Dear Mr. Trump,

On June 20th, in Tulsa, Oklahoma, along with Vice President Pence, you are scheduled to do a campaign rally. No doubt the idea of thousands of rabid, screaming, white-knuckled fans wearing MAGA hats and waving their Trump/Pence signs in glorious shades of red, white and blue gives you goosebumps and sends chills up and down your spine.

I am concerned, though, that you don’t understand the implications of holding the event during the middle of the COVID-19 pandemic.  Tulsa is already experiencing an explosion of such cases, and to schedule a large indoor gathering during this critical juncture has the potential to be a super-spreader event, where just one person can spread the coronavirus in geometric progression to countless others.  Up to this point, our state has been blessed by a relatively low number of COVID-19 cases, especially compared to our southern neighbor Texas.  But your rally has the capability to change all that, much like what happened in New Rochelle, when a single person spawned a nightmare beyond comprehension in nearby New York City and the surrounding area, directly leading to tens of thousands of deaths.

I must confess that your history concerns me.  Your acceptance speech for the Republican nomination for the presidency was moved to Jacksonville because health concerns rightfully expressed by the governor of North Carolina could prevent the wild, narcissistic celebration you desired. I am certain you prefer old-fashioned gatherings where your adoring followers are jammed together like sardines, social distancing be damned.  The promised masks – assuming they are worn – and hand sanitizer will be of some help, but without the cornerstone of social distancing, the protection they give will simply not be enough. Also, while you will be doing temperature checks prior to entry, remember that 25-45% of carriers are asymptomatic. In other words, they are infectious and checking for a fever does not adequately screen them. So, what are you thinking? Could it be that you still believe the coronavirus will go away without the vaccine, in spite of the lack of scientific evidence to support that notion?  Do you think the pandemic will miraculously fade into the background before your event in Tulsa?

This whole scenario reminds me of the old Russian fable called “The Scorpion and the Frog,” and it goes something like this:  A frog was peacefully sunning on the bank of a river, when a scorpion approached her and asked, “Would you carry me across the river on your back?”

The frog looked confused. “Why should I?  If I do, you will sting me, and I will die.”

“Why would I do that?  If I did, we both would die, because I would drown.”

Seeing the wisdom of his words, the frog nodded her tiny green head and allowed the scorpion onto her back.  Midway across the river, the frog felt a sharp pain in the middle of her back. Shocked, she said, “Why did you do that?  Now we both will die!”

As they began to slowly submerge in the water, the scorpion said, “I’m sorry, but I couldn’t help it.  It’s my nature.”

So, Mr. President, what is your nature?

It remains my fervent prayer that you will change your mind and not come to Tulsa, at least for the time being.  As an emergency physician, the health and well-being of my fellow Oklahomans is critically important to me. And I’m not alone. Tulsa City-County Health Department Director Bruce Dart has also expressed the hope that the campaign will push back the date of the rally. Much like New Rochelle, your event could precipitate a health crisis with overrun emergency departments and hospitals like nothing we have ever seen before in our state. 

The primary question is this:  For the short term, are you able to put aside your personal ambitions and desires for the greater good of your fellow Americans? Unfortunately, as evidenced by the time you ordered peaceful protesters tear gassed and forcibly removed from Lafayette Square in Washington, D.C., for a photo-op, along with your willingness to endanger those in North Carolina and Florida, you have clearly demonstrated that your nature is to place yourself first, no matter the consequences. Like the scorpion, you don’t seem to be able to help yourself.

Please reconsider your plans and prove me wrong by postponing your trip to Tulsa. If you don’t, it is likely that irreparable harm will result, and while I know you’d like to believe otherwise, you will be at least partially responsible for the pandemonium that follows.

Sincerely,

Gary D. Conrad, M.D.

“Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me; thy rod and thy staff they comfort me.”

Psalm 23:4

I’ve always known that being an emergency department physician was not the safest job in the world. Oftentimes I have to deal with violent patients, some drug induced, some with psychiatric disorders, and others who become flat out angry and aggressive because I refused to give them the prescription they coveted, usually some kind of controlled drug. With that in mind, once I asked a police officer in the emergency department what I should do if someone pulled out a gun, pointed it at my head and said, “I’m going to kill you.”

With a concerned look on his face, he said, “Let’s do a demonstration.” Seeing my nod, he jabbed his right index finger into the middle of my forehead and said, “Pretend this is a gun. Now, the hand is quicker than the eye, so as fast as you can, reach up and grab my hand with your opposite hand and twist it as though you were removing a gun.” After doing what he said, the officer nodded. “Good. If you move as quickly as you just did, he might blow off one of your ears, but at least you’d live. Also, make sure a nurse isn’t standing beside you, or otherwise the bullet might hit her.”

Yikes, that was comforting, I sardonically thought before I thanked him for his time. While in retrospect, it seemed like an odd question to ask, given the gradual uptick of violence in the emergency department over the years, why wouldn’t I?

Besides dealing with violent behavior, another risk of being a healthcare provider is contracting a disease from a patient. Caring is sharing, but not in medicine. I’m very fastidious about protecting myself from infectious secretions, and the truth is that being overly clean in the emergency department is an oxymoron. There’s no such thing, and I’d rather not bring infections home to my family.

The coronavirus, also known as COVID-19, is a whole different animal, unlike anything I’ve seen before. The problem is that while the patient may have symptoms such as a cough, fever, diarrhea, fatigue and/or shortness of breath, some have no symptoms at all and can be contagious at the same time. Besides that, the virus can survive and still be infective on a hard surface for up to three days, and while the mortality rate with influenza is around 0.1%, that of the coronavirus is close to 0.5%, about five times higher. In addition, older patients who contract this illness are far more likely to have bad outcomes. At sixty-seven years old, much as I’d like to believe otherwise, I am no longer a spring chicken, and along with those who are immunocompromised or have other serious medical issues, I am at high risk should I become infected.

Nowadays, when I go to work in the emergency department, I have discovered that I am more-than-a-little fearful of contracting this dreaded virus. What if I place my hand on a contaminated surface and inadvertently put it to my face? What if my defenses against infection are somehow breached? Let’s face it, I work in a high risk area, and social isolation is simply not possible. But neither is it for the nurses, physician associates, nurse practitioners, x-ray, lab and ultrasound techs, and countless others who could be exposed to a potentially fatal illness. And what about paramedics and EMTs, policemen, firemen, and all those whose job is intervene outside the sanctuary of the hospital? All of us walk in the Valley of the Shadow of Death, and we have no choice but to resolutely step forward and do our jobs, much as we’d like to hunker down in our homes and protect ourselves. I’m proud to say that I work alongside heroes, those who are willing to risk their lives in order to help humankind.

I have also noticed that when I return home from a day in the emergency department, I am much more aware of the preciousness of life, realizing that the possibility exists that my Earthly existence might be taken away from me sooner than I had planned. I pay close attention to the look of love on my wife’s face, the conversations we share as we lie in bed and listen to music, the smiles on the faces of our dogs Karma and Buddy, treasured moments talking with my ninety-year old father, who I have playfully nicknamed “The Top Rooster,” precious communications with my daughters,  and of course, cherished times spent with dear friends.

More than ever, I focus on little things, savoring the cup of honeyed Earl Grey tea I have in the morning, reading about the Oklahoma City Thunder in the Sports section of the newspaper, sitting quietly in meditation, watching colored birds as they flit in and out from the feeder, playing ball with the dogs, enjoying good food and drink, and so many other countless pleasures.

Sigh . . .

I want to live to a ripe old age and fully enjoy my time on Earth, but because of the coronavirus, I feel like I’m teetering on the razor’s edge, and there’s nothing else I can do other than to protect myself as best I can, experience each moment as completely as possible, and know that God is at my side. Whatever the outcome of my life – and there are no guarantees – I can ask for no greater blessing than that.

May the Divine be with us all during these challenging times.

Just recently, my ninety-year-old father took a tumble and fractured his right shoulder. After a short stint in the hospital and some time in rehab, he returned to his home of thirty-nine years. Realizing that Dad was not capable of caring for himself for the short term, my sister Connie, Aunt Gayle, and I agreed to watch him around the clock until he recovered.

Since my mother’s death almost three years ago, Dad had been amazingly self-sufficient, and nearly all visits to see him were for social reasons, simply to spend precious moments with the patriarch of the family. But nothing stays the same, and we all knew Dad would need our help at some point in time. It’s a blessed, sacred duty to care for a parent, and I was happy to do my part.

This morning was the first day I would care for Dad, and I took over for my sister, who had watched him not only the previous night, but also for most of the days since he arrived home. After a brief update on what his needs were, Connie left for her home in Tulsa and some all-important time with her husband. As I settled in, it didn’t take me long to discover that Dad’s requirements were minimal, such as walking alongside him when he had to go to the bathroom, fixing simple meals, and addressing the little needs that invariably cropped up.

Dad loved reading western novels, which allowed me the opportunity to mindfully survey the living area where we sat, the most obvious feature being a potpourri of family photos. When I used to deliver Mobile Meals to the elderly and infirm, one common feature of nearly all of their residences were these depictions of the past, somehow giving meaning to the present and also to the future. One photo in Dad’s house that brought a smile to my face was one of me and my daughters taken while river rafting in Colorado, bringing back all sorts of pleasant memories.

Hanging over the fireplace was a beautiful painting by family friend and artist Colleen King, showing sister Connie precariously crossing a stream on a log in Red River, New Mexico, where our family spent many summer vacations. On nearby bookshelves stood various ceramic angels that I had gifted my mother. She treasured her collection of winged, spiritual beings, and she never tired of receiving them for birthdays or Christmas. On the wall above and alongside the bookcase hung depictions of a number of glistening, golden birds in flight, reminding me of the classic book by Richard Bach, Jonathan Livingston Seagull. To my left, in an adjacent room was the dining room table, where my family celebrated many a Thanksgiving dinner.

I was flooded with memories as my father quietly read, yet I knew that these sacred moments I was now sharing with him would someday also be in the past, and the glue that held all of these recollections in their proper place – my father – would no longer physically be in the world. All of these symbols of his and my mother’s life would eventually be dispersed from the home, and one day another family with their own unique hopes and dreams would live in this space.

Yet now, my father is sitting in the same room with me and reading, moments sprinkled with conversation, laughter and sharing of thoughts. I value this time with him, and I’m honored to be caring for Dad, just as one day, when I was a young boy, he cared for me.

Present moment, wonderful moment.

I’ve added another location to my bucket list, the fascinating Waitomo Caves on the North Island of New Zealand. Enjoy!

https://bit.ly/1JtO7c3

“The highest reward for a man’s toil is not what he gets for it but what he becomes by it.”

– John Ruskin

On July 1, 2018, when I drive to work at the emergency department, I will have traveled there for forty years. How is that possible? Where has the time gone? It boggles my mind to think of the events of my life that have passed since then.  Even though I’ve lived in several different locations during that period, my trip to the hospital has remained much the same.  Repeatedly, I passed though the intersection where one morning after a night shift, I was broadsided by an intoxicated airman who ran a stop sign.  Other than being knocked silly and having a mild neck injury, I ended up being as fit as a fiddle.  Oddly enough, adjacent to the site of my accident sits a large, sprawling cemetery, and I’m certainly glad the accident didn’t find me needing a place there.  Closer to the hospital, I drove past the location of a bustling weekend flea market, a now-closed tire shop and a series of convenience stores.  Oftentimes, as I mentally prepared for the intensity of my day, I motored past these nondescript spots without paying the least bit of attention to them, steeling myself for the inevitable traumas that I would soon face in the emergency department.  Someday these places will be distant memories, flashes from the past that have no meaning whatsoever.

But now, as I anticipate my upcoming, four decade anniversary in emergency medicine, my thoughts roll back to 1978, when I first began my career.  I was green, very green, and while I thought I knew a lot about medicine, little did I know at that time how much I still had to learn. Fortunately, not only did I have the support and shared wisdom of my physician colleagues, even more critical was the team of experienced nurses who had my back.  While my fellow doctors were helpful in my developing practice, day-to-day I worked much more closely with the nursing staff and ambulance service personnel. As I think back, my memories of them are as distinct as if they were yesterday.  For those of you unfamiliar with those in my past work environment, please forgive my diversion into the olden days and their associated recollections, vivid memories begging to be shared.

First, I must mention Ann, the nurse manager of the emergency department, whose innate, calm disposition kept the chaos in some modicum of order.  I never saw Ann lose her cool, no matter how dicey the situation, though I suspect on occasion she blew a gasket just like the rest of us. How could I forget Frankie, practiced and direct?  I never had to wonder what was on her mind about patients, because she always told me, whether I liked it or not.  Then, there was Carol, the night shift RN, who was more than just a learned nurse, she was a great friend, and I always appreciated her insights when difficult patients walked through the door.  Pam was Carol’s trusty sidekick during the wee hours, a solid, centered caregiver who held it together when things were going bad. Rick was a terrific nurse, great in times of catastrophe, yet he was also the ultimate cynic.  Countless times, when I asked him how he was doing, he raised his eyebrows and sarcastically responded, “Another day in paradise.”  Even now, I grin as I recall the disgusted look on his face. Barbara was one of our most emotionally collected nurses, and even though everything was going to hell in a handbasket, she remained as cool as a cucumber; she was a tough, hardened emergency nurse.  Over the years, she has moved on to more of an administrative role, and she has become one of my close friends and confidantes. Darrell was an EMT (emergency medical technician) who later became an RN.  As good as a nurse as he was, he was an even better volleyball player, and he was one of the stalwarts of the emergency volleyball team.  Besides those previously mentioned, I have fond memories of many others from 1978, including Donna, Norma, Peggy, Cobehy, Dan, Debbie, Maria, Glenda and Carol C.

At that distant time, the corps of paramedics and EMTs on the ambulance service were the finest that could be found anywhere.  The Grand Master of the paramedics was the knowledgeable and oh so wise Harvey.  He was like a walking encyclopedia, one who knew the fine details of Advanced Cardiac Life Support (ACLS) better than most physicians.  When the occasions came for our biennial re-certifications in ACLS, I shuddered when I discovered that Harvey was the one testing me. Under the pressure of his beady-eyed, intense stare, I would break out into a cold sweat, and I prayed to God that I knew the right answers to his incisive questions. Fortunately, after Harvey heard a few correct responses, he usually took it easy on me, for which I was most grateful.  Keith was another one of our superb paramedics, who, after his stint in the ambulance service, later redirected his skills to become the executive vice president of a physician billing service.  I have the highest respect for him and his accomplishments.  Judi was the lone female paramedic at our hospital in those male-dominated years, and she was Ms. Reliable, someone I could always count on to make the right decision in the field.  I want to also give shout-outs to the long-time director, Romeo, also brothers Tony and Jerry, as well as Joe, Sammy and Jeff.  Of course, I could never forget Randy and Andy, players of hot fiddles in a local country and western band. Charlie Daniels was a rank amateur compared to them.

I have chosen in this blog post to honor the memory of two very special nurses. Gail was an RN who I had worked with for a number of years.  She was atypical for an emergency nurse, in that she was generally quiet and soft spoken.  Hidden underneath her gentle manner was a caring and compassionate nurse, one who provided excellent care to those fortunate enough to have her as a provider.  One tragic day, when Gail was forty-nine years old, she contracted flesh-eating bacteria. Despite our heroic efforts, which included surgery and high dose IV antibiotics, she died on July 28, 2003.  In the aftermath, I felt like the wind had been sucked out of my sails, as from the beginning of my emergency career, Gail had always been there, and all of a sudden she wasn’t – an agonizing vacuum had been created. Another who deserves mention is Diana, who I had worked with for some time before she was diagnosed with breast cancer.  Diana was one of the most kind and loving persons I have ever met, and whenever she entered, her beautiful smile lit up the room. Her warmhearted attitude never changed, in spite of the ravages of her disease and the side effects of its treatment. While her body gradually failed, her spirit continued to be effervescent, glowing and kind.  She died on October 28, 1996, at thirty-nine years of age.  I’ll never forget her.

In my upcoming book, The Pit: Memoir of an Emergency Physician, I will go into great detail about my thoughts on the field of emergency medicine, its inherent issues, and my feelings as my career gradually comes to a close.  But the primary purpose of this post is not to share my revelations, but rather, to take a walk down memory lane and express my deepest appreciation to  those health care professionals with whom I have worked, not only in the beginning, but also those throughout my career. These include doctors, nurses, paramedics, EMTs, physician associates, respiratory therapists, and x-ray and ultrasound technicians.  Over the years, as part of our job, we have all witnessed and shared in an enormous amount of suffering, mostly in our patients, but also in ourselves as we struggled with the trauma of what we have seen and experienced. From the bottom of my heart: Thank you, everyone!  The personal sacrifices you have made to help others are far greater than the general public could ever know.

So, in response to the quote at the beginning of this blog, how has emergency medicine affected me?  What have I become?  While it’s often hard to examine oneself dispassionately, when I look deeply at my start in emergency medicine, and compare that person to what I am now, I smile. Not only have my clinical skills improved, I am much more mellow and easygoing, and certainly more accepting.  That said, I still have a bit of an edge, something every good emergency physician wears like a badge of honor.  Since I began my practice, I couldn’t be more grateful, not only for what my career has done for me, but also for those who have allowed me to serve as their physician.

Would I do it all again?

Undoubtedly.