Tuesday, August 10, 2010

Reflection from a Tuesday on the Wards: Let Her Cry

*minor details changed. . . yeah, yeah, you know the deal

"Let her cry. . . .
if the tears fall down like rain. . . .

And if the sun comes up tomorrow,
let her be. . . .let her be."

from Hootie and the Blowfish's "Let Her Cry"


Have you ever been right on the tippy-tip edge of crying but manage to avoid crying by taking a few deep breaths or stopping-dropping-and-rolling before someone hits you with "the concerned look?" Well that's where I was the other day on the wards. Right there. On the brink of a ripple of emotion that could easily be nudged into a tsunami. Fortunately, I was rounding alone that day.

So there I was. . . . just me, my patient's chart, a nurse's clipboard with vital signs and a medication administration record--quietly wrapped up in a cocoon and waiting for these feelings to pass. Stay on task. . . talk to no one. . .write your note. Over and over reciting in my head, Please nobody come up to me. Please nobody come up to me.

No such luck.

From the corner of my eye I saw Ben, one of my interns, walking toward me. Oh no. Please don't start talking to me. No, not now, Ben. Please don't strike up a conversation.

"Hey, Dr. Manning," he said. "How's it going?" Eek eeek eeek.

I offered him a tight lipped smile. Please don't ask anything else. Please don't ask anything else. That's when he hit me with it. "The concerned look" followed by the dreaded "concerned question."

"Uuuhhh, Dr. Manning? You okay?" Damn.

The last sandbag before the levee breaks. . . . . . those two dreaded words: "You okay?" ( The only thing worse is the unsolicited hug.) Anyone who has ever been on the tippy-tip edge of being about to cry knows what happened next. Yup. . . sigh. . . .I started crying. Right there at the chart box in front of my poor unsuspecting, one-and-a-half-month-in intern (who happens to be male.)

Nope. No exaggeration.

Here's the thing: I had just got through talking to my patient and his daughter about his new diagnosis of widely metastatic cancer. One that couldn't be cured short of some divine intervention. In other words, I just told somebody who, just the week before had been minding his own beeswax and living his own life that now all that was about to be cut short. Real short. And that made me sad. . . .

Now understand that this gentleman was pretty up-in-age, but still. Bad news is bad news and like my late grandmother (Mudear) once told me when we sat side by side on a church pew at her younger sister's funeral, "Don't matter how old you get, your baby sister is your baby sister, your momma is your momma and your daddy is your daddy."

And you know what? It wasn't that they didn't take the news so well. Quite the contrary. The patient and his daughter took the news amazingly well. But every time I looked at his daughter (who was in her sixties, by the way) all I could think was, "Don't matter how old you get, your daddy is your daddy." Then I thought about my daddy. I thought about what age would be acceptable to me to hear that kind of news, and thought, um, the age of never. That made my heart swell a bit, but it wasn't even that part that took me to the tippy-tip edge of crying.

It was what this patient said in response to hearing about his diagnosis. This robust, elderly gentleman--I'm talking a gentleman in every sense of the word--sat there on the edge of the bed holding his daughter's hand with his legs comfortably crossed in front of him. She was holding a bible, which, now that I think of it, she always seemed to be holding every time I saw her. Instead of crying, she was looking at her daddy smiling. In fact, the only one who wasn't smiling was me. He looked at me with those wise, octagenarian eyes and said:

"Why you look so sad, doc? Don't be sad 'cawse I ain't sad. Babygirl, let me tell you something. I been here eighty plus years and God been good to me. Good, do you hear me?" (Every time he said "good" he patted his hand on the bed for emphasis.) "I ain't 'fred a no cancer. I done traveled the whole world, known a true love, had some wonderful chil'ren and more grands and great-grands than I can even count. So if cancer is His will for me, then so be it. I'm okay with that. 'Cawse good as God been to me, babygirl, I mean good as He been to me"--(he stopped and shook his head and tapped his foot while his daughter nodded in agreement)-- "The least I can do is accept His will. I mean it's the least I can do in return."


Something about encounters with my Grady patients who have that kind of intrepid faith moves me in the deepest parts of my soul. Problem is, when the deepest part of my soul gets moved, I almost always cry. No matter where I am. And if I'm not careful, it can evolve into "the ugly cry" quicker than you can say "Rumpelstiltskin." That said, I quickly managed to excuse myself from my patient's room to avoid unleashing the tears, let alone the ugly version of them.

"God bless you, sir," I managed to eek out before leaving.

Whew, that was close. I stepped out of the room, into the hallway, and did my best to disappear inside of the chartbox. I swallowed hard and coached myself to not cry--knowing that if I waited long enough, the emotion might just melt away. Unless provoked, of course.

But that's when my earnest, young intern did just that. Strolled up with "the concerned look" and asked me "the concerned question."

"Uuuuhh, Dr. Manning? You okay?" Dang. Here we go. . . . .

Poor Ben. He had to just stand there while I cried. Staring at me with this weird mix of empathy and freaked-outedness. Wondering if he should hug me or smack me. Or both.

Turns out this wasn't the first time this had happened to me. Or the second time even. Once I cried so hard about a patient in front of my resident (now one of our chief residents), Roy A., that I'm pretty sure I scared him. It was pretty mortifying. . . .but that particular day I was so overcome with emotion that I just couldn't reel it in. I know I spent a few days avoiding eye contact with Roy, which as you can imagine, was pretty hard since we were caring for patients together. Later that month he told me that he appreciated how invested I was, and that seeing me cry had taught him something. Roy helped me realize that revealing that vulnerability, especially when you're trying to be a role model, can sometimes can be okay. Actually, more than okay. Sometimes it's necessary.

So thanks to Roy and thanks to the wisdom that comes with time. . . . instead of feeling embarrassed at that chartbox, I saw it as a teachable moment. Allowing a novice physician to witness a more seasoned one humanizing a patient and the family connected to them.

And so sometimes I say forget it and let myself cry. . . managing to keep it two breaths short of the ugly kind. But I don't fight it. I honor what my patients give to me by not fighting it. I honor what this patient is teaching me by not fighting it.

Besides. . . . .it's the least I can do.


  1. oh I would have been a straight up mess had that been me... but what a blessing to be able to care for patients like that... makes the job really worth it, huh?

  2. Every time I read your blog I am left in awe. You are rarity and I salute you. I don't see this type of care and concern from any of my private practice physicians.... Seems like they are only concerned with a fiscally healthy practice.

  3. Dr Manning, you are a great role model! We are so lucky that you are our teacher, mentor and inspiration. After all, we do take care of REAL patients, real human beings.


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