Thursday, March 31, 2011

Thursday Top Ten: Double Takes.



Just about every day when I am at Grady, something makes me stop and say, "Wait, huh?"

That said, I will go light on the preamble this week as I bring you the top ten things this month at Grady that made me do a double take.


#10   ATL Ink.

All within the same month, I saw the following:

First was a man with the most bizarre tattooed hairline. It was literally a straight line across and looked like a person who had just been perfectly lined with clippers. . . . uuhhhh. . .from like twenty feet away. Up close, it was just. . um. . .yeah.

Second was this lady with what I am certain were tattooed eyebrows. But they were drawn really high. She kind of looked really Curious George-ish. Umm. . . .yeah.

Not the person I saw, but close.

Really, really. . .umm. . .yeah.

#9  The ATL Clippers.

Today I saw a woman sitting on a bench outside of Grady clipping her toenails. The good news is that she did not appear to be an employee. She also did not appear to be the least bit fazed by me standing there looking at her with a gaping mouth (that I had just thrown up a little bit in.)

0_0  -----> the look on my face.

#8   Food Fight.

How about my patient who kept saying he couldn't eat but every time I came in his room it looked like Picadilly Cafeteria had exploded on his tray, window sill, and sink?  And his tray would be clean.

"You eat all this?" I'd ask each day.

"Naaaw, doc. Wadn't me."

Wait, huh?


#7  Weight just one minute!

Like, when will this end?

"Hey, Dr. Manning! Ain't you the one be on Fox 5?"

"Yes, ma'am."

"Oh, you slender and trim. You be lookin' big-boned-ed on TV. All up in here."  She waved her hands around her hips and but-tocks.  And then up around her face.

Wait, huh? No she di'in't!!

Yeah. I got your "all up in here" . . . . .

#6  Falsetto.

Saw a man sitting cross legged (like sitting down on his behind cross legged) on the corner singing the Minnie Riperton version of "Loving You."  And as for the part that goes "Doo, doo, doooo, doo, doooo. .  . .AAAAA-AAA-AAAAA-AAA-AAAAAAHH"---he totally went for it.  Did I mention that he, like, couldn't really sing and that there were, like, no real onlookers?

Um, yeah.  It was really, really weird.




#5  The Mouths of Babes.

Little pre-school boy walked into a patient's room (who was obviously a relative) with his parent and promptly pinched his nose and announced:

"It smell STANK up in here!"

>_<      (look on my face when I heard that.)


#4   Pleasantries.

Man was lying on his side getting a spinal tap. Although he was very cooperative, he did not hold back yelping out during the procedure.  So here we are, in the thick of it--us spinal tapping and him yelping--when we hear someone enter and go to the patient in the neighboring bed.  Our curtain is pulled so we can't see. You can hear a few voices talking, and I gather that it's the phlebotomist. Mid-yelp, our patient yells out (from under the sterile field):

"Hey there, Frank! Tha's you?"

"Yeah tha's me!"

"Hey man, what you know good?"

"You got it, man!"

All while lying sideways under a sterile sheet in a fetal position.  Oh, and in between yelping. I bet money that he would have reached from under that sheet and given Frank a fist bump if he'd tried.

Wait, huh?

#3  Short but sweet.

"What yo' name is again?"

"Dr. Manning."

"Oh, tha's what they said, okay den."

"Was there a problem?"

"Naawww. I was tryin' to get somebody to know who you was. I said, 'You know. . . .that little bald-headed black lady that be heading that team that come see about me.'"

"Wait--and that description helped somebody to know me?"

"Yeah! They said, 'Who, you talkin' 'bout Dr. Manning?'"

Dang.


#2  Kilamanjaro.

I was preparing to listen to a patient's lungs and opened the gown to expose the back.  I saw the world's largest black head staring at me.  . . . .easily the size of my fist.

Is it bad that I all day I kept thinking about popping it open?

#1  A Helping Hand.

One of our patients could always be found with his hand parked in his diaper every morning on rounds. This wouldn't have been a problem were he not looking to shake my hand--with that hand.

Eeeww.

0_0 --------> look on my face when he reaches out that contaminated hand.*


*stole this hilarious thing (0_0)  from the hilarious pserendipity! (see my "whiskers on kittens" blog roll!)

****


Happy Thursday.

Wednesday, March 30, 2011

Leave it to Bieber.

Rick Roll? Meet the Biebs Bomb.


Ever heard of someone getting "Rick Rolled?"  Essentially, it's this phenomenon that was going on a few years back where you'd be minding your own business surfing the net or watching a video and BOOM! Suddenly you'd get interrupted by this horrid 1980's video of Rick Astley singing "Never Gonna Give You Up."  It's best when you are at work or in class and it happens--especially when you can't get the volume down.



Can I admit that I'd never even heard of this until one of the med students "rick rolled" me back in 2007?  I kept trying to open this page and every single time I kept getting that dreadful video! I was like, "What the. .. . ?"

I told my small group and they were like, "Dr. M! You got rick-rolled!?"


Ummm, yeah.

Okay. Why am I talking about this? Here's why. During a tender moment where we had just had lights out and finished bedtime stories, Isaiah decided that he wanted us to sing lullabies together. Our favorite "lullaby" is that beautifully haunting James Taylor song called "You Can Close Your Eyes." We've been singing it together since the boys could first make words, and despite how terrible our voices are, it always is a comfort and heartwarming when we do. . . .



That is, until Zachary started having Justin Bieber on the brain. Who needs to "Rick Roll" when you can "Bieber Bomb?"  Lately, Zachary has taken to "Bieber bombing" several of Isaiah's jokes or sneak attacking just about any song Isaiah sings--which, I have to admit, is one of THE most hysterical things I have ever seen or heard. What's funnier is that Zachary recognizes that it is funniest when the person LEAST expects it--a nod to his impeccable comic timing.

Just imagine it--poor Isaiah telling his joke:

"Knock knock, Mommy!"


"Who's there, buddy?"


"Boo."

"Boo who?"

"Awww, Mommy! Don't cr--"

"BABY! BABY! BABY! OOOOOOOOHHHHHHH!"


"Momm-mmmaaaayyy! Make Zachary stop it!"

Yup.  Once again Bieber bombed by the Zack attack. Dude--it's beyond hilarious. And it's terrible because I cannot contain my laughter when he does it. Which makes Isaiah even madder. He screamed tonight, "It's NOT funny, Mom!"

I tried so hard not to laugh. But . . . .it is funny, though. Like, real, real funny.

Having a bad day and need a laugh? Check this out. The original Bieber Bomb, courtesy of its creator, the Zack Attack.


(By the way, you can't see anything because we were in the dark.)

video


Dude. Is that not HILARIOUS?

***
(Oh, and if the Bieber Bomb goes viral? You heard it here first. . . .I'm just sayin' . . . .)

Happy feelin's.


Now playing on my mental iPod:
 "Happy feelin's in the air
Touching people everywhere
Plenty love and everything
Listen to the people sing. . . .

I've seen the light
Watched it shine down on me
I'm gonna spread my wings, yeah
And I'm gonna tell all I see
Of these happy feelin's
I'll spread them all over the world
From deep in my soul. . . . .. 

I wish you happy feelin's. . . ."

________________________________________________________

Ran into Miss Regina, the cafeteria lady, on the elevator yesterday.  The door opened on the second floor and on she came with her big ol' silver cart-- and oh-EM-GEE when she saw me. Just that very day someone had shown her the two posts on this blog about her and as it turns out, she had literally just read every line including your comments.

Oh me, oh my.

"It's you!" she exclaimed. "That lady who wrote those things about me! Somebody let me see it and I finally read it all today."

For a minute I was thinking,  Rut roh. Is she mad? Naaaaah.

"I'm glad you got to read it, Miss Regina."

"Oh Lord. . . .I was just crying and crying," she told me. "I kept saying, 'Me?' I couldn't believe it." She patted her chest and shook her head. "Mmm." She sighed to blow off the emotional charge. "I just--"  she stopped mid-sentence and closed her eyes and shook her head again. "Mmm."

Mmmm was right.

"And all them people," she went on incredulously, "them strangers on them comments. . . .saying all those nice things about me. . .'Miss Regina this' and 'Miss Regina that'. . .I mean. . ." She pressed her lips together and furrowed her brow in that same way actresses do when accepting Oscars or Emmys and they're trying not to do the ugly cry.  Hmmm. Now that I think of it, Oprah has done that like forty five times already during this farewell season. . .errr, but I digress.

Wow,  y'all. She was really happy. Which made me really happy. Which is probably making you really happy, too. Which makes me happy all over again.

Miss Regina grabbed my wrist and her face became serious. Something about the way she gripped my arm sent a bolt of electricity through me. "Please. . . can you tell them I said thank you? All those people who said those nice things about me? Tell them I said thank you. For real."

I smiled at her big and wide and kind of goofy even.  "Miss Regina, I think they'd want me to thank you."

She placed her palm on her chest, turned her head away and did the "girl, don't you go into the ugly cry" face again.

A smile spread across my face, oozing into my eyes and dripping down into my heart. I nodded, facing her as the elevator doors opened. I pointed at her and backed out of the elevator while continuing to nod my head.

"Yes, you," I told her. "Yes, you."

Yes, you.


Here's what I know for sure:  Flowers are best when given to the living.

Tuesday, March 29, 2011

Amazing.


 "Black don't crack."

~ Anonymous

On rounds this week. . . .

"Wait a minute. . . . I must be in the wrong room. I'm looking for somebody in their eighties. Pardon me for the interruption." Act like I'm leaving.

Flashes me a smile so sweet it gave me a cavity on the spot.  "You in the right room, baby.  You know I'm fixin' to make eighty-seb'm in a few more months." Sweetest little chuckle ever. Love it.

Playfully fold my arms and give her the hairy eyeball. "No way. Don't believe it." Reach over and check her wrist band. "Whaaat?" Chuckles even sweeter.

"Sho' is."

"You're in your eighties?"

Smoothing the covers over her legs. "Might even be in my nineties. . . . you know back then they ain't always keep track so good."

I smile and think of when my friend and fellow Grady doctor, Lesley M., told me last week that one of the Grady elders she saw wasn't sure of his age--"because they didn't count the barefoot years." Love the reference and wonder if her "barefoot years" were counted in that eighty-seb'm.  She looks skyward as if she's doing the math; then waves her hands and shrugs. "I says eighty-seb'm, but it may even be ninety. Who knows?"

This time we both chuckle. But hers is still sweeter. Especially the knee slap she added to this one.

I look at her and say exactly what I am thinking. "Amazing." Because it is. And she is.

"Tha's what I say every day. Amazing that the Lawd seen fit for me to be here this long. And you know, I do for myself, you know. Cooks, cleans, all that."

My mind wanders to my eighty-eight year old grandmother in rural Alabama who, like this patient, does for herself, too.  Again, I say exactly what I am thinking. "Amazing indeed."

"Is ain't it?"

Yes. Amazing that you were alive when there was a black Grady and white Grady and Martin Luther King, Sr. preaching around the corner at Ebenezer Baptist Church and when telegraphs were used instead of telephones. Amazing that somebody you know got sprayed with a fire hose and probably slapped across the face just for standing there. Even more amazing that despite that, you also turned on your cable TV in 2009 and saw a dapper young man of color sworn in as the president. Your president. President of the same country that houses this state that you were born and raised in--where a governor during your lifetime ran and won on the platform of "No, Not One!"--as in no, not one black child would integrate a school in the state of Georgia. Which, in the 1950's when all of that was going down, meant your kids.

Even if it is only eighty-seven counting the barefoot years, you've still seen a lot.

I shake my head and think, My, my, my. It bears repeating. "Amazing."

On to the business because I know I could do this part all day. And so, I get on with it. Ask my questions. Listen to her responses. Perform my examination. Review the plan. Laugh along the way. Grab all the wisdom and joy she spills all over the bed, the floor, and into my pockets. Loving every minute of her presence. Feeling her light shining. Decide to bask in it for a few more moments.

"So what's the key to being able to do for yourself at 'maybe-even-ninety?'"

"My mama always said keep your mind busy. And don't be lazy or idle. If you just set around and don't do no work, your mind go. I stays busy. I do stuff. Keep myself going. And mama also said don't be fred to work. Tha's what I mean by don't be lazy or idle."

Nod my head. Try to catch the wisdom between my fingers. Stuff that one in my sock for later.

Flash my penlight on her face. Squint my eyes. "So I have to ask an important medical question."

"What's that, baby?"  Face looks temporarily serious.

Inspect her face with the fluorescent light carefully. Raise one eyebrow. "There's a problem. I can't seem to find your wrinkles. Where are they?"

Gives me scolding but amused scowl. Then, looks around the bed playfully. Lifts the cover she just smoothed out. "Oh, dang! Musta left 'em at home!"

No--this time, really--sweetest chuckle ever.  Grab a little more of that joy to tuck in my top pocket for later.

Amazing, indeed.

::sigh::

Love it. Love her. Love this job.


***

Happy Tuesday.

Sunday, March 27, 2011

How.

 **Caution: Gag-worthy mush ahead. Proceed at your own risk. **
 ______________________________________
Something I hear several times per week:

"Your schedule is so crazy! How on earth do you manage to juggle kids and work and teaching and patient care and writing and . . . .?"








My not-so-secret weapon?  Harry.

Harry M. = Baritone cheer section + Selfless helpmate + Hands-on father + Absolute team player + Rowdy-boy tamer + Outfit assessor + Butterfly-inducing charmer + Prayer partner + Loyal friend + Late night listener + Flower bringer + Wonderful husband + All-around good dude.

(Feel free to gag right here. . . .)

I'm sorry. I just love my husband. . .is that so wrong? 

(Gag again if necessary. . . . )



 


For the record? This is how.

***

(Bleccchhh.)

Thursday, March 24, 2011

Thursday Top Ten: Ch-ch-ch-changes.

Proud to be one of those "Negro" physicians.


On May 19, 1996, I graduated from medical school. And although I look and seem ridiculously youthful (I know, that's what you were saying) it's been--as my patients at Grady like to say--"a mi-nute" since I was a medical student. This week, for a myriad of reasons, I have been reflecting on how much as changed since I was a medical student.

As a medical educator of both resident physicians and medical students, I get to see this evolution taking place before my very eyes. Some of the changes have definitely been for the better. But real talk? Some of them have probably been for the worse.

This Thursday, I bring you the top ten things that have sho' nuff changed since I was a medical student--good, bad, and . . .let's just say. . .different.


#10

Class.



For most folks who went to medical school in the early to mid-nineties like I did, the first two years were all pre-clinical and all in class.

We didn't go near any patients until third year. And no, I'm not counting the Physical Diagnosis class that we participated in for the second half of our second year. If I recall correctly, that clinical time was spent either shadowing some busy doctor OR scaring the crap out of yourselves by listening to your Physical Diagnosis partner and making very off diagnoses. (Like the ganglion cyst behind my ear that me and my partner Ernest P. decided was a slow-growing lymphoma. . . um, yeah.)

Anyways. We had class all day, every day Monday through Friday. And what's interesting is that the culture was that we went to class without fail. Skipping class was not cool. So for that reason, there were very few people in my class who didn't regularly attend class. Unfortunately, this isn't so much the case these days.

Verdict:

Not being in class 24 - 7 is a good thing. Getting clinical experience early in the game (our students start seeing patients in the first semester of the first year!) is a sho' nuff great thing.

But thinking that you can learn medicine from transcripts, from studying on your couch or in Starbucks without going to the like 2 to 3 hours TOPS of lectures that most medical schools have evolved to having? Wompity womp womp. Thumbs way down, dude. Medical school is not an on-line adventure. Period.

#9

The Internet.



So how 'bout we Xeroxed everything back in the 90's. Wait--do y'all even know what it means to "Xerox" something? Do people even say that any more? Dang.

Old tests were schlepped around in a big box and shared between friends or at Kinko's. There was no following the lecture on Power Point or any such thing. You took your butt to class. You busted out your highlighters and rollerball pens, and you took notes. Old school style.

Verdict:

Having the internet for resources, learning and sharing of material is definitely a sho' nuff good change.

Having one hundred and thirty people intermittently "poking" each other on Facebook during a lecture that you spent twenty hours preparing since they know that the transcript service will have it posted on line later? Boo hisss.


#8

Clinical work.



When I was in medical school, we had this rotation called the "acting internship." They do still have that now, but a lot has changed since we were in that role. We used to have two fourth year medical students join a team, and somehow that became the equivalent of one intern. We were folded into the call schedule, we wrote notes and orders, and we cross-covered sick patients overnight just like any intern would. And if you weren't there? Oh, you were definitely missed. And not just missed because you're nice--but missed because you were literally acting as an intern.

It was terrifying.

These days, the acting interns, or "sub-i" as they are affectionately called, do get to do more than the third year clerks--but as far as being exactly like interns? Uhhhh, not so much. Now it's not because they don't want to. But more because there are a lot more laws about who can write notes and orders and all that jive. It also requires more work out of the supervising resident since they have to be there to cosign and make every decision official. In other words--more layers between the student and the medical decision making really waters down the experience. And that "being terrified" thing? It's actually very necessary.

My classmate Jada R. and I were doing an away rotation at a very fancy-schmancy institution during our fourth year. We signed up for what we thought was a month of Ambulatory Pediatrics. SIKE! We arrived and promptly had a big ol' call schedule grid handed to us with our combined names as the "intern" on one of the teams for that month. It was crazy. What made matters worse was that we had the laziest senior resident of all time covering us who regularly said to us:

"Call me if you need me, but need me if you call me." (Right before he toodled off to the call room to post up with a tiny portable black and white television.)

Um, yeah. I will never forget the day that we both stood in front of the bed of this acutely ill child and, after doing all that we knew to do, decided to call a code. Us. The medical students. Called a code. And did I mention that this automatically made us the first responders? Lawd. Talk about some tremulous chest compressions. . . .

"First rule in a code: Check your own pulse . . ." ~ The House of God

Verdict:

Senior students getting less autonomy on acting internships? Uhhh, yeah. I'd say the old way was better, as long as the supervision was appropriate. Patient care is kind of like running long distance. The only way to learn to run long distance is to run long distance. Feel me?


#7


The clothes.

Cute on a baby. On a twenty five year old? Not so much.


When I was a medical student on the wards, we were anatomically different. Seriously. I am pretty sure that no one had a belly button, an upper thigh, or cleavage. If they did, I didn't know about it--because their ass got sent home by one of the senior faculty long before anyone could catch a glimpse of it.

Verdict:

Clothes for the club should be kept separate from clothes for the clinic. That's all I'll say on that.


#6

Cell phones.



I still have no idea how any of us knew how to find each other. My first cell phone was this scary contraption that I bought for emergencies only at the end of my senior year of medical school. Every call was five-trillion dollars per second and, for that reason, no one had your number. Matter of fact, if by chance you did give your closest friend your number, it didn't matter because you couldn't afford to answer the phone.

Verdict:

Being able to find each other is a good thing when you're a med student. Having cell phones sure would have saved a lot of folks from a lot of unnecessary fumbles. A quick text could have alerted you to all sorts of things before they happened:


"Girl, you need to change that short skirt 'cause Dr. Johnson is here today."


"Aww, damn! I'm too short?"


"Yeah, playa. Don't forget the stockings in case he's really tripping."


"Good lookin' out!"

Instead, all you could do is wince when such things happened.


#5


Breaks.
Machu Picchu


The only breaks we ever had were for major holidays connected to Jesus either being born or being resurrected. I'm saying--I cannot keep up with all the breaks that our students get. Spring breaks, fall breaks, intersessions, discovery periods---and when I tell you these students make the most of this time away? Baby, I mean it.

I ask the students what they are doing for their break and if often is one or all of the following:

"Vail"
"The Galapagos Islands and Machu Picchu!"
"South Africa."
"China."
"Bangkok."
"Hong Kong."
"Paris and then maybe Amsterdam for a bit."
"The Amalfi Coast."
"St. Tropez."
"The MOON."

Um, yeah. I promise you that I am not exaggerating AT ALL. Oh--and if I sound like I'm hating, oh it's only because I am considering the only place me and my friends went was Chattanooga, Tennessee to the outlet mall. One, because we were broke. Two, because we were broke. And three, because we NEVER had a large enough chunk of time to go anywhere other than Subway for a five dollar footlong between study breaks.


Verdict:

Becoming a doctor can be heavy. Taking time out for breaks and personal enrichment is a good change if you ask me.

#4


The Verbal Filter.


When I was a medical student, we called everyone who was already a doctor "doctor." We followed directions and showed up where we were supposed to show up and 99% of the time felt so freakin' happy to be in medical school that we wouldn't dare not act like it.

So this is probably one of the most disturbing new developments I've seen. Now, first, let me give the disclaimer that there are many, many wonderful, insightful, humble, and respectful medical students all across the country. But. There is also a growing culture of disturbingly entitled learners who not only look gift horses in their mouths but kick them in the teeth, too.

I overheard a student say this about a part of their curriculum that they didn't like:


Student: "This whole part of the curriculum is bullshit and a waste of time."


Faculty: "Well, it's mandatory, so if you don't go, you won't graduate."


Student: "Like I really won't graduate. Yeah right."

(SCRATCH THE NEEDLE ON THE RECORD)

Wait, huh? Awww, hee-yaaaallll nawww!!!

(Picture me kicking over a chair.)

Are you, like, kidding me? Yeah, now this? This is not something that would have gone down when I was a medical student. This exchange was in the presence of a faculty member. When I think about how much work, how many babysitters get hired, how many spouses get angry, and how many meetings we all go to just to work on the curriculum. . . . .all I can say is this:

Them's fightin' words.

Check it: There are goo-gads of studies looking unprofessional attitudes and behaviors in med students and how it all pans out for future disciplinary actions like litigation and state board problems. No shock--even the smart kids who have had professionalism issues are much more likely to find themselves in trouble at some point. And this isn't just my opinion. This is evidence-based.

Telling a professor to "stick it" by quasi-boycotting a part of the curriculum that they worked hard on or just fussing about that curriculum in the most unproductive way ever is not only entitled and immature, but painfully unprofessional. When I recertified for the Internal Medicine boards last year, I was required to do over twenty something hours worth of question banks, literature searches, surveys and much more. It was horrible. But you know what else it was? Mandatory. Now. If, by chance, someone has asked me my opinion on the whole thing, I would have wanted to say:

"I am a clinician educator. I work with medical students and residents in a teaching hospital every single day. I read. I teach. So forcing me to do fifty five hours worth of homework is like a giant thorn jabbed directly into my side."

The key word is "wanted." Just because you are thinking something doesn't mean you say it. And just because you don't exactly want to do something that is professionally mandatory, doesn't mean that you are so special that you get to be the one who doesn't. Be that the maintenance of certification process. Or just, as my husband the military dude would say, shutting your piehole and doing what you are supposed to do--like participate in a part of your med school curriculum.

Newsflash: That's life. Especially in medicine.

Verdict:

Some of that old school deference should be recaptured. To those who do "get it"-- I'm not talking to you. To those who are smirking at this and calling it stupid, here's my wise words for you: check yourself before your wreck yourself. Oh yeah, and while you're at it? Do what all of us grown ups and professionals do when we are faced with mandatory hoops that we must but don't wish to jump through:

Suck. It. Up.

Ugggh!

#3

The Library.

You don't know nothin' 'bout this.


A literature search used to involve waiting twelve thousand years for a librarian to help you find the paper that you located in the antiquated INDEX MEDICUS. There was nothing quick about a lit search back then. And it was PAIN. FULL. Oh and did I mention that since we did not have internet access during my intern year and med school years that our questions were found in big, fat, textbooks. That we carried around in our backpacks. Crazy, I know.

Verdict:

Hallelujah for Pub Med.

#2

The Confusion.

image credit


I have to give the medical students these days credit. These kids are scary smart. I recall quite a few times in medical school where I was frozen in terror during a lecture. I'd realize that, after taking three pages of notes, that I had NO IDEA what the professor was talking about. Whatsoever.

But the med students these days? Fuggeddaboudit. They are all over this stuff. They type 100 words per minute and they ask us questions so hard that we immediately question our medical school diplomas. I don't know if it's me, but the learners seem smarter than we were. Now, the work ethic seems to be a lot different--but sheer smarts? They've got that.

It's amazing how well these students can digest information and multitask. They grasp the most complicated concepts all while tweeting a friend, reading the New York Times on their iPads from the back of the room, and balancing their checkbooks at the same time. That part really impresses me.

Verdict:

The future of medicine includes some really bright minds. Which if you ask me, is a GOOD thing.



#1


The Friends and the Fun.

Class of 1996 in 2009


Boy did we have fun in med school. I'm talking a full on blast. We worked hard, yes. But man did we play hard. I made some of the best friends I've ever known in med school who remain my closest confidants to this very day. I'd like to think that our crazy duty hours and ridiculous schedules created that in us. I'm even tempted to say that we were WAAAAY closer than these young bucks in medical school these days.

But I can't.

The good news? It looks like that part hasn't changed one bit. I've witnessed some rich friendships grow out of the the medical school, and even a few love matches to boot. It warms my heart to know that the same ties that were fostered by those all nighters and post-exam parties in the 90's still live on.

Verdict:

A lot has changed. But some things always remain the same.

***

Happy Thursday.

Wednesday, March 23, 2011

The Puppy Mafia: Super Sleuths Now on the Case.

 Warning:  Extremely random and nonmedically related post ahead. Please check back tomorrow for your regularly scheduled programming. 

***

 I just KNOW that you all have been waiting and waiting to hear the latest update on The Puppy Mafia!  Bwaaah-haah-haaaaaah! Well, wait no more!

We have officially called in the professionals.

Yesterday Isaiah decided that he would take a snaggle-toothed bite out of crime--and take the matter of the missing Puppy into his own hands.  As I sat on the couch reading a magazine yesterday. . . . this is what went down:

In comes Isaiah (wearing my Target mini-trenchcoat and a hat from who knows where) -- who very randomly and promptly announces to me that he is, in fact, NOT  Isaiah but is instead "Detective Isaiah."

Dunn-dunn-dunn-duuuuuuuuunnn!!!!

That's "Detective Isaiah" to you.


Ummm, yeah.  Okay, so check it out. . . ."Detective Isaiah" was accompanied by his assistant, "Robert the Robot." 

video

 Is it me or does Robert the Robot bear a striking resemblance for Buzz Lightyear?

(I'm just sayin'.)

Their goal?  Well, in addition to fighting "wobbers" and "crime," this dynamic duo is determined to find the whereabouts of Puppy the Mafia Don of the Puppy Mafia.

Oh yeah--and as for whether or not it was a set up by Pup Pup? The head detective and his robotic sidekick don't believe that his disappearance involves foul play, as they stated in our interview yesterday.

video

Detective Isaiah wants to thank all of the readers of this blog who continue to keep hope alive for Puppy's safe return. He also wants you to know that both he and Robert the Robot are ON THE CASE.

We'll keep you posted.


See? These are the deep sorts of things that I get into when I get home from stamping out disease at Grady Hospital.  (Told you I didn't make these things up.)

***

Happy Hump Day.

Tuesday, March 22, 2011

Starting over.



Today I saw my patient who was mean to me yesterday.  He said he was sorry for how he spoke to me and that I didn't deserve all that. He told me that he was feeling "like he was going stir crazy." He told me that he sometimes feels "like he is trapped inside his own body." I get that because he kind of is.

I looked at his face all stubbly and ungroomed. His eyes were twinkling even though I hadn't turned the lights on in the room.

He rubbed his chin. "Can I shave?" he asked. "I'd love to have a shave."

I replied, "We'll get you shaved."  He looked relieved and appreciative.

I told him I was sorry for losing my patience with him yesterday.  He said, "Did you? You seemed pretty patient to me."  And I said, "Trust me, I wasn't." He laughed and then I did, too.

He said, "Let's start over."  And I said, "I'd like that."

So today . . .  that's exactly what we did.

Monday, March 21, 2011

Control.

Hey! It's my 300th post!  (Just thought I'd mention that.)
 __________________________________________________
***

"Got my own mind.
I want to make my own decisions.
If it has to do with my life. . . 

I wanna be the one in control."

~ Janet Jackson
____________________________________________________

I've been taking care of a few patients over the last few days who haven't been very nice to me.  One of them flat out told me to "Go Away, dammit!" when I tried to perform my examination on rounds today. She swatted my hands off of her and shooed me out of the room--for, literally, no reason that I could think of. 

Yeah.

I was tired from working over the weekend and from Zachary waking up repeatedly and whining while getting dressed and from Isaiah crying this morning before getting on the bus and from driving between Grady and Emory in the middle of the day for what has felt like the five trillionth time this month, so honestly? I just wasn't in the mood.  At. All.

I was alone.  There were no medical students with me or residents or even a nurse overlooking. I was super tempted to put my hand on my hip, let my backbone slip, and curl my lips. I was ultra tempted to grab up my cantankerous patient by the gown, stare at her nose to nose, and growl, "I WILL NOT go away. You WILL sit up and you WILL let me examine you and I will NOT be putting up with this TODAY! GOT THAT, LADY?!"

But I didn't.

Instead I just did what I could in between her exaggerated lip smacks and throaty insults; laying my quivering stethoscope any place that could possibly give me some answers and not a hand slap.  Okay. I'll admit that I was seething and had a rather funky attitude as I quietly told her the plan and halfheartedly asked if she had questions.

She did have one question: "Can you please just go A-WAY?" She then smacked her lips (very hard) and turned her back to me in a way so exaggerated that it looked planned and blocked by a director for a medical drama. "GO A-WAY!" she repeated.

So that's exactly what I did.

I wish I could tell you that I said something super poignant that allowed us to connect and then sing kumbaya. Nope. Not at all. I was tired. And I wasn't in the mood to be gracious.

After that patient, I went to see another patient who had decided early in his hospitalization that being nice to me or anyone else was not a priority.  He had gone from screaming and spitting mad, to eerily calm, to angry f-bombs, back to scary docile--all over a four day period. I had no idea what to expect this day, and truthfully? I wasn't even in the mood to find out.

Turns out that today was sarcasm day.

"Hey there. . .it's Dr. Manning."

"Well, well, well!  If it isn't DOC-ta Manning!"

"Hi sir. How are you feeling today?"

"Awesome! Just awesome! In fact, I could not be better!"

I cleared my throat and rubbed my neck.  "Umm, okay. Any pain today?"

"Let's see . . . .pain.  Um yeah! Everyone here is a pain in the ass! Does that count?" He gave me a sacchariny-sweet smile (complete with aftertaste.)

I pursed my lips and blew outward. Not. In. The. Mood. "Sir, are you moving your bowels okay?"

"I sure am!  But I'm not sure how since I barely eat this ridiculously disgusting diet! It's an absolute, f--ing joke. But, hey,  I am still AWESOME. Totally AWESOME."

I did my best to acknowledge the psychiatric aspects of his behavior. But it was hard today. And I won't even lie--all I could feel was annoyed. I felt myself crumbling.

"Look, sir.  This isn't helping anything. And I'm not about to stand here and listen to your profanity. I'm not. Not today, I'm not."

"Is THAT RIGHT?" he chided in an even more horribly cynical sing-songy tone.

He was totally pushing my buttons.

"That's RIGHT."

"Oh, well NEWS FLASH! I do what I WANT TO F--ING DO, ALRIGHT?"

I pressed my lips together and sighed hard.  "You know what?" I started and then stopped. It was the kind of "you know what" that precedes somebody getting cussed out on the corner or after dealing with a rude cashier.  I wanted to go straight L.A.--I take that back--straight INGLEWOOD on him, giving him back exactly what he was giving. I closed my eyes, gripped the bed rail, and tapped my foot to release the mounting frustration.

Lawd, Jesus. Help me to be more like you.  Whew.

I looked at his tray and the clear liquid diet that his condition required him to eat.  I glanced at the tubes and IV lines coming from every limb of his body. His youngish face was twisted and frustrated. His eyes narrowed and I braced myself for the venom that I saw him preparing to spew in my direction.

As I examined him, expletives whizzed past my cheeks and punched my shoulders. The worst ones you can think of. You've read all about my many tender moments at Grady--but there was nothing tender about this. At all.

In between f-bombs and grating sarcasm, I did my best to repeat the the plan to him that my team had discussed earlier that morning.

"I will speak to the specialists," I said with every drop of exhaustion that I was feeling evident in my voice. "As soon as they tell me what they recommend, someone from our team will be back to review that with you."

"GREAT, Dr. Manning! AWESOME!  Tell you what? I'll see you back in what, like, FIVE BILLION hours?!" He let out a cackle and squeezed his eyes shut.

I'm sayin'. .  . really?

I just stood there staring at him. I could feel my blood boiling.

I couldn't take it anymore. I walked out to the nurses' station, sat down and just put my head down on the desk.  I was tired. I was sick of hearing it. I closed my eyes and did my best to channel something. . .anything. . .to get me in a better place.

That's when, all of a sudden, this image of eighteen year old Janet Jackson followed by the word "CONTROL" underneath it popped into my head like a giant TV caption.

CONTROL!


Ah hah.

Kind of like Janet, that's really what we all want to some degree.  It's why Zachary was crying this morning when I wouldn't let him wear his big red rainboots to school and why Isaiah was giving me the business about wanting to be "a walker" to school and not a "busrider" and why I was so aggravated by my patients being so difficult. Control.

"If it has to do with my life--I wanna the one in control. . ."

The profanity? The refusal to cooperate? All ways to regain control for people whose unfortunate medical, social and psychiatric conditions had left them with virtually none. These two patients were frustrated with minds and bodies that had turned their backs on them -- which, truthfully, had little if anything to do with me or anyone else.

I finally admitted to myself that I was bent out of shape because I couldn't bend them in the direction I want them to go. No amount of kind words or soft intonation was working. Things that usually work for me. To control a situation.

Ah hah.

So today, despite what someone else might think was the right approach, I stopped trying. I went back in to see those two patients again; this time making up in my mind that I wouldn't make it about me. Because it wasn't.  On this day, I decided to let my patients have the control that they, too, craved by simply controlling me -- even if it meant getting pelted with a shrapnel of f-bombs, "go aways", and extraordinarily rude sarcasm-- and even if giving it to them was at the expense of just a little bit (okay, maybe a lot) of my own pride.

Funny. Once I looked at it that way, I somehow felt better about it all. And more in control.

***


"I'm in control. . . .and I love it."  ~ Janet J.

Sunday, March 20, 2011

Heartwarming.

Today on rounds. . . .


This is a snapshot of the medical student on my team with one of our patients--performing their own little "morning ritual."  Each day on rounds, this patient warms up the student's hands before she performs the exam. It's been their own little thing between them that, normally, no one else is around to witness.

But today, I was.


a therapeutic touch. . .



And now you were, too.


The power of touch goes both ways. . . . . yeah.

***

Happy Sunday.

Saturday, March 19, 2011

Happy.


This morning:

Isaiah:  "You know what, Mom?"

Me:  "What's that?"

Isaiah:  "I'm so happy."

Me:  "That's good, Poops.  What are you so happy about?"

Isaiah: "Mom. . . .sometimes it's good for you to just be happy on the inside."

Me:  "Preach, pastor."

Blowin' up.

Random Grady elevator moment:

I'm riding on a random elevator one random day and in steps this gentleman who appears to be somewhere between forty and fifty. He has bandages over his arms and lower legs, and someone has attempted with painstaking detail to cornrow his hair into several tight-ish braids which are fraught with peril considering that his probable European descent afforded him baby fine, stick straight hair. The giant jersey he was wearing was swallowing him up like Jonah in that whale, but this look was intentional for sure. Bandages or no bandages--this dude could not be more content. He tapped the bottom of his box of cigarettes, getting himself ready to go outdoors for a good smoke.

"What's up, doc?" he spoke with a raspy voice.

"Not much. You doin' alright sir?"

"Yeah, main. I'm doin' good now. But real talk, doc, I'm sayin', Grady pretty much saved my life!"

"Wow. That's great. Car accident?" I immediately jumped to the thing we are most known for--trauma.

"Naaawww! I got burnt! Like bad. Guess what happened, doc?" He kept tapping the box of Newports. I liked his voice. It was somewhere between Wolfman Jack and Samuel L. Jackson which, combined with his slippery cornrows, ginormous neck tattoo and surprisingly toothless grin, made him memorable and decidedly blogworthy.

"I can't even guess."

"My house. It jest blew up, for real. Like 'BOO-YOW!'"--he added in some jazz hands--"That sh@& straight blew the f--- up. It was crazy, doc!"

I decide that I am amused at people who randomly feel comfortable dropping happy f. bombs in the presence of complete strangers.

"Wow, that sounds crazy! Looks like you were really fortunate."

"Hella fortunate."

"Were you in the house?"

"Yeah, main. . . . but I got my azz up outta that piece. Then it was like 'BLAAAMMM!' Windows was breakin' and all kinda sh@%! I'm sayin', I coulda died for real."

"For real for real," I cosigned.

"Yeah. . . they was all like, 'What happened, folk?' and main. . . .I just laughed and told my peoples, 'Shiiiiiddd, I'm blowin' up!" He laughed at the play on words. I did, too. "Tha's so they wouldn't be all worried and sh@$."

Wow was he at ease with his potty mouth. I tried to picture his whole crib imploding windows and all.

Hmmmmm.

"So . . . .like. . .what made your house blow up, though? That sounds kind of crazy. . . .like. . . what were you doin' in there?" Immediately after I said that I chuckled, but then suddenly froze -- putting my hand over my mouth and widening my eyes.

Right then we reached the ground floor and the doors flew open. He slid a cigarette out of the pack and placed it behind his left ear. With a throaty laugh he stepped out of the cabin ahead of me.

"See, now doc? Now, you askin' too many questions."

And with that, he bid me adieu and headed off to smoke his square.

Being the nerd that I am, I entertained a differential diagnosis for things that might make entire houses blow up. Not a very long list.

Hmmmmmm.

Yeah, doc. You asking too many questions.

Friday, March 18, 2011

T.G.O.F. (The Gradys on Friday.)

Random sampling of stuff I heard and said today at Grady:

***
"How you doing today, sir?"

"Me? Awww, baby, I'm easy like Sunday mornin'. . ."

(If you don't know nothin' 'bout that--peep this jam from the Commodores circa the 1970s.)



***

Me:  "Hey there. Just coming by to check on you again."

My patient:  "Ooooh!"

Me:  "What?"

My patient:  "I 'in't knew you had all that gray in yo' hair!"

Me:  "Yeah. I got a hair cut so you can really tell since I'm due for color."

My patient:  "Ooo, Jesus, doc. When you gon' get it colored, baby?"

My stylist insists that I'm five years away from this.

***

Patient:  "Do y'all think this is cancer?"

Intern:  "That's a good question. What we can say is this: The scan looks concerning for something like cancer. But the only way to know is to get a sample of it."

Patient:  "You mean a biopsy?"

Intern:  "Yes, ma'am."

Patient:  "Well, go on then and let's find that out. And listen to me and you listen good--if it's something real bad, I don't won't nothin', do you hear me? Nothin'." 

Me:  "We promise to let you know what the biopsy shows the minute we get it. Then you can talk things over with your family to see what you all think is--"

Patient:  "My family?  No! This is MY BODY. I will make decisions about MY BODY. My family? They love me and they gon' want everythang no matter what. And this?  This MY BODY. And don't nobody need to talk nothin' over with me about MY BODY."


Silence.

Patient:  "Do I make myself clear?"

***


An environmental services worker walks by after cleaning the area. She smiles and says hello as she passes our rounding team.

Me:  "Hey--is that money pinned on your shirt because it's your birthday?"

Lady:  "Yes!"

Me:  "Awww!  Wait a minute--"  (pinning a dollar onto her uniform) "--there you go!"

Lady:  "Thanks!"

Med Student:  "How old are you today?"

Lady:  "Twenty one!"

Team in unison:  "Happy birthday!"

***

Student:  ". . .and that's our plan for her."

Me:  "Would you like some feedback on your presentation?"

Student:  "Yes!"

Me:  "Pulak, my dear, you sound like an intern. That's my feedback. You sound exactly like you are already an intern."

Student:  (big grin) **ting!**


***

 Patient transporter:  "You got kids, right Dr. Kim?"

Me: "Yep."

Patient transporter:  "Yeah, I figured 'cause you got little bit of that mummy-tummy like me."

Dayum.

***
"Standing in a patient's room talking to him and his family. Dinner trays are being passed.

"What's in there?"

I open the tray.  "Broth."

"Broth and what else?"

"Jello."

"It ain't no steak in there?"

"Nope. Just broth and Jello."

Pauses for a minute. Then does the old school Florida Evans move from Good Times. 

"Daaaaamn! Daaaamn! Daaaaaaaaamn!"

Hilarious, do you hear me?

*(Note:  All black people between the ages of twenty-five and fifty-five hear this and know exactly the moment and the scene from Good Times when this took place. If they don't, they automatically deemed imposters.)



***

Nurse:  "He seems confused today."

Me:  "He can't be confused."

Nurse: (looks at me puzzled)

Me:  "He told me I was lookin' slim and trim today."

Nurse:  "Aaaaah."

Me:  "So clearly he can't be confused."

Nurse:  "Clearly."

***
 
T.G.O.F. and T.G.I.F. to all. :)

Thursday, March 17, 2011

Thursday Top Ten: The Best (Match) Day Ever

Match Day.

To employment! (That's cider for me--I had to go back to finish rounding.)


Today was match day. The day where all of the fourth year medical students all over the country rip open envelopes that determine where they will be doing their residencies. A day full of angst--the sonic boom heard all over America after a nearly four year drum roll toward being a doctor.

Today was that day.

Emory School of Medicine, today as I crossed the street


For the nonmedical folks reading this. . . .here's how it all works:

You decide on a specialty after doing all of your clinical rotations.
You make sure that your choice of specialty matches up with your performance in med school.
(Certain specialties require otherworldly board scores and grades, etc.)
You gather your letters of recommendation.
You apply through the computer application system.
You wait to hear from programs and if you're lucky, you get a bunch of interviews.
You interview.
You fret about which programs in which cities you liked the most.
You fret some more.
You pray, if you're into that. (I am.)
You rank the programs in order of where you want to go.
(Little do you know that the programs are fretting, too.)
The program puts in their lists in order of who they want.
You hope and pray that the folks who you liked like you back.
On Match Day, you rip open an envelope and find out.

My Match Day Moment, March 20, 1996


Yeah. That's pretty much how it works in a nutshell. I remember that day for me. I was so freakin' happy. Like so happy. My first choice of programs wanted me, too. And most importantly, as my father quickly reminded me, I was gainfully employed.

Yay.

I am doubting that this was cider (but don't worry-- I didn't have to go back to round!)

We had a big ol' party where we signed each other's scrubs, toasted a few too many times, and graffiti'd our names all over a giant map with our residency locations. That day was awesome. And as you can see above. . . . I sho' nuff celebrated.

So with that said. . .even though I always have enjoyed coming to Match Day at Emory each year, never has it ever even come close to the enjoyment I had on my own Match Day. Not even close.

That is. . . . until today.

*Gasp* 

 I can't believe I'm saying it. . .but it's true. This year was the best Match Day ever.

***

Quick background: In 2007 our School of Medicine overhauled its curriculum. The remix included sixteen faculty members appointed to advise small groups of medical students and teach them over a longitudinal experience for all four years. I was one of those lucky sixteen faculty members.

So in July of 2007, I met these seven students who, along with many other students in the class, I came to know and love very well. The nature of the curriculum created these family ties in our small groups that leaped above and beyond any teaching experiences I'd ever had. And it trickled from one small group to the next, like neighbors standing on porches handing cups of borrowed sugar to other peoples' children. All for a cake that in the end everyone would be invited to come over to enjoy.

Yeah. Like that.

I'd advised students before, yes. I've taught students, too. But this? This was different.

Never have I known learners so well.
Never have I been so invested.


That's why match day this year destroyed my careful application of drugstore mascara. Yes. Completely annihilated it--and any chance of anyone ever using the word "stoic" to describe me--all with what bordered on "the ugly cry."

I told one of the students today:

"Imagine how you feel right now. Now multiply it by all of you students and take that value to the fourth power for every single year I've known you. Then you'll know how I feel."

And so. Here is your Thursday top ten. . . .the top ten reasons (in no certain order) why this was the best Match Day ever. . . .

. . . . and why I now know for sure that I am walking in my purpose.

***


#10 The Excitement.


It's impossible to describe the excitement of the day.  You can see it in these faces, though.

#9 The Anticipation



They can't legally release the results until noon on Match Day. Here's a few shots of people waiting with baited breath. . . .

That clock is for the countdown. . .

Preclinical onlookers: "We got next."



#8 The Moment.

Some times a bunch of words just don't suffice.

a nervous student

a proud mother

a dream realized

first choices aligned again

Another proud "mama": Dr. B., one of the head advisors.

In the presence of two gentlemen both headed to Harvard for residency. . . !

Disbelief by some, relief by most, pride by all.

Over the moon

A job with benefits, too!


Words from the wise.

It's a family affair.

***

# 7 through #1: My Small Group.

The seven wonders that I have had the pleasure of watching grow since their very first day of medical school orientation. And seven reasons why if this wasn't my job, I'd sure wish it were.


Look at these shots and you'll know how long I've known them. . . .
I've watched them growing up right along with Isaiah and Zachary . . . .


Zachy wasn't even walking yet!
Zachy less than a year old with Adam less than a year into med school. .

Wook at dat two year old Isaiah!
. . . and here we are today as serious doctors. . .

. . .well, sort of serious doctors. :)

May I introduce you to my seven wonders--and part of medicine's future?
Each is described in four words, even though four thousand would never suffice.
And don't worry--I can tell you that the future of medicine looks bright.

***


Alanna.
Thoughtful. Empathic. Mature. Empowered.
Internal Medicine, UC San Francisco.


***


Hreem (pronounced "Rim").
Driven. Organized. Focused. Confident.
Ophthalmology, Rush Medical Center Chicago.


***


Jin.
Insightful. Compassionate. Loyal. Patient-Whisperer.
Anesthesiology, Walter Reed Army Medical Center

***


Ant.
Activist. Inspiring. Memorable. Brave.
MD/MPH Candidate, to enter OB/Gyn Residency 2012


***

"My Three Sons": Dougie, CQ, and Sparky


(Gainfully employed sons, that is.)

Tony.
Talented. Magnetic. Fighter. Winner.
Otolaryngology (ENT), Henry Ford Medical Center


***


Adam (aka "Sparky").
Selfless. Dependable. Passionate. Incredible.
Internal Medicine, Barnes-Jewish/Washington University St. Lo.


***


Doug (with sweet wife, Anne)
Caring. Gracious. Focused. Funny.
Anesthesiology, Mount Sinai Medical Center, NYC


***

Oh happy day.