“In contrast, I maintain that those who are most spiritual instead manifest a ‘full spectrum personality.’ In other words, these persons are completely capable of expressing themselves in all ways, even though the emotions may not be ones considered to be typically ‘spiritual.’”
From “The Pit: Memoir of an Emergency Physician”
I have tried to the best of my ability to have a positive attitude about the coronavirus pandemic. As most of you know, by nature I am an optimist. Today, though, I found myself unsettled about this cataclysmic virus for a number of reasons. First of all, I am saddened by all of the deaths and suffering we have experienced. To date, the coronavirus has infected almost four million worldwide and killed over 275,000, with many more to come. I find myself furious that our ineffective, inept leadership in America has allowed this situation to become far worse than it should have been. I am troubled by the pain inflicted on my brothers and sisters in healthcare, a number who have died from the disease trying to save the lives of others, while many more have been emotionally scarred as they watched the tragedy unfold before them. Who could not mourn the resultant devastation of our economy and those desperate folks who are scrambling just to get by?
On a more personal level, it breaks my heart that I am unable to safely spend as much time as I would like with my soon-to-be ninety-one-year-old father. As an emergency physician, I am far more likely to be a carrier of Covid-19 than the average person, and since testing is not readily available for me – or anyone else for that matter – my visits with him have to be limited and take place carefully. I went to his home today for the first time in a while, and I found myself feeling proud of Dad’s resiliency and ability to care for himself. He is a tough old man, and I hope that I have inherited at least part of his stamina. Still, I look forward to the day when I can spend more quality moments with him, and I pray to God that time doesn’t come too late.
Someday, I hope we have an effective vaccine, and our world will experience a bright new beginning, a renaissance of sorts as we move out of the darkness of this challenging conundrum. While I greatly anticipate the joy that will accompany that time, in the present moment:
“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.
My wife Sheridan and I have been together for thirteen years and have been married for over ten. Over the years, I have talked with her off and on about going to Utah for a hiking adventure. I had previously been to the Beehive State a handful of times to various trekking locations, including Zion and Bryce Canyon, but nowhere compared with wildness and intrigue of Canyonlands National Park in the environs of Moab, situated in the northeast part of the state. Yet, something always seemed to get in the way of what I wanted so desperately, though I must confess that this was not because of any resistance from Sheridan, rather, due to an overwhelming desire to put my inspirations on paper. Five books later, associated with numerous overseas excursions for research, at long last there was a gap in my schedule. No more delays or diversions, it was time to go to Utah.
The first few days Sheridan and I shared in Moab were magical beyond description. After a strenuous, breathtaking hike to Delicate Arch in Arches National Park, the following day we hiked the little-known, but beautiful, Moonflower Canyon, discovering petroglyphs at the entrance and a small, reflective pond deep in the canyon, where we sat in meditation. Later that same day, we drove to the Island in the Sky, a mesa which rests on sheer sandstone cliffs over one-thousand feet above the surrounding terrain. There, we had unforgettable views of the lower canyons at Mesa Arch and Grand View Point.
The plan for the following day was to hike the Chesler Park and Joint Trails in the scenic Needles district of Canyonlands, a vigorous ten mile trek far away from the beaten path. But, while on the road, Sheridan read about a hiking trail in the far northwest part of Canyonlands, a place called Horseshoe Canyon, one that comparatively made the Needles area look as busy as Manhattan during rush hour. Yes, it was that isolated, but on the flip side, the place contained some of the finest rock art in North America. While the location was challenging to get to – a two and a half hour drive from Moab – the eventual reward was a chance to cast our eyes upon the Great Gallery, a panel of pictographs that included ornate life-sized figures, created sometime between 1 AD to 1100 AD. It was an easy call, we had to see it, no matter the difficulty. Little did we know at the time what we were getting ourselves into.
The next morning, after a hearty breakfast at the B & B, the Red Moon Lodge, we set out on our great adventure. We traveled a circuitous route which led us north to I-70, west to highway 24, and then south for twenty-nine miles to a dirt road that led us back east thirty-two miles to Horseshoe Canyon. As the driver, the back-country road was frightening. In many places it was rutted, with patches of sand, rock shards and washboarding that occasionally caused our two-wheel drive car to lose traction and unsteadily swerve. Assuming we achieved our destination, I also knew that we would likely be returning at night, and I couldn’t imagine how much more challenging this route would be when I was unable to read the detail of the road accurately.
I’m happy to report that after about an hour of nerve-wracking driving, we arrived at the trailhead of Horseshoe Canyon, eager to experience the trail and what it offered. After hiking down the gradual incline for about fifteen minutes, the unforeseen occurred: the soles of both of my aged hiking books began coming apart. I offered to try and continue as they were, but Sheridan advised that I return to the car and replace them with my hiking shoes, and I agreed. As quickly as possible, I retraced my steps back up to the car, where I changed into my shoes and came back down to meet her, patiently waiting alongside the path. Valuable time was lost, though, and we did not want to be on the trail after sunset. We pressed on.
And what a beautiful trail it was! The slabs of grey rock comprising the pathway gently wound down for a while, then steeply switchbacked to the canyon floor. In the canyon itself, beautiful brown sandstone walls and green and yellow cottonwood groves greeted us, and the stark, visceral beauty of the area was breathtaking. While the seven mile round-trip trail was flat at that point, much of the hiking was through deep sand, and I felt like I was slogging through mud. The trekking was exhausting, and after seeing two beautiful panels of pictographs, we stopped to have lunch on the trail, exhausted, but satisfied with what we had seen.
Shortly thereafter, a young, dark-haired hiker wearing a baseball cap and a friendly smile approached us from the opposite direction. He informed us that he had seen two more panels of rock art, one being about ten minutes away, and the last, the Great Gallery, was around forty minutes further up the canyon. After sharing our chocolate with him, he headed towards the trailhead, and in spite of our fatigue, our inner fires had been lit – we had to go on.
After over an hour of trudging along the sandy canyon floor, we arrived at the awe-inspiring Great Gallery. Seeing these images painted so long ago was captivating, and we lingered there, sensing the presence of spirit. We sat in meditation, connecting with an ancient energy that cannot be described in words. One thing I was certain of, and that was the place was sacred. While sitting before the images, I wondered: What inspired these artists of so long ago to create this magnificent work? Was their spiritual presence still in that place? How many more years would I be capable of making such a difficult hike?
After chanting ‘Om’ three times and thanking God for allowing us to be in that holy moment, we began the hike back to the trailhead. Deep shadows appeared on the canyon walls, and we knew our time was limited. Sheridan led the way as we slogged through the exhausting sand, battling fatigue with every step. Soon my left big toe began to hurt, and every step was painful. I then realized that my hiking shoes were simply not sturdy enough for such a trek. We kept moving – we had to – we had no choice.
After what seemed an eternity, we reached the place for the steep ascent out of the canyon, and pausing frequently to catch our breath, we slowly worked our way up. After a while, I ran out of water and was grateful that Sheridan still had some to share with me. As much hiking as I had enjoyed in the past, and I’ve done a lot, this was one of the toughest treks I had ever attempted. When we finally sighted our car in the distance, I breathed a sigh of relief, knowing without a doubt we would make it back. Shortly after we reached the trailhead, the sun started to go below the horizon. We had arrived with no time to spare. After what we had been through, driving the dirt road back to the highway would not be a problem. After all, even though we felt beaten and battered, we had somehow survived, and I was glad for that.
Now, as I sit and think about our experience at Horseshoe Canyon, several thoughts come to mind. First, I feel empowered and exhilarated that I was able to reach down inside myself and find the strength to complete this challenging hike, in spite of the many obstacles. Also, I am reminded that most spiritual experiences are accompanied by some sort of pain, whether physical, emotional or mental. I’m glad we made the arduous hike to Horseshoe Canyon, though I doubt we’ll do it again. Other adventures, other expeditions await us, and I’m more than willing to accept the discomfort that accompanies them.
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.
“I’m not sure at what point the red-tailed hawk made the transition from simply being a bird I enjoyed watching to something more, something personal. I began to notice when I was in times of duress — more often than not — they would fly over or in front of me. I had the distinct feeling my hawk friend was there to provide me comfort, to let me know that in spite of how bad the circumstances seemed at that given moment, events were happening just the way they should be.”
– From “Oklahoma Is Where I Live”
I’ve had a lot on my mind lately. Life is never without issues, though certain events of the recent past have been weighing heavily on me. Nothing that was dangerous or life threatening, but rather a collection of unsettling annoyances that I was having a difficult time shaking off. By nature, I am an optimist, but not as of late.
With this background in mind, this morning, as I walked to the front of my home to get the daily paper, I heard a loud screech overhead. Looking upward, I saw a gloriously majestic hawk flying overhead, and close behind was a second, no doubt its mate. In the brief moment that they flew over me, I felt blessed by their presence, and the burden I felt encumbered with became a little less heavy. I breathed in and out, knowing once again that the Universe – God – is very aware of me and my current situation, as She is of all of us.
I have recently discovered that a good number of those visiting my web site are from France! I feel delighted and honored, as Paris is one of my favorite cities in the world. The amazing food, the ambiance of walking the city streets or alongside the Seine, the Louvre, the friendly Parisians, the Eiffel Tower and the Musee d’Orsay, all create feelings of joy, contentment and peace. In honor of my friends from France, I have attached a picture that I took in 2015 while visiting the magnificent city of Paris. To all of you:
“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.
This morning, I awoke feeling grateful: Grateful to be alive and healthy, for the love of my wife and family, for times I still get to spend with my 88-year-old father, for a cozy home, food in my stomach and dear friends. I feel grateful as I watch our dogs Karma and Buddy chase after balls I throw them, for my work as an author and emergency physician, and for the dedicated nurses, paramedics and EMTs with whom I labor. I’m even appreciative of the day-to-day struggles, ones that help me to learn and grow. While some of these blessings may come and go, life itself is a gift from God, and I pray I never forget that.
When sorrows like sea billows roll Whatever my lot, thou hast taught me to say It is well, it is well, with my soul
It is well With my soul It is well, it is well with my soul
– Horatio Spafford
Just recently, while I was laboring in the emergency department, I discovered an old, familiar church song reverberating through my consciousness. Delighted to recall this moving tune, I softly sang “It is Well with My Soul” throughout the shift, somewhat ameliorating the maddening chaos.
This remembrance shouldn’t have come as a surprise, as I was raised in the Methodist Church, and every so often on Wednesday services, the congregation would happily put aside the modern hymnbook and break out the weathered, brown Cokesbury Worship Hymnal. Ah, what glorious music was printed on those venerable pages! Not only was “It is Well with My Soul” among the songs listed, but also “The Old Rugged Cross,” “Nearer, My God to Thee,” “In the Garden,” among many other memorable Christian classics. After years of singing them repeatedly, the words and melodies became indelibly etched in my mind, and, without fail, their rendition bestowed on me a warm, tranquil feeling, connecting me with a heartfelt, sacred time and space.
With this in mind, in the months prior to my mother’s death, knowing how much she loved these precious songs, often I would sing a handful of them to her as she lay in her hospital bed. When she was conscious, I would sing ones that she requested, invariably bringing a smile to her face. But, as death insidiously approached, she gradually became comatose, yet still I would repeatedly sing her favorites at the bedside, tears flowing from my eyes, feeling that somehow, someway, she could hear them. In this way, my mother and I were still able to communicate up to the moment of her death, giving me no small measure of comfort through those challenging times.
So, the next time I feel pressured or out of sorts, for whatever reason, I will try to recall songs of meaning from my past. In spite of the pain of the moment, the discomfort can be soothed and made bearable by healing melodies. Horatio Spafford was right.
No matter the circumstances, it is well with my soul.
Gary D. Conrad
