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At Home

From: The Hospitalist, February 2007

A peaceful night of rest? I wonder.

by James S. Newman, MD, FACP

James S. Newman, MD, FACP

It was 8 p.m. on a cold Minnesota night, and my vision was obscured by flurries of snow and decomposing wiper blades. I was late for home. When I arrived, 11 sets of eyes turned toward me. (Twelve, really, counting my boxer Chocky Locky). They were sitting in the dining room, and the evening meal had just started. I washed quickly and took my seat at the table.

We have a large dining table that seats 12, but our current dish service—due to an unforeseen disaster—has only 11 settings. Thus, our service was at its maximum capacity. Tonight’s crowd included my wife and me, a grandmother, four offspring of various genders and a female teenager of unknown origin, a male preteen well-known to the household, and two young females who had sat at the table before.

It was unclear whose turn it was to clear the table. The schedule was not available, and several offspring cited work limits they would hate to see abused.

As per standard operating procedure, each person at the table began to speak at the same time. Eventually order was established, though this was at best a transitory phenomenon. We received reports on each participant’s day, with highlights of lunch hour mayhem, recess riots, and general curricular boredom.

I began to question the unknown teen: name, age, place of origin, habits, and so on, but my history taking was interrupted. My younger son wanted to relay the results of an important test he had taken. He had passed and was now certified to use punctuation. I turned to resume my history taking, but made the important physical exam observation of intense eye rolling on the part of my daughter and her friend. This is a well-known physical finding in this age group and one that generally signals a pre-seizure threshold that I did not want to further induce.

After an intense nutritional session that included all major food groups and several minor ones, there were several short, unscheduled presentations. The grandmother gave a long and interesting family history with highlights of a great-great grandfather, who had been a freelance horse thief for both the Polish and Russian armies, and his son, who had been—alternatively—a gambler, a rabbi, a communist, and a union organizer.

After this history lesson, we received a fascinating report from one of my male offspring entitled, “proper placement of the hand and axillae, combined with repetitive flapping movements of the arm, to elicit an auditory stimulus similar to flatulence.” Much hilarity ensued.

Dr. Newman's staff performs rounds at a Chinese restaurant
Dr. Newman’s staff performs rounds at a Chinese restaurant

It was unclear whose turn it was to clear the table. The schedule was not available, and several of the offspring cited work limits they would hate to see abused. Eventually the job was done with only minimal threats of withdrawal of privileges. As I prepared to resume my reading, a call went out for transportation services. It was time to discharge one of the visiting children to her abode. I was happy to decrease the numbers in house, though I would have been happier to see our numbers go even lower. Our length of stay seemed to be rising daily. As I attempted to initiate the transportation home, I realized we had to go through the checklist. Do you have your scarf, your gloves, and your shoes? Did you have a good time? I considered a policy of no readmission in 30 days, but it was voted down in a team meeting.

I returned from transportation duties, and I sat quietly for a moment and looked at the Times and the Post-Bulletin. These were papers I had been waiting to review—especially the comics. But something always seems to come up when one has papers to review. My youngest daughter and her friends needed my guidance on an art project. I had hoped they would see one, do one, teach one, but I had to repeatedly sketch the face outlines for them to color.

As I sat down again to the papers, the doorbell rang. Nobody else appeared to be on doorbell duty, so I went to the front of the house. There was a young man in a white shirt and black tie. He was proselytizing for a religious group. I informed him that our house had adopted a “no religious rep policy.” This helps us to avoid being unduly influenced by reps, though I must admit I still use my Taoist pen. It’s a Zen-Pen: one side writes, the other doesn’t.

Finally, I returned to my seat. At that point, the room plunged into darkness. A moment of panic. Quickly, I took my own pulse, a technique I had learned from the medical literature. Once calmed, I went through the differential. The power might be out for the whole city or just the house. Perhaps a fuse had blown from one too many electronic entertainment devices. Or maybe mice had chewed through a power cable. As I pondered my next course of diagnostic action and reviewed my alternatives in an evidence-based and allorhythmic approach, I auscultated a series of breath sounds that might be interpreted as gasps or giggles.

I intuitively realized that it was a severe case of “little girls playing a joke on Dad by switching off the light.” I had two choices. The first was to be crabby and bellow for them to quit playing with the switch. I felt this to be a harsh choice with bad potential side effects. Instead, I ducked under the table and silently hid. When proper lighting was restored, they were amazed to see I had vanished, and when they came to investigate, I revealed myself and uttered the key phrase: “Boo!” A riotous wrestling match ensued, which led to the injury of a family heirloom and my spine.

It was time for bed, despite my elder son’s complaint of a type of chronic insomnia only remediable by late-night cartoon observation. Evening reading began. Such important journals as Click Clack Moo, P.J. Funnybunny Camps Out, and the Stinky Cheese Man and Other Fairly Stupid Tales were on the agenda.

As I drifted off to sleep, the phone rang. It was a wrong number. Several hours later, an emergency call for supplemental H2O was answered. Two hours after that, I awoke to a hideous scream; it was a nightmare. My alarm rang at 6:15, and I jumped from bed refreshed. No, that’s a lie. I stumbled from bed after hitting the snooze button four times. Morning nutrition rounds were a stale toaster pastry and coffee. Team Newman noted that there were last-minute reports not finished for school and preparation for a day of testing.

I drove to work exhausted after a night of Home. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.


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