The Leader of the Band

Jerry M. Lavender

The leader of the band is tired and his eyes are growing old
But his blood runs through my instrument and his song is in my soul
My life has been a poor attempt to imitate the man
I’m just a living legacy to the leader of the band

– Dan Fogelberg

In the spring of 1994, I first met Jerry Lavender.  At that difficult time, I was still battered and bruised from a painful divorce that had occurred in the latter part of ’92, and I was in the process of rediscovering myself.  Who am I?  What am I?  Why do I hurt so much?  Intensely introspective, I sought out anything that might make me feel semi-human again, and in the midst of my search, I recalled how much joy I had previously experienced with singing.  I was raised in the Methodist church, and I had sung in the choir from grade school through the summers of my college days.

Several moments stood out to me.  I was but a young boy when my church choir director asked me to sing a solo.  Not one that enjoyed standing up in front of others, at first I resisted, but eventually I came around to her way of thinking.  For some reason, God knows why, I chose not to say a word to my parents and a few weeks later, I stood up in my light blue choir robe and sang “In the Garden” at the Sunday morning church service.  I still remember the shocked looks on my parents’ faces, and how my mother wept throughout the performance.  Another fond memory occurred some years later, when I sang in the adult church choir.  One of my buds in the group was Richard Moody, a white-haired senior who enjoyed singing and laughing at least as much as I did.  A song we particularly liked was the Christian classic, “‘Tis Marvelous and Wonderful,” and one day Richard was over at my home doing handyman work in the garage, and we decided to seize the opportunity.  As I sang tenor, Richard sang bass, and we cut loose with a rousing two-part version of that joyous melody.  After a few stanzas, though, we heard howling, much like that of a wounded, rabid dog, and we discovered my brother Jim had been listening outside and had concluded that he couldn’t take our less-than-melodious rendition anymore.

With this history in mind, I decided to check around and see if I could find a community chorus, and, to my delight, I discovered the Edmond Community Chorale (ECC), a group that met weekly at the campus of the University of Central Oklahoma.  Fighting back my apprehension, I decided to give it a try.

∞∞∞

I’ll never forget the first time I walked into choir practice.  Around fifty to sixty people were in the room, some standing, some sitting as they chatted before the rehearsal began. At the front stood the director, Dr. Lon Dehnert, who warmly greeted me and introduced me to the pianist, Dr. Ron Wallace.  Then Dr. Dehnert led me to the tenor section, where I first met Jerry, a pleasant, balding man in his early sixties with a bright smile and  good-natured way about him.  I liked him immediately, and after a few moments of conversation, the choir began our warm ups and shortly afterward, we were given our music for the semester, the glorious Handel’s Messiah.

And so began our twenty-four year friendship.  Every Tuesday night, during the spring and fall school semesters, we would  meet, converse, and sing our hearts out, with Jerry always seated to my left.  The more I sang with him, the more I realized what a fine tenor he was.  Without fail, he would hit the pitches and rhythms perfectly, and he rarely missed an entrance.  When I was uncertain about how our tenor part went, all I had to do was listen to Jerry, and I was always on solid ground.

∞∞∞

Oh, what glorious music we sang over the years!  Besides Messiah, my personal favorites included Haydn’s Creation, Mozart’s Requiem, Vivaldi’s Gloria and Brahms’ A German Requiem.  With time, my musical skills gradually improved, and my friendship with Jerry deepened. On occasion, he would ask me to join him for a duet at his church, Olivet Baptist, in northwest Oklahoma City.  After a practice or two, we would do a song for his Sunday school class, and while our performances were always well received,  the clear favorite over the years was the bouncy, toe-tapping spiritual by Aaron Copland, “Ching a Ring Chaw.”

Around four years ago, Jerry left ECC, saying that he needed to care for his wife, who had been chronically ill for years.  While I understood his situation, I felt as if my heart had been ripped from my chest, after all, I had heard his voice in my left ear for over two decades.  Last year, when one of our fellow ECC members passed away, Jerry rejoined the choir for a musical tribute at her funeral.  How wonderful it was to be with him again, but little did I know that precious occasion would be the last time I would see him.  My dear friend, Jerry Melvin Lavender, died on February 20, 2018, at eighty-five years of age.

∞∞∞

Now, as I think about Jerry, many warm thoughts come to mind.  While he was a great tenor, he was a better friend.  The Dalai Lama once said, “My religion is kindness,” and Jerry was one of the kindest men I have ever known. Over all those years, I never heard him say a bad word about anyone.  Not only that, in spite of his conservative religious outlook, Jerry often told me how much he enjoyed the spiritually liberal books I had authored. Because he was my friend, not only did he tolerate my perspective, he embraced it, which was a great gift to me.

The world will not be the same without Jerry Lavender.  Once I heard of his death, my eyes welled with tears, yet after a short period of intense grieving, I came to realize how grateful I was that I knew him.  I have no doubt whatsoever that my years spent singing with him helped me to eventually heal from my wounds, and for that, I will forever be indebted to him. Besides, Jerry was a man who loved singing nearly as much as he loved life, so when he left the Chorale to provide for his wife, he made a great personal sacrifice. But that’s the way Jerry was; he always put others before himself.

I oftentimes said that Jerry was the spiritual leader of the tenor section, and no doubt he was also a leader in our ECC “band.” Today, much of what I am musically can be attributed to him, and I am honored to be part of Jerry’s living legacy.

Isaac Newton once said, “If I have seen further than others, it is by standing upon the shoulders of giants.”  Jerry was one such giant, a man whose greatness was measured by living in a humble, giving, accepting and loving manner.

I will miss him greatly.

The Chocolate Chip Cookie

“Think what a better world it would be if we all, the whole world, had cookies and milk about three o’clock every afternoon and then lay down on our blankets for a nap.”

– Barbara Jordan

No one in the world bakes better chocolate chip cookies than my wife, Sheridan.  No one.  I realize this sounds a bit grandiose, but as the crusty Western actor Walter Brennan used to say in his distinctive manner, “No brag, just fact.” Not only does Sheridan prepare them with the skill of a French pastry chef, at the same time, she infuses her bakery creations with her own special ingredient – love. Not only is the taste fabulous, but also I feel better, inside and out, after sampling them. They’re that good.

Just recently, when I was slugging it out in the emergency department, I received an email from Sheridan informing me that she had prepared a batch.  Any difficulties I was having at the time vaporized into the ethers, because no matter how bad the emergency chaos was – and, as might be expected, it was far worse than bad – in a few short hours I would be experiencing the nirvanic ecstasy of biting into one of her delectable cookies.

When I arrived home that evening, I quickly raced over to the plate of cookies waiting for me on the counter top and gobbled one down.  Amazing! The next morning, as I was preparing to go to the gym for a workout, I grabbed two more and hurriedly chewed and swallowed them as I rushed out the door. Incredible!

Later that same day, though, as I thought about it, I realized that while I had enjoyed the cookies immensely, I had to confess that I had been focusing on other matters while eating them.  I was reminded of the words of my spiritual mentor, the Zen Buddhist master, Thich Nhat Hanh, who once said, “Mindful eating means simply eating or drinking while being aware of each bite or sip.”

When I understood I was not attentively savoring these delicious cookies, I decided to give my full awareness to this sacred, gustatory experience.  First, I picked one up, turned it in my hand and gazed at it. The cookie was light-brown and crispy, sprinkled with chocolate chips and loads of pecans. As I took my first bite and slowly chewed, I breathed in and out and began to think deeply about what the cookie truly consisted of.  First of all, the pecans were native to Oklahoma,  arguably the best in the world, and they were carefully cultivated near the small Oklahoma community of Earlsboro, a loving present from my father, who always gifted bags of them to us at Christmas.  The cocoa and vanilla likely originated in rainy, equatorial countries, as they grew well in humid, tropical climates.  The eggs came from cage-free chickens that were organically fed, literally “Happy Eggs” from fowl that roamed the countryside, scratched the ground and ate bugs and worms.  The butter was also organic, free of potentially dangerous chemicals and hormones. Most of the ingredients of Sheridan’s cookies required timely rainwater for their eventual production, and besides that, the sun, along with the fertile earth, were necessary for the healthy growth of the cocoa and pecan trees, vanilla plants, sugar cane and wheat.

So, what does one of Sheridan’s chocolate chip cookies actually contain?  When I take a bite, in addition to the healthy ingredients, I am absorbing the essence of the warm, comforting sun, billowing rain clouds, the nurturing earth, the vigilance and attentiveness of the farmer, the caring of my father, and – of course – the love of my wife. So much more than just a snack. This chocolate chip cookie, like many foods prepared with love and mindfulness, is a gift from God and is as holy and hallowed as a sacramental wafer at the ritual of communion.

I smile in gratitude, as I humbly accept this blessing.

Thank you, Sheridan.

Aging

“Old age comes on suddenly, and not gradually as is thought.”

– Emily Dickinson

Where did the time go?  It seems only yesterday I was a young lad, fishing for crawdads, playing with our family dogs, Snappy and Mandy, scuffling with my brother Jim, incessantly pestering my little sister Connie, eating as much candy as I could get my hands on, and living the good life.  My only responsibilities were taking a daily bath, brushing my teeth, performing my chores, going to school, and keeping in my parents’ good graces.  These were happy times, the proverbial days of wine and roses, and the farthest thing from my mind was growing old.

Then came junior high and high school, with their associated adolescent difficulties, college at Oklahoma State University, medical school, marriage, working in the emergency department, raising three lovely daughters, divorce, and eventually marriage to Sheridan, the love of my life.  At that point, the writing bug bit me, and I feverishly authored five books, three published, with two more waiting in the wings.

One recent, frosty winter morning, though, as I looked at myself in the bathroom mirror, I saw the beginning of jowls, a bald, shiny head, a sprinkling of white hairs in various, odd locations, and more wrinkles than I remembered – lots more. To my dismay, I suddenly realized:  That’s me – I’m sixty-five years old.

In disbelief, I first looked away, then I glanced again at the aged man staring at me from the mirror. Seemingly overnight, I had morphed from a sprightly, pink-cheeked, innocent youth into a moldering senior citizen.

As much as I hate to admit it, the sad truth is that now I am on Medicare and a lifetime, no-way-out member of the Geritol Generation. How could anyone in their right mind describe these times of inexorable decline as the “Golden Years?”  If I had to take a guess, I might suppose that some out-of-work psychologist thought up this crazy notion while in a drug-induced stupor, just to make us feel better about our situation when we age.

So, now that I’m approaching the sunset of my life, what am I to do?  How do I stay away from eventually living at the Withering Heights nursing home and becoming miserable as I get old and decrepit?  Should I accept my fate as immutable?

As I asked these questions of myself, I thought back to my colleague and friend, Doctor Andrew Weil, who once said that the overall goal of aging was not to stop or reverse the aging process, aspirations simply not attainable, but rather, to achieve what some have called “compression of morbidity.”  In other words, by following a healthy lifestyle, the elderly can have a long and vigorous life, yet when death approaches, a rapid decline occurs, which is far better than lingering in misery.  So, in expectation of achieving “compression of morbidity,” as an integrative physician, here are my recommendations to those ensconced in their senior years:

1. Stay active. Those who become sedentary have a tendency to stay that way.

2. Watch television in moderation.  I used to drive for Mobile Meals and delivered food to the aged and infirm.  I was astounded at how many were watching TV when I knocked on their front door. Too much television is mind-numbing and not conducive to a healthy brain.

3. Eat well.  Diets rich in fresh fruits and vegetables are important, and should be combined with a rich source of omega-3 fatty acids, such as wild-caught salmon. Enjoy whole grain products, avoid fried foods, and limit the intake of refined sugar, red meat and white flour.  By all means, though, at least occasionally live on the wild side and enjoy a rich, totally unhealthy meal. More importantly, don’t feel bad about it.

4. Maintain social connections.  To love and be loved is meaningful at any age, but this is especially true in the older population.

5.  Always have something to look forward to, such as travel, trying a new restaurant, or even attending the weekly bingo game.

6.  Keep your mind active.  Crossword puzzles, Sudoku, and any hobby you enjoy are avenues to keep the mind sharp. As the old saying goes, “If you don’t use it, you lose it.”

7.  Avoid polypharmacy.  You’d be amazed at the cornucopia of medications that elderly patients are prescribed by well-intended physicians.  Remember, every medication has side effects and drug interactions of some kind.  Multiply that by an increasing number of different prescriptions, and you’ve got a potential disaster on your hands.

8.  Consider volunteer work.  It’s important to believe that one still has a purpose in life.

As I have pondered the aging process, the more I have come to realize that with a little time, effort and persistence, the “Golden Years” can be just that.  Granted, aging has it’s issues, but what about the positives?  One usually has more free time to do what one wants, rather than being constrained by parenting children, a busy work schedule or limited vacation time.  More moments are available to spend with loved ones, and retirement can be a time of mellowness and reflection, a chance to learn, grow, and heal from the wounds of earlier years. Besides all that, growing old is an opportunity to deepen one’s relationship with God, whether through spiritual texts, meditation, service to others – wherever your soul leads you.

Someday, as much as I’d like to believe otherwise, I will die.  Granted, at least part of what takes place before that point is beyond my control, but I plan to follow my own advice and do all that I can to have a lifestyle that limits my eventual suffering and disability. After all, I’ve got a number of destinations yet to explore and many more books to write.

Something to look forward to?

Always.

Love Never Dies

                                                                                                          

 

My mother’s death on August 12, 2016, followed years of suffering, mostly due to the arthritic discomfort of polymyalgia rheumatica, an inflammatory disease that caused her to have horrific, ongoing muscular pain. This devastating illness was complicated by multiple falls with subsequent fractures of her pelvis and ankle, and pain management only afforded her some modicum of relief.  For me and the rest of the family, to witness the persistent misery she endured was agonizing beyond words.

As her health continued to deteriorate, we did all we could to let her know we loved her. As mentioned in my previous blog post, we discovered that singing old church songs gave her comfort, such as Amazing Grace, It is Well with My Soul, The Old Rugged Cross, How Great Thou Art, among other Christian classics.  Oftentimes, we would sing songs that she requested, but as she gradually became unresponsive, we sang ones we knew she treasured.  On occasion, we would detect a smile on her face, but, towards the end, she gave no indication whatsoever that she heard anything.  Only hours before Mom died, my sister Connie and I belted out a number of these melodies as we sat at her bedside. Such was our way of communicating with our dear mother, and we both believed that somehow she heard these heartfelt renditions.

The funeral service in the days that followed was well attended and lovely, though I knew the healing process would take a long time. I’m not sure, however, that anyone fully recovers from the death of a parent.  I suffered mightily in the beginning, realizing that my world was now topsy-turvy and had been forever changed.  But, with the healing power of time, I learned to live with the vacuum created by my mother’s death, and life went on, simply because I had no other choice. Feeling a personal need to stay in touch, I made it a habit to occasionally talk with Mom and repeatedly tell her how much I loved her.  While I never heard a response to these seemingly one-sided conversations, little did I know that one day the inexplicable would happen, and she would finally answer me in a way that still leaves me shaking my head in amazement.

∞∞∞

Over a year after mom’s death, I was upstairs in my home office when I heard music coming from below.  Knowing my wife Sheridan was outside warming herself in front of our chiminea, I wandered downstairs to see what was up.  Much to my surprise, the television was on and playing old Christian music.  My eyes welled with tears as I first heard The Old Rugged Cross, followed by It is Well with My Soul, and finally, Amazing Grace. My mother loved all of these tunes, and while I had no idea how Sheridan did it, I was certain that she had somehow programmed the television to broadcast them. I was deeply touched, and when Sheridan came in from outside, I thanked her for setting up the television in that way.  She looked confused at my words and said, “I didn’t do anything.”

“What?” I questioned, surprised.

“Gary,” she compassionately repeated, seeing the baffled look on my face, “I didn’t do anything.  When I went outside, the TV was off.  I never turned it on.”

“But . . . how?” I asked.

“I don’t know,” she added, shrugging her shoulders.

I felt the blood drain from my face, and I stared at her in stupefaction.

This can’t be, I thought.

I was so stunned by this surreal event that I couldn’t bring myself to tell anyone.  How do I explain the impossible?  After all, somehow the television, along with the cable box and pre-amp, came on spontaneously, and besides that, the songs that sequentially played when I happened to arrive at the foot of the stairs were three of my mother’s favorites.

Being a scientist at heart, I felt this had to be a random, serendipitous cosmic event, following the known rules of the Universe.  But what would be the odds of such a happening without some kind of direction?  While putting an exact number on the likelihood of this event occurring fortuitously would be impossible, certainly it was infinitesimally small.

Over the weeks to come, I finally shared this story with my sister, my father, and one of my friends, feeling overwhelmed by the implausibility of this occurrence. I was reluctant to tell others, concerned that they might believe I had finally gone off the deep end, traipsing into the world of insanity, wanting so badly to communicate with my mother that my mind placed tricks on me.  With time and the chance to think deeply about this episode, though, with no small amount of trepidation, I finally decided to share this remarkable story.

∞∞∞

Now, I am reminded of the words of Zen Master Thich Nhat Hanh, who once said, “No birth, no death, only transformation.”  In other words, we have always been and always will be, and birth and death are simply events of transition as we move in and out of manifestation on this Earth.  So, with this in mind, I must ask and answer the following questions:

Does my mother still exist?

Unequivocally, yes.

With death, has the love disappeared that my mother and I shared?

Of course not.

Is death a barrier to communication with those we love?

Yes.

Is it possible for this barrier to be breached?

Yes.  After my experience, how could I answer otherwise?

After much consideration, I have come to the unavoidable conclusion that my mother whispered to me from beyond the grave, albeit in a most unique way.  She let me know not only how much she enjoyed hearing these songs in her dying moments, but also that she lives on, and I am most grateful to have both of these understandings confirmed.

So, thank you, Mom, for reaching out to me.  May your story give a measure of comfort to those who have doubt that their loved ones continue to exist.  I am, and always will be, your son, even though we are separated by the chasm of death.

And that’s a wonderful feeling.

I love you, Mom.

Healing Melodies

When peace like a river, attendeth my way,
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.

The Son I Never Knew

Sometimes, I wonder

What my son would look like now

If he had survived

The devastating tragedy of February 12, 1979

The day of his childbirth

The day he died

Sometimes, flashes cross my mind from that fateful time

Moments magnified, agonizing, gut-wrenching

Ones that take my breath away

Yet, in the midst of the chaos

I see his newborn face

He is so beautiful

Sometimes, I miss the moments we should have had together

Changing his diapers

Watching him take his first steps

Wiping his tears

Seeing him off to school

Little joys, never shared

Time heals all wounds – or so they say . . .

Yet, year after year, on Memorial Day

I tearfully stand before his lonely grave

And gaze down at the cold, rose granite marker

I look at his name etched upon it

Aware that dusty, cremated remains lie below

Remnants of a baby that once lived and breathed

My baby . . .

I feel an odd mixture of sadness, anger and remorse

And I wonder what might have been

I breathe deeply, in and out, and I try to understand

And yet . . . I never do

Texting

While you were texting,

you never saw the smile on your loved one’s face,

the twinkle in her eyes,

her arms as she reached out to you,

or heard her caring words.

While you were texting,

precious moments passed by,

ones that could have been shared with others,

ones that could have been filled with meaning.

Instead, you chose to focus your attention on a device,

picking out letters on a sterile, unfeeling keyboard,

ignoring the world around you,

a world that begs you to embrace it,

in all its beauty and complexity.

The glories of technology

can never replace the sparkle of a dewdrop,

the luminous corona of the sun,

the hummingbird as it darts about,

the juicy taste of a ripened peach,

or the smell of freshly-turned earth.

There is an opposite to mindfulness,

and that is:

Texting

Someday

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Someday, I may be cold.

But now, I have warm clothes and a comfortable home.

Someday, my vision may blur.

But now, I see the azure blue of the sky, blades of lush green grass and the soft glow of the morning sun.

Someday, I may be hungry.

But now, I enjoy the taste of good food and the feeling of a full stomach.

Someday, I may lose my sense of smell.

But now, I delight in the aroma of flowers and the fresh scent of air after a rain.

Someday, I may be alone.

But now, I treasure the softness of my wife’s body as we sleep together.

Someday, my hearing may leave me.

But now, I listen to the twitter of birds dancing outside my window.

Someday, the pets I love will no longer be at my side.

But now, I value rubbing their furry heads and seeing the love in their eyes.

Someday, my health will fail.

But now, I appreciate my wellness.

Someday, those I love will die.

But now, I hold each second with them as sacred.

Someday, no one of this earth will be aware that I existed.

But now, many know me.

Someday, when I die, I will leave everything of the Earth behind.

But now, I embrace my life.

In the present moment, someday does not exist.

Only the here and now.

And for that, I am grateful.

An Ocean of Wildflowers

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One might guess, after sixty-four years of life, that I would know when I needed to go to the wilderness to experience her healing caress. But older is not necessarily wiser . . .

The turmoil started around two weeks ago, when I noticed that I was getting grumpy and argumentative.  Besides that, events that would not normally have affected me became blown out of proportion and assumed an exaggerated sense of importance. As my fuse became shorter, the pressure inside me ratcheted up, and I felt like a time bomb waiting to explode.  In all fairness, I had recently been working more emergency department shifts than usual, and the difficulty of the patients had been extraordinarily high. Life and death decisions are never easy, and when I came home on such days, I was tired, irritable and depleted.

After waiting far too long, I finally realized I was at my wit’s end, and decided I needed to get away to the wilderness. Knowing I had the day free, I packed my trusty backpack, hopped in my 2004 Honda CR-V and headed for the Wichitas, a hiking Mecca in southwest Oklahoma, an area that oozed with the energy of the Native American.  I took the hour and a half drive in silence and focused on the road, while letting my consciousness randomly move in whatever direction needed.  I breathed deep, in and out, saying a silent prayer that I might find peace and healing.

When I drove into the Wichitas, I was delighted to discover that recent rainfalls had sprung the usually dry mountains to life, and they were green, verdant, and full of expectant energy.  After parking, I trekked through the rocky entrance of the Charon’s Garden Wilderness, and I began to time my breathing with my measured steps.  A short time later, I added my favorite mantra, given by the Zen Buddhist monk, Thich Nhat Hanh, repeating silently with my in- and out breaths, calming, smiling, present moment, wonderful moment.  Farther down the trail, I stopped my internal chanting and began softly singing “My Sweet Lord,” by George Harrison, and later I switched to the old Christian classic, “Nearer, My God to Thee.” I felt my consciousness expanding, and as I topped the plateau that led to Crab Eyes, a pair of boulders that rests on top of a nearby mountain, I was blessed by the grandeur of an ocean of beautiful wildflowers.  I caught my breath as blossoms of many varied colors, mostly yellows and reds, smiled at me.  It was as if they were saying: Troubled? Weary?  Stay here and linger with us, and you will find comfort. As I gazed at their magnificence, I was reminded of the words of Jesus, “Consider the lilies of the field, how they grow; they toil not, neither do they spin: yet I say unto you, that even Solomon in all his glory was not arrayed like one of these.” Indeed . . .

I walked across the grassy plateau, and, after hiking a bit longer, chose a rocky outcrop hidden away from the trail, a place where I had a panoramic view of Crab Eyes. I fondly looked up at the formation, and, in my way of thinking, they represented the caring, comforting eyes of God, always aware of me and what I was going through, whatever the situation. I felt reassured and closed my eyes. Once again, I focused on my breath, and I quietly listened inside and let the soothing peace of the wilderness flow into me. With time, I roused from my meditation, feeling refreshed and released from a good part of the heaviness that had previously pressed down on me. With Crab Eyes benevolently looking down at me, I opened my backpack and enjoyed a wilderness meal of a mandarin orange, native Oklahoma pecans, chocolate and a granola bar.  Once again, all felt right with the world. I sighed in contentment.

Lunch finished, I stood, shouldered my backpack and trekked back down the path toward the trailhead.  Once again, I experienced the beaming, joyful faces of the delicate, colorful wildflowers, and I wondered why I had waited so long to experience the healing of the wilderness.  As I considered that thought, I realized that a healthy diet, exercise, and a regular meditation practice are simply not enough to sustain me through the trials and tribulations of working in the emergency department.  Every so often, no matter how sound my physical, emotional, mental and spiritual practices, I need the benevolent nurturing of Mother Nature.

Next time, I promise that I will go to the wilderness before the situation gets out of hand.  And maybe, just maybe, my wildflower friends will again be there to greet me.

A Good Man

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An emergency department is a stress pit, a lake of exhaustion washing over all who work there.  The demanding environment smothers physicians, nurses, paramedics, EMTs, and anyone else who dares enter the battle zone in the war to save lives.  For over thirty-eight years, I have worked as an emergency physician.  I know the terms of engagement.

For physicians, in particular, one of our most difficult duties comes with informing family members that their loved one has died.  How I wish the Grim Reaper, with his frightening black robe and scythe, was a less familiar figure in emergency medicine, but he’s not. He’s always lurking in dark, secluded corners, hoping to collect his prey, and to his delight, the targets continue to arrive.  Hardly a week goes by that I don’t see a patient who presents in cardiac arrest and dies, despite our efforts.

Some families, recognizing the deteriorating condition of their loved ones, prepare for death by having DNR (Do Not Resuscitate) papers signed, and perhaps have arranged Hospice care. With these measures in place, the terminally ill one is given the chance to die peacefully at home.

But sometimes there are those, in seemingly good health, whose heart unexpectedly stops, and they come to me strapped to a stretcher in the back of a speeding, careening ambulance with lights flashing and sirens blaring.  Soon afterward, terrified family members show up at the emergency department, clinging to the hope that somehow, someway, their loved one was pulled from the bank of the River Styx, back into the land of the living.

I understand why families cling to such belief. Nearly every medical show on television has amazingly high resuscitation rates, which creates the expectation that health and recovery wait in the emergency department. The assumption leaves the physician with a difficult problem in explaining emergency death to families who do not realize that, in the real world, in spite of our technological advances, the overall chance of survival after cardiac arrest is abysmally low.

In reflection, I admit that, as medical students, we were never given a course on how to tell family members about the death of their beloved one.  Rather, by observing our attending and resident physicians, we formulated our own way of handling this most challenging task.  Perhaps, in this day and age, with medical humanism coming more and more to the forefront, this important skill is taught.

As an emergency physician, when someone dies, I do the very best I can to inform families of their loved one’s death in a caring and professional manner.  In spite of my years of experience in performing this demanding task, it has not become easier, and I don’t expect it to.

When a patient has passed away, usually, the process goes something like this.  Shortly after I have pronounced the patient dead, I enter the family room with the deceased’s chart in hand and introduce myself.  After sitting down and facing the family, I don’t delay in telling the bad news.  People don’t want to hear a long, drawn-out story before I announce the dreaded truth.  As quickly and gently as possible, I let them know their loved one has died. After they’ve had some moments to grieve, I ask to hear the story of the events surrounding the death so I can tell their family doctor, and later the medical examiner, the details of what happened. Empathy and expression of my sorrow for their loss are important to provide, for at this critical moment they are likely as vulnerable as they have ever been; the world they live in has been changed forever.

Most of the time, the members of the family are too stunned to have much to say, but on one particular occasion, I remember a very different ending to the conversation, one that will be forever imprinted in my mind.

 

One chilly winter day, I was scurrying around the emergency department, trying to keep up with crowds of sick people, when one of the nurses approached me, scratching some notes on a yellow pad.

“Doctor Conrad, the ambulance is bringing in a seventy-eight year old male in cardiac arrest. Their ETA is ten minutes.”

“Was it witnessed?” I asked, knowing that those who are by themselves when their heart stops—and don’t receive immediate CPR—are very unlikely to be resuscitated.

“No. He was last seen two hours before.”

“What was his initial rhythm?”

“Asystole.”

No heartbeat at all.  Not good, I thought.

“What is it now?”

“Still asystole.”

“How long have they been working the patient?”

“Thirty minutes.”

I shook my head, thinking: This patient doesn’t have a prayer, but we’ll do what we can. 

Promptly ten minutes later, I was waiting in the Code Room with several emergency nurses, when I heard the sound of an opening door and smelled the exhaust of an ambulance.  In seconds, the paramedic and EMT hurriedly rolled the patient into the room, IVs hanging from both arms. A fireman was performing chest compressions on him, while another was giving oxygen by ventilating him through an endotracheal tube, a hollow plastic tube the paramedic had placed in the patient’s airway.

They moved the patient from their stretcher to ours, where I performed a quick examination while CPR was in progress. The patient looked older than seventy-eight.  Must have been sick for a while, I thought. My initial inspection revealed his pupils were fixed and dilated. No cardiac sounds. No voluntary respirations. Good breath sounds with bagging. Abdomen mildly distended.

I asked the paramedic, “Update me.”

Her shirt was soaked in sweat as she quickly and concisely spoke. “Mr. Evans has a long history of hypertension, non-insulin dependent diabetes mellitus and had a coronary artery bypass graft some years ago. He’s on multiple cardiac meds. You’ve heard the report I gave to the nurse?”

“Yes.”

She added, “He’s still in asystole.”

“How long has he been down?” I asked.

“About fifty minutes have passed since the call.  Who knows how long he’s actually been in arrest, though.  We’ve been working him for around forty minutes.”

“Meds?”

“Seven rounds of epinephrine, two amps of bicarb.”

“When was his last does of epi?”

“Three minutes ago.”

By then, the nurses had transferred the emergency department cardiac monitor to the patient.

“Stop compressions,” I said to the fireman.

When he paused, I felt for a pulse and looked carefully at the rhythm on the monitor.  No pulse.

Flatline.

I directed, “Confirm asystole in two leads and check for a pulse with a Doppler.”

The results were as I expected; asystole was verified on the monitor, and no pulse was heard with the sensitive Doppler probe.

He’s dead, I thought. I wish there was something more I could do for him, but there’s not.

I grimly told those in attendance, “This patient is DOA. Time pronounced is 1330. Let me know when the family arrives. Good job, everyone.”

 

Minutes later, as I worked on his chart, one of the nurses walked up and said, “The wife of the patient in the Code Room is here. She’s in the family room.”

“Anyone with her?” I asked.

“No.”

I felt sad that the wife had to deal with the death of her husband by herself, yet I grabbed the chart and fought my way down the cold, institutional hall through a thick barrier of questions, screams and unpleasant odors.  I knocked on the door of the family room, entered and discovered a slender, gray-haired woman who appeared to be in her mid seventies.

“I’m Doctor Gary Conrad,” I said. “Are you Mrs. Evans?”

She nodded.

I pulled up a chair and sat in front of her.  “I have some bad news for you.  Your husband has passed away. He’s dead.”

Her eyes filled with tears. “I knew he was gone,” she said softly.

I took a deep breath and asked, “What happened?”

“Charlie had not been in the best of health,” she explained. “He went to the bedroom to take a nap this morning because he wasn’t feeling well. When I went to check on him, he didn’t respond and wasn’t breathing.”  She repressed a soft sob and put her hand to her mouth. She took a few moments to regain her composure before she continued, “I then called 911 and did CPR, but I felt sure I had lost him.”

“I’m so sorry,” I sympathetically said. “I’ve already talked to the paramedic, and with Mr. Evan’s past medical history, I’m certain his death will be confirmed as natural by the medical examiner. Once that’s done, we’ll take out all the tubes and you can see your husband.  Do you have any other family coming in?”

“Yes, I do, but I want to see him as soon as possible.  I don’t care if the tubes are removed.”

“I understand. Once we’ve finished speaking, his nurse will come for you and lead you back to his room.”  I stood to leave and asked, “Is there anything else I can do for you?”

“Yes, Doctor Conrad, let me tell you about my husband.”

Surprised, I sat back down.

She smiled through the tears. “Many years ago, when I was a young woman, my first husband died and left me with three small children. Then I met Charlie Evans, my second husband-to-be, and we fell in love.  And you know what he did?”

“No.”

Tears now streamed freely down her cheeks and her voice began to break. “After we were married, he adopted my children . . . and raised them as his own.  He was a wonderful father . . . and a good man. I will miss him terribly.”

I felt my face begin to flush, and my eyes welled with tears.

She looked at me with probing brown eyes and whispered, “I thought you should know that.”

“I’m glad you told me . . . thank you.” I stood and gently squeezed her shoulder. “His nurse will be with you shortly.”

I left the room and walked back to my desk, grabbing some tissue to wipe away the tears. As I thought about what just happened, I realized that in emergency medicine we have a tendency to dehumanize our patients, for if we know them as fathers, mothers, grandfathers, grandmothers or any role in life where they loved and loved deeply, then it’s just too painful.

Mr. Evans was more than just a body—one we tried to revive that day.

He was a good man.