edwinleap.com

I am an emergency physician.  As such, I spend a great deal of time communicating with other physicians.  ‘Will you see this patient?’  ‘Will you admit that patient?’  ‘What do you think about these symptoms?’

I have turned into a pretty effective communicator.  After years as a physician, I can get to the point in short order.  No more long histories, suspenseful build-up, dramatic conclusions.  Those were the devices of my youth, when I was not confident.  Now, my sentences are more neolithic.  ‘Heart attack.  Stable.  Thrombolytics.  You admit.  Ugh.’  (For a while I tried to be eloquent.  I once told our surgeon, in the spirit of the British authors I love, that my partner needed him for a trauma victim, who was ‘really quite sick.’  I might as well have spoken Bushman:  ‘Click, click, click.’)

Still, the one impediment to communication that remains is the OR circulating nurse.  I understand the need for circulators.  But I wish they were used more for errands at our hospital than for talking between physicians.  And mind you, by way of disclaimer, this may be a phenomenon only at my facility.  But it still bears telling.
My call to the surgeon, who happens to be in the OR, usually go like this:

‘Hi, this is Dr. Leap.  Is Dr. Adkins there?’

‘This is Julie, the circulator.  He’s scrubbed in.  What can I tell him for you?’

‘Tell him (I say this in my simplest prose) that I have an 18-year-old male patient with appendicitis, confirmed by CT.’

‘OK.  Dr. Adkins?  This is Dr. Leap.  He says he has a patient with appendolokolism.  I don’t really know what he means.’

‘What?  Ask him again.’

‘Dr. Leap, he doesn’t get it.  What did you say?’

(I heard the entire exchange.  My blood pressure is rising slowly, but surely, and causing serum to leak out my eyes.)

‘Julie, tell him I have a patient with appendicitis.  An appendix that’s sick.  You know?’

‘Dr. Adkins, he says the patient has had aploxilitis for 18 years.’

‘He’s crazy.  He’s full of %&*#.  Tell him to explain what he means.’

(I’m seizing, on the floor.  Foam out my mouth.  I don’t know how to communicate this any better than I have.)

‘Julie.  This patient is 18 years old.  He has appendicitis.  Dr. Adkins needs to see him when he’s done with that case.  Can you tell him that?’

‘Dr. Adkins.  Dr. Leap is kind of testy and he says for you to come to the ER as quick as possible.’

‘Tell Dr. Leap to go….’  (You know the rest.)

Ultimately, Dr. Adkins calls me.

I say, ‘Jim, the patient has appendicitis.  The CT is positive.  That’s all.’

‘Well why didn’t you just say that?’

‘Because, old chap, I’m really just an emergency physician, quite!  Crumpet?’

What I want to know is this.  Aren’t there speaker phones? Aren’t there Blue Tooth attachments?  Isn’t there semaphore?  Morse code?  Smoke signals?  Why, oh why, am I still trying to talk through the circulating nurse?

As we say in the South, ‘Bless her heart!’

Have a clearly communicated day.  And for heaven’s sake, don’t get appekidolikilitis!’
Edwin

This was my column in the Greenville News on Monday.  I hope you enjoy!

My wife and two of my children are out of town.  She took our two oldest sons on a church youth mission trip to North Carolina.  It has been, apparently, a great success.  It’s hard to tell, since every time she calls me there are screaming teens in the background.

‘You’ve had some great limes?’

‘No, we’ve had a great time!’

‘Pinch the cat with some pliars?’

‘No, put the clothes in the dryer!’

‘Oh.’

I’ve been here with my youngest for almost a week.  We’ve played and talked, gone swimming and read books.  It has been a delightful week.  Well, except that for all that I love my youngest, they may hold the land speed record for most words said in any 24 hour period.  ‘Papa look at this, papa come here, papa he touched me, papa she bugs me, papa will you play, papa will you read, papa will you come downstairs there’s something that I need…’  I love the sound of my children, I love their need of me.  I occasionally enjoy silence, but since the only time I get that is when they’re asleep, I’m just wallowing in my time with my amazing little progeny.

I miss my oldest two boys, as well.  As they mature and grow, their questions and conversations are all the more fun.  We can share jokes we couldn’t before.  Wrestling is a much bigger challenge.  And our discussions about life have greater depth; mixed with quotes from Monty Python skits.

However, I have to say that I really miss my wife.  A lot.  I don’t sleep as well when she’s away.  I’ve shared my life with her for over 18 years, and without her it’s just not the same.  Furthermore, I feel, as she reports when I’m gone, ‘hyper-vigilant.’  We both, when alone, sense a need for heightened awareness of our home and hearth.

And when she’s gone, I don’t get as much adult conversation.  While I enjoy discussing fairies and the concept of time with Elysa, and I certainly like a good chat about medieval weapons or the isotopes of Uranium with Elijah, sometimes I need a little more than either can provide.  As any temporary (or especially permanent) single parent will tell you, it’s fun to talk to grown-ups.  I like looking at my wife and hearing complete sentences that don’t end in question marks, or ‘when can we have ice cream?’  (Heck, I didn’t even mind the two ER shifts I worked.  ‘No, really, tell me more about your abscess!’)

But as I walked outside yesterday with the children, it occurred to me that when we’re married, we become more than accustomed to our partners.  We become, in some very real ways, ‘addicted’ to them, as neuroscience increasingly suggests.  The brain chemicals that our relationships stimulate create very powerful connections.  We don’t just want our partners, we need our partners.  When the Bible says ‘the two shall become one,’ God isn’t joking.  It’s no surprise, therefore, that couples divorcing feel especially miserable.  A death of a living thing occurs.  An addiction (albeit an appropriate one) is disrupted.  This is probably why break-ups result in poems, songs, depression, medication, stalking and unfortunate (often tragic) criminal behavior.  The same thing applies to unmarried couples who are intimate.  A deep link is formed; and it is severed only at great peril, only with great pain.

In medicine, we see a kind of beautiful, melancholy illustration of the power of long-lasting love.  Many of us have seen older couples where one partner died, followed with remarkable proximity by the death of the other.  We smile and cry, and say ‘I guess he couldn’t live without her!’

Maybe it was true.  Maybe, on more levels than we realize, our marriages link us with more than tender emotions.  We may find, as our rudimentary science develops, that beyond neuro-chemicals, even our DNA is affected by our partner’s genetic codes, and that the loss of one sends a message to the other; ‘Leaving, please follow as soon as you can.  I love you.  End transmission.’  Laugh if you want.  The mind, body and soul are far more complex than any theologian or scientist wants to admit; we just haven’t looked far enough for the inevitable fusion of the two disciplines, wherein each confirms the other’s truth.

All I know is this:  I miss my family, for reasons obvious and reasons profound.  And because, quite frankly, Papa is almost out of words.

Tonight our church started its annual Vacation Bible School.  It’s a long tradition in Christian churches, with many different faith traditions doing something similar.  Catholic to Presbyterian, Lutheran to Pentecostal, Methodist to my own Southern Baptist, we all like to take a little time in the summer, when the kids are out of school, to educate and evangelize them.

My own memories of VBS go back to the church where I grew up, South Side United Methodist Church, in Huntington, West Virginia.  The memory tastes like grape Kool-Aid, heavy on the sugar; it tastes like potato chips and sugar wafers.  It sounds like the balls thrown back and forth in the good-old-days of dodge ball.  It feels like the towel we brought to nap on when I went to VBS in first grade.

It was a lovely thing; a holy, tender thing.  The layout of the church is still in my mind, though I am taller and older.  I could probably find the very rooms where I first learned the ancient stories of my faith.  I wonder, if I walked through them, if I wouldn’t somehow fall back through time, if only briefly, and feel the safety of my childhood in that great red brick building.  They’re tearing it down, you know; some of my past will collapse in the rubble.

But VBS remains.  The lessons planted in my heart grew and bloomed.  I walk in the path I was taught.  My children attend VBS the way I did, and the way my wife did as a child.  Tonight, she taught kindergarten kids in a room decorated with ‘island’ colors, cardboard birds, beach balls and a giant, inflatable monkey.  My oldest, Sam, who is 13, helped his mother herd the little ones back and forth to different crafts, snacks, lessons and to me, where I helped organize games in the gym.  The men I was with all guided the children through obstacle courses and let them play volleyball.  We gave them bamboo poles to carry in a kind of relay.  We laughed as they spun around, dizzy, and fell down smiling.

And I realized what a precious time it is.  You don’t have to be a Christian to see the value of men and women giving their time to children.  The many children who attend the church were there.  But there were also children from local neighborhoods who road the church bus for lessons, snacks, or simple diversion from difficult lives and situations.

What all of them saw was a group of youth, women and men in bright green shirts, wearing flowers and captain’s hats, acting silly, dancing and singing and smiling at them.  What they saw was a group of people exhibiting interest in the children by offering them fun, insight, faith, hope and a framework for their lives.

I see the value of it.  Oddly, I used to feel a little uncomfortable evangelizing children.  Not anymore.  I’ve seen the children of wrecked world-views.  I’ve seen the children with empty eyes.  I’ve seen the children of disease, abuse, drugs and alcohol.  And I know that, without any doubt, the evil things of the world evangelize them with a passionate fervor.

Hopelessness, nihilism, cruelty, promiscuity, drugs, alcohol, violence, abuse, every negative thing in the world hides itself in flashy images on television, or in classrooms, in the lyrics of music or in the ideals of a political party.  The children of the world are constantly, shamelessly evangelized to grow up too fast, to ignore their families as irrelevant, to seek the solace of name-brands, money and fame.  They are preached the gospel of success along with the gospel of self-loathing.  You don’t have to agree with my faith to agree that we need to offer the children something more than all of that.

At Vacation Bible School, in a medium sized church in a little town in South Carolina, we’re evangelizing.  And I’m OK with it.  I hope the children come away with their own memories, like mine.  Memories of diet soda, pizza, trail-mix, silly hats, smiling faces, ridiculous games and a place where they were taught, by adults and young people, their inestimable worth in the eyes of the Creator.

Those are memories worth having.  Just like my own recollections of grape Kool-Aid.

Edwin

One of our nurses was checking a patient in a few days ago, and had the following interaction while taking his information.  Let me preface with the fact that the patient was in his mid 40’s.
Nurse:  ‘Do you work or go to school?’

Patient:  ‘I don’t work.  I’m thinking about getting disability.’

Nurse:  ‘For what?’

Patient:  ‘Oh, I don’t know.  Maybe my nerves.  I’m under a lot of stress.’

Nurse:  ‘Really?  What sort of stress?’

Patient:  ‘Those people I ride the bus with are driving me crazy!’

In a classic example of sheer, American know-how, in a brilliant perversion of the entrepreneurial spirit that makes us great, this individual figured that disability was tantamount to a career choice.  Like ‘I might become a pilot,’ ‘I might learn to be a plumber,’ ‘maybe I’ll go to law school,’ or even ‘I’ll go to New York City and walk dogs!’
In light of that, I began to wonder just what sort of disability I could get; then I started wondering what kinds of injuries or illnesses were unique to the practice of medicine in general, and to the practice of emergency medicine in particular.

For instance, could I get repetitive stress injury from typing too many orders onto the computer, born of our treatment algorithms, ‘pay for performance,’ and general spirit of defensive medicine?

Perhaps I could get ’suture wrist,’ similar to tennis elbow.  Or maybe, ‘bimanual hand,’ from doing too many stressful pelvic exams.

Certainly, walking on concrete for the past 18 years hasn’t made my knees feel very good.  Maybe I’d be able to wrangle some sort of arthritis determination.

Of course, the weight I have gained as a result of stress eating can probably be tied to hours spent in the emergency department.  At home, I’ll walk, play, ride bikes, jump on the trampoline, swim or wrestle the children.  At work, since wrestling, swimming, bike-riding and trampolines are out, I just stand around between patients eating tortilla chips and salsa, chocolate, Chinese food, cups of peanut-butter designated for patients, bland saltine crackers or most anything else that sits unattended in the break room.  ‘Omnivorus medicus chronicum.’

My senses have also started to slip; so there’s a possibility. My right eye cataract is driving me nuts, and my left has troubles too, despite Lasik.  It may have to do with looking at computer screens.  Or it may be some sort of cortical blindness that my brain has developed as a defense mechanism against very disturbing patients and family members; or from the strain of looking for imaginary redness, swelling and foreign bodies, and searching for unimaginably obscure insect bites.

My arms gets tired from writing vague information, and from performing the exams we have to document now in order to be paid.  Is that a kind of repetitive stress injury?

And my poor nose.  Assaulted for years by everything from draining wounds to feet that qualify as biological weapons, I may soon have a hysterical loss of smell, purely as a defense mechanism.

Of course, let’s not forget selective deafness. My auditory cortex simply has an ‘off switch’ that engages when any story passes 10 minutes, or begins with the words, ‘let’s see, it was back in ‘63 when I fell and all this started.’  I also experience this loss of hearing when I hear any news report that says I’m doing a bad job, or not doing enough to help the country in the course of my daily practice.

Furthermore, I think we all get a little bit of PTSD.  More on that later.  But what sort of disability rating can I get from telling people, over and over, that someone is dead?  That the news is bad?  That I have no idea how to help them?  Or that I simply won’t give them the same pain medications that their own doctor shovels into their Halloween pumpkins every month. Does that qualify?  The combination of terrible things and ridiculous things must cause some kind of ‘pseudo-stroke’ syndrome, or ‘near psychosis,’ or ‘patient tangential story disorder.’  I mean, there are pseudo-seizures, right?

I should do some research.  We may be sitting on billions in class action suits for doing what we do year after year, without anyone in positions of authority taking the time to recognize our unique risks and specially concocted work-related illnesses and injuries.  Considering the enormous fear of cell-signals and wireless networks, despite any evidence of injury, I think my above-listed ailments should cause some very real alarm, or at least some very significant snickering and forwarding behavior!

Fortunately, I don’t in the least bit want disability.  A best seller?  I’ll take it.  Strike gold on my property?  No guilt at all.  But simply to sandbag and decide work is too much, or too annoying, or to darn hard?  It flies in the face of my upbringing.  It insults my ancestors in their labors to survive.  It would shame my great grandfather who refused his Army pension, saying ‘I don’t want or need their money!’  It throws back into the face of God the very gifts and health he gave me and continues to pour out into my life.

I may not always like working, but I’m sure as shootin’ proud I keep going back.  And I’m equally proud that the idea of fishing for a disability diagnosis never crosses my mind.

Except during very busy shifts!

God bless you and keep you laughing…and working proudly!
Edwin

My dear wife is a great fan of the CSI series.  She watches it when she has time (which is not often these days).  I admit, the show is compelling.  The drama and stories pull me in; by the time it’s almost over, I really want to know who did it, and how.

It’s intriguing to watch the characters use science (real and imagined) to find the answers to bizarre crimes in glamorous cities.  But, just as ER does not reflect my own world of medical practice, so CSI doesn’t really reflect the realities of criminal behavior and forensics.  (And in both cases, the actors and actresses make us real folk look positively ugly.  As my partner Doug says, ‘medicine is acting for ugly people.’)
Let me put it this way.  I’ve met plenty of criminals, and for the most part, it doesn’t take advanced DNA analysis, a complex fiber-identification program, or even a national fingerprint database to catch these people.  Often it seems about as simple as this:

‘Son, you kill that boy down on Fifth street last night?’

‘Yes sir, he had it coming to, the lousy (expletive deleted)!’

In other cases, of course, it’s not so straightforward.  The murderer may, in his or her drunken or drug induced stupor, hide the body cleverly on the couch, on the front porch, in the pool, in the street or partially buried in a flower garden.  Where do they get their ideas?
In still other circumstances, the criminal’s silence and reticence can be tricky.  But these obstacles are usually overcome by drugs or alcohol in about 0.5 seconds.  ‘What did you do last night?’  ‘Oh, I killed this dude and stole his credit cards.  Want another round?’

Granted, DNA analysis probably comes in handy.  Especially in identifying the huge blood-stain on the t-shirt of the murderer, who fell asleep in the next room after killing her room-mate.

All I’m saying is, there are a few clever murderers, thieves and general miscreants.  But most of them ‘ain’t the brightest bulbs in the box,’ as we say in the South.

This realization has helped me to deal with the fact that I’m not nearly as smart as those dang doctors on ER.  I mean, I used to watch it and wonder if I had actually gone to medical school.  ‘Wow!  River blindness!  I didn’t even think about that last night!  I need to call that guy back!’

TV is TV, reality is reality.  And never the twain shall meet.

Have a great Monday, my brothers and sisters!  God give you laughter and ignorant assailants.
Edwin