The Nativity in the Emergency Department; my December EM News column

Merry Christmas!  This is my December column in EM News.  The Nativity in the Emergency Department.

http://journals.lww.com/em-news/Fulltext/2012/12000/Second_Opinion__The_Nativity_in_the_Emergency.9.aspx

I once wrote a story for Christmas in which the nativity happened in an old, beat-up hunting trailer behind a man’s store, somewhere in the South on a cold winter night. From everywhere and all around, rough people and businessmen and politicians found their way to it, situated as it was in a cluttered backyard of a poor but compassionate store owner. Mary and Joseph had a car that broke down, you see, and they were stuck. I doubt if it’s that original. I suspect Hallmark or someone has done this story over and over.

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Yet it still resonates; it still bounces around inside my mind. I envision that cold night, and the star, and the people in my neighborhood, camo-wearing hunters and bearded bikers, the guy with the meth lab that blew up (no kidding), the men in the garage across the highway. I suppose it’s because the story fits everywhere.

As you might expect, I have this image of the manger scene set in an ED. I think back over my patients, and it makes perfectly good sense to me. I can’t decide if it’s a busy night or a slow one. But there are Mary and Joseph, maybe homeless. We do see the homeless, don’t we? And certainly the poor. “Doctor, we don’t have any money or anywhere to go. Can we stay here tonight?” We might try social work, but face it, they probably went home already. The poor are always among us.

If it’s a slow night, the nurses are stricken with a kind of magic. They fluff Mary’s pillow, and one of them (who used to do OB) notices the way Mary is breathing and holding her belly. “She’s going to deliver!” (For the purpose of the story, Labor and Delivery is full to capacity.) All of the nurses are hovering, getting ice for Mary and coffee for Joseph, who has not so much as the change to buy one.

If it’s a busy night, everyone is frantic, and when Mary says, “I think the baby is coming!” the staff roll their eyes, as if they needed one more thing between the overdoses and the chest pains, the weaknesses and the demanding daughter in the hallway insisting on endless attention for her aging mother.

But they do the right thing, don’t they? They almost always do. We almost always do. Before you can sing “O Little Town of Bethlehem,” the baby is there. He’s crying because they do that. And Mary nurses him immediately after the nurses clean him off. But the nurses, and the doctor who caught him (fumbling, frightened … he hates delivering babies), all of them are somehow breathless. The hair on their necks and arms rises up, chills run along their spines. It’s not fear; it’s wonder. Inexplicable. Another poor baby. So what? Everyone is crying. Nobody knows why. Mary just takes it all in as Joseph wraps his arms around both of them, still in the same dirty sweater, still disheveled.

Of course, there are no animals. And yet. If it’s slow, the sleeping drunk in the next room wakes and stumbles in to see. Looking down, he cries, too. He understands something so deep he can’t express it. Something he forgot about hope and love and parents and forgiveness. He reaches into his pocket, pushes $100 into Joseph’s hand, and goes to lie down again. He sleeps in lovely dreams.

If it’s busy, things suddenly move slowly. Things happen. The mumbling, confused lady with dementia (whose daughter is so demanding) speaks for a few minutes with utter clarity, and finds her way to the door of the baby’s room. She holds her daughter’s hand and laughs, and recalls the details of her own maternity. The meth addict, tweaking and rocking back and forth, sits on the floor and just watches. He is calm. He does not scratch or scream. He is transfixed by the inexorable wonder he always hoped to find in drugs, and by the possibility that he might be whole again, that he might have his own wife, child, and delight. The man dying of lymphoma, passing the room as he is wheeled up for admission, asks the nurse to stop so he can look, and the child fixes its tiny eyes on him. He still dies, but he does it in peace.

The cardiac patient’s chest pain resolves, and the febrile infant in the hall-bed (the one who looked so sick) begins to laugh, cackling, breathless laughter. His fever is gone. Only the babies can see the angels swooping round, touching, healing, encouraging.

I can imagine all sorts of things. An angry mayor, searching for the child. Or professors and priests and ambassadors looking for him later, giving him gifts.

But all I see now is the dawn. Mary is strong. She has no time to be admitted. Joseph says they have to go. They are loaded with formula and money, with snacks and blankets (and diapers). They are hugged and kissed by strangers, and everyone waves goodbye.

The next shift asks, “What was that all about?”

“Don’t know,” is the answer, “but I’m glad I didn’t miss it.”

And the chaos descends again, tempered by inexpressible hope, washed in love.

The Questions we Cannot Answer

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My column in the December issue of Emergency Medicine News.  Merry Christmas to all and to all a good shift!

http://journals.lww.com/em-news/Fulltext/2016/12000/Life_in_Emergistan__The_Questions_We_Can_t_Answer.13.aspx

I remember the early trials of thrombolytics; not for stroke but for MI. During my residency we were still comparing tPA with Streptokinase. It was pretty incredible stuff. Now we’ve moved beyond that positively ‘medieval’ method of treating heart attacks and have advanced to incredible interventions in coronary and cerebrovascular disease. Furthermore, we are able to rescue more and more people from the brink of death with advanced medications and with techniques, like ECMO, that our medical forebears couldn’t even imagine. These days, people can say things like: ‘I had severe sepsis last year, but I recovered,’ or ‘A few years ago I nearly died of Stage 4 cancer, but here I am!’ Fifty years ago, twenty years ago, their families would have told their stories with sadness.

What we do is amazing. The science behind our saves, coupled with our training and passion, make medicine all but miraculous. I am proud of what I know, proud of what I do. I am so impressed with my colleagues. And I am often awestruck by the scientists and engineers, without whom we would be apes poking bodies with sticks (good-looking apes in scrubs, mind you).
If we could, at the end of our lives, look back at the gifts we gave to the sick and injured, we would see that they far outweigh our errors and mistakes, our losses and failures. And yet, for all our modern innovations, we have limits. We can ask and answer a constellation of questions, and we can fix untold numbers of problems. But there are questions that defy us, and problems that leave us shaking our heads.
In spite of our pride in science, and our common dismissal of all that is ‘unscientific,’ suffering remains, and we can’t answer why. Who knows this better than those of us who have dedicated ourselves to emergency care?
For all of our miraculous saves, men and women, boys and girls, still suffer horrible injuries and have cardiac arrests, fatal pulmonary emboli. They still die at the scene of car crashes. They still develop mental illness and kill themselves. Addiction still separates families and leaves parents weeping for children, lost from life or lost in the jungle of drugs and desperate lives.
Despite the extension of life we offer so many, even the healthiest men and women will, at some point, leave one another and pass away from this life. And, knowing this fact does nothing to ease the pain of the loss. The most ancient husband or wife still shudders and weeps with the loss of a spouse the way a newlywed would; perhaps more bitterly, knowing love more deeply at 85 than ever they did at 25. And yet, for all our scientific wonders, we can’t say what lies beyond this life.
What I’m saying is that for all our medical wonders, there are just questions we can’t answer, and things we can’t fix. And it is likely that our science, however wondrous, never will have that capacity.
We know it. It’s why we cry after failed resuscitations, and why we call our children when they travel, frantic to know they have arrived. It’s why every EMS tone terrifies the parents of teens and every scan of a loved one is terrifying to those of us in medicine. We can’t control the troubles of this life nearly as much as we think.
Mankind has always known this. Ancient physicians, as limited as they were, did their best and wanted more. They saw the dangers of this life, and their own incapacity, with what was likely more immediacy than we. And sick, injured humans have always known the fear of loss, the questions of suffering, the pain of death.
Into this ‘vail of tears’ we proceed every shift. This is why I often tell young physicians that they should read and understand more than medicine. I favor religious faith, natural to mankind as it is. But if they decline religion, they must have a philosophy. Or they should read great novels, stories, poetry; or reach into the depth of music for some kind of solace in this mess of the unknown.
But let me say this, now that December is here: Christmas comes to offer hope to the hopeless and answers to the hardest of questions. There are those of us who believe its message with all our broken hearts. But even those who find it a charming myth can surely see beauty in the story of God (however you perceive God to be) become man. God suffering with men and women and rescuing them. God come to give a hope of forever to humans trapped in mortality. This is especially poignant to those whose lives have been a succession of one devastating loss after another. It is comfort beyond medicine for them to believe in a God, come to forgive their wandering ways, answering them in the midst of their cutting, suicidal, self medicating cries for rescue. No pill is as good as God come to make every loss whole, and heal every pain in eternity. No resuscitation comparable to God come to die and defeat death.
The pain of this life is enormous. We try so hard, but we can do only so much. The manger in Bethlehem is, if nothing else, a beautiful story to remind us that just maybe, there is healing for the wounds that lie beyond our science. Perhaps the very dream that there is meaning, that there is hope, is a suggestion that there is more there, more here, than meets the eye.
And maybe, the manger is even more than a distant dream, more than a quaint bedtime story, glowing as it does in the chaotic night of human suffering that darkens our ER’s and trauma centers.
Merry Christmas!

The King is Here. Merry Christmas!

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http://www.greenvilleonline.com/story/opinion/contributors/2016/12/11/commentary-king-here/95198746/

Whenever I see the opening scene of Lion King, when Simba is presented to all the animals of the plains, I get emotional. Not because his character is a cute, sneezy fuzzball, but because of the reaction of all of the other beasts. As the music rises to climax, and Rafiki the wise mandrill presents the future king to his subjects, the animals do something that seems decidedly ‘non-Disney.’ Certainly it doesn’t appear ‘modern.’ All of the animals on the ground, looking up at the cub, begin to growl, roar, trumpet, jump, shriek, stomp the ground and, in the end, bow down silently in honor of the newborn king of the beasts. It gives me chills every single time. The kingdom is giving honor to the king.
I get the same feeling when I read about Aragorn in Tolkien’s Return of the King. He is the suffering servant, the mysterious wanderer of many names who travels the wilderness for years, growing stronger and wiser, protecting the innocent. He ultimately confronts evil and tyranny on fields of battle before he is crowned. No longer Aragorn, he is King Elessar, the latest in an ancient, nearly lost line of nobility, returned to rightful rule at last. It is an image of joy and hope, as the King ascends the throne and all’s well with the world; or at least Middle Earth. I want Elessar to be my king too.
Just as I always loved tales of Arthur, who may or may not have existed as we have been told, I enjoy stories of the not-at-all mythical Alfred, the only king of England ever to be called ‘The Great.’ He unified smaller kingdoms into one, promoted Christianity, order, justice and education. This despite many troubles, including invading armies and a chronic intestinal illness that left him wracked with pain.
There’s just something about kingship. I know, this is America and we don’t have kings. (Well, not exactly.) But deep in my heart, I want a king. I want a good king, a just king, a holy king. I want a king I can kneel before, serve, live for and if necessary, die for with joy in my heart.
This isn’t about misplaced patriotism, or some rejection of democracy. Monarchs are perilous things. But the king I want deserves to be king. Not only is it his birthright, he has earned the crown through fire and battle. He knows his people and has gained his kingship by love and sacrifice. The king IS the country. He loves the people and wants only the best for them. The king I long for, ache for, not only lives for the country but would die for it and his subjects.
Which brings us, round about, to Christmas. Hidden beneath the camouflage of fat Santas, elves, sentimentality and commerce, Christmas is the Christian celebration of the coming of the King. Not held high, but born low. Sought by poor shepherds and wise men, also searching for a king. Feared by another king, Herod the Great. Condemned by Pilate (not quite a king but close). Born among the people he lived a most ‘unkingly’ life on earth, living his few years as a common man, who was nevertheless most uncommon. He worked, healed, taught and rebuked the great. He told his followers that he came to serve not be served. That was the model for his reign. He announced his Kingdom with a thundering whisper, like no king mankind had seen.
The prophets knew this: ‘…of the increase of His government there will be no end…’ The apostles did too: ‘Then, opening their treasures they offered him gifts, gold, frankincense and myrrh.’ The carol writers understood it. ‘Come adore on bended knee, Christ the Lord the newborn King.’ That word, lord. We use it so flippantly as just another church code-word. But the lord is the one to whom we owe devotion, the one with authority. Our ancestors in less democratic times understood. ‘Thank you Lord. Help me Lord. Have mercy on me Lord. Send me Lord.’
Christianity is far more breathtaking than its detractors, or even many adherents, realize. For it celebrates the coming of the King and his Kingdom. Same king, past, present and future. The King that puts all other kings, counsels, parliaments, presidents and ministers to shame and flight. And gives the word King it’s proper meaning for all time.
If that’s not a reason for a celebration, nothing ever was.

Malpractice Isn’t a Sin

Dear physicians, PAs, NPs, nurses, medics, assorted therapists, techs and all the rest:

The great thing about our work is that we intervene and help people in their difficult, dire situations.  We ease pain, we save lives. Our work is full of meaning and joy.  However, we sometimes make mistakes.  But remember, in the course of a career you’ll do far more good than any harm you may have caused.

I know this issue lingers in many hearts.  I know it because it lies in mine.  And I’ve seen it in other lives.  I said this once to a group of young residents and one young woman burst into tears. I never knew the whole story, but I imagine there was some burden of pain she was carrying for an error she had made.

But just in case you too have lingering anxiety or guilt about some error you made in patient care, I feel it necessary to say this: neither honest errors nor even malpractice are sins.  They are mistakes, born of confusing situations, fatigue, inadequate experience or knowledge, overwhelming situations, the complexity of disease and the human body, social situations, systems problems, general chaos.  Born of your own humanity and frailty.  Your ‘shocking’ inability to be perfect at all times, and in all situations.  They do not make you evil, bad, stupid or even unqualified.  (PS If you’re not actually a physician but pretending to be one, you’re actually unqualified so stop it.)

As a Christian physician I have contemplated this over and over and have come to the conclusion that God knows my inadequacies and loves, and accepts me, regardless.  He has forgiven my sins.  I embrace that reality every day.  He forgives my pride, anger, sloth, greed, lust, all of them.  But he doesn’t have to forgive my honest errors.  Because they are not sins. Go back and read that again.  Your honest errors are not sins.

Mind you, all of the brokenness of this world is, in my theology, the result of ‘Sin’ with a capital S.  (Not in the sense of minute, exacting moral rules, but in the sense of the cosmic separation of the creation from the Creator.)

So, my mistakes, my failures are born of Sin, but are not ‘sins.’  If my mistakes, if the harm I may cause, come from rage, vindictiveness, cruelty, gross negligence, murder, drunkenness or other impairment on the job, then they could reasonably be due to ‘sin.’  But even so, those sins can be forgiven, and washed away with confession and true repentance.  (Not platitudes or superficial admissions of guilt, mind you, but genuine heart felt ‘metanoia,’ the Greek for repentance, which means ‘to change direction, or change one’s mind.’)

If you are not a believer, join us!  But if you aren’t interested, I love you too and want you to move forward, not burdened by unnecessary guilt.  If you are a believer, and a practitioner, remember that Jesus (The Great Physician) set the bar pretty high and doesn’t expect your perfection, only your honest, loving best.

Mistakes, even mistakes that rise to malpractice, are not sins.  But even if they rise to sin for reasons listed above, they are no worse than any other.  Which means Jesus atoned for them as well.

Move forward in joy.  You were forgiven before you even started worrying about it.

Now go see a patient. The waiting room is full of people who need you!

Merry Christmas!

Edwin

 

 

EvidenceCare: A Great New Information Tool for the ED

I walked through the halls of the 2016 ACEP Scientific Assembly, marveling at both the new and names-you-know companies that are guaranteed to help me gain control of my time, my practice, or my destiny and be a better, more informed physician.
As EM physicians we have to be focused on unearthing just the information necessary to make swift and thorough, often life-saving, decisions regarding a patient’s health and well-being. Responding at the pace necessary to keep up in a busy ER requires us to keep a ton of information in our heads or know where to go at a moment’s notice.
I came across an EM doc at ACEP who clearly understands, and sympathizes, with our need for accurate, useful information to apply in the chaos of the ED.  As a resident at the University of Virginia, Brian Fengler spent a year researching Pulmonary Embolism and publishing a protocol that was relied upon by many. A few years later, Dr Fengler was working in a busy ER and was faced with a woman who had a massive PE…and was 36 weeks pregnant. He knew exactly what to do for the patient but was puzzled as to the risks to the baby. He did what we do, and turned to Dr. Google for a consult. After 10 minutes of digging, he didn’t find anything more than he already had in his head. He took a chance and made a decision to treat the patient aggressively. Fortunately, it was the right move for that patient and her child. But, just as 80% of the decisions we all make in the ER every day, it wasn’t evidence-based. It was an educated guess. Is that the kind of medicine we want to practice?
Fengler didn’t. He never wanted to face the uncertainty he felt that day again. He went about creating a tool that helps docs like us put our fingers on the guidelines and evidence we need, specific to the patient we are seeing, in about 30 seconds. And, he built it to work how we think. I got to see his tool, EvidenceCare, at ACEP and was at once impressed and covetous.  I wanted to be able to use it!

The treatment guide-lines on EvidenceCare been authored by the best in the business… it’s like taking DeBlieux, Kline, or Mattu to work with you. Even better is the way it helps us connect with our patients by translating treatment recommendations into a language and format that makes sense to them…something that is proven to double patient satisfaction.

Furthermore, the treatment pathway you use on EvidenceCare can be imported into your EMR note to show why you made the decision you did!
Over the decades I have become acutely, sometimes painfully, aware that all the information I need to serve my patients isn’t in my head. While I firmly believe that there are things we should memorize, the volume of information we need to use on a daily basis requires that we use various tools to help us.  In fact, a physician friend made the great point that we should be able to access those tools when we take boards, since practice doesn’t occur in a sterile vacuum.  I couldn’t agree more.

So I encourage you to take a look at EvidencCare, for your own personal use or for your facility.  I’ve been using it and find it simple and elegant. And if you read the blog regularly you know I don’t pitch products very often, so that should tell you something.

EvidenceCare content is free.  But if you subscribe to EvidenceCare using the discount code LEAP, you get 33% off the premium edition which allows you to accrue CME, offers a shared decision make tool for use with patients, and allows you to paste information into the EMR as I mentioned above.

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Edwin

Sports Impairment and My Southern Man-Card

 

This is my column in today’s Herald-Dispatch.  My hometown newspaper in Huntington, WV!

http://www.herald-dispatch.com/opinion/edwin-leap-don-t-worry-you-won-t-lose-your/article_3706dd19-3472-520d-856d-09e3580d3886.html

It’s a terrible confession to make as a Southern male, but here it goes. I don’t care a lick about sports; not leagues, not high school, not college not pro. It feels liberating to say so. I figured I might as well be honest about it, because I’m forever confronting the reality of my sports-impairment in various and sundry ways.
One way my dilemma arises is I’m standing in the check-out line at a store, wearing my WVU t-shirt when another customer asks what I think of the Mountaineer’s chances this year. I usually make some sort of generally non-committal remark about how ‘I sure HOPE they do better this year!’ Which means that at some point in the distant future, if they manage to win a championship, I’ll have to be more careful and say ‘well, if LAST year was any indication this should be a good one!’ I try not to make eye-contact. It’s too uncomfortable.
What I usually want to explain, but never bother, is that I wear the shirt because I grew up and went to school there. And it was awesome and I have wonderful memories (same reason I wear my Marshall shirt). But it’s hard to stop a die-hard sports fan and say, ‘well, the truth is I really didn’t have time for sports because I was studying a great deal, but I’m proud I graduated!’ That makes people go to the next checkout line and shake their heads.
I’ve noticed the same thing at church. I remember finding myself in deacon’s meetings with little to contribute to the discussion at zero dark thirty Sunday morning. As everyone made the rounds of the previous day’s games, it was ‘Ed, Marshall did well yesterday didn’t they!’ ‘Sure did…(I guess).’ I put my head down, ate my biscuits and gravy and (since I live in South Carolina) I just let the orange or garnet wave pass over.


I’m not trying to be a snob, please understand. In my childhood I just wasn’t formally taught anything about athletics. Admittedly, my dad built a basketball court for me in the back yard. All the neighborhood kids and I had a great time there at all hours of the day and evening. But the rules were not exactly formally enforced. It was as much social time as athleticism. I also learned a little about football in the front yard. Specifically, I learned that ‘touch’ can be widely interpreted. I realized that lying on my back gasping for air one day, looking up at the fading blue sky.
I remember once around sixth or seventh grade that I went to the mother of one of my more athletically inclined friends and asked about joining a basketball league. She was kind, in a ‘bless your heart’ sort of way, and said we might be able to cram on the rules but it wasn’t looking good. Age 12 and I was already too old to start. I got the message and moved on without looking back.
Instead I filled my days with walks in the woods, turning over rocks in the creek for crawdads, seining for minnows, riding horses with my grandfather, shooting arrows into bales of straw, carrying my BB gun everywhere, shooting bigger guns whenever the opportunity afforded itself and generally acting like a joyous junior barbarian. Those became my preferred activities, until I discovered martial arts, then girlfriend, in high school.
My wife Jan grew up with brothers playing football. If I don’t understand a game that’s on, I just ask her and she guides me through. Two of my children attend Clemson University, and the other two are also fans, which is great. But they didn’t get it from me. Just recently they were all talking about the season and daughter Elysa said, with surprise, ‘why look at us, talking about sports like a normal family!’
I have great respect for all those devoted to their teams, who can quote stats like chapter and verse of scripture. May your team get all of the touchdowns, field-goals, runs and everything else it needs. But to all those who never got it, who never fell in love with sports, it’s alright. You aren’t alone.
Do your thing. You aren’t less of a Southerner or less of a man. And when the discussion turns to yesterday’s contest, learn to smile, nod and just say this: ‘that was some game!’

The Burning Babe. A Christmas Poem by Robert Southwell.

I posted this last year.  But every year it moves me again.  Merry Christmas.  Of note, the author was a Catholic martyr, killed in 1595. http://www.poetryfoundation.org/poem/174450

By Robert Southwell, SJ 1561–1595 Robert Southwell, SJ

As I in hoary winter’s night stood shivering in the snow,
Surpris’d I was with sudden heat which made my heart to glow;
And lifting up a fearful eye to view what fire was near,
A pretty Babe all burning bright did in the air appear;
Who, scorched with excessive heat, such floods of tears did shed
As though his floods should quench his flames which with his tears were fed.
“Alas!” quoth he, “but newly born, in fiery heats I fry,
Yet none approach to warm their hearts or feel my fire but I!
My faultless breast the furnace is, the fuel wounding thorns,
Love is the fire, and sighs the smoke, the ashes shame and scorns;
The fuel Justice layeth on, and Mercy blows the coals,
The metal in this furnace wrought are men’s defiled souls,
For which, as now on fire I am to work them to their good,
      So will I melt into a bath to wash them in my blood.”
      With this he vanish’d out of sight and swiftly shrunk away,
      And straight I called unto mind that it was Christmas day.

Christmas Poem, G.K. Chesterton

Christmas Poem

G.K.Chesterton

There fared a mother driven forth
Out of an inn to roam;
In the place where she was homeless
All men are at home.
The crazy stable close at hand,
With shaking timber and shifting sand,
Grew a stronger thing to abide and stand
Than the square stones of Rome.

For men are homesick in their homes,
And strangers under the sun,
And they lay their heads in a foreign land
Whenever the day is done.

Here we have battle and blazing eyes,
And chance and honour and high surprise,
But our homes are under miraculous skies
Where the yule tale was begun.

A child in a foul stable,
Where the beasts feed and foam;
Only where He was homeless
Are you and I at home;
We have hands that fashion and heads that know,
But our hearts we lost—how long ago!
In a place no chart nor ship can show
Under the sky’s dome.

This world is wild as an old wife’s tale,
And strange the plain things are,
The earth is enough and the air is enough
For our wonder and our war;
But our rest is as far as the fire-drake swings
And our peace is put in impossible things
Where clashed and thundered unthinkable wings
Round an incredible star.

To an open house in the evening
Home shall all men come,
To an older place than Eden
And a taller town than Rome.
To the end of the way of the wandering star,
To the things that cannot be and that are,
To the place where God was homeless
And all men are at home.

(Gilbert Keith Chesterton)

With thanks to:

http://www.gkc.org.uk/gkc/books/christmas-poem.html

Not only do GKC and I share a name (my first name is Keith, as is my father’s), he is truly one of my great literary heroes.  If you aren’t familiar with his work, please look it up.  His biographies of St. Francis and St. Thomas are very good, and his fiction is always fun; even his serious Christian work is a pleasure.  He was a great influence on C.S. Lewis.  Oh, and he carried a sword cane and pocket pistol with which to defend his treasured wife.  Thanks, GKC, for your gifts to us!

 

Holidays and Holy Days; My Christmas Book

This is a book of columns about Christmas and Easter that I put together with the SC Baptist Courier two years ago.  It’s still available and I think you would enjoy it!

https://www.amazon.com/Holidays-Holy-Days-Grace-Sacred-ebook/dp/B00PBHEF58/ref=sr_1_1?s=books&ie=UTF8&qid=1480385263&sr=1-1&keywords=holidays+and+holy+days+edwin+leap

 

Learning to be Careful; The Hard Way.

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One of the terrible things about being a physician who has spent his adult life working in emergency rooms is that you have a certain terrible clarity about the dangers of this life. It’s why we’re forever pestering our loved ones with phone calls and texts: ‘are you there yet!’ Or telling the children, ‘be careful! After midnight there are too many drunks on the road!’ Met, of course, with rolled eyes.

We see, we have seen, a shocking variety of ways in which people shrug off this mortal coil. However, it’s always a bit of an eye-opener when you walk through the valley of the shadow in person. I can think of a few times I did. Once, coming home from a residency interview, my dad and I nearly went full bob-sled under a jack-knifed tractor trailer driving downhill on an icy interstate in Maryland. There was the time I was almost stuck in the middle of a 10 foot wall of flames in the woods on our property. I ran out but only later realized how close I came to being barbecue. There was also the time I was bent over a tree that fell in an ice-storm, cutting it with a chain-saw. I stood up to stretch and another tree fell right where I had been bent. My doctor brain ran the possibilities and none were pleasant. I know what happens to the human body.

Now here I am, 23 years into my practice following residency, and I had another brush with my mortality. First, a little back-story. Like many families with multiple kids in high school and college, we are afflicted with vehicles. One of these cars (and I use the term loosely) is assigned to my high-school senior son, Elijah. For a few months the car (an automatic) would simply drop out of gear and lose all power. Thus it was consigned to the local transmission expert for a six week spa treatment, after which the transmission issues seemed fully resolved. But then it wouldn’t start.

So, one day last week Jan (my wife) and I decided to push it into a better location to try and jump the battery and trouble shoot. It was also in the way of the propane delivery truck, so it had to be moved. We were pushing it backwards, she at the front and I behind the open driver’s side door, pushing and steering simultaneously.

It’s a light car, an Infiniti I-10. Moving it was fairly easy. What became immediately clear was that stopping it was more difficulty. We pushed it across our driveway into the yard, which (we sadly forgot) slopes away at about 15 degrees.

The car picked up speed as objects on inclines are wont to do. But I was still behind the door. And it was headed for the many trees and stumps of our own forest. Jan yelled for me to be careful as I ran backwards. Then I tried (like the 52 year old fool I am) to jump into the seat and put on the brake. ‘Au contraire,’ said the involved force vector, which was hurtling the vehicle ever faster into the kingdom of the squirrels. And in my attempt, I fell to the side of the moving metal death-dealer, in front of the open door which my paramedic brother later described as a ‘scoop blade’ or some other horrible thing.

In a not very manly manner, I yelled. A lot. Perhaps to increase my strength as we do when lifting. Or perhaps because I knew it wasn’t going very well and I was very scared. I had visions of the car rolling over me and realized I had to push away. Finally, after being struck on the left shoulder and knee by the car door, I hit the ground hard and rolled away. As did the car, about 75 feet downhill into the woods, in the process nearly tearing off the driver’s side door, knocking down several trees and ending with a dent in the rear bumper and trunk.

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Many a small animal suffered panic attacks that day, and several trees crossed the rainbow bridge, or whatever it is trees cross when they are killed by hurtling bits of steel powered by stupidity.

Jan came to my side and I stood up, my pride injured, my arm black and blue, my knee tender and swollen. Nothing serious at all. The car? Less so. It had to be pulled out of the woods with a winch and hauled off on a flat-bed truck. In truth, I was ready to be shy of that car. I always had fears that it would lose power on the Interstate as Elijah pulled in front of a larger vehicle, or something like that. I’m ready to be done with it. I just didn’t realize we’d dispose of it by crashing it into the woods.

Christian that I am, I see divine providence all around. Maybe this was God’s way of making me sell the car; or scrap it. Certainly, God’s hand was in my escape from the Infinity that might well have launched me (somewhat ironically) to eternity. I am convinced that my guardian angel pulled me clear then threw his hands up and walked away for a snack break, or the weekend off. ‘Lord, I can’t be responsible when someone does something so ridiculous,’ he (or she) might have told the Father.

Even as I am thankful to God, I am also glad that I work-out, and so I have reasonable strength and agility. Among the many health problems associated with obesity and a sedentary life-style, one that is seldom mentioned, is that since life is dangerous, we must be prepared to rescue ourselves from said dangers as much as possible. As Rikki-Tikki-Tavi’s mother said, ‘A fat mongoose is a dead mongoose.’ I’ve always tried to live by that maxim. Except of course for not being a mongoose nor regularly encountering cobras.

I do think the lesson also reminded me to be more wary. I’m a guy who works in an emergency room. Not only do we treat the results of dangerous events, we are around the violent, the ill, needles, chemicals, infections and all sorts of things. I have to be diligent. Furthermore, I drive at all hours of the day and night. I work with power tools, including chain-saws. I handle firearms. I have a (sadly neglected) metal smithy where temperatures reach upwards of 3000 degrees F. I wrestle with my teenage sons. It is possible that God was just saying, ‘look, you’re no Spring chicken. I want you to do a lot more stuff for the Kingdom, so please be careful!’ To which I reply with a heart-felt, ‘You bet Lord, and thanks again!’

I shudder to think of the possible injuries I could have sustained the day the car rolled out of our control. They come to me in flashes of anxiety now and then, as I consider the horrific alignment of physics, anatomy and physiology. Head smashed against tree, hip dislocated, femur snapped like a dry branch, ribs broken, lungs collapsed. But the bottom line is I’m here, I’m fine, and God is good.

And I will try to never accuse any future victim of an accident of being stupid. Because bad things, dangerous and deadly things often start off with the most innocent of motives and accelerate much faster than we can imagine. All too often to terrible conclusions.

So we all need to just pay attention and think before we do, well, almost anything. Life is short. As one of my neurosurgeon friends used to say every time I consulted him, ‘hey, be careful out there, OK?’