When leading is following; my latest EM News column.

Here is my latest column in Emergency Medicine News.  I hope you enjoy it!

http://journals.lww.com/em-news/Fulltext/2013/02000/Second_Opinion__When_Leading_is_Following.8.aspx

My wife just built a pergola in our yard.  Mind you, a pergola is a thing I never knew existed until it was pointed out to me by my darling.  If I had been asked, ‘what do you think of her pergola,’ I might have thought, ‘well, it certainly fills out that dress nicely,’ or perhaps, ‘I remember that from pathology.  It incubates for four weeks, causes fever and weeping skin sores and is common in the Pacific islands.’

Turns out it’s that structure you see in elegant yards, or in the sacred pages of our Dixie Holy Book, Southern Living.  A pergola is the wooden framed structure that ladies of taste have in their yards, and on which assorted vines grow for shade, and beneath which said ladies and their charming children have cakes and lemonade in oppressive summer heat.  Incidentally, I have explained to my wife that Southern Living is merely house porn…images of things that one desires but which do not actually appear in nature and which are not actually available to mere mortals.  I now stand corrected, though our pergola may have wild animal carcasses dragged beneath it, unlike those in Southern Living.

Our pergola is almost finished. Thanks to the skill and vision of my Jan (who probably should have been an engineer), and thanks to the strength and agility of my children, the tools and experience of my various in-laws, it has risen from the ground behind our house.  Its posts are set in concrete, its beams securely nailed.  It’s tall posts and well-measured intervals caused me to ask Jan if it were aligned with the summer and winter solstice, and if we’d be dancing naked beneath it.  She smiled and said, ‘maybe!’

Pergola entered my vocabulary because it was something my wife desired; something of interest to her.  I’ve learned other things from that girl.  I’ve learned about leadership skills, which she used to teach to college students and still teaches to our church youth.  I’ve learned about volunteerism, and historical romance.  About Japanese words and her love of Ireland, land of her ancestors.  I’ve even learned things I can’t discuss here.

But she isn’t my only teacher; not at all.  From my children I learned many things as well.  If not for my son Seth, I wouldn’t have my deep love of the bag-pipe.  Many years ago, when he was small, we heard the band Albanach play a show.  They are a group of Scots who play pipes and drums the way Ted Nugent plays the guitar.  Watching their show, one understands why the English viewed Highland combat with a certain reluctance.  But they inspired my son.  And he has played the pipes, better and better, for years.  It was also Seth who led us down the path of learning the ancient art of blacksmithing.  A smithy sits in our yard, and we fire it up whenever we need to shape metal and feel the heat, see the sparks and ‘get our iron on.’

My daughter Elysa taught me the fine art of playing dolls, and endlessly teaches me about fashion and contemporary culture.  She makes me dance in the dining room, and asks me questions about my past, and her mothers.  She shows me how to make movies on an i-Pad and how to do all of the things on my computer I should understand, but don’t.  She also teaches me to see inside the hearts of others, for she is a born healer, all compassion.

Elijah, my 13-year-old, forces me to learn.  I am always behind his vocabulary, and interests, as he quizzes me on German words (I don’t know any, I try to explain), relativity (zoology degree, not physics), Norse Mythology and ancient combat.  (OK, I know a little.)  But his passion for knowing forces me to read, to learn and to never stop loving the act.

And my oldest, Sam, teaches me that there’s always a reason to laugh, always a new ‘Meme’ online that I need to see, always a new idea on BBC news or somewhere else that we need to discuss.  He introduced me to the band Muse, and is my guide to the modern music scene.  In fact, his enthusiasm for his favorite band led his mother and I to drive family and friends to see the band in Indianapolis in the summer of 2011.

What’s my point here, you may be asking?  Not to catalog my family hobbies, certainly.  My point is this.  We physicians can be a focused bunch.  We work, we study, we write or do research, we speak.  For so long, we’ve listened to our own interests and followed our own requirements.  We get lost in education, then in continuing education and in the vagaries of practice.  So lost, in fact, that we lose touch with the very interests and tendencies of the people we love.  And we forget that love is more than an emotion.  Love involves engagement in the lives of others, and sacrifice of some our time, some of ourselves, for their good.

If there’s one thing I’ve learned as a husband and parent, and not always done well, it’s that we have to open our eyes, ears and hearts to the passions of the people we love. I could have devoted my entire life, and all of my time, to me.  But what a loss.  I have learned so much more by being led by my dear family!  Lead on walks, lead to play X-Box, lead to imagine, lead to dance, lead to build a coal smithy and make things, lead to play airsoft, to listen to concerts, to read widely and always embrace life in its wonders.

In the process of following, of letting go of my own agenda, I was lead deeper into the hearts of my wife and kids.  I am safely ensconced there now, and their interests and joys have been welded to my own.  I couldn’t undo it if I wanted. But I don’t.

Because in the process, we have had laughter and love, games and trips, learning and adventure.  I have become so much more than a physician, so much wider in scope, wiser in life, richer in knowledge and skills.

And we have a pergola, for crying out loud!  How cool is that?  And I for one can’t wait to sip lemonade beneath it.

 

Bagpipes and anvils and music from alt bands

German and physics and myths out of Iceland,

Pergolas, dancing and daughters with bling,

these are a few of my favorite things!

Get rid of useless stuff this Thanksgiving…my Greenville News column for this week

This is my column in today’s Greenville news, on the topic of time wasted and time well used.

http://www.greenvilleonline.com/article/20121118/OPINION/311180007/Get-rid-useless-stuff-Thanksgiving?odyssey=mod|newswell|text|Opinion|p

I sometimes sit and think about the things that have wasted my time.  It’s a long list, and  probably would exceed my word limit for this column.  Regret can be very destructive if it isn’t accompanied by change.  But as I am trying to change, I feel like it’s alright to list some of the activities that have consumed my precious heartbeats.

For example, there’s worry.  I come from a family of worriers, so I’ll claim some environmental and genetic factors. But I also embraced it.  From worry about my future and education when younger, all the way through worry about the health and safety of my loved ones and on into worry about the future prospects and safety of my kids, worry has been a dark hobby of mine. More to the point, it has been an idol, before whom I have spent too many long nights in worship.  It’s worthless.

Next, said the writer, is communication.  Not that communication isn’t important.  It’s critically important!  I mean pointless communication. For instance, I have used too much time having e-mail arguments with people whose minds I will never change.  I have done the same engaging in political debate with opponents on Facebook or some other electronic black hole of time usage.

I’ve wasted time with television, flipping channels as if my body were riveted to my chair and no other option were available.  I’m not too much of a television guy, but I’d venture to say that I have, in total, used up weeks to months of otherwise productive life sitting before the glowing box.

A few other things come to mind.  For instance, I don’t know how much of my life has been devoted to trying to start small engines.  Lawn mowers, weed-trimmers, chain-saws and all the rest have consumed my limited span over and over.  Each summer I wonder how many hours will go down the tubes pulling the starter cord, adjusting the choke, checking oil and filters and replacing the string on trimmers.  I don’t know how to avoid it, but it still tends to trouble my summer days.  Living in the midst of what amounts to a jungle, weeds must be battled.  I just haven’t figured out how to make it a fair fight.

I could go on.  But it might be better to think about the things that haven’t wasted my time.  For instance, dates with my wife, shopping with my wife, talking with my wife or even napping with my wife.  Not a one, in all my years with her, has been a waste of time.  And playing with my children!  Whether board games or word games, whether tag in the pool or Halo 4 on the X-Box, dancing or wrestling, dolls or toy soldiers, not a second has been wasted.  Conversations with my wife and kids, in which we discuss everything from daily activities to philosophy and theology, are times that are always valuable.  Visiting with parents and grandparents, remembering past times, sharing wisdom and laughter, never a waste of time.

Reading my Bible, prayer, worship, alone or with my church family, or my own family, has always been a worthwhile expenditure of my limited heart-beats on this earth.  They make me wiser, kinder, humbler, more loving and more at peace. Reading in general!  (I can pretty quickly identify those books or articles that are pointless and I now move on right away.)  Reading has never seemed a waste to me.

This list, like the list of wasted time, is pretty exhaustive and could go on.  But let me also say that Thanksgiving represents much of what is good in my use of time. Thanksgiving is never a waste.  It incorporates time with the people I love, worship and praise for all my blessings.  It leads to laughter, games and rest.  And it involves food!  Preparing, cooking and eating good food is never an abuse of our fleeting time.  Turkey, dressing, gravy, assorted casseroles, bread, cranberry (fresh or jellied), pumpkin pie and all the rest are never, ever to be calculated as poor investments of our few decades on earth.

So this Thanksgiving, clean house. (No really, especially kids and husbands, clean house.  It will make the ladies happy.)  But also, clean house of the things that use your time, and your life, poorly.  And focus on the good.  You won’t miss the useless stuff.  And you’ll have that much more time to give thanks, eat, laugh and nap.

 

 

 

 

Cowboy doctors and shootin' irons

This is my column in the October edition of Emergency Medicine News

 

When I was a resident physician, I had the coolest classmates ever.  We worked together, laughed together, learned together and many of us stay in touch to this day.  Our practices have crossed the gamut of emergency medicine, with some in academics, some in private practice, some administrators, two involved in auto-racing medicine, one a bush-pilot/fishing guide and one an amateur mountaineer (recently evacuated from a mountain by helicopter…moron.  I love you man.).

But one of the things that united us, one of our favorite activities when the shifts were over, and a little time was our own, was shooting.  For the first time in many of our lives, we had a little money (especially when we began to moonlight).  And with that money our longing eyes fell on the shiny objects of our affection: assorted firearms.

We discussed them between educational sessions.  We read articles about them. We searched for the best deals in the gun-friendly city where we trained.  And when we finally had them in our hot little hands, along with our concealed carry permits, we took them to the range and fired at the silouhette targets before us in the holy confines of local indoor shooting facilities.

Those were good times and we formed quite a bond.  One of the places we went to shoot was slightly seedy, and while on the range, one of us always tried to keep an eye behind in case a local gang-member tried to rob the store while we were there. It never happened; and it was probably a product of our over-active imaginations and over-stimulated lives.   I know, I know.  Sounds crazy.  But then, what we did was crazy, wasn’t it?

We were emergency medicine residents.  We inserted ourselves into some of the most horrific situations imaginable.  Stabbing victimes rolled past us at work, cardiac arrests were commonplace.  Burns filled the ER with the smell of dead skin.  And into all of it, we plunged with the vigor of new recruits, fearless and confident.

Not only that, we flew with our hospital’s medical helicopter.  We landed,  mid-day or midnight, in summer heat or winter cold, at the scenes of accidents.  We stopped in tiny hospitals where the staff had virtually no training to handle the complex cases that stopped in their ER’s.  I did fasciotomies on a pediatric, and an adult, burn for heaven’s sake!  As  PGYII.  (I had never even seen one!) At the referral hospital. By myself.  It wasn’t so much emergency medicine.  It was cowboy medicine.

Maybe that’s part of why we loved our guns…and still do.  They represented capacity.  We were physicians dedicated to responding in crisis.  We knew cricothyrotomies and CPR, defibrillation and thoracotomies.  We placed tubes,  removed foreign bodies and managed poisons. We were being sent into the world to intervene.  Not to stand by, but to plunge into the storms of life.

To this day, I’m convinced that emergency physicians probably own more firearms than any other specialty. (Though I did know orthopedists with belt-fed machine guns, and an intensivist with a penchant for the Uzi…he really loved the classics.)  I think it’s explained, in part, by what I just said.  We want to be ready.  To be able to save lives, even our own. Because we all know what it’s like to have to wait on someone else to do a job that needs to be done, and to see them delay and avoid until someone dies, or we have to do it ourselves in the end.

Furthermore, even as we try to help people, Emergency Medicine xposes us (as few other fields do) to the realities of human behavior.  Let me be clearer:  our work puts is in proximity to the realities of human evil.  We are seldom deluded about the capacity of peope to harm others, as we close the lacerations, order the CT scans, call the surgeon, police and call the coroner.

I understand that this may rankle some readers. We all have our own opinions about things like gun rights and gun control.  I’m not trying to initiate a debate.  Rather, I’m trying to celebrate good times with friends.  I’m hoping to bring a smile to the faces of those of my fellow physicians who find time on the range relaxing, and who value their rifles, pistols, shotguns and revolvers (and never hurt anyone with them).

I’m ultimately hoping to explain why we are so often armed ‘to the teeth.’.  We are, in the end, among the last of the cowboys and cowgirls of the world.  We ride to the rescue.  We don’t shirk.  We have a frontier fatalism combined with a frontier hope.

And what’s a cowboy without his trusty six-shooter, I ask you?

Lost Proverbs of the Emergency Department

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

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

http://journals.lww.com/em-news/Fulltext/2012/06000/Second_Opinion__Lost_Proverbs_of_the_ED.11.aspx

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

 

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

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

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

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

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

And never take a knife to a gunfight.

Or a baseball bat to a knife fight.

A big dog is a wonder.

Play rough with it. Make it fight.

Then feed it bacon from your mouth.

Remember that spider? In your basement?

It probably bit you in the night.

Doctors always say abscess for spider bite.

Do you want riches? Do you want prosperity?

Work under the table. Taxes are for suckers.

Get your benefits from saps who work.

Find a woman who will love you.

Find a woman who will have your children.

And also her sister.

Long life is a gift. Gray hair a crown.

But when the aged are a problem,

Ask the doctor to admit them.

Belly pain is a curse and hunger a greater misery.

So never let pain be a reason not to eat.

Burgers solve all problems.

A helmet and a seat-belt make one safe.

But neither makes one cool.

Cool is worth the risk.

Pregnancy is magic.

Remember, you can’t be pregnant.

No way. No how. Unless you are.

Work elevates us. Work pays our bills.

Work drains us and stops fishing trips.

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

Doctors and nurses have money.

Don’t worry about them; they’re rich.

Health care is free … if you insist.

The wise man avoids conflict.

The foolish doctor makes mistakes.

Keep a lawyer’s card in your wallet.

Remember that you are strong. And loud.

Bully everyone you can. But learn to keep your

mouth shut when the cops arrive.

An argument is good

until the police arrive.

Pepper spray is no fun at all.

A thief is the one who gets caught.

Check the hospital cabinets!

Purses can hide lots of bandages.

Life is precious. Who would kill himself?

But saying you’ll do it is great drama,

And everyone feels badly for you.

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

If you feel afraid and think you might die,

Ask, “Could it be the meth?”

Do not take a chance on fever.

Do not pause to take Tylenol.

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

If food and fluid erupt from you like a volcano,

If your stomach aches, be afraid!

No one else in history has ever vomited but you!

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

There is love. How can it all be sweeter?

Oxycontin, that’s how.

Was your doctor good? Was your problem solved?

Did you receive what you deserved?

Do not neglect the satisfaction score.

Family is a blessing. They know all.

Remember, whatever your sister says is true.

She’s a nursing assistant, after all.

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

Remember, it was because of the dog.

You only had two beers, right?

Your time is precious. TV shows to watch.

Babies to make. Snack food and sodas.

Ask why your ER visit is taking so long!

What will you do when the ER is empty?

What will you do when the doctors quit?

That won’t ever happen! Funny joke.

Identification is important. For checks, for beer.

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

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

Tattoos and piercings make the girl and guy.

They show we’re edgy, bad, sexy.

What’s an infection now and then?

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

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

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

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

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

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

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

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

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

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

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

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

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

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