Like many doctors I lead mostly an internal life.  I've often thought about why this is so.  The recent suicide of a friend and colleague seems to really have affected me emotionally.  Ted was a gracious, soft-spoken man, very tenderhearted, but he was also very private, at least with me.  His son Gavin had been killed in a car "accident" in December of 2009, and I didn't meet Ted for the first time until around February of 2011.  I wasn't in a great emotional state myself at the time after being "fired" from my job as an ER physician for reasons I still can't figure out (ok, I wasn't "fired" but my contract was not renewed...the same thing) and going through my own emotional turmoil, and Ted was the only person who really seemed to believe in my abilities as a physician and give me a chance by hiring me.  Now it has been over 4 years since then and still working at the same place with no real problems with my clinical care, and Ted was my boss for most of that time.  Ted was scaling back his shifts so I think he was somewhat thankful when I joined on full-time, and whenever we would see his name on the schedule a lot of the time there he would have found someone else to work for him. However, we'd always see him on Wednesdays when the hospital administration would have all their meetings and he would always be there like clockwork.  I never really knew Ted before his son's death, but I am told he was never the same after that happened.

According to those who knew him and the newspaper reports, Ted's son Gavin was going to lunch with a friend from school and as a lot of irresponsible kids do, this 17 year old made the immature decision to drag race down a highway with another kid and lost control of the car and it flipped, and Gavin was killed instantly.  His parents were quite understandably devastated.  The driver of the other car was charged with involuntarily manslaughter which he was convicted of.  Ted, his father, was quoted on the news at the trial of the other driver who was convicted of this and said, "Mere words cannot convey what my heart and my family are feeling.  Our lives are shattered.  It is now seven months since Gavin's death, and we can see very little joy or hope in life".  It was a unfortunately a sign of what was to come and I will always wonder whether I was one of the many who was so wrapped up in my personal issues that I didn't offer my hand or heart in support.  The internal pain of that event is something I can't even imagine.  I'm not really sure if the trial and conviction of the other kid gave him any sense of closure or just added to the tragedy...

We doctors don't really hang out together, and I'm not really sure exactly why, but I have some theories.  In just a logical sense, we live very far apart and commute to work, and very few of us live locally.  We have kids and homes and other responsibilities.  There aren't that many of us to get together, and none of us takes the initiative to plan anything.  If I have a day off, chances are the others are working.  We come from many different stages in life, some younger, some older, as well as many different cultural and ethnic backgrounds.  Personally I've become somewhat of a loner.  I used to socialize with other physicians in residency, especially when there would be free dinners sponsored by pharmaceutical companies, but those mostly went by the wayside when the government deemed most of it illegal.  Now those dinners are rare, and if I did go I probably wouldn't know anyone.  There's a certain social akwardness in me I can't seem to figure out.  I used to be a very social person before I went to med school.  I was a hopeless optimist, people seemed to want to be with me, then I went to med school.  I was exposed to situations that I never dreamed of and was humiliated at times during my residency training.  I internally humiliated myself more during that time.   It was difficult to explain that to other people.  I knew I still wanted to be a doctor and couldn't imagine myself doing anything else, but I became my own biggest enemy, never wanting to let others see me sweat.  It was for good reason too, because I think the stress of my divorce was a primary factor in me being fired from my job.  The ER was so busy too that I didn't have time for personal problems.  On to the next patient...lucky to have time to eat or pee let alone cry or be vulnerable,  which was for the weak.  I did try to socialize some.  In trying to have a dating relationship it seemed like men were shy or uncomfortable about what I did for a living, and I certainly didn't fit in with the doctor wives since most all of my ER doctor colleagues are men.   What are we gonna talk about anyway?  Work?  Sports?  So I started staying home.  The nurses were my friends, but for some reason I didn't really hang out with them either.  It's partly my fault.  I should have initiated something to get together, having to get past the weird hierarchy that doctors and nurses shouldn't associate with each other, which I always thought was bullshit since my best friend is a nurse.

I either knew first hand that some of my colleagues and friends were drinking a lot, but I didn't really have the courage to bring it up.  That would be weakness to admit such a thing, and to the state medical board it might mean putting one's medical license in jeopardy, even if they never showed up for work intoxicated or it never affected their work.  It becomes very taboo to bring up any kind of substance abuse or depression to anyone else.  We are taught to be the strong resilient ones after all.  If you don't feel well or don't know something it's always better to fake it.  After all, isn't medicine "show business for ugly people"?  Sometimes people who aren't doctors don't understand that quote, but we doctors do.  So far I have not become an alcoholic and this might be considered a miracle, but suffice it to say I do have other forms of coping with stress that aren't particularly healthy for me either.  I have perfected my acting role even in the midst of extreme chaos and death when I have 10 other patients to take care of, a few of whom may be very sick or just plain impatient or ignorant, and I manage to put on a smile in the midst of the obscenities flying my way because it took way too long because I was tending to a dying person and failed to save them.  To be able to take a moment to go outside, lean against a wall and cry?  Really, I'm too busy for that... I hope that Ted hadn't fallen into that endless cycle of despair with grieving in his own life, both personally and professionally.    I have recently had first-hand experience with the disease of addiction.  I was so naive before.  Not any more.  I worry about others I know and I don't know what to say.  I know for some people after drinking a lot they really aren't thinking straight.  As a healer I should know how to bring up the subject but I don't and I've often said hurtful things to those I love dealing with addiction just out of anger and frustration.

I remember the stress of my divorce which in many ways seemed like a death to me.  My conflicts with my ex went on for years regarding the kids as he became a complete stranger.   He left me mainly because my lifestyle as a physician wasn't conducive to "normal family life".  I felt guilty for crying at home about it if the kids were around and tried not to do it.  I got some counseling, but it didn't really seem to help, as I often viewed the therapist as just about as messed up as I was (particularly since I had been married to one).  I didn't know how to help myself either, since being a doctor in the ER and working crazy hours was all I'd ever known or felt comfortable in my element doing.  Then  I was named in a medical malpractice lawsuit with 6 others that my only fault was just being there.  This ridiculous thing went on for four years.  I was advised not to talk about it with anyone due to federal privacy issues, and I kept my frustration inside.  It was right before trial when the plaintiff's attorney mysteriously withdrew from the case.  There was no apology for the undue unnecessary stress it caused me.  Just a dismissal from my attorney with a lot of unanswered questions.  Life goes on,..I'm told it is just one of the many irritations one must put up with for being a doctor.  This reinforces the fact that I must act compassionate and be nice to patients and their families even if I don't feel like it and they don't deserve it just because it is a major factor in whether I get sued again.  People are under the impression that doctors are sued for mistakes.  This is so not the case.  I  had also gotten into financial trouble with the IRS who wasn't particularly sympathetic to my issues since I don't live in poverty (but then when is the IRS sympathetic to anyone?).  It was mainly due to coincidentally getting divorced during a recession and owning real estate, which in retrospect I could have done things differently but how was I to know?  I'm in a way glad for these experiences which have humbled me, but I also feel a sense of exhaustion about it.  I still must go to work and deal with a failing medical system where I am merely a provider and get less and less respect from everyone, work harder, and see our government getting involved in an already broken system and making it worse, all the while not asking any of us doctors what we think.  I often envied those who weren't doctors.  At least they had a chance of enjoying their lives, as I spend so many holidays and weekends in my self-imposed prison of work-a-holism and "making the big bucks" wondering if something was inherently wrong with me.  I don't really think I have ever contemplated suicide, but after a couple glasses of wine my mind becomes foggy and tears are more likely to flow.  So I avoid the wine sometimes because it fogs up my contact lenses when I cry.  I went through all of these experiences at the same time.  Now it is mostly over.  Why don't I feel better now?  I'm constantly worrying about people and it sometimes consumes me.  Life is indeed precious and I'm reminded of this every day.  (By the way, telling a doctor " you make the big bucks" is  just another way of saying "suck it up chump").

I am mourning the loss of Ted.  I wish we all felt like we could talk to each other.  I can't even begin to imagine what his wife and son are feeling, and I feel emotionally inept about what I'd actually say to them.  There have been others who have committed suicide after becoming physicians too and this has affected me.  I hadn't seen Ted in over 7 months.  He decided to "retire" from being a doctor all together at the end of December last year and go into some heavy machinery business with a family member.  This baffled me because he was only 56.  His heart never really seemed to be in it anyway and he never seemed to want to work very much.  Then there was this mysterious worsening tremor he would have whenever he would come to work that resembled something totally preventable that I didn't even want to think about.  I wasn't really sure if it was the death of his son or not, but I suspect that was a major factor, but I didn't know him before that so I can't say for sure.    He seemed to drop off the face of the earth since December.  We were all busy working and going about our stressful lives, dealing with way to many patients, overworked doctors and nurses, patients having an attitude and being frustrated with our care and our rushing nature.  I should have called him to see how he was doing but I didn't.  Now he is gone and it is too late to say anything or express my concern.

I have a very understanding man in my life Shawn, who has been through his own personal turmoil and I thank God for bringing him into my life.  I am not the easiest person to live with...

Rest in peace Ted Westover.  You were sweet and kind to me.  You gave me a chance when no one else would.  I am eternally grateful to have known you.

The Birth of "Self Development"

I haven't blogged on this site for about 4 years, as I have been distracted by my divorce and other things professionally.  I decided it was time to pursue my own personal development, as like many others, I would like to be more "authentic", and to pursue my own psyche into facing the reality of what I really dream of what would be the ideal for myself and those who share my life with me. 
On my way to work one day, I searched on my iphone for "free self-development podcasts" and came up with some recommended ones and started to listen.
I was captivated by a magnetic Steve Pavlina, who seemed very convincing in his podcasts from 2005-06, and listened intently on my 80 minute commute each day to work.  He talked about how he followed his dreams and became successful, happy, and healthy.  His wife was a contributor to the podcasts, talking about lucid dreaming (interesting topic) and some psychic stuff  (which was interesting but not too much into it honestly).  I had meant to go on his website/blog when I had the time, but I was preoccupied with other stuff, and quickly downloaded a couple of his books to my kindle, as I was going on a week long cruise to Alaska with my fiancé Shawn.  Of course the internet access on a cruise ship is very expensive and someone one can do without for a week (although it is tough...), but I read with interest most of one book and portions of the other with interest.  I was determined to try some of the techniques he had suggested when I got home.  I was determined to become a happier, healthier, more disciplined version of myself.  I would be easier to live with, have more energy, and be able to pursue my life purpose, which is promoting mind, body, and spirit medicine.  Of course the challenging part is that this is not nearly as lucrative as my job as an Emergency Doctor, so I'd have to keep my "day job" (well day and night job) and do the MBS medicine on the side.
I came home and resumed the chaotic reality of my life.  I was curious about what was going on with Steve Pavlina, and got on his website, stevepavlina.com and was in for a SHOCK!  He was still the self-proclaimed self help "guru" I had intently listened to previously, but now he had decided to get divorced and start promoting "open" relationships (i.e. sleeping with multiple people) under the cloud of personal growth.  I'm not that self-righteous of a person, and certainly have engaged in behaviors in my past that I'm not necessarily proud of, however, an indulgent life of this nature appeared to be a step WAY back for him.  It was contrary to all the previous principles he had taught about discipline and authenticity. 
I couldn't resist writing to him as there was a way to do so on his blog.  I was confused by his self-destructive behavior, as it is clearly physically and emotionally risky on many levels as I'm sure most people will agree.   I fully didn't expect him to respond, but he did immediately...twice.  The first time he accused my of not really knowing him and basically being ignorant.  I wrote back saying that I was a doctor and I considered myself to be a fairly intelligent person and I was concerned about him and didn't really understand why his life would take such a direction.  He wrote back again in a very snarky way, implying that most doctors he knew were very egotistical and cared only about the size of their houses and about themselves.  I wrote back basically telling him he was totally wrong (at least about me) and never heard back from him.  I included a cut and paste from his own website about how he handles criticism.  I never heard back from him. I guess I struck a nerve...
So as far as my own personal development is concerned, I am filled with more questions than answers.  I understand the self discipline philosophy etc., however, on the day after my cruise I had to unpack and get ready for work the next day, and I had full intention to make time to journal, to read, and to spend time really thinking about making a plan for handling my purpose and my future.  When having kids, however, and not being able to control others I quickly discovered this to be more challenging than I thought.  The babysitter had my car, and we went to go get the car at a predetermined time and place, but was texted at the last minute that she was running late, and then didn't answer texts or phone calls while we were out to get the car.  I was going to go grocery shopping while out (we live in the country, about 20 minutes from the store and where we were to meet her), so then I had to shop later and make a special trip.  Then one of the kids was ill, and just wanted to camp out on my lap and fall asleep while cartoons were on.  And that was my day...
So then I thought about it, and how selfish it would have been to put myself before my kids, who needed to be comforted when sick and needed food in the house to eat,
I could just ignore everyone and serve myself and my own needs, however, the reality is that I have children who depend on me, and a fiancé I love and who also deserves my time.  I have bills to pay.  The more I thought about Steve Pavlina and did research about him, the more I completely lost respect in him.  His ex-wife has full custody of both of his children, he blogs continuously in grave detail about sex and dominating women, and talks about how he needs several hours a day of "cuddling" with women (where to fit in spending time with his children I have no clue...)  He has gone off the deep end of midlife crisis and perversion and I felt more and more sorry for his children the more I read.  He only pictures beautiful young women who eat "raw food" on his blog and has a noncommittal "girlfriend" (who apparently likes to sleep with other men besides him).  I guess in a way I'm a little heartbroken that the influence and possible mentor I thought I'd found is that troubled as a person, but also the psychopathology about how he spiraled out of control as "insanely" interesting.  There have been some very vocal critics of him which has been fascinating.  Seems like he prefers superficial relationships with multiple people above the deep commitment (and I believe many rewards, both short and long term) of a monogamous marriage and investing in his own children to be a loving example of how a person should be.  I feel sorry for him.  I wonder where all those cuddly women will be when he is an old, dying man...Will his children forgive him?
I have concluded that I could read every self-help book every written and get tidbits from many, but indeed it is up to myself ultimately.  I can't rely on any one person, because so many of those who capitalize on this industry are indeed very troubled personally (and I thought I had problems...).  So I am a work in progress and the only thing I can figure is how writing a blog in an honest way is a great way for me to grow myself, even if no one reads it!  Maybe I will learn something myself and be able to help someone else in the process, which would be very gratifying.
We all need to laugh at ourselves.  Life is a very funny thing and so unpredictable.  I want to roll with it and teach others the same.  I want to feel good about my path and make others feel good about theirs...authentically!!

"Sick" Children in the ER

I can't help but ponder all the folks that come into the ER who, how can I say this, if they just had one once of common sense wouldn't be there. That's the nature of what we do, so we have no choice rather than to grin and bear it, to make fun of it, and to laugh at it.
I recap some of my entries onto the facebook page, "Emergency Rooms are for Emergencies"
What is the most nonemergent case you have ever seen?

My Pediatric Favorites:
1. "My baby won't stop crying"--noted in triage to be soundly sleeping (otherwise asymptomatic, no cough, no fever, etc.)...exam absolutely normal, eating sleeping, developmentally normal.
diagnosis: umm, well baby check (cross out), umm, fussy (cross out), umm infantile colick-resolved--yeah, that sounds good...
2. "Vomiting all day"--4 year old child now chowing now on chicken mcnuggets, eating doritos and drinking mountain dew from baby bottle, has torn up everything in the exam room (including all the exam gloves, which are now strewn all over the floor). Did I mention the child was also very obese for her age? Mom worried she will get "dehydrated" exclaims "the vomicking got more worser" (no typo here).
3. "Fever"--child afebrile in triage, acting fine..."how high was the fever?"....answer "he felt warm, I don't have a thermometer" (but I have plenty of money for cigarettes, custom manicure...o.k. I digress here)..."did you give him any tylenol?"...answer "no, I didn't have any"...(parent now noted to be getting irritated, taking keys out of designer handbag, mumbles something about this taking too long, medicaid card falls out of purse onto floor)--the room is torn up in the same way as the previous patient and the gloves are all over the floor next to the medicaid card, the floor sopping wet from child playing with gloves in sick trying to make water balloons. "do you have any free samples of tylenol?"...I refuse to answer...
4. Actual case recently "5 yr old bit by snake on foot". Child running around room on bit foot, raising hell, no limp, no acute distress..."did you see the snake?" I question...answer, "no, but I know it was a moccasin"...On exam with magnifying glass, can see no bite or swelling of any kind...child now acting irritated (I'm interfering with his mission to destroy the ER). Hmmm, what diagnosis should I put on my t sheet???
5. I see the 287th child with "a really bad cold". There's no such thing as just a "cold" in the ER, just "a really bad cold/cough". Child doesn't cough not one time in the ER...lungs are completely clear...a little drainage from the nose, afebrile, throat and ears clear, child playing. When I try to explain that they don't need an antibiotic, they glare at me as though I've just fallen off a giant fruit truck (they are now contemplating going straight to the ER in the next town, because I've obviously a doctor freak who doesn't know what she's doing). I take a much needed 5 minute break to eat an apple, orange, and banana (momentarily neglecting all the "emergencies waiting), and contemplating my conspiracy to stockpile all the antibiotics in the world and let everyone perish from their colds...anyway, when does that fruit truck arrive back here to take me home???
---Meanwhile, the ER is completely full, unable to accommodate the really sick person in the waiting room in DKA vomiting all over the floor---
If we don't laugh over all of this, we would surely go insane....

(pictured are me (the oldest), my sister Kelly, and brother Chris as kids. At that time in my life I naively believed the Emergency Room was actually for Emergencies)

Today my sister and I went SHOPPING!!!

We had a blast, only to have to return to unruly children at home, which hubby wasn't too happy with retrieving 4 of them at the sitter since we got home late.

Tomorrow night I'm back in the ER, feeling more refreshed than my last shift.

I can't imagine having endless hours to shop like I perceive some people do.

These are the kids, mine and my sister's when we went on Spring Break. It's hard to get all of them to smile....

The ER adventure while sick...

The fast-paced ER I work is always an adventure in one way or another, but one of the downsides of the job is that it is nearly impossible to find someone to work when you fall ill, particularly at the last minute (because the gastroenteritis comes on rather suddenly), let alone it's a Saturday night, crap...
In six and a half years of doing this, I've never called in, and it's not out of luck, but just the reality of things...one must work while sick. I've known other docs to walk around the ER with a perforated appendicitis with an IV pole attached (I wonder what the patients must think of that!!) just because we feel we have to be so stoic.
No such drama for me, just gastroenteritis this time, chills, body aches, headache (from the caffeine withdrawal partly, no doubt, since I was too nauseated to drink my usual 3 cups at the beginning of my night shift).
The parent with the sleeping afebrile child who "had a fever at home...he felt hot...I didn't have a thermometer though...why do I have to wait so long in this ER, the worst ER in the world because I had to wait..." is always a bit unnerving, but adding the GI bug, it takes on a new dimension. "But ma'am, there were 3 people I had to see first that had trouble breathing" doesn't seem to matter. Sometimes it really seems to me like people live their lives in a bubble, oblivious to what's going on around them, and that there might be actual emergencies in an emergency room (imagine that). And, oh yeah, I had to take a 5 minute break to throw up. OK, maybe I should omit saying that...
But the nurses and staff were amazingly empathetic, and perhaps the paleness of my face after returning from the doctor's lounge wasn't pitiful enough. I never expect a lot of empathy from anyone in the ER, because with all the screaming, moaning, and drug-seeking, we all become a bit low on fuel in the empathy department. Isn't our caring nature why we went into medicine in first place? Oh yeah, I must remind myself of this, even while ill.
The night didn't end up too terrible, no gunshot wounds or combative drunk drivers typical of the usual Saturday night, and my waves of nausea were disappearing by about 2 a.m., so then I was able to hold down some Motrin. The only bad thing was that when 7 a.m. rolled around, my relief didn't show. The nurses because worried because my replacement was almost always dependable and early, and there was some black ice outside, so they started thinking of the worst case scenario (can you blame them, considering where we work?), only to discover by the emergency scheduling person who phoned him that he had accidentally set "Alarm 2" on his clock instead of "Alarm 1". At 8:30 he apologetically walked in as I wrapped up the "emergency toothache for 1 week" in room 15 and headed home, only to be delayed behind a "wide load" taking up both sides of the 2 lane country road. I slept for almost 20 hours, thanks to my gracious husband who pitied me (and dreaded when he would catch the bug next), and I woke up this morning feeling surprisingly better.
Today I treated myself with a manicure/pedicure and lunch out with my mom and sister, which I hadn't done in a long time.

ER and MindBodySpirit Medicine Blog

I'm an ER Doc who longs for something more meaningful, thus the MBS connection.
I'm no as philosophical as my husband, although I do possess a lot of his sarcasm and humor.
The ER, in many ways, is like an island of wilderness.
Every day brings different challenges, but in many ways is surprisingly mundane.
Every once in a while, a memorable someone meets my aquaintaince and makes a lasting impression on me (and hopefully I might make one on them).
Such an encounter makes me very introspective about life, love, and relationships.
When I mention patients I will make every attempt to respect their privacy and not reveal too many details, certainly not mentioning their names, but welcome any comments.
After all, I am not just a robot provider, I am human mortal who occasionally make mistakes.