Emergency Departments of The Rich and Famous

This was my October column in Emergency Medicine News.  All of those cool places to work have a dark side; or at least, a weird side!

http://journals.lww.com/em-news/Fulltext/2015/10000/Life_in_Emergistan__EDs_of_the_Rich_and_the_Famous.15.aspx

The following excerpts will give you an idea of what life can be like while practicing emergency medicine in very beautiful, very coveted areas of the United States. I will not name towns or hospitals, as the situations are highly reproducible from place to place and season to season. We’ll just call it St. Resort hospital. If you doubt me, call up your friends who work in such locales, with the rich, the powerful and the well rested. Or with the sun burnt, drunk and tasteless. Vacation sites cross all demographics, but in different ways.

‘Dr. Leap, I’m having chest pain. I have pretty bad heart disease, and I saw my cardiologist at the University last week. He said I probably need another stent because I’m having chest pain a lot more than normal. But my wife and I decided to drive here for the week. What should I do? My son is a heart surgeon at Mayo Clinic. (Two hours to nearest interventional cardiologist. And of course your son is a heart surgeon!)

‘Dr. Leap, my daughter has a laceration on her face. By the way, I’m a plastic surgeon myself! (Full disclosure, I trained at Harvard and I’m faculty at Duke!) Can you tell me how you’re going to close the wound?’ (Stands close by during closure, asking questions, sniffing and making subtle noises to guide technique.)

From administrator: ‘Dr. Leap, Mr. Whatzit is a very, very important donor to the hospital. It’s critical that he get good care. Do you understand?’ (You mean, unlike the bad care I give everyone else?)

‘Dr. Leap, I live in Big City, USA. This morning, I went for a hike and now I have red bumps on my legs. I’ve been on the Internet and contacted my physician at home. He said I should be very concerned about Brown Recluse Bites and Lyme’s Disease, and that you should give me a prescription for Doxycycline. Oh, and I’m a pharmacist.’ (In the South we call them ‘bug bites’ and go on about our business, remarkably free of antimicrobials. Patient unimpressed with my colloquial knowledge of unspecified ‘bug bites.’)

‘Dr. Leap, I passed out! My wife and I have been married for 50 years and we decided to come to South-Town and ride bikes to lunch. After about six miles, I felt so dizzy I just fell over! Oh, and I’m on Coumadin. And I have a defibrillator. I’m a cardiologist myself, and my electrophysiologist is at Cleveland Clinic and wants you to call.’ (Heat index around 115 degrees, humidity 100%. What were you thinking?)

‘Hey doc, I don’t know how the %#S@% that happened, but I had a few &^%# beers and went out into the surf at night and stepped on that $@^^ stingray. Yeah, I’m drunk. What about it!’ (BP 215/110, which is also his peak and trough alcohol level. Patient hasn’t taken meds, or seen a doctor, since Reagan administration.)

‘Dr. Leap, it’s the funniest thing. I mean, I’m in good shape. I row ten miles a day and run every other. But I came up here for a wedding and I can’t breathe! I have a headache and I’m coughing. My living? Oh I’m a malpractice lawyer. But my sister is head of pulmonary medicine at Washington University. Can you call her? She has a few suggestions for you.’ (Sea level to 10,000 feet in one day; and I’m happy to be told what to do by someone who isn’t here and thinks I’m a hick.)

‘Dr. Leap, I know you say I should be admitted, and you’re right, I can barely walk with that broken ankle. But I have a camp to clean up and an Elk tag to fill. And nobody to drive me back home in my camper. So I hope you aren’t offended when I sign out and go back. Nothing personal. I’ll come back if I have to.’

(This one I get. It’s an Elk tag! Who can blame him?)

‘Dr. Leap, dude, I passed out on the beach and my skin is like, on fire! You have to do something! Oh, and I left all my Oxycontin at home before we brought the RV down. Can you help me out? My doctor is on a mission trip in Asia or some ^$#^.’ (Footnote: (60% BSA covered in sunburns, with scattered blisters. Prednisone, yes. Oxycontin? Nope. )

From Medical Staff office: ‘Dr. Leap: here is the Summer call schedule. Nobody is on call because everybody is on vacation. Good luck.’ (Footnote: technically I’m on call. For everything. At least in some locations.)

Honestly, most all vacation town folks are nice people trying to stay healthy and have fun. The same goes for physicians and administration. But poor planning, unrealistic expectation of local facilities and carelessness take their toll.

So next time you’re tempted by the scenery in that glorious add, just keep this all in mind. Remember to wear your sun screen, acclimate gradually, and remember that 80% of the ‘manageable’ annual volume will probably be compressed into the three months that constitute the lazy, hazy, crazy days of summer at St. Resort Hospital in Vacationville, USA.

Staying on the ground is a blessing (My Greenville News column for today)

 

Here’s my column in today’s Greenville News, on the blessings of not flying this Thanksgiving.

http://www.greenvilleonline.com/article/20121124/OPINION/311240004/Staying-ground-blessing?odyssey=mod|newswell|text|Opinion|p

As I contemplate the Thanksgiving just past, I am thankful that friends and family traveled to my home. In part because I’m blessed with family, blessed with house and job, food and health.  But I’m thankful for another reason.  The location of my various family members does not require me to set foot on an airplane.

I recently took a whirlwind trip to San Diego, California for a speaking engagement.  How amazing flight is!  We can cross mountains and oceans, continents and hemispheres. We can make meetings hundreds of miles away and be home for dinner with the family.  And all of it while watching the news as if we were in our living room (except eating what we want), in a climate controlled,  ever-so-slightly reclining chair.

And yet.  Among the many activities of modern life, I doubt if any are as demeaning to the human spirit as commercial air travel.  For instance, on my recent flight from GSP, I checked in a few minutes past my 60 minute window.  I know, there has to be a cut-off.  But it required me to go home (to Oconee County) and wait 12 hours for my next opportunity to fly.  (It was a blessing, as I had church and lunch with family.  And mind you, it’s rather serene passing through Seneca, Clemson, Easley and Powdersville at 4:30 and 5:30 am.)

I returned and wound my way through security.  Ah, security.  When I travel with my wife, she says to me (as I begin to take my shoes off and grumble), ‘be polite…you don’t want to go to jail.’  I find our current system of airline security…’less than optimal,’ as it were.  ‘Take off your belt. Put your laptop on the conveyor belt.  Take off your shoes.  Move it along people.  Come on. Step through.’  Since Jan wasn’t there, I was reminded by the sign that said, in essence, inappropriate joking might result in arrest.  So I kept my raging thoughts to myself and smiled.

I ultimately made my flight, checking my bag to the tune of a soul-sucking $25, then wedging myself into a small seat on a small aircraft on the way to Houston as non-checked bags, possibly containing bodies, were forced into various compartments by people still in possession of their $25.  In Houston, I snacked quickly, boarded, then wedged myself between two individuals whose dimensions made it more comfortable to merely hold my hands above my head all the way from Texas to San Diego, as if being robbed.  Not to mention that my ‘row-mate’ to the left made odd grunting noises over and over, while awake, and while both playing on his iPad and watching the pay television mounted in front of him.  ( I wondered if he were contemplating eating me…grunts can sound rather like ‘yum’ in a dark cabin.)  I remained vigilant and survived, arriving in San Diego late at night but safe and sound.

When I  returned from San Diego back to Houston and Greenville,  I did something I had never done before. I road the  golf-cart/shuttle in the airport.  When I told the driver where I was headed, a little proud of my ability to walk quickly, he said, ‘you better get on.’  It turns out I had arrived at Concourse C but had to find my way to Concourse Z, subsection 15, sub-subsection alpha, orange, gate square root of 6.

You see, when one goes to Greenville, SC from larger cities, one often has to leave from remotely located, obscure parts of large airports.  After riding on the transport, riding on the train, running some more and finding my way to what I thought was the tiniest concourse in Houston, I was directed down another hallway, and another, and yet another until I came to a small door with a sliding panel and had to knock three times then whistle. A man slid it back and asked if we were there for the flight or the poker game.  Outside our biplane was ready and waiting.

I’m not blaming anyone.  Lots of people, lots of planes, lots of destinations.  It’s difficult to keep flight affordable, safe and (relatively) on time.  I understand.  And I felt for the dejected, overworked clerks, flight attendants and pilots I saw, for whom the glory of flight had long since passed, as evidenced by their mussed hair and desperate sprints for the exit doors.  God bless them all.

I’m just saying, ‘thank you Lord for keeping me on the ground for Thanksgiving.’

Showing my papers

1389.5 Holocaust A

Showing my papers

Do you remember the furor over the Arizona immigration law?  ‘We don’t want to live in a country where you have to show your papers!  This isn’t Nazi Germany!’

Everyone was all in a vapor about the idea of showing identification.  The same swoon many fall into at the suggestion, the very hint, that we should ask voters to show identification.  ‘It’s disenfranchises them!  It’s tyranny!  It’s jackbooted thugs asking for papers!’

Well let me just point out some recent experiences.  On a recent trip, I had to show my driver’s license (aka papers) every time I used a credit or debit card.  When boarding a flight yesterday, in Colorado Springs, I had to show my driver’s license (papers) 1) at the check-in desk 2) at the security check point 3) at the boarding gate.

(Do they expect a terrorist to get confused and accidentally pull out his Taliban Visa?  ‘Earn extra virgin points for every mile flown!’  Or his Al Qaeda Membership card?  ‘Member in good standing since 2011…down with the infidel!’)

By the way, my 14-year-old son had to touch his insulin pump and have his hands swiped for explosive residue.  He’s a scary looking guy, that one, with a backpack full of novels and a subversive disease!

When I returned home, I found my Medicare reapplication packet.  Medicare is sending this out to various providers to update their enrollment.  Here are the things I have to provide:

1) State Medical License

2) DEA License

3) Medical School Diploma

4) Residency Certificate/CME’s

5) Board Certification

6) Curriculum Vitae

7) Certificate of Malpractice Insurance

8 ) Social Security Card

9) Driver’s License (What?  So they no I can get a job as a truck driver if they turn me down?)

10) US Passport.  (Why?  I’m a citizen!)

Let me add that I have never been able to purchase a firearm, or even so much as a packet of Sudafed, without presenting my ‘papers.’

So to all those who are afraid we are inching towards a society of paper-checking brown-shirts, rest assured…we’re already there.  So don’t expect me to cry for anyone else having to show their papers.

It’s just that those of us who don’t pose any threat are the ones most frequently shaken down.

Just a little rant!  Have a nice day.

Edwin

Our families provide us with love and learning

beach house

Our families provide us with love and learning

(This is my column in today’s Greenville News)

I am currently relaxing on the South Carolina coast with a few family members. I think the total number only comes to 24. But sometimes we lose track of the children, so it could be 22 or 23. The women in the family have been pretty darn fertile, so we aren’t always sure. But the chaos of a multitude of children, well that’s the way we like it.

A family vacation is always a learning experience. I grew up in a smaller family unit. Collective vacations with cousins were not very common. We were more the ‘family reunion’ types. You know, get together, eat some chicken, visit a grave or two, sweat, eat some pie, go home.

But this clan I married into, they get together. In fact, I’m very proud of my wife who has missed one, that’s one, vacation with her family in all her…few years. (Almost slipped up there!)

The first time I went on a vacation with my wife’s family, we were 19-years-old and dating. We went (prophetically it seems) to Myrtle Beach. I was assigned a sleeping space in a closet. It’s a family joke that goes on to this day, these 27 years since we met. Fortunately, I’ve graduated to my own bed, fully equipped with wife; legal and all!. This week, my daughter slept in the closet, but only because she thought it was cool.

The annual trip is something we look forward to with great anticipation. When we arrive, we dispense rooms, stock the house with food and make plans. Over the years, the trip has certainly evolved. When we were younger and childless, we could stay up at all hours watching movies, playing cards and laughing ourselves silly. Morning had little meaning.

Now, one is apt to find an adult at any time of the day tumbled across a couch, snoring and drooling in a valiant attempt to make up for a year or so of lost sleep. Further, some of the family (not us) have small children. The smallest is four-months-old, our newest member, and she still cries. Her big brother still gets fussy when tired. His nearest cousins, only a bit older, are also wee ones, and subject to the normal, delightful characteristics of childhood like all the rest. So our family activities have to account for meal times, nap times, snack times and bedtimes. Not to mention allergies, childhood personalities, adult proclivities and all the rest.

For one glorious week, we mix it up, with laughter and chaos. We roll around in the ocean, eat ridiculous amounts of junk food, cook meals in the kitchen (each family unit gets their own night) and sometimes eat out. For that one week we are a commune…except that nobody is doing any serious work and the food is probably better.

We also take trips. I should say, rather, migrations. Today for instance, we drove to Savannah. Coordinating the needs, interests, desires, schedules, dietary habits and attention spans of so large a contingent of Appalachians is no small feat. My wife’s dual degrees, one in recreation and one in counseling, make things easier. But even in the madness of communicating, planning, meeting and moving as a herd, it’s never dull. And we always manage to make it a joy.

Family is like that. Family serves many functions. It is where we find comfort and encouragement. It is where we find (theoretically at least) unconditional love. With family we can fall asleep mid-sentence, and wake with a blanket over our legs. With family we can make dinner of leftover hot-dogs, a sushi roll and fudge-stripe cookies and no one will bat an eye.

Because it is a place of love, family is a place where character is molded. Family is where we learn (or should learn) genuine tolerance and love. It’s where we learn to see through, see past, the idiosyncrasies, the weirdness and difficulty of the people connected to us by marriage and genetics. And in time, learn to love them not in spite of crazy, but because of crazy! Family is where we learn to be grateful that they love us too, regardless of our own assorted personality disorders and innate strangeness.

Psalm 68:6 says, in part, ‘God sets the lonely in families.’ I know that I’d be lonely if not for the sprawling, wild family that came as a bonus prize with my wife. And I would be poorer if I hadn’t received the rich gifts of family vacation.

What do Baptists do at church camp?

Church Camp Helps Kids Learn How to Choose

This is my column in today’s Greenville News.

My wife and I just returned from helping to chaperone 20 middle and high-school students at a church camp populated by a total of 600 youth. We were at SummerSalt, the flagship camp of the South Carolina Baptist Convention, located near Winnsboro, SC at White Oak Conference Center. (Actually, I’ve always referred to it as ‘Hotternhades, South Carolina,’ but that’s just me.)

Since it is a Southern Baptist Camp, let me immediately set fire to the standard ‘straw-man’ stereotypes leveled at our denomination; and indeed, at evangelicals in general. We did not spend our time making lists of all the people we believed were going to hell. We did not meet secretly to discuss implementing a theocracy in America. (We have enough committees already.)

We did not froth at the mouth over the horrors of modern music or entertainment. In fact, the college-student led band could have outperformed many secular club bands. We didn’t discuss our hatred for homosexuals (or anyone else) nor did we teach the kiddies how to erect scaffolds on which to hang heretics or atheists. We didn’t scream about abstinence, even though we believe in it. (And married counselors, in separate dorms, modeled it.)

What we did was work with the camp staff, clergy and college-aged counselors to provide an engaging, entertaining, crazy-fun place for young people to learn about Jesus, set their lives on track and encourage (and be encouraged by) their peers.

You see, it’s hard world for the kids. I know, because I see them as patients when I’m not busy raising them. I see their bruises, physical and emotional. I see their overdoses and loneliness, their drunkenness and pregnancy, their STD’s and rebellion, their insecurity and their sorrow at parents who abandon and ignore them.

Popular wisdom seems to suggest that adolscence is a time of misery we should just embrace. That teen dysfunction is normative and inevitable. Young people will drink and use drugs. Young people will experiment with sexuality, and as long as there’s a condom and mutual agreement, it’s no different from playing volleyball or taking a walk. Young people will rebel and scream, run out and run away, fight and bully. Young people will hurt. “It’s just how they are!”

There is a dark truth to the fact that these things are common. But then, so are heart attacks, car-crashes and cancer. We still try to find ways to heal the pain and save the life. Likewise, young people need treatment for their hearts and souls, as surely as their bodies. And the goal of SummerSalt, the goal of Christian youth programs in general, is to show them that they have eternal worth and purpose, and that there is a cure for their pain and the vague sense of guilt and inadequacy that lives inside them just as it lives in every human.

At camp, we try to teach the kids about choices; in behavior, relationships, dress, careers, entertainment and every aspect of life.. About the fact that their decisions have consequences, sometimes small, sometimes large, often eternal.

Our goal wasn’t to make teens into stereotypes of Christians in general or Baptists in particular. (An admittedly terrifying prospect.) Our goal was, and is, is teach them about Jesus, and make them like Him, for He is vastly better than the best Christian..

What we do at church camp (and hopefully in Christianity in general) is this: we identify the root problem of humanity, which is our very epidemic, inherent, congenital broken human nature. We call that brokenness sin, though it hurts people’s feelings and makes them indignant. However, it wasn’t my idea. Jesus, whose teaching is twisted by every cultural, political and religious group when it’s convenient, was very fond of talking about sin. In fact, his main mission, his reason for coming to earth, was to conquer sin. (Don’t take my word for it. Read the Gospels.) In response to the very real problem of sin, we offer the cure, which is not a set of our own rules, but the person and work of (yep, you guessed it) Jesus.

What we do at camp, between water games and worship, music and laughter, is offer Him and His teaching to kids of every stripe, color, family, wound, crime, drug and economic status. Miraculous things happen, broken young people are made whole, families given hope. The treatment of deep, aching wounds begins.

And in a hard, sad world, those things are worth every second in Hotternhades, South Carolina.

The end of summer

Hi dear readers!  Here’s my farewell to summer column; it’s in today’s Greenville News.

Enjoy!

Well, the blackberries are tiny, hard balls on the bushes.  The dogs never come out from under the porch, except at night.  The pool is now the temperature of a very large hot-tub and the wind has all but ceased to blow here.  School supplies have been purchased and  both children and parents are ready to get back to the work of education.  Summer is nearing its end

            It feels for all the world as if I stepped in some kind of time-machine on Memorial Day, and was hurled forward to August.  But fast as it was, I do remember some things that are worth passing on to you, my sweltering, exhausted friends.

            First of all, a few thoughts on camping.  We only camped once this summer.  It was a wonderful reminder that our pioneer ancestors may have enjoyed the intimacy of the campfire and the peace of a world free of cell-phones.  But they did it while covered in sweat and grime, and while lying on rocky ground, as rain dribbled through tents and temporary shelters, being eaten by mosquitos and dreaming vaguely of some fast-food alternative to freshly clubbed rabbits, fried corn-meal or old jerky.  In all likelihood, they would have looked at our camps and asked why we left the house.

            Of course,  while camping I also learned that my daughter is fearless about baiting a hook, and that my boys could probably survive with only a cane-pole and a cup of worms.  And by way of advice, when you pitch your tent on a slight incline, all of the children roll downhill onto your body in the night.

            Next, a lesson for fathers and daughters. My wife and sons went with our church on a mission trip to Louisiana.  I cannot speak for them; though I hear tales of alligators on the church step and of (to repeat a theme) mosquitos the size of humming-birds.  And while they built and taught, my daughter Elysa and I stayed home and taught one another, building our bond even stronger.  We laughed, played, watched movies, went on a dress-up date and simply talked about everything.  I learned what I already knew; the bond of father and daughter is sacred and priceless.  And it involves occasional (terrifying) dancing.

            I also learned some truths at church camp:  If the temperature is any indication, Columbia and surrounding areas are paradoxically near the equator.  Getting lost in the middle of SC is like being lost in the desert, with no discerning landmarks.  And my sons are spiritually profound, but are also red-blooded males who are old enough to ignore me in favor of the fairer sex. 

            There, I also discovered that a dorm room filled with men and boys emits an odor much like an animal den.  And that it is repulsive to passing women, who suddenly recoil, cover their faces and ask, ‘what’s that smell?’  It was at church camp, in the wake of the World Cup, that I realized that the buzzing noise of the World Cup is made by an instrument called a vuvuzela.  And that it is entirely possible to threaten teenage boys so that they don’t play it at night, if you look crazy enough when you say ‘I mean it, Jesus loves you but I’ll kill you.’

            Regarding water-parks and theme-parks.  It’s embarrassing to be kicked off of a slide with your children because you’re too big.  I mean old.  I mean tall.  Shoot, you know what  I mean.  And there should be a law about swim-wear.  I won’t say anymore than that.  As for roller-coasters, they used to be such fun!  Now, days after riding several of them, I feel as if I have been assaulted with a golf-club.  The children laughed and screamed, and all I could wonder was if I’d be decapitated in the tunnel, if my eyes could actually pop out, and if my kidneys had been broken in half.  That was before my near-cardiac arrest on the first hill of one of the world’s largest coasters.

            I suppose I’m ready to move on.  I do long for some cool evenings. But the most important lesson of summer is to never, ever wish it away.  Mosquitos, campsites, stinging insects, church-camps and water-slides alike, I’d do it all over again.  Because summer, like childhood, just goes by too quickly to take it all in the first time around.

            But I’d leave out the vuvuzela.  And I mean it.