Inpathy

Inpathy:   An emotional dysfunction whereby one turns inward any difficult feelings.  Those feelings may be native or present due to being witness to the suffering of those around you.

This definition is from Matt's dysfunctional completely unabridged dictionary of life.   I had a longer title in mind but found that anything stretching over 2 lines losses its UMPH!  It, as a term, came to when contemplating my seeming lack of empathy for the struggles of those around me.  It was only half a joke when I described the trait and used myself as an example in a sentence.  I am currently resisting all the "Spelling Bee" jokes.  Origin, Root word, etc.  Not that they are too easy, but I have bigger fish to fry.  I don't even like fish, but I do like the metaphorical frying of fish.  Sometimes.  Sometimes I get metaphorical grease burns...and those hurt. 

What follows is an actual story.  By story I mean it represents actual events as much as I can recollect.  No names have been changed because I don't know them.  Well, I know one name but is really a wholly lack luster name for a villian and so I will not use it.  Better you should come up with your own and apply as liberally and as often as you see fit.   This is another patient encounter that demonstrated, starkly, the inadequate state of healthcare today.  Injustices happen everyday and while there are some that labor day in and day out to be the hands and feet of Christ ( Alli Mitchell) most of us ( Humans ) are preoccupied and apathetically content to step over the homeless and lecture our children about finishing their food because people are starving.  

It is about 9am in a small, rural emergency department that serves the community.  Being the only ER for about 30 miles around.  In trauma 2 is the next patient.  Chart reads:  "Needs cast removed."  It's early, not too busy, and strolling in I see a 6 1/2 year old toe headed little boy with a cast all the way down his left leg.  Beautiful little boy as calm as could be with bright blue eyes.  His mother was with him.  She was neither calm nor beautiful.  In addition to showing a disproportionate amount of wear and tear ( looking much older than her age ) her countenance was one of a distressed mother.  Anxious, escalating volume during the telling of her story, pointing of some fingers both actual and metaphorical and finally exasperation colored her overall presence.  

It turns out that the little boy, whom I will call emmanuel ( I just learned what that meant last night ) had broken his femur about 31/2 weeks ago.  He had come into the ER where I work, been seen by the "On Call" orthopeadic physician and had a long leg cast applied.  Furthermore this pt had a particularly unique fracture that involved the " growth plate."  This may seem counter intuitive,  but bones grow not from the middle but from the ends.  This is a big deal because if a kid has a fracture that impedes growth he could develop one leg that is shorter than the other.  And while we, as a society, all pay homage to the " Pimp Stroll " nobody wants their kid sporting it.  Certainly not outside the teen years.  

(The statement above is by no means meant to confer my approval of, support for, or even apathetic disregard for Pimps, Pimping, or the damage to the human spirit and soul that occurs to the victims of and participants in the whole process.)

In any event, this pt had been treated appropriately.  Wait for it...now the bad news.  Despite having seen the child initially the orthopedist did not accept medicaid and had instructed to the patients mother to call "one of the docs on the list".  Apparently, there is a list of saw bones (orthopedist) who accept medicaid and they are contractually obliged to see the patient.  I say apparently, because there was some disagreement.  Specifically, the mother was repeated told by each physician that because they did not see the patient initially that they were under no obligation to see the patient now.  There disinclination to see the patient was heightened by the gravity of his particular injury.  While the mother called all the listed providers...it didn't take long.  A list of only six was provided to her.  Big state, small list. The mother went back to the orthopedist, who via the front desk clerk, reiterated his position and someone else's responsibility.  So, she calls the medicaid office who refers her to the initial list or the initial doc, her choice.  No one seems to be listening to her.  Can't be seen, can't get seen, can't get help and child is all the while...still in the cast that needs to be removed.  Now, to be honest and to his credit, the initial orthopedist said that while he wanted to help he simply couldn't!   " I'm not on their list, I do this and I won't even get paid.  The docs on that list have to see em'  You know how it is...they come in and can't pay...someone on that list has to see em' Their primary doc is responsible for getting them follow...it's in his contract..."

Ahh yes.  A difficult situation he was in, wanting to help if only they had money or he was on the list.  However, despite all of his insipid excuses for not helping...he had helped.  He had given me the thread.  The thread which I would pull on to try and unravel this mess. 

So, the mother approaches me after over hearing some of the discussion and asks plaintively " is anyone going to help us "?  So...I lied saying of course and that I just needed to make another phone call.  Or two.   Off I go...get me Dr. XX's office I bellowed to the clerk.  The initial exchange had been a little more emotional and a little louder than what is reflected in this writing.   What I get is  Dr. XX's office manager..."this is so and so...how can I help you?"  Well, given that this was the first offering of help for the day, I thought I should make the most of it and gave it to her with both barrels. Telling her EXACTLY what she could do and EXACTLY what her boss could do.  It turns out that when the mother was telling me the story of everyone she called, well...she was...actually ...wait for it... TELLING THE TRUTH.  I know, you are all thinking " so what " ?  Well, it is a big deal.  I get more people lying to me than the IRS.  Ms. So and so was well versed with the situation and had personally helped to get "the list" and had made calls also.  I rapidly lost all of my machismo, realizing that a legitimate effort had been made and deftly deflected by the specialists.  After more discussion she agreed to readdress the issue with the pediatrician while I called Atlanta to speak to the Medicaid office.  

More looks by the family ensued.  A good bit of time used in explaining, that while I am capable of removing a cast, I am not capable of managing this fracture appropriately and the risks long term were simply too high.  Translation:  I can but I won't.  Didn't go over too well.  

After what seemed like an eternity, during which I had already called the initial orthopedist back to further press my case and subsequently lecture a man 30 years my senior about my opinion on his legal, medical and ethical obligations to this little boy. ( I heartily doubt that a 50 year old alcoholic smoker would have compelled me to such lengths.  But then again this little boy was cute and sympathetic.)  As you may have already discerned, I got NO WHERE with this Dr.   I spoke with the medicaid office briefly, to someone who knew next to nothing about virtually everything.  So armed with little more than I had started with, I waited for Ms. So and so to call back.  All the while trying to avoid eye contact and discussion with the mom who was making more frequent trips to my desk to inquire as to the progress.  Or lack thereof.  

Dr. E it's for you.  I have no idea how I answered the phone...all I remember is hearing a polished office voice say " I talked to Dr. XX and he said there is nothing that we can..." WHAT?  I screamed!  I literally started to raise my voice higher and higher, seething into the phone exactly what I was feeling about this whole situation and the complete and total renunciation of their responsibilities.   I demanded to speak with the Doctor.   In hind sight, I think she actually appreciated my petition to move up the chain of command.  Just a guess.  

"This is doctor So and so.  I have done everything I know to do.  I don't have anything to offer"  Well what I am supposed to do?  " I don't know but I can't help"  Can't help?  You absolutely can help.  You will help because you are legally required to.  You signed a contract and as a result are " the point person for all secondary care and follow up".  I have contacted the Atlanta office and discussed this case in detail...  I am sending this patient and his mother to your office directly from here with full knowledge of your responsibilities and obligations.  

O.K.  it is important at this time to say that the above dialogue occurred at a decibel such that anyone and everyone was involved in the discussion.  In fact it was so loud, so heated that when I slammed the phone down...no one, not a single person asked me "what happened, what's the matter, what'd he say"?  none of it.  I don't know how much of my empty threats he even heard because he was hollering just as much as I was.  Honestly, I can't say I blame him...too much.  Ernest efforts had been made.  But that's not always enough.  Oh yeah...the " I talked to the Atlanta office" sure it was true but it was completely devoid of any significance other than to be used as a bluff.  Whatever.   Sometimes a little info ( courtesy the villian ) can go a long way. 

Long story shorter...The orthopedic doc called me later that day.  He informed me that he had in fact seen the patient.  That the pediatrician had written a personal check to cover the costs...but that he obviously didn't take it.  Rather he threw it away.  Weird, if this mother on medicaid had managed to sell enough plasma or borrow enough money to be seen he would have taken it.  But given that this situation had blown up it was no longer about money.  I guess I should disregard his previous comments from earlier that morning about not getting paid.  I did breathe a sigh of relief when he told me he didn't keep the pediatrician's check.  Whew!  

What if this had not worked out?  What are we really doing as a society about healthcare?  We are continuing down a path of spending more than any other country but having an ever increasing disparity in the care provided.  We, as a system, simultaneously provide the most cutting edge therapy available and completely disregard the need for even the most basic of services.  

$ 168

O.K.  2nd time is the charm.  I say this because this is sort of like vu jada.  Meaning I have already written it once but when it didn't post it disappeared.  I grumbled at the time, muttering something about not caring if it posted anyway...stupid ole' computer.  But obviously that is not entirely true as evidenced by this late night rant.  So sit back as I try to reconstruct the details and find ways to embellish for my own self gratification.  

So it's 4am.  I am standing in front of a guy on a stretcher who is billed as "foot pain, non traumatic" per the triage note.  I walked in to see a 50 year old man who looked much older sitting with one shoe on and conversely one off sans sock.  I introduce myself ( because that's what the customer service handouts say to do) and consider offering my hand but somewhere between hanging by my waist and being fully extended I think better of it and simply put it back in my pocket.  Safe and sound.  And clean. 

In any event it's late and as he begins to tell his tale of woe and begin to think about how badly my eyes are burning.  I want to close them and roll my eyes around, just for a minute, but before I can fully devote myself to this distraction I hear him say " 2 years."  I immediately tune in, thinking 2 years?  It's 4 am and your in here for something ( I wasn't quite clear on why 'exactly' he was here) that has been going on for 2 years!?  Of course this was an entirely mental dialogue.  An outsider would have heard something akin to "Hmmpf!" 

The 2 years also caught my attention because as an ER doc I don't do chronic pain.  By "do" I mean treat.  Or at the least endeavor to treat chronic pain.  At least in theory.  In reality I treat chronic pain everyday because people either can't see their doc's, won't see their doc's or can't see their docs.  It is not as redundant as it would seem at first glance.  However, I will save the diatribe on health policy for a later rant.  So, when this guy with non traumatic foot pain ( read Drug Seeker) comes in I immediately defer to hospital policy (non existent) in explaining that I don't treat chronic pain (completely untrue) and that he would need to follow up with his own doc.  

Bam! done.  I take a hard line with patients that I believe are drug seekers.  Sometimes.  Most of the time.  Unless I am not sure...better to be kind than be wrong.  But seriously, 2 years?  So, even though the mental decision is made I have to go through the requisite steps.  Namely the exam.  So, I put on some gloves, poke around a little bit, everything seems to be ok I say flatly.  I take a quick listen to the heart and lungs.  Not that it has anything to do with anything...but it looks good and I paid all that money for a good stethescope.  

Well, as I am telling him about his good fortune of not having a break, sprain, or infection he begins to tell me his story.  Or retell, at least some of it.  He had a bad on the job injury 2 years ago.  A local orthopedist fixed it right up and soon he was back at work.  That is until he was layed off about 3 months ago.  Losing both his health insurance and his 17.50/hr job in one fell swoop.  At about that time he had been having increased pain in his ankle where the screws were at.  He came to the ED and learned via XRays that the screws were indeed backing out and needed to be removed.  He called the orthopedist and was told that yes the screws needed to come out and for only $500 he would accomodate him.  "500 dollars?  If I had that kind of money I'd be rich" he said.  I raise my four grand kids with my wife.  Okay Okay...at this point despite being dog tired and having already given my pain management speech ...I was hooked on the story.  I wanted to know WTF?  Why was the guy raising the kids?

"My son was killed in a car accident 8 months ago and their momma ain't around" he said. "You know what?  I went to apply for food stamps and they turned me down said ' I made too much' me, I don't have a job and just got my first unemployment check.  I make too much".   "You know how much"?  he said.  At this point I am actually moved.  4 kids?  I know personally how hard it is with 4 kids...now do that without a job and in chronic pain...man that's rough.  So...I come to long to venture a guess.  $168 I said.  His face went flat..."How'd you know that?" he said.  Uhhh, it was just a guess.   But while I mutter one thing or another I am doing the math.  168/week, 14/day, 2/day per person for food.    Maybe my math is off, but that seems tight.  

I can't imagine the weight of what this guy feels.  4 little people looking to him as their sole means and he is layed off, on unemployment for the time being making a fraction of his prior wages and with no real hope for the future as he talks about the 2 previous ED visits garnering him a total bill of almost $ 7,000.  " I had a good name at the bank, but they (hospital collection people) tell me this is gonna go against my credit"  At this point I realize the plight of this poor guy and would be willing to treat him for free.  Only thing is I don't do surgery and that is what he needs.  Instead, due to a lack of compassion and $500 he will go on to use narcotics in an attempt to control his constant discomfort or pain.  Running up huge bills, getting further behind, potentially become dependent and likely suffering from depression as his ability to work his hampered by the economy and his ailment.  

So, I proffer the administration of pain medicine in the ED as well as a prescription.  He kindly accepts and goes home.  No happy ending.  Just a glaring example of a broken system and greed.  I am not so sure there is not a role for socialized healthcare...somewhere in the system we have now.  I mean waiting on surgery that is forthcoming is better than waiting on surgery that isn't.

So, as I sit here I wonder...do I really have anything valuable to offer?  Is there any reason I should waste others time in reading this or the virtual ink to write it?  Well, I am honestly not sure and since this has become almost therapeutic sans couch or hourly rate I decide to really look deep, search for what has impacted me most of late.  

Well, I have a top three.  This is in  particular order.   These are all 3 life altering situations.  Strange, that they occurred in 2 days and to me they represent 3 very distinct situations that we could all find ourselves in.  That fact alone may be what scared me so much.  I hope that these recollections of the suffering endured by others will serve to do more than pass as therapy for me or a casual use of time for the reader.

#1.  A 4 year old otherwise healthy little girl comes in with her mom and dad for evaluation of abdominal pain.  She had been on an ATV driven by her older brother.  She, with the approval of her parents had been sitting in front of her 10 y/o brother who was driving the ATV.  Her brother hit a small tree with his right wheel causing the steering wheel to jerk to the right.  This resulted in the steering wheel hitting her in the right upper aspect of her abdomen.  No big deal.  Right ? Right.  Wrong.  I believed, hopeful person that I am, that despite the potential this beautiful bright eyed girl would be fine and that this was simply some expected discomfort that would pass.  

I was wrong.  This little girl had completely transected her liver was actively bleeding into her abdomen.  No time for watching or waiting.  The time lost in obtaining images at my little ER may have already been too much.  Angst and concern actively conveyed to both pediatric surgeons and parents.  Helicopters and electronic machines going beep rapidly attached.  Then as suddenly as the pt appeared she had gone.   Along with the grief racked parents that had accompanied her.  The same parents I had seen racked with guilt, eyes of the sobbing mother filled with emotional anguish.  

#2.  An 11 y/o boy who was a restrained front seat passenger when his mother swerved to avoid a deer thereby running off the road into a ditch.  Airbag deployed...check.  Seat belt working...check.  The patient walks in with his mom accompanied by the ambulance crew.  I saw him briefly from the corner of my eye (for a person prone to rash decisions and snap judgements that can be plenty) as he came in.  Shortly thereafter a nurse comes to get me.  After bidding me good day and with the requisite salutations completed she asked that I come see the patient toot de suite.  

I am juggling sick people, too many in fact, because with the changes in healthcare that is just how it goes.  ( healthcare, reimbursement, my take on the state of the union will come later)  In any event, I give the nurse a small measure of grief before remembering the old adage that nurses are my eyes and ears.   So, I am up and off to see him.  

Walking into the room I see the child on a bedside toilet.  He barely lifts his head to make eye contact with me.  When is the last time you saw any child comfortable in that type of position with anyone?  Much less a complete stranger in a foreign environment.   Walking into a thinly curtained room I see this pale child, half naked on a bedside commode who eventually looks up...and I immediately think Holy S*@t...I would prefer he never looked up so I could have continued to believe he was ok. Because this kid was a damn site from ok.  White, not like how you identify yourself on a voter card...but literally white...pale, drained of blood.   

Less than 24 hours preceeding I had come across a kid with a devastating injury (see case #1) and I was not about to let that happen again.   I immediately called Egleston.  AKA the cavalry.  I got the ER doc who immediately started with the requisite line of questioning.  "What is his 'crit' "? Uh...I don't know.  He just got here.  "What does his CT show"?  I haven't gotten it.  He rolled in 5 minutes ago.   "This kid is sick" I say.  He likely has a lacerated liver and I can't fix that so I am not trying to diagnose it.  After a few brief exchanges he relents saying "Ok, Ok, well get what you can and send it with him".   I take a deep breath, say thank you ( because it's alway appropriate) and go back to discussing the transfer of the patient with immunoglobulenemia and pulmonary fibrosis who has an oxygen saturation level of 58 or roughly that of a FISH.  Point is that it really is a little like a TV show for a few brief moments.  

By the time the helicopter arrives we have blood work and Cat Scans.  Blood work abnormal, check.  So what.  CT scan abnormal.  Holy S*@t.  The kid had ruptured his spleen and torn his liver.  He was also bleeding into his abdomen at an accelerated rate.  Hence his white appearance and my overwhelming fear he would die on my watch.  But tonight was not that night.  Knock on wood.  He left on a helicopter courtesy of Emory flight for a hastily arranged date with Hot lights and Cold steel.  AKA surgery. 

#3.  "I have a cough and it's keeping me from sleeping"  I ask the pratcically already answered question " Do you smoke"?  I ask because the treatment for a non smoker with a cough is dramatically different than for a pt who smokes with a cough.   Roughly speaking, a smoker gets treated with antibiotics because they can not fight off infections while non smokers do not unless they have clinical findings to suggest need of an antibiotic.  

Well, this patient had a chest Xray obtained based on the screening orders from a midlevel provider or physician assistant.  I had seen, examined and made the decision to discharge the patient before ever seeing the patient.  I checked the CXR as a matter of protocol, feeling that there were really no indications for having ordered it.  Unfortunately it was abnormal.  Not because of an infection, but because the Aorta ( which connects the heart to everything else) was widened to a concerning extent.  

So, I march back into the room and explain that this evaluation will take a little bit longer. I say "march" because when I am about to deliver news it really is a march of sorts.  I start to explain what I saw and what needs to happen and she says " so...am I going home"?  I simply say "well...lets get some tests and see what we find".  

3 hours and several conversations with her concerned fiancee later the results of her picture comes back.   It turns out that this 40 something yearold smoker has  a cough with bronchitis.  And an aorta which is about to burst.  Specifically it was greater than 7cm in width.  Normal is 3 or less.  Anything above 5 is a candidate for surgery due to risk of rupture.   I guess in hindsight I should have talked to her first, but I didn't.  My first call was to a thoracic surgeon who promptly accepted the patient for surgical repair that night.

So, I stroll back into the room and say "uh...so your pictures are back.  It looks like you have some other stuff going on.  The blood vessel from your heart is too wide and needs to fixed"  Cue the confused looks and vague stuttering responses.  Who wouldn't be confused.  You come in at 5pm for a cough and by 930 your leaving to have your chest cut open with death being a very real option. 

Lesson # 1.  Poor decisions, even those seemingly innocuous ones, can effect not only you, but your kids with devastating consequences.  

Lesson #2.  Even doing the right thing by your kids and the law does not necessarily guarantee your well being.  And that completely sucks. 

Lesson #3.  You never know what is coming.  So live your live your life.  Don't put off too much.  Enjoy the time you have.  I certainly have this holiday season.   God Bless. 

I have chest pain...

" open sesame " or is it " open says a me "  who knows.  If you do know please clue me in.  In any event the point is no matter how you say it... in the Emergency Room it's spelled " I - h-a-v-e  c-h-e-s-t p-a-i-n. "  Flat affect, crying, while laughing, with scorn or contempt it just doesn't matter how you say it as long as you can get out.  

Today I had an otherwise healthy young man, 21 years old, who according to nursing notes complained of chest pain.  When I spoke to him he complained of a sore throat.  Vague, nothing particularly concerning.  Nothing taken for discomfort and no real difficulties with eating or drinking.  When I asked him about his chest he said " oh yeah...my chest hurts 'right here' " and gestured somewhere around the middle of his chest and sort of moved his finger around.   I guess I was to assume that everything from nipple to nipple below his shoulders to his abdomen hurt.

Not one to be put off by vagaries I launched into my " where were you on the night of..." spiel.   I adroitly went from one feature to another asking for far more details than he could conjure.  Picture Bobby Fischer with a stethoscope- check and mate.   

So, realizing that he was: a. NOT SICK  b.  NOT SICK  and  c. gonna be fine no matter what I did.  I briefly explained that he was " fine " and was gonna be " fine " and could expect some improvement eventually.  I smiled, thanked him for coming and wheeled around to leave the room.  Case closed!  Now on to help other patients with varies maladies including but not limited to butt pain, toe pain, sinus congestion, insomnia, and bloated waist lines.  I long since opted for the cape free uniform...less risk of it getting caught in the door as I made my exit.  

Well, not so much.  I had a two step lead and was within a breath of being out of the door when I heard " hey doc"  It was like I was a 6 # chihuahua who had just come to the end of his leash...jerked back to reality immediately.  Forced to let go of the thought that my coffee could still be warm and I should find out.  

In any event I turned around to be courteous and asked ...Yes..??!!  That's when I was confronted with the nasty truth of the whole situation.   " Well...uh, my girlfriend..well she said the health department told her I needed to get checked for Trick.. stutter stutter "  Well as I am sure all of you know Trick = Trich or Trichomonas.  Latin for GROSSIOUS or GROSSUS.  Websters unabridged version defines it as a nasty protozoan sexually transmitted disease.  

The point is not that he had it or that he got it from his girlfriend or that he gave to his girlfriend and she didn't kill him.  The point is that this whole situation is indicative of why the cost of healthcare consumes almost 18% of the GDP.  A 4$ prescription that costs $275.00 because he feigned chest pain in order to be seen for exposure for an STD.  It's not that I mind seeing him or that he or his condition doesn't count.  It's just that not only do I need to do the right thing I have to do it after sorting through a host of bogus complaints (see chest pain).   

So, remember friends...It's chest pain.  Always chest pain and  something else.   

Just another day..?

Sometimes I lose perspective.  I mean I completely fail to appreciate what is really going on.  In my day to day "goings on" I come into contact with the drama of the human element.  Which is to say that I see a lot of life and all its related emotional elements while I'm working.   As a result I have become facile at compartmentalization.  That is a fancy word for stuffing emotions into little discreate areas of your psyche.  This, while a virtue at work, has not necessarily translated into a virtue in my personal life.  If you don't believe me ask my wife.  But not my counselor...as she may disagree given that it has created a steady revenue stream.  My question is not whether everyone is dysfunctional...but rather how can I make a profit out of it?  

It's a short lived question.  Supplanted by the realization that I really am dysfunctional.  Not in the funny sit com laugh track way...but in the " I have a problem feeling when things get tough " way.  And yes I realize that I shouldn't start sentences with "and" and that I use way too much punctuation incorrectly.  However, none of that is important.  What is important and what compels me is what happened today.

I bore witness to the last moments of a 55 year old man.  He came to the hospital with a massive heart attack.  aka a cardiac arrest.  aka "the big one" No name, no ID, no family.  Only a report that he had run into the back of a semi truck and been found unconscious with his foot on the gas literally burning rubber.  

As he rolled in on the stretcher I noted his color.  Skin mottled with a blotchy grey hue and a blueness about his face.  Intermittently struggling to initiate a breath...like a gold fish out of water.  That's it.  No pulse.  No pupil movement.  Only the cardiac monitor with strange bleeps and his occasional attempts to breath would bear witness to his tenuous hold on life.   

On the way to the hospital he had received lots of medicines.  Epinephrine, Atropine, Bicarb, Calcium, Amiodarone, Glucose.  He had tubes for breathing, fluids for blood pressure, etc.  All to no avail.  His heart wouldn't beat enough to pump blood.  He wasn't really breathing...just brain stem reflexes.  The problem was that while my head knew one thing, what my eyes saw was a human being who appeared to be clinging to life.  

I was completely vexed.  No matter how often this happens it is still never clear what the right thing to do is.  Ultimately I made the choice for him.  I stopped the treatments.  I believed and believe now that further treatment was futile.  So I swallowed hard and stopped. Everything.  Hands down the hardest thing I have to do.  NO questions.  Forced to compartmentalize uncertainty.  No tears.  No hand wringing.  There's no crying in baseball or in the Emergency Room.  Don't get me wrong, I hate body fluids and excrement...but this is the worst.   The problem is that even after you have made the decision, the one to essentially take life into your hands so to speak...there is more to do.  The family.

There is nothing like being the bearer of bad news...or the worst news ever for a newly widowed woman of 20+ years of marriage.  Watching the involution and collapse of a family upon the news of the patriarchs demise.  I have given the news 20 different ways and nothing softens the blow.  I can not even begin to put words to the emotion wrought by the death of a child.  

In any event, as I sit here tonight I can literally feel the crumbling facade of what was at one time my greatest defense.  My ability to become numb.  To check out.  My misguided  sense of good fortune has been to one too many counseling sessions and work shops.  All I can do now is attempt to "check" the sick feeling that continues to swell up in me as I realize the tragedy in the unexpected loss of life.  I simply want to cry.  Weep.  Wail.  For all those times I bore witness to God's miracle extinguished.  Sometimes early, unexpectedly or even completely able to be reasoned by the context.  

The power of prayer.  Even empty prayers by people new to faith can get answered...so be careful what you pray for.  I originally only asked to feel my wife's heart...to know her hurts and pains.  To be able to commune with her.  Look where it got me.  Closer to my wife.  Closer to my son's.  Closer to my daughters.  If I am not careful I could become a good person.  Maybe have a close friend or two.  I didn't even pray for that.  

So, it's been 2+ weeks since my last post.  Waiting on pins and needles I am sure you all have been ( insert Yoda voice)  So I still eat too many starchy foods, followed by a little too much red wine to help with the cholesterol...and yes maybe I cuss like a sailor.  A reformed sailor.  I have had 1 epiphony though, that which came as a result of watching a good man battle.  Battle leukemia.   Battle fear, faith, unfaith, unrecoited desires, etc.  It has been my honor to be present and a part of his life during this time.  It has not been totally self less.  The epihany I referred to came as a result of this whole situation.  I became aware of how precious life is and despite the scripture telling me that tomorrow brings woes of its own... it took watching a precious friend walk this out to really appreciate the truth.  The truth that time is more precious than money, more valuable than things and not guaranteed in the bill of rights.  So, accordingly we emptied out our 401k for XMAS.  Just kidding.  But I have tried to be present for my family.  Been diligent about trying not to worry about tomorrow until tomorrow.  All in all...it has helped me to realize that this is only the beginning of the road.  Oh, did I mention the conference...the one on unbelief, self loathing, sense of being, etc.  That went well.  Sort of .  As well as any process that requires brutal self evaluation and honesty can go.  But in the end there was revelation about who I really was at my core.  Who God created me to be.  Repenting, wailing and giving thanks for the gift that God had given me.