Dreaded Phone Calls

John P Erwin III MD

“John, um, this is Jim.  Little Jim has been, um, hit by an IED in Afghanistan {Soft sobs} …and it’s not looking good…”

These were the words that abruptly woke me up post-call on New Year’s Day in 2010.  As a cardiologist with many years of experience of being woken up to phone calls at all times of the day and night to respond to emergencies, this one made me momentarily speechless. I was seeing images of Little Jim growing up in our small community, going off to West Point, and marrying his high school sweetheart contrasted by images of my friend’s little boy being ripped apart by some God-forsaken bomb and now laying in some distant field with frantic medics rushing to save him.  His face…his son’s face, at that moment was also my little boy’s face in my head.

“John, are you still there?  Can you hear me?”

This shook me to my senses and helped my brain to re-engage with my mouth.  Sort of…

“Yeah, Jimmy, I’m here.  What are his vital signs? What are his injuries?  Where is he right now?”

What a ridiculous thing to say, but they were things that my physician’s mind had trained ceaselessly to go to in times of crisis.  The initial questions only increased this poor father’s angst to a higher level and induced more sobs – the types of grown-men sobs that will rip a heart right out of one’s chest. {Okay, John.  Get it together. You need to be there for him}

“I’m so sorry, Jimmy.  What do you know for sure?  I’m dressing right now to come over as we speak.  We’re going to get through this together, buddy.  Hey, man, I love you.”

I will someday relay the epic yet beautiful story that unfolds from this tragedy, but my focus today as we embark on a new year is upon inner peace.  Given that Jim is a retired Army Colonel, he later asked that we “have a de-brief over how I helped him” during those bleak hours, days, weeks, and months.  While I was very critical of my initial response, I was thankful that the only thing that he really remembered of it was me telling him that I loved him and that we would get through it together.  Truly, this is the basis of all supportive interactions and the presence that we need to have in times of crisis.

I’ve had young trainees ask me how I kept so calm in the midst of medical emergencies or while being berated by an emotionally hurting patient or family member.  Clearly, we need to have rigorous training and preparation to develop the confidence to know that we’re doing all that can reasonably be done in the best way possible.  In addition, all who know me understand that my Faith brings me great inner peace. This “Peace that passes all understanding” that I’ve fostered through my Christian Faith journey is a great strength to me.  I’ve found that the time between panic and peace is in inverse proportion the strength of my Faith at any given time, having prepared my heart and head with things eternal.  I’ll write more deeply on that subject at another time, but there are tenets of many faiths that help to foster inner peace.  Many of my agnostic or atheist friends who exhibit the ability to keep inner peace utilize practical steps that can be found here

All of us, in our own time have taken phone calls like I’ve described above and likely we’ll receive one or more equally tragic calls that will take us to our knees and remove the wind from our chests at some point again in the future. Knowing this, let us resolve to gain strength through presence, faith, and mindfulness exercise and keep these these two things in perspective:

  1.  “Anxiety does not empty tomorrow of its sorrows, but only empties today of its strength.” — Charles Spurgeon
  2. The storms of life are inevitable, but we can prepare ourselves to determine whether they will topple us or whether we will withstand them with a peaceful heart.

In 1939, King George VI addressed his war-worried nation with the following:

“A new year is at hand. We cannot tell what it will bring. If it brings peace, how thankful we shall all be. If it brings us continued struggle, we shall remain undaunted.”

He then turned to some lines of poetry by Minnie Louise Haskins:

“The Gate of the Year”

I said to the man who stood at the gate of the year “Give me a light that I may tread safely into the unknown.”

And he replied, “Go into the darkness and put your hand into the hand of God. That shall be to you better than light and safer than a known way!”

My friends, I pray blessings for each of you to have the happiest of New Years and to gain the resolve to not only persevere, but to flourish with whatever the new year brings our way! Godspeed.

6 thoughts on “Dreaded Phone Calls”

  1. Hi John! It’s been a while since we’ve communicated.

    Kinda’ reminded of the song popularized by songstress Anne Murray in 1983, which was entitled “A Little Good News,” which lyric in part was “We sure could use a little good news today.” I write “popularized,” because “A Little Good News” was written by Charles Frank Black, Rory Michael Bourke and Thomas Rocco, but it was Anne Murray’s expressive performance which forever made it her song – much like Johnny Cash owned, per se, the song “Hurt” by the group Nine Inch Nails.

    Anne’s Grammy Award-Winning performance on ALGN for Best Female Country Vocal, was also the County Music Association’s Single of the Year with the album of the same name, which also won CMA’s coveted Album of the Year award. And it was with that album that Anne Murray became the first woman to win the CMA Album of the Year.

    But I don’t much listen to commercial radio these days. If I do listen to broadcast radio, it’s while in my vehicle, and to a local Americana-format public radio station on the campus of one of the numerous universities in the area. But I also listen online, and to the Royal Amsterdam Concertgebouw Orchestra, just as much as I listen to Leadbelly, or something else that most folks don’t listen to… just because it’s good, and just because I don’t like being “told” what I should listen to by programmers. I can, and do that job well enough myself. I do think, however, that the old school “block format” stations could enjoy a significant resurgence in popularity if done properly.

    Nevertheless… I just heard from one my friends, the better half of a couple in Germany, whose spouse is on active duty as a Medic with a Special Forces Unit. Diana said Caleb broke his ankle, which will require surgery. She and their young son flew to be with him over the holidaze. What a New Year’s surprise, eh? Someone asked me, “How’d that happen?” To which I replied, “The usual way.” 🙂 I was wondering what the New Year would hold for us, seeing that they are way ahead of us. So far, it’s not looking good. At least as far as he’s concerned. But, he’s getting the best that our tax dollars can give. Which also begs the question, “If our military service members and their families get healthcare because it’s good for national security and readiness, why doesn’t our workforce get it too?”

    A peer, whose daughter’s firstborn 1yo (grandchild to her & great grandchild to her mom, also my friend) has wound up in critical care is suspected of having e.coli infection. What a crapper, eh? He’s on dialysis – not sure what kind – maybe CVVHD. But, lil’ Cedar is making progress, and the G and ET tubes have been removed. Children are resilient! They’re just waiting for his kidneys to start back up. So, here’s hoping.

    I recollect asking once, a surgeon with whom I worked, how he maintained his composure in difficult cases. His response was so unremarkable, that I don’t recollect his answer. I do recollect, however, how I later hid myself and wept bitterly after we’d given a nubile young female a colonoscopy in prep for a total pelvic exenteration. The condyloma completely covered her perineum and vulva. I wondered how she would cope with the emotional trauma that would inevitably take its toll upon her life, and quite possibly even cause her to take her own life.

    And then, I recollect how, in the L1 Trauma Unit the mother whose only son was a murder victim looked me in the eyes and communicated volumes without saying a word. As I went behind the curtains in an empty bay to weep, I wondered – was that how Mother Mary felt when she glanced upon her only son whose lifeless, limp, tortured body hanged from a gibbet?

    Where’d all this come from, eh? I’d not even meant to write any of that, save for the first two paragraphs.

    Even though I’ve taken the tough assignments, the ones no one else wanted, or would take, I bore up. I drove myself like a slave-driver – two, three separate curricula in as many institutions concurrently. And somehow, I never did the “freak out” under pressure. I’ve always known what to do, gave orders, was clear-headed, knowing what to do – even in the midst of community disaster – until I was diagnosed w PTSD following extensive involvement in the successful resuscitation of my patient… who later died – but NOT on my watch! I have a perfect record in that regard. It’s a very odd feeling to “freak out” when the cell phone rings. Perplexing, even. I could make phone calls, but couldn’t receive them. Weird, eh? And I told the psych, “all I want to know is why I responded the way I did.” That a-hole condescendingly said to me, “I cannot divine for you that answer.” Ooooh! I wanted to wring the mofo’s neck until his wretched life seeped from his eyes and ears, and his last gasp for breath and mercy was met with the utter lack of mercy he showed me.

    I don’t even like thinking about it. And even now, I feel my BP rising, my face flushing, and my heart pounding, my breathing shortened… very unpleasant. Very.

    I’d rather think about Shasta daisies, Mission figs and grapefruit in California, walking in cowboy boots in dress clothes in the Pacific, wilderness areas in the Sierras, the sweet smell of spring air at dusk in the San Joaquin Valley, the lush verdant hills and hollers of Tennessee and Alabama. The songs of the brooks, rivers and streams. The fragrances of magnolias, honeysuckles, and wisteria. The Southern pines tart pungency. And the myriad foods and whiskeys we feed ourselves. The people who are NOT like me. Their stories. Their songs. Their lives.

    Thanks for letting me bend your ear. I’ll talk to you later.

    1. Good to hear from you, my friend. As a lifelong fan of both Anne Murray and Johnny Cash, I agree. Another Canadian songstress had another tune that harmonizes with your thoughts. Terri Clark sang a song called “The World Needs a Drink” that was never released as a single. See it here. As I also share eclectic musical taste, I’m well versed with NIN as well! Music is very therapeutic and I prescribe it. We’re hoping to hire a music therapist to our Palliative Team as well.

      We are all flawed and all of our systems have flaws as well. I’ll write about some of that at a later date as well.

      You experiences and your closing paragraph are very moving to me. I’m personally embarrassed even when medical professionals that I know fail to live up to what we need in them. With that said, more often than not, I find those people are almost invariably masking pain of their own and doing a poor job at it rather than reaching for the help that they need for themselves. Your close reminds me of Phillipians 4:8 – “Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable–if anything is excellent or praiseworthy–think about such things.” With that, I’ll close as I cannot give better advice than the Apostle Paul. Happy New Year!

  2. I too have a strong faith in God. I am in a physical fight for my own life. I have been here before. I believe my own struggles have taught me to just ask ” what can I do for you right now”? I’m here for you. And..don’t say I understand how you feel…if you haven’t walked in my shoes.
    Most importantly… If you say you’re praying for me-really do it.

    God never promised us no trouble or pain..but he promised he’d be in the fire with us.

    1. Amen! I keep a prayer journal to ensure that I follow through on prayers that I’ve promised people. I track for outcomes, so keep me updated. My prayers are with you!

    1. My old college football coaches used to tell us that “pain was weakness leaving the body”! While I don’t think this is always the case, it’s a positive way to keep pain in perspective.

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