The Dangers of Summer

This was my most recent column in the Daily Yonder.  Unfortunately, the Yonder website is down or I’d give you a hot link.

It’s Spring now and all across the land things are bursting with life. Flowers are in bloom, yards are bright with new grass and the sun is high in the sky. My car was, for a while, covered in a thick, green coat of pollen. Carpenter bees are still turning my log-house into Swiss Cheese. It’s pretty out, the sky is blue and the days are warm. Blah, blah, blah. I for one don’t really like this time of year. And it’s mainly because warm weather brings me patients with all kinds of injuries; some of them pretty nasty.

In rural America, there are dangers that seldom occur to people in more populous, metropolitan areas. Ironically, though, rural folks often assume that life in the city is more dangerous. And indeed, murder rates are higher.

However, according to the CDC, deaths from unintentional injuries are 50% higher in rural than urban areas; https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html. These differences in death are due to several causes; rural citizens are further from necessary health care and are closer to large lakes and rivers, use dangerous equipment and firearms. Doubtless there are many factors involved in the difference.

Of course, some of the perils of rural life are just the result of living in close proximity to nature and all her deadly charms. In Spring and Summer, we encounter creatures that bite and sting. Just last year, while mowing our lawn, we must have run over yellow-jacket nests at least half a dozen times. By the end of the summer I just let the grass grow. ‘You win!’ I screamed to the little jerks, hiding in their holes. Whether it’s scorpions, hornets, wasps, centipedes, spiders or some other tiny monster, we simply encounter such creatures more in the warm months. And their various stings and bites, while rarely fatal, can cause dangerous allergic reactions. And make your spouse want to leave the area and move to a condo.

Fortunately, deaths from allergic reactions of all sorts are rare, and around 99 deaths per year in the US. https://www.aaaai.org/global/latest-research-summaries/Current-JACI-Research/death-anaphylaxis. Still, If you or your loved-ones are afflicted with such allergies, please talk to your physician about what to keep on hand; hopefully epinephrine injectors will get cheaper. And there are some other brands besides the ‘Epi-Pen’ that should be less costly. They just hurt a lot (the Black Widow) or make ugly wounds (the Brown Recluse).

Poisonous reptiles (Copperhead, Rattlesnake, Cottonmouth and Coral snakes) are also a feature of rural life in many areas. Those who ‘ooh and aww’ in city zoo reptile houses rarely have the singular delight of encountering these wonders in their own yards or whilst walking through the woods. But these creatures, while important to the eco-system, can deliver nasty wounds and in rare cases can be lethal. They’re certainly dangerous to your finances given the cost of anti-venin to treat the bites. So be aware as you go about working and playing in places where snakes are also enjoying the summer sun, or cool evenings.

Remember also that at least in the US, many snake bites occur because people are 1) intoxicated and 2) trying to mess with the snakes. And yes, ladies, this is a peculiar affliction of men that starts with ‘hey, betcha’ I can catch him!’ Actually, I have it on good authority that snakes don’t even like the taste of drunk people and would like to be left alone, thank you very much.

Now, other dangers of rural life have to do with the necessity of power-tools. In my own life, the chain-saw, weed-trimmer and lawn-mower are absolutely essential to keeping nature from simply over-running our house. But as the dear reader knows, these are things to be treated with great respect. Please use appropriate protective gear, like safety glasses, gloves, appropriate clothes and heavy shoes. Of course, those who work on highways or farms use much bigger types of tools and heavy equipment and have to be ever watchful. This is probably more true in Spring and Summer because that’s when farms are busy, roads need to be fixed, bridges repaired, pipes laid, power-lines connected, houses constructed and all the rest. God bless all those folks who make our lives better by doing hard, dangerous work on the hottest of days.

And of course, warm weather brings assorted recreational dangers. Hiking and camping are delights, but someone always manages to fall off of a waterfall or cliff-edge, break an ankle, sustain a laceration or encounter said biting and stinging creatures.
Bicyclists and motorcyclists look forward to warm months so that they can enjoy the open, dry road. But helmets really are important as is appropriate protective clothing, reflective material and good education. I’ve seen patients who left their tanned skin on 50 yards of asphalt. Nobody enjoys that.

Lakes and rivers are warm, and filled with persons who typically want to be dragged at high speed behind a power-boat while skiing, clinging to a large inflatable item for dear life, or kneeling on a wake-board. Likewise, fishermen head to their favorite spots (either in tournaments or alone for peace and quiet) and other aquatic persons kayak, canoe and raft the rivers that draw so many to rural America for vacations. All of which is fantastic! But remember to learn to swim, always wear life-jackets and follow local laws when doing all of the above.

Obviously there’s always the danger of heat exhaustion, heat stroke, dehydration and sunburn. We all have to remember to be careful to stay hydrated and remember that beer and caffeinated sodas don’t help. Also be reasonable about sun exposure and wear sunscreen to hep protect against skin cancers.

And if the gentle reader wishes to avoid painful foreign bodies and sutures, here’s another bit of advice. Wear shoes all; all the time. Simple and to the point.

Spring and Summer are glorious in rural America. But the dangers are many; I’ve only skimmed the surface here. Please remember to be safe, think before doing, follow the laws, don’t drink and boat, drive, ride, ski, pick up snakes, work with power-tools or do just about anything else. If you’re going to drink, find a chair and sit in it. That bit of advice would keep many an ER quiet all night long. Also remember that everything I said you shouldn’t do when drinking is something you shouldn’t do while taking narcotic pain medications.

I hope everyone has a great summer, free of emergencies. And that you can still be around when that first breath of cool air dips down from Canada and a proper season comes back once more.

Just please, please, be careful out there, OK?

(If you’re interested, here’s another link to a nice discussion of the unique injuries common in rural America. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448517/)

Grandmothers as an ER Preventative Measure

This is my column in the latest edition of the Daily Yonder.  Enjoy and share as you see fit. Link followed by text.

Life & Limb: Grandmothers — An Ounce of Prevention for a Pound of ‘Freak Out’

 
I have a theory that engaged, wise grandmothers could save families a lot of money by helping avoid hospital visits. Personally, my grandmothers were very important to my well-being as a child. Not only did they feed and dote on me, they kept me healthy and safe. I remember the time I made a spear out of a sharpened stick. (OK, one of the times.) I was running with it, and as I drew back my arm to fling it across the field I must have stumbled. It ended up going through the top of my shoe and between two toes, scraping them on the way to the ground.
I limped to the big white house under the maples where Grandma Leap helped me take off my blood-soaked shoe, cleaned the wound, probably applied Merthiolate (didn’t we all spend our summers painted orange?), and said ‘don’t tell your grandpa, he worries!’ Maybe she knew he’d take my now cool, blood-stained spear away. I was none the worse for the wear.
I have seen injuries like this time and time again in the emergency room. Relatively minor affairs; scrapes, bumps, bruises, stings, nevertheless brought to the hospital by anxious mothers and fathers, new to parenthood or simply far more worried than necessary.
I also remember the smell of Vicks Vaporub, slathered across my coughing, wheezing chest. I remember cool cloths applied during fevers. My grandmothers had those simple skills down pat. Honestly, I don’t ever remember coming to the hospital for a fever as a child. And yet, fever is one of the most common complaints for which parents bring kids to the hospital.

‘He started having a fever an hour ago, so we rushed him to the hospital!’
‘Did you give him anything for the fever?’
‘Nope, we just came straight away. We freaked out and decided it was better safe than sorry!’

I hear that a lot. There was a bruise. ‘I freaked out.’ There was a tick, ‘I freaked out.’ There was a rash. ‘I freaked out.’ The baby’s nose was congested. ‘I freaked out.’ Freaking out never helps anything. And from what I can remember, it was simply something my grandmothers never did. Their job was to draw on centuries of collected cultural and family wisdom, apply personal experience, mix it all with loving attention (and food), and bring calm to all situations. Or bring switches as the situation required.
I’m not suggesting that a family member is all that’s necessary in times of medical need. And admittedly, there are plenty of grandmothers who are as ‘freaked out’ as everyone else. (I’ve met them.) Furthermore, lots of grandmothers and grandfathers are already doing this job as primary caregivers of their children’s children. God bless them.
However, it seems to me that we have an unholy confluence of problems that make people seek healthcare for things our ancestors wouldn’t, or couldn’t have. First of all, families are separated for various reasons from wise older relatives; or don’t have any. Second, people have 24/7 access to online health information that often only increases fear. Third, we have enormous numbers of young individuals and parents who never learned much about their bodies. Add that to the general increase in anxiety that mental health workers report across the land, and families are completely overwhelmed by the sorts of ailments that have afflicted mankind since well before modern medicine existed.
It seems to me that with our long history of self-sufficiency, and our deep-rooted connections to place and family, rural America should be one of those places where grandmothers could make a real difference in an era of limited medical access, coupled with enormous medical anxiety.
Maybe, in the mountains, valleys, bayous and plains that make up rural America we can be health pioneers! What we need to do first is educate young people about how to give simple medical care to themselves and others. First-responder and First-Aid/CPR courses are a great place to start. Second, those of use who are more experienced can reach out to young people and young families; neighbors, church-members, strangers at the food-bank, and offer to be there to teach them how to manage life situations. And how not to ‘freak out.’
Finally, those of us in medicine, whether nurse, physician, medic or other, can spend time educating the people we see so that they know when, and most important when not, to worry. And never to freak out.
A thing that grandmothers, in times past, taught us oh so well.

 

Life and Limb: the Rural ER

Welcome, readers, to my new column in the Daily Yonder!  It will concern rural emergency medicine and things I see through that particular lens.  Have a great day and feel free to share liberally!  I’m honored by the Daily Yonder to be included on their team, dedicated to all things rural.

Life & Limb: In Rural E.R., Exams Include the Obvious Questions, Like ‘Did You Get a Turkey?’

A Happy Family and God’s Beautiful, Abominable Creatures

Call me Dr. Doolittle…

Once upon a time, a loving couple moved from the cold, bleak land of Indiana to South Carolina and bought a house in the woods. It was a lovely first home, and they enjoyed all their time in the house. While they were there, they learned about the beauty of nature; the birds, the raccoons, the deer; the ice storms that shattered trees, the flash floods, the brush fires, the stray dogs trapped in the creek, the giant hornets nests in the woods. It was beautiful all around. Nature is awesome!

Then, after they had brought four amazing children into the world, they said to one another: ‘What the heck! Let’s move further into the wilderness!’ And they had someone build them a house of logs, high on a hill near the state forest. While it was being built, they discovered rattlesnakes. Which are natures wonderful creatures. And soon after it was built and they moved in, they learned about wild hogs. Just one more amazing thing in the yard.

In time, the family learned all about the veritable Noah’s Ark that their home had become. Having grown up without scorpions (how poor life was!), the family learned to shake out shoes and watch where they stepped. Inside the house as well as outside. Gradually, centipedes stopped in. ‘Hello human family, we’re God’s creatures too! And we sting like everything else! Welcome!’ By now the family was not only amazed but mildly annoyed. They learned the centipedes are much harder to kill than scorpions. They felt sad doing it. The first time.

A charming family of giant rats lived under the porch. Such a cute family! And they set the dogs on them, who went to work with canine glee. The dogs later made peace with most of the forest creatures and started to completely ignore them.

One magnificent, exciting year, the family saw a cute little lady-bug (or what they thought was a lady-bug) in the kitchen. And the next day they woke to find, oh, about ten-bajillion of them hanging out all around the house and in the house and in their food and bathroom and on the windows and drapes. Some in the family, it turns out, were allergic to them and wheezed and developed rashes. But oh they were so cute. The family sprayed a chemical around the doors and windows that, years later, still seems to kill the creatures and probably cause cancer.

The house in summer was all abuzz with wonderful things. Carpenter bees slowly, with great dedication, began to bore holes all over the wooden beams of the big log house. The children made great sport of swatting carpenter bees with badminton rackets. It didn’t really help, but a dead bug is, well, you know. Eventually it is believed that the house, like a great building of brittle Swiss cheese, will collapse and kill everyone. Except the bugs, that is! Isn’t that wonderful? Nature…who knew?

Later, various wasps began to engineer amazing nests on the log house; which then developed into entire wasp civilizations. The wasps loved the house, and the family, so much that sometimes they went to bed with them and took showers with them! Stinging is like hugging to wasps. Except it really isn’t. The people engaged in campaigns to kill all the wasps, and enrich pesticide companies. The wasps are silly and always come back. The wasps live in the attic above the bedrooms too. We’re all a family.

Then stink-bugs came, and what a joy! They sing their happy, buzzing sounds all day and night, inside and out, and land in cooking food and brewing tea and onto the hair of unhappy females in the house. And when smushed, they smell terrible! What fascinating little nightmares. The family was told that stinkbugs prey on ladybugs. Isn’t that just a kick in the pants?

Lately, above the bedrooms, there have been noises. Adorable, furry bats have appeared in the big log house on the hill. Flying around inside the house, dropping onto the table. What incredible creatures! They are, apparently, rooming with flying squirrels. Will either of them eat the stink bugs?

The family still loves nature. Maybe, part of loving God’s critters is being in a constant struggle with them. At least then you learn about them in person, not from some sterile display or chapter in a book.

Maybe, just maybe, an apartment in the city would be nice sometimes. Because the creatures, so far, are winning.

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.

Appalachia Deserves Our Respect (And Already Has My Love)

This is my column in yesterday’s Greenville News.  Happy Birthday West Virginia!  June 20,1863.

http://www.greenvilleonline.com/story/opinion/contributors/2016/06/19/ed-leap-appalachia-deserves-our-respect/85974188/

 

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Tomorrow is June 20th, a special day in the hearts of my people; West Virginians. On June 20th, 1863, West Virginia entered the Union in the midst of a bloody struggle for the soul of the young nation. It was, prior to that, the sparsely populated, wilderness-filled backwater of the elegant, beloved Virginia, soul of the South. After June 20th, however, it was…well, a sparsely populated, wilderness-filled backwater all its own. But a free state that rejected slavery!
Those who live in South Carolina are generally well acquainted with my fellow West Virginians. I have a theory that West Virginians share a gene which, at various times of their lives, causes them to have an irresistible urge to drive to South Carolina’s coast. In fact, when the mines close down for two weeks every summer, untold numbers of miners and their families head to Myrtle Beach, which has been affectionately dubbed ‘the coal miner’s Riviera.’ Some of my earliest vacation memories are of the Grand Strand. My wife Jan, a true ‘coal-miner’s daughter’ has similar memories.
If you doubt the connection between SC and WV, I have a vignette: my brother-in-law Dave worked in the WV coal mines as a young man out of high school. His early cell-phone plan included, as local calls, Huntington and Charleston, WV and (you got it!) Myrtle Beach, SC.
I write about this today because West Virginia is in the heart of Appalachia, which stretches from Southern New York all the way to Northern Mississippi (passing through the Upstate of South Carolina). Appalachia is defined as a ‘cultural region,’ and indeed it is.
More to the point, I write this because Appalachia is struggling. Although poverty has improved over the decades, Appalachia as a whole still faces financial woes, much of it made worse by those who are all too anxious to kill coal, but provide no other employment options for those terminated as part of an environmental purge. As if the ‘coal industry’ is only some vast robotic behemoth, and does not represent the hopes and dreams, and often the only financial possibility, for an entire ‘cultural region’ of America.
Appalachia is also struggling with rampant drug addiction and broken by the many funerals, ruined lives and crimes that widespread addiction brings in its wake. From pill-mills dispensing oxycontin to meth labs and imported heroin, the toll in lost lives and lost hope is crushing.
When Jan and I have traveled home over the years, deeper and deeper into Appalachia, up Highway 23 through North Carolina, Tennessee, Virginia and Kentucky and then home, it’s easy to see a place of magnificent beauty, resilient people and serious, inexpressible hopelessness. I never know if the drug abuse is the cause of the loss of hope, or the result of it. Cart, horse. It’s all tragic.
Sadly enough, America frequently just isn’t interested. Appalachian people are still acceptable sources of scorn for much of urban, coastal America. They’re live in ‘flyover country.’ Trailer-trash, hicks, rednecks. People who ‘cling to guns or religion or antipathy toward people who aren’t like them,’ to quote a well-known political figure. When a culture is endlessly mocked and derided, its people get the message loud and clear. Don’t try. It doesn’t matter.
But this June 20th I’d like to speak for my ancestors, and the forebears of so many, who settled in the Mountains of WV and other portions of Appalachia after leaving the press and stagnation of Europe. I’d like to speak for those who still live there, and who find solace and connection in the ghosts of their ancestors, the starkness of the mountains and valleys, in the life, faith, culture and music of the cities and towns. Like me, they stay there because in Appalachia, the past and the present are difficult but inextricable.
And if nostalgia isn’t enough, let us remember Appalachian people keep the lights (and i-Pads, DVR’s and electric cars) on by mining coal. They also provide timber and produce, work in important industries and share their region for the recreation of any and all. All too many have also shed their blood in America’s many wars, and continue to boldly, proudly ‘stand on the wall’ around the world.
America loves to talk about its multiculturalism. And one of its greatest cultures is firmly entrenched, despite its pains and struggles, in the vast region we call Appalachia. It deserves our respect.

Tell me about your little hospital!

I’m putting together a project on small hospitals.  While I’m particularly interested in critical access facilities in rural areas, other small facilities (urban and rural) are welcome.  I’ve always contended that big teaching centers get all the ‘love.’ There are television shows and books and movies about the enormous referral hospitals in big cities.  But not so much about the little hospital at the end of the road on the mountaintop, or on the windswept coast or in the desert Southwest.

And yet those places have dedicated staff who do great things, save lives, comfort the sick and do most of it on a pretty limited budget and in all kinds of weather.

So if you are interested in being part of this project (I’ll reveal more in time), tell me about your hospital.  Where it is, why it matters, its great successes and struggles.  If you have anyone I can contact there, please let me know that as well.

I want to hear your stories!

You can respond here or e-mail me at edwinleap@gmail.com.

Sincerely,

Edwin Leap, MD

 

 

 

Snow, milk and bread. Still a mystery.

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Snow, milk and bread; still a mystery

(I resurrected this post from 2009, as our entire region of Upstate, SC is on lockdown from ice and snow.  Thank God we have tea and sugar!)

Living in the South for over 21 years, I’ve always been amazed by the general response to snow and ice. In particular, I am constantly fascinated by the grocery store dash for milk and bread. I grew up in West Virginia. Sure, we didn’t have winters like Michigan or Maine, but it was still cold and snowy. Nevertheless, I can’t ever remember my family saying, ‘Run to the store and get milk and bread!  The storm’s a comin’!’

This comes to mind today because all around our hill-top home, the forest is an ice covered work of art and the roads are slick highways to death and disability.  Being South Carolina, of course, everything is shut down.

But I digress.  The point is that I have contemplated this for quite a long time, so I have a few ideas. It may be that there is some secret knowledge that born and bred Southerners possess. Milk and bread may constitute the keys to some Gnostic cultural insight that I’m not privy to knowing. Or, it may be a kind of generally accepted joke.  If so, it’s a lucrative one for grocery stores. Whatever it is, I’ve decided that, in honor of winter, I’ll suggest some reasons why we might actually want, or need, milk and bread when ice and snow descend.

1) The most obvious answer is that we can drink the milk or eat whatever cereal we can find in the cabinet.  We can make sandwiches out of the bread.  And yet, this simplistic explanation it leaves me unsatisfied; hungry for some other answer, so to speak.

2) When the wind is stiff and the house (or camper) poorly insulated, we can mix milk and bread into a paste and caulk the walls for warmth.

3) When mixed into paste, milk and bread could also be used to write HELP, NEED CHEESE PUFFS! (or OXYCONTIN or XANAX) onto the sides of our houses. Unless they’re already white, or too snow covered for the letters to be visible (thus, food coloring).

4)) If a new ice age suddenly descends, we can use the milk and bread to lure animals like squirrels, rabbits, black bears and stray cats onto the porch, then drop cartons of frozen milk onto them, or snare them with nets made of plastic bread bags. We can then make breading to use whilst cooking them. Also applies to gerbils, guinea pigs, hermit crabs and large goldfish.  In a pinch, annoying neighbors may suffice.

5) Milk and bread may be combined with sugar to make some sort of winter confection to satisfy our need for something to eat besides milk and bread.

6) Milk and bread can be bartered on the black-market and exchanged for more exciting things like i-Pods and liquor, or more useful things like ammunition and camouflage. Except that everyone else also has milk and bread, so…

7) If one has purchased enough bread, it can be put under the back wheel of a vehicle stuck in the ice and snow to provide traction, so that the driver can venture forth to find… more milk and bread.

8) When the children are bored from being stuck inside for the 4-5 hours that snow actually lasts in the South, we can play games like ‘dunking for bread,’ ‘pin the cap on the carton,’  ‘cover baby sister in milk’ or ‘bread Frisbee.’  And our children can entertain us for hours asking ‘Mama, can we have something else besides milk and bread?’

9) Because we always get milk and bread but always forget dog food, we can mix the milk and bread and give it to the dogs (who will roll their eyes and eat it out of duty, but who will have already torn apart the trash for chicken bones).  But if thus conditioned, this will make #4 above much easier.

10) We can burst upon the art world with ‘milk and bread sculpture,’ which is almost as cool as ice sculpture but does not require power tools. (But may, unfortunately, sour before art critics can descend upon our area to review our work for the New Yorker.)

11) We can make hot chocolate and toast until the sun shines again. Unless, oh, you forgot the chocolate, didn’t you? Well, it’s back to milk and bread for you.

12) Milk and bread can be used in some sort of odd, Southern fertility ceremony. It must be true, considering the number of children born 40 weeks after the happy couples stocked up.

13) Milk and bread can be substituted for pseudoephedrine and ether in the manufacture of methamphetamine. Well, not really, but it’s much less dangerous and way more healthy.

14) It gives Southerners something to laugh about that people from other countries, like New York and Miami, don’t understand.

15) Going to the store for milk and bread reminds us of the things we need that are really important!  Like sugar and tea-bags,  chicken-livers, pop-tarts and Red Box movies to help us through the next 24 hours until everything melts.

If any of these are right, please e-mail me and let me know. I have to get to the bottom of this! And if it turns out to be a carefully planned conspiracy by dairy farmers and bread makers, then bravo, guys, bravo! Capitalism is alive and well.

Edwin

 

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?)

http://journals.lww.com/em-news/Fulltext/2013/10000/Second_Opinion__No_Matter_How_Hot_It_Gets,_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.

 

 

 

 

A snowstorm brings the gifts of solitude and silence

A snowstorm brings the gifts of solitude and silence

This is my column in today’s Greenville News.  Happy Winter!

http://www.greenvilleonline.com/article/20130217/OPINION/302170007/Ed-Leap-Snowstorm-brings-gift-solitude-silence

When I was in medical school in West Virginia, I was also in the Air National Guard.  One drill weekend, when I was scheduled to drive to my unit, a blizzard blew into town. And I mean the real kind, officially designated by the weather service and properly pedigreed.

I had every legitimate reason to call my Chief Master Sergeant, explain the situation, and stay in Morgantown, tucked in my apartment.  I didn’t.  I decided that I had to make the three and a half hour drive.  Was I patriotic?  Yes.  Was my girlfriend, and current wife, also at the end of the drive? Absolutely.

So off I went, in my little red Dodge hatch-back.  I slid into a guard-rail on the way out of town,  but the damage was cosmetic.  I continued on my way. The snow was thick, and the wind blew it in great gusts across I-79.  It piled up along the way, and at various points I recall that it was difficult to see the lights in business by the side of the road, difficult to make out the lights of other vehicles.  I could barely see road signs until I was very nearly next to them.  I drove behind, and by, snow plows and salt trucks.

As I drove further on my journey, I saw fewer and fewer vehicles, testament to the potential of the storm.  I pulled over at a fast-food restaurant for a break.  My hair and coat were wet with snow just from the walk into the building.  I grabbed a large Coke and a snack, then settled back into my car.

Not much further down the road, I spilled the entire drink in my lap; a sure way to stay awake when it’s below freezing and snow is swirling all about.  I stopped, next, at a shopping center and changed clothes.  Just in time, because wise managers were sending employees home for their safety.  Foolish and intrepid, I pressed on, my clothes dry and my drink refilled.

In the end, it took about six hours or more to reach home.  I made it to drill, and I visited with Jan.  It was a foolish, wonderful, thing to do, traveling in weather like that.  If my children did it, I’d be furious, and worried.  And at least they would have cell-phones, which of course almost no one had then.

But there was something about it that I can’t describe.  There was a beauty in that snow, that solitude, that uncertainty.  Maybe it was spending so much time with so many people in classes and in the hospital.  Maybe it was that fact that as a child, I liked to wander in snowy woods alone, and hide in snow-banks, listening to the wind in the trees.  Sometimes, loneliness is just the ticket.

A few weeks ago I was traveling in Indiana.  A snow-storm came up as I drove towards Evansville.  It was just a few flakes in Louisville.  But as I drove west on I-64, the flakes became more frequent, and ultimately, the roads became slick, the lights dimmed by the enveloping white.  Finally, the snow was blowing horizontally across the road, and cars were fewer.  I found my way to my hotel and settled in for the night.

Mind you, I had a cell-phone, and a more reliable (and likely safer) vehicle than back in my medical school days.  And I’m a better driver than I was then.  And unfortunately, I was driving away from my wife and children, rather than towards them.  But there was a similar emotion, a familiar sense of delight.

The highways of the Midwest are long and often straight.  Even when they snake up and down hills, their vistas are impressive.  Seeing the snow come across those highways, seeing the black clouds coalesce, sitting quietly in my car with the dash-board lights and radio, well that was a kind of quiet treasure; a gift of travel and solitude.

But it’s a gift we rarely receive these days.  Our phones are never at rest, and never leave us at rest. Screens are everywhere, in offices and waiting rooms, in homes and even in vehicles.  We clamor for more information, more entertainment, more people, more connection.  The lights of social media are never dimmed by weather.

It’s a pity, because solitude is often magnificent.  And silence is spiritual.  And few things bring them together like driving alone in a snowstorm.