Father | Elbrecht's Corpuscle

A Week in April

Posted on October 3, 2016 by Elbrecht

I had four patients die within one week.

When the totality hit me, I nearly lost control of my emotions.

On the Obstetrics service, a majority of all patient encounters are joyous and professionally reaffirming.

Each antepartum heart tone heard via ultrasound brings a sense of wellness and anticipation, both to the expectant mother and the caring physician.

But not every delivery has a pleasant outcome. Not every parent has a sense of anticipation. And not every physician can cope with those competing forces.

I delivered a 33-week-old neonate who precipitously declined within the first 24 hours of life. It had been an easy delivery, with the mother having given birth five times previously, and the fetus not yet having reached the period of greatest growth.

With one deep breath from her mother and a hearty push of the abdominal and pelvic musculature, the baby arrived, opening her eyes and taking her first breath while still cradled in my left arm.

She looked right at me. Deep into my eyes as she let out her first cry.

But despite our medical technologies and painstaking care, not every newborn baby survives.

She died in the neonatal intensive care unit 7 days later, an infection having made its way from the vaginal mucosa of her mother into her lungs and from there into her bloodstream.

The most aggressive antibiotics and procedures did not save her; there was nothing more we could have done.

Her death was unsettling. It came as the last of the four, but the one which nearly encompassed my entire being in darkness.

Two days after her birth, while awaiting another delivery on a quiet Friday night, the Code Blue alarms, indicating a cardiac arrest somewhere in the hospital, sounded overhead in the lecture hall.

My colleague, Dr O, was on medicine call that evening; she jumped from her seat across from me, immediately ending our conversation.

I glanced at my other colleagues remaining at the table and dutifully indicated I would join Dr O in case she needed back-up so they could complete sign-out.

The Code was called to a room at the furthest point possible from where we were seated, so rather than assuming I would eventually arrive to find Dr O having resuscitated the patient, I broke into a full sprint, clasping my stethoscope around my neck with my right hand to prevent it from flying off mid-stride, in case something went awry.

When I arrived a minute later, all hell was breaking loose, despite Dr O and a more senior physician, Dr B, deftly providing and directing life resuscitating efforts.

The woman, a 31-year-old mother of 6, who was admitted for nausea two days earlier, was accompanied in the room by her distressed and screaming 6-year-old son and her husband, who was shouting hysterically from her bedside, begging her to come back.

I stepped into hell incarnate and helped guide the husband and son to an adjoining room.

When I returned moments later, nothing had changed. She was still unresponsive. No heart beat was palpable; no rhythm identified on the cardiac monitor.

A deep sense of distress was evident in the room, despite the aggressive nature of our efforts.

The next hour lasted for an eternity, as Dr O, Dr B, and myself assisted the nurses in providing chest compressions, giving medications to stimulate cardiac contractility, and delivering electrical shocks to bring her back to life.

Nothing worked.

Her heart did not regain electrical activity. Her lungs did not attempt another breath.

Once we determined further efforts were futile, the husband, increasingly hysterical, was guided back into her room, to kiss the cheek of a lifeless body once belonging to the mother of his 6 children.

He begged us to try more. The despair in his eyes pierced everyone’s souls.

His son was sitting quietly in the adjoining room.

Physicians, nurses, security guards, and the chaplain cried; our emotions audible throughout the hallway.

I returned to the Obstetric floor after embracing my colleagues in a moment of silence. I stopped in the locker room to take off my sweat and tear-soaked scrubs and replace them with a new pair.

I delivered a healthy baby boy an hour later. His parents thanked me incessantly before I left the room.

I left the hospital the following Saturday morning having delivered several newborn girls and boys into this world.

All the while knowing a loving mother had unexpectedly died and another child’s life was being sustained in the Neonatal Intensive Care Unit.

When I returned to the hospital on Sunday night, I quickly scoured the electronic charts awaiting my signature.

A new electronic tab had appeared in the toolbar for me to click on. It read “Death Notice.”

I anticipated having to re-read the harrowing and emotional report of the unexpected death of the mother from Friday night.

Instead, I was blindsided by the account of another of my patient’s death, whom I had seen only a few weeks previously in the office.

He had been brought to my hospital’s Emergency Department on Saturday night, lifeless, despite the heroic efforts of the EMS and subsequent attempts by the Trauma Surgeons.

In the early evening hours of Saturday night, he had been found lying in a pool of his own blood, a trail of that blood following him for a reported 50 yards.

A bullet had pierced his femoral artery, the largest blood-carrying vessel in the leg; it had shredded the artery, leaving behind a capable exit path for the blood to flow from his body.

With each beat of his heart, more blood would gush from the wound in his leg, causing the heart to beat faster as it attempted to compensate for the missing blood.

Instead of a life-continuing effort, in its paradoxical nature, the heart beckoned the same death it hoped to avoid.

After scouring the internet for more information, I learned the 50-year-old man had been minding his own business in the parking lot of his apartment building when a man and woman approached him. They pointed a gun at him and demanded his wallet.

Having had several colorful conversations with him in the office, I could easily visualize him telling them to “Fuck Off”, his East Coast upbringing shining bright.

The following morning I received a phone call from my Program Director. She had also received notification of his death and wanted to check in with me.

I expressed my thanks for her concern. I did not tell her about the lifeless mother or the neonate only a few breaths from death.

A third patient died in the next 48 hours.

Honestly, I can not recall the details. None of them.

They have seemingly been erased from my memory, perhaps in a fitful effort to suppress the emotions death has brought to the forefront of my medical training so that I do not throw my heart up in the air and declare all is lost.

But I know another patient, someone for whom I cared, whose family loved them, succumbed to the only outcome known to our species.

Death.

So I will document that death here; despite my brain’s greatest efforts to forget it, I will forever know the impact it has had upon me.

When I received the call, I let out a deep sigh. I hung up as my eyes swelled with tears.

The fourth death. A seven-day-old child whose eyes I had stared into while holding in my left arm as she took her first breath.

Until the day I die, I hope to not forget the look I gave her. One of awe. And love. Excitement. And fear.

A gamut of human emotions, packed into one soul-penetrating experience.

I hope, despite her struggle for life, that in her final moments, the neurons in her brain grasped onto the emotions I transferred to her with our brief encounter.

That in the last beat of her heart and breath of her lungs, her mind went to the moment we shared; the look of awe and love and excitement drowning out the fear lurking deep in my eyes.

Sportsworld

Posted on May 19, 2014 by Elbrecht

—–

My father was sitting beside me the first time I had a naked woman in my lap. I was 16.

We were supposed to be going to Sportsworld, one of my favorite places to go during what I thought was my relatively normal childhood. My father informed my step-mother we were going to use the batting cages, ride the go-carts, and play some skeeball on a Saturday night; turns out one of my father’s favorite places to go during what I thought was my relatively normal childhood was Jezebel’s.

Both Sportsworld and Jezebel’s were on the outskirts of the ever-expanding city limits, but they were in completely opposite directions from my father’s home. After driving a mile in the “wrong” direction, it dawned on me Sportsworld was no longer our final destination. I simply sat in the passenger’s seat as Sportsworld got further and further away.

When we arrived, my father calmly told the bouncer, “This is my son. He’s 21.” The bouncer only glanced at me. By the age of 16, I had already been mistaken for a grown man several times, but typically it was while wearing slacks, a button-down shirt, and tie; not while wearing mybaseball cap, glasses, and cargo shorts.

—–

The bouncer waved me through; identification was unnecessary. Ending up at Jezebel’s that evening, rather than Sportsworld, was simply another example in a long list of why I had learned to distrust my father.

As a concept, distrust had been carefully weaved into our relationship several years prior. At the age of 7, my father entered my bedroom, put his hand on my shoulder and told me he was leaving our family. He was blunt and unapologetic, laying the blame at someone else’s feet and talking to me as if I could possibly understand his rationale; I did not.

—-

—–

The TV was on in the background and my eyes darted from the screen to his face as he relayed how he would not be there in the morning. As he lifted his hand from my shoulder and exited the room, his words were searing into my brain.

Somehow, I slept soundly that evening, but when I awoke the next morning, he was there. It was as if the previous night had been a dream. I wondered if I had misunderstood what he said; the weight of his hand on my shoulder had been so heavy. And so real. My 7-year-old brain wondered what changed. Only years later would I identify the feeling I had when I saw him the next morning as trust being smashed like a mandolin with a sledgehammer.

—–

Distrust was brewing. Eventually, he did leave. Seven years later. And the morning when I awoke and he wasn’t there, I knew why. He hadn’t come into my room the night before and repeated his reasoning to me. And I didn’t need him to. I still remembered his words, the weight of his hand on my shoulder, from when I was a child. If he had come to me again, I would have waved him through, as calmly and coolly as the bouncer at Jezebel’s.

—–

As I was being directed to a table near the main stage by my father, nearly six months had elapsed since I had moved away from my hometown of Wichita. My mother had decided to leave the place I had always known as home, forcing a decision to be made individually by each of her children as to where we would live. At 15, my options were limited.

I could stay and live with my father and my new step-mother or pack-up my life, leave my friends, and embark down a path of no return. The concept of trust, having germinated from an unrecognized emotion, which I had been unable to identify at the age of 7, was fully functional by this time.

Subsequently, when my father got married to a woman I had only met twice, I was completely aware that I did not trust him. He had not even bothered to invite us to the wedding, a civil ceremony in another state.

He simply relayed it as a fact one morning while dropping my brother and I off at school. This certainly factored in my decision as to whether I should stay in Wichita or embark to parts unknown; it made the decision to leave that much easier.

—–

Thus, my father must have viewed my six-week stay in Wichita during the summer of 1996 as a bit of a homecoming, but also as a chance to recover something he had lost; Me.

Driving the go-carts and playing video games seemed to me like a reasonable way to spend a Saturday night. But my father thought watching naked women grind on his son was a better idea. And perhaps a way to win me back. In the blink of an eye, I went straight from green-as-can-be to strip club veteran. By the time we left, I had put a dollar bill in places only possible if a woman weren’t wearing any clothes.

I suppose it was his own version of “The Birds and the Bees” speech.

—–

I roughly translated it as: “Have money. Women will get naked. And sit in your lap.”

Not too much in there about birds or bees. When I was living in nYc a couple years ago, a woman I was dating asked about my parents and my father in particular. Over the course of my sharing, the story of my night at Jezebel’s with dear ‘ol dad cropped up. It probably wasn’t the best example of his parenting, but it was a close approximation.

I believe her response was, “Holy shit.”

Alas, it wouldn’t be the last time he would suggest we visit Jezebel’s together. But by the next time he offered I was a grown adult, and didn’t feel like it fit with the holiday spirit after spending the morning feeding the less fortunate. When he suggested we go back to “Sportsworld”, I politely declined, despite his pleas.

As we pulled into the driveway on that humid summer night in 1996, fresh off a once-in-a-lifetime Dad and Son outing to the strip club, my father looked at me with his sheepish grin: “Remember, if she asks, we were at Sportsworld.” Naked women snatching up dollar bills is not exactly what I expected from my night. When we left his house I was prepared to a re-enact Death Race 2000 on the go-cart track, not witness fully-nude Flash Dance on the Main Stage.

—–

Then again, I had already learned all I needed to know about trust from this man.

Two and a Half Men

Posted on January 20, 2014 by Elbrecht

In a drug-induced state of psychosis, Charlie Sheen once famously said, “WINNING!” in reference to how his life was turning out post “Two and a Half Men.”

Having starred as the playboy uncle to the father-son duo who shared billing with him, Charlie was now an outcast from his on-screen role. So an urge to assume the real life playboy role of his younger years seemed to envelop him, resulting in the now-famous quote.

—–

I found myself in a similar role during the three months I lived with my friends, The Mastersons, during the summer/fall of 2013. And by similar role, I mean, broke pseudo-uncle who needs a place to live and decides not to leave.

#WINNING, indeed.

While my initial reasons for accepting The Masterson’s offer for a place to stay revolved around me being a broke medical student, my reasons for staying quickly evolved around the relationship between two members of the family, Matt and his son, Nathaniel. [Props to Jo and Lyla for putting up with me too.]

—–

I’ve written before about my experiences with playing “dad” in When I had a Son, but in the midst of The Masterson home, I found myself settling in to a hybrid role of uncle-playmate-curious observer.

In the case of the father and son in Two and Half Men, they constantly find themselves in the midst of Charlie’s high-jinks, womanizing, and tom-foolery. I’m guessing Matt and Jo were thankful my character, Me, brought none of those into their home. Especially since my bedroom doubled as Jo’s office during the day.

“Eaaaaaaaaaaaaaaaaaaaannnnnnn!!!”

As long as he was still awake when I returned home, Nathaniel would screech my name when I strolled through the garage door and into the kitchen. In his three-year-old mind, I must have seemed a like a walking, talking, ball-tossing, live-in playmate. Not that I minded his interpretation of my place in the Masterson home. I reveled in the role of “Uncle Charlie.”

—–

While I thoroughly enjoyed chasing Nathaniel around the house, playing with fighter jets in the living room, or eating dinner with him at the dining room table, it was fascinating to see his personality change, his capabilities increase, and his interests broaden from one day to another. Every day he was growing in mind, body, and spirit.

I have several other close friends with young children, but I may go several months between seeing them, making the changes in their behavior and capabilities more pronounced. In the case of Nathaniel, it was rare that I would go a day without seeing him, even if only for a few minutes. From this new perspective, I could observe his advancing development as subtle, but apparent, on close reflection.

—–

The opportunity of being “Uncle Charlie” with Nathaniel was enriching, but I was also carefully observing how Matt and Nathaniel’s relationship was developing. My observations with other friends and their sons are short-lived, never on such a daily basis, and typically revolve around celebrations of some sort.

But we all know that things could be different behind the closed doors of one’s own home.

In my opinion, the responsibility of a parent is to be an role model, while also being someone who’s willing to address incorrect behavior when necessary.

When one day Nathaniel went from playfully crawling on the floor with Lyla (who wasn’t yet crawling) to playfully sticking her fingers in his mouth and chomping down, Matt sprung from doting father into “Jesus Christ my son just bit my daughter’s fingers” mode.

—–

Nathaniel’s intent wasn’t to cause pain or disfigurement, but Matt had to make sure Nathaniel’s three-year-old brain would remember this was a bad thing the next time a finger came close to his mouth. So Matt raised his voice, alerting Nathaniel to his father’s watchful eye, and then removed Lyla from close proximity. He completed the parenting “Triple Crown” by explaining to Nathaniel how and why he had done wrong.

Charlie’s “Triple Crown” likely would have been to make a Triple Crown and Coke afterwards, but Matt resisted the urge to make a drink and instead continued playing with his son.

—–

Over the course of 3 months, there were many opportunities to witness the father-son bond growing between Matt and Nathaniel, from the aforementioned act of parenting, their Saturday morning Starbucks journeys, Matt reading and re-reading Nathaniel’s favorite books, and the two of them making dinner together.

Matt was the loving, doting father and Nathaniel, the lovable, huggable, curious son. Few things are more marvelous to observe.

But all good things do come to an end, as did even Charlie’s run on Two and a Half Men.

—–

When I only had a few days left in Columbus, Nathaniel and I were playing on the couch and I hadn’t yet told him I would be leaving soon.

I wasn’t quite sure how to tell him I wouldn’t be around every day anymore, so I simply said, “Buddy, in a couple of days I’m gonna go live with my mom just like you live with your mommy and daddy.”

Nathaniel tilted his head slightly, crumpled his nose, and replied, “Why do you want to go live with your mom?”

The real answer was a convoluted mess, so I answered, “that’s what people do sometimes.” Never deterred from playing, he went back to wrestling on the couch.

—–

I’m pretty sure in Two and a Half Men Charlie’s character was killed off, so I’m grateful that fate didn’t become Me when it came time to leave The Mastersons.

Instead, I was able to drive off into the sunset and on to another adventure.

WINNING, indeed.