Sunday, December 11, 2011


*names and details changed to protect anonymity. . .you know what's up

Just a castaway
An island lost at sea
Another lonely day
With no one here but me
More loneliness
Than any man could bear
Rescue me before I fall into despair

I'll send an SOS to the world
I'll send an SOS to the world
I hope that someone gets my
Message in a bottle
Message in a bottle

~ The Police "Message in a Bottle"

The story was straightforward enough. This forty-something year-old gentleman had been admitted to our team for chest pain. It started as a "twinge" and then evolved to more of a pressure. He was smart enough to not ignore any of it or do what many forty-somethings with chest discomfort often do--chalk it up to indigestion or acid reflux.

"My father died from a heart attack in his forties," he said matter-of-factly as I stood on his right side that morning on rounds. "And I think his brother before him did, too."

"Wow," I responded while nodding my head.

He pushed his hands down beside him and scooted upward in bed. I saw his biceps bulge when he did that, and looked at his date of birth to confirm his age again. Other than the deeply embedded crows' feet exploding from the corners of his eyes, he looked young for his age.

"Yeah. I'm not sure what either of them did about it, but the minute I felt something in my chest I came on in."  He ran his fingers through his reddish-brown hair to push it off of his face. It looked like some fairy had dusted Mr. O'Malley with freckles from head to toe. Even his lips were speckled with tiny brown spots.

"That was a smart thing to do," I affirmed with a smile.  Mr. O'Malley looked up at me and returned the favor. I decided that I liked how his almost invisible strawberry blonde eyelashes framed his eyes. I'd never seen eyes like these. Some unusual shade that appeared baby blue one minute and greenish-gray the next.

And so, I did what I usually do. I recounted the story that I'd just been told by my team and inserted a few more questions of my own as the team stood close by listening. Two interns, two medical students and a senior resident all focused on Mr. O'Malley and his words.

He was an excellent historian, so it was easy to create a fluid story board for his present illness. Chest pain that started at rest while watching television on his couch around 7 PM. Had just eaten some pizza from Papa John's delivery and washed it down with two Budweisers. That was about it. Nothing too crazy. "Matter of fact, it was Bud Light." We all chuckled at that clarification.

Beyond that concerning family history, the rest of the history wasn't too bad.  A previous smoker, but not any more. Very active, even played full court basketball several times per week up until about three years ago.

"What made you stop shooting the hoops?" my resident chimed in from the foot of the bed.

He glanced down for a moment as if thinking for a split second before answering that question. "Oh. . .uhh. . I was incarcerated at the time. I spent twenty years in federal penitentiary."

The room fell awkwardly silent. If you listened hard enough, you could hear the collective sounds of our conscious' reactions.

Twenty years? Daaaaaamn.

He closed his eyes and raised his eyebrows while nodding. Freckles were on his eyelids, too. He cleared his throat to break up the tension and said, "Yeah, so that was kind of time consuming." One or two nervous laughs tumbled out of our mouths. He curled his speckled lips and added in the students' direction, "Yeah, and don't believe what they tell you. I'd recommend medical school over the Pen. Definitely." This time we all laughed together, appreciating his willingness to ease things up.

My resident spoke up to keep us on task. "Well, Mr. O'Malley, the good news is that it doesn't look like you had a heart attack. We looked at your EKG and your lab tests and it all looks good."

"That's good to hear."

"Sir, have you had any more chest pain since you've been here?" I asked.

"No, ma'am," Mr. O'Malley replied.

"Okay," I continued. "Right now, the gameplan is to get you a stress test today and if that looks good, we should be able to discharge you this afternoon."  He nodded and held out a thumbs up. That's when I noticed the tattoo on the side of his right thumb. Some sort of intricate symbol that I couldn't quite figure out. He caught me noticing it and a strange expression came across his face that told me not to ask about it.

I reached for his right hand with mine and felt his pulse with the other. For some reason I intentionally covered that unexplained tattoo with my thumb as I held his hand. I feel certain that something in those chameleon-colored eyes washed over with appreciation for that gesture.

"Well, I guess it would be good if I examined you, now wouldn't it?" I teased. "Here I am giving you the plan and all I've done is arm wrestle with you!"  The team sounded like a laugh track behind me, but Mr. O didn't laugh at all. In fact, he looked worried. Unusually worried.

What the heck is going on? 

I paused for a moment and tried to figure it out. I had no idea. Scared I'd find something they didn't? Fearful that my need to examine him meant that I was hiding something that hadn't yet been discussed? I couldn't tell.

"Sir, you know, in teaching hospitals we always put our heads together about every patient. I don't want you thinking that me double checking the physical means something bad." I decided to make that disclaimer, hoping this might explain the terrified look on his face.

"Umm. . . noo. . .that's cool. I mean, I realize that."  His eyes darted from person to person and then back at me. I could tell that he was willing himself to be calm, but it wasn't working. His face became white as the sheet over his lap and his un-inked hand moved protectively over his abdomen.

What the hell? I couldn't figure out what was wrong.  Was he angry? Had I offended him? What? What was this initially cool dude so freaked out about?

I looked into his pleading eyes and tried to communicate with them. He was trying hard to give me a message and I wasn't getting it. "You okay, sir?" I finally asked. When he nodded in the affirmative, I reached for the top of his hospital gown and prepared to unfasten the buttons across the shoulder.  I noticed his forearm tensing up over his abdomen as I unsnapped the last snap and prepared to expose his chest. Carefully, I began to fold down the corner, but then froze for a moment.

What the hell was going on?

His face had now melted into a pool of dread and shame. I didn't know what the hell that was about but I knew for sure that for some reason he didn't want me to see his chest. And so, I did something I almost never do. I reconnected the gown and placed my stethoscope directly on top of his gown, fully ignoring one of my biggest pet peeves--listening to people through clothing.

I auscultated his covered heart, knowing that my medical students were all giving me the hairy eyeball and secretly preparing to call me a hypocrite for breaking my own rule: "S.O.S! That means 'SCOPES ON SKIN!"  

Next, I asked him to sit up for the lung exam. The gown gaped open in the untied areas exposing little pockets of skin that I could see from first glance were also covered with tattoos. I slid my stethoscope behind his gown--this time listening directly on his skin--and asked him to take a deep breath.

Inhale. . . exhale.

Methodically, I moved my scope off of that space and inched downward. That flick of my wrist unraveled the tie and the gown fell wide open revealing his entire back. Covered with more freckles and tattoos indeed. 

He immediately stopped midbreath and so did I.


I almost said that out loud because finally I understood his trepidation. And got that message loud and clear.

Fortunately I was the only one back there to see what that gown was hiding. His entire back had become a canvas decorated with a giant tapestry of absolutely horrific black swastikas and black letters.  I couldn't make out any of the letters--something on it was in German? I didn't know. . but those swastikas. . .those swastikas were unmistakable. And terrifying to see that up close.


I was so stunned that I didn't know what to do. So those three seconds of him midbreath and me frozen with my stethoscope trembling on his back felt like an eternity. That's when I decided to stick to the basics.

"And another deep breath," I continued. And he gave me breaths as long as I requested them.

After that, I simply tied up the back of his gown as normal as I could.

When I finished the exam, I faced him again and locked eyes with him. I knew for sure that what I saw in those eyes looked apologetic and ashamed. So I grabbed that right hand again and covered that little thumb ink once more, now knowing that it too represented something that probably wasn't so loving toward me, my Asian resident, or my Jewish medical student and intern. "Everything checks out fine." 

He squeezed down on my hand, his nail beds flushing bright pink. "Thanks." That was all he said with his mouth.  But that hand shake and those chameleon-eyes said a lot more.

Later that afternoon, I came back to see him prior to his discharge. The stress test was pristine and he was good to go.  I started off all business, talking about his follow up plans and seeing if he had any questions. He obliged me, but we both knew we had some loose ends to tie up.

"Twenty years is a long time," I finally said breaking the ice.

"Yeah," he quietly responded while looking down. "I was only nineteen when I got there. And. . .that world. . . . that world is so twisted up. You start thinking. . .  and believing things . . . .crazy things. . .that. . . .just. . .I mean. . .yeah. . .and then you come out in the real world and you . . . yeah."

"You got those in the pen?"  I called out the elephant in the room. Swastika tattoos weren't something I saw every day in real life. And I won't even front--having my stethoscope on top of one was scary as hell.

"Yep. In a gang. Like one of these gangs that becomes the only family you know to survive in a place like that. But when I got like thirty five I started realizing that I didn't hate nobody like that. Like in my heart I knew that wasn't true, you know?"

"And here comes this black lady doctor whipping your gown open in front of a group of onlookers."

"Man. I was so glad you didn't. You just don't know. I feel so ashamed of all this. Then when I saw you and saw that you was a black person? Man."

"I hear you. So. . . the chest ink is worse than the back?" I asked incredulously.

He nodded. "If you can believe that. And I'm telling you. You don't even want to see that shit, either. You really don't."

I decided to take his word for it. "You could probably get them all covered up, you know. Or removed."

"I know. It just costs a whole lot and I don't have a lot of extra money like that. Plus not everyone is hot to hire an ex-convict, you know."

Point taken.

"What's the thumb tatt?"  I at least wanted to know about that.

"Gang sign. But anybody who's done hard time would know what it is if they saw it, though. Soon as I get some money, I'm covering this one up first--'cause it's on my hand. Good thing most folks haven't done hard time or else I'd really be in trouble."

"You could rock a Michael Jackson glove. . . .you know. . .cover it up with a little sequined glove action until you can get it removed." I smiled as goofy as possible until he laughed out loud. That was all the nudge I needed to do a few MJ moves for him, including a leg kick.

Mr. O shook his head. "Doc, you one funny lady."

"Thank you very muuuuch, I'll be here all month!" I could tell he appreciated my lightness. And while there's nothing light about a swastika, I guess I just wanted him to know that we were cool and that I believed in redemption.

His face grew serious. "But for real, you got some good instincts, too. Thanks for paying attention."

"Thanks trying to communicate with me," I responded. Now that I think about it, it was kind of like a message in a bottle. . . floating on the surface. I snapped my finger and added,"Hey--what color are your eyes, Mr. O?"

"My grandma always said they was like a chameleon. Depend on where I am and what I'm doing." 

"Gotcha."  I looked at my billing card, circled "discharge" and prepared to leave.

"Hey, doc?" he said as I started toward the door. I stopped and raised my eyebrows. "You know. . . .like. . .  I don't hate you, right?"

I gave him the most high-beam smile I could. With a happy nod of my head I replied,"Good, sir. Because I don't hate you, either."

I hit him with one more MJ move complete with a point and headed off to see my next patient.

Happy Sunday.

Now playing on my mental iPod. . . . . The Police singing one of my favorites--"Message in a Bottle."  I couldn't embed it so click here to listen. 

Also on my mental iPod. . . this song (which I could embed) "Redemption Song" by Bob Marley.


  1. Jimmy Buffet calls tats "a permanent reminder of a temporary feeling" . Good for you to pick up on his nonverbal communication and respect him as the human he is right now, not who he was or was forced to be in prison.

  2. I effing love you. You know you have a book here in these posts? You know you do. You could get a publisher, easy.
    I feel so honored to be able to read all of this for free. I feel so honored to be someone you come and sit on my porch with for so many reasons but for some reason, this one post just made me have to say that.

  3. Love all your posts, and love Redemption Song, too...thanks for sharing your life & work here, Dr. Manning. Your patients are blessed to have you.


  4. You so rock. Seriously.

    I'm not the most forgiving person, but I believe in redemption - and what happens in prison is so a different world and you gotta do what you can to survive.

    I'm starting to wonder if prison reform is going to be my calling - our system in the U.S. is so unbelievably fucked up and nobody's seriously questioning. This story is a great reminder of that.

  5. What a wonderful doc you are!

  6. I would like to thank you for being my virtual mentor. I am a practicing hospital physician newly out of residency. In every post I learn something that I can bring with me to the wards. My patients benefit and my enjoyment of my jobs continues to expand as a result of your writings.

  7. You keep fighting the good fight. And keep taking the time to share it with us.

  8. Ah Dr. Manning -- you are a great person and you take that to work with you. All of your posts reflect your goodness. Thanks for sharing with us. Joanne

  9. You are truly a wonderful doctor (and writer). What you pick to write about -- what you choose to tell -- is amazing and true. I'm fascinated by the life you live, the lives you tend to, and I'm grateful to come here and read about them. Avidly grateful, in fact!

  10. Ahhh....This touches me in so many ways. Not only did you pick up on his silent clues intuitively, you acted upon your feeling wisely and compassionately. I love this post!

  11. Mary Alice -- Prison sounds like such a warped world. . .so devoid of reality. I'm glad that he evolved.

    Sister Moon -- You know first hand how it feels to need to write. I appreciate you reading and of course you know I love hanging out on your porch reading about venison chili and oyster trading. The love is mutual.

    Lena -- Isn't the Redemption Song gorgeous? I love that song because we all need redemption at one point or another.

    NOLA -- If anyone can advocate for the forgotten it's you. And I agree, forgiving can be hard, but redemption is, like I said, something we all need.

    A - 'preciate you!

    MD2007 -- Now that? That chokes me up. I deeply appreciate your words and feel honored to be a virtual mentor. I will do so responsibly. Let me know if I'm not, okay?

    OMgrrrl -- And thank you for reading, for real.

    Joanne -- I'm a work in progress, but I do love people and their stories. I just try to always remember that everyone was once somebody's baby, you know? That helps me see the innocence in them, even when it's been gone for a long time.

    Elizabeth aka warrior mama -- You know the feeling is so very mutual. I love reading about your life and hearing your perspective on things. I also like that you are the ATL transplant in LA and I am the LA transplant in ATL. I feel like we are babysitting each other's hometowns! :)

    Mommy aka Shugsie aka Toonces -- I love knowing that you are my #1 fan. That's good because I'm yours. :) I love you so much.

  12. How many times am I going to have to tell you to provide a warning to me before I read these posts??? I'm a HOT MESS right now... let me go close my office door! Geeeez!

  13. Kim you are so insightful and kept what might have turned into a negative experience for you and your team into a true learning experience for everyone. I can only imagine how the patient felt after meeting you and taking the compassion you showed him out into his interactions with others.

    Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.
    Martin Luther King, Jr.



"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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