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.    

1st timers...

So moved by another's blogging, we have decided to become bloggers too...  Using the electronic medium to delve further into ourselves and others...It seems sort of cliche that it would take an electronic posting to incite in us (Me) a desire to touch on our own feelings and attempt to communicate what we(I) feel by posting on the internet.  I am Matt Everett and I have approved this message. Of course I ran this by the committee for communications (i.e. my wife, aka Renee, aka Hot Mama, aka Boss lady, aka 51% vote) which also approved the message.