Wednesday, February 3, 2016

More than a notion.

"She needs a nursing home," someone said.

It was all matter of fact; the way such things are always mentioned on rounds with those frail elders who've slipped into the cognitive abyss. And I didn't know all the details. I mean, not enough to go arguing and pushing back on a plan that had been rolling forward for this hospitalized patient for the last week. So I responded  with a simple word. "Why?"

"Dementia," I heard them say in response. "Like, she's delirious one minute and then sort of inappropriate the next. It's weird. And honestly, it's mild but the problem is that she lives alone and doesn't really have anyone to help."

"Why is she delirious?"

"Part of it is adherence to what she needs for her health. The other part, we think, is some underlying dementia. She does have someone to make decisions for her, though. Even though they can't really take care of her like we'd like."

"No one around to see about her?"

"Well. No family that can give her what she needs. So we're pursuing nursing home placement but it's drama since she's majorly pushing back on it."

"Dang. So she's aware enough to let you know she's not feeling that plan, huh?"

"Yeah. We just want to safely discharge her, Dr. M. So her durable power of attorney will have to sign her in against what will she has remaining."


Now that? That punched me in the gut and made me gasp a bit. "What will she has remaining" felt like we were playground bullies. Something about that grabbed me hard and said, "Pay attention. Go and talk to her. Think."


Oh, and let me be clear: The team that was caring for this patient before was thoughtful and empathic.  I know I had the luxury of being the Monday morning quarterback. The delirium portion was mostly resolved so I was looking at her through fresh lenses. Fresh enough to feel unsure about sending her to a nursing home.


And so. When we went in there, I listened to her speaking. This woman was older than my mother and stated proudly that she was a "Grady baby"--meaning she'd been born in this very hospital. That always resonates differently with me when I hear it from my Grady elders. In a city of transplants, the true-blue natives enamor me. She was true-blue.

Yes indeed.

And so. Admittedly, there isn't some really elaborate story that follows. I'd imagine the preamble of it all serves as a bit of a spoiler alert that she was, indeed, as sharp as the proverbial tack. And while I can't say that there weren't a few wrinkles in the fabric of her cognition, I can say that none of it was substantial enough to rip her away from the place she'd called home for the last fifty years.


And that? That's the thing. That is the piece I put my kickstand on when thinking of her, discussing her and laying out plans with my team. This notion of uprooting people with very, very deep roots and recognizing that it's a big fucking deal.

Pardon the f-bomb.

In 2006, Harry and I had a young toddler, Isaiah, and were expecting our second child, Zachary. Harry, who has a background in real estate investment, had found this amazing home in a wonderful in-town Atlanta neighborhood--literally walking distance from my employer, Emory University. The schools in the area had great reputations and the entire environment was everything we'd dreamed of having. It certainly had some "fixer upper" necessities, but that didn't deter my husband at all. And his faith in the potential this house had was enough to get me on board.


The home we were in at the time was lovely, for sure. That said, it was significantly further from all that we do both professionally and personally. Getting closer in would be game changing for our family. And no, we didn't need more space or anything. But this? This house was uniquely special. An opportunity just presented itself and, even better, involved my better half utilizing the skills that he'd been fine tuning for the last several years--negotiation and renovation. We didn't look back.

No one knows what the future holds--economically or otherwise. But barring any major changes, we came into that home--now our current home--believing that, God willing, we'd grow old there. I imagine myself slowing down and easing out to that same mailbox someday. Asking Harry if he fed the dog or picked up eggs or even if he wants a cup of herbal tea. And us sitting in our sunroom where the kids watch television now, shaking the hand of some young woman that one of our boys desires to marry. Then later, holding the hand of the grandchild or grandchildren that come from that union, walking through this very neighborhood to do the things that I'd been doing since I was a pregnant thirty-something.


So after that, I picture my mind getting foggy. Not full on foggy, but foggy enough to cause some people to do a double take. Still okay enough to take a shower and make some grits and sweep the porch and feed the dog. Fine enough to wave at the mailman and grab the bills and even get on line and pay them one mouse click at a time. But maybe just off some. Not able to remember which Bush or which Clinton is president or even how to stay on track with every day conversation. Then, I pray, that there is someone who is ready to step in and see about me, you know? To be a go between in the gap of what I can still do but the fog of what I can't.


If, for some reason, that person or those people aren't readily presenting themselves, I think about someone having me in a cold, sterile hospital bed that some 911 call sent me over to on a whim because I'd fallen and couldn't get up. And then I think that, kind of like when people were put on ships and taken to the western world against their will, it must be awful to suddenly be told that you are never, ever going back to live at what has become the only home you really, truly know. Especially if my wits were still about me enough to feel that loss.

So yeah. I think of that and hope like hell that my doctor or doctors or nurse or nurses or social worker or social workers come busting in that room with their hands all splayed out screaming to every one to WAIT, WAIT, WAIT and THINK, THINK, THINK before just signing that form to send me off and away from the home I spent my whole life building. I want them to look hard, go find someone--anyone or some kind of resource to help me. Or at least try, man. At least fucking try.

Because thirty years from now, if you take me up out of my house without warning, I won't want to go either. And I swear on my sister's life that I will fight you tooth and nail with what will I have remaining. Yes. What will I have remaining. Damn right I will.

My patient said she wanted to go home. Her insight wasn't poor and, as it turns out, there are some people around who could see about her. She was a bit forgetful and tangential but she still knew that Cam Newton was going to the Super Bowl and that he was a hometown hero, straight out of southwest Atlanta where she'd lived her entire life. And she wanted to be home to watch that game on her own damn couch where she could clap her leathery hands and drink a light beer.

And you know what? If I have any say in the matter--and I do--that's exactly what she's going to do.

Hell yeah.

Happy Hump Day.

*details were changed to protect anonymity.

Saturday, January 30, 2016

The Secret o' Life.

The secret of life is enjoying the passage of time.
Any fool can do it, there ain't nothing to it.
Nobody knows how we got to the top of the hill.
But since we're on our way down, we might as well enjoy the ride.

~ James Taylor


"What's the key to making eighty-nine and still looking as good as you?" I asked.  The resident working with me smiled knowingly since this is one of the most predictable questions they hear me ask of the spryest of our Grady elders.

I never miss the chance to unlock whatever secrets my patients might have for longevity in life and marriage. So I always ask. And every time, I get an answer that makes me smile. Some short and sweet. Others long and elaborate. But somewhere nestled in every response is something for me to stick on a post-it note inside of my head for safekeeping.

And so. At the end of our visit, I asked that same question in that same way I generally do when addressing my Grady elders. I use their lingo, too. After hearing it enough times, I decided that I liked the idea of "making" some golden age. "Making" eighty-nine sounds like climbing the rough side of a ragged mountain--and now reaching those elevations that few have achieved. And interestingly, years don't seem to be referenced as being "made" until you get over a certain hump in the birthday game.


"You know I'm gon' make ninety in one month!" she announced with a proud slap of her knee.

I clapped my hands and nodded. "I saw that on your chart, Mrs. Calhoun! That's so great!"

"Sho' is." And from the look on her face, I could tell she meant it.

"So no secrets? You know I'm trying to find out how to make ninety and have it look like it looks on you, Mrs. Calhoun."

"Oh, baby it's simple. First, you gots to get on up in the mornings. Get on out the bed and move your body. I ain't saying you got to go crazy or nothin'. Jest get on out your door and walk some place. Work in your garden. Walk on over to see about a neighbor or to the store. But you can't jest stay holed up in the house watching the television."

"I like that advice."

"Mmmm hmmm. See, folk get up in age and stop moving they body. And now, I understand that ol' Arthur set in on some folk bones and they can't move. But even with my arthritis, I makes myself get on up and move. Every day."

"That's good stuff, Mrs. C. What else? You know we're taking notes." I winked at her and pretended to position my pen to write down her next words.

"Well, now another one is minding your own business, you know?"

I laughed when she said that. "My husband tells me I need work in this area, but yes, ma'am. I hear you."

"See, when you gets up in age, folk get to thinking they got the green light to weigh in on whatever they see fit. Like telling young folk what all they s'posed to be doing and how they s'posed to do it. Saying stuff about how folk run they house and who they decide to be with. And see, me, I figured out that staying worried 'bout stuff that ain't your business 'specially when it come to your kin as they start coming of age make you old. So, I jest mind my own business, you know? Even when folk used to try to get me to chime on in on something, if it ain't my business I jest shrug my shoulders and say, 'Ain't my business.'" Mrs. Calhoun shrugged for emphasis.

My resident nodded slowly and looked over at me. "That's great advice, actually."

"I never thought about the part about growing older and giving your opinion on something. That's a really good word."

"It's true, Miss Manning. Look like people excuse they elders for saying crazy stuff that ain't none of they business. So I think that make people judge folk and get to talking about a whole bunch of stuff that jest make everybody uncomfortable, you know? And I still got my thoughts on stuff but if it don't affect me and mine, I don't really fret about it. Saying a whole bunch on people's lives lead to arguments and hurt feelings and all that. Plus it make people not want to be around you. All that make you old."

"I really should have been writing this all down, ma'am." I squinted an eye and went on. "I can tell you mean what you're saying, too."

"I sho' do."

"Okay. So move my body and mind my business. Got it. Anything else we need to do?"

It's funny. Mrs. Calhoun was genuinely entertaining my questions about living to be an octogenarian. Though most of my patients answered me, few were so thoughtful in their replies. Her lip jutted out and she rolled her eyes skyward as if sifting carefully through her words. Finally, she lifted a long crooked index finger and looked straight into my eyes. "One more," she said in her gravelly voice.

I scooted my chair forward and leaned in. She didn't speak immediately. Instead, she held my gaze with narrowed eyes for a few beats, curled in that finger and brought it to her lips. I stayed silent, waiting for what I knew would be worth the time.

Her finger extended again to point at me and then the resident physician beside me. "This probably the most important thang. You got to see about yourself. I mean look out for your own happiness and don't let nobody treat you bad, you know? Like, when you a kid or a even a young person, it ain't always easy. But once you grown, you got to love yourself enough to not let nobody get away with being ugly to you. And that include you-yourself, too."

"Okay. . . " I lulled her to go on, leaning even closer.

"Put on some clothes every day. Brush your hair and care 'bout how you look. That's all a part of seeing about yourself."

"Got it."

She paused for a second and then patted her hand on the desk. "Oh! And I almost forgot. Make sure you got you a good stick a red lipstick in your  bathroom drawer. And that you wear it sometime."

"Red lipstick?" My resident glanced over at me raised her eyebrows. We both returned our attention to Mrs. Calhoun, intrigued with this unexpected statement.

"Yes, sugar. A good one, too. One that make you feel like a woman. Not no gloss or tint neither. I'm talking 'bout a R-E-D red that can't nobody mistake. You keep it there for when you need to feel strong and good. Or sometime jest for no reason at all. Paint it right on your mouth and look yourself in the face."

Damn. I was taking this all in in giant gulps. I wanted her to go on  and, lucky for us, she did.

"See, putting on some red lipstick--that's saying something to yourself. You telling yourself you worth noticing. But then you got to walk in that. Wit' your head all the way up like you know something they don't."

Whew. This woman was preaching, do you hear me?

My resident feigned a frown and groaned. "But Mrs. C, what if you look terrible in red lipstick? I can't even imagine myself with red lipstick." She laughed when she said that but Mrs. Calhoun didn't.

"Every woman can look good in red lipstick once she find the one that suit her. But the key is jest that she just got to make up her mind that she deserve the attention it brang, see. It ain't never the color. It's that part that hold women back from it."

And that? That I knew I wouldn't want to forget. Like, ever.

No, I would not.

A little later, I saw Mrs. Calhoun in the hallway, cane in one hand and discharge papers in the other. I stood there watching her and reflecting on her words as she took those short deliberate steps toward the exit. At the last minute, I decided to sprint up to her to hold the door--but mostly to tell her goodbye.

"It was so good talking to you, Mrs. Calhoun. Thanks, hear?"

'Oh, Miss Manning, you know I love talking to you young people." I beamed at her reference of forty-five year-old me as a "young person." She nodded in acknowledgement of me propping open the door for her and headed into the lobby.

Just as she was right in front of me, I spoke.  "Mrs. Calhoun? I'm just wondering. . . do you still have a red lipstick?"

She turned to look me in the eye and smiled wide. "Sho' do, baby."

"I love it. Think you'll wear it next month when you make ninety?"

"Maybe. But it ain't got to be no special occasion, do it?" Mrs. Calhoun reached out and patted my shoulder when she said that. Without saying a word,  I dragged in a deep breath and nodded hard to let her know I received her good word.

Because I did.

Move your body.
Mind your business.
See about yourself.
Oh, and have a good red lipstick. 

Words to live by. Like, literally.


Happy Saturday. Best. Job. Ever.

Now playing on my mental iPod. . . . 

Friday, January 29, 2016

Acutely wonderful.

with Jen and Lucas Grady chief residents 2015-16

It was wonderful and ordinary. Me, sitting on that little couch in their office and them talking to me from their desks. I had a paper in my hand filled with my thoughts on something and I needed their input. And nothing about that was unusual.

Especially this year.

"What do you think about this?" I asked. "Or wait a minute--what about that?"

And, like always, first we looked at each other speaking without talking. Then we all started talking at once yet somehow understanding and hearing what each person has to say. Ideas flying all over the place, crashing into walls, mixing with perspectives and considerations until they meshed into one thing. That's been the nature of this think tank we've developed over the last couple of years. And all of it has been wonderful.

Magical even.

In general, I have a great amount of affection for our Grady chief residents. On most years I befriend them and begin to hammer out ideas with them on things related to our residents and education. They ask for my help on an idea and I ask for theirs. Then, at the end of the year, I feel this slight bit of melancholy at the end of the year, knowing that it's the end of the era. And usually, it's sort of bittersweet but in a way that's mostly okay since that's the way of the medical education world.


But this year is different. The two chief residents at Grady, Jen and Lucas, attended Emory for medical school. I knew them both slightly as students; well enough to be happy when they matched into our program. Then Jen was placed into my Thursday morning resident clinic. I started working with her every single week and got to know her much better. She was also mutual friends with a few of my former small group advisees so the "getting to know you" process was swift and natural. I was immediately impressed by her and wasn't even remotely shocked when she was selected to be a chief resident.


And then there was Lucas. I had these smatterings of encounters with him in the clinic and always found his energy positive and infectious. But that all reached a fever pitch when he was assigned to work with me for his first ever senior resident Grady ward month. It was, in a word, awesome. We were drunk with teaching, high on ideas, and manic from the magnetism that we immediately felt as medical nerds. It was indescribably great.

But just when it seemed like it couldn't all get better, I learn that not only will Jen and Lucas be chief residents--they'd be chief residents at the Grady site together. And this meant that all of this energy would be in the office almost directly across from my own for an entire year.


We hit the ground running. Since we knew we'd be working together during their chief year, we started our collaboration process during their third year of residency. We hammered out ideas and created curricula. Ran our lecture ideas by one another and offered meaningful feedback. And essentially, pushed ourselves into this amazing zone of development that has lasted for over a year.

Great stuff has come from it, too. Seismic shifts, in my opinion, with the learning climate and the level of expectation our learners have from themselves and their teachers. Out of the box interactive sessions that feel more like a really fun gathering than a mandatory lecture. All a manifestation of what can happen when minds intermingle and ignite one another into being able to do their best work.

So yesterday, I was sitting on that little couch running ideas by Jen and Lucas. We skipped from idea to idea like rocks on a pond, influencing each other and laughing and doing the thing that we've been doing for the last two years. And as I looked at Jen, I noticed all of the words written behind her on the dry erase--board, deadlines, ideas, goals--many of which I sat with them to create. Then in the midst of it all, it dawned on me that it is almost February and that June would be here before we know it. And that, like all of the time I've spent with the chiefs, this time is finite.


A wave of sadness washed over me and I quickly coached it away. But right now, I'm feeling it. Feeling it in this weirdly complicated way since the biggest emotion I feel is deep gratitude for this era. But I think that's the hard part, you know? Sometimes you're doing something and you know it's an era. That once it ends it will never be this way again. At least not like this, it won't. And usually that's fine because our lives are enhanced by moving from era to era and the very best ones leave us forever changed for the better--they do. This is no different.

I remember feeling this way around this time during my chief residency. I had this profoundly special mentor named Rick Blinkhorn who was acting as chairman at the time of my chief year. He was smart and innovative and provocative. I loved him in the way you love a cherished mentor because I knew--and I mean it, I was very aware--of how great that era was. I could feel it each day when I met with him and knew I was growing toward something greater because of that time. It was acutely wonderful, that time. It was, and I felt it and knew it.

Yes. That.

Acutely wonderful. I guess that's it. My time working with Jennifer and Lucas in this capacity has been just that. Acutely wonderful. The immediacy of what comes out of our collective thoughts feels magical, not just pleasant. And since I know that it is finite, I feel a little sad about it.

But not so sad I can't enjoy it for what it is and what remains. Plus, I've lived long enough to know how much comes from these times and how much better I am as a result. I'm excited to see that part for us all.


I love that I am a thinker and a feeler. I love that these acutely wonderful eras in my life have been punctuated with chest-grabbing emotion to let me know that this is happening and that I am fortunate.  And let me be clear--much of what I do on my job and in my life are perennially pretty awesome. But somehow, some way these moments, that is, the pieces of my life that are acutely wonderful find a way to stand out. They grab me by the waist and pull me close with an outstretched hand to waltz me all around the room in big sweeping circles. And I feel it. And know it. And savor it. I do.

I'm nearing the end of something acutely wonderful and I know it. But you know what? I wouldn't have it any other way. No, I would not.


Happy Friday.

Thursday, January 28, 2016

All day and all night.

"as always, details changed to protect anonymity

"Where are you from? You aren't from Georgia," I said. His musical accent was a dead give-away.

"Guess," he replied.

"Louisiana. Totally." We both sat there smiling right after I said that. He then gave me a slow thumbs up and nodded.

"All day and all night, baby."

"Couldn't miss it," I added with a chuckle.

"This accent saved me."

"Yeah?" I raised my eyebrows, intrigued by what I'm sure was a piece of his story. I leaned into my palm and rested my elbow on the desk.

"I came here after Katrina. Didn't have a pot to piss in or a window to throw it out of. And I ain't exaggerating neither, baby. I'm talking the clothes on my back and nothing else."

"Family? Did you have any here?"

"Nope. That's where I ain't like most folk from Looziana. My family small, a lot of 'em out in the country and don't have nothing to help. Plus, I was a city cat, you know? I needed a city. So one of them church groups had a bus coming here and I got on it. Ain't had plan the first of what I'd do once I got here."

"Wow. So how did the accent save you?"

"I was in a shelter. For just one night and it was so, so terrible. Bugs, rats, people yelling and screaming and fighting. Had to get up out of there, baby. I had about forty dollars and blew it all on a cheap hotel room that night. Said I'd get me some rest and then go try to make something happen. Didn't have one dime when I checked out of that room. Not even a bottle of water on me."

"Then what happened?"

"Saw this man with a delivery truck outside of McDonald's. Walked right up on him and said, 'Brother, I need some help. I need to work. Give me a chance and I'll load everything off this truck faster than you can say shrimp etouffe."

And, okay. He didn't actually say "shrimp etouffe" but, admit it,  it sounds better for the story.


He goes on to tell me about how the dude at the McDonald's truck said that he wasn't the boss but, like me, heard that sing-song accent and asked him where he was from. And that man said New Orleans and then shared his story. The truck man then took out his cell phone and called up a friend. "My man got this moving company. He could use some good folks to help him." That's what my patient told me the guy at McDonald's told him.

"So the guy hired you?" I asked.

"He had me meet him a few blocks over and said, 'Look, bruh. I'm gon' have you work today and see how it go. If that go okay, we'll go with tomorrow.' And I shook his hand and said, 'Hell yeah, man.' Then I worked my ass off. Moved that shit off that truck in two seconds flat."

"That's awesome."

"It is. Been working with that man ever since. Got me a house and a car and even drive the delivery truck out of state for the company. We doing good, too. Real, real good."

"I love that. Did you ever see the guy from McDonald's again?"

"You know what? Like once or twice. But I told that man that he saved my life. Just 'cause he was interested in the way I talked. Which is crazy because every time I left New Orleans, I used to wish I didn't talk so funny. But now I love my accent. Love it 'cause I know it start up conversations, you know? And conversations lead to relationships. And relationships lead to chances."

I shook my head, then stopped and nodded it hard. "Damn. That's a good word, sir."

"Yeah, it is. It don't take much. What make us feel like outsiders is what open doors to being insiders. Crazy how it all work, ain't it?"

"So crazy. Yet so cool."

So, so very cool. All day and all night, baby.


Happy Thursday.

Wednesday, January 27, 2016

The Girl Code.

with Jada, one of my med school best friends, 2014

Every now and then I get a little crazy
That's not the way it's supposed to be
Sometimes my vision is a little hazy
I can't tell who I should trust 
or just who I let trust me, yeah

~ from TLC "What About Your Friends?"

I was talking to my student advisees today about this recent incident that has been circulating on social media and in the news. A resident physician at a hospital in Florida was caught on film after a few too many drinks verbally and physically assaulting an Uber driver. Let me tell you--it was no bueno.

Unh uh. 

Apparently, the dude who'd called (and paid for) the Uber car took out his smart phone and videorecorded her after she jumped into the car demanding it was for her. When the driver didn't oblige, she launched into a drunken tirade and even leaped into the passenger seat when the driver was trying to get away. She threw his phone in the street and called him, as the patients at Grady say, "everything but a child of God." Ha. The video went viral and the resident has since been placed on some kind of probation until the school decides how bad it all is.


My students wanted to know my thoughts and feelings about all of this. They wondered if I thought this young woman should be expelled from her program or simply given a firm tongue lashing. Just how appalled was I? They wanted to know.

And so. I thought about it. And then I told them.

So here's the thing. Inebriated people do some really stupid things. And unfortunately, she did her stupid thing in 2016 when it's as easy as 1-2-3 to spread it to every continent in less than an hour. Honestly, I'm not so sure that this, though worrisome, is what concerned me the most. I suppose one might gather that a person who acts this ugly once given the EtOH truth serum might be ugly deep down inside. But then, who am I to make that call? Lastly, she was physically abusive. This is probably the thing that will be the most damaging in terms of her future as a resident in that Neurology program. Assaulting someone in the street and having it captured on film is not, to again quote my patients, "a good look."


But surprisingly, none of the aforementioned things are what niggles at me the most when it comes to this. Instead, I'm most bothered by the fact that this drunken young female physician was allowed to make a fool of herself (and her family and her medical school and her hospital) for nearly five full minutes. And nobody did anything to stop her.

Let me clarify what I'm saying.

I cannot imagine that this young woman went somewhere and got this drunk alone. There's no way. Surely she was out with friends or, at least, acquaintances and had a few too many. And whomever those people were, had to see her leave. They waved goodbye and bid her a drunk-ass adieu. As drunk as she was, she certainly didn't stroll right out. Without question, this woman staggered and bumped into probably four or five people and tables before making her way to the door. And even if all of her people had left her earlier, surely there was somebody, anybody in that bar or club or whatever that noticed how drunk she was. Even a stranger should have been bothered by the sight if you ask me.


But then, as she stood out there yelling and embarrassing herself, I wondered who else was there? Where were her girls? Or better yet, where were any women? All women know that there is a girl code that states that we aren't supposed to let slips hang from dresses, panties show in low slung pants, menstrual accidents go unnoticed, and hair to get splashed with vomit. And, sure, most of the girl code gets called into action when one is on the younger end but even still. The girl code is the girl code.

Several years ago, I was in New Orleans with friends walking down Bourbon Street. I was big and pregnant with Isaiah and had just enjoyed a delicious meal. We all heard this commotion and saw a crowd of about 15 people standing around something. We assumed someone was playing an instrument or dancing, considering this was New Orleans. But it wasn't that.


What it was instead was a very, very drunk young woman on her knees doing the unthinkable to a slightly less drunk college-aged kid right then, right there in on that sidewalk. While a crowd hooped, hollered and snapped photos. It was horrible.

There were other girls there. They appeared to even know her and were acting incredulous with their hands to their mouths saying things like "OMG" and "Holy shit!" But they weren't doing anything. Like, at all.

Without batting a lash, my thirty-something year-old girlfriends all began screaming at her to stop it. We grabbed her under the arm and broke the whole thing up. And just like that, the cameras went away. I remember yelling out repeatedly, "What would your mother say? What would your father say? Get up!"

Well, actually I don't remember saying that. I just know my friends always tease me about that being my choice of words. But my point is that the girl code kicked in for all of us even though we didn't know her. We knew that no girl should let another girl be in that predicament and just stand by. So we didn't.

So, I guess my thought on the girl with the Uber goes to this. What the hell happened to the girl code? How on earth did this woman manage to do all of this out on South Beach or even leave any place alone and that drunk in the first place?

And sure. She should be responsible for her actions, yes. I mean, the child was thirty years old and a physician. But I just hate the thought of there being no girl code--or even guy code--anymore. I know for sure that, at some point in my life, I've been redirected or saved by it.

Maybe not to this degree, but surely at some point.

I ended that discussion by telling my students what I always tell them:

"Look. Don't embarrass me."

But this time I added something else:

"And also don't let anybody else here embarrass me or themselves on your watch. You got that?"

You know what? I think they did.

with Jada at our Med school banquet, 1996

I don't know what's going to happen with that young woman. I don't. But what I do know is that somebody, somewhere probably should have intervened--even if it wasn't any of their business. Because enacting the girl code rarely is about minding our own business. In fact, most times, it calls for the exact opposite.


Happy Hump Day

Now playing on my mental iPod. . . .a song about the Girl Code.

Sunday, January 24, 2016

Image of the Day, January 24: The Bail.

This photo was taken just moments after my running partners and I decided to bail on the 15K that we were scheduled to run this morning.  The forecast was schedule to be below freezing with a windchill that would make it feel like it was 15 degrees.


With this first text exchange, you could tell that I was still ready to do it for the story. Bailing hadn't occurred to me yet. But Jen's notion of us doing these races for fun was a good point. Having my fingers turn purple from my Raynaud's and wanting to cry for 9 miles wasn't exactly my idea of a fun morning. 

But, again. I ain't no punk so was willing. 

Then I went outside to walk the dog and thought I was going to die. I came in and that's when I received this text from Frieda, my other running mate. 

The part where we decided to bail got cut off.  I think my "never o'clock" got her thinking.


Just know that the red wine I could then enjoy while staying up late watching the first three episodes of Downton Abbey back to back to back was delicious. But not more delicious than the sleep I got in my warm cozy bed this morning.

I thought I'd look on social media later and feel super guilty. . . . .


Happy Sunday. #neveroclock #nonethirty #halfpastnaaaaw

Saturday, January 23, 2016

Image of the Day, January 23: Say cheese.

That moment when you ask your sons to take a photo of you and your friends who've come over to visit . . . . and then go back to look at the images and find this instead.

Yes, he took two blurry images of us. Yet somehow all 732 selfies of them came out perfectly clear.



Image of the day, January 22: The Genetics of the Dog Gene and Relationships.

When Isaiah kept begging us to get him a dog, I'd shake my head and say, "Dude. Dogs are major work."

"I know! I'll work!" he'd cry.

To which I'd reply, "Someday. But just remember: Being a dog owner ain't for no punks."

And so, as you already know, someday finally arrived. And in true Manning mama form, I promptly reminded him of that mantra the very first time Willow had an accident or needed to go out at a less than opportune time.

"Being a dog owner ain't for no punks."

I snapped this photo of him as I watched him from the door on an early wintry morning. He was groggy while pulling on his hat and boots but never tried to shirk the responsibility. Even with that dusting of snow on the ground and the bite of the wind, he toodled through that icy lawn smiling and giggling with his pup.

I guess he ain't no punk.

Seriously, though, Isaiah's been amazing. And all of this got me thinking about him and his dog gene. The medical education nerd in me finally figured it out. And so. Just in case you've never figured out your position on dogs, know that it isn't you and your lack of or overabundance of empathy. Instead it just might be your dog gene genotype.

Mmmm hmmmm.

Okay, so check it. In medical school and college genetics (and probably high school genetics, too) they teach you all about how people inherit things. When two animals or organisms or whatever mate, their genes get mixed all up in a mixing bowl. Turns out there's a method to the madness of how it all swirls out depending upon the genotypes of the parents.

You with me? Cool.

So. . .okay. Each gene is represented by two copies of an alphabet character. The letters represent how the gene gets expressed, or rather, how it looks in the offspring. A capital letter trumps the lower case letters in all cases. For example: Let's say the dog gene is represented by D. That means that a person could either be DD, Dd, or dd. Two of the same case of letter is called "homozygous." One big and one little letter is called "heterozygous."

Got that?

Okay, cool. So if you have two big D's or one big D and one little d, the outward expression of it is pretty much the same. That or you have a much more watered down version of whatever said feature may be. They call the capital letter "dominant" which means it dominates what happens in the end. The lower case characters are referred to as "recessive" and always get trumped by the big letters. Therefore, to demonstrate certain features in the offspring coded on a recessive gene, one must have TWO copies of the lower case letter.

See? You're halfway through the first semester of medical school already. So, yeah. That's basically it. Every feature of who we are is coded onto a gene that's in our chromosomes. And I firmly maintain that the dog gene is one of them.

Mmmmm hmmmm.

Since about 37% of American households have dogs, I'd go on the record as saying that the dog-loving gene is probably a recessive gene. And since you're damn near geneticists after my convoluted explanation, you should be full on ready for some genetic fun.

Okay so let's break these dog three genotypes down, shall we? Don't mind if I do.

Minority of folks: DD, that is, the "No, ma'am, no sir! Don't bring no canines 'round me!" gene. Please note that it can also be the "Scream bloody murder and have a panic attack if I see a dog within a 1 mile radius" gene.

Most folks: Dd, that is, the "Meh. I don't mind a dog. Or your dog. And would be fine to live my life without one. But could probably manage if I married a dd person who agrees to get their ass up on a regular basis" gene. This can also have variable expression and could lean toward the dog-loving gene side depending upon the type of dog and proximity to a dd person.

Minority of folks: dd, that is, the "if I don't have a dog in my home at some point, my life will NOT be complete nor will my home" gene. When there is what the geneticists call "complete penetration" these people become veterinarians, multiple dog owners, trainers, vet techs, rescue volunteers and breeders. The rest of them just go berserk when they see a dog or look at you like you're crazy if you wrinkle your nose up at the thought of a dog inside of a house.

You still with me? Cool. 

Okay, so I'm thinking Harry and I are both Dd heterozygous people. Do we mind dogs? No. But could we have taken it on in to the golden years without one? Probably.


We chose to mate. And that's where the genetic exercise comes in. Okay, so this thing is called a punnet square. (And yeah, sorry it has M's on it but that was all I could find on Google images and was already too far into my D explanation to go back and change it.)


So check this out. Top of the box? The BHE. Left side? Yours truly. The punnet square shows what happened when Harry mated Kimberly. As you can see, this combo gives you a 50% chance of being Dd which is what we think Zachary probably is. But it also gives you a 1 in 4 chance of being in the anti-dog camp or a full-on dog-loving genotyped individual.

And this? This, my friends, is the medical nerd's highly complicated and totally unnecessary interpretation of how two "meh" dog people ended up with a full on dog loving child.


This really is never an issue for a lot of folks. Especially if they are Dd and they have a bunch of Dd kids. It's only an issue when a Dd is required to live in the same house as a dd person.

Especially with a couple, man. (As for the DD/dd household? An urgent genetics consult is probably warranted.)

Okay, so back to the Dd/dd household. This is what it looks like when they mate. Praise the heavens this completely eliminates the chances of having a DD offspring.

Mmm hmmm.

But what if it isn't a mating issue and is simply a "live in harmony" issue? Well, my friends, this is what you have this random post for.

Okay, so check it. My dd friend is married to someone who is mostly likely a Dd person. She is stalking him on a daily basis to get him to break down and get a pooch. I am willing to even bet 100 dog treats that she will make said significant other read this.


And since I know she isn't alone in this plight, I offer you ten suggestions to those who are Dd and married or living with the dd people.
  1. Accept your fate. You are getting a dog. 
  2. Unless you resign yourself to the advice in #1, this won't be an issue because the dd person will worry you to death and you'll be dead.
  3. Consider getting them to get on your terms. For me, it was the breed and the timing. I asked for  six months mental preparation and a non-shedding breed. It helped me. 
  4. During the above "gestational period" read books, talk to people and fret. Then when you get the dog, it isn't as bad as you though.
  5. Get all sorts of cleaning things so your house remains non-dog smelling. 
  6. Or until you get desensitized and just think your house is non-dog smelling. 
  7. Stop thinking that a dog will cramp your style. You find out quickly that you are far lamer than you realize and you actually don't go anywhere as often as you think.
  8. Put up your chocolate. Not get rid of it. Just put it up.
  9. Get that dog something to chew on so he/she doesn't gnaw on your favorite Prada loafer, peep toe pump or worn-in Birkenstocks. Such occurrences, I'm told, are poor prognostic indicators for dogs in the homes of non-dd people.
  10. Come up with all sorts of snappy comebacks for the shit people will talk when they discover that you not only tolerate but have actually grown to LOVE the dog. These will come in handy.

You can thank me in Petco gift cards which, I forgot to mention, you will need. That is, a dog line item in your budget. 

Oh. And for those DD people out there who have just realized that they've fallen in love with a dd person? Well. I guess I'd say that this will be equally as difficult as the polar opposite religion thing. The stronger the feeling in either direction, the harder it will be for you. 

Damn! I'm breaking this down, y'all. Woooooo weeeee! 

Yeah man. So the dog gene is probably something that should be discussed before entering the covenant of marriage. Or when preparing to have babies. 


Oh! And before I forget--please know that there are a few other random genotype situations that should also be explored prior to marriage. Consider this knowledge bonus material cracked from the vault of hidden genetic mysteries. 

  • The motorcycle gene
  • The live-near-yo-mama gene
  • The firearms-in-my-house gene
  • The big city gene
  • The out in the country gene
  • The travel gene 
  • The won't-fly-on-the-same-plane gene
  • The scared-of-cruises gene
  • The football gene
  • The great outdoors gene
  • The go-to-concerts gene
  • The go-to-church gene
  • The people-stay-with-us gene
  • The go-to-bed-with-dishes-in-the-sink gene
  • The name-brand-groceries gene
  • The talk-on-the-phone gene
  • The only-likes-long-hair gene
  • The only-likes-short-hair gene
  • The never-let-the-seat-down gene
  • The too-cheap-to-dine-out gene
  • The hates-leftovers gene
  • The won't-watch-TV-with-you gene
  • The anti-social media gene

I know the married (and divorced) folks are nodding their heads and wishing they'd read this sooner. To which I say, my bad. But just think--imagine the happy homes you'll help now that I've shared the this with you! Ha. 

Man. I do believe if geneticists got involved in more relationships, so many homes would be happier. I'm just saying, man.

Damn. I meant for this to be all beautiful and deep since that picture of Isaiah above is so hauntingly peaceful. But, oh well. At minimum, I hope it gets my friend one step closer to getting a dog into her home. 

Can't you tell it's quasi snowing here and too cold to do anything? 


Happy Quasi-snow day. I wrote this on Saturday but let's count it as the one for Friday, okay?

Thursday, January 21, 2016

Image of the Day, January 21: Is that all you got?

I told my team that you have to roll up on disease like the mean girl who can fight in the middle school. Full on mean mug, gangsta stance and balled up fists.

This was the result.

#keepitfun #bestjobever

Happy Thursday.

Wednesday, January 20, 2016

Image of the Day, January 20: Q&A

We have an amazing culture of teaching at Emory. The best part, though, is that not only do the faculty get really into it, we also pour an incredible amount of time and energy into building the most junior of our learners into teachers, too.

This photo was snapped during our resident conference yesterday. This particular session is a unique monthly lecture series where resident physicians are coached by faculty members to deliver  high level, evidence-based lectures--but here's the kicker: They can only be 8 minutes long. We started doing this last year and it was an immediate hit. I think part of it has to do with young people just enjoying the inspiration of being taught by their peers. But also there's something to be said about somebody only talking for 8 minutes and that's it.

Of course, I had to come up with a witty title for the conference. We call it "BST Mode" (pronounced BEAST MODE)--short for "Bite-sized Teaching." My diabolical plot--of which BST Mode is a part--is to get us to a point where nobody ever lectures to anyone for more than 20 minutes. Okay, thirty minutes tops.

*insert wicked laughter*

The four residents were answering questions from the audience when I took this snap. It got me thinking about how critical of a skill the question and answer period is after a lecture. I've found that it can really make or break someone's merit at the end of a great talk. This fab four did great with theirs. That said, the nerdy teacher in me sees this as a great opportunity for some future focused teaching-learning-growing exercises. I like to think of it as "The Art of I Don't Know--But Here's What I Do Know."


I love my job. And this is one of the main reasons that, even if I had won the Powerball, I'd be right here at Grady. (That is, after being dropped off by my personal Uber driver.)


Happy Humpday.