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.


  1. Heartbreaking, gut-wrenching. I truly feel for him. Thank you for sharing his story.

  2. absolutely heart breaking. still very much in the process of learning to be okay with me and i think you are right... the more okay we are with ourselves, the more okay we are with others.

    Sometimes I think the best gift we can give to others is in fact working on ourselves first.
    Thanks for sharing this story.

  3. It's wonderful that you created a space for him to speak so openly and honestly. Very impressive (but not unexpected). :-)

  4. Kim, you are a GREAT physician...many strive to have connections with patients like this. Ultimately, for me, this is far more important than diagnosing the zebras and being the fastest, most productive go-getter.
    THIS is WHAT it's ALL ABOUT !!

  5. Oh yeah.... you got me with that one! AGAIN! And you didn't have to add the Stevie Wonder clip... that took it over the top! Alright... let me watch it one more time... sniffle sniffle...

  6. I thought about you Monday night as my resident presented a case of the "I look sick" young, AA, 29yo male, hypotensive with a SBP in the 80's, febrile, orthostatic...with his first dx of PNA...AND refusing to take an oralquick HIV test.
    After talking with him extensively and understanding his "fear" of this unknown territory, he finally agreed to take the test. Unfortunately, he was wisked into his inpatient bed before he could take the test in the ED.
    I called him today using info I had taken off of his chart to follow up on him. Needless to say, he was still admitted and of course he was told he was positive for HIV. He thanked me profusely for listening and convincing him to take the test which was then followed by a long silent cry/wimper. All I could say in my mind was "your so very welome, "Jeremiah" as I cried with him..thanx Kim for setting the way and for the example you ARE...

  7. I thought about you Monday as my resident frustratingly presented the sick-looking AA 29yo male, hypotensive (SBP-79), febrile, orthostatic with his first dx of Pneumonia...AND refusing to take the HIV test.
    After talking extensively with him and helping him to understand the 'fear' of the unknown, he agreed. Unfortunately, he was wisked into his inpatient bed before he could be tested in the ED.
    I called him today (got his info from his chart). He was still admitted and he had his worst fear confirmed. He was HIV positive. He thanked me for taking time to talk to him and for convincing him to take the test, all before he began a long silence, then a muffled cry. As I said 'your welcome' with my words shivering and tears running down my face, all I could say in my mind was.."your welcome Jeremiah".
    Thanks Kim for your stories and for setting the example in who you are...still love ya..

  8. Karma, thanks for sharing that. (Also, I didn't know how to not post both comments--I, too, have typed in a whole comment only to see it disappear into some abyss.) You know. . . every time I think of him and patients like him I want to cry. I am so proud to know you--an ED doctor who took the time to call this patient back. He was indeed your Jeremiah. Kay, I really appreciate you reading and reflecting. This is exactly why I write this blog.

  9. In tears. Beautiful story.


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

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