Friday, February 11, 2011

Claims adjustment.

*Names, details, etc. changed. . . .you know what's up. . . .
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"I can't take this, Dr. Manning," my resident, Fiona said to me one day near the end of rounds. "This is bordering on abuse. Seriously."

She was referring to the overbearing sister of our patient, Mr. Denton who had been admitted to our service the day before. He had an unfortunate stroke a little under one year ago--very likely as a result of active cocaine use. Up until then, he'd been living on the streets, shackled onto a crack cocaine chain gang that he couldn't escape. A massive brain hemorrhage finally did what no one else could--peel him away from a gripping stronghold that had alienated him from everyone he loved for years.

"What's going on?" I asked.

"First of all, she's yelling at the nurses, the intern, and me. She's demanding all sorts of things and it's just unreasonable. He shouldn't have even been admitted." Fiona sighed and shook her head. "I'm sorry, Dr. M. I'm just frustrated."

"Why the hostility?" I clarified the statement. "I mean from his sister. Where do you sense it's coming from?"

Fiona paused and squinted her eyes. I could tell she hadn't considered that question. "I don't know. I mean, we've been nothing but polite. . .but the minute I suggested that he be discharged, she lost it. She wants to know why we don't have physical therapy in here trying to get him up and trying to walk." She emphasized the word "walk" by furrowing her brow and shrugging her shoulders. Her mounting frustration was evident; a pink flush over her cheeks resembled that of someone who'd just been outdoors running.

This wasn't an unprofessional resident. Fiona was an effective communicator, an empathic caregiver, and a thoughtful leader. Her other strength was that she was an advocate for her interns, students, and the nurses. She wasn't the one to fool with when it came to tongue lashings by patients or their family members.

"How should we proceed?"

"I don't know, Dr. M." she said with a heavy sigh. "I mean, I know this isn't about me, but it's exhausting. I say we go in together, but I'm telling you. . . .it could be ugly."

I nodded and pressed my hand under the hand sanitizer dispenser. I bit the side of my cheek and looked at Fiona with trepidation before opening the door. The thing is, I wasn't sure what to expect. I knew that a resident this strong had given it a college try. I hoped that something with this repeat encounter would be better.

We entered the room to find Mr. Denton lying quietly in bed. His vacant stare and expressionless face were consistent with the regrettable extent of his brain injury. His arms were flexed upward and his wrists downward; his eyes somewhere very distant. It hurt to see.

His sister immediately rose from her chair and walked toward me with a pad of paper. "What is your name?" she asked while positioning her pen. The intonation of her question was confrontational; too much emphasis on the 'what' in that question.

"Dr. Manning. M-A-N-N-I-N-G."


"Yes, ma'am. That's correct." I waited a moment while she jotted it down. "I just wanted to come by to introduce myself to you and to examine your brother."

"Well, I need to know why isn't there a physical therapist here working with him? He really needs that. They need to get him up and walking. How can we know if he can or can't walk if we don't try? And nobody is feeding him. How can he get better if he isn't eating?" She moved around his bed, smoothing the covers and fluffing the pillows. She wiped some saliva from his lip and then spoke to him. "Junior, you hungry, ain't you?"

I stood there quietly; my eyes scanned the perimeter of the hospital bed. A bag hung on a pump on the right side of his bed filled with milky liquid. I traced the attached tubing as far as I could until it disappeared beneath the blanket near his torso. There was no point in pulling back the covers; I knew there was a gastroenteral feeding tube doing the work that his brain would no longer allow his esophagus to do.

I finally got to my examination. Mr. Denton's sister folded her arms and stood right next to me during the entire assessment.

The exam didn't reveal anything active. Other than this very sad state that had now become his new norm, I could only admit that I agreed with Fiona's assessment--there was no reason why he couldn't return to the nursing home.

I felt my pulse beginning to quicken as I searched for the right words to begin what would surely be a difficult exchange. "Ms. . . I'm sorry, I didn't get your name?"

"Alicia Mays. I'm his older sister," she quickly answered. "So what are you planning to do? Can we please get somebody in here to help him eat and get him up to walk?" Alicia blotted her brother's brow with a washcloth and then looked up at me.

"Ms. Mays. . . ." I started, "The thing is that. . . .your brother. . . his stroke has really damaged his brain pretty bad. Because so many of his nerves were hurt, that's why, like, walking would be really tough for him. Like the part of his brain that stayed okay is telling the muscles and nerves to tense up, but the part of the brain that got hurt is the part that tells it when to relax. Without both working together, it's hard."

"He's a fighter," she countered. "We ain't afraid of 'hard', are we Junior?" He lay still, without any change in expression.

"I can tell he is a fighter. . . .I mean. . .with such a big stroke, the fact that he . . . I mean. . .I can tell he is a fighter."

"Yeah. He is."

"Ms. Mays, you need to be aware, though. With all he has been through, right now, he seems to be doing okay. There isn't an active problem that we want to keep him in the hospital for. I think we could coordinate some things between our social worker and the nursing---"

"No, he needs to be eating before he leaves. And also to get up and work on his walking. A lot of people use a walker after strokes, so I'm thinking y'all could call somebody over here to get him a walker."

"Ms. Mays. . . .he can't swallow food because he could choke. That's because of the stroke, so I wouldn't expect him to eat other than the tube feeds. With the walking. . . . I just want to be honest. . . .walking may be unlikely, too. The stroke made it hard for him to breathe at first, and his oxygen was really low. That hurt his brain more. . . and. . " I looked over at Fiona who seemed to already be in a wincing recoil. ". . . .and the chance of him recovering to a point of walking and eating is low."

"Oh. Well, that's fine if you think that, Dr. Manning. But we ain't claiming that. My brother will beat this. He's gonna walk out of here and go to get himself a hamburger and fries." She chuckled a rather odd chuckle. "Ain't that right, Junior? We ain't claimin' that, are we? We know the Lord is able."

Fiona looked at me with pleading eyes and also a bit of confusion. This was hard.

"We ain't claiming that." Sigh. I know this phrase well. When you know the souls of black folks like I do, not only have you heard this spoken more times than you can count, you've probably uttered it once or twice yourself.

"Claiming" something means accepting it as so. "Claiming" something releases it into the universe as a possibility or even, a plausible outcome. You see, trusting in God means, as many folks in these parts put it, "claiming the victory" in advance--the victory promised to those who love God--and specifically Jesus.

I've had my share of "claims."

A few weeks ago, we learned that our home address was being redistricted out of the wonderful elementary school that attracted us to our neighborhood in the first place. All hell was breaking loose, and this house that we'd bought at great sacrifice in 2006 was suddenly going to sharply decline in value. But more than that, our kids wouldn't get to go to the school that we've waited, literally, four years to attend. Snuffed out just like that with Isaiah only in kindergarten.

But I wasn't claiming it.

We prayed about it. We went to meetings. We talked to other parents. And at some point, I said to Harry, "I'm not claiming it. Isaiah and Zachary will go to that school. They will." And the truth? It was a long shot. That awesome school is overfilled and the other one we were getting zoned for is underfilled. I knew it wasn't really personal, and that similar things were being proposed all over the county.

I talked to my dad who used to be on the school board in our county when I was growing up, and asked him what the chances were that there'd be a change of heart and we'd get to stay at our school. Based on his experience? Slim to none.

But still. I wasn't claiming it.

Or rather, I wasn't claiming a negative outcome. Now I do admit. . .at some point, I had a bit of a "claims adjustment" and decided that rather than blindly saying I "wouldn't claim it", I'd shift my focus to wanting what was meant to be. Somewhere in all of it, I really, really believed that we'd be okay. Slim chance or not. And as it turned out, the revised zoning kept our address intact.

Faith won.

So I got what she was saying. God answers some pretty tall orders, so who was I to argue with her, especially since I have plenty of my own testimonies? Though my approach wasn't exactly like hers. . .definitely. . .I got where she was coming from.

"Ms. Mays?" I finally spoke. She rummaged through her purse pulling out papers and writing things down as I spoke. "Ms. Mays. . . .this. . .this is not a good situation. And . . .I, too, am a woman of faith . . . .but if you can just listen to me for a moment. . ."

"I'm listening."

"I can only tell you what I know based upon my medical knowledge. Based upon that. . . .your brother's stroke has changed him where for him to walk or talk or eat on his own would be a miracle. And yes, Ms. Mays, miracles take place, they do. But. . . I cannot be dishonest and tell you there is something I can do in the hospital to make that miracle happen right now. But I can make sure the things he needs, he has. I can make sure he is not in discomfort, and I can answer your questions. . ."

In my head, I was thinking that I could and would pray for them, but I decided to keep that to myself.

"This is ridiculous!" she huffed. "Everybody thinks my brother is dead and he AIN'T DEAD!" Her voice rose up and startled me. "He AIN'T DEAD! He's GONNA WALK! He's GONNA TALK! He's GONNA BE ALRIGHT! You AIN'T GOD!!!" She aimed her index finger directly at me with her arm fully outstretched.

My chest was heaving as I sifted my brain for the right words. I needed to wring out my mind to get my emotions in check. "I don't. . . ." I felt my voice getting tiny and wobbly and my face getting warm. ". . I don't think I'm God. I don't."

"Y'all do. Y'all DO, but you AIN'T!" She pointed skyward with her right hand emphatically, the skin below her ample arms shaking. "He's a HEALER, do you hear me? He's a WAYMAKER!!" she bellowed. Just like I didn't like her "what" earlier, this time I didn't like the accusatory tone of her "He." I glanced at Fiona, whose face was now beet red. She almost looked like she would be sick. I turned my attention back to Alicia.

"Ms. Mays. . . . listen. . .I . . .I know who has the final word. . .I do. And if He intends for something more to happen, it will. . .whether your brother is in this hospital or at his nursing home." I abruptly stared at the floor and then looked back up at her. I felt my voice quivering. "And let me tell you one thing for sure. I do not think I am God."

She stared at me intently as Mr. Denton lay with the same blank expression, possibly oblivious to it all. I repeated myself, knowing that I sounded like a broken record . . .I needed to say it again for me more than anyone else. . .my voice almost a whisper, "I don't think I'm God."

The room fell into an awkward silence. I cast my eyes back down toward the linoleum squares below my feet. I could hear the clock ticking, a phone ringing at the nurses' station, and someone chatting in the hallway. Fiona's eyes were glued to her shoe laces, her mouth sealed into a terse line.

Finally, I shook my head and spoke quietly. "Ms. Alicia. . . .I'm so sorry this happened. I. . .I have a brother and. . . I'm so sorry."

Suddenly I heard Alicia quietly weeping. A tired, frustrated, complicated cry. She immediately began patting her eyes with a frayed piece of tissue fished from her handbag and turned away from us. For a fleeting moment I thought she was going to fully break down, confessing how guilty the family had felt for allowing him to be swallowed up by the world. I was sure a story was coming about how the family turned their back on him; unable to peel his fingers away from his crack pipes or their precious treasures that always seemed to disappear whenever he was around. We'd give her knowing nods, hugs even--embracing the pain that manifested as anger and suspicion--letting her know through our empathy that we understood.

But that didn't happen. She regained her composure before it ever had the chance to be lost.

"Just let me know when he will be discharged back to the nursing home," she mumbled while reaching for her cell phone. She refused my desperate attempts at eye contact.

"Ms. Mays, if--"

"Can you just please just let me know when he will be going back to the nursing home?" she interrupted me. "Please."

"Yes, ma'am."

She began dialing her Blackberry, and then paused to dismiss me with eye contact so searing that it immediately made me wish I'd not been looking in her direction. I obediently stepped toward the door.

I stammered as I reached for the handle, "Ummm. . . . .if you have any other questions. . .my name is--"

"Yeah, I got it," she said, "Manning. M-A-N-N-I-N-G."


  1. 1. I'm glad your kids get to stay in their school...we thought maybe James would have to be moved this year, and it is *not* a good feeling.

    2. You're not God?

    3. I can only imagine how hard it is for patient/patient families who are accustomed to fighting uphill battles to learn that, this time, fighting for what they want/deserve/need isn't going to work.

  2. Wow Kim, I definitely understand.
    Especially in our community where faith is the rock of strength we ALL need at times just to get by day to day. I agree, God can do miracles.
    I often pray with my patients and families when there is nothing else medically I can do. I think it not only helps the family to know I've done all I can, but the next healing will have to come from a higher power greater than me.
    It's tough when we learn our complete healing may not come during this lifetime.

  3. What a story! I love the strength and compassion I see in your doctoring.

  4. Although I don't always comment, I read every day. Please always keep writing. Thank you.

  5. I was browsing and found your blog. Though I'm and Ob/Gyn I know how you feel. You are an amazing story teller and I can tell an amazing teacher and doctor. Your patients and students are blessed to have you

  6. So many lessons here, so much to think about and consider, so much to absorb and carry forth. Thank you for your beautiful writing, the poignant stories and the invaluable lessons they teach.

  7. a wonderful blog as usual...always inspirational. thanks for sharing!

  8. I have been meaning to tell you- you are so beautiful

  9. I agree! :) Last year I was reading the post about how one of your sons thought that you looked like Halle Berry, and you really do! :) I love your hair too, my hair goes past my shoulder blades, but if I could pluck up the courage, I'd love to have a hairstyle like yours.

  10. How cool is it to know that a friend in New Zealand (Lucy) reads this blog every day? I'm just saying---technology is awesome!

    Rachael, right back atcha! Congrats again to you. :)

  11. Yup, you've really gone global now, Kim! Followers in the South Pacific - more than 12,000km away from Atlanta. :)

  12. Wow, what a difficult situation. (I'm so glad your kids get to stay in the district though! Praise God. ) But it sounds like you really did a great job getting to the core of the issue--that for the woman this was (understandably) a crisis of faith, not of medicine. I feel for her--I, too, have a brother--and for you, too. It must be really tough to know how to respond to someone whose questions and emotions lie in an area outside of your professional limits, but that coincide with your own personal and spiritual limits too. I've been thinking about this notion of 'claiming' (I grew up hearing it, too) a lot lately, especially because of this ( Thanks for the post!


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