The Women and Men who Love Emergency Physicians

This is my February 2017 column in Emergency Medicine News. Now, doctor, go hug your  husband or wife.

http://journals.lww.com/em-news/Fulltext/2017/02000/Life_in_Emergistan__The_Women_and_Men_Who_Love_EPs.20.aspx

When I go to work I take a lot of things with me. Everyone has their ritual, right? I take my backpack with my computer inside. I take my phone. I take charging cords, the true modern life-line. I take lunch. I carry a pen, flashlight and pocket-knife.
On a more abstract level, I take the wonderful education I received as a medical student and resident, coupled with my years of experience as a physician. I take my drug-store +2 diopter glasses, not only to read and suture but equally important, to look venerable and wise.
But I take something else. It’s certainly as important as all of the other stuff, if not more so in the long run. I take the love and support, encouragement and care of my wife Jan. Now mind you, this is not some hyper-sentimental claptrap. A spouse, for better or worse, is part and parcel, warp and woof of our lives. And in the best of circumstances (which I enjoy), my dear bride gives me encouragement, laughter, stability, passion and the not-so-rare kick in behind when I’m lazy, whiny or grumpy. (As I am so often wont to be.)
She reminds me of my priorities, reassuring me that I matter to her and the children however I may feel. She reminds me that feelings are often terrible lies. (A lesson we would all do well to remember.) In times past she has guided me through career changes because she could sense my unhappiness and dissatisfaction. This is because she loves me and knows what I need; often better than I do. In short, she is my most dedicated advocate.
While I work in the ED, she works hard to manage the children (rather, the teens who require more diligence than mere children.) She looks after the family finances, a thing which is useful in keeping me out of prison for delinquent taxes and in keeping the banker away from the door so that we keep our home.
And in order to keep me moving forward through busy, difficult runs of shifts, she ensures that I have things to look forward to with family when she does our ‘master schedule.’ Even though two of our children are in college, she tries to arrange family events around my days off so that I don’t feel left out. In addition, so that I can enjoy our life together for a long time to come, she takes me to the gym. She sometimes makes me plank. I hate to plank but I do it.
This might sound, to the modern ear, as if my wife is living out some sort of domestic indentured servitude. It is not. It is teamwork. It is unity. It is covenant. We are one. We have common cause in our marriage and offspring.
The result of her remarkable effort is that when I go to work, I can focus on my job. I can carry the love and care I feel at home into the exam room, into the resuscitation room. I am secure and happy. This makes me a far more effective, calm, satisfied physician than I would otherwise be.
Thus, I make the money that we share equally as partners. Not only in our personal corporation but in our lives. I don’t get paid for me; I get paid for us and for ‘clan Leap’ as a whole.
When I come home from work, I come home to smiles, hugs and a welcome-home kiss. I come home to laughter and dinner, or date-night. To stories of her day, and the many other lives she touches, in our family and beyond it.
Sometimes I come home to strategic family planning sessions. Occasionally I come home to a tired or angry or sad wife and it’s my turn to be the one in the supporting role. My turn to fuss at teenagers or call about car insurance claims. My turn to shoo her to bed early and manage things. My turn, on days off, to send her for sanity breaks.
Those of us who are married, or in long-term committed relationships (which we in the South call a common-law marriage) must admit that without our wives or husbands, this whole gig would be much harder, and much more lonely than it is with our dear ones. Furthermore, that the patients we care for are touched and loved on, vicariously, by those who love us. Their role is not subordinate but intrinsic.
Through me, through our marriage bond, every sick child in my care has my wife’s eyes looking down on it gently. Every struggling nursing home patient has some of her kindness. Every difficult, irritable complainer has her patience and every smart-aleck teenager (or grouchy consultant) has her raised eyebrows and crossed arms gazing firmly on their behavior.
All of us owe so much of our professional lives to the women and men brave and loving enough to stay with us through all of our stupid, arrogant, surly behaviors. And to those men and women, let me just say: you are as much a part of our practices as we are. Thank you for being the other half, the silent partner, standing invisibly by us as we do the hard work of medicine.
We couldn’t do it half so well without you.

New Year’s Eve With My Best Friend

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.

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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.

Driving Country Roads to the ER

These days, I work most of my shifts about 45 minutes from my ‘house on the hill.’ At one of those jobs, the day shift starts at 06:30. Which means I’m rising from my bed at 04:30 in order to get on the road in time. I’ve started waking up at four, spontaneously, as if it were the most natural thing in the world.

I lay out my clothes the night before, so as not to awake my darling wife in her sleep. Sometimes I am able slip out without her knowledge. Others she wakes to kiss me goodbye. Then I go downstairs and put together some lunch, get the backpack and make my way out the door. I know that my wife and children are safe upstairs, as I lock the door behind me.

The door creeks a little, or did until my son Elijah oiled it. (One always wonders why a teenage boy oils a front door…) Occasionally I lock it as I realize I left my keys inside, and poor, tired Jan opens the door for me patiently. On the front porch, by the soft yellow of porch-light or the shock of flashlight, I step over dogs freshly awakened from sleep, who look at me with gentle annoyance. The sharp-eyed cats sleep in more secret places, so are seldom seen in the morning. Other dogs (we have five), sleep on the gravel drive in the summer and seem confused as to how to react when my Tundra rolls towards them, slowly, and I roll down the window. ‘Get up, you silly dog!’ Heads and tails down they amble away.

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Up the long drive and down the road, I am suddenly all but alone on the two lane roads that lead me to Tiny Memorial Hospital. Despite the early hour, I am ‘awake, alert and oriented.’ The sky is dark, and in winter stars shine down when clouds don’t lay low against the earth. I scan the roadside for deer, their eyes reflecting the truck’s headlamps. Opossums sometimes shuffle across, along with squirrels and rabbits. (One day I saw a big, black bear on a hill by the road. He ran away as I stopped for a photo.)
I drive through forests, past sleeping houses and across a dark, still lake where sometimes, the light from a bass-boat shines across the emptiness where someone has fished all night…or started very early. Or a campfire on the shore still burns as their line rests untroubled in the water.

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It is so early that I drive past gas-stations and convenience stores still dark and locked, the ‘closed’ sign reminding me to keep on moving. The air, even in summer, is cooler and in winter, positively cold. Winter is my favorite, I think, with the heat of the truck turned out, and the chill wind blowing past.

I think as I drive. And I pray. And I listen to the news, a recorded sermon, a pod-cast. Many mornings I turn on an oldies station from the North Carolina mountains; in the loneliness of the drive the music of Sinatra, Johnny Cash and others, make me feel I’ve gone back in time.

I cannot talk on the phone (hands free or otherwise). I pass through places where cell-signals are only a dream, and often even radio reception is poor. Remote areas, mountainous places, lonely and beautiful places defy cell signals and seem to say ‘look around! What else do you need!’ Even at 5 am, I agree.
Eventually I am near, and I find a fast-food joint for the obligatory chicken biscuit and tea, because, well, the South and all. And then I roll into the ER parking lot, lock things up and head to work.
Because this is no urban trauma center, the early morning is sometimes very slow and relaxed. A few patients may be waiting for turnover, but often none. I can sit and think, I can ask about the previous night. I can ease into work. My drive has already prepared me, but it’s nice to have a few minutes peace in the department before the chaos of the day begins. I text Jan. ‘Here safe, love you,’ and she answers. ‘Love you back, have a great day.’
There are those who don’t have to drive long distances. For most of my career it was about 15 minutes to work. And there are those who have long commutes through traffic, and through the waking body of a large city, people and cars just starting to fill its veins and arteries. Sometimes I am jealous. It can be lonely where I am.
But I think I’ll keep it for now. There is a solemnity, a serenity to my mountain and lake commute, with animals heading to bed and people not yet rising, with my own thoughts and prayers to myself.

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And I suppose that if there were a better way to prepare for the madness, badness and sadness of the ER, I don’t know what it is.

Never Stop Discovering Your Spouse

Elysa photos 007

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

http://www.greenvilleonline.com/story/opinion/contributors/2016/06/05/ed-leap-never-stop-discovering-your-spouse/85286660/

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

Make Time For Romance Every Day

Happy Valentine’s Day!

http://www.greenvilleonline.com/story/opinion/contributors/2016/02/13/make-time-romance-every-day/80177498/

It Doesn’t Have to be Valentine’s Day to Date Your Spouse.

My wife and I have had some wonderful Valentine’s Days in the past. I remember the first time I tried to cook for her. A friend let me borrow her apartment. I cooked steaks and had the whole romantic thing set up for Jan, with flowers and all.

When I was in residency, our hospital had a yearly February ‘Sweetheart’s Ball,’ and all of the residents would be excused from work while the faculty took over our roles in the hospital. I’ll never forget how lovely my wife looked in her black party-dress, dark curly hair down around her bare shoulders. Wow. Anyway, back to the point. We have had a lot of delightful romantic times on and around February 14. But as the Day is now upon us, I’d like to offer some advice to the young, and even old, couples out there.

First of all, romance may seem spontaneous but it requires attention and effort. Sure, there are moments of wonderful emotion that sneak up on us. But if we don’t take time with our spouses, romance can be a tough sell. For instance, men, if you ignore your honey for the entire football or deer season, a bouquet of roses at the last minute will earn you a sweet, sarcastic smile and not a lot else.

Likewise, for the ladies, a man won’t feel romantic if he isn’t appreciated throughout the year. If he feels berated and belittled, the last thing on his mind will be sweeping you off your feet or twirling you around the dance floor.

And to both men and women, make an effort! No, our love mustn’t be predicated on appearances. But for heaven’s sake, try to dress up for special times together! It’s a sign of respect. And no, guys, it doesn’t mean your nice John Deer hat. It means leave it at the house. Ladies, yes, it means perfume and lipstick and that dress you know he likes to see you wear. I may be a Neanderthal, but it’s just how things work for most of the men and women in the world.

Second, build on the basics. What I mean is, date one another! I don’t care how long you’ve been together, married or not. Schedule, intentionally and regularly, date nights or date days. This isn’t complicated. It’s about time talking, listening (attention men) and holding hands. Some of our absolutely best dates have involved a quick snack of appetizers and a much needed trip to the grocery store. Freezer section flirting is the best!

I don’t know how many times we’ve wandered the romantic aisles of Lowe’s, looking at things we’d like to have in the house someday, or talking about repairs we need to make. Heck, my Jan loves yard work and a trip through the riding mowers is as good as a walk through the jewelry store. (Take that boys!)

Third, grow and stay active together. Find a hobby or activity you love, or you can agree on, and make it a date. It may be biking or fishing, taking an art class or volunteering for the church or a service organization. It might be fixing up the house or cleaning the attic. But do it together and talk. A lot. Couples thrive on communication, so never forget that. We’ve found, over the years, that movies may be fun but that afterward, we didn’t have any time to talk. Couples need to decompress, process, discuss and dream. They need to talk about what the kids are doing, and on some dates, need to make a vow not to talk about the kids at all, but only one another.

These days Jan and I have ‘workout dates.’ We go to the gym, work hard to stay fit (for ourselves and one another), then get lunch afterward. Believe it or not, if you eat properly, it isn’t as silly as it sounds. Ice cream and cake after workouts aren’t the same, by the way. (OK, maybe every fifth or sixth.)

It’s a time of red-roses and chocolate candy, dinners by candle and champagne; but mostly in theory. For much of the world, Valentine’s Day will be an exhausted kiss after the children are bathed and in bed, or holding hands during night-time prayers.

Fortunately, romantic dates come in many varieties all through the year. Just be sure that however you do it, you do it with the singular goal of loving your spouse better with every passing day.

Don’t Freak Out! Be Calm in 2016…

Here is my column in this week’s Greenville News.  Enjoy!  (And call your grandparents…they love you.)

http://www.greenvilleonline.com/story/opinion/contributors/2016/01/10/dont-freak-out-calm-2016/78362386/

A common theme in the emergency department is this one: ‘Doc, I freaked out and came straight to the ER!’ I wish I knew how many times someone has said something similar to me. ‘The baby had a fever so I freaked out.’ ‘I fell and got a big bruise and I was afraid I had a blood clot so I freaked out.’ ‘I saw a spider on my leg and I freaked out so here I am!’

I’ve wondered about this for a while now. I have a theory. I believe that some of the freaking out that leads people to the ER results from the absence of sufficient grandmothers and grandfathers. It isn’t that those dear folks aren’t out there doing their best. It’s that families are often mobile or broken, disconnected from all roots. So the collective calm and wisdom of the ages, often found in grandparents, is often difficult to obtain.

I remember any number of my childhood injuries consoled, bandaged and painted with Merthiolate by my grandmothers. What I don’t remember is anyone freaking out. Not even when I nearly impaled my foot on a makeshift spear whittled from a broom handle.

In addition to ‘the grandparent’ issue, we really don’t do a good job of teaching young people about sickness, injury or even health outside of birth-control; even though life involves far more than reproduction.

The medical world of freaking out, however, is a microcosm of a greater problem. We seem to be a nation that ‘freaks out.’ We freak out over weather, politics, culture, relationships, celebrities and whether or not our own social media posts or pictures are getting enough traction. We freak out when life is difficult and we freak out when we’re bored because life is so good. And when we freak out, we go looking for someone to keep us calm, cover our wounds and give us hope.

Maybe we freak out simply because we watch too much television, where every medical event is a screaming, chaotic blood-fest. Or it could be that we spend too much time on the Internet, where every insect bite is deadly and every bit of swelling is (of course) the sure-path to cancer. Sometimes we freak out because of what we put in our minds. A patient once told me, in tears, that he thought about death all day. It turns out his television viewing exclusively involved shows about murder.

On the other hand, perhaps it’s more than being educated (by school or grandma) about all the the things which should make us ‘freak out’ or not. Maybe it’s a matter of how to deal with anxiety and uncertainty in general. I have observed over the years that children from chaotic home-lives are much more anxious when we have to stitch their wounds, start IV’s, give them injections or any other stressful, frightening procedure. Those who come from homes filled with consistency and calm can often be managed with simple reassurance. It could be that calm was the most important salve applied by grandmothers.

I believe in preparing for crises. I became a physician in large part because I didn’t want to be powerless in the face of medical emergencies. I say we teach young people as much as we can to prepare them for life’s troubles, whether they involve open wounds or flat tires. Knowledge is power, as they say.

But I believe we can help the ‘freak out’ crisis with two other things. The first is by keeping families connected and involved, so that the young can see how adults handle stress. It’s important to model this for our kids, well into their 20s.

The second, however, is a little harder. I believe that everyone needs a belief system to bear them through hard times. As modern, technological and scientific as we have become, we have yet to escape our deep need for hope and meaning, for transcendence in the face of trouble. And yep, I’ll say it; for a God who will calm the storm or calm us in the storm and be waiting on the other side of it, in this life or the next.

Life is hard and scary. But there’s way too much freaking out. And with the right application of grandma, knowledge and God above, maybe we can spend 2016 with just a little less freaking out and a little more hope.

 

The Leap Physician Satisfaction System

This is my column from the November issue of Emergency Medicine News.  Observations on keeping physicians professionally satisfied, healthy and happy.

http://journals.lww.com/em-news/Fulltext/2015/11000/Life_in_Emergistan__The_Leap_Physician.7.aspx

The Leap Physician Satisfaction System

I have never been the director of any professional group. I have, however, been directed. As such, I have a few tips for those who are directors and administrators. I give you my ‘physician satisfaction system.’ It is arranged in no particular order.

In every physician break-room or lounge, there should be a wall for photos of girlfriends, boyfriends, children, spouses, parents, dogs, cats, horses, boats, new shotguns or whatever makes those doctors happy. Emphasis on children and spouses, boyfriends and girlfriends, moms and dads. See below.

Post this where physicians work. ‘If you have a husband or wife, please avoid having a girlfriend or boyfriend. It is unfair to your spouse and children. And it is very, very expensive, as hobbies go. You’re better off with a boat.’

In every physician break room there should be: 1) a recliner 2) a refrigerator with snacks and drinks 3) a television with cable 4) a computer with Internet and without the silly hospital fire-wall. Pay for it yourself if you must.

Know your doctors. The best way to do this is to talk to them. It’s tough to really talk on a shift. The best way to do this is away from work. A quarterly group dinner is a nice touch. Or simply, ‘hey, let’s go to lunch one day and catch up.’ You have to mean it though.

Remember that a married doctor is a unit. When there are important decisions to be made (into which you and your partners are allowed input) invite your doctors’ husbands and wives to give their opinions. You’ll be grateful for the wisdom a loving spouse brings to the table. And remember, nobody is more motivated to make the group money than a spouse with a mortgage to pay and babies to raise.

If you really want to score points, send a card or note to the group spouses now and then. Thank them for their service, their encouragement, their patience. Ask them how their family is doing. Remember that being married to a physician ain’t exactly a pony ride. Everybody needs a kind word.

Attend weddings, celebrate births, have anniversary parties. Visit the sick in your group. Send condolences. Mourn at funerals. Laugh and cry. If you take the time to know them, it won’t be hard. They’ll be family.

Lead…from…the…front. If your docs tell you nights are really hard, work a string of nights. If they tell you that someone on staff is really hard to consult, talk to that person yourself a few times. (Tell those difficult doctors to back off and play nice.) If everyone hates the EMR, do everything you can to make it work for them. Never ask your ‘troops’ to do something you won’t. Never, ever.

Be fiercely partisan towards your guys and gals.

Help your doctors develop long-term plans, including an exit strategy. Don’t talk about it, do it. We can’t all go into urgent care or academics, but we can plan for a slow, steady withdrawal as the years go by. Encourage wise decision making, especially in the young Jedi.

Develop a sabbatical. Encourage your doctors on sabbatical to travel, take a class, enjoy sleeping in their own beds. It may be the longest time they’ve slept all night with their husbands or wives consistently in years. It may be the first full reset of their circadian rhythm since medical school.

Watch your doctors closely. It’s easy to become overwhelmed, depressed, anxious. Help them through mistakes. Let them decompress. Let them be sad. Don’t chastise, teach. Find a local counselor in case they need to talk about that death, that tragedy, their personal demons. Doctors kill themselves sometimes. Try to keep it from happening.

Identify the strengths in your doctors. Some are born leaders; let them move in that direction. Some are brilliant clinicians, use that. Some are great with people. Let them mentor. Some have hobbies or interests that make them better physicians. Celebrate the unique individual gifts that every partner brings to the table. Now and then, use these to remind the hospital what a unique and valuable team you have.

Take pride in your group. A logo and t-shirt would be a nice point of pride. Brag about your doctors. Tell the local newspaper about them. Help them be invested in the community, treasured by the community.

Praise your partners, both to their faces and to others. Write down the good things they do for future letters of reference.

Give your team permission. Permission to succeed, permission to fail. Permission to try new things and sometimes, permission to leave it all behind.

On really busy nights, call in pizza from home. On terrible nights, come in and use your authority to make things happen more smoothly.

There are a lot of schedules, in a lot of ED’s, with holes in the schedule. If you don’t want your entire group to realize this, and leave, and then come back making more as locums than they did before, then be their advocate.

We have a hard job. But with the right leader, it can be wonderful even when it is hard. It’s up to you, directors, to set the tone. Good luck and Godspeed.

We Should Value Life Until The End. (My latest G-News column)

This is my column in today’s Greenville News.  I understand why people ‘want everything done’ when they’re old.

http://www.greenvilleonline.com/story/opinion/contributors/2015/11/15/we-should-value-life-until-end-ed-leap-thanksgiving-health-care-costs/75585450/

It’s a well known reality of health care economics that Americans spend a lot of money in the last year of life. I suppose that almost goes without saying, since serious illnesses and injuries that result in death are costly, at whatever age they occur. Being hit by a car and dying means you were hit by a car… in your last year of life. And that two weeks in ICU before you die is, obviously, expensive. But this truism is usually applied to Medicare dollars in the care of the elderly. This group often has protracted illnesses that require costly treatments, specialty care, hospitalizations and home-health; despite the fact that the improvements in outcome or length of life are often pretty limited.

When I was a young physician (younger…that’s better) I sometimes jumped on the band-wagon and wondered why everyone wanted so much for so little gain. I was always surprised when elderly patients didn’t want ‘Do Not Resuscitate’ orders, or other ‘advanced directives’ to limit care. I would sit with other young physicians and we would ask each other, ‘what does he hope to gain?’ Or of the family members ‘why don’t they just accept the inevitable?’

That was then. I have taken care of the elderly for my entire career. And over the past year, especially, I have worked in some communities with especially high numbers of senior citizens. That, coupled with the fact that I see things differently since I’m, well, less young, has given me new insight. So let’s re-frame the question. ‘Why don’t the elderly want to simply give up and die without a fight?’ To which the answer is, ‘they’ve lived long enough to know that every second is precious.’ Perhaps more importantly, they know that all of the people in their lives are precious.

I have watched elderly couples, 70s, 80s, 90s, and the way that they hold hands. The way they brush the hair from one another’s faces. I have heard them whisper ‘I’m here’ in the emergency room and ‘I love you,’ in the ICU. I recently listened as an older patient called his wife on the phone from the hospital. ‘How are you? Well you sound fantastic! I’m fine’ He encouraged her and comforted her, and wanted to simply hear her voice. They were anchors to one another in a treacherous, frightening world.

My son once reminded me of a saying, which I here paraphrase. ‘We die twice. Once when we breathe our last, and once when someone says our name for the last time.’ The elderly get this. They want to be with the people they love and to be remembered by them. And in particular, those with spouses hold on because that gray, infirm, frail woman or man whose hand they hold is the last repository of an absolute treasure trove of shared memories and stories. No one else knows the same subtle jokes, the same turns of phrase, the same looks that betray fear or joy. Nobody else remembers their trips to the beach or the way their children sounded when they splashed in the pool during vacation. Nobody else knows how to hold their hand just the right way. And no one else understands the importance of touching feet in bed under the sheets, or remembers their favorite restaurant now closed, or grasps the importance of that inexpensive ring worth more than a ten carat diamond.

Friends and children and grandchildren also hold such memories for the aged, or they hope to fill their descendents with those memories before they leave so that, for just a little longer, the stories will survive. They want their love, passion and experiences to remain, and not just in a box in a corner of an attic, that may or may not survive the purge when the house is sold.

The elderly want to fight death the same way we all do. Because life is incredible. And in fact, we should want them around. They have navigated many decades and many challenges. They have wisdom and they have perspective to spare and to share.

This Thanksgiving, if you want to really grasp the holiday, sit down with your older friends, uncles and aunts, grandparents and parents and ask them what they’re thankful for and what they love. (And watch the way they love.) Because odds are, you’ll learn something magnificent and hear some stories that deserve to be treasured.

Then, those ‘end of life’ expenses might suddenly make more sense.

My uncle Darrell Leap; a mensch among menschen…

My Uncle Darrell Ivan Leap recently passed on to glory.  Let me set the stage for you:  Darrell accomplished much in his 78 years on earth.  He was raised, with my father Keith and my uncle Karl, in rural West Virginia, on a small family farm.  From humble beginnings he became a well educated world traveler.  He served for a time in the US  Navy, doing oceanographic mapping of the Persian Gulf.  He was an expert in hydrogeology, ground water, and worked on some of the Nevada nuclear weapons test sites,analyzing the effects of blasts on underground water.  The Navy never left him, and he loved recounting stories of it.  He was  a professor emeritus of geology at Purdue University and a consultant to communities on the effects of toxic waste.  He sang in Bach Chorales, played the piano, composed and published music and always loved working with tools.  Appalachia never left him; so much so that in the end my dear aunt, his wife Myra, helped him take online tours of his hometown and environs. The following is the tribute I wrote for him. I was unable to attend his funeral.  (Unfortunately, emergency medicine is job where schedules are difficult to change.  More on that in another post.)  This was read by the pastor who gave the service.

 

I remember Uncle Darrell from very early in my childhood.  Darrell was a kind of mythic

figure to me.  He was always off on an adventure and he always brought interesting things back to show me

at Grandma Leap’s house, on Grapevine Road in Huntington, WV.  I still have Maracas and an African letter opener he

gave to me many years ago.  I recall a time when he came home and was completely exhausted from travel, but we stayed

up as long as he could keep his eyes open, putting together a model engine in the dim, small kitchen in

Grandma’s house.  He represented many things to me as a child:  courage, learning, the exotic and the

benefits of hard academic work.  ‘Take more math,’ was his endless mantra.  Sorry Darrell, it just didn’t

click.  More on that later.

 

One of my favorite things of all was to sit and listen, quietly, while my dad, Keith, Darrell and

Karl (of blessed memory as well) would sit and discuss their memories, or world events.  I just wanted

to be like them.  Strong and capable, men among men.  Menschen, in Yiddish; men of of honor and

integrity.  Together they ever inspired to greatness.

 

Fast forward and I was on summer break after my junior year in high school when Darrell took

me on a field trip with his geology students from Purdue.  He brought me to Indiana where we prepped

for the trip.  Then, for two wonderful weeks of 16-year-old freedom, I was among college students in

hotels and dorms, wandering alone around the wilds of Montana while they worked on projects and

I tried to avoid rattlesnakes, and ate Vienna Sausages alone on hillsides over rushing streams.  Heaven

must look a little like that; at least to a boy.

 

Life moved on.  Darrell married the love of his life, Myra, my treasured Aunt.  I found a girl,

Jan, and we were married.  Darrell and Myra were always welcoming to Jan as my wife, and to us as a

couple.  And when, in due course, children were born to us, they were always excited for our new

additions, always curious and encouraging.

 

As the children have grown into near adulthood, Darrell remained a figure who loomed large in

their lives.  He gave them his collected recollections and genealogical material, with which to anchor

themselves in time, place and history. And he always asked them about their interests, or was leading them

into his. We still have rock hammers and hand lenses he and Myra sent.  Darrell’s life, whether as Naval

officer, researcher on nuclear test sites or academic has always inspired my three sons and one

daughter.  I recall going over some photos once and our daughter Elysa said:  ‘Is there anything else

incredible he did you haven’t told me about?’  In fact, our youngest son, Elijah, has made it his life’s

work to exceed Darrell in mathematics, and has always been terrified that he wouldn’t be able to take

differential equations and thus at least match his great-uncle.  Darrell’s status as a professor emeritus

fills Elijah with awe, as an aspiring academic himself.  And don’t get me started on the harpsichord

Darrell built, which all of my children find fascinating, but especially our very musical son, Seth.  Sam,

Seth, Elijah and Elysa viewed their great-uncle Darrell as an inspiration and a joy, and always looked

forward to visits with him; he was a story teller, like all Appalachians, and he loved sharing them with

us.

 

Perhaps one of our best memories of Darrell was the time, several years ago, when we met

Myra and him at their cabin in Colorado.  It was a brief time of hikes and meals and board games,

when we slept in the cool mountain air after the generator shut off the power and there was perfect

darkness.  Maybe he liked to pretend he was a pioneer. We all certainly loved the experience.

Alas, you are here to honor him in has passage.  I am not, because my work in the emergency

room will not allow me to leave. I will blame Darrell for encouraging my academic life.  (You can

laugh now.)

 

When I told my first-born, Samuel, that Darrell had died, he texted back:  ‘Don’t worry Papa,

you’ll see him again.’  Indeed.  I am confident that I will see him in glory; but I will have to seek him

out among heavenly mountain rock faces, or in the choirs angelic, or as he walks along with Bach and

discusses music.  And he will be vibrant and whole as always.  And forever.

Uncle Darrell was a man among men.  And he lived life fully; the physical life, the life of the

mind, the life of family, the life of faith, and in his love for Myra, in the life of the heart.

I will miss him.  But I will look forward to our reunion. As I hope all of you will.

Thank you.

Edwin

Learning to Love Freedom

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

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

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

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

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

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

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

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

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

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

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

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