Thursday, September 30, 2010

Sweet Somethings



Ten random sweet nothings spoken to me by the Cocopugs in the past 24 hours:

  1. "Mommy, this lady is pretty, right?" (Referring to Demi Moore on cover of People Magazine) "But she isn't Mommy-pretty, though."
  2. "Mom, you are a champion macaroni-and-cheese-maker."
  3. "Mom, just because Rapunzo has long hair and you have short hair doesn't mean I don't think you're prettier."
  4. "Whoa Mommy! That dress looks good on you!"
  5. "I think I don't want to get married or grow up ever. But if I change my mind, I will marry a girl that is kind of like you, okay Mom?"
  6. "I told Zachary that he did a good job on his worksheet and he was happy, Mom. That's 'cause you told me that it's good to a-courage people. You are a good Mommy. Did that give you a-courage?"
  7. "Heeeey!!! It's SO good to see you, Mommy!" (afterschool greeting)
  8. "Last night, I told God that I was thanking Him for making you my mommy and Daddy my daddy. He said, You're welcome." "He did?" "Yeah, but in my heart, not out loud."
  9. "I love it when we wait for the bus together. Even if it's early and even if it's raining. Because we're together."
  10. "Mommy, I bet you are a really good doctor because you take good care of me, Zachary, and Daddy." "Thanks, Poops. That really gives me a-courage to start my day." "Mom, I think it's a-couragement."


Bonus one: "You know what, Mom? You're alright with me."

Sigh.

Tuesday, September 28, 2010

How to Make Your Life Miserable in the Hospital--Guar-OWN-teed: A Ten Step Guide

Mad Nurses = Miserable existence in Hospital


Aww, HELLS no! Did that 4-day-old intern just roll her eyes at me?



Ten Ways to Make the Nurses Hate (or at least Really Not Like) You:

1. Write all of your orders one at a time and twenty minutes apart. All. Day. Long.

2. Get an attitude and say some kind of condescending remark under your breath. (They can hear everything.) If that's not sufficient, roll your eyes behind their back. (They can see everything.)

3. Act like you are the only one who knows anything about the patient and his or her problem. Oh yeah. And refuse to listen to them or factor their opinion into anything whatsoever.

4. Sit in the Nurses' Lounge writing your notes when they are trying to give report or write new orders at change of shift.

5. Forget the fact that the nurse has been nursing since before you were born. Have the nerve to say something insulting like, "I'm not sure if you realize this, but in heart failure, we have to watch the salt and fluid intake."

6. Bark out orders like a drill sergeant. The say something crazy like what my dear friend, R.C., said to a nurse during our internship: "That's an order, not a suggestion!" (Not good.)

7. Work with the same nurses every day and refuse to learn their names. But expect them to know yours. Oh. And eat the snacks provided by the same nameless nurses every day.

8. Blame an adverse outcome on them when it was your fault. Or worse, get your ass saved by a nurse and take the credit for it on rounds. In front of the nurses.

9. Call in verbal orders when a patient is sick and needs your personal attention.

10. Start a medication that induces diarrhea two hours before change of shift. And then don't answer your pages.


One way to just maybe make up for #1 - 10.

1.  Arrive on ward bearing pharmaceutical company inkpens (that the doctors can no longer use without being accosted with paintballs by whatever the PETA-equivalent of anti-pharma is.)



*Coming soon. . . . .

Ten ways to KNOW for sure that the nurses hate
(or at least really don't like) you . . .


*On Call RN, will need your input here! :)

Sunday, September 26, 2010

Grady Seinfeld Moment: The Audacity of Hold-on

"Gurrrrl. . .no she di'-in't!!!!"

::Ring, ring, ring::



Me: "Uhhh. . . . hello? This is the Primary Care Center."

Caller: "Hey, somebody called Gino?"

Me: "Pardon me?"

Caller: "Somebody call Gino from this number?"

Me: "Umm. . .Mr. Gino, you've reached one of the doctor rooms in the clinic at Grady Hospit--"

Patient: "Oh, doc, that's for me!" (grabs phone out of my hand) "Gino, where you at?"

Gino: "I'm at the car wash."

Patient: "Awww, hell naw! The car wash? I thought you got your car washed yesterday? I told you you need to stay close by."

Gino: "The car wash ain't far."

Patient: "What car wash you at?"

Gino: (some unacceptable reply)

Patient: "Whaaatt!? You on Bankhead Highway? Call Anita on 3-way and tell her I need her to come get me from Grady."

Me: "Uhhh. . .excuse me. . . yeah. . .this like. . .isn't a public phone, ma'am."

Patient: (holding up one finger to me) "Gino, you need to call Anita right now. Or call my momma." (still holding up finger) "Just call me back when you get in touch with them."

Gino: "At this number?"

Patient: "Yeah. . . just call me back on this number, I'll be right here."

Me: "Uhhhh. . . ma'am?"

___________________________________________


Can I ask you a question? Hypothetically speaking. . . if you were at a doctor's appointment and your doctor stepped out of the room. . . . .and there was a telephone sitting on the desk, would you use it? Okay. . .I mean. . . .let's say that you forgot your cell phone. . .or your doctor was taking rather long to come back into the room. . . . then would you?

Wait--let me clarify that further. Let's say you were at a doctor's appointment, your doctor stepped out of the room, there was a phone on the desk, a sign that read "this phone is not for public use," and a mandatory "dial 9 first" prefix for all outgoing calls--then would you? Well? Would that stop you from picking it up, dialing 9, and then making a call?


Simply irresistable. . . .

Better yet. . . .if you were so bold as to pick up said phone, dial 9 and make a call. . . .like. . .what kind of call would it be? Would it be, like. . .a really quickie call. . .you know, the kind where you say, "Babe, it doesn't look like I'm gonna get out of here in time to get the kids. Need you to pick up. . ." or "Don't forget to pick up the dry cleaning!"

Or let's say, hypothetically of course, that you have a bit more chutzpah. . . would it instead be a medium length call where you call your mother back because she called you seven times that morning, and when you tried to call her back, your cell phone died?

Well. . . . . . let's say you had even more cojones than the medium-length-caller. . . still would it ever occur to you to not only pick up the phone and dial 9, but to then also commence to kicking back, relaxing, and holding a sho' nuff, AT&T, reach-out-and-touch-someone conversation with your best friend? Well? I'm just curious. Would that? I mean, occur to you?

Make yourself right at home.

Hmmm.

Okay, then let's just take this thing one further step. Let's say you did pick up the phone, and you did dial 9, and you did call your very best girlfriend, and y'all did launch into a "Girl, you ain't gonna believe who's pregnant again!" conversation. And let's say you were able to ignore the sign that clearly told you that the phone wasn't for public use . . . .tell me. . . .what, then, would you do when the doctor came back to the room? (I mean, hypothetically, of course.)

Would you:
  • a. look very embarrassed and quickly hang up before the doctor could catch you.
  • b. look very embarrassed, quickly hang up, and profusely apologize explaining that your phone died?
  • c. keep talking on the phone until your doctor asks you to get off the phone?

Okay.

And if on the off chance you chose 'c' . . . . .would you call someone who had the audacity to look at their caller ID, dial back the number, and ask to speak back to you? I'm just saying, would you?

Oh, and let's just say if your very best girlfriend did have the unmitigated gall to call back and ask for you. . .would you grab the receiver and say, "Hey girl, what's up?"-- followed by an instruction to call you back. . . . at this number?

Uhh okay, I was just wondering what you would do. . . .errrr . . . . hypothetically. :)

***

Number of times this has happened to me this month at Grady:

Minimum of ten times.

Number of times this has happened to me since I've worked at Grady:

Too numerous to count.

My take on it?

Awesomely amusing and blog-worthy.

Good times, man.

Saturday, September 25, 2010

Reflection on a Saturday: The Life of a Clinician-Educator


"Thank you for teaching me the art and the importance of the history and physical examination."

"Because of you, I'm a better doctor."

"I'm not here tonight as a colleague. I'm here tonight because I am his friend."

Tonight I am reflecting on all of these words of affirmation I heard directed at a fellow Grady doctor, Michael L. He was honored at our Emory Alumni weekend this year after more than thirty years on the faculty. Person after person came to the open microphone to share their personal accounts of how he'd impacted their lives. It kind of made me want to cry. I was reminded once again that when you give flowers to the living, it rejuvenates the giver as well.*

His response? (with what I believe was a bit of "choked-up-edness" in his normally stoic voice):

"I get paid to do what I love every single day."

::sigh::

Thank you, Dr. Lubin, for reminding me of why I'm doing this and for being the "Grady doctor" personified.



"Teacher, I need you."

****

*Click this link to listen to a narrative published in The Annals of Internal Medicine written and authored by . . .err. . .me. Drag the marker to just beyond the half-way point to skip all the scientific stuff and hear this article called "The Death of a Clinician- Educator." (When you hear a woman's voice reading, just back up to the beginning of it.)

I hope you enjoy it (and the gnarly music afterward which includes this cool song called "Teacher, I need you".) :)

Thursday, September 23, 2010

The Break-up: A Longterm Relationship Redefined

Back when everything was cool. . . .

______________________________________________________________________

I had a lovely lunch with myself on Tuesday. I finished up early at Grady that morning, and had the chance to sneak over to Rosebud for a delicious turkey burger with some kind of zippy chutney on top. It should have been super-psycho-yummy but. . .something was missing. And despite how yummy that turkey burger usually is, this day it just wasn't the same.

::Sigh::

The truth? Nothing is as good as it used to be ever since the break-up. Not even the turkey burger from Rosebud. Yep. You read that right--I said break-up. I'm in the middle of a horrible break-up.

We tried to make it work, we really did. But every time I thought we could co-exist, I'd look up and find myself betrayed. Early on, there were no holds barred. I never felt guilty about our relationship, despite what others were doing and saying. So comforting. . . .so warm and inviting. And no matter where I was. . . .Surprise! There you were -- always popping up. . .on the side, in the middle, and even late at night. We'd even fall asleep together, and first thing in the morning, you were the first thing on my mind. I loved our time over coffee in the mornings. . . Sigh. This isn't going to be easy for me.

And after all these years, too. It's crazy to even imagine it. . . . but I knew we couldn't keep going like this when I turned 35. That was the first time you left me wondering if this love was really a mutually good thing. Aaaahh. . . .but you were so wonderful to me during my pregnancies. . . .so dependable. . . early in the morning, in the middle of the night, and even when I was in labor. In fact, you were one of my best memories during my labor with Isaiah. And I feel bad turning my back on you, but like I said. . . .now that I'm older, I just can't do it. I made every effort to stay close to you in my late thirties, but by the time I turned 38--that's when you really started showing your true colors. At 39 and a half, I stood in the mirror staring at my reflection asking myself,

"Why do you keep doing this to yourself? Just leave this abusive relationship alone already."

Now, there's no question. It's a wrap. We will never ever be the same, and I have finally come to accept it. I'm not stupid. I realize that I will have to see you sometimes and deal with you in moderation. And you know what? I'm actually okay with that. In fact, that's my preference. But this all the time, every day thing? No way.

Not even two months since our break up, and I can see the difference already. I feel better when I look at myself. Oh, and remember the way my energy was so sapped at first? Even that's gotten a lot better. The headaches and drained feeling I had in the beginning have faded, too. Now I know for sure that I can live my life just fine with our love redefined. I will just deal with you in small bits and pieces.

And I'm okay with it. I really am.


Just because you look good, doesn't mean I still want you.


Yes. It's official. I have officially broken up with bread.

Buns? Rolls? Bagels? I'm talking to you. Don't call me. Don't ask to sit on my table with garlic butter or act like you just want to sit by my omelet masquerading as a biscuit. Mmm hmm. Don't act all inconspicuous in my salad thinking I don't realize it's you just because you're cut up in little squares. Oh, your name is "crouton" now? Yeah right. By any name, the verdict is the same.

Don't believe me? Last week when that lady in Panera Bread asked me if I wanted "a whole grain or French baguette" with my salad I just put my hands on my hips and said, "How 'bout neither?" Take that, you complex little carbohydrate. Like I told you before, it's a wrap. (And a lower carb one at that.)

Yes. I have broken up with bread. And Lawd have mercy, on Tuesday I nearly fainted from the temptation to get back together when they brought that turkey burger out to me on top of that soft-and-doughy/crusty-but-chewy/warm-and-toasty/freshly baked ciabatta. That server was smiling at me all goofy-like when she said, "Mmmm! And the bun is fresh from the oven!" OMG. The minute that aroma wafted into my nostrils. . . .gaaaaahh! It was screaming, "Oh come on! It's only lunch, baby! Must it be so final?"

And I admit, y'all. . . . I was weak. I was overcome with passion. . . and allowed our lips to touch. (That's how I knew it was crusty-but-chewy.)

Chal-laaaaahhhhh!!!!!

Why the break-up? Because the relationship is just too much for me. Oh my. . . . our relationship over the years has been so intense. . . . .a little too intense even. . . .

My feelings in a breadbowl:

I like a lotta ciabatta.
Challah makes me holla.
Yeast makes me a beast.
And if you say "focaccia," I say, "fo' sho!"

See? That's the problem. That day I couldn't comfortably wear a pair of jeans that I'd paid $100+ for, I knew then that it was time to walk away. That ciabatta roll at Rosebud, though? I almost completely fell off the wagon.

Aaaaahh, but don't worry. When I was 39 and a half, I might have gotten weak and gave bread back the key and the garage code--but not at 40. This time, I mean it. We're dunzo. I simply can't afford the ten pounds you guarantee you'll give me every ten years no matter how much you look at me with those crusty eyes of yours.

Can't we just give it one more try?

Nope. I am a doctor, so I have tried the American Heart Association's recommended diet and even though I don't have high blood pressure, I've even tried the DASH diet, thank you very much. But seriously. . . .unless you are training for a 10k or a marathon and running, like, really, really, really far every single day, when it comes to the AHA and DASH diets, as one of my patients once told me, "That dog don't hunt." Oh and that food pyramid with all the bread on the bottom? Puleaze. Unless being the shape of a pyramid is what you're going for, I hope you have a plan b.

Uhhhh, okay.

So to all of my beloved patients, friends, and family who are over 35 and who don't run like really, really, really far every single day AND to those under 35 who are perplexed at why the junk just perpetually remains in their trunk: I'm talking to you. Consider my break-up as an intervention. You want to be a little smaller? Then accept it. The days of liberal bread and refined sugar consumption are over. (Unless, of course, you are like my friends Julie J-M and Julie E. who actually DO run like really, really, really far every single day. . . . )

And still I rise. . . .

I will need your support through this break up. . . . . . . but with your help, I know I can achieve a new "normal." Occasional weekends, holidays, and special occasions. That's it.

::sniffle::

Thanks for your support.

Wait--I just know you didn't think I was talking about the B.H.E.? (B.H.E. = best husband ever)
(Don't worry, I didn't THINK you did 'cause he's wonderful.)



Wednesday, September 22, 2010

Reflection on a Wednesday: F-Bombs, Control, and Other Reasons To Go Off

*names, details, etc. changed. . . . you know the deal!

"Going off": Not the ideal response you want from your patient. . . .


"going off:" 1. to lose all control in a fit of anger, often accompanied by harsh profanity, furniture throwing, and insults about the mother of the recipient. Can precede a physical altercation and may or may not end in handcuffs, an arrest, or both.

ex: "That man kept cutting me off when I was talking so I ended up going off on him right there at the bank teller window."

ex: "You better stop talking before I completely go off on you." (*note: "completely" going off is worse than just going off.)
_________________________________________________________________

This woman (not this woman literally, but a woman) was going off on me in the hospital the other day. I mean completely going off. She was mad. Full-on, sho-nuff, cuss-you-out, tear-you-a-new-one, spit-flying-everywhere kind of mad. This woman was angry and hurt and frustrated and a bunch of other emotions that there probably aren't even words for. She had lost all control. But most of all, she had no control over an unfortunate diagnosis that had just been confirmed that day. And she was mad about it.

I know for sure that I wasn't rude or patronizing. I know I made an effort to be even more careful than usual, and auto-corrected my language as I spoke. I pulled out all the stops; using every single patient-doctor communication skill that I'd ever been taught. But none of them were working.

I kept track:

Three bullshits.
Five bitch-es.
Two chairs turned over.
And f-bombs too numerous to count.

I probably should have been scared or at least nervous. If a resident or medical student had been in this situation, I would have used my best sage attending voice to firmly remind them to remove themselves from the room. But I wasn't scared or nervous. Instead, I just felt sad.

I said to myself repeatedly what I always try to remember when a patient gets this kind of mad:

"This ain't about you."

Because it usually isn't. That kind of mad is reserved for people who are important to you. For most of my patients, that person is themself, not me. I don't waste any time getting on my high horse and thinking that I have that kind of power. Earlier in my training, I would internalize these exchanges and make it all about me. Next thing I knew, I 'd be neckrolling and raising my voice; reducing myself to an unprofessional, quivering blob of Jello. And so I've learned over time that in similar situations and in this situation, to remember that mantra: "This ain't about me."

It's about control. For this patient, the only piece of control remaining was in the decision to accept the diagnosis and treatment or not. The more I explained, the more she said derogatory things about me, the hospital and my "bullshit" diagnosis.

"You think you better than me. But you ain't shit, you hear me? Not shit." Wow.

"I don't think I'm better than you. I really don't, ma'am."

"You ain't the only one who knows stuff. Just because I don't have all them degrees don't mean I don't know stuff. I think this mess you saying is some bullshit. I'm going somewhere else. You think you can tell me anything 'cause I'm poor."

"Ms. Randall. . . .listen. . .I apologize if I have said or done anything that made it seem like I think I'm better than you. I care about you, Ms. Randall, and your income doesn't affect the way I see you or treat you." She rolled her eyes. I scoured my brain for those skills again. "Can we talk about how you feel a little more?"

"Fuck you. No." So much for the patient-doctor communication arsenal.

"Would you like for me to leave?"

"Yes. I'd like for you to get the hell out."


And that's what I did. I left the room. And gave her time.

A little later, one of the nurses came in to speak to her after I left. She began to cry. . .collapsing like a tired rag doll in the nurse's arms. She was shaking and wailing as the nurse consoled her, saying over and over again, "God, why can't I just catch a break? Why can't I just catch a break. . . .why, God?"

See? This was so not about me. This was about life and a hand that she wanted to throw in for another one. She was a single parent. She worked a minimum wage job. Her child's father was in the same place as her own father: state penitentiary. She could barely cover rent in an apartment located in one of the worst neighborhoods in Atlanta. She was losing money with every hour she was here and not at work. And now, she had just been handed a diagnosis that would surely cost her more money and more time. This hand sucked. Maybe even enough to warrant a few f-bombs if that's your thing.

Before I left the area, I slipped back into her room and carefully approached her. She looked up at me with apologetic eyes. I met her glance with a easy smile. No sorry required.

"Hey there," I said. At first, I was thinking about something more poignant like "You're going to beat this" or "You know, it's a blessing that this diagnosis was made early." I settled on the most vanilla thing I could muster.

"Hey. . ." she responded. Her voice was now hoarse. I missed the rest of the cry she had with the nurse, but it sounds like it was really therapeutic.

"Is now an okay time, or would you prefer for me to leave you alone for a little longer?"

"Naw. You okay. . . ."

"What can I explain better or what questions do you have for me?"

She took a deep sigh, and slowly started asking her questions and getting her answers. The rest of the encounter was, believe it or not, pleasant. I was happy to see her regain the control she so desperately sought earlier.

Final tally:

Seven bullshits.
seven bitch-es.
Two chairs turned over.
And f-bombs too numerous to count (one of which was followed by "you.")

But also:

Five whys.
Three maybes.
Two what abouts.

Oh yeah. . . .

And one thank you.

Monday, September 20, 2010

Best Effort



You tell me what's better than getting a fist bump from your kid early in the morning before he steps onto the school bus. . . . and having him look back at you and say,

"Best effort today, Mommy, okay?"

"Okay."

I think I'm ready to give my best effort now.

Sunday, September 19, 2010

Reflection of a Grady Doctor Outside of Grady: "What Would Oprah Do?"


"You can take the doctor out of Grady Hospital,
but you can't take the Grady Hospital out of the doctor."


~ Anonymous

________________________________________________________________

Although every year on January 1, I resolve to be so organized that everything I need to prepare meals is already in my refrigerator. . . . .it never seems to happen. No doubt about it--I'm the queen of "Let's have tacos," but "Oops, no taco shells," or "How 'bout chicken'n'dumplings?" but "Rut roh. No chicken or dumplings." That said, I was rushing through the aisles of my local supermarket picking up a few items for dinner one evening, and I had a grand total of five minutes to pick up spaghetti sauce, ground turkey, noodles, broccoli, salad-in-a-bag, and granny smith apples to stay on schedule. I'm proud to say that I did just that, and managed to slide into the line at approximately 5:05 p.m.--insuring that I would indeed make the 6pm daycare pickup cut off. Shweet!

I yawned and thumbed through a gossip magazine while waiting behind the one person ahead of me. A bikini-clad Kim Kardashian was on the cover with a headline underneath describing how she's "okay" with having cellulite. I felt amused as I asked myself if Kim Kardashian was really clear on what was considered cellulite. Decided that if she really knew first hand about sho' nuff cellulite on her hips, thighs, or buttocks and that if she happened to be truly "okay" with said cellulite, that there is no way in h-e-double-hockey-sticks that she'd allow herself to be photographed from the waist down in any bathing suit, let alone a bikini. (Errrr. . not saying that I personally have cellulite . . errrr. .. yeah. . . .)

I slowly inched my cart up to the front of the check-out line. A smile crept over my face as I imagine Isaiah and Zachary fighting over who gets to put what on the conveyor. As cute as it is when they go back and forth while trying to help me--demanding, "I'm the gentleman!" "No, I'M the gentleman!" --I have to admit that it is kind of nice to be able to make a leisurely visit to the store without pushing one of those twelve-foot-long,kid-friendly, mom-unfriendly carts with the dune buggy attached in front. I decided that, as un-relaxing as it sounds, kid-free grocery shopping qualifies as a Calgon moment. Aaaaaaah.

Suddenly, I overhear an exchange taking place between the cashier and the woman ahead of me:

"I'm sorry, ma'am, but this card is reading only three dollars and twenty-two cents," announced the pimply-faced check-out guy while handing her food stamp debit card back to her. In my opinion, his voice was just a lit-tle too loud for the situation. I also didn't like the way it lacked compassion, but perhaps I was reading to far into it. . . . .

"What?" replied the woman incredulously while shaking her head, "That don't sound right. Can you please check it again 'cause that don't sound right."

Pimply-face rolled his eyes and took the card back from her in a way that bordered on a snatch.

::Swipe::

He gave her an exaggerated sigh. "Still three dollars and twenty-two cents. What would you like to do, sweetie?" He curled his lips and blinked his eyes at her in slow motion. Not cool.

Okay, first of all, let me tell you about this lady. She was a grown woman. No, I take that back--she was more than a grown woman--she looked like she was a grown woman with grown kids, too. This woman had to be at least sixty--maybe a little older. (So why this nineteen-year-old child would think it was appropriate to address her as "sweetie" is beyond me.) Anyways, she was wearing some kind of uniform which suggested that she had just gotten off of work, and the sneakers on her feet suggested that it was a job that required her to be on them all day long. Although she was no taller than five foot two, she was at least two-hundred-fifty pounds which probably made working on those feet just that much harder. The buttons on her shirt were strained from her ample bosom, but I was able to make out her name embroidered on left chest pocket:

"Irma."

It looked like Irma had had a long, hard day. It stunk that someone who looked like she'd already put in some time on this earth was obviously still having to work so hard. It also stunk that after working all day, she'd have to deal with some teenager calling her out in the grocery store. I narrowed my eyes and gave the cashier a searing "ice-grill", hoping he'd look in my direction.

Irma feverishly rummaged through her purse as beads of sweat accumulated on her brow. I noticed her hands as she unloaded the contents of her bag on the counter one by one. Her stout fingers were each adorned with tightly-fitting rings that looked like they could only be removed a ring-cutter. She sighed and shook her head. Pimply-face finally looked over at me and mouthed, "Sorry." I stuck with the mean mug. Grrrr.

He drummed his fingers on that mini-counter used for check-writing and smirked at her impatiently. "Okay, honey, I have more customers, so I need to know do you want just one of these items or what do you want to do?"

Honey?! Why you little. . . . .


His patronizing tone was really ticking me off. It also annoyed me that he assumed that she had no alternative form of payment. Even if she didn't, the least he could have done was assume she did. Instead of waiting for her answer, he grabbed the microphone on his aisle and bellowed, "I need a manager on 3 for an cancel override!" I wanted to jump over that counter and grab him up by the collar (but don't worry, I didn't.)

Irma looked crestfallen. She slowly snapped her weathered purse shut and looked down. That's when I asked myself, "What would Oprah do?" (Yes, I know -- that's not how the saying goes. . .but I'm just being honest. . . .)

Come on! Y'all know what Oprah would do!

"Miss Irma?" I spoke loud enough for her to know I was addressing her, "I got you."

She swung around and looked at me with a bewildered stare. "Beg pardon?"

"Oh, I'm sorry. . .I didn't mean to startle you. . . I read your name on your shirt," I laughed. "But I can help you. I've come to the store and forgotten my wallet, or had the wrong card and it's such a pain to have to come back." I forced a nervous chuckle and looked in her eyes. She already looked grateful, particularly for the normalizing statement.

"You got. . .my groceries?" she asked with a stunned expression. "Like, you'll pay for them?"

"Yes, ma'am. Today I'm in a position to do just that, so with your permission, I will. Would that be okay?"

"Oh my. . .well, yes. . .well, thank you. . .thank you so much," she stammered. I could see why Oprah was so into the pay-it-forward thing. It felt kind of good. Then. . . .


Whoops.

That's when I did what I shouldn't have done. I looked. Yep. I looked. Inside Miss Irma's basket. I know I shouldn't have, but I did. Aaaaaaah. I shouldn't. Have looked. In her basket. As my college buddy used to say, "Got to be more careful!"

Here's what was in there:

  • three cans of Spam
  • two canned hams
  • some bacon
  • a bag of Ghirardelli milk chocolate squares
  • two bags of Oreos
  • a package of fruit cups
  • a gallon of milk
  • a twelve pack of generic colas
  • a six pack of Oodles of Noodles
  • a bag of Lays potato chips
  • a cabbage
  • some frozen corn on the cob
  • a box of four sticks of real butter

Dang! Why couldn't I just perform my random act of kindness and keep it moving? Why-O-WHY-O-WHY???
Arrrrrggggghhhh!!!

That's when I really started wondering, for real: "Seriously, what would Oprah do?" I wasn't sure of that answer, but here's what I do know for sure:


You can take the doctor out of Grady, but you can't take the Grady out of the doctor.


My friends, I know you are cringing because by now you know I'm fairly predictable and that my life is a real-life Seinfeld episode. . . . and yes, my friends, you KNOW what happened next.

"Miss Irma?" I asked while helping her place the items back onto the belt that the cashier had just put back into her cart, "Miss Irma. . .uhh. . .you don't have any medical problems, do you?"

See? Why is that your business, Manning? It isn't your business. At all. Who on earth do you think you are? Oprah would totally have not asked her that. This is why Harry is constantly telling me, "Watch your own lane!"

"I have high blood pressure and a touch of sugar," she answered matter-of-factly. "But for the sugar, I just take pills, not shots."

I looked at the Oreos and the chocolates and winced. I wanted to tell her that if she is taking antiglycemic medication that it wasn't "a touch" of sugar but a full-on bear hug of sugar, but decided for sure that Oprah wouldn't have said that. "Are these groceries for you?"



I know. It really wasn't any of my business to be asking. . . .but Spam, y'all? Really?

"Mmmm hmmm," she responded without the foggiest notion of where I could be going with this line of questioning.

::Boop! Boop! Boop!::

That was the sound of Pimply-face quickly re-ringing the items that had just been overridden. I raised my eyebrows sheepishly and looked in his direction. He wasn't paying attention to me, so I waved my hand in front of him. It was obvious that he hadn't forgiven me for ice-grilling him earlier. "Ummm. . . .excuse me," I said, "I need you to wait for just a second, okay?"

He shrugged, did an eye-roll/head-shake combo and began studying nailbeds (in a way that was waaaay too animated. . . but is another story in itself . . . .) I looked back at Irma who now had a shopping list in her hand that she'd retrieved from her purse. I noticed that a few people had gotten behind us in line, and against my better judgment, bit the bullet.

"Miss Irma. . . umm. . .listen. . uuhhh, I'm a doctor. . . .errr. . .and I'm a little bit concerned that some of the stuff in your basket. . . well. . .they might be things that aren't the best things for someone with high blood pressure and diabetes."

"Yeah, I was thinking them fruit cups could make my sugar go up. As for the cookies and chocolates, I don't eat them every day."

"Umm. . .okay. Well. . .the Spam is kind of salty. . and the ramen noodles are, too. . . .uuuhh. . plus they're really, really high in fat. . . .umm. . . .and the Lays probably wouldn't be so good for you. . . .and. . ."

Before I knew it, I had picked apart Miss Irma's entire basket and broken down the sodium content and glycemic index of every single item in far more detail than I'm sure she'd ever had any desire to hear in her whole life. By the time we finished the discussion, I had vetoed all but three items in her buggy. Yeah. It's not pretty, I know. (But I'm saying. . .I maintain that Oprah would NOT, I repeat, NOT have bought her some Spam.)

"Miss Irma, if you want, I could get you some fresh fruit and meat? That's a lot better for you."

"That stuff go bad on you," she countered. "Would you buy me some frozen pizzas instead? Or some chicken nuggets that I can heat up in the microwave?"

Dang.

That's when it dawned on me that this was much bigger than a chance encounter in a grocery store. This was about education and economics and resources and much, much more. I admit that the Pollyanna clinician-educator in me felt happy that our paths had crossed and conjured up this rosy image of her reading labels and making smart choices in the future. Unfortunately, the realist in me had to accept that this was a multi-layered problem that wouldn't be solved in ten minutes. But still. . . .I had to give it a college try.

"You could get some fresh chicken and then you could freeze it. . .you could even cook it, then freeze it?" I suggested half-heartedly. Deep down I knew she was right. That stuff does go bad.

"With my cabbage and my corn, huh?"

"Sure!" I was relieved to hear her response.

I pointed to a cooler a few feet away near the entrance of the store. "They have some chicken and fruit right over there. If we hurry, we can get it without losing our spot in line."

Before I could offer to do it for her, Miss Irma scooted to the icebox and returned with three packages of chicken and a box of clementines. We shared a smile as the bagger placed these last items in the bag.

"I sure 'preciate you, doc," she said genuinely.

I replied with a slow head bow as if pretending to tip an invisible hat in her direction. I was so glad that she didn't take offense to my dissection of her shopping cart. In fact, she seemed rather appreciative. "You should come see us in the Grady clinic," I offered.

But she didn't even hear me. She was too busy rummaging through the bags and looking around the counter as if she'd lost something. I gave her a puzzled expression. Irma pulled apart the bags again and finally said,

"I thought you said you was gon' get me the Oreos?"

Dang.

Oreos ARE awfully, good. . . .

Saturday, September 18, 2010

Reflection on a Saturday: Smelling the Roses


"Don't hurry. Don't worry. You're only here for a short visit.
So don't forget to stop and smell the roses.
"

~Walter Hagen
_____________________________________________


"Do you know what I miss the most? His smell. I miss that more than anything." She sighed quietly and shook her head. "That's a funny thing, isn't it?"

I didn't know what to say. This woman had just lost her son. There was nothing funny about that at all.

"When he was a newborn, I would just bury my nose into his tummy and smell his baby smell. . .and then. . .when he got a little bit older he'd go outside and play," she patted her eyes with a tattered piece of tissue and then chuckled softly. "I used to say, 'Boy, you need a bath 'cause you smell like outside!'"

I could suddenly feel my heart pounding in my chest. It felt like it was pumping tears straight into my eyes and gripping at my throat. This wasn't the normal empathy I feel in the hospital with my patients; this was different. . . . a distinct feeling reserved for mothers. Part of me has always felt that God aligns the hearts of mommies. We root for each other, protect each other, share with each other, and in our own way, stand together in our own little army. There's something instinctive about it, too. . . .almost like it was by design.

I took in what she was saying to me for a second and before I knew it, I was transported to those first moments in the mother-baby unit with Isaiah and then Zachary. The sterile hospital smells were dampened from my memory by the tender scent of baby. . . . . .unforgettable. Then, I reflected for a fleeting moment on the way my boys smell now. That "after play" boy smell. I knew exactly what she was talking about. Until that moment, had never thought of it as something to love. But it is. It so is. I swallowed hard and parted my lips to speak.

"I know that smell well," I responded gently. "That 'little boy' smell is so distinct."

"Yeah," she answered while staring off into the distance. "Yeah." She looked down and wrung her hands in her lap. A wrinkled shirt of his was balled up on her lap.

That suffocating feeling started trying to wrestle me down again. I took a few deep breaths. I still didn't know what to say.

"I used to hug him and just smell him, you know? Do you ever do that with your children? Just smell them? Like even when he was a grown man I would. He always smelled so good, my boy. He was so clean, you know? Do you have children?"

"Yes, ma'am." I was conflicted when I added, "Two sons."

"Oh. Well, I hope you smell them every chance you get. I know it sounds crazy. But. . ." She stopped talking mid-sentence and sighed.

Silence filled every corner of the room. Not even a television was there to provide background noise or even a belligerent patient in the neighboring bed. I tried not to look at her eyes; I feared that somehow they'd connect with my own in that mother-to-mother way releasing from both of us some primal mommy-army war cry. Instead I let my eyes rest on her hands. . . .delicate hands with long fingers that seemed made for a piano. She gripped the button-down shirt that had once belonged to her son. I clenched my jaw and pleaded with myself not to cry as I watched her draw the shirt to her face. She inhaled deeply.

That was it.

I covered my mouth with my hand to muffle the cries that I could no longer stifle. I knew it was a "no-no"--crying in front of a patient or their family--especially like this. . . but at that moment all I knew was that a mother lost her son. And that was something to cry about.

"I'm so sorry." I shook my head while gazing in her direction. I wondered if she knew that the "sorry" was referring more to her loss than my unrestricted emotion. I hoped she did.

She looked up at me with a haunting grief in her eyes that I secretly prayed to never know first hand. No. That was it. I quickly turned my back to her and gasped because I knew what was coming next: the "ugly cry." My right hand was still sealed tightly over my mouth while my left gently pressed down on the base of my neck. I wanted her to smell her son, too. I wanted her to be able to touch his face and hear his laughter--not conjure him up from a Polo shirt. The more I thought about it, the more I cried. I wanted to press down the emotions. . . but I knew the truth. Somebody in the mommy army just saw her child pronounced dead that day. Someone who felt him first create what felt like butterflies in her lower abdomen that later became defined kicks, and someone who'd likely made him a PB and J and kissed his boo-boos. The same someone who was later strong for both of them as death looked him in the eyes, and who first bravely asked me about hospice just a few days earlier. There was no pressing those truths down.

I reached for some tissue on the tray table and shifted my body back to face my patient's mother. The Kleenex in my hand was covered with mascara which suddenly reminded me of how potentially inappropriate my outburst had been. I sighed and tried to regroup. "Mrs. Cassidy? Listen, I'm sorry. I just. . . "

She stood up and wrapped her arms around me in a motherly way that I could feel instantly. What I was trying to say was, I just want to honor your son. I was never able to get it out, but I think she got the message.


***
Stopping to smell the roses in my life. . . . .

Even though that happened a while back, it still taught me a valuable lesson. I learned that the best way for me to honor her son is to make love a verb every day . . .like our playroom angel, CJ, once taught me, like my fellow mommy-soldier, Rachael, keeps teaching me, and like Isaiah, Zachary, and Harry continue to help me live every single day.



Yesterday morning before I left for work, I put one spray of Harry's cologne on my left wrist. All day long I drew my left wrist to my nostrils. . . . straining to detect the trace of my husband's signature smell. Tonight when I tucked in the boys, I climbed into each of their beds one at a time. . . .nuzzling my nose into their necks, kissing the tops of their heads hard and inhaling over. . and over . . .and over again. . . . . .

::sniiiiffff. . .aaahhhhh::

I want to take in the sweet scent of my own special roses while I can. . . .

I fell asleep praying and fully allowing myself to cry . . . . not with my hand over my mouth or my even a cover over my head either. A good hard cry--for every mother in the mommy-army who yearns to tip-toe across the hall and simply smell her son just one more time.


"Don't hurry. Don't worry. You're only here for a short visit.
So don't forget to stop and smell the roses. "

~Walter Hagen

Tuesday, September 14, 2010

Reflection on a Tuesday: Drinking Under Tables and High Pressures

*written with patient's permission, although details changed to protect anonymity

"My blood pressure is still borderline? Man!"

"Yeah. . .and from looking through the chart, it was 150/96 on your admission. It's pretty much been that since you've been here give or take a few points. That's a little more than borderline, actually." I paused for a moment, realizing that I sounded a bit discouraging. "I don't think this would be hard to get under control at all, sir. I mean. . . you're such a motivated patient, you know?"

I studied my patient carefully. He was in his late thirties, although he could totally pass for a twenty-something all day every day. His skin looked like someone had grabbed him by the tip of his toe and uniformly dipped him in milk chocolate--not a single blemish anywhere. Although his complexion suggested that he was of some African descent, his fine facial features were more eurocentric than afrocentric. . . .the kind of look that gets you described as "exotic" or "striking"-- which for him would be spot on.

"I eat right and I exercise. . . .in fact, I'm a health nut! I'm really kind of surprised that my pressure keeps running high."

As for his self-proclaimed "health nut" status, his appearance certainly supported that claim. There was such little body fat on him that the veins popping off of his forearms looked like linear relief sculptures. I could see why these elevated blood pressure readings were taking him by surprise.

"You're not a smoker, no?" I queried while looking at the notes on my billing card. "No tob" was what I'd scrawled on the back of the card--short for "no tobacco use."

"Smoker? Eeew! Hells no. I hate cigarettes!" He gave a playful shudder and then laughed. His pristine white teeth were almost too white. . .their perfect alignment akin to what one might expect when seeing a tabloid celebrity up close and personal. He gave me a smirk and added, "Now my boyfriend? Hmmphh. That's another story. He smokes those nasty cancer sticks. Ugggh."

"Oh yeah?" I responded with a smile, "You'll have to get him in here-- before his lungs do." He shook his head and curled his lips in an unspoken gesture that suggested that the discussion of getting his partner to quit smoking was an old battle and a lost cause. I pictured him standing on the porch nagging his better half or covertly dumping half of a pack of Marlboros down the toilet. I raised my eyebrows in amusement.

For a brief second it dawned on me how completely unfazed I was by his reference to a "boyfriend" (as opposed to a "girlfriend" or a "wife".) I thought about how way back in medical school such inferences caught me by surprise, and then later in residency seemed to be almost a novelty. I'd find myself launching into these exaggerated "girlfriend" , finger-snapping interactions with such patients, that I now realize (as an older and wiser person) were probably deeply offensive. Anyways, I've since resolved that, in addition to growing up, that learning to accept oneself is the first step to better accepting others. And lucky for me, some of my favorite Grady doctors (like my friends David M. and Jason S.) have helped to really open my eyes to other variations of "normal."

"Now I bet a 'health nut' must be a total nag to a smoker!"

"Chile. . . .I know that's right!" he chuckled but became more serious when looked down at the blood pressure cuff still wrapped around his arm. "And wouldn't you know--his blood pressure is frickin' LOW! Go figure." He let out a frustrated sigh.

This patient was used to being healthy. He was young, active, and for the most part, in pristine physical condition. He'd come to us after a fairly soft admission for what the emergency department called community acquired pneumonia. The initial portable chest x-ray demonstrated a questionable infiltrate, but his follow up two-view films were essentially unremarkable. A slightly low white blood cell count of three thousand, seven hundred coupled with his endorsement of male sexual partners led to concern about the possibility of HIV. Upon further history, our team learned that this patient had been with his partner for nearly ten years, and was as boringly monogamous as it gets. The HIV antibody test was negative, and it was explained to him that lower white blood cell counts weren't unusual at all in African-Americans (to which he replied, "Yeah, I knew that already.")

At this point, it was time to discharge him. He looked awesome, and seemed like someone that would reliably follow up and do all that was asked of him. But his blood pressure just kept on reading a little to high for my comfort level. . . .not so high that he'd need to stay hospitalized, but definitely too high to keep referring to as "borderline."

"So you lead a pretty healthy lifestyle, right? I mean, it could just be what we call essential hypertension. That's when your blood pressure is high from, say, what you inherited, and not really because of what you're doing so much."

"I'm a vegetarian and I only eat organic ninety percent of the time. I work out, I ---" he sighed again. "Man, this is messed up."

"What about alcohol?" I asked remembering the lecture my friend and fellow Grady doctor, Joyce D., had recently given the residents on hypertension management. I recalled her teaching point about how excessive alcohol consumption can take your blood pressure up more than most folks realize. It was pretty much all I had left.

"I drink some. Not much, though."

"Oh okay. So like, what is 'some?'"

"Oh Lord, I don't know, Dr. Manning. Like a few margaritas here and there? Like a bunch of us love to hang out at El Azteca--that patio is so much fun--especially in the summer. So I'll have a few when I'm out there."

"I love El Azteca," I commented while thinking of the large outdoor seating area that, now that I thought of it, was always teeming with young attractive men who seemed interested in, well, each other. "Is that one of your summer hang outs?"

"Oh yeah, baby. That's the spot in the summer!" We shared a lighthearted laugh.

"You know. . . .I was just thinking. . . .when you go there or anywhere, what would you say is the most drinks you have?"

He sat for a minute and gazed skyward in thought. "Hmm, like . . .maybe three? Of the bigger ones not the tiny ones," he admitted. "But I'm always eating and never driving."

Whoa! I recalled one of the last times Harry and I had enjoyed a meal at El Azteca Mexican Restaurant in the heart of midtown Atlanta. I'll never forget it. . . .I ordered one lime margarita--the small one--and felt super-swimmy in the head before I could even finish it. Even Harry could "feel" his--so much so that we had to sit on that patio for nearly two hours drinking water so we could drive home. That day we both laughed at how little alcohol we could tolerate, realizing that (unlike when we were in college) drinking anything with a hefty shot of tequila was unusual for us these days.

"Ummm, okay. . . .so. . .tell me this," I asked, "If one of the large margaritas counts as two drinks, how many drinks would you say you have in a week?"

"A full week? Counting wine at night and stuff like that?"

"Sure, including everything."

He started counting his fingers and making funny expressions of exaggerated embarrassment. "If you count it like that, doctor. . . like . . . damn. . .eighteen to twenty. That's bad, huh?"

"Well, it's more alcohol that you probably realize, you know? It can make your blood pressure run higher, too."

"Shut up!" he exclaimed putting his hand over his mouth. "Really?"

"Yep. Like for a man, you really shouldn't have more than four drinks in a day and more than fourteen for the whole week. It's less for us girls."

"Damn."

"Another question--are you like . . . .drunk from the margaritas? I mean. . .they're awfully potent don't you think?" I recognized the irrelevance of the question, but couldn't resist asking. All I could think was, Lawd! How could he not be passed out from three BIG margaritas from El Azteca when he weighs easily fifty pounds less than Harry?

"You know. . . .I just have a high tolerance. I mean . . .I definitely get loose. ." he paused to giggle, "but I ain't falling down or cussing folks out or nothing. I definitely feel the buzz but it's manageable. I'm just chillin'. Plus we sit out there for a minute. . . talking, laughing, eating, you know what I'm sayin'?"

"Yeah. . .I hear you. I could tolerate more alcohol when I was younger and having liquor more regularly. Now I can't even take the little margarita at El Azteca. . . .and you know, I'm not picking on you. . .I just wanted to tell you. . ." I carefully spoke. "There's this saying that I think of when it comes to drinking alcohol. . ."

"What's that?" He hung onto my every word. I was glad that he seemed so interested in my opinion and what I'd say next.

"Basically it goes something like this--'The only way you can drink like that, is if you drink like that.' "

"Wow. . . ." he said nodding slowly first, and then mid-nod changing to head shaking.

I went on. "It's kind of like when my friend was telling me how to prepare to run a half marathon. I asked her what the key was to running long distances and she said, 'Here's the key to running long distance: Run long distances. The only way you can run long distances is if you run long distances.'" I smiled as I recalled my colleague Julie J-M telling me this little nugget during a very short-lived idea I'd had once about me running a 13.1 mile race.

"Wow," he repeated. It really seemed to resonate with him. Turns out that this health nut was doing something that wasn't so healthy after all.


In the end, we printed out a guide for alcoholic beverages and how to gauge what "one drink" is. He agreed to limit himself to no more than three equivalent drinks in a day and no more than seven in a week (he chose the seven over the recommended fourteen.) We started him on a low dose of an anti-hypertensive and also reviewed low sodium eating, too. (The other thing about El Azteca is that, like all yummy Mexican fare, it's SAL-TY.)

Today I'm reflecting on how easy it is to get into health problems from bad habits that we don't see as bad habits. I completely related to my patient and his surprise about how excessive his alcohol consumption was and its effects on his body. The points in my life where my friends and I took great pleasure in social drinking came to mind. . . . he isn't the only one who's ever felt the buzz.

Then there's all those sayings like "high tolerance" and threats to "drink you under the table." Funny how those references never sounded pathologic to me back then. . . .but now that I think of it. . .and my admitted participation in such antics. . . it really kind of is. There's no denying: The minute I stopped drinking like that, I could no longer . . .well. . .drink like that.

The other part is that I guess I always thought of heavy drinkers as staggering, boisterous, rabble-rousers. . .stumbling over tables and spitting while they spoke in their slurred speech. But as it turns out. . . .they aren't. Many of them look just like any of us. They hold jobs, are attractive, are romantically attached, and are functional folks. In fact, a lot of heavy drinkers are the picture of health--just like my patient.

Take home messages:
  1. The only way to run long distance is to run long distance.
  2. The only way you can drink like that (without face-planting on the asphalt, that is) is if you drink like that.
  3. High tolerance: good for pain, good for running, good for exercise. Not-so-good for alcohol, capisce?
*Bonus side-bar take home message:
  1. Regardless of your personal beliefs, you've got to know that men who prefer men can have just as boring sexual histories and every day lives as anyone. . . . and seriously, a same sex sexual partner does not equal HIV risk. (Easy mantra: It's behaviors, not boyfriends, capisce?)
***

"And no salt on the rim, right?" my patient called out to me as he and his partner passed me in the hallway on their way out.

I smiled and gave him a thumbs up from across the nurses station and watched him disappear down the corridor, confident that he would do exactly as he'd promised.

Saturday, September 11, 2010

Reflections of a Grady doctor on 9/11: Where I Was.

*In loving memory of those who lost their lives on 9/11 and the people who love and miss them.

The E elevator at Grady Hospital.

That's where I was when I first heard about what was going on. I was on the inpatient service and had come in to round early before going to a clinic session I had scheduled with the medical students that morning. The day started off uneventful. No surprises from the patients, no issues overnight. I made good time, and was scurrying over to Medical Clinic 2 from 12B, the TB isolation floor. That's when I first heard the news. I thought it was a joke. This disheveled, toothless man who wreaked of this nauseating combination of urine, alcohol and must stepped onto the elevator and said,

"Hey Doc! Somebody just crashed a big a-- plane into a big a-- building in New York City!"

Yeah right. I gave him the hairy eyeball. One, because I was riding on the E elevator, which is the only one that takes you to the psychiatry floor (hello?), and two, because it wasn't like this guy seemed to be the most reputable source of information in the world. But being me, I did humor him for a moment or two.

"Oh yeah? A big plane was it? Like a 747?"

"Yuuuup! I ain't lyin' either, doc! A big plane full of people. And it was people all up in the building, too. Like a big a-- skyscraper! In New-York-City!"

I still remember the way he said "New-York-City"--like it was one word. I also remember laughing as I waved goodbye to him, making every effort to remember his animated story to recount to my colleagues later.

I was holding a Styrofoam cup with tepid coffee from the 12B nurses station that I did my best to continue sipping as I shuffled toward the clinic. As soon as I stepped into the waiting area leading to the patient rooms, I saw the crowd. Every patient, staff member, student, and faculty crowded around the little 20 inch television mounted on the corner of the wall.

I squinted my eyes at the image. The two towers of the World Trade Center, one with large plumes of black smoke spilling from a gaping hole on it's side. I put my hand over my chest and gasped. My toothless comrade and his exaggerated hand movements replayed in my head like a silent movie. What's going on. . . . . what in the--

That's when, right before our eyes, a second airbus slammed into the second tower. One woman hollered out in a high-pitched shriek, "Jesus!" --but not in that way a person does when they step on a hard plastic toy in their kids' bedroom or when they realize that they forgot their lunch for work in the refrigerator at home--but in that pleading way that people of deep faith use to petition higher powers. Lord knows, this was a time for calling on a higher power for sure.

Just like that, life as we knew it changed. Changed in a way different than how growing up and maturing changes you. Like everything that felt safe to you, like sitting at your desk at work or lolly-gagging next to the water cooler, could now be terribly unsafe. Every decision could be much more pivotal than you realize. . .like trying to get an earlier flight or stopping to pick up something instead of going to work or buying a coffee in the lobby instead of taking the time to make a cup at home. Two minutes, three minutes can be life or death. In the most everyday situations.

When I was in elementary school, I remember when my cousin, Tot, was hit by a car and killed. He was my uncle and his wife's only child, and just like that--he was gone. I remember as I grew older hearing of plane crashes and even when I became a doctor recognized how swiftly illness could descend upon a family and change it forever. So I learned to fear those things in a healthy way. Saying a little prayer before car trips and thank yous when airplane wheels would touch runways. Being mixed with prayerfulness and tearfulness when sick loved ones feel better or when babies are born with ten fingers and ten toes. Because now I knew what could happen.

But this was different.

A big plane crashed into a skyscraper in New York City. And then, right after that one, another one did. It sounds too crazy to be true. But it's true.

Today, I'm reflecting on the morning that those families had with their loved ones before this happened. I am praying that someone said, "I love you" and that someone else laughed out loud on a cell phone chat while en route to their beat as a New York City police officer. I'm deliberately allowing those sad feelings that I felt resurface. . . those emotions I felt when all of those lost people flashed upon my television screen weeping and holding up their Xerox signs reading "Have you seen my sister? Have you seen my fiance?"

We all called the people we knew in New-York-City and Washington D.C. like we always do when tragedies hit regions where we know people. "Y'all doin' okay?" "Yeah, we all fine." That's what we all get used to, right? That's what we all expect, and most of the time, that's exactly what we get. But this was different. It was so weirdly horrible and unexpected that nothing seemed expected anymore.

Yet eventually. . . .it passed . . . . .kind of like everything does. Like even the most horrific things seem to. People returned to living and took off their black clothing. They got used to the new skyline without it's two pillars and replaced the gaping hole that had taken the "penta" out of The Pentagon. And I guess that's what's supposed to happen, right? Life is supposed to go on. I guess.

Even though the world somehow bounces back from things like planes crashing into buildings and hurricanes putting entire cities/cultures/generations underwater and words that we never heard of like "tsunami" becoming as everyday as "Suze Orman" and carrying on after mommies and daddies lose their only children to unspeakable and unforseen circumstances. . . . .a little part of me feels the need to stay back and linger in the memory for a bit. Morose, I know. . .but necessary for me.

Earlier today I was sitting in the lobby of a car wash and a 9/11 tribute was playing on CNN. Somebody walked up and turned the channel to College Football. I sat there conflicted for a few moments before uttering in the tiniest, most non-confrontational voice I could muster, "Excuse me, I was watching that." I was so relieved when this wise looking elder added with eyebrows raised in a not-so-tiny, and unabashedly confrontational voice, "I was, too."

Yeah, it's heavy, I know. But sometimes it has to be. I have to make myself remember that even though today people like me are getting "Armor All, please" and "not too much air freshener since it makes me sneeze, okay?" and others are turning channels to the big game and rolling their eyes when asked to turn back, the least I could do is my teeny tiny part. . . .to actively remember what happened on this day . . . .to do my best to outstretch my hand in a way that no one may ever feel or care about. . . . yet a way that says, "I remember."

I heard this question multiple times on TV and on NPR today, "Where were you on 9/11?" I'm pretty sure they meant physically "where were you," but today I'm thinking about where I was mentally, too-- a place that I'd have to say is a far cry from where I am now nine years later.

Something changed that day. Life as we knew it changed forever. And somewhere deep down inside of us all, we all know that with these new rules of tragedy and catastrophes . . . .it could have been any one of us.

Friday, September 10, 2010

Reflections of a Grady Doctor after a Bedtime Story: The Gospel According to Shel Silverstein




"If you are a dreamer come in
If you are a dreamer, a wisher, a liar
A hoper, a pray-er, a magic-bean-buyer
If you're a pretender come sit by my fire
For we have some flax golden tales to spin
Come in!
Come in!"

~ Shel Silverstein
_____________________________________________________________

I was sitting on the couch with my laptop on my lap, and thinking. . . .I want to write. I need to write. But there's a problem: I have nothing on the tip of my tongue or fingertips to write about. I felt my engine stalling. . . .

(Hmm. . . . could this be the aftermath of me now being 40? Let's hope not.)

I put down the MacBook and decided to wait it out. Vegged out on the couch with the kids watching "Astroboy" on cable. As soon as the credits rolled, I marched them to their bedroom.

"Just one book, pu-leeeeease?"

I thought of my friend and fellow Grady doctor, Lesley M., who agreed with her husband that they'd never say no to a request for a book to be read--an agreement that I also adopted. (Eh hem. . ."never" sounded like a good idea at the time, Lesley and Rich. . . . ) So anyways. . . .tonight, I broke out "The Giving Tree" by Shel Silverstein. The book is part sullen/part deep/part thought-provoking/part sleep-inducing. (And okay, just a wee bit depressing. . .but depressing in a good way. . . ) Anyways. . .it held the kids captive as always.


". . .and the tree was happy."

I snapped the book shut in an unspoken "The End."

"Read it again!"

"Yeah, Mom, puleeeeaaaase?"

"No, you little coco-pugs. Bedtime."


Once I finally got them settled in/tucked in, I found myself reflecting on the book we'd just read, and I thought about how much of my childhood was punctuated by Shel Silverstein's writings.

Hmmm.


Turns out that Shel was a pretty insightful dude. Next thing I knew I was looking through some of his classic children's poems and stories and. . .

Ah hah.


A "light in the attic" came on. . .just like that. Something to write about indeed. Why? Oh it's simple. Life as a Grady doctor totally overlaps with the gospel according to Shel Silverstein. Totally.

Wait.

Before I go on--could you possibly be one of those rare people who didn't grow up on Shel Silverstein masterpieces such as "Where the Sidewalk Ends" and "Lafcadio?" I will give the disclaimer that my mother is a retired elementary school teacher AND a ridiculously avid reader of all things literary. . . .but I'm saying. . .didn't everyone grow up being mesmerized by the late Shel Silverstein and his grainy black and white illustrations? If you, by some strange chance, did not then please excuse me while I turn my back, clutch my chest and . . .

::GASP::

Seriously? Seriously. A childhood without Shel Silverstein is a questionable childhood at best. (No offense to yours.)

Alright. . .so where was I? Oh yeah, the gospel according to Silverstein. Care to join?

*(All of the following quotes are the works of Shel Silverstein.)

***

"How many slams in an old screen door?
Depends how loud you shut it.
How many slices in a bread?
Depends how thin you cut it.
How much good inside a day?
Depends how good you live 'em.
How much love inside a friend?
Depends how much you give 'em."


Going in circles. . . .


There was this patient I had once who goes down in history as one of my most memorable Grady elders ever. No matter what I asked him, he had some circuitous comeback or pontificating response that never quite qualified as an answer. I thought my questions were simple enough, but I'd find myself in this crazy loop of Mr. Miyagi commentary that never seemed to have a real endpoint. Now y'all know how much I respect the Grady elders, so it's not like I could just throw my hands up and say, "Would you just answer the question already?!?" Instead, I just had to endure. . . .

"Hey there, sir. How are you feelin' this morning?"

"I'm still kickin' just not high, doctor."

"Oh. . .okay. Are you alright today?"

"Oh, now I'm always gon' be alright, now. 'Cawse I know a man who died on a cross and rose on the thoid day. . ."

"Yes, sir." (Grady rule #1: Never interrupt any Grady elder who makes reference to any part of the Holy Trinity.) I pause and wait for him to finish. "Soooo. . . .how are you doing, sir?"

"I don't know, doc. I ain't no count." Starts rubbing his abdomen. Belches.

"Uhhh, okay." (No count = not good or not well. Thanks, Dad for teaching me such lingo.) "Is your stomach hurting?"

"Sometimes it boils on me, but tha's okay. 'Cawse I ain't no ways tired."

"Yes, sir." ("No ways tired" = words in an old Negro spiritual. Grady rule #2: Old spirituals are also not to be interrupted.) I wait a few beats before asking again, "Sir, I'm just trying to get an idea of how you're feeling today. .to make sure I'm not missing anything. . . so your belly. . .how is it compared to yesterday?"

"Every day that I wek up and see a new day is better than yesterday. You see, 'cawse I know a man. . . " ("I know a man" = Elder reference to Jesus. Back to Grady rule #1.)

This cryptic circuit went on every morning for two full weeks for, like, thirty minutes an encounter. To this day, I'm still not sure whether or not he felt bad or good. Seriously, it was never clear to me. Either way, I came to enjoy our morning chats, even if I had no idea what to chart afterward.

***
"I cannot go to school today"
Said little Peggy Ann McKay.
"I have the measles and the mumps,
A gash, a rash and purple bumps.

My mouth is wet, my throat is dry.
I'm going blind in my right eye.
My tonsils are as big as rocks,
I've counted sixteen chicken pox.
And there's one more - that's seventeen,
And don't you think my face looks green?

My leg is cut, my eyes are blue,
It might be the instamatic flu.
I cough and sneeze and gasp and choke,
I'm sure that my left leg is broke.
My hip hurts when I move my chin,
My belly button's caving in.


My back is wrenched,
my ankle's sprained,
My 'pendix pains each time it rains.
My toes are cold, my toes are numb,
I have a sliver in my thumb. My neck is stiff, my voice is weak,
I hardly whisper when I speak.
My tongue is filling up my mouth,

I think my hair is falling out.
My elbow's bent, my spine ain't straight,
My temperature is one-o-eight.
My brain is shrunk, I cannot hear,
There's a hole inside my ear.
I have a hangnail, and my heart is ...
What? What's that? What's that you say?
You say today is .............. Saturday?

G'bye, I'm going out to play!"

Mourning sickness. . . . .


There was once this resident rotating with me on wards who was about 15 weeks pregnant. She confided in me early in her pregnancy, and also did not hesitate to let me know how obstructive pregnancy was to anything more than the most basic patient care. (She didn't seem impressed by the two pregnancies I worked through on wards. . .)

Me: "How 'bout you give us a lecture on hyponatremia?"

Her: "Oh, my legs get tired when I stand at the board."

Me: "You can sit if you'd like."

Her: "But I get out of breath from all that talking."

Me: "Okay, then you can just make us a handout."

Her: "I have terrible carpal tunnel already."

Me: "Uhhh, okay."

Her: "Hey, Dr. Manning?"

Me: "Yes?"

Her: "Don't forget I have Saturday off. . . ."

Me: "Yes, I remember. Is everything okay?"

"Oh, yeah! I'm doing a triathlon!"

Um yeah.

****

"There is a voice inside of you
That whispers all day long,
'I feel this is right for me,
I know that this is wrong.'
No teacher, preacher, parent, friend
Or wise man can decide
What's right for you--just listen to
The voice that speaks inside."

The Hard Choices. . . . .

I was once talking to one of my most favorite former-Grady-doctors ever. She was struggling with a decision to continue working at Grady, or take a different job. Now y'all know how much I love me some Grady Hospital--but the job opportunity in question seemed like a really great fit for her. She was so conflicted! I sat and listened as she rattled off all the pros and cons of each. As badly as I wanted her to stay and be a Grady doctor with me, it really sounded like her decision was already made before she even knew it.

"But I don't know what to do," she said tearfully. "I love Grady, but. . ."

"Listen to your spirit," I replied. "What's your spirit telling you?"

She started crying. Hard. I just sat there watching her from the other side of my desk. Hunched over with her face in her hands, weeping.

"There's your answer, and don't worry. It's always hard to say goodbye to someone or something you love. Just know that more love awaits you."

Just know that more love awaits you? Whew. I have no idea where all that Jedi Master deep-ness came from, but thank goodness it came when it did. Too bad I wasn't on a Shel Silverstein kick. I could have just whipped out "Where the Sidewalk Ends" and had her read that poem. See? I'm saying. Shel was dope.

***
"Sandra’s seen a leprechaun,
Eddie touched a troll,
Laurie danced with witches once,
Charlie found some goblins gold.
Donald heard a mermaid sing,
Susy spied an elf,
But all the magic I have known
I've had to make myself."

Magic in the hospital. . . .

When I was a medical student, I never seemed to be the one that ever saw the exotic cases of anything. Nobody ever seemed to seize in front of me or exsanguinate before my beady little eyes. Every heart murmur I heard was an "innocent" one and even when I thought a patient had a mass in the roof of his mouth one day, even that turned out to be a "normal variant." Dang.

One day in the cafeteria, third year medicine clerkship circa 1994:

"I admitted a lady with acute intermittent porphyria last night!"

"Oh yeah? Well, I helped code a man in heart failure from wet Beri-Beri!"

"What did you see, Kim?"

"Errrr. . . .I saw a lady who ate at the all-you-can-eat shrimp feast at Cap'n D's and got the gouch in her big toe."

::crickets::

(Okay. . .although seeing gout (a.k.a. "the gouch") is not like seeing a leprechuan, I've since learned that since common things are common, seeing all of those "bread and butter" cases in med school was a good thing.)

***

"Tell me I'm clever,
Tell me I'm kind,
Tell me I'm talented,
Tell me I'm cute,
Tell me I'm sensitive,
Graceful and Wise
Tell me I'm perfect--
But tell me the TRUTH."

Feedback. . . . .

(This is what I'm subconsciously thinking when I solicit feedback from my husband . . .and from your blog comments. . . .hee hee. . . .wait, did I just say that?)

****

"Said the little boy, "Sometimes I drop my spoon."

Said the old man, "I do that too."

The little boy whispered, "I wet my pants."

I do that too," laughed the little old man.

Said the little boy, "I often cry."

The old man nodded, "So do I."

But worst of all," said the boy, "it seems

Grown-ups don't pay attention to me."

And he felt the warmth of a wrinkled old hand.

I know what you mean," said the little old man."

Kindred spirits. . . . . . .

This little ditty reminds me of why it's so beautiful to have medical students in the hospital. They have the most time to give, and their undivided attention can be such a blessing to sick patients. I remember being completely ignored by my attending during my 3rd year clerkship in Internal Medicine--so much so, that I was convinced that I would never, ever do Medicine. I initially thought I'd be a surgeon. . . . .until I discovered that I loved the post-op patients and consults on the surgical service, but not the OR. (Turns out that you need to like the OR if you want to do Surgery. . .picky, picky!)

I later learned that even though some of my attendings back then wouldn't know me if I walked up and smacked them across the face. . . .my patients knew me and appreciated my presence. Sometimes the patient and the medical student have more in common than they realize. I tell the students of how pivotal their role is to scared patients. I also tell them that you need that patient just as much as that patient needs you.

****
It was missing a piece.
And it was not happy.
So it set off in search
of its missing piece.
And as it rolled
it sang this song - "Oh I'm lookin' for my missin' piece
I'm lookin' for my missin' piece
Hi-dee-ho, here I go,
Lookin' for my missin' piece."

A perfect fit. . . . .

This book by Shel Silverstein-- "The Missing Piece"-- makes me think of my life before Harry and the boys. I can't say that I was really unhappy, per se--but something was missing. The ending of the book makes me happy because it reminds me of when I first met Harry. I guess the way I remember it is kind of like this. . . . I was just a-singing and a-rolling along like the circle missing the piece. Hi-dee-ho, here I go. So glad I found my missin' pieces!

Found: my pieces that I love to pieces

***
"Would you like to hear
of the terrible night
when I bravely fought the---
No?
Alright."

The late night storyteller. . . . .


Bwwah hah hah! This essentially describes one of the reasons I started this blog in the first place. Harry a.k.a. "the person who originally had to hear every one of my Grady reflections before this blog." My poor, poor husband. He'd lay in bed at night listening to me rambling on and on with my intricately detailed Grady tales. . . . .

"And then, you won't believe what happened next, babe!"

Snort. "Uh. . . huh? I can't believe that, babe."

"I didn't say anything yet, Harry." Snort.

Snort. That was the sound of Harry dozing off with the tiny snore that he would swear up and down was not, do you hear me? Not a snore but a wide awake snort.

"I'm listening, babe. I am listening."

"Okay, well then. . the nurse comes up to me and my team and says. . " Snort.


Starting this blog sort of let Harry off of the hook. Sort of. (Okay, I do still tell him quite a few of my stories, and okay I admit, sometimes make him listen to me read him my blog posts aloud. . . .)

So on behalf of Harry and me-- thank you for reading. . . .and for coming in and sitting by my fire. For truly, my friend, we have some flax golden tales to spin indeed. :)

***
If you didn't (gasp) grow up on Shel Silverstein. . . .and even if you don't have children. . . .please. . .
don't go another day without the gospel according to Silverstein. . . .