Flying cross-country in ‘steerage’

Flying Steerage

Flying Steerage

I can still remember when flying, even in coach, was relatively comfortable. I once flew to Japan on a Korean Airlines jumbo jet. Between the amazing food, the gracious attendants and the vast seats, it was practically a religious experience. Flying was also fun!  On a flight from Alaska to South Carolina, while sitting at the very front of coach, I asked a stewardess this question: ‘If I moved forward about six feet, into first class, it would cost $5000. Why is that?’

She looked around, leaned close and said, ‘We dance naked…’

Alas, that was then. I just flew from Denver to Cincinnati for business. I trudged onto the ‘regional jet,’ which would fly me across the amber waves of grain of the Midwest, sat down, stuffed my backpack under the seat in front of me and managed to wedge my feet beside it. Between the immovable placement of my lower extremities, the width of my seat and the (admittedly) unfortunate width of my body, a seat-belt was purely superfluous. Any crash that could have dislodged me would have been, by default, unsurvivable.

Fortunately, my stewardess was devoted to my safety, and asked that I remove my empty drink bottle from my seat-pouch. You don’t even want to know what can happen when a jet airplane hits the ground at 450mph and there’s a plastic bottle in front of you! It’s horrible…almost as bad as not sitting in the upright position.

Adding to the delights of our regional jet, there was a very large man seated next to me. Now, I don’t mean obese. This man was big. For all the world, he had the appearance of a Grizzly bear, drugged, captured and stuffed into a pet carrier designed for house-cats. His eyes were wild with confinement.

Our shared condition was made worse by the inconvenient presence of our arms. There was just no place to put them. We flew with our useless upper appendages held across our chests for most of the flight, although occasionally I was able to shift my body a few degrees to the aisle to return sensation to all limbs.

We were in the back row, so our seats could not recline. The seats in front of us were so close that when my fellow-traveler lowered his tray table, it stopped at about 30 degrees from the vertical and rested squarely on his nipples, between which he might reasonably have wedged his complementary drink.

Much like men in public restrooms, our ‘intimacy’ led us to avoid eye contact. Two and a half hours later, we arrived and unfolded from our seats, but both of us would have preferred the spacious confines of, say, a freezer crate.

This wasn’t the first time I had encountered the phenomenon of ever shrinking space in ‘steerage,’ where the masses are packed like so many Kindle-reading sardines. I dropped my water bottle on another flight (on a similar aircraft) and nearly wept. There was simply no way for me to reach it without dislocating my own shoulder or sharing an uncomfortable yoga position with the lady seated next to me.

When even the skinny flight attendant admits that it’s hard for her to walk down the aisles (as ours did), the rest of us are in for nothing but misery and blood clots. Perhaps those of us who fly often might have more room if we would simply lie down in the in the overhead compartments. Or maybe airline executives should fly with the masses more often, in order to enjoy the new seating arrangements first hand.

Despite the cramped quarters, and the fact that I could barely move enough to open my microscopic bag of pretzels, I had to laugh. The experience didn’t change the fact that I enjoy air travel. It’s still a miracle and a wonder; to this day I love watching throngs of humans navigate the intricacies of the process, for work and pleasure alike. Frankly, the spectacle of the public vs TSA is almost worth the price of a ticket.

However, I must confess that for my subsequent trip I rented a car. Sure, it tripled my travel time. But it was worth it to travel in a comfy seat, with a cup-holder and proper snacks; and to feel my legs.

I’ll fly again, but don’t think I won’t have something to say about it. On the other hand, this flight went a lot more smoothly than the time I had five rounds of forgotten .38 ammo in my carry-on. But that’s a story for another day…

South Appalachian Yoga…a craze to follow!

Jan, my very fit and lovely wife invited me to do some Yoga this morning. I elected to focus in relaxation techniques in the bed as she worked out. (Guys, what’s better than watching your wife do Yoga?) Yes, yes, I know I need to exercise. And I do exercise. Sometimes. But Yoga? Well I don’t think my ancestors (or I) were meant for it. It simply hurts too much. I rarely hurt my muscles lying in bed, you see. But as I listened to the smooth, silky voice of the instructor Jan was streaming on her i-Pad, I imagined something. I imagined the wonders of Southern Appalachian Yoga!

Stand with your feet one shoulder width (or muffin-top) apart. Now, reach up to the sky! This is called lighter at the Skynard concert. Slowly wave your lighter back and forth. Watch your balance and try not to capsize. Now, reach slowly down, down and pick up your imaginary burger. Hold it in front of you at arm’s length. It’s a Triple. Feel the weight. Put the burger down. Pull up your pants; nobody behind you needs to see that.

Legs two muffin-tops apart, now sit on your ATV. This is called ‘riding the trail.’ Grasp the handlebar. Work your wrist muscles as you drive down the trail in your mind. You hit a limb. Lie down on your back, arms and legs out. This is called ‘911.’ Relax and check every limb for injury. Breath deeply and contemplate this: did I take the roast out of the oven?

Roll over. Imagine the rifle in your hands; breath quietly as you sight that enormous eight pointer. This position is called ‘opening day.’ Good shot. Stand up. Reach behind you into the cooler, stretching for the beer to celebrate that shot! Reach for two; Bubba wants one as well. Hand it to him. He’s sitting on the ground.

Now, lie down again. Raise your back and hiss. This is called ‘copperhead at dawn.’ Bite your friend for good measure. Roll quickly onto your back and hold hands and legs in the air, with your mouth open and tongue out.

Then tip to one side, holding the position. This is called ‘road kill.’ Lie there a while and think about lunch. Or dinner. Stand up and take an Advil. You’ll be in shape in no time at all! Reward yourself with fried chicken. That’s Yoga!

Lost Proverbs of the Emergency Department

Here is my EM News Second Opinion column for June:  ‘Lost Proverbs of the ED.’

Here’s the direct link to EMN.  The text is below.

Lost proverbs of the ED:  found in an old liquor bottle outside an urban emergency department


Dear readers:  these proverbs came into my possession recently.  I long suspected there was a hidden body of wisdom, a secret society of people who pass their wisdom along to others.  I was both relieved and shocked to find that I was right.

He who has pain and asks not for medicine is a fool.

He who has no pain and asks not for medicine is a greater fool.

Verily, the number of all pain is 10. This is a great mystery.

Whoever would see long days and joyous life would think carefully,

And never take a knife to a gunfight.

Or a baseball bat to a knife fight.

A big dog is a wonder.

Play rough with it. Make it fight.

Then feed it bacon from your mouth.

Remember that spider? In your basement?

It probably bit you in the night.

Doctors always say abscess for spider bite.

Do you want riches? Do you want prosperity?

Work under the table. Taxes are for suckers.

Get your benefits from saps who work.

Find a woman who will love you.

Find a woman who will have your children.

And also her sister.

Long life is a gift. Gray hair a crown.

But when the aged are a problem,

Ask the doctor to admit them.

Belly pain is a curse and hunger a greater misery.

So never let pain be a reason not to eat.

Burgers solve all problems.

A helmet and a seat-belt make one safe.

But neither makes one cool.

Cool is worth the risk.

Pregnancy is magic.

Remember, you can’t be pregnant.

No way. No how. Unless you are.

Work elevates us. Work pays our bills.

Work drains us and stops fishing trips.

If you have a cold, get an excuse, silly.

Doctors and nurses have money.

Don’t worry about them; they’re rich.

Health care is free … if you insist.

The wise man avoids conflict.

The foolish doctor makes mistakes.

Keep a lawyer’s card in your wallet.

Remember that you are strong. And loud.

Bully everyone you can. But learn to keep your

mouth shut when the cops arrive.

An argument is good

until the police arrive.

Pepper spray is no fun at all.

A thief is the one who gets caught.

Check the hospital cabinets!

Purses can hide lots of bandages.

Life is precious. Who would kill himself?

But saying you’ll do it is great drama,

And everyone feels badly for you.

If your heart is racing, if your skin is drenched,

If you feel afraid and think you might die,

Ask, “Could it be the meth?”

Do not take a chance on fever.

Do not pause to take Tylenol.

Your cousin’s brain caught fire one time, and he ain’t right.

If food and fluid erupt from you like a volcano,

If your stomach aches, be afraid!

No one else in history has ever vomited but you!

There is joy to be had in life. There is beauty.

There is love. How can it all be sweeter?

Oxycontin, that’s how.

Was your doctor good? Was your problem solved?

Did you receive what you deserved?

Do not neglect the satisfaction score.

Family is a blessing. They know all.

Remember, whatever your sister says is true.

She’s a nursing assistant, after all.

When you roll your car, when you hit that tree,

Remember, it was because of the dog.

You only had two beers, right?

Your time is precious. TV shows to watch.

Babies to make. Snack food and sodas.

Ask why your ER visit is taking so long!

What will you do when the ER is empty?

What will you do when the doctors quit?

That won’t ever happen! Funny joke.

Identification is important. For checks, for beer.

ID matters to the parole officer. But don’t take it to the ER.

They’ll only send you a bill, you fool!

Tattoos and piercings make the girl and guy.

They show we’re edgy, bad, sexy.

What’s an infection now and then?

Watch for mysteries everywhere! (Especially in the shopping cart!)

Here is my column in today’s Greenville News.  Enjoy!  And remember what you put in the cart at the store…

Everyone loves a good mystery, don’t they? It’s why we enjoy shows like CSI, and The First 48. The idea that we can take the evidence before us and construct an explanation for events, why that’s good fun! And I wonder, sometimes, if folks aren’t taking notes in anticipation of future misdeeds!

It all makes me wonder. Someday, when I’m long gone to glory and the children are far away, someday when these woods and fields are unexplored and wide open before other occupants, I wonder what they’ll think?

How will they explain the assorted animal bones that litter our yard and woods ? I know that they’re the consequence of keeping a pack of dogs around the yard. Thanks to the dogs, I am never surprised when the law-mower flings half a mandible across the yard, or a small skull crunches beneath my foot as I work around the porch. Not that the dogs take the energy to kill anything, mind you. But they’re great at dragging things out of the forest that have been killed by other, more enterprising carnivores. Of course, the collected skeletons may seem a little odd to future excavators, since this place clearly wasn’t an active farm.

Coupled with the scattered shell-casings, lost arrows, abandoned hatchets and machetes characteristic of boyhood, future excavators might take this for a battlefield, a sacrificial location or an abattoir! Small creatures buried in boxes might also make it seem like a burial ground. My daughter recently interred a tiny tortoise in a wee box She tenderly wrapped it in a leaf and flower, with the kind of gentility only a child can show for a thing that seems so inconsequential to silly adults. Of course, I had to dig the hole, but that’s papa’s work.

When the kids were smaller, I wondered what an investigator would think of my last car. Somewhere, under a back seat, there were probably a couple of forgotten diapers, at least two pounds of potatoes in the form of petrified McDonald’s French Fries, enough straws to make a snorkel, enough loose change to re-fill the gas tank and multiple forgotten crayons. The seats themselves likely had enough DNA from childhood incidents and accidents to reconstruct a very confusing crime-scene involving blood, saliva and urine. I imagined the detective scratching his head next to my body, wondering if I had been killed by a diaper wearing short-order cook with a creepy penchant for coloring books.

However, I never wonder about the ‘story’ more than when I’m in line at WalMart or some other store that has a wide variety of items. As I check out, someone must be asking, ‘why would he need 500 rounds of .22 ammunition, 50 pounds of dog-food, a blade for a power-saw and scented hand soap?Can I get a deputy on aisle 20?’

And there’s the dietary issue. Sometimes our kids have friends over to visit. I always enjoy the look in the clerk’s eyes as I check out with 10 pounds of hamburger, 6 boxes of Swiss Cake Roles, 10 bags of assorted chips, batteries for the X-box controllers, 10 liters of Coke products, three boxes of Oreo Cookies and an archery target. ‘You don’t want to know,’ I think to myself. The only thing better would be adding a vial of insulin.

So it is with a smile that I view a big screen TV, a leopard print bra, stiletto heels, four gallons of wine and a packet of steaks. ‘Happy Father’s Day,’ it cries out! It is with a laugh that I watch Star Wars action figures, a box of Vanilla Wafers, a pack of juice boxes and some frozen kids’ meals. Mommy needs a little down time, apparently.

It is with wonder and a little surprise that I see frozen dog cookies, a car battery, a stroller, a chainsaw chain and a set of socket-wrenches. Just what sort of vehicle are we building, eh dad?

And it is with a sense of foreboding that I watch as 100 feet of rope, a set of steak knives, a shovel and a gray tarp roll down the conveyor. Family coming to visit? Big plans? I wonder if someone is going to show up on America’s Most Wanted.

I’m fairly easily entertained. But few things entertain me like constructing stories, whether it be from tiny corpses in my yard to scary purchases at the store.

There are mysteries, and stories, all around. Just you watch!

ER diagnostic clues…tattoos, knives and texting…

Today’s diagnostic clues for the ER:

The knife sticking out of the patient’s chest, crying for help as he calls the nurse a ‘’  might suggest he is a sociopath.  And that he wasn’t entirely an innocent bystander.

The ability to text the message, “I’ve been in a car wreck, bring me something from MacDonalds,” while lying on a backboard, suggests that serious injury is unlikely.

A tattoo on the back that says something lewd like, ‘Saddle up’ could indicate a high likelihood of STD.

A patient who says, casually, ‘I’m on the hospital board of directors you know’ is actually saying, ‘all science aside, you’ll do what I ask you to do.’

The comment, ‘I’ve had that degenerative disc disease since I was 12’ is a strong predictor of a pending disability application.

The patient whose face is covered in gold paint probably doesn’t need a work excuse if he survives to discharge.

When the complaint begins with:  ‘Well, he was with his daddy’s house all weekend, till I picked him up and found this…’ is likely to involve an attorney and affidavit.

When the complaint involves 1) more than three body systems, 2) more than two decades 3) more than three specialists, you won’t solve it in the emergency department.

If a patient is over 90, wearing dirty work jeans, has a farmer’s tan and says ‘I don’t feel right,’ you have roughly 30 minutes to save his life.

When the elderly patient’s family asks, before you even examine the patient, ‘are you gonna keep him overnight?’ you might as well plan to keep him overnight.

More than three empty narcotic bottles, and a pain scale of 10/10, suggests an economic transaction has been the issue,  rather than a medical problem.

Tuck these away, kids.  They’ll come in handy someday!  And there are plenty more.  Send me a few of your own in the comments!


Happy Ides of March! A short poetic tribute…


Calpurnia speaks

Poor Caesar had an awful day

Those many years ago,

when in the Senate’s hallowed halls

his noble blood did flow.

The messages he leaves to us

are many and profound;

control your passions, be not proud

don’t throw your weight around.

But one remains, one lesson true

and spoken soft and low;

It’s Mrs. Caesar, hands on hips,

who says, ‘I told you so!’

On the warpath!

Here in South Appalachia, we have another native uprising on our hands!  The Gottagetalortab and Stolemyoxy tribe continue to assail the stockades that are local pain clinics, family medicine offices, ER’s and pharmacies.  While sluggish and ataxic, and given to nocturnal hypoxia, they are a persistent bunch, often successfully carrying off hundreds of pills by pretending to have serious injuries and illnesses.  Their prizes are purchased with government wampum belts, in a remarkable inversion of the centuries old habit of buying off natives with cheap trinkets.

The local Cookameths were a problem, but have mostly blown themselves to bits by putting ether in their peace-pipes.  Most of their work has been outsourced to the Meximeth nation, who manage to ship vast quantities into the great American urban frontier, largely unassailed.  Got to give them credit.  If there’s a buck to be made, they’ll figure out how to do it!


Thanksgiving reflects simple comforts, pleasures

Here is my column in today’s Greenville News

Thanksgiving reflects simple comforts, pleasures

So much of what we do comes down to Thanksgiving. Not that I’m some sort of Thanksgiving nut, mind you. In fact, this is the first year in some time when I haven’t been scheduled to work in the ER on Thanksgiving. I eat, I go to work. (Where of course, I eat again until I need to check in to decide if I’m having turkey toxicity or a heart attack!)

I love the holiday, it’s true. But I love it because it’s a time of family. We usually have around 35 people in attendance, and we eat on every conceivable surface, sitting in chairs, on the floor, in the living room and everywhere else. We’d eat on the dog’s back if it held still long enough.

It’s chaos, with small children and teens, friends and family all talking and laughing and occasionally arguing over politics. It bears little resemblance to the beautiful portrait of Thanksgiving by Norman Rockwell, where everyone sits round a perfectly arranged table (admittedly, laughing), with father in a suit. But I think Norm (can I call him that?) would approve. Because he understood the value of common things.

Thanksgiving, with it’s Turkey and dressing, cranberries (canned for some, fresh for others), potatoes (mashed for most, cubed for one), it’s varied deserts from pumpkin pie to coffee cake, reflects simple comforts and pleasures.

Do we over-do it in America today? Probably. We eat too much and buy too much and use Thanksgiving as the holiday catapult with which to launch ourselves immediately into the mad fray of Christmas. But ultimately, we have a good idea. We love it not because it is large and over-blown, but because at it’s heart it’s a meal we share with those we love.

But then, isn’t most of what we do the same? If we are good and wise and if we love, then we work to provide food and shelter, for this time and for the future. We engage in science to help us live better, live safer, live longer, travel further and faster, communicate more effectively. We defend our nation so that others will not rob them of freedom, of life, of comforts. We practice medicine to return the sick to their families, whole; or if not, at least with some comfort. We preach because we seek to make this life bearable and the next life a certainty for all.

Yes, there are always those who seek the stars; who seek power, money and influence. But in the end, they will want homes among the stars, with dinner and loved ones. Some will use their power and money for comforts, at least for the ones they love best, and often for total strangers; so that others can have homes and food and gentle times together.

Most of our efforts are aimed, ultimately, at simpler things than we ever imagine. Thanksgiving is a time when we celebrate the smallest of things in a large way; things that our ancestors would have understood and that our descendents will doubtless comprehend.

It’s a time when we simply revel in one another, in husbands and wives, fathers and mothers, children, cousins, aunts and uncles, old friends and new and all the rest. At Thanksgiving people want to volunteer to give meals to others; because we recognize the mystery and relevance of such a simple comfort; the power of warmth, food and drink to chase away trouble and lift us up.

Ultimately, it bears similarity to communion. It is a kind of national sacrament, if I can say so without sacrilege. Whether one is a secularist or believer, we come to the table in remembrance of blessings past and in hope of blessings to come. We come to the table to enjoy the moment, not knowing the future but mindful of what we endured over the past year.

We come to the great American sacrament of Thanksgiving to offer gratitude to God for things elemental. When Jesus, who loved food, taught us to pray, he said ‘Give us this day our daily bread…’ He asked us to be mindful not only of spiritual things but of common, tangible ones. This God-man who, at his resurrection was found cooking fish at the beach.

He sure would have enjoyed Thanksgiving. Because He taught us what we recognize each year at this time, in a distant shadow of Easter. That a shared meal, simple or lavish, has a holiness, a sanctification, far beyond mere food.

Fear the contents of the plastic bag…

Emergency medicine is a specialty that requires a strong constitution.  It requires that nurses and physicians walk boldy into rooms where patients say, for instance:

‘I pulled this out of that draining hole in my groin; they (?) told me I should bring it for you to see.’

It requires that we courageously open the plastic bag, pull out the suspiciously wrapped washcloth and expose the horrors, the corruption, the foul contents wrapped therein…all the while expecting something to spring up and eat our eyeballs, or embed itself forever in our olfactory bulb like a nightmarish memory.

And it requires that we smile when the very person who brought the horrid, festering bit of decaying flesh asks:  ‘Can I have this Big Mac I brought?’

Do not fear, my friends and colleagues, the cardiac arrest, the gunshot wound, the overdose. Do not fear the schizophrenic homeless person afflicted by the CIA, wrapped in tin-foil.  Do not fret over the vagaries of Joint Commission. 

But fear the contents wrapped in plastic, lying in the same bag as the cheeseburger.

Be afraid.  Be very afraid.