Tuesday, June 29, 2010

Reflections on a Tuesday: Jeremiah's Eyes

*names, details, etc. changed. . . . .

Butterflies begin from having been another
As a child is born from being in a mother's womb
But how many times have you wished you were some other?
Someone than who you are?
Yet who's to say if all were uncovered

You would like what you see
You can only be you

As I can only be me.

from Stevie Wonder's "I can only be me."

I had just heard him presented to me by one of the interns on our team. A young man. . .not even legal yet. . . admitted with community-acquired pneumonia. "Double pneumonia" as some patients refer to it--the kind of aggressive lung infection that doesn't limit itself to only one lung or even one lobe. I stood tall, with my arms folded as the story unfolded before me.

"His white count is low," spoke the resident as the team stood in a semi-circle around the chart box, "like only two thousand." I nodded and continued to listen.

"If you calculate how many of those are lymphocytes, it's like not even fifty," added the intern.

"Do we know his HIV status?" I queried, considering one of the most likely causes of such a reduced white blood cell count. The team cast glances at one another, as if saying, I knew she was going to ask us this.

"He refused to be tested. . . and also denied every possible risk factor," the resident responded with an exaggerated sigh. "No matter what I asked, it was, 'Nope. Nope. Nope.' That's pretty much how the entire history went."

We wrapped up our discussion and entered his room to get more insight. I made confident, deliberate strides as the leader of my team; always believing that self-assured doctors make reassured patients. After passing by the first bed and pulling back the curtain, I froze. There sat a slender, young African-American man who could have easily passed for a pre-teen. I scanned his patient information. 20 years old. But it wasn't his youthful appearance that struck me the most. . .it was his troubled and lonely eyes.

He was, literally, shaking when we approached the bedside. . .vibrating beneath the she sheets. I did my best to relax him."Good morning, Mr. Foster. . . ." I smiled wide and cupped his hand in both of mine, "I'm Dr. Manning, the senior doctor on this team."

"Hi, Dr. Manning," he replied in a delicate and undeniably effeminate voice, "I'm Jeremiah. Call me, Jeremiah, okay?"

"Jeremiah," I repeated with a nod for emphasis. "What a strong name--Jeremiah. Okay. . .then Jeremiah, it is." He seemed to relax just a little bit which nudged me to continue. "Jeremiah, I heard a lot about you from my team. If you don't mind, I'm just going to recap what brought you into the hospital to be sure I have the story right. Is that okay?" He nodded quickly.

And so I narrated back to Jeremiah exactly what I'd been told. That he had been fine until two days ago when he started having shaking chills and coughing up something that looked like rust or blood maybe? That he'd never been sick before this. And that he'd never been hospitalized. Ever. Other than this pneumonia, he had never had any medical problems. He filled in the blanks with more information. Like the fact that he lived with his mother, and attended community college where he was studying to maybe be a nurse one day. That he sang solo in his church, and played a mean piano. Never smoked anything in his life, once tried alcohol and hated it, oh--and hadn't yet had his sexual debut. Ever. "Not even close," he said emphatically. His body was shaking again.

I listened as the intern explained to Jeremiah that he was being treated for a fairly extensive pneumonia. He was improving with our treatment, but his low white blood cell count was concerning. That sometimes people who have HIV can get really bad pneumonia. Had he ever been tested for HIV? Would he reconsider getting tested? Is he sure there are no risk factors we may have overlooked?

Nope. Nope. Nope.

We asked Jeremiah if he had any questions, and eventually left his room without much more insight or information on this man with the childlike face and the lonely eyes.

Later on that evening, I was standing at the nurses station writing a note just before heading out to pick up my kids. "Dr. Manning?" I looked over my shoulder and found Jeremiah timidly standing in the doorway. His narrow shoulders were wrapped in a hospital sheet, and his eyes were still sad and troubled. I took in his searching expression. The clock directly above my head had just creeped beyond the 5 o' clock mark.

"Hi, Jeremiah." I wanted him to hear me say his name, to know that he was worth remembering.

"Can I. . .do you have a minute to talk to me?" His voice was shrinking and now his body was trembling again. But I needed to go. Being late to daycare sets you back $1 per minute. But his eyes said, I need you. Those troubled, lonely, tired eyes. They needed me. I couldn't leave.

"Of course," I said while walking over to him. Crossing the threshold into his room, I dragged a chair over to his bedside and we both winced as it screeched across the floor. I mouthed the word 'sorry' and leaned onto my crossed legs with my elbows. Jeremiah settled back into the bed.

"Did you see I'm off oxygen, Dr. Manning?" He sounded nervous. Like this wasn't what he wanted to talk to me about. It wasn't what I wanted to talk about either. I took a deep breath and willed myself to be patient.

"That's really good. It's a huge step towards you getting out of the hospital."

"Oh okay. . ." His voice trailed off. I could feel myself getting anxious. $1 per minute for every minute after 6 p.m. The clock now read 5:14 p.m. . . . But his eyes. They are willing me to stay put. To wait. To listen. I swallowed hard and waited. He remained silent. But those eyes. . . .for some reason they seemed to be waiting just for me.

"Jeremiah, can you excuse me for one moment?"

Something told me that if he felt my thinly veiled attempt to rush him, that I might never have this opportunity with him again. I slipped out of the door to call Harry. "I have a situation here in the hospital. Can you pick up?" Harry groaned into my ear so loudly that I pulled pack the phone. "Babe, it's important."

"Babe! It's five-damn-thirty. I can't do it." ('Five-damn-thirty.' Oh, how my husband has such a lovely way with words.)

"Look, babe, it's important, okay?" Somewhere between another groan and the words, 'okay, but' he launched into his predictable Harry-style rhetorical questions. "So, when you need to work late, you can just call me at the 11th hour? When I need you to drop off without warning, can I just spring it on you? Can I just. . . . . " -- All that mattered is that somewhere in there, eventually, he said 'okay.' That was all I needed to hear.

I returned to Jeremiah's bedside visibly more relaxed and palpably more patient. "Okay, I'm sorry about that," I said gently as I settled back into the chair. His eyes still needed me. . . .

Then out of nowhere, Jeremiah looked at me and said, "Dr. Manning, do you like yourself?"

I turned the corners of my mouth downward, and grasped his question before answering. Then carefully, I replied, "Do I like myself? Yes, Jeremiah. I do. I really do." I pressed my lips together and paused for a second. "What about you? Do you like yourself?"

He looked out of the window wistfully. His dainty fingers were laced together over his abdomen. I could still see that he was shaking a little bit.


"Sometimes I wish I wasn't me. Sometimes." I waited to see if he would say more, but he just kept those lonely eyes fixated on some distant fixture in the Atlanta skyline. "Like. . . .somebody with different insides and feelings."

I could feel my every breath as I searched for the right thing to say or not say. I decided to keep waiting. I caught him looking at the ring sparkling on my left ring finger.

"You married, Dr. Manning?" I wasn't sure where this was going but I kept with him.

"I am."

"That's good. . . . " he murmured. His voice faded once again and came back. "If it was wrong to have feelings for your husband, Dr. Manning, what would you do?"

"Honestly, Jeremiah, I'm not in that situation, so it's kind of hard to say. . . . .are. . . you? In that situation, I mean?"

Without warning he buried his face into his slender fingers and began to weep. Hard. I reached out for his forearm, the closest thing I could touch. My first instinct was to start talking, but I resisted the urge.

"Dr. Manning?" he finally said with the trouble in his eyes reaching a painful climax. I opened my eyes wider fearing what would come next. I continued to hold his forearm in an attempt to brace myself just as much as him. "When I was in middle school, I used to. . . ." He started crying again and then slowly wiped his eyes with his palms. "I used to see a girl, and . . .and think. . .friend. . . or sister. . . ..but I would see a boy and. . ." Jeremiah's voice began breaking up with emotion.

"You're doing fine, Jeremiah. Doing fine, okay?"

". . I would have feelings for a boy like how you are supposed to like a girl. And I knew it was not right but I couldn't help it." He then let out this terrible, ashamed moaning cry that broke my heart. I was speechless. He sighed hard. "So when I grew older, I kept saying, I would stop feeling this way, you know? Like I kept asking to be changed into someone else with regular feelings, but I kept feeling like this. I would sing with all my might in church. Singing out to say sorry for feeling like this."

"Regular feelings? They're your feelings, Jeremiah." But this was more complicated than that.

"Why do I have to be like this? I didn't ask to be like this." He wiped his eyes with his forearm and stopped fighting the urge to cry. I waited patiently until the room fell to a hush.

"Does anybody know?" I finally asked.

"It would kill my mother. No. I haven't told nobody. . . .I never told nobody until now. . .I mean, my family is against that. Like they always suggested stuff, but they don't know. . . .nobody knows. . . ."

"So, there is no one. . .like, in your life?" I stammered.

"No . . . except there were some times that I did stuff. . .like. . .with . . .you know. " It was like he couldn't bring himself to say it, so I didn't make him.

"Somebody you knew well, or not so much?"

"Not. . .really at all. Like, more than once."

"You had sex?" He covered his face again and nodded.

"Okay," I said gently, "listen, it's not so much about if it was with . . .someone of the same sex as you. . .it is more about if you protected yourself and what you did."

"I didn't use nothing with none of them. I let them do everything. . . .but I wanted it . . that's bad I know. I just couldn't help it." Fat tears rolled down his cheeks again, his tiny neck being strangled with shame. He covered his face and shook his head again.

"It's okay, Jeremiah. It's going to be okay, alright?" I smiled and reached for his hand. "You are so brave."

"I don't feel brave," he whispered. I offered him an affirming squeeze. He took a deep breath and locked eyes with me. In his bravest voice yet, he said, "Do you think I could have HIV?"

I'm not sure why but I didn't hesitate. "Honestly? I think it's a real possibility. But I think you are in a safe place and knowing one way or the other would free you from worrying if you are."

"Okay. . ." he uttered in the tiniest voice possible. "Okay. . . ." Just then, I realized that he wasn't shaking any more.

"Flowers cannot bloom until it is their season. . . . .
as we would not be here unless it was our destiny. . . ."

Today, I am reflecting on how complicated the thin line between self acceptance and happiness can be. I am thinking of the loving interactions with my husband, the one I get to love without any one questioning or picking apart, that led to that single moment in time where my patient trusted me enough to be his authentic self. Every time I think of Jeremiah's quiet eyes and how they pleaded of me to stop and listen to him, I want to wrap my arms tight around myself. . .feeling thankful that I was dealt a hand that made it easy to be okay with me. Why? Because the older I get, the more I think that people who are the most okay with themselves are the most okay with others. That's my goal for myself, my children, and of course, my patients.

Thanks to several factors, most of which were completely out of my control, on most days, I'm alright with me. Because of that, a tiny part of me likes to think that there was something Jeremiah saw in my eyes that day, too. . . .something that made it okay to be honest with his doctor and with himself.

As it turns out, Jeremiah was indeed HIV positive and unfortunately also had advanced AIDS. But he got the help and treatment he needed, and even better, when he told his mother about his feelings, she hugged him and said, "It's okay, I love you, son." As simple as that. I still wonder if all along he'd known that his mother would be alright with the real Jeremiah, would he have eventually been alright with him too. . . .?

"Love the you that you see--you can only be you. . .as I can only be me."

Please take a moment to watch the amazing Stevie Wonder singing this haunting ballad. . . .
Today, I'm dedicating this to all of the Jeremiahs and to the Jeremiah in us all.

Monday, June 28, 2010

Random Reflection from a (Formerly) Cool Attending: Talkin' 'Bout My Generation

Me and Mom circa 1970 . . .before we lost our cool stock
(How rad is Mom's afro? I'm just sayin'!)

The Generation Gap. . . .

I used to pride myself on being a "cool" attending. Like, I was always familiar with the pop culture that permeated my learners' lives, and even received compliments on a fairly regular basis for the things I'd wear to work. There's something nice about having a 23 year old medical student ask you where exactly did you buy your shoes. I'd somehow managed for all of my thirties to stay ahead of that curve, reveling in my "cool" status.

It all started going downhill with me not being on Facebook. That was when I realized that I was the only person my students knew who didn't know what it meant to use the word "friend" as a verb. Somehow, I convinced myself that, despite this, I was still cool, telling myself, But look at your cool shoes, Manning! Come on, you still have it. You SO have it.

I still discover every day how much older I am than my residents and students -- like how none of them have any recollection of when MTV was just for videos, or can't recall when the non-buff Madonna writhed around on stage singing "Like a Virgin". There's also the moments when we discuss the point where we were in our lives when a particular song came out. . . . .they remember it as a pre-school memory, while I remember it as a high school after school dance anthem. And of course, there's the things like the aforementioned Facebook lingo that must be explained to me, or like how the students used Google images and Wikipedia to help me get what a "hipster" is. Regardless of all that, in my mind, I have maintained my cool position, and for the most part, stayed in step with most of my learners without actually feeling, well, old.

That is, until 40 started gaining on me. With the big 4-0 less than six months away, the generation gap has started to widen bigtime. . . . .and with that gap comes a few ticks down in the "cool" stock.


The end of cool as I once knew it. . . . .

I was rounding with my residents on the ward one day, and was in a rather playful mood. We'd all been full of giggles that morning, but had managed to stay on task enough to get through our eight new admissions. We listened as Dorothy, one of the students, presented the final patient.

She'd told us all about this gentleman who'd been admitted with an exacerbation of asthma. Fortunately, he was now doing much better. Dorothy reached the 'social history' -- the part where we discuss bad habits and living arrangements. "He doesn't drink, he doesn't smoke"--

"What does he do?" I interrupted quickly while letting out a goofy snicker. (Okay, yes, I know this was not the most professional thing in the world for an attending to do on wards, but I just couldn't resist the joke after such a perfect segue.)

"Pardon?" asked Dorothy.

"Don't drink, don't smoke--what do you do?" I sang with an accompanying finger snap. I chuckled again and kept snapping. . . . waiting for someone to join in. My dorky finger popping slowed down to an eventual halt.


The team just stared at me incredulously, wondering what on earth I could be talking about. Not one person nodded in acknowledgment. In fact, they all gave me these uncomfortable, tight-lipped smiles; almost like they felt sorry for me for my unfortunate old school outburst and for this revelation that I was actually not a cool attending at all. . .but instead, quite the contrary--a lame one.

"Adam Ant?" I queried, "Adam Ant, y'all! Goody Two Shoes? You guys don't remember Goody Two Shoes?" I started snapping again. "Come on, y'all! That was a popular song!"


Um, yeah. Popular in, like, 1982. Turns out that not only had they never heard of Adam Ant or the song before, a fair number of them weren't even born yet when the song was on Billboard's 100. Wow. My "cool stock" clearly fell 100 points that day. Turns out that I was "talkin' 'bout my generation" -- literally. (That's what I get for being unprofessional on rounds.)

Jay Z (not T.I. and not LL Cool J)

The Generation Gap continues to widen. . .

It gets worse. Tonight I was watching the BET Awards with my mom, dad, sister and husband. T.I., a rather famous rap star, was on stage performing. Mom said, "This hollering on stage is really annoying. I can't see how you guys stand this."

"That's because you don't know what you're listening to," my sister replied dryly.

"Yes I do," Mom shot back, "I know who that is. That's JJ Cool Z." She was 100% serious.

JJ Cool Z? Wow, Mom. Really? And I thought I was lame.

(That was so worse than the Adam Ant outburst.)


These days, I've been redefining what it means to be cool. I've started wearing my "grown woman" status as a badge of honor, taking pride in what I've never heard of and enjoying the hairy eyeballs that my students and residents offer me after hearing me belt out the song of some one hit wonder from the early '90s. Anyways, it turns out that Huey Lewis and the News were right: "It's hip to be square."

Oh, and for those who don't get the reference, that's too bad. I'm talkin' 'bout MY generation, not yours. :)


Adam Ant singing "Goody Two Shoes" from the early MTV video days. . . . yes. . .this used to be a popular song, people!

Thursday, June 24, 2010

Reflection on Thursday: Uploads, Downloads and Hard Drive Reboots


Do you ever have periods in your life where you feel like every drop of energy and productivity is being zapped out of you? Like. . . everyone and everything has their USB drives connected to you as their power source, but focused on their needs. . . . . . needs to download from your hard drive, but with very few uploads in return? I mean, I don't think it's on purpose. Sometimes it's the nature of where we are in our lives. People just need you. And while it feels good to be needed, it can be draining at times.

So that's where I'd been fairly recently. Drained. Finding myself stretched in so many directions sometimes that I can feel the seams popping . . . . .resident requirements, student needs, family life. . . . but wait--that's nothing new for me. What, then, makes it now feel so different?

The Difference . . . .

At the end of a particularly long day, I was sitting in the sunroom lounging on the couch. Slightly unusual that I was able to do this considering my kids were not only home, but very much awake. Lately the boys have evolved into being more tandem playmates than parallel playmates. This new arrangement keeps them occupied far longer, and affords me those periodic Calgon moments that used to be no more than fantasy. So there I lay on the couch. . . .mentally recapping my day. . .the highs and the lows. . . .I allowed my eyes to close. Ahhhhh.

"Mommy. Mommy!" I opened one eye and looked at Isaiah, standing in front of me with a Batman costume on. He leaned forward, close enough for me to smell his kid-breath, and repeated, "Mommy!"

"Yes, son. I hear you," I replied while closing my eyes again.

"Mommy, what does 'improved' mean?" he asked.

I rolled over, faced him, and met his eyes. I can always tell when Isaiah really needs my undivided attention. This was one of those moments. "It means you got better at something. Like remember when Mommy used to push you and Zachy in the double stroller, and I would get tired if I tried to run? And then I kept trying until I could run without getting so tired?" He nodded. "That means I improved. I tried and then got better."

Isaiah stood quietly for a moment, looking pensive. "It means at first you weren't doing a good job and then you did better?"

"Ummmm, not exactly," I responded, "It just means your hard work paid off."

"Oh," he answered while still looking concerned. I knew exactly why. Earlier that day, he'd participated in his "graduation" from Pre-K, and upon receiving his "diploma" he also received another special distinction-- "Most Improved."

His teachers somehow decided that all of the kids fell into two categories: "top achiever" or "most improved." Apparently, Isaiah didn't make their cut with the former, and --okay, I'll admit it-- I was slightly miffed. But after a while, I decided that I know my child and where he is cognitively. I decided to let it go. But Isaiah didn't.

"Why didn't everyone get most improved? Didn't everybody learn stuff and then do better?"

"You know what, sweetie? Everyone did learn and do things better. But maybe you did the most better." Most better? Really? I knew how crazy I sounded, and even more, I know my child. He would not buy this reply--no way, no how.

"I don't know if I want to be 'most improved.' Does it mean I had more trouble than them at first?" I sighed hard. Mostly because I didn't know the right answer to these questions, but also because I thought that the award and the very idea of giving such awards to 4 year old kids was complete bullshit. I wanted to look my son squarely in his eye and tell him just that, ending this conversation once and for all. But I couldn't.

Instead, I gently told him about awards and comparisons and how tricky that can be. How even Mommies feel funny sometimes when it comes to things like this, and especially so when it comes to their own children. Then I told him that he was special and wonderful and smart and amazing. He hugged me tight, and, literally, said, "Thank you, Mommy, for telling me that because I think I know a lot of stuff and when you say that it makes me feel proud of myself." Sigh. . .

So now I know what's so different. My children are growing older, and now they need more than just basic care. This, compounded with my professional life, gets pretty heavy at times. The downloads are no longer just diaper changes, cold milk, bubble baths or night time prayers. They now include questions like "what is improved?" or "are you proud of me?" or "why would God ever take a child to live in heaven?" The difference is that these types of downloads require more memory. . .and if I'm not careful to stop for a moment and breathe. . . .my hard drive gets drained and feels like it might crash.

Rebooting. . . .

Lately I've been trying to focus on the uploads and not just the downloads. I'm trying to be present enough to appreciate why those jumpdrives are attached to me in the first place. I've also been trying to slow myself down enough to receive what uploads I may have missed out on before.

A special upload. . . .

On last Saturday, Doug, one of my student advisees, got married here in Atlanta. I have known and advised him since his very first day of medical school, and through our unique curriculum at Emory, have had weekly contact with him since 2007 in a small group with 6 other students. He invited me to his wedding, and (being my perpetually five minutes late self) I managed to slip inside of the church moments before it would begin. Unfortunately, this meant that I was seated away from the rest of our small group, but nonetheless, I was thrilled to have made it just in the nick of time.

First came the organ music, followed by a soloist that sounded like a professional opera singer. This is nice, I thought. But then something happened. Doug entered with his groomsmen and the pastor. The minute I saw him walk in to await his bride at the altar, I felt overcome with emotion. I saw the first day of medical school, I saw the first day of clinical medicine, I saw the countless teaching sessions and mentoring sessions. . . .and somewhere in there, I saw my own sons. I willed myself to keep it together, 1) because I wasn't wearing waterproof mascara, 2) because it would surely lead to the ugly cry, and 3) because I was the absolute only black person there. (I figured that a hysterically crying black woman with raccoon eyes would not be such a good thing at this particular moment. . . .but I digress. . .) And so, this time I did the "pretty cry"-- complete with rapid mascara blotting, upward gazes, and eye fanning.

When the ceremony was over, I joined my student group in the vestibule. Doug walked up, and we congratulated him. It was such a moment, all of us there together supporting him on his big day. I could feel the upload--but just when I thought this was as good as it could get, he looked at me and said with genuine relief in his eyes, "I thought you weren't here. I looked and didn't see you with them, and I said to Anne, 'Dr. Manning. She didn't come. She's not here.'"

Anne touched his arm gently and added, "I told him you were here. I told him Dr. Manning would never miss this." Then she looked at him all new-bride-glowy. "See? I told you, Doug."

I couldn't believe what I'd just heard. That, with as much as he had going on, that he would not only think that, but actually take the time to say it to his new wife during his wedding. I chuckled to break up how intensely moved I was feeling. I looked at Doug and said, "Of course, I'm here, Doug. Of course, I made it."

He smiled and gave me a tight and genuine hug. "I'm so glad you made it, Dr. Manning. I mean that. I'm so happy you are here." And before I could even process the emotion I was feeling, he was whisked away to join his wife and family for wedding photography.

I walked out of the church and sat in my car for a few moments. I thought about how I had been feeling. . .how drained. . .how zapped. . .and then I thought about that moment in the foyer with Doug. It was the most perfect and simple reminder I could have ever been given about why I'm doing all of this. This is why you do this. This is what happens when you let people plug into you. And then I allowed myself to experience it, really experience it. . and then. . .allowed myself to cry. A tired, happy, and fulfilled cry.

Of course I made it.

I'm learning that the very best downloads I can offer don't involve diagnoses, or science, or complicated concepts. They involve relationships. . . . .and most times, just being there. Sometimes it's as simple as rolling over on the couch to face my son . . .and other times, it's just inconspicuously sitting on a lonely pew in a church full of strangers. . .quietly patting the corners of your eyes and wondering why you can't stop crying.

Members of my first small group circa 2010

My first small group as M1 students circa 2007

Tuesday, June 22, 2010

How do you spell relief?

Rocking the Pre-K graduation cap but feeling like I deserve to!

Ding Dong! The witch is dead!* *(At least for ten years, she is.)

Just received notification that I successfully passed that heinous American Board of Internal Medicine recertification exam. While it may not mean much to you, to me it means a whole lot. It means I get to do my job without worry or woe or threat of losing hospital privileges. In other words, it means I'm officially sho' nuff and bona fide to do what I do for ten more years. (Which is quite a relief considering it's probably poor form to be an academic teaching physician that isn't board certified, don't you think?)

Speaking of the ABIM recertification test. . . . .

Did I mention that I was asked to stop talking during the actual test? Umm. . .yeah, I'm not exactly proud of it, but errr. . . .well. . . . I have a tendency to talk to exams. Especially difficult exams. It's like I prepare for them, and then attack them full-on Rambo style like they're the enemy. I load up the ammo, put on my game face, and throw on my mental camouflage. Depending upon how I'm feeling, I might even tie a headband around my head and let out a primal war cry. It's me versus the exam, and I like to win. And this enemy was a doozy. . . . an all day computerized, no-coffee, no-snacks, no-nothin', difficult doozy. There I was. . . lying on my side in the trenches. . . .ready to pounce at a moment's notice, teeth gritted and machine gun bullets flying everywhere. "Aaaarrrrggggghhhhhhhhhh!" (That would be my war cry.) Okay, technically my "trench" was a testing center, and I was more sitting on a quasi-comfortable office chair than exactly down on all fours wearing battle garments in a dirt mound--but you get the picture. In a throaty, fairly diabolical (yet what I thought was a quiet and not-so-intrusive) voice, I told that exam exactly what I thought of it every chance I got:

"Ohhhh? Ha ha ha. . . you think I don't know that one, don't ya? Pneumonia and a brain abscess? Come on, playa. That's Nocardia, man. Don't try to play me! But that's a dirty question, man. Low down and dirty, man!"

It wasn't until after my third outburst, that the proctor came into the computer testing room and told me to put a lid on it. I take that back--she was sort of nice about it: "Umm. . . doctor. . . . I don't know how to say this, but. . . . well, there's actually no talking during the exam, okay?" What? You mean I can't talk during this test that required me to be fingerprinted twice before entering? Really? I'm sure she was thinking, Who does that? Uh. . . Dr. Manning, that's who. I bet money that I was subject matter for her "You ain't gonna believe what happened to me at work today" conversation at the dinner table that night. If only she'd known that my life is like one continuous Seinfeld episode, she would have understood. The good news? I don't talk in movie theaters, just extraordinarily heinous exams. The better news? I won't have to get muzzled again by her or anyone else until 2020! Woo hoo!

Me after getting Georgia ACP Outstanding Teacher Award
(looking calm considering I hadn't gotten a verdict on the ABIM recert exam yet!)

*For those who weren't reading this blog during my board review study period. . .check out this post to understand how challenging it is to study for anything as an almost 40 year old full-time working mama. . . . . whew!

Sunday, June 20, 2010

Early Morning Reflection on a Father's Day: Bridges Over Troubled Waters

Happy Father's Day to all the Super-Dads!
Super-Dad Harry and Sunday post-church mayhem, Manning style :)

When you're weary

Feeling small

When tears are in your eyes

I will dry them all

I'm on your side

When times get rough

And friends just can't be found

Like a bridge over troubled water

I will lay me down
. . . .

Like a bridge over troubled water

I will lay me down. . . . . .

from Simon and Garfunkel's "Bridge Over Troubled Waters"

Today I'm reflecting on fathers. . . . and not just any fathers, but the sho' nuff fathers. You know--the real men who stand tall with squared shoulders, who freely own and walk into their purpose as daddies, who unwaveringly accept the awesomeness of their responsibilities, and who love with all their might. Here's to those who accept the uphill fights, the selfless sacrifices, the exhaustion, and yes, the pressures, of being a true patriarch. The real ones who give their all to help grow boys into confident men and girls into self-accepting women. . . . .it's no easy task. All too often I sit and talk to patients only to learn of how some kink in the family tree robbed them of a relationship of their father, and worse, their ability to father their own children. It makes me remember to be thankful.

Okay, so I get confused of how that saying goes: "Anyone can be a daddy, but it takes a real man to be a father" (or is it the other way around?) I get it all mixed up because I think I'm not fully clear on which trumps the other. . . .but I digress . . .

pa pa
fill in the blank

Regardless of what you call them, here's to them all, living on earth or simply in our hearts--and here's to the men who helped make them the men they are.

Yep, so today I'm reflecting on and celebrating real fathers. . . .those who aren't just there for the glory. . .but those who've been there every single day to help write the story. . . .working, trying, praying, giving, leading, loving, failing but then dusting off and trying again and again and again. . . . .

. . . . thank you for being our bridges over troubled waters. . . . even when it's exhausting. . .

Ode to my Harry. . . the true patriarch of Team Manning and the man who had me at "Ohio". . . . . This is the song that always makes me think of Harry and how glad I am to be raising these man-children with him!

PaPa "talks" with Zachy two years ago on a visit to Atlanta. . . .
. . . . .and just this morning with the boys during their annual "Camp PaPa" trip to California (below, courtesy of multi-media textmessaging)
Come on. . . .what sixty-something year old man would agree to take two wild and stinky boys 2,000+ miles away from home for three whole weeks without their mother? My dad, that's who! (No, I'm not kidding!)

Daddy and I danced to the Eva Cassidy version of "Bridge Over Troubled Waters" (below) on my wedding day. Every time I hear her haunting rendition, I think of my dad and how fortunate I am to be his daughter (which always leads to the ugly cry.) This song has been covered so many times by so many amazing people, but whenever I play it on my mental iPod, this is the version I hear. Maybe it will make you think of somebody special, too. Enjoy--but beware of the ugly cry!

What song (and version of it) makes you think of your dad or someone else special? Do tell. . . . :)

Tuesday, June 15, 2010

Reflection of a Clinican-educator on a Tuesday: Reasons, Seasons, and Lifetimes

with my "small goup" advisees at the AIDS Walk 2008. . .
. . then as second year students. . .soon to be 4th years. . .

With my former fourth year student, Bianca S. at Commencement 2010


Nothing is here to stay

Everything has to begin and end

A ship in a bottle won't sail

All we can do is dream that the

will blow us across the water
. . . .

A ship in a bottle set sail.

from "Baby" by Dave Matthe

May and June mark the end of our academic year in medical education. The medical students either advance to the next level or become sho' nuff and bona fide doctors--albeit uncertified and untrained--but doctors nonetheless. The interns exit the novice stage and become residents; one week asking someone senior what to do, the next telling someone junior what to do. And of course, the senior residents and fellows finally get the stamp of approval that officially releases them from the nest. It's kind of bittersweet for folks like me--the surrogate mommies and daddies that helped guide them along this path to becoming full-fledged physicians. (Though I'm sure it comes as no surprise to you) I must admit that this time of year, I get just a wee-bit choked up. (Don't worry--it's usually not the ugly cry.)

with my former fourth year student, Olivier D., at Commencement 2010

Right now we are doing the whole "graduation" thing. Farewells to so many. . . our chief residents, our senior residents, and even the interns that spent this first year training in Internal Medicine as Transitional Year interns--all of whom will now flutter away to their chosen career paths. At risk of sounding cliche, I'll say it anyway: "Seems like only yesterday that y'all were deer in headlights asking me your cute little questions in orientation." Sigh.

with Shannon H. and Annie G., transitional interns 2009 - 2010
. . .Radiologists 2010 and beyond

What used to make these transitions so hard for me is the nature of time. With time, some of the most seemingly memorable people can fade into fuzzy blurs. . . .reduced completely to, snap your finger! snap your finger! "What was that guy's name? Uggghh! It's going to bother me all day! You know who I'm talking about! That guy with the sandy brown hair and freckles that went into Cardiology!" That guy took call with you every third night in the ICU and ordered Chinese and Mediterranean and Italian takeout with you. That guy told you that your inconsiderate boyfriend who made you cry between admissions was missing out and that it was his loss. That girl wrote you the nicest card at the end of the year, and even invited you to her wedding. Oh, and that student you worked with? She was the one you vowed to stay in contact with forever. What happened?

with my former advisees Shveta R. and Dorothy W. on Match Day 2007

A few months ago, I was at the ACP meeting in Toronto and saw this gentleman standing in the conference hall from a distance. I knew I knew him from residency training, or was it an away rotation during my 4th year of medical school? Hmmm. Maybe he trained at Emory? I know he was on a team with me at some point. But his name? No where near the tip of my tongue. I squinted my eyes and remembered that he was very nice. . . Lebanese, maybe. . . . .a great doctor. . . .and exceptionally smart. But despite my best efforts, I could not, for the life of me, place his name or his place in the time line of my medical life. It bothered me because I knew that we'd worked closely at some point, and that, whenever or wherever it was, I'd spent a lot of time with him. How could I not remember exactly who he was? Does it mean that I am a loser? Gosh, I sure hope not.

So here's the thing: Life happens. People move and people move on. Those every day surroundings fade into remote memories right along with some of the most every day people. What does that mean? Does it mean that those things were somehow less important? Does it mean that we have allowed ourselves to become so busy with our business, and fussy with our fussiness that we've neglected to preserve the flowers that we used to smell every single day? Naaah. It's not that simple. The older you get, the more you realize that there's more to it than that.

with former Grady doctors, Ben A. and Cherry L. (and their ninos) 2009

"People come into your life for a reason, a season, or a lifetime.
When you figure out which it is,
you know exactly what to do for each person."

~ Aleksandra Lachut

My mother shared this quote with me the day before I got married. She elaborated on the importance of all three, and how fortunate those who can discern such a thing are when meeting people along life's path. I've decided that this applies to the relationships fostered in medicine, too. There are some students and residents that I can close my eyes and see, hear, and bring to life with virtually no effort. Then there are classmates from medical school that I could not name if my life depended upon it.

As I pondered this more, I also thought about the people that I've had only fleeting contact with professionally--who somehow clicked with me and became "keepers." Like my friend Kris R. who worked with me at Grady for, like five seconds, but who, upon first meeting, was an automatic keeper. The instant friend that was only passing through but whose friendship felt exactly like worn-in slippers from the start, and who made me laugh so hard over dinner last week that I thought I would be sick. Or like my friend and fellow Grady doctor, Lesley M. who almost never shares the same clinic schedule or ward schedule or schedule period with me, but who seamlessly maintains "lifetime" status as one of the people I most look forward to seeing at work. Now I understand that some people have an impact on you for a reason. . . or only for a season . . .or, if you're lucky, a lifetime. And that the quantity of time they spend with you, or even the quality alone for that matter, is not quite what determines where they will fall in this line up. It seems to just sort of happen on some higher plane that can't be forced or explained.

I won't take it personally if a student, a resident, or a colleague doesn't remember me in high definition. It's okay because I know that some will. And despite their best efforts, I know that the others will eventually recall me only as, snap your finger! snap your finger! "You know! That black female attending that wore the short haircut that wrote the touchy-feely blog! You know who I'm talking about!" Yep. It's hard to imagine. . .but it's a reality that just is. And you know what? I'm okay with that.

After 'while. . . . . crocodile?

So yeah. . . . .I'm waving goodbye to some, saying "see you later" to others, and preparing to usher in a whole new complement of students, interns and colleagues. Through it all, I'll be silently sorting each of these special people into reason, season, or lifetime. Who knows? Some may fall into all of the above. In doing this,especially during these periods of transition, I think the "thank you for everythings" will feel more authentic, and the "you've been wonderful to work withs" will mean just a little bit more. No matter what, there is one thing I now know for sure: Despite how important I feel today, I know that for many, as of June 2010, my season in their lives has come to an end. . . . .and again. . . .I'm okay with that, too.

"To every thing there is a season, and a time to every purpose under the heaven."

~ Ecclesiastes 3:1 KJV

With our current and former chief residents, Julie J-M, Gabriel W., Roy A., and Rosette C.

Saturday, June 12, 2010

Reflection on a Sunday: The Religious Experience

The forbidden foods?

"You probably don't even eat red meat, but I just went to the most amazing burger place," a friend told me recently at the YMCA after our exercise class. "Girl, it was like a religious experience."

"I eat red meat," I replied.

"Really? I guess I just sort of thought good doctors didn't eat anything bad." While it was nice that she counted me as a "good doctor," I was still trying to decide how I felt about the intonation of her "really." It was like in that quasi-snarky tone where the first syllable is ultra high-pitched, you know? Kind of like when someone says, Is thaaat right? I decided to take it all as a compliment since clearly she was privy to my svelte bod following our 6 AM Body Pump class, and surely anyone with this body would not be eating--hush yo' mouth--red meat. Uh. . . yeah, that's it.

"Red meat in moderation is okay." Nice, official answer.

"But, no Kim, this is like a straight up burger joint. I'm talking fries, onion rings, burgers. . . . grease." She laughed for emphasis. "It just seems wrong for a doctor to eat something so unapologetically artery-clogging. . . . .like a doctor shouldn't even be caught anywhere close to a place like that." She laughed again. Kind of like a little cackle that said (in the most loving way, of course) -- "It sucks to be you." So much for the compliment.

I think I can understand how someone would assume such a thing about a doctor--especially a nerdy internist. I mean, we spend hours counseling people on the importance of eating right to keep their weight down, their bowels moving, and their sugars normal. We calculate body mass indexes, refer people to dieticians, and furrow our brows when potato chips fall out of someone's bag. How dare one of the aforementioned individuals be (more than just a little) interested in hitting some greasy burger spot for a religious experience with red meat?

Okay, so newsflash: Doctors don't follow all of their own rules. (Wait--is there something in the Hippocratic Oath that says I can't say that?) Either way, as blasphemous as it might sound for me to admit it, it's true. We are 100% pots calling kettles black all day long.

Before you fret about your fearless health care providers, don't worry. A lot of us do try really, really hard to follow our own rules. A lot of us work out more than just every blue moon, and try more than just a little bit to be health conscious. But just so that you won't feel like a horrible failure the next time you encounter your doctor's furrowed brow at your next visit, I will disclose a few things (probably against my better judgment) that will show you this doctor's clay feet.

  • Confession #1: I love, love, love salty stadium peanuts and sunflower seeds. I can devour them. Really. And when I do, I don't stop until my lips pucker and shrivel into little raisins.
  • Confession #2: I only breast fed my first child for 4 months. Wait, 4 months is generous because I'm counting the time that I pumped, too. Yup. Knowing full well that the American Academy of Pediatrics recommends one full year of the good stuff. The truth is that I fought the good fight with breastfeeding. I tried and tried and cried and cried before finally accepting that it was not working. I made a decision to not breast feed for my sanity, and spent way too long feeling guilty about it. (Did I mention that I am a board-certified pediatrician, too?)
  • Confession #3: I forgot to take my prenatal vitamins for 50% of my pregnancy. I did take them religiously for the first 20 weeks, but as soon as I saw that the ultrasound looked good, I became terribly noncompliant.
  • Confession #4: I missed a doctor's appointment just this past Friday because I didn't know it was scheduled for me. Yikes. Did someone from my doctor's office tell me? Kinda-sorta. I'm pretty crappy about checking our home voice mail which is where I heard the lonely reminder--errrr. . .today. What's worse is that I was in the very building just one hour before my appointment at another appointment that I was aware of. Oh, and the person who called to let me know I was a no show? She saw that I'd made the other one and blown off theirs in the computer. Nice.
  • Confession #5: I can eat peanut butter straight from the jar all day, every day if you let me. Chunky, creamy, Jif, Skippy, Peter Pan, no brand, the kind you stir, the kind you don't, organic, ordinary, reduced fat, or full fat--I don't discriminate. Peanut butter is my friend. My close friend. Especially after a long day in the hospital.
  • Confession #6: I not only found that burger joint, but ate at it yesterday complete with greasy fries and onion rings. Although it 100% negated the great workout I'd had that morning at the Y, it was so yumtacular that I felt 0% guilt.

So here's the thing: I tell my patients that moderation is the key. I regularly tell them that I, too, fall short sometimes and that I have to regroup, too. (I even give them a few examples if they don't believe me.) I tell them that it's so okay to be a work in progress. That a little indulgence is reasonable sometimes, but just not every single day. That each morsel you eat should either be for nourishment or if it's a treat, be worth it -- and that it should never be mindless. That you do have to pay the piper with some sho' nuff exercise on a regular basis. And that to get the results you want, you have to have at least some restraint with food/portions/etc. Oh,and for those same results to be sustained, that there must, must, must be balance.

I tell them that it's kind of like spending money, you know? Use your head, and don't go crazy with spending and restriction, or eating and restriction, either. In other words, it's okay to allow yourself a religious experience with a burger every now and then . . . or with a pair of red suede peep toe pumps for that matter. (I'm just sayin'. . .)

So there you have it. The cat is out of the bag right along with the potato chips. Your doctors are not perfect. In fact, they are anything but. I guess that is part of why I write this blog. To humanize patients and those of us involved in their care. In my opinion it's the only way to improve our relationships and outcomes. Why? Because when folks are on completely different pages, communication suffers. And evening out the playing field by being more authentic makes it easier to communicate, don't you think?

Me indulging in a full-fat, four-dollar latte from Starbucks (but "tall" not "venti" . . . .capisce?)

*Oh yeah, turns out the place is called "Farm Burger" and is a casual burger joint in downtown Decatur (a cool neighborhood in intown Atlanta.) My friend at the YMCA gave what was like the 5th endorsement I'd heard about this place, so I knew it was a must. The burger was what I'd describe as "psycho-yummy", a self-derived term that I reserve only for the most deliciously yummy foods I encounter. (Other examples of psycho-yummy include all peanut butter, anything my mother-in-law cooks, Antico Pizza, and Peter Luger Steakhouse in NY just to name a few. . . .) Anyways, if you're in the Atlanta area and are leaning toward the indulgent side of your balancing act with food, OM quadruple G, you've got to eat a Farm Burger. Not only is it bucket list worthy, it's a psycho-yummy party in your mouth that is a sho' nuff and bonified religious experience.

If you don't live a little, your relationship with food becomes this:

What are YOUR favorite psycho-yummy foods? Do tell. . . . .

Random Reflection: Ready (to go)

"You ready-ta-go, ain't ya?"

That's what people used to walk up to me say, like every day, in the last four weeks of my pregnancies with both of my kids. It was like this universal term that intimated that I was not only term but so term that I might deliver right there on the spot. What amused me about it was that I'd never heard anyone say that to me or anyone else before getting pregnant, yet once my protuberant belly reached critical mass, it was all I heard.

For the record, it's pretty unusual for anyone to approach me in Grady Hospital with phrases I've never heard at all. I mean, this is a hospital that cares for a large population of African-Americans from the southern United States. Let's be clear here: I'm African-American, my folks are from Alabama, and I attended both college and medical school down south. So I know these patients. They're my aunties and my uncles. My first cousins and my second cousins. Usually they don't surprise me with their terminology-- but every now and then something catches me off my game. Or just amuses me. The "ready-ta-go" thing definitely did both.

"Good morning, gentlemen! Y'all doin' alright this mornin'?"

This would be a standard greeting I'd make to the handful of middle-aged men sitting in the "Smoking Area" outside the hospital on most mornings. The standard reply would almost always be, "Alright, Miss Lady!" or if they actually knew me from the ward or clinic it might be "We don't know nothin', Miss Manning!"

Now, let me quickly digress to address a few things that may have caused you to take pause:

"Smoking Area"--What?? Yes, there is a designated smoking area outside of our hospital. It's a small area with benches and standing ash receptacles, and people use them. I would say that this is an indigent care, public hospital in explaining it, but it has nothing to do with that. I think it comes down to the reality being that some people smoke. And rather than having them smoke near the front door flicking cigarette butts and ashes on the toe of somebody's child, our solution is the "Smoking Area." Got it?

"Miss Lady"--What?? Miss Lady is kind of like this term of endearment for young to youngish women that I often hear around Grady. Sometimes the person saying it is being fresh. Most times they're just being nice. Got it?

"We don't know nothin'!"-- Huh?? That's just a way to say, "Nothing's going on" or "It's just an ordinary day." If you're really savvy, you might greet someone you know by saying, "Hey there, sir, what you know good?" To which he might reply, "Awww, I don't know nothin'." This is equivalent to "What's new?" "Not much." Got it?

"Miss Manning"--What's up with that? At Grady Hospital, "Miss" is a term of endearment, even when you are a doctor. Yep. I said it. And am not offended by it in the least when I hear it. Got it? (For background on this, see this post: Miss Manning, but not if you're nasty.)

Okay. So when I was what felt like 12 months pregnant, I greet the dudes in the Smoking Area who collectively say: "You ready-ta-go, ain't ya?" I smile and just wave in return. Up the stairs, and into the hospital. Passing through the automatic doors where an elderly woman is buying a newspaper. She makes eye contact with me:

"Good morning, ma'am! You doin' alright today?" I say with my standard greeting complete with the southern twang that somehow inhabits my body the minute I enter Grady.

"I'm fine, thank you!" she replies with her wobbly voice and then adds, "You ready-ta-go, ain't ya?"

"Yes, ma'am!" I'd laugh. "Any day now!"

"Look like tha's a boy in there. You have a blessed day, doctor."

" 'Preciate you," I reply.

Down the hall, to the elevator, looking at my inpatient billing cards while waiting for the lift to arrive. Crowd forms at elevator, southern hospitality and pleasantries exchanged. Young woman, looks me up and down. "You ready-ta-go, ain't ya?" she says with a chuckle. I smile and nod.

"Tha's a boy, all day!" adds another woman. (Did I mention that every Grady patient, no matter what their age, could always accurately tell me the gender of my child just by looking at my belly? But that's a whole different story. . .)

I step off the elevator and two men are in the hall who look lost.

"Can I help y'all find something?"

"We lookin' for 5J."

"It's right behind you," I say with a smile, "Just push that button and somebody will let you in."

"Wooooo. You ready-ta-go, ain't ya?"

"Yes sir. One more week supposedly."

"Alright then, Miss Lady. 'Preciate you."

And so it went on. All day, every day until the moment I left for maternity leave. Finally, when I went into labor and it came time to push, all I could think in my head (which is probably not normal) is: "you ready-ta-go, ain't ya?" Indeed, I was.

Is there a deep message in this post? Nope. This morning, I'm just reflecting on the special communication and endearing exchanges that I have with the patients and people in this public hospital. I'm smiling as I imagine them calling me "Miss" even though my badge clearly says "Doctor", and my heart is warmed by these universal "isms" that somehow permeate everyday conversation at Grady. And the verdict is simple. Love it. Love Grady.

Friday, June 4, 2010

Reflections from a Friday: Innocence Lost

Gary Coleman (1968 - 2010)
My main prayer for my kids is this:

"Please protect them from harm, illness, danger, calamities or catastrophes. Protect them from monsters, especially the monster in me -- and let no one or no thing rob them of their innocence before it is time. Amen."

Last week, Gary Coleman who played Arnold on Diff'rent Strokes passed away. I used to love that show. Apparently he fell and bumped his head, and died of an intracranial bleed of some sort. Similar to when Michael Jackson passed away, sandwiched in between the quasi-flattering comments about his life were coldcuts --literally cuts-- about all the unfortunate twists his life's journey had taken. I felt sad about them both.

There are others who make me sad, too. Okay, so I admittedly do more than just thumb through People Magazine and Us Magazine. Yep I read them more than I probably should, but mostly when I want to just do something that requires zero thought. When I'm thumbing through the pages and seeing which Housewife did what, and what the Jolie-Pitt kids are up to, there is inevitably some sad, drunken picture of Lindsay Lohan. Every time I see her in those pages I feel a little sad about her, too. I imagine her freckled face in The Parent Trap and Mean Girls, and shake my head. Damn.

It all comes down to the same thing: innocence lost before it was time. There are some things that kids just shouldn't have to see. . . .or do. . . or know until they can handle knowing it.. . .or seeing it. . .or doing it. For many kids, they don't even have a choice. It seems like everything that messes people up some how traces back to someone or something that robbed them of their innocence prematurely. They spend the rest of their lives trying to make sense of it or reconcile it. . . some kids slug it out and make it. A lot don't.

I see them every day at Grady. The products of innocence lost. Confused, addicted, troubled. Then I see that tiny percent of overcomers. . . triumphant, driven, surviving. The overcomers always share some story of some person who stepped in and fought off the demons that lurked in the shadows. . . . . protecting them, believing them, needing them, cherishing them. Isn't that what we all need from the start?

Today I am reflecting on all that my loved ones did to preserve my childhood during my childhood--and I am reflecting on every single one of my patients who were dealt a different hand than my own. Those tied up in a vicious cycle of confusion, lack of resources and ill preparation. Those whose lives are manifestos of generational curses that eventually lead them to lay in hospital beds before me as my patients in this public hospital. I am pondering how blessed I am to have been placed in my family as the middle daughter of two committed young parents. I am thinking of each curfew, each "go back in the house and change clothes". . . .every "I don't care what their mama does but your mama says no." . . .and all of the "because I said so's." Thanks to my parents, for the most part, I haven't had to "slug it out."

But now times are different. Kids see more, do more, have more. It's a different beast. Sigh.


"Why can't I see Avatar, Mommy?"

"Because you are four, that's why."

"But why can't a four year old see Avatar?"

"Because it has violence and it's too mature."

"Can I see it when I turn five?"


"But why, Mommy?" (tearing up)

"Because I said so."

I'll fight to try to do the right things. Make sound decisions. And do my best to protect their innocence as long as I can--one day and one prayer at a time.

~RIP Gary Coleman