Sunday, August 30, 2009

You can close your eyes. . .it's alright.

*patient gave permission to have her story shared

"So close your eyes

You can close your eyes,
It's alright

I don't know no love songs
And I can't sing the blues anymore
But I can sing this song
And you can sing this song
When I'm gone. . . ."

~ James Taylor

It's a gloomy and gray day today. Intermittent thunderstorms here in Atlanta have us all cooped up in the house. The kids are jumping on the furniture, and watching way too much television . . . .

I am sitting on the couch in the sun room watching the raindrops fall against the windows. It's so dreary out there. . . yet so apropos considering how I am feeling right now.

My patient died today. Just turned thirty years old. Homeless. Addicted to crack cocaine. Not sure how, or why or the exact cause of death. Just know that she had been back on the street and was probably still using. Just know that they worked on her for a while, and she just didn't make it.

I am crying right now because it's times like these when I feel so helpless. I am crying because I hate crack. I really, really do. I just want to run down the street screaming into the storm clouds until somebody, anybody hears me. I want to tackle every crack dealer and druglord one by one, punching them hard with my flimsy little wrists until they surrender. I want to flush every single rock down a giant toilet, and stomp on every glass tube, every home made soda can crack pipe, and every butane lighter. I feel like grabbing the inner city convenience store owners up by their collars and shaking them for carelessly selling all of that stuff side by side on shelves, knowing why folks are buying it. Yeah, I am mad as hell at crack right now. I really am. Crack is so, so wack.

Man, I wish I could have done something to pry her away from the stronghold of that addiction. I wish I could have just wiped the slate clean for her-- erased the mistakes, the HIV, the fear, the desperation. I wish I could just rewind back to when she was little, and be there to read her a story at bedtime, to tell her every single day how loved she is, and just to expect great things of her. . . .like my parents did for me. I wish she had all the chances that I had. She deserved it just as much as me.

Even though my interactions with her were brief, I remember them vividly. Right now, I am remembering her bright smile, her full head of wooly, unkempt hair, and the big, unreserved hug she gave me before she left the last time. I am smiling now as I think of the finger nails my resident painted bright orange for her during one of those first hospitalizations. It was such a thoughtful gesture.

"What color do you like your nails painted?" my resident asked her.

"Orange," she had said, " 'cause it looks pretty against my brown skin."

She was right.

Little sister,

You were so much more than what you called yourself - a "crackhead."
You were fearfully and wonderfully made. . . .
You were a beautiful, young, vibrant woman of color. . . .
and you were sick.

You fought for a long time, and now you can rest.
Know that somebody was praying for you and rooting for you.
Know that somebody cried when they heard that you were gone.

It was an honor to know you and to care for you.
I mean that.


Dr. M


"It won't be long before another day
And we gonna have a good time
No one's gonna take that time away
You can stay as long as you like

So close your eyes

You can close your eyes
It's alright
I don't know no lovesongs
And I can't sing the blues anymore
But I can sing this song
And you can sing this song
When I'm gone. . . ."

- from James Taylor "You Can Close Your Eyes"

~ A Grady Angel ~

~Sunrise: 1979~
~Sunset: 2009~

J.T. singing "You Can Close Your Eyes"
take a moment to listen to it and reflect on a Grady Angel. . . .

Saturday, August 29, 2009

No other way- Reflections from a Thursday at Grady

I'm a movement by myself
But I'm a force when we're together

- from Ne-Yo "You Make Me Better"

"Sir, were you ever on any pain medicines before today?" I asked a patient newly admitted to our service this week. He had just been hospitalized for severe abdominal pain, and was requiring more pain medicine than expected.

"No, he wasn't on no pain medicine," my patient's wife answered all while industriously wiping off the tray table in front of his hospital bed.

"Was so!" he retorted quickly, shaking his head at his wife.

"No, Daddy, you wasn't on no pain meds," she said calmly as she settled into the bedside reclining chair. I noticed a bit of swelling around her ankles. Tempted to ask her a few questions about her own health, I quickly reminded myself that she wasn't the patient.

He looked back at me and shook his head.

"Yes, I was on pain medicine, doctor." Looking toward his wife, he said, "Mommy, get that list of my medicines for me. Two of 'em was for pain." Mommy mumbled audibly that he indeed was not on pain medicine as she diligently filed through her weathered, oversized pocketbook for a folder filled with a stack of papers. Like clockwork, she pulled out a blue printout from the pharmacy that itemized the medications filled on his last prescription and handed it to me.

"One of 'em was for pains in my stomach and the other one was for pains in my feet from sugar," Daddy instructed. I looked over the paper carefully, and along with several other heart-related medications, there was a pill for acid reflux and another for the nerve-related pain of diabetes.

"Well, it looks like y'all are both right," I spoke through the smile creeping over my face. I knew that they were both equally convinced that they were right and the other was wrong. "Sir, the purple pill you take for acid in your stomach does help the pain, but probably doesn't qualify as a pain medicine."
"Told you," Mommy injected now laying a blanket over her husband that clearly was not a Grady-issued linen.

I chuckled out loud. "Not so fast, Mommy. This pill that he takes for the neuropathy in his feet is a kind of pain medicine. We call it neuropathic pain, which is really just a fancy way to say nerve pain. Neither medicine is a narcotic medicine, which is what I was thinking about when I asked. But either way, y'all are both right."

They both smiled and winked at each other. It was endearing. "How long have y'all been married?" I querried.

In unison, they answered, "Thirty-seven years."

"We worry each other to death, but wouldn't have it no other way," Mommy said with a twinkle in her eye. She had now reclined the chair and elevated her edematous ankles.

"Mommy, you been eating soup again? Your feet look like play-dough they so swoll up!" Daddy announced right in front of me. "She got some heart troubles, too, so she don't have no business eating soup."
"Low sodium," she recanted, "Low sodium. That means it don't have that much salt, right, doctor?"
"Nawww, they only write that on stuff you ain't got no business eating in the first place to trick you into thinking you can eat it, right doc?"

He had a point. I sort of liked Daddy's take on it.

"What? That don't make no sense at all. Of course, you can eat it if it has low sodium," Mommy continued. They both looked over at me simultaneously, and caught the amused expression on my face. They both collectively laughed.

"Told you we worry each other to death," my patient said while looking at his wife and her puffy ankles.

As if on perfect cue, they winked at each other once more. With a look of reciprocal admiration, Mommy added,"Yep, and we wouldn't have it no other way."

One of the best things I have learned from my patients at Grady is the true meaning of "for better or for worse, for richer or for poorer", and especially "in sickness and in health." Sure, I have seen patients languish alone for days with no visitors. But what a delight it is to be privy to a glimpse of lasting, loving marriages day after day! My patients are not all on street drugs or homeless without next of kin. Countless numbers of them are just like "Mommy and Daddy", standing vigil over one another in the hospital whether it be for something as minor as allergies flaring up, or something as devastating as a debilitating stroke or advanced cancer. And something about seeing this over and over again helps me see my own commitment to my husband differently. In a world where marriages are often fleeting, these patients give me something to look forward to. . . .even if it is several decades of "worrying each other to death."

Early this morning, I watched Harry sleeping peacefully. I kissed his forehead, pulled the covers over him, and thought about my patients. Then I thought about the last five years that we've spent worrying each other to death. I whispered to him, "You know what, Daddy? I wouldn't have it no other way."

Friday, August 28, 2009

Elevator Observations Part IV - Stop Frontin'!

I step onto the E elevators at Grady one day, and the other person is this fifty-something year old gentleman dressed in a white t-shirt that is 5 sizes too big, pants sagging around his bottom with 75% of his underwear showing, fancy sneakers with the laces untied, and a shiny "bling-bling" chain around his neck. (If you are imagining this fifty-something year old dude being dressed like a teenager in downtown Atlanta or perhaps a twenty year old hip hop star, you have the right image.) To make it even worse, he had his hair in a dreadlocked style, and the poor locks attached to his receding hairline were holding on for dear life. Yeah, the whole sight was just fraught with peril.

As if his appearance wasn't enough, picture this part:

When I step onto the elevator, the dude sucks his teeth--which happen to be covered with gold fronts-- pulls the toothpick out of his mouth (oh, forgot to mention the toothpick), and looks me up and down. Very, very slowly. Flashes me his very best, gold grill smile. TING! (literally)
Please don't say anything to me, please don't say anything to me.
I give him the quick "how you doing" nod, and hope that this will be the extent of our encounter.
Pu-leeeaaase! Come on, y'all! This is Grady!

"So, aaaaahhhh," he started after another tooth suck, "you a doctor?"
I won't be snobby. I won't be snarky. He just asked a simple question. He's African-american, I'm African-american. Maybe he's just proud of me. Yeah, that's it. What's the big deal? Just answer the damn question.
"Yes, sir, I'm a doctor." Genuine smile. Straightening up and looking respectable to my fellow brotha. Another nod. Yeah, proud of me. Power to the people.

"So what kind of medicine you practice?" Okay. Not so bad. Definitely proud of me.
"Internal Medicine, sir." Pleasant. Nice. Nothing fresh about his question. See? Just because he is dressed like a playa doesn't mean he is a playa.

He started nodding his head really, really slowly with the corners of his mouth turned downward. "Unh, Unh, Unh!" he said flashing every last one of the gold fronts. (Okay, think of the "unh! unh! unh!" at the beginning of the song "Brick House.") OMG. Is that a champagne glass design in his front tooth? Wo-ow. This is not good. Pretty sure this is NOT just about a brotha being proud of a sista for making it through med school.
"So Internal Medicine, huh?" Looks me up and down again and twirls the toothpick in the side of his mouth. Eeeeewww.
"Well, babygirl, I practice External Medicine," he replied followed by a "heh, heh, heh." Wait--did he just call me "babygirl" like I was Thelma from Good Times?

Yep, it was as disturbing as it sounds, yet instead of being completely appalled -- I was completely amused. I could tell this guy had been saving that mack-daddy line up for a long time, and thanks to me, he finally got his big chance. Part of me wonders if he simply thought this was just a funny thing to say, or if he actually thought I might be wooed by his incredible comic slash mack-daddy timing. You never know at Grady. Plus, you've just got to love the audacity of it all. It's pretty cool to live in a world where there's no such thing as "out of my league." I bet there would be a lot less single folks out there if they weren't so afraid to unleash their witty one liners like the gold front, receding dreadlocked, fifty-something year old, elevata playa.

So, yeah, he practices External medicine. . . . . . . .fortunately, I reached my floor before he had a chance to prove it.

Tuesday, August 25, 2009

True stories: Fatter not Phatter, Big Boned-edness, and Relief in Dolby Stereo

Fat (adj.): Obesity; corpulence.

Phat (adj.): Slang term for something that is excellent or attractive.

True stories. I ain't lyin'. (Hand over heart)

The following incidents happened to me at Grady on both today and yesterday, respectively:

Grady Seinfeld moment #1:

Stepped on the Grady 'A' elevators at 12:20 pm today. This environmental services lady (a different one) pushing cart of cleaning supplies says to me in front of the other five people on the elevator, "I seen you on Fox 5, doc. You know you look fatter on TV than you look at Grady." Again? You've got to be kidding me! Maybe she meant I looked "phat" not "fat" (She quickly clarified that for me.)

"Not like you look fat-fat, I mean you just look like you a LOT thicker on TV, you know like you just more big boned-ed." Big boned-ed??? Wo-ow.

A couple turned around and nodded . . . .still not sure if that nod was "yeah, I have seen you on Fox 5" or "hells yeah! you do look fatter (not phatter) on TV!"
Was too scared to ask. Prefer denial on this one.

Grady Seinfeld moment #2

Yesterday, I was sitting in the family waiting room having a meeting with my resident, Stacie S., on the 9th floor family meeting room. It's a very serene room with couches, a table, comfy chairs and such--meant to feel "homey" especially during family meetings (which we had just finished having.) Usually, if someone inadvertently pops their head in, they immediately retreat if it's obvious that someone is having a serious or private discussion (which we were.) Okay, so there is a bathroom just as you enter the room, and this random, twenty-something year old guy walks in the door and points to the restroom. We suspect he stepped in on accident, so we prepare to redirect him to another bathroom. Before we could say anything, the dude goes in the bathroom, DOESN'T CLOSE THE DOOR, and urinates for what seemed like an hour straight. I am convinced that he drank 8 liters of Coca Cola, held his bladder for 36 hours before coming in there, and was in some perverse way proud to demonstrate to us that he could pee in Dolby stereo. What??? Who does that???

Okay, so the dude waltzes out of the commode and me and my resident just looked at eachother and then him in disbelief. That Grady familiarity kicked in and I said, "Awwww, come on, dude! Next time close the door- especially with ladies in the room!" He did not look one bit embarrassed. For minute I thought he was going to say, "What ladies?", but I was relieved when all he said was, "My bad, doc! That's my bad." While zipping up his pants, and arranging himself. (Sorry, I just threw up in my mouth a little bit.)

Awwwww man. . .just thought about it! He didn't bother to flush OR wash his hands either. . . . . .

Take home messages:

1. As long as you think you're phat when you look in the mirror, that's all that matters.
2. If you must arrange yourselves, gentleman, do it in private.

Monday, August 24, 2009

Elevator Observations Part III - Quasi-Celebrity? You decide.

I ain't on some "oh, I'm a celebrity"
I deal with the real
so if it's artificial let it be.

- from The Roots
"Baby, You Got Me"

So, here's something funny. A little over a year ago, the head of nursing along with some one from Grady public relations approached me and my two friends/fellow Grady doctors, Neil W. and David M., about taking a photo for a handwashing campaign they were unrolling at Grady. "Having some of our Grady doctors along with some nurses would send a great message," she said. "What I have in mind is some nice laminated posters to put on the wards with a catchy slogan about hand hygiene." I'm down for some clean hands, and also down for Grady, so I went along with it.

We meet up a few weeks later, and get our picture taken by a professional photographer in front of this funky green backdrop. (I have since learned that such funky backdrops are actually quite high tech, depending on what you plan to do with the photograph.) They posed us into these very "somebody posed me" positions, and after about 30 minutes we were done. I recall receiving an email with a proof of the picture, along with a kind word of thanks from the head of nursing for our participation in promoting clean hands at Grady. Again, I am down for some clean hands, and also down for Grady, so I remember saying something like, "Cool, my pleasure."

So fast forward a few weeks or maybe a few months to the beginning of August 2008. I walk through the doors of one of the main entrances to Grady, and what do I see? This ginormous banner scaling the wall with hands the size of King Kong's when he scooped that screaming blonde out of that building. The hands look ultra sanitized and are surrounded by these animated bubbles. . . .below them is the what obviously won the catchy slogan contest-- "CLEAN BECAUSE WE CARE!" Aaaaah, but the best part? Nestled just beside the King Kong clean hands--no exaggeration--was a life size print of the picture we took in front of the funky green backdrop. (I should've known something was up when they put us in front of that thing.)

I was dumbfounded, gobsmacked, and whatever other word you can come up with to describe something that dumbfounds or gobsmacks you. Hello? This wasn't a laminated poster! I couldn't decide whether being on the Grady jumbotron was kind of cool or really, really weird. I have since settled on something in between.

Riddle me this: What's the only thing more bizarre and gobsmackable than unexpectedly walking into a lifesize picture of yourself in the lobby of Grady Hospital? Try unexpectedly walking into a lifesize picture of yourself in the other lobby of Grady Hospital. . . .and in the cafeteria of Grady Hospital. . . .and on nearly every floor of Grady Hospital! (Picture me with big, fake smile and fingers in my dimples)

Now, of course this has led to a myriad of comments from everyone from students to janitors to patients to complete strangers. Sometimes they just stand next to me at the elevator and do a double take, saying nothing. Other times, they come right on out with a comment.

My favorite one of recent memory happened just a few weeks ago. There was this Grady environmental services employee who joined me on the elevator near one of the scary, lifesize photo banners with the King Kong clean hands. She looked at the picture, and then at me. Back at the picture. Back at me. Here we go. When our elevator came and we stepped into the empty car together, she didn't hold back.
"You know what, Miss Manning?" Deep breath. . .this is Grady, so this could go anywhere. "You was fatter when you took that picture," she told me matter-of-factly.
I sort of smiled at her; the kind of smile you give someone when you taste a mouthful of something they cooked and it really, really sucks but they think it's worthy of Top Chef.

"Was that right after you had your baby? I remember when you was pregnant." Wow. Not the postpartum headcrack!
"Um, no," I tried to answer cheerfully, "my baby was almost two when I took that picture." Let's end it here. Good place to end it. We can ride this thing out with awkward silence. Better yet, let's just talk about the "Real Housewives of Atlanta." That always goes over well in the Grady elevator.

"Oh, okay then. You must've just been eating more back then, 'cause you was fatter on that picture." Wow, this is brutal. "But you was still cute. But you was fatter, though." Aaaah. At least I was still cute. Hmmm. Trying to decide if I ever want to be referred to as fatter. Looking her up and down now and trying to decide if I should tell her my assessment of her appearance, because I do have one.

"Really in your face, though." What?
"Beg pardon?" I spoke aloud. Immediately, I regretted it because it clicked right then that she was still on the "fatter" thing.
"In your face, you was fatter," she clarified as she inspected my face. Were fatter. WERE not was fatter."But you was still cute." See, Kimberly? There is a bright side. Was cute or were cute works for me.
"Even though they put too much make up on you. But you was cute even with the make up and your face fatter." Is she serious? Why is this lady hazing me? Doesn't she know I'm almost 40, and all weight-related comments good, bad or indifferent get internalized and compartmentalized forever? Dude, let me get to my floor. More people getting on. Sweet. Maybe she'll stop.

She stepped aside to let folks into the elevator but that didn't stop her. "They had a professional do your make up? Or did they airbrush it?" Killing me. Hope my expression does not show what I am thinking.
"You know they can airbrush pictures. You could have told them to airbrush it so your face wouldn't look fatter." She cannot be serious.
"That's what they do to Tyra and Michelle Obama. Oh yeah, and especially Oprah for that magazine of hers." Bananas. "They look a hot mess and then they get airbrushed. You shoulda had them to just airbrush you, Miss Manning. 'Specially since they all over the hospital." Oooophh! Body blow. Thanks for reminding me. All over the hospital, on every floor, and probably on a MARTA bus somewhere. Okay, I give up- can't take it any more. Need to attack before further annihilated.

(Insert cheery, fake smile here) "Nope, did my own make up, wasn't pregnant, and think I may have even been lighter in weight then than I am now." (Cheery, fake smile even bigger now.) "Glad you thought I looked cute, though." 7th floor. Finally saved by the bell. Okay, can't resist one more little dig.
"Will ask for that airbrushing next time they take a lifesize picture of me to plaster all over Grady." Snarky, I know. But she was asking for it.

Now I have since decided that her commentary was meant to be some sort of unknowingly camouflaged compliment. That whole episode has been added to my list of Seinfeld-esque moments I'm stacking up from my Grady experience. For a brief spell, I felt bad about my snarky sarcasm, but my sneaking suspicion is that she didn't even catch it. Especially because she had smiled and waved saying, "Alright then, Miss Manning!*" when I exited the elevator.
*(Remember "Miss Manning" is a term of endearment.)

Take home message: Being on the Grady jumbotron seems to have given folks in my Grady family this green light to have familiarity with me. And in a strange way, that part is kind of cool. . . .

So I guess I'm a somewhat of a quasi-celebrity inside of Grady. As long as nobody paints a mustache on my fatter, non-airbrushed, overmade up face, I'm okay with it. :)

Sunday, August 23, 2009

Never clock out

I had to work this morning. . . .yep, on a Sunday. Not exactly my first choice of things to do on a Sunday. . . .my preference is to go to church with Harry and the kids. Yeah, I was a little groggy when I first woke up, but a wonderful early morning snuggle session with Zachary on the sunroom couch was just the pick-me-up I needed before heading in to tackle the day at a "sho 'nuff "county hospital. Something about the innocence of 2 year old conversation--butterflies, Blues Clues, and big-boy underwear--lets me know that everything is alright with the universe. :)

Good morning, Grady!
(Here is a picture of Grady that I took right before walking in this morning.)

Some parts of morning rounds were rough. One person tearfully told me that no one in her whole life has ever loved her, and that she feels like a worthless mistake every single day. Someone else sat across from me as I discussed end-of-life issues regarding her dying loved one. One guy was stressed out because someone kicked the door in at his house while he lay in the hospital trying to get well. For him, a life or death situation in the hospital has become a life or death situation outside of the hospital, too. Another young woman took down my personal cell phone number so that she could talk to me more about a critically ill parent under my care. She asked me for the "best way to reach me" and sounded really upset. I wanted to tell her to have me paged. . .but the real answer was that the best way to reach me is my cell phone. . . .maybe I'll regret it, but right now, it seemed like the right thing to do. And lastly, I consoled my resident who was on the brink of tears all morning; not because she is a crybaby, but because she is an empathic young doctor who is now grasping the magnitude of what we do every day. It's an awesome responsibility.

This ain't a job for the faint of heart. These are human beings we are caring for, hoping for, and fighting for. We clock in but, in our hearts, the best doctors can't clock out no matter how hard they try. We are haunted by our patients and their stories, we hunger to learn more to understand their problems, and then we strive to do just a little bit better each time.

Now that it's all said and done, I guess I'm not so bummed about missing worship service today. Sometimes going into Grady on a Sunday kind of feels like going to church. Afterall, working at Grady is a ministry in itself. . . . .and something about squeezing my own loved one tight this morning made me want to try just that much harder so that my patients can do the same. (Zachary and me during our snugglefest this morning)

Friday, August 21, 2009

Listen to the Patient: Reflections from a Tuesday at Grady

serendipity: (n) the faculty of making fortunate discoveries by accident.

(n) the faculty of making not-so-fortunate, ironic, Murphy's law-type discoveries by accident. (my definition)

"Take these damn ties off me right now before I jump out of this bed and kick somebody's ass!" this agitated gentleman yelled in my direction. He was in the first bed in room 15, and I had to pass by him to get to my patient in the second bed. "Yeah, YOU, nurse, doctor or whatever you are! I'm talking to you." I guess he recognized my looking over a shoulder as a "you talking to me?" gesture.

"Sir, I'm not your doctor, but I can get your nurse," I calmly replied. Nice, but not condescending. I have learned that pouring on the kindess is the way to go in these situations.

"Well dammit, go get her right now, then. Find my damn nurse and ask her to get my damn doctor! And get this lady out of here!" he screamed back while pointing to the nurse's assistant seated next to his bed. She'd been given the delightful task of serving as a one-to-one "sitter" for a patient that was probably psychotic. "She's plotting against me! You probably part of the plot, too!" At that point, he began thrashing his hands all about in a futile effort to remove the four point restraints that had likely been placed on his limbs for safety while in the emergency department.

"I'm really sorry you're upset, sir," I carefully offered, "I'm not your doctor. . . but as soon as I finish with my patient in here, I'll try to get you some assistance." He didn't like that too much as exemplified by the litany of hard-core expletives that soon followed. He even heaped up a nice, big loogie in his mouth that he then hocked across the room, just narrowly missing me as I slid around the pink curtain separating him from his neighbor. Eeeeeewww.

You'd think that I would be really shaken up by such a thing, but admittedly, I'm not. This was clearly a patient with an active psychiatric illness complicated by something medical--which is why he was on our floor instead of the psychiatry ward. Not an unusual occurrence at Grady, and definitely not one that I felt particularly threatened by. When I first started doing this, I probably would have been somewhere between mortified/afraid ("Oh my gosh! What if this guy gets loose?") and angry/mad ("Oh no he DIDN'T just try to spit on me!! Oh NO HE DI-IN'T!!!") Now, I know how complicated psychiatric illness can be, and I've learned not to take any of this personally. I've also learned how not add insult to injury by further agitating an already agitated patient.

I examined the patient in bed two, and hoped to tip-toe past the loogie-hocker without getting called a female dog or being nailed with some other kind of bodily fluid. He had been ranting the entire time I was in there, and as soon as he saw me again, he focused his attention back on me. "If somebody don't get me out of here, I'm gonna call Mayor Shirley Franklin and President Obama!" (He really meant that.) He tried to grab the phone, but again was limited by the restraints. He glared back at the sitter. "And get this heifer out of my room!" This time I decided not to bite, as I knew it was all a part of whatever had him hospitalized. Instead, I just looked at the poor nurses' assistant with an expression of pity. It was only 3 pm. Boo, it's going to be a loooonnnggg shift, I thought while raising my eyebrows and shaking my head. I quietly left the room.

I could still hear the agitated patient hollering at the assistant as I stood by the nurses' station some twenty minutes later. I did, at least, keep my promise and told his nurse that he needed some assistance.

About 18 hours later, I returned to the wards the next morning to round with my team on the new admissions. The first thing I heard when I walked up was the booming sound of an angry and impulsive male voice. I winced with every profane word that escaped the door to his room. That unfortunate young nursing assistant from the day before came walking down the hall toward me. Another "f-bomb" came flying out of his room, and we all cringed once more. It looked as though she was heading to his room when we briefly made eye contact. "Lord, have mercy!" I said while placing my palm over my chest, "You're assigned to him again? Bless your heart!" Feeling bonded by our shared spit assault, she placed a hand on my shoulder and happily reported to me that today he was under another assistant's watch. We then collectively chuckled as I added, "Phew! I was about to say! Did y'all ever reach his doctors? Whoever it is, they definitely have their work cut out for them!" My team looked amused as they all shared knowing glances and grew quiet. It took me a few minutes and a few snickers to catch on. Finally, I opened my eyes wide and covered my mouth. My intern nodded slowly. "You've got to be kidding me!" I said with an incredulous gasp.

Nope. Not kidding. It was indeed true. After all that, I was his doctor after all. See, if I had just done what he'd initially asked, that is--"found his damn nurse, and told her to go get his damn doctor"-- I would have found out that the "damn doctor" he was looking for was me--close enough for him to spit on--literally.

Take home message: Never underestimate the power of Grady pseudo-serendipity. Oh yeah, and more important, like we tell our medical students over and over again like broken records: Listen to the patient.

Wednesday, August 19, 2009

Elevator Observations Part II

"Can you mash five please?" I asked as I joined crowd of people huddled in the 'A' elevators at Grady this morning. The unspoken rule is that the man (or woman) closest to the keypad is responsible for firming up the destinations and pushing the right buttons. I take that back. Mashing the right buttons.

It's official. Without even trying, I have blended into Atlanta, and even more, into Grady. The language that sounded kind of funny to me when I first started working here has now become second nature. I not only understand the words I hear around Grady- I find myself using them.

Case in point:
Me: "Hey there, Mr. Johnson- what you know good?" (How are you?)
Him: "I don't know nothin', doc!" (I'm fine)
Me: "You still running off?" (Are you still having diarrhea?)
Him: "No.. . but my stomach started hurting a little bit again."
Me: "Where 'bout?" (Where is the pain?)
Him: "Right there where you're mashing. . . ooohhh" (The place where you're torturing me now)
Me: "That's where your pancreas is and remember, it's flared up. Did you ask for the pain medication we prescribed for you?" (You have pancreatitis and we prescribed you some pain medicine)
Him: "Yeah they brought it, but it ain't no count." (I took the pain medicine, and it wasn't very helpful.)
Me: "Really? I'm sorry about that. How long have you been in pain?"
Him: "I'ts been a minute." (A long time)
Me: "I'm sorry. Let me try something different, okay? I'll notify your nurse."
Him: " 'Preciate you, Miss Manning." (Thanks, Dr. Manning)

See what I mean? I'm not kidding. . . .I'm slowly morphing into a true Southerner. I habitually "ma'am" and "sir" now, and I don't even flinch at the terms "high blood" (hypertension), "low blood" (anemia), "sugar" (diabetes), and "nature" (anything related to a man's ability to get a . . .well you know.) And just when I thought it was safe to still tell people I was from L.A., the other shoe dropped. I started mashing things.

Well. . .I'm not fighting it anymore either. I am a part of Atlanta, Georgia now- and even more, I am a part of Grady. So go ahead. . . . push your buttons in California, and press your buttons in New York. In Georgia, we mash bugs with our shoes, we accidentally mash our fingers in doors, and yes, we also mash elevator buttons. You got a problem with that?

Wednesday, August 12, 2009

Elevator Observations Part 1

I love NPR. Yep, I admit it. Despite how ridiculously cool I seem, I am a self-proclaimed National Public Radio nerd. Interestingly, I can do without watching the news on television, but give me a few moments with Renee Montagne or Kai Ryssdal during my commute or while making dinner for my family, and I'm all good. Ask Harry- it's my favorite background noise after a long day at work. (Personally, I think this is the result of all the talk radio my mother tortured us with over the years which, now that I think of it, I am doing to my own children.)

So you would think that being an NPR junkie and all, most breaking news I get from NPR, right? A natural catastrophe? An icon unexpectedly dies? Surely it would be straight from my friends at WABE 90.1 before anyone else, right? Uhh. . . .try no. While it is true that I probably get most of my news from NPR, I kid you not, I have heard some of the biggest headlines of the last decade from folks on the elevators at Grady Hospital. No exaggeration.

"Hey doc! Somebody crashed a big a** airplane into a big a** building in New York City!" this disheveled gentleman proclaimed to me one early Tuesday morning in September 2001. Okay, so he didn't look like the most reliable news source in the world, but I bit. "What?" I replied with amusement, assuming that this patient was likely on his way to 13B, the Grady psychiatry destination. He could tell I didn't believe him. He opened his eyes wide, placed his right hand over his heart, and lifted the left high over his head. "I ain't lyin' doc! I'm for real! It was like a big a** airplane with like whole bunch of people on it!" I shook my head as we reached my floor and waved goodbye. As soon as I arrived in the clinic that morning, there was a big commotion. All of the staff and patients were glued to the waiting room television, mouths wide open. Not even two seconds after I joined the onlookers, the second plane plunged into the other tower of the World Trade Center. Wow, I remember thinking. That dude was telling the truth.

And that was the first of many. Other memorable Grady elevator bombshells include John Edwards pulling out of the Democratic presidential race, Whitney and Bobby getting divorced, and even who won this season's cycle of America's Next Top Model. Okay, maybe the Top Model thing is not huge news, but that depends on who you ask and it saved me a few minutes on Google. My point is that, without fail, you can always count on the elevators at Grady to give you the real scoop.

My latest one? A few weeks ago, I joined a Grady employee on the elevator. I was heading upstairs from the ground floor, and from the pungent smell of smoke, more than likely he was returning from a cigarette break. This gentleman was one of our patient transporters, so I saw him often. Usually chipper and friendly, this day he looked unusually sad. As any Grady doctor would, I said hello and then asked him if he was okay. I seemed to startle him out of some deep introspection. "My bad--how you doing today, Miss Manning? I'm sorry, I'm just still messed up over the news," he said solemnly. "Wait-what news?" I inquired, now believing virtually all Grady elevator reports. I feverishly pulled out my iPhone to confirm that President Obama was okay. "Michael Jackson. He died, doc. Died. They found him dead in his house. 50 years old." I covered my mouth with my hand in disbelief. He balled his fist, pumped it twice over his chest, and then pointed skyward. "R.I.P. Mike." The doors flew open and he walked out of the elevator.

So. . . now whenever I'm behind on my NPR or even need to simply know what happened on The Real Housewives of Atlanta, I just ride the elevator at Grady. And the good news is, since they always take so long, you never have to worry about getting only half the story!

Tuesday, August 11, 2009

Everybody has a story. . . .

Ever drive down a major street in a large metropolitan city and witnessed someone erratically walking by with that dazed, drug-addicted look in their eyes? Or better yet, have you ever encountered someone who was giving you this long, drawn out story about how their car broke down, etc. and if only you could give them $5, it would be okay. . . .yet you know from the vacant look on their face that it is likely drugs? Yeah, well if you haven't then just take a trip to downtown Atlanta.

I see so, so many people whose lives have been ruined by drugs, particularly crack cocaine. The most disturbing part about it is that the majority of them look like me- black and female. It really, really sucks. . .and it can be really frustrating at times. But every now and then, I am reminded that every single one of the people I have met or cared for who uses crack cocaine has their very own story.

I was rounding recently and one of my patients, hospitalized for multiple things all of which were complicated by the fact that she was homeless and addicted to crack, had a sad look on her face that morning. When I asked her what was wrong, she gave me a half-hearted smile with a shoulder shrug and told me, "Today is my 30th birthday." Then I noticed this yellow legal pad on the tray table. She had scribbled down all about what she wished this day could be like instead and how much she wished her life could be different. We talked for a while, and I learned a lot about her. Then I thought about my 30th birthday. . . .a fabulous weekend laughing on South Beach with two of my good friends. . . .riding around in a convertible, basking in the Miami sun and sipping mojitos. . . .meeting my best friend, Lisa, in Atlanta afterward for even more celebrating. It was unforgettable.

As soon as I walked out of her room, I burst into tears. That happens to me more often than I should probably admit. (I keep waiting for this point in my career where I will become stoic and unaffected.) Crack cocaine is awful. It is a horrible, ruthless thief that robs young and gifted people of so much promise. And I see it every single day at work. Be glad if it has never occurred to you to try crack, and feel thankful if your family cherished you growing up. If that's your story, count yourself blessed. A lot of folks never even get a fighting chance- and if only they did, they might have gone on to do such great things. The late Keith Haring immortalized this truth in his art (pictured above), and Whitney Houston said it best in her latenight chat with Diane Sawyer- "Crack is wack." Talk about an understatement.

Anyways. . .the next time you see someone who clearly looks like they are "on something" just take a minute to ask yourself. . . "What's her story? How'd he end up like that? What are her talents? What did he want to be when he grew up?" And then, if that's your thing. . . .say a little prayer just for them. I know I do all the time. . . . . .

Like many of my unstably housed patients, this one went back to a downtown homeless shelter when she was discharged. . . . .where a large number of the folks there use crack. Damn.

*patient permission obtained to be subject of blog

Sunday, August 9, 2009

Miss Manning, but not if you're nasty

Sometimes, no a lot of times, my Grady patients call me "Miss Manning" - even though they know I'm a doctor. It used to seem a bit curious to me, but my good friend and fellow Grady doctor, Lesley M. told me that she sees it as somewhat of a term of endearment. I think I am starting to agree with her on this one. No one ever says "Miss Manning" with a nasty snarl or a roll of their neck. In fact in the countless numbers of times I have heard expletives in the hospital, never once was it paired with the infamous "Miss Manning." In my experience, folks who want to curse you out generally get the title correct. (Not that I am the target of frequent cuss-outs. . . .however, you will come to learn that in a sho-nuff county hospital, you could very well get randomly cursed out for just standing there.) Anyways. . . .Lesley is probably right on this one- kiss my *expletive* is almost always followed by "doctor."

And so . . . . this morning I was rounding on one of the patients on the inpatient service with an intern and a student, and as always, I reintroduced myself as "Dr. Manning, the senior doctor on the team." The intern went over the plan with our patient, and referred to me, Dr. Manning, several times. She even said, "Dr. Manning wants to examine you now if that's okay." We finished the encounter, which was quite pleasant. The patient asked a few questions which we patiently answered, shared a bit of small talk and then bid her adieu. We'd been in there around 7 or 8 minutes or so, and I even wrapped up the visit by pointing to my badge and saying "If you have any questions or concerns, my name is Dr. Manning." Sure enough, as we walked out of the room, the patient smiled wide, raised her hand, and hit me with a cheerful, "Thank you, Miss Manning!"

I love this job.

Saturday, August 8, 2009

Welcome to a "sho nuff" county hospital. . . . . .sho-nuff and 'bout it 'bout it

So here's the deal. . . .my sister, JoLai, set up one of these blogspot deals a few weeks ago, and I am admittedly biting off her. (Oh. . bite: v. to copy or follow someone's idea.) So yeah, I'm biting. . . . wait, not completely. I admit that I have toyed around with the thought of some kind of blog or online journal- especially about my experiences surrounding Grady Hospital. So it's a quasi-bite at best off of JoLai, but I can definitely say I was 100% nudged to do this by her doing it first.

So this blog is about my life at and associated with Grady Memorial Hospital. Grady Memorial Hospital (a.k.a. "The Gradys") is a fire-breathing dragon of a county hospital located in the heart of downtown Atlanta, Georgia. When I finished my residency and chief year in combined Internal Medicine and Pediatrics back in 2001, I knew one thing for sure. I knew in my heart that I wanted to go work in the trenches at one of the "sho-nuff" county hospitals. Okay, so what makes a "sho-nuff" county hospital? It's pretty simple. Two things: poverty and pathology. And not just "my lights got turned off this month" poverty. . . . but the searing poverty that exposes you to the extremes of disease and the social aftermath that both precedes and follows it. I always thought working in hospitals like this would feel more like a ministry than a job. And now I can personally attest to this. Bellevue in New York, Charity Hospital (RIP) in New Orleans, Jackson Memorial in Miami, Cook County in Chi-town, and of course, Grady Memorial in the ATL. All "sho nuff" county hospitals lying on a fault line of poverty and pathology.

Yeah, so quick background is that I am a faculty member at the Emory School of Medicine, and have been since 2001. Emory is responsible for the majority of the clinical teaching and care at Grady, and a part of this responsibility is shared with the Morehouse School of Medicine. (Shout out to the historically black med schools, including my alma mater Meharry and Howard Med!) I teach medical students, residents, and care for patients at Grady on both the outpatient (clinic) and inpatient (folks admitted in the hospital) settings. It's hard work. It's often draining. It can be extremely funny and extremely sad just moments apart. . . . . . and as exhausting as it can be, I couldn't see myself doing anything else.

Grady's where the fun is. . . . at least most of the time. . . .hope you enjoy the ride. . . . .speaking of which- I'd better hit the sack 'cause I have to round at the crickety crack of dawn tomorrow!

P.S. Oh and for the record. . . .I will not be violating patient confidentiality nor will I be looking to paint Grady in a bad light. I love me some Grady- don't get it twisted for a second! So. . . understandably, there can only be so much detail. . . but trust me- every day there is a Seinfeld episode just waiting to happen. Now, good night for real!