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Life in Emergistan: The Miracle of Emergency Medicine

Leap, Edwin MD

doi: 10.1097/01.EEM.0000511951.71089.3a
Life in Emergistan

Dr. Leapis the president of LeapMedicine, PC, a member of the board of directors for the South Carolina College of Emergency Physicians, and an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available, and Working Knights, Cats Don't Hike, and The Practice Test, all available, and of a blog, Follow him on Twitter @edwinleap, and read his past columns at





I've long been one of those guys who likes wandering through cemeteries. I've been doing it since childhood. We used to clean our ancestors' graves and bring flowers and flags on Memorial Day. I have always walked through the rows and read the stones for as long as I can remember. At least I've read those that were still legible, not erased by wind and rain or heartless vandals. (I pause with respect before the smooth, nameless, ancient markers lost to memory.) I tend, out of training from parents and friends, not to walk directly on graves. I was taught that it was rude. I imagine what it would feel like when someone walks on my grave, and I get a chill on a summer day! I don't want to do that to anyone.

I have seen the graves of my own people and that of my wife. I have visited the burial sites of untold strangers. I think Appalachians love this sort of thing. It's kind of a melancholy hike, a walk through the past. I find that these walks give me a sense of history and a sense of perspective. It's difficult to get too proud in this life knowing that one day somebody will laugh and walk past your headstone, calculate the number of years you lived, and promptly go on living with no more thought of you or your accomplishments.

But graves give me more than just perspective on my eventual passage. They make me think about what a wonderful gift modern medicine is. I was reminded of this a few days ago. Jan and I were waiting for our daughter, Elysa, to come to the car after a church activity, and I left my bride in the warmth of the car on a surprisingly brisk October day to explore a large cemetery I had never visited before.

Some graves were old; some of the deceased were born as early as 1822 (when our area of South Carolina was just wilderness). A tattered Confederate flag blew next to the small marker in memory of a Civil War veteran who had come home but died not long after. I wondered how he died. Those dying on battlefields are fairly easy to imagine, by musket or cannon. But not everyone who came home from our wars came back well. Some had TB, others paralysis, or chronically infected, draining wounds. Some killed themselves or drank themselves into oblivion. What put this young rebel in the ground years after the war? Was it possibly as mundane as a fall from a horse? An infected kidney stone? If only he had seen me in the ED.

Walking a little farther revealed a young married woman, maybe 29, resting beneath a large marker. (They must have been wealthy.) The marker had room for two names but bore only hers. Maybe her husband married again and now reposes by his second love. But did she die in childbirth? Did she have a pulmonary embolus? Did she develop pneumonia and die like so many in history before the arrival of antibiotics? If only someone could have seen her with modern diagnostics and medications. A little Lovenox, maybe? Some gentamicin?

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Before Their Time

There were, of course, also graves of children. In the hilltop cemetery of the Leap family lies my grandmother's brother, who died at 2. I think it was diphtheria, but it might have been the 1918 influenza. They lived in remote West Virginia. When the baby became sicker and sicker and struggled to breathe, there was little recourse. Doctors and emergency rooms were hardly around every corner then, so they rocked him and prayed. They may have sent to town for medicine or a salve. And then he died, and that was that. Tears, mourning, and a small grave.

So many stories: car wrecks in remote areas when cars were as unusual as emergency rooms, people dying from injuries too complex for local physicians to fix.

It's important to remember how important our work truly is. Had we been around, not only our specialty but many others, those who lie underfoot may still have died, but they could have done so with less suffering, more enjoyment, and longer lifespans. The children might have survived with antibiotics, ventilators, or simply vaccination. The headstones might have far fewer images of lambs, fewer children who lived just days or months, and instead there would be more of old men and women who died in their 80s.

Who knows what our children and theirs will have? And who knows what our descendants will think as they ponder the same questions about us? Go walk through a cemetery! The quiet graves and cold stone markers bear testimony to the harsh truth that life is hard. But it sure is made easier by the gifts you bring to the sick and injured, year after year.

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