Sunday, December 11, 2011

Medical Terms

Antiseptic: the woman married to Uncle Septic

X-Ray: pornographic picture

Cine X-Ray: pornographic movie

CAT Scan: Imaging a patient by running a feline over their body

PET Scan: Similar to CAT Scan, except a variety of animals may be used

Perirectal: in and around a lizard or snake

Clamp: a pain in your side that develops while exercising

Ultrasound: a noise that can only be heard by dogs

Operation: A children’s game that asks the contestant to remove the “wishbone”, “spare ribs”, etc.

ICU: looking at someone

Surgeon: a large fresh water fish

Tumor: one less than three more

Carcinoma: Short for leaving one’s automobile in Omaha

Cervical: a British nobleman named “Vic” for short

Thyroid: a hemorrhoid on the upper leg

Appendix: a program for I-Phone

Kidney: part of a child’s leg

Rectum: stopping short of killin’ em

Resect: have intercourse again

Anal: to dissolve a marriage

Duct: feathered, web footed water fowl

Spinal Cord: a collection of musical notes

Lung: reaching for an object

Lymphatic: physically dependent on tree branches

Hypoglossal: not very shiny

Vagus: not very definite

Peritoneal: Two Irish brothers

Gastric: a joke performed with flatus

Parathyroid: two hemorrhoids on an upper leg

Bile Duct: to purchase a feathered web footed water fowl

Bunion: an onion roll

Metacarpal: to encounter a scavenging fish while swimming

Humerus: funny


Feel free to add to the list

Wednesday, November 2, 2011

Celebrity, Inc.

I sat in the waiting room clutching my portfolio waiting for my name to be called. This is it, my big chance, I thought. All those years of hard work were about to pay off.

“Ethel McDuff”, cried the receptionist, her voice betraying just a hint of contempt. A tall, thin young woman, with a face like a turkey stood up and approached her desk.

“I’m Miss McDuff”, the woman exclaimed, a bit breathlessly.

“What is it you want to be famous for?” the receptionist queried, looking a bit bored.

“Supermodel”, Miss Mcduff answered. “Here’s my portfolio. Also, here’s my sex tape and police reports detailing the terrible abuse I suffered as a child. The sex tape appeared all over the Internet. Her are links to blogs expressing my outrage that something that should have remained private was so shamelessly spread over the web without my permission.”

“Uh huh”, the receptionist responded.

“And, you can see from these police reports what shameful abuse I suffered at the hands of my high school Physics teacher. Why, there’s no question I’m scarred for life. And, my parents divorced when I was seventeen. Surely, coming from a broken home, suffering such abuse and then the final humiliation of having my private moments smeared across the Internet qualify me for celebrity status.”

“Go right into Room 22, Miss Mcduff. Mr. Qwan, our modeling coach is waiting for you.”

I watched her walk out and down the hall; shoulders slouched, head bobbing up and down, her backside sticking out a bit too far. All she could model would be a Thanksgiving day turkey, went through my head. I pictured her covered in feathers, making turkey noises.

“Allen Brown” The sound of my name brought me back to reality.

I grabbed my recordings and sheets of music and approached the desk.

“What do you do?” The receptionist asked, still looking bored.

“I write music, all types of music and I play the violin. I have discs with all thirty of the symphonies I’ve written, each performed by a major symphony orchestra. The last, Symphony Number 30 was performed by the Philadelphia Orchestra last year. And here is the Met’s presentation of my opera, “The Minotaur Revisited”. It played to sold out houses for its entire run. Oh, and I have over fifty concertos and I’ve scored three Broadway musicals and Eight movies.”

“How old are you, Mr. Black?”

“Twenty two, and the name is Brown.”

“Any scandal in your life? Were you abused as a child, come from a broken home, suffer a life threatening illness as a teenager from which you miraculously recovered? Have you ever sailed around the world solo in only a dinghy or climbed Mt. Everest without an oxygen tank? Were you a sports star, perhaps you broke your neck playing football and were paralyzed from the neck down and learned to play your violin with only your lips?”

“I’m sorry Ma’am, I haven’t done any of those things. All I’ve done is write and play music, since I was two. See this Concerto, I wrote it when I was three. I did get straight A’s in school and I was the youngest winner of the Vienna Violin Competition.”

“Boring…nothing of any notoriety.”

“Should I make a sex tape?”

“Sex tapes only work for girls unless you make one with another guy and appear victimized, or if you’ve changed your gender. Even then, it’s a hard sell. I’m sorry Mr. Blue, I don’t see anything here that qualifies you to be a celebrity. Have a nice day.”

A bit of an exaggeration; you decide.

Sunday, October 9, 2011

Haunted Houses

It’s that time of the year again; the time for witches and ghosts and other creepy things that come out top frighten us at night. In recent years, Haunted Houses have become big attractions. Scarier and scarier effects, live actors and actresses made up in ghastly displays, multiple themes are all created to make us scream, cringe and soil our underwear.

I have to admit that I’ve only been to a few haunted houses over the years and these have been at commercial theme parks. The Haunted House at Disney World is a tame, whimsical ride that barely calls for a peep of fear; the one at Universal Studios is a bit more frightening, but still pretty innocuous. One thing that almost all commercial haunted houses share is the certainty that, no matter what may seem to be happening, the visitor will, physically at least, be left unharmed.

But, suppose this wasn’t the case? Suppose the evil characters were allowed to touch their hapless prey. I believe there is one haunted house in New York that requires its patrons to sign a release which specifically allows physical contact. Certainly, such contact, even if relatively benign, considerably heighten the scare factor. But, suppose it is taken a step beyond mere incidental touching. Suppose, the character was allowed to accost his “guest” and cart him or her away. Allow Vampires to grab the unsuspecting soul about the neck and pretend to drink his blood; faux mass murderers could throw their victims onto a table while a buzz saw hovering overhead descends ever so close to their uncontrollably quivering torso. Scenarios like these and others would be overnight smashes. People looking for the extreme fright would line up days in advance for such an opportunity.

What about taking it all a step farther? Introduce the real possibility of physical harm. Not for customer; perhaps one out of every thousand or so visitors would actually be attacked and have to to fight off Leatherface’s chainsaw or battle ghoulish Zombies or face the consequences. Let’s have a random client be locked in a room overrun with live rats and scorpions and snakes and then have the room gradually shrink in size until our poor visitor is buried beneath a mountain of deadly vermin and reduced to shaking bowl of jello. That would be a real scare and well worth the price of admission. I’m sure there would be endless self described macho men who would go through the house over and over, just to have the opportunity to show their stuff.

What about going even beyond? Instead of bored, out of work actors pretending to be monsters, psychopaths and villains, employ the real thing. When I was in medical school I spent at day at the state psychiatric hospital and I can attest that the patients there were beyond bizarre and I wasn’t even allowed to venture near the high security ward for the criminally insane. Let’s give those inmates a meaningful job, doing what they do best. Instead of a fake ax murderer chained to a wall brandishing a rubber ax, bring in the real thing and, just for screams, let him loose every thirty minutes or so. The pyromaniac behind bars? Give him or her some real fire to play with. Hannibal the Cannibal? Keep him locked away, but every so often give him a knife and fork, open the bars to his cell and let him provide the smug visitor with a truly worthwhile and cleansing scare.

You, dear reader, may think all this far too extreme, but in this day and age, where we read about murders and arson and violent assault on a regular basis, where such evil is all around us, on television, our computers, in our schools and workplaces, it is necessary to push the envelope if one wants to be a success in the fright business. And if someone ends up injured or worse, there are always a gaggle of lawyers ready and waiting to step in.

Now that’s really scary.

Saturday, October 1, 2011

Looking Cool

When I was in medical school, during my surgical clerkship, I was introduced to a large number of surgeons from a variety of different specialties. I always found the actual surgery to be fascinating, which is one reason I decided to specialize in this area. But, I also was fascinated by the surgeons. They all seemed so confident and comfortable in the operating room, like they were born to be there. In those early years, I also noticed that there were certain things that the surgeons did that looked “cool”. I distinctly remember being impressed by one surgeon’s ability to orient a needle exactly how he wanted it by manipulating it with only the needle holder. To my neophyte eyes this was the ultimate cool; recently I started thinking, again, about what it takes to look “cool” in the OR.

The cool OR fa├žade begins with appearance; properly styled, slightly form fitting scrubs, preferably monogrammed or inscribed with the individual’s logo, are a must. Designer scrubs are most cool for women. Scrubs that are too tight or too loose are a no-no. Scrub bottoms that are pulled too high or hang too low are definitely uncool. Even slightly different colored tops and bottoms disqualify the wearer from membership in the cool surgeon fraternity. Men should sport surgical caps jauntily worn slightly to the side. Bouffant style head covering is not acceptable for male surgeons, which leaves me among the uncool. Women may wear the bouffant style, but custom designed ones are required. There are no requisite shoes to be amongst the cool, although clogs tend towards being cool.

The real test of coolness comes during the operation. The aforementioned ability to manipulate a needle without holding it is still way cool. Holding multiple instruments on one hand is also considered essential cool. This skill involves putting your ring finger through ringed handle of scissors and/or clamps and flipping them back out of the way while operating with a different instrument. One instrument on the ring ringer qualifies for mild coolness, two brings the surgeon to the intermediate level, three raises him or her to expert and four means membership in the exclusive “superstar” club. Of course, any fumbling at any time, no matter how many instruments are involved, demotes the surgeon to complete uncool status. Similarly, attempting to manipulate the needle sans hands, being unsuccessful and then having to use fingers to adjust it also is very uncool. As a resident, one particular attending repeatedly tried to teach me to hold instruments on my ring finger instead of putting them down, which was my preference. He wasn’t really trying to teach me to be cool, he ws trying to teach me to avoid wasted motion. I never really mastered this skill; I still put the instruments down when I’m not using them and exchange them as necessary. I guess I’m still making unnecessary wasted movements. I don’t think my patients have suffered because of this deficiency.

Music played in the OR also can be a major contributor to achieving the proper state of coolness. Heavy Metal Rock and Roll played at over 100 decibels is supposed to be cool, while country western is not far behind. Listening to Swiss yodeling, classical music (my preference) or no music is not cool and also relegates me to the uncool category.

Being cool in the OR has the potential for all sorts of benefits. Having one’s choice of surgical techs and nurses is one perk. Being forgiven rude or ill tempered behavior also seems to be the province of the “cool” surgeon. Charming the OR scheduler to get a favorable start time for surgery also comes much easier to the coolest surgeons.

After thinking about all this coolness I realize that nothing I do fits into the aforementioned cool category. But, there are some things that surgeons do that are really, really, really cool. Treating the surgical staff with the greatest respect, being attentive to the worries and needs of the patient before, during and after surgery and making their families fully aware of what has or may transpire throughout the course of surgery; all these are the true epitome of coolness.

Throwing instruments, belittling and berating staff, ignoring patients and their family’s questions and concerns are definitely uncool. The coolest surgeons put patient first, do what’s right whether it’s the middle of the day or 2:00 am. Doing the right operation, at the right time and staying on top of any bumps in the surgical journey is what’s truly cool. All the rest is empty window dressing.


However, being able to flip the needle around with just the needle holder still looks pretty cool.

Thursday, September 8, 2011

Sign Out

Weekend sign out between Dr. Venable, who will be covering for Dr. Fresh over the weekend:

Dr Fresh, a young surgeon, who finished residency one month ago and came to work for General Hospital with a salary guarantee of $300,000/yr.: “Thanks you so much for covering for me this week end, Dr. Venable, my husband made plans to take me shopping and I don’t want to disappoint him and my nanny is off on Sunday, so I need to stay home with my daughter.”

Dr. Venable, a surgeon in his sixties who came to General Hospital 30 years ago and started in private practice with only his congenial smile, two hands and $2500 in the bank: “I’m happy to do it, Louise; I have to stay around anyway, to check on Mr. B. I did an esophagectomy today and he’s a bit frail. I want to make sure he’s OK.”

Dr. Fresh: “I’m surprised you still do big operations like that. I usually call the Foregut Surgeon to do such cases.”

Dr. Venable: “Well, I’ve always done them and I can’t remember having any serious problems, so I see no reason to quit. How many patients do you have in house?”

Dr. Fresh: “Only four, so it shouldn’t be too much work for you. First is Mrs. G. She had a mastectomy and is doing fine. Took me a while to do the surgery, however.”

Dr. Venable: “Big tumor?”

Dr. Fresh: “Not really, but I had never done a mastectomy before, so it took a bit of time, feeling my way around the anatomy.”

Dr. Venable: “You could have called me for help, I’m happy to assist.”

Dr. Fresh: “You’re right, I should have called you. Anyway, next is Mr. P; he had a colectomy ten days ago. He had a bit of fever today, 102 and is a little tachycardic, but otherwise he’s OK. Dr. Bug from Infectious Disease is supposed to see him today.”

Dr. Venable: “Ten days post op, do you think he’s leaked his anastamosis? Is he very tender when you examine him, is he eating, having BM’s?”

Dr. Fresh: “He was fine yesterday. I only saw him briefly today. I noticed the fever, that’s why I called Dr. Bug. He’ll sort it out; that’s what he gets paid for. In 312 is a young guy, Mr. X. I saw him in the ER with belly pain. His work up is in progress, CT Scan, Ultrasound, MRI. Results should be available tomorrow; just do whatever’s appropriate. He doesn’t have insurance anyway.”

Dr. Venable: “Oh, yes, his PCP asked me to take a quick look at him. I stopped and chatted for a few minutes and felt his belly. He said he’s had pain for three days and is pretty tender in his right lower quadrant. Probably has appendicitis.”

Dr. Fresh: “Can you take care of him? I need to get ready for this weekend and I don’t want to disappoint my husband. I’ve been so busy; I haven’t seen him all week. My last patient is in the ICU, Mrs. Q. I admitted her last night. She was in an MVA, has a few fractured ribs and CT showed a small splenic laceration. She’s stable, however. But, if you think she needs surgery please call me. She’s the wife of Mr. Q, who’s on the Board of Trustees, but I think she’ll be fine; her last hemoglobin was 9.5, only down one gram from the previous one, but her vital signs are stable.”

Dr. Venable: “Certainly, I’ll take good care of all your folks. Say hello to your husband for me.”

He smiled at her and patted her on the back, but as she walked away he shook his head and then turned to take the elevator to the third floor to see Mr. P.

The above scenario is only slightly exaggerated. I asked several physicians and nurses if they perceived any differences between younger physicians and older ones. Although there are many exceptions, the general consensus was that younger doctors are more likely to spend less time on history and physical exam, depend more on imaging and lab studies to establish a proper diagnosis, and be more concerned with lifestyle and financial benefits. The reason for these differences, in my opinion, traces back to the limitations that were placed on residency programs in the late 1980’s and early1990’s.

It seems that, at least in surgery, the physicians coming out of residency have had less opportunity for responsibility, less experience and more limited operative caseload. It may be as one older Ob-Gyn said to me:

“The young physicians say that ‘being a doctor is what I do’; older ones are more likely to say ‘being a doctor is what I am.”

Think about the difference.

Sunday, September 4, 2011

National Moon Day

It is obvious to me that this great country of ours is in dire straits. Mired in an economic quagmire, the national debt spiraling out of control, gridlock in Congress and a President who doesn’t seem to realize that he can’t will a recovery by wishful thinking, it’s time for the people of this great nation to make ourselves heard and seen. It’s time for all of us to go to Washington DC and let our elected officials know just what we think. It’s time for a National Moon Day.

What is a National Moon Day? I’m glad you asked. It’s to be a day set aside, almost holy; a day when every man, woman, child, toddler, infant, dog, cat, bird, mouse and rat (excepting those already ensconced in the Capitol building) will descend upon our nation’s capital city, gather together on the National Mall, peacefully, but with steely determination; a day to show our government leaders that we are serious and mean business. Then at precisely 1:00 pm, a nice round number, this great mass of humanity will, in unison, give a collective Bronx cheer, lasting for one minute. Then, on cue, everyone present will pivot 180 degrees, face the Washington Monument and simultaneously drop their drawers and “Moon” the Capitol and our Congressmen. The mooning will last twenty seconds and then everyone will disperse.

Such an act of complete meaninglessness and stupidity will send a powerful message to our elected officials, a message that we are tired and frustrated. It’s time the people of this still great nation were heard and seen. And it doesn’t matter if a Democrat, Republican, Tea Partyer, Independent, Liberal or Conservative is shocked or offended. They’re all to blame and they’re all worthy of our wrath.

The date for this great event is October 13, 2011, coinciding with the full moon. The demonstration is limited to those actions noted above. Any speech making will be prohibited; no obscene gestures, no profanity, no “Full Monty’s”, no alcoholic beverages or illegal drugs and no smoking will be allowed.

So be a part of a movement, mark the date on your calendar and show our elected officials that we’re ready to bend over and stand up to them with this one really idiotic gesture and, come Election Day, back up your bottom with your vote.

REMEMBER OCTOBER 13, 2011 NATIONAL MOON DAY

PASS IT ON!!!

Friday, September 2, 2011

I Have Seen the Future

The last four days have provided a sharp glimpse into the future that awaits those of us in the health care profession, physicians in particular. Over the last few years physicians have been burdened with mountains of paperwork, most of which contributes little to patient care, while taking away time that could be better utilized caring for our patients. (See my blog, http://heardintheor.blogspot.com,“Form Police”, January 15, 2011). However, the last four days have demonstrated that the administrative load that has encumbered us is now becoming a hindrance to proper patient care. The next few paragraphs detail actual events, each happening at the same hospital over a four day period.

Four days ago, while making my standard visit to my patient in the pre-op holding area, one of the nurses informed me that, per the Surgical Care Improvement Program (SCIP), my patient needed to receive different antibiotics than the one I had ordered. The patient was to undergo a laparoscopic biopsy of a retroperitoneal lymph node, with the possibility that she may require an open surgery, which would necessitate a much larger incision in her abdomen. Laparoscopic surgery is done with very small incisions, working through small cannulas, the operative field displayed on a high resolution monitor. The antibiotic I had ordered was Cefazolin, perfectly appropriate for the scheduled operation. The nurse informed me that, because there was the possibility the operation could be converted to open, she also had to receive Metronidazole in addition to the Cefazolin. I told her that the particular antibiotics she was insisting be administered were indicated if the patient was undergoing colo-rectal surgery, but all that was needed in this particular case was the Cefazolin. She replied that she was following the SCIP protocol and she would get in trouble if I didn’t order the Metronidazole. Not wanting to argue with the SCIP police, I ordered the additional antibiotic.

That same day I was to perform a major surgery on an elderly lady who had a large tumor in her abdomen; a tumor the size of a volleyball. The preoperative evaluation suggested that it could have been a large cyst that, perhaps, could have been removed laparoscopically. However, when I reviewed her CT Scans (X-Rays) just prior to surgery I was very doubtful that the surgery could be properly performed without a regular incision. I informed the OR crew that I would take a look with the laparoscope, but that almost certainly the surgery would be open and to be prepared. The surgical tech and circulating nurse did everything correctly, having both laparoscopic and open instruments opened and counted from the start of the operation. A quick look with the scope confirmed my suspicions and the surgery proceeded through an eight inch upper abdominal incision and the tumor, which was arising from her stomach, was removed, along with about ¾ of her stomach. As the surgery neared its completion I was informed that policy mandated that an X-Ray be done. I asked the reason why and was told that because we had converted from laparoscopic to open surgery, an X-Ray was required to confirm that no sponges or instruments had been left inside. I tried to explain that we had more or less planned to open the patient with a regular incision and all the instruments and sponges had been counted. The response was that it was corporate policy and I had no choice. The patient remained under anesthesia for an additional twenty minutes while the unremarkable X-Ray was obtained.

As this particularly surgery neared completion I informed the circulating nurse that I thought this elderly patient would need monitoring during the immediate post operative period and I requested that she go to the Intermediate Care Unit, which is a step below Intensive Care. A few minutes later I was informed that my request would require approval by the Case Manager, a nurse employed by the hospital whose primary job is to facilitate smooth transitions for patients preparing to leave the hospital. I asked what would happen if the Case Manager denied my request. No one had an answer; luckily, the patient apparently met the criteria for IMCU monitoring. Such criteria is a closely guarded secret, privy only to those that have been accepted into the Secret Fraternal Order of Case Managers (not really, although it often seems that way).

Two nights later I was on call for the Emergency Room. I received a call at about 10:30 pm from the ER physician requesting that I immediately come to the ER to attend to a Level I (most severe) trauma that had just arrived. He took the time to explain that the trauma was a BB gun shot to the shoulder area and that a Chest X-Ray had already been done which was normal except for the BB which could be seen overlying the right clavicle (collarbone). He added that there was a small amount of swelling over the area the BB had penetrated, but otherwise everything was normal. My logical response was “Why do I need to come in to see a patient who obviously can be discharged home with an ice pack, po antibiotics and pain med?” I was told by the nurse in charge that once a patient has been declared a “Level I” trauma I was mandated to see the patient within 30 minutes and only I, as the trauma surgeon on call, could make the decision to downgrade the trauma level. The trauma protocol clearly states that all penetrating wounds to the thorax be classified as “Level I”. The fact that this particular patient did not have a penetrating injury to his thorax was deemed irrelevant by the nurse who made the decision. The fact that the ER physician had evaluated the patient and determined that there was no significant injury was also deemed immaterial. I did get to meet a very pleasant family who were happy to be reassured that their son had not suffered any serious injury.

The final incident happened the following morning. A 13 y-o boy was admitted at about 5:00 am with an uncomplicated appendicitis. The OR was busy at that time, so the boy was scheduled for surgery later that morning, around 11:00 am. I saw the patient about an hour before surgery and, during my evaluation noticed that IV fluids were not being administered. I asked the nurse why and she informed me that pharmacy had not sent her the proper fluids. The fluid ordered was Lactated Ringers, one of the most commonly utilized IV solutions in the hospital. The nurse stated that they did have that particular fluid on the floor, but policy was that pediatric patients had to receive their IV fluids from 500cc bags and they only had 1000cc bags on their unit. This makes perfect sense if the pediatric patient is a baby, but this patient was an adult sized adolescent. He had been in the ER for several hours, had been on that particular unit for five hours and had eaten very little the previous day. All this made for a significantly dehydrated patient; one who was to be going to surgery a short while later. The nurse informed me that she was not allowed to go against policy. I asked her if she had considered calling me to inform me of the dilemma, but she hadn’t. She had been on the phone with pharmacy half a dozen times, but they still wouldn’t send her the proper 500cc bags of Lactated Ringer’s solution. Eventually, the boy received the fluid as ordered and he underwent an uneventful laparoscopic appendectomy.

These five scenarios have a common thread. They all illustrate that rigid adherence to written policy can be detrimental to our patients. As best as I can determine none of these five patients actually suffered or had any morbidity; but in none of these instances did the policy enhance the patient’s care or contribute to an improved outcome.

In each instance, however, there was real potential for injury. Administering unnecessary antibiotics opens the door to potential side effects, some of which can occur after only a single dose. Disruption of normal, symbiotic bacteria by the administration of antibiotics can cause transient diarrhea or severe colitis, while allergic reactions are always unpredictable. And, of course, the whole purpose of the SCIP program is to administer appropriate antibiotics in the appropriate manner. Yet, here is an example of the SCIP administrators, who are not physicians, insisting on inappropriate antibiotics. Every surgeon learns, as part of their training, the proper way to administer prophylactic antibiotics, which medication to order for which procedure and for what duration. But, surgeons also understand that there are often situations where deviation from the usual regimen is not only allowable, it may be vital and life saving.

The requirement that an X-Ray be obtained if a planned laparoscopic surgery converts to open is certainly reasonable. Very often, the conversion needs to be done expeditiously and there may not be time to count instruments and sponges properly. However, if such a conversion is planned and all the usual operating room procedures have been followed and the ending sponge, needle and instrument counts are correct, the immediate post operative X-Ray is a needless waste of time and money, besides requiring the patient to remain under anesthesia for an additional 20-30 minutes. It is usually in the patient’s best interest to perform operations with as little wasted time as possible. I believe the policy, which was written by corporate attorneys, not physicians, is correct; the administration of this policy, in this instance, was not.

The necessity of seeking the approval of Case Management for post operative monitoring is simply wrong. The surgeon best knows what occurred during the procedure and the co-morbidities the patient may have. The need for ICU or IMCU monitoring should be a decision left only to the physicians caring for that patient.

The patient with the BB to the clavicle was a case of bureaucratic overkill. Trauma is an area where adherence to certain protocols has been proven to improve survival. The first hour, the so called “Golden Hour”, is an important time of resuscitation and evaluation of the critically injured patient. However, in this situation it was obvious to everyone involved that the injury suffered was minor. Such strict adherence to protocol didn’t harm the patient and was only an inconvenience to me, as I needlessly come into the hospital late at night. However, in this particular hospital there are only three General Surgeons taking call, often we are being called all night. Unnecessarily calling one of us does put a strain on system that is already overtaxed. Such stress, theoretically, could lead to poor performance by the on call surgeon.

Finally, the last case; the failure to administer ordered IV fluids. Of all these events, this is the one with the most potential for harm. The patient with appendicitis often has had poor oral intake for the duration of their illness, usually 1-3 days and thus may be dehydrated. In addition, intra-abdominal inflammatory processes often result in significant body fluid shifts into the area of inflammation. Adequate fluid resuscitation is one of the first things a medical student learns. Withholding IV fluids because the right bag wasn’t available caused this necessary surgery to be delayed; waiting for the patient to be adequately hydrated. The appendix in this case was very inflamed, about to rupture. The nurse should have informed me or her superior of the difficulty she was having with pharmacy so that the situation could have been remedied in a timely manner.

All the protocols and policies that are developed are supposedly designed to help optimize patient care and improve outcomes. At what point is this goal lost? Starting in medical school physicians are taught that every patient is an individual; residents, no matter what their specialty, are taught to approach each patient with a fresh perspective and treat that individual’s unique problems with a therapeutic plan designed specifically for that individual.

Cookbook medicine, inflexibility and strict adherence to sometimes arbitrary rules developed by administrators and lawyers are destined to clash with the individuality that is inherent to a physician’s approach to their patients and the provision of what we doctors hope is high quality patient care. Physicians study textbooks during medical school and residency; one of the main things we learn from these books is that the majority of our patients are not textbook cases. Why should those individuals that are trying to formulate policy and protocol assume otherwise?

Why have all these rules and regulations been developed? What has happened in the medical profession that has caused government, insurance companies and hospital administrators to be compelled to draw up an ever growing mountain of rules, protocols, policies and forms that are heaped upon the shoulders of doctors and nurses, thus weighing us down and ultimately interfering with the quality patient care they are trying to deliver? I don’t have all the answers, but I believe there is a perception among non medical professionals that the health care system has let them down. The study done years ago, which was widely trumpeted by the media, that there were thousands of deaths caused by medical errors, fueled this drive towards creating a standardized approach to medicine. But, of all professions, medicine is the one that least lends itself to such an approach. The human body is a remarkable creation, able to withstand unimaginable insults and attacks. Sometimes, however, the body breaks and a doctor is called to evaluate, diagnose and treat the ailment. This is where the art of medicine comes into play. And it is an art; a combination of knowledge, judgment, experience, insight and, sometimes, a bit of intuition. To try to create a cut and dried recipe for every conceivable clinical situation will lead to mediocrity and less than acceptable outcomes.

Should doctors be allowed to run wild? Certainly not. It is the responsibility of our medical schools and residency programs to teach and train the physicians of tomorrow to be informed, conscientious, and diligent; always putting the needs of the patient first. Students who fail to measure up should be steered into areas where their particular aptitude is best suited. Students who are perceived by the teaching faculty to be lacking the proper skills to be a quality physician should be directed into other fields. Once finished and out in the real world doctors always need to keep the patient’s needs in sight. At the same time our health care administrators need to allow doctors to practice unencumbered and, if a physician persistently performs in a substandard manner, corrective measures should be instituted.

This brings us back to the problem at hand. Rigid regulation, as I have attempted to demonstrate, can become detrimental to patient care. Every aspect of health care should be directed towards optimizing patient care and improving outcomes. Clinical guidelines may be helpful, but it must be remembered that they are guidelines only. Doctors now are forced to follow an ever growing list of rules and protocols which have never been shown to improve patient outcomes, but do carry the potential to be a detriment to patient care. Nurses are threatened with a variety of sanctions if they deviate from these protocols; protocols that have never been adequately explained, the rationale for each protocol remaining a mystery to many of these nurses. Indeed, I have been to meetings where the administrators who formulated these policies have demonstrated that they are totally clueless as to the reasons each protocol was established in the first place. Provisions in the Affordable Care Act call for the creation of more protocols and policy, attempting to standardize health care delivery. Such a plan can only be successful when humans are built in the same way we build cars and computers, everyone the same and with identical, interchangeable parts. I don’t see this happening anytime in the near future; in fact I hope it never happens. (see Brave New World, Aldous Huxley).

The United States has long been cited as having the best healthcare system in the world. It is the doctors and nurses who deliver this care that built this great system. Let them do what they have been trained to do.

Saturday, August 6, 2011

A Simple Solution

The rising national debt is on everyone’s mind and lips these days. The recent fight over the debt ceiling, the downgrading of the United States Government’s credit ratings, and political rhetoric from both Democrats and Republicans all point to an impending crisis that looms in the months and years to come. It’s not time to point fingers or attempt to lay blame on any individual or political party. The truth is that every one of the 545 government leaders is to blame (1 President, 435 Congressmen, 9 Supreme Court Justices). They make the laws, they do the spending, they should be able to fix the problems they create. It has become painfully obvious that such a fix, left to the politicians, will never come. It’s time for the people of this great country to take matters into their own hands and remedy this potentially disastrous situation.

First, however, let’s look at a few numbers. The current National Debt stands at about $14.5 trillion dollars or about $47,000 for each man, woman and child in this country. It increases by an average of $3.95 billion each day. Insurmountable, one may say; it can never be fixed; it’s too overwhelming. But, now is not the time for despair. There’s a very simple solution. Just think about it. When you were in school, elementary, middle school or high school and you needed to raise funds for a trip or new uniforms, your group would hold a fund raiser. A bake sale or car wash; candy or cookies sold to coworkers, gift wrap or such sold to willing family members all generated adequate revenue to send Little Johnny to New York to perform with the orchestra, or Suzy to the National Junior Tennis Championship. Why can’t our elected officials apply this tried and true method to raise the capital needed to balance the budget?

But, the deficits too high, they may whine; or we don’t have the time, they say. Nonsense. It’s time our elected officials took responsibility for the fiasco they’ve created. Donating a few hours on a Saturday afternoon isn’t too much to ask of Mr. Boehner when the fate of the nation is at stake. Let’s look at the numbers. There are an estimated 247 million vehicles in this country. Mandatory federal carwashes, held monthly and asking a donation of $6 per car would generate almost $1.5 billion per month or $18 billion/year. Just scratching the surface? Perhaps, but consider this. Every minute that Al Franken is buffing a 1967 Mustang is one less minute that he is in the Senate chambers, dreaming up ways to spend our hard earned money. And, at least we would be getting something more than hot air from those individuals that are supposed to be representing us. Of course, the hot air that they generate would go a long way towards drying off some of those vehicles.

Then there are paper drives. The amount of useless paper generated in Washington DC must measure hundreds of tons. Just the healthcare reform bill alone could pay down our debt significantly. Take all that useless paper and recycle it; entire forests would be saved and billions more dollars could be earmarked for debt reduction.

What else? There’s always the ubiquitous bake sale. Let’s send Nancy Pelosi into the kitchen to bake some strawberry tarts; I hear that Chief Justice Roberts makes a mean chocolate chip cookie. Who could resist buying apple pie from President Obama? I suspect that a national bake sales, held bimonthly could generate another $10 billion annually. What about selling government memorabilia or renting out space in the White House or House of Representatives. Bill Clinton had the right idea when he allowed supporters sleep in the Lincoln bedroom. I say, make it a weekly event.

“Sleep at the White House, have breakfast with the First Lady, only $10,000/night”. I think the calendar would be full months, if not years in advance. Want to go jogging with the President? For the sum of only $5,000 you can have his ear for two or three miles. Breakfast with Harry Reid? Yours for $2000.

Too little, too late? Perhaps, but it would be a start. And, it would instill a work ethic and a sense of camaraderie in our politicians that is badly needed. I say, let’s give it a try. And, if our elected officials resist; if they say it’s beneath them and not dignified; then I say it’s time to send them home and elect men and women that are willing to roll up their sleeves and be serious about fixing the problems that our past and present politicians have created.

Monday, July 11, 2011

Food Demons


My name is Father Runyon; you probably never heard of me, but in the supernatural world my name strikes terror into a legion of demons that devote their time and energy to terrorizing the unsuspecting, natural world around us. Who are these demons? What do they do? They enter our homes and take over our food, bringing their evil into our kitchens, restaurants and eventually into our bodies. That’s where I come in. The bread that refuses to rise, cookies that burn without the slightest provocation, spicy food that’s bland, bland food that’s spicy; all these and so many more are the results of this vicious cadre of food demons.


Of course my services are not nearly as famous as some other priests; those who cast out demons from possessed individuals, rare events that are overly publicized. Food possession occurs on a daily, no, hourly basis and my phone never stops ringing, my e-mail overflows and I can’t keep up with the texts. I have hundreds of thousands of followers on Twitter and my Facebook fans number in the millions; all grateful and faithful recipients of my unique talent.


By this time you must be asking yourself, “Father Runyon, how do you perform these miraculous tasks? I never knew our food could be so dangerous.”


Well, it’s time to face up to the truth. Let me give you an example: Aerosol Whipped Cream; harmless, tasty, visually appealing. But, let one of these cruel and unrelenting devils penetrate the metallic can and, literally, all Hell can break loose. Just imagine a hot fudge sundae: Ben and Jerry’s Chocolate Chip Cookie Dough ice cream, a generous dollop of Hershey’s Hot Fudge and then, to top it off, Extra Creamy Reddi Whip. You spritz it on and plan to sit down and indulge in this most decadent dessert, but the Reddi Whip refuses to stop, it just keeps coming and coming, overflowing the bowl, spilling out onto the table and then to the floor. Still it keeps coming, a relentless blob engulfing everything in its path. You and your family run screaming from the house as Reddi Ship pours from the windows and doors. Then you remember Rusty, your dachshund, trapped in his pen, undoubtedly drowned or crushed by this white, creamy tsunami. That’s when they turn to me. I get calls like this all the time. Luckily, in this case, I was able to stem the tide of dessert topping, banish the evil fiend to its rightful resting place in the depths of Hell and, happily, rescue Rusty from certain death. We found him, in his pen, passed out, but still breathing, his belly swollen to near bursting by the forced consumption of aerosolized whip cream.


This is just one example of food taken over by the nether world. Let’s talk turkey, as in Thanksgiving Day roast turkey with cornbread stuffing and giblet gravy. November 23, 2006, Great Wappinger Falls, South Dakota, the entire town sits down for a sumptuous, homemade turkey dinner and, just as Pastor Salvatore Linguini is about to slice off the first drumstick, as if on cue, every one of the 40 turkeys that Mrs. Elderberry lovingly roasted rose up and, en masse, attacked the good people of that God fearing town. The town was in a panic and, despite my best efforts, I got there a few moments too late. Poor Tiny Tim, only 19 years old and scheduled to leave for South Dakota State the following year on a football scholarship, was struck down by a knife wielding roast turkey. Let’s just say that from that point on, Great Wappinger Falls celebrated their Thanksgivings with quarter pounders with cheese; shunning turkey for good.


And then there are hot chicken wings. Invented in Buffalo, New York, at least according to legend. However, the truth is that these microcosms of Hell spring directly from the bowels of Satan. Harmless, you say; true a bit hot and spicy, but definitely tasty.


But, have you ever ordered your chicken wings mild, only to have them explode inside your mouth as molten relics from a demonic volcano, burning the unsuspected palate going in and coming out, sending the unfortunate soul into near convulsions. The diner complains, but the chef’s kitchen contains only normal “Frank’s Louisiana Hot Sauce” and, perhaps, a bottle of “Tabasco”. Leave it to Satan’s diabolical henchmen to so corrupt our favorite foods.


“How can we be safe?” you ask. “Is there any way we can be shielded from these evil forces emanating from the underworld?”


Call me, Father Runyon, at 888-555-HELL and my team of ordained priests, specially trained in all the latest exorcism techniques and incantations, will free you and your kitchen from the ravages of food demons. We’ll stop milk from going prematurely rancid, cast out the pesky oven imp, the one that causes casseroles to burn or overflow. We’ll rid your refrigerator of butter trolls and lettuce ogres and all for FREE; that’s right we won’t charge you one penny. Just a small donation to the Runyon Church Fund and expenses.


So, get rid of all your food worries, make your kitchen, dining room and pantry safe. Call Today!



Sunday, June 26, 2011

The Lost Light

XII.




I returned to my apartment and found an empty shell, windows cracked and broken, the grass brown and withered, littered with dead plants and the interior a wasteland of dead computers, televisions and every other appliance humanity had relied upon to ease the troubles of this world. I tried to turn on some of these electronic devices, without any success. Of course, there wasn’t any electricity, no running water, nothing. One portable computer, battery operated, briefly started up, but died as the power ran out. One thing that did work was the gas stove and I found some packaged food that was still edible.


I went out to find my neighbors and the few that had returned were in a similar situation. We pooled our resources and hoped that the leaders of the day would find a solution. Leaders, I thought, are there any leaders left in the world? They are probably in just as dire straits as everyone. At this moment I felt a tremendous sadness over what we had lost and I was more than a bit worried.


I was in my apartment shortly after my encounter with Dr. Greenwood, savoring the paltry dinner I had scraped together when I had a very unexpected visitor. Any knock on my door caused the hair on my arms and the back of my neck to stand up, but this visitor more than any. I peeked out the door and saw Meno waiting, alone. I pulled the door open a crack and was greeted with the same smile I had always loved.


“Hey, Doc. Can I come in? It’s just me.”


He was holding his side in a funny way as it became obvious why he was there. I opened the door and hustled him in; I glanced down the hallway for his entourage, but he truly was alone.


“What happened to you?” I asked, although it was obvious that he had been in some sort of altercation. I moved his hand away and a blood soaked towel fell to the floor.


“It seems that Tyrone didn’t like the way I was running things; thought I was too meek and not using all my influence as I should. We had a bit of an argument and I guess I lost.”


“No doubt about that”, I answered as I examined the wide gash in his right side. “This goes through the muscle, almost into the peritoneum. Another half inch and you’d of had a big gash in your colon and probably be dead or close to it. But, I think I can stitch you up. Let me get a few things.”


“Take your time, Doc. I’m not going anywhere. Nice apartment, at least I think it used to be nice. Could use a bit of spiffing up, but, then again, everything needs a bit of spiffing up these days. I guess that’s where me and Tyrone had our disagreement.”


“How’s that?” I rummaged through my closet and found my old emergency kit. I opened the case and found some suture and instruments. The vial of Xylocaine had only a few drops.


“I hope you don’t mind a bit of discomfort. I don’t have any local.”


“I’ll grit my teeth; maybe you got a bullet for me to bite on?”


The wound at least was a clean slash, obviously the product of an extremely sharp blade, the type so popular with the gangs of years past. It was as clean and straight as the sharpest scalpel could make, perpendicular to the skin and straight down through the muscle, stopping just above the transversalis fascia. Meno winced as I washed it out with bottled water and then I began to sew.


“So what happened between you and your buddy?” I asked. I really was curious and I also thought that the conversation might take Meno’s mind off the pain he surely was feeling.


“Well, Doc, Ow…I was thinking about Abraham Lincoln and his second Inaugural Address, ‘Charity for all, Malice towards none’ sort of thing. I mean look at the world now. All we have are memories of our old advanced society, at least technologically advanced. But, now we have to start to rebuild from scratch. I proposed that my followers set an example, actually to emulate the man we sent away; to be servant leaders and embrace our enemies, Ow.”


“Sorry, I’m being as gentle as I can. I take it Tyrone disagrees with this approach.”


“Tyrone believes it’s time for us to be on top, to take what we want or need. We’re the strong now; the people follow me, at least the people in this area. You know, Doc, I spoke at the old Arizona stadium a few days ago. It was overflowing with people and all I had was a megaphone. There must have been 80 thousand, young, old, men, women, children; all sitting silently, listening to my every word.”


“I guess you’re the new Messiah”, I observed. “I’m done with the deep layers, just the skin to close now.”


“Well, Messiah means ‘Anointed One”, which I certainly am not. If we all do what’s right we can put this world back together in months. If we fight, exploit and lord over the weaker members of society we’ll destroy ourselves once and for all.”


“Sounds like you’ve got the right idea, what’s the problem…Tyrone?”


“Tyrone and his buddies; all those that felt like society owed them something. Eddie also doesn’t seem happy, although he’s not as vocal or as prone to violence as Tyrone; usually he just goes with the flow, but he also likes being on top for once. Me, I guess I never had that feeling of being downtrodden; I was on my way to a better life when all this started. I mean, I always thought I’d be in politics, but not like this.”


“You’re way beyond politics”, I observed. “There, that’s the last stitch.” I covered the wound with a clean dressing as Meno got up.


“Thanks, Doc. Good work. I just don’t know if I have the courage, you know; the courage to stand up to an angry mob. So, what do I do? Give in and hate myself for the rest of my life or stand up for what’s right and commit suicide in the process?”


“Do what’s right”, I answered. “Years ago, one of the younger doctors came to me with what he thought was a big problem. He was a Urologist and he was caring for a patient that needed to be treated with a stent. The patient was in the hospital and didn’t have insurance; didn’t have any resources at all. This doctor was worried that if he placed the stent he wouldn’t be able to remove it at the appropriate time because of her lack of insurance. I advised him to treat the patient in the best way he could, not to compromise the care he provided because of a social problem. Physicians are called upon to care for the sick and injured, not just the well healed sick and injured. Do you see my point?”


“I understand, but it may not be that simple. Maybe, I have a sense of how Jesus felt. He prayed to god to take the cup away; to find another way, apart from the Cross, to bring salvation into the world. But God said no, ‘it’s my way or nothing’. But, I’m not Jesus; I’m not sure I’m ready to go the Cross.”


“These are the times that try men’s souls”, I answered, empty words that offered no solace. “Follow your heart and do what’s right.”


“Maybe, Doc. But it may not be that easy. Thanks for the patch job. See you around and be very careful”, he advised as I closed and locked the door. I soon learned that he was not the man I thought he was.



XIII.




A few relief efforts had barely begun when the violent gangs appeared. The paucity of resources led to hording of food, fuel supplies, clothing, even water. The age old story of haves being attacked by have nots led to this violence and destruction. They were mostly young men drawn together by their shared misery, individuals who found strength and power in the anonymity of the mob. There were also young women within the gangs drawn to or forced into a life of near servitude in order to survive. They were the strong ones at that moment and they mercilessly exploited the old and weak.


Meno was at the front of the largest gang. His was the most powerful; thousands followed him and his every utterance, every command led to more violence. Whispers through neighborhoods spread the news. There wasn’t any radio, television or internet. Those that were considered to have a useful skill, who had the potential to be an asset to the gang were made to join; the weak, disabled, mentally ill or those who just didn’t fit the proper mold were eliminated, cast off, thrown into the fire like garbage. And Meno smiled, and his friends smiled. I knew Meno would come for me one day. After all, I had some skills that were scarce, but also in great demand. All I could do was wait. I thought about his ideals, his desire to do good, those attributes that he had in the past; now buried away, pummeled into oblivion by the temptation that comes with the power to dominate and exploit. What good was he doing now? Abraham Lincoln he was not; Adolph Hitler or Joseph Stalin maybe.


“A new order has begun”, they said. “Only the strong can survive. There is no more God, no religion, only those of us who have the vision to see a future where we will be stronger than humanity ever dreamed.”


The entire scene reminded me of the old movie, Mad Max and, as I thought about it, the whole depressing scenario truly was a post-apocalyptic nightmare. Violence and death became the way of life. Civility, decorum, manners, whatever one wants to call it became vague memories of a world that was now dead and buried.


The irony has made our whole situation almost comical, but actually supremely depressing. The media always portrayed scenarios such as ours as the consequence of some human created disaster or natural disaster. The aforementioned Mad Max, a Boy and His Dog, The Omega Man and so many other books and movies seemed to share this idea. War or disease could wipe out everything and leave desperate shells of humanity in their wake. The apocalypse brought about by humanity’s failings or by Satan, perhaps, that I could accept. But, how could God, who is supposed to love us and has given so much of himself, how can he turn his back on his people. As I think about it now, I realize that it was not God that brought this upon us. It was our own fallen nature, Satan’s final triumph that is leading to our ultimate demise.


I refuse to put the leader’s name to paper; he had a choice; he could have led the people back to civilization, established order and reason. Instead he chose wanton destruction. I thought he was a friend, but I could never call anyone friend that could carry out such violence. If mine is the only record of these horrific days, let it be written that it was human nature that led to our downfall, not a single man and not God.


It was hard for me to gather the courage to leave my apartment. The streets were now a dangerous place and there was nothing there. Withered, dried up trees and bushes, replaced by the cactus that had flourished before the Light appeared. Eerie silence filled the air. The old sounds were gone; no cars or buses, no bustle of people moving from here to there. Only an occasional dog rummaging through piles of garbage, baking under the desert sun. The daytime was quiet; the heat discouraged even the heartiest soul, the marauders preferred the coolness and cover of the night. I walked along abandoned streets, staring up at a relentless blue sky. This was a different light, one that brought no comfort, only anticipation of violence and death.


I went by my brother’s apartment one day, even started to walk up to his door, but I couldn’t bear to see him again. Perhaps he was the only sane one, safe in his fortress living on Spam and beans.


I walked to Ace’s home, figuring he was living the life of luxury. The grounds were dried up, like everything else. I knocked on the door, but there was no answer. The door was open, however and I gingerly pushed it open and called his name.


“Ace, you home?” No reply. His “autocycle” was gone as were a number of other items. The kitchen was a mess of open cabinets and drawers, everything emptied. I saw a pair of feet in the backyard, behind a wooden fence.


“Ace”, I called as I ran towards the lone figure. There I found him, I recognized his shoes; he was propped upright in a lawn chair, his hands folded in his lap; a perfect picture of serenity that lacked only one item: a head for the body. This is no time for entrepreneurs, I thought as I carried the headless body into the yard and buried it in a shady spot behind the garage.


“I guess it’ll be my turn soon”, I said out loud.


I left Ace in peace and wandered through the decaying streets of what had once been a bright, vibrant city. The desert sun scorched my neck and arms, but I was oblivious to the burning; the emptiness in my soul burned far more. Some people were about, foraging for anything little thing that could ease the pain and poverty of this new life “under the sun”.


A crowd approached and I saw my brother at the forefront.


“John, John; it’s Dan”, I cried.


He stopped as I approached and those following him also stopped.


“What’s all this; where are you off to?” I asked, curious, but also a bit fearful of this unknown mob following a man who recently had been holed up with a lifetime’s supply of Spam and beans.


“We’re going to find the Tree of Life”, he said enthusiastically.


“How do you know that it’s here and where to find it?” I inquired, even more curious.


“Listen, I was wrong about the Morlocks, OK. We had a rebirth of the Garden of Eden, didn’t we? And, in the center of that Garden is the Tree of Life and there should also be a Tree of Knowledge of Good and Evil. All we have to do is find the center of the Garden and we’ll be there. We eat from the tree and, bingo, we’re good forever.”


“Where’s the center?” I was almost afraid of his answer.


“Well, if the whole earth was “the Garden”, then it would be at the center point for the planet.”


“You’re going to the earth’s core?” A touch of sarcasm accompanied my question.


“That actually was my first thought, but that doesn’t make sense, I mean Hell would be there. No, after a great deal of thought, and a vote of all the people, we decided that Centerville is the place.”


“Centerville?”


“Centerville, Texas, to be exact. Halfway between Dallas and Houston, the perfect spot.”


I shook my head and then turned to all his followers. I saw a mass of tired, bedraggled people who shared only one thing: a look of hope. I couldn’t bring myself to say anything that might shatter that hope, the only thing left of any value in this world.


I smiled and held out my hand.


“Good Luck, John”, I said as we shook hands, “And good luck to all of you. Don’t forget me when you reach Centerville.”


The followers all wished me well as they left, a few implored me to go with them, but I politely declined. I slowly walked back to my apartment. I wondered about Phyllis and Dr. C and even went by their house, but it was empty, abandoned or worse.


I passed by the spot Dingo had occupied, waiting for his Savior. Dingo was gone, only a pile of rotting apple cores remained. I wondered if he had left with Jesus or had become a victim of the mob. I suppose it didn’t matter. His was a faith that couldn’t be shaken and either way he was now in God’s house, perhaps reunited with his mother who loved the lord in such a strong way.


Finally, I reached my apartment and made my way up the stairs. There needs to be a record made, the truth about these times saved for future generations. I suspected that time was short, at least for me. They would come; he would come and it would be the end. I could never join him; death would be preferable.


Darkness was falling now. Soon they’d be out and no one would be safe. I need to put all this down while I still could.



As I record my thoughts I realize one of the great truisms of the world. “Those who don’t learn from history are destined to repeat it. I think it’s now too late. It’s only a matter of time before we destroy ourselves. Memories of the abundance we used to have fuel hatred now. But, how could you let this happen, dear God; surely an omniscient God would have looked into the hearts of his creation and seen that all that was inside was hard stone. Love and Charity and goodness had long been replaced by a myriad of games, drugs and every other hedonistic desire imaginable.





As I finished writing there was a loud, crashing noise in the corridor outside and I heard voices outside my door. I put my writing in the desk drawer, in a panel hidden beneath the middle drawer, and I picked up my nine millimeter weapon. They were coming now, he was coming now and I knew that there was no reasoning, nothing I had that could satisfy their lust for death and destruction. Humanity finally unleashed. Joseph Conrad said it best, “The Horror, the Horror.”


And, somewhere, perhaps on a lone mountaintop looking out over the world or in the crowd that followed Meno and urged him on to greater destruction, Satan smiled.




(I originally ended the story at this point, but was told by my retired partner. Dr. Ebeid, that it left the reader in despair. I added the next chapter to provide some hope, Let me know which ending you prefer.)



Afterword



The words you’ve just read were recounted to me by my mother, Miriam. Dr. Marcus was my father and before his death he told her his story. His exact words were stored in her remarkable memory and she passed those words and his writing on to me. Almost every night she would sit with me and tell me the tale and I committed every word to memory, just as she did, to be passed on to the next generation. She witnessed the final conflict and was with my father at the end. Here is what happened:



The mob burst into the room as two shots rang out; both came from Dr. Marcus handgun. Two of Meno’s gang fell to the floor before the doctor was subdued. He was carried out into the street and, just as the doctor anticipated, Meno came to him. The grand leader was dressed in a dark suit and he wore dark glasses, even though it was nighttime. In a gesture reminiscent of Judas in the Garden of Gethsemane he approached my father and kissed him on the cheek.


“I considered you a friend”, he said to my father, “a man with special talents; someone who could have joined me to help rebuild this world. But, you have rejected me and this is something that I cannot forgive.”


All this time Dr. Marcus was restrained by two of Meno’s henchman. As Meno spoke to him, my father relaxed, which cause his captor’s to relax. He gestured for Meno to come closer, that he had something to say to the “great” leader.


“You…you could have helped bring light back into the world”, he said in a weak raspy voice. “You could have followed the example set by Him. Instead, you are leading the people to death and destruction. God knows this and in the end you will be judged and you will pay for your sins.”


Meno laughed. “God has forsaken this place. We are all alone and it is I who sits in judgment now. It is I who sentence you… to death And, because you put such great faith in this God who has abandoned us, you will die in a truly biblical way. Take him.”


Meno leaned forward as if to kiss him again. At that moment my father jerked his hand free and his arm shot out with a powerful and carefully measured back hand slash. The retractable scalpel blade found its mark with a surgeon’s precision; blood spattered my father as it sprayed out of Meno’s severed carotid artery and filled the hole that had been sliced into Meno’s trachea. In less than five minutes Meno lay dead on the ground.


The mass of people stared in disbelief at Meno’s lifeless body. Out of the silence, Tyrone jumped forward.


“You will pay dearly for this crime”, he hissed between clenched teeth, but he also had a sly smile on his face.


They took my father and beat him and carried him down the street. They chained him to a fence and, in true Old Testament fashion, they stoned him, mercilessly. My father went calmly, telling his attackers that they should put their faith in God, that He hadn’t abandoned humanity and that He would return. The Bible said so and nothing could be more true. He repeated the words over and over, until there was nothing let of him, only a bloody pulp; left for dead by the raging mob.


As the mass of people moved away, one person stayed behind, my mother, Miriam. She had been looking for him ever since their brief encounter; to tell him she was carrying his child and, perhaps, to fashion some sort of life together, facing the hardships of a world gone mad together. She had followed, shrouded by the safety of the crowd, protected by the anonymity of the mob, led by a sixth sense that told her that somehow Meno and my father were destined to meet.


She freed him from the wire fence and was surprised when she felt him take a breath. He opened his eyes and gave her a faint smile and she smiled back.


She took his mangled, bloody hand and placed it on her rotund belly and whispered, “This is your child that’s growing inside of me. I’ve been looking for you for months and now you know that a part of you will live on.”


I’m sure that in those dying moments he didn’t remember her or truly understand that it was his child that was growing inside her; I suppose it didn’t really matter. It was then that he told her his story and she committed every word to memory. He told her where to find his written record and the Bible that was stained with The Savior’s blood. And, he told that even though the world was chaos and destruction and death seemed to rule the day, there was still hope. The words of Revelation had not yet been fulfilled and Jesus would return again to vanquish evil and bring the new Jerusalem to all those who believed.


That was thirty years ago. Miriam is gone, Tyrone is gone, but the Word made flesh lives on. Now, our numbers grow everyday. The ravages of war are past and humanity is rising from the ashes like the phoenix, rebuilding this earth and carrying God’s word to every corner of the world. The blood on this Bible cannot be washed away. His blood brings hope and salvation to all of us.