Monday, May 30, 2011

There's nothing new under the sun.

"Summer, summer, summer time
Time to sit back and unwind. . ."

~ DJ Jazzy Jeff and The Fresh Prince

Every now and then I find myself marveling at how much has changed since I was a kid. But yesterday, I found myself marveling at just how much has not.

Kids are still kids. Laughter is still laughter. Fun is still fun. The ice cream truck is still the ice cream truck. And. Summer is still summer.

Isaiah with one of my besties and med school classmates,Tracey (aka "Auntie Punkin")

The only difference is that now me and my friends are the ones sitting on decks and porches having those grown up conversations over barbecue and a-dult beverages. . . . and the ones telling children to wait thirty minutes after eating before jumping back into swimming pools. (Where that came from, I do not know--but even as a doctor, I'm not about to challenge it.)

Wait. Isn't the point of the obligatory thirty minute "rest and digest" to actually rest? That wouldn't include basketball or freeze tag, would it?

I'm sure our parents used to wonder when we'd get tired just like we were all wondering this day and just like our folks, carried our children's exhausted little bodies in from the car like limp rag dolls after a full day of everything from cannon balls to Marco! Polo! to double dutch to two on two basketball.

A lot as changed, yes. But I'm kind of happy to know that a whole lot of things haven't.

Is it thirty minutes yet???

Happy Summer.

Now playing on my mental iPod. . . .it's not summer until I hear this song. . .

What are your favorite summer memories?

'Preciate you.

from Getty Images
Real people. Real memories. Real thank yous.

Harry as a soldier at the Tomb of the Unknown Soldier

To the countless men and women in the armed forces who have given their lives. . . .and to those who continue to lay their lives on the line every day so that I can enjoy all of the things you are missing. . .

. . . .like birthdays and soccer games and births and weddings and graduations and. . . . 

Thanks. Or as the Grady elders say, "'Preciate you."

Happy Memorial Day.

Sunday, May 29, 2011

The Reflex.

This morning, I woke up to the laughter of my children. The sun was shining and my heart was light. I loved on my boys for a few moments, turned on "The Electric Company" and my coffee maker, and then made the boys some breakfast while simultaneously cleaning up the kitchen that I hadn't felt like dealing with the night before. It was so perfectly mundane that I felt myself basking in it while scrubbing a pan in the sink. I smiled and savored it.

Shortly after that, I sat down to send an email to my friend Tasia G.'s son Omar who just finished 5th grade. He earned all 'A's and received countless citizenship awards. I loved the idea of an eleven year old receiving an unexpected congratulatory email from an adult. He is a great kid, and his parents are great people, so I wanted to tell him so. Sending that email felt good, too. I smiled again. Yes, this was a good day.

As the children chattered at the kitchen table about pancakes and swimming pools, I watched them and again allowed myself to be present in this every day moment. When Isaiah cleared his plate, he came and wrapped his arms around me saying, "You know, Mom? I really love you." And I looked back at him and said, "And you know, Isaiah? I really love you, too." Then he hugged me tight and I hugged him back, kissing the top of his head hard and deliberate.

"Mom?" he asked with his nose wrinkled, "Why do you always have to kiss me every time you hug me?"

I thought for a second and laughed. Then I said, "It's a reflex."

And he said, "What's a reflex?"

And I said, "It's something you can't help doing no matter how hard you try."

About twenty minutes after that conversation, my friend and fellow Grady doctor, Neil W., sent me a text message telling me that one of my F.P.'s had passed away this morning. "I knew you'd want to know," the text read, "I'm sorry to bother you so early on a Sunday."

And just like that, reflexively I cried. Quietly with my back turned in my kitchen with the third episode of "The Electric Company" playing behind me belting out over and over "It's electric!"

I'm waiting for this point to come where hearing this kind of news doesn't affect me in the deepest parts of my soul. I am waiting for enough years to pass where I don't ball my fist up and press it against my chest while tapping my foot. I remember how people would always tell us as interns that you have to detach yourself a little or else you'll go crazy. Hmmm.

This morning I am thinking that perhaps this kind of reaction is like trying to hug Isaiah without kissing him. It's a reflex. Kind of like waking up and seeing a sun shining and hearing your kids laughing and thanking God for it. Something I can't help doing no matter how hard I try.

This patient taught me one of the most beautiful lessons I have ever known:

"If you're lucky, everything you do is in the context of love."

Today, things as uneventful as turning on "The Electric Company," making pancakes, and sending an email were all done in the context of love. Crying about the passing of this very special patient was, too. Maybe because she was trying to teach me to make love a reflex. . . . .

Hmmm. I just thought of something--the last two words she ever said to me were these:

"Love you."

How apropos. Damn. Now I'm crying again. But that's okay, because I know it's only a reflex.

Happy Sunday.

Thursday, May 26, 2011

Top Ten: Doing the math.

Where is Daddy Warbucks when you need him?

My fellow blogger-slash-sisterfriend-slash-colleague-slash-fellow medicine nerd, Dr. Toni Brayer, authors one of my favorite medical blogs called EverythingHealth (which is a perfect name for her blog since she really does discuss everything. . .well. . .health.) She gets her blog on at ACP, too. If you like learning, check her out--very laypeople friendly.

Trust us. We're doctors.

Anyways. This week she shared a nice post with us summarizing what the CDC deemed the top ten public health achievements of the century. I peeped the list and thought, "Eh. Not bad to only be eleven years into it." If you get a chance, you can check out that top ten out here.

Oh yeah. I also enjoyed another of her posts this week that discussed the New England Journal of Medicine's recently published "The $650 Billion Dollar Question: Why does cost effective care diffuse so slowly?" or as she retitled it--"Why Health Care Costs So Much." Peep that post, too -- good stuff.

Okay. . . .now the link Dr. Brayer provides on that last post about health care costs points out some of the barriers to us delivering health care despite our abundant budget and resources. Stuff like legislative issues, uninsured patients, public misinformation about health care reform, misspending . . . all that.

But is that really the problem?

For real, y'all. What is it that REALLY is standing in the way of us getting folks healthy in a more cost effective way that doesn't make people fight, scream, dump tea bags, picket, or yell out uncontrollably while congress is in session?

Aaaaahhh. Look no further, my friends. . .because this week I bring you:

The Top Ten Things that, if we could simply erase completely, would make delivering effective health care without breaking the bank a piece o' cake.*

*(For the record, this list does not include calamities, catastrophes and accidental traumatic events which we can all agree would save us lots of money.)

But it does include everything else.

#10 -- (Frickin') Cigarettes.


Seriously? Just about every health problem under the sun is made exponentially worse by blazing up even a few per day. Think of it like playing the lottery--just by living you get one ticket. Add age and genetics into it, you get another ticket. Smoke on top of that? Just think of it like someone handing you an extra stack of tickets. Oh, and the jackpot? Try any one of the following:

Coronary Artery Disease (Heart attacks)
Lung Cancer
Cervical Cancer
Chronic Obstructive Pulmonary Disease
Throat Cancer
Bladder Cancer
Hypertension (High Blood Pressure)
Premature aging

Just to name a few. If cigarettes would just disappear, no one would ever get hooked on them. This would add fifteen minutes to a lot of doctor's visits and a whole, whole, whole lot of money to the health care honey jar.

#9 -- Obesity.

Sigh. What a doozy. It's the bane of our existence. Often a symptom of many, many different complicated things which is why it's such a hard thing to tackle. One time I was discussing weight loss tips on Fox 5 News. At the end of the chat with the anchor I said, "Here's the secret: move more, eat less." Although I actually think that is partially true, that oversimplified (and smug) statement coming from a person who technically hasn't struggled with being overweight makes me cringe. Shame on me for that. Obesity is like having your favorite necklace tangled up into an absolutely impossible ball at the bottom of your jewelry box. It's not as simple as tugging on both ends to unravel it.

That's all I can say about it. Obesity is complex. Food in western culture is worrisome. And the health care complications of all of it? Downright depressing. And costly, too.

#8 -- Drug Addiction and Illicit drugs.

What drug depends upon where you live and what's prevalent there. In Atlanta and Los Angeles, they seem to like crack. In Baltimore and central Ohio, heroine rules. Rural and suburban America digs methamphetamine and prescription drugs. But regardless of the drug of choice, the effects of addiction are the same--awful and destructive.

If there wasn't any drug addiction for us to overcome, we sure would be in a different place. I shudder when I think of the high risk behaviors that people struggling with addiction engage in and what the aftermath costs us. HIV from needle sharing and sex-working. Accelerated coronary disease and strokes from cocaine. Fractured and decaying teeth from meth. Liver failure from the acetaminophen component of Percocet and Vicodin.

Yeah. Drugs pretty much suck. Suck money. Suck period.

#7 -- Low Literacy and Low Health Literacy.

This is another complicated thing that costs money. Generational curses, crappy communicating skills on our part, a failing education system. . .these are just a few of the reasons why literacy issues annihilate the bottom line when it comes to health care dollars.

Guess what happens when people don't understand their health problems and the health care system? They take medications wrong. They leave the hospital and "bounce" right back. They don't understand the importance of what they need to be doing. They can end up in harms way. Case in point: Several years ago the AMA put out a set of health literacy videos, and in one of them an elderly, placid chap spoke with Grady doctors about his high blood pressure.

"You take this medication for hypertension. What is hypertension?"

"Ummm. . .I thank it means it's when yer hyper."

"So do you think I think that you're 'hyper?'"

"Ummm. . .I thank so. Like you can't sit still."

This guy could NOT have been more NON-hyper. He really thought that's what his medicine was for. Do you think he took it on the days when he felt sluggish and not "hyper?"

If low literacy and low health literacy weren't a speed bump on the road to exceptional health care, that would sho' nuf save some bucks. And some lives.

#6 -- Alcohol abuse.

Alcohol is a sneaky little devil. It creeps into families and strangles the offspring of alcoholics to the ground. Almost every time I meet someone struggling with this addiction, I ask them if they grew up with a drinker. And almost always, the answer is "my father" or "my mother" or "my grandfather" or someone else.

Then there are the casual drinkers that it tip toes up on. Starts as a cozy shoulder massage that evolves into a headlock. The college kids that play quarters in the dorm that find themselves having a couple of vodka and cranberries every night when they're alone. The "happy hour" fun loving uber-achiever that throws back more than ten martinis per week over jokes and clients. And of course, the soccer mommies and their red wine chat fests. It adds up.

Yeah. It adds up. To health problems and to big bucks.

#5 -- Poverty.

Sigh. Eating right costs money. Doing right costs money. Education costs money. Opportunity is often most abundant to those who have money. Getting medications costs money.

Being healthy costs money. And as some wise dude with a big afro once said,

"Nothin' from nothin' leaves nothin'. You gotta have somethin'."

'Nuf said.

#4 -- Ignorance.

This is different than low literacy. This is just not knowing and kind of not really caring that you don't know. Or kind of knowing but not caring. Like, when this lady I met told me she started smoking at forty years old. Not fourteen. Forty. Really?

Then there's the innocent things like eating ramen noodles because you think they are healthy or pouring a whole bottle of olive oil into a frying pan and drowning a few lonely broccoli spears in it for the same reason. That's ignorant, too.

Ignorance is tricky, too. Sometimes it's a person's fault. Other times it totally isn't. But I know one thing--if we all would just do better once we knew better, a whole stack of health care dollars could be saved.

#3 -- Cancer.

I wish there was a way to run cancer out of town for good. It would save money, yes. But more than that, it would keep a whole bunch of families intact.

#2 -- HIV and AIDS.

With Ryan White funding, the U.S. has definitely put forth a decent effort at treating our patients with HIV and AIDS. But when all of the other factors listed above get swirling along with it, it can be the ultimate costly train wreck. Sure, there are thousands of super motivated patients beating HIV down to the ground through healthy practices and antiretroviral medications. Absolutely. Even so, unfortunately, there are a whole lot of of other people who aren't. Especially when you get outside of the western hemisphere. And especially when you get inside of Africa.

If HIV would just disappear and never, ever, ever come back. . . .that would be good. And would save a lot of money.

#1 -- Mental illness.

Have you ever seen someone who has a genetic disease or birth defect that has caused them to have a distorted physical appearance? How about someone with a stroke whose face is flaccid on one side and whose speech sounds like they have a mouthful of sand? Your heart sinks a little. Because from what you see, their life has been profoundly affected. The key there is "what you can see."

That's what I hate about mental illness. It's slippery and elusive. It's dirty and cruel. It sucker punches twenty-one year old college whiz kids melting them into a pool of nonsensical voices. It drop kicks loving mothers rendering them frozen statues of fear, tears and pain. It turns even the very best people into marionettes on strings. . . snatching all control from them and handing it all over to a mind that skips like a broken record. All without being outwardly apparent. No tell-tale low set ears or downward slanting eye folds. No postured arm from neurologic deficits or dragging limp screaming stroke. Just odd behaviors and unexplained impulses.

Some people get a diagnosis and get treated. But my God. The incomprehensible number of people whose lives are ruined by mental illness--without even knowing what hit them--is horrible. Horrible and costly and devastating and. . . .yeah. Don't even know what else to say about that.


So . . . . that's my take on it. Mow these things down and there will be zero discussions about health care costs. For real. Sure, we'd still have to deal with tuberculosis and a few other things. But the mutinous money pit called health care as we know it now? It would be on a whole 'nother level.

Don't believe me? Read that list again. Then imagine a world without these barriers to contend with. And then. . . . you do the math.

Happy Thursday.

Check this out. . . . and tell me if this isn't costing us big health care dollars.

Wednesday, May 25, 2011

For colored girls. . .and so much more.

"Do you have any idea what it mean
to somebody like me to see you talking on that show? 
Do you?"

Okay. So here's a not-so-startling confession:  I'm feeling kind of melancholy today. Why you ask? Oh, I'm sorry--have you been under a rock, or better yet, on an I.C.U. rotation?  Uuuhhh, hello!  It was only the last day of the OPRAH WINFREY show.  Duhhh!

Dude. Deanna and I watched this together and bawled like we knew her personally. Man, oh man. It was not EVEN pretty.

I know, I know. At least one of you reading this has either a.) rolled your eyes so hard that they are now halfway down the block, b.) uttered aloud, "Please don't let this post be about Oprah," or c.) stopped reading this post altogether at the end of the last paragraph. But, hey.  What can I say, y'all? Oprah inspires me. For real.  (Oprah-haters, you can stop reading right here.)<-----

"Let your life be a mentor."

Remember when we were talking that day about a person's life serving to mentor others?  Surely this woman--this "colored girl" from Mississippi who went to a historically black college just like me--has mentored me for more than half of my life. Yes. Oprah Winfrey's life has absolutely served as one of my most cherished mentors.

Wrap your mind around that for a second. . . .especially those who aren't so keen on Oprah Winfrey. She was born in Mississippi in the 50's. Mississippi. In the 50's. As in, the worst place you could be during that time. As in the setting for "The Help." Ponder that for a moment. Now--can you even imagine what it has meant to people like me. . .yes, colored girls. . .to see her speaking with the sass of a sister, taking sometimes unpopular stands, all while holding the entire world's attention? Can you even begin to imagine how proud it makes me of who I am? You have to understand. . . .historically, that's been a struggle for my people. So for some, this thing is deeper than a day time television show with a cult following. I hope that makes sense.

I still remember the early Oprah shows when I was a high schooler, and then later when I was in college. As her show evolved into something more mature and responsible, so did I, and it wasn't until I really grew up that I really came to appreciate what this woman has done for so, so many people.

Especially me.

You think you know. But you have no idea.

Her example has made me want to live a more authentic life. Watching her has made me want to listen more carefully, react more thoughtfully, and live more intentionally. Even starting this blog came after adding it to my "vision board" -- an idea that I took directly from an episode of "The Oprah Winfrey Show." And the truth is . . .ever since I sat cross legged on my floor that evening cutting and pasting and scribbling my biggest, baddest dreams onto that board, something changed inside of me. My already good life started becoming my best life.

Today on her parting show she said that in the deepest parts of her soul she knew that every time she was on that show  that she was doing exactly what she was purposed to do. Like in some divine way she was aligning her energy and her dreams with a calling.  Some folks believe in callings and some don't--and that's cool.  I happen to be one that does.  That's one of the other reasons why I've admired Oprah Winfrey--she's one of the people that got me thinking about being deliberate about my dreams.  About striving to live and breathe and walk fully in my purpose.

I think my vision board helped me to move closer to that goal. It's especially helped me to try to set out to make a bold vision for what I will contribute to this world.  (And let me tell you. . .I have some whoppers on there!) I'm happy she gave me the idea to do it--I look at my vision board every single morning and every single night-- and feel recharged.

Vision compromised: I didn't get on your show, but hey, making 'O' mag was pretty damn cool.

I can't say that I've watched every single Oprah show for twenty-five years, but I have seen a whole bunch of them. I saw the one where she wheeled out the wagon with the fat. I watched that day when Tom Cruise did toe-touches on her yellow couch over his new boo, Katie Holmes.  I cried my eyes out when she introduced her half-sister to the world and even jumped up and down with the crowd on every single "favorite things" episode.  So, yeah. I've not seen them all, but I've seen my share for sure.

Might as well jump.

Of them all, my favorite moment ever in the history of watching Oprah was several years back when former child actress Tracey Gold appeared on her stage.  By no means was this one of the more popular episodes, in fact it probably flew under most peoples' radar. Either way, this was the moment that gave me that "ah hah moment" Oprah's always talking about.

Growing pains. For real.

Ms. Gold, once the golden child of the mega-hit "Growing Pains," was going through some real life growing pains of her own. As if coming on the show before to dish about her very difficult journey through anorexia nervosa weren't enough, this time she was on the show after she'd been arrested for a D.U.I. She'd had a few glasses of wine, drove onto the highway, and promptly rolled her SUV into an embankment nearly killing her entire family.   She was so, so ashamed of herself. I mean, of course she was. Putting your kids into the hospital due to being irresponsible? Um yeah. That's pretty heavy, man.


When the interview started, Tracey Gold was shaking like a leaf. I will never forget how dejected she looked. And don't get me wrong--she had messed up. Drinking and driving is an awful thing and there was no way to sugar coat that fact. But as I watched that episode. . . . I saw my own clay feet, remembering my own lapses in judgment when faced with similar situations through the years.

The shame seemed to suffocate her right there on that stage. But something about the way Oprah listened to her was. . . unforgettable. She didn't make excuses nor did she trivialize what Ms. Gold had done. But she didn't villain-ize her either. Instead she just listened and then admitted the many times that she, too, had had that "swimmy-in-the-head" feeling after that second glass of wine--and drove anyway.

Then, just as Tracey Gold seemed to be at her lowest point in that episode--where her expression looked as hauntingly pain-stricken as this mugshot from that evening's arrest. . . .

We all need redemption.

. . .Oprah Winfrey looked at her and said these words that I have told my patients, my learners, and many, many, many times myself:

"We are not our mistakes. We are our possibilities." 

This was, quite possibly, one of the best things I'd ever heard someone say.  I have that quote on my office door and wallpapered across my heart.  I ponder those words often, and think of them when dealing with Isaiah and Zachary,  and especially when caring for my patients at Grady Hospital.  See, the "ah hah" in those words was crystal clear -- they were words about redemption. Redemption, man.

That day, she needed redemption. Oprah has often needed redemption, too. . . as have many people she's spoken to over the years. So I guess what I'm saying is.  . . we've all needed redemption at one time or another. At least I know I have.

So, yeah.  I'm sad today because I feel like one of my most beloved mentors has just told me that she is moving far, far away even though she is saying over and over, "Oh, don't worry, you'll see me."

First day of kindergarten, 2010.

Last week it was the last day of kindergarten and Isaiah wept uncontrollably the whole way home.  He sobbed and sobbed telling me that he would really, really miss his teacher and also "just being a kindergartner."  No matter how many times I explained that "it would be different, yes, but better, you know?" this kid wasn't having it. Through breathless chest heaves he emphatically stated, "No, Mom. It won't be the same. Because we won't be in kindergarten any more."

Funny. I thought he was being a little dramatic that day, but now, I think I know how he feels. 

I told Isaiah that everything in life has a season and that the season for kindergarten was over.  I also told him that it was okay to be sad when a special season comes to an end.  He seemed to get that concept. After a good cry--and this is what he called it "a good-kind-of-cry, Mom"--he wiped is face and went back to playing and laughing and living.


I suspect that when it really sets in that the show has ended, I will have a good-kind-of-cry, too.  And then, I will quietly reflect on this very special season with this remarkable mentor whose very life has shown me what is possible for someone who looks like me and talks like me and dreams like me if I just give my best effort.  Perhaps, that might even lead to the "ugly cry"--a term I love that I also borrowed from this mentor. Kind of like that "ugly cry" I had while watching yesterday's episode. . .this part on the finale where the four-hundred plus previously underprivileged black men that she'd put through college quietly entered with candles filling an entire stage behind her. Quietly thanking her for sowing a seed into their lives. . . .literally. Men whose rich brown hues resembled those of my own sons . . .and the countless faces I see at Grady every single day.  Those faces represented hope and possibility. . .and I bet in those faces there was some redemption, too.


So. . . .to this mentor of mine who will probably never read these words. . . . I just want to say thank you.  Thank you for living your imperfect life in front of an entire world so that I could fold it into the blue print of my own life.  Thank you for helping me to create a bigger, clearer vision for myself, to savor every miracle, and to dream bigger even if it feels a little embarrassing sometimes. Most of all, thank you for letting your light shine in such a way that illuminates others and gives them the courage to do the same. . .and for reminding me that we are not our mistakes, we are our possibilities.

Yes, ma'am. I will follow you over to your new place. But, like Isaiah, I know in my heart that yes, this season has come to its end and no, it won't be the same.  I know it will be nice over there but, like Isaiah said, I won't be in kindergarten any more. . . . .

The last thing I told Isaiah after hugging and consoling him that day was to remember that his kindergarten teacher would always be his teacher. That makes me smile because right now I need to hear those words, too.

Say what you want about Oprah. Her success was no accident.

Yes, you will always be my teacher.

Thank you, Oprah Winfrey. It's been real. . . . for real. Now . . . if you'll excuse me, I think I will dry my eyes and go back to playing and laughing and living, too.

Happy Wednesday.

Now playing on my internal iPod. . . . . . .Beautiful.

Tuesday, May 24, 2011

Hair Raising Tales Part 3: The F.P.

*names and details changed although written with patient's permission.
The long (hair) good-bye.

The history behind the F.P. thing.

I have this little thing that I do on rounds each day. I've done it ever since I was an intern and how or why I started this ritual, I do not know. But I do it and I've done it going on fifteen years now. Every day I knight one of my patients as my "F.P." --shorthand for favorite patient.

When I first started doing this, I kept it to myself. On rounds, I'd simply place an asterisk in the upper right hand corner of the patient's tracking card--which meant that the patient was in the F.P. running. When rounds ended, I'd place the card of my F.P. on top. Again, why I did this? Eh. Beats me. I guess it just made the whole process of meeting and caring for folks a little more fun.

The other funny part about the F.P. thing is that there has never really been any kind of rhyme or reason to what deems someone F.P.-worthy. Sometimes it's something obvious like being wonderfully pleasant for no reason. Other times my F.P. might be delightfully wrapped in a cocoon of mild senile dementia interrupted by wisdom so crisp that if defies belief. And then there are the days where my F.P. is mindblowingly contrary and cantankerous, doing anything from kicking the whole team out of the room to tossing f-bombs around like confetti to refusing any and every therapeutic thing offered.Yep. Those folks challenge me so much that they're paradoxically endearing to me.

When I became an attending, I got a little more open about my F.P. ritual. So much so that by the midpoint of every ward month, members of my team often preface their patient presentations with this preamble: "This patient is totally going to be your F.P. today, Dr. M." By the end of the month, they are knighting their own F.P.s. And I just love it.

Which reminds me--I'll never forget the day that I hugged my student, Joelle, in the hallway as she cried over her patient who'd taken an unexpected turn for the worse. With a red nose and leaky eyes she sniffled quietly and said, "He was my F.P., Dr. Manning." Hearing that made me cry, too.

Every now and then, I meet a patient who is just so special that their F.P. status transcends a one day designation. These patients achieve a title that I developed somewhere during my senior year of residency--"F.P. All-Stars." I guess being an F.P. All-Star is like being in one of those airline platinum clubs where you immediately trump all others upon arrival. Work in a hospital long enough and you can form quite the collection of F.P.s. Not to mention F.P. All-Stars.


On Friday I was at the end of my solo rounds. I'd allowed the team to disperse after seeing our new admissions, especially since I knew the senior resident had already work rounded with the team on all of our pre-existing patients. At this point, I had been going around seeing the rest of our service of patients, reiterating the points that had already been made earlier that morning by the team. I love moments like this--they give me time to really connect with my patients in that way that I used to during internship. And enjoy my F.P.s even more. Especially ones like Mrs. Zebedee.

Mrs. Zebedee.

I'd intentionally saved Mrs. Zebedee for last. She was not only my F.P. on this day, but an F.P. All-Star. Even though she was pretty sick, seeing her was such a treat. Her attitude is always so calming and sure that it immediately washes me with a peace that is hard to explain. On this day, it wasn't terribly busy, so I'd carved out a little extra time at the end of my rounds just for enjoying her presence. I couldn't wait.

A fairly aggressive cancer was what had her hospitalized this time--the same one that caused our paths to meet in the past. The team had already told me that Mrs. Z. was doing okay today and that she was still tolerating her chemotherapy like a champ. My plan was to confirm this through a quick examination and a few questions then, depending upon how she was feeling, let her dictate what would happen next. A chat perhaps? A hand squeeze followed by a request to close her window shade? The ball was in her court. No daycare clock ticking or meetings looming over my head. This time was hers.

I approached her room, pausing to press down the sign hanging on the outside that had come partially untaped. It read "Neutropenic Precautions"--indicating that the chemo had wiped her white blood cells down to nearly nothing. This meant anyone with so much as a sniffle should steer clear of her and avoid bringing anything that could put her at risk of infection. After a soft rap on her door, I entered and just as predicted, was greeted with a big, warm smile.

"Hey, pretty lady," I greeted her.

"Hey, baby," she replied while sitting up in preparation for my examination.

I asked her my obligatory questions and searched her chest and back with my cold stethoscope. After a careful inspection of her skin for rashes or pressure ulcers and that ever intrusive abdominal examination, I recounted what she'd already heard from my resident and interns. She nodded in acknowledgment.

"You look good." I studied her smooth brown skin that didn't even have a hint of a wrinkle. Deep dimples sunk like valleys into her cheeks as she smiled in response to the compliment. Then she patted her covered head and then furrowed her brow.

"My hair," she said, pausing to clear her throat. "My hair is coming out."

I pulled a chair and sat down as close to her bed as I could. From the corner of my eye, I could see a picture of her beaming with those signature dimples and the thing she was most known for--her thick mane of jet black hair. As a hairstylist for many years, she was the master of doing the thing that every black woman has wanted at least once in their life--growing long hair. Hearing that she was officially losing hers immediately put a lump in my throat.

"How is it--I mean--are you. . .okay?" Great. That came out stupid sounding.

She slid her hand from her forehead, wiping off the satin bonnet that had been hiding her scalp. Instead of a clean ball of fuzz, I saw patchy areas of complete hair loss interspersed with islands of intact hair now clipped close to her scalp.

"I expected it to be different," she answered me while staring somewhere distant. "It's not. . . like I thought."

"What did you think?"

"I thought I'd feel more devastated. But surprisingly, I don't. It feels a little like a rebirth, you know? It's funny. Seems to bother everybody else more than it bothers me."

I narrowed my eyes and leaned forward. Propping my foot up on the edge of the bed, I rested my elbow on my knee and my chin in my palm. I wanted her to know that I wasn't in a hurry and that I was there to listen.

She went on. "I went ahead and clipped it on down. Once it started coming out, I figured I'd help it on along."

"Hmmm," I murmured not knowing what else to say. "How do you like it?" Right after saying that I immediately pressed my lips together out of fear that I'd said something stupid again, but she didn't seem bothered.

"Well," she said while cocking her head sideways to find her words, "I hadn't really ever had my head shaved before so I never knew what my head looked like. And you know what I'm thinking?"

"What's that?"

"I'm thinking my head is kinda cute." We both laughed as she struck a playful pose in her bed.

"You go, girl!"

"Girl, I woulda cut this mess off sooner if I'd known underneath all this I was Halle Berry!" She chuckled again, but this time more gentle. Her face became serious. "The hard part was yesterday. . ."

"What happened yesterday?"

"My daughter. She was trying to put my hair into a pony tail for me and every time she brushed it, a whole handful came out. I think it really upset her."

I thought about what she was saying and tried to imagine that exact scenario between my own mother and me. A quick wave of angst came over me as I found myself reminded of my own parents' mortality. "Did y'all. . .talk about it?" I asked. I didn't know what else to say.

She sighed hard and rubbed her head again. "Naaah. She wasn't ready."

"Has she seen you since you cut it down?"

"No. And I'm not going to even tell her unless she asks me to remove my bonnet. It's funny. Now this child's hair has been all the way to her tailbone one year and then fried, dyed and laid to the side another year and then she came home once with it buzzed down with clippers just like a boy--but me, her mama, has had the same hair for her whole life. I just think it was a lot."

"Wow," I whispered. When looked at from that perspective that sounded like a lot.

"When people love you, it becomes your reason for living. Like, before when I was younger? You know, I was worried about me. But now, I'm concerned about me because they love me and I love them. It wasn't like that when I was younger. 'Cause I didn't know love like I know it now, you know?"

I just sat there staring at her with these images swirling in my head:

Finally, I nodded my head and closed my eyes. "Yes, I do know." Because I did. I understood exactly what she meant.

"Don't get me wrong," she went on, "I care about myself and I want to get well for me, too. But, see, as you get older, if you're lucky everything you do is in the context of love. Everything."

I felt myself getting choked up so decided to stay silent. I took in her words carefully, scribbling notes in my head and across my heart for later.

She touched her head again slowly. "So, this hair? It didn't hurt me to lose it until I saw the look on my daughter's face. Now that? That hurt." She stared out of the window for a moment and I followed her eyes to the giant Coca Cola billboard with Atlanta traffic underneath. Eventually she sighed and looked back in my direction, shaking her head quickly and putting back on her signature dimpled smile.

"Everything you do is in the context of love," I repeated her wise words back to her. Staring skyward, I nodded slowly and let those words marinate. Then I added, "I like that. I will remember that."

Because I did like that. And I will remember that.

She reached out and squeezed my hand. "You are sweet," she said.

"And you are wise."

I hugged her and told her to get some rest. She hugged me back and said, "God bless you, baby. And all the doctors here at Grady." She hugged me like she meant it and she said that like she meant it, too. Because she did. I could tell.

"God bless you, too, Mrs. Z." I headed across the room toward the door.

She watched me walk past her bed and then said, "Love you."

I paused for a second, peered my head back inside and said, "You, too, Mrs. Z."

Because in that moment, that's exactly what I was feeling, too. And I felt lucky that I did.

"If you're lucky, everything you do is in the context of love."

~ Mrs. Zebedee

May we all be so lucky. And may your life be filled with your own collection of All-Stars, too.

Happy Tuesday.

Sunday, May 22, 2011

It's a beautiful day.

my little godson, jackson.

Last December my best friend, Lisa D., had a baby.  A sweet little baby boy with wide open eyes and kissable cheeks. And although she is nowhere near the first of my friends that I have witnessed enter the mommy-army, something about seeing her become a mother has been unusually endearing.

I still remember the day we met.  It was the first week of our first year of medical school and we had parked near each other in the parking garage.  She struck up a conversation with me on our way into class, introducing herself to me in her very Lisa way and even pointing out that, "Hey, we both have freckles!" We became fast friends, and eventually like sisters.

as freckle-faced medical students, Nashville 1994
Lisa has held my hand through just about every pivotal moment in my life since. From knee-buckling heartbreaks to our medical school graduation to the night Harry and I met all the way up to holding my bouquet as the honor attendant on my wedding day.

she did all the worrying for me on my wedding day.
good and pregnant as her honor attendant.
In those first few days when I first became a mother and sat cross legged on the floor weeping out of frustration from breastfeeding hiccups, she was the one who shrugged and said, "It's okay. You're already an amazing mother. No matter what happens with this breastfeeding thing, Isaiah is still the luckiest baby in the world. . . .so just relax, Kim. Relax and stop trying to be perfect."

I remember and appreciate those words to this very day.

Isaiah with his godmommy, Lisa

Last year when she told me in confidence that she was pregnant I thought I would explode.  I was sworn to secrecy but felt my heart growing with so much anticipation of seeing her become a mother that it was hard to contain.  I tucked a Mother's Day card into her purse last year when she was only a few weeks into the pregnancy, knowing that she'd scold me but not knowing where else to place my enthusiasm.

women can't be friends? ba-loney.

Not everything in life has come easy for my friend Lisa. But getting the motherhood thing? Honestly? It is the role she was born to play. Never have I seen a person make motherhood look more like a piece of cake. I mean it-- Lisa makes every aspect of it look effortless, kind of like stirring pudding batter or drinking water.  Not in that "I'm-the-perfect-mommy-and-I-make-all-of-my-baby's-organic-baby-food" annoying kind of way, either. But in a way that is quietly confident and self assured.  None of the awkward attempts (like I had) at getting her baby to latch on to her breast or those perpetually overwhelmed expressions (like I also had.) No frumpy post-partum-but-still-in-maternity-clothes appearances or hair that looks like a bird's nest. Nope, not her. Even going back to work for her was seamless and easy like Sunday morning.

And I have loved seeing it.  Every second of it.

I'll admit that part of it for me has been selfish. The shared joy of motherhood between us is something I'd looked forward to for years.  And now that it is here? It's a beautiful day.


 So today, I am reflecting on the joy of real true friendships. My friendship with Lisa has not been a perfect one--we'd both tell you that. But I can't imagine my life without her in it. So even when we have misunderstandings or growing pains, we've never stopped holding hands. I guess that's what real friendships are about.

more super-mom

So with that in mind, I'm also reflecting on how happy it has made me to personally witness the evolution of a true friend entering a new phase of life. I'm thinking about how it feels to see someone I love so dearly winning.  Because Lisa is winning. Winning at the mommy thing, winning at the life-change thing, and just winning in general.  Which means that, as a person who loves and cares about her, I am winning, too.

never fear. super-mom is here.

You see, friends root for friends. Whether they are winning or losing, they root for each other. They bring snacks after games and clean up boo-boos and say, "You'll get 'em next time." They pat you on the back and nudge you to get back into the game when you'd prefer to hang your head on the sidelines.


They also scream until they're hoarse and wave a big foam #1 finger just for you because you are their home team.  And that's what I'm doing today.  I am standing on the bleachers. Squeezing an air horn. Hollering, "Go! Go! Go! Go!" on behalf of my best friend as she sprints out of the mommy-race blocks.  And she's out in front, man. She's like Flo-Jo leaping over the hurdles with her hair flying behind her, looking beautiful and gazelle-like. And me? I'm head-to-to in best-friend paraphernalia, cheering for her and rooting for her, just as she has done for me over and over and over again.

almost famous super-friends

famous super-friends

Last summer Lisa met Gayle King--as in Oprah Winfrey's bff, Gayle King.  In her very Lisa way, she marched right up to Gayle and introduced herself, sharing details with Ms. King of her own best friend--me.  She went on to tell her that she was "my Gayle."  Ha.  If only she knew how many times she'd been my Oprah.

I hope you are rooting for someone.  And even more? I hope that someone special and necessary has been holding your hand and rooting for you, too.

Happy Sunday. It's a beautiful day.

Friday, May 20, 2011


"There's a time to laugh, 
a time to cry
a time to live and a time to die
a time to break and a time to chill
to act civilized and act real ill. . . "

~ Rapper's Delight

*Just a friendly reminder from a very serious medical professional that failure to lighten up can be hazardous to your health. For real.

Happy Friday.

This is Grady.

  *shared with their permission
Tell me you've seen anything cuter so I can tell you you're lying.

"Lawd I only know
What I know
The passing years will show
You kept my love so young
So new.

And time after time

You'll hear me say that I'm
So lucky
So lucky
to be loving you."

~ Dinah Washington's Time After Time

Today at Grady, I saw this lovely couple who--just last Saturday--had celebrated their sixty-first wedding anniversary. . . .

Me:  "Sixty-one years! Wow! That's amazing."

Him:  "Shooooot. Who you tellin'? These days folks act like they can't even stand to be together for sixty-one minutes."

Her:  "Sixty-one SECONDS."


Me:  "Alright. I've only been married for seven years and sixty-one seconds. So tell me--what's the secret to staying married for sixty-one years?"

Both smile real sweet and turn their faces toward each other. Kind of like they needed to pow wow on an answer before giving one. Husband keeps looking at wife and smiles. She blushes a little bit.

Him:  "I guess you jest need to love each other."

Her (still looking at Him):  "And forgive each other."

Him:  "Loving each other IS forgiving each other."

Her:  Says nothing, but looks at him so lovingly that it explains exactly why they have been married for sixty-odd years. 

Loving each other is forgiving each other? Whew. That's a good word, man.

See? This is what goes down at Grady Hospital, man. This. More than the gunshots and the car wrecks they mention on the news. We do those well, yes. But love and wisdom and heart? Yeah man, just like traumas, we get that here, too.  Every single day.

This is Grady.

Nope,  it's not what we're famous for. . . .but it should be.

Happy Friday, y'all. (And happy belated anniversary, Mr. and Mrs. H.!) 

If you don't know anything about Dinah Washington, know this: 
Her voice is like butta, do you hear me? Butta. Please get to know her.
Ella and Billie? I love y'all. Lord knows I do. But that Dinah? Now that's my girl. She is THE TRUTH.

 Oh yeah. . . and if after this, if you have a minute? Read this post with a link to my favorite Dinah song EVER.

Thursday, May 19, 2011

Thursday Top Ten: Boy, oh boy!

This just in:

TOP TEN WAYS to know fo' sho' 
that you live in a house with little boys:


You know exactly what the following things are:

Ben 10, Bakugan, Clone Wars, Lego Hero Factory, Super Mario Brothers and Beyblades.


Despite using an entire bottle of Fabuloso and almost all of the big jug of Clorox in your bathroom you swear you still smell pee near and around your toilet bowl exactly five minutes after you finish. And, on some days? You think you smell pee for the rest of the day.


You are willing to go to parks that don't have public restrooms. (As long as they have plenty of foliage.)


You launder a minimum of two costumes with every load you place into your washing machine irrespective of Halloween's proximity.


One of your brassieres was used as an aviator helmet this week, and in your purse next to your MAC lip gloss you have at least one of the following:

a Lego, a Matchbox car, a Nintendo DS, or an action figure of any sort.

Bonus points if you drive a volvo, an SUV or a minivan and there are cleats and soccer balls in the back.


Potty training involved aiming at a Cheerio or an M&M.


You know the difference between all the different Batmans and all of the different Spidermans. (Yes, I meant to say "mans" and not "men.")


You are a princess that gets rescued at least seven times per week from dastardly villains. (Especially if you tricked them into seeing "Tangled" by saying that it was about ninjas tangled up in the jungle instead of being all about Rapunzel.)


You finally accept that even if though you have a "no gun play or sword play" rule in your house that any and every household item is fair game for becoming a machete, a machine gun, or bazooka at any given moment. This includes, but is not limited to, paper towel holders, toilet paper rolls, wire hangers, shoes, hairbrushes, blow dryers, and empty juice boxes. Oh yeah, and bananas, too.


You reflexively let the toilet seat down every where you go. And feel convinced that you still smell pee.

Bonus one:

You've been asked at least once what happened to your. . . . . uuhhh. . . .on second thought, let's stop at ten. Heh.

Happy Thursday.

Yes, your toilet aim is questionable but I love you just the same.

Wednesday, May 18, 2011

Oh no, I said too much.

"Every whisper. . .
Of every waking hour I'm
Choosing my confessions
Trying to keep an eye on you
Like a hurt lost and blinded fool, fool

Oh no, I've said too much. . ."

~ from R.E.M. "Losing My Religion"

Sometimes patients ask you things that catch you off guard. Things like, "Hey, what race are you?" or even funny ones like, "When's the baby comin'?" when you aren't even pregnant. And sure. Those questions can be both perplexing and amusing at times -- which reminds me-- why is it that only black folks ask (black) me "what are you?" or even why is it that the very day you feel your most sleek and trim post-pregnancy just happens to be the day that some patient winks at you in the elevator and says, "Is it a boy?"

Um, yeah.

But those questions? Those questions are easy. Here's a question that can be a hard one:

"Do you believe in God?"

Or more specifically if you work at a place like Grady Hospital:

"Do you believe in Jesus?"
Now here's the thing: even for folks that have a very clear answer in their head to that question, it isn't necessarily an easy one. It steps into a fuzzy place that sometimes doctors get squirmy in with their patients. That personal space place. That inner thoughts and feelings place. And for some, that flat out none-of-your-business place.


Today I'm reflecting on this because yesterday I was leading a session with my second year small group students and the topic was "Spirituality and Medicine." Our discussion started off simple enough and then evolved to this one where we got into a very interesting dialogue about how one responds to patients asking questions about your religious beliefs (or lack thereof.)

The students had some interesting perspectives. They represent many different beliefs on a myriad of intensities, so I was keen on hearing their thoughts. One person asked if the best thing to do was to "just tell the person what they want to hear." Another was firmly against that. Some offered thoughtful examples of how they could navigate respecting where the patient was and protecting their own privacy. A few weren't sure what they'd do. And eventually, they asked me what I thought.

members of "Small Group Beta"

Okay. So, I think I am fairly transparent on this blog, or at least I try to be. Most have probably gathered that I am of Christian faith and wouldn't be surprised when I describe myself as observant. Nope, I'm not fire and brimstone. Nope, I don't have flaming stones to sling from my purse or hateful, disgusted stares for boys who hold hands with boys. Nope. I generally stay in my lane when it comes to judging since the whole judging thing is not my lane. I tend to focus more on that whole "love everybody" thing that Jesus was so into.


I don't pretend to be anyone other than who I just described and have what I like to refer to as a "personal relationship" with God. I pray regularly. Some days more than others. And fortunately, since my relationship with God is personal and we know each other so well, my guess is that He's cool with that. Some people fall into this "personal relationship" category, too, but their relationship with a higher power is so personal that chatting them up about it is like asking them about their weight. A major no no.

Though that isn't usually where I am, I do sometimes wince a teeny bit when the topic comes up. Sometimes it's because I am accompanied by someone else. Other times it's because I fear it will take me somewhere I am not sure I want to go with a patient. So, to answer their question, I tell them something that I heard a resident once say on rounds when asked those very questions:

"May I ask a question of you? Can you tell me why it is that you'd be interested in knowing that about me?"

It was one of the most kind replies to such a question that I'd ever heard. This came out of the mouth of a second year resident, too. He softened his eyes and his voice and respectfully countered with this beautiful response. And I meant to say "beautiful" because it was just that.

This resident happened to not be of Christian faith at all. But the answer the patient gave was so endearing. She simply said, "I want to know because I really like you. I want to know that your soul is saved, so that I can be praying for you if it's not."

And he replied, "I always appreciate prayers."

And she simply smiled back and nodded.
I have used a version of this ever since. One patient answered me by saying, "I want to make sure that the doctors caring for me are believers and that they don't think they God!"

I was with my entire ward team that day, and through this insight was able to answer accordingly.

"Ma'am, to be honest, I am of Christian faith. But more important, I certainly do not think that I am God. I also work with a number of wonderful doctors and students--some of whom are of Christian faith and some of whom are not--and I feel sure that they don't think of themselves as God or all powerful either. We just try our best to do right by you and give you our very best effort. That's something you should want all of your doctors to have in common."

And that answer feels good to me because it doesn't exclude or disrespect the scores of colleagues I have that have different beliefs than my own. Particularly when they are present when I'm asked.
Now. I'd be dishonest if I told you that there hadn't been many a time that I'd joined a patient in prayer or agreed to pray for them. In fact, I've closed my eyes and prayed for a patient right then and there at their bedside before. This has depended upon a lot of factors. The relationship I had with the patient, the urgency of the situation, and of course, the wishes of the patient. Other times, those prayers have been uttered quietly at chart boxes or in stairwells. . . oft times the nearest place I can privately reach to interlace my own beliefs with what I can do medically.

I am not sure these answers are the right answers. In fact, somebody reading this is probably saying that they aren't even close to the right answers. I don't know. But here's what I do know: Medicine is about a whole lot more than medicine. And regardless of what you believe or don't believe. . .it involves having some faith. Sometimes in you. Sometimes in your doctors. And sometimes, if that's your thing, in something altogether different.
Anyways. That's all I've got today. Happy Wednesday.

Now playing on my mental iPod. . . . .

Losing my religion by REM