gomer

The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.

"So what brings you into the ER tonight?"

"I've had a cough"

Did I mention it's 4 am?

"How long?"

"Oh......probably at least for at least 10 years now."

"Has it changed at all?  Gotten any worse?  Coughing up anything?"

"Nope.  It's the same."

Did I mention that his vitals were stone cold normal?

"Any fevers, chills, weight loss, night sweats, etc, etc, etc"

"Nope.  Just the cough."

Did I mention that the patient is comfortable, calm, completely relaxed? 

"So what exactly made you come into the ER in the middle of the night?"

Did I mention this is the ER, stressing the EMERGENCY aspect of that term?

"Oh, I just thought I should get it checked out."

"And why didn't you go to a primary care doc?"

"Well, I don't like my doctor very much."

Did I mention that there are actually other SICK people in the ER?

"Do you smoke?"

"Yup"

"You, sir, likely have a smoker's cough.  Follow up with your primary care doc."

Remember this the next time someone is blathering ignorantly on about why our medical system is becoming increasingly more expensive.  Because both your and my dollars went to pay an ER triage nurse, an ER nurse, and a doc to evaluate smoker's cough at 4 am.  Never mind the infrastructure of an ER.

first, to endure

The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.

My phone vibrated just as we sat down to eat.  My first weekend off in 6 weekends but by noon, I was already getting called back in to the hospital.  One of those, what I call 2-for-1 specials, came in.  In other words, a pregnant woman.  OB is one aspect of family medicine that just doesn't do it for me.  I've seen too many instances where an "uncomplicated" birth can go to a stat C-section in 5-10 minutes.  It's one of those instances where you just have to know your limitations because time means life.  For two people.

But I dragged myself back to the hospital.  Appropriately, it was raining heavily which just added to my frustrated and sleep deprived mood.  But I've learned to put that all away when with the patient.  Everything about the birth went fine.  No surprises.  No difficulties.  Perfectly routine and uninteresting which is the best kind of delivery to me.  The dad cut the cord and the parents were both joyful.  But when we asked if they had a name already picked out, the response made me stop for moment.  Josh.  I don't think I've ever delivered anyone with the same name as my brother.  No, I would remember that.  I signed the birth certificate with a sense of pride.  Probably more towards myself than anything.  I was a witness on my brother's death certificate.  And now I was the delivering doctor on this young child's birth certificate.  The words with which Hemingway signed his letters rang back through my head, "first, to endure".  I have endured.