Beyond The Final Breath

Republished at:  https://www.washingtonpost.com/national/health-science/we-didnt-save-his-life-but-we-didnt-disrespect-him-either/2017/02/03/74612afe-d1f6-11e6-9cb0-54ab630851e8_story.html?utm_term=.9e665c02ec43

Republished at:  http://www.kevinmd.com/blog/2016/12/didnt-save-life-better.html

“Well?  Did you save him?” “No. We did better than that.”

He came in pulseless. The machine performing chest compressions with the rhythmic thud, thwack, thump. His ribs heaving under the force of the compressor, keeping his heart artificially beating. The plastic tube secured in his airway forcing puffs of air to inflate his lungs.  His skin slightly purple-gray, on that narrow brink between life and death. His eyes like speckled round pieces of glass, with fixed pupils, staring nowhere.

Our team was assembled, prepared, ready. We worked deftly with experienced hands, our focus and determination fueled by adrenaline, a synchronized team, we worked side by side; this was our life to save and we were going to do everything.

But his glassy, fixed eyes spoke to me. As we regained a heartbeat, and we halted the chest compressions, and our adrenaline settled–here he lay, not out of the woods, but heart back from a standstill. His glassy eyes told me his heart was back, but his life of living was gone. The life that laughed, that smiled, that held his wife’s hand–there was no amount of life saving measures that could bring that part of him back.  We didn’t know how long ago he had stopped breathing. But it was long enough to have robbed him of his mind, his memory, of everything that made him that man his family loved.

His wife and only daughter arrived. I left him in my able teams’ hands and sat down with them. I looked them in the eyes. I told them the story of his final hour of life, from the perspective of his fighting, beating heart.

His heart was here with us, but his  brain had gone too long without oxygen before we could reach him. He would never walk out of this hospital. They listened to my words.  Words spinning and exploding beyond comprehension. They nodded their heads, as if to ask me to keep talking.  So long as I was talking, we didn’t have to move.  Tears were inevitable. It was so sudden. How could they be asked to make a decision of whether to continue with the resuscitation or to just let life walk its final march.

Yes, this was about them, but this was ultimately about him. What would he want? It is true it was sudden. It is true it is the toughest decision anyone will make.  But with the return of his heartbeat, the decision to continue resuscitation is as big, as active a decision as it is to stop all aggressive measures and let him be comfortable. These are both big decisions with big paths for us to travel down.  I needed them to understand that this wasn’t their decision to shoulder. It was their time to respect–in the most selfless of ways–the man they loved.  To step outside themselves, slip into his shoes and honor his wishes in the greatest way possible.  What would he have wanted if he saw himself in this moment?  Representing him in this way is a responsibility no one cares to bear, but this final act is the biggest, most giving way they could love and honor him.

His daughter immediately said, “oh, he would want none of this. He would want you to stop.”

They stood by his bedside. We withdrew all aggressive cares. We turned off the beeping monitors, we stopped artificially putting oxygen in his lungs, we turned off all pumps, we covered him with warm blankets, we let him be comfortable with his wife holding his hand for his final minutes, and his daughter stroking his hair.

And that’s how he left us.

Did we save his life?  No we did not.  Not today.  We did better than that. We upheld our promise to continue to respect his wishes beyond his final breath.

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Dance Moms

Dance Moms. Just that simple two-word title triggers guttural reactions in most.  It stirs up connotations of a middle-aged woman with frumpy hair and stretchy pants.  A coffee in one hand and an extra-large can of extreme-hold hairspray in the other.  It stirs up connotations of a once-was, or even worse, a never-was dancer way past her prime beaming on stage left, clapping emphatically and slightly maniacally for her daughter. It stirs up images of this shiny, bedazzled daughter of hers in a starch-stiff tutu adorned with silver sequins, hair in a high bun matted concretely to her head with an entire squeeze bottle of gel and bright pink lipstick outlining bright white teeth.

I know what you think. I know what you see.  It makes me laugh, because at times, when I’m not paying attention, I could mistakenly see what you see.  Those Dance Moms!  But fortunately, I’ve realized what Dance Moms really are.

My daughter was five when she announced she was ready to join her friends in their rhinestone leotards accessorized with large, bobbing, sparkling hair bow headpieces on that dance stage.  I shrugged my shoulders.  It wasn’t different than anything else we had tried.  A summer camp of basketball here.  A community T-ball season there.  A high school led soccer class there.  Dance?  Sure.  Let’s do it.  I went into it with no idea.  I imagined it would be a class once a week, and an adorable recital at the end of the year.  What’s the harm in that?

I imagine this is how most Dance Moms are created.  Eager moms and dads in this helicopter-parenting era, ready to encourage their sons and daughters in yet another endeavor.  Was I crazy to consider this?  No.  Ha.  I was just a sucker like the rest.

And so it began as I expected.  We signed up for a recreational dance class.  One class once a week.  A recital on the horizon.  My son joined too.  Why not?  But it wasn’t long before my daughter was invited to join the competition world, and my son, wise beyond his years, sniffed that there was something not for him about this place we had been bringing him every Thursday, and graciously bowed out.

Competition dance? Most definitely!  Why not?  My daughter smiled from ear to ear.  It sounded like a fantastic idea.  Slightly more rigorous classes with a couple competition weekends thrown in here or there?  Yes.  She was on board.  I was on board. This sounded like a great idea.

Ha.  Sucker.

I’m not quite sure where to start without diving right in.  Competition dance is not for the faint of heart.  It is for the diligent, the passionate, the committed. Because there isn’t anything that I have done on behalf of my children in these early years as a parent that has defined commitment as much as dance has.  It is a pure labor of love the things I have found myself doing that I never, in a million lives, would have imagined myself doing.

Putting 186 rhinestones on one dance outfit?  Been there.  Sewing appliqués onto sequined tiny tops?  Done that.  Wrangling my seven-year-old daughter’s long, straight hair into two perfectly tight buns on top of her head at 4 in the morning? Yep.  I’m raising my hand.

But here’s the truth. The real truth.  Underneath all those superfluous, flashy distractions you see on the surface is hard work.  So much hard work.  I’ve never seen girls this age work like this.  These girls that commit after school evenings to dance class then practice at home on their days off.  These girls that show up at 6:30 in the morning on a competition day and do not go home until 11:30 at night, only to get up at 6 am the next day, and do it all over again.

I remember one moment last year—my daughter was 7 years old.  She had literally been at a competition going on hour 14.  And there she was, doing cartwheel after cartwheel after cartwheel across the gymnasium practice floor.  Why?  Because she was loving every single minute of it. The early mornings, the late nights, the long days, the dance after dance with costume changes and intricate hair changes, she did it all because she was exactly where she wanted to be.

This past weekend, my daughter, now eight, had a full day of competition, snuck in a six-hour night of sleep, and at 6 am the next day, was up and ready for the next day of competition.  There was no complaint in any of her still-waking-up muscles.  She sat straight as I pulled her hair into a tight high bun.  She proceeded to go on to stretch, practice, and compete, giving it her all.  And every time I witness her in one of these moments, I just know.

This girl.  This girl of mine has grit.  All these dancers have grit.  They have passion. They have so much love for what they are doing. They are determined and strong and have so much bravery to go on that stage with those blinding stage lights and perform.  There is no doubt in my mind, that I am that mom standing on the sidelines, clapping emphatically, and yes, yelling slightly maniacally for my daughter.  For my friends’ daughters.  For my daughters’ friends.  I do this not because I was never a dancer and I am living vicariously through the powerful grace of this gorgeous girl of mine, but because I know what it took for her to get here.  The hours, the commitment, the practice, the right attitude.

I beam and can’t help bubbling over not because I see my life through her, but because I see the life this brings to her. I follow her around with extreme-hold hairspray, because that is the very small part of the competition that I contribute to in this bigger lesson I hope she is learning.  Work hard.  Work so hard.  Don’t forget the details.  Know that effort pays off.  Acknowledge that you are exhausted, but continue to carry yourself with grace and do what needs to get done.  And if your emotions get the best of you, let them come, and then let them go, and then pick yourself up and find your strength again.

This is what it means to be a Dance Mom.  To be the grit behind the grit.  Make no mistake—my daughter and her dance life do not define me, but part of who I am is most certainly Dance Mom. I am the support beam behind a very brave girl that feels empowered to live her passion and most importantly, is learning the importance of work ethic, a good attitude, and where it can get her on that stage and beyond.

To all my Dance Moms. I’ll happily and proudly be called a Dance Mom right alongside you.

And. Make no mistake. I am wearing stretchy pants.

 

 

Bring Your Daughter to Work

It was one of those slippery moments of working mom-hood, when childcare slipped through, back-up childcare slipped through, and I was left at a crossroads.  How do I get myself from point A to point B and what do I do with my four-year-old in need of supervision?  Thankfully, my day of commitments was a day of meetings.  A day of meetings was far more flexible for me than a shift at work seeing patients.  That would have been more of a figure-it-out, you-must-show-up-to-work no-nonsense scenario.  At least with these meetings, I could call-in, though it wasn’t as meaningful to just call-in.  But what other choice did I have?

I sat there, my morning coffee already heading towards its lukewarm destiny.  My four-year-old in her shimmery batman dress and cape, crawling in my lap, the crayon in her hand daring to leave marks on my sierra sand colored couch.  And as I sat there in a silent tantrum, not wanting to miss my department meetings, but feeling as if I had little choice, it dawned on me that there was an alternative.  I could just bring her with me.  I compiled a list of ways to approach this.  I could shoot my boss an email and apologize and let him know I was bringing my daughter.  I could show up with her and apologize and explain how childcare fell through.  Or, I could just show up with my sidekick.

I watched as my four-year-old mimicked my every move.  Sipping her milk and declaring how her coffee was hotter than mine. Drawing a panda version of me, picking my favorite blue color for the panda’s belly.  And at that moment, I decided there was truly no other way to show up than with her at my side.  Unapologetic and with assertion.  Because there was no denying that this is my life: I am a mom and a physician, and I care about both and I will show up for both the best way I can.  And more importantly, this is what I want my four-year-old to see with her little eyes.  I want her to know the unique privilege of being a woman. I want her to see that we can be parents and also contribute to the workforce. It may be a balance to strive for, but we do it the best we can.

The best way I can today means a purple backpack with daffodils stuffed with my iPAD with downloaded Disney movies, pink kid headphones, my daughter’s Leap Pad, a pencil bag of crayons, coloring books, snacks, a rainbow unicorn water bottle, and a stuffed animal.  And my hospital work badge.

So, that’s what I did.  It was a meeting I prioritized and if it meant bringing my daughter, then that is exactly what I would do.  No apologies.  This is how it is.

My little spunky four year-old, sat at my feet, because laying on the ground watching a movie was more fun than sitting at the rectangular shaped tables in stiff conference room chairs.  She watched episodes of Doc McStuffins, part of Sing, she played some preschool app games, she colored, she drew, she ate cereal, she only needed a potty break twice.  And all the time, she knew I was right there part of her world and part of my work world.

It felt like a small victory, but a victory nonetheless.  I chose to bring my daughter to the meeting because the alternative was missing out on important decisions, updates, and discussions.  I brought my daughter to the meeting because daycare is unpredictable.  But mostly I brought my daughter to the meeting because I wanted her to know that this is unapologetically who I am.  A working mom that certainly doesn’t have it all figured out, but is managing the best I know how.  I want my daughter—and all sons and daughters for that matter—to grow up tearing down the judgment and stigma that follows that of a working mom.  We can work, we can raise a family, and we can do it with no less confidence and competence than the next person.

 

Finding Margins

This weekend was like any other.  Kids’ activities, work, home improvement projects, social gatherings to allow ourselves the joy of connecting with other adult human beings.  It was a fluid mix of “I’ll drop off here and meet you there and so-and-so will pick up there.”  All the pieces like well worn, slightly beaten up and bent puzzle pieces. That subtle mix of knowing all the pieces should fit exactly as coordinated with that undercurrent of anxiety that we may get to the end and one piece will have gone missing from the tattered, but structurally sound box of collected pieces.

It seems astounding that every fifteen minutes, ten minutes, five minutes, three minutes counts in this interweaving of a family’s schedules.  There was the moment when I was getting ready for work; my husband was corralling our son and youngest daughter out the door to pick up our other daughter from a birthday party on the way to bring our son to baseball practice.  With thirteen minutes on the clock until the end of the birthday party and twenty-eight minutes until the start of baseball, he pulled out all the ingredients for beef stew to throw into the pressure cooker.  Beef, potatoes, carrots, soup mix.  I looked at him wild-eyed.  “What are you doing??”  “Making dinner” . . . with the kids climbing in the car and thirteen minutes until pick-up.

No. Just no. Go.

So. There are countless moments like that.  The wind tunnel that funnels us mercilessly in forward motion as time lapses quickly and impatiently.

These are not the moments that keep me fueled and running.  No, not these harried punctuated moments of start times and end times.  But instead, all the hidden, quiet in between moments.  The Margins.

It’s peeling myself out of bed twenty minutes before the slumbering haze of morning lifts to make coffee, shaking off the dizziness of sleep and orienting myself towards the day ahead, and maybe even catching a glimpse of the sunrise.  It’s the pain of getting my four-year-old to hockey early on a Saturday morning, only to find myself sitting solo, in silence, with nowhere I’d rather be than on those chilly bleachers, hugging my thermos of caffeine while watching with fireworks of pride as my daughter’s tiny four-year-old body glides across the ice with fierce determination.  It’s the forty-five minutes after lunch and before baseball on Sunday that I chose to sit and read and not scramble and trip over household chores while my two eight-year-olds built Legos.

It’s intentionally clearing space on these tightly organized, highly chaotic days with a myriad of demands.  It’s finding these margins and allowing myself this time to be present.  It was in that brief forty-five minute margin when my eight-year-old son asked me to help him find that one specific blue Lego piece in the sea of Legos.  I was startled by my own reaction.  My usual irritable, impatient, don’t-you-see-I’m-busy self was cast aside, and to my own shock and astonishment, I put down my book and helped him scour all the piles of tiny Legos.  With not even one iota of a mumbling nag of how he needs to keep track of his own things. We searched for a solid handful of minutes.  When we came up empty pile after pile, he finally conceded and said, “That’s okay.  I’ll just use something else.”  He paused pensively, and with sincerity added, “I love you mommy.”

That moment hit me. It confirmed to me that margins matter.  By choosing to create space to allow the impossible finding of a Lego to be my way of seeing my son—that moment mattered as much as, if not more than any other moment.

Margins—the clearing of space and time to allow and acknowledge your presence and the presence of others.  The time to be thankful that when we strip away all the orchestrated to-do’s, must-do’s, should-do’s, scheduled-do’s, that we see each other. That we see ourselves.  That we see our kids.  That we see our friends.  That we see our partners.  That we see those we love.  That we appreciate ourselves not for our busyness, our achievements, our productiveness, but for just being me.  Being you.  Being us.

I’ll keep finding margins because they matter.  They help preserve my stability, my sanity, my fuel for the rest of it all.

She’s Back

There is a list of names in every Emergency Department that is well known to each individual that works and fuels that ER. And I’m telling you, it is never a good thing when you are the patient with the name that we immediately recognize upon popping up in our waiting room. For the most part, it indicates that you are chronically sick and chronically in need of emergency healthcare.  This runs the gamut of chronic illness.  You may have a weak heart that frequently gets overloaded and you end up short of breath with fluid filling your lungs.  This may mean you have failing kidneys that cause your electrolytes to go dangerously high as they cannot be filtered through your kidneys. This may mean you are an alcoholic with poorly managed diabetes coming in with abnormally high blood sugars. This may mean that you have mental illness that causes unmanageable panic attacks or leaves you feeling unsafe and suicidal.  This may mean that you have chronic pain and frequent exacerbations of uncontrolled pain.  This may mean you are addicted to narcotics and doctor shop for refills on pain prescriptions. This may mean you look for providers that will give you IV medications to give you the high that some pain medications can provide.  Whatever the reason, a familiar name in the Emergency Department is never a good thing.

On this particular day, I stepped into the chaos of an already bustling Emergency Department.  My colleagues mid-hustle, moving swiftly and deftly about the chaos of a busy day.  And there, waiting to be seen was a name I was all too familiar with. She is a mother, a wife, a member of our community, a person who struggles with mental illness and self-harm.  Triggered by events that send her stress into an insurmountable wall.  I don’t pretend for one second to know what she lives through on a daily basis.  I don’t pretend to understand these uncontrollable urges.  I don’t pretend to understand what it must feel like to come to the same emergency department, see the same healthcare providers, anticipating how they may react, judge, or act. I don’t pretend to comprehend how difficult, how humiliating, or how much courage that must take. What I know is that she comes into our emergency department on a regular basis with undeniable self-inflicted wounds that take a prolonged period to repair.

There was a time when I called for social services every time she came in.  She always gently declined their services.  Even when they came to talk to her anyway, she dodged and ducked out of their way.  She will assert how she has a therapist appointment right around the corner. That her therapist knows she is here.  That she is working through some very hard things.  I’ve called her therapist on occasions and she has corroborated what she has told me.  It is a difficult case, her therapist tells me.  During one instance, she was admitted to the hospital for a more intensive mental health evaluation and management.  It turned out, this only snowballed her mental illness and made her spiral deeper down a dark hole.

I’ve seen her enough to know she means it when she says she is not suicidal.  She often greets me cheerfully.  Talks about the weather, about her day and her week and her kids, as if she wasn’t there for self-inflicted injuries, but just for a regular slip and fall. In the same conversation, she gives instruction and suggestions on how she would like her repairs done.  I slow my breathing and try to wrap my head around how I should act.  This is not normal and I cannot help her normalize this behavior.  On the other hand, she is a mother, a wife, a member of a community that is deserving of basic human courtesies and respect.  She is a human being that is struggling.  Struggling so hard to just live a daily life accepting all the triggers and finding a way to assimilate them in a healthy fashion.

If I am being one hundred percent honest, it can be hard for us with patients we see frequently to not see them through a lens of judgment.  The patient with a weak heart that is on a low salt diet that eats ham and gravy over the holidays with his family.  The patient with failing kidneys that routinely misses one or two rounds of dialysis and is in need of immediate intervention to ensure his heart doesn’t go into a lethal rhythm.  The alcoholic patient that has uncontrolled high sugars and will continue to drink when he is discharged from the hospital.  The young patient with debilitating anxiety convinced he is having a heart attack that comes in monthly to have it checked and is in need of persistent reassurance.  The patient with chronic pain that comes in with abdominal pain regularly and requests large doses of narcotics.  The patient who has been to every Emergency Department in the local vicinity in the last week, accumulating narcotic prescriptions, who yells aggressively when confronted.  My patient who inflicts harm on herself on a regular basis and wants us to do nothing but fix her wounds.

It is easy to make quick judgments. It is easy to feel as if they are less than.  It is easy to push all the fault on their shoulders.  But who are we to judge?  We come from a place without heart failure where we can excitedly enjoy an unrestricted holiday meal when reuinited with our families without worrying about our breathing.  We come from a place without three day a week dialysis, a place where we are sober, a place where we are not crippled with anxiety, a place where chronic pain doesn’t have a vice grip on our lives, a place where we haven’t fallen to the addictive properties of narcotics, a place where we have never experienced or worked through mental illness that urges us to harm ourselves.

Who am I to judge? I am no different. I am a person with my own issues; I am just exceedingly lucky my issues do not lead me to the Emergency Department on a regular basis. So, I’ll work harder to challenge myself.  I am not here for judgment.  I am never here for judgment.  I won’t fault myself for being human, but I will check myself and know the bottom line is that my patients are in need.

They are in need.

Whatever that need may be, in the Emergency Department, we are better equipped to help them navigate it at this moment than they can do by themselves.

That day I took a deep breath.  I checked my judgment.  I repaired all of her injuries.  The Emergency Department outside her room was bursting at the seams, but she deserved my full care like everyone else.  It took me about an hour.  I looked her in the eyes, mother to mother. Wife to wife.  Human being to human being.  I asked her openly if there was anything else I could do for her today.  “No”, she said.  “That is all.”

Never How it Should Be

Also published at: https://www.kevinmd.com/blog/2019/02/when-a-baby-arrives-dead-in-your-emergency-department.html

When a baby arrives dead in your emergency department

When a baby arrives dead in your emergency department

When a baby arrives dead in your emergency department

The world stops. You stop breathing. You are gasping for air.

She is limp, she is cool, she is pulseless.

Chest compressions on the tiniest 6 month old I have ever met are done with the finger pads of my index finger and middle finger. Quick, synchronized beats. I look at her blue, blue lips. It should never be like this.

Her eyes are fixed and dilated telling me that she has been like this for quite some time.

We stop and check for a pulse. No pulse. Chest compressions resume, we work to put a tube in her mouth to help her breathe. It is how I imagine a doll’s airway must look like. Stiff, tiny, a small pink flap over the throat.

There is a cool calm, a cool horror, a cool this-is-never-how-it-should-be. We work deftly to bring her back. But she is gone. She was gone before she arrived. She is gone now. She is gone.

There is hysterical sobbing heard by the family. Our insides are gutted. Our hearts, shattered. But the emergency department keeps pulsing, and we need to keep it afloat.

I meet my nice gentleman with the irregular heart beat in the 160’s. I check on my patient with the migraine headache. I discuss at length with my patient with the extraordinary high blood pressure and horrible headache the need to do a lumbar puncture to rule out a head bleed. She ultimately leaves against medical advice despite my coaxing and persuading. I evaluate a diabetic with intractable vomiting and abdominal pain. I see a sweet woman with severe pain who is now wheelchair bound and whose 80-year-old husband can no longer care for her at home. His shoulders relax and his eyes sigh in relief when I tell him I am going to admit her to manage her pain.

Throughout all of this, the weight of a dead 6 month-old suffocates me and holds me captive. My heart is in pain, and I am devastated, and this is too catastrophic to set aside to mourn later, but I do. I do, because this is what I do. This is what we do.

I’ll never forget walking into this. That sweet purple, lifeless, limp 10 pound baby on a huge white stretcher. The tiniest of chest compressions giving her heart an external beat. For those suspended moments in time, she was all of our child. We loved her, we ached for her, we didn’t want anything to harm her. We will all weep in our own ways over the days, weeks, months to come. Not even the usual armor that we constantly garner will keep these feelings at bay. This is one that will rattle us. Keep us jarred.

Because there is nothing natural

When a baby arrives dead in your emergency department

Lessons at the Stadium

Last night we took our son to the big football game between our beloved Minnesota Vikings and our most love-to-hate team, the Green Bay Packers. It was a big night for our son. He is a walking Vikings statistic generator obsessed fan. His love of football is around the clock. It starts in the morning with him putting on yet another Vikings jersey, throwing his football in our foyer, continues at school where he brings his football and football gloves to play a game with his friends at recess, and continues after school with more football playing, and ends at night reading statistics and talking about Sunday football, Monday night football, and Thursday night football with my husband.

He was on cloud nine when we stepped into that Vikings stadium last night. His wide-eyed stare, his toothy smile, his body tingling with excitement. I don’t think he stopped showing his left-sided dimple all night long. He loved every second of those over three hours of heated, edge-of-our-seats game play. He screamed loudly with complete elation with each touchdown. He SKOL-chanted in rhythm with his fellow Vikings fans. “This is the best night ever!” he screamed into my ear.

With every stadium game comes the adult jeerers and nasty comments about the rival team. Multiple times, the Vikings fan behind us made cracks about the opposing team’s quarterback, calling him a homosexual or gay. He yelled, “Why don’t you love your family! They will accept you for who you are!” While sometimes humorous, he crossed the line time and time again. He was so crass and loud, that it was unavoidable. My son turned and stared at him multiple times. There was no judgment in his eyes, only curiosity. As he had never heard those words strewn together and thrown aloud with such force. I heard the fan’s girlfriend lean over and quiet him trying to get him to show consideration for all the kids in the stands. “What?? Hey, don’t bring your kids to a Vikings game if you don’t want to hear the truth!” he drunkenly yelled. I did not see a productive conversation moving forward if we confronted him about this. So, I took note of his words so we could talk about it later. At one point, my always inquisitive and thoughtful son leaned over and asked me why the opposing team’s quarterback didn’t love his family. This was all news to him.

After the game on the drive home, as we came down from the high and exhilaration of a Vikings win; I turned to my son and asked him if he knew what it meant to be a homosexual or gay. He said he did not. We talked about kids that have two dads or two moms. We talked about how people can love whomever they would like, but that there are people that don’t agree with that. That though we know that you can love whomever it is you want, others who are close minded and close hearted will loudly make fun and judge people for decisions they don’t agree with. I told him that everyone is entitled to their opinions but there is a way to be kind and there is a way to open your heart to all kinds of people. I explained that that fan behind us was not one of those people that choose an open heart and kindness, and that there were many people just like him. I told him it was our job to support and show love for all kinds of people and stand up for people and their choices when they cannot themselves.

At the end of the day, I am thankful we were there to hear the truth. The truth is that we cannot shield our kids from other people’s close-minded, hateful rants. What we surely can do, is not brush these experiences under the rug. When the homophobia, racism, sexism, bigotry is loud around us, we need to be louder. I don’t mean yell back and be obnoxious in the stadium louder. I mean address these truths head on. Talk to them about these hard things and equip them with the right tools to process and react to this ever evolving, dynamic world.

We cannot just think that our kids are innocent and will find their way to the best conclusions. They are listening and learning every step of the way from everyone around them–for better or worse. Make this an active process, not a passive process.

The Vikings won. My son opened his eyes to another face of humankind, and because of it, he grew a little bit more into the man he is becoming.

The Man That Scares Me and The Man I Love

Republished at: https://www.kevinmd.com/blog/2018/10/the-man-that-scares-me-and-the-man-i-love.html

There is a man. He is in my house. I don’t know where he came from. But he just came into my house. And now he is living there. And I am afraid of him. I do not know who he is. There is a man in my house. I am so scared. I don’t know why he came. But he is there. And he tells people he is my husband. And he is not! He is not! And no one believes me. Do you believe me? He is not my husband. I am so scared. Do you believe me? I am a good person. I have seven children. I am an honest person. There is something wrong. I know there is. I know there is.

 My patient. Age 68. She perseverates about this man. She is insistent. She was found wandering in the hospital parking lot. No one is with her. She wants to let out her fear in screams, but her voice is thin and frail. She is so frightened.

 They told me she has early onset Alzheimer’s dementia a year and a half ago. Last week I found her standing outside in the rain. A few days ago she had walked down to the neighbor’s house three doors down at 11 o’clock at night without a coat on. Today, she had an accident in the bathroom. She hollered for me to come to the bathroom and then hurried me away because she said she was going to clean it up. I went to check on her and she was gone. She had taken the car and left. She drove herself here.

 My patient’s husband. He is soft-spoken. His left hand tremors as he stands. His face is slightly glossy and his expressions are muted. I explain that she currently is confused. She thinks he is not who he is. She may be frightened to see him.

Sometimes she gets like that. She yells at me. “Get out! Get out! You don’t love me! You don’t love me! You son of a bitch! Get out!” It hurts my feelings. It does. It really hurts my feelings. And then sometimes she tells me she loves me. She thanks me for being her husband.

He speaks with a hollow, flat voice. He stares at me with foggy, pale blue eyes. His sadness and defeat lean into me. He tells me to wait for his son. His son is arranging for her to go to a center. He’ll have the details to tell me.

We’ve been married 44 years. We have seven children. And 16 grandchildren! She is my world. Can I go in?

 We stand outside her room, and his eyes fall on the closed door handle. I tell him that she seems frightened at the moment, but he knows best. If he thinks she will be comforted by the sight of him, he is more than welcome to go into her room. If he thinks it may make matters worse, he is welcome to wait in the waiting room. Whatever he thinks would be best for her.

Well. I think I’ll try, Doc. If she shouts and hollers and shoos me away, I’ll go outside. But if I go in quietly, sometimes I can talk to her and she is okay with me staying there. And then sometimes she warms up to me. I’m going to try.

 He is soft spoken but resolute. I peer through the crack he leaves in the door as he slowly inches in. He leans over the railing of the bed. He straightens her white crisp hospital sheet. She looks at him and I can’t hear their conversation, but that is relieving. He settles into the seat next to her side.

The next time I enter the room, the husband has left with family to rest and the patient’s son sits at the bedside. He loves his parents and he tells me that they are arranging for her to go to a memory care center.

He won’t be far behind her. He can barely take care of himself, let alone her. It’s just been too much for him, you know?

 The last ten days has been draining on their family. This seems like a quicksand downhill plunge. They have been in and out of hospitals. She was at her neurologist’s three days ago and there is nothing to do. Maybe these new medications will help. They will take time. In the mean time, they are chasing her in the rain.

I come back when the work-up is finished. I am relieved. She has a urinary tract infection. I am not relieved there is something wrong with her but I am relieved there is something fixable. You see, urinary tract infections can make you more confused than normal. Confusion can be the absolute only sign that you have an infection. And there it was. The last ten days of rapidly losing this adored wife, this beloved mom, this treasured grandmother, explained with a urinary tract infection. IV antibiotics were started and I admitted her to the hospital where she would not wander into the rain and she would get better.

I am not saying this is the end of their battle, that it won’t still be a declining slope, but I am saying that maybe they haven’t completely lost her the way they had thought.

I go back into the room to tell them. She is no longer tense and tearful. She is relaxed and loved and safe next to her son. I tell them about all the things I have done. Laboratory studies, CT scan, and that she has a urinary tract infection that is very treatable. She laughs out loud and all sense of that frightened woman I had met before seem to be drowned right out. She holds her hand up high in the air to give me a high-five.

Wow! Good job, Doctor!  So thorough! Thank you!  

She laughs joyously like I have just uncovered the eighth wonder of the world for her to see. I thank her for the first high-five of my day. We all chuckle together like old friends and it feels good.

There it was. A glimpse of her real self. All the charisma, all the spunk, all the warmth. There was the woman he has loved for 44 years. There is the woman that raised seven children with all the strength in the world. I see her now. I can see why this is so hard. To see her, then lose her, then see her. It would hurt my feelings too.

Hold close to those you love. Remember all you love about them. Tell them often. Let what you love imprint itself onto you, because you never know which way life may turn.

 

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