I woke up
From a nightmare
A decade ago
About being
Alone
I got up
And looked in the mirror
And saw You
Your beautiful soft face
Wavy hair
And those eyes
I looked inside
And saw myself
Strong
Confident
Happy
So I went
Back to sleep
I awoke again
This morning
From another nightmare
And looked in the mirror
And there you were
Just As I had left you
I peered again
Into your eyes
And this time
I saw you
And the kids
All my happiness
But yet something
Was missing
I tried
To turn over
And scream
"How could you
Have gotten rid
Of me?"
But then
I realized
That the mirror
Was more a reflection
On me
Then you
Monday, October 13, 2008
Sunday, October 12, 2008
By The Way, I'm Also Great at Removing Wax from Ears
Years ago, before I started medical school, I thought it was so simple. I would become a doctor. The answers would role off my tongue. People would come to me and I would fix them. I would rush into the hospital room and singlehandedly save the day. It was so obvious. It was so straightforward. It was so laughable.
Back in those days I didn't undersatnd the complexity of medicine. I didn't understand that often the answers are not so clear. That sometimes there are multiple possibilities and it is difficult to differentiate which is right. That sometimes no matter how hard you try.... you miss the mark. That diseases are more likely to present atypically then in textbook fashion.
My naivete was shattered throughout residency and my first few years of practice. I would continually search for the textbook answers and they would often miss lead me. A clear case of cardiac chest pain would end up being heartburn.....and a clear case of constipation and indigestion would end up being a heart attack. The gods of medicine were laughing at me and I was fodder for their cruel sense of humor.
But as time has passed I have started to understand the patterns of human beings better. I am now more likely to diagnose appendicitis by the look on a person's face and their demeanor then anything I specifically note on physical exam. I am now apt to understand that testicular pain in a young man is just as likely anxiety and depression as it is orchitis or a hernia. I have learned these things. Not by reading them somewhere in a textbook but by experience....by missing something once....by vowing never to forget.
The medicine I practice today is much more nuanced. I watch the way patients walk into my office. I pick more up in their facial expressions.....in the words that aren't said. I understand a little better how people work. How they describe their own pain. What the diffetence is between psychic and physical pain. And how to try to treat each.
I also have learned that as a primary care physician I rarely race into the hospital (or office) to save the day. I will leave that for the surgeons. What I do is a lot more tame, a lot more calculated. Although I have never found myself to be a religious man I still beleive that we as humans have only so much power over our own lives. Sometimes people will either live or die and I as a physician may have very little to do with it.
I see my role as more behind the scenes. In those who are living I try to foster life with less pain and suffering. Less worry and concern. I manage their back pain, and diabetes , and heart disease. Like an insurance policy I am a crutch to help face the unimaginable...the unthinkable.
In those who are dying I try to fashion a softer landing. Ease the pain and desperation of what they are going through. I try to get them home and with their families. To die pain free surrounded by those who love them. Sometimes it works, sometimes it doesn't. But there is beauty and salvation in the attempt.
So I guess you could say as a primary care physician I am a jack of all trades. I help people live. I help people die. I try to manage ilness behind the scenes so people can live their lives. And occasionally...occasionally I rush into to save the day (if I'm lucky).
Oh...and by the way
I'm also great at removing wax from ears
Back in those days I didn't undersatnd the complexity of medicine. I didn't understand that often the answers are not so clear. That sometimes there are multiple possibilities and it is difficult to differentiate which is right. That sometimes no matter how hard you try.... you miss the mark. That diseases are more likely to present atypically then in textbook fashion.
My naivete was shattered throughout residency and my first few years of practice. I would continually search for the textbook answers and they would often miss lead me. A clear case of cardiac chest pain would end up being heartburn.....and a clear case of constipation and indigestion would end up being a heart attack. The gods of medicine were laughing at me and I was fodder for their cruel sense of humor.
But as time has passed I have started to understand the patterns of human beings better. I am now more likely to diagnose appendicitis by the look on a person's face and their demeanor then anything I specifically note on physical exam. I am now apt to understand that testicular pain in a young man is just as likely anxiety and depression as it is orchitis or a hernia. I have learned these things. Not by reading them somewhere in a textbook but by experience....by missing something once....by vowing never to forget.
The medicine I practice today is much more nuanced. I watch the way patients walk into my office. I pick more up in their facial expressions.....in the words that aren't said. I understand a little better how people work. How they describe their own pain. What the diffetence is between psychic and physical pain. And how to try to treat each.
I also have learned that as a primary care physician I rarely race into the hospital (or office) to save the day. I will leave that for the surgeons. What I do is a lot more tame, a lot more calculated. Although I have never found myself to be a religious man I still beleive that we as humans have only so much power over our own lives. Sometimes people will either live or die and I as a physician may have very little to do with it.
I see my role as more behind the scenes. In those who are living I try to foster life with less pain and suffering. Less worry and concern. I manage their back pain, and diabetes , and heart disease. Like an insurance policy I am a crutch to help face the unimaginable...the unthinkable.
In those who are dying I try to fashion a softer landing. Ease the pain and desperation of what they are going through. I try to get them home and with their families. To die pain free surrounded by those who love them. Sometimes it works, sometimes it doesn't. But there is beauty and salvation in the attempt.
So I guess you could say as a primary care physician I am a jack of all trades. I help people live. I help people die. I try to manage ilness behind the scenes so people can live their lives. And occasionally...occasionally I rush into to save the day (if I'm lucky).
Oh...and by the way
I'm also great at removing wax from ears
Thursday, October 9, 2008
A Tale of Two Vertebral Fractures
Mrs. Jones is an eighty year old lady with a history of sudden onset acute severe back pain. She walks into Dr. A's office for evaluation. After a thorough history Mrs. Jones is examined and Dr. A notes point tenderness over the lubar vertebrate. He suspects a vertebral fracture. He sends his patient immediately down to xray for a film of the lumbar spine and asks for a wet read. Thirty minutes later Dr. A recieves a call from the radiologist that indeed there is a lumbar fracture. Dr. A then calls the interventional radiologist at the hospital and arranges for Mrs. Jones to get an MRI and a consultation later that day. The next day she undergoes a vertebroplasty as an outpatient and is sent home with her pain relieved. Here's how it breaks down....
Dr. A saw the patient for a simple office visit and billed a 99213 (mid level visit) and spent 15 minutes with the patient.
Dr. A spent 30 minutes reviewing films, talking with radiologists, and organizing Mrs. Jones' care. This time was not compensated for
Mrs. Jones' cost to our medical system: 1 office visit, 1 xray, 1 MRI, costs associated with vertebroplasty (including outpatient interventional radiology consultation).
Alternatively Mrs. Jones walks in to see Dr. B with the same problem. Dr B is not as well trained, not as well informed, or doesn't have enough time. He takes a history and examines the patient. He diagnosis osteoarthritis of the spine and sends Mrs. Jones home with vicodin. Over the next few days Mrs. Jones' pain becomes excruciating. Furthermore more she is constipated. She calls Dr B for advice. He does not have enough time to see her so he sends her to the ER. Mrs. Jones has an xray in the ER that shows vertebral fracture (hospital day 1). She is admitted to Dr B's service. Dr B orders an MRI and gets the result later the next day Hospital day 2). He calls the interventional radiologist. The radiologist sees the patient the next day (hospital day 3)and sets her up for a vertebroplasty the following day (hospital day 4). Mrs. Jones is discharged after post op observation the next day (hospital day 5) with good pain control. Here's how it breaks down...
Dr. B saw the patient in the office and billed a 99213 but then admitted the patient to the hospital billing a 99223 for admission, 99233 x 3 for follow up days, and then a 99239 for discharge.
Mrs. Jones cost to our medical system: 1 office visit, 5 inpatient visits from Dr. B, 1 ER physician charges, 1 inpatient consultation from interventional radiology, 1 xray, 1 MRI, 5 days worth of hospitalization, costs associated with vertebroplasty.
Who benefits (IE MAKES MORE MONEY) from our current medical system: Dr. B, the interventional radiologist (in either scenario), ER physicians, The hospital
Who gets the short end of the straw: Mrs. Jones, Dr. A (good primary care physicians)
I have seen this soo often. Poor doctoring leads to increased costs across the board and increased revenues for those who deserve it least.
Dr. A saw the patient for a simple office visit and billed a 99213 (mid level visit) and spent 15 minutes with the patient.
Dr. A spent 30 minutes reviewing films, talking with radiologists, and organizing Mrs. Jones' care. This time was not compensated for
Mrs. Jones' cost to our medical system: 1 office visit, 1 xray, 1 MRI, costs associated with vertebroplasty (including outpatient interventional radiology consultation).
Alternatively Mrs. Jones walks in to see Dr. B with the same problem. Dr B is not as well trained, not as well informed, or doesn't have enough time. He takes a history and examines the patient. He diagnosis osteoarthritis of the spine and sends Mrs. Jones home with vicodin. Over the next few days Mrs. Jones' pain becomes excruciating. Furthermore more she is constipated. She calls Dr B for advice. He does not have enough time to see her so he sends her to the ER. Mrs. Jones has an xray in the ER that shows vertebral fracture (hospital day 1). She is admitted to Dr B's service. Dr B orders an MRI and gets the result later the next day Hospital day 2). He calls the interventional radiologist. The radiologist sees the patient the next day (hospital day 3)and sets her up for a vertebroplasty the following day (hospital day 4). Mrs. Jones is discharged after post op observation the next day (hospital day 5) with good pain control. Here's how it breaks down...
Dr. B saw the patient in the office and billed a 99213 but then admitted the patient to the hospital billing a 99223 for admission, 99233 x 3 for follow up days, and then a 99239 for discharge.
Mrs. Jones cost to our medical system: 1 office visit, 5 inpatient visits from Dr. B, 1 ER physician charges, 1 inpatient consultation from interventional radiology, 1 xray, 1 MRI, 5 days worth of hospitalization, costs associated with vertebroplasty.
Who benefits (IE MAKES MORE MONEY) from our current medical system: Dr. B, the interventional radiologist (in either scenario), ER physicians, The hospital
Who gets the short end of the straw: Mrs. Jones, Dr. A (good primary care physicians)
I have seen this soo often. Poor doctoring leads to increased costs across the board and increased revenues for those who deserve it least.
Tuesday, October 7, 2008
Letting Yourself Off The Hook
I was all excited yesterday. I finished work early and was enjoying the drive home when it hit me. What a beautiful day. Maybe I'll go for a jog. This was a rare luxury to have time to do this in the middle of the day. The sun was shining and I was psyched at the idea of running along Lake Michigan.
I have started to excersize again. It's been awhile. The first week was just walking on a treadmill. Yah....I'm in that bad a shape. But I figure if I am going to tell my patient's to excersize...I better do the same. All I have to do, I told myself, is start out slowly. Thirty minutes a day on the treadmill translates into roughly a 2 mile walk. A little sweat. A little increased heart rate. No big deal.
But yesterday was different. I had to take advantage of the beautiful day. So I ran into the house. Put on some shorts and a log sleave T shirt and headed out. It took less then 2 minutes to realize how painful this was going to be. First my chest started to hurt. Then my lungs felt like they were going to fall out of my chest. And last my legs and knees ached.
I could have given up. I could have quite. But I told myself that I was going to jog for 30 minutes regardless. So when my body, after five minutes, warned of near death I ignored it. Instead I psyched myself up for the pain. I vividly imagined other times in my life when I was met with harsh realities. In childhood when I had a learning disability...I didn't give up then did I? In residency when I worked 40 hours in a row without sleep....I didn't give up then did I?
As pathetic as it sounds I do this all the time when confronted with difficult situations both physically and emotionally. I turn a basic challenge into a referrendum of my previous successes and failures....a referendum of my character. It's not just getting a workout, it's an epic battle between good and evil. Between success and failure. What if my whole family was kidnapped and held at gunpoint and the only way I could save them was to run a marathon without stopping? Even in my current poor physical condition? Could I do it?
And as funny as it was these thoughts carried me. My breadthing became less labored. My stride became more secure. Although I was in immense pain I made it to the lake and enjoyed the stunning view. As I looked at my watch I realized that I had been running for only fifteen minutes. So I turned course to head back home. The terrain was more up hill and I began to struggle. But as I reached the twenty five minute mark I knew I would make it. I said that nothing would stop me from running the full thirty minutes and I meant it. I would conquer this challenge and live to fight another day.
And that's when it happened. A little girl rode passed me on the sidewalk on her bike. She must have been about ten. I watched as her figure slowly peddled in front of me. About 100 feet ahead she hit an uneven area in the pavement and fell. I looked down at my watch. A few minutes to go. Then I looked over at the girl....tears streaming down her face. As I came to her figure lying on the ground I stopped. I would not accomplish my task. I helped lift her up. She was not hurt. I bent over and picked up her bike as she wiped a tear from her eye. She let out a small embarrased giggle. I laughed. She took her bike and climbed back on. "Thanks," she said as she rode off.
I looked again at my watch and saw my thirty minutes had expired. Strangely and unexpectedly I had not reached my goal. I had not jogged for thirty minutes. I still had a good workout. I still would ache in the morning. But, by no fault of my own, I had fallen short.
As I walked the rest of the way home I thought again about my actions. Maybe life isn't always as black and white as I make it out to be. Maybe sometimes no matter how hard you try to succeed you fail. Maybe failure is not something to flog oneself over but a choice that we often have to make. And that choice can be beautiful and enrich us as opposed to leaving a stain on our character.
Maybe I haven't been feeling as good lately as I want to admit
Maybe it's time I stopped being so damn hard on myself
I have started to excersize again. It's been awhile. The first week was just walking on a treadmill. Yah....I'm in that bad a shape. But I figure if I am going to tell my patient's to excersize...I better do the same. All I have to do, I told myself, is start out slowly. Thirty minutes a day on the treadmill translates into roughly a 2 mile walk. A little sweat. A little increased heart rate. No big deal.
But yesterday was different. I had to take advantage of the beautiful day. So I ran into the house. Put on some shorts and a log sleave T shirt and headed out. It took less then 2 minutes to realize how painful this was going to be. First my chest started to hurt. Then my lungs felt like they were going to fall out of my chest. And last my legs and knees ached.
I could have given up. I could have quite. But I told myself that I was going to jog for 30 minutes regardless. So when my body, after five minutes, warned of near death I ignored it. Instead I psyched myself up for the pain. I vividly imagined other times in my life when I was met with harsh realities. In childhood when I had a learning disability...I didn't give up then did I? In residency when I worked 40 hours in a row without sleep....I didn't give up then did I?
As pathetic as it sounds I do this all the time when confronted with difficult situations both physically and emotionally. I turn a basic challenge into a referrendum of my previous successes and failures....a referendum of my character. It's not just getting a workout, it's an epic battle between good and evil. Between success and failure. What if my whole family was kidnapped and held at gunpoint and the only way I could save them was to run a marathon without stopping? Even in my current poor physical condition? Could I do it?
And as funny as it was these thoughts carried me. My breadthing became less labored. My stride became more secure. Although I was in immense pain I made it to the lake and enjoyed the stunning view. As I looked at my watch I realized that I had been running for only fifteen minutes. So I turned course to head back home. The terrain was more up hill and I began to struggle. But as I reached the twenty five minute mark I knew I would make it. I said that nothing would stop me from running the full thirty minutes and I meant it. I would conquer this challenge and live to fight another day.
And that's when it happened. A little girl rode passed me on the sidewalk on her bike. She must have been about ten. I watched as her figure slowly peddled in front of me. About 100 feet ahead she hit an uneven area in the pavement and fell. I looked down at my watch. A few minutes to go. Then I looked over at the girl....tears streaming down her face. As I came to her figure lying on the ground I stopped. I would not accomplish my task. I helped lift her up. She was not hurt. I bent over and picked up her bike as she wiped a tear from her eye. She let out a small embarrased giggle. I laughed. She took her bike and climbed back on. "Thanks," she said as she rode off.
I looked again at my watch and saw my thirty minutes had expired. Strangely and unexpectedly I had not reached my goal. I had not jogged for thirty minutes. I still had a good workout. I still would ache in the morning. But, by no fault of my own, I had fallen short.
As I walked the rest of the way home I thought again about my actions. Maybe life isn't always as black and white as I make it out to be. Maybe sometimes no matter how hard you try to succeed you fail. Maybe failure is not something to flog oneself over but a choice that we often have to make. And that choice can be beautiful and enrich us as opposed to leaving a stain on our character.
Maybe I haven't been feeling as good lately as I want to admit
Maybe it's time I stopped being so damn hard on myself
Monday, October 6, 2008
Don't Be Afraid (conclusions)
Don't be afraid!
Darren's mind had drifted again into a peaceful sleep. He once again relived the day his father was killed. The gun shot. Huddling into his mother's arms in the corner of the room. The fear. The strange look on his father's killer"s face. And then the jolt. He again saw his father's life flash before his eyes but it was different this time.
He saw his father at his own birth....but then he rushed out of the maternity ward to go check on one of his own patient's in the emergency room. He saw his father sitting at the bedside holding a patient's hand as he suffered....but he also saw how at the same time his mother was struggling at home because his father wasn't there. And finally Darren saw himself. At his own kindergarten graduation.....looking anxiously for his father to enter the auditorium...but he never came.
Suddenly Darren's own memories and his father's melded as if they were one story. His father had given up soo much to be a physician...but also had reaped certain rewards. He never had to worry about money because he always made enough. He wasn't concerned about being with his child becuase it was expected that as a physician he would have other responsibilities. His wife accepted it. Society accepted it. And finally he was deeply respected. He carried a certain stature just by the nature of his profession.
But Darren realized that all those things had now changed. He didn't make enough money like his father. Between medicare, insurance companies, malpractice insurance, and medical school debt he was always struggling. And his wife and child didn't accept the time and commitment it took to do his job. In fact society frowned on being soo involved with work that you missed out on your children's lives. And the respect of his fellow man....well that had gone long ago. Most people's views of physicians had changed.
Don't be afraid to choose happiness!
Finally Darren felt his dad's profound sorrow at dying too young. The moments lost to his profession would never be reclaimed. He could never hold his son again. He could never kiss his wife. And all the sudden the words Darren lived by changed. Had he always misinterpreted his father's dying advice. Or had he just been to young to understand? Did it matter anymore?
Darren's head jerked upward and became aware of his settings. The sounds of the ICU came back to him. A nurse had been standing patiently waiting for him to wake up..."Doctor...Doctor.....your patient will be up from the ER in a few minutes.....any preliminary orders?".
Darren stood up briskly and pulled his jacket off the chair. As he reached the exit of the ICU he remembered the nurse awaiting his response....."when she arrives please let the hospitalist on call know that they will be following her...I have to get home!".
As the words left his lips the whole ICU became quiet....other doctors, nurses, even secretaries looked up quizically at Darren....
In his ten years working at the hospital...
He had never given up the chance
to care for one of his own patients.
The Doctor has left the building
Darren's mind had drifted again into a peaceful sleep. He once again relived the day his father was killed. The gun shot. Huddling into his mother's arms in the corner of the room. The fear. The strange look on his father's killer"s face. And then the jolt. He again saw his father's life flash before his eyes but it was different this time.
He saw his father at his own birth....but then he rushed out of the maternity ward to go check on one of his own patient's in the emergency room. He saw his father sitting at the bedside holding a patient's hand as he suffered....but he also saw how at the same time his mother was struggling at home because his father wasn't there. And finally Darren saw himself. At his own kindergarten graduation.....looking anxiously for his father to enter the auditorium...but he never came.
Suddenly Darren's own memories and his father's melded as if they were one story. His father had given up soo much to be a physician...but also had reaped certain rewards. He never had to worry about money because he always made enough. He wasn't concerned about being with his child becuase it was expected that as a physician he would have other responsibilities. His wife accepted it. Society accepted it. And finally he was deeply respected. He carried a certain stature just by the nature of his profession.
But Darren realized that all those things had now changed. He didn't make enough money like his father. Between medicare, insurance companies, malpractice insurance, and medical school debt he was always struggling. And his wife and child didn't accept the time and commitment it took to do his job. In fact society frowned on being soo involved with work that you missed out on your children's lives. And the respect of his fellow man....well that had gone long ago. Most people's views of physicians had changed.
Don't be afraid to choose happiness!
Finally Darren felt his dad's profound sorrow at dying too young. The moments lost to his profession would never be reclaimed. He could never hold his son again. He could never kiss his wife. And all the sudden the words Darren lived by changed. Had he always misinterpreted his father's dying advice. Or had he just been to young to understand? Did it matter anymore?
Darren's head jerked upward and became aware of his settings. The sounds of the ICU came back to him. A nurse had been standing patiently waiting for him to wake up..."Doctor...Doctor.....your patient will be up from the ER in a few minutes.....any preliminary orders?".
Darren stood up briskly and pulled his jacket off the chair. As he reached the exit of the ICU he remembered the nurse awaiting his response....."when she arrives please let the hospitalist on call know that they will be following her...I have to get home!".
As the words left his lips the whole ICU became quiet....other doctors, nurses, even secretaries looked up quizically at Darren....
In his ten years working at the hospital...
He had never given up the chance
to care for one of his own patients.
The Doctor has left the building
Thursday, October 2, 2008
Don't Be Afraid (Cont)
Darren could barely keep his eye's fixed on the computer screen in front of him. The ICU buzzed with early evening activity. He tried to stay awake but he kept on drifting. I should be home now! His anger came and went quickly. Afterall he signed up for this job. He didn't, however, have any idea how hard it would be at the time he entered his training. It was supposed to be medical school and residency that were hard. But now ten years later he was still w0rking maniacal hours. Still not sleeping at night. And still scrounging to make ends meet.
His mistake in retrospect was going into primary care. But who knew ten years ago how poorly it would pay? Darren also had no clue how deeply school would put him in debt. And now there was the wife and kids. House payments. If only he had gone into radiology. That's where the money is!
But maybe it wasn't even about money. It wasn't just the economics but the respect issue. Darren worked just as hard as his specialist friends. In fact he probably filled out more paperwork, took more late night phone calls, and yet still was looked at as the bottom of the totem pole. His judgement's questioned daily. After all....he was just the "pcp". An acronym Darren had grown to hate.
Don't be afraid
As Darren nodded of in his chair he heard his fathers words again. They were words he lived by. Although his father died long ago his words remained. Darren couldn't remember when he had given him this sage advice. Was it a dream or did it really happen? It didn't matter. Whenever times got tough he would hear those words eminate from his innerds. His dad may be gone but his soul remained.
And that's why Darren went to medical school. And that's why he chose primary care while his friends went into more lucrative fields. And that's why he continued to see his own patients in the hospital while everyone else used hospitalists. And thats why Darren was sitting in the ICU, as he did many nights missing his family, and wondering where his life went wrong.
And that's why Darren's wife was threatening to leave him.
Don't be afraid
His mistake in retrospect was going into primary care. But who knew ten years ago how poorly it would pay? Darren also had no clue how deeply school would put him in debt. And now there was the wife and kids. House payments. If only he had gone into radiology. That's where the money is!
But maybe it wasn't even about money. It wasn't just the economics but the respect issue. Darren worked just as hard as his specialist friends. In fact he probably filled out more paperwork, took more late night phone calls, and yet still was looked at as the bottom of the totem pole. His judgement's questioned daily. After all....he was just the "pcp". An acronym Darren had grown to hate.
Don't be afraid
As Darren nodded of in his chair he heard his fathers words again. They were words he lived by. Although his father died long ago his words remained. Darren couldn't remember when he had given him this sage advice. Was it a dream or did it really happen? It didn't matter. Whenever times got tough he would hear those words eminate from his innerds. His dad may be gone but his soul remained.
And that's why Darren went to medical school. And that's why he chose primary care while his friends went into more lucrative fields. And that's why he continued to see his own patients in the hospital while everyone else used hospitalists. And thats why Darren was sitting in the ICU, as he did many nights missing his family, and wondering where his life went wrong.
And that's why Darren's wife was threatening to leave him.
Don't be afraid
Wednesday, October 1, 2008
Don't Be Afraid
Stephen reached for the shower door. He had no idea that his life would be over in seconds. As the bathroom door opened he looked up with surprise to see an unfamiliar face. The next thing he heard was a gunshot.
After a few moments Stephen stood up. He looked down to see his own crumpled body on the ground. With horror he thought of his wife and son who were still in the house. He neither felt sadness nor disdain. Anger nor suffering. His primary thoughts were on his loved ones. His movement towards the door was so quick that he became a flash of light. Into the hallway and towards his Son's room.
The man with the gun was standing over them. Susan huddled in the corner with Darren's 6 year old body bundled tightly in her arms. She was crying. She looked up to see a lightening bolt pass through her pursuer's chest and land between her arms on her son's torso.
The man with the gun smiled briefly. As Stephen passed through him he got a glimpse of the beauty he had taken from the earth. Beauty he himself had never been lucky enough to experience in his miserable life. And then the smile turned into a scowl with the horrifying realization of what he had done. He clutched his chest but it was too late. His heart had already stopped. He collapsed to the floor.....dead.
Darren hardly noticed that his mother was no longer holding him. Moments of fear and panic had been replaced by an awesome calm. He felt his whole body move as if the ocean had risen to knock him over but he remained still. His mind raced with primordial visions of his father. He saw his father's birth. He felt his anger as the other kids teased him on the playround. He experienced his father's joy and pain. His wedding day. The day he became a doctor. Countless moments of life and death. Sitting calmly holding a patient's hand. He saw his own birth and felt his father's pride and joy. And he heard his fathers words, not from his ears, but internally...
Darren....Darren.....Don't be afraid!
Darren's reverie was quickly broken by the schrill screams of his mother. She had raced into the bathroom and found his father....lying dead on the floor.
After a few moments Stephen stood up. He looked down to see his own crumpled body on the ground. With horror he thought of his wife and son who were still in the house. He neither felt sadness nor disdain. Anger nor suffering. His primary thoughts were on his loved ones. His movement towards the door was so quick that he became a flash of light. Into the hallway and towards his Son's room.
The man with the gun was standing over them. Susan huddled in the corner with Darren's 6 year old body bundled tightly in her arms. She was crying. She looked up to see a lightening bolt pass through her pursuer's chest and land between her arms on her son's torso.
The man with the gun smiled briefly. As Stephen passed through him he got a glimpse of the beauty he had taken from the earth. Beauty he himself had never been lucky enough to experience in his miserable life. And then the smile turned into a scowl with the horrifying realization of what he had done. He clutched his chest but it was too late. His heart had already stopped. He collapsed to the floor.....dead.
Darren hardly noticed that his mother was no longer holding him. Moments of fear and panic had been replaced by an awesome calm. He felt his whole body move as if the ocean had risen to knock him over but he remained still. His mind raced with primordial visions of his father. He saw his father's birth. He felt his anger as the other kids teased him on the playround. He experienced his father's joy and pain. His wedding day. The day he became a doctor. Countless moments of life and death. Sitting calmly holding a patient's hand. He saw his own birth and felt his father's pride and joy. And he heard his fathers words, not from his ears, but internally...
Darren....Darren.....Don't be afraid!
Darren's reverie was quickly broken by the schrill screams of his mother. She had raced into the bathroom and found his father....lying dead on the floor.
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