Tuesday, November 13, 2018

Yes, yes, y'all.




A life was saved. Yours. And I was there and involved and there to bear witness to it all.

Yes, I was.

No, it wasn't in that sexy or thrilling way. You know, like the kind where someone tears into the room and dives upon your chest for compressions in a single bound. It was nothing like the ones they recreate for melodramatic television dramas with people running beside fast-rolling gurneys steadying wayward IV poles and charging up defibrillator paddles at the same time.

Nope.

But still. A life was saved. Yours. And I know it was because I was there and have been doing this for a while now.

Sometimes we miss it. Those moments like this one. The ones where just one tiny shift in the path does something game-changing. A teeny, tiny nudge toward a seemingly insignificant fork in the road that moves the patient inches away from a giant cliff. Or maybe not a cliff because those are big and obviously treacherous. This was different. More like a slow, downhill trainwreck.

Yes, that.

See, a student listened to you and then shared your story on rounds. Described what you said in detail and all that had been done. And the way he honored your truth helped me to make sense of your perspective but simultaneously recognize that some aspects of our direction didn't make sense at all. And so, I asked one question. Which led to another question. That became a discussion with the whole team.

"Why is this?" I asked. "This doesn't make sense to me. Does it make sense to y'all?" This is what I asked my team. And yes, I said "y'all" because I think easy and calm learning and working climates help us think easier and take better care of patients like you. Or not even just like you. Like any patient who comes before us. I do.

So that student wrinkled his nose and thought about it. And so did my resident and my interns, too. And, though I could not see myself, I am certain that I did the same. Because it didn't make sense. The path we were on and that you'd been on for months and months did not.

Nope.

We came up with a plan. To bring in a consultant to look at some aspects of your case. The parts that weren't readily explainable by the standard pathophysiology of your working diagnosis. And that--that call? It was a game-changer. It was.

And, I think, it saved your life.

No, not in the fireworks and confetti way. Not like that old TV show "ER" or even the newer ones like "Grey's Anatomy." More like with the subtlety of shaking a tiny shard of glass out of a shoe that could ultimately lead to something bad or even adding a drop of much-needed oil to a bike chain and popping it back into place before the entire thing is irreparably destroyed.

Yeah. Like that.

And I thought about it the whole way home. I thought of you and the story you told and the student who listened and the socioeconomic challenges that you face. I reflected on the barriers all around your care that day and how God let this tiny ray of light slip in. And how all of it working together saved your life. I thought about that for my whole drive. Then the next day, I talked to my student about it and cried right in front of him.

I sure did.

"We don't always get it right," I said in our team room later, "but on some days, we do." And I wanted them to not miss what our team had done. They didn't.

A life was saved this week. Yours. And I was there and involved and there to bear witness to it all. A life just as worth saving as my own. Or any person involved in your care. I am so proud of the care our team gave to you and the privilege we had to be involved. Damn, I am. And no, we don't always get it right. But this time we did.

Yes, yes y'all.

***
Happy Tuesday.

Thursday, November 1, 2018

Stigma.



I tell myself: Speak in tones that aren't patronizing and sorrowful or as if you're irrevocably broken. Then coach yourself away from the fear of not being able to help.

Like really help.

I think what gives me the most angst is the math of it all. The numerator of too much always, always, always divided by that denominator of not enough.

Remainder: Too much.

It looks like a lattice. This network of scarred remnants of self-mutilation covering your limbs. I heard this lady say on television once: "Why would someone take a knife and cut themselves on purpose? Why would someone do that?"

The girl she was talking to on like Dr. Phil or whatever it was countered sharply: "You sound stupid. It is never about the cutting." Then she rolled her eyes hard in this way that made that point stick for me. Focusing simply on the concrete act is asinine. Because it is never just that.

"I think we can discharge you from the hospital," I said. "How does that sound?"

You nod and shrug. "That's fine." And that's it. Your eyes float over my head and somewhere else. Where I do not know.

"Are you still hearing voices?" I ask. You shake your head no. "Good," I say. Though I feel everything but.

The medical part has resolved. The psychiatry team has given their recommendations for the mental health parts. Our team has kept you firmly on the balance beam through this hospitalization even after a few topples. Now is the time to prepare you for the dismount. But that's the problem--the dismount. This life that awaits you just won't let you stick the landing.

Nope.

The math is bad. Too much divided by not enough. Too much is left over every time.

You are sitting on the edge of the bed. Yawning and rummaging through the sheets for a cell phone or a wallet or some other personal item. Shoulders slumped and resigned to whatever is next. I stifle an inward sigh. Whatever is next? It's just too much. Still divided by not enough.

But too much what? Divided by not enough what? Too much awful divided by not enough better? Too much need divided by not enough resources?

Or am I a part of the problem? Too much learned helplessness divided by not enough optimism? Too much ignorance divided by not enough courage? Too much darkness divided by not enough light?

I tell myself: Speak in tones that aren't patronizing and sorrowful or as if you're irrevocably broken. Then coach yourself away from the fear of not being able to help. Like really help.

Then help. Like really help.

Or at least make up your mind to try.

Yeah.

***
Wards, Day 1.

Wednesday, October 3, 2018

Power Autocorrect.





A quick email to a colleague:

"Greetings-- Just wanted to check in to see if you still wanted to. . "

"Was just wondering if you might still be able to. . .."

"Howdy! I was hoping to loop back to you about. . ."

"Sorry about asking so many questions but I was hoping you might be able to tell me. . ."


Good morning -- Revisiting last week's message about our project. Please refer back to the queries below and let me know your thoughts when you get a chance by tomorrow to allow us to move us forward. Thanks in advance. 


Words have power. And strength. Some words stick a pin in your power bubble. And unless we hear them, they hold us back without our even knowing. They do. 

Old habits die hard. But like all habits, they can die.

Yeah.

***
Happy Wednesday.

Wednesday, September 5, 2018

On Nike.



Nike.

This is the same company that created a dri-fit hijab for Muslim women athletes. “Seeing” people is not a new thing for them.



Nope.



For those feeling conflicted about the “Just Do It” campaign? Know this: People REALLY like to matter. And if you and your loved ones get to live your lives every single day as the ones who consistently get to matter in this country by historical default? Or if you’re down with Kap and Nike but are among those who have the luxury of being able to voluntarily remain silent or indifferent on a whim because of your outward appearance? Thank your lucky stars.

For real.




After that, take a moment to wonder what it’s like to breathe an involuntary sigh of relief every single time your black husband or son makes it home after dark. Or to regard the millions of families like ours who have to regularly run through “the police drill” with their middle school sons at the dinner table—because it could literally be life or death someday if you don't.

So you have to start early.




Sigh. 



It’s so much deeper than shoes, man.






Oh—and for the record? I’m the proud wife of a Ranger-qualified United States Army Veteran who approves of this message.

Don’t have a full appreciation for what a U.S. Army Ranger is? I'd suggest you Google it.

Seriously. You should.

That's all.

***
Happy Wednesday.

Sunday, September 2, 2018

Some type of way.



When I saw you on rounds today you were quiet. Your eyes looked in my direction but were otherwise vacant. This was a change.

Me: "You okay?"
You: "I'm okay."

I asked you to sit up in bed and carefully untied the back of your gown. Gently, I searched your back with my stethoscope, listening to see if you were improving.

Me: "Can you take a deep breath?"
You: *deep breath*
Me: "And let it out."
You: *let it out*

We repeating that exchange for a few more beats. The sounds emitted from your lungs confirmed what I'd been told. Things were improving.

I'd attempt to lift the mood.

Me: "You sound so much better!"
You: *head nod and shrug*

No such luck.

You'd been so upbeat the day before. So animated and full of light. Out of breath, yes. But still with eyes that twinkled. And so loquacious that I pulled up a chair to sit down and just let you talk. Today? None of that. Just quiet cooperation and a cloak of melancholy that didn't make sense.

Me: "What's wrong?"
You: "I'm okay."
Me: "Really? You seem sad today. Like you're not okay."
You: *silence*

Another shrug.

I slowed my movements and looked for a chair. Perhaps if you didn't feel like I was too busy to listen, you'd share. Something was wrong. And I didn't like the idea of you holding on to that something all by yourself while laying in a hospital bed. And so. I told you just that.

Me: "I don't like you in here by yourself with something heavy on your soul. If you feel like sharing, I want to hear. If you don't feel up to it, I can respect that."

A tear squeezed out of your eye and rolled under your chin. You sighed.

You: "Somebody came to talk to me about all this. Told me that if I don't do better I'm not gon' be here this time next year."
Me: *listening*
You: "Saying 'You need to lose weight and take your medicines! And stop missing appointments! And why you don't exercise and why you keep eating the wrong stuff and smoking cigarettes? You keep this up and you gon' die!' That's what they said to me."
Me: "Hmm."
You: "They kept on saying it was 'tough love.' Like every few words it was 'tough love' this and 'tough love' that. But to me? It wasn't no love in it."

Another tear slipped over your nose and disappeared into your nostril.

You: "I wanted to say, 'Do you know my life? Do you live where I live? Like, do you even know? I want to be healthy, too!' But all I did was just wait for it to be over. I just said, 'Okay' and acted like it was cool." *shaking your head*
Me: "Man. I'm sorry."
You: "That hurt my feelings, Miss Manning. For real. I know that doctor meant well but I felt some type of way about that."
Me: *silence*
You: "Like, I think when a doctor speak to you they should look you in your eye and see where you at. And if your face say this ain't okay? They need to do something else. Or just stop talking."
Me: "That's good advice for anyone."
You: "Know what? You right."

After that, we talked more about what makes it hard for you to get your medicines and make appointments and eat healthier and move your body and move toward being a non-smoker. You told me about where you live and who you live with and what it's like and how you get the things you need and what makes your nerves bad. Then we talked about a few strategies to help you make steps in the right direction. And the whole time I watched your face to see where you were.

Or if I needed to just stop talking.

The doctor who gave you what was believed to be "tough love" is a good one who, I have to believe, was looking to motivate you not be unkind to you. And I told you that, too. That we are all works in progress with blind spots and ball drops. All of us.

This seemed to resonate with you.

We didn't fix all your problems. But you were smiling when I left. Which, to me, was a start.

Yeah.

***
Happy Sunday.

Saturday, September 1, 2018

Ms. Doctor.



I was walking near the hospital entrance today and saw three young brothers standing out front talking and laughing in the sunshine. One was slender with long locs rolled into an afrocentric hipster man-bun. He was animated and talking with his hands. Another was short and stout with flawless espresso skin and a close cut fade haircut. His mouth was gleaming with gold teeth. The third fellow was leaning on the wall chuckling in response to his comrades. His dancing eyes were a beautiful shade of amber and his nose was dusted with freckles.

They were beautiful. Seriously, they were. They greeted me in deference as I passed by.

Manbun: "Hey Ms. Doctor."
Me: "Hey gentlemen. You guys doing alright?"
All: "Yes, ma'am."
Me: "That's great. Have a good day, gents."
They smiled and all said it again: "Yes, ma'am."

I liked the way they all called me ma'am. Even though hearing it always jolts me out of this frozen-in-time idea in my head that I'm forever thirty years old, something about hearing it said in my direction feels maternal and special. I always return the favor, greeting the young men I see around Grady as "gentlemen"-- no matter who they are. Just like I do my own sons.

Yep.

I could immediately tell they weren't being fresh. Just pleasant and respectful toward a woman that they saw as--dare I say it? An elder.

Gasp. An elder.

Ha.

As I walked by, I admired the vast variations in blackness that each of them represented. All so different yet clearly unified in this cultural thread that weaved them all together.

And me with them.

Manbun reached for the door when I got to it and held it open. Just then I noticed that all three of them had their pants hanging nearly to their mid thighs. At first I was going to ignore it but then I decided to use my elder license instead.

Sure did.

Me: "Now you know I don't like seeing my three handsome little brothers standing out here with their pants falling down. Pull up those britches, gentlemen."

And yes. I said "britches."

You know what happened next? All three of them immediately pulled up their low slung jeans up over their hips. And all of them mumbled apologies and words like "my bad" and such.

Me: "Who y'all here to see?"
Manbun: "Our homeboy."
Me: "Is his mama there, too? Did she have to see what I just saw?"

*laughter*

Me: "If she is there, I know she don't want to see your whole behind hanging out of your jeans."
And yes. I said "whole behind."
Manbun: "Ha ha ha we hear you, Auntie."
Me: "Okay, but for real--what's the deal with your entire butt and drawers hanging out of your pants?"
Them: *looking at each other with amusement*
Me: "I'm serious, y'all!"
Frackle face: "It's just the style, I guess."
Me: *old lady scowl* "A style that make it where you walking like a penguin?" *shaking my head*

*laughter*

Me: "Let me go in here and do my job."
*laughter as I walked through the door*
Manbun: "Hey Ms. Doctor!"

I turned around from the door and looked back. All three of them were standing in a row with their pants pulled all the way up and holding them at the waist. They all had these goofy, exaggerated smiles that reminded me of my own sons. Then we all burst out laughing.

I waved my hand at them and walked away shaking my head and smiling.

I told my team on rounds today: "If you stay with someone long enough, you'll always find a place where you intersect. Always."

No-- I don't like the sight of sagging jeans. At. All. And honestly? I'm not a huge fan of gold fronts either.

But I also don't like that video game Fortnite.
Or the random YouTube gamers I have to hear about nonstop.
Or dinner table discussions about skins and virtual outfits for video games.

Nope.

But what I DO have is a soft spot in my heart for goofy sons with silly smiles. And beautiful brown manchildren with knotty hair and easy slang who hold doors and also poke fun at me and each other. Just like the ones that stood outside of that hospital entrance today.
And just like the ones that came from my own body.

Yeah.

***

Pollyanna.



Her: "Do you think we should do any more testing?"
Me: "I think we should check another round of cardiac enzymes, don't you?"
Her: "I don't know, Dr. M. The timing aligns with the crack use."
Me: "That's true."

*silence*

Me: "Cocaine accelerates coronary heart disease. So, like, even if you use, it adds risk both short term and long term."
Her: "I get it. I guess I'm just trying to think through what we would do next, you know? If the cardiac enzymes are positive. Would we suggest cardiology come do a cardiac catheterization?"
Me: "If they are suggestive of an acute coronary syndrome? Yes."
Her: "Hmmmm. But let's think this through. So then we do the cath and it calls for an intervention. And then the intervention calls for the patient to take anti-platelet medicines that must be taken."
Me: "And that if they don't take them they'd be worse off."
Her: "Exactly. So I am torn. This isn't because I don't want to advocate for the patient. It's actually because I do."

*silence*

Her: "So what do you think?"
Me: "The same thing. Check them."
Her: "Really?"
Me: "Yeah."
Her: "And if the cardiac enzymes are positive?"
Me: "Consult Cardiology."
Her: "For a cath? And intervention?"
Me: "Yeah."
Her: "You wouldn't be scared of doing harm?"
Me: "I'm always scared of doing harm."

*silence*

Me: "Listen. I should tell you. I'm a total Pollyanna. . an eternal optimist--often to fault. So I want you to know that I truly get what you are saying. But I always have this little idea in my head that I can encourage the patient to quit. Like, if your heart depends upon it? And I believe right along with you that this isn't your lot in life and that you can recover? Yeah. I tell myself that this might be the day. The discussion that turned the ship around."

*silence*

Me: "But I get it."
Her: "I get what you're saying, too."
Me: "You make great points."
Her: "Let's check one more set. And if they are abnormal, we will cross that bridge when we get to it."
Me: "I like that plan."

*silence*

Her: "Hey Dr. M? What's a Pollyanna?"
Me: "You don't know what a Pollyanna is?"
Her: "I'm a millenial."
Me: "Then Google it."
Her: *smile*
Me: *smiles back*

Let's be clear: My resident is sensitive and empathic. And this discussion is as old as crack cocaine itself when it comes to ethical dilemmas at Grady. But regardless of that and all that I see, I can't shake my optimism. Some piece of me always believes that this might be the day.

Yeah.

I love this job.
****

#amazinggrady #eternaloptimist #igetburntalot #butsometimespeoplewin #blindspot #rooterfortheunderdog #alwaysalwaysalways #thismightbetheday

Friday, August 31, 2018

Fear is a liar.




Me: "So wait. I'm making sure I hear you correctly. You said this first started when?"
Her: "Like two and a half years ago."

*silence*

Her: "I know. I know I should've come before now. I know. "
Me: *silence*
Her: "You are probably thinking I'm crazy."
Me: "I didn't say that."
Her: "You didn't have to."

*silence*

Her: "I was just . . .I was just so, so. . . ." *starts crying*
Me: "Afraid?"
Her: *crying and nodding*
Me: "It's okay. You're here now."
Her: "I've been scared every day. And I would want to come but then I would just get too scared of some bad news."
Me: "I get it. I'm serious. I do."
Her: "You do?"
Me: "We all scared of something."

*silence*

Her: "What are you scared of?"
Me: "The same things you scared of, I think. Something bad. Something taking me from my family. Something that make it where I can't do what I want to do in my life."
Her: *staring*
Me: "Or rather what I feel like I'm supposed to do."

*silence*

Her: "Can I ask you a question?"
Me: "Sure."
Her: "Do you think I'm gonna be okay?"
Me: "I think anything is better than living every day in fear. So yeah. I think today you are more okay than yesterday. And that's a good thing."
Her: *starts crying again*

*silence*

Her: "I'm so relieved. To tell somebody. To get this weight off my chest."
Me: "And I'm happy that you are here and that we are sitting here together."
Her: *smiles*
Me: *smiles back*

I remember a few years ago when I had a health scare. I had something happening in my body that didn't seem right. I worried for two full weeks. When I finally told Harry I was crying before I could even explain. Man. I was so scared when I finally went to get it checked out.

Whew.

And no--I didn't wait two and a half years but even in those two and a half minutes that passed between the doctor looking at my results and telling me what could have been life-altering information, I fully understood how she felt.

Damn, I did.

Look, man. Fear can present itself in all kinds of ways. Sometimes it marches in like a King Kong with big muscles and gnashing teeth. Other times it's a smooth operator and completely in disguise. And the only things to take it down are love and truth. And today they both showed up like a badass tag team.

Sure did.

I love it when fear loses. And today it did.

Hell yeah.

***
#amazinggrady #fearisaliar #getitchecked #maketheappt #knowingisbetterthanworrying #loveisthewhat #andfearisapunkassbeeyotch

Thursday, August 30, 2018

Squeaks and Squawks.



Him: "Them shoes you wearing is some a your favorite shoes?"
Me: *looking down* "My shoes?"
Him: "Yeah. Your shoes. They your favorites?"
Me: *squinting eyes and thinking* "Ummm. . . I guess I like them. They're good work shoes for the most part. And this color goes with a lot of stuff."
Him: "You mean it's a good work shoe for YOU."
Me: "Huh?"

*silence*

Him: "Look here. If them ain't your favorite shoes--hell, your ONLY shoes, then you need to go on and retire 'em."
Me: *looking down at my shoes again*
Him: "Miss Manning you woke me up two different times this week with that damn squeaky shoe. And today it was both of 'em squawking? Lord Jesus! Unh uh!"
Me: *laughing*
Him: "Them shoes got to GO. Or you gon' need to kick 'em off for you get on my hall so folk can get some rest."
Me: *still laughing*
Nurse: "Tell her how you really feel."
Me: "I was in denial."
Him: "Well you need to get out of denial. Or out my room in that shoe."

*laughter*

He's right. I do love the shoes. And I have no idea why or when they started squeaking like this and how to fix it. Wait--I take that back. It was after getting caught in the rain last week. I guess I just hoped it wasn't as bad as I knew it was.



Ha.

That got me thinking about all of the things that we totally notice but that we act like people don't see. Like the skirt that used to fit but is now too tight. Or that stomach or thigh you bared that reeeeally wasn't ready for sunshine or for going un-Spanxed. Or that very odd weave or hairdo that leaves people speechless (to your face.) Or the reeeally wrinkled shirt that you know you should have taken a moment to iron. Or even the funny smelling shirt that you hope only you've noticed. Man. . .If you noticed? Oh, someone else noticed.

Totally.

And this? This is just one more thing to love about Grady. You'll immediately know if you've gained weight, if your decision to go grey is questionable and even if you need some gum since your breath smells like garlic and onions after lunch. Folk will tell you, do you hear me?
By the way--that same patient told me that I shouldn't button too many buttons on my white coat because it makes me look like I'm. . . wait for it. . . ."with child."

Bwah.

***

Wednesday, August 29, 2018

L-O-V-E.



I took care of you in the hospital for fifteen days straight. I was there when you first came in with those symptoms. And I held your hand when you found out why.
“I am not afraid,” you said. “I’m just really, really glad you’re here.”

And you said that every single one of those days after. You also said the same thing to me each day before I left your room:

“I love you.”

Which isn’t something we never hear as doctors but is something out of the ordinary. But you—you said it each and every time.

I love you.

Not “I’ve got love for you.” Not “I love all that you’ve done.” But those three simple words spoken with clear intention every time.

I love you.

When your body got sicker and you were in pain, I held your hand again. And you looked into my eyes and told me once more, “I am not afraid. I’m just really, really glad you’re here.”

And then, “I love you.”

You had a big fight ahead of you. The kind of big that comes in like a playground bully, stealing lunches and terrorizing the innocent and weak. You were brave and fought back. You did. But that bully wouldn’t leave you be.

No it would not.

Someone called me the other day to tell me you’d been readmitted. This time sicker and requiring intensive care. I was grateful to have been told and made a plan to go see you first thing in the morning the next day.

You transitioned before I could.

Damn.

Today I am thinking of you. Letting your memory remind me of the great privilege of caring for you and every one of my patients at Grady. I am remembering our time together and speaking back the words you gave to me:

I am not afraid. I’m just really, really glad you’re here.

and

I love you.

Yeah.
***