Jason A. Borton, MD


It is a busy Monday afternoon in the emergency department. There has been an unexpected cardiac arrest of a 46-year-old man. Our efforts were not successful. A family’s world is changed forever. They have moved through denial, and they are now angry. They want answers from me right now. I have none, but I offer my condolences. 

I walk back to the main part of the department. A nurse is waiting for me. The patient in Room 16 is refusing to leave. The patient in Room 25 wants to be off of work for a week because of her UTI. 

The unit secretary calls my name. I have two phone calls waiting for me. I glance at the patient board and we are full. There are 24 patients in the waiting room to be seen. 

It’s only 2 p.m., and I have two more hours left in my shift. I end up leaving the hospital at 5:30 p.m. 

It is a quiet Tuesday morning and my family is starting their day. I brew a cup of coffee and offer an invitation to my boys to come outside to help me in the pumpkin patch. My 5-year-old wants to look at Phineas, a name he and his brother chose for our Atlantic Giant pumpkin. 

I walk on cut sheets of plywood so as to not compact the patch soil. My sons follow me carefully in my footsteps. We make our way to Phineas. They carefully inspect him and lightly touch him. They lose interest after a minute or two and run off into the yard. I set my coffee down on a board and get down on my knees. It’s time to bury vines today and build up the strength of the plant, which now covers nearly 500 square feet. 

A light breeze blows on this early July morning. The soil feels warm on my hands. The coffee tastes good, and the silence is only occasionally interrupted by a plane headed toward the airport. 

The patient in Room 4 is having difficulty breathing. It’s 11:15 p.m. on a Thursday evening. I’m pulled into his room. His blood pressure is 212/115 mm Hg. His pulse ox is 84 percent on room air. His lungs are filled with fluid and his ankles are swollen. High dose IV nitroglycerin is started and IV lasix is given. BiPaP is started. 

About 45 minutes later, two liters of urine are in his Foley catheter bag. He is breathing much more easily. He can now speak in full sentences. He thanks me, and I tell him that I’m glad he feels better. I put a call out to his doctor, and he is admitted to the hospital. 

Phineas is putting on about 25 pounds a day. The recent deluge of rain has revved up his growth rate. Small growth cracks are starting to show on his surface. I apply a pasty fungicide to the cracks to keep them dry. I take measurements of Phineas, and his estimated weight is near 800 pounds. 

I’m spraying organic fertilizer, and I glance at the sheet covering Dixie, the other Atlantic Giant pumpkin in the patch. I notice a strange concavity to the sheet and I pull it off. Dixie has imploded, the result of a stem split that I had doctored for over a month. The smell of her rotting insides is horrible. I try to salvage some seeds from her cavity. After four months of tending to the plant on a daily basis, the pumpkin on this plant is gone. I realize that I’m not ultimately in control of what goes on in the pumpkin patch. 

A 53-year-old male is brought into the emergency department. He has end-stage pancreatic cancer. He is in hospice care, and his pain couldn’t be controlled at his home. He is pale and hypotensive. He doesn’t look like he’ll make it out of the hospital. He cries for pain meds. I step outside his room with his wife and his pastor. He has advanced directives and no heroic measures are to be taken. His wife wants him to be comfortable. She realizes that this is the end. Pain medication is ordered. Other tearful family members come into the room to comfort each other and to say their goodbyes. More pain medication is ordered. 

Three hours after his arrival to the emergency department, he is gone. I pronounce the patient dead, and I console the family. I walk out of the room and realize that I am also not fully in control of what goes on in the emergency department - but I do have the power to relieve some suffering. 

It is the first Sunday in October. Phineas is securely loaded into the bed of my pick-up truck, and my dad and I are driving to a pumpkin weigh off. Phineas has an estimated weight of 994 pounds. I’ve been working towards this day for five months. I am hoping the pumpkin goes over the half-ton mark. My previous year’s pumpkin only weighed 420 pounds. We arrive at the weigh off and one of my pumpkin growing mentors sees my pumpkin. “Nice pumpkin. Looks like you’re moving up in this sport,” he comments. 

The pumpkins are weighed, and finally it is Phineas’ turn to head up to the scale. I approach the stage and make small talk with the announcer. Phineas is judged to be suitable to go to the scale, and he is lowered. Numbers dance on the digital display and eventually the number 1,102 appears. Phineas now has a new name: the 1102 Borton 2009. I am grinning from ear to ear. My hard work has paid off. 

Growing Atlantic Giant pumpkins is how I deal with the stresses of a busy emergency department. While tending to a pumpkin vine, I contemplate and release situations that irked me on a busy day. Things can go wrong in the patch, but these problems develop over days - not minutes. Caring for pumpkins has helped me to care for my patients. Both pumpkins and patients need care. Plants need protection from cold, heat, and diseases. Patients require treatment from exposure to disease, to others, and to themselves. Like the emergency department, not everything that happens in the patch is a victory or a defeat. I plant a seed and five months later a pumpkin is weighed. I introduce myself and minutes to hours later a diagnosis is made. Patience and caring are the two most important factors in growing giant pumpkins and in practicing emergency medicine. 

is an emergency-medicine physician who practices in Williamsville and Buffalo, N.Y. His first book,

 “Memoirs of a Volunteer Firefighter,” 

This article originally appeared in the April 2010 issue of Physicians Practice.

Articles

Jason A. Borton, MD, on the parallels between growing giant pumpkins and life in the emergency department.