Friday, August 21, 2015

The Youth Code.


"I guess it's crazy to think someone could run 13.1 miles and still have high blood pressure."

"Exactly. I just keep waiting for somebody to tell me they looking at the wrong chart."

________________________________________________________

This week in the Grady Primary Care Center

"We think it's a really good idea for us to go ahead and get you on blood pressure medicine. As a matter of fact, this particular medication gives you an added bang for your buck since it protects your kidneys and lowers your blood pressure." Our patient raised his eyebrows gently and tried not to look as reluctant as I know he felt.

My resident chimed in. "Since you have diabetes, this particular medication is shown to help keep your kidneys from becoming weaker. You know that can be a big issue with diabetes."

Mr. Amos* shifted in his chair nervously. "I hear you," he said. But from what I could see, hearing definitely didn't mean he was feeling this plan.

Nope.

If you saw Mr. Amos walking down an Atlanta street, he's the last person you'd expect to be carrying with him diagnoses of diabetes and high blood pressure. He was, by our standards, young. Just shy of his fourth decade and with boyish looks that suggested he was far younger. Lean in build and tall in stature--no spare tire in sight. "Amos," as he told his to call him, had been athletic all of his life and examining him quickly let any physician know that he still maintained that lifestyle.

Yup.

But Amos was a victim of genetics. His mama and his daddy had been affected by diabetes. Two sisters were diabetic and grandparents, aunties and uncles all up the family tree had equally representative medical histories. Diabetes and hypertension simply ran in his family. It wasn't a "you gained too much weight" thing or a "you smoke/drink/use thing" either. But nonetheless, for whatever reason, that high blood pressure dog didn't hunt with him.

Nope.

Now when it came to the diabetes? Amos was awesome. He took his insulin and counted carbs. He did the things we asked of him and, though he occasionally had a few dietary indiscretions, he mostly adhered to our recommended meal suggestions. His number always looked great which made seeing this young, fit man a joy.

But.

Somehow he always managed to shake his providers off when it came to starting something for his blood pressure. He'd come up with some compelling gameplan to increase his physical activity and watch his salt. And since he was generally such a motivated and great patient, it wasn't unreasonable for someone to give that a shot. That is, the first two times.

Mmm hmmm.

On this day, though, from the chart review it was clear. Amos' genes were just too stubborn. For us to do right by him, he'd need blood pressure medication. And you know? This wasn't personal. It was just the standard of care.

So in the hallway before we'd gone back together to see Amos, my resident told me that he was pretty adamant about not taking blood pressure pills. I asked my resident if he knew why our patient was so against taking something for his hypertension and he admitted that he honestly didn't know. And so. That was one of the first things I explored when I encountered him.

"So, Mr. Amos. What is it about blood pressure pills that gives you such a bad taste in your mouth?"

He squinted his eyes and seemed to be thinking. I could tell that my question caught him off guard. "I guess I just feel like I can control it, you know? Without an extra pill."

That was reasonable. I thought for a bit about who he was--young and male. I imagined him having some trepidation about the potential for erectile dysfunction, a very real concern in many men who take antihypertensives. So I asked.

"Do you feel concerned that taking something for your blood pressure might affect your nature?"

And yes, I said "nature" because this is Georgia and I've been working at Grady for a while. Long enough to know that "nature" is a safe and all encompassing way to discuss not only what is found in the nether region but its function as well.

Amos' eyes flung open at that question and then he chuckled. "Good Lord. I hadn't even thought of that." He shook his head and shuddered.

So that wasn't it. And what's funny is that I felt sort of lost at that point because I was so sure that this was his issue that I'd already lined up my talk points to counter his concerns.

What was it, then? What had this compliant with appointments guy so gun shy with taking something for his blood pressure?

"You know what? I guess I just. . it's weird. . .I just see myself as too healthy for all that. And too young." Amos laughed again, this time at his admission to us. "I know it probably sounds crazy. But something about having high blood pressure just doesn't seem like it should be attached to me. It's like I just can't accept that, you know?"

"You don't feel that way about the diabetes, though?" I asked.

"Naw. Little kids get diabetes. Skinny folks and all sorts of folks, you know? Jay Cutler is a pro football player and he's got sugar. So I know that happens to people like me. But high blood pressure is something that just seem like it goes with smoking and eating bad and needing to lose weight. And even though I know it ain't personal, I always feel lightweight offended when folks come at me talking about my blood pressure. It's like I feel like they mixing me up with somebody else."

"I guess it's crazy to think that somebody could run 13.1 miles and still have high blood pressure."

"Exactly. Especially when they do all the right stuff along with it and they aren't that old. I just keep waiting for somebody to tell me they looking at the wrong chart."

Wow.

Now this? This was some real talk. Amos stuck a pin straight into the thing that stops so many youngish people from seeking a doctor's care. Hell, it's stopped me from getting care as regularly as I should, too.

Yup.

It seems like there's this line in the sand where some of us feel it's reasonable for us to have certain diseases. Hypertension and high cholesterol? Those are for the older folks. So a lot of the young ones look at it as some kind of fluke when you tell them they have it. Like you aren't talking to them in real life. Just for pretend.

And this? This is a tough mountain to move. Our myopic view of our reflection and how that plays into the likelihood of anything being awry with our health. Amos gave me a lot to think about.

So you know what I did? I told him just what I'm telling you. That I understood how he felt and got it that it seemed like some kind of crazy betrayal to keep tacking this diagnosis of high blood pressure on to his chart. Then we discussed family history and how "essential hypertension," that is, the kind that runs in families, works. And how people like him--despite their half marathons and burpees in the morning--needed some pharmocologic interventions in the morning, too.

This resonated with him. I mean, it did enough to get him to take that medication. And no, he didn't like the idea but he did get it that continuing to put this off was like him drinking poison but expecting someone else to die from it.

Yep.

So what's my take away from this encounter? Hmmm. Well, first of all it's this idea that it really benefits me and my patients when I really push myself to think about the WHY of a patient's position instead of just my own agenda. I also was reminded to just slow down and listen instead of tracking ahead with my scripted comeback since real people improvise and canned/planned dialogues feel like exactly that. And lastly? I think I recognized the power of just being honest with my patients about what's going on in my head and giving them a platform to share what's happening in theirs.

I learn so much from my patients at Grady. And I'm glad.

Yeah.

***
Happy Friday.

*details/names always changed to protect anonymity. Duh.


Thursday, August 20, 2015

The Somebody-Done-Somebody-Wrong Song.


Hey, won't you play . . .
another somebody done somebody wrong song?
And make me feel at home. . .

~ B.J. Thomas


A few years after I joined the Grady faculty, I was given the honor of leading this huge Emory sponsored Internal Medicine board review course as the director. In this role, I'd coordinate some eighty plus speakers and manage a substantial budget for a five day program. With attendees from all over the U.S. and beyond, it was a huge deal. Especially for someone as junior as I was at the time.

The first year went swimmingly well. I met tons of faculty members and was glad to be in a position that put me on the radar of a lot of well-connected people in our department. Given my triumphant neophyte crack at this program, our leadership tasked me with the same job for a second year. And that was cool.

Yup.

Not too much earlier than that first year of planning, I met the man of my dreams--the BHE. Then, in that second year as director, Harry and I were in the throes of wedding planning. And since I'd done this thing before and knew all the moving parts, all of that was cool, too.

But you know? Weddings are exciting and have this way of consuming you. I did my job, yes. But admittedly, I was quite distracted by things like invitation styles and calligraphy and showers and menus. My May 1 wedding had the lion's share of my thoughts and attention. I was quite thankful that I, one, had experience as the board review course leader and two, had an a very knowledgable coordinator working with me.

Things had gone without a hitch the year before. Our timeline of getting in touch with speakers, securing the venue, arranging the AV support and sending out the mass mailings of brochures was proposed to be identical to the prior session. Jana (name changed), my coordinator, had been a key part of the continuing medical education department for years and was a pro at this particular event. Through lighthearted emails, we quasi-discussed our action items and discussed our game plan of rolling with things just as we had in 2003.

Yup.

Jana knew every nitty-gritty detail of my wedding plans, too. As a matter of fact, her background with planning these medical meetings made her so connected in the hospitality industry that she was a key factor in helping me lock down my own wedding venue. It was great that our collective history of working on the board review event helped me to feel less stressed. And by less stressed I mean I wasn't really paying attention to the detail of the board review.

Nope.

The months leading to our May day nuptials were a whirlwind. Showers and dates with friends and so much more swirled around me and kept me floating in the air like Mary Poppins with her magic umbrella. That day finally came and it exceeded my wildest dreams. All of it, simply sublime. And the only thing better than that was the exquisite honeymoon escape Harry and I went on a few days after.

Hand in hand, we strolled along the island paradise of St. Lucia with goofy grins plastered on our faces. We lingered in saunas and took couples' massages. We ate the ripest, freshest fruit and met new people. And mostly just marveled at the blessing of being in love and now married.

Yup.

A few days into that honeymoon, I decided to make a lazy pitstop into the internet cafe of our swanky resort. Since we weren't on our cell phones, I thought a happy little message from the newly established "Team Manning" would be a good thing to send to our family and friends. And so I logged on and planned to do just that. Which was mostly cool.

Until.

I clicked into my work email and saw this one message dated April 30--the day before I got married. It was from Jana and had been sent a few minutes before midnight. In it, she described how she'd been going through some personal things and how, as of earlier that day, had resigned from her position.

Yep.



Turns out that in my wedding obsessed state, I hadn't even noticed that we'd not touched bases much about the board review program in March or April. Every email in my inbox referred to loose, slippery plans intermingled with brainstorming sessions about how to pull off a perfect wedding. Instinctively, I panicked. I internally prayed that she'd handled all of her action items (that is, the ones I assumed she knew of that were just like the ones she had before) although something welling in the pit of my gut told me that she hadn't.

Shit.

It was now May. The first order of business--and the most urgent to confirm--was that the brochures had been mailed out to the hundreds of physicians who were our targeted audience. Now. There was a simple way to know this for sure. I was among the physicians in that bulk mailing and should have received my brochure sometime near the end of March. Problem was, that was the furthest thing from my mind back then. And you know what? For the life of me, I couldn't recall getting one.

Nope.

Well. Turns out I didn't get one for a good reason. It never was sent. Nope. The 750 to 1000 mail flyers earmarked to be shot out to every corner of the southeastern U.S. never left Atlanta. And you know what else? That's because they never got printed.

Nope.

The last thing I could say with certainty was that I'd electronically put together the sample brochure and approved it for print. But confirming that it got printed? Then making sure it got mailed? Well. I'd left all of that up to Jana, my coordinator. You know, the one who'd just notified me of her resignation. And also shut off her cell phone and discontinued her university email account.

Sigh.

So me? Obviously, I was hysterical. Freaking out near the equator and ready to punch in a wall. I called Jana every dirty, slimy name in the book and lamented nonstop about how I couldn't BELIEVE that she hadn't done ANYTHING. And since my only sounding board was Harry, he just sat by sipping his all-inclusively provided spirits and listening.

"I talked to my division chief today," I huffed. "He is just as floored that this woman would just throw this whole damn thing under the bus. I mean, who DOES that? Doesn't even print OR send the damn brochures?" I shook my head and rolled my eyes. Every few seconds I said something similar, pacing all around Harry and dropping occasional f-bombs. This? This was a multi-thousand dollar disaster.

After the 24th hour of hearing me rant about the incompetence, unprofessional behavior and lack of consideration of Jana--the woman who was "supposed to be my friend"--Harry finally had had enough.

The BHE is a man of few words. But when he speaks? It's almost always worth listening to. And seared with honesty. He decided to let me know what he thought about all of this.

"This has nothing to do with that woman. You fucked this up. Period end of story."

Wait, huh?

I mean, we were supposed to be "Team Manning." He was supposed to take my side, leap to my rescue and hate Jana's guts right along with me. But that? That isn't Harry's style. He just shrugged and called like he saw it.

"You dropped the ball and this is your fault. How the hell did you NOT know that the damn brochure hadn't been sent? That's crazy. And why hadn't you asked to see the final before the mailing? You'd have known that it wasn't printed then. That's because you were focused on other shit."

"She had a job. She didn't do it." I felt my face getting hot and my eyes starting to prickle with defensive, hurt tears.

"You had a job. You didn't do it. She wasn't the director. You are."

I shook my head and folded my arms. "So you mean to tell me you think this is all on me?"

Harry raised one eyebrow and jutted out his lower lip. "Well. Honestly? Pretty much. You fucked up. You delegated and didn't follow up. And you're lucky as hell that your boss isn't me. I would have torn you a new asshole."

My eyes widened with his military man's lingo. He was pulling not a single punch.

"Look, babe," he finally said, softening his voice, "the best way for you to learn from this is to own your part in it. Call it what it is, man. You dropped the ball. And now you got burnt."

Now I was full-on crying. Partly because my feelings were hurt, partly because I was scared that I would cause my department to lose thousands of dollars, but especially because he was 100% correct in his assessment. I felt so exposed, so obviously wrong. But just a few moments later, I felt that anger welling up again so I started letting the pendulum swing back to Jana. "But she--"

Harry cut me off. "Babe, did you look at our wedding invitations before they went out?" I nodded and dropped my head because I knew already where this was going. "Of course you did. No way in hell would you have missed proofing them and making 100% sure that they got mailed out exactly six weeks before our wedding day. You made that a priority. This wasn't. So just call it what it is--you fucked up."

I plopped my face into my hands and sighed hard. "I did. You're right," I whispered.

"Then own it. And make that the last thing you say about that woman. Just figure out how you are going to fix it and focus on you." Next came the obligatory Army reference, a staple in Harry's lessons of love. "See this is like during my Army days when a private messed something up and I was the lieutenant in command. I couldn't go to the colonel with no bullshit song and dance about how Private Joe didn't do this or Private Joe didn't do that. Nawww, man. It was my job to handle all of that and present results to my superior officers. "

"So she was my private."

"Yep. And you need to thank God that I ain't your colonel."

That? That was one of the most pivotal learning experiences of my career to date. A painful lesson in accountability and the futility of finger pointing--provided in a beachside lounge chair against a Caribbean backdrop.

Yup.

Let me be clear: Jana was wrong in some ways. She was. But Harry's point was that it would be more useful to focus on my part first before wasting energy trying to decimate her. He also told me that by the time a person looks at what they did and works on that, they're too exhausted to go blaming another person. And so. That's eventually what I did. And you know? The truth hurt. It was as clear as day: I was so busy focusing on things unrelated to my own job as course director that I missed my opportunity to catch what wasn't being done in a timely fashion. Which ultimately fell on me, the responsible party, not Jana.


Tonight I was called by a mentee about something that immediately took me back to this place. This person was singing a somebody-done-somebody-wrong-song and the more I listened, the more it became clear. This was something my advisee needed to own for what it was: His fault.

Yup.

And so. I told him just like Harry told me (minus the expletives.) "You messed up. Plain and simple. You used poor judgement and now you need to own it and work through the consequences."

And, like me, he countered with all the reasons why this faculty member who'd given him a hard time was wrong. His dialogues sounded like that of a victim instead of someone who truly just effed up. Big time.

I was loving in my discussion, yes. But totally honest and not even remotely yielding to coddling or adding to the narrative of this being victimization. He was mostly quiet. I can't tell if he felt seriously angry and betrayed, or if he just needed time to reflect. Either way, I will sleep well tonight.

I will.

Sometimes? Sometimes when you fuck something up, you just have to stand the rain and own it. Put on your big girl panties, raise your hand and say, "Yep. I blew that one." Then be mature enough to work through the solution and the consequences that follow. Anything other than that--especially a never-ending commentary of how terribly you were treated and how much it is someone else' fault--is not only exhausting, it pulls the drain on any patience or respect people have for you.

Truth.

Listen. We are human beings and, by design, guaranteed to mess some things up. But humans who lead other humans must push beyond pridefulness to own wrongdoing. Paradoxically, it garners more respect than people realize.

At least, that's what I think.

So the board review? It went okay. We broke even which technically isn't the goal. My boss was glad that "that woman didn't cause us to lose money" and felt satisfied with things being even-Steven. But me? Deep down I knew the truth. That my husband was right and that I'd gotten lucky. But especially that this was all my fault for not following through with my responsibility as the leader of that program.



I like thinking about leadership lessons. I think they're an essential part of being a great clinical educator, physician, community leader and mom. The accountability thread permeates our lessons of love in our home. It's my hope that telling my son that leaving homework in a desk is his fault (not his teacher's) will pave the way to recognizing fault and making improvements later. Or as Harry says "being a grown ass man" when things happen. So that zero or that silent lunch is on you, bruh. It's pretty amazing how innovative folks become once they've owned a screw up and decide to try to find a solution.

Homework included.

So yeah. Sometimes? Sometimes you just fuck up. And when you do, step one is to admit it. To whom, you ask? Well, that depends on the situation. But I can say there is one person whom you should always start with.

Can you guess who that person is?

Yeah.

***
Happy Thursday. And sorry for the f-bombs. Blame my husband. Ha.

Now playing on my mental iPod. . . . kicking it old school, yo.

Wednesday, August 19, 2015

The pied piper of empathy.



Pleased to meet you
Hope you guess my name
But what's puzzling you
Is the nature of my game

~ The Rolling Stones


I was sitting at a lunch counter the other day chatting with one of my former small group advisees about his career interests. Gunan, who is now an intern, was rotating on the oncology service. During our conversation he told me about how much he was enjoying his experience.

"That's right in line with your chosen field of radiation oncology, right?"

"Yep."

"Good stuff," I replied.

"I think I just . . I don't know.  . I just like taking care of people with cancer."

Wait, huh?

I wasn't sure what to say to that. I mean, can a person technically like cancer? Is it even okay to say that? I wasn't so sure.

Gunan saw my wheels turning and clarified, "I've figured out what it is about cancer that makes me like it."

Like. Cancer. Uh, okay. 

I raised my eyebrows. "Oh yeah? What's that?"

Gunan paused for a moment to find his words. I think he wanted to be sure that it didn't come out wrong. After a few seconds he finished chewing his bite of sandwich and spoke. "You know what it is? People respect the cancer diagnosis. No matter who they are, they do."

I squinted my eyes at this concept which pushed him to go on.  From there he fleshed out the idea pointing out that there aren't too many other things that every person old or young fully respects like a cancer diagnosis. He described how even the most difficult patients straighten up the moment it gets uttered. Family members step in to help--even estranged ones come from the woodworks--because it's cancer. Almost like having a U.S. president walk into a room. Essentially, it's kind of like the universal last word of diagnoses.

Now this? This was a pretty thought provoking idea. And especially so since I'd never thought of diagnoses as rungs on some sort of ladder of respect.

Hmmmm.

"That's deep, man."

Lame reply, I know. But that's all I could say because this was such an interesting perspective--and one that I believe was extremely accurate.


Yep.

Gunan gave me something to really chew on that day. This idea of diseases being hierarchal and having one that is the President Obama of them all--cancer.

Heart disease is exponentially more likely to take out any person than cancer. It also has a much, much greater chance of disabling or redefining a life than cancer. And, though a lot about cancer is terrifyingly mysterious, when it comes to heart disease? Meh. Not so much. High blood pressure, obesity, inactivity, elevated cholesterol, and family history are just a few things that greatly increase the chance of a person getting heart disease. And you know? Society has done a pretty darn good job of getting that memo out.

Yup.

And sure, if someone doesn't seem so stressed about potentially getting something like heart disease, surely they'd feel the wake up call if they actually had it, right? In my experience, I'd say that answer isn't in the affirmative. While some folks definitely straighten up and fly right after a heart attack or some other cardiac event, many, many people don't. Nor do the people around them.

But cancer? That's a whole different story.



The other diagnosis that doesn't get it's full respect is HIV.  All of the aforementioned things about heart disease ring true for HIV. This virus? We know about it. Like, all about it. There are ways to prevent and treat it, too. But perhaps even more than heart disease, it gets treated like an annoying tick on a dog's butt--something to ignore or not even look for until your forced.

I've told people that they were HIV positive. I've held their hand and walked them through the process of getting into care, too. But unlike cancer, it doesn't arrive with the same amount of boundless empathy. And worse, many times it prompts people to run in the other direction.

The patients are usually somewhere between really, really adherent to all that you suggest or totally in denial. And you know? That doesn't happen so much with cancer.

Nope.

Compared to cancer, HIV, as the late comedian Rodney Dangerfield would say, gets "no respect at all."

Nope.




It's true. AIDS and heart disease just don't get the respect that they absolutely deserve, man. And don't even get me started on mental illness which really gets disrespected.

But cancer? For some reason it's on a lonely list of diseases that somehow escapes all that. Even the most ill-equipped, contentious, poorly resourced and opinionated patients and families respond swiftly to that six letter word. They become more pleasant, cooperative and agreeable. They try what you suggest and listen when you speak. It's pretty damn remarkable.

Yeah. My former advisee was totally right. And it's a fascinating observation, isn't it?

So what is it about cancer? Is it the terminal nature of many of its forms? Is it the ruthlessness of it in how it strikes or the triumph of those who overcome its prickly grasp? Is it our universal fear of it that makes us all feel some need to show strong empathy lest we awaken the cancer-gods and find ourselves stricken out of some punitive wrath? Maybe it's all of this. Or none of it. Whatever it is, there's just something about malignancy that makes everybody listen just a little bit closer, follow up a little more carefully, and immediately get onto our best behavior.

And you know? It's not just the patients and their families, either. Doctors are also in this same camp. Our empathy heightens for patients carrying a cancer diagnosis. I know for sure that this is so because I've felt it inside of me and witnessed it time and time again at Grady Hospital.


Let me give you an example.

I took care of this super-cantankerous gent named Mr. Kelly with a longstanding stronghold of alcohol abuse on my service recently. He'd been admitted several times over the years for withdrawal and complications of his alcoholism. That man had a very sick liver and never once got hospitalized on a "soft call."

Nope.

But even though he didn't walk the line on illness severity, that didn't make him nicer or uniquely appreciative of his healthcare providers. He was difficult. Due to his illness and unstable housing, Mr. Kelly's hygiene was poor and frankly, that made it unpleasant to care for him. And, if I man be frank, downright noxious. He also argued with staff and, due to fear and frustration, wasn't so nice most days. The team and nursing staff lost empathy for him. People went in only when absolutely imperative. And even though people held their eye rolls, you could feel them whenever his name came up in a discussion.

Yup.

But then he had that MRI that showed a mass on his liver. A mass with features pathognomonic for hepatocellular carcinoma--that is, liver cancer. A blood test and additional studies confirmed what we thought. Not only did Mr. Kelly have this bad diagnosis--he wasn't really a candidate for any interventions that could lead to a meaningful recovery.

Nope.



And that moment? That second when we scrolled through the MRI images and hit that big oval mass on his liver? It was a turning point. Suddenly we all began rooting for him in a different way. And I'm embarrassed to admit it but something about knowing this about him made me want to see him more and spend time in his room. The heavy cloak of foul dank odor that hit you when walking through the threshold somehow seemed insignificant now. And his "difficulties" suddenly seemed like "quirks" instead.

Yeah.

But you know? Mr. Kelly changed, too. The minute we sat in that room at eye level and shared that information, a switch turned on in him. Or off. Or whatever it was, he changed. He asked questions and listened. His family members took his calls and he took theirs. There were cards on his window sill and balloons tied to his bed rail. And the nurses, like me, in unspoken solidarity rallied around him to make sure he was comfortable and that all was well.

Yup.

One could argue that his advanced liver disease, cirrhosis and alcoholism were already equally as life threatening if not more than this new diagnosis. His life expectancy, chance for recovery from his liver damage, all of it already portended a very poor prognosis. And we, the physicians and nurse, knew that. Yet somehow when someone threw hepacellular carcinoma into the mix, we lined our ducks up and offered this man a new dignity. It's true.

And you know? I'm not sure how I feel about that. I'm not.

I talked to my friend Wendy A. about this whole concept. This idea of disease hierarchy and how some illnesses we throw our shoulders back to salute and how others get a head nod and that's it. I asked her thoughts on how cancer especially wins when it comes to that and why that was. And her take on it is that no person is exempt from the potential cancer diagnosis. She said, for this reason, perhaps, we all revere it.

Perhaps.

And I still don't know how even the ones that some cancer patients seduced into their lives through tobacco use or other finger-wag worthy habits garners the same empathy. But they do. Like, not these attitudes that the man who has sex with men got what what he had coming to him when he found out he had AIDS or how the lady who had a stroke after using crack cocaine got what she deserved. Again, regardless of the etiology, cancer escapes all that. Somehow it just does.

Yeah.

So the Pollyanna positive girl in me has decided that this speaks to some innate thread of good in all of human kind. And how, as awful as cancer can be, it's amazing that there exists something that stands out as a pied piper for humanism and care for human suffering made palpable.

Yes. That.



You know? I don't even know why I wrote about all of this. But I do know this: The complexity of what we do is mind-blowing, man.

Yeah.

***
Happy Humpday.

Now playing on my mental iPod. . . .The Rolling Stones performing "Sympathy for the Devil."  (Well technically the remix done by Pharrell but still, it's the Stones and it's awesome.)




Tuesday, August 11, 2015

Let it burn.


It's all right to cry
Crying gets the sad out of you
It's all right to cry
It might make you feel better

Raindrops from your eyes
Washing all the mad out of you
Raindrops from your eyes
It's gonna make you feel better

It's all right to feel things
Though the feelings may be strange
Feelings are such real things
And they change and change and change

Sad 'n' grumpy, down in the dumpy
Snuggly, hugly, mean 'n' ugly
Sloppy, slappy, hoppy, happy
Change and change and change

It's all right to know
Feelings come and feelings go
It's all right to cry
It might make you feel better

~ Rosey Grier, Free to Be You and Me


My outlook on life is almost always sunny. I prefer smiling to frowning and laughing to crying. Which is generally where I'm at.

But.

I don't like numbness. I mean, unless it's helping me while pushing out a 9 pound baby or something. Otherwise I like to feel things. It makes me feel alive and connected to what's happening around me.

Yeah.

Today is August 11. My sister, Deanna, would have turned 47 today. And just typing that makes me smile because she loved her birthday. She never let it just slide on by without any sort of pomp or circumstance--which to her was simply defined as being surrounded by friends and love. Deanna was all about acknowledging people and lives and milestones. Herself included.

That woman knew how to live.

So that--thoughts of how she lived her life so big and full--always make me laugh. But conversely, it stirs inside of me these complicated emotions. Like, anything that I live through or witness that is impossibly beautiful or wonderful, I imagine her enjoying it. And again, the smile comes followed by that wave of emotion pushing against my eyeballs for a fleeting second. Then, almost always, it quickly washes over.

But today is kind of different. Her birthday makes me ache to speak to her. So, so badly.

Yeah.

Another thing: I wasn't on Facebook when my sister was alive. And, as silly as it sounds, I came unglued today when trying to tag her in my post today. I simply wanted to say that I loved her and when I typed her name and it didn't pop up on a pull down page, I was reminded that there wasn't really a way to reconcile that. Because that would require her to be here to click that lonely little "accept request" button. But she never will.

And that? That did it. So instead of countering it with a phone call to a friend or some warm and fuzzy thoughts, I decided to just let it burn. To let myself cry the ugliest of cries and miss her in the rawest, most primal way. To speak out loud that I'm super sad that she's not here and how every single perfect moment or funny event is bittersweet without her. And I told her all of that. I did.

I am okay. I am. But that doesn't mean that I don't deeply miss my sister every single day. But especially today. Because this was her day.

Today, I decided to just let it burn. Let the hurt remind me of how fortunate I am to have known her. Isaiah cried a few times today, too. And I just held him tight and told him the same thing: "Let it burn, son. It's okay." Because it was.

And it is.

I'm rambling, I know. But really, I just wanted to take a moment to reflect on my sister's life. Because her life was awesome. And so was she.

Yeah.

That's all I've got. Thank you for listening, okay?

***

Now playing on my mental iPod. . . . .

Sunday, August 9, 2015

When somebody loves you back.

Photos by our friend and family historian, Angus Wilson with www.nileimages.com


It's so good lovin' somebody
And somebody loves you back

To be loved and be loved in return
It's the only thing that my heart desires
Just appreciate the little things I do
Oh, you're the one who's got me inspired
Keep on liftin', liftin' me higher

So good, good lovin' somebody
And somebody loves you back
It's so good needin' somebody
And somebody needs you back

We can build a world of love, a life of joy
Make our goal each other's happiness
I will do for you anything that I can
Oh, everyday I wanna do a little more
Do a little more, just a little bit more

It's so good, good lovin' somebody
And somebody loves you back and that's a fact
It's so good wantin' somebody
And somebody wants you back
Said it's so good

Oh to be loved and be loved in return
It's the only thing that my heart desires
Just appreciate the little things I do
Oh, you're the one who's got me inspired
Keep on liftin', liftin' me higher

So good lovin' somebody
And somebody loves you back and that's a fact
It's so good needin' somebody
And somebody needs you back

Said not 70-30
Not 60-40
Talkin' 'bout a 50-50 love

Said it's so good lovin' somebody
And that somebody loves you back, yeah

Said not 70-30
Not 60-40
Talkin' 'bout a 50-50 love, yeah

~ Teddy Pendergrass, 
When Somebody Loves You Back



I remember sitting up talking on the phone to my sister JoLai one evening late into the night. She'd been  dating this guy who was mostly nice and who was probably a decent human being from my recollection. But what mostly stands out in my memory is that too much stuff was complicated and fuzzy when it came to his actions toward my sister. Especially given the amount of time they'd been going out. So even though he was mostly nice and probably a decent human being? I'd seen enough to tell her my honest opinion when she asked.

"It shouldn't be this hard," I said. By this point, I'd lived through the sticky parts that she was tipping through in single hood. I'd finally made it to the mountain top to see the promised land of what it feels like when someone is genuinely, deeply invested in building something with you. So I knew for sure that even if a guy wasn't an assassin and even if he went to church and ran errands for his mama, that didn't excuse his indifference when it came to dealing with my sister's heart.

Nope.

And does this mean that the person is awful? No. It just means that they aren't the one. Period. End of story.

"This is too hard," I told JoLai. "There's too much to understand and too much that requires a disclaimer. You're too good for this. You deserve a man who is checking for you. And this dude isn't checking for you. Not like he should if he really wants to be with you."



And that was all I had to say. My sister knew exactly what I meant by that term. But maybe you don't, so I'll explain.

Okay. So checking for somebody means you're concerned about them and it shows through your actions. Girls around the way used to say, "Chile, please. I ain't even checking for that dude." Which meant that you weren't even giving him a second thought. (Even if that wasn't true.) Or we'd say, "Dang, nobody can say that dude isn't checking for her!" Which was a high compliment to the person whose significant other was never ambiguous about his or her allegiance to their mate.

When someone is checking for you? It isn't grey. It's pretty obvious. And no--those on the outside aren't so much the ones who should be convinced. Those in the relationship should.

Look man. The bible says it beautifully: Faith without works is dead. (James 2:17) In other words, I don't care what a person is saying-saying-saying if it is not commensurate with what they are doing-doing-doing. And especially if they don't seem particularly pressed about how I'm feeling-feeling-feeling.

Does this even make sense?

Either way, I had to bring back this old slang term for emphasis. And I'm glad I did because she got what I meant.

"You'll see. And one day, it will be super obvious."




She cried when I said that. And honestly, I'm not sure if it was because she believed it was true or because she was afraid it wasn't. My guess is probably a little bit of both.

Yeah.

Just a few months after we lost Deanna, JoLai met someone. A wonderful man named Joe. A really sweet guy with kind eyes, a tender smile, and a deep and throaty laugh so robust that it automatically made others around him laugh, too. And after those first few dates that she told me about, it was as clear as day. This dude was checking for her. Nothing about it was confusing.

Nope.



And sure. I know that there are relationships that start off lumpy and bumpy and then smooth out. I get it that people evolve into things sometimes, too. But I admit that I'm a real subscriber to the Malcolm Gladwell "Blink" theory when it comes to people. That is, almost always, your immediate discernment is spot on. And as I look back on my own unlucky dating history before Harry, I know that had I just gone with what I felt very early on about my interactions, I'd have saved myself a lot of grief.

Yup.

This man was checking for my sister. Right out of the gates he was. And not in a creepy way either. Just in a way that suggests deep interest and desire to grow this thing into something more. Not layer upon layer of excuses or what-had-happen explanations. Just actions that speak for themselves.

Yep.

So it evolved and continued. Until it exploded into this wonderful partnership and love.

"I know what you mean now," JoLai said. "This is what it is supposed to feel like."

And I replied, "Yes. Yes. Yes."

Early this year, Joe asked JoLai to marry him. And she said yes.

He even asked this guy first.



Yep.

Last week, on a Thursday actually, our immediate family stood around them in an intimate circle as they spoke heartfelt vows to one another. All of our feet bare in Florida gulf coast sands under the canvas of a near setting sun. My brother singing, one of our best friends as the officiant, and nieces and nephew there to lay down a broom for them to jump at the end.




God, it was perfect. So perfect.

And easy. Easy. Because it doesn't have to be that hard. Not when somebody is truly checking for you.

Nope.

Now sure. Life is complicated when you're grown. But not the kind of complicated that should excuse someone from their convoluted reasons for not calling you back or where they seem unsure about spending time with you or defining the relationship. No ma'm and no sir.

Sweet Joe, my sister's new husband, was once married before meeting JoLai. From his first marriage came two beautiful children, both in middle school. And yes, this, a blended family, will be a process that they'll all work at together. Which is perfectly reasonable and normal.



Because, again, life is complicated when you're grown ass people.

But what isn't okay is ignoring what is obvious just to not be alone. Sitting up trying to convince yourself that it's just fine for someone to act like they aren't hungry for you to be in their life and to have your presence. And I use the word hungry because I liken it to when someone offers me food when I'm not feeling rumbly in my tumbly.

Which is:

"Meh. I guess I could eat." 

And that? That is how a lot of people treat hearts and love. Like "Meh. I guess I could eat." Take it or leave it. Either way, I'll live.

And OH, I wish I had time to talk to somebody about how even eating a little of what you don't really want just spoils your appetite for what you do want.

Or just makes you overeat.

Whew! Preach, pastor!

I mean, I would talk about that if I had time. I sure would. But I don't. So I won't.

Mmmm hmmm.




So yes. JoLai is now married to a man who is checking for her. And you know what? She's checking for him, too. And we could not be happier for them.

Doesn't she just shine?

And you know what? It rained cats and dogs that morning and the night before. Then the sun just opened up and burst through those clouds. Which was special since that is exactly what happened 22 years ago on Will's wedding day and exactly what happened 11 years ago on my wedding day.

We decided that it's good luck. And that that downpour was just Deanna's tears of joy and that thunder and lightning was just her letting us know she was sho' nuf' there.

We got the message, Deanna. Ha.



JoLai reminded me of the words the BHE spoke several years ago when talking about finding the right person:

"Look man. You open the door and it's either sunshine or it's not. It doesn't take all day to figure it out. It's either sunshine or it's not." 


Which is so very true, don't you think?

Anyways. Damn, it was beautiful. Every single second of it. It was.

Sigh.

You know? I doubt I can think of a more deserving soul of true love than JoLai. But my guess is that somebody reading this is just as deserving but I just haven't met you yet. Or worse, you just don't realize that you're deserving. So today I'm sharing that word I spoke to her with whomever needs it.

It shouldn't be that hard. And it's either sunshine or it's not. And we all deserve sunshine. You included.

Yeah.

And look. This is a testimony. It is. JoLai's story and my own. Neither of us were lucky in love. But we were always deserving of something special and true. If it happened for us? It could happen for anyone willing to love themselves enough to expect someone to be checking for them. 

Yup.

I'll leave you with the song that's playing on my mental iPod. Mr. Teddy Pendergrass sings the ultimate song about how awesome it is to be mutually checking for each other.


So good, good lovin' somebody
And somebody loves you back
It's so good needin' somebody
And somebody needs you back.

True dat.

If you actually have a true love, savor it. And if you've been slacking off at checking for that love of yours. . . and we all slack off sometimes. . . ..just vow to do better, okay? Because it's so good, loving somebody when somebody loves you back.

And that's a fact.

***
Happy Nuptials.

Preach, Mr. Pendergrass.

Tuesday, July 28, 2015

Step One: Owning it.



I'm coaching one of our medical students for our upcoming Medical Student Teaching Competition. My assigned student, Kate P., is awesome. We've been meeting up and our energies line up perfectly. She's got spunk and great ideas. She's already a winner in my book.

Yep.

This is from our pow wow last week. What was going on here was our lesson on "Owning it." (A sultry "smize" and a minimum of a 3-inch heels are required for this exercise if you're under 5'6".) Because when you speak or teach, of course, you have to OWN the stage.

Duh.


And okay, okay. Maybe I exaggerate about the heel-height requirement but Kate was a good sport about it either way. And y'all already know how I feel about the whole "look good-feel good" thing.

Yes, ma'am and yes, sir.

And no, this wasn't something misogynistic or anything. I have similar conversations with my male mentees about ways to turn up swag when given the floor to speak. So, of course, it doesn't mean heels and a dress for every woman. But for me, it does. And since the point I make is that when you LOOK good, you FEEL good--and when you FEEL good, you DO good.

Or well. Hell, you get the picture.

And that Kate? She looks good, man.



Maaaaaan. Micky and Rocky Balboa don't have NOTHIN' on us.

Ha.

Prime Time Deion Sanders said it best:



Thats some real talk, man.

You can learn more about our Emory Medical Student Teaching Competition here.

***

Here's the AMAZING highlight video from last year's Emory MSTC put together by the extremely talented Chris S. (one of our students.) Shout out to our exceptional committee of student leaders who are organizing this event and to all of the students who have participated in any way. I'm SO in awe of these guys.  (This year it's on August 5 for those at Emory!)



****
Happy Tuesday, y'all. #bestjobever #teamkatethegreat #emorymstc

Saturday Night.



The other day I went to see one of my patients in the evening. The nursing staff had paged and said this patient was feeling anxious and upset and had asked for me. Me specifically. I had some things to do at Grady and was in the vicinity anyway so decided to just come on in.

Yep.

A lot has been going on with my patient. A lot. There was fear involved. A lot of fear. And frustration, too. And the thing about fear and frustration is that they can make us behave in ways that aren't always in our character. And since I get that usually I don't take such things personally. I recite the mantra that I tell my students: "This isn't about you." Because it almost never is.

But still.

At, like, 8-something PM on a Saturday night, I went to see my patient. I tapped on that door and creaked open the hinge expecting to be met with relief. Or at least some raw emotion and readiness to talk which I could have easily worked with, you know?

Instead, fear flipped an ugly switch on and I walked into a barrage of really unkind words and behaviors. Passive-aggressive. Or rather just sort of nasty-aggressive. Not dangerous or threatening. Just mean, you know? And I've truly grown to care for this patient so not only did those words catch me by surprise--they hurt. My feelings were genuinely hurt.

Yep.

When the nurses called me, I was sure that the combination of the rapport we'd built so far and the fact that I was up there after visiting hours when the lights get turned down would allay whatever had been going on. I was wrong.

I removed myself from that room and headed out to elevator. I snapped this photo of myself in the vestibule because I wanted to look at it and reflect on how I was feeling. Because my feelings were complicated.

Very.

The hospital was so empty at that hour that I stepped onto an empty lift and leaned my head against the wall on the way down. I could feel my pulse quickening and my face getting hot. Next thing I knew, my eyes welled up with tears and, before I could even stop them, I started to cry.

Kind of hard, actually.

I can't fully explain what I was feeling. Some of it was that my feelings were hurt. But that was only part of it. Mostly, I was just sad. Sad for my patient and this fear and this ugly behavior that came with it. Because that kind of thing almost always impedes excellent patient care by robbing even the most well meaning providers of their empathy. And empathy is a necessary element in quality patient care if you ask me. This patient didn't need anything else to work against all that was already happening.

Not at all.

So right now I'm feeling so sad. Like, every time I even think about the gigantic mountains that so many of my patients like this one are up against I want to steal away over and over again into the quietest elevators to weep into the crook of my white coat--just like I did on Saturday night. With no one looking or hearing or judging. Then, just maybe, even crying out into a vacuous airspace to my God or the Grady gods or any being with powers willing to take this on. Something, anything to defy the suffocating pragmatism and wrestle down the hopelessness I feel in such moments.

Maybe that would make me feel better, you know?

Then, when the doors pop back open, I can shadow box before re-emerging. Pop out of that elevator like a rejuvenated ninja with a new fight and a thicker skin. Believing in the little rays of light that sometimes seep through the darkness faced by so many of my patients, this one included. Or maybe even embracing some lofty idea that I could be that ray of light.

Maybe.

I am realizing that our patients aren't the only vulnerable people in the hospital. We are vulnerable, too. We so very are. Our universal precautions don't protect us from one of the most infectious exposures we face in caring for patients. . . .love.

On Saturday night, my patient was mean to me. Really mean. And yes, it was about fear but still. I have nothing in my little bag of Internal Medicine tricks to eradicate the effects of all that. I don't.

You know? Sometimes? Sometimes, this job is hard, man.

Yeah.

***

Wednesday, July 22, 2015

It don't stop.



"Hey Dr. M! You've been sitting in the same place for a while now. What are you doing?"

"Reading," I replied.

"Reading what?"

"Reading up," I said.

"Reading up on what?"

"On my patients." I didn't even look away from the computer screen when I said that.

"Like a paper or doing a literature search or what?"

"No. Just background stuff. And literature searches. And more. I don't know what's wrong with a lot of my patients. So I'm reading."

"Wait, what?"

"You heard me."

"You don't know what's wrong?"

"Nope. I like, don't. So I'm reading. So I can."

"But you're an attending. You're supposed to know what's wrong with everyone!"

*silence*

"Dr. Manning? Dr. Manning!"

"SSSSHHHHHH!!!!  Can't you see I'm reading!"

"Oh, okay. Sorry."


Hey students and residents! Newsflash: We DON'T know everything. And guess what? When we get home we grab some dinner, wash the dishes and then read up, too. Just like you. The only difference is that the exam is somebody's mama, somebody's daddy or somebody's child.

Higher stakes, yo.

Alright. Let me get back to reading, okay? I have a test tomorrow.

***
Happy Humpday.


Complicated.



"It's complicated," you said with a shake of your head. "You know? I mean, you know. Stuff is just so complicated with us."

I knew exactly what you meant by "us." You were referring to our shared culture and how tricky it is to navigate through it sometimes. And sure, it isn't that way with every black family. But still. I understood what you were saying.

"I'm sorry this is making it harder for you," I responded. I was leaning on my knee with my hand wrapped around my chin. I couldn't really think of much else to say.

"When somebody says they had sex with dude and they're a dude, tell the truth--deep down what do you feel inside?"

Your question caught me off guard. "Me?"

"Yeah. You."

"Well. I guess I don't think much of anything. I think it's your business, you know? But if you're asking do I feel bothered by it, no. I just don't. I know some people do. But I don't."

"A lot of people feel disgusted. I see it in their face when somebody is all obviously a gay dude, you know? I have friends like that. And they just don't care what nobody thinks about them. And see, me? That's what I don't want. I don't want that."

"Hmmm."

"Does that sound crazy?"

"What--not wanting to be looked at with disgust? No. Not to me."

"What would you do?"

Your questions were making my head hurt. I had never been asked these things so directly. But it was good. Good to be put in a position to challenge empathy.

"What would I do if what? Like if . . . I guess I want to understand what you're asking."

"If you loved a woman. Like the way you love your husband." You pointed at my wedding ring when you said that.

My first instinct was to answer immediately, impulsively. But then I decided to respect your question and actually pause to think about it.

What would I do if I loved a woman the way I love Harry? What exactly would I do?

Well. The truth is that I can't be fully sure. But I can guess. And that postulation would be based upon more than just me being "true to myself" and all that sort of thing. It would be grounded in how my family has always treated me and how sure I am that my parents would love me no matter what. And, as a result, they'd love who I love, too. I'm pretty sure my true friends would stick around and that I'd likely have just as everyday-boring-what's-for-dinner-wash-the-dishes-boring as I do now.

Just with a woman.

"Probably most of the same things I do now. Just with a woman."

"You'd still go to church?"

Lord. These questions.

"I think I would."

My head began to throb right after that because I started sifting through what it would look like to go to my church with a wife instead of a husband. And though I can't say it would be a no-go, I can say it would complicate things. That's for sure.

"So you'd be all out in the open? Like, you wouldn't be scared?"

"Ummm. It all sounds scary because that's not my reality. But hiding sounds much scarier to me. It sounds scarier than anything we've talked about so far." I bit my lip an let myself continue pondering your queries.

"Yeah. I can see that." You turned and faced the window. Not in a rude way, though. I think you just wanted to feel the sun on your face. I could still see the side of your cheek and your eyes. They looked like brown pools of water when you gazed into the sunlight. It was beautiful, actually.

"I . . .you know. . .I have a super supportive family," I added on. I needed you to know that. I didn't want to trivialize your feelings. "A lot of people loving and accepting you for who you are can make you brave, you know? So I think with that, it wouldn't be as hard for me."

You shifted back toward me and turned one side of your mouth upward. "I could see that when you walked in. Somebody told you that you were important when you were a little girl. And you believed it."

Damn.

"I . . .I don't even know how to respond to that."

"It's true, though, isn't it?"

I nodded slowly while still holding your searing eye contact.

"Stuff would be easier for me if that was my story. But it's not."

Since I didn't know what to say to that, I just stayed quiet.  After a few moments I spoke. "I feel a little scared that the hiding is standing in the way of you getting better."

You just stared at me without speaking when I said that, lost in your own thoughts. I waited to see what you'd say, the pause uncomfortable and prolonged. Finally, I couldn't take it any more.

"Tell me what you're thinking," I said.

"You know what I'm thinking, Dr. Manning? I'm thinking shit is complicated. That's what I'm thinking."

"But it doesn't have to be." As soon as I said that I immediately wished I hadn't. I hoped you didn't take it the wrong way. Easy for me to simplify the biggest hurdle of your young life. "I'm sorry I said that," I whispered.

You chuckled. "That's okay, baby." I immediately felt relieved. You raised one eyebrow and then added, "You want to know the real secret about complicated shit?" I widened my eyes in response to that, nudging you to go on. "The real secret about all complicated shit is just that--it's complicated for no reason. It never has to be complicated at all. But for whatever reason, it just is."

And that? That was some real talk right there.

And this? This is Grady. The place where I am challenged and pushed to search my heart. And think long and hard about what hides in the shadows of my mind.

Yeah.

***
Happy Tuesday.






Monday, July 20, 2015

Randomida, Part 2.



"Yes, we done come a long way like them slim ass cigarettes--
from Virginia--and we don't stop so we just gon' continue."

~ Andre 3000 from Outkast


Good morning, y'all. First this:

I was in clinic the other week with these three women. We were all the physicians leading the sessions that day in the Primary Care, Liver, and Women's Clinics. As a matter of fact, the four of us were the only attending physicians on the schedule that day.

Yes.

If it is lost on you, let me make it more transparent. These four women couldn't have received privileges at Grady 50 years ago. Moreover, 1972 marks the year that any woman who looks like these four even graduated from the medical school that employs them as physician leaders.

Man. If I wasn't a doctor who isn't a big fan of cigarettes, I would've lit a Virginia Slim up in that sucker and shook the ashes into the hand of anyone who doubted us.



(If you're too young to get the Virginia Slims reference, then you need to Google image it.)

Ha.

What else?



Yesterday morning I scooted in early to round before church. I have this patient that I'm super worried about and I've been seeing him first in the mornings and last before I go.

"You worried about me, ain't you?" he asked.

"Is it that obvious?"

"Kinda." He chuckled. "It feel good to have somebody feeling pressed about you."

I smiled when he said that. Pressed. Press-ure suggests some oppressive obligation to care. But pressed? That was decidedly less so. "You know? I am pressed. I want you to get better."

"Me, too."

After that, I just sat there and held his hand for a little bit. I asked him what I could do for him before I left and that was his request. So I obliged him.

It made me feel less worried, holding his hand. But I'm still pressed.

Yeah.

Oh yes. This:

I was in L.A. last week visiting my family and caught up with an old friend.

Now.


Here's the thing---we used to be very, very, very close. And life and states sort of happened and we lost touch. Then one day I ran into someone who gave me this idea that my old friend had changed and that she wouldn't be interested in reconnecting with any people from way back when. I'm not sure why, but I allowed myself to believe that.



Nothing could have been more inaccurate. I found her a few months back on social media. And a few days ago I saw her for the first time in probably about 17 years or so.



You know what? It was as if not a single day had passed. We were completely lock step and she was exactly the same person.  Well, not exactly the same since it had been 17 years but actually, like a lot of us, even better. She was just as funny and cool and silly and great. We laughed out loud and never missed a beat.

Nope.

Jocelyn P. used to be my roommate during my first year of medical school. She was in Jack and Jill with me as a kid and was one of my very best friends growing up. I am not so much ashamed of us drifting but I am ashamed that I let someone hold me from trying to reach out based on a random report from someone I never talk to.



I learned something that day. Just another reminder to go with my gut, you know? I have a lot of friends like Jocelyn. Not who so much got away but who I don't always see but whom fall right into our old natural whenever we do.

It was just awesome, man. I'm so happy that we're back in stride again.

Yeah.

Did I tell y'all that this sweet girl is getting married? I was in L.A. for her wedding shower. It was exquisitely sweet, too. And doesn't she look beautiful and happy? And don't you just want to reach out and touch that fro of hers?

Ha.


More on that soon. Nauseatingly more, actually.

Ha.

Three random snapshots from Los Angeles. Why? Why not?





The first is from a perfect weather day that had me feeling oh-so-Cali-girl. The last one is from a hellacious hike JoLai and I did at Scenic Overlook mountain in Baldwin Hills. How insane is that view of the city?

And duh. Obvi I had to get the $20 "busy toe" pedicure. The lady asked what I wanted and I told her, "The most obnoxious thing you can come up with." She looked puzzled at first but seems to have gotten the idea.

Ha.

I'm so in love with my husband. Good Lord that man is just meant for me. I spend half of my days swooning and the other half terrified because of the vulnerability I feel in loving him so much.

Maybe not 50/50. More like 80/20. That's more accurate.

Hey. We went to the drive in movie theater recently with the kids. It was so freaking awesome. Does anyone else still do this? Our kids loved it. And it was like $20 bucks for all of us.

Same price as the "busy toe."

Mmmmm hmmmm. What else?


Just a random photo with me and Iris W. She's one of my favorite residents. I adore her. She got asked to be a chief resident shortly after this photo was taken. Which is super awesome.


Ha. I read this thing about how taking selfies is really some sign of pathology and severe insecurity. I should have felt insecure after reading that but instead was just sort of weirdly intrigued.


I do think I love to capture how I'm feeling in a moment. Which means I take selfies.  This one above is one of my all time favorites. I had just been teaching my team and spending time with patients and nurses. I was feeling like I was in the zone and was just so, so glad to be where I was in the moment. So that expression is just that. 

In fact, I was hearing this song on my mental iPod that says: "I'm in my zone, I'm feeling it. . . ."


I sent this to my resident a few weeks ago. Why? Why not.

Ha.

Do selfies mean pathology? Well. I think everybody is pathologic, me included. I'm not so sure what pathology this represents in me but--as Ms. Moon says---ah lah.

I don't have a selfie stick though.

Yet.

Ha.

And lastly, this.




That's all I got.

Oh, and this.



Ha.

***
Happy Monday.