Late to a Funeral

Fifteen minutes late, I quietly slid into the back pew. The service was well under way and the pastor was over halfway through his reading of my deceased patient’s biography. “Oh well”, I thought, “at least I made it!”

I almost didn’t. The funeral was at 2:30 and I had spent the first part of the day at Disneyland with my family. Lisa and I had been invited to share the Saturday with my son and his family. There was no way I was going to miss an opportunity to be with my grandson. As Charlie is only 2, I figured he wouldn’t last that long and that the 2:30 funeral start time would not be a problem. I took my suit along in the car thinking that we would be done in plenty of time for me to make it.

I was mistaken. Charlie had greater than expected endurance and he did not run out of gas until after 2. When we exited the bus in the parking lot and headed for our car, it was 2:28. I wondered if I should skip the service, thinking that it would be disrespectful to be so late. I also wondered if it would matter to the family whether or not I was there at all.

Something inside made me feel like I needed to go. I checked google maps and saw that it was only an eleven-minute drive from the Toy Story lot to the funeral home. “I’ll drive so you can change in the car,” Lisa offered, and my decision was made. I slipped into the passenger seat, grabbed my clothes from the back seat and transformed into a quick-change artist. My clothes were on and my tie was tied by the time we arrived at the funeral chapel. I found the entrance, stopped to sign my name at the bottom of the guest book, and found my seat.

As is so often the case, I learned many new things about my patient from the service. I had only known him as a debilitated man with heart failure and diabetes. He was so much more. Listening to his life story and watching the slideshow I learned of a muscular man who loved to hunt and fish and enjoy the outdoors. He had built a business and a family, and he loved his grandchildren.

When the service concluded, we were excused by rows, starting from the back. The family waited up front as we all lined up to express our condolences. I was fourth in line and watched as the wife, also my patient, greeted the other mourners. The hugs exchanged were brief, as were the words shared. Until she saw me.

He eyes widened as I approached, then filled with tears. “You came!”

Her composure broke as she reached out her arms and embraced me. She held me tight, her head on my shoulder, and began to cry. Up until seeing me, she had been in total control. I returned her embrace, all the while wondering why it was me that had brought such a response.

After a moment, she gathered herself and relaxed her embrace. She took me by the hand and said, “You have to meet my kids.”

Her adult children were standing behind her. She pulled me to them saying, “This is Dr. Barrett.” Their faces softened in recognition of my name. It was clear that they had heard of me and knew who I was. I wondered what they had heard, and why I was the subject of conversation at all. I shook their hands, first the son’s and then the daughter’s. His handshake was brief, hers was not. She firmly held my hand in both of hers and with tear-filled eyes thanked me for taking good care of her dad.

“I know that because of you he lived long enough to see his grandchildren,” she said, “Thank you.” I did not know what too say. I couldn’t think of any particular treatment or diagnosis that justified her belief. I knew that I had loved her dad and done my best for him, but I did not feel comfortable being credited in such a way. I nevertheless mustered a feeble “thank you, it was my pleasure,” before turning away to allow others to offer comfort.

I exited the chapel stunned. I was totally unaware of how much I meant to the family, of how much my presence at the service was going to matter. My interactions with the man had always been brief, only rarely more than 15 minutes. How could I be so important?

It seems that I had underestimated the power of caring. While his conditions were not cured, his concerns were heard, his quality of life occasionally improved. He was not a heart patient to me, he was a man. Seeing him that way had made more of a difference than I could have imagined. Apparently, there are times when caring is as important as providing good care.

It is humbling to realize how close I came to missing out on the blessing given me by the family. They gave me much more than I gave them.

Bart

The Sins of our Past

The world has changed dramatically. Things that were once accepted will now ruin your life. I remember reading joke books that belonged to my dad. He had many “official” joke books, each making fun of a different group- Irish people, Italian people, black people, Jews, Mexicans and Poles. I read them all, some more than once. I laughed, blissfully unaware that the jokes would hurt anyone. (How could they? They were jokes.)

Thank God this was before the internet and social media. There is no doubt in my mind that if it had been possible, I would have posted some of the jokes online. The thought that this might later ruin my life would never have occurred to me. Even today, very few teens post with thoughts of the future.

Carson King definitely did not,

Carson King is a 24 year-old fan of the Iowa State Cyclones football team. After hearing that ESPN’s College Game Day show was going to be at the school for its weekly broadcast he decided to make a funny sign in the hope that he would be seen on TV. He chose his place behind the hosts well, and his sign, “Busch Light Supply Needs Replenished” with his Venmo account ID, was easily seen on the show.

To his surprise, people starting sending in money. Lots of money. When the amount reached $600 he concluded it was too much for him to keep and he decided to donate the money to the University of Iowa Children’s hospital. The money kept coming. Within days the story had gone viral, and thousands of dollars poured in. Anheiser-Busch got in on the action, offering to match every dollar donated, as well as putting Carson’s face on a line of beer cans, and giving him a year’s supply of beer. Venmo also offered to match the donations. Before long Carson had raised well over a million dollars.

Carson was soon a local hero, with many praising his kindness and generosity. He was universally hailed as a nice guy, online and on television. As his fame increased, the Des Moines register commissioned a reporter to write a story profiling Carson. As part of his “research” the reporter searched Carson’s Twitter feed, going back all the way to when he was 16 years old. Unremarkably, he found that teen Carson had made some inappropriate jokes. For some reason the paper decided these 8 year-old tweets were important enough to be included in the story about the good he had done.

The response was swift. Anheiser-Busch cut all ties. The special Carson King beer was pulled from production, and all promotions related to Carson were terminated. Carson’s humble apology was not enough to keep the beer company from running from potential controversy. They could not be “associated” with someone like him.

Fortunately, Carson’s story did not end there. A local beer company is producing an “Iowa Legend” beer, donating $1 per bottle to the hospital. Private donations have continued, totaling over $2 million dollars. Angry supporters of King delved into the reporter’s past social media posts. The reporter was fired after it was discovered that he had also posted offensive tweets when he was young.

The story is a reminder of an important truth- no one is perfect. We are all broken and sinful people; we all have done things that were ignorant and stupid. None of us wants to be defined by our past mistakes. With this in mind, we need to do everything we can to avoid defining others by their past.

It seems that many of the people in Iowa have embraced this. Carson was recently honored at a University of Iowa football game (the stadium is overlooked by the tower of the Children’s Hospital), the governor of Iowa declared a “Carson King Day”. Support for Carson has actually increased since the revelations of his past indiscretions.

I want to be that type of person, one who focuses on who a person is now more than who a person was before. I often tell people that one of the hallmarks of my faith is the truth that God is more interested in where I am and where I am going, not in where I have been. God forgave my past and redeemed my future. When I embrace this truth, I realize I cannot follow Him and focus on other people’s past failings. I must forgive.

Bart

A Dream Dies

For only the third time in 4 years, I am not on call for Ethics at Hoag Hospital. The first time was in April when I was on vacation in Tennessee. (I continued to take calls on my other vacations). The second time was after my surgery in August. This time is different. This time it is permanent.

I have been grieving over it for the last week, ever since I sent my letter of resignation to the Chief of Staff. I didn’t want to quit, but circumstances made it impossible for me to continue. I have been responding to consult requests since becoming the Ethics Chairman in 2015. While the volume of calls was only occasionally stressful, when the calls did come they usually resulted in 3-4 hours of work added to my day. Some cases were more demanding, and over the course of a week could result in over 15 hours of work. The reality that a call could come at any time brought additional stress,

I did not want to do the work alone, but my pleas for help were not answered. I labored on, hoping that eventually the quality and impact of my work would generate support. As is often the case, words of support came, but actual help did not.

What saddens me most is not that my efforts were not recognized, or that the help did not come. I grieve for the patients and families who will go without help, for the suffering that will be needlessly prolonged, for the conflicts that will drag on longer than they should, and the belief that I could have made a difference.

A wave of sadness passed over me when I took myself off call this evening, There is so much more I wanted to do. I wanted to have weekly rounds with nurses and physicians so we could identify potential problems earlier and provide more support for families. I hoped to train others in how to perform ethics consults, to train nurses and physicians in how to better communicate with patients and families and to educate community members in how to better communicate with medical providers. I shared these ideas to as many leaders as I could, wrote proposals and gave presentations, all of which were ultimate ignored.

I don’t like to admit defeat, but this was a fight I could not win. For now I will take solace in the knowledge that I did the best I could and the hope that God has other things in store for me to do,

Bart

Alone in Plain Sight

Day after day she sat on the sidewalk just south of my office, her belongings in a shopping cart beside her, her back resting against the chain link fence of the property next door. She had a cushion beneath her which at night became her pillow. I wondered how she ended up there what events had led to her not only being without a place to live but that had caused her to choose that small section of sidewalk to be her residence.

After a few weeks of wondering I decided to cast aside assumptions and aspersions and ask her. Returning to my office from lunch, I walked her way instead of into the office after exiting my car. I approached slowly, trying to appear non-threatening.

When I came up to her I noticed that she had a paper bag in front of her, nearly full with small bits of folded up paper, less than a centimeter square. She was busily tearing up larger pieces of paper, folding them over and over and placing them in her bag. From the amount in the bag I could tell she had passed many hours in this fashion.

She was slightly disheveled, but did not carry the odor that is often associated with those who live on the street. She was not filthy, and her hair was not oily or stringy. It seemed that there was someplace she went, at least occasionally, to clean herself up. I bent down next to her and said, as kindly as I could, “Hi, I am the doctor in the office right here. Can I ask you how you ended up here?”

Without making eye contact she said, “I’m sorry, I’ll leave.”

“I am not asking you leave,” I replied, “I am just asking how you ended up here.”

“I don’t know. I’ll leave,” her words were quiet and almost tremulous. She seemed to speed up her paper folding, obviously nervous.

“I am not asking you to leave,” I repeated, “Is there any place for you to go, anyone who can help you?”

“I don’t know,” her discomfort so strong it seemed a plea to leave her alone.

I paused for a moment, wondering what it was I could say to break through to her, before standing up and quietly walking away.

The next morning she was gone.

She was different from other homeless people I have encountered. There was a type of humility in her. She did not seem to feel entitled to help, or even to her piece of the sidewalk. She seemed overwhelmed by human interaction, unable to relate or converse. I wondered if she battled mental illness, or some other condition that had led her to the streets. The one thing of which I was certain was that she seemed to need help, and that society had not yet figured out a way to help her.

Bart

A Doctor Goes Under the Knife

“154/110,” said the admitting nurse. It was the highest blood pressure reading of my life, and tangible evidence that I was more stressed about my rib-removal surgery than I thought I was. I had been anticipating the procedure for months, going from panicked, to confident, and then back to scared again. The blood pressure made it clear that I had not totally conquered my fear.

I was not afraid of the procedure as much as I was of the recovery. The surgeon had gone to great lengths to make sure I was prepared for the agony ahead. “Every breath for the first week will be excruciating,” he had told me in his office. That is a lot of breaths. (at 15 breaths a minute, it’s 151,200 breaths to be exact.)

I worried about how I would get through it. I worried how Lisa was going to get through it. She had been through over a dozen surgeries with me over the last 37 years, from wisdom teeth to hernia repairs to knee surgeries, but I had not been totally incapacitated for any of them. From what the surgeon said I was going to need a lot of help.

The surgeon had performed the procedure over 1000 times before, and I ultimately decided that all of the other patients had somehow gotten through it and that I would too. The thought was comforting, a little. When they wheeled me into the operating room I resorted to joking around with the nurses and residents as they prepared to put me under. “Good night everybody!” I said as they put the mask on my face.

My next memory is of being wheeled into my hospital room. I was hooked up to IV pain medicine, with a button so I could get more whenever I needed it. The doctor had left a catheter inside the wound to drip lidocaine continuously into the area to control the pain. Other than a pain in the muscles in the middle of my back and a terrible sore throat, I wasn’t that uncomfortable. I figured it was because the lidocaine was doing its job.

The pain wasn’t bad through the night. I hit the button a few times out of concern that it might start up, but went through more throat lozenges than I did doses of pain medication. (My uvula had gotten pinched in the surgery, cutting off its blood supply).

I called the nurse a few times in the night to help me get to the bathroom, each time feeling like a wimp and a nuisance. I was a little unsteady on my feet from the meds the first couple of trips and did not want to fall. After a few times to the bathroom with assistance, I was confident enough to go on my own, even disconnecting and reconnecting myself from the oxygen monitor. (No one said anything, so I assumed it was okay…)

I did not sleep all that well because of the throat but felt surprisingly good in the morning. I remember the surgeon had said for me to try and take deep breaths, so I took several, again thinking that the lidocaine was the reason I was not in the excruciating pain I had been told to expect. He had also said I should try to get out of bed, so I grabbed a hold of my IV pole and took a few labs around the floor. The only significant pain I had was when I sneezed while walking. The nurses gave me a few curious looks when I asked if I could walk, but told me that it was okay.

I was fearful that my backside might be hanging out of my gown and asked the nurse if it was okay for me to put my clothes on. He seemed a little leery but said yes then stood nearby as I retrieved my clothes from a bag and put them on. He hooked the bulb of the surgical drain onto my shorts so it wouldn’t dangle.

A little after 9 in the morning the surgical resident and some students came to check on me. With hesitation, he told me that he needed to look at the incision under my arm. “Okay,” I said, raising my arm so he could get a better look. He looked a little puzzled, then looked at my wound.

I told him I was doing well, that it had been over 6 hours since my last pain medication dose, and I asked him when he thought I would go home. (I had been told 2-3 days)

“You can go now, if you want,” he said, “You are doing well.” The nurse came in later to go over discharge instructions. He told me that I was doing really well and that he was surprised that I was not in more pain.

I did not realize how well I was doing until I saw the surgeon for follow up 13 days later. He told me that most patients cannot move their arms at all after the surgery. They hold the arm up against their sides, as even the slightest movement is agonizing. (this explained the resident’s surprise when I raised my arm.)

He told me I could start to drive, then laughed when I told him I had started driving two days after surgery. I then told him that I had only taken a few pain pills and that I had gone back to work three days earlier. Another laugh, with him commenting to Lisa, “This is truly amazing!” He had never seen anyone do anywhere near as well as I had, had never had anyone with so little pain.

At one point in the conversation he started to say, “This is almost miraculous!” but he stopped at the mir- It seemed he did not believe in miracles.

That’s okay. I do.

Bart

PS: As is so often the case, being a patient left me with many lessons. I have a much better understanding of the fear that comes with a major surgery. I will be more sensitive to it in the future.

The surgery resulted in trauma to my phrenic nerve, the one that controls the diaphragm. For the last two weeks I have been living on one lung. I thought I understood shortness of breath before, but realize I didn’t. It was frightening to gasp for air after tying my shoes, to feel like I was suffocating every time I tried to lie down, and to need 30 seconds to recover after walking to the living room.

My lung patients will find me a much better doctor going forward!

(Thankfully, this appears to be getting better)