Rest and Digest, I'm only para-sympathetic

Each tiny limb pointed in slightly different directions.

But imagining their common origin to be the same, not unlike the flashes of a firework spraying outward from the center of the explosion, I was able to envision them before the plumping. The right was a reflection of the left, and the left of the right. And for a brief moment, among the mechanical-like rotatory movements of the wiry stubs, there was perfect symmetry. I had a sudden flash of Violet from Charlie and the Chocolate Factory (or Willie Wonka & the Chocolate Factory, if you're instead, a fan of the original) rapidly enlarging into a blue sphere, arms and legs stretched as if on the rack. She, unable to walk, had to be rolled out of the factory.

It occurred to me that this wasn't so different. Then, a new flash of thoughts barreled through my mind which seemed to center around the science and logic of this, and phenomena like it.

"Why would this be the plan that evolution chose? It seems terribly vulnerable at this very moment." I think, as I'm walking palm up, channeling my inner child for a horrible prank.

"Come to think of evolution and vulnerability, why in the world do we sleep? I mean, how vulnerable are we when we are unconscious? Very! Not as much NOW with locks on doors, burglar alarms and such, but, back when we had to worry about those effing saber tooth tigers.... it just seems awfully dangerous to fall asleep. You'd think the insomniacs would have been the only survivors, right Darwin? Our dozing ancestors would have been devoured in their sleep. With all the risk, I guess that makes the act of sleeping, for some reason, really important. At least I'm good at one important thing. I'm going to evolve the hell outta this body.... or, well, wait.... I don't think it works that way. Wait, what am I doing again?"

I look down at my gloved hand, "Oh, right!"

The 8 mechanized pistons swirl like the hands of a clock moving far too quickly.... Though they do nothing but wriggle in the empty air.... they propel not this glutton.

"Ugh, it's like me after I eat a Chipotle burrito. Man, I hate it when people pronounce it Chi-pole-tay.... it's Chip-oat-lay. Wow, I get annoyed easily by grammar related missteps. Speaking of missteps...."

I then think to fake a slip and send flying my recently plucked iron filled epicure. But, I think better of this. "Must.... be..... professional...."

I am, after all, recently aged 28 years. And, I am at work, so I should act like it.

I turn the corner and enter the bathroom, peer down at what looks like an oversized flesh colored kernel of corn, with red, wriggling hairs, 4 on either side. At the point of the kernel sits a tiny maroon spec that moments ago was buried in a quite brave, and cute, little girl who had been playing in the woods with her family 3 days prior. She had left not only with memories of s'mores, fishing and campfires. She had even taken with her the actual scent of their smoke in her hair, but also tucked in her golden locks hid an unwelcome and parasitic gourmand... a hitchhiker of sorts. Across state lines, and eventually into my ER it rode.... gorging itself to the point of immobility along the way. It looked of the obese restaurant patron in "Monty Python's: The Meaning of Life" just prior to exploding.

"How is it that you've evolved into this? How can this be the best version of you? You can't even move. You've eaten so much so that you are unable to touch any of your 8 legs onto the ground. Don't you just get eaten by a bird the instant that you detach yourself from your host? If not, what do you do while you wait for your body to digest your greedy meal? You can't move... so, I guess you just sit there. Ugh, I hate ticks."

This is my second to last thought as I flush the vampiric insect down the toilet of the ER.

My last one being, "What exactly do I diagnose this girl with... 'Attached wood tick, removed???' And I wonder if there's an ICD 9 code for it?"

Hot Monotony

From algorithms and equations my decisions are made.

In response to fragmented sentences on the screen in front of me... my fingers swipe and command orders. Electrical impulses from the computer illicit electrical impulses from my brain, to my nerves, and eventually to my muscles. Sodium and Potassium frantically trade places again and again within my cells. Action potentials are fired; a series of unconscious chemical messages that dictate my body's action... fueled by ATP... the gasoline for us all.

The result: click, point, click, clack, fwiiip... slide, tap, tap, tap.... ENTER.

Often times, before I even see you.... before I meet you, shake your hand, see the fear in your eyes, feel the deceit from the lack of their contact with mine, or judge the honesty (or lack-there-of) in the animated writhing of your body in this room, I have decided.

I already know what I am to do with you today.

These formulas usually find a very repeatable, reliable and calculable result. This is why they are useful, yes, but they are not mathematic certainties. To believe this, and to practice this, will create for you a brief career in this business.

Like many other in this world, my profession is defined, and decided, within the 'gray areas.'

Black and white is easy. It's the haze of the gray that causes confusion, panic and accidents.

When the computer screen and chart read, "vaginal bleeding x10 hours, +6 weeks pregnant," it triggers the automatic response from my brain, nerves and muscles to order the appropriate labs, and imaging. "This," I think to myself, "is about a mathematical as they come." (In the emergency setting, there are only a couple of things to worry about here, and really, only ONE work-up. If there was ever a time to put in the orders before seeing the patient, (to speed up their stay in the ER) now's that time.

As I head towards room 31, and leave the computer to perform its task of electronically sending my orders throughout the hospital on wires of copper, fiber-optics and ethernet, to separate destinations... (lab, nurses, techs and radiology), I find my patient outside of said room, waiting in line for the bathroom.

She is youthful, petite, and has the look of a scared young child in line for a haunted house, one that she would not have dared to step in to, if it were not for her braver, and older sister. Though today, she is alone here in the ER, and she is buried in her far too large hooded sweatshirt as if to hide from the ghouls in this place. Oh the horror she must feel as she thinks of all the terrible possibilities. She disappears further into her sweatshirt.

We begin talk. More specifically, I ask questions and listen to her answers, marking down the responses in the correct area on my chart, making sure to look up frequently and capture her gaze. Though rather than look at me, she aims her stare at the cuffs of her sweatshirt, as she teases at a loose thread in the cotton seam. This, a nervous gesture I have seen before. Still, I attempt to be more of a person while listening to her, rather than appear as the robot that I am, programmed with algorithms that will (or have already) led me to my implemented plan.

I am an accountant of words.

She tells me of her trip yesterday to planned parenthood, of her positive pregnancy test, and her diagnoses of a 6 week pregnancy. Her last period being about 6 weeks ago, and had not bled since then, until today. Now, there is pain, too, accompanying the crimson.

I finish logging her words, like a transcriptionist.

My hinges squeak while being pushed by the various pistons positioned nearest them as I set down the clipboard, and pick up the ophthalmoscope to check pupillary reflexes, then look in her throat. There are no surprises here. Next, check lymph nodes in the neck and listen for bruits. Now the heart and lungs.... I hear clicks of S1 and S2, no murmurs, rubs, gallops. Lungs are clear to auscultation, no wheezes rhonchi or rales. Now I have her lay back to check her abdomen.....

Does not compute.

As I pull back her oversized sweatshirt, her last line of defense... her big-sister-stand-in, the fear permeates from her pregnant belly, and fills the room, banging at my metal exterior. There is nowhere for her to hide now. Her exposed belly is convex, and hard to the touch.... and resembles the harvest moon.

She is full term. She is in labor.

This forces my circuitry to immediately rewire and demand a manual override.

I snap into action.... decipher how far apart contractions are... explain to her that she is much farther along than 6 weeks, in fact, she appears to be full term, and beginning to have contractions (I still am unsure if she really didn't know, or did, but was just in denial). I quickly perform a pelvic exam, the cervical os is partially open, admitting a finger, which now feels the calvaria of another living being, yet to officially join this world, and unknown (supposedly) to its mother only moments before.

Mother and surprise child are immediately transported to another facility where OBGyn can handle the delivery.

I, on the other hand, call the producers of "I didn't know I was pregnant" and tell them that I've got another story for their show.

Into The Abyss

It's not as much a call to arms, as it is a call to legs. He meant for them to get up and balance on theirs. Deftly taking steps, small at first, but with poise and intent. Weak from decades of neglect, they're at first, best at simply wobbling about, flapping under the weight from above. But with time, they remember the cadence.

They're running now. I can see them in the streets. Though steps filled with intent and poise have turned into stomps of criminal intent and poison; a visual cacophony before us all. Chaos is a word too hackneyed to properly encapsulate the blur of escalation that is occurring. Like slowly walking down a steep embankment inevitably turns into an uncontrolled sprint, and an eventual failure to keep pace with gravity. Face, meet earth.

The sudden stop takes away your breath... and leaves your face numb, with watercolors of green and yellow floating over your field of vision... like the unavoidable bruise that will soon paint your nose and cheekbones. This, a clear sign that you let yourself go to far... and that you need a lesson in restraint.

I, on the other hand, could use some passion.... so you've said. And, again repeat as you pick up your chosen weapon, and depart down that steep hill once more. I suspect you will be surprised upon your return, with a face bruised almost as badly as your ego.

But green and yellow will undoubtedly relent to purple, black, and finally flesh again. Bones heal, and egos forget past failures. But these things are only true under the most normal of circumstances. And these, my friend, are not normal circumstances. So, proceed with caution. This new path is unpaved, and is rife with danger and uncertainty.

Nose Dives and Car Rides

It was quiet in the car.

I remember this because it was not so much quiet, as it was silent. And I, over the years, have become a connoisseur of sorts with respect to silence. Not many people know that there are different kinds of silences. There are at least 14 that I know of... though I won't get into the subtleties of this here. All you need to know, is that this particular silence was one that signified more than awkwardness, more than tension, more than hurt.... It generated an unsaid, but all too well understood, sense of finality, a realization that so many things had gone unsaid over the years... but perhaps most importantly, an admission of mistrust.

Though, as I suspected, she didn't seem to care... neither the silence, what it signified, or even the statement following seemed to penetrate her exterior.

It was nothing new, it had been too late for years. This story isn't about that. I just remember this particular day, not because it's when I admitted to her that I felt as if PA school was perhaps a dream that would never come true for me, or because she didn't seem to care, or because it may have been the last time I saw her in that city (I really don't remember), or because it was the first time I discovered this specific brand of silence, but because it's when I admitted to myself that I might not ever get into PA school.

In looking back, it tells me something about my resolve.... or perhaps my persistence, whether or not it was supported by sound judgement. As you know, I made it.... and did well, and am doing well in my chosen career. Here's the problem... I've achieved my goal, my seemingly unachievable goal. Really, one that I thought I may never accomplish. Now, here I am.... and the problem is this.... I haven't a new goal.... or, let me rephrase that. I hadn't a new goal, until not too long ago. This lack of an endpoint, a distant and perhaps impossible goal, bothered me. It turns out, I'm goal oriented, and perhaps a bit more type A than I'd like to admit. I am now, however, cool and unbothered, for I have a new impossible dream.

I love what I do, I love my career. But that's it, it's a career, a job.... it's work. The people who have it figured out have managed to do something that they cannot even bring themselves to call 'work' or a 'job.' It's just what they do, it's their passion... and they happen to get paid for it... and yes, they may be few and far between. And for me, it sure as hell is a long shot.... but so was the thought of PA school while I sat inside that old Cadillac.

Here's to the impossible.