Emergency Medicine Day Quotes

Emergencies are crucibles that contain and reveal the daily, slower-burning problems of medicine and beyond—our vulnerabilities; our trouble grappling with uncertainty, how we die, how we prioritize and divide what is most precious and vital and limited; even our biases and blindnesses.

Until fairly recently, every family had a cornucopia of favorite home remedies--plants and household items that could be prepared to treat minor medical emergencies, or to prevent a common ailment becoming something much more serious. Most households had someone with a little understanding of home cures, and when knowledge fell short, or more serious illness took hold, the family physician or village healer would be called in for a consultation, and a treatment would be agreed upon. In those days we took personal responsibility for our health--we took steps to prevent illness and were more aware of our bodies and of changes in them. And when illness struck, we frequently had the personal means to remedy it. More often than not, the treatment could be found in the garden or the larder. In the middle of the twentieth century we began to change our outlook. The advent of modern medicine, together with its many miracles, also led to a much greater dependency on our physicians and to an increasingly stretched healthcare system. The growth of the pharmaceutical industry has meant that there are indeed "cures" for most symptoms, and we have become accustomed to putting our health in the hands of someone else, and to purchasing products that make us feel good. Somewhere along the line we began to believe that technology was in some way superior to what was natural, and so we willingly gave up control of even minor health problems.

It is undignified to inject yourself with hormones designed to slow or enhance ovarian production. It is undignified to have your ovaries monitored by transvaginal ultrasound; to be sedated so that your eggs can be aspirated into a needle; to have your husband emerge sheepishly from a locked room with the “sample” that will be combined with your eggs under supervision of an embryologist. The grainy photo they hand you on transfer day, of your eight-celled embryo (which does not look remotely like a baby), is undignified, and so is all the waiting and despairing that follows.

Every day," I said, "every day I go to work and I see my granddad. I see the drunks and the addicts, the people who have fallen right off the edge of the earth. I see people who have made every bad move anyone could make, made every major mistake there was to be made, and by the time I see them, they are paying for it, sometimes with their lives. That's why they came to the ER. "When you work in emergency medicine, you are seeing patients who are the least common denominator as far as human beings go; people who are heartbreakingly stupid and ditty and drunk and high and obnoxious--unbelievably obnoxious. These people have all flowed out of the darkest side of life. And when you are finished with them, that's mostly where they'll return. So each of you who is thinking you want to go into emergency medicine will have to ask yourself, 'Do I really want to do this?'" I tapped my chest. "I know the answer for myself--every day I work I'm taking care of someone who is just like my grandfather, someone just like my mother. But everyone in this room needs to ask himself or herself, 'Do I want to spend the rest of my life with addicts and idiots and drunks and psychotics? Is this what will make me happy?'" I peered at all of them over the top of the microphone. "Very few sane people answer yes.

Wake up every day, expecting not to know what's going to happen, and look for the events to unfold with curiosity. Instead of stressing and managing, just be present at anything that pops up with the intention of approaching it with your best efforts. Whatever happens in the process of spiritual awakening is going to be unpredictable and moving forward, if you're just the one who notices it, not fighting or making a big project out there. •       You may have emotional swings, energetic swings, psychic openings, and other unwanted shifts that, as you knew, feel unfamiliar to your personality. Be the beholder. Don't feel like you have something to fix or alter. They're going to pass. •       If you have severe trauma in your history and have never had therapy, it might be very useful to release the pains of memories that arise around the events. Therapy teaches you how to express, bear witness, release, and move forward. Your therapist needn't know much about kundalini as long as he or she doesn't discount that part of your process. What you want to focus on is the release of trauma-related issues, and you want an experienced and compassionate therapist who sees your spiritual orientation as a motivation and support for the healing process. •       This process represents your chance to wake up to your true nature. Some people wake up first, and then experience the emergence of a kundalini; others have the kundalini process going through as a preparation for the emergence. The appearance happens to do the job of wiping out, so is part of either pattern. Waking up means realizing that whoever looks through your eyes, lives through your senses, listens to your thoughts, and is present at every moment of your experience, whether good or bad, is recognized or remembered. This is a bright, conscious, detached and unconditionally loving presence that is universal and eternal and is totally free from all the conditions and memories you associate with as a personal identity. But as long as you believe in all of your personal conditions and stories, emotions, and thoughts, you have to experience life filtered by them. This programmed mind is what makes the game of life to be varied and suspense-filled but it also causes suffering and fear of death. When we are in Samadhi and Satori encounters, we glimpse the Truth about the vast, limitless space that is the foundation for our being. It is called gnosis (knowledge) or the One by the early Gnostics. Some spiritual teachings like Advaita Vedanta and Zen go straight for realization, while others see it as a gradual path through years of spiritual practices. Anyway, the ending is the same. As Shakespeare said, when you know who you are, the world becomes a stage and you the player, and life is more light and thoughts less intrusive, and the kundalini process settles down into a mellow pleasantness. •       Give up places to go and to be with people that cause you discomfort.

Of course, the Kremlin policy is utterly mad. Even with the help of useful fools like Gen. Butler, Moscow’s strategists are bound to fail (in the long run) – especially in Europe; for the natural instincts of sensible people are bound to awaken. However grim the situation may look, however horrific the military disasters to come, the circus clowns will be forced from the stage. Fear of death has a way of focusing the mind, and the threat of enslavement rallies many whose timidity would otherwise be assumed. It does not matter that these people are “late to the party.” As war grows closer, more observers will see the situation for what it is. Shortly before her death last year, a Russian historian wrote to me as follows: “Moscow is performing substantial war preparations. Training both military and civil defense [personnel] including the Moscow Metro, every day; medicine is in full readiness for [the coming] emergency….” J.R.Nyquist

10. What realities are captured in the story of Lou Sanders and his daughter, Shelley, regarding home care for an aging and increasingly frail parent? What conflicts did Shelley face between her intentions and the practical needs of the family and herself? What does the book illustrate about the universal nature of this struggle in families around the globe? 11. A key concept that emerges from the author’s interviews is “home.” Much more than just the place where you go to bed at night, home evokes a set of values and freedoms for many as they face old age. As you consider the life you want lead in old age, what does home mean to you? 12. Reading about Bill Thomas’s Eden Alternative in Chapter 5, what came to mind when he outlined the Three Plagues of nursing home existence: boredom, loneliness, and helplessness? What do you think matters most when you envision eldercare? 13. What can be learned from the medical treatment choices that were made in the final days of Sara Monopoli’s life? 14. What are your feelings about hospice care? When is the appropriate time to introduce hospice in the treatment of those with life-threatening illness?

Far from the cinematic drama of hospital emergency rooms, Slow Medicine embraces the unsung work of daily attention that is the greatest need and firmest foundation for longevity and quality of life at the farthest reach of age. Excellent chronic care attends to the day-to-day needs and conditions of the patient—by offering emotional support and social stimulation, supplying better nutrition, easing chronic skin and nail conditions, and making sleeping, moving, bathing, dressing, and voiding easier. Slow Medicine is the careful practice that most reliably sustains fragile patterns of well-being. This foundation for better elder care strengthens, rather than replaces, the selective use of high-tech care. During the time of the writing of this book, I have lived the

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