Odysseys of George

As life cruises along; vita non est vivere sed valere
Taken from KevinMD.com blog. 

A patient cheats death and changes two lives

| Physician | February 10, 2013

Throughout the course of my career I have probably been with hundreds of people as they transitioned into and out of death. Although I am familiar with what this journey looks like, I have not yet been privy to the journey myself. Rarely though, I have had the pleasure of listening to someone who has journeyed back from death and arrived with a story to tell. Regardless of your position on the validity of near death experiences, take this one for what it’s worth to you.

 

Years ago when I was ripe and round with my third child, I was trudging through a late night shift in the ER when a “code” came in by EMS. The patient was a young man in maybe his late 30s, and when the paramedics came around the corner with him they were all sweating from the efforts of professional chest compressions and airway support. I remember that they had been unable to place a breathing tube during transport due to the amount of vomit in the man’s airway. I recall, that due to my gestational girth, that I had to squat like a sumo wrestler to be able to see into his throat myself, but was able to secure a stable airway as we continued CPR.

I was giving the orders, but our entire team was trying to figure out why he had died, and what we could do to resuscitate him. One of the paramedics stated that he thought that drugs were involved and that this was a potential overdose situation.
So I tried a few more medications on him and unexpectedly, we got a pulse!

After a “successful code” we always go through a very detailed examination of the patient to look for sign and hints of what has been and is going on. As we rolled this young man to examine his back, my charge nurse, Penny pulled a couple of narcotic patches off

“Here is our problem,” she said.

We all shook our heads with a type of disappointment; we had come to see this all too often in our community.

“This is too bad,” I sighed while examining his pupils. Nothing about his examination suggested that he would live. He had no visible signs of brain life. Nothing. He seemed to be just a body to me, with a beating heart. I wondered aloud if he could even be an organ donor.

No family ever arrived to check on him, to hear my prognosis that I had practiced in my head.

“I think his brain just went without oxygen too long. I am so sorry, but I don’t think he will pull through this. We did our best, and I assure you that he is not suffering.”

I sent him to the ICU and never heard anything about him again.

Until six months later.

Again I was on a busy night shift and the place was bursting at the seams. I think the lobby was spilling over into the parking area and I was feeling quite stressed about how I alone was going to get to all of these people who needed my help. In the midst of carrying a pile of charts down a hallway of patients, my charge nurse Penny, said that something unusual had just occurred in triage. A young man walking with a cane came up to the triage nurse and asked if he could have a word with me.

She asked, “Do you have a problem that Dr. Murphy needs to see you for? If so sign in here,” she said, pointing to a pen and paper.

The man replied, “No, as a matter of fact, I do not have a problem, I just need to talk to her.”

My nurse replied rather shortly, “Well you just can’t show up here to chat with the doctor. See all of these people? She is very busy!”

In response, the man signed in to be seen and took a seat to wait his turn. On the chief complaint section, the paper read “something very important.”

I cannot recall how long he waited, but it should have been long enough to dissuade anyone with casual interests.

So, I will say hours later, I finally got to his chart and headed toward his room.

I had not even walking through the doorwhen this smiling gentleman, stood to greet me.

“Dr. Murphy, I see that you have had your baby girl! How is she?”

I stopped dead in my tracks, and an eerie uncomfortable sensation rushed over my skin. I didn’t know this man, had never seen him in my life (or so I thought) and he was speaking to me in very familiar terms about me and my 5 month old child.
I eyed him suspiciously. “Do I know you, sir?” I asked

He continued to smile but took a seat, a visible effort to ease my apprehension. “Yes, you know me, you just don’t remember me. 6 months ago you saved my life.I came here tonight to thank you personally, and to tell you my story.”

I sat on the stool in front of him and listened. As he talked, I relaxed further, feeling comfortable that he meant me no harm and was not a stalker or something.

He started by saying very matter-of-factly.

“I died and you brought me back to life in that room across the hall near the end of last year,” as he pointed toward the doorway and correctly toward our resuscitation room.

With great detail he began to report on the events of that evening.

“I had become addicted to pain killers because I struggled with a bad back. That night I had taken too many pills and had used some of my uncle’s pain patches … ”

He went on to explain how he somehow knew when he stopped breathing and then left “his body.” He recounted how he saw his girlfriend find him and then call 911 while she attempted to start CPR on him. He told me the words that she said and what the paramedics said and did on arrival to his home. He told me how he knew one of the paramedics and that she cried and struggled to do her job performing CPR on him while sobbing at the same time. He explained that he closely followed the events that were going on with “his body” and began to describe in accurate detail what had happened in the resuscitation room in the ER. He told me that we were dismayed that he had overdosed at such a young age. He stated that he watched as Penny, my charge nurse, rolled him over and pulled the two pain patches from his back and he heard her say “Here is our problem.” (Note: He did not state Penny’s name but called her that dark-haired charge nurse.) He recalled that I had talked about “whether he could even be an organ donor or not.”

“But, I came back into my body and I lived! And here I am today, but I am a changed man. I don’t take pain killers anymore. Now, this cane is my only medicine, it’s my only crutch,” he said, twirling his cane in the air, smilingly.

His story seemed to have come to an end, but after a brief pause he continued.

“But, I really only came here tonight to share two things with you.”

His eyes grew serious.

“First, when I was outside of my body, when I was dead … I saw something else. I saw that there was light coming from you and from your baby,” he was staring up at the corner of the room as if viewing the memory with a sense of wonder.

I stared at him in astonishment.

Then he turned to look directly at me, and with a deeply earnest expression said, “But, I really just wanted to thank you personally, face-to-face for helping to save my life, for being a part of giving me a second chance. I promise you Dr. Murphy that I will not waste it. There are things that happened to me when I was dead that I cannot tell you about, but I made a promise to use my life and my time differently.”

I sat quietly before him, without words. What could be said? It was as though he had taken on the role of the doctor and I was the patient. He spoke gently to me using expressions that I didn’t quite understand about some aspect of existence and being that I did not comprehend. But, I was grateful for his words.

That night this man gave me a gift. This gift was a deepened sense of appreciation for my own life, and for the gift of time itself. As a result, I became more keenly grateful for the lives of my children, my husband, my family and the opportunity we have all been given to experience this thing called life together.

All these years later if I could perchance meet up with this man again. This is what I would say to him.

“I am so grateful that you cared enough to seek me out to share your story. I have had many years to think about this and although I may have helped save your physical life that night. On more than one occasion you have helped save my spiritual life. Your story has always given me a second chance and I promise you that I will not waste it.”

Monica Williams-Murphy is an emergency physician and author of It’s OK to Die.

Radical Tactical Shift

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He swam across the North Pole successfully and thought this was another swim he could perform with the same mindset. Mount Everest, has never failed to bring humility to the masses that have laid their eyes on her. Humility and patience are the important essence in ones life.

After failing his first attempt to swim at 5300m on Everest in a newly formed melting glacier, his team of sherpas told him this, ” Lewis, you need to have a radical tactical shift if you want to do this swim. Everything that you have learned in the past 23 years of swimming, you must forget. Everything that you have learned in the army about speed and aggression, you must put aside. … Instead of swimming fast, swim as slowly as possible ….. remember never ever swim with aggression but with humility.” 

He continues,” Just because something has worked so well in the past, it does not mean its gonna work in the future. Now before I do anything in life, I ask myself, “What type of mindset do I require to successfully complete a task?” “

 

 <iframe src=”http://embed.ted.com/playlists/27/to_boldly_go.html” width=”560″ height=”315″ frameborder=”0″ scrolling=”no” webkitAllowFullScreen mozallowfullscreen allowFullScreen></iframe>

 

Lewis Gordon Pugh loves to pioneer new swimming routes around or between landmarks once thought unswimmable. In 2006, he swam the drought-stricken Thames; also that year he became the first swimmer to do a long-distance swim in all five oceans of the world. The following year, he made the first long-distance swim across the North Pole — where climate change made the ice temporarily disappear. Heading into the second decade of his swimming career, he’s regarded as the greatest cold-water swimmer in history.

His swims have given him a sea-level view of our planet, and inspired him to do his bit to help preserve it. He left a career in maritime law to become a public speaker on environmental issues with his group, Polar Defence Project — and of course to plan more astonishing swims and treks. In September 2008, Pugh and Robbie Hedgus kayaked across the Arctic Ocean into the polar ice pack, to raise awareness of the thinning sea ice and the dangers of climate change in the Arctic and across the world. And at the end of May 2010 he swam 1 kilometer across Pumori, a meltwater lake situated next to the Khumbu Glacier on Mount Everest, at an altitude of 5300 meters, to draw attention to the melting of the Asian glaciers. He completed the swim — the highest any person has undertaken — in less than 23 minutes. “Glaciers are not just ice: they are a lifeline, they provide water to 2 billion people, and we need to protect them,” he says.

 

http://www.ted.com/playlists/27/to_boldly_go.html

I heard about this a few months ago and saw this article in Medscape (Fecal Transplantation for C difficile: A How-To Guide David A. Johnson, MD) and decided to summarize it for easy reading. The issue would be how many of us would be willing recipients…..I guess when one does not have much of a choice then yes….

Before I go into faecal transplant, I must explain a little about Clostridium difficile(C.diff). C. diff is a species of Gram-positive bacteria of the genus Clostridium that causes severe diarrhea and other intestinal disease when competing bacteria in the gut flora have been wiped out by antibiotics. They are anaerobic, spore-forming rods (bacilli).

C. difficile is the most serious cause of antibiotic-associated diarrhea (AAD) and can lead to pseudomembranous colitis, a severe inflammation of the colon, often resulting from eradication of the normal gut flora by antibiotics. When the bacteria are in a colon in which the normal gut flora has been destroyed (usually after a broad-spectrum antibiotic has been used), the gut becomes overrun with C. difficile. This overpopulation is harmful because the bacteria release toxins that can cause bloating and diarrhea, with abdominal pain, which may become severe. C. difficile infections are the most common cause of pseudomembranous colitis, and in rare cases this can progress to toxic megacolon, which can be life-threatening.

Mild cases of C. difficile infection can often be cured by discontinuing the antibiotics responsible. In more serious cases, oral administration of, first, oral metronidazole and — if that fails — then, second, vancomycin and if unsuccessful again, intravenous metronidazole can be used. Relapse occurs in 20-27% of patients treated with metronidazole or vancomycin. Once a patient has one relapse, the risk for a second relapse is 45%. Relapses should be treated as follows:

    First relapse: The choice of antibiotic should be based on the severity of C difficile diarrhea/colitis
    For every relapse beyond the first, vancomycin (prolonged taper/pulsed regimen) is recommended to help clear persistent spores

Biotransplantation has recently come on the scene as a gastrointestinal procedure that can make a meaningful difference in patients with chronic Clostridium difficile infection (CDI).

FMT was used as early as the 4th century for acute diarrhea and food poisoning. Interest in FMT increased in the1980s when FMT was performed through a nasogastric tube. Long before its use in humans, FMT was used in animals, and the veterinarian literature is replete with uses for FMT.

FMT is now used as a treatment for chronic CDI, which has become an incredibly recalcitrant and relapsing disease. There are fairly strong evidence from a study of 77 patients from 5 centers around the country, which showed the effectiveness of FMT to be 91%-98% for achieving either a primary or secondary cure (after FMT, successfully treating patients who relapsed with antibiotics). This study suggests that FMT may be an effective treatment for recalcitrant or relapsing CDI. continue reading…

The Black Telephone

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When I was a young boy, my father had one of the first telephones in our neighborhood. I remember the polished, old case fastened to the Wall. The shiny receiver hung on the side of the box. I was too little to reach the telephone, but used to listen with fascination when my mother talked to it.

Then I discovered that somewhere inside the wonderful device lived an amazing person. Her name was “Information Please” and there was nothing she did not know. Information Please could supply anyone’s number and the correct time.

My personal experience with the genie-in-a-bottle came one day while my mother was visiting a neighbor. Amusing myself at the tool bench in the basement, I whacked my finger with a hammer, the pain was terrible, but there seemed no point in crying because there was no one home to give sympathy.

I walked around the house sucking my throbbing finger, finally arriving at the stairway. The telephone! Quickly, I ran for the footstool in the parlor and dragged it to the landing. Climbing up, I unhooked the receiver in the parlor and held it to my ear.

“Information, please” I said into the mouthpiece just above my head.

A click or two and a small clear voice spoke into my ear. “Information.”

“I hurt my finger…” I wailed into the phone, the tears came readily enough now that I had an audience.

“Isn’t your mother home?” came the question. “Nobody’s home but me,” I blubbered.

“Are you bleeding?” the voice asked. “No,”I replied. “I hit my finger with the hammer and it hurts.”

“Can you open the icebox?” she asked. I said I could.

“Then chip off a little bit of ice and hold it to your finger,” said the voice..

After that, I called “Information Please” for everything. I asked her for help with my geography, and she told me where Philadelphia was. She helped me with my math. She told me my pet chipmunk that I had caught in the park just the day before, would eat fruit and nuts.

Then, there was the time Petey, our pet canary, died. I called, Information Please,” and told her the sad story. She listened, and then said things grown-ups say to soothe a child. But I was not consoled. I asked her, “Why is it that birds should sing so beautifully and bring joy to all families, only to end up as a heap of feathers on the bottom of a cage?”

She must have sensed my deep concern, for she said quietly, “Wayne , always remember that there are other worlds to sing in.”
Somehow I felt better.

Another day I was on the telephone, “Information Please.”

“Information,” said in the now familiar voice. “How do I spell fix?” I asked.
All this took place in a small town in the Pacific Northwest . When I was nine years old, we moved across the country to Boston . I missed my friend very much.

“Information Please” belonged in that old wooden box back home and I somehow never thought of trying the shiny new phone that sat on the table in the hall. As I grew into my teens, the memories of those childhood conversations never really left me..

Often, in moments of doubt and perplexity I would recall the serene sense of security I had then. I appreciated now how patient, understanding, and kind she was to have spent her time on a little boy.

A few years later, on my way west to college, my plane put down in Seattle. I had about a half-hour or so between planes. I spent 15 minutes or so on the phone with my sister, who lived there now. Then without thinking what I was doing, I dialed my hometown operator and said, “Information Please.”

Miraculously, I heard the small, clear voice I knew so well. “Information.”

I hadn’t planned this, but I heard myself saying, “Could you please tell me how to spell fix?”
There was a long pause. Then came the soft spoken answer, “I guess your finger must have healed by now.”

I laughed, “So it’s really you,” I said. “I wonder if you have any idea how much you meant to me during that time?”
“I wonder,” she said, “if you know how much your call meant to me.”

“I never had any children and I used to look forward to your calls.”
I told her how often I had thought of her over the years and I asked if I could call her again when I came back to visit my sister.
“Please do,” she said. “Just ask for Sally.”

Three months later I was back in Seattle. A different voice answered, “Information.”
I asked for Sally.

“Are you a friend?” she said. “Yes, a very old friend,” I answered.

“I’m sorry to have to tell you this, “She said. “Sally had been working part time the last few years because she was sick. She died five weeks ago.”
Before I could hang up, she said, “Wait a minute, did you say your name was Wayne ?” ”

“Yes.” I answered. Well, Sally left a message for you.
She wrote it down in case you called. “Let me read it to you.”

The note said,

“Tell him there are other worlds to sing in. He’ll know what I mean.”
I thanked her and hung up. I knew what Sally meant. Never underestimate the impression you may make on others..

A Visit From Wisdom

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In the stillness of night Wisdom came and stood
By my bed. She gazed upon me like a tender mother
And wiped away my tears, and said : ‘I have heard
The cry of your spirit and I am come to comfort it.
Open your heart to me and I shall fill it with light.
Ask of me and I shall show you the way of truth.’

And I said : ‘Who am I, Wisdom, and how came
I to this frightening place? What manner of things
Are these mighty hopes and these many books and
Strange patterns ? What are these thoughts that pass
As doves in flight? And these words composed by
Desire and sung by delight, what are they? What are
These conclusions, grievous and joyous, that embrace
My spirit and envelop my heart? And those
Eyes which look at me seeing into my depths and
Fleeing from my sorrows ? And those voices mourning
My days and chanting my littleness, what are they ?

‘What is this youth that plays with my desires
And mocks at my longings, forgetful of yesterday’s
Deeds, rejoicing in paltry things of the moment,
Scornful of the morrow’s coming?

‘What is this world that leads me whither I know
Not, standing with me in despising? And this earth
That opens wide its mouth to swallow bodies and
Lets evil things to dwell on its breast? What is this
Creature that is satisfied with the love of fortune,
Whilst beyond its union is the pit? Who seeks Life’s
Kiss whilst Death does smite him, and brings the
Pleasure of a minute with a year of repentance, and
Gives himself to slumber the while dreams call him?
What is he who flows with the rivers of folly to the
Sea of darkness? O Wisdom, what manner of things
Are these?’

And she answered, saying :
‘You would see, human creature, this world
Through the eyes of a god. And you would seek to
Know the secrets of the hereafter with the thinking
Of men. Yet in truth is this the height of folly.
‘Go you to the wild places and you shall find
There the bee above the flowers and behold the eagle
Swooping down on his prey. Go you into your neighbor’s
House and see then the child blinking at the
Firelight and his mother busied at her household
Tasks. Be you like the bee and spend not the days of
Spring looking on the eagle’s doing. Be as the child
And rejoice in the firelight and heed not your Mother’s affairs. All that you see with your eyes was And is for your sake.

‘The many books and the strange patterns and
Beautiful thoughts are the shades of those spirits
That came ere you were come. The words that you
Do weave are a bond between you and your brothers.
The conclusions, grievous and joyous, are the
Seeds that the past did scatter in the field of the
Spirit to be reaped by the future. That youth who
Plays with your desires is he who will open the door
Of your heart to let enter the light. This earth with
The ever open mouth is the savior of your spirit from
The body’s slavery. This world which walks with
You is your heart; and your heart is all that you
Think that world. This creature whom you see as
Ignorant and small is the same who has come from
God’s side to learn pity through sadness, and knowledge
By way of darkness.’

Then Wisdom put her hand on my burning brow
And said:
‘Go then forward and do not tarry, for before walks Perfection. Go, and have not fear of thorns
On the path, for they deem naught lawful save Corrupted blood.’

Khalil Gibran

A Tear & A Smile

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I would not exchange the sorrows of my heart
For the joys of the multitude.
And I would not have the tears that sadness makes
To flow from my every part turn into laughter.

I would that my life remain a tear and a smile.

A tear to purify my heart and give me understanding
Of life’s secrets and hidden things.
A smile to draw me nigh to the sons of my kind and
To be a symbol of my glorification of the gods.

A tear to unite me with those of broken heart;
A smile to be a sign of my joy in existence.

I would rather that I died in yearning and longing than that I live Weary and despairing.

I want the hunger for love and beauty to be in the
Depths of my spirit,for I have seen those who are
Satisfied the most wretched of people.
I have heard the sigh of those in yearning and Longing, and it is sweeter than the sweetest melody.

With evening’s coming the flower folds her petals
And sleeps, embracing her longing.
At morning’s approach she opens her lips to meet
The sun’s kiss.

The life of a flower is longing and fulfillment.
A tear and a smile.

The waters of the sea become vapor and rise and come
Together and area cloud.

And the cloud floats above the hills and valleys
Until it meets the gentle breeze, then falls weeping
To the fields and joins with brooks and rivers to Return to the sea, its home.

The life of clouds is a parting and a meeting.
A tear and a smile.

And so does the spirit become separated from
The greater spirit to move in the world of matter
And pass as a cloud over the mountain of sorrow
And the plains of joy to meet the breeze of death
And return whence it came.

To the ocean of Love and Beauty—-to God.

Khalil Gibran

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