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.

Sports Impairment and My Southern Man-Card

 

This is my column in today’s Herald-Dispatch.  My hometown newspaper in Huntington, WV!

http://www.herald-dispatch.com/opinion/edwin-leap-don-t-worry-you-won-t-lose-your/article_3706dd19-3472-520d-856d-09e3580d3886.html

It’s a terrible confession to make as a Southern male, but here it goes. I don’t care a lick about sports; not leagues, not high school, not college not pro. It feels liberating to say so. I figured I might as well be honest about it, because I’m forever confronting the reality of my sports-impairment in various and sundry ways.
One way my dilemma arises is I’m standing in the check-out line at a store, wearing my WVU t-shirt when another customer asks what I think of the Mountaineer’s chances this year. I usually make some sort of generally non-committal remark about how ‘I sure HOPE they do better this year!’ Which means that at some point in the distant future, if they manage to win a championship, I’ll have to be more careful and say ‘well, if LAST year was any indication this should be a good one!’ I try not to make eye-contact. It’s too uncomfortable.
What I usually want to explain, but never bother, is that I wear the shirt because I grew up and went to school there. And it was awesome and I have wonderful memories (same reason I wear my Marshall shirt). But it’s hard to stop a die-hard sports fan and say, ‘well, the truth is I really didn’t have time for sports because I was studying a great deal, but I’m proud I graduated!’ That makes people go to the next checkout line and shake their heads.
I’ve noticed the same thing at church. I remember finding myself in deacon’s meetings with little to contribute to the discussion at zero dark thirty Sunday morning. As everyone made the rounds of the previous day’s games, it was ‘Ed, Marshall did well yesterday didn’t they!’ ‘Sure did…(I guess).’ I put my head down, ate my biscuits and gravy and (since I live in South Carolina) I just let the orange or garnet wave pass over.


I’m not trying to be a snob, please understand. In my childhood I just wasn’t formally taught anything about athletics. Admittedly, my dad built a basketball court for me in the back yard. All the neighborhood kids and I had a great time there at all hours of the day and evening. But the rules were not exactly formally enforced. It was as much social time as athleticism. I also learned a little about football in the front yard. Specifically, I learned that ‘touch’ can be widely interpreted. I realized that lying on my back gasping for air one day, looking up at the fading blue sky.
I remember once around sixth or seventh grade that I went to the mother of one of my more athletically inclined friends and asked about joining a basketball league. She was kind, in a ‘bless your heart’ sort of way, and said we might be able to cram on the rules but it wasn’t looking good. Age 12 and I was already too old to start. I got the message and moved on without looking back.
Instead I filled my days with walks in the woods, turning over rocks in the creek for crawdads, seining for minnows, riding horses with my grandfather, shooting arrows into bales of straw, carrying my BB gun everywhere, shooting bigger guns whenever the opportunity afforded itself and generally acting like a joyous junior barbarian. Those became my preferred activities, until I discovered martial arts, then girlfriend, in high school.
My wife Jan grew up with brothers playing football. If I don’t understand a game that’s on, I just ask her and she guides me through. Two of my children attend Clemson University, and the other two are also fans, which is great. But they didn’t get it from me. Just recently they were all talking about the season and daughter Elysa said, with surprise, ‘why look at us, talking about sports like a normal family!’
I have great respect for all those devoted to their teams, who can quote stats like chapter and verse of scripture. May your team get all of the touchdowns, field-goals, runs and everything else it needs. But to all those who never got it, who never fell in love with sports, it’s alright. You aren’t alone.
Do your thing. You aren’t less of a Southerner or less of a man. And when the discussion turns to yesterday’s contest, learn to smile, nod and just say this: ‘that was some game!’

Holidays and Holy Days; My Christmas Book

This is a book of columns about Christmas and Easter that I put together with the SC Baptist Courier two years ago.  It’s still available and I think you would enjoy it!

https://www.amazon.com/Holidays-Holy-Days-Grace-Sacred-ebook/dp/B00PBHEF58/ref=sr_1_1?s=books&ie=UTF8&qid=1480385263&sr=1-1&keywords=holidays+and+holy+days+edwin+leap

 

Learning to be Careful; The Hard Way.

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One of the terrible things about being a physician who has spent his adult life working in emergency rooms is that you have a certain terrible clarity about the dangers of this life. It’s why we’re forever pestering our loved ones with phone calls and texts: ‘are you there yet!’ Or telling the children, ‘be careful! After midnight there are too many drunks on the road!’ Met, of course, with rolled eyes.

We see, we have seen, a shocking variety of ways in which people shrug off this mortal coil. However, it’s always a bit of an eye-opener when you walk through the valley of the shadow in person. I can think of a few times I did. Once, coming home from a residency interview, my dad and I nearly went full bob-sled under a jack-knifed tractor trailer driving downhill on an icy interstate in Maryland. There was the time I was almost stuck in the middle of a 10 foot wall of flames in the woods on our property. I ran out but only later realized how close I came to being barbecue. There was also the time I was bent over a tree that fell in an ice-storm, cutting it with a chain-saw. I stood up to stretch and another tree fell right where I had been bent. My doctor brain ran the possibilities and none were pleasant. I know what happens to the human body.

Now here I am, 23 years into my practice following residency, and I had another brush with my mortality. First, a little back-story. Like many families with multiple kids in high school and college, we are afflicted with vehicles. One of these cars (and I use the term loosely) is assigned to my high-school senior son, Elijah. For a few months the car (an automatic) would simply drop out of gear and lose all power. Thus it was consigned to the local transmission expert for a six week spa treatment, after which the transmission issues seemed fully resolved. But then it wouldn’t start.

So, one day last week Jan (my wife) and I decided to push it into a better location to try and jump the battery and trouble shoot. It was also in the way of the propane delivery truck, so it had to be moved. We were pushing it backwards, she at the front and I behind the open driver’s side door, pushing and steering simultaneously.

It’s a light car, an Infiniti I-10. Moving it was fairly easy. What became immediately clear was that stopping it was more difficulty. We pushed it across our driveway into the yard, which (we sadly forgot) slopes away at about 15 degrees.

The car picked up speed as objects on inclines are wont to do. But I was still behind the door. And it was headed for the many trees and stumps of our own forest. Jan yelled for me to be careful as I ran backwards. Then I tried (like the 52 year old fool I am) to jump into the seat and put on the brake. ‘Au contraire,’ said the involved force vector, which was hurtling the vehicle ever faster into the kingdom of the squirrels. And in my attempt, I fell to the side of the moving metal death-dealer, in front of the open door which my paramedic brother later described as a ‘scoop blade’ or some other horrible thing.

In a not very manly manner, I yelled. A lot. Perhaps to increase my strength as we do when lifting. Or perhaps because I knew it wasn’t going very well and I was very scared. I had visions of the car rolling over me and realized I had to push away. Finally, after being struck on the left shoulder and knee by the car door, I hit the ground hard and rolled away. As did the car, about 75 feet downhill into the woods, in the process nearly tearing off the driver’s side door, knocking down several trees and ending with a dent in the rear bumper and trunk.

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Many a small animal suffered panic attacks that day, and several trees crossed the rainbow bridge, or whatever it is trees cross when they are killed by hurtling bits of steel powered by stupidity.

Jan came to my side and I stood up, my pride injured, my arm black and blue, my knee tender and swollen. Nothing serious at all. The car? Less so. It had to be pulled out of the woods with a winch and hauled off on a flat-bed truck. In truth, I was ready to be shy of that car. I always had fears that it would lose power on the Interstate as Elijah pulled in front of a larger vehicle, or something like that. I’m ready to be done with it. I just didn’t realize we’d dispose of it by crashing it into the woods.

Christian that I am, I see divine providence all around. Maybe this was God’s way of making me sell the car; or scrap it. Certainly, God’s hand was in my escape from the Infinity that might well have launched me (somewhat ironically) to eternity. I am convinced that my guardian angel pulled me clear then threw his hands up and walked away for a snack break, or the weekend off. ‘Lord, I can’t be responsible when someone does something so ridiculous,’ he (or she) might have told the Father.

Even as I am thankful to God, I am also glad that I work-out, and so I have reasonable strength and agility. Among the many health problems associated with obesity and a sedentary life-style, one that is seldom mentioned, is that since life is dangerous, we must be prepared to rescue ourselves from said dangers as much as possible. As Rikki-Tikki-Tavi’s mother said, ‘A fat mongoose is a dead mongoose.’ I’ve always tried to live by that maxim. Except of course for not being a mongoose nor regularly encountering cobras.

I do think the lesson also reminded me to be more wary. I’m a guy who works in an emergency room. Not only do we treat the results of dangerous events, we are around the violent, the ill, needles, chemicals, infections and all sorts of things. I have to be diligent. Furthermore, I drive at all hours of the day and night. I work with power tools, including chain-saws. I handle firearms. I have a (sadly neglected) metal smithy where temperatures reach upwards of 3000 degrees F. I wrestle with my teenage sons. It is possible that God was just saying, ‘look, you’re no Spring chicken. I want you to do a lot more stuff for the Kingdom, so please be careful!’ To which I reply with a heart-felt, ‘You bet Lord, and thanks again!’

I shudder to think of the possible injuries I could have sustained the day the car rolled out of our control. They come to me in flashes of anxiety now and then, as I consider the horrific alignment of physics, anatomy and physiology. Head smashed against tree, hip dislocated, femur snapped like a dry branch, ribs broken, lungs collapsed. But the bottom line is I’m here, I’m fine, and God is good.

And I will try to never accuse any future victim of an accident of being stupid. Because bad things, dangerous and deadly things often start off with the most innocent of motives and accelerate much faster than we can imagine. All too often to terrible conclusions.

So we all need to just pay attention and think before we do, well, almost anything. Life is short. As one of my neurosurgeon friends used to say every time I consulted him, ‘hey, be careful out there, OK?’

On Veteran’s Day ask, ‘what would I die to defend?’

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Veteran’s Day has always meant something to me.  But then, I was born in 1964.  I’m the last of the ‘Baby Boomers.’  I grew up on stories of family members in time of war.  I remember my father, Keith Leap (my name also) leaving for Vietnam when I was four years old, and remember (vaguely) his return.  I recall my uncle’s stories of the Navy, and of a grandfather in the Army in Mississippi and a great-grandfather who served during the Spanish-American War.  There were others, back to the Civil War, the War of 1812 and the Revolution.

I grew up looking for dates of service on tombstones, and for flags, ranks and units of the fallen.  I grew up with toy guns, toy soldiers and war movies, in a time when we threw plastic grenades with caps in them, which sometimes actually went off and frankly surprised us.

A great-uncle I never met was a Col. in the US Army in France during WWI, and I always heard that he said he was determined to bring his men home safely.  Another great uncle gave me a bayonet he took from an ammo-dump in Italy during WWII; there appears to be a ding in the side from a bullet. A neighbor survived the Bataan Death March; not surprisingly, he suffered as an alcoholic as long as we knew him.  I once met a gracious gentleman who was a former Wehrmacht soldier, who (after a CT scan when his arms were held above his head) said ‘the last time I held my arms like that one of Patton’s soldiers had a rifle in my back!’

I was immersed in veterans and their stories.  And the ones I knew were ever humble and kind.

Was I taught to idolize war?  Was I taught that bloodshed was the answer?  Was I taught that violence was some sort of higher good, as if we were Lacedaemonian children of Sparta?

I don’t think so.  I think I was taught to idolize sacrifice, courage, and simply fortitude.  I grew up in Appalachia; fortitude was necessary, if only for my ancestors to survive against nature.

I suspect that much that these men did had less to do with bravery than determination; in practical application they can look the same, I suppose.

Many brave men and women follow that tradition of service.  They fight, are wounded and die on many fields.  They live or die by their conviction, by their camaraderie, by their patriotism and belief in something higher.

This is hardly limited to the armed forces.  Many live their convictions, in all sorts of fields of endeavor.  But what I wonder now is this:  who will die for their convictions?

We live in a time when many people, especially those in universities, are emotionally wrecked by the slightest challenge to their beliefs, the faintest intrusion into the coddled safety of their own fragile minds.  College administrators give them coloring books, Play-dough, therapy dogs.  Safe rooms are established where they can cry when things don’t go the way they perceive that they should, when there is no trophy or certificate for all.   I suppose this is included in the price of tuition?

But on Veteran’s Day, I must ask of all Americans, what beliefs will they, will we, go through life willing to die to defend?  We should all ask this. What matters most?  Faith, country, family, these are things men and women historically died for.  Ideology?  To some extent, but I wonder.

Will generations of young people learn the lesson of Veteran’s Day?  Not that they need to serve in the military to be real Americans; not that the only heroes are those in uniform, those in battle.  That is a heresy that would produce a warrior class, and we don’t need that.

The lesson, as I see it, is different.  What will you have the courage to stand up and live for, instead of lying down and weeping?  And what will you have the fortitude to die for, if it comes to that?

On this beautiful Veteran’s Day, contemplate that, whether you are or were or never were in the armed forces.  And find an answer.

The future may call on you to decide.

I Love America! My latest Greenville News column.

It’s an ugly political season.  But I still love America!  This is my most recent column in the Greenville News.  Please share liberally.

http://www.greenvilleonline.com/story/opinion/contributors/2016/10/23/ed-leap-love-america/92453876/

Over the Summer I was working in the ER at North Greenville Hospital, doing some temporary work for GHS. I arrived in Traveler’s Rest early one morning to get some breakfast and a drink for work.
As I pulled into a drive-thru, I looked at the nearby gas-station. I was amazed at how busy the place was. And I was suddenly overwhelmed with love for America and her people. It was about 6:45 in the morning, but there were cars and trucks of every variety. I saw utility company trucks and pest-control vans. Those pulling trailers full of lawn-equipment, with mowers and weed-eaters. Electricians, plumbers, contractors, police and EMS workers were getting out of all manner of vehicles. Many essential, difficult jobs were represented, as men and women were headed to work. Motivated by dreams of success, and by love for those they support, they were up with the sun. There were people of every race and ethnicity, many of them working on the same crews, for the same companies, laughing together.
It was going to be a long, hot day, so they were loading up on breakfast, coffee, snacks, water and other drinks. Trucks were being fueled, the staff of the gas station hurrying to keep up. There was an energy there that was quintessentially American. I felt honored to see it.
The wonderful thing is that America and Americans, for all our contentious behavior, remain wonderful. We work and innovate. We strive and create. We educate and parent and look after our loved ones young and old. And despite the reality of bias and discrimination, we are one of the most welcoming nations on earth. We adjust to social changes, we generate and rapidly adapt to technology, and even when it looks bizarre, the average citizen and average politician try to make democracy work.
We are conflicted at times, but usually over means, not ends. We want to help refugees even if we reasonably fear terror. We may worry about immigration but typically enjoy immigrants as our friends and neighbors. We desire to see the poor and their children lifted up. We still, as a nation, want to see justice done. Thus we are equally offended by false imprisonment of the poor and by the way the wealthy and connected sometimes stand apart from the law.
I meet all kinds of Americans in my work. I meet poor, rural Southerners struggling to find jobs, and facing chronic diseases with limited resources. I meet immigrant families trying their best to care for sick children. And even though we live in the South (where popular media loves to paint us as just so hateful), I regularly encounter doting white grandmothers and grandfathers cuddling and adoring their beautiful, mixed-race grandchildren, looking after their sons and daughters-in-law who have different skin colors, and sometimes different languages. I am often amazed at the men and women whose English grammar may not be perfect, but who learn Spanish out of love for a partner; not for a grade in a class or semester abroad.
I see my colleagues care for everyone, with never a thought to treating them poorly because they are gay, lesbian or transgender. I watch as physicians and nurses struggle mightily against the death and suffering of people different from them.
There are churches and pastors, congregations and church groups as well as government and secular organizations (and individuals) who help provide housing for the poor and drive people to work who are battling the nightmare of drug addiction. Those same people adopt children and spend time and money to give food to hungry families.
In America the laborer and the academic are both passionately devoted to fairness and those who never graduated high school are as important to the republic as those with advanced degrees.
Are there exceptions? Obviously. And it doesn’t take many hateful, cruel, manipulative people to cause great damage. ‘A little yeast works through the whole batch of dough,’ said St. Paul.
And yet, the lovely reality is that we remain a great nation, going through a hard time. I don’t know where it will lead. Maybe to darker places, maybe not. But for now in America, the America I see every day that I work, the America that starts the day early and ends it late, working together for common cause, the love outweighs the hatred, the strength outweighs the weakness, every time.
That’s something to celebrate.

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.