Never Stop Discovering Your Spouse

Elysa photos 007

This is my most recent Greenville News column.  Inspired, of course, by my amazing wife Jan.  All my love baby!

June is here, and while it certainly isn’t the only month for weddings, it is a popular one. This month, many young men will have a brand new thing called a wife, and many young women a thing called a husband. Both are perplexing, and both are wonderful. As such, I have some insight to share.
Gentlemen, what you have before you after the vows are said and rings exchanged, is a woman of your very own. She has been thinking about this her whole life. In fact, she has been unconsciously (and consciously) evaluating men as husband material since she first realized that there were boys in the world other than her father and brothers. She chose you. (Don’t question it, just be glad…she knows you’re imperfect, trust me.) And what she wants is your love and devotion. She wants you to stand by her and be faithful. She needs to know you won’t run away when things get tough. She needs to know that you still think she’s amazing when her life is a hot mess and her hair won’t do anything right and she just cries for no reason. She does not expect you to figure it out or fix it, as much as you want to do that.
The great wonder is that she just wants you (you among all other men on earth!) to share life with her, hold her, protect her and get old with her. She could have had people better looking, smarter, stronger or richer and every smart husband realizes this. She wanted you to share her mind, heart and body. She probably wants to have your baby. (It’s a compliment of the highest order.) Something about you drew her in to your orbit. Observe this advice, honor her dreams, speak kindly and treat her gently, love her lavishly and you will never in this life find an ally more true or comfort more wondrous.
This beautiful thing before you is yours; and she should be your favorite hobby, best friend, greatest confidant. She will give all of that back and more. But remember what the Little Prince said: ‘You are responsible forever for what you have tamed.’
Ladies? What you have is a man, also of your very own. As a young man, he didn’t probably didn’t think about weddings or marriage as much as you did. But deep inside, he wanted it. He wanted a woman to care for. Good men like caring for things; we protect, we defend, we provide. It’s our wiring. On some level, even as you wove your spell he ‘hunted and gathered’ you. In a hilarious expression of the whole process, ‘he chased you till you caught him,’ as my wife used to say. He is sometimes slow to understand things natural to you. Like feelings. He is sometimes uncomfortable with lengthy discussions of emotions. He is fascinated by your feminine ways, tears, declarations of love and complicated rituals. He struggles with bra-straps and is confused by make-up, skin products and your many shoes. But in all his simplicity, he is far more complex than your friends (or society) lets you believe. He is in awe of you and if you are kind to him, encourage and respect him, he will do anything you ask just to make you happy.
He needs a little space sometimes. And honest to goodness, there are times when he says ‘I’m not thinking about anything,’ and is telling the absolute truth. We men go to that place sometimes, even though your multi-tasking brains can’t fathom it. Let the man have it now and then. Just a little down-time. He’ll be back.
Your husband, properly treated, will love you and the children with a devotion that comes fairly close to worship. And when he says ‘you’re beautiful,’ don’t tell him no, don’t deny it. He really believes it because you are his, and he’s amazed that you agreed to marry him in the first place.
Husbands and wives, his whole process is an incredible mystery. Two people, two complex creatures, with dreams, hopes, wounds, bad habits and all the rest come together and make, as the Bible says, ‘one flesh.’ Two humans who barely know themselves choose to know another and love them for life.
As you pass through the portal of the wedding into the new life called marriage, may you never stop discovering the unfolding, life-long wonder that is your spouse.

Learning to Love Freedom

I have to admit that I’ve become a bit of a freedom junkie.  As a native West Virginian, there’s this desire, deep inside, to be unfettered.  When I was a child I expressed it by wandering all day long through the hills and valleys around my home.  No phone, of course, and no radio.  No way to contact, or be contacted by, anyone else.  I remember being about 13 or 14 when my dad let me go off into the woods with my single-barreled shotgun to hunt.  I never shot anything.  But I was free.

Later I was encumbered in some ways by college, medical school and residency.  But when my wife and I moved to South Carolina, and ended up in our rural, hilltop log-house, I rediscovered the deep inner peace of freedom.  Our family roams at will through the woods around our home, the state forest across the road.  On July 4th and New Year’s Eve we set off fireworks as long as we want.  On Halloween our bon-fire roars high as the tree-tops.

We throw clay-pigeons over the back yard and shoot them; we have lost untold arrows in the woods, and have behaved like barbarians for years, simply for the joy of doing what we wanted to do.  Our five dogs and three cats collude in our freedom, and have furry smiles as we sling dinner scraps over the back deck into their un-caged, happy mouths.

In 2005, my wife and I discovered a kind of liberty that we had never imagined.  We began to homeschool.  That adventure liberated us from the constraints of state-determined schedules, curricula and ideology.  It allowed us delicious, lavish time together, whether the kids were playing in the pool while rehearsing Latin declensions with my wife, or traveling to the Grand Canyon during the off-season.  We were unencumbered, and while the children learned much and learned well, we had precious little oversight to pester or constrain our wild, free time together, when we rolled about in our fragrant love for one another.  If we had known how it would be all along, we would have started homeschooling much earlier.

Two years ago, I found more freedom.  I took the plunge, left my partnership of 20 years and Jan and I started a small corporation, LeapMedicine.  I began working as an independent contractor.  I worked where, and when, I wanted.  I still do.  If I don’t want to work a holiday, I don’t.  If I want to work, I do.  If I work a shift and don’t like it, I don’t go back once my committed shifts are over.

There are costs to freedom.   It’s magnificent but unpredictable.  The cost of owning a business is sometimes daunting in America today, although I wish I had done it sooner.  There are others.  We recently tried to refinance our mortgage.  We discovered, to our chagrin, that large companies want people in communities of boxes.  You can refinance a house in a subdivision.  But a log house on a hilltop is unnerving to banks and lenders.  It isn’t the same as everyone else.  It’s less predictable, and understandably.  It may not sell.  Only so many people are comfortable away from the crowd, away from the comfort of commonality.

Indeed, we are nationally obsessed with being members of a herd.  Ask a kid in school if it’s OK to be different, the way every kid book with a quirky penguin and a sad skunk says it is.  It isn’t.  There’s a price, and it’s paid in bullying or marginalization.  Maybe it’s good training, because the same dynamic certainly exists in the world of adults.  Try saying the wrong thing, wearing the wrong emblem, believing in something unpopular, standing for a viewpoint on principle not popularity.

Bullying just takes different forms; like social media campaigns, or lawsuits.  Being marginalized means ridicule by a professor, lack of promotion by a boss, firing by a corporation.  America, the land of the free, doesn’t really like freedom these days.  Freedom means you might hurt someone’s feelings, crush their fragile self-esteem, say something shocking.  Freedom of ideas is a beautiful dream, but the kids on the adult playground of modern thought are like the bullies from our childhood, dressed up in suits, with law degrees and political offices; and with the same fragile sense of self the old bullies had.  But they have more power to punish the free, more power to torment the outlier.  Fortunately, truly free people relish their freedom so much that they become hardened to the ways of bullies and go on living in joy and liberty.

I set out to write this as an homage to homeschooling.  But as so often happens, I discovered that homeschooling, and even business ownership, are merely some of the sweet fruits of an attitude, of a decision, to be free.  It was what made America, once upon a time, a great country.  It’s what real Americans long for, live for and are willing to defend and die to preserve.

I hope that my children, and their children and all the rest can remain free.  I hope that they can thumb their collective noses at those who silence, subjugate, manipulate and ridicule those who just want to live and be left alone.  I hope they take their children on trips and walk away from unnecessary constraints.  I hope that they forge new ways to be free and remake this nation.

Freedom.  Take every step necessary to preserve yours, and your children’s.  Because once it is surrendered it does not return easily.

And once enjoyed, perhaps the most addictive thing in all the world.

Homeschooling Offers Families a Great Option. (My column in today’s Greenville News.)

I have, in my house, a rising Tiger. Our second-born, Seth, begins his college career at Clemson this fall. He has always been, and remains, an amazing young man. He is filled with both passion and compassion, he loves learning, reads voraciously, is strong as a bear and is an outstanding musician. He makes our parental hearts swell with love and pride. Oh, and for the record, he looks like me and is thus incredibly handsome. What? His mother tells us that all the time so it has to be true!

Like a growing number of college students, Seth comes to the university from the home-school world. From the time he was in 4th grade, he was educated by his awesome mother (with a little help from me), and over time by wonderful teachers in several co-op groups, culminating in a few semesters at Tri-County Tech, receiving college credit as a ‘dual-enrollment’ student.

It appears to have been a good experience for him. His college acceptance letters came without a glitch, giving him several choices for his university education. And despite the constant protests to the contrary (by those outside the home-school world), Seth does just fine in the mystical ‘socialization’ arena.

I have always said that education can be accomplished with great success in any of several ways. Public school, private school and home-school all work just fine. But they only succeed to the extent that parents care and are involved in the educational process. All can fail miserably if parents are dismissive and believe ‘that’s someone else’s job,’ and particularly if moms and dads suggest that learning is drudgery, unnecessary, boring or somehow a form of oppression.

However, for anyone considering home-schooling, I would say that it is a fantastic way to spend time with, and really know, your children. Jan and I have emphasized learning from the beginning. But home-schooling allowed us to tailor the learning to the child. More than that, it allowed us that precious, ever dwindling commodity, time.

You see, our schedule was our own. Yes, the state mandates 180 days of school per year. But we could accomplish that in any way we desired. If we had a schedule conflict, learning could take place in the afternoon and evening. If we had the opportunity to take a trip during the ‘school year,’ we took it and learned in the car, in the hotel or at the National Monument. If I was working evenings, we could play and visit during the day and they could finish up later; or I could help with school during the day while Jan took a welcome break for lunch with friends.

Furthermore, we could design curricula for the interests of the children, whether it was learning Biblical Greek or taking bagpipe lessons. BB-gun team was a credit towards PE. Jan once applied for, and received, a grant of beautiful copies of art from the National Endowment for the Arts. The entire process was, in a word, flexible.

The reason this matters to me, as a parent, is that the world grabs our kids so quickly these days. They have school, of course, but culture tells us that if we want our kids to succeed, they have to engage in a vast array of activities. Beyond academics, clubs, teams and the ubiquitous Internet conspire with parental work and home responsibilities and seem to drive us ever further apart.

This endless motion sometimes robs us of the simple joy of being together; of eating and laughing, telling stories and just sitting quietly, basking in the presence of those we love most. My schedule has always been pretty malleable. But I feel deeply for the loving mothers and fathers who work second and third shift, and for whom any time with their children is rare and precious. For them, in particular, online or home-schooling could offer unimagined opportunities to enjoy their children while they can.

I wouldn’t trade a day of it. And Jan and I would do it all over again; and hopefully do it even better. But as Seth goes off to Clemson, and my remaining two children likely transition to public school this fall, I just hope that parents keep their options open. Even a year or two of home-schooling, strategically placed, can offer opportunities, memories, and bonding that they’ll never regret.

And never forget.


Marriage is a work of art and a labor of love.

This column is dedicated to my lovely wife Jan, as tomorrow is our 25th Anniversary!


When we look at beautiful houses, or breathtaking historical structures like the Pyramids or the Mt. Rushmore, we are in awe of the craftsmanship, the beauty. Sometimes it seems that they simply fell from the sky, magnificent as they are, and suddenly occupied the spaces before us. It is inconceivable that the field, the mountain, the lot was once empty, once the domain of small creatures and weeds. It is unimaginable that the thing that rises before our eyes was once stone sleeping in the arms of the mountain, wrenched free by untold thousands; or that the lovely shapes of a beautiful home are made by wood that grew in the forest and was assembled in noise, and dust and sweat by builders.

Just so, when I look at older couples, I am in awe. I meet them all the time. ‘We’ve been married 55 years doctor! It has been a great life so far!’ They touch their hands together, smile and dote. The movements of their eyes, the laughter, the instant grasp of communication, it all seems so natural. As if, from the moment they met, the connection was made. The carousel switched on and springing to life in the darkness, full of music and color.

We forget that there were times when those charming people struggled. When he thought she was crazy, and she thought he was lazy and all of their parents wrung their hands in worry and folded them in prayer for the young couple. There were times when they had no money and others when they had no time. And there was sickness and struggle and exhaustion as surely as there was health and joy and adventure. A marriage is an edifice that rises up with great, and endless, effort. The construction of one entity from two is no small thing, and while the words are said as covenant, the building process may last a lifetime, even if it looks perfect to the casual passerby.

This week is our anniversary, Jan’s and mine together. On May 26, 1990, we were young and in love, we were nervous and excited and we walked down the church aisle. She was one year out of graduate school and I was one week out of medical school. We were a little crazy and a little thrilled. Before us lay a move to a new city, and the beginning of new jobs for both. We were, to use the above analogy, an empty field, full of building materials. It was for God, and our own love and effort, to make the structure; to make a family, a temple of good things, a unity to care for one another and survive and thrive in the world.

Anyone who knew us well during those early days would say that the construction was, at times, a messy business. There was romance and argument, conflict and communion. There were days and nights apart due to work and there were amazing trips together which united us. Like a house rising from the dust, we took shape. Later, in time, the house was ‘in the dry,’ and it was a matter of decorating and beautifying the marriage; the comfortable, well furnished rooms with trust and comfort and hope and laughter, and then to bring children and turn them loose inside it.

Our marriage has lasted this quarter century and grown better and more beautiful every single day. I would not trade it for anything, nor her for anyone. We belong together. We have become, in every way, our perfect match. (A thing, young couples, that is seldom discovered but usually made.) Oh, we still have work to do. A room to add, a wall to paint, a rough edge to sand. But all in all, the whole thing is simply magnificent. Time and effort, God and devotion will do that.

And to anyone out there wondering why they don’t have it yet, I say this: don’t put down the tools until you’re satisfied. Keep learning and growing and adding and building. And before you know it, you’ll step back and realize that the marriage you built looks perfect to everyone else. And you can smile at each other because you know that there are secret flaws. But that they don’t matter a bit because even they help hold the thing together, stick and stone, heart and soul.

So happy anniversary to my Wild Irish Rose! Thank you working with me all these years to get it right.

When the children return home, it’s a blessing

My column in this weeks’ Greenville News.  Enjoy the kids when they’re home!  And Merry Christmas!

My children, about whom you have read for nearly 20 years now, are growing up. The oldest will turn 20 this month; the youngest will turn 14 next month. And there’s those other two, in the middle, how old are they? Oh yeah, 15 and nearly 18. (The curse of the middle child.)

Our firstborn is in college nearby, living with friends. The others are so busy with coursework that even though they live at home, as autumn passes I seem to see them less and less. They are forever consumed with papers and tests, reading assignments and other projects.

And yet, despite their advancing ages and exploding maturity, they love home. They love home because they love familiarity and comfort. Because they love to eat and sleep and relax without being in charge of everything. They love sitting by the fire and playing games; times when they can slip comfortably into sweat-pants, t-shirts…and childhood.

During these times of rest and relaxation, they occupy themselves in many ways, from staring at the many screens in their possession to simply and joyously tormenting one another. A favorite game? ‘Tiny Punches,’ wherein three corner the fourth and hit him, or her, repeatedly with very short punches. I have received this treatment; and when I find myself in a corner with three of the children around me looking at one another, I know what’s coming.

In years past, there were others. Avalanche involved building a huge wall of pillows and blankets and collapsing it on one another. Another game required that they jump from the landing onto a pile of pillows; beneath which one might find a concealed dumbbell for an extra soft landing. And there was the static torture. Wrap a sibling, or parent, in a fluffy blanket, in the dry air of the basement, then rub it as hard as possible. I swear, I wish I knew how much charge that generates. I recall the pain and the sparks. (Works well on a trampoline also.) I’m just glad I didn’t have a pacemaker.

I am not suggesting you play these games; unless you’re feeling bold. (Like one-legged kick-fight, it can end badly.) I am suggesting that our children, even as young adults, are still children. As we should all be, I believe. It’s at Christmas that we recover those simple joys and simpler times.

Modern culture likes to pretend that high school and college kids are the end all, be all of worldly wisdom and education. To which I say ‘nuts.’ They’re bright and articulate and culturally aware. But they’re still, in so many ways, immature. To us, their parents, they’re still children. And they always will be. It’s why we constantly ask them if they need anything, it’s why we load them up with everything from food to toilet paper when they leave. And why we hug them out of the blue. (A thing they secretly love.)

Granted, at 18 they can vote and go to war. And they can, at 21, drink alcohol. (An odd and probably inappropriate dichotomy in my opinion, but that’s another column.) But they don’t know enough yet. Nowhere near enough. Because a huge part of successful learning is simply born of living through a lot of things. Thus, sadder-but-wiser parents share wisdom with enthusiastic-but-vulnerable offspring.

This Christmas, as the kids come home, as they unwind from exams, as they look for the comfort of friends and laughter and as they seem to sleep like the dead, remember that they are also seeking the wonderful joy of the familiar and the safe. They want to let their guards down and know the simplicity of childhood once more. Best of all, in the process, they are giving us a gift as parents. They are saying, without so many words, ‘I still need you and I’m glad I’m yours.’

So if you find yourself in a house suddenly bereft of chips and soda, if you find the television occupied by video games, and notice that you are being ambushed by large kids who look vaguely like the little ones who lived there not so long ago, take it for what it is.

It’s a blessing of the first order, to have children who still need you. Please proceed to enjoy every second. Because if you do, they’ll just keep coming back. And eventually, they’ll bring more with them.


Thanksgiving: mission accomplished. Check!

Thanksgiving week checklist:

Time spent with wife and four amazing children.  Check.

Fed 28 family members and friends.  Check.

Gave injured dog his medicine; sometimes, when he agreed and wasn’t a big baby.  Check.

Played X-Box…with wife and children. Check.

Ate more than reasonable, but maintained weight.  Check.

Standard Southern relaxation of shooting in backyard.  Grass littered with shell casings.  Now ammo poor.  Check.

Cousin sleepover with kids. Check.

Watched Elf.  Check.

Put up Christmas tree and decorations, according to wife’s excellent aesthetic sense.  Check.

Ate various incarnations of turkey and dressing, including chili.  Check.

Took out trash.  Check.

Long hike today, now exhausted. Check.

Best of all, thankful to God above for his grace and mercies.

Check, check, check.

Happy Thanksgiving to you all!



Image Credit


The Best Way to Learn Tolerance? Raise a Teenager.

Here’s my latest at the Huffington Post!


If you want to understand tolerance, it’s helpful to have teenagers. I have four of them. Four wonderful, brilliant, engaging creatures brought to this earth by their mother and me. They are entertaining, they are well-read, they are courteous and insightful. And they are each, at times, surly, self-centered, lazy and stubborn. (You know; like every human ever born on this earth.)

I would give my life for any one of my children if they needed. I would stop a bullet, stand in front of a train or give them a kidney. I believe I’ve already demonstrated my love by watching ‘ironic’ sit-comes with them for hours on end.

But sometimes, well sometimes, they drive me absolutely crazy. And never more than when they think they know everything. Which is pretty much every, single day. It’s a huge conflict because their mother and I, in fact, know everything.

Not a week goes by that they do not remind their parents about another social injustice in the treatment of women or minorities, another philosophical quandary (are chickens sentient and if so, what about factory farming?) or the latest research suggesting video games are good for mind, body and soul (and give you a shiny coat as well). They quote statistics on global climate change, they argue with one another about licensing parenthood. And they seem to go out of their way to pick ‘hot-button’ topics to challenge the apparently irrelevant education and moral authority of their parents. In our house, ‘because I said so’ is a long lost trump-card.

This is particularly interesting because my wife and I are what you might call ‘conservative.’ Or what others would no doubt call ‘right-wing, Bible-thumping, Southern nut-jobs.’ In the colloquial, that is. And it’s even more interesting because our children were home-schooled. (I know! Can you believe it?)

Our children were raised in the Baptist church, in the sultry, Confederate Flag waving ‘Buckle of the Bible Belt’ (where damned progressives would go for eternal torment if they believed in such things). Our four kids, stewed for years in all things Southern, are each deeply concerned about their pet causes, among which are included social justice, renewable energy, global climate change, animal rights, fairness, equality, racism and feminism.

So as you might guess, we disagree on certain issues from time to time. But here’s the remarkable thing. Their mother and I may not always share their opinions, but we don’t love them one iota less. Nor do they love us less! Dinner conversations are always fascinating. We all learn from one another. They lift their Baby Boomer parents to new ways of viewing old problems. And hopefully (can you hear me Lord?) we anchor them in traditions and truths that have remained relevant for thousands of years and hundreds of generations of their ancestors.

I am so proud of them. I see in their eyes, and hear in their passionate words, the fire I first saw in their mother when we met in college. Their mother, who still has a t-shirt from the first Earth Day, and who was aggrieved to be born too late for Woodstock. Their mother who learned to tolerate a staid, gun-loving, tradition following Republican, who became their father. I became more like her and she became more like me. We ‘tolerated’ each other so well we ended up with four children in about seven years. And they’re like both of us. We all tolerate one another in abject, breathless, unquestioning love.

This is how it works. We can banter about the word ‘tolerance’ if we want. But it’s too easily a weapon of suppression. Tolerance is the word we now use to say ‘you have to agree with my views.’ However, as one sees with teenagers, tolerance in truth means to disagree, but to respect. And in it’s highest, most beautiful incarnation, to disagree and yet love.

We all change over time. I don’t know exactly how my kids will end up; where they will lie in the political, moral and spiritual spectrum of the future. But I know that even when we disagree, I’m proud of the people they have become through this wonderful mixture of reading, listening, arguing and discussing. (And no small amount of parental prayer.)

The thing is, if a bunch of rural home-schooled kids can grow into the kind of people who can endure the views of their parents without screaming, and if those parents can face the emotional and intellectual wanderings and pilgrimages of their children without shipping them off to boarding school, then there’s hope for a world of tolerance. As long as we understand that tolerance doesn’t have to mean agreement. But it does have to mean love.

The most important thing in life (hint…it’s not medicine)

Every year, in May, we take a beach vacation. Because we home-school, our schedule is a little bit more flexible, so we can enjoy the coast before the masses descend. This year, however, was special. I worked a lot of extra shifts over the winter. Furthermore, now that I do locums I write my own schedule in whatever way I like. We had long wanted to stay on vacation for more than a week, and this year our wish came true. We planted our winter-weary, school-sick, work-fatigued selves at the beach for three glorious weeks.

Frankly, we didn’t quite know what to do. In past years we rushed to fill our time, and we watched the weather to be sure we could enjoy every second in the sun. We ate out more and we sat still less. We vacationed frantically, you might say.

While our time together was finite this year, we did not feel it press so close upon us. And so we slept late and cooked our meals in our rented house. We played games until late in the evening and we biked as much as we could to as many places as possible (only coming close to heat exhaustion once).

It being May, and the Atlantic, the water was cool but not cold. The sand was a hot blanket and the pool was heated and our bodies began to come alive with warmth and plenty of Vitamin D. We were tanned and lean from exercise; not fatter as our evening ice-cream should have made us. And we were happy, together, as all families are meant to be. In fact, that trip was a little like my image of heaven, in which the good things go on and on but never become mundane or boring; a place where love precludes any annoyance or frustration, and the same delightful cycle of rest and play is forever untarnished. Time stopped a while at Hilton Head this Spring, and it felt as if our lives floated in a magical suspension of one reality, replaced with a higher reality of life at its very best.

However, one of the best things about the trip, one of the most powerful gifts and realizations, came when Jan sagely reminded me of a fascinating fact. Since I started residency and we were newlyweds, this trip was the first time we had slept together in the same bed all night, for three continuous weeks, in 24 years. Between night shifts and travel and shifts ending at one or two or three in the morning, we had often missed the intimate comfort that comes from sleeping together through the night.

It is the price of a career in our specialty. Despite the assertions of specialists who always seem surprised at late night and early morning consults, we know that people are sick and people die at all hours. And the consequence of that fact is that someone always has to be up and available. And as noble as it is, that reality extracts much from our lives as flesh and blood humans, who crave sleep and touch. Humans who can endure loneliness but do not enjoy it for long.

All of us are proud of our work and our dedication. Proud that we can wake from a nap on a dime and make obscure diagnoses, or intubate at 4 am after sewing a lip back together. Proud that we can go for hours on Pop-Tarts and coffee, or whatever other heinous concoction does the trick. And our spouses are proud of us, as we are of their courage and fortitude when we are away.

But that doesn’t mean it isn’t hard. And from my own perspective, I have a very real sense that none of it is the way it was meant to be. Death and sickness are as wrong as sleeping apart from my wife. It’s a thing to ponder. And if you, dear reader, can find a way to never leave the side of your love in the watches of the night, I encourage you to think long and hard. It would be a precious gift. Alas, for most of us it is almost impossible. But we can dream.

When we left the beach, it was not really with sadness. (There was, admittedly, some brief anger as we tried to close the luggage carrier in the pouring rain.) Rather, we left with the joy and rested hearts that always come when we rediscover love and simplicity; when we rediscover one another. We were ready to leave, I suppose. The children (rather, the teens) were filled with joy when we returned to our hillside home, nestled in a jungle of Blue Ridge foliage, overgrown from weeks without resistance from humans and our machines. And they were very clear: they missed their mountains, for all that the beach was grand. When you’re born from two West Virginians, you have a gene for mountain grandeur, to be sure.

Returning home we petted the dogs and cats and sifted through long neglected mail. The kids reconnected with friends and summer began in earnest. And for two more nights, before I was off again, my wife and I slept side-by side in the last remaining days of vacation; listening to one another breath in the wee hours and holding hands.

I think we should all pause, now and then, to spend lavish amounts of time together. And if that means making less, owning less, or signing up for one less committee, one less project, it’s probably worth it. Because our life is far more wonderful, far more precious than shifts and payrolls, schedules and papers.

So if you want to glimpse heaven, leave it all behind for longer than normal. Lie on the sand or climb the mountains or do whatever you and yours find best. But be careful. It might change your life forever, as you rediscover the fact that for all its wonder, medicine is not the most important thing in your life.

Not even close.

Orbit little worlds. A poem about my children.

Here’s a poem of mine from many years ago, resurrected today on Throw Back Thursday at the ACEP Medical Humanities Section website.

I hope you enjoy!  All my little planets are much older now, but still they stay in orbit one around the other as kids who, rather than disdaining their siblings, treasure them.  I remain their archivist and astronomer…and always will be.


Orbit little worlds

Spin around and spin around

and hold each other tight,

spin in giggling circles

with your smiles starry bright;

hold your hands together

and fall upon the floor

laughing little brothers

I am watching from the door.

Up you go and spin some more

in orbits sure and strong,

your gravity grows tighter

though you won’t be little long.

So little planets, orbit on,

through your starry space,

and save a place for sister

for you soon will see her face.

A little moon I think she’ll be,

fair in sparkling skies,

and I will be a star-gazer,

with wonder in his eyes.

For never have the worlds aligned

so perfect, true and bright

that I could watch the worlds I love

then touch and hold them tight.

To sleep, perchance to dream: of CHF, OD’s and PE

This is my column in the July edition of Emergency Medicine News.  It’s my way of trying to put to words what we all feel during our night shifts, when morning seems an eternity away.  Rest well, my friends, whenever you can!,_Perchance_to_Dream__of.9.aspx

Tonight I will sleep in bed, all night, with my wife. The hours will pass in pleasant dreams, wrapped in a blanket, warm beside my darling. We are on vacation, and our teenage children will be sleeping in their beds as well; after they have watched enough bizarre videos on YouTube and eaten all the chips in the house.

But as I sleep, many of you, my dear colleagues, will be wading through the morass of the night. I still work nights, here and there. And once upon a time, I worked nights full time. But those days are thankfully gone. Nevertheless, I remember. I remember what it means to work at night. And I remember that sometimes, it seems that the night will never end. It’s hard to explain it to anyone who hasn’t lived the experience. But I know. And maybe you can share this with them, so that they will also understand.

I remember hot summer nights when I came to work and walked through a parking lot that looked more like field of tail-gaters before the Clemson-Carolina game. Sitting on the beds of trucks, smoking in open car-doors with music playing as toddlers in only diapers climbed around the seats eating french-fries, the unwashed masses seemed to find solace in the red glow of the ER sign. Their assorted illnesses mere pretext for the grand social event of the evening.

‘Hey doc, get in there and hurry things along, will ya?’ I’d smile and cringe.

Once inside the door, someone, a registration clerk or triage nurse would always say the lines I hated most. ‘If I were you, I’d leave.’

‘If I could don’t you think I would?’ I would respond. And inside, filling rooms and lining the hallways, would be the contents of my night. Typically, my cross-covering partner would be up to his or her gluteus in large reptiles, and spend the next two or three hours trying to clean up messes. So I would wade right in and begin.

There was always some chest pain, young and old; high risk and low. And some that began with ‘I was really upset and had this pain after my wife and me got into a fight.’ There was also the young woman who passed out, and the old man with CHF. Most nights would include the screaming girlfriend of the loser of some fight, his chest slashed open, or his face caved in by someone’s fist.

Some patient would have a hip fracture and one would have an overdose and one would just want to die but be angry about being held, and in the midst of it all would lurk a very nice, very tolerant patient with something horrible; a subarachnoid hemorrhage or a pulmonary embolus.

And to cap it off, several would just need their chronic illnesses evaluated, whether weakness or numbness, or strange bump under the skin. (Mayo clinic having failed miserably to elucidate the cause.) And without fail, there would be a multi-layer closure to be performed because Jim Bob or Mary Sue became so drunk that they fell and split open their scalp or lip.

All of this would build and build until about 3 am, when things would seem to slow down. However, the next four hours would be devoted to the sorting out and disposing of the night’s dramas and traumas. Although peace was not a certainty, and the waning shift was sometimes punctuated with mundane requests for narcotics, or with those terribly injured in a roll-over accident, their swimsuits still sparkling from the Mica in the creek where they had been swimming.

Even before the advent of EMR, charts needed to be completed, by hand or by dictation. And since I was usually alone after 1 am, I would be the one to close that complex lip, reeking of Jim Beam. Between all of the disparate complaints, it was imperative that I not fail to read a c-spine or collate the results of all of the CT heads, CT abdomens, CT angio’s, EKG’s and serial troponin levels.

As night crawled on, there were annoyed consultants to query, transfers to arrange, admissions to sell and family members to contact. There were police officers who needed their ‘clientele’ cleared and sadly, sometimes, there were coroners to contact and death certificates to sign.

But the remarkable and reproducible aspect of it all was the way that time lurched to a stop. Once, when we went off of Daylight Savings, we kept moving the clock back to 2 am to torture a young nurse. ‘This night is never going to end!’ she said, as we laughed. But how right she was!

Nights always lingered, and as my mind slowed, and the paperwork piled up, I wanted nothing so much as another pair of hands, or eyes; another person to help chart, or just to see the 5 am ectopic work-up, or the 6 am wrist laceration.

I recall looking outside, past the ambulance bay doors, wondering if dawn would ever come, and thinking that if it didn’t, I must surely have died and gone to eternal punishment. When that fatigue arrived, no caffeine, no snack, no nurse MacDonald’s run, nothing helped. When your mind is a fog, when it’s an absolute effort of will to see the patient, do the procedure and then document all of it. When nothing, nothing in all the world, is better than ten minutes, face down on the desk with eyes closed and sleep instantaneous; sheer joy until the next nurse question, x-ray tech call, or ‘chest pain in room 9.’

I don’t miss those full-time nights. And even though I still do one here and there, I hope to do them less and less. And more than that, I hope that one day medicine will evolve in such a way that we don’t have to risk our patients, and ourselves, with the very real danger of pure exhaustion in the never-ending misery of the night, where fatigue meets necessity, where human limits meet unlimited human need.

Because as I go off to bed, I can say that nights are meant to be enjoyed, not merely endured. Sweet dreams..