“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.
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 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.
 
With the recent passing of my mother, at least once a week I take my eighty-seven year old father out for lunch. It’s a warm, happy time, as I get to spend one-on-one moments with him, something that rarely happened when my mother was alive. But times have changed, and while I greatly miss my mother, now is the time to focus on my dad, and I’m glad to spend moments with him, a man I admire more than any other.
Recently, as we were returning to his home after eating, I realized we were passing by my old stomping grounds, the area where I lived from second grade until my graduation from high school in 1970. Eleven years I resided there, and when the time for college came, I left my beloved home in southwest Oklahoma City for Stillwater and the orange and black of Oklahoma State University. As hard as it is to comprehend, over forty-six years have passed since then. Where has the time gone?
Dad was agreeable for a little sashay into the past, much like Michael J. Fox in “Back to the Future,” so we made a right turn into the neighborhood and after driving ten blocks, we arrived at 64th Street. Another right turn and four houses later, our old digs came into view. I was astonished to discover how small the red-brick home appeared. When I was a lad, it seemed much larger. How did our family of five fit into such a tiny place?
When I stepped out of the car to take a picture, shown above, I was flooded with a kaleidoscope of memories, a collection of odd snippets that I couldn’t believe I still remembered. I recalled when the neighbor to our east planted a mimosa tree, which grew into an overshadowing, lurking giant, and how my father and mother hated cleaning up the debris that it shed on our lawn. Through the chain link fence, I could see the infamous storm shelter, mentioned in “Oklahoma Is Where I Live,” the one constructed by my father, with the assistance of my uncle Dale, which leaked an ocean of murky water onto its floor. I remembered when my father planted multicolored ornamental pepper plants in the front flower beds, ones we were just supposed to admire, but we tried to eat them anyway, much to our fiery dismay. And who could forget the time Dad lovingly bought a train set for us, which, when not in use, was kept raised up on pulleys in the garage? I also looked back on the moments my brother and I were coerced into going to my sister Connie’s dance recitals and trying not to squirm in our seats. I recalled the ping pong matches my brother and I used to have, bitter games of high intensity that often led to angry disagreements, and the times my amazingly tolerant parents allowed us to invite our friends over on Friday nights for penny-ante poker, many of us smoking Swisher Sweets Cigars and trying to act like professional gamblers.
Of course, how could I not recall puppies – lots of them. We had two fox terrier mixes, Snappy, the male – my first dog, and Mandy, the female – my brother’s dog – and they produced litter after litter of cute, wiggly puppies. One such litter is seen above, with me to the left of the photo, and my brother, Jim, to the right. Nothing in the known Universe is better than snuggling up to an adorable puppy, one that is bound and determined to lick you in the face.
Dad and I then decided to drive around and check out the old neighborhood. Again, powerful unbidden memories swept through my consciousness, wanting once again to be remembered. Across the street from our home was the residence of Charlie and Michael Babb, neighborhood chums my brother and I wrestled and played games of football and baseball with, occasionally breaking out windows when we were lucky enough to hit long fly balls. My bud Marvin Turner’s home was just around the corner, and a block north was the home of Lisa Forrester, a young lady I had a longstanding, unrequited crush on. We drove past the houses of old friends George Hargraves, Patty Keller, Adena Shepherd, Sarah Thompson, Phil Calame, well, the list goes on and on, all bringing up warm feelings of bygone times.
After I returned Dad back to his home, more recollections flooded my mind, and this process went on for days, pulsing in and out of my awareness. As I basked in their glow, I realized that the feeling of love and connection that bathed and protected me as a young boy continued to surround me, even as an adult. As I look deep inside myself, I realize how important it was that I felt safe, a blessing not every child had. Not that I wasn’t exposed to neighborhood bullies and occasional cringe-worthy moments – I was – but overriding all of this was a feeling of security, love and the opportunity to morph into the person I would become. As the twig is bent . . .
So, thank you, Mom and Dad, for finding a house in such a tightly-knit neighborhood and providing a loving home environment for me to grow up in. You gave me a firm foundation upon which I was able to eventually go to college, become a physician, raise three daughters and, finally, evolve into an author. Also, thank you, all my old friends, wherever you may be, for contributing memories I will cherish forever. And, most of all, thank you, God, for giving me the opportunity to live and breathe, and allowing me to appreciate the simple pleasures in life.
Such as being licked by a tail-wagging puppy.
 My beloved mother has died, and up to this moment in time, every second I have been alive, she has been in the world. Tears stream from my eyes as the stark realization occurs that she no longer walks the Earth. Never again can I call and ask how she’s doing, no longer can I bring her a bag of palmiers, her favorite cookies, and no more am I able to share my latest happenings with her. She had been ill and had suffered greatly for a number of years, so her death was not unexpected. Yet, I am in a state of disbelief. How can this be?
The Zen Buddhist monk Thich Nhat Hanh once said, “No birth, no death.” In other words, we have always existed and always will. Annihilation does not occur at death, only the moving out of manifestation. My Christian friends say death is a time for celebration and joy, since believers enter the heavenly spheres to be with Jesus. Somehow, though, in the present moment, all this spiritual rhetoric rings hollow to me. It is head-centered and not balanced with the heart. The uncomfortable truth is:
Gone is the woman who went through labor for me.
Gone is the woman who changed my diapers, fed and cared for me when I was helpless.
Gone is the woman who rubbed Vicks VapoRub on my chest.
Gone is the woman who wiped tears from my eyes.
Gone is the woman who cried the first time I got on the bus to go to school.
Gone are sacred stories of my life, ones only she knew.
I lie down in my backyard and gaze up at the clear blue, morning sky. White, wispy clouds hang high, and I watch as Mississippi Kites circle overhead and bumblebees buzz in and out of nearby bright-yellow squash blossoms. A canopy of blackjack oaks surrounds me, and the clean, warm air that brushes against my face is a harbinger for a piercingly-hot Oklahoma day. Everything seems the same, but it’s not. My universe is forever changed.
Now, as I think deeply about it, I am struck by the notion that the best way I can honor my mother is to live my life as fully and graciously as I can, demonstrating the love she so often shared with me. I, and those she loved, will become her legacy, for in one hundred years or so, it is likely that no one on this Earth will remember her. But the chain reaction of kind and loving acts that she set in motion will go on forever, and the world will be better for it.
If Roy Rogers and Dale Evans were here, they would sing to my mother:
Happy trails to you,
Until we meet again.
Happy trails to you,
Keep smiling until then.
Who cares about the clouds when we’re together?
Just sing a song, and bring the sunny weather.
Happy trails to you,
Until we meet again.
Bon voyage, my mother, adviser, confidante, wellspring of unconditional love and support. I love you, and I always will.
Happy trails . . .
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 Gary D. Conrad
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