Sabbatical

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Friends,

August was hectic with the kids home from school = No posts

September is hectic with the High Holy Days = No posts

But I’ll be right back …

 

Wishing you and yours a Shana Tova

“For a good year may you be inscribed and sealed, immediately, for a good life and for peace”

Lights, Camera, Action!

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And the ‘Actor of the Year’ award goes to…

The lady from number ten with the dizzy spells!

 

Everyone puts on a show. Absolutely all my patients bar none. I’m not implying that they don’t / didn’t feel well. I’m suggesting that people don’t say “the whole truth and nothing but the truth, so help me G-d.”

Some put on more of a show; some less – depending entirely on their self-esteem and emotional stability.

Some put on an impeccable show; some put on an inferior show – depending entirely on their acting skills.

The only patient that doesn’t perform is an unconscious one. It is then and only then, that one can see the person as they actually are – making the initial diagnosis thankfully, remarkably simple:

Unconsciousness!

For all my other clients, accurate diagnosis is more difficult and is, essentially, a labor of love; separating the wheat from the chaff. ‘Tis an art form – of which I am the artist. Theatre – wherein my patients are actors. In the early days it was near impossible, but ultimately, I have become somewhat of an expert in distinguishing the percentage of the ‘illness’ that is life threatening and the fraction that belongs to Bollywood.

Nothing against Bollywood – it’s a perfectly nice place, sunny, music, dance and all. I just want to know who hails from there. Please.

 

“Why is it?” you ask.

“Why is it that everyone becomes a red carpet actor when it comes to emergency medical situations?”

The answer, or answers, brings us to the core of the human condition and the psychological or perhaps psychosomatic heart of operations beating within all of us.

Do please come inside for a closer look.

 

The Why, Who and How

The reasoning is remarkably simple. We can all relate to it, and if but perfectly honest with ourselves, are guilty of it.

Hint – Ever pull out your Iphone and scroll aimlessly through decade old whatsapp history when someone joins you in an empty elevator.

No!?

You must not have an Iphone, whatsapp or elevator!

 

WHY

The inner emotional mechanism goes something like “I’m embarrassed, I feel silly, I feel insecure.” Translated into real-time: “I made a fuss and initiated an emergency medical response. There are lights flashing, sirens blazing, and ambulances speeding through the streets towards me; they can’t land here to find me well and healthy!”

This quickly turns into – “Oops, they’re here now; someone’s taking my pulse, another’s unwrapping a non-rebreather mask; I can’t just stand up, dust myself off and go buy a bagel.” It becomes a snowball situation, once started, nigh impossible to stop.

 

WHO

The more immature the person, the longer the spiel goes on. And in case you were wondering, maturity in these matters is in no way correlated to age. On the contrary. It’ll very often be the younger ones that say, “Hey, it doesn’t hurt anymore – See ya later!” before whizzing off like a speeding bullet.

Forgive the cynicism, but my lamentable, ineluctable and yes, cruel deduction is that:

  • The younger the child, the less room there is in his life for falsehood and inflated ego. Gimme a toddler’s honesty over an adult’s artifice anyday.
  • Tweenhood is a time of businesslike deliberation, “Go back to the skatepark, or milk this for all its worth?” Better yet, “Will this buy me time off school, or a reprimand from Dad?!”
  • Late teens, early twenties – same type of considerations, except higher stakes and more intense social pressures; chicanery in full bloom.
  • Forty, Fifty, Sixty year olds – Ladies and Gentlemen, take your seats and pray silence for an all-out performance of Phantom of the Opera.

 

HOW

It all starts with eyes shut tight. This allows the patient to slip, quite seamlessly, into the fictitious world of sirens wailing, people encircling, bystanders observing, someone trying to get my Mum on the line, and then eventually the quintessential desperately anxious shouts of “Will somebody get some water ASAP?!”

And now, deep into the first half and nearing the intermission one can’t expect the leading actor to sit up and say “Thanks everyone for your help – and that’s a Wrap!”

N’est pas possible.

And so therein begins a particularly problematic escalation that can continue ad infinitum. Bystander to Teacher – Teacher to EMT – EMT to Ambulance – Ambulance to ER Nurse – Nurse to Doc – Doc to Surgeon. A lie; perpetuated with no foreseeable end in sight.

Why’s this all happening?

Oh that’s right, feelings of insecurity.

Pity.

 

Postscript

Of course not all patients behave in this manner; stay tuned for another post with detailed case studies and examples. Oh and if you’re looking for the trusting, undoubting, believing, optimistic Shmeel – He’ll be back in the office on Thursday.

A Tale of Two Newborns

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They had entirely different responses, one sobbing quietly, the other remarkably calm – the mothers.

They were crying insistently and incessantly and with definite purpose – the patients.

The patients in both stories were newborns, one but a week old.

Brand new souls entrusted to brand new mothers.

New mothers who made good and sometimes preposterous decisions.

Decisions that would have unfortunate consequences.

Consequences that would involve – you guessed it – yours truly.

 

One would hope that the most serious calls would get the fastest response. But that’s not always the case. In fact in the forthcoming tales I was on scene in mere seconds, when the emergency was, well, not really an emergency.

 

Tale 1 – Good Judgment

I was literally sitting on my bike, talking on the phone, immediately outside the building wherein the emergency occurred. Lightning fast response, for an absolutely immaterial call. What a waste.

Murphy’s Law 1 – The Desperate and Needy 0

 

The beeper said:

2 Week old Baby – Miscellaneous medical problems – Ingrown Toenail.

I know – I did a double take as well – how could that possibly be true? Don’t ingrown toenails take weeks to develop and involve some fault on behalf of the subject, such as cutting too close?

I was on location before the mother had put down with Control.

 

Act One:

“Hello Madam – what seems to be the problem?” I asked the stoically calm Kimpeturin.

“My baby had an ingrown toenail – treated several days ago by a podiatrist – and is now behaving curiously,” was the ‘matter of fact’ response.

Still no wiser – neither about the toe nor about the baby.

I asked the same question again, phrased differently – and got the same response, phrased differently.

 

Act Two:

Do a once over of the infant.

Get a comprehensive medical history.

Procure a complete set of vitals.

 

This was sure to uncover the underlying problem. But – it didn’t.

 

Act Three:

Pretend you understand the whole situation.

Make believe everything is under control.

Get the baby to a hospital.

 

Worked like a charm.

 

I had now been on scene for about 3 minutes when Unit #22 joined the baby shower, bearing a heavy EMT knapsack, instead of gifts.

“What’s going on?” he asks, breathless from the 2 flights and his decade seniority.

“Her baby had an ingrown toenail – treated several days ago by a podiatrist – and is now behaving curiously,” I repeat verbatim, with a hundredth of a tinge of sarcasm in my voice. #22 immediately knows what I am insinuating and takes the mothers side.

I could sense the speech coming. My mentor had lectured me tens of times on this matter. And so it begins…

“A Mother always knows best. If a mother says that something is wrong with her child, you have to trust her unconditionally, irrespective of your clinical findings!”

Aye Aye Captain.

Ambulance comes, transports mum and child, and, if you must know, there was something awry with the baby and she spent several days in hospital recovering.

From what? Only Mum knows.

 

Tale 2 – Bad Judgment

No I don’t normally sit around on my bike, on my phone, waiting for calls, but;

I was literally sitting on my bike, talking on the phone, immediately outside the building wherein the emergency occurred. Lightning fast response, for an absolutely immaterial call. What a waste.

Murphy’s Law 2 – The Desperate and Needy 0

The Beeper said:

1 Week old Baby – Miscellaneous medical problems – Too Relaxed.

I know – I did a double take as well – how could that possibly be true? Don’t mothers hope and pray that they give birth to children who remain calm and relaxed and sleep through the night?

I jog to the door of the building and meet the mother in the hallway coming towards me from her apartment located at entrance level. She hands me the baby, as is the custom in times of panic, and for good measure yelped “Help!”

I do a one second observation. Infant Conscious – Yes. Infant Breathing – Yes. Great; let’s move to the couch in the house please, its pitch black in the hallway.

 

Act One:

“Hello Madam – what seems to be the problem?” I asked the uncontrollably hysterical mother.

“My baby was crying, and so I gave her a few drops of ‘RELAX’ to calm her down,” she said between sobs.

“And…”

“And now she is too relaxed. Look at her, she is barely moving!”

 

Several Important Pointers:

  1. She was right – the baby was hardly moving. Not quite unconscious, but certainly dispirited.
  2. ‘RELAX’ is a herbal concoction so strong, it could make an elephant count sheep whilst lying wistfully on its back.
  3. The mother had given the newborn several drops of this innocent concoction in the hopes of having a quiet night.
  4. She would now not have a quiet night.
  5. I have a wild imagination, but could never ever make something like this up.

 

Act Two:

Do a once over of the infant.

Get a comprehensive medical history.

Procure a complete set of vitals.

 

Vitals were thankfully normal:

Pulse: 150

Sats: 97%

Respirations: 26

Blood Pressure: No chance on an arm that small

 

Act Three:

Baby is transported to hospital and makes complete recovery. No charges filed against the new mother. RELAX is pleased to learn that their product does indeed work, but adds a caution to the label:

“Not for use on Restless Newborns”

Always wanted to know how those absurd warnings get onto product labels?

Now you know!

 

 

Postscript

Not all Mothers always know best – but mine certainly does. Happy 27th Birthday Mum!

Shooting at the Western Wall

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There is a simple, absolute rule that I have created for myself.

“Shmeel: Always take all your equipment.”

Always.

So that when you find yourself in the right place at the right time, you also have the right tools.

Let me qualify this though. It doesn’t mean that I need to carry around a defibrillator at my kid’s school graduation.

 

Take to Graduation List

Camera

Water

Snacks

Defibrillator

 

That wouldn’t go down well with my wife, or my kids, or the school, or my self-image.

What it does mean is that:

  1. Always carry your communication devices on your person, so that you can be alerted to an emergency in your vicinity. It would be a shame to be shopping in Store #1, oblivious to someone dying in Store #2.
  2. When responding to an emergency, always take all your equipment. Don’t assume the EMT that arrived before you followed protocol, and don’t assume you won’t need that Burn cream. Because actually, you will.

 

But I find it hard to follow rules; even my own – which brings me to the beginning of my story.

 

I zip through the opening between the barriers and head towards Jerusalem’s Old City. Private cars are no longer allowed to enter the old city area and the municipality has set up a barrier that scans license plates and only opens for public transportation or emergency services. It’s a completely automated system and no amount of Israeli Chutzpah will help.

Authorized = Open Sesame.

Unauthorized = Shut as a clam

I whiz through the cobblestone streets – Jaffa Gate on my left and King David’s Tower on my right; my final destination is the Western Wall. Ambucycles are not allowed into the actual Kotel compound unless there is a medical emergency. So I park my bike in a dedicated but unofficial motorcycle parking area and dismount.

Security is tight at the entrance, not dissimilar to what you would find at an airport. Every entrance is manned by several armed guards and visitors need to pass through a metal detector, while their bags get a ride through an X-ray machine.

I beep whenever I go through the detector. Actually I don’t just beep, I chorus. The reason is simple – the extensive collection of electronic devices on my belt. I always seem to forget a radio, or beeper, or keys, or small change and make a fool of myself with a manual search.

Not this time. This time I would leave all my paraphernalia locked up under the seat of the bike and pass security, without a symphony.

“There won’t be an emergency in the next few minutes anyway, right?”

WRONG!

I make it to the wall and Pray. Several minutes pass and all is calm around me. It is early evening and the sun is setting swiftly. There is a cool breeze blowing and except for the birds chirping, men praying, and kids laughing, all is serene.

 

BOOM – First a quiet one and then,

BOOM – A louder one.

 

Most people run away from an explosion. We run towards it.

 

When I say ‘we’ I mean ‘I’ and when I say ‘I’ I mean ‘I would normally run towards the sound, IF I thought it was an emergency.

But I didn’t think it was an emergency. The absurd reality of a Jerusalemite’s existence lately, is that loud explosion type noises are part and parcel of daily life.

 

It might be the Iron Dome intercepting a Hamas missile.

It might be typical construction type sounds from one of the countless building sites.

It might even be fireworks emanating from E. Jerusalem celebrating the end of Ramadan.

 

“It’s certainly not an emergency, right?”

WRONG!

I end my prayers, take several steps backwards, and head towards the exit. The exit, however, is blocked by several burly guards.

“You ain’t going anywhere, brother!”

As it dawns on me that something is drastically wrong, a medic in uniform and carrying a backpack EMT kit brushes past me. The guards wave him through.

“I’m with him,” I blurt out, “I’m an Ambucycle medic!”

“And I’m Elvis Presley – Show me some ID,” came the cynical reply.

“I don’t have any. All my stuff is in the bike.” Even as the words came out, I knew it sounded meek.

“You ain’t going anywhere, brother!”

So I peek over the barricade and behold. A lady, covered from head to toe in ‘coverings’ is lying on the floor and about a dozen army / police / security stand around her. Something funky is definitely going on! I’m about to make another go at convincing my captors to let me free, when the all-clear is given and civilians are allowed to wander once more. I run towards the center of attention and glean the following from the EMS personnel on scene.

The lady, covered entirely with only her eyes showing, had attempted to bypass security and rush into the complex. An ever alert policeman noticed the breach and shouted for her to stop. She ignored the call and he fired a warning shot in the air. She continued walking, and fearing the worst he shot at her legs. The bullet grazed her foot and she fell to the floor. She was found not to be carrying any weapons, but the reason for her strange behavior was as yet unclear.

She was loaded into the waiting ambulance and sent to hospital with a police chaperon.

 

All’s well that ends well, but like I said at the start;

 

“Shmeel: Always take all your equipment.”

Always.