Friday, September 16, 2011

Get a grip.

What wisdom can sometimes look like.

I heard a talk given by one of the Grady senior faculty on something intriguing. He talked about "Wisdom in Medicine." Bill B., the one who gave this lecture, was the perfect dude to be giving this lecture for a few reasons. I mean, he is wise, yes. But he also has that whole wise persona about himself. White hair and beard. White coat that never, ever seems to have a speck of dirt on it. And all kinds of official letters behind his name after the M.D.

But I'm thinking that wisdom looks like a lot of things. Not just like Bill B. and Dumbledore.

Anywho. Bill B. talked and we listened and then we talked and he listened about wisdom in medicine.  He, too, suggested that wisdom can be found in many places and that we need to role model this for our learners. I was sitting at the end of the table next to one of my favorite Grady doctors, Robin K., who looked over at me and said, "Hey, do you feel wise sometimes?"

And the thing is, I laughed because secretly there are moments where I do. I looked at Robin and said, "You know? I don't know everything. But sometimes I do feel a little bit wise."  And we chuckled because honestly, who admits to being wise?

Just then, Bill B. shows a picture of Socrates and said that "Socrates was the only wise man of his time because he was the only one who didn't think he was wise."

Whoops.  My bad.

Maybe "wise" sounds a bit pompous and pretentious so that's why Socrates avoids claiming it.  Yeah, yeah. Fine, then. How about we refer to it as "mother wit" instead? Yeah. Mother wit.  Mother wit is that knowledge you get with time that can't be found in books. It's mostly learned from trials and errors and watching and sitting at the feet of elders. And Lord knows you don't need to be a doctor to have or gain that kind of wisdom.

This is why that discussion intrigued me so much. I like this idea of talking about the fact that being a good doctor or an effective human being is about more than pouring through articles and regurgitating big scary words and facts. It's about "getting it."  And how many times have all of us been in a situation where you see some aspect of a situation that some really smart-on-paper person just can't seem to get?

Now. Many a time that dunce has been me. Picking through every single fine detail and sifting through medical literature to find an answer when what I really needed was just some mother wit.

Which reminds me.

There was once this man I was caring for who I'll call Mr. Everett. He'd had a stroke and a prolonged hospitalization. Mr. Everett had to learn how to do the most basic things all over again, and lucky for him and us, he was super motivated to do just that. He worked with PT to walk again. He worked with OT (occupational therapy) to lift a fork and comb his hair again, too.  There was only one problem that kept making things difficult. His blood sugar control.

Technically, it wasn't that problem per se. The thing is that Mr. Everett was having issues with eating and chewing after his stroke, which greatly affected his caloric intake. With wacky food intake, the insulin he received for his diabetes was all over the place. Talk about frustrating. He was hell bent on not having any kind of feeding tube placed, yet no matter how many times we tried to advance his diet, he'd gag and sputter and have issues.  He'd passed the swallowing studies and the speech/chew folks assured us that his mechanical ability to eat wasn't the problem. Which kind of sucked considering he'd come so far with regards to everything else.

So on and on it went. Liquids ----> thickened liquids ----> soft mechanical diet ------> regular diet -----> gagging, sputtering, not eating----> thickened liquids --->soft mechanical diet -----> regular -------> gagging, sputtering, not eating. . . .


"Mr. Everett, I'm not sure we can pull off having you eat this regular diet. Even with help, you have trouble," I'd say.

"I don't want no feeding tubes feeding me. I can eat and I want to eat."

That's all he would say. So this went on for easily more than seven days.

Then, one day I come in and see Mr. Everett sitting up in the bed throwing down on his tray. Cutting, slicing, peppering, grubbing. I was totally perplexed, as was his nurse.

"Mr. Everett!" I exclaimed, "You're eating! And swallowing! I'm so happy!"

His nurse had similar things to say and we were so happy that we did the cabbage patch dance around his bed. He simply smiled, swallowed and dug in more.

What the?

And so a few hours later, I'm rounding with the team and gushing about Mr. Everett's esophageal epiphany. I went on and on about him feasting on the breakfast tray and even demonstrated the dance that I did with the nurse.

"I guess it just all finally came together!" the senior resident said with a triumphant smile. "He must have just needed some time."

"Yep. Time seemed to be the key," I responded, "but it's really kind of amazing how all-of-a-sudden it was, you know? Like someone unraveled a mystery."

And we all sat there over tepid coffee, smiling at feeling all proud of ourselves for "curing" Mr. Everett. Now his blood sugars were consistent and he was on his way to getting discharged.  Score.

Then, in comes one of the interns, Nicki M., who'd been off dealing with another patient. Her co-intern looks up and says, "We were just talking about Mr. Everett. Can you believe it? He's eating! Like a champ! Dr. Manning said he cleaned his plate this morning--a regular diet, too!"

We were all so invested in him as a team that, even though Nicki wasn't the primary intern caring for him, this good news was for her, too. Nicki scooted her chair up to the table and nodded. "I'm so glad that worked for him."

I was puzzled by that statement. But his improvement was awfully abrupt, so I couldn't resist getting clarification. "What? What do you mean 'that worked?'"

Nicki rocked on the back legs of the chair and answered with nonchalant shrug, "Poligrip. Extrastrength."

We all looked at each other in disbelief.

Yes. You read that right.  Poligrip. Extrastrength.  

It turns out that Nicki had heard about Mr. Everett so much on rounds that she'd decided to go hang out with him in the middle of the night during her call night. She looked and listened and asked and explored. And you know what she discovered? That at home he uses extrastrength Poligrip for his dentures and that the kind he's been given in the hospital both irritates his gums and doesn't work. Every time he tried to macerate his food, he couldn't. Because his dentures were too loose.


So Nicki called the pharmacy and they didn't have it. The next day, she personally went to CVS and bought him some. Simple as that.

Now. You tell me--was that mother wit or what? Something had told Nicki to go in there that night. It wasn't even her patient, but she went. Something made her think beyond all the technicalities and academic things to something as simple as denture adhesive.  Denture adhesive.

So, yeah. I've had a few of those Poligrip extrastrength moments in my life. And fine. If Socrates doesn't want me to refer to it as wise--I won't. But I think Bill B. was right.  Medicine and life are about a whole lot more than just being smart.  You need the knowledge, yes. But most of all you need you some "mother wit" and an ability to just "get it."


  1. That IS a great story and it's not just about Mother Wit or wisdom, it's about not looking for zebras when a tame little pony is right there wagging her mane at you.
    But I do love the phrase "mother wit." I hope I have some by now.
    And how do we KNOW that Socrates didn't think he was wise? Maybe he was just self-deprecating. Haha!

  2. if i'm ever hospitalized, i hope i have staff that takes the extra time to talk and find out what the problem is. great work. so wise ;-)

  3. oh i love this story. now that is an intern i would love to work with!


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