This Halloween article has been a favorite of our readers, as many who work the ER, relate to the chaotic nature of such an evening, and so we decided to run it one more year. ENJOY!
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Awhile back, I had the fortune or the misfortune of working the ER on Halloween night, which happened to fall on Friday. At the time, I was living in a small but very multicultural town in Northern New Mexico. The night turned to be wackier than any of us expected. Of-course the usual, Friday night crowd kept us busy with drunkenness, bar brawls, car accidents, sniffling noses, and the standard medical incidents. But the unusual was what made it, well, rather memorable.

It started with the usual minor accidents due to drivers watching the trick and treaters rather than the road and running into each other. Kids falling in the dark streets and bruising themselves, and so on. Then closer to midnight, two very striking young ladies showed up in the ER in witch attire. Well the outfits were more risqué than witchy and that attracted some unwanted attention. The ladies were from out of town - California to be exact - visiting friends for Halloween. They were sisters with a long history of asthma - yes, both of them. At the friend’s party, the guests got to drinking and smoking and more smoking and different kinds of smoking, and before long the indoor atmosphere got too polluted and our young ladies found themselves in severe distress. Their inhalers just weren’t doing the job, and they were rushed to the ER by the police - ambulances were busy chasing fender benders. In their haste, they didn’t grab their coats and showed up in revealing witch costumes.

It was particularly cold that evening in the high country of Northern New Mexico. As it was usual for our town, several locals and their homeless friends used to sneak in the waiting area of the hospital to get warm. They were regulars and generally subdued and quiet, if they got rowdy, we would ask them to leave, and they usually quieted down. But that night being Halloween, they had a bit too much to drink and the arrival of two very attractive blond witches - well, just got them too excited. The policeman who brought the witches was known to be a bit rough and, as he too was interested in the ladies, got into an argument with the others in the waiting room. In his roughness, he turned one of the unwelcome visitors to the wall and grabbed his Mace Spray and proceeded to use it on his subject. A scuffle ensued and as the officer pressed the Mace Spray, the man ducked and the officer sprayed himself in the eyes. Well you can guess the chaos that followed.

In the confusion, the uninvited visitors dashed out into the dark night. We covered our ladies with patient gowns and rushed them to the P.T. Department across the hall and locked the door. As it was the standard treatment of the day, we gave them each a shot of epinephrine and started them on a nebulizer. Much to our dismay, they told us that they had been dealing with asthma much of their lives. They were started on a new treatment by their pulmonologist back in California but didn’t know the medication they were given. Fortunately for us, it all turned out well. Our intoxicated friends made it back to the sanctuary of another warm place, we flushed the officer’s eyes and sent him home, dressed, bandaged, and splinted other injured patients, treated the sniffling children and cared for other medical problems. It was a full and eventful night. Our out-of-towners responded well to our treatment and left the next day for California.

We were lucky that night, for our patients were young and did respond to the management of their acute asthmatic attack. Today, of course, better treatments are available and with the help of telecommunication we can access patients’ medical charts from out of town and consult their providers back home - even on Halloween evening. New tools allow us to care for this mobile generation. Still, it helps to remind ourselves of how we dealt with medical urgencies back in the not so distant past.

Come o nature of autumn cool
Rest your head upon the golden leaves
Your fruitful toll of summer, fulfilled
With the sun, soil, and
Water, to the life giving seeds
Grown to nurture man and beast.
 
Now it's time, rest your weary days
Set for the long nights ahead
Pull the darkness over the naked limbs
Seek a warm abode to hibernate
Blissfully dream among the stars beyond
Of green pastures and berries abound.
 
Now the cold wind of autumn brings
Nudge of the season to rest and sleep
Nature's promise to revive
And the joy of being alive
Soon to rouse you to the hope
Of all that is so revered.
 
Reza Ghadimi - Autumn 2022

On a cold and dreary night, long ago in New York, after a long and arduous day of working in the South Bronx, I was going home on the subway. I was surprised, when for the third time, I heard someone say; Hey doc, how is it going?

I was so tired that I had not noticed the pertinence of the question, till the third time. Amazed, I asked the man sitting next to me: How do you know I am a doctor?

"Your stethoscope." He said, pointing to my neck.

I laughed, after touching my neck and noticing that the head of my scope was sticking out of the back of my collar. In my haste and fatigue, I had forgotten to take it off, when I put on my parka, and the head of it was hanging over the hood.

Sheepishly, I removed it and placed it in my pocket.  "I am just a PA student." I informed him. Which ended the uncomfortable conversation.

I find it interesting that a simple tool, such as that, clearly identifies one's occupation. Furthermore, I find it amusing that I still remember the incident after fifty years, and often wonder if I would still be greeted, had the tool identified my occupation as something else.

It shows the respect and value, our profession awakens in people.  Not many can make such a claim. It also reminds me of the many times we hear on the news of how, some of our colleagues violate this sacred title. I suppose that we are all guilty of taking advantage of our position at some point or another.  But when it rises to a criminal level, it tarnishes us all. So who is to blame, is it our responsibility to police each other, are we our brother's keepers, or should we fault the system that, in many cases, has unrealistic demands of us.  Maybe it is all of the above. Still, I feel proud to also note that looking comparatively, our group's offenses are relatively small.  But, they are there and when they come out, it makes us all wither. Our profession deserves better than that.

October 6 to 12 is International Physician Associates Week.  We salute all our brother and sister PAs. Especially all the old timers. Those of us who truly made this profession. Our profession started in the 1960s, so we are celebrating fifty-five years, and we are worldwide, so this is International Physician Associates Week.  We have come a long way, still much has to be done.
I was one of the first PAs in the country and am a living history of the many fights we had. Along the way, we gained much and lost a few too.  Though AAPA likes to take credit for all the achievements, the practitioners in the field are the ones who deserve credit.  For state by state, and country by country, we fought the prejudices of our fellow practitioners, government regulators, legislators, media and the public.
When I first came to New Mexico in 1973, no one knew what a PA was.  The secretary of the NM Board of Medical Examiners, told me to my face: "PAs will practice here over my dead body."  I am proud to say that not only are we still practicing here, I actually served as the first PA on the NM Medical Board forty years later, and held his job as secretary of NM Medical Board in 2008.
My book Practicing from the Heart in the Age of Technology is all about our experiences and struggles, as a PA, in this country and around the world.  Humayun J. Chaudhry, DO, MACP, FRCP, President and CEO of Federation of State Medical Boards wrote the foreword to this book.
Paul B. Roth, MD, MS, F ACEP - Dean of the UNM College of Medicine, Chancellor, UNM Health Sciences Center, CEO, UNM Health System, said: In Practicing from the Heart, Reza Ghadimi has captured the true heart of our healing profession… Every student thinking of entering the health professions should read this book.
Go to the home page of this site and read their endorsements and on the Blog page, the many stories that truly make our history.
 
                                             Keep up the good work and do not give up the fight.

The UN General Assembly brought hundreds of leaders and policymakers from around the world to New York for a couple of weeks.  I found this year's session very disappointing. Many talked, yet little of substance was discussed, as it seemed that blame-placing and finger-pointing was the only thing on the agenda.  Although climate change, hunger & famine, and overall health of the world is in dire need of attention, political issues trumped them all. Leaving everyone flabbergasted and at the mercy of uncontrollable circumstances. Interestingly and on cue, several hurricanes have developed and are causing havoc everywhere. 
 
On a positive note, the Nobel Prize Committee is meeting right now and some interesting people are awarded this year's prizes:

For medicine:
Svante Paabo, a Swedish scientist, won the Nobel Prize in medicine for pioneering the use of ancient DNA to unlock secrets about human evolution that provided insights into our immune system.
 
For physics:
Alain Aspect, John F. Clauser and Anton Zeilinger are awarded for their achievements in quantum mechanics. As the Committee announced: The trio won for their experiments with what’s known as entanglement – an unimaginable phenomenon of two particles behaving as one and affecting each other, even when they are at vast distances to each other, on opposite sides of the planet or even the solar system. (What?)

For Chemistry:
Carolyn R. Bertozzi, Morten Meldal and K. Barry Sharpless were awarded the Nobel Prize in Chemistry “for the development of click chemistry and bioorthogonal chemistry.”

For Peace:
The Nobel Peace Prize was awarded Friday to Belarusian human rights advocate Ales Bialiatski and two groups, Memorial, a human rights organization from Russia and the Center for Civil Liberties, which is based in Ukraine.

For Economics:
The Nobel Prize in economics was awarded Monday to Ben Bernanke, Douglas Diamond and Philip Dybvig for their research on banks and financial crises.

When I consider these mind-boggling scientific facts, I am reminded of an astronomer who said: "When you have all the cosmos to think about, who cares about the kind of soup you are served in a restaurant."  The total disregard and ignorance of many political leaders, however, reminds me of a cartoon, I once saw, showing:  A man standing in front of an observatory, shaking his fist at the cosmos, yelling: "You don't make me feel insignificant."
As these mayhem developing conundrums, sicken the population in many ways, the job of healthcare providers become ever more challenging.  If they ever award a prize for patience, I am sure that healthcare providers will be the top recipients of it.

Reza Ghadimi

Fading or faded, the memory of a fall day, no matter how great
Slips away slowly, yet leaves an impression of the unforgettable
Much like a one-night affair of long ago, with that special stranger
Though love has since, followed with all kinds of specials
That one memory, lingers on and shows her head
At all the right and wrong places.
 
Sandwich between warm days of summer
And wonderlands of winter, she sits
Not particularly comparable, unforgettable nevertheless
How the golden leaves of Aspen, shimmer just so
The morning sting of the autumn air
A jab to the notion of what's to come
The heat of the afternoon sun,
A reminder of what just passed.
 
The cumulus clouds of the day's late hour
Majestically, crowning the darkening hills
Into the atmosphere to meet the rising strawberry moon
While the cactus and sunflowers shine still
To the autumn's dancing winds of change.
The harvesting crowd, rush to beat the shortening days
To pick the last of the apple, grape, chili, and maize
Before the frost freezes their goodness, within.
 
Indeed, it was a special day that is unique to all senses
As memory awakens the un-special, yet unforgettable
The heart recalls the unusual beat of that day
Much as it does, to the fading memory of the nameless one
And who was the one on that foggy night in London Town?

Reza Ghadimi
September 2022

Interesting thing, calendars. It is one of the ingenious inventions of mankind, that we use without regard to its origin or makeup. The hieroglyphics discovered in caves, tombs, pyramids, and stone monuments around the world, reveals its origin to be tens of thousands of years old.

One such calendar of interest is the Ancient Egyptian Thoth Calendar, established in the reign of Pharaoh Shepseskaf (2494–2345 BC.) It was Thoth who created the 365-day calendar. Twelve months of 30 days each, 360 regular days with five extra days added on to the end of the year, and a single day added every fourth year as a leap year, making the calendar reliable to this day. The New Year's Day fell on the first day of the month of Thoth, around August 29 in our calendar.

It is believed that Thoth was the author of the Egyptian Book of the Dead and the Book of Breathing. Thoth loved sharing his knowledge with others. Today, Internet makes it possible for us to listen and share our knowledge with people around the world. Let's think of Thoth and share our stories. I think that would make Thoth sit up in his tomb and smile. The Feast of Thoth is celebrated as a day of writing and sharing stories in Egypt today.

So it is that calendars represent man's unique way of registering his accounts, and immortalizing people important to history. Like Mother Teresa, born August 26, 1910, who gave a new meaning to serving selflessly. Mikhail Gorbachev, the last leader of the Soviet Union, who died last Tuesday, August 30, proved that differences can be resolved peacefully and amicably between big rivals, even ones like the United States and USSR.

And the philosopher Georg Hegel, born on August 27, 1770. He devised the concept of Dialectic, the idea that all human progress is driven by the conflict between opposites, that each political movement is imperfect and so gives rise to a counter movement which takes control - and is also imperfect - and thus gives rise to yet another counter movement, and so on to infinity.
Hegel wrote, "Genuine tragedies in the world are not conflicts between right and wrong. They are conflicts between two rights."

Just think how many of today's world conflicts we can resolve by just following some of the teachings of these three people mentioned in our calendars.

Reza Ghadimi
September 1, 2022

Out of the nature that surrounds
And the world that turns around
Day and night set the mode
To work or rest when it's sound.
Time works to nature's need
Evolving life takes time indeed.
Those who live urban ways
Want speedy lives, and ready meals.
Forget the required time for
Life to develop, plants to grow
Cattle and sheep to graze.
Time for children and maize to grow
Jungles breath and oceans breed.
For seasons to arrive and produce
Grow the seeds to edible feed.
It matters not where it was sowed
Only time for it to grow.
Time is integral to life.
Mindful we must be of time
Less it will leave us behind.

Reza Ghadimi
August 2022

Reminiscence of bygone days, memories of what (once) was.  Nostalgia need not be for long ago or far away, sometimes one can feel longing for something quite recent. Though my fishing trip just happened, I desire for its peace still.  There is something soothing and calming to the soul, watching a river gently flow past.  Perhaps its resemblance to our body's circulatory structure, reveals how much a part of nature we are. Or that its motion reassures us of our existence, a testament to our being.
 
The tranquility of the deep gorge I was in was comforting and peaceful. The crows, magpies, and occasional jump of a fish, did keep my attention immersed in its beauty. But the modern world still found ways to disrupt it with over flying aircraft and the occasional whistle of a distant train. 
 
Such places are everywhere, as are peaceful people who live there and are oblivious to the intrusion of what lays beyond (see old & new in Blog Archive). I recall another such place on a mountaintop in Central America. A couple of caring RN nuns, ran a semblance of a clinic there and occasionally, health practitioners from the outside world came and helped out, for a few days or weeks. I talk about it in my book, Practicing from the Heart in the Age of Technology - (A SALUTE TO OUR NURSES). The gentle folk, living in those remote places, had only a day-to-day task of keeping themselves and their animals, safe and cared for.  What help, occasionally came to them was a blessing. A gift from another world, beyond their perception, perhaps, even from gods. It was not to be taken for granted, only appreciated.  I felt ashamed that my intrusive world was encroaching violently upon theirs.
 
But of course the other side of this reality is the fact that modern technology - like the augmented reality in training medical students and healthcare professionals - will ultimately lead to better providers as well as discovery of better ways to research, develop, manufacture pharmaceuticals as well medical and other devices that will help everyone, including people in isolated areas. The trick is not destroy one way of life, while improving the other. Then we can all enjoy the peace of nature, no matter our lifestyle.
 
Reza Ghadimi 
August 2022

A documentary starts by showing a small caravan of six camels and four men walking across the hot sands of Mauritania in West Africa. The hooves of the camels and sandals of men displace the dry sand with every step, leaving a long trail stretched to the horizon, dramatically revealed by the slow rise of the camera for an aerial view.  Suddenly the camels are alarmed, as a faint rumbling sound is heard far away.  The men stop and watch amazed as the whistle of a train is heard in the distance.  Soon several locomotives come into view pulling a long train of hoppers carrying iron ore. Men and beast watch as twenty first century interrupts their ancient way of life.
 
The film reminded me of another documentary across equally desolate and isolated yet incredibly cold Siberia. Where temperatures dip bellow -70C.  There too, people have their primitive lives disrupted by modern transportation systems. New man comes with trains, trucks, machinery and remove the iron, copper, lumber, etc from their backyard and leave destruction and waste to their land and often sicken them in the process. As the journalist traveling the cold of the arctic said "a country is not a place on a map at all, but a story full of people you meet and places you visit." Interestingly, while these places and thousands of others like them are exposed to fresh realities, the healthcare system is not one of them.
 
There are thousands of nationalities worldwide. It might be difficult to understand other lifestyles and traditions, but they do exist and have needs that are disrupted by modern life. The information technology/internet is reaching them faster than the amenities it portrays, adding to the disparities they see and feel.  Among them and perhaps the most needed is healthcare.  These people see this as a new way of slavery.  It is time this is changed and they receive their share of prosperity.  The absurdity of it is that it cost so relatively little to provide healthcare to every corner of the world.  Programs such as Project Echo can educate and supervise people in these areas to care for themselves. We have the means, even the money, it just takes a little caring.

Reza Ghadimi
July 2022