Night Shift: Four Fathers

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Anyone who has practiced emergency medicine for a few years can sympathize with Keanu Reeves’ epic rant on bad fathers in the movie Parenthood, (“You know, Mrs. Buckman, you need a license to buy a dog. You need a license to drive a car. Hell, you even need a license to catch a fish. But they’ll let any butt-reaming asshole be a father.”)  But I’ve also seen some epic dads and have written about them over the years.  As Father’s Day approaches I like to remember some of these Hall of Famers.

Trust

Though I had to write about this child in fictionalized terms to preserve their privacy under HIPAA, the story I told was completely true.  A very worried young father carried his beautiful little three-year-old girl into the ED.  Moments before they had been playing their usual gleeful game of chase through their house when the child looked back at her father about to catch her and fell striking the coffee table.  It was a history we’ve all heard thousands of times and the injury was the same with a long linear laceration of the eyelid just inferior to the supraorbital rim.


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There was lots of blood, lots of crying by baby and mother and now a fear-filled encounter with a big strange man in a white coat.  “I’ll need to suture that wound closed,” I explained.  (This was before Dermabond.)  “I won’t hurt her.  But I’ll need to restrain her in a papoose in order to keep her still so we can get a good repair.”

He looked at me with the calm of hearing the word “good repair.”  Then he turned to the little girl and looked long into her little trusting eyes.  “The doctor will not hurt you.  I will stay with you and hold your hand.  He will fix your cut and then we can go home to play again,” he said with the slightest smile.

Then turning to me he said in broken English, “You will not need to restrain her.  She will lie still.”


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Oh boy, I thought doubtfully.  I wish I had a dollar for every time I’ve heard that.  But this time I decided to try it.  As I prepared the tray I watched him place her carefully on the gurney while talking to softly and reassuringly.  “Lie still and close your eye.  I will hold your hand,” he said as he took her tiny hand in his.  And that’s what she did.  To my amazement the procedure went off without a hitch.  Only twice did she open her eye to look at his.  When we were done and he took her back into his arms, she took his face in her tiny hands and said with that same faint smile, “Can we go home and play?”

Empathy

Another day that looms large in my memory was a guy who I will admit I judged prematurely.  At first glance he struck me as a tough Hell’s Angels biker.  A bandana barely obscuring his spiked hair, scruffy beard, big belly, multiple piercings and tattoos.  But he wasn’t the patient.  Rather he was there with his son, a six-year-old mini-me version complete with the same outfit and hair.  Only his tattoos were from the toy store.  His son had a broken wrist from falling off a skateboard.

I explained that I would be casting his wrist after a very minor quick reduction.  “You’re not going to hurt him, are you?” he asked with a somewhat dark, almost threatening expression.

“Not much,” I reassured him.  “And it will be quick.”  I didn’t want to get on the bad side of this guy.


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Sure to my word, the reduction was quick, but the child was tougher than I expected and only grimaced and whimpered slightly with the pain.  But when I turned to check on the dad, I was surprised to see big tears welling up in his eyes as he tightened every bulging muscle in his body.

After the casting I returned to the room to give him the home-going instructions, but found mom with the boy instead.  “Is your husband OK?” I asked.

“Oh, he’s not the boy’s dad,” she said casually dismissing the idea.  “He just lives in the neighborhood.  In fact we aren’t even dating.  He just started taking care of my son when his father left.  I don’t know what I’d do without him.  He’s more of a dad to my son than his old man ever was.  He once told me that his father abandoned him at about the same age as my son.  And he swore that no kid should ever go through that alone.”

As I returned to the nurses’ station I could see the “tough guy” sitting in the waiting room pale and sweaty with a concerned look on his face.  But that all changed when his “little man” came out with big smiles and wanted a high-five…and an ice cream cone.

Sacrifice

Not everyone who went to war in Iraq and Afghanistan were young hard charging 20-year-olds.  There were more than a few men, officers and enlisted who were old enough to be their fathers.  One such “old man,” as we were frequently called, was brought in by his “boys” in a screaming convoy.  The “Gunny,” short for Gunnery Sergeant, had been at the wheel of a HumVee transporting a group of Marines through town when their vehicle was stopped by a crowd of boys running in front of the vehicle.

Safety protocol called for the vehicles to never stop.  But these boys had gotten used to US soldiers giving them candy from their MRE rations.  Rather than run over the boys, the Gunny had slowed to a walk.  “One of those kids tossed a grenade into the HumVee almost in Gunny’s lap” a Lance Corporal shouted breathlessly as they raced into the Shock Trauma Platoon carrying their wounded leader. “But Gunny knocked it to the floor.”

“He held it under the dash with his foot until it exploded,” shouted another.

A large portion of the Sergeant’s foot was gone and the rest was a bloody mangled mess.

“I thought we were all going to die.  But Gunny saved us,” said another seeming to fight back tears.  “He blew his foot off.  And the first words out of his mouth after the explosion was ‘Is everyone OK?’”

“Is there anything left of my foot, doc?” the Gunny said calmly through gritted teeth.

“Not much,” I replied.

“My kids back home are expecting me to still play softball with them.”

“Yeah, he’s a really good softball player,” they all seemed to say in unison.

“I think the guys at Bethesda have some pretty cool prostheses,” I said.

“See, boys,” the Gunny said reassuring his Marines.  “Everything is going to be cool. Nothing to worry about here.”  You could feel the tension in the room ease with those words of reassurance.

I’ve thought a lot about that guy over the years.  He probably should have gotten the Medal of Honor for sacrificing his foot to save those in his vehicle.  But I think he got something far more precious to him.  The lifelong love and respect from the young men he called his ‘boys.’

Leadership

Speaking of Medals of Honor, the memory of this man will never leave me.  He was brought in by ambulance gasping as if for his last breath.  His history was end stage COPD.  He had been intubated many times for astronomical CO2 retention.  As I prepared to intubate him again, he reached out his bony hand and put it on mine and mouth the words, ‘No thank you.’

“What’s he saying,” I asked incredulously to his grown son who arrived to stand at his side.  He’s going to die if I don’t tube him.”

“He knows that, but it’s OK,” his son said with calm resignation.  “The last time he was on a ventilator, he was in the ICU a long time.  He could see that it was really tough on my mom.  And the bills were astronomical.  He made the decision not to go that way again.  He knows it won’t change the outcome.”

“Is he depressed?”  I asked.  “Does he want to end his life?”

The man put his hand back on mine and looked with kindness into my face and mouthed “No, no (gasp), I’ve had a (gasp) wonderful life.”

“Then why did he come to the ER?” I said with some frustration showing.

“He told me that when it ‘came time’ to call the ambulance,” his son said.  “He didn’t want mom to have to watch him die.  He thought it might be ugly and too much for her.”

“Are you sure about this?” I asked turning to the man with a deep sigh.

That’s when he smiled gently, placed his hand on mine reassuringly, winked at me…and died.

Approaching his wife with the news of his death I found her surrounded by friends and family already celebrating the life of a truly great man.

“I always knew he taught me how to live,” said his son.  “But now I know he taught me how to die.”

Yes, Keanu, there are a lot of bad fathers out there.  And we’ve seen the results of their failures.  But there is also hope every Father’s Day.  We’ve seen that too.

ABOUT THE AUTHOR

FOUNDER / EXECUTIVE EDITOR Dr. Plaster has been an emergency physician for more than thirty years, working exclusively night shifts for the past twenty years in emergency departments across the country. During that period he joined the U.S. Navy and served two tours in Iraq. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly and the founder of Plaster Publishing.

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