This is a very nice article about how toxic social media has become.
It makes me strongly consider moving all of my interactions here, rather than Facebook or Twitter!
This is a very nice article about how toxic social media has become.
It makes me strongly consider moving all of my interactions here, rather than Facebook or Twitter!
Call me Dr. Doolittle…
Once upon a time, a loving couple moved from the cold, bleak land of Indiana to South Carolina and bought a house in the woods. It was a lovely first home, and they enjoyed all their time in the house. While they were there, they learned about the beauty of nature; the birds, the raccoons, the deer; the ice storms that shattered trees, the flash floods, the brush fires, the stray dogs trapped in the creek, the giant hornets nests in the woods. It was beautiful all around. Nature is awesome!
Then, after they had brought four amazing children into the world, they said to one another: ‘What the heck! Let’s move further into the wilderness!’ And they had someone build them a house of logs, high on a hill near the state forest. While it was being built, they discovered rattlesnakes. Which are natures wonderful creatures. And soon after it was built and they moved in, they learned about wild hogs. Just one more amazing thing in the yard.
In time, the family learned all about the veritable Noah’s Ark that their home had become. Having grown up without scorpions (how poor life was!), the family learned to shake out shoes and watch where they stepped. Inside the house as well as outside. Gradually, centipedes stopped in. ‘Hello human family, we’re God’s creatures too! And we sting like everything else! Welcome!’ By now the family was not only amazed but mildly annoyed. They learned the centipedes are much harder to kill than scorpions. They felt sad doing it. The first time.
A charming family of giant rats lived under the porch. Such a cute family! And they set the dogs on them, who went to work with canine glee. The dogs later made peace with most of the forest creatures and started to completely ignore them.
One magnificent, exciting year, the family saw a cute little lady-bug (or what they thought was a lady-bug) in the kitchen. And the next day they woke to find, oh, about ten-bajillion of them hanging out all around the house and in the house and in their food and bathroom and on the windows and drapes. Some in the family, it turns out, were allergic to them and wheezed and developed rashes. But oh they were so cute. The family sprayed a chemical around the doors and windows that, years later, still seems to kill the creatures and probably cause cancer.
The house in summer was all abuzz with wonderful things. Carpenter bees slowly, with great dedication, began to bore holes all over the wooden beams of the big log house. The children made great sport of swatting carpenter bees with badminton rackets. It didn’t really help, but a dead bug is, well, you know. Eventually it is believed that the house, like a great building of brittle Swiss cheese, will collapse and kill everyone. Except the bugs, that is! Isn’t that wonderful? Nature…who knew?
Later, various wasps began to engineer amazing nests on the log house; which then developed into entire wasp civilizations. The wasps loved the house, and the family, so much that sometimes they went to bed with them and took showers with them! Stinging is like hugging to wasps. Except it really isn’t. The people engaged in campaigns to kill all the wasps, and enrich pesticide companies. The wasps are silly and always come back. The wasps live in the attic above the bedrooms too. We’re all a family.
Then stink-bugs came, and what a joy! They sing their happy, buzzing sounds all day and night, inside and out, and land in cooking food and brewing tea and onto the hair of unhappy females in the house. And when smushed, they smell terrible! What fascinating little nightmares. The family was told that stinkbugs prey on ladybugs. Isn’t that just a kick in the pants?
Lately, above the bedrooms, there have been noises. Adorable, furry bats have appeared in the big log house on the hill. Flying around inside the house, dropping onto the table. What incredible creatures! They are, apparently, rooming with flying squirrels. Will either of them eat the stink bugs?
The family still loves nature. Maybe, part of loving God’s critters is being in a constant struggle with them. At least then you learn about them in person, not from some sterile display or chapter in a book.
Maybe, just maybe, an apartment in the city would be nice sometimes. Because the creatures, so far, are winning.
My column in today’s Greenville News.
I love a good action movie. I tend to prefer the Marvel franchise over DC. I think Superman is too perfect and Batman just too moody. I mean, which rich guy would you rather party with? Bruce Wayne or Tony Stark? Exactly.
But I have always been amazed at the amount of destruction wrought by my beloved X-men and Avengers when battling monsters, aliens, gods and other ne’er do wells. Buildings and freeways and bridges destroyed, untold cars exploding, earthquakes and giant holes in the ground. It’s apocalyptic! In fact, if that were really happening, the toll of human dead would be staggering. Tony Stark could probably make a fortune selling coffins, and ER docs like me would be overwhelmed.
Movies like that are obviously meant to be outlandish; and to take your hard-earned vacation money. But I fear that television and movies sanitize too much of our bitter human experience, making misery somehow palatable.
Take regular action films for instance. Whatever the underlying story, it seems that gun-fights are everywhere! Bullets fly in all directions. Then, at the end of it all, bystanders aren’t injured. Nobody lies moaning or screaming for help. We don’t see the pools of blood spreading across the ground, the skin becoming more clammy, more pale as police call for an ambulance, as the paramedics or surgeons try frantically to stop the flow. We don’t see, or hear, the family member of the dead when they’re told what happened. I’ve done that a bunch and it’s something you never, ever forget. Scenes like that don’t make for fun entertainment.
In our movies nobody sees survivors, good and bad, condemned to paralysis, or with colostomies or amputations from those exciting gun-fights. What about characters punched and kicked to a pulp, their faces bloodied until they can’t breathe? They get chronic headaches, brain damage, vision problems, inability to chew or smell. I have seen them die too.
But we’re oblivious to more than real violence. When we watch trials and cheer for justice, when we want this or that person to go to prison for their crime, we sometimes forget that the imprisoned don’t see their families much, and their families miss them for years, or for life. And let’s not forget that prison, real prison, is a place where violence, rape and drug addiction are far too common.
I hate it when someone says, ‘guess he’ll get it good in prison; I hope he enjoys his cell-mate,’ or some other bit of cruelty. It’s never OK to wish for someone to be raped, male or female. Ever. Although prison has a necessary role, maybe we need to revisit the boundary between punishment and torture. We should want better for even the worst; especially if we call ourselves Christian.
There are others disconnects, of course. When characters in movies have multiple sexual partners, it looks like nothing but fun to modern, sexually liberated viewers. But we seldom see the misery of loneliness that comes from all of those connections, made and broken. Films and television do a poor job of showing us the pain and terror of HIV or hepatitis, the anxiety of unplanned pregnancy and the reality of abortion. They fail to reveal the suffering brought by cervical cancer associated with HPV. The don’t show the tears shed over infertility caused by chlamydia or gonorrhea infections; the danger to newborns caused by herpes. It’s also hard to fathom the fact that many who work in pornography are miserable in heart, mind and body, and some around the world are compelled to do it against their will, working as sex slaves.
On screen, getting drunk is just what you do. We have all laughed at intoxicated characters, for as long as actors have played them. But we seldom consider the mortality and disability from car crashes. We rarely think about the way men and women die from head injuries or asphyxiation due to alcohol or drug abuse. We don’t get to witness the abuse and neglect of children, the cruelty to spouses, the lost hope, lost productivity and broken families from both.
We have to remember that what we see in movies and television is seldom the whole story. Sometimes, the truth is better. And sometimes, unfortunately, the reality is a lot worse, and far darker than the screenwriter, producer or director can ever, or would ever, convey to our entertainment soaked, reality challenged culture.
Gather round kids! Let Grandpa Doctor Leap tell you a few things about the old days of doctoring in the emergency room…
Back in the good old days, medicine was what we liked to call ‘fun.’ Not because it was fun to see people get sick or hurt or die, but because we were supposed to do our best and people didn’t wring their hands all the time about rules and lawyers. Sometimes, old Grandpa Leap and his friends felt like cowboys, trying new things in the ER whether we had done them before or not. Yessiree, it was a time. We didn’t live by a long list of letters and rules; we knew what was important. And we were trusted to use our time well, without being tracked like Caribou through electronic badges. Those were the salad days…
When I was a young pup of a doctor, we took notes with pen and paper and wrote orders on the same. It wasn’t perfect, and it wasn’t always fast. But it didn’t enslave us to the clip-board. We didn’t log-into the clip-board or spend twenty minutes trying to figure out how to write discharge instructions and a prescription. We basically learned in grade-school. EMR has brought great things in information capture and storage, but it isn’t the same, or necessarily as safe, as the way humans conveyed information for hundreds, nay thousands of years.
Back then, kids, the hospital was a family! Oh yes, and we took care of one another. A nurse would come to a doctor and say, ‘I fell down the other day and my ankle is killing me! Can you check it out?’ And the doctor would call the X-ray tech, and an X-ray would get done and reviewed and the doctor might put a splint on it or something, and no money changed hands.
In those days, a doctor would say to the nurse, ‘I feel terrible, I think I have a stomach bug!’ And she’d say, ‘let me get you something for that,’ and she’d go to a drawer and pull out some medicine (it wasn’t under lock and key) and say ‘why don’t you go lie down? The patients can take a break for a few minutes.’ And she’d cover you for 30 minutes until you felt better.
We physicians? There was a great thing called ‘professional courtesy,’ whereby we helped one another out, often for free. Nowadays, of course, everybody would get fired for that sort of thing because the people who run the show didn’t make any money on the transaction. And when you have a lot of presidents, vice-presidents, chief this and chief thats, it gets expensive!
When medicine was fun, a nurse would go ahead and numb that wound for you at night, policy or not; and put in an order while you were busy without saying, ‘I can’t do anything until you say it’s OK or I’ll lose my license. Do you mind if I give some Tylenol and put on an ACE? Can you put the order in first? And go ahead and order an IV so I won’t be accused of practicing medicine?’ Yep, we were a team.
There was a time, children, when doctors knew their patients and didn’t need $10,000 in lab work to admit them. ‘Oh, he has chest pain all the time and he’s had a full work-up. Send him home and I’ll see him tomorrow,’ they might say. And it was glorious to know that. Or I might ask, ‘hey friend, I’m really overwhelmed, can you just come and see this guy and take care of him? He has to be admitted!’ And because they thought medicine was fun too, they came and did it.
In those sweet days of clear air and high hopes, you could look up your own labs on the computer and not be fired for violating your own privacy. (Yes, it can happen.) You could talk to the ER doc across town about that patient seeking drugs and they would say, ‘yep, he’s here all the time. I wouldn’t give him anything,’ and it wasn’t a HIPAA violation; it was good sense.
Once upon a time we laughed, and we worked hard. Back then, we put up holiday decorations and they weren’t considered fire hazards. We kept food and drink at our desks and nobody said it was somehow a violation of some ridiculous joint commission rule. Because it was often too busy to get a break, we sustained ourselves at the place we worked with snacks and endless caffeine, heedless of the apparent danger that diseases might contaminate our food; we had already been breathing diseases all day long, and wearing them on our clothes. Thus, well fed and profoundly immune, we pressed on.
In those golden days of medicine, sick people got admitted whether or not they met particular ‘criteria,’ because we had the feeling there was something wrong. We believed one another. Treatment decisions didn’t trump our gut instincts. And ‘social admissions’ were not that unusual. The 95-year-old lady who fell but didn’t have a broken bone and didn’t have family and was hurting too much to go home? We all knew we had to keep here for a day or two and it was just the lay of the land.
I remember the time when we could see a patient in the ER and, because my partners and I were owners of our group, we could discount their bill, in part or entirely. We would fill out a little orange slip and write the amount of the discount. Then, of course, the insurers insisted on the same discount. And then nobody got a discount because the hospital was in charge and everyone got a huge bill, without consideration of their situation. The situation we knew, since we lived in their town.
Back when, drug reps left a magical thing called ‘samples.’ Do you remember them, young Jedi? Maybe not. Young doctors have been taught that drug companies, drug reps and all the rest are Satan’s minions, and any association with them should be cause for excommunication from the company of good doctors. But when we had samples, poor people could get free antibiotics, or antihypertensives, or all kinds of things, to get them through in the short run. And we got nice lunches now and then, too, and could flirt with the nice reps! Until academia decided that it was fatal to our decision-making to take a sandwich or a pen. Of course, big corporations and big government agencies can still do this sort of thing with political donations to representatives. But rules are for little people.
When the world was young, there was the drunk tank. And although mistakes were made, nobody pretended that the 19-year-old who chose a) go to the ER over b) go to jail, really needed to be treated. We understood the disruptive nature of dangerous intoxicated people. Now we have to scale their pain and pretend to take them seriously as they pretend to listen to our admonitions. They are, after all, customers. Right?
These days, we are perhaps more divided than ever. Sure, back in Grandpa Doctor Leap’s time, we were divided by specialty and by practice location; a bit. But now there’s a line between inpatient doctors and outpatient doctors, between academics and those who work in the community, between women and men, minorities and majorities (?), urban and rural, foreign and native-born and every other demographic. As in politics, these divisions hurt medicine and make us into so many tiny tribes at work against one another.
And finally, before Grandpa has to take his evening rest, he remembers when hospitals valued groups of doctors; especially those who had been in the same community, and same hospital, for decades. They were invested in the community and trusted by their patients and were valuable. Now? A better bid on a contract and any doctor is as good as any other. Make more money for the hospital? In you go and out goes the ‘old guys,’ who were committed to their jobs for ages.
Of course, little children, everything changes. And often for the good. We’re more careful about mistakes, and we don’t kick people to the curb who can’t pay. We don’t broadcast their information on the Internet carelessly. We have good tools to help us make good decisions. But progress isn’t all positive. And I just wanted to leave a little record for you of how it was, and how it could be again if we could pull together and push back against stupid rules and small-minded people.
Now, Grandpa will go to bed. And if you other oldies out there have some thoughts on this, please send them my way! I’d love to hear what you think we’ve lost as the times have changed in medicine.
Grandpa Doctor Leap
A friend of mine is serving with this team. Keep them in your prayers, and consider donating or volunteering.
Alfred is 95 years old, and sits quietly in his wheelchair, rocking back and forth. His strength is gone, and his veins and tendons bulge through fair, translucent skin, stretched over muscles of long lost size and use. His greatest foe is gravity, which holds his lithe, bird-like form in the chair enough to cause sores on his hips, but only barely. It looks as if he might float away.
He remembers little, but smiles often. And his simple joys are coffee and sweets, pecan pie, banana pudding, chocolate cake These things, these beautiful, delicious gifts anchor pull him into in reality, and out of the reverie which possesses him for hours at a time as he stares out the window at passing seasons, and passing lives on the highway.
He is not bitter. Sometimes he sings, and sometimes he laughs. And she knows the name of his roommate, Jake, but forgets it weekly. He kisses the hand of his nurse, Kendra, who loves him like a grandfather and sometimes reads the Bible to him, drawing from the well-worn and underlined pages in his copy, which his children brought years ago. When the verses are read, he closes his bright, tired, grey eyes and leans back in repose, ready for the journey. But he cannot recall a word that was said; there is no need, for the are well carved into the stone walls of his mind, whether he remembers or not.
Alfred dwells, it seems, betwixt worlds. His muscles and bones, his frayed and frazzled nerves and short-circuited brain, his assorted plumbing and weary organs all remain in part, but not in youthful whole. His thoughts so scattered, his memories like abstract art, known only to the painter.
Perhaps, Alfred has already begun the journey. Maybe across the bar, there is a house where he lies asleep; or the beginnings of him, what will be fully Alfred. His memories are traveling there like files being stored. His wisdom and laughter, his busy hands, by which he farmed and worked, making and fixing, fathering and providing, and with which he cared for his dear Ruby before she went ahead. All of these pieces surely precede him and are being assembled by God’s angels, guided by the King Himself. Like bits of a great temple crossing the sea to be reassembled; but even better and more solid than before.
A shape is there, a form, a place prepared for him. All that is strong and good and well is becoming more and more real as he, every day, becomes less and less real in his room, in his chair, in his world where he sweetly greets the strangers that are his own children and grandchildren, and hugs them and kisses them with tears he could not explain, his love deeper than breath even if he does not understand it.
Do not fear for Alfred. He is, slowly and patiently, becoming more and more than we can possibly believe. He only appears to be less. He is, unseen by any of us, transforming before our eyes.
One day, Alfred will depart. He will leave the broken, failing bits of form behind, an empty shell on a beach, a shed snake-skin, old antlers. One day Alfred, finally and fully himself, will draw a deep, first, precious breath from air in a place he prayed to go, and open his new eyes on landscapes and visions and joys he could never in his best imagination hope to have. He will touch his own arms, firm and strong, and new blood flow through vessels that will never narrow. He will stand and be amazed. He will hear waves crash, or wind in trees, and the music of being truly alive at last.
And if all goes as he dreams (and it is likely his dreams are now visions), he will see God first, and his Ruby second and all the others who make the same trip and longed to see him again. And then all the journey and trouble, all the wait for finality, all the pain and loss will not only make sense, but be irrelevant to his new, redeemed, perfect life.
My column in the Winter 2017 Gray Matters, Newsletter of the Osher Lifelong Learning Institute at Furman University.
THE NEWSLETTER OF THE OSHER LIFELONG LEARNING INSTITUTE @ FURMAN
PAIN MANAGEMENT AND THE TIE TO ADDICTION – PART 2
Sometimes medicine offers us wonderful, almost unimaginable gifts. Heart attacks that were devastating, life-altering events a few short decades ago are now treated with an expediency and skill that our grandparents couldn’t imagine. A couple days pass, and the victim is home with stents in occluded arteries and directions to modify activity and diet. Pneumonia, once the ‘old person’s
friend’ (so called because it took the aged to eternity), is far less terrifying, thanks to both antibiotics and the pneumonia vaccine.
However, some of the things we do give benefits that are less clear. Although it could be an entire column in itself, the ‘stroke center’ movement, with the promise of miracles from ‘clot-busting drugs’, is a thing full of as many questions as answers. And what about depression and anti-depressants? When I looked up the side-effect profile of an anti-depressant a friend was taking, I was reminded that all of them have the potential side effect of increasing suicidal behavior.
But what about pain management? Thanks to improved understanding of the physiology of pain, the persistence of medical providers, and the investment and research of pharmaceutical companies, we have a wide array of pharmaceuticals available for the treatment of pain. Some are over-the-counter, like acetaminophen and ibuprofen. And others, those we refer to as narcotics or opioids (because in previous times they were derived from opium), are useful, potent, and (as is increasingly evident) fraught with danger unless used very cautiously.
Of course, for a very long time, physicians were taught to be judicious in prescribing narcotics. Our venerable teachers warned young doctors in training to be frightened of the side effects. We were especially aware of the very immediate danger that patients would stop breathing and die due to excess sedation. We were also aware that over time, patients on narcotics might develop problems with addiction.
About 20 to 25 years ago, that whole paradigm shifted and physicians were suddenly accused of callous disregard of suffering for prescribing too few narcotics. I remember this because I was in my emergency medicine residency at that time. We were constantly reminded to give more narcotics and be sensitive to pain. We were taught to use the ‘pain scale,’ in which a patient-reported score of zero meant no pain and a score of ten meant ‘the worst pain of your life.’ Never mind that it was entirely subjective and that there was no objective standard, no ‘painometer’ against which to measure it. We were instructed to see pain as the ‘fifth vital sign’ after blood pressure, pulse, respiratory rate and temperature. Of concern to many, these initiatives coincided with the development and aggressive marketing of ever more powerful, addictive medications like Oxycontin tablets and Fentanyl patches and lozenges.
Patient satisfaction surveys included the question ‘was your pain adequately treated?’ Physicians were castigated when those satisfaction survey scores fell. Physicians were instructed, by non-clinician
administrators, to give more pain medication to make patients more satisfied. (A satisfied customer/ patient is one that may come back!) Physicians who resisted, in the name of science or safety, were too often met with threats of reduced income or job loss if patient satisfaction scores fell. In some instances, physicians were (and still are) reported to state medical boards for alleged inadequate treatment of pain.
I sincerely believe that most of those encouraging us to write more narcotics prescriptions did so out of genuine concern and compassion. People are in pain, so why not treat the pain? In medicine, where science meets suffering humanity, it’s so easy for us to say, ‘Well, it just makes sense, doesn’t it?’ We assume that our compassion will be supported by our science. It happens with infections; sure it’s probably a head cold, but what’s the harm in an antibiotic to keep the patient happy? The child bumped her head pretty hard, so what’s the problem with a CT scan, even though she looks good? The parents are customers, after all, and want a scan!
With tragic consequences, our compassion sometimes causes harm as the Law of Unintended Consequences rears its ugly head. For instance, those antibiotics for colds? They can cause dangerous allergic reactions and life-changing intestinal infections requiring hospitalization or surgery, and resulting in death. Those CT scans everyone wants? Physicians are trying to reduce the number of scans, as many of us are concerned that they may induce malignant tumors later. And those pain medications? The evidence looks pretty damning.
Addiction to prescription narcotics is growing at a terrifying rate in the U.S. Likewise, death rates from narcotic overdoses have soared. The U.S. has seen 165,000 deaths from opioid overdose between 1999 and 2014. http://www.cdc.gov/drugoverdose/data/overdose.html. In fact, opioid-related deaths have now surpassed deaths from firearms in the United States. http://www.cbsnews.com/news/drug- overdose-deaths-heroin-opioid-prescription-painkillers-more-than-guns/ Admittedly, some of those deaths are not due to prescription opioids but rather to injected heroin. However, many heroin addicts began their addiction issues when taking legitimately prescribed pain medication.
Sadly, seniors are not immune. Physicians don’t want to see seniors suffer, so they often give narcotics even for pain that in decades past would not have been treated with those drugs. We give them for back pain, headache, arthritis, or other less serious conditions. And we use them extensively in treatment of chronic, intractable pain. In fact, in 2015, one-third of Medicare recipients received a prescription for an opioid analgesic; some 40 million prescriptions. https://www.statnews.com/ 2016/06/22/many-opioid-prescriptions-seniors/
Furthermore, seniors not only develop addiction, not only die from accidental overdoses, their narcotic analgesics have a host of side-effects, including (but not limited to) the following: excessive sleep, impaired thinking, increased pain sensitivity, nausea, constipation, and cardiac arrhythmia. In addition, opioid drugs contribute to weakness and loss of balance and thus to falls, resulting in head and spine injury, various fractures, and other trauma. Their already impaired reflexes are dampened by their medication so that for those who still drive, it becomes an even more dangerous activity than before.
No one is immune from this devastating epidemic, not rich nor poor, not young nor old. The medical profession, the mental health community, law-enforcement, social services, churches, families, and friends all have to come together and find ways to roll back the rising tide of death and addiction, which came as an unforeseen outcome of attempting to ease suffering with compassion and science.
This problem will be highlighted this spring at an OLLI bonus event, March 31, 2017: Seniors and Opioids: Unexpected Origins of a Greenville Epidemic. I will be speaking in conjunction with James Campell of the Phoenix Center addiction and rehabilitation facility. We really hope you join us to learn more about this pressing public health crisis.
This is my column in today’s Greenville News. Official link not up yet at the News website, but I’ll post it when I can.
I remember being an adolescent, ringing in the New Year with my family. My mother a nurse, and my father a pastor, we just weren’t big ‘party people.’ Their mantra (which is now mine) was ‘nothing good happens after midnight!’ (I have plenty of anecdotal doctor stories to back up that assertion, by the way.)
We’d shoot some illegal fireworks off, or fire a gun from the back porch at midnight, and we’d eat some shrimp as the ball dropped in far-off, sparkling, exciting NYC. Then mom and dad usually fell asleep early and I wished for something to do. They were busy folks, and reasonably tired, so New Year’s Eve wasn’t much different from any other night. My wife’s childhood memories were similar, as her parents worked hard and rested when they could. Furthermore, those were the ‘dark ages’ when the Internet wasn’t part of life, and communications to the rest of the kid world were restricted to the house phone and the postal service. (Can you imagine?)
So it was no surprise that Jan and I celebrated a remarkable event on December 31st. For the first time in 22 years, we spent New Year’s Eve together… with nobody else. No kids, no relatives, no friends. Zero.
We aren’t opposed to enjoying the holiday, mind you. Over the years of our dating and marriage we’ve had lots of wonderful New Year’s Eve celebrations, from small affairs with friends to dress-up evenings in crowded restaurants.
We’ve had many parties at our house on the hill, with plenty of food and fireworks, bonfires and chaos. We’ve had church youth group events where dozens of young people played capture the flag in the freezing cold, the night illuminated only by flashlights, after which shivering teens (and leaders) warmed themselves by the fire and passed out on the floor from fatigue.
Most years the attendees were simply bunches of our kids’ friends and our own, along with as many family as possible, whom we promised that the fun and laughter would outweigh the danger of stray bottle rockets, brush fires or jackets set on fire by sparklers.
But this year, all of our ‘children’ from ages 15 through 22 (not so much children now), had things to do, people to see and places to go. Based on our own experience as young people, we could hardly blame them. And rather than try to make them feel guilty, rather than be stuck on some dead-end, potentially toxic nostalgia, we said ‘be careful and have fun! Keep us posted where you are and what you’re doing!’
I had worked all day in the ER and arrived home, where Jan had a yummy meal waiting. I took dinner to our room where we settled in for a very, very uneventful evening. Good Clemson parents, we periodically paid attention to the score of the Clemson-OSU game. Good former homeschool parents and life-long nerds, we watched Tolkien’s Return of the King on TV. We weren’t cold, nobody around us was intoxicated, we didn’t have to drive anywhere and the wait for food was non-existent.
I seem to recall learning that Clemson had won, and the dark forces were pouring out of the gates of Mordor, right as I said, ‘I love you baby! Happy New Year!’ At that point the dark forces of fatigue enveloped me and I was out around 11:30. Jan, with more fortitude than I, stayed awake until after midnight.
Emotions are funny things. And we humans can keep lots of competing emotions in constant tension together. That night, even as we missed our children and thought back on all the beautiful, laughter-filled evenings of the past, we were buoyed up by the deep, underlying love and friendship that we have had since our first date almost 33 years ago. We rang out the old, and rang in the new together, with joy and contentment.
Parents everywhere should try to remember that as wonderful as our kids are, and as delightful it is to spent time with them and others, our marriages are the deep, holy bond that will remain, and see us to the end. We know there will be parties again. But party or not, the best New Year’s Eve, the best day, the best night, the best life, is the one we spend together.
How do the vows go? In sickness and in health, for richer for poorer, at parties or at home with only you? I do. Always.
My Christmas column from Christmas Day, 2016
Merry Belated Christmas!
The Christmas Gift We All Desire
It’s here at last! What seemed to take forever for children arrives and passes like a shooting star for adults. But joy of joys, it’s Christmas morning! And a special morning since it’s Sunday. Families who attend worship services will, based on personal experience with small children, be up at zero dark thirty, as kids rush to the presents and the chaos begins.
Photos will be staged. (My parents made us stay in the hallway while they prepared the camera…Jan and I have since done the same, forcing children to stay on the stairs while we took our time tormenting them, they like horses headed to the barn for oats.) Families will have systems, as gifts are handed out in a manner devised to avoid wholesale riots.
Food will be prepared; in our home Christmas breakfast is bacon and cinnamon rolls. Cats will be watched carefully to avoid the climbing, and tipping, of trees. Mostly they will busy themselves with wrapping paper,licking and pretending not to be as excited as the kids. The dogs (at least our dogs) will look in through the glass of the door in puzzlement, and wait for partially eaten anything (and any chance at cat food).
Gifts will be opened, as parents and partners hope that they have given joy to those they love with this gift or that. There will be joy and squeals, hugs and kisses. Hours will be spent enjoying new items or searching through wrapping paper for batteries or lost instructions.
Those off to church will have to pry the kids away from their recently obtained treasures, or take some along. Older children will wear new clothes. Parents will fall asleep in chairs, as they were up until the wee hours wrapping, assembling items or simply enjoying the sweet wonder, the special silence of Christmas Eve. That stillness, in a dark house with tree lights, is every drop as precious as the big day itself. Personally I find a much greater connection to the whole nativity story on Christmas Eve, as if I were watching the tale unfold in a starlit lens to antiquity.
And yet. There are those families where the above is as fantastical as Santa and his reindeer. For some, for those in poverty, those with family members separated by prison sentences, those whose homes are the slave-quarters for addiction, Christmas will not look this way. Nor for those with loved ones far away in school, in work, in war. For many the separation from loved ones is the great gulf of death, and even sweet memories are painful reminders of what is no more. Still others find the day hard because of recent illness, injury, surgery, diagnosis of cancer. Our family walked through some of that too. However beautiful the wrapping paper and lights, however delightful the gifts, a pall hangs in the air and the thoughts turn to what was, or what might be, ‘if only.’
But that is, ultimately, the purpose of this day. It is not, it turns out, a day especially made for the joy of the now, nor for pets to get new sweaters, or adolescents to stock up on electronics. The joys and wonders of Christmas, from Santa to gifts, from feasts to surprise visits, are magnificent side-effects of the joy and purpose of the day. The day we remember the one born to set all things right.
The passage that I have come to most associate with Christmas (having lived life a bit) is not found in the Gospel accounts of Jesus’ nativity. It is found, oddly enough, at the end of the Bible, in Revelations, chapter 21. Dear old St. John reports:
‘And I heard a loud voice from the throne saying, “Behold, the dwelling place of God is with man, and He will live with them. They will be His people, and God Himself will be with them as their God. He will wipe away every tear from their eyes, and there will be no more death, or mourning or crying or pain, for the former things have passed away.” And the One seated on the throne said, “Behold, I make all things new.”’
That’s Jesus telling us that one day, things will be more grand than we can ever imagine; even better than our best dream of Christmas. He will meet our deepest needs and desires and banish suffering. Forever.
Now that’s a Christmas gift I can’t wait to open. Merry Christmas!
Merry Christmas! This is my December column in EM News. The Nativity in the Emergency Department.
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.
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.