As Ralph and I wake up this morning, we want to wish ALL mothers and mothers to be a very special “HAPPY MOTHER’S DAY!”

On that note, we want to subtly remind all you “children” to acknowledge the observance of this special day by:

Visiting your mother and thanking her for being your mom.

While you are visiting, give mom a big hug. 

If you can’t go visit, give her a call, if you can’t call send her a happy text.

Send her a special gift: a card, flowers, a keep sake, etc.

Most of all, let her know you love and appreciate her.

T and Ralph

 I don't usually make long posts but this morning I need to tell you the story of my journey.

When I was diagnosed with rectal cancer in November 2022 I was definitely surprised and in shock. No family history of cancer, no personal "high risk factors", and no previous symptoms. 

After breaking the news to Kat and Seth I immediately began aggressive treatment. Fortunately, over the years in clinical practice I have had the privilege of working with some of the best Oncology Specialists in the Memphis area. Kat and I chose my care team and the journey began. After my initial treatment of 12 cycles of bi-weekly chemo and 30 cycles of radiation that ended at the end of March 2023 the tumor was destroyed and all that was left was scar tissue. 

Since that time, I have had monitoring, scoping, imaging, and close follow up with oncology, GI, and oncology surgery. In January of this year, a second tumor was found. The treatment for this tumor involved surgically removing the tumor and a section of my rectum which created the need for an ileostomy.

I am a firm believer that "everything" happens for a reason. While we may discover the reason, many times we never figure out the reason(s).

For me, this journey has been a multitude of emotions:

Humbled that I had a disease the may end my life.

Wondering "why me".

Experiencing the side effects of chemo personally that I had explained to patients over the years personally.

Realizing that the cancer was not just a "physical" problem, but had created  mental, emotional, psychological, family, and life issues as well.

I am blessed with an awesome support system. Family, friends, students (former and current), colleagues, patients (former and current), many others and even strangers.

those of you that know me, know that I have named that "voice inside my head" Ralph. Ralph and I have very intense "discussions" about many things. After diagnosis, we realized that I had to treat not only the cancer, but my psychological well being as well. 

I have been involved in public safety with fire and EMS since I became a volunteer firefighter and first responder in 1978 and remain involved today. During that time I have been assaulted by patients and family members, shot at, stabbed, and verbally abused. Ralph and I decided that if we were going to let cancer win this battle it was going to need to "up it's game". Developing this mental attitude led me to adapt a slogan: #nottodayreaper. I initially had a few t-shirts made with the slogan on them for Seth, Kat and myself. Once the word got out about the shirts, I started getting requests from folks for one of the t-shirts. As of today there are 120 of these shirts throughout the United States including Alaska and Hawaii. It was not a money making project, it was a mental health project.

So, what has this journey taught Ralph and I?

I have had the opportunity to speak to several cancer support groups, individual cancer patient's and their family members, and the general public about cancer from both a provider standpoint as well as a patient standpoint. 

I have been contacted by friends and acquaintances asking if I could speak with their "friend" who has cancer. (I am always willing to speak to them)

I have realized that I truly am "one of the lucky ones with cancer" with minimal symptoms.

And so many other things.

I get asked frequently about what I tell people with cancer when I talk to them. 

I will share a letter that I wrote to one of my "cancer friends" that I have been speaking with since shortly after my diagnosis. Please keep in your mind, that this lady had stage 4 lung cancer and continued to text and call me throughout my treatment program. 

February 14, 2025

Dear (I am not sharing her name),

I hope this letter finds you well. I’ve been reflecting on the impact you’ve had on my life, and I wanted to take a moment to express my heartfelt gratitude.

I want to sincerely thank you for sharing your hopes and fears with me. I hope that our talks have helped you understand your disease process. Your kindness, support, and presence in my life have meant more than I can express. I remember when I was diagnosed and the phone call you made to me. That moment showed me that no matter what is cast upon us there is a reason. Although we may never truly know all of the reasons, one of the reasons was that you and I could connect and support each other.

You’re questioning and openly sharing your fears and hopes encouraged me to share my medical knowledge as well as my personal experience with cancer truly inspired me. Because of you, I have had the honor and privilege to meet and talk with literally hundreds of cancer patients and hopefully in some way made their journey a little easier.

I just want you to know that your actions and presence are deeply appreciated, and I am truly grateful to have you in my life. Thank you for being an amazing friend.

With gratitude and appreciation,

Thomas “Tommy" Cooper

Now to close the circle of our relationship, the day I rang the bell at the Radiation Center she called me on the phone to make sure I "rang the bell loud and long". We talked for about 10 minutes and yes many tears were shed.

4 days after this call, I received a letter, which I thought was from my friend by the return address. However, when i opened it it was from her husband. Unknown to me, she had called me from her Hospice bed and left this earthly world shortly after she hung up with me. Her husband told me she had made her peace with her death and had told him when she hung up the phone from our call that "everything was good now, Tommy has completed radiation".

Now many of you are asking "why" I have chosen to share the story of my journey. I share this to let you know that you are NEVER alone in your battles. I am always available by text, email, or phone if you need to ask questions, scream, cry, holler at someone, need someone to listen, or need a hug.

Respectfully Tommy and Ralph

#nottodayreaper

Stuck in Dutch Harbor and eating lunch

 Ralph and I made it to Dutch Harbor and looks like all flights this evening are going to be cancelled. All checked in to the Grand Aleutian Hotel.

We are sitting in the resturant and our neighboting table is the Sig Hansen (from the F/V Northwestern and Deadliest Catch) family and some boat crew members. 

But guess what folks, they are doing the same things you and I do at a family lunch. Eating, laughing, joking, and enjoying each other. They all are cordial and friendly and deep down just people.

As professional courtesy I introduced myself, I thought introducing Ralph might be a stretch. I told him who I was and what I was doing in Dutch. Since he is currently filming for Deadliest Catch, we wanted him to see what we were going to post to verify we would not be doing anything contrary to his contractual obligations. He approved the text and offered to get a family member to take our picture.

Ralph and I are sharing this to remind all of ya’ll that they are “just folks”.

Special thanks to the Hansen family and crew.

Follow them on Deadliest Catch!

Remember, take care of yourself and each other.

T and Ralph

Continuing to learn about different cultures everyday

 Good morning!

Ralph and I are nearing the end of this evolution in Alaska. You have read, and hopefully learned, about our interaction with a multitude of cultures as we work in rural and remote places. Each day is a welcomed cultural learning opportunity for us. At our current assignment, we are blessed to be learning and interacting with plant staff from 15 different cultures and backgrounds. This morning Ralph and I had blintz for breakfast. We heard some of you say: "a what?". So let's take this opportunity to learn about cultural things. 

First off, what is a blintz and where do they come from. Well, blintz are a large component in the Jewish culture. A cheese blintz (Hebrew: חֲבִיתִית; Yiddish: בלינצע) is a rolled filled pancake in Ashkenazi Jewish cuisine, in essence a wrap based on a crepe or Russian blini. Traditional blintzes are filled with sweetened cheese, sometimes with the addition of raisins, or fruit preserves and then slightly sautéed.  Blintzes represent foods that are now considered typically Jewish, and exemplify the changes in foods that Jews adopted from their Christian neighbors. If the blintzes are served at Passover, matzo meal is used instead of flour.

While we are at it, do any of the non Jewish readers know the major Jewish holidays? Most Jewish holidays are religious holidays observed in Judaism based on the biblical mitzvot and rabbinic mandates. The major Jewish holidays in order from the start of the Hebrew calendar are:

• Rosh Hashanah
• Yom Kippur
• Sukkot
• Shemini Atzeret
• Simchat Torah
• Chanukah (Hanukkah)
• Purim
• Pesach
• Shavuot
• Tish-a B’Av

For the Jewish people around the world, these are 10 of the most important Jewish holidays. Shabbat, which is a day of rest celebrated on the seventh day of the week, is also given the status of a holiday. Rosh Chodesh is a minor observance, occurring on the first day of  each month of the Jewish calendar.

Link to explanation of the Jewish calendar.

Ralph and I get asked all the time: "how do you get so much information about so many things?" The answer to that is simple: we interact with individuals and groups from all over the world, we are naturally curious, we actually talk to people and ask questions, and we definitely are not bashful.

We hope ya'll have a very blessed day.

Till next blog,

T and Ralph

Imaging Decisions

This is for informational purposes only. This is not to be interpreted as “medical advice”.

Ralph and I get asked quite frequently how do we treat patients without imaging capabilities. For those working ER in facilities with imaging capabilities, obtaining x-rays/CT Scans/etc is not an issue. However, when you work in rural or frontier areas imaging may not be obtainable without involving enormous transportation costs. So, today we are sharing some guidelines for determining the necessity and/or urgency of obtaining imaging for certain injuries.

Canadian C-Spine Rule

The "2 and 6 rule" in the context of C-spine fractures refers to the Canadian C-Spine Rule, which uses a system where if a patient meets two high-risk criteria OR a single high-risk criterion with six low-risk criteria then cervical spine imaging is recommended to check for potential fractures; essentially indicating a need for further investigation to rule out a C-spine injury. 

Key points about the Canadian C-Spine Rule:

High-risk factors (mandate imaging):

·         Age greater than 65 years 

·         Dangerous mechanism of injury (e.g., significant fall, high-impact collision) 

·         Numbness or tingling in extremities (paresthesia) 

·         Low-risk factors (allow for clinical assessment without imaging):

·         Simple rear-end collision. 

·         Sitting position in the emergency department.

·         Able to walk at any time since the injury. 

·         Delayed onset of neck pain.

·         Absence of midline cervical spine tenderness.

NEXUS Criteria

What is the Nexus criteria?

NEXUS (National Emergency X-Radiography Utilization Study) is a set of validated criteria used to decide which trauma patients do not require cervical spine imaging. Trauma patients who do not require cervical spine imaging require all of the following: alert and stable. no focal neurologic deficit.

NEXUS Criteria for C-Spine Imaging

Clears patients from cervical spine fracture clinically, without imaging.

Focal neurologic deficit present

No0

Yes+1

Midline spinal tenderness present

No0

Yes+1

Altered level of consciousness present

No0

Yes+1

Intoxication present

No0

Yes+1

Distracting injury present

No0

Yes+1

If none of the above criteria are present, the C-Spine can be cleared clinically by these criteria. Imaging is not required.

These are just two of the guidelines for C-spine imaging, there are several others. Know and learn the guidelines used in your clinical setting.

This is for informational purposes only. This is not to be interpreted as “medical advice”.

Have a great day!

T and Ralph

How does your culture celebrate the New Year?

 With our travels over the years, Ralph and I have been fortunate to meet and become friends with individuals and groups from many countries and cultures. The ways of celebrating events varies greatly from family to family, region to region, culture to culture, and country to country. We are going to list the way some of our friends celebrate the New Year:

 Italy

Eat 12 spoonful's of lentils, one with each chime of the clock at midnight.

• Rosh Hashanah

  The Jewish New Year, which is celebrated on the first and second days of the Hebrew lunar month of Tishrei. It's a time for reflection, atonement, and forgiveness. 

Sinhalese New Year

Marks the end of the harvest season and begins at a time determined by astrological calculations.

Islamic New Year

Starts on the first day of Muharram, the first month of the lunar Hijri calendar.

China

Celebrate Lunar New Year, which marks the beginning of spring and a new year on the lunisolar calendar.

Denmark

Smash old plates and glasses against friends and family's doors to banish bad spirits.

Colombia

Walk around the block with an empty suitcase to wish for a year of travel and adventure.

Spain

Eat 12 grapes, one for each chime of the clock at midnight, for good luck and happiness in the coming year.

Finland

In Finland, people predict the coming year by casting molten tin into a container of water, then interpreting the shape the metal takes after hardening. A heart or ring means a wedding, while a ship predicts travel and a pig declares there will be plenty of food.

Panama

To drive off evil spirits for a fresh New Year’s start, it is tradition to burn effigies (muñecos) of well-known people such as television characters and political figures in Panama. The effigies are meant to represent the old year.

Brazil

In Brazil, as well as other Central and South America countries like Ecuador, Bolivia, and Venezuela, it is thought to be lucky to wear special underwear on New Year’s Eve. The most popular colors are red, thought to bring love in the New Year, and yellow, thought to bring money.

Greece

An onion is traditionally hung on the front door of homes on New Year’s Even in Greece as a symbol of rebirth in the New Year. On New Year’s Day, parents wake their children by tapping them on the head with the onion.

And ya'll think Ralph and I are weird...... 

Thank you for over 36,000 views!

 Thank you all for supporting our blogging. We have officially received over 36,000 views. While this doesn't seem like a large number when compared to many other blogs, to us it gives validity to our efforts. 

Whether you read the blogs because you are considering doing locums assignments, need a good laugh, or just scratch your head and think "wtf" Ralph and I are very appreciative.

We try to inform, occasionally educate, and attempt to give you a small dose of stress relief. But we always want you to remember that we get as much or more from you than we can ever hope top give back to you.

Forever humble,

T and Ralph