#6. That Light Looks Green....

Security clearances are not granted for any of the same reasons one may have achieved a parking spot under the awning at work ( which is the peak of the food chain in PHX). However, it was only with tremendous patience and professional reserve, that a Special Investigator endured what no man before him has ever done: he reviewed, in detail, the purpose and activities of every international trip I've taken in the past ten years. Nearly every one of these was because of Peacework Medical Projects. He did this in person with only cold water and fruit to sustain him. It took two and a half hours.

He never lost focus, but somewhere along the second hour he did seem to become a believer in the work that Peacework accomplishes. I appreciate this immensely. Not only did he accept that the work is credible, accountable, and consistent, but his expediency has hastened getting the necessary credentials to go to Iraq.

And the sooner I get there, the sooner I can set the dates for Peacework's summer 2012 efforts in Haiti. And that will be another foreign trip to explain to a future special investigator when the time comes to renew my security clearance...and that too will be special. Not spectacular, just special.

Peacework is worth the trouble. All of it, every time. It just comes in unlikely presentations some days.

It would appear that my next post will be from the Syrian Desert.

#5. Holding that Thought in my Home ER

My Home Base ER, the one I've called my own since 1999, is a special place. It's not just that I'm biased toward this irreverent, remarkably capable, uniquely challenging hotbed of mixed pathology and sociology. It really is special.

 While waiting for this Iraq contract to fall into place, I've returned for a few shifts of the experience at "The 'Vale".  We know it, love it, and sometimes less than love it, and we are fond of saying "Only at The 'Vale".

There's a reason this phrase has become commonplace. There is a reason this phrase is accurate. It seems that for every set of hoofbeats, there really is the occasional zebra, and the zebra may sometimes have a peacock riding in on its back. And the peacock may be playing a bagpipe.

Unfortunately, there is no zebra specialist on call for us. Anywhere. And no one will even discuss accepting the peacock problem without a zebra consult. The conversation ends each time before you can bring up the part about the bagpipe. (What's the bagpipe about anyway?)

This is only a part of what makes the 'Vale team so good. We overcome. Just get the zebra and peacock separate beds and figure it out.  Put the bagpipe in a belongings bag for later. The  translation phone, of course, get that out again, because this is not going to be our common language here, which is Spanish.

The peacock refuses a bed, thanks, just wants her oxycontin refilled, and a different ride home if we're keeping the zebra.  The zebra, being a zebra and not a horse, is mysteriously ill. He is his own worst historian, as if he just looked in a mirror this week and realized he was covered with alternating black and white stripes.

More hoofbeats. Horses this time. Herds of them. It's the bread and butter stuff of the ER: sore throats, lacerations, headaches, mental health crises, sprained ankles, chest pain, skin abscesses, abdominal pain, difficulty breathing, bleeding during pregnancy, drug overdose, skin rashes, fractured bones, the occasional gunshot wound, car accidents...pain, pain, pain in every way the body can hurt.

Our nurses triage and manage the flow and flood expertly. Every patient and every family gets roomed and ready to be seen by a physician or PA in a series of movements that is a coordinated dance. It may appear chaotic. It may sound noisy. But there is a willful system that functions gracefully despite superficial appearances.

Some come by ambulance to this Level II trauma center. Some come by private vehicle, and these drivers just do not check on the trauma level of the 'Vale before transport, which is why we sometimes get major trauma from the streets. This ER is a place to stabilize such a patient for further transport. Our docs do it best. Probably because they get plenty of practice.

So what about that zebra? A thourough work up was completed. With stripes growing more and more pale, he was admitted to the ICU with an anemia of unknown origin.  Lots of work to be done for his ailing animal. The ICU RN calls back to ask how we attached the nasal canula.

The peacock's pain was treated at the visit, non narcotic Rx, follow up provided, and no taxi voucher from the charge nurse. She found someone to come give her a ride. Unfortunately, there was not a chance to see which species arrived. Too busy. Hoof beats pounding.

It's noisy at shift change. There's an IPod that just met two extra powerful speakers. A patient has found the volume on the Sponge Bob channel. (He needed a chair for this.) Nurses are huddling to round on which patients are where, who is in transition, and who needs what care. They probably discuss other things too, but that's what I can relay here.

Then I hear above all of this from a registration clerk, as she pulls her chair under an open desk, "Hey, who left their bagpipes here?!"