Monday, October 27, 2008

Passions Meet...

I love this time of year not only for the beautiful changing of the seasons but also for...Deer Hunting!!!
A dilemna existed for both last year and this year. Last year I was studying for Family Practice Board exams(PASSED!!!) that we are required to take every 7 years. This year it is my first attempt at Palliative Medicine Boards. There are only a handful a physicians Board Certified in Palliative Medicine and this year is the first that the governing body of the ABMS offered these boards. Of course, each year, the day long tests were in the middle of archery season...FIGURES!!!
The day that I took the above photo with my cellphone was a wonderful day in my blind. The does were bounding....bucks were yet sleeping...a few raccoons and 1 red fox passed my way. Despite these welcomed interuptions I was successful in at least becoming a little more least in theory!
So....Passion meets Passion. I took my studies to the woods.....soon we will see if my preparation was worthy. The exam is 10/29/08....2 days from now....wish me luck!!!

Thursday, October 16, 2008

A Sailor's Salute

The hospital room was bright, much too bright to fall asleep, but this he did, finally.

It was five days prior on a Saturday morning that he presented the Emergency Room with an unremitting pain in his chest.
I was in Tampa attending a Palliative Care conference that week. It was a wonderful conference that helped reinvigorate my passion for “End-of-Life-Care.” Thousands of people congregate annually with the same common passion. It was a beautiful week. A beautiful week, until Saturday morning.

I love to travel! I enjoy experiencing the local flavors of each new city. I search out the places that many other travelers do not….out of the way diners, shops, stores and restaurants. I make it a point to talk to some of the “locals” and follow their lead to the best places to visit. Saturday morning was to be no different.
When I awoke, I can’t say that I knew something was wrong. I didn’t. All I knew was that I awoke without that good feeling that we all have grown to appreciate. I wasn’t crisp. Suddenly I wasn’t excited about learning a new city. Despite waking up in sunny Florida, I felt as if clouds had moved in. Moved in and dampened every ray of sunshine. It was a feeling that thankfully, I don’t experience often.
The conference wrapped up early Saturday and we found ourselves with the greater part of the day to fill as our plane wasn’t leaving until evening. We found a little antique store in quaint Ybor, a beautiful little reprieve from the business section of Tampa. We found ourselves trailing through the narrow pathways of nicely displayed racks of clothing and accessories from years gone by. I did enjoy the little shop, but not as much as one would expect. From here we walked the less than crowded streets, several blocks to have lunch. Like usual, we searched out a place that the locals frequent….and frequent they did.
The exterior of the Tropicana did not reveal it’s interior. From the outside I didn’t think that there were going to be anyone inside. I was wrong, very wrong. As if walking into a different century, we entered the Tropicana. The little diner was indeed….the hub of activity. Now I realized why the streets weren’t crowded. We were greeted by a hostess with the faintest hint of an accent that I have yet to identify. We then wound through more narrow paths of chattering people toward our table.
An elderly gentleman, undoubtedly a local, adorned atop his weathered face, a sailors hat. Not just any sailors hat, but a real sailors hat. It was inscribed with what appeared to be his last name on the left side top. The name I forgot as quickly as I read it. The name itself wasn’t important. The means in which it was written was. The cap was bleached white and black letters were written very uniformly and neat, all capitalized and not tucked away in a fold, but displayed where all could easily see whose hat this was. I imagined many of these hats aligned on a table or possibly a hat rack. The sailors of years passed would then hurriedly pick out their hat from the many other look-alikes and be on their way. On their way to some….sailor emergency.
It is obvious…I’m not a sailor.

We sat down at our table thankfully in view of our sailor friend. We were shown the lunch menus and placed our orders with our waitress who also possessed the same unfamiliar accent. She appeared irritated that we questioned the contents of some of the items on the menu to help us make our selection. I’m sure it would have been quicker if we would have just yelled out, “Hey Nicky!!! Bring us the usual.” Even though we were obviously from out of town, we managed to sink into our surroundings.
Our sailor friend was truly a joy to watch. It was obvious that everyone knew who he was, of course everyone but us. He spent his time between being poured into an old wooden chair and jumping to his feet to greet what appeared to be every passer-byer.
I wonder if he was disappointed when we didn’t acknowledge him as we passed his table. I hope not, as of course this was not our intent.
He would not only jump to his feet when someone approached him and called out his name. He would jump up and salute them. He would take his weathered hand, press his index finger firmly to one predestinated area on his forehead and then snap it away cleanly. This salute was quick and much more crisp than I would have expected. This salute was a real one. The sailors salute looked different than the civilian salutes that many offered back to him. I wonder how many times in his life he adorned his signature salute. This fact, I guess, reinforced that he had been, and still was at least in heart, a true sailor.
We ate our meal, took in all the sights and sounds and exited the little diner. I avoided walking past our sailor friend because I couldn’t call him by name as everyone one else was. He was busy anyway and did not notice us.
Back out on the sidewalk we quickly noticed, in the distance, someone singing. It was an outdoor festival about a block away. We made our way in the direction of the music and found ourselves perusing the many artisan tables under the perfect Florida weather. There was a perfect breeze and the setting couldn’t have been more…..perfect. A Jimmy Buffet type gentleman was playing guitar and entertaining the little crowd with songs that everyone new. I attempted to overcome my less than joyous demeanor by looking over every booth and every little item. It was here that I received the call.
I heard the chilling tone in my sister’s voice. She and my parents were in the emergency room and my dad was having a heart attack. Not that this wasn’t bad enough, I of course was a thousand miles away. I walked away from the crowd as not to be distracted from one detail and absorbed the severity of my sister‘s phone call. The doctor, a distant colleague of mine, planned to take him immediately into surgery. I discussed hurriedly with the cardiologist my dad’s condition. Personal discussions with physicians come with the territory of being a doctor, a fringe benefit that the public is not privy to.
Of course my dad wouldn’t let anyone do anything until he made sure that I agree. Agree I did.
Immediately after talking to my dad and hanging up the phone, I realized now where that knawing sensation that I awakened with this morning was from. I felt guilty for not knowing that something was wrong. But guilt was not the predominant feeling.

We drove to the airport to see if we could fly out early. Behind the counter was a dark-haired young lady. I explained the circumstance without burdening her with details and she appeared willing to help. She spoke little, but appeared to busy herself trying to find me a different flight.
I couldn’t see her computer screen, as we were facing each other. I was watching her face throughout the process. She seemed very serious. I also noticed that she was very pregnant, and I wondered if she wasn’t feeling good that day. Any other time I would have tried to engage her in conversation, but now was not the time, apparently for either of us. She searched through what appeared to be hundreds of computer screens that comprised of even more flights and found that I could at least fly out a few hours earlier. For this I was grateful.
As she handed me my updated boarding pass, she looked up and peered with slightly tear filled eyes directly into mine.
“I hope your dad gets better.” She said with hidden emotion.
Those words stopped me in my tracks as if she was speaking a foreign language. She was. Until that moment, I never thought of my dad getting better. I envisioned a tall, thin, weathered old man lying on a cold operating table, helpless. I saw more. As a physician I always see more. I oftentimes see more than I am comfortable seeing, and this was such a time.
I know that I paused, looked deeply back at her and thanked her for helping me. She helped me more than she knew. The young black-haired, soon-to-be mother saw what I couldn’t, my dad getting better.
“I hope your dad gets better.”
That sounds so much more full of hope, full of promise, full of a future. Maybe she was able to see what I couldn’t because she, herself was full of hope. I’m sure that she, expecting the birth of her unborn child, over the past several months, has lived for the unseen promises of hope, faith and love.
I doubt if I ever get the opportunity to thank this young lady and she probably will never read this. But for those 6 words of hope…I am so thankful.

The next hours turned into days. I managed to arrive at the hospital and it is there that I would stay for the next several days. My dad underwent an emergency catherization and they were able to open one vessel temporarily preventing any further immediate heart damage. He subsequently had open heart surgery two days later.
It was two days after his surgery that I learned my greatest lesson.
The hospital room was bright, much too bright to fall asleep, but he did, finally. After watching him suffer not only with the pain of the surgery but also with the fearful agony of the unknown, He finally rested.

I was sitting in a “noisier than should be” chair at the side of his bed slightly closer to the foot of the bed than the head. After the endless days of a body full of pain and fear, my dad finally slept. And I watched him. I looked at every line on his face. I mentally traced the bridge of his nose and brushed the hair from his brow. I felt his weakened breath against my imagined hand. He looked peaceful, restful and most important, without pain. I then watched as his jaw relaxed, his lips parted ever so slightly and he began to breathe slightly deeper. His chest rose symmetrically and without effort. Even his shoulders relaxed which surprised me as I couldn’t tell that they weren’t.
Then I realized….This was the longest that I have ever studied my dad. I’m sure that as a child, like most of us, I watched and learned from my dad. But that was with a child’s perspective. In my adult life, I was too busy. The world moves us all along as if being fast-forwarded. Deadlines to meet, schedules to keep, patients to see.
Not this week. This week I was stopped in my tracks facing a huge dose of reality.
I wanted to reach out and touch him but I was afraid that he would awaken. I wanted to gently lay my hand against his sunken cheek. I don’t ever remember holding my hand to my dad’s face. I have to others….my children, my wife, my sister, mother, even patients. But I never touched my dad’s face. That hurt my feelings.
Out of my defense he would have looked at me as I held his wrinkled face in my hands and felt a little awkward himself. I wonder what the skin on his face felt like.
I imagined it to be cooler that expected, rough from working outside most of his days. I imagined his skin to be moist with perspiration from the recent events. Some of what I imagined my dad’s face to feel like was more difficult to envision. Honest, loyal, worthy, protecting, loving, patient, determined are only a few. There was no shortage in what I felt, holding my hand to my dad’s cheek, even if it were imagined. It felt so reassuring as if to repeat those magical 6 words heard earlier in the week.
“I hope your dad gets better.” And “got better” he did.

Why is it oftentimes difficult to show our loved ones just that… Were we raised from infancy to refrain from the loving touch. Have we been taught to offer the voice of love but hide deeply the physical accompaniment or have we learned this on our own in an attempt to save time and effort. If this is so….it’s not too late…for any of us…myself included.

At the time that I am writing this, my dad is home and recovering from his heart attack and surgery. I still have yet to physically touch his face but continue to watch him and mentally caress smooth, his furrowed brow. I have made great strides and have been met with equally great reward. I have held his hand in mine over the past several days and this has allowed our relationship to deepen.

I challenge you to do the same. I almost lost my chance but by the grace of GOD I, or should I say, we have another opportunity.

And if ever the circumstance presents itself again, I will make it an effort, to take the time to accept the salute from an old sailor.

Excerpt from "The Journey Learned" 2008

Wednesday, October 1, 2008

Evening Guest

The above photo I took with my cellphone from my "soon to be" backyard the day we put a bid on our "soon to be" new house. I currently reside in the epitomy of YuppyVille, USA and long to escape the Burbs. I drive by the "Lake House" almost daily...slowly drive away feeling a bit renewed and dream of the day when this new chapter begins.
Expect to have many sunset, fireside evenings with friends and family filled with lighthearted laughter, heartfealt talks and deafening silence....the Heron is invited back as well.

Dr M