Tuesday, July 17, 2012

I'm here.

Got my house
It still keeps the cold out

Got my chair
When my body can't hold out

Got my hands doin' things like they s'posed to
Showing my heart to the folks that I'm close to

I got my eyes though they don't see as far now
They see more 'bout how things really are now

And I'm thankful for each day that I'm given
Both the easy and the hard ones I'm liven'

But most of all

Yes, I'm thankful for lovin' 
who I really am. . .

I'm beautiful
Yes, I'm beautiful

And I'm here.

~ "I'm Here" from The Color Purple 


I saw a lady recently whose chart wasn't making sense. Kept all of her appointments but wasn't following through on the plans her doctors gave her.

"That's weird, don't you think?" I said to the resident caring for her. "Doesn't make sense to come to the doctor but not do what the doctor tells you to do."

"It is kind of weird." My resident squinted one eye and thought for a bit then shrugged. "I'm not sure if she has some. . .I don't know. . .cognitive issues. I give her clear instructions and, I kid you not, when I see her again it's like it never happened. It's crazy."

"Who does she live with?"

"Her daughter. . . I think. . . hmmm." She tapped her finger on her lip. "I don't really remember. I know her daughter is very involved. She usually comes with her to the visits but isn't here today."

I nodded my head. Okay. That gesture meant that I'd heard enough and wanted to talk to the patient for myself.

We knocked on the door and entered the room. I had just put hand sanitizer on my hands and rubbed them vigorously together in preparation to shake her hand.

"Good afternoon, Ms. Jane. I'm Dr. Manning and I'm the senior doctor working with your doctor today."

"Hi Miss Manning," she replied with a big smile. I returned the gesture because for whatever reason I find the "miss" instead of "doctor" thing more endearing than offensive.

I sat on a chair and repeated several of the points her doctor had already spoken to her about. We chatted about her diabetes and how concerned we were about her taking the insulin the wrong way. Next we talked about the anti-platelet medicine called Plavix that she was still supposed to be taking but had stopped. Lastly we sorted out the blood pressure medication and reaffirmed that it was good that she was taking the cholesterol pill at night like it was prescribed.

She was very engaged and followed every word. So earnest and focused. So respectful and invested. So why were the plans unraveling every time? This didn't make sense.

"I hear your daughter is normally here with you? I'm sorry I didn't get to meet her."

"She got a different job that don't let her off so easy," she said. "She normally like to come but haven't been to my last few doctor 'perntments because-a her job."

"Do you live with her?" I appreciated that natural segue.

"No ma'am. But she do see about me."

I nodded my head. What came next should be predictable to you at this point if you know me or you've been reading here for a while. Yep. I started exploring the story. Her story.

"Ms. Jane? Where'd you grow up?"

"I grew up in Alabama. In the country."

"Is that where school was for you?"

My resident watched, knowing this line of questioning well. Her facial expression said it all--Here we go with Dr. Manning's line of literacy questions. 

"Yes, ma'am."

"What grade did you make it to?" I continued.

"I made to the tenth. But tha's when school only went to the tenth so I finished."

My resident looked at me and somewhere in her eyes I saw a tiny flicker of triumph.Or perhaps relief that her attending hadn't just uncovered literacy as the reason for nonadherance to the medical plan.

"What kind of work did you used to do?" I recalled that the resident had told me she was retired.

"Housekeeping and such. But I been retired a long time."

I nodded again. Then I just sat there in silence thinking of what to say next. Polite Ms. Jane waited patiently for me to find the next question.

"Ms. Jane? Do you ever. . . like. . .does it ever get kind of confusing to you to keep track of all your medicines and directions from us?"

That question caught her off guard. Her eyebrows raised. "Beg pardon?"

"You make the appointments but some parts . . . I mean. . .it seems like maybe it was hard to keep track of."

Ms. Jane just watched me for a moment, studying my face to see where I was coming from. She carefully answered me.

"Sometime. Sometime if my daughter not there it's kind of hard."

"What does your daughter help with?"

"She help with telling me what I'm s'posed to be doing and what all y'all want me to do. She good with all that stuff."

"Ms. Jane? What about when we mail things to you or give you papers to read? Do you feel comfortable with looking over that stuff if your daughter is at work?"

Again she hesitated. Then finally she spoke. "Sometimes. . . .no."

"Does your daughter realize that? I mean. . .that like. . .if she isn't there that you might have some trouble with the papers?" I chose my words carefully.

"Do she realize? Realize that. . . what? You mean. . . . " She froze and then readjusted herself in her seat. That was enough to stop her from finishing her sentence.

Letting go of our eye contact I looked down at a piece of paper in front of me and spoke while doodling with a nearby ink pen. "Sometimes, Ms. Jane. . .even when you went all the way through school, it's some stuff you didn't get. And that's okay, you know? Because nobody knows everything perfect." I looked up again and reestablished our gaze.

This was cryptic, I knew it was. But I was trying my hardest not to come right out and ask. But Ms. Jane had my number and understood where I was going. Her eyes began to fill with tears.

"Ms. Jane?" I said her name again to hold her attention. "There's some stuff I didn't learn well in medical school. I think to myself. . .  sometimes . . . .if people knew the things I wasn't so sure about they might laugh at me, you know? Then I just tell myself that it's okay to not be sure about everything. It's always good to keep learning."

The tears began to spill onto her cheeks and she wiped them quickly. She placed her hands into her lap and began to wring them nervously. "One time," she started and then stopped. She took a deep breath and went on. "One time, my daughter was at her new job and I got a paper from Grady. I know the Grady red sign so knew it was from y'all. I took it next door to my neighbor and asked her to help me. I told her I couldn't see it without my readers and could she read it for me." Then she began to weep. Hard.

I handed her the tissue passed to me by the resident and waited for her to finish.

"My neighbor--she so nice--she turned around and came back with a pair of readers. 'I got a spare,' she said. And she gave me her readers and closed the door. And I was jest standing there with them readers and them papers not knowing what to do." Her face twisted up in this complex mixture of shame and relief. It was like we'd rubbed a genie out of a bottle.

I  tread delicately--careful not to make assumptions. "So. . . .the readers weren't enough?"

Ms. Jane shook her head and squeezed her eyes tight, like somebody bracing for impact. "I don't read good, Miss Manning." Then she crumbled into full-on weeping but pressed on. "I be wishing I could read good but I didn't never learn. I wanted to go back to learn but I never had no time. It make you feel so bad, too, not reading. Like you always got to count on somebody."

I felt a lump building in my throat. "Does your . . . daughter know?"

Her forlorn expression told me that answer. More tears. More shame.

"The newspaper. It come to my house every single day. Every morning I take it out the plastic, open it up and look at the words and the pictures. Hoping it's jest gon' unlock in me one day. And nobody think I can't read good since I get the paper, you know? But to me, it's jest words and pictures and nothing else."

Now my eyes were welling up, too. I could see the unfolded sheets sprawled across her kitchen table. I could feel the defeat she felt when her well-meaning neighbor handed her a pair of reading glasses.


"I'm so glad you told us. I'm so, so glad." I reached out and squeezed her hand and I swear to you it felt like someone deflating a balloon under pressure.

"We can make it a lot easier for you, okay? Thank you for telling us that," her resident doctor said. And that resident smiled at her warm and genuine which Ms. Jane seemed to appreciate.

I did, too.

And so. We spoke to our Grady pharmacists who swooped right in to help. They smiled and listened an normalized something that she'd been ashamed of for more than sixty years. Then they gave her a card that explained all of her pills with pictures instead of words making it easy for her to follow whether she  had readers or not.

image credit

When the visit ended, we shifted off of the low-literacy issue out of fear that making such a big deal about it might make her feel self conscious. So I excused myself while they wrapped things up and shook her hand like it was really no big deal.

Even though it was.

Right before I left the room, I caught a glimpse of her pocketbook sitting beside her on the desk. Under it was a stack of papers from Grady tucked neatly into a manila folder. And peeking out of the mouth of that purse? Today's issue of the Atlanta Journal Constitution. Refolded because it had clearly been opened earlier that day.

Once I closed the door it dawned on me. Today, something did unlock. Right there in that room when one brave soul had the courage to tell her doctors that she could not read.

When I got into my car to head home and thought about that exchange, it hit me. Really hit me. I cried all the way home. No, Ms. Jane. You don't read good, but you're here.

You're here!

And now I'm crying again because I'm just so proud to be a Grady doctor. So appreciative to be where I am. So blessed to be here, too.

I'm here. We're here.


Happy Tuesday.

Now playing on my mental iPod. . . . Fantasia brings it home and puts me on my feet just like she did when I saw her singing this on Broadway. This is a song for every person who is still here. . . .damn, it is. (It sounds best when you periodically yell out, "Girrrrrl! You betta SANG that SONG!")


  1. I love the visual inf card. Good for Grady. Good for you for getting to the bottom of the issue preventing this woman from complying with the medical advice. Reading that made me sad and happy for her at the same time. There's nothing like being understood.

    1. This is not the actual card we use at Grady, but ours is similar. They tape the pills right onto the card--isn't that cool? She was so brave. I was so proud of her and so proud of our amazing staff of PharmD's who helped her out.

  2. Replies
    1. For whatever reason, I wanted to come straight to your porch and tell you about this in person. I knew you would appreciate this story.

  3. I'm so glad you were able to handle that situation with such grace and make her life better. I can't imagine what it would be like to navigate life without being able to read.

    1. Me either. I don't know everything--I don't. But I have learned from experience that people don't just keep appointments and not do what you say for nothing. People that don't care don't come. Or people that are scared to get care don't come either. I wasn't sure what it was but it was something. I'm glad she told us.

  4. I loved this - thank you.

  5. You're a good person. Touching one person at a time is all any of us can do.

    1. I'm a work in progress who wants to be a good person. Some days are better than others, Jill. But I do love people and always appreciate it when people show me and my loved ones compassion.

      Thanks for your kind words.

  6. This reminds me of my early teaching days. I had assigned a project where the students had to write about an animal of their choice - habitat, food - and other facts that were well defined in the instructions. Only one student did not do the assignment, and when I talked to her father (an older single parent raising two children) about it, he became very angry and threw the instructions toward his daughter exclaiming that it was her job, not his. He stormed out angrily with her, the instructions left wrinkled on the floor. Thinking about other encounters I had had with him, I realized that he wouldn't help her because he was not able to - either because he couldn't read or because he couldn't understand what he read. The next day, she and I talked and comforted each other. We worked together on the assignment every day during recess until it was completed.
    That encounter heightened my sensitivity and affected my teaching forever. The inability to read is exacerbated by the shame one feels. Thanks for helping Ms. Jane.

    1. Thank you for instilling the kind of values in me that made me want to.

      Love you, Tounces.

  7. Your intuition is amazing. So is your grace and kindness in dealing with every person you meet. You're an everyday hero, you truly are.

    Poor Miss Jane, hiding that secret, living so handicapped. I wish she were able to get some help from a literacy program. I believe no one is too old to learn to read.

    Bless your heart for being you.

    1. Grady is full of people like that. I'm serious. It's just a place that's full of grace.

  8. When you think about how much of daily life is dependent on the ability to read, it is humbling. We take so many things for granted, especially education. So many people suffer in silence with so many unknown consequences. I find such pleasure in reading, it has enhanced my life in so many ways its hard to imagine my life without the ability. Thanks for blessing me with this today. We all need perspective from time to time. You do such a great work, every day. I am immensely proud of you & the fact that you listen with your heart.

    1. Isn't reading so fundamental to everything? That same lady told me that she once got on the MARTA train and was deeply thankful to a teenager who helped her find her stop. She was used to riding the buses and could see where she was through the windows.

  9. What a beautiful, touching story. Thank you from me too, for helping this lovely lady. My heart goes out to her.

    As a person who cannot remember not knowing how to read (my older sister taught me when I was about three and I have no real memory of learning), I can't imagine life without reading.

    I'm so glad you were Ms. Jane's doctor and could help her.

    You are a lovely, wonderful person, Dr. Manning. Don't ever doubt that.

    I'm thankful for your parents and family too, all of those who instilled such values and love in you. May God bless you all many times over...

    Love and smiles,
    Jae in Clayton, NC

    1. Like I said earlier -- Grady is full of grace. It really is.

  10. God bless Miss Jane and her doctors. You know you touched her in a special way and really helped her. Not just a pat on the back and call me in the morning kind of help but really helped her with something she will never forget. It doesn't get much better than that. Not for a helping professional like yourself. Also bless your mother, she done good!

    1. Our patients do so much for our souls, too, don't they? She gave me something, too.

  11. Now I'm tearing up. You are an amazing kind hearted person and the Good Lord, knew what he was doing when he made you a doctor. Wow, that was the most uplifting thing I've read today. Bless your heart and all the doctors who learn from you.

  12. I am someone who reads your blog everyday. I don't usually comment on any blogs I read, but your posts move me so much....very often to tears. I only recently discovered your blog, and I literally read through every post in just a few days.

    I am currently a non-trad pre-med student and your posts always remind me of the end goal, and why I set out on this path in the first place - to make a difference. Your compassion and authenticity always shines through in everything you do. Thank you for taking the time to share these experiences. #inspiration


    1. Dear Angela,

      Thank you for reading my blog every day. There are lots and lots of blogs. I appreciate that you take the time to read here. I do.

      I'll keep the light on for you at Grady, okay?

      ~ Dr. M

  13. Crying again even on the second read through. (and I'm in the library - so sniffles stand out). Amazing story. Thank you for being there for your patients and honoring their lives with these wonderful story tributes.

  14. Med school doesn't (and probably should) teach you how to maneuver through conversations like this. You truly have a gift, and your residents/interns are lucky to have you as a role model.

    1. Believe it or not, medical schools have really gotten great at including learning about health literacy and communication. I learned a lot of this from a colleague who used to be at Grady with me. A lot of it takes practice and thinking but I've had some awesome role models. Our students do, too.

  15. YOU were the catalyst for that human being's revelation. YOU were-you wonderful human being, you.

    Maria, fellow Meharrian

    1. Maria, I appreciate those kind words but really she was just a brave person kind of like a lot of people I meet at Grady. I just love having a place to tell these stories. She gave permission to share her story -- details changed of course but the sentiments are all true.

  16. Where is the "tears in my eyes" reactions button?!? I really have to stop reading your posts in public. Touching as always, thank you for the reminder to take the time with our patients, there is ALWAYS a reason, and it is our job to figure it out.


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

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