"Arm Pain"

I had a 19 year old patient one night who came in with her boyfriend for “arm pain”. She had her left arm in a sling and she wouldn’t let go of it with her right hand. I went in to check her out after the nurse had her signed in. She was anxious and emotional, and her arm was obviously in pretty terrible pain. She had good sensory function in her fingers, good pulses and capillary refill, but she couldn’t grip my fingers with her left hand. I didn’t think it was due to a physiological defect, it was probably just too painful. It’s hard to explain, but there is a different look to someone who can’t move, as opposed to someone who simply won’t because of the pain.


I asked, “How did this happen?”

She answered, “I was lying in bed and I rolled over and hit my elbow on the wall.”

Her boyfriend cut in, “Yeah, didn’t you say you hit your funny bone? Show him where it hurts baby.”

She pointed to a spot on the ulnar side of her forearm, the bony part about three inches below her elbow. I took the sling off to take a better look. There was a swelling hematoma forming on the surface over her ulna, and the whole area was so tender and she was so hysterical there was no point in doing any more examination. It would only cause her pain and not tell me anything I wouldn’t learn when the x-ray came back.

So I went out to wait for that and talk it over with the ER Doc. See, here’s the thing. It is next to impossible to break a bone knocking your elbow against a wall. Not only that, but when you roll over and smack your elbow against a wall you hit the head of the humerus, and maybe if you are very, very skinny, the very tip of your ulna. Long before you hit hard enough to break a bone, a healthy young woman is going to put her elbow through the plaster or wallboard. Bone is a lot harder. Yeah, it can hurt to jolt the ulnar nerve, what we call the “funny bone”, but it goes away in minutes, it doesn’t break bone, and it certainly doesn’t cause a transverse fracture of the ulna three inches lower. Sure enough, that’s what the x-ray showed. One of the bones of her forearm was cracked right through, but still in place without angulation. This is what we call a defensive injury, meaning it is associated with someone putting a forearm up to ward off a blow to the head.

The ER Doc went in and showed her the x-ray, and asked her boyfriend to step out for a few minutes. He refused. The doctor asked her again how this happened. She said she fell out of bed onto the floor. He explained that didn’t make sense, and asked if someone had maybe hit her in the forearm with a stick or a pipe or something. She denied it. He explained that if she was being hit, or if she remembered anything different eventually she could come back in and we had resources for her. There is an organization here that provides free shelter to women and children in dangerous domestic situations. She said she was fine. She just wanted pain meds and a cast.

So the doctor sent the nurse in to splint the arm and fix the sling so it would work right. I went in to watch and size up the boyfriend. He wouldn’t make eye-contact with me until just as they were leaving, but right at the end I caught his eye and looked him dead on.

There is no proof, of course, and we can’t press charges without her consent. But I believe he is guilty. So I stared him down. Irrationally I wanted him to take a swing at me. He was taller than I am by about four or five inches, and heavier by at least twenty pounds, but I guarantee in a fight I would kill him, because the extent of his courage is beating up on a woman.

But if she won’t stand up for herself, there is nothing I can do for her.

Bleeding Stories

I had a 58 year old patient one night who came in because he couldn’t stop bleeding.


The first sight I had of him was when I glanced into the room where the nurse was checking him in. I wasn’t planning on talking to him, but he was sitting on the gurney with his feet towards me, and a bloody washcloth between his feet. My eye zoomed straight in to a definite blood splatter right across his crotch! Now, here’s the thing about blood. It doesn’t go up, usually. It goes down. Unless, of course, it is squirting out of something, like say, an open artery. Veins don’t squirt, only arteries do. But even if it was an arterial bleed, how would it squirt upwards from his ankle to his crotch? It took me a few minutes to get the story straight, but eventually it came out that he had been lying on his back with his leg up in the air when the bleeding started. He had been taking off his socks to go to bed and he had felt something rough underneath the sock. He scratched it and it came off and started bleeding, and he couldn’t get it to stop, so he went and stood in the bath tub and called his daughter. She came to see and she couldn’t get it to stop either, so she covered it with a wash cloth, took off her belt, wrapped it three times around his ankle, and buckled it. Then she drove him into the ER where I saw him. It’s somewhat ironic that my intervention was to teach a man in his fifties how to stop a bleeding cut with direct pressure and to scold him for picking at his scabs. Seriously though, the number of people who don’t know how to do something as simple as stop bleeding is astonishing. Even civilian EMS personnel are generally useless at stopping bleeding.

This incident led the nurse to share a story from when she was working in a trauma center in a major city (I won’t say which city, but it was in the New York, San Francisco, Houston level of majorness) and an upper class looking lady came running in at three in the morning with blood all over her face. “Look,” she said, “I don’t want you to tell anyone I’m here, and I don’t want anyone to know what happened.”

“Okay,” said the nurse. “Why is that?”

“Do you know who I am,” the lady asked.

“No,” the nurse said, “I’m a travel nurse, I’m not from around here. Who are you?”

“I’m the mayor.”

“You have a nose bleed. What’s so terrible about that?”

“I was picking my nose. People cannot know about this!”

I don’t know whether or not that ever got out, but apparently the mayor, before she left for the hospital had called her son when she couldn’t get the bleeding to stop. Then she had decided she didn’t want him to know what happened, hung up and left for the ER herself. He was worried, so he came over and knocked on her door, and getting no response, peered in through the windows. And of course, all he saw was an empty house with blood all over the floor. So he called his buddies and they kicked down the door and raided his mom’s house while she was at the ER. I wonder how she explained that one when she came home to a house surrounded by lights and sirens.

Hey Dad, can I help?

This is a very old photo. I think it is actually a digital picture of an old film photo my mom took before they invented digital cameras.


The muscular gentleman with the ax is my dad. The slightly less muscular gentleman on the stump is my littlest brother. Or rather, he was my littlest brother at the time. Now he is only the youngest. At nineteen he's actually the tallest of us five boys nowadays, and a good deal more muscular than he was then.


What can I say, he wanted to help cut wood. He was too little to swing the ax, really, but you'll note he has his "working man" boots on; and cast your eye, if you will, over the casual competence of his pose, carefully copied from his older brothers who learned it from our father. We wanted to help cut wood too.

I don't know how many times we got in the way, slowed down the work, messed up the projects, and just plain made a nuisance of ourselves in our eagerness to help Daddy outside. For the first few years we weren't much earthly use out there. He could have gotten things done ten times faster without us, most of the time, but he let us help out.

I was reminded of this because of a conversation I had. We had been talking about the difference between merely accepting God's will, since He is going to get His way no matter what we do, and positively embracing it. I said that we should try to go beyond merely doing what He wants because we really have to, and try to be eager about it. We should ask Him, "Hey, can I help? Is there anything I can do? Please." She said to me, "I'm afraid to want to help God because I'm sure I'll mess it up." I've felt that many times myself. It was good for me to hear someone else say it, because it's always easier to see the truth when someone else is missing it than when I am the one missing it.

I don't think God cares whether we mess up the work in our eagerness to help him, anymore than my father did. Sometimes it might have gotten a little annoying, and the work might have taken a lot longer, but my father didn't work to get the job done. He worked to raise us. We were the final cause and end of his work, so he could deal with a little chaos and delay from us. It was all about what was best for us, from beginning to end. That's what fatherhood is all about. He learned it from God. God's fatherhood is for our sake. The work He does is for our sake, and He is more than capable of doing it without us, but it would be for nothing without us. Just as my father might have gotten the work done faster without us, and it would have been a waste if we had never learned to work ourselves, so with Jesus we must "Be about our Father's business." He doesn't need us to do it. But He wants us.

A Funny Story

Recently, we were wondering what to do for our Korean teacher at the end of the course. There are only three of us, but usually the class pitches in and gets her a plaque or framed photograph or something. There was also the baseball bat, the cavalry saber and the infamous Mae-Mae Stick (that's another story!) but she already has a bunch of both ornaments and weapons. However, in a stroke of pure genius, one of us, M, came up with the perfect plan. His wife is currently doing pottery as a hobby in a nearby town, and they have a little shop where you can go, buy the pottery, paint it however you want, and they will fire it and glaze it for you. Now, one thing you have to know about M is that he is a silver tongued bandit. I've seen him talk on the phone to operators and such, and the moment he hears a woman's voice on the other end of the line, you can hear the change in his voice. He practically pours charm through the phone line, and they eat it up. He's a pretty good guy, all round, but he has a natural talent for charming ladies, and this was one of his typically charming notions. He thought, "Wouldn't it be cool if the three of us went out there and each painted up a piece of pottery and put our pictures in the bottom of them, and gave them to Sunsengnim (that's the honorific title for a teacher or older person) so she could have something useful and cool." So just to be sure, he went out to the shop with his wife one weekend, to make sure it was going to be fun. He made himself a little cigar tray using very simple, bold colors, whipped it out in twenty minutes and congratulated himself on having found the perfect idea.


So then he had to explain to his team sergeant why he needed to get off from PT on monday afternoon.

"You're going to do what? Dude, you know if you want to skip out of PT once in a while, all you have to do is just ask. You don't have to come up with a story like that."

So that was taken care of. He then convinced B and I (I didn't take much convincing) and accordingly we headed out to this artsy little town together after class one day, in lieu of tromping around in the woods for three hours with a 65 pound ruck.

As soon as we got into town I knew exactly what we were in for, and B started having second thoughts. It is one of those old, artsy southern towns with plenty of tea shops, coffee shops, bakeries, and Obama stickers. It even has a wine tasting shop. There appears to be a building code that requires there to be at least one art shop per block, and all the buildings along the whole strip (one street, going one way on one side of the old railroad tracks, and the other way on the other side) are made of brick. I half expected to see some skinny painter with a beret and a scarf sitting at one of the corners, or perhaps a picturesquely unfashionable poet being melancholy over a bottle of wine at one of the outdoor tables. All in all, it's without a doubt the nicest town within an hour's drive. It's beyond me how it managed to remain so clean and pretty, while Fayetteville, just across post, is a total ghetto.

But I digress.

M parked across the street from the pottery shop, and we got out, B voicing his concern about how the shop looked a little on the not-particularly-masculine side (and why shouldn't it? It is owned and operated by women.) Usually he and I play the rennaisance men to M's typical Infantry Officer mentality, but this time it was B who was mentioning how it would look for three soldiers (in uniform) to go into a pottery shop together and sit down at one of those tables that looked they came right out of pre-school, and start painting pottery. And I admit, it was probably not what you would expect, but then I've always thought that it's probably not healthy to be a cold-blooded killer all the time, so, visualizing a samurai composing a haiku about cherry blossoms, I entered into the thing wholeheartedly. Besides, I haven't messed around with painting stuff since I was a kid.

We picked out a piece each, M grabbed a coffee mug, I grabbed a sushi bowl, and B got the plate since he's the artist of the group and that was going to be the center piece, with the picture of us and Sunsengnim in the middle. This was what M had been looking forward too because, while he just likes to throw things together and see how they turn out, he knew that B draws comics and other kinds of art, while I'm an uber perfectionist, so he was ready to watch and laugh as we both became totally immersed in our projects, while he finished his in record time. So we took off our blouses, and sat down at the brightly colored pre-school table with the fingerpaint trays, three big, tough Special Forces soldier wannabes, and commenced to painting. And we painted, and we painted, and we painted. Even M took longer than he expected because he hit upon the notion of doing zebra stripes, and that turned out to be more complicated than you might think. B incorporated elements from the Korean flag with his own color scheme and a fading black border around where the photo is going to be, while I experimented with a blue, watery looking idea for my sushi bowl, finishing it up with a water lily and lily pad painted on the bottom so you actually have to turn the bowl upside down to see it. The flower alone took the better part of an hour, and M's comment was, "Wow, out of control, man. Out of control."

We painted. Of course we made mistakes, and our lines weren't straight and whatnot, but as B said, it's the thought that counts. Sunsengnim is like our Korean mom. She feeds us, teaches us, scolds us, and is actually about the same age as my mom. Actually, she's the grandmotherly kind of lady, whose own kids are grown, but who isn't actually a grandmother yet, so she adopts stray kids, or in this case, soldiers who need to learn Korean. So it really doesn't matter whether the stuff is really a work of art in the end. She'll like it anyway.

A mother and her two daughters (who probably were actually in pre-school) came in, painted, and left, and still we painted. Finally, after three hours, we were finished. Actually, the other two were finished well before I was, but they waited. And it was pretty marvelous, if I do say so myself. B still wasn't sure that he wouldn't rather have done land nav, but he did say he would probably come back with his wife and kids sometime.

Now all we have to do is wait for them to be finished, and then M's wife will pick them up, and we will give them to Sunsengnim next week, which is test week. I need to get some pictures, and post them on here. I'm pretty excited.

Also kind of tired. I stayed up far later than I planned in order to write this.

The Return of the King

See, he returns, in grave triumphant joy,
The warrior returning, from the wars, from the strife
Proud and fierce and tall, who before was bent
Strong now he, whom lately we thought crushed
And bowed, and wounded sore and maimed
And in the end destroyed, yet here he comes.
Beyond all hope, beyond all looked for joy,
The foe lies slain, the hero's sword is sheathed
And he, himself returns to claim his bride.



He crests the hill, and sees her from afar
And calls her name. She hears and knows his voice.
Even from afar, she is all fair.
All pure and white and spotless is his bride
For whom he fought, and bled and all endured.
She scored his heart with pain, yet still he loved,
And now his love is hers, and she is his.
And he to her is more than she could wish
Rugged, strong and brave, a warrior born
Forged to burnished steel in hell's hot flames
Which tried him sore, but could not overcome.
Which only proved his mettle, and his love.



He sees her thus afar, and she sees him.
It is... too much... they can't wait anymore,
But each toward the other cries out and runs.
She stepping lightly, but he, a juggernaut
A perfect storm of peril, strength and speed,
Leaping, bounding, pushing all aside.
He will not be stopped, desire cannot be stayed
Nor even any longer slowed, for now,
His patience sees its end, its one true goal.
He bears down on her with all his burning heart,
A hunter, warrior, lover, husband, king
'Til just before it seems they must collide
(Certain death to her, thrice welcomed end)
He pauses, holds, is still, and draws her close
And gently, gently, seals her with his kiss.

Choices

All things work together for good to them that love God.
I was reminded of this verse (Romans 8:28) today in my xanga subs this morning, and then again after daily Mass. It was good to be reminded of this, since I was very busily engaged in reviewing an second guessing all the decisions I've ever made, which is kind of fun, if you've never tried it. It makes you feel important. You can feel like you're accomplishing something, without doing anything productive.
But you have to wonder if our choices really matter as much as we think they do. Of course, with any choice, God is not neutral. He definitely has a way He would prefer to see us go, and we ought to search out that way, but, I don't know about the rest of you, I've never received any kind of certainty about what that path is supposed to be. From that, I am forced to draw the conclusion that I don't need it. If I did, it would be given.

Whenever I need certainty, I have it. I know what the right thing to do is in most day to day situations. Then the problem is choosing it. But when it comes to major life decisions, does it really matter? If all things work together for good, to them that love the Lord, then in one sense it doesn't. Nor does it make sense to judge decisions then based on what I know now. If I make a decision based on the best information I have, striving for the most noble thing, asking for God's guidance, and trusting Him to head me off if I do something crazy, then how can that decision be a wrong one. It may not always be wise, or prudent, but it must be good and just and loving. If this trusting surrender is the impetus behind every decision, then I think it can be made in confidence, and stuck with when the second-guessing happens (it always does).
You see, we live in such a universe, created by such a God, that do as we will, go where we will, choose as we like, we can not escape His love. We stand at crossroads all the time, and stress about which road we take, which is the best one, which one will take us where we will be happiest, and God laughs. It's so hard to explain how I see it. The choice is not a burden, it is a gift. It is a share in the uncontrollable fertility of God's creative love. Not content with laying only one set of blessing in front of us, and only one path to walk, from which, if we stray, we lose all the blessings forever, He instead gave us an infinity of choices. It's as if He is saying, "Try me. There is more good that I have in store for you than you can ever taste in one lifetime. Go where you will in your life, there will be samples along every possible path you can take, because I will be with you no matter where you go." The blessings are not part of the path only, but also moment by moment gifts from God.

The agonizing over choices can sometimes be a lack of trust, a cynical attitude that knows no matter what we choose, we're going to have to give something up. If we take the right hand course, all the left hand sights will be denied us, and if we take the left, we won't see what the right is like. Cynicism always looks at what will be lost by every choice. Trust always sees what will be given, confident that no matter what we choose, God will be there first. The only thing that can truly deny us the gift, is sulking.

My Lady

My name was Dullus Marius, stationed in Galillee,

I was a centurion, the toughest in the valley.

Of all strong, hate-filled men I was then the worst,

Now I fight for The Nazarean, but I saw her first.

I saw her only once and stopped to stare.

She was tall and stood straight, forthright and fair,

Fair, divinely fair, with spring blossoms woven

In dark honey hair, in smooth locks cloven.

The loveliest work of His most divine art

With not the slightest evil in her heart.

The mother I never knew, the sister I never had,

The woman all men love. She was both sorrowful and glad.

Her eyes as deep as the starry midnight sky,

She turned full upon me as she passed by.

I bowed in deepest shame, and there and then

Swore myself her son, though I never saw her again.

 
This is an old poem, but among all of my poems it is still one of my favorites. It is even more Marian, and therefore more relevant, than when I wrote it.