors, church-members, strangers at the food-bank, and offer to be there to teach them how to manage life situations. And how not to ‘freak out.’
Finally, those of us in medicine, whether nurse, physician, medic or other, can spend time educating the people we see so that they know when, and most important when not, to worry. And never to freak out.
A thing that grandmothers, in times past, taught us oh so well.

 

In an Age of Terrorism, do Something!

Here we go again.  In London three are dead and many injured thanks to the low-tech use of a car and knife in yet another act of cruelty and cowardice in the name of terrorism.  If you’ve been on a retreat, in a coma or hiking the AT, here’s a link:

http://www.bbc.com/news/live/uk-39355505

Brits rise up in unity and solidarity, etc.  Great.  We should all show unity and solidarity.  But we should all be able to DO something since the political class as a whole, around the world, seems to think the whole terrorist thing is like a teenage phase and has nothing to do with any particular belief, ideology or policy.  Witness the endless handwringing we usually see as police and officials struggle to figure out the attacker’s motivation.  ‘Gee, what could it be?’

Fortunately, the Brits have put more police on the streets.  ‘Armed and unarmed.’  It’s a great strategy really.  One of the dead was an unarmed police officer who clearly distracted the attacker and absorbed the knife so that others could use, you know, weapons to aid him in his pursuit of martyrdom.

I rant on.  But what I want to say is this.  We individuals cannot predict terroristic acts, and we certainly can’t stop them before they start. That’s the job of law enforcement and the military.  We can only do what we can, when these events happen, if we happen to be present.

So I’ve been thinking about things people should know how to do.  First of all, we should know how to PAY ATTENTION!  I have recently seen a commercial for a cellular company in which a young man streams movies and TV everywhere he goes, on the street, on the sidewalk, on the bus. The world around being, apparently, just too boring.  This is dangerous.  We should watch and learn.  Is that a suspicous package?  What does it mean that smoke is coming from under the hood of that parked car in the crowded area?  Is that a real gun the scary man pulled out?  Or is it just an oddly shaped, giant cell-phone? Why is that gentleman speeding towards me on the sidewalk?  Wait, am I on an episode of Impractical Jokers?  Paying attention to danger leads to running or fighting which leads to being the guy interviewed the next day about what happened, instead of the one remembered as ‘a really great guy who will be missed.’

We should also read.  Learn, from news, books, websites and classes, how to identify concerning behaviors and situations.  What does a firearm sound like?  What does a bomb blast look-like? (Clue, TV and movies get it wrong a lot.)  It’s easy to hear or see something dangerous and immediately think it’s nothing; we want it to be nothing, after all.

One of the sites I visit is Active Response Training. They have lots of articles about self-defense, as well as reviews of mass terror events, etc.  They also have excellent classes; I’ve taken one myself many years ago.

http://www.activeresponsetraining.net

Furthermore we should stop being lazy slugs and get in shape.  Sheesh, America, there are lots of great reasons to be fit; being attractive to your mate or potential mate is a good one.  So is living long and staying away from ER doctors like me.  But another is that when you are fit, you can run and fight.  This isn’t some right-wing way of looking at things.  It’s called an ‘evolutionary advantage.’   Run, bike, lift weights, hit the punching bag.  Do it until you’re exhausted then do it some more.  Say it with me:  Fitness = Survival.  It isn’t hard.

As a child I loved the Chuck Jones cartoon production of Rudyard Kipling’s mongoose story, Rikki-Tikki-Tavi.  In the movie, Rikki the Mongoose says:  ‘A fat mongoose is a dead mongoose.’ That is, a fat mongoose can’t fight poisonous snakes.  I’ve never forgotten that lesson. Thanks Rikki!  And thanks Mr. Kipling!  (Not sure if it’s in the book, but the cartoon message really impacted this kid…)

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So what else can we do in an age of terrorism?  Emergency physicians like me understand  how to manage serious injuries, but we need to encourage citizens to learn 1) first aid with hemorrhage control and 2) CPR.  CPR classes are everywhere and typically include use of Automated External Defibrillators or AED’s.  In fact, in trauma situations like those involving terrorism, CPR and AED’s are probably not going to be very useful.  But it’s good to know for other sorts of emergencies.

DHS has a website and initiative called ‘Stop the Bleed.’  It’s worth a look as there are training videos.  Many companies also sell bleeding control kits that citizens can, and I think should, keep in their vehicles or on their persons.  A tourniquet and dressing don’t take up much space.

https://www.dhs.gov/stb-learn-how-stop-bleed

I would encourage young people to consider taking local First Responder or EMT basic classes.  It’s information you’ll never regret having, and it looks great on a resume.

We need a veritable army of first responders out there, ready to help while police and EMS are either tied up, on their way or being attacked themselves.  Physicians should be part of the effort to teach this material as well.

Last, but not least.  Those so inclined should learn to fight.  Obviously, the average person isn’t Rambo or an Army Ranger.  Most of us will never be up the the level of an MMA fighter.  But it may not take all that.  MInd you, self-defense classes can be absolute crap.  Especially the stuff they foist on nurses and physicians in order to handle attackers and dangerous patients (since security is usually told not to touch anybody…).

And self-defense skills need repetition like all motor skills.  But those people who want to learn can learn.  Learning to fight, whether boxing, wrestling, martial arts, etc., is hard, painful work.  It isn’t for everyone.

.However, sometimes, it takes just a willingness to do something, or anything. I saw a video this week in which a citizen and CWP holder shot, and killed, a man who was holding down a police officer and beating said officer badly.  Now, he was armed with a pistol, but might just as well have used the shovel I keep in my truck to hit the guy on the head.  Or might have thrown a rock.  Or picked up a stick.

In a building, a fire-extinguisher might be just enough delay and distraction.  A can of wasp and hornet spray kept in the office is mighty nasty stuff if sprayed in the face.

If so inclined, as many of us are (and far more physicians, nurses, medics, etc. than you might imagine), carry (legally) a firearm or reasonable knife.  If the attacker is bent on killing you anyway, can you do worse than fight?  You may slow him (or her…sorry). You might keep them from killing anyone after they kill or maim you.  Or, if you’re in good shape and have trained in some sort of class or fighting discipline (or just get really lucky…or have angels fighting with you), you might win!  Sure, sure, people will call you a monster.  But lives will be saved.

It’s a dangerous world, and always has been. But there are things we can do to make it less so.

Sitting back while the danger grows with our fear, apathy and inability?

Those are just bad options.

So:  Put down the phone, pay attention, read and learn, get in shape, learn to help the injured and learn (or at least consider) how to resist.  America, heck, civilization, needs this now more than ever.

 

 

Introducing Social Orbit

This is a post by the good folks at Social Orbit, an excellent new social media application. Which, by the way, has been giving away signed copies of my book ‘Life in Emergistan.’  I encourage you to check it out and sign up. There’s a banner add over to the side that will take you directly to their site to learn more.

Medicine is changing.  A lot of the comradery and connection with our physician peers has been eroded because physicians are all so busy worrying about CPOE, EMR, TJC, metrics, billing, pop-up alerts, patient satisfaction surveys…the list goes on and on.  Orbit was founded to create a community where doctors can connect with each other and reconnect with what they love about medicine.  Greg Hadden, MD FACEP (co-founder of Orbit) notes, “There is an overwhelming feeling in medicine that the physician is turning in to just another cog in the medical machine.  The providers are the heart of medicine and the center of healthcare delivery. While every other company and organization is focused on trying to make medicine more efficient, they are forgetting the individuals in healthcare that actually make it all work.” Orbit wants to focus there.

 Orbit is a unique product unlike anything else out there.  By putting together a resource that has things that doctors value and by creating a fun environment of collaboration, Orbit hopes to provide something that doctors want to contribute to and engage in. The ultimate goal is to see all physicians sharing, collaborating, and supporting each other.  The app also wants to be a one-stop-shop for doctors. Orbit can keep them up-to-date with breaking medical news, help them plan their CME travel, help explore job opportunities, do HIPAA compliant chat, and learn…all while winning some really awesome prizes that focus on helping them recharge their emotional batteries.

 The future of Orbit is bright and the developers have a lot of grand plans for the app!  “In order to get there, we need doctors to give us a shot.”  More Orbiters means a bigger community, more collaboration, more sponsorship, bigger prizes, more frequent prizes, etc.  There is incredible potential with this and the developers have a lot of fun stuff they are constantly working on adding and integrating.  In addition, Orbit has big plans for expansion into other specialties in 2017 with the ultimate goal of developing additional platforms for APPs, RNs, EMS, and international healthcare providers. However, it’s important to the developers that the rollout is measured and strategic.  Says Hadden; “We need to be confident that when we get to that stage we are still able to serve our members by protecting the integrity and privacy of the group. US-based physicians are the only group that our app currently is able to verify and validate.  We want to ensure that we are not letting in attorneys, MBA/MHA hospital administrators, recruiters, etc.  Also, I think there are a lot of physicians that want to connect in a physician-only platform.  As we build out the app, our users will be able to customize the content they see and with whom they interact.  As an example, as we progress to include APPs, if a doctor wanted to participate in a physician/APP community then they would be able to do so.  On the flip side, if an APP only wanted to connect with other APPs, then they could customize their account to exclude physicians as well.”

 ACEP16 marked Orbit’s emergence out of beta testing and its introduction to a larger audience.  The Orbit booth at ACEP16 was packed the majority of the time with most of those people coming up to find out what the tagline, “Seriously Fun Medicine”, was all about.  Hadden explains, “In Orbit, medicine is a serious business…but it can also be fun!

 

www.socialorbit.com

Apple Store link: https://itunes.apple.com/us/app/orbit-medicine/id1120695349?mt=8