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God loves drunks!

Published by Edwinlea August 25th, 2008 in Uncategorized. 3 Comments

Friends,

This is my column in today’s Greenville News.

For God so loved the drunks

            I often joke that I’m not only an emergency medicine specialist; I’m an ‘alcoholologist.’  It took quite a while for me to develop that expertise.  See, I grew up in a home where no one used alcohol and none of our friends used alcohol.  Consequently, other than some college and medical school exposure to the stuff, I was pretty naïve about alcohol.

Now, 15 years into my practice, 18 years after medical school, I can safely say I’m well-versed in the management of intoxicated people.  I can calm them, negotiate with them, speak their language (‘just two beers doc!’), manage their injuries and keep them safe without much difficulty.

It’s a useful skill, since emergency departments see lots of people who are intoxicated.  In fact, American hospitals spend vast amounts of money caring for alcohol-related accidents and illnesses.

The scenario goes like this:  EMS picks up an unconscious person.  He smells of alcohol, but no one knows exactly what happened.  He was on the ground, so he may have fallen and sustained an injury.  The paramedics put him on a backboard and in a neck collar in case his neck or back are broken.  He arrives at the hospital.  He might end up on the ventilator because he isn’t breathing effectively.  He may become combative, requiring nurses, physicians, paramedics, security and police-officers to try to contain his behavior.  We take x-rays of his neck or back, or of any injured body part.  If he’s very confused or stays unconscious, he’ll get a CT scan of the brain to rule out brain injury or stroke.  Labs are drawn.

As he gradually awakens, he grows belligerent.  He’s angry at the staff, at his friends, at his life.  If he isn’t admitted, if he doesn’t have an obvious medical problem, we discharge him; though it may require valiant efforts to get him a ride home.  We may have to call a taxi (which the hospital often pays for).  On the way out, we may try to guide him toward some kind of rehab.  At the end of the encounter, everyone is tired and frustrated.  More often than not, the patient will never pay for the care he received.  Far too often, he’ll do it all again.  If friends or family take him home, they shake their heads in sadness.

That said, I admit that we sometimes fail.  People slip through the cracks.  Intoxicated persons can be treated badly, neglected, ignored.  Medicine is imperfect, its practitioners flawed.

Still, why do we do it?  Why do hospitals and physicians, nurses and paramedics, even hospital administrators, keep pressing on and caring for society’s alcohol abusers?  Why do we use staff and resources to do tests that we all suspect will show nothing, just to rule out the possibility of a problem in someone who constantly abuses the good will (and finances) of society?  Why do we plead with them to be still, or cajole and bribe them to stay safe in our emergency rooms, rather than just letting them get up and leave?

We might argue that if not for medical malpractice, we’d say ‘there’s the door!’  Without the risk of lawsuit, we might allow paramedics to leave them where they’re found.  Without plaintiff’s attorneys, we wouldn’t order those tests.  And that might be part of it.

Perhaps we do it because we know that alcoholism is a disease; a terrible, destructive disease, and so we feel duty-bound to treat its victims however difficult or expensive it may be.

Maybe we do it from a collective evolutionary instinct.  If we treat the sickest, the herd will be better and safer.  That might be true.

But I submit that the reasons we try to do right are deep and wonderful.  In medicine, we care for the drunks because we recognize the worth of even the most difficult and broken person.  We jump through hoops and try our best, we give our time and our skills, we accept that we’ll never see a dime, because at its foundation, medicine and our culture rest on the assertion that each individual has intrinsic worth in God’s eyes, and so must have worth in our own.

That’s the reason we wade through blood, vomit and stool.  That’s the reason we face the risk of flying fists.  That’s the reason we come back and do the same things, to the same people month after month, year after year.

‘For God so loved the world,’ the scripture says.  And the world includes the drunk as well as the sober.

Grabbing our fears by the rattle

Published by Edwinlea August 21st, 2008 in Uncategorized. 1 Comment

My family lives in rural South Carolina.  In fact, we live right in the heart of rattlesnake country.  Fortunately, our otherwise useless pack of dogs does one thing fairly well; they apparently move around and make enough noise to keep the snakes away.

So I was surprised last week when I came home and my wife informed me that her father (who lives on the same driveway as we) had killed a rattler with a golf club.  Jan had ridden past the snake and was afraid the children would be bitten.  So, my father-in-law dispatched it for his little girl. 

Upon discovering the news, I did what any good South Carolinian might do.  Grabbed two kids and went off to find the body.  It took ten minutes of poking in the bushes to find the 2.5 foot snake, whose markings made it incredibly hard to see (and disturbingly easy to walk over).  It was still writhing reflexively, but it’s head was crushed.  I didn’t need the .410 shotgun we had brought along in case the aluminum driver had failed to live up to its promise.

We decapitated the snake with a hoe, and took it home.  There, using a skinning knife I had used on several occasions in Alaska, we removed the rattles and skin.  It continued to move, rather sadly in a way. See, I don’t like snakes, but I hold no particular animosity toward them.  I understand their place in the eco-system.  However, I have cared for some bad rattlesnake bites and I don’t want my dear wife or any of my children to experience one.

As we skinned it, the children all gathered round, put on rubber gloves, and touched it.  They were enthralled.  Its heart was still beating in its long, narrow chest.  Its nervous system, wondrously sensitive, made it continue to try to strike us even once it was beheaded.

Its lungs were as lacy as any human lung.  Its stomach was empty, apparently not having eaten in some time.  The kids and I discussed anatomy and snakes in general.  We discussed skinning and caring for the removed skin.  And when all was done, I had removed the lovely snakeskin from the lovely snake, and tacked it onto a board to dry.  My youngest boy asked that I bury the snake; he’s sensitive to things like that.  (Though if I were thinking, I’d have pan-fried it just for the kids to have the experience.)

In the end, it was a great lesson in what not to fear.  The things that seem the worst to us often are only shadows cast by smaller fears.  That old snake left us all a lesson in how even something dangerous can be, in the end, just another living thing trying to get by in a hard world.  It seemed less terrible as we opened it, touched it, took what we could use and then put it back into the earth.

The rattle is still scary.  The skin is drying well.  And we’re all less afraid, and more respectful, of rattlesnakes than we were before. 

It was a good day, the day of the rattlesnake.

Sorry, Mr. Snake.  Thanks for your gifts.

Edwin

Unbelievable boldness and deception

Published by Edwinlea August 19th, 2008 in Uncategorized. 3 Comments

Not long ago I cared for a healthy appearing young woman who was under arrest for a non-violent crime.  While being arrested, she suddenly took a number of muscle relaxants.  She said she was afraid she’d have a drug charge if she was found with them, though alleged they were hers; she just didn’t like carrying the bottle.

In the midst of evaluating her, I asked why she had the prescription.  ‘For back pain.  By the way, while I’m here, can I get something for my back?’  She asked it without any hesitation, or any sense of the remarkable impropriety of her question.

‘Let me get this straight,’ I asked.  ‘You’re under arrest and took an overdose, and you think I’ll give you pain medication?’

‘Well, yeah, it’s the ER.  I just thought since I’m here…’

‘It isn’t going to happen,’ I said, and walked out.

‘Whatever,’ came the universal response behind me.

Fast forward.  While caring for a man with chest pain and chills, I asked for a urine sample.  The patient’s nurse brought the urine to me and said that it looked murky and she had a funny feeling about it.  Indeed it did.  Under the microscope it was, in fact, full of bacteria and white blood cells, consistent with a bladder infection.  Astute and appropriately cynical, my nurse felt that the urine belonged to the patient’s wife.

When confronted with his ‘bladder infection,’ the patient asked, ’shouldn’t my wife be on some antibiotics, too?’  Later, a specimen directly obtained from the patient was clean as a whistle.  I suspect he was originally hesitant because he thought I was ordering a urine drug screen.  I wasn’t; not until the second specimen, at least.

The average person, the normal citizen, the otherwise functional patient has no idea of the remarkable degree of dysfunction and deception we see in the modern emergency department.  Furthermore, they have no idea of the incredible boldness, the unflinching willingness to lie, misrepresent and manipulate to get what they want; and get it all for no charge.

I shake my head at the end of the day.  I love knowing the things I know, I love caring for people and treating sickness and injury.  Heck, I even like opening MRSA filled abscesses day after day, everywhere from head to buttock.  I do, however, become weary of being the recipient of constant lies.

It’s difficult to be lied to in medicine.  We inherently want to believe the stories we are told.  We hate to imagine that people are deceitful and wicked.  We want them all to be honest, forthright and truly in need of the things we offer.  It isn’t that way, unfortunately.

But if there’s any benefit, I can say that my eyes are open wide.  I am appropriately suspicious and by now, much wiser than I was in my youth.  The scriptures say to ‘be as wise as serpents and as innocent as doves.’

My patients, God bless every tricky one of them, have helped me to have that reptilian wisdom.  Maybe, hopefully, God willing, my suspicions, rather than making me dislike my human brothers and sisters, may save a life now and then.  Or at least, help me to see through the fog of bold deceptions in order to do the right thing.

May you be blessed with clarity and holy cynicism, today and always!

Edwin

Speaking out as physicians; my current EMN column.

Published by Edwinlea August 18th, 2008 in Uncategorized. 3 Comments

We’re told, over and over again, about the failure of medicine in America.  About the tragedy of our system, the horror stories of care unavailable, the misery of lives unprotected, the cost of surgery and medicine and hospitalization.  The public is inundated with the information that medicine has failed; that only the government, that great bumbling knight on the lame white horse, can ever come in and make sense of the debacle of American healthcare.

Well, I doubt it.  I think, on the whole, that we do a bang-up job taking care of untold numbers of people.  I think that we exhibit enormous care and compassion to those we see.  I also think that the news is not, as the AMA says, ‘one in seven Americans has no health insurance.’  The news is ‘six in seven Americans do have health insurance.’  That’s good news in an economy as diverse and complex as our own, in which we maintain the freedom to succeed without the weight of a completely socialist tax system.

But I agree with one thing.  Medicine has failed in a very real way.  We’ve failed by refusing to view the humans we see in totality, as humans, and by refusing to make them accountable.

Medicine, rather physicians, has decided that we can treat the body, but not the life.  That with chemicals, surgeries and ‘programs,’ we can make everyone healthier, even as they engage in every form of destructive behavior imaginable.

What we have failed to do is hold our fellow humans to any sort of accountability.  And the reason is that we’re told not to judge.  Don’t judge their drug use; don’t judge their drinking.  Don’t judge their promiscuity and don’t judge their family situations or lack of parenting skills.  And in the process, we have abdicated the influential role we once occupied, and should occupy again.

What our patients need to hear from us, once again, is ‘Tsk, tsk!  You mustn’t do that!’  What they need us to do is advocate for the wholeness, the wellness of their lives.  Beyond organs and bones, beyond the isolated concern for infected genitalia or needle-tracks, we need to remind them that some ways of living are bad; and some activities (however approved by the entertainment industry)  are destined to shorten their lives and leave them miserable on the way.

You see, when we don’t do that, we devalue our patients.  We look at them and say ‘well, it’s his life, he can do what he wants!’  Then we write the prescription and walk away, secure in the deluded belief that we have done our best as medical technicians.  Not professionals, of course, but technicians.  The prescription, the surgery, the referral to the mental health clinic, these become our ways of neglecting our duty.       When we refuse to see the value of each individual life that passes our way, we don’t have to tell them the whole truth, and we don’t have to offer them any solace, and we sure don’t have to offer them any guidance.  We slip in, we slip out, and the transaction is complete.

But what we need to do is more difficult.  More often than we acknowledge, we should look at them and say ‘you’re better than this, you know?’  We need to look into the eyes of the Meth addict and say ‘I know you can do great things; so you have to stop using drugs.  It’s criminal and worse than that, it’s ruining your life.  God made you for a reason and it wasn’t to use that garbage.’

We should look at the ‘baby-daddies’ that accompany poor, confused, pregnant little girls and say ‘Did you do this?  Are you going to take care of this young woman and the baby you made?  Or are you going to knock up a few more, eh Casanova?  Is this child your responsibility?’  We can be the defensive father or mother that girl-child lacks, if only for a while.

We ought to look at the parents of the teenage pregnancies, or the parents of the girls who will be pregnant, who are on oral contraceptives at 14, and whose boyfriends stay in the room for their pelvic exams, and say ‘do you want your daughter pregnant by this boy?  Are you crazy?  Don’t you know how hard this will be for her, and that he will give her a disease and abandon her, or else beat her and the baby?  Or ‘Son, do you want to marry this girl, or live with her, her crazy parents and that Chihuahua that you know is somewhere in the house?’

And when married men or women, or any men or women, come to us with STD’s, we need to caution them about how unfair it is to share that joy, how cruel it is to take it home to a spouse, and how they need to be more responsible.  Because what happens in Vegas, or Manhattan, or San Francisco or Cancun never stays there.

The teenage drunks need us to look at them and remind them of how adult drunks, old drunks, miserable drunks live.  And when we see drunk drivers, we should all do what I so often do.  That is, I say ‘you could have killed my wife or children.  Is that what you wanted?’

See, one of the reasons health-care in America is expensive and overwhelmed, is that individuals have no sense of their own worth, and no sense of the worth of anyone else.  And because families are struggling with infidelity, divorce, selfishness and abuse; families which were once the starting point and anchor point for proper behavior and attitudes.

People just aren’t taught how to live and how to behave.  And part of that education would have been learning right from wrong, learning to follow a set of moral/behavioral rules that lead to health and good relationships, not misery, drugs, drinking and disease.

As long as we sit back and write out drugs, nodding our heads and congratulating ourselves on our enormous cultural sensitivity and tolerance, all we’ll do is enable more misery for generations, and ennoble (by our silence) the very behaviors all of us pray each night for our children to avoid.

You know by now that I’m a Christian.  Worse than that these days, I’m a Southern Baptist Deacon.  But I’m not even saying we have to evangelize.  Most of the world’s major religions agree on some basic moral tenets, like the welfare of the innocent and poor, the safety of children, the value of marriage and family and the worth of individual lives.  So all of us, Christian or Jew, Moslem or Hindu, Bahai, Buddhist, Shintoist or Zoroastrian, and everything in between can at least agree on one thing.  Humans are behaving badly and suffering for it.  And we physicians owe it to them to speak out.

Guess what happens when you do?  I know, because I’ve done it.  They say, ‘Doc, you know, I realize what you say is true.  I’m trying to do better.  I agree with you.’  Or ‘Nobody ever said that to me!  Thanks!’  We are all children of God, and like all children, we want boundaries and rules.  The idea that we don’t is shear post-modern madness.

Some will get mad.  Let them.  Let them complain.  But folks, the world is in a bad way, and much of it because people don’t know any other way to behave.  Let’s offer them our insight, and our wisdom, served up with love and compassion.  And let’s use our medical badge to get close to them, and remind them by our concern that they are worthy of our concern.  The idea will surprise them.

The results might surprise us all.

Solace at home

Published by Edwinlea August 17th, 2008 in Uncategorized. 1 Comment

I’m working days right now.  I was in the ER 7-4 Thursday, Friday and today, and will be again tomorrow.  They’re busy shifts, full of everything from wounds to strokes, Bell’s Palsy to pneumonia, drunk left-overs from the night to hospice care.  At the end of a day, I feel emotionally drained.

I’ve sifted through so many complaints to find the one or two very bad things.  I’ve disappointed people by saying ‘I can’t find anything.’  I’ve angered families by saying, ‘I can’t admit your mother.’  I’ve asked other physicians for help only to have them circuitously, ever so politely, tell me that I didn’t need their help and could deal with it myself.  When I finish the last patient each day, turn in the pager and head for home, I really need some solace.

Fortunately, it’s there.  On the way home today I stopped to by some Coke Zero for Sam, my 13-year-old who is ill.  I got some Chex Mix for my daughter Elysa, who asked her mother to ask me for it.  I bought a watermelon and corn to eat with the steaks I was planning to grill.  And when all was prepared, we sat down to dinner as a family.  We’ve done it about five or six times this past week.  It has been a wonderful treat.  We played a trivia game where we had to list things from a card, like ‘The Seven Wonders of the World,’ ‘The Five Pillars of Islam,’  ‘The Ten Commandments,’ ‘The gods of Olympus,’ and so on and so on.  We laughed and joked and told stories.

We’ve read Bible stories and discussed their meanings.  I have tucked children in bed, talked with them, kissed their heads, rubbed aching tummies in the night, given Tylenol for fever, checked the glucose of my diabetic son, kissed my wife good night and held her, prayed my prayers and slept.  I have risen in the morning and begun again.

Sometimes medicine can drain us.  So we need a solace.  A home is such a place.  My home reminds me that I work to support the ones I love.  My home makes me laugh and smile.  My home fills me with warm memories of life with my lovely wife and children.  Home is my safe place, my own place, my hide-away from EMS tones, cranky doctors, sick patients, pharmacy phone calls about Percocet, dictations and every other niggling detail of daily life in medicine.

My family also reminds me that I take care of the other families out there.  Part of my job is to see to the well-being of the families who come to me.  I am there to ensure that they are well enough to return to their own places of solace, if such they have.  (For not every home is a solace.)

Before I wrote this, we jumped on the trampoline.  The air tonight is cool like Autumn.  The sky low with clouds, and green trees are dropping golden leaves amid the dried, dead remains of blackberry bushes.

In the cool air we laughed and bounced, wrestled and rolled.  In the cool evening we gave each other love and comfort.  In the past, when I played with the kids on that great bouncy delight, I would tire and they would huddle around me saying, ‘give Papa energy!’

Tonight they did.  Tonight my wife, also, gave me energy.  Tonight, my home and all I love, and work to secure, gave me more delight than I could have imagined.

I will sleep sweetly.  I will return to work tomorrow, having traversed the infinity of the night.  I will awaken reborn through the love of my family and the sweet solace of my log home on the red-clay hilltop in South Carolina.

Edwin

CT Scans; the new physical exam

Published by Edwinlea August 12th, 2008 in Uncategorized. 8 Comments

I work in a busy, medium sized emergency department. Because we’re busy, and because of the ridiculous burden imposed by EMTALA, lots of consultants don’t really want to come to the emergency department.

Can’t say I blame them, really. It’s often a thankless job, thanks in no small part to our legislators who made sure everyone has access to health-care, but conveniently forgot to pay the people who are doing the hard work and actually seeing the sick, dying, wounded, drunk, angry and annoying.

If I were in another specialty, I’d honestly consider going off the call schedule, opening a surgery center or any of the other options docs do to avoid hospital affiliation and EMTALA-mandated work.

However, we’re still stuck with the problem until we all unite together and insist on it being changed.  For now, people still come to the hospital and need care, need studies, need specialists.  For now, I have to sort through it all.

Which brings me to the point of this post.   A few nights ago I cared for a small child with abdominal pain and fever that began about 12 hours prior to arrival.  He had no vomiting or diarrhea, no cold symptoms, no urinary symptoms.  His knees were drawn up, and he was lying on his right side.  He was quite tender to exam, and showed guarding.  One year ago, he had an appendectomy.  One less thing to worry about.
His CT abdomen and pelvis, with contrast, was essentially negative.  His CBC, urine and electrolytes were normal.  I called the on-call surgeon and described the child and studies.  He told me that it sounded viral.  I admit, I hadn’t re-examined the child at that point.  I asked, and probably with the wrong tone, ‘So are you telling me that nothing bad can be wrong with this child?’  My surgeon friend became annoyed with me (not with the patient), and came to the department to do an evaluation.
What followed was a back-hall argument that turned out to be a little too loud.  I felt badly and apologized, and so did he.  But I tried to point out that in the emergency department, we are often faced with a conundrum:

Sick patient, worrisome exam, negative studies.

So, what do we do?  Now, I’m throwing this out to everyone, ER doc, FP, Internist, Hospitalist, Surgeon and all.  I’m not being sarcastic; I want to know.  Have we reached a place in medicine where the science of labs and imagining is sufficient to rule out dangerous etiologies without exam?  Have we reached a place where history and physical exam are simply vestiges of the old days of medicine?

I’m not a researcher, but many of you are.  Please give me your thoughts on this.  I don’t want to argue with anyone, and I don’t want to miss a diagnosis.  I also don’t want to cause already over-burdened specialists to have to come to the hospital when they needn’t.  But sometimes, frankly, I want another pair of eyes, another set of hands, another brain admittedly sharper than my own, to help make a decision.

And I’m just not sure the scanner qualifies.

What do you think?  If I’m all wet, if I need to quit my belly-aching and stop worrying, I need to know.

Let me have it!  And please forward this to other docs in other specialties as well.  Because it applies to cardiology, ENT, pediatrics, anyone who relies on any kind of lab-work or imaging.

Have a great day!

Edwin

Photos in the emergency room

Published by Edwinlea August 7th, 2008 in Uncategorized. 3 Comments

I love walking into the offices of obstetricians, family doctors or pediatricians, where pictures of children and their parents cover the walls.  It’s a beautiful tribute to what those practices do; they help bring children into the world, they keep those children healthy, they protect them in sickness and give parents peace of mind.

Considering modern privacy laws, I doubt if we could do the same thing in the ER.  The thing is, while families love for their babies to be featured in photographic collages, few want to be remembered for their last really big alcohol binge, their huge heart attack, or that cat bite that became infected.  Few people want to remember their emergency department visits at all.  You know what I mean:  ‘Look honey!  That’s you when you ate too many hot-dogs and vomited on the nurses!  What a nice picture!’

But there are some pictures we could put up.  I realized this a long time ago, and never acted.  I wish I had. 

What I should have done was start a wall of family photos in our doctor’s lounge.  It would have served as wonderful solace on busy shifts, on lonely nights, on early mornings when we all feel so distant from the ones we love most.  Our nurses already do this.  Their lockers are wonderful to behold, covered with images of husbands and wives, children and parents, friends, co-workers and even pets.  To walk by their lockers is to look inside their hearts; at what motivates them to continue the difficult job they do; and at the people and things that truly give them earthly delight.

It could have been the same for the physicians in our group.  Maybe we wouldn’t have seen so many marriage problems if the faces of our loving wives and amazing children had looked down on us as we dictated charts, or as we sat to rest, on the arduous, sometimes tragic, shifts that we endured year after year.

It certainly would have been a reminder to be thankful for their well-being; and thankful for our jobs, that have provided so well for the needs of the spouses and children God entrusted to us.

No artwork could have compared.  And as I sit in this lounge this morning, looking around at plates, soda bottles, junk mail, drug samples, unused fruit, the breeding ground of running shoes and all the flotsam of our medical lives, I can see that beauty of any sort would have been, make that would be, a welcome addition.  What could be more beautiful than my wife, my three sons, my daughter all smiling at me while I work?

I think I’ll start it now.  Maybe it isn’t too late.  Possibly it will offer a new perspective to our younger members.  Perhaps it will sustain all of us as we grow older, and hopefully wiser, in the practice of medicine, the practice of life, the practice of love.

So let me encourage you to do it as well.  Take photos and put them on the walls.  Ignore anyone that talks about fire-hazards, or fire-codes.  The only thing that will set the ER on fire is the patients. 

Let your day at work be llifted up and made lovely by the faces of those you love; spouse, child, parent, friend or lover. 

Maybe the days and nights will be a little easier for all of us that way.

Edwin

 

Blessings not curses

Published by Edwinlea August 6th, 2008 in Uncategorized. 2 Comments

When I was younger, after medical school, I went through a profanity phase.  It was a ridiculous time of my life, and one I’m happy to report is long gone and long forgiven.  It was an odd time.  I was newly married, and in residency, so maybe the stresses of medical education, or the stress of a new marriage made me…oh, who am I kidding!  I was young, tough, immature and wanted to sound cool like everyone else going through their profanity phases.

I have friends who have had, and continue to have, profanity phases.  Some of them use profanity like a kind of sub-dialect of English.  In that dialect, assorted bits of profanity can be used as almost any type of word: noun, verb, adjective, adverb, conjunction or preposition.

Many of their phases were abruptly ended by the arrival of children, whose little angelic faces looked up one morning and said something like ‘Mommy, good (expletive deleted) morning!’  At which point mommy screamed, called daddy, threatened daddy, and both put up a ‘cuss jar,’ in which each had to place a dollar for each bit of profanity uttered.

The prospect of their little prince or princess talking like a drunken sailor to the pastor, teacher or ancient auntie has thus forced many parents to shut down their foul language in short order.  Other parents, weaker but more honest, have used the ‘cuss jar’ to buy luxury homes, private jets and small islands.

All humor aside, since profanity so often begins at home, students in elementary school, middle and high school are sometimes better versed in this kind of speech than they are in the basic tenets of English grammar.  Even worse, they send it in text messages!

And parents, too many parents, aren’t the least bit interested in their children using proper, civilized words.  They sometimes seem almost to encourage it in their homes, where screaming curses must be the musical soundtrack of hard lives and sad, abused kids.

Having begun at home and been refined in gatherings of students, profanity is all too ingrained in our culture.  It floats through hospitals, schools and businesses; it inhabits clubs and bars; it is a staple at sporting events.  It is constantly reinforced on television and movies; even in some music.  And ultimately, it diminishes us all.

Having been the recipient of plenty of drunken, raging profanity in the emergency department, I can say that I never enjoy it.  Granted, in the right mouth it can have an almost comic-poetic quality.  But the right mouth is seldom the one slurring and spitting at me.

See, I have realized that when we curse, we are usually (consciously or not) invoking or calling for evil or misfortune upon a person, thing or situation.  If not that, we are certainly expressing an angry, seething dissatisfaction with a person, thing or situation.  This is never constructive.  Actually, it’s frankly destructive to any person who is the victim of our curses.  And more than that, when we curse we often frighten the people around us.  Children are especially sensitive to the tone of profanity, which tends not to be expressed in a gentle, smiling whisper.  (Unless someone stubs their toe in the church vestibule.)

So I’m calling for an end to curses and a beginning of blessings.  I’m asking parents to teach their children, by example, to use language that builds others up.  To express anger with words that may show frustration, but do not call down evil upon anyone or anything; to speak like angels, not demons.

I’m asking office workers, government officials, public servants, physicians and nurses, teachers, students and everyone else to simply be considerate.  I’m asking everyone to return civility and chivalry to the world, and to elevate our language, not drag it lower.       The world is badly in need of blessings.  So let’s spend our linguistic energies creating ways to say kind things, hopeful things, and beautiful things.  Even in our disagreements, our speech can be gracious.

It’s possible!  So far, I’m happy to report that my children have heard, and learned, very little profanity.  ‘Dang it,’ ‘rats’ or ‘cuss-a-monkey’ are their verbal invectives.  In fact, my kids are disturbed by profanity.  I’m proud of that.

Because I know that even if they have their own profanity phases as adults, in the back of their minds they’ll know that they have better words to substitute; and that in the end, blessings trump curses.

Disclaimer:  This was my Greenville News column last week, but it’s a point that’s important to me, so it’s reincarnated on the blog.

Running Rant II…the sequel

Published by Edwinlea August 2nd, 2008 in Uncategorized. 5 Comments

Tonight I’m working third shift in the emergency department.  It seems appropriate to take this time, yet again, to update everyone on my experiences and observations.  So, it’s 1:18 am.  I have only seen 11 patients since 11 pm.  Standard stuff.  But, as always, the night is rich with wisdom to be mined and cast abroad across the blogosphere.

Patient:  ‘My child has a fever.  The pediatrician said for me to come in and have someone check his ears and throat.’  I almost called the pediatrician back just to say, ‘hey, his ears and throat are fine.’  Which, of course, they were.  It was a FEVER! 

Patient:  ‘I jutht tookk fooorteeen ambeean.’  Translation:  I just took fourteen Ambien.’  Why?  ‘I hadd surggerrree and wantteddd somethinngggforrpainn.’  Pill count comfirms fourteen missing Ambien, possibly some missing Meprozine (demerol/phenergan).  Not suicidal, just hurting. I used to think toxicology was fascinating, and I had visions of exotic envenomations and higher biochemistry.  Nope.  This is community toxicology.  Ambien, Xanax, Valium, Lortab, Oxycontin.  Identify, observe, intubate if necessary, release when alert.  Fascinating.

Essential procedure:  I realized recently that residents in emergency medicine should add, to their procedure list, ‘get cup of ice for patient or family member.’  They’ll be doing it a lot more often than they intubate.  

Nights are the time when young people, with otherwise uneventful, unemployed lives, realize that they aren’t tired enough to sleep and nothing is on television. And on Friday and Saturday, the drama-meter reaches an all-time high as young men and women scream at each other, fight like angry cats and declare their undying, drunken love.  Nights are when people who should be in bed wander the steamy summer nights, explore after-hours Wal-Mart, and invariably stop by the ER in hopes of some interesting story or medication. 

They would be tired, and probably home in bed (instead of pushing their babies in strollers at all hours of the night) if they held gainful employment.  As Christine (of neuromotivator fame) observed:  ‘Get a job; it will make you tired every single time!’

1:55 am.  I’m up to 13 patients.  Among them, passing out and rash for 6-12 months.  As expected, a negative workup.  Thank heavens for the biscuits and jam our ward-clerk, Charlene, brought for us.  Biscuits and jam are as good as any anti-depressant on earth.

Before I came to work I watched Michael Caine in ‘Zulu,’ the movie about the British fighting the Zulu in 1879.  Surrounded and outnumbered, they won the day.  I feel surrounded and outnumbered.  But at least they could fire volleys with their .455 Martini-Henry rifles.  All I have is Lortab to throw at people.

02:45 am.  I have seen 17 folks.  Evaluated a baby for sepsis, diagnosed tennis elbow (an emergency if ever there was one) and have heard the nurses fielding question after question…’How long?’  ‘How many doctors are there?’  ‘Am I next?’ 

4:45 am.  Patient:  49-year-old male, wrecked vehicle after 45 minute police chase.  Charged with first offense failure to stop; second offense driving under suspension.  Under SC law, neither crime, nor their combination, constitute a felony.  His enlightenment?  ‘Doc, I messed up tonight!’  He’s lucky he wasn’t in Georgia.  They would have shot his tires out.  The SC legislature, and the DUI attorney lobby, robbed me of the joy of knowing he would go to prison.  Rats.

5:50  I’ve seen 25 patients.  I’m so tired I lie my head by the computer, but not before eating the last biscuit and jelly.  I…just…can’t…stop!  They keep coming.  The night, barring any other disasters, will involve 28 patient encounters.  Sutured chins, sick babies, motor vehicle accidents, chest pain, falls, lacerations, even some hypergloobiotrineziosis.  Well, it’s as good a name as any for all of the weak, dizzy, tingling all over, confused, rash covered chest pain patients I’ve seen.

8:00  I’m trying to finish up some charts.  Reflecting on how we continue to do this job despite the fact that modern emergency care is an almost impossible endevor, in which we are always overwhelmed and always at the mercy of someone with no real problem, no desire to pay their bill and no interest at all in how exhausted or beaten down the staff may be when they check in for six months of itching.

EMTALA has killed us, and we continue to do our best. 

8:30:  I’m tired.  Finishing charts and going home. 

God give us all patience and strength to do the right thing, and the courage to confront what is wrong.

Edwin

 

MedBlogs Grand Rounds 29 July, 2008. ‘Why do we do it?’

Published by Edwinlea July 29th, 2008 in Uncategorized. 11 Comments

Welcome to Grand Rounds! This is my first time hosting, so thanks for your patience as I stumble through. And thanks to everyone who submitted! There are some extremely insightful folks out there, and I’m grateful to showcase their thoughts.

Here’s how I’m setting this up. As I said when I called for submissions, my theme this week is ‘Why do we do it?’ That is, medicine being what it is, many providers (nurses, physicians, PA’s, NP’s, etc) are dissatisfied and frustrated. So why is it that all of these good people keep coming back? Why do docs like me return to the packed, over-burdened, understaffed emergency department, day after day, year after year? Why do surgeons operate at all hours on the injured and dying, aging too quickly and leaving their families at home? Why do family doctors care for so many complicated and ungrateful individuals…at a financial loss? Why do students sacrifice so much of their lives to become physicians? Why do nurses endure the hours and patient ratios, the annoying physicians and the pesky families in order to care for the sick? Why do we do it?

It’s a question I think about quite often, so I wanted everyone else’s thoughts as well.

Now, here’s the layout. The first section will contain links that address the theme. Following that will be some comments from non-bloggers who had something to say after reading my question. They don’t blog, so I’ll be posting their insights here.

The second section will contain links to topics that are not on our theme, but still contain useful, important information that were submitted by people who deserve our attention.

Let me explain section three. Section three will contain links that are basically advertisements. As a free-market capitalist, I’m fine with advertisements as long as we know that’s what they are.

Now, finally, if I mess this up, it’s entirely my fault. Please forgive me if I get something wrong. I’m really not very good with computers, blogging, websites or any of that stuff except the writing itself.

Section One: Why do we do it?

Here’s what I think. We do it for so many reasons. Because it’s exciting, because we love challenges. Because we have families to support and need the money. We sometimes do it for prestige, we sometimes do it for power and control. But what matters to each of us is not why ‘we’ do it, but why ‘I do it.’

I do it for a few reasons. First, because I believe God called me to it. I never intended to be a physician. I wanted to be…lots of things. That wasn’t on the short list when I started college. But it became very important to me, and it has become such a wonderful life, such a great job, such a rewarding experience that I know the hand of the Creator was in it. But more than that, I think he puts the desire to help into our hearts.

We care, not because humans on their own do, but because the need to help the helpless, to heal the sick, is God’s gift to us, and God’s extension of his own hand into our world. Modern health-care requires nothing less than a divine initiative to keep us going, caring for both the best and the worst of humanity, in difficult situations, and often for little earthly reward.

Second, I do it because it’s my way to support my family. The children and wife I was blessed with need things. My work as a physician is an honest way to provide what they need. And a way to show my children that parents provide by working. They need to see me going to and coming from work, and doing my work well and with honor.

Third, I do it because it’s a great laboratory for writing. Patients show us many things as writers, from nuances of language and dialog to the soaring and diving emotions of human experience. Let’s just say, I carry a notepad.

Finally, fourth, and most important, I have come to see that I do it because I love wallowing around in humanity. I love knowing that I’m caring for people as broken and messed up as I am. I love touching them, hearing them, being intertwined, however briefly, in their lives. I love using my hands and brain simultaneously.

I love learning to love them. Medicine, brothers and sisters, is poetry in flesh and blood. Learn the meter and you’ll see more than you ever imagined.

That’s why I do it.

Now, onward and upward!

Edwin

In this post, Anesthesioboist tells, without telling, the shear joy of her work and in the ‘not telling,’ explains why she keeps coming back. This is the way good writing works, friends.

http://anesthesioboist.blogspot.com/2008/07/tales-from-saint-boonies-songs-in-or.html

It isn’t just people who directly care for patients who ask ‘why do we do it?’ Here’s a post from Colorado Health Insurance Insicer, on improving reimbursement for physicians using electronic transfer of billing data. Wait, you do it to help us make more money? Then you’re my hero! Keep up the good work.
http://www.healthinsurancecolorado.net/blog1/2008/07/24/electronic-prescription-transmittal/

Although this post, by South African surgeon Bongi, is not openly related to the theme, it addresses it. Sometimes we do what we do through shear will-power and professionalism. Next time I whine, I’ll have to read this post again. I salute you, doctor. I couldn’t do what you’re doing.

http://other-things-amanzi.blogspot.com/2008/07/im-on-my-way.html

An interesting twist; this blogger addresses ‘why we do it,’ by reminding me why he blogs: to spread the news about coping with pain. In this post, we are treated to a look at the therapeutic benefits of the Wii. Do NOT show my children this post! It would only validate their desire fo a Wii.
http://www.howtocopewithpain.org/blog/194/wii-chronic-pain/

From Hope for Pandora, a middle of the night post on ‘Why?’ Those night-time thoughts are often the best, though sometimes I used to come off of night shifts with the keys to fixing everything, and insights that approached enlightenment. But then, I went to sleep and forgot them. Maybe it was the bacon I ate. Still, this post makes beautiful connections on purpose.

http://hope-for-pandora.blogspot.com/2008/07/typing-my-way-through.html

Some physicians find meaning in moving from medicine proper to larger arenas of interest. Here’s a post from Canadian Medicine on a physician whose interest in climate change is driven by his interest in patient welfare.

http://canadianmedicine.blogspot.com/2008/07/interview-dr-pierre-gosselin-physician.html

This post addresses ‘why we do it’ by showing the results. A well-known and highly respected dietician, she points out how a congressman benefited from proper diet and exercise. Trimming the fat from a congressman seems to have worked well. Now, how about trimming the fat from congress?

http://www.healthline.com/blogs/diet_nutrition/2008/07/way-to-go-congressman-ric-keller.html
From chaplain, English professor and ER volunteer, Susan Palwick, a reflection on why she teaches medical students. Not an easy task, I can tell you. I hope she keeps it up. Medicine without humanity is a terrifying prospect.

http://improbableoptimisms.blogspot.com/2008/07/score-one-for-narrative-medicine.html

Dr. Zhang reminds us, with Yucca plants, Tarantulas and healthy skepticism, that we do what we do out of interest!

http://cockroachcatcher.blogspot.com/2008/07/psychosis-plant-talks-back.html

At last, a reason to become a physician that invokes the power of Star Trek! I love this post. And as a long-time fan of Star Trek, I completely agree…Thanks Dr. R!


http://mymedjokes.blogspot.com/2008/07/my-trek-to-medicine.html

Why we do good things matters. But we must also ask, ‘why do we do evil things?’ This post, from J.C. Jones, MA, RN, asks how psychiatrist and war criminal Karadzic moved from medicine to evil. We may never know the answer, but the question is always relevant.

http://www.healthline.com/blogs/healthline_connects/2008/07/medical-doctors-and-genocide-dr.html

P J Geraghty tells us, not how we providers are special, but how some of our patients families are remarkable. Like those looking through tragedy to organ donation. Why do they do it, I have to ask? Or more to the point, how?

http://evelgeraghty.wordpress.com/2008/07/22/the-ghosts/

Dr. Auerbach gives us National Estimates of Outdoor Injuries. I guess, if you’re going to hike, snowboard or ski, you should do it indoors?
http://www.healthline.com/blogs/outdoor_health/2008/07/national-estimates-of-outdoor.html
Dr. Dee tells us, candidly, that the mountain of debt threatening to fall on him keeps him coming back. I know the truth. It’s what he later tells us; he just likes it! Well, if you like it, you’ll get the debt paid off without even realizing it!

http://www.nzou.com/2008/07/26/why-i-do-it/

I love the answer from Dr. Chan at Rural Doctoring: but I’ll let you read it for her great ending, which sums up what so many physicians feel, and so few can articulate as eloquently.
http://www.ruraldoctoring.com/2008/07/case-metastatic-cancer-week.html

Dr. GC George loves what he does because he is constantly learning from that most amazing of all texts; his patients. Here is a man writing with humility and a great heart. His mother’s prayers, apparently, continue to be answered.

http://www.gcgeorge.net/2008/07/27/why-do-we-do-it/

Why we do it is closely allied to ‘how do we do it?’ and ‘how will we afford it?’ This post by DrRich explores how much money we spend in our attempts to do the right thing.

http://covertrationingblog.com/general-rationing-issues/is-treating-cancer-worth-it

Kerri ,at Six Until Me, explains why she does it. Does what? Keeps moving on, keeps finding happiness despite medical annoyances and set-backs. What’s not to love about a ceramic blue-bird?

http://sixuntilme.com/blog2/2008/07/blue_bird_of_happiness.html

From friend and co-worker Loon1900, a discussion of what motivates an intelligent, capable young man to work as a nurse in an ER full of difficult, ungrateful patients. (And speaking as someone who works there, quite a lot of nutty physicians!) His answer is just what I would expect from someone of his character. Well done.

http://www.xanga.com/loon1900/667910565/item.html

Psychiatrist doctor dymphna, aka Dr. Cordes, loves her work and considers it a ministry. I think she’s absolutely correct in that assessment.

http://drdymphna.wordpress.com/2008/07/28/why-do-i-do-what-i-do/

My friend and former roommate John has an excellent, inspiring, post on why he is still a physician:

http://www.lightalongthejourney.com/?p=688

I have included notes from non-bloggers, who happen to read my blog and want to comment:
Here’s a note from ‘Dr. in training’ Ye, who gives us a most eloquent, lovely, and candid look at the path she took to medical school. I’m glad God directed her in the path she took. (And Dr. Ye, the desire to be useful is a wonderful reason for pursuing medicine!)

Hi!
Your question - ‘why do it’ was interesting, perhaps because not only do I like listening to other people’s reasons for going into med school/becoming a doctor, but because it’s something I spent a couple of years trying to figure out, and even now, my reasons continue to change and make themselves clearer.
Granted, I’m only in my first year of medical school [and in Australia], so I suppose I’ll be forgiven for being a little idealistic.
I can’t really remember when I first decided I wanted to be a doctor. When I was young, I’d read encyclopaedias and be particularly interested in this picture of a baby inside a mother’s womb - the translucency of the skin and the baby, so perfect, really called to something in me. I’ve always liked pretty things, after all.
Then in high school, it sort of just was the thing to say. With parents who put a lot of pressure on me to do very well, and the two ‘proper’ accepted answers when someone at church asked ‘what do you want to be’ was either a lawyer or a doctor, I always said I wanted to be a doctor, without really thinking about it. [My father had been involved in law, and I’d known from a young age that really, I wasn’t interested.] I’d always liked science and maths, and in Year 12, I discovered a love for chemistry, and as it was a prerequisite for most medical courses, I figured [naively, I know] it was predestined.
When the time for interviews came, that was the question everyone knew would be asked at every interview at all the schools. By then, I’d had that dream for a long time, and I believed that God that wanted this for me. I still couldn’t explain it - just that I really, really wanted to. [Admittedly there was the fear of disappointing my parents, but was I going to tell the examiners that? No.] Perhaps getting into medicine represented for me just another success in my life - something akin to walking along a relatively easy, straight path where my future was so clear and so obvious to me. [I tend to plan my life out, many years in advance.] However, I didn’t see a small branch in the road until I came to it, and at the crossroads, I was blown onto its path.
To sum it up in a word, bewilderment.
I actually got accepted into law. Basically, I hadn’t done well at the interview - my marks and UMAT score were not particularly high, but high enough. My parents were disappointed, but not unduly concerned. After all, I’d gotten into law, which was good enough - it would ensure financial security, and wouldn’t be a waste of my schooling. I don’t think my mother understands to this day why I chose to defer and re-sit the UMAT again, so I could re-interview, and apply again to medical school. To be quite honest, I’m not sure I do, either.
Maybe it was just pure stubbornness - it sounds so petulant, but I’ve always gotten whatever I’ve truly wanted. I suppose they weren’t that great achievements; getting into a selective school, getting a project featured in the school magazine. I couldn’t believe that I hadn’t gotten in, especially as I’d prayed so hard, hadn’t asked God for much, and I’d worked hard for my marks. I was also afraid what this would do to my father - who wasn’t of good health anyway, and stressed about the littlest thing. Even if I didn’t stress, he would, so I’d wanted to get in, so that he would stop worrying.
But really, I couldn’t stomach the thought of doing a course in law. So I declined my arts/law degree places and decided to sit the UMAT again. My friends thought I should defer, just in case, but once faced with the decision, I knew I couldn’t do it - so why hang onto a place I wasn’t going to accept anyway, while robbing someone else’s who might really want it? Besides, I thought that if I left that option open, there was the possibility of weakening and doing something I knew I’d hate. I had doubts about what God wanted for me - did he want me to do law, instead? But there was no vision, no future when I imagined that, and I wanted to study medicine so badly that I prayed that I’d get into medicine, even if I was to combine my degree with a law degree later. I tried so hard, that year, for His will to be done, but I also thought - please let His will be that I do medicine and not law.
During that year, I learnt things. I had much more time on my hands, and I did study hard for the parts of the UMAT I’d done badly on. [I did much better the second time around ^^] I learnt, when I wasn’t allowed to give blood, that one had to be healthy themselves to be able to look after other people. I learnt, when one of my closest friends moved countries, that people and circumstances change, and that I can’t control everything in my little world. I learnt, while working at my parents’ store, that there are many different types of people in this world - arrogant, annoying, rude, those without integrity, those who are immature, those who are thoughtless. However, I also found that those people were only significant in their rareness - most people, when talked to for even just a minute, became a 3-D persona who were pleasant, easy to talk to, and most of all - kind. It was a little bit of a culture shock - I realised how cloistered my school life had been - filled with similar-minded people, who were all intelligent and smart. I learnt really, how hard it was to get into medicine. But I think the biggest shock of all was learning that I was not infallible. That things didn’t always go how I wanted them to, when I wanted them to.
Even I think that it sounds arrogant - a 19-year old girl thinking that she could accomplish anything. However - it had always been like that. My parents were always away at work, and tried to give us the things they could afford, that we wanted. Especially for me, who didn’t like to ask for money and did without unless they asked. That way, I’d known that if I’d really wanted something, my father, if not my mother, would get it for me. I’d always been intelligent, having been taught well from a young age by my parents who understood the importance of education. And I liked school, so I studied. Good grades came easily to me, especially at a small, local primary, then high, school.
Near the time when results came out, I was terrified of praying to God - I did pray that He’d change my feelings, that I would want what He wanted, but oh, no, I didn’t. I still wanted to do medicine - I clung onto that idea as if it was the last reliable thing on Earth. But this time, I was accepted.
I was happy - but I couldn’t believe it. I spend those holidays alternating between feeling insanely happy and smug and wonderful and wondering what I’d do if my name wasn’t on the enrolment list, if they’d made a mistake, if they’d let me in anyway [because after all, it was their mistake - don’t ask about the logic]. Even after enrolment day, when my name was on the list, I spent the first couple of months of school checking and re-checking the class lists and allocations, just in case my name wasn’t on it. It was only after the midsemester exams that I figured, they really have accepted me, I’m really in med school. And by then, I couldn’t even be completely euphoric, due to that horrid exam, but I did spend a couple of days going around with a smile stuck on my face.
I initially wanted to do medicine because it was the only acceptable answer. I’ve only got a semester of medical school behind me, but now my reasons for wanting to do medicine are different. I still like the science part of it. But I realise that I want to do something practical, even if it’s measuring someone’s blood pressure with a mercury sphygmometer, or talking to patients and hearing stories. I also figure that doctors will always be needed, and it’s nice to be useful. Learning the subject is absorbing, even if it’s intimidating that there’s so much to know. But even that’s exciting, because there’s so much to look forward to. Ultimately it feels as if it’s myself I’m learning about, which is also interesting, but what draws me to medicine the most is the utter fascination I feel for it. The various factors that influence patients in coming to see a doctor, the various biochemical reactions in the body that manifest and appear as different symptoms, and the fact that I will [hopefully] be able to do something, even if it’s little. Because to me, being helpless and being able to do nothing to contribute or help is a situation I don’t ever want to find myself in. I’m not sure that the lessons I learnt last year were all that hugely notable, but I still believe that God has a plan for me, something He wants me to accomplish. So now, while I can, I’ll revel in my idealism, letting it shape me. For I think that making my ideals a reality is something that I can always work towards - I’ll never accomplish it.
Oh gosh, that’s long. Thank you, if you’ve read all this, and I hope it was worth your time…and not too uninteresting.
Now, insights from the other end, after medical school. This is from an emergency physician in the Midwest, well into practice:
I am 10 years out of residency and work at 3 different hospitals because I enjoy the cross section of society that I see by working in 3 distinctly different EDs.Isn’t that what emergency medicine is about? And I stick with it because I know I am good at this(10 years of experience is considered by many residency directors(ie Carey Chisholm) as the peak of our career. I am experienced, triple boarded and generally love what I do. To get through my shifts I pray before each shift, God help me to love my patients and colleagues, and protect me from malpractice. And my prayer is answered daily! I love my work and my patients! It is the threat of malpractice and the experience of 2 suits(unsuccessful for the plaintiffs but stressful nonetheless) that has me planning my retirement/chance to leave medicine at age 50(9 years and 5 months from now). The anticipated further erosion of respect, and decreasing reimbursement adds to this. I have not decided what I will do when I am 50 but it most certainly will not involve working all night, not getting paid by a significant proportion of patients that I see, being verbally abused and physically threatened and lied to by patients to whom I am giving free but top notch care, and functioning under the daily cloud of the malpractice threat. So I do it for the reasons stated above and because the end is in sight: my physician husband and I have saved aggressively for retirement, so as of 2017 ….I am outta here!!From my friend and emergency medicine mentor Tom:
Thats a great question. Why do we do it? Is it because we invested all our early lives, substantial money and hours, to enter a field where we help people, and despite the fact that we work longer, harder hours for less and less, it still boils down to that–we WANT to help people? For the most part, I think so. Sure, we have become jaded by the drug seekers, the stupid parents, the drunk drivers maming the innocents, domestic violence, and the fact that “all patients lie.” We are told every year we will get paid less and less by the lawmakers that then vote themselves raises or the insurance company CEOs who take their huge bonuses. But all that starts to fade away with the smile of one child in pain that you know you have made comfortable. It goes away when, even when you have lost a patient, their family thanks you for all you did. It goes away when you have the privilege to see the miracles we (and God) perform on a daily basis with the upgrades in medicine (or sometimes, just God on his own!). It goes away when we see patients that we used to see die now living on a regular basis. It goes away when a hospital CEO comes up to you and thanks you for the good job you do. And occasionally, every so often, you are PROUD of what you do every day and know that despite what you say, how much you want to quit at times, you never could. Because down deep you know it is a blessing to be a physician and God gave you the gift to be one, and that is what he intended for you. To throw that away would be a sin.
My friend Vicki, a compassionate and kind PA, has this to say:
I vividly remember as a 3 year old having the calling to go into medicine - but I knew I did not want to a doctor or a nurse. Those were the only two medical professions that involved direct patient care that my simple mind could embrace. Thus, I searched somewhat randomly looking for my niche’ is various medical research settings always coming up empty-handed. Finally, in 1989 I discovered my career path as a physician assistant.At that time I was doing what most people would do when they’ve just learned their loved one, in my case my 29 year old sister with a barely 2 year old daughter, was diagnosed with stage 4 lymphoblastic lymphoma. I was accompanying her to her numerous visits and ultimate admission to Fred Hutcherson Cancer Research Center (FHCRC) in Seattle.All of her day to day care was administered by incredible PAs and I knew that was the career I had been searching for. So I began the cumbersome process of applying, interviewing and praying for admission to PA school. My training was extremely challenging because my oldest child was 3 and my baby was 8 months old when I started PA school. Frequently I would ask myself “Why am I doing this?”The answer came years later during the end of my PA training while I was in my last rotation at none other than FHCRC. My first day at the hospital was my sister’s birthday, the first room I rounded in was the room she was in and my first patient died the same day she did. What are the odds of those “coincidences”?It was then that I realized why I “do” medicine. The fundamental of my calling is wrapped up in this - all of life is precious no matter what stage, it is an honor to walk into someone’s life at perhaps their most vulnerable moment and be able to provide excellent medical care, but more importantly, a drink of “Living Water” and the privilege to witness a miracle that I am positive medicine did not prepare me for or create in most humbling.I am deeply honored and privileged to practice medicine!

Section Two: Assorted links to important topics

Falls: A topic important to me as an Aikido student! As my Sensei says, we’re only born with one fear: the fear of falling. Most Aikido students spend a long time learning to fall, and a longer time learning to make other people fall. But how do we keep the elderly from falling? And most importantly, how do I keep from falling when I get old? That break-fall may not work at 95!


http://neuroanthropology.net/2008/07/21/fall-prevention-in-older-people-stephen-lord-at-hcsnet/

Finding the truth can be elusive when the media gets involved. Ironic, huh? When I was in journalism school, however briefly, we were told that we were ‘gatekeepers of information.’ At the time it sounded heady and cool; now it sounds creepy. Here’s a post on the way the media affects public perception of insurers.

http://insureblog.blogspot.com/2008/07/caitlins-story-jumps-shark.html

Last week I was reading Slate magazine and saw an article on a death in an ER, which occurred while a psychiatric patient was awaiting a bed. I had issues with the conclusions the writer made. I’m glad someone else did as well. Thanks to Emergiblog for this honest, and critical, look at the Slate piece.

Although I confess to little knowledge of it, ADHD is always in the news, and certainly a diagnosis many patients carry. Here’s a much viewed post on a relevant topic.
Looking for healthy links? Ways to make yourself more fit, or make fitness less painful and more fun? A post and links from fitness fixer!
http://www.healthline.com/blogs/exercise_fitness/2008/07/new-fitness-fixer-index.htmlFeel like some coffee? Liver feeling ‘out-of-whack?’ Grab some Joe. Pity I hate the stuff. You coffee drinkers may have yet another reason to celebrate your icky, bitter nectar of life. Here’s a post on coffee and liver cancer.http://www.highlighthealth.com/diseases-and-conditions/increased-coffee-consumption-associated-with-lower-risk-of-liver-cancer/

Traveling Doc takes us on a teaching adventure in Borneo. Heck, I’m not sure I ever want to practice anywhere but South Carolina! Thanks for letting us adventure vicariously through you!

http://borneo-breezes.blogspot.com/2008/07/trip-up-mountain.html