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Everybody has a Pitch Count…Good Managers Know When You’ve Reached It

Everybody has a pitch count, be they a baseball pitcher or a military, police or critical care health provider.  At some point one can push themselves so hard that they can injure themselves or if not that start making mental mistakes that cost games for a pitcher or lives to people in military, public safety or critical care medicine.  In baseball managers have to make sure that their pitchers don’t wear themselves down.  It is very easy for a pitcher, especially a hard thrower to wear out early from overuse causing injury.  At times hard throwers, or for that matter any pitcher can over pitch.  They can try to do too much.  At first this may not be noticeable, maybe they lose a little bit off of their fastball or their curve ball may not be as sharp.  The pitcher may shake it off and tell his coaches and trainers that nothing is wrong.  They do this for a couple of reasons.  First, they are competitors; they want to do the job that they have to do.  Second, they don’t want to admit that something is wrong with them be it a possible physical injury or maybe even a mental issue which is keeping them from getting good control of their pitches.  Of course the physical wear and tear on pitcher is brutal.  The physical punishment of throwing a baseball 80-100 mph on the arm, especially the elbow and shoulder is brutal.   The amount of torque applied to these joints is severe.  If a pitcher is using incorrect technique or has thrown too many pitches the effects can be devastating to his career.

While I am not a pitcher, when I played I was a utility infielder and catcher, I do think that everyone has something to learn about life and work from managers, pitchers and knowing when a pitcher is suffering from overuse injuries or has lost his physical or mental edge.  The manager has to know when the pitcher has reached his pitch count and when it is time to pull him even if the pitcher wants to stay in the game.  The same is true with anyone who serves in military, police or intensive medical professions such as EMS, Emergency Rooms and Intensive Care units. This became apparent to me over the past year and a quarter since I returned from Iraq.  I am now 49 years old. I stay in pretty good shape and physically can still outperform many younger people in such things as push-ups, sit-ups and running.  I pretty much know my physical limitations especially coming back from Iraq with some physical and emotional scars.  I work in ICUs and if my life as a chaplain was limited to simply doing that work on the floor I could do it forever.  I thrive in the environment and actually am more at ease on an ICU or in an ER than I am on general patient floors or doing administrative tasks.  However, those are also part of my life.  So I have to achieve a balance.  I am usually pretty good at knowing when it is time to tell my manager, in this case our director of pastoral care that I am not doing well.  Yet, sometimes even when I know I’m not doing well I won’t stop.  I will push myself to the point of physical and emotional collapse.  I hit this point last week following a month of family illness, end of life planning for my dad, a medical emergency with Judy and several very demanding weeks at work where I put in a huge amount of hours because the job had to get done.  I hate to leave something undone or have to leave something for someone else to do.  I don’t like to be taken out of a game.  My first Navy tour after 17 ½ years in the Army I was my Division Chaplain’s relief pitcher.  I ended up taking several battalions because their chaplains either got in trouble or were pulled for another assignment.  Likewise I was given the task of working with young guys who had run into some kind of trouble to see if they could be salvaged.

A good manager has to recognize when his pitcher is having problems before he gets in trouble.  Until the advent of relief pitchers that were primarily relief pitchers and not washed up former starters, they generally pitched deep into a game.  As such many racked up huge numbers of wins, strike outs and complete games.  In fact most of the top ten are guys that pitched when it was almost unheard of to bring in a reliever.  Thus there are men like Cy Young who won 511 games, Walter Johnson with 473 wins and Grover Cleveland Alexander and Christy Matthewson who won 373 each.  Young played 22 years and had a record of 511 wins and 316 losses.  He pitched 7356 innings. He played in 906 games, started 815 games and had 749 complete games.  No wonder the award for best pitcher is named after him.  Cardinals Hall of Fame pitcher Bob Gibson started 482 games and completed 255 of them. In 1969 he won 20 games, 13 of which were shut outs. Gibson once reportedly said:  “I used to get tired in the seventh inning too. And the manager would come to the mound and ask me if I wanted to come out. Then I would look over at the bullpen and see who was warming up. Then I would say, ‘No, I’m going to stay in.”

As baseball moved forward teams began to have more depth on their pitching staffs. Rotations were developed where pitchers pitched every 4th game, and frequently in our era every 5th game.  Additionally since the 1970s the specialist relief pitcher has become a key part of the game.  While there were relievers prior to that, the relief pitcher as a specialist did not really get off the ground until Rollie Fingers of the Oakland A’s won salary arbitration against A’s owner Charlie Finely. At that point pitchers who could come into a game on no notice in certain situations became more and more a trend.  Now it is standard for a team to have long, middle and short relief specialist as well as “Closers.”

In a sense while some people may not like it, it is not a bad thing for the game.  One only has to look at how many pitchers had abbreviated careers o of overuse injuries including Sandy Koufax and Dizzy Dean who are both in the Hall of Fame.  If you look you can find others. This was especially true before the advent of “Tommy John surgery” when pitchers with a torn rotator cuff faced the end of their careers. As such teams became much more aware of how many pitches a starting pitcher and even relievers should throw in a game.  The pitch count was developed.  For a healthy starting pitcher in the middle of a season this is usually around 100 pitches.  Relief pitcher counts will vary.  While pitch counts are not necessarily the Gospel, there is a point in every pitcher’s career where he hits his own pitch count limit, be it in a game or a career. As Whitey Ford said:  “Sooner or later the arm goes bad. It has to…Sooner or later you have to start pitching in pain.”

So you may be asking what does something arcane like the mechanics, kinetics and injuries have to do with life.  As you know the Deity Herself speaks to me through baseball.   This has application to those in high stress jobs where they are called on to put their lives on the line for others or deal with danger, death or tragedy in an environment where just one mistake can be fatal or where a word, gesture or throw away comment can harm someone else.  The managers, supervisors or commanders of people who do such work have to be cognizant of the effects of this on their people.

I am luck, the Deity Herself has surrounded me with a number of people who can look at me and tell me to sit down even when I want to continue to keep pushing.  Last Friday was one of those days.  It was the culminating point of a nearly a month of personal and professional stress, lack of sleep and the lingering effects of my PTSD and chronic pain which flare up when I have exceeded my personal pitch count.  My boss was away last week.  However we remained in communication.  I was scheduled for weekend duty, which for me I remain in house because I am not able for the most part to meet the response time for a emergency call.  When my boss came back he must have checked in with several folks who k now me to see how they thought I was doing.  Friday afternoon after I got home I got a call from the acting department head who told me to stay at home that my boss was going to pull my duty for me.  I really needed this.  However, I told him that I still could come in if needed and was told to stay home and take care of myself.

With a manager like that I will be able to keep playing my game longer.  I may have occasional rough outings but I will do fine.  The lesson is that everybody has their own personal “pitch count” even if they do not throw a baseball.  Like my favorite theologian Harry Callahan says: “A man’s got to know his limitations.”

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Filed under Baseball, ER's and Trauma, healthcare, Loose thoughts and musings, philosophy, PTSD

Whirling, transient nodes of thought careening through a cosmic vapor of invention…

mental floss

“My mind is aglow with whirling, transient nodes of thought careening through a cosmic vapor of invention…” Headley Lamar (Harvey Korman) Blazing Saddle’s

Blurred Days, Preparing for Death and Medium Rare Diseases : The past 10 days have been a blur.  So much has happened that I have a hard time coming to grips with it all.  First was going out to California to assist my mom and brother in dealing with things concerning my dad’s worsening condition.  It was good to have a couple of visits with him where he was with me at least for a few minutes.  I will treasure those figuring that they may well be the last that I have with him on this green earth.  Yet it was hard.  I had to kind of package away my stuff for a while and hoping to process when I got back.  It seems that the Deity Herself has decided that she needed to build more character in this character than this character thought that he needed.  When I got back we were faced with the first real health crisis in our lives.  Judy contracted Epiglotitis somehow and we spent the majority of the past three days in hospital ER’s or having her admitted to hospital.  Nothing is ever normal for us. Maybe it’s because neither of us are normal.  In fact Judy is Abbess of the Abby Normal (see the link on my blog roll).  So Epiglotitis is very unusual, 10-40 cases in a million.  Most are kids and it is almost unheard of in this country.  The Third Year ENT Resident said that he had never seen it before.  The attending almost missed it until the ER Attending saw the soft tissue X-Ray.   As I said in my last post after I had made the diagnosis which was confirmed by the physicians: “It’s a kid’s disease except when it happens to adults.” It is what probably killed George Washington.  Thankfully even early Monday morning though the ER Attending did not see it he did the right thing in a heavy dose of IV antibiotics and steroids.  This probably arrested the development of the condition.  When it worsened we got Judy into the ER pretty fast and again the right thing was done.  She seems to be doing well now that she has been discharged home and for this I am most grateful that she is not dead  or even the Grateful Dead. However two long nights in ER with little rest following the trip to California have left me worn out.  I do hope that the Deity Herself does not think it necessary to build any more character in this miscreant Priest.  Thankfully my Department Head took my duty today and put me on two days of leave to put myself back together. Sleep has been fitful and my anxiety levels have been rather high.  Thankfully no PTSD meltdowns this time at least not yet.

The Holy Unction of the Baseball: If you remember my post Baseball in Between Life and Death in the ICU I mentioned a dear woman and her husband who were both big baseball fans.  She was in the ICU and seeming to be getting better and I promised her a baseball.  She crashed hard.  The next day when I brought the ball in she was heavily sedated and intubated. She was trying to die on us.  If you recall I placed the baseball in her hand and she gripped it tight. Her husband and sister said that she did not let it go for about 7 or 8 hours.   I prayed for her as I did this.  I went to California and she was still pretty bad off.  By the time that I came back I heard that she was doing a lot better.  I saw her yesterday and had a wonderful visit with her and her husband.  There is a possibility that they may be actually able to do something to help her heart function.  She remembers having the ball in her hand and wondering how it got there even when she was heavily sedated.  Could it be possible that the Deity Herself could have made The Holy Unction of the Baseball a new sub-Sacrament of the Sacrament of Healing?

Don’t Screw Up the Prayer: I did the invocation and benediction at the groundbreaking ceremony for Preventive Medicine unit at Norfolk.  I’ve done hundreds of prayers at military and civil functions.  They are not hard to do.  What you don’t want to be is too memorable because if this is the case you have probably done something to be remembered and not in a good way.  I have seen this done a number of times.  Often the Chaplain has no clue that he stepped all over it.  This can happen by going too long, forgetting the words or trying to be too uppity, sectarian, funny or unique.  Since most of the time the people at these functions have to be there the chaplain cannot presume that they are the show and can do whatever they want.  In the Navy this is really important.  I write these prayers out and have done so for many years now.  Not only do I write them out I read them several times before I ever get in front of a live audience.  Doing this keeps me from doing something stupid, which on occasion even I can do.   I even have a basic format that I put the prayer into: The introduction; specific event/unit/situation that I am asking God to bless, and the closing sentence.  I try to keep it to 30-45 seconds, never more than a minute.  It is not good when they look at their watches when you are praying or yawn. In the public forum you have a place to be a witness, but it is always a delicate balance. The people at the event are not there to see the chaplain.  The chaplain is like the ceremonial first pitch or meeting between the managers of the two baseball teams and the umpires to discuss the ground rules.  Chaplains are not the main event unless it is an actual worship service.  Even memorial services and ceremonies where the chaplain plays a huge role, the chaplain is not the reason everyone is there.  It is no place to try to be Paul Harvey and tell “the rest of the story.” Thus this ministry in the public arena can be one that either provides the chaplain entrance into the community with opportunities to provide great ministry, even evangelical ministry.  Or ensures that they remain an outsider to the community, nipping at the fringe and hoping someone will hear them.   When we were done I had an officer compliment me on my prayer.  He said it wasn’t too long, wasn’t too short and honored what they were doing.  I love it when a plan comes together.

A Tale of Two Burgers: Yesterday I did something that I have not done in years.  I had two hamburgers in a single day. Both were fast food burgers and usually I maybe eat A HAMBURGER every 45-60 days.  Yesterday as you know from reading this was rather hectic.  One the way home I stopped by Sonic to get a Super Sonic Double Cheeseburger with Mayo, Mustard and Ketchup. For fast food this is a hell of a burger.  It is tasty and big.  Sure it’s not the best hamburger in the world but it will work in a pinch.  Early this morning after leaving Judy at the hospital I stopped by a 24 hour McDonald’s.  I was hungry and tired.  Unfortunately they have an exceptionally limited after midnight menu. Two Types of Quarter Pounder, The Big and Tasty Burger, a Southern Chicken Sandwich, Chicken McNuggets and Chicken Strips.  Not much to choose from.  I should have gone with the McNuggets or regular Quarter Pounder but taken in by the name I asked for the Big and Tasty.  This was very possibly the very worst hamburger that I have ever had.  The meat was bland and greasy and topped by a mound of mayonaise that drowned out any other taste.  I could feel my arteries closing as the first bite went down.  I can only say “Never Again.”

Moving to the Front of the International League: My Norfolk Tides are now 26-12 not only atop their division but now has the best record in the International League.  This is a exciting young ball club.  We have not had anything like this in years at Norfolk.  I just hope that the Orioles don’t rape the Tides to fill their roster.  I know that the minors exist to support the big team but right now this is a special team and fun season.  I pray that the Deity will ensure the Orioles success so that we can continue like this the rest of the season.

Getting the call reversed: It looks like our insurance company has decided to agree with us and the body shop and denial the fraudulent claim against Judy.  Sometimes arguing with the umpire nicely gets the call reversed.

As always thank you for your kind words, encouragement, concern and prayers over the past 10 days.  They are appreciated and I know that they are effectual.

Peace, Steve+

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Filed under alzheimer's disease, Baseball, ER's and Trauma, healthcare, Loose thoughts and musings, Military, PTSD

Monday Monday…a visit to the ER and the DMV

Well what can I say?  If you remember Garfield the Cat and how he hates Monday’s you can probably understand this post.  Maybe you have lived this yourself. Maybe not, but there is always tomorrow.

I really expected to have a nice day recovering and resting from my very draining trip to California to help out with my dad.  It started that way but didn’t end that way.  When I got home I found out that my license plates had been stolen off of my car.  Thus I knew that today I would need to go to the DMV to report them stolen and get them replaced.  I figured that this couldn’t be too bad, I called my boss yesterday afternoon and he graciously gave me the time to do so.  Of course I could not gotten through the front gate without them, but still it is good to have an understanding boss.

Late in the evening I started to get my things together for work.    After having watched the movie Fletch with Judy I was tired and expecting to go to bed.  Judy had told me earlier in the evening that she had a sore throat and had taken some throat stuff to make it feel better.  The throat stuff usually takes care of the problem.  This time it didn’t.  She started complaining of sharp pain of like 9 on the scale of 10 in her throat and that she was having a hard time swallowing.  This to me was odd.  Judy has a super high threshold for pain, that fact that she has been married to me for nearly 26 years testifies to this.  Once in Germany she had a cavity filled with no anesthetic when the Army dentist who had the shrine to Dr Mengele in his office refused to give a topical before sticking her with a needle.  She let a broken ankle go for a year before having something done about it.  Sorry I don’t like to suffer like that.  But she has a super high threshold for pain.  So at 0002 in this morning (for those not German or military both of Mickey’s hands are pointing straight up to the 12) yes Monday dark and early, we set out for Sentara Bayside ER.  I was not a happy camper.  I picked up one of my Andrew Greeley Bishop Blackie Ryan mystery novels and took Judy through the rain to the ER.

Now to me a real ER is where guts are hanging out, people a being coded in multiple rooms. In a real ER there are gunshot wounds, stab wounds, burns, strokes, heart attacks, people mangled in car or industrial accidents. Likewise there are always Police with knuckleheads who have been arrested, drug overdoses, suicide attempts and real live psychotic people who think that they are Jesus.  Death, crisis, mayhem that dear readers is my kind of ER.  Eating a cheeseburger with a trauma surgeon while looking at the track of a bullet in an open chest after some gang banger got whacked and we could save him.  That is an ER to me.  I did my residency at Parkland Memorial Hospital in Dallas as the Trauma Department Chaplain and worked as an ER Department Chaplain in a Trauma Center in West Virginia.  I’m used to full waiting rooms, upset people and various forms of craziness.  I now work in a teaching hospital and have the adult and pediatric ICUs.   To put it mildly this was not what I experienced this morning.  We got there and there was no one in the waiting area, which unlike places I have worked before was nicely decorated and relatively comfortable.  They even had Lifetime set as the channel on the cable TV.  Judy went through triage quickly and was taken back.  After a while I was called back.  Judy was getting an IV placed and a full panel of labs and a CT Scan of her obviously swollen neck were ordered.  This was a bit scary for her, and a little unsettling for me as first she is my wife and I don’t want to lose her, but also because I know that if untreated whatever was going on could threaten her airway.  This is never a good thing.

The nursing staff and the ER physician were very nice.  I have no complaints.  For a while it looked like that Judy might be admitted until she responded to the three different IV meds and drips that she was on.  Now whatever was going on was potentially serious but seemed to have been nipped in the bud.  I did try to comfort Judy by telling her that it couldn’t be that bad because she wasn’t intubated, didn’t have a Foley catheter or NG tube, but she didn’t find that terribly comforting.  I young man how had cut his arm pretty bad after giving a dumpster an elbow was across the way and had a pretty cool cut, but still pretty mild by what I am used to.  Compared to the places that I have worked it was far too sedate.  It was really kind of boring.  I guess that is okay, I didn’t want Judy to be the one who got sporty and provide the entertainment for the evening.

We got out of the ER about 0330 and hit 24 hour Walgreens to pick up her medicine.  She even got good stuff for pain, Vicodin.  All I ever get is Motrin, no let me take that back, my Nurse Practitioner here put me on Ultram for my chronic pain in my shoulders.  But this isn’t like Vicodin.  The people in the pharmacy were all friendly, giving us a cheery “Good morning” every time that we turned around. We finally got home well after 0400.  Checking in with the boss I got permission to come in late.

This afternoon I still had to go to DMV to get the license plates.  I didn’t get much sleep and what I had was not very good.  Groggy and grouchy like a bear waking up from hibernation I put myself together.  I did not want to go to the DMV, but it had to be done.  Now the DMV sends chills up my spine.  I grew up in California, so my first experience of the DMV was in that fair state.  The DMV in California is like the major league of the DMV.  I’m sure that I stood in line behind Jimmy Hoffa one day well after he went missing never to be seen again.  He’s probably still in line.  The last time I went to the DMV here it was a long wait.  Today I expected the worst.  It started out where I thought that would be the case when the rent-a-cop at the door sent me outside and told me that I couldn’t have my Norfolk Tides travel mug filled with Dunkin Donuts French Vanilla coffee, Splenda and Coffee Mate Nonfat French Vanilla creamer in the building.  I thought, “well isn’t this just great….I’m tired as hell and have to wait in DMV for what could be forever without more coffee.”  I was even less happy than when I got there.  Thankfully the rest of the DMV time was not too bad.  The lady at the desk was friendly and had lived in California and even knew something about Mudville.  I left with my temporary tags and stopped by the Advance Auto Parts store on Princess Anne Blvd in Virgina Beach to pick up a new license plate frame and mounting devices.  Now Advanced usually gives military members a 10% discount on the purchase.  Showing my ID card I expected this.  However the young man refused to give it to me because “I had not specifically asked him for it.”  I thought this was kind of shitty as all the other guys there have went out of their way to honor this.  I decided to say the hell with arguing with him and just write a nasty comment on my blog with tags for Advance Auto Parts on Princess Anne Blvd in Virginia Beach.  Following this I got Judy some soft food to eat and went in to check in with the boss, drag all the stuff I would need for the week into work and to go through my hundred or so e-mails so I wouldn’t have to do that tomorrow.

In a few minutes I head over to the Church of Baseball, Harbor Park Parish for a double header between the Tides and the Louisville Bats.  Tonight, though tired I need this.

Thank you all for your prayers, encouragement and kindness this past week.

Peace, Steve+

Post Script: The double header against Louisville was great.  The Tides swept the twin bill winning 6-2 in the first game and 2-0 in the night cap.  Justin Christian homered and Matt Wieters  a triple with Chris Tillman picking up his 5th win with no losses. David Pauley getting the win, his third and Jim Miller his 10th save striking out the side to close the game. The Tides are now 25 and 12 and up by 2.5 games over the Bulls in the IL South. I really needed tonight, the weather was a tad bit cold but it was good to be back with my Church of Baseball Friends.  Barry my partner down in section 102 B had his daughter down and it was fun to be with both of them. My section usher Elliott was back as was Chip up in section 202.  Had my usual King Twist pretzel from Kenny up on the concourse.

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