Make Time For Romance Every Day

Happy Valentine’s Day!

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.)

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.


Happy Veteran’s Day, Pop

Happy Veteran’s Day Dad!


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I want to take a minute and honor my dad, the Rev. Keith Leap.  I have a pretty keen memory, and it reaches far into my past.  So one of my earliest memories is of my dad taking me fishing the day before he shipped out to Vietnam.  Dad was a company clerk with the 1st Cavalry Division, Airmobile.  He was in country in 1968.  There, he was in constant peril from small arms fire, rocket and mortar attacks and all the other endless ways that a war zone can end one’s life.  He was young, and thin as a rail. I can see the photos in my mind, although I don’t have any of them. But what I remember vividly is that day fishing at Twin Lakes in Huntington, WV.  I seem to recall that it was foggy, and that because I was three, most of our fishing consisted of me dropping a line into the grassy shallows next to our feet.  We never caught anything. We’re both, quite frankly, pretty abysmal outdoorsmen.  But he took the time before leaving.  That sticks. When he returned, thank God, he was posted at Fort Monroe in Hampton, VA.  We lived there a time and I loved the military feel of the place.  I remember the commissary, where there were dioramas of POWs in fake grass huts over the freezer section.  And I remember the PX, where (in that time in history) a boy could find the coolest toy guns ever, from toy belt fed machine guns to toy bazookas.  We took our guns seriously back then! I had a little uniform, with a 1st Cavalry unit patch and my name.  It was the old olive drab, and I had a helmet and a wood and steel bolt-action toy rifle with a real fake bullet in the breach.  I was the baddest of the bad!  But only because I was trying to emulate my hero. I have had an adventurous life.  I have flown to car crash scenes in a medical helicopter.  I have opened the chests of those with wounds to the heart. I have traveled the world, and I have been a consultant on WMD for the DoD.  I have married and loved a dream of a woman, and raised four children to be his grandchildren.  And yet, so much of my adventure was my attempt to equal my father’s courage and service. I was in the Air National Guard for a number of years.  I was a flight surgeon, in fact, with an F-16 squadron in Indiana.  And on the night that Desert Storm began, I was rocking babies in the nursery, an intern desperately frustrated that there was an honest to God war and I couldn’t be there.  Not that war is good.  But a man wants to match his father.  When veterans stand in church, I am always a little slow to stand.  My service cost me so little.  His could well have cost his life.  That’s why we went fishing that misty WV morning, a day so full of  import that a boy little more than a toddler still remembers it at 51. Dad ultimately became a much beloved pastor, now retired.  War did not end for him, it just became the war for the soul of man, the war eternal, of which our temporal and frequent outbreaks of international blood-letting are merely the consequence.  And for that I honor him as well.  Having been a church attending Christian for most of my adult life, I suspect that enemy fire is easier to bear than the bitter attitudes, stubbornness and outright cruelty that can emanate from so-called Christian church members. So here’s to you, Pop.  Happy Veteran’s Day. Veteran of war, veteran of fatherhood, faithful husband, committed pastor and longtime lover of Foghorn Leghorn. I say, I say, I say, You da’ man! Love you, Ed

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.

The Best Way to Learn Tolerance? Raise a Teenager.

Here’s my latest at the Huffington Post!


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

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

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

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

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

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

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

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

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

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

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

Don’t trivialize marriage

My column in today’s Greenville News concerns marriage, and its joy, importance and gravity.  Whatever you believe about marriage, please take it seriously.

Last month, beneath the low clouds of a cool October sunset, my brother and his fiancee were wed. The wedding took place at Lindsay Plantation, in Taylors, SC. Friends and family sat in folding chairs, in the lush green grass of a hill-top, while a violinist played softly, the sound carried on such faint wind as there was. Nature itself seemed to pause and watch with bated breath.

Our father performed the ceremony, which was brief but beautiful as traditional and personal vows were exchanged, along with rings. There was laughter during the sacrament of marriage, and there was also the solemnity of covenant.

And then, as there should always be, there was a party. Theirs was beneath great chandeliers in the former horse barn, open on each end so that cool air could flow through and caress the well-dressed, if slightly over-heated, guests as we ate, talked and danced the evening away. I spun Jan around the floor a while, reminded in the flush of emotion why I love her so much, and have for so long. Our four children were there also and visited with family from far away. I believe that young people should view holy things from time to time. They should be reminded that these things matter immensely.

It was just the way a wedding should be. A reminder of both gravity and levity. A promise and a joke. A prayer and a dance. And all of it witnessed and supported by those who love them both. Everyone should have such a wedding. No drama; all joy and light and hope. I think it was good because they both know that the wedding is simply the gateway. It’s the marriage that matters.

Nevertheless, we live in a world in conflict over marriage. Who should be allowed to marry? Who should do it? What defines it? What preserves and what destroys it? These are terribly important questions. But I won’t attempt to answer them; not now. It’s likely you can guess my personal beliefs, but that isn’t my point.

What I will do is this. I’ll make a plea. Whatever you, dear reader, believe about marriage don’t trivialize it. Don’t use it as a weapon or a form of theater. Never make it small or insignificant.

Whatever you believe about marriage, or who should marry, please, please make your marriage a bond that has consequence. Make it a thing of absolute commitment, with no wavering. Never say ‘we’ll try it and see how it goes.’ Any such thought is simply a path for escape; a way to let insignificant issues drive a wedge wider and wider between you and yours.

Whatever we end up believing about marriage, as a culture, I hope that we remember that it is a force for stability; a pillar on which civilization is balanced. The less certain it is, the more precarious that balance.

Whatever we believe about it, never forget that the children of a union, born or adopted, count on that marriage. It is their safe haven, the kingdom that is a family. And divorce is a civil war, a bloody revolution, a wild-fire. And the children may never full recover, whether they were young or old when the cataclysm occurred.

No matter our definition of marriage, it cannot be a thing entered, or abandoned, lightly, as if it were the prom or a drive in the country. It must have what I saw in my brother’s wedding. It must have promises taken seriously and laughter and joy taken even more seriously. It must be a feather as heavy as a stone.

Jesus used the metaphor of marriage extensively, and referred to the Church as ‘The Bride of Christ,’ and to himself as ‘the Bridegroom.’ This was no small thing, no casual use of language. His love was demonstrated in his sacrifice for all who would be his bride, in full expectation that she would be devoted to him wholly.

At Stephanie and Stephen’s wedding, there was great happiness all around. And I thought, for a minute, that if this was a prequel for heaven, some people might be in grave danger of not enjoying heaven at all.

Because to grasp the staggering joy of the covenant requires recognition of both the weight of the promise and the levity of the party. Our culture has to keep both in mind if marriages, and weddings, are to continue to be the things of absolute value they were intended to be.


Let’s not devalue mothers this Mother’s Day.

This was my column in yesterday’s Greenville News.  Happy Mother’s Day to all of the wonderful mothers out there!

Let’s not devalue mothers this Mother’s Day.

Women today have choices about their future careers.  There’s hardly a field where women aren’t prominent, and that’s a wonderful testament to the diversity of our culture. But often, when a young woman states that her goal is to be a mother, there’s a kind of disappointment leveled by others.  ‘Do you mean after you go to school and have a career?  I mean, don’t you want to accomplish something?  For you?’

I understand.  Everyone has dreams and goals, plans for greatness.  And the friends and family of these future mothers have their best interests in mind.  They don’t want their loved ones to subvert themselves and give all of their efforts and talents, all of their youth to someone else.  And yet…

Who among us does not?  In a very real way, most of us are ‘ancillary.’  I think about myself and my fellow physicians.  We are not the end purpose of medicine.  We’re here to allow everyone else to stay healthy and navigate illness and injury, in order to go back to their families, friends and jobs.  We succeed to the extent that they need us less and less as they grow stronger and more robust.

The same is true in business.  If our young woman, with dreams of motherhood, should climb the corporate ladder first, well good for her!  But for whom is she climbing? First of all for her supervisors, maybe later for the board of directors (all of it financially rewarding, we hope) and in the end, even if she is CEO, she works for whom?  Her customers and clients.

Do teachers accomplish their great works for themselves?  They may find their work rewarding, but they teach so that children can move off into the world and find their own work, their own families and lives, can support themselves…usually by working for others.

Women in the military serve the nation.  Women in higher academia serve the future of the institutions, their academic disciplines and their students.  Hard working women in small businesses or large serve the ‘customer,’ who is always right.  And in public service, police, fire, EMS or others, heroic women serve the good of the public at large.

As artists, whether in music, visual arts or literature, women may be very independent, but they still hope to please critics and buyers, and hope to advance the quality and expression of their particular art media.

So I wonder, if a woman says that she wants to stay home and raise children, why is that somehow a lower path in so many minds?  That woman, who may or may not have worked for any of the industries or groups I’ve listed (a small sample of the whole) will turn her attention to caring for, serving the children she bears or adopts.  They will be her customers (although not always right), her public, her industry, her small nation, her medium of expression.

The markers of her success will be theirs. Their health and happiness, their ability to care for themselves as adults, their entry into the world and into their own families. Those will be the metrics by which she will judge success or failure.  And in some cases, when children are very ill or disabled, their comfort will be the product she produces for years…or for a lifetime.  This isn’t just emotion.  The intact family is a very clear and validated predictor of future health and success for children.

I’m not in any way suggesting that women who work are failing their children; not at all.  I’m saying that motherhood is more than cribs, cuddles and laundry, diapers, mini-vans and soccer practice.  It’s too easy to reduce it to a set of visual cliches, so commonly attributed to motherhood in our society.  What I mean is that motherhood is not a lesser path, or a mere supporting role.  There are no mere supporting roles, for we almost all support someone, work for someone, help someone or produce for someone.  Even the President is a servant of the people.

But the role of mother, in developing the children of the nation, is foundational.  And her work, for work it is, is essential to the future of the nation and the well-being of our citizens.

So when young women choose that path, at reasonable ages, with husbands and sufficient financial resources, we ought to encourage them.  Motherhood, you see, is a choice the world cannot afford to devalue.

Happy Mother’s Day!


Be proud of returning to the fire, doctors

This is my column in the October Emergency Medicine News.  ‘No matter how hot it gets, doctors, be proud of returning to the fire.’

(Who knew that blacksmithing and medicine had so much in common?),_Be.6.aspx


When I want to clear away the chaos and confusion of medicine, I walk down the worn path in our back-yard (followed by children, dogs, cats and deer). At the end of the path is the shop, which the kids and I helped a friend to build for us. We helped set the foundations and nailed the floor; we raised walls and put in roof trusses.

The shop sits in an area that was once a garden, but a soil-poor garden that yielded more blackberries, brambles and hornets’ nests than corn or beans.  The best crop of the garden was a treasure trove of arrow-heads and Native-American pottery; what still lies there I can’t imagine, but it is evident to me that someone, some people, camped or lived in what is now my yard a very, very long time ago.  They would be surprised to see my shop.

Under the extended roof at the back of the shop is our smithy.  Years ago, my son Seth asked if he could learn to blacksmith.  He may have been born in the wrong century.  He plays the bag-pipes and banjo and black-smiths.  (And is addicted to science.)  But to condense the narrative, we have.  Well, I should say we’ve learned a bit thanks to our gracious teacher George, the man who cannot seem to feel the heat of the hottest fire.  We don’t really even rise to the level of his apprentices,  but we can build and tend a coal-fire, we can handle a hammer and anvil, we can forge-weld iron, twist iron and curve iron; we can quench the iron and we can do most of it without being burned (very often) by the lemon-yellow and orange colored metal.

When I want to let my mind rest from medicine, I walk down that path and look at the old tools and the old anvil and vise.  I look first for wasps and rattlesnakes, of course. But then I just take it in.  The old colors, the bits of rust, the ordered disorder of a work-place; gravel on the ground, coal in the corner.  It isn’t professional and it isn’t perfect.  But it’s beautiful.

Rarely has a hobby captured my mind like this one.  And seldom has any activity enabled me to slip the bonds of medicine so readily.  From the moment I start the walk, I drift into a different place and time.  And when I start the fire, when the coal burns, the green sulfur clouds the air and blows around me, as I turn the crank of the blower that feeds air to the fire, well from that moment I am meditating.

It can be a hot day or a cold day, but cold days are best; cold days when standing by the fire is a comfort; cold days when it’s so hot there that a t-shirt is enough.  It can be a sunny day or a rainy day.  Rainy days fill our bucket with water from the sky with which to quench hot metal from the earth.  It is mystical.

And taking that metal, cutting it, heating it until it is over 2000 degrees, then shaping it from a mundane round or square stick into a wall-hook, a decorative leaf or even into a new tool, well that’s pure joy.

It’s unlike the emergency room.  It is single-minded.  The interruptions are virtually non-existent; and if they exist, they are laughter and jokes between my sons and me; or gentle arguments about how best to accomplish the task at hand.  Or the warning shout, ‘Hot Iron!’ which reminds us to watch lest we be burnt.

There are mistakes, but they are of small consequence.  Burnt metal can be cut off and thrown on the ground.  Crooked metal can be hammered straight.  An item made poorly can remain as a reminder of what not to do next time.

It’s so unlike the emergency room, where mistakes can be life-ending.  Where danger lies at every turn and if we shouted every danger we would shout for 8 hours.  And yet. There’s the heat and smoke.  There’s the risk of injury.  And there’s the shaping of something.  The transformation of something.  Hammer and hot iron and anvil and water; tongs and vise.  The change from what was to what is.  The rescue of an old piece of scrap, a lawn-mower blade, a piece of re-bar and the gift of watching those things have new life.  And the ring of that anvil, made around 1850, that says ‘I’m alive!  I’m alive!  I’m still here and needed!’

They seem connected to me, those two divergent places.  Writers see everything in metaphor and simile. Maybe the heat is metaphor for the pressure and stress of our work in emergency medicine.  Or maybe hammer striking heated metal on anvil is a metaphor for the way we want to shape a new reality; from sickness to health, from injury to healing.  We are blacksmiths of the human body; or red-smiths, maybe, for the blood we see spilled.

I know that as I grow older, I see another metaphor here.  I see my patients like those unshaped bits of iron; of uncertain value and utility, dirty and sometimes abandoned. But I know that in them lies potential; beauty and goodness beneath years of rust and disuse and neglect.  Like the way I put the grinder against my 150+ year-old anvil and when I stopped, it’s rough surface shined like a new platinum ring.

Most of our hobbies, our ‘avocations’ give us insight into our medical work.  Perhaps we choose them for that reason.  Or maybe just for the escape; for the Zen moments of ‘no-mind’ that allow healing and rejuvenation as we work at a thing without feeling as if it is work.

All I know is this.  Medicine seems to be getting more difficult all the time.  And the house of medicine is leaning on our specialty more heavily than ever before.  But whatever your hobbies, let me assure you that we have walked through the smoke and fire, all of us. We have all been ourselves shaped by the fire, hammer and anvil of suffering and struggle.  We have also shaped new realities for the people we have treated and saved.  And most of us keep coming back because we feel a comfort in the artistry that medicine has become; a deep, abiding pride in our craft.

So I say this, friends:  be strong. Do not be afraid of the struggles to come.  Embrace them with joy. Find the peace that comes from artistry well-practiced; for remember, medicine is art.  And however hot it gets, however choked you are by smoke and ash, however tired your limbs, be proud of the skill and strength that brings you back to the fire each day.

Only a few could do it.  And you are numbered among them.

If you’re looking for me, I’ll be down the path, hammer in hand.





Edisto therapy

I came to the beach anxious this year. I hadn’t been feeling well. My blood pressure up, my stress level high.  My stomach hurting, maybe from gastritis.  My wife and I brought our four children and eight others.  Not exactly stress-free, you say?  You’d be surprised.

The house we rented is across the road from the beach on Edisto Island, in SC.  It’s an older house, with a torn screen, doors that won’t lock and water that tastes vaguely like the ocean it sits near.  The disposal didn’t work. The doors and walls creak.  In the entire house, in which there were 12 kids from ages 12 – 18, there was one television; and not even a flat-screen!

Over the course of the past few days Jan and I have slept and rested, read and chatted, largely ignored by the endlessly laughing, chatting, texting, photo-taking, soccer-playing mass of young people.  In other words, except for providing the space (paying for it) and cooking, we’ve had a week-long date; the kind of date when husbands and wives lie down together with amorous intent then fall promptly to sleep due to chronic fatigue.  And then consider it a great evening!

We have, of course, spent our days by or in the ocean, letting the waves ease away our stress, and the sound of the ocean soothe our hearts with its ancient, cyclic music. We have body-surfed and walked the beach, and watched as our youngest two travelers did cart-wheels in the sand, and the older members of our band flirted and stood in an intimate circle sharing their jokes and their hearts with one another.  Watched as our oldest and his love walked hand in hand through the surf; a delight of young romance if ever there was one.

The weather has been perfect.  The rain has fallen a few times, and the evening wind has been the perfect temperature for blowing away the brain-fog I felt before arriving.  We have eaten well, but simply; spaghetti, tacos, sandwiches, shrimp and grits.  And we have been to a restaurant only once; but to the Piggly-Wiggly grocery store multiple times as our stocks diminished. Especially our stock of proper, drinkable water and pure ice.

All of it, though, has been one endless therapy session for me.  I have thrilled at the feel of the sand, the roll and song of the waves, the brush of the breeze, the youth and beauty and strength of these young men and women in our charge, the cool sheets in a small room with my warm wife, the paucity of television screens or other disruptive technology, have added up to a remarkable amount of relaxation that I can’t recall having in ages.

Here, this week at Edisto Island, I have embraced a reality that I rejected for too long.  That I am affected by this hectic, modern life. That my medical career fills me with anxiety.  That I worry too much.  That I see too many things that are bad and embrace too few things that are good. That I have defined myself too long by my ability to endure and rejected for too long the necessity of just being; of just breathing and sleeping, eating, loving and laughing.  Things which require no odd schedule, things which require no classes or certifications, no endurance of suffering, no plan to handle every contingency.

As I sat on the beach this evening, after walking with Jan and while watching Elysa and her friend Islay do cartwheels on the sand, I began to wonder.  What’s more real? This island and the peace of the ocean?  Or the chaos and uncertainty, sickness and struggle of the emergency room?

Is it possible, just possible, that this place (and these people) who put me at ease are more solid than even the most solid struggle?  Is it possible that to the extent that this place feels a little like heaven this week, that it actually is a little like heaven in comparison to the terrifying things I encounter at work?

I suspect that when we arrive in heaven, it will feel vaguely like this (though vastly better).  That the shores of the great sea will be composed of soft sand, firm breezes and clear water and that every bit of it will be so substantial, so ultimately real, that every stress and struggle of this life will seem misty and false at best; hellish at worst.  At least, if we can recall them at all in the midst of the blazing joy that will envelop us.

Speculation; but important.  Because I needed this week and these realizations.  And I needed the time to pause, in silence, free of news, free of worry, free of chaos, and listen to the laughter and the waves.

Because right now, I feel more real than in the midst of the most unreal horrors.  And that’s a blessing.

Treating children? Learn to love.

Dear readers, this is my EM News column for July.  Or at least, what it’s supposed to be.  Apparently when I submitted it to my gracious and excellent editor, Lisa Hoffman, I only attached half of the piece.  So if you read it in the magazine and it looks a bit silly, this is why.  Here’s the full text.  (And the link to the unfortunately truncated version).


I’ve learned a few things about children over the years.  While most have come from raising children, the rest have come from caring for them as patients.  Knowing children, knowing their hearts and their ways, gives me great joy.  I like to think that as I know them better, I become more like them, and while my time on earth may not be any longer for it, it may be richer.  Or perhaps one day I will simply wake in Narnia and find that I was always a child, dreaming dark dreams that will suddenly end.

So, in light of what I know, here are my tips for taking care of children when they are your patients. They are not given in order of preference or importance; and only generally in sequence.

First, walk into the room, look at them and smile.  Don’t give them that condescending smile you learned in medical school interviews.  Smile.  Watch them, because sometimes they’ll smile back.  Learn to wink.  Winking is very useful.  It conveys the idea that you are paying attention, even as you listen to the boring adults.

Move purposefully, but slowly.  No barging in, slamming down charts, jerking open cabinets or yanking things off the wall.  Modulate your voice.  If you need the nurse to get something, don’t yell.  Say it softly.  Give children at least the concern and demeanor you would give to a wounded stray cat or dog.  The children deserve it even more.

Sit down and talk, both to the child and to the parents.  Let your attention be a pendulum that moves between them.  They both have things to tell you. But first, complement the child.  Tell them you like their name, or the stuffed hedgehog they are clutching.  See what they are watching on the television.  (It is useful to have at least a passing knowledge of cartoons, so that you can tell them what your favorite is.  Or at least, what it used to be.  The Road-Runner will likely always be with us.)  At the right age, video games or sports (or in certain locales deer season) make great conversational topics to put the child at ease and show that you are not, actually, a monster.

At some point, complement the parents. Tell them what a strong, or beautiful, cute or brilliant child they have.  It suggests you noticed that their child is special.  Indeed, what child isn’t?

Ask your wee patient, ‘can I check you out?’ If they say no, ask mom or dad to help.  But again, move gently and carefully.  Put your stethoscope on their knee first.  Use the otoscope on mom, dad or older sister. Or on yourself! Odds are, things will go alright.  If you aren’t kind, the child will scream and the screaming and kicking and fighting will get squarely in the way of your exam and assessment. And hurt your ears.

If screaming and fighting persist, be firm and have parents and/or nurse hold child in something reminiscent of WWF, but allowing plenty of air to pass in and out of lungs.  Children, like small animals, are not always rational and must sometimes be told and shown that they aren’t in charge  despite endless empowerment talk from experts.  You are smarter and bigger. And they need your to take charge.  Sometimes to save their little lives.

As you assess them, cultivate that thing we don’t discuss in medical school but the thing that makes for the best medicine.  Practice loving them.  Imagine them at home playing, in the yard running, in bed snuggling, in school learning. Imagine them well and pray that you can return them to that state as quickly as possible.  Unlike many adult patients, the children have no desire to be in the hospital.  To a child, disability means nothing except sitting in bed while other kids play.

Practice thinking also about how much their parents love them.  About how they were anticipated and how they are treasured.  If you sense that their parents could not possibly care less, then project love onto the child.  Show them that at least with you, an adult finds them to be of inestimable worth. Give them crayons, give them stickers.  Give them snacks if the situation allows.  Shower them with concern.  Occasionally, an infant or small child will climb into your arms and want to stay there. Or will hold out their arms, as if to say, ‘please take me away from these crazy people!’  You cannot do that. But you can still look at them with love, treat them with skill and try to discern if they are in danger.

If you must hurt them a little, try to explain why.  And tell them you’re sorry, and that you wish there was some other way to do it.  Talk to them endlessly, so that they know you are not a robot in white.  Learn what you need to know to save them, or ease their pain.  And if you find something terribly, terribly wrong, talk to their parents first.  If, G-d forbid, one of them dies, remember that for the child’s family, the universe suddenly collapsed and all good things ceased to be bright.  Either way, with grave illness or death, remember that the parents will suddenly be wounded children themselves.  Follow the above steps and be gentle.  It’s acceptable to cry with them.

Now, bear this in mind.  For all our knowledge and skill, all our education and cool professionalism, we were all children once. And because of dementia, strokes, accidents and illnesses, we may yet be like children.  Everyone you treat was a child.  Everyone you treat is afraid, and mortal, and suffering some unique wound of the heart or soul.  Don’t forget the child in everyone.

So, when you walk into the exam room of an adult patient, don’t forget to smile.  Make no sudden moves. Sit and talk.  Ask them about the things they love…And learn to love everyone, if you can, with the love that should be showered on every child on earth.  For on some level, we are all children still.