Mostly Cajun, is this week’s edition of The Name Game, applies a generous helping of snarkasm to the name choices found among the birth announcements in the local paper:

Brittney T. & Jacob A. sort through dog droppings for the remains of the Scrabble set and find a name for their new son, Jeaven, and a manly single-syllable name for the middle. Gage. Jeaven Gage.

I larfed and larfed…

If you actually asked any of my friends what they think my IQ is, the answers would probably be evenly divided between, “Pretty damned high,” and “Please God, don’t ask me that. He’s insufferable enough as it is!”

But if you really want to know, the answer is, “Smart enough not to pay a $9.95 monthly cell phone surcharge in order to take some silly quiz.”

Get it?

Got it?

Kthanxbai!

Charge nurse: “Whatcha got, AD?”

Ambulance Driver: “Hand pain and swelling for one week.”

CN (cocking one eyebrow skeptically): “… and?“

AD (deadpan): “Well, it’s really bad, life-threatening, ambulance-type hand swelling. You know, the emergent kind. It even hurt a little. Yesterday.”

CN (sighing): “Can this emergent case of hand swelling go to triage?”

Speedy Doc, chiming in: “Nah, Exam Two is open. I can dispo this in no time.”

CN (resignedly): “You heard the man, AD. Exam Two it is.”

***five minutes later***

Speedy Doc: “Howdy, Sir! What brings you to the ER today?”

Synaptically-Challenged, Mouth-Breathing Waste of Protoplasm, hereinafter known as “Pokey,” because I had a really sweet Lab puppy with that name, and it helps keep me from strangling my patient to think of him this way. (Plus, it’s easier to say than “SCMBWP.”): “My whole hand is swolled up, Doc! And it hurts like a sumbitch! I was at the other hospital last week fer pneumonia, and them sumbitches let mah IV infla… infer… umm, infilter?… uh, leaked and swolled up!“

SD (palpating the man’s hand and noting the decided lack of swelling and painful response): “Hmm, looks okay to me.”

Pokey: “Yeah, but it was a lot more swolled up and sore a coupla days ago!”

SD: “So, let me get this straight. Your hand has been swollen and painful for a week, but you call an ambulance to bring you to the hospital once it gets… better?“

Pokey: “Yeah, but I wanted a doctor to look at it!”

SD: “Well, I have good news, Sir. This doctor thinks you’re gonna be just fine. The nurse will be back in a moment with your discharge instructions.”

Pokey: “Wait, ain’t you gonna perscribe some medicine? How’m I gonna git home?”

SD: “You can get ibuprofen from Walgreen’s, and there’s a pay phone outside the lobby. Buh-bye now.”

They beat us out of the ER by a good five minutes.

Yeah, she’s still a fan, even if we aren’t married any more.

First of all, to those of you who donated to help fund Jules Scadden’s Muddy Angels ride, many thanks. A total of $145 was donated from my readers, and Jules sends her thanks. All of the money was donated to the bike ride’s charitable fund, which will help provide needed financial support for the spouses and children of EMTs killed in the line of duty.

Second, several bloggers have covered the Kansas school administrators who took it upon themselves to shave a six-year-old student’s head, because they didn’t like his haircut.

My parents ran into a couple of similar self-styled arbiters of good taste and hygiene at my older sister’s junior high school when I was but a wee tot. The vice-principal of the school sent my sister home three days in a row for “inappropriate attire.” Now, my older sister can be a bit of a pain in the ass, and hygiene and her don’t belong in the same sentence, but my parents were not ones to let their daughters leave the house dressed in the Hoochie Mama Summer Casual Uniform.

After day three, Dad left work, went home and scooped up a handful of outfits, marched into the vice-Fuhrer’s office, tossed them on his desk, and ordered, “Choose an appropriate outfit.”

The little tyrant, on the verge of peeing himself, stammered that all of the proffered outfits were suitable school attire, two of which were the very ones she was wearing when sent home.

So Dad smiled with that crazy, “this guy might gouge my eyes out and make me a human Jack-O-Lantern” look of his, and quietly said, “If you send my daughter home one more time with this bullshit, we are both going to jail.”

To which the administrator replied, “Mr. Grayson, there’s nothing illegal about me enforcing the school’s dress code.”

To which Dad replied, “No, but fighting is illegal.”

At which the confused administrator blurted, “But I’m not going to fight anyone!”

And Dad replied, with that thin smile of his, “You will or your ass-whipping will be even easier than it should be.”

And from that day forth, said administrator never harassed my older sister again. Even ten years later, his obsequious ass-kissing to me and my twin sister was downright unseemly.

And at KatyBeth’s school, right now, I dare say that such would not happen, because a) her principal and faculty would not dream of taking such liberties, and b) know that the lynch mob would have plenty of willing participants.

But it’s one thing standing up to a school administrator drunk with their own authority. What do you do when the guy abusing his power is doing so under the color of law?

Troopers of the Oklahoma Highway Patrol recently got into a physical altercation with a paramedic on the side of the interstate, while the paramedic was trying to care for a patient in the back.

I was reserving judgment until I knew more of the story, but Voodoo Medicine Man rightly makes the point that the video does not paint a flattering picture of the troopers in question.

Now, the medic in the video gives his side of the story.

This was worse than the Ryan Moats debacle, folks. These troopers pulled over an ambulance on a run, and tried to ticket the driver. And when his partner protested, they got physical. They claim that the paramedic assaulted them first, but all that is caught on camera is the cops doing the choke-slam on the medic.

Their justification doesn’t wash, either. Neither the video nor the other accounts tell whether the ambulance was traveling with lights and siren, but according to the medic, the trooper was using his lights only. Ostensibly, the trooper pulled over the ambulance for failing to yield right-of-way on an emergency response.

My question is, if the response was that much of a law enforcement emergency, why didn’t the trooper just note the ambulance tag number and ticket the driver later, or have a word with the service director, after they handled their call?

If you have enough time to get into a dick-measuring contest on the side of the interstate rather than completing the call you were assigned, clearly that call wasn’t that important.

Just as clearly, the trooper considered their dick-measuring contest more important than the patient in the back of the ambulance, though.

Me, I’d fight a bear with a switch for KatyBeth.

I’d charge Hell with a bucket of ice water.

I’d go broke providing for her, and damned near did a number of times.

I’d do anything.

Well, Chris and Melody Byrne of the Anarchangel are the same as you and I, and they’ve been fighting a lengthy, tedious and horribly expensive international custody battle for several years now, and the bills are coming due.

They need money for legal bills, plain and simple, and in my estimation it’s a measure of how much they love their kids that they’re willing to go to whatever lengths they can to earn the funds they need – even if it means swallowing a lot of pride and parting with a number of prized possessions.

To that end, they come not with hat in hand, but offering something for your dollar. If you’ve ever tried any of Chris’ recipes, you’d no doubt part with a few shekels for a whole collection of such recipes, and still have money left over to pay for your angioplasty.

They need orders now, folks. As close to yesterday as possible. If you’re a blogger, please spread the word through your blogs. You don’t have to be a gun blogger to sympathize with their predicament. All you have to be is a parent. If we can boost a shitty review of Cycles and More to #4 on the Google results page, we should be able to do twice as much for a really worthy cause.

If you have it to spend, make an order, will you? Even if you don’t cook all that much, it would make a dandy addition to a cookbook collection.

Yeah, I’m talking to you, William The Coroner, and all the rest of you as well. I’m asking nicely for a couple of friends who need the help.

Don’t make me put the Billy Mays hard sell on your asses.

I’ll do it, I swear.

And yes, the horn plays Dixie.

Somewhere, Uncle Jesse is rolling in his grave.

When you partake in your Memorial Day barbecue today, try to remember a few things.

When the smoke from the grill blows into your eyes, try to imagine the terror of the young pilot as the smoke fills the cockpit of his F4 Wildcat, spiraling into the sea off Guadalcanal.

When you sample those pork ribs, remember the Iowa farm boy whose life blood stained the surf at Normandy.

When you eat a bite of potato salad, think of an Idaho preacher’s kid who died with a prayer on his lips, asking God to forgive him for the enemy soldiers’ lives he had taken.

When you welcome your niece’s new boyfriend to the table, remember the black kid from Mississippi who died right beside his white buddies in Vietnam, though he wasn’t even allowed to eat in the same restaurants back home.

When you scold your misbehaving grandchild, think of the little boy whose only knowledge of his father will come from stories told by family, because Daddy died on a dusty street in Fallujah while he was still in the womb.

When you fetch your wife another glass of tea, think of a young wife living in base housing at Fort Benning, as she hears the news that her husband died at Ia Drang.

When you invite Grandpa to say grace before the meal, think of young men cut down by a hail of fire from a Maxim at Belleau Wood.

When you reflect with pride on your daughter’s recent graduation, think of a young woman cartwheeling into the sea in her F14 Tomcat after a failed carrier landing.

When you look with distaste at the tattoos on her new boyfriend, think instead of the former gang kid from Detroit who found a way up and out of poverty in the Army, only to die from an IED blast in Baghdad. And remind yourself that what matters is how he treats your daughter, not the ink on his arms.

When you sit at the table, think of a Navy Captain, a husband and father, who died at his Pentagon desk on September 11. His death was no less honorable.

If you’re traveling today, think of the passengers of United Flight 93, for in a field outside Shanksville they became the first soldiers in our war on terror.

When your boys fight, as boys will do, remember the boys on both sides who died at Gettysburg.

If a loved one can’t make it to the gathering today, think of Mrs. Bixby and her five sons.

While your kids play in the pool this afternoon, think of other kids not much older, trapped below decks as the Arizona went under at Pearl Harbor.

When you take a shower tonight, think of young men reeking of machine oil and sweat, desperately trying, and failing, to surface their wounded submarine somewhere in the Pacific in 1943.

I tell you of these things not to spoil your appetite or your day, but to remind you that the things we enjoy in our lives are made all the sweeter when you consider what made them possible.

Remind yourself also that your sacrifice is infinitely easier. All you need do is sacrifice a moment of your time every few years to pull a lever. The way to honor a dead soldier is not simply to fly a flag on Memorial Day. Vote to preserve the freedoms they died defending.

And stop by your local Veteran’s Cemetery and put out some flowers on the grave of your choice. It need not even be the grave of someone you know.

Bring your children along, and explain to them why. It’s important.

… and its name is Reggie Hammond The Handover. The brainchild of Medic 999, The Handover joins such well-established blog carnivals as Grand Rounds and Change of Shift.

This edition is hosted by Lt. Michael Morse, at Rescuing Providence.

Go, read. Some good stuff to be found over there.

My buddy TOTWTYTR celebrates his first blogiversary today.

Aside from sporting the most tongue-tangling nickname in the blogosphere, he’s one of my best friends, and wicked smaht.

Stop by and send him your dancing rodents!

… I give you the Ten Craziest Bacon-Inspired Products.

You can bet that #1 on that list will be in my first aid kit forthwith.

h/t to LPN With an M16.

Wolff Parkinson White Syndrome is a rare cardiac conduction disorder that affects less than 3% of the human population.

In fifteen years as a paramedic, I’ve seen it twice. Both of those times, the victim was over 40 years of age before being diagnosed.

Weird, that.

The first victim was a 52-year-old woman who had gone for years without an explanation for her frequent syncopal episodes. CT scans, ECGs, MRIs, a number of occasions where she wore a Holter monitor for 48 hours or more… all of them revealed nothing other than her baseline rhythm of atrial fibrillation, right up to the day she suffered one of those syncopal episodes while attached to my cardiac monitor.

One cardioversion attempt later, she was back to good old atrial fib, none the worse for wear. My partner and her husband had to change their shorts, but I, stalwart EMS professional that I am, remained stoic and utterly unflappable the entire time.

Rumors that I squealed like a little bitch and forgot to use the gel conductive pads before shocking her are entirely unfounded. Srsly.

But in the fourteen years and untold number of patients since, I’ve never encountered another case until last week, at least not when there was an active problem that required intervention. Of course, there is also the possibility that I saw a lot of it early in my career and was too ignorant to recognize it for what it was.

During those years, I have formed a few opinions about management of abnormal heart rates in the field:

• Hemodynamically unstable rate problems are best treated with electricity, not those selective cardiotoxins we call antiarrhythmics.

• Conversely, hemodynamically stable tachycardias are best treated with diesel fuel and tincture of time, and perhaps PFT Therapy.

• Instability in any patient with a rate problem has less to do with the actual number on your monitor than how your particular patient is dealing with it. Some people with a rate of 160 are infinitely sicker than the guy with a rate of 220.

Most of the people I use adenosine on could easily wait another five minutes until they arrive at the ER. Honestly, I push it to placate the ER doctors and nurses. Ditto for Cardizem. Oh, it’s clinically indicated every time I give it, but the patient is rarely so sick that “watch and wait” could not be considered a viable alternative. I rarely give lidocaine or amiodarone outside of arrest situations because most ventricular tachycardias are better treated with cardioversion.

Hence, the therapeutic electrocutions. If a patient is so sick that they have to be treated in the field, nine times out of ten, that treatment oughta be transcutaneous pacing or synchronized cardioversion.

To a great degree, I think a lot of my colleagues have it backwards; they think nothing of pushing selective cardiotoxins antiarrhythmics, yet have an almost mythical fear and loathing of electrical therapy.

Me, I’m just the opposite. There have been times when I’ve unsuccessfully tried pacing or cardioversion, but I can safely say that, if it had an undesired effect, I’ve never had to thumb through a Nursing Drug Reference to find out how long it takes someone’s liver and kidneys to metabolize and excrete a jolt of electrical current.

So flash forward to last week, when I met my second WPW patient. She’d been diagnosed five years prior, but had never had a tachycardic episode prior to that night. When it hit her, she promptly passed out. She came to a few seconds later, complaining of 10/10 chest pain and difficulty breathing. Her BP was okay at 112/64, but she looked like crap…

… which, to an experienced clinician, is an even more reliable indicator of instability than the blood pressure.

She was lethargic and weak, but coherent, so I was able to get a pretty fair history as I attached the cardiac monitor and Rookie Partner got vital signs.

So when I had all my ducks in a row, I lit her up like a Christmas tree:

A few observations from the event and the war stories afterwards:

• When a patient tells you, “Oh, no nasal sprays! I’ll throw up!”, it’s best to believe her and hold off on the intranasal Versed. Better to spend an extra couple of minutes to find a vein and give it intravenously.

• Synchronized cardioversion works much better if you actually hook the hands-free pads to the patient cable. Plus, you get the added benefit of not looking like a goober. But it gives your partner a cool war story of his own, and he has so few, the poor kid…

• A forty year old woman, when hit with 100 Joules of current, will make a sound exactly like Macho Man Randy Savage. For the past week, RP and I have been giggling like fiends and saying “Oooooh yeah, snap into a Slim Jim!”

• Most of my colleagues, when faced with the same patient, would have given her adenosine or Cardizem. And quite possibly have killed her in doing so. One does not suppress the normal conduction system when the patient has an abnormal accessory pathway that is much faster, kiddies. That’s a helpful tip from your Uncle Ambulance Driver.

I’m sorry I didn’t know your name.

It’s important for me to know who you are, and not simply to fill in the blanks on my run form. Much of what I do for my patients and their families depends upon their rapport I can develop with them during our short time together. To do that, we need to know what to call each other.

I’ve been known by many names. My mother gave me my first two, and insisted on calling me by my middle name all my life. When I was a child, I detested having what I thought was a girl’s name. As I aged, I grew to like it. When she was angry with me, she’d run through a litany of her children’s names: “C’mere Terry… Sheri… Darlene… Kim… Goddamnit you know what your name is! Now get over here!“

The only person who has ever called me by all three of my names at once was my third grade teacher, Mrs. Sanders, after having discovered that I drew a life-sized chalk outline of a naked woman on the cafeteria wall. I got caught because I signed my name to my work. My parents were so mad, they couldn’t even speak, much less use my name.

My paramedic instructor still calls me Lugnut, fifteen years after graduation and ten years after I eclipsed his accomplishments in EMS. My co-workers have, at various times, called me Dr. Grayson, EMS Yoda, and The Answer Man. That’s when they aren’t using terms like prick, asshole, and arrogant ass. The readers of my blog call me AD.

And truth be told, at one time or another, all of them have probably been accurate.

Normally, I make it a point to know my patients’ names, and make sure they know mine.

I introduce myself and my partner to every patient. I introduce my patients to the nurse at the ER. It’s just so much more comforting to know the names of the people who will be caring for you.

Chances are, if you had been conscious at the time, I’d have smiled and winked slyly, and introduced myself as the man who’d be poking unnecessary holes in you today. Or the overpaid taxi driver. Or as a proud graduate of the Close Cover Before Striking school of paramedicine. Or as the actor Chris Farley, doing research for my latest role.

And if you had pointed out that Chris Farley is dead, I’d have winked again and pointed out, “See? You’re not quite as fucked up as you thought you were!”

And I’d have learned your name as well. If you were my age or younger, I’d probably have used your first name. If you’re of a certain culture, I’d attempt to learn your proper name, but I’d probably call you by your street name. If you were older than I, I’d never call you buddy, sugar, sweetie or honey. I’d probably call you Mr. or Mrs., Sir or Ma’am, perhaps even after knowing your given name.

I fear that if I did otherwise, my female forebears might rise out of the ground and git me. You show respect to your elders where I’m from.

So forgive me for not knowing your name, but I already know too much about you already.

I know from your clothing that you weren’t homeless. You were well dressed, if not expensively so. You were well groomed.

You weren’t drunk when it happened. Normally, your blood would have reeked of ketoaldehydes if that were so.

I even know how you died, inasmuch as one can surmise such things without an autopsy. Evaluating the mechanism of injury, the kinematics of the trauma you sustained, comes as naturally as breathing to me.

When the SUV struck you, he was already standing on his brakes, the front end and bumper diving toward the pavement. It struck you near your right knee, which explains the open fracture there.

Only that one leg fractured, and all the ribs broken on your right side. You never even turned to face the danger, never even saw it coming.

Your spleen and liver were probably ruptured as well, in that phenomenon we refer to in dry medical prose as tertiary collision. Simple physics, really. Objects at rest tend to stay at rest. Objects in motion tend to stay in motion. That is, until acted upon by an outside force. In this case, those objects were your internal organs, and the outside force was the impact with the walls of your abdominal and chest cavities.

The head injury probably occurred when you bounced off onto the pavement. No abrasions on you; you weren’t dragged. All the blood and brains were concentrated right there on the pavement beneath your ruined skull.

And all that I can forget, because ultimately you will fade into a half-remembered diagnosis, as so many other patients do; The Diabetic Lady, The Code At The Lakefront, The Assault Patient, The Pedestrian MVA On The Interstate…

It’s harder with you, because I also remember the shell-shocked look on the face of the man that hit you. He’ll never be the same again.

And I know what you looked like before the accident, smiling there in that family portrait in your wallet. Your daughter looks like more like you than your wife. And I’m having a hard time forgetting that, too.

And perhaps I feel a little guilty because I didn’t even try to resuscitate you. I didn’t try, because I knew that the effort would be futile. Your injuries were too extensive. But still, a part of me feels guilty, because not even trying wasn’t what I signed on for.

So forgive me if I didn’t dig further than that, and instead merely handed your wallet to the police officer. I knew your driver’s license was in there, but I told myself I didn’t need it because you were never a patient. If you were never a patient, I never needed to know your name.

And knowing your name is more than I can afford right now.

… what I think of NBC’s new EMS show Trauma, I’ll give you my standard opinion on such things:

If it gets me laid more often, I’m all for it.

Problem is, anyone likely to be impressed by this dreck isn’t likely to be anyone I’d want to sleep with anyway.

Let’s see what it Trauma has to offer, shall we?

• Characters so thinly drawn, they’re even labeled in the trailer (The Father, The Fighter, The Rebel…). All that’s missing is the Social Outcast Who Becomes A Valuable Member Of The Team Because of His Mad Tech Skilz.
• Overwrought drama. “The fighter” even exhorts her cardiac arrest patient to “Come back to me, honey!” Which he promptly does, then mouths “thank you” around his oral airway, complete with profoundly grateful facial expression. Straight outta Compton prolonged cardiac arrest, even!
• Totally implausible scenarios: Uninjured mothers riding in the EMS helicopter alongside their critically injured son? Really? And while we’re at it, medical helicopters in San Francisco?
• Three helicopter crashes in a 3.5 minute trailer. Actually, this is the only part of Trauma that remotely approaches the reality of EMS.

Meh. Color me monumentally unimpressed.

If you want to see a better representation of EMS, go read Epijunky’s posts, Fan of Her Life, Part 1 and Part 2.

She cries for her patients (sometimes more than she should), she questions her skills (sometimes more than she should), and she wishes all the while that she were saving lives and stamping out disease doing 911 calls, rather than doing the interfacility transfer shuffle.

And through it all, her humanity shines through. She sees her patients as people, not as bit players in her personal adrenaline drama.

Would that more EMTs saw their patients this way. Television shows like Trauma aren’t going to draw people like that to our profession, unfortunately.

…there’s a new column up at EMS1.

Enjoy.

I just wish you could have known KatyBeth, Mom. She inherited our sense of humor.

Happy Mother’s Day.

There are few things more dismal than an ICU waiting room. People gather in familial clusters, keeping vigil against the specter of death. Books and blankets abound, snacks and cups of stale coffee cluster on tastefully appointed end tables, and the soon-to-be bereaved seek to mask their uncertainty and seek diversion in months-old editions of news magazines. Huddled together for support and security, they share the fear among them, as if spreading it around lightens the collective burden.

But there is always enough fear to go around.

And here I sit in an ICU waiting room, keeping my own vigil. Privacy is something I can only wish for, even here. Some of these familial clusters I have met before, in different circumstances; living rooms, bedrooms, breakfast nooks. Their fear was more visceral, more raw then, not the kind of settled-in dread they’re feeling now. Some of them come over to say hello, perhaps to thank me, only to realize I’m here for my own personal reasons, and so they beat an embarrassed retreat back to their own clans. Others keep their distance, looking at me with accusing eyes.

I sit here surrounded by the members of my family, alone yet not allowed the comfort of solitude. I am not one of these people any more. I divorced myself from them long ago. My sisters are here, and their families. My oldest sister is sobbing piteously, a crying jag that has lasted for three solid days. Sometimes it seems as if she has been crying for most of her forty-four years. She has always been ruled by her emotions. My father is here as well, looking forlorn and feeble. He sits there next to my aunt, lost in his own private Hell. His hands sit limply in his lap, trembling with Parkinson’s disease.

Inattention tremor, my education and training tells me. Inattention tremor, bradykinesia and hypophonia, all caused by loss of dopamine-producing cells in the substantia nigra. Replacement therapy with Sinemet or similar drugs will only slow the progress, not cure the disease. Eventually, he’ll become bed bound and rigid, and the disease will settle a blank mask over his features.

A different part of my brain tells me that he’s not there yet, because the fear on his face is palpable. He’s wondering what he’ll do once Mom is gone. That part of my brain is wondering where my Daddy went, the Daddy of my childhood, the Daddy that used to quiet my fears. That man isn’t here any more, either.

I want to go to Dad, to comfort him in some way, but doing so would only bring on more crying, more unwelcome histrionics from my sisters. I want to get Dad out of here, if only for a little while, but that will have to wait until Terry gets here, if he indeed gets here in time.

My mother is dying.

My mother has been dying for thirty years, if you listen to her talk. Throughout my childhood, it was her children who were killing her. Occasionally, it was her grouchy husband. Other times, it was life in general. Mom was an extraordinarily persecuted woman. She was, among other things, a Professional Martyr.

But this time it’s for real. My sister Sheri had called me a month ago, breaking the news. At the time I had chalked it up to Sheri being Sheri. Like I said, she has always been ruled by her emotions. Genetic traits in my family are strengthened with each successive generation, not diluted. In the case of fucked up X chromosomes, my oldest sister rolled snake eyes in the DNA craps game. Every bad trait of Mom’s, she inherited in spades. Mom was worse than Grandma.

I suppose we should be thankful Sheri has birthed only boys. A daughter would be too frightening to contemplate.

But a second call from Sheri three days ago made it real. Aside from being an unwelcome second phone call in a one-year span, it also bore the unsettling news that Mom had been admitted to the ICU.

Okay, so apparently a doctor also thinks Mom is sick. Sick enough to need intensive care.

I walked into the ICU maybe 12 hours after Mom had been admitted following her lung biopsy. The Missus and I walked right past the waiting room, avoiding my family gathered there. I knew the security code to get into the ICU, so I let myself in even though it wasn’t normal visiting hours.

“Well hello there, AD!” one nurse greeted us cheerily. No one even questioned my presence there, despite the fact that I was not in my uniform. Several nurses asked about upcoming ACLS classes. Everyone was perky and cheerful.

“Actually, I’m here to see about my mother,” I told them. “She’s in Bed Six.”

“Oh. I’m…I’m sorry. I didn’t connect the names,” the charge nurse stammered, embarrassed. No one else said anything, and an awkward silence followed.

“Can we go in and see her?” I asked politely. “I know it isn’t visiting hours…”

“No, go right in,” the nurse interrupted. “I was just going to bring her a popsicle, but I’ve got some charting to do here…you can just bring it to her yourself. Take all the time you need.”

If it can make an ICU nurse somber and solicitous, it’s bad.

“Well, look who’s here!” Mom greeted me with a grin. “My prodigal son and my favorite daughter-in-law! How long has it been since I’ve seen or talked to you, five years?” Despite the hearty greeting, her voice was harsh and strained, muffled by the oxygen mask.

More like three years, Mom.

“How ya’ doing, Mom?” I asked softly, pulling a chair next to her bed. I stole a glance at the telemetry monitor mounted above her bed.

Atrial fibrillation. Since when did she have atrial fib? Pulse oximetry is only 84%, despite the non-rebreather mask. BP only 90/50.

“I’m dying,” she said matter-of-factly. “I won’t make it out of this hospital. You kids have finally killed me.” The last sentence delivered with a wink and a grin.

“Want something cool to wet your whistle, Mom?” The Missus asked tenderly, sitting beside her on the bed and unwrapping the popsicle. Mom nodded weakly and The Missus gently slid the mask up onto her forehead and fed her tiny bites of the popsicle.

She leaned close to Mom, winked mischievously and whispered, “Remember the first time I ever saw you eat a popsicle?”

Mom’s eye snapped open wide and she chuckled. The laughs began as the big, rolling belly laugh that I knew so well, and ended with painful, wracking spasms of wet coughing. A suction unit gurgled quietly in the background, and I could see a chest tube draining bloody pus into a collection chamber.

I remember that day. It was maybe thirty minutes after you met her for the very first time. She was the first, and only, girlfriend I had ever allowed to meet my parents, and then only because she insisted that my parents be a part of our wedding. In ten minutes you were cackling like old girlfriends, and then you proceeded to show The Missus how a wife pleasures her husband, using a popsicle to demonstrate. The Missus had been shocked at first, then you both dissolved in a fit of giggles. She told me later that now she knew where I had inherited my sense of decorum and my internal censor.

“I won’t be doing that any more, I’m afraid,” Mom had answered hoarsely after the coughing fit had passed. “I’m too old for that, anyway.”

“What did the doctor say, Mom?” I pressed. “Sheri didn’t make much sense when she called me, and she doesn’t understand medical terminology.”

“He said I’m dying,” Mom repeated, as if I
were still a child. “I believe his exact words were ‘advanced pulmonary fibrosis of a particularly aggressive nature’ or some such bullshit.”

“Did you get a second opinion?” I asked desperately. “Maybe another doctor might – “

“Charge me money to tell me I’m dying, but using different language? No thank you. I know I’m dying. I’ve felt it for the past month.”

“Maybe another doctor somewhere else, Mom,” I argued. “Somewhere with better hospitals. I can arrange an ambulance to take you to Houston – some of the best hospitals in the country not eight hours away. Hell, I’ll go with you myself…”

“Listen to me.” she scolded. “I have less than 30% of my lung capacity left. I’m taking steroids in doses that would kill a horse, they have my stomach so irritated I could shit through a screen door, and I’m only getting worse. So grow up and accept it. I. Am. Dying. I’ve already signed a DNR, so it’s out of your hands.”

“You’re giving up, Mom. Don’t give up. Not while you’re still strong enough to bitch at me like I’m a five year old.”

“What should I do,” she coughed, “Wait until I’m too weak to make my wishes known, and rely on my kids to make the right decision? You might be perfectly willing to let me die, but Sheri won’t. You know it and I know it.”

I said nothing. She was becoming angry, and all too many of our conversations for the past twenty years have been angry. I just held her hand and sat by her bed until she dozed off, and then The Missus and I slipped quietly out of her room.

I made my entrance into the ICU waiting room, greeting relatives with whom I felt no kinship. I was struck by how frail and tiny Dad felt when I hugged him. I hugged or shook hands with everyone, pretended to be interested in family gossip, and prayed for it all to be over soon so I could get away from these people.

I settled into my own isolated niche with The Missus at my side, who was wise enough to leave me alone with my thoughts. She stayed next to me, squeezed my hand occasionally, and allowed me my silence.

Later that first day, Bodie, Mike and Reggie showed up. I was comforted by the fact that my family was there – the family I had chosen. My wife, and my partners. They spent the next three days keeping vigil with me, missing work and family commitments, losing salary money. God I loved those guys.

I spent those days sorting through my feelings for my mother, and by extension, my entire family.

You see, as my mother went, so went our family.

My father worked long hours at his small business when I was growing up. He always came home tired and cranky. In my teen years, we rarely got along.

My mother was the one who taught me how to catch a baseball. My Mom taught me how to ride a bike. My Mom taught me how to swim.

My Mom also taught her children that mediocrity was acceptable, and that excuses were more valuable than doing the work. She taught us that our failures were always someone else’s fault, and in so doing, taught us how to repeat those failures for the rest of our lives.

I made straight A’s throughout school. When I was a kid, Mom used to reward me for those A’s – a dollar here, a quarter there, more when Dad’s business prospered – until one day in the fourth grade when the rewards stopped. She needed the money to reward my twin sister for B’s and C’s. Her reasoning? “It comes so easily for you, and you don’t need the motivation.”

She was right about that. There would soon come a time when everything I did was entirely self-motivated. I craved neither my mother’s approval or even her acceptance.

She taught us how to laugh. There was much joyful giggling in my childhood.

She also taught us emotion without reason. That lesson crippled my sister Sheri, who learned it all too well.

My Mom taught me how to stand up to a bully. When I was eight, the neighborhood bully beat me up and stole my new Boy Scout knife. It wasn’t the first time he had beaten me up. I still bear an inch-long scar on my right temple as testament to his cruelty.

“You go over to his house, and you get that knife back, or you will deal with me,” Mom had ordered. “You better decide who you’re more afraid of.”

I marched tearfully over to the bully’s house, knocked on his door, and dealt out the worst fear beating I’ve ever administered. How bad was it? I beat a ten-year-old unconscious, that’s how bad it was. But I got my knife back, and I was never afraid of David Young again.

My Mom was also the one who invited that enemy into our home and gave him the opportunity to steal my knife in the first place. She invited him to join our Cub Scout den, and this after he had left me with seven stitches in my temple.

My affinity for people and my love of medicine, I got from Mom. I inherited those gifts from her. She was a fifty-year-old housewife with a GED who decided to go back to school and become a nurse. I used to proofread and edit her essays when she was in nursing school.

I learned CPR by playing hooky from junior high school and tagging along with Mom to LPN class. The nursing students used me as a practice assessment dummy for an entire summer.

When I was a high school sophomore in 1984, I used that knowledge to help revive a man who had choked and arrested at a hotel restaurant. It was my very first save, and the very first time I saw paramedics in action.

When Mom took her licensing exam that year, back in the days before electronic testing, she got a perfect score. One of only eight people to have ever done so in this state, I might add.

Mom also taught me the value of sarcasm. Our car stalled once at a red light in rush hour traffic. A jerk in the car behind us kept leaning on his horn while Mom vainly tried to start the car. Eventually, she got out, walked back to the man’s car and knocked on his window.

“Sir, I was wondering if you could help me,” she said politely, in her best helpless Southern belle voice. “You see, my car won’t start…and I was wondering…if you might come up and see if you can get it started…while I sit back here and honk your fucking horn for you.”

The guy apologized for being an ass, helped Mom push the car off the road, and stayed there with us for thirty minutes in the July heat until we got the car started.

Mom could also be a profane, shrieking harpy who could be heard cursing like a sailor throughout the entire neighborhood.

She rented a house trailer to a black woman in the 70′s, and then stood up to our all-white neighborhood association who demanded that she terminate the lady’s lease.

When I was seven, she caught me with a Chick O Stick I had stolen from the neighborhood grocer. She marched me back down there and made me confess my crime and promise to sweep his store after school for a week to make restitution.

When I was fifteen, I also watched her purloin the seat from a toy tractor at Wal Mart, because the one she had bought for my nephew was missing the same part.

My cousins always adored her because she was the crazy Cool Aunt who let them get away with stuff.

To her kids, she’d deal out syllable whippings when we misbehaved. Ever had a syllable whipping? Imagine someone grabbing you by one arm, and whipping you with a switch with the other hand, all while you run in a circle, desperately guarding your hindparts and trying to get away. She’d swing with every syllable, and when Mom was mad, she had a bad tendency to get long-winded.

Many was the time I ran in a circle through the disciplinary equivalent of Hamlet’s Soliloquy – “Don’t-you-e-ver-do-that-a-gain-do-you-hear-me-you-lis-ten-to-me-while-I’m-talk-ing-to-you-I’m-your-moth-er-damn-it-and-I-will-be-o-beyed…”

There
were also many times where I had to intervene for fear she’d beat my demonic twin sister to death.

She told riotously funny jokes until we’d collapse in giggle fits, laughing until our stomachs hurt.

She’d also sit alone in the dark for days on end, eating white bread and staring vacantly at soap operas. And some days, she’d contemplate suicide.

My mother was the Barbara Mandrell of psychiatric disorders. She was bipolar before bipolar was cool.

She’d let my twin sister get away with murder, because she was a Troubled Child.

She also had an aggravating tendency to walk in at the culmination of hours of torture at the hands of my twin sister, at just the precise moment I’d finally snap and retaliate.

“Oh, so you two wanna fight, huh?” she’d muse. “Well, I’ve got the cure for fighting. When you get done, you won’t wanna fight any more, believe you me!”

She’d then proceed to the hedge and gather three diabolical switches, test them for proper flexibility and tensile strength, and then hand one to each of us.

“Go ahead and fight,” she’d exhort us. “Work out all that aggression. And if you don’t fight, you get a whipping from me.”

I’d spend the next five minutes getting lashed by not one, but two psychotic females.

She would mortify me in front of my friends with her mouth and her antics…

…but they kept coming back because I had the coolest Mom in the neighborhood.

She taught my Cub Scout den how to dance. We were at that socially awkward age where you first start to notice girls, but still haven’t figured out how to approach them. We had a school dance, and all of us were stressing because none of us knew how.

“Dancing is easy,” Mom had said, “just pretend you’re drying off after a shower.”

“Huh?” said a dozen eight-year-old boys.

“You just do The Towel,” she explained, and then proceeded to demonstrate, to my utter mortification. My five-foot-nothing, 300 pound mother grabbed an imaginary towel, stood up and showed us how.

“You pretend you’re drying your lower back, like this,” she said, while shimmying her hips.

“Mom, please don’t…”

“And then you pretend you’re drying your shoulders,” she said, striking a disco pose straight out of Saturday Night Fever.

“Okay Mom, I think we get the idea…”

“And then you dry between your legs,” she’d say, doing a pelvic thrust.

“MOM!”

Mom was also a noted philosopher, quoted by no less an American luminary than Paul Harvey:

Joyce in Louisiana writes:

“I’m just a simple woman, unable to grasp the nuances of science, geopolitics or world affairs. We are embroiled in a war in Vietnam that I do not understand, and we are impeaching a President whom I no longer trust.

Yet this I do know: Why, in a country that has been able to land a man on the surface of the moon, must we continually be forced to purchase hot dogs in package of ten, while hamburger buns come in packages of eight?”

Who says all the world’s great philosophers are dead?

My Mom said it first, folks. And she changed the world. You can now get hot dog buns in packages of ten.

Three years earlier, my Mom took me out for dinner on my birthday. We didn’t talk much even then, but after dinner she took me for a drive. She had something to say.

She told me that night that my twin sister and I were not our Dad’s biological children. Our father was her teenage sweetheart, a man whom she had an affair with after she married Dad.

My twin sister had known for fifteen years. My entire family had known, except me. And now she wanted me to build a relationship with this man.

“There’s no hole in my life he needs to fill,” I told her nastily. “I know who my father is – the man who fed me, clothed me and disciplined me when I needed it. The man who has been here for thirty years. Don’t expect me to feel some kinship with a man just because he fucked another man’s wife over thirty years ago. I don’t even feel a kinship with you.”

We didn’t speak again until that moment by her hospital bed, three years later.

I spent the next three days reliving every memory of my childhood – good and bad. I found some forgiveness in my heart, and mom granted me her own. In the balance, the good times outweighed the bad.

The day before she died, she had my Dad and her teen sweetheart to her bedside, and made them reconcile their differences. She told them she wanted the only two men she had ever loved to find some common ground with each other, to harbor no bitterness after she was gone. Because they both loved her, they agreed.

Mom grew steadily weaker, but kept her sense of humor until the very end.

In one moment when we thought she was too far gone to hear, Terry and I stood on either side of her bed holding her hands, both of her estranged sons come back home. Terry whispered, “Mom, I sure wish I could switch places with you.”

Mom cracked one eye open and whispered back, “Yeah, I wish you could switch places with me, too.”

Those were the last words I heard from her before she died.

After her funeral, The Missus and I took her nieces skiing on the lake. The eldest of them was celebrating a birthday, and I couldn’t see canceling a birthday party. The kids deserved their fun.

“Are you sure you’re okay with this?” The Missus had asked me as we lay there on a beach towel, basking in the sun.

“Yeah, I’m okay with this,” I assured her as I watched the kids trying to dance to some hip hop music I’d never heard before. “Mom would roll over in her new grave if I canceled a kid’s birthday party.”

You’re sure?” she asked, squeezing my hand.

“Yep, I’m positive,” I replied firmly, getting to my feet. “and I don’t know about you, but I’m tired of watching those spastic nieces of yours try to dance. You really are some countrified white girls. Somebody needs to teach them how to do The Towel, and I’m just the man to do it.”

… I’d say your prisoner has a medical problem.

After a thorough examination, I’d say she has acute incarceritis compounded by stainless steel allergy and chronic hickory deficiency. Note the drunken sobbing and moaning in faux pain, interspersed with screamed threats of lawsuits and speculation about our ancestry. Why, it’s practically pathognomonic for the condition.

And no, I’d say her shoulder isn’t dislocated at all, her screamed assertions to the contrary. You will note that she raises both arms well above shoulder level to give us the double “You’re number one!” sign whenever one of us peeks in the holding cell window? People with dislocated shoulders cannot do such things, at least without a great deal of pain.

Then again, I’m sure you already knew that.

No, what you seek from me is indemnification against liability, and I cannot provide that. Might I suggest that you have your jail nurse grow both a brain and a pair of balls, or that you transport the patient to the ER in your car for a doctor to proclaim her healthy enough to spend the night in the drunk tank.

Failing that, I’d prescribe a Monadnock shampoo, and a little capsaicin mouthwash, PRN.

Kthanxbai.

Go. Read. Laugh.

Swine flu has always been a bit more agile at making the interspecies jump than avian flu. But if this latest BBC report about the latest mutation is true, you can forget about hand washing and N95 respirators.

Instead, everyone needs to start practicing their head shots.

Officials at the CDC and WHO were asked to confirm or deny the initial report, a request that strangely went unanswered for nearly 24 hours.

When they finally did issue a press release, it consisted of only one word:

“Brraaaaaiiiiinnns.”