It's Complicated

My son glances up at me with those stunning brown eyes as his fingers pull at the sides of my pant leg. His head plunges downward and he clasps his hands behind his back. He is working up the courage to ask. His feet sway side to side. I know what's next....daddy, can I come with you to the hospital?

My heart sinks and then bounces back into my throat hampering my voice. How do I explain to a seven year old and keep him from becoming enamored? Should I tell him being a doctor is not just about pagers and fancy phones? Blue tooths, reflex hammers, and pens with shiny pharmaceutical logos?

*

He is shimmying back and forth in his booster as I turn down the car radio to answer a page. How do I explain my life's work? The all consuming task that has swallowed my youth. Ground me into pieces and spit me out...ragged and torn.

What do I tell a little boy about uncertainty? About the irrational complexity of the human body and the self inflicted torture of those who willfully try to master it. Or of consequences. Could I explain how it feels to be responsible for the loss of anther's life?

*

As we enter the hospital he marvels at the balloons in the gift shop. For him, the wards are a carnival of grandparents with kind words and smiling nurses offering sweet treats. But does he see the beaten and haggard bent over their rosary beads in the ICU waiting room? Or hear the mindless hum of the ventilator? Or notice the fetid smell of sterility that permeates the hallways?

Can I explain to him that a doctors career is series of battles which are all inevitably lost. And that victory occurs in crowded exam rooms were quiet desperation is met not with miracles but humanity and humility. A kind smile, a generous hand, and a partnership built on difficult decisions.

How...I ask you...do I protect him from a profession fraught with such difficulty?

How do I elevate him to a life that offers so much?

Sometimes We Are Doctors

If death was the end zone, George had been on the one yard line twice in the last five years. And I, as part of his team of doctors, watched as he stubbornly maintained his goal line stand. Miracles rarely happen in medicine. They certainly don't happen to the same person more then once.

Yesterday as George glided into my office you would have never known that eternity's grip had been so close. He was the picture of health. Strong and confident. He walked with a lightness found only in those who have escaped the ICU's tenacious grasp.

His complaints were minor. An ache hear...a pain there. Nothing extraordinary. Our conversation eventually turned social. After leaving the office he was going to his rental property to mow the lawn. It was a house. He owned it for years.

His current tenet, Jim, had moved in shortly after George's first hospital adventure. A young man with two children. Originally his wife had lived with them but she left Jim and the children one quiet morning.

Jim, overtaken by depression, eventually lost his job.

There he was. Two children. No wife. No income. Living in a rental property with no hope of having money to pay the next months rent.

George clearly remembers the day sitting in his kitchen with his hand on Jim's shoulder as the kids slept quietly in their bedrooms. Don't worry about the rent. You'll pay it when you're able.

After all that George had been through...compassion was more a privilege than a burden. He would wait. Two years to be exact. Until Jim could cover the monthly costs. Another year before he would pay the past dues. But Jim's children would grow up healthy and happy.

Looking across the exam table into George's warm kind eyes I felt great pride at being one of his doctors. One of the team of people who helped him stave off the inevitable. Because George would then help Jim. And Jim would bring up two wonderful children. And Jim's children would go on to touch other lives. Like dominoes my good intentions had helped start a reaction.

I believe George sensed what I was thinking. As left the office he turned and looked at me squarely.

We are all patients sometimes...

and sometimes we are doctors.

I Am All Of These

The edges of Cameron's lips rise undeniably toward the clear blue sky. His legs move methodically. One motionless on the scooter and the other periodically kicking to propel himself forward. He weaves in and out dodging my shadow as I jog beside him.

I struggle to keep pace. My breathing unsteady and labored. My joints aching. And my brain foggy from lack of sleep and replaying the events of the day.

*

The hospital was uncharacteristically quiet. Even for 5 am. My eyes fluttered with fatigue as I willed my mind to focus after two nights of countless interruptions. I felt no joy in this early morning excursion.

The room was lit by a small lamp. A woman in her forties sat with a young child curled on her lap. A boy...Cameron's age. My eyes adjusted to the absence of light.

The middle aged man lying on the bed looked far older then reality. He took deep irregular breaths. Each pause a question. His wife held his hand gingerly. I inhaled the seen cautiously. I couldn't help but think of my dad. Were his last moments like this?

The woman dabbed her eyes with a tissue. She tried to move slowly to avoid waking up the child perched on her waist. I placed my hand on her shoulder. It won't be long now. She replied softly. I know.

I sat for a few moments and waited. The breaths became less and less frequent. Then suddenly they stopped. The woman shuddered. Mutely shaking she sobbed. Visceral, uncontrollable movements made more powerful by there silence.

From the distance I could here a kitschy lullaby on the PA system. Somewhere in the obstetrics ward a baby had just been born. I remembered a poem by John Donne:

Each man's death diminishes me,
For I am involved in mankind.
Therefore, send not to know
For whom the bell tolls,
It tolls for thee.

*

Cameron has fallen behind. He stops to tie his shoes. My thoughts sprint forward without the distraction of companionship.

Father and son. Doctor and grieving family member. Above the fray and yet bruised and broken below the surface.

I am all of these.

Cameron clanks ahead and the sun catches the tail of his scooter and blinds me momentarily. I stop and bend forward my arms resting on my knees. My calfs exploding. My heart flubbing. And my brain longing for the sweet reconciliation and abandon of sleep.

He pauses a few feet ahead and cranes his neck backward. Dad...dad...you can't stop now!

His words are like daggers filleting open my torso and exposing a deep, primal need....to be told what to do.

My legs respond despite the minds abrasive litany of curses.

Despite all that has happened today.

I will continue running.

Sometimes Our Healthcare System Is Like This

Sometimes our healthcare system is like this:

I'm sitting outside a restaurant eating lunch with my brother and cousin. Out of the corner of my eye I see a woman fall.

Her wrinkles and unsteady gait betray her youthful facade. A cane bounces against the building and lands next to her. She is disoriented. Confused.

We jump out of our chairs and turn around. A flash of blazing cell phones connected to shaky hands greets our arrival. Multiple bystanders cry out in unison...we're calling 911.

The lady sits up and leans against the side of the building. Her eyes regain clarity...No...don't...I'm OK!

The cell phones recede but the crowd is restless. They form a circle around their prey ready to pounce. Are you OK? Did you hit your head? Does your hip hurt? With each question the anxiety level rises. I try to clear a path. To give her space.

We hoist her into a chair. She is beginning to recover. The owner of the restaurant hands her a glass of water.

A young athletic women bursts through the crowd. She grasps her cell phone like her hands are the jaws of life pulling an accident victim out of a car crash. She is almost yelling....I just want you to know an ambulance is on the way! She speaks into the air. To no one in particular.

As the fire truck and ambulance arrive the poor women quietly shakes her head. No...no...I didn't want this.

She slouches nonchalantly and listens as the EMT tries to convince her to go to the hospital. But...I'm okay...really.. I'm okay. I just slipped while trying to get up.

They force her to sign a medical release and then the ambulance and fire truck slink away quietly.

With little hesitation. The women leans over the cain and propels herself out of the chair. She hobbles across the alley...her hips swing comfortably side to side. She walks fifty more feet and then enters a medical complex.

Even with the twenty minute delay at the restaurant...

She will be right on time

for her orthopaedic appointment.

Regret

She comes to me. On a cold winter day. Hobbling into the office. She carries her walker with the indifferent embrace of a despised relative. She unpeals the layers. First hat and scarf. Then over sized down coat. Daintily she removes her sweater.

I ask what hurts...and she tells me.

She tells of the serpent slithering through her spine. Squeezing her insides and spitting venom towards the thighs. She tells of mal-lubricated joints and the fecundity of aging.

She tells me of her late husband...and how he was a "good man". Regret dabbles at the corners of her lips...toying with the idea of springing forth but reticent.

She tells me of her mother in law. Handicapped and depressed. A miserable soul who spent a decade cloistered in her guest bedroom. Her voice says....I would never burden my children...although the words will remain unspoken.

And she tells me of a man. Who she dated as a teenager. Who fought in World War II and sent a letter proposing marriage. She still doesn't know why she declined. Although he survived the war....their love did not.

On days like today she often wonders. Is he alive? Alone, arthritic, in a doctors office like herself.

I wait for her to continue. My impotent stethoscope rests in my coat pocket. A cabinet feet away is filled with samples of drugs to cure most any malady.

Today I will slough off the bloated title of healer...drug pusher...fortune teller.

I will sit back. Ignore the light buzz emanating from the computer. Fail to answer the persistent vibration of my pager.

Abandon myself to anther's needs....

and I will listen.

The Jury Is Still Out

I heard his body crumple before the commotion began. Nurses scurried to and fro. I looked up cautiously from my charts...I was the only doctor in the building.

I placed my charts in a neat pile and nonchalantly walked over. Noticeably absent was the sense of adrenaline. The fear. This was just another day at work.

The sea of nurses parted and I knelt down next the aged man. My fingers reached for his carotid pulse. His chest was moving rhythmically up and down. I placed an oxygen cannula on his nose and checked his blood pressure. Nothing was amiss.

After a moment his eyes began to flutter. We hoisted him into a chair and he was returned to his room for further assessment.

And as I sat down to return to charting I felt a certain sense of satisfaction. I was a seasoned pro. I could handle a crisis without even breaking a sweat. Look how far I had come since medical school!

Look how far I had come? As I write these words I feel a sense of shame rise through my torso and chest.

Since when has nonchalance become OK? Isn't the sense of fear, the adrenaline, the heart racing that makes us most human as doctors? That binds us to our fellow man.

For better or worse...we are not robots. We are deeply scarred individuals with foibles and peculiarities. When cut we bleed...just like our patients.

And when a person falls in front of me suffering form a heart attack...or stroke...or god knows what...shouldn't my pulse run, my brow sweat, my heart skip a beat.

Because when death, and pain, and suffering become part of our routine then we have lost that vital connection between those who care and those who are cared for.

I have come a long way from the innocent boy who started medical school. Who became faint at the site of blood...whose adrenaline raced with each new trauma.

But have I become a better human being?

The jury is still out.

The Art of Differential Diagnosis.

I awkwardly unscrewed the top off the dishwasher door. The two young women stood above me approvingly. I acted like I knew what to do.

It was a new machine but I already drove out twice in the last six months. Damn latch. I didn't have the heart to tell the girls that I couldn't fix it. Or to explain how, as a child, I avoided the cabinets full of tools that my father left behind when he died. So much material but no capable hands to teach me how the hell to use it.

So I grew up in a mother centered household. We didn't fix things. We called someone.

As I pulled the cover off the door my mind raced back to the office. To the image of the uncoordinated violinist.

She taught music until the economic downturn. Saddled with impatient debt and screaming debtors she started to perform regularly. Until the day she noticed something wrong.

I glanced blankly at the guts of the washing machine door. Gently I eased the latch out of its compartment and glared. Why was it stuck?

My violinist had lost control of her left index finger. Try as she might...she couldn't play the challenging pieces. The finger was lame...dumb. Slowly responding to the music while the others raced ahead obliviously. But the index could no longer keep pace on the finger board.

The latch was being held back by a catch. A safety mechanism perhaps?

I stared into her eyes. Her pupils were reactive. I weaved and bobbed through the neurological exam noting no abnormalities. At last I came to the hand. I compressed each nerve in the wrist carefully and watched for a response. Her pulses were normal. Then I asked her to place both hands on the exam table face up.

I greased the catch with DW40. It still wouldn't release the latch. Finally I removed the spring from the catch and watched it fall to the side. The latch now moved freely.

After concentrating for a few minutes I noticed it. A lump in her left wrist. It was small but placed perfectly to impinge on the long tendon that races through the hand and ends at the tip of the index finger.

I suspected a ganglion cyst. A quick procedure by the hand surgeon and her finger would dance again.

It took another thirty minutes to remember how to fit the latch back in and then screw the top on. I watched with satisfaction as I closed the door.

Flipped the latch...

and started the dishwasher.