I sat in the huge rotunda of the US Naval Academy Chapel and looked up at the soaring height of the dome and the giant stained glass depiction of Christ walking on the water. As the Naval Academy choir braced and sang the Navy Hymn, Eternal Father, to end the Sunday service, I witnessed a time-honored tradition. Two midshipmen flag bearers slowly removed from their stands the flags of the United States and the Naval Academy. They then dipped the flags, one by one, in symbolic thanks to God, the One “who bids the mighty ocean deep, its own appointed limits keep.” Then, as they marched crisply past our pew, tossing the flags behind their head to fly free, my mind went back to the fluttering of the flag I hung outside our Shock Trauma Platoon in Iraq, just one year ago.
Olfactus amissio. Anosmia. For some it is a medical condition. But for emergency physicians, it is a talent, cultivated through years of practice. Who else can walk into the room of a patient who hasn’t bathed in a month and say pleasantly, “Hello, I’m Doctor ___, how can I help you.”
“So, what do you think about health care reform?” asked Geoff. My wife’s family had gathered to celebrate my mother-in-law’s 80th birthday. I always looked forward to the food and the stimulating conversation, particularly with Geoff, my ‘liberal’ brother-in-law from New Hampshire. Being well read, Geoff loved a good debate on a variety of topics. But this topic had the potential to be long winded and personal. All I wanted was some of Mom-Mom’s brisket with her famous homemade barbecue sauce. I just stared at my plate, piled high with delicious food, knowing that the talk would be heating up as my food got cold.
I picked up the first chart of the night and read the chief complaint. “Suicidal.” You never know what that means. It could be an old man who has sat all day with his shotgun in his mouth and finally thought better of the situation. It could be a belligerent drunk who was thrown out of his house by his wife and knows that he can stay in the hospital over night if he claims he’s going to kill himself. Or it could be a mixed up teenager who has experienced her first break up. It might mean a long work up and a lot of hand holding. Or it might be a quick “get out of my ER.” You just never know.
I sat transfixed reading the email from a friend. I couldn’t believe what I was reading. Finally my wife broke into my thoughts. “What are you doing? I’ve been calling you for ten minutes. And when I find you, you’re staring at the computer, shaking your head and mumbling.”
Josiah Yoder often came to our Ohio emergency department straight from the fields, still wearing boots caked with mud and manure. He wore sturdy black pants and suspenders over his blue shirt, which always showed signs of sweat and heavy wear. His face was mostly obscured, hidden as it was behind a thick, full beard and a wide-brimmed black hat. He was so quiet that we often overlooked him in the waiting room. But everyone knew him, and as soon as they saw him waiting he was escorted back to one of the cardiac rooms.
A sense of sadness and doom struck me as I entered the room.
78-year-old female, chief complaint: sent in by home health nurse. “One
of those,” I thought. Alone, elderly, contractures of both left
extremities, vitals normal, no dyspnea, well dressed and groomed. No
suitcase sign. Awake and in no distress, but hasn’t made eye contact
“Isn’t it about time you started back to work in the ER?” my wife asked as she walked by my desk. I was working quietly on the computer. Well, OK. I was just fiddling around on Facebook. But I wasn’t bothering her, was I?
I have a confession to make. I love my job. I’m often afraid to admit this out loud. I look forward to going to work in the ER and miss it when I’m away...
I want my time here to mean something. But it seems like I spend a lot of time in the ‘horizontal time accelerator’, my bed. The truth is I do a lot of nothing. I just end up killing time.