There is this lady. This lady that I see every day at a point in my day. Pretty much at the same time. Like, if I walk the direction I need to walk to get where I need to get, I will see her. See her in the path of where I am going. That is, if I take the way that is fastest to get where I need to go. Which is mostly what I do.
So every day, there she is. Doing what she does while I go where I go. But then, whenever I get closer she eases in my direction. Comes nearby and says a cheerful hello, like always. Includes some open ended questions that call for me to open it into a conversation. And then, if I don't run any form of interference, she will pause to chat. A little bit about this. A little bit about that. And a little bit about the other, too.
All of it takes no more than 2 minutes, really. And sometimes less than that if all she wants his a hello and a hug. She is a hugger. One who puts her whole body into those hugs, too. Both arms, torso to torso, and pressing into you. Complete with the "mmmmm-mmmm!" sound effects. Yes, she does that.
But. There are some days. Like, some days where I feel like I'm super busy and feeling harried. Or where I'm late. Like, where I really just want to get to where I am trying to get without stopping to chit or chat or hey or hug. Even for a moment. Telling myself that I am just "focused" today and want to just stay on my task. Whatever that task may be.
And so. On those days, my walk is more brisk. My body language is fast and deliberately standoffish. I typed and deleted that last sentence twice. That word "standoffish" made me cringe. Especially when connected to me. I had to add it back because it is true of what happens. That is what I do. Like, on those days, I do this thing to demonstrate that I don't want to be interrupted. Not even for a hug.
So on those days, she will call to me in her singsongy voice as I whisk past going wherever I need to go. She simply calls out a "hello" that floats out into the vacuous hallway then swirls down to the ground like some kind of lonely feather. My salutation in return shoots out and hits it like a fast ball. Quick, pressured. Making it clear that it would be this one pitch. And that's it.
Doing that always feels bad. I mean, because it's not nice really. I'm old enough to know that. So on a lot of days, I just take this really circuitous route to the place I need to go that doesn't take me past the place where I would pass her. But fickle fate somehow always reroutes her path to overlie my own at some point. It does. So then, I'm back to where I was. Either cooling my jets or deciding to turn them on high.
I am not proud of this. I'm writing about this because I am just thinking this morning. I'm thinking about those two minutes (or less) that I so stingily clasp in my hand. My decision to withhold some piece of me, albeit a fleeting piece, because I just sort of don't feel like being bothered. And you know? I am really not sure why I don't want to be bothered by this very sweet individual on some days.
There is this melancholia about her. Like this piece of her that I can tell needs a human interaction as much as she can get it. And I think it's even worse that I am not always forthcoming with it since I know that. Like some sort of middle school mean girl who has decided not to be your friend. On certain days.
Maybe the sadness in her eyes overwhelms me. Makes me feel like what I give needs to be all or none. And like the all isn't necessarily my job since I work a job where I have to give that kind of all all the time.
I don't know.
I know about pieces of her world. Even though I don't have a lot of contact with her, there is the stuff she has told me. And, no, I don't know what her full world is like away from the place where I pass her each day. But what I am processing this morning is this realization that I am a tiny sliver of her world.
There's probably some complicated piece of my psyche that this underscores. And I don't know what that is since I'm not a psychiatrist. But what I do know is that I love people. And I want to be a good person.
So today, I've made up my mind. To be bothered. And interrupted. By her.
And before you say that, from what you read on this here blog, I seem very good about being bothered, I will say that on some accounts I am. Like, I am very, very good about say, a stranger, in the Grady hallway hitting my pause button because they are lost. Or that wayward medical student who wants to pick my brain. But this? This is different. This interruption is like that movie Groundhog Day. I know what's going to happen. Yet I find myself using some energy to redefine the outcome and order of events.
I'm not really even sure why.
Withholding kindness isn't cool. Even if on other days you give an extra heaping helping of it, it's not. And so. I am going to work on that. With her. With me. Because two minutes is nothing. Except for when it's something.
"Any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee.” ~ John Donne
It has now happened to me too many times to count. A person comes into the hospital. Our hands touch at that first meeting and our hearts connect. No, not just in some obligatory way that gets outlined in that first year med school lecture about "BEING EMPATHIC." But more in a natural way. The kind that happens when you strip down the armor of stoicism and reveal a piece of who you truly are.
Yes. So this happened to me this week. It did.
From our first encounter, I knew. I knew this patient, this person would leave me forever changed. I inwardly chuckled, knowing that it would be one of those weeks of late departures--not because of neediness on her part but my own selfish desire for more. More while I could have it. More because my patient was preparing to leave. She was.
It wasn't obvious at first. So mostly, it was just her quick wit and wisdom that created this giant magnet to which I attracted. Between laughs and reflections, I'd coordinate her care with the residents and speak to consult teams. And for every single day that she was there, I would round on her twice. First, for logistical things like pain control and management. Then, to simply close out my day. I'd drag a chair to her right side, hold her hand, and soak it in. I would and I did.
On Friday she was slowing down. Together we'd agreed upon a master plan for an intervention the following week aimed at making her feel better. But some piece of me was conflicted. "Is this what you want?" I asked her.
"What do you think?" she said.
"I think I don't want you to be uncomfortable."
"Okay. Let's play it by ear, okay? If I'm not up to it, I think you will know. And I will trust your judgement."
"I will pay attention, okay?"
"You always do, Dr. Manning."
And that was the end of that discussion.
When I stepped into her room yesterday, the lights were off. It wasn't pitch dark, but more filled with shadows and only the morning sunlight. The family was at the bedside and another consultant was there, too. My team walked in and the family, with whom I'd also developed a connection, notified us that she wasn't talking. The pain in their faces grabbed me by the neck and punched me in the chest. And that, coupled with those shadows, was telling. It was.
I went to her. Usually, I offer a subtle hello and fall back when a consulting colleague has come first, but on this day I broke the rules. She was my patient. An urgency was swelling inside of me. Something was telling me, screaming to me--"You will not get a 'two-a-day' today. You will not."
She was looking straight ahead, not speaking but appeared totally lucid. Like all of this silence was voluntary, representative of elevated thoughts and reflections. The first thing I did was touch her hand like always and move close to her face. "Hello sunshine," I murmured.
And just like that, her face erupted into an enormous smile. Relief washed over the family and even the consultant. She was still there. She was. But still. I could feel it. Her hand on this day was ice cold. Yes, her spirit was still warm, but nothing else.
I asked her questions about her pain and nausea. She nodded yes and no appropriately and told me how she was. All nonverbal but still fully present. And so. I kept talking to her. And to the family. Fielding questions from them and all the while holding her cold, cold hand.
The consultant slipped out and all that remained was the family, my team, my patient and those shadows. More questions from the family came. Concrete queries that you ask when you love somebody. Love's myopic view doesn't allow for big picture objectivity. Not that kind of love. But what I've learned is that some piece of this love category, that is, the doctor-patient love category, leaves the sliver of insight that gets lost in other kinds of love. And now that I know this, I have to use it. I must.
So, I try. I try to talk but my face. It starts to get boiling hot and those tears. Those pesky tears they pour from my eyes. My voice cracks and I feel her icy hand tighten around mine like a vice grip. She knows. Her clasp stabilizes me. She gives me courage to be honest and transparent. And so I do.
I give her hand an affirming squeeze to let her know I got the marching orders. Then I turn to her daughter. "Tell the family to get here. Get them here. Today. Now. To love on her. Love hard on her like she loved on all of you." And then I started weeping outright. And because she was holding my hand, I couldn't even wipe the tears fast enough since that would have been a two-hand job.
"Love on her," her daughter repeated while holding my gaze. "Love on her."
"Yes. It's all we have. Love is the what."
There wasn't much more to say after that. Our rapport was good and my patient's response was obvious. I leaned in to tell her good bye and asked once more if she needed anything. She nodded yes to pain medicine and no to nausea medicine. "Okay," I told her. "I got you."
And then, just like that, she spoke. "You look so beautiful." Her voice was clear. Nothing garbled or suggesting confusion. Sure, direct, clear. And those words? They were a gift. Not just to me, but to her family. They needed to know that she was there.
Shortly after that, my team left. Sujin, the third year medical student broke down crying and I consoled her in the hall. And my intern Sonali did the same. "Let it hurt. You want to be affected," I told them. "And don't let anyone tell you otherwise." Then, all of us just stood there in quiet awe of the amazing privilege we'd been given as the caregivers to this soul. We sure did.
A nurse saw us walking up the hall afterward. She asked me, "What happened? Did your patient expire?"
I smiled with my red face and snot-filled nose and replied. "No. We are just feeling fortunate to be her doctors. That's what you see." That is exactly what I said. Because it was true.
My patient passed away yesterday. Only a few hours after that encounter. That family got to her and they were all glad they did. Sonali, the intern caring for her, loved her, too, so returned to the hospital. That sweet intern sure did. And all of it was good. It was.
I'm so glad my boundary issues allow me to feel this way. My chest is heaving as I write this, but in the very best way. We are all connected, I think. Being aware of it and surrendering to it is the issue. That's what I think.
During one of our late afternoon handholding sessions, my patient asked me to write about her when she transitioned. I promised her I would. And so today, I honor that promise and also present a piece of her love to you. Because love? Love doesn't expire. And love, my friends, is the what.
Happy Sunday. And thank you for Angella for that beautiful mantra that I say or write somewhere nearly every day.
My patient took off her glasses and said, "I can't keep looking through these rose-colored glasses. I just can't."
I was holding her hand and both of us had tears in our eyes. Her body was sick and she knew it. I felt sad because there wasn't any other treatment to offer.
Then, all of a sudden, she looked at me and smirked. "You know what? I just noticed that these ol' glasses of mine really are rose-colored!" She threw her head back and laughed so hard that I did, too.
After that, we just sat in silence. Holding hands, looking out the window, and wishing on invisible stars.
Today I received an email from a former Emory student/resident that was, quite possibly, the single, most moving thing I've ever had written to me or about me in my entire career. I'm busy right now. Just got back on the hospital service. Have been mad at myself about missing personal deadlines on completing a manuscript I need to finish. And dreading the over 15 "strong" letters of recommendation that students are depending upon me to write for their residency applications. This work can be so grueling sometimes. And sometimes thankless, too.
I started out this day feeling frazzled. I rushed the kids all around the house this morning and still got both of them to school just after the bell. (Fail.) After that, I drove to work coaching myself like a good girlfriend, saying things like, "Girl, stop tripping! You are a great mom" and "Oh, come on. You're an awesome doctor." Because, you know? It was just one of those days. I was so turned around at one point that I thought it was Friday. Except it was Thursday.
But then I checked my email. While sitting in my minivan waiting for my son to come out of ultimate frisbee practice and feeling flustered about the things I still had to do once I got home. A simple tap of my thumb and there it was. Waiting on my iPhone like a balm for my soul. On a day that I truly needed it.
As a clinician educator, I have won some really great awards--I'm talking career-defining ones that parents and family fly in to witness. I've also done some cool stuff--from talking to Anderson Cooper on CNN to publishing in JAMA and Annals of Internal Medicine in the same month to even getting a medical blog nod in the doggone Oprah Magazine. But nothing--and I do mean nothing--compares to one individual learner's affirmation that you've had a real, true impact on his or her life and career. It supersedes any trophy, plaque or media attention. My fellow clinician educators (and educators in general) know what I mean.
"Believe half of what you see and none of what you hear."
A few years back, I was in clinic and went into a room to listen to a patient's heart sounds. A resident physician working with me that day had already seen the patient first. Before I entered the room, he'd described everything about the past medical history including a "easily audible" heart murmur. Even though it was pretty straight forward, I still wanted to listen. And so I did.
"It is an early peaking, systolic murmur," he said as we walked up the hall, "radiating to the carotids. But super loud." That description was suggestive of a narrow aortic valve. I figured that a murmur this loud had been assessed with imaging in the past.
"Did she get an echocardiogram?" I asked. The two dimensional ultrasound of the heart, or echocardiogram, visualizes the blood flow and the heart valves. Though the physical findings lead us to where we are going in heart disease, actual images tear the roof off of the sucker to confirm things. The clinic was busy. And this was an upper level resident. So I cut to the chase. I wanted the echo results.
"She did," he replied. "I need to double check the final read but I'm pretty sure it confirmed aortic stenosis."
"Do you know how severe?"
"No. I'll have to look again when we go back into the room. But I know she doesn't have any symptoms which is good."
So he went on to tell me a few other things about her before we reached the room. After a quick knock, we entered the clinic room together. Nothing about it was unusual.
"Hi there, ma'am. My name is Dr. Manning and I'm one of the senior doctors in the clinic working with your doctor. We always put our heads together about your health and figure two brains is better than one." She smiled and I smiled back. After a quick review of her concerns and the plan of care, I reached into my pocket to pull out my stethoscope. "Mind if I listen to your heart?"
"Not at all," the patient replied. "Guess four ears is better than two, huh?"
I chuckled and nodded while placing the rubber tips of the stethoscope into my ears. And honestly? I wasn't even thinking too hard when I did that. I reached over to her chest and searched the classic listening areas--aortic, pulmonic, tricuspid and mitral--with the cold diaphragm.
The whole "not thinking too hard" thing wasn't because she didn't matter. It was just that I'd heard the story and exam already including the echo results. This was mostly a formality, honestly. I even made comment about the pretty necklace she was wearing as I slid it out of the way to reach her chest. The patient began sharing that she'd splurged on it during on a vacation once and how she hasn't removed it since. I raised my eyebrows and nodded, then lifted one finger to let her know we'd need to hit the pause button for a few moments.
You know. So I could hear the murmur that already had a diagnosis.
And so. I lean in and quickly listen. And just like that, I recognize that what I was hearing isn't at all what had been described to me. I raised my eyebrows. "What did you say this murmur was from?"
I squinted my eye and listened again. "Hmmm. This murmur sounds diastolic to me. Hmmm."
"She definitely has aortic stenosis. I heard a crescendo-decrescendo murmur. And it was during systole."
"Okay." I carefully listened again. I then felt the patient's pulse and listened some more while timing it out with the rhythm of the heart. And still what I heard sounded like the flow of turbulent blood during the relaxation phase of the heart cycle. I listened some more. And then once more. "Aortic stenosis, huh? Okay. I guess my hearing is off today." And that was that.
I conceded since I knew that the imaging supported his assessment. But honestly? That murmur sounded nothing like what he was saying to me. The whole thing made me uncomfortable, especially feeling so off on something like this--a bread and butter physical finding.
"Yup. Stenosis. But let me just confirm how severe, okay?" He pecked into the computer and clicked a few screens. And while he did, the patient asked a few questions.
"Is my heart okay?"
"Have you been told about your heart murmur?"
"We're just talking about your heart murmur. That's just the flow of blood rushing over your heart valves. Have you been lightheaded or dizzy?"
"Naw. Never that."
"Okay. We're just checking to see how narrow your heart valve is but it sounds like this is an old issue, okay?"
"Oh alright then."
She asked a few questions about aortic stenosis and what that meant while he moved through screens to confirm for me the final reading on the echocardiogram images. Since I was less occupied, I pitched in and explained. Even though my ears were telling me of a different diagnosis.
So as we discussed all of that, suddenly I notice a funny look on the resident's face. "Oh must've misread that," he mumbled to himself. "Um, Dr. M? It's actually moderate to severe aortic regurgitation."
He said that right after I'd finished my soliloquy on aortic STENOSIS and right after I'd finally talked myself out of what I knew to be true based upon what I'd heard with my own ears.
And no. It didn't turn into a big thing with the patient at all. I apologized and told her that I'd misspoken and that her heart murmur was more of the kind you get form a leaky heart valve instead of a narrow one. My face felt like it was a million degrees. She laughed and said, "I was wondering. I been told before my valve was leaky. I ain't never heard of it being stiff and narrow before so that was news to me."
So here's my point of telling you all of this:
The things that happen to me at Grady are simply metaphors for life. Trust your gut and what you know. Listen with your own ears and then listen again. Believe your ears, especially when they've heard a lot of things. Same goes for your eyes. But especially believe yourself even when odds stack against what you think. That is, when you feel sure.
I doubted myself. And honestly? It wasn't even a soft call. I felt embarrassed for my initial instinct to doubt the echo report when I shouldn't have. I shouldn't have at all. Plus, I hadn't seen that echo result with my own eyes. That's a lesson, too.
And no. I am not always sure. But this time I was. And I'm still mad at myself for not laying down my nickel and betting on me. I recognize it's okay to be wrong. But I think my "ah hah" moment is in that I need to be just as okay with being right.
Does this even make sense?
As for my resident, I gave him some feedback. I'm pretty sure he, too, convinced himself of what he heard based on what he thought the images showed or could have just been so junior that he misjudged what he heard altogether. So yeah, I gave him feedback right away. But as I did, I showed my own clay feet and revealed what I'd done wrong as well. I'm senior to him yet I needed him to understand that even after 20 years of being a doctor, we are still works in progress. I let him know that being scared of looking silly isn't a good reason to not push when you feel pretty sure. And mostly, I was sure, even though I was being told otherwise. I was just two seconds away from saying, "Well, I don't know what that echo is saying, but this murmur isn't consistent with aortic stenosis at all." But I didn't. After all, the echo said it was aortic stenosis.
You didn't quit smoking. Nope. Not even after that big, long, drawn out discussion we'd had about you setting the perfect quit day. "Juneteenth!" you announced with a big, loud laugh. You banged your hand on the desk and clapped your hands after. I typed it right into the chart when you did:
QUIT DATE: JUNE 19, 2016
Then you added, "Perfect, ain't it? The day of emancipation, right?" And I nodded my head in acknowledgement, loving the idea of you being freed of the nicotine stronghold on the very day that our people came up from under the dark cloud of slavery.
"That day sounds perfect," I replied. And I said that because it was true.
But sadly that day came and went. And you didn't quit. Nope.
Your blood pressure was high today, too. You promised that you'd take your blood pressure pills but when I looked into the pharmacy history, you hadn't picked up a refill for two full months.
342. That was your blood sugar reading on the finger stick today. Which meant that you probably weren't taking you insulin either. (Even though you'd promised you would.)
And last was your weight. Your chief concern at the last visit was losing weight and quitting smoking. We'd talked and talked and talked all about it and you sounded so ready. So ready. Together we identified some simple tweaks that could be made to help you shed pounds and, I have to admit, I was just as excited as you.
But that didn't work out either. Instead of dropping a few pounds, you gained nearly ten. 9.73 to be exact. Which didn't fit the gameplan we'd discussed. At all.
So yeah. Essentially none of what was supposed to happen happened. And honestly, I'd be lying if I said that some piece of it wasn't frustrating because it was.
Yeah, it was.
And so. I creaked open the clinic room door to come see you. The undeniable scent of cigarette smoke wafted into my nostrils the very moment I stepped inside; it had found a crevice of every part of that room. I coached myself to not be disappointed in you. To not feel like you'd hoodwinked and bamboozled me into believing that this visit would be some celebratory party where I fist bumped you for your big emancipation from cigarettes and unhealthy foods. Yeah.
"Good morning," I started. I took the seat across from you and smiled. Trying my best to not sound condescending, I added, "It's good to see you."
I was kind of tired that morning. Isaiah had forgotten to tell me about a homework assignment he had until the very last minute which forced a late night/early morning kitchen table science combination. Zachary couldn't find his shoe and seemed hell bent on wearing only the pair that had the missing mate. Our dog decided he'd tear up a throw pillow overnight. And I'd run out of creamer that morning so had to drink black coffee which I did but did not enjoy one bit.
So yeah. I'd hoped for some good news from you.
"I didn't quit, you know."
I sighed and leaned my face into my hand. "Yeah. I know."
"I gained some weight, too. Even though I ain't had much of a appetite. I just ain't been doing so good." Your mouth twisted when you said that and I could have sworn I saw tears glistening in the corners of your eyes.
"What do you mean by that? By 'ain't doing so good?'"
That's when those tears became undeniable, spilling over your lashes and onto your cheeks. You offered a lopsided shrug in response. And this? This was different for you. Normally you were chipper and full of happy spunk. And even though I was not so thrilled about your failure to clear the hurdles we'd pinky sworn upon, at minimum, I'd expected some funny one-liner about why it didn't happen. But not this. Not tears.
And so. I just waited. I touched your forearm and waited.
"Remember my grandson? The one who was staying with me?"
I thought for a moment and then remembered him from a visit once. He'd driven his grandmother to the clinic one day and seemed rather unhappy about having to sit in on a discussion of antihypertensives and insulin. "I do."
"Well. . he. . he. . " You couldn't finish. Instead you just dropped you head into your hands and wept hard. Your ample bosom shook rhythmically along with your fleshy arms.
"Oh my goodness. . .did he get hurt? Is he . . is he alive?" My hands covered my mouth immediately after I said that. I hated to be so direct but I'd worked at Grady Hospital long enough to know that it was a fair question. Your home address was in a rough part of town and that grandson was in your custody after drugs left his mother unfindable and incapable of raising him. The same streets that took his mama, though, preyed upon him, too. And you knew that. You'd lamented about your concerns of him selling drugs on corners and getting mixed up with the wrong crowds. So yeah. That question wasn't unreasonable.
"He got locked up. Caught a murder charge. He gone, Miss Manning. He might as well be dead. He gone for his whole life. And he ain't but nineteen."
I felt my eyes throbbing with tears. I puckered my lips outward and swallowed hard to try to keep myself from crying, too. It didn't work. "I'm sorry," I whispered. The tears splashed disappeared under my chin before I could wipe them away.
"Me, too," you murmured back.
And that was it. We didn't utter another word about you blood pressure or your smoking or your blood sugars or your weight. We just sort of sat there and felt the enormity of how hard this life can be sometimes and pushed all of the rest of it to the back burner. And yes. Your blood pressure and weight and blood sugar are important. But your emotional well being is, too. You'd lost your baby boy after losing the baby girl who made him. Your aging soul didn't deserve this pain. The streets were winning 2 - 0 which meant you were 0 for 2.
Later that day I thought of you. Thought of your grandson and the significance of his age--19--and that date you'd so cheerfully chosen for your quit date--June 19 or, as you said it, "Juneteenth." That number was supposed to be a happy one, representing freedom and a brand new day. Instead, it turned out to be symbolic of pain.
I hated that.
Here's what you taught me, though. That sometimes even when there is some pressing shit to discuss, something else more pressing should take precedent. And that sometimes the reasons that people don't follow through on things is because they physically and emotionally cannot. That slowing down and paying attention to souls matters more than slapping wrists for missing marks.
This lesson is one I need in all aspects of my life. So thank you, my friend. And know that this morning I am quietly weeping into my coffee and holding your hand. Feeling sad that nineteen hurts for you and wishing there was something I could do to fix it all. Like offer you some kind of Juneteenth to rescue you, your baby boy and his mama from the shackles of your reality.
"Let's talk about all of that other stuff next time, okay?"
Like many of you, my social media timelines have been flooded with frustrated, hurt, angry posts in reaction to the senseless death of yet another black man at the hands of police. This time, it was Mr. Alton Sterling of Baton Rouge, Louisiana. It was captured on a grainy cell phone camera. Two cops took him down and shot him multiple times at close range ending his life. His kids saw that video. I saw it, too.
Here's what I'm thinking about:
Just maybe, you are my friend and your world hasn't been flooded at all with bitter one liners and battle cries from your peers about this. Just maybe, you have checked your social media threads of choice several times but, because this doesn't hit quite as close to home for you or those whose posts fill your screen, you had no idea about this incident until just now. If that is the case, consider this an invitation. First, to Google #altonsterling to understand what happened (if you weren't aware already.) Then, I invite you--my nonblack friend---to be as sickened, appalled and bothered by those hashtags as me.
That is, if you weren't already.
I want you to imagine talking to your sons about police and feeling your heart turn a tiny relieved flip when your husband comes home from a regular day--alive. Talk to your kids, make this a big deal in your house, and please, join us in being pissed off--because everything depends upon that. Nothing changes when we don't provide anybody space to empathize. But now that you have the space to stand with me, I want you to know that any indifference here forward will be hurtful--whether I am telling you or not.
I think we are all super guilty of polarizing others when upset about the things that affect our own communities. Our soapboxes are so tall that they make people shrink, hide and peep through their blinds like voyeurs. Black, white, straight, gay--we build these walls that won't let good people be allies--or at least let them ask enough questions to feel something. And no, I don't think it's intentional. Pain just makes us all impulsive.
At least that's what I think.
For my friends who don't know what it's like to worry in this way about your father, your brother, your husband and your sons. . .I want you to read this post (if you haven't already.) If you feel so inclined, you can also read or re-read this one, too. It will give you more perspective of what it's like raising black boys in America.
Then my hope is that you will accept my invitation. To ask questions. To comment. To say something. To feel something. But especially to be pissed the eff off. Because no movement ever really gets moving until more than just the oppressed get mad. My prayer is that we can all be a little more aware of each other's joy, pain, sunshine and rain.
This is our reality. Thank your God if it isn't yours.
Two weeks ago, I did something that I have never done in my entire medical career. Had I come close to it before? Yes. And is it something I probably should have done a few times in the past? Definitely.
So . . . what was it that happened, you ask? Well, I'll tell you. Um, yeah. . . I'll tell you even though, after twenty full years of not doing this, it's pretty hard to actually confess. I. . I. . .sigh. Okay. . .I. . .I . . . I . . whew.
I. Called. In. Sick.
*squeezes eyes closed and turns head so you won't look at me*
It was the week of our interns' orientation in the hospital. Those first few days had gone just fine and at the end of the hustle-bustle of a particularly crazy afternoon, I popped by a casual eatery to grab a late lunch. And that part was fine, too.
It wasn't until about an hour and a half later that I began feeling this cramping sensation in my midsection. My tumbly became rumbly and before I knew it, I was in and out of the restroom doing what the Grady elders (and my daddy) refer to as "running off." Somehow I managed to get a long enough window to get over to get the kids from their camps but admit that I sprinted from my car to the front door.
Thank goodness I did.
And you know? The running off part I could mostly deal with. I mean, I was hydrating and such and told myself that if there wasn't anything in my gut, the "running off" would eventually "run out." But then came the nausea. And then came the vomiting.
And so. I pretty much spent the next several hours trying to decide which end of my body to aim at the commode. I tried all those home remedies like ginger ale and the non-home remedies, too, like antiemetics and antidiarrheals. But mostly, this was something that was just going to have to run it's course. Literally.
I didn't catch a wink of sleep until about 4:30 that next morning. My alarm went off at 6am and I just sort of stared at it for a few beats before silencing it. Finally, I sat up on the end of the bed and prepared to treat the day like any other Thursday. I grabbed a t-shirt and a pair of sweats, pulled on some socks and shoes and prepared to walk Willow. And that was fine, too.
Well, I take that back. It actually would have been fine if I wasn't lightheaded from my certain dehydration and on the verge of vomiting the remains of the Canada Dry ginger ale and the electrolyte drink that I'd carefully sipped all night. After only two steps toward the door, I felt my belly churning again. But still, I grabbed the leash (and my tummy at the same time) and took Willow for what I am sure was the least gratifying dog walk ever.
You know? I didn't even think to wake Harry and ask him to take the dog out instead. Even though I knew he would have, I didn't. Then, when I came back inside, I stood staring at the medicine cabinet and trying to decide which concoction would allow me the best chance at not barfing all over a patient. Or passing out on them.
But somewhere in the middle of all of that, I spoke out loud even though no one but me was awake. "I really, really feel like shit." Which, I am sure, is exactly what I said. Followed by a dry heave.
And right then and there, I had an ah hah moment. I recalled all of the times I've told countless residents that self care is essential. Even though, particularly when it has come to personal illness, I've never given my health priority over going to work.
It dawned on me that if I were advising any of my students or residents, I would tell them to immediately contact a supervisor in order to afford that supervisor as much time as possible to cover the clinical duties. And then I'd tell them to drink, drink, drink fluids like crazy and get in bed under the covers and get some legit rest. And/or seek medical attention if it is even more serious.
But for myself? Chile please.
So with my dog at my feet wagging his tail and me hunched over the kitchen sink on one elbow out of fear of projectile vomit, I made up my mind to do the unthinkable. Yes. I decided to call in sick.
Um, because I was. Sick, that is.
Now. I tried as hard as I could to recall a time ever in my career that I'd done that but came up with nothing. And I think I came up with nothing because that adequately represents how many times I've decided to stay in my household infirmary versus crappily do my job while ill. And how many times I acknowledged that I was too unwell to work.
I blame jeopardy. Confused? Okay. Let me explain.
At nearly every residency training program, there is this back up schedule that is designed precisely for moments such as these. And you know? Nearly every residency training program calls it by the same name: JEOPARDY.
So when one is sick, they call the chief resident or schedulers or whomever--and that individual refers to the "jeopardy schedule" and notifies some unlucky soul who, up until that moment, was basking in an awesomely easy assignment. Only to be thrust into the firing line of some essential patient care situation such as the intensive care unit, hospital service, or something else even more hellacious. And yeah, it's exactly as sucky as it sounds when you get called.
Similar to, say, jury duty, everyone knows that the jeopardy schedule is everybody's necessary civic duty. That is, in the resident community. But, just like jury duty, it isn't one of those things anybody is particularly pumped up about getting notified about. But physician jeopardy is more complicated than that.
When I was a resident, we had this longstanding culture of bravado when it came to toughing it out through illness on the job. And I can't say that it was because our program leadership wasn't supportive of our personal needs. It was just this thing that sort of happened, you know? Most of the time they had no idea.
Well, I take that back. They were supportive when a person actually endorsed being ill as a reason to call off. But because they came up in the same system, I can't ever remember anyone insisting that someone leave back then. Go lie down for a few moments? Sure. But full on leave and cause another resident to be called in? Never.
Oh, and before I go further, I will say that there is always this teeny, tiny subset of individuals that call jeopardy 200% more than anyone else in their entire program. Most notable was this girl who had taken two benadryl on accident and called in because she was afraid she'd be drowsy. (Me countering her with the half life of benadryl, which she'd consumed 4 hours before, didn't seem to make a difference.)
Anyways. The vast majority of my resident colleagues worked when ill. Furthermore, there was this esprit de corps between us that caused us to rally around the sick guy and fill in the gaps. (Forget the fact that everyone was getting exposed to whatever illness the person had.)
A few times stand out in particular. One was my junior year when I was taking call in the cardiac care unit (CCU.) I came down with fever, chills and a terrible headache. My neck was tight and I had some nausea and diarrhea, too. It was the summer and I had just come off of the pediatric inpatient service where kids with aseptic meningitis from enteroviruses was rampant. I even had a tell-tale viral exanthem (rash) to go with my constellation of symptoms. And you know? I was 99.9% sure that viral meningitis was exactly what was going on with me.
Maybe even surer than that.
I called one of my classmates (who was also on call) and asked him to come examine me in the nurses station which he did. "Dude. You probably got viral meninge. You gonna go to the ER and let a second month intern do a spinal tap on you?" He bit into the room temperature honey bun he was eating and laughed at his own joke.
"No way, dude. Did you see my rash?" I asked while pulling up my sleeve.
"Cool," he replied. "So what are you gonna do?"
"I think if I take some Motrin, I can make it through the night."
"Yeah, probably so."
And I am not kidding you. This is what happened. I took the call, fever, stiff neck and all.
Super stupid. Especially since it could have been something far more serious.
That same friend called me the following year (when we were both on call again) to check him out in a call room. He'd developed some shaking chills and a nasty, rattly cough rather suddenly. When I got there, he was breathing super fast. "Dude! Holy shit. You look like you're about to code."
"I feel like I'm about to code."
I listened to his lungs. "Yikes. You've got signs of consolidation. This looks like a bad pneumonia. And that history, man! You might have pneumococcus, I think."
"Hmmm. Cool. Think I can tough it out?"
"You're breathing pretty fast, bud. Let's go to the PICU nurses station and pop a pulse oximiter on you to see if you're hypoxic." Which is exactly what we did.
Guess what his oxygen saturation was? 82% (96-100% is normal.) Craziness.
Let me tell you. This guy? He looked sick-sick. It was NOT a soft call. At all. That said, I am convinced that were it not for the whole needing oxygen thing, he would have slugged it out through that call with his pneumonia.
Would you believe that he got admitted to the hospital that very night? And you know? We were so entrenched in that culture that I can remember like yesterday cracking jokes in his room about him spreading TB to the interns and telling him that I was totally going to present him in morning report the next day.
Which he found funny, too. That is, when he wasn't nearly about to code.
I blame this word "jeopardy." The actual definition means "danger of loss, harm or failure." I can't think of anyone who has ever wanted to be the one responsible for putting someone in that situation--that is, one involving jeopardy. Especially another overtired resident who finally, finally, finally is on a lighter work assignment.
But see, that word just underscores the culture. It sounds heinous, punitive even. And to tap into it literally puts another person in peril, if you follow the definition. And I think that's a part of the problem, frankly.
The one time I called jeopardy as a resident was when my father had a massive heart attack requiring emergency surgery. And you know what? I actually took call all night before taking a flight out, now that I think about it. We also have a jeopardy schedule (also called "jeopardy") in my current faculty position and you know what? The one time I called jeopardy with this group then was on November 15, 2012--the night my sister Deanna passed away.
So yeah. I am reflecting on all of this and realizing that doctors who neglect themselves really aren't the best physicians at all. Coming to work while truly ill puts patients in danger, can make things worse and it probably increases the chance of an error happening.
Now. Do I think folks should be calling off for sniffles or allergies? No. Do I think taking two benadryl should allow a rain delay at best but not a full on call off? Damn right. But do I believe that a vomiting, diarrhea-ing, teeth-chattering person should have another able physician working in their place? Definitely.
If you ask me (though no one did) the first step is changing the name. Instead of calling it "JEOPARDY" it might be better to refer to it as "FAMLY EMERGENCY/ILLNESS PATIENT CARE BACK UP." This way, those who need it will understand when it is to be called. And those who get called will feel okay with being called in.
We could even call it "FEIBU" (pronouced FAY-BOO?) for short. As a reminder that this is for FAMILY EMERGENCIES and ILLNESS when back up is needed. And that FAMILY EMERGENCIES and ILLNESS happen and aren't a sign of weakness at all.
Oh, and the times that folks get pulled in because of human scheduling glitches NOT due to the needs of a colleague dealing with a FAMILY EMERGENCY or ILLNESS? Well. Keep right on calling those times "jeopardy."
So yeah. I acknowledged that I was ill and called off the other day. My colleague Stacie S. was great and made sure I didn't have to feel guilty. And my other colleague Alanna S. was super kind about picking up my slack in the resident clinic that morning. And you know? I think if my patients knew of my decision, they would have appreciated my choice to call off, too.
And so. I drank fluids and rested in my bed all day. That photo is proof that I was exactly where I was supposed to be, too. I went through a whole lot of hand sanitizer and considered going to get a bolus of IV fluids at one point. But the next morning, I felt a thousand percent better which taught me a mighty lesson.
And you know the best part? Not a single patient was harmed or put in jeopardy--thanks to my decision to first put the oxygen on myself.
"It's the end of a love affair. But not just any love affair--like the love of my life."
~ Mr. Caldwell
For as long as he could remember, she was there. From those early days sitting criss-cross applesauce on the porch shelling peas with grandmama, right along with the unmistakeable scent of red Georgia clay was the hint of her presence wafting by with every humid breeze.
"I can't remember a time without that being a part of my life," he said. And when he said it, he looked down at his hands and sighed. "I just can't."
There was a sadness about him. This heavy cloak of melancholy that pushed against the agenda I'd planned before entering the room. See, this was supposed to be a congratulatory conversation. Me applauding his triumphant separation from alcohol.
But as soon as I came into that room and laid eyes on him, I could feel it. Yes, this was a good thing he'd done for his health. And definitely, abstaining from Jack Daniels for 16 full months after nearly a lifetime of being his best friend is no minor feat. So, yeah. I had all these lofty plans of shaking his hand hard and telling him how great it was. Reaching out with both hands and staring deep into his eyes to let him know that I meant it.
Because I did.
But. None of that felt right once I actually sat down. His shoulders were curled inward and his expression was lonely. Like some middle school kid chosen last in the kickball lineup, the kind you immediately want to hug and defend. Yes, Mr. Caldwell had crossed the one year hurdle with AA and had the improvements in his health to show for it. But still. He didn't seem happy.
I guess I'd sized him up with this assumption of what he'd be like and where his mind should be, you know? Imagining some gum chewing chap with a bunch of AA key fobs proudly telling it on the mountain that he's just taking it one day at a time. I was expecting a testimony of how now even the smell of alcohol makes his stomach turn a little, especially now that he's broken free of that stronghold. But that isn't what I found.
"You seem sad," I finally said. "Like. . . . what you've done for yourself is so amazing. And you're doing so great, too. But you seem. . . . I don't know. . . sad."
Mr. Caldwell just stared at me for few moments without speaking. Then, instead of saying something in response, he just sighed and shrugged. His lips moved and I think he said, "Yeah" -- but it wasn't audible.
"Is everything okay at home? Did something happen?"
"No, ma'am. Everything fine with my people, Miss Manning. My kids so happy I don't drink no more." When he said that, the corner of the left side of his mouth turned up a bit.
"That's great, Mr. Caldwell!" I did my best to ramp up the enthusiasm to counter his somber mood. It didn't work.
"I'm okay," he finally said. Then, to make sure I knew he meant it, he repeated himself, this time a little more firmly. "I'm okay."
I leaned into my palm with my chin and squinted my eyes a bit. "You know? You don't seem so okay, Mr. Caldwell."
And something about that--my body language and that last statement--unlocked something. I could tell. His eyes focused on mine some more and I could tell he was trying to decide whether or not to tell me something.
"Tell me," I pressed. "Tell me what is making you so sad."
Mr. Caldwell took a big drag of air through his nostrils, closed his eyes and then shook his head slowly. Then he just froze for a beat with his eyes still closed before parting his lips respond. "I . . I just. . . " He sighed once more and went on. "I just miss it is all."
"Miss what? You mean drinking, sir?"
"Yeah. Like, I keep waiting for that point where I lose the taste for it but it ain't never happened. So when I see it or smell it or see folks drinking, it . . .it just. . .I guess it just make me feel sad."
"Like. . . you know how when you was little how your main memories are tied to how stuff smell or the sounds you hear? See, that's how it is with me and drinking. Like, I come from a long family of alcoholics. But not fall down drunk and cuss you out alcoholics. Happy, domino and card playing drinkers. Shit talking and laughing. Having fun. But drinking the whole time. Even with kids around."
The image he'd painted was so vivid that I was at a loss for words. He kept going.
"My grandmama and my granddaddy drank a lot. I was raised around them and both my parents died from problems related to drinking. So I know that it's bad for my health which is what got me to quit, you know? That time they kept me in the hospital, I knew I had to quit so I did. But I guess as time go by I'm realizing that just about every memory I have involve either me drinking or being with somebody who was drinking. Going all the way back."
"You know what, Mr. Caldwell? I never thought of it that way." I said that because it was true. "For you, alcohol is like an old friend."
"Naaah. It's even more than that. Alcohol for me? She family. As much a part of my family as anything. Even when I was a kid."
"You started drinking as a child?"
"Naw, not at all. But my auntie'nem used to sit us on the porch and braid our hair down in cornrows. My mama didn't like cutting out hair so us boys always had braids. I'd be sitting right on the step between her legs. Every so often she'd fuss at me or my cousins saying, 'You bet' not knock over my damn drink!'" That made him laugh. But it was fleeting. "It's funny 'cause whenever I smell some gin, I want to cry for missing my auntie so much. That mixed with Newport menthols. And then along with the smell of some collard greens cooking with ham hocks and the sound of somebody cranking a ice cream maker."
And that? That made my eyes sting. Partly because I finally understood what he meant. But also because I knew there wasn't really anything I could do about it. I started to counter him with some canned commentary on the health benefits of no longer drinking but none of it felt right. Instead I just twisted my mouth and nodded. Because I got it.
I put my hand on his and squeezed it. "Thank you for giving me a new perspective, Mr. Caldwell. I get it."
Finally, he let out an unexpected chuckle. "Sometimes seem like the ones you can't get enough of don't love you back, do they? I love her but she don't love me."
"Yeah, she's funny like that."
"But I miss her. Every single day. Even though I shouldn't, I do. And all the people I loved though the years that's associated with her. My whole world different. My whole life different."
"In a good way?"
"I'm alive, which is good. I ain't getting DUI charges, which is good. But just imagine if whatever it is that connect you to all your favorite people, favorite memories and favorite things, you can't do no more. Or if you couldn't be around none of it no more. It's hard."
"That sounds super hard."
After that we just sat in silence. Him looking directly at me, face washed over with this complicated grief, and me squeezing down on his hand with mine. I kept wanting to say something or feeling like I should but nothing was feeling authentic enough. I stayed quiet.
Finally, Mr. Caldwell sighed and gently pulled his hand back. "I appreciate your concern, Miss Manning. I do." He began sliding his papers and medications back into his little knapsack and then pulled the drawstring closed. Patting the bag, he said for closure, "Yeah. So I guess I'm sad 'cause it's the end of a love affair. But not just any love affair--like the love of my life."
"Wow," I whispered.
"Sound crazy, don't I?"
"No, sir. You sound honest."
In the twenty years that I have been a physician, I have asked the same question of countless patients struggling with alcohol use disorders: "Did you grow up with any drinkers?" To date, I have never once heard a response that included anything other than the affirmative.
This? Mr. Caldwell's story? It opened my eyes. He taught me a new layer of why it's so hard for people to let go of alcohol. And you know what else? Thanks to Mr. Caldwell, I will never look at alcohol abstention the same way again.
Now playing on my mental iPod. . . .Mariah Carey singing "Can't Let Go." Because sometimes, even though you try, you can't let go.
"There's a time to laugh, a time to cry, a time to live and a time to die,
a time to break and a time to chill, to act civilized and act real ill."
~ Rapper's Delight
I broke down crying in front of my small group of medical students the other day. I didn't mean to. It just sort of happened. One moment I was talking about one thing, and the next minute I was trying to talk with my mouth hinged open and nothing coming out but mushy squeaks.
We'd just finished up the human sexuality module and I was tasked with debriefing with my group of first year medical students. A panel of patients had just sat before them speaking of their own stories of sexuality and how it affects their lives. Things like identities and behaviors and feelings and religion and joy and pain and sunshine and rain. And all of it was super important to discuss.
So, as scheduled, we headed upstairs to our small group work room to share thoughts and talk through feelings about all that we'd heard. And I know that this group is thoughtful and transparent so I wanted to give this moment the time that it deserved. I truly did.
Only I didn't.
See, this took place on a Tuesday. To be exact, it was the Tuesday after the 49 happy, smiling, dancing and likely imbibing human beings were massacred in what had felt like a safe place. Most young. One a mother grooving at a nightclub in solidarity next to her manchild. Per the stories, she hollered out to him to run and he did. She took a bullet and lost her life. He lived. And then there were the beautiful faces of the others that I'd studied one by one on websites and in magazines. The majority of them immortalized by bold, unapologetic selfies taken at their own hands. Something about that made me feel like a kindred spirit to them all.
I am haunted by that awful event. I am and I accept that I am. I am especially drawn to and haunted by that mother--whose name was Brenda Lee Marquez-McCool. Even though I didn't know her personally, I mourn the loss of her life and count her as one of my heroes. One, she was brave. And two, she loved her boy unconditionally. Her boy was a same-gender-loving brother. And how cool is it that she not only supported her son, she also danced with him in a club on the day she died?
And so. While I had every intention of talking about human sexuality from the perspective of our curriculum, I didn't. I mean, at that time I just couldn't.
As time goes by I am recognizing the power of my influence more and more. So I needed my advisees to know that this happening trumped anything else we were supposed to discuss. I wanted them to have a space to touch and agree and feel something, anything together. Or find that feeling if somehow it had been swirled into life like a teaspoon of yucky medicine in apple sauce--there but not really.
I sat down and looked at their faces in that room. None of them older than 27 years old. All of them representing some different appendage of their own diaspora but still all belonging to this tribe now. One of them, that I know of, same-gender-loving, too. Another of Muslim faith and observant. And especially, all of them special and amazing and people whose lives matter to me deeply.
So with all of that in my mind, I opened my mouth and tried to speak on all of this stuff. Well, I take that back. First, I tried to talk about what we were supposed to talk about. But then, I closed my laptop, then closed my eyes for a moment to hold back the tears I felt stinging in my eyes.
"I'm supposed to talk to you about what you just learned about," I finally eked out. "But instead I need us to talk about the fact that 49 human beings lost their lives Sunday morning. And, yeah. I know that these shootings are happening a lot. A whole lot. But I . . ." My voice trailed off and started crackling. I tried my best to clear it and go on. "I need to honor them. And what happened. And I need it to not get all lost into this abyss of how cruel the world can be and count as just another thing. Because even if it was that. . . it wasn't that."
They just stayed silent. One student immediately started to cry.
"I need you to know how sorry I am that this is the reality that you have in your twenties. How sad I am that this hate crime against the LGBT community is going to make somebody feel lonelier for so many reasons. And angry, too. How hurt I am that this will make even more people misunderstand my peaceful, thoughtful brothers and sisters who practice Islam. But especially that it will just leave you a little bit more afraid, you know?"
And it's weird. Nobody was really saying anything with their mouths. But they all had these expressions on their faces that spoke volumes. Then, in between being a soppy, weepy mess, I needed to be clear that this was a hate crime and that we needed to hit the pause button for a moment to say that.
Okay, so can I just unpack for two seconds on that part? I think the Orlando massacre is one of most complicated and effed up things that could possibly happen anywhere. But since it happened in America, like many, I'm guilty of needing to label it with some clear compartment of what it was. And I think it comforts us to treat those compartments as if they're mutually exclusive, you know? But I'm realizing that they aren't.
How people see same-gender loving people in this country (and this world) is a major problem. It has this ripple effect that makes people turn inward to hate themselves as much as one can possibly hate anyone or anything. And everyone knows that self hate always ends in hurt directed toward others. So all the subtle shit-talking that I've heard over the years that I never spoke up on? I'm trying to be braver. Like, call things out or at least not stay indifferent, you know? Because that's like watching a mugging in broad daylight and just thinking the whole time that it's really, really fucked up. But not doing anything.
At least that's what I think.
And here's the other thing. The gun control aspect is relevant. I mean, it is. It is relevant as hell, you know? But I don't want that to totally overshadow the fact that it was a hate crime. Yeah. I guess that's what I'm saying. Better yet--here's an analogy: Like, if my son was playing outside on a street that should be safe and a person comes speeding down the street hollering at the top of their lungs that they HATE-HATE-HATE black boys and that they should die. . . .and then mows down my kid with a car, crashes into a tree and dies? That would be some tragic shit, right?
And if that car was like, a hot rod, and we could all agree that no person should need a hot rod for everyday use and that it's just too damn easy to get a hot rod, that would be also worth talking about, too.
I mean, it would. But you know what would be even more tragic to me? If I turned on my television and the only conversation (that got any real airplay) was about how we need to control the speeding laws on that street and stop people from having lead feet on gas pedals or access to hot rods. With very little mention the fact that this man went after my baby as a target with that hot rod. With every intention of eliminating him because, as he chanted out loud and even said prior to turning the key in the ignition, he HATE-HATE-HATES black boys and they should be eliminated. That would be like insult to injury, don't you think?
And let's be clear--the hot rod and speeding issue is significant and worth marching on Washington about. But it isn't the only problem in this situation, you feel me?
Oh, and if that man looked like me and also said that he represents all of the people who are just like me before doing that? And if everybody thought ill of people like me because he unfairly associated me and my people with his hateful act--when really people like me are nothing like that? Man. That would hurt, too. Especially if it happened during one of the most meaningful times of the year for my people. And especially if nobody seemed to mention how wrong it was and how hurtful that part could be to me, either.
But none of it can be put in just one box, right? My point is just that I want us to not ignore certain boxes. Or even walk around like the boxes were never there in the first place. Does that even make sense?
Sigh. I'm rambling. I know.
So, yeah. That's what happened a few weeks back and I was fine with it. I gave them space to debrief, too, and ended the whole conversation by telling them how much I love them and how much each of their precious lives deeply matters to me. And they got that. They did.
I'm working hard at being a better steward of my influence with my learners. Shooting down complacency and showing emotion when it's necessary. Because a lot of times it is necessary.
And one other thing:
That mother? That beautiful, brave mama bear Brenda Lee Marquez-McCool who dove on the sword and died in the club shielding her beautiful boy from that hateful man's gunfire? Her boy's name was Isaiah.
Just like mine.
Happy Monday. And rest in paradise, Ms. Brenda. You sound like you were my kind of chick.
Honestly? I write this blog to share the human aspects of medicine + teaching + work/life balance with others and myself -- and to honor the public hospital and her patients--but never at the expense of patient privacy or dignity.
Thanks for stopping by! :)
"One writes out of one thing only--one's own experience. Everything depends of how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give."
~ James Baldwin (1924 - 1987)
"Do it for the story." ~ Antoinette Nguyen, MD, MPH
Details, names, time frames, etc. are always changed to protect anonymity. This may or may not be an amalgamation of true,quasi-true, or completely fictional events. But the lessons? They are always real and never, ever fictional. Got that?