A Chapter Book

Tonight I had the chance to spend several hours in one of my favorite places – the Emergency Department of my local hospital.

A dislocated kneecap (its a temporary thing and will be fine in time, go easy).

Putting staples in the back of a 9-year-old boy’s head (brave little kid, very nervous father, my first time holding the “staple gun” – funny how I always pictured a great big stapler and this thing is actually so small!)

Woman brought in by police officers who found her digging in the neighbor’s flower beds looking for her “stuff” (a little too much meth and a week without her psych meds, she’ll be fine after ‘catching up’ the meds and sleeping it off with a few warm blankets provided by a nurse who I’m convinced is one of the best nurses on the planet).

Then there was a man I’ll call Jack.

I was sitting beside my mentor while he caught up on charting when I heard the ER Director holler, “Is Student Doctor J still here?” 

“Come with me, I want you to feel this.”

I entered a room where an older gentleman sat in a chair wearing that oh-so-flattering hospital gown.

After quick introductions, the Director said, “Here, feel right here. Jack fell about 8 feet off a ladder. Tell me what you feel.”

I pulled aside Jack’s gown and immediately saw deep bruises where his back had hit something on the way down, and I felt him wince as my hand gently probed his right side. My fingers almost immediately found the “rice crispies” feel of subcutaneous emphysema – air trapped under the skin where it most definitely didn’t belong.

The Director towered over me, and with eyes dancing (he knows how much I love to learn / feel / experience new doctor-type things) asked, “Do you feel it? Tell me what it means.”

Yes, I feel it. There’s air under the skin. Perhaps a broken rib punctured his lung when Jack fell. We need to check the x-ray for fractures and the CT for a collapsed lung and be prepared to put in a chest tube if necessary.

Jack took in the information, asked a few questions, then a few more.

“I understand,” he said. “I just need to know what to expect. I’m so grateful my lung isn’t collapsed right now, and if it happens later I understand when to come back in. Now let me tell you why I’m not going to worry…”

And there followed a full 15 minutes of what I can only call masterful storytelling. Understand, 15 minutes is a long time in an ER. When I began to feel impatient, I’d remind myself, stay present! This is as much a part of doctoring as stapling a kid’s head wound or calling the Crisis Line for an overdose. 

Jack talked about spending his life in film – he was well past 80 after all, and had a rich history as a communications professor and a successful film director and loved stories. He talked of being married to his first wife for 52 years and watching her die of a rare cancer that followed the facial nerves. As he reached out to gently touch his second wife’s hand, he described the amazing experience of them finding each other after each losing a spouse, yet discovering a way to fully embrace their next chapter of living.chapter


Chapter books.

Jack said, “Everyone’s life is a chapter book. Not everyone knows how to let a chapter be read and finished so they can move on to the next. But the book, the story, is so much more than just one chapter!”

At 80+ years old, Jack looks and acts much younger than men twenty years his junior. His ribs and his lung will heal. His wife will gently support his recovery. And his ‘chapter book’ story will continue to inspire med students like me.

Thank you Jack.