Tuesday, May 11, 2010

Reflections from a new beginning: The Graduate

The Complete Package?
It is what it is. Or is it?

my medical school graduation photo, circa 1996
(Yup, that's me with ALL that hair.)

"When you know better, you do better."

~ Maya Angelou


The last few days have served as the celebratory swan song of our graduating medical students. Parties, events, gatherings, ceremonies. . . .it's a very festive time. They had a wonderful black tie dinner celebration last week, and I was honored to make the students' short list of faculty invitees. I felt terrible when I had to decline--but it was Isaiah's birthday that day, and I knew that (even though he was going to have a big party just two days later) home was where I needed to be. And so I said something like:

"Thank you for the invitation, but regrettably, I have to decline."

Sure, I fleetingly considered going for "just a little while" but knew that "just a little while" would turn into "Dr. Manning, you have to meet my mother" and then me looking at my watch and saying "I guess I can stay for the awards portion" and inevitably, a sheepish text message to my husband saying "I'm so sorry, babe, but it would be rude for me to leave. Be home soon as I can. xoxo." I felt conflicted that I couldn't be two places at once, but as terrible as I felt, I didn't allow myself to feel terrible enough to miss tucking my son in on his 5th birthday. And when I pulled the covers over him and heard him say, "Thank you, Mommy. I feel so special," I knew I'd made the right decision.

Colleagues and fellow faculty/mommies/Grady doctors, Joyce D. and Lisa B. in their regalia
at Emory School of Medicine Commencement, May 10, 2010

Yesterday was the med school commencement ceremony at Emory. It was, believe it or not, the first one that I have attended since joining the faculty in 2001. Watching all the students march in with their regalia on and with their families close by was quite a sight. The whole thing brought back tons of memories. Seems like only yesterday that I was the one looking in the mirror trying to perfectly position my cap. . . . . I remember much of that day quite well because it was pivotal for more reasons than just the obvious. . . . .

Two graduations in two days. . . .

When I graduated from medical school on May 19, 1996, it had been an exciting weekend. My younger sister, JoLai, had commenced from law school the very day before, and our entire family drove as a swift, proud caravan from her festivities in Birmingham, Alabama to my ceremony in Nashville, Tennessee. It was awesome. I'm talking really awesome. Pride oozed from my parents that weekend. I mean. . . . imagine how they must have felt. . . .literally seeing their two youngest kids finish professional school less than 24 hours apart! The third and fourth of their four children to receive terminal degrees. They could not stop smiling. Seeing how proud they were is a child's dream; the image is forever etched in my mind.

My classmates and I vibrated with excitement as we lined up and awaited our big moment. We graduated in this huge sports arena, but despite this, as soon as we marched into the large space, naturally, we each craned our necks with hopes of finding our families standing somewhere in the wings. Most could not make out their own amidst the sea of onlookers. Lucky for me, I saw my loved ones the minute I took my first few steps onto the slick wooden floor. There they sat in a row: my youngest sister, JoLai, the newly conferred juris doctor, my brother William and his wife, Francoise, who'd taken a similar walk in 1991 when they received their doctorates in Veterinary Medicine, ultra-proud Mommy and Daddy, both looking like they would vomit from the excitement, my oldest childhood friend, Kim B., and last but not least, standing on her feet applauding was my eldest sister and 1994 law school graduate, Deanna. That collective sight was moving. Everything about that moment said one thing to me: Complete. It should have been one of the happiest moments of my life. So why, then, did I suddenly feel so sad?

It is what it is. . . . .

Just two years before, my older sister, Deanna, entered her own professional school graduation and scanned an auditorium for those same smiling faces. The scene was likely almost identical--all were present, hooping and hollering, cheering and high-fiving--all but one member of our family: me. In May of 1994, I was in my final days of preparation for the first installment of the USMLE (U.S. Medical Licensure Examination) and was terrified to do anything that would take me away from studying--even for a moment. That included spending the weekend before the test with my family at my sister's law school graduation.

Interestingly, from the moment I made that decision until the day I finished medical school, I never felt like it was wrong. I deeply believed that this "sacrifice" was a necessary evil, and told myself (and my family) repeatedly that I just "had to do what I had to do." I was strangely proud of my resolve, and felt validated when I got notification that I'd successfully passed this critically important exam. I "did what I had to do," and "it is what it is" I repeated to myself and others over and over again. Although I was pretty convincing to most, a couple of people questioned me--but I could not be moved (or guilted) into doubting my rightness. Sure, my sister was graduating from law school, and sure, it was only a 3 hour drive away, but this is medical school, man. Medical school. Hey, man, it is what it is.

It was not until I placed my foot on that auditorium floor, head held high, and the room swirling with the first few notes of "Pomp and Circumstance" that something clicked. It did more than clicked. It clocked me in the head. The more steps I took, the more that fuzzy snapshot of my celebratory family quickly sharpened. That's when I got it. . . .the fact that all of my loved ones had made whatever sacrifices necessary to be there. . . . Will and Fran taking off from their busy Veterinary practices, Dad, Mom, and Deanna all flying from California, and Kim B. driving from North Carolina. It was like someone swiftly punched me in the chest, knocking my wind out. I gasped. How could I have not gone to my sister's graduation? I began asking myself. How could I not given her the experience of "complete"?

Now it seemed like Deanna was clapping in slow motion. . . . silently cheering and then exaggeratedly pumping her fist the closer I got to her. I could feel myself being strangled by shame and regret the more I watched her; genuinely proud of me and somehow forgiving the debt of me snubbing her from the very moment she was affording me. What's wrong with you? How could you have thought that was a good idea?

I cried throughout my entire ceremony, and got it together only to make my walk across the stage to receive my diploma. There is one smiling photo that I have seen of myself from when I'd left the stage (which I can't seem to find), but it in no way represents how I was feeling. My classmates all thought (being the drama queen that I can sometimes be) that I was overcome with emotion about finally becoming a doctor. What none of them knew was that I was in the middle of an "ah hah moment" and that I was learning a very important lesson.

My conscience was exploding: How could you have not been there? How could you have done this to her? You robbed her of her "complete". . . . and why did you think so little of yourself that you would actually believe that you could not have been there with your family and have done well? How can she be standing there clapping for you when you did this to her?

The thoughts were suffocating. I wanted nothing more than to get out of that seat on that row in that room and to run as fast as I could to my sister . . . .pleading with her and telling her that I was wrong. Terribly, terribly wrong. I repeated in my head what I should have said two years before: I'm so sorry. I should have been there. You mean more than a test. Our family means more than a test.

Later that evening, that's exactly what I did. I told her how sorry I was, and despite my best efforts not to, I cried hard right there in front of her (yup, the ugly cry.) Her response let me know how deeply hurt she'd been by my decision, and how long she had been waiting to hear those two words.

"It was only 3 hours away, Deanna," I eeked out between sobs, "3 measly hours. I should have been there, sister. I'm so, so sorry. . . "

"You didn't know," she replied gently, "You didn't know."

"Please forgive me." Suddenly I remembered how puzzled she sounded when I matter-of-factly told her that I wasn't coming during a brief board review study break phone call back in 1994. The thought of it made me cry even harder. "Please forgive me," I repeated. "I was so wrong. But you are right, I didn't know."

"I love you, Kimberly. Of course I forgive you," she said, "and I appreciate your apology. Even two years later. You have no idea how much I really, really appreciate your apology." She could of just said, "It is what it is." I continue to be thankful that she didn't.

What I know for sure

Deanna was right. I didn't know then but now I do know. I now know that I am smart enough and whole enough to do well professionally without shortchanging the other, arguably most important aspects of my life. I know that sometimes you do have to say "regrettably, I can't attend" but that there are also times that you must say "I will be there no matter what." I now know that "it is what it is" is no excuse for missing a milestone. As my former chairman, Dr. Blinkhorn, once told me before I moved to Atlanta, "There are times when your personal life must be paramount. The older you get, the more that is the case. The ones who seem to get this early seem to do the best overall." He was so right.

My hope for my students and residents is that they indeed care for their patients with all their might and attack all there is to learn about medicine with zeal, but never at the expense of family and important relationships. It's a bit of an oxymoron considering medicine is often a selfless pursuit. . . . . but again, it is those who maintain self who are able to give the most.

So in the end, my memory of graduation from medical school is bittersweet. Fortunately, I can say that it is more sweet than bitter. Beyond me officially becoming a medical doctor, it was a new beginning. . . . .and indeed a graduation. The start of me learning that honoring thy patient starts with first honoring thyself. . . . .and that honoring thyself involves honoring those who make your picture complete.

Me and Deanna at JoLai's law school commencement, May 18, 1996

Being there: Our COMPLETE family during another proud milestone
Grand Opening of Will's new veterinary practice, July 4, 2008

"When you know better, you do better."

~ Maya Angelou


  1. My sister and I will be graduating the same year in 2012 with a JD and an MD, respectively. I can't even imagine what my parents' faces will look like as we each cross the stage...

  2. . . .I can imagine it, Ant. I can.

  3. Good grief... first I listen to the StoryCorps with Dad & now this... Boo hoo!!! You wore me out today! Xoxo

  4. Dr. M,
    Thanks for always reminding us "student docs" to remember our priorities! I'll be heading to California the weekend before our last M1 exam to attend my little brother's college graduation and I KNOW I'm making the right choice :)

  5. Thanks Kim for sharing this very important lesson. Just in this one post you have inspired to do what I already know that I should be doing... Thank you from the bottom of my heart...on sooo many levels.

  6. That retrospectoscope is always 20/20. Fav quote: As my former chairman, Dr. Blinkhorn, once told me before I moved to Atlanta, "There are times when your personal life must be paramount. The older you get, the more that is the case. The ones who seem to get this early seem to do the best overall." He was so right.


"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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