The Dwarf

This story isn’t much about the dwarf, although she played a significant role. About 1984 or so, I was working full time in the E.R.s of mid-south Texas: Kingsville, Alice, and such. A company contacted me saying they needed a board-certified physician to be the medical director of a small E.R. in a little town, I don’t remember exactly which one. The job required driving the three hours down to the hospital from my home in Corpus Christi to attend a meeting once a month and paid $500. Seemed like a pretty good gig at the time.

My first trip there I discovered how dysfunction was the hospital. Staffed by a small handful of non-certified itinerate ER doctors who worked 24 hour-shifts, a purview of the roster of patients floored me. These guys were treating about four patients an hour non-stop, up to 50 patients a day, almost all of them non-paying Mexicans. At the luncheon meeting, I was representing an ER that I had no idea how it functioned, ER doctors who’d I never met and really couldn’t even name, and with no idea about any issues of staffing, equipment, or procedures.

At the first meeting it became clear within minutes that the administrator was an incompetent bipolar buffoon, who made decisions on whims and ruled with intimidation. His arbitrary pronouncements rolled out in endless contradictions, mostly based on fantasy and speculation. I sat dumbfounded, glad I had little to contribute to this bizarre disquisition.

After the meeting I followed the assistant administrator into her office for a debriefing. I’m not making this up, although it sounds like a bad television sitcom, this woman was an Hispanic dwarf, who clearly ran the hospital, ignoring everything the administrator said and making intelligent decisions. She outlined some issues with the E.R. and suggested some solutions. When I returned home that evening, I e-mailed a report with those recommendations to my employer.

The job didn’t last long. On my fourth visit or so, the administrator presented his plans for the rebuilding of the hospital. It included reducing the number of ICU beds in his hospital from eight to four. I pointed out that the trend in American medicine was for outpatient care when possible, and that those who came into the hospital tended to be older and sicker and needed more intensive care. I suggested instead of halving the ICU beds they should be doubled.

He laid into me with vehemence, telling me I had no idea what I was talking about and that he would be sure I never worked at his hospital again … not that I’d ever had a single shift there anyway.

After that meeting the dwarf took me into her office, told me I was right, but I shouldn’t have said anything. My contract was terminated, which, really, was a good thing. It wasn’t worth the six-hour drive and clown show, even for the easy money.

I’m currently writing my memoir, “I Saved Lives,” about my forty-two year as an emergency medicine physician. This is one of the chapters.

Administering COVID-19 Vaccines

Eight a.m. this Friday morning, I pulled up to the Gruich Community Center.  I’d been assigned as the “doctor consultant” for Memorial Hospital’s outreach vaccine administration extravaganza.  The city of Biloxi had donated the facility’s use for the day, and by the time I arrived fifty Hospital employees manned their stations.  Their ambition; vaccinate 1200 people within the next seven hours.

Over the past seven months I’ve staffed three of Memorial’s COVID testing stations.  These involved drive-up situations, no appointment needed.  This would be my first shift at a vaccination center.

Memorial began providing vaccinations for the public on January 7th.  They set up a center at the D’Iberville Community Center, and, unlike the testing centers, this required scheduling an appointment. After receiving the vaccine, each person had to be observed for fifteen minutes before release to insure no one had one of the rare adverse reactions. 

Initially restricted to those over 75 years of age or those with serious health conditions, the age barrier has been lowered to its current cut-off of 50.  Age limits are waved for certain high-risk situations, such as those living in a nursing facility or working as a healthcare provider.  Most of my friends have joined me in being fully vaccinated.  It gives one a sense of being armored!

One of the nationwide issues in vaccine distribution has been providing access to those in the community without transportation.  Memorial’s solution has been to target these areas with these one-day centers in the poorer urban areas.  Setting up the night before, Hospital employees transformed this expansive13,000 square foot sports floor into a vaccination machine.

I marveled at the well-organized set up.  As each client (if I might call them that) entered the Gruich Center’s front door, they came into a small foyer with a greeting table on each side.  Two Hospital employees manned each table, checking in those who’d made appointments and walk-ins as well.  The clerks handed each client a clipboard with a single page registration form and a six page “Fact Sheet for Recipients and Caregivers” about the Pfizer Vaccine. 

Inside, the floor had been bisected by a row of 14 black-draped vaccination booths.  On the entry side, four dozen chairs, scattered at six-foot “safe-distance” arrangements, provided seating opportunities for clients to fill out the registration form.  Name, birthdate, address, and phone number occupied the top section.  Below, the form listed five “Yes or No” questions.  Do you have a fever?  Have you been diagnosed with COVID in the prior 90 days?  Have you received other vaccinations in the past four weeks?  Have you ever had a severe allergic reaction?  Are you pregnant or lactating? 

Here is where I did most of my work.  A lot of people have had allergic reactions in their past, such as to bee stings, shellfish, or antibiotics.  Fortunately, only severe allergic reactions to vaccines would disqualify a recipient.  I reassured those with concerns, advising them that we had an experienced emergency physician on site (me) as well as emergency medications.  Throughout the seven-hour event, I spoke with about forty clients. The sheet also mentioned possible complications with implants. I explained that getting the virus posed a higher risk of inflammation to these foreign objects than did the vaccine.

After the client completed the registration form, a trio of nurses directed each to one of the fourteen vaccination booths, staffed by Hospital employees trained to administer the vaccine.  In on the north side of the booth, the client received the vaccine and a sticker that gave a time 15-minutes in the future.  Out the south side of the booth, they’d choose one of the eighty chairs set up on the other two thirds of the Center’s floor.  Here the recipient would rest, receive a bottle of water and an energy bar, and wait for the timekeeper to call out the time on their sticker so they could leave.  Everyone was reminded that they needed to return in three weeks for the second shot.  The vaccine and its administration were provided at no cost to whomever walked in the door.

The Hospital administrators’ organizational skills insured a smooth operation.  One station held five pharmacy techs rapidly preparing vaccine syringes.  Another table hosted six computer attended ladies entering the registration information and arranging follow up visits.  Yet another provided opportunities for citizens to join the Hospital’s Portal system, a method of communicating with physicians and setting up appointments from a home computer.  One spot provided an opportunity to sign up as organ donators.  All workers received box lunches.

By the end of the session, we had administered 1050 of our 1200 allocated dosages.  As of March 6th, 90 million COVID-19 vaccine dosages have been administered in the United States to almost 60 million people. That’s nearly 20% of the population. Across the country, we’re averaging 2 million doses a day.  At this rate, every person in this country will have the opportunity to be vaccinated by the end of May.  Once this has been accomplished, we truly can return to near-normal, including crowds at concerts, movie theatres, and sporting events.

In all the vaccine programs Memorial has administered, we haven’t had a single serious reaction.  While receiving the vaccine does not guarantee the person won’t become infected with the virus, it does almost completely eliminate the risk of the infection being so bad as to require hospitalization or cause death.  I’m incredibly proud of my hospital and the part we’re playing in saving lives.  Don’t hesitate.  If you haven’t had your vaccine, call Memorial’s COVID-19 Hotline at 228-867-5000 for an appointment, or the service provider nearest you.

Saturday Morning Vendor

The sun’s barely up yet the farmer’s market already bustles.  Although I’m early, other vendors have filled the best spots, the ones with road frontage, so I stake a claim around the bend.  This February morning, fog rests heavy, saturating all with its wet chill. It takes me nearly a dozen trips to pull all my booth pieces from the Rav-4: tent, tables, cloths, bookstands, and the two heavy boxes of books.  My fellow vendors gather to help raise the tent, and we gab, catching up on family and health news.

We’re an older crowd, retirees with time to devote to those passions we’ve postponed while the demands of work and family-raising exhausted both energy and time.  The booths change every now and then, the honey-man from Lucedale stopped setting up, the Chinese vegetable-lady moved to a different market.  New ones settle in to replace them.

Mary, a woman in a threadbare jacket, displays a hundred colorful caps she’s crocheted, many with animal or superhero themes. Annie, a sweet lady with perpetual smile, offers soy candles in a variety of colors and aromas.  On the corner, Joe’s home-built bird houses wave in the gentle breeze.

Tig’s Fresh Baked Goodies draws a steady clientele, her sugary cookies, scrumptious pecan pies, and hearty bread loaves feed visitors and vendors alike.  By noon she’ll be sold out. I buy a sesame roll, half price with the vendor discount. 

It takes me forty-five minutes to set up my booth, my books displayed in categories.  On one end sit the four non-fiction books: Mississippi histories, biographies, and memoirs.  The collection of twenty-four biographies of Mississippians features a cover with the old stars and bars Mississippi flag, published before the flag controversy.  It now solicits mixed reception.  One African-American saw it on my table and turned her nose up, striding away with insulted pride.  An older fellow with a MAGA hat purchased one for the nostalgia benefit.

Just across the path, old Frank leans on his cane, watching over his melted glass.  Frank’s been out for two months, dealing with kidney failure, heart stents, and chronic lung disease.  He hobbles over to talk about his latest medical adventures, rejoicing in being outside and feeling useful.  His table features melted bottles collapsed into ashtrays, chunks of colors hanging from driftwood to make a mobile, clanking in the breezes, and lovely multi-colored brooches made by his granddaughter.  A wonderful day of sales for him will be forty dollars.

Children books hold rein in the middle of my table, the “Princess” stories an attraction for adolescent and teenybopper girls.  One little tyke proudly tells me she’s in third grade but reading at the fifth-grade level.  I set my bestseller up front, the children’s photobook from the Galapagos Islands.  Full of pictures of brightly colored lizards, birds, and a gigantic, green-shelled tortoise, schoolboys love to gawk at the wonders of weird creatures. 

Kathleen paints caricatures of fish on fencing boards, six-foot long patio paintings that sell surprisingly well.  Down the strip, Paul displays his pelican paintings.  At $100 a pop he only needs to sell one or two to make the morning efforts worthwhile.  A third painter, Sylvia, paints turtles on slate shingles.  She’ll make three hundred dollars today.

My friend, tall and bald Robert, sets up next to me, displaying his sketched glass.  His dangling Christian cross earring accents his scraggly white beard.  Tattoos decorate both arms, giving the accurate impression of this being a rough and tough welder, whose soft side shows in the poetry book he wrote and proudly displays for sale.

Next on my table stand the three adult fiction books, the murder mystery, contemporary romance, and collection of medical short stories.  On a pretty day like this I’ll sell three or four of those.  I’m a multi-genre kind of guy, which makes it harder to build up a fan base, although I like to claim I have something for everyone.

Attracted by the row of tents, out-of-towners driving by stop to browse, Louisianans puttering along the beach road, snowbirds from the Midwest, perhaps shopping to fill up their second home.  A scattering of locals out for a Saturday stroll wander by, often with dogs on leash.  I have a few repeat customers.

“I loved this book,” says one blue-haired matron, picking up my murder mystery, and with a little encouragement I talk her into buying the contemporary novel.  A nine-year-old scampers up to my booth, points to the “Zany Zombie” tome and calls out, “That book was awesome.”  A fellow with an orange warning vest glances my way and says, “I don’t read.”  I try to sell him an audiobook.  No dice.

On the far end I have a rack of five-dollar books, seven 100-page novellas, including sci-fi, poetry, and a Bible book.  These paperbacks curl in the humidity, later needing to be pressed back down. The bestseller here is the ghost story.  “Hey, for five bucks, what can you lose?”

By noon even this February day begins to show its South Mississippi heat.  It’s a lovely way to spend a Saturday morning, sitting in the shade of a park, watching the people wander by.  Each sale is a boost to my ego. “Oh, they bought my book – they LIKE me.”

It takes twenty minutes to break down, put away the unsold books, drag the parts back to the car, everything carefully arranged in the hatchback like a Tetris puzzle.  I’m home by one, where the French girlfriend has lunch ready. 

“Good sales, Fee-leep?” she asks.

“I sold 13 books and gave away two.  A hundred and sixty-three bucks.” 

She claps her hands.  “Magnifique!  You buy me la broche in Zay-les, oui?”

Easy come, easy go. 

Dr. Mejia, the Cardiologist

As we travel through life we’ve had mentors, people who helped us find our paths –- perhaps a favorite teacher or friend. Their interactions might have been prolonged, years of tutelage, like an acharya. Or maybe just a momentary event, a brief interaction where the fellow gave advice that fortified our soul.

Over the past several months I’ve been writing the memoir of my career as an emergency medicine physician. As I look back over the years, I’m remembering some of these inspirational interactions. This is a story of one of those moments from an instructor during my residency, forty years ago. 

More than just pudgy, Dr. Mejia’s waist measurement almost matched his height. He smoked Cuban cigars and pontificated about the virtues of various blends of Scotch. When I would run into him at the hospital cafeteria during lunch, he’d have a tray full of fried food and desserts. Sometimes he’d have his family with him, a shy but ever smiling wife and a squadron of kids, stepchaired up in yearly ages. Fun and knowledgeable, he loved cardiology and the many pleasures of life.

One day he didn’t show up for rounds, and word spread that he’d had a massive heart attack. I checked in on him, finding him intubated and sedated in our hospital’s quiet six-bed ICU, a somber place where Dr. Mejia had so often been the physician looking down on the patient instead of the other way around. As I held his hand his eyes flashed open, their look of terror haunting. 

I’ve known many a patient who quit smoking after they’d developed lung cancer, or diabetics who gave up desserts only after their pancreases gave out. The shock of a health crisis often creates a catalyst for change.

Dr. Mejia took a leave of absence from the hospital and it must have been a year before I saw him again. Trimmed down to 120 pounds of solid muscle, it took several minutes of conversation to convince me it was truly the same man.

“It’s wonderful to see you again, Dr. Mejia. How are you feeling?”

He spread out his arms in his characteristic welcoming gesture. “As you can see, never been better.”

The change was so remarkable I couldn’t help but ask how he managed it.

“I eat only one meal a day, usually a salad for lunch, and work out for two hours each morning,” he told me.

“Do you miss your old life?”

A wry grin settled on his face and he gave a snort. “Oh, I suppose I still salivate a little when I see a thick juicy steak or a whipped cream topped pie. But, no, I don’t really miss it. Every day we make choices in our lives, Philip.”

He paused to check the reading on his beeper that’d just chimed. Looking up, he put his hand on my shoulder and said, “Don’t let it take a near-death experience to inspire you into making the right ones.”

I Saved Lives

A young man came in with a knife wound to his side, blood inside his chest squeezing all the air out of his lung.  I placed a tube in his side releasing the pressure giving him back his ability to breathe. 

Ah hour later, a businessman, his face ashen and wet from perspiration, presents with symptoms of a heart attack.  As I watched, his heart stopped and he died. I ordered the nurses to perform CPR as I readied and then used a defibrillator to shock his heart, bringing him back to life.

My next patient was a young woman complain of stomach pain.  Even though she denied ever having had sex, my questioning made me suspect she might be having an ectopic pregnancy.  My sending her to the O.R. instead of home saved her life.

After forty-two years of full-time practice, in 2020 I retired from emergency medicine.  One day my wife asked me, how many lives do you figure you saved in your career?  I honestly don’t know.  Certainly a few hundred.  But there was much more than just saving lives.  There’s been the influence I’ve had on the thousands I’ve helped, encouraged, and advised.  There’ve been the medical students whose careers I’ve steered.  There’s been the political influence I’ve had on the course of medicine.

Emergency medicine is a rush.  I would have no idea when I went to work what would be waiting for me.  Throughout the day there might be nothing important, or I might have six critical patients all come in within an hour’s time.  There’s vomit and feces and blood. There’re children crying in fear, adults crying in pain, and elderly crying in despair.  Crazy people with their delusions and drug seekers with their tales.  Child abuse.  Gunshot wounds.  Suicidal overdoses.

I loved my job, never doubted I’d made the proper career choice, never hesitated going to work.  Every day, no matter how sad or angry or unsettled I might have felt, when I arrived at work and saw the sufferings and misfortunes of my patients, I knew my life was ten times blessed. 

People would ask me, “How do you handle the stress?”

I’d give the answer serious consideration, for, indeed, some people would consider my job stressful.  However, I never did.  I liked the House of God answer, “The patient is the one with the disease,” meaning, “Since I’m not the one having the heart attack or the acute appendicitis, I’m not the one under stress.” 

But that’s not the true answer.  I never felt stressed working as a physician in the emergency room because I always felt in control of the situation. Even in the most seemingly frantic situations, I relied on method.  Obtain the history.  Check the vital signs.  Carefully and thoroughly examine the patient.  Consider what could be wrong.  Order appropriate tests.  Deduce the answers.  Explain the situation in terms the patient can understand.  Provide the necessary treatments.

I always saw the good in people.  In my hands, a homeless alcoholic received the same kind care as the manager of a bank.  The color of a person’s skin mattered only in whether it might make a difference in their disease.  Those with language difficulties or mental handicaps received special attention, and my determination to be certain I understood what they wanted, and they understood what I told them.

I made a few mistakes – of course, I’m only human.  Sometimes the cause of the patients’ problems wasn’t discernable early on.  But I always tried to be gentle and understanding, tried to find out what was really going on, even from those who were misleading me. 

At my heyday, I worked twenty-two days a month, averaging as many as five patients an hour in each twelve-hour shift.  One month I grossed a hundred thousand dollars in billing.  The company that did that service for us told me they’d never ever, in all their twenty years of providing billing for hundreds of doctors, they’d never seen an E.R. doctor treat that many patients.

You think you can imagine what it’s like? Plenty of people have seen it on TV I’m sure.  Lights flashing, Sirens blaring. People scurrying.  But there’s nothing like really being there!  It’s the difference between watching a game on the tube and actually being in competition.  There’s NOTHING IN THE WORLD like being in the midst of trying to save someone’s life.

It's over now, but once … yes, once, I saved lives.

Update on COVID from a COVID testing center doctor

Two days a week I work in the COVID testing clinics.  I’ve been rotating through all three of the testing centers near me, the ones in Long Beach at the walk-in clinic, Biloxi at Cedar-Lake road, and at the small drive-up in Gulfport across the street from Memorial Hospital.  When I started working these clinics in August, we were seeing 30 patients or so during a nine-hour shift.  Plenty of time for a lunch break.  By September the numbers had increased to 50, and when October rolled in we exceeded 70. Lunch breaks were cancelled.  In November we processed more than 100 COVID tests a day.  The incredible volumes created issues with traffic control and access to the Biloxi clinic, so the clever administrators arranged in December to move that clinic to D’Iberville at a drive-through hangar.  The first week they opened they processed over 180 people in one day.

And then came January and the patient numbers plummeted, as did the rates of positive.  In early January we had volumes of over 150 patients a day with around 20% positive rates.  Monday I worked at the Gulfport clinic and we saw only about 60 patients with just a handful of positive cases, and Friday at the Long Beach clinic we tested 80 patients with less than 10% positives.

The statistics for Mississippi tell the same story. From an all time high of 3203 cases on January 9 and its 7-day average of 2370, the number of new reported cases dropped to 705 on February 1st, with an average of 1210. Even with the new highly contagious variants, the U.S. statistics don’t show another spike. What has happened?

It doesn’t make sense.  Sure, the Christmas surge is dying out.  And, yes, vaccinations in process might be reducing the spread.  But there’s got to be more.  Are people being more careful, wearing masks and social distancing?  I don’t think so.  Maybe people are realizing that it doesn’t matter if we diagnose them with the COVID infection or not – unless they’re seriously ill we’re not going to do anything for them besides recommend vitamins.  And if they ARE really sick, they need to go directly to the emergency room.  My guess is that we’re having falling numbers mostly because people are deciding not to get tested.  Just a theory.

I wonder if this significant drop in numbers will affect complacency?  Last Thursday I picked up a phone-in order for pizzas at a local pizzeria.  The place was packed!  Probably 80 people sat at tables and another twenty-five to thirty hung out in the bar.  No one was wearing a mask but the waitress.  Okay, you have to take off your mask to eat pizza, that’s fair.  But the barflies were in each other’s face-space, sharing jokes and watching the sports on the tele.  Clearly a super-spreader place.

COVID can be a deadly disease – it often is.  Nearly half a million Americans have died from it, and over two million worldwide.  For some people, infection complications cause permanent health issues, including thought disorders, heart and kidney damage, and other weird effects like rashes.  Yet for most people, it’s little more than a nuisance, or even no symptoms at all.  Perhaps people have developed a sense of inevitability.  With only a one out of a hundred chance of death, why bother being careful? 

There’s also the danger of having a positive COVID result.  Out of work or school for ten days, unable to visit friends and relatives, and avoidance of social events!  I suppose there’s also anxiety about having possibly already spread it before having been diagnosed.  With all those problems, I’ve heard that many of my fellow health care workers have avoided getting tested.

I suppose I’m one of the lucky ones.  I work the COVID clinics.  I go out shopping and to restaurants.  I’ve never tested positive, including my most recent test on Thursday morning. And, I’m happy to say, I’ve had the two-shot Maderno COVID vaccine series.  Nevertheless, I continue to wear my mask whenever I’m out.  And I’m certainly not going into a bar and standing around spitting in the faces of strangers. 

Meanwhile, it’s Superbowl Sunday.  Are you going to a party?  Perhaps you should wear a mask.  Just saying.

Reflections on choosing to become an emergency room physician

As a child I rescued housebound spiders and flies and released them outside.  I’d stand up for kids being bullied. Gentleness and compassion seemed ingrained in my genes.  By age seven I had already decided I’d become a physician.  

Medical school was a bitch. Eighteen-hour days, absence of social life, including a resultant divorce, occasionally made me question my goal. Yet even then, as a powerless dweeb, the joy I felt when offering kindness and information to my patients convinced me that my persistence would be rewarded.

The first day I stepped into the emergency room as a third-year medical student, I realized I’d discovered my lifelong home.  The need for direct and accurate targeting of intervention made correct life-changing decisions paramount. Why become a surgeon, merely cutting out diseased parts?  What attraction neurology, the dull testing of nerve impulses and reflexes?  No, for me the adrenaline rush of staunching the bleeding, relieving the chest pain, and diagnosing the bellyache offered question, quest, and completion.

For forty-two years, each day I stepped into the emergency room I thanked God for providing me the best possible career.  Bringing comfort to my patients with their acute trauma, chronic pains, drug addictions, and social situation disasters, provided all the fulfillment my life needed.  Without ambition for money, fame, or gratitude, I provided unbiased service to rich and penniless, youth and pensioner, regardless of race, gender, religion, or sexual or political preferences.

Now, at sixty-seven, I’ve retired from the emergency room.  I still offer physician services at the COVID or walk-in clinics.  No longer do I enjoy the adrenaline rush.  Not for me the quick life-saving actions.  Still, the hurt and the needy come to seek my help. Like a disconsolate fly buzzing to get out the closed window, even though my intervention may seem minor to me, to that fly, it’s life changing.