Laugh, Smile, Cry

Emergency medicine will make you laugh, or it will make you cry. Sometimes you cry after laughing. Sometimes you cry because you're laughing so much. Sometimes you just cry. Between the stress of waiting rooms filled with patients, critically ill patients brought in by paramedics, an ever-beeping alarm indicating the 83-year-old in room 3's heart rate is >110 flashing on the computer screens, unit clerks clarifying orders that are unclear or illegible, phones ringing with consulting physicians, and nurses and patients alike trying to snag your attention to answer one last question or just request an extra blanket or glass of water.

The chairman of emergency medicine at Wright State, Dr. Glenn Hamilton, taught us as eager fourth-year medical students, anxious to enter the field of emergency medicine that an "emergency" is "defined by the perception of the patient who comes or the people who bring the patient to the emergency department (Emergency Medicine: An Approach to Clinical Problem-Solving, Second Edition)." At my hospital, patients write their chief complaint on a form as they check in to triage. As a first-year intern, I was working with Dr. Thomas Elson who pulled me aside for some one-on-one teaching. "Come see this patient with me." He said with a smile. Dr. Elson always smiled. Few attending physicians have the innate ability to laugh in the midst of a busy shift, but Dr. Elson had that gift, taking time to laugh, smile and encourage us as residents and the emergency department staff even on the kinds of days when as many patients were waiting to be seen as we have rooms in our department.

I was struck by the wait time listed on our tracking board for the patients as I stood up to follow Dr. Elson to room 22. The gentleman had waited nine-and-a-half hours. His complaint was listed as "other" by the nursing staff. Apparently, "My ankles are too thin!" is not in our database as prefabricated common complaints. After taking a laxative in the morning, he felt his usually edematous (swollen) ankles were too thin. Needless to say, after his nearly ten hour stay, he was glad to see a physician and was reassured he could be safely discharged to the care of his primary care physician. We encouraged the worried gentleman that he did not need admitted to the hospital and was not in any imminent life threat because of his newly skinny ankles. Rarely have I seen a more relieved patient leave our emergency patient, a wide grin crossed his face as Dr. Elson shook his hand thanking him for his patience on a busy day.

For a harried intern, the chance to see one of attending physicians enjoy life, take time to laugh, and share that joy with others was a powerful lesson. When I'd run into Dr. Elson at the local Italian eatery, picking up a pizza in my scrubs, trying to run home and spend some time with my wife, Dr. Elson would stop me. He asked how Mindy was. He introduced me to his wife and family. He asked me about church and friends in the area. He shook my hand and grinned the unforgettable smile of his. He told me to "take it easy" and meant it. When you've slept less than two hours in the last thirty, words like that mean a lot.

Dr. Elson died a couple of Saturday nights ago. He passed away peacefully in his sleep after a nearly 18-month battle with renal cell cancer after a day filled with firemen's frying fish and watching Ohio State eat up on Minnesota's golden gophers. Three days later, I sat dressed up in my wrinkled grey suit next to my fellow residents honoring Dr. Thomas Elson's death. In his home church we listened to his friends, coworkers, and family remember the husband, father, physician, teacher, and the man of God Dr. Elson was in their lives. I cried remembering that he taught me to smile while I work and to remember what's important when you go home.

Andrew Jacques ('05)