Ruined by Reality

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“I’m sorry but the image of a naked baby flying around shooting an arrow into the heart of someone just doesn’t really make me want to fall in love,” I said. It was Valentine’s Day and we had just been seated at Cafe’ Normandie, our favorite French restaurant.

The lighting was low and a fire was burning in the fireplace. As the waiter served the first wine course I sat staring at the card my wife had given me.

“Way to ruin a perfect moment,” she finally said after staring at the ceiling in exasperation.


“I’m sorry, Honey. But when I think of being shot in the heart, I think of, you know,” then in a whisper, “being shot in the heart.”

She squinched up her face as if she’d just bitten into a lemon.

“I have to admit, though, it was pretty cool the first time I did a thorocotomy in the ED,” I continued, oblivious to her expression. “You know, it’s just one giant incision from the axilla all the way to the sternum. You insert your finger in one end of the incision and in one sweeping movement you can blunt dissect through the entire length of the intercostal muscles exposing the pleura. Open the pleura, crank on the rib retractors, and presto, you have the whole chest cavity open to you.” I thought of continuing my dinner time didactic but I emerged from my reminiscing to see my wife shaking her head and hands at the same time. At first I thought it was some weird tremor. But then I realized she was trying to give me the discreet signal to ‘knock it off’. She pointed with her head at the couple seated insanely close to us. The gentleman had just been served something that resembled a bloody lung and his face was pale, even in the low light.


“Sorry,” I whispered. “Do you think he heard me?”

My wife just shook her head in resignation. I’m not sure whether it meant ‘It’s ok’ or ‘You’re such a moron’. I went with the former.

“Are you ready to order,” the pouty waiter said, appearing nonplussed by the whole scene.

“Yes,” my wife responded without waiting for me. “We’ll have the chateaubriand steak for two.”


“Isn’t that just sort of a roast?” I asked.

“And a vegetable, ma’am?” the waiter proceeded, pretending that I wasn’t there.

“Yes, the broccoli, please,” she said with a maternal authority.

“I thought it already came with potatoes,” I protested to no one in particular. Which was appropriate, since no one was listening.

“Do you remember the first time we went to a french restaurant?” she finally said, trying to move the conversation back to the topic du jour.

“Yes,” I recalled with a wistful smile. “I had just been accepted to medical school.”

“That’s right.”

I beamed at my first score of the evening.

“And now you have a son-in-law who is in medical school. So what have you learned in the last 40 years . . . besides how to (whispering) cut open someone’s chest?”

“Hmm,” I sighed. She had a way of asking The Question. “I’ve learned that life is hard and messy.”

“And how so, my dear,” she said with a twinkle in her eye as she sipped her wine. Her face in the candlelight reminded me of why I had asked her to marry me.

“Ask JD. He studied 60 hours a week to get into medical school only to study 80 hours a week just to survive in medical school. And when he gets out he’ll work Lord knows how many hours in residency. If he’d known how hard it really was going to be before he got in, he might not have done it.”

“Isn’t that true of everything worth doing? Would we have had children if we had known that the first two would end up doing stints in the PICU? Those weeks scared me to death and put years on my life.”

“I celebrated my 30th birthday in that PICU waiting room.  All I wanted for a present was an increase in his pulse ox.”  We both sighed deeply as we looked at each other silently.

Just then multiple waiters reappeared with beautiful platters of meat and vegetables.

“I’ll bet if everyone had to see the brutality of killing a cow, skinning it and cutting it into pieces to get this beautiful piece of meat, they would never be able to eat it.”

My comment seemed to take the wind out of our tableside ballet and our servers became a trio of bumbling clowns. Mr. Pouty shot a look at my wife. I probably could have done without that comment, I thought.

Yes, you probably could have done without that comment, my wife’s mind echoed.

One step forward. Five steps back.

“Hey, would you have married an ER doc if you had known about all the nights, weekends and holidays I’d have to be gone? If you had known all the kids games I was going to miss? Would you have married me?” I paused, questioning whether to continue. “If you had know that I would be gone 180 nights a year?”

“It’s had its benefits,” she said with a little smirk.

I tried to give her a hurt look, but laughed instead. “Seriously,” I continued, taking her hand. “I see so many people in the ER who seem out of touch with reality.  They smoke two packs a day for twenty years and then they’re surprised when they develop lung disease. They have no dietary discipline and yet they don’t understand why they are obese. And I guess the biggest dreamers are the ones who think that lust is going to last and seem surprised when the boyfriend brings an STD home. It’s like some fairy godmother is going to sprinkle moon dust over them and they will stay madly in love forever. Nobody thinks that love is a lot of hard work.”

“Hard work,” she said with mock seriousness.

“Nobody thinks that there are going to be good days and bad days,” I preached on.

“That’s right. Good decades and bad decades.”

“People always seem surprised when they ask me ‘Is this going to hurt’? and I tell them ‘It sure will’. It’s going to hurt like hell to drain all that nasty pus out of the boil on your butt.” The man at the next table over shot me another sickened look.

My wife was wagging her head again. “I can take you out of the ER, but I can’t take the ER out of you, can I?”

“I guess not,” I said, suddenly seeing only her in the crowded restaurant. “You know what I’ve learned after all these years in emergency medicine. I’ve learned that I can live with reality. Yeah, there’s going to be a lot of pain. People are going to get sick and injured. Sometimes I’m going to be able to help them. And sometimes I’m not. Sometimes they are going to go home and get well. And sometimes they are going to just die. Sometimes I’m going to love what I do and sometimes I won’t.”

“And what about us?” she said, suddenly serious and peering straight inside of me. “Do you still love the reality of what we’re doing here?”

“Let me put it this way, sweetheart. I’m a lot like that ugly old couch of ours. If you are ever expecting me to be rid of me, you’re going to have to have me hauled off.”

She paused. “Now that was romantic.”

Photo by Eva Blue.


FOUNDER/EXECUTIVE EDITOR Dr. Plaster has been an emergency physician for more than 30 years, working exclusively night shifts for the past 20 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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