Wednesday, December 29, 2010

The Good Fight.

I am reflecting on these words today:

"I have fought the good fight, I have finished the race, 
I have kept the faith."  

~ 2 Timothy 4:7

You fought the good fight. And you fought it your way. For you, this was a death with dignity indeed.

Thank you for your wisdom, your bravery, your trust, and your honesty. Thank you for teaching us all how to better honor our patients. Thank you for . . . . . everything.

"Alright then, friend."

Monday, December 27, 2010

Evidence-based Medicine.

Today on rounds:
(photo taken and shared with patient's permission)

The best therapy we have to offer.  Hands down.

Sunday, December 26, 2010

48 hours.

"Yet do I marvel. . . ."

~ Countee Cullen

In 48 hours, I:

  • Talked on the phone with my very pregnant best friend about what life would be like for her as a new mommy.
  • Rounded with my team while admiring all of the staff who were wearing Santa hats.
  • Smiled at a Respiratory Therapist who had his nose painted red like Rudolph.
  • Thought about my friend Davina and her son, C.J., who was born on December 24.
  • Told my friend Davina that I was thinking of her and her son C.J. who was born on December 24.
  • Donned brand new Christmas eve pajamas with the kids. And Harry, too. (Major feat, people.)
  • Popped a big bowl of (real-from-a-heavy-pot-not-microwave) popcorn to bring downstairs to the "man cave" for a Christmas eve family movie night. (Equally major.)
  • Also brought down extra blankets and gourmet caramel apples (sliced, please)--upon Isaiah's request.

  • Realized that although I've read The Polar Express to my children five trillion times, I had never seen the movie until then.
  • Decided that even though I liked The Polar Express book better, being snuggled under blankets in new P.J.s with my husband and my kids made that fact an easy one to ignore.
  • Wrapped gifts until 2 a.m.
  • Went to CVS to get batteries and a gift card at 2:05 a.m.
  • Watched the wonder of Christmas through the eyes of a four year old and a five year old.
  • Thought about my mentor, Neil W. and his wife, Tamara, whose son, Matthew, was born on December 25.
  • Remembered praying for Neil and Tamara to have children, and felt warm inside imagining what a difference a day (and a prayer) makes.
  • Went to see the Yogi Bear movie on Christmas, which was not anywhere close to as enjoyable as The Polar Express.
  • Almost cried when Zachary squealed, "This is the best Christmas EVER!"
  • Wanted to go to sleep hugging the glorious red Tory Burch totebag my husband gave me for Christmas.
  • Decided to go to sleep hugging my husband instead.
  • Watched the wonder of snow on the ground through the eyes of a four year old and a five year old on the morning after Christmas.
  • Drove in that wonder-ful snow and into Grady for post-call rounds.
  • Despite having to work over the holidays, was reminded repeatedly of why I love, love, love my job.
  • Received a text that my best friend had her baby--that our other best friend (Tracey, the world's greatest OB-Gyn) delivered. Sigh.
  • Remembered when Tracey delivered Isaiah and Zachary -- and smiled.
  • Remembered when Tracey and I were clueless medical students -- and smiled again.
  • Left Grady Hospital. . . .and headed to the other hospital. . . .
  • . . . .where I talked and hugged and laughed with my newly post-partum best friend about what life would be like for her as a new mommy. Married to a new daddy.
  • Received a text that one of my very ill patients passed away as I was rocking my new god-son in the mother-baby unit at the other hospital.
GG and the Pooh-bear
  • Left the other hospital to head back over to Grady Hospital after asking myself what my mentor, Neil W., would do with that text. (Go back to Grady.)
  • Ran into my best friend's mom on the way out and wanted to cry when we talked about what life would be like for her as a new grandmommy.
  • Hugged her tight and felt her joy run through me.
  • Reached Grady and was surprised at how quiet it was when I walked back into the building.
  • Made it all the way down the hall and to the J elevators without a single person asking me for directions or help or money. (Very unusual.)
  • Stepped off of the elevator and immediately heard voices.
  • Joined what looked like a tear-filled family reunion with all of my patient's loved ones.
  • Hugged them all one by one.
  • Thanked them for trusting our team to care for their loved one.
  • Reached my patient's granddaughter last, who never left her grandmother's side for the entire hospitalization.
  • Hugged her tight and felt her pain run through me.
  • Quietly whispered in her ear, "Thank you for teaching me to be a better daughter and granddaughter."
  • Felt her hug me tighter and told her I meant that.
  • Was again stunned by the stillness of the hospital as I headed toward the exit.
  • Felt the tiny snowflakes on my cheeks and the blistering cold on the walk to the parking garage.
  • Sat in my frigid car for a moment. . . .taking in the wintry silence.
  • Reflected on the last 48 hours of life and love full circle.
  • Marveled at it all.
What a difference a day makes.

    • Cried and cried. All the way home.

    Not so bubbly.

    Grady elder moment:

    Today after my rounds, I was asked to stop by a patient's room. She had some skin findings that a colleague had requested I look at for a second opinion.

    "Hellooo?" I spoke loud enough to alert her of my presence.When I came around the pink curtain, this Grady elder was in the middle of being given a sponge bath by one of our nurse assistants. She was fussing through the whole process.

    "Dammit! It's cold! What is you doing with that cold ass water?" and "Be gentle, you hear? You so heavy-handed!" and "If I get pneumonia from being cold, I'm gone come for you."

    I admit--I was a bit amused at her tirade. But the nursing assistant who was so diligently and delicately bathing her was calm and professional. I decided to take her attitude.

    "This water is pretty warm but I can warm it some more if you'd like," offered the caregiver. She was doing a great job at deflecting her cantankerous commentary.

    "Nawww, jes come on and finish, hear? You so heavy handed. Lawd have mercy!" The patient muttered a few more inaudible things that were surely related to her discontent with this task.

    I debated whether I would ask to take a peek at her now while she was already mad and already exposed, or just wait until tomorrow. This was my last stop before heading out, so I'd hoped to examine her before my departure.

    "Stop mashing my foot when you turn me, hear?"

    "Yes, ma'am," answered the nursing aide with a patient smile.


    Already feisty. Already spitting fire.

    Why not?

    I decided to go for it.

    "Hey there, ma'am, my name is Dr. Manning. I was asked to come by and see about your rash by your doctor. If you don't mind, I just want to take a quick peek at your--"

    "Do it look like a good time to you, Miss Manning? I mean, tell me. Do it?"

    "Uhhhh, well, the thing is. . .I was hoping to take a look while you already had your skin uncovered. I won't disrupt things. Would that be alright?"

    She could not have given me a hairier eyeball. Then she said:

    "Well, you tell me if this is alright: How 'bout I walk in a room while yo' entire ass from the top all the way down to the bottom is hanging out the back of a sheet covered with cold bubbles and then ask you is it a good time for a stranger to take a 'quick peek' at you. Tell me how you thank you would like me to do that?"


    "Yeah. I didn't thank so. Don't try to make it seem like you conveniencing me. It ain't nothin' convenient about having somebody looking across yo' whole ass from the top all the way to the bottom no matter how quick they say they gon' do it."


    "Alright then, Miss. . .what's yo' name again?"


    "Alright then Miss Manning. You get on back to whatever you was doing before you came in here bothering me and trying to take a 'quick peek' cross my behind." She looked up at me from her compromising position for emphasis.


    "Uuuuhh. . .yes, ma'am. . . .uuhhhh. . . Merry Christmas, ma'am." I was at a loss for words.

    'Merry Christmas?'

    She looked up and gave me an even steelier, hairier eyeball than that first one. Which was the exact moment that I realized that even being wished a Merry Christmas is no consolation for bad manners-- especially when your entire backside is hanging out and covered with cold bubbles.

    Um. . . yeah.

    Saturday, December 25, 2010

    Peace on Earth, Good Will Toward Little Brothers.

    (For today, at least.)


    Peace and light to you and yours on this day and always.  . . . .

    Thursday, December 23, 2010

    Elevator music.

    On the Grady elevator yesterday:

    • A nurse was wearing a really scary Christmas sweater. She told me she was off today, but on her way to the party on her unit.  100% truth: I almost opened my mouth to ask was it an "ugly sweater" party (people do have those you know.)  It was kind of like one of those Twix commercials, though-- you know. . . the ones where somehow everything hits a pause button while you get it together. My Twix pause allowed me to recognize that this was probably a fashion forward decision on her part that had zero to do with a party theme. Yikes. (For the record--it wasn't an ugly sweater party.)

    • A woman stepped onto the elevator and started singing. Loud. Like I wasn't there.
    "A child! A child! High above the trees! With a voice as big as a kite!"  

    Uuuhhh. Okay.

    • A little boy gets on the elevator, looks me up and down and commences to compliment every single thing I have in his line of sight.
    "I like yo' shoes."


    "I like yo' shirt."


    "I like yo' hair."


    "I like yo'. . . " Points at my pager. "Wha's that?"

    "A pager."

    "Oh. Could I have it?"

    "No, sweetie, I need it."

    "Oh. I like yo' belt. "


    "I like yo'. . . ."

    • An elderly gentleman with salt and pepper hair starkly contrasting his dark brown skin got on the elevator with me right before I left for the evening. He was absolutely "Grady elder" personified.  "Ground please," he spoke in the kind of rich and throaty tone that makes you immediately stand up taller. I obliged him and pushed 'G.' He crossed his hands in front of him, cleared his throat, and nodded. 
    • I caught him reading my badge, confirming that I was a doctor. His head made the tiniest nod when he saw it--but I caught it. For the ten flights down he stood there smiling at me. . . .in that proud granddaddy kind of way.  He didn't say a word for the entire ride, but his expression. . . .sigh.  
    "You have a blessed day and a safe holiday, okay young lady?" 

    "You, too, sir."

    He stopped and looked at me--almost lovingly-- for just a moment. Not in a fresh way, either. Just in an inexplicably proud granddaddy way that immediately made me feel proud, too. The Grady elder turned up his collar and picked up his stride toward the door and toward his life.

    I love this job.

    Wednesday, December 22, 2010

    Cross my heart.

    *written with my patient's permission.
    At Grady today on rounds:

    Late afternoon sunshine is pouring into the room. My patient's face is illuminated by strips of light beaming through blinds and interrupted by shadows. . . . .

    I sit beside my patient's bed with one very simple plan: To simply hold his hand and be there. That's all. It is, at this point, the only thing I have to offer. . . . .

    "You know what, doc?"

    "What's that, my friend?"

    "Every night when I fall asleep, I keep my fingers crossed. Tight. . . ."

    "You do?"

    "Yeah. . . .I do."


    "I just cross them. . .just hoping. . . you know? Praying. . .you know?"


    "I know."

    "Hoping I can cross 'em tight enough so things'll be different when I wake up. . . ."


    ". . . .that I will wake up."


    I hold his hand in the quiet of that moment. There are no words that I can think of so I just rub his hand with my thumb. Finally, he falls asleep.  I rise and close the blinds; his face is now covered with shadows. Yet somehow it is still illuminated. 


    I decide that tonight I'm going to cross my fingers, too.

    Tuesday, December 21, 2010

    Monday, December 20, 2010

    Reflection on a Monday: The Snoopy Dance.

    The Snoopy Dance

     "And I love how you came along
    and made the world for me secure. . . 

    It's deeper than you know--
    You made me believe I'd found a love for my soul."

    From Kindred and the Family Soul's "Just the Way You Are" 


    Becoming a doctor is such a selfish walk. You declare a major in college and then you work super hard to make excellent grades. You align yourself with equally studious people (some of whom seem really cool on the exterior but are secretly as nerdy as you) and together you perpetuate the belief that you must, must, must study super, duper hard.

    To get an A in Biology 101.
    To get an A in Organic Chemistry.
    To set the curve in Physics 102.

    Then the MCAT rears it's ugly head. Because you want to go to the medical school of your choice, and because you'd prefer to not be explaining that, yes, I realize that I will graduate magna/summa cum laude yet I was having a bad day when I took the MCAT or although I was top of my major in pre-med I am not a strong standardized test taker therefore I am hoping this can be overlooked. So you purchase fat books and programs and bury your nose and your life into them.

    And then you get into medical school.

    Your parents/study partners/high school teachers/everybody remotely connected to your parents celebrates. And you do that dance that Snoopy used to do when he was super happy. You imagine yourself in a white coat dropping all kinds of diagnostic bombs like House, but without his drug problem. You envision your arms folded on rounds pontificating a clinical dilemma. You see the legions of patients whose lives will be better because of you, the one doctor who always listens/never rushes them/treats them with respect.

    You arrive at your medical school -- and then. You meet a new posse of super driven folks; even more super driven than the people from your college/university. The stakes are higher. Everyone is going over $150,000 in debt, so failure is not an option. At all.

    So you study like crazy. You have fun on the weekends after exams, yes, but always looming behind you is the need to achieve, achieve, achieve. So that you can have your pick at the next level. So that when you go for residency interviews, you aren't saying things like, yes, I did do well in medical school but I am just not a strong standardized test taker, or see, the preclinical curriculum was tough for me, but I came into my own when I started clinicals which is why I got all honors on my rotations including medicine and surgery.

    You miss some things.
    Even things you shouldn't have.
    But you get so worried about achieving that it seems okay.
    You fret a bit.
    And on some days, you fret a lot.

    Then, if you're lucky, you match in the residency of your choice. Your family celebrates. You want to do pirouettes and, if you aren't too cool at this point, you actually do them. Or even the Snoopy dance. On commencement day you see the proud look in your parents' eyes which, unbeknownst to you, has as much to do with the fact that you are now a doctor as it does the fact that you are a gainfully employed doctor to boot.

    A doctor with a job.

    You enter internship. And it starts all over again. New road dogs. New challenges. New hurdles to jump. Do I want to do a fellowship? Oh my, then I need to be the best thing since running water and Estee Lauder on every rotation. Especially the ones in the specialty of my choice.

    And so.

    After all this, at some point the dust settles and you finish your training. Suddenly you have a little more time and a little more money. You emerge from the cloud of me, me, me and realize that, oh yeah, there were other people who may or may not have been in medicine there along the way. Or they sort of were, except on an attentiveness scale of one to ten you were, at best, a solid five.

    If you're lucky, somebody thumped your head early in this process and you had a wonderful partner to hug you tight and call you "hon" instead of doctor, doctor, doctor.  Or. You could be someone who had your head thumped early, yet fickle fate never brought prince or princess charming from out of the stacks of the library or from perusing the shelves in your favorite Starbucks study haunt to love you forever and ever.

    So you worry. You wonder.  Wait, what's really important? Oh yeah, more than just me and my medical milestones.

    Oh yeah.


    Today is my husband Harry's birthday. And for this reason, I am reflecting on achieving what is really important. Whether you are a doctor. Or a nurse. Or any other kind of uber-achiever. Relationships with the people who matter most are what's most important. If you get a chance to narrow it down to one super-special person, hot damn. You've hit pay dirt.


    For a while during and especially after my residency I worried about that.  All that hard work. All the studying and gunning to "get there" to the promised land of doctor-hood.  But my dust settled and I looked to my left and my right and with the exception of my (wonderful) immediate family, it was just me, myself, and I. Oh yeah, and my professionally framed medical degree.

    I wanted a love for my soul.  But it hadn't happened and it wasn't happening.


    What frustrated me most was the fact that I couldn't just work at it and study for it to achieve it.  There was no intense review book for finding a love for my soul.  And for nerdy academic types, that was a hard pill to swallow.

    After some (very) unappealing dates and some (majorly) dead end getting-to-know-yous, I decided something very simple: I couldn't force this particular milestone.  No amount of studying would get me there. Instead, I focused on myself, but in a different way. At thirty one, I made a pact with myself to not waste a single moment on any human being who had not gotten the memo on my awesome worth.  I didn't want to be seen on the arm of Mr. It's-not-you-it's-really-me when the love for my soul came walking by. So that's what I did. Oh yeah, I also decided to make every effort to just be content with me in the interim.

    It was worth a try.

    Two weeks later, I met Harry. And just like that, I felt a different reason to strive other than me. Because finally, after all of that studying and trying and worrying and praying and waiting and achieving, I'd found the pièce de résistance. The one I'd been hoping and praying for. I'd found a love for my soul.

    And sure, it probably sounds nauseatingly cliché, but that's okay. Because love does that to you. Especially a love for your soul.

    Now that's a reason to do the Snoopy dance.
    A love for my soul that led to two bonus loves for my soul.

    So this one's for you, Harry.

    Thank you for being a love for my soul
    and the best and most important achievement I never studied to attain.

    ~ K.M.
    Now playing on my mental iPod. . . .

    Sunday, December 19, 2010

    To you.

    Good morning.

    Happy Sunday.

    Letting go.

    *details changed/omitted. . . but written with permission of the patient.
    The greatest of these is love.

    "No matter what the people say. . . . I can't let go."

    from Anthony Hamilton's "Can't Let Go"

    This is ridiculous.

    This is what I said to myself while reviewing the chart of one of my recent inpatients. I let out a sigh so exaggerated that three nurses looked in my direction.

    This critically ill gentleman with a ruthlessly aggressive and irreversible malignancy that was clearly declaring itself victorious over his young body wasn't tolerating yet another chemo regimen. I shook my head as I scrolled through his labs. Evidence that every one of his organs was failing was even more apparent.

    Despite a prolonged hospitalization, multiple chemo regimens with abysmal complications, and terrible relapses, a stubborn elephant was standing squarely in the doorway leading to his room. This man was dying.

    But like many elephants in rooms, not many people wanted to acknowledge it. Especially since it involved the "d" word.

    "They cannot be serious, " I mumbled under my breath at the computer screen.

    I was referring to the two guns blazing, horribly noxious chemo medication he'd just been started on that morning by the specialists. It would be sure to make to make him feel like crap. It would likely make his failing kidneys fail more (which would make his failing lungs fill with more fluid and fail more.) Furthermore, it would also be likely to cause some of his final days to be inhabited by nausea so intense that one might liken it to having their insides turned inside out. I hated to see him tortured when the prognosis was so poor.

    The other thing was that, despite his critical state and the unlikeliness of a meaningful recovery, his chart still indicated that all heroic measures be performed in the event of a cardiopulmonary arrest. Patients in this stage of disease often sign a "do not resuscitate" order--or as one of the Grady elders once put it to me, a "let me go in peace" order. But not this patient. I was determined to give him the courage to change his mind.

    We talked for several minutes about all that had transpired over the last several weeks. I talked to him about the disabling side effects of the chemo regimens only to be followed by gripping setbacks. Over. And over. And over again. I wondered if he knew that it was okay to say, "No more."

    "What do you want?" I asked my patient in a quiet voice.

    "What do I want." He said it as a statement and not a question. Like he needed to let it marinate.

    I cast my eyes downward toward his left hand that rested in my own. I couldn't help but notice his identification band; reminding me of what was so unfortunate about this situation. A man with a date of birth that was well after my own had to decide what he wanted. Or rather how he wanted to die.

    "I know what I really want," he murmured with a sideways smile. I widened my eyes and encircled my fingers around his puffy hand. His rich chocolate skin was smattered with bruises from blood draws and capillary blood leaks. "I want. . .I mean. . . I don't want to die. That's . . . that's what I want. I want to live."

    Those words were like a dagger piercing me straight down to the white meat. This young father with a life full of unfinished items to cross off of his bucket list simply wanted what we all want. To live.

    I didn't know what to say.

    I watched his laborious breathing and tried not to notice his distorted body; all a result of the massive fluid that his failing body was accumulating. Beeping machines surrounded him and we did our best to ignore them.

    Just then, a phlebotomist came in in and wrapped a tourniquet around his arm.

    "Hey friend," she greeted him in that familiar tone only achieved through repetitive encounters.

    "Hey, vampire lady," he responded with a weak chuckle.

    She quickly plunged the needle-tipped vacutainer into the crook of his right arm. Methodically, she gently attached one glass tube after the next. She met my eyes for a fleeting moment; we both recognized how awful this was. The blood rolling against the sides of the container hypnotized me for a moment. Finally, I shook my head and came to.

    What are we doing? I asked myself.

    Chiming alarms. Tangled tubing. And someone jostling him from a quiet slumber to draw his blood every eight hours. All for what? I closed my eyes and swallowed hard. This sucked. Why were we doing all this to him? This gentleman was dying.

    "Okay, friend, that should do it." Vampire-lady carefully removed the rubber tubing from around his upper arm and placed a bandaid on the oozing site. It would surely bleed out and around that bandage considering his failing bone marrow had robbed him of platelets and his failing liver wasn't making clotting factors.

    "One of these days, you gon' stick me and nothin' is gon' come out." He laughed, not really realizing the irony of his joke. She also laughed, but it was that pained, gallows kind--like that nervous laughter when someone is on their way to the electric chair.

    "Alright then, friend," she finally responded before leaving. I decided that I liked the way she called him "friend." I heard the lyrics to the old Kenny Loggins song briefly on my internal iPod:

    "Whenever I call you friend, I begin to think I understand. . . ."

    He looked like he was falling asleep. But his breaths were so fast and taxing that I knew it wouldn't last. He startled me when he returned to our initial conversation.

    "I want to live. That's what I want. So whatever they have to give me, I'm gonna take it."

    Of course.

    That's what I want, too. I want you to live, too. But the fact is that your body is dying. God is trying to take you home. And short of Him changing His mind, He'll get His wish regardless of what you're offered. And since I had no panacea, I was looking for the next best thing--a peaceful journey to the other side.

    So far, it was anything but.

    The zealous therapy being offered to him by the specialists hurt me to watch. To me, every toxic bag of experimental, last ditch medication hung on his IV pole translated to time away from his son and his wife. In my heart, I felt he wanted permission to let go. But since I was on a totally different page than my colleagues, there was very little I could do.

    "You got a cure for me in your pocket?" He bravely smiled. I wished that I did.

    At that moment, a nurse walked in and pricked his finger for a blood sugar measurement. I cringed, recognizing that even this--a simple piercing with a lancet to his middle finger--was more than I wanted him to endure. The nurse seemed to intuitively know to respect our "moment."

    I squeezed the brown pillow that had once been his hand, and put my other on his bony shoulder. His eyes closed in what seemed to be unison with my own. Before I could talk myself out of it, I uttered an internal prayer.

    It was all I had left. It may not have been completely appropriate but this was out of our hands. And in knowing that, I felt the need to be obedient.

    I opened my eyes just in time to see him mouth the words "thank you" while tightening his grip on my hand. I nodded slowly.

    The alarm bells went off on his monitor signifying that his respiratory rate was high. I pressed the "silence" button. A minute later it sounded again.

    "What do you want?" he finally asked me.

    "Excuse me?" I answered, surprised by him turning the question on me. I pushed the yellow silence button once more, hoping to get out of it.

    He repeated. "What do you want." Again in that same statement-like way. I decided to let it marinate, too.

    My eyes threatened tears as his bloodshot eyes pierced me with a tenacious gaze. What did I want? Was he serious? My heart was screaming:

    I want you to live!
    I want you to be cured!
    I want you to put a boutonniere on your son's lapel on his wedding day!
    I want you to argue with your wife over names for your next baby!
    I want what you want!

    I softened my brow and pressed my lips together to fight the mounting emotion. Finally, I offered him a childlike shrug and said, "I don't know. . .I just want. . . .I just want you to have. . .a death with dignity. That's what I want at this point."

    "I'm dying for real, ain't I?"

    I pressed my lips even harder and nodded. My eyes stung with tears. "Yes. . . " I paused to keep from crying. "I'm so. . . sorry."

    "Me, too." We stared at each other for a moment. This young man--nearly ten years my junior--with the perfect smile and twinkle in his eye was dying. This husband, this father, this brother, this friend with skin of the same striking dark brownish-reddish hue as my Isaiah's was being called home. And there was no denying it.

    "I know I'm sick. . .but. . .do it make sense that I just can't. . . you know. . .put it in writing for y'all to not do anything for me? Like not revive me? I'm just. . .I just can't. I gotta keep fighting."

    "Even if it means. . .dying in. . .dying in the hospital?" There. I'd said it out loud. The 'd' word.

    "I don't want to die in the hospital."

    "But you could. Attached to all this." I reached over and silenced the alarm again.

    "I know." He sighed hard. "But I just can't. See, tha's what's hard. I just can't say 'no more.' I gotta go down kicking and screaming. For my wife. For my son. It probably don't make no sense to, but I just can't make myself do nothing else. I just can't let go."

    And the truth is, it did make sense for a young father of a son that looked just like him and husband of a doting wife to want to "go down kicking and screaming." To have trouble with letting go. That's when it dawned on me.


    Even though my agenda that morning was to get him to "have the courage" to halt all aggressive measures and get home to his family for his final days, I had to acknowledge what was true all along: He was courageous. Who did I think I was--marching in there with my agenda to "give him courage?" Me give him courage?

    Love had already done that.

    This was his decision, not mine. And just maybe, a death that takes place in a hospital bed surrounded by beeping devices while fighting tooth and nail to the bitter end--for him--was a dignified death. I let go of my agenda and decided to respect his.

    The alarm relentlessly sounded again, and again I pressed that yellow square. 60 more seconds of peace and quiet. It was the least I could do. I watched him as his eyelids floated downward and decided to ease toward the door.

    "You know what I really want?" he broke the silence, startling me again.

    I paused with my hand on the door. "Sir?"

    "I think. . . .I think right now I just want something to help me get a little sleep and to help me move these bowels." We shared a quiet chuckle.

    "Alright then, friend," I responded before leaving his room.

    Alright then, friend.

    Take a moment to reflect on courage. . .and to listen to Anthony Hamilton's haunting ballad "Can't Let Go" here.

    Friday, December 17, 2010

    Work shoes.

    "That's hot, babe."

    Okay, so here's something I deal with in my household:

    My (wonderful) husband believes that any shoe that is less than 17 inches tall should be reserved for work. When we went to the Jay Z concert a few years back--I kid you not--Harry had to give me a horsey back ride all the way to the car when it was over. Yes. He carried a grown woman for like six blocks, man. To this day, I do not feel guilty as I maintain that I was 100% taking one for the team when I got myself dressed that night. ("The team" = Harry.)  
    There's just something about dolling up in heels that makes my husband's heart go pitter patter. And I'll admit--I like to make his heart go pitter patter. (Even if it renders me in need for emergent orthopedic surgery.)
    Happy spouse, happy house.
    Dreadful platforms with a wooden heel? Perfect for a night on the town. Darling little kitten heels? Fuggeddaboudit. If it ain't "car to bar"-- my husband deems it a "work shoe."


    That said, my usually uber-sweet husband takes great pride in unleashing some real zingers on me when it comes to my collection of quasi-fashionable work shoes. (Good thing I have such a positive self image when it comes to my "orthotics.")

    "Aren't these cute, babe? Come on!"

    "Yeah. Cute if you're going to Grady."

    "I get a lot of compliments on these, you know!"

    "Uuuuhhh, okay."


    So today I'm reflecting on work shoes and what they say about you before you even utter a word. . . . here's my take on it. . .complete with a nice little Harry commentary for your entertainment.

    "Work shoes?"

    "People really compliment those?"

    This shoe says:
    • "I am rounding but I still would like to maintain at least one iota of style.
    • "However, that style must also be vomit-proof hence the shiny finish."
    • (If you ask Harry) "I am on my way to go work in a hospital in my fashion-orthotics."

    "Nice little shoe to wear to walk to breakfast on Saturday."

    This shoe says:
    • "I am a wannabe chic resident or an intern who is on call today."
    • "And I am hoping and praying that my attending is not 50 or older or else I will be chastised about these shoes."
    • "I don't run or do any form of exercise."
    • "I hope that the really, really cute (fill in the blank) will notice how cute I am in my cool sneaks and start crushing on me."
    • "I hope that my belligerent and inappropriate patient in restraints will not notice how cute I am in my sneaks and start hitting on me."

    "I hope that's for work."

     This shoe says:
    • "I know, I know. . . I'm working in the hospital. But can't a girl still wear a heel?"
    • "Even if it's a lame, Mary Poppins-esque heel, it counts."
    • (If you ask Harry) "I am on my way to work. Why else would I own this shoe?"
    • "And especially, if it weren't a work shoe . . . .why would you own this shoe in two different colors?"
    "The only thing worse than that shoe in black is that shoe in brown."

      "That's a nice work shoe, babe. . . "

     This shoe says:
      • "I am secretly the Carrie Bradshaw of the hospital--wearing my 3+ inchers to Grady like it ain't nothin'!"
      • "But seriously? I'm really here to sign a few charts and sit in a meeting. Otherwise I would require another horsey back ride out of the hospital."

        "Uggh. Orthotics."
      This shoe says:

        • "I am an intern."
        • "I am a resident."
        • "I am an ER doctor."
        • "I am a nurse who is at work."
        • "I am an attending who just had bunion surgery or who has plantar fasciitis."
        • "I am a medical student who wants to 'look the part' on my clinical rotations so I bought a $130 pair of horrid shoes with adorned with staples."

        steely glare without comment

           This shoe says: 
          • "I just quit my job at the hospital or withdrew from medical school so don't care if you see me in these."
          • "I compost." 
        "Grounds for divorce." ~ Harry

        Wednesday, December 15, 2010

        Nothing is Something.

        Nothing on a Tuesday night.

        If being a doctor at a place like Grady Hospital doesn't teach you anything, it teaches you this: Every moment that you have is not promised.  In the twinkling of an eye, you might find yourself longing for the everyday monotony of "nothing going on." 


        That's what I'm reflecting on today. The zen of everyday nothingness. . . and slowing down to savor just that. I am hitting pause on the questions like
        • Am I reading enough to my kids?
        • Is this TV show too mature?
        • Are commercials bad for kids to see?
        • How come my husband only wants the most expensive razors when the CVS brand is fine for my legs?
        • When will I make time to practice Spanish on that Rosetta Stone software that I was so excited to get?
        • Why won't my kids stay in their own beds?
        • Is my exercise routine too routine?
        • Why don't I manage my calendar better?
        • How much is too much to pay for a pair of shoes?
        And so on, and so on, and so on. . . . .

        There are people who long for questions like these to fill their brains instead of the life or death ones. . .or the painful ones.  So today, I celebrate the mundane. I am taking joy in waiting for school buses and heating up leftovers and clipping fingernails of squirming pre-schoolers and nearly jumping out of my skin when a toy dragon growls at me in the middle of the night. Because to many. . . .nothing. . .just the chance to have a day filled with nothing. .  .would really be something.

        Want an even better reminder? 

        Watch this awesome video celebrating the brave life and the wisdom of the late Elizabeth Edwards. (Thanks for sharing this, Becs.)

        Monday, December 13, 2010

        The Internship Chronicles: Cumulus Clouds

        *names details changed to protect anonymity. . .yadda yah. . y'all know what's up!
        cloudy with a chance

        I'm not sure why, but these days, I have internship on the brain. . . .

        (squiggly fingers as we go back in time, anyone?)

        Black cloud: (n) A doctor or nurse whose very presence near the wards, clinic, ICU or emergency department, by definition, guarantees a.) multiple new hospital admissions b.) a few very, very sick patients that are just sick enough to keep everyone terrified until sunrise, c.) a random catastrophe such as 35 college kids being brought in by ambulance after a backyard deck collapsed during a keg party or 8 people getting wretched food poisoning off of Ain't Jenny's potato salad. . . .or of course d.) all of the above.

        White cloud: (n) A doctor or nurse whose very presence near the wards, clinic, ICU, or emergency department, by definition, guarantees a.) virtually no admissions that evening, b.) very few patients with extremely straightforward problems such as a ringworm, a diaper rash, or head lice, c.) or a medication refill for something that is non-narcotic that their (totally privately insured) patient knows the exact dosage, route, and frequency of, or d.) all of the above.

        old school beeper (back when "14" was the way to say "hi.") Yeah, baby.

        First Year, Med-Peds Internship: Medicine Ward Month, circa January 1997

        "Hey, Kim. I'm down in the cafeteria eating dinner. Care to join?" asked Julia, one of my co-interns on call on another floor that January evening.

        I looked at my nerdy calculator watch (I used to calculate a mean GFR back then. . . ) and furrowed my brow. "Dude! It's only 6:15! You're already eating dinner?"

        "Yeah, man. Mike is covering us and he's a black cloud," I heard Julia saying as I imagined her leaning against the bank of phones that lined the back wall of the cafeteria. "This may be our only chance for chow, dude. Then again. . . .I'm pretty much a white cloud, so maybe my good luck will cancel out his." We both laughed.

        I sat there for a moment and pondered that statement. Julia was right. Everyone knew that the senior resident covering us, Mike, was always in the eye of some kind of storm. A future critical care doctor, there was no doubt about it--this maverick of a resident was as fearless as he was smart. I thought about the other two calls I'd had under his watch. The most memorable occurred not even two months into my internship. This man with pneumonia started out coughing up scant streaks of blood in the emergency department. By the time Mike and I got him upstairs and admitted to the floor, he'd begun hocking up big red lougies. A few moments into us taking the admission history with our TB-proof N-95 masks on, the guy looks at Mike and--I kid you not--starts spraying what looked like buckets full of blood up from his chest and out of his mouth. It looked like something out of a horror flick.

        If "O.M. (expletive) G!!!" had been a popular thing to say back then, I assure you that's exactly what I would have said. Instead, I alternated between mouthing "wow" repetitively and being a frozen statue of fear, intensely hoping that this Mike character had at least one clue about what to do next so that there'd be at least one clue between the two of us.

        "Turn him right side down!" Mike ordered to the nursing staff in the most sure way ever. Two seconds later, the patient had two large bore IV's in place, Mike was holding a 8 fr endotracheal tube in his right hand preparing to intubate him, and a big metal blade in the other. Four seconds after that, he had a developed stat portable chest x-ray in his left hand that helped locate the source of the bleeding and the position of the endotracheal tube, was writing orders with the right and already had a pulmonologist en route to perform an emergent bronchoscopy. You had to be there, man. It remains one of the dopest, raddest reflex responses to a patient catastrophe that I've ever seen in real life. (Kind of like the way people have all the right answers on those hospital dramas, but this was an actual doctor unscripted--not George Clooney or Noah Wylie.)

        Yeah, Mike was a black cloud. I took Julia's advice and joined her in the cafeteria for chicken pot pie and tepid coffee in the 6 o' clock hour.

        "I don't know what kind of cloud I am," I told Julia as I poked at a strange piece of meat in my pot pie with a plastic fork.

        "Weren't you in the hospital with Mike the night that man with TB exsanguinated on 9B?" She was referring to the aforementioned patient who spewed blood from his chest like a fire hydrant.

        "Yeah, that was me," I replied.

        "Wait. . .and weren't you there that day that woman came in with the platelet count of 1?"

        "Uuuuhhh, yeah. . . .I sure was. That night was crazy. But she did okay. That lady was so nice."

        "Dude," Julie stated matter-of-factly, "You are totally a black cloud."

        "I did get 14 admissions one night on the Peds wards a few months back," I added, strangely proud of this record. For a fleeting moment, I remembered the three different baby Velasquez-es that I cared for that night--all under one year old and all with brochiolitis. Even though I knew their first names were different, it was scary to imagine mixing them up. That was one rough night.

        "Sounds crazy, but consider yourself lucky. Black clouds become bad ass seniors later. Nothing scares you when you're used to all hell breaking loose all around you all the time. You and Magic Mike might just be like one big ol' tornado cloud."We both chuckled again.

        Suddenly, a pager going off interrupted us. I looked down at my pager and then back up at Julia with a big smile. She checked her quiet beeper and gave an exaggerated stretch signifying the sleep she'd be sure to get based upon her track record.

        "Cumulus clouds, baby!" she chided as we gathered up our trays and prepared to leave.

        I shook my head and scurried off to get my first admission from "Magic Mike."

        The admissions and the pages came steadily, like clockwork, all night long. We admitted patients under a "firm" system--which meant there were no guarantees for equal distribution of admissions. That night? Five for me, none for Julia. Chest pain. Pneumonia. Altered mental status. Neutropenic fever. And the cross cover calls. . . .they just kept. on. coming. Patient awaiting discharge now has a fever. Sudden need for more oxygen in another. It just didn't stop.


        But that's okay, I had Magic Mike bumping clouds with me. A six foot tower of teaching and supervising power. (Not to mention the fact that he was easy on the ol' eyeballs to boot which made for some very inappropriate commentary on the part of Julia and me at times. . .but I digress. . . ) Yeah, but Magic Mike was dope. The total "Cool Hand Luke" of senior residents, and I was glad to be his underling that night. I secretly hoped that someday an intern would feel the same way about me.

        Finally, after the steady barrage of four worrisome admissions and horrid cross cover calls, Mike gave me my final new patient of the call: an early morning yet super basic case of a vaso-occlusive pain crisis in a young patient with sickle cell anemia. Thank goodness! Bread and butter medicine!

        "How is your pain on a scale of 1 to 10," I recall asking my terrified young patient.

        "A nine. . ." he whimpered quietly.

        "Okay. We're going to be getting you some more pain medicine on a pump in the next few minutes. This way you can push a button to get it on demand. How is your breathing?"

        "It's okay," he panted back between shallow breaths splinted by pain. His eyes were like brown saucers and his teeth were chattering.

        He didn't look okay. He looked sick. And not just sick. He looked sick sick.

        I remembered the advice that I'd always been given in such instances: Keep coming back to do serial examinations. I finished my work up and my orders for pain medications, fluids and antibiotics and made a plan to come back to see him in one hour. I stole away to an empty patient room just three doors down for a few moments of shut eye. Exactly thirty minutes later, I received a page.

        I sat on the edge of the bed, rubbed my eyes and called the number back--all the while secretly praying that someone needed an emergent stool softener and nothing more. Fat chance for a black cloud like me.

        "Kim, it's Lisa. I need you to get over here. Now. Mr. Jackson. . .this kid is just not right. . . "

        Lisa, one of our very best nurses, knew a sick patient when she saw one. I knew she was talking about my final patient, Mr. Jackson. I didn't even say good bye --when Lisa said "jump" to an intern, the proper response was "off of what building?"

        When I reached Mr. Jackson's bedside, his entire face was covered with a non-rebreather mask pumping 100% oxygen into his mouth and nostrils. He was leaned forward in a tripod position and working with all of his might to breathe.

        "Mr. Jackson?" I greeted him. He looked up at me with extremely tired eyes. He had a right to be pooped--he was breathing more than thirty times a minute. I placed my stethoscope to his chest and heard what sounded like someone blowing bubbles into a cup of milk with a straw. Shoot!

        "Mr. Jackson!" I addressed him again. But this time he just slunk down toward the pillow and closed his eyes. I grabbed his shoulder and shook him. "Mr. Jackson!"

        Before I could even get scared, sirens were going off above my head and people were swarming the bedside. Everyone that arrived seemed to be equally as junior as me, which 100% freaked me out since there was no one to defer to. Julia was placing a femoral line. Another intern was attempting to get an arterial blood gas. And at the head of the bed stood me and my black cloud--this time with the blade in my left hand and an ET tube in my right.

        Totally tubular (image credit)

        The respiratory therapist clenched and released the ambu bag that forced the breaths into my patient's chest that he couldn't make on his own. I kept straining my neck to see if someone from Anesthesia would come rushing in to save me from intubating this patient, or even better, Magic Mike to appear in the doorway. "You ready, doc?" asked the respiratory therapist in a tone that sounded far more like a statement than a question. Lisa the super nurse locked eyes with me from the med cart and spoke for me:

        "She's ready. Let's go."

        This would be my very first intubation on a real, live, non- plastic human being. My heart pounded furiously as I stared at the quiet face of this twenty-something year-old young man who was depending upon me to get this right. Lisa sensed my angst and came directly to my right side after pushing Versed to settle him.

        "Eyes on the vocal cords. . . . " I coached myself.

        "You got this, baby," Lisa whispered.

        ". . .vocal cords visualized. . . . ET tube please. . . . ." Thump-thump. Thump-thump. I was certain I would have a heart attack. Or wet my pants. Or both. Please don't eff this up, Kimberly. Please don't eff this up. He's only twenty. Oh my gosh. Please don't eff this up. Despite what my mind was saying, I tried my best to look calm--doing my very best impersonation of Magic Mike. ". . .okay, guys. . . I'm in." I stepped back and let the respiratory therapist connect the tube to the ambu bag.

        "Good job, sweetie," Lisa kept coaching in my ear.

        And right then, after gazing at those pink vocal cords for dear life, I blinked for the first time in two minutes, losing my left contact lens from one of my bone dry eyeballs. Toric ones, too. Damn.

        Just as the respiratory therapist connected Mr. Jackson to the carbon dioxide detector, Magic Mike bounded in gasping. "Shit. What happened?" It was obvious that he'd just run up several flights of stairs.

        "You're in, doc," confirmed the RT after looking at the carbon dioxide changer, this time a statement--no question about it. I offered her a smile of relief.

        "The chest x ray is completely whited out," I told Mike, "I think it's either acute chest syndrome or maybe ARDS from a bad Pneumococcal pneumonia, but it evolved pretty fast. He lost consciousness right in front of me and Lisa."

        "Did he lose his pulse?" Mike queried with worry in his eyes. "Gosh, he looked pretty good when I saw him."

        "No, he never lost his pulse. It was all respiratory and witnessed. He'd been on a non-rebreather for a bit and just crashed. We ordered blood and called the Hematology fellow. She's coming in." I thought for a moment about my first encounter with Mr. Jackson, and how I struggled with whether or not he was sick. . .or sick sick. Now I knew that answer. He was sho' nuff sick sick.

        "Damn, I'm sorry, Kim," Mike apologized. "I was drawing blood cultures in the skilled nursing facility when I heard the code. Dude, I'm so sorry. I'm so glad you guys had it under control."

        With my one good eye, I watched the ICU team whisk Mr. Jackson down the hall as the respiratory therapist bagged breaths that sounded like rhythmic sighs. "I hope he's okay. I never should have left him. I was so tired and I wasn't sure what else to do. I guess I should've called you." I said quietly.

        "You were right on the floor, Kim. With such a rapid response by everyone, hopefully he'll do okay." Mike began walking backwards to catch the elevator. "You done good, kiddo."

        Once things were quiet again, Julia and I stood outside the doorway, sort of in an intern daze. Lisa passed by and patted my shoulder before going to give report to the nurses coming in for the morning shift. "Good job, Kimmy."

        "See?" Julia said with an eyebrow raised.

        "See what?"

        "Told you it was good to be a black cloud. I probably would have given him a foot rub and fluffed up his pillow." She laughed softly, but I could tell she was somewhat serious.

        Julia had been scarce that evening. Not because she was lazy or anything. . . she was just. . .a white cloud. I studied her obvious bed head and took note of her throaty voice--all signs of someone who'd gotten some sleep. I glanced at the snow-covered cars now visible in the top deck of the parking garage as the sun rose in the window behind Julia's head. I had officially been up all night. After a much-needed back stretch, I shook my head and yawned.

        "Lucky you, man," I teased Julia.

        She reached toward me with her right hand and delicately plucked what was my contact lens from my left cheek.

        "Here ya' go, three blind mice."

        I smiled gratefully as she placed what now looked like a tiny piece of Saran Wrap into my cupped hand. "Thanks for the help with that line placement, chica."

        "Ha. It was the least I could do."

        I hi-fived her with my free hand and we bid each other adieu. All was finally quiet on the mid-western front.

        After a prolonged hospitalization in the ICU and ward, my 5th admission, Mr. Jackson, was discharged home. He had a full recovery and celebrated his 21st birthday a few months later.

        Almost fifteen years later, I now know that Julia was right. When you're a trainee--as crazy as it sounds--you probably want to be a black cloud. Because just maybe enough of those stormy nights might set you and your patients up for cloudless skies later.

        Just maybe.

        Sunday, December 12, 2010

        When I was an intern. . . .

        Today I'm reflecting on my internship. . . 1996. . . .back in the day. . . (insert wiggly fingers here as we go back in time)

        When I was an intern. . . . 
        • I didn't have an email address.
        • Or a working cell phone that wasn't the size of a football or that didn't cost $500 per second. 
        When I was an intern. . . . .
        • Clinical questions were explored in the big fat textbooks that sat on the shelves of every ward. (Up-to-date? Chile, please.) 
        • I read the Washington Manual so many times that I could tell you what page you could find "management of gastrointestinal bleeding" without even opening the book.

        When I was an intern. . . . 
        • "Duty hours" was this obscure thing you heard of occasionally mentioned with regards to training programs in New York state. They allegedly had some rules about how long one could work (although no one I knew in New York state was following any kind of rules regarding them back then. . . .)
        • Post-call (meaning: you've been up all night admitting sick patients) essentially meant very little to anyone besides you.
        • Nobody cared if you were speaking in tongues or writing in hieroglyphics at 4:35 p.m. during post-call sign out rounds due to lack of sleep. (Or if you had clinic the following day.)
        • "You okay with sticking around a bit longer?" was not an unusual thing to hear at 1pm after being up all night-- when the only alternative to eking out a tiny "o.k." was to swallow hard and blink fast until you no longer wanted to fall to your knees in tearful exhaustion. ('Cause you knew that if you dared protest, you'd hear a soliloquy that starts with "When I was an intern. . . .")
        When I was an intern. . . .
        • I once (stupidly) took call two nights in a row because my co-intern and I both wanted an entire weekend off during our "one in three" call schedule month.  (Translation: I worked more than 48 hours straight. Not. Smart.) That Sunday morning while rounding with my attending, I recall him saying, "Who's the on-call intern?"  "Me."  "Uh, okay. So where's the post-call intern?" "Also me."  "Uhhh, can you do that?"  "I think so."  "Uh, okay.  Who do we have first on our list?"
        • I was so tired on that Sunday that I had to call a friend to come and drive me home.
        When I was an intern . . . . 
        • I practiced presenting my patients in the car on the way to one of my ICU rotations because I was so intimidated by my take-no-prisoners attending that I felt it was 100% necessary.
        • Case in point: That same attending in the ICU held his hand up to his ear in the middle of my patient presentation one day and said, "Ssssshhhhhh! Do you hear that? Listen."  Everyone looked puzzled and tried to listen to whatever he was talking about. He then narrowed his eyes and exclaimed (yes, exclaimed), "It's the sound of your patient yelling around his endotracheal tube, 'Help me! Help me! This intern is trying to kill me!' " This was followed by a laugh that originated from so far in the deepest parts of his belly that I thought it would never end.  Um, yeah, so that's why I was practicing my oral presentations on the way to work. . .
        • The only comforting thing about that ICU month was that this same take-no-prisoners attending did not discriminate when divvying out the insults. One of my all time favorites remains: "Do you know what this patient would say if she could talk?"  "No, sir."  "She'd say, 'Somebody save me! I'm surrounded by a group of snot-nosed intern assassins!' "  
        When I was an intern. . . . .
        • On my ER rotation in December of 1996, I was scheduled for twenty-two "twelve hour" shifts. (My four clinic sessions were folded into two full-day sessions--on my OFF days. Nice.)  
        • Oh, in the aforementioned month? Nearly all of my shifts were from 2pm to 2am--exactly perfect for making certain that I had no time for any possible meaningful contact with anyone not requiring stitches, IV fluids or a splint.  
        • Whoops, I almost forgot. I did get one shift that wasn't from 2pm to 2am--Christmas Day--which was 10am to 10pm. Exactly perfect for guaranteeing that I would have no time to do anything remotely exciting before work or make anybody's celebration after getting off. 
        When I was an intern. . . . . 
        • I burst into tears on rounds after my attending kept pimping me on obscure pharmacology questions post-call. 
        • I cut the back of my hair with a pair of Fiskars from my sewing kit because I didn't have enough time to go to a professional. (And actually had such a distorted view of style that I thought it looked pretty darn good.)
        • Blinked out my left contact lens every single time I intubated someone. ("Eyes on the vocal cords. . . steady, steady. . . . and I'm in!" Blink. "Damn.")
        When I was an intern. . . . 
        • I fell asleep in my car in the parking lot post call. In Cleveland, Ohio. In the winter. (Fortunately, a security officer tapped my window and woke me up before I developed frostbite.)
        • I called my chief resident after the first big snow and asked what I should do about coming in. My chief laughed so hard that I was sure he would tear an intercostal muscle somewhere. That was the answer to that question.

        When I was an intern. . . .
        • I learned so much that I thought my head would explode.
        • I was often more terrified than I had ever been in my entire life.
        • I made some really, really great friends who sometimes carried me away from the battlefield on those days when I could no longer walk for myself.
        When I was an intern. . . .
        • I cried so hard when I lost my first patient that I wondered if I was cut out for this profession.
        • I sometimes wasn't sure I'd make it. 
        • I prayed. A lot.

        Funny how much has changed since I was an intern. New rules, new war stories.  . . . but some things remain the same no matter when you trained or how gruesome your personal version is of the "when I was an intern. . . ." saga:

        You learn.
        You try.
        You grow.
        You cry.

        And if you're lucky. . . this doesn't end when you finish your internship.  :)

        Thursday, December 9, 2010


        Pa Pa do preach.

        Love this picture of my daddy speaking to my son.


        It takes a village, man. . . . . . . . . and a fanny pack.


        "Rise in the presence of the aged; show respect for the elderly. . . ."

        ~ Leviticus 19:32

        Tuesday, December 7, 2010

        Cultural competency.

        The following conversation between Isaiah and me took place tonight on the floor next to our Christmas tree:

        "Hey Mom. . . . wanna see something cool?"

        "Sure, bud. What's so cool?"


        "Jon gave it to me."

        "That was nice of him."

        "Do you know what this is, Mom?"

        "Uhhh. . . .yeah, son. I'm pretty sure I do know what it is. Do you?"

        "Yeah, Mom. It's a dreidel. You spin it and see where it lands."

        "Okay. . . "

        ". . .and then, if you're lucky, you get some money. But not regular money."

        "Oh yeah?"

        "Chocolate money."

        "Sounds like my kind of money."

        "Do we have any chocolate money around here?"

        "No, Poops, we don't."

        "Well, how are we supposed to play the dreidel game then?"

        "Uuuhhh, I'm sorry, bud. I didn't really expect us to play the dreidel game this year. . . ."

        "You know, Mommy. . . ."

        "Uh huh?"

        ". . .. anybody can play the dreidel game. You don't have to be Jewish, don't ya know."

        "Well, that works in your favor."




        "What country are you from if you're Jewish?"


        "You can be from anywhere. It's a religious faith, not a nationality. Kind of like how we are Christians, but that doesn't have anything to do with what country we are from."


        "When I was in Mexico City last week, I met a lady in my hotel who was Jewish. She was Mexican and Jewish."

        "Was she celebrating Hanukkah?"

        "I'm pretty sure she was celebrating it when she got home. But it was her birthday. That's why she was there."

        "Oh. 'Cause we talked about celebrations in my class. That's why I asked."

        "These are good questions, Isaiah."

        Keeps spinning the dreidel.

        "But we share, though, right? Christian people and Jewish people do?"

        "Sharing is always a good idea, I think."

        "Jon let me have this dreidel on the bus. I said I would tell Santa to come visit his house. I need to add that to the bottom of my list. To go bring toys to Jon. Even though he got some gifts for Hanukkah already. A lot, actually, since Hanukkah lasts a long time."

        "That was nice."

        "Can I tell Jon 'Happy Hanukkah' even though I'm Christian?"

        "I can't see why not."

        "Okay. . . . . .but you know what?"

        "What's that?"

        "Tomorrow I'm gonna ask if he can give me some of that chocolate money, too."

        "Let me know how that works out for you."

        To my friends (from all countries) celebrating Hanukkah. . . .have a wonderful celebration!