My Mom

I took a year off from writing this blog.

I lost interest. It’s not important.

Most of you who know me, know my Mom passed away on May 1st of this year.
Other than the birth of my kids, it’s the most significant event of my life.

I can’t write about her here. She’s above that. I can’t tell you in words how great she was. We abuse words like”love”. I don’t “love” chocolate ice cream anymore. But I do love some people. I tell them (sometimes for the first time). They already knew but it still freaks them out to hear it out loud. I think that’s funny.

I am not bitter or depressed. Sometimes I am sad and I miss her and I don’t think that will ever change. I still work and I still laugh. It’s only now at random times, I can be stopped still in my tracks when I think about her. And for those few minutes nothing seems important.

Mother, at the end, told her friends she loved them. More so, or with more meaning, than she did before she was sick. That was important. She would want me to share that.

I can’t go into all the things my sister, father and I went though.

I won’t go into what insights we got and how it has affected us all.

Someday, I might be able to find a way to write it all down but that book would be many chapters. I am not in the frame of mind to do that even now.

My mom’s sickness was hardest on her but hard on us all. Now the sickness is over, and we are thankful for that. Her memories will always be mine. She is still very much alive.

Anyway, the point of the blog is brain candy. Fun stuff, provoking ideas, the view of the world from middle aged ER doc. I am ready to do that now. Life continues. And for those of you (the 3 of you) who occasionally read this, I’ll try to put in a little more writing time.

P.S. If your mom is still alive, call her. I sure wish I could call mine.

GSW!

The Setting:

I work in a private community hospital. The “community” we serve is in a dangerous part of town. There is a fair amount of earned non-taxable income. This is slang for drug dealing and prostitution. Drug dealers have a vested neighborhood interest and that is they don’t want any other drug dealers in their neighborhood. I didn’t say it was a happy community. Interlopers here frequently get introduced to the business end of a gun.

I don't live in this community. When I moved into my neighborhood we got cookies!

My neighbor, Chris, has much better looking flower beds than me. Still, I haven’t shot him…..not yet.

Anyway people always want to hear about Gun Shot Wounds. We are wonderfully blessed to be located near Vanderbilt University. The chaps down at Vandy have a most excellent Trauma Center, but they don’t take it all. There is a screening process.

We get 2 kinds of GSW’s at Skyline: the quick and the dead. EMS takes GSW’s to the chest and abdomen to Vandy, if the patient is alive when they arrive. These are the serious but saveable patients. This is good for multiple reasons. Primarily they have the staff to take care of it. They also get state funding. My surgeons are a great bunch of guys. They would love to take out your appendix or gall bladder. They don’t do so well with exploded livers and spleens. They also like to get paid and dealers and hookers don’t get health and dental.

First the Dead:

The first type of GSW’s we get are the “not quick” - meaning dead. EMS is called to a volatile scene, they scoop, they run. They don’t take the patient to Vandy if the game is already over. A tragedy has occured. It’s a failure on multiple levels. Having no where else to go, EMS comes to the ER. There is usually nothing for us to do. The police come and take a lot of pictures. I’ll speak to family members where I never really know what to say.

The family is ushered into the “Quiet Room”, every ER has one. This is where we break the news. I have some standard phrases I have honed over the years. There is a real art to this and we even practiced this in residency. “Your son is dead”, “I am sorry for your loss”, “This is as bad as it can ever get”. Sometimes everyone is real quiet, sometimes not. I go back to the bedside and help the nurses with the body if I can. There is a lot of gravity in this situation. Someone will inevitably try to crack a joke just to break the tension. This is an ER coping mechanism, not disrespect. I am sure we have all developed some deep psyche repression issues because of this, but it comes with the territory. Thick skin or at least the semblance of it.

And then there are the quick:

The quick are extremity shots and I can’t begin to explain what a non-event this has become. We get a call “GSW to the arm” and it’s really no big deal. If the arm is not blown off and no major bones, arteries or nerves are broken, the patient gets discharged. This summer alone, I have personally taken care of different patients with GSW’s to the arm, leg, both legs, in leg/out butt, in arm/out shoulder, etc. All of these patients were discharged. These people have been shot! Frequently they are out of the ER in less than 90 minutes.

Ironically every single patient has the exact same history.

Me: What happened?
Patient: I got shot.
Me: Who shot you?
Patient: Some dude.
Me: What were you doing?
Patient: Minding my own business.

“Some dude” has major issues with people minding their own business, he has shot over 20 patients this year. That’s the bad news. The good news is that Dude has pretty lousy aim.

I have seen several patients who have been shot multiple times and they are fine. Can you believe their luck? With my luck, someone could accidentally drop a bullet in a fireplace, it explode, bounce off 5 different things and hit me right between the eyes.

We saw a "Dude" this week who had been shot in both arms. How does that happen!? How can a bullet travel through both arms and miss everything between? No kidding, I have seen TWO patients in my career who got shot in their freaking head and the bullet glanced off the skull and the patient got away with minor injuries and a hell of a headache. These guys should drop whatever they are doing and immediately move to Vegas.

So anyway, One of the purposes of this blog is to try to give helpful ER insider tips. Here is this months entry.

Don’t get shot.

Eight Dollar Beer Rant

One draft beer at a Titans game is going to set you back eight bucks!

Actually, I don't have a problem with that. ER doctors and nurses hate drunk people. There is no way to sugar coat it. It's just that simple. Let me start with the guy who had "two beers”, every drunk patient I have ever cared for has only had “two beers”. Mr. Two Beers climbed a utility pole in an attempt to turn a city street light so that it would shine more directly on his lawn so he could cut his grass at night. Funny right?

Not so funny when he was electrocuted and fell 20 feet.

How about the young lady who was in Nashville celebrating her bachelorette party on the eve of her wedding; she didn’t have to pay for her drinks that night and everyone was buying. The ladies made it to see me that night in the ER. A night of fun ended up with me on the phone with this young girls parents telling them she had stopped breathing and was now on life support. Party over.

How about the fraternity pledge who passed out drinking, regained consciousness and then was required to participate in one more “brotherhood building” event consisting of dropping shots of whiskey into mugs of beer and drinking the entire thing. He passed out again but this time didn’t wake up.

Alcohol is the drug involved in more accident deaths than all the others combined. More than cocaine and heroin by far. Marijuana doesn't even make the list. The beauty is that not only is alcohol legal, it is marketed more than any other drug in the world.

Where is the FDA?
The FDA sends out frequent warnings about drugs that may cause you harm. Pediatric cold medicines and vomiting medicines recently made the list. You can't buy them over the counter and I can't prescribe them to you if you are under six. So tell junior he better just learn to love the taste of boogers. A certain arthritis medicine, later deemed unsafe, triggered a class action law suit. From reading their advertisements, I am not sure if Viagra is going to make me have sex or cause me to have a heart attack. Look at the lawyer speak heaped on drug company commercials. When is the last time you heard a declaimer on Budwiser commercial? Viagra should be so lucky.

Don't drink? Well you're not safe either. Overwhelmingly the number of fatal car accidents in the United States are alcohol related. Domestic violence, alcohol related. Child abuse, alcohol related. Assaults, alcohol related. My unofficial estimate is that alcohol cost our health care system in the hundreds of millions of dollars.

Now, I’m not a pariah either. I enjoy a nice glass of wine with dinner or sharing a beer with a friend. But what I am saying is that alcohol is a mind altering depressant and must be treated as such. I’m not proposing a new era of prohibition, but the ideas of prohibition were not misguided. Like all medications there should be strict regulations on its distribution. Abuse of this medication cannot be tolerated. Not only should you have to have a license to sell alcohol it should also be required for individuals to have a license to buy and consume alcohol.

Primarily our parents, high school principles and college presidents should completely crack down on underage drinking. It is absurd that one can purchase a six pack of beer for less than ten dollars. Our DUI laws are advertised as strict but how common is it for someone to get 2 DUI’s? Public intoxication is considered a misdemeanor and maybe gets a citation. How can we all be offended by the evil tobacco and let alcohol have a free pass? Where are our class action lawyers when we need them? Our law enforcement in Tennessee should take this crime much more seriously. It’s also time for our insurance companies to consider alcoholism as dangerous a diagnosis as cancer.

So next time you are at a Titans or Predators game and have to fork over eight dollars for a beer, you should think in a more intelligent world this price is about right.

I'm back

A funny thing happened on the way to forty.

I have been asked more than a few times why I took a break writing. My answers have varied, if you did ask you likely got one of the following answers: "Writers block", "Kids, Summer, you know the deal", "It's complicated". The truth is: I don't know. But I think I've got a better handle on it.

I turned 40.

I would have told you it's not a big deal to me. It's just a number. Our traditional way of keeping track of time, nothing more. The Mayans invented the calendar, blame them. For new parents (who only speak of their child's age in months: I am a little over 480 months).

Let's say the average U.S male life span of productive life is 75 years (900 months). That's not very long, I'm over half way there. The ridiculous thing is I don't feel like an adult. Med school will do that to you. College done at 23, med school done at 27, residency done at 30, got my first real job then. I've only been in the work force for 9 years. I just got my loans paid off, I have a little in retirement but the sad part is :I'm halfway done! I've used half my months and I just now got to the place I want to be.

Life is fast. I have a great life but the pace is blinding. My kids aren't babies (mostly), my parents are getting older. Which leads to another reason for my writing hiatus.

My mom was diagnosed with malignant melanoma about 4 years ago. Her lesion was deep and ulcerated. She had a wide margin resection and did very well. Top shape. Life is good.

She had an axillary node recurrence at the beginning of this year. She had a second surgery, an axillary node dissection followed by 6 weeks of radiation therapy. Not a good thing but we'll get through.

She had a third recurrence just a few months ago. There are multiple lesions spreading from her spine to the arm pit. Surgery is not an option, radiation won't help, she's now on chemo. This has been a major blow to the family. Like most moms, my mom is the glue. The hell of the thing is that she is not "sick". She doesn't feel bad. I know the disease, I've read the statistics and I know the prognosis but I just can't get my head around it. My colleagues get an altruistic look in their eye and whisper "How's you mom? or I'm sorry about your mom." And I'm just like "Man you don't get it, she's not that sick". I feel like I'm one of those family members who are in denial about what's going on. I'm not ready for this. Life is fast. There is no slow gear.

I jokingly complain about Danielle all the time but the truth is she's great. She's great in the fact that she pushes me out of my comfort zone. Third kid-her idea. Sell our house all the time -her idea. Travel everywhere -her idea. Her shenanigans have gotten us in trouble before. We almost got killed one midnight on a deserted Costa Rican back road, we were stopped by machine gun welding soldiers in Macedonia, I thought we were done for in turbulence over Peru. But one thing is for sure, it's never boring. Now she's talking smack about moving to New Zealand or selling the house, taking the whole year off to travel the world. When we get back, no big deal, we'll just start over. Most of that's just talk but sometimes I'm not so sure.

She saw her mother suffer and die horribly from Alzheimer's disease. She was just patching things up with her father and then he suddenly died as well. Since then her attitude is "if she can't control the end, then she is damn sure going to make the best of this part". I know she's right in principle. I think about it this way: I know roughly about 2000 people. Meaning if you handed them my picture they could come up with my name. 900 months from now that number may be 200. 900 months from then maybe 20. And 900 months from then, well.....yeah. That's not depressing. That's just the way it is here on earth.

So why not. Why not move to New Zealand. Why not travel for a year. Why not take that job that guy has been hounding me about. Why not go deliver health care in a place that I can really make a difference. (I am not making a huge difference passing out Lortab and blood pressure meds here in Nashville). That's a stretch, I do make a difference about once a week. Which is more than most ambulance chasing lawyers can say in a lifetime. Sorry, swords shoot from the depths of my self pity.

That's it. Philosophy class is over. But friends the end is coming, let's get over it and over ourselves. No one is guaranteed 900 months so there is no point dwelling on it. That's no license to act stupid but there is also no denying that the clock is ticking. It's so corny but true: Each day is a gift. Live life every day. My goal is to hit the pillow each night knowing that I have made the most of the day. That's probably going to mean getting out of a rut and taking some risks. That's what it has taken me 480 months to learn. Alright, tomorrow is coming, lets get to it.

What Do We Do With The Pirate?

As you all know by now the U.S. Navy captured a Somali Pirate this month. Some say he was trying to escape others say captured. Doesn’t really matter, we’ve got him now.

So what do we do with him?

When I’m driving home late at night sometimes I pretend I am President and am preparing to address the nation about a problem we are facing. My constituency is the steering wheel. I’ll bet many of you do the same.

At this point I am going to have to disclose some things.

I really don’t have a political affiliation. I did vote, but I did not vote for Barack Obama. The biggest issue for me was taxes. Not that I am against taxes, I am not. It is the price we pay for a free society (Oliver Wendell Holmes). I like paved roads, providing education for our children, protecting our country, protecting our environment, caring for the truly needy. I do believe that government should stay out of religion and religion should stay out of government, but they are like two kids that can't keep their hands off each other. Maybe I am a Democrat?

I do however believe our government is lousy at managing its finances. The government lives in a way you and I could not. We have a budget. We stick to it.

I don’t think it’s the government’s responsibility to pay for my college, give me housing, provide my healthcare or childcare or really even deliver the mail. There are already so many government sponsored boon-doggles, I have lost my faith in government to be efficient at most anything. I don’t believe that government is going to solve any of my everyday problems nor do I expect it to. I do think we all pay too much in taxes for the return we get. Maybe I am a Republican?

At the end of the day I am more suspicious of government than I am trusting of it. I think the writers of the constitution were much the same.

Anyway, back to the pirate.

I’ve been taking a poll among friends asking what would you do if you were the judge? I say judge because the president is in a separate branch so factually he has no more say than you or I. Of course I don’t really believe that. President Obama’s wishes will go a long way here.

Here are the undisputed facts about the pirate as I know them:
He is a pirate.
He steals and holds goods for ransom.
He was not the mastermind but guilty nonetheless.
He was caught red handed.
He is a teenager.
He comes from a country of abject poverty and corruption.

So what are you going to do with him?

Here are your options:

Release him back to Somalia. This is probably the easiest thing to do. He’ll go back to his lifestyle. He’ll get his 15 minutes of fame but he won’t be much of a problem for us again. He may go back to pirating but that problem is still going to be there weather he is there or not.

We could put him in prison. Easy as well. We would forget about him eventually. He could do some hard time with some of our bad guys. After his release he would be deported. Too old to do much pirating. The problem is now we taxpayers have to pay for his food, lodging (as it is) and healthcare. It’s probably a step up for him compared to daily Somali life. But it is still prison, he is a teenager, surely we can do better.

We could have killed him. If he had actually shot that captain this is what the majority of American’s would have wanted. Don’t be so naive to think that wasn’t discussed at some level. This kid could be a problem. If we jail him he could become a living martyr. We could have easily been told he drowned or was shot with the other bad guys. The fact that we even know he exist means the government ruled this option out. I am glad about this.

Or lastly, we could do something good with him. This is my favorite option, probably because I soon will have teenage boys.

We could take this kid and give him an education. Provide him some type of family. He would get healthcare and security. He could discover a country that mostly has peace, because most Americans are peaceful. We don’t have to steal food. We don’t have to bribe judges or pay off the police. We believe we live in a country that provides our citizens the opportunity of a good life. A life we choose based on the choices we make.

This young pirate is truly guilty. But what were his options? I am not sure that I would not have made the same choices he made if I were a 16 or 18 year old Somali youth.

We could take this young man and show him what the U.S.A. is really all about. Not what he has been told. With a little love and some opportunity this kid could become something he never dreamed he could be. He could be a doctor, lawyer, school teacher, really anything he chooses. And when he turns forty, we pull the trigger.

By that I mean then send him back to Somalia. He doesn’t owe us a thing. He can do whatever he wants. We could support him as best we could from afar but it’s his choice. He can go back to being a thug or he can go be the leader that his people so desperately need.
If we do this job well, I know he will make the right decision.

Anyway, that’s what I would do. I would be interested in hearing your comments.

How I Remember It

It's a cold winters day in February. Friday exactly, the day most people pack it in, take it all home. I’m on the 2pm to 10pm shift. Not bad. Usually those are peak hours, a good time to work. But on this Friday afternoon it’s a little slow.

I working with one of our new docs. She just completed her residency last year. She’s green, nervous, frequently seen looking up doses for penicillin and the like. She has potential but needs some polishing. I know only I can help this young apprentice to one day be an ER Jedi.

At my hospital there is one thing every ER doc fears……..Delivering a Baby.

In our current health care climate, many hospitals have gotten out of the Labor and Delivery business. Mostly because of profit and liability issues. Anyway, not all hospitals have an L&D suite or staff Obstetricians. At my hospital we don’t have any ER coverage for OB/Gyn. So we don’t birth no babies.

Anyway back to me.

On this blustery Friday afternoon we are strolling along. Suddenly a red truck speeds to a stop outside our ambulance doors. A young man jumps out and appears to be yelling for help through the glass. Sometimes patients do this. We always go check it out, but it better be good.

It’s good......... His girlfriend is in labor.

Tension heightens as the staff help the 19 year old out of the car and checks out the situation. This could be an emergency, the next sounds from the room…

"We need a doctor in here."

The patient is screaming, obviously in the throws of a contraction. She says she is 5 and half months pregnant. That’s 22 weeks. A baby is considered full term if over 35 weeks. A non viable fetus is less than 20 weeks. 22 weeks is no mans land. 22 weeks is premature. 22 weeks is bad. If born, the baby could live, but at 22 weeks there will be complications. We are talking neonatal breathing machines, umbilical IV lines and feeding tubes.

This girl is 19 years old, this is her first pregnancy, she has had no prenatal care. To make things even better she is stick skinny. By that I mean she has a very small pelvis. In Alabama there is a thing referred to as birthing hips. Good birthing hips are wide and the misses can spread her legs far apart creating a wide opening. I’ve seen good birthing hips that you could pass Volkswagen through. Bad birthing hips are small framed girls, tight pelvis and it’s even worse if it’s your first pregnancy. Bad birthing hips define this young mother.

So the first step is to see where we are. I slip on a glove, add a little KY jelly and insert my fingers into the vagina hoping to feel a closed cervix. What I actually feel is a baby’s head. The nurses are staring at me in anticipation waiting on the news....... "We are going to have a baby here." is my response. "Oh sh*#!" is the general refrain.

Accounts of what happened next differ, but this is how I remember it….

The nurses generally begin to panic. There is confusion. Some of the staff are yelling, some are starting to cry, a few passed out and one or two are on their knees praying. This is a scary situation, they need leadership, they need a hero.

So I stand tall and brave between this young girl’s thighs. I take both my hands to my v-neck collar of my scrub shirt and rip it down the middle exposing my pectoralis muscles and 6 pack abdomen just beginning to glisten with sweat. I run my fingers through my perfect hair and raise my hands to shoulder height. "Gloves!" I call, and gloves are placed onto my steady hands. "Gown!" I call and I am draped like a priest giving his most holy service. In a calm, confident tone I look at the charge nurse, "Get me the delivery tray, I am going to usher in the miracle of life."

My young assistant doctor is panicking. "Excuse me Doctor Gibson, but her pelvis is too small! You will never get the baby out! No doctor in his right mind would even try this! What are we going to do?" I have no choice but to slap her firmly across the face. "Dr. Barnett, remain calm. I am no ordinary doctor." Ashamed that she has lost her composure, she quietly gathers herself.

I insert my index fingers into each side of patient’s vagina around the child’s head. I begin to stretch the vagina open with all the strength in my fingers. An IV has been started but I can’t give any pain medications. Narcotics in a preterm delivery could depress the child’s respirations. Mom is going to go naturally. Mom is pushing and screaming. I am stretching, a ER tech in the back of the room just vomited. The contraction subsides.

The baby’s head is facing the wrong direction. Meaning its nose is facing up. Usually babies come out with the nose facing the floor. Ideally I would like to try to rotate the baby but there is no time and the child is lodged into position. Another hurdle I must overcome.

This is getting bloody. I call for suction. I continue to stretch. I can see the head well now. If the baby gets stuck, I am going to have to start cutting. I must stretch, she must push hard!

At the crescendo of the 5th contraction the baby’s head pops out. One more good stretch and I reach my fingers under the child's armpit, rotate the body and with one more push the baby is out.

"Clamps" I state commandingly.

"Scissors!" The child is now free.

I am now holding the child across my right forearm and tap it on the bottom. The room is filled with silent awe.

The next sound we hear are the eeking of a newborn’s cry.

Elation fills the room. Tears of fear have turned into tears of joy. Nurses and complete strangers are hugging, music is in the air and as I listen closely, I can hear the sounds of angels singing.

View from the Other Side

I have a work routine. I dress in scrubs, sometimes a white coat. I talk with patients, extract their symptoms, do an exam and formulate a problem list. This is usually followed by ordering some labs, sometimes X-rays, and starting treatment. I chat with friends. I have my perspective, this is my side and that’s where I live.

I have never been a patient. I’ve never been on the other side. Until recently....

I was visiting my parents in Birmingham and we were having a "fun day". We ate greasy hamburgers for lunch, had afternoon coffee and met my sister and her family for some spicy Chinese food. Fun enough?

In the past few years I have had some stomach problems, initially self diagnosed as indigestion, later as gastritis and finally an ulcer. The cause of my stomach problem is all on me. Fast food is often my best option and I have a daily habit of a 6 pack of diet coke. Not to mention my job can be a little unnerving at times.

So on February 6th I woke up at two in the morning in excruciating pain. I basically felt like I had been stabbed in the stomach and someone was twisting the blade. I drank a half bottle of pepto, no luck. I took a Prilosec, no help. I drank milk. I drank water. I tried to make myself puke. Nothing helped and my pain was only getting worse. Changs sweet and spicy chicken is having its revenge. Damn the Asians!

It’s funny (not gay), when you are at your weakest moments, how your imagination can run away with you. Is it my stomach? It's never been this bad. Could be gall bladder. Could be a kidney stone. Probably not appendix, but could be. This is killing me. Could I have a gall stone lodged in my common bile duct? Possible. Could I be developing pancreatitis? That's really pain full and this is really pain full. That could mean surgery. Could I have a perforated ulcer? This is actually my worst fear. That's definitely surgery. This is not going well.

So I come to the first decision every person on the other side (the patient) makes. They decide to come to the hospital. This was not as easy as I thought.

It's the middle of the night. I'm not at home. I am about to ask my 74 year old mother to drive me to the ER. I'm in agony. This completely sucks. After 30 more minutes of anguish I decide there is no other option.

I have one friend who practices in Birmingham. I call and of course she is not on shift. At this point is doesn't matter. If I am leaking my stomach contents into my peritoneum there is only one place I'm going in Birmingham: UAB.

I arrive and am quickly triaged. I go straight back. (Usually not a good sign). I meet Dr. Buckman. He is about my age. He knows I am a fellow pit doc (that's slang for ER doc. If you really want to be in the know refer to the ER as "the pit". Usually because the ER is always located on the bottom floor of the hospital but also considered by many as a place of primordial ooze that some of the most basic forms of life miraculously survive. Anyway, it is 4am now and Buckman looks a little tired. I give him a succinct story about my symptoms but leave out my list of possible diagnoses. That's his job. I should stay out of the way.

He examines me and says "I think you've got a perforated ulcer". Oh great! This Buckman is a real wordsmith. So much for sugar coating.

That means major surgery. I'm 300 miles from home. I've got obligations this weekend and I'm back on schedule in the ER starting Monday. I am not prepared for this and my entire career is based on being prepared for an emergency. It's just not a good time.

Buckman plays his trump card, "Well, if you've got it, there are no other options."

I know he's right. There is an unintended psychological warfare going on in the hospital. I am in severe pain. I have on a hospital gown and a pair of boxers. One person walked in while I was changing and I'm pretty sure at least 3 people saw me naked. But since I've got this burning fire poker in my belly, I could hardly give a care. I'm pale and feel lousy. I don't know any one's name. Someone whom I have never met and who has never met me could be opening my abdominal cavity in the next few hours. I am at their mercy. I feel helpless.

So to make a long story short, I ultimately did not have a perforated ulcer, just an ulcer. I got outstanding treatment and was discharged in a much improved condition.

As for my treating physician, Dr. Buckman was a flat out stud. I knew he was concerned. Not by what he said but by what he did. He showed up in X-ray after I had my films done. Later I saw him again in the CT scan control booth looking at my images as they were being developed. He didn't have to do that, but he knew that something could be bad and he didn't sit around and wait on the answers to come to him. He actively sought them out. It's those kind of actions that separate the great from the good.

Barbara, my nurse, was fantastic. Like all great ER nurses she has the most face to face time with the patient. She started an IV, was quick with the meds and double checked the doses at the bedside in my clear sight. I only got a small dose of pain medicine (my request) but she hooked me up to the monitor just to be safe. I (and she) knew that probably wasn't necessary but still it was comforting. She wasn't taking any chances and I really appreciated that. I joked with her and she joked back. I was facing a crisis but I was confident she knew my case and was looking out for me. She was a pro.

There is a thing called "The Patients Bill of Rights". As a physician, I have always rolled my eyes at this idea, thinking what is the point? I am on the patients side. I want to get the diagnosis right. I want them to get the right treatment. But now I know the Patients Bill of Rights is not about me, it's about the patients' trust.

So I have written the ER Patients Bill of Rights:
1. The Patient has the right to be afraid. We know that you don't know us and that is naturally frightening in this critical time.
2. The Patient has the right to be believed. I will believe you are sick.
3. The Patient must know that the doctors and nurses are asking them for their trust.
4. The Patient must trust that I will do the best for you to come up with the right diagnosis. Not of of fear of being sued, but because I want you to get better.
5. We (including you) are part of a team. We must all work together and do our best to solve this problem.

*This Bill of Rights may not apply to everyone. If you come in weekly and have cried wolf too many times, you have betrayed our trust. And this is a two way street.

So what have I learned from being on the other side?
It's miserable. But when it's miserable I want to be the kind of doctor that (and I can't believe I'm saying this) is a comforter. It's not just getting the diagnosis and providing treatment. It's about reaching out and really helping someone in a time of need.