Tuesday, November 29, 2011

The agony of de feet.

(This should be required reading for all future physicians.)

Wet foot, dry foot
Low foot, high foot
Front feet, back feet
Red feet, black feet
Left foot, right foot
Feet, feet, feet
How many, many feet you meet!
~ Dr. Seuss

I have this medical school classmate (that shall remain nameless) who hated feet when we were in school. Oh my goodness. Absolutely detested them. And touching them? Out of the question.

The funny thing about it is that this woman was and still is quite possibly one of my favorite medicine nerds and doctors of all time. Being friends with her made me a better medical student because I knew no one who valued their medical education more than she. Just being in her presence made you want to try harder and do better.

Anyways. Despite all that wonderful-ness, her Achilles heel (interesting proximity) was feet. Yes. Feet. Bigs ones, small ones, flaky ones, pedicured ones. It didn't matter. There was just something about them. . . . .all wiggly and sweaty and fresh off the ground that gave her the complete heebie jeebies. As a matter of fact, she used to even examine the toes of her diabetic patients using two tongue depressors! She had whatever is the complete polar opposite of a foot fetish.  More like a foot-a-phobia.

Which reminds me.

The closest I ever got to seeing her catch a case was the day I decided as a joke to put my bare foot on her. O.M. -expletive- G. I slid my foot out of my flip flop one day and touched her with my big toe during one of our big exam study marathons--and what did I do THAT for? Man. We were punch drunk from sitting in the library for twelve hours straight, so I thought my little prank would lighten things up. That's what I thought.


Seriously? We almost fell out for good over that. If I recall correctly, she froze and said, "B-word, did you just stick your bare FOOT on me?" And from the dead serious look on her face, my instinctive response was to run for my life. Fortunately, I've since learned to keep my feet to myself, and for this reason, we were in each other's weddings and remains tight like cornrows. Oh--and yes, she is now an amazing clinician who does, for the sake of her patients, occasionally touch their feet when medically indicated.


Tonight I was judging yet another stinky feet contest between Isaiah and Zachary and remembered my classmate. I sent her a text about the foot anti-fetish which made us both LOL.

But then. . .that got me to thinking.  I started reflecting on . . .well. . . .my clinical experiences through the years with feet. And you know?  My buddy might have been on to something. . . . .

I started to torture y'all with the top ten terribly, horrible no good very bad feet stories but quickly realized that would be cruel.  But that doesn't mean I won't share a few of the best foot horrors I've had. You know. . .the ones that have made me have fleeting thoughts of choosing a new line of work.

Caution to those who have a foot anti-fetish. . . .


Horror #1: What's in a word?

Okay. So I was in my third year of residency and was running a ward team. We were busy as I don't know what, but we were having loads of fun and taking good care of patients so it was all good.  One day we were rounding post call and the overnight intern was presenting his patient to me.  Back then, one of the interns was on call with a cross cover senior each night. As the ward team leader, I learned about the patients early the following morning unless I was that person supervising the night before.

On this day, I hadn't been in house overnight so this patient was new to me. I remember it like it was yesterday. The intern presented this extremely straightforward patient with a case of community acquired pneumonia. He had an oxygen requirement and involvement in more than one lobe, so this had gotten him hospitalized. In addition to that, he was unstably housed, so had lots of social issues to boot.

So I hear all about this gentleman and his respiratory issues. The intern was all over it, and had all the management wrapped up tight.  We prepared to walk into the patient's room when she stopped me and added, "Oh yeah. . .I forgot to mention that he has this funky, serpiginous rash on his foot."


"What do you mean by a 'funky, serpiginous rash'?" I immediately demanded of her.

My intern wrinkled her nose and shrugged. "I don't know. Some kind of parasitic thing or something fungal? I'm not sure. I put in a consult to Derm already."

And in she walked ahead of me like it was no big deal.

But it was a big deal. It was a big deal because of that word she used: "serpiginous."

ser·pig·i·nous (sr-pj-ns)adj.:  creeping from part to part; having a wavy border.

The thought of anything awaiting me that would be described as "serpiginous" made the hairs on my neck stand up.  And especially a serpiginous foot? Creeping. . .worm like. . . wavy. . . lawd. I was terrified.

And rightfully so.  Those feet. Good heavens to mergatroid. It looked like the patient had stepped on some tangled web of hot yarn and branded the sole of his foot with it.  It literally was worse than smelling chitlins cooking. I was so grossed out that I had to remove myself from the room.

Later on that morning when we were rounding with the attending he asked me to "do some teaching on that foot lesion" since he "knew how much I liked dermatologic manifestations of medical illnesses."

"Sir, this is actually not medical-manifestation related. It's a purely an infectious Derm thing. Let's just see what they say."

My interns snickered because they knew I was trying hard not to have anyone expose those feet again. And that's when my attending insisted. "Oh, don't be silly, Kim."  And with that he pulled off a sock. And worse--he said this:

"Hmmm. . . .this is serpiginous." He leaned in closely. "Dr. Draper, step over here with your pen light."

But that was not happening. Dr. Draper was in the hallway leaning over a water fountain.  Dude. He lost me at "serpiginous."

I googled "serpiginous rash" and decided it would give you nightmares to post a photo. Instead, I took a picture of the goose flesh I keep getting every time I type the word "serpiginous."

If you want to make me run from you just say "serpiginous" three times fast.

Up until that day, I used to have thoughts about being a dermatologist instead of an internist. This was the day it became very clear that the thought of having to see someone repeatedly for their serpiginous eruption would cause me post traumatic stress for real.


The point was feet, wasn't it? Oh hell. It was on a foot and yes, it was super-duper gross so that counts.  Sure does. Oh, and for you medicine nerds? The diagnosis of that funky s-word rash was "cutaneous larva migrans" which I hope and pray I never, ever, ever see staring me in the face again. 


Horror #2:  Winter boots.

The worst possible smell I ever smelled in a hospital was that of feet coming out of heavy snow boots during Cleveland winters.  I mean it.  At least once per week, one of my clinic patients would need their annual Pap/pelvic exam.  No big deal in the summer. But the winters? Another story.

Picture this: Two really, really, REALLY sweaty, bare feet propped approximately four inches away from your face on some stirrups.


(That was me passing out from remembering it.)

The good news is that I do think it has adequately made me an appropriate authority for judging the stinky feet contests at my house.  My point of reference is quite extreme, man. Our frontrunner is Zachary, however, he has nothing on the snowboot feet. At. All.

Horror #3:  Admit to Medicine? Not.

I was eight and three fourths months pregnant with Isaiah and rounding at Grady one day.  The ER was hopping with patients and we were getting bombed with new admission after new admission. The patients were great as always, but I was so, so tired. This day I was trying to keep up with the team but finally had to sit down in a chair on the ward.

Until I got this page:

"Hey Dr. M. There's a patient who is getting admitted to us who I think may be a surgical admission. He needs an amputation but is refusing so the default is us. Can you come down to the ER?"


Pregnant, tired, and not in the mood for a fight.  But I had no idea what we would do for a patient warranting something that could only be corrected by surgeons. Especially considering we aren't surgeons.

So down I go.

"What's the deal?" I ask the resident while looking for yet another chair to sit down in.

"This man has a necrotic foot and no palpable pulse. It's really bad, too. He needs an amputation but is reluctant so they can't consent him. Surgery won't take him if he won't consent."

"Well, getting your foot cut off is something to be reluctant about, don't you think." I twisted my mouth for a minute and asked more questions. "Why is his foot necrotic? Is he a diabetic or does he have peripheral arterial disease?"

"Actually, no."

"That's weird. Why is his foot necrotic to the point of amputation then?"

My resident just looked down and sighed.  This was puzzling.  I was tired and my feet were hurting. My hip was hurting, my back was hurting and now my head was hurting from not understanding what this dude was doing with a dead foot and no good reason for it.

"Let me go see it." I shook my head and set out for the room. My resident grabbed my arm and stopped me.

"Uuuuhh. . . Dr. M? Listen, it's no big deal. Let's just admit him. Besides, he's a nice guy and has a lot of social issues that we can help with. Don't go in there. It's okay."

I looked at him suspiciously.  "What's up with his foot?"

That's when the ER resident walked up and asked me, "Hey Dr. Manning. I'm sorry about that admission. I mean, it's totally surgical, you know, but he won't consent to the surgery. I have never seen anything like that! Maggots?"



"Ex-squeeze me??"

"Oh, you didn't know? Mr. Parker has had on the same pair of socks and shoes for almost nine months. The left foot can probably just be debrided and cleaned up but that right one had some kind of sore on it that got infested with maggots.  They've pretty much eaten up his toes."

Aw. Hell. No.

I swallowed hard and searched for that seat again. All the color sank from my face, I'm sure, as I plopped down and asked, "So what am I supposed to do?"

"I mean we can't send him back to the street like this. He's homeless, Dr. Manning."

I looked at the resident and then down at my ginormous pregnant belly and wanted to cry. Now this? This was up there with the serpiginous foot. I took a deep breath with closed eyes.  "I'm going in there to talk to him."

My resident and the ER guy looked at each other and realized there was no point in trying to stop me.  I was going in. 

And so I did. Alone. I could see people looking and pointing at me through the glass window separating the patient's room from the rest of the ER. They seemed worried that I would faint. But all I knew was that I had no magic treatment for a maggot infested foot. So I needed to try to speak to him myself.

So I take a history and learn his story. Homeless for five years. Lives outdoors, under bridges, and all over. Had been given a pair of steel toe boots a year back by an outreach group and also some socks. So yes. I confirmed that he had been wearing those shoes and those socks for almost nine months. And yes, he pulled off that dressing and I am not kidding or exaggerating one single bit--it looked like his toes had already been amputated and the stump was alive with wiggling maggots.

Alive. With. Maggots.

I leaned on the bed rail to brace myself. Thank goodness for the pregnant stuffy nose--at least I couldn't smell anything.  "Mr. Parker, sir? Have you actually seen your foot?"

I'm not sure why but I decided I'd ask this before anything else.  And guess what his answer was? No.  No! He had come in because he was having pain in the foot and people around him on the streets were complaining about the smell. He had never actually seen what the commotion was under that sock, though.

And so. I showed him his foot. I pointed out the larvae and the denuded metatarsals. And those maggots seemed to wake up and wiggle extra just for him. He looked as aghast as I did and asked, "So now what can they do about it?" So I told him that it was surgical. Surgical debridement or amputation or something that was beyond my expertise. Honestly? Probably an amputation under the knee. But if he waits, more.

And just like that he said he wanted surgery. No arm-twisting just a simple mirror on his foot. So out I walked with my big ol' basketball belly and personally called surgery myself.  And yes, they graciously accepted Mr. Parker to the surgery service.


I know it sounds crazy to have not taken your shoes off in nine months. But he said that those steel-toe boots were good, sturdy shoes and he was scared they'd get stolen if he removed them. So he didn't.


Now that patient? He was super sweet. But that foot of his? Literally it was like some mini-Medusa head with writhing appendages. Yes. And if that description makes you throw up in your mouth a little bit--or just throw up period--then that means I have accurately painted the picture for you.

Medusa Head: Peter Paul Rubens - Oil on Canvas

That? Now that was the worst of all the feet horrors. Whooo-weeeee.


Damn, it's late. Wait, what was the point of me telling you all of this? Hmmm. Oh well. I'm pretty sure there isn't one.


Here's one:  If any aspiring medical doctor reading this thinks that blood and bodily excrement are the only considerations you must get cool with before entering the field of medicine--honey, think again! Contrary to what they might show you on Grey's Anatomy, a world of funky, serpiginous, sweaty, and maggot-infested feet await you just behind the curtain in Room 2.

Up feet, down feet

Here come the clown feet.

Small feet, big feet

Here come the pig feet.

His feet, her feet

Fuzzy fur feet

In the house and on the street,

How many, many feet you meet!
~ Dr. Seuss

Happy Hump-day all you medicine nerds.

Monday, November 28, 2011

Taking a load off.

I saw a fellow Grady friend today and we greeted each other like normal. Passing through the hall way, going about our normal every day. Quick small talk. How was Turkey Day? Obligatory pause for expected response: Good and yours? Mouth moving saying "fine" before I could even think about what it was like. Fine. Kind of like saying "muy bien, y tu?" when you don't speak Spanish and someone says "como estas usted?"

Yeah. Fine.

No big deal, though, because it was fine. More than fine, it was great so I added that on, too. So we passed each other and that was that, but then someone asked a question about some mundane thing and I can't really even remember who did. But what I do know is that the second exchange slowed me down enough to see something I hadn't noticed before. Couldn't put my finger on it. A heaviness was there. . . . something hard to explain. 

First thought was to ask. "You okay?" But I didn't because I figured the "yeah, I'm fine" would be just like that "muy bien, y tu?"  Instead I just made more small talk, looking to see if I could figure it out but I couldn't. This was a good friend. But a stoic one. Decided to back off.

But that heavy was there. No. It wasn't in my head.

Oh well.

I got back to my own hustle bustle and went about my business. Much to do, much I've procrastinated on so I'd put it on a post it note in my head for later. Back to work. Eventually allowed myself to forget about that heavy altogether with all my own busy.  But then I ran into my friend again. And there it still was. That heavy.  

But still I waited because sometimes heavy is private. And even when concern is well-meaning it's better to let it wash up like placid waves instead of crashing like surf.  So that's what I did. Waited.

Small talk was where it started. Laughed about this and that and chatted about that and the other. And somewhere in it all, it came out. Just like that the heaviness was explained.

"I'm sorry," I said. "It looked like you were flying on one wing."

"Yeah. . . ."

That was it.  That was all. No dramatic hugs or tears or melodrama. Just a listening ear and a little bit of trust found in an unexpected place. At work.

Imagine that.

You know. . . at Grady we give so much of ourselves to our patients, our learners, and our careers. But each of us is human and connected to lives that extend beyond the walls of the hospital. Today I was reminded of one of my favorite things about working here--these really deep and genuine friendships that I've forged over the years.  A place to put your heavy down and know it's safe.

I've had my heavy on some days and I was so glad to have one of several people see it and feel it and know it. Sometimes that heavy is 100% patient-care related. But many times it isn't at all. And this time was one of those times.

So the placid waves rolled up and the heavy washed away just a little. And that was good.

Every job isn't like this.  But thankfully this one is.

And this? This, too, is Grady.


Now playing on my mental iPod. . . . Donny Hathaway's haunting voice does this the most justice. Please. . .listen to this and be moved deep in your soul.

Why the caged bird sings!

Here's something cool:

I just had a narrative/story published in the November 16, 2011 issue of The Journal of The American Medical Association (JAMA.) And yeah, that's kind of a big deal, but that's not the really cool thing to which I'm referring. Nope. That ain't it at all.

This is. 

At the end of my story, there was a little over a half of a page left of blank space so they added a quote to fill it up.  Here's the quote:

"One writes out of one thing only--one's own experience. Everything depends of how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give."

~ James Baldwin (1924 - 1987)

Now is that rad or what? That THIS--a James Baldwin quote--would be the chosen words to follow something I wrote?  In a medical journal--better yet--The JAMA no less!?

To me? That was an extraordinarily high compliment to have my story inspire placing that quote. And maybe it had nothing to do with my story. But still. It was there. Right next to my story.

Talk about hyped. I was more excited about seeing that than my own article. I don't know. It just felt sort of. . .sort of. . . spiritual to read those words behind my own. Because they resonate with me, and so does the author.

Why, you ask? Because the author of that quote is James Baldwin. James Baldwin, y'all! Unfamiliar? Okay, well check it-- Mr. James Baldwin was the iconic Harlem-based writer whose literary genius inspired the likes of Toni Morrison and Maya Angelou. A social activist and fearless, award-winning author who both challenged and moved Ms. Angelou to write her critically acclaimed autobiographical novel "I Know Why the Caged Bird Sings." A man whose words read like art forms. . . . 


Yeah. That dude. As the chosen person behind a quote in a top-tiered medical journal. Damn.

His words? After my words? Maaaaaaan, that's what I'm talking about.


No relation to Alec or Billy.
In the words of James Baldwin:

“Love takes off the masks we fear we cannot live without
and know we cannot live within.” 


“Not everything that is faced can be changed, 
but nothing can be changed until it is faced.”  


“Children have never been very good at listening to their elders, 
but they have never failed to imitate them.” 


“The most dangerous creation of any society is the man who has nothing to lose.”

“The price one pays for pursuing any profession or calling
is an intimate knowledge of its ugly side.”

“It is certain, in any case, that ignorance, allied with power, 
is the most ferocious enemy justice can have.”

“Trust life, and it will teach you, in joy and sorrow, all you need to know.” 


You feel me, now?

Happy Monday, good people. . . . happy Monday indeed.

Sunday, November 27, 2011

Back to life, back to reality.

(image from The Shawshank Redemption)

"Back to life, back to the present time
Back from a fantasy, yes
Tell me now, take the initiative
I'll leave it in your hands 
until you're ready. . . "

from "Back to life" by Soul II Soul

Recently I saw this man with one of the residents in the clinic who we'd seen before. He'd had his fair share of medical problems most of which were secondary to some bad habits he'd picked up over the years. Habits like crack cocaine, gin, and cigarettes. Well, turns out that those habits all got kicked when he was incarcerated for getting caught with a crack rock in his pocket. For that he went to prison.

Now he's out of prison and has a low-paying but "real, honest" job. This job let him off that day for his appointment at Grady. And he appreciated that. I know he did because he told me.

Prison was awful according to him and he described it as being in a "time warp." When he was released, he found that his teenage daughter had become a woman with her own children. And his once scrawny son was "big enough to take me down."  Lucky him, those children believed in redemption and welcomed their daddy right back into their lives just like the prodigal son. . . . .fatted calf, ring of gold and all that.

And their timing was perfect because he was ready to value his life. Prison was awful, yes, but also a gift he'd told us. Because it brought him out of the cloud he was in and brought him back to life and back to reality.

So now? He wanted to live. He cared about his health and wanted to preserve what he hadn't destroyed.

On this day, he looked a little distracted.

Oh no. Relapse? 

I hoped not. So I just flat out asked. "Sir, you look a little distracted today. Are you alright?"

And he wiped his face with his hand and shook his head. "I'm jest flustered, tha's all. I was late so that got me real flustered."

Justin, the resident with whom I was working, followed up with a little more information. "The clerk up front mentioned that you'd come to check in on time but then you left out?"

"Yeah," he answered quickly, almost cutting my resident off. He dragged the heel of his hand across his forehead. "Yeah, it was just some stuff, you know, I had to take care of."

Rut roh.

Justin and I exchanged glances. Not sure why but we did. Both of us were wondering what that was all about and hoping it wasn't some symptom of a slippery slope.  I'm ashamed to admit that I immediately thought of those "Lock up" reality shows--you know where people get out of jail and then just before the credits roll some message tells you in big block letters that they got rearrested for the same thing. I studied him carefully--wanting to be wrong.

His face was covered with a thin film of sweat. His hair was a little unkempt and I wasn't sure if it was because he'd just pulled off the knitted skull cap he was wringing in his hands or simply hadn't combed his hair. The tail of his shirt was out on one side and he kept nervously tapping his right foot.  The whole sight of it made me cringe a little.  Damn. I'd seen that look before. Five years in prison and now this? Damn.

Just as I was parting my lips to speak, Justin spoke before me. "You just don't seem like yourself. What did you have to take care of?"

I shot him an almost scolding glance. What kind of question was that? Especially when your suspicion isn't exactly one that folks readily admit to? But Justin is kind-hearted and not the least bit passive aggressive. I think he just sincerely wanted to know.

"I had to pay a bill I wasn't expecting yesterday. The electric had a reconnect charge, and I didn't plan on that. So then I didn't have my co-pay when I got up here."  He looked down at his shoes. "But man. . .I really needed to keep my appointment. And I'm sayin' . . . I needed to see the doctor."

I wasn't sure what to say to that, so I said nothing. He kept talking.  "And they wasn't mean about it, you know, but the thing is I am supposed to pay ten dollars for my visit and that's a discount, you know?"

"So they worked it out for you?" Justin queried, still trying to sort it out in his head. Now that I think of it, there was some redemption in that question, too. He was determined to give our patient the benefit of the doubt.

"Well, you know, they couldn't since this isn't, like, the emergency or nothin'.  I called my daughter and she helped me out."

"How?" I blurted out before I could stop myself. Now if anyone should have been getting a scolding glance, it should have been me for that dumb-ass question. What difference did it make how his daughter helped him? He was here so obviously it worked out.

But that question didn't faze him one bit. He answered like it was as relevant as "did you take your medicine this morning?" or "have you been experiencing any shortness of breath?"  No big deal.

"She was at work, but she was able to get away for a second to wire it to me, so I had to catch the bus up the street to get the Western Union she sent me."  Justin and I locked eyes instinctively, yet again. "Yeah, so tha's why I was late. I had to walk up to Boulevard to get the bus."

Wait, huh?

Hold up. So let me get this straight. This fifty-something year-old man caught a city train to his appointment at Grady on his off day. Had to get the lights turned back on the day before so didn't have the co-pay for his visit today? So he subsequently called his daughter to wire him TEN DOLLARS? And caught a BUS to go get it? To see US??? 


"She wired you ten dollars for your visit?" I asked him almost a little bit too incredulously--even though he'd just told us that and I knew he was serious.

"Well, really she wired me twenty. She was mad because it had to be in a multiple of twenty. I 'idn't realize that and neither did she 'til she got there." He shrugged. "So yeah. I'm sorry I'm all flustered. I just really needed to see my doctor and make sure my pressure and my lab work is okay."  He meant that.

Alright, so check it.  I will not make this unnecessarily heavy. This was just an eye-opening smack across my face. A grown ass man had already come over the river and through the woods to see us. Trying to get his life and his health right, and wanting so bad to do so that he called his daughter AT WORK and asked her to wire him TEN DOLLARS for his doctor's visit. THIS required him to walk a little over a mile, catch a bus, and go up into a CVS pharmacy to get TWENTY dollars.  Seriously? Seriously.

I won't even go into what an ass I felt like for assuming he was sweaty and "flustered" because he'd gone around the corner and gotten a hit. And let me tell you--this man was 100% serious and wasn't lying. This man was clean and thank God his kids believe in redemption because I needed that reminder provided by their example.


TEN DOLLARS? Really?  Man. I can probably locate ten dollars in change inside my couch as we speak. And here I am sitting across from this dude who is at least fifteen years my senior and this is what he has to deal with?  Damn.

Look. Everyone knows that folks are struggling all over the place. But working at Grady Hospital makes this waaaaay more than a damn notion.  I opened a magazine and read about Kim Kardashian and her fifty trillion dollar wedding extravaganza for her 72 day marriage. I read that and then thought about this man interrupting his daughter at work to wire him a ten dollar bill. And her having a discussion with him about the perils of it being a twenty and not a ten that she had to send. Damn, now if that don't make you feel glad for what you have, I don't know what does.

You know. . . this situation reminded me of that day that patient wouldn't stay for his cardiac catheterization. He told me flat out that folks out here "is losin'" and sometimes you have to make some hard decisions. Those decisions seem simple or crazy to me but not to someone like him with a felony charge and a second chance he's trying to hold onto. Damn.

Some folks wonder how we do it. Hearing all this stuff day in day out.  But honestly? I left that man feeling inspired and grateful as hell for what I have.  And if that isn't a reason to keep coming back to do what you do every day, I don't know what is.

Turns out that his blood pressure was just fine. And so were his labs.


Yeah, man. Back to life, back to reality.

Now playing on my mental iPod. . . ."Back to life" by Soul II Soul.

Saturday, November 26, 2011

Top Ten: This is how we do it.

Christmas 2010

Well, good people. . . . Thanksgiving has come and gone which means one thing and one thing only: The flood gates are now open for the season of jingle bells, pine cones and holly berries! And--yes--the time for latkes, dreidels, and Chanukah gelt!


That's right, I said it. And you don't EVEN have to tell me how impressed you are with my knowledge of non-Christmas holiday traditions (or especially my spelling of Chanukah with a 'c'.) Because me? I'm culturally competent like that. See, thanks to my friends of Jewish faith like Lesley M., Neil W., Natalie L., Ann I., and Nat F I have mad skills when it comes to menorahs and I'm nice with my Yiddish. Matter of fact, this came in handy last year when Isaiah's friend gave him a dreidel.

See, I would start telling y'all about how Hanukkah (sorry, it felt like I was trying too hard with that whole 'c' spelling) isn't even the same week every year or about how (contrary to what many people --okay I--used to think) the kids aren't opening a whole Christmas morning's worth of gifts for eight nights in a row.  Maaaan, I could even go so far as to tell you about how annoyed all my Jewish friends are with us non-Jewish folk going to the movie theaters on Christmas day. I mean, I would tell you all of those things, you know, because I could. . .but see, I won't because THAT is not the point of this post.

The point of this post (yes there is one this time!) is to do for you what my Jewish friends have done for me. . . .to provide you a little extra insight into my culture--just in time for the holidays!

Now. For those new here, I should share with you that I am a black woman living in the Southern United States. I was raised in California by my parents--both African-Americans and Alabama natives-- which technically means I'm not a GRITS (girl-raised-in-the-south) but I am the next closest thing.

Anyways, I have found that being up on other people's cultural traditions is a good thing. Especially as a person who works in a hospital, it always makes things so much easier when you have a bit of a clue about things outside of your own little world. And beyond that. . . . you never know who you'll find yourself down with. Or in love with. . . . .

Basically, I think the more we share about each other's cultures the better. Especially this time of year because there's no telling who might invite you over to their house to break bread. And we all know that being outside of what you know can sometimes feel like being on a completely other planet!

So in the spirit of the holidays, I bring you this week's top ten:

Top Ten Things you should know that would make participating in a holiday meal and/or celebration with my people a lot easier for you.  

Let me first say that I apologize for being a day late and a dollar short for those who this would have helped on this past Thursday. Oh, and I'm the first to say--I am NOT the authority on black folks and holidays at all.  These are things I have noted in my own experiences and nothing more. Seeing as my father is one of eleven children, I've had my share of big ol' holiday family shindigs.

Disclaimer: If these kinds of things offend you, stop reading now and go straight to the list of favorite posts for some good and unoffensive reading. Otherwise. . .

Doing the holidays with my people? It just might behoove you to know the following things:

#10   -- We are on a first-name basis . . . .

. . . .with our greens.

Isaiah on Thanksgiving with collards

"What's these? Collards or Turnips?"

"Collards with a little bit of mustards mixed in."

"These the turnips?"

"Naw, those collards, too. They just cooked all the way down. Oh and these aren't cooked with pork."

"Y'all didn't make no turnips?"

"Naw. Turnips taste too bitter."

"Not my turnips. My turnips never taste bitter."

"Hmmph. Well you shoulda brought yo' turnips, huh?"

Rule:  Don't ever show up with a pot full of mustards. I just read a wonderful article that properly described mustard greens as the "Tito Jackson" of the greens family. So true!

#9  -- Don't get too fancy. . . . .

. . .with the cranberry sauce.

*This may or may not occur depending upon whose house you have dinner at.*

"What the hell is this?"

"It's cranberry sauce."

"This ain't cranberry sauce!"

"Shhhhh! Mama's work-friend brought it. She said it's from real cranberries."

*silence, followed by keys jingling in hand*

"What you 'bout to do?"

"Maaan, I'm 'bout to go to Kroger's to get me some real cranberry sauce in the can."

(*This may or may not be based upon true events. Ah hem.)

Whew! Crisis averted.

Rule:  It's fine to make cranberry sauce from real cranberries. HOWEVER. Depending upon whose house it is, just be sure to have a can of the jellied Ocean Spray kind in your purse in case of emergency.

#8 -- Dressing for the occasion.

Dressing is what my people have next to the turkey. Not stuffing.

Stuff it!

"Oh, wow! Your cornbread stuffing is delicious."


Rule: Stovetop by Stouffer's is stuffing. My people? They make dressing. (At least in my experience.)

#7  -- "Sure! Here you go!"

This is the only proper answer to the following question:

"Excuse me--can you pass me some hot sauce?"

Which reminds me: it better not be Tabasco, either.  Regular old Lousiana hotsauce or RedHot or Crystal's will do. Those little peppers with the vinegar also may or may not be present.

Rule:  Hot sauce is a staple for my people.

#6  --  Don't forget the lyrics.

You are absolutely of my culture if you can relate to this:

"'Twas the night before Christmas and all through the house
Not a creature was stirring not even a mouse. . . . ."

If in your head you immediately heard the first few bars of The Temptations singing "Silent Night" followed by someone belting out "in my mind. . . I want you to be freeeeee" after reading those words there is a 99.9% chance that you are either African-American or deeply connected to someone African-American. As a matter of fact, of all of the things I say on this top ten, this specific music is the one indisputable thing that you will absolutely find at every single house. And this? This song will be played if you go to a holiday celebration with my people.

Don't get my reference at all? Take a listen:

Now that I think about it, if you don't want to feel left out at the celebration, I would suggest listening to and learning this song--particularly if spirits are being poured. You never know if you just might be expected to be the high falsetto Temptation in a front-of-the-fireplace impromptu concert. (Yes, people. This could happen.)

Rule:  No holiday celebration is complete without the Temps singing "Silent Night."

#5  -- And while you're at it. . . .

. . .you might as well learn this one, too. NO gathering of my people during or around the holidays is official until you hear this song a minimum of twelve thousand times.

As a matter of fact, if you made a iPod playlist with just The Temps singing "Silent Night" and Donny Hathaway singing "This Christmas" my bet is that not a single one of "my people" would even notice. Also, if you have never heard this song on the radio, it means that you have never listened to the black radio station in your city at Christmas time. Without the least bit of exaggeration, I can assure you that in Atlanta you can hear it every hour on the hour from Thanksgiving until December 25.

Rule: Familiarize yourself with Mr. Hathaway's version of this song. (You'll get extra cool points if you know the part where he says "shake-a-hand, shake-a-hand.")  OH!! Don't be tempted by the other renditions either--Donny Hathaway singing "This Christmas" is the holy grail of soul Christmas music--constantly imitated, but never, ever duplicated. Also -- this, too, might be a part of the impromptu concert in front-of-the-fireplace. (But the good news is that because it doesn't involve multi-part harmonies, you might be safe if you just nod your had and do a two-step.)

#4  -- A pound of butter. . .  .

. . .is in the pound cake. For real.

Oh, and there will be no less than seven hundred and thirty seven forms of dessert. Pound cake will definitely be one of them but also count on some sweet potato pie, pecan pie, and a red velvet cake. If you're lucky, someone will bring a caramel cake and some banana pudding. And you know you are celebrating with my people if you encounter a 7-Up cake or a Milky Way cake--which are prepared with 7-Up and Milky Way bars, respectively.

Rule:  Watching your weight? Step awaaaaay from the pound cake. Matter of fact, just don't come to the party because there is NOTHING you can eat.

#3  -- Chit-chat

Let's just get one thing clear: "chitterlings". . . is pronounced "chitlins" not chitter-lings. Got that?

Me-myself-personally?  I don't eat chitlins nor have I ever even put a single chitlin in my mouth. Why, you ask? Real talk--after watching my T'Renee (Auntie Renee) clean them once when I was a child, I was so traumatized that this was all I needed to assure that I'd never, ever try them. So. . . . you DO realize that chitlin's are pig intestines, right? So cleaning them involves. . . .*sorry, just threw up in my mouth a little bit* . . . .cleaning what's inside of intestines. (See above scary-photo. Sorry, smell not included.)

Now. Usually this is followed by some history lesson about how when our people were slaves we had to get creative with what we had. The chitlins were scrapped, so voila! They became a delicacy in the slave quarter.  And y'all know how I feel about history, especially black history, so I once got very, very, very close to tasting a teeny-tiny bite smothered with hot sauce after hearing such an explanation behind the fact that we were actually eating intestines. Just as the fork got near my lips, my PTSD of seeing that pig-poo rolling down the drain and into the sink made me dry heave.  Couldn't do it, man. Still can't.

Confession #1:  When I was pregnant with Isaiah, my mother-in-law cleaned and cooked chitlins in my house. I immediately threw up when I walked in from work and smelled them. Like immediately. Mother (my mom-in-law) felt so bad for me that no chitlin has been cleaned or prepared in my home since.

Confession #2:  During that last time while carrying Isaiah, I saw my husband actually eating some chitlins and am still wondering if that should have been grounds for divorce.

Rule:  Never, ever volunteer to clean chitlins and make every effort to not be there when it's taking place. Even if you're trying to get in good with the future in-laws. Don't do it. Especially if you happen to be pregnant.

#2  -- Know what this is:

photo courtesy of my pal Lesley M. who snapped a photo of this because she knew it would make me laugh!

Question:  What you know about some chow-chow?

"Pass me that chow-chow, baby."

"I'm sorry-- pass you the what?"

"The chow-chow for these collards and these chitlins."


"Pass me that hot sauce too while you at it."

Okay, okay. Maybe the chow-chow thing is an exaggeration, but my Mudear always had some handy whenever one of those eleven kids asked for it. We were at our Thanksgiving party at Grady a few weeks back and I loved it when I heard one of the nurses ask for some chow-chow! (Made me think of my Mudear.) Oh and the best part? They had some!

Rule:  Okay, look. The deeper into the south you go and the higher the median age of the attendants at the holiday dinner, the more likely you are to encounter a request for some chow-chow--a pickled relish that goes on top of some of everything. Mostly young folks? No chow chow necessary. Expecting the Grady elders? Uuuuuh, at least consider it.  Consider yourself officially in the know.

#1  -- Amazing grace.

image credit

Dining with my people? You might consider having a snack before somebody starts praying over the food. Especially during the holidays. Ha. Now, if you're lucky, you might have my dad who keeps it real simple with:

"Good bread
Good meat
Good God
Let's eat!"

But don't count on that.  By November and December, a lot has gone down in the lives of black folks so in addition to showing your appreciation for the vittles, there's a whole year's worth of shout outs that just might have to precede that. These may or may not start with individual words of wisdom. I'm not ageist, but I've noticed that the length of the prayer mostly depends upon the age of the food-blesser. Be particularly skeptical of those who have a tendency to randomly break out in singing old negro spirituals while waiting for the elevator.  Then again, depending upon where you are in the bible belt, some young folks can sneak you with some surprisingly long-winded sermons dinner blessings.

Essentially, just be ready for anything. (Oh and if you are asked to recite a scripture, the shortest one in the entire bible is "Jesus wept." - John 11:35.  *You're welcome.*)  

See anything can happen. . .it might not quite like this one, but this one is pretty doggone comical. . .

Rule:  Anything can happen at the holiday dinner table. Even during the blessing of the food.

Now!  You should be fully prepared to fit right into any holiday celebration with my people!

Okay, so what's up with you and your people? What do y'all do during the holiday season? Do you eat chow chow, too? What songs should I know before coming over there? And most important--should I bring my own can of cranberry sauce in my pocket book to put next to your. . .err. . . stuffing?

Weigh in. How do you and your peoples do it?

Now playing on my mental iPod (in addition to the standard soundtrack.) James Brown always helps us get on the good foot for Christmas!

Thursday, November 24, 2011

So not fair.

Schedule is in. November wards. Thanksgiving month. A big family month. At least in his family. But this year, not so much. Because of that schedule. On the wards. At Grady, no less. Damn. Not fair. So not fair.

Call schedule is posted on line. "Just check and see," his wife said. Too scared to even look. Just got married at the end of medical school. First Thanksgiving in this city away from immediate family and also first Thanksgiving with new immediate family--his wife. She nudges more. "Just check. And see."

He checks. He sees.


Thanksgiving day ------> Long call.

This was before the no overnight rules for interns so this meant one thing. This meant no Thanksgiving. At least not for real Thanksgiving. Not fair. So not fair.

"I'll come to the hospital and have a meal with you in the cafeteria, okay?" his wife offered.

He decided that this was better than nothing.

Thanksgiving day. Busy, busy, busy.  Someone ate too much gravy and shook too much salt. Heart failure exacerbation. Another person forgot to get their blood pressure medications. Hypertensive emergency. One young guy couldn't say no to pecan pie. This wouldn't be such a big deal if he didn't have insulin-dependent diabetes. That admission was a doozy--diabetic ketoacidosis. One step away from what the Grady elders call being in "the diabetic coma."

"Is now good?" his wife asked.

"No. Not now. I'm getting bombed."

"Okay," she answered warmly. "I'll call you in an hour."

And she did. And it still wasn't good. So she called two more times and finally decided that this night just would not be good for quaint cafeteria dining. Visions of toasting with paper Coca-cola cups and gazing into his eyes over mystery hash faded away.

Not fair. So not fair.

"I am downstairs," she said in the most cheerful voice she could muster. "I have a plate for you. All of the classics. Everything you love."

And he scampered down the stairwell and out to the hospital entrance where his bride stood wrapped in one of his college sweatshirts over her nice sweater-dress. She extended her arms with this special offering--a plate of homecooked food.

He peeked under the foil. All of the trimmings and all of the trappings. And dessert on the side.

He hugged her tight and silenced his beeping pager. "I'm so sorry," he spoke softly. She kissed him on his scruffy cheek and scurried back to the car.

Not fair. So not fair.

So angry. Angry he signed up for this, a job that doesn't close on major holidays and that is open 24 - 7. Felt good about being a doctor. But not so good about being one that has to work on Thanksgiving day.

It was ten o'clock when he finally got around to heating up that plate. And just as the microwave beeped, so did his pager again. Damn. Not fair. So not fair.

One of the cross-cover patients. A youngish man with throat cancer. Unable to eat foods by mouth and receiving nutrition through tube feeds. He was in pain. That's all. Just wanted something more for pain.

"Okay," he said. "I can give you some morphine. Is this okay?"  And the patient nodded because this was okay. He prepared to leave the room and get back to that plate.

"You know what I wish? I wish I was eating some turkey and dressing. Or even just around people eating that kind of food. This doesn't even feel like Thanksgiving."

The intern looked around the room. No flowers or cards or balloons. No beloveds perched in bedside chairs determined to bring a festive atmosphere into the hospital. Nope. None of that. Next he looked up at the television. NFL football with a big banner at the bottom of the screen that read "Happy Thanksgiving." Beyond this, he wasn't sure if there was any other way the patient would even know it was turkey day. This made the intern feel even sadder because football was a part of his family's Thanksgiving tradition. And even his wife was a supreme trash-talker on NFL Sundays.

"My wife brought me a plate of food from her aunt's house. I haven't even touched it. I'd sit down here with you if I didn't think it would be cruel for you to see all that food."

"Do you like football?" his patient asked.

"Do I?"

"Oh, then. . .man. . . .it'd be great to have Thanksgiving together. You with your plate and me with my tube feeds."

Both men laughed. The intern thought for a moment about the offer. His pager had finally calmed down. Things seemed to be a little less crazy than before.

Why not? 

A few minutes later he returned to the patient's room where they shared Thanksgiving together. One intern and his twice reheated plate and one patient with his twice restarted tube feeds.  They shared and laughed and even talked a little trash about the New Orleans Saints. And funny thing. That pager didn't go off once.

The next day, the intern went home to his loving wife and shared a belated Thanksgiving dinner together. The next week, that patient he broke bread with passed away.

Not fair. So not fair.


Up, up and away.

We remembered CJ. . .

and Granddaddy-in-heaven. 
We talked about who they were and why they were special. We talked about being thankful and what we are thankful for. Isaiah is thankful for his family. Zachary? "This whole world."

We hugged and kissed and said "I love you." (With puppies as our witnesses.)

It was special and perfect and beautiful.

Happy Thanksgiving to all. 

Now playing on my mental iPod. . . . the man in black sings this best.

. . . and to the "mommy of an angel" ~ I love you!

"and lo, I am with you always, even to the end of the age."  ~ Matthew 28:20

Wednesday, November 23, 2011

Remembering to never forget.

"Why would God take a child?"

This was what my son Isaiah asked me three years ago when he saw me crying into the crook of my arm. I was staring into the perfect face of my friend Davina's baby C.J. on a photograph in my hand. Eyes like tiny pools of light and features so symmetric that you wonder if they'd been mapped out by some world class architect. That three year-old face was on an obituary.

"I don't know, son."  My voice sounded more like a croak than a voice. Just looking at Isaiah made me erupt into more tears. Here he was, asking this innocent question at three years old. The same age as C.J. Carried in my womb during the same months Davina had carried him. Both big babies. . .surprisingly big babies to be coming out of not-so-big mamas.

And they began growing up and throwing our lives into upheaval in that way that only kids can. Requiring things to be kiddie-proofed and giving us reasons to linger in the kid section at Barnes and Noble. Making us change our choices of music on the radio and even the kinds of cars we drove. Because now? We were mamas. This was a new part of our identity and as thirty-somethings it was a welcome addition.

And so on this day, three years ago C.J. didn't feel good. Mamas know that sometimes their babies just don't feel good, especially at three years old. So even with that, the day was pretty ordinary. Woke up on Sunday. Went to church. Had something to eat. Came on home. Watched some cartoons. Nothing too exciting except for C.J. being under the weather a bit which, again, could be considered totally ordinary with a pre-school aged kid, right? Right.

But then C.J. kept not feeling well. So of course his perfect mama and his wonderful daddy did what good mamas and daddies do in such instances. They watched him for a bit and then took him to see a doctor. And for what? A febrile illness in November in a three year-old? Anyone reading this who has worked in a pediatric emergency center knows that this, too, is very ordinary. The bread and butter of pediatrics, especially in late November. Probably just dehydrated. Or some kind of viral infection. Or an ear infection perhaps? Or all of the above.

That fever was something more. It evolved from the mundane to the unthinkable. From "will I get a shot?" and "may I have some juice?" to  a medical emergency. Running, yelling, compressing, injecting. Not everyday things at all. And definitely not what a single person walking into that emergency department that night expected.

They signed up for Amoxicillin and, just maybe, some IV fluids. Not this. No, not this.

On November 23, 2008, my friends Davina and Cedric came home from that emergency department without their son. They walked into their house--sippy cup still on the coffee table and the Nickelodeon Channel still playing on the television. On this day, three years ago, C.J. lost his life to an overwhelming bacterial infection.

I still remember hearing that news. I was sitting in the clinic speaking to one of the residents about a patient that Monday and it came as a simple text from Harry.

"C.J. died last night."

Just like that. Like some kind of horrible mistake. And I froze in my tracks when I read it because this could not be real. No, it could not. But it was. Yes, it was.

C.J.'s father, Cedric, is one of Harry's very best friends. They were roommates in the Army and in each other's weddings. We came to the funeral and yes, it was exactly as awful as you might imagine the funeral of your close friends' three year old and only child. To this day, it is the only time I have ever seen my husband really and truly cry.

Though I knew Ced's wife, Davina, I'd never really knew her well before this happened. But somehow in all of this awful, Davina and I grew closer. It started with text messages and then became phone calls.  And eventually we developed a tight bond of our own. .  . . as women, as wives, as mothers.

Yesterday I was sitting on my deck watching the boys riding their bikes in the backyard. I savored that image. Them now big enough to play out back without me standing right there. Screaming. Yelling. Growing. Living. I thought about those early morning moments of happy anticipation I feel right before they awaken and how their little bodies feel when pressed against mine in a hug. And then I listened to their laughter and watched how dirty they were getting. . . and could already imagine that little boy smell that they would surely have once they came running like gangbusters into the house. That? It was too much. I dropped my face into my hands and I wept and wept.

I don't know why God would take a child. I don't. I am a believer but this one leaves me speechless and picking at my nails. This one makes me afraid and confused about the will of who I know is a loving God. When I do get my words again, they're nothing more than a mass of frustrated questions which fortunately, I'm sure God gets. And yes, I know that there are not-so-religious people who read this blog and that's okay because I bet you know how I feel, too. Because really? No matter what you believe, there is nothing natural about a mother burying her child. Or grandparents driving to town for Thanksgiving but coming to a funeral instead. Nothing at all.

Yes. Today is November 23, 2011 and this is the third year C.J. has been gone. Three years on earth and three years in heaven. This in itself is gut-wrenching. . . . the equality of these numbers and yet the inequality of what they represent. So I am just writing what comes to my head and my heart. And really just trying to honor C.J and his memory and a fellow mother's pain.

Look, I know someone is reading this and saying, "I thought this was a medical blog? What the. . .?" I know. And to someone else this whole post might seem macabre and morose or just too damn heavy. I know that, too. But I try to just write about life. And life is about joy and pain and sunshine and rain and dammit, a mother lost her baby three years ago today. A mother who carried that baby nine and a half months lost her perfect, angelic little son without any warning at all. A father who puts his life on the line for this country every single day lost his namesake. A soldier, a brother, a husband who spent part of those precious three years in far off lands fighting for far away people came home and then had to live through this. And. A grandparent had to receive a phone call on this day three years ago that they would never see their grandbaby alive in this life again. And I cannot and will not allow myself to ever, ever forget that. Not on any day but, especially, but not on this day. No, I will not.

So yes, I will remember. On this day, I will look at C.J.'s picture and imagine him at six years old. I will see him climbing a tree with Isaiah and Zachary or telling me the name of his first grade teacher. I will speak to Davina and tell her I love her and ask her to tell me a story about C.J. And I will listen and laugh and do my best to hold her hand. Yes, and I 'm sure that all of that will make me cry very, very hard but that's okay. Because something about that feels good and right. To me, it does.

It's okay to live our lives even after tragedy but life has this way of making us forget things and people and situations unless we decide to remember. So this is what I have decided. To remember. Yes, you were here.

Every year in November I try to think of ways to honor C.J.'s memory. Usually it comes through writing. But one thing that C.J.'s transition has given me is a much deeper and active love for my own life and those in it. My silly posts about stuffed puppies and Camp PaPa postcards are really my attempt to just live and love with more intention. Not a perfect life. . . . just one that isn't aimless, you know?

I'm rambling. I know.

Every year, Davina releases balloons into the sky on November 23 in C.J.'s memory. This year, I think me and the kids will do this, too. We will talk about being thankful and about love. We will speak of people special to our family that have passed on, too.  And we will talk about C.J. and his life. Yes. We will.

Who do you love? Do they know it? Will you participate with me in making this a day of intentional love?  Do something, some tangible act of love today. Talk about someone who isn't here. Pull out their photos and bring them to life. Release a balloon or better yet a grudge. Find something bigger and better than words. Even if it makes you cry a little. Hell, even if it makes you cry a lot. And then hug your loved ones even tighter than usual. Because you can. Do it for every mama and daddy and grandmama and granddaddy and daughter and son who would give anything in this world for something so simple.

Who's in? I hope you are. I bet that would make my friend Davina smile. And I bet it would make C.J. smile, too.

Remembering C.J. posts:

Year One: November 23, 2009
Year Two: November 23, 2010

Now playing on my mental iPod. . . my friend just reminded me of this song last week:

. . .and this is on my mental iPod, too. . .and when sang by Whitney Houston it just moves me deep in my soul.

 . . . and last but not least, C.J.'s favorite song to which he always shook his booty. This one's for you, kiddo.