I walked out the door and down the steps on a clear St. Louis morning. The air had a slight chill as the sun began to rise in preparation for the new morning. Spring had not yet transitioned into summer and the humidity was minimal.
As I had done on so many other days, I walked with my lab coat slung across my arm. My stethoscope would occasionally pop out of the pocket and dangle from a thread before I scooped it back up and placed it awkwardly into its temporary resting place. If the temperature dropped, I may slip the coat over my shoulders and wear the stethoscope around my neck.
When I arrived at the hospital, I walked through a side entrance and took the elevator to the medical wards. The resident's office was busier then usual. The interns awoke and left their adjacent call rooms to find that they were no longer on the bottom rung. The new interns, donning neatly pressed and clean white jackets, had arrived for their first day of work.
My fellow residents and I basked in the glow of our final day of training. We would stay for a few hours and hand off patients, help with rounds, and generally enjoy the absence of true responsibility.
We walked the floors as if we were kings. We strutted back and forth and chatted with the nurses.
A few hours later it was time to go.
We left the sheltered and protected existence of training and launched ourselves into the vast unknown.
And we never looked back.
*
There is a sense upon leaving residency that you know just about everything. That you've seen and done all that is important. You've cared for the sickest of the sick, and dealt with the poorest of the poor.
A list of dieases and procedures has been appropriately checked and checked off. An air of confidence lingers.
But I have to admit that the majority of doctoring, I learned after training. The ivory towers provided a good working knowledge of the arcane, but the day to day, bone on bone grinding of patient care was learned on the fly. Each encounter provided a new skill, a new fount of knowledge from which to draw from.
And I was often surprised at my own prior misconceptions. I would have never imagined that as an attending, I would sleep less and work harder then in residency. I couldn't comprehend the crushing responsibility of being the bottom line. No one prepared me for the three am call from the nurse when there was no one higher up on the food chain to call for advice.
Yet the hardest skill to achieve was not the science but the art. How to become a "healer" and not just a doctor. How to know when to place your hand gently on the shoulder of a mourning patient or to raise your voice to an unyielding family member.
I still struggle with how to remain humane and kind, as well as stay effective. Medical knowledge comes and go. Diseases are discovered and cured. But in the purest sense, the job of the physician is to be a beacon, a lighthouse, to guide each ship safely to land in the harshest of conditions.
This is what it is to be a doctor. After all these years of training and practice,
I know this much is true.
Friday, December 30, 2011
Wednesday, December 28, 2011
On Carrots And Sticks
Larry knew he had to make a doctor's appointment immediately. The searing chest pain almost stopped him in mid stride. For a moment he considered going to the emergency room and then thought better of it. He remembered the heart attack 10 years ago, this felt nothing like it.
The doctor's office answered on the first ring. He began to explain his predicament but the receptionist interrupted him.
Sir, you haven't been in the office for over a year. You better come in right away!
As Larry hung up the phone, he realized that he didn't mention the burning over his left rib cage. No matter, he thought, he would bring it up with the physician.
*
Later that day, Larry strode into the waiting room. He caught his breath in pain as he leaned up against the front desk. The receptionist took his insurance card and began to click on the computer screen.
Are you married?
What race are you?
Do you subscribe to any religion?
Larry answered each question cautiously, but wondered why he was being interrogated. The gum in the receptionists mouth cracked and popped as her eyes concentrated on the screen in front of her. As she looked up at Larry, she realized that he was losing patience. She focused on the screen as she mumbled in his direction.
New government requirements! If we don't ask, the doctor doesn't get paid.
When she finished with her questions, Larry was directed to sit in one of the flimsy chairs and wait. He placed his left hand over his heart and probed for the source of pain. He winced as if daggers were skewering him. The front desk person hadn't inquired about the reason for his visit either.
*
A few minutes later a nurse walked through the sliding glass doors and called his name. He shuffled gingerly into the exam room and waited as the nurse signed into the computer.
Boy Larry, you haven't been here for greater then a year. We have alot of work to do!
The nurse measured his weight, height, and waist circumference. She asked about domestic violence and gun use. As the minutes passed, Larry marveled at the detailed and often nonsensical material being covered.
To her credit, the nurse did ask Larry about pain. She even had him rate it on a scale from one to ten. But she didn't bother to ask any other details.
*
When the doctor finally walked into the room, Larry heaved a sigh of relief. He waited quietly for direction. The doctor shook his hand and sat down at the computer.
Wow! We haven't seen each other in a year.
He then preceded to stare silently at the computer for a few minutes. Larry watched as he clicked and typed from time to time. Moments later he was being motioned onto the table. The doctor examined him head to toe and then directed him back to the seat.
Everything looks good. We'll see you next year.
Larry was stunned. He stood to get the doctor's attention.
But what about my chest pain?
The doctor turned and removed his hand from the door knob, and glanced back at the computer.
That reminds me. With your history of heart disease, it says here that you're due for a stress test.
Without another word, he left the room.
Larry sat back in the chair and tried to put the pieces together. If the doctor had given him the chance, he would have explained that he tripped and slammed his chest against the book case. Did he really need a stress test?
When Larry made the appointment that morning, he was thinking more along the lines of an xray.
He figured he cracked a rib.
The doctor's office answered on the first ring. He began to explain his predicament but the receptionist interrupted him.
Sir, you haven't been in the office for over a year. You better come in right away!
As Larry hung up the phone, he realized that he didn't mention the burning over his left rib cage. No matter, he thought, he would bring it up with the physician.
*
Later that day, Larry strode into the waiting room. He caught his breath in pain as he leaned up against the front desk. The receptionist took his insurance card and began to click on the computer screen.
Are you married?
What race are you?
Do you subscribe to any religion?
Larry answered each question cautiously, but wondered why he was being interrogated. The gum in the receptionists mouth cracked and popped as her eyes concentrated on the screen in front of her. As she looked up at Larry, she realized that he was losing patience. She focused on the screen as she mumbled in his direction.
New government requirements! If we don't ask, the doctor doesn't get paid.
When she finished with her questions, Larry was directed to sit in one of the flimsy chairs and wait. He placed his left hand over his heart and probed for the source of pain. He winced as if daggers were skewering him. The front desk person hadn't inquired about the reason for his visit either.
*
A few minutes later a nurse walked through the sliding glass doors and called his name. He shuffled gingerly into the exam room and waited as the nurse signed into the computer.
Boy Larry, you haven't been here for greater then a year. We have alot of work to do!
The nurse measured his weight, height, and waist circumference. She asked about domestic violence and gun use. As the minutes passed, Larry marveled at the detailed and often nonsensical material being covered.
To her credit, the nurse did ask Larry about pain. She even had him rate it on a scale from one to ten. But she didn't bother to ask any other details.
*
When the doctor finally walked into the room, Larry heaved a sigh of relief. He waited quietly for direction. The doctor shook his hand and sat down at the computer.
Wow! We haven't seen each other in a year.
He then preceded to stare silently at the computer for a few minutes. Larry watched as he clicked and typed from time to time. Moments later he was being motioned onto the table. The doctor examined him head to toe and then directed him back to the seat.
Everything looks good. We'll see you next year.
Larry was stunned. He stood to get the doctor's attention.
But what about my chest pain?
The doctor turned and removed his hand from the door knob, and glanced back at the computer.
That reminds me. With your history of heart disease, it says here that you're due for a stress test.
Without another word, he left the room.
Larry sat back in the chair and tried to put the pieces together. If the doctor had given him the chance, he would have explained that he tripped and slammed his chest against the book case. Did he really need a stress test?
When Larry made the appointment that morning, he was thinking more along the lines of an xray.
He figured he cracked a rib.
Tuesday, December 27, 2011
Evolution/Devolution
Sitting in my office, I tap the last words of the progress note on the keyboard as the student shifts in his seat. He looks up at me with all the innocence and naivete of one who is at the beginning of an arduous journey. I strain to hear his words.
So, how does it feel to be a doctor?
I'm taken aback by the sincerity of the question and the rawness in his quivering voice. I ponder carefully how to respond. A million cliches pop into my head, and I fight them off one by one.
This time will be different.
This time, I'll tell the truth.
*
I can't remember a time when I didn't want to be a doctor. In fact, my identity and profession have intermixed to such an extent that I often can't tell them apart. My internal image includes a lab coat and a stethoscope. It always did. Even as a child.
My voyage through medical education was powerful. Like a flower, the seeds of identity blossomed and became external reality. But I couldn't help feel a certain sense of unease. It was as if the more I learned, the less the burning embers of humanity would glow.
When you encounter death and destruction at every turn, such things lose their profundity. And patience and tolerance become the exception and nary the rule. Such a treacherous path for a wandering soul.
Once, while sitting in the exam room, I found myself staring at the clock while I talked to a patient about her recent cancer diagnosis. I listened to the barrage of questions, but secretly I was calculating how to end the appointment early to run errands.
As the patient left the office, I realized how far I had fallen. I promised myself that that would never happen again. But now my eyes were wide open.
After all these years in medicine, it wasn't the difficulty of diagnosis nor the desperation of disease. What I find myself continously struggling with is maintaining the beauty and humility that were present when I started this process. Because somewhere amongst the paperwork, fears of malpractice, sleepless nights, and unexpected outcomes, something broke.
How does one build armour strong enough to repel the demons of sickness and despair yet allow the skin to bask in the piercing barbs of humanity? How do I evolve as a physician without devolving as a person.
*
How does it feel to be a doctor?
Well, how does it feel to be a human being?
Mired in the morass of moral frailty, I struggle with my own imperfection.
The difference is, as a physician,
the affect is greatly magnified.
So, how does it feel to be a doctor?
I'm taken aback by the sincerity of the question and the rawness in his quivering voice. I ponder carefully how to respond. A million cliches pop into my head, and I fight them off one by one.
This time will be different.
This time, I'll tell the truth.
*
I can't remember a time when I didn't want to be a doctor. In fact, my identity and profession have intermixed to such an extent that I often can't tell them apart. My internal image includes a lab coat and a stethoscope. It always did. Even as a child.
My voyage through medical education was powerful. Like a flower, the seeds of identity blossomed and became external reality. But I couldn't help feel a certain sense of unease. It was as if the more I learned, the less the burning embers of humanity would glow.
When you encounter death and destruction at every turn, such things lose their profundity. And patience and tolerance become the exception and nary the rule. Such a treacherous path for a wandering soul.
Once, while sitting in the exam room, I found myself staring at the clock while I talked to a patient about her recent cancer diagnosis. I listened to the barrage of questions, but secretly I was calculating how to end the appointment early to run errands.
As the patient left the office, I realized how far I had fallen. I promised myself that that would never happen again. But now my eyes were wide open.
After all these years in medicine, it wasn't the difficulty of diagnosis nor the desperation of disease. What I find myself continously struggling with is maintaining the beauty and humility that were present when I started this process. Because somewhere amongst the paperwork, fears of malpractice, sleepless nights, and unexpected outcomes, something broke.
How does one build armour strong enough to repel the demons of sickness and despair yet allow the skin to bask in the piercing barbs of humanity? How do I evolve as a physician without devolving as a person.
*
How does it feel to be a doctor?
Well, how does it feel to be a human being?
Mired in the morass of moral frailty, I struggle with my own imperfection.
The difference is, as a physician,
the affect is greatly magnified.
Sunday, December 25, 2011
From Birth To Death
As luck would have it, she happened to die while I was in the room. I sat with her family as the last breath precariously left her lips. We waited for the next as if it was a forgone conclusion. It never came.
Walking toward the nursing station, my mind wandered back to medical school.
*
I tentatively followed behind the resident as we entered the birthing room. The patient writhed in bed and opened her mouth, but nothing came out. Her face tensed and then relaxed. The contraction had passed.
We stood quietly for a moment, and then the resident cleared her throat.
This is Doctor Grumet, he will be delivering your baby.
My back muscles tensed and I gritted my teeth. My mind bobbed back and forth between embarrassment at being referred to as a physician, and fear of performing the delivery myself. I looked over at my patient. After months of going to the residents free clinic, she learned to accept what she was being told without questioning.
Although she refused the epidural from the beginning, her sighs of pain made me wonder if she regretted it. The nurse and resident stood by her side bracing her legs. As she started to push, I looked down in anticipation.
A tuft of hair bounced in an out of the birth canal with every contraction. After a few minutes, the head broke free and I tentatively pushed down and delivered the anterior shoulder. I slipped my hand over the baby's neck hoping to gain traction as the posterior shoulder broke free. I caught the body clumsily with my other hand, and held the baby up for the mother to see.
After forceps were applied, the umbilical cord was cut. Minutes later I delivered the afterbirth and sutured a small lacertaion.
I left the room, and sat at a desk with the chart in front of me. I paused and looked down at my hands. Only moments before they had taken part in the ritualistic dance of childbirth.
It was a familiar dance.
One that had been performed over and over again since the beginning of time.
*
I often marvel at how similar birth and death feel. The ephemeral movements of the soul are difficult to diagram, but it is impossible to escape the feeling that as the last grain of sand slips free, the hour glass is just waiting to be flipped back over.
And we struggle to control that which occurs between bookends. Doctors and patients fight to write more pages to prolong introduction and ending. Yet sometimes I wonder If we miss the point.
I haven't delivered any babies since medical school, but I see my share of deaths. And each time, I can't help but hear the same words echo in my head.
This is how it's always been. This is how it always shall be.
There is nothing to fear
Walking toward the nursing station, my mind wandered back to medical school.
*
I tentatively followed behind the resident as we entered the birthing room. The patient writhed in bed and opened her mouth, but nothing came out. Her face tensed and then relaxed. The contraction had passed.
We stood quietly for a moment, and then the resident cleared her throat.
This is Doctor Grumet, he will be delivering your baby.
My back muscles tensed and I gritted my teeth. My mind bobbed back and forth between embarrassment at being referred to as a physician, and fear of performing the delivery myself. I looked over at my patient. After months of going to the residents free clinic, she learned to accept what she was being told without questioning.
Although she refused the epidural from the beginning, her sighs of pain made me wonder if she regretted it. The nurse and resident stood by her side bracing her legs. As she started to push, I looked down in anticipation.
A tuft of hair bounced in an out of the birth canal with every contraction. After a few minutes, the head broke free and I tentatively pushed down and delivered the anterior shoulder. I slipped my hand over the baby's neck hoping to gain traction as the posterior shoulder broke free. I caught the body clumsily with my other hand, and held the baby up for the mother to see.
After forceps were applied, the umbilical cord was cut. Minutes later I delivered the afterbirth and sutured a small lacertaion.
I left the room, and sat at a desk with the chart in front of me. I paused and looked down at my hands. Only moments before they had taken part in the ritualistic dance of childbirth.
It was a familiar dance.
One that had been performed over and over again since the beginning of time.
*
I often marvel at how similar birth and death feel. The ephemeral movements of the soul are difficult to diagram, but it is impossible to escape the feeling that as the last grain of sand slips free, the hour glass is just waiting to be flipped back over.
And we struggle to control that which occurs between bookends. Doctors and patients fight to write more pages to prolong introduction and ending. Yet sometimes I wonder If we miss the point.
I haven't delivered any babies since medical school, but I see my share of deaths. And each time, I can't help but hear the same words echo in my head.
This is how it's always been. This is how it always shall be.
There is nothing to fear
Friday, December 23, 2011
Dying Of The Old Guard
Millicent couldn't help but feel out of place. The sterile white sheets were anything but soft and downy. They rubbed against her feet like sand paper. She twisted herself into a ball and waited. The edges of her gown creased in the back exposing her derriere.
Millicent's histrionic nature plagued her from childhood to her mid seventies. Although she pictured herself waiting for death, more likely she would spend a few days in the hospital till the antibiotics eradicated the mucous in her lungs.
The nurse said that her personal physician would see her once she got settled on the floor. But it had been hours since she left the chaotic emergency department, and still no hide nor hair of Dr. Howard.
Milicent couldn't help but smile through her febrile haze. Dr. Howard was an "old fart" like herself. They had been together for decades. The graying of his hair reflected in the bowing of her spine. Of course he was probably in his fifties and she in her seventies, but that didn't stop Millicent from overestimating their equivalence.
*
Millicent dozed on and off. The much needed sleep was interrupted by occasional fits of barking cough. Each time she opened her eyes she glanced at the clock. Her IV dripped beside her bed, and beeped from time to time as if jealous of the silence.
The nurse came and went. Around midnight, she walked in and woke Millicent from a deep sleep.
Your doctor is at the nursing station. He will be in shortly.
Millicent sat and rearranged her hair. although she felt miserable, there was no reason to appear so to the handsome Doctor Howard. She glanced at the clock in the corner of the room and almost fell out of her bed. Midnight-why the heck was he rounding so late? Millicent briefly worried about poor Dr. Howard's wife before her reverie was interrupted by a knock at the door.
A young boy walked into the room wearing an over sized lab jacket and a stethoscope that twisted around his neck and likely got lost somewhere underneath his scrubs.
I'm Dr. Thomas. I will be taking care of you here at the hospital.
For a moment Millicent thought that she was still dreaming. She rubbed the sleep from her eyes and looked up at the young man questioningly.
There must be a mistake. Doctor Howard is my doctor!
*
Dr. Thomas sat at the bedside and quietly explained how Dr. Howard no longer came to the hospital. That instead, he use a group of physicians called hospitalists. Hospitalists were available twenty four hours a day to take care of people like herself. Times had changed and many physicians, like Dr. Howard, no longer felt able to see patients in the office and hospital.
Millicent couldn't believe her ears. After all those years.
So you will call Dr. Howard first thing in the morning?
By now Dr. Thomas was half way out the door. His beeper had gone off, and he looked like he was rushing out of the room to another emergency.
No, I will be gone in the morning. But one of my partners will come by tomorrow and he will call Dr. Howard.
As the door closed, Millicent found herself feeling very alone. The cough that had been a mere nuisance hours ago now exploded in her chest.
Being laid up in the hospital with pneumonia was bad enough.
But what really burned Millicent to the core,
was the feeling of abandonment.
Millicent's histrionic nature plagued her from childhood to her mid seventies. Although she pictured herself waiting for death, more likely she would spend a few days in the hospital till the antibiotics eradicated the mucous in her lungs.
The nurse said that her personal physician would see her once she got settled on the floor. But it had been hours since she left the chaotic emergency department, and still no hide nor hair of Dr. Howard.
Milicent couldn't help but smile through her febrile haze. Dr. Howard was an "old fart" like herself. They had been together for decades. The graying of his hair reflected in the bowing of her spine. Of course he was probably in his fifties and she in her seventies, but that didn't stop Millicent from overestimating their equivalence.
*
Millicent dozed on and off. The much needed sleep was interrupted by occasional fits of barking cough. Each time she opened her eyes she glanced at the clock. Her IV dripped beside her bed, and beeped from time to time as if jealous of the silence.
The nurse came and went. Around midnight, she walked in and woke Millicent from a deep sleep.
Your doctor is at the nursing station. He will be in shortly.
Millicent sat and rearranged her hair. although she felt miserable, there was no reason to appear so to the handsome Doctor Howard. She glanced at the clock in the corner of the room and almost fell out of her bed. Midnight-why the heck was he rounding so late? Millicent briefly worried about poor Dr. Howard's wife before her reverie was interrupted by a knock at the door.
A young boy walked into the room wearing an over sized lab jacket and a stethoscope that twisted around his neck and likely got lost somewhere underneath his scrubs.
I'm Dr. Thomas. I will be taking care of you here at the hospital.
For a moment Millicent thought that she was still dreaming. She rubbed the sleep from her eyes and looked up at the young man questioningly.
There must be a mistake. Doctor Howard is my doctor!
*
Dr. Thomas sat at the bedside and quietly explained how Dr. Howard no longer came to the hospital. That instead, he use a group of physicians called hospitalists. Hospitalists were available twenty four hours a day to take care of people like herself. Times had changed and many physicians, like Dr. Howard, no longer felt able to see patients in the office and hospital.
Millicent couldn't believe her ears. After all those years.
So you will call Dr. Howard first thing in the morning?
By now Dr. Thomas was half way out the door. His beeper had gone off, and he looked like he was rushing out of the room to another emergency.
No, I will be gone in the morning. But one of my partners will come by tomorrow and he will call Dr. Howard.
As the door closed, Millicent found herself feeling very alone. The cough that had been a mere nuisance hours ago now exploded in her chest.
Being laid up in the hospital with pneumonia was bad enough.
But what really burned Millicent to the core,
was the feeling of abandonment.
Thursday, December 22, 2011
Transfer Of Addictions
We danced around the subject. James wasn't going to ask me directly to increase his meds, but I knew that's what he wanted. My brain did a silent eye roll as I watched him hop around the room.
It was true that his foot looked swollen and bruised. But the xray was negative and there was no reason to expect a more sinister process. He stubbed his toe; no more, no less.
But James had a problem when it came to pain.
Or had he just become a victim of our medical system?
*
There was a time when James was not strung out on pharmaceuticals. Alcohol was his poison then. But he got into a car accident and suffered a knee injury. The DUI was the least of his problems.
The MRI of his knee was normal but his pain was excruciating. Visit after visit to his internist and orthopaedist left him with a medicine cabinet full of narcotics, which he felt good about because at least he was no longer drinking.
The custody agreement for his son required regular breathalyzer testing. But they couldn't fault him for taking the medications his doctor prescribed, could they?
By the time he came to see me, he was taking several norco and oxycontin a day without relief. I reviewed his MRI and lab tests skeptically. When I explained that in the absence of pathology I wouldn't accelerate his dosing, he almost fell out of his seat.
It never occurred to him that maybe the medicine wasn't helping. Our conversation went something like this:
What is your level of pain when on medication?
10/10
What is your level of pain without medication?
10/10
We argued back and forth, month after month. Each time I prescribed less pills.
*
Finally when the courts threatened to take his son away, James got serious about kicking his medication habit. He got admitted to the hospital and was treated for withdrawal.
The next few months were difficult. James struggled with daily activities. He found a job and spent more time with his son. I would be lying if I said that he didn't have pain. But he learned to use more mature coping mechanisms. He attended physical therapy, acupuncture, and biofeedback.
He was making significant progress, or so I thought.
And then he disappeared.
*
Six months later he waltzed through my door with a large medication list. As I silently read through the consult note, I felt my eyes popping out of my head. He had seen a pain specialist at the local university and was again using large doses of narcotics.
We were back to square one.
I buddy-taped his bruised toe and sent him on his way. I assumed shortly after leaving the office, he would be on the phone with his pain specialist.
*
We've created a nation of junkies. The tide began to turn when the government made pain the sixth vital sign. The miserable and wretched learned that they could stop cowering under illicit and costly activities. Now all they had to do was show up at the doctor's office where kindly nurses would check their blood pressure and pulse before serving up the perfect lob:
Are you in any pain today?
Why yes I am!
Instead of protecting the cancer ridden and orthopedicly adventurous, we have turned our offices into dispensaries.
Unfortunately we still haven't come to terms with the fact that narcotics do not treat psychic pain. Furthermore, they are particularly poor at relieving chronic orthopedic conditions.
So the treadmill continues. We use pain medication inappropriately. The human body becomes use to it and then needs more. Minor traumatic injuries become emergencies.
And as a nation, we transfer our addictions.
It was true that his foot looked swollen and bruised. But the xray was negative and there was no reason to expect a more sinister process. He stubbed his toe; no more, no less.
But James had a problem when it came to pain.
Or had he just become a victim of our medical system?
*
There was a time when James was not strung out on pharmaceuticals. Alcohol was his poison then. But he got into a car accident and suffered a knee injury. The DUI was the least of his problems.
The MRI of his knee was normal but his pain was excruciating. Visit after visit to his internist and orthopaedist left him with a medicine cabinet full of narcotics, which he felt good about because at least he was no longer drinking.
The custody agreement for his son required regular breathalyzer testing. But they couldn't fault him for taking the medications his doctor prescribed, could they?
By the time he came to see me, he was taking several norco and oxycontin a day without relief. I reviewed his MRI and lab tests skeptically. When I explained that in the absence of pathology I wouldn't accelerate his dosing, he almost fell out of his seat.
It never occurred to him that maybe the medicine wasn't helping. Our conversation went something like this:
What is your level of pain when on medication?
10/10
What is your level of pain without medication?
10/10
We argued back and forth, month after month. Each time I prescribed less pills.
*
Finally when the courts threatened to take his son away, James got serious about kicking his medication habit. He got admitted to the hospital and was treated for withdrawal.
The next few months were difficult. James struggled with daily activities. He found a job and spent more time with his son. I would be lying if I said that he didn't have pain. But he learned to use more mature coping mechanisms. He attended physical therapy, acupuncture, and biofeedback.
He was making significant progress, or so I thought.
And then he disappeared.
*
Six months later he waltzed through my door with a large medication list. As I silently read through the consult note, I felt my eyes popping out of my head. He had seen a pain specialist at the local university and was again using large doses of narcotics.
We were back to square one.
I buddy-taped his bruised toe and sent him on his way. I assumed shortly after leaving the office, he would be on the phone with his pain specialist.
*
We've created a nation of junkies. The tide began to turn when the government made pain the sixth vital sign. The miserable and wretched learned that they could stop cowering under illicit and costly activities. Now all they had to do was show up at the doctor's office where kindly nurses would check their blood pressure and pulse before serving up the perfect lob:
Are you in any pain today?
Why yes I am!
Instead of protecting the cancer ridden and orthopedicly adventurous, we have turned our offices into dispensaries.
Unfortunately we still haven't come to terms with the fact that narcotics do not treat psychic pain. Furthermore, they are particularly poor at relieving chronic orthopedic conditions.
So the treadmill continues. We use pain medication inappropriately. The human body becomes use to it and then needs more. Minor traumatic injuries become emergencies.
And as a nation, we transfer our addictions.
Wednesday, December 21, 2011
Educational Distress
I woke in a panic. My heart felt like it was thumping out of my chest. I sat up and waited for the blare of the alarm radio to wash out of my ears. The room was pitch black. I pushed the covers aside and crawled out of bed and inched my way to the bathroom. The cold morning air did nothing to soothe my nerves.
I showered, dressed, and locked the door behind me as I made my way to the garage. Although my stomach was growling, mild nausea overpowered my sense of hunger. I turned the key in the ignition and was met by the throaty voice of a public radio announcer.
By the time I hit the on ramp, I settled into my morning drive. I felt an overwhelming sense of unease as I remembered the dream that yanked me out of sleep.
*
It's the first day of high school, or maybe college, and I am sitting contentedly in class. As I look around the room a panic overtakes me.
I forgot to bring my class schedule!
I forage through my backpack without luck. It's a new semester and I have no idea where I need to be next. Without room numbers or building names, I am lost. I start to breath rapidly as the fear overtakes me. My head pounds and my eyes begin to water.
I feel a strange sense of doom about starting the year off this way. It's as if somehow by missing the first day of classes, I will suffer great harm. I will lose some essential piece of information that will be devastating. I will fail miserably.
I jump out of my seat and sprint to the door. I have to quickly get to the administration building to print up a new schedule. But when I exit the class, I can't seem to remember which way to go.
I walk back and forth aimlessly trying to reconstruct the correct path. With each failed attempt my mind races even further out of control. I feel like I just got punched in the gut. I glance repeatedly at my watch as if I could freeze time.
When I finally get to the front of the administration building, I heave a sigh of relief. I walk up the steps and approach the entrance.
The door is locked.
*
The fetid odor of cleaning products mixed with the refuse of human illness is the first thing that hits me as I enter the medical floor. I try not to breath out of my nose. A demented patient is lost somewhere in the jungles of Viet Nam and swings at his nurse. He just barely misses her.
It is six in the morning and the maintenance man walks past me pushing the floor cleaning machine. It sounds like a garbage truck and the noise disrupts the otherwise quiet hallway where sick patients try to get their rest.
I take a deep breath, and for the first time this morning, I feel the calm wash over me. My heart is no longer racing and the nausea is gone. I have finally shaken the stress of my nightmare.
Thank God I'm no longer a student!
I showered, dressed, and locked the door behind me as I made my way to the garage. Although my stomach was growling, mild nausea overpowered my sense of hunger. I turned the key in the ignition and was met by the throaty voice of a public radio announcer.
By the time I hit the on ramp, I settled into my morning drive. I felt an overwhelming sense of unease as I remembered the dream that yanked me out of sleep.
*
It's the first day of high school, or maybe college, and I am sitting contentedly in class. As I look around the room a panic overtakes me.
I forgot to bring my class schedule!
I forage through my backpack without luck. It's a new semester and I have no idea where I need to be next. Without room numbers or building names, I am lost. I start to breath rapidly as the fear overtakes me. My head pounds and my eyes begin to water.
I feel a strange sense of doom about starting the year off this way. It's as if somehow by missing the first day of classes, I will suffer great harm. I will lose some essential piece of information that will be devastating. I will fail miserably.
I jump out of my seat and sprint to the door. I have to quickly get to the administration building to print up a new schedule. But when I exit the class, I can't seem to remember which way to go.
I walk back and forth aimlessly trying to reconstruct the correct path. With each failed attempt my mind races even further out of control. I feel like I just got punched in the gut. I glance repeatedly at my watch as if I could freeze time.
When I finally get to the front of the administration building, I heave a sigh of relief. I walk up the steps and approach the entrance.
The door is locked.
*
The fetid odor of cleaning products mixed with the refuse of human illness is the first thing that hits me as I enter the medical floor. I try not to breath out of my nose. A demented patient is lost somewhere in the jungles of Viet Nam and swings at his nurse. He just barely misses her.
It is six in the morning and the maintenance man walks past me pushing the floor cleaning machine. It sounds like a garbage truck and the noise disrupts the otherwise quiet hallway where sick patients try to get their rest.
I take a deep breath, and for the first time this morning, I feel the calm wash over me. My heart is no longer racing and the nausea is gone. I have finally shaken the stress of my nightmare.
Thank God I'm no longer a student!
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