"Is the pain bad enough to make you want to beg Jesus for mercy?"
A "yes" answer is 100 percent accurate for diagnosis of kidney stone. Every time. Works in deep southern Ohio ERs in Ross, Pike, Scioto, Hocking, Highland counties.
I used to always hear when I first moved here from the Cleveland area, "You are not from around here, are ya?" Don't hear that anymore. One patient asked if I was related to those Cottons in Pikeville, Kentucky. I do wear baseball caps a lot.
Southern Ohio folksiness works now in one of Columbus' busiest ERs. "Hi, I'm Dr. Cotton, like no polyester, no rayon." You can feel the patient and family relax. I ask what kind of work they do - gets them to talk, and now I have a person in front of me, not just a clinical diagnostic problem.
Southern Ohio charm works well for all the corporate measures of ER docs. I do middle-of-the-road in number of patients seen per hour, productivity etc. Last measure I was top rated by Press-Ganey patient satisfaction--although, frankly, these scores are not the most statistically valid, and many excellent, excellent docs don't do so well on them.
I am not folksy and nice, fetch blankets and cups of coffee purely out of altruism. Rather it is survival. The professional literature is full of reports showing ER docs scoring very poorly on "compassion fatigue," "burn-out," suicide. If I drive home thinking, "Brad, you were a jerk today," I feel bad. This rubs off on the wife and children, I suppose even the three dogs. If I drive home thinking about the patient who laughed, the hands I shook, the kid I high-fived - then I have a new lease on life and can go back for another shift. Survival.
I apparently slipped a little this past shift. I cussed. One of the nurse practitioners said, "Brad, that makes me uncomfortable, you never swear - that's like hearing my Dad swear or something."
Crap. So am old enough to be the father of a lot of my co-workers. Called out on it.
Dr. L---, leaving our ER to another job, said, "Brad, I'll miss working with you - always so calm and with your sense of humor." I answered I suppose that included the time we hid behind the room divider when the psych patient was throwing feces.
To speak "southern Ohio evangelical" - not the language of commitment and devotion I would choose, but I live here, so I speak it - working in the ER is a "ministry to a hurting world," and "I am so blessed" to be given the opportunity to serve.
We are a community of ER docs, nurses, techs, social workers, firefighters, EMS, police. The bigger community of all who work with "grittiness" of life includes pastors, counselors, teachers.
I include on my Christmas card list Jeanne Bay, my 12th grade English teacher who, when I wrote an essay on the Beatles' "I am the Walrus" ("Don't you think the joker laughs at you? Koo-koo a koo ga-joob!!!!") complimented my writing but also asked if I truly felt this badly about the world. I said I did. I still do - only now I can do something about it.
I tell suicidal teens I need them to get a good job and pay a lot of taxes so I can retire. I need their success. I need your success. In whatever you do. I needed Emily Dickinson, who wrote poems but never left her father's farm. (I also need Hemingway and Carson McCullers.) I need the clerk at Walmart, the server at Bob Evans. I even need those folks at work, at the computer "help desk" (aka the "no help" desk - I know they have my picture on the wall down there, not with dart holes in it but rather a note saying, "Be nice to Dr. Cotton - you know he doesn't understand software.")
I need you to be all you can be. I need politics also that takes care of your health, ahead of health insurer and Big Pharma profits. I need politics that believes in science over Big Oil profits.
I need you to drive home feeling proud of what you did that day.