On a Sunday

Black and white shore line

Songs of the faithful

Ricochet around the world

Amplified by hate

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The Apple and The Tree

I don’t usually post on Mondays anymore because the clinic is usually crazy but I did want to reblog this post from Twindaddy at Mental Defecation. Typically I don’t get a ton of people popping over to read reblogs but I would encourage you to hit the link on this one.

Mental Defecation

The apple doesn’t fall far from the tree, the old saying goes. It’s an obvious statement, of course. Unless an apple tree is at the top of a hill any apple that falls from it isn’t going far at all.

My tree has dropped three apples, so to speak. None of them have fallen far from the tree. To be frank, I’d bet money the genetic engineers of Jurassic Park cloned my “apples” directly from me if I didn’t know better. I can see my likeness in their jokes, their intelligence, their behaviors, and their personalities. But nothing quite dissected how similar we are until I read a short essay today.

I was talking with Baby B about meds and school when he mentioned he’d finished an essay he needed to turn in for English tomorrow was finished. I inquired more about it and found out that the topic he’d…

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Going Places

IMG_1253

“Ok, I’m going to call it. Any objections?” 

Silence from the room. 

All motion stopped. No more CPR. No more rummaging for the next medication in the crash cart. The nurse on the phone calling for another two units of pack red blood cells simply stopped mid sentence and hung up.

I dropped the empty syringe that had spent the past hour and a half clutched in my right hand into the pocket of my white coat. The fingers were stiff and achy as I stretched them out. “Time of death….” I cranned my neck around the greying head of the house supervisor so that I could see the wall clock by the door. “…. 0325.”

“Good job, everyone. Let’s clean up so we can let the family back.”

Syringes were counted and recorded by the clerk to make sure the amount of each med given was accurately reflected in the log. Debris was swept up. Hands gently covered the emaciated body with a gown and pulled up the sheet, the eyelids were closed. A nurse took out the IV and another pulled the tubes from his nose and mouth, wiping the blood and mucous from the now lifeless lips. 

He looked so peaceful.

Cancer of the stomach. He had certainly suffered. He was not willing to die peacefully, refusing hospice and refusing to sign a “do not resuscitate” order. He fought even at the end. 

My wrist still hurt. 

I liked being around death. It was hard to explain to people. They would stare at me with a puzzled and slightly horrified look on their faces, lost for words so I stopped talking about it altogether. I always wanted to ask the dying to put in a good word for me when they got to where they were going, but I never did.

One by one everyone left the room.

In a minute I would go out to his wife and children and explain that we had done everything we possibly could but I needed a minute before facing the onslaught of grief.

I put a hand on his chest and said a silent prayer for his soul, then one for mine. I looked back up at his face. Strangely, his eyes were open. They were a bright blue. The bluest blue I think I had ever seen.

Then they blinked.

A hand grabbed my shoulder and pulled me closer. 

His hand. 

My heart skipped a beat as fear rushed through my body and into my fingers and toes. 

Then the hand let go and fell back to the bed with a flop, as if there was no more energy left. It must have been some sort of cadaveric spasm…

“She knows.” 

The rasping sound came from his lips but how could that be? He was still attached to the heart monitor, someone had forgotten that detail, and there was no heartbeat. I checked for a carotid pulse. Nothing. No breathing.

“What do you mean? Who is she?”

The eyes bore into me. 

His lips moved. “She knows…” I touched the lips. They were cold.

“Who is she?!?!??” I asked again.

No response.

My voice rose as I asked again and again but the blue eyes just stared back at me never wavering. I grabbed the shoulders and shook him but he still provided no answers.

Anger and terror rose up into my throat, swelling into a tight lump that lodged there. My brain raced from irrational thought to irrational thought. I could not breathe. 

Someone knew what I was doing? But how? I’d been so careful!

My hand touched the pocket with the empty syringe.

Rage. 

I grabbed his shoulders and shook him. Hard. I punched the chest. I yelled at the blue eyes, tore at his lips…

Someone pulled me away.

“Doc! What the hell is wrong with you?”

“She knows. She knows. She knows. She knows. She knows. She knows. She knows. She knows. She knows. She knows….”

New Outlook

Lookout at Rockefeller Center in NYC

The beeps. 

I know those beeps.

From where? 

I don’t have the energy to find out. My head hurts something fierce. I slip away, choosing to remain in the darkness for now.

*****************************************

The pain at my sternum is excruciating. 

Make it stop!

Except that I don’t have a voice. There is a tube down my throat and I cannot speak. I try to grab the hand at my chest by my arms do not respond.

“Dr. Slaughter? Wake up. Can you hear me?” The voice is much too loud and the words are spoken slowly as if the man enunciating them were speaking to an imbecile.

The pain stops. Then I realize…

A sternal rub!

My eyes are open. He moves his face close enough to mine that I can smell his aftershave. 

“Dr. Slaughter? My name is Dr. Holcomb.” He was too young to be a doctor. Too young to be competent. “Wake up!” he shouts into my ear. 

The pain again. Stop with the damn sternal rubs you f***er! I AM awake.

*****************************************

“The patient is a 45 year old male who happens to be a local physician. A neurologist. He suffered a brain stem hemorrhage two weeks ago and is currently in a persistent vegetative state. He has no family we have been able to locate.”

*****************************************

I take inventory. What can I move? Arms? No. Legs? No. I try to tense my abdominal muscles. Nothing. A shift or a scoot to take pressure off of my hips. Not even a millimeter. Smile? No. Wrinkle the nose? No. Tongue? Not that either. Blink? Ok. Yes. A blink. I try to move my eyes. Left. No. Right. No. Up? Yes. Down? Yes. 

Not much to work with but it’s something.

*****************************************

My dog! Who is feeding my dog?

He was probably dead by now.

*****************************************

“Well, his catheter caught on the IV pole so when they were wheeling him down for the MRI, it got rippped right out. We have to place a new one.”

“Should we use the lidocaine jelly?”

“Nah. He can’t feel anything anyway.”

I felt it, bitch. I felt that catheter rip right through my urethra. Use the goddamn lidocaine jelly. Come on. Look at my EYES. See me moving them? Blinking? 

Please? Just LOOK at me. Really look look at me. Someone?

I can make tears.

The night nurses here suck. 
*****************************************

The woman is smiling at me. 

Who is she?

She’s gorgeous. Dark hair. Blue eyes. Long lashes. I have this strange feeling. I think I should know her. 

“Remember me?” She whispers. 

No. No, I don’t.

“I was the intern you came on to ten years ago. A newbie. You told me to go get some gauze and then followed me into the supply room, locking the door and forcing yourself on me. I made it seem I was flattered.” She fixed her gaze onto my eyes and leaned in closer. “But I wasn’t.” 

Her hand was under the sheet, stroking my genitals. An erection. Horror and pleasure washed over me.

Oh, God.

The heart monitor registered the increase in heart rate. A nurse stuck her head in. The hand was withdrawn.

“Oh! Dr. Rutherford. I didn’t realize you were in here.” 

“Dr. Holcomb asked me to see the patient.”

The nurse nodded then stepped out, drawing the curtain closed behind her.

“I hate you.”

Suddenly, fingers wrapped themselves around my scrotum and squeezed tight. Painfully tight. I closed my eyes, fighting the excruciating pain.

“You have locked in syndrome, don’t you, Dr. Slaughter?” She laughed. “You can feel everything but you cannot move. Well….” she chuckled again. “You can move your eyeballs up and down and blink but they haven’t figured that out yet, have they? You taught me well about so many things…”

Another squeeze. More pain.

“You probably know better than anyone that you likely won’t recover.” She smiles sweetly. “But I’ll be back to check on you. Every single day…”

Friday the 13th

Ellis Island building detail

Every Friday the 13th I tell myself I am NOT going to work. I am so over the bad luck. 

Is it really that much worse than other days? Are people sicker? Is it maybe that everyone is walking around irritable and more afraid than usual and it boils over into how they interact with others? Am I just hypersensitive? Is it a self fulfilling prophecy? 

I dunno. 

All I know is that I don’t want to do it anymore.

Then it sneaks up on me. Every single dang time.

BAM! 

There is nothing to do but just get through it. Buckle down and get it done. 

Survive. 

And we do. 

We always do.

This Friday the 13th it was different, though.

“She looks yellow…” the medical assistant whispered as I pulled up the chart. 

I scanned her info. I’d never seen her before. Hypertension. Diabetes. Cholesterol. Nothing else remarkable.

Knocking authoritatively on the exam room door, I entered.

“Hi! I’m Dr. Denisof. Tell me what’s been going on?” I shook her hand, taking in her appearance. She was quite jaundiced. 

“I don’t know. I woke up this morning and pretty much freaked out when I looked in the mirror.”

“Any other symptoms?”

She shook her head. “Nothing.”

“No fevers? Abdominal pain? Nausea? Diarrhea?” She shook head no each time. 

“Hmmmmm.”

I started examining, working my way from her head down. Eyes, ears, nose, throat all fine. Lungs clear. Heart regular rate and rhythm, no murmurs. 

“Let’s have you lie down.”

She complied.

Her abdomen sounded normal. I pulled off the stethoscope and palpated her abdomen. No masses. Liver felt maybe a bit enlarged. No pain. 

I helped her sit up.

A strange look came over her face and she doubled over, gagging. Blood poured out of her mouth and into her hands, dripping onto her lap.

“Call the ambulance!” I yelled out the door then grabbed an emesis bag, thrusting it under her mouth. She gasped and the vomit stopped for a moment before another retch wracked her body, bringing up more. The room filled with the scent of rust and iron. 

“Need help?” An MA stuck her head in:

“You called 911?”

“Yes ma’am.”

“Can you print a chart summary and her last set of labs for the EMS?”

“Sure thing!”

“And let the other patients know I am going to be running late while we deal with an emergency.”

“No problem.” 

Sirens were audible in the background, growing louder. Having a clinic so near the fire station definitely had its benefits.

Another retch, more blood. 

I put my hand on the patient’s back and looked into her frightened eyes. “You are going to be OK.” She nodded but did not look convinced.

My mind was running through the differential diagnosis. Causes of rapid liver failure, fulminant hepatitis…. infection? Some sort of aggressive cancer? Drugs? A closet alcoholic? 

The sound of a stretcher came from outside the door and two hunky firefighters in dark blue uniforms stepped in. 

“What do we have here?” the tall one asked.

I gave the run down of what I knew, pointing at the bloody emesis bag. 

As I spoke four sets of eyes grew bigger and the firefighters suddenly backed out of the room. 

What the hell?

“Hang on, I’ll be right back,” I told the patient. I left the door cracked so I could hear any more vomiting or any sounds of distress.

One of the men muttered into a radio receiver on his shoulder. The other took a step toward me, his hands raised.

“Doc, we need for you to step back into the room.”

“Why? What’s going on.”

“You are quarantined.”

What?” More sirens. Through the windows I could see police cars racing into the parking lot, surrounding the building.

“Look, no one can leave this clinic. No one. The CDC will be here shortly and they’ll explain everything.”

*****************************************

The above was a bit of fictional doctor horror brought to you by the month of October…

Thursday Thoughts From the Throne #7

Clock feature in a small park in NYC

Is the day over? No?

Phew!

Made it. 

My colon has been awfully out of whack this week. So has my running schedule, come to think of it…

So, most of the time I try to avoid talking politics and religion with my patients and my friends. There are only a few trusted people I feel I can have a rational conversation with. Today, though, I ran across one of those people who was trying to convince me that my theology was misguided and that abortion was wrong in all circumstances. Even in the case of an 11 year old girl who was molested by her uncle.

Don’t get me wrong, I like this guy. He is a good man, even if we fundamentally disagree. However, he made a comment about prayer in school that got my dander up. Specifically he said that Christian prayers only should open every school day and that more of it probably would have prevented the Las Vegas shooter from killing all of those people.

Um. No.

I am going to skip the theology question and the abortion issue and hit on that school prayer statement.

Being prayed at is not the thing that prevents hurting people from lashing out. Love does. Good parents who try to do right by their kids and their spouses, fellow human beings who show kindness…. these are the things that prevent damaged people. 

Loving people who need it is awfully darn hard. 

I am not saying don’t pray. Go ahead and pray. I pray. Prayer is powerful. Prayer can help you love, help you find kindness when you don’t think there is any left inside of you. Here’s the thing, though: Don’t you ever think for one minute that your prayer means you have done your duty and your responsibility to other people stops there. No. You have to physically reach outside of yourself and help those around you or you are just saying empty words. 

I used to be that person, the one for whom the world was black and white. No amount of arguing or reasoning could change my mind. I was so full of anger back then. Why doesn’t everyone see the logic that I see? Life had to show me the all of the other shades of gray and the myriad of vibrant colors that make up this world. It had to show me that I am not as smart as I thought I was. 

Life is still teaching me.

Kind of makes me wonder what I will think of this post in ten years…

The Overseers

Through a window at the American Museum of Natural History in NYC

I see your drones flying overhead,
Your truck driving by.
I know you are watching me,
Following my every move… 
Silently waiting 
For the proper time to strike. 
You know my internet searches,
The names of my kids. 
You know my habits 
And my darkest faults. 
Some days you know my secret wishes 
Before I can even get the chance 
To wish them. 
Always there, behind the scenes 
Your satellites measuring my level 
Of devotion. 
Well placed hints, strategic glimpses, 
All forms of intimidation
Meant to remind me that I am yours 
Entirely,
Forever subject
To your every whim.

*****************************************

If you want to see something fun, zoom in on the bottom left of the photo.

Cirrhosis 

Laundry room, Ellis Island hospital

He sat silently weeping in the corner. His hand shook terribly as he reached up to wipe his eyes. Misery was etched across his face.

“You didn’t stay at the treatment center.” He had not even lasted a day. “What happened?”

“My wife cried so hard when she left me there. I couldn’t stand it.”

“What about an outpatient center? A day program?”

“Maybe,” he said, noncommittal.

Each visit, fewer family members came until finally it was just him. 

Alone.

And each visit there was less of him. His body was swollen and bloated, faded. A once strong man, now made a shadow. It was hard to stand by and watch. Not as hard as living it, though, I was sure. How he could continue to do this to himself was a testament to the power of addiction.

“You’re going to die.”

“I know.” Then he smiled. “This is the one way I can kill myself and the family still gets the life insurance payout…”