A Bit About the Author

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My own stories, from a life well lived, and experiences well earned.

• Triumph & Disaster
• Air Goes In & Out
• Man of the House
• It's a Dry Heat

Triumph & Disaster

Anyone who knows me has heard me say that the "miracle of life is not a pretty sight". This is likely due to the fact that the majority of child births that I have attended have been less than routine, and of course I have been on the receiving end of the process. Mothers and fathers are vested in the 9 months of anticipation and are often blinded by the joys of having a child, so they seem to block out or perhaps repress the sights, sounds and smells of labor. I have usually been involved when the process of labor has gone wrong and intervention is required to reverse the course. Of the 27 children that I have delivered, only a handful have been routine, the others have been the unexpected or terribly wrong.

TriumphA blizzard has set in over the county. There is 18 inches of snow on the roadways and nearly 3 feet of snow on the ground in some areas. The county road crews are barely able to keep the main roads clear, and haven't been able to even consider the side roads. The clouds hang low in the sky and large flakes continue to fall. It has been a relatively quiet day for emergency services as, thankfully, most people have stayed home. I am working at an outlying station, away from the city, that covers several square miles of the rural county and three small towns. This is what we consider an outpost station, or a sleeper station, as most days are all but uneventful. The station is attached to a small rural hospital. A couple bunk rooms, a locker room, showers, bathroom, kitchen and living room all packed into less than 800 sq. feet, hidden behind the bay that houses the two ambulances. We call it the cave, because there aren't any windows to speak of. The radio crackles, interrupting the book I am reading, as I sit lounged in the chair in the living room. My partner grumbles as he is in the middle of making his lunch in the kitchen."Medic 51, imminent birth"The address is out in the country, in between two of the towns. The words "imminent birth" are the dispatchers way of saying the baby is actually coming. Otherwise, it would be "pregnant female, abdominal pain", if there was little chance of a delivery. Those are just some of the code words that we have developed over the years.We head out the station door, into the the bay, hit the buttons... one raises the door, the other changes the traffic signal. As the door goes up, the reality strikes home. Even after shoveling the driveway this morning, there is a fresh 6 inches of snow and it is still coming down. That means our 6 minute response likely doubles to 12 minutes. It also means that the helicopter is grounded, so no air support if we need it. The closest hospital equipped with a NICU is 18 miles away in the city."Medic 51, enroute"As predicted, it is slow going. Any acceleration kicks the rear of the ambulance around, so we have to move at a steady pace gradually accelerating. The only saving grace is that there isn't any traffic, so we have the road to ourselves, eliminating the stop and go and dodging of other cars as they figure out what the lights and siren on the big shinny white truck means."Medic 51, 10-21 dispatch"Now in all reality we've done away with the "10 code" system in most places, but some of them are still used as a matter of convenience. 10-21 means contact dispatch by phone, as there's apparently more to the story than they want to talk about over the radio. This had become more common of late, as we have recently had mobile phones installed in all of the units. Since I wasn't driving, I called dispatch.The back story to this adventure was relayed by the dispatcher. This couple had several children and had made the decision to have a home birth. They had enlisted the assistance of a midwife and had planned the delivery to be at home with family. They had taken all of the appropriate classes, and had stocked up the appropriate supplies for the delivery. Upon going into labor, they called the midwife, who was on the way and keeping in touch by phone. The delivery was going much faster than they had anticipated, and with the inclement weather the midwife was taking longer to arrive than planned. Here is where the real, shall we say wrinkle, appears. The father to be calls the midwife and simply states that he sees a foot. For those that don't know, babies are supposed to come out head first. There is no acceptable variation on this. Babies presenting butt first are termed breach, and babies that think they can walk out, or go foot first, are called footlings. To her credit, the midwife immediately recognized this as a problem beyond the scope of the planned situation and instructed the father to go back to his wife and tell her to stop pushing. She told him that she would call back in a minute and hung up. She then called 911 and set our journey in motion.As we turned onto the country road leading to the house, we could see the fire engine from the local town pulling up to the house. A minute later they came across the radio, "active delivery, breach". We arrived just moments after the update and scrambled into the house. Through the living room, down the hall, to the bathroom. There was mom, on her knees, leaning over the bathtub. There's no polite description, she had two extra little feet and legs.As rare of a presentation as this is, and with all the potential complications, the delivery was actually quite smooth. As a matter of fact, I didn't really do much of anything. Mom said she had to push, and push she did. Out came the rest of the body. This is where the problem arises. The body is smaller than the head, and will often come out smoothy, but then the head is trapped. And no, you do not pull on the baby! You have to coax the head out, making sure that the cord isn't wrapped around the neck, and ensuring that the baby can breath, as she (it was a girl) has been exposed to the outside world and now has a breathing reflex. It really was that simple though, I made a space for her to breath, checked for the cord, which wasn't around her neck and mom delivered in two pushes. She wasn't breathing when she came out, but simply warming her up and giving her a couple breaths with the BVM solved that. She started crying and pinking up right away.

DisasterIt is spring in the city. It has been a beautiful day, and as night has fallen the sky is clear, dotted with innumerable stars. It has been a busy day at one of the central stations, but not overwhelming, there have been breaks for meals and coffee which doesn't always happen. We have just completed a run, restocked the unit, and are sitting outside of the emergency department chatting and drinking coffee with another crew.The radio breaks the conversation."Medic 53, imminent delivery"Medic 53 had been having a busier evening than us, so we (Medic 54) volunteered to take the call. It was common place in our little community, as a group we often looked out for each other. We hopped into the unit and started off."Medic 54 enroute for Medic 53"We were only a mile or so away, headed toward the apartments across from the university. Arriving at the apartments, we got out and headed toward a ground floor unit and knocked at the door. From inside came the shout of a young woman to come in. Entering the apartment, it was dark except for a light coming from the living room. A young woman sat alone on the couch. She had a look of panic on her face and could only say the words "its too soon". She sat on the couch, reclined against one end, her feet up on the couch in front of her staring at her lap. There in the dark was the smallest infant I had seen. He was only a little bigger than my outstretched hand. We immediately got to work, asking questions, and preparing to take care of mother and infant. This was her first pregnancy. She started having cramps about an hour earlier, she had cramps before and they had always gone away so she didn't think much of it. Then they started getting worse, and her water broke, so she called 911. In the time from making the call to our arrival she delivered her son. I looked at the infant, perfectly formed, just in miniature, and looked back at her. "How far along are you?" A question that may seem irrelevant at this point, but there is an unwritten rule that infants less than 25 weeks just don't survive. They haven't developed enough, their organs won't function outside of the womb, in particular their lungs. "25 weeks last Tuesday", today was Friday. It was close, but I was going to try. I carefully moved the infant to a warming pad and covered him with a blanket. He was blue, and wasn't breathing. I knew that I had to warm him up and get him breathing as quickly as I could. I reached for the BVM and tried to give him a breath, but the mask was too big, it wasn't made for an infant that small. I would have to intubate him (put a breathing tube in). I quickly placed my fingers across his little chest and felt a heartbeat, about 100. I didn't have much time, 100 is too slow for a newborn. I assembled the equipment, grabbing the smallest items we carried. I looked at the laryngoscope and then at him, there was no way it would work. Think. I looked at her, she was being attended by my partner and the firemen who had just arrived behind us. She was both panicked and hopeful in her gaze back at me. Think. I looked at the firefighter with me and asked him to get 2 MAG lights (those big black flashlights) and to hand me an adult stylet. He looked at me with a quizzical look and reached for the items. A stylet is a coated wire that is used to stiffen the breathing tube, so we can adjust the shape and angle of the tube to facilitate placement. I opened the package and started bending the stylet, I bent it into the shape of a mini laryngoscope. The idea clicked in the firefighters look, he knew where i was going with this. The fashioned laryngoscope would be the right size, but it doesn't have a light to see into the throat, therefore the MAG lights. Since the infant was so small, I could essentially light him up by "transillumination", a term that I am sure I just made up in relation to this circumstance.Lights in place, pointing toward each other on either side of his neck, my fashioned laryngoscope in one hand, and the breathing tube in the other, I went to work. Opening up his tiny airway, all I could see was fluid coming from the base of his throat, fluid from the lungs. "Suction", as I held out my hand. The suction tube landed in my hand, and I held the end of that tube to the end of the breathing tube. Passing the tube into his airway, I sealed the junction of the tubes with my fist and drew the tube out sucking the fluid out with it. Once you use a breathing tube for suction, it's pretty much done, in particular tubes this small, as they get clogged so easily. Theres only one more tube that size in our kit, only one more chance. With a fresh tube, I go in again, opening his tiny airway, I can see the top of the trachea, or at least I think the top of the trachea, it’s hard to be certain at this point. I pass the tube into his trachea, to the beginning of his lungs. Pulling the fashioned laryngoscope out I grip the tube like his life depends on it, because it does. The firefighter attaches the bag to the tube, and ever so gently squeezes. His chest expands, the tube is in his lungs, we can breath for him.I finally look up, realizing how focused I was, my partner gets my attention. He has a strange look on his face, and simply repeats what the young woman had apparently just said, "what about the other one?". The other one? What other one? Apparently there are twins. Seeing the look on my face, my partner radios in, "dispatch, second unit to our location, code 3". There was an immediate response over the radio, "Medic 53 on location". Apparently, Medic 53 had already headed in our direction to see if they could help, like I said, we had a great community there. I sent one of the firefighters out to meet them, to have them bring their pediatric kit in as I had used everything in ours.When they arrived inside, I simply asked them to take the infant, we would bring mom with us. They left their kit, gathered up the infant and were gone as soon as they had arrived. We moved mom over to the stretcher, grabbed the kits and were on our way right behind them. As we loaded her into the ambulance, she uttered the fateful words, "I have to push". Climbing in after her I looked at her and said, "try not to", but it was too late. I moved the blanket out of the way, and saw the brother, lying there between her legs, still encased in the amniotic sack. He wasn't going to survive like that, too small, just like his brother. I shook off a brief wave of doubt, could I manage to do this twice? I grabbed another warming pad from the cabinet, and shouted to get going. Laying out the warming pad at the end of the stretcher, and gathering a blanket, I went to work again. I had to cut the sac and get him out. With a gush of fluid I opened the sack with the cord scissors and moved him over to the warming blanket. Just like his brother, he was no bigger than my outstretched hand and wasn't breathing. I felt for a heart beat, there it was, a little faster than his brothers, that's a plus. Again, I set up the MAG lights, found my fashioned laryngoscope, and grabbed both tubes out of the new kit. I was anticipating the fluid in the lungs this time, I attached a suction adapter to the first tube, something that I had to improvise the last time. Looking into his throat I saw the same fluid bubbling out, but I was more prepared this time and immediately suctioned it out. Airway clear, I once again looked into his tiny throat and saw the trachea, familiar to the last time, my doubts had dissipated and I pushed the tiny tube into his tiny trachea and toward his lungs. Gripping the tube, I attached the little bag and gave it a gentle squeeze, his chest expands. I can breath for him. I manage a half smile as I look up at the young mother.The ambulance comes to a stop at the hospital ED, there is a group there from the NICU to meet us. They had met the other unit moments before, and had heard there were twins. A nurse climbed in to help breath for him as I tied and cut the cord, I gently handed him across to the nurse who placed him into the waiting isolette and whisked him into the hospital. We unloaded mom on the stretcher, and followed them into the Hospital. As we passed through the door, she reached up and took my hand, gently squeezing it. We transferred her over to the hospital stretcher, and let them get to work.As we headed toward the door to reassemble our unit, the neonatologist came into the hallway. He looked at us and asked, "who did that?" Our looks must have given away the obvious question of, who did what? He rephrased, "Who intubated the infant"? "I did", I responded matter of factly. He looked at me, shaking his head in disbelief, "I didn't think that was possible in a 23-24 week old". Apparently, the young woman was off with her gestational ages, they were 24 weeks at the most. We spoke for a moment, as I explained how I had accomplished this, and relayed the events of the last few minutes. He shook my hand and returned to the care of these tiny boys.

Following the delivery of the baby girl, months before, in the dead of winter, my partner came to the station with a copy of the towns local paper. The parents had run a full page article expressing their gratitude for our assistance in bringing their daughter into this world. She spent some time in the NICU, but was a healthy baby girl. It turns out that the father was the pastor at the towns church and had regaled the congregation with the story of his daughter's backward approach to entering this world. The local paper offered him the opportunity to express himself and he gladly took it.In the weeks following the delivery of those infant boys, I received a card from their young mother:"I just wanted to let you know that I appreciate all that you did for me."
"When I delivered my sons at home and was scared, you made it a little easier for me by being so kind."
"I know that my twins were just too little to make it, but knowing that you did all you could to save my little boys, means so much to me."
"You will never be forgotten by me. Thank you so much!"In the many years that have followed, this is one of a handful of cards that I have kept, and one of the only ones that still brings tears to my eyes.Though I still maintain that childbirth is not a "pretty sight", I also maintain that it is called the "miracle of life" for a reason.

Air Goes In & Out

There has been a long standing quip in emergency medicine:”Air goes in and out, blood goes round and round, any variation on this is a bad thing"This is actually the basic premise for “cardiopulmonary resuscitation” or CPR; where the goal is to restore both ventilation (air going in & out) and circulation (blood going round & round), thereby resuscitating the individual.To this end, there is often considerable focus placed on managing the airway and ventilation of patients during both the training for and practice of emergency medicine. However, this training and the resultant practice are seemingly in conflict.During training the concept is to place the student into controlled environments, often with the anesthesia department in the operating room, where a skilled practitioner can guide and supervise the airway management of patients undergoing general anesthesia. The conflict arises because this is far from the reality of the practice of emergency medicine. The anesthesia department provides an environment where the patient has been pre-screened, prepared, and positioned for both anesthesia and the subsequent procedure. In the practice of emergency medicine none of theses things are present, patients at the scene of an emergency are in a variety of circumstances and positions that are out of the practitioners control.


It is late afternoon, in early winter, and the first snow is beginning to fall. It is the first snow of the season, and has caught the community in the inevitable first snow conundrum of learning to drive again.The radio interrupts the silence in the station,"Medic 56, respond to Chinden and Glenwood avenue, injury accident"We're less than a half mile away. Out the station door, start the bus (an east coast term for ambulance), hit the buttons, one raises the door, the other activates the traffic signal in front of the station."Medic 56, enroute"As the bus pulls out, I notice the snow on the ground, the roads are getting slick and the snow is still falling. It only takes a couple minutes to arrive at the scene. The fire department arrives at the same time, and another medic unit is enroute to assist.Arriving at the accident and surveying the scene, there are two vehicles involved. One is angled in the street having been struck from behind and spun around, the trunk bent and collapsed into the rear tires. The other vehicle is upside down in the canal next to the road way, where it came to rest after striking the other vehicle and sliding off the road. These canals run along the roads all over the county, designed as run off for rain and irrigation ways for the farming communities. The canal is about 6 feet across and 3 feet deep. Due to the recent unseasonable rain and now winter weather, there is about 2 feet of standing water in the canal.The vehicle is an old, four door sedan, perhaps a Pontiac Sunbird, there appear to be two people inside. As myself and several firefighters approach, we peer through the windows, and see an elderly couple. The passenger is a woman who is trying to free herself from the seatbelt. The driver is a man, who is not moving, and appears unconscious. Both doors are locked, and the tops of the doors are wedged to the side of the canal with about 18 inches of water up the window. There won't be an easy way in, as the doors won't open, and breaking the glass on the windows will simply let water into the car, which may in turn drown the trapped couple. We'll know more when we can get inside.It turns out that I have been about the same size for most of my life. A size that seems perfectly suited for crawling into awkward, little spaces. Being the senior medic at the car, and being the "right size", means that I am elected to enter the car. We decide to break out the back window as it will let the least amount of water in, and will allow us to move supplies in and people out.Something you should know about emergency services, is that we are in direct opposition to the engineers at automobile factories everywhere. As they strive to design vehicles that will survive an accident, we strive to know the best way to disassemble them.As one of the firefighters goes around front to explain what we are doing and reassure the woman that we are going to help her, a single blow to the back window, with an axe from the engine, shatters the glass into a thousand little bits. I crawl through the back window, shimmying along the roof of the car on my back, shuttering with a brisk chill of icy water as it sloshes in with me. As I arrive between the front seats I finally see my two patients. It only takes a moment to figure out what I need to do. I introduce myself and the woman responds instantly, there is nothing from the man. This is one of the fastest evaluations available. If you are talking, you must be breathing and you must have a pulse. It doesn't tell me much else, but it instantly separates the critical patient from the less critical patient. I reach up to the throat of the man and check for a pulse, he has a pulse, but not breathing. I hear a tapping at the window. It's my partner, the other medic unit has arrived and taken over for him with the patients from the other car. I signal to him that I need the airway kit, and oxygen. Looking down toward my feet and the broken back window, I can see a group of firefighters waiting for the next move. I shout down that we need to move, now. Instantly they are going about shoring up the car so it doesn't shift on us while we work, and looking for the best way to extract the two patients. As the airway bag is passed forward, one of the firefighters yells up that they can "pop the doors". Essentially, they will remove the hinges and cut or pry the locking bolt, removing the entire door. I point at the passenger side, and yell back to pop that one first.I drag the airway kit up from between my feet and set it on my chest so I can dig through it. I grab the BVM (Bag Valve Mask) out of the kit attach the oxygen tubing, bring the mask to the face of the man and squeeze. Half of the air escapes from around the mask and I can just see his chest expand. Poor seal, I need to be able to hold the mask better. I shimmy up further, and lean on the steering wheel, so I can hold the mask better and squeeze the bag. Much better, his chest expands and no air leak. However, this isn't going to work forever. I look over at the woman pinned, upside down next to me and explain what I'm doing. I ask her a few basic questions, what's her name, what's the date, where are we? She answers without a glitch, the second evaluation down, she is alert and oriented. Squeeze the bag. More questions, does anything hurt, medications, allergies, medical problems? Again she answers right off and seems to be generally healthy, with some shoulder and hip pain. Squeeze the bag. Now to my other patient, her husband of 45 years. Medications, allergies, medical problems? He hasn't been so fortunate, heart problems, breathing problems, and medication for both. Squeeze the bag. That's enough to get me started.There's a shout from down by my feet, they want to slide a pump tube into the car, so when the door comes off, they can start pumping water out, it won't keep it out all together, but we won't drown. They are ready to pop the door. Squeeze the bag.The car is shored up, the doors ready to go and the pump is in place. Squeeze the bag. I quickly drape a blanket over the woman, to deflect any flying glass or parts. Squeeze the bag. A few pops, a crunch, some shouting, and rocking the car a bit and the door is gone. The pump whirs into action as the icy water sloshes into the car. Squeeze the bag. The firefighters and my partner descend on the car, quickly and cautiously extracting the woman from her seat. Squeeze the bag.So this isn't going to work. Just watching them extract the woman from the car, there wasn't going to be anyway for us to get this guy out and breath for him at the same time. Squeeze the bag. I shout for them to send someone around to the drivers side. Its going to be our turn soon, and I need to get him ready to move. Squeeze the bag. I hatch a plan in my head. Shouting through the window and over the noise of the group extracting the woman. I need a cervical collar (to steady his neck), a KED (kendrick extraction device) to stabilize his spine when we move him, an IV set up, and the suction. Squeeze the bag. They can set up some sand bags as a dam across the top (now bottom) of the back door window, so someone can crawl through to help. Squeeze the bag. The rear drivers side window shatters and a familiar face pops through handing up equipment as it arrives. Squeeze the bag. We work the cervical collar into place to support his head and neck. I pass the BVM back to the firefighter leaning through the window and he takes over breathing for the man. Squeeze the bag.


At this point, you may be wondering how the opening diatribe about the conflict between training and practice for airway management applies, well here it is. In training, I was in a sterile operating room with a half dozen staff members wishing about, able to assist at any moment. The patient was lying quietly on an adjustable operating bed, having been prepared for the procedure, monitors attached, IV in place, medications administered. There was often quiet classical music playing in the back ground. Establishing an airway was a straight forward, by the numbers, routine procedure.Here, in the real world, in the practice of emergency medicine, it was quite different. I am lying on my back, in a car, in freezing cold water, upside down in a ditch. The patient is strapped into a seat, upside down, stuck in one position. The only sounds are of the controlled chaos interwoven through an emergency scene. There is no routine, there is nothing straight forward about it.However, this is the challenge I signed up for, I'm not complaining about it, I am simply pointing out the contrast between training and practice.


Squeeze the bag. So here we are in the car, I have everything ready, neatly laid out on my chest (in contrast to the airway cart in the operating room). I look at the firefighter who is breathing for the patient, and signal him to breath a couple times in a row. Squeeze, Squeeze and stop. Now if you have never inserted an endotracheal tube (breathing tube) this may not make much sense, so suffice to say, everything is backwards to how it would normally be. The patient is upside down, and I am upside down. Instead of the usual method, which you have likely seen replicated on TV, where one gently slides the laryngoscope into the back of the throat and passes the tube into the trachea. I am holding the laryngoscope like knife in the psycho movie about to stab down into the shower, something we call the tomahawk approach. However, to add a twist, due to how I am lying, I like to call this one, the reverse tomahawk. Despite all the contorting, and shifting around I had to do, things actually went quite smoothly and I managed to pass the tube into his trachea and secure his airway. Squeeze the bag. His chest expands, I can hear lung sounds on both sides. I secure the tube into place. One problem solved.In the mean time, the rest of the firefighters along with my partner have managed to extract the woman and take her back to the waiting ambulance. Now it is our turn. However, there is a problem. The door on this side is not going to come off without rocking the car off its shoring. Plan B, remove the windshield and come out the front of the car. They assure me it won't take any more time and it will work better. Fine, I have an airway so I can breath for him, he still has a pulse, and we can finish packaging him up, while they remove the windshield. I have the KED passed in and with some extra hands manage to slide it between the patient and his seat. I put those extra hands to work securing the straps as I start an IV.As we finish shifting around in the car, getting the patient ready, the windshield pops out behind me. Brrrr, a fresh wave of cold water sloshes into the car, the pump had at least kept additional water from coming in and my body heat had warmed the pool I was lying in. Hands reach in from the front of the car, a back board is slid into place as I roll out of the way and take over breathing for the man. As many hands as can, hold onto him and support him as the seat belt is cut and he slides toward the roof of the car, guided in swooshing motion to the backboard. once on the board, he slides free and is lifted out of the car to the waiting stretcher. Off to the bus sitting silently by the road, waiting for its precious cargo.When we left the hospital that afternoon he was being admitted to intensive care, both he and his wife had survived, though at an average age of 75, their injuries were automatically deemed critical. Though certainly not your average car crash, in retrospect, it was simply a testament to the teamwork, and improvisation that are the hallmark of emergency medicine.Though there are other aspects of the story, this is one that I choose to share with my students and with the practitioners that train them in regard to airway management. To my students; train fervently and be excellent, because you never know how or when you may need to demonstrate that excellence. To the practitioners who guide and train those students; demand excellence and challenge the mediocrity, because if they can not master the routine they will not be able to adapt to the austere.

Man of the House

It's Spring in Albania. It has been almost 6 months since war broke out in Kosovo. Slobodan Milošević, then president of Yugoslavia, has ordered the "ethnic cleansing" of the country. He has pit the culturally diverse communities of Serbians and Albanians against each other and rallied the concept that the Albanians are degrading the country and are the major cause for political and economic downfall.Like so many before him, he has managed to convince the populous to project their insecurities on the minority. Despite the fact that the Albanians have lived in and supported the Yugoslavian way of life for hundreds of years. True, there origins are of Albanian descent, however, they have established homes, careers, families, and lives in Yugoslavia.By Spring, there are an estimated 250,000 Albanians that have been ejected from Kosovo. The process has been brutal. Soldiers have entered the towns and engaged in mass genocide, killing thousands. They have summarily executed men, women, and children burying them in mass graves. They have tortured thousands more. They have stripped entire families of their homes, their possessions, their very identity and have chased them out of the country in fear of their lives. There is a mass exodus of refugees, though "displaced persons" is the new politically correct term, across the border into Albania, a country that is already destitute and listed as one of the poorest nations in the world.The United Nations is now involved. They have begun a military effort on behalf of the Albanians and all out war is underway. I have chosen to volunteer with an NGO (Non Governmental Organization), which is providing medical care and support for the masses of displaced persons fleeing Kosovo into Albania.

I have been in country for almost a month now. We have established several clinics through out the Northern territory of Albania, along the border with Kosovo. Most of the clinics are set up in makeshift camps. One of the camps is essentially a tent city with 8000 residents. From the elderly to small children, they have created temporary homes in row after row of donated canvas tents. Another camp, is set up inside an old abandoned tobacco factory, 5000 residents occupying every possible space in the 4 floors of the old brick building. They have formed small 8x8 "apartments" by hanging tarps and sheets for walls. There are communal bathrooms, kitchens, and laundries outside the building, where the only water source comes from several hand pumps. We tend to the myriad of ill and injured residents of these camps. Each day we arrive with supplies and personnel, open a improvised clinic and provide what care we can.As the United Nations begins to make headway in this conflict, they establish two large camps (Hope and Eagle) in the southern territory of Albania. This change establishes a new direction for our group, we are asked to triage groups of refugees as they come across the boarder and ensure they are able to travel south to these new camps. I have been asked to spearhead this endeavor. We have set up a layover point in an abandoned rail station, at the northern most junction of the main north south line. As the refugees arrive by truck, we will provide them their first resting point. We will provide food, water, and basic supplies. We will treat the illnesses and injuries that we can, determine if there are any who need treatment at hospital and triage them. Those who are able to continue on, will be divided into two groups and sent by rail to camp Hope and camp Eagle.

During my time in country, I have seen many things, I have born witness to many atrocities, and I have seen the raw, unabashed sacrifice of human kindness. The contrast is truly black and white. However, to explain the significance of this triage point, I believe I can capture its essence in the story of one young man.

A burst of gunfire tears him from his sleep. As he looks around the small room that he and his family have come to call home over the past few days, he sees his father at the window. They have already traveled so far, they have already lost so much. With the little ones, they had to stop here to rest. An old abandoned shack, set back from the street, no one seemed to notice they were here. Another burst of gunfire, shouting outside, and everyone is awake. His father is motioning for everyone to get up, to stay quiet. There are soldiers in the street, they are moving house to house, the armies death squads. His father starts sorting them into groups, they will try to sneak out the back a few at a time. His grandmother and little sister will go first, they will need the most time. They open the back door, and slide out into an alley way. Just as the two of them pass through the back door, the front door burst open, soldiers shouting for them to get out. They are grabbed, kicked, dragged from the little shack out into the street. They are forced into a group of other people, other families who are being taken from their homes. They continue down the street, herded along, as the soldiers are going house by house. The soldiers are dragging more people out and forcing them into the ever growing group. A man bolts, running from the group toward the hills, gunfire rings out and he falls to the street. They are pushed on, through the town, the group continuing to grow. As they reach the end of the little town, the soldiers have gathered a group of about 200 people, men, women and children. They are shouting, laughing, firing in the air. They push them to the side of the road, lining them up in front of a large ditch, demanding to see their "papers".Then silence. Gunfire suddenly erupts. Chaos ensues. Bullets streaming everywhere, as people begin to fall all around him. Reaching for his brother, he is knocked backward into the ditch. Bodies dropping on top of him, blood everywhere. Incessant gunfire, screaming all around. Once again silence. He is buried beneath the bodies, a suffocating weight, but he dare not move. He can hear the soldiers walking back and forth. A single gunshot, then another. A muffled scream, another. The soldiers are walking back and forth along the ditch, finishing their job. Suddenly he feels a searing pain, as a bayonet is thrust into the bodies, thrust into his side. He bites down, containing the pain, containing his own scream. Another gunshot a few feet away, another scream.Boom! Theres an explosion. Boom! Another explosion. The soldiers are running, there's the sound of jets overhead. Boom! Another explosion. It all fades.It's quiet now, he doesn't know how long it's been. It's starting to get dark. Slowly, he moves, pushing the bodies away that are lying on top of him. Slowly, he crawls out from the ditch, out from his would be grave. Pausing, he looks back at the ditch, it's hard to make out the faces in the dark. The sound of trucks down the road getting nearer, he picks up a jacket from the ground, and keeps moving to the side of the road. He makes his way behind the houses, slowly moving out of the town. He knows where they were headed, where the convoys heading out of the country meet, they were only a few miles away. Through out the night he moves between the houses, behind the hills, following the road at a distance. As he reaches the edge of the town that serves as a meeting point, he sits down behind a barn and waits, knowing that the convoys pass through for just a few minutes each morning.As dawn breaks, he awakens to the sound of several trucks coming down the road. He gets up and slowly moves toward the edge of the road, waiting to see if this is the convoy. He can't be sure, but he doesn't have a choice. He steps into the road and waves them down. The trucks slow to a stop. It is the convoy he was waiting for, one of the KLA (Kosovo Liberation Army) soldiers gets out to take him to a truck that still has room. As they pass by several trucks, some one shouts his name. A little girl, his sister. They made it out! His grandmother and sister made it out of the town. They make room for him in the back of the truck. He hides the pain as he climbs in, biting his lip as his little sister hugs him. The convoy is under way again. They will make several similar stops along the way, picking up stragglers along the road, all fleeing their homes, all hoping for safety. The trip is long, about 6 hours of winding mountain roads, stuck in the back of a truck. No food, no water, no time for breaks as they rush toward the border.

I've been out at the train station for a few hours now. For the past couple weeks, I have gotten up, met with the other members of the team for breakfast, gathered supplies and headed to our northern most clinic, at the train station. I arrive early, to set the clinic up, meet with the army unit that is providing protection and get an update on the number of refugees that are expected for that day. It doesn't really take that long, but I have also started my own "side clinic" for the local community that lives around the train station. A group of boys have latched on to me, and come to the station every morning to help. In return, I have been spending a couple hours going out to their homes in the area and providing what care I can to their families. Today has been no different.The lieutenant from the army unit comes by to let me know that the convoy is a few minutes out. Everything is ready as the trucks pull into the station. They back up to the loading ramps and open the gates. There is no way to describe the destitution, the pain, or the sorrow that emanates from these people. They are sick, tired, hungry and broken. We are likely the first glimpse of hope for them in weeks. As they unload from the trucks, soldiers and volunteers alike help them into the station. They are guided through a food and supply area where they are given bottled water, meager food rations, blankets and clothing. From there they are separated into two groups bound toward the two camps in the south. They camps are all but identical, however, we need to divide them up so neither camp is overwhelmed. They can rest and eat in these waiting areas where we've set up benches for them, almost like a real train station. From there we make our rounds through the groups looking for those who may need medical attention.I spot him over against the wall. He's a good looking kid, in any other circumstances I would imagine he could be in some teen magazine. But something was wrong. He didn't look right and he wasn't eating like the majority of the kids his age. Over the years I have come to rely on my "somethings wrong, spidey senses", so I went over to talk with him. Now, I had managed to pick up some Albanian while I was there, but for the more in depth conversations I relied on a translator. We set in with the common greetings, introductions, and basic questions. He was 13, his sister was 7, and his grandmother (who I guessed to be mid 50's, asking a woman's age isn't polite anywhere) were the only members of the family that arrived. He was pleasant enough, just distant, and seemed to be fixated on the idea that ALL of them had to go to the same camp. I reassured him that we sent families together, that there wasn't anything to be concerned about. I asked if there was anything we could do for them. If they felt sick, had been injured, needed medication. They assured me that they were fine, that it had just been a long trip. Though not really satisfied with the answers, I decided that there was a few hours before the train came, so I could let it rest for now. We moved on to another family, and another, asking the same questions, offering the same assistance. Some had issues that we could help with and I directed them to the clinic we had set up in the station. Others were beyond what we could offer, either medications we didn't have, or long term problems we couldn't address. I wrote out clinical notes for those people to present to the intake officers at the camps where they were headed. That would at least get them into the clinics there, where they could have follow up care. We had a good relationship with the camps and they always addressed the concerns that we sent them.As I was kneeling down, scribbling out one of these notes, I felt a tapping at my shoulder. The little girl, the young mans sister, was standing there. She held out a rag, a torn up shirt really, that was soaked in blood. I looked up at my translator, and he went to work investigating the source of the rag. It was her brother, he had been wounded, and didn't want to say anything for fear of being separated. He had made the little girl and grand mother promise not to say anything until they reached their destination. She just couldn't keep quiet anymore because he looked so sick.We immediately headed back to where they were. As we approached, he saw the look on my face, and saw his sister and knew the story was out. He immediately started in that he was fine, that he could wait, that they had to stay together.Now over the years, I have developed a, shall we say, knack for persuasion. I assured him that they had all been assigned to the same camp, they were already on the list, and that it was more trouble to change it than to just leave it alone. All I wanted was for him to come with me to the clinic so I could get him a better bandage for the trip. Apparently, this seemed reasonable, because he agreed. We helped him up and guided him over to the clinic. As we moved across the station and into better light I could see how pale he really was. Supporting his arm I could feel the heat radiating off of him, the heat of a fever. There were cots set up in the clinic, and I chose one by the wall, with a little more privacy. As he removed his jacket, I could see the blood soaked shirt underneath. He lifted his shirt, and pealed away the makeshift bandage. The wound wasn't large, only about an inch and a half, but it was deep in his abdomen. It was surgical, and I am not a surgeon, nor was I equipped to fake it here. He needed a hospital, and he needed one now. I pressed a fresh bandage over the wound, and he winced in pain. His abdomen was already starting to tighten up, an automatic response to the spreading infection. I told him he needed to go to the hospital. I told him there was a military hospital a few miles away that could take care of him, they would fly him over there and he could go to the camp a few days later. He protested, reminding me that I had said his family would stay together. I told him that the military won't fly family, just the injured. He could meet them at the camp later. He insisted that they stay together. I could see that this was going to be a circular argument. He looked at me, and motioned me to sit down, looking around I could see that he wanted to tell me something, but quietly. I sat at the edge of the bed, and motioned for my translator to sit in a chair close by.There the three of us huddled together as this young man relayed his story of the past few days. The story of his family running to escape, of their murder in front of him, of his destitution as he crawled free from their bodies, of the glimmer of joy having found his sister and grandmother alive, and of the awesome responsibility he now felt as the man of the house. As his story came to an end, the events of the past few days broke through in waves of emotion. He grasped my arm, and began sobbing. I put my arm around him and whispered është mirë, "it's ok", the only words that would come to me at the moment.Several minutes passed, before I could leave his side. I asked my translator to bring his family over, and to reassure this young man that I would do everything I could. I went to the lieutenant and asked to contact the hospital. Briefly relaying the young mans story to the captain on the other end of the phone, was enough to circumvent the "no families" rule. The helicopter would be enroute within a few minutes, for all of them.I returned to the young man and explained the new plan. He and his family would be flown to the hospital, they would treat him, and when he was well enough, the whole family would go together to the camp. The glimmer of a smile that passed over his face, as he finally relaxed, was one of the best sights I had seen in this makeshift clinic. As we awaited the helicopter, I set about getting him ready for the trip. I started an IV to replace the fluid he had lost, started some antibiotics to treat his infection and cleaned and bandaged the wound. Having done all that I could to treat him, we sat together and talked. Not about the atrocities that he had just endured, but about the hopes and dreams that any 13 year old boy should have. About cars, holidays, football, where he wanted to go with his family, the future that lay before him.As the helicopter lifted off that afternoon, I hoped that my actions could temper the actions of those who brought this tragedy of war. The politics surrounding the war in Kosovo have presented many facets. Those who have supported and those who have condemned the imputes for war. There are those who have said that the atrocities reported are government propaganda, that they have been blown out of proportion and weren't that bad. I challenge them. I have heard the stories first hand. I have seen the results first hand. I have stood over the mass graves of hundreds of slaughtered men, women and children. I challenge them to have one ounce of the fortitude of this young man. I challenge them to admit the heinous behavior that takes place in war, and to embrace the change necessary for it to never happen again. No one should have their childhood ripped away from them, no one should be thrust into the roll of "man of the house" before their time.

It's a Dry Heat

I'm sorry but at 130° it doesn't matter if it's wet, dry or otherwise; it's just bloody hot. It's stifling, constricting and oppressive and it is every day in the desert. Imagine that blast of heat when you open the oven door to retrieve the thanksgiving turkey, but coming from all directions, not just the rush of hot air into your face. Don't get me wrong, there are beautiful places in the Middle East, but across the plains it is hot, dry, dusty and dirty.This day begins just like any other day, set up the clinic, take sick call, requisition supplies, and keep up with the paperwork. The average day is simply mundane, not like the constant adventure that you see in the movies. Half way into the morning there's a pounding at the door, there has been an incident, they need a medic. The mundane day turns to chaos in an instant. Grab the kit, grab the vest, grab the weapon, head out the door, and flip the sign."Medic Out"I'm by no means an old man, but this is clearly a young mans game. As I run across the compound to the helipad in blistering 130° heat, carrying all that gear, it reminds me I should be more committed to "cardio" in the mornings.The blades on the helicopters are already spinning up, and the members of the team are assembling. There is a quick briefing on the tarmac before we get underway. A convoy, traveling down route Irish, was hit by an IED (Improvised Explosive Device). There is a ground team on the way, and we are being deployed for air support and MEDIVAC.We load up, and are quickly underway, the helicopters lifting slowly into the air, tilting ever so gently forward, shifting into formation, pushing ahead toward the incident. The trip is oddly serene, its quiet over the radio headsets and the city beneath seems eerily calm. Each member of the team is likely mulling over our different rolls and jobs, preoccupied in our own little worlds, the only sound is the constant deep pounding of the rotor over head. There really isn't much to talk about anyway, we've all been here before, we are all "seasoned" at what we do.We bank to the left toward the incident, quickly closing in; the weapons are charged, and the side doors opened up.Every incident is unique, as we fly over, there is smoke slowly rising from several of the vehicles in the convoy. It appears the IED was set off in the middle of the convoy. There is one HMMWV at the lead that is parked side ways, with the soldiers positioned to return fire, a couple of them have started moving back toward the damaged vehicles. One tanker is over turned, on fire, the main source of the rising smoke. Another HMMWV on its side just off the roadway. A second tanker, with the wheels blown away from it, is sitting with the cab ground into the pavement and the tank twisted around sideways. Two more tankers are piled into each other like a wreck on a highway at home. And the last HMMWV turned sideways in the road with those soldiers moving forward to the injured.The headset interrupts my thoughts, the decision is to make a touch and go, where the helicopter touches down for a moment, we get off and then the helicopter takes off again circling above, waiting for us to return. The helicopter descends, the skids hit the pavement. Everyone is off in an instant, moving forward to the mangled vehicles and injured personnel.Then it hits, all hell breaks loose. There are dozens of them, pouring over the embankments at the side of the road and running toward us. Not soldiers, just men with guns. Lots of men, lots of guns. Im not sure if you could see it or hear it first. But there is definitely a hail of bullets coming toward us. Glass shatters, there’s a constant pinging of bullets off the metal of the vehicles behind us, in front of us, all around us. They are coming from all directions. A steady stream of bullets, you can see them, hear them and feel them as they slice through the air all around you.Do you remember that scene from Heartbreak Ridge, Clint Eastwood fires on his platoon during training and says, "This is the AK-47 assault rifle, the preferred weapon of your enemy. It makes a distinctive sound when fired at you". Well, it does!Suddenly the calvary engages. There is a rain of bullets from above as our gunship circles around and unleashes the twin M60's. The horde of men scatter and seek cover from the gunship, still firing at us, but sporadically, giving us the chance to seek cover, to move forward toward our objectives. We fan out to cover as much ground as possible, to reach as many injured as possible.I meet up in the middle of the mangled convoy with a couple of the soldiers from the forward HMMWV. We quickly exchange notes. I let them know there are ground reinforcements a few minutes out, we have one EVAC helicopter and one gunship for cover. I point to where the EVAC is supposed to retrieve us, its just off the side of the road, behind a berm, in a small clearing. One of the soldiers tells me that there are two more soldiers stationed at their HMMWV, they count 3 dead in the second overturned HMMWV, and one wounded. The cab of the first tanker is demolished, and on fire, 2 dead. We agree to move to the other tankers, then back to the overturned HMMWV for the other injured soldier.Peering out from behind the rear of the tanker, bullets are again hailing toward us, as the horde of men has some reprieve from the gunship above as it circles around for another run. The forward and rear HMMWV have also opened fire with their top mounted M60's, keeping the horde from moving in on us, though not keeping them from firing at us.We move forward, returning short burst of fire, dodging between the mangled vehicles, ducking, sliding, running, stopping, and firing. It seems like an hour to move 10 feet. The gunship is back overhead, “unleashing the rain”. We move a bit faster as it is now their turn to seek cover. I see one of the tanker drivers crawling out and dropping to the ground. He can move, so he doesn't need me right now, I point at him and one of the soldiers takes off toward him to bring him back to the rendezvous point. The other soldier and I move forward again, while we can. We take cover behind the next tanker, that's where we see the other driver and his copilot, they're fine, but unarmed and scared.I look for the gunship, it’s circling around again. When it gets overhead, the truck drivers and soldier can move to the rendezvous point. I can move to the HMMWV, get the injured soldier and follow them to the rendezvous point. Brilliant plan. The HMMWV is only 30 meters away, note to self, DO CARDIO!There's the gunship overhead, we split, soldier and drivers head back to the meet point, I head to the HMMWV. Even with out the extra cardio I seemed to cover the distance in a few seconds, perhaps adrenalin is as good as cardio. There he is, lying on the ground propped up behind the tire of the HMMWV. He's conscious, M16 in hand and returning fire when he can. That works, he can shoot, I can drag, and we can get off the road where I can look at him. It's almost psychic, he just gets it when I reach for the drag handle on his vest and point toward the side of the road…Insert slow motion scene here…In reality I know it was only a few moments, but it replays as if it was a slow motion scene in a movie. Grabbing on to his vest, I turn to start moving toward the side of the road, and there he is. A kid really, no more than about 16 I'd guess, with a gun. I had holstered my weapon, so I could drag the soldier, and he was firing the other way. So there we were, face to face, about 20 feet apart. The look on this kids face was surprise, maybe shock, I don't think he expected to come around the HMMWV and find us there. Then, in a moment, his expression changed to a look of hate. Perhaps all of the propaganda, all of the indoctrination, or some lingering atrocity that caused him to join the Jihad in the first place had been summed up into one piercing look of hatred.He fired.I wasn't counting at the time, but three rounds hit me, square in the center of my chest. It knocked me to the ground, pulled the breath out of my lungs, and hurt like a son of a bitch. Thank god for kevlar! There was a moment of stunned disbelief, for me, and apparently him as he just stopped and looked at me. Perhaps questioning if I was dead, perhaps setting his sights on the soldier behind me, either way he had just stopped. Then he slowly began to raise his weapon, maybe a conditioned response. I didn't really think at the moment, I didn't plan, I didn't have a “Matrix” moment of supernatural training. I simply drew my side arm and fired. His head snapped back, and he fell to the ground. There was no joy, no revelry, just the simple fact that he was dead.The soldiers voice woke me from my haze, "are you ok?". Time resumed to normal speed, as I rolled to my knees, pealed the top of my vest back and looked at the shirt underneath, no blood, I can breath, I can move, I'm Ok. I reach for his vest again and we resume our journey, sliding past the young man I had just put into a grave.At the side of the road, ducked down behind the berm I was back to myself. Looking over my patient, his leg was mangled from the shrapnel coming through the side of the HMMWV, I tied a tourniquet around his thigh to control the bleeding. His arm had some shrapnel imbedded in it, but just a few pieces. Hmmm, where else would you say just a few pieces of shrapnel? And he had a nasty gash just under his helmet. Overall he's good to travel.One of the other soldiers came back from the meet point to help get us back over there. When he arrived, he looked at me funny and said "hey doc, your hit". I looked at my chest again, looked at him, and he shook his head, pointing at my arm. Sure enough, there was a slash through my shirt and blood trickling down my arm. Looking at my arm, it was just a graze, perhaps a fourth bullet?We were ready to go, the gunship was swinging over again, and I could see the EVAC swinging in to land at the meet point. As the M60's on the gunship opened up again, we both took hold of the patient and started to run toward the helicopter that was approaching for a touch down. Timing was once again perfect, we arrived, just as the skids touched the ground. We all loaded up, and lifted off again.The trip home was uneventful, routine really, I was back to doing my job. Bandaging, splinting, IV's, medications and notifying the nearest CSH (Combat Support Hospital).It wasn't until the job was done that I had the opportunity to think. This wasn't the first time that I had taken a life, and sadly it wouldn't be the last. But this time, it was more personal. I was face to face, just 20 feet away. He was a kid. He was the same age as the kids on the soccer team I had coached at home. Wincing with each breath from the bruises on my chest, the dull ache in my shoulder from the now sewn up hole, and the flashes of todays events interrupting my thoughts, I had to ask, is it worth it?There is an insane amount of money to be earned as a contractor in the desert. The job is usually very simple, providing routine healthcare for who ever shows up at the clinic door. There is the odd charm of practicing medicine with out the encumberments of insurance and restrictions of the American healthcare system. You simply treat people. You care for their maladies regardless of who they are, how they can pay or what their status is. Your job is to make them well and get them back to doing what they need to do. It might take 5 minutes and a few Ibuprofen, or it could take an hour of just listening to and discussing the problem of the day. It is truly free form medicine. You may need to be the scientist, physician, or counselor; what ever it takes.Then there are days like today. The realization sets in. No matter the satisfaction you get from truly practicing medicine. No matter the ridiculous amount of money you can make. Is it worth trading your life for? The odds are that one of those bullets will hit their mark, and you won't be around to spend the money. But more importantly, is the impact that days like today will have on your life, and it won't be a life any more. You will end up mired in the memories and internal conflict born from being forced to make choices that no one should have to make. All politics and justifications aside, medicine is about preserving life, not taking it. And what is more, life is about living wether you are an aging American medic or a kid who should have a soccer ball, not a gun.

A selection of written works that have inspired over the years.

• IF
• Desiderata
• Do not go
• Man In The Glass
• Thinking
• Laughing Heart
• Psalm of Life
• Man in the Arena
• Invictus

IF

by Rudyard Kipling

If you can keep your head when all about you
Are losing theirs and blaming it on you,
If you can trust yourself when all men doubt you,
But make allowance for their doubting too;If you can wait and not be tired by waiting,
Or being lied about, don’t deal in lies,
Or being hated, don’t give way to hating,
And yet don’t look too good, nor talk too wise:If you can dream—and not make dreams your master;
If you can think—and not make thoughts your aim;
If you can meet with Triumph and Disaster
And treat those two impostors just the same;If you can bear to hear the truth you’ve spoken
Twisted by knaves to make a trap for fools,
Or watch the things you gave your life to, broken,
And stoop and build ’em up with worn-out tools:If you can make one heap of all your winnings
And risk it on one turn of pitch-and-toss,
And lose, and start again at your beginnings
And never breathe a word about your loss;If you can force your heart and nerve and sinew
To serve your turn long after they are gone,
And so hold on when there is nothing in you
Except the Will which says to them: ‘Hold on!’If you can talk with crowds and keep your virtue,
Or walk with Kings—nor lose the common touch,
If neither foes nor loving friends can hurt you,
If all men count with you, but none too much;If you can fill the unforgiving minute
With sixty seconds’ worth of distance run,
Yours is the Earth and everything that’s in it,
And—which is more—you’ll be a Man, my son!

Desiderata

by Max Ehrmann

GO PLACIDLY amid the noise and the haste, and remember what peace there may be in silence.
As far as possible, without surrender, be on good terms with all persons.
Speak your truth quietly and clearly; and listen to others, even to the dull and the ignorant; they too have their story.

Avoid loud and aggressive persons; they are vexatious to the spirit. If you compare yourself with others, you may become vain or bitter, for always there will be greater and lesser persons than yourself.

Enjoy your achievements as well as your plans. Keep interested in your own career, however humble; it is a real possession in the changing fortunes of time.

Exercise caution in your business affairs, for the world is full of trickery. But let this not blind you to what virtue there is; many persons strive for high ideals, and everywhere life is full of heroism.

Be yourself. Especially do not feign affection. Neither be cynical about love; for in the face of all aridity and disenchantment, it is as perennial as the grass.

Take kindly the counsel of the years, gracefully surrendering the things of youth.

Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with dark imaginings. Many fears are born of fatigue and loneliness.

Beyond a wholesome discipline, be gentle with yourself. You are a child of the universe no less than the trees and the stars; you have a right to be here.

And whether or not it is clear to you, no doubt the universe is unfolding as it should. Therefore be at peace with God, whatever you conceive Him to be. And whatever your labors and aspirations, in the noisy confusion of life, keep peace in your soul. With all its sham, drudgery and broken dreams, it is still a beautiful world. Be cheerful. Strive to be happy.

Do not go gentle into that good night

by Dylan Thomas

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
Though wise men at their end know dark is right,
Because their words had forked no lightning, they,
Do not go gentle into that good night.
Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.
Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.
Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.
And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.

The Man In The Glass

by Peter Dale Wimbrow Sr.

When you get what you want in your struggle for self
And the world makes you king for a day
Just go to the mirror and look at yourself
And see what that man has to say.

For it isn’t your father, or mother, or wife
Whose judgment upon you must pass
The fellow whose verdict counts most in your life
Is the one staring back from the glass.

He’s the fellow to please – never mind all the rest
For he’s with you, clear to the end
And you’ve passed your most difficult, dangerous test
If the man in the glass is your friend.

You may fool the whole world down the pathway of years
And get pats on the back as you pass
But your final reward will be heartache and tears
If you’ve cheated the man in the glass.

Thinking

by Walter D. Wintle

If you think you are beaten, your are
If you think you dare not, you won't,
If you like to win, but don't think you can
It's almost a cinch you won't

If you think you'll lose, you're lost
For out in the world you'll find,
Success begins with a fellow's will
It's all in a state of mind

For many a game is lost
Ere even a play is run,
And many a coward fails
Ere even his work is begun

Think big and your deeds will grow
Think small and you'll fall behind
Think that you can and you will
It's all a state of mind

If you think you are out-classed, your are
You've got to think high to rise
You've got to be sure of yourself before
You can ever win a prize

Life battles don't always go
To the stronger or faster man
But sooner or later, the man who wins
Is the fellow who thinks he can

The Laughing Heart

by Charles Bukowski

your life is your life
don’t let it be clubbed into dank submission.
be on the watch.
there are ways out.
there is light somewhere.
it may not be much light but
it beats the darkness.
be on the watch.
the gods will offer you chances.
know them.
take them.
you can’t beat death but
you can beat death in life, sometimes.
and the more often you learn to do it,
the more light there will be.
your life is your life.
know it while you have it.
you are marvelous
the gods wait to delight
in you.

A Psalm of Life

by Henry Wadsworth Longfellow

Tell me not, in mournful numbers,
Life is but an empty dream!
For the soul is dead that slumbers,
And things are not what they seem.

Life is real! Life is earnest!
And the grave is not its goal;
Dust thou art, to dust returnest,
Was not spoken of the soul.

Not enjoyment, and not sorrow,
Is our destined end or way;
But to act, that each to-morrow
Find us farther than to-day.

Art is long, and Time is fleeting,
And our hearts, though stout and brave,
Still, like muffled drums, are beating
Funeral marches to the grave.

In the world’s broad field of battle,
In the bivouac of Life,
Be not like dumb, driven cattle!
Be a hero in the strife!

Trust no Future, howe’er pleasant!
Let the dead Past bury its dead!
Act,— act in the living Present!
Heart within, and God o’erhead!

Lives of great men all remind us
We can make our lives sublime,
And, departing, leave behind us
Footprints on the sands of time;

Footprints, that perhaps another,
Sailing o’er life’s solemn main,
A forlorn and shipwrecked brother,
Seeing, shall take heart again.

Let us, then, be up and doing,
With a heart for any fate;
Still achieving, still pursuing,
Learn to labor and to wait.

“Man in the Arena”

by Theodore Roosevelt

an excerpt from "Citizenship In A Republic"

It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better.

The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming;

but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.

Invictus

by William Ernest Henley

Out of the night that covers me,
Black as the Pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.

In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeoning of chance
My head is bloody, but unbowed.

Beyond this place of wrath and tears
Looms but the Horror of the shade,
And yet the menace of the years
Finds, and shall find, me unafraid.

It matters not how strait the gate,
How charged with punishments the scroll,
I am the master of my fate:
I am the captain of my soul.

A selection of media presentations that have given pause.

• Empathy
• McRaven

Empathy: The Human Connection to Patient Care

If you could stand in someone else's shoes, hear what they hear, see what they see, feel what they feel. Would you treat them differently?
- Cleveland Clinic

Admiral William H. McRaven
University of Texas Commencement, May 17, 2014

Remarks by Naval Adm. William H. McRaven, BJ '77, ninth commander of U.S. Special Operations Command, Texas Exes Life Member, and Distinguished Alumnus.