A little more crazy than I was back then...

 When I’ve been going for days on end with little sleep and too much work.  When I’ve been getting yelled at by an asshole resident who wants to blame a medical student for not making them look good.  And when I feel I don’t have nearly enough time to study all the mountains of material I need to wade through, I sometimes wonder how I got here.

I am what the medical school admission committees refer to as “a non-traditional student.” This is their nice way of recognizing that some students didn’t go into medical school directly out of college when they were 22 years old. The way they like to think of it, some people can bring real life experience to the class. The way I like to think of it, I just didn’t have my shit together as much as most of my classmates when I was their age.

The people who enter medical school right out of college are usually people who always knew they wanted to be a doctor. They worked hard in high school so they could go to a good college, worked hard in college so they could get into a good medical school. I had no such discipline when I was younger. Out of 300 people in my high school class, I graduated #279, with a D average. After that, I knew college wasn’t really a feasible step quite yet. I could try it, but I would have failed out the first semester and never went back. I thought about taking “a year off” and just working for a bit and traveling on my own for a while to see where I wound up, but then I looked at my older friends who were in their mid-20’s. All of them had “taken a year off” as well, and there they were, 6 years later, still working dead end jobs with no real prospects of going anywhere. I didn’t want to wind up like that.

So I joined the Air Force reserves. One of the first questions the recruiter asked me was “what kind of work do you want to do?”. They were pushing for me to go into something called “Combat Control”, which is where you parachute into a combat zone with a little radar on your back and pretend like you are an air traffic controller while everyone else tries to shoot you. That didn’t sound like too much fun. In fact, I wanted to have a military job where people weren’t technically allowed to shoot at me. There are only 2 jobs that I know of which fall under that category: chaplains and medics. And since I was raised Unitarian Universalist, the idea of huddling over wounded soldiers with a bible in my hand didn’t seem nearly as practical to me as huddling over them with an I.V. bag. So medic it was.

I moved into the air force life and spent a year being trained in the basics of medical field work. It was a rough year for me. I was never cut out to be in the military, and being a rather angry, angst filled teenager just out of high school didn’t make things any easier. And when I got back, I thought I was finally done with all my training and could go on with a real life when the Air Force kindly told me that in fact, it had forgotten to mention that I still had 4 more months of training to do, and that instead of starting college (I was planning on majoring in history) I would spending the fall of 1996 working at the hospital on the Air Force Academy. So college was put off for another semester, and I started my first job working in the hospital.

I was a 19 year old medic working in a military emergency room (this was back before Tri-care, and the Air Force Academy actually had a real emergency room there). I found it ironic that I was apparently old enough to walk around a hospital handing out high end narcotics to my patients, but not old enough to order a beer.

Working in the emergency room wasn’t technically my first job, but it was my first real job. Before then I’d done some under the table work for my father, and lasted a week or so as a janitor at the McFrugal’s discount store. But it was in the emergency room that I really first learned about the importance of personal discipline and responsibility.

At 19 years old you are still very impressionable when it comes to those you look up to. No matter how cynical and hardened we like to pretend we are at that age, the truth is we haven’t been around to get hurt enough times to really be that wisened. Which is why it’s very important to try and be a good role model to people at that age, because they haven’t really learned to doubt you yet, so even little things you say can have a major impact on their lives. As was the case with me and Dr. Greeno.

As I remember him now, Dr. Greeno was a funny looking little man. He was short, around 5’5”, his white coat came down well past his knees. He wore thick horn rimmed glasses and wet comb-over hair. His white coat was always white, though often stained, and his uniform was among the worst I ever saw. He always just pulled it right from the clothes drier and never bothered with ironing his shirts or polishing his boots. Dr. Greeno had better things to do with his time.

Working that job for a few months was to become a major event in my life. For the first time, I worked as a member of a team who’s goal was to make people feel better. Whether they were in a car accident, victims of violence, injured in battle or just had the stomach flu, we were there for 12 hour shifts, working together. It took a few weeks for the rest of the crew to really accept a reservist teenager into their ranks, but once they found out that I would try anything as long as they were willing to teach, the night shift crew took me under their wing and taught me how to really be a medic, which was a lot different than the training I had just spent a year going through.

I was working one evening in early November, when we got called to the dorms for two patients that had been “drinking too much”. A couple of my crewmates went out in an ambulance and picked them up, and we were dreading the return. Military alcoholics can be a real pain in the ass to work with on a Friday night, and none of us were really in the mood to wrestle anyone. But when the crew returned and dropped two nearly comatose men onto beds in the ER, we were relieved that these people were so drunk they had nearly passed out. They weren’t angry, raging drunks who wanted to scream and start fights, they would have been totally happy just going to sleep and having the rest of the world leave them alone.

Which was our first clue something wasn’t right. If they were passive and compliant drunks who just wanted to sleep it off in the dorms, why did someone call for an ambulance?

The crew divided into two teams, one for each patient, and we raced to set our respective patients up for monitoring and blood draws before we introduced the case to the doctor Greeno.

My partner and I were trying to put in an I.V., get a rectal temperature, draw blood and put the patient on oxygen and a heart monitor all at the same time when I started getting the feeling that something just wasn’t adding up. This guy was out of it, fighting off our I.V., but he wasn’t doing it like a drunk would, with curses and slobbering bullshit. He wasn’t saying anything, he was too out of it to talk. He was just reflexively jerking his arm away in response to pain. We drew a blood alcohol test on him, and I wasn’t terribly surprised to find that his blood alcohol level was .08 (this is the legal limit in DC, and under the legal limit in Colorado). He was drunk, but he wasn’t so drunk that he couldn’t talk to us.

Something else had to be going on. But while the techs all turned to Dr. Greeno for guidance, I decided I’d rather see if I could figure out on my own what was going on. To help us do the paperwork, we needed to find out who these two guys were. So after we’d changed them into hospital gowns, I grabbed their wallets to look for their respective military ID cards (keep in mind here that at this point, it was fairly common practice among the technicians to steal the money out of the wallets of the annoying drunks who couldn’t tell us their names).

And there, when I opened up the wallet of Patient A, the first thing I noticed was a small fold-up calendar. Written on that day’s entry were the words “appointment at 2:00 with Doctor Bethany, room 3C”. I knew who Dr. Bethany was, she was one of the psychiatrists at the mental health unit. And then, tucked beneath the fold up calendar, I saw a picture of a naked man in the plastic photo holder. Not expecting this, I sat there stunned for a second by the awkwardness of finding gay porn in my patient’s wallet. But then, when I looked at the picture, something about it rang a bell in the back of my head. The naked guy in the picture looked familiar somehow.

I opened up the wallet of Patient B and there was another picture of a different naked man, again who looked somehow familiar. It took me a minute to recognize them, but when I lined the pictures up with the respective military IDs, I figured out what was going on.

And of course at just this time, Dr. Greeno walked into the patient room and saw me going through the wallets of our patients, with gay porn strung out on the table before me.

“Uh…Jarrad? You want to tell me what you are doing?”

“I think I may have figured out what’s going on here, Doc.” I handed him the photographs, “This is patient A’s wallet, complete with a naked picture of patient B. And this is patient B’s wallet, which had the naked picture of patient A. In patient A’s wallet is a calendar telling us that he had an appointment with mental health today. My guess is, these guys are gay lovers who don’t like the fact that they have to hide their love for each other in the military. The stress is messing with them and patient A is on medication for it. I get the feeling that this isn’t a night of rough drinking, it just doesn’t add up. This is something else. Maybe a suicide pact or something.”

To his credit, Dr. Greeno didn’t just dismiss the inane babbling of the 19 year old rookie, but looked at the pictures, looked at the calendar, and looked at the lab results from the blood tests we had just gotten back. All this he did without saying a word. He looked at both of the patients laying in their respective beds, both just now starting to come into consciousness again. Then he said to me, “Take those pictures and throw them away. During cases of suicide attempts we have to call in the office of special investigations, so these guys are going to be in enough trouble as it is. They don’t need to get shit for being gay too. Get a nasogastric tube in each of them with some activated charcoal. I’ll make the call to the O.S.I. Don’t tell anyone what you found.” And he left the room.

We went about our jobs as if we’d never had this conversation. It was a busy night and we didn’t have a chance to talk again. It turns out that my guess was right. Patient A had gotten his prescription that day of valium, and the two of them had decided to die together since one of them was about to be stationed somewhere else and they didn’t want to leave each other. It all sounds hopelessly melodramatic now, but doesn’t everything when you’re 19? Between the two of them they had taken an entire bottle of valium along with whatever other pills they had laying around the house, and washed it down with whiskey.

I wasn’t scheduled to work with Dr. Greeno again for a week, but when we did, it was a slow night and he pulled me out of the hallway for a minute and into the back office. “Jarrad, I wanted to tell you the other night that you did a good job. I’ve been watching how you work with patients and how you are willing to learn the job and think outside the box. And I can tell that you are still new at this. But I can also tell that you are going to be good at this job, Jarrad.”

“Thanks, Doc. That’s nice of you to say.”

“You know why you’re going to be good at this?”

“No. Why do you say that?”

“It’s not because you’re smart, or can think outside the box. You’re going to be good at this because you are just a little bit crazy. And in order to be good in the emergency room, that’s exactly what you need to be. A little bit crazy.”

“Oh…Uh…thanks.”

I didn’t know what else to say. He’d just complimented me, but told me I was crazy at the same time. What are you supposed to say to that, especially at 19? Dr. Greeno, wherever he is today, probably doesn’t remember me at all, but he’ll stick out in my memory as the first person who ever encouraged me to go into medicine as a career, not just something on the side while I tried college life. It was the first time that I thought I could really learn to enjoy this work.

I didn’t think much of this incident at the time. I chalked it up to another one of those weird things you see in the ER at night and let it go. But when I look back on this episode, what strikes me most is that Dr. Greeno had me throw the pictures away. When all the other emergency doctors and nurses I worked under took pride in their nonchalant attitude towards the silly patient, Dr. Greeno actually cared enough to try and help them hide something that would have had them kicked out of the military. He saw the problem coming up and dealt with it in what was no doubt an illegal way, as he was hiding information relevant to the case, but one which would help the patients in the long run. Doing something like that takes a certain kind of compassion that you don’t see often in emergency medicine.

It was after that when I started thinking that instead of just going to college to learn some basics and maybe major in history, I should think about going into medicine. But it would be years yet before I’d have the confidence in myself to think about medical school. I enrolled the next semester at a community college with the thought of going into nursing. As it turned out, life had other plans for me and I was derailed in my education for a bit and wound up getting a degree in philosophy. When it came time to go back and try to go into nursing, something in the back of my head just wouldn’t let go of the idea that I could go further than nursing. I didn’t want to be a nurse, I wanted to be an emergency room doctor.

And now here I am, looking at the massive book I’m supposed to memorize and wondering why my patient keeps having abdominal pain and I start to feel completely overwhelmed, I start to think, “Maybe I’m just a little bit crazy.”