Thursday, September 29, 2011

The Shaman - His Agonies, his Ecstasies, his Poetry

      This guy walked into an ER - about forty years ago - intending to make some extra money while working on his surgical residency and after taking care of some rather challenging patients over several of his free weekends, he found himself re-thinking his career choices.  His conclusions, as I know you've guessed, launched a ground-breaking specialization.  Surely it will come as no surprise, then, to you, that the highlights of this experience - his experience - of eventually becoming an Emergency Medicine physician will be shared here.
      Imagine my surprise, however, given the 'glum chum' atmosphere prevailing in this household since he retired, as I watch my fingers labor over the keys this evening, at my election to write about it.  And as is my wont, I am moved to at least try to parenthetically illustrate some of the emotions, motivations, and evolving processes of his specialization with excerpts of poetry.  More specifically, the crafted meanderings of Dorothy Parker which I mention up front lest anyone be confused by 'gender specific' pronouns.  This specialty is populated by men AND women; so too will be the artistic commentary about it.  Starting now.
      (Her mind lives in a quiet room, a narrow room, and tall.
With pretty lamps to quench the gloom and mottoes on the wall.
There all the things are waxen neat and set in decorous lines; And there are posies, round and sweet, and little straightened vines.
Her mind lives tidily, apart
From cold and noise and pain,
And bolts the door against her heart, out wailing in the rain.)
      The first ten or so years Doc worked with a group of family practitioners who, wanting more regular schedules, forfeited their private practices and joined together to work exclusively in the ER.  Naturally, our boy was the 'young upstart', all energetic, sponging up knowledge and experience, the "go to" guy in the group.  And his slower-moving, less excited and far more easily fatigued, colleagues were all too happy to let him 'go for it' - his it, theirs, that of the community - just wound him up and let him be the "Road Runner" of the group.
Young, leisure-suited, Doc Leavy, Jr.
      So it was that his experiential and exposural base grew exponentially.  Always a voracious reader, he would perch on the cutting edge, literally, of emergency procedures, encouraging them to follow suit - a 'following' to which they were most definitely NOT suited.  He was the rising star; theirs was setting peacefully at dusk, having walked the dogs, checked the ripening honeydews or snap peas, drawled a bit but mostly nodded off, 'listening' to the Missus. 
      In 1976, a new hospital was built in Chesapeake and Doc's group won the contract to operate the Emergency Department.  In that this was their second facility, they hired more new docs and our boy was elevated to Chairman of the new facility, a position daunting to his partners but abject Manna to him.  Throwing himself into it full bore, he wrote protocols - for the hospital, for the emerging EMS System of the city, for the ER itself.  The patient population grew as did the  body of knowledge about their presenting pathologies and the treatment thereof.  It's called progress.  Our doc embraced the challenge, learned new techniques and procedures, attended major conferences in this evolving specialty and would return re-charged, ordering new equipment, urging, teaching, spreading  the news that broadened the base knowledge required of the receiving, attending physician in the ER.  The younger, newly-hired docs gobbled it up.  The old school, hard core, resistant founders of the group balked.
      (If I had a shiny gun, I could have a world of fun
Speeding bullets through the brains of the folk who give me pains;  Or had I some poison gas, I could make the moments pass
Bumping off a number of people whom I do not love.
but I have no lethal weapon - Thus does Fate our pleasure step on!  So they still are quick and well
Who should be, by rights, in hell.)
      Enough.  By 1980, Emergency Medicine became a legitimized specialty, IE, The College of Emergency Medicine administered an official Board Specialty Examination nationally.  Doc Leavy and a friend  - soon to be a partner - were the first two Emergency physicians to take and pass the national boards in the state of Virginia.  With that, our boy moved on to the largest group in the area.  Based at a teaching hospital which established a medical school and became a Level I Trauma Center, he forged along, ahead, beyond most of his colleagues and for thirty years treated the most fragile, compromised, life-threatened people in our community at all of the facilities which this vanguard group covered.
      So many recollections of working with him were shared at his send-off salutes.  The night he was head-butted by a crack patient, losing five front teeth.  He got treatment, of course, but returned to FINISH HIS SHIFT!  He'd been spat on, verbally abused, reported (insensitivity - refusing to give a drug-seeker narcotics) and feared while respected by the nurses and EMT's.  Known for his Irish temper - and propensity to throw things - they spoke of learning to duck (or give him the RIGHT thing at the first request) to steel themselves against crying (or leave the room but provide a hardened replacement) of learning more from him than from ANY other source. 
      Because his motivation was pure even in the moments his manner may have been rough - "We are just NOT going to let this patient die or hurt or lose a chance at healing.  That's why we're here - to DO IT RIGHT BECAUSE WE CARE!" This refrain was repeated by doctors, nurses, techs, EMT's, even patients in attendance at his 'farewell fetes'. 
      (Oh, life is a glorious cycle of song, a medley of of extemporanea
      Their job is not pretty.  Which is why they recalled how much they'd laughed with him as well.  This phenomenon is common in any group of people who work together in an atmosphere where at any moment a man, woman, parent, child, priest or thief can slip away.  The miracle doesn't work.  And the 'miracle workers' cry.  But there was the day "Administration" circulated a memo suggesting a more homeopathic approach in the ER and Dr. L.  went out and bought ferns , hanging one in each examining bay;  looked the other way as the nurses became more and more confused as to why a paranoid schizophrenic was getting increasingly paranoid (because Doc's own son, working as a tech in the ER, was whispering eerie little nothings over the PA system that the patient could hear); absolutely refused to get a new car, driving a Chevy Impala convertible that was SO shabby, he once left the keys in, top down & ran in because he was late.  The car was running ALL night in an open lot and no one even tried to take it; refused to quit smoking but could ALWAYS be found, so concerned was he about the weather and therefore his patients' safety en route to their homes, that he sacrificed ANY free time he may have had to go out - in all weather - to the ambulance bay and check the skies.  And pity the nurse who, finding him to say, "Dr. L., Mr. X is going south."  Thinking of 92 year-old Mr. X, he'd snap back, "Then what the Hell are YOU doing out here!"
      But he also had that little way of always sliding on to sit next to a child on the stretcher when asking her questions.  And he could always be found sitting with the family -  shedding a few with them - after having to tell them their loved one didn't make it.  One of his partners calculated that over these years he had seen and treated over one hundred fifty thousand patients.  And so MANY of them would not be here today had he not.  And ole "tuffy" took it like a champ, last night.

      (I think no matter where you stray, That I shall go with you a way. Though you may wander sweeter lands, you will not soon forget my hands.  Not yet the way I held my head, nor all the tremulous things I said.  You still will see me, small and white and smiling, in the secret night. 

BUT NOT FORGOTTEN  - Dorothy Parker Poems)
Later, Lorane. . . .
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