Wednesday, May 9, 2012

Please and thank you.

For the most part, I've always been a "please" and "thank you" kind of girl. I have my mother to thank for that. She has always been the kind of person who is gracious with people---but especially strangers. Got on a badge in the grocery store? Mom will greet you by your name and thank you by the same. And if she wants something from you or needs you to handle something for her, you can at least count on a nice ice-breaker about how you are before she jumps right into it.

With this upbringing under my belt, I blended perfectly with one of the very first senior residents I had assigned to me during my internship. His name was Antoine and he was probably one of the kindest, most polite people I'd ever met. It astounded me to see him interact with people. Everyone from the head nurse to the man pushing the wastebasket in the hallway had his full attention. I loved that about him. He called each and every one of them by their name and, when he didn't know it, would make a point to learn it. There was something so mindful about the way he treated people in the hospital. They all seemed to have his respect which I quickly learned was a very effective way for him to get theirs.

But of all the things I watched Antoine do, there was one thing that always stuck with me. Every single time he wrote an order in the chart (this was before everything was electronic) he always started it with "please" and then, just before his signature, he would write those two words I've heard my mother say a million times "thank you."

Now, to you, this may not seem so odd. But trust me--in a hospital chart it was quite unusual. No matter how small the order, without fail, he always had those signature words flanking the request.

Please discontinue Foley catheter.

Thank you, 

Antoine R., M.D.



1. Advance to regular low sodium diet.
2. Give patient 2mg Morphine Sulfate now and then q4 hours as needed for pain.
3. Offer pain medication q4 hours. 
4. Arrange for Physical Therapy consult.

Thank you,

Antoine R., M.D.

Since this was my first senior resident, of course he became a very important role model for me. Which reminds me -- always take your role as a supervisor (particularly one that is early in someone's training) very, very seriously. Your good--and bad--habits live on through them.


Following Antoine's lead, I did the same thing. On every single order I wrote, I added that simple start and closed with that signature gesture of gratitude. And just like it did for my senior resident, it strengthened my relationships with the nursing staff and ancillary teams. Especially when combined with my mother's early example.

Please and thank you. Simple enough, right?

This brings me to a something that happened to me just a few weeks before I moved to Atlanta. I'm not sure what got me reflecting on it, but it remains one of the best things that has ever happened to me so I thought I'd share.

The Please and Thank You Doctor

I still remember one of the first times that I ever called the hospital operators. Announcing myself as "Dr. Draper" still sounded funny. Especially since it wasn't preceded by the word "student." Though I don't remember exactly what the call was for, I do remember how surreal it still felt to be a doctor. Entrenched in habit, I am certain that once I got over being a full-fledged physician, that it went something like this:

"Thank you for calling MetroHealth Medical Center where your health is our primary care! This is Operator Margaret. How may I be of assistance to you this morning?"

"Good morning, Margaret. This is . . .uh. . .Dr. Draper. You doing okay today?"

"Uhhh. . . I'm well, thank you. How may I direct your call, Dr. Draper?"

Very early on I recognized that this follow up question -- "how are you?" or rather "you doing okay?" invariably caught people off guard. Particularly over the phone.

Kind of like Antoine signing his orders with "thank you."

Anyways. That response -- a pause followed by what I am certain was a smile through the phone -- always warmed my heart. That's when I moved that practice from just "habit" to something more deliberate. I made a decision to add a tiny ray of sunshine to any operator, desk clerk, or lab tech I spoke to over the phone.

So those early nervous exchanges soon evolved to this:

"Thank you for calling MetroHealth Medical Center where your health is our primary care! This is Operator Drema. How may I direct your call this afternoon?"

"Operator Drema! This is Dr. Draper. How are you enjoying the lake effect snow this week?"

"Awww, hey Dr. Draper! What's with this snow? It's April!"

"I know! I left a message for the mayor of Cleveland and told him that Canada called. They want their weather back."

And invariably that operator would chuckle and then professionally move right into the point of the call. Over time, I came to "know" nearly every single operator. So much so that on the very rare instances that I heard an unusual name, voice or accent I would introduce myself. And even welcome them.

It was kind of like Mommy in the grocery store. On steroids.

I was at Metro for five full years. Four as a resident and one more as a chief resident. This meant that I got to know and greet a whole bunch of operators over those years. By the end of my time there, those salutations were easy and familiar. This was very interesting considering in all of that time I never once saw a single one of them face to face.

I used to have thoughts of marching down into the basement to greet them all in person. But after three years or so I had created this entire idea in my head of what they all looked like. The woman with the throaty, deep voice was a snappily dressed transgendered person. The man with the super deep voice looked like Barry White. The operator with the squeaky voice was four foot eleven and had hands tinier than those of a toddler. She even needed her head gear specially fitted since she was so small. I imagined what race they were, what kind of make up they wore and even came up with visions of sparkling gold teeth for one of them. So this stopped me from destroying my imagery by going down there.

Goofy, I know. But residency is hard so you have to amuse yourself however you can.

My final weeks at Metro were spent attending on the wards. Even though I was a chief resident, back then we were credentialed as junior faculty members. This meant that we not only got to do some formal teaching on the wards as attendings, we also "got to" fill in holes for faculty who couldn't fulfill their duties for whatever reason. I was given the great fortune of being the finger in the dyke for a senior faculty member who'd decided on a last minute sabbatical.

Even though he was on wards.

Uh, yeah. This kind of stunk since my last day was June 24 but this time frame I had to step in for was from June 1 - 15.  Yes. I loved working on the wards. But not up to the last week before I was trying to move from one state to another.

June can be a tricky time because it is the last month of the academic calendar. What does that mean? It means that working that month can be either a gift or a curse. On the gift end, your residents and interns are seasoned and independent thinkers and workers. Your teaching focus can be more on patient care and medical knowledge than just logistics of how to get things done or worrying about errors. Kind of like working a shift on a job with a veteran worker versus the guy or gal that's still in trainee mode.

So yeah. June can be totally awesome for that reason, but conversely, it can absolutely suck dish rags for the very same reasons. Sometimes by June the interns know (or think they know) just as much as some of their residents. The dynamic becomes bumpy and uncomfortable. The interns feel micromanaged and the residents feel frustrated. There's also the risk that the resident already has a job and has mentally checked out of residency. They give the interns carte blanche to do whatever they want while then veg out in call rooms on twice fluffed pillows. Even if all hell is breaking loose.

This particular June was mostly a curse. The team didn't fully gel and the service was busy. On top of that, I was no better than they were. My mind was halfway to Atlanta already and my feet were ready to be inside of Grady Hospital. My patience was short with my resident at times and also the petty arguments he constantly got in with the interns. Back then, all interns got the final week of internship off as an unpaid (though super-welcomed) vacation. So even they were out to lunch in that final week with me.

It was painful.

Despite all of this, we slugged it out and took good care of our patients. The days were long and this was before duty hours reform so by long I mean waaaaay more than the current 16 hour maximum. Call days morphed into post call days that lasted 36+ hours. And even though I wasn't the one who had to sleep there all night, I was the one responsible.

And seeing as I was almost getting ready to LEAVE for GOOD, seriously? I just wasn't in the mood for all or any of this.

So I'm not sure of the exact day, but late in the afternoon on what I believe was two days or so before I was to finish my two-week stint I got paged to the floor. What I distinctly remember is that I was all the way down in the Radiology department with one of the medical students. I'd gotten tired of waiting for someone to transport our patient to the CT scanner so, with the help of the student, we had just wheeled our patient down there on our own.

Since I was pushing this ginormous bed through the hall way, it took a moment for me to reply to the page (which back then were only numerical). Subsequently, the person calling paged me two more times in a row.


I get to the nearest phone and call to see what's going on.

"Dr. Draper? I'm sorry to keep paging. This is Mrs. Tift."

"Mrs. Tift? Hey, there, I'm sorry to take so long. We were transporting our patient to CT. Is everything up there okay?"

"Oh yes, Dr. Draper. I was just calling you because we need you to come back up here soon as you finish. Someone left something up here for you."

And since I was in wards-mode, I immediately thought it was something that would add to my work. Or my headaches.

"What is it, Mrs. T? Should I be worried? Should I run up right now?"

"It's not a medical emergency. Just come on up when you finish."

"Can I send one of the interns right now? They're both on the floor."

Mrs. Tift spoke back in her impossible-to-read, stoic voice, "No, Dr. Draper. This requires the attention of the attending physician."

Now. Let me just say that I'm the kind of person who doesn't do well with things like this. Like, when someone says, "Hey, I have something to tell you later" that never works for me. I worry. I fret. And then I press them until they tell me right then and there.

Yeah. So don't do that to me.

So, of course, I speed up the transport process with my trusty med stud and safely get our patient into the CT suite to wait in queue for an image. You'd think I would have strolled back to the ward after that, but being the nosy and worry-warty person that I am, I pretty much jogged. Which made my unfortunate medical student feel a need to do the same.

I got a few more pages on the way back. Both were about patient-related things that, really, my resident should have been handling. My shoulders felt tired and my head felt pulsatile. I was tired. I was overwhelmed.

I was ready to go. Away. To my new job. And my new life. Not because I didn't love my training there. But more because I felt like my season there was over and mentally I was ready for the next one.

Kind of like getting lake-effect snow in the middle of April when you're ready for spring to be sprung.

We trotted to the elevator and finally got to the ward. I walked briskly to the nurses' station where Mrs. Tift was and approached her. Anyone nearby could see the urgency in my body language and, I'm sure, the tired in my eyes.

"Hey Mrs. Tift. You said there was something that needed my attention?"

And stoic Mrs. Tift looked me square in my eye and smiled so big and wide it almost scared me. She held her right hand out and gestured to something--then she nodded and smiled some more.

I looked around to see what she was talking about. I scanned the area for a stack of papers needing my signature or better yet, a long, lost stethoscope from my internship. Seeing neither, I swung my head back to her and looked puzzled.

"You don't see that, Dr. Draper?"  She let out her signature raspy laugh. "That has your name on it."

And since I still looked confused, Mrs. Tift put her hand on what she was referring to and pushed it toward me on the counter. And this is what it was:

It was an absolutely spectacular bouquet of long-stemmed pink roses. Beautifully arranged in a vase with a card peeking out of the top.

"Looks like you have an admirer, Dr. Draper!"  Mrs. Tift winked at me and had no qualms about standing right there to check my reaction as a marker of from whom they came.

"Roses? Who in the world would send me roses?" I asked. And I was serious. My romantic life in Cleveland was non-existent. So I had no idea who they were from. In fact, I felt kind of scared to even open the envelope.

"Not just roses," a senior nurse named Mrs. Vogel chimed in, "TWO DOZEN of them. You go, girl!"  And slowly but surely, the nurses started gathering near me to get the scoop on my suitor.

Problem was, there wasn't one.

So finally I rip open the envelope and read the card inside. And by the time I got to the end of the very short note, it was as if someone had punched me in the chest and knocked all of the wind out of me. Then, like someone flicking on a sprinkler, I began to weep. A deep, hard, tired weep.

The nurses and staff all looked worried. Mrs. Tift came around the counter and put her arms around me. And I turned my head into her bosom and just wept and wept. She patted my head and back and asked if I was okay. I nodded hard but couldn't stop crying.

Nurse Vogel came to my side and finally asked what everyone was surely wondering. "What was it, Dr. Draper? Is everything okay, honey?"

In response, I looked up from Mrs. Tift's safe embrace and handed Nurse Vogel that card. She read it and immediately covered her mouth. Tears welled in her eyes, too. Nurse Vogel had known me since my very first days as an intern, so I trusted her to see that card. And also to read it out loud which is what she took it upon herself to do.

To the "Please and Thank You" doctor with gratitude. Thank you for always taking the time to be kind. Please don't ever stop. Wishing you the best in your future endeavors.


The MetroHealth Hospital Operators

And that card had the signatures of every single one of them. Drema. Irma. Margaret. Charles. Vera. Amanda. All of them.

It remains one of the proudest and most moving moments of my entire life. In fact, just writing about it has me reliving it and bawling all over again.

Before I went home, I took the elevator to the basement. I asked two people how to get to the operators' suite and finally found that vacuous room where they all worked for all those years. I walked right in with that giant bouquet of flowers and thanked each and every one that was there. I hugged their necks and thanked them right back for taking all of my calls for the past five years and for always making me feel like I wasn't a burden.

And, of course, they said, "You weren't."

And you know? The Barry White man was a tall, thin Caucasian man. The tiny-voice lady was taller than me and quite big-boned. The throaty, deep-voiced person was just a lady with a throaty, deep voice. And no, not a single person had gleaming gold teeth. So that imagery was dead for good. But that's okay because the reality was so much better.


The point of this story? Hmmm. I'm not sure I have one. But telling it sure did my heart good.

Now. Please . . .pardon me for such a long post. I didn't mean for it to be--I really didn't. And listen. . .thank you. . . seriously, thank you for taking the time to read here. I mean that.


Kimberly M.

Happy Tuesday.

And here's one of my favorite random acts of kindness. . . . .


  1. Warn me, Sister. WARN ME!!! Grrr. I'm at work & somebody walked in here and asked if I was okay! LOL!!!

    Love, love, LOVE this one :)


  2. I cried when I read this post. It really touched me. Thank you!

  3. It's always the being nice that gets me and makes me cry. sniff, sniff.

  4. Seriously, could've used a warning too. Beautiful. Even if it makes me cry.

  5. This actually and really did bring tears to my eyes. I think that if we have one purpose here on this earth, it is to recognize each other as fellow humans.
    I have been trying for quite awhile now not to pretend that the check-out girl or the bag boy is just a...tool? That they are real people, as real as me and yes, they are working but when they say, "How are you today?" as they have been trained to do, I look squarely into their faces and say, "I'm fine. And how are you?" And I mean it. I want to know. How ARE they? Many are taken aback. "Thank you for asking," is something I hear a lot.
    We start with recognition and courtesy and we go on to respect and acknowledgement. And then we can open our hearts to others and they open their hearts to us.
    I'm sorry for the long comment. I am in a state today.
    And how are YOU?

  6. Please keep telling your stories.
    You gave me the weepies.
    Thank you.

    I was raised to be kind too, and it's the small gestures of kindness that can make me cry, but in a good way, on a bad day.


  7. such a touching story- and the thing is, please and thank you gets you so far, especially in the craziness of a hospital. thank you for sharing.

  8. You have me crying too. The small things matter a lot. Thanks for the reminder.

  9. I'd just read a sad post and really needed to close the computer, but I saw that you had a new post and thought "I'll just go by the Grady Doctor's and say Hi."

    Yes, it was a long post, but worth the read.

    You warm my heart. Thank you, Dear One. x0 N2

  10. This is a beautiful illustration of the deep essence of politeness, which isn't about formality and exclusion but making space in which
    another person can be genuinely acknowledged. What a different society we'd live in if such civility were the norm rather than the exception. Lovely.

  11. Wow.

    Maria, fellow Meharrian

  12. Seriously had me crying too! I love these stories:-) My mama taught me as well, to always be polite and that advice has served me well over the years. Hopefully, I am instilling the same into my own children.

  13. From the Deck of the Poop,
    Well, you know that ole PoopDeck was ragged early-on in the post. As Ames said "The small things matter a lot".
    When I was in B'ham back in January I stop by to visit the mother of my very dear friend, line brother, high school classmate... who passed a few years ago. He was her only child and she still refers to him as her baby.
    When I was leaving, she said "call me sometimes Tony."
    For some reason, I guess with Mother's Day approaching, I decided to call her. She was totally not expecting the call and the joy that she displayed was unbelievable. I think that I am her link of sorts to her baby.. she laughed and cried.
    It was a small thing but it mattered greatly to me and her.
    Small things matter!!!!


  14. I'm deep south raised, so I grew up saying please and thank you.

    So when my daughter hit middle school, and started to develop a 'tude, I decided to take a different and less physical approach to treating this problem than my mother did.

    I started saying please and thank you to her regularly as in "will you please clean the litter box", ect, and I'm convinced that taking this approach is the main reason she's a 15 year old with FAR less attitude than the average 15 year old girl.

    Please and thank you go a long way, especially at home.

  15. "Thank you" for being such an awesome writer. "Thank you" for always sharing such beautiful stores. "Thank you" for always uplifting me in some way. I always know that I am going to get something special when I come here to read. "Please" don't ever stop writing. You have such wonderful gifts and talents that you continue to share with your patients and the rest of the world. I really appreciate this space you have here.

  16. I admit I catch myself in forgetting to say thank you and often correct that wrong before the exchange has passed. So let me take this opportunity to ask you to please continue writing and thank you for sharing your wisdom with us.

  17. Beautifully written.
    Thank you, Kimberly.

  18. I always read but rarely comment. This made me bawl!!! You are a very talented writer. I felt like I was there with you through all of it.
    - Bridgette

  19. Thank you. Thank you. Thank you. I am crying right along with you. You are an inspiration.

  20. What a beautiful post. A wise person told me once to "pay attention to the invisible people"... you know, like the waitress who takes your order, or the cashier at Target, or the hospital operators. You have mastered that art and it comes back to you a hundredfold. It still makes me tear up to read this and I've read it several times!

  21. Well dang. **stops typing to wipe tears aways** Thank you for sharing and please don't stop.


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

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