Dealing with Tragedy
It’s been decades since the near disaster; the time when all of our society hung by the thinnest of threads and only the strength and fortitude of one small boy saved us all from our short sightedness. As I look back over the years I am astounded and a bit saddened by what has happened to all of us that were engulfed by the events of the day.
Of course the exploits of the two heroes have been widely reported in the tabloid media over the years. Horton, the noble steadfast beast, remained true to his principles for a period of time, but even he was unable to avoid scandal.
The sordid affair with Miss Maisey producing a bastard child eventually drove that pachyderm to a lifelong addiction to peanuts. Although he protested loud and long, claiming that he had only the noblest intentions, the product of their illicit union could not be denied. Horton did acquit himself to some degree over the years, raising his elephant bird son, eventually sending his unique offspring to veterinarian school before the lad was tragically crushed while caring, ironically, for an elephant at the Miami Zoo.
Horton overcame the subsequent depression and, after a stint at the Betty Ford Clinic, went on to star in several movie adaptations of his life and win an Oscar nomination for Best Supporting Actor for his role as lead elephant in Tarzan and the Leopard Men. After penning his memoirs he settled down in The Bronx, where he continues to live with his wife, Esther. In a recent interview he was quoted:
“I’ve lived a long and full life with enough adventure for ten elephants. I have to say that through it all I’ve remained true to my principles treating everyone equally, with compassion and the right amount of love and kindness. And, for those of you that have tried to wrong me over the years” he added while popping a peanut into his mouth, “I have to say, be careful, be very careful, I won’t forget…I’ll never forget.”
The other hero of note was Jo Jo, only a young boy at the time. But, it was his timely “YOPP” that saved us all. Of course, he was celebrated in both print and electronic media and his fame spread. Only a few years later he went on tour with his rock group, “Jo Jo and his Yo-Yo’s”. They played to packed houses for two summers straight and there song “Yipps and Yopps” stayed at number one on the Billboard charts for five months straight.
After a few years, however, his star began to fade. Addiction to heroin plagued him and less than ten years after reaching the pinnacle of success and fame he was found dead, with a needle in his arm, at a crack house on 17th Street. His band tries to carry on without him and you can still see them on Thursdays, here in town at Lena’s Café.
Mother Kangaroo tried to rise above her role, claiming that her only crime was ignorance and that Horton should have been more forthright and insistent regarding his claims. She said in the weeks that followed the events that she feared for the safety of her young son, that a crazed, wild elephant posed a great danger to the jungle. She realized later that it would have been better to humor Horton at the time, but she was trying to set a good example for her son; that it is always best to confront danger, rather than hide.
She eventually, after her children were grown, had a brief affair with a Tasmanian Devil, before marrying the Lorax and finally settling down. They formed the nonprofit organization, “Green Against Pollution” which championed “Green” technologies and fought against waste and exploitation of our natural resources. Mother Kangaroo’s most successful campaign was against the use of beezle nuts and beezle nut oil, citing the considerable smoke that could pollute the air when this oil is used for cooking as well as the dangers of intoxication when excessive quantities of this particular nut are ingested.
Her son, Angus Kangaroo, made a name for himself some years after the near tragedy. His book, “Momzilla, Life in the Pouch”, hit number one on the New York Times best sellers list and stayed there for sixteen straight weeks. He eventually came out and spoke out strongly for “Kangaroo Rights”, battling years of built up prejudices against Kangaroos and their many marsupial relatives. His second book, “I have a Pouch and that’s OK”, although not selling as well as his debut, received much critical acclaim and raised awareness about the plight of marsupials everywhere.
The greatest tragedy that followed our near demise was the suffering of the Wickersham Brothers. The guilt of having nearly destroyed an entire civilization was more than the three of them could handle.
The eldest, Hiram Wickersham, was found hanging from a beam in his jungle apartment only three weeks after the events. The note only said “I’m Sorry…I’m Sorry”.
Elrod Wickersham, the youngest, immediately hit the talk show circuit, claiming that he never wanted to boil that dust speck, as was widely reported. He was only going along with his brother’s wishes and claimed that he never intended to go through with the horrible deed; that he would have stopped them before it was too late; that he also feared for his own life and that if he interfered he would have found himself belly up in a boiling cauldron of beezle nut oil. Of course, he became an outcast from society, never able to clear his name and eventually joined a monastery in Perth.
Ambrose Wickersham, the middle brother, earned even more notoriety in the years to come. He never apologized or denied any wrongdoing in the Whoville affair. In fact, in the aftermath not a word was heard from him. Two years later he was photographed throwing stones at an elephant in the Houston Zoo and it was only a short time later that his hatred for all elephants came to light. It seems that the Wickersham’s father was crushed to death by one of the elephants in the “Outback Circus”, part of a combined elephant/monkey act. Although an investigation proved the death was an unavoidable accident, Ambrose was never able to forgive the elephant and harbored a lifelong enmity towards all elephants, be they Indian or African. Only a few years ago he died in a manner similar to his father. He climbed into the elephant enclosure at the Sydney Zoo and taunted the residents until they charged him and he was trampled. The death was ruled a suicide by the Sydney Coroner’s Office.
Valad Vlad-I-Koff, the eagle that cast our home into the vast field of clover actually came out unscathed. He claimed that he was trying to save us by hiding us from the vicious mob and deranged elephant in one place where we would be safe, the field of clover. I almost believed him at the time, but later eyewitness accounts refuted his claims. Still, he became a successful businessman, starting “Eagle Courier Services”, a company that specialized in overnight deliveries. Rumors abounded a few years ago that the company was involved in delivery of illegal drugs and merchandise, but these allegations remain unproven and Valad sold the company only last year and retired to Palm Beach, Florida.
As for me, the Mayor, I have weathered the years, staying in my position as Mayor of Whoville for forty one years. The near disaster led to a call for more safety measures and plans were made to construct a bright beacon that would make our presence known to the smallest being in the outside worlds. In addition, work was begun on a powerful amplifier, something to make all the outsiders aware of our presence. Political infighting stalled all these projects and then the faltering economy and shrinking tax base forced us to abandon them completely. I never married, as my child hood sweetheart, Cindy Lou, chose to marry that professional baseball player instead. I heard that he has mistreated her terribly, but I can’t say for sure.
So now I spend my days walking in the park, feeding the ducks and reminiscing over those old days. Every day I stop and admire the statue of Horton that sits in the middle of Whoville Park. The ears and trunk have turned green over the years, but the statue still stands as a reminder to all the generations of Who’s, reminding them and us of the fate that we narrowly avoided.
For those of you that don't remember "Horton Hears a Who" here is a link to the text of the story by Dr. Suess http://www.johnhenrybikes.com/newsletter/horton.htm
Saturday, September 18, 2010
Saturday, September 4, 2010
Airport Security
I recently had the pleasure of flying from Houston to Albany, NY, the occasion being a visit to my parents. As always, I arrived at the airport more than an hour before my scheduled departure time, even though I only had a carry on bag. These days you never know about the line to pass through the security checkpoint. Thankfully, the line was pretty short and I was able to spend my time sitting by the gate, instead of standing in line.
As I approached the security checkpoints, I performed the usual preparatory actions: had my boarding pass and ID in hand for the security guard and then went through the ritual partial disrobing. I put my laptop computer, wallet, keys, cellphone, watch, belt, shoes and my bag in the gray plastic bins and prepared to pass through the metal detector, clutching the waistband of my pants, lest they unceremoniously slide down to my knees. I managed to pass through without setting off any bells and whistles, sat down to get myself dressed and while doing this thought about this ritual I had just experienced.
I suppose it makes sense to separate metal objects I guess, although these days I think most explosives are made of plastic of some sort. Taking the belt off is necessary because most belts have some metal in them and could set off the metal detector. Removing the shoes is in response to the shoe bomber, Richard Reed, although I suspect there are some shoes that could serve as terrorist weapons without any hidden explosives.
I thought about the “Shoe Bomber” and removing one’s shoes. Shoes at the time were a fairly good hiding place; something ubiquitous and unassuming. The requirement that shoes now be removed and scanned seems to be a perfectly reasonable response to that past event. But, wasn’t there recently an “Underwear Bomber?” It seems to me that an appropriate similar response to this new threat is called for. Unless this issue is properly addressed underwear will remain a viable option for transporting bombs. I realize that it is not practical for every passenger to remove his or her underwear while passing through security. The time for each passenger to remove their underwear and then dress would be way too long. Plus, I could see some people wanting to go through the line even if they weren’t flying anywhere. One solution would be to make it illegal to fly while wearing underwear. Of course, objections to this plan would inevitably be raised by the pro-underwear crowd and it is likely that the ban on flying with underwear would probably be found to be unconstitutional by the current Supreme Court.
Perhaps, random underwear checks could be done. Every tenth person could be required to submit to a thorough undergarment inspection. Passengers who objected to such violation of their personal space could be given the opportunity to declare that they are sans underwear, which could be confirmed by a quick peek which would add a mere few seconds to the security process. Women wearing thongs also could make such a declaration. After all, no respectable bomb could fit inside a thong.
There are a few other flaws in the current screening procedures. I’ve recently learned that terrorists are finding newer and more clever ways to smuggle their explosives aboard. Apparently, plastic surgeons are being recruited to perform breast augmentation on would be suicide bombers, utilizing breast implants filled with explosives. If this is true then a new line of security becomes necessary. Personnel with special training and very experienced in examination of the breast would become necessary to discern the subtleties inherent in an explosive breast implant.
With the changes that have come in health care I see this as a new and potential lucrative revenue stream for general surgeons and gynecologists who have suffered decline in income as reimbursement has fallen for traditional health care. In addition, there will be a need for proctologists as terrorists go beyond shoes and underwear and start carrying their explosive devices inside body cavities. In order to perform complete exams only proctologists capable of palming a basketball would be qualified.
It is possible that future screening procedures will require several stations. I can just hear the chatter: “Right arm up over your head…Left arm up…bend over…next…hey captain, come check these out…next”. I think retired doctors would be best suited to such work.
These security measures may seem drastic to the typical lay person. But, dangerous times demand appropriate and effective methods to outwit the evil forces that lurk in the shadows. These few modest proposals would go a long way towards deterring these desperate, would be assassins and would help make our skies safe for us and for our children.
As I approached the security checkpoints, I performed the usual preparatory actions: had my boarding pass and ID in hand for the security guard and then went through the ritual partial disrobing. I put my laptop computer, wallet, keys, cellphone, watch, belt, shoes and my bag in the gray plastic bins and prepared to pass through the metal detector, clutching the waistband of my pants, lest they unceremoniously slide down to my knees. I managed to pass through without setting off any bells and whistles, sat down to get myself dressed and while doing this thought about this ritual I had just experienced.
I suppose it makes sense to separate metal objects I guess, although these days I think most explosives are made of plastic of some sort. Taking the belt off is necessary because most belts have some metal in them and could set off the metal detector. Removing the shoes is in response to the shoe bomber, Richard Reed, although I suspect there are some shoes that could serve as terrorist weapons without any hidden explosives.
I thought about the “Shoe Bomber” and removing one’s shoes. Shoes at the time were a fairly good hiding place; something ubiquitous and unassuming. The requirement that shoes now be removed and scanned seems to be a perfectly reasonable response to that past event. But, wasn’t there recently an “Underwear Bomber?” It seems to me that an appropriate similar response to this new threat is called for. Unless this issue is properly addressed underwear will remain a viable option for transporting bombs. I realize that it is not practical for every passenger to remove his or her underwear while passing through security. The time for each passenger to remove their underwear and then dress would be way too long. Plus, I could see some people wanting to go through the line even if they weren’t flying anywhere. One solution would be to make it illegal to fly while wearing underwear. Of course, objections to this plan would inevitably be raised by the pro-underwear crowd and it is likely that the ban on flying with underwear would probably be found to be unconstitutional by the current Supreme Court.
Perhaps, random underwear checks could be done. Every tenth person could be required to submit to a thorough undergarment inspection. Passengers who objected to such violation of their personal space could be given the opportunity to declare that they are sans underwear, which could be confirmed by a quick peek which would add a mere few seconds to the security process. Women wearing thongs also could make such a declaration. After all, no respectable bomb could fit inside a thong.
There are a few other flaws in the current screening procedures. I’ve recently learned that terrorists are finding newer and more clever ways to smuggle their explosives aboard. Apparently, plastic surgeons are being recruited to perform breast augmentation on would be suicide bombers, utilizing breast implants filled with explosives. If this is true then a new line of security becomes necessary. Personnel with special training and very experienced in examination of the breast would become necessary to discern the subtleties inherent in an explosive breast implant.
With the changes that have come in health care I see this as a new and potential lucrative revenue stream for general surgeons and gynecologists who have suffered decline in income as reimbursement has fallen for traditional health care. In addition, there will be a need for proctologists as terrorists go beyond shoes and underwear and start carrying their explosive devices inside body cavities. In order to perform complete exams only proctologists capable of palming a basketball would be qualified.
It is possible that future screening procedures will require several stations. I can just hear the chatter: “Right arm up over your head…Left arm up…bend over…next…hey captain, come check these out…next”. I think retired doctors would be best suited to such work.
These security measures may seem drastic to the typical lay person. But, dangerous times demand appropriate and effective methods to outwit the evil forces that lurk in the shadows. These few modest proposals would go a long way towards deterring these desperate, would be assassins and would help make our skies safe for us and for our children.
Saturday, August 28, 2010
Genius Phones
F. N. Stein and IBS Computing announced today that they have completed design and construction of the next generation of smart phones. The new ultra portable phones are completely implantable, combining the latest in biocompatible materials with the most powerful nanotechnology ever developed.
“This new technology far exceeds the technology offered by the existing I- Phone or Android systems. The Q Phone, as it is called, comes in two parts which are implanted under the skin of the user, a receiver implanted in front of the ear and a transmitter implanted beneath the buccal mucosa within the mouth,” stated Dr. Stein, CEO of F.N. Stein.
He went on to add that the convenience and power of these phones will bring new meaning to the term “smart” phone.
“If the existing technology is called smart, these will have to be dubbed genius”, Dr. Stein gushed. “It will no longer be necessary to carry your phone in your pocket or on your belt and you can get rid of those ugly Bluetooth ear pieces once and for all.”
Dr. Stein went on to explain that the new phone automatically integrates with signals from your brain to dial a contact in a nanosecond. Conversations are completely private as the transmitter can send a clear signal even if it is only the faintest whisper. Incoming calls are audible only to the receiver and text messages are transmitted directly to the cerebral cortex. It will no longer be necessary to fumble with your phone or push buttons or “swipe” icons back and forth. The Q Phone is 100% intuitive and functions are executed with only a quick thought.
“The Q Phone goes far beyond “hands free”, Dr. Stein proclaimed. “It’s almost speech free. The controversial ‘driving while texting’ debate will become ancient history as these phones free the driver to concentrate on the road, even while sending out and receiving messages with just a thought.”
There are already hundreds of thousands of useful and unique “apps” for the Q Phone. Besides the obvious GPS or reading apps, the new technology expands the possibilities, making this phone truly worthy of the name “genius”.
Expected to be among the more popular applications is the new Date Buddy. This completely free app will be your coach during those trying moments when you are trying to make time with that hot babe at work. Instead of the usual fumbling for the right words, the Date Buddy will automatically monitor the conversation and transmit witty sayings to the subscriber, guaranteeing that the target will be swept away by the users dashing and debonair manner.
For the user expecting to appear on “Jeopardy” the Q Phone has instant access to the entire Internet, discreetly and secretly. The Wikipedia app can bring the entire online encyclopedia to the tip of your tongue instantly guaranteeing that even the dullest user will appear intelligent and sophisticated.
“We’re expecting to be able to release these implantable phones before the second quarter of 2011. We’re still working out a few bugs with the implant technology. Right now it requires a visit to the doctor to have the devices properly implanted. We’re hoping that a self implantation kit will be feasible before the final version is released”, Dr. Stein reported.
There was no immediate comment from representatives of Google, makers of the Android platform; however, Steve Jobs was quoted as saying “This implantable phone is pirated from technology developed by Apple. The IPhone 5 was slated to be such a device. We intend to file a patent infringement suit in Superior Court next week.”
Dr. Stein laughed off Mr. Job’s comments, saying that he had been working on this sort of device for decades.
More information is available at http://www.geniusqphone.com
We at “Heard in the OR” will keep you posted as this story develops.
“This new technology far exceeds the technology offered by the existing I- Phone or Android systems. The Q Phone, as it is called, comes in two parts which are implanted under the skin of the user, a receiver implanted in front of the ear and a transmitter implanted beneath the buccal mucosa within the mouth,” stated Dr. Stein, CEO of F.N. Stein.
He went on to add that the convenience and power of these phones will bring new meaning to the term “smart” phone.
“If the existing technology is called smart, these will have to be dubbed genius”, Dr. Stein gushed. “It will no longer be necessary to carry your phone in your pocket or on your belt and you can get rid of those ugly Bluetooth ear pieces once and for all.”
Dr. Stein went on to explain that the new phone automatically integrates with signals from your brain to dial a contact in a nanosecond. Conversations are completely private as the transmitter can send a clear signal even if it is only the faintest whisper. Incoming calls are audible only to the receiver and text messages are transmitted directly to the cerebral cortex. It will no longer be necessary to fumble with your phone or push buttons or “swipe” icons back and forth. The Q Phone is 100% intuitive and functions are executed with only a quick thought.
“The Q Phone goes far beyond “hands free”, Dr. Stein proclaimed. “It’s almost speech free. The controversial ‘driving while texting’ debate will become ancient history as these phones free the driver to concentrate on the road, even while sending out and receiving messages with just a thought.”
There are already hundreds of thousands of useful and unique “apps” for the Q Phone. Besides the obvious GPS or reading apps, the new technology expands the possibilities, making this phone truly worthy of the name “genius”.
Expected to be among the more popular applications is the new Date Buddy. This completely free app will be your coach during those trying moments when you are trying to make time with that hot babe at work. Instead of the usual fumbling for the right words, the Date Buddy will automatically monitor the conversation and transmit witty sayings to the subscriber, guaranteeing that the target will be swept away by the users dashing and debonair manner.
For the user expecting to appear on “Jeopardy” the Q Phone has instant access to the entire Internet, discreetly and secretly. The Wikipedia app can bring the entire online encyclopedia to the tip of your tongue instantly guaranteeing that even the dullest user will appear intelligent and sophisticated.
“We’re expecting to be able to release these implantable phones before the second quarter of 2011. We’re still working out a few bugs with the implant technology. Right now it requires a visit to the doctor to have the devices properly implanted. We’re hoping that a self implantation kit will be feasible before the final version is released”, Dr. Stein reported.
There was no immediate comment from representatives of Google, makers of the Android platform; however, Steve Jobs was quoted as saying “This implantable phone is pirated from technology developed by Apple. The IPhone 5 was slated to be such a device. We intend to file a patent infringement suit in Superior Court next week.”
Dr. Stein laughed off Mr. Job’s comments, saying that he had been working on this sort of device for decades.
More information is available at http://www.geniusqphone.com
We at “Heard in the OR” will keep you posted as this story develops.
Saturday, August 14, 2010
Don't Think
I read a missive from hospital administration recently, posted on the wall in the physicians work area at one of the hospitals. The message read something along these lines:
“Per JCAHO* regulations physicians should refrain from writing orders allowing for a range of medication to be administered. Specifically, pain medication orders should not say:
Dilaudid 1-2 mg IV Q3h prn pain
Instead such orders should be written:
Dilaudid 1 mg IV Q3h prn moderate pain
Dilaudid 2 mg IV q3h prn severe pain
Orders written in the former manner, allowing for a range of dosage allow the nurse administering the medication to make independent judgment decisions. Such decision making is not permitted under the nursing licensure.”
My reaction to this directive was that the lunatics are in charge of the asylum and everyone should run for cover. Nurses are to become robots, methodically passing out meds and dutifully charting when the patient last belched, while ignoring their patients overall wellbeing. I asked several of the nurses in various hospitals their opinion of this rule. I pointed out that, to me, there wasn’t any difference between the two orders. What they said was a bit disconcerting. The nurse is supposed to ask the patient about the severity of their pain and then medicate accordingly. So, if the patient responds that he is feeling severe pain he is given the higher dose, no questions asked.
Now, I’ve been in practice for over twenty years and I can tell you that pain; its intensity, quality, severity and every other aspect is the most subjective of clinical symptoms. I’ve had patients, who have undergone a very minor procedure, tell me the pain is the most excruciating they’ve ever felt, while others, who have just undergone a major abdominal surgery with a stem to stern incision, report only mild discomfort.
There are patients who appear nearly comatose after surgery, barely arousable, but will state that their pain is severe and will request their medication every three hours on the dot. In this situation, what is the nurse to do? Blindly administer the higher dose prescribed for severe pain or actually think that the patient’s pain may not be as severe as reported and give the lower dose, and/ or call the doctor to have the medication adjusted.
No matter what, a good nurse has to use her best judgment to care for her patient in the most compassionate, but also clinically appropriate, manner possible. Patients, who are human, have widely varying ideas of what the hospital experience should be, particularly when it comes to pain. For some, pain relief means completely numb from head to toe; for others it means just enough medication to have the edge taken off. Most are somewhere in the middle. The nurse serves as the doctor’s eyes, learns to make a proper judgment and provides a continuous image that complements the snapshot the doctor receives on daily rounds.
The idea that nurses not be allowed to think echoes the words of one of my medical school instructors, Dr. John Adams. In the early 1980’s I was at the University of Rochester Medical School in upstate New York. Dr. Adams was the classic curmudgeonly surgeon. Loud, intolerant of ignorance or incompetence by subordinates, he often chastised the residents on his service for writing orders with a dosage range in the way that is now prohibited. He must be working for the JCAHO, because his exact words were:
“Don’t write Demerol 50-75 mg IM q3h. That allows the nurse to think; we don’t want the nurses to think. Their job is to do what they are told to do.”
Who would have thought chauvinistic Dr. Adams was such a visionary?
Actually, I don’t think that he had such a low opinion of nurses, rather, I believe, he was trying to drive home a message to the residents and students: orders should be clear and specific. Such clarity allows the nurse to perform her task efficiently and provide the patient with the best care possible. Doctors and nurses are a team, working together to help an individual who is sick or injured recover and return to a normal life.
Years ago I read a study on factors affecting outcomes on critically ill patients. I don’t remember which journal it was in, but the study looked at ICU patients and a number of variables that could have an effect on the patient’s recovery. The only variable that made any difference was the quality of nursing care.
This makes perfect sense to me. The critically ill patient requires continuous monitoring. Most of the time it is the nurse that is at the bedside checking vital signs, urine output, oxygenation and every other parameter that may be indicative of the patients well-being. The best ICU nurses will pick up on subtle changes that could be harbingers of impending deterioration in the patient’s clinical condition. If such nurses are shackled by the “don’t think and don’t make judgment” rules, these critically ill patients will suffer.
Besides acting as physician’s eyes, nurses also provide a level of protection for the patient. If an order is written or a medication prescribed that seems to be in error the nurse is there to question it. Despite what some doctors may believe, we physicians are not perfect and sometimes errors are made. A vigilant nurse often picks up on this, questioning the order; calling the doctor for a “clarification” (correction). Sometimes it is an omission that needs to be brought to the doctor’s attention. In all situations the nurse is the patient’s advocate, doing his or her best to smooth the often bumpy road to recovery.
Doctor’s, by necessity, approach patient care from a very different angle than nurses. Medical School and residency teach us the underlying pathophysiology and the clinical manifestations of various diseases and medical conditions. We take this information and establish a diagnosis and institute a therapeutic plan. Our primary purpose is to see that the disease process is properly treated and see the patient to a complete recovery or at least keep chronic diseases under control.
Nurses share in this goal, but along the way they are often called upon to provide comfort, counseling and to allay fears. The nature of their profession allows nurses to do this in a way doctors cannot. The best nurses always seem to find the time to sit with their patients, provide reassurance and still manage to do all the ridiculous charting and filling out of seemingly endless forms that generate reams of paper that no one ever looks at.
In the middle of these essential activities the nurse often have their carefully planned schedule disturbed by a million other tasks, usually accommodating the interruption with a smile and a shrug of the shoulders. I know that when I have asked nurses to help with a bedside procedure they are only eager to help and always insist on finishing up all the cleaning and reordering of the patient room when I am finished. I sometimes wonder if it is eagerness to do all they can to help or if they really want to be sure that the patient’s room is properly returned to an orderly state.
Nurses are truly amazing in their ability to calm anxiety, inform ignorance, allay fear, provide comfort, stroke egos (especially OR nurses), see us all at our worst moments and invade our most intimate places and do it all with a smile and a wink that says “I know you don’t feel well now, but just give us a little time and you’ll back home with your loved ones before you know it.
I may be a bit biased towards nurses. After all, I married one; Laura, my wonderful, beautiful, intelligent wife of twenty five years, the cutest little nurse I had ever seen, always took the time to talk to her patients, share their feelings and make sure that all their treatment was delivered in the best, most professional manner. When we first met I think I used to exasperate her by my asking for patients’ vital signs and her appraisal of their condition. But, we shared our concern for the patients’ well being and have continued to share for twenty five years.
Nurses and doctors, along with surgical technicians, respiratory therapists, physical therapists, occupational therapists, speech pathologists, patient care aids and all the other allied health personnel, share a common goal; that is to treat the sick and injured and allow them to return to happy, healthy, productive lives. The doctor provides the diagnosis and overall therapeutic plan, institutes the plan’s delivery and makes alterations and interventions when necessary. The nurse provides the monitoring, the immediate delivery of therapy, nurturing, comforting and compassion on a continuous basis. If our nurses are not allowed to “think” our patients will end up suffering, with longer stays in the hospital and some, I am sure, will never leave the hospital.
It is something for all of us to think about.
*Joint Commission on accreditation of Healthcare Organizations
“Per JCAHO* regulations physicians should refrain from writing orders allowing for a range of medication to be administered. Specifically, pain medication orders should not say:
Dilaudid 1-2 mg IV Q3h prn pain
Instead such orders should be written:
Dilaudid 1 mg IV Q3h prn moderate pain
Dilaudid 2 mg IV q3h prn severe pain
Orders written in the former manner, allowing for a range of dosage allow the nurse administering the medication to make independent judgment decisions. Such decision making is not permitted under the nursing licensure.”
My reaction to this directive was that the lunatics are in charge of the asylum and everyone should run for cover. Nurses are to become robots, methodically passing out meds and dutifully charting when the patient last belched, while ignoring their patients overall wellbeing. I asked several of the nurses in various hospitals their opinion of this rule. I pointed out that, to me, there wasn’t any difference between the two orders. What they said was a bit disconcerting. The nurse is supposed to ask the patient about the severity of their pain and then medicate accordingly. So, if the patient responds that he is feeling severe pain he is given the higher dose, no questions asked.
Now, I’ve been in practice for over twenty years and I can tell you that pain; its intensity, quality, severity and every other aspect is the most subjective of clinical symptoms. I’ve had patients, who have undergone a very minor procedure, tell me the pain is the most excruciating they’ve ever felt, while others, who have just undergone a major abdominal surgery with a stem to stern incision, report only mild discomfort.
There are patients who appear nearly comatose after surgery, barely arousable, but will state that their pain is severe and will request their medication every three hours on the dot. In this situation, what is the nurse to do? Blindly administer the higher dose prescribed for severe pain or actually think that the patient’s pain may not be as severe as reported and give the lower dose, and/ or call the doctor to have the medication adjusted.
No matter what, a good nurse has to use her best judgment to care for her patient in the most compassionate, but also clinically appropriate, manner possible. Patients, who are human, have widely varying ideas of what the hospital experience should be, particularly when it comes to pain. For some, pain relief means completely numb from head to toe; for others it means just enough medication to have the edge taken off. Most are somewhere in the middle. The nurse serves as the doctor’s eyes, learns to make a proper judgment and provides a continuous image that complements the snapshot the doctor receives on daily rounds.
The idea that nurses not be allowed to think echoes the words of one of my medical school instructors, Dr. John Adams. In the early 1980’s I was at the University of Rochester Medical School in upstate New York. Dr. Adams was the classic curmudgeonly surgeon. Loud, intolerant of ignorance or incompetence by subordinates, he often chastised the residents on his service for writing orders with a dosage range in the way that is now prohibited. He must be working for the JCAHO, because his exact words were:
“Don’t write Demerol 50-75 mg IM q3h. That allows the nurse to think; we don’t want the nurses to think. Their job is to do what they are told to do.”
Who would have thought chauvinistic Dr. Adams was such a visionary?
Actually, I don’t think that he had such a low opinion of nurses, rather, I believe, he was trying to drive home a message to the residents and students: orders should be clear and specific. Such clarity allows the nurse to perform her task efficiently and provide the patient with the best care possible. Doctors and nurses are a team, working together to help an individual who is sick or injured recover and return to a normal life.
Years ago I read a study on factors affecting outcomes on critically ill patients. I don’t remember which journal it was in, but the study looked at ICU patients and a number of variables that could have an effect on the patient’s recovery. The only variable that made any difference was the quality of nursing care.
This makes perfect sense to me. The critically ill patient requires continuous monitoring. Most of the time it is the nurse that is at the bedside checking vital signs, urine output, oxygenation and every other parameter that may be indicative of the patients well-being. The best ICU nurses will pick up on subtle changes that could be harbingers of impending deterioration in the patient’s clinical condition. If such nurses are shackled by the “don’t think and don’t make judgment” rules, these critically ill patients will suffer.
Besides acting as physician’s eyes, nurses also provide a level of protection for the patient. If an order is written or a medication prescribed that seems to be in error the nurse is there to question it. Despite what some doctors may believe, we physicians are not perfect and sometimes errors are made. A vigilant nurse often picks up on this, questioning the order; calling the doctor for a “clarification” (correction). Sometimes it is an omission that needs to be brought to the doctor’s attention. In all situations the nurse is the patient’s advocate, doing his or her best to smooth the often bumpy road to recovery.
Doctor’s, by necessity, approach patient care from a very different angle than nurses. Medical School and residency teach us the underlying pathophysiology and the clinical manifestations of various diseases and medical conditions. We take this information and establish a diagnosis and institute a therapeutic plan. Our primary purpose is to see that the disease process is properly treated and see the patient to a complete recovery or at least keep chronic diseases under control.
Nurses share in this goal, but along the way they are often called upon to provide comfort, counseling and to allay fears. The nature of their profession allows nurses to do this in a way doctors cannot. The best nurses always seem to find the time to sit with their patients, provide reassurance and still manage to do all the ridiculous charting and filling out of seemingly endless forms that generate reams of paper that no one ever looks at.
In the middle of these essential activities the nurse often have their carefully planned schedule disturbed by a million other tasks, usually accommodating the interruption with a smile and a shrug of the shoulders. I know that when I have asked nurses to help with a bedside procedure they are only eager to help and always insist on finishing up all the cleaning and reordering of the patient room when I am finished. I sometimes wonder if it is eagerness to do all they can to help or if they really want to be sure that the patient’s room is properly returned to an orderly state.
Nurses are truly amazing in their ability to calm anxiety, inform ignorance, allay fear, provide comfort, stroke egos (especially OR nurses), see us all at our worst moments and invade our most intimate places and do it all with a smile and a wink that says “I know you don’t feel well now, but just give us a little time and you’ll back home with your loved ones before you know it.
I may be a bit biased towards nurses. After all, I married one; Laura, my wonderful, beautiful, intelligent wife of twenty five years, the cutest little nurse I had ever seen, always took the time to talk to her patients, share their feelings and make sure that all their treatment was delivered in the best, most professional manner. When we first met I think I used to exasperate her by my asking for patients’ vital signs and her appraisal of their condition. But, we shared our concern for the patients’ well being and have continued to share for twenty five years.
Nurses and doctors, along with surgical technicians, respiratory therapists, physical therapists, occupational therapists, speech pathologists, patient care aids and all the other allied health personnel, share a common goal; that is to treat the sick and injured and allow them to return to happy, healthy, productive lives. The doctor provides the diagnosis and overall therapeutic plan, institutes the plan’s delivery and makes alterations and interventions when necessary. The nurse provides the monitoring, the immediate delivery of therapy, nurturing, comforting and compassion on a continuous basis. If our nurses are not allowed to “think” our patients will end up suffering, with longer stays in the hospital and some, I am sure, will never leave the hospital.
It is something for all of us to think about.
*Joint Commission on accreditation of Healthcare Organizations
Sunday, August 8, 2010
Backyard Nature
The World Around Us
This evening I sat in my backyard next to our swimming pool and watched the myriad activity in the bushes and the trees that line the rear edge of our yard, separating our home from the neighbor behind us. From the near edge of the pool I watched as a Cardinal timidly foraged for food beneath the bushes. He would pick up a few seeds, stop and look around, then pick up a few more. This went on for about five minutes and then he made his escape, taking short hops through the bushes, presumably returning to Mrs. Cardinal.
A few feet away, a much bolder Blue Jay was in engaged in similar activity. Bolder than the bright red Cardinal, the Jay took few pains to hide himself and loudly announced his presence, once he had returned to the safety of some higher branches. The big black crows are even bolder, every Spring staking claim to the small park in front of my home. They can be seen on the ground and in the trees at the four corners of the park, a bit reminiscent of “The Birds”, although I don’t think anyone has ever been attacked.
I live in a suburban area, close to some wooded areas and several bayous. Surprisingly, this populated neighborhood is teeming with a variety of wildlife. Besides the aforementioned birds, there are finches, doves, squirrels, rats, field mice, frogs, lizards, a rare snake and at least one turtle. Sitting outside in the late afternoon seems to afford the best view. The heat of the day has diminished and nighttime predators are not on the prowl.
So, in the early evening it is possible to see numerous lizards scurrying about or catching the last few rays of the departing sun. If I watch closely I can usually see lizards racing along the top of the fence or sunning themselves on top of the stone Hippo statues that guard our pool.
In a few weeks I will be treated to the hummingbird spectacle. Every year for about two weeks, in late August and early September hummingbirds stop in Houston on their way south. We always set up a feeder and manage to attract some of these diminutive birds. Watching their social order is sort of a metaphor for humanity. Usually, one hummingbird will claim the feeder as his own. He will take a drink and then fly away to perch on the nearby tree, all the time keeping his watchful eyes on “his” feeder. If any other hummingbirds try to approach he will swoop in and chase them away. Of course, the other hummingbirds want their fill of the sweet, fake nectar, so they will team up. One pretends to go in for a drink and allows himself to be chased away and, during this pursuit the others will saunter in for a leisurely swig. Not unlike many people really.
The rats and mice that I see create something of a dilemma. I know that they are vermin and carry disease, but it just doesn’t seem right to kill them. For a while we had a bird feeder in the backyard. This feeder fed not only birds, but also squirrels, mice and rats. There were several nights when our dogs would be outside barking nonstop and, when I investigated, I found them looking up at one or more rats taunting them from a branch high above the ground.
My dogs, actually, are very efficient at keeping our home free of such vermin. Before we took down the birdfeeder I found five dead rats in a week’s time. One afternoon I inadvertently witnessed the spectacle. In the middle of the day the three dogs, two Basset Hounds and a West Highland White Terrier, were outside barking in the continuous manner that signaled that they had something cornered. When I checked it out I saw them standing around something that was on the ground. Before I could intervene, Genevieve, our fat Basset Hound made a surprisingly quick lunge and in an instant a big rat lay dead. Don’t let anyone tell you that Basset Hounds are slow and lazy; she made very quick work of that execution. Needless to say, I took the bird feeder down that day and didn’t find any more dead rats.
There have been other rodents that have invaded our home. There was the time I went to check on our dogs early in the morning. They had been doing there nonstop barking routine, but by the time I went to see what all the fuss was about the noise had stopped. When I checked on them I found a baby possum lying stiff on the floor by their doggy door. I looked at it, lying rigid on the floor and assumed it was dead, but then my wife and I began to wonder; there wasn’t a mark on the little beast. We picked it up in a towel and carried it outside, locking the dogs inside. We laid the little critter among the bushes behind the pool and, as we suspected, the baby possum picked its head up, looked around and scurried away. It seems that possums really do play possum.
More recently, I sat and watched a field mouse make its was around the side of our house. It saw me studying its movements, but pretended I wasn’t there as it walked between our garbage cans and then stopped at our back door, reared up on its hind legs and pushed against the doggy door. Luckily, for the mouse, it was too small to push the door open, because just inside the door, asleep on a cushion was our West Highland Terrier, Coconut. I am sure that Coconut would have made short work of that mouse. Unable to break into our house, the mouse went on his way, still unperturbed by my presence.
In my recently released novel, “Joshua and Aaron”, the hero, Joshua Smith is given a pair of “goggles” that allow him to see the teeming life that exists apart from humanity, in the city around him. He is told that “we see and hear what we’ve been trained to see and hear.” There is a wonderful world around us; full of life; a gift from God. All we have to do is take the time to sit and watch; it’s a spectacle better than anything television or the internet can provide.
This evening I sat in my backyard next to our swimming pool and watched the myriad activity in the bushes and the trees that line the rear edge of our yard, separating our home from the neighbor behind us. From the near edge of the pool I watched as a Cardinal timidly foraged for food beneath the bushes. He would pick up a few seeds, stop and look around, then pick up a few more. This went on for about five minutes and then he made his escape, taking short hops through the bushes, presumably returning to Mrs. Cardinal.
A few feet away, a much bolder Blue Jay was in engaged in similar activity. Bolder than the bright red Cardinal, the Jay took few pains to hide himself and loudly announced his presence, once he had returned to the safety of some higher branches. The big black crows are even bolder, every Spring staking claim to the small park in front of my home. They can be seen on the ground and in the trees at the four corners of the park, a bit reminiscent of “The Birds”, although I don’t think anyone has ever been attacked.
I live in a suburban area, close to some wooded areas and several bayous. Surprisingly, this populated neighborhood is teeming with a variety of wildlife. Besides the aforementioned birds, there are finches, doves, squirrels, rats, field mice, frogs, lizards, a rare snake and at least one turtle. Sitting outside in the late afternoon seems to afford the best view. The heat of the day has diminished and nighttime predators are not on the prowl.
So, in the early evening it is possible to see numerous lizards scurrying about or catching the last few rays of the departing sun. If I watch closely I can usually see lizards racing along the top of the fence or sunning themselves on top of the stone Hippo statues that guard our pool.
In a few weeks I will be treated to the hummingbird spectacle. Every year for about two weeks, in late August and early September hummingbirds stop in Houston on their way south. We always set up a feeder and manage to attract some of these diminutive birds. Watching their social order is sort of a metaphor for humanity. Usually, one hummingbird will claim the feeder as his own. He will take a drink and then fly away to perch on the nearby tree, all the time keeping his watchful eyes on “his” feeder. If any other hummingbirds try to approach he will swoop in and chase them away. Of course, the other hummingbirds want their fill of the sweet, fake nectar, so they will team up. One pretends to go in for a drink and allows himself to be chased away and, during this pursuit the others will saunter in for a leisurely swig. Not unlike many people really.
The rats and mice that I see create something of a dilemma. I know that they are vermin and carry disease, but it just doesn’t seem right to kill them. For a while we had a bird feeder in the backyard. This feeder fed not only birds, but also squirrels, mice and rats. There were several nights when our dogs would be outside barking nonstop and, when I investigated, I found them looking up at one or more rats taunting them from a branch high above the ground.
My dogs, actually, are very efficient at keeping our home free of such vermin. Before we took down the birdfeeder I found five dead rats in a week’s time. One afternoon I inadvertently witnessed the spectacle. In the middle of the day the three dogs, two Basset Hounds and a West Highland White Terrier, were outside barking in the continuous manner that signaled that they had something cornered. When I checked it out I saw them standing around something that was on the ground. Before I could intervene, Genevieve, our fat Basset Hound made a surprisingly quick lunge and in an instant a big rat lay dead. Don’t let anyone tell you that Basset Hounds are slow and lazy; she made very quick work of that execution. Needless to say, I took the bird feeder down that day and didn’t find any more dead rats.
There have been other rodents that have invaded our home. There was the time I went to check on our dogs early in the morning. They had been doing there nonstop barking routine, but by the time I went to see what all the fuss was about the noise had stopped. When I checked on them I found a baby possum lying stiff on the floor by their doggy door. I looked at it, lying rigid on the floor and assumed it was dead, but then my wife and I began to wonder; there wasn’t a mark on the little beast. We picked it up in a towel and carried it outside, locking the dogs inside. We laid the little critter among the bushes behind the pool and, as we suspected, the baby possum picked its head up, looked around and scurried away. It seems that possums really do play possum.
More recently, I sat and watched a field mouse make its was around the side of our house. It saw me studying its movements, but pretended I wasn’t there as it walked between our garbage cans and then stopped at our back door, reared up on its hind legs and pushed against the doggy door. Luckily, for the mouse, it was too small to push the door open, because just inside the door, asleep on a cushion was our West Highland Terrier, Coconut. I am sure that Coconut would have made short work of that mouse. Unable to break into our house, the mouse went on his way, still unperturbed by my presence.
In my recently released novel, “Joshua and Aaron”, the hero, Joshua Smith is given a pair of “goggles” that allow him to see the teeming life that exists apart from humanity, in the city around him. He is told that “we see and hear what we’ve been trained to see and hear.” There is a wonderful world around us; full of life; a gift from God. All we have to do is take the time to sit and watch; it’s a spectacle better than anything television or the internet can provide.
Sunday, August 1, 2010
Dr. Write
CC: SOB and Abd pn.
HPI:
65 y-o WM w/ hx of CHF, CAD, IDDM, Htn, &SLE was admitted @BMC c/o CP, SOB, LUE edema and UTI for 7 days. Pt. also c/o no BM for 1 wk. and + LGIB. Pt. also c/o abd. Pn and N&V for 2 wks. (-) flatus x 3 days.
PMH:
As in HPI. + CHF, CAD, s/p CABG, LGB, BIH and ORIF LH.
NKA
MEDs: see list.
FH:
n/c
SH:
Cig: 2 ppd x 30 yrs. Etoh (-) ret.
ROS:
See HPI
PE:
VSS, AF
HEENT: NC/AT, PERRLA, EOM’s nl,
Neck: NT, (-) Br.
Pul.: Cl. To A &P
CVS: RRR, nl S1S2 w/o m, S3 S4, (-) JVD
Abd: (+) BS, w/o HSM, B9
Rectal: WNL
Ext: w/o C, C, E, pulses 2+
Neuro: NLS
A/P:
65 yo WM w/ MM Probs. Plan CT A/P, CXR, EKG, CC cath.
Consult GS, Card, GI, Pulm.
CCM.
I will happily accept any one's translation of this perfectly plausible History and Physical.
HPI:
65 y-o WM w/ hx of CHF, CAD, IDDM, Htn, &SLE was admitted @BMC c/o CP, SOB, LUE edema and UTI for 7 days. Pt. also c/o no BM for 1 wk. and + LGIB. Pt. also c/o abd. Pn and N&V for 2 wks. (-) flatus x 3 days.
PMH:
As in HPI. + CHF, CAD, s/p CABG, LGB, BIH and ORIF LH.
NKA
MEDs: see list.
FH:
n/c
SH:
Cig: 2 ppd x 30 yrs. Etoh (-) ret.
ROS:
See HPI
PE:
VSS, AF
HEENT: NC/AT, PERRLA, EOM’s nl,
Neck: NT, (-) Br.
Pul.: Cl. To A &P
CVS: RRR, nl S1S2 w/o m, S3 S4, (-) JVD
Abd: (+) BS, w/o HSM, B9
Rectal: WNL
Ext: w/o C, C, E, pulses 2+
Neuro: NLS
A/P:
65 yo WM w/ MM Probs. Plan CT A/P, CXR, EKG, CC cath.
Consult GS, Card, GI, Pulm.
CCM.
I will happily accept any one's translation of this perfectly plausible History and Physical.
Saturday, July 24, 2010
Donuts
A Tribute
I brought a dozen donuts home this morning. I stopped at “Riley’s Donuts” on my way home from the hospital and picked up a variety of donuts and kolaches. There is no great, special significance about donuts or kolaches except that the act of bringing donuts home after making rounds at the hospital is a tribute to Dad.
Donuts a tribute to Dad? It isn’t hard to understand, really. Growing up on Sunnyside Road in Scotia, New York, Dad worked as a doctor, specifically a Urologist in solo practice. Every weekend, unless he was out of town, he left at about 8:30 am to make rounds on his hospital patients. At the time I didn’t really understand what “rounds” meant and even on the rare occasion I accompanied him, I still didn’t know. (Accompanying him to the hospital meant sitting in the lobby, being watched by the volunteer in the Gift Shop). I always had this vision of him walking in a great circle, somehow seeing his patients along the way.
Anyway, he usually returned home at about 11:00 and when he walked through the door I would look to see if he was carrying anything besides the newspaper. A single bag meant Dunkin Donuts, always welcome on a Sunday morning; two bags was even better, deli from Gershon’s. I recall that he returned with one or the other about half the time.
I never knew if there was any rhyme or reason to the appearance of these goodies, but I know I looked forward to them. I suspect now that he really liked donuts and corned beef and Mom certainly didn’t mind not having to prepare anything.
Dad was a bit mysterious in ways like this. He would do things seemingly for no obvious reason, as if it was expected, that it was part of his job as dad. Saturday mornings he would make pancakes for everyone before he left for work. Usually he was gone when I came downstairs, but the pancakes would be waiting there, sometimes a little cold, but always delicious; they were one thing that Dad was very adept at cooking.
The other unexpected, but always welcome, treat was going to “Twin Freeze” for ice cream. This was, and still is, the ice cream half of “Jumpin’ Jack’s” drive in in Scotia. Until I was about eleven I never realized that Jack burgers and loaded steak sandwiches even existed; the food part of the drive in was a separate building. Jumpin Jack’s, to me, was only Twin Freeze and the soft ice cream was a special treat. Even today, it is one of my first stops when I visit Scotia. Growing up, it was an often unexpected pleasure to take the short drive around the lake to Twin Freeze, to check out the special flavor of the day, but almost always settle for a hot fudge sundae with chocolate ice cream; an indulgence that was usually consumed by the time we pulled in the driveway at home.
Of course it wasn’t just desserts that were special to Dad. He had nine sons and, although he was always interested in whatever activity we were involved with, the one thing that he would do with us was teach us all to sail. My brother Charlie wrote about family sailing’s origins on Collins Lake in a small pram in his book “Centerboard”, but for me sailing began with the “Rebel”. The “Rebel”, nicknamed the “Tub”, was a boat that was kept at our summer camp on Sacandaga Lake. Dad was always looking for a crew, and when I became old enough I was drafted. He taught me the intricacies of tacking, luffing, coming about, hard to lee and all the other components of sailing that were necessary to navigate the ever changing winds on Sacandaga Lake.
But more than the sailing lessons it gave me time alone with him; time to talk about what he thought was important, raising his family, being a doctor, plans for the future. I was never a big talker, but I was a pretty good listener. Dad could be stubborn at times and he occasionally clashed with some of my brothers. Sailing gave him time to soften his resolve and find a compromise. I learned a great deal from him at these times. And, there was the time we sailed through the swarm of bees. We never knew why they were out there in the middle of the lake, but we managed to sail right through the heart of the swarm, thankfully emerging unscathed.
Other things about Dad stick in my head. When something adverse happened, which was unavoidable in a family with nine boys, he always responded with a cool head and kept everything in the proper perspective. If there was a car accident his first thought would be “is anybody hurt?” Damage to the car was secondary. He intervened when necessary, but allowed us all to grow and develop in our own way. I think he was pleased with the three of us that decided to go into medicine, but he was just as pleased with my other brothers in various other professions.
Dad loved us all although he very rarely said it. His concern for each of us as different individuals showed this love and even today, if some difficulty arises, I will frequently stop and think “What would Dad do?”
Dad just celebrated his 95th birthday. He still shows concern for me and always asks about my family’s well being. He suffers with so many of the ravages of advanced age, poor eyesight that keeps him from watching his beloved Yankees as closely as he’d like, poor hearing, congestive heart failure, arthritis. He would say “It’s tough growing old, but it’s better than the alternative. When I wake up in the morning and I’m still breathing; it’s a good day.”
And so when I buy donuts on a Sunday morning it’s a tribute to Dad. But, also, like Dad, I really like donuts.
I brought a dozen donuts home this morning. I stopped at “Riley’s Donuts” on my way home from the hospital and picked up a variety of donuts and kolaches. There is no great, special significance about donuts or kolaches except that the act of bringing donuts home after making rounds at the hospital is a tribute to Dad.
Donuts a tribute to Dad? It isn’t hard to understand, really. Growing up on Sunnyside Road in Scotia, New York, Dad worked as a doctor, specifically a Urologist in solo practice. Every weekend, unless he was out of town, he left at about 8:30 am to make rounds on his hospital patients. At the time I didn’t really understand what “rounds” meant and even on the rare occasion I accompanied him, I still didn’t know. (Accompanying him to the hospital meant sitting in the lobby, being watched by the volunteer in the Gift Shop). I always had this vision of him walking in a great circle, somehow seeing his patients along the way.
Anyway, he usually returned home at about 11:00 and when he walked through the door I would look to see if he was carrying anything besides the newspaper. A single bag meant Dunkin Donuts, always welcome on a Sunday morning; two bags was even better, deli from Gershon’s. I recall that he returned with one or the other about half the time.
I never knew if there was any rhyme or reason to the appearance of these goodies, but I know I looked forward to them. I suspect now that he really liked donuts and corned beef and Mom certainly didn’t mind not having to prepare anything.
Dad was a bit mysterious in ways like this. He would do things seemingly for no obvious reason, as if it was expected, that it was part of his job as dad. Saturday mornings he would make pancakes for everyone before he left for work. Usually he was gone when I came downstairs, but the pancakes would be waiting there, sometimes a little cold, but always delicious; they were one thing that Dad was very adept at cooking.
The other unexpected, but always welcome, treat was going to “Twin Freeze” for ice cream. This was, and still is, the ice cream half of “Jumpin’ Jack’s” drive in in Scotia. Until I was about eleven I never realized that Jack burgers and loaded steak sandwiches even existed; the food part of the drive in was a separate building. Jumpin Jack’s, to me, was only Twin Freeze and the soft ice cream was a special treat. Even today, it is one of my first stops when I visit Scotia. Growing up, it was an often unexpected pleasure to take the short drive around the lake to Twin Freeze, to check out the special flavor of the day, but almost always settle for a hot fudge sundae with chocolate ice cream; an indulgence that was usually consumed by the time we pulled in the driveway at home.
Of course it wasn’t just desserts that were special to Dad. He had nine sons and, although he was always interested in whatever activity we were involved with, the one thing that he would do with us was teach us all to sail. My brother Charlie wrote about family sailing’s origins on Collins Lake in a small pram in his book “Centerboard”, but for me sailing began with the “Rebel”. The “Rebel”, nicknamed the “Tub”, was a boat that was kept at our summer camp on Sacandaga Lake. Dad was always looking for a crew, and when I became old enough I was drafted. He taught me the intricacies of tacking, luffing, coming about, hard to lee and all the other components of sailing that were necessary to navigate the ever changing winds on Sacandaga Lake.
But more than the sailing lessons it gave me time alone with him; time to talk about what he thought was important, raising his family, being a doctor, plans for the future. I was never a big talker, but I was a pretty good listener. Dad could be stubborn at times and he occasionally clashed with some of my brothers. Sailing gave him time to soften his resolve and find a compromise. I learned a great deal from him at these times. And, there was the time we sailed through the swarm of bees. We never knew why they were out there in the middle of the lake, but we managed to sail right through the heart of the swarm, thankfully emerging unscathed.
Other things about Dad stick in my head. When something adverse happened, which was unavoidable in a family with nine boys, he always responded with a cool head and kept everything in the proper perspective. If there was a car accident his first thought would be “is anybody hurt?” Damage to the car was secondary. He intervened when necessary, but allowed us all to grow and develop in our own way. I think he was pleased with the three of us that decided to go into medicine, but he was just as pleased with my other brothers in various other professions.
Dad loved us all although he very rarely said it. His concern for each of us as different individuals showed this love and even today, if some difficulty arises, I will frequently stop and think “What would Dad do?”
Dad just celebrated his 95th birthday. He still shows concern for me and always asks about my family’s well being. He suffers with so many of the ravages of advanced age, poor eyesight that keeps him from watching his beloved Yankees as closely as he’d like, poor hearing, congestive heart failure, arthritis. He would say “It’s tough growing old, but it’s better than the alternative. When I wake up in the morning and I’m still breathing; it’s a good day.”
And so when I buy donuts on a Sunday morning it’s a tribute to Dad. But, also, like Dad, I really like donuts.
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